THE TREATMENT NOVEMBER 1, 2009
During the Bush years, a fellow at the Kennedy School of Government was writing a book called Savin’ it! on abstinence education in the public schools. As part of his research, he contacted then-Attorney General John Ashcroft with a request for personal testimony. His letter noted:
The book’s fourth chapter, ”Role Modelin’ It!” will feature the personal stories of abstinence heroes for our nation’s young people to emulate …I would very much appreciate if you could share your abstinence story. I can tell by your passionate advocacy that you will have a lot to offer this book… I hope you will find the time to inspire the next generation of sex-free leaders.
I don’t know whether the author ever completed this monograph, though he did complete another book soon after.
My next health policy book will include a similar chapter on what you might call budget abstinence heroes: Men and women will proclaim the virtues of fiscal conservatism, and then actually resist the temptation to mess around in the fine print when the adults aren’t looking.
Sadly, I can’t find many self-avowed fiscal conservatives who honor the budget abstinence pledge. Consider these lines from the Washington Post:
House leaders abandoned an effort to include a public option backed by liberals that would establish reimbursement rates to providers based on Medicare. Rural Democrats strongly opposed that approach because of the potentially ruinous effect on doctors and hospitals in their districts, where Medicare rates are generally well below the national average.
Only a few lines later:
House negotiators were able to lower the price tag in part by expanding Medicaid coverage to a broader slice of the population... The adjustment reflects findings by congressional budget analysts that covering the poor through Medicaid--which pays providers far less than Medicare--is far more cost-effective than offering subsidies for private insurance policies.
To recap: Rural hospitals will be protected from efforts to reduce the deficit by imposing Medicare reimbursement rates. Urban hospitals (and patients and states) will be forced to accept a system of far lower reimbursements, in order to spare the federal government the cost of private insurance.
This is not a particular surprise, but the hypocrisy is galling. To avoid the evils of a government-run program moderates say will pay providers too little, we’ll put a markedly larger population into a government-run program that pays providers even less.
I can tolerate another giveaway to rural constituencies who profit from our peculiar political system. When the recipients of such giveaways--Mike Ross, Kent Conrad, and others--are such ostentatious advocates of fiscal discipline, it’s a bit rich.
Money and sex have a way of exposing the hypocrisy in all of us. At least when our kids are old enough to demand our personal abstinence stories, we have the decency to blush.