More on the Kansas Experiment

Y’know, maybe we all should have been paying more attention to Kansas. I wasn’t fully aware that Gov. Brownback had not only refused to expand Medicaid under the ACA; he actually privatized it.

Let’s start with what looks like a re-written press release from 2011.

Gov. Sam Brownback and his administration’s top social service officials today unveiled their proposal for reforming the state’s Medicaid program.

In a nutshell, it would expand managed care to all currently on Medicaid, including nursing home residents, the disabled and the mentally ill. It also would prompt reshuffling of departments at four state agencies. Officials said the plan would save the state $12.5 million in the coming fiscal year and a total of about $367 million over the next five years.

The plan was to turn the Kansas Medicaid program over to private companies, who as we know always do everything better for less money, right? Anyway, the retooled Medicaid program was named KanCare, and lots of stuff got shuffled around from this department to that one, which obviously was another cost saving. So how did it work out? This is now:

Since Brownback’s inauguration, 1,414 Kansans with disabilities have been forced off of the Medicaid physical disability (PD) waiver. In January of 2013, Brownback became the first governor to fully privatize Medicaid services, claiming he would save the state $1 billion in 5 years without having to cut services, eligibility, or provider payments. Now, under Brownback’s “KanCare,” PD waiver cases are handled by for-profit, out-of-state, Fortune 500, publicly-traded managed care services. Kansas has contracts with three managed care profiteers — United Healthcare, Sunflower State Health Plan (owned by Centene Corporation), and AmeriGroup. Amerigroup and Centene each gave $2,000, Kansas’ maximum allowed contribution, to Brownback’s re-election campaign. …

… Brownback’s claims of savings without risking patient eligibility is mere sleight of hand when taking a closer look at the numbers. When Kansas experienced a $217 million revenue shortfall in April of 2014, Brownback actually broke a promise made to the federal government as to how many people with disabilities would be served. When applying to launch the KanCare program, the Brownback administration originally promised the U.S. Department of Health and Human Services it would accommodate 7,874 people on the PD waiver, according to numbers from the Kansas Department for Aging and Disability Services. After the first revenue shortfall, Brownback changed that number to 5900 – nearly a 25 percent cut in services amounting to $26 million.

Note that some of the services being cut could mean life or death for some people.

Death panels? Do I hear death panels?

One of the people whose services were cut complained.

Bullers, a former 15-year veteran reporter for the Kansas City Star and father of two, fought from the time of his managed care review in January of 2013 all the way to New Years Eve of 2013 for his full-time care to be restored. He used his status as a public figure in Kansas to organize awareness campaigns in both traditional and social media, and even arranged a meeting with Gov. Brownback. Bullers said he “got really pissed off” at Brownback’s response to a question he asked about not having a home care provider available if his ventilator came loose, stopping air from getting into his lungs.

“He said, ‘Just go over to your neighbor’s house and they’ll put it back on for you,’” Bullers said. “I mean, here’s the governor of the state of Kansas, telling me that, you know, your life isn’t worth it, that it’s okay if you die and leave two small children without a father.”

Death panels!

About a year ago The Pitch published a long expose on the screwup that is KanCare. The points it makes, in brief — Privatizing a service doesn’t make the cost go away; it just shift the cost around. And then in addition the private companies take profits and administrative costs, so less money goes to the patient. How in the world this scheme was going to save the state money seems to have been magical thinking. Ultimately the only way to make the program less expensive is just to pay for less stuff.

And I understand there have been issues with the private companies failing to disclose information to the state that has frustrated people responsible for eliminating fraud. See also KanCare companies lost money in first year.

And, of course, Brownback turned down million of federal dollars by refusing to expand Medicaid.

The wonder to me is that while Brownback has been trailing his Democratic opponent in polls, it hasn’t been by a huge amount. Apparently a substantial percentage of Kansas voters intend to return this loser to office.

When Stupid Is an End In Itself

Of all the many signs the U.S. is no longer a great nation — big, still wealthy, powerful, conspicuous, yes, but not great — the fact that we can no longer organize ourselves to so much as fix the flippin’ bridges, never mind build new ones, stands out. Much of the nation’s greatness, and weatlh, came from doing big, splashy things — the transcontinental railroad; the Panama Canal, the Hoover Dam, the moon landing.  Some of these things were done primarily by government, and some by public and private partnership. For example, while the transcontinental railroad was built by private companies, those companies depended on government land grants and loans, and the route itself was laid out by government surveyors. If Washington hadn’t pushed it, it never would have been done.

Paul Krugman writes that infrastructure investment is precisely what the country needs, economically and otherwise. It would both boost the economy by getting more dollars into peoples’ pockets and, y’know, fix the bridges before they fall down. But because of current prevailing political ideology, no, we can’t.

And it’s all about ideology, an overwhelming hostility to government spending of any kind. This hostility began as an attack on social programs, especially those that aid the poor, but over time it has broadened into opposition to any kind of spending, no matter how necessary and no matter what the state of the economy.

We’ve reach point at which stupid is an end in itself.

You can get a sense of this ideology at work in some of the documents produced by House Republicans under the leadership of Paul Ryan, the chairman of the Budget Committee. For example, a 2011 manifesto titled “Spend Less, Owe Less, Grow the Economy” called for sharp spending cuts even in the face of high unemployment, and dismissed as “Keynesian” the notion that “decreasing government outlays for infrastructure lessens government investment.” (I thought that was just arithmetic, but what do I know?)

Here’s a crucial point —

Never mind that the economic models underlying such assertions have failed dramatically in practice, that the people who say such things have been predicting runaway inflation and soaring interest rates year after year and keep being wrong; these aren’t the kind of people who reconsider their views in the light of evidence. Never mind the obvious point that the private sector doesn’t and won’t supply most kinds of infrastructure, from local roads to sewer systems; such distinctions have been lost amid the chants of private sector good, government bad.

If you look closely at most of the prominent Republicans in Washington, one of the striking things about them is that their bios often reveal them to be the creatures they claim to hate — lifelong political / government apparatchiks.  Although they pride themselves on being friends to business, most of them have worked most of their lives in government and politics. I’m sure there must be some exceptions, but most have never actually run a company or so much as managed an assembly line. Paul Ryan is a good example; according to bios I have read, his only non-political private sector employment was a summer job for Oscar Meyer, during which he got to drive the weinermobile.

I can never tell how much they believe their own crap, but basically we’re dealing with people who are long on ideological theory and short on experience. Unfortunately, you can say the same thing for most of our Captains of Industry, most of whom have no idea how the products they are selling actually get made.

It’s like a perfect storm of derp. The people in charge of things, public and private, have no idea how stuff gets done and no idea what stuff needs to get done. And the country is at their capricious and greedy mercy.

And it hardly matters that the states that have put the “Spend Less, Owe Less, Grow the Economy” mantra into practice have had disastrous results. See, for example, “The Great Kansas Tea Party Disaster” by Mark Binelli:

“That word, “experiment,” has come to haunt Brownback as the data rolls in. The governor promised his “pro-growth tax policy” would act “like a shot of adrenaline in the heart of the Kansas economy,” but, instead, state revenues plummeted by nearly $700 million in a single fiscal year, both Moody’s and Standard & Poor’s downgraded the state’s credit rating, and job growth sagged behind all four of Kansas’ neighbors. Brownback wound up nixing a planned sales-tax cut to make up for some of the shortfall, but not before he’d enacted what his opponents call the largest cuts in education spending in the history of Kansas.

“Brownback hardly stands alone among the class of Republican governors who managed to get themselves elected four years ago as part of the anti-Obama Tea Party wave by peddling musty supply-side fallacies. In Ohio, Gov. John Kasich – whose press releases claim he’s wrought an “Ohio Miracle” – has presided over a shrinking economy, this past July being the 21st consecutive month in which the state’s job growth has lagged behind the national average. In Wisconsin, Gov. Scott Walker, whose union-busting inadvertently helped kick off the Occupy movement, cut taxes by roughly $2 billion – yet his promise to create 250,000 new private-sector jobs during his first term has fallen about 150,000 jobs short, and forecasters expect the state to face a $1.8 billion budgetary shortfall by mid-2017. A recent analysis by the Detroit Free Press, meanwhile, laid out how the tax policies of Gov. Rick Snyder, a wealthy entrepreneur who campaigned in Michigan as a nerdy technocrat, have resulted in businesses paying less ($1.7 billion less per year, to be exact), individuals paying more ($900 million per year) and – here’s the kicker – job growth slowing every year since Snyder’s cuts have been enacted.”

It will not matter that teabag economics crash and burn in the real world, because stupid has become an end in itself. Not taxing and not spending is an end in itself; that it sinks budgets and costs jobs does not matter.

And when the bridges begin to buckle, some Reince Priebus clone will trot out and say those bridges were built by Democrats and the fact that they finally collapsed after decades of neglect proves government doesn’t work.