Tag Archives: Poverty

Why Aren’t Flu Vaccines Free for Everyone?

If you have health insurance in the United States, you can usually get a flu vaccine for nothing. But for the 28.9 million Americans who are uninsured, a flu vaccine can cost up to $50. For a population that is often hard pressed, this can be unaffordable. And if you have a family of 4 to vaccinate, the numbers are even worse.

Meanwhile, COVID vaccines cost absolutely nothing, whether you have insurance or not. Why aren’t we doing the same for flu vaccines?

Medicare pays $10-60 for flu vaccines, with an average price of $36 across all the vaccines they cover. If the federal government bought one for every uninsured American, the price would be $1.04 billion.

In the midst of the COVID pandemic, it’s easy to forget just how deadly the common flu can be. But the flu has killed between 12,000 and 61,000 Americans per year since 2010.

How do we decide if a policy is worth it compared to the number of lives it could save? The government uses a figure called the “statistical value of a human life” to measure whether many policies, such as environmental regulations, are worth it or not. That figure is about $10 million.

At that rate, giving a free flu shot to every uninsured American would only have to save 100 lives a year in order to pay for itself entirely. That’s just 0.2% to 0.8% of all flu deaths. Offering free flu vaccines to 8.8% of the entire population would probably prevent a lot more than a fraction of a percent of flu deaths.

Let’s give this policy a try!

For more on health, check out these posts:

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Photo: “01a.UStreet.NW.WDC.13September2015” by Elvert Barnes is licensed under CC BY-SA 2.0

Texas Failed to Prepare Its Energy System for a Deep Freeze

As many in Texas enter a fifth day without power in freezing temperatures, I searched for information on how such a disaster could’ve happened.

I came upon some excellent perspective from Professor Daniel Cohan at Rice University:

See the entire Twitter thread here. Very much worth reading.

Not preparing the full energy system, from natural gas wells to the electrical grid, for a deep freeze seems to be the culprit.

This makes sense to me as someone who has lived his entire life in the frozen North…northern Maine, Wisconsin, and New Jersey. We’ve had storms and cold even worse than what Texas is experiencing on a regular basis, but I don’t recall the power ever going out. And I’m very grateful for that as I type this in my warm living room.

To me, this calls into serious question the Texas regulatory model, where ERCOT regulates a Texas-only grid that’s exempt from Federal oversight. If they can’t plan for extreme events, why do they exist?

In the mean time, as families resort to making little fires in their homes to stay warm, perhaps Governor Abbott can help. If the Governor’s Mansion has power, why not invite people to come there and warm up? Even a small gesture like that could bring warmth to a few people.

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Photo: “Caricature: Texas Governor Greg Abbott” by DonkeyHotey is licensed under CC BY-SA 2.0

How I Know The Need Out There Is Real

I was at the grocery store recently when the woman behind me in line tried to return a pair of hubcaps.

There’s nothing wrong with them. I just need groceries more than I need hubcaps.

That’s what she said. The hubcaps cost $14. Fourteen dollars was the difference between her eating or not eating.

You may be picturing her in your mind. I’d wager your picture is wrong. She was a nicely dressed woman in her 50’s who would have fit right in at a corporate office. Perhaps she used to work in one.

“Like I said, there’s nothing wrong with them,” she repeated.

The store manager took pity on her and let her return the perfectly good hubcaps. In place of them, she slid a small pile of groceries down the conveyor belt.

It’s easy for us to make excuses. Isn’t this the government’s job? What about food stamps? But it’s easy for people to fall through the cracks of a system that’s largely indifferent to them. Paperwork gets lost, caseworkers don’t show up, appointments are all booked until three weeks from Tuesday, etc.

The economic devastation of this pandemic is very real. And it may be a lot closer than we think. I certainly didn’t expect it right behind me in line at the grocery in my well-off town.

How can we help? A favorite charity of mine is the Salvation Army. It provides food to people who have nowhere else to turn. You can donate here.

Have a great weekend and a happy Valentine’s day, everyone!

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Photo: “Swan, homeless, on Mission St.” by Franco Folini is licensed under CC BY-SA 2.0

Brazil’s Society is Collapsing as COVID Slams its Economy

There is a huge increase in homelessness in Brazil, per Der Spiegel. Many have lost jobs due to the COVID pandemic, leading to a second humanitarian crisis, this one economic. I found this quote from a factory worker who recently lost his job particularly striking:

“I never thought I would end up in this situation,” he says, “and suddenly …” He snaps his fingers and his eyes fill with tears. The worst, he says, is the hunger and the constant feeling of being dirty. “It is the most terrible experience I have ever had in my life, the biggest humiliation.”

This is a man who worked…he was not lazy. But unfortunately, he has still lost everything. Financial relief from the government, on which one third (!) of society depends, is expiring:

…the government in Brasília ceased paying out an emergency allowance for the poor struck by the crisis as of January. Fully 67 million Brazilians – almost a third of the population – had been relying on the 600 real (around 90 euros) each month. “It helped people in the favelas pay for rent or food,” says Kohara. And they have no savings, he adds. Their situations are now so tenuous that they could end up on the streets from one day to the next.

This drives home the importance of stimulus measures in the US. In addition, perhaps an international poverty relief effort is needed.

More here.

Photo: “Slums in Rio de Janeiro, Brazil” by World Resources is licensed under CC BY-NC-SA 2.0

What If Homelessness Is Caused by Brain Injuries?

A couple of months ago, a man approached me on the street near my home. He asked for a bit of money, and although I usually never do, for some reason I gave it to him. I later saw him on a regular basis near the neighborhood grocery. I found out his name was John* and he used to work in construction. Several times a week, I’d run into him and stop and chat for a few minutes.

One day, I noticed he had large purple bruises on his forehead. He told me he had tripped over his shoelaces and gone down hard. Especially if someone is exhausted and cold, it’s easy to see how this could happen. He had been to the hospital, but they dismissed him quickly, perhaps because he was homeless.

He had lived in our town for 48 of his 53 years, and only become homeless recently after losing his job, like so many others. It troubled me to think that after a lifetime of contribution, our town had cast him aside so readily.

I was reminded of John yesterday when I heard that over half of homeless people may have brain injuries. Skeptical, I decided to do some digging. I found a metanalysis in The Lancet that confirmed this astounding figure:

The lifetime prevalence of any severity of TBI [traumatic brain injury] in homeless and marginally housed individuals (18 studies, n=9702 individuals) was 53.1%

This is much greater than the general population:

The lifetime prevalence of TBI in homeless and marginally housed individuals is between 2.5-times and 4.0-times higher than estimates in the general population. Moreover, the lifetime prevalence of mo­derate or severe TBI in this population is nearly ten-times higher than estimates in the general population.

It’s difficult to say whether the brain injuries are a cause or effect of homelessness. But, homeless people tended to have their first TBI at a young age. To me, this argues that brain injuries are a cause of homelessness:

Age at first TBI ranged from 15 years to 19.9 years, and we calculated a weighted mean age of first TBI of 15.8 years.

Perhaps the relationship works both ways:

TBI could increase the risk for homelessness, and homelessness could increase the risk for incident TBI.

It’s common for us to blame the homeless for their condition. After all, many are addicted to alcohol and drugs, aren’t they? But that too may be related to head trauma:

several characteristics of homeless and marginally housed populations (eg, residential instability or substance use) were associated with sustaining TBI

Another study from Canada found similar figures, and noted that the first TBI usually happened before they became homeless:

The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness.

A British study found that homelessness was not a significant predictive factor for head injuries. However, it didn’t address the question of whether the homeless had a TBI before becoming homeless.

Imagine two people, one with an stable and well-off family and one with a chaotic and impoverished family (or no family at all). They both hit their heads. One gets support and good medical care, but the other may wind up homeless.

I sometimes wonder if that’s what happened to John. Did he get hurt, wind up homeless, and then find himself in a position to get hurt again?

I haven’t seen him lately, despite looking for him over and over. I hope he found a nice place to stay this winter, and I hope to see him again.

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*Not his real name

Photo: “Thomas (Tomaso) is Homeless” by Franco Folini is licensed under CC BY-SA 2.0

Is Zoning Keeping Poor People Poor?

I recently subscribed to a newsletter from the journalist Matthew Yglesias that has turned out be outstanding. A message I received this morning really struck me. Yglesias argues that the best thing we can do for the poor, given that housing is their biggest expense, is to build housing like crazy:

This is diametrically opposed to the narrative we so often hear, that new development replaces the urban poor with, well, people like me. Yglesias’ argument makes sense in terms of basic supply and demand. New York is creating 3.9 jobs for each new housing unit. In San Francisco and Silicon Valley, the numbers are far worse, at over 6 jobs per new housing unit! (And sure enough, SF/Silicon Valley is more expensive than NY.) Unless the average household size is about 4 in the case of NYC or 6 in SF/Silicon Valley, this simply won’t work. There will be more workers who need apartments than there are apartments.

What happens then? You guessed it: your rent goes up. However, I was greatly encouraged by this tidbit:

Now, you’re on my territory! I’ve lived in Hudson County, NJ for about 6.5 years and love it here. And I did notice that we seem to build a lot more than New York does. But you know what they say: the plural of anecdote is not data.

The data is in! And it’s striking, especially since Brooklyn’s population is around 2.6 million and ours is under 700,000! Dividing Brooklyn’s roughly 2,559,903 residents by 9696 new permitted units gives us 264 residents per new apartment allowed to be built. In Hudson County, that ratio is approximately 672,391 residents divided by 8,238 units, or 82 residents/new unit.

We are building housing more than three times as fast as Brooklyn, our nearest competition!

So, is all of Hudson County a noisy construction site surrounded by snarled traffic? Hardly! There are countless parks, a beautiful waterfront walkway, and lively, pedestrian-friendly streets. It’s actually not so different from Brooklyn, except it’s cheaper and arguably safer, especially these days.

Yglesias’ argument also makes sense given an inside view into NYC development that I happen to have: my friend Tim* is a commercial real estate broker in New York City. He often works with owners of lower productivity industrial real estate in poorer parts of the city that were recently upzoned to allow apartments. A typical client might be the owner of a small factory that is not very profitable, who can do better selling his land to a developer who will build apartments. The factory can move somewhere cheaper nearby (hello, New Jersey!) and people can have places to live.

My one bone to pick with Yglesias’ otherwise excellent article is:

I think a lot of sensible people have different opinions on that one!

Check out Yglesias’s website here. Tons of great reporting of the sort we don’t see enough of!

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*Not his real name

Photo: “MichaelPremo_MsWard-4364” by michaelpremo is licensed under CC BY-ND 2.0