The powerful and the powerless in hard fiscal times

I recently had a 12:30 meeting at a Chicago clinic. Rather than getting stuck in traffic, I walked down to 63rd street and caught the Green Line. The L meandered across the south and west sides, past vacant lots littered with the usual detritus of low-income urban life. My fellow passengers included a fair number of boisterous teenage boys. They didn’t bother anyone. They were just being loud and adolescent, but many nearby adults would have been happier to see those youth hired to do something more useful than goofing with their friends. This might have happened, too, had Congress come through with a better jobs bill.

Last month, I attended a meeting with leaders of local government, criminal justice systems, and nonprofit agencies concerned with youth violence. Judges, police, correctional officials, social workers, and young people themselves will tell you that a job is one of the best things we can do to keep kids out of trouble. It gives youth a place to be, something worthwhile to do, and a little money in their pocket which can only reduce the lure of other things.

The job numbers for youth are terrible right now. Cities and states don’t have the money to pick up the slack. We were hoping for more money from the federal government through a jobs bill and some other things that didn’t come through. Across the nation, youth are applying to summer job programs that can hire a fraction of those looking for work. Many of these same kids go to schools facing punishing budget cuts. To give one small example, kids are losing JV and other sports opportunities at the very moment politicians rail about the growing problem of child obesity.

This morning’s Times includes a beautifully reported story by Kevin Sack about state AIDS Drug Assistance Programs. For the first time in years, many programs are capping enrollment, establishing waiting lists, or limiting medications for people living with HIV and AIDS. States, under great fiscal pressure, are cutting many health programs. Senators are bickering about whether to ship some TARP or stimulus funds over to ADAP. Everyone seems to feel badly, but no resolution has been found.

Then I read that the United States Senate could not find 60 votes to extend unemployment benefits to two million people. Congress also failed to extend Medicaid support to states that are therefore making deep cuts in dental care and other related services. “Concern about the federal deficit” is the most commonly cited reason. The budget really is tight. Programs will be cut; constituencies are bound to be disappointed.

Not everyone will be equally disappointed, however. Today’s paper contains two other stories showing sunnier outcomes for specific groups. For example, large banks won a reprieve (courtesy of Scott Brown) from a $19 billion fee in financial regulation reform. Physicians got another reprieve from Medicare’s “Sustainable Growth Rate” formula, which, in principle could impose a 21 percent reimbursement cut. Congress continually modifies this complicated and politically impossible policy with the ritualized “doctor fix.” (Last month Congress voted to replace the 21 percent payment cut with a 2.2 percent increase. See Austin Frakt for the details).

Still, the contrast in urgency is striking. In these cases and others, organized, rather privileged interests fare well when the political shoving starts. That’s politics 101. It applies to both parties, though more glaringly and with less embarrassment in the GOP. Sometimes this fact of life produces good policy, sometimes not. I’m sorry the banks got off the hook. I’m glad Congress always fixes the SGR, since a drastic reimbursement cut would be terrible public policy.

No Senator or Representative wants to lose her job creating a mess for Medicaid patients and providers. Concerns about federal deficits remain, but these concerns take a back seat when something is very important to Medicare patients and providers. That’s good. I only wish more politicians felt the same fear about disappointing people living with HIV, disabled Medicaid recipients now losing services, and disadvantaged urban youth. Until they do, politicians will continue to rather feel badly as they neglect important needs. And the politics of the federal budget (and state budgets, too), will remain disspiriting.