Aaron Carroll has a post entitled I guess they did want Obamacare to be more expensive. Looks like Confederate states are hell bent on doing Medicaid expansion under Obamacare in a horribly expensive fashion.
Carroll purports to be surprised because this is coming out of the same political faction who claimed Obamacare should be opposed because it was too expensive. Cost was always primarily a pretext. Note that the same contingent is not concerned about expense when it’s time to talk about war or tax cuts or farm subsidies. Among other things, they probably want to set Medicaid expansion up for failure so they can complain that it’s broken and too expensive down the road after forgetting that they insisted it be broken and expensive.
I still think Indiana will opt in.
Too much money at stake. And I think Pence’s idea of only opting in if he can channel the money to the Healthy Indiana Plan is preposterous and bad for the citizens of Indiana.
Medicaid had always had inefficiencies. There are fifty state Medicaid agencies with varying levels of competency.
And those people who live in Mississippi who must leave their healthcare needs to the wisdom of that leadership! Sometimes I wonder if there must be something in the water to brainwash those people when they vote, bit it must be the same thing in our water, where it’s like chickens voting for Colonel Sanders.
When I was doing healthcare IT consulting, I ran into some really incompetent Medicaid programs. Idaho still ran a lot of its program on paper. West Virginia long term care was run by a petty tyrant that dared you to sue her over anything.
Medicaid should be unwound, transferred to Medicare, and be only a distant memory.
The states can be the laboratories for democracy. More often, they are the lavatories for democracy disposal.
Come think of it, some of the most mean-spirited and draconian legislation–stuff that makes some totalitarian states look almost acceptable–actually come from our states, and the only thing that seems to stand in the way of the worst and most egregious offenses is the Federal government. (Think: Indiana as we now write.) Didn’t the founders invest a lot of hope in small governments with high levels of participation? What a disappointment.
Yes, I think the padagidm was effective government as close to the voters as possible. But majority vote in states, absent federal fiat, can mean totalitarinism, especially when states ignore their own consititutions, like Indiana is given to do.
Along the lines of the last two posts, in the current Chronicle of Higher Education, Mark Weiner has written “The Paradox of Individualism”. (He teaches law at Rutgers.) Contrary to the commonly held idea that robust and assertive government restricts individual freedom, he maintains that a strong and assertive government serves to maintain the important structures and institutions of the society which address and maintain individual rights. When the such a government devolves into an absent or weak state, individuals depend upon collective groups to advance their goals and vindicate their interests. We end up with clans, the system that continually waits for the dissolution of government. But instead of maintaining individual rights, with the clan system the rights and obligations of persons are influenced by their places within the kin groups to which they belong. Equal access is attenuated as is freedom which is based on access to the constraints inherent in an organized government. The emergence of the clan system is especially a threat in hard economic times, and despite the claims of those who maintain that they have more freedom in the absence of a strong government, they actually have much less when that government devolves into the clan. It doesn’t take a lot of imagination to appreciate what a society would look like if we were all “sovereign citizens”.
Makes me think of Hobbes’ Leviathan. The sovereign is a super-predator that clears the nation of all of the lesser predators. If you get sideways with the sovereign, you’re screwed; but on the whole, it’s a better situation than dealing with the multitudes of lesser predators.
Hi Stuart, I came across your comment to Doug’s post while surfing the Web. Thanks for bringing up my article/book in this context–and for articulating my argument so well. Although I don’t talk specifically about health care in The Rule of the Clan, the debate over the Affordable Care Act certainly provided a backdrop for me as I thought about my argument. As for the law itself, I taught and lectured about it on a number of occasions, and I was a strong supporter. It’s a terrible shame to see the impending result of the state of denial about the legislation by a number of Governors. In addition to the issues Doug notes, simply the failure to actually plan for its coming into effect is saddening. Also, I’m intrigued by your reference to draconian legislation in Indiana. I’ll do some searching to find out–thanks for flagging it. And thanks again for your interest in my Chronicle essay. Cheers, Mark
Thanks for your acknowledgment and adding to the discussion.