Public Policy and Governance – Page 42

Fed Up Yet?

Americans are understandably distracted by the current cultural battles that are, at their base, efforts to halt the steady erosion of White Christian male privilege. I spend a fair amount of time analyzing and discussing those battles, and ignoring a much more substantial disagreement about what a society/country owes its members/citizens.

It’s the question inherent in that old Amex commercial proclaiming “membership has its privileges.”

As I’ve noted previously, in the United States, the “privileges” of citizenship do not include health care or financial security. Our approach to social welfare has been and remains punitive–and as a result, the “systems” we’ve built incentivize greed over good works.

A recent report from the New York Times focused on the reality of America’s approach to health care.

Many hospitals in the United States use aggressive tactics to collect medical debt. They flood local courts with collections lawsuits. They garnish patients’ wages. They seize their tax refunds.

But a wealthy nonprofit health system in the Midwest is among those taking things a step further: withholding care from patients who have unpaid medical bills.

Allina Health System, which runs more than 100 hospitals and clinics in Minnesota and Wisconsin and brings in $4 billion a year in revenue, sometimes rejects patients who are deep in debt, according to internal documents and interviews with doctors, nurses and patients.

Although Allina’s hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients, including children and those with chronic illnesses like diabetes and depression. Patients aren’t allowed back until they pay off their debt entirely.

Companies like Allina–theoretically “nonprofit”– get huge tax breaks for providing indigent care in their communities. An investigation by the Times found that almost all nonprofit hospitals have– for decades– fallen short of that charitable mission.

Allina cuts off patients who owe money for services received at any of its 90 clinics. Written policies instruct staff on how to cancel appointments for patients with at least $4,500 of unpaid debt– how to lock their electronic health records so that staff can’t schedule future appointments.

“These are the poorest patients who have the most severe medical problems,” said Matt Hoffman, an Allina primary care doctor in Vadnais Heights, Minn. “These are the patients that need our care the most.”

In 2020, less than half of 1 percent of Allina’s expenditures were for charity care, well below the pathetic national average of 2 percent for “nonprofit” hospitals, despite the fact that its annual profits since 2013 have ranged from $30 million to $380 million. In 2021, its president earned $3.5 million–and it recently built a $12 million conference center.

It’s estimated that 100 million Americans have medical debts. Those debts make up approximately half of all the outstanding debt in the country, and are responsible for half of all personal bankruptcies.

Some 20 percent of hospitals nationwide have debt-collection policies that allow them to cancel care. The most expensive “health care system” in the world doesn’t seem very focused on health.

Then, of course, there’s what Jamelle Bouie calls a “twisted view” of the social safety net, most recently illustrated by the GOP’s insistence on work requirements for SNAP and Medicaid beneficiaries.

As Bouie notes, there’s plenty of evidence that work requirements don’t lead to more employment–that their only effect has been a loss of benefits by poor Americans.

Work requirements don’t work, but Republicans still want them, so much so that they threatened to crash the global economy to get them. Why? The obvious answer is that work requirements are an effective way to cut programs without actually cutting them. With a little extra paperwork and another layer of bureaucracy, states can keep thousands of people who qualify from getting access to benefits.

To add insult to injury, It cost states tens of millions of dollars to implement work requirements. In Arkansas, for example, implementation cost close to $26 million; in Iowa, the cost of administering the new rules was $17 million over three years — far more than the state would have spent on SNAP during that period.

We keep hearing that America is the richest country in the world. Not only could we afford to be less punitive to the people who most need a hand up, we could actually save money in the process. Tax dollars already pay some 70% of the country’s medical costs, and those dollars would probably cover 100% if CEOs weren’t overcompensated and we saved health insurer overhead.

I’ve previously argued that a Universal Basic Income would solve significant social problems– Whatever the pros and cons of a more expansive, less punitive view of “membership,” stories like these should remind us of the multiple deficits of what passes for current health and welfare policies in “rich” America.

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More Evidence For My Thesis….

A recent paper published in Nature looked at the effects of cash transfers in a number of pilot programs around the globe. The researchers reported (in typical academic-ese):

We evaluated the effects of large-scale, government-led cash transfer programmes on all-cause adult and child mortality using individual-level longitudinal mortality datasets from many low- and middle-income countries. We found that cash transfer programmes were associated with significant reductions in mortality among children under five years of age and women. Secondary heterogeneity analyses suggested similar effects for conditional and unconditional programmes, and larger effects for programmes that covered a larger share of the population and provided larger transfer amounts,…Our findings support the use of anti-poverty programmes such as cash transfers, which many countries have introduced or expanded during the COVID-19 pandemic, to improve population health.

This research focused on health; other studies have shown dramatic improvements in a variety of social outcomes.

I’ve long obsessed about what an updated social contract might look like, and whether it’s possible to craft a governing structure that both respects individual liberty and provides basic material security. My periodic musings revolve around two issues: whether anyone is truly free who struggles daily just to survive, and whether government safety-net policies can help unify an increasingly fragmented population.

The Greeks were right about that “golden mean” between extremes. The importance of hard work and individual talent shouldn’t be minimized, but neither should it be exaggerated. When the focus is entirely upon the individual, when successes are attributed solely to individual effort, we fail to recognize the social and legal structures that privilege some groups and impede others.

When we ignore systemic barriers, we feed stereotypes and harden tribal affiliations. That’s why the first priority of a social contract should be to nurture what scholars call “social solidarity,” the ability of diverse citizens to see ourselves as part of an over-arching, inclusive American community.

A workable social contract connects citizens to a larger community in which they have equal membership and from which they receive equal support. The challenge is to achieve a healthy balance—to create a society that genuinely respects individual liberty within a renewed emphasis on the common good, a society that both rewards individual effort and talent, and nurtures the equal expression of those talents irrespective of tribal identity.

As I have frequently argued, policies can either increase or reduce polarization. Policies intended to help less fortunate citizens can be delivered in ways that stoke resentments, or in ways that encourage national cohesion. Think about widespread public attitudes about welfare programs aimed at poor people, and contrast those attitudes with the overwhelming approval of and support for Social Security and Medicare.

Significant numbers of Americans stubbornly believe laziness and lack of motivation are major causes of poverty, and that social welfare breeds dependence, despite ample evidence to the contrary. Social Security and Medicare are viewed differently. They’re universal programs; virtually everyone contributes to them and everyone who lives long enough benefits from them. Such programs avoid stigma.

That universal policies unify is an important and often overlooked argument favoring a Universal Basic Income. But pilot programs continue to highlight numerous other positive consequences.

America currently has a patchwork of state and federal programs, with bureaucratic barriers and means testing that operate to exclude most of the working poor. Welfare recipients are routinely stigmatized by moralizing lawmakers pursuing punitive measures aimed at imagined “Welfare Queens.” Meanwhile, current anti-poverty policies haven’t made an appreciable impact on poverty.

A Universal Basic Income is a cash grant sufficient to insure basic sustenance–and unlike welfare, a UBI has no phase-out, no marriage penalties, no people falsifying information.

Support for the concept isn’t limited to progressives. Milton Friedman proposed a “negative income tax,” and F.A. Hayek wrote “There is no reason why in a free society government should not assure to all, protection against severe deprivation in the form of an assured minimum income, or a floor below which nobody need descend.”

In 2016, Samuel Hammond of the libertarian Niskanen Center, described the “ideal” features of a UBI: its unconditional structure avoids creating poverty traps; it sets a minimum income floor, which raises worker bargaining power without wage or price controls; it decouples benefits from a particular workplace or jurisdiction; since it’s cash, it respects a diversity of needs and values; and it simplifies and streamlines bureaucracy, eliminating rent seeking and other sources of inefficiency.

Hammond’s point about worker bargaining power is especially important in today’s work world, with dramatically-diminished unions and the growing “gig economy.” With a UBI (and single payer health coverage), workers would have freedom to leave abusive employers, unsafe work conditions, and uncompetitive pay scales.

A UBI wouldn’t level the playing field, but it sure would reduce the tilt.

A UBI would also have much the same positive effect on economic growth as a higher minimum wage. When poor people get money, they spend it, increasing demand—and increased demand is what fuels job creation. (If nobody is buying your widgets, you aren’t hiring people to produce more of them.)

Counter-intuitive as it may seem, a significant body of research supports the
importance of a robust social safety net to market economies. As Will Wilkinson of the Niskanen Center has written, the Left fails to appreciate the important role of markets in producing abundance, and the Right refuses to acknowledge the indispensable role safety nets play in buffering the socially destructive consequences of insecurity.

I have previously written about the salutary effects of a UBI--effects the linked article (and several other studies) have confirmed. I have also suggested budgetary adjustments that could pay for it.

Of course, it won’t happen.

As we’ve seen in other policy domains, notably health care, American policymakers don’t care about evidence, no matter how persuasive. (Don’t confuse them with the facts!)

Maybe in my grandchildren’s lifetimes……

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Red And Blue

In the midst of the recent, ridiculous drama over the debt ceiling–the very existence of which is bizarre and in conflict with both the 14th Amendment and common sense–Harold Meyerson published an illuminating essay on America’s “new civil war.”

As Meyerson noted, anyone still mystified about why Democrats and Republicans in Congress can’t even agree to honor the debts that they already incurred need only take a look at what Democrats and Republicans are doing in states that they respectively control.

Meyerson’s examples were Minnesota (Democratic) and Texas (Republican).

Yesterday, we posted a piece by my colleague Ryan Cooper on how Minnesota, where Democrats now control both houses of the legislature and the governor’s office, has just enacted its own (to be sure, scaled-back) version of Scandinavian social democracy—including paid sick leave for all, paid family leave, a minimum wage for Uber and Lyft drivers, sector-wide collective bargaining in key industries, and the outlawing of “captive audience” meetings, in which management compels employees to attend anti-union rants. A new law also strengthens women’s right to an abortion. Similar laws have been enacted or are under consideration in other Democratic “trifecta” states, though none quite so pro-worker as some of Minnesota’s.

Also yesterday, we posted one of my pieces, this one on everything that Texas’s Republican legislature and governor are enacting to strip power from their large cities, almost all of which are solidly Democratic. One new bill says the state can declare elections to be invalid and compel new ones to be held under state supervision in the state’s largest county, Harris County, which is home to reliably Democratic Houston. And the state Senate has also passed a bill that would strip from cities the ability to pass any regulations on wages, workplace safety, business and financial practices, the environment, and the extent of property rights that exceed the standards set by the state. Which leaves cities with the power to do essentially nothing.

Meyerson concedes that other Republican trifecta states haven’t gone quite as far as Texas, but he notes that Tennessee’s legislature abolished Nashville’s congressional district and expelled its assembly member, and Alabama’s legislature revoked Birmingham’s minimum-wage law. (And although he didn’t put it in these terms, Florida is fairly far along on the road to fascism.)

Beyond their war on cities, Republican trifecta states have long refused to expand Medicaid coverage, have recently also begun to re-legalize child labor and legislate prison terms for librarians whose shelves hold banned books, and in the wake of the Dobbs decision, criminalized abortions.

As Meyerson observes, Democrats states are moving in what is overall a more humane direction, while Republican states–very much including Indiana– seem intent upon returning to what Meyerson calls “a nightmare version of the past”.

Any dispassionate view of America today has to conclude that the differences between these two Americas are almost as large and intractable as those that split the nation in 1860 and ’61.

I have frequently quoted survey research showing that most Americans, even those in Red states, do not support GOP priorities. As Meyerson says–and as readers of this blog have repeatedly opined–Republican victories in the nation’s Red states rest on the GOP’s relentless demagoguery on culture-war issues and immigration, and the party’s adeptness at gerrymandering.

The result is twofold: voters in the more thinly inhabited, rural areas of Red states can and do impose their biases on the urban inhabitants of those states (cities are Blue in every state, including the Red ones)–and the Senators they elect stymie progressive efforts in Washington. (In Texas, shifting demographics are eroding the dominance of that state’s rural voters–hence the unconscionable and probably unconstitutional efforts to neuter the electoral preferences of urban Texans.)

There is significant data showing that Blue states have healthier economies as well as healthier citizens–that on balance, Blue states are donor states, sending more dollars to Washington than they receive, while Red states increasingly rely on the excess of dollars they receive over those they remit–making Red states ironically analogous to those shameful “welfare queens.”

Americans “vote” in a number of ways; including with their feet. Thanks to the economic impact of Republicans’ culture war policies, Blue cities and states continue to gain population at the expense of the Red states. Unfortunately for our political system, the votes of rural Americans currently count more than the votes of urban Americans, and thinly populated states punch far above their weight in Washington.

If we could just adjust our electoral systems to fairly reflect the will of all voters, a lot more states would be Blue…..

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Wow…

Allow me to begin with an admission: I’m not a scientist and I don’t play one on TV.

That said, the various newsletters and publications I receive increasingly feature reports of scientific breakthroughs (one of which is described below), reminding me that a constant focus on humanity’s seeming inability to escape tribalism and social discord gives one a distorted picture of where we are as a species.

There is a substantial mis-match between humankind’s social/political progress and our very impressive advancements in science and technology. I am definitely not advocating that we sit back and ignore climate on the theory that science will save the day. We still need policies to address the reality of a warming planet. But in addition to other measures aimed at reducing harmful emissions, those public policies need to incorporate and encourage insights produced by the scientific community.

Some of the emerging technologies that promise to have a significant effect on climate change:

Carbon capture and storage that captures carbon dioxide (CO2) emissions from power plants and industrial facilities, preventing them from entering the atmosphere. Evidently, the captured emissions can then be stored underground or used in various industries.
Breakthroughs in renewable energy promise significant reductions in the cost of energy. The last few years have seen increases in solar and wind power generation, advancements in batteries that store energy, and improvements in the efficiency of renewable energy systems.
Consumers have warmed to electric vehicles, and we are on the cusp of widespread adoption of electric automobiles as driving range has increased and charging infrastructure improves.
Green hydrogen is hydrogen produced through renewable energy sources (such as electrolysis of water using electricity from wind or solar power.) Carbon-free hydrogen (with which I was–and am– unfamiliar) has a wide variety of applications.
The movement toward sustainable agriculture doesn’t just reflect health concerns; innovative agricultural practices reduce greenhouse gas emissions and increase carbon sequestration.

There’s much more. I lack the background to fully understand these advances, but from what I read, it appears that advanced materials being developed for use in construction and manufacturing can also significantly reduce emissions and our carbon footprint.

And that brings me to the “wow” of today’s title. The Washington Post recently reported that scientists have found a way to create energy out of virtually any material.

Nearly any material can be used to turn the energy in air humidity into electricity, scientists found in a discovery that could lead to continuously producing clean energy with little pollution.

The research, published in a paper in Advanced Materials, builds on 2020 work that first showed energy could be pulled from the moisture in the air using material harvested from bacteria. The new study shows nearly any material, such as wood or silicon, can be used, as long as it can be smashed into small particles and remade with microscopic pores…

“What we have invented, you can imagine it’s like a small-scale, man-made cloud,” said Jun Yao, a professor of engineering at the University of Massachusetts at Amherst and the senior author of the study. “This is really a very easily accessible, enormous source of continuous clean electricity. Imagine having clean electricity available wherever you go.”

It’s worth emphasizing–as the article does–that this discovery is just the beginning. It will take much more work and experimentation to bring the energy generation to scale and make the invention commercially usable.

The scientists first must work out which material would be most efficient to use in different climates. Eventually, Yao said he hopes to develop a strategy to make the device bigger without blocking the humidity that can be captured. He also wants to figure out how to stack the devices on top of each other effectively and how to engineer the Air-gen so the same size device captures more energy.
It’s not clear how long that will take.

“Once we optimize this, you can put it anywhere,” Yao said.
It could be embedded in wall paint in a home, made at a larger scale in unused space in a city or littered throughout an office’s hard-to-get-to spaces. And because it can use nearly any material, it could extract less from the environment than other renewable forms of energy.

“The entire earth is covered with a thick layer of humidity,” Yao said. “It’s an enormous source of clean energy. This is just the beginning in making use of that.”

Good news, but it’s all about timing. Once again, humankind finds itself needing to avoid calamity in the interim between now and a promising future. At a bare minimum, avoiding the unthinkable will require a Congress composed of rational adults, and that will require the defeat of the GOP’s current clown show.

Fingers crossed.

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Guns

Want to invade Mexico? The option is on the table if America re-elects Donald Trump (a/k/a “the former guy” or TFG). According to the Washington Post,

former president Donald Trump is preparing battle plans to attack Mexico if he regains the White House. This is only the latest escalation of saber-rattling in the wake of the recent kidnapping and killing of Americans in Mexico. Former U.S. attorney general William P. Barr, Rep. Dan Crenshaw (Tex.) and Sen. Lindsey O. Graham (S.C.) are among those calling for U.S. military action in Mexico to take on drug cartels.

The author of the essay acknowledges that the Mexican cartels need to be stopped. But–as he points out–this isn’t a problem Washington can bomb its way out of.

There is a way to accomplish that goal, however. The U.S. could: cut off the gun pipeline that arms the cartels.

Duh.

I rarely address America’s gun crisis, because I know what every sentient citizen knows: the “Second Amendment” purists (a/k/a gun nuts) will remain unmoved by death and/or data, and too many of the lawmakers elected by the majority of Americans who want rational regulation are spineless Republicans unwilling to buck the NRA. My two-cents worth is highly unlikely to resolve the stalemate between America’s delusional cowboys and those of us who recognize that the problem is the ubiquity of weapons.

That said, my cousin–a medical doctor I often cite on this platform–sent me an op-ed he recently published in his local paper, and it is worth sharing, because it addresses the predictable effort by pro-gun advocates to divert attention from weaponry to mental illness.

With his permission, here it is, in its entirety:

The spate of recent firearm deaths at schools and public places has rightfully triggered a lively public debate. Among all the clatter, we often hear politicians stating that we can reduce firearm deaths, such as those occurring in public places, if we would simply employ better detection and management of mental illnesses. But this is a flawed concept: At best it would solve only a tiny fraction of the problem, estimated at approximately 3-5%. In reality, most people who are violent are not mentally ill, and most people who are mentally ill are not violent. Although seemingly logical at its surface, let’s clarify this issue further by applying scientific/numerical analysis.

Since 2006, there have been approximately 550 mass shootings in the United States, resulting in 2,900 people shot and killed. Since most of these shootings are perpetrated by single gunmen, this means that roughly 550 (or slightly more) individuals carried out these heinous acts.

According to the National Institute of Health, the prevalence of major mental illnesses in the U.S. is approximately 4.2% of the entire population, meaning that about 10.4 million people harbor serious mental disorders. Even if one assumes that this entire group of 550 killers were mentally ill, which is clearly false, this total number would constitute an infinitesimally small percentage .0053 of all those suffering from mental illness. Unless we had a fail-safe method of detecting 100% of individual would-be killers from this large group of mentally ill, our ability to detect a future killer remains at nearly zero, which represents the proverbial needle in the haystack. Supporting these data, all mental health professionals freely admit that it is virtually impossible to predict accurately—nowhere near 100%—of those with known mental disorders that are likely to perform such acts of violence. Compounding this problem even further, laws in this nation generally preclude forced detention of mentally ill individuals that have not yet performed any act of violence, for more than brief periods. What this means is that, given these extremely daunting numbers, detection and treatment of those with suspected mental illness in the effort to ward off gun violence is a virtual impossibility, notwithstanding the pronouncements by many ill-informed politicians.

It all boils down to a simple bottom line: Major efforts must be aimed primarily at sensibly limiting everyone—whether or not mentally ill—from freely obtaining firearms capable of killing—especially of the mass variety.

We must allow numeric principles to guide us, not a bunch of mercenary political figures, often under the thrall of the NRA, who wish to apply so-called “common sense measures” to control this national scourge! Detection and treatment of mental disorders is indeed a laudable goal, but not in the effort to reduce firearm deaths!

One of those inconvenient data points: Mass shootings in the United States have tripled since the assault weapons ban lapsed.

If we are going to talk about the role mental illness plays in this mayhem, we might start with TFG and move on to the lunatics arguing that arming everyone in sight will make us safer.

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