Opinion essay fail in New York Times by one-fifth of Trump cabinet

The on-camera politicos heading agencies responsible for federal support of the social safety net have written an op-ed in the New York Times that’s newsworthy for comprising a lazy string of platitudes supported by factual and language inaccuracy. ChatGPT, is that you?

The lede is the straw man origin story of America’s safety net, and by the second sentence, we’re in crisis: “Millions of able-bodied adults have been added to the [welfare] rolls in the past decade, primarily as a result of Medicaid expansion.”

Well, maybe, but the Affordable Care Act was a one-time event, and if Medicaid is welfare, so too is Medicare. (Full disclosure: I support Americans’ healthcare access in the interest of public health alone. It’s sloppy the heads of HHS and CMS’s ontological sleight of hand reveals they don’t).

Most people, on hearing “welfare” think the program that is “state-administered cash assistance” (formally, TANF), or both TANF and SNAP (food stamps). I believe this, because when Bill Clinton reformed welfare, he replaced Aid to Families with Dependent Children (AFDC) with Temporary Assistance for Needy Families with splashy welfare-to-work elements. Welfare is TANF alone or with SNAP, as the programs are administered together by states.

The op-ed writers both cite President Clinton’s “success” reforming welfare, yet explicitly state “many of these [new] recipients are working-age individuals without children who might remain on welfare for years.” Again, the F in TANF is for families; only those with children qualify. So, per the op-ed’s universe, welfare now excludes TANF, which includes time limits on benefits and return-to-work requirements. SNAP does, as well. Four charging reformers missed the mirror’s reversal of their definition.

A Protestant (Calvinist, originally) work ethic is the op-ed's central argument. It’s Little House on the Prairie, here, sanitizing the racist, sexist propaganda of “welfare queens” and absent fathers. “White Hands,” attacking Black workers, was its spiritual successor. The powerful were desperate for power. Here, the American Enterprise Institute cosigns, with no Barbara Ehrenreich in sight.

Those who work sentiently with the “welfare” population know their personal challenges are enormous with little room for error or available help. There is no space, financially, logistically, for catchup.

The challenges are structural. Customer-facing service jobs typically offer much worse health insurance than Medicaid, both in deductibles and copays. To achieve this, Medicaid reimbursements are lower than those of Medicare or private-sector health insurance.[1] By subsidizing home ownership, the US tax code benefits the winners and the established middle class, but not those historically harmed by redlining, etc. Margins on affordable housing are thin, and it’s challenging for management companies to profit while delivering quality product in perpetuity. This is all bad for individuals’ already-fragile housing stability. [2]

Meanwhile mental health hasn’t meaningfully advanced since SSRIs in the late 1980s; the ads run around the clock are for new-use approvals commonly used off-label. The psychological, psychiatric, and neurological prisms often fail to divine successful treatment. For depression, with enormous societal and personal costs, DSM’s “disease model” isn’t supported by objective tests, such as blood or imaging.[3] So, its onset and resolution are subjective, while the practitioner-client relationship is sustained mostly by continued payment.[4]

And anyway, change is hard for the best of us, even with healthy personality types A or B. A subject’s current state isn’t always the direct result of catastrophe; it's sometimes regression to mean. The man who oversees HHS’s largest-in-government budget (including entitlements) should relate to the “human” in its name.

The safety net was never a “step up” (the metaphor breaks); it prevents mass starvation, disease, and Dickensian child poverty in American farmlands and cities. Sophisticated people have long known this. Others wrote the subject text and submitted it to the Times.

1. Someone’s unhappy, and they’re increasingly private-equity owned. It's a brute force approach to rebalancing payer mix to favor higher rates.
2. The DC market rewards new construction of “higher end” one- and two-bedroom buildings defined mostly by their newness. A tell is blatantly entry-level HVAC only slightly better than New York City’s, and motels’, dreaded PTACs. Margins matter apart from sales and marketing upmarket, as well.
3. Now we openly treat depression with antipsychotics, which can cause permanent involuntary body movements charmingly known as extrapyramidal symptoms. The "new" use of psychedelics in mental treatment increasingly looks more movement than science, however. Staff staying out of the supply is as good advice for researchers as drug dealers.
4. For those accepting Medicare or private insurance, margins are tight, patients churn frequently, and “practices” are mostly 1099s. Evidence-based?