WASHINGTON -- Nobody talks about the poor anymore -- at least nobody who wants to get elected to a political office. While Republicans, according to caricature, are expected to ignore the poor, Democrats are not noticeably more attentive. There is an unspoken bipartisan consensus to concentrate on those constituents who exercise political clout -- those who vote consistently, who turn up at town hall meetings and volunteer in campaigns, who call congressional offices to complain about services cut and programs abolished.
Impoverished Americans have been abandoned as hopeless, too much trouble to bother with. Their problems are their own fault, right? Ronald Reagan's genius was to persuade us that any government effort to help the poor only worsens their circumstances. That's why the budget-cutters and deficit hawks are busy going after health care for poor people: Who's going to notice? Who's going to care?
While the Affordable Care Act, which Congress passed last year, was misunderstood in some quarters as a giveaway to the poor, it is not a program for those who can't afford to contribute to their medical care. The health care program that provides assistance to those without the means for even a threadbare insurance policy is Medicaid, which is funded with federal and state dollars.
As state budgets are pared, governors and state legislatures are slicing Medicaid. Mississippi Gov. Haley Barbour, who is eyeing a run for the GOP presidential nomination, recently bragged that he requires Medicaid recipients to register every year to prevent fraud. Actually, that's an old trick that has little to do with fraud.
If you require a person without child care or a car or even taxi fare to show up at a government office once a year, you raise the likelihood that some will give up and drop out of the program. Medicaid enrollment sags. (How many of us would maintain our driver's licenses if they expired annually?)
Arizona, meanwhile, has become the poster child for life-threatening cuts to health care for the poor with its decision to stop paying for certain organ transplants. Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine, told The New York Times of having to tell patients they are no longer eligible. "The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they're not on the list anymore. The frustration is tremendous. It's more than frustration," he said.
While transplants may be subject to reasonable debate since they are extremely costly, require lifelong pharmaceuticals and may not add much to life expectancy, the same cannot be said of routine preventive medical care. But the latest plans from GOP budget-cutters will cut preventive care, which is cheap and cost effective.
A newly energized GOP House majority wants to cut about $1 billion from community health clinics, which have been a backbone of health care for the impoverished for decades, not only in urban centers but also in rural areas.
According to the National Association of Community Health Centers, the loss of $1 billion -- a third of the clinics' federal funding -- would force staff reductions, shut down centers and leave nearly 3 million people without regular health care.
Efficient and effective, community health centers provide vaccinations for children, high blood pressure and diabetes meds for those with chronic illnesses, and care for routine maladies. They not only prevent deteriorating health in patients, but they also ease the burden on taxpayers by decreasing the patient load in emergency rooms.
And they used to enjoy broad bipartisan support. "This is a really good use of taxpayers' money," former President George W. Bush once said of them.
But a congressional majority that cannot bring itself to cut welfare to farmers, that protects the elderly and that barely nips at the military/industrial complex sees low-hanging fruit in health clinics that serve the poor. It's an odd stance for a group of elected officials who proclaim fealty to the tenets of Christianity. What ever happened to compassionate conservatism?
If compassion is dead, what about pragmatism? If the poor are expected to fend for themselves, they'll need to be reasonably healthy.