Miserable by Design - New York Times
The New York Times

October 3, 2005

Miserable by Design
By
PAUL KRUGMAN

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.

List of 11 items
. Copyright 2005
The New York Times Company

Posted by Miriam V.