Why is it that in the United States of America we can’t ever seem to get anything completely done? We look at this problem or that problem and wrangle about how to “make it better” – like maybe “cut child poverty” or “increase the number of people who have ‘access’ to healthcare” but never decide to wipe out child poverty completely or cover all of our citizens with health insurance as so many other nations have succeeded in doing.
Not long ago, before he went on leave, in the New York Times was a column by likely the most caring of their stable of mostly great columnists, Nick Kristoff, who eloquently and sensitively describes the problem of child poverty in the United States and how President Joe Biden’s 1.9 trillion dollar American Rescue Plan will “cut child poverty in half”. Kristoff went on to quote Jason Furman, Harvard economist, asserting that Biden’s bill is the the “most ambitious proposal to reduce child poverty ever proposed by an American president”. He further goes on to speculate about whether we’re able to “shrink” child poverty.
So what’s wrong with all this? While the intention is truly honorable and greatly needed, it’s the use of words and phrases like “cut in half”, “reduce” and “shrink” that concern me. We never seem to come up with a plan to get rid of child poverty once and for all. Isn’t it possible to do this in the world’s richest country? I would certainly think so. Do Democrats and Republicans both deem child poverty unacceptable? I would think that they do and therefore we need to stop beating around the edges of this problem and attack it head on.
So perhaps we should ask why child poverty exists here in the richest nation in the world? And why do we insist on referring to “child poverty”rather than “poverty”? Does child poverty exist in well-to-do or middle class families. Or can children be well off in poor families? Of course not, so let’s stop separating “child poverty” from the larger and more real problem of family poverty. Why we have poor families, why we have poverty in the first place, is that simply we do not ensure that families have enough money to live honorably and securely. It’s the never-ending curse of “low wage jobs”, where the head of a family can work full time and still be poor, or that the head of a family can work multiple jobs or both parents can work and still not earn enough to keep a roof over the family and keep food on the table, much less take care of health and education needs.
I mean, how long can we continue to kick the poverty can down the road? President Johnson waged his “War on Poverty” well over 50 years ago and so many aspects of his program certainly did “reduce” poverty. But did it rid this wealthy country of the disgrace and shame of harboring minions of poor people, homeless people and sick people? No it did not. And direct efforts to “reduce” poverty ever since them have been cumbersome and incremental efforts limited by work requirements, means testing and the like rather than direst direct financial support. Even President Biden’s much ballyhooed antipoverty efforts lately have been defined by “tax credits”, providing help for those with jobs who actually file tax returns, but little or nothing for the extremely poor who do not have any regular income and thus cannot access tax credits.
If we are serious about taking care of our children and their families, we would attack the problem of “low wage jobs” directly so that anyone who worked 40 hours a week could afford decent housing and all the other advantages that enable one to live an honorable and hopeful life. And let’s stop listening to the excuses of business owners who say that increasing employee pay would “drive them out of business”. I say too bad. Any business that cannot pay a living wage to its workers should not be in business and should relinquish its role to other entities that can provide the same service while paying its employees reasonably.
For example, fast food companies have long protested increasing wages to a living level because they would have to raise prices of menu items. This is simply not true. In other developed countries fast food workers are paid a living wage and menu items have not skyrocketed. Apparently the fast food owner, franchisee, or corporation would simply have to be satisfied with less profit.
This is further illustrated in another very entertaining and informative article by Nick Kristoff focusing on Denmark.
And unfortunately we have chosen yet another incremental program to “reduce hunger” in poor families – the food stamp program or SNAP (Supplemental Nutrition Assistance Program) as it is now called. So rather than ensuring that families receive enough money to live properly, we accept their poverty but lend a hand to enhance their ability to purchase food for their families. Again, why the beating around the bush, helping people to live better while staying in poverty but never really getting ahead. SNAP’s official description underscores its incrementalist approach: “SNAPprovides nutrition benefits to supplement the food budget of needy families so they can purchase healthy food and move towards self-sufficiency”. Oh sure, how generous.
The same incremental principle has been applied when we try to even up the playing field in terms of internet access. Since poor families often cannot afford broadband connections, rather than make sure they have enough money to purchase this essential benefit, we instead provide yet another program to assist them. This proposed $50 per month subsidy for broadband connection for poor is merely one more source of assistance for poor families that can end or be withdrawn when the other political party is in power. This is no way to end poverty or end the curse of “low wage jobs”, the main cause of poverty.
And then there is the issue of healthcare incrementalism. President Obama’s signature major legislative accomplishment, the Affordable Care Act, despite its accolades, simply increases the number of people who could afford to buy medical insurance. It has expands coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010. It did so by expanding Medicaid to cover those with low incomes, and by subsidizing private insurance for people with higher earnings. There’s those words again – “increases”, “expands” and “subsidizes”.
And since it functions through the existing jungle of corporate control of healthcare, it does so through funneling more money to healthcare corporations, either directly, in order to “cover preexisting conditions” or something similar, or indirectly, by subsidizing purchasers of healthcare insurance. And, most significant of all, it does not, will not and will never cover everyone. As I noted in my article about Obamacare, it contains the seeds of its own destruction and ultimate demise, in that the only way it can “extend coverage” is by shelling out ever more money to insurance companies, which has to be definitely limited. There will always be “holes” in the Affordable Care Act, always be groups of people that will remain outside its coverage. Truly the only way to provide medical care to all US citizens without exception and from birth to death is through a single payer program like “Medicare for All” as so many other nations successfully provide.
And yet, despite Biden’s promise to provide a “public option” for those seeking health insurance, this effort has come to nothing. He insists that any effort to extend healthcare to more people will be done through “building on Obamacare”(there’s those incremental terms again – “extend”, “more” and “building”) This will never work since the whole objective of health insurance corporations is to increase profit, not cover all Americans. They will always be trying to limit coverage in some way or increase deductibles or maximums or copays.
And then there are other incremental programs that cover additional individuals but never everyone. One is the Children’s Health Insurance Program” or CHIP,, which was started during the Clinton administration as a halfway step to obscure the fact that Hillary Clinton’s proposed program for health insurance had miserably and spectacularly failed. Ostensibly, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In most states, thus, it constitutes only yet just another incremental approach to healthcare – covering only “some” children, but not their entire families.
Okay, right now people fortunate enough to have health insurance obtain it in myriad ways – Medicaid for the indigent, Medicare for the elderly, CHIP for children who qualify, medical insurance from employers for those who have jobs and whose employers provide it. Ah, but another problem – the apparently infinite variety of programs, higher or lower copays, higher or lower maximum reimbursements, limiting who or what can provide the care, and on and on – all are related to our profit based system and incremental approach. Why can’t all Americans be covered from birth to death, like Canada does, or Norway, or Finland, or every other developed country in the world – and at a much lower cost? How amazing it would be to simply go to the doctor or hospital, present your identification, get treated and go home, knowing that all providers were fairly compensated but that profit was not part of the system. And of course, Medicare itself is an incremental program, in that it does not provide for all of the health needs of our elderly population, containing the glaring holes of no coverage for hearing, vision or dental needs. This lack is now ostensibly being addressed by a dizzying array of “Medicare Advantage” programs, all provided by for profit corporations who reap those profits from overly generous reimbursements from the government. And their vaunted coverage of hearing, vision and dental needs is woefully insufficient.
And now there is childcare incrementalism – even if the “Reconciliation Bill” goes through entirely, it will only be “narrowing the gap” between what European countries pay for childcare and what the US pays. Reliable childcare is absolutely essential in an advanced nation like ours. Yet people struggle every day, just as my wife and I did when our children were young, to find reliable and reasonably priced childcare, when both parents choose to or must work. Rather than having to seek out childcare among neighbors, friends and relatives, Europeans are able to send their children to professionally run and staffed facilities provided by the state – what a difference from the risky, varying quality here in the “richest country in the world”. And that cost to a family is heavily subsidized by the state as well. But here, even with the long shot effort of Biden’s “Build Back Better” legislation, which may never pass anyhow, we will only be partially crossing the chasm between what we have and should have. Again, an incrementalist approach to a serious social need.
And also consider our feeble efforts to increase the minimum wage to $15 per hour, even itself, though a big step, wholly insufficient to provide a decent life for its recipients. Our feckless Congress has steadily refused to raise the minimum wage and every single bill proposed or passed at the state level to do so raises it so gradually to that by the time anyone reaches $15, the effects of inflation will have rendered it already inadequate. Fifteen dollars an hour is in itself merely an incremental goal. If the present federal minimum wage of $7.25 was adjusted for inflation since its inception it would be $22 per hour now.
And I suppose that the most important example of the curse of incrementalism is our scattershot effort to fight the existential threat of a steadily and inexorably warming climate. Yes, we have some electric cars on the road, many more solar installations than ten years ago, and a steadily increasing number of “wind farms” on the plains, mountaintops and coasts of our country, but not nearly enough to make an impact on our shameful position as the number two carbon polluter in the world. And the country that is number one, China, has rapidly become our “rival” or our “enemy”, making necessary cooperation between the two to combat climate change all but impossible. And fossil fuel companies still enjoy privileged status among the “lawmakers” that inhabit our useless Congress and thus are still largely unregulated and still, would you believe it, subsidized by the US government. And President Biden’s “Build Back Better” program contains revolutionary legislation for the climate promising to “reduce emissions by 50 percent by 2030” so is accordingly incrementalist at best. And even this incremental approach is apposed by “King Coal” Senator Joe Manchin of West Virginia. So unfortunately, this is the best that the world’s number two carbon emitter, the United States, can do. Michael T. Klare in a brilliant article for Tom Dispatch makes it crystal clear that for the world to save itself, China and the U.S. must unite as climate partners and lead the way for other nations to follow. If they do not, climate catastrophe is inevitable. We cannot any longer be incremental in this most important fight.
And then of course as a nation we have to contend with covid incrementalism. Certain elements of our society cannot seem to get it through their heads that we have required vaccination for serious diseases for decades, with nary a peep from anyone save the few rabid antivaxxers who are prepared to sacrifice the health of their children on the altar of misinformation and obstinance. When I was a child and the Salk polio vaccine and later the Sabin version became available, millions of thankful parents and children lined up to get immunized, with little concern about its origin or manufacturer or concerns about its efficacy. And I do not remember any of the corporate Pfizer – Moderna – Johnson & Johnson wrangling and profit seeking nor any politicization of vaccines that characterize the US struggle and dysfunction with covid 19 vaccines today. And, likely most important, there were successful efforts to immunize the entire world against this dreadful crippling disease so that today isolated cases of the disease lurk in but three countries – Nigeria, Afghanistan and Pakistan.
Covid 19 cannot be controlled until the entire world is vaccinated. But this effort is incremental at best since our government has chosen to protect the patents and formulae of the corporations who have developed the vaccines, despite their development being financed by billions in government subsidies. Many US citizens, including myself, have longed for this “richest country in the world” to lead in immunizing everyone everywhere, just as we did with polio vaccines. But instead we have decided to allow pharmaceutical corporations to selfishly maximize profits. Pfizer has in fact become a quasi government entity all by itself – negotiating sales of its vaccines directly with governments across the world independent of any US government role.
And finally, historically we’ve used incremental means to resolve racial segregation issues – school busing to integrate schools was really beating around the edges of the issue, rather than facing it head on and resolving issues like income disparity and racism that created segregated housing in the first place. We very badly need to address racial segregation head on which would include properly educating our population about slavery, Jim Crow and lynching in this country as well as our country’s and our hemisphere’s disgraceful genocide of its native population. Correction of our nation’s terrible inequality, especially evident in its black and other minority populations, would help too. And what about reparations? This whole issue is far to large to address here in one paragraph but we need to face it and solve it as a nation. Get it done once and for all.
And one more thing. The Democrats need to hire someone like Frank Luntz to help with their messaging. Why on earth have they always called this latest bill the “Build Back Better” bill, which has all the oomph of Hillary Clinton’s “Stronger Together” or even more maddening and obfuscating, the “$3.5 Trillion Reconciliation Bill”. This bill contains hugely important and popular legislation that will help all Americans – like making Medicare covering vision, hearing and dental needs, establishing a universal pre-K program and a childcare program for all families, making community college free, a substantial push against climate change and much more. While some very popular provisions have already been cut, to garner more Congressional support, some better messaging would have likely had a very positive effect and the entire bill would have had a much better chance at surviving and becoming law.