Public Policy and Governance – Page 198

No Ice Floes Handy?

According to legend, when their elderly became burdensome, Eskimos put them on ice floes and let them drift out to sea.

If I thought that Trump and his “best people” could read, I’d suspect they were emulating the Eskimos.

A week or so ago, a friend who no longer lives in Indianapolis was in town, and met my husband and me for breakfast. During the “catching up” talk that takes place when old friends haven’t seen each other for a while, we asked him what his wife was doing. He said she’d been working part-time as an advocate for nursing home patients–a position required as a condition of federal grants for nursing home care–but that the Trump Administration had eliminated the requirement, along with a number of other regulations intended to protect the sick and elderly residents of such institutions. So she was looking for another job.

I was pretty incredulous; why would even this benighted administration refuse to protect helpless old folks against the well-documented abuses encountered in numerous substandard nursing homes?

Turned out, however, our friend was right. I saw this article from The Hill not long after our conversation:

The Trump administration is reportedly rolling back the use of fines against nursing homes that have been cited for violations such as neglect or mistreatment.

The move comes after the nursing home industry requested the change in the Medicare program’s penalty protocols, The New York Times reported over the holiday weekend.

The American Health Care Association had argued that inspectors were too focused on finding wrongdoings at nursing homes instead of assisting the facilities.

A 2001 Congressional investigation uncovered reports of serious, physical, sexual and verbal abuse in a third of the nation’s nursing homes. That led to more monitoring and additional regulation. Since 2013, nearly 6,500 nursing homes have been cited for one or more serious violations. Approximately two-thirds of those were fined by Medicare.

Nevertheless, the personnel installed by Trump at the Center for Medicare and Medicaid Services argued that the regulations and fines were counterproductive.

“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide.”

A lawyer from the Center for Medicare Advocacy disagreed, observing that the revised regulations and diminished penalties have “pretty much emasculated enforcement, which was already weak.”

So let’s see….this administration wants tough penalties for street crime and drug use and illegal immigration, because Trump and Sessions say punishment is a deterrent to socially undesirable behaviors. But we don’t need to fine or otherwise punish the owners of nursing homes that mistreat their vulnerable inhabitants. (Sorry–I know the word “vulnerable” has been banned.) We can gently suggest they desist, and maybe those bedsores will go away by themselves….

The regulations no longer being enforced weren’t imposed by some abstract, rule-happy big government bureaucrat; they were put in place because of evidence that far too many nursing homes were abusing and neglecting their elderly, incapacitated patients, and doing so with impunity.

Someone needs to explain to me just how forbidding elder abuse “gets in the way of quality care.”

Actually, ice floes might be more humane….

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Institutional Arson

As I have noted previously, Michael Gerson is one of the very few principled conservative Republicans who have not traded in their ethics (to the extent they had them) for partisanship advantage in the Trump era.

I have become a semi-regular reader of Gerson’s columns, not because I necessarily agree with his policy preferences (in many, if not most cases, I don’t), but because he is intellectually consistent and honest, and his opinions are for that reason worth considering.

In an otherwise unremarkable recent column for the Washington Post, Gerson used a phrase that struck me. The column itself addressed the all-too-obvious GOP effort to delegitimize Robert Muller and his investigation of Russian interference in the 2016 election.

This quote will convey Gerson’s general approach to that issue–an approach with which I agree wholeheartedly:

Some of Trump’s defenders are claiming, in effect, that the FBI is engaged in a “coup d’etat” (the words of Florida Republican Rep. Matt Gaetz) — a politically motivated attempt to reverse the results of the 2016 election. Their evidence? That some senior investigators donated to Democrats, supported Hillary Clinton and called Trump an “idiot.”

If that last charge were considered a disqualification, we would have the political equivalent of the Rapture (including, apparently, some of the Cabinet).

It was the sentence immediately following this quote that struck me:

Trump Republicans are willing to smear a man of genuine integrity, and undermine confidence in federal law enforcement, for reasons they must know are thin to the point of transparency. This is beyond cynicism. It is institutional arson.

Institutional arson.

That is a perfect description of the current administration’s approach to governing– although, even as I was typing the words “approach to governing,” I realized how misleading that phrase is; it gives Trump and his merry band of vandals far too much credit. Trump is interested in exercising power–and clearly uninterested in governing.

Gerson is certainly correct when he asserts that the strategy employed by Trump supporters against any institution (the courts, the media, law enforcement) that threatens to expose the administration’s deception and corruption is profoundly anti-conservative.

Genuine conservatives have a point when they claim that Trump voters were not conservatives as we have long understood that term. As data has emerged about the motives of those voters, it appears that racial resentment, coupled with disdain for the enterprise of government and general anger at the “way things are going” fueled a desire to elect someone who would “blow it all up.”

If voters wanted to “blow it all up,” they voted for the right candidate. The only consistent thread in this erratic and ignorant Presidency has been Trump’s obsession with overturning anything his predecessor did. If destroying Obama’s legacy requires damaging the institutions of government, or snatching healthcare away from millions of Americans, or trashing America’s image abroad –well, that’s okay with Trump. No wonder people have dubbed him Agent Orange.

As Gerson noted,

Other presidents would be restrained by the prospect of social division and political chaos. For Trump, these may be incentives. He seems to thrive in bedlam. But the anarchy that sustains him damages the institutions around him — a cost for which he cares nothing.

If history and sociology teach us anything, it’s that anarchy doesn’t work. Institutions–even flawed ones– are vitally important to social stability, and they are a lot easier to destroy than to rebuild.

Ironically, the people who voted for institutional arson are the most likely to get burned.

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What Happened to Faith In The Market?

I’m a capitalist. A real one, not the Congressional variety. I believe in (properly regulated) markets, with the important caveat that I believe in markets in those areas of the economy where markets work. (Markets only work, I constantly remind anyone who listens, in transactions with a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.)

Being predisposed to competition and markets doesn’t mean I think government’s role is unimportant, or that public assistance is never warranted.Government can help markets in a number of ways: outlawing monopolies and anti-competitive practices or, in compelling cases, granting subsidies or tax incentives to industries deemed critical to the national interest.

It won’t surprise anyone reading this to discover that, in today’s America, subsidies are more often used to suffocate progress and protect profitable, established industries than to move the nation forward.

American business spokespersons can be counted on to profess devotion to markets. They can also be counted on to avoid competition whenever possible, because their belief in the market’s level playing field is wholly fictional.

As Vox recently reported,

The coal industry and its allies in the Trump administration have recently devoted considerable energy to arguing that subsidies to renewable energy have distorted energy markets and helped drive coal out of business. “Certain regulations and subsidies,” says Rick Perry, “are having a large impact on the functioning of markets, and thereby challenging our power generation mix.” You can guess which regulations and subsidies he’s talking about.

This is nothing new, of course. It is in keeping with a long conservative tradition of challenging the economic wisdom and effectiveness of energy subsidies.

At least, uh, some energy subsidies.

Energy analysts have made the point again and again that fossil fuels, not renewable energy, most benefit from supportive public policy. Yet this fact, so inconvenient to the conservative worldview, never seems to sink in to the energy debate in a serious way. The supports offered to fossil fuels are so old and familiar, they fade into the background. It is support offered to challengers — typically temporary, fragmentary, and politically uncertain support — that is forever in the spotlight.

The article goes on to shine that spotlight on those older subsidies, beginning with the twenty billion dollar annual production subsidy we taxpayers provide to the fossil fuel industries that contribute massively to climate change. We provide that financial assistance despite the fact that these companies are very, very profitable.

The twenty billion dollar figure is only a beginning. It subsidizes only direct production costs. Another $14.5 billion in consumption subsidies also benefit fossil fuel companies–things like the Low Income Home Energy Assistance Program(LIHEAP), which helps lower-income residents pay their (fuel oil) heating bills.

It also leaves out subsidies for overseas fossil fuel projects ($2.1 billion a year).

Most significantly, OCI’s analysis leaves out indirect subsidies — things like the money the US military spends to protect oil shipping routes, or the unpaid costs of health and climate impacts from burning fossil fuels. These indirect subsidies reach to the hundreds of billions, dwarfing direct subsidies — the IMF says that, globally speaking, they amount to $5.3 trillion a year. But they are controversial and very difficult to measure precisely.

Finally, OCI acknowledges that its estimates of state-level subsidies are probably low, since many states don’t report the costs of tax expenditures (i.e., tax breaks and credits to industry), so data is difficult to come by.

The best available estimate is that energy companies get $20.5 billion annually in corporate welfare, of which 80 percent goes to oil and gas, and 20 percent to coal. And we don’t know how much remediation will eventually add to that figure.

Vox’s summary says it all better than I could:

If you ask people in fossil fuel industries, their support staff in conservative think tanks, or fossil-state politicians, they will tell you why these fossil fuel production subsidies are necessary. It’s always been this way. They’re more than paid back by tax revenue. Other industries get them too. (For the record: More than half the $20 billion is available to fossil fuels alone). They create jobs. They’re important for national security. Tax expenditures aren’t subsidies at all, if you think about it. Etc.

If the endless debate over energy subsidies has taught me anything, it’s that nobody thinks their own subsidy is a subsidy — and no one outside think tanks and universities really gives a damn about the economic distortions of subsidies as such. Everyone thinks their favored energy sources deserve support and the other guys’ don’t. Period. They use whatever economic argument is handy — “picking winners” if you’re against the subsidy, “supporting jobs” if you’re for it — but such arguments are always instrumental. As I said recently about coal’s rent-seeking, there are no true free marketeers in struggling industries.

Speaking of rent-seeking, here’s a final fun factoid from OCI: In the 2015-2016 election cycle, oil, gas, and coal companies spent $354 million in campaign contributions and lobbying and received $29.4 billion in federal subsidies in total over those same years — an 8,200% return on investment.

The next time some corporate poo-bah piously invokes the genius of the market, tell him to give it a rest. It’s abundantly clear that no one really wants to “let the market decide.”

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Connect The Dots!

It’s not just easy access to guns–although that access certainly facilitates rising American homicide rates.

As the Guardian recently reports, there is a strong–if surprising– connection between income inequality, respect, and increases in violence.

A 17-year-old boy shoots a 15-year-old stranger to death, apparently believing that the victim had given him a dirty look. A Chicago man stabs his stepfather in a fight over whether his entry into his parents’ house without knocking was disrespectful. A San Francisco UPS employee guns down three of his co-workers, then turns his weapon on himself, seemingly as a response to minor slights.

These killings may seem unrelated – but they are only a few recent examples of the kind of crime that demonstrates a surprising link between homicide and inequality.

The article cites emerging research that strongly suggests that inequality plays a pivotal role in escalating passions in encounters that might otherwise end with some profanity and fisticuffs–that it raises the stakes of fights for status among men.

The connection is so strong that, according to the World Bank, a simple measure of inequality predicts about half of the variance in murder rates between American states and between countries around the world. When inequality is high and strips large numbers of men of the usual markers of status – like a good job and the ability to support a family – matters of respect and disrespect loom disproportionately.

Inequality predicts homicide rates “better than any other variable”, says Martin Daly, professor emeritus of psychology and neuroscience at McMaster University in Ontario and author of Killing the Competition: Economic Inequality and Homicide.

Other studies show that rates of gun ownership rise when inequality does. Rising inequality also predicts the re-emergence of cultural traits like placing more emphasis on “honor.”

“About 60 [academic] papers show that a very common result of greater inequality is more violence, usually measured by homicide rates,” says Richard Wilkinson, author of The Spirit Level and co-founder of the Equality Trust.

Why would financial inequality lead to a renewed emphasis on status and respect? Researchers explain:

When someone bumps into someone on the dance floor, looks too long at someone else’s girlfriend or makes an insulting remark, it doesn’t threaten the self-respect of people who have other types of status the way it can when you feel this is your only source of value.

“If your social reputation in that milieu is all you’ve got, you’ve got to defend it,” says Daly. “Inequality makes these confrontations more fraught because there’s much more at stake when there are winners and losers and you can see that you are on track to be one of the losers.”

Social science is methodically enumerating the negative social consequences of extreme inequality. Most reasonably well-educated people recognize that inequality produces social instability–history teaches us that growing anger from those with nothing to lose leads to riots, even revolutions–but most of us are less familiar with other ancillary effects.

There is ample evidence that large gaps between the rich and poor retard economic growth, depress marriage rates, and raise crime and homicide rates. (Ignoring the 41 million Americans who live in abject poverty in order to gift your already obscenely wealthy donors with a tax cut also implicates that pesky little thing called morality.) Historical precedent suggests that these effects–left unaddressed– ultimately destroy societies.

None of that evidence, evidently, is persuasive to the Paul Ryans and Mitch McConnells of this world. Or perhaps they know and just don’t care. They are perfect examples of what Hannah Arendt called “the banality of evil.”

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Ryan: I Yam What I Yam

The GOP doesn’t even bother to pretend any more. The party is waging a class war in which the rich and connected are taking unremitting aim at the struggling, powerless and unconnected: children, the disabled and the working poor.

Excuse my language, but the only thing “trickling down” is piss.

On December 6th, The Hill reported on Paul Ryan’s next despicable but not unexpected goal:

House Speaker Paul Ryan (R-Wis.) on Wednesday said House Republicans will aim to cut spending on Medicare, Medicaid and welfare programs next year as a way to trim the federal deficit.

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an interview on Ross Kaminsky’s talk radio show.

Health-care entitlements such as Medicare and Medicaid “are the big drivers of debt,” Ryan said, “so we spend more time on the health-care entitlements, because that’s really where the problem lies, fiscally speaking.”

No, Mr. Ryan, the “problem” lies with snakes like you.

The ink isn’t even dry on the mammoth tax gift that Congressional Republicans have just jerry-rigged–a bill with one and only one goal: to reward their donors and patrons, and make rich people richer. To be fair, sticking it to the poor wasn’t a goal–it was just an outcome they were perfectly willing to accept. (That isn’t true of the provision that will cost 13 million Americans their health insurance coverage–that was deliberate. I remain amazed by the GOP’s intense hostility to the notion that poor people might get access to medical care. The possibility clearly offends them.)

Ryan is confident that he has gotten the President on board.

“I think the president is understanding choice and competition works everywhere, especially in Medicare,” Ryan said.

Leaving aside the fact that we have a “President” for whom the word “understanding” is never accurate, any economist can explain–to both Ryan and the President–why “choice and competition” do not work for Medicare, or Medicaid, or almost anywhere in health care. Hell–any halfway competent high school student who has taken elementary economics can explain it.

For reasons that escape me, Paul Ryan set his sights on entitlement programs from his first days in Congress. The mental midgets who form a majority of his GOP colleagues have been only too happy to parrot his insistence that Social Security and Medicare are the real impediments to Nirvana–not the greed of their corporate masters or their disdain for facts and evidence. They don’t just ignore the experience of all other Western democratic countries–they ignore American history, and more recent “experiments” like the recent disaster in Kansas.

Ryan also mentioned that he wants to work on changing the welfare system, and Republicans have in the past expressed a desire to add work requirements to programs such as food stamps.

Speaking on the Senate floor while debating the tax bill last week, Senate Finance Committee Chairman Orrin Hatch (R-Utah) said he had a “rough time wanting to spend billions and billions and trillions of dollars to help people who won’t help themselves, won’t lift a finger and expect the federal government to do everything.”

His comments were echoed by Ryan.

“We have a welfare system that’s trapping people in poverty and effectively paying people not to work,” Ryan said Wednesday. “We’ve got to work on that.”

These are the statements of delusional people–inhabitants of fact-free (not to mention compassion-free) bubbles. Most people on food stamps already work, and those who don’t, can’t. The only people we are spending “billions and billions” on who won’t help themselves (unless hiring expensive lobbyists qualifies as self-help) are the recipients of the enormous subsidies and tax giveaways to corporate bigwigs who are unwilling to compete on a level playing field in that market they piously extol.

American government is infested with a (barely) human variety of cockroach: blabberus giganteus Ryan.

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