Why is America the only wealthy nation that doesn’t guarantee essential health care for all? (We’ve made a lot of progress under Obamacare, but not enough, and the Trump administration is doing its best to kill it.)
Why do we have much higher poverty than our economic peers, especially among children, and much higher infant mortality despite the sophistication of our medical system?
The answer, of course, comes down to politics: We are uniquely unwilling to take care of our fellow citizens. And behind that political difference lies one overwhelming fact: the legacy of slavery.
All too often, white Americans think of the social safety net not as something for people like themselves fallen on hard times, but as a giveaway to “Those People.”
This isn’t idle speculation. If you want to understand why policies toward the poor are so different at the state level, why some states offer so much less support to troubled families with children, one predictor stands out: the African-American share of the population. The more blacks, the less compassion white voters feel.
The story gets even clearer if you look at the implementation of the Affordable Care Act, which allows states to expand Medicaid coverage at federal expense – that is, to provide health insurance to a large fraction of the population at no cost. You might think that this was a no-brainer, and so far 31 states and the District of Columbia have taken advantage of this opportunity. But only two of those states are among the 11 that seceded in 1861 to form the Confederacy.
Which brings me to Virginia, which is holding crucial state elections in four weeks.
Until recently, Virginia seemed to be emerging from some of the darker shadows of its history. The state is becoming more ethnically diverse, more culturally open; it is, you might say, becoming more like America.
Not accidentally, Virginia has also become politically more like America, at least in national elections: Like the electorate as a whole, it supported the Democratic presidential candidate in the last three elections.
But is Virginia’s apparent moral progress an illusion? And if it is, what does that say about America as a whole?
Virginia was, of course, the site of the infamous Charlottesville march by torch-carrying white supremacists that ended with the death of a counterprotester.
More important, perhaps, is the fact that despite its growing political moderation and its Democratic governor, Virginia is among the states still refusing to expand Medicaid, even though that refusal means gratuitous financial hardship for many and a significant number of people dying from lack of medical care.
How is this possible? Democratic-leaning voters are much less likely than Republican-leaning voters to cast ballots in state and local elections; as a result, a politically moderate state has a hard-right Legislature. And there’s a real possibility that it may soon have a Republican governor, too.
Here’s how that might happen: Ed Gillespie, the GOP candidate, is trying to pull off an upset by doing all he can to mobilize the white nationalist vote. He’s accusing Ralph Northam, his Democratic opponent, of dishonoring the state’s Confederate heroes. He’s not only accused Northam of being soft on illegal immigration, but he’s insinuated that this somehow makes him an ally of a violent Central American gang.
These cynical ploys probably won’t change many minds in a state that disapproves strongly of Trump and all his works. But they might mobilize enough angry white voters to swing the election if Democrats don’t come out in equal force.
Whatever happens in Virginia, the consequences will be huge. If Gillespie pulls this off, all the worst impulses of the Trumpist GOP will be empowered; you might think that things can’t get even worse, but yes, they can.
If, on the other hand, Northam wins and Democrats make big inroads in the state Legislature, it won’t just probably mean that hundreds of thousands of Virginians will get health insurance, and it won’t just be an omen for the 2018 midterms. It will also encourage at least some sane Republicans to break with a man they privately fear and despise (see Corker, Bob).
For whatever reason, however, Virginia isn’t getting nearly as much play in national media or, as far as I can tell, among progressive activists, as it deserves.
Folks, right now this is where the action is: Virginia is now the most important place on the U.S. political landscape – and what happens there could decide the fate of the nation.
Paul Krugman is a columnist for The New York Times. Reach him c/o The New York Times, Editorial Department, 620 8th Ave., New York, NY 10018. © 2017 NYT News Service