Category Archives: Politics

Passing health care reform – and a kidney stone

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

It was Saturday morning, March 29, and the pain in my lower back was growing more intense. I knew what was happening. It was not my first kidney stone.

If you’ve ever had one, you know the drill: the writhing, the fruitless shifting of positions hoping to find relief, the heaving. When I could take the pain no more, I shakily told my wife to wake the kids and drive me to the emergency room. When we arrived, I begged the admittance clerk to hurry. I underwent a CT scan and was given drugs that, blessedly, took away most of the pain. Surgery removed the stone a week later.

I’m grateful for modern health care, but no consumer product is free. The total out-of-pocket cost for that episode so far is nearing $6,000, including a big hospital bill that recently arrived – six months after the surgery. I’m hoping there will be no more surprises. My insurance company was billed more than $12,000 for the surgery alone and paid about $10,000 of that.

Ask me about health care reform, and I’ll generally say the system doesn’t function enough like a free market. Patients don’t act like consumers, and medical providers don’t act like a business. We must encourage patients to be more price-conscious so they’ll shop around and refuse unnecessary care. That kind of behavior will force medical providers to become more efficient and cheaper.

That’s Steve the political philosopher talking, and I’m not saying it’s wrong. But what did Steve the kidney stone patient do? Certainly not call the various emergency rooms at 6 a.m. on a Saturday looking for the best combo deal. I went to the only one in my hometown. There I was at the provider’s mercy not only as a patient but also as a consumer. I would have bought whatever service the hospital was selling in order to take away that pain.

Over the course of a week, my kidney was scanned numerous times, including the day before the surgery and the day of. At the hospital, already wearing my gown, I finally asked if it was really necessary to do it again. I was told the doctor liked to see if the stone had moved overnight. What would you do – refuse the scan? Of course I did what the doctor, who is also the seller, told me to do. I had no buying power in that situation.

Health care reform – that’s a hard one. Try as one might, it doesn’t fit neatly into any political ideology, including my fuzzy one. The mandate by the Affordable Care Act (Obamacare) that all Americans must have insurance, which conservatives argue is an unconstitutional edict – it once was a conservative idea. A major issue in this year’s legislative races is the private option, which uses federal dollars to buy private insurance for poor people who make too much money for Medicaid. It was created by Republican legislators and Democrat Gov. Mike Beebe’s administration and now provides insurance to 200,000 people. Other Republicans say it’s just Obamacare by another name.

OK, it is more government, at least on the front end. But uninsured people generally wait until they are very sick to seek care, and then they go to the emergency room, and they can’t afford to pay for their care, so the rest of us pick up the tab. So what’s the easy answer on that one?

No matter how health care is reformed, there will be winners and losers. During Monday’s AETN debate, Sen. Mark Pryor described a church meeting with a diabetic constituent thanking him for voting for the Affordable Care Act. Because it made it illegal for insurance companies to reject his pre-existing condition, the diabetic has coverage for the first time in 15 years. On the other hand, Pryor’s opponent, Rep. Tom Cotton, had his own story: a dentist and his wife lost their insurance because it didn’t comply with all of the act’s mandates. Libertarian Nathan LaFrance said doctors are telling him their attention is now focused on entering computer codes instead of caring for patients.

Take the words “Obama” and “Obamacare” out of the picture. Whose story is more compelling? The diabetic’s, the dentist’s, or the doctors’?

Aren’t they all? Health care reform – that’s a hard one. I don’t know the right answer, but anyone who tells you there’s an easy one is probably wrong.

Is Asa the private option’s better option?

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

Want the private option to go away? Maybe you should root for the candidate for governor who seems most supportive of it. Want it to survive? Maybe you should root for the candidate who seems most on the fence.

Let’s review the backstory before explaining.

The private option came about because of two provisions in the Affordable Care Act, otherwise known as Obamacare. First, it required states to expand their Medicaid rolls to serve more poor people. Second, because it was doing that, it cut government reimbursements to medical providers for giving uncompensated care to people who don’t have insurance and don’t pay. The thinking was there would be less uncompensated care because more people would have Medicaid.

When the Supreme Court ruled Obamacare constitutional, it also said states didn’t have to expand Medicaid, and many Republican-led states did not. Arkansas legislators – Republicans, actually – along with Gov. Mike Beebe’s administration instead created the private option, which serves the same population by using government dollars to buy private insurance instead of enrolling them in Medicaid.

As a result, about 200,000 Arkansans are benefitting – most through the private option, and the rest because they were routed into Medicaid while trying to enroll in the private option. The federal government is paying for almost all of the private option now; the state will begin kicking in a small share in 2017, eventually paying 10 percent under the program’s current terms.

Supporters say it’s is a rational mechanism for funding health care for 200,000 people. We’ll end up paying for health care for them anyway – often in the emergency room if they don’t have insurance. Smaller hospitals have closed in states that turned down the money. The private option’s mechanisms encourage recipients to behave like health care consumers and be more picky and choosy with their decisions, in theory reducing the cost. So far, it seems to be doing much of what it was intended to do.

Opponents say it’s just Obamacare by another name, inevitably resulting in more government and more debt. Doing business with the federal government is a risky deal, they say. That 10 percent will amount to real money, and at this point, we don’t even know how much it will cost.

The funding mechanism must pass the Legislature with a three-fourths majority every year. Democrats are all for it; Republicans, who likely again will have majorities in both the House and the Senate next year, are split between “yeses,” “no’s,” and “heck no’s.” It barely passed earlier this year, and there will be even more legislative opponents after this year’s elections.

Which brings us to this year’s campaign for governor. Democrat Mike Ross is totally for it. Republican Asa Hutchinson, knowing his party is split, has hedged throughout the campaign. In Tuesday’s televised debate, he referred to its successes but says Arkansas must know the costs before deciding whether or how it should continue.

If he’s really against it, he’d say so.

Let’s not ignore the other candidates: Green Party nominee Joshua Drake supports the private option, while Libertarian Frank Gilbert is opposed.

When the Legislature convenes in January, the new governor will have an agenda (along with all 135 legislators), but everything will hinge on the private option. It’s that big and that controversial, and Hutchinson probably gives it a better chance of continuing in some form.

That’s because Hutchinson, the Republican, would have much more pull with the Republican “no’s” than Ross. (No one will flip the “heck no’s.”) Every legislator in Ross’ minority party is already for it. He could use his veto if the Legislature left out the private option, but the Legislature could override that with a simple majority – the same percentage that passed the bill in the first place.

So Ross perhaps would be more eager to fight for the private option, but Hutchinson, the outwardly more reluctant warrior, would have more weapons.

Hutchinson would have his own motivations for saving it. He has plans, including cutting taxes by $100 million during his first year in office – a difficult prospect anyway and an impossible one without the private option’s federal dollars. He does not want to spend his first term reneging on his campaign promise, plugging budget holes, and trying to save endangered hospitals.

The private option may survive, albeit with changes, regardless of who wins. It may die either way. But it probably has a better chance of surviving with help from the candidate for governor who won’t say he supports it.

Obama, Obama, Obama and Bloomberg

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

This being a nonpresidential election, President Obama is not on the ballot, but you wouldn’t know it from this year’s campaign.

Obama and his “job-killing agenda” apparently are running for U.S. Senate, along with former New York Mayor Michael Bloomberg. Obama is running for Congress. He’s running for lieutenant governor. He’s probably running for your local offices too.

There’s a reason why Arkansas Republicans continue to tie Democrats to the unpopular president: It works politically. For decades, the state GOP scratched its head as Democrats continued to dominate Arkansas while much of the rest of the South became Republican. Then in 2010 Arkansans changed allegiances. President Obama and Obamacare were like a light switch that flipped the state from Democrat to Republican.

It’s fair game for Republicans to point out that President Obama is a Democrat in a state where Obama is unpopular. Democrats in Congress will certainly be more supportive of his policies than Republicans will. It’s a shorthand way to draw a distinction.

But we’ve heard Obama’s name an awful lot since 2008, and frankly, it’s becoming a little much. He’ll be out of office in two years. I mean, the lieutenant governor’s race? Really?

Perhaps the guilt-by-association campaign reached its height, or depth, with a National Rifle Association radio ad supporting Rep. Tom Cotton in his race against Sen. Mark Pryor. In the accusatory tone to which we’ve all grown sadly accustomed, a voice says Michael Bloomberg, the former mayor of New York, sleeps behind armed guards but wants to take away our guns, so vote for Cotton.

The ad is ridiculous on so many levels. While Bloomberg is an aggressive pro-gun control activist with a lot of money, he’s no longer an elected official, and when he was, it was in New York City. His main connection to Arkansas is a clumsy ad buy he made earlier this campaign cycle against Cotton’s opponent, Sen. Mark Pryor, because he thought PRYOR was too pro-gun. A conservative and pro-gun family member of mine was so insulted by the implication that we Arkies can’t tell Bloomberg from Pryor that he declared the other day that Cotton had lost his vote.

The modern campaign is a far cry from the Illinois Senate election of 1858, when Abraham Lincoln and Stephen Douglas faced off in a series of debates where one spoke for 60 minutes, the other spoke for 90 minutes, and the first spoke for 30 minutes. Surely with that much time at the podium, the two were forced to offer more than just denunciations of President Buchanan. Somehow, the voters in the audience were able to pay attention and grasp the issues despite not having grown up with broadband internet access – or maybe that was the reason they could.

Campaigns are supposed to be job interviews between employers (the voters) and potential employees (the candidates). If you were looking for someone to represent your company, would you hire him or her if they spent the entire interview criticizing the other prospect waiting on a metal folding chair in the hallway?

Voters, more so than candidates, are responsible for lifting the campaign’s tone. A prospective employee will do what is necessary to get the job, and if the employer is only swayed by nastiness and innuendo, well, soon word will spread through the employment line.

So maybe Arkansas voters could follow the examples set by Lincoln, Douglas and the state of Illinois. AETN will televise a series of debates Oct. 13-17 for the major offices and include all the candidates, including the Libertarian and Green Party nominees. (Full disclosure: I’m a questioner in two of those debates.) A televised Senate debate is planned for the state’s ABC affiliates Oct. 14.

Political elites believe most of us are not very engaged. They think we can be manipulated. Let’s prove them wrong. There’s a month left until the election. Let’s conduct our own job interviews and hire who we think are the best candidates based on who they are, the policies they support, and whether they are competent enough to do the job.

That’s what we would do with any employee that matters. Don’t these?

The United States, or these United States?

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

The federal government will not reform itself. We’re past the point of electing different politicians or enacting different policies. Instead, the government’s underlying structure must be changed through a constitutional amendment process never before used in American history.

That was the message of Michael Farris, head of the Convention of States Project, during testimony before the House and Senate State Agencies and Governmental Affairs Committees Wednesday.

The Constitution has been amended 27 times using one process – Congress proposes a change, and three-fourths of the states ratify it. But Article V of the Constitution also includes another provision where two-thirds of state legislatures, or 34, would call for a convention. Delegates would consider constitutional amendments, each state having one vote. Proposed amendments would have to be ratified by three-fourths of the states – 38, in other words.

That method has never been used successfully, but Farris says it’s the only hope to fix a broken system. His group is asking states to pass resolutions for a convention that would consider how to impose fiscal restraints on the federal government, limit its powers and jurisdiction, and impose term limits on members of Congress and Supreme Court justices.

So far, Alaska, Georgia and Florida have passed nearly identical resolutions to that effect, and Farris’ group plans a hard push in about 20 states, including Arkansas, this upcoming year. Rep. Bob Ballinger, R-Hindville, said he or someone else will introduce the resolution in 2015 if it has enough support.

Farris assured legislators that Article V’s high standards for ratification – 34 states to call a convention and 38 states to ratify – mean only amendments with broad popular support would have a chance of being ratified.

That being the case, the movement must expand beyond its current base and way of thinking. Its leaders and supporters appear to be almost exclusively very conservative individuals. During a presentation to a home-schooling group Wednesday, Farris suggested one change would involve clarifying the Constitution’s “general welfare” clause so that, “If the states can spend money on it, the federal government can’t.”

That would give a lot more power and responsibility to the states, but it also would mean ending Medicare and Social Security as we know it at the federal level. Such a change would be impossible to sell politically in a lot more than 13 states.

Legislators had varying reactions to Farris’ testimony. Rep. John Walker, D-Little Rock, a well-known civil rights advocate, said the same states’ rights argument was made on behalf of slaveholders and segregationists. Farris said that wouldn’t happen again and that legislators could instruct their delegates not to repeal the Constitution’s civil rights amendments. Later in the session, Rep. Douglas House, R-North Little Rock, and Rep. Jim Nickels, D-North Little Rock, said delegates could ignore whatever instructions legislators gave them. To that, Farris replied, “We’re really dealing in international law here is what this is is because it’s a meeting of sovereign states, and there are recognized principles of international law that govern, and there are no … exceptions in international law or in American law.”

Sovereign states being governed by international law? Such thinking would be a huge leap for a lot of people. Prior to the Civil War, the United States was a plural entity, as in “these United States.” Afterwards, it became a singular: “The United States.” The emerging national identity enabled the country to become the world’s greatest economic and military power. But it’s also led to a bloated, irresponsible, and unresponsive federal government. No state manages its business as badly as the federal government does, and many, including Arkansas, do it much, much better.

A rebalancing of power is needed, though not to the extent that Farris supports. An Article V convention may the best hope of doing that because, as he argued, the government will not reform itself. And with only 13 states required to kill any measure, what’s the worst that’s likely to happen? A bunch of people gather in one place and argue forever without accomplishing anything?

We already have that. It’s called Congress. So if this just turns out to be a big waste of time, we can live with that. What we can’t live with is not trying. Thanks to Article V’s parameters, a convention probably can’t hurt, and it might do some good. I’m for it – a convention, at least, and then let’s see what amendments are proposed.

Everyone’s an extra, even in Congress

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

I’m not the good guy. Neither are you. And neither are Mark Pryor nor Tom Cotton.

I bring that up because we’re in the middle of a campaign season where television ads, and many news providers, treat what should be a statewide job interview instead like a TV show.

And boy, there are a lot of those ads. According to the Center for Public Integrity, the candidates, the parties and independent groups had broadcast 40,576 of them in Arkansas during the 2014 campaign in the Senate race alone as of Sept. 22.

From the time we are born, Americans are fed a steady diet of fiction. Movies, books, TV shows – including sitcoms – often feature three elements: a protagonist who is the hero (along with sidekicks and love interests), an antagonist who is the villain, and extras.

Except in rare cases, whoever spends the most time on camera is the hero, even if the antagonist is more worthy of admiration. For example, in “Rocky,” Rocky Balboa may have had a heart of gold, but he had been a lifetime underachiever and a loan shark’s debt collector, while Apollo Creed was an undefeated champion, smart businessman, and devoted husband and father. We cheer for Rocky.

In our lives, we’re the protagonist, so we believe we’re the hero, which means there must be villains somewhere. Our flaws are merely the personal challenges all heroes must overcome, while the villains never change and have only evil intentions. That’s how a story works.

This is not a healthy thing for any of us. It leads to pride and narrow-mindedness and a lack of grace toward others. It’s particularly problematic in politics. There are many reasons why today’s Congress is dysfunctional, but could one be that its members, raised on television like the rest of us, have bought into the fiction?

For the past year-and-a-half, we’ve watched Cotton and Pryor try to destroy each other on television. Other races with less money at their disposal are behaving in a similar fashion, especially now that the election is nearing. The gloves have really come off in the 2nd Congressional District race between French Hill and Patrick Henry Hays.

I’ve been around enough of these campaigns to know that few of the candidates believe they are at fault. Both sides believe their opponent started it all by lying and slinging mud, so everything they do now is justifiable. In the battle between good and evil, the stakes are too high to worry about fair play.

The next time you’re tempted to put your faith in a politician, or even, for 700 words, a columnist, google “Voyager” and “Pale Blue Dot.” You’ll see a photo of Earth taken by Voyager I from four billion miles away. The planet is tiny. On that little blue dot are billions of smaller dots, all of us running around thinking we are the center of the universe – or at least, the hero of the story.

The truth is, we’re all extras. Every last one of us.

It’s not that either Cotton or Pryor are villains. In fact, they’re both good people – good extras. But when 535 extras journey to Congress, all believing they’re the hero and all looking for dragons to slay, well, then you get the train wreck that Washington has become.

There’s a reason the Constitution’s defining principle is a limitation of power. Our government is designed to prevent the rise of even the most benevolent of dictators for fear of where that could lead.

Under the Constitution, compromise and cooperation are required to accomplish even basic governance, despite the fact that it’s bad TV. For us to think constitutionally requires us to overcome a lifetime of fictional programming, where you don’t compromise or cooperate with the villain. You defeat him, and then you get the girl.

But that’s TV, not real life. I’m not sure if today’s candidates always know the difference. I’m not sure if we voters do, either.