HEALTH CARE/Joan Retsinas

The Many Ways to Lose

In the spirit of Elizabeth Barrett Browning, let me answer Donald Trump’s question to minority voters: What do you have to lose?

Let me count the ways – not just for minority voters, but for everybody who is not protected by a trust fund.

First, health insurance. Mr. Trump promises to repeal Obamacare, replacing it with “something terrific.” In the meantime, people who were formerly uninsured have gotten insurance. Drop Obamacare: they will lose insurance, until that “something terrific” kicks in.

Obamacare allowed states to expand Medicaid. Families whose incomes were too high for Medicaid could sign up for the expanded version. Drop that option: millions of people – mostly working families - will lose insurance. In fact, the number of uninsured families remains high in those states that did not elect to expand Medicaid. Under Mr. Trump, a lot of Americans will rejoin the army of the uninsured, again, until the “something terrific” kicks in.

Second, environmental protections. Poor people are more likely to live in or near polluted sites, including Superfund sites. If you wonder where the worst sites are, check out the Environmental Protection Agency’s EJSCREEN ( Not surprisingly, the sites with the highest pollution indices are home to people at the lowest incomes. The federal government has been key – admittedly, not as vigilant a key as possible, as desirable – in cleaning up our air, water, and land. The federal government, though, is the only hope. The much-vaunted private sector is not about to morph into a pro bono Superhero.

Third, vaccinations. The government has made a slew of vaccinations widely available, including those for flu, pneumonia, polio, HPV, tetanus, whooping cough., measles. Getting government out of people’s lives may mean getting government out of the vaccine delivery system. (And erecting stringent immigration screens that bar people without documentation from getting basic care, including vaccinations, puts everybody – with and without documentation – at risk.)

Fourth, workplace safety protections. Conservatives point to voluminous restrictions on businesses. But the workers at the lower rungs of the workplace depend on those restrictions. Review OSHA’s Severe Violator Enforcement Program. The people most likely to suffer are not the white collar executives, but the line-workers. For instance, OSHA recently fined an Ohio chicken processing plant for multiple safety violations. One teenage worker who cleaned the liver-giblet machine lost a leg; another worker lost two fingers cleaning the fat-sucker machine. After those “incidents,” the company fired both workers.

Fifth, neighborhood health clinics. The safety net of public clinics is beyond porous –lacey, thanks to budget cuts. But millions of people depend on those clinics – people with and without insurance. Yet Mr. Trump is not promising to rebuild that infrastructure.

Sixth, housing safety regulations. All those tiresome rules about fire and safety codes. They absolutely hinder the zealous private sector that builds most homes. Wealthy tenants and homeowners can insist on “quality.” The poor cannot; they depend on the government to watch out for them. Indeed, millions of poor tenants depend on the government to subsidize their rents, as well as to see that the landlords provide “safe” housing. Without the subsidies and the oversight, some people would end up homeless.

For decades the federal government has worked to improve the nation’s health through a series of concerted complicated actions, from Medicare to Medicaid, from the Environmental Protection Agency to OSHA, from neighborhood clinics to vaccinations. Boggling details. Candidate Trump scorns the pettiness of specifics. He offers few hints on what he would do. Yet he asks poor voters what they have to lose?


As for those Americans fortunate enough to be wealthy, they too would lose. Trump-world would split sharply into two classes: wealthy and poor. To glimpse the future, visit a major city in the developing world, with its beggars holding forth beside skyscrapers. Or browse an archive of Dorothea Lange photos of rural farmers from the Depression. The lowest rungs of Horatio Alger’s ladder would sink even lower. Maybe we’d pay less in taxes, but the costs of living in that world far outweigh the tax savings that Mr. Trump et al promise. We would be making America not greater, but sicker.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, October 1, 2016

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