Right Diagnosis; Wrong Prescription

I know that this blog tends to reiterate certain themes, but we all have our preoccupations. Those who are regular readers will recognize a couple of mine: the importance of “hiring” (electing or appointing) government officials who actually know something about government; and the critical difference between “what should we do?” and “how should we do it?”

The election of Donald Trump and his subsequent choice of cabinet officials has pretty emphatically made the case for my first premise. (There’s a Facebook meme to the effect of “If you think anyone can run  the government, I hope your next colonoscopy is performed by a plumber.”)

My second preoccupation–the difference between “what” and “how”– remains less obvious. I thought of it, however, when I read this column by Catherine Rampell in the Washington Post. As she points out, it’s one thing to correctly diagnose a problem. It’s quite another to devise a remedy that will solve the problem rather than inadvertently making it worse.

By all means, let’s raise the living standards of workers at Amazon, Walmart, McDonald’s and other employers of low-wage Americans.

And, by all means, let’s raise Jeffrey P. Bezos’s taxes, too. The founder of Amazon (and owner of The Post) is the wealthiest man in the world. He didn’t need the tax cut that Republicans just gave people like him.

But the sloppily designed Stop Bad Employers by Zeroing Out Subsidies Act (a.k.a., ahem, the “Stop BEZOS Act”) is a terrible way to do either of these things. It’s virtually guaranteed to hurt the very low-income working families its sponsors want to help.

The bill Rampell is citing addresses an issue that I’ve written about several times: some of the nation’s largest companies (including Amazon) pay their workers so poorly that taxpayers make up the difference with food stamps and other social welfare benefits.. In effect, we are paying a portion of those workers’ wages. Meanwhile, the company’s  “savings” go to shareholders as additional profit.

It’s pretty despicable, and it should stop.

The “Stop Bezos Act” would establish a “corporate welfare tax” on firms with at least 500 employees. Companies would pay a tax equal to 100 percent of the value of safety-net benefits their employees receive, including Medicaid, housing subsidies, food stamps and subsidized school lunches.

That certainly sounds good. As Bernie Sanders, the bill’s sponsor, has said,

The working families and middle class of this country should not have to subsidize the wealthiest people in the United States of America. That’s what a rigged economy is all about.

Agreed. The diagnosis is spot on. The prescription, however, would be a disaster; it would hurt the very people it aims to help, because it would discourage firms from hiring workers suspected of drawing benefits.

These workers come, disproportionately, from some of the most vulnerable populations: families with children, older people and workers with disabilities.

Families with children are much more likely to use food stamps. Older Americans who are poor are much more likely to be on Medicaid. And workers with disabilities would face even more barriers to employment under this bill than they already do.

Under this bill, Medicaid-eligible workers with disabilities or other health issues would become thousands of dollars more expensive. Working-age people over 45, who cost Medicaid about twice as much as their younger counterparts, might face even more discrimination in the job market than they already do.

The bill tries to address these issues by barring employers from asking job candidates about benefits. But firms could easily infer which applicants are more likely to get them, based on their races, genders, Zip codes, etc. Such “statistical discrimination” would be difficult to police.

Moreover, employers get information about dependents and marital status when newly hired workers fill out their HR forms. Guess which workers would be at the top of the list when it’s time to downsize?….

Perhaps worst of all, as the Center on Budget and Policy Priorities points out, the bill would ultimately create a new corporate constituency to push for cuts to social programs and stricter eligibility requirements. Suddenly, reductions to Medicaid or school lunches would be directly equivalent to a corporate tax cut.

This bill would also require new oversight, probably spawn multiple lawsuits alleging discrimination, raise equal protection issues (why treat companies with 500 employees differently than those with 480?) and generate numerous new regulations.

Simply raising the minimum wage would go a long way toward solving the problem without creating perverse incentives or requiring additional bureaucracy.

Stop Bezos is a great soundbite. We should do it. How we should do it, however, matters. A lot.

Why Politics Matters

Do you know folks who think political decisions don’t affect them? Who think voting is a waste of time? Among all of the other reasons they’re wrong, it turns out that a state’s political environment affects how long its residents live.

That was the astonishing conclusion of a study reported by Inc.The study ranked life expectancy in all 50 states, and came to some truly eye-opening conclusions. Among them: residents of Mississippi have the same life expectancy as residents of Bangladesh.

This truly is a fascinating study, pulling together reams of data to create “the most comprehensive state-by-state health assessment ever undertaken,” according to a press release. (The study itself was published in the Journal of the American Medical Association.) It’s unusual because most big studies examine the United States as a whole, and yet there’s a vast disparity of health and longevity among the states.

The report itself focused primarily on the data, rather than on differences in the public policies of the various states, but the following excerpt from the Discussion section is illuminating on that score.

Mortality reversals in 21 states for adults ages 20 to 55 years are strongly linked to the burden of substance use disorders, cirrhosis, and self-harm, and this study shows that the trends for some of these conditions differ considerably across different states. Case and Deaton have called some of these conditions “deaths of despair” and argued that they are linked to the social and economic status of white US adults.

States differ widely in their support of interventions to curb substance and alcohol abuse, and in the availability of programs addressing those dependencies. As far as the statistics on “self-harm,” the language is guarded, but clear: “self-harm” is suicide, and most people who kill themselves use a gun.

The availability of guns is a huge public health issue, and medical and public-health professionals have been arguing for a public health approach to gun violence more  forcefully in recent years. The American Public Health Association and the American Medical Association have both issued statements calling gun violence a public-health problem, and advocating more research. (The “Dickey Amendment,” passed by Congress in 1996, effectively prohibited the CDC from even studying the issue.)

The larger “take away” from the data is economic. States where the percentages of low-income Americans are highest have higher incidences of alcoholism, drug abuse and suicide. It shouldn’t come as a shock that Mississippi, where citizens have poor health outcomes also has an economy that ranks in the bottom of American states.

The environment also plays a part: states that do a better job of controlling hazards like lead and coal ash, for example, reduce illnesses and deaths from avoidable environmental pollutants.

All of these influences on lifespan–the economic health of a state, the efficacy of local environmental protection, the easy availability of guns–are direct outcomes of the  public policies supported by state and local lawmakers. (It will not shock anyone who follows these issues that the states with the worst outcomes tend to be reliably Republican.)

If the disaster that is Donald Trump hasn’t brought home the importance of voting, perhaps explaining to the disengaged that local political policies have a demonstrable effect on our lifespans and those of our families and friends will do the trick.

 

Baffle Them With Bullshit

The BBC recently opined that the goal of all those Russian bots and trolls isn’t to convince Americans of any particular fact or position–it’s to bombard us with so many competing versions of everything that nothing makes sense.

The observation reminded me of the old saying, “If you can’t convince them with your arguments, baffle them with your bullshit.”

CNN recently ran a story with a similar premise: the title was “Why Russian Trolls May be More Excited That the NFL is Back Than You Are.

The same Kremlin-linked group that posed as Americans on social media during the 2016 US presidential election has repeatedly exploited the controversy surrounding the NFL and players who have protested police brutality and racial injustice during the National Anthem, playing both sides in an effort to exacerbate divides in American society.

The debate is almost certainly an irresistible one for the Russians, given that it includes issues of race, patriotism, and national identity — topics the Russian trolls sought to exploit during the run-up to the election, and have continued to focus on in the two years since.

Propaganda in the age of the Internet has gotten far more sophisticated, and the goals it pursues are no longer limited to winning a particular debate or political campaign. The changes really started in earnest with Big Tobacco–the PR firms trying to head off new regulations realized that a frontal attack on the medical science showing that smoking is linked to cancer would fail, because contrary scientific studies paid for by the tobacco companies wouldn’t be seen as credible.

Instead, they hit on a tactic that has since been used to great effect by  other special interests, most notably fossil fuel companies denying climate change: they claimed that the evidence was still “inconclusive” and Congress should wait for more information before acting. Encouraging confusion was far more effective than attacking the science. The tactic played into the reluctance of lawmakers to pick a side in contentious debates.

It’s even easier for the Russians, because their goal is simply to divide us. They don’t care which side “wins” a debate–their goal is to add fuel to the fire and watch it burn.

Darren Linvill, an associate professor at Clemson University who has been studying the Russian group’s behavior with his colleague Patrick Warren, explained that the trolls “don’t slant toward one side or the other in the NFL flag debate, but they do slant very steeply to both extremes,” he said.

“Kaepernick is either a hero fighting a corrupt system or a villain who has betrayed his country. It’s two very simple, divisive story lines told at the same time with the goal of dividing our country rather than adding nuance to an ongoing, important national conversation.”

The most pernicious aspect of a fragmented media environment in which partisans can “shop” for the realities they want to find is the overwhelming uncertainty that less ideological citizens experience. We no longer know which sources are credible, which advocacy groups we can trust, which “breaking news” items have been vetted and verified.

We don’t know what’s bullshit and what isn’t–and that’s paralyzing.

About That Umpire Analogy…

In the charade labeled “hearings” on Brett Kavanaugh’s nomination to the Supreme Court, we have once again been treated to the facile comparison of judging and “umpiring,” first used to great effect by now-Chief Justice John Roberts.

There has been plenty to criticize about these hearings, even if the unconscionable and un-American treatment of Merrick Garland isn’t still sticking in your craw. Like so much of federal governance, which has abandoned even the pretense of concern for the common good, the process of selecting a Supreme Court Justice has devolved from a consideration of the candidate’s character and qualifications into a battle for partisan dominance.

Even before the late-breaking allegations that he tried to rape a young woman while in high school–allegations that appear more credible by the day (why else would Senator Grassley have previously secured and pocketed that letter by 65 women saying Kavanaugh was a nice guy), and considerable evidence that he had perjured himself during his prior confirmation hearings, Kavanaugh had emerged as a (very accomplished, clearly intelligent) partisan hack.

We shouldn’t be surprised by either the extreme partisanship or the lack of candor; that’s why he was nominated.

His unwillingness to really engage Senators’ questions, and his pat (non)responses have been par for the course, as the process has become more superficial over the years. The “umpire” analogy is of a piece with the smug responses we’ve come to expect, but my cousin–a doctor with a blog of his own that I quote from time to time–had a perfect reaction to that bit of sophistry:

I usually devote time to exposing health frauds and quackery. But now, I can’t resist bigger prey, namely the U.S. Supreme Court. Recently candidate judge Brett Kavanaugh stated that he likened his Judicial position to that of an “umpire,” an opinion previously attributed also to Chief Justice Roberts during his early hearings in 2005. This assertion, while seeming to express purity and impartiality, is patently false!Why? Because we can first use the example of a real umpire, who works individually in a baseball game and makes binary decisions such as “safe” or “out.” Although usually easily decided, borderline decisions can be resolved by instant video replay, again observed by a single person, usually the umpire himself.

Now let’s extend this analogy to the supreme court: Using the baseball analogy, we place nine justices, or “umpires,” near first base, in order to judge outcomes. A ground ball results in a close call at this base, and our justices then, after thorough discussion, decide that, by a vote of 5 to 4, the runner is out. But the minority of 4 think, possibly correctly, that he is safe. Sound ridiculous? It is!

Here is what makes this scenario so ridiculous. Out of necessity, judges make complex decisions that are subjective, vulnerable to individual bias, education and background, usually require more than one person, and are subject to later reversal by other courts or, in the case of the Supreme Court, even the same court in later years. Examples of reversals are manifold and include such issues as legitimacy of slavery, equal access to public restaurants and schools, etc., etc. Does that description sound even remotely like an umpire? I think not!

I’d say that’s an excellent diagnosis!

 

Picture This

There’s an old saying arguing that one picture is worth a thousand words. An activist named Joe Quint is testing that thesis.

The promotional postcard reproduced below describes the project, sponsored by the “Faith, Justice and the Arts” program of St. Paul’s church.

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On the website giving additional information about the project, Quint explains what motivated him to produce graphic representations of the consequences of gun violence.

It was mid-2014 – right after the University of California at Santa Barbara shooting – and I happened to glance at that weeks’ issue of PEOPLE magazine. The cover story was about some Kardashian wedding and there was a little blurb in the upper right corner about the shooting… with a subhead saying ‘How could this happen – again?’. Setting aside the disproportionality in importance of these two stories, I was struck by both the naivety and irresponsiblity of that copy….

I became increasingly frustrated by inaction – my own and the inaction of my country. I could no longer pay lip service to the importance of reducing the over 36,000 senseless and preventable deaths that take place every year. I could no longer just sign petitions or – worse – scratch my head in amazement every time there was a national tragedy and wonder what it was going to take to change society for the better.

The result of his frustration was It Takes Us, a long-term documentary project about the impact of gun violence on the survivors, their family members , and on witnesses to these horrific acts.

One of the unfortunate consequences of the turmoil generated by Trump and his administration is the sheer number of important issues competing for our attention. Gun violence and our need to address its causes must compete with assaults on women’s equality, efforts to undo environmental protections, defund public education, eviscerate the ACA…the list goes on. But as the teenage survivors of Parkland have reminded us, America’s gun culture can no longer be ignored.

If you live in or around Indianapolis, or another venue listed on the website, go see the exhibit.