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Congressional Health Care Bill and the Purpose of Government

Look, I get it.  It doesn’t do anybody any good (except maybe politicians) to caricature the opposition, and I understand that Big Government types believe, at some level, in the mission of government, and on that level, an equivalence between funding and policy goals is justified.  But reading news from up north, I can’t help but think a critical line of perspective has been crossed:

The health care bill that Congressional Republicans plan to bring to the House floor for a vote Thursday afternoon would result in “a massive loss of critical funds” for Massachusetts, Gov. Charlie Baker said. …

The potential loss of federal revenues, a major source of funds for the state budget, could compound budget problems associated with tax collections that for many months now have come in well short of the projections that Baker and legislative leaders have used to plan state spending.

Somewhere in this process of elected officials’ making statements and journalists’ reporting them, shouldn’t somebody have the role of putting front and center the key question, here, which is whether a particular policy is better for the people of the United States of America?  If ObamaCare crashes of its own weight, wouldn’t that be bad, too?  If so, wouldn’t that be worse than a state-level budget crunch?

(Yes, look, I get it… a health-industry collapse would just mean more money and power for the federal and state governments.  I’m being rhetorical, here.)

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Government Is Allowed to Change Bad Decisions (As on Medicaid)

Virgil Dickson, of Modern Healthcare, reminds us that government is allowed to rethink bad decisions, even when they relate to welfare entitlements:

Democratic lawmakers in Oregon are considering ending the state’s Medicaid expansion in an effort to address a $1.6 billion budget shortfall.

The state’s Ways and Means committee, which includes both senators and representatives, suggested cutting Medicaid expansion in an effort to curb Oregon’s $1.6 billion budget deficit.

As Kevin Mooney pointed out in this space in 2012, the Medicaid expansion was implemented in Rhode Island through administrative action and with little debate.  It was just assumed that we would and should do it.

It’s been a disaster.  In a policy brief from the RI Center for Freedom & Prosperity, we expected one in four Rhode Islanders to be on Medicaid by 2020.  Instead, we’re already nearing one in three and increasing every month.  Medicaid enrollment exploded as soon as the expansion and the health benefits exchange (HealthSource RI) came online, and it’s reaching the point that the exchange is shuffling its own paying customers onto Medicaid, undermining its own business model.

Legislators should admit that the expansion was a mistake and repeal it.

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Does ObamaCare Kill?

Here’s an interesting finding to ponder as we wrap up the work week, from Brian Frankie in The Federalist:

We know that the same year Obamacare’s insurance expansion provisions took effect, there was a pronounced, and statistically significant, surge in U.S. adult mortality. We know the surge in mortality remains after removing drug-related deaths, and other external morbidity causes, from the statistics. That is all we know. The rest is speculation. But it is fascinating speculation.

Has Obamacare, or some of the secondary effects of Obamacare, actually caused the negative impact in U.S. adult mortality so evident in the statistics? Is the improvement in public health that was assured turned out simply to be another false Obamacare promise, like being able to keep our doctors and health plans, or reducing our health costs?

As with the infamous ObamaStimulus metric of jobs “saved or created,” supporters of the O will insist that we cannot possibly know what mortality rates would have been like had ObamaCare never passed.  That’s a nifty trick to never have to truly subject one’s policies to real-world assessment, but serious discussion would require finding some evidence that an even bigger surge came in low.

I’m not saying I’ve got any answers on a Friday afternoon, but I certainly find it plausible that ObamaCare actually killed thousands of people (to put it in not-at-all-inflammatory terms).  Medicaid has worse health outcomes than private health insurance, even than no coverage at all, so people ushered onto Medicaid would be expected to increase mortality rates, especially if they’d planned to buy private health insurance through an exchange and discovered their eligibility for the free version.

Whatever the cause, we should certainly get past the simplistic public debate that saving ObamaCare saves lives and trying to eliminate (or even substantially reform) it is an inhumane goal.

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You Can Save Rhode Island From Progressive ANTI-JOBS Agenda!

As taxpayers continue to be asked to fund generous corporate subsidy programs, lawmakers are now dueling over two new spending ideas, reimbursing localities to phase-out the car tax and public funding for free college tuition, each of which would likely further raise taxes and fees on Rhode Islanders. But would these programs make Rhode Island a better state? Not only does cutting the sales tax to 3.0% make sense for improving our state’s troubled economy, it is also the cure to the dangerous progressive agenda.

The four major PROGRESSIVE legislative initiatives that Rhode Island families and business owners should be worried about are:

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The Cheese Sandwich Lesson for Socialism in Schools

It’s difficult to believe that Bob Plain isn’t trying his hand at parody with an interesting article on RI Future today about “lunch shaming”:

It’s known as lunch shaming. Students are subjected to special, sometimes embarrassing, treatment because their parents didn’t pay the school lunch bill. “Some provide kids an alternative lunch, like a cold cheese sandwich,” according to a recent NPR story. “Other schools sometimes will provide hot lunch, but require students do chores, have their hand stamped or wear a wristband showing they’re behind in payment. And, some schools will deny students lunch all together.”

The so-called cheese sandwich policy seems popular in suburban Rhode Island: Bristol/Warren, South Kingstown, and East Greenwich all use it.

From Bob’s article it appears that we’re talking debts in the amounts of $5 or $10, which seems like a paltry amount that districts could find some way to accommodate.  I’m trying to imagine a working-to-middle-class private school taking such steps.  In a transaction in which one side actually has the option to leave, other approaches have to be considered, whether a mandatory up-front fee, a deposit of some kind, a credit card on file, mandatory use of a payment processor that handles the collection, or a slight increase to all lunches in order to generate a reserve fund that provides a buffer for this sort of “debt.”

Putting aside the “what would the private sector do” comparison, though, think of what this little story says about the relationship of government to the people.  Adults in position of authority over school districts with budgets in the tens or even hundreds of millions of dollars are agonizing over ways to embarrass children so as to extract a few owed dollars from their parents.  That doesn’t indicate a mindset of provider-client or public-servant–beneficiary.  Rather, it indicates the dynamic of ruler-subject similar to a Dickensian orphanage.

Suffice to say it takes a series of monumentally bad social and public policy decisions to get us to the point at which the proverbial lunch lady is scornfully handing a child some bread and cheese over $5 owed.  We should start unraveling those decisions.

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Work Requirements for Medicaid in Maine

The Wall Street Journal’s Jennifer Levitz reports that the GOP-governed state of Maine is looking to add work requirements to the Medicaid program for those enrollees who are able-bodied adults.  When the state did the same with the food stamp (SNAP) program, enrollees dropped 90% and analysis suggested that the group of people who had been on food stamps actually saw an increase in wages.

The argument against such reforms shows the completely different starting point of each side:

But Maine’s approach is drawing criticism from advocates for the poor, who say jobs, volunteer positions and transportation to either of them can be hard to come by in rural pockets​with persistent unemployment. They say those losing the assistance turn to charities instead, increasing demand at food banks.

To which I would ask:  So?  Whether society provides food for the poor through a government program or private charity, we’re still supporting our neighbors.

The implied difference is that private charity has the feel of relying on the goodness of others while government programs have the feel of society’s handing over what it owes — an entitlement, in other words.  That difference is critical, and right in line with the work requirement.

What we owe each other is the chance of personal development and fulfillment, which comes from working, including being part of a self-supporting family team, even if not everybody within it works.  For those who really can’t work and who aren’t part of family that can address the greater challenges it faces, we should offer help in a way that shows genuine concern and community, not forced entitlement.

The attitudes and mechanics of welfare affect each other.  There’s a difference between the obligation to care for other people and a right to be cared for.  When a third party — government — asserts the authority to impose the obligation and bestow the right, it harms those who face adversity and deprives those who contribute of the benefits of being charitable.

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A State Without Children

Way down in his weekly roundup column, Ted Nesi highlights another point from the recent RI Kids Count report:

One statistic that stood out: Rhode Island now has the fifth-lowest birth rate in the country, following a 15% slide in the number of babies born here over the last decade. What does that mean for the state’s future? It’s already having an effect on the economy, with Care New England saying the decline in births is hurting revenue at Women & Infants.

That’s an understated example of the effect of this dynamic.  Indeed, it would be difficult to overstate the effects of an increasingly sterile population.

To touch on one narrow political matter: As I’ve pointed out in Tiverton and for the state as a whole, our public schools have generally lost about two full grade-levels worth of students in the last decade.  Picture no fourth and no fifth grade students in the entire state; that’s how much enrollment has decreased.  This leaves a bureaucratic, unionized, and expensive education establishment demanding increased budgets to educate fewer children, which its partisans do against a taxpaying public that has less and less actual use of the schools.  That battle alone will be huge in Rhode Island.

But even an issue of that magnitude is as nothing to the reorientation of a society with fewer children.  The way people think and interact with the world will change on that basis.  Indeed, not having children (or not having multiple children) takes pressure off of people to become full adults, making them more susceptible to the pitch of the “government plantation” advocates to look to central planners as parents to us all.  It also makes us vulnerable to people from other cultures in which Peter Pan has been held at bay.

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“Save RI”: The Antidote To The Progressive Agenda

Rhode Island families understand that our quality of life can only be improved if more and better businesses create more and better jobs! Yet, the progressive-left has a very different vision. They are openly promoting job-killing, anti-business, and anti-family policies. Their so-called “fair shot agenda” would transform our Ocean State into a liberal utopia … where businesses face even higher legal and financial risks, and where worker safety, absenteeism, and workplace productivity are compromised.

The Ocean State faces a stark choice.

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Rhode Island Does (or Did) Something Right

In its design (as opposed to its objective) Stephen Moore doesn’t much like Medicaid:

You’d be hard-pressed to find a more poorly designed program in the federal budget than Medicaid, the health insurance program for low-income Americans. The costs are shared between the states and the feds, which means that the more money a state wastes under Medicaid, the bigger the check Washington writes to the state. No wonder the program costs keep spiraling out of control.

Obamacare added nearly 20 million people to the Medicaid rolls, and the left considers that a policy victory. Federal and state budgets are swelling.

Oh, to return to the days when taking people off of welfare — not putting them on the dole — was the goal.

In an unusual experience, for a conservative, Moore cites Rhode Island as an example of a different way, referring back to a block-grant program implemented in the waning days of the President Bush and Governor Carcieri days.  Gary Alexander, who ran Health and Human Services in RI back then comments in Moore’s essay:

Alexander has become the Pied Piper for Medicaid waivers. “This is such a terrific solution because in Rhode Island we reduced costs and provided better care. When the state had an incentive to save money rather than spend it, this changed everything.” He added, “State waivers are the way out of the Medicaid crisis.”

Of course, elected officials in Rhode Island moved quickly to give away the budget slack in the Medicaid expansion and other constituent buy-offs, so clearly we have to work on step 2 of the “saving money” process (i.e., not immediately spending it on something else).  But it’d be nice to be recognized more often for innovative, smart policies.

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The Dead End of Rhode Island’s Government Plantation Model

The entitlement mentality in this state will be palpable as the federal government rolls back the Obama Administration’s give-aways. Lynn Arditi writes about the potential cost to Rhode Island if it refuses to change its Medicaid program to reflect federal spending under the Republican health care plan:

Predicting how much it might cost the state to cover the roughly 70,000 adults in the Medicaid expansion population under the Republican plan is especially difficult, health experts say, because people move on and off the rolls. If, for example, the job market weakened and people who had left the Medicaid rolls return, the lower federal cost-sharing rate means they’d be much more expensive to re-enroll.

“While certainly we’d support the state continuing to fund the Medicaid expansion population,” [Linda] Katz [of the Economic Progress Institute (no relation)] said, “the reality is … it would be very difficult to replace with state dollars the federal dollars and keep people insured.”

Rhode Island never should have signed on to the Medicaid expansion if this was possible, and the likes of the RI Center for Freedom & Prosperity were ignored when we warned that it was most definitely possible.  What everybody can see clearly now is that insiders and bureaucrats padded their budgets at great cost and risk to others.

And it’s not just Medicaid.  Dan McGowan reports from Providence for WPRI:

President Donald Trump’s proposal to eliminate the $3-billion Community Development Block Grant (CDBG) program would be a “devastating” blow to Rhode Island’s capital city, Mayor Jorge Elorza said Friday.

Trump’s proposed budget would do away with the 42-year-old CDBG program, which provides local governments across the country with funding for community centers, housing programs and neighborhood improvements.

None of these programs should ever be built into state government budgets or the local economy.  They should be treated as gravy on a healthy, independent economy.  Instead, we’ve allowed our elected officials to suffocate real industry and substitute a government plantation model premised on being able to bill the federal government and local taxpayers for government services for others.

Eventually, when you turn toward an obvious dead end, you reach it.

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Paying for the Entitlement That Never Should Have Been Extended

This is a great idea that Rhode Island should pursue, as reported by Michelle Hackman in the Wall Street Journal:

Ms. Verma, a health policy consultant, made a name for herself as the architect of Indiana’s Medicaid expansion program under then-Gov. Mike Pence, which that state administered through a federal waiver. Ms. Verma struck a deal with  the Obama administration allowing Indiana to charge enrollees under the expansion monthly premiums.

There is no reason childless, able-bodied adults relying on a government welfare-insurance program can’t pay something to give them a stake in their coverage.  From the beginning, we’ve seen examples of people who were willing to pay for private insurance, but who discovered their eligibility for a free plan through Medicaid.

Moreover, the state of Rhode Island never should have leaped into the ObamaCare Medicaid expansion with so little thought. Some of us warned at the time that the state shouldn’t count on the federal government holding the share it would pay at 90%, particularly as part of an unpopular and entirely partisan bill.  Since the state government conducted absolutely zero public debate over whether to accept the expansion, we can only surmise that elected officials and bureaucrats in Rhode Island either didn’t care to look that far ahead or counted on their ability to do what they’re trying to do now: get political mileage out of the federal government’s predictable move and attempt to transfer the burden to state-level taxpayers.

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The “Real” News About Healthcare Reform

The Providence Journal and Rhode Island progressives are doing a disservice to the people of our state by advancing a biased and non-realistic perspective on the federal healthcare reform debate.

There are few issues that are more personal or important than planning for the care that can preserve the health of ourselves and our families. But what governmental approach best helps us accomplish this?

Currently, our state is following the federal Obamacare approach of seeking to insure more people with government-run Medicaid or with a one-size-fits-all government-mandated private insurance plan. This approach is in a death-spiral.

Continue reading at Rhode Island Center for Freedom and Prosperity.

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The Economics of Giving Stuff Away

As is typical, Kevin Williamson is worth reading on the practical economics of government policy:

We are a very, very rich country. We can afford all sorts of things: food for the hungry, health care for the indigent, education for children, and hearing aids for families that for whatever reason cannot manage to scrape together $1,000 a year to invest in the well-being of their own children. (Those $5,000 hearing aids last for about five years, meaning that their real cost over time is less than the $1,200 a year typical American family spends on cable television.) I myself am all for doing many of those things, though I do not think that government very often is the best instrument for getting them done. But if we are going to use government, then, by all means, let’s use government in the most honest, transparent, and straightforward way we can. Forget the insurance mandate and just write the check.

In that regard, Democrat Governor Gina Raimondo’s free tuition would be preferable to some other policy that tried to force somebody else to pay for it — homeowners insurance or something like that.  Of course, other basic economic lessons come into play, which struck me when WPRI’s Dan McGowan tweeted:

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“Affordability” is a measure of price against value.  Following Williamson’s price estimate for hearing aids, in-state tuition at the Community College of Rhode Island (CCRI) is less than the average family cable bill.  Rhode Island College (RIC) and the University of Rhode Island (URI) are substantially more, but both saving and borrowing spread out the payments.

Considering that the average monthly student loan payment for all years of all colleges is somewhere around $280, two years of in-state tuition in Rhode Island would be much less.  That means young adults are valuing a large number of other things — cable, cell phones, video games, weekly dinners out, and so on — more than they’re valuing education.

Pushing the price down for them doesn’t make them value the education any more.  What it will do, though, drive up tuition and hurt taxpayers.

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Governor Pitches Free College to More Kids Who Can’t Do Math or Read at Grade Level

Last week, Democrat Governor Gina Raimondo and Democrat Senate President Teresa Paiva Weed visited Rogers High School in Newport to promote the governor’s plan to buy votes by giving families taxpayer dollars for two years of public college:

“When I talk to people around the state like your parents, they tell me that they are kept up at night thinking about your future,” Governor Raimondo told the students. “I want you and Rhode Islanders like you to get the jobs companies are creating here. The number one barrier to a college degree is cost. Our Free College proposal is affordable and an investment we need to make in your future. I am so thankful for Senate President Paiva Weed’s leadership and partnership. Working with her, I’m confident that all of you will have a shot at a good job here in Rhode Island.”

The women didn’t mention that 96% of students at Rogers High School are not proficient in math, and only 21% are proficient in reading.  A more honest message would be:

In cooperation with your teachers’ union, we have ensured that most of you are not receiving the education that you deserve.  You’ll be excited to hear that rather than fix the problems that we’ve created for selfish reasons, we’re going to take tens of millions of dollars from your parents and neighbors and cut two to four years out of your adult life in order to try to get you to where you ought to be right now.

The reception that these politicians get when they abuse their power like this — using school time to campaign to children — ought to be more like a Tea Party town hall than a pep rally.  It would seem that keeping students under-educated has its benefits.

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The Key Paragraph of the ACLU UHIP Settlement

You may have read that the state government settled the lawsuit that the ACLU filed over the debacle of the Unified Health Infrastructure Project (UHIP; aka RI Bridges, if it ever works).  As I’ve asked before, was this necessary?  Even assuming the state wouldn’t have taken the same steps that it has promised in the settlement once negative attention forced action, couldn’t a push from a few activist groups have produced the same result?

Well, mostly.  This part of the settlement probably wouldn’t have been in the outcome of a simple petition:

Plaintiffs shall be entitled to recover their reasonable attorneys’ fees and costs pursuant to 42 U.S.C. § 1988. Within sixty (60) days of the Court’s entry of this Order as an order of the Court, Plaintiffs shall file a bill of costs and motion for attorneys’ fees and costs with the Court pursuant to 42 U.S.C. § 1988, unless such time is extended by agreement of the Parties or order of the Court or unless such motion is rendered unnecessary by agreement of the Parties. Prior to filing such motion, 13 Plaintiffs shall present a bill of costs and fees to Defendant and within fifteen (15) business days thereafter, or at such time as the Parties mutually agree upon, the Parties shall confer by telephone or in-person in a good faith effort to agree to an amount in settlement of fees and costs. If the Parties are unable to agree to a fee amount, Plaintiffs may file a motion for attorneys’ fees and costs with the Court.

Indeed, if a petition-driven resolution had included language promising money to the activists, it would have seemed shady.  But in this case, to recap, the state is having trouble providing money and services to needy people, and some activist lawyers managed to make a payday of it while appearing to be warriors of charity.  That’s government under a progressive regime, I guess.

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Risk Aversion in Stocks and in Politics

Here’s an interesting find from Justin LaHart in the Wall Street Journal, in a brief article titled “Why the Stock Market Doesn’t Like Republicans“:

The two economists created a model where people have a choice between being entrepreneurs and working for the government, and of voting for a political party that favors lower taxes or higher taxes. When risk aversion is low, more people want to be entrepreneurs and to vote for the low-tax party. When risk aversion is high, the opposite is true.

It is a highly simplified version of U.S. politics and economics. But the implications for stock prices are interesting. The low-tax party gets elected when risk aversion is low, and then if risk aversion merely returns to the mean, stocks suffer. For the high-tax party, the opposite is true.

The next question, obviously, is what causes these changes in sentiment, because the variables seem more to correlate than to cause one another.

Of course, they may have a causative relationship indirectly.  The high-tax party, for example, is likely to sense this dynamic (whether consciously recognizing it or not) and change policy in a way that makes people more risk-averse (such as regulations to make independent activity more difficulty while acclimating people to dependence on government’s socialization of risk).  Indeed, even when they promote entrepreneurialism, they strive to make it seem like something that cannot be done without the safety net of government subsidies.  (“You didn’t build that.“)

The insight has implications for advocacy, too.  Conservatives who make a theme of imminent doom under progressive rule — however accurate that theme is — may be making the public more inclined to fall for progressive promises of security.  The key, perhaps, is to make people feel secure in their families and their own ability to transcend

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The Anti-Poverty Idea That Became a Dependency Trap

Jason Riley recently wrote, in the Wall Street Journal, about Peter Cove, who once was a warrior in the “War on Poverty” but has come to the quite different conclusion that the government is now promoting dependency:

“We have edged toward a moral cliff where the shame of being dependent on government aid has been replaced by a breezy bonhomie for entitlement,” he writes in a new book, “Poor No More.” “We have moved from a commitment to serve the deserving poor to an assumption that all are deserving. And much of this rests at the feet of politicians trolling for votes by larding on the largesse.”

What Cove is talking about, in my view, is the business model of the government plantation.

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