The Tragedy of American Social Policy

I know I have neglected this blog for the past couple of weeks… traveling to a conference, teaching, grading, etc. have all kept me more than busy and unable to string together more than a few coherent sentences. Frankly, I don’t know how the truly active bloggers do it! But as part of this recent pattern of neglect, I discovered that I forgot to hit “publish” for this posting two weeks ago. Ordinarily, I might just let it lie — but if you missed the NYT editorial by Andrea Campbell, I am glad to be calling your attention to her story…

Whether it’s in Africa or the United States, one of the biggest questions for any society concerns how to address the risks of an individual falling terribly ill or being severely injured in an accident. At the most fundamental level, a decent society ought to do what it can to make sure that someone who is dealt a particularly unlucky set of circumstances will be afforded the resources to recover in some reasonable way. This is particularly true in societies that clear possess the resources to provide such social protections.

In yesterday’s New York Times, MIT professor Andrea Campbell, who was a colleague of mine at Yale a decade ago, when we were both Robert Wood Johnson Health Policy scholars, penned a touching and devastating op-ed about her sister-in-law, recently paralyzed and made a quadriplegic from a traffic accident. Campbell explains that her sister purchased short-term medical coverage for her unborn baby, which will expire soon (the baby was born safely through c-section.) And when that policy does expire, the horrors of our health/social policy system will become evident:

…my sister-in-law will be covered by Medi-Cal, California’s version of Medicaid, because she is disabled and has limited income. But because my brother works, they are subject to cost-sharing: they pay the first $1,100 of her health costs each month. Paying $1,100 leaves them with a monthly income of just 133 percent of the federal poverty level. If my brother makes more money, their share of the cost increases.

They must also meet the Medi-Cal asset test: beyond their house and one vehicle, they can hold $3,150 in total assets, a limit last adjusted in 1989. They cannot save for retirement (retirement plans are not exempt from the asset test in California, as they are in some states). They cannot save for college (California is not among the states that have exempted 529 college savings plans from their asset tests). They cannot establish an emergency fund. Family members like me cannot give them financial help, at least not officially. If either of them receives an inheritance, it will go to Medi-Cal. Medi-Cal services that my sister-in-law uses after age 55 will be added to a tab that she will rack up over the rest of her life. When she and my brother die, the state will put a lien on their estate; their child may inherit nothing. Even my brother’s hobby runs afoul of the asset test: he enjoys working on old cars, which he can no longer keep.

I spend most of my time on this blog writing about what goes wrong and right in Africa. Given the wealth and capacity of the United States — the state and our society — this is one sorry state of affairs.

As Campbell concludes, writing in the context of the current court battles over “Obamacare,” such personal tragedies are exactly why we need better social policy.