Category Archives: Social Policy

An Interview with Jay Pearson

 

Jay A. Pearson, Assistant Professor at the Sanford School of Public Policy
Source: Duke University, 2017

Jay Pearson is an assistant professor at Dukes Sanford School of Public Policy, with research focusing on the health disparities between distinct social groups.  He recently published a challenging op-ed in the L.A. Times titled Donald Trump is a Textbook Racist, in which he comprehensively explains how the presidents behavior fits every academic definition of racism. 

The op-ed was the first of a planned series which will next address our misguided notion of extreme vetting.  The last installment will address the Trump administrations likely poor health legacy for the nation, with a special emphasis on how his policies are likely to most impact those demographics which disproportionately voted for and continue to support him. 

Q: How would you characterize the responses to your L.A. Times op-ed?  

A: As you might imagine, the responses were incredibly varied. My contemporary colleagues – and not just at Duke but around the country – and students – and not just students who are in my course right now but students from the past – were congratulatory, supportive and encouraging.

In fact, the single most consistent message that I got from my junior faculty colleagues – again, from across the country – was, “Thank you for doing something that we all believe should have been done.”  We all had the same or at least similar training in terms of these social constructs and the conceptual definitions of them.  We teach this stuff in our courses, and we have frequently wondered why no one had done something in a public forum.  Because, you know, this issue of whether or not the president is a racist is not open to debate.  He meets and exceeds the formal definition.

Q: There’s an apparent disconnect between the academic definitions of racism and the understanding of the term among a large segment of the populace.  How do you think we bridge that gap, both individually and as a society?

A: I think we can do a significantly better job of teaching these concepts and constructs in both formal settings – that is schooling – and in informal community settings.  I am firmly of the opinion that this is stuff we should be teaching in schools fairly early on.  The interesting thing for me is the basic conceptual definition – the idea that it’s a negative prejudicial bias combined with sufficient power to leverage action – has been around since at least the ‘60s in the academy.  And so I can’t think of any good reason why it should not be incorporated into the history and social studies curricula, and not just offered to a select group of students at elite institutions like Duke.

And there are a few good models, I think, in other places of the world.  For instance, in Germany, every kid who goes to public school gets a fairly rigorous course of study on the Holocaust.  That makes sense to me.  That is not asocial.  Folks are willing to acknowledge the history, and the contemporary impact on life chances of different segments of the broader population. 

Q: What specific policies do you believe would be most effective in addressing our country’s white supremacist past and its current institutional racism?

A: It’s important for me to make a distinction here, because you introduce two constructs: one is white supremacy, and the other is institutional racism.  And I think before we can move forward with good policy on the white supremacist piece, we need to have good research and begin to systematically test the most effective strategies to communicate that concept, and communicate those in such a way that people are willing to acknowledge that white supremacy actually exists.  The literature in that area is conspicuously impoverished.

So interestingly, ironically, I suspect that Donald Trump and his administration are inspiring many of us to take more seriously the business of engaging in this particular course of scientific inquiry, that is: “What does white supremacy look like?” and what the various dimensions are, and how we go about designing effective intervention strategies to counteract its impact.

Q: In your courses you discuss the need for greater representation and retention of people of color as a means of achieving equity.  Do you have any best practices around this idea for future policy practitioners?

A: I do.  I think that first we need to not be afraid of engaging in discussion and dialogue about the value of diversity across multiple settings.  The literature here is fairly rigorous.  The findings suggest that in areas as diverse as the military and multinational corporations, leaders are stepping forward to both acknowledge the value of and encourage engagement in the process of bringing social diversity across multiple dimensions to bear.  So it’s not just racial diversity; it’s gender, it’s socio-economic position, gender identity, and sexual orientation.  The research suggests that productivity and quality of the product are both enhanced when multiple perspectives are represented.

Research also suggests that the success of diversity efforts is largely contingent upon the willingness of these very same leaders to step forward and make it a priority.  That is absolutely the case in university settings, and while I don’t know this literature nearly as well, I suspect that it’s the case in the military also.

Q: What would be your advice for policy-makers and students with respect to weighing the effects of institutional racism on their potential policy outcomes?

A: First, I would say: assume and accept that that particular phenomenon is more pervasive and impactful than most people can potentially imagine or get their heads around. This implies that you need to have some humility and listen to the voices of folks who are actually contending with the imposition of this particular phenomenon. So that’s a first.

Second, I think it is important for all of us – and we all can benefit from this – to get some more formal training, so that we have at least a rudimentary appreciation for just how pervasive this racism thing is.  So: humility and additional training.

Blake Rosser is a first-year Master of Public Policy candidate interested in political corruption and social justice.

The Intrinsic Durability of Obamacare

Source: Quora

Despite having control of the Senate, House, and Presidency, Republicans have been repeatedly unsuccessful in their attempts at repealing the Affordable Care Act and replacing it with an alternative. The fight drags on; on Tuesday, the Senate narrowly voted to advance to floor debate, and needed Vice President Mike Pence to cast a tie-breaking vote. An economic concept called loss aversion provides some insight into the uphill battle Republicans are facing with a healthcare replacement. It also indicates that voters are even less likely to support a “repeal-now, replace-later” plan.

Introduced by behavioral economists Daniel Kahneman and Amos Tversky, loss aversion refers to the idea that people feel more pain when they lose something than pleasure when they gain something.

Kahneman explains the phenomenon in this way: Let’s say I told you that I was going to toss a coin; If it lands tails, you pay $10. How much money would you need to gain if you won, before you took the bet? “People want more than $20 before it is acceptable,” says Kahneman, “And now I’ve been doing the same thing with executives or very rich people, asking about tossing a coin and losing $10,000 if it’s tails. And they want $20,000 before they’ll take the gamble.”

Companies use this glitch to influence our behavior, too. Would you pursue a $10 rebate as doggedly as you would avoid a $10 surcharge? Gaining something is only about half as enjoyable as losing something is painful, according to empirical studies. So in the world of politics the threat of losing something, be it a part of your income or a service you’ve become accustomed to, can have a heavy impact.

This became the case with the Affordable Care Act. Initially, and for many years, the ACA was opposed by the majority of Americans. It was not until serious discussion of losing the act became part of the public discourse that the ACA gained majority approval in Gallup polls.

While it is the Republican Party’s general consensus that Obamacare should be repealed, the Congressional Budget Office’s well-publicized projections of coverage loss, Medicare loss, and insurance regulation loss have made their proposals deeply unpopular to the public. In June, the CBO forecasted that the Senate’s plan would leave 22 million more people uninsured. The gains that they tried to sell, like decreasing taxes and lowering the deficit, have not been very effective. In an unexpected move last Tuesday, Republican Senators Mike Lee and Jerry Moran joined Senators Susan Collins and Rand Paul in announcing they would vote against the Senate’s latest bill. Because Republicans have only 52 seats in the Senate, losing any more than two votes is fatal. These defections sank the bill, which was only narrowly supported.

Finding consensus between the moderate and hard-right wings of the party has proven to be extremely difficult. “This has been a very, very challenging experience for all of us,” McConnell told reporters following the bill’s collapse. “It’s pretty obvious that we don’t have 50 members who can agree on a replacement.”

Once something becomes the status quo, it becomes more difficult to do away with because of loss aversion. It is this phenomenon that makes it difficult to alter welfare and service programs once they have been put in place, and it is one reason why Social Security is a third rail in Washington.

Politically, Obamacare is inherently difficult to repeal. Obamacare sought and succeeded at creating a rapid expansion of coverage over the course of President Obama’s tenure. An expansion in the economy that, once in place, created a new status quo; not only for individuals, but for health-related businesses. Interestingly, many at the far right of the Republican party came to power during the Tea Party movement. It was a movement that began in response to the threat of a different loss from the status quo; the increase in taxes that came with Obamacare.

The Senate’s latest proposal, to repeal parts of the Affordable Care Act with no required replacement until two years down the line, would increase the number of uninsured by 17 million next year and 32 million by the end of a decade. Immediately after its introduction, this idea was opposed by three Republican Senators, Shelley Capito of West Virginia, Lisa Murkowski of Alaska, and Susan Collins of Maine, who announced they would vote against it.

This plan is likely to generate and even stronger sense of loss aversion. Supporting Senator McConnell’s plan to repeal now is essentially a choice between keeping the status quo, and rolling the dice with the hopes of getting a better outcome in the future. This will be an even harder sell than the one from last week.

Political rhetoric about loss is common and effective. “Loss” was something that President Trump used to great effect in the election, by saying that people will lose their guns, lose their money (through higher taxation), or lose their job to globalization. Rhetoric is not reality however. Should Congress pass a bill that takes away people’s healthcare, voters will feel the losses directly. Despite Tuesday’s vote, repealing Obamacare is still a long shot.

Neil Browning is a 2017 Master of Public Policy graduate interested in public health, development, and international affairs. He was the editor-in-chief of the Sanford Journal from 2016-17.

HOTMA Expands Opportunities for Low-Income Families

hud-logoLow-income families have historically struggled to access low-poverty neighborhoods through federal housing programs. They have been challenged by a number of barriers, from transportation to discrimination, and have been left with no other alternative but to move into areas of concentrated poverty. But with HOTMA, there is hope.

H.R. 3700, the Housing and Opportunity through Modernization Act of 2015 (HOTMA), has unanimously passed both the House and the Senate. President Obama is expected to sign this bill that updates several components of the nation’s low-income housing programs. Among other changes, the bill boosts an effective tool to serve low-income families: project-based vouchers. Continue reading

Our Winter 2015 Print Journal is Here!

Our new print edition is out! After months of hard work, the Sanford Journal of Public Policy is proud to announce that our Winter 2015 print journal is ready to go, and we couldn’t be more proud of it.

Sanford Journal Spring 2015 Print Journal

 

 

 

 

 

 

 

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Medicaid Expansion and Health Insurance Uptake, In Two Maps

The New York Times just published an article detailing changes in newly-insured people through the Affordable Care Act, otherwise known as Obamacare. 

Since passage of the ACA, people have become insured for a variety of reasons. Some gained insurance through expanded Medicaid coverage. The below map is from The Advisory Board Company and shows states that accepted and denied the ACA’s Medicaid expansion.

The two maps do not coincide perfectly, but there are some correlations. Check out Arkansas, Kentucky, and West Virginia in relation to their non-Medicaid-expanded neighbors. Wisconsin, Pennsylvania, and Maine look similar on the first map for apparently different reasons.

What patterns do you see?