Final Exam

In what ways did Medicaid not change after the ACA?

-5-year waiting period for new immigrants -Benefits package -Mix of funding (national + state) -Use of waivers by states (have been offered since the Reagan administration)

Who is eligible for OASI?

-95% of workers are covered; those who are not covered are usually government employees -Earning requirement: "40 quarters" rule, pay at least $1,300 per quarter for 10 years -Family: spouse or dependent child -Age: normal retirement age was 65; became 67 -Early retirement at 62 (reduced benefits if you choose to do this)

How does UI differ from classic social insurance models?

-A lot of variation from state to state -Practice of experience rating - in UI not everyone pays the same rate, depends on what your history of laying people off is

With equality in governance, what is being equalized? (three parts)

-Access • For example, K-12 education. Says that if you are a child in this country, you have the right to have access to an education during this select period of time. • Doesn't guarantee that you will come out of it as smart as everyone else or as intellectually fulfilled as your counterparts in another state, but you have equality in your right to an education in some form -Benefits •For example, if the situation was that once you retire, no matter your work history, you will get $600 per month after you retire -Outcomes •People end up in same spot regarding education, proficiency, life attainment •Critics say that when we talk about equality more attention needs to be paid to this part - equalizing outcomes

In the U.S. you are more likely to live in poverty if you are:

-Black -Hispanic -A child -Living in the South -

How are parts B and D of Medicare similar?

-Both are voluntary -D is financed mostly by general revenues and monthly premiums (elderly usually 14%) -Both B and D have late penalties to prevent adverse selection -Those premium costs increase with income -70% of Medicare recipients get part D

How does social insurance fit in with "classic American values"?

-By making you work, you are being individualistic, helping yourself and contributing to society -By being given cash benefits you are given the ability to decide how you'll live your life

What do DI benefits look like?

-Cash -Medicare (after 2 years), and vocational rehab. -5 month waiting period -Length of benefit: until you can work again; turn 66; or die -Value of benefits tied to past work history -avg. benefit of $1000/ month -11 million people

Free cash in Finland

-Changes in market driving experiments in social programs Ex: Finland, where a lot of jobs were lost due to decline in the country's tech industry -Support from: Utopians: emancipation from the meaningless low-wage work Labor: empowering workers Libertarians: shrinking gov. By consolidating all programs -also get rid of dependency -but scared of the expensive price tag

Talk a bit about Old Age and Survivor's Insurance (the basics)

-Created in 1935 as part of the Social Security Act -Originally aimed at industrial workers -Payroll taxes started in 1937, regular benefits started in 1942 -Amended in 1939 to include survivor's insurance -Purely national program; run by SSA (decides eligibility rules, benefits, and financing)

Who is eligible for DI?

-Depends on work history: sliding scale for years of paid work -Covers almost all workers -Nature of injury or illness: impairment must last at least a year, or result in death -Must prevent substantial gainful activity -Must be verified by state-level disability determination agency; denial can be appealed

What is experience rating?

-Experience rating determines how high (or low) a premium employers will pay to insurance companies. -Premiums depend on the history of employee accidents or casualties - if a place has a history of a lot of casualties, it is thus determined as less safe and the employer(s) will be charged a higher premium. Worker's compensation**** -This is supposed to encourage safer workplaces

Name a few social programs (created after 1980) that don't rely on payroll taxes

-FMLA- Family, Medical Leave Act; passed in 1996 and provides 12 weeks of unpaid leave only applies to businesses that employ 50 or more people -TANF -Child Tax Credit

How is WC easier to get than DI?

-For DI you usually have to wait about 6 months before receiving benefits, but once your eligibility for workers' comp is confirmed, you start getting benefits in 3-7 days. -Can be a temporary disability for WC, while it must be a long-term or permanent disability for DI

Give two reasons why a culture/values explanation might not be very helpful in understanding the failure of national health insurance in the U.S.

-Generally the US wants limited government this would imply that they wouldn't want national health insurance. --> This is the culture/values explanation but you've seen an expansion in this. Specifically programs related to insurance for healthcare A huge portion of the public wants more govt involvement with health insurance programs -Steinmo, Watts, and Quadagno all say the cultures/values explanation isn't true because we have seen an expansion of govt programs despite the public not wanting increased government involvement. Contradictory evidence -Shift in public opinion to support health care generally -culture/values is not a great way to explain why we have some policies and programs but not others

Medicare: Part A

-Hospital insurance, 100 days long term hospice and respite care -Compulsory -99% of total recipients -Not covered: acupuncture; wheelchairs; eye care, dental -If you don't sign up by 65 you have higher penalties -Most expensive

What is the poverty line for a single person v. for a family of four?

-If you are a single person, the poverty line is about $12,082 -If you are a family of four (with two kids) the poverty line is about $24,447

How is Medicare part A different from Medicare part B?

-In-patient care vs. outpatient care -Payroll tax vs. general revenue and monthly premium

Besides payroll taxes, name one other important source of revenue for Social Security.

-Interest on Social Security trust fund surplus -Financed by two funds OASI trust fund DI trust fund -Taxation of Social Security benefits Wealthy people pay taxes on benefit they're withdrawing --> Payroll tax - FICA Federal Insurance Contributions Act

Why did Republicans support drug benefit changes in 2003?

-It was a way to reach out to the elderly as a voting block -They had promised to do this -But there were questions about the overall cost and the open-ended entitlement portion of it

What are the alleged "two tiers" of the American welfare state?

-Lower tier: public assistance; means-tested programs (i.e. Medicaid, TANF, SNAP, Public Housing) -Upper tier: social insurance programs (upper tier is the more generous, arguably better tier) --> benefits are more generous --> better in that it is less stigmatizing --> tend to grow more in good times and be less likely to be cut back in bad times

Why did many elderly people want to repeal the MCCA in the late '80s?

-Many elderly people felt they were getting a raw deal since the program was not funded through a flat tax rate, but rather it would be just retired people who would pay for the benefit. Also, some people didn't like that poor seniors would be paying less than more affluent ones. -It was also a progressive tax A discriminatory, ageist tax

In the U.S. you are less like to live in poverty if you are:

-Married -A non-Hispanic white person

Current members of the military are eligible for what kinds of benefits?

-Medical care -Retirement pensions -Help paying for college -Housing subsidies -Life insurance

Poverty Line (i.e. who developed it, how)

-Mollie Orshansky developed it in the '60s -Formula for the poverty line in the '60s (and still today): 3 x Economy Food Plan (now called the Thrifty Food Plan) -Draws a stark line at a specific dollar figure to find who is poor and who isn't -Orshansky's background with the Department of Agriculture helped her find what should count as a minimal food budget / helped her determine how much the average family spends on food

What changes did the ACA (2010) introduce to improve the financial health of Medicare?

-More affluent people were taxed at a higher rate -Trust fund expected to expire in 2028 -Changed reimbursement rates to providers -smaller rate of increase in reimbursements (cannot keep raising the prices) -less for Medicare Advantage (Part C) -less for hospital readmissions and hospital-acquired conditions -more for primary care providers (to keep patients healthy) -more for high quality care (cancer survivor rate; better than national coverage) -New Center for Medicare and Medicaid Innovation (to eliminate inefficiency in healthcare) -New Independent Payment Advisory Board (to monitor growth in Medicaid expenses)

Who is eligible for UI?

-Must have been working for a year (25+ hours/week), been unemployed involuntarily, must be willing, able and looking for work -Must take any offer of suitable work -Someone whose company went bankrupt and closed -Someone who worked full-time at minimum wage for two years, before being fired for low performance

The Social Security Administration has responsibility for which major programs?

-OASI -DI -SSI -TANF -Medicaid (grants to states for medical assistance programs for low-income citizens) -Medicare (health insurance for aged and disabled) -SCHIP (State Children's Health Insurance Program, for low-income children)

How are parts B and D of Medicare different?

-Part D varies a lot across the country; different lists of drugs -With different co-pays and deductibles; at different prices; from state to state, and even within states -Part D has the doughnut hole

How is funding for Medicare Part D progressive?

-Progressive financing means that the rate that we get from people goes up as their incomes go up -Medicare, both B and D, have more expensive premiums for the affluent and elderly -Whereas with other programs (i.e. Social Security) they tend to be regressive, with flat premiums

Who wouldn't be covered by the FMLA?

-Public officials -Part time people -Employees in businesses under 50 people

The Hidden Welfare State

-Refers to tax expenditures with social welfare objectives that are often not included in discussions about the U.S. welfare state. Howard's terminology implies that "visible" social welfare programs are designed to help the neediest, but the "hidden" programs often offer benefits to wealthier individuals and companies. -Programs that constitute the visible welfare state of direct expenditures include: Social Security, Medicare, and Aid to Families with Dependent Children (AFDC, now Temporary Assistance to Needy Families). -The hidden welfare state refers to tax expenditures (deductions) with social welfare objectives: tax deductions for retirement saving, charitable contributions, higher education, and the home mortgage interest deduction. All of these deductions benefit constituencies with considerable disposable income.

Why did some people think (early on) that social insurance programs would threaten core American (liberal) values?

-Seen as a threat to individualism, self-sufficiency, and liberty -By giving people cash, government is trusting them to spend the money responsibly However.. This was different from giving people a basket of food -- they didn't trust people with cash Social Security is rewarding workers and giving Americans the freedom to spend money as they see fit ... that's America values. Social Insurance is a better fit with our core values; more "American" way of dealing with the ups and downs of capitalism than with Socialism

Sometimes, the elderly lose. Name two specific policies that AARP supported in the 1980s or 1990s, but which were repealed or not enacted.

-Social Security amendment of 1983 -MCCA (Medicare Catastrophic Coverage Act of 1998, repealed one year after it was passed because it taxed just seniors instead of everyone)

Three types of relationships within government:

-Solidaristic (i.e. family, religious groups) --> determined / formed in terms of need - Instrumental (esp. economic relationships, like that between buyer and seller) --> determining who will get resources based on who deserves them (pie. Twin Peaks reference.) -Citizenship --> Equality (the status of a citizen is an equal status) --> political v. social equality

Name one important difference between Stern's version of universal basic income and Murray's version.

-Stern was going to keep disability insurance - Stern wanted to keep all the other programs, and just add another level of universal basic income -Murray wanted to get rid of all of the other programs because he wanted less government. -Murray wanted to give $3,000 more for healthcare -Murray also wanted to wipe out all other social insurance programs -Stern wanted to wipe out public assistance programs, but would keep things like Social Security

Why does it make sense to give the elderly credit for defending Social Security and Medicare, but not for expanding them?

-Thanks to seniors protesting, the attempted privatization of Medicare failed in 2005 as did cuts to Social Security. -Credit can't really be given to the elderly for expanding the programs because Medicare and Social Security expanded before they or the AARP got involved. **So offensive failure, defensive success -Wasn't established until 1958 long after these benefits

Name two general reasons why the AARP has trouble taking a strong, clear stand in debates over social policy.

-The AARP has a pretty wide customer base and can't always condense the opinions of the people they're representing into one straightforward position (varying political ideologies) - Many elderly join AARP for its services, unrelated to lobbying and politics -Competing interest groups among the elderly

Why did bureaucrats have a lot of influence over the expansion of Social Security in the middle of the 20th century, according to Martha Derthick?

-The SSA actively cultivated their team to have a shared worldview. The agency recruited, socialized, and trained their employees to ensure that everyone was on the same page and shared similar goals / had similar ideals about what the goals of Social Security should be, as well as how they should go about accomplishing those goals. -Their office was physically isolated from D.C. (which was and still is v expensive and swampy, with very little office space) → moved to Baltimore area -The Social Security Agency worked hard to make sure that they had highly intelligent people working for them who were well versed on everything related to their department. Since expertise was concentrated in this one physical building, other people in D.C. had to go straight to the source to get quality, up-to-date information about what they were doing. This gave them a lot of agency over the information that was being disseminated. -High cohesion and had a similar vision philosophy of gradualism, they were in baltimore and looking into house ways and means; high concentration of expertise v. politics

In Social Security, what is the "replacement rate"?

-The amount of money from your former earnings that you get back (the amount that is "replaced") with monthly social security payments -A percentage of pre-retirement earnings replaced by the social security benefits. -Attempt to help the low-wage workers get 'pulled up' a bit -Replaces 53 percent of income for low earners, 39 percent for medium earners, 32 percent for high earners, and 26 percent for extremely high earners -This is the percentage of a worker's pre-retirement income that is paid out by a pension program upon retirement. There is a cap to the replacement; low wage workers get more percentage back of their initial wages compared to higher wage earners

How did Medicaid change after the ACA?

-The eligibility rules → extend Medicaid to every non-disabled, non-elderly adult up to 133% / 138% of the poverty line (133 is true if after a 5 percent income disregard) -Before the ACA, many states had changed their rules so that kids were covered up to double the poverty line. States have to keep these existing rules for children, even if the income threshold is above 138% of the poverty line -Financing: To promote expansion, the national government would pay states 100% of additional costs (2014-16), then 95% (2017) and eventually 90% (2020-) -Mental health benefits have gotten a little more accessible

According to Campbell and Morgan, whose opinion mattered most in debates over financing the welfare state during the last decades of the 20th c.? Explain briefly.

-The opinions of economic and political elites mattered the most because they had the most influence and often the most power as well to make changes with regard to funding patterns. -Safer seats than republicans; didn't to have to look at the median voters

Why were new social programs created in the 1930s, not a major break with the past?

-The state has been helping to take care of poor mothers and their kids -Child labor laws -We had been doing this at the public level for awhile; it is not a break from the past - the difference is that the national government is getting involved

Why did Democratic officials steer clear of payroll tax increases, starting in the 1970s?

-They didn't want poor people to feel the pressure to pay extra payroll taxes, especially since there was a recession in the '70s - the poorer people would face an unfair burden. -The flat tax rate of payroll taxes would be a big burden on middle and low income workers because these rates had continually increased through the late '60s and early '70s as a result of Medicare expansion and Social Security increases -Undue burden on the poor; flat tax

What do benefits from OASI look like? Who benefits?

-Total: 50 million people -Old-Age Insurance (retired workers and spouses): 44 mil, average $1362; 709 -Survivors Insurance (aged widow; child) 6 mil; average $1301; 839 -Cap at $2,687 per household **Determine benefits using AIME Most of the elderly get most of their income from social security ⅔ of elderly, 50% or more; ⅓, 90% or more -More women, minorities in the program

How is the welfare state a system of stratification?

-Two strata - those that make and contribute, and those that take from the welfare state and are needy -If you have a society that relies heavily on dessert, earning, and merit, then you tend to have a strata between paid and unpaid workers -Idea that we should quit the welfare state as it is so that we don't have these strata between citizens, would open up for a better playing field for everyone

What was the "man-in-the-house" rule? (1968)

-Under the man-in-the-house rule, a child who otherwise qualified for welfare benefits was denied those benefits if the child's mother was living with, or having relations with, any single or married able-bodied male. The man was considered a substitute father, even if the man was not supporting the child. -So officials would randomly spot check and be super intrusive and look around the homes of single women on welfare and see if there were any signs of a man living there (i.e. an extra toothbrush, a pair of men's shoes, etc.)

Medicare: Part B

-Voluntary -Together with part D, makes up SMI (Supplemental Medical Insurance) -Doctor visits, x-rays, small to mid-sized -90% voluntary -Affluent pay more -134 avg month -General revenues pay 75% ; beneficiary premiums 25 %

Medicare: Part C

-Voluntary, people pay themselves -33% of people are covered -Managed care organizations; gives a flat rate to something and you can show up and you might not have control over your doctor -Covers wellness improvements like yoga -Beneficiary premiums around 40ish -Medicare advantage

Why did Republicans promise a prescription drug benefit in 2000?

-Wanted to be on the record as saying that the Republican party helped elderly people (esp. Since the 2000 election was coming up at the time) -They also believed in helping the elderly, but they didn't agree on how much to help / how much to spend -Bill Clinton 1999 state of the union address on the lack of prescription drug benefit

Summarize the main points made by Rector and Sheffield about the welfare system (i.e. is it working or not?)

-War on poverty has been a failure -More people are becoming dependent on welfare -Spent $22 trillion since 50 years ago (since Johnson's declaration of war on poverty) -3x gov. Military spending -Spending on welfare rose but the poverty rate remained the same -more spending → less progress Failures of poverty line -Does not give accurate information on living conditions Incomes and living standards were rising rapidly before the war on poverty -Failed its original goal to eliminate dependence, and causes of welfare -Argues to reduce welfare spending, increase work requirement, and implement anti-marriage penalties

Who is eligible for worker's compensation?

-eligible as soon as they work -~90% of workers are eligible, depending on state; many states exempt small businesses, agricultural industry, etc. -nature of injury can be temporary or permanent -can be partial or total -injury must be work-related -must be verified by doctors -denial can be appealed

What are some characteristics of most social insurance programs in the U.S.?

-financed by payroll taxes -eligibility is based on a history of paid work -benefits are based on past wages -budgetary entitlements

How is the design of the EITC consistent with classic liberal values? Give two examples.

-requires that people work, so it fits into the liberal value of individualism, and of making a personal contribution to society and the maintenance of your own well-being - ????

As of 2015, what is the official poverty rate?

13.7%

Regressive Tax

A tax imposed in such a manner that the tax rate decreases as the amount subject to taxation increases. "Regressive" describes a distribution effect on income or expenditure, referring to the way the rate progresses from high to low, so that the average tax rate exceeds the marginal taxrate.

Progressive Tax

A tax in which the tax rate increases as the taxable amount increases. The term "progressive" refers to the way the tax rate progresses from low to high, with the result that a taxpayer's average tax rate is less than the person's marginal taxrate.

AIME

Average Indexed Monthly Earnings: -best highest earning 35 years and given to you through SS -A calculation used to determine the Primary Insurance Amount (PIA) amount used to value an individual's social security benefits. -AIME takes your top 35 highest earning years up to age 60 and indexes it for wage growth, and then averages it to get a monthly amount. 1st 885 → 90% replaced; 2nd $885 - $5,336 → 32% ; 3rd $ above 5,336 → 15% or more

What do benefits for WC look like?

Benefits come in the form of cash, medical care (half and half between the first two); and vocational rehab -waiting period: 3-7 days -length and value of benefits vary by nature of injury and states (usually less than half of prior wages) --> Est. 4,821 job-related fatalities and 3 million occupational injury

How can we keep the Social Security Trust Funds from being depleted by 2034?

Can solve this by increasing the payroll tax, increasing the cap on payroll taxes, increase eligibility age, decrease benefits, change benefit formula to include 40 years

CHAMPUS

Civilian Health and Medical Program of the Uniformed Services - a US federally funded health program that provides beneficiaries with medical care, supplemental to that available in US military and Public Health Service facilities.

COLA

Cost of Living Adjustment - An adjustment made to Social Security and SSI to counteract the effects of inflation. COLAs are generally equal to the percentage increase in the consumer price index for urban wage earners and clerical workers (CPI-W) for a specific period.

McGovern Plan

Democrat who opposed Nixon's plan, supposed to be more generous -Extend to individuals and childless couples -But plan got discarded, as Congress focused more on a fully-employment agenda Changing Perspectives -Plans fail in the Senate -Nixon impeachment→ dropping the plan -Economic struggle in 1970s→ focus on individual gain, moving away from the societal focus

What important role do states play in the DI program?

Disability determination agencies exist at the state level, and these agencies determine whether a person is 'truly' disabled. These decisions can be appealed. --> The flaw with this is that determinations vary widely between states. While in one state someone may qualify as disabled, another person in a different state, with the exact same condition, many not qualify.

Why did the SSA annoy the courts so much? (from Erkulwater reading)

Each court decision only applied to the ruled case but did not generalize to similar cases -compounded by changes in understanding of mental illness -lawyers argued that SSA standard was outdated; and must consider each circumstances and factor, not just clinical symptoms -publicity and media also drove the changes

EITC

Earned Income Tax Credit - a refundable tax credit for low- to moderate-income working individuals and couples, particularly those with children. The amount of EITC benefit depends on a recipient's income and number of children.

Social Security Act

Established in 1935, the SSA was the U.S's first social insurance program

What does financing for WC look like?

Financing: $62 B total expenditure Revenue: $92 B -premiums paid by employers to insurance companies, self- insurance, or state funds -more private than public -premiums follow "experience rating" -If employers have a history of paying WC, they pay more for insurance

The normal retirement age for Social Security was historically ____ but is slowly increasing to ____. The age of early retirement ____ has stayed the same.

Historical retirement age: 65 Slowly increasing to: 67 Age of early retirement: 62

HI

Hospital Insurance

Is Medicare social insurance?

In these ways, yes: -It is near-universal -Not everyone is covered, but in most sections we see really high percentages of people who are on this -Benefits are earned through work history -Financed by payroll taxes -Especially parts B and D In these ways, no: -Other sources of revenue -More progressivity in revenues -Benefits not tied to past earnings

What is the dependency ratio?

It is a measure showing the number of dependents, aged zero to 14 and over the age of 65, to the total population, aged 15 to 64. It is also referred to as the "total dependency ratio." -From Mary Ross's, "Why Social Security."

Why was the Sullivan v. Zebley (1990) case so important?

It opened the door for more children to be eligible for DI, because it did not hold them to what was then the standard of determining eligibility, which was whether or not they could hold a job

What do Medicare parts A and B not cover?

Long-term care; most dental care; glasses; dentures; cosmetic surgery; hearing aids; and foot care

After two years on DI, what do recipients automatically get?

Medicare

MCCA (1998)

Medicare Catastrophic Coverage Act - repealed a year after it was passed. It taxed seniors instead of everyone.

MMA (2003)

Medicare Modernization Act - created part D, prescription drug coverage. Championed by the Republicans. Example of delegated governance.

Medicare (1976)

Mostly for old and disabled people → must be 65 or older to be eligible -Parts A and B are run entirely at the national level, by the Department of Health and Human Resources -It is a single-payer, national social insurance program administered by the US federal government, currently using about 30-50 private insurance companies across the United States under contract for administration. Medicare is funded by a payroll tax, premiums and surtaxes from beneficiaries, and general revenue. It provides health insurance for Americans aged 65 and older who have worked and paid into the system through the payroll tax. It also provides health insurance to younger people with some disabilities status as determined by the SSA, as well as people with end stage renal disease and amyotrophic lateral sclerosis.

Medicaid

Mostly to give aid to families and children

During which administration did the U.S. House of Representatives actually approve something close to a guaranteed income?

Nixon Administration

Since the '70s, have any new social programs been financed with payroll taxes?

No - they've all been financed by general revenues, it just depends on whether they are direct or indirect

Unemployment Insurance (UI) --> (1935)

Of all the social insurance programs we've discussed, the cost of this one goes up and down the most of all. Three tiers of UI: -UI is for up to 26 weeks -Extended benefits - 13 weeks -Temporary emergency federal benefits - (maximum) 99 weeks → and that is 99 weeks total, includes the other 26 + 13 weeks' [States with higher benefits (avg $); Massachusetts, New Jersey, Minnesota; Washington, Connecticut] [States with lower $$ benefits: Arizona, Alabama, Florida, Tennessee, Mississippi[ [Shorter benefits (time on UI): Kansas] [Longer benefits (time on UI): Massachusetts and Montana up to 30 weeks]

When will funding for Disability Insurance (1956) be depleted?

Of all the social insurance trust funds we've discussed in class, the funds for this one will be depleted the soonest, because it costs a lot of money. Estimated to be depleted by 2023.

OASI (1935)

Old Age and Survivor Insurance

In Congress, why were members of the House Ways and Means committee and the Senate Finance committee really pleased to have jurisdiction over Social Security?

Opportunity to win votes - increases in benefits just happened to happen right before congressional elections.

What is the role of the states in Medicare?

Part D - states pay for about ten percent of the drug benefit cost. Before Part D, Medicare was a truly national program.

"Doughnut Hole"

Part of Medicare Part D: -Beneficiary pays 25 percent, Medicare pays 75 percent --> But only up to a certain amount. -First $400 spent is just on the beneficiary to pay, then afterwards Medicare starts to help -Then after that, Medicare will help up to $3,700 -Then after that, the coverage gap kicks in (differs entre brand name and generic drugs) → CG is the time between when Medicare stops helping you when they've spent $3,700 on you and when they start helping you again after you've spent a total of $8,000 (including the 3,700 that Medicare helped out with) -Coverage gap is an issue because it leads to more people not taking their meds and then they end up in the hospital -Then when spending is up to $8,000 Medicare shows up again and beneficiaries only have to pay 5 percent

According to a survey conducted by the National Academy of Social Insurance (NASI), Americans want to make what kinds of changes to Social Security?

People are willing to spend more for SS; believe in more benefits too -most favored changes: Eliminate the cap on earnings taxable Gradually raise payroll taxes Change COLA (cost-of-living adjustments) to be higher for seniors Increase minimum benefit -Not benefit cuts, but change financing Weakness: question wording → likely to give a positive answer on protecting benefits

Describe a long-term demographic trend that made social insurance necessary in the 20th century.

People started living in cities and moving away from tight-knit family communities, so rather than look for support from their small group at home, they looked for help from society as a whole. --> Increased lifespan also made social insurance necessary - dependency ratio gets higher. Older people are living longer and are thus more dependent on their families, except that their families are moving away. boo. --> Also people have fewer kids because they don't need free labor and they don't have as much room in the city

Describe a long-term economic trend that made social insurance necessary in the 20th century.

People used to live off the land (and thus had readily available food sources) but with industrialization there were no ways of providing food outside of buying food at markets, using money to fulfill this basic need. So then when you don't have money to purchase food you fall behind. (Just like in The Jungle)

Nixon's Family Assistance Plan

Plan in 1969 that would have guaranteed a minimum income for poor families.

What are classic liberal values?

Political ideology that values the freedom of individuals — including the freedom of religion, speech, press, assembly, and markets — as well as limited government. It developed in 18th-century Europe and drew on the economic writings of Adam Smith and the growing notion of social progress. --> Individualism

Medicare: Part D

Prescription drug benefit, passed in 2000

What was the Townsend Plan (1933)?

Proposal by Dr. Francis Townsend, during the Great Depression, for an old-age pension. (**The movement in support of this lost steam after Social Security passed.) •Equal in the sense that everyone would get $200 a month, every month, with the age cutoff being 60 •Conditions: have to spend whole $200 every month, recipients must be retired •The idea is that all elderly people get taken care of, and we get a massive stimulus for the economy → Pull people out of labor market (less people vying for limited number of jobs, so more young people are employed) and then make them spend money in the market

What is social insurance?

Provides support for people suffering from economic insecurity "In general, the Social Security Act helps to assure some income to people who cannot earn [ie. public assistance] and to steady the income of millions of wage earners during their working years and in their old age [ie., social insurance]....... The act is a foundation on which we have begun to build security as States and as a people, against the risks which families cannot meet one by one." -SSB, Why Social Security? (1937) "Social insurance rests on the widespread acceptance of the desirability of protecting workers and their families from dramatic losses of economic status brought on by a set of common risks to labor-force participation." -Marmor and Marshaw (2006)

According to Quadagno, the main impediment in the United States to national health insurance in the middle of the 20th century was...?

Shifting interest groups This was because: -In 1930s doctors were v important, but in the mid 20th century not as much -Doctors and the AMA lost power in the '60s, '70s, and '80s, and these new actors came in and were particularly sensitive to the cost of health care: insurance companies, managed care organizations, employment organizations -Mid 20th century health insurance/pharma more powerful

What is one way that some U.S. states have gone beyond the requirements of FMLA?

Some states have extended coverage so that workers receive paid leave.

SMI

Supplemental Medical Insurance. Part of Medicare part B

What is SPM?

Supplemental Poverty Measure - Instead of using a food plan, the SPM poverty thresholds are based on expenditures on FCSU plus a small amount to allow for additional expenses. These thresholds are further adjusted for different family sizes and compositions, housing status, and geographic differences in housing costs

SSI

Supplemental Security Income - a Federal income supplement program funded by general tax revenues (not Social Security taxes): It is designed to help aged, blind, and disabled people, who have little or no income; and. It provides cash to meet basic needs for food, clothing, and shelter.

Name one country that currently offers retirement benefits of equal cash value to many of its citizens.

Switzerland

TANF

Temporary Assistance for Needy Families

FMLA

The Family and Medical Leave Act of 1993 (FMLA) is a United States federal law requiring covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child

Social Security Trust Fund (+ what year will it be depleted)

The Social Security trust funds are financial accounts in the U.S. Treasury. There are two separate Social Security trust funds, the OASI Trust Fund pays retirement and survivors benefits, and the DI Trust Fund pays disability benefits. Will be depleted by 2034. Social Security taxes and other income are deposited in these accounts, and Social Security benefits are paid from them. The only purposes for which these trust funds can be used are to pay benefits and program administrative costs. The Social Security trust funds hold money not needed in the current year to pay benefits and administrative costs and, by law, invest it in special Treasury bonds that are guaranteed by the U.S. Government. A market rate of interest is paid to the trust funds on the bonds they hold, and when those bonds reach maturity or are needed to pay benefits, the Treasury redeems them.

What is the actuarial deficit? (in reference to Social Security)

The difference between what Social Security will need to pay out in the future and the income rate of the Fund right now

Executive Federalism

The idea that the White House can work with states without Congress. Under which presidents and their appointees facilitated transformations in Medicaid without congressional authorization

Delegated Governance

The idea that you are relying heavily on private actors - in some way or another - to implement a program. Ex: relying on potentially dozens of pharmacy companies to run benefits in each states, and competition between them will keep prices down Ex: Medicaid cannot dictate what drug prices are

Federalism

The mixed or compound mode of government, combining a general government (the central or 'federal' government) with regional governments (provincial, state, cantonal, territorial or other sub-unit governments) in a single political system. --> in the U.S, the distribution of power between states and the national government

Why were Steinmo and Watts so sure that the Clinton health plan would be defeated?

This failed because of the filibuster override rule - Clinton and the Dems didn't have the 60 percent necessary to override.

In Social Security, what is the "40 quarters" rule?

This rule helps determine whether someone has worked long enough and earned enough money to qualify for Social Security. They must have worked 40 quarters - ten years.

Summarize the argument (testimony) made in favor of welfare by Greenstein to the CBPP

Welfare has been successful -increase in average income, lower infant mortality, and low child malnutrition -The SPM model, shows more significant decline in poverty rate -since it accounts necessary expenses -Looking forward Increase minimum wage and education Expand EITC to more childless adults Increase subsidized jobs -make businesses more willing to accept jobs 4) Reforming and expanding section 8

Why do some people say the poverty line is too high?

•A lot of poor people are getting a lot of government benefits - these things are not being counted as income so by not capturing this, the government is not getting the whole picture •A lot of the poor get tax refunds - the measure we have of the income of the poor is before tax refunds which is not captured and so they actually have more money than we think

According to Steinmo and Watts, why haven't we successfully established universal healthcare in the U.S?

•A lot of veto points in the system - minorities can block reform because there are so many points where you can stop things from going through •Consider political parties to be institutions, consider political parties and whether there is a lot of party unity, how well they are organized and how well membership is maintained / kept track of - in the U.S. parties are very loosely joined, party candidates can't necessarily count on the support of their whole party •Has this changed over time? •Say that we got Medicare because the timing was right and we had an overwhelming number of democrats in Congress who were able to surmount all the obstacles / hurdles to push it through, not necessarily a sign that we will see similar levels of improvement in the future

According to Esping-Andersen, what is de-commodification?

•De-commodification - occurs when a service is rendered as a matter of right, and when a person can maintain a livelihood without reliance on the market (22) --> strengthens workers and weakens employers --> The process of viewing utilities as an entitlement, rather than as a commodity that must be paid and traded for --> The strength of social entitlements and citizens' degree of immunization from market dependency

Why do some people think that the poverty line is too crude?

•Doesn't capture differences in geography (i.e. it is insane to think that we can set a one-size-fits-all poverty line across the country when we know that it costs much more to live in some places than in others - i.e. Blacksburg v. San Francisco or New York) •The only difference is in Alaska and Hawaii, where food costs are substantially higher since so much food has to be shipped to those places •Severe v. deep poverty •The poverty line makes it difficult to make good comparisons over time - there is more to spend money on now than fifty years ago. The life of a poor person is arguably better now than it was a few decades ago because, for example, poor people usually have indoor plumbing whereas in past years they may not have. Modern conveniences that would have been previously unimaginable

According to Quadagno, why does the U.S. not have universal healthcare?

•FDR feared a big backlash from the AMA and doctors if he tried to include health insurance in the Social Security Act •Key idea that interest groups change over time •Doctors and the AMA lost power in the '60s, '70s, and '80s, and these new actors came in and were particularly sensitive to the cost of health care: insurance companies, managed care organizations, employment organizations •Specific strategies of interest groups: -Powerful feature of the AMA is that geographically they are everywhere •Doctors tend to be local elites - more likely to have contact with members of Congress, thus able to lobby them directly -Try to unseat members of Congress who are pushing national healthcare •Says that we got Medicare through organized labor

Who are the key players in the "Medicaid industrial complex"? (Olson reading) --> these are the groups with the most money in the game

•Nursing home industry •Hospitals (care more financially than doctors and the medical associations) •Hospitals are the most likely to get stuck with uncompensated charity care if Medicaid doesn't exist •Pharmaceutical industries •Drug equipment manufacturers → These people should be trying to prevent cutbacks and blocks in the program, protect (guarantee) reimbursement rates (don't want those reimbursement rates to be cut back)

Briefly describe the typical "social democratic" welfare state

•Tend to see in Scandinavian countries - Sweden, Finland, Denmark •"Our blonde friends who are freezing." -CH •With regard to homogeneity: "You're Sven, I'm Sven, I'll help." -CH •Not an us v. them mentality

Briefly describe the typical conservative / corporatist welfare state.

•Tends to be continental Europe - France, Germany, Austria, Netherlands •Corporatist type as gendered •Programs tend to be based around male-factory-worker model, who has a wife at home. So the design of the program works out so that women are second-class. •Tends to rely pretty heavily on the social insurance model •Have some means-tested programs, but generally rely on social insurance •Conservative in that whatever inequalities workers saw during their career will come back around when they retire •Corporatist in that these programs tend to be decided upon by a small group of business, labor, leaders. •Relative to the liberal welfare states, tend to have less poverty and less inequality

Why was the Townsend Plan a terrible idea?

•The numbers didn't add up •With 2 million people who were eligible, would've needed $29B → at the time, the government revenue as a whole was about $27B (?) •The plan was to raise the money for this via the "transaction tax" --> As goods are being made, as supplies are being bought and sold to make those goods, those things are being taxed → so not a tax on individual people, but a tax on the process itself •This would've elevated the elderly to the top tier of the income distribution - would've put them in the top 15 percent of the 1930s •Would've created pretty sizeable generational inequity •In Chris's words, the plan was, "...too bloody generous, and too bloody huge." --> **this type of plan works in a few other countries on a more modest scale

Why do some people say the poverty line is too low?

•We don't spend a third of our incomes on food anymore - that number is super out of date. For most people, food is about 1/6 of the average person's budget. •The "thrifty food budget" was never supposed to be used as a sustainable food budget, it was supposed to be used as an emergency food budget, like if you absolutely had to you could live on that budget for about two months or so, but it is sub-ideal. You could technically survive but it would be really tough to make that work - about $1.50 per meal •The problem with this measure is that it doesn't capture the fact that you have to spend money to make money - doesn't appreciate that people have other places where they need to spend their money (i.e. transportation to get to work, buying a uniform or otherwise necessary clothing or shoes for work, paying for childcare while you are at work)

Briefly describe the classic "liberal" / residual welfare state.

•i.e. Australia, Canada, U.S, New Zealand •Tend to have smaller welfare states, but their goal is to 'catch the losers' in the market •Expect that people will first and foremost take care of themselves through work •Examples in this category tend to be Anglo-Saxon former British colonies