The Poor Really Are Different

- with apologies to F. Scott Fitzgerald.

Heather McDonald has a must read article posted at City Journal.  In it she describes the failure of a model program set up two years ago in New York which attempted to bribe poor New Yorkers into behaving in ways more in line with their long term interests:

Bribery Strikes Out
It isn’t lack of opportunity that keeps poor people poor.

A welfare mother in Central Harlem is not poor for the same reasons that a subsistence corn farmer in Mexico is poor. That’s just one of the many self-evident conclusions to emerge from a dangerously misguided antipoverty program begun by New York City Mayor Michael Bloomberg in 2007. Bloomberg’s initiative, Opportunity NYC–Family Rewards, bestows cash rewards on (for the most part) single parents and their children if they act responsibly—by attending school, for example, or by working. Interim results for New York’s effort, which is modeled on a program in Mexico that targeted agricultural peasants, are now in. Not all of them are as blindingly obvious, though, as the fact that multigenerational urban poverty in America is far different from Third World rural poverty. One detail in particular stands out: that the lives of America’s underclass are characterized by a degree of disorganization that is rarely grasped or acknowledged. The implications of this revelation will be difficult, if not impossible, for the welfare industry to accept.

The article is filled with actual data, statistics which show that the bribery worked, minimally, for those who were already most competent, and failed to make any difference for those who were least competent.  In addition, it should be clear to any honest observer that the level of poverty for the poorest in new York City is such that they would be considered rich in the Third World. 

I work part time in a clinic in New York which primarily serves the poor.  Most of my patients do not work and almost all come from broken or chaotic families.  The patients on Disability have tremendous incentive to keep their appointments, since to a certain extent they have reason to believe their continuing disability payments depend on maintaining their Psychiatric disability.  (The perverse incentives for many of my patients, who are unable to work productively because of a lack of education and sense of responsibility, is striking, but for another day.) 

I differentiate my patients, broadly speaking into four groups. 

Group A:

Approximately 25% of the patients I see have very significant, major Psychiatric disorders, including Schizophrenia and Brittle Bipolar Disorder.  I see my job as helping them remain stable, obtaining needed services, and enabling them to gain as much gratification from their lives as possible in the face of serious mental illness.

Group B:

A second, smaller group, perhaps 10% of the people I see in the clinic, consists of young people who by virtue of characterological and/or neurotic conflicts are unable to succeed in their developmental tasks, which can include graduating from school, forming healthy relationships, and negotiating the vicissitudes of life.  Many of these young people come from impoverished backgrounds and have had little in the way of role models.  I try to steer these young adults to appropriate Therapists with whom they can establish a long term therapeutic relationship which can offer an external framework for them to build upon and eventually internalize. 

Group C:

Perhaps 20% are patients with various character and substance disorders who come to the clinic seeking abusable drugs to use or sell, or seeking to "game" the system to gain the life time sinecure of payments to which they believe they are entitled.  Recently a patient, perhaps less cunning than most, said he needed disability because he didn't like to work in his previous field (in which he was last employed four years prior to our meeting.)  He had never graduated high school and had worked as a short order cook but didn't like the work or the income he could garner from the jobs available.  As a result, he was "depressed" and felt he needed help to get on disability.

Group D:

The fourth group of patients, the largest cohort, ~40% of the total, are the most troubling.  Many are deeply unhappy about their lives, which have not turned out how they would have hoped.  Most have had multiple failed relationships and are either alone or in the midst of yet another unsatisfying relationship.  Those who have school age children complain of how difficult it is to manage and control their children without a father in the house.  Their teenagers are truant and worse.  They consider themselves victims of a cruel and uncaring fate, with little agency or responsibility. They desire medication to help them cope with their realistic misery. 

Groups C and D, those with substance and/or severe character pathology and those who have failed at life, are impoverished by their own decisions, not by any lack of opportunity.

(The percentage of missed follow-up appointments for medical problems and tests, or work evaluations, hovers north of 75%, despite frequent reminders.  These are the kinds of issues that the program described by Heather McDonald were designed to address.)

The most tragic patients are those who come to the clinic in Group B and show themselves to be merely sojourning through Group B on their way to Group D. 

One young woman, raised by a single mother who had chronic anxiety (and who had long ago surrendered to her anxiety) had been an academic stand-out in High School.  She came to the clinic in her last year of high school, anxious about going away from home for the first time.  She appeared to engage in her therapy and did well for a time.  She did extremely well in her senior year and gained a scholarship to a SUNY school.  Unfortunately, once at school she neglected her work in favor of dabbling in recreational pharmaceuticals and dalliances with young men.  She did not return to therapy during her summer break.  By her third semester she was failing all her courses and lost her scholarship.  She dropped out of school, took a job as a hostess at a Restaurant and shortly thereafter moved in with a boyfriend who was dabbling in drugs.  When she became pregnant, he left.  Her future, so rosy two years ago, is grim.  She is likely to follow in her mother's footsteps into a life that is narrowly circumscribed and unhappy and yet another generation will be consigned to poverty.

As Heather McDonald points out, our Social Scientists and Social Engineers (Progressive Politicians) have not yet devised a way for society to address the internal deficits that keep people in poverty when opportunities abound.  Nonetheless, they will probably keep trying and spending a fortune of our money in their doomed efforts.