THE CENSUS BUREAU reported last week that the poverty rate rose in 2003
for the third consecutive year and that the percentage of people without
health insurance climbed for a third straight year as well. But what's
really revealing about the trends in poverty and health coverage is not
the similarity, which reflects the downturn in the business cycle, but
rather the contrast. Put simply, the long-term trend in health coverage
is negative: The percentage of Americans without insurance is up from
about 13 percent in the late 1980s to nearly 16 percent today. But the
long-term trend in poverty is positive: The rate ranged between 13
percent and 15 percent in the 1980s, but it has hovered at about 12
percent in the past half-decade. Moreover, the real decline in poverty
is bigger than suggested by these numbers.
What policy prescriptions follow? The health insurance figures are a
call to action: Economic growth over the past 15 years has failed to
improve coverage, so some kind of policy response is essential. Indeed,
this conclusion is only reinforced if you dig into the data. The
percentage of uninsured has gone up despite expanded government
activism: Since 1987, the first year for which the Census Bureau has
data, government has gone from covering 23.3 percent of the population
to covering 26.6 percent, a rise that primarily reflects the extension
of Medicaid to a wider circle of low-income people. But the trend in
company-provided health insurance has been negative, except during the
extraordinary bubble of the late 1990s. The soaring cost of health
insurance is driving companies to withdraw coverage, and there's little
reason to expect this trend to reverse itself. More government activism
-- possibly in the form of incentives to companies to keep offering
insurance, such as those proposed by Sen. John F. Kerry -- seems
unavoidable.
tvoivozhd---that is a bunch of bullshit too, Bush already tried to
subsidize employers to keep offering health insurance to
employees---each year the number of employers who offer employees health
insurance declines---for the very good reason that employer-provided
health insurance and pensions for employees is the worst of all possible
worlds. Any and all Canadian employers will tell you they are for
tax-paid Universal National Healthcare because it makes them competitive
in global markets. They cannot compete if they provide pensions and
healthcare and their domestic or global competitors do not. Tje only way
to level the playing field is for all principal trading nations to adopt
a tax paid Universal National Healthcare system---as all leading nations
but the U.S. already do.
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Interpreting the poverty data is harder. Economic growth has been a
powerful antidote to poverty, and the long-term reduction in the poverty
rate is all the more impressive because it defies powerful head winds.
High immigration in the past two decades might have been expected to
increase poverty; the same goes for the rise of single-parent families,
which are four to five times as likely to be poor than two-parent ones.
Yet economic growth, while powerful, is not a magic bullet. For one
thing, the surprisingly small increase in the poverty rate during the
recent economic downturn owes something to the policies of the 1990s,
which provided financial incentives, training, child care and other
services to people trying to escape poverty via work. For another, the
positive news on the number of people in poverty masks an alarming
trend. The number of people in extreme poverty -- that is, subsisting on
less than half the income defined as the poverty line -- stands at 15.3
million, higher than at any time since the Census Bureau began
collecting data 28 years ago.
This fact deserves more attention than it has received. The policies of
the 1990s may have successfully pushed former welfare recipients into
work, but those who have not found work, or who have found it and then
lost it, appear to be worse off than before. A bit oddly, the
congressional debate on reauthorizing the welfare law has dwelt minutely
on the details of the design of work incentives rather than on the
program's function as a safety net; it is not often noted, for example,
that fewer than half the families eligible for money and job training
actually receive any, a shocking contrast with the participation rate of
80 percent that prevailed in the mid-1990s. A combination of deft
government incentives and a strong economy may have reduced overall
poverty. But the people at the very bottom are being forgotten.
[Homestead] Poverty and Health,
Tvoivozhd, 09/01/2004