America needs to build a railing for its people to hold onto in crisis, from infancy to old age. A support system can’t remove the hazards of life, but it can prevent peoplefrom having to fall all the way into poverty before they get help.
The railing would not be a “womb-to-tomb” welfare state but a support structure. It can’t--and shouldn’t--be built by government alone; it must involve all areas of American society, public and private, personal and institutional. To be comprehensive, it should have the following elements:
* Provide babies with a healthy start in life and nurture children’s development to maturity. A national children’s trust fund would complement the Social Security trust fund. Because children can’t contribute payroll taxes, revenues could come from a small surtax on the estates of the wealthiest Americans--an “inheritance” for all children.
The children’s trust fund would ensure that every mother-to-be receives comprehensive nutrition and prenatal care; it would enhance child development programs in day-care centers and schools and provide health care to all children.
* Buttress families’ ability to provide a secure and nurturing environment. No government agency should be allowed to force families to split up or “spend down” to poverty before receiving health care. This part of the railing must also include job training for dislocated workers, counseling for people suffering other life crises and a national system that requires absent working parents to pay child support or face federal penalties.
* Provide a minimum level of health insurance for everyone. This would cover prevention, regular checkups, hospitalization, in-home assistance and hospice care, as proposed by the Clinton plan.
Scarce health-care resources must be allocated where they do the most good. For example, hospice care, which allows terminal patients to die at home, costs a fraction of the cost of keeping such patients “alive” with futile treatments and life-support systems.
* Upgrade Social Security and ensure that it remains solvent for future generations. This is the only part of the “railing” already in place. It is America’s most successful social program, most effective in alleviating poverty. The challenge is to reform it without destroying it, to make the system more equitable for women, especially homemakers whose benefits as widows now consign them to poverty.
A balanced society allocates resources with an emphasis on children, on the assumption that prevention can reduce problems later. It also upholds the ideal that public institutions exist to help people when they encounter difficulty passing through the milestones of life--not to punish them.
Underlying this approach is the basic connection between Americans: We all share life’s journey. While each individual is unique, the stages of human development are universal. All people are vulnerable as they pass through the difficult transitions of infancy, childhood, adolescence, adulthood, aging and dying. At one time or other, everyone needs help along the way.
The annual cost of added programs for child and family support and health care would be between $15 billion and $60 billion, depending on whose figures you use. (The top figure is roughly what Americans spend annually on tobacco, toiletries and haircuts.) Preventive programs reduce suffering and save taxpayers’ money. Surely the support railing is an important social asset, not a luxury.
America has the financial and social resources to begin building this railing, if we move step by step. Completing the railing will require national leadership and sustained commitment. But the risks of not building it far outweigh the costs. The dangers of pushing more people over the edge are clearly visible as our economy falters, our public institutions disintegrate and our family structure breaks apart.
The stairs are steep and perilous. At the bottom lurks despair that nothing can be done. At the top lies hope, not of easy solutions, but of difficult choices. The risk of failing is outweighed by the danger of standing helplessly while more people fall. All journeys begin by taking a first step.