Home / General / The Quiet Parts Loud: Medicaid Edition

The Quiet Parts Loud: Medicaid Edition


ryan is a working man

A Republican from Brownbackistan says that repealing Medicaid is fine because poor people want to be unhealthy. No, really:

The law’s Medicaid expansion, which Kansas has not adopted despite support from many hospitals, including some of Marshall’s former colleagues, is one of the big sticking points for Republicans. Many GOP-led states adopted it and want to see it preserved in some form.

Marshall doesn’t believe it has helped, an outlook that sheds light on how this new player in Washington understands health policy.

“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

Pressed on that point, Marshall shrugged.

“Just, like, homeless people. … I think just morally, spiritually, socially, [some people] just don’t want health care,” he said. “The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I’m not judging, I’m just saying socially that’s where they are. So there’s a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought [into] the ER.”

This is sort of the ultimate Republican healthcare argument, in that it’s both nakedly sociopathic and either willfully clueless or actively dishonest about the policy details — to state the obvious, repealing Medicaid and/or the exchange subsidies will have the effect of people using less preventative care and relying on emergency rooms. But, of course, this will be a matter of free will! If you choose to use an emergency room because you don’t have access to any other form of medical care, you still have made a choice!

The bigger problem for the country is that however much time the Speaker of the House of Representatives spends getting reluctantly and accidentally photographed at soup kitchens, all the relevant evidence suggests that he’s no less sociopathic. Whether or not they win this particular fight, having people who think like this in control of Congress is terrifying indeed.

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  • Lot_49

    If those Jayhawk Poors just shopped at Whole Foods and used their gym memberships more, they’d be a lot healthier.

    • Pat

      California says that if Congress block grants Medicaid, then they’ll try to implement single payer.

      Given that California is one seventh of the nation, that’s a whole lot of employer-based insurance dollars at stake.

  • Schadenboner

    I just don’t get it. Really, I don’t. This isn’t even “He and I have different philosophies” this is just some straight-up Cobra Commander, Skeletor, Blofeld, Goldfinger villainy.

    Because I have Republican friends and family I bend over backwards to write in a way we can all be decent people, just ones who are starting from different priors.

    But what in the actual, literal fuck?

    • MAJeff

      They’re assholes for whom cruelty is a virtue. That’s cultural conservatism: hierarchies are virtuous, and those who lack virtues are poor for good reason and need to be punished further for their lack of virtue.

      • Hogan

        At the farther edge of the sanity horizon, it’s not even punishment–they prefer it that way.

      • Lost Left Coaster

        Indeed, in a similar vein, I expect that many Trump supporters have been delighted by these stories coming out left and right about families being torn apart by sudden, unexpected deportations by ICE.

        They love this stuff. They love to see this kind of pain inflicted.

    • Marlowe

      BTW, this guy is another in the seemingly endless parade of crazed right wing Rethug doctor/congresscritters. Is the medical profession really that filled with heartless, non-empathetic people? Their cruelty is so obvious that they are all but twirling their mustaches between title cards in a silent movie as they tie the poor widow to the train tracks.

      • j_doc

        No, the majority of doctors are emphatically not like this. Witness the immediate backlash over the AMA’s decision to endorse Price for HHS secretary, and the AMA is the bastion of the mustache-twirling clique. (Every AMA communication on political matters now includes the line “A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured.”) If anything, doctors as a whole are more liberal on health care matters than society at large.

        But doctors come from a broad swath of society, and there’s plenty like him. Mostly older, mostly men, mostly of a patriarchal bent, who perhaps got into medicine to make a good living, and especially those who have been most hit by the financial changes associated with managed care and the move away from fee-for-service. You don’t find many family practitioners, primary care physicians, or geriatricians among this group.

        • StellaB

          Rep. Jim McDermott, MD is very much on the good side, but he’s a psychiatrist, not a surgeon.

          • ColBatGuano

            Was. He retired this year.

  • rfm

    This is a very coherent Marxian analysis of the lumpenproletariat and more proof that the GOP is actually more left than the Democrats, who want to impose imperialist notions of “health” on the underclass.

    • Scott Lemieux
      • howard

        wow, this is amazing: how did you find this garbage?

        • Scott Lemieux

          Magary’s last Jamborooo of the season.

      • Schadenboner

        I really feel like we’re only about six months away from the Surgeon General making the same speech as the Minister for Sport in the YPM episode The Smoke Screen

        E: Humphrey said it.

        • howard

          thank you for reminding me that it’s been too long since i’ve watched an episode.

      • Origami Isopod

        There are absolutely good points to be made about the role of classism in public health campaigns and smoking as a class marker. They can be made without celebrating smoking.

        Then again, that’s the same asshole who wrote this piece, which argues that invisible disabilities are something only spoiled rich kids worry about.

        • Scott Lemieux

          The other problem with the piece is that employees involuntarily subjected to second-hand smoke receive no consideration at all.

          • Origami Isopod

            Yeah, that too.

          • employees involuntarily subjected to second-hand smoke

            “Involuntarily”? Look here, Mr. Elitypants, those employees are voluntarily choosing to work there!

        • That’s quite a piece.

          While there is such a thing as verbal aggression and it’s good to take people’s word that they were subjected to it in most cases, from a writer I want a little more narration and/or description, lest they come off as “ironic” in the bad sense. It’s possible her friends did shut her down after saying “ew, gross!”, or that they really did expect this to be a sufficient signal that she had to stop talking, but she hasn’t shown it.

    • LeeEsq

      This type of analysis reminds me of Bryan Caplan’s attempt to argue that mental illness doesn’t exist. Even the few people that like Bryan Caplan’s thought found this dumb. Science and physical reality doesn’t care about ideology.

      • apogean

        That’s an argument with some intellectual pedigree. I think it’s wrong, but it’s not just Caplan being a dork.

      • Sev

        The piece also references Typhoid Mary as a victim, though she actually was a public health menace.

  • BobOso

    The Jesus quote… These people believe with religious fervor that the invisible hand of an unfettered market is the Holy Spirit; God is a wealthy GOP landowner with authoritarian tendencies and Jesus was his radical libertarian son who “told it like it is” to the libtards.

    Jesus wept indeed.

    • wjts

      Kurt Vonnegut had some useful things to say about that passage and the smug holy rollers who like to quote it.

      • Steve LaBonne

        It has long been a source of wonder to me that the sociopaths who misuse that verse are completely oblivious to the blistering irony inherent in the the fact that in John’s version the occasion for and recipient of Jesus’s remark is none other than Judas. You would think that would be food for thought. Of course thought is not something greatly in favor amongst the Babbitry.

        • Porlock Junior

          The oblivious sociopath in whose work I first saw the abuse of that aphorism was Billy Graham. 50 years ago he had a newspaper column, and sometimes one would see it in the local paper.

          And yes, the sanctimonious Mr Graham was explicitly arguing against the Government giving away money and stuff to people just because they were poor.

      • Lost Left Coaster

        That’s an amazing little essay — I probably read it years ago, but it has been awhile. I’m always in awe of Vonnegut’s amazing compassion and empathy. He was a model human being. So much of my moral education came from reading his books as a teenager.

        I’m just as glad that he doesn’t have to see what we’re going through now. The pain…the pain would have just been too much for him.

      • Tom in BK

        I’m both glad and sad that Vonnegut didn’t live long enough for the Trump administration.

        edit: er, what LLC said above.

    • Peterr

      “Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

      Professionally speaking, Jesus wasn’t making a comment on the moral choices of the poor. He was commenting on the moral choices of the Powers That Be. The Powers That Be have a knack for sticking it to their lessers that is very very persistent, making the presence of the poor rather persistent as well.

      Here ends the sermon.

      • Well, from a more skeptical and materialistic point of view, Jesus is saying his disciples should use the money for their group’s spiritual practices and to honor Him. He’s not saying, I think, that spending money on decorating the chapel is more important than spending money on helping the poor. In effect, Judas is presented as if Martha responded to being ignored, in favor of Mary, by betraying Jesus instead of accepting her separate blessings. (It only works because he is who He is, and therefore in the immediate moment Judas shouldn’t be focusing on people outside the circle.)

        IOW, I don’t see where Powers That Be come in. It is, as others have pointed out, a rebuke specifically of Judas, rebuking whom needs little explanation.

      • DrDick

        Which is also why he said that the Powers That Be have as much chance of entering heaven as a camel does of passing through the eye of a needle. He also explicitly commanded his followers to care for the sick.

        • Porlock Junior

          And if they didn’t do it for the actually sick, they were not-doing it for him. If you’ve gotta have a Deity, that’s the kind to have.

    • Yes, considering that the full statement is “You will always have the poor, but you won’t always have me”, it is a little odd that those who claim to believe that Jesus is the Eternal Son of God, say that Jesus meant this statement (but only the first half, for some reason) to express some universal, eternal truth about the human condition.

    • Aziraphale

      Jesus was quoting Deuteronomy 15:11. Before that, in Deuteronomy 15:4, we read
      “However, there need be no poor people among you, for in the land the Lord your God is giving you to possess as your inheritance, he will richly bless you, if only you fully obey the Lord your God and are careful to follow all these commands I am giving you today.”

      In other words, if in your rich country there are poor people, you are doing it wrong.

      • Porlock Junior

        Also, if you are not doing enough for those poor people, you are guilty of the sin of Sodom. Not the nonsense about putting the right thing in the wrong hole, but the real thing; for according to the prophet Ezekiel,

        “Behold, this was the iniquity of thy sister Sodom, pride, fulness of bread, and abundance of idleness was in her and in her daughters, neither did she strengthen the hand of the poor and needy.”
        Ezekiel 16:49

  • howard

    being a jew, i may be mistaken, but i was of the impression that jesus showed humility to the poor.

    • Schadenboner

      Forget it. He’s rolling.

    • Thom

      Indeed. Using that one line ignores the entire context of the Gospels as a whole.

      • DrDick

        ignores the entire context of the Gospels as a whole.

        This is what religious conservatives do best.

    • N__B

      He was quite kind to the poor. He tossed them the football each time he scored a touchdown.

    • These people are more about never being without honor in their own house.

      • DrDick

        Veritable pharisees or money lenders in the Temple, as it were.

  • Joe_JP

    The full quote (Mark 14:7):

    The poor you will always have with you, and you can help them any time you want. But you will not always have me.

    The Medicaid expansion being voluntary is the subject of a current series of blog posts:


    • Scott Lemieux

      That is great stuff; will do a separate post on it.

      • Denverite

        Btw, this:

        In a real sense, some northern states were already in compliance with the ACA standard (at least for parents) that Chief Justice Roberts treated as an across-the-board radical expansion of “old” Medicaid. I don’t think you can pick up this fact from the Roberts opinion, which makes it pretty misleading. The ACA was truly “new” only for childless adults, which Roberts duly noted, although without adequately accounting for the 1980s expansions in eligibility. One more point. Rose comments that state governors were very successful in lobbying Congress during consideration of the ACA with respect to obtaining more generous terms than were originally proposed. She concludes their success in whittling down their financial contribution “illustrates their tremendous influence in Washington.” This point in aid of a vision of cooperative federalism is worth bearing in mind.

        is why I ultimately come down on Scott’s side on the whole NFIB Medicaid expansion ruling (despite being fairly sympathetic to Roberts’s view, which I’ve been blasted for on here).

  • JdLaverty

    There is a special place in hell for a rich politician who references the gospels in support of his assertion that poor people don’t deserve healthcare. A particularly miserable and painful circle, I like to think…

  • N__B

    The best part is that the asshole is a doctor.

    • Origami Isopod

      As Shakezula implies just below, this part was entirely unsurprising. Lots of doctors are shitheels, and the less privileged their patients are, the worse these doctors treat them.

    • Dennis Orphen

      After reading Bill Lee’s Junky many years ago I started calling them croakers. And with the inevitable dismantling of the regulatory state…….

  • Every day I read about scummy doctors who rip off private payers and Medicare, harm their patients and then whine when they’re busted. But (supposedly) law abiding trash beings like this are just as bad.

    • howard
      • Doctors who are misguided/overenthusiastic about appropriate medical care are indeed a huge problem and something we’re far more likely to encounter. I had someone like this in mind (speaking of stents).

        • Dennis Orphen

          A guy isn’t feeling well so he goes and sees his doctor. After describing his symptoms he says “So, doc, what’s wrong with me?”

          “That depends. How much insurance do you have?” the doctor replied.

          Sometimes I struggle with the fact that far too many people don’t understand that health care is a natural monopoly. Then I remember that many people don’t really understand anything. And as our world continues to increase in social complexity it’s going to get worse.

          • Steve LaBonne

            They’re too busy getting a burger at Buttfuckers.

          • Dennis Orphen

            I should clarify, I have lots of respect for people in the medical profession, in case anyone gets the wrong idea.

      • I was ambivalent about that article. It would be very difficult for most people to do what that guy did. And a lot of people couldn’t, even armed with the exact same information.

        I have been told by HCP to go research something myself on the Internet and make my own decision–not sure whether they realized I didn’t have access to the same sites and databases they did.

        I also met apparent dismay from another HCP when I said I’d done research online into pelvic pain to see if it could be serious. (None of which suggested the actual cause, fibroids, which no matter what anyone tells you, darn well can hurt.)

      • j_doc

        That story is the same scenario as the infamous George W Bush stent, which caused a minor firestorm in the Cardiology community. The report was that a “routine stress test” revealed a non-symptomatic blockage which was then stented. Not one bit of that preceding sentence is standard of care, and the evidence on each point is very strong. It’s a classic case of more-is-worse and how the rich and powerful can get worse healthcare in the misguided pursuit of more-is-better.

        • This has been standard practice in my experience, that is, it was the standard applied to at least one of my parents (covered by Medicaid and possibly still a union plan) regarding at least one of their stents, unless something was not conveyed to me.

          (That it’s not standard practice was not conveyed by the piece, either.)

        • Dennis Orphen

          See my joke above.

  • georgekaplan

    The right-wing Jesus cultists have so successfully purged their religion of any obligation toward fellow humans, so completely made it a merely internal exercise of a sterile, abstract “faith” in a deity that absolved them of all human responsibility two thousand years before they were even born, that they see absolutely zero conflict between claiming adherence to Jesus and a callous, mindless defence of a hideously unequal and unjust social order. Sure, if the spirit of Jesus (literally the only thing that matters) moves a person to be charitable that’s nice and all but for them the spirit of Jesus moves them to do favors for rich people. How can it be wrong? If it were wrong their “personal savior” (what a grotesque concept) would tell them it was wrong but He’s just peachy with greed as it turns out.

    • dogboy

      “whatever you have done to the least of these, that’s cool, whatevs” -Gospel of Ryan

      • wjts

        I believe the original Greek is better translated as, “Whatsoever thou hast done unto the least of these, be certain thou hast done it unto them good and hard”.

      • Dennis Orphen


    • Steve LaBonne

      Remember, this is a supposedly pacifist religion that turned overnight into the state religion of a military dictatorship the moment Constantine offered the bishops power and money beyond their wildest dreams. Like every long-lasting major religion it has made a career of being whatever people want it to be.

    • Dennis Orphen

      It’s all just part of the con. Nobody (and I mean nobody) on the right believes any of it.

      • Bitter Scribe

        Oh sure they do. They believe their twisted version of it that allows them to obsess over and judge other people’s behavior, especially their sexual behavior, while being forgiven (i.e., avoiding responsibility) for anything they may do wrong themselves.

    • Cheap Wino

      If you don’t see how giving money so that the church can start a tv station and print pamphlets to try and convert those African heathens isn’t doing Jesus’ most important work then I don’t know what to say to you.

  • nemdam

    My favorite thing about the Paul Ryan picture is that he went to the soup kitchen when it normally wasn’t open (so almost no one was there) and washed clean dishes. Sort of sums up Paul Ryan perfectly.

  • This is just the logical conclusion of the idea that everyone is responsible for everything they do and everything that happens to them, that they could choose just about anything–not only any action, but any end-state–and have no one to blame but themselves if they don’t. If someone is poor, they SHOULD look at it as if they chose poverty. If someone is sick and can’t afford to do what they need to become well, similarly, they should realize that they CHOSE to be in the place they are.

    It goes beyond “the just world fallacy’ to see all circumstances as God and God’s Will, and the individual as simply choosing how to respond to “God,” i.e. circumstance. It’s perilously close, as Barbara Ehrenreich demonstrated, to “The Secret,” and not anything a religion should take on.

    It’s quite bad enough even without looking at what it does to a person who manages to get the power to help people, and won’t.

    • It goes beyond “the just world fallacy’ to see all circumstances as God and God’s Will

      which is to say, the unjust world fallacy.

    • The most charitable interpretation I can put on this attitude is that it comes down to fear. If you can convince yourself that all the bad things that happen to people are their own fault, then of course you and your family aren’t in any danger, because you’re good, smart people who would never do any of the stupid, evil, reckless things that lead to misfortune!

      And the thing is, it’s a vicious circle. You’re afraid of the precariousness of your existence, so you convince yourself that bad things only happen to people who invite them somehow. So that makes it OK to deprive those people of help. But because the people at the top want to take away everyone’s help, including the “deserving”, that just makes life more precarious for everyone. So your fear increases, and thus your need to believe that people who suffer deserve that suffering. So you support even more draconian restrictions on help for the needy, and so on and so forth.

      Of course, when I say that I’m being charitable, that only goes so far. Because the simplest way to stop this vicious circle is simply to admit that even people who get themselves into jams deserve help getting out of them. It’s the failure to acknowledge that truth that is the moral black hole at the center of this clusterfuck.

    • GeorgeBurnsWasRight

      Reminds me of a conversation I had with a guy once who was in some New Age religion. (I have no idea if his explanation was what his group actually taught.)

      His belief was that objective or external reality doesn’t exist. Therefore, all problems, mistakes, errors, etc. exist only in our minds. So once you master getting rid of all this negative thoughts, you’ll be infinitely rich, infinitely successful, and infinitely happy. None of which he was close to yet, because he hadn’t mastered what he was being taught yet. But that was going to happen real soon.

      Never saw him again, so I don’t know if he succeeded. Or perhaps he did, and left behind my pathetic reality where people sometimes do wonderful things and other times do really crappy things, and everything in between.

      • Hogan

        Maybe he should have tried these guys:

        The Yen Buddhists are the richest religious sect in the universe. They hold that the accumulation of money is a great evil and a burden to the soul. They therefore, regardless of personal hazard, see it as their unpleasant duty to acquire as much as possible in order to reduce the risk to innocent people.

  • Origami Isopod

    I’m going to take the post title as permission to share here the usual kind of “saying the quiet parts out loud” story. Also, the same guy’s previous greatest hit.

  • And I’m not judging, I’m just saying socially that’s where they are.

    No, you are judging, you ignorant fucking asshole.

    • Dennis Orphen

      “I’m not an actor but I portray one on TV.”

  • Bitter Scribe

    I’m sure that in a previous life, this guy was claiming that slaves didn’t really want to get paid or have the right to quit their “jobs.”

  • carolannie

    Because I totally loath assholes who use the carefully culled words “the poor shall always be with us” and because I am not a Biblical scholar, I always post this when I see that phrase

    • carolannie

      This is one of a series that Fred Clark posts occasionally over the years

  • GeorgeBurnsWasRight

    This politician/physician falls into the first category of Colbert’s quote: “If this is going to be a Christian nation that doesn’t help the poor, either we have to pretend that Jesus was just as selfish as we are, or we’ve got to acknowledge that He commanded us to love the poor and serve the needy without condition and then admit that we just don’t want to do it.”

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