Exam 3 Slides

• Assumptions and Myths aboutPublic Assistance• American attitudes toward publicassistance can be characterized as:– A mixture of compassion and hostility• The many myths surrounding publicassistance make it imperative to:– Discriminate between fact and fiction
• Aid to Families with Dependent Children• Designed to maintain and strengthen family life by– Providing financial assistance and care to needy dependent children in their own homes• Or in the homes of responsible caregivers• Arguably the most controversial program in the U.S. welfare system
• Aid to Families with Dependent Children• The requirement for receiving AFDC• Originally called Aid to Dependent Children• Income maintenance programs• Job Opportunities and Basic Skills (JOBS)program
• Aid to Families with Dependent Children• The Personal Responsibility and Work Opportunity Reconciliation Act of 1996– Emergency Assistance Program– Entitlement– Disentitlement– Block grants
• Aid to Families with Dependent Children– States began implementing “diversion” programs to keep families whose needs:• Could be met through other means from ever entering the welfare rolls• Has the PRWORA Worked?– Democrats and Republicans had pronounced the PRWORA a raging success
• Supplemental Security Income (SSI)• SSI is designed to provide cash assistance to the elderly– And to disabled poor individuals, including children• In 2009, the SSI program served 7.68 million people & over $4.1 billion benefits
• Supplemental Security Income (SSI)• To qualify for SSI, an applicant must have limited resources• Began during the Nixon presidency– A substitute for a number of state-operated disability programs• Major concerns regarding SSI
• General Assistance• Also known as General Relief in some states• Cash and in-kind assistance programs financed and administered entirely by:– The state, county, or locality in which they are located
• General Assistance• Most states limit GA eligibility to the severely poor, without children• Although states are generally responsible for GA– Some devolve financial responsibility to their counties
• Trends and Issues in Public Assistance• Transforming Public Assistance Policy into Labor Policy– Removing federal responsibility for providing long-term cash assistance to the poor:• Shifted the problem of poor support away from social welfare and into labor policy
• Trends and Issues in Public Assistance• Teenage Pregnancy– Strongly associated with public assistance and welfare dependency– Out-of-wedlock births have grave economic consequences– The anti-teen pregnancy movement is highly politicized
• Trends and Issues in Public Assistance• Welfare Behaviorism– Behavioral Poverty– Personal and Parental Responsibility• Welfare to Work– Workfare– Often, former welfare recipients who get jobs join the ranks of the working poor
• Conclusion• For a half century, AFDC did little more than dispense checks• Whenever possible, states will attempt to transfer the most troubled families to SSI• The future of families dumped from state welfare programs is bleak
• The Uninsured• In 2009 roughly 84% of Americans had health insurance coverage• The number of uninsured children has generally gone down since 2002• The relatively high number of uninsured Americans is not surprising• Ramifications of lack of coverage
• The Organization of Medical Services• Most health care costs in the United States are paid for by:– Private insurers, public plans, and the public provision of health care• Physicians in solo practice• Group outpatient settings
• The Organization of Medical Services• Physicians employed in corporate-owned for-profit clinics or in non-profit clinics• Hospitals• Public health services delivered on:– The state, local, regional, national, or international level• Auxiliary health services
• Major Public Health Programs: Medicare, Medicaid, and SCHIP• Medicare & Medicaid– Coverage– Gaps in Medicare Coverage– Reimbursements to Providers– Funding• The State Children’s Health Insurance Program
• The Health Care Crisis• Eroding coverage, rising costs, cost shifting & increasing anxious citizens– Fear about getting/keeping health insurance• Overview of U.S. Health Care Expenditures• U.S. Health Care in International Perspective
• Explaining the High Cost of U.S. Health Care• Hospital Costs• Physicians’ Salaries– Physician organizations argue high salaries needed to repay debts incurred in med school• The Pharmaceutical Industry– The United States is the largest pharmaceutical drug market in the world
• Cutting Health Care Costs• Managed Care– Health Maintenance Organizations; Preferred Provider Organizations; Point of Service– Exclusive Provider Organization; Independent Practice Association; The Network Model;– Physician–Hospital Organization• The Underinsured
• Reforming U.S. Health Care• National Health Service• National Health Insurance– Single Payer System• Incremental Reform• The Patient Protection and Affordable Care Act (P.L. 111-148)– Enrollment and Employer Requirements
• Reforming U.S. Health Care– Cost and Funding– Health Insurance Exchanges (HIE)– Subsidies– Regulation of the Health Insurance Industry– Public Health– Medicare; Medicaid– Abortion
• Comparative Analysis: Health Care in Canada, Britain, and Australia• The Canadian Health Care System– Public Administration– Comprehensiveness– Universality; Portability; Accessibility– Freedom of Choice• Britain’s National Health Service• The Australian Health Care System
• Mental Health Reform• The National Association for Mental Health (NAMH) pioneered efforts to provide:– Social support & treatment for the mentally ill• The issue of mental health attracted even wider public attention during World War II
• The Community Mental Health Centers Acts• The first Community Mental Health Centers Act was passed by Congress– And signed by President Kennedy• The philosophical basis for transferring mental health care:– From the state hospital to the community
• Deinstitutionalization• Many states planned to shift responsibility for the mentally ill to the CMHCs• A series of judicial decisions in the mid- 1970s enhanced the civil rights of:– Mental patients while requiring states to provide them with treatment
• The Revolving Door• By the late 1970s some 40,000 poor, chronically ill mental patients had been:– “Dumped” in New York City– Marginalized many patients• Resources for state mental hospitals dwindled, leaving patient care uncertain• National Alliance for the Mentally Ill
• CMHCs under Siege• The discharge of patients from state mental hospitals:– Imposed an enormous burden on the CMHCs• CMHCs faced significant cuts in federal funding• Changed priorities; targeting chronic care services & services for insured people
• Mental Health Service Delivery• The Substance Abuse and Mental Health Services Administration (SAMHSA)• Static federal funding for mental health services signaled declining leadership:– In mental health reform
• Parity for Mental Health Care• Many who had received mental health services in the past found their options:– Rationed, attenuated, or eliminated• An evaluation of the Mental Health Parity Act• May have marked the end of the downsizing of mental health care
• Issues in Mental Health Policy• Just over half of all Americans will experience a mental disorder• Medication has become a popular intervention• War in Iraq and Afghanistan
• Substance Abuse• Mental health services are often associated with substance abuse• The interaction of emotional difficulties, alcoholism, and substance abuse is:– Reflected in social welfare policy and has been institutionalized in the SAMHSA• Alcohol Abuse & Drug Abuse
• Conclusion• Mental health and substance abuse policies have been complex in part:– Because they have addressed behaviors that are not well understood• Major policy disputes made it more difficult to reach consensus about optimal program
• History of U.S. Criminal Justice• Modern criminal justice in the US can be traced to the faith in social science:– That originated in the West in the 18th century• Modern criminology dates from the Age of Enlightenment• The notion of a genetic origin of deviant behavior
• The Criminal Justice System• The U.S. criminal justice system is similar to education and mental health programs– States & localities provide a significantly larger portion of services than federal govt.• Prisons have been a signal concern in criminal justice
• Juvenile Justice• New York City House of Refuge• Incarceration as the intervention of choice for young offenders• Elected officials redoubled their efforts to contain what was perceived as:– An explosion in the number of juveniles who were engaged in violent crime
• The War on Drugs• Government interdiction of supplies, aimed at eliminating the substance• Treatment programs deployed to diminish the demand for illegal drugs• Observers of urban poverty described a deterioration in inner-city communities– The 1980s in contrast with those of the 1960s
• The Underclass and “Moral Poverty”• The contention that “crime” was largely a:– Bourgeois contrivance to maintain control over hostile minority youth• The increase in crime could be attributed to proliferation of drugs, which had:– Become so extensive as to represent de facto normalization of drug abuse
• The Underclass and “Moral Poverty”• The conservative prescription for moral poverty• It is understandable how delinquency- prone youth could find gang involvement:– A natural progression in socialization• The evolution of liberal policies that divert youth from delinquency
• Legalization of Drugs• Seemingly endless retreats in the War on Drugs• Momentum toward legalizing drugs reached its peak during the mid-1980s• By the 1990s, legalization of drugs drifted to the margin of substance abuse debate