CareTalk Podcast – What NYT’s Nick Kristof Got Right & Wrong About Biden

New York Times writer, Nick Kristof, recently published an article that asks whether or not Joe Biden is capable of saving Americans from the perils of poverty, drugs, mental-illness and more. In this episode of CareTalk, John and David debate what Kristof got right/wrong in his arguments.

Read Nick Kristof’s original NYT article, “Can Biden Save Americans Like My Old Pal Mike?” here: https://www.nytimes.com/2021/02/13/op…

David Williams:

Hey John, Nick Kristof and the New York Times thinks Biden can save the white working class. What do you think?

John Driscoll:

I think it’s worth exploring.

David Williams:

Welcome to Care Talk, your contemporary home for incisive debate about health care, business and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David Williams:

Well John, I know how you spent your Valentine’s Day weekend, reading the New York Times. And I know you read the article by Nick Kristof called, Can Biden Save Americans Like My Old pal Mike? What is that article about?

John Driscoll:

Well David, for those of you who don’t read on the weekends. Nick Kristof had a really fascinating article. Really, poignantly painful about a classmate or his neighbor who had a rough time getting and keeping a working class job, ended up living on the streets. And it was a strangely introspective article for the reliably liberal New York Times. But I thought quite poignant and made a lot of really good points. But you, as a predictable liberal critic, probably had problems with it.

David Williams:

Well, it’s a good article, John. It was well-written and I think you always get something out of seeing personal experience. He tied it in with his friend who had problems while he was growing up and then actually ended up dying at age 55 on the streets from a heart attack and used that as a taking off point for whether Joe Biden could actually help people like that. So it has strengths because it’s very specific and there’s a lot of people like his friend, Mike and I think there’s some strengths in there, but it has some limitations as well. John and I will … I’ll defend the liberals. One of the things Kristof said was, like many liberals with a university education, reliable paycheck. He found maybe he was too scornful of labor, too enthusiastic about international trade and too glib about creative destruction. And he was too heartless about its toll. That’s his sort of self-loathing approach. And I’m not a self loather, John. Maybe he needs to see be in therapy.

John Driscoll:

Well, no. Look, I don’t think that we’re honest about the down … There’s a tremendous amount of upside to capitalism. It’s the greatest job and career creation vehicle the world has ever seen. But there is no question that we also have in the last 20 years sort of ignored the ugly downside that citizen Trump built up on. The resentment of rural and undereducated white. But let’s be honest David, they have been paying the price for a lot of other people’s successes. You’ve seen job erosion, you’ve seen manufacturing jobs leave. You’ve seen industries get unwound. You’ve seen … As Ross Perot pointed out, the great sucking sound of jobs to places like Asia and Latin America, and that costs not just measured in economics, but in health care.

And you see it in the painful story of Nick’s friend Mike, who didn’t finish high school, came from an abusive household and had a hard time keeping a job, keeping his family and staying sober. But clearly, as reported in the article, had a heart of gold and it makes you really wonder whether we should be focusing a little bit more on the implications of not having a policy around the things that are basically the prices we pay for a growing economy.

David Williams:

It sounds like he’s gotten around to reading Hillbilly Elegy and putting his own spin on it. Now there’s certainly a lot of parts to that about despair and so on. I think he goes a little too far. So he talks about, mental illness caused by poverty. Well, sure. There’s extra stresses on people who are poor from mental illness. Certainly, mental illness causes poverty because it’s hard to work, if you don’t have a job. He gives his example of his friend, Mike. I have a very close friend who met a similar, very unfortunate fate. And he actually went to … He was raised with a functional home and he went to a top 10 law school, had plenty of supports. Actually, had funds. He still ended up on the street because mental illness is very strong and it’s going to overcome Kristof’s thing about the scandal of not having enough treatment for mental illness.

Mental illness is going to grab a hold of you at every level, John. And a lot of it is relative. So there’s people who are a little more successful than you and their own kids are screwed up because they have affluenza. You could look at it at all different areas. So I thought that was overstated.

John Driscoll:

You’re being a little harsh on it. I would agree with you that mental illness is everywhere and it affects every class, every race, every gender, but there is no question, just measure it, Dave. You look at the level of trauma that folks who are poor, who can’t find a job, who are trying to live in poverty and emerge. The level of stress they have and how it directly ties to heart disease, hypertension, depression, and stress. I don’t think you can … You shouldn’t reject it because it’s an incomplete point. You can reject it because that’s what you’re doing. It just may have been more, imprecisely drawn, but there’s no question that if you can’t get a job, you can’t beat your addiction. And you’ve got a family that that’s going to affect your mental health.

David Williams:

John, you pointed out that citizen Trump, and maybe we won’t call him that for so long, if he gets stripped of his citizenship, eventually. Since, he didn’t have the other punishments assigned to him yet. But if you look at what he did, certainly what he and his cronies have done is recognize the ability to leverage the resentments of this class of people that you’re talking. But I don’t think it’s the right thing to do. And I think if you look at … Once you listen to him about trade policy and so on. No, I would say that trade is actually not the cause of job loss. I think you’re seeing … It’s actually, really technology and that what the Republicans had done again, by turning against free trade, it was terrible. And it’s been so successful that they basically forced the Democrats along with it. Case in point the Trans-Pacific Partnership, which we abandoned and Obama had to abandon it and Biden’s had to stay away from it, as well. We’re just going in the wrong direction. We’re learning the wrong lessons from the suffering that we see.

John Driscoll:

At least you’re admitting to the suffering, but let’s think about maybe what is I think embedded in Nick’s article, but he probably didn’t want to state it this way. In Europe, there are actually shock absorbers for people who lose jobs, they keep their wages. Look at how Germany and some of the Nordic countries have handled, basically having kind of a wage gap support during the pandemic. So they don’t have everybody who works in a restaurant, losing their job, losing their income and going on the rolls. There are some shock absorbers built into the system. I do think that universal health care matters and access to local primary care matters.

I mean, there are some solutions in there. For example, the European countries have actually built in effectively social policy shock absorbers that can help individuals and families and communities navigate the dislocations that are natural. I don’t think you have to be anti-trade to be honest about the cost of trade in some of these communities.

David Williams:

John, I think that one of the things that Kristof didn’t say specifically, but that I endorse is that empathy is an important part of policy. And recognizing that people have challenges and you shouldn’t have harsh punishments on them, is a good idea. The European example, I think is too much coddling. And in fact, there is something to kind of the American rugged individualism approach and ensuring a quality of opportunity. So for example, in Europe, they don’t do a very good job of absorbing immigrants. One of the reasons is, that they load them up with social services. They never really get integrated into the economy. What we’re trying to do here and I think what you’re actually seeing in the US is, actually a shift toward a multi-ethnic democracy. And that’s pretty hard and it’s being resisted mostly by the Republican party.

But what we should actually have is more immigration, because I think immigrants are actually people that … Yeah, they have these challenges as well, but guess what? They go and they work hard and set a good example, and we should have more democracy too, so that we don’t have the Senate representing people they shouldn’t. We should have DC statehood, John. That’s my number one suggestion here.

John Driscoll:

The whole point of this conversation was what we agree and disagree with Nick Kristof on. Now you’re throwing your own immigration and democracy agenda at it. Can you just stay on point? What do you think he got wrong?

David Williams:

Well, he didn’t talk about Europe. He knows to stay away from that one. So I think that one thing that he got wrong, was this big focus on how we needed to have a big expansion of kind of mental health care and drug treatment programs. You’re wasting money there. So John, on drug treatment programs in particular, to give something that we know a little bit about from how the health care world works. Soon as you start expanding those programs, then people find ways to charge $2,000 every time somebody comes in for their drug treatment, to test them for drugs. I think that’s throwing good money after bad.

John Driscoll:

I think you’re making a really interesting point because I don’t think what Nick gets is that, the current drug treatment centers, he wants a massive expansion, and it is criminally stupid that only 20% of the people who want drug treatment can get it. And it’s even fewer within our prison system, which has its own weird compounding. But the private and the near private public solutions for drug treatment have an 80% plus failure rate. So I think we do need more support there, but we need programs that work. And if you look around, you can find them. It’s just not currently what we pay for.

So we pay a great deal of money to a small group of facilities that do not such a great job. That’s clearly an area where we need to kind of reinvent the solutions, but look, the deaths of despair are on the rise, David. If you look at working class whites, that’s the category that gets a lot of attention because it supported citizen Trump and it’s where a lot of that resentment is catalyzed. Their life expectancy goes from 50 years old to nearly 80, if you look at it from 1900 to the end of the last century, and it’s actually reversed. We’ve got life expectancy declining in working class whites and deaths of despair, opioid abuse, death by hanging and shooting, alcoholism.

And those are the ones that are easy to measure, are increasing pretty radically. And that is the direct cause of that decline in mortality, which is defined by whether you have a four year college degree. So I also think that we’ve got to figure out a way in a very … In many ways, it would sort of suggest that getting education right, and getting wages right, could have a bigger impact on health care in these communities. Then another health care policy recommendation from people like you and me.

David Williams:

So John, since I bashed Europe before, I’ll reward them here. You say that having a college degree is a good thing. Part of the problem though, with college in this country is, it’s very expensive and people come out with a lot of debt and sometimes they come out with a lot of debt having wasted time, and they’re not improved. In some places like in Germany, they actually do more vocational training. And that might be a good idea. There’s a need for tradespeople here in this country. There’s a labor shortage there. So that might be an approach to take.

One thing that we haven’t talked about so much is, that this article is very much about President Biden and him being the right person for the job here. I’ll see what you say, but I agree with that because no one can call him a crazy socialist, that’s just not convincing when people do. He has certainly his own upbringing in hard times, both as a kid, with his dad being in this working class category that you describe. And certainly the tragedies that he’s had in his own life. And he points out that … Kristof, points out that Biden didn’t do stupid things like saying, “Defund the police.” He’s got a much more nuanced view of it.

John Driscoll:

Well, I think Biden is a really interesting example because his father was a working class dad who did lose his job, had to travel around to find a job. But the jobs that his father found and lost are not the jobs that are available to someone without a college education, today. There’s a real challenge there. While we’re picking at Nick Kristof, maybe we should get at, what did you think of his big five ideas?

David Williams:

Well, I think the big five is good, John. Isn’t that something from World War II or something like that? So he had five things. Well, let’s just pick them off one by one. So the first one was about high quality, early childhood and daycare program that’s modeled on what they have for the US Military. Now John, I’m a big, big proponent of early childhood interventions because I think in the first couple of years of life, is really where equality of opportunity comes in. And so, boom, I’m big on that one.

John Driscoll:

Well, I think it’s really hard to argue with babies wrapped in flags. I totally agree with you that, that is probably the single greatest opportunity and you see it in the universal sport for Head Start, but hard to disagree that a better start wouldn’t be better for kids. And no one can hold it against some poor young kid who wants access to early childhood education and daycare.

David Williams:

But John, to be fair. Yes, it’s kind of motherhood and apple pie almost, literally, but there hasn’t been the support for it, actually. It hasn’t actually come through. Those things haven’t been funded that well. It’s not just sort of saying, “Yeah, we’re in favor of that.” No, it’s a real commitment of resources.

John Driscoll:

But it’s one, it’s really hard to get people to disagree with. And I love the fact that he brought in the vets. I’m pretty clear that the minimum wage needs to get to 15 or better but why haven’t you been more public about it? I mean, clearly Kristof thinks that a higher minimum wage would be helpful, but what do you think?

David Williams:

Certainly John, I studied economics in college, not quite as a prestigious college as where you were and you certainly said, “There’s a trade off.” If you have a higher minimum wage, then you’re going to have more unemployment. I think what people have realized over time is that actually, first of all, the minimum wage is so low now. You can’t really live on it. And if you have a higher wage, I think it’s a good thing. It will bring out of poverty. And also, you know what? If you pay more for something, you respect it more and the same is true for paying for people’s labor. And so it’s actually going to improve the dignity of work by employers having to think hard about, how do I make sure I’m not wasting somebody’s time? They have to be able to be affective, if I’m paying them more. So I’m all in favor of it, John.

John Driscoll:

Other than correcting you for the false trade-off, that if you increase wages a little bit, you can’t take costs out of elsewhere. That’s a silly point, but the other interesting point that or a simply narrow, mechanical view of it, but he also talks about scaling up proven initiatives like Year Up, which are basically apprenticeship programs where people get a chance to … From a rougher, incomplete educational background, the opportunity they’re going to grow into a job that worked. And apprenticeship is something that was true a couple of 100 years ago. You probably remember that Dave, during the Ben Franklin era that you grew up in and Year Up, that’s right, we should invest in that.

David Williams:

Yeah. I actually had an internship with Ben Franklin making kite strings. I’ll tell you about that in another time. Now, the next one I already told you, I think is a stupid idea, which is the huge expansion of drug treatment programs. Forget that, that’s a big waste of money and it’s a further transfer of funds into the health care industrial complex. I’m against that, John.

John Driscoll:

I’d spend the money, if we could get it right. But right now, I agree with you. But what about that … The Biden child allowance, what is it about 350 bucks per kid, per month. That is part of the emergency stimulus of President Biden. You’re kind of stingy actually, with allowances for your kids, but what do you think of Biden’s more generous investment?

David Williams:

Well, so if it’s $350 a month, I guess that’s going to be $351 for my kids because they currently get about 25 cents a week. I don’t think it’s really a great idea, but I actually think this is an example of Biden being savvy. So rather than calling it like an income transfer or something that looks like it’s a socialistic thing, you focus on what’s happening. It’s not a transfer from old to young or from rich to poor, but it’s a childhood and it’s allowance. It’s a good thing. I think it’s a good marketing. They should say, a childhood allowance, just like the military gets an allowance.

John Driscoll:

And bandwidth for all, your favorite. I know that you’re sort of a technophile, what did you think of that?

David Williams:

Well John, people compare it with like the Tennessee Valley Authority, rural electrification project. The truth is, remember when people were saying I got to get my son a computer or my daughter so that they can keep up in school? Bandwidth for all, is just going to mean more looking at TikTok and Facebook and other nonsense. So I think dial up is good enough for people.

John Driscoll:

You’re too much of a cynic. I think it’s essential that we have universal access to bandwidth. It’s proven absolutely critical during COVID. Digital first is going to be more of an issue going forward. Everyone needs to have access to technology and bandwidth, particularly at a time when we’re trying to turn around parts of these communities. And I think that what this comes down to, and it reminds me of the sainted Senator Moynihan’s point, that we need a national family policy. The breakdown in these communities, the breakdown of some of these core elements of citizenship. Being able to work a full 40 and get paid a living wage, that’s elemental. Making sure people have the money to pay for their kids, early childhood education. That’s elementally about a family policy. And if we could kind of frame it that way, I think we’d get much more buy-in. We would even be able to get in a red state or blue state policy. It might actually be a red, white and blue policy.

David Williams:

Well John, speaking of bandwidth, I’ve about hit the cap of the length of this episode and I’m sure our listeners have as well. I don’t want Comcast or anybody else to be … T-Mobile to be charging anybody any overages here. So I’m going to say, we wrap it up now John. And say, that’s it for this edition of Care Talk. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. If you like what you heard, please subscribe and leave us a review. Thanks for listening.