Counting Their Teeth

“I earned my social security,” the woman told her friend. “I paid for it from the day I turned eighteen. All those years of hard work. It’s not like it is welfare.” Her friend nodded her head enthusiastically. “It’s not.” Then she paused. “Without social security, what would we do?”

I overheard this conversation within the last few weeks, but I thought back to an interview I did thirty years ago. Helen, a big woman with a deep voice, told me how hard she had worked her whole life. She was criticized because her kids were what we now call a “latchkey children.” She would qualify for welfare, a social worker told her so she could stay home. Nevertheless, Helen was too ashamed to accept that help, and she felt there were too many strings attached it. Offended when the social worker suggested it again, she said, “Miss Nelson, my kids are going to get an education no matter how. And they’re not going to have you on the street corner counting their teeth!”

Today attitudes toward government-sponsored, health-care reform are attached to the difference in reputation between social security and what Helen thought of as welfare. In the past such welfare was called Aid to Dependent Children. It is now called Temporary Assistance for Needy Families (TANF) because of a strict work requirement and a five-year time limit.

In 1965, the government enacted two group health assistance categories. Medicare (Part A and B), which was attached to Social Security, and Medicaid, a program to provide health care for the poor. In the process, Congress institutionalized two tiers of public financing for health services.

Paul Starr, in Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform, (2011) states that, “The benefits that the elderly receive in the upper tier have been understood as an earned right, even though seniors have never paid enough in payroll taxes to earn their insurance coverage. . .. That moral claim has nonetheless given Medicare political security, making it unthinkable (at least until recently) to rescind the program, cap it, or cut it in a recession. In contrast, the recipients of Medicaid, like welfare, are not regarded as having earned any right, and that lack of a moral claim has made Medicaid politically insecure and more vulnerable to cutbacks.” (47)

Medicare was established on a national basis, which meant that seniors received the same benefits wherever they lived, but Medicaid was left to the whims of different states. According to Starr, care for the poor varied greatly. Arizona waited until 1982 to establish its program and restricted its benefits. In addition, the poor had to fit into acceptable categories: the aged, blind, disabled, and families with dependent children. Starr continues that the “lower moral standing of Medicaid was reflected in payment rates to doctors that were so low that many refused to take Medicaid patients.” (47)

This history explains how the punitive measures towards health care provided the poor were formed, but it doesn’t really explain why protected categories of citizens, such as seniors, would feel that their moral right to a benefit they earned would be considered more important than, for instance, the moral right of children to grow up healthy.

Ezra Klein, speaking on the Ed Schultz show on MSNBC on February 17, 2012, quoted a political science study that showed that there are three groups of people in the United States that benefit from government programs. At the bottom are those on welfare, medicaid, food stamps, and unemployment, who have to go through humiliating and shaming rituals in welfare offices, such as repeatedly presenting complex documents and standing in long lines of similarly shamed people. At the next level are recipients of social security and medicare for whom benefits usually come in the mail and are not associated with stigma. At the third level are people who get their aid through tax breaks and never have to go through humiliating rituals at all.

We must ask ourselves several questions. As Americans do we feel we have to punish failure, and are the poor conceived of as having failed? Is it because we are so afraid that we will become like them that in rejecting them we are somehow rejecting weakness in ourselves?

I remember the shame of asking for food stamps and the way those waiting in line with me diverted their eyes from each other. Similar rituals are still going on today.


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