Krugman on red state/rural healthcare crisis: from facts to politics

Paul Krugman takes up rural issues again today in his New York Times column.  The headline is "Self-Inflicted Medical Misery.  Red America’s homemade rural health crisis."  His jumping off point is the Washington Post's recent coverage of a remote area medical clinic in Cleveland, Tennessee, population 41,285.    The headline for that WaPo coverage was gut-wrenching, "'Urgent needs from head to toe’: This clinic had two days to fix a lifetime of needs."

In his op-ed column, Krugman characterizes what is happening in rural America as "a severe crisis of health care availability, with hospitals closing and doctors leaving."  But Krugman's real focus is on policy, and he reprises the common "it's their own damn fault" mantra.  Krugman writes:

Tennessee is one of the 14 states that still refuse to expand Medicaid under the Affordable Care Act. So I’m not sure how many readers grasped the reality that America’s rural health care crisis is largely — not entirely, but largely — a direct result of political decisions. 

The simple fact is that the Republicans who run Tennessee and other “non-expansion” states have chosen to inflict misery on many of their constituents, rural residents in particular. And it’s not even about money: The federal government would have paid for Medicaid expansion.

Krugman thus concludes that rural America is suffering largely because of "gratuitous political cruelty," and that cruelty is a product of meanspiritedness and a "cynical calculation" that rural voters will continue to blame Washington--and not Republican-held state capitals/governors--for the federal benefits they don't get.     

Krugman also closes the causation circle on the loss of health care resources in rural communities--a loss that also has implications for wealthy rural residents:  a reason that hospitals are closing and doctors are leaving rural America is that Medicare expansion did not occur.

Lastly, here's a video segment produced by the New York Times and published a few days ago about the push for Medicaid expansion in North Carolina. Among the voters featured here as supporting Medicaid expansion are life-long Republicans and folks who voted for Donald Trump in 2016.  Governor Roy Cooper is supporting Medicaid expansion, but Republican legislators are opposing it.  One of the posters pictured at Medicaid expansion rally appeared to show the locations of hospitals that had closed due to North Carolina's decision, to date, not to expand Medicaid.