Republicans couldn’t have found a better target than Medicaid. It’s everything they hate—a huge government program that serves poor people and is administered by a nonprofit instead of private sector. Unfortunately, it was also working extremely well. Community Care of North Carolina, the nonprofit that administered the program, was a model for other states. Even Republican Senator Richard Burr praised CCNC’s success in keeping costs low and saving money.
So what were Republicans who took over the legislature to do? Gut it, of course. In the midst of the Great Recession, when unemployment was reaching double digits and the need for Medicaid assistance was increasing, they slashed the budget. Former Secretary of the Department of Health and Human Services Lanier Cansler, a Republican, warned legislators that the cuts would cause a budget shortfall.
Cansler was right, of course, but cynical Republicans started pointing at the shortfall and claiming the program was broken. It wasn’t but that didn’t matter. The free marketeers wanted to privatize the system because profit is more important the poor folks. Besides, by cutting the budget, they could shift more money away from a program for poor people to subsidize their tax cuts for the wealthy.
Now, after mismanaging the budget for four years and shortchanging Medicaid, the GOP is going to fix it by turning it over to insurance companies. The Republicans broke a program that was working and then turned it over to people who specialize in making money instead of delivering services. Maybe they can break it so bad the GOP will argue to scrap it altogether.
Republicans needed to prove a point: Government can’t do anything right. To do it, they broke a program that was working and now added uncertainty to the lives of hundreds of thousands of North Carolinians.
Their other target is public schools. It will take longer than Medicaid, but the method is the same. They’re slowly depriving schools of money and then complaining they aren’t working. They’re also subsidizing private schools, shifting money into the pockets of those who already have it. Expect to hear soon that public schools are broken beyond repair and we need to turn them over to for-profit education companies. It’s a cynical way to run a government.
Thomas Mills is the founder and publisher of PoliticsNC.com. Before beginning PoliticsNC, Thomas spent twenty years as a political and public affairs consultant. Learn more >
I’m amazed by the tone of surprise in the article–and some comments.
This is the master plan that ALEC and Heritage and the Rutherford Institute and the rest of the “vast, right-wing conspiracy” that Hillary talked about 20 years ago has been developing, perfecting, and implementing ever since Reagan. A few commentators have pointed it out for years, even decades: break it, then complain it’s broke, and give it to your rich friends to “fix.” Slash taxes for the rich (and cut them by 2% or 3% for the rest of us, then declare a budget crisis and slash spending even more. Meanwhile, sell state assets to those same friends at fire-sale prices to cover the immense deficits, as has been done recently in Louisiana and Kansas. This is the predictable, and predicted, and PROVEN result of “Reaganomics.” So watch for privatized highways and bridges next, to go with the schools, Medicaid, prisons, etc.
What amazes me is that IT’S TAKEN SO LONG FOR COMMENTATORS LIKE THOMAS MILLS TO WAKE UP AND REALIZE IT. It’s been going on for 35 years, with planning in place during the Nixon era, for gawdsake.
The truly sad reality is that conservatives from rural areas are undermining their own communities and handing a boon to urban areas. Medicaid is an essential payor for healthcare in rural communities. (Not expanding Medicaid plays a huge role in why individual health insurance policies are so expensive in rural NC.) CCNC served to support community healthcare delivery systems. Privatizing Medicaid payment will likely undo that support and further undermine those systems. Who wants to live–much less start a business–in a community that has no doctors or emergency care? That is why the mayor of Belhaven raised such a stink.
Sure, the big medical centers are buying up small physician practices and hospitals in urban as well as rural areas. (Fat lot of good it did Belhaven.) Their reimbursement rates are higher, not lower, though, and consumers are having to pay more out of pocket. Moreover, their interest in rural areas is primarily to draw patients and dollars out of their home communities and into the big urban centers (Durham, Chapel Hill, Charlotte…)
In theory, healthcare delivery is rationalized, maybe even more efficient, although that remains to be seen. If you look across the United States, healthcare systems that successfully achieve effectiveness (good outcomes, healthy people) with efficiency (low per capita costs) are not in big cities with competition among huge medical-industrial complexes. They are in areas where community-based health care providers collaborate to take a population-based approach to delivering services. (Check out the work of Elliott Fisher at the Dartmouth Institute or just look for maps that show per capita Medicare spending.)
The visionaries who created CCNC got it. I doubt the MBAs running stockholder-owned managed care companies will give a shit about North Carolina towns like Wilson, Eden, or Spruce Pine.
I’m with you, Puzzled. CCNC got it right, and was in process of getting more of it right. This move by the NCGOP to throw public money at the private sector will back-fire, because, at the end of the day, profit will be given priority over people’s care.
Why is not William James the prominent American Philosopher whose philosophy is called Pragmatism not more revered than the fabulist novelist and second rate philosopher Ayn Rand who took her name ironically from a machine is heart wrenching for what is under the hood of all these people aim for.
Einstein said, “You cannot go wrong if your goals are correct.” and they have goals defined by Free Trade? Free Markets, and Privatization of government in such a confused and simplistic jumble at the same time that it may as well just be called licensure to loot and destroy as was the C.S.A. aim to eat at the heart of the U.S.A. from within before the full outbreak of the Civil War.
It is not the will of the people as much as tricks of gerrymandering and lies along with ignoring of the facts, and goals? Their goals are to privatize everything and create a bureaucracy of the Corporation.
The goals of the Corporation are enslaving the people as wage slaves for all MBAs are taught from the first and second and third to simply never pay labor, and never give power to labor in any board room.
This explains the fear that too many citizens will vote. How those votes are counted is a fear to be faced as the machines are now to be replaced.
A Democratic Party that abandons the field where it is most fought on the TV Screen as it is as well now to nominate the supposedly pragmatic candidate that Barney Frank says will do the US good as Sanders ever could when the leader Trump sets the agenda for the GOP with more of the block headed solutions Dictator Mussolini forced down the throats of the Italian people fine with it till they weren’t.
Nothing works that you don’t believe in, and don’t kid yourselves that GOP and NC leadership really believes in Democracy and the wisdom of the people.
And no other institution is more against risk than the real insurance companies who would see us all strapped down in one place like pigs and chickens in industrial farms before led to slaughter.
Thomas: You are so on-the-mark. You wrote “Maybe they can break it so bad the GOP will argue to scrap it altogether……Republicans needed to prove a point: Government can’t do anything right. To do it, they broke a program that was working and now added uncertainty to the lives of hundreds of thousands of North Carolinians.” This, of course, is the overarching master plan that the NCGOP has followed to weaken and winnow down government programs in NC since 2010—no matter how important those programs may be.
The recipe? Break/undermine a public program by cutting/limiting its budget, then claim that it doesn’t work well enough, then invite the private sector in to “fix it.” And who cares that the top aim of private enterprise is profit, a priority well ahead of any public service priority, right?
Maurice: Dollar is normally a strident supporter of and shill for all that the NCGOP wants done. But his Cary district is not so badly gerrymandered that he can totally support the neo-con agenda of his party with impunity. I’ll guess that he’s hearing from some unhappy constituents about all the partisan and ideological moves his party is advancing. I am not surprised in the least that he will voice opposition to the more extreme and egregious efforts of his GOP colleagues.
The Charlotte Observer reports that Rep. Nelson Dollar, a Cary Republican, said arguments that Medicaid costs were out of control are wrong, and that it is a mistake to invite into the state commercial HMOs, which “have failed repeatedly in North Carolina.”
We need reform in North Carolina that is based on caring for our citizens, not for a group of stockholders,” Dollar said.
http://www.charlotteobserver.com/news/politics-government/article36225402.html#storylink=cpy
Let’s not forget the fact, and I believe it is a big part of the motivation, that the NC GOP right wing nuts also create a new donor class when they put Medicaid in the hands of mostly for-profits…just like was done with prison privatization across the country.