Tag Archives: Poverty

Health Policy Post! My Actual Day Job!

I work at a state Medicaid agency that’s planning to cut payments to doctors who can get that dough back by improving their patient outcomes. It’s generally called “paying for value.” Its opposite, “paying for volume,” pays docs for the number of services they provide, rather than their patients’ improved ability to bike to the river.

Clearly we need to pay for health care quality instead of for however many brains one can stuff into an MRI machine.

But we also know that social factors–jobs, education, immigration status, housing and food security–determine up to 80% of a person’s health. Not their doctor. Not their genes. Not their kale smoothies or meditation apps.

So paying doctors for outcomes may not make much sense for doctors who primarily serve people with low wage jobs in polluted neighborhoods and who generally live without the kind of accumulated advantages that allow me, for example, to hit the bookstore for something to read on the airplane, which I’m flying tomorrow to a small town with a fantastic pastry shop and a famous theater.

Dhruv Khullar points out that scoring doctors who take public insurance against doctors who don’t, and paying them less when their patients inevitably can’t manage their chronic conditions as well, will probably result in lower-income people getting worse care.

And we haven’t yet figured out how to use the health care system to address people’s actual health needs: food, safe and secure housing, child care, decent wages.

I’ve been saying this around the office for a while, that value-based payments may punish doctors for poverty the same way that teacher evaluation systems punish teachers for poverty.

But Dr. Khullar is a doctor published in the New York Times, and I’m a pee-yoo-rocrat blogging for about 3 readers (hi guys!).

So not that I can do much about it, but I’ll spend my Fourth of July thinking about how to leverage health care funding streams to mitigate social inequity. Also cake. Happy Fourth.

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On Medicaid Work Requirements

As expected, and I’m shocked they took this long, Donald Duck’s administration announced that they will allow states to institute work requirements for Medicaid recipients.

A few panic-staving reminders: Continue reading

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What!?! The Farm Bill?!?

Mark Bittman, whose recipes frequently inspire me to bow out of life and cook all day, except that cooking is part of life, so it’s a pleasantly contradictory fantasy, hit it out of the pantry with a scorching op ed about the Farm Bill.

Farm Bill?

Yes, the Farm Bill.

Which outlines a megamart of food-related policy. And sets the budget. Pitting the SNAP program (food stamps) against CROP INSURANCE.

Which means, as you know, that if farmers get hit by weather (which they will because climate change) then the federal gummint will subsidize the insurance that pays them out anyway.

And every cent that subsidizes millionaire farmers’ crop insurance is taken away from hungry children for whom even their parents’ jobs won’t cover groceries. (41% of SNAP recipients have jobs.)

And, I don’t want to make assumptions, but Congresspeople may not know what it’s like to look for work and not be able to find it. It seems that when they lose their jobs, they can walk straight into a lobbying firm and rocket to the 1%. If they weren’t already there to begin with.

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When does “poverty” become “middle class”?

Paul Buchheit broke out his TI-81 to riff on the Census’s assertion that 15% of people in our country live in poverty.

Turns out, depending on how you calculate it, 50% of our residents are pretty dang close.

The IRS reports that the highest wage in the bottom half of earners is about $34,000. To be eligible for food assistance, a family can earn … about $30,000 for a family of four.

$4000 isn’t much for a family of four. It wouldn’t take more than, say, a brief hospitalization. A job reduction or furlough. A serious car repair? Or a year of additional expenses that comfortable families take for granted: mandatory fees for student clubs, textbooks, winter coats, plane tickets.

$4000 a year is just $333 a month.

And the reason we talk about it as inequality rather than the normalization of poverty?

While food support was being targeted for  cuts, just  20 rich Americans made as much from their 2012 investments as the entire  2012 SNAP (food assistance) budget, which serves 47 million people.

And as Congress continues to cut life-sustaining programs, its members should note that their 400 friends on the  Forbes list made more from their stock market gains last year than the total amount of the  foodhousing, and education budgets combined.

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Child Abuse Prevention

Hey friends!

I don’t often bring up my day gig here (mostly because it prevents me from spending an hour+ of daily blogging about the brain tussles I have with myself), but this is pretty dope:

Teva Sienicki, President and CEO of Growing Home, got published in our hometown rag.

Today’s the last day of Child Abuse Prevention Month. At Growing Home we’re doing a wide variety of things to prevent child maltreatment among low- and no-income people in Denver’s north suburbs.

You get your short-term, emergency interventions, like 3 days of healthy food and 60 days of emergency shelter. But you also get your long-term supports. Like parent education and after-school programs that focus on social and emotional development alongside academics. Life skills classes for shelter residents. Nutrition demonstrations in the food pantry.

After years of (academic) focusing on big, abstract social forces with zombie noun names like “post-industrialization” and “financialization,” I’ve been enjoying working in an environment that, against all my dissertation-trained cynicism, actually helps people. Actually breaks the cycle of poverty. Actually closes some of the achievement gap.

Please share Teva’s op ed! We wanna get some serious page hits.

Relatedly, the NY Times published an op ed about new research showing that for the first time in decades/ever, upper income levels are outperforming middle income levels at college. Researchers believe that this change is due to new intensive (time and $$$) investments in early childhood education.

Yup. Early childhood education matters. It does, in fact, influence children’s life chances. Their ability to stay afloat in a hostile globalized economy 20-30-40 years later.

That means, among other things, you can stop blaming and punishing teachers for the effects of poverty.

Hah! Just kidding. I know you love to blame teachers. With their “tenure” and “summers off” and used Hyundais.

Da noive.

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Seneca Falls, Selma, and Stonewall

I can’t think of a time that a president has so directly, forcefully, thoughtfully, and eloquently argued that we must pay attention to those whose voices are weakest if we want our country to fulfill its promise.

Happy.

Continue reading

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