Tag Archives: Pete Buttigieg

Highways And Civil Rights.

I typically do not link to media sources that are obviously partisan (unless that partisanship is what I’m highlighting), but I was fascinated by a recent post from Daily Kos about the Biden Administration’s recognition of the impact of transportation policy on civil rights.

I first became aware of that connection when my husband and I became involved with (largely unsuccessful) efforts to keep the state from rebuilding the Interstates that had carved up neighborhoods in our downtown fifty years ago. I pointed out that the routing decisions made at that time not only divided historic neighborhoods, but exacerbated public safety problems and delayed the ensuing commercial and residential redevelopment of our downtown. Those decisions also decimated Black neighborhoods, and evidence suggests that particular result was not accidental.

Since being confirmed as Secretary of Transportation, Pete Buttigieg has been emphasizing the role played by transportation in civil rights.

In an interview with Politico, Buttigieg again repeated that saddling Black communities with the pollution and bifurcation associated with highways was “not just a matter of halfway accidental neglect” but “intentional decisions that happened.” He’s vowing reforms; much of the rest of Politico’s article consists of former Obama administration officials expressing their own wary hopes that the time is now right for more sweeping changes.

The post goes on to connect the dots, pointing out that environmental policy is also a civil rights issue. The U.S. highway system is just one example, but it’s a powerful one.

Moving swiftly to electric vehicles would alleviate the thick soot buildups recognizable to anyone who has lived next to a major artery. Restructuring mass transportation networks so that more Americans can use them to get to more places both lessens the climate impact single-person transportation and allows residents of currently isolated neighborhoods access to far more jobs and services than they currently have. Removing highways to replace them with smaller surface roads and more green space not only stitches together now-divided neighborhoods, but lessens urban heat island effects that magnify heatwaves and further strains our electrical grids.

Those of us who live in Indianapolis understand the extent to which the Indiana legislature’s animus toward our efforts to improve the city’s inadequate mass transit is motivated by a belief that transit is used predominantly by “those people.”

The post also had a good explanation of the problem with spending a disproportionate share of tax dollars on highways rather than environmentally-friendly transit.

It is akin to the elevator problem in urban high-rises: The more floors are added, the more elevators are needed to transport people from one floor to another, and the more space those elevators take up on each floor. After a certain threshold, so much space must be devoted to the elevator shafts on each floor that there is little to no room left on each floor for actual living or office space; there is nowhere left for the people in the elevators to actually go.

In American metropolises, the space devoted to roads, highways, garages, parking spots, setbacks and related structure takes up so much space that it makes the islanding of each neighborhood a fiat accompli. You could not walk to a grocery store or other services even if you were motivated to do it, but need a car simply to drive past all of the infrastructure devoted to cars between you and it. Mass transit becomes less viable because the roads and parking spaces have imposed a cap on population density surrounding each stop, stretching out the fabric of each city and forcing transportation planners to either put an interminable number of people-collecting stops on each line or to decide that the majority of each neighborhood will simply not be served.

The situation we face with transportation is evidence–if more were needed–of Heather McGhee’s premise in The Sum of Us: decisions based on racism and the desire to disadvantage “those people” end up hurting all of us.

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Medicare For All? Or For All Who Want It?

Elizabeth Warren and Bernie Sanders have made “Medicare for All” a centerpiece of their campaigns. Pete Buttigieg has offered “Medicare for All Who Want It.” Both proposals have generated criticism, and in my opinion, most criticism of both is misplaced, because the discussion fails to distinguish between two very separate issues: 1) what would a sensible system look like, and 2) how do we get there?

I was prompted to revisit the issue because my cousin–the cardiologist I often cite on this blog–has done his own analysis of the current state of healthcare in this country, and concluded that a single-payer system is both preferable and inevitable. (Those who want to get “into the weeds” of that analysis should follow the link.)

In my most recent book, I also make the case for single-payer–and point out that a fully-implemented single-payer system would be much less costly than our current patchwork, dysfunctional approach. Virtually every economist who has analyzed the situation agrees. That doesn’t necessarily mean that taxes wouldn’t go up, but any increase would be more than offset by savings on premiums, co-pays and other costs currently borne by individuals and employers.

At any rate–I’m in full agreement that a single-payer system is needed. I depart from the “vote for me and I’ll change the system” approach being taken by Warren and Sanders because there is an enormous mountain to climb between where we are and where we need to be, and the suggestion that all we have to do to get a single-payer system is elect a Democratic president (or perhaps a Democratic president and Senate) is ludicrous.

It isn’t simply that politically powerful insurance and pharmaceutical  companies would throw everything they have into that debate. Voters rebel when they are told they will be forced into a new system, no matter how demonstrably better off they would be. Just getting the Affordable Care Act through Congress took enormous political capital, and that was after numerous (unfortunate but necessary) concessions.

In a recent column for the New York Times, political scientist Jacob Hatcher writes that we shouldn’t lose sight of what Ms. Warren is trying to do.

She’s making an evidence-based case for shifting the debate away from the perilous place it’s now in. Rather than “Will taxes go up?” or “Will private insurance be eliminated?” she wants us to ask a more basic question: How can we move from a broken system — a system that bankrupts even families who have insurance and produces subpar health outcomes despite exorbitant prices — to one that covers everyone, restrains prices and improves results?

I actually don’t see Warren asking (or answering) that very important question–she seems to be making the case for an immediate change that would eliminate all private insurers, and if my impression is correct, it is a politically fraught case.

Nevertheless, “how” is the most important question. As Hacker writes,

Getting to affordable universal care has always been a problem of politics, not economics. Given that the United States spends much more for much less complete coverage than any other rich democracy, it’s easy to come up with a health care design that’s much better than what we have. The problem is figuring out how to overcome three big political hurdles: financing a new system, reducing disruptions as you displace the old system and overcoming the backlash from those the old system makes rich.

Yep. And that brings me to an interesting paragraph in my cousin’s post. Dismissing the “public option” (which is what “Medicare for All Who Want It” really is), he writes,

Even now, given our current healthcare pricing, a medicare type program, operating with lower administrative costs, would be far cheaper than those offered by their private counterparts. This would allow employers to willingly relinquish expensive private plans in favor of the cheaper public option that would reduce the cost burden of extra employee benefits. This means that the public option would likely supplant the present private plans completely in short order. (Emphasis mine.)

Yes. That’s the point.

“Medicare for All Who Want It ‘ isn’t the answer to the “what” question. It’s the answer to the “how” question.

Hacker

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