Human Services Issues - Research Paper Example

Social Problems in the United s: Homelessness, Unemployment, and Health Care/Managed Care The Homeless There is no generally recognized data of the actual population of homeless in the United States currently obtainable, and the most current figures by the Bloomberg administration, as cited by Julie Bosman (2010), successfully evade the problem of concrete figures of homeless people. According to the Bloomberg Administration, “the number of people living on New York’s streets and subways soared 34 percent in a year, signaling a setback in one of the city’s most intractable problems” (ibid, para 1). It is commonly recognized that individuals become homeless for different causes, and nearly all of these are strongly connected to poverty, as Kaufman (2008) suggests. It is shown in the articles of Bosman (2010) and Kaufman (2008) that since housing takes up the largest percentage of individual and family income traditional belief indicates that this whole population is in the verge of homelessness, and numerous do become homeless at some point in their poor life. Other, more definite roots of homelessness involve issues of employment, weakening public support, limited affordable housing, substance abuse, mental problems, domestic violence, and lack of health insurance (McNamara 2008). Any one of these issues is adequate to make a family or an individual homeless, and for numerous people, homelessness is the outcome of a personal conflict between being employed in a low-paying job with no health privileges and lack of accessible, low-priced housing. A family and individual in the aforesaid situations usually cannot pay for housing on their earnings from a minimum-wage employment, and they are not entitled to public support. This reality is accurately described by Bosman (2010) by stating that administration officials were surprised and demoralized by the marked increase in the prevalence of homelessness. Even the commissioner of homeless services, Robert Hess, declared that the city of New York is now feeling the enlargement in its massive shelter system several years ago (McNamara 2008). As cited by Bosman (2010), Hess declared, “And now we’re seeing the devastating effect of this unprecedented poor economy on our streets as well” (ibid, para 2). Statistics show that children make up 25% of the homeless in urban areas, and among the homeless adult, 14% are unmarried females and 47% are unmarried males (McNamara 2008, 52). Previous reports from the 1997 study of the U.S. Conference of Mayors of homelessness in urban areas suggest that 36% of the population of homeless people is made up of homeless families (McNamara 2008, 52). New York City, as clearly explained by Bosman (2010), is bearing the brunt of the national recession. However, homelessness is not just an outcome of the declining economy; it is also brought about by the reduction in the number of low-priced housing alternatives to working and poor individuals and families in New York City. The article of Bosman (2010) gives the insight that in other corners of the United States individuals blame their homelessness and poor conditions on impoverished individuals. The traditional belief that poor individuals become poor due to their own weaknesses remains. This belief normally rules out children, who are regarded innocent, but it is difficult to support children without supporting their parents. Although Bosman (2010) obviously think that it is vital for individuals to assume responsibility for their own lives, it is also vital that in an affluent country for society to also assume responsibility. In several regions of the country, homelessness and poverty are quite indiscernible (McNamara 2008). Bosman’s (2010) article showed that the homelessness and poverty awareness of New York has raised a very developed knowledge of poverty and its roots. This article indirectly shows hard proof that the officials of New York understand the problem of homelessness. Meanwhile, the most broadly used description of homelessness arose from the early policymaking towards the issue, and is enclosed in the original Stewart B. McKinney Homeless Assistance Act of 1987 (McNamara 2008). The description of homelessness offered in Mckinney Act’s Section 103 involves (McNamara 2008, 13): (1) an individual who lacks a fixed, regular, and nighttime residence; and (2) an individual who has a primary nighttime residence that is (a) a supervised publicly or privately operated institution designed to provide temporary living accommodations; (b) an institution that provides temporary residence for individuals intending to be institutionalized; or (c) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings (ibid, p. 13). Following the federal plan development for combating homelessness, the Department of Homeless Service, as discussed by Kaufman (2008), is reporting on a new program to deal with homelessness. Describing homelessness to involve helping the homeless to become independent, self-reliant, and permanently housed is the core of the article of Kaufman (2008). The article clearly discusses the consolidated plan of the Department of Homeless Service. Basically, the initiative is composed of two components: (1) a harmonization of community-based practices for recognizing the requirements of the homeless and developing a process to deal with those necessities, and (2) enhancing significantly the budget for homeless assistance to deal with the observed needs. The initiative also proposed greater funding from public agencies, enlarging the number of individuals entitled to assistance, and enhancing the focus on short-term and long-term housing in relation to emergency support (Kaufman 2008). A number of initiatives surfaced from the initiative to deal with homelessness. These involved shelter-plus care, supportive housing, and emergency shelter grants (Kaufman 2008). Current policy attempts by the Coalition for the Homeless, which is the main advocacy group for the homeless, involve focus on the federal budget allocations for homeless support, reform on public housing, educational and health care programs for the homeless, and focus on the effect of existing welfare reform determine the prevalence of homelessness (Kaufman 2008). There are numerous religious-based attempts to address the problem of homelessness, making use of different methods that have a less tendency toward initiative to solve the issue and more toward recognizing the homeless families and individuals ‘as is’ and giving generous food and shelter (McNamara 2008). Kaufman (2008) wrote a fairly accurate account of the current situation of homelessness in the United States by providing up to date figures and policy responses. However, it appears bias towards the effort of the government to address the problem of homelessness without taking into considerable account the point of view of those individuals and families actually experiencing homelessness and poverty. Unemployment The unemployment rate is one of the most fundamental markers used to measure the economic condition. The length of unemployment has increased considerably in relation to the rate of unemployment over the recent decades (Mooney et al. 2010). A number of possible causes have been suggested for this pattern. Goodman (2010) claim that increasing duration of unemployment is concentrated among particular groups of people, such as women, and mainly is an outcome of the improvement in the labor force participation of women, which has trimmed down the occurrence of temporary unemployment related to shifts in and out of the workforce. On the contrary, Madden (2011) claimed that increasing long-term unemployment is connected to weakening job security through the major role of increasing long-term job loss. The problem with the articles of Madden (2011) and Goodman (2010), primarily, is that much of their discussion on the solutions to the problem of unemployment has focused on the major contribution of reductions in actual wages and faster economic development. Faster economic development is seen as a way of creating more jobs. Reductions in actual wages are a response to the belief that through their claims for bigger wages, several worker groups have opted to lose their jobs. How much development and how big a reduction in actual wages would be needed to cut down the enormity of the unemployment problem remain points of contention. Ottosen and Thompson (2006 as cited in Mooney, Knox & Schacht 2010) recommend major reforms on the National Labor Relations Act in the United States as a means of discouraging groups of workers from providing the fringe benefit premiums and monopolistic compensations that increase business expenditures and result in unemployment. Such recommendations are usually very hard to put into effect. Replications by Debelle and Vickery (1998) for the labor market of Australia are indicative of feasible reduction in wages as long as the unemployment goal is not too low. This kind of recommendation is not that encouraging. Furthermore, numerous scholars and practitioners, such as Goodman (2010), think that the economic development levels needed to make a big difference to the problem of unemployment are not likely to be maintained by a large number of economies. According to Goodman (2010), the United States and other countries may adopt other strategies to support the reduction of the rates of unemployment. Primarily, the processes of gathering and distribution of information on job vacancies could be enhanced. Goodman (2010) recommended following a model where in job centers have integrated, countrywide databases of employers, jobs, and potential applicants. This kind of database may lessen the time used by a regular employee on the unemployment roll and hence trim down the rate of unemployment. Subsequently, unemployment sectors could reinforce their selection and recruitment qualifications. And, there may be developments to the training and education given to young individuals, with a better emphasis on vocational abilities. Ultimately, countries have to make sure that their welfare systems, still according to Goodman (2010), do not give discouragements to work. There could be a role for unemployment initiatives as well that aim at different groups of unemployed individuals. Carol West (1994 as cited in Mooney et al. 2010) studied the unemployment initiatives intended to lessen structural, seasonal, frictional, and cyclical unemployment in the United States. Several of these initiatives are intended to reform individuals to complement current jobs while others generate employment to complement current worker abilities. The reform well-defined over time and the temporary duration of several initiatives make assessment complicated. A large number of initiatives seem to do little more than restructure the group of jobless individuals, though apparently they have the ability to play an equity role in the labor market (Mooney et al. 2010). Goodman (2010) even argued that initiatives of the labor market can be a cost-effective way of dealing with the prevalence of unemployment. Several other solutions to the problem of unemployment have been discussed by Goodman (2010). These strategies influence the labor market by trimming down the availability of labor. Nevertheless, they have not gained much advocacy among economists. On the other hand, Madden (2011) focused more on the ‘softer’ aspect of long-term unemployment. In her article, she stated that in long-term unemployment, emotional and psychological difficulties can remain and the single actual solution appears to be getting a new job. Yet, as argued by Madden (2011), in the economy such as that of the United States, getting a job promptly after the first unemployment phase is not constantly simple. This makes the problem of an increased possibility of physical and psychological health difficulties that are more permanent. As stated by Madden (2011), long-term unemployment has a much profound effect than short-term unemployment on an individual’s career prospects, emotional health, and finances. According to the current Pew Research Center study that examines the experiences and points of view of employees who have lost jobs at some point in the Great Recession, of the people who have encountered unemployment duration of at least six months, over 40% admit that the recession has brought about significant changes in their lives (Mooney et al. 2010, 104). Madden (2011) is stating that the impacts of long-term unemployment quite surpassed its financial impact. She clearly reported that long-term unemployment does not only distress the unemployed temporarily but also has profound repercussions for the long-term well-being and health of these people, as well as their families; this assumption has been empirically supported. The study of sociologist Kate Strully discovered that individuals who lose their jobs are considerably more prone to have stress-stimulated conditions, like depression, arthritis, and diabetes (Mooney et al. 2010). Economist Till von Wachter examined the income and mortality documents of employees in Pennsylvania during the 1980s recession. He discovered that death rates boosted dramatically for the jobless in the period they lose their employments. Mortality rates continued to be considerably greater for people who lost their jobs than for similar employees who did not (Mooney et al. 2010). The life expectancy, in fact, of the jobless is reduced by roughly a year. The article of Madden (2011) has an air of certainty that stress is worsened when unemployment privileges have to be negotiated. However, another actual impact of stressful conditions that may be reduced by support from officers, who are expected to help those individuals in need, but continues to serve for their own interests. Health Insurance/Managed Care The assistant secretary of health, education, and welfare of former President John F. Kennedy, Wilbur Cohen, and other social workers fulfilled primary functions in the progress of Medicare (Court & Smith 1999). From its beginning the Medicare initiative has had crucial weaknesses and inconsistencies in coverage. Most particularly, Medicare does not finance prescription medication. Figures from 1998 and 1999 show that 7 million, or 18%, of the 38 million beneficiaries of Medicare are registered in managed care (Wise & Rickel 1999, 83). Seniors preferred to register in HMOs due to the prescription drug privilege and the little to no deductibles and co-payments (Court & Smith 1999). After several years of managed care, it has been known that it is a predicament for disabled people and the elderly (ibid, p. 33). Federal officials at the General Accounting Office discovered that HMOs regularly provided imprecise and false accounts of costs and benefits to Medicare beneficiaries (Wise & Rickel 1999). And HMOs regularly ‘pick the best’. Picking the best is the effort to register patients who are the healthiest, hence decreasing cost. The article of Holmes (accessed 2011) is discouraging. Holmes claims that the elderly patients with specific chronic illnesses were nearly twice as prone to weaken in physical condition in an HMO as in another form of facility. The Medicaid initiative has gone through considerable change since its formation. The Congress ratified the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 (Wise & Rickel 1999). The policy removed AFDC’s open-ended federal privilege scheme. Strict work requirement and time limits were implemented (Wise & Rickel 1999). The investor-owned segment is increasingly becoming prevalent all over the whole industry of managed care, as eloquently expressed by Holmes. He showed that the expansion in MCOs’ size, through vertical and horizontal integration, has led to industry concentration bearing a resemblance to oligopoly in the non-profit as well as the investor-owned sector (Holmes, accessed in 2011). This implies that competition is possible to take place more on quality, marketing, and innovation, than on price, all of which are difficult to evaluate. As industry concentration enlarges, consumers and employers might find themselves at the hands of companies which are more responsible for their shareholders than to the public they cater to (Court & Smith 1999). Holmes (accessed in 2011) was actually successful in showing that HMOs are organizations aimed at maximizing profitability. The cofounder of Columbia Health Care Corporation, Richard Rainwater, described health care in this manner: “The day has come when somebody has to do in the hospital business what McDonald’s has done in the fast-food business and what Walmart has done in the retailing business” (Court & Smith 1999, 36). Health care services, under the system of capitalism, are identical to fast food: a product to be purchased and sold. Holmes (accessed in 2011) showed that in managed care terms, money used on health care is regarded a ‘medical cost’. Patients’ needs as well as medical social workers’ core values unavoidably conflict with HMO shareholders and administrators whose main interests are increasing profits and regulating costs (Court & Smith 1999). HMOs have been the powerhouse behind remarkable drops in hospital confinements, resulting in the currently notorious ‘drive-through-delivery’. Disabled patients or those on ventilators are released from the hospital when they have bleeding injuries that could cease within minutes (Wise & Rickel 1999). Families and friends increasingly take the responsibility of patient care whether they are able or know the medical treatments and instruments that have to be used. Holmes argues that social workers confront serious problems when patients are forcefully discharged from hospitals before they are ready. Doctors are pressured by HMO officers to release patients as quick as possible. They have been warned of being dropped from the networks of HMO or have been provided with financial rewards to discharge the patients from hospitals (Wise & Rickel 1999). Although the HMOs are forcefully discharging patients from hospitals, their executives are being given unbelievable compensations. The far-reaching arrival of managed care has not rendered health care more affordable or available. It was certainly not aimed to. Health care cost increases annually as does the population of uninsured. According to the Weil (1991), a national health care system, with the federal government as the single payer, can mitigate the health care problem. A national health care system would get rid of health insurance businesses. Every individual would be insured by and have admission to a health service given by the federal government. As argued clearly by Weil (1991), only within a national health care system, with admission assured to everyone, can health care truthfully become a human right. National Association of Social Workers (NASW) has unfailingly recognized health coverage as a main concern and an issue of human rights (Wise & Rickel 1999). Senator Daniel Inouye established in 1993 the National Health Care Act, a recommendation of NASW for a Canadian-form single-payer structure (Court & Smith 1999). NASW has to initiate campaigns for a national health care system as a main concern. The concept of a national health care system, where in the government would spend tax money to finance universal health coverage, pulling out medical care from private insurance employers and organizations, gains popular advocacy (Weil 1991). A 1993 Time Magazine survey reported that 32% of the population thinks that deep-seated change was required, and 47% believe that the health care system must be fully reconstructed (Court & Smith 1999, 82); public support, each year, increases for a national health care system provided by the government, such as those in Europe and Canada (Court & Smith 1999). As claimed by Weil (1991), the only way we can acquire a humanitarian healthcare system is by developing a well-built, social movement that compels the government to remove the health insurance industry and institute a national health care system. Developing this movement is not a short-term endeavor. Policymakers will not ratify a national healthcare system unless they are forced to by a big, well-structured, social movement. Conclusions The homeless are all around the wealthiest country in the world. They are the miserable who spend their time roaming around the city and town in the country. These homeless people are from rural areas without the money to acquire shelters and gain access to public services. As been defined, the homeless are individuals who have been ignored and displaced. Their population makes them a society of outsiders, rootless and very itinerant, enveloped with prestige, wealth and overindulgence of everything that which they miserably lack. A stable and well-grounded economy is not immune to homelessness; the numbers increase as the economy experiences recession. Homelessness is a problem both in urban and rural areas. The homeless in rural areas has a tendency to be White and female. Shelters in rural areas are inadequate; hence homeless individuals usually live with relatives and friends. Cause-oriented groups have discovered that homeless people in rural areas are laid-off employees, penniless farmers, dislodged occupants, and migrant employees. Tenants on Indian reservations are ever more located among the homeless people in rural areas. Significantly high unemployment, together with the heightened numbers of individuals coming back to reservations to live, has brought about too much problems on an already limited and unstable social service system. Homeless individuals in rural areas usually relocate to cities, hence adding to homelessness in urban areas. The United States has several of the highest rates of long-term unemployment, or defined as being jobless for more than six months, it has documented. In the meantime, job increase has been, and seems to stay, discouragingly low, suggesting that unemployed people for the moment are prone to stay so for the near future. Still, if the government account reveals the predicted enhancement in business hiring, it will not be sufficient to cause a genuine impression in those sums. Hence the mass of long-term jobless people will perhaps be unoccupied for considerably longer than their equals in previous recessions, lessening their chances of being employed in the end even when the economy improves. On the other hand, the health care system of the United States constantly understands the lessons from the favorable and unfavorable experiences of managed care. The politically inclined health care system reaction may retard development in several regions in the country, but experimentation and modernism will remain stable. Managed care is not just a collection of updated administrative processes for regulating the access to medical care and the increase in the costs of health care; it has become the label for a reform in the manner health care is financially supported and structured in the United States. The general feature of managed care groups is the growing assimilation of provider and insurer positions, which has strengthened vertical integration in the sector of health care. Certainly, the transition from a long-established paradigm of an individual physician applications and autonomous community clinics to networked systems that offer a complete array of services financially supported by capitation fees and depending on advanced management and medical information systems is a distinctive character of the current health care system in the United States. References Bosman, J. Number of People Living on New York Streets Soars. The New York Times, 2010. Court, J. & Smith, F. Making a killing: HMOs and the threat to your health. University of Michigan: Common Courage Press, 1999. Debelle, G. & Vickery, J. Labor market adjustment: evidence on interstate labor mobility. Economic Research Department, 1998. Holmes, L. The Problem(s) with Managed Care, About.com, http://mentalhealth.about.com/library/weekly/aa112497.htm, accessed February 2011. Madden, K. Surviving Long-Term Unemployment. MSN, http://msn.careerbuilder.com/Article/MSN-2498-Job-Search-Surviving-long-term-unemployment/, 2011. McNamara, R.H. Homelessness in America: Volume 1, Faces of Homelessness. Westport, CT: Praeger, 2008. Mooney, L.A., Knox, D. & Schacht, C. Understanding Social Problems. Belmont, CA: Wadsworth Publishing, 2010. Weil, T.P. Managed-Care Plans. Their future under national health insurance. West J. Med 155.5 (1996): 533-537. Wise, T.N. & Rickel, A. Understanding Managed Care: An Introduction for Health Care Professionals. Switzerland: S. Karger, 1999. This Article Read More