US children’s health insurance bill nearer…to veto

An update on this story. Back then (about a fortnight. Americans, that’s two weeks), the news was that the White House was threatening to veto planned legislation that would provide health insurance to around 4.1m uninsured American children – more or less so that the access and outcomes of the children in the richest nation on Earth would maybe catch up to the rest of us in the OECD.

In response, the Senate went ahead and passed the bill.

A proposed expansion of government-funded healthcare for children was poised for approval by the US Senate on Thursday, in spite of a threat by President George W. Bush to veto it.

The bill would give 3m more lower-income children access to the decade-old State Children’s Health Insurance Programme (SCHIP), representing the most ambitious domestic healthcare proposal by Congress for years.

(a) somewhere, there, the number of children affected has changed; (b) it can’t be hard to be “the most ambitious domestic healthcare proposal by Congress for years” – not that I’m knocking the effort. Just every lack of effort until now.

When I first wrote about it, it was relative to the cost: specifically that, if you didn’t give sick little kids adequate treatment, they became sick adults, required a hell of a lot more care. They don’t earn much lifetime income, they aren’t productive. They probably die before using much social security, but they won’t contribute very much to it and they’ll use a hell of a lot of Medicaid before then anyway. My point is, it costs more – you ever hear of an ounce of prevention being worth a pound of cure? It’s true – that’s why drug companies sell neither preventions nor, where they can help it, cures. Because those are worth a tonne of palliative treatment. Just ask Chris Rock (that’s a Bigger and Blacker reference).

New argument, then: socialised medicine is choiceless – like communism:

But Mr Bush and other Republican critics have condemned the measure as the start of a broader push by Democrats to expand “socialised medicine” in the US.

“Their goal is to take incremental steps down the path to government-run healthcare for every American,” said Mr Bush recently. “It’s the wrong path for our nation. Government-run healthcare would deprive Americans of the choice and competition that comes from the private market.”

Two things, both very important. George Bush, lazy C-average scion of bone-idle capital-w Wealth, would not know what “deprived of choice” even means. As I said in an earlier post, this is a man who hears of a woman working three jobs, and thinks she’s marvellous. His mother sees poor people on army cots in the Astrodome and thinks it’s working out well for them. The President will not familiar with, say, your insurer offering the choice between one specific provider of their choosing or no provider at all. He will not be familiar with a choice between medication for your daughter’s asthma or the rent.

I have at least a couple of colleagues who are not sympathetic to this – this is fine. I’m from a social-welfarist country, Americans are not (Americans are misled throughout childhood and onwards, but that’s another matter). Here, then, is the second thing: when Bush, those ‘other republicans’ or any other dip-shit insists that socialised medicine offers you no choice, or is anti-free market, they are lying to you.

First example: my country. Australia has universal health insurance, funded out of general taxation (i.e. not by a specific tax, although there is a surchage on higher incomes). I’ll return to this. We also have: public hospitals, that treat you for free; private health insurance; private hospitals, that get some money from the government, some money from your private health insurance, and money from you, if they want; we have subsided medicine (our Pharmaceutical Benefits Scheme is generally acknowledged as the world’s best. The US’s original Medicare D is consider the dumbest); we have non-subsidised medicine. And if you consider our statistics ex-indigenous, our health outcomes are among the best, as is our quality of care and of life. But, then, so are our education outcomes.

I say ex-indiginous because their circumstances are the result not of health policy, but deliberately racist ones – whichever country you are in, I invite you to send a letter to the nearest Australian embassy, expressing your disgust at my government.

For other versions of the first example, you can look at just about any European country. Second example, Medicare and Medicaid in the US. Once Medicare D is made to make some bloody sense, it too. Specific to which, consider the legislation for the same, the one for which debate was held up for hours while Tom DeLay could earn a rare ethics back-hand, beating and bribing support out of legislators. For legislation which, ultimately, reduced choice because of corrupt concessions to the private market.

The key is the old Republican trick: harp on and on about how bad government is at managing things. It is – when they’re in charge. Put people with brains and a sense of civic duty, rather than fund-raising, in charge, and you’d be amazed at what a government can manage. PhRMA’s interests are not your interests. They’re consistenly the most profitable industry (oil might be, now) – do you honestly think they got that way by offering you choices, for your own good?

Returning to money. As I’ve said, the whole point of insurance for children is that (a) bad things shouldn’t happen to animals or children (fuck you, Ted Nugent), but more relevant to this (b) it’s cheaper for us, as a society, to treat them while they’re young and make them strong, and benefit from that later when they learn, work, make money and pay taxes, not need welfare.

Relative to the cost to you: if there’s one thing that gets on the tits of health economists of my ilk (i.e. non-American, for the most part), it’s the hackneyed old WSJ canard that you can’t afford public health care. I will stack, any day, the tax burden in my country, in Britain, in South Africa, in Holland, you name it, against the private health insurance premia that you pay. And in Australia, health insurance is community-rated. You, there, with the history of sickle-cell, or breast cancer, who can’t even get insurance in the US? You can in Australia! And for the same price as me. Or, don’t, just use public hospitals. You will pay less in taxes, because Medicare, or the NHS, or any other ’socialised medicine’ sector doesn’t need to keep profits competitive – it doesn’t even need to make profits exist.

So. If moving from the profit motive and K-street to the Hippocratic oath and good government is going to send Americans under when the rest of us prosper in good health, explain these to me:

To the extent that more of your taxes are even needed:

Report card for America’s infrastructure

Subtitle:

Long commutes.
Dirty Water.
Delayed flights.
Failing Dams.

With each passing day, aging and overburdened infrastructure threatens the economy and quality of life in every state, city and town in the nation.

That’s from the American Society of Civil Engineers. Former students will recognise this complaint from the days of the Highway Bill, USD275b, as pork-laden as one could imagine a single piece of legislation being and ultimately doing bugger-all for anything. It was the usual combination of media vacuity, Republican conservatism and Democratic spinelessness, so we got gay marriage and Terry Schiavo, instead of Government.

We’ve seen what has happened routinely, since: the levees in New Orleans, a steam pipe in New York (built in 1924 and hardly repaired since). I found this “report card” via the blog Management IQ, over at Business Week, and it comes in response to the bridge collapes – relatively minor, really, on the scales of Failed Infrastructure, but man did the news howler monkeys need something (and get it. It’s everywhere).

It might seem silly to blame Republican-model conservatism: those steam pipes sat un-invested-in through Democratic and Republican governments, in all combinations and at all levels, and still they sat there. It isn’t a Republican thing, per se, so much as an ongoing matter of fact. George Monbiot, in his book Captive State, wrote a lot about it, through Tories and New Labour, in Britain.

Nearer to the US, Emily Thornton wrote about the issue in Business Week only recently:

Roads To Riches

Why investors are clamoring to take over America’s highways, bridges, and airports—and why the public should be nervous

…

In the past year, banks and private investment firms have fallen in love with public infrastructure. They’re smitten by the rich cash flows that roads, bridges, airports, parking garages, and shipping ports generate—and the monopolistic advantages that keep those cash flows as steady as a beating heart. Firms are so enamored, in fact, that they’re beginning to consider infrastructure a brand new asset class in itself.

With state and local leaders scrambling for cash to solve short-term fiscal problems, the conditions are ripe for an unprecedented burst of buying and selling. All told, some $100 billion worth of public property could change hands in the next two years, up from less than $7 billion over the past two years; a lease for the Pennsylvania Turnpike could go for more than $30 billion all by itself. “There’s a lot of value trapped in these assets,” says Mark Florian, head of North American infrastructure banking at Goldman, Sachs & Co (GS).

There are some advantages to private control of roads, utilities, lotteries, parking garages, water systems, airports, and other properties. To pay for upkeep, private firms can raise rates at the tollbooth without fear of being penalized in the voting booth. Privateers are also freer to experiment with ideas like peak pricing, a market-based approach to relieving traffic jams. And governments are making use of the cash they’re pulling in—balancing budgets, retiring debt, investing in social programs, and on and on.

But are investors getting an even better deal? It’s a question with major policy implications as governments relinquish control of major public assets for years to come. The aggressive toll hikes embedded in deals all but guarantee pain for lower-income citizens—and enormous profits for the buyers. For example, the investors in the $3.8 billion deal for the Indiana Toll Road, struck in 2006, could break even in year 15 of the 75-year lease, on the way to reaping as much as $21 billion in profits, estimates Merrill Lynch & Co. (MER) What’s more, some public interest groups complain that the revenue from the higher tolls inflicted on all citizens will benefit only a handful of private investors, not the commonweal (see BusinessWeek.com, 4/27/07, “A Golden Gate for Investors“).

There’s also reason to worry about the quality of service on deals that can span 100 years. The newly private toll roads are being managed well now, but owners could sell them to other parties that might not operate them as capably in the future. Already, the experience outside of toll roads has been mixed: The Atlanta city water system, for example, was so poorly managed by private owners that the government reclaimed it.

It’s a pretty good piece, detailing the few neat characteristics of investing privately in public infrastructure. It is extremely low-risk, with a captive market. That captivity being one of the problems, as Sydneysiders discovered with the cross-city tunnel, for example. Every country, every city will, by now, have a local variant of the same theme.

The other problem, as the highway bill, New Orleans levees, New York steam pipes, etc. bring out every now and then, is that there is little incentive to invest in proper infrastructural upkeep – even by government, still less by private managers. Only recently the Metronet story demonstrates the pitfalls of even going halfsies, and letting the government keep responsibility, supposedly, of the infrastructure.

If you’ve read this blog at all, or if you sift through the privatisation stories, you’ll notice that I am not, at all, a fan, but the US makes a very distinct example. Since the early days of FDR and the freezing-out of the Republicans, they have deliberately taken the country back from the bottom-up: comptroller, state houses and finally gerrymandering whatever they’d missed, once they had Congress and the Senate (thank you, Gingrich revolution). Anyone the least bit left heard this in any grassroots/Daily Kos stories at the last election.

Along the way, the (mostly) Republican brand of conservatism (for Gingrich and Vitter types, read: impeach Clinton while nailing everything-that-moves-and-isn’t-their-wife) contributed greatly to this problem: underinvestment in schools, highways, hospitals, telecommunications, you name it (again, Democrats and the media take their place in the blame, either as good people who did nothing or, like Jack Murtha as a well-known case, as bad as anyone else in the house). Privatisation followed the Grover Norquist school of drowning government in a bathtub, i.e. starving State and local treasuries of funds. Lack of proper oversight meant that, once private, little was done to ensure that private money was in fact going to maintenance.

This is another moral hazard problem. If you bought a highway, motorway, bridge, tunnel, rail network or so forth, where is your incentive to actually maintain it properly? If proper oversight doesn’t force you to, fine you, take your property away, then there is no risk there. In the event of a disaster the government will be needed anyway because of the scale – so why bother?

This is the problem, and what makes the US a great example. The government does not invest anything like at the required level, because pork and highways to bloody nowhere in Alaska are too important (if they did, the National Guard would have had its equipment replaced, not blown to shit in a desert in Iraq and left in pieces). Once privatised, infrastructure is still not properly maintained. In fact it, like the steam pipes in New York, effectively disappear, until they blow up in our faces.

This brings us back to the American Society of Civil Engineers, who tell us, consistently in fact, that more than 27% of the country’s bridges are “structurally deficient or functionally obsolete.” Or that “$1.6 trillion is needed over a five-year period to bring the nation’s infrastructure to a good condition.” Their ‘Action Plan’ can be found here. It’s worth going through.

In a conversation with a colleague about the ability of the US to protect/repair its way out of whatever will happen with climate change, he insisted I not use New Orleans as an example for my side – because it is poor and nobody gives a shit about it. I agree, to an extent, just as I agree with the assessment of Kanye West, to an extent (in that it isn’t so much that Bush doesn’t like black people, he just doesn’t understand poverty. When he refers to a woman working three jobs and says it’s great, or points to a war veteran and says he’ll get him some new legs. He clearly has no empathy or imagination whatsoever). If Manhattan fell to an earthquake or a tsunami or cyclone, then we’d be able to really judge.

It is, though, an example of a critical problem with governance. Senators, for example, are concerned with their own states. The money to properly fortify levees in New Orleans will be assigned not based on general recognition of that need, but the outcome of horse-trading, during which other states will get money they do not need. That is not government, that is politics. Privatisation and under-investment in public infrastructure is not government, it is business. At some point (some point before the disasters) we need government.

If you can’t believe the American Society of Civil Engineers, who can you believe? Economics students, join in with the most obvious rebuttal (Jason, if you’re reading this, no coaching). I’ll give you a hint: it is called the Agency Problem.

There are no recoveries on your stock market

I recommend to the media the words tumultuous and volatility:

A volatile Australian share market staged a recovery today despite continuing uncertainty among investors about the extent of the trouble on Wall Street.

Never mind, they have those. They just do not understand their meaning. The Australian share market cannot ’stage a recovery’ in periods of volatility. Just like the US share market cannot. Bloomberg’s third day of stocks advancing is fine – leaves plenty fo scope for retreat, tomorrow. Amongst other things, there are no signals that the volatility will either Bear – or Bull – itself into some stability anytime soon.

As luck would have it, nobody in ‘the media’ even knows I exist, and clearly nobody closer to them than me has whispered, into their ear, “stop that. It’s annoying.”

Here’s is the stock market (courtesy of the Big Picture and with apologies to the artist, whom I do not know):