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“…awesome in its evilness.”


A very good discussion between Harold Pollock and Jonathan Gruber on the Supreme Court decision that will kill some of society’s most vulnerable citizens:

Jon: I think, Harold, the single thing we probably need to keep the most focus on is the tragedy of the lack of Medicaid expansions. I know you’ve written about this. You know about this, but I think we cannot talk enough about the absolute tragedy that’s taken place. Really, a life-costing tragedy has taken place in America as a result of that Supreme Court decision. You know, half the states in America are denying their poorest citizens health insurance paid for by the federal government.

So to my mind, I’m offended on two levels here. I’m offended because I believe we can help poor people get health insurance, but I’m almost more offended there’s a principle of political economy that basically, if you’d told me, when the Supreme Court decision came down, I said, “It’s not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?” The fact that half the states are is such a massive rejection of any sensible model of political economy, it’s sort of offensive to me as an academic. And I think it’s nothing short of political malpractice that we are seeing in these states and we’ve got to emphasize that.

Harold: One of the things that’s really striking to me is there’s a politics of impunity towards poor people, particularly non-white poor people that is almost a feature rather than a bug in the internal politics in some of these states, not to cover people under Medicaid, even if it’s financially very advantageous to do so. I think there’s a really important principle to defeat this politically, not just because Medicaid is important for people, but because it’s such a toxic political perspective that has to be … It has to be shown that that approach to politics doesn’t work because otherwise, we will really be stuck with some very unjust policies that will be pursued with complete impunity in some of these places.

Jon: That’s a great way to put it. There’s larger principles at stake here. When these states are turning – not just turning down covering the poor people – but turning down the federal stimulus that would come with that.

Harold: Yeah.

Jon: So the price they are willing … They are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.

Again, it would be unfair to blame the Supreme Court for this if there was a clear constitutional command that the ACA’s funding mechanism plausibly violated, but there isn’t. The relevant precedent overwhelmingly suggested that the mechanism was constitutional, and applying the logic of the decision leads to transparently absurd results. But while the Supreme Court handed them the tools, it’s the Republican statehouses that are standing between medical facilities and the working poor, declaring “unnecessary suffering and death now, unnecessary suffering and death tomorrow, unecessary suffering and death forever!”

…Lithwick on the evil in Virginia.

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