A kibitz on Medicaid reimbursement & health reform

I’ve been writing various things on this issue, following up the Illinois audit study I cited the other day. Here is one additional kibitz, cross-posted on TCF’s Taking Note.

As two great philosophers have noted, it’s odd to see Republicans touting low Medicaid reimbursement rates as an argument against health reform. These arguments make little sense on the policy merits. These arguments make little sense given the political history of health reform. These arguments make little sense when one considers Republican governors desire for greater leeway in cutting Medicaid budgets, which would likely make these problems worse. Forbes Avik Roy and the Atlantic‘s Megan McArdle are right, however, that Medicaid often pays below average cost, sometimes below marginal cost, too. Donald Taylor and Greg Anrig have advanced creative proposals to address these issues by partially or wholly federalizing Medicaid. Continue reading “A kibitz on Medicaid reimbursement & health reform”

The Illinois budget challenge

Illinois’ budget season is upon us. The governor’s proposed budget will be painful for thousands of needy people across the state.

Illinois released its budget. Here are the gory details, all 472 pages worth. Here is a nice column by the indispensible Eric Zorn about the controversial $8.75 billion borrowing measure. Here are two other good sources from the Tribune and from Micah Maidenberg at Progress Illinois.

If you don’t care about any of that, here is me droning about it on Chicago Public Radio. If you don’t care about that, either, here’s the story. Continue reading “The Illinois budget challenge”

“Speak Softly and Carry a Big Stick”: The Coach and the President Heed an African Proverb

African-American leaders know better than to frighten their followers. Shouldn’t the rest of us know better than to berate them for their self-restraint?

The people who’ve spent the past several seasons calling for the head of Coach Lovie Smith on the grounds that he’s “ignorant and weak” and “emotionless” (among many less printable adjectives) are nowhere to be found since he led the Chicago Bears to the NFL Conference championships. Having failed to bury Smith, they absolutely refuse to praise him.

Why?   Because Coach Smith is a soft-spoken professional who leads not by shrieking but by—well, leading.   Chicagoans, particularly Chicago sports fans, can’t seem to wrap their heads around the notion that this gentle man— this gentleman—could possibly be any good at coaching football. That’s because the mold for Da Coach was set by Mike Ditka, a screaming, foul-mouthed, temper-losing maniac whose heart attack only narrowly missed taking place on the field.   If you’re not yelling like that, you must not be leading.

But if Coach Smith behaved like that—berating his players and abusing the press in rants liberally sprinkled with profanity—we’d hear nothing but tut-tuts about what an angry black man he was.  Probably neither the fans nor the team itself would be willing to follow him.  It’s no accident that the most successful African-American coaches — Tony Dungee, Mike Singletary, Lovie Smith — are all matter-of-fact and free of braggadocio.   That’s the way black men have to negotiate the world to avoid waking the not-very-soundly sleeping dogs of white racism.

Which brings us to the case of President Obama.   Everyone who derides him for not being tough enough—for not being Franklin Roosevelt or Lyndon Johnson—seems to forget that they’re speaking of someone whose life has required constant attention to the problem of being non-threatening.   That’s quite a challenge for a man who’s tall, brilliant and black.

But the President has succeeded at it through a combination of self-deprecation (“a skinny kid with a funny name”) and unshakable composure (“No-Drama Obama”).   If instead he’d emulated FDR in saying of his opponents “I welcome their hatred,” Fox News would have announced that he hated all white people. (Oh, right, someone on that network did that anyway.)   If like LBJ he’d insisted a reporter accompany him while he used the toilet, he wouldn’t be considered a lively and original character but just some ghetto type who didn’t know how to behave.

Consider the reportage when the president held a news conference explaining his decision to make the tax-cut compromise.  Having answered a series of questions designed to get him to say that he’d betrayed his promises, his party and his people, he was finally irate enough to respond, “It’s the health care battle all over again. Some people would rather rest in their purity than get something done,” or words to that effect.   As a rebuke goes, his was a pretty mild one.   But it was sufficient to produce several weeks of headlines about how the President had “scolded” his party and how “angry” he was.   If he’d actually been angry, we’d probably have seen articles of impeachment.

So all the people who want to give the President—and the Coach, for that matter—lessons in leadership should bear in mind that both men have learned precisely how much force they can use before that force is turned against them.   And they haven’t learned it from the Op-Ed pages or the screaming-heads fests.   Experience keeps a hard school but we will learn at no other.

I myself wrote—but fortunately did not post—the following incredibly misguided advice:

I understand the President’s unwillingness to assume the role of Angry Black Man into which his opponents wish to thrust him. But when the people on the other side of the table are card-carrying members of the Paranoid Style in American Politics, it’s time to stand up and call them the proto-fascists they are.   And hoping they’ll be willing to compromise seems a deliberate act of denial, like whistling past the graveyard. Instead, Barack Obama should emulate Harry Truman.   Give ’em hell, Barry!

WRONG!   As the Tucson shootings demonstrate, the last thing we need right now is public officials giving each other high-decibel hell.   And even if hell were called for, a black man in power couldn’t be the one to deliver it.   That’s an indulgence reserved for powerful white men—and every powerful black man knows it. It’s time the rest of us learned the same lesson.

The volume of reproach and disappointment and disapproval and correction directed at Coach Smith and the President says nothing about their leadership ability.   It’s purely a reflection of the fears and fantasies a significant subgroup of American white people have about American black people.   The fact that one of them produced a championship team, and the other achieved the health-care reform none of his white predecessors could manage (among many other victories), demonstrates that they’re far better leaders than anyone less challenged could dream of being.

So let’s stop giving them hell.

Needed: Painful grand compromise in Illinois

For every dollar I pay in federal income tax, I pay only $0.13 to Illinois. That’s just not enough.

Me in the Chicago Tribune.

Illinois has a $13 billion deficit, alongside very serious long-term budget challenges. Taxpayers–especially the affluent–must pay higher income taxes. Politicians must submit to a more transparent and disciplined budget process. Public employees must renegotiate some unsustainable retirement arrangements. And the media must raise its game to cover these issues with the required diligence and depth. There really is no alternative at this point.

Hey Governor Quinn: Raise my taxes already

People like me should pay higher state income taxes in Illinois.

My friend Mike O’Hare and my University of Chicago colleague (and fellow Princeton engineering alumnus) Todd Henderson are fighting over the expiration of the Bush tax cuts. I’ll let that exchange speak for itself, except for one comment. Whatever one thinks about the Bush tax cuts, professors like us should pay higher state income taxes here in Illinois.

I’ve written a few pieces lately on the precarious financing of state public employee health and pension funds. Thanks to inexcusably back-loaded collective bargaining agreements and accompanying budget shenanigans by Springfield politicians of both parties, Illinois now faces large unfunded liabilities that will drive our structural deficit long after the current economic crisis is resolved. Many states–Illinois included–continue to presume unrealistically high expected returns to avoid confronting the full magnitude of this problem.

Atypical but prominent corruption or sweetheart deals convince many voters that the problem here is caused by lavish and excessive pensions to public workers. In my view, some adjustment to current and future pensions is indeed warranted. Yet the real problem is not the pensions themselves but the failure to properly finance them or to raise adequate revenue to cover the state’s obligations.

Here’s where Professor Henderson and I come in. We should pay a few percentage points more in state income taxes to help fix this problem. For every dollar I pay in income taxes to the federal government, I pay about twelve cents to the state of Illinois. Our 3 percent income tax produces high burdens on low-income people in the form of other taxes. It also leads Illinois to rank 40th in the nation in the taxes we levy on the wealthiest 1% of citizens. And we just don’t raise enough money this way.

The results are predictable: poor services, and desperate budget measures that kick the financial can down the road to burden future constituents, taxpayers, public workers, and others. Illinois schools and other public services are not what they should be, either, when one considers the tremendous resources available across our state. These services won’t get better if nothing is done as additional bills come due.

This is where people like Professor Henderson and I come in. If people like us pay two or three percentage-points more in state income taxes, Illinois could raise several billion dollars in additional tax revenue every year. This would be enough to cover most or all of the unfunded liabilities in our public employee pension and health benefit systems. It would reduce our reliance on regressive and overly cyclical sales taxes. I wouldn’t be overjoyed to pay higher taxes. In these troubled economic times, people like us with secure six-figure incomes can certainly step up to do more.

If such taxes were enacted as part of a broader package to improve the state’s fiscal posture, it could have a huge impact in other ways. As affluent, tenured professors at one of the nation’s leading universities, we can afford to pay a little bit more. We also have much to gain from getting our state’s fiscal house in order.

I can’t say I am a disinterested observer. As a caregiver for an intellectually disabled man, I’m disgusted that Illinois ranks 51st in the nation in its ability to provide community-based housing and services to intellectually disabled people. I’m disgusted by the way families are treated when they–when we–need help. I’m disgusted by the long waiting lists for important services. We can do a hell of a lot better than this.

So Governor Quinn, raise my taxes already. It’s ok. Really.

Six Degrees of Rod Blagojevich

Ambinder puts it well:

Having read through the charging document twice, there’s no evidence whatsoever that anyone associated with the Obama presidential transition did anything improper. Obama himself is barely mentioned.

However — the transition will be called to account for all of its members’ contacts with Blagojevich, and those Obama advisers who are mentioned by pseudonym — including Valerie Jarrett — will face pressure (and the candidate’s promise of transparency) to make a public accounting.

(Emphasis in original). Chicago is a big city, but politics is a small town. People know people. They have professional, political, and for all I know, even business relationships. Connections will be drawn. This will get ugly, particularly in the fever swamps of the far right.

Two things I think that Obama should do, relatively quickly:

1) Make it clear that Fitzgerald will stay on. Obama is between a rock and a hard place, because if he keeps Fitz on, even if it is clear that there is no evidence against him, then the wingnuts will say that Fitz is covering up for Obama to keep his job. But that’s better than firing him. And Fitz is damn good at his job: when in doubt, you might as well at least do the right thing.

2) Waive all secrecy provisions concerning the investigation as far as he or anyone on his staff is concerned.

Update: To use Churchill’s formulation, we have a case here of anticipatory plagiarism: Obama promised last June to keep Fitzgerald on. I’m waiting for Republicans to criticize him for this. (Obama, not Churchill).