Public Policy and Governance – Page 207

Deconstructing The Rhetoric

A week or so ago, an Indiana legislator–a Republican– posted a comment to Facebook about the current effort to “repeal and replace” the Affordable Care Act. I know this particular Republican to be thoughtful and well-intentioned; he’s not one of the mean-spirited or rigidly ideological partisans who populate our Statehouse.

His “logic,” however, defied reality.

He began by saying that we are not debating healthcare–we are debating access to health care via insurance coverage and that government should “let the insurance market work.” (Why he thought the distinction significant mystifies me, but okay.)

I am a huge proponent of markets–in areas of the economy where they work. Most people recognize that healthcare is an area where markets do not work; market transactions require a willing buyer and a willing seller both of whom are in possession of all information relevant to the transaction. That definition doesn’t characterize doctor-patient interactions, and it also doesn’t characterize the health insurance “marketplace.”

Even if you assume that all citizens understand the complexities and “fine print” of the policies offered by health insurers, that they all understand the technical terminology employed and are able to make considered opinions about the nature and extent of their desired coverage, you are left with several major problems that cannot be solved by “market magic.”

First of all, most Americans get their health insurance through their employers. They don’t get to participate in the choices involved. (This coupling of insurance and employment is problematic for lots of reasons unrelated to the subject of this post; for one thing, it makes American businesses less competitive in the global economy. But that’s a subject for another day.)

Second, significant numbers of people who do not get their insurance through their jobs–either because they don’t have jobs or their employer doesn’t offer it–cannot afford the coverage they need. (That’s why we have Medicare and Medicaid.) In the U.S., non-governmental health insurance policies are priced to cover expenses that include not just the expected payouts to providers, but the costs of marketing, profits and taxes. Private insurance overhead also includes very substantial salaries paid to insurance companies’ management, costs not incurred by Medicare and Medicaid. Last time I looked, Medicare overhead averaged around 3% while private insurance overhead averaged around 24%.

Third, and most important: markets, by definition, are voluntary. (That “willing” buyer and seller…). Insurance works by spreading risk. If younger, healthier people decide they aren’t “willing” buyers–if only the elderly and sick and people with pre-existing conditions participate in the market–the whole system comes crashing down. Insurers have to charge higher and higher premiums, and policies become more and more unaffordable. That’s why the ACA’s mandate was an essential part of the law.

If we accept the premise that access to healthcare is a human right–and I am well aware that most Republicans do not accept that premise–then people who cannot afford insurance must be subsidized. For the reasons I’ve listed, providing access through “market forces” would add enormously to the costs of the insurance and thus to the amount of the subsidies.

There is a reason other developed nations have pursued a variety of ways to nationalize health insurance; it’s the only way to make universal access cost-effective.

When you deconstruct Paul Ryan’s rhetoric about giving people the “freedom” to go uninsured, and the GOP’s reverential references to “market economics,” what you get is what the Congressional Budget Office described: millions of Americans losing insurance entirely, and millions of others paying much more for much less coverage.

Eventually, Americans are going to have to decide between a system like “Medicare for All,” that pays for actual healthcare, and our current, unsustainable and immensely more expensive insistence upon subsidizing the bottom lines of Big Insurance and Big Pharma in the name of “the market.”

The purchase and sale of health insurance in today’s U.S. can be called many things, but a genuine market isn’t one of them.

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Bleeding Expertise

Drip, drip, drip…

No, I’m not alluding to the daily emergence of new evidence confirming the Trump campaign’s collusion with Russia. I’m talking about the accelerating rate at which people who actually know what they are doing are abandoning this bizarre administration.

When the CEO of your company, or the Executive of your political subdivision, or the President of the United States is intellectually and emotionally unfit to lead, the people who work for that company or city or branch of the federal government face an uncomfortable choice: do they hang in there and try to make things work despite the dysfunction at the top? Or do they weigh their ability to do their jobs against the likelihood that their continued employment is simply enabling dangerous incompetence?

One long-time American diplomat who concluded that he had to resign wrote a column in which he explained his decision. David Rank had been a member of the U.S. Foreign Service since 1990. Most recently, he ran the U.S. Embassy in China.

This month, I resigned from the State Department’s Foreign Service, stepping down as the senior U.S. diplomat in China and ending a 27-year career. I served five presidents — three Republicans and two Democrats — and, like my colleagues throughout the Foreign Service, took pride in the tradition of loyal, nonpartisan service. I also took seriously my oath to defend the Constitution against all enemies, foreign and domestic, and the obligations that came with representing the American people.

When the administration decided to withdraw from the Paris agreement on climate change, however, I concluded that, as a parent, patriot and Christian, I could not in good conscience be involved in any way, no matter how small, with the implementation of that decision.

The job he held all those years was hardly what you’d call “cushy:” Rank had his close calls with bombs, guns and grenades; his father died when he was on assignment in Taiwan. His mother died while he was in Afghanistan. He missed both the birth of his first child and his only son’s senior year of high school.

Government workers make those sacrifices because they believe in the importance of the service they are rendering.

Rank says he leaves with gratitude for his experiences, for his colleagues and for the opportunity to serve his country. But he also leaves with deep-seated concerns.

I worry about the impact my departure will have on colleagues who remain. Many of these colleagues, some with decades of contributions ahead of them, share my dismay not just at the decision to withdraw from the Paris agreement but also at the unraveling of 70 years of bipartisan foreign policy that has made the world and the United States safer and more prosperous. Rather than encourage them to follow my example, I hope my departure will send a message on their behalf so that they can continue to work within the system to make things a little bit better, a little bit at a time. That work will always be honorable work and, I suspect, will be more important than ever in the coming years.

I worry about the frequently politically motivated portrayal of those who work for the American people as members of some mythical elite, separate and suspicious. Such false characterizations drive talented Americans away from public service or discourage them from entering it in the first place. My experience has been that those who work for America look like America. For my part, I certainly never felt particularly “bicoastal.” I was raised in a decidedly working-class town south of Chicago. My wife grew up showing hogs and cutting corn out of beans. Like many of my colleagues, I am a product of a public education, from grade school to grad school.

I worry about the denigration of expertise at a time when a complex world demands it more than ever.

For my part, I worry about the loss of people like David Rank. And I especially worry, as he does, about the future of a country that sneers at knowledge and education as elitism, competence as snobbery, and uncongenial facts as “fake news.”

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The Evil of Indifference

Politics has been called war without the killing; a process in which people with very different notions of the common good, the best way forward–even how winners should be identified and rewarded and losers punished–clash without bloodshed.

Throughout history, we’ve become accustomed to the passions that ideological combatants have brought to our political “wars.”

These days, however, politics isn’t really about that clash of ideas and passions. It’s about power and privilege, increasingly dismissive of ideas and political philosophies.

Even a blind person can see that Donald Trump and the Republicans who control Congress are utterly indifferent to policy except to the extent those policies operate to keep them in office. Trump, especially, is often called out for lacking even rudimentary knowledge of–or interest in–the legislation he supports. He is utterly indifferent to the contents of that legislation; his only goal is “winning,” which he evidently defines as getting good press.

This approach to governing isn’t only dishonest; it’s very bad for morale. There is nothing more disheartening than putting your heart and soul into a cause and finding that your employer is totally indifferent to it.

Citing Donald Trump’s ongoing quest to undermine and repeal the Affordable Care Act, his refusal to meet with HIV/AIDS advocates during the primary, and his general “lack of understanding and concern,” six members of the Presidential Advisory Council on HIV/AIDS, established by President Bill Clinton more than 20 years ago, have resigned. Former council member and Lambda Legal lawyer Scott Schoettes writes in the group’s resignation letter:

“As advocates for people living with HIV, we have dedicated our lives to combating this disease and no longer feel we can do so effectively within the confines of an advisory body to a president who simply does not care.

The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and—most concerning—pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.”

Scientists who have devoted their careers to understanding and fighting climate change didn’t resign from the EPA–they were terminated by administrators indifferent to the consequences of environmental degradation.

The agency quietly forced out some members of the Board of Scientific Counselors just weeks after leaders told them their tenure would be renewed, said Robert Richardson, an ecological economist at Michigan State University and one of those dismissed.

The board is tasked with reviewing the work of EPA scientists and provides feedback that can be a powerful voice in shaping the agency’s future research. The cuts “just came out of nowhere,” Richardson said.

“The role that science has played in the agency in the past, this step is a significant step in a different direction,” he said today. “Anecdotally, based on what we know about the administrator, I think it will be science that will appear to be friendlier to industry, the fossil fuel industry, the chemical industry, and I think it will be science that marginalizes climate change science.”

And of course, the news has been full of the indifference–and hostility– with which the Administration and Congressional Republicans have responded to the CBO analysis of their “health” bill, including predictions that it’s vicious cuts would be responsible for 208,500 preventable deaths by 2026.

Indifferent to human suffering, indifferent to facts, evidence, science, indifferent to world opinion….but not to criticism from cable news personalities.

How far “leadership” has fallen.

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Reality Doesn’t Care Whether You Believe It (Part II)

One of the defining features of our time is increasing complexity; the rapid growth and sophistication of technology, the globalization of economics, science and even governance, in short, the accelerating production of vast amounts of knowledge that no one person can hope to master (or even identify).

This complexity requires informed and thoughtful policymaking, an understanding of how the various aspects of our shared environment interact, if we are to avoid unintended and very harmful consequences.

Unfortunately, we have elected a President and numerous lawmakers who are not up to the task, to put it as delicately as possible. They are supported by voters who dismiss people who do have expertise, people who actually know things, as “elitist.”

A couple of examples: a while back, the New York Times ran an article about automation, addressing a number of likely consequences of new AI (Artificial Intelligence) technologies:

A.I. products that now exist are improving faster than most people realize and promise to radically transform our world, not always for the better. They are only tools, not a competing form of intelligence. But they will reshape what work means and how wealth is created, leading to unprecedented economic inequalities and even altering the global balance of power.

It is imperative that we turn our attention to these imminent challenges.

What is artificial intelligence today? Roughly speaking, it’s technology that takes in huge amounts of information from a specific domain (say, loan repayment histories) and uses it to make a decision in a specific case (whether to give an individual a loan) in the service of a specified goal (maximizing profits for the lender). Think of a spreadsheet on steroids, trained on big data. These tools can outperform human beings at a given task.

I have posted previously about the potential consequences of AI and automation generally for job creation. The number of jobs lost to automation already dwarfs those lost to outsourcing and trade–and yet, activists on both the Right and Left continue to focus only on trade policy.

This kind of A.I. is spreading to thousands of domains (not just loans), and as it does, it will eliminate many jobs. Bank tellers, customer service representatives, telemarketers, stock and bond traders, even paralegals and radiologists will gradually be replaced by such software. Over time this technology will come to control semiautonomous and autonomous hardware like self-driving cars and robots, displacing factory workers, construction workers, drivers, delivery workers and many others.

Unlike the Industrial Revolution and the computer revolution, the A.I. revolution is not taking certain jobs (artisans, personal assistants who use paper and typewriters) and replacing them with other jobs (assembly-line workers, personal assistants conversant with computers). Instead, it is poised to bring about a wide-scale decimation of jobs — mostly lower-paying jobs, but some higher-paying ones, too.

If Donald Trump has ever addressed this issue, or suggested that he is even aware of it, it has escaped my notice.

Richard Hofstadter’s book, Anti-intellectualism in American Life is, if anything, more relevant today than when it was written. What Hofstadter and others who have addressed this particular element of American culture failed to foresee, however, was a time in which the federal government (together with a good number of state governments–Texas comes immediately to mind) would be controlled by people who neither understand the world they live in nor know what they don’t know.

Science Magazine recently reported on the EPA’s dismissal of 38 science advisors.

U.S. Environmental Protection Agency (EPA) Administrator Scott Pruitt continues to clean house at a key advisory committee, signaling plans to drop several dozen current members of the Board of Scientific Counselors (BOSC), according to an email yesterday from a senior agency official.

Unlike most of Trump’s cabinet, Pruitt is proving to be effective. Unfortunately, he is proving effective in his efforts to destroy the EPA–not just by denying the reality of climate change science, but by rolling back regulations that protect air and water quality. He appears to be operating on a theory common to this administration: if a reality is uncongenial, ignore it or deny its existence. If evidence contradicts your worldview, dismiss it.

Yesterday, in a reference to Neil DeGrasse Tyson, I observed that science and reality are true whether or not you believe them.

The worst thing about giving simple and/or corrupt people the power to run a government they do not understand is that complicated realities continue to be realities, and the longer we fail to engage those realities, the worse the consequences.

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Reality Doesn’t Care Whether You Believe It (Part I)

La La Land isn’t just the title of a movie. Increasingly, it’s where our government officials live.

The Trump administration is debating whether to launch a governmentwide effort to question the science of climate change, an effort that critics say is an attempt to undermine the long-established consensus human activity is fueling the Earth’s rising temperatures.

This effort is being pushed by Scott Pruitt, the truly dangerous Secretary of the EPA, but other administration troglodytes are also involved.

Energy Secretary Rick Perry, who once described the science behind human-caused climate change as a “contrived phony mess,” also is involved in the effort, two officials said.

At a White House briefing this week, Perry said, “The people who say the science is settled, it’s done — if you don’t believe that you’re a skeptic, a Luddite. I don’t buy that. I don’t think there is — I mean, this is America. Have a conversation. Let’s come out of the shadows of hiding behind your political statements and let’s talk about it. What’s wrong with that? And I’m full well — I can be convinced, but let’s talk about it.”…

Other agencies could include the Commerce Department’s National Oceanic and Atmospheric Administration, the White House’s Office of Science and Technology Policy and NASA, according to the official, all of which conduct climate research in some capacity.

And then there’s Florida. As CNN reports,

A new Florida law would let anyone in the state challenge, and possibly change, what kids are learning in school.

Any Florida resident can raise concerns about teaching material they find unfit for public school classrooms, according to legislation that went into effect Saturday. The bill was introduced in February by Rep. Byron Donalds, R-Naples, and was signed into law last week after passing with bipartisan support…

Supporters of the law have disputed material presenting global warming and evolution as “reality.” Others found certain reading material to be “pornographic.” And for some, US and world history textbooks seem biased and anti-American.

Impetus for the measure came from a conservative group called “The Florida Citizens’ Alliance.” That organization gathered testimony from “at least 25 people” (!) in favor of the legislation, and their reasoning (I use the term loosely) was predictable.

One woman took issue with evolution being taught as a “fact,” arguing that the “vast majority of Americans believe that the world and the beings living on it were created by God as revealed in the Bible.” Another person complained that history classes were making students “subservient” by teaching them about the president’s ability to issue executive orders.

Shades of Trump’s go-to response when his “facts” are challenged: “a lot of people agree with me.” A lot of people still believe the earth is flat and that aliens landed and are buried in Roswell, New Mexico.

What’s that great Neil DeGrasse Tyson quote? Reality doesn’t care whether you believe it or not…

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