The Return of Much-Needed Medicaid Reform

Last year, I narrated this video making the case for Medicaid reform. The proposal is very simple: Replicate the success of the welfare reform of the 1990s by block granting the program and giving states full autonomy to figure out how best to provide health care to low-income people.

Medicaid reform is critical to save the nation from Greek-style fiscal collapse, especially if it is part of a comprehensive modernization of entitlement programs, and I was very impressed that the House of Representatives actually adopted a version of this reform last year as part of the Ryan budget.

But with the Senate refusing to enact a budget and Obama opposed to reform, the proposal languished.

In this case, though, languish is not the same as die. Led by Congressman Rokita of Indiana, reformers on Capitol Hill have introduced a new proposal to block grant Medicaid.

As you can see from the chart they prepared (click to enlarge), the proposal will cap outlays for the block grant at the current level of Medicaid spending. This policy will save $1.8 trillion over the next 10 years, when compared to leaving the program on autopilot.

Writing about the proposal, Emily Miller of the Washington Times opined.

At the state level, Medicaid is the biggest expenditure, growing at a faster pace than even Medicare. Making matters worse, Obamacare mandates will increase the Medicaid rolls by an estimated 17 million to 25 million people. In order to give states flexibility to deal with this, the House rank-and-file GOP would eliminate the one-size-fits-all mandates for the federal funds. This also would provide better care.

The Washington Examiner also is impressed by the new proposal.

Medicaid represents a federal mandate that forces state governments to shoulder as much as half of the program’s annual costs but allows them virtually no say in how it is run. Even if Washington permitted the states some flexibility, there is little incentive for them to figure out more efficient ways to operate Medicaid, since the federal subsidy is paid with only incidental concern about performance. And thanks to Obamacare, unless Medicaid is reformed before 2014, the burdens it imposes on the states will only grow more severe. That’s when Obamacare requires state governments to spend an estimated $118 billion more of their own money in order to extend Medicaid coverage to an additional 17 million to 25 million people. Four House Republicans want to change all of that by converting the federal government’s share of Medicaid and Children’s Health Insurance Program funding into a single block grant with none of the strings that now prevent state officials from improving the way the program is managed.

These are all good points. The bottom line is that failure to reform entitlements guarantees that politicians eventually will impose a value-added tax. Or they’ll push red ink to unsustainable levels. Actually, based on what’s happened in Europe, where higher taxes simply meant higher spending and more debt, we’ll get both.

Simply stated, Medicaid reform is good health policy and good fiscal policy.

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Great Moments in European Political Correctness

Europe is in shambles. Nations are going bankrupt. There are riots in the streets. So you would guess that the folks at the European Commission are focused on some big issues.

But you would be wrong.

The eurocrats in Brussels have much bigger fish to fry. They’re addressing the unmitigated horror of inadequate female representation in corporate boardrooms and contemplating continent-wide quotas.

I’m not kidding. Here are some excerpts from the New York Times report.

Frustrated that her previous efforts to get more women into the top echelons of European business have not yielded stronger results, Viviane Reding, the senior justice official in the European Union, was to announce a new effort Monday that could result in legislation requiring that women occupy up to 60 percent of the seats on corporate boards. …E.U.-wide rules were now needed, she said. “Personally, I don’t like quotas,” Ms. Reding said. “But I like what the quotas do. Quotas open the way to equality and they break through the glass ceiling.” Countries that have quotas “bring the results,” she said. Ms. Reding has long campaigned for major changes in European boardrooms and had given industry “a last chance” to improve its record on placing women in top management.

Isn’t that nice. She doesn’t like quotas, but she has no choice because she gave industry a “last chance” to engage in gender bean counting and they didn’t comply.

I wonder if it’s ever occurred to this über-bureaucrat that it’s not her job to tell private companies who to hire, fire, or promote?

"Nice business you have, shame if anything happened to it"

As an aside, the New York Times manages to demonstrate its bias by directly implying that “genuine equality” only exists if boardrooms have equal numbers of men and women.

Having now concluded that self-regulation has failed, Ms. Reding has set her sights on legislation that could, if enacted, drastically speed up a revolution in the position of women in the workplace that began many decades ago but has so far failed to deliver genuine equality in many areas of business.

Has it ever occurred to the reporter that “genuine equality” exists when everyone has an equal chance and government doesn’t put a thumb on the scale? But regardless of what he thinks, doesn’t good journalism mean keeping his opinions to himself?

Maybe I’m just too old fashioned.

Let’s return to the meat of the story and the actions of Ms. Reding. In this passage, I like how she blames “society” because companies didn’t kow-tow to her voluntary suggestions.

In the announcement to be made Monday, Ms. Reding will call for a new round of consultations with governments, trade unions, companies and civil groups. The move comes a year after she called on companies to take voluntary steps to increase the representation of women on boards to 30 percent by 2015 and to 40 percent by 2020, by replacing departing male directors. …Ms. Reding said that the severe economic downturn in Europe that has pressured companies to focus on their bottom lines was not responsible for the failure of her voluntary initiative. “It is really a question of society,” she said.

The story continues with discussion of the onerous plans being concocted by Ms. über-bureaucrat.

Ms. Reding said that the consultations, beginning Monday and ending on May 28, would determine the proportion of women that should be on boards under any E.U.-wide legislation; whether quotas should apply to state-owned companies as well as publicly listed ones; whether both executive and nonexecutive boards should be covered by the rules; and what sanctions should apply to companies that do not meet the objectives, and if there are circumstances where exceptions are necessary.

Unfortunately, the private sector in Europe has the same cringing approach as their counterparts in the United States. Instead of boldly saying that corporate boards are a private matter for shareholders to decide, representatives from big companies accept the intrusion and merely complain about implementation.

…the European Round Table of Industrialists, a forum for the chairmen and chief executives of major multinational companies, has warned that big divergences among sectors and national traditions meant any measures should remain voluntary. “Societal changes take time,” said Carlo Bozotti, the chief executive of STMicroelectronics, a semiconductor company, and the head of a group at the Round Table looking at the issue. “There is no one-size-fits-all solution for industrial companies from multiple sectors, of various structures, and from diverse cultural backgrounds,” he said.

The article concludes with an assertion that “gender-diverse” boardrooms lead to better economic performance. That may very well be true, but it suggests that shareholders are deliberately sacrificing income and wealth in order to retain something akin to an old boys’ network. That seems rather implausible, to say the least.

There is plentiful evidence from business consulting firms including McKinsey & Co., and from Catalyst, a nonprofit research group, that companies with gender-diverse management teams experience higher growth in their share prices, better-than-average operating profits, and outperform their rivals in terms of sales, return on investment capital and return on equity, according to the report. That research showed that women asked more questions and made fewer reckless decisions, proving that “women are not a cost, women are a benefit,” Ms. Reding said.

I want to close with a semi-optimistic note. As crazy as it is for Ms. Reding to try to dictate the number of men and women in corporate boardrooms, at least she’s not complaining about discrimination based on looks or height and trying to get government involved in those areas. At least, not yet.

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