Have you lived in Western style poverty? Have you mingled with those who patronize pawn shops and payday lenders?

Please cite the various randomized control trials, and I would say it is far too early to draw conclusions on the effects of the medicaid expansion as it has only been two full years since rollout.

I speak from experience, as someone from a wealthy family and a wealthy area that shunned the family business and went out with nothing to seek startup fortune. I had a good start in 2009 with a success in affiliate marketing, when that dried up I put all that I had made into another venture that limped along at sub-ramen levels for a while and then I pulled the plug.

The fallout was not fun, and the effects not benign. It was pre medicaid expansion and there was no healthcare to be had, and almost no safety net to be found whatsoever.

I could have gone home and had everything I needed but I wanted to make it on my own. I had been living in Boulder, Colorado and thought a move to Austin would lower expenses and extend the runway for the company.

That was ill-advised, and another story, but it added another dimension to my troubles at the time.

Was it a stupid risk? It was but I was young and felt invincible, and in 2010 with a liberal arts education there weren't a ton of jobs waiting for me.

The wealth transfers you speak of are not easy to get. I'm not even sure where you get the 15-20k number. What else is there for a low earning single male besides SNAP, and now Medicaid.

In that time, as someone who found themselves with no assets and no income the only benefit I seemed to have qualified for was about $160 a month that could be spent at the grocery store.

Feeling a tremendous amount of shame I applied for SNAP benefits, even though I knew that they were really a subsidy for American farmers, ideology had trained me that subsidies for corporations are virtuous, while subsidies for basic human needs are shameful.

Even though I qualified, the overworked staff denied my valid claim. It took them over a month to tell me this. It would have taken another month to apply again and maybe they would get it right that time. I gave up and having good credit financed my nutrition via credit card.

I hadn't coded since elementary school, but I was able to pick up django web dev and find a high paying job in a couple months.

But that happy ending is not typical. There is no way that the stress from that period didn't shave a little bit of time off my life.

And the lack of liquidity prolonged the period by a good bit. I spent so much time doing this or that to get $200 for the rent, it was tremendously inefficient and stressful. Bad terrible memories, a place I never want to go back to. I was sad during all of this. It broke up the relationship I was in with someone I really loved.

I spent a lot of time with those who ride the bus, with those who pawn. Their lives are very different than the lives of the families from my coastal home town. Their lives do kill them slowly, which is why life expectancy is a full dozen years longer for the wealthy.

I have since moved back to the wealthy coastal town I grew up in. Life is so easy here, because there is wealth here. You can get a nice boat for almost nothing because someone just doesn't want it anymore.

Someone I knew was just gifted a boat for $1 because the owner was just happy it was going to stay on the island.

No one ever gives my former bus riding compatriots anything.

The thing is the people that live here are no different genetically than the people at the pawn shops back in Texas. The only difference is the presence of wealth, and the virtuous effects that has when it's sustained for a few generations.