Tales from the Welfare Jungle in the Good Ol' USA

Australia is fascinated by America. Our culture is saturated with the images of US products and popular culture – think Nike, Coke, McDonalds…Like the rest of the world we scoff their fast food, pay high prices to wear their fashions and pay squillions to wear the state of the art running shoes. Old and young alike avidly watch US TV shows which range from the witty and creative to the mind-blowingly appalling (nominating examples would only embroil me in a distracting controversy). It was the Australian obsession with all things American that drew me to apply for funds to study in the US. I was an Americanite. I loved the movies, the TV, the books, the clothes, the food, the sport, the comics. In a fit of Yankee enthusiasm I even learned the rules of Gridiron and taught myself to throw a spiral pass.

But it was more than popular culture that brought me here. I had seen the pervasive American influence begin to affect politics as well as food and fashion. This influence was much more sinister and insidious than even bad television. As a volunteer at a legal clinic for homeless and disadvantaged young people I had watched political leaders increasingly flirt with ideas like "zero tolerance" and "the war on drugs". With more alarm I had begun to see the practices of US police being implemented by stealth in New South Wales, my state, with predictably dire consequences for the young, the poor, the indigenous and the ethnic minorities. It was this American influence that I decided to take a closer look at during my year abroad.

When I told my friends I was off for a year at an Ivy League university I could see them picturing me sauntering through beautiful gothic buildings, reading great books and engaging in fascinating exchanges of ideas with brilliant professors and students in lecture halls and coffee lounges. I don’t think anyone (especially me) envisioned me wrestling a hysterical, screaming autistic 9 year old splashed with blood to the floor whilst simultaneously trying to restrain his agitated mother from attacking the nurse desperately trying to collect a sample of blood before it hit the floor. Yet that is how I spent my morning. The experience of this morning, and especially of the family I was trying to help this morning, has crystallized many of the feelings I have had about the dangers of American influence since I arrived here.

Don’t get me wrong, America is a great place, an exciting and fascinating country, a land of opportunity and ideas, of wealth and creativity and of natural beauty and human warmth and kindness. It is a land where I have met many passionate and effective advocates for social justice and change. It is a place where I have spent many happy hours strolling in ivy covered grounds and indeed engaging in those eagerly anticipated intellectual debates. But it is also a nation suffering from tremendous contradictions. The US invented incarceration as a humane alternative to the British use of hanging, whipping and other cruel and unusual punishments. Yet just this week, in the country of individual rights, a state legislature declared that prisoners are not "persons" for the purposes of human rights protection in response to reports of systemic sexual assaults by guards of female prisoners. Reports also emerged this week that homelessness was on the increase in the richest nation in the world. At a time when the US has never been more confident in its place in the world, and of its authority to set moral norms for all other nations, the country seems blissfully ignorant of the fact that its wealth and standing has done little to prevent an inhumane atmosphere where routine abuses of human rights are directed towards the poor, the homeless, the imprisoned, the sick and disabled, the black, hispanic and indigenous populations, and many others without money or a powerful voice.

We should certainly look to the US and what it has to offer in opportunity, theory, ideas and programs. I for one will be proselytizing on my return for the adoption of many American advances in legal education and university based legal services for the poor. But we should always regard political references to the "American" approach with caution, even suspicion. This great nation does some terrible things to its own people.

You probably have heard all this before, I am certainly not the first to observe that the US offers much of both the best and worst of the human condition, so enough grim rhetoric. Let me provide some examples, actually just one example, a client with whom I have been working through my school’s legal services program (a fantastic US led initiative).

Denise Washington is a black woman in her forties. She has three children who suffer from a variety of medical issues including autism, serious behavioral problems and asthma. Ms Washington has been a long-time client of the legal clinic for a number of reasons. At one time her house burned down. Homeless, she and her children were evicted from a shelter after a dispute and her children were taken from her by the Department of Children and Family Services (DCF). A long attempt to regain the children was jeopardized when she appeared at a local hospital asking for counseling - she was extremely stressed and feared that she might take drugs. Instead of receiving counseling Ms Washington was reported to DCF who raised the incident during the neglect case. I took over Denise Washington’s case when the Department of Social Services (DSS) threatened to discontinue her welfare benefits. The reason given was that she had failed to comply with a number of "work for welfare" requirements.

How does the welfare system in the US work? It must first be understood that while there are some limited ways to receive compensation if you become unemployed, there is no general entitlement to unemployment benefits. Cash benefits are granted only to impoverished single mothers with children (benefits known as TANF – Temporary Assistance to Needy Families) and to people who are so profoundly disabled that they are unable to work at all (benefits known as SSI). Occasionally people outside these categories are entitled to food stamps, a benefit which can only be used to purchase basic groceries. The standard food stamp allocation is $2.00 per person per day.

Presumably the political justification for family benefits is that whatever the fault of the parents in failing to succeed in the land of opportunity, one cannot punish the children. But every effort is made to ensure that welfare recipients do not exploit their entitlement and fall into idleness. Thus, since Bill Clinton’s famous "welfare reforms", family benefits are time limited. The only way to obtain an extension of benefits past the 21 month limit is to establish that you have made "good faith efforts" to look for work. This good faith effort requires regular attendance at workshops and orientation sessions run by the DSS. This is what had undone my client. Ms Washington had missed a number of orientation sessions and penalties from the DSS had reduced her cash allocation to $90.00 a month. Now her time limit was up and her extension application was being formally denied.

I was confident that I could have her benefit entitlement restored. After all she had children with serious medical problems and that constitutes grounds for a medical exemption from the requirements under the regulations. As I argued in our appeal of the termination, Ms Washington has a child with both autism and seizure disorder and his condition prevented her from attending sessions when he was home sick from school. Another session was missed when Ms Washington had rushed to the school of her child who was having an asthma attack. During previous attacks he had needed to go to the ER (no easy feat when you have neither a phone nor a car). Yet another session had been missed when her third child was taken to the ER suffering from "homicidal ideation" after he attacked a child on the school bus. Surely this was a classic case of a necessary medical exemption?

Perhaps not. The officer was sympathetic but refused to grant the exemption. He wanted to know more - how many ER visits had there really been, how often were her children sick? Surely she could work when her children were in school? (a period between 8.30 and 1.30). I found this attitude depressing but also puzzling. Why was it so important, in the richest country in the world, that she work at all? After all this is the land of family values - shouldn’t mothers be available for their children and protect them from the temptation of drugs and teen sex and the dangers of the street?

Recent economic analysis has also cast doubt on the nexus between employment and an end to poverty. Mothers taking low paying jobs (the kind that ‘work for welfare’ trains them to get) have been shown to be worse off in "material hardship terms" (evicted or homeless for failure to pay rent, missing meals, utilities being disconnected, sick children not going to the doctor etc) than they are on welfare. It certainly is not because of the generous amounts of welfare – estimated to constitute approximately 40% of the bare minimum costs needed for survival.

The combination of low minimum wages and means tested benefits results in women having added expenses for transportation, work uniforms and child care at the same time that they lose benefits like medical insurance and subsidized housing. It has been said that many working mothers are "one sick child" away from serious financial crisis. This helps to explain the cycle of women that go on and off welfare. Three-quarters of TANF benefit recipients leave welfare after less than two years but 40% of them will find their way back on the rolls within another year after finding that work has made them no better off but has substantially undermined the quality of relationship they have with their children.

So why the urgency to push welfare mothers off the rolls? It appears to be rooted in a deep distrust of welfare recipients by a nation clinging desperately to the myth of the American dream. This hostility and blame hasn’t always been an American trait. In 1934, at the height of the great depression, President Roosevelt introduced the "New Deal" – a radical governmental approach to poverty that introduced welfare payments and the concept of a state maintained safety net for the poor. Then, like now, there were dire predictions about the potential for fraud, waste and mismanagement. Roosevelt replied "better the occasional faults of a government that lives in a spirit of charity than the constant omissions of a government frozen in the ice of its own indifference".

The current welfare climate in the US couldn’t be more chilly. It was Ronald Reagan who first presented the myth of the Cadillac driving "welfare queen". But countless public figures have contributed to the popular conception of the typical welfare recipient- a black, lazy, teenage mother, brought up in a culture of welfare dependency, destined never to work and only to have more and more children to push up her cheque and condemn another generation to crime, poverty and sapping the resources of the state.

The reality is that most welfare single mothers are white and in their mid-20s, they are not teenage black mothers. In fact the largest single group of recipients are in their 30s. The average number of children for a welfare recipient is just 2. Almost all welfare recipients have worked before and most continue to hold at least one job while on welfare. As discussed above, working does little to improve their position. But the stereotype will not die. Making welfare mothers work is one of the more benign approaches that has been suggested - partially implemented proposals include forms of forced contraception and sterilization for welfare recipients. Today my clients report that the DSS has stepped up its practice of random drug testing urine samples before some mothers can receive food stamps and benefits.

But back to my long-suffering client Ms Washington. I was determined to maintain her benefits and that meant getting proof she could not attend work sessions due to her children’s health needs. This led me into another abyss: the US medical system. At first I tried to obtain the documentation myself. It took two weeks to get an appointment at the local hospital’s outpatient clinic. I was put on hold. I was hung up on. Many times I was transferred into the ether of phone line limbo. Eventually I stood for two days in the hospital refusing to leave until somebody would see me. When I was eventually given my audience the doctor refused outright to sign a letter about the child’s condition without a full examination. I explained the urgency, the court hearing, the difficulty of being a mother with 3 children and no car and phone. The doctor wouldn’t budge. Exhausted, I gave in.

On the day of the appointment I picked up my client and her son David long before our scheduled appointment. This outpatient clinic, like many others, uses appointments known as "overbooks", meaning that some seven people are often assigned to the same half-hour slot. Patients are seen on a combination of first-come, first-served and an urgent medical need basis. It pays to come early and be as visible as possible. I almost laughed out loud when I finally made it to the head of the registration queue. The first (and only) question asked: what kind of insurance do you have?

The significance of medical insurance in the US health system cannot be overestimated. Horror stories abound about people who died after their insurer refused to cover treatment requested by their doctor. Worse still, Congress felt compelled in 1992 to enact legislation requiring ER rooms to treat, not turn away, dying patients without insurance.

As we discovered, the approach to older disabled children also leaves much to be desired. The packed clinic comprised almost entirely poor black and hispanic mothers. David went to the "children’s room": three dusty books and absolutely no toys, coloring books or crayons. In the packed main room, also no magazines or books. Ms Washington and I engaged in desultory conversation until fights broke out in the children’s room and David became bored. He would approach us, touch us on the arm and say "primary care" and then repeat the whole exercise a second later. This would happen again and again and again. This manifestation of autism was reasonably amusing when I saw it in Rain Man but lost its appeal and novelty value pretty quickly as the minutes ticked by in the waiting room. Ms Washington tried to distract David by asking him to read to us medical pamphlets but it was a frustrating task as any difficult words (which are fairly common in medical pamphlets) led David to revert to his "primary care" mantra. An hour passed very slowly.

My naivete again showed in my excited assumption that having our name called meant we were about to be seen. The moment that we entered the clinic area David, who doesn’t like doctors started to get agitated and drew back whimpering and muttering. Ms Washington tried to keep him calm while he was weighed, measured and his blood pressure taken. We were then shown a small consultation room where we waited 20 minutes, taking turns to grab David as he tried to escape.

A nurse then arrived and said it was time for David to be finger pricked which I heard as "finger printed". David started to moan and cry but I couldn’t see the harm in a simple finger print and assured him that he would be fine and that it wouldn’t hurt a bit. Ms Washington said that she found it hard to see David so upset and that he would hate it, so she would wait outside to catch him if he ran out. When I realized they were actually going to prick him for a blood sample I tried to explain it wasn’t necessary as it was not a medical appointment. I was completely ignored. David started sobbing and I had to help him into the chair. The nurse grabbed his hand and pricked him but he started to scream and sob hysterically and would not stay still. There was a fair amount of blood about but the nurse could not get a sample so she tried to grab him again while he screamed and struggled. Ms Washington heard the commotion and rushed in. She became angry that the sample had not been taken when he was already screaming and bleeding.

The nurse barked out, over my protests that it wasn’t necessary to do it at all, that we would not be seen if we did not hold him down. Eventually all three of us held David down to get the sample but Ms Washington started yelling and grabbing at the nurse when it took too long so I had to physically restrain her while still holding onto a hysterical screaming David. The nurse was angry by now and stormed off in a huff with the sample leaving us with a bloody David. On the way out she tossed us a band-aid and told us to put it on David ourselves. I was shaking by this stage but I held David as best I could and Denise managed to get the band-aid on. We then waited another 40 minutes in the consultation room losing patience and composure as a now shaken David continued his desperate bids for freedom.

Dr Smith finally arrived and launched straight into an interrogation of Ms Washington about David (despite his required presence and the agony of the tests she did not even glance at David). How often he was ill, when, where was he treated, what for? Ms Washington explained it was regular, he had diarrhea or nausea or fever and was brought home from school. She treated him herself. Dr Smith then told me she could not write a letter as there was no documentation to substantiate that the illnesses had actually occurred. I asked her to trust Ms Washington or to write a letter simply stating that is what she had been told, like a lawyer would. She refused, it was quite clear she did not believe Ms Washington. After some debate she said she would get the attending physician. Ms Washington was angry and frustrated so I asked her and David to wait for me in the waiting room.

I was left for about 10 minutes alone in the room and then the attending physician and a social worker came back along with Dr Smith. They said David’s illnesses did not relate to his autism. I explained that it didn’t matter what his sickness related to, we just needed to substantiate that Ms Washington needed to be available to take care of him when he got sick. Dr Smith argued that could apply to any number of parents and she couldn’t excuse them all from work for welfare (god forbid). After much toing and froing the attending physician agreed to write a letter saying David had regular and unpredictable illnesses and that Ms Washington needed to be at home to care for him. I waited for a further 10 minutes or so. The social worker then approached me and asked in a conspiratorial fashion if Ms Washington had retained me to help her get out of welfare requirements. I stated that I was with the law school clinic, that Ms Washington was a long-standing client and that we helped her with various legal issues from time to time. She seemed disappointed there was nothing more sinister. When the letter arrived it was hand written and consisted of only a few lines saying that David often was sick and unable to go to school. No reference was made to his medical history. By the time we took David and Ms Washington home it was after 4:00. David missed the next day at school and his absence on those two days was later used as evidence in a petition that Ms Washington had " educationally neglected" her children.

This was obviously unjust but the school had a point. The entire exercise was a waste of the child’s time. And a waste of my time, a waste of Ms Washington’s time, a waste of the hospital’s time and waste of time for the bureaucrats that had to process the eventually successful application. I am beginning to understand the notion of "welfare wastage" but it is not on the part of the recipients but due to the callous and restrictive rules implemented to make sure poor people don’t get a cent more than they might be entitled to.

Since that day I have had many other disturbing experiences with the US system involving my client. I have had a teacher dramatically whisper to me that: "she lives with a man you know", a nurse practitioner tell me: "between you and me I think she is on crack"; a senior pediatrician make derisive remarks about David while he and Denise were in the room and in ear shot and in some ways worst of all a young female judge say laughingly: "I assume her children all have different fathers, ha, ha, ha". The response of my supervisor eased some of my anger "not the twins, no". The really scary thing is that Ms Washington’s life is not unusual by US standards, in fact she is extremely lucky to have free legal representation. Her struggle to get by is mirrored by countless others that daily do battle with a system that seems to have declared war on their desire to live and raise their children in peace.

I read this morning in the Sydney Morning Herald (god bless the internet, the salvation of the homesick) that debate is occurring in Australia about the level of coercion that should be implemented in trying to get welfare mothers off the rolls and into the workforce. While Australia is ahead of the US in its provision of living wages and humane labor standards I think the US experience offers a cautionary tale about the desirability of imposing coercive measures on those with an already demanding life. But I can’t write more, my pizza has arrived and Buffy the Vampire Slayer has just started… best wishes from America.