How The Poor Live Now

editorial in Vanity Fair, December 2003

Many of America's poor can't find a job. Others work two or three. Then there are the children. The number who live below the poverty line continues to climb. If we decide this is unacceptable, writes a leading presidential candidate, we can do something about it

Growing up in New York City, I was acutely aware of those around me. The city has a particular closeness that makes it impossible to shield oneself from social inequality; some of America's richest and poorest families live literally within blocks of one another. As a child, I often rode the Lexington Avenue subway; studying the faces of the working-class adults who commuted down from Spanish Harlem and the Bronx. They sometimes had their children in tow, and it did not take a great leap of imagination to envision trading places with one of them. Even at that young age, it was obvious to me that there was very little separating us, other than a few subway stops and circumstances of birth.

Working hard and giving back to the community and to society were familial expectations, and the effects of my doing so would prove far deeper than just a sense of civic duty and a solid work ethic. As my three brothers and I grew older, our exposure to people across the economic spectrum began to shape how we saw the world. Charlie (who would perish in Laos in 1974, near the end of the war in Southeast Asia) spent time working with underprivileged children, while I chose a summer clearing fields and repairing corrals on a Florida cattle ranch. I worked alongside Cuban exiles who spoke little or no English; many could not find employment of any other kind. It was a grueling job, but the toil was tempered with the knowledge that I had a comfortable home to return to at the end of the summer. The same could not be said for most of my Cuban counterparts, a reality to which I was not oblivious.

Poverty had many faces, I was learning; it seemed not to spare those who worked the longest or labored the hardest, and there was certainly no guarantee of escape, regardless of dedication or force of will. A stint as an undergraduate teaching junior-high-school children from low-income families in New Haven only deepened my sense of the realities of social inequality. I clearly had opportunities that others never would, and although I did not feel guilty about my upbringing, it was obvious that the playing field was not a level one.

After graduating from college, I followed in my father's footsteps and began working on Wall Street. I wasn't sure what I was cut out for, but it clearly wasn't investment banking. After some soul-searching, I decided that I wanted to pursue a career in medicine-- the idea of setting up my own practice appealed both to my impulse toward community responsibility and my hope of making a concrete, tangible difference in the world, one person at a time.

While in medical school, I had an encounter that crystallized my thinking about the effects that poverty can have on the entire course of an individual's life. I was attending Albert Einstein College of Medicine, in the Bronx, and I was on my psychiatry rotation in one of several Bronx hospitals among which I circulated. A 14-year-old Puerto Rican boy came in for treatment. Robert (a pseudonym to protect the patient's privacy) was psychotic, and he was also from a poor family. I knew enough about the condition to understand that it could be influenced by any number of factors-- lack of pre-natal care, nutrition, early medical attention, or ability to pay for treatment, to name a few. If Robert's family had been able to shoulder the burden of his incredibly expensive condition, would it have progressed to such a stage?

Robert was not unique. Every day in the Bronx, I saw how low-income patients who had left serious illnesses untreated because they couldn't afford to go to the doctor. It was a terrible cycle being played out in slow motion before my eyes: a small, treatable condition appears; it goes unattended, grows into a serious health risk that finally erupts with a vengeance; and the patient lands in the emergency room. The bill is astronomical, and the family is bankrupted.

Any sane person could conclude that this was not the most efficient way for our health-care system to be run, nor the most humane. I had no doubts that capitalism was the best possible economic model (I had been raised by a stockbroker, after all), but there were gaps, inconsistencies, and plain cruelties that the market alone would never address, and not only in health care. It seemed to me that local communities and national government had roles to play in easing the pain of economic inequalities.

This view was in line with prevailing attitudes at the time. Politically, the question of the government's role in addressing poverty appeared to have been settled long ago. I came of age during John F. Kennedy's New Frontier and Lyndon Johnson's Great Society, saw Barry Goldwater's anti-government extremism beaten back in an electoral landslide, and took note as Republican Richard Nixon followed in his Democratic predecessor's footsteps in continuing to develop progressive initiatives to fight a "War on Poverty". Regardless of ideology, everyone seemed to agree that using government as a tool to ensure social justice was generally in the best interests of the nation as a whole, as long as it was done sensibly.

It's hard to believe how much we've changed since then. The ideal of national community, along with an ethos stressing that "we're all in this together," has been replaced by a widening chasm between the rich and the poor, a shrinking middle class, and a "fend for yourself" attitude. This transformation happened gradually, but was influenced by governmental actions and rhetoric from the top down. In 1980, Ronald Reagan won the presidency while denouncing "racial quotas" and "welfare queens," convincing a dispirited electorate that someone else was to blame for their problems (a technique which is particularly effective if the "enemy" is a group, such as low-income single mothers, in no position to fight back). Since then, many on the far right have become more and more fearless about promoting tax cuts for those at the top (resulting in fewer services for those who need them most), while accusing those who oppose these measures of inciting "class warfare."

The numbers are startling: When you adjust for inflation, the minimum wage in this country has actually decreased 38 percent since 1968, according to the U.S. Bureau of Labor Statistics. Meanwhile, the booming economy of the 90s did not assist many of those in the lowest income categories, especially in areas where housing prices rose while incomes remained stagnant. In 2002 alone, according to the U.S. Census Bureau, 1.7 million more Americans dipped below the poverty line, bringing the national total to 34.6 million. Nearly one-third of those-- 12.1 million-- are children. Tax cuts tilted toward the highest earners have accelerated the problem; as federal income taxes are reduced, state and local taxes are often forced to rise. Many of these, such as the sales tax, disproportionately affect low-income workers. Supporters of tax cuts will tell you that everyone benefits, but in many cases they don't. I recently received an e-mail concerning a Georgia family about to be evicted from their home. They had just received their tax-rebate check. After paying their federal income taxes last year, they were expecting the promised $400 per child. But their total rebate for their two children was $13.50.

What we have seen since the 1970s is a governmental effort that has ended up directing even more wealth into the hands of those at the top, while the safety net for those at the bottom slowly frays. This has resulted not in a rising tide lifting all boats but in an ever shrinking middle class and a breakdown of our American community. Most critically at risk are families like Robert's, which have had the odds against them from the beginning, and which now have no recourse available to them other than that offered by a government whose anti-poverty program, they feel, is rapidly becoming little more than "Get a job."

If only it were that simple. Some American families are on the verge of permanent hunger in spite of the fact that the parents may be working not one but two or three jobs. Their problems are usually not limited to putting food on the table; many such families cannot house themselves or afford to seek treatment for their medical problems. Poverty knows no prejudice: my first patient on my first E.R. rotation in the Bronx was a 13-year-old African-American girl who was dealing with complications from an unwanted pregnancy; my first patient on my first E.R. rotation in Vermont was a 13-year-old girl in exactly the same circumstances, but Caucasian. The face of poverty is rural, it is urban, it is black, white, Hispanic, male, female, young, and old. It is an American face. These families work as hard as any of us, and many work harder than most, and yet they spend their lives one paycheck, one accident, or one medical emergency away from total financial ruin.

And the problem is not confined only to those below the poverty line. As I've traveled the country, I've felt nothing so much as a sense of fear. People everywhere are afraid that very little separates them from disaster, that their jobs are not secure, and that if they lose their jobs there will not be another one waiting. They know something is wrong in our country, and they don't know what they can do to make it right. Most are good people who work hard. I have seen their joys, their frustrations, and their attempts to change their reality. The problem is not one of the motivated versus the lazy. It is larger and deeper, and if we are going to address it, we must do so honestly.

Ultimately, the question is: What kind of country will we be? Will we be a country that declares anti-poverty efforts a national embarrassment or a national priority? Will we be a country that values escalating tax cuts for the highest income brackets, or one that values the services that tax cuts inevitably kill through financial starvation? Will we accept the problem of poverty as a consequence of capitalism, or will we strengthen capitalism by restoring fairness? Will we choose leaders who practice a politics that polarizes, or leaders whose politics address the common good, targeting not just those most likely to go to the polls but also those who don't or can't? In short, will we close our eyes and ignore one another, or will we stand together as a community?

I do not accept that there is no solution. I know, because in cities and towns across America, I have seen remarkable ones. I believe that, since poverty stems first and foremost from a breakdown in community responsibility, community-based solutions can lead the way in helping us understand how to overcome it.

Fighting poverty can be about providing more opportunities to get ahead. In Mississippi, Governor Ronnie Musgrove recognized that even in today's technological world many of the students in his state were not being taught any computer skills, largely because so many districts could not afford up-to-date equipment. Job training and entrepreneurship were also in short supply in Mississippi, crippling economic growth. The state came up with a beautifully innovative solution. Through a Computers in the Classroom initiative, the governor teamed up with the AOL Foundation and a local Mississippi nonprofit group to train teachers in educating students about repairing, upgrading, and building computers. Classrooms across Mississippi became impromptu high-tech factories-- some were compared to old-fashioned barn-raisings-- where students not only made computers for themselves and their fellow students, but learned skills to which they likely never would have been exposed. Many graduates of the program now have plans to pursue careers in computer science and computer repair, and some even plan to start their own local tech businesses.

Long-term investments in communities can also reduce the likelihood of poverty for future generations. In West Los Angeles, the Mar Vista Family Center, which is funded both publicly and privately, interacts with low-income parents and children in order to help develop truly nurturing environments so that kids have the skills to succeed later in life. I've long been a believer in early education as a key to success, and Mar Vista, like Vermont's Success by Six program, operates on the premise that investing now in families with young children beats investing in social programs or prisons later.

Another approach to the problem of long-term poverty is to eliminate those expenses that can trap families in a cycle of debt. In my home state of Vermont, the rising costs of health insurance had caused many of our small businesses to cancel coverage for their employees, and many more poor families had gone uninsured for long periods of time. As I had witnessed years before in the Bronx, many illnesses were going untreated until circumstances were dire and costs were prohibitive. We felt that something had to be done to make health care more accessible to those who could not afford it. By working within existing programs, we were able to expand coverage to 91 percent of adults and to virtually every child in the state. Low-income Vermonters now have a resource to ensure that they remain healthy and are not ruined by medical expenses.

The hard truth is that there is no single solution to long-term poverty. But simply because the problem is daunting does not mean we should shy away from trying to solve it. The faces on these pages come from communities across America, and I believe that, when we pull together as a national community and focus on the faces behind the statistics, the American people can effect extraordinary change. We must invest in that change. To paraphrase John F. Kennedy, our work may not be finished in the next few months or the next few years or perhaps in our lifetimes. But for the sake of our United States and all who dream of living out its promise, let us begin-- one face and one community at a time.

Transcribed from a hardcopy of Vanity Fair

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