The Federal Government covers 90% of the Medicaid expansion costs. Which means that there is a some cost in terms of state taxes.

But that's not the reason I usually see expressed. It usually comes expressed like this:

“The health care industrial complex made up of hospitals, medical device manufacturers and pharmaceutical companies are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging.”

“We must reform Medicaid and double down on pursuing common-sense policy reforms to unleash innovation and increase access that can all lead to lowering costs,” Zander said.

https://www.jacksonville.com/story/news/politics/state/2020/...

I'm afraid I don't entirely understand what that means.

A lot of these states have big problems with gerry-mandering and there tends to be huge wealth disparity between the few small wealth centers in the state and the rest of the state is extremely poor. The money just isn't being distributed with any sense of equity.

* * *

Income inequality isn't an issue, wealth inequality is.

I find it perfectly fine to earn 8 time as much as my artist best friend does as long as we are in a market-based system. What bothers me is that I do not pay enough taxes, and could pay even less by declaring my donations.

If you were actually bothered by not paying enough taxes, you could just pay more. You can literally just go and donate to US Treasury.

No, what actually bothers you is that others don’t pay enough taxes.

Well yes, since others not paying enough taxes is part of the tax system being unfair, someone who actually cares about fairness would be bothered by it and them personally paying more doesn't fix that. Do you not care about fairness? "You could pay more yourself" has always been more of a snide low-effort attempt to shut down conversation than to engage in it. Please try to do (and be) better.

I strongly suspect that blue states are even more unequal measured by wealth than by income.

Some guesses: - It benefits corporations and the wealthy (whom the government actually work for) in some way - Politicians think running on "rugged individualism" works - Same politicians truly believe in trickle-down economics and austerity.

The politicians benefit, and run on a platform of deflection. "Just imagine how much worse it would be if the government helped you."

> Who benefits in these 10 states that have still failed to expand Medicaid?

The people who run on this as a component of their platform.

Spite.

Segregationists closed public pools and defunded public schools, rather than share with black people. Hurting poor whites as much as poor blacks.

Of course they'd also gut the social safety net.

Some Americans would gladly eat shit if a black person had to smell their breath after.

The best policy isn't Medicaid. The best policy is to not wreck your pancreas in the first place.

It's a good thing we can address problems on multiple levels then, the personal responsibility level and when that fails with a social safety net.

The social safety net is a poor substitute for a fully-functioning pancreas.

Agreed, but for the people with broken pancreases I bet they're thankful for the safety net.

Most T2D is reversible. Get BMI balanced with endocrine pancreatic function, and T2D goes away. Not sure if I'd classify getting shots instead of making much-needed lifestyle adjustments as a "safety net".

Safety belts and airbags are mediocre solutions, too, but that doesn’t imply you shouldn’t have them, even if you are a very careful driver.

Also, like with drivers and car accidents, there are people who happen to get type 2 diabetes even though they do what they can to avoid it.

T2D doesn't arise from a moment of bad luck or inattention. T2D arises from a long stream of sub-optimal choices and ignored warning signs. I am not here to argue for or against socialized medicine. I am here to tell people that they should fix the actual problem instead of opting for the quick fix. I encountered this problem a couple years ago. If I trusted those damn doctors, I'd be stuck, sticking myself several times a day, and keeping an eye on my insulin supply, but I didn't, so I'm not.

Type 2 diabetes doesn't really wreck the pancreas, at least no more than other tissues. The problem is that cells throughout the body become insulin resistant. While it is obviously better to avoid the condition in the first place, most cases if caught early enough can be put into remission by eliminating carbohydrate consumption. (Adherence to such a diet can be difficult for many patients due to economic and cultural issues.)

That's not a policy. That's indulging in a fantasy world. A policy might be ending subsidies for sugar, or creating subsidies for healthier foods, etc.

McDonalds didn't put a gun to anybody's head. Neither did Crisco, or KrispyKreme, or CocaCola. Subsidize broccoli and tofu all you want. They'll still eat hamburgers and wash them down with a soda.

Things are not that black and white. There are many places in both urban and rural America where access to healthy food is much further away and more expensive. If you're relying on food stamps unhealthy foods will often make your dollar go further. This is especially important when you're trying to feed a whole family. The corner mcdonalds or bodega is easier to access food when you don't have a car and work double shifts. Food preferences are also learned early in life and harder to break as you get older. This is a far more nuanced problem than people choosing unhealthy foods because that's what they want.

To combat this NY state, for example, has a whole program around getting additional benefits on top of SNAP for produce at local farmers markets which has been very successful. So yes, while no one is holding a gun to their head your hyperbole is not really adding anything useful to the discussion.

I've been poor. I've been in situations where the only lunch option was McDonalds. Didn't get fat. Didn't get diabetes. How come? Ordered a cheeseburger, small fries, water, while all of my co-workers "super-sized" their orders. My bill and my BMI were always far lower than theirs. People here can blame corporations, "red staters", "food deserts", and whatever other divisive new york times nonsense they want. Ultimately, you've only got one pancreas, and instead of pointing fingers, you should take care of it.

I didn't get pre-diabetic until I was wealthy--eating out, non-stop sushi and Thai. Unfortunately for me, rice has a very high glycemic index. It is not suited to the genetics of my people.

It's not about who benefits. It's about fucked up cultural priorities. It's not just the politicians who are the problem. The voters who keep electing these people over and over are asking for this too.

https://www.bostonreview.net/articles/jonathan-m-metzl-dying...

> Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act and the related expansion of Medicaid coverage. Had Trevor lived a thirty-nine-minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky adopted the ACA and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms.

> Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”

> At the most basic level, Trevor died of the toxic effects of liver damage caused by hepatitis C. Yet Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma that, as he made abundantly clear, aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and nonwhite others. Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.

Medicaid expansion under the ACA isn't "free" for state budgets. The Federal government only puts in part of the funding. So by forgoing expansion the state politicians can keep taxes low or continue funding other priorities. Some politicians also have ideological objections to expanding government control over the healthcare system.

(I am not endorsing these policies, just explaining some of the reasoning behind them.)

I pointed this out earlier but its important to understand given what's going on in the US currently.

>>Federal government only puts in part of the funding

Via the issuance of debt.

I mean, medical debt collectors benefit, and they do have lobbyists.

Given how often I see the argument that “blue states subsidize red states” I can see why folks who want to maintain their dignity wouldn’t want to expand their reliance on blue state largesse. That money comes with no strings attached.

Also, even if it’s true that blue states may bear the brunt of taxes, inflation hits everyone equally.

Inflation literally doesn't hit everyone equally, prices are set in local markets, not fixed at a national scale.

Things like federal mortgage subsidies probably cause more inflation in less affluent regions where housing is less competitive than they do in affluent regions (where the competitors for housing aren't particularly pricing their offers to the largest payment they can afford).