“Who sinned, this man or his parents, that he was born blind?” Asked of Jesus by the religious authorities of the day, this question haunts many conversations about social welfare and health policy. Self-reliance—that people should “get what they earn”—is embedded in America’s cultural mythology. In some subtle way, people in poor health must be responsible for their condition and simply have to pay when illness strikes.
This is the moral question underlying health policy: Who should bear the cost of caring for the sick? That we are neither wholly blameless or nor wholly guilty for the state of our health is the Gordian knot we labor in vain to untie. We know that smoking often causes lung cancer and obesity can trigger diabetes. But not all lung cancer comes from smoking and diabetes has other triggers. We’re not willing to deny care to victims of either disease. We admire self-reliance but also sense the injustice in “blaming the victim” for diseases and conditions that have no known link to personal decisions (and some that do). As the Republican Congress and the Trump Administration seek to unwind Barack Obama’s Affordable Care Act (ACA), this “who pays?” question takes center stage. Read more »
Last week we looked at how the Affordable Care Act and the Republican replacement plan changed health insurance for those of us who buy insurance either through our employers or on the individual market. This week we’ll look at how the ACA and the new plan change access to health insurance for people with low income.
The ACA expanded Medicaid in two ways. First, it added adults in poverty to the program, not just poor children and their parents. Before the ACA, low-income adults without dependent children were ineligible for Medicaid in 26 states—the cost of doctor visits, hospital stays, prescription drugs—all had to be paid in cash. The ACA also pushed Medicaid eligibility up to 138% of the federal poverty line (FPL) for everyone (although some states, like New York and California, were already there). For context, the FPL for a single adult is $12,060 and, for a family of 3, $20,420.
At least until a group of states took the matter to the Supreme Court, which ruled that Congress could not require the Medicaid expansion, even though most of the cost was shared among all federal taxpayers. Currently, 19 states have chosen not to expand Medicaid eligibility. Read more »
“Welcome to a New Day!” proclaims Spectrum’s website. Like the (probably not) Chinese proverb, “May you live in interesting times”, being “new” may not be a good thing. Spectrum is the spawn of Time-Warner Cable (TWC) and Charter Communications. Do we expect that two market-dominating cable providers to produce a consumer-friendly child?
Don’t make the mistake of thinking that economists, fond as we are of markets, blindly favor the interests of business. No, we like markets because we distrust business. The 18th century’s Adam Smith noted that “People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public.” When competition reigns in a free market economy, the competitors police one another and protect consumers. Read more »
Just over a week ago, the tranquil Village of Cherry Creek voted, by a 2-1 margin, to dissolve. Located about 20 miles northeast of Jamestown in Chautauqua County, the village was formed in 1893 to offer residents more “urban” services than were offered in the town, now including street lights, water, sewer and sidewalks. In 1900 the village was home to 700 with another 1,000 in the Town of Cherry Creek outside the village. It was a self-contained community with a successful cannery, foundry, and flour mill plus a business district with a bank, hotels, churches and other establishments. Nearly everyone who lived in Cherry Creek, worked in Cherry Creek. Read more »
Governor Andrew Cuomo, channeling the presidential campaign positions of Bernie Sanders and Hillary Clinton, has proposed eliminating college tuition for all families with income below $125,000. I was a tenured SUNY college professor in a former life—shouldn’t I be cheering Governor Cuomo’s call for free tuition for the children of nearly three-quarters of New York’s families?
But I’m not. Let me try to explain. Read more »
Mario Cuomo noted that “we campaign in poetry but govern in prose.” Trump’s campaign was hardly poetry—it was more like a sensationalist novel, with racy sex, clichéd dialogue and improbable plot twists. Now Trump & Co. are writing the screenplay for a movie and doing casting. And we wonder—some with hope and some with fear—whether the movie will be true to the book.
With Congress firmly in Republican hands, the policies reflected by Trump’s cabinet choices are steeped in Republican orthodoxy. While Trump may love a brawl, he can’t make America great again without winning votes in Congress. Read more »
“Charles, why are there a dozen bowls of water in the backyard?” she asked. “The dogs are thirsty,” Dad explained. He always was a soft touch—dogs could always hustle the last bite of cookie. Now he was seeing friendly dogs everywhere. As he sank further into Parkinson’s dementia, however, the hallucinations turned to bouts of paranoia. Mom hid both kitchen knives and new door locks to prevent his wandering. As his problems with eating, sleeping, toileting, and medications worsened, her health began to decline. She couldn’t continue.
At a friend’s suggestion, she called someone who connected weary caregivers to willing “live-ins.” Lesya, a Ukrainian who’d left her young daughter in the care of others to make a better life in America, moved in the next day. Mom didn’t ask many questions. She didn’t check for Lesya’s green card. She paid in cash. A year later, pneumonia sent Dad to the hospital and he died soon after. Read more »
Arthur Gardner was an electrician. Born in 1883, one year after Thomas Edison turned on the lights for 59 customers in Lower Manhattan, my grandfather was part of a new and rapidly growing occupation. He spent his workdays running wire through the homes of Chicago’s wealthy South Shore neighborhood. Electricity displaced the use of coal gas, which, in its turn, had displaced oil lamps and candles. Just as gas lighting propelled an expansion of industrial production and improved literacy, electricity—good for so much more than lighting—made vast new industries possible.
Arthur raised a family of gearheads—amateur engineers who tinkered with every kind of technology. My father began a career in computers in 1960, taking night classes in computer programming languages throughout my childhood. Coding books—FORTAN, COBOL, RPG—littered our basement. When our car needed winter “ballast” for snowy streets, we threw in 8 or 10 boxes of IBM cards. I still have a few. Read more »
Oscar Wilde’s quip, “the truth is never pure and rarely simple,” is flagrantly ignored by the “Best Places/Top Cities” industry. Yes, these “top XX” lists have been around since Athens v. Sparta. We’ve had decades with the “Best Places to Live” lists; U.S. News & World Report turned rankings into a market segment. For WalletHub, with revenue driven by the “eyes” attracted to its website, it’s the whole business model. And now that we’re awash in data, it is ever cheaper to capture someone’s attention with a new ranking. Should we be paying attention? Read more »
As one of Rochester’s resident data geeks, I often find myself explaining why we don’t know what we don’t know. At the “micro” level—e.g. an individual firm—we have become accustomed to knowing more and more about our customers and what they buy, where they buy it and when they buy it. A sophisticated food retailer like Wegmans, for example, can tell you how many gallons of milk were sold yesterday at each of its 89 stores. I wouldn’t be surprised to learn that they could tell us how many gallons of 2% were sold in Pennsylvania last Tuesday between 10 and 11 am! High volume, low margin retailers depend on this information to keep the shelves filled, satisfy customers, and improve their bottom line.
Aggregate information about our communities—milk consumption is one thing but what about more consequential information about employment, income and educational attainment—is far more difficult to obtain. We rely on the same sources of information we’ve used for decades. Data on employment and earnings still depend on twice a year reporting from firms covered by federal unemployment insurance. The state and federal labor departments supplement with monthly sampling that give us a snapshot of trends that have yet to be reported under the unemployment insurance program. Just in the last decade we’ve had access to labor data that matches reporting by firms to income tax records, although this takes time and is only available after a couple of years have passed. Read more »