[Mb-civic] Krugman

[Mike Blaxill]

Miserable by Design
    By Paul Krugman
    The New York Times

    Monday 03 October 2005

    Federal aid to victims of Hurricane Katrina
is already faltering on two crucial fronts:
health care and housing. Incompetence is part of
the problem, but deeper political issues also
play a crucial role.

    Start with health care, where conservative
senators, generally believed to be acting on
behalf of the White House, have blocked
bipartisan legislation that would provide all
low-income victims of Katrina with health
coverage under Medicaid.

    In a letter urging Senate leaders to reject
the bill, Mike Leavitt, the secretary of Health
and Human Services, warned that it would create
"a new Medicaid entitlement." He asserted that
victims can be taken care of by Medicaid
"waivers," which basically amount to giving
refugees the health benefits, if any, that they
would have been entitled to in their home states
- and no more.

    As the Center on Budget and Policy Priorities
points out, many needy victims won't qualify for
aid. For example, Medicaid doesn't cover
childless adults of working age. In fact, surveys
show that many destitute survivors of Katrina are
being denied Medicaid, and some are going without
medicines they need.

    Local hospitals and doctors will often treat
Katrina victims even if they can't pay. But this
means that communities that have welcomed Katrina
refugees will, in effect, be financially punished
for their generosity - something local officials
will remember in future crises. (The
administration has offered vague, unconvincing
assurances that it will do something to
compensate medical caregivers. It has offered
much more concrete assurances that it will
reimburse religious groups that provide aid.)

    What about housing? These days, both
conservatives and liberals agree that public
housing projects are a bad idea, and that housing
vouchers - which help the poor pay rent - are
much better. In the aftermath of the 1994
Northridge earthquake, special housing vouchers
issued to victims worked very well.

    But the administration has chosen, instead,
to focus its efforts on the creation of public
housing in the form of trailer parks, which have
been slow to take shape, will almost surely be
more expensive than a voucher program and may
create long-term refugee ghettoes. Even Newt
Gingrich calls this "extraordinarily bad policy"
that "violates every conservative principle."

    What's going on here? The crucial point is
that President Bush has been forced by events
into short-term actions that conflict with his
long-term goals. His mission in office is to
dismantle or at least shrink the federal social
safety net, yet he must, as a matter of political
necessity, provide aid to Katrina's victims. His
problem is how to do that without legitimizing
the very role of government he opposes.

    This dilemma explains the administration's
opposition to Medicaid coverage for all Katrina
refugees. How can it provide that coverage
without undermining its ongoing efforts to reduce
the Medicaid rolls? More broadly, if it accepts
the principle that all hurricane victims are
entitled to medical care, people might start
asking why the same isn't true of all American
citizens - a line of thought that points toward a
system of universal health insurance, which is
anathema to conservatives.

    As for the administration's odd insistence on
providing public housing instead of relying on
the market, The Los Angeles Times reports that
Department of Housing and Urban Development
officials initially announced plans to issue rent
vouchers, then backed off after meeting with
White House aides. As the article notes, the
administration has "repeatedly sought to cut or
limit" the existing housing voucher program.

    This suggests that what administration
officials fear isn't that housing vouchers would
fail, but that they would succeed - and that this
success would undermine the administration's
ongoing efforts to cut back housing aid.

    So here's the key to understanding
post-Katrina policy: Mr. Bush can't avoid helping
Katrina's victims, but he doesn't want to
legitimize institutions that help the needy, like
the housing voucher program. As a result, his
administration refuses to use those institutions,
even when they are the best way to provide
victims with aid. More generally, the
administration is trying to treat Katrina's
victims as harshly as the political realities
allow, so as not to create a precedent for other
aid efforts.

    As the misery of the hurricane's survivors
goes on, remember this: to a large extent, they
are miserable by design.

http://www.truthout.org/docs_2005/100305N.shtml