Category Archives: Public Policy and Governance

The Incomprehensible Attack on Medicare

I understand a lot of the fixations of the far Right (although I disagree with virtually all of them). But I’m at a loss to understand their vendetta against Medicare, or their belief that access to healthcare should be considered a privilege, not a right.

If we take Paul Ryan and his ilk at their word, they evidently believe that market competition will bring healthcare costs down, and that guaranteeing access to healthcare promotes overuse (i.e. you’ll go to the doctor more frequently than you really need to). They believe these things–if they really do– despite overwhelming evidence to the contrary.

The great virtue of markets is that they enable voluntary exchanges; they provide an incentive to provide goods at a price buyers are willing to pay. The classic description of a market is “an exchange between a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.”

That is not a description of the “buyer” having a heart attack. Even in the absence of insurance requiring the use of specific providers, people do not–cannot–“shop” for medical care. We are  generally not “willing” buyers, and as non-experts, we certainly do not have sufficient “information relevant to the transaction.”

As Josh Marshall pointed out at Talking Points Memo,

You think it’s hard getting good insurance when you’re 30 or 50? Try getting good private insurance when you’re 70 or 80.

Providing health insurance coverage to seniors will unquestionably cost more if run through private insurance. No one who has looked at the comparative data on the cost efficiency of Medicare and private carriers can question this. There’s no money savings. Quite the opposite. The only difference is that seniors will pay vastly more out of pocket because the vouchers won’t come close to the costs of a policy. The upshot of the Ryan plan is significantly increasing the cost of what society pays for the medical care of seniors and then making seniors pay dramatically more out of pocket. All with none of the bedrock gaurantees Medicare provides.

There’s a reason administrative costs of Medicare–which doesn’t need to advertise, show a profit or cover outsized salaries to upper management– are dramatically lower than those of private insurance companies. As Marshall points out, the irony is that at the same time they are attacking Obamacare, Ryan and his cronies are proposing to replace Medicare with something that looks very much like Obamacare.

But building an exchange and subsidy adjunct for non-seniors onto an existing and fairly robust private health insurance system is one thing. Creating one from scratch for people who are all pretty much by definition bad risks is close to laughable. Laughable if you’re not bankrupted or dying because you couldn’t get care.

Remember the other things Medicare significantly guards against. If parents have insupportable medical bills or have no way to pay for care, they go to children. In the absence of any other options, that’s how it should be. But that money comes out of other things: buying homes, putting kids through college. The social insurance model of Medicare has positive effects well beyond direct beneficiaries.

Recent polls suggest that significant majorities of Americans don’t want to get rid of Obamacare, let alone Medicare. I still remember that senior at a Town Hall meeting carrying a sign that said “Keep Government’s Hands Off My Medicare.” He may not have recognized that Medicare is a government program, but he’ll certainly identify the perpetrators of attacks on it.

Fortunately, even in the Time of Trump, efforts to deprive millions of Americans of access to basic healthcare will not be a slam-dunk. As Marshall has also reported,

Many Republicans can see the political danger of touching Medicare. No one campaigned on this in 2016. Support for phasing out Medicare and replacing it with private insurance and vouchers is minimal outside libertarians and conservative ideologues. That’s why word play about ‘reform’ and averting ‘bankruptcy’ and ‘saving Medicare’ are the catch phrases. If anyone said, ‘We have an idea to have seniors get private insurance instead of Medicare and a check from the government to pay part of the cost’ they’d be laughed out of whatever room they were in. What’s most salient is that it is toxic within the coalition around which Donald Trump has at least temporarily remade the GOP.

In the real world, nothing about this Ryan/Trump effort makes sense. Practically, fiscally and politically, it would be a disaster. Given the characteristics of those who would be in need of coverage, it wouldn’t even benefit insurance companies or Big Pharma.

This is ideology-cum-religious fundamentalism: don’t confuse me with the facts.

 

Why We Don’t Negotiate with Terrorists

The principle that government does not negotiate with terrorists is a longstanding American policy, endorsed (to date, at least) by foreign policy experts of both parties. The reasons are–or should be–obvious: when you reward an activity, you encourage it.

If kidnapping our diplomats or other citizens proves profitable, more kidnappings will occur.

Of course, if you are the spouse or loved one of the person being held hostage, you are likely to have a somewhat different perspective. Which brings me to the recent announcement–made with much fanfare–about Carrier Corporation’s decision to keep a thousand of its employees in Indiana, rather than moving their jobs to Mexico. Affected employees are undoubtedly (and understandably) euphoric.

Details thus far have been sketchy, but it appears that Indiana will provide financial “incentives” to keep the company here for the next few years. Since federal government contracts currently generate $6 billion dollars annually for Carrier’s parent company, United Technologies, it is likely that promises about that contracting relationship sweetened the deal.( A spokesperson for Trump hinted that the government might relax regulations United Technologies found “onerous.”)

As one economist tweeted, “Every savvy CEO will now threaten to ship jobs to Mexico, and demand a payment to stay. Great economic policy.”

Trump’s Carrier “accomplishment” is Exhibit A in what would likely be a long list of “teachable moments” if Trump were teachable. The lesson is: deals that make perfect sense in the private business sector can be invitations to disaster in the public sector.

I learned that lesson when I served as Indianapolis’ Corporation Counsel. Cities get sued with some regularity; a car goes in a ditch and the driver blames the design of the road; a building inspector tags a property and the owner disputes the violation; a homeowner objects to a sewer assessment, or a rezoning..the list is endless.

In the business world, it often makes fiscal sense to settle a suspicious “slip and fall” case, for example–especially when the amount at issue is much less than the cost of litigating the matter. If a City did that–if it “bought off” relatively small claims–it would be tantamount to hanging a sign out that said “Come sue us–we’re patsies.” Plaintiffs and their lawyers know that, unlike many private defendants, government entities have money; if all they had to do was file a lawsuit, if they didn’t have to risk going to trial, it would be open season.

So–unless the City was clearly in the wrong– we litigated them all, large or small.

Thanks to Americans’ ignorance of the significant differences between the public and private sectors, there’s a widespread and profoundly naive belief that anyone can “do” government, that public sector experience and/or specialized skills are unnecessary.

I wonder how many terrorists Trump and his cabinet of inexperienced newcomers will negotiate with–and what it will cost us taxpayers– before they figure it out…

 

Botswana, Micronesia and Us

According to the Pew Research Center’s “Fact Tank,” no other democratic nation elects its President quite the way the U.S. does, and only a handful are even similar.

Besides the U.S, the only other democracies that indirectly elect a leader who combines the roles of head of state and head of government (as the U.S. president does) are Botswana, the Federated States of Micronesia, the Marshall Islands, Nauru, South Africa and Suriname. (The Swiss collective presidency also is elected indirectly, by that country’s parliament.)

At this writing, Hillary Clinton looks likely to win the popular vote by over two million; Donald Trump won the electoral votes of the so-called “swing states” by the thinnest of margins–  a collective hundred and seven thousand votes.

The dictionary definition of “democracy” is “rule by the majority.” Although it is certainly true that America’s system was not originally intended to operate by majority rule (it was instead conceived of as a representative democracy), and it (thankfully!) remains true that our Bill of Rights limits what government can do even with the support of popular majorities, we have changed our electoral system over the years, and we have done so in the name of increasing popular democracy.

In two of the last four national elections, the candidate clearly preferred by a majority of citizens has not become President.

We need to ask ourselves whether America truly wants to move in the direction of genuine democracy, or whether we want to continue a system that privileges the votes of more rural citizens over the votes of urban Americans– a system that decides who will win based  not upon the larger number of votes cast, but upon where a candidate’s voters happen to live.

I fully expect that the elevation of a mentally unstable and monumentally unfit man to the Presidency of the most powerful nation on earth will usher in an era of chaos and social upheaval. I have no idea what will emerge in the aftermath–assuming that there is an aftermath, and that a thin-skinned and vengeful ignoramus in possession of the nuclear codes doesn’t destroy the planet.

If and when we do emerge, we need to decide whether we are committed to democratic decision-making or not. If we are, we have a lot of housekeeping to do.

And the Hits Keep Coming….

Well, so far we’ve seen no sign of Donald Trump becoming more “Presidential.” In between his appointments of truly horrifying men to his cabinet, he continues to tweet petulant rejoinders to criticism and to whine about “unfair” media coverage;  those childish behaviors have distracted attention from his equally disastrous policy agenda.

To the (very limited) extent that Trump advanced policy proposals during the campaign, those proposals centered upon privatizing government functions. When you drill down on his promise to address America’s decaying infrastructure, for example, what you find is a scheme to give huge tax write-offs to private contractors, who would be expected to finance and repair our bridges, roads and sewers; essentially, his plan sells infrastructure to private interests.

As Josh Marshall writes at Talking Points Memo, 

There will be a mix of tax giveaways and and corporate welfare to incentivize private sector infrastructure spending. And there is good reason to think that most of those giveaways will simply be pocketed for spending that was already happening. In other words, big giveaways, more budget busting without even getting the benefit of new stuff or spurring demand.

As depressing as that particular “bait and switch” proposal is–after all, America desperately needs a massive infrastructure investment–it pales beside Trump’s promise to spend twenty billion dollars on a school choice initiative.

Twenty billion dollars is a lot of money. Although Trump hasn’t been specific about the source of those dollars (surprise!), it appears he intends to take it from the $15.5 billion currently going to Title I grants for districts and the $12 billion currently going to state grants for special education.

Raiding those two pots of money would be devastating to districts serving poor children and those with special needs, and there are significant practical, political and legal impediments to such a program. Even if those impediments could be overcome, however, a massive new effort to privatize–or more accurately, abandon– the nation’s public schools is exactly the wrong thing to do.

I know I sound like a broken record, but voucher proponents fail to understand both the mission and importance of public education. They see schools as “vendors” providing a consumer product called marketable skills– as places to train the nation’s workforce.

Providing students with marketable skills is important, but it isn’t education. And it most definitely is not preparation for life in a diverse democratic culture. Public schools have a civic mission; as Benjamin Barber once put it, they are constitutive of a public.

Abandoning our public schools and privatizing other essential government functions is tempting to lazy legislators and administrators alike, because it’s easy. It doesn’t require actually knowing enough about the function or mission involved to accurately analyze the problems, marshal the necessary resources, or do the hard work of fixing what’s wrong.

Unfortunately, easy answers are almost never the right answers. It turns out that when  public officials contract out government functions, they are still responsible for the results, and they typically lack the resources and expertise needed to properly monitor the contractor. The ensuing mistakes are costly, both politically and financially.

It also turns out that privatized schools and ill-conceived public-private partnerships have just as many problems and failures as public schools and projects, if not more–and they have the added negative effect of hollowing out government’s ability to function in important dimensions of our communal life.

Having raised children doesn’t equip me to offer child development services. Having run a business doesn’t equip someone to manage–or even understand– government. Trump is proving that point.

Research Confirms…Or Does It?

A major contributor to the success of Donald Trump in the 2016 election was the level of social distrust, fed by the fragmentation of media and decline of credible, reliable journalism. Citizens simply don’t know what information they can trust–which sources are reputable and which are peddling disinformation–so they choose the “facts” that are most congruent with their pre-existing beliefs.

The problem isn’t limited to media sources.

A recent article by Harvard’s Shorenstein Center points to a phenomenon that has been depressingly obvious to academics and others engaged in legitimate research.

Think tanks often provide valuable and impartial policy research. But entrenched conflicts of interest across the political spectrum, and pandering to donors, often raise questions about their independence and integrity. A few years ago, think tanks were seen as places for wonky scholars and former officials to bang out solutions to critical policy problems. But today, as the Boston Globe has written, many “are pursuing fiercely partisan agendas and are funded by undisclosed corporations, wealthy individuals, or both.

The article provides journalists with tips on how to ferret out conflicts of interest or other indicators of bias; its list of appropriate inquiries will be helpful not just to reporters, but to citizens who are increasingly unsure of who and what to believe:

  • Look at the think tank’s annual report. Who is on staff? On the board or advisory council? Search for these people. They have power over the think tank’s agenda; do they have conflicts of interest? Use OpenSecrets’ lobby search, a project of the nonpartisan Center for Responsive Politics, to see if any of these individuals are registered lobbyists and for whom.
  • To find out more about an executive listed on the board, read his or her firm’s public filings with the Securities and Exchange Commission. Our accounting tip sheet should help.
  • Does the organization focus on one issue alone? If so, look carefully at its funding.
  • Does the organization clearly identify its political leanings or its neutrality?
  • Does the annual report list donors and amounts? Are large donors anonymous? If the answer to the second question is yes, you should be concerned that big donors may be trying to hide their influence.
  • What is its budget? Has the budget changed radically in recent years?
  • Does it have a conflict of interest policy?
  • Look up the address. Is it a street address or a post office box? Google either: Is it shared with other organizations? Do they share a suite, a phone? What is their relationship?

I have frequently written about the “wild west” that is our current media landscape. This article reminds us that it isn’t only conspiracy websites, social media “memes,” or the growing difficult of distinguishing satire from reporting that should worry us.

We have gone way beyond the days of the National Enquirer (my favorite headline ever: “Sadaam and Osama’s Gay Wedding”). Today’s inability to know which information resources are trustworthy and which are not is poisoning not only our ability to conduct fact-based discussions, but our willingness to trust our social and governmental institutions.

Social capital–the connections we have with others–requires general social trust. The continuing erosion of that trust threatens those human connections, not to mention our ability to see ourselves as members of a democratic polity.

I simply don’t know how we fix this and still maintain fidelity to the First Amendment.