What’s the matter with Kentucky?

My liberal friends are anxiously reading Alec MacGillis’s, Who Turned My Blue State Red, in the Sunday New York Times about growing Republican strength in poor communities. Alec brilliantly explores why eastern Kentucky and similar locales support Republican politicians pledged to cut Medicaid, Food Stamps, and disability programs that specifically benefit these very communities.

MacGillis notes two key points. The first is depressingly familiar: low voter turnout among the specific people most harmed by Republican policies.

The people who most rely on the safety-net programs secured by Democrats are, by and large, not voting against their own interests by electing Republicans. Rather, they are not voting, period.

MacGillis presents reams of figures that document the simple fact that nonvoters are much more likely than voters to be uninsured, to be unbanked, to have serious unmet economic needs.

The second point is more interesting and more comprehensible at a human level:

The people in these communities who are voting Republican in larger proportions are those who are a notch or two up the economic ladder… And their growing allegiance to the Republicans is, in part, a reaction against what they perceive, among those below them on the economic ladder.

These Republican voters are not particularly lashing out at supposed others, be they immigrants or black residents of the inner city. Rather, these voters are reacting to their own neighbors and perhaps friends and relatives, who rely on food stamps, Medicaid, or disability payments and who don’t seem fully deserving.

I’m not sure what lesson this provides, from the standpoint of either politics or policy. Supporters of expanded social provision must find better ways to engage poor people, to get out their votes. We can also find more opportunities for fruitful alliances across economic and ideological lines. Over the next several years, I am confident that Medicaid will be expanded across the South, despite widespread opposition. There’s too much money at stake for too many people for the battle to continue much longer after President Obama leaves office. Some tightening of particular programs may help, too. On balance, it’s probably a good thing that federal disability programs have tightened some of their procedures in evaluating mental health and musculoskeletal conditions that have shown the greatest increase in recent years.

Whatever the political or policy lessons, Alec’s essay captures a basic human reality, aptly summarized in the title of Paul Thorn’s great country song: “I don’t like half the folks I love.” 


Viewed from afar, one might think that categories such as “deserving poor” or “disabled” are reasonably clear-cut. Viewed up-close, things seem much more fuzzy. Many people who rely on public aid straddle the boundaries between deserving and undeserving, disabled and able-bodied. Many of us know people who receive various public benefits, and who might not need to rely on these programs if they made better choices, if they learned how to not talk back at work, if they had a better handle on various self-destructive behaviors, if they were more willing to take that crappy job and forego disability benefits, etc.

It’s easy, even viewing our own friends and relatives, to confuse cause and effect regarding more intimate barriers. A sad reality of psychiatric disorders is that the very symptoms which inflict mental pain on the sufferer can make themselves felt to others in ways that undermine empathy and personal relationships.

Across the Thanksgiving dinner table, you see these human frailties and failures more intensely and with greater granularity than the labor economist could possibly see running cold data at the Census Bureau. But operating at high altitude, the labor economist sees structural issues you can’t see from eye level.

There have always been vulnerable people, whose troubles arise from an impossible-to-untangle mixture of bad luck, destructive behaviors, and difficult personal circumstance. That economist can’t see why your imperfect cousin can’t seem to get it together to hold a basic job. She can see that your cousin is being squeezed out by an unforgiving musical-chairs economy. Every year, in the backwaters of America, that economy seems to put out fewer and fewer chairs.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

21 thoughts on “What’s the matter with Kentucky?”

  1. Solution – give Medicaid, food stamps, free public college tuition to Ivanka Trump, the rest of the Trump kids and to EVERYBODY. Pay for this by restoring the Eisenhower tax rates. Let there be only one means test in the nation – the tax code.

    People love big government when it is fair and when it is simple. Social Security is just great and beloved. Medicare not quite as simple but still pretty good.

  2. Some tightening of particular programs may help, too. On balance, it’s probably a good thing that federal disability programs have tightened some of their procedures in evaluating mental health and musculoskeletal conditions that have shown the greatest increase in recent years.

    I've brought this up before, but it's something I dealt with when I was unemployed, on the autistic spectrum, and dealing with depression and fibromyalgia. (So, both mental health and musculoskelaton, at least by symptoms.) I was able to work the jobs I was applying for long before anyone who knew about my conditions was willing to hire me. Having a condition that means people won't hire you effectively is being disabled for all practical purposes, no matter how able bodied one might be.

  3. A couple of thoughts:

    Totally agree with the free college for all. It gobsmacks me that this is seen as some wild and crazy idea. I grew up in New York City, where the city college system was free until the 1970’s and nobody thought that was at all extraordinary. Now I live in Cincinnati, another city that once had a free university for its residents. And I don’t think we have to fear the free colleges being overrun with the children of the one percent. They will continue to enroll in the Ivies and similar schools.

    Two, I just went to a workshop for parents of children with disabilities on applying for Social Security as they reach adulthood. I came away understanding that even though my son is on the autism spectrum and is only moderately functioning, there is a very good chance he will be turned down (a 65% chance). It makes me nauseous just to type that. My husband and I really are going to have to live forever. Makes me hate this country. What a miserable, hateful people we are.

    Three, we used to have a national organization dedicated to getting low income people registered to vote and involved in the political process. You may have heard of it. It was called ACORN. I’d never heard of it until it was de-funded and forced out of existence but clearly the Right-wing knew all about it and understood what a threat it posed to them.

  4. It's not easy, but what can really help is that for long-term aid you have strings attached in return, like completion of provided education, training, psychological therapy, and so on, then at least people can see the recipients are made to earn the money with work in the classroom and other self-improvement.

    And a big problem is that even people of good character, in today's high-tech world, can easily end up with no health insurance, or laid-off and unemployed long term, or sick, with no way to get treatment. The safety net is really needed by people of good character too in today's world.

    1. I'll add some more things too:

      First, another thing to do is push for aid to disadvantaged children. If you provided Medicare to all children, then there wouldn't be this feeling that these are just these lazy, no-good, undeserving moochers, as most people give children a chance to develop character, even if they have flaws now, which is expected of children in general. So we can really push for, especially, high social return Heckman-style early human development investment.

      Some might say that free health insurance for someone's children is helping that lazy low character person, but look at our free K-12. Few think this is an undeserving $10,000/year given to lazy adults, as opposed to children, at least not now that it's long been the status quo. I think the same would largely be true for free Medicare for all children, and free preschool and pre and post natal care for most children, and high quality developmental day care, etc., once it became the status quo. It would be for innocent children, and so that our country wasn't third-world with a large little-educated segment of our population.

      Second, a big problem is that people don't realize how small the cost of aid to the poor is as a percentage of total government spending, and of GDP, and that it would be more costly in crime, prisons, disease, and other social problems and costs not to spend it. And that to some extent it's unavoidable and well worth the cost to have some money going to low-character people so that the responsible and good character majority can have social insurance, which almost everyone really needs in today's very risky world. You can find fraud in private homeowners and health insurance, but it's well worth paying this price, which you'll never get to zero, so your family is not terrible at risk.

  5. Great post. There is always a strain of "I did it so why can't they do it?" in human nature. To me, what is fundamentally depressing is that the golden era when things seemed to be getting better – economically and socially – for most looks more aberration than trend.

  6. It's like you can't accept as real what the proles see all around them. Look, I know somebody who's worked insanely hard all their life, getting up at hours I consider mad, (And I'm a morning person!) to pull more than one job. Now she's got Lupus, and the preventative radiation for her lung cancer is going to render her mentally disabled, and she's on disability. And I don't mind a bit, *because she's disabled*.

    I know another person, very personally likable, who's on disability. She's not disabled at all, in fact, she's running a small business on the side, off the books. Works quite hard at it, and I'm ideologically predisposed to admire entrepreneurs, but the fact remains, she's on disability, *and she's not disabled.*

    The lady across the street is on disability too, and again, it's real, But, that's three people I know on disability, and a third of them are faking it.

    "the labor economist sees structural issues you can’t see from eye level." Just the latest version of, "Who are you going to believe, me or your lying eyes?" These people are opposed to redistribution, because they can see with their own eyes that a lot of people are gaming the system, They're opposed to redistribution, because in a way, redistribution is like opiate painkillers. Opiates are necessary for people who are in serious pain. *They're addicting for people who aren't.*

    Finding a better way to distinguish isn't just something that would be nice. It's important. Because redistribution to people who don't need it isn't just waste. It' corrupts people.

    1. So, 2 out of 3 are *not* cheating.

      And for the record … while the side business seems clearly out of line, which we might want to adjust… I am not clear that you yourself actually *know* that this person isn't disabled. Afaik, and I could be completely wrong… "disabled" is contextual, based on the profession, so you can be disabled for a category of things, but not for all of them. (Or, I could be wrong! Not sure.) I bet someone here knows.

      1. It's also important to note what sort of disability payment someone is receiving. Private disability policies are usually written such that you qualify for payments if your are disabled for the specific job you had when you took out the policy (or whatever job you had when it was last modified), not for whether you are disabled in general. So it's possible to be legitimately collecting from the policy while working another job, though some percentage of your wages above a certain level will be deducted from the payments.

        That's of limited relevance to this particular discussion, as this is generally not true of government disability coverage, but worth keeping in mind.

      2. Yes, you could be completely wrong, and she was quite frank about it: Claiming disability got her son cheaper tuition at college, she ran the numbers, and it was financially better to be "disabled", so she's "disabled".

        From a conservative standpoint, the essay above just reinforces the negative views about this sort of income redistribution. You've set up a situation where an ever increasing fraction of the population are on the dole. Where, unless you've got better than average income potential, actually working for a living doesn't make financial sense. From the perspective of people who work for a living, this looks horrible, degrading, morally depraved. You're encouraging people to be parasites!

        From the perspective of a politician, it's great: You take money from a small fraction of the population, (Yay, progressive taxation!) give it to a much larger fraction of the population, and rake in the votes from the people you're giving free stuff to, who conveniently outnumber the folks who are net tax payers. Meanwhile you tell the people you're ripping off, that you're buying them peace, that you're the only thing between them and the mobs with pitchforks.

        Only, the damned slackers have just one job, showing up to vote, and they're not doing it! That's what all the pissing and moaning is about, not that so many people are on the dole, but that they're neglecting to vote for you in return. Harold's just confirmed the conservative view of things, that so many of those people who are voting base their votes on: Welfare is politicians buying votes with other people's money.

        And, that's why income inequality keeps growing, because the government wants it to grow: Income inequality is great, if that's your model for staying in power: A few rich people paying you for protection against the mobs, a plurality of people dependent on the government, and thus voting for you, and you're golden. The people in the middle, who make too much to be grateful for handouts, and too little to be a good source of taxes and under the table kickbacks? Perfectly useless under that model.

        You're just mad that more and more people have figured that out, and don't want to be governed by politicians who think they're dispensable.

        1. Actually, under my model, her son wouldn't be paying for tuition at college. No one would pay tuition for public schooling.

        2. Actually no. Poor people don't vote — that was the *point* of the article. So redistributing to them does not in fact benefit politicians. It is the middle and upper class non-haters who reward them for being non-uncompassionate.

          Anyway, this is all a red herring. No one here is arguing against basic anti-fraud measures. Some kind of reasonable after the fact income verification. (Note: wouldn't your friend also have to be lying to the IRS? ) Whereas, the position you *seem* to be advocating (although I can't really tell – are you just trying to explain the haters, or are you one of them?) would in fact result in your 2 worthy friends getting screwed. In every program there is a risk that somebody somewhere will cheat. What I don't understand about conservatives is their desire to punish 95% of people for the sins of the 5%. (And you know what? if your 30% figure were correct – which I doubt – the point would still stand.)

          Those programs won't be there for people who really need them if you keep thinking this way. Is that what you want?

    2. As I mentioned above, I went to a beginner workshop on Social Security Disability recently. It is a pretty byzantine system and I don’t claim to understand it (yet).

      But one thing that was made quite clear is that SSDI recipients are allowed to earn small amounts of money to supplement their (measley) government benefits. Don’t remember the amount, would have to dig through my notes.

      So it is possible that your neighbor is totally legit. Working for herself probably makes it possible for her to arrange things around her particular constellation of abilities and disabilities.

    3. I accept that you've seen three people who you know are on disability and that one of them is faking it. I'm not willing to accept that your sample of three is representative. Sorry for being all mathematical about it, but I'm kind of biased toward valid use of statistics.

      1. I've no idea whether this is representative. I'm trying to explain why somebody in the middle income bracket, personally acquainted with folks on disability, might be down on income redistribution.

  7. Republican Gov. Paul LePage recently began enforcing Maine’s volunteer and work requirements for food stamp SNAP recipients to keep their benefits. The end result was more than 9,000 non-disabled adults getting dropped from the program.

    The rules prevent adults who are not disabled and do not have dependents from receiving food stamps for more than three months, unless they work at least 20 hours a week, participate in a work-training program, or meet volunteer guidelines for 24 hours out of the month. Any one of those three getting met will not result in the loss of their SNAP food benefits.

    Maine Drops 9000 From Food Stamps After They Refuse To Comply With Work Requirement

  8. Even though our GDP says we are a nation of abundance, the right wing has converted us in practice to a nation of scarcity (doesn't hurt that the top layer trousers most of the revenue so that for many people the scarcity is real). So we ostensibly have to make "hard choices" and let some people starve, freeze or succumb to easily-treatable ailments because they're not deserving enough.

    Is the US unique in the population of people wanting to turn their moral judgement into law? I see the same strain in safety-net programs, drug legislation, abortion legislation &c: "I think your decision is morally suspect even when my decision to do the same thing would be morally justifiable, so I will pass a law against you doing this thing."

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