Usually when America's welfare programs are debated, we think in terms of spending. And that debate matters. Compared to most advanced Western nations, spending on the U.S. welfare state is quite stingy. But it's not the only debate we should be having.
Every welfare program — from Medicaid to food stamps to TANF and more — is also a mess of personal interactions, which have an effect on low-income Americans all their own. And on this front as well, we could be doing a whole lot better.
Take Medicaid, for instance. It's a crucial program that provides health coverage for over 70 million Americans. But it's also a complex bureaucracy. Jamila Michener is an assistant professor of government at Cornell University who did interviews with dozens of Medicaid recipients and advocates, and pored through large surveys of beneficiaries. "I found that Medicaid recipients often feel stigmatized," she wrote in The Washington Post. "The people I interviewed told me that they were treated like 'stupid animals,' made to feel like they were 'nothing,' and 'looked down upon' for needing help. Not all beneficiaries were treated this way, but for those who were, such experiences proved that 'no one listens' to people like them."
Sometimes, this happens because people on these programs have a run-in with a caseworker or administrator who is grumpy, judgmental, racist, or in other ways prejudiced against the very people they're trying to serve.
But often, the message that people who get government aid are somehow "lesser" or "undeserving" is built into the very fabric of the program's design. In some states, the application forms for programs like Medicaid, food stamps, or welfare can run from 24 to 31 pages. There's often also a requirement for an in-person interview to determine eligibility. Trips to the local agency office can often come with absurdly long wait times. For low-income Americans who face chaotic and unpredictable work schedules, unreliable transportation, difficulties finding child care, and just a lot of stress in general, those can be huge and dispiriting hurdles.
A recent report from the National Council on Aging looked into how elderly and disabled Americans specifically experience interacting with these programs. Its section on food stamps, for instance, found that recipients will often "do anything to avoid the social services department." They feel the agency often treats them like "second-class citizens." One program counselor said there's "lots of stigma around benefits from the [agency]." The "alphabet soup” of benefits is also confusing in its own right.
For many programs like Medicaid and food stamps, recipients have to regularly report their income and changes in life circumstance. That in itself can be a hassle. But it also means they can lose their benefits and have their lives suddenly upended should any of those factors change in the wrong direction. So the program becomes a capricious and frightening force in their lives, and every instance of paperwork is a grim roll of the dice.
In some instances, the internet has made the application process and data tracking more efficient and user-friendly. But the temptations of digitization can also make the process worse, as recipients get fewer interactions with actual counselors and are funneled into clogged phone lines instead.
But perhaps the most important effect is what it does to the political attitudes of low-income Americans. For many of these people, the paperwork and office visits for various welfare programs is the most prominent example in their lives of government at work. When that experience is degrading, belittling, or discouraging, that in turn effects their view of government — and more importantly, their view of the worth of political participation.
"Beneficiaries come to believe that it's hopeless to try to change the system, or influence the world," Michener wrote. In fact, one of the most consistent themes from Michener's interviews is that disgust with welfare programs leads to disgust with politics, period. It feels like you have "'no say in the process' and no real political influence," one interview subject said. "It does kind of feel like you just reach a fork in the road where you just give up, you just lose," said another.
Joe Soss, a professor of politics and sociology at the University of Minnesota, has noted this phenomenon as far back as the original welfare program AFDC in the 1990s, before it was upended by President Clinton and a GOP Congress and transformed into TANF. Despite the programs' relatively greater generosity back then, many recipients still felt at the mercy of the program and its caseworkers, who both took on capricious and god-like abilities to affect recipients' lives. And the lesson the recipients often took away was that they were politically powerless, and there was no point in voting or agitating to change the system. Participants in AFDC were actually noticeably less likely to be politically active than recipients of other, differently designed welfare programs — even after controlling for factors like race, income, and education.
We usually think of policy as the result of politics. But as Soss and others point out, politics can also result from the design of policy and administration. It's a well-known fact that poorer Americans vote and participate in politics in far lower numbers than their more well-off fellow citizens. One big reason why is surely that welfare programs can often be a confusing and humiliating experience, which inevitably communicates lessons to those Americans about life, their place in society, their prospects, and more.
So what should be done about this?
One thing worth noting is that relatively universal programs like Social Security and Medicare seem to engender little-to-no sense of stigma or anxiety in their recipients. Those recipients also participate in politics at the same rate as other Americans. So moving all welfare programs towards more universality and less means-testing could help: Recipients will feel less singled-out, and fewer eligibility rules will mean administrators won't see themselves as separating the sheep from the goats as much. Moving to more direct cash aid when possible could also help, as that requires less interaction with bureaucracy and gives recipients more freedom and power over their own lives.
But more fundamentally, we need to reform the institutional culture of these programs. Workers and administrators should be trained to be as welcoming and supportive towards recipients as possible, and workplace cultures should encourage those values. We also need to invest resources in increasing staff, lowering wait times, streamlining application processes, and making offices more available.
That will require a change in political attitudes from all Americans. Because if you're a voter or politician who thinks welfare recipients actually are lazy, disreputable, or undeserving, well, then you might think all the bugs I just listed aren't bugs at all, but features.