Tag: New York

Daily News Op-Ed: Why Is Governor Cuomo Still Trying to Cut Medicaid?

(My Roosevelt colleague Naomi Zewde and I have an op-ed in the March 26 Daily News, criticizing Governor Cuomo’s plans to push ahead with cuts to state Medicaid spending despite the epidemic.)

Last week, as the coronavirus shut down much of New York, the state announced a bold plan to drastically cut funding for the state’s hard-pressed health care providers.

That’s right: As the coronavirus crisis escalates across New York State, Gov. Cuomo is proposing to slash funding for those at the frontlines.

Specifically, the cuts come via the Medicaid Redesign Team, appointed last month by the governor with the charge of cutting $2.5 billion from the state’s annual health spending. These cuts will not only mean an even more overstretched health care system; they will mean lost jobs.

For example, $200 million is slated to be cut from Consumer Directed Personal Assistance (CDPA), which allows elderly or disabled New Yorkers to hire their own home care assistants. As a Daily News editorial recently noted, CDPA was responsible for 36,000 new private-sector jobs in New York City in 2019, a lion’s share of all such jobs.

The biggest savings come from across-the-board cuts to health care providers, including $400 million from the state’s hospitals.

Cutting health spending in an epidemic seems like obvious lunacy. But it’s even worse than it seems.

Since the start of this epidemic, nearly one in five American households have had their hours cut or been laid off due to the virus. In New York, Cuomo said that the state has “never seen such volume” of unemployment claims.

As the economy slides over a cliff, we desperately need to keep people employed so that they can pay their bills and keep local businesses running. The proposed cuts will not only kneecap our health care system, but they will also deepen the coming recession.

But don’t we have to do something about out-of-control Medicaid spending? No, we do not. Medicaid spending is already under control.

Over the past five years, Medicaid spending in New York has risen by a steady 4% a year — exactly the same growth rate the state’s economy has had as a whole. And thanks to the Affordable Care Act, the share of total Medicaid costs paid by the state has gone down.

The apparent Medicaid crisis is entirely of the governor’s own making. When an arbitrary “global cap” on Medicaid spending turned out to be unachievable, instead of accepting reality, the state shifted a portion of the bill from fiscal year 2019-2020 to 2020-2021. This created the illusion of a big rise in this year’s costs.

Not only are there no runaway costs to rein in, but health spending is also an important economic stimulus. About 13% of New Yorkers work in health care — more than in manufacturing and finance combined. New York’s hospitals are stable sources of employment in many communities where good jobs are scarce. While many of the state’s traditional industries are in decline, health care promises to be a growth industry in the 21st century — if its growth isn’t cut off by shortsighted cutbacks.

Cutting state Medicaid spending today would be especially perverse, as the federal government appears poised to pick up a larger share of the program’s spending, just as it did in the last recession.

When private sector spending falls in a recession, the role of government is to lean against the wind, and boost public spending to fill the gap. Fiscal stimulus is primarily the responsibility of the federal government, but a state as large and rich as New York should also do its part — especially if leadership in Washington is lacking.

In normal times, trying to balance the budget through Medicaid cuts would be a mistake. Today, it is economic malpractice.

A Most Violent Year

I just watched this movie.

Oscar Isaacs plays the owner of a fuel oil company in 1981, the peak year of violent crime in New York City. Needless to say, it’s an industry in which organized crime is salient, in real life and of course double in the movies. But he just wants to sell fuel oil. One way of looking at it, is it’s The Sopranos from the point of view of the people they preyed on. Another way, it’s the kind of movie Deirdre McCloskey used to call for, a celebration of bourgeois virtue. I don’t know if McCloskey would like the results in this particular case. What’s very clear here is how much bourgeois virtue depends on, or is constituted by, its dialectical relationship with the liberal order on the one hand, the rule of law; and on the other hand the personal loyalties of family and tribe. Your status as a business owner depends on your relationship to your wife, children, in-laws, on the one hand, and to the agents of the state on the other. The capitalist is always an embodied human being, never the pure personification of capital. (It’s worth noting that Isaacs’ key counterparties are a Hasidic clan and a grandfather-granddaughter operation.)

We also see the void at the heart of the capitalist ethic. Several times, other characters ask Isaacs why it’s so important to him that his business keep growing. His answers range from “Just because” to “I don’t understand the question.” These exchanges reminded me of a line from Nietzsche that Bob Fitch used to describe real estate speculators:

We must not ask the money-making banker the reason for his restless activity, it is foolish. The active roll as the stone rolls, according to the stupidity of mechanics.

Isaacs’ performance is quite affecting, and it’s clear that his character has real human connections to his family, his employees, and his business peers. That only makes it more effective when we see how much his concrete choices come down to “the stupidity of mechanics.”

The depiction of New York back in the day feels real. The dialogue is smart and the camerawork and sound are effective, in my uniformed judgement. It’s a good movie, I recommend it.

The Wheels of Justice Do Grind Slow

I’ve had only had one job that paid minimum wage (or minimum plus 50 cents, as I recall.) That was as a bookstore clerk at Shakespeare & Company on the Upper West Side in the mid-90s.

The 85th St. bookstore was the flagship of the Shakespeare operation, which at that time included four Shakespeare and Co stores, two or three Murder Inks, and I think one or two other literary bookstores. It was generously, maybe from a strict business standpoint, overgenerously, staffed. We did spend a lot of time reshelving.

What’s memorable about the place is how everybody there was a book person. Some of us wanted to write fiction, some essays, some plays (that was kind of the store’s thing). Some wanted to work at publishers, some — for serious — were into the printing and bookbinding side of things. Most of of us wanted to write book reviews; some — well me, at least — left to edit the book review section of a marginal left-wing magazine. The book culture of the place was smoothly continuous from those of us behind the registers to the buyers to the mysterious owners upstairs. When publishers’ representatives came by we all met them, as a matter of course: they were selling to the store. I remember one of them spinning out this mystery novel she was going to write about a serial killer knocking off Granta‘s best young American novelists one by one; it seemed like a pretty good joke.

They used to have contests, beginning of the week, pick a book, whoever sells the most of it wins, well, I don’t remember what the prize was. Anyway I took it seriously; books I thought people ought to read. Oh hey, you’re interested in history, do you know Eric Hobsbawm? Oh, Jared Diamond, sure, but you know Plagues and Peoples covered a lot of that same ground? It was a point of pride.

And we hated shoplifters. There was one fellow who was a regular — he was obviously getting instructions on what specific resaleable books to steal. One time we’d had enough — it so depressing when two hours before closing there’s no one in the store except the professional shoplifters — and when he made his run for it we didn’t just accept the alarm-went-off;-oh-well as always. We took off after him. Why? it wasn’t our money. But we did: we caught him: or rather, like a lizard’s tail, we caught his bag, full of stolen books and hypodermics.

I first encountered the word “snarky” working at that bookstore. It was in a New York Magazine article about what was wrong with us, what was wrong with independent bookstores in general, why chains were the future. People wanted an antiseptic book purchasing environment, not all those book people telling them what to read. Whatever, we thought, all separately wondering how to incorporate “snark” into our new novel. But we should have seen the writing on the wall.

When the Barnes & Noble opened at 66th St., that was bad. When the next one opened at 82nd and Broadway, that was the end. This was not long after I started; surrendering, they had a going-out-of-business sale. And that was even worse. There was a brief false summer as the locals — our former customers! — picked over the stock that was suddenly attractive at 40% off; but as soon as the owners unwisely tried to reopen at full price those same customers tripped over each other rushing back to the lattes at Barnes & Nobles.

For the record, I suspect that if the Shakespeare & Co. guys could have competed with Barnes and Nobles at their scale, they would happily have done so. They weren’t doing it for the sake of small. Still, what matters is that you can get the books you want, and there it’s all progress, right? From your point of view as a consumer, probably, sure. I’m prepared to argue that you lose something when there are no more bookstore clerks like me, trying to sell you on William H. McNeill. On the scale of things it’s a small loss, but it’s a retreat from the world as it should be.

I don’t know if Shakespeare hired us because no one but book people would work for what they would pay, or because they had some vague idea that their clerks would rise to manage their little empire or simply because they were book people themselves. But hire book people they did. Within their world, you could imagine that it was a natural progression from clerking at a bookstore, to buying for a bookstore, to editing novels, to writing novels. As in a civilized world it will be.

Which is all to say: Fuck you, Barnes & Noble. I hope all of your stores close.