“reckless taxing and spending spree.”

Conservative policy experts said that although some expansion of government aid was appropriate during the pandemic, those programs should be wound down, not expanded, as the economy healed.

“Policymakers did a remarkable job last March enacting CARES and other legislation, lending to businesses, providing loan forbearance, expanding the safety net,” Scott Winship, a senior fellow and the director of poverty studies at the American Enterprise Institute, a conservative group, wrote in reaction to the data, referring to an early pandemic aid bill, which included around $2 trillion in spending. “But we should have pivoted to other priorities thereafter.”

Jason DeParle and Margot Sanger-Katz contributed reporting.

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Many Pandemic Retirees Weren’t Ready. How to Cope if You’re One of Them.

Andrea Jones hadn’t yet settled on a date to retire from her customer service job at United Airlines when Newark airport started looking like a ghost town in March 2020. After 28 years with the carrier, she still loved her work. But by the end of that month, she had hung up her blue uniform for the last time. She is still struggling with a sense of loss.

“I wasn’t at all ready to leave,” she said. “It hit me right between the eyes.”

Ms. Jones, 68, of East Windsor, N.J., retired to protect the health of her husband, George, who has multiple myeloma, a form of cancer. Fortunately, the Joneses had a nest egg, and United offered a retirement package that enabled her to keep their health insurance.

Patricia Scott has not been so lucky. Ms. Scott, a special-education teacher in Stockton, Calif., retired in January to preserve her own health. A grandmother of 10, she survived breast cancer in 2016; her oncologist told her she couldn’t risk catching Covid-19 by returning to the classroom. Now, at age 66, she is on financial quicksand. “My income is half what it was,” she said. She is single and in debt. “I’m stressed, I’m depressed and I’m terrified.”

For many of the nearly three million workers ages 55 to 70 who have left their jobs since March 2020, retiring during the pandemic has inflicted two traumas. Like Ms. Jones and Ms. Scott, most felt they were forced out of work before they wanted to go, said Teresa Ghilarducci, a professor of economics and policy analysis at the New School for Social Research. Among that subset, the majority, like Ms. Scott, were financially unprepared, Ms. Ghilarducci said.

research from the New School, far more older workers retired during the pandemic than during other recessions. After the 2008 financial crisis, for example, 1.9 million older workers left the labor force in the first three months of the recession. In the first three months of the pandemic last year, 2.9 million left the work force. The latest data shows that 1.7 million of the newer wave of retirees left despite financial uncertainty, Ms. Ghilarducci said.

Their departures generally were not a bid for a few extra years of bird-watching. “A lot of people were pushed out of their jobs,” Ms. Ghilarducci said; she attributed that push partly to age discrimination. “It used to be that employers would let the ones they just hired go first in a recession, but this time older people who have been in their jobs the longest have been hit hardest.”

Lack of enforcement of anti-discrimination laws was a factor, she said. So was what some employers saw as a rare opportunity created by the pandemic to get rid of older workers, who are perceived to be less productive and more expensive.

Regardless of the reason, the new army of reluctant retirees, disproportionately made up of Black workers and those who lack a college degree, according to June data from the New School, is in trouble. One key reason: Debt rates among Americans 65 and older are the highest they’ve ever been, Ms. Ghilarducci said. And they are likely to rise as more people are forced to draw down their assets to make ends meet. Collecting Social Security earlier than anticipated will add to their vulnerability, since claiming earlier will permanently reduce their benefits.

Even for people with a financial safety net, the hurdles can be significant. “There’s a lot of stress that comes with having retirement forced on you,” said Malcolm Ethridge, a financial adviser in Washington who has several newly out-of-work older clients. “It takes time to get past the disruption.”

Jovan Johnson, a certified financial planner in Atlanta, said Ms. Scott and others in her situation should start looking for a pro bono financial adviser who can help make sense of their money. “There are a lot of us out there who will help people out for free during a crisis,” he said. He recommends searching sites like the XY Planning Network.

The primary benefit of sitting down with a professional may be relief from panic, he said. But the 15 new retirees who have contacted him for pro bono help since the pandemic started, among them nurses and teachers, have also gained a better understanding of how to manage limited funds. “Everybody deserves to have a plan,” he said.

Pen and Brush after 23 years as executive director, the stress started last year, when she contracted Covid-19 and spent several weeks in an intensive care unit. She was not psychologically ready to retire, but because she has still not fully recovered, she felt she had to. “I was one of those people who was going to have to be wheeled out of there, I loved it so much,” she said.

Now she is adjusting to what she said was a more limited routine. Sunday nights and Mondays flummox her the most. “It’s like when you have that dream where you have a final exam and you’ve never been to class, or you forget your locker combination. I keep thinking, I have to go to work.” Instead, she takes walks with her husband, Wallace Munro, a retired actor, and visits the grocery store more than she thought she would ever want to.

“It’s something to do,” she said. “You have to restructure your life when something like this happens to you. It’s so easy to get depressed.”

Mr. Johnson, the financial planner, offered tips on juggling your income and expenses when you’re thrust into joblessness with little warning.

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Collapse: Inside Lebanon’s Worst Economic Meltdown in More Than a Century

TRIPOLI, Lebanon — Rania Mustafa’s living room recalls a not-so-distant past, when the modest salary of a security guard in Lebanon could buy an air-conditioner, plush furniture and a flat-screen TV.

But as the country’s economic crisis worsened, she lost her job and watched her savings evaporate. Now, she plans to sell her furniture to pay the rent and struggles to afford food, much less electricity or a dentist to fix her 10-year-old daughter’s broken molar.

For dinner on a recent night, lit by a single cellphone, the family shared thin potato sandwiches donated by a neighbor. The girl chewed gingerly on one side of her mouth to avoid her damaged tooth.

“I have no idea how we’ll continue,” said Ms. Mustafa, 40, at home in Tripoli, Lebanon’s second-largest city, after Beirut.

The huge explosion one year ago in the port of Beirut, which killed more than 200 people and left a large swath of the capital in shambles, only added to the desperation.

and the central bank unable to keep propping up the currency, as it had for decades, because of a drop in foreign cash flows into the country. Now, the bottom has fallen out of the economy, leaving shortages of food, fuel and medicine.

All but the wealthiest Lebanese have cut meat from their diets and wait in long lines to fuel their cars, sweating through sweltering summer nights because of extended power cuts.

long lines at gas stations, where drivers wait for hours to buy only a few gallons, or none at all if the station runs out.

hampered the investigation into the port explosion, and a billionaire telecoms tycoon, Najib Mikati, is currently the third politician to try to form a government since the last cabinet resigned after the blast.

Mustafa Allouch, the deputy head of the Future Movement, a prominent political party, said, like many other Lebanese, that he feared that the political system, intended to share power between a range of sects, was incapable of addressing the country’s problems.

“I don’t think it will work anymore,” he said. “We have to look for another system, but I don’t know what it is.”

His greatest fear was “blind violence” born out of desperation and rage.

“Looting, shooting, assaults on homes and small shops,” he said. “Why it hasn’t happened by now, I don’t know.”

The crisis has hit the poor hardest.

Five days a week, scores of people line up for free meals from a charity kitchen in Tripoli, some equipped with cut off shampoo bottles to carry their food because they can’t afford regular containers.

Robert Ayoub, the project’s head, said demand is going up, donations from inside Lebanon are going down, and the newcomers represent a new kind of poor: soldiers, bank employees and civil servants whose salaries have lost the bulk of their value.

In line on a recent day were a laborer who had walked an hour from home because he couldn’t afford transportation; a brick layer whose work had dried up; and Dunia Shehadeh, an unemployed housekeeper who picked up a tub of pasta and lentil soup for her husband and three children.

“This will hardly be enough for them,” she said.

The country’s downward spiral has set off a new wave of migration, as Lebanese with foreign passports and marketable skills seek better fortune abroad.

“I can’t live in this place, and I don’t want to live in this place,” said Layal Azzam, 39, before catching a flight to Saudi Arabia from Beirut’s international airport.

She and her husband had returned to Lebanon from abroad a few years ago and invested $50,000 in a business. But she said that it had failed and that she worried they would struggle to find care if their children got sick.

“There’s no electricity. They could cut the water. Prices are high. Even if someone sends you money from abroad, it doesn’t last,” she said. “There are too many crises.”

Drone footage by David Enders and Bryan Denton. Hwaida Saad contributed reporting.

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This Ethiopian Road Is a Lifeline for Millions. Now It’s Blocked.

AFAR, Ethiopia — The road, a 300-mile strip of tarmac that passes through some of the most inhospitable terrain on earth, is the only way into a conflict-torn region where millions of Ethiopians face the threat of mass starvation.

But it is a fragile lifeline, fraught with dangers that have made the route barely passable for aid convoys trying to get humanitarian supplies into the Tigray region, where local fighters have been battling the Ethiopian army for eight months.

the world’s worst humanitarian crisis in a decade.

wrote on Twitter. “People are starving.”

Ethiopian prime minister, Abiy Ahmed, who won the 2019 Nobel Peace Prize, said last week that his government was providing “unfettered humanitarian access” and committed to “the safe delivery of critical supplies to its people in the Tigray region.”

But Mr. Abiy’s ministers have publicly accused aid workers of helping and even arming the Tigrayan fighters, drawing a robust denial from one U.N. agency. And senior aid officials, speaking on the condition of anonymity to avoid jeopardizing their operations, said the government’s stated commitment to enable aid deliveries was belied by its actions on the ground.

Aid workers have been harassed at airports or, in the case of a World Food Program official last weekend, have died inside Tigray for want of immediate medical care.

Tigrayan fighters had marched into the regional capital, Mekelle, hours after beleaguered Ethiopian soldiers quit the city. The city airport was shut, so the only way out of Tigray was on a slow-moving U.N. convoy that took the same desolate route out as the fleeing Ethiopian soldiers.

We drove down a rocky escarpment on a road scarred by tank tracks. As we descended into the plains of Afar, the temperature quickly rose.

publicized the flight but made no mention of the delays or harassment — an omission that privately angered several U.N. officials and other aid workers who said it followed a pattern of U.N. agencies being unwilling to publicly criticize the Ethiopian authorities.

Further complicating the aid effort: The war is now spilling into Afar.

In the past week Tigrayan forces have pushed into the region. In response Mr. Abiy mobilized ethnic militias from other regions to counter the offensive.

Mr. Abiy has also resorted to increasingly inflammatory language — referring to Tigrayan leaders as “cancer” and “weeds” in need of removal — that foreign officials view as a possible tinder for a new wave of ethnic violence across the country.

Ms. Billene, his spokeswoman, dismissed those fears as “alarmist.” The Ethiopian leader had “clearly been referring to a terrorist organization and not the people of Tigray,” she said.

Inside Tigray, the most pressing priority is to reopen the road to Afar.

“This is a desperate, desperate situation,” said Lorraine Sweeney of Support Africa Foundation, a charity that shelters about 100 pregnant women displaced by fighting in the Tigrayan city of Adigrat.

Ms. Sweeney, who is based in Ireland, said she had fielded calls from panicked staff members appealing for help to feed the women, all of whom are at least eight months pregnant.

“It brings me back to famine times in Ireland,” Ms. Sweeney said. “This is crazy stuff in this day and age.”

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Youngest U.K. Lawmaker Takes a Break, Citing PTSD

Ms. Whittome, whose father is of Punjabi heritage, has been an outspoken advocate for many causes, from social justice to women’s rights, a role that has sometimes drawn criticism from those on the other end of the political spectrum. After activism during widespread protests against a controversial policing bill earlier this year and the Black Lives Matter protests last year, she detailed a torrent of abuse.

In an interview with the news outlet The Independent last year, she spoke of the hate mail and racist abuse on social media that had become the norm, and of having to report a series of death threats to the police.

The abuse she detailed, particularly on social media, has become typical for many women in Parliament. Female lawmakers, and in particular women of color in Parliament, have long faced abuse, both online and in person, at a disproportionately higher rate than their male counterparts, reports have shown. Before the last general election in 2019, in which Ms. Whittome won her seat, some women chose not to stand in the election, citing the abuse.

Her office is still open and staff are still working while she takes leave.

And while the details behind Ms. Whittome’s trauma were not given, her frank discussion of her mental health struggle also highlights a broader issue, mental health experts said.

David Crepaz-Keay, the head of applied learning at Britain’s Mental Health Foundation, a charity that has been carrying out a nationwide study of the pandemic’s impact on mental health since early last year, said it was also indicative of a shift in public discourse.

“We’ve noticed a huge change in the kind of broader public willingness to engage in talking about mental health, even over the last five years,” he said, pointing to society’s long history associating shame and disgrace with mental illness.

But more recently, public acknowledgment of mental illness — including by other members of the British Parliament and lawmakers elsewhere like Kjell Magne Bondevik, who took a leave of absence as prime minister of Norway in 1998 and spoke openly about his depression — has helped to normalize the struggle.

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Belarus Is Isolated as Other Countries Move to Ban Flights

MOSCOW — The tray tables were being raised and the seat backs returned to their upright positions as passengers on Ryanair Flight 4978 prepared for the scheduled landing in the Lithuanian capital, Vilnius. Then the plane made an abrupt U-turn.

For many passengers, it initially seemed like one of those unexpected delays in airline travel. But after the pilot announced the plane had been diverted to Minsk, the capital of Belarus, one passenger — Roman Protasevich, a prominent Belarusian opposition journalist who had been living in exile since 2019 — grew terrified, certain that he faced arrest.

“He panicked because we were about to land in Minsk,” Marius Rutkauskas, who was sitting one row ahead of Mr. Protasevich, told the Lithuanian broadcaster LRT upon arrival in Vilnius.

Sunday’s ordeal — described by many European officials as an extraordinary, state-sponsored hijacking by Belarus to seize Mr. Protasevich — quickly led to one of the most severe East-West flare-ups in recent years.

report rejecting the idea there were K.G.B. agents on the plane, instead showing three people who said on camera that they had decided to stay in Minsk by their own choosing. They included a Greek man who said he had been traveling to Vilnius on his way to visit his wife in Minsk.

In Lithuania, the police launched an investigation on suspicion of hijacking and kidnapping, and interviewed passengers and crew. They were told that the fighter jet dispatched by Mr. Lukashenko to escort the flight had not forced the Ryanair plane to land, according to people with knowledge of the investigation who were not authorized to speak publicly.

Instead, these people said, the pilot had decided to land the plane in Minsk after Belarusian air traffic control had requested that he do so because of a bomb threat on board.

other confessional videos that critics of Mr. Lukashenko have been forced to record while in jail.

an urgent meeting for Thursday to discuss it.

In recent years, Mr. Lukashenko had profited by playing the interests of Russia and the West off against one another. But amid last summer’s popular uprising against him over his disputed re-election, Mr. Lukashenko threw in his lot with Mr. Putin — and has relied on his support ever since.

Last year, the European Union sanctioned Belarus officials — including Mr. Lukashenko — over human rights abuses, to little apparent effect. The flight bans could have a greater impact, at least on regular people; the summer 2021 timetable of Belavia, Belarus’s national carrier, includes flights to 20 E.U. cities.

And some analysts said the restrictions could require costly rerouting for European airlines, which are already avoiding parts of Ukraine, Belarus’s southern neighbor, because of conflict with Russia.

The flight bans could cause new problems for Mr. Lukashenko inside his country, where the ease of travel to the neighboring European Union had long softened the strictures of living inside an authoritarian state. Ukraine, which is not a member of the E.U., also said it would ban flights to and from Belarus. The growing isolation means that Belarusians will increasingly need to travel east to Russia in order to get out of the country.

Yevgeny Lipkovich, a popular Minsk-based blogger and commentator critical of Mr. Lukashenko, said that his own travels abroad had allowed him to “remain an optimist, despite the regime’s best efforts to force me into depression.”

“If they close down the air loophole, there’s no question that the pressure inside the country will increase,” Mr. Lipkovich said. “And it’s disgusting to live in a pariah state.”

Reporting was contributed by Ivan Nechepurenko from Moscow; Tomas Dapkus from Vilnius, Lithuania; Stanley Reed from London; and Matina Stevis-Gridneff and Monika Pronczuk from Brussels.

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These Twins Lived Together. In Covid, They Died Together.

NEW DELHI — Joefred and Ralfred Gregory moved through life as one.

They went to the same college. They studied the same thing. They wore matching clothes. They trimmed their beards the exact same way.

Identical twins, they were two handsome young men in northern India who above all else really loved each other. And when they both were struck by Covid-19 last month and hospitalized, it was like they shared one sick body.

Hours after Joefred died, Ralfred’s mother told him that his brother was still alive, to keep his spirits up.

has suffered so much and keeps suffering. Though India’s overall case numbers have dropped this past week, the deaths keep going up.

On Wednesday, India broke a world record for the most reported Covid deaths in a single day: 4,529. However alarming that number is — three Indians dying every minute because of the coronavirus — experts say that it is just a small fraction of the true toll and that the real numbers are far higher.

Joefred and Ralfred, 24, had a special bond. Though their parents gave them similar names, they said they didn’t raise the twins to copy each other. Still, neighbors said that where you saw one, you saw the other, even after they reached adulthood.

the worst surge of infections that any country had seen since the pandemic began.

So many people were getting infected at the same time, especially in northern India, where Meerut is, that hospitals couldn’t cope. Sick people were being turned away. They were dying in the streets, in the back seats of cars parked in vain outside hospital gates, at home, gasping for air.

There was a deadly shortage of lifesaving oxygen and medicine. It was the Covid nightmare that all nations have feared since the pandemic began, exploding with a fury.

leading Indian newspapers ran stories, showing the two brothers side by side in identical suits. Television stations jumped in as well, with their doctor talking about how thoroughly the virus had destroyed their lungs.

Credit…via Gregory Raymond Raphael

Of all the thousands of deaths in recent days, these two seemed to really unsettle people, perhaps because the twins were just in their 20s and had looked so healthy, or maybe it was simply their closeness. Across social media, people exchanged messages such as “This is so heartbreaking!” and “How devastating it must be for the parents. So young …”

Their father says he feels like his heart has been torn from his body.

“I keep thinking that maybe I shouldn’t have brought them to the hospital,” he said. “Maybe I should have kept them at home. There is a parental love that the hospital can’t give.”

“But there’s no use of saying, ‘If this could have happened, or that could happened,’” he said. “My children are gone now.”

Every day, he said, he visits the graveyard.

Beneath a young neem tree, Joefred and Ralfred Gregory are buried in two coffins but one grave.

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Israel Targets a Hamas Commander Who Escaped Death Many Times

As Israel has focused its firepower on Hamas’s warren of underground tunnels and infrastructure in the Gaza Strip, it has simultaneously been engaged in a parallel clandestine strategy: a targeted killing campaign against Hamas’s military leadership.

Israel has tried several times in the current fighting to kill Mohammed Deif, the commander of Hamas’s military wing, a spokesman for Israel Defense Forces said Wednesday. Mr. Deif, a shadowy figure who has been atop Israel’s most-wanted list for nearly three decades, has become a symbol of the militant group’s resilience.

“Throughout the operation, we have tried to assassinate Mohammed Deif,” said the spokesman, Brig. Gen. Hidai Zilberman.

Israeli commandos have come close a few times over the years, and Mr. Deif has been wounded, but he has always survived.

A senior Israeli army officer said that Mr. Deif, 55, had played a pivotal role in the latest conflict, including ordering the firing of 130 rockets at Tel Aviv last Wednesday, one of the harshest attacks on Israel’s commercial capital since the fighting began.

Mr. Deif, revered among many Palestinians for his strategic prowess and ability to evade Israeli efforts to kill him, has spent decades underground. He has survived at least eight attempts on his life, including by ambush, bombings of safe houses where he was staying and missiles fired at his car, Israeli intelligence officials said. The officials, like others quoted in this article, spoke on condition of anonymity to discuss operational details of an active mission.

During those attempts, he has lost an eye and a hand, sustained neurological damage from shrapnel, suffered hearing damage and was left with a limp, according to a current and a former Israeli intelligence official.

A senior Israeli intelligence official said that since the last Israeli incursion into Gaza in 2014, Israel had several opportunities to kill him but had refrained from doing so for fear of setting off a war.

Even before Israel was founded as an independent state in 1948, those fighting for its creation had long engaged in targeted killings. But the program has raised moral quandaries internally and internationally about the ethics of such actions.

In August 2014, Israeli warplanes dropped at least five bombs on a house in the Sheikh Radwan neighborhood in Gaza where Israel believed Mr. Deif was staying. The house was reduced to rubble, and one of his wives, Widad, 28, and their infant son, Ali, were killed, along with another resident and her two teenage sons.

Israel thought that the strike had killed him. Although he survived — and subsequently fell into depression, according to the intelligence official — the attack fanned rumors of a security leak among Hamas’s leadership.

Security experts believe that Mr. Deif avoids detection by eschewing digital devices, using notes and couriers, and limiting his contacts to a tight, secret inner circle.

The commander, born in the Khan Younis refugee camp in Gaza, rose quickly through the ranks after joining the Islamist organization that became Hamas in the late 1980s. He has orchestrated numerous attacks against Israel, including a series of deadly bus bombings that derailed the peace process in the mid-1990s.

He is also credited with building Hamas’s military wing, the Qassam Brigades, into a fighting machine that can lob rockets against Israel, deploy commandos for naval missions and outmaneuver Israel in the warren of Gaza’s underground tunnels.

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Prince Harry Shares ‘Pain and Suffering’ of Growing Up in Royal Family

“I’m going to be vulnerable,” he said about sharing details on his mental health. “If I get attacked for it, let’s see who’s attacking me.”

In the interview with Ms. Winfrey in March, Meghan also shared her mental health battles, saying that she had struggled with suicidal thoughts when she was part of the royal family. Last year, she shared the trauma of miscarriage in an essay published in The New York Times.

Symptoms of depression and anxiety have been on the rise in many countries since the beginning of the coronavirus crisis, and Harry said that it was important to talk about the feelings caused by the pandemic.

“We’re now in the emotional phase,” Harry said, making reference to a Times article about the feeling of languishing. “You just feel flat. It’s not depressed, it’s definitely not flourishing,” Harry said. “You lack the energy and the will, your motivation, because you sit and wonder, ‘What happens next?’”

Harry said efforts like founding the Invictus Games, a sports event first staged in 2014 that showcases the talents of wounded servicemen and women, had helped him deal with his own mental health problems. “If we’re looking after our body and our body gets injured, what do we do when our mind gets injured?” he said.

About moving to the United States, Harry said “that wasn’t the plan.”

But, he added, “Sometimes you have to make decisions and bring your family first, and put your mental health first.”

And, once again, Harry was asked if he had seen the Netflix series “The Crown.”

“Elements of it,” he said.

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Why Cash Is Better Than Expanded Health Insurance for the Poor

The Biden administration is moving in a new direction. It is trying to help low-income Americans by pushing for direct cash assistance in addition to expanding health insurance.

Each is a laudable goal. But doing both at once may not be feasible, as lawmakers raise concerns about the total price tag of Biden’s plans.

If the administration has to make hard choices, it can do more to help the poor by prioritizing cash transfers over expanded health insurance. That’s because cash helps recipients directly, while health insurance would pay mainly for care that many uninsured people were already receiving at low or no cost.

For over a decade, health insurance expansions have dominated the budget and politics of legislation directed toward the poor. In 2019, the government spent more than $600 billion on Medicaid — the major health insurance program for low-income Americans. This was more than 10 times the amount spent on the largest cash transfer program, the earned-income tax credit.

legislation enacted in March brought a welcome shift in focus toward cash benefits. Among its temporary provisions were about $100 billion in increased payments to low-income families with children and $15 billion in stepped-up wage subsidies for low-income workers, overshadowing the approximately $35 billion in new spending for health insurance.

The evidence indicates that for the low-income recipients of these programs, cash transfers will provide a greater bang for the government’s buck. Two separate studies that my collaborators and I conducted found that, on average, low-income adults would benefit more from a dollar in cash than a dollar of government spending on health insurance.

These kinds of comparisons are inherently difficult. One approach we took to measuring the value of health insurance to recipients was to see how much they were willing to pay for it. Another was to estimate the effects of such insurance on their lives, like improved health and increased economic security. Neither approach is airtight.

But they gave very similar answers: The benefit of Medicaid coverage received by a newly insured adult is less than half what that coverage costs taxpayers, which is about $5,500 a year.

The reason is simple: The uninsured already receive a substantial amount of health care, but pay for only a very small portion of it, especially when their medical bills are high.

estimated that 60 percent of government spending to expand Medicaid to new recipients ends up paying for care that the nominally uninsured already receive, courtesy of taxpayer dollars and hospital resources. In other words, from the recipient’s perspective the alternatives are $5,500 in cash or only about 40 percent of that — $2,200 — in health insurance benefits, on top of the care they were already receiving.

The United States has a longstanding tradition of providing free medical services to the indigent. Hospitals emerged in the 18th century largely to care for those with no other sources of help. In modern times, federal and state governments have enacted a grab bag of policies to help defray some of the costs incurred by hospitals and clinics in providing humanitarian care.

The result is today’s health care safety net for the uninsured. It is grossly inadequate and inefficient. It needs a radical overhaul.

But in the meantime, the direct benefits from expanding insurance to the low-income uninsured are, paradoxically, limited by the imperfect patches currently in place. Hospitals are major beneficiaries of health insurance expansions, which reduce their financial burdens and increase their profit margins.

Health insurance has always been an important financial tool for hospitals. During the Great Depression, they pioneered the first widespread health insurance in the United States to help ensure payment for provided care.

More recently, in 2006, when Senator Mitt Romney was the Republican governor of Massachusetts, he embraced the state’s health insurance expansion — which became the blueprint for Obamacare — as a way to reduce the costs that uninsured patients imposed on hospitals and taxpayers. Hospitals later used similar logic in lobbying for Medicaid expansions under Obamacare and against their repeal.

Of course, the newly insured have also benefited greatly from health insurance expansions. On this point, the evidence from Obamacare is in, and the research results are clear: Medicaid coverage is better than the safety-net care available to the uninsured.

saved lives. They also increased access to medical care and reduced medical debt, which can impose substantial financial and emotional pain on patients and their families, even though most of it is never repaid. Covering some of the remaining 30 million Americans who are still uninsured would most likely produce similar benefits.

But people in need also benefit greatly from cash. And there is evidence that cash transfers can also save lives.

In addition, a large body of work shows that wage subsidies to low-income workers with children help lift their families out of poverty, increase economic self-sufficiency, and improve their health and well-being. A recent experiment found that wage subsidies very similar to the ones that were temporarily expanded in March also increase employment and earnings for low-income adults without dependent children. Likewise, direct cash transfers provide important benefits to families and their children, whose academic achievement and physical and mental health can improve as a result.

In an ideal world, everyone would have health insurance and sufficient income. But in the real world, budgetary and political constraints often force wrenching trade-offs.

There are powerful moral imperatives for making sure that everyone has adequate medical care, as well as sufficient income for their nonmedical needs. It’s hard for economists to weigh competing moral imperatives.

But we can, at least, stack dollars on scales. And the good done by cash transfers tips the scale in their favor.

The Biden administration is now trying to make permanent its temporary expansions of both cash subsidies and health insurance. If forced to prioritize how best to help those who are struggling economically — either because of the coronavirus pandemic or from longer-term, structural obstacles — it’s time to recognize that cash is more effective than insurance.

Amy Finkelstein is the John and Jennie S. MacDonald professor of economics at the Massachusetts Institute of Technology.


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