Psychology of Public Policy – IHSS as a Model for a New Welfare State

Introduction:

(For previous parts in this series, see here)

One tricky dilemma that progressives have had to face about the welfare state has been the contradiction between our desire to provide universal protection against the great social ills (poverty, disease, lack of education, poor housing, and unemployment), which tends to be broadly supported by society, and society’s resistance to violations of the social norm of reciprocity. The easiest attack on welfare has always been to assert that other people are getting something for nothing and thus divide society between the payer and payee.

While progressives ran headlong into the brick wall of social resistance in the welfare politics of the 1970s, it’s not foreordained that all forms of social welfare have to meet the same fate. It is possible to be both right and smart – and learn to tack into the wind of public opinion.

Looking at the IHSS model gives us one possible solution for how to do just that.

The Eternal Problem of Single Motherhood:

As any number of historians of social welfare or women’s history will tell you, single motherhood has always been both a major source of poverty and a potential psychological blend of gender, cultural, racial, and class anxieties used to prevent any alleviation of said poverty. Single mothers are easy to “other” – in the 1950s-1990s, framing black women as “welfare queens” tapped into all three, but the phenomenon was equally visible when it came to white women in the 1910s-1930s when “mothers’ pensions” were the issue of the day.

It’s not just a question of conservatives tapping into fear, anxiety, and resentment to abolish programs or zero-out funding; there’s also been a historical tradition of using state benefits to regulate women. The current fad for trying to encourage marriage is only the most recent trend; infamously, the “man in the house” rule under the old AFDC program sought to prevent single mothers from having sexual relationships if they wanted to continue to receive benefits.

The welfare rights movement in the 1970s tried to overcome the barrier of single motherhood by forcing a crisis in the welfare system, hoping that the outcome would be a national guaranteed minimum  income guaranteed by right. This backfired horribly in part because a GMI ran right into popular belief in the importance of work and reciprocity.

However, in the debate, two very useful things were learned. Firstly, that the American people really do want to protect children and to help the poor, but react negatively to methods of delivery that violate social norms (as evidenced from surveys that show a desire for increased spending on the poor, but antipathy to welfare).

Secondly, that the caring work done by women, be they single or married mothers or caring for a sick loved one, is both valuable and unpaid. Live-in child care can range from $15,000-38,000 a year, live-in elder care can range from $18,000-60,000 a year, yet millions of Americans (mostly women) provide this care without being recognized for their labor and their contribution to the family.

And this is where IHSS comes into the picture.

IHSS – Squaring the Circle:

In the past, I’ve argued that expanding social insurance into new areas of public policy is one way to make the public’s expectations about wage labor work in our favor. In-home supportive services (IHSS) is another model that accomplishes the same ends.

IHSS is a state-level program that exists in California, but receives part of its funding through Medicaid. It provides money for seniors, the disabled, or the blind to hire in-home care for “housecleaning, meal preparation, laundry, grocery shopping, personal care services (such as bowel and bladder care, bathing, grooming and paramedical services”), accompaniment to medical appointments, and protective supervision for the mentally impaired.” The program allows seniors and the disabled the ability to control their own care while remaining in their own homes rather than being institutionalized.

One interesting wrinkle in IHSS is that recipients have the choice to either hire a professional carer or to designate a family member as their carer. In both cases, the carer becomes a contracted state employee, because they get at least part of their paycheck from the state government.

It’s my belief that this model of service provision offers a way to tap into society’s beliefs about work and extend social welfare to groups that have been extremely difficult to cover under traditional welfare. If a relative can get paid for providing care to a loved one who’s either elderly or disabled on the grounds that their loved one can’t look out for themselves on their own, the same logic applies to children.

An In-Home Child Care Service (IHCCS) program could be established in such a way that children are given a monthly care budget (similar to current IHSS recipients), and the primary caregiver for those children is recognized as a contracted state employee. Whether it’s a single or married parent, or a relative of the parents, IHCCS could provide not just a paycheck but also professional training so that the parent can get a qualification as a professional child care provider. Alternatively, the primary caregiver could use the IHCCS payment to hire a professional carer so that they can work.

IHCCS kills several birds with one stone. Firstly, it provides social protection to children and prevents child poverty and single-parent poverty. Secondly, it provides a wage for the unwaged “second shift” – removing a major source of gender inequality within the family (and by allowing IHCCS recipients to contribute to Social Security, Medicare, UI, and similar contributory programs, a major source of gender inequality within the social insurance system). Thirdly, it expands positive economic liberty, by allowing flexibility between work and home to millions of Americans.

Extending the Model:

The IHSS model is useful for more than just back-filing the gap in our welfare state left by the end of AFDC. There are many kinds of unwaged work that we deem socially important but don’t always provide compensation for:

• Caring for the Elderly and Disabled (Long-term and Temporarily) – IHSS hardly is a comprehensive answer to the phenomenon of 46 million Americans who provide care for an adult relative of friend without pay. As a state-level program that gets partial funding from Medicaid, IHSS is also strictly limited by wealth (must have less than $2,000 in property, for example). Establishing an IHSS-like program that operates through Social Security/Medicare/Disability Insurance would eliminate the need for seniors to spend down their life’s savings to get care while compensating 46 million Americans for their labor.
• Higher Education and Training: for all that the U.S emphasizes the importance of getting an education and/or job training, we don’t do a very good job of enabling people to pursue their ambitions. We tend to rely on loans and Pell Grants to finance tuition, but we don’t do very much to help the 40% of college-age Americans who aren’t attending college become skilled workers. What help we do give to college attendees hasn’t kept up with the increasing cost of education, much less the cost of living. Providing a “trainee salary” to people in higher education or skills training, and providing training in tutoring or mentoring for people interested in that line of work, or letting people who need help use part of their salary to hire a tutor or mentor is a great way for us to recognize the hard work that young people are doing in developing the human capital of their generation.

Conclusion:

Conservatives like to portray welfare as the source of dependency and a danger to economic liberty. What the IHSS model of social welfare policy shows us is that, far from causing dependency, it can be a way to pay people for the unpaid labor that society needs to function while expanding their positive economic liberty.

So the larger question is – why aren’t we doing this already?