The Idle Rich And The Dignity Of Work

On Thursday, the Trump administration ruled that states could apply for waivers in order to mandate work requirements for Medicaid recipients. In its guidance to the states, the Centers for Medicare & Medicaid Services (CMS) based its ruling on what is essentially the "dignity of work" argument, a standard trope on the right.

According to CMS, "One comprehensive review of existing studies found strong evidence that unemployment is generally harmful to health, including higher mortality; poorer general health; poorer mental health; and higher medical consultation and hospital admission rates.  Another academic analysis found strong evidence for a protective effect of employment on depression and general mental health.  A 2013 Gallup poll found that unemployed Americans are more than twice as likely as those with full-time jobs to say they currently have or are being treated for depression.  Other community engagement activities such as volunteering are also associated with improved health outcomes." Now I will fully admit I haven't read all the studies cited here. But I'm sure these days the biggest effect that unemployment has on health and depression comes from the lack of financial wherewithal with the loss of dignity caused by unemployment coming in a distant second. In fact, CMS also cites another study that shows that "higher earnings are positively correlated with longer lifespan". That seems the more relevant issue.

Because the Republican party's philosophy today is to make sure everyone feels as much pain as possible, even its own voters, Kentucky has become the first state to implement these requirements. Besides creating conditions that will probably throw tens of thousands off of Medicaid, Kentucky's rules will also mean that many others will go for months without Medicaid because they have violated some of the complex rules around the requirement. There is a 6 month lockout period for failing to register annually or failing to report any change in circumstance. In addition, those who fail to comply with the 80-hour per month work requirement will lose their eligibility until they complete a state health or financial literacy course. Of course, the governor, Matt Bevin, has made it clear that dignity of work has absolutely nothing to do with the state's actions. The whole goal is to cut as many people off of Medicaid as possible because they are "an expense Kentucky cannot afford."

We see this same dignity of work argument used against proposals for a Universal Basic Income in response to the growing threat of artificial intelligence to employment in general. This is summarized by Oren Cass in a National Review article where he says, "Those who work to provide for themselves and their families know they are playing a critical and worthwhile role, which imbues the work with meaning no matter how unfulfilling the particular task may be. As the term 'breadwinner' suggests, the abstractions of a market economy do not obscure the way essentials are earned...Stripped of its essential role as the way to earn a living, work would instead be an activity one engaged in by choice, for enjoyment, or to afford nicer things."

Remarkably, though, when it comes to the idle rich, the very people empowered by the latest Republican tax bill, the conservative mantra of the dignity of work seems to disappear. For centuries, there have been an entitled rich who live off inheritances, some of whom wasted their lives on sex, drugs, and hedonism. But you don't hear Republicans saying that trust-fund babies need to have their inheritance taxed to the max so they can learn the dignity of work. It's exactly the opposite. The "death tax" must be repealed. The new tax bill explicitly benefits passive ownership of businesses, hardly encouraging actual work. Similarly, Republicans are never concerned that someone who has made billions of dollars should have his marginal tax rate raised to 90% otherwise he/she might leave it to the children or, God forbid, might stop working themselves, thereby losing the dignity of work and engage in activities "by choice, for enjoyment". No, as Oren Cass readily admits, the real concern for conservatives is, "An underclass dependent on government handouts would no longer be one of society’s greatest challenges but instead would be recast as one of its proudest achievements." The class and racial bias in that statement is staggering.

Beyond the pros and cons of UBI, the one thing we should all be able to agree on is that income is one of the great drivers of health and well-being. And, as the idle rich already show us, most people do not just take the money and waste their lives with it. They find their passions and pursue them. And, as every parent will tell you, there are things that provide dignity and pride far beyond making money. That is just as true of the "underclass" as it is of the rich. The vast majority of the people on Medicaid already have a family member that is working, Cass's "breadwinner", and are on Medicaid because some disability or care-giving responsibilities prevent them from working. So all this talk about the dignity of work from Republicans is just blather, another excuse to punish the least among us, nothing more.