Public Policy and Governance – Page 218

Despicable and Inexcusable

When I sat down to write about yesterday’s vote in the U.S. House, I discovered that Paul Waldman had beaten me to it, with a column so detailed and scorching that there is no way I could equal it.

Waldman titled his piece “Every Republican Who Voted for this Abomination Must be Held Accountable.” His words fairly sizzle on the screen–and for good reason.

I won’t mince words. The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can’t recall what it might have been. And every member of the House who voted for it must be held accountable.

Waldman starts with process criticisms: the GOP passed this bill without holding a single hearing on it. They were desperate to hold the vote before the Congressional Budget Office could issue a report describing its effects. Hardly anyone had an opportunity to read the damn thing. And as Waldman points out, “all this despite the fact that they are remaking one-sixth of the American economy and affecting all of our lives.”

In contrast, the Affordable Care Act (which Republicans constantly claim was “rammed through”) was debated for an entire year and was the subject of dozens of hearings.

Waldman notes that every major stakeholder organization vocally opposed this bill: the American Medical Association, the American Hospital Association, the AARP, the American Cancer Society, the American Heart Association, and on and on.

But then he gets to the horrifying details. Quoting from his exhaustively researched article:

Takes health insurance away from at least 24 million Americans; that was the number the CBO estimated for a previous version of the bill, and the number for this one is probably higher.
Revokes the Affordable Care Act’s expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.
Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.
Slashes Medicaid overall by $880 billion over 10 years.
Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager tax credits pegged not to people’s income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.
Allows insurers to charge dramatically higher premiums to older patients.
Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.
Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.
Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
Produces higher deductibles for patients.
Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.
Shunts those with preexisting conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can’t cover the population they’re meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.
Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you’ll have to document every condition or ailment you’ve ever had.

One significant item Waldman’s list omits: the measure also defunds Planned Parenthood.

Every single Indiana Republican voted to do this to the American public and the citizens of Indiana.

I expected those votes from Rokita, Walorski, Banks and Bucshon, and I’m disappointed but not surprised by Messer and “Tennessee Trey.” But I am disgusted by Susan Brooks, because I’ve known her a long time; unlike her colleagues, she’s highly intelligent–and she knows better. I’ve watched her abandon integrity in vote after vote (during her first two years, her voting record was virtually indistinguishable from that of Michelle Bachmann.) I’ve watched her hide from her constituents during the recent Congressional recess. And now, I’ve watched her obediently vote with the lunatic caucus of her party for legislation that is not only absolutely indefensible, but will disproportionately harm women. It makes me physically ill.

Again, Waldman says it best:

Perhaps this bill will never become law, and its harm may be averted. But that would not mitigate the moral responsibility of those who supported it. Members of Congress vote on a lot of inconsequential bills and bills that have a small impact on limited areas of American life. But this is one of the most critical moments in recent American political history. The Republican health-care bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.

If Hoosiers (and other Americans) don’t begin working right now to defeat every single Representative who voted for this cynical assault on decency and basic humanity, we deserve what we get.

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What Portugal Can Teach Us About The Drug War

America’s policymakers evidently didn’t learn anything from the disaster that was alcohol prohibition. (Jeff Sessions clearly didn’t!)

In fact, for a country whose citizens constantly assert a belief in individual liberty, we rank right up there on the forced prudery scale. As any historian or political scientist can confirm, America’s legal landscape is littered with religious moralism masquerading as public safety.

When it came to drug use, and our incredibly expensive and demonstrably ineffective drug war, moralism joined hands with racism, first against Asians and Opium, and then against African-Americans, as Michelle Alexander copiously documented in The New Jim Crow.

Years of criminal justice research have confirmed the futility–and injustice–of America’s approach to drug prohibition, an approach that creates drug “schedules” unsupported by evidence of harm, fails to distinguish between use and abuse, treats drug use as a criminal justice issue rather than a public health problem, and requires massive wasteful public expenditures.

Those are mistakes Portugal no longer makes.

Portugal decriminalized the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. The drugs were still illegal, of course. But now getting caught with them meant a small fine and maybe a referral to a treatment program — not jail time and a criminal record.

The reactions from so-called “experts” were predictable. And wrong.

Whenever we debate similar measures in the U.S. — marijuana decriminalization, for instance — many drug-policy makers predict dire consequences. “If you make any attractive commodity available at lower cost, you will have more users,” former Office of National Drug Control Policy deputy director Thomas McLellan once said of Portugal’s policies. Joseph Califano, founder of the Center for Addiction and Substance Abuse at Columbia University, once warned that decriminalization would “increase illegal drug availability and use among our children.”

But in Portugal, the numbers paint a different story. The prevalence of past-year and past-month drug use among young adults has fallen since 2001, according to statistics compiled by the Transform Drug Policy Foundation, which advocates on behalf of ending the war on drugs. Overall adult use is down slightly too. And new HIV cases among drug users are way down.

Now, numbers just released from the European Monitoring Centre for Drugs and Drug Addiction paint an even more vivid picture of life under decriminalization: drug overdose deaths in Portugal are the second-lowest in the European Union.

Portugal has now operated under decriminalization for fifteen years, a time period sufficient to allow us to draw some conclusions. At a minimum, we can conclude that the country hasn’t experienced the dire consequences that opponents of decriminalization predicted. The Transform Drug Policy Institute, which has analyzed Portugal’s policy outcomes, says of of Portugal’s drug laws,

The reality is that Portugal’s drug situation has improved significantly in several key areas. Most notably, HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialise.

Of course, there are other aspects of Portuguese society that are important contributors to these salutary results. As an article from Vice points out,

Though often narrowly assessed in reference to its decriminalization law, Portugal’s experience over the last decade and a half speaks as much to its free public health system, extensive treatment programs, and the hard to quantify trickle down effects of the legislation. In a society where drugs are less stigmatized, problem users are more likely to seek out care.

So let’s see….a country that doesn’t stigmatize or criminalize personal drug use, and provides its population with an extensive “free public health system” seems to have solved–or at least significantly moderated–its drug problem.

And of course, Portugal–like every other industrialized country— spends far less per capita on medical care than the U.S. does.

We don’t learn from our own failures, and we refuse to learn from other countries’ successes. I think that’s what’s called American Exceptionalism.

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Yep….

In the wake of November’s election, my biggest concern was the prospect of Donald Trump in charge of a unified government: with a Republican House and Senate, I was sure we would see legislation canceling progress on the environment, reversing rights for women, gay citizens and immigrants, and eviscerating public education, among other nightmares.

Jennifer Rubin, a conservative columnist for the Washington Post, recently explained why we have yet to see that legislation. Her column was titled “Here’s why, even with control of everything, the GOP can’t govern.” She began with a quote from the Wall Street Journal:

Many popular postelection wagers took a hit last month after Republicans failed to repeal and replace the Affordable Care Act, which highlighted the difficulties they could face advancing new legislation even while holding the White House and both houses of Congress.

She went on to describe the current situation.

If one had any doubt, this week’s events — a half-baked tax proposal that would not pass one let alone two houses, another failed effort at Trumpcare, White House bluffs and retreats on the budget — should have disabused observers of the notion that Trump’s agenda would sail through Congress…

Trump cannot manage to devise attractive legislation or get down in the weeds of negotiation, while House Speaker Paul Ryan (R-Wis.) seems willing to accommodate whatever group is currently rocking the boat, regardless of the likelihood of success. Neither Ryan nor Trump can lead a successful legislative effort. As a result, members of Congress figure there is little reason to stick their necks out for either one. “Members of Congress have watched with horror as Trump thrashed about in Washington with little predictability, guided by top aides with little experience in the trenches of government,” Time reports. “Staffers with decades of Hill experience find themselves sidelined by political neophytes who think barking orders can get Congress to act. More than once, White House officials have told Paul Ryan that his role as Speaker may be in jeopardy if he does not do more to help Trump.”

Rubin notes that –given his priorities–Trump’s inability to get things done is a gift; gridlock looks pretty good when balanced against this administration’s goals.

This is not to say we don’t have substantial problems or need competent leadership. However, this president and this Congress have not a clue how to proceed. They would potentially do much more harm than good. They are prisoners of extreme ideology, unrealistic expectations and their own incompetence.

Wonkblog recently came to a similar conclusion. In a column tracing the reasons that financial markets aren’t betting on a big Trump stimulus anymore, Matt O’Brian wrote

But a funny thing happened on the way to Trump’s making great deals. It turns out that everything is more complicated than anyone named Donald Trump knew. It isn’t easy to get Republicans to agree on a health-care plan when some of them think the problem with Obamacare is everything, and others think it’s just the name. Or to get the whole party to agree on which tax loopholes to close to pay for all their tax cuts. The result, according to Trump, is that health-care reform is always a week away, and tax reform, always two weeks.

In the meantime, though, the economy is still chugging along at the same 2 percent pace it has been the whole recovery. So when you add it all up — a government that’s doing nothing today, that looks as if it will be doing nothing tomorrow, and an economy that’s doing nothing different from what it has been the last decade — there’s no reason to expect the dollar to go up anymore. And it hasn’t. It has given back most of its post-election gains to now only be up 1 percent over that time.

I don’t know about you, but I’m gratified that these clowns seem unable to learn.

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Transferable–and Not-So-Transferable–Skills

A recent article in the New York Times reflected upon Trump’s relationship with Steve Bannon (which appears to be unraveling). That article was one of many focusing on the disarray in the White House and the tensions between Bannon and the various others who have the President’s ear, and wouldn’t ordinarily prompt me to post.

But this paragraph caught my eye:

In a way, to believe in Mr. Bannon’s genius is to adopt the president’s belief in a sort of vulgar technocracy — the belief that the “best people” can solve any problem put in front of them, whether they have expertise in that field or not. A newspaper publisher can broker peace in the Middle East and revolutionize the government. A neurosurgeon can run the Department of Housing and Urban Development. A life as a real estate mogul and celebrity businessman is adequate preparation for the presidency. But the ability to grab power does not grant the wisdom to wield it, and ungrounded grandiosity is just pretension.

During the campaign, I was constantly amazed by the number of people who appear to hold the belief that no special knowledge or experience is necessary to run a government agency-or for that matter, to run the government. They clearly believe that any reasonably savvy person (or in Trump’s case, anyone who can fog a mirror) can be President.

I watch television during my morning treadmill routine, and the other day I was struck by an ad for a window installer. He emphasized the length of time he’d been installing the product, and how important his knowledge and experience were.

May I point out that governing the United States is more complicated than installing double-paned windows?

Indianapolis once had a Mayor named Goldsmith who shared Mr. Trump’s evident belief that smart people can do any job, no matter how unrelated their prior education or experience. I still recall the woman with a distinguished scientific background who thought she’d been hired to oversee environmental assessments, and was astonished to discover she’d been hired to manage planning and zoning. (Because she was a smart person, she left.)

It’s bad enough that we have a President who substitutes arrogance for competence, but the problem is compounded by the fact that most of his personnel choices–in addition to lacking any relevant expertise–don’t appear to be all that smart, either. (Trump apparently confuses a willingness to flatter his already outsized ego with intelligence.)

We have a cabinet composed of people who have no idea how government works. The Secretary of State appears oblivious to the web of international agreements and protocols within which the United States is expected to operate. The Secretary of Education has never set foot in a public school; during her confirmation testimony, she displayed appalling ignorance of the most significant policy issues facing that department. But there is no humility accompanying her ignorance; instead, she comes armed with self-righteous hostility to the entire enterprise of public education.

There is the new head of the EPA, whose disdain for science and evidence (not to mention the agency he manages) is matched only by his regard for the bottom lines of fossil fuel companies. And the Secretary of Housing and Urban Development who barely seems to understand what day it is, let alone the importance of HUD’s mission to neighborhoods in America’s cities.

Jeff Sessions does know how government works, of course; what recommended him to Trump appears to be his determination to reverse the progress made on civil rights–to further eviscerate the Voting Rights Act, encourage overreach by the police, and re-invigorate the drug war.

Most of the others are just as bad.

It’s not just that we have a self-aggrandizing buffoon in the Oval Office. We now have a government populated with–and being run by–dangerous ideologues with second and third-rate intellects who lack both relevant experience and any obvious willingness to learn, or to devote themselves to the tasks they’ve been assigned.

Our best hope actually lies in their incompetence. As Trump would say, SAD.

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Environmentalism is About More than Climate Change

If Saturday’s March for Science did just one thing, I hope it underlined the message that protecting the environment is about much more than climate change, critical as that issue is.

Do the climate change deniers at least believe that children in Flint, Michigan, and East Chicago, Indiana should have lead-free water to drink? What about the rest of us? Should Americans continue to have routine access to safe, potable water? Breathable air? Toxin-free fruits and vegetables?

How do Republicans justify Trump’s reversal of an Obama-era regulation to protect U.S. waterways from coal mining operations? (I don’t know about you, but to me, “Let them drink coal ash” sounds even worse than “let them eat cake.”) What about the elimination of information on methane emissions, removal of the word “science” from the EPA’s Office of Science and Technology mission statement, and the promised roll back of auto pollution standards?

Huffington Post has published a list of Trump’s anti-environment measures in just the first 90 days of his administration.

I’d be interested in hearing Todd (don’t confuse me with the facts) Rokita’s justification for the administration’s refusal to ban an insecticide that, as extensive research has demonstrated, harms the developing brains of fetuses and children who eat food from plants treated with the compound.

Much of the EPA’s own research outlines chlorpyrifos’s adverse health effects. In 2016 the EPA reported“sufficient evidence” that low levels affect brain development and concluded that some American 1- to 2-year-old children are receiving up to 140 times what are considered safe levels in their food. The EPA has also reported elevated levels in water supplies and established that the compound adversely affects 1,778 out of 1,835 studied species of wild animals.

I’ve noticed that all those pious “pro life” Republicans lose their zealous commitment to the well-being of the fetus when the threat to the unborn must be balanced against the health of corporate bottom lines, rather than the health of the mother.

Trump has issued Executive Orders that would undo both the Clean Power Act and the Clean Water Act. According to those much-maligned scientists, reducing the scope of the Clean Water Act as called for in the Executive Order risks seriously degrading waters used for swimming, fishing or drinking.

Speaking of Republicans, incomprehensible as it may seem today, it was a Republican President–Richard Nixon– who established the EPA that is under such relentless attack from today’s GOP. As Nixon stated in his 1970 State of the Union address to Congress,

“Restoring nature to its natural state is a cause beyond party and beyond factions. … Clean air, clean water, open spaces – these should once again be the birthright of every American.”

Well, times (and the GOP) have certainly changed. As U.S. News recently reported,

Currently, there is a systematic attempt to undermine this legacy. President Donald Trump proposes to slash the EPA’s budget by 31 percent and reduce its workforce by 3,200 employees – the harshest cuts in the agency’s history. But the environmental problems for which the agency is responsible have not shrunk or even stayed constant; instead they’ve grown significantly since the 1970s. The U.S. population has grown by over 100 million, economic activity has quadrupled, electricity use has tripled and the inventory of toxic substances has grown to over 85,000 compounds.

Every elected official who supports this assault on the EPA is supporting the presence of particulates, smog and greenhouse gases in the air we breathe, lead and coal ash in the water we drink, and toxic pesticides in the food we eat.

We need to challenge them to deny that.

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