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“You either trust . . . your state . . . or you don’t”
May 8th, 2017 by Dr Karma

I’m a federalist.

I’m an American, so I should have the same rights in each state.

Thus, I had a knee-jerk negative reaction to Oklahoma Congressman Tom Cole’s discussion of the Republican health care plan on Morning Edition last Thursday. He did the typical Republican move–demonizing the federal government while making moves to allow the states to deny care to their citizens:

“But at the end of the day, you know, you either trust your governor and your state legislature or you don’t. In my case, I do. And it’s far easier, if they make an error, for people to frankly correct them and — or fire them if they need to, than it is to deal with a sort of faceless, federal bureaucracy that’s in many cases thousands of miles away.”

Having grown up in the South, I don’t trust state or local government more than I trust the federal government. Why was I taught that evolution was wrong in a public school? Because of local decisions. Why was my history teacher forced to pretend that the world was created 6000 years ago? Because of local decisions. Why was my doctor not allowed to talk to me about all my options for care when I was pregnant? Because of local decisions. Why was my aunt not able to get healthcare in the South even though she’s disabled? Because of local decisions.

Of course, I can point to a lot of federal decisions that have been awful too, but there are two important points to consider. First, and this is our fault, voters don’t usually pay attention to or vote in local elections. Second, the federal government–with its constitution–tends to move toward equality–and that’s where my values lie. The constitution says I shouldn’t have been taught Christian b.s. in a public school and recognizes my right to disagree. The federal government’s position is that my queer friends have the same rights that I do, that my Jewish neighbor has the same rights as her Christian ones, that my students of color deserve the same opportunity as their white counterparts, that my disabled staff have equal access to a job, etc. etc. etc.

But the Republican move is always to “let the states decide.” To decide whether your disabled child can go to public school. To decide if you can have access to healthcare. To decide if you can be married to your partner.

We’re American. The “state” I live in shouldn’t decide whether I’m equal to my neighbors. I am.

The end of Cole’s interview really brought the point home for me about trusting the states: “Look, I live in a state where we’re down to a single provider who’s losing money. We have a 69 percent rate increase coming for people that don’t have — aren’t subsidized in the pool. And finally, because we’re not a Medicaid expansion state, you know, we’ve got hospitals taking care of classes of patients that in other places they get compensated for — not here.”

We’re not having those problems in California–because California didn’t fight Obamacare. In other words, it shared the federal government’s move toward equality.

It’s that last line that gets me–he doesn’t live in a Medicaid expansion state, so he’s upset because uninsured patients are costing his state a lot of money.

In other words, his state chose to leave a significant portion of its population uninsured. Each state’s budget office can confirm it would make fiscal sense to expand Medicaid. But states like his didn’t. It left its people in danger. It left itself in a bad financial state. Why?

Because it was “Obamacare.”

No, Mr. Cole, I don’t trust the states to always do the right thing for their people, especially states like yours.

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