Public Policy and Governance – Page 248

Playing with Fire

Every once in a while, I read something that makes me want to pound my head against the nearest wall.

A few days ago, this was the “something.”

The article addressed the dogged determination with which Republicans in Congress have opposed any and every proposal coming out of the Obama White House–even, as we have seen, proposals that had originally been theirs.

That strategy was eventually articulated publicly by former Republican Congressional staffer Mike Lofgren.

A couple of years ago, a Republican committee staff director told me candidly (and proudly) what the method was to all this obstruction and disruption. Should Republicans succeed in obstructing the Senate from doing its job, it would further lower Congress’s generic favorability rating among the American people. By sabotaging the reputation of an institution of government, the party that is programmatically against government would come out the relative winner.

…There are tens of millions of low-information voters who hardly know which party controls which branch of government, let alone which party is pursuing a particular legislative tactic. These voters’ confusion over who did what allows them to form the conclusion that “they are all crooks,” and that “government is no good,” further leading them to think, “a plague on both your houses” and “the parties are like two kids in a school yard.” This ill-informed public cynicism, in its turn, further intensifies the long-term decline in public trust in government that has been taking place since the early 1960s – a distrust that has been stoked by Republican rhetoric at every turn.

I know this is an era of exceptionally strong partisanship. I also know that both parties routinely engage in behaviors that do not serve the common good.

But I also know–and there is ample research confirming—that trust in the enterprise of government is absolutely essential to the operation of that government. To deliberately undermine popular belief that government as an institution is both necessary and (in the main) beneficial is to intentionally destroy its ability to function.

Accountability is important. No one in her right mind would suggest that every government program is well-run (or even necessary), or that every government official is a wonderful person devoid of self-serving motives, or that we should turn a blind eye to ethical and legal transgressions. We need to identify and correct the very real problems that exist. But with all its imperfections, with all its opportunities for mischief, the American administrative state has served us well.

Making governance impossible in order to gain political advantage so that you can ultimately control the institution you have neutered is rather obviously short-sighted.

If true, it is also–and I use the term advisedly–evil.

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Political Gamesmanship from Indiana’s Governor?

As regular readers know, I posted a critical review of Governor Pence’s “State of the State” address. I certainly wasn’t alone–editorial writers and columnists around the state panned the presentation.

Critics focused particularly on the Governor’s unwillingness to endorse civil rights protections for LGBT Hoosiers, and his declaration that he “would not sign” a bill he considered insufficiently protective of religious liberty. Like most critics of that pronouncement, I assumed that the lack of specifics–the Governor certainly didn’t say what provisions he would or would not accept–was tantamount to a veto threat.

We may be wrong—but not for reasons that are particularly comforting to those on either side of this debate.

Over the past two days, in separate conversations, people with broad political experience observing Indiana government have parsed the Governor’s language and arrived at a different conclusion. They point out that what Pence said was “I will not sign a bill…” He did not say “I will veto a bill.” Under Indiana law, the two are not the same thing.

In Indiana, when the state legislature passes a bill and sends it to the Governor, there are three actions that Governor can take: 1)he can sign the bill, after which it becomes law; 2) he can veto the bill and send it back to lawmakers, who can then sustain or override the veto; or 3) he can allow the bill to become law without his signature.

Politically, as everyone has pointed out, Pence is between a rock and hard place. His reelection prospects are utterly dependent upon the loyalty of his base of “Christian Soldiers.” He cannot afford to lose them, and they will leave at the slightest sign that Pence is softening his stance against equal rights for LGBT Hoosiers (and that would include any statement suggesting that he might allow an expansion of civil rights to become law).

Unfortunately for Pence, the number of these religious warriors is steadily declining, so he also needs significant support from the business wing of the Republican Party— and the business community is virtually unanimous in its support for civil rights expansion.

As the Democrats have pointed out (almost daily), Pence spent some 175 days avoiding taking a position—desperately trying to placate those on either side of the issue.

As one of the lawyers I talked with observed, the “non-position” communicated to the legislature in Pence’s State of the State address had two possible interpretations: 1) please don’t send me anything that will force me to decide what to do; or 2) if you send me a bill, I won’t sign it–but I won’t veto it, either. It will become law without my explicit endorsement.

The carefully noncommittal framing of the Governor’s statement in the State of the State was even more cowardly than it appeared in the moment, because it allows people on both sides to believe that he shares their concerns–that he is “with them.”

Disingenuous as it may have been, however, it gives some small measure of hope to those of us who want to see genuine civil rights protections for LGBT Hoosiers enacted in Indiana.

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The State of the Governor

So–I poured a stiff drink and listened to Mike Pence deliver (his version of) the “State of the State.”

The word “smarmy” comes to mind.

There is much that might be said about this particular effort to put lipstick on a pig–the state he described is not one I recognized, nor the state that widely available data describes. (My son, with whom I was watching, asked what grade I would give a student whose assignment was to deliver an accurate assessment of Indiana’s economic and social well-being and utterly failed to do so.)

There were some truly cringeworthy moments. The Governor, you may be surprised to learn, is “honored to be the Commander in Chief” of Indiana’s National Guard. At the conclusion of the forced, wooden speech—a pastiche of talking points and trite adages that met with dutiful but definitely not enthusiastic applause—he declaimed several lines from “On the Banks of the Wabash.”

The part of the speech that the entire state was waiting for—the Governor’s position on extending state civil rights protections to LGBT Hoosiers—came at the end, and the Governor’s discomfort was palpable.

Pence assured everyone that he had “prayed” about the issue. (Clearly he hadn’t thought about it—but then, nothing in the speech gave evidence of much thought.) He reprised his “Hoosiers are good people who don’t discriminate” mantra and then engaged in a rambling discourse about the importance of religious liberty.

Bottom line: he won’t sign a bill that deprives religious folks of their ability to act on their beliefs everywhere—including at work.

There are two rather obvious responses to that declaration, one legal and one political.

First, the Constitution protects citizens’ right to believe anything. Full stop. It does not, however, protect an untrammeled right to act on the basis of religious doctrine. If my sincerely held religious belief requires me to sacrifice my first-born, or take drugs, or murder abortion doctors, or cheat nonbelievers, the government has the right to step in and say “too far.”

People of good will can disagree about the specific rules that are necessary to a fair and functioning society, but the Constitutions of the United States and Indiana have never been interpreted to privilege socially harmful behaviors simply because those behaviors are religiously motivated.

Second—and here, I admit to more than a bit of shadenfreude—Governor Pence has wedged himself firmly between a political rock and hard place.

The religious extremists who have always been his base will desert him in a heartbeat if he signs any bill that, in their eyes, “legitimizes” LGBT Hoosiers. Meanwhile, polls confirm that a solid majority of Indiana voters support adding “four words and a comma” to the state’s civil rights statute. And given this administration’s other blunders—its unremitting war on public education and Glenda Ritz, the proposed “news bureau,” the lack of attention to Indiana’s crumbling infrastructure, etcetera etcetera—Pence simply does not have political capital sufficient to weather widespread disapproval of this particular culture war battle.

The wooden and forced delivery of last night’s platitudes suggests that the reality of his position is beginning to dawn on our “Christian soldier” Governor.

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Medicare for All

I’ve been interested to see how frequently the comments to this blog end up discussing (and debating) America’s health care system–even when the ostensible subject of that day’s post is something entirely different.

(As I was typing the phrase “healthcare system,” I was reminded of a graduate student—a hospital administrator—who corrected my use of that term. “America doesn’t have a healhcare system,” he said. “We have a healthcare industry” and it’s not the same thing.)

I often share insights from my cousin, a respected cardiologist who also spent many years teaching medicine. He recently sent me a thoughtful analysis of that healthcare industry, and the prospects for fixing what everyone realizes is unsustainable. I particularly like his introduction to the issue:

When considering the best way to solve our country’s medical care woes, I am reminded of Churchill’s famous statement about democracy as a form of government, in which he stated in effect: It’s a terrible system, but everything else is worse. This same statement might apply to a single payer system in medical care, for it probably beats everything else, as I explain below.

He noted that a truly effective system will require cost controls, including tort reform, the excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. He is convinced that these issues can be resolved, and that a single-payer system (for example, “Medicare for All”) is both inevitable and the best solution:

In an article on why a single-payer system would be our best solution, Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and an architect of the Affordable Care Act (ACA), contended that although the ACA has been “a step forward for the country,” it “does not deal with the problem of waste and complexity in the system,” as he feels a single-payer system would. I can personally attest to the complexity of the system with the many headaches provided by a dizzying array of differing insurance forms pertaining to treatments, hospital admissions and a multitude of other issues.

And James Burdick, MD, a transplant surgeon at Johns Hopkins University School of Medicine and author of the forthcoming book Talking About SINGLE PAYER!, argued that a single-payer system is “a more economical way to use healthcare resources. You could reduce expenses and still improve quality. That’s a tremendous opportunity that you don’t have in many other fields.” Of course, as he pointed out, this would virtually eliminate the entire commercial insurance industry—with $730 billion in revenues and a workforce of 470,000. (Maybe these same workers could be involved in more productive work such as restoring our nation’s wobbly infrastructure!) But Dr Burdick also maintains that a single payer system would likely restore doctors’ authority. And those who favor this system say that for all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments would be eliminated.

He also reports that there is growing physician support for a single-payer system. For example, a 2014 survey of Maine physicians conducted found that nearly 65% of respondents preferred the single-payer option over trying to fix the current system—up from 52% in a 2008 survey.

Interestingly, a majority of the population (51%) now supports Medicare for all, according to a national poll released this past year.

In reality, a government-run single-payer system is the only way to provide effective basic medical health therapy and management, but for those who desire a higher level of care—and can afford it—there should be a private-pay system, contrast with the Canadian system. This would, de facto, constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a “one size fits all” system, but would be the most pragmatic approach.

Usually those against single payer system trot out the usual vague objections that we are becoming “socialistic.” But what about our current Medicare system, is that not socialistic? I might add further that I personally have worked at a VA hospital, and, despite all the current noise, found that once patients were able to access the system, the care is quite good. Its main problem seems to be gaining initial entry into an overburdened system in a timely manner. By contrast, it is highly unlikely that a random assortment of for-profit HMOs would do a better job serving the high-utilization health needs of our veterans.

His conclusion–with which I concur:

Whether we like it or not, basic healthcare is like a utility—something everyone needs, and, in the best interest of our society, everyone should receive. Although there are many variations of the general theme as I have enumerated above, we are moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including the Republicans!

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Don’t Confuse Me with the Facts!

Just how depressing have America’s policy debates become? What is the extent to which emotion and ideology have replaced reliance on facts, evidence and data–and what are the consequences of our refusal to confront unpleasant realities?

Permit me to offer just two examples.

In Florida, as you have probably heard, state workers are not permitted to use the phrase “climate change.” As the Guardian wryly noted,

You might have missed it, but Florida has solved climate change. Our state, with 1,300 miles of coastline and a mean elevation of 100 feet, did not, however, limit greenhouse emissions. Instead, the state’s Department of Environmental Protection (DEP), under Republican governor Rick Scott, forbade employees from using terms like “climate change,” “global warming” or “sea-level rise”. They’re all gone now. You’re welcome, by the way.

It’s pointless to call linguistic distortions of reality like this Orwellian: people tune you out when you use that word and, besides, Big Brother at least had wit. These are just the foot-stamping insistent lies of intellectual toddlers on the grift. It is “nuh-uh” as public policy. This is an elected official saying, “I put a bag over your head, so that means now I’m invisible” and then going out looting.

It isn’t only Florida; Scott Walker’s Wisconsin has a similar rule.

North Carolina went them one better:

In North Carolina, the legislature passed a ruling after the state’s Coastal Resources Commission released an estimate predicting the sea will rise 39 inches along the state’s coast in a century, ABC News reported.

The estimation alarmed developers and seaside residents. If the state was to take action, it would cost hundreds of millions of dollars, said ABC. North Carolina would need to draw new flood zones, build waste-treatment plants and elevate roads, and several permits of planned development projects would be in jeopardy.

So the state’s legislature promptly addressed the problem–with a bill banning the actual measurement of sea levels; henceforth, sea-level rise “may be predicted based only on historical data.”

It isn’t only climate change. For a number of years, Congress has banned federal research by the CDC on gun violence–a ban it extended in the immediate aftermath of the Charleston church shooting that left 9 people dead.

The ban began with the 1996 Dickey Amendment, which barred the CDC from involvement in any research that could be interpreted as advocating tougher gun laws. Jack Dickey, a Republican Congressman from Pine Bluff, Arkansas, who was then a junior member of the House Appropriations Committee, authored a rider to a spending bill that also slashed $2.6 million from the CDC’s budget— the precise amount that the organization had dedicated to studying gun violence the year before.

Ever since, CDC studies on guns and public health have been virtually non-existent. Dickey has since expressed regret over sponsoring the measure.

Every single day, 89 Americans die from gun violence, and yet we refuse to support research on the causes, effects and consequences of those deaths.

Representative David Price, vice chair of the House Gun Violence Prevention Task Force, recently argued that

“Regardless of where we stand in the debate over gun violence, we should all be able to agree that this debate should be informed by objective data and robust scientific research.”

Representative Price is wrong. There is nothing that ideologues and interest groups fear more than “objective data and robust scientific research.” Their most fervent hope is that public policy debates continue to be conducted in the absence of evidence. Their motto is: don’t confuse me with science or fact.

Problem is, as Neil DeGrasse Tyson is fond of noting, science is true whether or not you believe in it. Facts exist whether we accept them or not.

Ignoring reality is ultimately unsustainable.

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