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Show Rapidly escalating health care costs-consistently running double the general inflation rate during the 1980shave played a major role in the crisis. But two other factors also have contributed: the declining scope of Medicaid-the joint federal/state health care program for the poor-and changes in the job market. Social Policy in Europe While social welfare programs in the United States were drastically cut in the 1980s, many western Eur~pean nations were increasing assistance to the1r populations-especially families and children. These countries now provide a variety of income supplements-family allowances, housing assistance and government-generated child support-to buttress widely available job, job training, child care and health care programs. The United States offers a patchwork of income assistance programs to low-income people and uses tax deductions as a means of providing some acrossthe-board relief to all taxpayers. In practice, however, those with little or no income reap the smallest benefits from tax breaks. In contrast, many European nations provide universal family or child allowances-cash benefits provided monthly or weeklywhich are supplemented if one or both parents are unemployed. These programs ensure that all families-regardless of income or work statusreceive benefits. Because more people can qualify for govemme~t help, European families tend to be bette~ off than th~rr American counterparts. The rate of child poverty m the United States is 60 percent higher than it is in Great Britain and more than double the rate in West Germany, Norway and Sweden. European nations have developed income support systems without creating disincentives ~o wor~ .. The country most known for its generous soc~~ po~1c1esSweden-has the highest labor force participation rate in the western industrialized world. This has been accomplished in two ways: income assistance payments typically don't exceed what families ~an earn in the workplace (minimum wages are set high) and state-supported parental leaves and child care ensure that neither male nor female workers have to leave the labor force for extended periods. Single mothers and their children also fare better in most other industrialized nations. In France, for example, a newly divorced mother is eligi?le for a special social security payment for a year, relffibursement for health care expenses, a family allowance, a variety of special tax deductions and government training programs. American politicians have tended to view European social welfare programs as unworkable here. ~s the current debate over social welfare reform contmues, perhaps the European approach can provide guidance on how to prioritize welfare expenditures and develop successful programs in this country. T ighter federal eligibility requirements for Medicaid have reduced the number of program participants, while state income limits for would-be recipients have not kept pace with inflation. As a result, Medicaid cove~age of low-income individuals dropped from 63 percent m 1975 to 50 percent in 1985. Medicaid cov~r~ge is now virtually limited to AFDC and SSI rec1p1ents. Recent changes in the workplace have only exacerbated the problem. Studies show that nea!ly half of ~he full-time jobs created since 1979, many m the service industries, pay little more than the minimum wage and offer few benefits, including health insurance. Moreover, many employers who do provide health insurance are reducing their insurance premium c~ntributio~s or refusing to contribute to the cost of family prermums, for~ing workers to pay more for insurance or to drop the1r coverage. Health Care: A Basic Human Need? Ironically, the health care crisis arises at a _time w~en health care access and coverage had been 1mprovmg. The private sector's provisi~n of empl?y~e health insurance as well as the creat10n of Med1ca1d and of Medicare (the non-means-tested federal progra~ providing health care to the elde!ly) have -~amatlcally increased the number of Amencans rece1vmg regular health care. Before these programs existed, routine medical care was often considered a luxury. Today, few people would want to deny basic ?r emergency medical care to those who ca~ot affor~ 1t. However debate continues around what kind of medical care ought to be available to the medically indi~ent. Some believe only emergency care should be provided, through public hospitals and clinics. Others argue that preventive care, such as immunizations and prenatal care should be offered to everyone. Even less agreement exists over the widespread availability of counseling, sex education and alcohol and drug abuse treatment programs as well as costlier medical treatments, such as liver or heart transplants. The price tag may be the pivotal consideration for offering any of these services to the poor. But equal 7 |
