I can show you some gravestones if you'd like. The US health system is essentially inaccessible to those with chronic but treatable conditions who aren't continually holding down relatively good jobs. I can go and get my major depression treated at $5 per minute because I have an employer that pays $20k per year for health insurance.
I know families of five whose household income is less than my health insurance premium. I live in a first-world country where people buy antidepressants that they need from their friends and off the street, and have to beg/barter to refill the prescription that keeps their body from destroying their GI tract. Suicide is an ever-increasing problem. I step over the homeless on the way to work and reflexively look for signs of respiration. The dead are everywhere.
Obama (almost) fixed this. The Affordable Care Act extended Medicaid coverage from the absolute indigent, to those making up to 133% of the poverty line in their state, something around $16,000 per year.
The group that is in a bad spot are those right above that number, as even though their premiums are subsidized, deductibles are anywhere from 2400 to 6400 per annum.
That said, you are right the dead are everywhere.
Poverty kills. It deteriorates every system of the body, and it's first target is the brain.
The status quo is an evil waste of humanity, and poverty is grossly expensive and inefficient.
The medicaid expansion similarly had no statistically significant effect on health, though it does make people feel better: https://www.nber.org/oregon/
Now, you may have discovered some correlations between poverty and bad health. As correlation is not causation, and an RCT is the best way to check. So apparently the correlation is caused by something else - i.e., some third factor which makes people both poor and unhealthy.
The RCT you cite examines the effects of "wealth shocks" (read: unexpected winnings) in a population of Swedish lottery winners on mortality and health care utilization, in a country that already has access to taxpayer-funded universal health care. The state pays 97% of all medical costs there [1]. Using this to support your claim borders on intellectual dishonesty IMO.
Re: Medicaid, it's difficult to find high-quality health care in the US as a Medicaid patient, mostly because practices are free to turn you away simply because you're a Medicaid patient. "We don't take Medicaid". That's it. One of the major academic health systems here (in Oregon) systematically directed all Medicaid and Medicare patients to a single low-resource clinic across town by policy, citing inadequate reimbursement rates. The result is long wait times and inadequate care.
[1] Glenngard, A., Hjalte, F., Svennson, M., Anell, A., & Bankauskaite, V. (2005). Health Systems in Transition: Sweden. WHO Regional Office for Europe, 2005
The state provides health care, yet there are still disparities between rich and poor. This confirms my second and third studies which show health care doesn't help.
This study also shows that (as postulated by folks down thread) that money doesn't change health behaviors.
That's the point - health disparities are mostly not caused by either health care or wealth. They are caused by something else (e.g.diet, exercise, genetics).
Here, I'll give you another comment to downvote: your original claim that was supposedly backed by the Swedish RCT was "giving poor people money does not improve health". You've now reversed the direction of causation. Money could easily improve health outcomes without completely eliminating disparities between rich and poor. Your conclusion does not logically follow from your claims.
The US absolutely does not have a universal health care system; roughly 33 million remain uninsured, and a large number of those who are insured do not have adequate savings to pay their high deductible (which can be as high as $6,000 per person per year in-network, and twice that out of network).
The Sweden study absolutely does not show that, and I've explained why elsewhere in the thread. The mere fact that something is an RCT does not make it instantly generalizable to all populations, no matter how many times you repeat the claim. You'd need to at least control for pre-intervention access to care and study a US population to even get close to what you're claiming.
What's the mechanism by which you think wealth increases health? It's not getting more healthcare, since if it were Oregon should have increased health.
If it's buying non-medical things, what is the relevance of Sweden's UHC?
You've made numerous unacknowledged factual and logical errors already, and appear to not understand the limits of the RCTs you're citing. I don't see any value in continuing this discussion. Have a great day.
Have you lived in Western style poverty? Have you mingled with those who patronize pawn shops and payday lenders?
Please cite the various randomized control trials, and I would say it is far too early to draw conclusions on the effects of the medicaid expansion as it has only been two full years since rollout.
I speak from experience, as someone from a wealthy family and a wealthy area that shunned the family business and went out with nothing to seek startup fortune. I had a good start in 2009 with a success in affiliate marketing, when that dried up I put all that I had made into another venture that limped along at sub-ramen levels for a while and then I pulled the plug.
The fallout was not fun, and the effects not benign. It was pre medicaid expansion and there was no healthcare to be had, and almost no safety net to be found whatsoever.
I could have gone home and had everything I needed but I wanted to make it on my own. I had been living in Boulder, Colorado and thought a move to Austin would lower expenses and extend the runway for the company.
That was ill-advised, and another story, but it added another dimension to my troubles at the time.
Was it a stupid risk? It was but I was young and felt invincible, and in 2010 with a liberal arts education there weren't a ton of jobs waiting for me.
The wealth transfers you speak of are not easy to get. I'm not even sure where you get the 15-20k number. What else is there for a low earning single male besides SNAP, and now Medicaid.
In that time, as someone who found themselves with no assets and no income the only benefit I seemed to have qualified for was about $160 a month that could be spent at the grocery store.
Feeling a tremendous amount of shame I applied for SNAP benefits, even though I knew that they were really a subsidy for American farmers, ideology had trained me that subsidies for corporations are virtuous, while subsidies for basic human needs are shameful.
Even though I qualified, the overworked staff denied my valid claim. It took them over a month to tell me this. It would have taken another month to apply again and maybe they would get it right that time. I gave up and having good credit financed my nutrition via credit card.
I hadn't coded since elementary school, but I was able to pick up django web dev and find a high paying job in a couple months.
But that happy ending is not typical. There is no way that the stress from that period didn't shave a little bit of time off my life.
And the lack of liquidity prolonged the period by a good bit. I spent so much time doing this or that to get $200 for the rent, it was tremendously inefficient and stressful. Bad terrible memories, a place I never want to go back to. I was sad during all of this. It broke up the relationship I was in with someone I really loved.
I spent a lot of time with those who ride the bus, with those who pawn. Their lives are very different than the lives of the families from my coastal home town. Their lives do kill them slowly, which is why life expectancy is a full dozen years longer for the wealthy.
I have since moved back to the wealthy coastal town I grew up in. Life is so easy here, because there is wealth here. You can get a nice boat for almost nothing because someone just doesn't want it anymore.
Someone I knew was just gifted a boat for $1 because the owner was just happy it was going to stay on the island.
No one ever gives my former bus riding compatriots anything.
The thing is the people that live here are no different genetically than the people at the pawn shops back in Texas. The only difference is the presence of wealth, and the virtuous effects that has when it's sustained for a few generations.
But if I understand correctly, the point of bringing up the Oregon study was that access to medical care doesn't seem to have a lot to do with it. At least not the incrementally better access provided by Medicaid programs.
I would certainly speculate that there is a bundle of ideas that contribute to it. Ideas about personal decisions being impactful, leading to things like less smoking and better diet, and even better life situations (which can presumably lead to a different relationship with stress).
Probably because the poor behave differently from the rich - they tend to overeat more, exercise less, smoke more and drink more.
Also any disabled person (who probably has other health problems that reduce life expectancy) is by definition poor (poverty is defined as low market income).
All of the behaviors you cite could be caused by extreme stress, poverty, or threats to safety/well-being (rather than being a cause of poverty). I've felt it, and I've done it.
tl;dr; Sad personal story and no stats. Also, faith healing worked for my uncle so I know that all those randomized control trials are wrong!
My numbers come from the BLS Consumer expenditure survey, though they moved it and I don't know where it is now. I blogged about it and reproduced it in a graph:
I would call it a comeback story with a happy ending, as I got to semi-retire at 31 in a beautiful place. The thing is I know I was able to do this because of the wealth effect, and not because I am personally better or more deserving. That's a point that many well off people miss.
The experience gave me insight and empathy. I really learned how the other half live. I will never be a poverty scold because of it.
I posted the story because I think your spreading incorrect information. It's not easy to be public about money troubles, something I think hurts workers and benefits the capitalist class.
I read your blog post for the second time (saw it on HN before) just now and I still don't see the mechanism by which people can choose to receive 22,000 per year by not working.
Has UBI been instituted without my knowledge?
For what must one apply to make the rational decision to not work.
Update to reply:
Ok so I read the paper, it says exactly what I state in other comments.
If your not going to work you better be in a protected group.
The paper lists 5 means tested transfer programs
Temporary assistance for needy families - this is only for people with kids and mostly single mothers
SNAP or food stamps - which isn't enough to survive off of unless your pancreas handles carbs really well
Section 8 housing - you can get on a wait list or maybe find a landlord willing to deal with you
Other than that it lists
Ss disability : you have to be disabled or severely mentally ill
Ss. You have to be over 65
Pell grants - students only
So that's it. So tell me how does a 35 year old non disabled man or woman with no kids make the rational choice to not work?
Even with subsidized housing and food and Healthcare they would still need spending money.
I'm telling you that there's a lot of people that get by with work in the informal economy and that isn't accounted for in those BLS stats.
You are right about western poverty if we tall about germany, but not us, unless you are in a protected group.
No, we don't have a UBI. We have a ragbag of cash and in-kind transfers that add up to approx $20k. Go read the CBO study I linked to, it explains in detail.
Why do you keep ignoring the research I've posted, and continue spreading myths? What do you gain from it?
I read a few of the links you posted. To support a claim that "giving people money does not improve health", you cited an RCT examining Swedish lottery winners who were already covered by a UHC program. People who already have high-quality health care don't spend their lottery winnings on more health care, and winning the lottery doesn't cause significant damage to health. Great. This says nothing about the US population in question, and absolutely does not prove your original claim.
In the US we had a lottery that directly gave out healthcare. That also had no effect on health.
The Sweden result shows that money has little/no effect via non-healthcare purchase mechanisms, while Oregon shows healthcare directly has little/no effect.
Depends on why they aren't working. If they have no capital, and no pension they better be in a protected class, like students, seniors, disabled, single mothers with children or be very attractive.
Otherwise there is almost no financial support coming their way in the United States, except for a meager food ration that has to be primarily carbohydrates, and basic health care.
Everyone will hate them, they will be chased out of any dwelling they inhabit by a man with a gun (eviction), and death will come for them eventually, as it does for us all, but for the destitute it moves with all possible haste.
And that is why there is no army of millions of non working people in the US, getting by on welfare. That is a middle class myth. The only group that could do this are those who qualify for S.S disability.
Most of the non-working are the rich. A lot of the people we think of as non-workers are getting by by other means, and a lot of it is the underground economy, and most of that is drug sales.
Lastly, disability fraud as a substitute for welfare is a huge problem that no one is attempting to solve. NPR did an expose on it: http://apps.npr.org/unfit-for-work/
60% of the poor don't collect income reportable on a w2 form. That does not mean they do not engage in productive activities that produce cash.
There is a huge informal cash and barter economy of legal goods, and another one for illegal goods.
And yes, the tax man will sell your home out from under you in a tax sale if you do not pay property taxes for long enough.
All of us live under a sword of damocles in regards to cash flow. You gotta keep putting quarters in the meter to live in modern capitalism.
I define rich as those who have sufficient wealth in financial instruments and assets such as treasury bonds and equities to pay for their lifestyle without the need to collect 1099 or w2 income.
They are the only ones who truly do not work, the only ones who can truly sit back and relax. They are the real loafers, the true moochers, and the laziest of all classes of society, I also have the ambition to become one myself, but I will have no pretensions that I would be engaged in anything other than having found a way to have others serve me, no different than any lord or pharoah or emperor, and in fact with much greater security and ease.
So you're saying that we overestimate poverty because the poor engage in extensive tax evasion/disability/welfare/unemployment fraud? And that if we properly tracked work activities by the poor, that poverty would be a much smaller problem than it really is?
Good to know. How large do you think this problem is?
I define rich as those who have sufficient wealth in financial instruments and assets such as treasury bonds and equities to pay for their lifestyle without the need to collect 1099 or w2 income.
Numbers please. How many such people are there?
What percentage of the 15.6 million officially non-working poor do you believe are actually committing tax/disability/welfare/unemployment fraud?
Now lets compare the numbers.
They are the only ones who truly do not work, the only ones who can truly sit back and relax. They are the real loafers, the true moochers, and the laziest of all classes of society...
So a person who produces X resources in year 1 and 0 resources in year 2, but consumes X/2 in both year 1 and 2 is a moocher? Um, ok. That's an interesting definition, to say the least.
> So you're saying that we overestimate poverty because the poor engage in extensive tax evasion/disability/welfare/unemployment fraud? And that if we properly tracked work activities by the poor, that poverty would be a much smaller problem than it really is?
No, Im saying that almost all poor people work, they have various hustles to get by. Most of them are not illegal activities, but yes for the most part these are untaxed cash transactions.
Even the homeless man on the corner with a sign is engaged in a form of work, as it is an active process that takes time, and if they did not do it, they would not have money.
Is it productive, no not very, but the good ones provide entertainment in the form of funny signs, stories or puns. I have donated to quite a few who made me smile on my trip across America.
It does less harm than many respectable professions.
And yes, if you are living off the dividend payments from S&P 500 companies that you neither created, work in nor manage, you are mooching.
It's a respectable mooch, for sure, but a mooch none the less.
What else can we call Sam Waltons heirs other than epic mooches?
Tens of thousands of people toil everday for them, all over the world. They have expert MBA's manage the entire operation for them. The pharoahs themselves didn't have such a great system of exploitation of labor.
My main point in all of this is to be aware of class biases in our perception, and the ideology that comes from, and mainly that we should stop beating up on the poor and scolding them.
In that case, how come millions of non-workers aren't dead?
[edit: to clarify, I mean in the US and similar western countries.]