Kentucky, Medicaid expansion and Babylon 5

In 1994, there was an episode of the acclaimed sci-fi TV series "Babylon 5" titled "Believers". Here's the basic plot synopsis:

Dr. Franklin faces an ethical dilemma when the parents of a dying child refuse to let him operate for religious reasons. Their son is suffering from a chronic respiratory ailment and will die soon. It can be cured with surgery; however their religion prohibits surgery (believing that cutting into a body will release the spirit, reducing the body to something worse than death—it is something only to be done to food animals). Franklin's associate Dr. Hernandez attacks their beliefs, but Franklin reprimands her, telling her that they have to work with the parents, not against them.

Despite his best efforts, the parents still refuse to allow the surgery. Franklin goes to Commander Jeffrey Sinclair to convince him to order the surgery, but Sinclair refuses, as the cultural neutrality of the station must be respected. Eventually he performs the surgery against orders, saving the boy's life. Unfortunately the parents now consider the son to be a soulless demon and at first abandon him. They eventually return for him saying that they have brought his "travel robe" and are going to take him "to rest." After they leave Franklin checks Hernandez's notes on the species in the medical database and realizes that the boy was wearing a robe used in spiritual journeys, not physical ones. He runs to the family's quarters fearing the implication that "journey" in this case provides, but it is too late. The parents have already murdered the boy.

It's a heartbreaking episode, and the plotline above is clearly based (or at least inspired by) the various real-world clashes between medical science and "faith healing", in particular the controversy over Jehovah's Witnesses and blood transfusions.

Anyway, I was reminded of this episode earlier today when I read this story by John Cheves of the Lexington Herald-Leader about the jaw-dropping cognitive dissonance found in the Kentucky gubernatorial election a couple of weeks ago:

Kentucky counties with highest Medicaid rates backed Matt Bevin, who plans to cut Medicaid

BOONEVILLE — The 66 percent of Owsley County that gets health coverage through Medicaid now must reconcile itself with the 70 percent that voted for Republican Governor-elect Matt Bevin, who pledged to cut the state's Medicaid program and close the state-run Kynect health insurance exchange.

Lisa Botner, 36, belongs to both camps. A Kynector — a state agent representing Kynect in the field — recently helped Botner sign up for a Wellcare Medicaid card for herself and her 7-year-old son. Without that, Botner said, she couldn't afford the regular doctor's visits and blood tests needed to keep her hyperthyroidism in check.

"If anything changed with our insurance to make it more expensive for us, that would be a big problem," Botner, a community college student, said Friday at the Owsley County Public Library, where she works. "Just with the blood tests, you're talking maybe $1,000 a year without insurance."

Yet two weeks earlier, despite his much-discussed plans to repeal Kynect and toughen eligibility requirements for Medicaid, she voted for Bevin.

"I'm just a die-hard Republican," she said.

"I'm just a die-hard Republican," she said.

I went on a little rant about this a week or so ago regarding a different Kentuckian, but the story above is infinitely more in your face about it. I alternated between disbelief, face-palm exasperation, flat-out unbridled rage and eventually extreme depression and dispair as I read each succeeding paragraph:

Owsley County Judge-Executive Cale Turner, a Democrat, said the election results didn't surprise him. His constituents wanted to express their opposition to Democratic President Barack Obama and what they perceive as "the liberal agenda" on social issues, Turner said.

"To be honest with you, a lot of folks in Owsley County went to the polls and voted against gay marriage and abortion, and as a result, I'm afraid they voted away their health insurance," Turner said. "Which was their right to do, I guess. But it's sad. Many people here signed up with Kynect, and it's helped them, it's been an absolute blessing."

The community's largest-circulation newspaper, the Three Forks Tradition in Beattyville, did not say much about Kynect ahead of the election. Instead, its editorials roasted Obama and Hillary Clinton, gay marriage, Islam, "liberal race peddlers," "liberal media," black criminals and "the radical Black Lives Matter movement."

"The people I talk to, health care wasn't even mentioned," said Gary Cornett, chairman of the Owsley County Republican Party. "In Southeast Kentucky, the social issues are important. We're a small, traditional, tight-knit community, and there are certain ways we do things."

The trend seemed to hold across the state. At Transylvania University, political scientist Andrea Malji said she has crunched state data and found a "99 percent confidence level" between the counties' Medicaid enrollment levels and their gubernatorial choices. The larger the Medicaid numbers, the more likely they were to back Bevin, she said. The lower the Medicaid numbers, the more likely they were to favor the Democratic nominee, Attorney General Jack Conway.

...Malji, who is from Pulaski County, where Bevin captured 72 percent of the vote, said she heard people back home denounce "Obamacare" while thousands rushed to sign up with Kynect. They didn't seem to realize that Kynect, Kentucky's response to the federal Patient Protection and Affordable Care Act, is the same thing as Obamacare, she said.

"There's either voter disconnect here, where the people weren't thinking about or weren't aware of Bevin's stance on health care, or these counties just have higher levels of social conservatives who thought it was more important to vote on social issues," Malji said.

The article goes on and on. It's depressing as hell.

I, and many others, have often criticized Democrats generally (and Democratic nominee Jack Conway in particular) for shying away from the ACA and President Obama. After all, a Republican isn't going to vote for a "Republican-lite" when they have the real thing to choose instead, and the last quote above from Ms. Malji partly supports this criticism: Some voters simply didn't know that Bevin promised (repeatedly) to take away their Medicaid coverage, or that both that expanded coverage as well as the kynect exchange which they love so dearly are simply Obamacare under a state-specific brand name.

To that extent, Conway and the Kentucky Democratic Party are indeed partly to blame for refusing to make the connection (or at least doing a lousy job of it).

HOWEVER, the "run away from the President/the ACA" issue is one that's fixable, as long as the candidates and the party choose to make the necessary changes.

It's the second half of Malji's quote which I find far more disturbing.

"These counties just have higher levels of social conservatives who thought it was more important to vote on social issues."

Seriously, assuming that this is the larger part of the problem, how exactly was Jack Conway (or, a couple of years ago, Alison Lundergan Grimes), the Kentucky Democratic Party, the DNC or President Obama himself supposed to deal with it?

How do you win over the mind of someone who genuinely believes that (to quote the article) "gay marriage, abortion, Islam, liberal race peddlers, liberal media, black criminals and the 'radical' Black Lives Matter movement" are more important and a bigger "threat" to the "certain way that they do things" than dying of treatable illnesses like diabetes or emphysema?

I'm not talking about those who didn't know that "Kynect = Obamacare" or who didn't know that Bevin campaigned on taking their healthcare coverage away; I mean yes, that's pretty pathetic and depressing in and of itself given that this was such a high profile part of the election.

In fact, I'm not even talking about the Bevin voters of a higher income; I may still think their priorities are completely out of whack, but if losing Medicaid expansion and kynect wouldn't (directly) impact them, I guess I can at least understand them voting their interests otherwise.

I'm talking about those who knew that they were risking losing healthcare coverage and still voted for Bevin anyway...because of utter nothingburgers like "liberal race peddlers", whatever the hell that is.

How do you argue with these people? How do you get the slightest bit of logic to penetrate their brains when they truly believe the equivalent of "cutting into a body will release the spirit, reducing the body to something worse than death"? How do you convince someone to support you when they honestly believe that doing so would turn them and their children into "soulless demons" and would rather die than allow that to happen?

If Kentucky was disconnected from the rest of the country, at this point I might be tempted to say, "You know what? To hell with them; fine, let them lose healthcare coverage and rot away." Unfortunately, it's not that simple. Kentucky is still part of this country. They control 2% of the U.S. Senate and 1.4% of the U.S. House, as well as 1.4% of the total population. They have resources and provide part of the U.S. economy. In addition, there are many wonderful people in Kentucky as well; do they deserve to be dragged down into the abyss just because their fellow Kentuckians are fools?

I don't know what the answer is. I'm sure many Republicans will snarkily state that the first step is to stop referring to these people as "fools"...but I'm tired of it. I'm tired of accomodating bigotry and hate as being a "different set of values". I'm tired of seeing intelligence, science and knowledge being treated as a negative thing. I'm tired of busting my ass to educate people with factual information about the mountain of lies being spewed at them by the likes of Mitch McConnell, only to have 12th century, racist, homophobic, xenophobic, anti-intellectual theocratic morons spew diarrhea all over it.

No wonder neither McConnell nor Bevin had any problems lying through their teeth; the people were all too ready to either believe the garbage coming out of their mouths...or to not giving a crap about it even if they knew they were lying.

I'm just tired of it all, and am seriously starting to wonder why the hell I even bother to do this.