Multiple and Interrelated Benefits It would be a mistake to leave the reader with the conclusion that most social policies and social programs pursue their objectives through single benefit or service strategies. Although there are instances of that, it is not the general case, especially in relation to programs that intend to deal with the social problem of poverty. It is common for citizens to think of programs like Social Security or even unemployment security as providing only a single benefit, but in fact eligibility for one benefit form very often automatically qualifies a person for multiple benefits. The fact of interrelated benefit packages certainly makes the analysis of social policy with respect to benefit forms, in particular, a lively and complex venture. It is not surprising that programs and policies should have more than a single kind of benefit; after all, we have already seen that multiple goals or objectives are commonplace. Where that is the case and where such goals are diverse it would be expected that different benefit types and thus multiple benefits would occur. Lewis and Morrison found that multiple benefits can occur in two major forms: (1) benefits from one program can alter benefits in other programs and (2) program benefits can change personal tax liability.6 The U.S. Unemployment Insurance (UI) program is an example of a benefit that generates multiple benefits: eligible, involuntarily unemployed workers might receive both a cash payment, services from the state vocational and rehabilitation service, and referral to employers searching for workers. The purpose of rehabilitation services is to retrain the employee and to provide trained and ready-to-work employees for employers. Maintaining the stability of a large workforce for the economic enterprise of the country as well as for relief of unemployment is a goal of the UI program. The TANF program (Temporary Assistance to Needy Families) is another example of a highly complex package of benefits and services. It is difficult to elaborate because of interstate variation, but the list that follows characterizes the most general case: a cash benefit, a medical card, child support enforcement, special food allowance for infants and pregnant mothers, vocational training, family planning services, and so forth. Notice that elements in this benefit package are mostly compulsory: child support enforcement, job searches, and/or vocational training are compulsory. In the past, â€œbenefitsâ€ were sometimes used punitively against clients: sterilization, family planning, and abortion. Furthermore, some program policies automatically disqualify a recipient from benefits from another program. We will discuss those complex examples in Chapter 9, which deals with program and policy interrelationships. Criteria for Evaluating the Merit of Benefit and Service Types Stigmatization, Cost-Effectiveness, Substitutability, Target Efficiency, and Trade-Offs Whenever there is a benefit to be given in remedy of a specific tangible need, it can be given in the form of cash or it can be given it in the form of directly consumable articles (e.g., food or clothing). The question is: â€œWhich form is best, why, and from what point of view?â€ Almost all U.S. public benefits available in income maintenance programs could be given in kind. The issue touches on more than income-related benefits. Think for a moment about the delivery of medical care benefits and services. A cash approach would give dollars directly to families in need, that amount equivalent to whatever was the price of the necessary medical care. This benefit is most commonly given not in the form of cash, but in the form of a credit or voucherâ€”a strategy that is more related to an in-kind benefit than a cash strategy. Such examples serve to illustrate how the evaluation criteria apply to this general question. From the consumerâ€™s point of view, the major difference is the degree to which a choice can be exercised with regard to the goods or services deliveredâ€”the evaluation criterion we earlier called consumer sovereignty. From the benefit giverâ€™s point of view, the major difference is the ability to exercise control over the nature of the article and the way it is consumedâ€”the evaluation criterion we earlier called target efficiency. If a family needs cheese and you give them $5 to buy it, the family can decide whom to buy it from, when to make the purchase, under what conditions, and at what priceâ€”an example of maximum consumer sovereignty. If you give the family a letter telling the cheese store to give the family $5 worth of cheddar and to add it to your bill, the choices that can be made by the family are thereby limited. But notice that from the point of view of the benefit giver (the person who is paying for the cheese), it may be important to restrict the choices. For example, the benefit giver may get a special price from the cheese dealer if a great deal of cheese is purchased this way and our cheese dealer can purchase more economically if he can count on volume sales. Not only that, the merchant knows that no advertising expense is incurred. Thus, the benefit giver is able to help more hungry people because cheese can be purchased for less in an in-kind, rather than a cash, benefit form. Under this condition (but only this condition), giving the benefit in an in-kind form satisfies the evaluation criterion of cost-effectivenessâ€”the benefit is delivered at a cost that is effectively the lowest relative to the other available and practical forms and means of delivery. Note that it is also true that the benefit goes directly for the specific social problem of concernâ€”hunger. This is an example of the evaluation criterion called target efficiency, a virtue here because the efficiency involved makes it possible to benefit more hungry people. There is not much else to do with cheese except eat it, though a genuinely imaginative person might use it to catch mice, or sell it to a neighbor at a cut-rate price, or trade it for another commodity. And, of course, there is a well-known street trade in food stamps. Here are the arguments against the preceding conclusions. With regard to the lower expense of in-kind benefits, they say, it is not entirely clear whether economies of scale work in a way that inevitably yields a lower unit cost than cash (and, thus, generate a cost-effective benefit form). A person can take the view that the only way to establish a true cost is through an exchange in a free market, even a cheese market. How can the benefit giver really know that the price charged by the cheese merchant was the best price on that day for that amount of cheese of that particular kind? Whereas the price quoted to the in-kind benefit giver may have been the best price the benefit giver could have obtained that day, suppose there was a cheese crisis the day following; if the family had cash with which to deal, they might have obtained twice as much cheese for half the price. On the other hand, the cheese merchant may have had bad luck selling his Swiss that week and wouldâ€™ve sold twice as much to the family for half the price. (Of course, it might also have worked in exactly the opposite direction.) The same argument raises an objection to an extension of social control via the purchase of cheese. The cost to the family is a lack of consumer autonomy, and that makes them even more dependent and less able to cope with the stresses of life. After all, this argument goes, independence and self-reliance are built on experience in such small matters as deciding whether to buy cheddar, Swiss, or mozzarella. Notice how important are the details, for it is on them that the ultimate conclusion depends. Notice the trade-offs operating here between the various evaluation criteria. A trade-off occurs when the policy system has to suffer some disadvantage in order to get another advantage. In general, benefits delivered in the form of cash increase consumer sovereignty and reduce target efficiency. Another example of trade-offs is with regard to programs to reduce poverty. When such programs create low unemployment (a virtue), economists believe that they will invariably increase inflation (a vice) as more employed workers become consumers with money to spend. Although considered by economists to be a side effectâ€”and certainly it is in the sense that it was not intendedâ€”it is undeniably an important effect on the lives of most people. But then it pays to notice that economists arenâ€™t always right: In the 1994â€“1998 period of historically low unemployment rates, inflation did not appear as economists predicted. Somewhat more serious is the argument that the price of in-kind benefits is stigmatization. When the consumption or acquisition of benefits is public, certain kinds of items become associated with â€œbeing on welfare,â€ and negative attributions are made to those so identified. Although someone seen eating a slice of cheddar cheese attracts little attention, it certainly is the case that disparaging comments are made to women who spend WIC vouchers in grocery stores (a mild form of in-kind benefit). According to Terkel, local welfare agencies bought certain kinds of shoes and dresses during the depression, and those who wore them were sure to inspire negative comments from others.7 Some of these objections to in-kind benefit forms do not apply in all instances; it is surely not the case that all noncash forms stigmatize recipientsâ€”not all consumption or delivery of the article or good is public. For example, one way to avoid public consumption or delivery of foodstuffs in a noncash form is to use a subsidy method that was common in England. If the U.S. government wished to increase the nutritional level of its low-income citizens, it could subsidize the price of a popular food to the point where it could become the least expensive, most nutritious food available (e.g., bread or milk products). The public treasury could subsidize the bakers or grocers, perhaps 40 cents a loaf; every month, those vendors would tote up how many loaves they sold and submit a bill to the public treasury. In return, they would agree to sell bread for half the former price, maybe 35 cents a loaf. Thus, the consumer gets bread at a reduction and the baker or grocer still makes a profit. Would the consumption of bread increase? Very likely. Would consumers be stigmatized for buying bread? Not very likely, because everyone pays the same price. Would the benefit go only to those who â€œreallyâ€ need it? No, because there would be considerable â€œseepageâ€ to those not in low-income brackets (again, a question about the target efficiency criterion). Would this form of the benefit be more cost-effective than cash? That question can be answered only through the empirical study of increased nutrition as a result of the increased use of the subsidized foodstuffs The increase in nutrition resulting from the cash-benefit strategy would also have to be studied and the net results of the two compared. Note that the cost of achieving the nutritional goal is the cost of the subsidy for the foodstuffs actually bought by the poor; the cost of the destigmatization of the in-kind strategy is exactly the cost of subsidizing the foodstuffs bought by the nonpoor. Thus, in this case, the exact cost of the trade-off can be specified. Those who strongly support cash benefits argue that such a benefit form clearly has an advantage along the lines of ensuring consumer sovereignty by means of which receivers maintain control over when, what, and how things are bought. From the consumerâ€™s point of view, that autonomy is a major issue. The Political and Public Administration Viewpoint How does all this look from the benefit giverâ€™s view, the perspective of the legislature, and the public program manager? Politicians and bureaucrats have their own preferences for benefit forms, as well as evaluation criteria of their own. Linder and Peters think that one such is administrative complexity, for example.8 Itâ€™s only natural to expect that public administrators will value a benefit form that is simple rather than complicated to administer. It would seem preferable to administer a fairly simple program delivering a partial cash subsidy to the elderly to pay part of their winter heating bill rather than administer an in-kind commodity program for the same purposeâ€”one in which the benefit would be gas or oil or electricity (or cow chips for that matter), which the government owned and would deliver directly to consumers. Think of the problems of storage, delivery, services, and all the rest. A cash benefit places the responsibility on the beneficiary for obtaining the product needed and, thus, avoids the administrative complexities. Or consider a program that delivers services for severely mentally ill children. Such a program may involve such complexities as administering income or asset tests to a wide variety of income levels (e.g., to determine whether to charge for hospitalization); coordinating the program activities of a wide variety of professionals; facing high costs per case and treatment strategies of uncertain and sometimes controversial validity to consumers potentially capable of deviant and antisocial behavior. On the other hand, the public policy may choose to deliver this benefit in a form that simply subsidizes the costs of such services in the private sector by the consumer. In this case, the public administrator looks to the cost issues and struggles with determining whether charges are fair and whether services were actually delivered, but certainly that is less complex than taking responsibility for their actual delivery. The form taken by the benefit is determining here. Material, hard benefits are obviously simpler to administer than personal social services, which are often intangible and often controversial as to their effectiveness. It is quite likely that less complex practices also entail low administrative cost, another evaluation criterion of preference to public administrators and political figures who must account to the public in such matters. Another evaluation criterion common to public administration and the political context is the extent of adaptability across different kinds of users. A subsidy (equivalent to cash) is obviously quite adaptable to different kinds of users: those who heat with gas versus electricity; those who live in apartments versus their own homes; those who live in rural areas versus central cities. An in-kind benefit may not be so adaptable across the diverse users in those examples. Political risk is also an evaluation criterion in this context; for example, the level of public visibility of the benefit form may be an issue here. The cash-equivalent subsidy for the winter heating program for the low-income elderly is quite invisible in that such programs can be handled via the U.S. mail. Note, however, that even if benefit receipt were visible, in this case it might be a political advantage rather than a liability; the viewpoint in our society is that the low-income elderly are surely â€œdeserving poor,â€ and that a politician who helps them projects the image of a social and moral conscienceâ€”good political images, no doubt. Contrast the level of political risk via the high public visibility of a program that generates benefits in the form of psychiatric services for severely mentally ill children. Because such children are capable of social deviance, they can be highly visible to a sensitive public and if the benefits (no matter how great or obvious the need for them) are delivered to a population group that is considered deviant, the political risk is high. It is widely believed among social historians that the popularity of mental institutions as a benefit form for the severely mentally ill or shelters for the homeless are, in the first instance, appealing to politicians and public administrators simply because such institutions effectively reduce the visibility to the public (hence the political risk) of the targeted social problem and the people who are subject to it.9 Finally, another evaluation criterion, potential for failure to reduce or soften the impact of the social problem, should attract the attention of the reader. There are few social programs that have an unmitigated record of success. New programs should actually be thought of as experimental ventures and should be proposed to decision makers as exactly that. Too many unkept promises, and too many disappointments on the part of those who fund programs create an enduring pessimism that will come to haunt social program providers in the future. This evaluation criterion points to that issue; surely, before politically astute legislators make a public commitment in support of a social program, they make calculations of their potential for failure. Those who seek funding should be prepared to make statements about the probability for success of their program design. Furthermore, they should also be prepared to make proposals as clear experiments on ideas that have no history. Experimental failures are not a moral mistake; program failures, for which success has been widely advertised, are immense political mistakes. Criteria for Evaluating the Merit of Benefit Types: Consumer Sovereignty, Coercion, and Intrusiveness This section considers an evaluation criterion that is preferred by the authors/analysts: consumer sovereignty. One argument for its generally positive effects is that it allows for making choicesâ€”a strengths approach. The cash benefit expended contributes to the support of the general public economy in ways that in-kind benefits cannot. Cash benefits support ordinary businesses and ordinary employers and employees. In-kind benefits, if they are to achieve their major advantages of economy of scale and expense reduction, must enter a special market at the producer and wholesaler levelsâ€”certainly not the same retail market corridor used by the ordinary citizen/consumer. Support of that market bypasses many free markets, and in a way, that costs jobs because employers will not need the employees that are created by the additional cash demand for goods and products. In the long run, this argument speaks to the appealing idea of creating more employment and more taxes paid by a mechanism that remains faithful to a cash market system; cash benefits ensure that â€œthe consumer is king.â€ The point is that, in contrast to in-kind benefits, cash benefits have capacity for welfare-expenditure reductions just because when welfare recipients spend welfare dollars, those dollars create some employment while in-kind benefits do not. One wouldnâ€™t expect that free-market advocates would prefer a welfare benefit form that takes welfare beneficiaries out of the free market in the ways outlined before. Radical free-marketeers often find in-kind benefits attractive on the view that in-kind benefits are socially stigmatizing and, thus, make welfare unattractive. Still there are those who seriously advocate for in-kind benefits. Alva Myrdal, the 1983 Nobel Prize winner in economics, is an example. Most of the arguments discussed before can be read in greater detail in her work.10 However, Myrdal makes two other points we have not covered previously and are worth noting because they concern cogent arguments about their limitations. The first is that the issue of consumer choice is not very relevant when it comes to benefits targeted primarily toward children; children seldom exercise much consumer choice in poor families. The second is that in-kind benefits cannot be seriously preferred where family income is not adequate in the first place. In the last analysis, Myrdal comes out for restricting in-kind benefits to secondary needs, nonbasic food, shelter, and clothing. With that view, then, it would seem that the kinds of benefits Myrdal really advocates as appropriate for in-kind forms are items such as medical care, education, perhaps clothing, and surely expert services. The issue of substitutability of goods, also important to Myrdal, refers to the possibility that a public policy or program the intent of which is to increase food purchases, for example, may not do so because more food is not purchased. Instead, the family uses food stamps to purchase the same amount of food they would have bought ordinarily; the money released by the availability of food stamps can then be used to buy other commodities of choice; the net gain, then, is not necessarily in food items. For example, the socially conforming family may use the extra purchasing power to buy books or more vegetables for the children. The less socially conforming may use it to buy illegal drugs, clothes, or a good time. Substitutability is an important idea because it shows how the inkind benefit, when it concerns items that are vitally necessary for survival, may not always be an effective way of controlling the consumption pattern, amount, or kind of benefit received. The same argument might be made with respect to the provision of vouchers for medical care, physician prescriptions, and credit for child care or work clothing, for example. Substitutability is probably a criterion that has wide relevance to the evaluation of the merit of benefit forms, whatever those benefit forms might be. Consumer sovereignty is a virtue because it works against coerciveness and intrusiveness of government in the lives and private affairs of citizen-recipients of public benefits. Coerciveness and intrusiveness into private lives should be conceded as an important criteria for evaluating benefit and service types. It is important for readers to remember that intrusiveness into private affairs can violate a citizenâ€™s right to privacyâ€”which itself derives from constitutional provisions. Being a recipient of public benefits doesnâ€™t change that. Obviously, some types of benefits and services are worse offenders than others in this respect. The greatest potential for this offense is when beneficiaries are dependent on public benefits for their very physical survival. That would direct us to means-tested programs like TANF, food stamps, or SSI for the disabled or aged. Their means tests must be repeated at intervals in order for the program administrators to carry out their responsibility to see that beneficiaries are still actually eligible: for example, beneficiaries may be living a shared life with a household member who is working and earning but not be reporting it as household income. Notice that reporting it requires revelation of the beneficiariesâ€™ personal relationships, where that would ordinarily be considered â€œprivate affairsâ€ were the person not a welfare beneficiary. One of the reasons means tests are objectionable is that they cannot easily avoid this kind of intrusiveness. But notice in contrast programs like Social Security Retirement and Disability, which are usually means tested but only at the level of individuals, not households. No need there to be concerned about who else is sharing a household, a bed, or an income as in TANF or food stamps. AFDC, in particular, had a history of notorious intrusiveness. The best example is the public welfare staff/county prosecutor â€œnight-ridersâ€ in Newburgh, New York, who routinely stationed themselves outside recipientsâ€™ dwellings after dark to see who came and went. It was a county-administered program at that time and the local policy concerned what was called the â€œman-in-the-houseâ€ rule: Any recipient who had a â€œman-inthe- houseâ€ (anytime after dark presumably) lost her benefits (illegally as it turned out). The point is that the eligibility rule has to do with who shares a household income, not with who sleeps together. Besides being a violation of citizensâ€™ privacy rights, knowing that there was a â€œman in the houseâ€ doesnâ€™t necessarily tell you anything about household income sharing, though recipients were disentitled just on that basis. The reader shouldnâ€™t conclude that this is an argument against administrative rules; rather, it is an argument about how such rules should be applied with due respect for their legality. And it is advice to practitioners to be alert to abuses of that kind. Of course, the reader must realize that there are social programs whose very nature it is to intrude into private affairs, the obvious example being families whose children are being severely physically abused. Notice that the issue there is social control but of a kind that is legally sanctioned. Although that cannot justify just any kind of intrusion or coercion, it is an important distinction because when the intrusion has occurred by court order, it also means there is a way of remedying abuses through the court system and the legally required defense attorney. In contrast, administrative, extrajudicial coercion, and privacy intrusions occur buried in organizational privacy, without clear and ready remedies. Criteria for Evaluating the Fit of the Benefit/Service Type to the Social Problem Analysis Whatever the type of benefit, the basic question is whether it fits the social problem analysis, that is, fits compatibly with the definition of the problem. One way to approach this question of fit is to look at what the problem definition implies as the most prominent needs of the people who have the problem and ask whether the benefit the program delivers is relevant to any of them. If it is not, then the benefits are clearly off target and irrelevant to the social problem. They may even be desirable yet not a relevant benefit. Think of an after-school recreational program for children who are disruptive in classrooms. As desirable as this recreational program might be (perhaps it provides afterschool hours supervision for working parents when no adult is at home), if the program cannot make a case for some linkage with classroom behavior, then the program fails the fitness test. Notice that you might create a fit by a design for the recreational program that tailors itself to outcomes that are relevant to decreasing disruptive classroom behavior in some way. That is, of course, exactly the point: If the tailoring is strong, the program activities would likely be much more specific than just simply â€œrecreationalâ€â€” recall that the definition of recreation is â€œdoing what you want, when you want.â€ The policy and program analyst should also look at the social problem theory and, in particular, its derivativeâ€”the social program theory. Note that program theory will specify some set of factors as a preferred outcome and describe how to set in motion a chain of events (or processes) to obtain just that outcome. The benefit/service type must be one of those events, causal antecedents likely to set this chain of events in motion. And there must be a plausible and logical argument as to why this benefit would be expected to have that result. That is what â€œfit of the benefit/service typeâ€ is all about. If that argument is not there, then there is no fit. There are some historical examples of bad consequences as a result of this lack of fit with the social problem analysis. In the 1970s, federal payments to states for foster home care were raised to 100 percent of state costs. There was an entirely innocent motive on the part of the U.S. Congress: States complained that they didnâ€™t have funds to provide all the foster home care they needed to protect children from abuse and neglect. The legislation and the federal dollars appropriated made cost-free foster home care available to states. The benefit/service was a bad fit to the social problem of concern. The social problem wasnâ€™t just the lack of foster home careâ€”couldnâ€™t be, since foster home care is never more than a means to some other end. In this case the â€œbad thingâ€ that identifies the social problem was the neglect and abuse of children. Clearly, foster care protects children from immediate harm, but it doesnâ€™t by itself change anything for next year or the year after that. As it happened, within the year, there were massive increases in the numbers of children removed from their homes and placed in public foster home care facilities. It would appear that cost-free foster care created large-scale overuse of this service.11 Not only that, many believe that cost-free foster home care funding was a major factor in children continuing in long-term foster care, â€œstuckâ€ there for interminable periods. That phenomenon came to be called foster care drift, a phrase referring to children who neither return to their own homes nor are placed in permanent adoption. Foster care drift has bad consequences: Many children in foster care for long periods literally lose their place in families since families are living, organic things, changing with age/stage development of their members and adapting to the surrounding social and economic circumstances. The program of cost-free foster home care actually created a whole new social problemâ€”foster care driftâ€”an outcome that should be kept in mind when initiating new social programs. It is a great temptation for legislators, policy makers, and social practitioners alike to believe that a personal social service can (somehow) substitute for a necessary material need. It is almost always a mistake to believe that job training can provide a livelihood when the economy itself is not at that moment providing jobs for that particular person, to believe that various â€œcounselingsâ€ can help a mother find a way to deal with an aggressive child acting out when she has to work two jobs and twelve hours a day in order to feed and provide shelter for her family. That is not to say that personal social services are never effective, only to say that they can only be effective for people who are at least minimally fed, housed, and clothed. It would seem to be obvious, but the history of the provision of social welfare benefits in the United States shows that important and very costly mistakes can be made in that regard. In legislating the 1962 amendments to the Social Security Act, social workers and other human service proponents convinced Congress that personal social services should be institutionalized as a major strategy against the problem of poverty. It wasnâ€™t exactly a new ideaâ€”the emergency relief legislation of the depression era in the early 1930s had provided for special units of social workers to be available for difficult cases on an individualistic basis to those who were poor and/or had personal problems. Prior to that time, private charitable agencies as far back as the Charity Organization Societies of the mid-1800s included social workers as part of a system to tailor cash assistance to individual characteristics and to plan and implement service and benefit delivery. In its 1962 amendments, the Social Security Act provided the first federal statutory instance in the United States for the general provision of personal social services to families on relief. According to Morris, at the same time Congress increased the federal dollar match (to state funds) to 75 percent for this purpose as if to underscore their commitment to the â€œrehabilitationâ€ of the poor via personal social services.12 This effectively put into practice the idea that services were an inextricable part, if not the major strategy, for a solution to the problem of poverty. The social problem viewpoint was that the cause of poverty was an interaction between lack of material resources and some personal attribute (attitude, cultural approach to work) and was amenable to change by a service strategy: family, group, and individual counseling; job and parent training; referral agencies; and service coordination, which avoided duplication of services. Indeed, the very name of the federal agency responsible for basic income maintenance programs (e.g., AFDC) was changed to the Family Service Administration.13 Congress was convinced to increase appropriations by hundreds of millions of dollars for services and the training of personal social service workers on behalf of those ideas. Federal expenditures for personal social services increased from $194 million in 1963 to a billion and a half dollars by 1972.14 Not surprisingly, services werenâ€™t successful in reducing poverty. The money was directed at what was perceived to be the shortcomings of individuals rather than the shortcomings of the economic system. The mistake was to think that these services could somehow substitute for the problems
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