Donna Shalala: Healthy Hopes

Few members of the Clinton cabinet have navigated the treacherous shoals of Washington, D.C., as deftly as Donna E. Shalala, the outspoken secretary of health and human services. Frank, feisty and folksy, Shalala is an ideologue with a knack for getting things done. An unrepentant believer in the safety net, she has helped smooth the way for states to experiment with welfare and Medicaid reform. A staunch defender of women's issues, she has revamped the nation's policies on breast cancer. A public health advocate, she has poured money into AIDS research, worked to immunize toddlers and funded flu shots for the elderly.Shalala was born on Valentine's Day in 1941 to a middle-class Ohio family-her father ran a grocery store, her mother was a schoolteacher. In 1970 she moved to New York City to begin a spectacular academic career at Hunter College that culminated in her becoming president in 1979. She was appointed chancellor of University of Wisconsin-Madison in 1987, the first woman to head a Big-10 university.Shalala is hardly an ivory-tower academic, however. The diminutive secretary likes to ditch her Secret Service bodyguards on weekends and go tooling around in her green Mustang convertible. With her fast-talking New York street smarts and her lopsided smile, Shalala comes across as tough, practical and funny. She's also an astute partisan. In her speech, welfare recipients are always "working families," and health care access is always about "kids with earaches."Reporter Chris Lydgate caught up with Shalala between campaign stops, where, under the steely gaze of her bodyguard, she talked about welfare reform, the working poor and the eternal mysteries of life.Have you ever been on public assistance? Welfare, food stamps?Yeah. It's called the National Defense Education Act -- college loans. And mortgage deductions for the houses I've owned. I mean, let's be real. All of us get help from the government. For some people it's direct assistance, cash assistance. For others, it's help going to college or buying a house.So when people talk about the corrosive effects of being on welfare, you don't think it's simply a matter of getting money from the government.I think it's a matter of not having a goal or an opportunity and being left with the responsibility for children. I think it's the breakdown of the understanding that we ought not to have children until we're emotionally and financially ready to take responsibility. And that men have as much responsibility as women. The best protection for American children is parents who want them and who can take care of them.Isn't that the Republican approach to welfare reform?You can't do JOBS Plus and take as much money out of the system as the Republicans want to. The fact is, the Republicans are supporting the end of guarantees. If you have an adult disabled child, you can't get health insurance. That's scary. They want to end the guarantee that poor kids will get decent health care. That's scary, especially for the parents of every kid who sits next to that kid in the classroom. The Republican plan would push 1.5 million American kids into poverty.One of the elements of the Republican proposal is to reduce the number of disabled kids who get social security disability. Are you concerned about the steep ramping-up of that population?>?That increase is partly the result of a court ruling. Some of those kids need to be reassessed and others don't. But you don't arbitrarily throw millions of kids off the welfare rolls without being extremely careful. These are children! Nor do you second-guess their parents about how money could be spent to help them.But is there enough money to pay for the bureaucratic apparatus for reassessing them?As long as you don't want the Republican tax cut for the rich, we've got plenty of money! The problem is, to get their tax cut, they cannot be careful about poor children. So they make crude decisions and throw all these kids off automatically. Because they're not trying to do welfare reform. They're trying to finance a tax cut.Clinton campaigned on a platform of ending welfare as we know it...And we put out a plan to do that. The Republicans didn't like it much, because they said it didn't save enough money. You have to spend money up front, to give people the job experience so they can move into the private sector. What has Oregon done? It has taken the welfare money and, instead of cutting the bejeezus out of it, it took the money and gave it to the private sector to give people some job experience. A job in the private sector is the most important thing that we can do for people. But the private sector can't take the risk on someone who doesn't have any experience, so we'll subsidize that job for a period of time.Everybody that knows welfare reform believes that you have to spend some money up front to save it in the long run. The people of Oregon are willing to spend money if they think that people are honestly getting some real work experience and getting into the job market so they can support their family. The difficulty is not getting people jobs but keeping them there.What do we owe people who aren't willing to work?Nothing. [Pause] But we've got to protect their kids. Most people who have kids are willing to work. They need a hand up, not a hand-out. They put people to work right away in Oregon. For most people, that's a good idea. Sending them in to the work force, early on, is important.What about increasing the minimum wage?We want to do that. If you get up and go to work in this country, you ought not to have to bring up your children in poverty. It's in the interest of this country to have every family lifted above the poverty line. There are thousands of families who are working, but still need food stamps.What's wrong with block grants?I have two main objections. One is you destroy the guarantee for the disabled, for poor children. So you're at the mercy of the economy of the state. You've got an uneven system, where justice is dependent on geography. Where a kid is born will determine whether they get decent health care. That changes the definition of what it means to be an American.Second, if the economy goes bad in some part of a state, the genius of the guarantee system we have is that it kicks in for working families. Welfare rolls and Medicaid and food stamps go up when the economy goes into a tailspin. If a business leaves, people need those programs as a transition to support their families. That's called economic stabilization. You don't need it all the time. But when the timber industry goes belly up, you need that program to kick in. It's critical in rural areas, when people lose their jobs. And if you don't have that automatic system, the state has to raise taxes to take care of those people-the wrong time to raise taxes!So the federal government has always played this role, with an automatic increase if there's a downturn in a state's economy. That's a safety net for every working family. Because the people who go into those programs have been working. The poorest of the! poor get taken care of in the block grant. It's working folks that get hurt.I don't understand.What happens [with block grants] is that you take care of the poorest of the poor first. Then you run out of money for those who are marginal. But who are the marginals? They're working poor who lose their jobs, or middle class families who need a little help because the breadwinner lost their job. Suddenly they've got no income -- all they've got is their house.The entitlement isn't there to keep people on the dole. It's there to protect people for short periods of time when their fortunes change. It's in everybody's interest to keep those programs.This is sort of whimsical, but do you know why the Pentagon has five sides?No. [Pause]I've been asking people this for years, no one seems to know.Uh, Let me guess. [ticking off her fingers] Army, Navy, Air Force, Marines. I have no idea. But when I get back to Washington, I'll ask [Defense] Secretary [William] Perry.That would be great.

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