The welfare problem to be analyzed in this paper is not focused on particularities, that is, problems that rampage certain sectors of the society (like the educational or social sector). Rather, the problem rests on the welfare policies of the US government. It is generally noted that recently many state governors complain that federal law is directly prescriptive and less flexible. Added to that, the public believes that welfare is generally anti-work and anti-family. Many people also believe that reforming the welfare system in the United States is a necessary step of the government without sacrificing the welfare of children (Sawhill, 1995:URL cited). Those who receive welfare benefits from the government believe that the welfare system is degrading and demoralizing, forcing them to find jobs in the labor market. Many experts also note that the US welfare system has little influence over the course of growth of children, especially in poverty alleviation. Nonetheless, food packages which stem from welfare security policies are generally insufficient to move a family above the poverty line.
Now, the US welfare system is attacked from different fronts; all of which have specific interests to protect. It is generally noted that the US welfare system has four problems: 1) it does not give the state government flexibility (executive and legislative) to structure welfare policies or at least implementing regulations, 2) it does not motivate people to work (driving the economy down), 3) some say that it is responsible for the breakdown of the family (it is noted that the number of wedlock births in the United States is increasing yearly), and 4) it has little influence on poverty alleviation, especially those which involve the old and children (Sawhill, 1995:URL cited).
The so-called “welfare problem” is not the result of impulsive legislative response to the growing problems in the social sector. It is the product of history; the successive legislative reforms that proved unsatisfactory and unresponsive to the needs of the social sector. Here what is presented is the long history of legislative reform in the welfare sector; reforms that were mixed with vicious politics and politicking.
The so-called national welfare system had been established during the time of President Franklin D. Roosevelt. In the 1920s, the United States had a booming economy, characterized by low inflation and unemployment rates. On October 29, 1929, the stock market collapsed. Many businesses were forced to close. From banks to railroad companies, the effect of economic depression was clearly seen (Welfare, 1998: URL cited). Hence, the so-called “Great Depression” began. It was estimated that when the Great Depression began, there were about 18 million disabled, elderly, and single mothers who were living in subsistence level (below or close the poverty line). The US government in cooperation with state government established public charities in order to reduce the effects of the Great Depression on the social sector. The private sector also helped in such undertakings. Fathers usually abandoned their children for financial disability. Riots were numerous in major cities. Unemployment rose to a height unprecedented in American history (Welfare, 1998: URL cited). The government realized that the need for a national welfare system that coincide with political ideology (Roosevelt is a Democrat).
The start of serious reform began with the term of President Ronald Reagan. As a republican, he believed that the management of the economy should be less focused on curbing unemployment via “easy money.” What was needed is a labor force that can stand economic recessions and increase productivity to the level of potential GDP. Thus, in 1988, the US Congress enacted the Family Support Act. Its purpose was to emphasize job sustainability by increasing funding for the education and training of the labor sector. The general objective of the program was to curb unemployment in the United States and create a productive labor force.
When he was governor, President Clinton supported the said act because he believed that the “welfare system” ought to end. In 1994, the Work and Responsibility Act was passed (Sawhill, 1995: URL cited). Its general purpose was to invest in education and training for a period of two years (the limit). After the said limit, the “recipients” would have to work (or they may lose their benefits). This generally increased the personal responsibility of the younger generation. Added to that, it also gave the states time to expand their legislative and executive flexibility on welfare policies. And finally, it made the budgetary cost management more efficient.
The Goals of HR 1952
The said bill was introduced in the US House of Representatives (on its first reading) on April 19, 2007. It is generally known as the “National Health Information Incentive Act of 2007.” The bill was created to amend title XI (and some provisions) of the Social Security Act and to alter some provisions of the Internal Revenue Code of 1986. The purpose of the bill are stated in section 2(b) of the said act, that is,
“To create incentives that encourage physicians and other health professionals to adopt interoperable electronic health records, electronic prescribing systems, evidence-based clinical decision tools, remote monitoring, patient registries, secure email, and other health information technology as a key component of a national health care information infrastructure in the United States to ensure the rapid flow of secure, private and digitized information relevant to all facets of patient care. To do so in a voluntary manner that does not become an unfunded mandate on small physician practices. To do so in a manner that does not compromise the medical care provider’s ability to make patient care decisions based solely on his or her clinical expertise and experience, and what the provider and patient concludes is the best for a particular patient based upon scientific evidence and knowledge of the patient’s medical history” (H.R. 1952: National Health Information Incentive Act of 2007, URL cited).
Hence, the general goal of the said bill is to make the national health infrastructure more responsive to the needs of the social sector; that is, the children, elderly, and the disabled. Nonetheless, because the rapid flow of secure, private and digitized information is an important factor in patient care, the act provides that the national health infrastructure should be efficient and effective in providing medical care based on scientific knowledge and knowledge of the patient’s medical history.
There are findings that became the grounding point of the bill’s formulation. Here are some of the findings: 1) In March 2001, the Institute of Medicine conducted a study which concludes that in order to improve quality, the entire nation must have a national commitment to structuring an information system to support health, quality management, medical and clinical education, health care services research, and public accountability; 2) A study conducted by the National Committee on Vital Health Statistics in November 2001 claimed that a national health information infrastructure will improve patient safety, healthcare quality, and consumer healthcare; and 3) the Institute of Medicine (October 2002) reported that calls on the federal government to approve steps to encourage and mage development in the information technology infrastructure is a critical variable to healthcare enhancement (H.R. 1952: National Health Information Incentive Act of 2007, Sec. 2(a1,a2,a3), URL cited).
The Clients of the Policy and their Needs
Small medical care providers are generally the targets of the said bill. This includes physicians and health professionals inside or outside the public sector. The bill is inclined to provide financial incentives to small medical care providers as part of its efforts to build and maintain a strong national health infrastructure. In general, it is provided that
“The Secretary shall provide for additional payment to medical care providers in small practice settings, including physicians and others in clinical practice, for the purpose of assisting such entities to acquire and adopt patient registries, evidence-based clinical decision support tools at the point of care, electronic health records, secure email, and other health information technologies defined by the Secretary as a key component of a national health care information infrastructure” (H.R. 1952: National Health Information Incentive Act of 2007, Sec. 1181 (c1), URL cited).
The bill also provides small medical care providers the so-called “optional financial incentives.” In general, the bill provides that the Secretary of Health and Human services is authorized to make grants or provide loans to small medical care providers. This is in lieu of the principle of responsible medical care, where physicians and health care professionals are encouraged to build a strong health infrastructure. This can only be achieved if health care providers are provided with the right incentive to work, in accordance with the principle of confidentiality and impartial health assistance.
This incentive scheme of the bill was the result of some of the findings that revealed the needs, wants, and strengths of the target. A Commonwealth Fund survey of physicians concluded that there exists a gap between the support for and willingness of physicians and other healthcare professional in providing patient-centered services. The same study noted that acquisition costs as well as physician and staff time required to build a strong national health information system had been hampered by the lack of incentive to work (principle barriers). The study also noted that the success of a national health information infrastructure depends not on the strength of health policies but on the widespread utilization and acceptance of electronic health records which entirely depends on physicians and healthcare professionals.
It is very clear that the purpose of the bill is to increase the motivation of physicians and healthcare professionals to work. This is in accordance of the goal of the federal government of building a national health infrastructure that is responsive to the needs of both the medical care providers and the patients (establishing a patient-centered service system)
Social Programs Implemented as a Result of the Policy
Although the bill is not yet passed on both the two Houses of Congress, several state governments are beginning to structure welfare policies that heavily depend on the philosophy and principles of the said bill. The state government of California, for example, predicted that there will be an increase of retail clinics nationwide (over1500) by the end of 2008. This increase can be described as insignificant, since the propensity to provide healthcare services to potential patients has been decreasing in recent years. A report from the California HealthCare Foundation noted that retail clinics (composed of physicians and assistant healthcare professionals) help fill the care gap for the uninsured and underinsured recipients. This provides an average savings of 240 dollars for each service procured by a potential patient. Hence, the response of the state government was to issue a set of legislative measures to increase incentive package to physicians and healthcare professionals. The effect of the policy can be seen from the restructuring of the Medicare program of the federal government. After the passage of the Balanced Budget Act in 1997, the Clinton government was able to solve the country’s budget deficit; unexpectedly creating a budget surplus. The 794 billion dollars surplus was transferred to the Medicare program. The general purpose of the Clinton government was to increase drug benefit and preventive care to the health sector. The Bush government, however, criticized the policies of the former administration, charging that such transfer would invariably return to the old “welfare system.” Hence, a legislative proposal in accordance with HR 1952 is being prepared by the Bush administration in order to potentially streamline the “welfare system”; that is, to encourage physicians and healthcare professionals to adopt new technologies in the medical sector (improving medical services to patients). The Bush government also passed the so-called “Remote Monitoring Access Act of 2007” to provide an efficient and health effective programs in the rural areas (in accord of the plan to build a national health infrastructure). Hence, although HR 1952 is not yet passed in Congress, it is generally assumed that this will complete the goal of building a national health infrastructure.
Policy’s Strengths and Weaknesses
The policy has certain strengths and weaknesses. The potential strengths of the said policy (potential since its effectiveness in implementation after a given time period would serve the basis of its strengths) are as follows: 1) the incentive mechanism of the policy directed to physicians and healthcare professionals is expected to increase the number of retail clinics throughout the country, 2) it is expected that the gap between physician motivation and quality of service will decline, and 3) the said policy is in line with almost all the social welfare reforms of the government – hence its effectiveness would be made viable and stable by other existing policies. The policy though has certain weaknesses. To name: 1) there is no assurance that the care gap between physician motivation and quality of service will decline, 2) financial incentives will become a burden for the government, and 3) this would significantly alter some of the “favorable” and “time-tested” policies of Medicare.
The Pros and Cons of the Policy
Those who favor the bill noted that by offering grants, loans, and tax incentives to physicians and healthcare professionals, it will offset the costs of adopting heal information technologies (IT). The main proponent of the bill, Rep. Gonzalez noted that such incentives would stimulate adoption of technologies in the welfare sector, resulting therefore to huge public benefits (CQ Staff, 2007: URL cited). An interviewed physician said that such legislative measure will get the best lifesaving technology into the offices of physicians and therefore into the lives of US patients (CQ Staff, 2007: URL cited).
There are lawmakers who opposed the passage of the bill. Their main argument lies on the fact that the incentive mechanism is a general compromise of the Balanced Budget Act transfer of funds into the Medicare program of the US government. Such “multiplicity” of functions would generally cost the government.
Stakeholders of the Policy
There are stakeholders in the policy. The primary stakeholders of the policy are potential American patients. The structuring of a national health infrastructure is always directed to the needs of health care beneficiaries. The incentive mechanism of the policy serves to offset technology adoption costs in physician offices in order for the patients to get the best medical care from these professionals. The direct stakeholders though are physicians and healthcare professionals. The facet of creating the best medical workforce that caters to the needs of every American patient depends on the level of motivation as well as the quality of medical care provided by these professionals. Hence, the creation of the bill is a direct response to these factors.
Role of the Social Work Profession in the Policy
The primary role of the social work profession in the policy is to provide patients with conducive “environments” where social and psychological growth can be experienced. This role though should be seen as secondary since this is only involves posteriori approaches in medical care; that is, the stage where medication is almost complete. Hence, it should be noted that the role of the social work profession, in the case of social workers, is limited.