Wednesday, December 2, 2009

Implement, Evaluate, Adapt!



Today's email brought an article by Star Parker, entitled "Back on Uncle Sam's Plantation."   Although I don't personally know anything about Parker, she writes that she is a Horatio Alger type success story who lifted herself from poverty through personal perserverence.  From this perspective, she addresses the context of social entitlement programs and the way they tend to induce people to stay on the dole instead of working their way out of poverty.  Although the article was originally written early in 2009 and directed at Obama's stimulus package, the person who sent me the article was asking that I think about it in light of health care reform package.  As I have to get on the road today, I don't have time to summarize Parker's article, so I've provided a link to the whole thing, here: http://townhall.com/columnists/StarParker/2009/02/09/back_on_uncle_sams_plantation.

I want to make a few comments on the political realities of implementing social programs to fix social ills.  I would ask that you consider this:  despite Parker's take, the social programs of the late 60s, early 70s did not cause African American poverty.   The problems of poverty - blight, unemployment, poor education, hunger, etc. in (primarily) the minority communities of America - obviously pre-existed the implementation of welfare programs.  And, even though we radically reconstructed the welfare system under President Clinton to reduce benefits and the dependence that such programs were thought to foster, poverty hasn't disappeared. 

Please note:  the 60s/70s welfare programs were not fully a success, but neither were they fully a failure. They solved some problems (e.g. more children had more meals) and complicated others ("should i take this job and become ineligible for AFDC?").

And though scholars suggest the programs did to some extent induce dependency, this does not prove that they caused or even purpetuated the welfare state. A study (here: http://www.sppsr.ucla.edu/ps/pdf/s01/PS234/moffitt(1992).pdf) demonstrates that  employment rates were undifferentiated across beneficiaries (recipients) and non-beneficiaries of both foodstamps and Aid to Families with Dependent Children (AFDC) programs. In both types of households,eligible heads of household were working about 17 to 21 hours a week, regardless of whether they received benefits. Those who received benefits did not stop working. So the benefits weren't directly responsible for the part-time work situation. More likely, it is the fact that recipients families were most frequently one-parent female heads of household who split their time between work and family care. Since the labor statistics don't vary, but the enrollment does suddenly blossom, we have to ask why the welfare rolls saw such an enormous increase. It turns out that enrollment shot up not because people were suddenly working less, but based on shifting eligibility requirements. When congress loosened the requirements, more people signed up. Period.



Unfortunately, every social program gets its start as an expensive social experiment.  Each social program begins as an idea or collection of ideas about how to fix something that's broken enough to attract the attention of our legislative bodies - untested ideas that have been shaped by committee - politically negotiated.  They've been pushed and shoved through the political system, where often they are reshaped to conform to the wishes and whims of the voting members of the legislating body. There is an Aesop-type fable elsewhere in this blog explaining this phenomenon.  http://ecocuriosity.blogspot.com/2009/07/off-topic-how-legislators-do-it.html

There are also plenty of examples of the way ideology and politics impact the creation of social programs in today's Health Care bill.  Here are two:

The current bill negotiated by Congress makes illegals ineligible for federally funded insurance. Why? Because it is politically and ideologically unpopular among some voters to use taxpayer dollars to support the existence of illegals in our country. By insisting that the insurance reform eligibility rolls do not include illegals, a Congressperson can tell his or her constituency that s/he did not support the use of taxpayer dollars to help illegals. HOWEVER, those Congresspersons are being disingenuous at best.  They are neglecting to tell their constituents that health care for illegals is already taxpayer supported, and will continue to be - because emergency room services for the indigent is mandated and subsidized by the government, aka the taxpayers.  Uninsured illegals will continue to use hospital emergency health care services, which costs many times more than health care would cost if uninsureds had insurance, guaranteeing that taxpayers will actually pay far more to support illegals' health care than if they were simply made eligible for the new health insurance plan.  Refusing to allow coverage for illegals in the current health care bills not only ensures that taxpayers will continue to pay for illegals' health care, but it insures we will pay MORE for illegals' health care.

A second example: The first concession made by Obama's negotiating crew was made to shut up a formidable opponent of the health care bill - the pharmaceutical industry. http://www.nytimes.com/2009/08/06/health/policy/06insure.html?_r=1 The agreement ensures that any government health insurance program will not use its negotiating power to negotiate pharmaceutical prices. This is a great deal for pharma and a lousy deal for the American people, who often pay more for drugs than citizens of other countries. (See this study, showing that only the Japanese pay more for prescriptions, while other countries pay between 6 and 33 percent less http://knowledge.wharton.upenn.edu/papers/1210.pdf).

In sum, social welfare programs are not the cause of poverty, single-family African American households, hunger and blight - even if the way these problems are handled is not always the whole solution.  A health care reform program won't be the cause of the current problems with our health care system.  And it won't be the whole solution either.   Whatever health care reform passes will undoubtedly have parts that work, and parts that don't.

My point is this - you cannot blame the original problem on the proposed solution. You can, however, have some programmatic goals and stop every so often and say, "is this program working well?" Is this program getting us to our intended goals? If not, let's re-evaluate and monkey with it some more. This is called Adaptive Management.

What we cannot do is to say, simply, "social programs are bad and we will avoid them." We have a huge problem both with the number of Americans receiving inadequate health care, and with the skyrocketed costs of health care service provision. Something must be done. By saying, "social programs cause problems," we are avoiding the reality - the problems are already here and with us, and we cannot stick our heads in the sand. Experiments though they be, we have to try SOMETHING.
 
Try, evaluate, adapt.  Adaptive Management.

By the way, here is an interesting chapter exploring some of the complex reasons for poverty in the United States:  http://www.havenscenter.org/files/2006_PTraps_Morenoff_0.pdf

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