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Posts published in July 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.

Renewing the Declaration


On July 4, 1776, the Second Continental Congress adopted a remarkable Declaration, proclaiming the thirteen American colonies to be free from British control. The delegates famously stated: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

The 56 colonial signers listed 27 grievances against King George III that caused the split with Great Britain. They were fully aware that they were placing their lives and fortunes at great risk because the King was bound to use force of arms to squelch the rebellion. Nevertheless, they concluded the Declaration, “we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.” They were united in the struggle to gain the blessings of liberty for the colonists and their descendants, no matter the cost.

We won that fight and established a government of the people, by the people and for the people. Our ancestors bestowed those hard-won rights upon us and we now enjoy more freedoms than any other society on Earth. Why is it, then, that we are no longer united? Why are we at each other’s throats, rather than working together to achieve greater heights for our country and its people?

Benjamin Franklin provided the answer to a woman who asked him what had been achieved by the Constitutional Convention of 1787. She asked, “what have we got, a republic or a monarchy?” He replied, “A republic, if you can keep it.” Franklin was obviously not putting the onus on the lady, Mrs. Powel, to keep the republic. The “you” he referred to was all of us.

Franklin knew that future generations would lose this exceptional form of government if they did not work hard to keep it. It would take the same kind of unity, sacrifice and commitment that drove the Declaration signers to make the break with Great Britain. We can’t just sit on our hands and take our nation’s blessings: Every citizen is obligated to contribute to the preservation of our democracy. When one does not have to pay a price for a precious thing, its true value may not be appreciated.

We too often take our freedoms for granted. Many of us do not know how government works or what to do if it is not working effectively. Others do not keep up with what is going on in society or know how to address serious societal problems. Too many don’t vote. Few serve this great nation.

We could take a cue from those who signed the Declaration and pledge to do more to serve and improve our country. Strengthening civic education in our schools would help. Our youngsters should learn more about governing and of their responsibility to work cooperatively to improve our system of government.

Everyone should have the opportunity to serve their country in some role. Military training should be made available to more young men and women to relieve the strain on our volunteer force. There are many things young Americans could do in civilian society, like building up their communities and building their character in the process.

We need more inspirational leaders, besides our school teachers, who will encourage young people to pursue careers in public service roles. And there should be more programs for older Americans to help others in need.

We can get started this Fourth of July by reflecting on what each of us can do to make this a more caring and communal country and how we might enlist others, including those with whom we have political disagreements, in achieving that goal. That would renew the spirit of that first Independence Day in 1776.

There WILL be single payer


For several years, I’ve predicted the eventuality of a single-payer health care system in this country and submitted myself to verbal stoning from those who disagreed. And there were some who did, in fact, hurl some verbal rocks. Problem is, aside from criticism - warranted or not- the “throwers” offered no alternative or even decent arguments against the concept.

It’s coming, my friends. Like it or not, it’s nearer now than it was a year or two or three ago. In fact, our national health care law - the Affordable Care Act (ACA) or what’s left of it - may force the arrival of single-payer day sooner than previously expected. In my view, that may be its ultimate signature benefit.

Definition: Single payer health care is paid from an insurance pool, usually run by government - state or federal or a combination - with monies raised from individuals, employers or government. Or all three. The “payer” collects medical charges and pays for services rendered through one source - usually government using contractors. Care can be offered from many sources but there’s usually only one “payer.”

The quality of our health care is, for the most part, not in question. Neither is availability, though that currently differs somewhat based on location, ability to pay or availability of help to pay. No, the most powerful force - the most urgent - is C-O-S-T. Cost consuming about 20% of our nation’s economy. Cost bankrupting families hit with unexpected health problems. Cost leaving millions without preventative care or complete care even when needed. Cost driving profits to record levels for unscrupulous insurers. Costs - and dealing with them - that have driven gutless politicians into hiding. C-O-S-T.

I don’t believe politicians of any party - including their lobbyist friends - will solve this out-of-control national problem. In fact, it may be best they can’t - or won’t. Because any major change they’d make would be politically-based, self-serving, not systemically founded on equal access and reduced cost which are what needs fixing. The system of cost control. I’ve heard all the garbage about “getting government out of the health care business” and none - based on years of experience - makes a valid point. I’ve heard no ideas offering as sure a fix to our health cost issues as single payer. Whether government or a designated third party.

I can attest in the first person to having lived with single payer. To seniors, it’s called Medicare. Run by the government. I’ve been covered for more than 17 years. Without a single issue or complaint. Including major surgery. Access has never - never - been in question. Given my optional “medigap” insurance, cost has never - never - been an issue. The actual hands-on care has been first rate in the several locations where we’ve lived.

The Medicare option I chose costs about $100 a month. “Medigap” is about $220. A co-pay is seldom required. Never do we talk of not proceeding with care because of cost. Most prescriptions require no co-pay.

Access. First class care. Lower cost. Monthly out-of-pocket is about $320. If you’re younger than 65 and are paying any insurer, can you beat that? Are you eligible for all - ALL - necessary care for you and your family? Or, like so many in this country, are you “winging it” without insurance for cost or other reasons? Are you taking the unwinnable gamble you won’t need expensive medical care? ‘Cause, if you are, you’ll lose. Guaranteed.

Two significant changes in our national thinking are necessary to bring this about. First, a recognition that this not a problem that needs a political solution. It needs a professional, well-crafted and equally beneficial private health provider and insurer based solution with a top-to-bottom redesign to include all. All Americans. Politicians, even in the best of times - which these aren’t - can’t and/or won’t do that.

Second, Americans who have an unreasonable and entirely unwarranted resistance to all things government must join the rest of us in the real world. A chief tenet of government is to act in, and on behalf of, the “common good.” We accept that as fact in such things as the military, highway systems, aviation safety and other infrastructure needs.

Health care is an “infrastructure” need. When people are denied access - for cost or any other reason - they will cease to contribute to that “common good.” They will, instead, become economic and costly drains on that “common good.” If we agree we need government to defend ourselves as a nation - if we agree we need strong government to provide the economic and vital support infrastructure to make this nation successful - we need a common government guarantee of personal health. We’ll never truly achieve the first two guarantees if we continue to disregard the third.

If you have a workable concept for a non-political solution to our out-of-control health care problems, step up, my friend, and demand the podium. If you don’t, then rethink the concept of “single payer” and the concept of why government exists in the first place.

It will come. Bet on it.