Personally I find the whole government and business comparisons to be a bunch of crap. Because there should be no profit motive involved in government, the motive should be to provide great service for the taxpayers. Government should not be run like a business and business should not be run like a government. They’re different for a reason.
Be that as it may, Ross Ramsey makes some solid points on how Perry and the wing nuts use the business analogy only when it suits them, and throws it aside for ideological reasons when it doesn’t. Medicaid Expansion Confounds Conservatives.
Both Perry and Dewhurst can claim to know how the business world works, whether their recent records support it or not. But look at the capper: They and others are talking seriously about walking away from a gargantuan federal freebie.
The federal government is offering to pay all of the costs of expanding the Medicaid program to some of the state’s uninsured population for three years, then to pay 90 percent of the costs for several years after that. Texas could, according to a report commissioned by Texas Impact, an interfaith public policy group, spend $15 billion over the next 10 years and pull down $100 billion in federal funds as a result.
Here’s the business question: Why leave that kind of money on the table, especially if it’s going to be spent elsewhere if Texas opts out?
The argument for expansion is that it would take care of a lot of people for some period of time — even if it doesn’t take care of them forever. The choice is between insuring a crowd of people for a few or many years, or not insuring them at all. Between providing their health care in expensive and inefficient emergency rooms, or taking care of them by expanding Medicaid.
It’s not just a good-government take-care-of-those-less-fortunate thing, either. Medicaid has enough flaws to feed a dozen think tanks. But by expanding Medicaid, the state would also bring in billions of dollars to pay for health care for people who aren’t insured now, providing relief to local taxpayers who wouldn’t be on the hook for nearly as much uncompensated care, turbocharging the state’s medical economy, and bringing federal tax dollars paid by Texans back into the state.
If you don’t do that last bit, by the way, the money would otherwise go to places like California, Massachusetts and New York. Where’s the business sense in that? And where, because that’s a transfer of wealth in some measure from red to blue states, is the political sense?
It might be true that a Medicaid expansion will work only for a few years in Texas and other states; they can quit if that time comes. For many officeholders, it makes political sense to opt out. But if they were running state government like a business, without the political undertow, the conversation would already be over.
There are a few things Ramsey says that I don’t agree with. Like “..politicians understand how businesses operate”, and “Medicaid has enough flaws to feed a dozen think tanks”. But his general overall point that for the good of the state, Perry and the wing nuts should be able to set aside ideology and do what’s right, and hide behind an “it’s good for business” excuse, to do what’s right. That I can agree with. If that’s what it takes for the GOP in Texas to do the right and moral thing the so be it.
[UPDATE]: Perry is digging in, Gov. Rick Perry heckled in DC as he rules out Medicaid expansion.
Gov. Rick Perry faced hecklers this morning in Washington as he made clear today that despite mounting pressure, he won’t expand Medicaid, even though that could cut the number of uninsured Texans by as much as 1 million.
“We are not going to be expanding Medicaid in Texas,” he told the Texas State Society over the shouts of protesters filtering through the window of the Republican-run Capitol Hill Club, arguing that doing so would be too costly.
On the sidewalk, roughly 30 people shouted “Rick, Rick, You make me sick!” and “You will never be president.”
Inside, four people who paid $30 for a breakfast of scrambled eggs and chicken fried steak blended in with more than 100 members and guests of the Texas group, popping up to interrupt Perry at regular intervals.
“Do you bequeath our next generation of leaders death and illness? Healthcare is a human right. Healthcare is a human right, Gov. Perry. Do what is right for Texans,” one woman shouted at the governor before a Perry aide escorted her out.
“Two million people in your state do not have healthcare because you are refusing to have Medicaid expanded,” another heckler shouted later.
[UPDATE II]: Michael Lind at Salon has a great article on why Perry and the wing nuts don’t want to expand Medicaid, because they’re cheap labor conservatives. Southern poverty pimps:
Finally, there is the welfare state. Universal, portable social insurance programs like Social Security and Medicare increase the bargaining power of workers, by reducing the penalty for quitting a job because of poor wages or poor treatment. If they quit, they don’t endanger their healthcare access or their retirement security. Workers with adequate social insurance are more likely — to use a time-honored Southern phrase — to be “uppity.”
Apart from a high federal minimum wage, nothing could be a greater threat to the Southern cheap-labor economic strategy than universal, standardized federal social insurance. In order to maximize the dependence of Southern workers on Southern employers in the great low-wage labor pool of the former Confederacy, it would be best to have no welfare at all, only local charity (funded and controlled, naturally, by the local wealthy families).
But if there must be a modern welfare system, then the Southern oligarchy prefers a system that allows state governments, rather than Washington, D.C., to control eligibility and benefit levels. By controlling eligibility, Southern state governments can minimize the amount of the local workforce that has access to good social insurance, reducing the power of Southern workers to be “uppity.” At the same time, giving Southern states the option to have lower benefit levels provides the neo-Confederates with yet another bargaining chip, along with low wages and low taxes, that can be used by Southern state governments to lure business from more generous states or nations.
It is all a system, you see. Southern conservative policies toward immigration, labor unions, the minimum wage and social insurance don’t reflect supposed conservative or libertarian ideologies or values, even if conservative or libertarian intellectuals are paid to dream up after-the-fact rationalizations. These policies are reinforcing components of a well-thought-out economic grand strategy to permit the South, as a nation-within-a-nation in the U.S., to pimp its cheap, dependent labor for the benefit of local and foreign (non-Southern) corporations and investors.