What's This? Democrats and Republicans are both right

Surprise! Democrats and Republicans are both right.

Those on the far right like Grover Norquist see government as a monster which must be shrunk in size "until it can be drowned in the bathtub." To people like Norquist, government is wasteful, needlessly duplicates programs, and consistently fails to reach its goals. Indeed, there is some evidence to support him.

"Based on our rough calculations, less than $1 out of every $100 of government spending is backed by even the most basic evidence that the money is being spent wisely. As  former officials in the administrations of Barack Obama (Peter Orszag) and George W. Bush (John Bridgeland), we were flabbergasted by how blindly the federal government spends. In other types of American enterprise, spending decisions are usually quite sophisticated, and are rapidly becoming more so . . . But federal government - where spending decisions are largely based on good intentions, inertia, hunches, partisan politics, and personal relationships - has missed the wave." (The Atlantic, 6/19/2013).

According to Orszag and Bridgeland, much of the problem stems from the fact that Congress rarely evaluates the success or failure of the programs it launches. "Evidence of success is barely considered when legislation is proposed and discussed in committee and on the floor of Congress. There is no systematic way in which members of Congress or other key decision makers are informed about that evidence, or lack thereof. They instead tend to rely on ad hoc assessments provided by lobbyists and interest groups. And once legislation is up and running, there is no mechanism for automatically tracking its effectiveness, beyond counting the number of people served by a program, no matter what the impact it has on their lives."

So, faced with these unsettling facts, extreme right-wing purists might retreat to a position where the federal government does little more than repair interstate roads and raise a military. "Leave whatever governing must be done to local government."

Hmm. Only one problem here. Our local selectmen seem about as prone to make mistakes as federal officials are. Also, as Chris Muns pointed out to me, we can't govern in the 21st Century using a model designed for the 18th Century when towns were largely isolated from one another and had to depend on their own resources to solve life's problems. In modern-day America, we have by their very nature some problems that are indeed local in nature; others that are state-wide; and still others that involve the entire nation.

Also, as far-right types are loath to acknowledge, some governmental expenditures are wise investments that actually save money in the long run.

In an AP story (07/08/13), Lauren Neergard writes about the relative costs of nursing homes versus fixing up elderly people's residences so that they can continue to live there. According to the AARP, the average cost of a nursing home per resident is $50,000 per year. Much of the time, that substantial figure is paid by a governmental program, Medicaid.

It should come as no surprise to anyone, that rather than living in a nursing home, the vast majority of older Americans would prefer to remain in their homes as they age. An AARP study in 2010 found that nearly 90 percent of seniors want to remain in their current home for as long as possible. And it would be cheaper, much cheaper, for taxpayers to help them do so.

The thing that often drives senior citizens out of their homes are not physical disabilities per se, but rather their inability to get around their residences. Neergard writes, "Environment can be as disabling as disease, and too often, older Americans wind up in a nursing home not because they are so ill but because they can't get through their days safely."

Neergard comments, "A major research project (funded by the National Institutes of Health and the Centers for Medicare and Medicaid services) will bring handymen, occupational therapists, and nurses to the homes of 800 low-income seniors in Baltimore to test if some inexpensive fix-ups and strategies for daily living can keep them independent longer, while saving millions in taxpayer dollars spent of nursing home care."

So, does this story have a happy ending? Let's wait and see. According to Orszag and Bridgeland, the outcome should be rigorously tested to see if the money was well spent.

On the other hand, should we simply ignore the needs of the elderly, put them on ice floes and push them out into the Bering Sea? The more callous amongst us might think that's not a bad idea. But, most of us take a more sympathetic view of grandma.

No, let's combine Republican demands for cost effective government with Democratic concerns about meeting the needs of the average person to produce programs that have a demonstrable record of success. Compromise is not a dirty word.