How do you structure + incentivize government orgs to prevent these sorts of issues?
The basic problem comes from making things too complicated.
For example, there are a million programs that provide subsidies to the poor. The poor can't afford housing, so we have housing vouchers. The poor can't afford food, so we have food stamps. Heat, school, medicine, the list goes on.
The problem with all of these programs is that they're bureaucratic nightmares to navigate and cause all kinds of perverse incentives, e.g. inflating the price of school/medicine/housing, forcing people to buy a specific amount of the subsidized thing instead of spending some of the money on something they might need even more.
And the programs are all trying to do the exact same thing, which is to give money to the poor. Which we could instead do directly with a universal basic income and erase all of that unnecessary complexity from existence.
The reason why UBI works well is because it's a cash handout (like the other person said, you're not specifying the needs of the individual), it's a universal and not means tested program (you don't have to go through a bureaucratic maze every time you become eligible), and it's instantaneous for people who have sudden changes in fortune (IE, the income stream is already set up).
A UBI is pure redistribution. There is no money that doesn't go to the poor, because where else would it go? Taking money from the rich and then giving them some of it back is just the same thing as only taking the difference to begin with, and the entire difference goes to the poor.
It's equivalent to a government benefit with a phase out rate equal to the tax rate.
Drugs and medical treatments in the US are already very expensive compared to the same in other countries. If everyone suddenly has an extra $1k/mo, why wouldn’t the drug companies increase their prices even more?
To me (as a European) it seems like a better option is universal healthcare, to at least make life critical medicine and treatments available to everyone, no matter their financial status.
That's only how prices work for uncompetitive markets. In a competitive market anyone who raised prices would lose business to competitors.
Moreover, monopolies can raise prices in response to anything that causes the poor (or anyone else) to have more money. The problem isn't a UBI, it's the existence of uncompetitive markets.
> To me (as a European) it seems like a better option is universal healthcare, to at least make life critical medicine and treatments available to everyone, no matter their financial status.
Price controls are independent of single payer. If you had single payer and monopoly/patented suppliers without price controls then prices would be... high. So nobody does that. But you can also have price controls without having single payer.
The problem with price controls is econ 101 -- you get underproduction. And when the thing being produced is medicine and medical research, that isn't good.
The counties with single payer do it anyway, and thereby don't pay their share of the research cost and cause there to be less research than there would be. We could do the same thing, single payer or not, and pay less for medicine. But then there would be even less research.
A possible workaround is to subsidize medical research directly, but then you're not saving the money, you're just spending it on the same thing with different routing. Which method of funding research is more effective is open for debate, but you can't avoid paying for the research unless you don't want to have it.
Some of this is purposefully done for a reason. You want people to be buying more eggs, milk and bread. Not Candy and Jelly.
In some case this seems to be exactly what has happened.
Only it doesn't actually do that.
If someone has $5 from their job and $5 from the government and wants to buy $6 worth of bread and $4 worth of candy when you want them buying $10 worth of bread, saying they can only spend the government money on the bread changes nothing.
And is almost universally wrongheaded to begin with, because individuals know better than the government what they actually need. It's too easy to find the government telling a diabetic they can't buy a candy bar when they need it to avoid hypoglycemic shock.
Responsible individuals do. Not every one.
People make their own bed. If someone eats too much candy and dies of a heart attack, it was their choice. The government is not your mother.
It makes no sense to punish all the responsible people with crushing bureaucracy just to save a few fools from themselves.
Except if you had a job, you had to give half of your income back to the program until your income was above 2x the grant's value per month. (something like $800/mo, not in the bay area)
When you started a job you had to get your management to fill out a form and submit it to the local government.
When you stopped a job you had to get your management to fill out a form and submit it to the local government.
You had to fill out and get your management to sign time sheets showing how much you worked.
You had to save half of your income (and because homeless youth, that usually meant half of a likely barely above minimum wage job) to pay back to the program.
If any paperwork was submitted late you got threatened with getting kicked out of the program.
If you earned too much money you got kicked out of the program.
If your management failed to send in paperwork you got threatened with getting kicked out of the program.
If your case worker who was responsible for submitting your paperwork didn't submit it on time, you got threatened with getting kicked out of the program (this was often the case)
So literally every single month there was a new crisis and the threat of being homeless again. Not an idle threat but an actual "you're going to get kicked out unless..." ... in a program designed to help youth homeless as a result of abuse.
So on top of dealing with whatever severe personal problems, you have to keep down a job that already has a reason to stigmatize you under a program that put you in an apartment which at minimum wage would cost well over 50% of a full time income, but you also have to manage the constant crises of misplaced paperwork and new requirements and poorly understood and explained rules.
It's just a recipe for failure for the most vulnerable people who are the least capable of dealing with uncertainty and stress ... and the very real and constant threat of returning to living on the street, or in a shelter (they're horrible places), going back to the abusive situation you came from, or very likely getting taken advantage of by someone new.
... because a set of well intentioned people with no idea what it is like to be in anything like that situation couldn't come to terms which were simple and straightforward for giving aid to those in need.
If you make sure that your government employees are educated, provided with good benefits, feel like they have an impact, etc., the outcomes will invariably be for the better.
A very good example of this is teachers. The OECD tells us:
"[...]in nearly all countries, when teachers perceive that appraisal and feedback lead to changes in their teaching practice, they also report greater job satisfaction. When teachers believe that appraisal and feedback is performed only for administrative purposes they report less job satisfaction. In addition, teachers who report that they participate in decision making at school also report greater job satisfaction. Indeed, although fewer than a third of teachers believe that teaching is a valued profession in their country, those teachers who report that they can contribute to school decisions are more likely to report that teaching is valued in their society."
http://www.oecd.org/edu/school/TALIS-2013-Executive-Summary....
And other sources tell us that satisfied teachers tend to lead to better outcomes.
"TN teachers’ job satisfaction linked to performance scores"
https://news.vanderbilt.edu/2017/02/01/tn-teachers-job-satis...
In other words, much like regular companies, governments with happier employees tend to have better outcomes. This should be hardly surprising to most HN readers.
In 10 years of various levels of being a model citizen (or not), all of my dealings with the local and national government have been satisfactory, even when they were in a position where they could make me have a very, very bad day if they felt like it.
My one negative interaction with the police (coerced into accepting a search of my bag) was because I was doing something else illegal, listening to music while riding my bicycle, and I am smart enough to know the difference between beating the rap and beating the ride.
Same in India. Pay is very good(you also get to make a fortune through bribes), working hours are non-existent and you get other benefits like a lot of holidays, health care and fat pensions after retirement.
The American voting public has not the interest or attention span in tackling small complicated problems. The politicians they elect therefore has little interest or motivation to fix these small complicated problems because doing so usually involves spending political capital on compromises. Sometimes a few of them get big ideas about civic duty, but not very many people vote for that. They just vote for whomever yells the loudest about their set of pet issues which are usually red herrings erected to distract the population from actual issues. (abortion, gun control, immigration, etc. not that this issues are _unimportant_ but politicians use them to secure power on both sides and keep up the yelling because if they actually solved them, they would have to tackle the sorts of issues that threaten the powerful)
Share stories of what being in a program is like.
Focus on the cost of administering complex vs. simple programs.
However liberal your locality, it's still hamstrung by a variety of state and federal laws that make building effective government systems much more challenging than in other developed nations.
Negative incentives work far better for organizations than they do for individuals.
I spent some time homeless and on food stamps. When the lack of resources and lack of compassion for your plight can cause you to literally go hungry -- well, it felt to me like a "beating." It felt actively hostile. That is what I was trying to capture and convey.