Private Philanthropy and Public Welfare

...In this connection, Frankel pointed out that one of the chief justifications of our system of decentralized capitalist competition is that it encourages invention and innovation...

...asked Frankel...

...Muller's message for those concerned with health and welfare is that the time is not far off, thanks to modern medical science, when man will be devoting a madly disproportionate amount of his resources and energies to support a community overpopulated with those not pulling their weight...

...Alfred de Grazia and Ted Gurr in their recent book, American Welfare (New York University Press), try to measure it...

...where the father, the man who produced this child, this human being, doesn't exist...

...Liberals and conservatives frequently can define their differences in terms of their attitude toward this basic development...

...Now, these immense contemporary pressures for improvement in health and welfare programs threaten our unique system of private voluntary support because such pressures call for greater efficiency...

...The practical lesson that emerges from Cloward and Ohlin on how we beat this situation is neither novel nor simple...

...But de Grazia and Gurr provide a salutary balance to Carter's rather euphoric study by conceding that a good deal of this frenetic do-good activity is "bootless...

...The two are inextricably fused...

...Several recent books, one likely destined to be a classic in its field, help clarify the ferment in health and welfare...

...It is they who "assuage the assaults of conscience" for all of us—they, abetted by Carter's "gentle legions" of responsible citizens...

...Not only are the 8.2 billion dollars in private philanthropic giving in large measure women's work (incidentally, fourfifths of the total amount comes from some fifty-eight million taxpayers, not from corporations and foundations), but there is a hard-to-measure nonmonetary contribution, too...

...Let's imagine a man who refuses to go on a regular regimen of physical exercise and decent diet that his doctor prescribes for him...

...After his book appeared Horwitz was asked to testify before the New York State Legislature's Subcommittee on Public Welfare, which concerned itself with the whole public assistance program...

...Hamlin's charges—termed "appallingly baseless" by National (Polio) Foundation president Basil O'Connor, a man second to none in suffering criticism ungladly—include characterization of veterans' organizations as the worst offender, criticism of poor staffing and self-centered jealousies, criticism of inadequate consolidation of operations, and claims that so-called educational activities are in fact not educational but fund raising...

...it is the group's solution for unjust deprivations ("unjust" because qualified people are rejected) that arise from the fact of the discrepancy between the numbers who compete for opportunities and the relatively limited supply of op portunities for those who are disadvantaged from the start—poor motivations, insufficient education, no social sophistication, deficient parental guidance, poor inner discipline resulting from demoralization...

...Medicated survival" is his wry term for our accomplishments in forestalling death...

...Clearly there, is a desperate need for workers with Horwitz's devotion...

...Hamlin's anxieties about complacency are widely shared among the most thoughtful observers of health and welfare...

...Hamlin's most telling, if anticipated, disclosure is that more than half of the $292,000,000...

...What happens...

...The problems arising in health and welfare are not susceptible to resolution through any one avenue, any ingenious shortcut...

...It is Frankel's paradox that the health and welfare problems of today and tomorrow are the creatures of our social yearnings for progress in the immediate past...

...A fascinating study has recently been published by two sociologists, Richard A. Cloward and Lloyd E. Ohlin, that does more to clarify why "the system" produces delinquency than anything else I have encountered...

...The brilliant address by philosopher Charles Frankel of Columbia at the National Conference of Social Workers this year bore directly on this point...

...What has overwhelmed Horwitz as a man of profound compassion and sensibility is the disparity between the formal excellence of the law and its intent and the actual way people are allowed to exist...

...for example, illness is now the greatest single threat to economic security...

...Health and welfare matters, to such a large degree voluntary, are overorganized and yet in a state of confusion...

...Roberts has concerned himself (in The Cost of Health) with the economic criteria for the distribution of health resources...

...He is vastly impatient with the mechanics...

...He believes the smaller ones should be combined into a single chapter...

...Robert H. Hamlin of the Harvard School of Public Health...

...The seemingly irreversible world trend toward rationalizing activities is currently being reflected in the United States in everything from regional planning of hospitals to the United Fund movement...

...When questioned as to whether he had any criticism of this program, Horwitz answered no...

...The older case-worker today is beginning to encounter successive generations of dependents, a new kind of parasitic subculture wherein the illegitimate offspring of unwed or deserted mothers on relief inexorably repeat the parental precedent...

...Probably no areas in the cold war are more sensitive than health and welfare...

...It is that widespread and fundamental economic, political, and social reforms are the only answer, that there are no short-cuts, and that individual psychological therapy is inexpedient and unavailing...

...But now, as the population boom accelerates and resources become strained, increased spending on health and welfare can be justified on moral and humanitarian grounds alone...

...Obviously because we haven't yet put this extraordinary opulence to work that we can respect...

...Why, then, are we so apologetic about our wealth, so worried about our alleged materialism...

...Dr...

...The notorious Reichs Institute dealt with the genetically unfit by dispensing fatal doses of barbiturates...

...How we could manage without their ministrations is a puzzle, unless total takeover by the state is considered an acceptable solution...

...He classifies disease as either "proplutic," wherein the cure is economically justified since it restores the patient as a functioning member of society...

...Horwitz has a touching faith in what can be accomplished by compassionate people, especially caseworkers, who will be concerned...

...Americans do this, he said, because they mistakenly believe that in this manner they will preserve individual initiative and liberty, whereas the exact opposite is true...

...The decrease in mortality rates and increase in morbidity are a prominent theme in the Somers' book, too, in which the authors, like Frankel, identify this trend as a fundamental source of disruption in the organization of .health and medical care...

...dependency] doesn't require, as some people suggest, to use language easily, 'massive rehabilitation,' knocking down this, pushing that over, sending in 'task forces.' Because just like an army in the field, if there is no ammunition in the infantryman's gun, he is helpless...

...He offered this analogy to explain his somewhat paradoxical notion...

...Thus we treat the migration into cities of the colored and disadvantaged from rural areas—a root source of so many of the problems in health and welfare—as an accident (though it has been under way for 150 years), instead of planning permanent agencies to prevent the problems—for example, institutions, with a status equal to our schools, for the re-training and relocation of these individuals...

...A brilliant, if at times eccentric, elaboration of this point is made by Paul Goodman in his recent book, Growing Up Absurd (Random House...

...where their whole vision of life is' public assistance...

...Generosity and the private sacrifices of millions do not in themselves assure effective programs...

...If I were to establish a purpose for the book [The Inhabitants] I would say that the purpose was to recreate this peculiar world that I observed working for the Department and to make this world have meaning for people who never enter it...

...He is concerned, nevertheless, over lack of proper accounting systems and over the inefficiencies inherent in such a multiplicity of small local affiliated societies—more than 100,000 of them...

...Muller's concern for man to exercise discrimination in procreation is of a different order of thought...

...As a result the doctor comes to his house every week—he intervenes in the man's life—the fellow feels he has no freedom at all—the doctor's always around—and all the medical bills are very high...

...Indeed, perhaps Dr...

...Americans are now giving, in contributions and taxes, one tenth of the gross national product in support of private and public philanthropic works and social welfare programs, according to the findings of the National Bureau of Economic Research...

...It highlights any deficiencies in our public services...

...Much of the dissatisfaction over our handling of health and welfare reflects our affluence: America's very wealth dramatizes our increased capacity to cope more effectively with social problems...

...But for all its virtue, it is this voluntary aspect that also largely explains the incessant bickering, confusion, and anxiety that increasingly characterize health and welfare fields...

...Indeed there is evidence that monies and energies are being badly wasted and the public is often misled, according to a just-released study on the national voluntary health organizations by a twenty-one-man ad hoc committee of the Rockefeller Foundation directed by Dr...

...Called Delinqency and Opportunity: A Theory of Delinquent Gangs (Free Press), the Cloward-Ohlin analysis impressively demonstrates that the underlying cause of juvenile delinquency is to be found in the discrepancy between our asserted system of equal opportunity for all and the harsh realities of unequal opportunity, most manifest in the case of Negroes...

...American health and welfare activities suffer from this same deficiency, with resultant mounting costs and a hodgepodge of meddlesome governmental interventions, Frankel said...

...EDWARD T. CHASE has written on social problems for many American publications, including Harper's, The Atlantic, Commentary, and The Reporter...

...collected by fifty-six major national voluntary health and welfare agencies went, not into action programs, but into fund raising, organizational expenses, and "education...

...This, in an age of science, inevitably leads to technological unemployment...

...He doesn't take any planned program, or planned approach to the problem of maintaining his health...

...The difference lies in the extraordinary degree of voluntarism in our health and welfare services...

...Most conservatives and liberals alike will agree that either Americans solve such problems as medical care for the elderly, urban slums, juvenile delinquency, and a new kind of dependency leading to parasitism deriving from such causes as structural unemployment, illness, family breakdown, and ignorance— or putting an American on the moon first will be starkly irrelevant...

...or "antiplutic," wherein society remains burdened .despite treatment because the disease is of old age or of children with congenital'defects—the very success of the treatment exacerbates the cost to'- society...

...Americans are unsure both of what should be done and who should do it...

...Efficiency, however, requires a rationalization of resources...

...Its merit lies in the thoroughness with which it reviews every project, institution, and program of interest in health care and the comprehensiveness with which it surveys the vast current literature and tackles each substantial issue...

...In recent years philanthropic spending has grown faster than both personal income and population, while the purchasing power of the dollar has declined...

...The ammunition is dedication and sympathy...

...The more one ponders the problems and the literature, the more one must agree with the thesis of Professor Frankel, that the government undertake preventive social planning on the vast scale commensurate with the problems suddenly upon us...

...There would appear to be no room for complacency...

...It is the price we pay for our success, the inevitable defect that goes with our virtue," and hence our response must be deliberate planning, not shortrange, patchwork expedients to an "emergency," for these don't work...

...They now do for the first time what Moses proposed in 1300 B. C. That is, they tithe...

...It's difficult to shock in a city like New York...

...No other society today has a better chance to demonstrate what the possibilities for human well-being might be," said Frankel, but we falter in this task and are creating a world-wide "image which has made millions abroad associate us with the past rather than with the future...

...Hamlin does not make sensational claims of fraud...

...they are costly and augment rather than diminish the "government interference" Americans fear...

...They fortify each other's contempt for the conventional world...

...It would also assure that more specific information is made available to the public on actual programs, what the real purposes of agencies are, and how funds are being used—-information of a kind too often hard to get now...

...Frankel then proceeded to clarify Secretary Ribicoff's comment that America was simply drifting in health and welfare...

...Excessive jLnterference in the life of the individual by the authority is actually a concomitant of the ad hoc approach and lack of social planning, Frankel claimed...

...If you walk into some of the buildings I go to—I have one building where every girl over thirteen has had one baby, some have started on their second, some have already aborted a second...

...It [delinquency...

...It is no criticism of the book to remark that for one reader, at least, among its most provocative contributions are the perceptive quotations from its sources, some of which are difficult or virtually impossible to come by...

...Private Philanthropy and Public Welfare by Edward T. Chase THERE is at least one key difference between the approach, "of the United States toward the care of its troubled and .victimized and that of the rest of the advanced nations of this welfare-state world...

...He accords to the united fund movement just one accomplishment: it has corrected the abuse of over-lapping multiple solicitations in factories and offices...

...Muller thus calls for a revolution in world mores whereby somehow man can face up to the need for selectivity in reproduction and devise means to achieve it...

...There is another pressure causing uneasiness: the cold war, which creates a pressure to excel, or at least to present a persuasive example for the rest of the world of how we, as a society, resolve social problems...

...I was hoping that the book would be able to shock the community...

...Hamlin...

...He has no reality in this world...

...It is expressed both by the extent to which key services are financed and performed by private individuals and by the extent to which responsibility is left to myriad local autonomies...

...He demonstrated that the root trouble was that instead of deliberately constructing permanent institutions for preventing social problems, we have persisted in dealing with them on an "ad hoc, retrospective" basis, always from the therapeutic and remedial viewpoint, as if they were "accidents," like an act of crime...

...Historically, up .to now, expenditures for medical care and welfare have been rationalized as money savers since they have increased productivity;, it is well established that this explains the motivations for the alleged altruists among the reformminded English industrialists of the late Eighteenth and Nineteenth Centuries...

...Hermann J. Muller, the Nobel prize geneticist (writing in Daedalus, summer 1961 issue, and in the Dartmouth College conference report, The Great Issues of Conscience in Modern Medicine...

...This is no longer true and the devil of it, according to Muller, is that those with superior intelligence and character reproduce themselves the least, while those who are shiftless, superstitious, dull, and irresponsible reproduce themselves the most...

...On the contrary...

...The speculations that Muller's contentions give rise to can be scary in the extreme...

...Where Goodman differs fundamentally with Frankel, who in essence is advocating adding institutions to, rather than condemning, our existing order is in suggesting that our whole system is cockeyed, with juvenile delinquency perhaps the most dramatic sign...

...Until now matters have been tolerable since the defectives usually have died or, because of their condition, have not reproduced...

...What is essential is "sound social planning" if we are to avoid over-centralization since the true purpose of such planning is "to simplify, to rationalize— to provide a stable set of alternatives in which individuals are freer to act...

...So, far from being an example of a welfare problem caused by our society's malfunctioning, technological unemployment must be viewed as evidence our system is doing well, Frankel contended...

...If those concerned with progress in welfare, are overwhelmed with the magnitude of this task, requiring as it does a sustained, multi-faced assault from every quarter in order to effect reforms on the necessary scale, then they might lose heart altogether if they ponder the dismal prospects advanced by the Somers' book and by Dr...

...Alienated as they are, with no loyalties to conventional society, they are quite free from guilt in breaking the rules of the world of squares...

...In any society, and particularly in a rich one, men need a sense that there are large projects under way...

...The phenomenon of decreasing mortality rates and increasing morbidity because more of the elderly live on into advanced age is but one aspect of this...

...If this seems somewhat speculative, it is all too concrete a problem for the welfare caseworker assigned, for example, tc our city "ghettos for psychopaths," wherein the so-called multiproblem families exist...

...On the other hand, he goes overboard for the national health agencies, such as The American Cancer Society, The National Tuberculosis Association, The American Heart Association, The American Red Cross, and others, on two grounds: they are democratically responsive (as opposed to what he terms the "big brother" approach of the united funders, which he resents as autocratic, impersonal and bureaucratic), and they are "the fullest exercise of authentic voluntarism...

...But can they be...

...The best of them, Doctors, Patients and Health Insurance by the husband-wife writing team of Herman M. and Anne R. Somers (Brookings Institution) is a tremendous accomplishment...

...There is almost nothing you can think of, no condition of life, that can't be met by public assistance," Horwitz testified, going on to say that, because of this, for the newly arrived Puerto Ricans the system is viewed as something magical...

...Such government regulation would not only help the agencies perform more efficiently, says Dr...

...No less a figure than Department of Health, Education, and Welfare Secretary Abraham A; Ribicoff stated recently at the National Conference of Social Workers that "the nation is just drifting in the welfare field" and that a whole new approach is needed...

...One of these is The Gentle Legions by Richard Carter (Doubleday), an elegantly professional writing job by a bright and knowledgeable journalist bent on getting to the bottom of the united fund-national health organization row...

...It was precisely this kind of development—rationalizing the use of resources—that produced the British National Health Service...

...It is refreshing to encounter Carter's spirited reminder of how much essential social work is achieved by the "gentle legions," as he calls them, of women doing voluntary social work...

...Delinquency happens to take the gang form under conditions such as our vast urban slums where large numbers are alienated and seek a collective response to their rebuff...

...Similarly, child labor laws, admirable accomplishments of an earlier era, now must be modified, suggested Frankel, because all too often the curse of modern American youth is that they cannot find any useful work...

...One is reminded (explicitly by the Somers) of Hitler's race purification program...

...It's as though the baby was brought about by artificial insemination...

...Carter manages to make this tiresome but significant controversy meaningful by the richness of his concrete detail about the principal health organizations and their fund-raising drives and by the intelligence of his defense of these independent health agencies as against the local united fund approach...

...They show that lower class gang delinquency is "normal" behavior...

...Soon we will discover there is no other choice...

...They give a "book value" of $3.5 billion to the annual unpaid public activity in America devoted to welfare by about four million private individuals...

...The Somers introduce their discussion by referring to the writings of the British physician Ffrangcon Roberts...

...He contends that the Federal government should supervise the voluntary agencies to ensure standardized accounting systems...

...Yet it is not that Americans do not care...

...But this does not resolve the coming dilemma posed by the Somers and by Professor Muller...

...A negative feedback from culture to genetics has now set in," he writes, because science is preserving into their reproductive years persons with detrimental genes...

...One consequence of this is that there are major studies under way fearfully weighing the survival chances of voluntary philanthropy...

...They are employed by the authors to raise fundamental questions about social justice, allocation of limited resources, genetic deterioration, and over-population—the great issues that are destined to haunt health and welfare in the all-too-near future...

...The underlying theme of the book is the trend toward institutionalized care, with the doctor but one member of a coordinated health care team, and the conflicts and hostilities engendered by this trend...

...The problem they pose is that modern science has reached the point where its benefactions, in the form of preserving lives, are now for the first time uneconomic in the fullest sense of the word...

...And the countrywide debate over Newburgh's (New York) "get tough" welfare policy has disclosed profound public ignorance and a melange of conflicting views and atitagonisms...

...By Muller's calculations about twenty per cent of the human race, or every fifth individual, carries a detrimental gene that occurred in the preceding generation...

...Hamlin's disenchantment with the voluntary agencies prompted him t6 tell me that he felt Carter's book "dangerous, because it promotes complaceny in the agencies...

...For the first time, Americans topped the eight billion dollar mark in private giving last year—$8.2 compared to $7.8 in 1959 and $7.1 in 1958...

...These issues will be more comprehensible if approached after first considering points developed in other recent studies...

...Leisure, hitherto a coveted ideal, becomes a burden for the burgeoning population of the old, now denied a role in the work force and blessed with longevity but cursed with ever-increasing morbidity—non-fatal chronic afflictions...

...We don't have to be told what causes delinquency," he testified at another point...

...Perhaps the most graphic documentation of this appears in a novel entitled The Inhabitants (World Publishing Company) by a social investigator for New York City's Department of Welfare, Julius Horwitz, Horwitz has undergone the devastating experience of working for years in the upper west side of Manhattan...

...Rationalization always leads to the institutionalizing of services, which leads to central planning, with the inevitable turn to government, particularly the national government...