In a a juxtaposition of events that redefines the meaning of “coincidence,” President Trump announced a new policy for prescription drug pricing this morning, and the the Spring 2025 issue of the Journal of Economic Perspectives, released three days ago on Friday morning, begins with a four-paper symposium on drug pricing. (Full disclosure: I work as Managing Editor of the JEP, so this coincidence was perhaps more apparent to me than to others.) The four JEP papers are:

• “Economic Markets and Pharmaceutical Innovation,” by Craig Garthwaite
• “Patents, Innovation, and Competition in Pharmaceuticals: The Hatch-Waxman Act after 40 Years,” by C. Scott Hemphill and Bhaven N. Sampat
• “Lessons for the United States from Pharmaceutical Regulation Abroad,” by Margaret K. Kyle
• “The Economics of Generic Drug Shortages: The Limits of Competition,” by Rena M. Conti and Marta E. Wosińska

Trump’s proposal starts from the well-known fact that US consumers pay higher prices for brand-name prescription drugs than buyers in other countries. His executive order (yet to be tested in court) would require that US consumers pay prices for drugs no higher than charged in other countries. From the JEP paper by Margaret Kyle:

Kyle points out that Trump’s proposal fits under the category of “external reference pricing,” which is to say that US drug prices for brand-name drugs would be set based on prices in other countries. Of course, if this was to happen, the players in the market would adjust: for example, drug companies would probably seek to charge more for brand-name drugs in other countries. Trump’s executive order does not differentiate between brand-name and generic drugs, but the logic of the order suggests the possiblity of higher US prices for generic drugs.

Kyle points out that many European countries already have a version of “external reference pricing”–in which prices for a drug in one European country are not supposed to be more than in neighboring countries. Strategic maneuvering results. Kyle writes:

A less optimistic assessment of external reference pricing considers the European experience. As noted above, external reference pricing like this would induce a number of strategic responses from other stakeholders. These include delayed launch and/or supply limitations to lower-price markets, as well as efforts to make products less comparable across countries (Kyle 2007, 2011; Maini and Pammolli 2023). … Some European countries also use hidden rebates. For example, the use of France as a reference by other countries ultimately led to agreements between manufacturers and the government to establish a public price as well as secret rebates paid by manufacturers back to the government (Kanavos et al. 2017). This allows the official price (that which is referenced by other countries) to be higher, like the list price in the United States, than what is in fact paid. These nonpublic prices have prompted calls for greater price transparency, but the effects of increased transparency here are ambiguous. When (true) prices are secret, a manufacturer can more easily lower its price in a country, because it sees no negative consequences from having that secret price referenced by other countries. In concentrated markets, transparent prices could also facilitate collusion by manufacturers. However, nonpublic prices make economic assessments much more challenging. The evidence suggests that US adoption of reimportation or external reference pricing would have only modest effects on US drug prices (but would probably reduce access or price transparency in other countries).

But there are two elephants in the room along with this discussion. One is that the higher prices for brand-name drugs paid by Americans also fund the research and development costs of pharmaceutical companies. The Trump administration is seeking to cut government support for R&D in other ways, like reducing grants given through the National Science Foundation. If we are threatening to cut off the sources of funding for pharmaceutical R&D, it raises a fundamental question: What’s a new drug worth, anyway?

The fundamental tradeoff in US pharma markets is that drug companies do research, get patents, and then charge a lot for brand-name drugs. But after the patents expire, the drugs become available in generic versions, where US consumers actually pay less than those in other countries. Hemphill and Sampat point out in their JEP article how this tradeoff was formalized into law 40 years ago with the Hatch-Waxman act. As Conti and Wosińska point out in their JEP article: “In 2023, 92 percent of US drug prescriptions were filled as generics, representing less than 13 percent of overall invoice spending on drugs …”

Of course, a primary benefit of new drugs is their health benefits. In JEP, Garthwaite sketches some past and future benefits of new drugs:

Pharmaceutical innovations are responsible for 35 percent of the remarkable decline in cardiovascular mortality from 1990 to 2015 (Buxbaum et al. 2020). Previously deadly conditions such as HIV/AIDS have been transformed into manageable chronic maladies and others such as hepatitis-C have been cured. Gene therapies are becoming more commonplace as treatments for a wide range of rare and deadly genetic conditions. Advancements in immuno-oncology are providing meaningful advances across a variety of cancers as the body’s natural systems are used to combat cancer. Most recently, the first truly effective treatments for obesity in the form of GLP-1 agonists have emerged with corresponding improvements across a host of cardiometabolic outcomes such as heart disease, diabetes, and chronic kidney disease.

However, the benefits of successful pharma R&D go beyond immediate health benefits for the ill. Garthwaite writes:

[M]edical technologies transform the medical risk individuals face (that is, becoming afflicted with a condition for which there is no treatment) into a financial risk (that is, finding a way to finance the purchase of medical innovations if they get sick (Lakdawalla, Malani, and Reif 2017). All risk-averse consumers should value this reduction in health variance. Indeed, the insurance value of the new innovation can even exceed the value of health insurance in the first place, especially for disease areas where the existing treatment armamentarium is quite poor and the physical effects of the condition are quite severe. This could explain why many treatments for rare diseases so often exceed several thresholds based solely on clinical value. Another gain from new drugs is that scientific progress is often iterative, building on the knowledge and insights from previous advances. Thus, an optimal level of innovation will only be achieved to the extent the eventual value created for society by the next generation of innovations is in some way accounted for in revenues for the manufacturers making incremental progress. … Consider how medical innovations can change available treatment options for individuals who are not yet afflicted, but could become sick in the future.

To put it more bluntly, none of us knows what health conditions we or our loved ones may face in the future. Successful new drugs reduce this risk of what might happen. Paying a lot for a new drug when you need it is no fun, but not having the drug available at all is probably worse.

The other elephant in the room is about the long-term health of the pharmaceutical industry. The Trump administration has put a high priority on supporting US producers in many industies. Well, US firms account for 40-50% of global pharmaceutical sales, according to industry sources. There are about 350,000 US jobs in “Pharmaceutical and Medicine Manufacturing.” The success of the US firms is driven by spending 20% or more of its revenue on research and development, most years. In short, policies that dramatically reduce R&D spending by pharma companies will kneecap their ability to stay ahead as leading exporters in global markets, and pose a threat to several hundred thousand US jobs.

There are a variety of potentially useful mechanisms to negotiate lower drug prices for US consumers discussed in the papers of the JEP symposium, which do not threaten to cut off the future pipeline of new drugs.

But clearly, President Trump prefers what might be called a bumper-car approach to issues: that is, ram full-speed into a problem with a half-baked proposal, then spin the wheel back and forth while backing rapidly away, then ram full speed into the same problem again, and so on. Whatever the merits or demerits of this approach as a negotiating strategy, R&D projects are long-run investments that pay off only over extended periods of time. Playing bumper-car games means that industry will focus on project with a more immediate payoff, while reducing or postponing projeects that would only have longer-run payoffs. But it will be very hard to identify those groups of future patients who suffer because future breakthoughs in new drug therapies are delayed, or don’t happen at all.

The post What’s a New Drug Worth? first appeared on Conversable Economist.

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Every year, hurricane season rolls across (mostly) the southern United States and every Republican affected by it suddenly converts to a diehard big government socialist. The rest of the year, the federal government is evil and wicked and useless. But when the flood waters come and the winds tear the roof off their house? Well, SOMEONE has to come and help them! It’s not fair to be left to fend for themselves! They pay taxes, dammit!

Now, we’re all old enough to remember the right declaring FEMA was a tool of Satan is the distant past of *checks notes* October 2024. The right spread a ton of disinformation about FEMA workers helping the community of Asheville, which had been almost wiped off the map by Hurricane Helene. It was so bad, it became dangerous for them to work in some areas and FEMA workers had to leave. It was a huge win for Trump, who lied and lied and lied about what was happening there, leaving thousands of people in danger and without help.

But did Trump give a shit? No. Of course, he didn’t. Aside from being a sociopath, Trump is also a Republican and that means he doesn’t think the government should help “the little people.”

Previously, Trump used the federal government like a protection racket. Help would come only to states that voted for him. Or if the governor would bow and scrape and beg, feeding Trump’s insatiable need to dominate and have his fragile ego catered to. But that was before. Now, Trump has refused to send help to Arkansas after a series of deadly tornadoes:

As is customary, Arkansas Republican Gov. Sarah Huckabee Sanders asked the federal government for help. After a major disaster, the usual procedure is for the federal government to issue a disaster declaration, setting the wheels in motion for the Federal Emergency Management Administration to step in with funds to help the state clean up.

But President Donald Trump said no. In a letter from April 11, the federal government said it had “determined that the damage from this event was not of such severity and magnitude as to be beyond the capabilities of the state, affected local governments, and voluntary agencies.”

Arkansas was on its own.

Two things to note here: First, Arkansas is deep red. This is Trump Country. They probably fly more Trump flags than American flags. Second, Sarah Huckabee Sanders, you should recall, was one of Trump’s most loyal and effective propagandists during his first term. Her job was to berate the legacy press and gaslight the nation and she did it with a smile in the name of Jesus.

None of that means a fucking thing to Trump. Arkansas can rot and die for all he cares.

The same with West Virginia. They were also denied FEMA funds. Remember Western North Carolina? That whole region that was devastated by Helene that Trump was SO concerned about back in October? Well, they can go fuck themselves now that Trump’s president. They asked for more help and were denied because Trump got what he wanted so he doesn’t give a shit about North Carolina anymore.

Boy, I bet all of those Republicans are thrilled about their vote for Donald Trump! He’s a real man of the people. A populist who cares about the common American!

Did you know the Opinionated Ogre has a weekly podcast? It’s true! New episodes every Thursday! Catch the latest episode here:

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In reality, the Trump regime is planning to end FEMA. We know this because last week, the acting head of FEMA was fired. Why? He had the fucking nerve to say he did not agree the agency should be eliminated. That’s it. That’s the entire reason. He didn’t say he didn’t support reducing the size of FEMA or limiting its role or anything like that. He said he thinks FEMA should still exist to help states and, welp!, that motherfucker had to go.

Here’s the news guy:

WASHINGTON, May 9 (Reuters) - David Richardson, the new head of the Federal Emergency Management Agency, told staff on Friday he will "run right over" anyone who resists changes and that all decisions must now go through him.

"I, and I alone in FEMA, speak for FEMA. I'm here to carry out the president's intent for FEMA," Richardson, who was most recently assistant secretary for DHS' office for countering weapons of mass destruction, told the staff.

You can tell this scumbag is just dripping with compassion. He’s going to be champing at the bit to serve the American people in their time of need! For sure!

In this context, “serve” means “on a platter.”

Hurricane season starts in just a few weeks. There are predictions it could be another above-average year, which means the southern United States will more than likely get walloped. Those are all red states packed with millions of loyal Republicans, not one of whom means a fucking thing to Donald Trump. Unless Mar-a-Lago is damaged, no one is getting a penny from the government they elected.

You see, Republicans in the White House think states should handle all of their disasters by themselves. Elected Republicans all over the country say exactly the same thing when disasters hit blue states. Republicans were opposed to sending aid to California when the wildfires devastated communities. They didn’t want to send money to NY when Superstorm Sandy hit. Screw those stupid libtards, right?!

But every year, like clockwork, a hurricane pummels the south and leaves devastation. And who shows up with their hand out? Republicans.

It’s important to understand that blue states cut off from FEMA money will hurt but they tend to be wealthier states. They won’t be able to replace the funds lost but they’ll muddle through.

Red states, though? Most red states are poor as fuck. They’re already leeches to begin with, taking far more in government money than they contribute in taxes. They’re not going to be able to afford a fucking thing when a hurricane levels a few dozen communities. I guess all those Trump voters are shit out of luck.

But of course, that’s the point. The fascists in the White House want to increase poverty and misery and desperation. They want entire states reduced to rubble so the billionaires can buy everything for pennies on the dollar and the population can be pushed into factories and sweatshops to work for a dollar or two a day, just like the factories in China and Taiwan.

Desperate, poor, hungry, uneducated, and easy to control. That’s the American dream of the fascist right. They’re not even hiding it. The legacy press simply refuses to report on it and even more imbeciles refuse to believe, despite Republicans TELLING us this is their plan.

So buckle up, Southern states. You voted to get rid of the federal government and you thought that would mean those big city slickers would get it in the neck but you, as loyal Trump Humpers, would be protected. You thought that nothing in YOUR life would change because all of the stuff government did for you was invisible or you were too stupid to notice it or you figured you “deserved” it because you were white and Republican, not like those lazy Blacks on welfare or dirty Mexicans stealing your Social Security. None of that is true but that doesn’t matter because you fucked around and now you’re about to find out what life is like when a hurricane annihilates your town and FEMA doesn’t show up.

No one is coming to save you because your state cannot handle disasters of this scale on its own. That’s why we had FEMA in the first place. But you knew better. You knew we didn’t need no stinking Feds.

Don’t come crying to us when that doesn’t work out the way you thought it would. Go talk to the Republicans you elected to stab you in the face. You wanted this? Enjoy. I’m all out of empathy for your dumb ass.

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The Blue Wave has begun and the fascist fucks are scared. There are 175 days until it hits Virginia and Pennsylvania. If I were a billionaire fascist loser, I’d think REALLY hard about getting out of the way.

More than a month ago, I agreed to an offer to be a visiting scholar at a private US university next year. This was no simple matter because of obligations to my own family and (somewhat more unexpectedly) my department. I have made no public announcement on it yet not because I am especially personally worried by the Trump administration’s policies toward higher education, but rather because I am still completing (electronic) paperwork and background-checks from the host institution. (It would be bad luck to announce before the process is fully completed.)

Now, by academic standards, I have moved jobs (not always willingly) quite frequently and I have also accumulated quite a bit of visiting positions. I have worked in three different countries and have held all kinds of academic jobs during the last quarter century. So, I am familiar with the great variability in the process by which the (electronic) paperwork for an appointment can be completed. When it comes to paperwork before the appointment-process is completed nothing will ever beat my experience moving to Flanders back in 2009. But Stateside, I had a rule of thumb that wealthy private institutions are relatively unencumbered by paperwork relative to the state institutions in order to ‘enter’ the system. I have to abandon this maxim.

I have no prior experience with this particular private university and N=1, I shouldn’t make any claims on the basis of it. But since university administrators in the same ecology tend to mimic each other, I would not be surprised if what I am experiencing is part of a wider trend of bureaucratic enshittification [a phrase I am stealing from my friend Tom Stoneham] at US private universities. (I won’t bore you with a graph of the rise of the number of administrators in US universities, but I am not the first to remark on the phenomenon.)

As is well known, ‘enshittification’ was coined by Cory Doctorow to discuss the predictable patterns of deteriorating quality of online platforms and products over time. In the present post, I appropriate the term to apply it to organizations. I am not claiming enshittification of online platforms has the same root cause as enshittification of organizations.

During the last two weeks, I have been mulling the significance of Joseph Tainter’s (1988) The Collapse of Complex Societies. A key insight of this book is repeated in the ‘summary’ chapter at the end:

Sociopolitical organizations constantly encounter problems that require increased investment merely to preserve the status quo. This investment comes in such forms as increasing size of bureaucracies, increasing specialization of bureaucracies, cumulative organizational solutions, increasing costs of legitimizing activities, and increasing costs of internal control and external defense. All of these must be borne by levying greater costs on the support population, often to no increased advantage. As the number and costliness of organizational investments increases, the proportion of a society’s budget available for investment in future economic growth must decline. (p. 195)

Tainter is a trained anthropologist not an economist, but he has fully internalized the significance of opportunity costs (and, as the next paragraph makes explicit, marginal returns).

When I first read the quoted paragraph, I read ‘sociopolitical organizations’ as a synonym for ‘state,’ ‘empire’ or ‘society’ (as is clearly intended from wider context). But, upon reflection, one could read the paragraph as scale invariant, and then if one replaces ‘future economic growth’ with ‘future growth in knowledge,’ one has a nice description of the process of bureaucratic enshittification of universities.

Of course, universities are not just oriented toward advancing knowledge; they are multi-purpose organizations. But in this they are no different than states/societies/empires. So, the comparison between state and university is not altogether silly. Both require (recall) the art of government in their leadership.

Interestingly enough, it’s pretty clear that during the last half decade, many national polities have decided to scale back their investment in universities. (But I write this with unease because I have been unable to extract this unambiguously from the OECD data I looked at.) And this need not be irrational. For, as Tainter puts it, “investment in sociopolitical complexity as a problem-solving response often reaches a point of declining marginal returns.” (p. 194) For, “as the cost of organizational solutions grows, the point is reached at which continued investment in complexity does not give a proportionate yield, and the marginal return begins to decline.” (p. 195)

Now if we zoom out toward the political scene, we can immediately see that DOGE’s/MAGA’s way of scaling back on organizational complexity — breaking and unilaterally changing contracts, punishing perceived political enemies, offering specious justifications, etc. — is exceptionally brusque and in violation of all principles of good governance, but it would be a mistake to treat it as an isolated example. Universities’ budget constraints are getting harsher in much of the OECD, and we should expect, then, not just ongoing closing of departments/schools, but also the collapse of whole universities. (The UK’s Higher Education system — which caps tuition — is exceptionally striking example of this process.) So far there is no sign that university bureaucracies/structures have been or will be genuinely decomplexified.

While (recall) I am no friend of the leadership of US private higher education and the quality of the educational aristocracy it has produced, I am not defending MAGA higher ed policies because its way of scaling back is so destructive on the legitimacy and efficiency fronts that it may well undermine societies’ general ability to make the kind of scientific, technological, and social breakthroughs on which the maintenance of social complexity relies. And because MAGA has risen to power (Stateside and elsewhere), in part, through a strategy of sowing distrust not just toward technocratic elites and it is actively destroying non-trivial features of the machinery of government that witnesses truth, makes society legible, and provides society with the public goods that makes all kinds of private transactions possible, they have also undermined their own and their successors’ ability to steer the ship of shape in sensible and cost-effective ways.

Lurking in the background is, alas, AI. Now, the good news is that indeed AI carries the possibility of making the task of information processing faster and more cost-effective in bureaucracies. And let’s stipulate that it allows for greater centralization and fewer layers of bureaucracy where rule-following work is relatively standardized.

But because of the feverish focus on AGI and existential risk and fears of job-loss among white collar and creative labor, it has generally been overlooked that as we move to an AI intensive-society genuine expertise is not made redundant by AI at all as AI displaces the rule-following work even experts often do. For, unless the training and output of AI is monitored by agents that can catch dangerous error, one constantly risks creating junk machines where ‘garbage in’ produces ‘garbage out.’ And if society undermines the sociopolitical organizations that train, certify, and employ experts, then the social benefits of applying AI will not be reaped at all, but society will nudge itself into collapse.+

The previous paragraph suggests, then, that the skillful introduction of AI may well aid society in postponing a dire downward spiral of increasing marginal costs of bureaucracies and other complex systems. But how to get from here to there is by no means obvious even if we had non-corrupt, skillful leadership and could smooth the process with the fruits of economic growth.

• An earlier, somewhat modified draft of this post was published at Digressions&Impressions.

+As Tainter notes that may well be a good thing for many, so here I am not taking a stance on evaluating such collapse.

Have you seen the plethora of stories quoting Trump saying “I don’t know” about this, that, or the other thing? He claims that he doesn’t know who signed the executive order invoking the Alien Enemies Act to deport the 200-plus Venezuelan migrants his administration claimed (without evidence) were members of a violent gang. He doesn’t know who gave the order, since overturned by a judge, to deport migrants to Libya. He didn’t know anything about members of his cabinet and others who used the insecure publicly available Signal app to discuss top-secret plans to attack the Houthi rebels in Yemen. He didn’t know anything about Elon Musk’s DOGE dimwits canceling a program that has provided health care for 9-11 survivors and first responders.

But there is so much Donald Trump does know! The man is a world-class expert when it comes to knowing how to abuse and sexually assault women. A judge in New York even ruled that he had sexually assaulted and likely raped E. Jean Carroll in a case that awarded Ms. Carroll $5 million, which he has been avoiding paying by appealing the jury’s verdict. At least 26 women came forward in 2016 during his first campaign for president claiming that he had sexually assaulted or harassed them. Trump was even heard on an audio tape made by the television show Access Hollywood claiming, “When you're a star, they let you do it. You can do anything. Grab 'em by the pussy. You can do anything.” Donald Trump is so comfortable with the idea of abusing women that he appointed a man, Pete Hegseth, who had been accused of raping a woman and had paid her $50,000 to keep her mouth shut about it.

Trump knows a lot about adultery. He cheated on his first wife, the mother of his first three children, with his second wife, who gave him his fourth child. He cheated on his third wife just four months after she gave birth to his fifth child. And like his Secretary of Defense, he knew exactly how to keep that transgression quiet: He paid the woman with whom he had had sex, Stormy Daniels, $130,000 to deny that she had an affair with him during his first campaign for president.

Despite the fact that Trump knew E. Jean Carroll well enough to rape her in a department store dressing room, and he knew Stormy Daniels well enough to have sex with her in a hotel room while playing at a celebrity golf tournament, Trump claims to this day he never met either woman and doesn’t know who they are.

Trump knows a lot about avoiding paying taxes. According to the New York Times, which got access to two decades of his tax returns, he paid no tax at all in 11 of 18 of those years. In 2016 and 2017, years during which he reported making millions of dollars of income, he paid only $750.

Not only does Trump know how to cheat on his golf game – he claims to have won every club tournament that he has entered – he knows how to use his ownership of multiple golf courses in this country and overseas to avoid paying taxes. Between the years 2000 and 2020, Trump reported losing $315.6 million from his ownership of golf courses. He famously went bankrupt five times while he owned casinos in Atlantic City, so it’s clear that the author of “The Art of the Deal” knows one hell of a lot about losing money doing business.

Trump claims to know everything there is to know about tariffs and how they are a tax on other countries, not on this country. He knows all about how to “make deals” with other countries over tariffs: first you impose absurdly high tariffs on foreign nations. Then you cancel them.

Trump knew plenty about how to steal an election in 2016. “Russia, are you listening?” His factotum Roger Stone was in touch with both Wikileaks and “Guccifer 2.0,” later identified as a Russian intelligence agent. After taking office, he knew exactly how to lie about it, claiming that “Russia Russia Russia” was a “hoax.”

Having lost the 2020 election, he knew all about how to steal that one by working assiduously to overturn the results. He knew exactly how to incite a riot of his supporters at the Capitol on January 6, 2021. “Be there. Will be wild!” he tweeted.

For the next four years, he knew how to lie about the 2020 election: he won it. Biden lost, and he was the one who “stole” it.

In fact, if there is one thing Donald Trump really, really, really knows how to do, it is telling lies. The Washington Post kept count of his lies during his first term, finding that he had told 30,573 “untruths” in four years. Seemingly, that took some effort.

Or not. He’s already lying about not knowing so much about what he has done as president. Recently, he claimed, “I don’t know her,” about Casey Means, his appointee to be Surgeon General. Maybe that’s because she wasn’t an employee of Fox News. He knows a lot of Fox News hosts, appointing more than 20 of them to jobs in his administration.

It is all smoke and mirrors, what Donald Trump claims he knows and doesn’t know. What we know is, whenever he opens his mouth, he’s lying.

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There’s a move underway — across political lines — to send the mentally ill, homeless people somewhere else. Essentially, it seems to be a movement towards re-institutionalizing people we would rather not see walking around aimlessly.

In some communities like Los Angeles, the emphasis seems to be on the rising number of homeless people. In New York, there’s a tendency for officialdom to equate public mental illness cases with crimes on the street or in the subways.

Donald Trump has made it plain that if he can see homeless people around Washington, he believes the city is reflecting some kind of third-world values rather than seeing increased homelessness as a more logical outcome of economic and social policies that favor property owners and upward mobility.

In short, we’re seeing more proposals to move the homeless away from where they can be seen as if parking them somewhere will put the problems out of mind.

Health and Human Services Secretary Robert F. Kennedy Jr is pushing a proposal for “wellness farms” under his Make America Healthy Again (Maha) initiative to gather the homeless.  New York Gov. Kathy Hochul promotes  expanding involuntary commitment, New York City Mayor Eric Adams has directed police and emergency responders to hospitalize people deemed “mentally ill”, even without signs of imminent danger. In California, Gov. Gavin Newsom’s Care courts compel people into court-ordered “treatment” while in Los Angeles, Mayor Karen Bass is building new apartments but losing a public relations war on spreading homelessness.

Justice Department officials are brainstorming ways to clear homeless encampments and increase the involuntary hospitalization of people with mental illnesses across the nation, according to documents obtained by The Washington Post. The Trump administration is committed to aggressive steps to clear homeless people from public spaces, apparently thinking that more law enforcement is the right answer to social issues.

Trump issued an executive order last month to make Washington “safe and beautiful” that included a directive for the National Park Service to remove all homeless encampments from federal land in the nation’s capital.

‘Psychiatric Imprisonment’

As Jordyn Jensen, executive director of the Center for Racial and Disability Justice at Northwestern Pritzker School of Law, argued in a recent op-ed in The Guardian, we’re witnessing a “new era of psychiatric control being marketed as a moral imperative.”

The op-ed basically argues that under the rubric of humanitarian help for the suffering, we are turning increasingly in court orders, civic policies and now federal pressures to coercive methods of locking up the homeless or mentally ill.  Columnist Jensen says that decades of research — probably now all on the spending cuts lists —  show that involuntary psychiatric interventions often lead to trauma, mistrust, and poorer health outcomes, including suicides and flight from mental health care.

While policies address visible homelessness, they may “divert attention from the actual drivers of distress: poverty, housing instability, criminalization, systemic racism and a broken healthcare system.” What officials see as meeting citizen demands to do something about homelessness, she sees as psychiatric imprisonment under the guise of compassion.

Clearly no one knows how many are homeless in America, but city-by-city counts towards providing services pegs the total as several hundred thousand. Definitions obviously are hard to come by since addictions and untreated mental illness are factors beyond poverty and lack of affordable housing alternatives. Add in the decisions over the last couple of decades to forgo institutionalizing mental patients when they might do better through adaptation to living in society and you get a social stew that eludes the kind of easy answers promised by broad overstatements.

So what we are starting to see now is an expansion of state powers to surveil, detain and “treat” those deemed disruptive or somehow deviant.  Since addictions skew racially, there are racial aspects that are part of this unhoused equation as well. With the arrival of lots of migrants, there is more competition for shelter space when it is available.

And there remains a certain bias that institutionalization was ended prematurely.

Danger or Blight?

In New York, the Hochul proposal could see individuals detained because they present an imminent danger to the community, but rather because they are deemed unable to meet their basic needs resulting from perceived “mental illness,” a vague, subjective standard. Hochul proposes expanding the authority to initiate forced treatment to a broader range of professionals to consider personal histories. New York City and California now have similar rules on the books.

In reality, much of what is reported as “crime” in my Harlem neighborhood revolves around the aimless behavior of a relatively known set of characters who are addicts or mentally ill. Police don’t know what to do and have tried adding social workers to some calls.

Even while reading about these approaches, news arrived that the new federal budget from Donald Trump proposes to eliminate money to deliver Narcan to addicts and generally to lean on local law enforcement to locate and deport migrants. These are the same migrants whom Trump insists are bringing fentanyl and heroin into the country.

The Trump administration has made major cuts to the Department of Housing and Urban Development and its homelessness efforts, with advocates warning that the cuts could worsen the number of people living on the streets in the country.

It could be that we need more psychiatric institution beds — or a different set of social services that target and coordinate care, reduce personal harm, and seek to treat people with dignity. But if the construction of prisons did not eliminate crime, why do we think that building tent cities on the edge of town just to rid more traveled areas of homeless will reduce mental illness?

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The post Hiding the Homeless appeared first on DCReport.org.