Patterson observes that, because these people live in states largely
controlled by Republicans that have declined to participate in a vast
expansion of Medicaid, they are among the eight million Americans who
are impoverished, uninsured and ineligible for help. Under the
Affordable Health Care Act, the federal government has agreed to pay for
the expansion through 2016 and no less than 90 percent of costs in
later years.
Americans who have been excluded for coverage
under Medicaid, and are presently without insurance, stand in stark
contrast to those individuals who with slightly higher incomes will
qualify for federal subsidies on the new health exchanges that became
operational this week, and those who are poor enough to qualify for
Medicaid in its current form, which has income ceilings as low as $11 a
day in some states.
Patterson reports that people shopping
for insurance on the health exchanges are already discovering this
irony. He quotes an unemployed health care worker in Virginia who asked
through tears, "How can somebody in poverty not be eligible for
subsidies?" At age 55, this woman suffers from high blood pressure.
Before she lost her job and her house, and she was forced had to move in
with her brother in Virginia, she lived in Maryland, a state that is
expanding Medicaid. "Would I go back there?" she asked. "It might
involve me living in my car. I don't know. I might consider it."
Patterson notes that the "26 states that have rejected the Medicaid
expansion include approximately half of the country's population, but
about 68 percent of poor, uninsured blacks and single mothers. About 60
percent of the country's uninsured working poor are in those states.
Among those excluded are about 435,000 cashiers, 341,000 cooks and
253,000 nurses' aides."
The article quotes Dr. H. Jack
Geiger, a founder of the community health center model, "The irony is
that these states that are rejecting Medicaid expansion - many of them
Southern -are the very places where the concentration of poverty and
lack of health insurance are the most acute. It is their populations
that have the highest burden of illness and costs to the entire health
care system."
The Times concludes that "The
disproportionate impact on poor blacks introduces the prickly issue of
race into the already politically charged atmosphere around the health
care law. Race was rarely, if ever, mentioned in the state-level debates
about the Medicaid expansion. But the issue courses just below the
surface, civil rights leaders say, pointing to the pattern of
exclusion."
A political system based Apartheid (from
the Afrikaans, "the state of being apart") was first created in South
Africa by the minority white Dutch descendants (Afrikaaners) through
their National Party (NP) government, which was the governing party
between1948 to1994. Under that system of enforced racial segregation,
the rights of the majority of the population - Zulus, Bantus and other
indigenous peoples - were severely circumscribed solely to maintain
white supremacy and minority rule.
The organized system
of apartheid owed its intellectual inspiration to the writings of a
former South African leader, statesman, and sometimes academic Jaan
Christiaan Smuts who, for most of his political life, was a vocal
supporter of segregation of the races: "The old practice mixed up black
with white in the same institutions, and nothing else was possible after
the native institutions and traditions had been carelessly or
deliberately destroyed. But in the new plan there will be what is called
in South Africa 'segregation'; two separate institutions for the two
elements of the population living in their own separate areas. Separate
institutions involve territorial segregation of the white and black. If
they live mixed together it is not practicable to sort them out under
separate institutions of their own. Institutional segregation carries
with it territorial segregation."
Not surprisingly, Smuts,
not unlike Southern politicians such as Strom Thurmond here in the U.S.,
saw the indigenous people as immature human beings who needed the
guidance of white population, who were better educated and better
equipped to understand politics, economics and social development. As
Smuts argued, "These children of nature have not the inner toughness and
persistence of the European, not those social and moral incentives to
progress which have built up European civilization in a comparatively
short period."
Smuts delusions and those of the National
Party that imposed apartheid, as well as the state-sanctioned system of
Jim Crow segregation that prevailed throughout the Southern states of
this country for one hundred years from the end of the Civil War until
the passage of the Civil Rights Act of 1964, were little less than a
convenient set of rationalizations.
These rationalizations helped to obscure the real reason why political systems based upon economic and social inequality were created - a fear that, if the disadvantaged victims of segregation were empowered - rule by the well-born and the privileged would be dismantled and oligarchy would give way to democracy.
This, too, is now the fear of so many Republican legislators in the Congress and in the state legislatures that the GOP presently control, and explains why their opposition to the Affordable Health Care Act and an extension of Medicaid are so intense.Their fear is that, if poor black citizens in hard-scrabble states such asTexas, Alabama, Mississippi and elsewhere are provided with access to affordable health care, and their health and that of their children are qualitatively improved as a consequence, they may grasp the possibility that government policies can improve their lives; and their participation in the political process will correspondingly increase.
Similarly, among poor, disadvantaged whites, access to affordable health care may inspire them to eschew the politics of envy as they begin to understand that their fate is inextricably linked to that every other person who is similarly-situated, irrespective of race, sex or orientation.
It is a basic proposition in the progressive democracies of Western Europe that role of government, in the words of T. H. Green, is understood to be that of a "positive instrument for the public good." Should ordinary citizens in the United States begin to comprehend the full implications of that proposition, the defenders of a status quo based upon inequality - in which the interests of one group are continually and successfully pitted against another- as well as their divisive and mean-spirited policies- will become anathema.
