The US welfare state has a lot of problems. Most conspicuously, it lacks many benefits found in similarly developed countries like child care, paid leave, and universal health care. These omissions tend to dominate the public debate, but creating a decent welfare system will require more than just adding new benefits. We also need to clean up and rationalize the welfare state we already have.
In this paper, I propose a series of moderate reforms to major welfare programs including Medicare, Medicaid, Social Security, Supplemental Security Income, Unemployment Insurance, and Supplemental Nutritional Assistance Program. The overall purpose of these proposed reforms is to move towards a welfare state that is simpler, more coherent, and more centralized.
After the reforms in the paper are implemented, every elderly, disabled, and unemployed adult will receive public health insurance from a consolidated Medicare program as well as an earnings-related cash benefit or a minimum cash benefit equal to the one-person federal poverty line. Every individual in need of long term services and supports will be eligible to receive benefits from Medicaid regardless of their income or assets. SSI for disabled children will become a universal SSDI allowance for disabled children. The SSI program and most of the Medicare savings programs will be eliminated. And SNAP will become a full-blown negative income tax based solely on a family’s gross income.
Due to these changes, billions of pages of paperwork currently dedicated to recording income, assets, and expenses of households will be eliminated. Hundreds of state-level SNAP and UI programs will also be eliminated as the programs are centralized into the Social Security Administration.
Beyond administrative streamlining, these changes will also fill in most of cracks in our existing welfare programs. Waiting periods for receiving disability benefits or Medicare are eliminated. Unemployment benefits are extended to all jobseekers, not just those with certain earnings records. And many asset and income tests are eliminated to ensure that everyone in a qualifying category — such as elderly, disabled, or unemployed — receive the benefits they deserve.