Thursday, April 7, 2011

The "Promise" of Choice

We face a possible government shutdown, with political parties unable to come to consensus on goals and strategies. There is much that could be discussed over the long run as we approach questions of the deficit, but our legislative maneuvering has forced a confrontation that was anything but urgent. There is absolutely no reason that this particular increase of the debt ceiling would mark our social demise. It's just an easy tool to use for political posturing.

In the midst of this posturing, Rep. Paul Ryan (R, WI) introduced some broad outlines of his proposed budget for 2012 that will be considered by the House. There are many sources of analysis one can read: some of his numbers are very unclear, the CBO disputes some assumptions, the Chairs of the Deficit Reduction Task Force think it puts too much burden on the poor, the young, and the elderly.

Yesterday on NPR, I heard the explanation that Ryan's approach to Medicare would be to give vouchers to future seniors (exempting those like me who are over 55) to allow them to shop for the plan right for them. Medicaid would be changed to a block grant program, giving a fixed amount to the states and letting them experiment with the best way to deliver services in their area. Both of these moves were described as valuable because they allowed people CHOICE.

Ever since hearing that comment, I've been thinking about the idea that choice isn't evenly distributed. One has to have a certain level of resources before choice can be properly exercised. As if to make that point for me, today's LA Times comics page included the following strip from Candorville (written by Darrin Bell):

There is a true temptation to think all the world is like my people. We generalize from our situation.

Yesterday I had another illustration of this same problem. I was watching Roger & Me, one of Michael Moore's earliest documentaries about the impact of GM plant closing on Flint, Michigan (where GM was founded) in preparation for relocating to Michigan and to spur some of my thinking on my Broken Stories project. Moore wanted CEO Roger Smith to go to Flint and meet with unemployed workers impacted by GM relocation, but GM was non-responsive. One executive explained how a business needs to be concerned for the bottom line and not in supporting a community's needs.

Folks were working at fast food places (WalMart greeters were not the rage in 1989). One woman was selling rabbits out of her home. When Moore approached her about her business, she asked if he was interested in rabbits "for pets or for meat".

The documentary shows President Reagan telling people to relocate to the Sun Belt because that's where the jobs were going (in what proved to be a stop-off point to overseas). At another time not in the documentary, he encouraged unemployed factory workers to get jobs as computer programmers. Celebrities Pat Boone and Anita Bryant, both of whom had be spokespeople for GM, encouraged people to "have a positive attitude" and things would work out.

Listening to Reagan, Boone, Bryant, and GM folks, I realized the limits to our naive belief in choice. There are significant segments of the American population who do not have geographic mobility. They lack resources, they have parents who need care, there are family members in institutions. Furthermore, they need to deal with complicated choices between programs, options, deductibles, eligibility, and the like.

I remember when the last administration passed the Prescription D drug benefit (which, by the way, was a bigger deficit challenge than even the tax cuts for the wealthy). When that first passed, senior citizens were inundated with materials informing them how to choose among the various providers. Many were simply not capable of working that out without help.

Of course, the middle class seniors had less to worry about. Companies showed up who would make the best decisions for you for a fee. You could maximize your choice just like those folks on the financial services television commercials (why are none of those folks concerned about how to keep grandma out of the home?).

The idea of choice lies behind some of the Tea Party fury. They argue, "it's my money" and not the government's (a ridiculous position articulated by GW Bush). They should have the say in what they do with that money. It's less clear what they'd propose for those whose money won't go far enough to allow choice. Of course, the more money one has, the better one can choose to keep it out of the government revenue stream. You do that by having tax lawyers who can help you avoid taxes. The most unbelievable example is General Electric, that got a $3 billion dollar TAX REFUND because of the excellent work of the nearly 1,000 tax attorneys in their employ.

But the lower part of the economy doesn't have these options. If you are not geographically mobile, don't have skills that translate to other industries, are unemployed, or elderly, or very young, you will choose between the options that you have. This most likely means lessened coverage, poorer health, inadequate nutrition, earlier mortality, and crime in the streets.

I'm not suggesting Rep. Ryan or the late Roger Smith are insensitive to workers and the unemployed. I am suggesting that they've made the mistake of building programs or corporate strategies based on what would work for them. They'd exercise rational choice to maximize outcomes.

But for the poor, the young, and the elderly, it's no choice at all.

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