Category Archives: Public Policy and Governance

Fun With Numbers

The Affordable Care Act  maintained existing Medicaid coverage for low income children. Whether or not their parents will have coverage is being left up to the states.
In Indiana, that’s a problem.
As a recent report from the Institute for Working Families explains, right now, Indiana only covers working parents who make up to 24 percent of the poverty line, which comes to $4,581 a year for a family of three. The Medicaid expansion provision in the Act encourages coverage for these low income adults by expanding Medicaid to 133 percent of the poverty line ($25,390 for a family of three).  According to a recent study by the non-partisan Kaiser Commission on Medicaid and the Uninsured–a study which is consistent with Congressional Budget Office’s estimates– 215,803 previously uninsured Hoosiers would have access to care by 2019–if Indiana implements that provision of the Act.
And why wouldn’t we?  The Act provides 100 percent federal funding for the expansion of Medicaid for its first three years, phasing down after that to 90 percent federal funding by 2019.  According to the same study by Kaiser, this will cost Indiana $478 million from 2014-2019 (an average of $79 million each fiscal year).
Interestingly, in a study commissioned by the State of Indiana, the estimated cost (2.58 billion) is approximately 5 times greater than the cost shown by the non-partisan Kaiser study (478 million).
What the Indiana study evidently ignores are the savings involved: Medicaid expansion would save the state substantial amounts we now pay for uncompensated care for the uninsured. We pay those costs two ways: through our tax dollars, and through higher premiums charged to those who are insured. (In fact, according to Kaiser, during the 2014-2020 time period, each insured Hoosier will otherwise pay over $2000 to subsidize the uninsured.)
Let’s try an analogy: let’s say you’ve been taking a bus to work, and you and a couple of friends buy a car. Your share of the car expenses will be 150. a month. The cost to you will thus be 150 per month minus the 40 bucks a month you’ve been spending on the bus. This is a concept called net cost. 
If the state refuses to expand Medicaid, people with incomes between 100 percent and 400 percent of the poverty line will be eligible for subsidies to help them afford coverage in the new health insurance exchanges.  But people below the poverty line won’t receive coverage at all, since the Affordable Care Act assumes they’re covered by Medicaid.
That seems deeply unfair–even immoral.
My question is: why is depriving these people of coverage so important a goal that the Daniels Administration is willing to issue a deceptive analysis of the costs involved?
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Fraud and Waste

Candidates for office are notorious for promising to cut taxes and claiming that they will pay for them by reducing “fraud and waste.” Usually, this is bullshit; especially at the local level. Americans love to believe bloat exists in service delivery, but usually, the only way to pay for tax cuts is by eliminating services.

That said, a recent Congressional report has identified one way to save the federal government money by curtailing an activity that is actively harmful: funding tuition at for-profit schools of “higher education.” (Note quotes here.)

The Committee that issued the report was headed by Senator Tom Harkin. It hasn’t gotten the attention it deserves. The report documents aggressive recruiting, exorbitant tuition, abysmal student outcomes, regulatory evasion, and taxpayer dollars pocketed as profit.

According to the summary of findings published by the New York Times, students at for-profit colleges are charged, on average, four times as much tuition as students at public universities, and eighty percent of that comes from American taxpayers. Furthermore, according to the blog Political Animal, “these colleges do an exceptionally crappy job of educating students.”

Retention rates are horrendous: the majority of enrollees, according to the Times, leave without a degree, but even those who earn a credential usually discover it isn’t worth the paper it’s printed on. And–perhaps the most telling statistic from a taxpayer’s point of view– students at for-profit colleges make up 13% of the country’s college students, but account for 47% of defaults on student loans.

Think about that next time you see one of those gauzy–and expensive–commercials for a college you never heard of.

The Obama Administration has tried to change the student loan system so that tax dollars cannot be used at most of these schools, but the effort–like so many others–has been met with fierce lobbying and obstruction. You might think that all of those politicians running for office on a platform of reducing fraud and waste would applaud this recommendation. After all, refusing to fund con artists would actually protect those who are currently getting ripped off, as well as saving tax dollars.

You’d think this would be a no-brainer, one of those rare “win-win” situations. But you’d be wrong.

And we wonder why Congress has a 17% approval rating. (Maybe the 17% attended for-profit colleges.)

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The People Around Him…

We’ve been on the road, stopping at a couple of charming Bed and Breakfasts in the North Carolina mountains, so I haven’t been blogging with my usual frequency. I also haven’t been glued to my usual sources of political news.

Even so, I have seen the British press’s less-than-admiring coverage of Romney’s visit to England–ranging from a big headline “Mitt the Twit” to “worse than Sarah Palin” to “Do we have another Dubya on our hands?” One columnist described Romney as “devoid of charm, warmth and sincerity.”

Since this visit was initially intended as an extended photo-op–former Olympic savior visits England to cheer on this year’s games–it has been something of a PR disaster.

The most troubling observation by the notoriously sarcastic Brits, however, was the comparison to Dubya. And it is troubling not because Mitt, like George W, constantly displays these “not ready for prime time” moments. Let’s face it, no one is ready to lead the free world. Obama wasn’t, Clinton wasn’t, Reagan wasn’t. (Granted, most of them managed to hide that fact more adroitly.) Even the shared arrogance that leads to these “what were you thinking” moments isn’t the most disturbing characteristic they share.

It’s the people with whom they surround themselves. And actually, on that score, Dubya was better.

When candidates demonstrate that they come up short on knowing, for example, the intricacies of the capital markets, or–in Herman Cain’s memorable formulation–the name of the President of “Ubeki-beki-stan”–most of us understand. The Presidency requires expertise in more subjects than it is fair to expect any candidate to master. So we look to the advisors the candidate has chosen to rely upon. Who is he listening to? How sound are the people around him?

Dubya had some good people (Colin Powell, the early Condoleeza Rice) whose counsel he simply ignored. Their nuanced approach was overpowered by the Dick Cheney/John Bolton/neocon contingent–the purveyors of a Manichean worldview where good and evil were clearly labelled and all the answers were easy ones. (The questions, unfortunately, were generally the wrong ones.)

Romney has chosen to surround himself with the absolute worst of these. Most knowledgable foreign policy experts–Republican and Democrat alike–consider John Bolton crazy. But there he is, at the center of Mitt’s foreign policy team. Most legal scholars will readily admit that Robert Bork is brilliant–but consider his approach to the constitution far out of the mainstream of legal thought (at best) and twisted/dangerous at worst. Bork is advising Mitt on potential Supreme Court nominees.

I could go on, but the bottom line is that for whatever reason–perhaps an effort to solidify the support of the extremist GOP base, perhaps because he actually agrees with them, perhaps because he really doesn’t know better–Romney has surrounded himself with the worst of the Bush Administration’s leftovers. He is listening (presumably) to the people who took us to the edge of depression, who blithely led us into a war of choice in the most unstable and dangerous part of the world, and who still haven’t learned from their mistakes.

A lot of pundits, focused on the horse race, have noted Romney’s frequent gaffes, and attributed them to the absence of good staff work. Fewer have asked the question: if Romney’s campaign people are inept, what can we expect of the people he’d depend upon in the White House? And if the answer to that question is “the worst of Bush’s advisors”–we’d better hope that the Koch brothers and their ilk don’t manage to buy this election.

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Health and the Market

Well, I see that the Congressional GOP is threatening to shut down the government in October if the Democrats block repeal of the Affordable Care Act, aka Obamacare, and the partisan rhetoric is predictably flying.

A Democratic friend sent me an email listing the multiple sins of the Bush Administration, from wars of choice to decimation of the economy to the massive increase in the national debt; the message was something like “You didn’t get mad about any of these things, but now a black guy wants to provide healthcare to Americans who don’t have it, and that makes you mad!?” A Republican friend sent me a similarly incendiary message insisting that Obama is a “socialist” who hates capitalism and wants to destroy the market “that made American health care the best in the world.”

Let’s stipulate that not everyone who opposes Obamacare is a racist, and that American healthcare before the ACA was not only not the best in the world, but actually ranks around 37th. Other than that, my purpose is not to engage these arguments, but to point to a perfect example of the way “the market” works in areas like healthcare, where buyers and sellers are not on equal footing, and do not possess the sort of equivalent information that is necessary for markets to work.

I have previously referred to a book written my cousin, Morton Tavel, in which he takes on the “snake oil” aspects of the healthcare industry. He has now created a blog devoted to the subject, and his first post is a perfect example of “the market” in medicine–a discussion of all the ads about “low T”–testosterone deficiency. I encourage you to click through and read the whole post, but the bottom line is that  “low T” is extremely rare. The numbers the manufacturers are hyping are misleading at best and fraudulent at worst, and the “remedy” they are promoting is expensive, unnecessary and unlikely to restore the virility of the aging men who miss their morning erections.

Markets are wonderful where they work. And they work more often than they don’t. But in those areas where they don’t work, they enable the snake oil salesmen who prey on the unwary and drive up costs for everyone.

As with so many policy debates, this isn’t an “either-or” debate between all market all the time and socializing every aspect of the economy. We “socialize” functions that markets cannot efficiently provide–police and fire protection, infrastructure provision, national defense, public education. We leave to the market those economic areas where markets have proven their effectiveness.

The decision whether to leave an activity to the market or provide it through government should be based on evidence, not ideology. And as every other western industrialized country has long recognized, the evidence for government’s role in healthcare is overwhelming, just as the evidence for the market in consumer goods and manufacturing is overwhelming.

The evidence also tells us a lot about elected representatives who–having lost the argument–are willing to shut down the American government in order to protect the profits of health insurers and drug companies.

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Incivility and an Inability to Govern

There’s an interesting symposium on political civility in a recent issue of PS: Political  Science and Politics. The articles wrestle with some foundational questions: what is the difference between the sort of argumentation that illuminates differences and is an inevitable part of democratic discourse and rhetoric that “crosses the line”? What do we mean by incivility?

The consensus seemed to be that incivility is rudeness or impoliteness that violates an agreed social standard.

I’m not sure we have agreed social standards in this age of invective, but surely attacks that focus on, and disrespect, persons rather than positions should count as uncivil. An example of civility in political argument might be Dick Lugar’s often-repeated phrase to the effect that “that is a matter about which reasonable people can differ.” (Hard to imagine Mr. Mourdock, who has taken pride in incivility and intransigence, making such a statement.)

The contributors offer a variety of perspectives on the definitions and causes of today’s nasty politics, but one of the most trenchant observations came from a Professor Maisel of Colby College, who attributes the gridlock in Washington and elsewhere to “partisan one-upmanship expressed in ways that do not show respect for those with differing views.” As he notes (referring to Erik Cantor)

If your will is to prevent legislation from passing, to prevent the president’s agenda from moving forward, to work the system to your political advantage, then lack of civility works.

In other words, if your over-riding motivation is simply to beat the other guy–to keep the President from a second term, as Mitch McConnell famously admitted–and if that motivation outweighs any concern for the public good, governing is impossible.

The reason politicians no longer “respectfully disagree” with each other, Professor Maisel points out, is that they do not in fact respect the views of their opponents. They hardly know them. The days when Congressional families lived in Washington and socialized–when their children went to school together, and their spouses carpooled or otherwise interacted–are long gone. It’s easy to demonize people you don’t know.

Add to that an even more troubling aspect of today’s politics, a disregard for fact and truth, enabled by partisan television, talk radio and the internet. Survey after survey shows that people on the Left and Right alike get their “news” from sources that validate their biases. Worse, we have lost the real news, the mainstream, objective journalism that fact-checks, that confronts us with inconvenient realities. In such an environment, it becomes easier to characterize those with whom we disagree as buffoons or worse, unworthy of our respect.

When political discourse is so nasty, and regard for truth so minimal–when the enterprise of government has more in common with a barroom brawl than a lofty exercise in statesmanship–is it any wonder that so many of our “best and brightest” shun politics?

Government is broken, and we need to fix it. Unfortunately, the symposium contributions didn’t tell us how to do that.

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