[T]he difference between being surrounded by a loving family or being homeless on the street is determined not just by our own level of virtue or self-discipline, but also by an inextricable mix of luck, biography, brain chemistry and genetics.
[S]uccess in life is a reflection not only of enterprise and willpower, but also of random chance and early upbringing.”
So what’s the solution to this problem? It is apparently very simple: All we need is love. (Kristof’s column is actually titled “Where Is the Love?”) And just in case you are not motivated in that way, Kristof draws on the work of Harvard professor John Rawls to give a rational philosophical reason to spend more on welfare programs.
But before getting into that let’s pause for a moment. Is being born really a matter of luck? Doesn’t that take willful activity on the part of two parents? And is the inability of parents to support their children really a matter of luck? Or is it the result of bad habits and undisciplined behavior.
One of the biggest differences in how the left and the right view the world concerns the welfare state. Currently, the federal government spends about $1 trillion a year on 126 means tested welfare programs. That amounts to almost $22,000 for every poor person in America, or $88,000 for a family of four.
What difference does all this spending make?
Among people on the right, there is little doubt. These programs are destroying the culture of the recipient communities. They are replacing a culture of self-reliance and self-help with a culture of dependency. Amazingly, a record 91.5 million people of working age — almost one third of the entire population — are not working and not even looking for a job.
Among conservatives I have met who were once poor (and I have met a surprising number of them), the view that welfare subsidizes and encourages dependency is almost a self-evident truth. I’m not sure I have ever met a liberal who was once poor. But then again, the liberals I encounter are all in the academic and public policy world ― far away from the poverty population they so often talk about. I think this is a fascinating sociological phenomenon. If my experience is different from yours, weigh in in the comments section.
[BTW, I am ignoring the shake down artists ― Jesse Jackson, Al Sharpton and the like. We have no idea what these folks really think, since (as Juan Williams has documented) they routinely use liberal causes to line their own pockets.]
New York Times columnist Paul Krugman claims that Republicans who want to trim back welfare spending are waging a “war on the poor.” Most people on the right think it’s the other way around: it’s the welfare state and its apologists who are really harming the poor.
Who is right?
Walter Williams on black families and the welfare state
For your Thanksgiving dinner delight I am offering fodder for a friendly debate.
The idea that John F. Kennedy was really a conservative, rather than the liberal icon he is so often depicted as, is the thesis of a new book by Ira Stoll. The idea is seconded by George Will in a column in The Washington Post. Are they correct?
Before examining the case, let me make an important distinction. I seem to be one of the few writers who sees conservatism and liberalism as sociologies, not ideologies.
An ideology is a set of ideas that cohere. Socialism is an ideology. So is libertarianism. Suppose I told you that socialists believe the government should nationalize the steel industry and the auto industry. You would have no difficulty inferring what their position is on nationalizing the airline industry. Right? Suppose I told you that libertarians believe in a free market for tinker toys and ham sandwiches. You would have no difficulty inferring that they also believe in a free market for Rubik’s Cubes.
Sociologies are different. They represent a set of ideas that are often incoherent. These ideas are likely to come together not because of reason, but because of history or happenstance. Not only do the ideas not cohere, they may be completely contradictory.
First marriages are taking place later in life. And, increasingly, couples are opting out of marriage entirely. Living together prior to marriage — or as a substitute for marriage — is about 15 times more common today than it was 50 years ago. About half of all women of childbearing age have lived with a romantic partner prior to marriage. This figure approaches three-quarters of women in their 20s. Social conservatives may dismiss this as a case of waning morality — morally-challenged couples shacking up rather than entering into holy matrimony. Yet the reasons could be partially economic.
The decline of marriage may be partly due to so-called marriage penalties in the federal tax code, and in government welfare programs. You can add another penalty to the list: the ObamaCare exchange marriage penalty.
A centerpiece of ObamaCare is the establishment of health insurance exchanges where qualifying individuals can purchase subsidized, individual health insurance. However, these exchange subsidies — which are based on the federal poverty level (FPL) — are far more generous to cohabitating partners than to married couples.
The reason cohabitating couples fare better than married ones is because the federal poverty level does not rise proportionally with the number of individuals in the family. For example, the poverty level is $11,490 for an individual, but only increases to $15,510 for a married couple — just $4,020 more. Thus, two unmarried individuals living together qualify for larger federal subsidies than they would if they were married.
But you say it’s time
We move in together;
Raise a family of our own,
You and me.
An interesting story in The New York Times a little over a year ago relayed the journey of a woman who had broken the shell of one of her hearing aids. Shocked at the price of hearing aids from private audiologists — at least $2,000 for a set, and usually $3,000, she sought another solution. Learning that about 70 percent of this price is retail mark up, the woman searched online and found hearing aids available at reputable online stores — such as Audicis or Costco — for as little as $399. Searching a little more, she found an audiologist who offered to repair the shell of her old hearing aid for $100. So, that’s the choice she made.
But it gets even better. Only one year later, new technology has allowed entrepreneurs to develop hearing aids that they plan to sell for $300, and that have better sound quality than ever, according to neutral reporters.
You may remember that when Health Savings Accounts were introduced there was almost universal outrage among liberals about the horrendous burden cost-sharing places on all but “the healthy and wealthy.” A press release issued by the Center for Budget and Policy Priorities (CBPP) within a week of the Ways and Means committee approving an HSA bill in 2003 said –
This legislation would lead many employers to move away from providing low-deductible comprehensive insurance, noted Edwin Park, a senior health policy analyst at the Center and the report’s lead author. Policies with deductibles of $1,000 or more, higher co-payments for medical services, and coverage for a narrower array of health services could well become the norm for employer-sponsored coverage, with employers expecting their workers to pay uncovered costs out of their tax-favored Health Savings Security Accounts, Park stated.
Low- and moderate-income workers, who would benefit little from the tax breaks that the new accounts would provide, and older and sicker workers, who could face large increases in out-of-pocket health care costs as a result of the loss of comprehensive insurance, could be sharply affected, he added.
Here is irony: the people who talk the most about the need for a social safety net (including the president himself!) are cheerleaders for a health reform that is going to shred it.
How is that happening? By means of the Affordable Care Act (ObamaCare).
Through the Medicare and Medicaid programs, the federal government provides billions of dollars in subsides every year to hospitals that see a disproportionate number of patients who are poor and uninsured or who are on Medicaid. In both cases the result is the same: hospital revenues fall well short of the cost of care they dispense.
The shortfall is what people in the health policy world call “uncompensated care” and the payments are referred to as “disproportionate share” money.
Readers can be forgiven if they are naturally suspicious of hospital accounting. Just as hospital charges are for the most part phony numbers, so are most estimates of uncompensated care. Still, the is no denying that hospitals like Grady Health in Atlanta and Parkland Memorial in Dallas would not exist, or would not be able to maintain the current level of service, without a great deal of government money.
That’s where ObamaCare comes in. One of the ways that the health reform is being funded is through cuts in disproportionate share funding for hospitals. The theory was: if more people ― especially low and moderate income people ― are insured, there will be less need for hospital subsidies. That theory overlooked four important features of the reform, however.
For the past six years President Obama and the Democrats in Congress have waged a relentless attack on the health insurance industry. In the most recent iteration, the president assures us he is not responsible for the wave of health insurance policy cancellations. The insurance companies are.
Okay, so where is the other side?
When is the last time you saw an insurance industry executive interviewed on a TV talk show, presenting the industry’s answer to all these attacks? You can’t remember seeing that? I can’t either.
Well what about the health insurance industry trade groups, the folks who are supposed to explain to Congress and the general public the industry’s position? When is the last time you saw one of those representatives on TV? Can’t remember? Nor can I.
Okay, let’s try one more option. When is the last time you saw someone from a university or independent think tank giving the health insurance industry side of all the complaints that are being slung their way? Don’t bother responding. We both know that answer as well.
I submit that this is not a small matter.
A free society requires the free flow of information. In any public policy dispute, if only one side is heard from, we are likely to get further and further away from the truth. The attackers will find there is no penalty for getting minor facts wrong or shading the truth. That will embolden them to make more serious errors, eventually resorting to downright lying. If the only entity providing any push back is the Washington Post fact checker, we are in real trouble. Roughly 99.99% of the population doesn’t read the Washington Post.
But what threatens the foundations of a free society most of all is when it is the government (and its allies in the private sector) who are doing the attacking, and when the reason there is no response is that the victims of the attacks have been threatened and bullied into silence.
I believe that is where we are today ― not just with respect to health insurance, but with respect to health care generally. I’m afraid other industries are not far behind.
For the past 20 years I have been trying to convince my colleagues in the health policy community that managed competition contains perverse economic incentives. These incentives do more than misallocate resources. They create ominous risks for the health and safety of patients with serious medical conditions.
Consider the editorial in Monday’s Wall Street Journal. If you are inclined to believe Barack Obama’s claim that people losing their insurance are giving up skimpy coverage for much better benefits, read the editorial again, and again, and again.
The patient in question has a rare form of cancer that is almost always fatal. Yet she is alive, thanks to the efforts of doctors in San Diego, at Stanford University and in Texas. Over the past year, UnitedHealthcare has spent $1.2 million on this woman’s medical expenses. But she has just been informed that her insurance is being cancelled. And in the new California exchange, the only plan that will allow her to continue seeing her San Diego doctors will not pay for the doctors at Stanford or in Texas. There is no reimbursement for out-of-network services.
Here is my prediction: the kind of coverage this woman had will never again be seen in the individual market in this country.
It’s as though two completely separate conversations have been going on. From day one, the health policy community has correctly seen the Affordable Care Act as an attempt to completely change the health care system. This isn’t even controversial. It’s accepted by all as an undisputed fact.
However, no one has ever said this to the American people. In fact, the message of the Obama presidency — going all the way back to the 2008 campaign — was just the opposite. In that election, Barack Obama rejected Hillary Clinton’s call for an individual mandate (a proposal that would obviously affect everyone) in favor of his own proposal which appeared to mainly help those who couldn’t afford insurance. And how many people would that be? You could be forgiven if you thought it was about 10% of the population.
Then, on the eve of the passage of the ACA, virtually every Democrat who appeared on TV to defend it had one and only one message to offer: people were being discriminated because of pre-existing conditions. And how many of those people are there? Well for the first three years under the law, anyone denied insurance because of a pre-existing condition was able to enter the new (ObamaCare) risk pools and pay the same premium a healthy person would pay. How many did that? About 107,000. That’s out of a U.S. population of approximately 314 million!
To allay concerns about ObamaCare’s individual mandate, the president repeatedly promised that “if you like your health insurance plan you can keep your health insurance plan” and “If you like your doctor you can keep your doctor.” Over and over again the message was the same: most people will be completely unaffected by the new health law.
Then over the past week or so, the general public woke up to some stunning revelations. It now appears that as many as 10 million people will lose their individual health insurance policies as of January 1. To put this number in perspective, the administration’s goal for next year is to sign up 7 million people. We could actually end 2014 with more people uninsured than there were at the end of 2013.
On top of that, The Washington Post has just awarded the president Four Pinocchios for his statements. Although it took them five years to do so, when they finally got around to it the write up was devastating. “Four Pinocchios” is a nice way of saying that the president has been lying all along. [Or, is it possible the president didn't know? More on that below.]
So why has it taken so long for the mainstream media and the general public to wake up to what is going on. I think there are three reasons: (a) insurance industry executives (who knew what was going on) were threatened and bullied into silence by the Obama administration, (b) the health policy community (who also knew what was going on) abandoned their role as critical analysts and assumed the role of cheerleaders for the new law instead and (c) the health care media (who should have known what was going on) didn’t do its job.
Matty told Hatty about a thing she saw.
Had two big horns and a wooly jaw.