Public Policy from the Vantage Point of History

How Policy Legacies Shape Policy Performance

By Edward Berkowitz

Our time of pandemic and economic recession exposes the deficiencies in our social welfare policies. Since new policies are so hard to create, we invariably rely on old policies, with their own peculiar histories and origins, to face new challenges. Sometimes an old program is an awkward fit for new problems. After all, these policies emerged in particular contexts that were different from those we face today.

I have devoted my academic career to studying the influences of history on public policy. My most recent effort is Making Social Welfare Policy in America: Three Case Studies Since 1950, published this year by Chicago University Press. It argues that inevitably we respond to new problems with old programs. Close historical study of a program’s origins therefore aids in the analysis of public policy. The program’s initial structure — a product of a largely serendipitous historical process — determines its future course.

Legislated in 1956, Social Security Disability Insurance, the first of my case studies, allowed people with physical or mental impairments that lasted for an extended period of time, to drop out of the labor force and claim Social Security benefits for which they would otherwise have had to wait until they reached retirement age.

The developments that aided its passage included the consolidation of the organized labor movement into the AFL-CIO in 1955, strengthening its political clout. Particular events, exclusive to the moment of the program’s creation, mattered, such as the retirement of Senator Walter George, the conservative Georgia Senator, in 1956 and his desire to insure his legacy by sponsoring a liberal piece of legislation. That basic program could be expanded in some ways, such as lowering the age of eligibility, but not in others, such as changing its unusual state-federal structure in which individual states make disability determinations under contract to the federal government.

That mattered in the long run because state determination of disability created inefficiencies and inconsistencies in the program which have yet to be remedied. That mattered because the strict definition of disability adopted in 1956 — the inability to work — thwarted the desires of those who proposed a rehabilitation rather than an income maintenance approach to disability. When public preferences changed to make the civil rights, and particularly the right to employment, of people with disabilities a major objective, legislators had to work around the Social Security Disability Insurance program, leaving it in place and adding the Americans with Disabilities Act in 1990.

When Congress passed Medicare, my second case study, in 1965, it created a health insurance program with two distinct parts. One part, funded by payroll taxes, paid hospital bills, and the other part, funded by premiums collected from beneficiaries by the federal government and general revenues, paid doctors’ bill. Examining the events surrounding the program’s creation reveals that Republicans on the Ways and Means Committee wanted to offer some sort of alternative to the administration’s health insurance bill that covered the hospital costs of the elderly. This alternative became Part B of Medicare which covered doctors’ bills.

Once in place, the two parts of Medicare have remained in place to the present day. Because Medicare’s administrative structure is so rigid, policymakers have had to add new parts to the program to accomplish modern policy objectives.

In the era of George W. Bush, Congress legislated a prescription drug plan keyed to the Republican preferences for private administration and the encouragement of market forces. Because of Medicare’s locked down structure, that required the enactment of what became Medicare Part D. In creating a new part for the program, policymakers had to leave the core of the program intact and build on top of it.

The emphasis I put on origins in Making Social Welfare does not explain the development of all important social welfare policies. Sometimes the gap between a program’s original objective and modern conventional wisdom becomes too large for an existing program to bridge. Welfare, the third of the case studies in my book, provides a classic example. Created in 1935 to keep needy mothers at home with their children, the Aid to Families of Dependent Children program proved unable to shift its identity and become a means of putting mothers of dependent children to work, despite the desires of all the presidents from John F. Kennedy to Bill Clinton.

In 1996 a realigned Congress decided to abandon the program altogether and replace it with a new block grant program called Temporary Aid to Needy Families. As with the other programs, the only way to explain the 1996 legislation is to examine what happened in 1996 in detail and to appreciate such things as the strong desire among conservative Republicans to prevent “illegitimate” births.

Even in this last case, history helps to illuminate modern features of public policy. For example, states, rather than the federal government, administer the new program, just as they have since 1935. The very categories that we use in public assistance, such as dependent children, the elderly, the blind, and the permanently and totally disabled, reflect decisions made by the Congress that passed the Social Security Act in 1935.

The case studies in Making Social Welfare Policy contain lots of stories about how public policy gets made and how programs get amended. I find that the origins of programs, and in particular their administrative structure, matter to their future development. Furthermore our programs almost always lag behind the current conventional wisdom. Often when we try to remedy modern problems, we forget the histories of the programs already in place, depriving policy analysts of an important analytical tool.

The question now is whether these foundational social programs are up to the job of responding to massive unemployment and the lack of health insurance that often accompanies it. It is time to examine those programs’ history through a historical lens and determine what makes sense today.