What A Government Shutdown Could Cost Us
I don’t want to start a market panic here. I’ve no desire to be known for “The Klein Crash of 2011.” But it’s safe to say that much of Washington finds the low, low yields on Treasurys — which represent the market’s serene confidence that the U.S. can handle its debts — a little baffling. Senior government officials have told me they think Treasurys are probably a bit overpriced, which is a bit like the executives of GE privately wondering why investors are so sure they won’t go bankrupt. The investors might be right, but it’s not comforting to hear.
The market isn’t totally wrong, of course. The federal government probably won’t default on its debt. But it’s actually pretty hard to explain how we get the spending line and the revenues line to match each other. And we have a really dysfunctional political system. We’ll figure it out somehow. We always do. But our low borrowing costs are an advantage we want to preserve for as long as possible. That means keeping the market from realizing that partisan polarization mixed with our weird legislative system makes insane outcomes easily imaginable.
This is why a shutdown would be so dangerous. A last-minute deal tells the market that America is a country that dithers and procrastinates and anguishes but eventually makes the necessary decisions to avert terrible consequences. We can be trusted to follow through, even if only at the last minute. A shutdown tells the market that our political system has become so dysfunctional that we actually can’t be trusted.
Asger Lau Andersen, David Dreyer Lassen and Lasse Holbøll Westh Nielsen — remember them? — have looked into how the market treats late budgets in the states — and late budgets in the states, it should be noted, are considerably less public and psychologically disruptive than a shutdown of the federal government during a weak economy. The answer is: not kindly (pdf). “We estimate that a budget delay of 30 days has a long run impact on the yield spread between 2 and 10 basis points,” they conclude. To put that in context, economists estimated that if the Federal Reserve pumped $400 billion into the economy, it’d lower yield spreads by about 20 basis points, or two-tenths of a percent. And it actually gets worse than that: “Markets also punish late budgets much more harshly if they occur during times of fiscal stress.”
I think it’d be fair to characterize this as a time of fiscal stress, don’t you?
There are some reasons for optimism here. Markets seem to punish fiscal mismanagement more lightly if the state has access to lots of money, which usually means reserves. The federal government has access to lots of money — though through borrowing, not reserves — so it’s possible we’d get off lightly, too. If you look back to Treasury yields in 1995, you don’t see an obvious change, but (a) perhaps yields would have been lower without the shutdown and (b) the economy is a lot weaker today than it was in 1995. At any rate, do we really want to test this? And if so, how many times? The tea party types are already promising to oppose an increase in the debt ceiling in the absence of massive entitlement cuts. Sen. Marco Rubio says he’ll oppose lifting the debt ceiling unless it’s accompanied by “a plan for fundamental tax reform, an overhaul of our regulatory structure, a cut to discretionary spending, a balanced-budget amendment, and reforms to save Social Security, Medicare and Medicaid.” That’s quite a list of demands in order to avoid economic catastrophe.
The irony of all this comes clear if you consider why we’re afraid of deficits in the first place. If the market comes to believe our debt is too large for our political system to pay back, they’ll become more skittish about buying government debt, and that’ll send interest rates higher and the economy lower. But if we have a series of shutdowns while we argue over how much to cut and how fast, our paralysis will convince the market we can’t get our act together in time to pay off our debts and they’ll send interest rates skyrocketing anyway. We’ll have caused exactly what we sought to prevent, and done it now, when the economy is weak, rather than later, when the economy is stronger. As I said at the beginning of this piece, I’d sure hate to be known for causing an economic crash. How about you, Congress?
By: Ezra Klein, The Washington Post, March 30, 2011
After Medicare Fraud, What’s Next?: Florida Gov Rick Scott’s Extremely Profitable Policy Proposal
Florida Gov. Rick Scott is one of the most entertainingly shameless figures in American political life. In the 1990s, Scott headed Columbia/HCA Healthcare, the largest for-profit hospital in America. While Scott was running Columbia/HCA Healthcare, it got involved in a bit — okay, a lot — of fraud. As Forbes reported, the company “increased Medicare billings by exaggerating the seriousness of the illnesses they were treating. It also granted doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. In addition, it gave doctors ‘loans’ that were never expected to be paid back, free rent, free office furniture, and free drugs from hospital pharmacies.”
The scale of the fraud was so immense that Columbia/HCA Healthcare ended up paying more than $2 billion (PDF) back to the federal government in the single largest fraud case in history. (The previous record holder? Drexel Burnham.) Scott resigned shortly before the judgment came down.
Today, Scott is enjoying a second act as governor of Florida. And, as Suzy Khimm reports, he doesn’t seem all that chastened. Before running for office, he turned his $62 million stake in Solantic, the urgent-care clinic chain he founded after resigning from Columbia/HCA Healthcare, over to a trust in his wife’s name. Solantic doesn’t take traditional Medicaid, but it does work with the private HMOs that, under a 2005 pilot program, were allowed to contract with Medicaid. And Scott is now pushing a bill that would expand that program across the state making those HMOs — the ones Solantic works with — the norm for Medicaid.
Asked about the apparent conflict of interest, Scott said, “If you look at everything that I want to accomplish in health care in Florida is basically what I’ve believed all my life. I believe in the principle that if you have more competition it will drive down the prices.” And I believe him. But he could have sold his stake in Solantic when he got into government. Since he didn’t, the fact remains that Scott is pushing a policy his family stands to profit from immensely . Which is, for Scott, real progress. In the 1990s, he made his money off single-payer health-care programs by cheating them. Today, he’s making his money off single-payer health-care programs by running them. No matter how you look at it, it’s a step up.
By: Ezra Klein, The Washington Post, March 25, 2011
Tea Party Extremism Run Amok
The success of the Tea Party movement and legitimate concern over the size of the deficit raise a serious question: What does it mean to promote small government?
The pious commitment to keeping big government out of people’s lives—or championing local control—was a common theme among Republican candidates last election season, particularly among those who professed sympathies for the Tea Party element. But local control and small government sound remarkably like pure lawlessness, as Dana Milbank brilliantly reports in Wednesday’s Washington Post.
Milbank—often amusing, always readable—with this most recent and very well-reported column, an absolute must-read, chronicles some of the anti-federal-authority efforts by state legislators:
When Louis Brandeis called state legislatures “laboratories of democracy,” he couldn’t have imagined the curious formulas the Tea Party chemists would be mixing in 2011, including: a bill just passed by the Utah legislature requiring the state to recognize gold and silver as legal tender; a Montana bill declaring global warming “beneficial to the welfare and business climate of Montana”; a plan in Georgia to abolish driver’s licenses because licensing violates the “inalienable right” to drive; legislation in South Dakota that would require every adult to buy a gun; and the Kentucky legislature’s effort to create a “sanctuary state” for coal, safe from environmental laws.
U.S. News’s own Robert Schlesinger also recently questioned the mental stability of some of these local lawmakers.
Setting aside the pure absurdity of some of those ideas, the philosophical underpinnings are pretty disturbing. Where did these local officials get the idea that any community standard—be it a proven ability to make a left turn (if not parallel park) or to avoid poisoning the environment for generations who might come after us—is some egregious infringement on their own rights?
If the anti-big-government, local-control camp wants to prove its sincerity, it can help out right here in the District of Columbia. Still the last place in the country where citizens are denied the right to full representation in Congress, the nation’s capital is again experiencing attempts by members of Congress to make decisions about school vouchers and other matters. The same lawmakers who say they want the federal government to have less control over people’s lives are using Washington as Congress’s personal lab rat. If they really believe in local control, the lawmakers will let the city of Washington alone.
By: Susan Milligan, U.S. News and World Report, March 16, 2011
Government by the Week: Is A Government Shutdown The End-Game For The GOP?
Parents have begun arranging alternative child care for their preschoolers, uncertain of whether their Head Start program will be there when they need it. The Social Security Administration is unable to open new hearing offices to handle a backlog of appeals. The Pentagon has had to delay equipment repairs. There is chaos throughout the federal government, as Robert Pear reported in The Times on Tuesday, because a riven Congress has forced agencies to operate on a week-by-week basis.
Yet, on Tuesday, the House passed another short-term spending bill. This one keeps things going for all of three weeks. The Senate will almost certainly join in shortly to avoid an impending shutdown on Friday, the result of the stopgap bill from two weeks ago.
These slipshod exercises in governance were choreographed by House Republicans, who knew that neither the Senate nor President Obama would ever accept their original proposal to gut nonsecurity discretionary spending with $61 billion in cuts through September, including riders to end financing for Planned Parenthood and the health care law. They had hoped to use the pressure of a potential shutdown to achieve much of their goal, but, so far, all they have accomplished is a cut of about $10 billion, mostly from earmarks or programs that the president himself proposed to cut. (The new bill cuts $6 billion.)
House Republican leaders, who say they do not want a government shutdown, have, so far, held off their more fanatical freshmen, who want to slash everything in sight. But the leadership cannot do so forever, and the evidence of that was clear on Tuesday. More than 50 Republicans refused to go along with the three-week resolution because it did not cut enough. Several specifically complained that it allowed financing for Planned Parenthood and the health care law to continue.
This is not a group that cares much for pragmatic compromise, and the three weeks are just a timeout. Representative Mike Pence of Indiana, a Republican who voted no on the new bill, spoke for many of his colleagues when he said the budget could not be resolved without a willingness to shut down government. “By giving liberals in the Senate another three weeks of negotiations,” he said, “we will only delay a confrontation that must come.”
He is absolutely right about that. If Democrats, including the president, do not draw a clear line soon, making their priorities and their limits unmistakable, they will be harried by these kinds of votes for years. Even in the unlikely case that an agreement is reached in three weeks to finance the government through September, a different vote will be necessary just a few weeks from now to raise the debt ceiling. Republicans have already vowed to vote that down — even though it could be financially disastrous — if they do not get their way. And then there is the vote for the fiscal 2012 budget, which begins Oct. 1, and then the year after that.
At some point, Mr. Pence will get his confrontation. If Republicans continue to press for cuts of tens of billions from discretionary spending, setting back the economic recovery largely for ideological purposes, Democrats will have to say no, even if that results in a short-term shutdown. The American people will be able to figure out who is at fault. Responsible governing means agreeing quickly to a deal to finish out the fiscal year, and then starting a serious talk about entitlement programs and taxes — the real causes of a soaring deficit.
By: The New York Times, Editorial, March 15, 2011
The GOP’s Health Policy Cynics
The health care community is discovering to its shock and dismay that it’s not simply traditional Republican conservatives who have taken control of the House of Representatives, it’s a new group of cynics.
Conservatives, like liberals, have a more-or-less coherent set of ideas. They use political power to push preferred policies, whether related to health care, housing or a hundred other possible issues. William F. Buckley Jr., one of the fathers of modern American conservatism, “had a way of … making conservatism a holistic view of life not narrowed to the playing fields of ideology alone,” as one admirer put it.
Although cynics may claim conservative credentials, their view of government is really nothing more than a quarrel about its cost. It brings to mind Oscar Wilde’s immortal phrase, “The cynic knows the price of everything and the value of nothing.”
The contrast between the two viewpoints was on stark display at two recent marquée meetings, AcademyHealth’s yearly policy conference and the sprawling Health Information and Management Systems Society — HIMSS – Health IT Conference and Exhibition.
AcademyHealth’s “Running of the Wonks” (my term, not theirs) is a magnet for researchers and policy mavens who are inured by long experience to most political rhetoric. Yet at the general session featuring a bipartisan dialogue among congressional staffers, the harsh rhetoric from the GOP participants stunned the crowd. The new federal health law, it seemed, was evil incarnate, and the rhetoric of “repeal and replace” was wielded with a fundamentalist zeal.
“The bureaucracies that administer ObamaCare” must be cut, declared one aide to a powerful congressional leader, setting the tone. And in case anyone didn’t get the point, the word “ObamaCare” was deliberately repeated every few syllables in a tone of disdain combined with wonder at how such a monstrosity had ever come to be. (AcademyHealth meeting rules said the staffers could not be quoted by name.)
The audience of wonks quailed, then quietly queued up for the question-and-answer period. They knew, after all, that the health law’s fine print incorporates a generous helping of initiatives championed by both conservatives, and those on the left. Besides, these were staffers speaking, not politicians playing to the press. Surely, gentle reason would triumph. Alas, it was not to be.
The Prevention and Public Health Fund? “You mean, the prevention health slush fund, as we like to refer to it?” replied a GOP staffer.
The Innovation Center at the Centers for Medicare & Medicaid Services? “An innovation center at CMS is an oxymoron,” responded a Republican aide, before adding a personal barb aimed at the attendees: “Though it’s great for PhDs who come to Washington on the government tab.”
There was also no reason the government should pay for “so-called comparative effectiveness research,” another said.
“Everything’s on the chopping block,” said yet another.
Everything? At HIMSS, where GOP staffers also spoke, attendees were chagrined to learn that “everything” applied to them, too. The subsidies for health information technology that were part of the American Recovery and Reinvestment Act were targeted in legislation introduced in late January by Rep. Jim Jordan, R-Ohio, chairman of the Republican Study Group. His bill would repeal this funding and eliminate all remaining stimulus spending, including about $45 billion in unspent health IT funds.
Those focused on the substance of health policy might be forgiven for feeling blindsided. After all, the McCain-Palin health policy platform in the 2008 presidential election called for coordinated care, greater use of health information technology and a focus on Medicare payment for value, not volume. Once-and-future Republican presidential candidates such as former governors Mike Huckabee (Ark.), Mitt Romney (Mass.) and Tim Pawlenty (Minn.), as well as ex-Speaker of the House Newt Gingrich, have long promoted disease prevention, a more innovative federal government and increased use of information technology. Indeed, federal health IT “meaningful use” requirements can even be seen as a direct consequence of Gingrich’s popularization of the phrase, “Paper kills.”
Ah, but that was back before the Republican cynics swept into power. It was back before traditional GOP conservatives — worried that any suggestions outside a single-minded focus on slashing spending would be seen as disloyal — eschewed ideas in favor of ideological declarations.
This column was filed just days after a two-week compromise was signed into law to avoid a federal government shutdown. It allowed funding for health reform to continue, but instituted other budget cuts. Obviously, the cynics yielded a bit, at least for the moment, to the conservatives, and the liberals and centrists have given ground to both.
Still, one wonders what the urbane Buckley would think of a movement that seems intent on ignoring the real-world context of its actions. Buckley launched his lifetime crusade against liberalism with God and Man at Yale, a book that took aim at the academics who’d taught him as an Ivy League undergraduate. Alas, the GOP cynics are cocooned instead in an underground bunker of their own design, as impervious to realities they’d prefer to ignore as the ivory tower academics they’ve come to scorn.
By: Michael Millenson, The Health Care Blog, March 9, 2011. Post Originally appeared in Kaiser Health News.
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