March 2017 – Page 5 – Sheila Kennedy

It’s Not Just Complicated…

Trump generated a lot of well-deserved criticism–not to mention sarcasm–for his recent expression of surprise at the complexity of health policy, saying “Who knew it was so complicated?” The universal response was “Apparently, everyone but you!”

Which brings us to the bill currently before Congress.

Virtually every headline about Paul Ryan’s proposed ACA replacement has been negative: NBC’s said bluntly “Experts: The GOP Healthcare Plan Just Won’t Work.”

While their objections vary depending on their ideological goals, the newly introduced American Health Care Act (AHCA) is facing an unrelenting wave of criticism. Some experts warn that the bill is flawed in ways that could unravel the individual insurance market.

Among other problems, the article pointed out that the bill is almost certain to reduce overall coverage and result in deductibles increasing. It will also phase out Obamacare’s Medicaid expansion. Older, sicker and lower-income patients will be the bigger losers.

The headline of the Washington Post’s Plum Line was equally direct: “The New Republican Health-Care Plan is Awe-Inpiringly Awful.”

Noting that Trump had campaigned on a promise to replace the ACA with “something terrific,” Paul Waldman, who authors the Plum Line, observed that the bill is

so far from terrific that there doesn’t seem to be anyone other than House Speaker Paul D. Ryan (R-Wis.) himself who thinks this bill isn’t a disaster. It’s being attacked not just from the left but from the right as well. Heritage Action and the Club for Growth, two groups that exist to browbeat Republicans into upholding hard-right principles, have just come out against it.

Waldman marveled that

House Republicans have accomplished something remarkable: They have written a bill that would make every problem they’ve complained about much, much worse. If there’s any saving grace, it’s that almost no one will be happy about it, except for the wealthy people to whom it gives a gigantic tax cut.

So… Republicans are going to drastically reduce the number of Americans with health insurance while increasing costs pretty much across the board: individuals, state governments and the federal government will all pay more. According to insurance experts, the bill will also do enormous damage to the insurance market. The GOP is evidently willing to inflict all that pain in order to give rich people a tax cut.

The problems with the bill range from the ludicrous to the outrageous, and you can all decide for yourselves which parts you find more horrific or ridiculous, but as a number of observers have pointed out, the promises of a genuine Republican replacement for Obamacare were always impossible to keep.

Today’s GOP is an increasingly uncomfortable amalgam of true believers who oppose the very notion that government has an obligation to provide access to health insurance, and who are working frantically to eliminate Medicare and Medicaid, and the party’s realists, who know that taking health insurance away from Americans who finally have been able to access it–not to mention Medicare recipients– is political suicide.

That’s a political fence that can’t be straddled.

What Ryan and his minions are trying to do is square the circle: drastically reduce coverage while pretending they are doing no such thing.

Some day–if and when sanity and a modicum of honesty return to American government– the United States will join virtually every other first-world country and provide universal coverage. I’ve previously posted about the multiple benefits and clear superiority of Medicare for All.

In 2006, the Economist—hardly a leftwing publication—had this to say about the U.S. healthcare system:

“America’s health care system is unlike any other. The United States spends 16% of its GDP on health, around twice the rich country average, equivalent to $6,280 for every American each year. Yet it is the only rich country that does not guarantee universal health coverage. Thanks to an accident of history, most Americans receive health insurance through their employer, with the government picking up the bill for the poor (through Medicaid) and the elderly (through Medicare).

[…]

In the longer term, America, like this adamantly pro-market newspaper, may have no choice other than to accept a more overtly European-style system.”

Obamacare was a step in the right direction, but America still spends more per person on healthcare than any other country–and we still rank 37^th in outcomes. (If our infant mortality rate was as good as Cuba’s—Cuba’s!—we would save the lives of an additional 2,212 babies every year.)

Other countries have opted for more efficient–and more humane– national systems.

In 2017 America, we are still arguing over whether healthcare should be viewed as a right (or at least a utility), or whether we should continue to treat it as a consumer product, available to those who can afford it and “tough luck” to those who can’t.

That circle can’t be squared.

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The Bully Pulpit

I recently attended the bat mitzvah of a cousin’s daughter at the synagogue in which I grew up. My cousin’s daughter did a great job with her Torah portion, but I was particularly struck by the sermon, in which Rabbi Dennis Sasso forcefully and eloquently connected those ancient teachings to America’s contemporary challenges.

I sometimes need to remind myself that for every judgmental scold or religious con-man, there is a religious leader like Rabbi Sasso wrestling with the nature of human community and authentic moral behavior.

He was kind enough to share a copy of his remarks.

Judaism is not just a set of general principles or lofty ideals. It is the living out of those values in the here and now, in the everyday of human encounter between a person and his/her neighbor, a man and woman, parents and children, elected officials and the people, nation and nation.

And so, in this week’s Torah portion, entitled Mishpatim (“Ordinances”), we have the fleshing out of the Ten Commandments. We find here the beginnings of a constitutional biblical tradition, upon which future post-biblical (rabbinic) legislation will evolve, not just as a faith tradition but as a religion of ethical nationhood.

The Rabbi noted that the book of Exodus contains many laws that mirror those of our civil state, including, most significantly, “laws forbidding the oppression of the powerless, the weak, the widow, the orphan, the poor and the stranger — the disenfranchised members of society.”

The commandment to “love your neighbor” occurs in Leviticus 19. However, the commandment to “love the stranger,” the foreigner, the immigrant, (a much more difficult task) – occurs here twice and 36 times in the Torah (“Love the stranger…” “for you know the heart of the stranger, as you were strangers in the land of Egypt”).

The heart of the sermon–at least to me–was the explicit application of Jewish teaching to matters pending at the Indiana legislature.

Reading through this week’s portion we can find guidance regarding many bills currently before our State and Federal Legislatures.

There is SB 439 – regarding Hate Crime Laws – likely not to pass in Indiana because of the pressure of conservative forces that feign to promote themselves as religious. Well, they are quite out of sync with the biblical heritage they purport to uphold – a heritage that teaches – “You shall not hate your neighbor in your heart.”

The growing vitriol expressed in words and acts of anti-Semitism, Islamphobia and other ethnic and gender directed prejudice speak of an epidemic of hate that must be contained. We should be alarmed by what is happening to words in our times – particularly in the political and religious arenas. Language has become shrill, offensive and misleading. Words, angry and hostile weapons.

Then there are legislative initiatives to curtail rights for LGBTQ+ citizens and to impose doctrinal understandings of reproductive health and abortion rights. Interestingly, this week’s Torah portion contains the key passage that defines miscarriage and abortion not as murder, but as a civil matter (Ex. 21:22-24).

Abortion is a painful and serious decision to be made by a woman in consultation with her physician, loved ones and in keeping with her religious values. In the Jewish legal and moral tradition, termination of pregnancy is never defined as homicide, and it is not only permissible, but required to protect the life and health of the mother, in some cases even her mental health. In Jewish law, the fetus is not defined as a “person,” with independent legal and moral status, until the moment of delivery. Judaism does not share the view that human life begins at conception. Throughout pregnancy the fetus is potential life, to be honored and protected, but dependent on and subordinate to the life of the mother.

To impose particular doctrinal restrictions on abortion constitutes not only a violation of privacy and civil rights, but a limitation of religious rights, by imposing beliefs and values that counter the faith traditions of others. And certainly to muddle legislation with unscientific and potentially injurious information is a pious fraud.

Consider the higher health risks for women and infants that proposed legislation – which includes threats to cut funds for Planned Parenthood – would involve. Our state’s infant mortality rate, already among the highest in the country, would rise dramatically.

Ironically, some of the same groups that counter hate crime laws, and advance restrictions on health care and civil rights, piously advocate for prayer in public schools and, paradoxically, promote liberalization of gun laws – guns that can kill in schools, domestic settings and hateful social encounters…

Today, our nation struggles with the issue of immigration, our response and responsibilities to the stranger in our midst. Our deepest Jewish convictions tell us that protecting the humanity of immigrants, who have come to the United States to better lives for themselves and their children, puts our communities on a path towards strengthening families and society and ultimately, the moral values of our nation. By all means, we need to ensure the safety of the homeland, and guard the security of our borders, but not in ways that discriminate, intimidate and create a siege mentality and police state.

Keeping families together, allowing immigrants to fully contribute to our communities, providing relief for millions of aspiring Americans from unnecessary deportation and family separation, these are at the heart of the Jewish legislative and moral traditions. It is also the best of the American tradition which we as Jews have helped to shape and from which we have benefited.

The Rabbi closed with this profound and increasingly relevant quote from Abraham Joshua Heschel:

When faith is completely replaced by creed, worship by discipline, love by habit; when the crisis of today is ignored because of the splendor of the past; when faith becomes an heirloom rather than a living fountain; … its message becomes meaningless.

Words applicable to both religion and political ideology–and definitely worth pondering.

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That Social Safety Net

It may be time to re-conceptualize the social safety net.

Most of the people who refer to a social safety net use the term as shorthand for a variety of so-called “welfare” programs, from Social Security, Medicare and Medicaid to TANF and other income-support measures. Defining the social safety net in that way—and focusing, as so many Republican political figures do, on support for needy Americans—facilitates criticisms of measures intended to help the poor.

After all, the comfortable ask, why should the prudent and solvent among us have our hard-earned monies taxed to support “those people”?

It’s easy to see the persistent attacks on income-supports for disadvantaged folks as both dishonest and mean-spirited, and most efforts to rebut them tend to revolve around the realities of social supports: the percentages of recipients who are children, elderly and/or disabled, the overwhelming numbers of impoverished Americans who work forty or more hours a week, etc.

We may be missing the forest for the trees.

A “social safety net,” properly conceived, is the web of institutions and services that benefit all members of a given society while building bonds of community and cross-cultural connection. In this broader understanding, the safety net includes public education, public parks, public transportation and other services and amenities available to and used by citizens of all backgrounds and income categories.

Public education is a prime example. Even granting the challenges—the disproportionate resources available to schools serving richer and poorer neighborhoods, the barriers to learning created by poverty—public schools at their best integrate children from different backgrounds and give poor children tools to escape poverty. Public schools, as Benjamin Barber has written, are constitutive of a public.

Common schools create common cultures, and it is hard to escape the suspicion that attacks on public education have been at least partially motivated by that reality. While supporters of charter schools and voucher programs have promoted them as ways of allowing poor children to escape failing schools, the data suggests that most children—including poor children—are better served by schools that remain part of America’s real social safety net.

This point was recently underscored by Thomas Ratliff, a Republican member of the Texas Board of Education—a board not noted for progressive understandings of the role of education. After setting out the comparative data about costs and outcomes achieved by traditional public schools in Texas and those operating via various “privatization” programs, he concluded

When you hear the unending and unsubstantiated rhetoric about “failing public schools” from those that support vouchers or other “competitive” school models, it is important to have the facts. ISDs aren’t perfect, but they graduate more kids, keep more kids from dropping out and get more kids career and college ready than their politically connected competitors. Any claims to the contrary just simply are not supported by the facts and at the end of the day facts matter because these lives matter.

Recognition that “these lives matter” is the hallmark of a society with a capacious understanding of citizenship—both in the sense of who counts as a citizen, and what constitutes the mutual obligations of citizens to one another.

The actual social safety net is not limited to the (grudging and inadequate) financial assistance given to the most disadvantaged in our society. The true safety net consists of the many institutionalized avenues within which the citizens of a nation encounter each other as civic equals, and benefit from membership in a society built upon the recognition that all their lives matter.

Defining the social safety net that way allows us to see that the portion of our taxes used to assist needy fellow-citizens isn’t “forced charity.” It’s our membership dues.

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There’s Talking and Then There’s Doing….

Over at Talking Points Memo, Josh Marshall makes a really important point. In a post reflecting on the various reasons that the rollout of the proposed healthcare overhaul has been going so badly, he points to the important role of a President in the passage of complex or controversial legislation.

True, the health-care bill has numerous glaring defects. As Marshall also points out, the defects should have been expected, since the GOP has been promising to do something that is basically impossible–continuing to cover people while offering more carrots and employing fewer sticks.

Even though Republicans control both houses of Congress and the Presidency, the bill faces formidable obstacles. Major stakeholders hate it, Republican lawmakers are divided, and the bill won’t get a single Democratic vote. Faced with significant opposition, what is needed is what Marshall calls “the mix of formal and informal powers, favors and threats, public presence, the ability to protect or punish” that only a President can bring to bear.

This is something President Trump has shown virtually no interest in doing. We’re at roughly a month and a half into the administration. The GOP has unified control of the government and yet no significant legislation has moved at all. That is a stunning reality which the storm and chaos of Trump’s short presidency has largely obscured. But it is an almost unprecedented development. Some of this may be an inherent limitation because the President came into office as a minority President. But as I argued a month ago, the President simply has no appetite for the hard work of passing laws. He has defaulted to rolling out executive order after executive order, in most cases Potemkin decrees with vaguely legalistic language and limited actual impact. Like so much with Trump, it’s a mix of authoritarianism on the one hand and impatience and flimflam on the other. The upshot isn’t so much a poor man’s as a lazy man’s authoritarianism.

I think it is deeper than Trump’s obvious aversion to actual work. It is equally obvious that he has not the faintest understanding of how government actually works–and even less interest in learning what he doesn’t know. He is used to running a family business where he issued orders and people who were related to him and dependent upon his largesse obediently followed them. He wasn’t even the typical CEO of a publicly-traded company who would at least have to answer to a Board of Directors and shareholders.

A diligent and intellectually curious person with Trump’s background would be disadvantaged by that lack of relevant experience. Trump is neither diligent nor intellectually curious (judging from his vocabulary and spelling of his tweets, he isn’t even very bright). Several of the skills that Marshall identifies as critical to the passage of legislation are simply beyond his capacity to acquire or exercise, and his self-obsession precludes any engagement in the sorts of “schmoozing” required to cajole recalcitrant lawmakers. (It is impossible to imagine Trump strategically stroking the egos of crucial legislators.)

Ironically, the very traits that make Trump so manifestly unqualified for the Presidency may end up saving healthcare….

Fingers crossed.

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Behind the Statistics

Linda Greenhouse, an always insightful observer of law and courts, has written an excellent column for the New York Times about the Trump Administration’s reversal of Obama’s policy phasing out private prisons.

For Trump loyalist who keep pointing out that the stock market is doing well, she provides a “think about this” example of just what is fueling that optimism:

So the Trump administration is putting the welcome mat back out for private prisons, just as candidate Donald Trump said he would do, reversing the Obama administration’s policy of phasing them out for federal prisoners. It’s no wonder that shares in some of the nation’s biggest for-profit prison companies soared by double digits the day after the presidential election, making them among the biggest winners in the immediate postelection rally.

Greenhouse also provides us with a stark reminder of the “cost controls” that allow private prisons to make money. Her example comes from Indiana.

A decision on Feb. 21 by the federal appeals court in Chicago came just in time to remind us that privatization is a really bad idea. The United States Court of Appeals for the Seventh Circuit reversed a federal district judge’s dismissal and sent back for trial a case with the most appalling facts, brought by a dead prisoner’s mother against the company to which the Indiana Department of Corrections had outsourced its inmates’ medical care.

The opening paragraph of the opinion by Chief Judge Diane P. Wood tells the story: “Nicholas Glisson entered the custody of the Indiana Department of Corrections on September 3, 2010, upon being sentenced for dealing in a controlled substance (selling one prescription pill to a friend who turned out to be a confidential informant). Thirty-seven days later, he was dead from starvation, acute renal failure, and associated conditions.”

After reciting the facts of this particular, egregious example, Greenhouse notes that she has two reasons for her focus on the Indiana case.

The first is to show the recklessness of President Trump’s wave-of-the-hand decision to retain the private prisons that a Justice Department study last year concluded “do not maintain the same level of safety and security” as those operated by the Bureau of Prisons. Sally Q. Yates, the holdover deputy attorney general whom President Trump fired last month for refusing to defend his travel ban, relied on that conclusion in announcing that private prison contracts would not be renewed and that the 22,000 federal inmates housed in those prisons would be cut to 14,700 by May 2017 and eventually to zero.

Greenhouse’s second reason was to highlight the stark differences between the judge’s opinion upholding the right of the mother to sue and the original decision, by a different judge, dismissing the suit. As she pointed out, the choice of the people who render judgment in our system–the judges nominated by the President and confirmed by the Senate–is important. Those choices matter.

When I read about this case, and the absolutely unnecessary death of a “felon” whose crime consisted of the sale of one prescription pill, it reminded me of something else that matters: the harm done by policies rooted in nothing other than social disapproval –what the Founders called “the passions of the majority.” Greenhouse has provided us with one example–drug laws that sweep far too widely and impose penalties wildly disproportionate to the offenses. The Trump Administration is in the process of providing us with another–the indiscriminate deportation of people whose only “crime” is coming to our communities without documentation.

Everyone disapproves of drug abuse, but not everyone agrees on the difference between “use” and “abuse”–or even the difference between harmful and harmless substances.

Similarly, everyone disapproves of illegal entry into the country in the abstract, but when we fail to distinguish between people who were brought here as young children by their parents, people who have been longtime assets to their communities or who have served in America’s armed forces, and the “bad hombres” of Trump’s rash rhetoric, we aren’t just being inhumane, we are supporting measures that are both costly and stupid.

It matters who our judges are. It really matters who the President is.

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