Bureaucrats a Conservative Can Love

July 2, 2018
Posted by Jay Livingston

Conservatives don’t like bureaucracy. They utter the word “bureaucrat” with the same sneering tone they use for “liberal” or “feminist.” They hate regulations and red tape.

But there’s something they hate even more – poor people. Well, not exactly. What they hate is the idea that some poor person somewhere might be getting food or medical care that he of she does not “deserve.”

So the Trump administration is allowing states to impose work requirements on people who get Medicaid. The assumption is that hordes of able-bodied people who could be working are idly whiling away their time in unproductive self-indulgence. We should not reward this indolence by giving them free medical care.

The reality of the lives of poor people on Medicaid is, of course, far from this image of dolce far niente. Most of them work. But under the work requirements, they will have to go through the bureaucratic process of documenting that they are employed. Those who can’t negotiate the red tape will lose their health coverage even though they were working. How many such people will there be, and how many freeloading idlers will be kicked off Medicaid?

Those are the questions that the Kaiser Foundation answers in its recent report (here). The answer is that most of the people who will lose coverage will lose it because of the paperwork, not because they failed to meet the work requirement.

Kaiser made estimates of what would happen in each of four scenarios – the cells in this 2 x 2 table. The top and bottom row are the high and low estimates of the percent of Medicaid recipients the work rules are aimed at — people who would lose coverage because they failed to find work (or some substitute like being in a job training program or volunteering). The Kaiser estimates are based on what happened when states imposed work requirements on people who received welfare (TANF) or food stamps (SNAP).

The columns are the low and high estimates of the collateral damage — people who really did meet the work requirement but who would lose coverage because they were not able to complete all the necessary paperwork each month (things like documenting the number of hours worked).

Even under the most favorable scenario, the people who are “disenrolled” for bureaucratic reasons outnumber those who are disenrolled because they didn’t work. – 62% to 38%.

The work requirement and the bureaucratic requirements surrounding it seem to assume that poor people have, or should have, a “job” – a regular place of long-term employment — the kind of job that middle-class people have.* In fact, the great majority of Medicaid recipients do work. But the work that poor people get is often temporary. In retail, food-service, and construction, hours are irregular and uncertain. Turnover is high. In a bad month, a low-wage worker may work less than the 80 hours required, and consequently lose benefits.

As for administrative costs, Kaiser says this:

States implementing work requirements will likely have to design new systems to reflect changes in eligibility rules, to enable enrollees to report compliance, to interface with other programs (such as SNAP, TANF, or employment training), to implement coverage lock-out periods, and to exchange eligibility information among the state, enrollment broker, health plans, and providers. New staff may be required to conduct beneficiary education, develop notices, evaluate and process exemptions, and review more applications as churn increases and enrollees appeal coverage lockout periods.

More money spent on more bureaucrats and more red tape. You’d think that conservatives would rise up and shout “No!” But the states that are most eager to impose work requirements are the states dominated by conservative governments — Kentucky, Arkansas, Tennessee, Indiana, and others.**

Sure bureaucracy and bureaucrats are bad, but apparently, if we can keep even one undeserving poor person from getting Medicaid, then all the bureaucratic regulations we impose on people and all the bureaucrats we pay to enforce all these new regulations, will have been worth it. Who cares if a few of the deserving poor are discomfited? How many of them could there be anyway among all these freeloaders getting Medicaid? The answer is: a lot, far more than the number of freeloaders.

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* Arkansas even assumes that poor people have broadband access. The state is requiring that Medicaid recipients submit their forms online. No in-person, no phone, no snail mail.

** Conservatives have a similarly flexible view of federal budget deficits.

Frank Loesser — “My Time of Day”

June 29, 2018
Posted by Jay Livingston

Today is the birthday of Frank Loesser, composer of one of the greatest Broadway musicals, “Guys and Dolls.”  The most frequently played song from that show, at least by jazz musicians, is “If I Were a Bell.” Miles, with his 1956 quintet recording, made it a standard part of the jazz repertoire, and that’s the version I was going to use here.

Instead, I’m going with “My Time of Day” – not so well known and rarely sung outside the context of the show. Here is Peter Gallagher in the studio for the cast recording of the 1992 revival. The saxophone player doing the intro so beautifully is Red Press.

The song is very different from standard Broadway fare. It begins in the key of F. The lyric for the first two bars is, “My time of day is the dark time.” The first emphasized note, “day,” is on the flatted fifth of a chord(G7) – very unusual for Broadway songs then in 1950 or now. Then comes “dark time,” a descending interval of a tritone, also uncommon.
                   
A few bars later, “When the street belongs to the cop, and the janitor with the mop” is sung over four descending major chords – G, F, E, D – so unusual that I cannot think of another song with this sequence. A few bars later, the song shifts key to G major, which is where it ends. Except it doesn’t really end. There’s a tense chord that leads to the next song,  “I’ve Never Been In Love Before,” a duet sung with the female lead.

Loesser wrote other musicals (“Most Happy Fella,” “How to Succeed”) but “Guys and Dolls” is by far the best.

Who Should Satire Satirize?

June 25, 2018
Posted by Jay Livingston

Those children at the border – families separated, children sent far from their parents. It all seems so cruel. But what else can we do? The defenders of the cages and the family separations can make it all see so rational, so based in procedural and legal rules.

Swift satirized this way of thinking in  “A Modest Proposal,” where he lays out a perfectly rational solution to the problem of impoverished children — a policy other less rational people might find cruel

I was thinking of trying to write something along similar lines, but not only do I lack the wit (in the 18th-century meaning), but I thought that too many people would not see it as satire or irony. The left would be outraged, and the right would try to figure out ways of implementing the suggestions.

In any case, someone at Texas Tech beat me to it. The difference is that while Swift was using exaggeration to scorn those who inflicted cruelty, the Texas Tech student is using exaggeration to scorn the victims of that cruelty.*

In case the jpg above is too fuzzy to read, here are the key comments

Alex Provost: Don’t bother reporting them just use a firing squad The cocaine cowboy: I’m telling you build a wall, and the us govt. can sell permits for legal hunting on the border and we can make a sport of this, can be a new tax revenue stream for the govt. The cocaine cowboy: The us govt would be making money to stop illegals insted of spending it, win win for everyone Nate Novak: Kyle run for president in the future please The cocaine cowboy: No the poors would get me ... I’d stop all of their support and let them die ... I couldn’t get votes haha

Haha indeed — this from students who are getting tens of thousands of dollars from the taxpayers in the form of lower tuition (compared to what they would pay at a private university) plus whatever other financial aid they may get.

Satire works best when it is comforting the afflicted and afflicting the comfortable.  But The cocaine cowboy’s modest proposal puts it the other way round, comforting the comfortable and afflicting the afflicted. Like too much of what passes for humor on the right — like Trump’s mocking a disabled reporter — it speaks with the voice of smugness and cruelty.                                

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* Insider Higher Ed (here) has more information.

Proof and Institutions — Football and Brain Injury

June 23, 2018
Posted by Jay Livingston

Malcolm is a great storyteller, and in an episode of Season Three of his podcast Revisionist History (here), he tells the story of Owen Thomas. Thomas was a star football player, in high school (he actually started playing competitively before that, when he was nine) and then at U Penn. In his senior year, he committed suicide. He had always been outgoing and happy  — his teammates selected him as team captain — and a good student, but he became depressed and confused, unable to remember things.

The episode is called “Burden of Proof.” How much proof do you need, Gladwell asks how much proof that multiple blows to the head that football players inevitably suffer causes irreversible brain damage? How much proof do you need that football caused Owen Thomas’s suicide?

Gladwell is particularly outraged at the statement by the Penn administration

While we will never know the cause of Owen Thomas’s depression and subsequent suicide, we are aware of and deeply concerned about the medical issues now being raised about head injuries and will continue to work with the Ivy League and the medical community in addressing these issue. Owen’s untimely death was a terrible tragedy, and we continue to grieve for his loss.

Listen to Gladwell read it and then tear into its hypocrisy.



Gladwell’s tone of moral outrage turns to disappointment, almost despair, as he acknowledges that there’s little hope for change any time soon. 



Transcript:

After the speech, as I walked to the reception, one of the big deans at Penn looked at me and shook his head. He said, “We’re not stopping football.” Of course not. And it won’t stop. At least not until the thrid suicide or maybe the fourth suicide or the fifth, at which point the students and alumni at Penn will finally say, “That’s an awfully high price to pay for a game.”

As the title of the episode suggests, Gladwell thinks that it’s all about scientific proof and that the problem now is that the evidence is not yet overwhelmingly convincing. But when that proof does emerge —  the fourth or fifth suicide — Penn students and alumni will be persuaded and force Penn to jettison football.

Gladwell slights the more important reason that football continues: It is embedded in an large structure of institutions and interests —  a structure so large that we cannot imagine how it might be disassembled — and embedded in our consciousness. That’s the point I was trying to make when I posted this http://montclairsoci.blogspot.com/2018/02/the-social-construction-of-brutality.html months ago on Superbowl Sunday. We cannot envision what life would be like without these institutions.  “I wouldn’t be here if it weren’t for football,” says one Penn student, a football player, in the Q&A following Gladwell’s talk. He could not imagine other pathways for people like him to get to the Ivy League that might arise to replace football.

I doubt that he and the others — the deans and alumni — will change their minds even as science accumulates more proof, just as no amount of proof will convince climate-skeptics. More likely the change will come slowly. It will seem sudden — a decision to cancel the football program — but it will come because more and more of the students who then become alumni will have grown up playing and watching soccer rather than football. When attendance at Penn soccer matches starts to rival that of football, the university administrators may decide to dump football. They’ll probably make some high-minded moral statement, and they’ll explain their long delay in reaching the decision by saying that till now the evidence had been ambiguous. But when that day comes the decision will not be about proof any more than it is now.