A Walk in the Woods

A walk in the woods at Horseshoe Lake Park

A Walk in the Woods — Self Improvement or Self Care?

Despite my best efforts, my life is dominated by “shoulds”. I should take a walk; I should exercise more; I should do yoga… All of these “shoulds” are aimed at making me a better, healthier, more successful human being. I am hooked on self improvement.

Last night as I was drifting off to sleep, it occurred to me that I could focus on self care instead of self improvement. In an instant, everything changed. I was now able to be kind to myself — nurturing, in fact. It occurred to me that I can apply this thinking to all of the “shoulds” in my life. The weeding that needs to be done — I am spending quiet time outside, away from all types of distractions, focusing on the plants and the soil — instead of working to satisfy a societal norm. Instead of trying to fit in with the neighbors’ perfect gardens.

Self care helps me to be more discerning. I can ask myself if a job I am doing really needs to be done. I can confront the anxiety of my childhood, where there was always more work to be done, where the job was never, ever complete, and determine if the job needs to be done in the first place.

Growing up, I had to clean my room every Saturday. The job could have been satisfying, could have made sense. I could have learned to look at what I had done and feel good about how the room looked. Instead, it was a never ending chore, that lasted all day, instead of forty-five minutes. Because nothing was ever good enough, I would scrub the carpet with a rag and a pail of water. I look back now and marvel at the insanity of what I did, of what I thought I had to do. I was nine years old.

Now, before I take a walk, I think of it as self care, instead of a way to get enough steps in. It’s a way to hear the birds, to see a new plant, to notice the flick of a deer’s ear in the park where I am walking. It helps me decompress, to know that most of my jobs don’t decide the fate of the human race.

The image I have included is based on my walk this morning in a local park.

 

How to Get People to Vote by Mail

SHOW THEM THESE FOUR BENEFITS

There are four significant benefits to having people vote by mail in upcoming elections during the Covid 19 pandemic.  Getting people to change the habit of voting in person, on election day, can be hard.  Stressing the following FOUR BENEFITS can make it a little easier.

Illustration by Joan Savitt

The first benefit is that voting by mail is SAFE.  Safe not only from disease, but also from fraud.

In addition to being an illustrator, I am also a voting warden in a local precinct outside of Boston.  Our last in-person election was the Massachusetts Presidential Primary on March 3.  I kept wondering if my poll workers were safe, as they had the greatest exposure to people who could potentially have had Covid 19.   Most poll workers are older (often retirees).  I have had people in their 90's work for me.  Clearly, they are in a high risk category.  And elections in my Town are held in gymnasiums and a library.  It is easier to pick up the virus inside one of these spaces than outside of it.

We had a Town election scheduled for March 17 - which was postponed and will now take place on June 13.  This one will take place mostly through absentee balloting.  (As of 5/25/20, the Attorney General of Massachusetts has only authorized "no excuse" absentee voting through June 30, 2020.)

Some worry that voter fraud will increase with mail-in voting.  Research has not shown that to be the case.  On May 20, 2020, Amber Phillips wrote in the Washington Post "There is no evidence of widespread fraud in either regular voting or mail-in voting...  But there is not any evidence of routine or even statistically significant fraud in the five states that do all-mail elections, election experts say."

On May 15, 2020, Pam Fessler writing for NPR wrote that Kentucky's Republican Secretary of State Michael Adams said "the presumption that absentee voting is less secure is frustrating because Kentucky has safeguards in place to protect against fraud."

The second benefit to voters is EASE.  Rather than taking time out of what is usually a work day to vote, and maybe stand in the rain, snow or hot sun, you can vote from home, as soon as you have your ballot.

The third benefit  is CONVENIENCE.  Vote whenever you want.  Spend an hour looking over the ballot and ballot questions with a cup of coffee in the comfort of your own home.  Do it on the weekend - in your pajamas, if you like!

The fourth benefit is the potential for your municipality to SAVE MONEY.  When most of the voting is done by mail, a city or town does not have to rent as many places to hold the election and does not need to hire as many poll workers.  Not as many ballots may need to be printed.  In my Town, a police officer is hired for each polling place, and works a thirteen hour shift.  Dinner is provided for all workers.  These costs, although not eliminated entirely, will probably decrease.

Initially, costs may go up if high speed tabulating machines are purchased.  The data, though, seems to suggest that costs will go down.  A PEW Charitable Trust report from March 22, 2016, titled "Colorado Voting Reforms:  Early Results" states "In fact, one study of the switch to all mail voting in Colorado concluded that major expenses fell by 40%, to about $10 per voter from $16 per voter."

Encouraging people to vote by mail is so important during the pandemic.  Publicizing the four benefits of mail-in voting, Safety, Ease, Convenience and Cost Savings can help election officials make a strong case for doing so.

Medical Bankruptcy

Should it be Driving the Debate on Health Care?

Bankruptcy caused by medical issues is a hot topic

Medical bankruptcy is highlighted as a reason to either expand the Affordable Care Act, add a public option to the ACA, or adopt Medicare for All.

The impact and size of medical bankruptcy, though, is up for debate.  From a May 30,2019 article titled "Medical Bankruptcy and the Economy" in The Balance, author Kimberly Amadeo writes "Medical bills were the biggest cause of U.S. bankruptcies, according to a CNBC report.  It is estimated that two million people were adversely affected."

A February 11, 2019 CNBC article titled "This is the Real Reason most Americans file for Medical Bankruptcy", author Lorie Konish writes "Two thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall....  An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found."

Confusing the issue is research, most notably from a study conducted by the New England Journal of Medicine, which found that medical issues cause far less bankruptcy than is commonly believed.

 From a March 28, 2018 Washington Post article titled "The Truth about Medical Bankruptcies", author Megan McArdle cites the aforementioned study.  "Carlos Dobkin, Amy Finkelstein, Raymond Klender and Matthew J. Notowidigo did what's called an i event study.  Instead of looking at bankruptcies to see how many involved medical bills, they started with the illness, and asked how much more likely people were to declare bankruptcy after they got sick ....  The fraction of bankruptcies caused by medical events is just 4%."

One factor that complicates the issue is that people don't have to share the reason for their bankruptcy when they declare it.  So estimates are made based on interviews.  

Everyone seems to agree that issues such as low wages, little or no savings, and unsteady jobs, coupled with an unexpected medical expense, cause people to declare bankruptcy.

Having medical insurance is no shield against bankruptcy.  From a February 9, 2019 article in MedAlertHelp.org titled "The Truths and Myths Behind Medical Bankruptcies", Dr. Lina Velikova, MD writes "And having health insurance is no protection against bankruptcy.  Unanticipated issues, such as hospitals/providers not being in network, deductibles, copays and denied claims, all contribute to the financial burdens of medical care."

One final issue muddies the discussion, and casts a shadow over the future of health care in America.   The cost of providing health insurance for their employees is creating a big financial burden on employers.  In a September 26, 2019 article in the New York Times titled "Employers Battered by the Soaring Costs of Health Insurance", author Reed Abelson writes "Employers remain the main source of health insurance in the United States, covering about 153 million people.  But premiums and deductibles are pushing employer-based coverage increasingly out of reach, according to a new analysis released Wednesday by the Kaiser Family Foundation....  The average premium paid by the employer and the employee for a family plan now tops $20,000 a year, with the worker contributing about $6,000, according to the survey."

As health care premiums continue to rise, it is clear that the health care system in the U.S. may be reaching a breaking point.  What isn't clear is how much bankruptcy is caused by medical issues.

Medicare for All

And the Two Issues that Bookend the Debate

Medicare for All could eliminate the private health insurance industry

Health care, and how to pay for it, is a big issue on the campaign trail because it is a big issue for just about everyone in America.  Elizabeth Warren and Bernie Sanders both support Medicare for All.  They both want single payer, through the government, instead of the current mix of public and private insurance.

Medicare for All seeks to deal with problems associated with our current health system - rising costs, denied treatment and medication, and personal bankruptcies caused by medical expenses.  It introduces a big, contentious issue (beyond higher taxes) - eliminating an entire industry in a short time.  

From a New York Times March 23, 2019 article titled "Medicare for all Would Abolish Private Insurance.  'There's no Precedent in American History'", authors Reed Abelson and Margot Sanger-Katz write:  "But doing away with an entire industry would also be profoundly disruptive.  The private health insurance business employs at least a half million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues.  Its companies' stocks are a staple of the mutual funds that make up millions of Americans' retirement savings."

And yet, because private health insurance companies are in business to make money, customers are often denied coverage.

From a March 19, 2019 article in InTheseTimes.com titled "Yes, We're Coming for your Private Insurance Plan", author Natalie Shure writes:  "The reliance on private insurance creates structural obstacles to reform.  For instance, a piecemeal web of competing insurance plans makes it difficult for any given insurer to command any leverage in negotiating prices with healthcare providers and drug companies."

There are other reasons why healthcare, in its current form, is so expensive in the U.S.  One driver of these costs is lack of transparency.  From a July 31, 2018 Wall St. Journal article titled "Why Americans Spend so much on Health Care - in 12 Charts", author Joseph Walker writes:  "Among the reasons is the troubling fact that few people in health care, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling.  Providers, manufacturers and middle men operate in an opaque market that can mask their role and their cut of the revenue."

Walker continues:  "One reason prices are rising:  Hospitals are becoming more consolidated and are using their market clout to negotiate higher prices from insurers."

Supporters of Medicare for All assert that only the federal government is large enough to bend the cost curve down.

Medicare for All may very well be able to erase many of the problems found in the current health care system.  In the plans supported by Bernie Sanders and Elizabeth Warren, though, it introduces a huge, troublesome issue - eliminating an entire industry and the jobs that go with it.

Is Joe Biden going to save the Democrats in 2020?

What is his compelling message?

Is Joe Biden a knight in shining armor?

Joe Biden has been leading by double digits in the polls for the Democratic Presidential nominee since before  he announced his candidacy.  Elizabeth Warren is inching up, but still has a lot of catching up to do.

Oddly, Biden doesn't seem to have a positive reason for running.  Mostly he wants to defeat Trump.  He also doesn't have large, enthusiastic rallies, as some of the other candidates do.

A 9/3/19 article in the New York Times by Mark Leibovich titled "So Why's Joe Biden want this job?  Um, tough one" discusses "the paradox of the leading candidate not having a compelling reason to run.  When asked by a reporter why he wanted to run, Biden responded with "I think it's really, really, really important that Donald Trump not be re-elected.""

If Joe Biden had not been vice-president during Obama's term in office, would he be leading in the polls now?  Is his implied promise to return America to the halcyon days before Trump enough to beat Trump?  Is it even enough for him to get the nomination?

Thinking about the candidates in the most superficial way possible, I could not say what Biden stands for beyond defeating Trump.  Elizabeth Warren wants to stop corruption in Washington D.C., offer Medicare for all, and help people with onerous student loan debt.  Bernie Sanders also wants Medicare for all, a $15 minimum wage, and to help people burdened with college loan debt.

I looked at the websites of the three top candidates.  Biden, by far, has the most detailed and expansive plans for topics ranging from health care to education to criminal justice reform.  No one could accuse him and his team of skimping on the depth and breadth of his positions.  Notably, he doesn't say how he would pay for anything.  And he still doesn't seem to have "that vision thing" (thank you George H.W. Bush).

Biden's website opens with:  "Our Best Days Still Lie Ahead."  The three pillars that support this statement are:  1.  We've got to rebuild the backbone of the country, the Middle Class.

2. We've got to demonstrate respected leadership on the world stage.

3. We've got to make sure our democracy includes everyone.

I cannot seen any reasonable person disagreeing with these statements.  I cannot see, anyone either, being propelled into the streets to support them. 

Elizabeth Warren's website has an urgent sounding headline:  "We will Save our Democracy."  (If we need to save it, it must be in peril - a lot of people are thinking that.)

Warren's website, despite her mantra "I have a plan for that" is much less detailed than Biden's.  Unlike Biden, she says how she is going to pay for everything.

What Warren's site lacks in details it makes up for it with arguments that many will find visceral and compelling.  For instance, one of the items on the site is:  "Rebuild the Middle Class", followed by "After decades of largely flat wages and exploding household costs, millions of families can barely breathe.  It's time for big, structural changes to put economic power back in the hands of the American people."

This phrase delivers a punch to the gut (mine, at least).  I didn't experience that on Biden's website.

Ironically, the nerdy, wonky Elizabeth Warren seems to "feel your pain" (thank you, Bill Clinton), more than the touchy, feely Joe Biden.  The next debate may shed light on whether Joe Biden has a different rationale for running for president, and, if it even matters in the long run.

Bernie Sanders wants to raise the Federal minimum wage to $15 an hour by 2024

The pros and cons of raising the minimum wage

Bernie Sanders demands a minimum wage of $15 an hour

The Raise the Wage Act of 2019 was passed by the House on July 18, 2019.  It would phase in raises to the minimum wage to $15 an hour by 2024.  The bill would index future minimum wage increases to median wage growth.  Currently, the minimum wage is $7.25 an hour; it has not been increased since May, 2007.  Senator Mitch McConnell is not likely to take up the bill in the Senate.  (Ironically, Senator Sanders was chided for not paying his campaign workers an effective minimum wage of $15 an hour - largely because his staff were working, on average, 60 hours a week.  This issue has been rectified.)

The biggest question people have about raising the minimum wage is whether or not it would decrease hiring.  Another question is what would the impact be on different parts of the country that have different pay scales.  Where pay scales are lower, workers would benefit enormously; the businesses that hire the workers, though, would experience a pretty drastic increase in wage costs.

Liberal economists, such as those who work for the Economic Policy Institute (EPI), believe that raising the minimum wage would be good for the economy.

In testimony before the US House of Representatives on February 7, 2019, Ben Zipperer, economist for the EPI, stated that a single parent earning the current wage does not earn enough in full time work to rise above the poverty line.  He also state that if the minimum wage had "kept pace with labor productivity growth since 1968, this year it would be more than $20 an hour."

The EPI cites studies that show that raising the minimum wage would not adversely affect employment.  In one study mentioned, they found:  "In their meta-analysis of 739 estimated effects from 37 published studies on the minimum wage and employment between 2000 and 2015, Wolfson and Benjamin (2016) find 'no support for the proposition that the minimum wage has had an important effect on U.S. employment.'"  (From a 2/5/19 report by David Cooper for the Economic Policy Institute titled "Raising the federal minimum wage to $15 by 2024 would lift pay for nearly 40 million workers.")

On the other side, some economists have argued that increasing the minimum wage, especially in areas where the difference between the current and proposed minimum wage is significant, would adversely affects employment.  In a 9/28/18 article by Adam Millsap in Forbes Magazine, he quotes from a study published in the American Economic Review that maintains that increases in the minimum wage reduce employment in the long run.

The studies' authors, Paul Beaudry, David Green and Ben Sand, found that over a ten year period  "that a 1% increase in wages leads to a 0.3% to 1% decrease in employment rate depending on whether wages increase citywide or only in one industry."  The authors found that most of the loss in jobs is  due to firms closing, rather than layoffs.

The minimum wage debate is complex.  The plan Sanders proposes eases the impact on business by phasing in the increases over several years.  What does not seem to be in doubt is that it is difficult to live on a full time minimum wage job.

On an interesting historical note, Otto von Bismarck created the first social security system in the world - to keep the masses from adopting socialism.  You have to ask yourself, if people cannot afford to live on the minimum wage, what will happen to economic growth, and our internal national security, if working class people having little or no disposable income.

Is Free Universal Pre-Kindergarten a Prescription for Success?

Some Democrats running for President think so

Democratic politicians want to help ease the burden of childcare

Free universal pre-kindergarten for all three and four year olds is being touted aggressively by two men running for president.  Both Bill deBlasio and Julian Castro propose it.  As mayors of New York City and San Antonio, TX, respectively, they have experience with such programs.  Both men initiated them for four year olds - and both have been considered successful.  Other candidates have expressed interest in universal pre-K, but not as forcefully as Castro and deBlasio.  Elizabeth Warren, Kirsten Gillibrand, John Delaney, and Jay Inslee all want it in some form.

A successful pre-K plan has to both help children get ready for kindergarten and help families save money.  Additionally, it should raise the pay of pre-K teachers.

Publicly funded pre-K would ease the financial burden on families with small children.  For example, The Care Index found that the average cost of care for a four year old in Illinois is $10,414 - about 19% of the median household income, and about 61% of income for a single parent earning a minimum wage.  (The U.S. Department of Health and Human Services defines affordable child care as being no more than 10% of a family's income.)  (From a New America article titled "Policy Recommendations:  Universal Pre-K" by Abbie Liederman.)

Some would argue that poor families can avail themselves of the Head Start Program, which is available to families living at or below the poverty line, the homeless, any foster child, or families receiving public assistance.  Head Start, though, does not address the pre-K needs of families living much above the poverty line.

Others look to the Head Start Program to argue agains universal pre-K, stating that the benefits gained during the program fade soon after the children enter kindergarten.  In a study  released on 12/20/17 titled "Head Start Programs have Significant Benefits for Children at the Bottom of the Skill Distribution" by Marianne P. Bitler, UC Davis; Hilary Hoynes, UC Berkeley; and Thurston Domina, UNC, sponsored by The Center for Poverty Research at the University of California, Davis, found that while academic results often fade for most children - those who were in the bottom of the "achievement spectrum" seem to  benefit long-term.   There is also a question of whether the disappearing benefit is the fault of Head Start, or of a failing public school education.   And people are just starting to study the apparent positive impact that emerges when former Head Start students become teenagers.

It will be interesting to see if this issue gains traction as the campaign season progresses.  Families with small children will be happy if it does.