TEXAS and the Cruel Social Experiment

We may be in the middle of a huge social experiment and one that will likely reveal the effects of right wing social engineering. A number of states are threatening to opt out of Medicaid expansion. It will be a hard sell to the public as hospitals and health systems gear up to avoid losing billions of federal Medicaid dollars. Once election politics are over, it will be a hard sell to leave scores of uninsured with no option and state taxpayers, health providers, and insurance buyers holding the bill.

There are some states that might just “opt out” through. Texas is probably a likely candidate. There is an interesting irony playing out in Texas. Texas had the worst prior coverage in the US, dead last, so they have the most to gain. The comparative dollars per capita of new federal dollars going into an expanding the Texas Medicaid program would be very high because there are so many uncovered Texans (estimated 2 million new people would quality for expanded Medicaid). But the cost to implement the changes also rises (the feds pay everything for 3 years but starting in 2017 Texas would have to pay 10%). So while Texas has a potential huge windfall, the unfunded costs are also huge. A lot more than many states. Some states, like Maryland, have done such a good job in the past, their costs will actually go down. They will reap the benefits of all the federal expansion with a net savings. Those benefits should quickly trickle down to local agencies, governments and taxpayers. Local funds that previously made expanded coverage available will be freed up by the federal coverage dollars.

Further, while Texas cost-cutting has left programs at absolute minimums (Texas has the lowest per capita budget in the nation), no surpluses accrued to the state government because they also cut taxes so much to their corporate friends that their state budget remained underfunded. They have no income tax, only sales tax, corporate taxes and a host of fees to support revenue. They are legitimately broke. They passed last year’s budget with a 4 billion dollar underfunding of Medicaid (http://sunshinereview.org/index.php/Texas_state_budget). That bill has been kicked down the road. Texas also has $280 Billion in debt and unfunded liability, so paying the State part of expansion would definitely be a problem.

This creates an interesting, if cruel, social experiment. Some states will opt out, not many, but a few. Some states will find the money to expand. Some states will put up nothing, because they already addressed the issue and are already laying down a track record and database. I predict that hindsight will finally cast a true light on the detrimental effects of the poor care in American terms. No doubt more American lives will be lost due to lack of insurance. Previous studies suggest 45,000 deaths a year are attributed to lack of insurance (http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/). With that previous data and improvements likely to show in states that “opt in”, one has to wonder how the GOP will justify the such losses.  I am sure Fox will figure out something.

Texas Healthcare at the Bottom – the Irony

If you live in a “Red” state, it is likely that your state government has been cutting services. Texas is a model of such policy, ranking at the bottom of healthcare in the US according to federal agencies. http://www.dallasnews.com/news/state/headlines/20120705-federal-agency-ranks-texas-at-bottom-for-health-care.ece

The results of conservatives slowly starving governments at all levels are the continued erosion of vital infrastructure and social services. Just how bad is Texas? Texas is the worst place in a country that the WHO ranks 37th  in overall national health (America’s current ranking). This is a crime in progress.

The irony of this cannot escape me. Texas hospital systems provide some of the best cardiovascular surgical services in the world. In the days when I went to medical school, their University System was one of the best and attracted top tier physicians along with patients seeking their care. And like many western states, tuition was dirt cheap, bordering on free at state universities. In Arizona (yes, that Arizona) residents of the state gained easy acceptance to state universities and if they had the need and maintained high GPA’s, tuition was waved under a general resident scholarship program. Being broke and otherwise without support, I qualified and owe my current life to that program.

In Texas, and other states, such investments in education and state talent bred a great system. The remnants of those investments now stand as islands in a rising sea. Still providing the best, but being starved of the resources on which they once depended. Priorities have changed, sacrifices must be made, and resources rationed (oh that “R” word). What stays is high dollar paying services like open heart surgery, and what goes is charity care, ancillary services, community programs, long term health investments, and then actual hospital clinical staff as ratio’s of patients to nurses in hospitals and nursing homes rise.

What is missing is the previous generous federal grant programs that paid for top tier professors to engage in basic sciences research in aerospace, medicine and other technology. The states themselves are broke and are unable to provide the subsidies they once did, let alone make up the missing federal money.

 

America’s Biggest Wasted Resource

This nation has lost its focus on what made us great. I read today about Norway’s current ranking as the most mother friendly nation. As I delved deeper into the issues, I began to think about the tragedy of America’s biggest and least talked about waste of national resources, that of our people. In a country of more than a quarter billion people it is more than a statistical probability that there are a lot of very smart people in all avenues of the nation.

Many of these people would be destined to be quite successful given reasonable opportunities. A smaller percentage (but still a large number) might be destined to be the nation’s, or the world’s, greatest scientists, entrepreneurs, politicians (as in leaders, not today definition), artists and philosophers. However, such potential can only manifests itself when the individuals obtain the education and social support needed to learn and mature.

We often talk of how great America is, and the huge accomplishments that have been part of our history. A closer look at the successes in the 20th century reveals that we produced much of those achievements after large scale education of the population. Support of public schools became the rule. The GI bill after WWII resulted in a heavy GOVERNMENT investment in education and unleashed a wave of technology that drove our nation forward.

The labor movement brought millions of Americans up to the middle class and raised middle class family standards to a level that made it possible to send their kids to college. Even if our parents could not quite afford to send us, low interest student loans applied toward tuition at heavily subsidized state universities made college financing quite manageable.

A look at the civil right movement is another clear example of bringing more of the population along with it’s locked-up talent into the mainstream though education. Absent the advances made during those years, it would likely be a rare sight to find an “intelligent” (educated) person of color either in middle or upper levels of society in America. All the current success stories could be just a list of wasted minds and lost productivity.

Every time we educate a population, we release its previously hidden “people resource”. It is kind of like mining. If you want to release the buried treasure or energy resource, you have to painstakingly mine it and separate it from the lower value resources. The only way to mine the American population for our national treasures, our best scientists, leaders, entrepreneurs, artists, musicians, etc., is to cast a broad net of education over them so the most important, and currently most wasted American resource can be recovered before it is forever lost.

If we could turn the conversation to this kind of mining, you would have my support for “drill, baby drill”.

 

Justice Roberts “Conversion”

There has a lot in “news” about Justice John Roberts alignment with the liberal side of the bench declaring the ACA constitutional. The Right has called him a traitor. The left is scratching their heads, but smiling. What was his thinking and what are the implications of Justice Roberts sudden conversion?

First, we progressives should be thankful. However, is this thankful as in ‘a beggar given a small bit of food’, or as in ‘Thanksgiving thanks’ for all that is good? We might also ponder what motivation and thinking is behind his decision to part with his usual company and accept his unpopularity within his own previous support group.

In the long run, this decision matters little to the monied interests who have taken control of the political Right. Those guys get their healthcare with VIP access and at a cost that does not even constitute pocket change. Healthcare access is about social justice, not financial power over democracy. I am fairly certain that most of the concern generated in this corner of the universe will be focused on financial implications and opportunities to exploit for financial gain to guide their next investment or hedge. They want to know who the winners and losers are so they can place their bets and be winners, regardless of which sectors win or lose. That is way their game is played. Consequently, I doubt they brought their full influence to bear. So it is not likely that this decision, despite all the rhetoric, is a big deal to them. It does, however, play into the storyline of Obama the Socialist, and for that they give thanks and raise money.

This decision was also certain to be one of the greatest legacies for the Roberts Court. One might ponder for a moment the historical notations attached to the Roberts Court if it had continued the regular issue of 5-4 decisions, appearing partisan in their outcomes, and culminating with this one. There has been an increasing perception of the SCOTUS as just another partisan piece of our broken system. After the Bush v. Gore and Citizens United decisions, a decision against the ACA would likely have cemented the perception of this court as partisan and no longer respected as an independent third branch of government.

Restoring credibility to the Roberts Court may not be very good for progressives. At some level the Court will gain additional credibility to the past and future decisions. From a court that brought us Bush v Gore and Citizen’s United, that is not good news.

I also think Justice Roberts must deal with his own ego. This is a very powerful man. Not only is he the Chief of the SCOTUS, he will likely remain so for a very long time. He is a young man with no possibility of being defeated in an election later down the line.  That kind of power has to be an ego booster. I say this only to suggest that feeling that mojo may help him be more independent, and to act to save his name and that of the Court. I would be think that perhaps Justice Roberts will mark this decision as his time to take command of the court as a more independent voice, but I would not hold my breath.