KILLED BY A THOUSAND CUTS
Writing about the state of health care in the US these days is like standing on a dismasted ship in the middle of a hurricane. No one knows where this all is going. Those who saw hopeful signs of a country on the verge of agreeing that universal coverage should be a bedrock principle on which to recraft and remodel the clinical and educational health systems have seen that movement undermined at a federal level. Those who saw socialist conspiracies on every page of the Affordable Care Act (ACA, Obamacare) railed against government health care but lost ‘bigly’ in the Congress. Now they have infiltrated the federal government with managers whose sole goal is to kill the ACA by a thousand cuts. To keep going, those of us educating future family doctors to practise in underserved communities often engage in magical thinking and pray for pixie dust.
HOLDING THE ‘UNDESERVING POOR’ HOSTAGE
As always, those in communities with the fewest resources, who have just recently begun to believe that health care would be there when they needed it, stand to lose the most. Beginning with Nixon and expanded dramatically by Reagan, and now enshrined by the current administration, Republicans have always played the ‘undeserving poor’ card. The stereotype of low-income families as lazy, entitled, and lacking in self-reliance has been countered by the facts for decades. Yet, the latest administration fantasy — that Medicaid recipients should all be working — seems to ignore the fact that most recipients who are …
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