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SOCIAL
WELFARE Restricted Welfare System Military Rule prevented
the country from developing a real
public welfare system –Military Focus on rapid economic growth and not on
social policies –Increasing Gaps Late 1970s, rise of a movement
claiming for welfare programs (middle and working class) Social rights consecrated in the 1988
Constitution—Insufficient
implementation Policy Structure: About 50% of workers make no contributions to the system –Fiscal Gaps Programs and services based
upon the Organic Social Security law promulgated in the 1930s and
changed in the 70s and 90s. November 1998, Social Security Reform
(fostering people’s
transferring to the private system) In Brazil, universality means exclusion--
Targeted policies Economically, Brazil’s
national debt, de-industrialization, and dependency have increased Socially, the gap (one of
the biggest in the world) is widening Politically, loss of
legitimacy of the system and pessimism External Debt led to—Cuts in
public expenditure—lack of resources to spend in education, health, etc. Brazil’s industry hit by
globalization (unemployment) Many social reformers
argue for a strong paternalistic state (Danger of authoritarianism) Voluntary Associations Lula has brought new
hopes, with his goal of allowing all Brazilians to have three meals a day—Will
he be able to achieve even this minimal goal? PUBLIC HEALTH 1940
Special Services for Public Health (SESP) 1975
Plan for Immediate Care (PPA) First real step towards universalization-
creation of the National Institute of Medical Assistance and Social Security 1988 Constitution: Sistema
Único de Saúde (SUS) Single and ambitious health system,
covering in principle the whole nation. Foundation of the present system –1990
Organic Health Law:
Gvt. Stronger commitment from 1985-92, Hindered by successive financial (and debt) crises (IMF, World Bank loans) Two health care
systems: –Public: federal (basic services), state (endemic
diseases, parental and infant care), municipal (emergency) –Private: for profit institutions, philanthropic |
SOCIAL WELFARE Place of Birth of the Welfare State First Statutory Social Insurance System Bismarck,
1883, compulsory sickness insurance 1889, Provisions concerning old age and invalidity
insurance 1923, the Empowering Act (local responsibility/
employer/employee financing of the system) After WWII 1945-1949-Reconstruction of the social welfare
system while integrating war veterans, victims, and refugees. 1949 Basic Law settles conditions for social
welfare policy: Social State, inspired in Bismarck’s welfare state –Key
elements applied throughout the nation with local differences in implementation 1950-69 Ec. Growth and expansion of the welfare
state 1970s Welfare Reform (expansion) Late 1970s-1980s Economic problems and reduction
of programs (not as severe as elsewhere) 1990s Problems of reunification Before
Reunification –West Germany: Pluralism,
Corporatism, Decentralization. High welfare provision hierarchically
organized and distributed –East Germany:
Centralized and Universalistic, wide-scale coverage, deficiencies of quality After Reunification:
organizational uniformity, with differences –Western social insurance was extended to the
Eastern States with benefits calculated on the basis of their (Eastern)
income Social
Market Economy Welfare
policy objectives are –Defined and articulated by the
federal gvt. –Implemented at the local level/increasing
role of the federal gvt. Since the 1980s (and with reunification) Funded by both the state and the private sector
(employers/employees) The
German System •Social Insurance –General Assistance program
covering income losses caused by sickness, unemployment, old age, or
disability. Semi-autonomous organization (employers/unions) locally
administered and sponsored by the federal gvt. •Social Assistance
(benefits for those who cannot apply for social insurance, calculated
according to needs)—State institutions, benefits for refugees, social housing •Personal
Social Services provided by the states (Lander) Criticisms and Problems •The welfare system reproduces the
inequalities of the labor market •Reunification
brought about a crisis of the welfare system (huge unemployment, more
individuals in need, lack of resources, inequality between the West and the
East) •No roll back of the
state PUBLIC HEALTH Corporatist
autonomous system established by 1883 Health Insurance Act (sickness funds)
Principles –Solidarity: commitment to take care of each
other –Subsidiarity: belief
in shared power, mutual respect, and incorporating as many people as possible
into the system. Self-help, family, voluntary associations –Corporatism: party and labor forms of representation
•After WWII, 2 systems –East: nationalized health care (erosion of the
private sector) –West: renewed commitment to the pre-War
principles. Extension of coverage in the 1960s
1992 Health Care Structural Reform Law (limits budgets to contributions, increases consumer choice, stricter controls, opens sickness funds to competition for clients) •Productive & Efficient system Organization
•Corporatist, decentralized, multi-payer system
based upon the same principles •The Federal gvt. Has no
power of implementation •System centered on sickness funds, which have the status of public-law bodies
and make health care decisions –Sickness funds are intermediaries between
the Gvt. And the people –Comprehensive benefits –9/10 Germans are enrolled in sickness funds –Disincentives to profit –Funded by taxes, gvt. Subsidies, and individual contributions. Also, private insurance
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SOCIAL
WELFARE •Antecedent: British Poor
Laws (1601) •The British Welfare State
developed out of the belief that “every individual has the right to support
in times of need and emergency.” –1942 Beveridge Report: social welfare seen as a right
of citizenship. Expanded notion of liberty. Attack against the “five
giants of modern society”—want, disease, ignorance, squalor, idleness. –Three decades of expansion
of the Welfare State –1979: Thatcher’s
Structural Cutbacks (limits: health care & benefits for the elder) –1997: New Labour’s “Welfare-to-Work” approach. Main Social
Welfare Instruments •From WWII to 1979/80: –Single weekly contribution
for “cradle-to-grave” benefits (“all-in” insurance) –Five areas of benefits:
cash benefits, health care, education, housing, personal & social services
(about 70% British received at least one cash benefits, and health and
education were available to everyone) •Since 1979, Thatcher’s drastic erosion of the
Welfare State—Privatization (of pensions, health, education), weakening of
the idea of universal access—Replaced with the notion of incentives and
disincentives New Labour» Conservatives Shift in the
Debate •From –How much to expect, and
how should the State provide for its citizens’ needs •To –How to make the choices
concerning welfare services •Problem: lack of resources to fund a comprehensive
welfare state (the British welfare state looks obsolete in comparison with
the Swedish or the German) PUBLIC HEALTH •The Poor Laws (workhouses/poorhouses) •1911
National Health Insurance (all manual workers over 16 earning small
salaries). Weekly payment •Until 1948, administered through voluntary
associations and a few public facilities (most medicine was paid) •WWII and post-War led to the expansion of the
system •1942
Beveridge Report:
recommended the creation of a comprehensive national health system •1946 National Health Service Act (NHS): nationalization of all hospitals, creation of health centers, redistribution of physicians across the country, teaching facilities, physicians could have private practice. Funded through taxes.
•1974 Attempt to integrate the national with the
regional with the local levels. Creation of Regional Health Authorities (RHA)
and District Health Authorities (DHA) •1980 NHS becomes more autonomous and specialized.
More power ffor RHAs •1982 Elimination of RHAs.
DHAs become fully responsible for the
administration of health •1979 Margareth
Thatcher (backed by Milton Friedman and von Hayek) believed that
privatization would improve the performance of the system –1983 Griffith Report, recommended to move to an insurance-based health system. Did not
work
•1989 the NHS in crisis •1990 National Health Service and Community Act
(encourages competition within the health industry) •Since 1997 New Labour has
maintained the system •1990s—the State imposed a Market into the
state-administered system Organization•Universal Access to Health Care for all citizens •80% paid through general taxation (plus
individuals’ regular contributions plus co-payments) •NHS, internal market made up of purchasers and
providers. State central control •DHAs buy services from
public, private, or semi-private providers •2002 Integrated care, groups practitioners in
local community groups Main Problem/s•Health gap (mostly geographical)
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SOCIAL
WELFARE •1938 National Health Insurance •1944 Employees’ Pension Insurance •Occupation—Western-style welfare reforms
(1946 Daily Life Protection) 1960s: Prosperity & Social Welfare •National pension scheme •Late 60s: movement pro-Welfare State •1973, the “First Year of Welfare” –Dramatic increase in social expenditure during the
1970s –1980s Japan looked like Germany •Mid 1980s (economic crisis, cutbacks)
Development of the idea of a Japanese Welfare State— “Reconsider Welfare” –Complex System: Family,
Community, Corporation, and... The State (the State only supports people who
are also supported by their relatives) Mixture
of welfare-state principles, insurance, and individual responsibility Four Main Areas •Public Assistance •Social Insurance •Basic Welfare •Public Health Main Actor: the Central
government bureaucracy Main Problem: the aging
population PUBLIC HEALTH WHO 2000 Report
ranks the Japanese as the #1
Japanese culture
introduces healthy
habits
Comprehensive national
health care
program
Before WWII, German
influence
1922 Health Insurance Law
offered coverage to certain workers (2,000,000)
1938 Ministry of Health
and Welfare
War led to extend coverage
to many more Japanese
After WWII and the American
occupation
– 1948
Medical Service Law/Social Medical Fee Payment Fund
– 1961 Every Japanese
had coverage (Universal System). “Golden Era”
Problems
1970s Rising Costs (1972 Free
Health for 72+)
1970s/80s Gaps and
inequities
New Health Problems:
drugs, suicide, pollution, inadequate housing, cancer
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SOCIAL
WELFARE Gradualism •Early commitment with
solidarity and universalism since the 18th century (because of the political
power of the agrarian industry, the increasing power of the working class,
and the existence of a centralized monarchy) •The Poor Law (1882) •The Pension Act (1913) •The National Unemployment
Commission (1914) •1932-1976 Social
Democratic gvts—Welfare State based upon a Keynesian policy •1980s Growing deficit
& Inflation •1990s Austerity measures
(did not undermine the structure of the Welfare State, at least not yet) Structure •Social Insurance:
universal (sickness, unemployment, disability, old age, long-term care). No
means-tested •Social Assistance Benefits:
Means-tested (Housing and child benefits) •Social Services: Parental
benefits package (12 months leave at 80% of gross earning, further 180 days
of leave until the child enters primary school, up to 60 days per year to
face emergencies); Daycare PUBLIC HEALTH •1660 Collegium Medicum •1752 •1800 King Gustavus Adolphus created “crown” hospitals (for soldiers with
syphilis) •19th century- Expansion of “crown hospitals” •Health
Care is seen as public responsibility and supported by the national insurance
system 1874
Public Health Act (expanded coverage) •From the late 1930s, the Social Democrats
organized a universal health care system •1955 the National Insurance Law covered the
entire population •1959 Elimination of private beds •1969 Elimination of private practice for
physicians •1976 Reversal (allows private health services) •1982 Health and Medical Services Act •1990s Objective: decentralization Health
care is seen as a basic human right •All residents are covered •Physicians perceive salaries •National Ministry, National Board of Health and Welfare, County
councils (provide health, run hospitals). Some competition with private
providers •System funded by personal income taxes, the National Health Insurance System, National Grants, and user fees
Health Care is seen as public responsibility and
supported by the national insurance system •System funded by personal income taxes, the National Health Insurance System, National Grants, and user fees
in scope and territory—Decentralization of health care at the county level
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UNITED STATES
SOCIAL
WELFARE Reluctance towards social
policy Social welfare policies
developed after the 1930s by the federal gvt. –Roosevelt’s
New Dealâ Limited (and always problematic) Reason: American political
culture and values, with an emphasis on self-reliance and individualism Poverty is seen as the individual’s
fault Early 20th century â punitive approach •After 1929: acceptance of the notion that crises
may produce poverty that are not the poor’s fault –1935
Social Security Act â social security and unemployment compensation/
Preventive and alleviative •(AFDC) Aid to Families with Dependent
Children •Post WWII, prosperity & suspension of
social welfare •1960-8 Kennedy-Johnson â the Great Society & the War on
Poverty (Medicare, Medicaid, housing subsidies, school feeding
programs, programs for pregnant women, Equal Opportunity Act/curative) •1968 Nixon (Milton Friedman) inexpensive
programs based on dis/incentives â Workfare •1980/90s Reagan & Bush: hostility to
welfare. Poverty seen as the individuals’ fault â punitive approach. Welfare seen as the root
of all problems •1996-Clinton, the Personal Responsibility and Work
Opportunity Reconciliation Act â End of Welfare? Organization •Since 1996, recipients of welfare are required
to work •AFDC was eliminated and replaced by TANF,
limited temporary assistance to families –States administer funds and programs (no national
unified programs anymore) Elimination of benefits
for immigrants Punitive & Incomes
approach •Different Programs Direct Cash Assistance In-Kind
Assistance Programs Services (health care,
childcare, help dealing with alcohol or drugs) PUBLIC HEALTH #1 in per capita
expenditure in health
#37 in performance (in our
sample, only better than
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