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Carrot vs Stick: The Social Safety Net, the Earned Income Tax Credit, and Work Requirements

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In the next year and a half, we here at Healthcare Triage are going to take some deep dives into issues of health policy, especially those that touch on social determinants of health and health equity. The episodes that do so will be a bit longer than usual. They’ll look a little different. They also come to you thanks to the support of the RWJF, which has generously supported their creation. We’re excited about this opportunity to really dig in, and we hope you will be, too.
For the next three weeks,we’re going to talk about work requirements. First, we’ll talk about the basics and other government work promotion efforts, then we’ll discuss what we’ve learned from TANF, and finally we’ll discuss what this might mean for Medicaid.
Work requirements are the topic of the next three episodes of HCT.
Resources used in the making of this episode:
Income and Poverty in the United States - 2015: goo.gl/rvQtuk
How does the EITC affect poor families?: goo.gl/ECYnkr
Effective Policy For Reducing Inequality? The Earned Income Tax Credit and the Distribution of Income: goo.gl/8XFGyT
The Supplemental Poverty Measure - 2015: goo.gl/KaGBZi
Policy Basics: The Earned Income Tax Credit: goo.gl/ynKSYy
Earned Income Tax Credits: goo.gl/163d4k
Linking EITC Income to Real Health Outcomes: goo.gl/A26YLy
Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment: goo.gl/F4VPVu
Credits:
Aaron Carroll -- Writer
Meredith Danko - Social Media
John Green -- Executive Producer
Stan Muller -- Director, Producer
Mark Olsen - Graphics
/ aaronecarroll
/ crashcoursestan
/ johngreen
/ olsenvideo

Опубликовано:

28 окт 2018

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Комментарии : 72

@gg3675 5 лет назад

Certain costs should really be taken into consideration. I’m working class and when my state started work requirements for people getting food stamps, the thing that held people back from getting benefits was working out the schedule to get to the random parts of town between working their shitty seasonal or food service jobs that people tend to filter in and out of. The answer? Many people I know just started stealing most of their groceries. That means the “externality” was borne on the backs of grocery stores and overburdened the justice system when the simple answer actually helps those sectors and creates jobs in grocery stores because of increased spending. I know that’s just my experience but I’d be willing to bet that reducing benefits is correlated with increased crime, all other things equal

@zhubajie6940 5 лет назад

Why don't we require that companies are required to pay enough in a given month (both hours, benefits, and pay rate) to make it instead of subsidizing Walmart with these tax credit programs?

@thatjillgirl 5 лет назад

People always claim that if the safety net is too good, people will just stop working. But countries that have universal healthcare coverage.......still have people working. Most people working, in fact. It's almost like most people actually do like having an income that affords them a better lifestyle and more spending money.

@gg3675 5 лет назад

thatjillgirl unemployment in Sacandinavia: Norway - 3.9%, Iceland - 2.8%, Denmark - 5%, Sweden - 6.2%, Finland - 7.6%. Looking just at those numbers, you’d basically conclude that the social safety nets in Scandinavian countries have basically no effect on employment. They’re all within completely normal ranges for European countries, with Iceland and Norway at “full employment.”

@shatteredreality11 5 лет назад

G G no, you'd conclude social safety nets increase a person's reservation wage. If you had to work or starve to death, you'll probably work, even for little money, if you had SSN, your leisure - employment tradeoff changes. Therefore lowering employment relative to if the country didn't have SSN. Unemployment is defined by those seeking work over those employed, if you stop seeking work you're no longer included unemployment statistic. If you choose to live on SSN alone, you're not included in unemployment %

@TimothyNelson 5 лет назад

@@shatteredreality11 If you stop seeking work, you also fall out of the labor force. If the SSN in these countries was causing people to stop working and to stop seeking employment, then their labor force participation rates would be lower, right? But they aren't; in fact, in every Nordic country except Finland the LFPR is higher than in the US: data.worldbank.org/indicator/SL.TLF.CACT.ZS?view=map&year=2017

@shatteredreality11 5 лет назад

Timothy Nelson LFPR is too messy to use, for one, apprenticeships are vastly more utilised in western Europe than USA, so young people are more likely working in apprenticeship than studying full time (as in the US). better just to compare how many people are receiving unemployment benefit in the USA vs in each if these countries. There's a reason LFPR is not used much as a statistics outside the Internet

@km1dash6 5 лет назад

There's also a big policy problem: the threshold for what counts as "poor" varies state-by-state and program-by-program. You can make poverty level wages, yet make too much money to be covered by Medicaid in some states. So adding work requirements is a way to kick people off of Medicaid in those circumstances.

@kgal1298 5 лет назад

That's definitely the issue here and you can't really set a standard nation wide because of the wage disparity state to state or city to city. That's why some states are laying the foundation to do their own type of health care, but it becomes more complicated when you have nation wide insurers to deal with. I think this is part of the reason some want medicaid for all, but that wouldn't be beneficial to the pharmaceutical or for profit hospitals that currently have negotiation powers with insurance companies. I'd have to assume if socialized health care were a thing it would definitely hurt their bottom line more so than hurt the tax payers. Of course for tax payers the younger you are the higher the tax burden will seem since if you are in relatively good health you won't want expensive health care and that was one of the arguments with Obamacare and of course one the reasons the GOP didn't manage to come up with a suitable replacement.

@lightbox617 5 лет назад

We really need to re define the numbers for poverty. If I worked 40 hours week at $15 an hour, I would not be able to afford my rent, health care/insurance and food. Forget about owning a car which I would need to get to work. Only in this country. We are industrialized, sophisticated and behind the rest of the industrialized world in literacy, infant mortality, longevity, literacy and civic engagement. I am very privileged to be able to spend 2 or 3 months a year in other countries. My step mother was Canadian. It is increasingly difficult for me to watch local news on TV and hear local Politicians spread the ignorance that suits there re election bids. Thanks, Dr. Carrol, for giving us some numbers based,, accurate assessments of the U.S Health Care System

@TacComControl 5 лет назад

This. So many of these things are shown as a "Look, we lifted people out of poverty", but in reality, what happened is that More people ended up in poverty due to factors such as a ridiculous rise in the cost of rent, while poorly managed programs claimed their "work requirement" pushed people out of the old numbers, old numbers which are still beyond ridiculous. More to the point, many people who might be affected by this are disabled in some way. So yeah. Fuck the war on the poor.

@gg3675 5 лет назад

Joseph Harrietha I think there needs to be some nuance to your approach. Different people live in different areas. $15 and hour would be fine in most of the country, but in New York and San Francisco it’d be enough to get by in the way you laid out if you don’t have kids. The idea that it’s just that simple to move or take public transport assumes that those things are options. What if you owned your house after the market crashed? If you moved you’d be taking on debt. What if you have kids and would have to change schools, find a new day care, etc? In much of the country public transport is a total mess (I’ve commuted 2+ hours to jobs a 20 minute drive away).

@Eris-_ 5 лет назад

@@gg3675 $15 is enough to survive on...but not _thrive_ on. No savings, so much smaller chance of seeking additional education, etc. You're stuck at that, there is NO upward mobility, and you're too exhausted from doing all your own house work to try to get elsewhere. There's no chance of the American dream at 15 an hour.

@kadenjacobson9764 5 лет назад

@@josephh6697 You do understand the absurdity about telling poor people to sell all their things to move into an even poorer area, don't you? Poor people don't have the money to put down on a new place, or have things to sell that could fetch such a price, and already utilize public transportation. A lot of people are stuck in the cities they are born in. Not to mention issues such as having insurance and assuring you don't go even more broke just from health complications or an accident. Isn't it more reasonable to demand a genuine and comfortable living wage for your labor rather than suggesting that someone sells all their stuff and move into an empty apartment in the middle of the boondocks for no discernable reason other than you did it?

@IkomaTanomori 5 лет назад

How about the other school of economists, who disagree that social safety net programs disincentivize work? Because there's more evidence for their position than for the one you actually mentioned.

@armorsmith43 5 лет назад

Can you do an episode on Nurse staffing levels and Massachusetts ballot proposition 3 (in 2018)?

@eugenetswong 5 лет назад

And on nurse scheduling techniques.

@Eris-_ 5 лет назад

Here is how nurses get better schedules: refuse all overtime so they're forced to hire more nurses.

@devinmurray4984 5 лет назад

Are you planning on looking at the recent data in support of universal basic income? Seeing how that compares to social safety nets work requirements and EITC would be informative. Rather than relying on people eventually no longer needing access to these services you just pay everyone an actual living wage. Implementation is an important aspect of course, but there are a handful of programs that have been very successful doing this.

@JBNCATS 5 лет назад

Hey man thanks for this video.

@kujmous 5 лет назад

Excited for more. Excellent episode.

@red-ocracy546 5 лет назад

I'm so excited about the next three episodes! This is going to he awesome!

@davidhamilton5471 5 лет назад

I would be very interested to hear your opinion on a Universal Basic Income (UBI).

@macwall3626 5 лет назад

Nice introductory video on the subject. However I think healthcare coverage should never be tied to work. We should strive for single-payer healthcare rather than further engraining the work and healthcare coverage relationship. Healthcare should be a right and not a stick/carrot.

@macwall3626 5 лет назад

Also on a more sciency note: do we have external validity via transportability on the effect of work on health in countries with single-payer systems? In other words... Of the people in countries where healthcare is a right, do we see the same effect of work on health as we do in the US?

@nicholasparliament7197 5 лет назад

I agree, however, note that Dr. Carroll is discussing access poverty alleviation programs, not specifically healthcare. Albeit they are inextricably linked. I am no expert, but I could imagine a pretty just society with universal healthcare that employs work incentives (at least EITC type schemes) for other poverty alleviation programs. I think the case for universal healthcare is extremely strong, but I like to see this channel branching out into broader policy discussions in an objective, data-driven way.

@Revlemmon 5 лет назад

I work full time however I can not afford to pay for insurance. I would be happy to get off of medicaid, unfortunately unless my income nearly doubles I'm stuck with it. Employer insurance costs way too much for a family of six plus the insane deductibles.

@kcallamajaji 5 лет назад

Great information on the EITC. I didn't know a that it benefited that many people. That's wonderful.

@IronicCliche 5 лет назад

My big problem is that I need insurance due to health and medicaid/care create a lot of issues thanks to common beaurocratic errors.

@radamh 5 лет назад

While a good intro to the topic I got a hint that States aren't filling in most of the gaps here. My state of Nebraska provides subsidies for child care, housing, and training. Due to the high variability of cost across the US I am for local control and decision making when it comes to welfare.

@lukebrennan88 5 лет назад

@healthcare triage are those figures at the beginning of the video about workers in poverty including the earned income tax credit in the calculation of poverty, or is that basically poverty for people working without considering additional benefits?

@cm374787 5 лет назад

I'm on a program exactly like this in Australia, it works to keep the dole bludgers from abusing the system, but it's a pain in the butt for those of us who do the right thing and are trying to get work.

@chrismarshva 5 лет назад

Question. West Virginia. If you (me) are vastly overeducated and overexperienced (while in DC area), are they ignored? P.S. 1. Asperger syndrome nullifies your gifts 2. A certain warehouse that shall remain nameless was a negative experience. Colleagues say it is mean.

@chrismarshva 5 лет назад

No fucking drugs, no fucking alcohol, no fucking criminal history, no fucking credit problems. Excellent driver.

@jabberwockydraco4913 5 лет назад

why is it saying "This video requires payment to watch"?

@jabberwockydraco4913 5 лет назад

I reloaded it and now it's saying "We are experiencing problems with our servers. please try again later" How the fuck does google have server trouble.

@joshuagrahm3607 5 лет назад

Jabberwocky Draco google plus is being taken out of RU-vid, but it’s so integrated in unknown ways by third parties that it’s constantly breaking

@NotHPotter 5 лет назад

They supply the world's knowledge a click away. How do they not have server issues more often?

@TheCowgirlgem 5 лет назад

Why so US focused? Other countries also have work requirements for government aid. (And other countries also have viewers.)

@mekat861 5 лет назад

I hate the idea of work requirements. People will be kicked off Medicaid even if they met the requirements because of the hoops they have to jump through. When you are poor, sick and/or disabled those hoops are much harder to deal with especially if you have limited access to a phone, transportation and a computer. I understand putting work requirements in place for financial programs that pay money out but putting them in place for basic lifesaving healthcare is bad policy and endangers lives. Those that say this won't impact the disabled are being naïve at best and disingenuous at worst.

@marlonmoncrieffe0728 5 лет назад

Yeah, I get the good intentions and I know that disability abuse exists but in the long run, work requirements for medicine is wrong, both morally and pragmatically.

@Nerdcoresteve1 5 лет назад

"Most economists agree that if we make safety net benefits too robust it disincentivises work." Yeah, but most economists take it on faith that you can model economies by assuming all participants are perfectly rationally self-interested, prices are created magically out of thin air, among other ridiculous notions. Do they have any evidence for this claim? I'll admit I'm biased. I want a comfortable UBI (meaning what we used to consider a middle class income but is now upper class) for everyone. And I believe that such a policy would reduce employment to a point. People who need to take care of children or loved ones would probably not get jobs because they shouldn't be working in the first place. Likewise people with disabilities who now struggle to get their disabilities recognized would get relief. Students would be able to focus on their education (which I think should also be free) and more people would stop working to get more education. Why should we care about that? The truth is more people are working because they have too than should, because they have good reasons why they shouldn't be working. Work is not our ultimate goal. Life is. Saving lives, improving lives, helping us all become our best selves. That should be our goal. The truth is we have an excess of productive capacity needed to serve that goal, but instead it's serving greed.

@bosniankumquat1835 2 года назад

"Yeah, but most economists take it on faith that you can model economies by assuming all participants are perfectly rationally self-interested, prices are created magically out of thin air, among other ridiculous notions. Do they have any evidence for this claim? " That's bullshit and shows how little you know about economics. Most economist with exception of some neo classical economist reject the perfect rational actor belief . Most of them believe while were are usually rational things like culture , upbringing , biology and other factors stop us from becoming perfect rational actors. Also a portion of studies done by economist are backed up by empirical evidence.

@aerendyll 5 лет назад

But what about the people who literally can't work due to disability, then? I can't help but suspect those people are left out in the cold.

@xfortunesquex 5 лет назад

Thank you for mentioning this. I am young and disabled, and what you're saying is true. Even if politicians swear up and down that people who need it won't go without, it's not true. I know countless people aged 20-35 who are disabled through no fault of their own, and they're struggling just to get their medication.

@SangoProductions213 5 лет назад

You can look this up on Google. Although you might want to keep looking past the first article that enforces your already held beliefs, as Google really likes to keep people in their bubbles.

@SangoProductions213 5 лет назад

@jfsfrnd I really should stop being a lazy bastard and get back on to my financial education series so I can talk about Universal Basic Income in depth. Basically: It's not the godsend that people make it out to be, but it can be a relatively simple means of a social safety net, with *relatively* small administrative costs...which might actually be semi-detrimental to helping the poor. After all, just look up the results of when people win the "Poor man's tax", and get given a bunch of money without earning it. Several have even committed suicide over it. With the conventional social safety nets, people have to spend the "aid" in specific places, like health care and food. This can actually be useful to those who don't know how to manage money, which tends to be the case when you are poor. Not always. Just tends to be.

@radamh 5 лет назад

They receive disability benefits. That is a completely different topic.

@niknok8550 5 лет назад

A friend of mine has seizures. Doesn't qualify for disability. He doesn't tell places he has seizures cause he's been fired for it.

@Psillytripper 5 лет назад

it erks me that discriminatory measures are still used in many states against working citizens who have substance abuse problems but alcohol or a prescription is ignored. can you imagine how many hard working cannabis users are excluded in many states from benefits due to state mandates for drug testing to qualify. many people will laugh at the idea, but don't kid yourself into thinking cannabis makes people worthless workers. its just an excuse to discriminate against someone you can easily identify and pick on . and a drug free america workplace policy doesnt really make sense with the available science. its just another form of suppression at this point

@pet3590 5 лет назад

Intro is really quiet

@isidoreaerys8745 2 года назад

The fact that the difference between a $48 dollar Earned income Tax credit and a $3000 dollar one is how many government dependent poor children are being brought into the world is both discriminatory, and incentivizes reckless breeding and the destruction of the climate.

@Marco_Onyxheart 5 лет назад

Social security programs in the US? Hahahaha. What, you're serious?

@aarcaneorg 5 лет назад

You say "TANF" strangely. It's monosyllabic. Tahnff, not Tannif

@wreckervilla 5 лет назад

robots and ubi

@krellend20 5 лет назад

The goal of work requirements is not to alleviate poverty. It's to save the government money so they can lower taxes. Politicians don't actually care to lift people out of poverty, they just want to credibly claim they do because to do otherwise is bad for their election prospects.

@eugenetswong 5 лет назад

Thanks for not making this political.

@4G12 5 лет назад

Those stats aren't very believable to me. Wise man said that there are lies, damned lies and statistics. For instance, in Australia, 1 hour of paid work is already enough to count someone as employed. The only real solution is to end the rein of the church of money, but if the economy is actually rational and economical , people would be too happy, healthy, and productive, which is bad for business. After all, someone who is already happy and healthy will not need to and has no incentive to spend more on stuff one in pain is forced to spend on, such as health... ahem... sick and dying care.

@SangoProductions213 5 лет назад

So, if your statement is to be at all relevant, then even 1 hour of paid work is enough to, on average, pull ...what did they say... 90% of people out of poverty. Damn. You make one hell of an argument, 4G12. I'd love to see you back up your claims at all. But I can't expect that.

@kgal1298 5 лет назад

Health care is a billion dollar industry and much like funeral homes will never run out of business. That's the problem it makes money and that's the one thing capitalism requires. . And I don't know much about Australia, but in the US to be considered in poverty in many areas you have to make less than 20K as a single person I think it's 40K when you are married with a kid. It's not that bad it's more so our tax system and the elite trying to pay less into the tax system.