Tag Archives: Poverty

George Will, Plain Bad Arguments, Weak Analogy

You’re on your own

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It wasn't long ago that George Will called Obama's very catchy "you're on your own" line (from his acceptance speech) a straw man of the (discredited) Republican philosophy of government.  So I was struck when I read this encomium to being on one's own (creepy lines in bold).

When Medicare was created in 1965, America's median age was 28.4; now it is 36.6. The elderly are more numerous, and medicine is more broadly competent than was then anticipated. Leavitt says that Medicare's "big three" hospital procedure expenses today are hip and knee replacements and cardiovascular operations with stents, which were not on medicine's menu in 1965.

After being elected to three terms as Utah's governor, but before coming to HHS, Leavitt headed the Environmental Protection Agency. He came to consider it a public health agency because the surge in Americans' longevity in the last third of the 20th century correlated with cleaner air and fewer waterborne diseases. Longevity is, however, expensive, and demography is compounding the problem.

In the 43 years since America decided that health care for the elderly would be paid for by people still working, the ratio of workers to seniors has steadily declined. And the number of seniors living long enough to have five or more chronic conditions — 23 percent of Medicare beneficiaries — has increased. Many of those conditions could be prevented or managed by better decisions about eating, exercising and smoking. The 20 percent of Americans who still smoke are a much larger percentage of the 23 percent who consume 67 percent of Medicare spending. Furthermore, nearly 30 percent of Medicare spending pays for care in the final year of patients' lives.

If only we could find some kind of completely tone-deaf market analogy for how medicare should work:

Suppose, says Leavitt, buying a car were like getting a knee operation. The dealer would say he does not know the final cumulative price, so just select a car and begin using it. Then a blizzard of bills would begin to arrive — from the chassis manufacturer, the steering-wheel manufacturer, the seat and paint manufacturers. The dealership would charge for the time the car spent there, and a separate charge would cover the salesperson's time.

Leavitt says that until health-care recipients of common procedures can get, upfront, prices they can understand and compare, there will be little accountability or discipline in the system: "In the auto industry, if the steering-wheel maker charges an exorbitant price, the car company finds a more competitive supplier. In health care, if the medical equipment supplier charges an exorbitant price, none of the other medical participants care."

The auto industry?  The one with the huge bailout?  Anyway, back to the ice floe:

Rather than ruining the new year by dwelling on Medicare's unfunded liabilities of about $34 trillion (over a 75-year span), ruin it with this fact: In the next 50 years, Medicaid, the program for the poor — broadly, sometimes very broadly defined — could become a bigger threat than Medicare to the nation's prosperity.

This is partly because of the cost of long-term care for the indigent elderly, some of whom shed assets to meet Medicaid's eligibility standard — sometimes as high as income under 200 percent of the federal poverty level. And many states, eager to expand the ranks of the dependent with the help of federal Medicaid money, use "income disregards" to make poverty an elastic concept. For example, they say: A person who gets a raise that eliminates his eligibility can disregard the portion of his income that pays for housing or transportation.

Governments with powerful political incentives to behave this way will play an increasingly large role in health care. As is said, if you think health care is expensive now, just wait until it is free.

Indigent elderly, since you're a threat to our nation's prosperity, "you're on your own."

David Brooks, Inexplicable

Methodological individualism

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David Brooks has discovered that human behavior is more complicated (and the science more uncertain) than some headlines he vaguely remembers seem to have suggested:

It wasn’t long ago that headlines were blaring about the discovery of an aggression gene, a happiness gene or a depression gene. The implication was obvious: We’re beginning to understand the wellsprings of human behavior, and it won’t be long before we can begin to intervene to enhance or transform human life.  

But, alas.  

Few talk that way now. There seems to be a general feeling, as a Hastings Center working group put it, that “behavioral genetics will never explain as much of human behavior as was once promised.”

"Behavorial genetics" seems kind of scientific.  What conclusion can we draw from the new-found skepticism about the glories of the scientific mind:

Today, we have access to our own genetic recipe. But we seem not to be falling into the arrogant temptation — to try to re-engineer society on the basis of what we think we know. Saying farewell to the sort of horrible social engineering projects that dominated the 20th century is a major example of human progress.

We can strive to eliminate that multivariate thing we call poverty. We can take people out of environments that (somehow) produce bad outcomes and try to immerse them into environments that (somehow) produce better ones. But we’re not close to understanding how A leads to B, and probably never will be.

This age of tremendous scientific achievement has underlined an ancient philosophic truth — that there are severe limits to what we know and can know; that the best political actions are incremental, respectful toward accumulated practice and more attuned to particular circumstances than universal laws.

Wholly crap!  "Aggressive behavior in an individual" might be the subject of behavorial genetics (worthy of all well-informed (not Brooksian) skepticism), "poverty" is not a genetic property but rather a (relative) social and economic one.  One whose causes, by the way, are largely well known: lack of financial resources, etc. 

By linking poverty with behavorial genetics (whatever that might mean exactly), Brooks seems to claim the explanation for poverty lies mainly with the individual poor person.  But Brooks is then too respectful of the deep human mystery to inquire further about it.

So Brooks' pseudo-skepticism masks a very dogmatic adherence to the claim that individuals are largely responsible for their social destiny.  And that's not very skeptical.

 

*minor edit for "cogency"

Op-Eds and other opinions, Red Herring

Life isn’t fair

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Deep thinking on the issue of race, poverty and justice from a former CEO.  Here is the quick and uncharitable summary: life is unfair to people unjustly deprived of opportunities, but they don't have to go around complaining about it–that only makes it worse. 

Life isn't fair for people of any skin color. And sadly, in America today, many blacks face barriers such as economic insecurity, scarce jobs and poor schools, which create even higher hurdles for them to overcome. There is no cure-all for this inequity. But the effect that Jeremiah Wright has on Barack Obama's presidential campaign is far less important than the effect of the terrible message that Wright and others like him send to their congregations.

Positive thinking isn't going to solve America's race problems. But vitriol will only ensure that our nation's racial divide is sustained. We need to listen to the messages being sent in our communities and ask whether they encourage progress. A positive mind-set is at least a start toward success.

This has an almost Daily Show-like quality to it.  The vitriol of Wright (and people like Wright–you know, those people) is so bad that it distracts us from the real problem their vitriol is pointing out–you know, the fact that:

Sadly, in America today, many blacks face barriers such as economic insecurity, scarce jobs and poor schools, which create even higher hurdles for them to overcome.

If only someone could point out that injustice in a rhetorically effective way–then people would notice that attempts to resolve it, such as the following, have failed to address the core problems:

This challenge has not gone unnoticed. Each year the federal government spends hundreds of billions of dollars — specifically, more than $10,000 per poor person for welfare, Medicaid, the earned-income tax credit, job training and food stamps. Put another way, taxpayers are doing their share. 

Where could we find such a person to draw attention to this injustice?