Saturday, July 11, 2020

Other countries invest in the public's health and welfare. We invest in creating billionaires. ???


It’s not just Donald Trump. It would be nice to think it was, and that, if it was far from perfect, everything was much better in the US before him. Maybe it was; certainly many of the horrible things that he and his administration have done were not done by previous administrations, of either party. These include total denial of climate science (or any science), overt (not subtle) racist appeals, gutting most of the federal agencies responsible for the quality of our life (not to mention survival of our planet) in areas such as health, environmental air and water quality, education The administration has replaced of most of the protections we have had with the most rapacious policies we have seen. Oh, yes, and destruction of our relationships with our allies, and moving ever closer to war with – almost anyone, although his friendship and authoritarian bromances with many of the world’s most autocratic leaders might limit that.

And it’s not just his supporters, as nice as it would be to think that they are just stupid (as long as they do not remain the majority, or the effective majority given the intrinsic inequities of the Electoral College). While the most of them may be stupid and have no understanding of where their own self-interest lies, or are at least more committed to racism than their self-interest, there are a minority of them who are smart (if not wise) and very rich people who have been quite pleased with the direction of (most) of the administration’s policies. That is why they fund it.

And it is not even the Republican Party, as much as that party has, at least for 4 decades, been the party of giveaways to the richest, destruction of the environment, bellicosity which has led to several horrible and pointless wars, appointment of right-wing Supreme Court and lower court justices who manage to convince themselves that they know what the “founders” would have thought 250 years later about issues that they could not imagine, and of course racist approaches to almost everything.

But the most important general trend in the United States over the last 40 years, while it has sometimes been accelerated by Republican administrations, has continued under the Democratic administrations of Carter, Clinton, and Obama. It is the increasing, ever increasing – and incredible, at this juncture -- concentration of wealth in the hands of a few, to a degree that has not existed since the days of the “robber barons” of the late 19th century. A recent article in the Guardian, The US has the most billionaires in the world – but here's what it doesn't have’ documents what citizens of other industrialized have that we don’t: low-cost, or even free, college education, universal health coverage, guaranteed paid vacation and paid parental leave. And more. And, of course, we also do not have what the article refers to as an “inhospitable climate for billionaires, one in which they actually have to pay taxes commensurate with their income and wealth. Our climate is definitely hospitable for them. And, thus, if you are both a billionaire and a completely selfish immoral person, you should be happy with US policies. If you are neither, or only one, you should not be.

There is obviously no disconnect in between these two things, the hospitable climate for billionaires and the limited programs that benefit our people. In the 1950s, as our economy and that of the rest of the world, rebuilt from World War II (ours rebuilt faster because, after the bombing of Pearl Harbor, there was not actual war fought on our territory), under the Eisenhower administration, employment, wages, and unionization increased. The wealthy were wealthy, but regular people, workers, found unprecedented economic success, buying houses, cars, and sending their children to college. CEOs made about 30 times what the average line worker made – a lot more. Of course, the growth was not equitable; minorities and particularly African-Americans were still marginalized, but even many of them got decent jobs.

 In the 1960s, mainly under the Johnson administration, the federal government developed programs to help Americans at a level not seen since the New Deal of the 1930s. In addition to passing laws like the Civil Rights Act and the Voting Rights Act, it developed programs to aid the neediest in our country, both Medicare and Medicaid, and the “War on Poverty”. That “war’s” programs are often derided, by the right, as a failure, demonstrating the fatuity of “throwing money at problems”, but in fact this narrative is incorrect. While the US did not “end” poverty, it decreased poverty a whole heck of a lot. Expansion of programs such as Aid to Families with Dependent Children (AFDC) and food stamps and the Fair Housing Act kept millions of children in homes, with food. The development of HeadStart made a real difference in early childhood education. As with most social service programs, the failings were almost entirely the result of not doing enough, not spending enough, and not a result of doing and spending too much.

But the money the government was spending needed to come from somewhere. And relatively more equitable taxes was more than the wealthiest wanted to pay. Of course, most people didn’t and don’t want to pay taxes, but the billionaires had a lot more clout to get what they wanted. So they got tax breaks for themselves and their corporations, and huge expenditures for “defense” (the US spends more than the next 10 countries together), really just another way this country subsidizes its corporations, and this became the order of the next four decades. Beyond not taxing the wealthiest, the US has subsidized them.  This is well-described by Paul Krugman in his recent piece “Why Do the Rich Have So Much Power?” (7/1/2020). Every penny spent on helping the neediest, or kept by the average American, is another penny not in the pocket of billionaires who are apparently possessed by the desire to have endlessly more despite the fact that they will not be able, in their lifetimes and those of their descendants, to buy enough mansions, private islands, planes, and yachts to spend it all.

Then comes a major crisis, like the COVID-19 pandemic. It hits everywhere in the world. Not equally, of course, the poor and the old and minority communities and the disenfranchised are hit the hardest. But a great deal of the first wave was in developed countries. Some were hit particularly hard, like Italy and Spain, and then France and Germany. Some responded aggressively and limited the damage, like the Scandinavian countries (except Sweden). But the US has responded abysmally poorly, with the most infections in the world – 25% of all COVID-19 cases in a nation with 4% of the world’s population. And tens of millions of unemployed people. And hungry people. And, increasingly, homeless people. Because we have not only, over the decades, purposely decimated our public health infrastructure, we have purposely inadequate social infrastructure of any type. While, in this pandemic, the people of other developed countries get cash bailouts, and expansion of the social support systems that we never had, the US expanded (for a little while, we don’t want to go too far!) unemployment insurance and gave folks one-time $1200 checks. Thus the NY Times can report that “Europeans get paychecks. Americans scrounge for food” (7/3/2020). And, thus, as reported by Robin Wright in the New Yorker “To the World, We’re Now America the Racist and Pitiful”. They used to envy us; now they pity us.

Some years back, I was amazed to hear the chair of one of the highest-income departments say they couldn’t afford nurses, and could only have medical assistants in their clinic. Since my department was one of the lowest income, and we did have nurses, I initially didn’t understand. But then it came to me.  Our group hired the nurses and medical assistants we needed to run a quality practice, and paid what was left to our physicians. Their department paid their doctors (i.e, themselves) what they thought they deserved, and then looked to see what might be left to pay staff. A different approach. There are a couple of ways, generally speaking, a society can  allocate resources: one is to spend what is necessary to meet the needs of the people, with the remainder going to profit, or savings, or (if this is the goal) to enhance the wealth of the rich. The other is, well, the opposite – give the rich what they want and see what is left over.

In ancient Egypt, we are told, Joseph advised the Pharaoh to stash away reserves of food when times were good in case they were needed in the future. As the 7 years of plenty wore on, there were certainly those who must have said “Enough!” But then came the 7 years of scarcity, and the Egyptians were glad that they had saved. We haven’t, on purpose, because our purpose has been to make the richest richer and preparing for real problems that might befall the rest of us was not really high on the agenda.

We have not been meeting the basic needs of our people in the best of times. Poverty and racism are key social determinants of health, and for too many of us, our pre-existing health was marginal. We do not have affordable, universal health care. And we have cut resources for public health planning and preparing for a crisis, such as that we face today. For most Americans, that is a double hit, and for the poorest and worst off, it is unconscionable. This needs to change, and it needs to start immediately. Equitable taxation, meeting the needs of our people, and planning and preparation for the future.

Or, I guess, we can just keep funneling money to the billionaires.

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