Too much and too little: part II

Part I of this two-part set gives some background, but here’s a quick summary:

I got a job this fall, and because of my new income from the job, I was deemed ineligible for the subsidized health insurance I’ve had for several years. I made too much to qualify. So I applied for private insurance, but because the health insurance marketplace calculates income caps in a different way, I actually made too little to receive subsidized insurance there. So that’s the first great irony: as long as I had a job, I simultaneously made too much and too little to receive any assistance paying for health insurance. Without that assistance, my routine mental healthcare could add up to about half my monthly paycheck. But, and here’s the second wonderful irony, if I stopped working, I would be eligible again for my original insurance. So I had an incentive to actually leave my job. The timing of various eligibility decisions meant I had about four days over Christmas and New Year’s to find new insurance. Ultimately, this whole situation left me standing in awe at the functioning of a dysfunctional system, though what I had to deal with was tiny compared to the impossible scenarios many others face in our Kafka-esque American healthcare system.

Here in part II of the story, I want to discuss something deeper, one of the philosophical and psychological assumptions upon which our fair system operates.

No human system, be it a system of governance, of ethics, of justice, or of apportioning aid, will operate perfectly in all scenarios. Some cases will always emerge in which these systems fail to deliver what they should based on what they attempt to do. Sometimes, for instance, someone who should not reasonably receive public aid will get it, or someone who should get it won’t. These situations represent what I’ll call false positives (something is received that, based on all principles of justice, should not be) and false negatives (something that is deserved is not received). My recent incident with health insurance illustrates the potential for false negatives to lead to absurd situations, in my case, a situation where I would be able to receive health insurance for this month if and only if I quit my job. However, I think the situation also illustrates something deeper about how we view systems of aid and those who use them.

I’ll assume that these systems, which together constitute the notoriously-porous social safety net in the US, should operate on compassion: they provide some basic level of services for people who may not be able to otherwise afford healthcare, food, etc. Granted, it’s a minimal level of compassion, but sadly even it seems more than we can sustain.

From what I can see, much of the present thinking about systems of aid appears to operate not from a position of compassion but from one of either fear or—if you’re more cynical—spite. Anecdotal to outright hypothetical examples of false positives are used to justify tighter restrictions on who can receive aid. The so-called “welfare queen,” who lives comfortably if not even richly off aid she doesn’t deserve or hasn’t earned is an anti-capitalistic demon. This nefarious creature lives at the expense of others, doesn’t bother working for pay because she’s lazy—or greedy, or embodies some other vice (as with most folk monsters, exact descriptions of her vary). But what all invocations of this deplorable beast have in common is the goal of inciting righteous indignation. “How dare people do that!” we are supposed to say. “I work so hard for what I have, and she doesn’t work at all!” The situation is unfair. And I agree completely—it is unfair. A false positive is always unfair. However, we seem to be so swayed by images like this, the Demons of the False Positive, that we let our human indignation override our human compassion.

I’d argue that any real system we as real people can implement will tend to err either in favor of false positives or false negatives. It will tend either to be too lenient (compassionate) or too strict (exclusionary). We have decided without saying it outright that we would prefer a system that is too strict than too lenient. In essence, we have said that false negatives are almost universally preferable to false positives. We would rather have someone else suffer concrete hardship than live with our own sense of indignation. A system that tends to err on the side of false positives would undoubtedly be open to exploitation. Welfare abuse might be more common. More people may very well be able to get benefits they don’t deserve. More people could cheat [1]. But, and here’s where I get to my real point, who cares? These people may be siphoning from a system designed for others, but we could always fund that system better with the expectation that some of that money will not go to those it’s intended for. After all, we have a fine history of giving away tremendous amounts of money that ultimately vanish before reaching their intended beneficiaries [2]. Why not err on the side of alleviating preventable suffering? Why not fear the false negative more than the false positive? Because, we have tacitly admitted, we place our own injured sensibilities over another person’s need to eat or escape an abusive situation or live somewhere more tenable and dignified than the sidewalk under a highway overpass [3].

I’ve repeatedly said “we” here because the problem ultimately is a collective one: we, as a combined human organism, have reached these conclusions in which we value our own sensibilities over others’ lives and dignity. But these draconian priorities are ultimately promulgated and advanced by a subset of humanity. They tend to be those who have plenty already if not far too much. They have never been in danger of going hungry. And they believe, often incorrectly, that they have gotten to where they are through their own virtue: they are simply more driven, more gifted, more diligent, more willing to actually work than those who want aid. But I’d argue that’s their first error: few people actually want to live off aid. Few people set out to be a burden on the system. I’ve met someone who, as a child, dreamed of growing up to be a firetruck. I met another who confessed he wanted nothing more when he was young than to grow up to be Jamaican. But I’ve yet to meet anyone who grew up aspiring to be a burden on the system. Some may exist (I don’t make a habit of interviewing children), and some may develop such an urge later in life, but again, who really cares if a small number of people receive aid for themselves when they shouldn’t? I’d also argue that most of the people who live in fear of the Demon of the False Positive have not actually reached their positions through their own effort. Most did, admittedly, make one excellent choice: they chose to be born to wealthy parents. So really, I shouldn’t condemn them unduly because they showed astounding prescience in selecting the circumstances of their birth. Through the myth of self-sufficiency, however, their capacity for indignation and ultimately spite has grown: if they struggled but overcame to become obscenely rich, surely everyone who doesn’t earn enough to eat is simply not trying hard enough. The myth of the meritocracy becomes particularly alluring to those who have succeeded economically. The myth lets them congratulate themselves.

My partner teaches middle schoolers, students who are usually 11 or 12. She came home yesterday with two postcards she was going to mail to a student. I could tell by the bright, often illegible signatures on the cards that her class had written them, but beyond that I couldn’t work out why she had them. I asked her. She told me that one of her students (a 12-year-old, remember) was going to be absent from school for a while.

“Is he sick?” I said.

“No. He’s staying home to take care of his sibling because one of his parents is sick, and they can’t pay for childcare.”

I looked again at the well wishes and signatures of children, written in joyful colors that brought to mind a carnival or a field of wildflowers blooming in Spring. My personal struggles with my health insurance shrunk to their rightful proportions.

We have grown so afraid of false positives—or so righteous in our spiteful indignation—that we would rather restrict the conditions for aid programs until they generate false negatives than suffer the possibility of someone receiving what they don’t deserve. Put more bluntly, we would rather condemn someone else to unnecessary deprivation than suffer the vague suspicion that someone somewhere might be cheating. The result? We’d rather send 12-year-olds home from school to care for a sibling than pay for childcare through public revenue. We’d far rather cheat others than wonder if we’ve been cheated.

I doubt I’m ultimately saying much new here. I am, after all, only a dilettante philosopher, and I do not have the expertise to recommend concrete policy changes that might rectify our dysfunctional system. However, I must believe we can do better, for ourselves and our children. Otherwise, how can we possibly be worthy of our own regard?

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[1] In its own twist of irony though cheating has recently, and in select scenarios, become a mark of pride. Somehow, through a mind-bending argument, tax evasion has become a sign not of an abrogation of civil responsibility but of outright patriotism. Cheating the country out of tax revenue is actually a sign you love your country because nothing could be more American than shrewd exploitation for personal gain—in this case, exploitation of loopholes in the tax code (a tax code you may well have helped write). If that’s the case, I have to wonder: why don’t we actually applaud those who steal from the welfare system just as we applaud those who steal far more from the country at large?

[2] Many of these examples actually come from healthcare fraud, though not the kind the Demons of the False Positive are able to enact. These instances of abuse of the system are instead coordinated efforts on an awe-inspiring scale. They are not the types of abuse that allow someone to “earn” a living by doing nothing more than receiving personal aid they don’t deserve; they are the sort used to buy gold bars, $6-million-dollar properties, and one-way trips to London to try to evade authorities. As well, apparently, as books such as the non-incriminating “How To Disappear: Erase Your Digital Footprint, Leave False Trails, and Vanish Without a Trace.”

[3] The Government Accountability Office runs an excellent blog that provides thoughtful discussions and recommendations on topics such as homelessness, social services, and inequality in the US.