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By Shami Dugal
This is not a technically or fiscally motivated article. It is philosophical in nature and may raise more questions for reflection than delivering answers or recipes for solutions. At the very least it provides a methodology or lifecycle for discussing equity and fairness in social policy which is a recursive loop of resources, recipients, redistribution, rationale and results.
At one extreme, equity and fairness implies a balance between need and fulfilment. At the other end of the spectrum are personal choices and outcomes from those choices. If two individuals begin life in the same social strata, they may not end up in an equal position in terms of wealth and position. This can be considered an example of horizontal equity. If they begin in different social strata, there is greater likelihood that those starting from a higher social position, with its inherent benefits, will enjoy better results than someone climbing the social ladder. This is a view of vertical equity. Since life is governed by social position, circumstances, personal motivation and often pure chance like winning the lottery, how can equity and fairness be realized?
Who should get what, how much, for what types of needs and under what circumstances? What will be the results of such allocation and how will they be measured? Who can decide what the measures should be and will they result in equity, equality or simply meet some established baseline? What are the short and long term effects of such policies? Does the electorate have the patience to wait for results or will it knee-jerk a new round of changes before the first ones have had time to mature?
To what degree does the State owe citizens a level of equitable distribution of opportunities and resources? Should equity be a goal of economic policy? Does equity promote growth? If the moral objective of social policy is to promote the well-being of the lower economic classes, it will undoubtedly cause redistribution of resources because the collection of funds to support the state’s policies can only come from those that are well off, currently termed the “one percent.” Today, the United States is mired in discussions about how the President’s policies are wrapped around redistribution of wealth and resources, thereby causing the country to drift closer to socialist policies.
People migrate to the United States in search of a better life. That constitutes opportunity, employment, decent wages and basic life amenities such as food, shelter, transportation and healthcare. This standard has been diminishing for a number of reasons which are hotly disputed both across and within political parties. What one political party calls excessive greed is considered just rewards from a desired laissez faire economic environment. What is the new normal? Is there a new economic order that is emerging?
When I speak to people from other countries, there is not as much of a desire as before to migrate to the United States. Certainly there are countries with wars, strife and refugees for whom anything other than their current conditions would be a god send. However, emerging countries are retaining business, talent and in fact attracting work from the so called “first world” countries. Their view is that an equalization of power and wealth is taking place.
The advantage that the United States has over most countries is its intellectual ability to deal rationally with its issues and find improvements through a democratic process. One has to believe that the pushing and pulling from different ideologies will result in systems that will eventually benefit all the citizens and not just the one percent or the ninety-nine percent. While the country is going through intense soul searching, the next decade and rounds of elections will determine what path the country takes in rationalizing how to deal with the five R’s.
On a final anecdotal note, I worked for a large chartered bank as an IT manager some years ago. Those times were reminiscent of today when the economy was soft. The bank, in its wisdom to achieve some measure of fairness, decided one year to offer an across the board increase to staff but not its management. My boss, a tall self-styled version of Don Rickles, muttered to me that the peasants were getting too close. That was a moment of realization for me of the disparity between the two classes and the desire for one to stay well above the other. No doubt that element still exists, but it there is a surging demand for that gap to close.
Shami Dugal is a member of ASPA and on the SHHSA Board. He has bachelor’s degree in operations research from University of Waterloo (Canada) and a master of public administration from Drake University (Des Moines, Iowa). He is an engagement leader for Netsmart (www.ntst.com), which helps health and human services organizations transform care through the collaborative, coordinated management and exchange of clinical data across the care spectrum and through effective practice management that improves revenue cycle management.