Fed Up Yet?

Americans are understandably distracted by the current cultural battles that are, at their base, efforts to halt the steady erosion of White Christian male privilege. I spend a fair amount of time analyzing and discussing those battles, and ignoring a much more substantial disagreement about what a society/country owes its members/citizens.

It’s the question inherent in that old Amex commercial proclaiming “membership has its privileges.” 

As I’ve noted previously, in the United States, the “privileges” of citizenship do not include health care or financial security. Our approach to social welfare has been and remains punitive–and as a result, the “systems” we’ve built incentivize greed over good works.

A recent report from the New York Times focused on the reality of America’s approach to health care.

Many hospitals in the United States use aggressive tactics to collect medical debt. They flood local courts with collections lawsuits. They garnish patients’ wages. They seize their tax refunds.

But a wealthy nonprofit health system in the Midwest is among those taking things a step further: withholding care from patients who have unpaid medical bills.

Allina Health System, which runs more than 100 hospitals and clinics in Minnesota and Wisconsin and brings in $4 billion a year in revenue, sometimes rejects patients who are deep in debt, according to internal documents and interviews with doctors, nurses and patients.

Although Allina’s hospitals will treat anyone in emergency rooms, other services can be cut off for indebted patients, including children and those with chronic illnesses like diabetes and depression. Patients aren’t allowed back until they pay off their debt entirely.

Companies like Allina–theoretically “nonprofit”– get huge tax breaks for providing indigent care in their communities. An investigation by the Times  found that almost all  nonprofit hospitals have– for decades– fallen short of that charitable mission.

Allina cuts off patients who owe money for services received at any of its 90 clinics. Written policies instruct staff on how to cancel appointments for patients with at least $4,500 of unpaid debt– how to lock their electronic health records so that staff can’t schedule future appointments.

“These are the poorest patients who have the most severe medical problems,” said Matt Hoffman, an Allina primary care doctor in Vadnais Heights, Minn. “These are the patients that need our care the most.”

In 2020, less than half of 1 percent of Allina’s expenditures were for charity care, well below the pathetic national average of 2 percent for “nonprofit” hospitals, despite the fact that its annual profits since 2013 have ranged from $30 million to $380 million. In 2021, its president earned $3.5 million–and it recently built a $12 million conference center.

It’s estimated  that 100 million Americans have medical debts. Those debts make up approximately half of all the outstanding debt in the country, and are responsible for half of all personal bankruptcies.

Some 20 percent of hospitals nationwide have debt-collection policies that allow them to cancel care. The most expensive “health care system” in the world doesn’t seem very focused on health.

Then, of course, there’s what Jamelle Bouie calls a “twisted view” of the social safety net, most recently illustrated by the GOP’s insistence on work requirements for SNAP and Medicaid beneficiaries. 

As Bouie notes, there’s plenty of evidence that work requirements don’t lead to more employment–that their only effect has been a loss of benefits by poor Americans.

Work requirements don’t work, but Republicans still want them, so much so that they threatened to crash the global economy to get them. Why? The obvious answer is that work requirements are an effective way to cut programs without actually cutting them. With a little extra paperwork and another layer of bureaucracy, states can keep thousands of people who qualify from getting access to benefits.

To add insult to injury, It cost states tens of millions of dollars to implement work requirements. In Arkansas, for example, implementation cost close to $26 million; in  Iowa, the cost of administering the new rules was $17 million over three years — far more than the state would have spent on SNAP during that period.

We keep hearing that America is the richest country in the world. Not only could we afford to be less punitive to the people who most need a hand up, we could actually save money in the process. Tax dollars already pay some 70% of the country’s medical costs, and those dollars would probably cover 100% if CEOs weren’t overcompensated and we saved health insurer overhead.

I’ve previously argued that a Universal Basic Income would solve significant social problems– Whatever the pros and cons of a more expansive, less punitive view of “membership,” stories like these should remind us of the multiple deficits of what passes for current health and welfare policies in “rich” America.

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Rational Self-Interest

Sunday “sermon” time…..

Adam Smith argued that a market economy serves the common good by allowing individuals to operate on the basis of self-interest. I agree. The problem is, too many of our contemporary “Captains of Industry” don’t understand where their own self-interest ultimately lies.

The worst thing about avarice is how shortsighted and ultimately unproductive it is, even for those whose pursuit of ever-fatter bottom lines is all-consuming.

That’s because a more equal society is in the long-term best interests of even those people who don’t feel any obligation to feed hungry children or find jobs for ex-offenders or make health care accessible to poor people. First, there’s the fact that– in order to remain competitive in a constantly changing global economy– America needs to use everyone’s talents. Social injustices that prevent people from reaching their potential are a drag on that competitiveness.

Second, it is cheaper to deal with problems at the front end than at the back. When we cut programs that help poor folks, we may save a few dollars in taxes, but (as substantial research confirms) we end up paying far more, in costs ranging from lost productivity to prisons.

But it’s the third argument that ought to make us stop and think. As I have argued before,democracies require stability in order to survive.

In countries where there are great gaps between the rich and poor, in countries where some groups of people go through their lives being marginalized or despised while others enjoy privileges and respect, in countries where some people are exploited in order that others might benefit—that stability is hard to come by. A wealthy friend of mine once put it this way: “I’d rather pay more in taxes than spend my days worrying about angry mobs rioting in the streets or desperate people kidnapping my children.”

Most of us understand that—as Elizabeth Warren has pointed out–no one succeeds solely by his own efforts. There is a social and physical infrastructure required to support and enable entrepreneurship and wealth creation, and we taxpayers have built and maintained that infrastructure. And that’s fine. Adam Smith was correct that we all benefit when someone builds a better mousetrap, or improves on another guy’s widget. But when someone profits from his better mousetrap, the people who paid for and maintained that infrastructure–the people who invested in his business via the support systems that enabled him– have a right to a return on that investment in the form of taxes.

A genuine devotion to one’s own self-interest requires us to recognize the degree to which we depend on social stability and an adequate infrastructure–both social and physical.

The contemporary Oligarchs–with their greed and contempt for the common good–are  undermining the very system that has allowed them to succeed. What they fail to recognize is that when the system fails, they will fail with it.

 

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Who Are We?

Today is Sunday. And Father’s Day.

Believers who celebrate Sabbath on Sunday will go to church and hear exhortations about living a good and moral life.  Depending upon the denomination, the focus will be on love and compassion, charity and social justice.

In most families, Fathers will receive sentimental greeting cards from their children thanking them for their patience and love and support. Some will get sweaters or ties or sporting gear; others will have a family dinner.

These Norman Rockwell experiences make us feel good about ourselves. We’re good people, family people, caring citizens.

So here is my question: how many Americans will go to work tomorrow for an employer who has cut his or her hours in order to avoid paying for health insurance? If we are to believe the media reports, it’s not an insignificant number.

At Indiana University, where I teach, there’s a new rule that Graduate Assistants–already poorly paid–cannot work more than 29 hours a week, because then they would be eligible for health insurance. The Indianapolis Star recently reported that several Indiana school districts were planning to cut back hours for many staff positions, so that they could avoid insuring the people in those positions. Private employers, of course, have been engaging in such practices for years, in order to avoid compliance with a number of regulations that apply only when employees work a certain number of hours.

This response to an effort–however flawed–to extend basic health services to people who currently can’t afford those services tells us something about our culture. And what it tells us isn’t consistent with that Norman Rockwell version of ourselves.

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