sarah serluco: my blog

Please review the legislative brief on House Bill 771 from the menu on the right.

Wow. Melissa Carter’s presentation left me uttering that one word. There is so much information to take in but, I think the one thing that surprised me the most would be the fact that until just within the last decade the children within the child welfare system were never counted. There wasn’t anyone charged within the welfare system to know exactly how many kids were in foster care, awaiting adoption or in need of intervention. It’s amazing to think that we have passed legislation, put a system in place and spend lots of money to help a population of children and never really took the time to keep track of them. Melissa’s work is great in understanding who they are and what is actually working to help them.

I realized that the system that everyone thinks is so terrible is actually more effective than first thought. Georgia actually does a good job at protecting its children. It seems as if the breakdown comes at the lower level within the workers who administer the services. We need to look more at these people and see where we can  make some real change. I am sure low wages and frustrations with the job has created a difficult work environment for some. As Melissa had said, the Emani Moss case was most likely the fault of a caseworker and not the system as a whole.

The legislative session has proved that politics and personal benefit constantly come before the welfare of the children. We saw many needs for new policy with the marijuana bill as well as the autism bill but, the politicians got in the way of getting legislation passed. The discussion we had of Georgia Senator Renee Unterman was an example of this common power play. All the streams were open but the window closed quickly. It didn’t help that the legislative session was so short.

Today’s welfare system is a result of the shift of responsibility between parent and government. “The transfer of responsibilities required an elaboration of administration and judicial techniques and investigation, decision and supervision.” This happened when the first institution to protect children was established in 1912. The broad mandate at that time reads very much like the goals of every child protective service today. The idea to move away from law enforcement and focus on the casework and the services provided to parents to keep the children in the home. Melissa showed us statistics that supports the effectiveness of this today. I believe, to create real change and make a difference with those in child protective services is to find good people to work for the system. It starts with those creating the public policy and runs all the way down to the caseworkers. Lets find a way to create the best policy in which to tap into these great people.  Maybe through raising salaries, requiring special skills or education.  I know there are some amazing people right here in our class.  I look forward to seeing what we can do.

I feel as if there is a sense of desperation and confusion in the air over the Affordable Care Act. Troubles continue to loom for the President and Democrats over what we can all agree was an unsuccessful “roll-out”. Concept good, roll-out bad. We’ve seen website glitches, repeated changes in the law and constant movement in deadlines. Remember, “if you like your doctor, you can keep your doctor”? On the other side, the Republicans distracted by their own vision, voted over 50 times to repeal the ACA and the dozen or more alternative plans proposed by the party haven’t mustered up the support, even from their own people, needed to make any real change or refocus the discussion in any useful and productive way.  

We’ve been hearing about a universal healthcare plan for the nation since the Clintons were in office. I remember working for MTV’s Choose or Lose campaign and covering the elections at the time. Healthcare options came up and was debated and discussed in our town hall meetings. Our viewers loved the idea but no one seemed ready. The Clintons tried, but the push back from voters was so strong it became too hard politically to get any legislation passed. It wasn’t the right time. There has always been an obvious need to fix a system that became broken a long time ago. Recognizing this need, Medicaid was created in 1965 in order to provide healthcare for low income families. In 1986 the Emergency Medical Treatment And Labor Act (EMTALA) came out of Congress. The law was enacted to provide emergency medical services to all regardless of the ability to pay. It was a significant at the time to combat “patient dumping”  which became so prevalent. And lets face it, morally wrong. Historically we have tried but have fallen short.

There are some serious problems that we can all agree on and I think we need to focus on these issues and fix them. Nobody should ever go bankrupt because they can’t afford to pay their medical bills. There should be a safety net built in somewhere in our system to help protect us from this happening. It is sad and disgraceful to see the people in “Sick In America” have to go through what they did to stay healthy and alive. Another issue is that everyone with a pre-existing condition should absolutely be accepted for healthcare coverage. We as a nation need to show more compassion for those that are sick and in need. This isn’t the time to turn our backs but a time to help lift them up. Respecting our own people in this way could create a climate to help others and continually set the tone to solve future problems. Another issue is why are administration costs so high in this country? Taiwan is at 6 or 8% while we are close to 25%. How does this happen? How are insurance carriers able to pilfer our pocket- books? Why does everything cost so much? One reason is we need major tort reform. Doctors perform tests and do procedures that are not needed just to cover their you-know-whats. But that’s another story. The main reason costs are high is there is an inefficient delivery system. We saw that topic come up quite regularly in the Frontline documentary. Too many rules, too many companies involved and too much to process. We pay too many people in order to administer the system.

Here are the reasons why I think a national healthcare can’t work in the US.  We don’t require everyone in the country to participate. If you remember in “Sick Around The World” every single citizen of every country was required by law to participate. The success of these programs were directly linked to the fact that they mandated 100% participation. How could we require 320 million people in the US to take part? Our population is too large to enforce it. My belief is, if everyone thought it was the best for them and best for their families then they would participate. But they are not. Even our own professor opted out after weighing her options. I opted out. After my premium went up 22% in December I tried to shop in the marketplace. I was excited to have the option – single mother, limited income, student…where else could I find better. What I discovered is that I will pay more and sacrifice my coverage. It didn’t work for me.

This country was founded on an entirely different culture. We are not Europe, or Asia. There are too many that don’t trust the government to run anything right. Like the people of the U.S., the Doctors and businesses will always fight back when someone tells them how much to charge, how much to pay, where to buy, who to see etc. You get my point. Can you picture our doctors consulting a printed price book to see what to charge like they do in Japan? I can’t. When Senator Pelosi tells us, “we have to pass the healthcare bill so you can find out what is in it.”,  people are just going to be skeptical. Does she really think everyone trusts the government that much? (Click on the link to see a great interview with David Gregory from Meet The Press.  He asks a lot of good questions. And Pelosi has some good comments regarding intentions and what is the goal for ACA.) But getting back to topic, you can’t just tell Americans that they must do something.  It needs to be a choice. When you take that choice away then it will never work properly. So when you are dealing with a public that is steeped in the belief of freedom of choice then lets present to them a plan the right way. Don’t rush the implementation just because all the political streams came together.  Right now close to 60% of Americans disapprove the ACA. Not one Republican senator voted in favor of the ACA. Give the people what is necessary to be a healthy prosperous nation – lower premiums, lower healthcare costs, accessibility for all. Far too many mistakes were made here and now we are not getting what we need. Lets get it right.

I haven’t ever really felt that social policy has the ability to change poverty in this country and after reading DeParle I am even more pessimistic that it will ever get better. The stories of Opal, Jewell and Angie not only are depressing to read but created frustration and anger for me. I think I started the book thinking that I would be given some answers or solutions to the problems of our social welfare system but instead it left me thinking that it’s a never ending cycle with no chance of moving up in society. One review of DeParle’s book from Dissent Magazine author David Glenn echoes my sentiments by saying, “DeParle doubts that welfare played a major role in causing family breakdown in the first place and also seems to doubt that public policy can do much to repair family breakdown today. We’re left with the helpless feeling of watching people drift from crisis to crisis.” I find the word helpless to best sum up my feelings. The review also went on to say, “No one who reads this book attentively will close it with the idea that if only these people would clean up their acts and pull themselves up by their bootstraps, all would be well.” What happened to Clinton’s idea that we could give a new generation of people the “piss and vinegar” that our ancestors had. It just hasn’t worked out that way.

Our welfare policy is based on the idea that we learned, which is, liberty requires positive help from others and society to ensure basic resources. It is our moral obligation to provide opportunities to the poor. We are given plenty of examples in DeParle’s book that shows us how this is done through our welfare system. The girls in the book are given a welfare check and later help to find work. But the lives of those on welfare can never be equal to the rest of us and I think DeParle was trying to say this. They operate in a different world other than normal society. Even the welfare system isn’t enough to give them a leg up. They find ways to keep the welfare check and get paid from a job on the side operating completely outside the system. They realize from the beginning that it doesn’t work in their favor and they just do anything else in order to survive.

Where is there equality if you live in a system that isn’t fair to begin with? Yes, we are treating them equal by providing opportunity and resources but why do they seem to continually be unequal and even more unequal as time goes on? “Without the security of having one’s basic needs met, a person can’t make free choices.” (Stone, p. 126) I believe that there will never be a welfare system that can ever lead to equality because we all have a different idea of what equality is and what are basic needs. We have different tastes, abilities, disabilities, dreams, desires etc. Not to mention that we live in a society that treats men and women differently, races and sexual preferences to name a few. How could we place one equal value on resources when we all want and need something different? A published article I read on equality and welfare discusses these points and offers this statement, “If we want genuinely to treat people as equals (or so it may seem) then we must contrive to make their lives equally desirable to them, or give them the means to do so, not simply to make the figures in their bank accounts the same.” Is this possible? I believe that DeParle thinks there is a liberty-welfare tradeoff. The world we live in is too complicated.