Marta Russell
In his
"new" fight against poverty, Republican presidential candidate George
W. Bush says he will issue a call to America’s "armies of compassion"
to end poverty, hunger, welfare and crime by donating to charity. The political
goal of compassionate conservatism is to separate George W. from the now
unpopular politics of Newt Gingrich. But W.’s compassionate conservatism is just
a cold Contract on America warmed over.
Gingrich,
for instance, preached "we must replace the welfare state" with a
"strategy of dramatically increasing private charities." It was
Gingrich who idolized author Gertrude Himmelfarb (The De-Moralization of
Society) who advocated that the deserving poor should receive goods like socks
in place of welfare aid. And it was the Contract (Personal Responsibility and
Work Opportunity Act of 1996), which ended poor people’s entitlement to public
assistance and severed approximately 300,000 children with disabilities from
Supplemental Security Income and Medicaid.
George W.
has already been using the armies of compassion in his home state of Texas – a
state known for having the largest percentage of uninsured and the largest
incarceration rate in the country. Gov. Bush has the dubious distinction of
having signed the most death warrants for public execution of prisoners than any
other governor. Since Texas is a state with no income tax, social services are
paid for with charity golf tournaments, telethons, and fund drives. When
charities don’t raise enough to cover the need, one gets to join the more than
20,000 people who are already on the waiting lists for services there.
What is
less known is that Texas has more children living in nursing homes than in any
other state. In an era where independent living has been a goal of the
disability rights movement, this matter of institutional bias in Texas has
people with disabilities (PWDs) rightly alarmed at the prospect of W. making it
to the White House. The disability rights movement considers
institutionalization a type of wrongful incarceration, and instead advocates
that community-based, in home, self-directed personal support services, which
are now optional through Medicaid, be made mandatory in every state. The most
severely disabled individuals are found on these front lines. Their motto
"we’d rather die than go into a nursing home."
Ironically,
this movement is about being safe from the care-giving industry. Consumer
Reports, for instance, conducted an investigation of nursing homes which
concluded that nursing "homes" range from inadequate to scandalous. It
reported that about 40 percent of all facilities certified by the Health Care
Financing Administration (part of U.S. Health and Human Services) have
repeatedly violated federal standards, including critical aspects of patient
care standards. The Los Angeles Times reported on a California study which
showed that nearly 22,000 nursing home inmates died from preventable conditions
such as malnutrition, dehydration and urinary tract infections between 1986 and
1993. The California Advocates for Nursing Home Reform reported in 1995 that
29,652 residents were physically restrained, another 32,103 were administered
psychotropic medications, and chemical restraint use jumped 12 percent over
1994. These documented violations directly resulted in 19 deaths and indirectly
in another 45 deaths.
Even so
public policy remains aligned with institutions. 1970s government adjustments to
the Social Security Act mandates states to provide nursing home care as an
entitlement but allows in home support services to remain optional under
Medicaid. This bias in favor of institutionalization results in a patchy system
where some states provide in home service programs while others do not, some
grossly underfund theirs and some limit the number of people served. With no
national entitlement, disabled people’s freedom is at risk because in home
support programs are subject to the yearly budget ax. The calculating nursing
home industrial complex has steered public policies towards institutionalization
and away from citizen-controlled home-based care because institutionalization is
profitable for them. Gov. Bush is a benefactor of nursing home support and
(surprise!) he has supported institutionalization of PWDs in for-profit nursing
homes and state institutions over providing quality in-home care. Ideologically,
it is in sync that George W. sides with profiteering nursing homes over in home
care that would be directed by disabled persons or that he endorses charity over
public entitlement to services. In both matters W. has sided with the interests
of capital. Bush tops all opponents in money raised($50 million) from commercial
banks, securities & investment, insurance, real estate, and health
professionals for good reason.
Disablement
is big business and it is a part of the political economy. Under what I call the
Money Model of Disability, the disabled human being is a commodity around which
social policies are created or rejected based on their market value. The
corporate solution to disablement – institutionalization in a nursing home –
evolved from the cold realization that PWDs could be commodified; we could be
made to serve profit because federal financing (Medicaid funds 60 percent,
Medicare 15 percent, private insurance 25 percent) guarantees an endless source
of entrepreneurial revenue.
In the
macro economy "unproductive" people with disabilities have been made
of use to the capitalist order. When one individual generates $30,000 – $82,000
in annual revenues for nursing home corporations the electronic brokers on Wall
Street count that person as an asset, PWDs contribute to companies’ net worth.
Corporate dominion over disability policy measures a person’s "worth"
by their dollar value to the economy and PWDs are worth more to the Gross
Domestic Product when occupying a bed in one of these institutions instead of a
home.
W. told
the press that if elected, he will dedicate $8 billion during his first year in
the White House for tax credits and grants as part of what he calls "a bold
new approach" to governing … enlisting charities and religious
organizations to deliver social services. Specifically he would expand the
federal charitable deduction to taxpayers who do not itemize, permit a credit
against state taxes for contributions to charities addressing poverty, raise the
cap on corporate charitable deductions from 10% to 15% of a company’s taxable
income. But what he is proposing is to further serve the financial interests of
the same old bastions of elite power and privilege.
Nonprofits
and charities create an illusion that they are mending the holes in our social
fabric. By donating tax deductible dollars, the rich appear to be generously
concerned about the plight of the poor. However behind the benevolent front
there is an enormous hoarding of wealth. Left Business Observer editor Doug
Henwood says "in economic terms, the larger nonprofits could be thought of
as giant stock portfolios, often with marketing operations grafted on." For
instance, in 1995, the nonprofits held assets $1.2 trillion, of which $414
billion (or 35%) is in bonds, and $295 billion (25%) is in stocks. Henwood
concludes "the nonprofits have a significant impact on Wall Street."
Jerry
Lewis understands the Wall street connection. When Evan Kemp, then head of the
E.E.O.C, criticized the Muscular Dystrophy Association, Lewis told George W.’s
father, then President Bush to "act to protect and preserve the invaluable
American private-sector institution. . .with a categorical disavowal of Mr.
Kemp’s assault on MDA"; the sacrosanct MDA private charity business
complete with its financial portfolios and real estate holdings.
Nonprofits
are managed independently, primarily by the wealthy elite, and they do not pay
income taxes. In 1997 the total revenues of Operating Public Charities in the
United States was $649 billion, about 12% of the GDP, none of which was taxed.
Roughly one third of every dollar donated is subsidized by the federal
government. That means public revenue which could be going to the public’s
welfare is lost to nonprofits. For example, Gregory Colvin, an attorney
specializing in tax law calculated that "the $1.5 million raised and spent
through the Kennesaw State College Foundation… could translate into a Treasury
loss of about $500,000 in tax savings by Gingrich’s donors." By giving
other tax breaks and government dollars to charity, W. will be steering money
from democratic entitlements into the hands of charity portfolio managers.
In
addition nonprofits often serve as suppliers of services to the middle and
upper-class in echo of the old conservative mantra of tax credits for charitable
donations – such a credit benefiting wealthy donors rather than nonprofits
themselves. The Kennsaw State College Foundation, for example, had nothing to do
with serving underprivileged populations, rather it was a forum for Gingrich to
spread his politcs. Country clubs are often formed as nonprofits, but they cater
mainly to the upper class’s luxurious lifestyles.
In this
light George W’s proposal is questionable, because giving is a negligible
revenue source in social service (20%), education (15%) and health care (5%) as
compared to, say arts (50%). Moreover, most individual giving in the US
concentrates in religion (approximately 60% of all charitable giving in the US).
Yet W. plans to establish an "Office of Faith-Based Action" in the
Executive Office of the President and to expand "Charitable Choice" to
all federal social service programs, allowing religious organizations to be
eligible for funding on the same basis as any other provider, without impairing
their religious character. Further, he intends to provide federal matching funds
for the establishment of state offices of faith-based action.
W’s idea
of subsituting grants for entitlements is not "new". Reagan had
ambitions of turning the welfare system into grants to local groups dedicated to
self-help for the poor. Gingrich tried to undo federal entitlements by turning
Medicaid into state block grants with no strings attached as to how the money
could be spent. One can guess, the amount spent in this "new" system
would not be likely to equal the previous amount under a Federal entitlement.
The main
disadvantage to service recipients of the nonprofit approach, sometimes referred
to as "mellow weakness" (Seibel, W., 1989, The function of mellow
weakness: nonprofit organizations as problem nonsolvers in Germany, in James,
(ed), The Nonprofit Sector in International Perspective, Oxford) is that
nonprofits are often used as a smokescreen for government agencies to discharge
its public responsibilities while creating an appearance that something is being
done. That is, instead of a well-funded and comprehensiove program to solve a
social problem, governments often dole out money to nonprofits to merely tackle
it.
Of
significance to the future of in home support services, W. says he will promote
alternative licensing regimes that recognize religious training as an
alternative form of qualification for delivery of non-medical social services.
Attendant services, which assist PWDs with cooking, dressing, transferring from
bed into a wheelchair, are non medical services. The upshot of George W. getting
elected in Y2000? Prepare yourselves to GO TO CHURCH TO GET AN ATTENDANT! No
matter that no one is entitled to receive any service from a charity, much less
service that is timely or competent. Under W.’s leadership, it is likely that
more PWDs will end up in nursing homes.
Serving up
charity as the answer to social ills is not singularly a GOP tact. Liberals,
seemingly ignorant on economic justice, have historically embraced the charity
paradigm. Neoliberal President Clinton advocated a greater role for charitable
organizations during welfare reform. He urged each of the 135,000 churches,
synagogues and mosques that have more than 200 members to hire one person coming
off welfare. Three years later studies show that welfare reform has done nothing
to reduce poverty for women and children; to the contrary, indicators are that
it has increased it. Presidential candidate Al Gore joined with traditionally
Republican territory in May when he said America must "dare to
embrace" religious programs and called for a "new partnership"
between church and state.
The
reality is that neither the "armies of compassion" nor neoliberal
"volunteerism" will be a real solution. At best, charities postpone
societal questions about economic equality. At worst, charities serve as
self-serving tax shields and allow right-wing ideologues to assault the
"socialist" safety net while disingenuously claiming that private
charities will pick up the pieces. In the process the U.S. Treasury is robbed of
dollars that could be put to entitlement programs. Charity is nothing less than
an attempt to justify capitalism’s inherent injustices which makes it a
euphemism for economic oppression. Until economic justice can be fully realized,
the public wealth must be distributed more responsibly and a democratic
government must be held to the task.