The deserving sick: Income-maintenance policy towards the ill and disabled

Illness and disability often result in a serious loss of income. Government response to this problem has been piecemeal, so that there is a patchwork of different programs, some state and some federal, covering particular types of medical disabilities and particular categories of people. This article briefly describes existing programs and then evaluates income-maintenance policy towards the ill and disabled using four broad criteria: clarity of objectives, adequacy of coverage, adequacy of benefits, and equity. The general findings are that extreme program fragmentation in this policy area have led to competing (and sometimes inconsistent) objectives, large gaps in population coverage, benefit levels that do not meet even minimal standards, and tremendous inequities across different programs. Recommendations for improvement include the development of a more workable definition of disability and development of a guaranteed minimum income plan in conjuction with supplementary disability insurance plans.The author would like to thank Randall Bovbjerg and James Vaupel for their thoughtful criticisms.