Basic Income’s Lessons For Health Care’s ‘$1,007 Sandwich’
COVID-19 is changing the conversation around basic income.
Zi-Ann Lum, HuffPost Canada, 03/29/2020
OTTAWA — Poverty has long weighed on Hugh Segal’s mind. For decades, the former senator has been a vocal champion for a guaranteed basic income to lift the country’s poorest out of the cycle of poverty. He credits his formative years, growing up in an immigrant family in Montreal’s working-class Plateau neighbourhood, for sowing the seeds of his advocacy.
“What bothers me the most about [poverty] is the amount of people whose lives are being wasted because they’re caught in a scramble of too many jobs, too little pay, insufficient resources to cover rent, food, transport, clothes,” he said, in an interview. “Their kids pay a huge price, and it produces all kinds of difficulties.”
Poverty doesn’t affect only low-income earners, he added. To illustrate his point, the former chief of staff to Brian Mulroney shared an anecdote about the cost of preventable illnesses to a public health-care system. He called it “the $1,007 sandwich and bowl of soup.”
The story goes that researchers at a Toronto hospital studying population health noticed a trend among some lower-income patients who would show up in the emergency room. The cases seemed to be a chronic illness, but after triage, staff believed what the patient would benefit most from was a bit of advice and a bowl of soup and a sandwich.
“Seven dollars for the hot bowl of soup and sandwich, $1,000 for what it cost to do the triage to figure out what [their] health circumstance was when [they] showed up,” Segal explained. There’s plenty of research to support this, showing low-income people are at a higher risk of diabetes, heart disease and chronic illnesses than Canada’s richest 20 per cent. Segal’s point is clear: When people don’t have resources, they don’t have resilience — and that affects everyone.
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I spoke to Segal at the end of February. Two weeks later, on March 11, the World Health Organization declared the COVID-19 outbreak a pandemic. Stories from overworked Italian doctors warned the world to move past nationwide nonchalance and take preventative measures seriously. In less than three weeks, the highly contagious respiratory disease had stretched that country’s health system beyond its limits, bringing it to its knees.
On March 12, the NBA suspended the rest of its season after a player tested positive for COVID-19. That same evening, Prime Minister Justin Trudeau’s wife, Sophie Grégoire Trudeau, was diagnosed with the disease after developing flu-like symptoms days after speaking at a high-profile London, U.K., arena event. Actor Idris Elba also tested positive, after posing for a picture with her there.
By the end of the week, office workers were being told to work from home on the advice of health officials. Panicked shoppers cleaned out toilet paper and pasta from grocery store shelves. Social distancing became a ubiquitous term overnight. One by one, municipalities and provinces declared states of emergency. Health workers urged us to #FlattenTheCurve. Countries around the world announced border closures and restrictions on non-essential travel. We’ve been told to cancel dinner plans with family and friends and to move them online. Stores, restaurants and bars began to announce temporary shutdowns on their Instagram pages. Then workers, particularly those in the tourism, travel and hospitality industries, started getting laid off.
“The economic impacts of the pandemic will be brutal,” Canada’s parliamentary budget officer, Yves Giroux, tweeted, hours after the federal government announced a $82-billion financial assistance package to mitigate the financial shock caused by an entire country being grounded home for an undetermined period of time. A week later, the value of that announced aid package had risen to $107 billion and tens of billions more were to be spent to help small and medium-sized businesses.
Academics and advocates from around the world have used this moment to urge political leaders to see the coronavirus pandemic as an opportunity to “save lives” and test a universal basic income.
With the economy unfurling at the mercy of the current COVID-19 public health crisis, the Canadian government has introduced new measures to get money directly into people’s pockets. It’s a live test of a kind of guaranteed basic income. Employment Minister Carla Qualtrough told the Canadian Press recently it could be a preview of a new normal.
“This could be the impetus to really, radically simplify how people access income support from the federal government,” she said.
The basics of basic income
It’s a concept of many names.
Guaranteed basic/liveable income is the idea that there should be a social welfare program in place to, like its name suggests, guarantee everyone a sufficient minimum to access the basic necessities of life such as food, clothing and shelter.
There are two ways a guaranteed minimum income can be transferred directly to individuals or couples.
One avenue is through a universal basic income, where everybody gets a cheque. This flat amount would be given to all citizens, regardless of their employment or financial situation.
The other option is a negative income tax. Eligibility is based on a person’s employment or financial situation. Families with no income are eligible for the maximum amount to reach a baseline minimum income. To implement this, governments would have to decide on a baseline income (for example, the market basket measure, which is Canada’s official poverty line) as a measure of minimum support. Any income above would be taxable. Anything below would be eligible for a top-up to meet that baseline level, similar to the Guaranteed Income Supplement for low-income seniors.
Guaranteed income for emergencies
The economic crisis caused by COVID-19 has forced countries to think on their feet — and to be open to putting cash into people’s pockets, quickly. In the U.S., the Trump administration has put together a $2-trillion stimulus package that includes one-time $1,200 payments to every American adult who earns less than $75,000, plus an additional $500 per child, to help get people financially through the pandemic.
Canada has promised a suite of targeted measures, including two kinds of direct payments: a top-up of its child benefit and the Goods and Services Tax credit to help low and modest income earners. A new Canada Emergency Response Benefit (CERB) has also been introduced as a safety net for impacted workers who are not eligible for employment insurance. It promises monthly, $2,000 cheques, for up to four months, to Canadians who’ve earned at least $5,000 in the previous year and have seen their income drop to zero because of the COVID-19 crisis. The money is taxable, reported as income and progressively taxed next year.
A senior official in the prime minister’s office told HuffPost Canada they favoured the CERB’s targeted approach because it allowed the government to give more money to those who need it most, rather than spread the cash thinly to everybody, including those whose incomes are unaffected by the pandemic. HuffPost is not identifying the official because they were not authorized to speak publicly on the topic.
One factor repeatedly cited by officials is the need to get cash out quickly and the fact the government has no database with every Canadian’s address.
Another factor was timing. There may come a time, one official said, when the government does decide to send money to those affected by the pandemic or not to help pump the economy. But right now, with mainstreet shopping sprees temporarily verboten and scores of businesses on hiatus until further notice — where would those with extra cash spend it?
‘I can’t stockpile,’ says ex-basic income recipient
When coronavirus panic shopping became a thing, Ashley was constantly reminded of not having the financial means to buy her own emergency reserve of food. The viral photos and videos of people hoarding groceries annoyed her. “I can’t stockpile,” she said. “Where’s my help?”
The single mother, who didn’t want her full name published because of concerns about the stigma of being on welfare, lives in subsidized housing in Hamilton, Ont. with her 13-year-old son. Diagnosed with post-traumatic stress disorder and generalized anxiety disorder, her income comes solely from the Ontario Disability Support Program (ODSP) cheques she gets at the end of each month. She is not eligible for the government’s new $2,000 monthly CERB payments. The Ontario government has promised new discretionary benefits for those on social assistance, but details are thin.
“There is really nothing available,” she said about COVID-19-related support for those on social assistance. “No increase in cheques either.”
She receives less than $21,000 annually. It takes careful budgeting to make sure she meets her basic needs and those of her autistic son. “There’s more month at the end of my money,” she joked over the phone.
Ashley was one of 4,000 participants in Ontario’s cancelled basic income pilot project launched by the previous provincial Liberal government. She qualified because she earned less than $34,000 annually and lived in Hamilton, one of the three regions researchers selected for the pilot. Couples qualified if they earned $48,000 or less, collectively.
Watch: Photographer chronicles scrapped basic income pilot. Story continues below.
By the pilot’s design, basic income cheques were reduced by 50 per cent for every dollar participants earned in employment income. You would be able to keep your hard-earned money, get a slimmer top-up, preserving the incentive to work. This was a remarkably different rubric to the one followed by Ontario Works, the province’s welfare program.
Under existing rules, adult welfare recipients are taxed 50 per cent on all earnings after the first $200 in employment income. The high taxation rate, according to anti-poverty advocates and social assistance recipients, leaves many feeling trapped.
“When I was on basic income I wasn’t using food banks,” Ashley said, adding that she wasn’t stressing about having enough money to buy bread. “My mental health went up. My morale went up … I was actually shopping at the grocery store.”