Public Policy and Governance – Page 167

Speaking Of Symbolism…

Most sane observers understand that Trump’s wall is entirely symbolic. If built, it clearly wouldn’t prevent the entry of undocumented folks (the majority of whom fly in and overstay their visas) or the successful smuggling of drugs (which tend to come by ship or air).

Even Fox News rebutted the Administration’s claim that 4,000 terrorists had been stopped at the Southern border (the actual number appears to be 6 people on the watch list). I’m told that most of the Saudis responsible for 9/11 entered through Canada.

The obscenely expensive wall Trump wants to build between the U.S. and Mexico is solely intended to send a message: ignore the poem on Lady Liberty. If you are brown, you aren’t welcome.

The government shutdown triggered by his tantrum over the wall provided Trump watchers with another symbol–one more example of how truly corrupt our know-nothing President can be. Not that most of us needed the reminder.

As federal employees tried to figure out how they would pay their mortgages and put food on the table during the shutdown, as landlords threatened to evict tenants dependent upon Section 8 vouchers that stopped coming, as millions of Americans who rely on SNAP (food stamps) faced the likelihood that those benefits wouldn’t be forthcoming…Talking Points Memo reported that the President managed to keep a historic site incorporated in his hotel fully staffed.

WASHINGTON (AP) — Smithsonian museums are closed. There are no federal staffers to answer tourists’ questions at the Lincoln Memorial. And across the United States, national parks are cluttered with trash. Yet despite the federal government shutdown, a historic clock tower at the Trump International Hotel remained open Friday for its handful of visitors, staffed by green-clad National Park Service rangers.

“We’re open!” one National Park Service ranger declared around lunchtime, pushing an elevator button for a lone visitor entering the site through a side entrance to ride to the top of the 315-foot-high, nearly 120-year-old clock tower.

The Trump administration appears to have gone out of its way to keep the attraction in the federally owned building that houses the Trump hotel open and staffed with National Park Service rangers, even as other federal agencies shut all but the most essential services.

A watchdog group has filed a Freedom of Information request over the Trump Hotel’s exemption from a shutdown that furloughed hundreds of thousands of workers and crippled many agencies.

Completed in 1899, the Romanesque-style former post office is on the National Register of Historic Places. The GSA pays for the National Park Service to run the building’s clock tower for visits by the general public. The tower initially closed to the public after the shutdown started. The GSA noticed then that the deal under which the park service staffs the site had expired, and renewed it, and the park service reopened the tower this week, the agency said.

There could hardly be a clearer symbol of Trump’s priorities.

Are more than 800,000 hard-working federal workers desperately trying to make ends meet? Is air travel becoming dangerous as TSA personnel call in sick rather than continue working without pay? Are the national parks overflowing with trash? Well, first things first–we certainly don’t want to inconvenience Trump’s business.

The wall is a symbol of his bigotry; the park rangers tending to the clock tower are a symbol of his self-engrossed avarice.

His presidency is a shameful symbol of national decline.

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Progress Report From Juanita Jean

So much winning…

A few days ago, my favorite Texas blogger summed it all up:

As of this moment, we have no Attorney General, no White House Chief of Staff, no Interior Secretary, no Director of the EPA, the Secretary of Education is a religious nut trying to destroy education, the VP is a religious nut who believes women should be subjugated, the Secretary of State is a political hack helping cover up the murder of a Saudi journalist, the Director of National Security wants to bomb Iran, 18 countries have no US ambassador (including Australia), half of the positions in the State Department remain unfilled, the stock market is down almost 3,000 points, China now owns Pacific rim trade, the US is the only major power to NOT be in the Paris accords, the entire world is either terrified or laughing at us, and the president has shut down the government for the last 10 days over his 5th century solution to a 21st century problem. Notice I didn’t mention anything about everyone convicted, in jail, or on the way to jail, or Trump’s current average of telling over 500 lies per month.

This is great? Are we tired of winning yet?

The answer to her (entirely rhetorical) question is: yes, some 60% of us are very tired of Trump and his version of “winning.

The question that is harder to answer is, what the f**k is wrong with that other 40%?”

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Reich’s Rules

What American politicians call privatization has been a focus of much my academic work.(If you go to the “Academic papers” section of this blog and search for privatization, you’ll find a lot of entries.)

I phrase it as “what American politicians call privatization” because–as Morton Marcus pointed out to me years ago– genuine privatization is what Margaret Thatcher did in England. She sold off government-owned assets like railroads and steel mills to the private sector, after which they were private. They paid taxes, and either prospered or failed, but government no longer had much to do with them.

What Americans call “privatization” is very different. The accurate term is “contracting out” –and it refers to the decision by government agencies to provide government services through for-profit or non-profit surrogates. That process should not be confused with procurement–no one expects city hall to manufacture its own computers or the myriad other items it requires in order to function. (Admittedly, the line can get blurry: contracting with a private paving company to fill potholes, for example. But few privatization critics are troubled by those long-standing practices.)

It is important to recognize that when a government agency contracts with a surrogate to provide services that the agency is legally required to provide, government remains legally responsible for the proper delivery of those services.

Robert Reich recently enumerated five rules that should govern these decisions. His rules are very similar to those on my class lecture on the subject. It should be obvious, for example, that government shouldn’t contract out when keeping a service in-house will be more efficient and cost-effective.

Other rules are less obvious, but no less important.

Don’t privatize when the purpose of the service is to bring us together – reinforcing our communities, helping us connect with one another across class and race, linking up Americans who’d otherwise be isolated or marginalized.

This is why we have a public postal service that serves everyone, even small rural communities where for-profit private carriers often won’t go. This is why we value public education and need to be very careful that charter schools and other forms of so-called school choice don’t end up dividing our children and our communities rather than pulling them together.

Don’t privatize when the people who are supposed to get the service have no power to complain when services are poor.

This is why for-profit prison corporations have proven again and again to violate the constitutional rights of prisoners, and why for-profit detention centers for refugee children at the border pose such grave risks.

Don’t privatize when those who are getting the service have no way to know they’re receiving poor quality.

The marketers of for-profit colleges, for example, have every incentive to exploit young people and their parents because the value of the degrees they’re offering can’t easily be known. Which is why non-profit colleges and universities have proven far more trustworthy.

Don’t privatize where for-profit corporations face insufficient competition to keep prices under control.

Giant for-profit defense contractors with power over how contracts are awarded generate notorious cost overruns because they’re accountable mainly to their shareholders, not to the public.

Perhaps the most troubling contracting practices involve the military; contract soldiers are uncomfortably similar to mercenaries, and the growing use of private companies in America’s various wars and military actions generates a number of very thorny issues, a topic I’ve explored elsewhere.

One of America’s many overdue conversations should address what services we expect our various levels of government to provide and the nature and extent of the evidence needed to support a decision to outsource service delivery.

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About Those Right-Wing Judges…

As most of you know by now, a conservative judge in Texas struck down the entire Affordable Care Act, ruling it unconstitutional.

The decision is a reminder that when judges are appointed on the basis of party loyalty rather than legal acumen, the results can hurt a lot of innocent people.

Legal scholars who have reviewed the decision believe it is badly flawed and will be overturned, but Daily Kos recently enumerated the consequences should it be upheld.

The most obvious loss would be that part of the law that forbids insurance companies from excluding coverage of pre-existing conditions. But as the author noted, if the law were really to disappear, that’s just a part of what would be lost.

As many as 17 million people could lose their coverage in a single year. The 15 million people covered under Medicaid expansion could lose their coverage. The improvements to Medicare that have saved the program billions of dollars—and reduced prescription drug costs for seniors—would be erased. Young people wouldn’t be able to stay on their parents’ insurance until they’re 26. The ban on annual and lifetime caps would be gone, and medical bankruptcies would escalate. Having lady parts would again cost women more than men, and being over age 50 would cost everyone more again. Limits on out-of-pocket costs would be gone. The tax credits that 9 million people are receiving to help them pay premiums would be gone.

The post focused on the political fallout of the threatened losses. (Even Republicans concede that the issue hurts them.) But the real lessons aren’t partisan.

There are two obvious “take-aways” here.

First is the incredible amount of damage that can be done by elevating ideologues to the bench. This sort of “smash and burn” judging is a direct result of viewing the federal courts as a partisan political prize rather than a constitutional safeguard to be protected by the appointment of dispassionate, knowledgable and qualified legal scholars.

The second is equally obvious. As important as the ACA is, as much of a step forward that it represents, it falls far short of what Americans need and most other wealthy countries have long had. Not only is it vulnerable to the sort of judicial assassination we’ve just experienced, it is simply insufficient.

It would be poetic justice–not to mention actual justice–if this effort by a radical judge prompted Congress to pass Medicare for All, or at least a “public option” allowing citizens of all ages to “opt in” to the program.

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Is This As Stupid And Worthless As It Looks?

There is a new federal rule requiring all hospitals to post a master list of prices online–enumerating the services they provide together with their prices, so that people can review them, and presumably “shop” for the best deal.

Think about that for a minute, then review the fine print on your health insurance, assuming you are fortunate enough to have health insurance. You will note that you have very little choice of what your insurer calls “provider networks.”

Think, too, about the last time you or someone in your family had a medical emergency. If you fell off a ladder, were in an auto accident, were having a heart attack or found yourself in any of a number of similar situations, your most urgent task was getting to the nearest hospital as soon as possible; I’m pretty confident you didn’t delay in order to review and compare hospitals’ charges.

There are other reasons to file this new requirement under “worthless.” Hospitals in America’s ridiculous healthcare industry don’t charge every patient the same price for the same service. Patients with insurance are actually charged less than those without, for one thing. For another, most hospitals don’t even have a good idea of what their services cost them to provide.

Some years ago, we had friends over for dinner; one of them was, at that time, vice-president of a local hospital, and I asked him to explain the infamous five-dollar aspirin. We’ve all seen those itemized bills after emergency room visits or hospital stays that include bizarre and frequently outrageous charges, including per pill pricing that vastly exceeds what the same pill would cost at the local drugstore.

Our friend’s response was honest, if not reassuring. Because hospitals must deal with multiple insurers as well as Medicare and Medicaid reimbursement rates and with uninsured patients, they engage in “innovative” and “creative” cost-accounting. In other words (although he didn’t put it quite this way), they play games with individual bills, depending upon the likely source and timing of payment.

The bottom line: unless things have changed rather dramatically since that dinner party, hospitals really don’t know what any given service actually costs them, and there is no “standard charge” for a given medical procedure.

As I have said many times, I am a believer in markets–in economic areas where markets can work. If I set out to buy a widget, I’ll shop around to see who makes the best widget for the best price. The market for widgets works, because it provides what is essential to a market transaction: a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.

I know what sort of widget I want, and pricing information–what widgets are going for–is easily available. The guy selling me that widget knows what his widget cost to manufacture, and how much he needs to get for it.

If I have a stomach ache, or measles, or a broken arm; if I am having a heart attack, all I know is that I need medical care. I don’t know what medical science has to say about appropriate medications and their dangers (I may not even know my diagnosis); I have no idea what my treatment options might be, which ones are least likely to manifest side effects, or what they should cost. I’m not even a “willing” buyer who can walk away if I think the price is too high. I lack the knowledge to evaluate the quality of the care I’m receiving, let alone the ability to walk away if I think that quality is substandard.

Markets simply don’t work in these situations, and knowing that a hospital has posted its “best guess” prices is irrelevant.

Every other advanced country has figured this out. I’m beginning to think that “American Exceptionalism” means “exceptionally dense.”

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