Evil, boiled down to a thick sauce.
Matt Yglesias stares in wonder at John Shadegg and the Republican Study Committee's Katrina budget. Schedule A of the budget gives us the theme: "Tough Choices for Tough Times" -- that is, how to pay for Katrina reconstruction without having to do anything extreme like cancel tax cuts to multimillionaires. Sure enough, the choices these tough thinkers offer are very tough. If you're poor.
One of the proposals is to "Reduce Medicaid Administrative Spending". Nobody likes that red tape spending, afterall. Let's cut it! Didn't Katrina prove how awful bureaucracy can be?
"Under this plan," the Study Committee explains, "the federal government would cap the per-enrollee amount that it pays each state for Medicaid administration. This would give states a stronger incentive to improve the efficiency with which they manage their Medicaid programs."
Of course, another way they could cut those costs back down would be just to discourage people from participating in Medicaid in the first place. But that can be at least a little tricky since the feds are supposed to regulate Medicaid's reach to some extent and protect poor people from governors like Haley Barbour. To make the offloading of Medicaid users easier, the Study Group proposes to "Increase Allowable Co-payments for Medicaid": "This option would raise the federal limits on allowable co-payments in Medicaid--from $3 for adults and zero for children to $5 and $3, respectively. The higher co-payments would apply to outpatient hospital visits, prescription drugs, non-emergency visits to emergency rooms, and visits to physicians and dentists."
Because God knows it's a drag on the system for low-income families to be going to the dentist all the time. But the good news is that the research shows that if you just raise the co-payments just a wee little bit, by an amount that most voters can't imagine would be a burden for a poor family to pay for an occasional doctor's visit, a good chunk of them will just stop going. From a budget-strapped state Medicaid administrator's point of view, this is just perfect. No fuss, no muss.
Making poor people pay for more of their care also has the additional benefit of slightly lessening the fiscal shock to the states (and therefore the amount of grumbling from Republican governors who are required for successful campaign events) of moving to a "Block Grant" for the acute-care section of Medicaid. The tough-thinking Republicans explain this part of the plan as follows: "Funding acute care with a block grant rather than with federal matching payments would strengthen states' incentive to spend money cost-effectively by eliminating the subsidy for each additional dollar spent on health care." Families USA explained what this really means back in 2003, the last time the GOP, with support from the Bush Administration, made a block grant proposal.
Having been tough on Medicaid participants, the Study committee moves on to crack down on Medicare users, grad students (this one is defensable IMO, not that it'll save much money), civil servants, Eastern Europe, Egypt, Ireland, sub-Saharan Africa, AIDS sufferers everywhere, Columbia (this one might be a good thing; I don't know enough about it to judge), East Asia, the U.N. and the Peace Corps. Especially laughable is the item containing the authors' justification of killing the Millineum Challenge Accounts because they're redundant with USAID payments. This item appears a full seven bullets before they urge cutting USAID "operating expenses" on the grounds that the USAID is basically a front for junkets. Not that the junket class has too much to worry about. Basically, the only group out there that wouldn't be paying for Katrina in this budget is Homo Americanus Millionairus. Oh, except for Homo Americanus Billionairus.
By page six, the Study Committee has dropped all pretense of being "a different kind of Republican" -- or whatever it is these days -- and has wandered back into Newt Gingrich territory. Kevin Drum calls the three pages of "Eliminate"s and "Reduce"s a pretty standard "conservative wish list" and wonders how the revival of cracking down on EITC claimant abuse can be seen as anything but class warfare. I think it might actually be a secret partisan weapon to demoralize liberals by reminding us of Bill Clinton's single biggest sellout back in 1999, caving into that shameless GOP-engineered crackdown on the working poor as a way of getting at the IRS.
But that's not all. Two added bonuses in today's budget are eliminating the cap on recollection of overpaid SSI payments (translation: if you're permanently disabled and the government has systematically given you too much money because they messed up their calculations, and then some bureaucrat discovers the mistake, you're fucked) and making sure unwed teenaged mothers can't qualify for the funding required to move out of their parents' houses. Oh, and since it's unfair that the poor take all the hits, there's also the elimination of matching funds for federal elections.
Really, though, all this is just gravy, especially the concluding section on "corporate welfare", which (a) is geared almost entirely to cutting payments to politically powerless clean-technology programs and (b) cuts a grand total of $50 billion over 10 years, or just under 10% of the meat of the proposal, which is contained in Section I: "Tough Choices for Tough Times". The real long-term cost cutting -- about 25% of the whole -- comes from slashing federal responsibilities toward Medicaid. We can tell just how tough this is by the authors' assurances that this won't hurt a bit: the real costs of Medicaid come from bureaucratic inefficiency and user "abuse" (the latter is one of Haley Barbour's favourites). But to really demonstrate how "tough" they are, these tough-thinking Republicans are actually back-loading the whole thing. For instance, increasing the co-pays in Medicaid will save $90 million next year. But over the course of the next four years, it will magically save an additional $1.89 billion. We only get tougher as time goes on.
What this suggests is that, despite the hyperbolic title of this post, in fact the GOP Study Committee isn't so tough after all: they're actually a bunch of softies. Sure, they'd like to see block grants for Medicaid -- actually they'd like to eliminate Medicaid, period -- but they really aren't going to force it through over the wails of goo-goos. They're just going to wait until Katrina is out of the news and the governors start wingeing, and then, with Arlen Spectre and Mike DeWine's help, they'll keep those future cut phase-ins from going into effect and just run up the deficit instead. I say this because of my Pollyannish belief in human nature. Because it's much better to be an intellectually unserious coward posturing as a "budget hawk" than it is to be the sort of evil fuck who'd use a natural disaster as an excuse to shake hundreds of thousands of people out of the safety net.
One of the proposals is to "Reduce Medicaid Administrative Spending". Nobody likes that red tape spending, afterall. Let's cut it! Didn't Katrina prove how awful bureaucracy can be?
"Under this plan," the Study Committee explains, "the federal government would cap the per-enrollee amount that it pays each state for Medicaid administration. This would give states a stronger incentive to improve the efficiency with which they manage their Medicaid programs."
Of course, another way they could cut those costs back down would be just to discourage people from participating in Medicaid in the first place. But that can be at least a little tricky since the feds are supposed to regulate Medicaid's reach to some extent and protect poor people from governors like Haley Barbour. To make the offloading of Medicaid users easier, the Study Group proposes to "Increase Allowable Co-payments for Medicaid": "This option would raise the federal limits on allowable co-payments in Medicaid--from $3 for adults and zero for children to $5 and $3, respectively. The higher co-payments would apply to outpatient hospital visits, prescription drugs, non-emergency visits to emergency rooms, and visits to physicians and dentists."
Because God knows it's a drag on the system for low-income families to be going to the dentist all the time. But the good news is that the research shows that if you just raise the co-payments just a wee little bit, by an amount that most voters can't imagine would be a burden for a poor family to pay for an occasional doctor's visit, a good chunk of them will just stop going. From a budget-strapped state Medicaid administrator's point of view, this is just perfect. No fuss, no muss.
Making poor people pay for more of their care also has the additional benefit of slightly lessening the fiscal shock to the states (and therefore the amount of grumbling from Republican governors who are required for successful campaign events) of moving to a "Block Grant" for the acute-care section of Medicaid. The tough-thinking Republicans explain this part of the plan as follows: "Funding acute care with a block grant rather than with federal matching payments would strengthen states' incentive to spend money cost-effectively by eliminating the subsidy for each additional dollar spent on health care." Families USA explained what this really means back in 2003, the last time the GOP, with support from the Bush Administration, made a block grant proposal.
Having been tough on Medicaid participants, the Study committee moves on to crack down on Medicare users, grad students (this one is defensable IMO, not that it'll save much money), civil servants, Eastern Europe, Egypt, Ireland, sub-Saharan Africa, AIDS sufferers everywhere, Columbia (this one might be a good thing; I don't know enough about it to judge), East Asia, the U.N. and the Peace Corps. Especially laughable is the item containing the authors' justification of killing the Millineum Challenge Accounts because they're redundant with USAID payments. This item appears a full seven bullets before they urge cutting USAID "operating expenses" on the grounds that the USAID is basically a front for junkets. Not that the junket class has too much to worry about. Basically, the only group out there that wouldn't be paying for Katrina in this budget is Homo Americanus Millionairus. Oh, except for Homo Americanus Billionairus.
By page six, the Study Committee has dropped all pretense of being "a different kind of Republican" -- or whatever it is these days -- and has wandered back into Newt Gingrich territory. Kevin Drum calls the three pages of "Eliminate"s and "Reduce"s a pretty standard "conservative wish list" and wonders how the revival of cracking down on EITC claimant abuse can be seen as anything but class warfare. I think it might actually be a secret partisan weapon to demoralize liberals by reminding us of Bill Clinton's single biggest sellout back in 1999, caving into that shameless GOP-engineered crackdown on the working poor as a way of getting at the IRS.
But that's not all. Two added bonuses in today's budget are eliminating the cap on recollection of overpaid SSI payments (translation: if you're permanently disabled and the government has systematically given you too much money because they messed up their calculations, and then some bureaucrat discovers the mistake, you're fucked) and making sure unwed teenaged mothers can't qualify for the funding required to move out of their parents' houses. Oh, and since it's unfair that the poor take all the hits, there's also the elimination of matching funds for federal elections.
Really, though, all this is just gravy, especially the concluding section on "corporate welfare", which (a) is geared almost entirely to cutting payments to politically powerless clean-technology programs and (b) cuts a grand total of $50 billion over 10 years, or just under 10% of the meat of the proposal, which is contained in Section I: "Tough Choices for Tough Times". The real long-term cost cutting -- about 25% of the whole -- comes from slashing federal responsibilities toward Medicaid. We can tell just how tough this is by the authors' assurances that this won't hurt a bit: the real costs of Medicaid come from bureaucratic inefficiency and user "abuse" (the latter is one of Haley Barbour's favourites). But to really demonstrate how "tough" they are, these tough-thinking Republicans are actually back-loading the whole thing. For instance, increasing the co-pays in Medicaid will save $90 million next year. But over the course of the next four years, it will magically save an additional $1.89 billion. We only get tougher as time goes on.
What this suggests is that, despite the hyperbolic title of this post, in fact the GOP Study Committee isn't so tough after all: they're actually a bunch of softies. Sure, they'd like to see block grants for Medicaid -- actually they'd like to eliminate Medicaid, period -- but they really aren't going to force it through over the wails of goo-goos. They're just going to wait until Katrina is out of the news and the governors start wingeing, and then, with Arlen Spectre and Mike DeWine's help, they'll keep those future cut phase-ins from going into effect and just run up the deficit instead. I say this because of my Pollyannish belief in human nature. Because it's much better to be an intellectually unserious coward posturing as a "budget hawk" than it is to be the sort of evil fuck who'd use a natural disaster as an excuse to shake hundreds of thousands of people out of the safety net.
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