Privatization in the United States

Medicare and Medicaid managed care In the United States, under the Medicare managed care the government pays a managed care organization (MCO) a fixed amount called the "capitated rate" for all medical services received by a beneficiary in a given period. Enrollment in the programs has increased substantially since 1990; in 2002 60% of Medicaid beneficiaries and 12% of Medicare beneficiaries were being treated by MCOs. Private sector involvement in Medicare and Medicaid is not limited to MCOs; private doctors, hospitals, nursing homes provide medical care; reimbursement claims are processed by private intermediaries; and peer review organizations, utilization review committees and accreditation organizations like JCAHO are staffed by private medical personnel. One of the primary recipients of U.S. outsourcing contracts is Maximus Inc., which administers Medicaid and Medicare, as well as the Children's Health Insurance Program (CHIP), welfare-to-work, child support enforcement, and other government programs. Welfare privatization Homeless shelters and food banks are run by private organizations, who also provide treatment services, operate Head Start programs and work with child welfare agencies. Privatization of welfare system expanded in 1996, when the Aid to Families with Dependent Child (AFDC) program was replaced with the Temporary Aid to Needy Families (TANF) program. Welfare services that are often privatized include workforce development, job training and job placement are often privatized. The United Nations uses private subcontractors as well, and in some cases, "failed states" have relied on private entities extensively for a range of tasks including building critical infrastructure, managing social services programs and using private military companies during the course of armed conflicts. == US Constitution ==

The United States Constitution only constrains state action and, with few exceptions, "erects no shield against merely private conduct, however discriminatory or wrongful". Gillian Metzger writes: Adequately guarding against abuse of public power requires application of constitutional principles to every exercise of state authority, regardless of the formal public or private status of the actor involved: 'It surely cannot be that government, state or federal, is able to evade the most solemn obligations imposed in the Constitution by simply resorting to the corporate form' and thereby transferring operation of government programs to private hands" Even if private actors cannot be held accountable through the traditional constitutional mechanism, they may be bound by other regulatory or contractual requirements. Tort law might be another avenue of protection, and some may argue that this protection could be even more effective as public agencies and employees usually enjoy some degree of immunity from civil liability. ==Criticism==

Historically, governments have at times turned government-run institutions into privately held corporations or simply abolished the publicly run institution in order for privately owned competition to enter and compete in the market in question. However, critics often point out that historical methods of privatization were quite different than modern methods. For example, in the United States in the 19th century, a corporation might be chartered by a public entity, such as a municipality, for a very specific purpose (for example, constructing New York's Central Park) with significant constraints on its purpose, task, and duration. Such a corporation would then often cease to exist after its purpose had been fulfilled. This kind of public-private partnership differs in significant ways from a common modern form, where publicly held services or resources might be handed over to a private company with few stipulations and for an indefinite period of time. Critics of privatization also charge that lucrative contracts may be given to political allies, relatives or friends of public officials and that subsequently, these contractors may not qualified to do the work and/or may provide less quality to the general public. For example, in 2006 the LA Times reported on this pattern in an article stating that for "Indianapolis, New Orleans, Atlanta and other cities, privatization has been accompanied by corruption scandals, environmental violations and a torrent of customer complaints." Another criticism of privatization, particularly in regard to municipal services such as water utilities, is that some municipalities have seen unacceptable increases in prices of services while seeing also a decrease in the quality of service and level of maintenance of the utility. For example, in Jacksonville, Florida, a company called United Water Resources owned and operated the municipal water system. After monthly bills increased in 1997 by almost $10 per month, and further requests for rate hikes later as well. The municipality's public utility, JEA, decided to buy the water system for $219 million, projecting that this would actually save customers 25% on monthly bills. On the other hand, publicly managed utilities have occasionally reported trouble as well. The New York Times reported in 2004 that a consortium of citizen's groups had won a suit against the city of Los Angeles to repair 488 miles of sewer lines and conduct other maintenance. ==Factors that lead to privatization==

There are several leading factors that contribute to municipal or county governments outsourcing. Economics in the format that governments can operate in a more manageable and effective manner. Public administrations have been criticized for their lack of effective service. The quality of service may be slow and employees may not be held accountable for their responsibilities. The view by the public is that public organizations are not friendly, and removed from high-quality public service, the lack of public relations, and training show in the inability of their personnel to deal with the public. Privatization is thought to be a valuable policy instrument that leads to a greater good. Privatization of public resources injects new value into public assets and increases the privately held capital base of a country. Governments that implement privatization as part of their reforms use it as a mechanism to pursue a variety of objectives, both macroeconomic and fiscal. Governments undertaking privatization have pursued a variety of objectives. In some cases, privatization is a means of achieving gains in economic efficiency, given the extensive prevalence of poor economic performance of public enterprises in many countries and limited success with their reform. Privatization can also be a mechanism for improving the fiscal position, particularly in cases where governments have been unwilling or unable to continue to finance deficits in the public enterprise sector. The decision as to whether to transfer ownership or operations of a public water utility to a private firm is complex. Immediate economic questions such as “Won't privatization increase customers’ monthly water bills?” are accompanied by larger and longer-term questions relating to public health, employment, political control, environmental issues, and relations with other city services. ==See also==

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