Some actual bipartisan legislation to help people living with disabilities

My latest at Wonkblog.

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Veronica Perrone Pollack and Vincent Perrone, blowing out the birthday candles.

The Achieving a Better Life Experience (ABLE) Act would allow people with disabilities and their families to establish 529-style accounts for education, transportation, and other expenses. Identical versions are co-sponsored by seventy senators and by 359 members of the House. It’s amazing to see Senators Bernie Sanders, Jay Rockefeller, Mitch McConnell, and James Imhofe co-sponsoring the same bill.

In an era so disfigured by mean-spirited and polarized gridlock politics, this is no little thing. More here.

If this White House event didn’t exist, Thomas Piketty would have to invent it

This White House event, chronicled in the New York Times, seems both politically astute and more than a little sickening.

From the fashion section, naturally

Blame the game, not the players….

Maybe my favorite part of the story comes from the reporter:

(Disclosure: Although the event was closed to the media, I was invited by the founders of Nexus, Jonah Wittkamper and Rachel Cohen Gerrol, to report on the conference as a member of the family that started the Johnson & Johnson pharmaceutical company.)

Seeing our race and class differences, seeing past these differences, too

The internets are filled with recent reminders of the many ways we fail to recognize our own parochial and privileged perspectives in both intellectual life and in our institutional roles.  The #CancelColbert dustup and the extended debate between Jonathan Chait and Ta-Nehisi Coates provide two examples of the current state of play.

As these debates remind us, we are all to some extent rendered parochial by our race and our class positions, and by other things, too. Age and family responsibilities provide obvious sources of difference. Disability status does, as well. I hate blunderbuss labels such as “black activist” or “white liberal,” which flatten out so much human granularity.

Not long ago, I took my family on a tour of the Woodlawn neighborhood immediately south of UC. Our young and fit tour guide got so excited lambasting the university for its historic insensitivity towards the community he neglected to notice that he was walking far too fast for Vincent to keep up. Vinnie and I ended up a few hundred yards behind, accompanied by a nervous publicity flack from the local alderman’s office. I think the guy was worried that we would be accosted or something.

These same distinctive experiences create unexpected connections, too. I spoke last Saturday at my school to admitted students and their parents. A Pakistani-American young woman in a head-scarf sat across from me at our big lunch table. Her father accompanied her. Maybe sixty years old, he sat rather awkwardly looking somewhat out of place in his traditional pakul hat.

I mentioned at some point how many students have caregiving experience with a relative or a sibling. The man suddenly lit up. He pointed to his daughter and said: “That’s her little brother.” This person, whom I had regarded as a forbidding stranger, turned out to be quite smart and funny, and someone with whom I share more than a few powerful personal experiences.

We had a wonderful conversation about the realities of caring at home for a young adult with cerebral palsy and cognitive disabilities in our area. It was the kind of intimate conversation I couldn’t have conducted with many of my young friends in journalism or academia, with whom I otherwise share so many cultural and professional affinities.

Group identities matter—none mattering more than those connected with our national history of white supremacy. We must view these differences without claiming that we have transcended them. We need to see past these differences, too, to recognize human particularity across the obvious divides. These are so much more interesting and more profound.

“Almost awesome in its evilness.” Jon Gruber on states’ rejection of Medicaid expansion

Over at healthinsurance.org, I interviewed MIT economist Jon Gruber on the state of ACA.  We discussed a huge range of things, ranging from the case for the “Cadillac tax” to lessons of the botched rollout. It was a pretty upbeat conversation. But Jon was characteristically blunt regarding states that have declined ACA’s Medicaid expansion:

Jon: I think, Harold, the single thing we probably need to keep the most focus on is the tragedy of the lack of Medicaid expansions. I know you’ve written about this. You know about this, but I think we cannot talk enough about the absolute tragedy that’s taken place. Really, a life-costing tragedy has taken place in America as a result of that Supreme Court decision. You know, half the states in America are denying their poorest citizens health insurance paid for by the federal government.

So to my mind, I’m offended on two levels here. I’m offended because I believe we can help poor people get health insurance, but I’m almost more offended there’s a principle of political economy that basically, if you’d told me, when the Supreme Court decision came down, I said, “It’s not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?” The fact that half the states are is such a massive rejection of any sensible model of political economy, it’s sort of offensive to me as an academic. And I think it’s nothing short of political malpractice that we are seeing in these states and we’ve got to emphasize that.

Harold: One of the things that’s really striking to me is there’s a politics of impunity towards poor people, particularly non-white poor people that is almost a feature rather than a bug in the internal politics in some of these states, not to cover people under Medicaid, even if it’s financially very advantageous to do so. I think there’s a really important principle to defeat this politically, not just because Medicaid is important for people, but because it’s such a toxic political perspective that has to be … It has to be shown that that approach to politics doesn’t work because otherwise, we will really be stuck with some very unjust policies that will be pursued with complete impunity in some of these places.

Jon: That’s a great way to put it. There are larger principles at stake here. When these states are turning – not just turning down covering the poor people – but turning down the federal stimulus that would come with that.

[...]

They are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.

More here.

Poverty, inequality, and Public Health

IMG_3018Below are my comments on a panel held over the weekend in India to celebrate the opening of the University of Chicago’s new Delhi Center. Regular readers will recognize much of what’s here. I hope it is of interest.

Thank you very much for the opportunity to speak on this panel for such a special occasion.

I will use my time to discuss some linkages between poverty, inequality, and health. I do so with trepidation, since I can see some of my betters—James Heckman, Jean Dreze, and Martha Nusbaum to name a few—are here today in this audience.

It’s humbling for any American to speak on these topics when so many great Indian political economists have made fundamental contributions. Many of these men and women were motivated by their first-hand observation of famine, deep poverty, gender and caste inequality. These matters are fundamental in the efforts of the world’s largest democracy to address the post-colonial development challenges of one billion people.

These matters have wider application, as well. Scholars, policymakers, and citizens want to know whether, when, and why various forms of inequality harm the most vulnerable citizens. The truth is, inequality sometimes is harmful, sometimes not. The mechanisms are complicated, and often indirect. We can’t always tease them out, which doesn’t mean that they aren’t there.

My own work concerns domestic US poverty and public health policy. Even so, Amartya Sen’s Poverty and Famines: An Essay on Entitlement and Deprivation was probably the most important book of my graduate career. His combination of rigorous economics with a passionate commitment to equality and human flourishing was revelatory to me.

I assign my introductory microeconomic students a stylized problem modeled on Sen’s analysis of the Bengal famine. It’s a parable, of course. Like most parables, it’s been cleaned up a bit, crystalized to its essentials before inclusion in the sacred canon of economics problem sets. The basic mechanics remain useful to elucidate one possible pathway through which inequality can undermine public health…. Continue Reading…

Zeke Emanuel on the troubled start (but bright future) of the ACA

Over at the Washington Post‘s Wonkblog section, I had a long conversation with Zeke Emanuel about his new book Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System

Dr. Ezekiel Emanuel (Photo by Candace diCarlo for University of Pennsylvania)

Dr. Ezekiel Emanuel (Photo by Candace diCarlo for University of Pennsylvania)

We covered the full range of health-wonk topics. Emanuel is scathing about many short-term implementation failures of the Affordable Care. Yet he is quite bullish about health reform’s long-term prospects.

There are a few surprises, too. For starters, Emanuel notes that ACA might have included further malpractice reforms had physician groups or Republican senators really wanted that. Whatever was said in public, behind closed doors doctors didn’t prioritize malpractice; nor were Republicans ready to actually negotiate about it. President Obama and others were ready to deal–were there a deal to be had.

Emanuel also offers some striking blue-sky predictions. Most notably, he predicts that the long trend of explosive health care cost growth will abate. Over the coming decades, he predicts, health expenditures will grow no faster than the national economy: “GDP+0.” If this actually happened, our nation’s public finances would be fundamentally different.

“Adopted,” A poem for a cold Saturday afternoon

My step-mother Arlene Pollack published her second poetry collection, Persons, Places, and Things. Here is the first poem in the collection.

 

Adoptedarlene_book

Knowing full well my search would lead nowhere,

With eyes veiled to conceal my interest,

I have looked for Mother in places known and rare.

 

At first I sought her in those places where

My heart felt most at home, yet, all the while,

Knowing full well my search would lead nowhere.

 

One summer in Rome, I thought I’d seen her there,

Retraced my steps to find her shop; could not.

I have looked for Mother in places known and rare.

 

I have looked for Mother deep within my heart,

Studying myself, the children I have borne,

Knowing full well my search would lead nowhere.

 

In my travels, making time to spare,

I have searched through records, for what I do not know.

I have looked for Mother in places known and rare.

 

I have not found my mother anywhere;

Yet she has never once been lost to me;

Knowing full well my search would lead nowhere,

I have looked for Mother in places known and rare.

If you like your reduced ER use, you can keep it

IMG_1553The latest results are in from the great Oregon Health Insurance Experiment (OHIE).

In a randomized experiment, individuals offered Medicaid coverage showed higher rates of emergency department (ED) use than did their otherwise comparable peers not given the same opportunity.

The effect size was pretty small—about one extra ED visit per recipient, every 3.5 years or so. In dollar terms, this amounts to an estimated annual expenditure increase of something like $120 per recipient. We can’t say from this paper whether the extra ED visits were valuable or cost-effective. We can say that these results will embarrass some liberal advocates who argued that expanded coverage would reduce overall rates of ED use.

They should. This talking point was never properly evidence-based or even particularly plausible given prior research. It’s not obvious that reducing the rate of ED use is even a sensible policy goal. Advocates across the political spectrum should stop using the ED for cheap talking points about the mythical savings associated with universal coverage or about the misbehavior of Medicaid recipients who supposedly waste huge amounts of money through overuse.

We might, instead, take some satisfaction that we have created a system, open 24 hours per day, 365 days per year, which people turn to when they need help. Our challenge is to make this system work.

More here.

“Targeted demobilization of minority voters”—the most disgraceful practice in American politics today

Perspectives on Politics is a leading journal published by the American Political Science Association. December’s issue includes a sobering article by Keith G. Bentele and Erin E. O’Brien titled, “Jim Crow 2.0? Why States Consider and Adopt Restrictive Voter Access Policies.” The abstract tells the basic story:

Recent years have seen a dramatic increase in state legislation likely to reduce access for some voters, including photo identification and proof of citizenship requirements, registration restrictions, absentee ballot voting restrictions, and reductions in early voting. Political operatives often ascribe malicious motives when their opponents either endorse or oppose such legislation. In an effort to bring empirical clarity and epistemological standards to what has been a deeply-charged, partisan, and frequently anecdotal debate, we use multiple specialized regression approaches to examine factors associated with both the proposal and adoption of restrictive voter access legislation from 2006–2011. Our results indicate that proposal and passage are highly partisan, strategic, and racialized affairs. These findings are consistent with a scenario in which the targeted demobilization of minority voters and African Americans is a central driver of recent legislative developments…. [emphasis added]

Bentele and O’Brien’s statistical analysis of 2006-2011 data makes plain what was already pretty obvious. Republican governors and legislatures have sought to hinder minority turnout for partisan purposes. States were especially likely to pass restrictive voting laws if Republicans were politically dominant, but where the state observed rising minority turnout or where the state was becoming more competitive in the national presidential race. Variables that capture the strategic value to Republicans of minority voter suppression are more powerful predictors of restrictive voting legislation than is actual incidence of voter fraud.

This is the most disgraceful and toxic practice in American political life. It’s out there. It’s blatant. I keep waiting for decent conservatives to speak out against this stuff. Now that would be a Sister Souldjah moment worth watching. So far, no takers.

Memories of these efforts will darken the Republican Party’s reputation for many years. It certainly should.