Author: Larry Littlefield

Liberalism, conservatism, Republicanism, and Democratism: these “ideologies” are so often and so easily discarded for the benefit of an organized group of political supporters that it isn’t reasonable to call them ideologies at all. When it comes to social benefits and burdens, only capitalism and socialism are consistent. Under capitalism you get what you earn, at least in theory, and those who believe effort and talent should be rewarded, and incentives are required to get people to work on behalf of others, can agree with that. Under socialism you get what you need, at least in theory, and those who believe we are all one human family can agree with that. In addition to what you earn in the marketplace and what you need at home, however, there is another justification for obtaining public benefits – what you’ve got. All too often, increasingly often, public benefits are services are provided to those who already have them, because they already have them. Even as others, who have greater needs, are denied. Even as others, who have earnings that are taxed to pay for the benefit, are also denied.

Thus far, my equity and eligibility posts have reviewed public policies that direct, attempt to direct, or pretend to direct public benefits to the less well off, or to those most in need. Yet government eligibility rules have often directed public benefits, services and protections to the better off, not the worst off, with not only “conservative” and Republicans but also “egalitarian” Democrats in support. And the policy of providing benefits to the better off hasn’t been limited to obscure, limited-cost programs; it has been characteristic of the history of the most extensive and expensive public programs in the country. Over the past century and a half, many now universal or near universal benefits and protections such as public education, Social Security, unemployment insurance, and the minimum wage were offered first to the organized and influential, then to population at large, and finally to the least well off – the poor, the sick, the disabled, and minorities. The better off, in short, were the “thin end of the wedge,” those with the political clout to get a public benefit created, who later felt a duty to offer the same benefit to others. Until more recently the government, and the tax burden, reached some kind of maximum/equilibrium and the march to universal benefits stopped, leaving inequities in its wake. No one feels much duty to others anymore, even if they are receiving benefits themselves.

The non-decision to implement a “hope no one shows up” non-policy, discussed in my prior post, is directly connected to the issue of standards, and to the cost of benefits per recipient. For every needs- and means-restricted benefit, there is a tradeoff between the number of beneficiaries that can be served and the amount that can be spent on each. This tradeoff is being made, generally without a direct acknowledgement that it is being made, in almost every major category of public service, from education to health care. And liberals and Democrats, in pushing to enact expensive benefits, often end up agreeing to serve some people but not others – others who are just as in need, or more in need, than those who receive the benefits. As the United States, with the most expensive health care in the world but also the most uninsured people in the developed world, finally acknowledges how bad its health care finance system is, the issue of standards will clearly move to the forefront. Clearly the U.S. can afford basic health care, even good health care, for everyone just by using what the government is already spending. But that would mean some beneficiaries would have to give up extravagant health care, and it is those with extravagant health benefits, not the uninsured, who have political power.

The constant liberalization and restriction of eligibility, and increase and decrease in personal scrutiny, under means- and need-restricted programs is the off-the-books, under-the-radar outcome of an ongoing struggle between “liberals,” who want many people eligible for expensive services (often because they earn a living providing those services) and “conservatives,” who do not require services and do want to pay taxes to help those who do require them. In economic expansions, when more services may be offered without a tax increase, advocates often demand, and receive, more extensive services for more people. In economic downturns, when falling tax revenues lead to budget crises, there is generally a sudden finding of “waste, fraud and abuse.” In all times, however, politicians often compromise by gross hypocrisy. While focused on the needs of particular group (supported by organized advocates), they prove their compassion by passing laws that, in theory, make many people eligible for extensive services and benefits. But during the budget process, when different needs and priorities are in competition, resources are scarce, and tradeoffs must be made, they save money by not providing enough to cover everyone theoretically eligible to get all the benefits they are theoretically entitled to. Having claimed credit for making a benefit available, both Republicans and Democrats “hope no one shows up” to claim it.

When one examines public policies to ensure the care of the poor and those with special needs, and goes beyond the rhetoric about “racism,” “welfare queens,” “malingerers,” “big corporations,” insurance companies, “big government,” “compassion” and “rights,” one finds difficult choices and high stakes. The choices are often made by low level, underpaid public officials who cannot possibly have the information required to make them fairly and correctly, and who are at any moment subject to political blame for injustice and suffering, for waste, fraud and taxes. People don’t like to be forced to confront such difficult choices. And you don’t attract votes, viewers or readers by forcing them to.

I’d like to digress from my equity and eligibility series for a post to discuss a bad solution to the massive problem alluded to my the prior post – the custodial care of the frail elderly. The government is faced with very difficult issues. At what point is custodial care necessary? How can you be sure, for a given person, that point has been reached? What are the responsibilities of the senior citizen in question, to provide or pay for that care, or his or her children, particularly as the generation that decided not to stay together, or even get together, to benefit those children reaches deep old age? Faced with these issues and potentially massive public expenses, some advocate advising, mandating, or requiring private long-term care insurance, in effect converting the public policy problem to a fight between families and insurers. But I would neither purchase nor advise the purchase of long term care insurance, either for family members or as a matter of public policy.

Like the old and the young, the disabled are generally thought of as inherently deserving of public assistance. Those who are blind, deaf or crippled, unlike those who are the parents of illegitimate children or addicted to alcohol or other drugs, are not despised for bringing their problems on themselves, even in Red States. Reasonably thoughtful people take a “there but the grace of God go I” attitude toward the needs and conditions of those suffering a disability. Most people, if forced to think about it, are willing to pay taxes to assist those with the added burden of caring for a disabled spouse, child, or parent. In 1998 4.3 percent of all public spending was on services and benefits specifically for those with special needs – for the disabled. Most of these have eligibility restricted based on means, as well as needs. A disabled individual with enough income to provide for their own care would not be eligible; a disabled individual living with a spouse or parents who are not poor also may not be ineligible. There are few single disabled adults who are not reliant on public benefits, however, because those born with severe congenital disabilities such as mental retardation, mental illness, blindness or deafness are unlikely to earn much money during the course of their lives, and are likely to require extensive assistance, particularly health care. But deciding who is in need is not always straightforward, and this leads to below the radar conflict and non-decisions.

Here in the Untied States, people have decided that the elderly are entitled to a modest level of retirement income and health care, and the young to an education, at public expense. Those who want the government to be “smaller” often argue that these services should be delivered in a different way, with the government financing the benefits but the private sector providing them. But they dare not overtly challenge the right to receive these universal entitlements, so universally popular are they with the American people. In other developed societies, those with “bigger” governments, additional human needs are also considered the responsibility of society as a whole, rather than of each individual person or family. In those societies, for example, virtually everyone receives government-funded health care, not just the elderly. One example is Canada, right next door. Government-funded housing is also more common in other places.

While the United States does not provide universal food, clothing, and health care via government programs, however, few Americans are willing to see people in their own communities starve for lack of food, freeze to death for lack of shelter, or die or become crippled by readily preventable diseases and easily treated injuries. The American compromise has been to assume that most non-elderly people will buy food, housing and health care for themselves, but for the government to provide for those who do not have the means to afford them. Means-tested benefits are thus a substitute for universal benefits, and a way to avoid deprivation at, theoretically, a lower public cost.

Age is the most simple and most common of the criteria used to restrict eligibility. In 1998 about one-third of all public spending was on services that were available exclusively, or primarily, to the young or old, regardless of their income or other circumstances. These include elementary and secondary education (10.9 percent), social security for the retired (11.2 percent), Medicare (6.6 percent), and public higher education (3.9). Public higher education is theoretically available to everyone, but in practice is used primarily by the young. Social Security is only available to those 62 and over, Medicare to those 65 and over, and their share of public spending is going to soar in the next few decades. While the rules vary, one typically becomes ineligible for public elementary and secondary education after a certain age, typically age 21, even if one had not finished high school. There are additional services restricted to the young and old, such as senior citizens centers, and youth day camps and recreation activities, but spending on them is not tabulated separately from other, similar activities. These services may be enough, however, to increase the overall share of public funding allocated to age-restricted services and benefits to one-third of all government funding. Public education for the young and retirement income and health care for the elderly, along with the military and interest on federal, state and local public debts, are the most costly public programs. The age-restricted programs are also the most popular, for four reasons, discussed below.

Enough of the preliminary facts; let’s move on to principles. A public sidewalk is the sort of thing that many people think of when they think of the government. It is the common property of everyone in the community, and everyone in the community, regardless of who they are and where they are from, has an equal right to walk down it. On a public sidewalk, everyone is equal. Most public services, however, are not like a public sidewalk. Less than 20 percent of all public spending – federal, state and local — is on services that everyone can experience, or have an equal right to experience, on any given day. Even adding in the military, space research, legislators and other central administrators, categories of government that do not benefit people directly but, one might argue, benefit all people indirectly to an equal extent, “general” services still account for just one third of all public expenditures. Debts and pension payments, for which no public services are received, accounting for about one-sixth. About half of all public spending goes only to those who are eligible to receive services and benefits, based on criteria, rules, regulations, and applications accepted and denied. The next three weeks of posts will be a review of public benefits and services that aren’t available to everyone, and of the fairness of the philosophical foundation and practical criteria that are used to determine who does and does not get them. Read them all, and I personally guarantee you’ll never think about any public policy issue the same way again.