mykeystrokes.com

"Do or Do not. There is no try."

“A Familiar Premise Of Free-Market Conservatism”: Iowa’s Radical Privatization Of Medicaid Is Already Struggling

On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaid ever attempted.

In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.

Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.

An Iowa administrative law judge late last month recommended that Iowa throw out the contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid $138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process.

The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent.

The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.

Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.

Branstad had the authority to implement the new program without input from the state legislature. But officials with the Centers for Medicare and Medicaid Services (CMS) were in Iowa this week and will make a ruling next week on whether the plan can proceed.

“The rollout has been an absolute unmitigated disaster,” said Democratic Sen. Joe Bolkcom, the Iowa chamber’s majority whip. “CMS and the Obama administration need to protect vulnerable Iowans from this train wreck.”

Branstad has implicitly acknowledged some difficulty. This week he extended until April the “safe harbor” in which Medicaid providers will receive 100 percent reimbursement regardless of managed-care network.

In response to my inquiry, Branstad’s office sent me to the state’s Department of Human Services, where a spokeswoman, Amy Lorentzen McCoy, said all is well. The state, which now has 12 percent of Medicaid recipients in managed care, would have gone this way anyway, she said, but the urgency increased with the recent Medicaid expansion. (Branstad was one of the few Republican governors to accept the Obamacare expansion of the program.)

Now, as the nation’s attention turns to the Iowa caucuses, Iowans will likely be witnessing either a fight between Branstad and President Obama (if the federal government forces a delay in the Iowa program) or chaos (if the program is allowed to proceed). Other states, such as Kansas and Kentucky, have tried similar experiments, but they either moved more deliberately or didn’t extend the private program to vulnerable populations such as the disabled.

“A lot of issues have been raised with the pace of the rollout” in Iowa, said Julia Paradise, a Medicaid expert with the Kaiser Family Foundation. “The provider networks for the plans have not yet been established. There’s a lot of confusion among beneficiaries.”

Branstad could recognize this, and slow things down. In failing to do so, he’s relying more on dogma — faith that the private sector always does things better — than reality.

 

By: Dana Milbank, Opinion Writer, The Washington Post, December 11, 2015

December 14, 2015 Posted by | Free Markets, Medicaid Privatization, Terry Branstad | , , , , , , , , | Leave a comment

“The Conscience Of A Corporation”: A Deeply Held Relationship With Five Members Of The Supreme Court

So here is Walmart, insisting that “our core basic belief of respect for the individual” is at odds with an Arkansas bill that would allow religious-based discrimination. And here is Marriott, slamming as “idiocy” similar measures in other states. And somewhere in there is the family-run pizzeria, asserting that Indiana’s new law allows them to deny wedding day pies to people whose choice of spouses they don’t approve of.

These businesses sell Chinese-made consumer goods, hotel rooms, and rounded dough burdened with pepperoni and extra cheese. Since when did they start spouting off about the deeply held convictions guiding their corporate consciences?

You can blame last year’s Supreme Court decision in the Hobby Lobby case for unleashing a herd of ponies that have gone off in quite unpredicted directions. There, in a partisan 5-to-4 ruling straight from Republican fever nests, the court gave certain corporations the right to challenge laws that they claim violate their religious beliefs. In that case, it was about contraception in the health care package.

Let’s pause to consider this new entity — a moneymaking organization no different from a lone human being who feels conscience-bound to live a certain way because of a deeply held relationship with God. Let’s pause, because five members of the Supreme Court would not.

One justice, the irrepressible Ruth Bader Ginsburg, warned of the consequences of giving corporations a soul: “The court, I fear, has ventured into a minefield.”

Ginsburg predicted that the court’s “expansive notion of corporate personhood” would invite profit-making companies to start using religion as an excuse to ignore laws they didn’t like. And indeed, states packed with right-wing legislators who see phantom persecution behind every new episode of “Modern Family” have clamored to give companies a spiritual opt-out clause.

So it is in Indiana. State lawmakers were also told to look before taking a big leap into spiritual exemptions for business. In a letter in February, legal scholars warned of corporations’ citing religious justification for “taking the law into their own hands.”

But, lo, look what happened on the way to forcing religion into the marketplace: The corporations — Apple, Nike, Yelp, Gap, PayPal, Big Pharma companies like Eli Lilly and the nine largest companies with headquarters in Indiana — have rebelled. They are saying: No, don’t give us the power to discriminate. We’d rather remain soulless purveyors of product to the widest possible customer base. Which is, I suppose, how capitalism is supposed to work. Bless the free market.

Indiana’s law is “not just pure idiocy from a business perspective,” said Marriott’s president, Arne Sorenson, but “the notion that you can tell businesses somehow that they are free to discriminate against people based on who they are is madness.”

Not March Madness, the culmination of which is what Indiana thought we’d all be celebrating in the Hoosier State this weekend. But political lunacy, of the type that’s been on display ever since the Republican Party hitched itself to the crazies who dominate its media wing.

But let’s not get too far ahead of ourselves. Walmart, which effectively killed the Arkansas bill a few days ago, remains locked in poverty wage mode, despite its recent boast of raising pay to at least $9 an hour. Apple, and most tech companies now strutting across the moral stage, continues to do business with countries where a person can be executed for being gay.

Their outrage is selective, and calculated: In corporate America, the branding conceit of the moment includes just the right dash of social activism. A little environmental nudge from your cereal, a talk about race from your barista — it’s mostly harmless.

Chick-fil-A learned a lesson in its journey from behind the grease counter and back over gay marriage. After condemning same-sex marriage and becoming a culture-war battleground, the corporate leaders of a company that professes to run on biblical principles now say they will stick with chicken talk. Everyone is welcome.

Good call. Nothing in the secular world keeps Chick-fil-A’s founders from free worship in private. For that matter, nothing in the secular world deprives any business owner of a lawful spiritual pursuit outside of the public square. Their profits will rise or fall because of consumer demand, rather than which side of a biblical exhortation the chicken-eater may be on.

All of this, the free market in tandem with the First Amendment, has worked pretty well in a clamorous democracy such as ours. It’s only when activist judges — thy names are Clarence Thomas, Antonin Scalia, Samuel Alito, Anthony Kennedy and John Roberts — have tried to broaden the intent of the founders that we’ve gotten into trouble.

In 2010, those five judges created the notion of corporate personhood — giving companies the unfettered right to dominate elections. After all, Exxon is just a citizen like you and me. And in 2014, those five judges gave corporations a soul, a further expansion of business entity as a citizen. Well, they tried to. As the saying goes, a corporation will never truly be a citizen until you can execute one in Texas.

 

By: Timothy Egan, Contributing Op-Ed Writer, The New York Times, April 3, 2015

April 4, 2015 Posted by | Corporations, Discrimination, Free Markets | , , , , , , , , | Leave a comment

“Corporations Are Artificial, Too”: Modern Corporate Capitalism Is Anything But Natural

One of the reasons it’s difficult for liberals to easily and effectively win arguments about economics with conservatives is that conservatives have a very simple mantra: let the natural forces of the market do their work. Government is seen as an interloper and distorter of Darwinian forces that would otherwise ultimately let all goods and services achieve their perfect prices with maximum efficiency.

There are a number of gigantic problems with that worldview, of course. The free market refuses to pay for a wide variety of crucial infrastructure items and investments in public health and safety; consumers are at an information and power disadvantage against unscrupulous companies; and human life and dignity are unacceptably cheap on the open market.

But there’s another key lie in the conservative “natural economy” story, which is that modern corporate capitalism is anything but natural. It’s an artificial system encoded arbitrarily into law and interpreted in a specific way that tends to give maximum advantage to executive and shareholders at the expense of society. Kent Greenfield examined right here at Washington Monthly one way in which that is true: the Dodge v. Ford case that explicitly denied corporations the right to engage in more socialistic practices and demanded that they only serve the bottom line for their shareholders. The corporate veil itself another artificial legal construct, as is the notion of corporate personhood.

Our society is built on rules and regulations, all of them socially and legally built out of artifice. That is just as equally true of business as it is of government.

 

By: David Atkins, Political Animal Blog, The Washington Monthly, January 24, 2015

January 25, 2015 Posted by | Capitalism, Corporations, Free Markets | , , , , , | 1 Comment

“Hypocrite Alert!”: Republicans Believe In The Power Of The Free Market—Except In Cuba, Apparently

On Thursday, the White House announced that Alan Gross and an unnamed Amercan spy would be released from Cuba in exchange for three Cuban spies. President Barack Obama, who campaigned on normalizing relations with Cuba in 2008, has described Gross’s captivity as one of the main impediments to negotiations with Cuba. Speaking from the White House shortly after Gross’s release, Obama described plans to re-establish diplomatic relations, open an embassy in Havana, and ease travel and trade restrictions.

“It is clear that decades of U.S. isolation of Cuba have failed to accomplish our enduring objective of promoting the emergence of a democratic, prosperous, and stable Cuba,” said Obama. “We cannot keep doing the same thing and expect a different result. It does not serve America’s interests, or the Cuban people, to try to push Cuba toward collapse.”

Republican presidential hopeful Senator Marco Rubio, a strong believer in the democratic power of free trade, nonetheless denounced Obama’s decision. “Barack Obama is the worst negotiator that we’ve had as president since at least Jimmy Carter, and maybe in the history of this country,” he told Fox News Wednesday morning. “It’s absurd and it’s part of a long record of coddling dictators and tyrants that this administration has established.”

Earlier this month, Jeb Bush told a gathering of the U.S.-Cuba Democracy PAC, “I would argue that instead of lifting the embargo we should consider strengthening it again to put pressure on the Cuban regime.” Bush, who essentially announced on Tuesday that he’s running for president, has not yet commented on the White House’s policy shift.

Opponents of normalizing relations with Cuba say easing sanctions rewards a dictatorial regime that oppresses its people. However, this notion flies in direct contradiction with the theory that free markets breed democratic institutions. While there are obvious limitations to the democratizing effects of capitalism, the Republican Party has long touted itself as the vanguard of free-trade economics.

For several decades, America’s policy has been to funnel money into democracy promotion efforts in Cuba that have no proven efficacy (and endanger the lives of the Americans implementing the projects). In 2009, The Council on Hemispheric Affairs estimated that the U.S. had spent half a billion dollars over the past 20 years enforcing blockade restrictions and broadcasting pro-democracy messages on Cuban radio and TV stations (which were often blocked by the Cuban government).

There is no precedent for setting full democratic reform as a precondition to economic relations. Since 2011, Raul Castro has implemented 250 economic reforms modeled after the system in Communist China. In the 1970s, the U.S. normalized trade relations with China, Romania, Czechoslovakia, and Hungary after they took similar steps to implement preliminary economic reform. Even after economic normalization, the U.S. continued to pressure these countries to improve their human rights practices. As Obama said, “We know from hard-learned experience that it is better to encourage and support reform than to impose policies that will render a country a failed state.”

 

By: Jessica Schulberg, The New Republic, December 17, 2014

December 20, 2014 Posted by | Cuba, Free Markets, Marco Rubio | , , , , , , | 1 Comment

   

%d bloggers like this: