November 18, 2022
Dear Interested Readers,
Family Health Project Update: Adding Evidence and Experience To The Wisdom of Universal Basic Income.
Last week my wife and I were delighted to attend an event offered by the Family Health Project and its founder, Joe Knowles. If the project sounds familiar it may be because I have written about the project before. Since you may not click on the link, let me begin by reintroducing Joe Knowles. To give the full picture I must take you back to the post for March 9, 2021 which was entitled “Considering Income Support As A Tool To Improve The Social Determinants of Health.” Joe sent me a laudatory comment that I used to begin my post for March 19, 2021.
Terrific piece, Gene — most especially your conclusion, that change must be driven from within.
That conclusion from the March 9 post which excited Joe was:
Many studies have shown huge returns on investment from programs that improve health and well-being for previously impoverished populations. It’s time to set our biases against the poor aside and do what is good for them and will be ultimately good for all of us. We could do away with the conversation about the social determinants of health by effectively addressing the problems and situations that perpetuate them.
After starting the March 19 post with Joe’s quote, I went on to reintroduce Joe who had previously been a guest contributor. I wrote:
Joe and I met when we were both serving on the board of CRICO, the captive malpractice organization that insures the physicians working at Harvard Medical School-affiliated medical practices and hospitals. You might remember Joe from his previous contributions to these notes. Joe is a “serial entrepreneur” who co-founded the Institute for Health Metrics in 2003 where he is now CEO. In recent years Joe has followed his passion for public health and has launched projects aimed at improving maternal and child health. His projects have brought him into close contact with federally qualified health centers and the MGH Institute for Health Professionals.
Joe and I have had an ongoing conversation about the social determinants of health for several years. Prior to COVID, we enjoyed, and I intellectually profited from, getting together to exchange ideas over lunch in Manchester, New Hampshire which is almost exactly halfway between his home In Massachusetts and my home in New London, New Hampshire. It was at one of those lunches that Joe told me that he had gotten a small grant from a private foundation and together with some of his own money and donations from family and friends who were interested in his idea, he was launching a pilot project designed to use the concept of universal basic income as a way of improving child poverty and the health of children. He was moving from contemplation to action. He had been motivated in part by a book written by the economist Jeff Madrick entitled, Invisible Americans: The Tragic Cost of Child Poverty. The review of Madrick’s book in the Washington Post said:
Madrick argues that the most straightforward and effective way to significantly reduce child poverty is through a cash allowance available to all children. The idea is similar to a universal basic income, a concept being discussed in progressive circles. Every child would be guaranteed an income that would be paid to their parents, perhaps $300 to $400 a month. Through such payments, Madrick argues, child poverty could be cut in half. Many Western industrialized countries have adopted similar policies, lowering their poverty rates as a result.
Madrick’s book was published in early 2020 before the COVID lockdown. Joe’s Family Health pilot predates the child tax credit which was the equivalent of an experiment in “universal basic income” that lifted millions of children out of poverty before the benefit expired at the end of 2021 and was blocked from renewal in the American Family Plan and the Build Back Better bill by Senators Joe Manchin and Kyrsten Sinema. The Inflation Reduction Act of 2022 was the much-reduced version of Build Back Better that Manchin and Sinema finally supported in part because it was stripped of the child tax credit.
I reviewed the benefits of the child tax credit in the post for September 30 after data was published that showed it had lifted millions of children out of poverty before it expired. My summary at the end of the post was:
I know at least seven things that are true about the current state of poverty in America. First, no matter how much success has been recorded over the last twenty years we could have done more. Second, all of the programs that have helped could be vulnerable to sudden cancelation for political reasons as we experienced with the very effective pandemic child tax credit. Third, the combination of housing shortages, inflation, and the high cost of gas and heating fuels will push many families who have recently “escaped” poverty back into the economic stress from which they had enjoyed a brief escape. Fourth, poverty remains the most significant negative factor in our analysis of the social determinants of health. Fifth, poverty is a problem across all racial groups, but the percentage of white Americans in poverty is half of the percent of impoverished minorities while many impoverished white Americans continue to be politically aligned against their own best economic interests. Sixth, we will never see health equity as long as we tolerate economic inequities and poverty. Finally, we have the ability to eradicate poverty “as we have known it,” all we need is the will. To add an eighth thing that I hope is true, I believe that someday we will eliminate poverty, and when we do we will ask ourselves how we tolerated its presence as long as we did.
I have never seen Joe when his face was not demonstrating one of the world’s greatest smiles. He exudes positivity and hope. I can even see the sunshine of his soul in the picture that is used on the website of his company.
I get the sense that Joe begins each day by asking himself what he might do today to make the world a better place. When my wife and I were greeted by Joe at his event he said something like this:
“Gene, Do you know what a one-word definition of the social determinants of health is?”
I sensed Joe wanted to make a point that would require me to say, “No, Joe. What is a one-word definition of the social determinants of health?” I did say something like that, and he flashed his big smile as he answered:
“Poverty!”
After some time for all the attendees to enjoy some refreshment and conversation, Joe called us all together. He reported what I already knew which was that for almost two years fifteen first-time mothers who were patients of the Lynn Community Health Center, which is a federally qualified health center founded in 1976, had received $400 every month on a debit card beginning on the day their baby was born. Joe now has proof that $400 can make a huge difference in the lives of these women and their babies. I expect that as time goes by there will be increasing returns for these children on this small but critical investment in the irradiation of poverty.
There are no strings attached to this resource. The new mothers can use the money in any way they believe they need to use it. Many of the patients at the Lynn Community Health Center are undocumented, and could not be recipients of the child tax credit even if it still existed. I also knew that after the successful launch in Lynn, Joe and his staff had expanded the program to the Whittier Street Health Center, an FQHC in the Roxbury neighborhood of Boston where I enjoy being part of the “President’s Advisory Council.”
The main speaker for the evening was Kiame Mahaniah, MD, MBA, the CEO of Lynn Community Health Center.
Dr. Mahaniah’s description of Lynn expanded my knowledge of this venerable North Shore Community which had once been a major manufacturing center. Now Lynn has a very diverse immigrant population, and 40% of its citizens get their care from the Lynn Community Health Center. As you might imagine, finance is a continuing challenge, but the staff is dedicated to their patients. They know that they are on the frontline of the effort to improve the social determinants of care while providing patient-centered care to every patient in their native language. The work is challenging, but the professional staff is not deterred by difficult social problems or the great needs of a population where many live in poverty. The staff consistently pushes to go far beyond the extra mile even though their efforts are continuously threatened by difficult financial challenges.
I hope that you will explore the Family Health Project’s website, but in case you do not, here are some points I want you to know:
Almost 1 in 5 children in America live in families with incomes below the poverty line. Growing up in poverty increases exposure to factors that can significantly impair child brain development and lead to poor health outcomes.
Family Health Project has undertaken a simple, replicable program to help new mothers and their babies facing life without enough money. Family Health Project provides new mothers with $400 per month for 36 months without condition.
Poverty is unacceptable. Direct giving is one scalable solution.
Reflect on those points for a moment then read on:
Modeled after the pathbreaking study, Baby’s First Years, Family Health Project has four elements:
- Referrals: A Federally Qualified Health Center refers participants to us,
- Money transfer: $400 is sent to mothers via a debit card every month,
- Support: Ongoing support is provided to moms,
- Funding: The project is funded solely by gifts from individuals.
I can expect that with a divided government no bill that effectively addresses poverty in general or childhood poverty specifically will get through Congress before we have a chance to unify the government in 2025 following the election of 2024. For the next two years, the most likely improvements in healthcare and in the quest to improve the social determinants of health will come from concerned individuals. Medical professionals can lead the way, but everyone can contribute to making our society more equitable by contributing to efforts like the Family Health Project. My wife and I left the event convinced that we should add the Family Health Project to our charitable donations. I hope that you will also take advantage of the opportunity to support this work. If you are so inclined, click here.
Random Thoughts on the Changing of the Seasons and Trump’s Big Announcement
Pictures say a lot. The old cliché that a picture is worth a thousand words is an under-call if I am the writer. For today’s header, I turned once again to the little Japanese maple in my front yard. Several weeks ago it was gloriously red. It was so red it almost looked like it was on fire! It looked exactly like the tree that you can see if you clicked on the link above. I featured it as a header on the October 21 post, and then on the October 28 post, I presented a before and after contrast that showed its bare limbs that signaled to me that we were in late fall.
Today’s header shows the little tree once again. It looks stoic to me after our first snowfall. We got about two inches of snow overnight on Tuesday, but the snow had switched to a freezing drizzle before I snapped the picture. Wednesday was a miserable day with a continuous drizzle which made it feel even colder than the 36 degrees that my weather ap declared. The chilly drizzle lasted until after four which meant that I did my walk with a headlamp in the early evening. At least the town had plowed the road and a drizzle in the mid-thirties doesn’t freeze.
I was really looking forward to our first snowstorm. Often our first snow is a nice six or eight-inch “dump” that is followed by bright sun that overnight can transform the browns of our late fall landscape into a glistening white wonderland. That was not the case this year.
The dreary scene on Wednesday matched my mood. You see I had gone to bed in a bad mood after wasting more than an hour listening to Donald Trump’s big announcement. If you were watching on CNN or Fox you know that they got so bored that they cut away mid-speech. I was watching on CSpan and simultaneously following the “real-time” comments of Maggie Haberman and other New York Times pundits on my laptop.
I have an obsession with my aversion to the former president that has recently been heightened by listening to Maggie Haberman’s book Confidence Man which intensified my disgust with the former president as it gave me some appreciation of the origins of his psychopathology. I should have ended my self-induced torture there, but then I listened to Bob Woodward and Trump chat for over eleven hours in twenty recorded interviews that are now available on The Trump Tapes. It is really annoying to have such an emersion in Trump’s narcissism. delivered in his own voice.
By the time the former president finished his “announcement,” he had been talking for sixty-three minutes. He had been “riffing” on his greatness for at least half the time. If he had stayed on message with his prepared remarks he would have been done in thirty-five minutes. Had he deleted all the superlatives that he applied to his performance in office he would have finished his speech in about twenty minutes. Had he deleted all the narcissistic references to himself, his comments about his abuse by the press, and the innuendo about being a victim of a flawed election process it would have been a ten-minute announcement of the pain that will be available to all of us for the next two years. He did make a couple of policy statements. He announced that he would make elections one-day events with only paper ballots. He also favors executing all drug dealers.
The Washington Post cataloged over 30,000 lies during the four years of his presidency. If they reset the meter to zero before Tuesday night’s kickoff to the 2024 election, he is already into double digits. He announced many times that “Latinos and Blacks” love him and that after four more years of his leadership everybody including those who might be left of the radical left will love him. As much as I despise what he has done to the country, I realized that he is so flawed that he deserves help and pity, not hatred. I am not even sure that it is worth the effort of the legal system to continue the many legitimate investigations about his conduct in office or his misuse of documents after leaving office.
It is probably not worth the effort to hold him accountable for his abuse of democracy and self-dealing actions in office. It is also true that his enablers will never own up to their contributions to his abuse of his office or their own failures to faithfully live up to the responsibilities of their offices. Republicans will control the House at least for the next two years. Because of the “calcified” positions of both parties, I am resigned to the continuing loss of our Congress’s opportunities to use legislation to improve inequality, the social determinants of health, the health of the nation, or the progression of global warming over the next two years. It will be up to President Biden to use executive orders and his well-developed political skills to prevent the erosion of what has been accomplished.
I expect that the main actor and most of the supporting cast will never be held accountable for the damage they have done. Some overly enthusiastic low-level devotees may be held accountable for following him, but not Trump. He will continue to be a provocateur of discord for years to come or until a majority of Republicans stop kowtowing to his far-right base.
I have mentioned before that I read Jeffrey Kreuger’s interesting 2014 book, The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed-in Your World. What I took away from the book is a sense of the spectrum of narcissism and the damage that those most afflicted can do to others. Krueger gave many examples from politics and the world of celebrities that demonstrated his thesis that ultimately “it [almost] always ends badly with a narcissist.” What was not clear was “For whom does it end badly?” Trump was one of Kreuger’s most prominent examples of an extreme narcissist based on his TV show and antics in New York before his infamous 2015 ride down the escalator to announce his first run for the presidency. With the election last week, many ambitious Republicans who were willing to announce their fealty to Trump had their efforts end badly. I am thinking of Dr. Oz, Keri Lake, and many other “election deniers” who tried to ride Trump’s narcissism and his dwindling base to their own benefit. Liz Chaney has predicted that it will end badly for others who placed their allegiance to Trump above their oath to uphold and defend the Constitution. Those of us who want him to go away probably have many more cold wet days and several elections to endure before the excision is completed, and we need to continuously remind ourselves that until he is completely off the stage and forgotten it could still end badly for all of us.
I am sorry for the dour-sounding conclusion to today’s note. In reality, my glass is half full. I am delighted that the red wave was a pink ripple. We still have hope that like a rainbow the long arc of history will lead to a pot of gold that we can call justice. There are those like Joe Knowles and the dedicated professionals at Lynn Community Health Center who will keep trying to make a difference and should serve as an inspiration for all of us. The challenge is to know how to live, love, work, and play in expectation of that day when we finally make poverty a thing of the past.
Be well,
Gene
