Of chickens, eggs and Medicaid expansion in Georgia

Republican Brian Kemp argues that jobs must come first in rural communities – which then will make broadband and health care economically feasible.

The pair have yet to make a side-by-side appearance that might draw out their differences. Thus far, comparison shopping has been limited to last month’s annual gathering of the Georgia Chamber, where Abrams and Kemp were brought to the stage one at a time, to make their case before perhaps a thousand business and political leaders.

The two didn’t appear too far apart on the need to bring greater internet access to rural Georgia. Access to health care was another matter. Abrams, as she has done elsewhere, mounted a full-throated argument for Medicaid expansion – as offered by the Affordable Care Act.

"For Georgia, this is an economic opportunity the likes of which we will not see again," Abrams said, pointing to $8 million in Medicaid dollars that have bypassed the state every day since 2014. She pointed to Glenwood, Ga., where the loss of the hospital resulted in the departure of a bank, pharmacy and other businesses amounting to 30 percent of the community's economic base.

Her remarks won applause from a largely Republican audience.

In his allotted 25 minutes, Kemp spoke of cutting regulations and cutting taxes. But he devoted only a single sentence to the medical needs of rural Georgia: “As governor, I’ll also tackle health care, to lower cost and improve access,” he said.

In a subsequent scrum with reporters, Kemp was pressed to elaborate – on Medicaid expansion, in particular, which could extend health care coverage to nearly 500,000 Georgians.

“Throwing more government money at a failing system is not going to be helpful to rural Georgia,” Kemp said. “If you don’t have a tax base in rural Georgia, if you don’t have people that are working there, it’s going to be hard to support a local hospital.

“So we need an innovative governor that’s going to work with those folks that have rural hospitals to see how we can innovate, how we can look at other revenue resources,” Kemp said.

But expanding Obamacare is not one of those innovations, the Republican maintains.

We’ve been here before, or somewhere close by.

During this campaign, many have declared that rural Georgia requires something like the New Deal assistance that FDR pushed through Congress during the 1930s. Rural electrification is often cited as a parallel.

The question was on my mind last weekend, when I happened to sit in on a talk by Joe Crespino at the AJC Decatur Book Festival. Crespino is chairman of the Emory University history department. On Sunday, he was hawking copies of a new book, "Atticus Finch: The Biography."

Crespino is a longtime resident of the Depression-era South. So I shot him a note the next day. Is rural electrification, which brought the light bulb to millions of Southerners, an appropriate parallel to what’s needed today?

Yes and no, he replied.

As far as rural broadband goes, the comparison works, said Crespino. “That’s just a straight-up direct analogy with electrification. The problem with electrification in the 1930s was that no private business wanted to commit the resources to build the power lines back in the hollers and rural areas where you were not going to have the number of subscribers to justify the cost,” he said. “So, you do need greater government incentives.”

And Medicaid expansion in rural Georgia? The better parallel is what happened to King Cotton, Crespino said.

Say what?

Think market irrationality, he began. After the Civil War and emancipation, the rural South drifted into a sharecropper economy – a logical development, given that farm labor was suddenly mobile and landowners had little capital.

But under the stress of the Depression, the system went into a death spiral. It became irrational. “You had poor Southerners, white and black, planting more and more cotton, flooding the market, driving the price down,” Crespino said.

The Roosevelt administration responded with the first-ever federal crop subsidies. Farmers in Georgia were paid not to grow cotton, in order to create scarcity and drive up the price.

The program was greeted with suspicion, if not outright hostility. In his autobiography, "An Hour Before Daylight," Jimmy Carter noted that, to his father, the cotton subsidies were "a totally unacceptable invasion by the federal government." Even though they ultimately worked.

The subsidies also turned the elder Carter into a follower of Eugene Talmadge, the former president wrote. The demagogic champion of white farmers, who would become an infamous segregationist, rode opposition to the cotton program into the Governor’s Mansion.

Now consider the American health care system. It grew spontaneously in the mid-20th century, tied to employment. Its well-known shortcomings included a ban on insurance for pre-existing conditions, which chained many a parent to a single company for a lifetime.

But when employment disappears from a region, as it has from rural Georgia, an employment-based health care system becomes an irrational one, Crespino noted. Which is why seven rural hospitals have folded in Georgia since 2013. More are expected to follow.

The Affordable Care Act can be seen as a federal attempt, as with cotton subsidies in the 1930s, to correct a cycle of irrationality. There are other commonalities, too. Inequities, for instance. Large landowners were the biggest winners in the 1930s. With the ACA, insurance companies are, Crespino said.

Both the cotton program and the ACA have played into the racial politics of their day.

“I heard on the streets of Plains a steady stream of racist condemnations of the federal government’s programs that ‘paid the worthless [African-Americans] not to work,’” Carter wrote in his boyhood memoir.

We currently have a big push among Republicans to tie Medicaid benefits to work – or, at least, job training. “I believe in helping our most vulnerable, but requiring work from those who can,” Kemp says in one of his softer TV ads of the general election.

But only November will tell us whether rural Georgia of the 1930s has an even larger lesson for us — which could be that economic rationality and political rationality are two entirely different things.

Credit: Kenneth Rogers

Credit: Kenneth Rogers