Our Free Market Model to Deliver Social Services Isn't Working

By Brian T. Lynch, MSW

You’ve noticed your mother is aging more quickly in the last few months and is much more forgetful.  Maybe she is also having trouble walking and seems frail or unsteady on her feet.  Perhaps you are a young couple with an infant and your beautiful baby girl seems a little developmentally delayed or just not quite right somehow.  What if your adolescent son is skipping school, staying out late and getting in trouble with the law, or you've been diagnosed with a serious medical condition, or someone you love has been injured or suddenly disabled?   When (not if) you find yourself in a moment like this you will be knocking at the front door of America’s social service networks.  What greets you may be far less than you expect.

Most people don’t give much thought to the social services available to them until they need help. It’s then they often encounter a confusing labyrinth of public, private and non-profit agencies that make up their community’s “social service network”.  These local networks are an array of overlapping or disconnected services with confusing acronyms for names.  These agencies may have income eligibility, municipal boundary or geographic “catchment area” restrictions.  Some services can only be accessed through other public agencies. Some agencies take private insurance but not Medicaid or Medicare.  Others accept private insurance from only certain carriers.  Some have sliding fee scales, others don’t.  Local agencies may be funded to serve only certain target populations, such as children over or under certain ages or veterans, or only those with certain qualifying conditions.  If your needs are even a little complicated or require several types of services, you may need experts, such as case managers,  to help you navigate the social service system in your area.  Once you do become involved with local service networks (and especially if you work in the field) you will soon see glaring service gaps or redundancies in certain areas, huge disparities in the quality of services from place to place, inconvenient hours of service or critical services located in areas not accessibly by public transportation.  

This patchwork of publicly funded social services forms local and regional social service networks made up of private service providers, non-profit agencies and certain government offices.  The actual networks created are less the result of social service planning than of market forces in our “free market” system of funding social services in America.  Under this system both non-profit and for profit social service agencies compete for public tax dollars to meet the social service needs in the community.  

For more than thirty years we have been privatizing public social services based on this free market model.  The rationale for this public policy decision has been that free markets are more efficient and government is too big and ineffective.  But little attention has been paid to the inevitable consequences that a market driven system will have on the distribution of services across vastly different demographic areas. 

Larger and more affluent social service organizations are better positioned to compete for public dollars and expand their services.  Smaller agencies that may be in a better position to meet local needs are often unable to successfully compete for funding.  Social service “products” are becoming more generic, or less individualized to the needs of particular communities or individuals.  Our social service delivery model has produce greatly unequal access to services with some geographic areas rich in services while other, often neighboring areas suffer due to fewer or inferior services. 

We have come to the point in America where the quality and availability of essential services needed by, say a child for instance, becomes an accident of birth or where their parent happens live.  The financial crisis since 2008 has caused us to rethink our ideas and biases about our brand of free market economics.  We should now be no less vigorous in rethinking the application of the free market model to the delivery of essential, tax payer funded social services.

Not surprisingly, the free market approach to social service delivery mirrors what we see today in our free market economy.  Larger corporations have tremendous advantages over smaller, more local businesses.  Most of the mom and pop store that once served local communities have been driven out of business.  Chain stores that replace them tend to locate in more profitable communities and away from less profitable or economically blighted areas, further adding to the decline of poorer communities.

Another consequence of our particular brand of free market capitalism is the tendency of large corporations to optimize profits by catering to the average, hence largest segments of the population.  For example, big retail clothing outlets carry a range of sizes that is narrower than the population as a whole.  This forces some customers to shop in higher priced specialty stores and settle for less fashionable clothing.  In another example,  privatized bus and rail services tend to drop less profitable routes isolating those who can’t drive.  This  can have a disproportional impact the poor or elderly living in commercially less viable areas. In fact, the free market model is efficient, in part, because it discriminates between profitable and less profitable geographic markets or market segments. 

What then makes the free market model the best approach for dispensing publicly funded social services, especially since the distribution of need for services is so often found in commercially unviable communities?

This is a question I hope to explore in future posts.  I hope to elaborate on this discussion of our social service delivery model.  


For now, however, please consider a minor example of how a alternative system might look. The example below may serve as a window into a different ways of thinking about social services.

Imagine the benefit of a seamless partnership between public health, education and community social services conveniently located in public buildings distributed throughout cities and local communities across America.   Imagine if each of these public facilities provided modern classrooms, resources and teachers to educate our children during the day and provide remedial and secondary educational services to adults in the evening. These facilities would also provide after school and evening sport and recreational opportunities for the community.  Imagine each of these facilities having community health clinics or screening centers staffed to meet the local public health needs of these children and families.  Imagine each of these facilities serving as comprehensive social service intake and referral centers for families and the surrounding community .  Each of these local facilities could be configured, staffed and funded to best meet the local needs of the immediate surroundings.  A network of these local facilities would have among its goals the elimination of health, educational and social inequality and the provision of equal access to all public services.

This might seem like a grandiose plan, but much of the bricks and mortar infrastructure already exists to support it… our public schools.  Public schools are located in the communities they serve and more accessible than most social service agencies serving the same community.  

This concept above is a small start, yet it goes well beyond what is currently under construction in the field of Education today, for example.  Some work is being to to develop what is being called “full-service community schools".  An example of this can be found on the Website of Steny Hoyer, a Congressman from Maryland and from the Oakland Unified School District, in California, which is attempting, with some success, to implement this model. 

Full-Service Community Schools - Thinking Outside the Classroom

Why do so many schools have auditoriums? Why do they have athletic fields?

We take features like those for granted today, but there was a time when a school building with anything more than classrooms and chalkboards was considered wildly unorthodox. But, more than a hundred years ago, educators came to realize that schools can be more than simply places for instruction: they can be the center of their communities.

Indeed, classroom education is only one piece of the puzzle when it comes to ensuring that all children succeed. The notion of building a future of opportunities for our children through community partnerships that give them and their families the tools they need to grow and thrive is at the heart of the full-service community schools movement.

Full-service community schools work with local organizations and the private sector to coordinate a wide range of services for students and families. At a full-service community school you might find health clinics or dental care, mental health counseling, English lessons for parents, adult courses, nutrition education, or career advice. For high-need communities that require social services, there is no more welcoming -- or efficient -- place to house them than in a public school. Schools like these quickly find a place at the heart of their communities, staying open long after school hours and on weekends, giving neighbors a place to come together and participate in the education of their children.

Here in Maryland, we have seen the success of such a model in our state's Judith P. Hoyer Early Child Care and Family Education Centers, or "Judy Centers." The 24 Judy Centers throughout Maryland promote school readiness through collaboration among community-based agencies and organizations located within each Center. State evaluations of the Judy Centers have shown increased access to high-quality programs and services for low-income and special needs children and that they improve school readiness and minimize the "achievement gap" at the start of first grade.

A decade of research on full-service community schools has consistently shown that they promote higher student achievement and literacy, stronger discipline, better attendance and parental participation, a reduction in dropouts, and increased access to preventive health care (a factor that is especially urgent as we face a possible flu epidemic).

With these benefits in mind, Congress is considering legislation I have introduced that could greatly expand the number of full-service community schools in America -- one of the most important pieces of school legislation in recent years. It would provide grants for states and school districts to work with community organizations and businesses to create the kind of programs that have had so much success at schools across America. Strengthening services in schools also has the potential to save our country money on everything from prison systems to emergency room visits.

  

Oakland Unified School District:

A Full-Service Community School in Oakland serves the whole child; it invites the community in and extends its boundaries into the community in order to accelerate academic achievement; it shares responsibility for the student, family and community success. 

http://www.thrivingstudents.org/reference-materials