Wednesday, 11 February 2015

Social mobility, social welfare policies, and the myth of the American Dream

One question I get every day is why is the U.S. the only developed country without universal health care?  A related question is why is the gap between rich and poor increasing?  & why does the U.S. have such a different attitude towards the poor than the rest of the world?  This is but a cursory answer, and it begins with a little comparative history.
In Europe, there was an almost total lack of social mobility prior to the 20th century.  The socio-economic class into which you were born completely determined your opportunities in life.  This was understood by everyone rich and poor, aristocrat and commoner.
In the U.S., (leaving aside for our purposes legal discrimination based on sex, race, etc.) the class system was formally abolished.  Everyone was entitled to 40 acres & a mule and, if you worked hard enough, you could pull yourself up by your bootstraps.  A boy born dirt poor in a log cabin could become president.  A barefoot child laborer could rise to become factory owner and robber-baron capitalist.  It is the myth of the American dream.
Now think about what attitudes toward poverty are shaped by these two scenarios.  In Europe, poverty is an accident of birth, so the poor deserve help to level the playing field.  And Europe has created social welfare programs that were designed to overcome socio-economic barriers.  The problem in the 21st century is that those barriers are long gone.  It has been nearly 100 years since people were forbidden to attend university if they hadn't been born into a high enough class.  Even the heir to the throne in Great Britain has married a commoner.  But the attitude that there is nothing you can do to better yourself persists and it is a problem that Europe needs to sort out, along with immigration, but that is another post entirely.
In the U.S., the myth that the playing field is level, that everyone has an equal chance to succeed if they work hard enough, has resulted in a blame-the-poor mentality.  There is a belief that, in this land of opportunity, it is your own fault if you are poor, so why should people who have worked hard for their own success help you?  This is why there is universal health care in every other developed country except the U.S.  Americans blame the poor for not being able to afford health care and other necessities.
In the post-war era, when the social welfare programs that we do have in the U.S. were launched, there was a temporary shift in attitude because of the Great Depression and WWII.  There was a shift in Americans looking to the federal govt. rather than the states to solve problems because the problems during the Depression were too large for states to handle individually.  The frontier had closed at the beginning of the 20th century, the population was increasing, and urban slums filled with poor immigrants working for obscenely low wages in dangerous working conditions were growing during industrialization.  As the population urbanized, we went from a self-sufficient agricultural economy to a dependent urbanized one -- i.e., instead of producing what they needed to survive, people worked for wages, which they spent to buy these necessities.  Living in crowded conditions near employers, they could no longer produce goods for themselves, so they became dependent upon wages.
All of these things (closing of frontier, immigration, population increase, urbanization, industrialization, Depression) led Americans to take a more European attitude towards poverty, that it was not laziness on the part of the poor, that the playing field was not level with equal opportunity for all.  There was also a different attitude towards women working outside the home.  So-called welfare was originally meant to support widowed and abandoned wives with children, who were expected to stay home with their kids.
Now, fast forward to the 21st century.  These social programs were created before most people living today were born.  There are families where succeeding generations have been born to mothers on welfare.  There is an argument that dependence upon social welfare has become a way of life rather than a temporary safety net for the truly needy.  Those who oppose aid to the poor, including universal healthcare, believe that the playing field is now level, that those in poverty are simply too lazy to work and earn money for themselves.
The reality, of course, is that the playing field is far from level.  A child born into an urban ghetto with failing schools and gangs does not have an equal chance of financial success as a child born into a middle-class suburban community with good schools and Scouting.
Most of the debates between proponents and opponents of social welfare policies dance around this central ideological difference, but it is simply that those who oppose helping the poor believe poverty is their own fault and those that favour helping the poor believe that their socio-economic circumstances are beyond their control.  & n'er the twain shall meet.
The way to end poverty is not to continue the social welfare programs of the past (most of which have been updated already) but to look at the root causes and address them with a "teach to fish" not "give a fish" model of assistance.  But that is not going to happen as long as society is split in where it places the blame.  As I always say, you can have your own opinion but you can't have your own facts.  Both sides need to come to the table with the same set of facts before meaningful discussions about solutions can occur.

Thursday, 7 August 2014

Book Review: Year of No Sugar by Eve Schaub

Eve Schaub and I have a lot in common. We are both 40-something writers who have adopted Vermont as our physical and spiritual home.  Seduced by the New England small town and rural aesthetic, we know our way around a farmers' market and can wax rhapsodic on the virtues of local, seasonal, and organic everything.  We are both lapsed vegetarians, a transformation in attitude occasioned by the availability in areas like ours of locally and humanely raised meat. For vacation we'd both go back to Tuscany before we'd go anywhere else. Finally, and most relevant here, we both became aghast at the insane amounts of sugar in American food and attempted to wrest some control of the volume of sugar in our diets from multinational corporations and well-meaning bake sale vendors.

For Ms Schaub, her sugar epiphany was catalysed by a video on the evils of sugar. Whilst far from being ignorant about healthy eating, she experienced a dawning horror at the amount of sugar her family, particularly her two daughters, was mindlessly consuming despite her avoidance of fast food and obviously empty calories such as soda.  Avoiding sugar entirely seemed impossible but, not being one to shy away from a challenge, that is exactly what she set out to do, for an entire year, with her family joining her.

Predictably, there were tears from her children, but her husband, leery of radical diets from having grown up with a father who experimented with bizarre dietary extremes, was surprisingly game. Her book chronicles the setting and enforcing of the no-sugar rules for the year, which budgeted for monthly treats, a "birthday party rule" that allowed the girls to make their own choices about what to eat when they were away from home and their peers were eating sugar, and a personal exception for each family member – the one form of sugar they could not live without for a year. The difficulties of shopping, dining out, eating at someone else's house, negotiating holidays like Halloween and Xmas, are all described with unvarnished candour.

They made mistakes, especially in the first few months, not realising, for example, that balsamic vinegar contained sugar.  I think my favourite mistake was when they bought their daughters some strawberries and plain yoghurt for an afternoon snack in Florence only to discover the yoghurt was actually whipped cream. I bet the girls were in heaven. Some recipes adapted to be made with dextrose (an allowed form of sugar in her experiment) were a success but others failed to gel, literally. As an appendix, Ms Schaub lists recipes that are sugar-free as well as recipes for their monthly sugary treat.  The latter I found a bit odd as recipes with copious amounts of sugar are, to put it mildy, not difficult to find and somewhat at odds with the tenor of the book.  But I understand that readers might be curious about them, considering how evocatively she describes their monthly sugar mirage, and how carefully they selected their most beloved family recipes as treats.

Another thing Ms Schaub does not sugarcoat (sorry—I was going to have to use it at some point, so best we get it out of the way) is her children's reactions.  But it is clear that neither girl will have cause to look back on it as the Year from Hell.  The number of exceptions, the sweet but sugar-free treats made from dextrose and fruit, and their opportunity to eat sugar at school if they so chose, hardly made it a literal year without sugar.  The scary thing, as Ms Schaub notes, is how much less this still notable amount of sugar was compared to a typical year, let alone a typical American child's diet.  Remember, these were kids who had a mom that bakes bread and who had never set foot in a fast food restaurant, so their sugar consumption was already far below the norm. The most striking point, which the author emphasises repeatedly, is that the girls adjusted in many respects more easily than the adults because they had less time on earth to become addicted to sugar.  At five, the youngest was the quickest of the entire family to adapt, and by the end of the year the palates of the entire family had changed to such an extent that they willingly chose to eat less sugar even when it was allowed. 

In addition to the gradual alteration of their palates, another point the book makes is how the process of avoiding sugar in 21st century America exacts a mental toll due to the vigilance necessary to police the sugar content in every morsel that drops into our shopping carts or passes our lips.  As consumers in America, we have more nutritional privilege, more choice, than people virtually anywhere else on the planet, but that illusion of choice evaporates when faced with an entire aisle of cereals or sauces all of which contain some form of sugar.  Skipping dessert, as Ms Schaub explains trenchantly, does not cut it. Go to a cookout steeling yourself to resist the s'mores and find that the buns, dogs, condiments, side dishes, even the chips, all contain hidden sugar – and the only drinks without real sugar contain poisonous artificial sweetener, which is worse.  Any event of significance, from major holidays to ostensibly healthy occasions like a 10K fundraising run, is accompanied by vast amounts of sugar.  Avoiding it requires superhuman will power or complete social isolation.  During her family's year of no sugar, they employed both of those tactics, along with the aforementioned judicious exceptions to make holidays and birthdays bearable.

I have taken a far more moderate approach to the sugar problem–there was never any possibility of me having the will power to give up sugar entirely, let alone when on holiday in Florence, surrounded by gelato–but I experience this same frustration and horror at sugar, sugar everywhere.  When I picked up the book, I knew exactly how the author was going to react when she started looking for the hidden sugar in everything because I have been there, and continue to rage impotently against the purveyors of sugar.  I, too, peruse labels and cook and bake from scratch. That is simply a necessity. I wish I did not have to. It would be nice to stop for an ice cream with friends or enjoy a cookie in a coffeehouse that did not contain ten times the amount of sugar necessary.  Also, as Ms Schaub notes, making everything is time-consuming. I prefer baked goods and ice cream with much less sugar than in purchased varieties but it is not practical to always bake or make my own ice cream.

But the more prepared foods you eat, the more sugar you ingest, and any food, whether it contains sugar or not, is more satisfying when it is homemade.  The ultimate lesson of her book is not just about avoiding sugar for health reasons but about appreciating food. Mindless eating is invariably less healthy than cooking local, seasonal, organic, fresh ingredients from scratch. Kids, she notes at the end of her missive, are inherently aware of this. They will take homemade bread over store-bought cake. Children know, she concludes, what is special. That sense is something we have lost in the world of corporate food where sugar is used as a drug to stimulate unhealthy consumption and addiction. It is less will power than an appreciation for real food that may save us.

Thursday, 10 October 2013

How To End Welfare As We Know It – Really!

Ok, Rethuglicans. I see your welfare disdain and raise you a plan. Rep. Steve King of Iowa said in July that the U.S. has a "cradle-to-grave" welfare system that encourages dependency. You know what? I agree. Wait, hold your shrieks of outrage and/or your applause. Let me explain: The U.S. welfare system does encourage dependency. It is difficult for someone receiving benefits – Rep. King noted that there are at least 80 different programs – to become financially independent and no longer need this assistance. There are, to put it mildly, disincentives to leaving some of the programs. But the reasons are not what Rep. King and other cons think they are. In fact, the reasons are of their own making.

Reason #1) Lack of universal, single-payer health care
One, single-payer health care system for ALL Americans would reduce welfare dependency more than any other policy change. Mothers on benefits who get a job lose Medicaid for their child(ren). If they do not get insurance with their job, which is common for low-wage workers, and they cannot afford to buy coverage, also common, they have little choice but to quit their jobs if their child becomes sick or just not get a job in the first place. Welfare case workers have plenty of stories of women who work low-wage jobs with no benefits calling them up & saying, "My child is sick, what do I do now that I am working and no longer have Medicaid?" "Quit your job so your child can go to a doctor" is the response they get.  This also applies if the mother, rather than the child, is ill.

The phenomenon of people needing to keep their income below a certain level in order to maintain their eligibility for government-subsidised health care increases the use of benefits substantially. The same situation applies to people on SSI disability. They may be able to do some work but they would lose their disability payments if they took a job, even a part-time one, so they don't work at all or only under the table.  Most people who are not totally disabled could do some work, just not enough to survive.  Despite some attempts at reform, most welfare programs are all-or-nothing.  You earn, you lose.

Beyond mothers and children, medical expenses are the single greatest source of financial strain on Americans. People who lose their jobs and their homes when they become sick or injured sign up for unemployment, food stamps, Medicaid, and other benefits. All because of medical bills they wouldn't receive in a rational, humane health care system. I just read about a cancer victim who could not afford surgery – no insurance provided by his employer – who lost his job due to his declining health. Once he was unemployed, he was eligible for Medicaid and received treatment.  He was also now eligible for unemployment and food stamps.  So, we have a man who was gainfully employed full-time, receiving no government assistance, who winds up on three benefits programs due to health care expenses.  If we had universal health care, he could have received immediate treatment without losing his job.  He may wind up on disability -- a fourth program -- which he could have avoided had he gotten treatment earlier, before the cancer spread.

Universal health care would solve this, and many other problems. (Obamacare, alas, won't.) You cannot decry the use of social welfare benefits in one breath and oppose universal health care in the next; they are inextricably linked and inversely correlated.

Reason #2) Lack of a liveable minimum wage
We've all heard by now about Walmart workers being eligible for food stamps, and about many other companies scheduling workers for hours just below the threshold at which they would have to provide benefits (another problem that would be solved by universal health care!). I realise that many of the workers on benefits are not working full-time but that does not imply that full-time wages at $7.25/hour would support them; rather, full-time hours would still not pay a living wage but would trigger federal laws requiring their employers to pay benefits. So, it amounts to the same thing.

Listen carefully: No-one who works a full-time job should need government benefits to make ends meet. By definition, every full-time job should fully support an individual. In fact, the Rethuglicans who want women in the kitchen barefoot and pregnant and not in the paid workforce should be in favour of all full-time jobs supporting an entire family, wife and kids included. It is absurd that someone who works full-time should have to avail him- or herself of social welfare benefits just to keep a roof over their head and eat. The point of working full-time is that you are making a living. No full-time job should be allowed to pay so little that a person living within commuting distance of it cannot live on their wages. It should simply be illegal. Full stop.

So, if you oppose a minimum wage, don't complain about people receiving benefits to make ends approach.

Reason #3) Lack of adequate family-planning resources
The classic image of a welfare recipient is a single woman with children. The Rethug strategy for reducing out-of-wedlock births is to eliminate sex ed., impose abstinence-only education, and hinder the availability of birth control and abortion. If you want to reduce the number of single moms on welfare, the sensible strategy would be to enhance sex ed., and reduce the cost and increase the availability of birth control and abortion. Make it mandatory for all schools to teach accurate sex education and explain, repeatedly, to teenagers all birth control options and the importance of using them correctly each and every time they have sex.

Remove the stigma associated with abortion. Make it a given that anyone who cannot support a child without government aid will have an abortion if they get pregnant. I don't mean make it mandatory – we are not China -- I mean make common sense the cultural norm instead of religious drivel. Create a culture where having sex without using birth control conscientiously or continuing a pregnancy when you do not have the money to support the ensuing baby is simply unconscionable. Just not done. Unthinkable. Do that instead of making abortions harder to obtain and allowing insurers to opt out of covering birth control and you will see far, far fewer women on welfare. 

Whilst we are on the subject, payments to the disabled constitute a considerable welfare expense. Since we have the technology to diagnose foetal abnormalities in utero, why not make it a moral imperative to abort foetuses with serious issues instead of spending tax money on their lifelong care? Rethugs applaud when a pregnant woman says she won't abort AND they balk at paying benefits. But they don't see the clear connection between them.  And I haven't even addressed the people on permanent disability benefits because they were the victims of gun violence or members of the military disabled in unnecessary wars.  The Rethugs blame the Dems for the size of the welfare state, but the majority of it is of their own making and perpetuation.

These three reasons are just the tip of the iceberg. The point is that if you say that you don't want citizens sucking on the government teat long-term, or at all, then you need to create a country - socially, economically, and legally - where citizens have both the incentives and ability to take care of themselves. The people who tend to screech the most vociferously for the government to get out of people's lives tend to be the ones most dependent upon its services and the ones most likely to favour the very policies that increase dependence.

Tuesday, 23 April 2013

In praise of telecommuting: The slacker work ethic

When I worked in an office, I got nothing done.  I mean, literally nothing.  I viewed the hours I was stuck there, rather than any work I might produce, as the price of my paycheque & benefits.  Physically being in my cubicle, at my desk, from X am to X pm, was my job.  I had to answer the phone if it rang, go to meetings, deal with requests from bosses, but only at a bare minimum.  It was mainly clock-watching.  Before the Internet, it was harder to kill the time and look busy.   But for nearly 20 years now, both work and slacking off have involved staring at a computer screen.  My day revolved around deciding what I would have for lunch & afternoon snacks.  I never ate breakfast before work (not even once in all my years of working in an office, no exaggeration) – eating it at my desk gave me something fun to do whilst waiting to get lunch.  As you would expect, on the rare occasions when the job was busy & I was actually working, the time flew by much faster than on the days when I was staring at the clock, reading Fark, or trying to sneak a book on my lap under the desk.  When I had freelance work, I would try to do it at my day job.  Since I was trapped there for X number of hours, might as well use that time to get it done rather than my precious free time.

When I segued from cubicle dronedom to freelancing full-time, my work habits changed drastically.  When working from home, I was trapped at my desk only as long as it took to get the work done.  I didn’t have to sit there until 5:00pm if I finished.  I could do a million other projects, whether chores or hobbies.  I could reach a certain point in an assignment, go out for a run, and come back to it, refreshed and ready to tackle the next stage.  If I wanted to shop when the supermarket was less crowded or hit the gym when it was least busy, I could go in the middle of a weekday & work in the evenings or weekends.  The key difference was that I was no longer merely putting in time: I was rewarded for productivity, not being in a certain place for X number of hours each week.  I was compensated based on the quality and quantity of my work, not whether I was 15 minutes late or took an extra vacation day.  The biggest incentive to get work done was that I was free when it was finished – not a moment sooner or later.

So, you can imagine my reaction to the recent corporate trend to bring telecommuters back to the office.  Obviously, I think it is a huge mistake.  You want people to be productive, you don’t put them in a cubicle, you let them work sitting next to a swimming pool.  You can bet they will get that assignment finished so their butt can be in that pool as soon as humanly possible.  Put that same person in a cubicle and tell them they cannot leave until 5:30pm, and I will show you a person reading Amazon reviews and web comics all day long.  I’ve noticed that I barely have time to skim the headlines of the papers since I began telecommuting.  I really have to think an article is worth my treasured time to read the whole thing.  When I worked in an office, I read the paper cover-to-cover every day.  Remember when games like Tetris came with a panic button that switched the screen to a spreadsheet if someone walked by?  And when corporations started blocking websites to prevent their employees from checking their personal email and doing online shopping on "company time"?  You won't find a virtual worker slacking off because they are paid for results, not time.

To be fair, one of the reasons put forth for ending telecommuting is that face-to-face contact is useful for brainstorming and innovation.  I will grant you that the idea-generation and problem-solving stages of a project can benefit from group brainstorming sessions.  But that is what meetings are for – whether in person, or over Skype.  I have no objection to the theory that innovation needs collaboration but that necessity does not translate into a blanket ban on telecommuting.  Making people come into the office, in person or virtually, for facetime is reasonable.  But the high-handed command at Yahoo! to come back into the office full-time or quit was extreme, and will end up being counterproductive.  There is also a certain irony to a technology company banning working over the Internet.  It also does not help their image that the CEO is filthy rich.  A lower-paid employee could never afford the childcare arrangements she has made that enable her to put in long hours at the office despite being a new mother.  At best, she suffers from a lack of empathy.  I expect she has no clue how the little people beneath her live, and cares less.

Telecommuting is cheaper for employers, and it is a necessity in a society that does not provide paid parental leave.  It has become increasingly viable due to new technology, and it will continue to become practical in more industries.  It will never be an option in hands-on service industries (a virtual firefighter or hair dresser – uh, no) but the people who enter those professions know what they are getting into.  Trying to roll back time and turn people back into clock-watching cubicle zombies will lower productivity, not raise it.  I can vouch for that.

Monday, 1 April 2013

Location, Location, Location

Today’s Sunday Magazine cover story, “Is Giving the Secret to Getting Ahead?”, includes the line, “Studies show you shouldn’t move for location, since what you do is more important than where you do it.”  I’d like to know what studies these are, and who the respondents were, because I take issue with this supposed result.  Where I live is much more important to me than what I do for a living.  That clearly is not true for everyone but I can’t believe that the majority tend to the other extreme.

Work should take up, (for the sort of people who would be facing this job vs. location dilemma, i.e. mid-to-upper-level white collar), as few hours of one’s life as possible – 40 hours per week, maybe more in busy periods with overtime.  Most of one’s life is lived outside of work.  Work provides the money to do the things we love – play sports, pursue hobbies, own property, raise a family, etc.  Most people, if they won the lottery, would quit their jobs and move - to the coast, to the mountains, to whatever aesthetic environment appeals to them.  I know a guy who works in finance, for example, who lives to snowboard.  He has an MBA and a 6-figure salary, so you’d think he’d be about as career-oriented as anyone, but his main criterion for location is that fresh powder is within commuting distance.  This is not someone who would be happy with a great job in Florida. 

Speaking of Florida, I have known several people who moved there for jobs and found that, yes, Florida was just as tacky as they feared it would be.  They have all moved at the first opportunity, work not being enough to hold them in a location without any redeeming qualities, (okay, except TWWOHP, but you can't go there every day), not to mention cockroaches the size of Volkswagons.

I realise that some people would take any job to get as far away as possible from their families, and with good reason, but just as many others would be miserable living too far from their close-knit clans.  No job would make up for that.

Speaking of family, people with children tend to prioritise good schools and safe neighbourhoods.  Of course, they have to make a living to support their families, which often means moving for jobs, but location is still particularly important to them.  Most people I know wouldn’t consider raising a child south of the Mason-Dixon line.  When jobs take parents to an undesirable location they often endure unreasonable commutes for the sake of living in a better area for their children.  These long commutes can be both miserable and unhealthy.  Are they worth it for the job?

For myself, I am aesthetically married to New England.  I love the four distinct seasons and I live for fall foliage.  No job could be worth living in the South or PNW and missing out on the seasons each year.  I love the flora and fauna of New England, the historic architecture, the colonial history, the traditions and foods of the area.  I wouldn’t exchange maple syrup and pumpkins and cider and colonial farms and lilacs and autumn leaves for the foods and architecture and traditions of another region that don't resonate with me.

And I haven’t even mentioned politics. What job could be worth living in a red state?  What career move could outweigh being stuck in a place without organic food and coffeehouses?  There are still places in America where they’ll scratch their heads and offer you fish when you tell them you are a vegetarian, where they think that Fair Trade coffee means you want to barter for your cuppa.  I can see visiting such places and coming home with some interesting stories, but living there?  Putting down roots and buying property and raising your children there?

One of the (many) reasons I haven’t found a job in my field is because I am not willing to move to Outerbumblefuck, Kansas.  I know myself; I know that aesthetics are the most important thing in the world to me.  I don’t live to work, I work to live.  The things I love to do are not lucrative so I just want to make as much money as possible in as few hours as possible so I can devote as much time as possible to doing the things I love.  Giving up everything I love in life for a stupid job sounds like the worst trade-off in the world, especially given how insecure employment is.  If somebody told me that, if I could suck it up & live somewhere I didn't like for 10 years, I could earn enough to buy the farm of my dreams back in New England, of course I’d do it.  The short-term sacrifice, with the guaranteed pay-off, would be well worth it.  It would be an adventure.  But packing up my farm & leaving everything I love for a job that could end in a year, leaving me with no money, no farm, no roots, no money (worth mentioning twice), just adrift in a place I hate and no way to get a situation as good as the one I left?  That would be idiotic.  Moving for a job is a huge risk because nothing today is more unstable than the job market.  You move alone, away from family and friends and support networks and then you get laid off in 6 months and wind up homeless.  Yeah, job over location, smart move.

Within reason, figure out where you want to live, where you would be happiest, and then find a job there.  If you are in a highly specialized field, you don’t have that option, but this survey was clearly not aimed at such people.  Someone who wants to be an actor has to live in LA or NYC; someone who wants to be an astronaut has to live near NASA in Houston.  But I can’t imagine anyone that career-focused cares much where they live, and such driven folk are a tiny minority.  Also, if you are at the top of your profession, you can maintain two homes: one near work, one wherever you want to live.   But that lucky scenario doesn’t apply to most people.  For most people, their company transfers them to Cleveland and they either move or they lose their job.  They are not choosing job over location; they are stuck.

Another common situation would be this:  Let’s say you studied all your life to be a trumpet player.  After you graduate from Julliard, you audition for orchestras.  There are only so many with openings at a given time, so you cannot be choosy about location if you want a job in your field.  You get hired by the Seattle Symphony, but you hate rain.  Does having your dream job, one you literally worked since childhood to achieve, trump living in a place that depresses you?  I cannot imagine that it does but then I cannot imagine having a “career” rather than a “job.”  I cannot imagine caring more about what I do during working hours than what I do outside of them.  I wish I could get inside the head of someone who lives to work, just for a day, to experience that kind of drive and singlemindedness and energy.  I’ve never felt it and cannot fathom it.  I have goals about which I am passionate, but when it comes to making sacrifices or taking risks or working hard to achieve them, they take a backseat to comfort in the present.  That's why location is so important to me:  I cannot imagine being so engaged by a job that I could ignore living in an ugly, tacky, aesthetically-repugnant place.

Thursday, 28 March 2013

You got a better idea?

Health care is a human right, not a privilege of the wealthy.  A civilised country ensures that medical care is available to all its citizens, without regard for ability to pay.  The details of the provision of universal health care vary by country, but the basic premise is the same:  Health care is simply available to all, not on a fee-for-service basis.  When I lived in the UK and went to a doctor, there was no paperwork, no bills, no co-pays or dealing with insurance companies, no questions of what or how much insurance would cover.  The medical staff were paid salaries rather than paid on a per procedure basis, so they had no incentive to order unnecessary procedures.  They weren’t paid more if they squeezed more appointments in per day or if they ordered more tests.  Medical costs were contained because there was a single payer, the government; there was no ability of providers to charge higher rates to some customers the way the uninsured pay higher prices than the rates negotiated by insurance companies and the government in the U.S.

The U.S. is the only developed country that does not provide universal health care to its citizens.  It is also the only country where a citizen can be bankrupted, lose their house, and become unemployable due to medical expenses.  In case you are scratching your head over how medical bills can make you unemployable, here’s how:  Potential employers routinely run credit checks on potential employees.  Unpayable medical bills on an applicant’s credit history can cause them to be passed over for jobs, a vicious circle making it even harder for them to pay their bills.  The U.S. is the world’s richest country and the rest of the world wonders how people can die here due to being unable to afford medical treatment.

The U.S. needs to adopt single-payer universal health care as soon as possible – better late than never.  But that is not politically viable at present.  In fact, an interim measure, the Affordable Care Act of 2010, popularly known as Obamacare, that takes baby steps in the direction of increasing health care coverage for Americans, has generated considerable backlash.  Now, backlash for not going far enough would be legitimate, but this is ire from people who think the Act goes too far in trying to patch together some form of health insurance coverage for Americans who would otherwise be uninsured.

The legislation has many provisions, and you can find someone who objects to each and every one of them, but the gist of the argument against Obamacare seems to be that we, the taxpayers, cannot afford to provide health care coverage for those who cannot afford to pay for it themselves.  Subsidizing coverage for people who cannot pay their own premiums, the thinking goes, will place an enormous and unfair tax burden on those who work hard to pay their taxes and their own insurance premiums.  Moreover, since insurers will not be able to turn away high-risk customers, everyone’s premiums will go up to compensate.

The premium cost complaint is easy to address:  Legally cap premiums.  It is not as if the status quo ante was a paradise of affordable premiums.  Most people without employer-provided insurance could not afford to purchase coverage or, if they found a plan they could afford, the coverage was so meagre that they were egregiously underinsured.  Many Americans are walking around who technically have health insurance but who find the coverage worthless when they need it.  Underinsurance is actually a bigger problem than lack of any insurance.  And small businesses have always struggled to be able to provide health insurance to their employees, and many of them gave up long before Obamacare.  Some people stick with jobs they hate because they need the health insurance.  The best option would be a single-payer system that would take private health insurance out of the equation altogether but, until the political power of the insurers can be overcome, an interim solution would be to legally limit what they can charge.  Obamacare does do this, but the limits are weak, and insurance companies have been rushing to jack up premiums before the law goes into effect in 2014 so that the new higher rates are grandfathered in.  A better interim measure would be to mandate minimum coverage, to end the problem of underinsurance, and to cap premiums.

What’s that you say?  That if insurance companies were forced to provide more coverage for lower premiums they might get out of the health insurance business?  Gee, wouldn’t that be a pity.  They should be allowed to continue to charge extortionate premiums for useless coverage because that is the American way.  Uh-huh.

Moving on to the complaint about the cost to taxpayers to cover the uninsured.  One obvious point is that the taxpayer already pays when the uninsured use emergency services and/or are unable to pay health care bills.  Those charges are passed on to others.  Another obvious point is that we have a patchwork of taxpayer-subsidized health insurance that covers certain segments of the population, such as the very poor and those over 65.  Extending this coverage to other segments of the population would actually be more efficient than the current system.  As mentioned above about countries with single-payer universal health care, the government can tell providers what it is willing to pay for services and they can like it or lump it.  Costs can be kept down based upon what the government is willing to pay.  I realize there is a counter-argument that providers could stop accepting patients if their profits are limited in this way, but that is an unfounded fear. If it started happening, it could also be addressed with legislation.  This may come as a shock to some Americans, but some countries do not allow the private practice of medicine.  You accept government rates of payment or you don’t practice.  It’s not the American way, I know, but neither is it likely that providers will stop taking public patients.

But Obamacare is a weak law written with the cooperation of insurance providers, to their advantage.  Instead of taking away their customers and putting them in a universal single-payer system, it requires everyone to purchase private insurance, greatly raising the number of customers for the industry.  It is a huge boom to the insurance industry, and it does not decouple health insurance from employment, which is long overdue.  Companies started offering health insurance to employees after WWII as a perk, to lure good workers.  Over the years, employer-provided health insurance became expected, even though it makes no sense and places a senseless burden on employers.  Believe me, most employers would be happy to get out of the health insurance business.  Although they are increasingly trying to pass the cost of health insurance onto their employees, it remains a huge, unwanted expense, not to mention the fact that smaller companies simply cannot afford to offer it.  Instead of disconnecting insurance from employment, Obamacare provides incentives for employers to offer it.  This is a mistake.   In the short term, it can be addressed by states providing counter-incentives for employers NOT to provide health insurance.  In the long run, we simply have got to decouple employment from health care coverage completely.  There is no logical connection between the two.

My last point is a question to those who oppose Obamacare:  How do you propose handling health care costs for those who cannot afford to purchase insurance and do not receive it from their employers?  (I include in this statement those who are underinsured, which is essentially the same as being uninsured except that instead of merely not having coverage you are also flushing money down the toilet every month paying useless premiums.)  There are, as I see it, three options:

1)   Those who cannot afford care do not receive it.  If you cannot afford to pay for your own health care costs, or those of your family, you should suffer and die if you become ill or injured.  Health care is not a right; it is a privilege for those who can afford it.

2)   Individuals and private charities should provide health care for those who cannot afford it.  Such care will be purely serendipitous – if you are ill or injured, there may or may not be a private charity willing to provide care at that place and time.  But relying on the kindness of philanthropic strangers should be your lot if you cannot pay your own health care costs.

3)   The status quo is fine.  If people cannot afford their health care costs, it is the right of creditors to sue them and confiscate their assets.  If they cannot get a job due to a poor credit rating from unpaid medical bills, they should have thought of that before they got ill or injured.

          Corollary to status quo option can be split two ways: 1) Taxpayers should continue to absorb the costs when people who cannot afford care use emergency rooms.  This is a huge waste of money, but it is more acceptable to us than comprehensive coverage.  2) The law that emergency care must be provided to everyone, regardless of ability to pay, should be overturned.  We should not cover emergency room care for those who cannot afford it, let them die.

So which will it be?