Donald Trump was elected President last fall because of his surprising and unexpected strength with blue-collar workers. These folks have had a rough time in the 21st century economy: high unemployment, unstable marriages, opioid addition, lower longevity, etc.
My last post discusses a new book by Richard Reeves which makes the case that the real inequality in the U.S. is between the top 20% (the upper middle class) and the lower 80%. The upper middle class are mostly the well-educated professionals who benefit from the modern high-tech global economy. Mr. Reeves believes that this elite group is so entrenched with privileges as to be self-perpetuating. His response to this situation is to try to expand opportunity more widely by, for example:
- Reducing unintended pregnancies through better contraception by making LARCs (long-acting reversible contraceptives) more widely available to free more young women from the burden of unwanted children.
- Expanding access to early childhood education including home visitation to give a big preschool boost especially to kids from low-income families.
- Getting better teachers for unlucky kids by giving teachers a substantial bonus to teach in high poverty schools. This will attract better teachers to the more challenging schools.
- Funding college more fairly. Free college is a terrible idea. It would just be yet another boondoggle for the upper middle class. All student debt repayment should be income-based. The status of vocational postsecondary learning (at community colleges) should be elevated.
Conclusion. The idea here is not to pull down those who are well off but rather to give more people the opportunity to succeed in the modern economy. Of course, faster economic growth is another way to create more and better paying jobs. But faster economic growth has its own limitations and, at any rate, is difficult to achieve with a rapidly aging population. I will return to this topic soon!
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It Does Not Add Up 
The four strategies are all well-grounded based on their validated economic return on investment, especially for early childhood development at 7:1. Unfortunately, the national funding for all of these strategies is unavailable given the nearly $800 Billion Federal deficit projected for this year almost entirely from the excessive cost of our nation’s healthcare spending. Our nation has solved its ‘scientific mandate’ for the equitable availability of Complex Healthcare to the exclusion of its ‘humanitarian mandate’ for the ecologic accessibility of Basic Healthcare for each citizen, community by community. There is no reason to project that the current strategy to improve the cost and quality problems of our nation’s healthcare will do anything to fix it.
We need only apply the Design Principles, ascribed and validated by Professor Elinor Ostrom, for Managing a Common-Pool Resource (CPR). The CPR for healthcare is represented by its portion of the Gross Domestic Product allocated to health spending, 18.2% of GDP in 2016 ($3.46 Trillion). For comparison, it was 5.0% of the GDP in 1960, an increase of 2.34% compounded annually over economic growth. To coin a phrase, we are going to ‘hell in a hand basket’ solely on the back of our nation’s very excessive healthcare spending.
New funding RULES, new competition RULES, quality MANDATES, new computer MANDATES and new political REGIMES will continue to fail to achieve any true results for changing the cost and quality of our nation’s healthcare. Remember, we are the ONLY advanced/developed nation of the world with a worsening maternal mortality ratio (MMR), for 25 years. (See 2015 UN/WHO/IMF Report on world-wide maternal mortality.) HINT: Among our nation’s 50 States, each State’s MMR is highly correlated with its poverty level.
It is time to begin a reconsideration of each community’s COMMON GOOD and the level of ‘social capital’ that’s required to support it. Since the end of WW1 100 years ago, there is not much imagination required to view the magnitude of change within our nation. Our ability to solve the social dilemmas, faced by each person daily, with COOPERATION AND TRUST is under daily attack. Our nation’s problems can not and will not be solved without a strategy to reverse the ‘social capital’ decay affecting each person’s family, neighborhood and community.
I totally agree with you. In particular that our current 18.2% of GDP spent on Complex Healthcare is far to much and grotesquely interferes not only with fiscal common sense (balancing the budget) but also prevents us from addressing many other social problems which are holding back middle class progress.