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Posts published in “Day: July 3, 2019”

Welfare/welfare state


It is best to define the welfare state not through its noble goals but through its instruments.
► Cato Institute, 2018

“Welfare” is enshrined as a core purpose of the U.S. constitution: to “promote the general Welfare.” Its top dictionary definition (per Merriam Webster) very much reflects that: “the state of doing well especially in respect to good fortune, happiness, well-being, or prosperity.
That means, in recent political discussion, “welfare” is one of the great, classic terms of art.

The word gets two basic kinds of artful usage, referring to “welfare” as benefits for the needy – “a government program which provides financial aid to individuals or groups who cannot support themselves. … The goals of welfare vary, as it looks to promote the pursuance of work, education or, in some instances, a better standard of living” – and as the “welfare state,” which is in part a metaphorical extension of that.

There has never been a “welfare program” in the sense of a single specific program going by that name (which may contribute to the feeling that it’s hard to get a handle on it). But support for low-income people is an old concept, going back at least to the first Roman Emperor Augustus, who offered a “grain dole” for the poor. Societies through the Middle Ages and beyond provided variants, more generous or less. Commonly this was regarded as charity, but the term “welfare” came into use early in the 20th century as an alternative to denigrating associations of receiving “charity.”

Welfare in the sense of “well-being” had been around for centuries; Shakespeare used it long before it became part of the American Constitution.

In Great Britain welfare work appeared in 1903, welfare policy 1905, welfare centre 1917, and welfare state 1941. An essay on this noted, “One result of this new usage was that the word moved from being a term for a condition to one for a process or activity.”

Negative connotations soon returned, however, and much political discussion about “people on welfare” implicitly involved lazy and shiftless people (often with racial overtones as well). It was sufficiently part of the social conversation in the 60s and 70s to get a quick reference in a comedy music record (“When You’re Hot You’re Hot”), when singer Jerry Reed, singing the part of a street gambler tossed into jail, complained, “Who gonna collect my welfare?”

There may be no single “welfare program,” but there are – under its umbrella – a number of programs which do distribute benefits, sometimes direct income, often to lower income people. The Supplemental Nutrition Assistance Program (long known as “food stamps”) usually would be included, as would Temporary Assistance for Needy Families, and several others, but exact list easily could be debated. Some people might include Social Security, Medicaid and Medicare on the welfare list, though probably most Americans wouldn’t. Polling has shown those as both highly popular and justifiable at least on grounds that the recipients have paid into it.

“Welfare” has gotten less attention in the new millennium, probably in large part because of the “The Personal Responsibility and Work Opportunity Reconciliation Act of 1996,” signed by President Bill Clinton, which he said would “end welfare as we know it.” It did make some major changes, though the results have been mixed.

One historical description said “The new law built on decades of anti-welfare sentiment, which Ronald Reagan popularized in 1976 with the racially-loaded myth of the ‘welfare queen.’ In the two decades that followed, progressives and conservatives alike put forward reform proposals aimed at boosting work and reducing welfare receipt.

Progressive proposals included expanded childcare assistance, paid leave, and tax credits for working families. Conservatives, on the other hand, tended to favor work requirements – without any of the corresponding investments to address barriers to employment. In 1996, after vetoing two Republican proposals that drastically cut the program’s funding, President Bill Clinton signed the Personal Responsibility and Work Opportunity Act into law. The new legislation converted AFDC into a flat-funded block grant – TANF – and sent it to the states to administer. The law’s stated purpose was to move families from ‘welfare to work’.”

How well that’s worked out is a subject of debate, though as a matter of politics the subject has moved from front to back burner. (That’s not to say it might not shift again.)

Writer Elisabeth Park said that “When conservatives talk about ‘welfare,’ they make it sound like this pit that lazy, undeserving people wallow in forever, rather than a source of help that’s there when we need it – and that we all pay for through our taxes. … Instead, we should say Social Safety Net: This resonates better, because it conjures an image of something that catches us when we fall, but that we can easily bounce out of.”

But the word “welfare” already does double duty, with a second use just as active in the new century as it was in the last, with “welfare state.”

Back in the 70s William Safire wrote of the “welfare state”: a “government that provides economic protection for all its citizens; this is done, say its critics, at the price of individual liberty and removes incentives needed for economic growth.” Welfare state as a term has been around for a while, about a century, referring to various nations in Europe (Sweden may have been the first to get the description).

A welfare state (says the Cambridge Dictionary) is “a system that allows the government of a country to provide social services such as healthcare, unemployment benefit, etc. to people who need them, paid for by taxes.” The exact list of services varies from place to place – by location and by what is meant by “welfare state.”

But what is meant, exactly, by “welfare state”? What benefits or services does it provide, what restrictions does it impose? All that seems to be in a beholder’s eye.

The Cato Institute, which to put it mildly is no supporter of a welfare state, offered in one essay: “It is useful to regard the welfare state as a special kind of welfare system, which we define as arrangements to deal with various risks facing individuals – such as acute poverty, sickness, and accidents. A brief look at history reveals the existence of various welfare arrangements – for example, family (kin) based, religion based, civil based, corporate based, and market based (insurance through jobs, private savings, and commercial insurance). Countries have always had some type of welfare system combining all or some of the above arrangements.” It points out that a “welfare system” – in which some needs are met through non-governmental means – is not the same thing as a “welfare state.” The essay doesn’t clarify, though, how to make the jump from public provision of the services and benefits, to private provision. (Charity never has been nearly sufficient to meet the needs addressed by public systems.)

Most studies of the “welfare state” face an obstacle: No two are exactly alike, and the provisions enacted by each are different, and change over time. Most governments in recent centuries – and many from much older – incorporate at least a few elements of the “welfare state,” while absolute (even if extensive) “cradle to grave” provisioning is still highly unusual.

“Welfare state” can be used only as a general concept (as it’s often used as a term of opprobrium) rather than as something specific; the closer you try to get to specificity, the more the term, as specific definition, slips away. It has that in common with many political words.

One of the growing concepts in health care (astonishingly, not a subject of serious political controversy) is coordinated care, which has been defined as “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.”9 Less bureaucratically, it means medical and other professionals work both together and directly with the patient so that a complex problem – such as a chronic illness which may have several causes and need several plans of attack – can be addressed comprehensively; piecemeal approaches wind up in many cases as poor band-aids on symptoms rather than real solutions, resulting in regular relapses.

Welfare (aside from the full-state element) could be reconsidered with something like that in mind.

A book called Radical Help by Hilary Cottom10 addressed some of this in Great Britain. One report on the book11 cited the case of Ella, “a British woman who grew up in a broken home and was abused by her stepdad. Her eldest son got thrown out of school and ended up sitting around the house drinking. By the time her daughter was 16, she was pregnant and had an eating disorder. Ella, though in her mid-30s, had never had a real job. Life was a series of endless crises – temper tantrums, broken washing machines, her son banging his head against the walls. Every time the family came into contact with the authorities, another caseworker was brought in to provide a sliver of help. An astonishing 73 professionals spread across 20 different agencies and departments got involved with this family. Nobody had ever sat down with them to devise a comprehensive way forward.”

Ella’s case is more the norm than the exception, in the United States too. Her situation inside that structure never really improves, even after (in Cottom’s estimate) the British system spends a quarter million pounds yearly, mostly on administrative cost and time, on her and her family.

When Americans turn cynical about welfare, situations like that – and its American counterparts – are part of what they’re bearing in mind.
Cottam described a new approach being tried in Britain comparable to coordinated care. Ella and others like her instead meet with something called a “life team,” an interdisciplinary group of professionals; the focus now is to figure out where Ella would like to take her life – in a productive way – and then find answers to get there. Instead of Ella plugging into a one-size-fits-all system, the “system” reshapes to get her on her feet. And, as in the case of coordinated care, the results often have been surprisingly positive.

If “welfare” is redefined as flexibly helping people lift themselves up, rather than as a system for dispensing benefits, “welfare” could take on a more positive meaning.