Leadership and Crisis

by Bobby Jindal

  I also support the use of the death penalty in instances of violent child rape. What? The death penalty for a crime other than first degree murder? Yep, you heard me right. In Louisiana we had a law stipulating that if you violently rape a child under the age of twelve, you might face the death penalty. It was applied in a case in Harvey, Louisiana, a few years ago involving an eight-year-old girl who was violently raped by her stepfather. The case is too awful to describe here, but the girl suffered serious internal injuries and immense psychological trauma. As the prosecutor in the case rightfully put it, child rape is in some ways worse than homicide. For its victims, “It takes away their innocence, it takes away their childhood, it mutilates their spirit. It kills their soul. They’re never the same after these things happen.”

  Patrick Kennedy, the defendant, was found guilty by a jury of his peers and sentenced to death. The decision was upheld in the appeals process, but in June 2008 the U.S. Supreme Court declared the law unconstitutional in a 5-4 decision. The hearing sounded like a meeting of legislators. It was the justices’ “independent judgment” that there was a “national consensus” that the death penalty should apply in instances of first degree murder, but not brutal crimes such as child rape.5

  Funny, I wasn’t aware the Supreme Court had begun basing decisions on public opinion polls. One justice declared that child rape was not as heinous as first degree murder. (Tell that to the victim.) What an outrageous example of judicial overreach—the judges were assuming the role of legislators. Instead of making independent ethical judgments, they should have simply evaluated whether the law was consistent with the Constitution. When you violently rape a child you have indisputably devalued them and scarred them for life. You should face death.

  At this point, you may be wondering why I’m arguing for the death penalty in a chapter about life. Well, my point is this: we need to value our children by protecting them, nurturing them, and by devising harsh penalties for those who abuse them. It’s part of a culture of life. That may sound ironic, but it’s true. We value life so much that we’ll exact the ultimate penalty upon those who want only to destroy it.

  I realize that many people who want to crack down on these predators disagree with me on the death penalty; they’d prefer that we “lock ’em up and throw away the key.” I’m fine with that—let your conscience be your guide. But if you believe we should try to rehabilitate these people, that locking them up or executing them will make matters worse, then I don’t think we’re going to find any common ground. Sexual predators have a high rate of recidivism, and I’m just not going to take any chances with our children.

  We need to apply the same standard when it comes to the elderly. This is a particularly vulnerable group, especially because some old folks may deny their own usefulness to society.

  Euthanasia is a sure sign of a culture in steep decline. No thinking American is for euthanasia in its starkest and most obvious forms. However, Princeton Professor Peter Singer has argued for infanticide and euthanasia for the severely handicapped or disabled, claiming, “The notion that human life is sacred just because it’s human is medieval.” He also asserts people with Alzheimer’s cease to be people and should have their lives ended prematurely. His argument is so outrageous one is tempted to think he’s just trying to attract attention. For those who take him seriously, it should be noted that when it comes to his own mother, who struggles with Alzheimer’s, Mr. Singer rejected his ethic and hired a group of healthcare workers to look after her.6

  But the stark views that Singer and other academic types espouse are not the real threat, since the majority of Americans would never approve of killing Alzheimer’s patients. The bigger problem is presented by the more subtle forms of euthanasia, when the issue becomes cost control at the end of life. For example, are there any limits on the interventions we should take to prolong life? Maybe so, but one thing is clear: these decisions are difficult and must not be made by the government or some group of experts, but by the immediate family, the people who genuinely care for the patients.

  In the debate over nationalized healthcare, the challenge of euthanasia is a real one. It’s presented as a cost problem, and in a nationalized system healthcare cost will be the principal driver of decisions. When you think about it, all life is a cost problem. A patient-centered healthcare system is far more fair and compassionate in arbitrating these questions. When you are ninety-four years old with a long list of ailments and a prescription drug list to match, God help you if you are at the mercy of a faceless, heartless bureaucracy of a centralized government healthcare plan.

  But the main question here is not cost but control: who has the right to control end of life decisions? I have a simple answer: individuals should have the final say, as long as they are of age and of sound mind—period! If they are not of age or sound mind, then their immediate family members should make the decision. With the input and guidance of their doctors, who are bound by the Hippocratic Oath and are directly involved with their treatment, this is the best way to make these decisions.

  Who should never be involved in these decisions? The government. It’s that simple. Not in America. Ever.

  So how does our culture currently measure up on the “defense of the defenseless” barometer? Right now the gauge is in the red zone. Some people believe Roe v. Wade caused our current situation where we have turned our backs on the defenseless. But that’s not really true. That is merely a symptom, a result of a society where some people, particularly the elites, no longer believe in the innate value of human life.

  But I’m no pessimist. While some Americans no longer believe in the sanctity of human life, I think deep down most still do. Call it the shadow of our Judeo-Christian heritage or call it the ember of a divine spark in all of us, but most Americans still want to believe that human beings are of eternal value.

  In fact, there is strong evidence that shows Americans are gradually becoming more pro-life in their point of view. Polling by Gallup shows a ten-point increase in the number of Americans who consider themselves to be pro-life over the past decade. Fifty-one percent of Americans now consider themselves pro-life, the first time Gallup has ever reported a pro-life majority.7

  Scientific advancements and logic are at least partially the cause of this shift. Twenty years ago, when a young couple saw an ultrasound picture of their first child, it was a blurry scan that was almost impossible to decipher. With today’s technology, however, you know exactly what you are looking at. You see the form of your child, you see the wonder that has been created. In fact, I signed a bill as governor that requires providers to give an ultrasound to mothers before any decisions are made. It’s just common sense. It’s hard to see anything other than a precious little baby, your precious little baby. Suddenly it doesn’t matter whether you once were persuaded by the poll tested slogans of “reproductive freedom” or “freedom of choice”—that’s all a distant memory. You know what you are looking at, and you wonder at the marvel of this new creation, and you begin to think of the boundless opportunities that lie in the near future.

  We cheer and our hearts are warmed when people are pulled from the wreckage of a building. We don’t care how old they are or whether they are “useful to society.” It’s the rescuing of human life that matters. We have to fight to nurture that spark back to a flame and struggle against the devaluation of human life and the cultural coarsening it inevitably causes.

  CHAPTER 14

  SAVING MEDICARE

  Let’s face it: railing against big government without proposing specific ways to reduce costs can make for pretty good politics. But of course, it accomplishes very little. So let’s discuss a simple reform that could save a program that is now one of our biggest looming budgetary disasters.

  The growth in entitlements is the most serious fiscal challenge we face today. People might denounce foreign aid or defense spending, but the promises the federal government has made to the poor, retired, and elderly in the form of S
ocial Security, Medicare, and Medicaid dwarf other spending. In 2009, entitlements and other mandatory government spending comprised more than half the federal budget. If we are going to close the budget deficit instead of just talking about it, we’ll need to reign in entitlements. And by far the biggest and most challenging of these is Medicare, where spending is expected to triple by 2050.1

  The best way to defuse a ticking time bomb like Medicare is to reform it early, before we’re forced to take really disruptive measures. Congress had a chance to do that in 1997...and blew it. But the reform proposals that emerged back then point to a viable way to shore up Medicare’s long-term financing.

  Although Washington commissions don’t typically accomplish much, Congress had a real shot at reforming Medicare when the National Bipartisan Commission on the Future of Medicare was created in 1997. Republicans, who controlled Congress at the time, wanted to reign in exploding entitlements, and Democrats were showing a willingness to tackle what had long been a liberal sacred cow. President Clinton had conveyed to Democratic Senator John Breaux of Louisiana, who was a co-chairman of the commission and a close personal friend of the president, that he was serious about reforming the program.

  Congress and the president had just cooperated in overhauling welfare to cut dependency, reduce teenage pregnancies, and save money. That effort had forced both parties to make uncomfortable political decisions; Republicans had to commit to spending on child care, transportation, education, and other government programs, while Democrats had to reform their cherished Great Society programs by instituting work requirements for welfare recipients. But both parties had a stake in reform as well. This was especially true of President Clinton, for whom welfare reform became the political equivalent of Nixon going to China.

  Medicare reform posed an even bigger challenge than welfare reform. The federal government’s approval of Medicare, which offered to help pay for the healthcare of nearly all Americans aged sixty-five and older, was an essential reform for the elderly, about half of whom had no health insurance when the program was approved in 1965. Understandably, the program was modeled on the typical employer-sponsored health plan of the 1960s. The problem is that the program has hardly changed in more than forty years. As Senator Breaux said more than a decade ago, “Throwing more money into this 1965 program is like putting more gas in an old car, it still runs like an old car. ... Above all, we need to give this car a major overhaul first.”2

  Medicare’s costs exceeded expectations from the beginning. Washington developed archaic and confusing stopgap plans to plug the holes, including price controls, payment schedules, and complex formulas for paying doctors, hospitals, and other providers. A core problem is that Medicare is designed as a pay-as-you-go system, meaning today’s taxpayers have to finance the benefits that are now being paid out. That might work fine when lots of young people are supporting a smaller group of retirees, but as Americans’ life expectancy has risen and the population has aged, the program has become unsustainable.

  The Medicare Commission began as a good-faith attempt to solve these problems, though it still featured some typical partisan bickering. Even before the commission was named, there was a weeks-long fight over who would be chairman—it seemed like Congress would need a commission to appoint the commission. Eventually, both sides agreed the commission would have eight Republican and nine Democratic members. John Breaux served as chairman, while Republican Congressman Bill Thomas was named administrative chairman.

  Knowing my track record of reform as head of the Louisiana Department of Health and Hospitals, Thomas asked me to serve as the commission’s executive director. The timing wasn’t great, coming just weeks after I had married Supriya. The job would last just one year—not exactly what you call job security. And we didn’t really want to live in Washington, so suddenly you are talking about one heck of a commute. But it was a great opportunity to help bring about long-term reform. This was the sort of thing I had studied in graduate school—transforming large systems—and had been working on ever since in business and healthcare. I would have understood if Supriya had opposed the move, but as always she was incredibly supportive. She likes a good challenge as much as I do. So I took the job, packed my bags, and headed to Washington, while Supriya held down the fort back home in Baton Rouge.

  I quickly realized my biggest task was keeping the chairmen working together. Breaux and Thomas are as different as you could imagine. Relying on loud, angry shouting to motivate his staff, Thomas had been voted the meanest member of Congress by staff and colleagues several years in a row. But he was also one of the smartest congressmen I’ve ever met. He would read your memo and then tell you why footnote number twenty-three was wrong, and he would correct lobbyists about their own industries. Democrats considered him a worthy opponent, a man both feared and respected in Washington.

  John Breaux, in contrast, earned a reputation as every president’s favorite senator. He had managed to become good friends with George H. W. Bush, Bill Clinton, and later George W. Bush. He was a back-slapping moderate who voted for the creation of SCHIP under Clinton in 1997 and the Bush tax cuts in 2001. It was hard to find anyone who would say anything bad about him.

  In short, Thomas and Breaux needed a buffer... and that would be me.

  In the end, the two men actually complemented each other quite well as part of a well-balanced commission. The commission’s seventeen members comprised elected officials and bureaucrats, including some strong-willed members such as Senators Phil Gramm and Jay Rockefeller, Congressmen Jim McDermott and John Dingell, economist Stuart Altman, and former Clinton administration official Laura Tyson. Eleven of seventeen votes were needed on the commission in order to make official recommendations.

  I watched with a mix of bemusement and frustration as an early dispute broke out over where the commission would meet. Various people and groups offered us office space, but commission members feared we’d be beholden to whoever gave us space. There was also a big fight over whether to use House or Senate space. (There’s an old saying in Washington that the other party is the opposition, while the other chamber is the enemy.) Someone even suggested renting space downtown just to avoid the issue. I said that was ridiculous; we were not going to waste taxpayer money just because some people were acting like children. Eventually we ended up working behind stacks of books at the Library of Congress. It was the quintessential Washington solution—split the difference to fix a problem that should not have existed in the first place.

  Once we got down to work, Republicans and Democrats quickly agreed Medicare was on an unsustainable path, as the ratio of workers to retirees was expected to decline from 4-1 to 2-1. That would force the Part A trust fund into insolvency even before the baby boomers retired. In 1997, 37 percent of Medicare funding was coming from general tax revenues and other sources, because the payroll taxes or premiums that people paid into the system weren’t covering the costs. Everyone on the commission knew the situation would get worse without major reform, and I think we’ve been proven right in the thirteen years since then. By 2007, Medicare was taking $179 billion from general revenues to cover the shortfall; that’s equivalent to about half the federal corporate income tax receipts the government takes in every year. The Medicare Trustees calculate that as of 2009, Medicare’s total excess costs are an astonishing $85.6 trillion.3

  The government was keeping the program alive, as it still is today, through short-term budgeting gimmicks that allowed Medicare to limp on for another five- or ten-year budget window. Instead of structural reform, it considered band-aid solutions such as means-testing, raising the eligibility age, price controls, and arcane payment rules. Government planners dictated how much to spend on a particular service or procedure, and then cut the volume necessary to meet that line in the budget. As economist Len Nichols put it at the time, Medicare was setting 10,000 prices in 3,000 different counties. Senator Breaux and others realized how ridiculous this was. “I never went to medical s
chool,” Breaux said. “Why are elected officials determining how medical decisions are made?”

  In 1997 Medicare still closely resembled 1960s-era private insurance, having failed to incorporate new technologies, procedures, and private-sector benefits. Over time, the program was covering fewer and fewer healthcare costs. You still had separate hospital insurance and medical insurance, there was a nearly $800 hospital deductible, and there was no real coverage for outpatient medicines, no limit on out-of-pocket spending, and limited coverage of preventative care. Seniors were still left paying for half their healthcare, causing 89 percent of them to enroll in some other program such as Medicaid, Medigap, private Medicare plans, or employer-provided coverage. This resulted in duplication and a lack of coordination.

  Overall, we found Medicare to be an inefficient, wasteful system that was mired in red tape. Mayo Clinic president Dr. Robert Waller testified to the commission that more than 130,000 pages of laws, regulations, guidelines, rulings, and other stipulations applied to Medicare procedures and services. The American Hospital Association reported that because of Medicare and other regulations, nurses were often spending as much time filling out paperwork as they were tending to patients.4

  This created bizarre and frightening situations for some patients. A retired judge told our staff how he had been rushed to the hospital with chest pains. The doctor wanted to perform a certain procedure, but he suddenly withdrew the recommendation after the judge said he had Medicare. The judge quickly figured out the doctor had changed his mind simply because Medicare would not cover the procedure. But when the judge offered to pay for the procedure out of his own pocket, the doctor informed him it was illegal for Medicare members to pay for separate procedures! (Congress did try to fix this problem in its typical head-scratching way—it allowed providers to collect private payments from Medicare patients if the providers quit Medicare for two years.) The judge’s story was an aggravating reminder of the dysfunction of Medicare; if you are a Medicare member, you can pay for a vacation, but you may not be able to pay for your own healthcare.