Tales from the Welfare Jungle in the Good Ol' USA

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.