Rural Incentives Are Inefficient

Keith Rural Subsidies would be a more accurate name.

Keith Rural Subsidies would be a more accurate name.

Every country music fan and Sarah Palin supporter understands that real America lies thriving and vibrant somewhere between the immoral coastal cities and other places that with disproportionate shares of minorities. What is less known is how frequently Congress uses tax money to make the rural lifestyle more practical. For example, via Kaiser Health News, we see there’s plenty of support from a cadre of bi-partisan, “fiscally responsible” rural Senators to encourage significantly higher Medicare payment rates for rural hospitals that aren’t actually far from other medical institutions.

Congress created the “critical access hospital” category in 1997 to ensure access to care in isolated parts of the country. Under the law, hospitals that are at least 35 miles away from other health facilities can be deemed “critical access” hospitals; those hospitals can collect 101 percent of their costs from Medicare, for a maximum of 25 beds, rather than the usual 95 percent of allowable costs.

Growth in such hospitals exploded, and by 2006, there were 1,280 critical access facilities. And many of them won the designation despite being located within 35 miles of other medical facilities; state officials routinely waived the requirement with federal acquiescence.

The rapid growth slowed three years ago when Congress, worried about billions of dollars in added Medicare costs, eliminated states’ rights to waive the 35-mile rule. Since then, only a couple of dozen new critical access hospitals have been designated. The total is currently about 1,300.

Now lawmakers from rural states want to ease the rules, partly by making it easier for hospitals to qualify for “critical access” status even if they are less than 35 miles from another facility. Supporters note that the hospitals, besides providing emergency and limited inpatient treatment, are often the mainstays of small-town economies. “Hospital reimbursement systems that work well in larger cities do not necessarily work in rural towns, where people still need health care,” Pryor’s spokeswoman said, “but the same volume of patients is not present.”

The point here is that there are serious economic incentives to living in urban, more densely populated areas. One such benefit is close access to emergency medical care. I don’t posit that rural Americans should be condemned to die, but where you choose to live actually is a matter subject to at least some individual preference, and using Federal policy to tilt the scales in an inefficient, impractical, and anti-majoritarian direction really doesn’t seem like an appropriate use of  tax money. If people want to live in more remote urban areas, then that’s fine, but they should at least have to accept that there are significant trade offs to doing so (or maybe send us urban folks picking up the tab a thank you note or something).

Ending these sorts of policies, which build on a long tradition of funneling Federal money towards poor, rural states (whose politicians often bristle at the mere hint of Federal spending), would ultimately encourage more optimal use of resources while — wait for it — using the magical powers of the free market.


Palin and Inherent Links

Behold, as Sarah Palin takes to the Washington Post to deride cap-and-trade legislation without even once mentioning “climate change,” the more politic and civil cousin of “global warming.” As Kate Sheppard says, “this op-ed is just bad enough to make me wonder if Palin may have written it herself.” Indeed. Palin predictably opens with with the simultaneously ironic and sadly accurate attack on the media, who in her view, spends too much time covering her press conferences and not enough time addressing the policy issues of our day. And true enough! But unfortunately, the wheels fall off shortly thereafter.

At first I was going to do a “quote by quote” rebuttal of the Palin’s assertions, but instead I’ll just post the requisite links so you don’t risk brain damage from reading the op-ed itself.

  1. EPA projected GDP with Waxman-Markey
  2. Cost estimates from the CBO
  3. The minimal effect of expanded off-shore drilling

You’ll note there are only three links, and none of them go to studies showing the costs — both human and economic — that global warming will cause. That, of course, is because Palin doesn’t address the notion that climate change is harming the planet. After all, it’s much easier to win an argument that’s literally one-sided — who can blame her? What’s remarkable though, is Palin’s ability to generate complete nonsense even without conceding climate change is a problem. It’s pretty impressive:

American prosperity has always been driven by the steady supply of abundant, affordable energy. Particularly in Alaska, we understand the inherent link between energy and prosperity, energy and opportunity, and energy and security. Consequently, many of us in this huge, energy-rich state recognize that the president’s cap-and-trade energy tax would adversely affect every aspect of the U.S. economy.

For the sake of argument, let’s allow the first point, that American prosperity has always been driven by a steady supply of abundandt, affordable energy. Anyway, I’d really like to hear Palin explain why there is an “inherent” link between energy and security. Let’s say, for example, that the entire world recevied its energy from the sun. If this were the case, then no nation would have a competitive advantage when it came to powering their societies, and thus would have no need to benefit from another nation’s expense. Thus, the link between energy and security is not “inherent.” What Palin means, however, is that there is an inherent link between limited, valuable resources and security. To Palin, this “consequently” (?) proves that a cap-and-trade plan would adversely affect the economy, but what it actually demonstrates is the need to move away from limited, valuable resources. Palin’s solution to this problem, it seems, is to rely more heavily on limited, valuable resources.

Redneck Indeed

Ugh…can’t resist… (via Karen Tumulty)…those nutty Wassilans

WASILLA — A 42-year-old Wasilla woman was arrested Thursday at her home by Alaska State Troopers with a search warrant in an undercover drug investigation. Sherry L. Johnston was charged with six felony counts of misconduct involving a controlled substance.

Johnston is the mother of Levi Johnston, the Wasilla 18-year-old who received international attention in September when Gov. Sarah Palin and her husband, Todd, announced their teenage daughter was pregnant and he was the father. Bristol Palin, 18, is due on Saturday, according to a recent interview with the governor’s father, Chuck Heath.


Gift Idea

Via Marc Ambinder, anyone looking for a gag gift…

You betcha, it’s the 2009 Sarah Palin calendar! A perfect gift for those looking to pay homage to the most embarrassing era in American political history without spending $150,000 at Saks Fifth Avenue! See the Palins as they exist in nature: strafing animals, dilling-baby-drilling, denying science, and acting all fertile and shit!


A lot of people have watched this interview with Sarah Palin where something uncomfortable looking is happening to a turkey in the background.

Frankly, I was pretty underwhelmed. Anyway, what I thought was interesting was the part of the interview where Palin talks about how Alaska state budgets will have to adjusted to account for the declining price of oil. One of Alaska’s oddities is that shares more in common with Iran, Russia, Venezuala, and Saudi Arabia than most people realize.

Annals of Self Defeating Arguments

Sarah Palin, on “Preconditions”:

WILLIAMS: What — first of all, what in your mind is a precondition?

PALIN: You have to have some diplomatic strategy going into a meeting with someone like Ahmadinejad or Kim Jong-il, one of these dictators that would seek to destroy America or her allies. It is so naive and so dangerous for a presidential candidate to just proclaim that they would be willing to sit down with a– a leader like Ahmadinejad and just talk about the problems, the issues that are facing them. So that — that’s — that’s some ill-preparedness right there.

Does Sarah Palin know what a precondition is?

You Son Of a Bitch…

This tepid “endorsement” of the Palinator is not even close to my favorite Arnold clip, but way better than End of Days:

And for good measure…my favorite Arnold clip…