Public Policy and Governance – Page 302

Fun with Trans-vaginal Probes….

It was only a momentary diversion, but yesterday the Indiana Senate debated a proposed amendment to the offensive bill requiring (among other things) that poor women wanting prescriptions for abortifacants undergo two trans-vaginal probes.

Here’s the relevant language:

“Before giving, selling, dispensing, administering, prescribing, or otherwise providing an erectile dysfunction drug to a man showing symptoms of erectile dysfunction, a physician licensed under IC 25-22.5 shall do the following:

(1) Examine in person the man showing symptoms of erectile dysfunction.

(2) Conduct a prostate examination or oversee a prostate examination by an individual who is licensed or certified in Indiana and whose scope of practice includes the conducting of a prostate examination.

(3) Document the following information on the patient’s medical records:

(A) The size of the patient’s prostate.

(B) Whether the patient is showing symptoms of benign prostate problems.

(4) Provide the following information to the man diagnosed with erectile dysfunction:

(A) A copy of the final printed drug label.

(B) The name and telephone number for the physician who prescribed the erectile dysfunction medication and information for follow-up care in the event of an adverse event described in section 2 of this chapter.

(c) A physician licensed under IC 25-22.5 who gives, sells, dispenses, administers, prescribes, or otherwise provides an erectile dysfunction drug to a man shall schedule a follow-up appointment with the man at approximately fourteen (14) days after prescribing the erectile dysfunction drug to:

(1) conduct a physical exam, including an electrocardiogram, to ensure that the man is healthy enough for continued sexual activity; and assess the degree to which the erectile dysfunction drug has aided in temporarily relieving the symptoms of erectile dysfunction.

(d) The physician described in subsection (c) shall make a reasonable effort to ensure that the patient returns for the follow-up appointment described in subsection (c), including recording in the patient’s medical records:

(1) the date and time of the follow-up appointment;

(2) a brief description of the efforts the physician and the physician’s staff took to ensure the patient’s return; and the name of the individual who performed the efforts.

There’s more, but you get the idea.

Gee–I wonder why this eminently reasonable amendment, motivated solely by concern for the health of the male patient, was voted down.

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Quote of the Day

From Dick Lugar’s first address after leaving elective office, an observation worth pondering:

Perhaps the most potent force driving partisanship is the rise of a massive industry that makes money off political discord. This industry encompasses cable news networks, talk radio shows, partisan think tanks, direct mail fundraisers, innumerable websites and blogs, social media and gadfly candidates and commentators. Many of these entities have a deep economic stake in perpetuating political conflict. They are successully marketing and monetizing partisan outrage.

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Betraying the American Dream

When I was growing up, the accepted description of America was “land of opportunity.” It was commonly believed that the American Dream could be attained by anyone willing to work hard; social mobility was the name of the game.

Knowing that poverty isn’t necessarily permanent is hugely important in a capitalist system. Inequalities are inevitable, but they need not be paralyzing, they need not engender the sorts of simmering resentments that lead to social unrest, because they are seen as temporary and (fairly or unfairly) a reflection of the effort and entrepreneurship of the individual.

We are beginning to see what happens when it becomes apparent that Americans can no longer work themselves into the middle class. Thanks to short-sighted and mean-spirited public policies, such social mobility as previously characterized our economic system (it was probably never as obtainable as national mythology had it) is largely a thing of the past.

In a column addressing the need for high quality early childhood education, Gail Collins put it bluntly: “We have no bigger crisis as a nation than the class barrier. We’re near the bottom of the industrialized world when it comes to upward mobility. A child born to poor parents has a pathetic chance of growing up to be anything but poor. This isn’t the way things were supposed to be in the United States. But here we are.”

In his recent book on inequality, Nobel-prize winning economist Joseph Stiglitz underlined the current lack of social mobility in America–and its unpleasant consequences.

We have a problem, and it isn’t temporary, isn’t a result of the recent economic downturn. Social scientists have documented the characteristics of stable democracies–the attitudes and institutions that keep societies from erupting, that strengthen the social fabric rather than tearing it. A perception that the government “plays fair” and a belief in opportunity for advancement–a belief that effort and diligence will be rewarded–are among them.

In his State of the Union speech, President Obama proposed two measures–universal access to preschool and raising the minimum wage–that would begin, however modestly, to address the problem. There is ample research connecting early childhood education to later economic well-being. There is equally persuasive research rebutting the proposition that a higher minimum wage means fewer jobs. (The latter proposition seems so logical, I used to believe it was self-evident; a copious amount of research, however, shows otherwise.)

The “usual suspects” met the President’s proposals with their usual screams of “socialism.” Those usual suspects, however, should rethink their support of the status quo. When poor people lose hope–when the belief in the possibility of bettering their condition disappears, and they face the fact that social mobility is rapidly becoming a myth and the American Dream is out of reach–they become people with nothing to lose. Eventually, they take to the streets and threaten the comfortable.

What’s that old line? Pigs get fed, but hogs get slaughtered.

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This Has Gone Too Far….

The news that Senate Republicans plan to filibuster the President’s nomination of (Republican) Chuck Hagel for Defense Secretary ought to be the final straw.

Harry Reid clearly allowed himself to be punked, settling for a toothless agreement with Mitch McConnell rather than the genuine reform of the much-abused filibuster that he promised. And we are all paying a high price for his fecklessness.

I understand the legitimate use of that legislative weapon to prevent a majority from running roughshod over the minority. But in its current form, the filibuster is being used by a minority–by partisans whose positions were emphatically rejected by the electorate–to defeat virtually every effort undertaken by a popularly-elected majority. As a result, government has been brought to a standstill. Nothing can be done unless a super-majority vote can be rounded up–and finding sixty votes in a Senate occupied by too many small-minded, mean-spirited partisan hacks is no easy task.

At the very least, those who want to bring government to a halt should have to stand on the Senate floor and actually talk. It should not be enough for the minority members to raise their little pinkies and announce that they are “virtually” filibustering, so please go f#*#k yourself.

The intransigence of these GOP Senators has cost this country dearly during the recent economic meltdown. For every bad idea they’ve blocked, we’ve lost many more opportunities to improve the lives of middle-class Americans, to strengthen our crumbling infrastructure, to create jobs and take measures to protect the environment.

The federal legislative system is designed to work on the principle of majority rule. A majority of those who have been elected to represent the voters is supposed to determine what laws will be enacted. That doesn’t mean that Senators who oppose legislation cannot express that opposition forcefully in their floor speeches and their votes. It does mean that when the minority party consistently refuses to allow an up-and-down majority vote, that party isn’t just blocking particular measures: it is undermining American government–and it is becoming increasingly clear that destroying the capacity to govern is not an incidental or unintended consequence of these tactics; it is the real reason for them. It’s a feature, not a bug.

Presidential nominees have never been filibustered. Even John McCain–who has made his contempt for the man who defeated him quite plain– has argued against such an unprecedented move. If the Republicans want to vote against Hagel’s confirmation, fine. That is clearly their prerogative–although, as Dick Lugar has maintained, there should be a rebuttable presumption that the executive is entitled to his choice of those he wants populating his administration. Preventing an up-and-down vote simply because they can–motivated by spite, anti-government fervor and a level of partisanship that dwarfs anything previously seen–is beyond reprehensible. It is beyond irresponsible.

It’s despicable and profoundly unAmerican. And it needs to stop.

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An Unhealthy Partisanship

As Hoosiers proved again last November, we’re a Red, Red State. And evidently, that partisan identity–and a deep desire to thwart that Kenyan interloper who inexplicably occupies the White House–is motivating a costly and immoral decision on healthcare.

The Affordable Care Act–aka “Obamacare”–provides incentives for states to expand Medicaid coverage. That expansion is not mandatory, however. (The Supreme Court’s decision upheld the Act, but not provisions making Medicaid expansion obligatory.)

There’s a lot of misunderstanding about Medicaid and who it covers. Currently, Indiana’s Medicaid program provides health care to about one in seven Hoosiers–mostly children, pregnant women, the disabled, seniors in long-term care and very low income families. The word “families” is key here, because non-disabled childless adults under the age of 65 are not eligible for Medicaid, no matter how poor they are. And the “eligibility” of families with children is mostly illusory: a family of three (mother, father, child) with income over $4582 a year makes too much to qualify.

The new health reform law gives Indiana the option of expanding Medicaid to provide care to Hoosiers who are currently uninsured–by increasing eligibility to low-income working adults with incomes up to 138% of the federal poverty level. Last year, that would have been $15,415 for an adult, and would have allowed that family of three to make the princely sum of $26,344.

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.

The arguments against participating mainly boil down to two: the feds might change the formula sometime in the future, and we don’t like the government or the President.

Let’s see: on the one hand, the federal government will pay to cover nearly half a million Hoosiers whose lack of insurance is currently costing all of us money and jobs. On the other hand, we can show that socialist Barack Obama how much we hate him.

Even Ohio Governor John Kasich–a man without a “blue” bone in his body–has concluded that cutting off one’s nose to spite one’s face is rarely a sane public policy option.

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