Market based approaches are a threat to vulnerable people

images by Simon Bosch, courtesy of the Sydney Morning Herald

State and Federal Governments of all persuasion continue their love affair with "market based approaches" to the provision of health services and human and community services. 

These market based approaches take many forms, including privatization and contracting out of government services, competitive tendering of services to not-for- profit and for profit agencies, increasing use of for-profit providers and the private sector  to provide services, use of user pay and cost recovery principles, the application of business metrics and the imposition of corporate management models and approaches that have their origins in the for- profit business context.

But they all are predicated on the assumption that applying market principles to the delivery of health and human and community services will drive innovation, deliver greater efficiency and better quality services and save Governments money.

However, the worsening crises we face in so many areas of social and public policy are largely the result of an over reliance on market based approaches in service delivery and/or the increasing reliance on the private/corporate sector as a provider of services.

The crises in affordable housing, the collapse of corporate provider ABC Learning in childcare, the crises enveloping aged care, the problems resulting from the privatization of employment services, the costs and inaccessibility of many health, medical and dental services, the accelerating cost of public services such as water, gas and electricity, the rationing of services for children and families, are all examples of social policy problems that have been created or compounded by market based approaches.

Adele Horin's piece in the Sydney Morning Herald Sad Truth behind Closed Doors is further evidence of the dangers of relying on market based and for- profit approaches in the delivery of health and human services. Horin shows that a reliance on market based approaches is a threat to the health and well being of vulnerable people. 

Horin argues that the reliance on for- profit providers of boarding houses  to accommodate and support people with mental illness has failed to protect and improve the lives of  vulnerable people. Horin draws on the work of Sydney academic Gabriel Drake who calls the rise of licensed boarding houses in Sydney, as "the privatisation of the back wards". 

In a study of inner Sydney licensed boarding houses, Drake describes a situation where large numbers of people with only their disability in common,  live together with little to do, receive poor mental and physical health care, and have few chances to learn skills. Their pension is handed over. They can't afford a bus fare. They become highly dependent on the boarding house owner.

Horin describes how the failure by Governments to provide the funds  and support to people with mental illness who were "de-institutionalized" and moved out of large psychiatric institutions meant that they were thrown to the vagaries of the "market"

And so hundreds moved into the boarding houses which were run for profit with minimal or no accountability or monitoring. People with sometimes serious conditions, such as schizophrenia, went from the state being in charge of their welfare to a boarding house owner.

The state passed a law to license boarding houses that accommodated people with psychological or intellectual disabilities. But three Ombudsman's reports in nine years - two of them secret and the latest delivered to the Minister for Disability Services last month - testify to the failure of the responsible government department, Ageing, Disability and Home Care, to do its job of inspecting and monitoring the boarding houses properly.

A weak law, and some aggressive licensees, did not help the hapless bureaucrats in their role of protecting and improving the lives of the vulnerable residents.

It is time the state government took a serious look at boarding houses, both the licensed kind, and the unlicensed, which cater to a slightly different clientele of poor, single tenants often with alcohol and gambling addictions.

Sarah Burnside on market logic and welfare reform

Most weeks Sarah Burnside*, a West Australian native title lawyer and writer, reflects on State and national issues in national online publications such as Eureka St, New Matilda and Online Opinion. A previous piece she wrote on the WA mining boom was published on this blog (and contains links to many of her writings).

In the piece published below Sarah analyzes Tony Abbott's recent statements on his plan to reform disability pension arrangements. Like Kevin Rudd before him, Opposition Leader Tony Abbott is engaged in a concerted political strategy to re-brand his party's three decades long embrace of punitive neoliberal social policies under the banner of 'compassionate conservativism'. But the contradictions are always evident, as Sarah Burnside points out in this important piece.

What is also interesting is the silence of Tony Abbott, and all those who argue the urgency of welfare reform, over the bigger problem of 'corporate welfare' for corporations and business and the provision of generous 'middle class welfare' by the Howard government (of which Abbott was a key figure) and subsequent Rudd Government.

Tony Abbott's proposal to reform the Disability Support Pension
by Sarah Burnside
Opposition Leader Tony Abbott drew media attention recently for proposing a 'welfare crackdown' to include compulsory work-for-the-dole schemes and higher threshold for eligibility for disability pensions. With respect to the latter, Abbott proposed a review by the National Audit Office to determine more stringent eligibility rules for the disability pension and suggested that recipients with 'less serious medical conditions' be required to undergo annual medical reassessments and sit two interviews each year to 'encourage them into employment'. Currently, 700,000 Australians receive the disability pension. Abbott estimates that around one-third of these people have conditions he would class as 'less serious'.

The Centrelink website explains that eligibility for the Disability Support Pension (DSP) is determined by reference to a set of criteria and usually requires a report from a person's doctor or specialist, and a job capacity assessment. People may be eligible if they are unable to work for15 hours or more per week at or above the relevant minimum wage or be reskilled for such work for the next two years because of illness, injury or disability, or if they are permanently blinded.

Unlike previous Coalition rhetoric on welfare recipients, which tended to damn them as 'bludgers', Abbott's language is more sophisticated, being couched in terms of care. In his 2009 book Battlelines, Abbott posited that 'allowing people who could readily work to stay out of the workforce for long periods is cruelty,not compassion'. This is a classic example of 'compassionate conservatism', a trope employed by UK Tories and US Republicans to varying success in the past decade to counter perceptions of the Right's heartlessness. The implication is that progressives are ideologically wedded to the welfare state but have little empathy for those who are dependent on it; conservatives alone manifest genuine concern for those members of the community. David Penberthy of The Punch supports Abbott, writing:

Apparently it's better to maintain a welfare program that would consign people to a dispiriting life of idolence, exposing them to the mental health anguish that comes with non-participation, rather than ask them some slightly tougher questions about what they would actually do.

The arguments are persuasive- surely no one wants to condemn their fellow citizens to a life with no prospect of employment. Anecdotal evidence suggests that most welfare recipients wish to find employment and that, lacking the social hub of a workplace, they feel isolated and lonely. Several issues are glossed over, though, in the invocation of compassion to justify limiting access to the disability pension.

Firstly, welfare recipients and their families would no doubt challenge the assertion that it is easy to 'qualify' for the disability pension or retain access to it. Interactions with government bureaucracy, involving vast amounts of paperwork, are often frustrating at best and mystifying a worst. Former welfare rights advocate Susie Byers discerns a 'culture of punishment within Centrelink and its parent Department's', born of a 'suspicious pessimism about the motivations and goals of those who are unemployed, raising children, or living with disabilities'. Byers suggests that the process of achieving government benefits is dehumanizing and humiliating, noting that those who claim payments 'expose themselves to invasions of privacy that would make the humblest of aged pensioner feel like a criminal'.

Abbott's suggestion that an audit of the eligibility rules is needed 'to ensure that only those who genuinely deserve the benefit receive it' subtly invokes the stereotype of the bludger without providing any evidence of such exploitation, Generally speaking, it seems likely that any benefit system will attract the self-interested as well as the needy. So be it: this is the price we pay for living in a civilized community that cares for its citizens. To make a whole class of people suffer for the sins of a few- even under the mantle of compassion- would be in this context as in others, profoundly unethical.

Secondly, Abbott's classification of muscular-skeletal and psychological/psychiatric disabilities as the categories within which 'less serious' conditions might be found seems opportunistic. Muscular-skeletal conditions may involve chronic pain which is inherently difficult for external parties to perceive. Similarly, psychological or psychiatric illness is not readily identifiable by bureaucrats seeking to limit entitlements. The nomination of these categories suggests a certain lack of sophistication-if someone's not in a wheelchair or holding a cane they must be capable of holding work. These are people already people vulnerable to accusations of malingering, given the increasing sceptisim about diagnoses of mental illness. It is thus important to note that one cannot qualify for the disability pension by feeling a bit blue. The criteria regarding psychiatric impairment in the Social Security Act 1991 (Cth) specify that mild but regular symptoms which tend to case subjective distress' and give rise to 'minimal interference with function in everyday situations' will not of themselves render one eligible for the pension.

Thirdly, despite the existence of such services as Job Services Australia and the Disability Employment Assistance Services it is far from clear that there is an aequate level of support available to help people with disabilities find jobs and mentor them while in employment. A HREOC National Inquiry into Employment & Disability in 2006 noted that, although 'most people with disability want to work if they have the capacity to do so.. we cannot expect high participation rates if people with disability have work-related expenses that are higher than their potential wages or they cannot access the supports they need'. A 'tightening' of the criteria for access to the disability pension would increase the existing need for serious investment in encourageemnt of flexible workplaces and programs to help people find and stay in employment.

More broadly, there are problems with the prevalent view, integral to Abbott's rhetoric, that employment necessarily imbues people with self-esteem and a sense of purpose and enables them to lead meaningful lives. Such a claim might hold true for skilled workers, including educated professionals such as politicians, or those at the other end of the Australian job market, the prospects are less alluring.

The writer Anne Manne, a trenchant critic of the 'Get to Work neo-liberal program', cited her own experiences of dismal jobs, including a stint as a jillaroo, in her 2008 Quarterly Essay ' Love and Money:The Family and the Free Market'. Manne challenged the view that paid work is inherently fulfilling, noting 'when my university teachers talked of the liberation of work, they did not mean domestic help in rural NSW', but rather-like Betty Friedan in The Feminine Mystique- 'prestige work'. Self evidently, prestige work is not available to all. Many workplaces are not flexible enough to cater for the needs of people with disabilities, Further there will always be jobs no one wants to do; such roles are filled by the people relegated to being the leftovers of the modern economy.

In her 2005 Griffith Review Essay law Professor Rosemary Hunter traced shifts within the Australian labour market and their effects on family disputes, noting that the 1990s had seen a 'rise of precarious low-quality employment'. Hunter suggested that 'Australia's current low unemployment rate.. does not signal economic prosperity but rather the rise of the working poor, and the phenomenon of labour market churning, whereby people move constantly between unemployment and poorly-paid, casual and part time jobs, which they must accept as a condition of continued support when they are again unemployed'. The superiority of such a life over one on the disability pension is not immediately obvious.

Currently families make up the shortfall in support of people with disabilities: this kind of informal care is characterized by feminist economist Nancy Folbre as the 'invisible heart' that combines with the 'invisible hand of the market' to render our society functional. Reliance on the family, however, is not sustainable. Its time for a real debate about how people on government benefits can be supported to live meaningful lives, including assistance securing employment where appropriate. The seductive language of dignity, choice and productivity employed by Abbott is unlikely to assist such debate.

*Sarah Burnside is a West Australian solicitor with an interest in history, native title, nationalism and politics. She works at the Yamatji Marlpa Aboriginal Corporation (YMAC), which represents native title claim groups in the Yamatji and Pilbara regions of Western Australia. The views expressed in her articles do not necessarily reflect those of YMAC.