Medical Tuesday Blog
Gov’t Healthcare: The Moral Fabric
https://www.nationalaffairs.com/publications/detail/american-exceptionalism-and-the-entitlement-state American Exceptionalism and the Entitlement State (Part IV continued from April, May, June)
By Nicholas Eberstadt
Asking for, and accepting, purportedly need-based government welfare benefits has become a fact of life for a significant and still growing minority of our population: Every decade, a higher proportion of Americans appear to be habituated to the practice. If the trajectory continues, the coming generation could see the emergence in the United States of means-tested beneficiaries becoming the majority of the population. This notion may seem absurd, but it is not as fanciful as it sounds. In recent years, after all, nearly half of all children under 18 years of age received means-tested benefits (or lived in homes that did). For this rising cohort of young Americans, reliance on public, need-based entitlement programs is already the norm — here and now.
It risks belaboring the obvious to observe that today’s real existing American entitlement state, and the habits — including habits of mind — that it engenders, do not coexist easily with the values and principles, or with the traditions, culture, and styles of life, subsumed under the shorthand of “American exceptionalism.” Especially subversive of that ethos, we might argue, are essentially unconditional and indefinite guarantees of means-tested public largesse.
Some components of the welfare state look distinctly less objectionable to that traditional sensibility than others. Given proper design, for example, an old-age benefit programs such as Social Security could more or less function as the social-insurance program it claims to be. With the right structure and internal incentives, it is possible to imagine a publicly administered retirement program entirely self-financed by the eventual recipients of these benefits over the course of their working lives. The United States is very far from achieving a self-funded Social Security program, of course, but if such a schema could be put in place, it would not in itself do violence to the conceptions of self-reliance, personal responsibility, and self-advancement that sit at the heart of the traditional American mythos. (Much the same could likewise be said of publicly funded education.) Moral hazard is inherent, and inescapable, in all public social-welfare projects — but it is easiest to minimize or contain in efforts like these. By contrast, the moral hazard in ostensibly need-based programs is epidemic, contagious, and essentially uncontrollable. Mass public provision of means-tested entitlements perforce invites long-term consumption of those entitlements.
The corrosive nature of mass dependence on entitlements is evident from the nature of the pathologies so closely associated with its spread. Two of the most pernicious of them are so tightly intertwined as to be inseparable: the breakdown of the pre-existing American family structure and the dramatic decrease in participation in work among working-age men.
When the “War on Poverty” was launched in 1964, 7% of children were born outside of marriage; by 2012, that number had grown to an astounding 41%, and nearly a quarter of all American children under the age of 18 were living with a single mother. (In the interest of brevity, let us merely say much, much more data could be adduced on this score, almost all of it depressing.)
As for men of parenting age, a steadily rising share has been opting out of the labor force altogether. Between 1964 and early 2014, the fraction of civilian men between the ages of 25 and 34 who were neither working nor looking for work roughly quadrupled, from less than 3% to more than 11%. In 1965, fewer than 5% of American men between 45 and 54 years of age were totally out of the work force; by early 2014, the fraction was almost 15%. To judge by mortality statistics, American men in the prime of life have never been healthier than they are today — yet they are less committed to working, or to attempting to find work, than at any previous point in our nation’s history.
No one can prove (or disprove) that the entitlement state is responsible for this rending of the national fabric. But it is clear that the rise of the entitlement state has coincided with these disheartening developments; that it has abetted these developments; and that, at the end of the day, its interventions have served to finance and underwrite these developments. For a great many women and children in America, and a perhaps surprisingly large number of working-age men as well, the entitlement state is now the breadwinner of the household.
To be continued in August as ENTITLEMENTS AND EXCEPTIONALISM
Government is not the solution to our problem,
– Ronald Reagan
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