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Retroactive UHIP Checks Illustrate the Hazards Inherent in the System

The latest UHIP debacle provides a warning about what this system will look like when it’s fully operational:

The update caused the Unified Health Infrastructure Project (UHIP) system to recheck the eligibility of applicants for the State Supplemental Payment program, and in cases where they were found to have been eligible for payments for a number of previous months, they were retroactively sent an individual check for each month. But no note was attached to explain why the identical checks had arrived.

Move past the scandal of the system’s not working and imagine what this looks like when it’s functional.  People will automatically get checks, and they’ll automatically go up and down with their eligibility.  That will be a very visible incentive for people not to earn money, because they’ll be accustomed to watching their benefit amounts go up and down.

The popularity of lotteries and raffles show that people can be irrational about money in this way.  Just as people will shell out cash for an almost imaginary possibility of winning, they will sometimes give up the potential for more money when they see an existing income source reduced.  Or they can learn the lesson the other way:  After their work-related income goes down, they’ll see an automatic increase in welfare to help make up for it.

One suspects that the number of welfare recipients (or people, for that matter) who keep spreadsheets and line graphs of their total income to be relatively small, especially quantifying benefits that don’t necessarily come with an obvious dollar amount.  Moreover, people will tend to put a thumb on the scale of their feelings when it comes to exchanging assistance for work to the extent that the jobs available to them aren’t the most exciting.

This is one of the many ways that UHIP will enhance the negative effects of a welfare state more than it gains taxpayers in efficiency.

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Two Candidates for Governor

Two tweets posted on Twitter today within one minute of each other are telling, as well as related to part of my conversation with John DePetro for my weekly call-in yesterday.  First:

Second:

I don’t juxtapose these to promote Patricia Morgan, or even to advocate against Gina Raimondo.  An impression of Democrat Governor Gina Raimondo has been building, and it could (and should) be a barrier to her reelection no matter how much money she’s able to dump into Rhode Island’s relatively small media market.

When it comes to actual crises and errors in the executive branch, Raimondo takes an incremental approach.  A new revelation puts UHIP in the news, so she comes up with something that appears to be a response and walks away again.  Meanwhile, her affection for photo ops and staged events is well established.

That isn’t leadership, and people know it isn’t leadership.  Whatever collage of pleasant feelings canned photo ops might generate can be washed away by manifest bad management.  To the extent that her ample professional staff (in and out of the campaign) believes that photo-ops are indispensable, every single one of them should be of a leader fixing problems.

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An Alternative Rationale to Bigotry

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RI Housing Regulation Serves Minorities Poorly

The opening paragraph of a Wendell Cox article in New Geography could apply to many, many more issues than housing:

America’s most highly regulated housing markets are also reliably the most progressive in their political attitudes. Yet in terms of gaining an opportunity to own a house, the price impacts of the tough regulation mean profound inequality for the most disadvantaged large ethnicities, African-Americans and Hispanics.

When government makes something more expensive to achieve progressive goals, it inevitably puts that thing disproportionately beyond the reach beyond demographic groups that are disproportionately less wealthy.  This is a very simple concept.

Not surprisingly, the Providence metropolitan area does very poorly.  Cox’s metric is the ratio of the median house price to the median annual income — basically, the number of years the household at the exact middle of the area’s income distribution would have to save all of its income in order to buy the house at the exact middle of the area’s real estate market.  He then provides tables showing how many more years black and Hispanic households would have to save than the average.

Black families in the Providence area have to save for an extra 2.12 years (above an average of 4.26 years).  That’s 19th worst out of 52 metro areas reviewed.  For Hispanics, the Ocean State’s ranking is even worse, at 4th worst out of 53.

The obvious thing to do with housing, as with all economic activity, is to ease up government’s thumb so that it can become more affordable.  That strategy works on the other side of the scale, too, loosening government’s stranglehold on the economy so that opportunity can flourish and incomes rise.

The difficulty, here, is that progressives want to impose burdens, in this case on the housing market, based on their ideological preferences.  When those proclamations have adverse consequences, they blame external, often fictitious factors like institutional racism and avaricious landlords.  As a remedy, they then propose to alleviate the consequences in a way that gives them power and makes the subjects of their condescension dependent on their good political graces.

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Achieving Health Care for All

From my wonky perspective, this is the most important part of Mike Stenhouse’s health care–related op-ed in today’s Providence Journal:

I believe that a two-pronged approach to health care can ensure affordable access for every American. First, let patients determine what level of coverage they need by repealing most government mandates. Health services and insurance have become unaffordable because of rapidly expanding government interference in the market. The free market did not create our health-care crisis; over-regulation did. Increased transparency and consumerism, as well as major tort reform, could reduce medical liability risks and further drive down costs.

Second, subsidies or vouchers for low- and middle-income Americans to purchase private insurance is a benefit a wealthy society such as ours should provide. If we pool all of the federal and state dollars currently allocated to health care — and eliminate wasteful government bureaucracies — we can subsidize sustainable, lower-cost, high-quality private health care for those who need assistance.

I’ve been arguing for this for about as long as health care policy has been a visible national topic of conversation.  Allow catastrophic-coverage plans that protect people in the case of… umm… catastrophe, and route everything else through health savings accounts that have some sort of tax favorability for those who contribute to them (whether the plan owner, an employer, or some sort of benefactor), from which Americans pay directly for health care services.

Such a program would cover everybody for the unpredictable worst, and it would preserve the utility of a pricing mechanism.  People would know what they’re paying for services and could decide whether any given procedure was worth the money.  Moreover, as a society, we could better understand what we’re funding when we deposit money into the accounts of our disadvantaged neighbors.  We could look at the cost of providing everybody with catastrophic coverage plus some basic preventative and emergency care, and then we could debate what additional services ought to be covered through the welfare program.

Meanwhile, employers, private charities, and others could make similar decisions for people in whom they take an interest.  Of course, this wouldn’t allow progressives to control our lives or siphon money from our health care.

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Maybe the Question Should Be: Is Rhode Island Still “Crimestate”

The Associated Press reported, yesterday, that Rhode Island became the New England leader in murders per 100,000 residents in 2016, largely because Connecticut (the prior leader) dropped so much.

Looking at the FBI data from which the report derived, however, puts that change of rank in a more disturbing context.  Rhode Island was already — and remains — number 1 in New England for every form of property crime listed in the table except motor vehicle theft, making the Ocean State the worst for property crime in the region.  Here are the rates per 100,000 residents:

  • 359 burglaries
  • 1,389 larcenies-thefts
  • 151 motor vehicle thefts
  • 1,899 property crimes total

That makes our number 2 rank for violent crimes all the more worrisome, with the following rates per 100,000:

  • 3 murders
  • 42 rapes (under a revised definition)
  • 51 robberies
  • 143 aggravated assaults
  • 239 violent crimes total

Only when it comes to robbery is Rhode Island not either first or second.

Any analysis of these numbers would require broader contexts related to demographics and geography.  Population density surely plays a role, for example, particularly when it comes to property crime (although that doesn’t explain why Rhode Island’s property crime rate would be higher than New Jersey’s).

Nonetheless, the Ocean State appears to be losing ground in these rankings and must turn that around.  As with everything, one can’t help but suspect that policies that seek to attract and generate government dependents don’t help, whereas policies bringing about broad private-sector opportunity would improve things across the board.  Perhaps, that is, Rhode Islanders steal because they can’t earn and aren’t satisfied with what they’re given.

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“Pay for Itself”? UHIP Is Designed to Increase Costs.

Ted Nesi and Susan Campbell report on the costly future of the Unified Health Infrastructure Project (UHIP):

Two years after insisting Rhode Island’s new $445-million benefits system would pay for itself by next June, state officials now admit they have no idea if the problem-plagued computer system will ever save enough to cover its cost.

Folks still aren’t getting the bigger picture when it comes to costs.  UHIP is designed to maximize the use of government services.  Not only will it never cover its “costs,” but it will continue to increase public expenditures.

At some point in the future, some gubernatorial administration may announce that the system has stopped enough proverbial “waste, fraud, and abuse” to cover the expense of implementing the program, but we can be sure such a calculation will brush aside actual increases in spending on the programs.

Rather than simply update our operating systems for welfare programs, Rhode Island government officials chose to make the state an experiment in interweaving all programs for “one stop shopping.”  We’re already paying the price, and it’s a bill that will continue to grow.

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The Coincidence of Medicaid Expansion with Opioid Abuse

The Wall Street Journal recently put a spotlight on a matter that deserves more consideration:

A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.

There were also marked disparities between neighboring states based on whether they opted into ObamaCare’s Medicaid expansion. Deaths increased twice as much in New Hampshire (108%) and Maryland (44%)—expansion states—than in Maine (55%) and Virginia (22%). Drug fatalities shot up by 41% in Ohio while climbing 3% in non-expansion Wisconsin.

A quick look around the Internet didn’t produce Senator Johnson’s evidence, so I’m not able to say how Rhode Island fits into the picture.  Still, data from the Family Prosperity Index (FPI) shows that Rhode Island’s illicit drug use (other than marijuana) as a percentage of population matches that of New Hampshire, with Maine well below.  Recall that Rhode Island’s government jumped right into the Medicaid expansion with scarcely any discussion.

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When Government Pays Us to Be Parents

Zach Maher, in a Wall Street Journal op-ed, explains how the government-paid-parental-leave-in-Sweden-is-great scales fell from his eyes:

When the girl’s parents refused to subject her to this unnecessary procedure, the hidden machinery of the Swedish welfare state sprang into motion. My brother-in-law and his wife were required to attend multiple interviews with social workers and to submit friends and neighbors in their small town for questioning. Social workers even inspected their home. Suddenly, decisions as benign as what milk to buy seemed potential evidence of parental deficiency. My in-laws feared their two children might be taken from them.

In Sweden, the state reserves for itself ultimate responsibility for children’s well-being. As a parent my job is to give my kids the trygghet necessary to become productive, tax-paying members of Swedish society. This is why I receive financial support and medical benefits. The state is paying me to be a parent. I am, in effect, an employee—and if I do a poor job, my responsibility as a parent might be taken away from me.

 

When we give government responsibility for things — even good things, like the well-being of children — we also give it authority over those who provide those things, like parents.  Suddenly, government isn’t just filling in gaps, but seeking out gaps by putting parents under the microscope.

The United States is not immune to such thinking, obviously.  Some 20 years ago, on Matt Allen’s Mental Floss radio show with the more-liberal Jennifer Brien, the latter argued that schools have to teach sex education (liberally tinted, naturally) because parents simply aren’t doing the job adequately.  I called in to ask what gives her or the government the right to make that determination, but she wouldn’t be shaken from the assertion of need.  (And then I was cut off.)

Suggesting that he and his wife “insist… on having their own ideas about raising children,” Maher asks, “Does this mean we can’t accept parental support from the state?”  My guess is that he doesn’t really have a choice — that the government doesn’t actually see it as an exchange or contract.

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Universal Basic Income and Our Aspirations

Once upon a time, folks actually hoped that a universal basic education plus a prosperity-driven increase in free time would draw people toward intellectual pursuits and self improvement.  I’m sure there’s data on such things, but for my purposes, here, let’s just speculate that most folks’ general sense would be that it hasn’t quite worked that way.

In a recent Wall Street Journal op-ed, Dan Nidess asks why we would expect a universal basic income to have a different effect.  Indeed, he suggests that the policy “addresses the material needs of citizens while undermining their aspirations”:

At the heart of a functioning democratic society is a social contract built on the independence and equality of individuals. Casually accepting the mass unemployment of a large part of the country and viewing those people as burdens would undermine this social contract, as millions of Americans become dependent on the government and the taxpaying elite. It would also create a structural division of society that would destroy any pretense of equality.

UBI supporters would counter that their system would free people to pursue self-improvement and to take risks. America’s experience over the past couple of decades suggests that the opposite is more likely. Labor Department data show that at the end of June the U.S. had 6.2 million vacant jobs. Millions of skilled manufacturing and cybersecurity jobs will go unfilled in the coming years.

Notably, Nidess uses the term “productive class,” which I’ve been using for years in attempting to describe what populations have been leaving Rhode Island.  Basically, the Ocean State has been attracting the poor and (largely) holding on to the wealthy while driving out those who are looking for some way to transform their smarts, brawn, and effort into wealth.

Put in those terms, it’s clear that Nidess fears the UBI would bring about a national version of what I’ve called the “government plantation” or “company state,” whereby the government draws in dependents in order to provide services billed to somebody else.  Whatever arguments and motivations may underly such policies, they certainly don’t have the feel of being healthy for our society.

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Indirect Moral Corruption Driving Catholics Out of the North

Part of the cynical wisdom, up here in the Northeast, is that the Catholic Church has to support pro-immigration policy because it needs immigrants to keep its parishes going.  To the extent that this demographic pressure has any effect on what the Church actually does, a Catholic News Agency article about the Church’s growth in the South should suggest other policy positions that the Northern Church could promote:

The growth in part reflects the number of Catholics moving south from northern dioceses. Though this results in the closures of churches and schools in former Catholic strongholds, it is driving new expansion in the U.S. South.

I’ve half-joked that I’ve remained in Rhode Island out of missionary motivation, and only the jest part is political.  A region that is driving families apart and separating people from their homes presents real moral challenges.  In that regard, the Catholic Church — all churches — should acknowledge what the government plantation policies of Rhode Island are doing and impress upon believers their moral obligation to stay and to change things.

Working against poverty and injustice can’t be limited to standing up for those who are clearly oppressed, or else good works risk falling into vanity.  Vanishingly few people in contemporary America question the righteousness of helping those who immediately need help, but if we’re serious about helping those whom we can’t so easily see, whether because their problems are not so obvious or because their problems haven’t yet manifested, we have to take a broader view.

That means a society that draws people toward fulfilling lives of familial stability and self-motivated work.  And while the constituencies who see a Democrat vote as part of their cultural inheritance won’t like it, the policies on which we’re currently focused are clearly not serving that end.  The moral corruption of the government plantation is that ignoring the structural justice that brings stability and prosperity, but that requires a resilient and sometimes unpopular maturity, produces ample opportunities to display visible righteousness on behalf of those whom our ignorance has harmed.

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Going from Crime to Illness Means Big Growth for the Government Plantation

Marc Munroe Dion picks up on what I’ve been calling “the government plantation” in his latest “Livin’ and Dion” column about the budget consequence of recasting drug use from a crime to an illness.  Noting that a person who comes across a homeless beggar could feed him or her with a $10 sandwich, but:

If you ran a non-profit agency, you’d need an outreach worker to find the homeless guy, an intake worker to make sure the homeless guy was really hungry, a case manager to find out what kind of sandwich he likes, a nutritional expert to make to make sure he got a healthy sandwich, a coordinator to introduce the outreach worker to the case manager, a facilitator to go into the store and buy the sandwich, and a five-member board of directors to approve the $10 sandwich, which would be referred to in all documents as a “nutritional expenditure for indigent substance abuse-affected client.”

At all times, the homeless guy eating the sandwich would be referred to as a “client.” Total cost of the sandwich? $65,000, not including benefits, and pensions.

Rhode Island’s state government is deliberately working to transform our economy into one built on this very model.  Declare some benefit to be a right, find a way to collect money from the rest of the economy and other states (via the federal government), and fill out a massive bureaucracy with government-satellite non-profit agencies with plenty of well-paying jobs whose holders will tend to support the system politically and to fund the necessary political action through their labor union dues.

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