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Eighth Edition

American Social Welfare Policy A Pluralist Approach

Howard Jacob Karger Hawai’i Pacific University, School of Social Work

David Stoesz Flinders University/Carnegie Mellon University-Australia

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Library of Congress Cataloging-in-Publication Data

Names: Karger, Howard Jacob, author. | Stoesz, David, author. Title: American social welfare policy : a pluralist approach / Howard Jacob Karger, Hawai’i Pacific University, School of Social Work, David Stoesz. Description: Eighth Edition. | New York : Pearson, [2018] | Revised edition of American social welfare policy, [2014] | Includes bibliographical references and index. Identifiers: LCCN 2016040802 | ISBN 9780134303192 (alk. paper) | ISBN 0134303199 (alk. paper) Subjects: LCSH: Public welfare—United States. | United States—Social policy. | Welfare state—United States. Classification: LCC HV95 .K354 2018 | DDC 361.973—dc23 LC record available at https://lccn.loc.gov/2016040802

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ISBN 10: 0-13-462812-8 ISBN 13: 978-0-13-462812-7

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The years since the publication of the last full edi- tion have been marked by dramatic events on the domestic and international fronts. Although the U.S. economy bounced back from the global finan- cial crisis (GFC) of 2007 to 2008, the post- recession gains were largely realized by the top 1 percent of U.S. wage earners who accounted for 85 percent of total income growth from 2009 to 2013. By 2013, the 1.6 million families in the top 1 percent earned 25 times more than the 161 million families in the bottom 99 percent. It is little wonder that this egregious income inequality led to large numbers of angry people, which in turn, fueled the rise of presi- dential candidate Donald Trump.

The international front was especially turbulent as the Arab Spring toppled or destabilized govern- ments in Tunisia, Egypt, Yemen, Libya, and Syria. By 2016, at the same time, the war in Iraq and Afghanistan continued to drag on. By mid-2016, an increasingly bloody civil war in Syria claimed more than 400,000 lives and was largely responsible for the 1 million immigrants that entered Europe in 2015.

The instability in the Middle East led to the creation of ISIL (Islamic State), a militant group di- rectly or indirectly responsible for numerous mas- sacres, including the 2015 attack on the Bataclan Theatre near Paris (130 dead and 368 injured); the 2015 Ankara, Turkey, bombing (102 dead and 400 injured); the 2015 San Bernardino attack (14 dead and 24 injured); and the 2016 Orlando nightclub attack (49 dead and 53 injured). Western nations continue the struggle to find a balance between pro- tecting privacy, civil liberties, and public safety.

Despite the domestic and international chal- lenges, the way forward was stymied as the federal government was virtually paralyzed by the Repub- lican Party’s control of the Senate and the House of Representatives. With the death of Antonin Scalia, even the Supreme Court was divided between lib- erals and conservatives. A divided government re- sulted in a virtual standstill of policy options.

In the midst of this virtual paralysis, several important policy developments emerged in the first term of the Obama administration. Some of these achievements include the Dodd–Frank Wall Street Reform and Consumer Protection Act, one of the

most significant financial reform acts since the Great Depression; the Patient Protection and Affordable Care Act of 2010 (known as Obamacare); repeal of the military’s Don’t Ask Don’t Tell (DADT) rule; the Credit Card Accountability, Responsibility, and Disclosure Act; and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPS).

The presidential election of 2012 proved to be one of the most acrimonious in recent memory. Ex- treme Republican Party ideologues drove the party far to the right in areas such as contraception, abor- tion, health care, voter’s rights, and immigration. In the end, President Obama’s moderate approach tri- umphed as he won 303 electoral votes compared to Mitt Romney’s 206 votes. The election illustrated the sharp divisions in American society between the more liberal Northeast, West Coast, some West- ern and Midwestern states, and the more conser- vative South and rural areas. These patterns reflect differing perceptions of where America should be heading.

The acrimony of the 2012 presidential election was far eclipsed by the 2016 presidential election, as Republican candidates vied to outdo each other in appealing to the white and increasingly conservative base of the party. Extremist candidates like Ted Cruz and Donald Trump handily defeated more moderate candidates such as Jeb Bush and John Kasich.

On the Democratic side, Vermont Senator Bernie Sanders introduced a European-style democratic socialist vision to mainstream American politics. Defying all odds, Sanders won several primaries against favored Democratic nominee Hillary Clinton, including Oregon, North Dakota, Minnesota, New Hampshire, Michigan, Indiana, and Vermont. In the raw primary vote count, Sanders received 12 million votes compared to Clinton’s 15.8 million.

In one of the most shocking upsets in recent po- litical history, Donald Trump beat Hillary Clinton for the presidency, despite some polls showed her chances for victory at between 70 and 99 percent. Progressives of all ilk and Democrats were in shock, disbelief, and fear.

Several changes will be required if human ser- vice professionals are to reclaim a prominent role in social policy that they had at the turn of the century through luminaries such as Jane Addams, Lillian

P r e fac e

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Wald, Grace and Edith Abbott, Mary Simkhovitch, and others. Markets have been a primary means of distributing goods and services to the non-poor, and the application of market dynamics to low- income families should be evaluated on merit, not discarded solely on ideological grounds. State and local politics have been important arenas for intro- ducing innovations in social welfare and for pro- viding social workers a first step on the ladder of public service. Such opportunities should be cele- brated, not dismissed.

Public policy involves the kind of power that oc- curs in three basic forms: money, votes, and networks. Although these resources have been the staple of pol- itics, the information age requires players to possess a higher level of sophistication. To be competitive, one must have command of information systems, large data sets, and complex decision menus.

If social work can educate students about these methods and begin to insert itself into the policy environment, the profession will again become an influential force in social policy. On the other hand, if the profession rests on its historic laurels, it will remain tangential in the policy arena. Such an eventuality would essentially waste the substantial assets that social work brings to social affairs: a dis- tinguished legacy, the altruism of the young, and a unique moral imperative.

This edition of American Social Welfare Policy attempts to provide the information necessary for understanding social welfare policy nationally and internationally. In addition to discussing the basic concepts, policies, and programs that comprise

American welfare state, the text includes infor- mation on the voluntary nonprofit sector, the for- profit corporate sector, and the new strategy in social policy (i.e., tax policy and expenditures). The penultimate chapter examines food policy, and environmental and sustainability issues. The final chapter examines the influence of global capital- ism, a development that not only weds the devel- oped nations to the undeveloped nations but also in the process shifts capital and jobs in unprece- dented numbers. In recognition of our increasingly interconnected global environment, this edition has put more emphasis on international social welfare policy.

Acknowledgments The reviewers of this and previous editions have provided an invaluable service in identifying de- ficiencies. Earlier editions were aided by Dr. Stephen Thornton, Deanna Machin, Dr. Peter Kindle, and Crystal Joyce. In addition, the follow- ing reviewers contributed useful suggestions for this edition: Karen Tabb Dina, University of Illi- nois at Urbana-Champaign; Savvas Georgiades, University of North Carolina at Pembroke; Justine McGovern, Lehman College CUNY; and Clarence Williams, Grambling State University. This edition owes a debt to Elisa Arrington. In anticipation of the next edition, comments by students and faculty are welcome. The authors can be reached via email: Howard Karger at Hkarger@gmail.com and David Stoesz at Davestoesz@aol.com.

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Howard Karger (right) is professor, Hawai’i Pacific University, School of Social Work. David Stoesz (left) is professor, Flinders University/Carnegie Mellon University-Australia. Howard and David have been friends and colleagues for more than three decades. In addition to eight editions of

American Social Welfare Policy, they have coauthored three other books: The Politics of Child Abuse in America (with Lela Costin) (Ox- ford University Press, 1996); Reconstructing the American Welfare State (Rowman and Little- field, 1992); and (with Terry Carrillo), A Dream Deferred ( Aldine, 2010). Howard’s book, Short- changed: Life and Debt in the Fringe Economy (Berret-Koehler, 2005) examines the financial practices and products that exploit millions of American families. The book won the 2006 Inde- pendent Publishers Award in Finance/Investment/ Economics. David’s book, Quixote’s Ghost: The Right, the Liberati, and the Future of Social Policy (Oxford University Press, 2005), explains how con- servatives have assumed control of domestic policy and proposes a new framework for social policy. Quixote’s Ghost won the 2006 Pro- Humanitate Literary Award.

a b o u t t H e au t H o r S

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PArt ONE American Social Welfare Policy

cHaPter 1 Social Policy and the American Welfare State 1

cHaPter 2 A Brief History of the American Social Welfare State 25

cHaPter 3 Social Welfare Policy Research 47

cHaPter 4 Discrimination in American Society 59

cHaPter 5 Poverty in America 101

PArt tWO the Voluntary and For-Profit Social Sectors

cHaPter 6 The Voluntary Sector Today 131

cHaPter 7 Privatization and Human Service Corporations 145

PArt tHrEE the Government Sector

cHaPter 8 The Making of Governmental Policy 167

cHaPter 9 Tax Policy and Income Distribution 187

cHaPter 10 Social Insurance Programs 205

cHaPter 11 Public Assistance Programs 227

cHaPter 12 The American Health Care System 247

cHaPter 13 Mental Health and Substance Abuse Policy 281

cHaPter 14 Criminal Justice 299

cHaPter 15 Child Welfare Policy 317

cHaPter 16 Housing Policies 333

cHaPter 17 The Politics of Food Policy and Rural Life 359

PArt FOUr the American Welfare State in Perspective

cHaPter 18 The American Welfare State in International Perspective 389

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PArt ONE American Social Welfare Policy

cHaPter 1 Social Policy and the American Welfare State 1

Definitions of Social Welfare Policy 4

Social Problems and Social Welfare Policy 4

Social Work and Social Policy 5

Values, ideology, and Social Welfare Policy 5

the Political economy of american Social Welfare 6

the u.S. economic continuum 7 Keynesian Economics 7 • Conservative or Free Market Economics 8 • The Global Financial Crisis (GFC) 11 • Democratic Socialism 11

the u.S. Political continuum 12 Liberalism and Left-of-Center Movements 13 • classical conservatives and the far right 15

the Welfare Philosophers and the neoconservative think tanks 17

conclusion 18 Discussion Questions 22 • Notes 22

cHaPter 2 A Brief History of the American Social Welfare State 25

early antecedents of Welfare Statism 26 Judeo-christian Doctrine and Social Welfare 26

the english Poor Laws 27

the Poor in colonial america 28

Social Welfare in the civil War era 29

industrialization and the Voluntary Sector 29 Social Darwinism 31 • Religion and Social Welfare 31 • Charity Organization Societies 32 • Settlement Houses 33 • African American Associations 35 • The Social Casework Agency 36 • The Progressive Movement 37

The Great Depression and the Modern Welfare State 37

the Post-World War ii Welfare State 39

the Languishing Social Welfare State 41

conclusion 43 Discussion Questions 44 • Notes 45

cHaPter 3 Social Welfare Policy Research 47

a Proposed Model for Policy analysis 50 Historical Background of the Policy 51 • Problems That Necessitate the Policy 52 • Policy Description 52 • Policy Analysis 52

researching and analyzing a Social Policy assignment 54

Social Policy research and the internet 55

conclusion 56 Discussion Questions 56 • Notes 56

cHaPter 4 Discrimination in American Society 59

Discrimination 60

racism 61

the Minority Middle class 61

african americans 63 The Demography of African Americans 63 • African Americans in Poverty 63 • The “Diswelfare” of african americans 63

Hispanic americans 66 Hispanic Poverty and Income 67 • Diversity in the Hispanic Population 67

american indians 67

asian americans 68

immigrants and immigration 69 immigration-based Discrimination in europe 71

Women and Society 73 Violence and Sexism 73 • The Feminization of Poverty 73 • Myths around Women and Work 75 • Income and Job Disparities between Men and Women 76 • Day Care: A Barrier to Female Employment 76 • Other Obstacles Faced by Working Women 78 • Abortion and Women’s Rights 79 • Gender Discrimination and Violence in an international context 80

Gays and Lesbians: Two Populations at Risk 82 Gay Rights 84 • Gays and Lesbians in the Military 84 • Gay and Lesbian Family Life 85 • AIDS and the Gay community 86

co n t e n t S

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ageism 87 Elderly Poverty and Social Programs 87 • Health care and the elderly 88

People with Disabilities 88

Legal attempts to remedy Discrimination 91 Desegregation and the civil rights Movement 91 • Affirmative Action 91

conclusion 92 Discussion Questions 93 • Notes 93

cHaPter 5 Poverty in America 101

theories on Poverty 102 Culture of Poverty 102 • Eugenics and Poverty 103 • The Progressive understanding of Poverty 103

Who Makes up the Poor? 104

Measuring Poverty 106 Measuring the Depth of Poverty 109

families and Poverty 109 Child Support Enforcement 109 • Children in Poverty 110 • Poverty and the elderly 110

the rural Poor 110

Work and Poverty 111 A Profile of the Working Poor 111 • Why Are There Working Poor? 111 • Underemployment and Unemployment 112 • Dual Labor Markets 113 • Wages and Poverty 114

Strategies Developed to combat Poverty 116 IDAs 116 • Three Approaches to Combat Poverty 116

america’s fringe economy 118 the unbanked and the functionally Poor 119 • Credit and the Poor 119 • Transportation in the Fringe economy 122

World Poverty 123

conclusion 125 Discussion Questions 126 • Notes 126

PArt tWO the Voluntary and For-Profit Social Sectors

cHaPter 6 The Voluntary Sector Today 131

traditional Providers 132

the independent Sector 133

advancing Social Justice 135 The United Way 136 • Elite Philanthropy 136

the future of the Voluntary Sector 138 Commercialization 138 • Faith-Based Social Services 139 • Social Entrepreneurship 140 • issues facing the Voluntary Sector 141

conclusion 141 Discussion Questions 142 • Notes 142

cHaPter 7 Privatization and Human Service Corporations 145

Privatization issues 147 Commercialization 148 • Preferential Selection 148 • Dual Levels of Care 149 • Cost-Effectiveness 149 • Oligopolization 150

the challenge of Privatization 150

unions and the Private Sector 151

Social contributions of business 153

corporate influence on Social Welfare Policy 154

the future of corporate involvement in Social Welfare 155

Human Service corporations 155

Consolidation and Growth in New Human Service Markets 157

Nursing Homes 157 • Hospital Management 157 • Health Maintenance Organizations 157 • Child Care 159 • Home Health Care 159 • Corrections 159 • Public Welfare 159

Private Practice 160 the future of Private Practice 162

conclusion 162 Discussion Questions 163 • Notes 163

PArt tHrEE the Government Sector

cHaPter 8 The Making of Governmental Policy 167

technical aspects of the Policy Process 168

a critical analysis of the Policy Process 170

the Policy Process 171 Social Stratification 171 • Formulation 172 • Legislation 173 • The Fiscal Cliff and Sequestration 177 • Implementation 178 • Evaluation 178 • Marginalization 179

Social Work and advocacy organizations 181 advocacy organizations and the new Policy institutes 182

Political Practice 183

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conclusion 184 Discussion Questions 185 • Notes 185

cHaPter 9 Tax Policy and Income Distribution 187

History of u.S. tax Policy 188

federal taxes 189

taxes, Spending, and the Debt 190

tax Policy and Special interests 192

income Distribution 193

State tax Policy and the Poor 194

the efficiency of tax Policy in reducing Poverty 195 tax expenditures as antiPoverty Policy 196

the anti-tax Movement 197

the Debate over economic inequality 198

conclusion 201 Discussion Questions 201 • Notes 202

cHaPter 10 Social Insurance Programs 205

Definition of Social insurance 206

the background of Social insurance 207

the financial organization of Social insurance 207

Key Social insurance Programs 208 OASDI 208 • Unemployment Compensation 210 • Workers’ compensation 212

the Social Security Dilemma 212 arguments against the current Social Security System 213 • Arguments for the Current Social Security System 213 • Social Security in Trouble 214 • The Long-Term Prospects for Social Security 214

Medicare (Hospital insurance and Supplementary Medical Insurance) 216

Lingering Problems in the Social Security System 216

reforming Social Security 217 Privatizing Social Security 217

Pension Systems in Selected industrialized countries 218

Canada’s Retirement Income System 218 • Retirement in the United Kingdom 219 • The chilean experiment in Privatizing Social Security 220 • Germany’s Social Security System 220 • The Greek Pension System 221 • The Australian Retirement System 221

conclusion 222 Discussion Questions 222 • Notes 222

cHaPter 11 Public Assistance Programs 227

assumptions and Myths about Public assistance 228

aid to families with Dependent children 231 the Personal responsibility and Work opportunity Reconciliation Act of 1996 232 • Has the PRWORA Worked? 235 • Teenage Pregnancy 236

Supplemental Security Income (SSI) 237 Problems in SSi 238

General Assistance 239

trends and issues in Public assistance 239 the transformation of Welfare Policy into Labor Policy 239 • Welfare to Work (Workfare) 241 • Welfare Behaviorism 241

conclusion 242 Discussion Questions 243 • Notes 243

cHaPter 12 The American Health Care System 247

the uninsured 248

the organization of Medical Services 248

Major Public Health Programs: Medicare, Medicaid, and S-cHiP 250

Medicare 250 • Medicaid 254 • the children’s Health insurance Program (CHIP) 256

the Health care crisis 256 overview of u.S. Health care expenditures 256

explaining the High cost of u.S. Health care 258 Hospital Costs 259 • Physicians’ Salaries 259 • The Pharmaceutical industry 260

cutting Health care costs 261 Managed Care 261 • The Underinsured 263

Gun Violence and Health Care Policy 263 The Debate around Gun Control 264 • What can be Done 266

u.S. Health care in international Perspective 266 Comparative Analysis: Health Care in Canada, the united Kingdom, and australia 267

reforming u.S. Health care 271 National Health Service 271 • National Health Insurance 271 • Incremental Reform 272 • The Patient Protection and Affordable Care Act (P.L. 111-148) 273

conclusion 274 Discussion Questions 275 • Notes 275

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cHaPter 13 Mental Health and Substance Abuse Policy 281

Mental Health reform 282

the community Mental Health centers acts 283

Deinstitutionalization 283

the advent of Psychotropic Medication 285

the Psychopharmacological Scandal 286

children’s Mental Health 288

Mental Health and Substance abuse funding 289

Parity for Mental Health care 290

Post-traumatic Stress Disorder 291

Substance abuse 292 Alcohol Abuse 292 • Drug Abuse 293

conclusion 294 Discussion Questions 294 • Notes 295

cHaPter 14 Criminal Justice 299

History of u.S. criminal Justice 300

the criminal Justice System 301

Juvenile Justice 303

the new Jim crow 306

the War on Drugs 308

the underclass and “Moral Poverty” 309

the Prison industrial complex 310

Legalization of Drugs 312

Police Violence 313

conclusion 313 Discussion Questions 314 • Notes 314

cHaPter 15 Child Welfare Policy 317

History of u.S. child Welfare Policy 318

Protective Services for children 320

foster care for children 323

adoption 325

Head Start 326

emerging issues in child Welfare 326 Day Care 327 • Maternal and Child Health 327 • Teen Pregnancy 327

conclusion 328 Discussion Questions 329 • Notes 329

cHaPter 16 Housing Policies 333

overview of Housing Legislation 334

The Federal Government and Low-Income Housing Programs 336

issues in Housing Policy 340 Trends in U.S. Housing 340 • Problems in Homeownership 341 • Homeownership and the Subprime Mortgage Crisis 341 • The Downside of Homeownership 342 • Problems in Finding Affordable Rental Housing 343 • Gentrification 344 • Overcrowded and Deficient Housing 345 • Other Factors affecting Housing 345

Homelessness 346 characteristics of the Homeless Population 346 • Trends in Homelessness 348 • Attempts to Address Homelessness 349

Housing reform 350

Housing in an international context 351 comparison of u.S. and european Housing 351 • Public Housing 352

conclusion 352 Discussion Questions 353 • Notes 353

cHaPter 17 The Politics of Food Policy and Rural Life 359

the contradictions of american food Policy 360

Hunger in the united States 361

Governmental Food Programs 362 SNAP (Formerly Called Food Stamps): A Description of the Program 362 • SNAP: Who is in the Program, and What Does it Cost? 364 • Special Supplemental nutrition Program for Women, infants, and Children (WIC) 364 • Other Food Programs 366 • Have the Food Programs Worked? 367

farming in the united States 370 Governmental Farm Policies 370 • Biofuels, Fracking, and Farming 371 • The Face of u.S. farming 372

farmworkers 374

issues in american farming 376 The Corporatization of American Farming 377 • Genetic Engineering 377 • Global Trade 378 • Food Safety 378 • Local Selling 379 • Organic Farming 379 • Sustainable Development 379 • Climate change 379

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conclusion 382 Discussion Questions 382 • Notes 383

PArt FOUr the American Welfare State in Perspective

cHaPter 18 The American Welfare State in International Perspective 389

typologies of Welfare States 390

american exceptionalism 391

the Welfare State in transition 393

ranking national Development 394

the fourth World 395

capability Poverty 397

international aid 399

Global Capital 399

the future 401

conclusion 402 Discussion Questions 403 • Notes 403

Glossary 407

index 415

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Social Policy and the American Welfare State

C h a p t e r 1

Source: Jeff Greenberg/the Image Works

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2 part 1 american Social Welfare policy

Social welfare policy is arguably best viewed through the lens of political economy (i.e., the interaction of economic, political, and ideological forces). This chapter provides an overview of the American welfare state through that lens. In par- ticular, it examines various definitions of social welfare policy, the relationship between social pol- icy and social problems, and the values and ideol- ogies that drive social welfare in the United States. In addition, the chapter examines the effects of ideology on the U.S. welfare state, including the important roles played by conservatism and lib- eralism (and their variations) in shaping welfare policy. An understanding of social welfare policy requires the ability to grasp the economic justi- fications and consequences that underlie policy decisions. As such, this chapter contains a brief introduction to Keynesianism, free market eco- nomics, socialism, and communitarianism, among others.

American social welfare is in transition. Start- ing with the Social Security Act of 1935, liberals argued that federal social programs were the best way to help the disadvantaged. Now, after 70 years of experimenting with the welfare state, a discern- ible shift has occurred. The conservatism of U.S. culture—so evident in the Reagan, Bush (both Bushes), and even Clinton and Obama presiden- cies—has left private institutions to shoulder more of the welfare burden. For proponents of social jus- tice, the suggestion that the private sector should assume more responsibility for welfare represents a retreat from the hard-won governmental, social leg- islation that provided essential benefits to millions of Americans. Justifiably, social advocates fear the loss of basic goods and services during the transition in social welfare.

The election of Barack Obama as the 44th President of the United States in 2008 not only broke a racial barrier but also promised to sweep away the strident conservatism that had defined the presidency of George W. Bush. The Obama victory, with 52 percent of the vote and increased Demo- cratic majorities in both chambers of Congress, heartened liberals who had anticipated an expan- sion of government social programs. However, the euphoria among liberals soon gave way to despair as the Democratic Party lost control of the House of Representatives and barely held on to the Senate in the midterm elections of 2010. Although Obama won the presidency for a second term in 2012, the

midterm election of 2014 saw the Democratic Party also losing control of the Senate.

While liberal pundits hailed the resurgence of “a vast new progressive movement,”1 struc- tural limits and the emergence of a strong reac- tive element would restrain Obama’s ambitions. Massive deficits left by the Bush administration, compounded by a severe global financial crisis and two unfunded wars, meant that economic issues would trump other priorities. Reduced tax revenues would impede the ability of the govern- ment to meet existing obligations, let alone expand social programs. Obama’s centrist inclinations to build bipartisan support for his legislative agenda failed as newly elected extremist Tea Party legisla- tors squashed most of his attempts at compromise. Instead, ideologically driven legislators focused on social issues such as abortion, and even resuscitated previously long-dead issues like contraception. Parts of the nation had not just turned right, but hard right. The fires were further stoked by allega- tions around Obama’s birth certificate, whether he was a Muslim and a socialist, and so forth.

The 2012 presidential election was marked by the often extreme positions taken by Republican presidential contenders. Long-dormant issues resur- faced as Republican candidates vied for the support of the religious right and Tea Partiers. This politi- cal climate led to an anti-science orientation, often reflected in wildly unsubstantiated claims like birth control pills can cause prostate cancer. Former Mis- souri Republican congressperson Todd Akin stated that doctors had told him it is extremely rare for “legitimate” rape victim to become pregnant: “If it’s a ‘legitimate’ rape, the female body has ways to try to shut that whole thing down.”2 Despite the lack of any medical evidence, former Republican presidential candidate Michelle Bachmann warned that mental retardation could occur from the HPV (human papilloma virus) vaccine.