How Democrats fall into the welfare trap
by David Atkins
Digby and Dave Dayen have been doing a tremendous job of highlighting the ridiculous conventional wisdom that all of the GOP governors will opt in to the Medicaid expansion in ACA simply because the hospitals want them to. The CW assumes that Republican governors are driven purely by corporate greed, rather than a deep ideological commitment to the idea that the undeserving poor should be left to suffer out of a sense of Calvinist cosmic justice. For GOP governors and their base, there are two kinds of people: those who deserve to prosper and be happy and those who don't. For them, the greatest injustice in the world is the taking of their tax dollars to assist the undeserving, and the removal of their private authority to abuse and exploit the undeserving.
Sometimes the definition of "undeserving" is based on race. Sometimes on gender. Sometimes on sexual orientation. Sometimes simply based on how much money one has, which in circular fashion is itself proof of one's worth. Sometimes it's all of the above. But for modern Republicans, it's about much more than just the money. It's about ideology.
Which in turn leads to a very important point that Digby made earlier:
But then that was always going to be a problem when they decided to continue to have a taxpayer funded program for the poor rather than a taxpayer funded program for everyone.This is the heart of the problem. The reason that Social Security and Medicare are so popular is because they're for everyone over the age of 65. From a financial and economic justice standpoint it would make sense to means test social security so that multimillionaires aren't getting those government checks. But from a political standpoint it would be a disastrous conversion of a popular universal program into a welfare program for the less fortunate. Social Security works functionally and politically because everyone over a certain age is eligible for it. The same goes for Medicare.
By making Medicaid subsidies and targeted secondary populations like young adults and those with pre-existing conditions the liberal core of the Affordable Care act, we have once again taken what should be a universal program (Medicare for All) and made it less politically palatable by converting it into a safety net patch for the less fortunate. That in turn opens progressives up to the old liberal stereotype of someone who wants to take "normal" Americans' money and give it to degenerate ne'er-do-wells, and also makes it easy for ideologically conservative governors to slash the most important part of the program, leaving only a few crumbs and a mandate to buy private health insurance for everyone else.
I've said it before: what made the New Deal so popular and effective was the fact that most of its programs benefited everyone (well, at least everyone white.) The Civil Rights Era alienated a huge number of Americans who weren't yet prepared to see women and minorities as equally deserving human beings. For liberalism to be politically palatable for enough of the public, the benefits of liberalism cannot be seen as going overwhelmingly to people that suburban and rural whites consider to be less than fully deserving of the same empathy and basic rights that they themselves enjoy.
As the Affordable Care Act becomes increasingly associated with Medicaid, and as Republicans continue to demonize it as taking away Medicare money to give to "undeserving" people, the Affordable Care Act itself will be unpopular.
Democrats need not be shocked by Republican governors' refusal to accept Medicaid funds, and they need not feel that the experience of the Affordable Care Act means that Americans don't like "socialized medicine." What Democrats need to learn from this experience is that Democrats need to avoid the welfare trap, and need to embrace the power of universal social insurance.
Universal social insurance has always been popular and will remain popular when implemented. It's just a matter of having the courage to enact it in the first place.