The global crisis caused by the pandemic emphasised the importance of being able to rely on a solid public welfare system and shed light on the many limitations of such a system in our country. What can we do to fix this? It is definitively necessary to invest more resources and to have more public sector interventions, but that is not sufficient. The way services are provided is just counterproductive.
Overcoming the traditional model
Unfortunately, despite many successful experiences, the traditional model of welfare related public interventions all too often features hierarchical relationships that ignore the voices of service users, employees and citizens in general. In many cases service users even risk being treated as inferior parties. Moreover, impersonal and bureaucratised management practices that prioritise protocols and procedures over individual relational and care needs are very common. Whenever personalised interventions do take place instead the temptation to adopt a patronising approach is always lurking in the background. Besides, in light of the fact that needs are changing and that satisfying them requires the active engagement of the individuals that present them (chronic conditions are an example of this), the traditional model seems less and less efficient.
The pseudo-market (lack of) logic
The path taken in recent decades to face the weaknesses of the public sector with the use of pseudo-market mechanisms does not seem any less problematic. “Pseudo-market” is the introduction of market elements inside the public sector. The risk is that the typical weaknesses of the private sector are then added to the public sector ones.
“Pseudo-market” is the introduction of market elements inside the public sector. The risk is that the typical weaknesses of the private sector are then added to the public sector ones.
It is helpful to consider some examples. Over the past decades tax reductions became an element of the benefits system. This generated horizontal inequalities because whenever service users present the same needs the concessions tend to restrict service access to those who are able to pay and prioritise common/shared goods and services, with its associated “consumerism”, undervaluing network based services. Concessions (or tax expenditures) are a public expense, as the term “tax expenditure” suggests.
Another trend we saw is the increased use of external services and the so-called incentivising remunerations. The risk of relying on external services is that the quality of service provision worsens, especially around what concerns dimensions that are not observable, such as the level of care (the most important one). In addition to that, there is also the risk to damage the provision of care. In this sense it is particularly worrying to see the signs of increasing real estate activity in favour of businesses that want to invest in nursing homes.
Not to mention the similar issue concerning incentivising remunerations where the most extreme- unfortunately real- cases involve executive management of the Italian National Healthcare Service being rewarded for cutting excess capacity even though the maintenance of such capacity is a reason for public intervention, as it allows better preparedness for emergencies such as pandemic outbreaks. Once again the issue is that there are multiple dimensions to the quality of service provision and that many of these are not observable. The reduction in costs is obviously more evident than the potential repercussions on patients. The focus on obtaining external funding might mean more money but can also reduce the social motivation behind the work.
Pseudo-markets favour the differentiation between the best and the worst services.
Furthermore, if we consider these same observable quality dimensions of service provision, pseudo-markets favour the differentiation between the best and the worst, at the expense of the search for a general improvement of quality practices. The presence of significant social and local service provision inequalities can lead to the so-called “Matthew effect”, where the best facilities continue to improve and the worst ones are stuck in the opposite loop. Additionally the facilities that seem better might have benefitted from advantages that are not based on merit. For example, the greatness of schools depends a lot on the social composition of their student body.
Turning things around
Given the situation it is necessary to turn things around. In this sense, the concept of welfare meant as the common good seems very promising to those who believe in an entitlement-based welfare system. As Stefano Rodotà taught us, the common good is a set of “things that are functional to exercising human rights and to the free development of the individual” and it is created through management modalities that truly reflect its nature. Adopting a common good perspective means combining the dedication to human rights to the need to guarantee consistency within the institutional system. In other words, the system providing the services should reflect the values it is supposed to be based on.
Adopting a common good perspective means combining the dedication to human rights to the need to guarantee consistency within the institutional system.
What would change in the welfare system if we acknowledged that aspect? First of all, the provision of welfare services must be guaranteed equally and fairly to everyone, without favouring some groups and not others, as they constitute human rights. Obviously it is not always possible to do that. For example, fulfilling the right to an income is central to enable individuals to develop freely but providing the same income to everyone might prove difficult to do. A common good perspective would at least force us to verify that nobody is excluded from this right. In Italy, for example, this might mean cancelling the benefits’ eligibility criteria that, despite the step forward made with the introduction of the Citizenship Guaranteed Minimum Income (Reddito di Cittadinanza), still hinder access to this support for many people in need.
The diversity of the people needing welfare services
Furthermore, if the provision is meant to reflect the nature of the common good, then being able to represent the diversity of the people receiving welfare related services should be guaranteed. That means that, even though the government is still responsible for providing funding, defining what constitutes minimum support to satisfy basic needs, and monitoring and supporting good practice, local services should consider adopting more of a participatory model based on the co-planning and co-programming of services. How can all the parties involved be represented otherwise?
The welfare dimension also belongs to life forms that are different from the typical market ones, which has positive effects in terms of greater freedom.
Productivity, with its associated organisational and work remuneration modalities, should also reflect as much as possible the intrinsic value of the goods that result from it. In short, the direction to follow should focus on providing decent salaries, appreciating the public ethos and the provision of care, and adopting an approach centred on the relationship with and between the people who benefit from those services. In addition to these there should be more openness to social organisations and volunteering, to acknowledge that the nature of the common good is that it belongs to everyone. Therefore the welfare dimension also belongs to life forms that are different from the typical market ones, which has positive effects in terms of greater freedom.
Finally, for a welfare system- intended as the common good- to work everyone should claim concessions and benefits based on their individual financial situation and avoid relying on a common resource exclusively for personal gain.