Salem, where I practice, is not actually super liberal like the Portland area. We're probably a pretty even split down here, but outlying areas are definitely more conservative and especially as you continue south and east (excluding Eugene). But I see quite a few patients that are Medicaid, very difficult situations with multiple chronic health morbidities. The continued lack of social or financial support, resources to help them is what drives my interest in expansion of some social programs that get derailed or defunded in many red states. Many of these people are pretty disabled, yet they can't qualify for various reasons for disability, or the burden to do so is just a huge red tape process. Many have significant psychological problems, have been abused, etc. So many are single moms were the dad just disappeared, or was incarcerated or what have you, that they can't contribute, and any job they CAN do certainly can't support them with current housing costs and rents. Any assistance programs there are have long waits, or not enough funding, even in liberal Oregon. Just adds to even more psychological trauma and depression. Creates such a negative societal mindset about everything in life.

Unfortunately there is so much government waste, too many redundant or unnecessarily burdensome regulatory processes, really too many cooks in the kitchen. Of course how to you unwind that? I see it in medicine too, we spend so much on healthcare administrative costs than actual increase in costs of delivering the basic care, that's where the increasing money is going to. Maybe something to be said for Euro style medicine where everything is fixed with certain benefits, certain costs, so they don't necessarily need ever expanding numbers of people to process pointless claims, prior authorizations, insurance management apparatuses.