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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Dense Pence

I’ve been told that Mike Pence’s law school nickname was “dense Pence.” Perhaps that was apocryphal–I wasn’t in school with him– but Pence’s entry into the Presidential sweepstakes suggests its appropriateness. 

Allow me a couple of admissions.

I’ve known Pence ever since we were both losing Republican candidates for Congress. I was an occasional “guest” on his call-in show, trying–without much success–to defend those “un-Christian” First Amendment clauses mandating separation of church and state…

By the end of his embarrassing term as Indiana Governor qua Priest, I was the owner of several of those “Pence Must Go” signs that were widely displayed around Indiana prior to Trump’s rescue of Pence’s doomed candidacy for a second term.

So–as these admissions suggest–I’m not a fan.

That said, the media reaction to his Presidential candidacy has largely confirmed my belief that anyone who actually thinks Pence might be the eventual nominee is smoking something, and it’s very strong.

The New York Times polled the paper’s opinion writers. Let me share a few of their responses.

When asked how seriously a Pence candidacy should be taken, Michelle Cottle said: “As seriously as the wet dishrag he impersonated for most of his term as V.P.” Katherine Mangu-Ward contributed: “Mike Pence is a serious person. He is seriously not going to be president.”

Frank Bruni admitted to being  “unsettled by how strongly Pence has always let his deeply conservative version of Christianity inform his policy positions.” Bruni noted that while he deeply respects people of faith,  Pence “makes inadequate distinction between personal theology and public governance.” Bruni was far more polite on that subject than Cottle, who said that Pence “wants to ram his conservative religious views down the nation’s throat.”

Jane Coaston described Pence’s entry as “a candidacy no one wants.”  Michelle Cottle offered backhand praise with “He’s a uniter: Everyone dislikes him.”

Coaston summed up the panel’s verdict: He might be the most uninspiring candidate currently running. (She did say he has great hair.)

Then there’s the Washington Post headline: “Mystery surrounds Mike Pence’s doomed presidential candidacy.”

Having spent the past 2½ years being booed by Republican audiences and mocked on social media, Mike Pence has decided that the American people are finally ready for him. So, with the obligatory period of prayer and contemplation out of the way, the former vice president has officially filed the paperwork to run for president.
 
There’s no mystery about whether Pence could overcome former president Donald Trump and seize the leadership of his party. The mystery is why he thinks he has any chance at all.

Pence is a photo negative image of contemporary political attractiveness, simultaneously repelling Republicans, Democrats and independents. In his bewildering belief that he might become president, he demonstrates the power of ambition to cloud the mind of even the most experienced politician.

The article describes Pence as someone who “reminds you of a regional manager at a midsize Indiana ball-bearing manufacturer.” And if that description isn’t sufficiently dismissive, the article points out that “there is almost no significant group of voters who does not already dislike Pence for one reason or another.”

In a general election, Pence would offer voters the worst of all possible worlds: an uncharismatic candidate advocating the GOP’s unpopular policies. Voters are not clamoring for someone to tell them why we need to cut taxes for the rich and outlaw abortion, delivered in the tone of a stepdad explaining why you’re being grounded for the rest of the school year….

Other long-shot candidates have something resembling a rationale. Nikki Haley paints herself as the leader of a new generation of conservatives. Tim Scott offers a conservatism that is hard right in substance but kinder and gentler in manner. But Pence — who at some point might have seemed as though he was constructed in a lab to become the GOP nominee (experienced! conservative! devout!) — is now exactly what no one wants.

If elections revolved around policy preferences, no GOP candidate would stand a chance; poll after poll confirms that a majority of Americans soundly reject Republican policies on abortion and guns, its wars on trans children, books and (undefined) “wokeness,” the party’s steadfast refusal to raise taxes on the obscenely rich …

What does appeal to today’s Republican voters is bigotry and White Nationalism. Pence’s original usefulness to Trump and the GOP was his ability to cloak racism, misogyny and homophobia in Christian piety–to pretend that he represented a party that hated the sin but loved the sinner.  

In the intervening years, the GOP has thrown off the cloak, and thus no longer has any use for Pastor Pence. Why he doesn’t understand that is, as the Post says, a mystery.

 

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Choices

When I read the June 2d issue of the Indiana Business Journal, I fumed.

An editorial by current Lt. Governor and  2024 gubernatorial candidate Suzanne Crouch was titled “Why I support Universal School Choice for Hoosier Families.” Of course, “school choice” sounds way nicer than “Why I support destroying Indiana’s public schools,” or “Why I support school vouchers despite overwhelming evidence that they don’t deliver educational benefits, are socially divisive, and are a huge taxpayer subsidy to religious institutions.”

If you doubt the accuracy of that last statement, the IBJ helpfully included lists of Indiana’s largest private primary and secondary schools. Only four of the 25 primary schools listed were not religious–Park Tudor, Orchard, Sycamore and the International School.  Park Tudor–a very expensive private school ($25,930 a year!)– doesn’t accept vouchers. Sycamore limits enrollment to gifted and talented children, and the International School also appeals to a specialized constituency.

All of the other schools on a list headed by the Oaks Academy and Heritage Christian School are either Catholic, or conservative or fundamentalist Christian.

When it comes to the 19 secondary schools, only three–Park Tudor, University High School and the International School–are secular.

I have posted numerous times about the myriad ways in which advocates of “privatization” and “choice” in education have contributed to the hollowing out of America’s civic structure. (If you type “vouchers” into the search bar at the top right of this blog,  you”ll get more data than you probably want to absorb…)

I’ve linked to studies showing that fundamentalist Christian schools are teaching creationism rather than science, and whitewashing history. Science denial and bogus history are unlikely to prepare students for life in contemporary American society.

I’ve linked to various lawsuits challenging religious discrimination practiced by religious “academies.” Significant numbers of those schools refuse to enroll gay children, or children of gay parents.

I have pointed out that vouchers shortchange rural residents and those in small towns, where there aren’t enough students to support alternative, private schools, and Indiana’s voucher program deprives their public schools of desperately needed funds.

I have echoed knowledgable others, like Doug Masson, who points out that pious rhetoric about giving options to poor minority children “trapped” in those terrible public schools is nothing more than a scam.

Back in 2019, Indiana’s voucher program cost taxpayers $161.4 million; by 2025 it will cost  $600 million. And forget “poor children.” Indiana’s voucher program disproportionately serves upper-middle-class white children, a majority of whom are clearly not “escaping failing schools” because–despite lawmakers’ original promises– they never attended public school.

As Doug Masson wrote about that 2019 report:

This reinforces my view that the real intention of voucher supporters was and is: 1) hurt teacher’s unions; 2) subsidize religious education; and 3) redirect public education money to friends and well-wishers of voucher supporters. Also, a reminder: vouchers do not improve educational outcomes. I get so worked up about this because the traditional public school is an important part of what ties a community together — part of what turns a collection of individuals into a community. And community feels a little tough to come by these days. We shouldn’t be actively eroding it.

No kidding!

“Choice” sounds great. Providing citizens with a wide freedom of choice–of religion, politics, lifestyle– is a quintessentially American goal. But voucher programs are evidence that institutionalized choices can also promote division and undermine civic cohesion.

In far too many communities today, the “educational choice” being offered is the opportunity to shield one’s children from intellectual and cultural diversity. Vouchers provide parents with tax dollars that allow them to insulate their children from  one of the very few remaining “street corners” left in contemporary American society. Whatever their original intent, vouchers today are mechanisms allowing parents to remove their children from public school classrooms and classmates that may be conveying information incompatible with those parents’ beliefs and prejudices.

That an otherwise credible candidate for Indiana Governor wants to make support for increased tribalism “universal” is appalling. At best, it tells me that Crouch is totally unfamiliar with the educational and social science research; at worst, it’s a sign that she is competing for the Christian Nationalist vote that is so large a component of today’s GOP.

It goes without saying that if Mike Braun emerges as the Republican nominee for Governor, he will double down on Crouch’s position.

Speaking of “choice”– Hoosiers have one next year.

One of the many reasons I have been so impressed with Jennifer McCormick, the Democrat running for Governor, is that–after trying to protect Indiana’s public schools as a Republican Superintendent of Public Instruction– she left a political party intent upon destroying public education.

Every schoolteacher in Indiana–and every citizen who understands the importance of America’s public schools–should choose to vote McCormick.

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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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