Update: Increasing Assets For The Poor

Ms. Frog of frogblog followed up on my post about Harold Ford's "American Stakeholders" proposal by pointing me towards the work of Michael Sherraden, a Washington University professor who studies asset creation policies.

You can read about his work here and here. I found it quite cheerfully encouraging - he's found that small, practical programs to encourage savings are highly effective, even among the very poor - people traditionally considered to be unthrifty and improvident.

the fact is that poor people can and do accumulate assets, and Sherraden has the data to prove it. Participants in programs of matched savings called IDAs, which resemble 401(k) retirement plans, have saved an average of $33 per month and 71 cents of every dollar that could be saved or matched. Interestingly, the 43 percent of participants monitored whose incomes are below the poverty line save almost as much as other program members, and save a much larger portion of their income.

Garance Franke-Ruta Gets It Right About Dean

If you've ever spent time in the medical arena you know that being a physician is something very different from being an attorney, which is what John Edwards, John Kerry, and Joe Lieberman are. Your stance to the world is simply different if you're a physician, because -- outside of a few specialties, like plastic surgery -- your power doesn't come from how you look or how you appear or even how you sound. It comes from your knowledge and the capacity to do things no one else is authorized to do in their daily lives -- to touch bodies, to demand of individuals, to prescribe courses of action -- and from the human power of interaction. You can't convince people to be healed, no matter how eloquently you speak about disease and suffering or what you wear. You have to actually do something to make a person better. You also have to do the right thing. And if you don't, the consequences can be dire and literally deadly. (from Tapped.)

As someone who works in medical settings and grew up in a medical family, this strikes me as absolutely correct. Howard Dean has the consummate physician's personality. He's brash, direct, impatient, and forceful. He's very, very certain about his positions. But he's also ready to change his mind if presented with convincing new data - at which point he'll be very, very certain about the new position. Doctors pretty much have to be that way.

It makes him stick out like crazy in a field of politicians and lawyers, because he doesn't place the same emphasis they do on carefully crafted nuances of language. I imagine that he's just plain baffled by the constant accusations that he's "flip-flopped" on this issue or that. For a doctor, there's nothing wrong with changing your diagnosis and your plan in the face of new information, or changed circumstances. But the other candidates and the media seem to see it as a cardinal sin.

Gov't Handouts For Demon Youth?

Harold Ford, Jr. had a thought-provoking op ed in Sunday's Washington Post, outlining a couple of proposals intended to build assets among people with moderate income.

His central proposal is to provide "American Stakeholder Accounts" of $1000 in investment funds for each child born in the United States ($2000 for children born into families below the poverty line). The accounts would accrue interest until the child was 18, at which point the money could be withdrawn tax-free and used for... well, whatever the kid wants to use the capital for, I suppose. Ford offers a list of sober, reasonable choices - "to pay college tuition, purchase a home, start a business or invest for retirement" - but his program is modeled after a British program in which, apparently, the 18-year-old recipient just gets free ownership of the money.

I don't think this program will ever get off the ground, if only because the primary beneficiaries are teenagers - one of the most despised groups in America. But it's an interesting prospect. My cynical initial reaction was that we'd see more 18-year-olds driving nice cars than ever before, but in retrospect, that may be unfair. Maybe kids who grew up knowing that they'd have a financial stake coming to them would think about money differently. Our society currently treats youth as irresponsible children who can't be trusted to make their own choices, and who can be expected to be dependent on adults until somewhere in their mid-twenties. Accurate perception, or self-fulfilling prophecy?

We'd certainly have to start raising and educating teenagers differently if we knew that, at the end of their minority, they'd all have full control of $6,000 or so. We could, of course, put heavy restrictions on how the money could be spent. It could be limited to the list of adult-approved uses Ford suggests, things like college tuition or job training. But it would be far more interesting to provide a mandatory high school course in money management - principles of investing, for example, and how to avoid scams - and then just turn young adults loose. Maybe they'd want to pour the money into world travel or political activism or the charity of their choice or a really nice ride. Maybe they'd waste it all on clothes and CDs, and in six months they'd be crying that it was all gone. Probably they wouldn't make the precise choices that adults would make for them.

But growing up conscious that, at a defined age, they'd be handed the adult-level status and responsibility that comes with a significant amount of money to spend or invest - that just might push back the ludicrously extended adolescence our society has imposed on young people, and prompt them to take themselves seriously, as adults. In turn, it might prompt adults to take them more seriously, as well. I'm all for that.

Euthanasia, Part 2a: Prospects At The End Of Life - Pain

A 2002 comprehensive state-by-state review of end of life care found that dying people in America have inadequate access to pain control and specialized support services. Seventy percent would prefer to die at home; only 25% do. Most do not have access to hospice care or don't receive the full suite of available hospice services. Dying people fare better with access to palliative care, which is treatment that focuses on relieving pain and suffering rather than attempting to cure disease. But only 17% of community hospitals and 26% of academic heath centers have specialty teams for palliative care. The American Pain Society reports widespread problems with insufficient pain control at the end of life.

It's no wonder that many of these people decide that they want to kill themselves. But it doesn't have to be that way.

State-of-the-art pain treatment is phenomenal. It encompasses narcotic and non-narcotic painkillers; slow-release narcotics that don't cause heavy sedation; medicines that increase the effect of painkillers, such as muscle relaxants or low-dose antidepressants; biofeedback; hypnosis; acupuncture; nerve blocks; nerve stimulation; and even the surgical implantation of tiny painkiller pumps near the spinal cord. The American Pain Society estimates that over 90% of dying patients can receive adequate pain relief without being overly sedated, and that pain relief can be accomplished with sedation in the rest. But most dying patients are offered only narcotic pills or injections, in increasingly larger doses. With narcotics come undesirable side effects: nausea, constipation, depression, over-sedation. And doctors may be reluctant to prescribe sufficient quantities of narcotics for pain relief, either for fear that the drugs will be abused, or for fear that they will depress breathing and perhaps hasten death.

Why is there such an enormous gap between the possible and the actual? Because specialty pain treatments are complicated and expensive. Not many doctors are experts in pain management, and patients may not be referred for pain services even when they are available - only 20% of patients with chronic uncontrolled pain are seen at specialty pain clinics. Costs are also a complicating factor: insurance companies would certainly rather pay for an inexpensive morphine injection than an epidural medication delivery system. In many states, funding for skilled home nursing care is limited; thus, patients who can benefit from, for example, patient-controlled analgesia pumps may need to choose between the desire to die at home and the desire for appropriate non-sedating pain control. This is despite the fact that dying at home, even with a visiting nurse in attendance, is significantly cheaper for the overall health care system than dying in a nursing home or the hospital.

Pain, and the fear of pain, are major justifications for Physician-Assisted Suicide (PAS). Proponents of PAS have assured me that pain often cannot be controlled in terminal illness. If that is true, it might be a legitimate argument for the availability of PAS - but the pain control available to most dying people falls so far short of adequacy that the proposition can't even be said to have been tested.

Adequate pain control will be more expensive. Increased access to palliative care will require expansion of the health care system in a direction that is not generally profit-enhancing. But ethically, can we as a society ask dying people to choose between suffering and killing themselves, in order to save the rest of us some money?

Good News/Bad News

Limestone's HIV-positive inmates admitted to education, work programs
Classes now open to HIV inmates

Buried deep in both of these articles is a one-sentence acknowledgement that this good news, this display of enlightenment, applies only to male prisoners. Female prisoners with HIV are still segregated in Alabama prisons, barred from attending GED classes, drug treatment groups, or job training. The Alabama Department of Corrections doesn't seem to see any pressing reason to change that policy, probably because, unlike the men, the women aren't suing in federal court.

This story's also been covered extensively in the gay press, for example, here. The gay press articles do mention in the lead sentence that HIV+ women continue to be denied access to education, but what they leave out is a lot weirder.

"Alabama still remains out of the mainstream in housing HIV-positive prisoners separately from others," cautions 365gay.com. Here's what they don't say, courtesy of the Birmingham News:

Less than a year ago, an AIDS doctor visited the facility and found deplorable conditions. Sick prisoners living in a vermin-infested warehouse were denied basic medicines and, at times, left to die by an overwhelmed medical staff, according to a report filed last year in the federal lawsuit.

The gay press usually does a great job of covering AIDS advocacy issues. So how come, reading their coverage, it would be easy to come away with the impression that the worst thing that was happening to those inmates was the denial of GED classes, and that their greatest lingering problem is that they're not being given HIV-negative cellmates?

Go, Otter, Go!

My Significant Otter is en fuego over in the comments section of Obsidian Wings:

I spent years preparing myself to give my life in the service of my country if necessary, and I believe that the least that my country owes me in return is telling me the truth when it comes to what we need, and what we spend our money on. Don't piss on my hands and tell me it's raining, for God's sake!

If we need to all shell out to make sure that we can check incoming cargo containers for hidden nukes, or to pay for draining a terrorist swamp in Iraq, then I'm OK with that. Just don't say that only those making less than some particular amount get to shell out more money to cover it. Don't tell me that gay people don't get the same rights as Britney Spears. Don't tell me that massive deficits and tax cuts go together like beer and pretzels. Don't tell me that we can get along with half-assed planning for rebuilding Iraq. Don't tell me that you think all of us out here in the 50 states are morons, who can't be trusted to follow whatever line of reasoning you want to provide for your actions.

There aren't individual comment links, but scroll down to the post from Michael N. at 2:04am. It's worth reading the whole thing.

Now That Iowa's Over

Calpundit linked to this nicely-presented site, which supplies poll data for upcoming primaries through Feb 3. Some of the data is pretty old (Oklahoma was apparently last polled before Christmas), and none of it, of course, is post-Iowa. But it does raise some interesting points:

Gephardt, of course, was killing in Missouri. He had 37% in the polls as of 1/11/04, compared to Dean's 19% and Clark's 15%. Now that he's dropped out of the race, where will his supporters go? My money says they don't go to Dean - the Dean/Gephardt rivalry in IA got too nasty. I would've had trouble crossing over to Gephardt if Dean had dropped out, and I'm guessing that the reverse will also be true. Kerry could really make out here, if he can convince Gephardt supporters that he's the closest equivalent. But it's definitely time for a new MO poll!

Kerry's definitely got a shot at winning New Hampshire. But in every Feb 3 state, he's trailing the leader by at least 10 points. In Arizona, Oklahoma, and South Carolina, he's trailing the leader by more than 20 points. How much will his IA win help in these southern states? I'm guessing that they don't really look to IA for their political guidance. On the other hand, if he also wins New Hampshire, there will begin to be a certain aura of inevitability about him that will probably influence voters in later contests.

Edwards' surprisingly good performance in IA could give him enough of a boost to take South Carolina. But he's nowhere right now in the other Feb 3 states, which are all about Dean and Clark. I don't think Edwards has a strong enough organization nationwide to be able to take advantage of his IA boost, but then again, I would've said that he didn't have a strong enough organization to get the IA boost in the first place.

The upcoming set of contests are all primaries, rather than caucuses. (Huh, wait. Apparently, New Mexico has a caucus. How come I've never heard of that before?) That should make the poll data more reliable, because polls are closer in structure to a standard election ("pick your favorite candidate, and then go home") than they are to the horse-trading and vote-shifting caucuses.

I wonder how long it will take for Lieberman to drop out.