Public Policy and Governance – Page 295

What Is WRONG With These People? Rerun Edition

The Atlanta Journal-Constitution recently ran a story that left me banging my head on my desk.

“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”

After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

“We have passed a law that says that a navigator, which is a position in that exchange, has to be licensed by our Department of Insurance,” Hudgens said. “The ObamaCare law says that we cannot require them to be an insurance agent, so we said fine, we’ll just require them to be a licensed navigator. So we’re going to make up the test, and basically you take the insurance agent test, you erase the name, you write ‘navigator test’ on it.”

As the article points out, Georgia is not the only state where Republicans are in charge and are doing everything in their power to insure that people don’t get healthcare.

Think about that. No matter what your policy differences with the President, no matter what concerns you might have about the ACA’s approach, what sort of human being deliberately–indeed, gleefully–takes steps to insure that other people will continue to suffer?

How much do you have to hate the President that you are willing to let thousands of people go bankrupt and/or die if that’s what it takes to deny him a policy victory?

The Atlanta reporter asked the obvious questions:

Why would you take pride in making it harder for Georgians with pre-existing conditions to get the insurance coverage that had previously been denied to them, and that might save them from potential bankruptcy or even death? Why would you block the federal government from offering Medicaid coverage to more than 600,000 lower-income Georgia citizens, coverage that would allow them to compensate hospitals and doctors now forced to treat them for free? Why refuse to educate uninsured Georgians on the fact that they will soon be eligible for subsidies to help them pay for health insurance, as other states are doing?

I’d ask how low these people can go, but I’m afraid I’ll find out.

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Conflicted

I haven’t posted anything about the situation in Syria, because–to be utterly candid–I’m conflicted about it. Not about Assad–he’s a vicious dictator–but about what America should or could do that wouldn’t simply make a horrible situation worse.

I don’t consider myself either a hawk or a dove; I opposed our intervention in Iraq, but not Afghanistan, because the situations were very different. Afghanistan had harbored and supported the people who attacked us. Iraq was an obvious war of choice, trumped up by people who quite clearly had no understanding of the complex political realities of the Middle East. Furthermore, we had international support for our response to Afghanistan, and a pathetic, trumped-up “Coalition of the Willing” for our aggression in Iraq.

Justified or not, neither war went well.

Now I am listening to the arguments for and against a “targeted” action against Syria. The President’s argument–Syria has defied international norms and inaction will send a message that such violations can continue with impunity–resonates with me. But so does the argument that another “go it alone” cowboy intervention in the world’s most dangerous region is likely to end badly, doing more harm than good.

Until I read this post by Andrew Sullivan, I thought I was the only person impatient with the self-righteous moralists on both ends of the political spectrum. On the Right, we have the American Exceptionalists who believe we should be the world’s policemen, not to mention the irony-challenged chickenhawks who pontificate about saving the lives of Muslims they routinely stereotype and discriminate against here at home; on the Left, we have the anti-imperialism scolds who loudly accuse anyone considering any intervention of any sort for any reason guilty of moral turpitude and/or commercial intent. To both camps, waging war or not is apparently a simple decision, to be made without any ambivalence or concern for the truly disastrous consequences that could flow from a wrong decision.

A recent article by George Packer in The New Yorker made all of these points far more clearly than I can. (Actually, this article from the Onion did an even better job of laying out the unattractive options–and when the Onion is the voice of sanity, that sort of sums it all up.)

Whatever we do, act or refrain from acting, prudence requires that we think carefully about the pitfalls. What do we want to accomplish, what decisions and tactics are likely to achieve that goal, and at what cost–not just in human lives and dollars, but to America’s long-term international interests?

I’m all for realpolitik. I just don’t know what it looks like right now.

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Revenue Enhancement

A couple of days ago, a former partner of my husband copied me on a message he sent to his City-County Council representative. It began:

Today we were the recipients of an unannounced revenue enhancement effort “inspection” by a member of the Indianapolis Fire Department, acting under authority of General Ordinance #46, supposedly under the guise of State law.

The message went on to describe a Fire Department program in which individual tenants of commercial buildings were notified of an obligation to “self-inspect” their leased premises –and charged $25 each for that dubious privilege. Those failing to respond were assessed a $60 fine.

The owners of the building were not notified, despite the fact that they would seem to be the parties responsible for maintaining fire safety standards. And as the writer noted, tenant “self-inspections” are unlikely to generate confidence-producing results.

What particularly irked my correspondent–a registered architect who has to comply daily with fire safety regulations–was the fact that the building in which he has his offices is fully sprinklered, has a supervised alarm system, and is regularly inspected by the State Fire Marshall.

The purpose of these laughable “self-inspections” is rather obvious, and it isn’t fire safety. It is, as he asserted, “revenue enhancement.”

The City’s taxing authority has been constrained (unwisely, in my view, but that is a separate conversation), so it is trying to compensate by raising “fees.” The difference between a tax and a fee is that the former is levied on the population at large in order to provide services that benefit the entire citizenry; fees–at least in theory–are levied on the people benefitting from the service.

Fire safety is a good example of the elasticity of this theory. Many years ago–in colonial times, actually–fire protection was a consumer good. Fire departments (privately owned) would respond to fires at the homes of those who could afford the “insurance” they sold. That didn’t work very well, as you might imagine, and lawmakers recognized the benefits of providing “socialized” fire protection.

Thanks to America’s current hysteria over taxation, we seem to be moving back to the bad old days. Affluent neighborhoods are hiring their own “security” in the absence of adequate police protection. And now, we’re evidently going to use a “safety program” to charge commercial occupants for a portion of their fire protection.

This isn’t progress, folks.

Maybe its time for a community-wide discussion of what government is for.

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Unhealthy Indiana

Yesterday, the IBJ reported the latest data on public health indicators, under a headline that telegraphed the results: “Indiana public health continues to slide.”

When the most recent data is compared to previous studies, it becomes quite clear that Hoosiers are moving in the wrong direction. We are fatter, more sedentary, more diabetic. Hoosiers smoke more than citizens elsewhere, and more of our babies die in infancy.

Not exactly a distinction we would choose.

Furthermore, since our policymakers seem to care a lot more about money than about Hoosier health and well-being, it may be useful to point out that poor health drives up costs. As the IBJ pointed out, Indiana employers spend more per worker on healthcare than employers elsewhere in the country. And that doesn’t include the costs of sick days or reduced productivity as a consequence of health issues. (Forgive me for an indelicate observation: Indiana legislators determined to keep business taxes low don’t seem to understand that the added costs incurred by reason of an unhealthy workforce are just as much a part of business overhead as state income or property taxes.)

No–true to our Hoosier Heritage, which is nothing if not shortsighted–State government is perfectly content to shift health costs to employers, and keep Indiana’s public health spending low. And it is low. In 2012, Indiana ranked 49th out of 50 states in per person spending on public health, despite the fact that preventative public health measures like immunization and screenings demonstrably and dramatically lower overall health costs.

To add insult to injury, Governor Pence has signaled that he will not expand Medicaid in order to participate in the Affordable Care Act, aka “Obamacare.” As I have previously noted, there is no rational basis for that decision; it rests entirely upon a perceived political need to pander to a rabid GOP base motivated solely by an unreasoning hatred of President Obama and anything he supports.

If Indiana opts to participate, an estimated 450,000 Hoosiers would benefit. And here’s the kicker: if Indiana does participate, the federal government will pay all the costs for the first three years. The state’s portion would then phase in gradually, topping out at 10% in 2020.

And if we don’t participate? Well, poor people have this pesky habit of getting sick anyway. And we already pay to treat them–frequently, in the least cost-effective way, when they appear at hospital emergency rooms. When uninsured folks are treated there, the costs of their un-reimbursed care drives up the premiums of those with insurance. If the hospital is public, our taxes go up. If the hospitals still can’t recover their costs, they cut healthcare workers or reduce services. The 10% Indiana would eventually have to pay to cover far more people is unlikely to be more than we are actually paying now in a variety of ways–it would just be more visible and much more cost-effective.

Indiana certainly wouldn’t want to do something that was actually cost-effective.

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Dear Lord, Where Do They Find These People?

According to Rep. Tom McClintock, there simply is no such thing as white-collar crime.

At a town hall meeting in El Dorado Hills, California on Tuesday, a constituent asked McClintock for his “stance on Wall Street criminal practices.” The congressman responded, “Well first of all, for a criminal practice there has to be a gun. It’s pretty simple.”

I think we know what’s simple, and it isn’t the Congressman’s intriguing theory of what it takes to constitute criminal behavior.

Every day, it seems we meet a new officeholding whack-a-doodle.

This week it was Lee Bright calling Lindsey Graham a “community organizer for the Muslims.” Last week, Steve King explained that for every young immigrant who was a valedictorian, there were a hundred others with “calves the size of cantaloupes because they’re hauling 75 pounds of marijuana across the desert.” Before him, Paul Broun insisted that evolution and climate change were “lies from the mouth of hell.” Rand Paul insists that black people have no trouble voting–and that despite his opposition to the 1964 Civil Rights Act and any and all measures to lift people from poverty, he’s all for equality. And of course, almost every week there’s some new insanity from Louie Gohmert, who Charles Pierce memorably called “perhaps the dumbest mammal to enter a legislative chamber since Caligula’s horse.”

There’s a new one just about every day. Michelle Bachmann hasn’t even taken her crazy eyes into retirement yet, and literally dozens of her fellow Republican Congresscritters are contending for her title of “least securely tethered to reality.”

It would be funny if it weren’t so terrifying.

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