In this issue, vilifying the poor over health care, the bad news on leveling inequality, the good news on wages, and the trouble with the post-election giving surge.
As you may have heard the GOP in now deep into "repealing and replacing" the signature healthcare law passed during the Obama administration. Before we get into the bill, you might be interested in reading this report from the RAND Corporation on the social determinants of health:
America spent $3.2 trillion on health care in 2015, nearly $10,000 per person. Yet by the most basic measure of population health—life expectancy— it ranked No. 28 among 35 of the world's most advanced nations. Researchers have called this the American health care paradox, the spend-more-get-less model of health care. Americans, one writer quipped, take a risk with their health just by living in America...
At least part of what's ailing health care in America, according to that theory, is its very focus on health care alone. America's vaunted medical system can, and does, provide some of the best care in the world—but it will always be playing catch-up to what happens outside the doctor's office. Too many fast-food restaurants and not enough parks. Poverty, unemployment, segregation, disorder. Even the everyday grind of chronic stress. More and more, research suggests that those should be treated as medical problems, not just social ills—and that addressing them could yield better health at lower cost.
The new healthcare bill is wildly unpopular on both sides of the political aisle jeopardizing its chances of passing the Senate. In probably the best summary of the challenges, various pain points and ill-considered compromises, New York Magazine's Jonathan Chait says Republicans have "realized the impossibility of the task midway through, but, unable to retreat on their commitment":
The best indication of the quality of the plan is that it has drawn almost universal scorn from the health-care-policy community. It’s predictable that experts on the left would dislike Trumpcare. But the right seems barely any more favorable. Conservatives like Peter Suderman, Philip Klein, Bob Laszewski, and Avik Roy, who have spent years savaging Obamacare, are united in their disdain for its replacement...Republicans have found themselves frantically scrawling out a hopelessly inadequate solution in order to meet a self-imposed deadline driven by their overarching desire to cut taxes for the rich. “Expanding subsidies for high earners, and cutting health coverage off from the working poor: it sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats,” writes the Republican health-care adviser Avik Roy. The caricature is true.
The most disconcerting portion of this acrimonious healthcare debate is the way people with the least means to obtain coverage are being vilified in addition to being left behind. In the Washington Post, Stephen Pimpare argues that people are not poor because they are lazy and cell phones are not the reason they cannot afford healthcare as reasoned by Republican Congressman Jason Chaffetz:
Chaffetz was articulating a commonly held belief that poverty in the United States is, by and large, the result of laziness, immorality and irresponsibility. If only people made better choices — if they worked harder, stayed in school, got married, didn’t have children they couldn’t afford, spent what money they had more wisely and saved more — then they wouldn’t be poor, or so the reasoning goes... Never mind that research from across the social sciences shows us, over and again, that it’s a lie. Never mind low wages or lack of jobs, the poor quality of too many schools, the dearth of marriageable men in poor black communities (thanks to a racialized criminal justice system and ongoing discrimination in the labor market) or the high cost of birth control and day care. Never mind the fact that the largest group of poor people in the United States are children. Never mind the grim reality that most American adults who are poor are not poor from lack of effort but despite it.
In addition, folks who are rural, elderly, disabled or female will face extra challenges to coverage under the new plan. Over at Esquire Magazine, SE Smith says the cost-cutting measures to Medicaid have widespread implications for disabled Americans:
The proposed system of "block grants" mean that individual states may run out of Medicaid funding before they've met the needs of their residents, likely triggering crackdowns on benefits eligibility as well as dreaded lifetime per-capita limits on recipients...Changes to Medicaid could end up pressuring more people into institutional settings, Evans says, because caseworkers and states may decide that they aren't eligible for community-based services as part of cost-cutting measures. Research shows that home-based services are actually less expensive, but policies that effectively force people into institutions are a perennial problem.
The Daily Beast's Gloria Ryan says the bill amounts to a giant tax on women. "[I]f the House GOP plan were signed into law as-is, women could face financial repercussions for being poor, or for using birth control, or for not using birth control, or for giving birth, or for having children who need medical care," she writes. Meanwhile rural health providers worry about what it might mean for their patients. "There are hundreds of federally qualified health centers in West Virginia, Kentucky and Ohio. And there are hundreds of rural hospitals providing inpatient and emergency care dependent on government funds to function," reports Mary Meehan. Check out this chart:
In the Nation, former Ohio congressman Dennis Kucinich says our political economy is at fault for creating poverty and inequality:
The privatization of the money supply is one of five major factors in poverty and inequality today, the other four being the emergence of the military-industrial-intelligence-congressional complex, the maintenance of the for-profit health-care system, and the erosion of public education through the creation of charter schools and the tremendous lifelong debt burden placed on those seeking higher education.
Today we face a renewed threat of privatization that could dramatically thrust the American people deeper into poverty.
Meanwhile, this Economist book review of Walter Scheidel’s “The Great Leveler”, which looks at when real progress on reducing inequality happens--it isn't pretty:
Only four things, Mr Scheidel argues, cause large-scale levelling. Epidemics and pandemics can do it, as the Black Death did when it changed the relative values of land and labour in late medieval Europe. So can the complete collapse of whole states and economic systems, as at the end of the Tang dynasty in China and the disintegration of the western Roman Empire. When everyone is pauperised, the rich lose most. Total revolution, of the Russian or Chinese sort, fits the bill. So does the 20th-century sibling of such revolutions: the war of mass-mobilisation.
And that is about it. Financial crises increase inequality as often as they decrease it. Political reforms are mostly ineffectual, in part because they are often aimed at the balance of power between the straightforwardly wealthy and the politically powerful, rather than the lot of the have-nots. Land reform, debt relief and the emancipation of slaves will not necessarily buck the trend much, though their chances of doing so a bit increase if they are violent.
Meanwhile the Marshall Project looks at "pay-to-stay" jails where folks who can afford it can have hotel-like amenities for the jail time.
Pay-to-stay jail assignments make up only a small fraction of the tens of thousands of inmates sent to detention centers in Southern California each year. But allowing some defendants to avoid the region’s notoriously dangerous county jails has long rankled some in law enforcement who believe it runs counter to the spirit of equal justice.
The Economic Policy Institute is back with this report on the state of U.S. wages in 2016:
Rising wage inequality has been a defining feature of the American economy for nearly four decades. In 2016, with an improving economy, most workers at all income and educational levels finally began to see an increase in wages. But large gaps in equality by gender, race, and wage level remain, and some of these gaps are increasing... In fact, wage growth in 2016 was more rapid for middle- and low-wage workers than for those at the top (defying the longer-term trend of more wage growth at the top). To be clear, there is still substantial work to be done to reach genuine full employment, reduce wage disparities by gender and race, and reverse the damage done to wages by decades-long growth in inequality and wage stagnation. But 2016 was a welcome break from years past—only time and proper policies will tell if this performance is to be repeated in coming years.
The Atlantic's James Fallows is back with a look at why Americans are optimistic about their own communities but not the nation. "Just as Trump’s appeal seemed grossly out of touch with modern African American life, so does the heartland-rage theory miss the optimism and determination that are intertwined with desolation and decay in the real 'out there.'”
In the Stanford Social Innovation Review, Timothy Ogden looks at the surge of giving to certain organizations since the election and says there may be reasons for most other nonprofits to be worried:
Clearly, for these organizations and the causes they support, this is good news. But this flood of giving should also be a cause for concern for other nonprofits. That’s because there is very little reason to believe that this giving represents a net addition to the total amount that will be given this year in the United States. The United States is one of the most generous countries in the world. However, historically, there has also been a very clear limit to that generosity: two percent of national income...It’s possible, as some have claimed, that the surge in giving really is a sign of something changing in Americans’ willingness to give (at least among Americans who support a progressive agenda). But it’s worth noting that the “two percent rule” is stronger than political affiliation. And keep in mind a few events that did not change what Americans were willing to give in total: the Haiti earthquake, Hurricane Katrina, the Indian Ocean tsunami, and 9/11. As any good fundraiser will tell you, there is a huge gap between intentions and actions.
Also in SSIR, Cheryl Heller looks at ways to design impact measurement and the future of the social design sector:
We find ourselves at an inflection point, with a need to define, measure, and scale the impact of social design if we are to realize its potential.
This complex and somewhat amorphous challenge, as it happens, is exactly the kind that designers like to take on...While we need a more concise and consistent way to define the field overall and explain its principles, we also need to dispel the notion that there’s a simple formula for evaluating where, how, and to what extent it works. In particular we need to disabuse some enthusiasts of the notion that evaluating social design requires nothing more than Post-it Notes, a cluster diagram, and anecdotes from the field about how much people liked it. We need language and information architecture that illustrates the different applications of social design, and links their various goals to metrics and outcomes. We need to audit all the types of tools people are using to measure impact and very likely develop additional ones. In short, we need to map the process.
The Nonprofit with Balls blog suggests funders should work harder to protect marginalized communities in the next four years:
[T]he leaders I’ve been talking to are fired up and ready to fight. But we are also really exhausted. Nonprofits, especially ones led by marginalized communities, are shouldering too much of the burden. Many of the leaders I heard from have been leading and responding to the various consequences of the travel ban and the uptick in xenophobia and racism. They are still running their regular programs, but now there is an increased demand for services, and on top of that, they must also be involved with resistance efforts. With usually the same level of resources. This is a recipe for burnout, and we have to do something about it quick. We must sustain organizations serving marginalized communities, as we need to them to keep going for the long-haul. It’s only been a month into the new administration. We still have at least four years to go, and many leaders and nonprofits at the forefront of the battles are already stretched thin. The role that funders play is more vital than ever, but to be effective, we have to reconsider a few things.