Capitalism Triumphs Again!

RAM clinic, Pikesville Ky., June 2011. Photo by Scott Elmquist

RAM clinic, Pikesville Ky., June 2011.
Photo by Scott Elmquist

By Peter Galuszka

If there were any questions about just how capitalism has failed, one need look no farther than Wise County, where, this week, hundreds, if not thousands, of people will line up for free medical care.

The event is ably noted in The Washington Post this Sunday by a young opinion writer named Matt Skeens who lives in Coeburn in the coalfields of southwestern Virginia.

This week, the Remote Area Medical clinic will come to the Wise County fairgrounds to offer free medical and dental care to anyone who needs it.

You might ask yourself a question: why do so many people in one of the parts of the United States that is fantastically wealthy with natural resources need free medical care? Where is the magic of capitalism so often lauded on this blog?

A few insights from Mr. Skeens:

“Local representatives of Southwest Virginia will travel to the fairgrounds to stand on a coal bucket and assure us they’re fighting against President Obama and the ‘war on coal.’ These politicians won’t mention that with their votes to block Medicaid expansion, they ensured that the lines at RAM won’t be getting any shorter. But hating Obama in these parts is good politickin.”

Skeens runs through a list of mountain folk who can’t afford health care. One is a breast cancer survivor who hasn’t had a screenings in years. His grandfather, a retired electrician and coal miner, had also camped out at RAM clinics to get help.

Odd that this is the way I found neighboring West Virginia when I moved there with my family from suburban Washington, D.C. in 1962. Just as it was then, the riches that should have helped pay for local medical care went out of state. Much of the coal left by railcar or barge. Now, natural gas released by hydraulic fracking will find its way to fast-growing Southeastern cities or perhaps overseas thanks to new proposed pipelines such as a $5 billion project pitched in part by Dominion Resources.

While I have never been to the Wise County RAM clinic, I did happen to drop by one in Pikesville, Ky., a coalfield area that is one is Kentucky’s poorest county. It is not far from Wise. I was busy researching a book on Richmond-based Massey Energy, a renegade coal firm, in June 2011.

Photographer Scott Elmquist and I were on our way from Kentucky to an anti-strip mining rally in West Virginia when we noticed the RAM signs. More than 1,000 people had started lining up at the doors around 1:30 a.m. at the local high school.

It was packed inside. A Louisville dental school had sent more than 50 dental chairs that lined the basketball court. Some of the patients said they were caught in a bind: they had jobs but didn’t have enough health coverage and couldn’t pay for what they needed.

Since then, there’s been some good news. Unlike Virginia, whose legislature has stubbornly refused to expand Medicaid to 400,000 residents who need it (supposedly in a move to tighten federal spending), Kentucky expanded Medicaid last year. Now, 375,000 more people have health insurance.

Not so in Virginia. People continue to suffer while those with comfortable lives laud the miraculous benefits of capitalism.

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45 responses to “Capitalism Triumphs Again!

  1. see Peter – this PROVES that Charity care is better than nasty govt care!

    More! More! I wonder if these are the same Doctors who refuse to take ObamaCare!

    I even have an idea for convicted bribe-taker McDonell. Don’t send to prison – send to Southwest Va to work at charity clinics.

    • I don’t think that doctors who refuse to take ‘ObamaCare’ (assuming they can identify the policies) would bother with RAM.

      But I second the comment about McDonnell.

  2. It’s interesting that this piece does refute a criticism I’ve heard from those on the political left.

    For years, I’ve heard that “if the face of poverty was white rather than black” in the South that “things would change.” These people pointed to Maine and Vermont (where the black population is tiny) and how the face of poverty was rural and white….thus the social/education/health programs were much better there than in the South.

    But interestingly, SWVA is very white and is the face of poverty in this annual article (It appears in the Post on a yearly basis). Yet, there’s no movement on the issue in Virginia.

  3. Yes and a very telling point.

    Also I wonder what capitalism has to do with this?

  4. Actually, this seems more like a failure of socialism than capitalism. Isn’t Obamacare the law of the land? Everybody has insurance coverage. If you have a pre-existing condition then others without pre-existing conditions pay more so you can be covered. Not sure why Mr. Skeens’ friend who is a breast cancer survivor can’t get insurance. Wasn’t that the whole point of Obamacare? There is Buchanan General Hospital in Grundy, VA with 134 beds. Why don’t people use their Medicaid, Medicare or Obamacare supplied insurance and seek treatment in Grundy? Here’s a list of heath care providers in Southwest Virginia – https://www.vhi.org/hospital_region_print.asp?region=3

    So, Obamacare guaranteed coverage to those with pre-existing conditions or who couldn’t afford insurance and there is a long list of health care providers in Southwest Virginia. Where is the capitalism-inspired problem? A lack of Medicaid expansion? That’s capitaism’s fault? Really? Not the fault of the Imperial Clown Show in Richmond? And when Kentucky expanded Medicaid? Is Kentucky not a capitalist state? Really? As for all those European countries which liberals love to love over their universal health care? They are not capitalist? Germany, for example, is rated the most capitalist country in the world – ahead of the United States.

    As usual, liberal double-talk tries to blame something utterly irrelevant for teh failure of yet another big government program concocted by the utterly insipid and corrupt US political system.

  5. What does this have to do with capitalism? Perhaps not such a surprising question, at least at BR.
    In many opinions here, capitalism is seen as the best system through which all classes can prosper. When all work together, the benefits are supposed to be unlimited — or so we are told. I tend to agree, in general.
    But sadly not in Appalachia. Unfettered capitalism has resulted in a huge redistribution of wealth from an area that by most standards would be rich. It has happened through trickery, force and corruption. It is why there is a persistent underclass that never enjoys the fruits of its labor.
    The rest is a medical system that cheats workers out of what is due them. Want and example? Peabody Coal, the nation’s biggest coal firm, set up Patriot Coal so it could unload unwanted Central Appalachian properties. The real reason was so Peabody could unload pensions and benefits for retired miners. It has been bankrupt twice. It has tried to do just that.
    This is one reason why you have so many needy people in an area that has been perpetually abused. As lawyer Bruce Stanley says, there isn’t a war on coal, as coal’s war on the local people.
    And that is why there is RAM.

    • I think there are a few factors here:

      A.) The “capitalists” did extend pretty good money/benefits for a while….we all read the stories that appeared for years up until the early 00s about how much more coal miners made in terms of benefits/wages than a lot of white collar workers….so, a fair analysis would point out that SWVA mining workers did receive the benefits of capitalism for decades.

      B.) “Culture” rather than “capitalism” helped put SWVA in the position it finds itself in….some regions took economic prosperity and used that prosperity to raise taxes and build great schools, infrastructure, etc. When SWVA was receiving the benefits of capitalism, it did nothing to further the benefits that came from the mines to build the public infrastructure necessary to attract additional economic development. Rather, it just kept taxes low. Thus, when coal left, there wasn’t the public infrastructure for economic development, etc.

      C.) One of the more controversial aspects of capitalism in the 21st century is place. A lot of economists would tell you that there are jobs (and some very good ones) that are unfilled b/c people aren’t willing to move/retrain. And that’s why Appalachia is such a tough nut to crack. People aren’t willing to move. Now, that’s a controversial proposition. But economists on the right and left will tell you that it’s the region’s biggest problem. Most people on this board have probably moved a few times in our lives to chase better opportunities. And don’t give me the “classism” b.s. either…it’s not just white collar workers. Plenty of blue collar workers do the same (move to get better jobs). But most people in Appalachia aren’t willing to move. So I’m not sure what to say about that….

      • Well.. good points.. but questions:

        1. if capitalism was good “for a while” then does that mean they used to have a good network of clinics and hospitals and most closed?

        My recollection is that they never had them to start with but I’d be corrected.

        2. Coal in SW VA was dying long before the “war on coal” because the big western strip mines can get at coal a lot easier and cheaper. The only thing that kept coal halfway alive in the east was the KIND of coal – that was not found out west but even then it was expensive requiring deep shaft mines or mountain-top removal.

        3. – move to a job – same problem across RovA.. really crappy 20th century educations. Move to an urban area – get a bottom tier job with no future and live in crappy neighborhoods with even crappier schools …

        If Virginia really wants to turn this around – we need a public education system that works like Germany’s where kids receive world class educations whether they are college bound or not. Technical education in Germany and other OECD countries is what lets there kids move to where the 21st century jobs instead of being trapped as kids in RoVa are.

        Just as it is with health care – the question is not whether we want to pay or not – it’s how we want to pay. Do we just want to provide entitlements or do we want to provide better educations?

        and I don’t think if you leave education up to those localities – that it will get better… sorry to say.

        • “If Virginia really wants to turn this around – we need a public education system that works like Germany’s where kids receive world class educations whether they are college bound or not. Technical education in Germany and other OECD countries is what lets there kids move to where the 21st century jobs instead of being trapped as kids in RoVa are.”

          But we cannot seem to marshal the political will to do what needs to be done to offer such “technical education” to such people for all the oft discussed cultural and political reasons.

          Now too as C’ville Resident points out, we have major cultural weaknesses within our society with the unfortunate result than many folks might not take advantage of such education if it were offered to them. This ever larger and growing portion of our population, spreading throughout all groups within society being the chronically unemployed. These now include parts of the educated folks.

        • 3. – move to a job – same problem across RovA.. really crappy 20th century educations. Move to an urban area – get a bottom tier job with no future and live in crappy neighborhoods with even crappier schools …

          Somebody should tell this to all the Latin Americans with 5th grade educations and no ability to speak English pouring into Northern Virginia. They seem to thunk they can start at the bottom and work their way up. Based on what I’ve seen – many of them do just that.

    • Agree with much of your analysis on this one, Peter.

  6. Perhaps those trying to kill the coal industry in the region has something to do with the poverty and bankruptcy and pullout of indutry and dearth of jobs there.

  7. re: why don’t they have insurance?

    Don -sometimes I think you’re not very aware my man.

    Remember –

    1. – Virginia turned down the MedicAid Expansion
    2. – able-bodied adults do not get Medicaid in Va – even if they work full time

    and

    3. – who do you think pays for those without insurance that go to Buchanan General Hospital?

    4. – if someone in SW Va lives 3 hours from the hospital and gets deathly sick – what happens ? they often die…even if they’re white!

    • How does any of that have anything to do with capitalism? Our politicians turned down Medicaid expansions not the Chamber of Commerce. Meanwhile, in Kentucky (you know – the state that elected Mitch McConnell and Rand Paul) they expanded Medicaid. So, is Virginia capitalistic and Kentucky something else? Or, does Virginia have the Imperial Clown Show in Richmond and Kentucky has something else.

      Having dealt with political science … let’s move on to geography. Go back and look at the link I provided in a previous comment. Click on it. You’ll find a list of health care facilities in Southwest Virginia. There are 23 acute care facilities. Of these 19 are called hospitals. Please let me know the location of the town in Southwest Virginia that is 3 hours from a hospital. 3 hours by what means of conveyance? Camel?

      • Don – how do you explain the “free” clinics if there are adequate medical facilities already in place?

        Don – did you happen to notice that some of the “medical facilities” your link was citing were things like:

        Regional Surgical Services
        Roanoke Ambulatory Surgical Center
        Roanoke Valley Center for Sight
        Surgery Center of Central Virginia
        Surgery Center of Lynchburg
        The Rehabilitation Hospital of Southwest Virginia

        you think these are facilities that serve the uninsured?

        here’s a challenge for you – go back and remove the surgery centers .. “center for sight” and others and just list out the real hospitals and clinics that are available 24/7 for emergencies and/or will treat the uninsured.

        shame on you !

        • The adequate medical facilities charge money. They aren’t free. But Obamacare meant everybody not only could get insurance but had to get insurance. So, now that we have Obamacare and everybody is insured why do we need free clinics at all?

          Perhaps the reality is that the folks going for the free treatment don’t have insurance and therefore need free treatment (not just local treatment but free treatment). But Obamacare made sure everybody could get health insurance – no? So, which is it Larry – people have health insurance but don’t use it preferring to go for free treatment or there are still a whole lot of uninsured people years after Obamacare passed? Those are your only two choices I am afraid.

          As for your ridiculous liberal smoke grenade about surgical centers – it’s a shame you don’t understand the concept of acute care. The acute care facilities were listed with the designation “acute”. Was that really all that hard.

          The first four entities called hospitals on the list?

          Buchanan General Hospital (Buchanan County) – 103 beds
          Carillion Franklin Memorial Hospital (Franklin County) – 37 beds
          Carillion Giles Community Hospital (Giles County) – 25 beds
          Carillion Tazewell Community Hospital (Tazewell County) – 56 beds

          You can continue the research into what “hospital” means if you’d like.

          Oh Dear Larry – you are wrong yet again.

          shame on you!

  8. Don,
    What is a 15 minute drive here can be a 60 minute drive there.
    And, one of the problems there is that very few jobs pay much. Coal did (maybe $60K) but coal production peaked about 1991. What’s left are call centers, retail, services and a little bit of tech.
    The coal companies are on their way out. They have long been union bashers so many workers don’t have protection, such as UMWA pension funds.The old contracts that did exist are being torn up. (It’s a Car on Coal”, you see).
    For people of low income, there is Medicaid. But many people have some type of job that places them just out of reach of typical Medicaid. Obamacare subsidies, strangely, may be likewise out of reach. So many people are caught working with no health insurance since they may have to do cut-down weekly hours if they are at Walmart or the like.
    Frankly, what I am finding increasingly annoying about this blog where I have contributed for a number of years is the unchanging attitude of many of the commenters. They are typically successful and well-off, but they have this crazy idea that they are entitled because they are smart and hard-working. So are many of the under-privileged, but they’re just not so lucky.

    • If the medical industry in SW Virginia needs tax dollars to survive, put them on the federal GS schedule. The head of United Health can be paid whatever they want, but reimbursement is limited to SES. Doctor reimbursement is limited to GS-15.

      And can someone answer why people can keep everything they work for except for health insurance? I work just as hard as my colleagues at the law firm, but since I’m Of Counsel, instead of Partner, I don’t share in the annual partner bonuses. The officers of Credit Suisse get stock options my daughter doesn’t get even though she’s been getting good reviews from her boss. I worked for a company years ago that had a defined benefit pension plan, in which I’m vested. Do I need to share that with someone who only has a 401K? Or maybe just a small IRA?

      I guess lines are drawn wherever liberals want to draw them. Or maybe they have found something hidden behind penumbras and emanations that the rest of us don’t see.

      And as far as blue collar workers moving, it’s been happening for years. One of my Dad’s uncles was a painter, born around 1890. When things got tough in the Midwest, he moved his family to San Pedro, California and painted in a shipyard during WW2. My mother had uncles who moved from their lifelong homes to other cities to get a better job with the railroad they worked for.

      • Yes look at what happened before during and after WW II.

        • Liberalism is premised on the principle that the only thing one can do wrong is not pay more taxes, unless you are at the very top. Bill Gates and Warren Buffett can create their own NGO on a tax-free basis. But let some family make $200 K and they are treated as greedy and evil.

          We seem Millennials whining they cannot afford to live here, when there are many good-paying jobs elsewhere. My daughter got one in Raleigh. She and a couple of friends are renting an entire house — in compliance with the local occupancy code. So Fairfax County wanted to put SRO apartments in every residential zone except the Estate class. And give them tax breaks too.

      • re: where the line is drawn

        is if you are paying for their needs anyhow…

        you want to pay twice as much – why?

        health care is not Credit Suisse stock options for top dawgs..

        tell me what “entitles” anyone to the govt-protections provided with employer-provided health insurance or seniors getting health insurance for 104.90 a month?

        I can go with any arbitrary philosophy where everyone gets treated the same by the govt – what I can’t go along with is the inequitable treatment.

        no one “deserves” or “earns” govt tax breaks for employer-provided or Medicare.. you did not “earn” it .. you did not get it from seniority or partnership status.. you got it because you are a person.. nothing more. Why do you deserve it and not others?

    • Peter:

      There are many hospitals in Southwest Virginia whether you care to believe it or not. I provided a link to a list of those facilities. Larry can claim that they aren’t hospitals but they are. You can claim that they don’t exist but they do. The people partaking of free health care clinics are not forced to that because there are no health care facilities in Southwest Virginia. They are forced to that because they can’t afford to pay for the facilities that do exist.

      Your patently absurd contention was that the need for free healthcare in Southwest Virginia was the result of “capitalism”. While, as is so often the case, you provided no argument or evidence you did make that claim. I have called you on that claim because it is ridiculous. You can’t defend the claim because it is indefensible. Instead, you blather about people not having empathy for others. Typical liberal pap. I am amazed you haven’t started calling people racist yet in a lame attempt to justify your twisted logic.

      The working poor in Southwest Virginia need free medical treatment because the Virginia General Assembly did not vote to expand Medicaid. This has nothing to do with capitalism. Nothing whatsoever. It is yet another failure of our political class. In Kentucky, Medicaid expansion did pass that conservative and capitalistic legislature.

      When you indulge in the modern liberal tactic of blame smearing you do a disservice to those you claim to want to help. Declaring capitalism to be the culprit for the General Assembly’s refusal to pass Medicaid expansion may make your bleeding liberal heart feel good – somehow. However, it does nothing to help the people you claim to care about. An article listing the Southwest Virginia General Assembly members who voted against Medicaid expansion might have achieved something. A babbling diatribe against capitalism quoting an op-ed piece that had nothing to do with capitalism against the backdrop of legitimate human suffering was despicable. You used the suffering of the poor in Southwest Virginia to make a random liberal point that had nothing to do with their suffering. You simply used those people as literary wallpaper for your bizarre economic philosophy. Now that is callous.

  9. MedicAid expansion is already paid for by the earmarked taxes (not general fund) that fund Obmacare.

    In other words, Virginians are already paying these taxes much like they are already paying Federal gas taxes.s

    Not taking the Medicaid money is like not taking Federal transportation dollars.

    2 billion dollars and 30,000 jobs many of that to RoVa that is heavy on working uninsured and light on access to Medical care. That money would not only provide better care to citizens – it would provide jobs … the full range from nurse assistants to doctors.. that would boost economic development… and reduce the entitlement burden on Nova and the rest of Va.

    You can bet your boots if DOD proposed 30,000 jobs and 2 billion dollars for Virginia that not one of anti-MedicAid folks would turn down that money!

    That money would spur more Community College offerings for SW and South Central kids .. something that would give them a real job without having to move to NoVa.

  10. LarrytheG, You have to love the responses of the conservatives! What does this have to do with capitalism? They have plenty of health facilities there. Why don’t they have insurance? They are lazy. They need STEM classes.

    And Reed, you’re just going to have to trust me on this one, but when times were booming for coal, it still was a mess — more destruction, more exploitation, more death, more black lung, and so on. Coal has always been boom bust so the cycles were rather short. And greed played a big role.

    Let me give you an example. When Germans striped-mined coal, they would carefully move the overburden in precise lots so they could be refilled and reclaimed in precisely that way. Why? That’s the way the Germans did it, regardless of the extra cost.

    In Appalachia? Are you kidding? Let ‘er rip, boys! Just toss it down the creek bed. Somebody complains? Pay off the regulators and let the plaintiffs blunder through your alphabet soup companies.

    Don’t believe me? Doesn’t matter. That’s the way it was. I say regulate the hell out of those bastards!

    Don’t believe I said that? I just did! On Bacon’s Rebellion, no less! Ha, ha, ha.

    • My question to you:

      If the proximate cause of the situation is a failure to expand Medicaid, then why are the Delegate and Senate districts in SWVA so ruby red? The very legislators who vote on the issue are ALL Republicans in all of the districts including the former coal counties. Chaffin crushed the D 2 to 1 last year when the D’s poured nearly a million in to keep Puckett’s seat. I believe that south and west of Charlottesville, there is one Democratic Delegate and one Democratic Senator…both centered in Roanoke. Every other state legislator is Republican.

      Something doesn’t add up. If Medicaid expansion was so important to these people, why have they become the most Republican part of Virginia? Even more R than Southside or the Shenandoah Valley……

    • More agreement, Peter. Tell it like it is and was! Thanks. Unfortunately, Cville Resident also is correct. They keep voting Republican. Both parties are bad, but not always in the same way.

      • And don’t get me wrong. I have a lot of sympathy for these people. But you also have to respect democratic choices. If these same people keep re-electing politicians who don’t vote to expand Medicaid, who am I to say “expand Medicaid” on their behalf? I could understand if the elections out there were close. But they’re not. The GOP just demolishes any Dem that runs for the state house, even when the Democrat is well-funded.

        • So long as the Democrats are pursuing their Cultural Marxism, the Republicans will continue to do well, even though their economic policies harm these people. Of course, the Republicans will only give them rhetoric for their votes, nothing more.

    • The only person I accuse of laziness on this thread is you. You were intellectually lazy when you used the suffering of a number of people to try to make a point that couldn’t be made.

      Did the corrupt Virginia legislature allow unscrupulous coal mining companies to ravage the land without repairing the damage? Yes, they did. This is anti-capitalistic. Proper capitalism is based on a deep sense of property rights. When one party violates the property rights of another it is the government’s responsibility to stop that violation. The violating party owes compensation to the violated party. When the corrupt state government in Virginia took money from the coal companies and allowed those companies to violate the property rights of others it should be seen as a socialist or communist act. In effect, the government’s inaction implied that the government had property rights to all of the property and could decide not for force respect for private property rights. Had the government respected the private property of all of its citizens it would have come down on the side of those whose creeks, streams and groundwater was being ruined.

      You are seriously confused about what capitalism really is. Perhaps you spent too much time in the former soviet Union and simply forgot.

      Good to see you like the German approach. You know what Germans like? Capitalism.

      http://finance.townhall.com/columnists/danieljmitchell/2014/10/12/believe-it-or-not-a-communist-nation-is-the-worlds-most-procapitalist-country-n1903963/page/full

    • Capitalism aside: — Peter, you did say at the outset, “the riches that should have helped pay for local medical care went out of state.” So, why doesn’t WV tax these extractions and provide the medical services that are needed — especially if KY can find a way? I agree with you about Medicaid expansion in VA for Virginians, but as for your snipe about out-of-state corporate thievery of natural resources, what’s that got to do with it? Who ELSE is going to take care of the local folks if their own politicians don’t?

  11. The bottom line is that Europeans simply provide better healthcare at a lower cost to most of their citizens. Period. The US does not. The fact that it’s govt provided and therefore ‘socialist’ is anathema to many here. So in fact, the answer to those who earlier wondered what capitalism has to do with healthcare? I would say everything. After all, the sicker you are, the more money those pesky insurance companies make. And if it’s a catastrophic illness, well, too many people have to go bankrupt or sell their homes to survive…

    So as long as we don’t get it, we’ll continue to have free clinics, and higher rates of illness and mortality than those countries that do get it…….

    http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

    • Many foreign nations first addressed health care on a broad-scale basis on a greenfield basis. So it was easy to launch a plan that treated virtually everyone the same. It’s similar to what the U.S. did with Social Security and Medicare.

      For historical reasons, the United States expanded health insurance on a broad-scale basis through employers. The feds put in wage controls during WWII and employers needed a way to reward their employees. Health care was not covered by the wage controls. Then WWII was followed by a period of great prosperity and little competition. Health care expanded. But as the economy continued to change, some didn’t get health care. Illegal immigration carved at the economic bottom, and globalization put caps on worker earnings. And we also see a winner take all economy. Wall Street gains, not by funding businesses, but by arbitrage.

      In this environment, to expand health care, you need to take from many to give to some. But like it or not, Americans are not willing to give up much of anything so that someone else can get something. Look at labor unions. They were strong supporters of the ACA, but are fighting to preserve their better than average plans. Many younger people are refusing to join insurance pools because they don’t want to pay big subsidies for the sick and elderly. Federal, state and local employees will fight tooth and nail not to weaken their policies. (And no they are not a step away from bankruptcy, because they are guaranteed by Uncle Sam to be able to purchase discounted insurance until they and their spouse both die.) In the United States, socialism is giving up what you worked for so that someone else can get something for little or nothing.

      And, Larry, I know you don’t think this is fair. But I’m not arguing fairness, just reality.

      • not a question of “fairness’ TMT . It’s a question of equitable treatment by the govt.

        Employer-provided health care is a govt entitlement that costs the US treasury 300 billion a year as well as guarantees insurance to some people but not others.

        this is not the fairness or unfairness of life – this is inequitable treatment by the govt towards some citizens and not others.

    • Everybody should stop over-using the “socialist” pejorative. The United States Marine Corps is provided by the government. Does that make the Marines “socialist”? Neumann is right about people jumping on that term when it really isn’t appropriate.

      Total government spending as a percent of GDP is a better gauge of whether a government leans socialist than a government’s approach to health care (or any other single thing). By that measure, even under the current administration, the United States isn’t very socialist at all. Our government spends a lower percentage of our GDP than almost any other developed country (Australia is a notable exception).

      So, contrary to Tea Party belief, our government doesn’t actually spend too high a percentage of our GDP. However, the question remains as to whether our government is honest and competent. Here’s where I have issues. I see very little reason for faith in the honesty and competence of our government at any level. A lot of our money seems to be wasted, siphoned off to crony capitalists, special interests, campaign contributors and who knows what else.

      If you want a more economically just society the capacity to spend (without getting into the socialist realm) exists. However, the confidence in our elected officials largely does not exist.

      How many politicians cried crocodile tears and howled fake howls of derision at the Citizens United ruling? How many went out and led an effort to amend the Constitution so that there could be no doubt as to whether corporations (or unions for that matter) had the same rights as people?

      Both sides are too corrupt to be given any more of our money to spend.

  12. ACA is still in its infancy, and certainly needs to be tweaked considerably. That said, I don’t think that that our primarily privatized healthcare system has much of a future in the long term. It’s inefficient, wasteful, needlessly complicated and too expensive. There’s just nothing inherently wonderful to recommend it. Eventually healthcare will evolve, like so many other things in this country, even if we arrive at that place in a much different way than Europeans did.

    Remember, trend is not destiny.

  13. Not so random in sw virginia, groveton. It us a failure og capitalism and promise

  14. Excellent points on where the wealth went. Where, indeed? We are still dealing with a 19th century model of capitalism that we all genuflect before.

  15. Esoecially YOU groveton.

  16. Don,
    I Agree. But the Marines are a bad comparison. They were part if of the constitution. We pay taxes so they and other armed forces will protect us. Ditto other services
    This does not say there should not be single payer health. If it us good for the Marines, it should be good for

  17. Guess some people here never heard of the Hillbilly Highway. Every June, right after high schools graduation ceremonies, the roads were filled with kids heading North. They went to steel mills, assembly lines, tool and die factories, Goodyear Tire and even to low end DC government jobs. Others joined the time honored tradition of the military draft or enlistment. They would join relatives in Cleveland or Detroit who had made the journey before. That was then. How many of those rust belt jobs are left now?

    Those that stayed mined coal, ran the coal trains, worked for the Dept. of Highways, cut timber, or took over from their fathers the job of subsistence farming.

    I remember as a kid back in the 60’s my grandfather took me through an old town scheduled to be flooded by dam construction. There was an Agriculture outlet there with a line of people outside. I asked what that was about, and my granddad said, “Those are folks beggin commodities. That’s food from the government. They don’t have any ground to grow food and soon they hain’t no place to sleep.” Back then you had to be in really dire straits to accept anything from the government. That’s hill culture and it just wasn’t done. I hated digging in gardens, but the mental picture of those people stuck with me for years.

    When it came to doctors, you worked your own deal while the Dr. charged what he thought you could afford. Sometimes we paid the bill by bartering, say a pickup load of sand and gravel, or brush cutting around his fishing camp down on the river. Now a days the Dr. may be from someplace like the Philippines, working a couple of years in the sticks to get a chance at US citizenship. As soon as time is up, it’s off to the big bucks in NYC.

    In the old days, people had pride. Eventually you use it all up.

  18. A powerful comment that rings true from a past much forgotten today.

  19. re: why do rural folks vote Red?

    not just that way in Va but most of the South.

    Perhaps another question is why they think they can go to the ER and get treated when many who do know they cannot pay for it.

    why does anyone think they are “entitled” to go to the hospital to start with?

    when you go to the Doctor – virtually every one of them has a sign that says “payment is expected at time of service” and some credit card logos.

    what if the entrance to the emergency room said that also?

    so here’s the problem with the “anti” folks. They say, like TMT, that we’re “giving” something away to people who did not earn it” when we created Obamacare and the MedicAid expansion.

    but did we really if we promise free access to the ER anytime anyone wants to go?

    this is really an ignorant argument in many respects as it basically boils down to HOW you want to pay not IF you want to pay.

    Do you want to WAIT until someone who never goes to a doctor shows up in the ER with thousands of dollars of necessary treatment for an undetected problem…

    or do you want folks going to primary care to screen and detect disease and treat it when it’s far cheaper?

    TMT think’s it’s a “too bad, you’re late to the entitlement party” – problem so that folks who get employer-provided courtesy of the govt just got there first – and nothing is left for the late comers.

    Make no mistake -there are millions of people who work and pay taxes that don’t get the tax breaks for insurance that employer-provided get.

    Make no mistake that the people with employer-provided get special govt protection that prohibits the insurers from canceling policies on people whereas no such protection is accorded to those who had to buy insurance out of pocket on the market.

    so it’s thrice dumb.

    1. – not providing the same access to insurance to ALL people who work ..

    2. – thinking that people without insurance don’t go to the ER for treatment

    3. – thinking that others who have insurance don’t pay for the folks go to the ER

    but the biggest FAIL is the simple fact that the “anti” folks have never put forth any serious alternative and continue to blather about “ideas” like tort reform and insurance across state lines.

    Has anyone given even the most rudimentary thought to what it means to require insurance companies to sell across state lines?

    is it imposed by the Feds?

    whose state regulatory rules apply when buying across state lines?

    If Blue-Cross is selling insurance in Va and NC – why would someone go buy the NC Blue cross?

    how does any of that deal with denial of insurance to those with pre-existing conditions?

  20. ‘LarryTheG’, I do not envy your perseverence. It’s obvious that to many, if you can’t afford to get health care you don’t deserve it. Remember the republicans applauding the idea that an uninsured person should just die? That was in 2012 at one of their endless ‘debates’.

    Remember the republican/capitalist/conservative health plan: Die Quickly!

  21. I’m accused of being “liberal” here but I’m far more fiscal conservative than those who throw that pejorative…

    the problem is that Gruber was correct.

    since WWII – people think that it’s the employers that are providing health insurance to their employers and that those who do not work for an employer who offers it are not worthy … they did not work hard enough to get a “good” job.

    which is in my view worse than ignorant but it is what it is.

    The reality is that if the govt did not provide 40% worth of tax breaks and rules that prevent denial of insurance to those with pre-existing conditions – that insurance that employers offered would be exactly the same as insurance offered in the marketplace,

    So it takes a significant level of denial and hypocrisy to continue to assert that those with employer-provided “deserve it” and those without it do not.

    TMT changes his tune from time to time shifting back and forth from the “they don’t deserve it” to ” they got their too late for their free entitlements” song and dance.

    So we have people working full time jobs – paying taxes – who are denied the tax breaks and denied the protections for pre-existing and our excuse is either “you don’t deserve it” or ” sorry, you’re too late, we’re out of entitlements”.

    I believe in individual responsibility – yes – but I also believe if the govt is going to be involved – it should be equally for all – not discriminatory.

    and the thing is – we all pay for the ones who can’t get insurance – anyhow.

    it’s a moral issue but it’s a much bigger fiscal conservative argument. Why in the world would we pay for others – in the most expensive way possible so we can pretend.. they don’t get care or don’t deserve it?

    Here’s my thing. – and I’m not alone on it – I’m joined by Mitt Romney and CATO and even Heritage.

    take away the govt benefits for employer-provided and see what happens.

    at that point – you’ll find out what people really think about access to health insurance. CATO/Heritage thinks the free market will result. It will – and we’ll end up with 3 times as man uninsured as we have now.

    so my primary goal is to make sure people understand the truth about the govt involvement in employer-provided an not allow them to pretend.

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