Public Policy and Governance – Page 318

The Indiana Legislature in Action

When a Facebook friend posted yesterday that the Indiana House had voted 78-2 to declare the Grouseland the state’s official rifle, I was sure he was joking.

Apparently, he wasn’t.

According to news reports, the House vote followed a similar wide approval (48-2) by the Senate. If Gov. Daniels signs it, Indiana will have the (dubious) distinction of being only the third state with an official gun.

Whoopee for us.

So let’s see if I can put this important piece of legislation into perspective. Lawmakers didn’t “have time” to consider legislation that would have allowed Indianapolis citizens to hold a referendum on public transportation–a critical element of economic development. But they did have time to debate the proper singing of the national anthem, consider whether Girl Scouts are secret lesbian members of Planned Parenthood, and argue about who should be able to buy specialty license plates. They couldn’t manage to agree on the terms of a smoking ban that would actually protect the public health, but they were able to be virtually unanimous in designating a state gun.

Well, that will certainly make life better for those of us who live in Indiana.

Use that gun. Kill me now.

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A Blunt Instrument

Today, the Senate is poised to vote on a proposal by Missouri Senator Roy Blunt that could potentially eviscerate health insurance guarantees for millions of Americans under the guise of protecting religious liberty.

The Blunt Amendment is indeed a blunt instrument, part of a deeply cynical and wholly phony debate over whether requiring employers to offer a basic package of benefits in their healthcare policies violates the “conscience” of those who may disagree with some of those health services (e.g., contraception) on the basis of religion or morality.

This started, of course, with resistance by some employers to contraception coverage.

Under the original rule that would have required Catholic hospitals and universities to pay for contraceptive coverage, there was a barely plausible religious liberty argument. Once the regulation was changed, so that insurance companies were to offer the coverage directly to employees without charge, even that argument evaporated. (Think about it: how does the fact that your employee can get a medical product that your religious beliefs prohibit you from using violate your First Amendment rights? You aren’t being forced to use it, and now, not even forced to pay for it.)

This is a violation only if your “religious liberty” includes the right to tell other people how to live.

For most of the talking heads and lawmakers making all the noise, this wasn’t even really about contraception. The real motive for this entire manufactured controversy is the Republicans’ persistent effort to kill the Affordable Care Act. The Blunt Amendment would give every employer the right to opt out of coverage for health care procedures and products that offend his conscience. (How we would know that a particular coverage really bothered his conscience rather than his pocketbook is an open question.)

Don’t believe working women should have babies? Don’t cover maternity benefits.

Don’t believe in immunizations? Don’t cover the costs of vaccinations.

Don’t believe in artificial “assistance” for sex? Don’t cover viagra.

Okay, you get the idea. Passage of this proposal would make health coverage unworkable–which is, of course, the point. It has nothing to do with religious liberty, as I’ve previously explained, and most Senators clearly understand that.

One of the saddest footnotes to this dishonest nonsense is watching Dick Lugar, of all people, jump on this bandwagon, in yet another pathetic effort to pander to the Tea Party zealots trying to oust him.

The day before yesterday, Senator Olympia Snowe of Maine announced she wouldn’t run for another term. There were evidently limits to what she was willing to do to placate the irrational know-nothings who have assumed control of the GOP. Lugar would have done better to emulate her, and depart with dignity.

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Costs and Benefits

A colleague and I were in a conversation last night with someone thinking about moving to Indiana. My colleague noted–somewhat proudly, I thought–that despite the recession, and unlike so many neighboring states, Indiana has a budget surplus. He attributed that to sound “money management” by the Governor.

This morning’s Ft. Wayne Journal Gazette has a somewhat different take on how that surplus was achieved.

As the paper noted,

The dirty little secret behind Indiana’s budget surplus is exactly how it came to be. Not the bounty of a booming economy but the result of nicks, cuts and downright slashing of programs critical to the safety of vulnerable Hoosiers and to the economic future of all its residents.

The article focused especially on cuts to child services, noting that DCS returned an “astonishing” amount of money to the state at the same time that repeated reports of abuse went un-investigated, and at least six children died.

In a forthcoming article, Morton Marcus notes that Indiana’s unemployment remains among the highest in the country, despite the recovery. He makes the point–so often ignored–that government jobs are, in fact, jobs. When the state lays off workers, cuts teachers, police officers, child protective workers and others, it not only reduces the effectiveness of services we all depend upon (with sometimes tragic results, as the Journal-Gazette article documents), it reduces employment. It reduces the number of people paying taxes, and increases the number of those needing public services.

When times are tough, tough decisions absolutely need to be made. Budgets–at least in Indiana, which has a constitutional provision requiring it–must be balanced.

The question is: how? And at whose expense?

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Explanations are in Order….

The most recent issue of NUVO features a lengthy exploration of a curious relationship between the Indiana Family Institute–the virulently anti-gay, anti-choice, “traditional values” organization–and the State of Indiana.

According to NUVO, IFI contracts with the State of Indiana to the tune of 1.5 million dollars, to provide a “Healthy Marriage Demonstration Project.” The purported goal is to strengthen child support enforcement by “promoting healthy marriages and healthy parental relationships.”

Leaving aside my personal conviction that IFI–which traffics in religious bigotry and extremism–and “healthy” are contradictions in terms, this article raises a number of questions.

First of all, as a matter of policy, why in the world are we spending scarce Medicaid dollars on marriage, healthy or not? Medicaid is supposed to provide a safety net for people too old, poor and/or disabled to pay for needed medical care. The Governor routinely bemoans its expense, and we hear constantly that fiscal realities require reducing payments to nursing homes and doctors who are providing these medical services. Why would we take a million and half dollars away from those pressing needs for a dubious social experiment?

This unsavory relationship isn’t simply bad policy. It raises substantial constitutional concerns.

No one who has ever encountered IFI, or Sue Swayze, the project director, is left with any doubt about their positions, or the explicitly religious roots of those positions. That’s not a problem when they are lobbying the legislature–like all Americans, they have the right to voice their opinions and attempt to persuade lawmakers to pass or defeat measures in which they have an interest. But it is a big problem if they are taking tax dollars to provide religiously-infused services to the State.

The rules that govern contracting-out are clear: faith-based and religious organizations are entitled to contract with government to provide secular services. The government can support the soup kitchen in the church basement, so long as what is being served is soup, not theology. Tax dollars can buy beds for elderly patients in religiously-affiliated nursing homes, so long as those tax dollars are being spent for housing and nursing care, not religious services. And whether it’s a good idea or a boondoggle, IFI could constitutionally provide counseling about healthy marriage–if that counseling was based upon sound psychology and professional counseling standards.

It is inconceivable that IFI would operate on that basis.

This is an organization permeated with a religious extremism that views gay people with horror and loathing, and still attacks the American Psychological Association for its 1975 decision removing homosexuality from its index of mental illnesses. IFI wants to outlaw abortion and many forms of birth control. It wants to destroy Planned Parenthood. Their representatives and their website are candid about these goals, and filled with conspiratorial accusations–most recently, they defended Rep. Bob Morris’ attack on the “commie lesbian feminist” Girl Scouts and their “connections” to Planned Parenthood.

If there’s someone out there who thinks IFI can deliver programming that doesn’t incorporate these and other religious elements, I have some swampland in Florida to sell you.

According to Andy Kopsa, who wrote the NUVO story, the Daniels’ Administration was unable to provide any evidence of monitoring or oversight of this contract, and IFI refused repeated requests for interviews.

So–we have a lot of tax money being siphoned away from needy Medicaid patients into a contract with an extremist organization that is philosophically incapable of providing its (dubious) services in a constitutionally acceptable manner.

The question is, why?

Perhaps the answer might be found in the photos of supportive politicians that accompany the article–Dennis Kruse, Eric Turner, Jim Banks, Larry Bucshon, Todd Rokita, Dan Burton, Todd Young, and of course, Mike Pence–aka “the usual suspects.”

Looks like they’re buying “street cred” with their base. With our money.

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The Problem with “Principle”

Principles are necessary “rules of the road” for human and social conduct. We consult our guiding principles when we encounter real-world problems, in an effort to craft solutions that will be both practical and just.

When principles lose their connection to the real world, however, they lose their ability to guide us to good decisions.

There are a couple of ways principles get divorced from reality. One example was the Supreme Court’s decision in Citizens United. The Court applied an important abstract principle—upholding the widest possible marketplace of ideas—without a proper appreciation of the messy realities of money and American politics.

Isolation from the nitty-gritty of politics goes a long way to explain the Court’s disconnect from the likely real-world consequences of decisions like Citizens United. A different kind of isolation from reality can be seen in the ferocious attack by Republicans on the very idea of universal healthcare–what they contemptuously call “Obamacare.” It’s what happens when principles harden into rigid ideologies, and defending those ideologies becomes more important than solving real problems.

Recently, a friend emailed me to ask a question about the Komen/Planned Parenthood controversy. Her interest was more than casual: she has breast cancer. And as she explained,

“My husband and I are on the mend now but found ourselves in a terrifying situation. I was diagnosed in June, had my lumpectomy and chemo, radiation. In the middle of all of this Tom had chest pains. He was in heart failure and could have died. He had emergency open-heart surgery to correct a birth defect he had no idea he had. The doctor replaced his aortic valve because it had 2 flaps instead of three. No blockages fortunately.

I am ashamed to admit this but we have no health insurance. This is because we are both self-employed, not part of a group, so our premiums increased yearly until we could no longer afford the $1700 per month premiums.

We thought we might even have to divorce to protect our home from creditors due to medical bills. We both have always worked hard and paid our bills but this was beyond our control.

Through the Little Red Door we found Indianapolis Medical Society Project Health. They helped us both financially. Without them I do not know what we would have done.”

According to the Medical Society’s website, Project Health is a community partnership to improve access to health care for low-income, uninsured residents of Indianapolis. It combines donated physician care, hospital services, medication assistance, and case management in order to wring the most out of existing community resources and service providers so that patients can receive timely and appropriate care.

Project Health and other nonprofit organizations make a valiant effort to help the uninsured, but in the real world, there is simply no way the nonprofit sector can address the needs of the estimated 45 million Americans who have no health insurance.

I have my own “principled” critique of the Affordable Care Act. It’s far from perfect. But it is an effort to help real people with real problems in the real world.

What I’d like to say to the (well-insured) politicians intent on mischaracterizing, savaging and repealing “Obamacare,” is this: It is entirely appropriate to suggest alternatives, to offer proposals that would improve coverage and efficiency. It is entirely appropriate to acknowledge that regulations accompanying universal coverage will generate conflicts of the sort we’ve seen with the recent flap over contraception, and to try to minimize those.

What is neither appropriate nor humane is your insistence that people continue to suffer and die for your political “principles.”