Paris in early December is a wonderful place – the odd little Christmas villages tucked away here and there, selling little Jesus and Mary figures and small pots of questionable foie gras, the old-school window displays at the big department stores, Galeries Lafayette and Au Printemps, the seedy North African guys on the bridges selling hot chestnuts, and the thousands of tiny white lights in the bare plane trees all up the Champs-Élysées. Sometimes there was even a bit of snow in the air, near midnight, as you walked back to the hotel across the Pont des Arts, with the dark black Seine flowing below. The small bookstores were warm and quiet in the afternoons, and there was cognac at the Flore in the early evening, with the windows all steamed up so you could hardly see the all shoppers hurrying home. Kicking around alone in Paris for a couple of weeks in early December was a good thing. This was not Los Angeles. Every year it got better.
The exception was December 2000 – the year you had to explain America. Travel alone and you will get drawn into conversations with the locals, and that December, the long conversations – in a mixture of bad French and bad English, with gestures and diagrams when necessary – was all about the election, and specifically about Florida. The matter of the Florida recount was still in the courts and the young French guys didn’t get how this could be such a mess, particularly since the guy who pretty much ran the Florida election was Bush’s brother, and the Supreme Court was packed with justices appointed by Bush’s father. This seemed to them like something from a third-world joke of a country, faking it. The absurdly complex Palm Beach ballots, with the misalignments, and then all that stuff with the hanging chads, had them rolling their eyes too. The French invented the farce – remember Georges Feydeau – but this was absurd. Of course the French also invented the absurd – remember Sartre and Camus and those guys. The only response was to explain that Florida was a special place, the exception. The rest of America wasn’t like that. Folks down there in Florida were just strange. They finally accepted that, reluctantly. The French do love to discuss politics, but Al Gore finally conceded, so it didn’t matter much. We talked of other things. They wanted to hear about Hollywood.
Maybe it was wrong to dismiss Florida as an anomaly. Their reluctance to accept that proposition was understandable – maybe there was something wrong with what passes for democracy in America. After all, it was a Frenchman, Alexis de Tocqueville, who wrote the seminal book on that very thing – his Democracy in America – but then America erupted with a decade of bad jokes about how lame Florida was, and is. It is a strange place – retirees and rednecks and Disney World – and it only got stranger. In 2010 they elected Rick Scott as their new governor – the multimillionaire who spent seventy-five million of his own money on that campaign. He co-founded Columbia Hospital Corporation which later merged with Hospital Corporation of America and became the largest private for-profit healthcare company in America. They were the largest hospital chain in America, but he resigned as Chief Executive in 1997 and the issue was Medicare fraud – billing for what never happened. The company admitted to fourteen felonies and agreed to pay the federal government over six hundred million dollars in fines, for ripping us all off. Scott was not implicated in all this, or not exactly. He argued that he had no idea what his subordinates were doing, which makes him a wildly incompetent executive, when he wasn’t pleading the Fifth, on the advice of his attorneys, which might mean he was up to his eyeballs in screwing the government, and taxpayers, out of billions of dollars. Neither alternative is pretty, but the retirees and rednecks elected him anyway. Everyone loves a dashing and clever scoundrel, or something. Maybe they just wanted someone who knew how to screw the government big time, and get away with it, and then walk away with all the money. That would make his election hero-worship, if you hate the government a lot, except it’s your government, and that’s your money. Folks down there in Florida are just strange.
Those December trips to Paris ended long ago – a quiet retirement here with the palm trees in Hollywood will do just fine – but then the idea of explaining all this to those French guys is depressing, even in the abstract. Florida is still strange, and Rick Scott doubly so. Still, he represents a certain kind of Republican politician common these days – one of the many who say no to everything, on the principle that government is always the problem, never the solution – that Reagan thing, taken to the extreme. Now it’s a Tea Party thing, and in the current issue of Mother Jones, the cover story from Stephanie Mencimer reviews what Rick Scott has done during his past two years of tea party-inspired budget slashing. He cut Florida’s corporate tax rate to next to nothing, and at the same time slashed billions of dollars from education. He tried to require welfare recipients to submit to drug tests – the courts shot him down, and the labs that would make a bundle from that, now all in his wife’s name, won’t make a bundle – but he tried. He also famously turned down federal funds for a high-speed rail project – that would have resulted in jobs and development for his state, but that was the government doing things, and governments should not do things, private industry should. He killed a deal to protect the Everglades – that was God’s business or something – and objected to taking money from any federal program even remotely connected to Obamacare. He said Obamacare would kill jobs, but never really explained how it could do that. It was just wrong for the government to be involved.
Mencimer also adds this detail:
Of all the big pots of federal money that Florida has rejected, none quite compares with Scott’s moves to block Obamacare’s expansion of Medicaid to the working poor. Today, a single parent with two children can’t qualify for Medicaid in Florida if she makes more than $3,200 a year – one of the nation’s lowest eligibility levels. …
If Florida rejects the Medicaid expansion, state hospitals stand to lose about $654 million a year in federal payments for care to the uninsured – payments that were reduced in Obamacare on the assumption that hospitals would gain revenue by caring for the newly insured. The hospitals, particularly public ones that have already lost $1.5 billion to state budget cuts over the past eight years, have been lobbying hard for the expansion, but tea partiers have been equally vocal, and in June, Scott announced that he would be rejecting the Medicaid expansion. “We don’t need to expand a big-government program to provide for everyone’s needs,” he said. “What we need is to shrink the cost of health care and expand opportunities for people to get a job so more people can afford it.”
Government is always the problem, never the solution – you know the drill. But the prospect of millions more without healthcare, flooding the emergency rooms, made the hospitals queasy, and they need the money. Mencimer notes that Scott is now the least popular governor in the country, and this sort of thing may be why. Providing for everyone’s needs, at least in a rudimentary way, so folks aren’t dying in the streets or starting a revolution in anger and despair, is what governments do, or ought to do. You could ask a certain French king about that, if he still had his head.
The odd thing is that Rick Scott finally seemed to understand that:
Gov. Rick Scott announced Wednesday a proposed three-year expansion of Florida’s Medicaid program – enrolling an additional one million poor and disabled Floridians beginning next year – after the Obama administration gave the state tentative approval to privatize Medicaid services.
If the Legislature approves, Scott’s announcement means the state will extend eligibility in the federal-state program to single people and families earning up to 138 percent of poverty. The state plans to enroll almost all of them, along with the 3.3 million people currently being served by Medicaid, in private HMOs or other doctor-operated networks.
“While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care,” Scott said at a press conference. He added that the expansion would have to be renewed in three years.
That’s a switch, even with the waiver to privatize Medicaid services completely, and he still has a controlling interest in a whole lot of private providers. He joined Jan Brewer in Arizona and John Kasich in Ohio – take the money, your chances of reelection are better if citizens aren’t dying in the streets and all the hospital don’t go broke and close. This is the intersection of grudging compassion and survival politics, and Kevin Drum adds this:
This is only a three-year commitment, and it was conditional on Scott’s plan to privatize Medicaid. But it’s still a surprise for a guy whose approach until now has been modeled after a chain saw. In the end, Florida’s hospital industry apparently had more clout than Florida’s tea partiers.
That means Florida is strange no longer, and Ezra Klein argues here that this as a sign that Republicans are making peace with Obamacare:
The health-care law goes into effect next year, and implementation is sure to be rocky – all the more so because so many states have left the bulk of the work up to the federal government. But so long as Obamacare is accepted as the law of the land, and repeal is dismissed by most Republicans as little more than a pleasant fantasy, then a constructive process can begin in which Republicans seize on problems with the law as an opportunity to reform the reforms – and through that process, begin to buy into the new system. That’s how the fight over Obamacare ends, and the work of health-care reform continues.
Maybe that’s too rosy a view, but Matthew Yglesias counters with this:
The way the Medicaid expansion works is that the federal government will foot over 90 percent of the tab for states that cover more patients. Meanwhile, residents of states that don’t expand Medicaid don’t gain any special exemption from the taxes that fund the program. So even if you think the expansion is deeply unwise, it’s a simple collective action issue.
Scott did the math, but Slate’s David Weigel points out the odd politics here:
He knows full well that the Republican-run legislature has to sign off on the plan. So either legislators affirm it, and help out Scott in 2014, or they buck him, and make Scott seem – for the first time in recorded history – like a centrist. When Charlie Crist has joined the Democratic Party and beats you like a rug in early polls, that’s a decent menu of choices!
Yeah, Charlie Crist, the former Republican governor down there, and now a Democrat, was always a reasonable pragmatist – and a nice guy with no chip on his shoulder about anything. He will be governor again – the polls show him winning easily. Scott’s only hope is to show he’s reasonable too. What is the country coming to? What happened to nutty Florida?
There’s more. Douglas Holtz-Eakin, who advised McCain on healthcare in 2008, and Avik Roy, who advised Romney on healthcare in 2012, both seem to be okay with Obamacare:
The great irony of Obama’s triumph … is that it can pave the way for Republicans to adopt a comprehensive, market-oriented healthcare agenda. The market-oriented prescription drug program in Medicare has controlled the growth of government health spending. Similarly, conservatives can use Obamacare’s important concession to the private sector – its establishment of subsidized insurance marketplaces – as a vehicle for broader entitlement reforms.
While most Americans view their healthcare system as “free-market,” Switzerland actually has the most market-oriented healthcare system in the West. It translates into universal coverage and low entitlement costs. Swiss government entities spent about 3.5 percent of gross domestic product on healthcare in 2010, compared to 8.5 percent in the United States.
Matthew Yglesias puts this in perspective:
At the highest level of abstraction, the idea of the Affordable Care Act is that over time Americans should be transitioned out of a blend of employer-provided insurance and lack of insurance and into a system of regulated, subsidized, individual plans. The model is Switzerland. Douglas Holtz-Eakin and Avik Roy – two of the most important conservative health policy thinkers around – propose that Republicans embrace a system whose goal is to transition Americans into a system of regulated, subsidized, individual plans modeled on the Switzerland approach.
In other words, they want Republicans to surrender.
No repeal of Obamacare, no denouncing the individual mandate as unconstitutional, no insistence that the uninsured can just go to the emergency room. Surrender.
It’s not unconditional surrender, of course, because they are who they are:
Roy and Holtz-Eakin are conservatives who want to reduce spending, so they favor making the subsidies less generous. In order to make less generous subsidies viable, they want to loosen the regulations to make the insurance plans stingier. They want to gradually-but-steadily raise the eligibility age for Medicare, so that over time a larger-and-larger share of the elderly population will be covered by Obamacare rather than Medicare. Last, and by no means least, they want to transition low-income Americans out of Medicaid and into the Obamacare exchanges. If you did all that stuff, then you wouldn’t need as much tax revenue to finance Obamacare.
So don’t get me wrong, these are substantial changes they’re proposing. But don’t buy their rhetoric either – this isn’t an alternative to Obamacare. It’s a negotiated surrender.
Obama won this one:
In fact, it’s exactly the kind of outcome the White House was hoping for when they launched this process back in 2009. They really wanted a bipartisan bill that a dozen or more Senate Republicans would vote for. It would have made Obama look better, would have given vulnerable Democrats political cover, and it would have sped the process and let other items get on the legislative agenda. If at the time Republicans had organized around concrete asks in exchange for guaranteed votes, they could have easily gotten them. Key players like Max Baucus and Joe Lieberman and the then-large Blue Dog Caucus that held the median position in the House of Representatives were not adverse to this kind of thinking. America ended up with a more left-wing bill because Republicans instead adopted a tactical posture of root-and-branch opposition.
Now the GOP can’t just turn around and get the deal they could have had four years ago.
They have to take what they can get now, what they call the Swiss Option perhaps, but the economist Aaron Carroll points out some problems here:
Do they know that the Swiss health care system has an individual mandate? Do they know that the Swiss health care system has arguably more regulations, such that they can’t even charge a 25 year old and an 80 year old a different price (like you can in Obamacare)? Do they know that the Swiss health care system regulates drug prices and fees for lab tests and medical devices? Do they know the most someone can pay for insurance in Switzerland is 8% of income (which is less than Obamacare allows)?
Don Taylor offers this:
Holtz-Eakin and Roy’s piece was and is primarily political, and doesn’t really have much to do with any facts or policy. …. Given all this, the main content of the piece was reform of Obamacare v. strident ideological language arguing against something without offering an alternative that has been the norm for most opponents of the law for the past 34 months. So, even though my first thought was “Switzerland! I thought you guys hated mandates” I am personally glad to welcome them down from the ledge.
Maybe it’s time to head back to Paris and meet up with those local political junkies again. Florida isn’t crazy anymore, or at least not quite as crazy – and American politics in general isn’t the farce it seemed either. In fact, see this in Bloomberg:
President Barack Obama enters the latest budget showdown with Congress with his highest job-approval rating in three years and public support for his economic message, while his Republican opponents’ popularity stands at a record low.
Fifty-five percent of Americans approve of Obama’s performance in office, his strongest level of support since September 2009, according to a Bloomberg National poll conducted Feb. 15-18. Only 35 percent of the country has a favorable view of the Republican Party, the lowest rating in a survey that began in September 2009. The party’s brand slipped six percentage points in the last six months, the poll shows….
There’s also the new poll from USA Today/Pew:
President Obama starts his second term with a clear upper hand over GOP leaders on issues from guns to immigration that are likely to dominate the year, a USA TODAY/Pew Research Center Poll finds. On the legislation rated most urgent – cutting the budget deficit – even a majority of Republican voters endorse Obama’s approach of seeking tax hikes as well as spending cuts. …
Those surveyed say by narrow margins that Obama has a better approach than congressional Republicans for dealing with the deficit and guns. By double digits, they favor his plans on immigration and climate change, including limits on emissions from power plants.
The president’s overall job approval rating is 51%, a bit higher than it typically has been for the past three years. The approval rating for Republican congressional leaders is a dismal 25%….
By almost 3-to-1 (71%-26%) those who were surveyed favor Obama’s proposal to raise the minimum wage to $9 an hour from the current $7.25….
The crazy folks have been marginalized, but then Steve M at No More Mister Nice Blog says not so fast:
And yet just today, Representative Bob Goodlatte, chair of the House Judiciary Committee, said an immigration plan with a path to citizenship is a nonstarter. Republicans have also made clear that a plan to head off the sequester that involves any tax increases whatsoever is a nonstarter. A minimum wage hike? Also a nonstarter. Meaningful gun legislation at the federal level? So unlikely that the president, in his State of the Union address, begged Congress just to vote on it. And on and on.
The entire country is now just like the U.S. Senate: The Republican minority imposes its will, and the majority, under the current rules, can’t do a damn thing about it. Gerrymandering of House districts guarantees that there’ll never be serious electoral consequences for Republicans when they defy the will of the majority; that plus the literal filibuster in the Senate means that there’s no incentive whatsoever for Republicans to be responsive to the American people.
Maybe that trip to Paris can wait – no need to talk to those guys there. This too would seem to them like something from a third-world joke of a country, faking the democracy thing. And Florida would still be hard to explain. Maybe it’s the pythons everywhere. It’s a strange place.