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Social Security coverage faces economic hard times with a changing proportion of workers and elderly. An alternative plan can provide better retirement, survivorship, and disability benefits at reasonable cost.
In a social security system that includes prepaid, integral medical care, psychiatric services function in prevention, treatment and rehabilitation in a close relationship with the rest of medical care, the psychotherapies are part of an eclectic system of psychiatric attention, but also of the psychological aspects of institution-patients, institution-beneficiaries and institution-staff relationships. Within diverse psychotherapeutic schools, common denominators of the therapeutic process are outlined, as well as the background philosophy of the system.
This article explores differences in Social Security eligibility and benefit levels for older men and women using survey data from the Health and Retirement Study combined with administrative records on actual work histories and Social Security rules. We are able to determine the fully insured status of those persons, how close they are to meeting eligibility criteria when they are not fully insured, and their prospects for benefits. Around three-quarters of older women nearing retirement today will be fully insured for Social Security old-age benefits on the basis of their own accounts, but the rest would need substantial extra employment to rise above the eligibility threshold. Further, two-thirds of older married women who are fully insured have sufficient lifetime earnings to translate into an age-65 primary insurance amount worth at least half their husband's, but the other one-third can expect no additional retirement benefit from contributing to Social Security late in life. Finally, most wives will not be able to improve their benefits by working more under current rules. These results have mixed implications regarding the potential impact of women's rising labor force attachment on eventual retirement benefits. Working more years could increase women's chances of becoming eligible for Social Security benefits, but that effect is likely to be small. Furthermore, even when women do become fully insured according to the rules, not many wives will receive a higher benefit at the margin. The reason is that married women still receive higher Social Security benefits as a spouse than they do on the basis of their own work record. In fact, the net benefit from Social Security due to additional work is negative once one takes into account the Social Security contributions the women paid while employed. Benefits paid to widows are even more likely to be based on the spouse's work history rather than on the woman's. Hence, the rising labor market attachment of women in the future may increase their eligibility for benefits but will produce only modest (and often negative) impacts on their old-age Social Security benefits under current rules.
Most Latin American social security institutes are direct providers of medical care services to their beneficiaries. As many of the institutes have developed serious financial problems over the course of the last decade and a half, they have come under increasing attack for (a) exacerbating inequalities in access to and use of health care, (b) further heightening the geographic overconcentration of services, (c) focusing a disproportionate amount of resources on high technology, curative care to the near total exclusion of primary health care, and (d) being administratively top heavy and, more generally, inefficient. In the past few years, many Latin American countries have begun searching for methods to ameliorate these problems. This paper analyzes three recent efforts, all of which involve some degree of privatization: (1) El Salvador's partial privatization of specialty physician outpatient consultations, (2) Peru's minor surgery and its decentralized ambulatory care programme, and (3) Nicaragua's "administrative services only' approach wherein social security beneficiaries choose to join a certified public or private provider organization for one year, and, on behalf of the individual, social security pays the organization a fixed, annual, per capita fee to provide all health care for the enrollee. The paper also identifies political and technical considerations, as well as health care market characteristics that have shaped these efforts and that condition their likelihood of success, including: the size, composition, level of capacity utilization, degree of organization and geographic distribution of private sector resources; relative prices in the private vis-a-vis the public sector; and the size and nature of the private health insurance market. Other Latin American countries would do well to examine these factors and characteristics before embarking on efforts to reform their own social security health care delivery systems.
Widow benefits have been a part of the Social Security program since the 1939 amendments to the Social Security Act (widower benefits were added later). For many years, the Social Security law called for paying a widow(er) a fraction of the deceased worker's primary insurance amount (PIA). However, the worker--while alive--may have received the full PIA as his or her retirement benefit. Over time, arguments were made that a widow(er) should be treated as generously as his or her spouse was. The 1972 amendments to the Social Security Act allowed for a widow(er) to receive a full PIA, subject to actuarial reductions if the widow(er) benefit was claimed before the normal retirement age (NRA) and subject to a new provision of the law commonly referred to as the widow(er)'s limit. Generally, the widow(er)'s limit specifies that if a worker received reduced retirement benefits (because the worker claimed benefits before the NRA), then the worker's widow(er) cannot receive a monthly benefit equal to the full PIA. Rather, the widow(er)'s benefit is generally limited to the amount the worker would receive if he or she was still alive. The limit provision appears to be motivated by the overall intent of the 1972 Congress to pay a benefit to a widow(er) that was comparable with what the worker received. A number of changes to the limit provision have been discussed. This article looks at the following options: Abolishing the limit, Raising the limit by requiring that it never be set below the average PIA among all retired-worker beneficiaries. Adjusting the limit for some widow(er)s--that is, only persons who are widowed before the NRA (the ARLA option), Making a simpler adjustment to the limit by abolishing it for persons who are widowed before age 62 (the SARLA option), and A proposal by Robert J. Myers that would make modest adjustments to the limit for cases in which the worker died before the NRA. The most fundamental change--abolishing the limit--would increase benefits for about 2.8 million widow(er)s and would cost about $3.1 billion a year. Most of the additional government expenditures would not go to the poor and the near poor. Another change would be more successful in aiding low-income widow(er)s: requiring that the limit amount never be set below the average PIA among all retired-worker beneficiaries. About 58 percent of the government expenditures from that option would be received by the poor and the near poor. Overall, 1.2 million widow(er)s would be helped, and the cost would be about $816 million a year. Although the limit provision is consistent with the overall intent of the 1972 Congress, it can have effects that may have been unintended and that some policymakers might consider unusual. Persons who delay receipt of Social Security benefits usually receive higher monthly benefit amounts, but a widow(er) who faces a limit cannot increase his or her monthly benefit through delayed receipt of benefits. Thus, many persons who are widowed before the NRA face strong incentives to claim benefits early. That is somewhat unusual because the actuarial adjustments under Social Security are approximately fair, so there are no cost savings to the Social Security program from "forcing" a widow(er) to claim early benefits as opposed to allowing him or her to delay receipt of benefits in exchange for a higher monthly amount. And many widow(er)s would be better off if they could use the Social Security program to, in effect, save (that is, delay receipt of benefits in exchange for a higher amount later). This article analyzes two other options that would provide widow(er)s with additional filing options under Social Security. The ARLA option would ultimately help about 229,000 widow(er)s, and the cost would be small (about $69 million a year). The SARLA option would help about 117,000 widow(er)s, and the cost would be about $41 million a year. Robert J. Myers, a former Chief Actuary of Social Security, has offered a proposal that would provide relief from the widow(er)'s limit in cases in which the worker dies shortly after retirement. That proposal would help about 115,000 widow(er)s, and the cost would be low (about $57 million a year).
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Using data from the Social Security Administration's 1982 New Beneficiary Survey, we tested a life-course model that suggests that early- and late-life caregiving reduce monthly Social Security benefits of newly retired women workers. Each child raised was associated with a loss of $8 to $16 dollars in the 1983 Social Security primary insurance amounts (PIAs). The 1983 PIAs of women leaving their last jobs to care for others were $127 lower than the PIAs of women who left because of the availability of Social Security benefits, to receive a pension, or because they wanted to retire. Leaving work to care for others exerted a stronger depressing effect on the Social Security benefits of women with low- and moderate- as opposed to high-earnings histories.
In the early years of the Social Security program, public support for old-age pensions was high but knowledge and understanding about benefits and taxes were low. Understanding has greatly increased, even though the program has expanded, and support for Social Security has remained high. Data from the surveys and polls examined in this article indicate that support for Social Security was strong even during the late 1970's and early 1980's, when a fiscal crisis generated a crisis of confidence in the public's perception of the system's ability to pay benefits in the future. The proportion of the American public declaring confidence in the program declined sharply from a large majority with confidence (63 percent) in 1975 to a minority with confidence (39 percent) in 1978. Following the restoration of program financing through the provisions in the 1983 amendments, the trend has reversed. By 1988, nearly one-half of the public expressed confidence in the future of the Social Security program. For the most part, other aspects of public opinion regarding Social Security have shown great stability over the years. The program is popular and has been well-supported. Support for the Government to spend more for Social Security has been consistently high, as has support for benefits to increase with inflation and for benefits to increase even if it means higher taxes. Many individuals rely on income from Social Security or expect to rely on it when they retire. It is clear that the public wants the program to continue. If participation were optional, about three-fourths of the population would stay in the program.
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The Social Security Administration is issuing interim regulations to implement sections 1, 3, and 4 of Pub. L. 96-473 (enacted October 19, 1980) that make a number of changes in the application of the earnings test for retirement purposes. The provisions are designed to eliminate some unintended and harsh effects of the limitations on the use of the monthly earnings test imposed by the Social Security Amendments of 1977. Section 1 permits the use of the monthly earnings test by those beneficiaries entitled to child's benefits, young wife's and young husband's benefits (entitled only by reason of having an entitled child in their care) or mother's and father's benefits, in the year that entitlement terminates, if termination is for a reason other than death and the beneficiary is not entitled to another type of Social Security benefit for the month following the month of termination. Section 3 excludes from gross income, for purposes of the annual earnings test, self-employment income which is received in a year after the initial year of entitlement to insurance benefits under title II (other than disability benefits and childhood disability benefits) and is not attributable to services performed after the month of entitlement. Section 4 provides for all beneficiaries the use of the monthly earnings test in the first taxable year after 1977 in which a beneficiary has a non-service month in or after the month of entitlement to benefits.
International social security agreements are advantageous both for persons who are working now and for those whose working careers are over. For current workers, the agreements eliminate the dual contributions they might otherwise be paying to the social security systems of both the United States and another country. They also favorably affect the profitability and competitive position of American companies with foreign operations by reducing their cost of doing business. For persons who have worked both in the United States and abroad, and who are now retired, disabled, or deceased, the agreements often result in the payment of benefits to which the worker or the worker's family members would not otherwise have become entitled. Credit for social security coverage the worker earned in the United States and the other country can be combined, if necessary, to meet eligibility requirements, and partial benefits can be paid by one or both countries. Because international social security agreements benefit both workers and employers, the agreements program is supported by organized labor and the international business community. Since the first agreement was signed 15 years ago, every Presidential administration has endorsed the program. In view of this support, and the fact that the agreements enhance the image of the United States as a socially progressive member of the international community, it is expected that totalization agreements will be concluded with additional countries in the future.
Based on published and unpublished data from the Bureau of the Census and the Social Security Administration, an assessment is presented of how major racial/ethnic groups in the United States fare under Social Security. The Social Security Act was signed into law in 1935 to provide economic security to U.S. workers. Today, there are some 44.5 million Social Security beneficiaries in this country. The majority of these beneficiaries are retired workers (62.3 percent) with survivors of deceased workers comprising another 11.6 percent. Several aspects of the Social Security system are particularly important to minority groups. The data indicate that minorities rely more on Social Security benefits in retirement than do whites. In comparison with only 16 percent of white elderly beneficiaries, one-third of elderly blacks and one-third of elderly Hispanics depend on Social Security payments for 100 percent of their retirement income. Minorities also have less retirement income from other sources, such as pensions and assets, than do whites. Both blacks and Hispanics tend to have lower earnings than whites and, thus, benefit from the progressive benefit formula of the Social Security system. Further, blacks, with shorter life expectancies, benefit more from the disability and survivors benefits than do whites. Social Security has a major impact on poverty rates, particularly for minorities. Without Social Security benefits and no other changes in savings or pensions, poverty rates would be around 60 percent for blacks, Native Americans and Hispanics versus 24, 12 and 20 percent, respectively, with Social Security benefits. The U.S. minority population will continue to grow in both numbers and proportions. By 2050, almost half (47 percent) of the total U.S. population will be minorities due principally to growth in Hispanic, black and Asian populations. The increasingly diverse population will change the composition of the nation's workforce as well as the size and makeup of its elderly population. These demographic changes will be important to consider when evaluating the future role that Social Security will play in the lives of these changing populations.
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