Obamacare Is Widening the Gap Between “Red” and “Blue” America

  • submit to reddit
Red and blue state map, based on returns in last four presidential elections. (Wikimedia Commons/ Angr)

Red and blue state map, based on returns in last four presidential elections. (Wikimedia Commons/ Angr)

The fact that the citizens of “red” and “blue” states live in what are essentially two countries with very different governments has largely flown under the radar, but it may become the defining story of our time. The two major parties are not only highly polarized ideologically, but as Dan Balz noted in The Washington Post“polarization has ushered in a new era in state government, where single-party control of the levers of power has produced competing Americas.” Three-quarters of US states are now controlled by one of the two major parties — the most in 60 years — and “officials in these states are moving unencumbered to enact their party’s agenda.”

When the Supreme Court ruled that states could decline Obamacare’s Medicaid expansion without facing a penalty, the justices set in motion a process that’s now pushing our two countries even further apart as about half of the states passed on the opportunity to insure their poorer residents.

The overall numbers are in, and for all its warts, Obamacare appears to have extended insurance coverage to about ten million people who didn’t have it before. (The precise number varies from study to study, but as Josh Marshall of Talking Points Memo points out, they’re all in the same ballpark.)

According to Gallup, the share of Americans who lack health insurance has fallen to the lowest level since before the Great Recession began.

But the Urban Institute offers a fascinating finding: The rate of uninsured is now almost 50 percent higher in states that refused the Affordable Care Act’s (ACA) Medicaid expansion (18.1 percent) than in those that embraced the policy (12.4 percent).

This chart tells the story:

This growing coverage gap isn’t entirely a result of the Medicaid expansion — the rate of uninsured dropped by four percentage points in expanding states and 1.5 points in states that refused the expansion. Rather, it reflects the fact that “red” and “blue” states have always had very different budget priorities — the latter, as a group, have long spent more on health care, education and anti-poverty programs, and Obamacare’s ACA expansion, which offers billions of federal dollars to states that take it, is now deepening that divide.

Now that legislating is all but impossible in a deadlocked Washington, these kinds of differences between “red” and “blue” America will only grow starker. And it goes well beyond health care — last week, Maryland joined Connecticut in raising that state’s minimum wage to $10.10 per hour, and a number of other states under Democratic control are expected to follow. The same dynamic is playing out with other issues — from paid sick leave to prison reform to efforts to tackle climate change.

We’re witnessing an important real-world experiment in state governance, and as the Urban Institute study shows, the results are already coming in.

Joshua Holland is a senior digital producer for BillMoyers.com. He’s the author of The Fifteen Biggest Lies About the Economy (and Everything Else the Right Doesn’t Want You to Know about Taxes, Jobs and Corporate America) (Wiley: 2010), and host of Politics and Reality Radio. Follow him on Twitter or drop him an email at hollandj [at] moyersmedia [dot] com.
  • submit to reddit
  • Anonymous

    Are the red states taking more than they are giving in federal taxes? If so is this not another level of welfare ????

  • Anonymous

    Heck yes. It needs to stop. it is the reason some of the Southern states have low taxes, because the feds pick up the pieces. Or ..US

  • scl

    The problem the article is addressing is that the red states TURNED DOWN Fed money to expand Medicaid in their state which would have provided the funding to cover those people who make under 13k per year. Because they turned it down, they screwed over the poor or unemployed in their states because they cannot get anything. They do not qualify for premium assist because they are at the Medicaid level and their state won’t expand Medicaid to cover them, so they are out in the cold. So the red states screwed over thousands of the residents in their state for political reasons. So that is going to mean more people that cannot pay for their healthcare and they will continue to go the the ER with a cold and the hospital will have to write it off forcing costs to get higher. Yeah, that was really smart of the red states. It’s not ObamaCare that left the lowest income residents out in the cold, it’s the state that did that.

  • Fred F. Cuomo Tondalo

    Excellent answer for the future of upheaval when the useful idiots realize they have been hoodwinked

  • Anonymous

    Mr. Holland, aren’t you overstating and being somewhat dramatic in your reference to two countries?

    I live in a red state and while I am not 100 percent pleased with some state house policies, our standard of living is relatively high. In all fairness to those states you hammer, their reasons are less about punishing those uninsured and more about long-range planning with budgets. The fact is, there is a major unknown: the costs of ObamaCare beyond what the government currently throws in to the mix.

    For various reasons, the Federal government is not entirely trusted. This situation is very much like people who bought homes in the late 90s (many who could not afford them), and found their mortgage payments soar well beyond what they could afford. State governments may seem this scenario playing out for them with affordable healthcare. One day, suddenly, it’s not affordable.

  • Anonymous

    Why do think it’s just Southern states? Better check your facts on this. You sound prejudiced with your sweeping assumption.I did respond in an earlier message, and I recounted why states chose this route. Read it if you like – or not.

  • Anonymous

    The feds pick up the vast majority of the costs of expanding Medicaid, but beyond that the burden of the uninsured falls entirely on the states. Their public hospitals are facing enormous pressures because the ACA replaced funding for treating the uninsured with the Medicaid expansion — many are going under.

    Obviously, those lawmakers say it’s about fiscal considerations because they have to say something. But the reality is that it’s a matter of privileging ideology over sound public policy. And that’s hurting a lot of real people. It’s nothing less than an outrage.

  • Anonymous

    What Mr. Holland DOES understand and that you and many red-staters do not is that the COST of having so many denied health care coverage is far, far higher than simply paying for it as a fundamental right of citizenship.
    Honestly it’s like blinkers on a race horse. “Your” standard of living is not indicative of so many others in your red state and could even be so much better if your legislators would not be so aligned with their corporate and racist masters.

  • Anonymous

    Race card playing does not work with me. I hear your own prejudice – and that of Holland’s – in reference to regions of the country. What is the difference? Prejudice is prejudice. But this is not about race. It is about equity and taxpayers – maybe you are not among them – who are having to pay more than our share for people who are being drawn to become more dependent upon the government. These people are not just black or Hispanic. There are many whites, too. Yes, we need healthcare for people who genuinely who can’t afford it and for children, but ObamaCare, Affordable Healthcare or BushCare (if you choose to call it that) is not it.

  • Anonymous

    The poor and disabled of our country, especially children, have long been in dire need of reliable healthcare coverage. O-Care is not it.

    Many of us could forgive its harried, unprofessional roll-out in 2009, the mismanaged messages about it over the years, the hyperbole, the unimaginable stupidity of the website launch, the millions being spent on marketing in the aftermath of near-failure and lack of planning by Team Obama, and even Obama’s lies. After all, he is just a politician trying desperately to seal his legacy, and that’s all he is. Most people who object to ObamaCare are insulted by its very concept and by not being given an opportunity to even understand it – because our own elected officials in both parties were more eager to get it pushed through and to explain it. In fact, we now know they did not understand it and still have no idea of whether it will succeed – and they don’t know the cost of that success. As a business person, and a taxpayer, I am always interested in costs.

    The other side of the coin involves people who work hard and are being faced with rising healthcare costs (yes, we are), loss of doctors accepting Medicare (as in my elderly mother’s case) and even loss of hospitals accepting Medicare. People on ObamaCare and Medicare patients will eventually be left with third-tier medical facilities and doctors to serve them. I can’t speak to hospitals “going under” throughout the U.S., but in my state the handful that did not make it are being closed because of mismanagement. Apparently, you do not know all you should before you charge into penning the article you did – or maybe you prefer not to delve into situations that don’t suit your “research.”

  • Joey

    I don’t really know, but my guess is that when an uninsured person walks into a hospital, they get free health care paid by the tax payers or by higher premiums paid by the people who have insurance.
    So if you refuse the extended medicaid from the federal government, your state still pays for the uninsured – who get penalized by giving money to the federal government at tax time.
    So aren’t the state governments really just hurting themselves?
    I hope somebody can correct my faulty logic if I am wrong.

  • Anonymous

    I said nothing at all about “regions of the country” — only who’s in charge of various state governments. We can all look at a map.

  • Anonymous

    Theoretically, you are correct. But let’s see, what is the theory? Better yet, what is the plan? We have been asked to buy into – literally – a healthcare system that so far has managed to engender confusion, even fear and a lack of confidence among the majority of Americans, if you believe the polls.

    But why wouldn’t people sign up through exchanges for private policies rather than for Medicaid? Yes, we’ve seen the enthusiastic numbers for Medicaid sign-ups, as opposed to those registering for regular policies. But if there are 45 million people in this country without insurance, surely all of these are not in-need cases. If even 25% of those signing up are going to require terminal government assistance or subsidies, why not just have given these people Medicare? The government could have devoted the time and money expended on the website start-up and marketing to tackle corruption and abuse in Medicare. I’m serious. As a taxpayer, I would be more than happy if I knew I were helping pick up the tab for those people genuinely in need. But then, that would not have been a very dramatic legacy for Obama – no pomp and ceremony, fewer photo opps and fewer sound bites.

  • Anonymous

    Did I miss something from the findings of the Urban Institute – that is, why don’t non-Medicaid people in the hateful red states have insurance? It seems that would be a worthwhile question to delve into. For example, a lot of younger people simply did not buy and are going to accept the penalty. What is this percentage? It seems that those overseeing The Plan, such as it is, have never had a handle on who’s who out there. If they had, there would not have been the necessity for the on-going postponements and other last-minute changes. My younger sister used to close her eyes when she held the basketball to toss it in the general direction of the hoop, hoping to make her goal. If she did, she was thrilled. If she didn’t, she shrugged.

  • BG, dismayed leftie

    If you put someone like Louis Gohmert in a position of power, what do you expect to get in return?

    Stop electing idiots, liars and jackasses. Please.

  • BG, dismayed leftie

    A few years ago, a friend and I were in the “socialist hellhole” known as Paris. We stopped in a little café for lunch, and as it turns out, the proprietor spoke perfect English (as many French people do) and we began a lengthy conversation with him. He had been to the States several times, and after he decided we were okay, he said, “You know, we French think you Americans are nuts. We know some people are going to abuse the healthcare system, but it’s the price we are willing to pay to make sure everyone is covered.”

    That is the way civilized adults deal with the issue. Unlike us, they don’t treat everyone like kindergarteners and punish the entire class because one kid acted up.

  • Anonymous

    What a weird, linkbaity title.

  • OhioBrian

    Exactly, which is why we should just have Medicare for All, rather than the Byzantine, Balkanized, bureaucratic mess that is the “private” market and the ACA. After all, by all accounts and comparisons to other developed democracies, we already pay by far enough for Medicare alone to cover the entire population…or for really fantastic healthcare we could increase slightly. Right now we pay though about $8500 per every man, woman, and child per year (and yet don’t cover 15% of them with the tens, perhaps over a hundred thousand unnecessary deaths per year our shortsightedness entails), to which we should be paying less than three grand for five star service(say 8% GDP vs. 17%). Oh, keep in mind that because you’re an American “taxpayer” there are far less hospital beds, doctors, and physician consultations per population than your OECD counterparts, so if a new Plague, bio-attack, antibiotic/vaccine ineffectiveness hits, the US is going to really enjoy the fruits of its own stupidity. HEALTHCARE IS NATIONAL DEFENSE AND YOURS AND YOUR FAMILYS’ DEPENDS ON YOUR NEIGHBOR!

  • OhioBrian

    Unfortunately given that our country has failed on healthcare for the last 60-70 years, including the desperate debate in 2009 for almost a year, your criticisms regarding the ACA may indeed be valid, but as they don’t occur in a vacuum, they are also highly misplaced. Ultimately and unfortunately I think misery led to its passage, misery will make it fail, and even more misery will be what finally leads us to universal healthcare. And the fact that the American people don’t understand this due to obfuscation is primarily on the shoulders of one party and the controlling healthcare interests. Just the nature of our system that we have Medicare, Medicaid, Private Insurance tied to employer and now ACA is absolutely indicative of the disingenuousness of the politics, again particularly on the Right (or those on the “left” in fear/pocket of). In truth intellectual honesty necessitates that the arguments should be Medicare for All or for None, Obamacare/Medicaid for All or None, nothing but private unregulated insurance, or savings/payment directly out of pocket. Most of the world, even the US itself has realized that the latter two are not workable solutions. Also, sad to hear about your mother’s case, but its also telling that she has Medicare(cause why don’t she just pay direct?), it already highly subsidizes the education of 100% of the doctors in the country, and that those facilities who refuse it are likely the ones who will soon be out of business. The Red states are going to find this out as larger percentages of their populace will be going to the ER without insurance…in fact the only reason there is a hospital or ER in so many places right now is that they’re mandated by the government.

  • OhioBrian

    Exactly, but try screwed over millions as the estimate is the Medicaid portion of the ACA covered 5 million people in the Red states who will also now even more face tens of thousands of unnecessary deaths compared to the Blue. It’s also going to cost them when they realize that mandating the ER, yet not covering everyone, means many hospitals find clever ways of taking that segment (or themselves) out of business to serve more profitable areas or make these departments very costly from a wait, customer service, or even financial standpoint to offset and offer “moral hazard” to those coming to the ER. This affects EVERYONE, not just those who can’t afford healthcare, and don’t be surprised if your ambulance tarries or takes you to the furthest facility because of GOP particularly but, also American stupidity on healthcare. Just even here in Cleveland where I live, they’ll cart you off to MetroHealth on the west side if you’re black(even if you’re several hundred blocks away on the east), as well the “awesome” Cleveland Clinic closes down ERs and hospitals in the inner city serving hundreds of thousands, yet opens brand spanking new full facilities in the Exurbs (well past even Suburbia) as they know full well few will then come to the ER(with those that do filtered for wealth), and yet the OR and testing facilities will make them a fortune. Such stupidity, mismanagement, and inefficiency is killing this country (particularly its worst off who actually do die from this)! And thank God at least Kasich was smart enough to let the Medicaid expansion go through, unlike the Rick Perry types whose states’ citizens will now choke on their malfeasance, not being able to overturn the ACA, meanwhile their tax dollars in this regard go to the Blue states.

  • Anonymous

    I must have been sleepwalking when I elected Gohmert. I have no idea who he is.

  • Anonymous

    Sorry he didn’t succeed. I don’t recall any discussion by Obama re: Medicare vs. affordable healthcare.

  • Jay B.

    You recounted it, but you were wrong on every level. But let’s say that it’s because states are worried about future potential health care expenditures — so it’s better to let the sick die now? Isn’t that a little morally obtuse? That’s your BEST explanation. Of course, that also plainly ignores the GOP’s vested and oft-stated insistence that they will crush Obamacare. In both cases, the GOP is punishing the sick, the poor and children without providing even the basic plan in return.

  • Anonymous

    The southern states get more back from the feds than they send in…FACT.

  • Anonymous

    You are getting close! Go to Mediciad .gov /CHIPS/ eligibility.
    There you will find a family of 4 in 2011 had to make over 67,000 a year or the kids had to be in Medicaid/Chips. The threshold to not be in Medicaid was 67k a year for the family of 4, this is now 81k/year for the same family size in Hawaii in 2014. these are not people who required terminal government assistance, but if they applied on the health care exchanges the kids were automatically put into Medicaid! Crazy , but true! And none of this is disclosed to the family prior to application, SURPRISE! This only caused mayhem for the 5% of the US population who already had private health care insurance. However the ACA is designed to drive small employers into the individual market adding another 45 million people into this mess. No wonder the the employer mandate was delayed by Presidential Decree!

  • Anonymous

    The problem with Republicans is that their entire platform is based on policy without prescriptions, which is essentially meaningless catchphrases like “we need affordable healthcare but not this.” Okay, the what? *crickets* Republican opposition to Obamacare might have worked if they themselves had a workable (i.e. better) solution. But they do not. The current conservative proposal, delayed five years while the GOP wasted five years pretending repeal was an option, they are finally crafting will leave more uninsured while still not addressing costs.

    Opposition and saying no, especially while conceding that something needs do be done but offering no viable alternative, is no way to govern. And it’s why a generation or two of upcoming voters rightfully do not trust Republicans to govern. Why would anybody hire a doctor who said “We need to save your life, but open heart surgery is not the way. Let me do it–even though I have I idea what I’m going to do.” Well, anyone who is not in the tea party minority within the right wing minority.

  • Anonymous

    Medicare is a government-based program, so of course it is not perfect. It is not a panacea. It is just the best option available now for those dependent on the government for health services. It does need a make-over and ensuing oversight – more efficient than now. For the most part, American workers have contributed toward Social Security and Medicare. It is not an “entitlement,” as are many other government programs (SNAP, for example). Come to think of it, I am not sure why they are called entitlement programs. I guess it’s a euphemism.

  • Anonymous

    I will have to think about what you are saying. You are probably correct about our having universal healthcare, best option or not, and with younger generations it may work. Many young Americans are living in a kind of diminished society from the one in which I grew up, was educated, married and have been able to find satisfying employment and lifestyle opportunities. Who knows what is in store for them?

    I have good friends who live in Greece, Canada and Great Britain. They have become accustomed to their healthcare, but when they speak of it, you realize that it is quite mediocre. My friend from Canada (Alberta) recently travelled to Phoenix for specialized knee surgery.

    My mom worked for 40 years, so she has earned Medicare. Yes, she has paid out-of-pocket expenses, and that has become more common in the past couple of years as her health declines. The moment the medical and insurance industries heard the words “affordable healthcare,” they began to scramble to answer their own primary question, “How can I continue to make money out of this?” That is what they do to stay alive in a business sense: they have to make money.

  • Anonymous

    The Republicans will not repeal ObamaCare, but when/if they take the Senate in the fall, they will need to scramble to improve it. That has been their promise. Apparently most Americans are not happy with most aspects of it. Even if never improved. affordable healthcare will have a rough ride for the next half-decade, at least. The sources I read re: people continuing to lose coverage is not silly campaign rhetoric but articles from business publications.

    Having worked for two different agencies in my state, I can assure you that people in need do not go without. They are not living in wealth, but most people I know do not. If a child starves in the USA, this is usually due to the blatant neglect and stupidity of parents (usually, The Parent – the single mother), and not The System. This country has problems that are not going to be resolved by commenters on this website or any other – and they apparently are not going to be resolved by our elected officials in D.C. They are mostly indifferent to us.

  • Anonymous

    I think it depends on the states you are talking about, but I don’t doubt this. Having worked for government agencies, believe me, I am not for tearing apart our government. The FAA, EPA, Department of Defense and even our often-bungling law enforcement agencies are among those who serve us well. They do need more oversight and an overhauled culture. Their failures can be laid directly at the feet of Congress and the White House – and in the many politicians and presidents of the past.

  • Anonymous

    No surprises but very discouraging.
    Most media re not going to share this kind of information with the public and, in fact, seem to have become the mouthpieces for the Obama-Rama. They all know best for us, so there.
    The USA is a remarkable, resilient country. We will overcome the wrongs of the sitting Congress and the presidency of Obama, but it will require a strong leadership we have not witnessed in the White House in decades. We don’t need a blamer but someone who has the ability and personality to work with the Congress. Obama is not a bad person but is passive-aggressive. Our country will prosper with better leadership, but we still have many tough decades ahead.

  • Anonymous

    I am totally down with all you say. The Republicans have lost my respect for myriad reasons, but having worked in local campaigns from an early age, I have always been able to recognize campaign babble. It seems all politicians are now in perpetual campaign mode. The GOP is playing to a base that is disappearing – literally – and the Dems are trying to hold on to a base that is expanding but, in many cases, is poverty-stricken and uneducated. The situation looks bad for both parties, and their actions show their desperation.

  • Phil

    Joey you have never walked into a hospital uninsured, have you? It isn’t ‘free’ they send you a huge bill, first off, and send bill collectors next. And they don’t fix what’s wrong with you. They give you emergency treatment. For a broken arm that’s fine. When they find you have lung cancer or diabetes or anything that is not an “emergency” they tell you to go see a doctor of your own, and give you a couple days pain meds if you can afford to fill the prescription. I have accompanied young adults who simply cannot afford coverage several times to the ER in the past year only to watch them come away with their health need untreated.

  • Phil

    Because people don’t have to have much to be disqualified from Medicaide; and yet they cannot afford $140 a month for insurance when they are already struggling to pay the rent and eat.

  • Phil

    And I’d like to point out that a loot of the so called ‘confusion’ over Obamacare is actually a planned political action funded by millions of dollars in false advertising by the right wing, They actually ran ads discouraging young people from signing up. They used scare tactics and raised points that have nothing whatever to do with Obamacare. It has worked poorly but it surely impacted a lot of young people who otherwise would have health care now.

  • Anonymous

    Yes, these should be the candidates for Medicare. But the vetting process and oversight of the candidates and the medical community would have to tighten up – a lot. I would prefer to pay government employees to do this rather than spend tax dollars on “learning” conferences in Vegas or at some Arizona spa.

  • Anonymous

    How did they manage to get insurance companies to drop people they were insuring and to increase rates? Just after hearing about affordable healthcare, my insurance company increase my family’s rates after a lengthy period of no escalation. I am so relieved Democrats don’t employ any of those dirty tricks. Someone ought to declare a war on dirty tricks. I guess that would be Mr. Obama. He is adept at doing this. He has done everything but to declare war on menstruation, and maybe in his drive to attract women, he will do this next. I know there are women who would like to be done with that. Obama can sign an executive order to seal the deal. Heh.

  • Phil

    People weren’t dropped, junk policies that didn’t meet the law’s requirements were dropped and the people were guaranteed to not be refused new policies. I’m 65 this year so I am not getting a policy; I’m fortunate to qualify for VA coverage, best health care I’ve ever had…but until now I could not possibly get/afford insurance; no one wanted me with my existing health conditions. If I were a year younger I’d be paying about $400 without subsidy (and $140 with…)
    Dirty tricks? How about the ads that claimed
    Obamacare would put the government into your doctor’s office with you?
    Increasing rates? Yeah some insurance companies simply jacked up rates on existing policies in the expectation that people would not investigate. Most people I know have seen much lower premiums. Have you bothered to check the website to see what is available or just let your insurer hijack your wallet? I am so relieved you spoke up about this problem. Maybe someone will provide real facts and figures to show how Obamacare hurt them but every single person I know has found their coverage better and costs lower…and the people on TV are universally shown to be misleading when real reporters investigate.

  • Phil

    If you are saying you prefer single payer, so do I. I have government run healthcare and it has been much better than insurer run denials…

  • Phil

    I am trying to understand your comments and this is what I gather: you don’t like Obama because the Republicans won’t pass the bills he would really like to be passed. If he were a better President the Republicans would work with him.

    If that is your position please don’t reply because I don’t live in DIsneyland.

  • Anonymous

    All I can say, Phil, is good for you. And good luck.

  • Anonymous

    I like the Republicans about as well as I do Obama. Actually, like is not a fitting term. Respect is. I have little respect for them, but I think Obama is the biggest joke of a president we have had in my lifetime, including Jimmy Carter. Obama isn’t a bad guy, but he has no credentials. For the most part, his speeches are banal. He can’t lead. Foreign Policy is in the dumper. The economy still struggles -except for Wall Street, which has funded his campaigns.

    I stopped being politically correct a long time ago. The main reason Obama was elected is because he is black, and people, with good in their hearts, wanted to be part of electing the first black president. Now they’re part of history. Good for them. The other reason he was elected is the GOP’s inability to run a younger candidate who can win above someone who promises a better life for an increasing number of uneducated, poor and needy people in this country, many of them immigrants. In the 50 years blacks have stuck with the Democrats, they are still at the bottom of the food chain. That may sound harsh, but it is the truth. Now your turn to say it is the evil Republicans’ policies that have kept them down.

  • OhioBrian

    Yeah, I can’t speak much for Greece other then just know that it’s pretty far from being a “developed” country in reality with corruption fairly rampant. As far as GB and Canada, along with the States, these are often held up as examples of what not to do either amongst the OECD comparisons; In the UK, the government completely runs everything and its a 100% socialized system with no patient co-pay of which there are many that think it should be scrapped for some of the more modern systems Europe, rest of Commonwealth, Japan, etc. has..It’s similar to how certain industries at one point were completely nationalized in some European countries, and for which they’ve pulled back and allowed privatization as neither the government by itself, or unregulated market will end up being a good solution. One thing, good or bad that can be said about the UK is that whatever they have, percentage of GDP wise it’s pretty cheap in comparison to a lot of other countries.

    Canada is more complex as they indeed have a hybrid system of public/private, most similar to what we’d be like having Medicare for all ages. Many of their problems are just due to simple mismanagement, and the same “piecemeal” or “hands off” or even overlooking approach the US currently takes towards its healthcare. For example, doctors and hospitals wise per capita, Canada ranks right there with the US at dead last amongst the top 50 countries. And this is just bad governance of the problem as even in the US it is much the governments area to fund training, allow certification, and ensure there are enough doctors and facilities to cover the populace. Again though, the US and Canada are last place on these critical metrics which is why wait times are particularly long there. Here, people just don’t goto the doctor till absolutely necessary, the US having one of the lowest physician consultation rates..and we still often have to wait. This is even more perverse too as we are one of the more obese and sick countries as well, yet often don’t go to the doctor even with insurance.

    Absolutely right; there’s no panacea. Still, the US according to the Bloomberg rankings is now 48th out of the 50 nations it studied Healthcare efficiency metrics for, falling behind both China and Iran, but just ahead of Syria. When we’re talking about improving our systems though we shouldn’t use the lower performers of exemplary of what we want to be, but rather emulate the best, and the world has experimented heavily in this area since the end of WW2 particularly, so its not like we don’t have good ideas on what works and what doesn’t.

  • Anonymous

    Republicans have spent the last 40 years tearing the US government apart. When we do not have a strong central government, people will be shocked at life in America. Greed, pure Republican greed for the almighty dollar.

  • Anonymous

    Douse the angst and revisit your math. Nearly half of that time the Dems have held the White House. Factor in the years of their congressional control and Supreme Court appointments. Greed? Team Obama is yet to prosecute a big fish from Wall Street. That’s because a large percentage of his campaign contributions come from them. If individuals in this country are struggling, maybe they should look away from the blame game and into mirrors. What – no education? Uncaring parents? Alcohol problems? Too many marriages? Kids out of wedlock? Jail terms? Drug addictions? Bitterness? Antisocial behavior? Obesity? Tobacco use? It’s called life. Some people deal with it better than others. Most often, it’s about choices – yours. It’s not something Ronald Reagan did to you.

  • Anonymous

    Yeah, but those old Duck Dynasty boys from Maine are really okay. Oh, wait – that’s Stephen King from Maine. Well, Honey Boo Boo – that little Hawaiian chick. Hmmm … that’s Obama’s home state. D.C.? The call girl business should be taxed. About two-thirds of our elected officials, their lobbyists and friends regularly use their services. There are more madams in D.C. than anywhere else, per capita. My state isn’t there in your list, but in most of the states/areas you mention, there is a lot of illiteracy and large minority populations. Those usually go hand-in-hand, and states are left having to deal with them. I assume the Feds are delighted to help states with minorities.

  • Anonymous

    I retired from a great UNION company with a great UNION pension. Worked and saved money all my life. Today we pay people less on the hour than I made 35 years ago. We have made rules very hard for poor people to jump through hoops to get help. Republican states take federal money that is suppose to be used to help people and they are using it for other things. Living in the US today and eating can;t be done on the low wages we are paying people. Tip wages have not gone up since 1991. CRY ME SOME TEARS FOR CORPORATIONS? The economy was thriving under Clinton. Bush started wars on lies and pushed massive tax cuts that benefited the wealthy. Not the working man. Charts do not lie. The bridge between the wealthy and working man show, while staying flat for years for the man working in small time USA, the wealthy have bought a build up to massive wealth. Money buys congress and senate to give welfare like never seen before. It ain’t going to the poor. People would not need help if they could earn enough wages to keep themselves.

  • Anonymous

    In the 70s the world began to change.
    Put politics aside. People’s lifestyles were changing, and this was not necessarily driven by politics but by the people: women and minorities were entering the workforce in large numbers, many of them in management positions. This affected household structures, as well as the economy and the culture. This was an educated generation with some disposable income. In the late 1970s, Jobs and Wozniack founded Apple, and the rest is history with the advent of the personal computer. Technology would change everything.

    People can blame Reagan and politics all they like, but the great social movements are the drivers. I recall reading in the early 1980s in a Harvard Business Review that the middle class was disappearing, slowly but surely. I am middle class, so this got my attention. One of the issues it mentioned was, as you exhibit it, UNIONS, and their likely waning. People who had little formal education were making big salaries and had major benefits in unionized corporations, but corporations were bringing technology on line. Workers who had made top UNION dollars were now out of work, many with little education and skill sets that did not match up to The New World. It happens. Put an “Sh” in front of that if you wish.

    The economy thrived under Clinton because of technology. That’s when the promise of the 80s boomed. Clinton also was around long enough to witness the tech. bubble bursting, and the economy going south in the first quarter of 1999. Bush inherited a sour economy. Also in Clinton administration: he repealed the Glass-Stegall Act, which had separated commercial and investment banks, and he revitalized the 1977 Community Reinvestment Act. That mandated that minorities could not be discriminated against in seeking mortgages, so they and many others got in over their heads. This brought on the housing bubble of 2006-07 and helped lead to the current financial collapse. I am not wealthy, but I did get Bush’s tax cuts. Didn’t you?

    People have to change with the times, and if they don’t, they are often left behind. Maybe younger generations will stay in school, marry later and postpone childbearing until they can afford children. A struggling single person dining on noodles and waiting tables is a tough life, but it turns tragic and poverty-stricken when kids are brought into the picture. In these cases, even a little bit of education would make all the difference.

  • Anonymous

    Are you for real? Unions have been gone for almost 40 years. As they continue to stomp out what few are left, Americans are working for less money on the hour than I made in 1978. If corporations were not sitting on trillions of un-taxed money and having a hard time, but they are NOT. Living in the US can not be done living on salaries like tip wages that have not gone up since 1991. The Bush tax cuts should have NEVER happened. I lived well without them. He started wars on lies, and cut taxes. DISASTER. We can not run a civil country paying no taxes. The wealthy are not paying their fair share. have not been in years. The tax rate is high till they get to the bottom line with all the things they write off, bought and paid for by their hard earned dollars of buying the congress and senate.

  • Anonymous

    Well, maybe all those nasty rich people will just leave the country and take their corporations with them. Who’s left to carry on? Many wealthy individuals have already left. No doubt there will be plenty of low-level jobs for Hispanic immigrants. Maybe they can babysit for unwed mothers – the out of wedlock birthdate is over 70% for minority women – while they go out and … what do they do? Oh yeah, get pregnant again by some dude who thinks it’s his obligation to impregnate every woman he meets. And they all continue to be poverty-stricken and at the bottom of the food chain. Ignorance and apathy are this country’s real enemies.

  • Anonymous

    Maybe ObamaCare will help these people. It is my understanding that is its primary target.

  • Anonymous

    The more educated, younger professionals are leaving France. Hollande’s government is in shambles. It’s been in the news in the past ten days with the mayoral elections there. France is fun on the surface, and its cuisine and culture are intriguing. Its economy stinks.

  • infidel

    Rumionemore – It doesn’t sound like the lack of being ‘politically correct’ fuels your interesting perspective regarding Obama. You criticize him, but tend to disregard the reality that ensued upon his election: the contingent of Republicans that have essential stymied and obstructed on a level unprecedented in recent history. And it began with McConnell’s statement the day Obama was elected. Add that to the fact that Republicans have tried over 50 times to repeal the ACA, but offer nothing – and I mean nothing, as an alternative. You also seem to be unaware of the actual history/evolution of what has come to be called the PPACA – and all the players involved. Don’t even get me started about how much time/resources Republicans have wasted regarding the Benghazi witch hunts – and being the party of “No!”

    Now you say Obama was elected because he was black. Hmm… that’s also interesting. Just what empirical data are you basing that ‘politically incorrect’ statement on? And have you tried to entertain the notion that you might be stunningly wrong? Or would that threaten your world view too much?
    As far as presidential credentials – would you say that Bush owning a baseball team qualified him?
    When you make a blanket statement regarding Obama’s foreign policy, again, what is it that you are giving attention to that would support that assertion factually? You think his predecessor had better foreign policy? You obviously do.
    And if you think that ‘tough decades are ahead,’ I genuinely wonder how it is that you do not think that it is not ‘tough’ NOW? Maybe you don’t feel it, but many many others certainly do. Lets start with the 48 million Americans – including 16 million children.
    Obama the blamer? Riiiight! Give us a break. Are you one of those right-wingers who think the office of president was just created in 2008? Or do you just enjoy reiterating Republican talking points?
    Your cavalier swipe at Obama having powers of executive orders also seem to suggest that he not only hasn’t any right to issue them as he sees fit, but that other presidents have not done so!
    Where was your sharp tongued voice of criticism during those 8 years of Bush which ended in the worst financial disaster since 1929? Oh that’s right…. there was never a president before Obama! Oh yeah – there’s that thing that happened in Iraq….

    Since “The Black Man’ has become president, have you lost all semblance to a sustainable history/cultural perspective?
    Fine – you don’t respect the President. Duh!
    But I also detect elements of racism in your comments. In another earlier one you made reference to “poverty-stricken and (the) uneducated” as an expanding base for the Dems. But have you actually made any personal efforts to connect the dots between institutional racism, economics and access to education (and affordability) – and why the numbers are indeed ‘expanding?’
    Ever hear of the term ‘white privilege’ – and given that concept a fair hearing?
    Someone should make efforts at representing the voices of less fortunate Americans – God knows that Republicans have no interest in doing so because they capitalize politically in demonizing that group to their base/constituency! And honestly it sounds like they have certainly have succeeded in doing so with you. We all know that the poor are all mostly composed of moochers, losers and illegals, right? And that they comprise a substantial voting block that wields enormous power and influence on laws and law makers? I hear the Supreme Court recently issued a ruling that the poor are people too – right up there with corporations!

    There are enormous points of irony spread throughout your comments in this thread and another one of them is that the “federal government is not entirely trusted.” Hmm… and just why do you think that’s so? Consider that when you have right wing media sources such as FOX newz, drudge and talk radio blather an incessant stream of preaching the great evils of big government and (again) demonizing federal programs (and the opposite party) and the politicians who speak up for the ‘economically challenged,’ how do you not think this distrust is a self fulfilling self generated prophesy? And they sew this self-generated distrust among a large group of people (their viewer/listeners) who seem to have zero critical thinking skills – and who also see no problem with imposing their version of Christian morality on others – even extending to women’s healthcare. They’re told to distrust and so guess what? Surprise!
    This ain’t rocket science.

    And since we overcame the lame presidencies of Bush I and II, and Reagan, getting over Obama’s term will be a breeze.
    Pretty sure of that.

    [On a more useful note, I would highly recommend you checking out two books: The Party Is Over - How Republicans Went Crazy, Democrats Became Useless and the Middle Class Got Shafted; and Zombie Politics and Culture in the Age of Casino Capitalism. This might lend additional perspective that you seem to be missing.]

  • Anonymous

    You know that old saying about making assumptions, so I won’t go there, but you have no idea who I am or what I believe. I am reading “The Party is Over” and find that it aligns with my general beliefs. I am not pleased with being called a racist, no more than I would take kindly to be calling a sexist or someone who discriminates against people because of their religion, sexual orientation or the region of the country in which they reside.

    I have little respect for any of today’s politicos, including the Republicans .All are indifferent to us. I will say that, as a holder of a journalism degree and someone who has professionally worked closely with media outlets, that you should not rely too heavily on their slants for your best information – whether FOX, MSNBC, ABC or even public broadcasting. They all have a slant – even the Moyers crowd. They hammer the GOP for catering to the wealthy, and yet there are Pelosi, Boxer and Feinstein who are enormously wealthy. I believe Pelosi came close to being caught for insider trading. Any politico who can is happy to hold out his or her hand to the Wall Street donors.

    For the record, I have found Al Jazeera America to be among the most objective outlets. I trust its newscasts – it’s not filled with sound bites of Obama or McCain – and I record “Consider This” because I find it timely and enjoyable.

    Obama? He’s too big a topic. Not very complicated, actually, but simply causes too much discussion for all the wrong reasons. All I will say is that I am not disappointed in his presidency, as are some of my friends and colleagues who voted for him. As a career person in executive management, I would never have hired him – or anyone else for such a stunningly important job – with such a slim resume. Attractive, relatively articulate, nice wingtips, good overall presentation of self, but I would have been counseled by my CEO. What were you thinking with this hire? I agree about Bush and his hateful wars and all the false heroes like Petraeus and Cheney that were pawned. The Republicans were remiss in not presenting a more qualified candidate than McCain, but Obama? No thanks.

  • Anonymous

    I do agree with you about someone speaking for less fortunate Americans, but I am not sure it should be an elected official. He/she has too many other motivations.

    The loyal partner of poverty is ignorance, and I see few corporate or political leaders jumping on that bandwagon to try to raise levels of education. That is the key out of poverty. I’ve volunteered with kid and youth organizations, and it breaks my heart to see young people becoming parents in their teens. They’re almost never married, and usually come from single mother households. About 65% of the time, this means they stay in poverty. It’s cyclic. I did hear the Urban League president decry this situation in an interview with Al Jazeera, but you will not hear Sharptons or Jesse Jacksons try to guide young people out of this so-called cultural rut and mindset. It doesn’t benefit their spin, which also feeds their big careers. Yes, poverty and ignorance are eating away at our nation’s strength and resolve.

  • infidel

    Good job at addressing zero out of about 15 questions I asked – though strangely enough, I got a better idea of where you are coming from. No one is ever ‘pleased’ to be called a racist because no one believes that the term ever applies to themselves, but to be more accurate, I never called you one. I merely pointed out that some of your comments sounded a bit racist – if not definitely elitist. Implications are not assumptions.

    I get that you are not a happy camper with regard to American Media and its politicians, but from what you have written in your comments, your tendency to make incredible broad stroke generalizations in your incessant tendency towards only seeing the ‘darker elements’ of the media and politicians, are mind boggling. Yes – much is f-’d up, and we probably agree on much, however it is equally important to look at where positive change is actually occurring, being mindful of those elected officials who are doing good work – and letting them know, and calling out specific media sources that blatantly and intentionally mislead. And probably most importantly, not patronizing businesses/corporations that advertise with those sources.

    Most positive changes occurring in America are being done in small ways and incremental steps – with a few exceptions, this is how these things have always evolved. Those result are cumulative and creates a culture that brings about more awareness for positive change. And the biggest threat to our legacy as a country, is the continued influence of dark money – that both parties are guilty of – maybe not equally, but enough to make it a viable threat overall. The Supreme Court has not helped in this regard either.

    For all your dissing of Obama, I can tell you that out of the available choices, he was clearly the best man for the job. And a president’s term is only as good as those he surrounds himself with. That is why Bush was such a disaster with having psychopaths Chaney and Rumsfeld surrounding him – not to mention how ill-prepared he was for the job. I can’t say Obama has any equivalent to that. The GOP were more than ‘remiss’ (and that is an interesting word choice) – they had no better viable candidate – simple. Maybe Jon Huntsman, but he had no appeal factor to the right wing loonies. Plus the Republicans had no new ideas – or anything to offer a diminishing middle class after 8 years of Bush and Co. Despite whatever disappointment I have in him, I’ll take Obama over that gaping void any day – thank you very much.

    On a personal note, I also am thankful for Al-Jazeera – but also ITN, NHK, BBC and PBS (Frontline, WW in Review, News Hour – and yes, Moyers.)

    [I am pleased you are reading The Party's Over. Please add Zombie Politics to your list.]

  • Anonymous

    Well, next time you’ll have to number the questions. I was going for broad strokes approach. I recommend The Four Agreements by Don Miguel Ruiz to just about everybody. It is not political but instead is a philosophy of a life pathway that almost anyone could follow – any socioeconomic level, gender, political persuasion and so on. We are living in a culture of people who seemed trapped within themselves for myriad reasons. I think a teenager could read the book and think, I can do this, but the concepts would probably resonate more with adults. I think of the extent of polarization in our country, and I see this as a barrier that could eventually devastate our way of life, once very gratifying.

  • infidel

    Despite all the crap, it is STILL an immensely gratifying life.

    But as the modified Curran (attrib.) quote goes: ‘the price of freedom is eternal vigilance.’

  • Anonymous

    Yes and yes.
    I don’t expect to be economically tied to government programs, with the exception of Social Security/Medicare, which I have paid into for many years, have freed myself from political movements and noises, and have gotten out of the stock market. I am a damned happy person on most days.

  • Anonymous

    What would have been great here would have been two maps … one showing how states voted in 2012 and one showing which states declined Medicaid expansion.

  • Guest

    The chart is pretty flawed. To call KY, my state, red and thus resistant to the ACA misses the mark. We have a Democratic Gov. who was present at the last State of the Union addresss because he has helped build the best state run health exchange with millions enrolled in Medicaid already.