The powerful and the powerless in hard fiscal times

Surprise: People with AIDS and disadvantaged youth fare worse than large banks, Medicare recipients, and physicians in squabbling over the federal budget.

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.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

7 thoughts on “The powerful and the powerless in hard fiscal times”

  1. This piece just reminds me how disappointing it was that California voters rejected a public campaign finance initiative last month.

    We had a chance to even the playing field just a little bit, so that legislators could, maybe, vote their consciences just a bit more. Or, at a minimum ('cause I don't really buy the corruption argument much anyhow, I think that happens on the margin mostly, though still would be nice to get rid of even that), they could have spend more time doing their jobs, instead of fundraising.

    We get the government we deserve, don't we?

  2. In America…

    When it comes to stepping on the poor and lower middle class it is "all the market can bear."

    And since that market doesn't vote, doesn't protest much, doesn't have any agitators…

    It can, and does, bear a lot.

    It is always worth repeating:

    In America, class warfare is successfully waged from the top down.

    Without so much as a peep or a tweet or a poop from anyone that matters…

  3. Harold,

    I have to question this anecdote here. First, the really poor don't ride the Green Line. It costs a quarter more than the bus. If these teens have no money and all the time in the world then they would have caught a CTA bus.

    And I also have to question if a jobs bill would really have helped them at all. I mean I am in favor of more infrastructure spending, but that money will go to people who have experience as a certified electrician, plumber, pipefitter, or part of some union. These poor fellows don't really have a chance of getting any of that money do they?

  4. I don't know what, if anything, is being planned for 2010, but whatever the case, I can only hope that the Obama campaign decides to double its efforts and try to register millions of new voters, especially in states where there's never any active campaigning, like Texas. There are quite literally millions of people up for grabs. If all of the people who aren't registered who are open to our message decide to vote, the Republicans will have a very, very hard time winning elections.

  5. The ultimate example of this comes from Joe.My.God.

    I'll simply quote my comment from COGITAMUS:

    A Republoco Candidate for a seat on the Arizona Corporation Commission has proposed to save the state money but cutting off all public utility service to 'illegal aliens.'

    If undocumented immigrants have their utilities turned off, Wong predicts it would keep costs down for everyone else. "The [state] constitution gives the Corporation Commission specific authority to deal with rate-making which is setting the price that we pay for the electric, natural gas, telephone service, private water companies," Wong said. Wong, whose grandparents immigrated to the United State from China, said his plan would start off by having utility companies verify the immigration status of new customers. He would then focus on finding existing customers in the country illegally.

    And, given Arizona's frequent 110 degree days, cutting off air conditioning — and water, and refrigeration — might do well to reduce their numbers as well. Not perhaps as quickly as gas ovens, but that might raise the rates on other customers too much.

    Soetimes the deadly consequences of acts — like cutting off unemployment checks or some of the ugliness in unreformed health care — can be hidden. Sometimes, though…

    The effort it takes for someone to make himself blind to his own evil makes me disgusted to share the same planet.

  6. Benny: not to cast unfair accusations, but the young and limber are the ones who can jump turnstiles, right? Which is the big thing in France, I hear. Well, more power to them. Here in LA, we are going to waste money catching the 5% of nonpayers on the metro. Big whoop.

    But you make a great point – that stimulus money should be creating apprenticeships, and they should hire girls too!

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