Is New York's "Safety Net" A Success?

One of the many specialized publications here in New York is something called “Crain’s New York Business.” As its title suggests, Crain’s covers mostly the affairs of the business community, although from time to time it also dabbles in political and policy matters. Sometimes it even has some sensible things to say. And sometimes not.

This week’s issue of Crain’s is dominated by a cover story titled “The State of Inequality: A Program for Every Problem.” The article has the byline of Crain’s head editor Greg David (although I doubt he actually wrote it — it’s not his usual style at all). It purports to be a review of the state of the “safety net” and its many subsidiary programs here in New York, together with, to some degree, a comparison of same to similar programs in certain other states (Georgia, Texas, Washington).

This lengthy piece is a serious embarrassment to Crain’s. It could not be worse if they simply had published verbatim a pile of campaign propaganda fed to them by a Cuomo or a de Blasio — which may very well be what this actually is. I’ll first take you through what the article says, and then I’ll go over a few of the elephants standing around here that they have somehow missed.

The basic theme of the piece is that New York has the most extensive array of social safety net programs in the country, and THEY’RE WORKING !!!!!! And how do we know that THEY’RE WORKING !!!!! ? Because we have followed the basic journalistic technique of interviewing some of the beneficiaries of the programs, and some of the bureaucrats who run the programs. And, remarkably, those people are unanimous in declaring the great success of the programs that they benefit from and/or administer. QED! Now, has anyone thought to maybe go out and collect some data as to, for example, how New York compares to other jurisdictions in actually reducing poverty, or reducing income inequality, or (in the case of medical programs) extending life expectancy? Of course, you will not find any of that in this article. . . .

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Goodbye To Obamacare

Obamacare!  It was supposed to usher in a new era of healthcare nirvana.  Universal "coverage"!  Better health!  "Bending the cost curve"!  "Affordable" care!

Have you noticed that you haven't been reading much about Obamacare recently?  Yes, there was a blip of press mentions last year, when the Republican Congress was making some failed attempts at full repeal of the Act.  (See my coverage here from September 27, 2017.)  And since then, mostly radio silence.  So, was universal "coverage" in fact achieved?  And, what happened with the health results?  And with the famous "cost curve"?  I'll bet you don't know.  Could it be that the press just doesn't report things that are unfavorable to the official narrative?      

And now, rather suddenly, it looks like Obamacare may be on its last legs.

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In The Progressive Vision, Dictatorship Is Never Far Below The Surface

It seems that the favorite causes of the progressive left -- the two biggest at the moment being fighting "climate change" and establishing universal health "coverage" as a "human right" -- have been running into some roadblocks lately.  On the "climate" front (I put "climate" in quotes because none of this has much if anything to do with the actual climate) President Trump withdraws the U.S. from the Paris accords, appoints climate skeptics to key administration positions, and sets about dismantling various Obama-era regulatory restrictions on fossil fuels.  Abroad, China, India and others race to build coal plants, while the UN itself admits that even under its worst-case scare tactic models the implementation of the Paris accords would have little to no measurable effect on the climate.  On the universal health "coverage" front, Obamacare continues its slow inevitable decline, while multiple states (Colorado, Vermont, California, New York) that have flirted with "single payer" systems in the past couple of years have backed off when the enormous costs became evident.  What's a good progressive to do?

The answer is simple: dictatorship.  If these stupid plebes and Trumpers can't see the morality and the necessity of immediately establishing the progressive utopia, then this whole democracy thing just isn't going to work.  A few correct-thinking experts, armed with the full coercive powers of the state, can impose the needed progressive solutions in the blink of an eye.  What's to lose?

Often the advocacy for the dictatorship of supposed experts has proceeded by muted euphemisms.  I'm thinking, for example, of the statement by top UN climate bureaucrat (Executive Secretary of the U.N. Framework Convention on Climate Change) Christina Figueres at a press conference in February 2015 that mankind must "intentionally . . . change the economic development model" in order to stop global warming:

This is the first time in the history of mankind that we are setting ourselves the task of intentionally, within a defined period of time, to change the economic development model that has been reigning for at least 150 years, since the Industrial Revolution.  This will not happen overnight and it will not happen at a single conference on climate change…It is a process, because of the depth of the transformation.

See?  She never mentioned "dictatorship"; or, at least, she didn't use that exact word.  But more recently, the perceived need for soft euphemisms seems to have lessened.  Let's just go ahead and say it!  A couple of examples for today:

Over in Europe, prominent environmentalist Jørgen Randers (professor of "climate strategy" at BI Norwegian Business School) took to the pages of Svenska Dagblat yesterday to make an explicit call for dictatorship to solve the "climate crisis."  According to Randers, the call for dictatorship is supported by multiple "climate experts."  At his Cool It blog, Bjørn Lomborg (who fortunately seems to have the ability to read Swedish) covers the matter, and helpfully provides a translation of the key passages.  Here are the translated headline and sub headline from the Randers article:

Democracy must be suspended to solve the climate crisis.  An elite government is better than democracy -- at least if the world is to succeed in resolving the acute climate crisis, according to Professor Jørgen Randers.  Several climate experts highlight a clear model:  China's dictatorship.  

Lomborg is rather scathing in his commentary:

Look at the costs to achieve the sort of climate policies that Randers and many others are advocating. If the EU fulfills its promise of cutting emissions by 80% in 2050 (which is the most ambitious climate policy in the world today), the average of the best peer-reviewed models show that the cost would run to at least $3 trillion per year, and more likely double that – meaning $6,000 for each EU citizen per year. Of course, few will vote for that.  [MC note -- the cost could easily be a multiple of even the larger estimate.]  Moreover, asking for a dictatorship neglects one of the main reasons for democracy: how do you ensure that the dictator does what is good for you? . . .  Look at China, which unfortunately is held up by many environmentalists as a green ideal.  It gets 86% of its total primary energy demand from fossil fuels (International Energy Agency data, latest from 2014, extrapolated to 2017). How is that ultra-green?

Meanwhile, over in the healthcare arena, we have the premier British medical journal The Lancet publishing an opinion piece on November 4 by its head editor Richard Horton, making an explicit pitch for more Marxism in medicine.  The title of the piece is "Medicine and Marx."   Unlike Randers, Horton does not actually use the word "dictatorship"; but I wouldn't call his effort "euphemisms" either.  Rather, Horton writes in the old Soviet/Orwellian Newspeak, using the words those guys employed to mean (to anybody who was alive and awake) not just "dictatorship," but "totalitarian rule by jackbooted thugs."  Example:

21st-century health care [is] better investigated and interpreted through a Marxist lens. . . .   Marxism defends a set of values. The free self-determination of the individual, an equitable society, the end of exploitation, deepening possibilities for public participation in shaping collective choices, refusing to accept the fixity of human nature and believing in our capacity to change, and keeping a sense of the interdependence and indivisibility of our common humanity. . . .  Marxism is a call to engage, an invitation to join the struggle to protect the values we share.

Wow.  Could anybody alive possibly still buy this?  As to the reference in the last line to "the values we share," John Hinderaker at PowerLine comments:

What values are those? Mass murder? Totalitarianism? Rule by a criminal elite? A rigid class system in which a few ruthless and politically connected thugs prosper, and everyone else starves?

Come on, John!  Aren't those really minor quibbles when are so close to achieving the holy grail of universal health "coverage"?

The Cruel, Heartless Expansion Of Medicaid Under Obamacare

You have undoubtedly noticed that the official Democratic talking point about any and all efforts to repeal or even modify Obamacare is that this is "cruel."  OK, sometimes it's "heartless."  Or maybe "a human tragedy."  You are taking away "healthcare" from the people and leaving them to suffer in the streets!  People will die!!!!

Just to warm you up for this post, here is a small roundup:

  • Sen. Richard Blumenthal (D-CT), commenting on the Graham-Cassidy bill on September 20:  "We are on the precipice of one of the most cruel and outrageous legislative acts in recent history."
  • Washington Post, July 20, commenting on the then-current Republican "repeal only" plan:  "CBO again confirms the cruelty of GOP’s ‘repeal-only’ plan."
  • The New Republic, March 14, commenting on another earlier version of Obamacare repeal/replace known as the American Health Care Act:  "[T]he incredible cruelty of the Republican legislation didn’t become clear until Monday, when the Congressional Budget Office . . . estimated it would undo nearly all of the coverage gains we’ve seen under the Affordable Care Act, creating human tragedy on a scale far greater than even pessimistic analysts imagined.
  • New York Magazine, September 5:  "[Trump's position on immigration] contains the same mix of cruelty and desperate incompetence as his position on repealing Obamacare."

Etc., etc., etc., etc.  I mean, isn't it completely obvious that people who have "healthcare" are going to have superior health outcomes to those who don't?

Well, some things that seem like they obviously must be true turn out not to be true at all.  I have linked many times to the famous randomized study from Oregon published in the NEJM in 2013 that spectacularly failed to demonstrate any health gains from putting people on Medicaid.  Then in a post from March of this year, I went through the then-just-published neighborhood-by-neighborhood health data for New York City for 2015 to examine whether those neighborhoods with very high Medicaid participation rates had better or worse health outcomes than the other neighborhoods in the City.  Uniformly and without exception, the high-Medicaid-participation neighborhoods had worse health outcomes, and by large amounts, and on every metric considered.  

And finally, in a post in August of this year, I noted that the full implementation of Obamacare in 2015 and 2016, instead of being accompanied by an increase in life expectancy, had been accompanied by a decrease in life expectancy.  How could that have happened?  I asked:

Could it be because expanded Medicaid is paying for opioids for the vulnerable?  That's a very reasonable hypothesis, although there are not yet enough data to prove it.

It's only been a little more than a month since that post, but some data are starting to trickle in.  And sure enough, those data strongly suggest that large numbers of new Obamacare Medicaid recipients are using their "healthcare" to obtain and use (or maybe sell) opioid painkillers, with very bad follow-on health effects.  An op-ed by Allysia Finley in Monday's Wall Street Journal, "Does Medicaid Spur Opioid Abuse?", collects some facts and figures, which were originally put together by CDC at the request of Senator Ron Johnson (who lost a nephew to a heroin overdose).  Some particularly dramatic examples:

Data from the Centers for Disease Control and Prevention show that overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn’t—for example, 205% in North Dakota, which expanded Medicaid, vs. 18% in South Dakota, which didn’t. . . .  Between 2010 and 2013, overdose deaths rose by 28% in Ohio and 36% in Wisconsin. Between 2013 and 2015, they climbed 39% in Ohio, which expanded Medicaid, but only 2% in Wisconsin, which did not.

I wouldn't call it definitive proof yet, but all data I have seen so far indicate that a big use of expanded Medicaid has been to obtain prescription painkillers.  Some -- indeed, many -- of those prescriptions will inevitably be abused.

Of course there has been some push back.  Here is an example from the AP, August 31, "Medicaid fueling opioid epidemic? New theory is challenged.":

[U]niversity researchers say Medicaid seems to be doing the opposite of what conservatives allege.  “Medicaid is doing its job” by increasing treatment for opioid addiction, said Temple University economist Catherine Maclean, who recently published a paper on Medicaid expansion and drug treatment. “As more time passes, we may see a decline in overdoses in expansion states relative to nonexpansion states.”

Seems like Ms. Maclean has no data to support her position, but speculates with great confidence that the government program will end up having a positive effect since, I guess, all government programs must inevitably have positive effects because their proponents are such great experts and such good people and so well-meaning.  Right!

Or there's the theory that people do much better in life striving to make it on their own than they do by accepting government handouts.  Anyway, if deaths keep going up more in the Medicaid expansion states than the others, then which one is "cruel" -- Medicaid expansion or not?

 

How To "Solve" All Known Human Problems: Spend Some Of The Infinite Free Federal Money

Are you somebody who laments the end of bipartisanship in the U.S. Congress?  You feel that politics has become so polarized that we just can't "get anything done" any more.  Why can't the Congress just get back to "solving problems" like it used to?

If you are one of these people, you will be glad to hear that a new bipartisan "Problem Solvers Caucus" has been formed in the Congress.  It consists of some 43 Congresspeople, roughly equally split between the two parties.  The leaders are Rep. Tom Reed (R-NY) and Rep. Josh Gottheimer (D-NJ).  Gottheimer -- who narrowly took his Northern NJ seat from eight-term conservative Republican Scott Garrett in the last election -- has a website biography of himself that doesn't even mention his political party.  Instead, it rings with the clarion call for bipartisanship.  Sounds like he's your type of guy!

Josh’s approach to public service is rooted in his experience in both the public and private sectors. During his time working with President Clinton, Senator Frank Lautenberg, and Speaker Thomas Foley, he saw that, by seeking common ground, it’s possible to find a bipartisan path forward without compromising your core values. Josh firmly believes that it doesn’t matter if an idea comes from the Democratic or Republican side of the aisle, only whether it will help the communities and people of the Fifth District.

As its first task, the Problem Solvers Caucus has taken on Obamacare.  Here we have the ultimate polarizing partisan issue.  Not a single Republican voted for the Obamacare bills on their way to enactment back in 2010, and not a single Democrat has voted for any of the Republican-sponsored repeal/replace measures that have been under consideration by Congress this year.  And as a result, as premiums soar, insurers withdraw, and Obamacare otherwise craters, we are at an impasse with seemingly no resolution in sight.  Surely this is a clear example of a "problem" that is in desperate need of a "solution."  Call in the Problem Solvers!

And it turns out that the Problem Solvers have actually put forth their proposed solution (or more precisely, plural solutions) in a press release issued on July 31.  Here is a copy of the press release from the website of another member of the Caucus, Rep. Ryan Costello (R-PA).  Will it surprise you to learn that essentially every proposed "solution" consists of the exact same thing, namely throwing more and more of the infinite free federal money at Obamacare to keep it afloat and save its participants from having to pay the full cost of their "coverage"?  Some excerpts, with comments interspersed:

1. Bring cost-sharing reduction (CSR) payments under the Congressional oversight and appropriations process, but ensure they have mandatory funding. CSR payments are an important part of helping households earning between 100% and 250% of the federal poverty level afford to participate in the individual market. Bringing CSR payments under the appropriations process ensures that Congress can provide proper oversight.

The "cost sharing reduction payments" -- those are the insurance company bailouts that were provided for in the Obamacare law, but without appropriation, and then Congress declined to appropriate the money.  So Obama just went ahead and spent the money anyway without appropriation and in defiance of the Constitution.  A federal judge in the D.C. District Court declared the payments unconstitutional, but then declined to issue an injunction pending appeal.  Meanwhile, the Problem Solvers decline to tell us how much money they are prepared to throw at this.  But with a little research, we find that the amount of the CSR payments has recently been running around $7 billion per year, and with projections that the subsidies will rapidly escalate to around $12 billion annually by as soon as 2020.  By the way, President Trump has so far continued these blatantly unconstitutional expenditures, although to his partial credit he has said he will discontinue them as part of his strategy to get Congress to act on Obamacare repeal.  Thus, note that in the "Problem Solvers" press release, the phrase "bring CSR payments under the Congressional oversight and appropriations process" is the euphemism of the moment for "spend $120 billion or so over the next ten years of the infinite free federal money so that people don't have to take responsibility for themselves."  Problem solved!

2. Create a dedicated stability fund that states can use to reduce premiums and limit losses for providing coverage—especially for those with pre-existing conditions.

"Create a dedicated stability fund" -- another one of the literally infinite number of euphemisms for "throw some more of the infinite free federal money at it."  For this one I can't find any estimate of the cost.  $100 billion?  How about a trillion?  Problem solved!

3. Adjust the employer mandate by raising the threshold on the requirement for employers to provide insurance under the employer mandate to businesses of 500 employees or more. . . . Additionally, the definition of “full time” under the employer mandate should indicate that a full-time work week is 40 hours.   

Did you doubt that there is an infinite number of ways to say "throw some more of the infinite free federal money at it"?  This time it's "adjust the employer mandate" -- which of course means that fewer people will be insured through employers, which means that more people will head for the exchanges, which then means more of the "cost sharing reduction" payments.  Of course, the infinite free federal money will step in.  Problem solved!

4. Repeal the medical device tax. This tax adds a 2.3% sales tax on medical device supplies. The costs of the tax are passed on to consumers and it should be repealed. 

Well, that's roughly $3 billion per year that was a big part of the "scoring" that supposedly made Obamacare affordable.  But then, a lousy $3 billion per year is not even a rounding error when the money you are playing with is infinite and free.  Problem solved!

Read enough of this stuff and you start to understand what Rep. Gottheimer is talking about when he says "it doesn’t matter if an idea comes from the Democratic or Republican side of the aisle, only whether it will help the communities and people. . . ."  It means "Republicans can also come up with ways to throw around the infinite free federal money."  The people on the paying end will never notice!  What I can't believe is how many Republican Congresspeople are dumb enough to get schnookered into going along with these transparent dependency-creating vote buying schemes for Democrats.

Where is a single Congressperson from the Democratic side who will go along with any "solution" to any "problem" that involves spending less federal money?

A New Level In The Rhetoric Of "Our Opponents Are Evil"

A recurring theme here is that, while Republicans think Democrats are wrong in their public policy prescriptions, Democrats think Republicans are evil.  The recent events of Charlottesville and their aftermath have helped move the rhetoric to a whole new level.  Previously, if you advocated that less dependency on "free" government food or healthcare subsidies would be a good thing for the country and even for its poor citizens, you were merely "cruel" or "heartless."  Now, any failure to get on board with each and every policy prescription of the extreme left, let alone any support for President Trump, brands you at the minimum as a "racist," if not a "neo-Nazi" or a "white supremacist."

The deep-thinking Michael Moore gave a good summary of the current talking points in a CNN interview a few days ago:

“If you vote for a racist, what are you then? Because it sure sounds like racism to me,” he told Lemon during the late-night interview, after Moore and Mark Ruffalo protested outside Trump Tower with the audience of his current Broadway show. “He’s absolutely a racist,” Moore added of Trump, saying later in the interview, “If you still support the racist, you are the racist.”

Maybe you thought that Trump's policy prescriptions were, on balance, better for the country than those of Hillary Clinton? Or maybe you thought that Trump would be a more competent steward of U.S. foreign policy?  Sorry, but these possibilities are no longer allowed.  You are evil -- racist evil!  

Or consider the thoughts of Democratic intellect Russ Feingold (recent loser in an attempt to reclaim a Senate seat from Wisconsin) in the Guardian on August 19, "How the Republican Party quietly does the bidding of white supremacists":

Let us finally rip off the veneer that Trump’s affinity for white supremacy is distinct from the Republican agenda. It isn’t. . . .  The lesson from Charlottesville is not how dangerous the neo-Nazis are. It is the unmasking of the Republican party leadership. . . .  Where are the Republican leaders who are willing to call out the wink (and the direct endorsement) from President Trump to the white supremacists and acknowledge their own party’s record and stance on issues important to people of color as the real problem for our country?

John Davidson, in a column at the Federalist commenting on Feingold's piece, captures the concept well:

Finally, finally, someone on the Left just came out and said it. Being a Republican is apparently no different than being a white supremacist. Supporting a lower marginal tax rate puts you in the same company as the Ku Klux Klan. Therefore, punching a Nazi is the same as punching someone wearing a MAGA hat. . . .  This is the logical endpoint of what social justice warriors have been arguing since before Charlottesville. Everyone who opposes their political agenda does so out of hatred and bigotry, and there’s little difference between the GOP establishment and fringe neo-Nazi groups.

OK, I understand the game, but what I can't understand is the lack of much attempt at push-back.  Just breathe the word "racist," with or without any basis, and corporate America runs for the hills.  CEOs abandon President Trump's business councils en masse.  Formerly sane right-side pundits (e.g., Bill Kristol, Charles Krauthammer) compete to distance themselves from any element of the President's agenda.

Who is left to point out that it is the left-side handouts-for-all agenda that has proved a disaster for everyone who falls into its clutches, and most especially for black Americans?  You literally can't find anything about that in any media source these days, "mainstream" or otherwise.  OK, a little of it persists at a few think tanks.  But mostly it is left to the lonely voice of the Manhattan Contrarian.  A few obvious observations, made repeatedly here over the years:

  • Fifty years of the "War on Poverty," and the poverty rate remains more or less exactly where it was when the "War" started.  Except in Democrat strongholds, like New York, where "anti-poverty" programs are even more generous and pervasive, and therefore the poverty rate is up a full five points since the War on Poverty began, with no reason to believe it will ever go down -- at least until the "anti-poverty" programs are reduced or ended.  So-called "anti-poverty" programs are specifically designed not to lower poverty and reduce dependency, but rather to perpetuate poverty and increase dependency.  The poor are trapped in a lifetime of dependent poverty.  The only beneficiaries of this system are the government functionaries who make a comfortable and secure career without ever accomplishing anything they are supposed to accomplish.  The cost is about $1 trillion per year to accomplish nothing.
  • The moral crusade of "healthcare for all" remains a disaster as an anti-poverty measure, and even worse as a public policy.  By definition, no amount of free or subsidized healthcare will ever raise any poor person out of poverty.  Not only have all attempts to demonstrate better health outcomes among those with free healthcare failed, it is obvious to anyone who looks that areas with pervasive Medicaid participation have dramatically worse health outcomes than areas with less Medicaid participation.  The recent full implementation of Obamacare, expected by all on the left to bring improved health outcomes, has in fact brought noticeably worse health outcomes.  Could it be because expanded Medicaid is paying for opioids for the vulnerable?  That's a very reasonable hypothesis, although there are not yet enough data to prove it.
  • And then there's subsidized "affordable" housing, often characterized here as "the worst possible public policy."  Don't get me started.

The inheritors of the mantle of slavery, segregation, Jim Crow and the KKK -- that is, Democrats and progressives -- now purport to claim the moral high ground with a program of handouts designed to keep black America in dependency forever.  How can any sane person concede the moral high ground to them?  Sure, Donald Trump is an imperfect vessel for the other side.  So?