The Welfare State Is Broken. Here’s How to Fix It.

A social entrepreneur in Britain shows the way.

I met Cottam in London last week and she made the point that welfare systems are often designed to manage needs, but they are not designed to build capabilities so that families can stand on their own.

Moreover, most Western systems were not designed to confront the kind of poverty prevalent today. When these systems were put in place in the 1950s and ’60s, unemployment was more often a temporary thing that happened between the time you got laid off from a big employer and the time you got hired by a new one. Now, economic insecurity is often a permanent state, as people patch together different jobs to make ends meet. Health issues for people in the welfare system are often chronic — obesity, diabetes, many forms of mental illness.

Our legacy welfare structures are ill suited to today’s poverty.

For example, Ella was asked if she would like to lead a “life team” that would help her family turn around. She agreed. She was given the power to select the eight people from across agencies who would comprise the team. She chose people from social work, the housing authority and the police force.

Members of the team spent 80 percent of their time with the family and only 20 percent on administration. Ella and the team worked together to stabilize her most immediate issue — negotiating away eviction notices. Then the team worked to improve inter-family dynamics so there wasn’t so much violence and screaming.

Cottam has designed other programs with a similar collaborative ethos. Backr is a program that takes people who are detached from the labor force and helps them join extended social networks where they can connect one another to job openings and develop skills. Circles is a program for the elderly. It brings together lonely seniors into small groups that are part social club, part concierge service and part self-help cooperative. Wellogram is a similar social structure for the chronically ill.

Basically, Cottam’s programs create villages within the welfare state. Her systems are not designed around individual clients, but around relational networks. People tend to have better outcomes when they are held accountable by a network of peers. Three-quarters of the smokers in Wellogram successfully quit, 44 percent lowered their blood pressure, 64 percent started work or went back to school.

The old legacy welfare programs were designed for people enmeshed in thick communities but who had suffered a temporary setback. Today many people lack precisely that web of thick relationship. The welfare state of the future has to build the social structures that people need to thrive. This is one way government can build community.

Adverse Childhood Experiences International Questionnaire (ACE-IQ)

Adverse Childhood Experiences (ACE) refer to some of the most intensive and frequently occurring sources of stress that children may suffer early in life. Such experiences include multiple types of abuse; neglect; violence between parents or caregivers; other kinds of serious household dysfunction such as alcohol and substance abuse; and peer, community and collective violence.

It has been shown that considerable and prolonged stress in childhood has life-long consequences for a person’s health and well-being. It can disrupt early brain development and compromise functioning of the nervous and immune systems. In addition because of the behaviours adopted by some people who have faced ACEs, such stress can lead to serious problems such as alcoholism, depression, eating disorders, unsafe sex, HIV/AIDS, heart disease, cancer, and other chronic diseases.

Here’s the Deal: What’s next for health care?

The Washington health debate has largely overlooked the fact that America is getting sicker. There is some slight good news here, as obesity levels seem to be flattening. But this is after a dramatic increase over the past 20 years. Here are some major problem areas as we enter 2018:

Summary: In short, get ready  for another rocky year — or maybe two or three — of health care news.

 

.. How many terrorists have come from these countries? According to one researcher at the right-leaning CATO Institute, between 1975 and 2015, there have only been nine people from these eight countries to have either carried out an attack in the United States or have been convicted of planning one. Another figure from that same research: There have been zero fatal acts of terrorism conducted by an individual from any of these countries.

It’s All About Trump’s Contempt

There is, however, a unifying theme — Donald Trump’s contempt for the voters who put him in office.

“I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.” Well, he hasn’t done that, at least so far. He is, however, betting that he can break every promise he made to the working-class voters who put him over the top, and still keep their support. Can he win that bet?

.. remember his claims that he would pay off the national debt?

.. 29 percent of the population is on Medicaid, almost 19 percent on food stamps.

.. West Virginians .. more than 4 percent of the population, the highest share in the nation, receives Social Security disability payments, partly because of the legacy of unhealthy working conditions, partly because a high fraction of the population consists of people who suffer from chronic diseases, like diabetics

.. they supported Trump because he promised — falsely, of course — that he could bring back the well-paying coal-mining jobs of yore.

.. Maybe he would take benefits away from Those People, but he would protect the programs white working-class voters

.. it would be apocalyptic: Hundreds of thousands would lose health insurance; medical debt and untreated conditions would surge; and there would be an explosion in extreme poverty, including a lot of outright hunger.

.. Coal isn’t coming back; these days, West Virginia’s biggest source of employment is health care and social assistance. How many of those jobs would survive savage cuts in Medicaid and disability benefits?

.. people who voted for Donald Trump were the victims of an epic scam by a man who has built his life around scamming.