Weekly Briefing

Enough is enough

WB-Wake-up

If these proposals don’t move you to action, nothing will

Last week in this space we looked at what has become one of the defining divides between modern conservatives and progressives: their competing views of the relationship between citizens and government.

For conservatives, the relationship between government and citizens (like everything else) is chiefly a no nonsense economic transaction. In this worldview, government is an ill-defined “them” from which Americans should seek the best possible “customer service” at the lowest possible price. Similarly, as with shoppers competing for the best bargain at the mall, the relationship between “customers” is competitive; when someone else obtains a government “benefit” that is not provided to me, I have a right to feel wronged or, at the least, covetous.

For progressives, the relationship is very different. They tend to view it as one in which stakeholders relate to structures and services that they co-own with their neighbors. Government is not a “them” but an “us” that we all invest in so as to promote a society in which all citizens can enjoy freedom and have a good chance to thrive. While progressives strongly oppose corruption, dishonesty and inefficiency, they do not automatically view their neighbors and fellow citizens as competitors for government goodies or resist the notion that different citizens bring different real and legitimate needs to their relationship with government.

The practical implications of these competing worldviews have been on public display for some time now at the national, state and local levels. Recently, however, two examples from Washington and Raleigh really capture the essence of how this divide is playing out. They also show how absurd the results can get when ideology blinds conservatives to simple common sense and human decency.

Medicaid and pregnant women

Example #1 is a provision inserted into the Senate version of the state budget to alter eligibility of pregnant women for Medicaid — the state health insurance program for low-income people. Here’s how Tom Vitaglione, Senior Fellow for Health and Safety at the advocacy group Action for Children, described the program in a recent article:

In 1988, North Carolina had the worst infant mortality rate in the nation, losing almost 13 babies for each 1,000 born. Recently, a News and Observer article cited a federal report indicating that North Carolina’s infant mortality rate in 2011 had dropped to 7.2 per 1000. Our state was lauded for having one of the largest rate decreases in the past five years. Not mentioned was that our rate has dropped by an incredible 43% in the 23 years since we were worst in the nation 

This remarkable success story is not happenstance. It began with a concerted bi-partisan effort, led by Governor Jim Martin, including investments in health education and medical care, many of which are still in place. Perhaps the most important contribution was the expansion of Medicaid coverage to pregnant women and infants in families with incomes up to 185% of the federal poverty level. This meant that all low-income pregnant women (about half of all pregnant women in North Carolina) and their infants would have access to the wonderful advances in prenatal  and neonatal care that were being introduced at that time. And all of this was complemented by health education and home visiting targeted to this group of women at greatest risk for adverse pregnancy outcomes.” (Emphasis supplied).

Amazingly however, as Adam Linker of the North Carolina Justice Center’s health policy team explained in a recent post on The Progressive Pulse blog:

The legislature is now set to roll back that progress. One of the Senate budget provisions moves Medicaid eligibility for pregnant women down from 185 percent of federal poverty level to 133 percent of federal poverty level (about $15,000 in annual income). The rest of the provision is a poorly constructed attempt to provide political cover for this mean spirited move.”

As Linker explains, the rather stunning move would affirmatively kick thousands of pregnant women off of the program by significantly lowering the income threshold that confers eligibility. A woman trying to get by on, say, $17,000 per year would now be forced to spend thousands per year on health coverage.

Mind you, North Carolina’s program is far from generous. Even under the current rules, eligibility ends 60 days after the child is born. As Vitaglione notes:

This is why there has been such excitement in the medical and advocacy communities regarding the possibility of Medicaid expansion (under the Affordable Care Act) to adults up to 138% of the federal poverty level. This would mean that hundreds of thousands of women nationally (and tens of thousands in our state) would have access to care that would not only improve the health of women, but also improve the outcomes of their pregnancies.”

But, of course, not only are lawmakers not expanding Medicaid, right now they are seriously considering constricting it.

The war on Food Stamps

Sadly, the examples of such convoluted and ideologically-driven attacks on essential public safety net programs are not confined to North Carolina. The U.S. House of Representatives is currently advancing a proposal to slash spending on the nation’s SNAP program (aka “Food Stamps”) by $21 billion over the next decade. This would result in the removal of two million people (most of them working families with children and senior citizens) from the program. It would also end free school lunches for 210,000 children and some people would lose the benefits because they own a modest car – something many of them need to get to work. You can read all the gory details in this brief report from the Center on Budget and Policy Priorities.

As Nobel prize–winning economist Paul Krugman explained last week in the New York Times, this would be a painful and downright absurd disaster. Moreover, it may not be the end of the assault. House Budget leader and former Vice Presidential nominee Paul Ryan wants to further limit SNAP by making it a “block grant” that would simply allot a finite pool of dollars to the states each year – regardless of the economy or the demand for the program.

As Krugman, also notes, the rationale for the decision (to reduce costs for taxpayers and to prevent citizens from becoming “dependent” on the government) reflects the current ideological orientation of the conservative movement. Just as with the move to limit Medicaid for low-income pregnant women, the right is willing to slash a program targeted at the some of the nation’s most vulnerable and sympathetic citizens in the name of limiting taxes on some and preventing access to government goodies for others.

Krugman also offers this powerful retort:

Look, I understand the supposed rationale: We’re becoming a nation of takers, and doing stuff like feeding poor children and giving them adequate health care are just creating a culture of dependency — and that culture of dependency, not runaway bankers, somehow caused our economic crisis.

But I wonder whether even Republicans really believe that story — or at least are confident enough in their diagnosis to justify policies that more or less literally take food from the mouths of hungry children. As I said, there are times when cynicism just doesn’t cut it; this is a time to get really, really angry.”

Going forward

Of course, Krugman is right. Whether conservatives actually believe that what they are doing will be beneficial to the supposedly dependent people they hope to cut off (or, as seems more likely, the moves are simply driven by the hard economics of competition for government goodies), both explanations fall short. And both also show that now is clearly the time for progressives to fight back energetically for a healthier and more humane vision of the relationship between citizens and their government.