Home > Jay Bookman > Archives > 2008 > December > 11
Thursday, December 11, 2008
Health care as an economic issue
The Atlanta Journal-Constitution
Another half million Americans are freshly out of work, joining the roughly 10 million that had already been pushed into unemployment. A lot of them are freshly out of health insurance as well.
Health-care costs for employees and retirees are also part of the reason that U.S. industry in general and automakers in particular have a hard time competing with overseas industry.
Given all that, President-elect Obama is apparently intent on pushing major health-care reform, in part as an economic issue. It makes a lot of sense. But you also get the sense that Obama is trying to do an awful lot of very big things in a very short timespan.
WASHINGTON — Calling an overhaul of the health care system a basic element of his administration’s economic recovery programs, President-elect Barack Obama on Thursday presented former Senator Tom Daschle as his choice to become secretary of health and human services and to lead efforts to secure “affordable, accessible health care for every single American.”
Mr. Obama, noting that more than 45 million people have no health insurance, said, “The runaway cost of health care is punishing families and businesses across the country.”
A major health care initiative “has to be intimately woven into our overall economic recovery plan,” Mr. Obama said, adding: “It’s not something that we can put off because we are in an emergency. This is part of the emergency.”
Mr. Daschle echoed that sense of urgency. “Our growing costs are unsustainable,” he said, “and the plight of the uninsured is unconscionable.”
Mr. Daschle brings a kind of moral passion to the campaign for universal coverage. Health care, he says, is rationed on “the worst possible criteria: one’s ability to pay or one’s health condition.”
At the heart of the health care system, Mr. Daschle wants to establish a Federal Health Board, an independent entity like the Federal Reserve. The board would make coverage decisions for federal health programs. It would, he says, “reduce or deny payment for new drugs and procedures that aren’t as effective as current ones.”
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Birthers, speak up now or forever hold your piece
The Atlanta Journal-Constitution
Patrick Ruffini, a Republican media and Internet strategist (and parttime blogger) has this to say to the birthers:
“The Obama citizenship smear hasn’t gained traction in mainstream conservative circles, but this is exactly the kind of stunt the left will use to tar all conservatives and silence legitimate criticism of Obama and his policies. We need to be vociferously calling out people who traffic in this nonsense.
Scandal stories didn’t get much traction during the campaign, so if we are smart, I am hopeful we won’t see a repeat of the ’90s opposition to Clinton, which was primarily scandal driven, and tarnished the Republican brand so that only Bush’s big-spending conservatism could save it. Which is got us in the pickle we are in today.”
Anybody know anybody who needs to get that message?
This will be the last thread on which birther nonsense can be posted. From here on out, it will be deleted.
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Obama pledges complete account of Blagojevich contacts
The Atlanta Journal-Constitution
The president-elect’s statement this morning on the Blagojevich indictment:
“Let me say that I was as appalled as anyone by the revelations earlier this week. I have never spoken with the governor on this subject. And I am quite confident that no representatives of mine would have had any part in any deals related to this seat. I think the materials released by the U.S. attorney reflect that. I have asked my team to gather the facts of any contacts with the governor’s staff about this vacancy so we can share them with you. And we will do that in the next few days.”
That’s exactly what he ought to do. Document every contact, every conversation and email, and ensure that the account is totally complete.
A lot of folks on the right are raising questions, which is fine. Those questions are legitimate and deserve answers, which Obama has now pledged to provide. However, it is not legitimate to portray the existence of questions as some kind of evidence of corruption. That is a foolish leap of logic.
There is no evidence of scandal or corruption regarding Obama in this case; to the contrary, as Obama points out in his statement, all evidence so far points the other way. I’d be very surprised if that changes.
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Privatizing government can backfire
The Atlanta Journal-Constitution
For reasons that aren’t quite clear, Georgia may soon try to completely privatize its troubled mental-health system. According to Commissioner B.J. Walker of the Department of Human Resources, privatization offers “another way of looking at things” that could stimulate “real, positive change in mental health.”
There’s no doubt change is needed. Investigations by the Journal-Constitution have concluded that abuse, neglect and shoddy medical care contributed to the deaths of 136 patients within the state system from 2002 through 2007, and the U.S. Justice Department has warned Georgia officials that conditions are so bad that they violate patients’ civil and constitutional rights.
According to documents prepared by Walker’s staff, the state is proposing to hire private contractors to build and operate new hospitals to replace dilapidated state-owned facilities, some of which are more than a century old. The documents claim the step is justified because Georgia lacks the money to build new state hospitals on its own.
But think through the logic, or rather illogic, of that: If a private company builds new facilities on the state’s behalf, where exactly would the company get that money? Inevitably, the cost of those new facilities would still be borne by taxpayers, even if the money is hidden in private contracts.
In theory, of course, the profit motive will drive contractors to cut costs as much as possible, making operations more efficient. But that isn’t the problem here in Georgia. As AJC stories have documented, the deaths of so many patients in the state system can be attributed to insufficient and poorly trained staff, and to the fact that Georgia ranks near the bottom in per-capita spending on mental-health care.
Cost-cutting driven by privatization —- with no increase planned in funding —- is certain to compound rather than cure the problem.
A similar blind faith in the power of privatization is now driving transportation policy as well. With gasoline tax revenues falling well short of what is needed to reinvest in infrastructure, the latest fad is to raise revenue by allowing private companies to build toll roads or convert existing lanes to toll lanes.
In effect, that creates the same kind of shell game driving privatization of mental-health care. The public would still foot the bill, but it would do so through tolls paid to private companies instead of through taxes.
That way, politicians get to claim they’re holding the line on taxes and private companies get lucrative contracts. The only people who lose are the public.
And while tolls do have their place, in many cases the loss to the public is significant. In a survey of toll projects around the country, the Washington State Department of Transportation found that operators spend an average of 22 cents in overhead —- toll collectors, equipment, etc. —- just to collect a dollar in revenue. Raising revenue through the gas tax, by comparison, costs less than a penny on the dollar in overhead, according to data from the Federal Highway Administration.
Privatization also creates a whole new means for politicians to trade contracts for campaign contributions and other favors, as the latest “pay to play” scandal in Illinois demonstrates. Among his many other alleged sins, Gov. Rod Blagojevich is on tape demanding that highway contractors deliver campaign contributions of at least $500,000 in return for his approval of a $1.8 billion private tollway project.
In the popular image of privatization, of course, contracts are awarded only through a tough competitive bidding process. In real life, that’s not how things work.
According to a recent investigation by National Public Radio, the federal government has greatly expanded the number of private contractors it has hired, paying them more than $400 billion last year to do work once done more cheaply in many cases by government employees. “The administration has given the majority of that contract money to companies that didn’t have to compete to get it —- or faced only limited competition,” NPR found.
Katherine Schinasi, a high-ranking official with the Government Accountability Office, told NPR that in many cases, federal officials pay little or no attention to contractors under their supervision.
As a result, they can’t answer even the most basic questions from the GAO, such as whether contractors have done a good job or whether they’re saving taxpayers money.
In certain well-defined tasks, privatization undoubtedly offers significant benefits. But because it has been embraced as a panacea, and because so many have found it a lucrative means of milking the taxpayer, too often it creates far more problems than it solves.
