THE current debate over health care in the United States illustrates the difficulty of creating social policy in the 1990s along with the delivery system to implement it.
The US may be so large and diverse that a relatively simple social plan like Social Security, launched in 1935, cannot be accomplished. With so many vested interests, and so many proponents of differing values in the US putting pressure on government, a satisfying, effective national health program may be illusory.
Jonathan Freedman, a 1987 Pulitzer Prize winner for editorial writing, suggests that health care ought to be part of a larger ``life-span'' program addressing human needs from birth to death. In his new book, ``From Cradle to Grave: The Human Face of Poverty in America,'' Freedman argues persuasively on behalf of a new guiding ``image'' for government when it comes to helping people: Provide a handrail instead of a safety net.
Health care is part of Freedman's handrail up the staircase. So are strengthened child-development programs, family support services, and Social Security. Freedman's approach in building his argument is to tell detailed stories of people at all stages of their lives, who are lifting their lives out of abuse and hopelessness with the help of some ``low-cost, high-yield'' programs and innovative social agencies.
``I find simple life stories more persuasive than brilliant, abstract arguments,'' Freedman writes. What alarms him, and prompts his book, is the depth of the domestic crisis in the US. Last year 37.5 million people fell below the poverty line. Forty percent of the poor are children.
Freedman found a number of community groups or organizations that help troubled lives in poverty. Two stand out: School-Based Youth Services in New Jersey and the Citizens Advice Bureau in New York.
The first program puts ``services where the kids are'' and provides mental health and family counseling, primary preventive health services, employment services, and substance-abuse counseling. Schools with the program unanimously praise it.
The second program is a store- front, walk-in counseling service with nine offices in New York. Anybody who walks in the door will get some kind of help and support, ``a human connection for people stymied by the system.''
For Nitza, a desperate, lonely, and homeless Latino woman, the Citizens Advice Bureau saved her life and her children. Or rather it was Myrna Perez, the counselor behind the desk, who began Nitza's turnaround when she said to the bedraggled, foul-smelling woman, ``I see good in you.''
Freedman explains that Nitza credits Ms. Perez's faith in her ``for giving her the first justification to have faith in herself'' and was like a ``point of security from which to climb.''
In fact, this kind of one-to-one boost and reassurance happened often enough in Freedman's research and talking with people that the experiences ``have convinced me that the healing of the soul, whether through psychological treatment, prayer, or other means, is as much a part of fighting poverty as economic relief.''
For anyone who wonders how people become ensnared in poverty and abuse and how government often fails to help them, this is a book of genuine clarification. Written with a straightforward style free of jargon and excuses for the poor or government, Freedman's book does not offer a detailed plan of how to get beyond what exists now. Rather, he argues convincingly that success in programs already under way indicate that solutions are here.