Ten years ago, I sat in my office in Albemarle doing an assessment on a 40-year-old male client whose treatment was paid for by a combination of state and county funds. He said something that really opened my eyes.
“I can’t stand people getting those government handouts.”
I remember thinking to myself, “Without those handouts, you couldn’t afford me. Heck, I couldn’t afford me.” I kept this to myself, instead building rapport and engaging him in treatment.
In this same job, I had a female client who had applied for much-needed Medicaid, but had been denied. She revealed to me her plan to remedy that. She would feign suicidal ideation multiple times, get hospitalized from the ER, which she couldn’t pay for, and then force the state’s hand. She executed her plan, which was more successful than applying. I remember thinking how sad it was that she had to go through this to get something she obviously needed. Also, how much money did Stanly Regional, her hospital, have to eat in this process?
Year in and year out, the No. 1 source of bankruptcy in the United States is medical bills. This is true across regions, races, and all strata of people. But medical bills also are impactful for those families that avoid crippling debt. An example: While the majority of us taking our children to childcare each morning have healthcare benefits, an overwhelming amount of the teachers working with our children don’t. These teachers, who are instrumental in the development of our children, often lack the healthcare needed for their children to receive adequate pediatric care because they fall in the coverage gap called the doughnut hole. They make too much for Medicaid as it currently is structured in North Carolina. They don’t qualify for the Affordable Care Act. But they don’t have healthcare tied to their jobs.
Like those childcare workers, many blue-collar working adults and their children lack healthcare. This means we have many young people getting behind medically, harming their educational prospects and setting them up for greater medical needs and costs down the road.
These diverse sets of individuals, both urban and rural, would benefit from Medicaid expansion. Stanly Regional Hospital and other rural hospitals disproportionately serving our many uninsured would benefit from Medicaid expansion. Our economy, which would inherit many more good paying jobs, would benefit. Our fight against the opioid epidemic — and other addictions I saw firsthand in Stanly — would benefit. And yet, we have a set of politicians, overwhelmingly upper-class Republican men, who prevent our governor from expanding Medicaid while likely enjoying some of the best healthcare out there.
Many people say identity politics are destructive and divisive. And they’re right. Except it’s not identity politics, which are designed to resist racism, sexism, homophobia, and transphobia, that are truly destructive. It’s the genius political construct of whiteness that for over 100 years has allowed elites to convince working-class white people to stop voting with working class black folks. Instead, those white people vote their race over their wallet while elites pocket profits. It’s why the uninsured white man and white woman I described in Stanly County vote against officials and policies that would give them healthcare, out of fear that it is giving a “handout” to urban black women like my children’s hard-working childcare teachers. Unethical, but genius.
Don’t hate the player — hate the game, they say. Agreed. But isn’t it past time for a new game?