Social Care
Discussion
The Case for a Social Co-op Approach to Social Care
John Restakis (from ch. 6 in: Humanizing the Economy):
"There are three compelling reasons for the promotion of co-operative models for the delivery of social care. The first has to do with the nature of social care and the kind of models that are best suited to deliver that care. This concerns the question of Relational Goods. The second reason concerns the relation of organizational structure to service design, delivery, and efficiency. The third reason is the need to humanize care through the socialization of its content and its manner of operation. The democratization of care is essential to this.
The reasons flow from the nature of social care itself and the ways in which co-op models require caregivers and users to make explicit and reinforce the human relations that underlie care. The principles of reciprocity, equality, and accountability are inalienable qualities of humane care. They are also organizational attributes of co-operative organizations. They are not attributes of either state or private, for profit systems."
The role of relational goods for social care
John Restakis (from ch. 6 in: Humanizing the Economy):
"In social care, relational goods are services to persons that are characterized by the exchange of human relations. Because in relational goods the quality of the personal relationship lies at the core of what is exchanged between the provider and the recipient they can be optimally produced only by the provider and recipient acting together. Beyond this, relational goods have also been defined as the value of the relationship itself, over and above the particular goods or services that are produced. These qualities apply to the unique nature of social care. Reciprocity, the entering into a relationship of mutual benefit on the basis of equality, is the basis for a type of care where both caregiver and recipient share in the generation of care as a human relation, not as a purchased commodity or a charitable offering. Consider for example, care for a person with a disability. A reciprocal relationship would provide the recipient the means to determine how his or her care would be provided to them; they would have a say in determining when the service would be offered, who their care-giver would be, what the content of the care would be, and how their personal preferences and needs can best be served. Reciprocity in social care entails sharing among equals: of information, of responsibility, and of power. It is the source of dignity for the user, vocational gratification for the caregiver, and mutual accountability for both. Without the democratization of care through the sharing of power and the reordering of relationships on the basis of equality none of this is possible. Co-operative structures in which power is shared between provider and user make this possible.
Services such as education, health care, and care for people with disabilities are “social” because they are not merely commercial commodities. They refer to social relations that are wholly different from the exchange of commodities for profit that characterize commercial transactions. This is why the reference to such services as “products” or the recipients of social care as “clients” is so profoundly false. It is the unthinking urge in a market society to commodify a human, and social, relation. Neither state bureaucracies, which depersonalize social service recipients, nor private sector firms, which instrumentalize recipients as a source of profit, can ever be suited to the provision of relational goods.
To be clear, I am not claiming that private sector firms are incapable of attending to the caring aspect of a social service. I am saying that the cultivation of the relational aspect of care, what is in essence its human factor, is not generally in their interest since it means investment in time and therefore money and their objective function is to maximize profits. The same problem of conflicting priorities also serves to undermine private firm investment in employee training and professional development that results in additional reductions in service quality, employment standards, and staff morale. But in both cases - state and for profit delivery - what suffers is the quality of a caring and reciprocal relationship which is at the heart of the service being produced. This shortcoming of conventional delivery systems has actually little to do with the intentions that lie behind these models of social care. What is at issue is the faulty physiology of the structures and the economic principles used to provide care to people. And, as will be explored in more detail below, neither the redistributive economic logic of government nor the commercial exchange logic of the private sector can do justice to the reciprocity principle of social and relational goods."
History
John Restakis (from ch. 6 in: Humanizing the Economy):
"Historically, the rise of social care in the advanced capitalist societies is inseparable from the advent of democracy, which in turn became possible only with the rise of an organized working class. This is understandable. A prime cause behind the struggle for democracy in the west was to establish a political system capable of distributing to the majority a share of the material security and prosperity that was the privilege of elites. This only comes with a commensurate distribution of political power.
And so social policy – the broad distribution of material security through public means – is a factor of democracy. What I want to show is how democracy is essential also for the protection of the human and social dimension of social care itself. The character of social care - the nature of its content, its manner of operation, and the distribution of its benefits – has remained relatively unchanged since the great wave of social reform was enacted after the end of the second world war. It was at this time that the universal systems of social security, health insurance, family benefits, and public welfare were established. And while it is true that the nature and extent of these social care systems varied greatly from one country to the next, and especially between northern Europe and America, they shared essential common features – in particular the rising importance of government as the provider of social care. But almost all the social policy reforms in Europe and North America since then have been centered on matters of redistribution - extending the coverage of social welfare systems to larger segments of the population. The actual delivery of these services – the fundamental character of the relation between the state and the citizen - remained relatively unchanged until the introduction of free market ideas in public policy in the 1980s. Until then, publicly funded social programs were delivered almost exclusively by the state through centralized bureaucracies.
To be sure, these vast delivery systems succeeded in distributing benefits to unprecedented numbers of people. The quality of life for the vast majority of people improved dramatically – greater than at any previous period of history. Centralized bureaucracies were deemed essential for systems in which universal coverage required regulation, standardization of services, and equality of access. Their moral foundation however, was based on notions of charity – the social responsibility of the state to care for its members. But it was a profoundly paternalistic system in which the state provided and the citizen received. This is the nature of charity. The essential character of this disempowering, and ultimately belittling, system was not to be altered until the 1980s when, ironically, the state monopoly over social care was called into question by the adoption of free market principles in the public services by Margaret Thatcher. This shift in the presumptive role of the state by the embrace of the free market cracked a centuries-old mould that had fixed the citizen as a powerless dependent of the state in matters of social care. The fact that citizens contributed to the cost of these services through their taxes had little effect on the powerlessness that they often experienced when actually using these services, particularly social welfare which carried with it the additional indignity of social stigma.
It was a model whose antecedents extend back to the Poor Laws that stripped the poor and the weak of their autonomy and social identity. And just as the adoption of utilitarian, free market ideas dissolved the relations between the commercial economy and society at the dawn of the industrial age, so too has the adoption of these same ideas threatened to destroy the social content of care in the public economy. Social care is being commodified. The de socializing dynamics of the Industrial Revolution that were, at least in theory, contained within the market economy have now reached deep into the public systems that were once the preserve of the state. The colonization of the public domain by commercial interests in the late 20th century is in some ways analogous to the enclosure of the commons in the 18th century. As a result, a number of uncomfortable questions arise. Will civil society find the means to reclaim the social and collective foundations of the public systems that are being abandoned by government and annexed by capital? In an era where free market ideas and the influence of capital reign supreme within government, can the state be trusted with public welfare? If not - and this is not merely hypothetical - what is the alternative? And finally, can social care be humanized?
In Canada, as in much of the industrialized west, most of the debate on the changing role of government has centered on government’s retreat from the provision of public services, largely as a response to the deficits of the ‘80s and ‘90s and the rise of the view that the private sector can do better. But changes in social policy and the delivery of social care have also been fuelled by widespread public discontent with traditional delivery systems. People were fed up with the paternalism, inflexibility, and dehumanizing attributes of state bureaucracies. The story of Annie and Al Albo recounted at the beginning of this chapter had become a pattern all too familiar for far too many people. Combined with the burgeoning public deficits this provided a fertile context for the rethinking of public services.
When universal social care systems were first established at the beginning of the last century, first in Western and Northern Europe and then later in North America, social, cultural, and economic conditions were far different from what was to evolve in the wake of the unprecedented material prosperity generated by capitalism. Throughout most of the 1900s, large portions of western society were still an accident or a sickness away from total ruin. Basic social security, health care, worker compensation, these programs were designed to provide a basic standard of care for large classes of people. It was an era marked by a mechanistic industrial paradigm, an age of assembly line automation that paved the way for the service based consumer society that has since come to replace it.
But this transition to a post-scarcity society has brought its own attitudes and expectations along with it. Chief among these is the accelerating individuation of society — the strange rise of the individual as someone who is defined solely by what he or she buys and the construction of personal identity as an extension of market forces. Fuelled by the relentless message of the free market, this has made choice in the marketplace a criterion of personal freedom and a symbol for consumer culture as a whole.
Previously, in the mass industrial age, basic health care and universal social security reflected a model of social care that was geared to large classes of people who lacked these necessities. Social needs were generalized. In the post-scarcity era, in the fantasy age of unlimited personal consumption, needs have become specific and concrete, reflecting the precise needs and preferences of individuals, not classes. With society awash in material goods people now expect that social goods and services will also recognize and respond to them as individuals. Their growing failure to do so provides one means of understanding a possible new future for civil society generally and co-operatives in particular.
The very notion of standardized systems of care that can be applied to all, regardless of personal preferences, has become something of an anachronism. And although the reaction against universalism is rooted in the dubious belief that basic needs have now been addressed, a belief that is willing to overlook the dire conditions of many that still struggle in poverty or barely survive on social assistance, yet it is a point of view that has become characteristic of the consumer age (or at least that segment of society that has the money to pay for alternatives, and is not prepared to wait in line). This is especially true with those public goods that are amenable to personal preferences, and most especially, to their improvement in quality by the expenditure of disposable income, for example health care, home care, services to the disabled, and public education. This shift in social attitudes, combined with the inability - or unwillingness - of the state to respond to the change in public expectations, has been a key factor in opening the way for the commercialization of social care. There is a growing market for it. Another factor was the failure of those forces that believed in universal public care to understand this change, to acknowledge its meaning and implications, and to provide progressive responses that were capable of addressing it.
What eventually arose was a twin movement. A push for more pluralistic and private models of care on the one hand – a continuation of the free market logic, and a contrary movement toward non-commercial, social economy solutions on the other. Both approaches call for more pluralism in how care is delivered and more choice on the part of the individual. They differ radically on how this should be achieved and this in turn derives from profound differences in the perception of what social care is.
The privatization of social care is the familiar route of the free market approach. The socialization of care on the other hand is less well known and less documented. The fact that it is also less lucrative for private interests goes a long way to explain why so little attention was paid to it. The other reason is that for two decades a relentless campaign to discredit government and the very notion of public services was conducted through all the available channels of the media and the academy by the think tanks and private sector promoters that championed the privatization of public services. The clamour for privatization - particularly in health care - has not subsided. There is simply too much money to be made. Despite this, and despite the growing demand for individualized care, public opposition to privatization of universal systems has remained strong. But something is changing nevertheless. A new interest has arisen in the role of civil society with respect to public welfare and social care."