I have referred to states creating their own “insurance exchanges” consistent with Obamacare, as “constructing your own gallows.”  States that are expanding Medicaid are doing further damage by helping to build a constituency.  As George Bernard Shaw famously said, “the government that robs Peter to pay Paul will always have the support of Paul.” Beneficiaries of government loot aren’t likely to vote against someone whose campaign is based on taking those goodies away. 

Creation of vast new numbers of Medicaid recipients virtually guarantees that they will only politically support those who maintain or even increase these benefits.  I agree with Mencken who described elections as “an advance auction on another’s property.”  It thus pains me to provide this political admonition to those supposed “conservatives” out there who are actually considering expanding Medicaid in their states. 

Medicare beneficiaries shred anyone suggesting that this Ponzi scheme be curtailed or eliminated, paying little attention to the rational arguments, reacting many times like an entitled voter bloc.  Same with Social Security.  I’ve heard all the arguments.  “I paid into that.  That’s my money!”  There is no point in pointing out to people who say this that they have probably long since consumed any money they paid in.  It makes no difference to many of them that thieves in Washington made off with the money they did pay in long ago, the source of funds for the current beneficiaries being the future elderly, who will likewise victimize their young. 

One of the cynical truths about American politics is that just as politicians can be bought and sold, so can the voters.  What beneficiary of a government program is going to support the politician advocating for ending this handout?  Every handout from Uncle Sam comes from someone’s wallet.  Increasing the number of folks at the trough adds to the power of those willing to “redistibute” the wealth of taxpayers.  

Justice Roberts interestingly gave the states an “out.”  Why on earth wouldn’t the states seize this opportunity?  Embracing Medicaid expansion will bring financial hardship to those states that take this road and for what it’s worth, wreck political devastation on any state “leaders” that decide to undo this later.   

The big hospitals want this Medicaid expansion.  Many of the big insurers want this Medicaid expansion as this will remove the liability of many of the sickest and poorist of patients from their roles.  “Conservatives” who expand Medicaid in their states will be acting in the interests of the health cartel, giving little thought to future consequences.  American politics.  Everything’s for sale.  Grant favors now, make others pay later.  Current “conservatives” pulling the trigger on future “conservatives.” Yet another Ponzi scheme.

G. Keith Smith, M.D.