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Thanks for this careful take on the compelling economics of Medicaid expansion. My view: it's not really about economics. It's about white supremacy.

Exhibit A: Seven of the ten Medicaid non-expansion states seceded from the Union and became part of the Confederacy. If you think that's coincidental, there's a bridge in Brooklyn I'd like to sell you.

Exhibit B: Of the other three non-expansion states, only one (Wisconsin) was fully a "free state" during the Civil War. One out of ten. Another, Kansas, was fully a "free state" in name only. Remember "bloody Kansas"? Kansas residents fought their own vicious, intensely violent version of the Civil War starting years before the War's official outbreak in 1861: https://en.wikipedia.org/wiki/Bleeding_Kansas.

The tenth non-expansion state, Wyoming, didn't become a state till decades later, in 1890. For the purpose of this historical narrative, it didn't exist.

So, of the nine present-day Medicaid non-expansion states that existed as states in the Civil War, seven were traitors who fought to keep Black folks enslaved rather than keep the USA together. Seven out of nine. I'd call Kansas — literally and figuratively — a split decision. So, kinda seven-and-a-half out of nine ... 83%.

I leave you to draw your own conclusions about the deep-seated moral filth revealed in this rough analysis.

One more thing. Why do we have two separate federal programs in the first place, Medicare and Medicaid? Medicare was originally envisioned as a program of universal care. Southern Democrats — Dixiecrats, the "solid South" congressional voting bloc — said no way, 'cuz it would mean givin' Black folks — known by the n-word — the same rights and resources as White folks. Dixiecrats vowed to let everyone sicken and die before allowing that to happen. So we ended up with two programs and a broken system. Maybe Alan Unell has already written about this racist origin story. If not, hey, how about it?!

Side note: the same racist policy and strategy prevented communities from keeping the beautiful public pools that families had long enjoyed. White supremacists had these pools filled with dirt, wiped off the map, rather than share these treasured amenities with people of color.

So yeah, the economics of Medicaid expansion make perfect sense — if only it were really about economics and not white supremacy.

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Thank you for the history lesson. I really appreciate it. I was aware that when Medicare passed one senator, demanded a 20% copay in the hopes that black subscribers wouldn't pay and would die earlier. Your comment makes that all seem accurate. I am just shocked at how hateful people can be. Anyway, thank you.

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