The saddest story I read all weekend came from National Public Radio. NPR went down to Clay County in Kentucky, the poorest county in that state, and it spoke to the people there, many of whom are terrified of what may happen to them after the new administration takes office.

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering. The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years. "It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago. Lockaby finally got treated for a thyroid disorder that had left her so exhausted she'd almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

Life already is hard in her part of Kentucky's coal country, where once-dependable mining jobs are mostly gone. In Clay County where Lockaby lives, 38 percent of the population live in poverty. A fifth of the residents are disabled. Life expectancy is eight years below the nation's average. Clay's location places it inside an area familiar to public health specialists as the South's diabetes and stroke belt. It's also in the so-called "Coronary Valley" encompassing the 10-state Ohio/Mississippi valley region. About 60 percent of Clay County's 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.

The dread that Freida Lockaby faces comes from the fact that, in 2015, in one of those surprise elections that are becoming commonplace, Kentucky elected a Tea Party hooligan named Matt Bevin to be its governor. Bevin campaigned specifically on doing away with Kynect, the healthcare program developed in Kentucky under the auspices of the Affordable Care Act. Central to its success was the ACA's Medicaid expansion and the FREE MONEY! that came with it. Kynect was widely popular. Kentucky elected a governor who pledged to do away with it.

And, of course, in the recent presidential election, Kentucky was carried by a Republican candidate pledged to do away with the ACA entirely.

In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin's view — $1.2 billion from 2017 to 2021, according to the waiver request he's made to the Obama administration to change how Medicaid works in his state. Trump's unexpected victory may help Bevin's chances of winning approval. Before the election, many analysts expected federal officials to reject the governor's plan by the end of the year on the grounds that it would roll back gains in expected coverage. A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care. "I think it's much more likely that a waiver could be approved under the Trump administration," she said. "On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed."

You know the punchline, right? In 2015, Matt Bevin swept Clay County with 71 percent of the vote. Two weeks ago, Donald Trump received 86 percent of the votes cast.

I hate this. I hate that the United States is still fighting over healthcare when the rest of the industrialized world has left the issue behind. I hate the politicians who stoke dread and hate in order to get elected to make the problems of places like Clay County worse. I hate the impotence of the political opposition in making its case. I hate all these things, but the thing I hate worst of all is the overwhelming temptation to gloat over the miseries of people who, for whatever reason, vote against their own self-interest. Hell with self-interest, they're voting against their own survival.

Manchester, Clay County, Kentucky. The Washington Post Getty Images

I hate the impulse to consider them stupid and ill-informed. I hate the impulse to shrug and say that these people brought it on themselves and good luck to them. I hate how goddamn easy it would be to give thanks to Whomever that I'm lucky enough to live in this Commowealth (God save it!) and not that one, and to pat myself on the back for the political discernment it takes to make sure you don't cut your own throat every time you walk into a voting booth. I hate the sin against charity that these kind of stories make so easy.

Since this is Thanksgiving Week and all, it's important to remember that the first thing that the Pilgrims agreed to do upon arriving in what they called "northern Virginia" was to agree to form themselves into "…a civil body politic, for our better ordering and preservation and furtherance of the ends aforesaid; and by virtue hereof to enact, constitute, and frame such just and equal laws, ordinances, acts, constitutions and offices, from time to time, as shall be thought most meet and convenient for the general good of the Colony…"

We are not that now.

Clay County is proof enough of that, but, if you need more, look into your heart and your soul and acknowledge how easy it is to conclude that the people there deserve what they're getting.

It's clear that, for all the anthropological expeditions into the "forgotten white working class," the whole point of the election got missed. It is clear now that the incoming administration is going to make the lives of the people in Clay County immeasurably worse. Tiger Beat On The Potomac gave us a look at what's coming down the line for them.

House Republicans are currently in the process of making lists of regulations that fall within their time frame and could potentially be repealed early next year. One of the major ones they're eyeing is Obama's overtime rule that requires companies to pay time-and-a-half to employees who make under roughly $47,000. The rule is set to go into effect Dec. 1 and will be a top priority for Republicans to reverse, multiple sources said…A GOP wish list shared with POLITICO includes a repeal of Obama's order to stay deportation of undocumented immigrant parents whose children were born in the U.S., and Labor Department fiduciary rules that expand conflict-of-interest requirements to financial professionals. House Republicans are also sketching out a plan to possibly pass two budgets in the first half of the year — though some leadership sources cautioned that nothing has been set in stone.Doing so would allow GOP lawmakers to unlock a fast-pass procedure called reconciliation, which in turn would enable them to dismantle Obamacare and potentially even pass tax reform on likely party-line votes.

There is nothing in there that will improve the lives of the people of Clay County, who voted for this change in government by a preposterous margin. They will be poorer and sicker as a result of it. The social fabric of what's left of their communities will fray even further; if Speaker Paul Ryan, the zombie-eyed granny starver from the state of Wisconsin, has his way with Medicare and with the Social Security disability system, a lot of families are going to find themselves custodians of elderly parents and handicapped children without anything close to the wherewithal to provide proper care. I can see this as clearly as I see the words on the screen, and I hate the sight and thought of it.

The Washington Post Getty Images

Perhaps, somewhere, there's a political mind sharper than my own who can figure out how to reach people so filled with desperation that they will cast votes that literally will immolate their own lives. (Remember, Matt Bevin made absolutely no secret of what he intended to do. There was no insulting "repeal and replace" jive from him. And the people whose lives depended on the program voted overwhelmingly for a guy pledged to destroy it.) All the glib talk about how the Democratic Party has to "reach out" to this folks is coming from people who don't have the first fucking clue how to do it.

Ease up on the social issues, they say, as if tossing the privacy rights of 51 percent of the population, or jacking around trying to find a "middle ground" on gay marriage somewhere between civil unions and Leviticus, ever slowed the slide before. I suppose the Democrats could go back to being the party of Jim Crow, but I think they might have a little trouble with their base there.

I am at a loss. Almost all of American politics is based on the notion that people, individually or in groups, in the Congress or in a ward committee, will vote based on their own self-interest. The Constitution depends vitally on the notion that interests will balance other interests and, in doing so, hold at bay the fratricidal danger of what the Founders call "faction." This basic truth seems to be completely lost among the people who most desperately needed. A politics has been created for them in which their self-interest is almost completely obscured and, where it is not obscured, it is separated for them from the obligations of self-government.

I read a lot of Albert Camus in college. (Hey, we all did.) I've gone back to him in recent days because a lot of what he wrote seems to make sense in the current political context that we've created for ourselves. In his Letters to a German Friend, which he wrote clandestinely during the German Occupation of France, Camus laid out the struggle between his country's conquerers, and the nation that still existed in the dark cellars by candlelight.

"No", I told you, "I cannot believe that everything must be subordinated to a single end. There are means that cannot be excused. And I should like to be able to love my country and still love justice. I don't want just any greatness for it, particularly a greatness born of blood and falsehood. I want to keep it alive by keeping justice alive." You retorted: "Well, you just don't love your country." ...

The story from Clay County saddens me because I just don't know what to do. It angers me because of how quickly and readily touches those dark forces in me that are little different in their malignant arrogance than the ones that drive our new president-elect. It sickens me how easy it is to dismiss the calls for justice from Clay County just because they are incoherent and ill-directed. It defeats me. I cannot help that.

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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