To oversimplify, the lives of the mothers in the suburban group were not startlingly different from those of the mothers in the inner-city group. Though they certainly fared better in employment, income, and independence of welfare, the differences were not great. Interestingly, though, neither group of mothers felt more socially isolated than the other, which is to say that the poor, black mothers in the white, middle-class neighborhoods felt no more socially isolated than their counterparts in the city. It was not that the suburban mothers did not often feel isolated; they did. But so did the inner-city mothers, who often felt forced to choose self-isolation as a way of protecting their children from the dangers of the ghetto.
It was in the lives of the children as they grew that the important differences were noted. As might be expected, the several years immediately following their transfer to more advanced suburban schools proved trying for children from the inner city. They had much to catch up on—in many cases years of work—because their previous schools had simply not been teaching at the same level. After three or four years, however, their performances improved markedly. They began to do as well compared to their suburban peers as their inner-city counterparts were doing compared to their inner-city peers. To express it another way, if black inner-city kids had gotten A’s in the inner-city, they were now making A’s in the suburbs; those with B’s in the inner-city had B’s in the suburbs, and so on. The children had “jumped the track” from ghetto educational standards to suburban educational standards.
Some of these children have now been followed for over twenty years, and the differences between the two groups continue to be astonishing. Far more children in the suburban group graduated from high school, ten times as many matriculated into four-year colleges, and, of those that did, there were proportionately fewer college dropouts. As these children now move into adulthood, similar differences are being found in their employment histories and income levels. While their roads through the suburbs were sometimes bumpy, and while not everyone succeeded, a high percentage of these former ghetto kids were moving out. For them, the cycle of generational poverty had been broken.
There are several conditions in the study that should be noted. First, only one or two families were moved into any particular suburban neighborhood. This was an important condition because it did not allow the children—especially the adolescents—to congregate and maintain a ghetto subculture in their new neighborhood or school. Children were essentially forced to integrate themselves into a suburban culture and leave their ghetto problems behind.
Second, their new neighbors knew nothing of their histories unless the new families chose to tell them. Neighbors were therefore allowed to form their own opinions of the newcomers without the prejudices that “the ghetto” immediately conjures.
Third, these black families were often integrated into white neighborhoods despite a considerable reluctance on the part of the black mothers. No one was forced to take the housing offered by the study, of course, but the very few who chose not to take housing offered to them were dropped from the study and had to move into the usual queues for inner-city housing. Since most African Americans understandably prefer to live in neighborhoods with something closer to a fifty-fifty racial mix, presumably most of these black families would have chosen to move into middle-class black or more integrated neighborhoods. In all probability, their children would have done just as well or better in affluent black neighborhoods, but this has not been tested.
These results must challenge those of us who blame individuals or their families for the frequent failures of the inner city. Take the families out of the inner city, the Gautreaux Project strongly suggests, and they will do as well as any ordinary range of families might. The Gautreaux Project is now being replicated in five cities across the United States in a U.S. Department of Housing and Urban Development (HUD) program called Moving to Opportunity. Since the participants only finished moving into their new homes in 1999, no experimental results are yet available. Affluent communities have in some cases reacted negatively to such projects, however, creating significant obstacles to the establishment of similar programs elsewhere. Public protest at a site chosen by HUD in Baltimore led Congress to eliminate funding for a planned expansion of the program. A similar non-HUD program in Fairfax, Virginia, a suburb of Washington, D.C., was canceled when neighbors objected to moving one low-income family into their affluent neighborhood.
MENDING THE SAFETY NET
In the absence of real desegregation, the task of eliminating American poverty will certainly be very difficult. It would be possible, however, to design a social insurance system that would lift the income of most poor Americans above the poverty level. The following is a proposal that, I think, could be accepted by a majority of Americans. Since it involves only one new program (favored in reliable polls by a large majority of Americans1) and an expansion of three currently existing ones, the proposal seems politically feasible.
First, the new program: universal health coverage. People cannot move out of poverty unless health care is provided to all Americans. Health insurance in the United States is currently largely employer-based, although fewer and fewer employers now offer it and still fewer offer fully paid family coverage. Most low-wage employers do not provide health insurance, and those that do often require unaffordable co-payments. On their own, low-income, working-class, and even middle-class people simply cannot afford family health care premiums that average more than $7,000 a year. With one out of six Americans currently uninsured and the trend away from employer-sponsored coverage, the only reasonable option seems to be some form of national health insurance. Congressman James McDermott, a physician from the state of Washington, has repeatedly introduced a proposal in the House of Representatives for a “single-payer plan” that would provide universal coverage to all Americans without increasing total health care costs for the country. Sixty to eighty members of the House have usually signed on to this bill.2
Like the Canadian system mentioned in the previous chapter, a single-payer plan would make the United States government into the sole “insurance company” to offer health care. Regardless of what one thinks of it in other areas, the federal government handles insurance very efficiently and cheaply. Social Security operates with an administrative overhead of less than 3 percent compared to more than 25 percent for combined overhead and profit at private insurance companies. Doctors would remain in private practice and still bill the “insurance company,” but there would be only one company to bill, the government. The plan would be administered on the state or regional level, and fee-for-service rates would be negotiated between state governments and physician representatives every year.
Such a shift would have a powerful impact on the insurance industry, and that has, of course, created strong political opposition to such a plan. There would certainly be some negative effect on the economy as private industry lost jobs that were only partially offset by new government hiring, but the increased efficiency and universal coverage would certainly be worth it.3
The administrative savings from such a plan would be enormous. Not only would government overhead be far less than private insurance company overhead, but administrative costs would also be less for doctors and hospitals. The current Byzantine system of private insurance—in which different policies exclude different conditions from coverage and pay varying amounts for conditions they do cover—is an expensive bureaucratic nightmare for health-care providers. In separate studies the Congressional Budget Office and the Office of Management and Budget demonstrated that the administrative savings of a single-payer plan would be enough to provide comprehensive health coverage for all of the uninsured in the country. In other words, we could give everyone access to comprehensive health care for the same total cost that now leaves over 43 million people uninsured!4
When polled, Americans overwhelmingly favor such a plan. Typical is a USA Today/Harris poll from November 23, 1998, in which 77 percent of the gener
al public and 53 percent of employers agree that “government should provide quality medical care to all adults.” As the Wall Street Journal indicated in a 1998 article, two-thirds of Americans said they believe that “the government [should] guarantee everyone the best and most advanced health care that technology can supply.”5 Even when it was suggested that such coverage might raise taxes by $2,000 a year (probably an overly high estimate), almost half were still supporters of the plan. “The fact that almost half of the public is willing to pay $2,000 extra to guarantee access to others is striking,” noted the Journal.6
So much for a much-needed new program. What of older programs already in place? First, the Earned Income Tax Credit, a well-accepted, successful program could be expanded so that no person working more than, say, thirty hours a week would earn less than the poverty level for his or her family. There are now millions of poor people who have a full-time worker in the family. With an expanded EITC, none of these families would be poor. Some state and even local governments have created their own earned income tax credit that is supplementary to the federal EITC. A further provision could offer an extra credit to parents of small children, making childcare more affordable. The coordination and expansion of these programs would bring all working people and their families out of poverty.
Second, unemployment insurance could be expanded so that employees who are laid off receive income that keeps them above the poverty level. Several administrative changes in the program would be necessary. Benefits for low-income workers would have to be supplemented to provide at least a poverty-level income to those out of work. Currently, unemployed people receive less than half of their previous income. Low-wage earners, of course, cannot live on half of already abysmally low incomes, so they would need significant supplements. This could be done through the tax code (even as part of the EITC), so that wage earners with larger families received adequate income. In addition, the benefit period would need to be extended so that workers could continue to receive benefits until they find work. People who refused appropriate work offered by employment services could have their benefits temporarily reduced. Finally, the program would need to be expanded so that all people who leave work are covered. Currently only 40 percent of unemployed workers receive any unemployment payments at all. The expansion of this program would mean that no person able and willing to work would remain in poverty.
Third, the government Supplemental Security Insurance (SSI) program, which provides disability benefits to those permanently disabled, and Workers’ Compensation, which provides benefits to workers who are injured on the job, must be carefully expanded in several ways. Eligibility must be extended so that between the two programs everyone who really cannot work, for whatever reason, qualifies. Currently, for example, people who are temporarily disabled due to injuries incurred off the job receive no benefits from either program. Worse, even people who are clearly permanently disabled may not receive disability determinations. Causes such as disabling back pain (often impossible for the claimant to “prove”), mental conditions that do not meet certain criteria, disability due to addiction, and many other disabling conditions do not, in practice, make the claimant eligible. As a physician, I sometimes struggled for years to get examiners at SSI to understand that one or another of my patients was, indeed, disabled.
Here again our preoccupation with the “undeserving poor” makes it harder for us to imagine solutions. Political attitudes and budget appropriations ensure that regulations are designed to weed out every single person who might be malingering. Informal agency attitudes, even the personal attitudes of the examiners, make the process stricter yet. But in practice it is not possible to screen out all those who should not qualify without excluding many who should. Of course, it is important to make sure that unemployment and disability insurances are used appropriately. But because we emphasize so strongly the exclusion of those who might not need it, too many of those with legitimate need fall through the cracks. The level of coverage under Workers’ Compensation and SSI must be increased at least to the poverty level.
The total cost of these changes would not be prohibitive. The cost of universal health care would necessitate an increase in taxes, but that would be offset by the elimination of insurance premiums paid by those employers who currently provide coverage, the elimination of premiums paid by individuals for their own coverage, and the folding of Medicaid and Medicare into the new program. In addition, because coverage for medical expenses is a large part of the cost of premiums for car insurance, liability insurance, Workers’ Compensation premiums, and other similar insurances, these costs would all decrease significantly if all medical bills were paid through national health insurance.
The exact cost of the other three programs is not known, although it would not require more than a relatively small (certainly less than 5 percent) increase in federal expenditures. In 1999, the total “poverty gap” (the amount of money required to raise all the incomes to the poverty line) was $65 billion.7 By contrast, yearly Social Security income alone is approximately $500 billion. The tax deduction that homeowners are allowed to take for the interest they pay on their mortgages (really an income transfer program to the middle class!) costs the United States treasury $63.2 billion a year.8 Compare all of this to the $1.3 trillion tax-cut of 2001, and the amounts look manageable, indeed.
Although the political likelihood of enacting the above programs is at present small, we should not confuse the issue by saying that we have “tried everything” to eliminate poverty or that “the government can’t solve the problem of poverty.” The government—that is, the American people acting together—can solve the problem of poverty, and it would be neither an enormously expensive nor utopian project. The problem has been that we have not been willing to consider it.
Would the above programs simply make it too easy for people to sit back and let the government take care of them? The evidence suggests not. The backbone of the above programs is the expansion of the EITC, which has consistently been shown to encourage work.9
AND JUSTICE FOR ALL
Even if we lift people out of poverty, of course, much of the damage that has already been done by generations of impoverishment and oppression remains and there will be much left to do. Inner-city schools will still have to be radically improved and vocational training provided for the millions who do not have the skills to enter the job market of the twenty-first century. Urban neighborhoods must be rebuilt and closer political and economic ties established between suburbs and the cities. Social services must be provided to the current victims of inner-city poverty—especially the children—to overcome some of the emotional damage already inflicted.
The details of welfare policy and governmental programs must not be allowed to obfuscate the central truth. The larger American society, through its structures and programs, built the black urban ghettos and then decimated them; it is the responsibility of those of us who benefit from the structures and programs of our society to undo the damage. The causes of ghetto poverty do not lie in the individual behavior of inner-city African Americans, but lie primarily in forces outside their control. It is up to them to do what they humanly can; it is up to the rest of society to change existing programs and create new ones to allow everyone to enjoy a decent standard of living.
Justice demands that the conditions in our inner cities be changed. The current response to the problems of poverty is mostly to add police, increase prison sentences, and throw up our hands, insisting, “There’s nothing more we can do.” It’s a response that does not match our stated values.
I have worked in the inner city for almost two decades. The poverty I see is not intractable, nor are its causes mysterious. Our social welfare programs tend to work about as well as they are designed to. We must not allow ourselves to use their failure as a rationalization that relieves us of our responsibility to our fellow citizens. The black urban ghetto exists because of concrete historical events and our failure to respond app
ropriately to those events. This inaction is not worthy of the American people, who are, at a personal level, eager to eradicate injustice and willing to give of their resources to do so. We must not let the poverty of the ghetto stand. Fortunately, it’s not too late. We know what to do, and we have the ability and the resources to do it. It’s past time that we remove this stain upon our American democracy.
Acknowledgments
Every book is the work of many people, even if only one is designated as “author,” and I am grateful for all those who participated in the creation and evolution of this book. The manuscript is anchored in eighteen years of experience at Columbia Road Health Services, Community of Hope Health Services, Christ House, and Joseph’s House in Washington, D.C. The staff and clients in those institutions pricked my conscience and my interest and first pushed me into questioning the origins of inner-city poverty. The Servant Leadership School of the Church of the Saviour several times gave me the opportunity to teach the course that is the origin of much of the material here. I am indebted to the students in those classes for helping me inquire more deeply and think more systematically about the inner city. Unknowingly, they reviewed the initial manuscripts and helped develop them.
Gordon Cosby first suggested that I take the content of the course and turn it into a pamphlet, which he encouraged the Servant Leadership School to publish. David Wade illustrated that early edition.
Urban Injustice: How Ghettos Happen Page 13