John Bouman

A New Way Of Defining Progress

John Bouman — Thu, 24 Jul 2008 09:47:02 -0700

Nine years ago, Chicagoan Mark Emerson left his job with a large company that offered group health coverage to pursue the American dream and start his own business. He did not know that this would begin an ordeal in which he was "charged back into the stone age” as a customer of the private health insurance market. Mark and his wife now pay more in health care costs than they do on their mortgage payments and real estate taxes. Despite being two healthy people, their insurance costs continue to climb. Though he has reached the point where he can no longer afford his premiums, Mark is unwilling to drop coverage and face the potential nightmare of going without insurance. He feels stuck, and help is nowhere to be found.

Mark is an American icon—a middle class entrepreneur. But he is just one of many middle class folks in cities across the country who struggle with similar situations. Escalating health care costs. The foreclosure crisis. The rising price of energy. Food prices and urban food deserts. Our perceived freedom as ordinary people to decide who to be, what to do, and how to live has increasingly drifted out of our control. We have to ask whether we are making progress as a country in improving our quality of life.

And, for that matter, what defines progress?

A report issued this month by the Columbia University Press and Social Science Research Council, titled “The Measure of America: American Human Development Report,” gives a fresh perspective on the concept of progress. It is the first and only report to combine the three issues Americans care about most -- health, education, and income -- in one measure. The report is based on the notion that whether someone makes a decent wage and has access to quality health care and schools determines their ability to sustain a tolerable life. Although the UN has used the so-called Human Development Index (HDI) to evaluate other countries, this is the first time the United States has been evaluated in this way.

This new measurement helps shed light on current urban dilemmas, including the uneven progress among racial and ethnic groups. For example, Chicago’s 4th Congressional District, primarily comprised of Latino communities, ranks lower than the national HDI average in all three areas, but particularly in education and income. Across the United States, about 40 percent of Latinos age 25 and up do not have a high school diploma, which corresponds to the rate of Americans as a whole in the mid-1970s. The report thus tells us that Latinos are about 30 years behind the nation’s progress in educational attainment.

Another example comes from the Chicagoland’s 2nd Congressional District, which is heavily African American, with mixed economic neighborhoods and suburbs. Median income in the district is somewhat above the national median and somewhat below the Illinois median. But the report reveals a looming problem. Only 21.2 percent of the district's residents have a bachelors degree and seven percent possess a graduate degree, compared to national averages of 29.2 percent and 10.9 percent, respectively. For these communities to compete in the new economy, attaining higher education must be made a priority.

Future reports will measure whether we're moving in the right direction. Each of the three main areas of focus include several sub-categories, such as an individual’s ability to attend a college of choice, access a lawyer in time of need, build assets, find affordable housing, and receive quality health care. Some localities do well on many of these measures, but everywhere there are shortfalls and inequalities that call out for solutions. Fortunately, the American Human Development Report is not just a catalog of problems; it offers examples of what is working in the U.S. and other countries, and prescribes the necessary changes.

The report’s collection of factors provides a pragmatic reality check on how we are faring in America. This is not another poverty index. It applies to everyone, including people like Mark who are unquestionably middle class. It is an excellent way not only to highlight our most pressing problems, but to define what it means to make progress and identify the solutions that we should demand of our leaders.

John Bouman is the president of the Sargent Shriver National Center on Poverty Law, a Chicago-based law and policy center that champions economic opportunity for low-income people.

Previous columns:

A Case Study In Preserving The Status Quo, June 27, 2008

A Case Study In Preserving The Status Quo

John Bouman — Fri, 27 Jun 2008 11:42:54 -0700

This year in Springfield, the main players in the health insurance industry provided a case study in how they resist even the simplest changes. They once again illustrated how they do not understand, or at least do not take seriously, that the health care system is in crisis and approaching a crossroads.

About a third of the uninsured in Illinois – 600,000 people – are between the ages of 18 and 30. Working together, two Chicago-based organizations, Public Action for Change Today (PACT) and United Power for Action and Justice, came up with a basic solution to assist many of these uninsured young adults -- one sponsored by Sen. Dan Kotowski (D-Park Ridge) in the Senate, and Reps. Beth Coulson (R-Glenview) and Julie Hamos (D-Evanston) in the House. The proposal required employer-based group insurance plans to allow employees to keep their children as dependents under their insurance until the age of 30 (or until they acquire different insurance or get married). The employer would not be required to pay any portion of this dependent coverage and could pass the full tab onto the employee.

The idea behind this plan is to simply provide a new option -- at least for the families that could afford it -- to cover their young adult children with decent insurance. To the extent they are financially able, many families would be continuing to assist their kids in any event as they return from college, make their way through graduate school, or take entry level jobs without benefits. Since the parents would likely be responsible for the costs of any serious health expenses, making sure their kids have proper insurance is obviously in their interest. However, the age limit on dependents often bars them from adding their young adult children to their coverage.

The proposal by PACT and United Power represents a minor tweak to the current health care system. It would cost the government nothing. It would cost employers nothing. Insurance companies would have thousands of healthy young people as new paying customers, who in turn would improve the overall health profile of the employers’ insurance groups. By helping mostly middle class Illinois families help themselves, it would put a significant dent in the uninsured population.

Seventeen other states have passed similar reforms. Indeed, the sponsors found broad support for the proposal in both chambers of the Illinois General Assembly. So it should be easy to pass, right?

Not so fast. Before you can get a vote on the floor, the bill must clear the committee to which its assigned. And that’s where this plan hit a roadblock.

Chaired in the House by Rep. Frank Mautino (D-Spring Valley) and in the Senate by Sen. William Haine (D-Alton), both insurance committees include legislators with industry interests and a business-oriented point of view.

When the bills reached these committees, the business community -- led by the Illinois Chamber of Commerce and the National Federation of Independent Business -- joined representatives of the insurance industry in raising various objections. They worried that their markets might change. They worried that employers would be hit with increased premiums if one of the young adults turned out to have high health costs. Finally, they objected on ideological grounds to being required to do something, even if it didn’t cost them a dime.

After these concerns were raised, the committee leaders demanded compromises. As a result, PACT and United Power agreed to lower the maximum age of the dependents to 25. But with each concession came additional concerns. It became clear that the industry opponents, abetted by the committee leadership, were simply stalling. And indeed, the session ended with the bills still pending.

The effort will be resumed as early as the veto session this November, and there are promises of renewed negotiations over the summer.

But the larger implications of this story are most interesting.

Our private, market-based system of health coverage has failed in many ways, producing anxiety and anger at kitchen tables everywhere. There are almost 50 million uninsured nationwide. But that’s just the tip of the iceberg. While the majority of Americans have health insurance, every year their plans cost more and cover less. It’s gotten to the point where health care costs are a prime cause of personal bankruptcies. Meanwhile, many insured persons with health conditions are a job loss away from losing their coverage permanently.

As a result, Americans in all income groups -- insured or not -- are mad enough to demand a change.

One way to reform the system would be to scrap private coverage altogether and institute some form of so-called “single payer” health insurance. If the private market cannot adjust and get the job done, then the growing unrest among voters will ultimately produce this type of overhaul. But in the meantime, advocates will push for less drastic reforms to address the health care crisis.

This brings us back to the proposal pushed by PACT and United Power. Of all the significant changes needed in the private market system, their proposal is perhaps the simplest. And yet even this little tweak was successfully opposed by status quo forces, mostly on the grounds that it might have a slight effect on business arrangements and costs. Never mind that it would assuredly reduce the number of uninsured young adults in Illinois.

As I said, the system is at a crossroads. Those committee members who choose the status quo over positive change are making the wrong choice. After all, if the private system cannot adapt to answer this crisis, it may face a greater risk than mere change -- extinction.

John Bouman is the president of the Sargent Shriver National Center on Poverty Law, a Chicago-based law and policy center that champions economic opportunity for low-income people.