Pride, Privacy, and Assistance

Pride, Privacy, & Assistance

“Margaret said she had known a lot of shelters – crossed the country twice, staying in shelters along the way – and The Refuge was one of the best, mainly because they didn’t pry and didn’t attach conditions to their help. She wanted to keep her private life private, and at The Refuge she could do this,” writes Elliot Liebow about one of the women he profiled for his book on homeless women, Tell Them Who I Am. Being poor and asking for assistance is hard. It is not easy to admit just how needy one is, what mistakes one may have made along the way, and what personal shortcomings one is still struggling to overcome. However in the United States, getting aid often requires going through a series of questions and divulging such personal information to strangers, agencies, and charities before someone is willing to provide assistance.
In the past I have written about our preference for private charity over government provided aid. I suspect that part of the reason we favor private charity is because we can attach more conditions to the aid and ask more questions of those receiving the aid. It would not be fair for the government to place certain restrictions on how aid can be utilized, to require certain actions of those requiring aid, or to ask certain questions of the petitioners. However, many private charities or religious organizations can limit aid for seemingly trivial reasons. For example, first amendment protections mean that the government could not deny someone aid for wearing an offensive t-shirt, but a religious organization could certainly deny someone aid or assistance if they refused to change out of an offensive shirt.
What I think is important to realize from Liebow’s quote is that there is an additional issue beyond charitable strings and limitations that goes with the questioning and lack of agency that people experience when asking for aid. The questions people face are often repetitive, sometimes don’t seem relevant, and can be prying. People lose their sense of privacy and individuality, something most of us prize and assume to be ours by default, similar to how we think of constitutional rights (in some senses privacy is a constitutional right). Liebow continues, “To the petitioner, it is as if the wall of questions that stands between her and life’s necessities is a hurdle to be scaled only by those willing to leave their pride and privacy behind them.”
Many of us have made mistakes that make us cringe when we look back on them. Hopefully most of us have appropriately processed what went wrong and learned from our mistakes, but nevertheless, we don’t normally like to think back on our worst moments. We certainly don’t like to have people bring those moments up over and over and ask us to keep reliving them or remembering them. Even if we have accepted our mistakes and learned important lessons, we want to leave those mistakes in the past and move forward. The continual questioning and lack of privacy for those in needs means they can never move forward from their mistakes. They become defined by their errors, poor judgement, past laziness, previous drug use, and any other potential cause of their poverty and homelessness. They can’t move forward because they need help and can’t receive help unless they are willing to give up any privacy and pride and live within their worst histories. The questioning and limitations we place on aid seem harmless and sensible to the donor, but to those who need aid for daily survival, it can be humiliating and make everything feel much more difficult for them. “It is difficult to appreciate the intensity of feeling, the bone-deep resentment that many of the women felt at always having to answer questions,” Liebow wrote.
The Limits, Strings, and Expectations of Charitable, Religious, and Familial Aid to the Needy

The Limits, Strings, and Expectations of Charitable, Religious, and Familial Aid to the Needy

I’ve written in the past about aid provided by charitable organizations in the United States. Aid provided by families comes with many of the same pitfalls as aid provided by charitable organizations. Our country is generally not comfortable with aid provided by a faceless government to everyone who qualifies. Many people in the country prefer that aid be provided by charities and/or religious organizations instead. Implicitly, what people seem to prefer is aid provided in a manner where certain restrictions and strings can be attached.
My two main criticisms of aid provided through religious organizations is that donors are engaging in a divine quid pro quo, giving money in exchange for divine reward. The implicit idea is that charitable aid provided to those in need comes with the expectation that individuals receiving assistance will become more religious and/or more respectful toward those churchgoers who donate money. Those who provide aid through religious and secular organizations are also able to be more selective and excludable than aid provided by government. It is easier to deny people aid for lack of a job, for drug use, for perceived sexual deviance, and other factors when you are a small charity or a church organization with a limited amount of aid available to give.
In the book Evicted, Matthew Desmond shows that these same strings and limitations are also present in aid provided by families, another preferred method for aid and assistance that Americans favor over government aid. In telling the story of a young woman who was evicted while Desmond was researching the book, he writes, “Over the years, she had learned to ask her favorite aunt for help only during true emergencies, and evictions didn’t quality. If Arleen asked too often or for too much, she would hear about it. Merva might give her a lecture or, worse, stop returning her calls.”
Our country shames those who receive aid, and all the strings, expectations, and personal responsibility lectures that accompany familial, charitable, and religious aid contribute to that shame. This is not a bug in the system, it is a feature. American’s don’t want a well functioning and efficient government program to deliver aid to any struggling American who needs it. They want a system that shames the poor, wastes their time, and limits aid if they are criminals, drug users, or sexually promiscuous.
The story of Arleen is important. Her landlord assumed she had family to stay with or to hold her over if she was evicted. We assume people can always fall back on family until they get their lives on track. We assume that family will do the tough work of instilling personal responsibility in another, or absorb the societal costs of a dejected family member on behalf of the rest of us. We set up limitations and strings on aid from other sources and make government aid hard to access so that people cannot receive aid unless they are personally responsible. When they are not, we expect their family to take up the responsibility that the needy person lacks. This is a system that deprioritizes aid to those in need in favor of principles and rule following.
A Limitation on Nudges

A Limitation on Nudges

“Rare, difficult choices are good candidates for nudges,” write Cass Sunstein and Richard Thaler. Throughout their book Nudge, Sunstein and Thaler try to encourage limitations on nudges. They acknowledge that anytime people are in a position to influence decision-making by determining how choices are designed and structured, they will be providing people with nudges, regardless as to whether their nudges are deliberate or inadvertent. However, the authors don’t encourage people to step beyond nudges and truly limit people’s choices or prevent them from making decisions, even if those decisions are ones the individual would deem bad for themselves.

 

Nudges are helpful in rare and difficult choices because we are likely to make mistakes in those areas. We don’t make large investment decisions on a regular basis, we only enroll in healthcare plans once a year (and usually we just let ourselves roll into the same plan as last year), and we hopefully never have to make major life altering medical decisions. When we don’t get immediate feedback on a decision, when we don’t have an opportunity to practice and improve decision making in certain contexts, then we are likely to make mistakes. We won’t use appropriate discount rates, we will be influenced by irrelevant factors, and we will not consider all of the necessary information when making our selection. Nudges can help overcome all of these factors.

 

But we don’t necessarily need direct nudges in every decision situation, and we don’t need people to go beyond nudges and actually limit choices in most of our decisions. Buffets can nudge us by placing salad at the front of the line, so that we load our empty plate with more salad and have less room to pile on the tri-tip at the end of the line. This can be a useful strategy for buffets to save money by encouraging people to eat cheap fillers and could be a useful strategy for school cafeterias to encourage more healthy eating. But placing tri-tip under a cover that requires that we press a lever with one hand and open the lid with a second hand is beyond a reasonable nudge. Sunstein and Thaler believe that nudges should be easy to avoid or bypass for those determined to make their own choices, even if it isn’t what is generally understood to be in their best interest. A limitation on nudges, in the authors view, is a good thing, and helps protect nudges for situations where they are truly helpful and meaningful.
Living Under Constraints

Living Under Constraints

In Letters From a Stoic, Seneca quotes Epicurus in writing, β€œIt is wrong to live under constraint; but no man is constrained to live under constraint.”

 

Quite frankly, Seneca and Epicurus are wrong. The stoic thinkers make two arguments in the short quote, and both fail to live up to the reality of humankind’s existence. The sentiment shared is noble, and certainly rings true in my American ears, but on closer reflection, proves to be a fiction.

 

The first argument, that it is wrong to live under constraint assumes that human beings can somehow exist separate from society with all needs and desires fulfilled. Stoic thought focuses on our mind and what is within our direct control. Stoicism hinges on the idea that our thoughts and reactions are the only thing we can possibly have true ownership and control over. It encourages us to move beyond our ego, which drives us to acquire possessions, build a reputation, and always bolster our social status with things beyond our control. Stoic philosophy encourages self-awareness and a sense of self-contentedness that comes from controlling one’s mind and being satisfied by simply experiencing life, whatever life is presented to us.

 

However, having constraints in our lives is important, and might actually be better for us than unlimited choice and possibility. A famous study on jam selection and satisfaction from 2000 suggests that people who had a limited selection of jams were more satisfied with their selection than people who picked a jam from a more broad and expansive selection of jams. With unlimited choice, options, and opportunities, we are unhappy. We can’t make a selection when we are not living under constraints, and we are constantly unsure if we truly made the best choice when our choices are unlimited. Constraints play a powerful role in helping us understand who we are, where we fit in society, and by creating bounds for our decisions, actions, and lives. Without constraints, we do not always flourish, sometimes we flounder.

 

What we see is that our lives are guided by and defined by constraints. Therefore, the second argument of the two stoics, that no man is constrained to live under constraints, is clearly wrong. We might not be actively constrained by another human being, but we are constrained by our governments, our home owners associations, or our bosses or customers. We are also constrained by nature and our physiology. There is a limit to how fast we can run, what forces our bodies can endure, and much we can eat. Our brains are incredible machines, but they too are limited in how long they can operate without sleep, how difficult of tasks they can work through, and how much they can remember. There is simply no way to escape constraints, and living in a complete freedom, as Seneca seems to be suggesting with the rest of his letter after the quote above, will not lead to unbridled happiness. It is constraint, and how we learn to live within constraints, which brings forth our creativity, our imagination, and makes life actually possible.
The Specter of Rationing Care

The Specter of Rationing Care

American’s fear having to wait for anything. We want to order things from the comfort of our own home and have them delivered in two days. We don’t want to wait behind more than three people in line at the grocery store, and we don’t want to wait for medical care (to be honest these are all examples from my own life – not picking on anyone who isn’t like me here). Our fear of waiting is used as a reason against universal health coverage. We are told about Canadians who cross to the United States to have surgeries that they would have to wait several months to have in Canada. We are told that we won’t be able to schedule an immediate primary care appointment if more people were to have access to health care. And we are told that the high costs of medical care stop unnecessary care from happening, preventing us from having to wait to see a doctor.

 

However, these fears of waiting and the specter of rationing care presented to us in these scenarios is overblown. It is true that some Canadians chose to get care in the United States for elective procedures, but presenting that fact to us in isolation is misleading and done in bad faith. The reality of our waiting for care is much more complex. Dave Chase does a good job of explaining it in his book The Opioid Crisis Wake-Up Call, “People often raise the specter of rationing care. In reality, it’s overuse (i.e., unnecessary and potentially harmful care) that leads to reduced access by squandering enormous financial resources that would be better used for individuals who actually need care and can’t get it.”

 

We act as though our healthcare system is following good market incentives to find a good balance between wait times and receiving the right care. But we often fail to acknowledge that our healthcare system isn’t performing like an ideal market, and that it often pushes people to too much of the wrong type of care. Chase details this in his book with unnecessary back surgeries. Those who have a legitimate need for a back surgery might have to wait, because primary care providers get a bonus when they refer patients to orthopedic surgeons who are paid to operate. The right path for a patient might be physical therapy, but the money for the providers is in the surgery.

 

We should not raise the specter of rationing care when we are so wasteful with the care we provide through our current system. We waste a lot of money when we don’t have a concern about rationing care, and when we reward providers for doing more surgeries, prescribing more pills, and offering more treatment, even if the efficacy isn’t proven. In his book, Chase doesn’t advocate for a universal coverage system with healthcare covered by the federal government, but he does show how employers today can do more to ensure their patients get more of the good care (the effective PT and preventative check-ups) for free. This reduces the demand on the expensive and unproven treatments later on, and actually reduces the demand on the system for services that we are afraid of rationing.

To Wear a Sweater or Not?

There is a story that I hear from time to time in different contexts. Depending on the context, it is framed as either positive or negative, with different ideas about what our future holds and how we should behave. The story manages to hit political and social identities, aspirations and fears for the future, and concerns over self-sufficiency and parochialism. The story is about a president who encouraged us to wear sweaters during the winter.

 

I’ll start off with the negative view, one perspective of which Tyler Cowen expresses in his book The Complacent Class. He writes, “Jimmy Carter put on a sweater and urged Americans to turn down the thermostat, representing a new era of lowered aspirations. In other words, the American response to economic adversity was to seek to restore comfort more than dynamism, and Americans pushed their culture in this direction all the more in the 1980s.”

 

Cowen’s critique is that as a response to inflation and oil insecurity from foreign oil dependence, Carter suggested we accept limitations and lower expectations. Our president at the time did not encouraging Americans to find new ways to make the world the way they want it. I think this critique is fair. Instead of imagining that the world could be better, that we could be comfortably warm and energy independent through new technology, the story suggest we should just deal with some level of discomfort.

 

I’ve heard others reflect on this story in a similar way. They criticize Carter for a defeatist attitude and for thinking small. People don’t like the parochial feeling of having an elitist person tell them to be tougher and to put on another layer rather than be comfortable but use more resources. Its easy to understand why someone might have the mindset that they deserve to run the heat, even if it is wasteful, because they worked hard to be comfortable and they can afford it.

 

I also think there is value to having our top political leaders signal that we can be more and that we can use science, technology, innovations, and a sense of purpose to make the world a better place. Perhaps encouraging us to keep the thermostats where they were, but also encouraging us to, as the line from the movie The Martian says, “science the shit out of this” would have landed us in a better place than where we are now.

 

But on the other hand, perhaps Carter was right. I have heard people praise Carter for being honest and realistic with the American public. I have heard people criticize Reagan, Carter’s successor, as being an out of touch elitist wearing a suit 24/7. I think people today desire a president like Carter who would signal that they were more in touch with America by turning down the temperature in the White House, making a personal sacrifice themselves before asking others to do the same.

 

Carter’s statement that we need to conserve resources and think critically suggest that we should not just use resources in a wanton fashion. This is a sentiment that climate activists today are trying to mainstream, and perhaps if we had listened more carefully to Carter, we could have shifted our technology to be more green, less resource demanding, and less polluting. After all, who are we to decide that the world should perfectly suit us for every moment of our existence? Isn’t a little discomfort OK, and isn’t it a good thing for us to recognize that the world doesn’t revolve around us? Is it better if we turn the thermostat down, put on a sweater, and pull out a board game to play with friends and family rather than crank up the heat and stare at our screens?

 

My takeaway from this story almost has nothing to do with the story itself. Whether we decide Carter was right probably has more to do with who we want to be, who we want the world to see us as, and what is in our self-interest than it does with whether we truly believe his attitude reflected and encouraged complacency. My takeaway is that events happen in this world, and we attach stories and meanings to the events that can be understood in different ways depending on our background and context. The narrative we create and attach to an event matters, and it shapes what we see, what we believe, and in some ways how we feel about the things that happen in the world. Think deeply about your goals, what you want to achieve, and how a narrative can help you reach those goals, and you will find the ways to tie that narrative into an event. At the same time, watch for how others do the same thing, and when you have discussions with others and want to change their mind, be cognizant of the narratives at play before you go about throwing statistics and facts at someone. Maybe a new narrative will be more effective than a bunch of economics and math.