Category Archives: Entitlements

Seven Years and Counting…

Medicare’s Hospital Insurance Trust Fund (HI) will be depleted in seven years — three years sooner than forecast previously, according to the 2018 Annual Report of the Medicare Boards of Trustees. By 2026, Medicare Part A, which covers hospital payments, will be running a $52 billion annual deficit, a gap that will increase rapidly in successive years.

The forecast is based upon implementation of current policy and makes a variety of assumptions regarding employment, growth of payroll tax receipts, and hospital costs that may or may not be on target. However, the trustees note, shorter-term projections are more likely to be accurate than longer-term projects — and seven years is not that far away.

The trustees’ report triggers a formal Medicare funding warning. President Trump must submit to Congress proposed legislation to respond to the warning within 15 days after submission of the FY 2020 budget. Congress is then required to consider the legislation on an expedited basis.

The political problem is that successive Congresses and presidential administrations have kicked the can down the road for so long that any fix will be politically painful. Rather than phasing in remedies over time, allowing a smoother glide path to solvency and making it easier for affected parties to adapt, Congress will have to enact dramatic remedies…. unless it decides to kick the can down the road again, perhaps by funding the Medicare HI  gap with general revenues.

According to the Congressional Budget Office’s most recent forecast, the federal government is on track to be running a $1.076 trillion budget deficit by 2026. Maybe Congress will say, what the heck, what’s another $52 billion, let’s fund the HI deficit with borrowed dollars. But maybe it won’t. If there’s another recession between now and then, the fiscal outlook could be a lot more alarming than it is today.

Winter is coming. Reforming the federal government is hopeless. Virginia’s only hope is maintaining a fiscally robust state and local government.

The Service-Dog Thing Is Out of Control

Attorney General Mark Herring has taken action against a problem that is fast becoming a social crisis: that is, the runaway enthusiasm for “service dogs.” The AG’s office has filed a lawsuit against Service Dogs by Warren Retrievers, Inc., a Madison County dog breeder that trains Labrador and G0lden retrievers to be “diabetic alert dogs” and sells them for $25,000 a pop… er, pup.

While making grandiose claims about the dogs, Service Dogs by Warren Retrievers often delivered “poorly trained puppies with significant behavioral issues and inadequate skills or training to notify a customer of a potentially life-threatening high or low blood sugar situation,” the AG’s office said in a press release. The business also allegedly misled customers about certain aspects of its payment structure and lied about the principal’s service in the armed forces.

“Our investigation shows that, in many instances, Service Dogs was simply selling a $25,000 pet, leaving customers with a huge bill and no protection,” Herring said. “Customers have a right to rely on the accuracy of a business’s claims, especially when it involves a person’s health and well-being.”

The company says it is committed to changing the lives of those living with “invisible disabilities such as Autism, Diabetes, PTSD, and Seizure Disorders.” The website provides heart-warming video testimonials of happy employees, satisfied customers, even former Governor Terry McAuliffe, and, of course, lovable pooches. You truly have to have a heart of steel to watch these dogs and not go, “Awwwwwww.”

I don’t know if the AG’s charges against Service Dogs are warranted or not. But I will say this: The service-dog thing is out of control.

Service dogs have long been a staple of society as companions for the blind. Blind people need help navigating streets and sidewalks, and and everyone accepts the idea that the dogs can give them mobility and autonomy. Because the blind are few in number, everyone is willing to make minor accommodations for them and their dogs.

But the concept of a “service dog” is morphing. Service Dogs by Warren Retrievers is a perfect example: It helps people with “invisible disabilities” such as autism, diabetes, PTSD and seizures. That stretches the definition to encompass, I’d guess, 10% of the population. But the concept is even more elastic. Now people have “emotional support dogs.” And they want to take these dogs onto airplanes and into the workplace. If we include people who need “emotional support” among the protected category of “the disabled,” we’re probably talking about half the population!

Because the “disabled” enjoy legal protections, and because anyone who utters inappropriate sentiments might find him/herself tarred as an “ablist” and a bigot, people are scared to resist the trend. Americans always push the boundaries as far as they can, and there are no discernible criteria in our culture of victimization that people can draw upon to say, “That’s enough!”

What if you’re allergic to dogs? What if the dog sniffs your crotch? What if seeing a dog triggers post-traumatic stress because a neighborhood dog mauled your kid? Do you have rights? Not now.

Herring’s lawsuit does draw a line of a sort — the service dog must be capable of providing the advertised service, in this case, detect swings in blood sugar. That’s a start.

Can Medicaid Expansion Address the Doctor Shortage?

Teresa Gardner Tyson, executive director of Health Wagon. Photo credit: Virginia Business

With Virginia on the cusp of Medicaid expansion, it is heartening to see someone asking the obvious question: What good is Medicaid coverage if you can’t find a doctor? Bob Burke at Virginia Business states the obvious:

Getting a Medicaid card doesn’t necessarily mean you have a doctor at hand. Plenty of places in Virginia — especially rural areas — already are short of health-care providers. Oftentimes, people there depend on nonprofit community health centers or free clinics (both of which are chronically underfunded) scattered around the state, or they just go without. This is the true access challenge.

Virginia has a network of clinics, health wagons and other services that provides basic care to poor Virginians, but the system operates on a shoestring, and thousands of people fall between the cracks. An important question is what happens to the existing medical infrastructure for the poor, as inadequate as it is, when Medicaid comes along?

Teresa Gardner Tyson runs The Health Wagon, a mobile clinic that delivers care to people in Southwest Virginia. Medicaid expansion would be favorable to the people she treats, she says, but it’s not a panacea. Some of Health Wagon’s patients are already Medicaid patients — and they can’t find any other health provider.

About five years ago, Health Wagon hired a consultant to run the numbers on how best to take advantage of Medicaid dollars if they started flowing. “We’d have to go back and look at those numbers again” and see whether becoming a Medicaid provider makes sense, Tyson says. “We’re sustained by donations and grants, and at the end of the day, though, we do give free care, [but] the care that we give is not free.”

Here is my question: What happens to those donations and grants if Medicaid expansion is enacted? Will Health Wagon still have a purpose? Perhaps it will, if nothing is done to address the shortage of health care practitioners in Southwest Virginia and there’s nowhere else to go. But if that shortage isn’t addressed and patients still can’t find doctors, is anyone better off?

The Virginia Community Healthcare Association (VCHA), which has 29 member organizations at 147 sites, serves about 100,000 uninsured people every year. CEO Neal Graham estimates that of that number, about 70,000 would be eligible for Medicaid after expansion. He also estimates that expansion will bring an additional 100,000 patients into the clinics and community centers. But it’s not clear at all from Burke’s article that the clinics will have the resources to staff up to meet the extra demand.

There are two problems in rural Virginia: a lack of health coverage and a shortage of health care practitioners. Medicaid expansion fixes the first problem. But as long as the program pays less than Medicare and private insurance — typically forcing medical providers to operate at a loss — Medicaid expansion will do nothing to recruit new practitioners to under-served areas. If lawmakers want the expansion to work, they must address the shortage of doctors, nurses, and technicians. Otherwise, they’re just perpetrating a cruel hoax on Virginia’s poor.

Virginia’s Hidden Deficit: the Unemployment Trust Fund

Virginia Trust Fund Solvency. Graphic credit: “Trust Fund Solvency Report 2018.”

There are many measures for gauging a state’s fiscal condition. The most commonly cited is the condition of its General Fund: Is the state balancing its budget? Digging deeper, one can examine the degree to which a state is funding (and falling short of) its pension obligations. And one can track the extent to which a state is neglecting repairs of  highways, transit systems, buildings, water-sewer facilities, and other public infrastructure, thus building up future maintenance obligations.

Then there’s the Unemployment Insurance Trust Fund. This is the fund, financed through employer payments, from which states draw to pay benefits to Virginians laid off from their jobs. State funds are designed to build up reserves during good times so they can maintain benefits during bad times when payments spike. If states run dry, they can borrow money from the federal government, which they then are required to repay. States are not directly on the hook for unemployment insurance. But restoring solvency to a fund by hiking employer contributions is the functional equivalent of a business tax increase. Lower business contributions make for a better business climate; higher contributions do the opposite.

So, it’s worth asking what kind of shape Virginia’s unemployment insurance reserves are in. And the answer is… not very good. Not the worst — we’re not in the same abysmal condition of California, Ohio or Texas, but we fall below the recommended minimum adequate solvency level. We probably could ride out a weak recession, but are ill prepared for a severe one.

The U.S. Department of Labor publishes an annual “State Unemployment Insurance Trust Fund Solvency Report.” Twenty-nine states, including Virginia, are beneath the recommended solvency standards. The Old Dominion’s relative position compared to other states is shown in the chart above. We’re in the middle of the pack. While we’re not far from the recommended level of solvency, we’re still below it — and we certainly haven’t built up large reserves like Wyoming and Oregon.

(For those tracking the 50 states’ progression toward Boomergeddon, note that several states noted for their fiscal profligacy — Illinois, Connecticut, Kentucky and New Jersey — have among the least adequately financed trust funds.)

As of Jan. 1, 2018, Virginia has $1,148,000,000 in its unemployment insurance trust fund. That may seem like a lot, but the number is meaningless without comparing it to the number of workers it is meant to cover. The chart atop this post gets to the adequacy of that number. Unfortunately, it is far from self explanatory.

The key numbers are associated with the four blue arrows.

The reserve ratio is derived by taking the trust fund balance and dividing by the state’s total wages paid for the year.

The 2017 benefit cost rate is calculated by expressing the level of uninsurance benefits as a percentage of yearly wages. A smaller number — Virginia’s is 0.19% — is good. It reflects Virginia’s low unemployment rate and low unemployment insurance payments.

But low unemployment is expected during periods of economic expansion. The acid test is how well the trust fund holds up in a recession. So, the Labor Department benchmarks against two measures: (1) the highest benefit cost rate ever, and (2) the average of the highest three highest years over the past 20 years.

The Labor Department then calculates the Average High Cost Multiple, which is the Reserve Ratio divided by the Average Benefit Cost rate. “Values greater than one,” states the report, “are considered the minimum level for adequate state solvency going into a recession.”

Virginia’s value is 0.92, meaning (as I understand it) that its trust fund has 92% of the reserves deemed adequate to make it through a recession without resort to extraordinary measures.

Working Longer Versus Saving More

One of the big decisions Americans must make as they plant their retirement is when to start collecting Social Security benefits. The popular wisdom is that each year you delay collecting Social Security translates into an 8% increase in annual benefits. The Social Security Administration can afford to goose the payout because (1) it pays you one year less than it would have otherwise, and (2) it collects the interest on the money.

Now comes Sita N. Slavov, a George Mason University economics professor, and four colleagues with a paper, “The Power of Working Longer,” that compares the monetary rewards of working longer versus saving. The bottom line:

Delaying retirement by 3-6 months has the same impact on the retirement standard of living as saving an additional one-percentage point of labor earnings for 30 years.

I’m not smart enough to follow their methodology, so I’ll just assume that they’re right. But they’re making one critical assumption — that Social Security payouts remain the same, even though the Social Security Trust Fund is scheduled to run out in 2033. At that point, payroll taxes will cover only 75% of promised payouts.

For readers of Bacon’s Rebellion, who from my observation are more affluent than the average American, the news gets worse. When the Social Security Trust Fund runs out of money — as seems inevitable, given the bipartisan refusal of presidents and Congress since George W. Bush to touch the issue — you won’t even get 75% of what you were promised. Too many senior Americans rely upon Social Security as their sole source of income, and a cut of 25% would prove devastating. Inevitably, Congress will tweak the program to soften the blow. Thanks to the chronic budget deficits and the massive national debt that will prevail 15 years from now, the United States will be in no position to bail out the program entirely through borrowing.

There is no way to know what a future Congress will do, but I expect it will resort to some combination of borrowing, higher payroll taxes, and redistribution of Social Security benefits from higher-income Americans to lower-income Americans. There’s no way around it: The middle-class will get hosed.

I’ll qualify for Social Security benefits next year. Even though I plan to continue working and earning income, I’m going to start cashing in on the program while I’m still entitled to 100% of my benefits. I fully expect the Trust Fund to run out by the time I’m 80, and I’m arranging my financial affairs to accommodate a 25% to 30% cut in my Social Security benefits by then. In the meantime, I’m making sure I get what I’ve been promised.

I’m also telling my Millennial kids both to start saving now and to plan to work well into their late 60s. Hopefully, modern medicine will help them remain healthy, active and vigorous a bit longer than our generation, so a few extra years of work won’t prove too burdensome.

Nobody should trust the American political class to live up to its promises — especially when the consequences are 15 years down the road.

Race, Responsibility and the Welfare State

by Vic Nicholls

What is the justification for taxing people to provide healthcare? There is no mandate for it in the Constitution. The “general welfare” was never considered to include health care. The campaign slogans of the Founding Fathers never included, “Free leech treatments for all!”

Are all men “created equal”? No. Everyone has different talents. I can’t get on a football or basketball team. They can’t do what I do in Information Technology. Is it the job or responsibility of the United States government to make me equal to them or them equal to me? No. Are we equal in the sight of God? Yes.

Should people who sacrificed to made the personal choices to earn college degrees and delay having children until they were married be penalized for making those choices by forcing them to pay for others who didn’t? Would you expect to pay higher insurance because your neighbors’ kid wrecked two of his parents cars? Is it fair to discriminate against those with bad driving records? Should the government require equal insurance premiums for everyone?

If we institute Medicare/Medicaid for all, where would personal responsibility start and end? If there is a shortage of doctors, how do we determine who gets one and who doesn’t? Since we were given the right to “life, liberty and the pursuit of happiness,” how does freedom from the tyrant’s power to tax me to fund his armies and empire translate into the power of my fellow countrymen to tax me to provide them 21st-century medical care?

Nowadays, appeals to personal responsibility and initiative are described as justifications for white privilege. If you earned a B.A. degree, got a job in your field, married, and then had kids, would you expect your children to have a better start in life than one who’s parents didn’t? Of course! Does that make you “privileged”? Not at all.

Notice that in listing the essential requirements for success in life, I didn’t mention race. That’s because I know non-white spouses who followed the formula and live as well as I do.

Many assume that all differences between the races are due to racism. But once you factor out marriage, education, in-wedlock birth, age (whites are older on average than blacks and Hispanics and have had more time to climb the income scale), and inheritance from parents who made the same responsible choices, what difference is there left?

If it’s racism that keeps people down rather than hard work and grit that allow people to rise, how do we explain the career of the noted African-American economist Dr. Walter Williams? He grew up in the projects with his mother and sister, but no father. He earned a Ph.D. in 1972, and has been teaching at George Mason University since 1980, and he publishes a nationally syndicated column. Racism was worse back then than it is now. How do we explain his success?

Explain Mae Jemison. She was born in Alabama in 1956. Her mother was an elementary English/math school teacher and her father was a maintenance supervisor. Her family moved to Chicago to give her better educational opportunities. She graduated high school in 1973 and went to Stanford at age 16, graduating 4 years later with a B.S. in chemical engineering and B.A. in African/Afro-American studies. Engineering professors would pretend she wasn’t there. Her family was always encouraging, though. She got her M.D. in 1981 at Cornell.

Explain Dr. Ben Carson, Dr. Charles Drew, or countless others less famous. Explain my African-American next-door neighbors, both of whose kids have masters’ degrees. I can explain their success: My neighbors married before the kids were born and have lived in the same house since the ’80’s. They sacrificed a ton to make sure their kids got a solid start in life. 

It’s time we asked a different question: When government takes away from those who worked for their success and gives it to those who didn’t, does it subsidize failure? When government subsidizes failure, do we get more of it?

Vic Nicholls lives in Chesapeake. For more on the topic, she recommends viewing Walter Williams’ speech, “How much can discrimination explain?” on the video above.

The Cult of Personal Fragility

Once upon a time, Americans prided themselves for being tough and resilient. They were strivers. They were survivors. They bounced back from adversity. Now they have become a nation of wimps, whiners and victims.

In writing a column about the absurd proliferation of “emotional support animals” on airplanes, George Will absolutely nailed what is happening:

A cult of personal fragility is becoming an aspect of the quest for the coveted status of victim. The cult is especially rampant in colleges and universities, which embrace the therapeutic mission of assuaging the anxieties of the emotionally brittle.

Well said! I predict that the phrases, “cult of personal fragility” and “anxieties of the emotionally brittle,” will enter the national lexicon. People are fed up with this nonsense.

Trigger warning, crybabies: Nobody cares about your anxieties. It’s time to grow up and act like big boys and girls.

Entitlements, Fiscal Limits and the Looming Age of Rage

Now that Democrats are close to parity with Republicans in the House of Delegates, there is renewed talk of Medicaid expansion in Virginia. Meanwhile, in Washington, President Trump and Republicans are pushing a tax-cut plan that would spur economic growth but, even with stronger growth, would increase deficits by $1.5 trillion over the next ten years. Nobody is talking about the $14.6 trillion national debt except as a cudgel against partisan foes. Even as Medicare, Disability, and Old Age and Survivors trust funds are projected to run out within a single generation, entitlement reform is not up for discussion.

Just a reminder… Here’s are U.S. budget deficits forecast by the Congressional Budget Office without counting proposed GOP tax cuts:

The “on-budget” deficit is what we conventionally think of the deficit. It does not include the draw-down of “off-budget” Medicare and Social Security trust funds. Data source: Congressional Budget Office.

Within eight years, the U.S. will be running $1 trillion-per-year deficits every year, pretty much forever. And the CBO forecast does not take into account the likelihood of a recession or two over the next ten years, in which case deficits will metastasize.

And here’s the off-budget forecast. Payouts for Medicare hospitalization, Social Security disability and Social Security old-age programs exceed tax revenues, but interest income on the assets will keep the respective trust funds in the black for the next couple of years. By 2020, however, the off-budget numbers shift  into deficit mode and plunge rapidly thereafter.

Barring major changes in U.S. spending programs or economic growth, here’s when the trust funds are expected to run out, according to Medicare and Social Security trust estimates:

  • 2028: Disability trust fund runs out of money.
  • 2029: Medicare hospitalization trust fund runs out of money.
  • 2035: Social Security trust fund runs out of money.

Back when the Simpson-Bowles commission tackled the deficit issue in 2010 — the last time Americans thought seriously about entitlement reform — the county had 25 years before keystone social safety net programs imploded. If Congress had acted then, it could have put the trust funds into fiscal balance with relatively minor tweaks (slightly higher payroll taxes, slightly reduced benefits, slightly older retirement ages) that had a large cumulative effect over many years. But a decade of delay will require more painful sacrifices, which means they likely never will be made.

If nothing gets done until the trust funds run out of money — what I call Boomergeddon — the programs will have to cut benefits to match revenues generated. We are only twelve years from massive dislocations to the Medicare program, and 17 years from disruptions to Social Security. Baby Boomers beware, your retirement will be a lot uglier than you realize.

As for those $1 trillion+ on-budget deficits every year, they put Virginia at special risk. Any Congressional effort to tame deficits without touching entitlements will require cuts to discretionary spending, the biggest pot of which is related to defense, intelligence and homeland security…. which happens to be Virginia’s biggest industry sector. Son of Sequester will subject the Virginia economy to chronic economic stress and fiscal pain. But instead of dealing with Virginia’s long-term structural issues, the next session of the General Assembly could well consume itself in a renewed debate over expanding Medicaid.

As Americans speak no evil, see no evil, and hear no evil, we hurtle toward an era of brutal fiscal limits, broken promises to millions of Americans, and polarization and rage that will surpass anything we see today.

How Medicaid Is Cannibalizing Virginia’s Budget

Source: JLARC

Three big trends are worth noting from the Joint Legislative Audit and Review Commission 2017 state spending update, a review of state spending over the previous 10 years.

First, General Fund spending has been constrained by limited revenue growth resulting from Virginia’s weak economy. The increase in spending has averaged 2.0% per year. Adjusted for inflation and population growth, General Fund spending actually declined 1% over the decade.

Second, the Medicaid program has crowded out spending for other priorities. Medicaid hogged 60% of all General Fund revenue growth over the decade. Medicaid’s share of the General Fund pie increased by 73%.

Third, the healthy growth in non-General Fund spending was driven in large part by tuition increases at Virginia’s colleges and universities. In other words, when faced by stagnant revenue and untouchable Medicaid spending increases, legislators cut what was cuttable. They reduced state support for higher education knowing that colleges and universities could fall back upon the expedient of raising tuition.

Cheerful thought of the day: As Virginia’s population ages, Medicaid spending will go one way — up — and it will continue to squeeze other spending categories. Here’s the spin that Republican legislators put on the JLARC report:

House Speaker William J. Howell, R-Stafford: “Once again, this annual report from JLARC shows that the increasing cost of Virginia’s current Medicaid program is crowding out needed funding for our public schools, colleges and universities, roads, and law enforcement officers. We consistently argued that Virginia can barely afford its existing Medicaid program, let alone the massive cost of expansion, and this report vindicates that position.”

Speaker-designee Kirk Cox, R-Colonial Heights: “It’s a simple proposition: if you cannot afford your mortgage payment, you don’t build a new addition to your house. Virginia’s current Medicaid program covers around 1 in every 8 Virginians, and as this report shows, the costs are staggering and continue to climb, despite ongoing reform efforts. It would be financially irresponsible to ask taxpayers to fund the massive expansion contemplated under the Affordable Care Act.”

Del. S. Chris Jones, R-Suffolk: “Even as we instituted major reforms aimed at bending the cost curve, and controlled spending growth in other areas of state government, Medicaid costs continue to increase dramatically. This growth eats into funding that could be used for our teachers, law enforcement officers, and hard working state employees.”

Bacon’s bottom line: Yeah, the Republican leaders are stingy bastards for not expanding Medicaid. But the alternative is worse. Latest news on the Boomergeddon front: The state of Illinois, which expanded its Medicaid program in 2013, incidentally, and now has to cover 10% of the expanded costs not funded by the federal government, has $16.5 billion in unpaid bills. The state also has $200 billion in total liabilities, including pension debt. Meanwhile, pundits are asking if debt-ridden Chicago will become the next Detroit. One good recession, and it will be.

To see what it’s like to operate a government bordering on insolvency, watch Puerto Rico flail as it tries to recover from Hurricane Maria. It’s not a pretty picture. It’s easy to be compassionate when you’re paying with other peoples’ money. When other peoples’ money runs out, everything goes all to hell.

Poverty and the Virginia Welfare State

Greetings from the Virginia welfare state

Greetings from the Virginia welfare state

Let’s say you’re a woman living in the City of Richmond. Let’s say you have two children, ages three and seven, but no husband. Let’s say you work 40 hours a week earning the minimum wage, or $15,080 per year. How much can you potentially receive in public benefits?

Sean Gorman, the Richmond Times-Dispatch PolitiFact reporter, added up the numbers based on a report by the Virginia Department of Social Services:

  • Welfare — $3,840
  • Food stamps — $2,268
  • Women, Infants and Children food basket — $600
  • Child care assistance — $12,468
  • School lunch — $1,296
  • Housing voucher –$10,692
  • Family Access to Medical Insurance Security Plan — estimated $9,807 (based on comparison to Medicaid)
  • Total — $40,971

Add that $40,971 to the wages the woman earns, and we’re talking $56,000 a year. Then consider that the $40,971 in benefits are not taxable income. To earn the same amount in take-home pay– accounting for social security, Medicare, federal income taxes and state income taxes — the same woman would have to earn $5,000 to $10,000 more, depending on what assumptions you make. (That is a back-of-the-envelope calculation derived from running numbers through a federal tax calculator.)

Thus, under the Virginia welfare state, a woman with two young children working for minimum wage enjoys roughly the same standard of living as a woman with two young children earning $60,000 to $65,000 a year. Then consider that the 2015 median household income in Richmond was $60,700, and consider the fact that the median household income includes many two-income families.

Discussion questions:

  • Income inequality. What do these numbers imply for the debate over income inequality in the United States? Does it make any sense to decry the disparity in income without taking into account benefits that low-income households receive from the welfare state?
  • Upward mobility. What do these numbers imply for social mobility? If a woman cannot better her material condition by working diligently and acquiring the skills needed to earn more pay, do welfare benefits act as a deterrent to self-improvement?
  • Poverty and marriage. Given the incentives of the welfare state, what reason do poor women have to get married and to raise their children in a stable partnership with their father? To what extent do welfare benefits render low- and working-class men economically peripheral and irrelevant for any role other than as sexual partners?
  • The nature of poverty. To what extent is the scourge of poverty in Virginia — substance abuse, domestic violence, child neglect, ill disciplined behavior, crime, dropping out of high school, out-of-wedlock births, and associated dysfunctional behaviors — the result of material deprivation or the consequence of welfare-induced family breakdown?

I would guess that the $40,000 tally of welfare benefits is a high number — not all similarly situated women apply for and receive the full gamut of benefits. Even so, the number is extraordinary. It is a testimony to the upward-striving nature of American society that anyone makes an effort to improve themselves at all.