Useful Fantasies

Yesterday, I noted with some alarm the fact-free nature of the GOP debate.

A recent report from the Brookings Institution offers a useful reminder that–inconvenient or not– facts really do matter, particularly when economic policy decisions must be made.

The dog days of August have given way to something much worse. Congress returned to session this week, and the rest of the year promises to be nightmarish. The House and Senate passed budget resolutions earlier this year calling for nearly $5 trillion in spending cuts by 2025. More than two-thirds of those cuts would come from programs that help people with low-and moderate-incomes. Health care spending would be halved. If such cuts are enacted, the president will likely veto them. At best, another partisan budget war will ensue after which the veto is sustained. At worst, the cuts become law.

The putative justification for these cuts is that the nation faces insupportable increases in public debt because of expanding budget deficits. Even if the projections were valid, it would be prudent to enact some tax increases in order to preserve needed public spending. But the projections of explosively growing debt are not valid. They are fantasy.

The remainder of the article–which is well worth reading in its entirety–explains that projections of deficits result from the use of “conventions” (assumptions) that do not reflect current reality, and are evidently not intended to do so.

I do not pretend to understand the utility of these conventions for budgetary purposes, but   to the extent they produce “projections” that do not reflect reality, their use as ammunition in the effort to reduce government to a size that can be “drowned in a bathtub”–to use Grover Norquist’s phrase–is pernicious.

But what if we did face persistent deficits?

The assumption seems to be that the only avenue open to policymakers would be budget cuts. It’s as if we have taken tax increases off the table–despite the fact that America’s tax rates are historically low, America’s wealthiest enjoy a wide range of unconscionable tax loopholes, and America’s most profitable corporations continue to evade taxes by parking their profits offshore.

I don’t understand the dogged determination of the “morality party” to ignore the facts in order to protect the perquisites of the already advantaged at the expense of those who have little or nothing.

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“Winning” By Making Shit Up

There is evidently a consensus among the pundits that the “winner” of Wednesday night’s GOP debate was Carly Fiorina.

There is also a consensus among fact-checkers that virtually nothing she said was accurate–and in the case of her attack on Planned Parenthood, was manufactured out of whole cloth.

Of course, the GOP primary voters to which she and the others were throwing their red meat were highly unlikely to notice.

I don’t know what’s more terrifying: the GOP’s embrace of “look at me, look at me” Donald Trump (who is unable to answer any substantive question with even a modicum of understanding or gravitas, and who endorsed the discredited theory that vaccines cause autism) or Ben Carson (the “scientist” who doesn’t believe in evolution or climate change and hasn’t a clue what government does) or Fiorina’s obvious calculation that she can improve her prospects by being the female face of the war on women, even if that requires playing fast and loose with those pesky things called “facts.”

Probably the best summary of the debate(s) was offered by Gail Collins, who–in one particularly memorable phrase–compared Jindal and Santorum to “rabid otters.”

The one indelible “take-away” from the debate–at least for Hoosiers–is that today’s GOP sure isn’t the party of Dick Lugar and Bill Hudnut.

How does that car commercial put it? This isn’t your father’s Oldsmobile…

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Whose “Religious Liberty” Do We Protect?

A couple of years ago, the website Raw Story had a troubling report about a conflict between religion and individual rights that is both accelerating and less visible than the high-profile conflicts (think Kentucky clerk) that make the news.

Healthcare providers and institutions are increasingly consolidating. In Washington State, for example, if all of the mergers planned when the Raw Story article was written were consummated, all hospital beds in nine counties are tied to religious institutions. That includes the University of Washington system.

Why should we care? Why is this is medically problematic?

Recently a woman was traveling across the Midwest when she developed abdominal pain. She and her husband went to the nearest hospital, where she was diagnosed with a potentially fatal ectopic pregnancy. The doctors recommended immediate surgery to remove the fallopian tube containing the misplaced embryo, a procedure that would reduce by half her future chances of conceiving a child. They failed to mention that a simple injection of Methotrexate could solve the problem, leaving her fertility intact. (In fact, at a secular hospital she found on her smart phone, it subsequently did.) Why the omission?

According to Catholic teaching, an injection that destroys an ectopic embryo counts as an  abortion; removing the part of a woman’s reproductive system containing the embryo is not.

The article has several other examples of situations, both in the U.S. and abroad, where theological commitments have trumped sound medical practice. In 2012, for example, a 16-year-old Dominican girl was denied cancer treatment for weeks while doctors debated whether chemotherapy would constitute an abortion. She eventually miscarried and later died.

An angry father shared his daughter’s experience:

A Catholic doctor at a Catholic hospital went against my daughter’s wishes and signed consent to have a hysterectomy because of severe endometriosis. One ovary had already exploded. My daughter had never intended or desired children nor was she in a suitable situation to have a child. She was single, in her late 20s. When she awoke from surgery she learned that the doctor had over-ridden her wishes and consent in an attempt to save her fertility. The operation was botched, leaving my daughter on permanent disability, in pain, with even more health problems than she’d had before.

When we go into a hospital, most of us expect our doctors and other healthcare providers to honor our expressed treatment directives. Many of us have Living Wills or other healthcare documents that reflect our own considered, deeply-held beliefs.

When a patient’s wishes are disregarded because they are inconsistent with someone else’s religion, that’s an unjustified denial of religious liberty–a denial that is particularly egregious because the  “bargaining power” of the parties is so unequal.

In a diverse society committed to civic equality, hospitals dependent upon government funds (Medicare, Medicaid, etc.) should be required to respect the decisions of adult, competent patients.

And medical practices consistent with accepted standards of care should never take a back seat to doctrine.

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The Light Begins to Dawn…

America has long had a “bandwagon” approach to policy; our penchant for simple solutions leads us into all manner of fads: the New Public Management, outsourcing and privatization, untested education “reforms,” and others.

For the past couple of decades, the answer to virtually every management challenge has been “privatization.” As I’ve indicated previously, there are times/situations where contracting out (which is what our version of “privatization” really is) makes sense, but thanks to our penchant for jumping on the bandwagon, government agencies have employed this method of delivering public services without the sort of rigorous analysis–or often any analysis–that should accompany decisions to turn tax supported programs over to private vendors.

Lately, however, citizens and public officials are beginning to recognize the downside of inappropriate contracting. A newspaper in North Carolina recently editorialized on the results of that state’s privatization of mental health services:

[A]ccess to services was confusing; services became unavailable to clients, and the number of people with mental illness who ended up in emergency rooms and jails significantly increased.

According to the Orange County Register, privatization’s consequences for Costa Mesa, California, were similar.

When the Costa Mesa City Council attempted to privatize large portions of municipal operations, it did so without conducting any analysis about whether its actions would save money – or whether it would cost more, which it did….

Southern California has provided fertile ground for other failed outsourcing initiatives. In the 1990s, Seal Beach thought it was on the cutting edge of local government privatization. The beach community managed to save about $30,000 in its first year of privatized jail services, and local officials were quick to pat themselves on the back for what they thought was really smart governing.

But what privatization delivered was two decades of lawsuits, two in-custody deaths, improper responses to medical emergencies, inadequately trained staff and a steady stream of violations uncovered by state regulators and health officials. Privatization of Seal Beach’s jail has resulted in so many serious problems that the city is now spending a reported $1.2 million just to start the process of bringing jail services back in-house.

The county of Orange’s most recent information-technology debacle provides yet another cautionary tale. After the county entered into a staggering $132 million contract with Xerox to upgrade phone and computer networks, performance by Xerox was so poor that the Board of Supervisors appears to be poised to sue over the broken promises and cost increases.

The article cites other examples, and notes that enthusiasm for contracting may finally be on the wane:

Across the country, governments of all sizes are rethinking the outsourcing of services as they discover its many unwelcome consequences, including lack of transparency, cost overruns, lack of competition for contracted services, and glaring weaknesses in accountability and oversight.

It’s hard to argue with her conclusion:

Services provided by public entities should be judged by what is best for the health, well-being, civil liberty and security of the public. Inserting a profit motive is an open invitation to graft and corruption and, more often than not, results in services that cost more and serve the public less.

We’ve noticed.

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The Economics of “Social Policy”

There are economic consequences to most policy choices. That’s just as true of so-called “social” policies as it is of decisions to build roads or wage wars.

When religion is driving policy, economic repercussions tend to get ignored. So it was interesting to read Two Sides, Same Coin–a report by the University of California at San Francisco on the economics of abortion policy. Researchers followed women who were turned away–who wanted to terminate a pregnancy but were unable to do so. As the report noted,

Access to comprehensive reproductive health care, including abortion, is essential to women’s economic security. Yet many progressive politicians and advocates often ignore this important connection. This report delineates the many links between these topics—including that family planning increases women’s economic opportunity, lack of supports for pregnant and parenting women interferes with their economic stability, and there is an unfulfilled potential for reproductive health care to help create economic security—and the need to integrate both issues into any proactive policy agenda to achieve equality for women.

The Guardian recently noted the “costly choice” faced by pregnant American women:

For a country where politicians are rather eager to promote family values, America has few policies that make it easy to have children. On top of high health-care costs and limited employer benefits, the country has little in the way of affordable child-care. It is unsurprising, then, that three-quarters of women who choose to have an abortion say it is because they cannot afford to have a child. Some will argue that they can always put their child up for adoption. Others will add that marriage can be a fine antidote to poverty (45% of all women who seek abortion are unmarried). These are fair points. But perhaps instead of closing down abortion clinics, lawmakers might consider more ways to give these women better choices.

Perhaps the most widely-read economic analysis of abortion policy was the argument by the authors of Freakonomics,  

who concluded that legalization of abortion in the 1970s explained a substantial part of the crime decline in the 1990s. (Evidently, children born into households where they are wanted, and where the adults are financially and emotionally capable of raising them, commit fewer crimes.)

None of this is an argument for making moral choices on the basis of economic consequences. But opinions on the morality of abortion are hotly contested.

It’s interesting to note that people who believe that the moral position requires respect for personal autonomy and reproductive choice tend to give generously to organizations like Planned Parenthood. On the other hand, the lawmakers most willing to use government’s power to impose their personal moral/religious beliefs on women who may not share them have shown little interest in ensuring the well-being of children once they are born.

The economic consequences of that disinterest fall on the rest of us.

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