In his Sunday column Nicholas Kristof returns to West Virginia and calls for an “integrated set of early interventions”, including family planning, home visitation programs, support for breastfeeding, lead-poisoning prevention, and screenings for hearing and visual impairments, and pre-K. So far so good, these are all worthy social programs that we should be investing much more in as a nation.

But Kristof goes astray when he argues that “American antipoverty efforts over the last half-century haven’t been more effective [because] they mostly treat symptoms, not causes” and, in an accompanying blog post, to say he’s frustrated the current inequality debate is “mostly about the minimum wage and unemployment benefits” which “to [his] thinking are useful but not the most cost-effective measures.”

The idea that labor standards and social insurance “treat symptoms, not causes” is a very strange one. In fact, increasing our very low minimum wage would help address one of the fundamental causes of high poverty in the United States: employers’ failure to fairly compensate workers despite rising productivity. As economist Hillary Hoynes and her colleagues have found, “the lack of improvement in poverty rates despite rising living conditions is due to the stagnant growth in median wages and increasing inequality.”

This is one of the reasons why increasing our very low minimum wage rightly looms so large in current debates (as should related issues like full employment and increasing workers’ bargaining power). Moreover, while I don’t think there is much sense in comparing the cost-effectiveness of labor market standards like the minimum wage with those of social programs like home visiting, the immediate cost-effectiveness of an increase in the minimum wage is quite evident and direct since it would reduce public expenditures that currently go to subsidize employers who provide inadequate compensation. 

As in previous articles where he parachuted into deepest Appalachia to cover domestic poverty issues, Kristof continues to pit social insurance and improved labor standards against early childhood programs. This is a false dichotomy. The United States doesn’t have an unusually high child poverty rate because it raised the minimum wage too much and invested too much in social insurance, while underfunding early childhood programs over the last 50 years. It has an unusually high child poverty rate because, among other things, it didn’t raise the minimum wage enough, underinvested in social insurance, and underfunded early childhood programs, while providing massive tax benefits to the wealthy and structuring the market in ways that send money upward.

West Virginia, the state Kristof chose to highlight in his column, provides a perfect example here. According to the West Virginia Center on Budget and Policy, corporate tax cuts enacted in recent years will cost the state $205 million in fiscal year 2015 along. This is big money in a small state like West Virginia, where it amounts to about 4.5 percent of state revenues. As WVCBP has shown, it’s nearly enough, for example, to make in-state tuition free at all 4-year and 2-year colleges in West Virginia. Similarly, it would have taken only $25 million to provide a universal home visiting program in West Virginia.

But instead of expanding programs like this, West Virginia’s Governor is now proposing to cut them to close a budget deficit caused by previous tax cuts. Many of the programs Kristof says he favors are on the cutting block. Home visiting, for example, would be cut by 25 percent, under the Governor’s budget.

Of course, you wouldn’t learn any of this from reading Kristof since it doesn’t fit his frame pitting social insurance against “child investments.” It would be great to see Kristof follow up with a column urging West Virginia policymakers to put kids before corporations, but I’m pretty sure he doesn’t have the spine to do it.

Historical Appendix

One could easily get the impression reading Kristof that the early interventions he mentions—family planning, home visitation programs, free at-home help for new moms who want to breast-feed, lead poisoning prevention, screenings for problems like hearing and visual impairment, and quality pre-K—are new ideas that have little to do with the “War on Poverty.” Nothing could be further from the truth. Here’s a basic review.

  • Family Planning: As Martha Bailey has detailed in an important recent paper on family planning, the first U.S. family planning programs were first funded (quietly) under the original War on Poverty legislation, the 1964 Economic Opportunity Act. Family planning funding was then expanded more explicitly in 1967 and, with the passage of Title X, in 1970. Moreover, Medicaid, another program that has its origins in the War on Poverty, now provides the bulk of funding for family planning, with expenditures on family planning increasing by over 500 percent since 1980.

  • Early Hearing Detection and Intervention: Kristof highlights the case of “little Johnny” who benefitted from a hearing screening by the Save the Children at 18 months. What Kristof does not say is that federal legislation passed in 2000 authorized federal funding for statewide newborn and infant hearing screening and intervention programs. Since the early 1990s, the percentage of newborns screened for hearing loss shortly after birth has increased from nearly zero to about 98 percent. And West Virginia has had legislation requiring screening of all newborns for hearing impairments since 1998.

  • Preventing Exposure to Lead and Other Toxins: The Lead-Based Paint Poisoning Prevention Act, the first major federal law addressing lead-based paint, was enacted in 1971. The Consumer Product Safety Commission banned the residential use of lead-based paint in 1978, and further programs to reduce lead-based paint hazards were further strengthened in 1987-88 and in 1992. (For more, see HUD’s legislative history and CDC’s page on Lead).

  • Breastfeeding Promotion and Support: The federal government promotes and supports breastfeeding under the Women, Infants and Children (WIC) program, which was established in 1972, and reachs about 53 percent of all infants born in the United States. Under WIC, breastfeeding women are eligible for an additional 6 months of benefits (after the initial 6 months that all postpartum women are eligible for), WIC agencies can use funds to purchase breastfeeding aids, including breast pumps, and agencies must have a plan to promote breastfeeding. In addition, the Affordable Care Act amends FLSA to require employers to provide reasonable break time and a private, non-bathroom place for nursing mothers to express milk during the workday.

  • Home Visiting Programs: As Heather Weiss writes, “the war on poverty in the 1960s began another major round of home visting programs designed to help disadvantaged children and families.” More recently, the Maternal, Infant, and Early Childhood Home Visiting program was established in 2010 as part of, wait for it … the ObamaCare law! The current funding levels are very modest, but it’s a start, although if Congressional conservatives have their way it would be repealed along with the rest of the Affordable Care Act. By the way, it’s worth noting that the Affordable Care Act, which encompasses far more than health insurance, is the single, most important piece of public health and child investment legislation enacted in the United States in at least the last decade, if not much longer.

All of these programs are inadequately funded and merit greater public investments. But it’s just wrong to imply that these are new ideas that are fundamentally different from the ideas that animated the War on Poverty, or that an excessive focus on expanding the “safety net” over the last several decades has impeded their growth.