Standing Up for Parents’ Rights

The Turner family

This is adapted from my article published by the Oklahoma Council of Public Affairs blog InterAlia.

Imagine traveling outside the state where you reside and your child becomes ill. At first reflection, you wouldn’t hesitate to take her to the best and closest hospital. Well, after reading about the parents of 16-year-old Justina Pelletier from Connecticut who were charged with medical neglect, I will now hesitate before having my child treated by someone other than our family doctor.

In February 2013, when Justina began experiencing some gastrointestinal problems, a Tufts University doctor treating her wanted the girl to visit a doctor at Boston Children’s Hospital (BCH). Justina was taken by ambulance to BCH because she was in a wheelchair at the time and heavy snow was falling in Boston. She was taken to the emergency room and her parents informed doctors that she was there to see a specific gastroenterologist. The intern at BCH instead called upon a psychologist who diagnosed Justina with somatoform disorder. This disorder is a mental condition where the patient’s symptoms have no physical or biological explanation.

The Pelletier family refused to accept this new diagnosis and kept repeating that she was at BCH for the specific purpose of seeing a certain gastroenterologist to treat her diagnosed mitochondrial disease as directed by her doctor at Tufts University. Her parents never requested a new evaluation of Justina and repeatedly refused to accept this new diagnosis and accompanying psychiatric treatment. The BCH doctors called in Massachusetts Children and Family Services to take custody of Justina and had her parents escorted from the hospital.

Justina’s parents live in Connecticut and were forced to hire lawyers and travel between Connecticut and Massachusetts during their fight to regain custody of their child. Poor Justina spent a year in a locked psychiatric unit at BCH and then was moved to another locked facility in Massachusetts. Her parents were only allowed a one-hour weekly visit and 20-minute phone call for the 15 months when she was in Massachusetts.

Fortunately, Justina is now going home. However, it was only because her father risked going to jail by breaking the judge’s gag order to speak with the press. That there is even a discussion about who has rights over children – the parent or the government – is profoundly disturbing.

Consider recent legislation that passed in Michigan that provides children 12-17 years old the option to deny their parents access to their online medical records. One mother went to the press and expressed her dismay when medical personnel at her doctor’s office informed her they would be having a private conversation with her 17-year-old daughter to discuss this new right of privacy from her parents. The doctor’s office manager also reportedly said that during the five-minute private conversation with her daughter a nurse would discuss birth control options, HIV, and share information about sexually transmitted diseases. When this mother refused to allow the conversation, they informed her she could not opt out of this new medical records access law. Sounds pretty heavy-handed.

Parental rights are doubtless more secure in Oklahoma than in some of the more liberal states. Oklahoma’s newly enacted Parents’ Bill of Rights (pdf) may be seen by some as duplicative, given that Oklahoma already has laws that firmly protect parents’ relationships with their children. However, given Washington’s desire to assert its preeminence over the states, Oklahoma policymakers must remain vigilant and active.

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In Praise of Enterprise Zones

Obama speaks about the sequester in Washington

This is from my article published by the Oklahoma Council of Public Affairs in their February Issue of the Perspective Magazine.

Economic distress does not always manifest equally throughout America. Some communities are hit hard economically while others may only feel a small economic hiccup. If the same communities are hit repeatedly then they may slide into a state of permanent decline—Detroit is the current poster child for this kind of economic tragedy.

Of course, this is not a new problem. Policymakers have been attempting to tackle hotspots of economic distress for decades. Perhaps the most popularized attempt was the idea of “enterprise zones” first touted by Jack Kemp while serving as Secretary of Housing and Urban Development under President George H.W. Bush.

Fast forward to today and the idea of enterprise zones is alive and well. In fact, President Obama has even embraced the idea of enterprise zones with his recently launched Promise Zones (PZ) initiative.

PZs are designed to help areas of the country that were hit hard by the recent Great Recession and will initially include areas such as San Antonio, Philadelphia, Los Angeles, Southeastern Kentucky, and right here in the Choctaw Nation of Oklahoma. The PZs are intended to help build infrastructure, increase access to education, reduce crime, and, most importantly, provide incentives for businesses to hire and invest by expanding the existing Empowerment Zone tax credit.

Additionally, Senator Rand Paul (R-KY) recently unveiled his Economic Freedom Zones (EFZs) (pdf) which would reduce taxes, enhance educational opportunities, and reduce regulatory burdens. Sen. Paul’s tax reductions include enacting a 5 percent flat rate for the individual and corporate income tax, a 4 percentage point reduction in the payroll tax, boosting expensing on new investments, eliminating the capital gains tax, and a $5,000 per child educational tax credit to help children attend the school that most meets their needs. Unlike PZs, EFZs will be available to any jurisdiction that meets certain criteria and would receive these benefits for 10 years.

However, it’s not just Uncle Sam that has found the enterprise zone model to be useful. There are currently more than 3,000 enterprise-type zones in the United States. Most of these zones are implemented by the states, but they can also be coupled with local tax relief through a popular vehicle known as Tax Increment Financing, which often provides rebates on property taxes or earmarks money to be used for infrastructure improvements.

These initiatives are noteworthy, especially since a new problem has arrived on the scene which threatens to drag down economic prosperity: demographic winter.  Demographic winter is the situation which arises when, due to declining birthrates, there are not enough young people to sustain the current population level. As a consequence, the area afflicted with demographic winter experiences a slow-moving economic depression as both the labor supply and customer base shrinks.

Recently, Kansas implemented a new twist on the enterprise zone model—the Rural Opportunity Zone (ROZ)—in an effort to fight the growing problem of demographic winter in its rural counties. There are currently 73 counties that qualify for a ROZ. ROZs offer individuals a 5-year abatement on their individual income tax and/or student loan repayments up to $15,000 if they move into one of the qualifying counties from out of state.

Overall, enterprise zones, in their many forms, are a step in the right direction. Yet, there are still flaws that reduce their effectiveness. Among the largest flaws is the degree of difficulty complying with the selective parameters of the program. For example, while a tax credit does reduce one’s tax liability, it does not reduce the complexity and compliance costs associated with tax filing—it could actually make them worse. At the extreme, these problems can cause businesses and individuals to forgo the benefits of these zones.

One proposal in Maine seeks to address the problems associated with such complexity. The Free ME initiative would eliminate Maine’s income tax (individual and corporate) and sales tax completely on a county-by-county basis starting in the most economically distressed county. Free ME would create a clean, level playing field for all participants and would not disappear until tangible economic benefits are seen—specifically, seeing the county move back to the state average on key economic variables such as unemployment and poverty. The Free ME initiative is receiving much-deserved state and national attention. This is worth keeping an eye on.

In conclusion, it is not every day that two people from opposite ends of the ideological spectrum, like President Obama and Senator Paul, agree that changing incentives do in fact make a difference in the lives of families across America. This targeted approach embedded in the idea of enterprise zones can help pave the way to broader reforms as the EMZs show progress in tackling some of the most difficult economic challenges of our time, such as stubborn pockets of poverty and demographic winter. The recipe may need tweaking, but at least policymakers are in the right kitchen.

The Negative Impact of Multi-Generational Welfare

Table 1 Percent of Births on Medicaid by StateThis is from my article published by the Oklahoma Council of Public Affairs in their February Issue of the Perspective Magazine.

Government welfare programs were originally designed to be temporary to help people get back on their financial feet. Today, that is no longer true. For instance, SoonerCare, Oklahoma’s Medicaid system, imposes no time limits on the recipients as long as they meet various income-eligibility requirements. As we have discussed in these pages previously (“Oklahoma Growing Increasingly Dependent on Medicaid,” April 2013), Oklahoma already has an unhealthy dependency on SoonerCare.

As a consequence, it is very easy for families to become trapped in multi-generational welfare, which robs them of personal responsibility and self-reliance. There is a multitude of anecdotal evidence that multi-generational welfare in fact exists. Now, new academic research by economists Gordon Dahl, Andreas Kostol, and Magne Mogstad verifies this reality.

In a new study (“Family Welfare Cultures (pdf),” National Bureau of Economic Research, Working Paper No. 19237, July 2013), the authors examine family welfare cultures by looking at Norway’s disability insurance system. Norway’s homogeneous demographic makeup helps to keep the focus on welfare policies. The authors found “strong evidence that welfare use in one generation causes welfare use in the next generation.”

What really makes this study remarkable is that the authors firmly trust they have found more than a simple correlation. Instead, they believe they have found a causal link between parents dependent on welfare and their children following in their footsteps.

The causal link they found can be summed up succinctly: children learn from their parents. The authors “find suggestive evidence … in favor of children learning from a parent’s experience” with government welfare. In other words, children are conditioned by their parents’ welfare experience that significantly increases the chances that they too will end up dependent on welfare.

More troubling, the study also found that “consistent with this increase in adult children’s welfare dependency, we find that parental DI (disability insurance) receipt decreases the probability that a child will work or pursue higher education.” Therefore, income-based welfare, like Medicaid, becomes a self-fulfilling, multi-generational prophecy—low-income parents on welfare hamper the ability of their children to achieve a better life for themselves.

Of course, the question remains, how big of a problem is this for Oklahoma? To better answer that question, let’s examine a relatively new data series that shows the number of births on Medicaid as a percent of all births for each state.

As shown in Table 1, this percentage ranges from a whopping 71 percent in Louisiana to a low of 27 percent in Virginia, with a median value of 45 percent. (The data come from the National Governors Association (pdf) as reported by the Henry J. Kaiser Family Foundation. The table is an amalgam of several years because not all states report the number of births on Medicaid every year. To fill the gap, we used the highest percentage reported between 2003 and 2009, the latest year of available data. Note: we used the median Montana value because the maximum value appears to have been misreported.)

Unfortunately, Oklahoma is in the very high range, with 62 percent of all births on SoonerCare, the fourth highest in the country. In absolute numbers, that represents, on average, approximately 30,000 babies that are born right into Oklahoma’s welfare system each and every year. These data strongly suggest that Oklahoma has a very significant multi-generational problem in the Medicaid system.

In conclusion, this analysis should give Oklahoma’s policymakers yet another reason to stop expanding the Medicaid rolls. (For starters, how about a moratorium on advertising for SoonerCare?) Oklahoma’s very high number of births on Medicaid strongly suggests that multi-generational welfare is a very real problem with dire outcomes for the parents and especially the children. Breaking this cycle will not be easy, and compounding it by increasing Medicaid rolls would be a step in the wrong direction.