Last March, The New York Times carried the story of John Knigery of Portland, Oregon. The eighty-two-year-old victim of Alzheimer's disease was found abandoned near the men's room of a dog-racing track in Coeur D'Alene, Idaho. A picture showed him in a wheelchair, clutching a teddy bear, as attendants loaded him onto an airplane for the flight back to Portland and whatever arrangements awaited him there.
To seniors, John Kingery's story is their worst nightmare; to baby-boomer adults, it is a dread picture of a future not as distant as it once seemed. According to the American College of Emergency Physicians there are over 70,000 cases a year of this "granny dumping"--and many more to come, if current trends continue.
The plight of people like John Kingery has become a kind of ideological Rorschach. To those on the left, it suggests Reagan budget cuts and the decline of social services. To the right, it suggests a society so benumbed by government programs that people neglect family obligations. There are elements of truth on both sides. But the roots of this problem go deeper than these hackneyed cliches of the conventional debate.
A basic function of a society is to bring needs and resources together. But in America today, vast needs exist alongside vast resources of unused time, particularly of retired people and the young. The first impulse might be to call this a failure of economics, since the market is how Americans generally believe that needs and resources come together. But the failure here is greater, and more basic--that of the informal safety net upon which a market economy depends. Grandpa used to move in with Aunt Millie or one of the kids. Neighbors would check in to make sure he was okay. James Thurber's riotous accounts of his childhood in Columbus, Ohio, recall those extended family arrangements.
Of course, this system hardly worked for everyone. Many of the elderly were left in dire poverty, which is why we needed Social Security in the first place. But families and neighbors--most often women but children and retired folks as well--did provide a lot of care for those who could not provide for themselves.
The political right loves to evoke such ties as a lost Eden. But they have no real ideas for rebuilding that Eden, largely because they are not willing to face up to what pulled those ties apart. In the first instance, it was not government programs so much as the modern market economy that disrupted the extended family--that led family members to work and live far from each other, that brought commercial influences into the living room through the media, and that turned the neighborhood into an carport. It is not welfare programs, moreover, that separate young people from old but rather an age-graded society that isolates the generations from each other and provides few crossroads where they could meet or even come to appreciate each other's needs. In both cases, the market was turning things people used to do for one another into things they had to buy for money. For the most part, government programs merely continued this process, trying to address damage already begun.
Today, the need to repair the informal safety net is not a mere figment of nostalgia but a hard budgetary fact. The federal government is spending enormous amounts for the care of the sick, the elderly, and children. Yet as needs grow, resources can't keep pace--if resources continue to be defined in terms of services bought with money.
But quietly a new kind of community-building has began to appear across the U.S. It is based on the principle of the blood bank, except that people contribute time. Help a neighbor and somewhere down the line a neighbor--probably a different one--will help you. These networks, called Care Shares or Time Dollars, have turned neighborhood organizations into communities of reciprocal self-help. They have turned people the market defines as useless--retirees, the young, and "disabled"--into a productive community resource. They have spread rapidly to over a hundred localities, and to such countries as Sweden and Japan as well. The U.S. Administration on Aging is funding service banks under the Older Americans Act, and Florida has embraced this dynamic to try to rebuild community cohesion in the rubble of Hurricane Andrew.
To be sure, such efforts are not free of difficulties. They require money to start; and with people working longer hours, not everyone has free time to contribute. But they illustrate the need for new social inventions that lie outside both the government and market realms and that can take the much-heralded "traditional values" and give them traction in the real world.
THE NEIGHBORHOOD WE HAVE LOST
In the past year, I have talked to older people across the United States about the kinds of neighborhoods they grew up in. They recalled a world that is rapidly disappearing--the local grocers who carried the family on credit until the paycheck came, and the neighbors who brought home-made soup to people who were ill. "On the farm, if you ran short of help, they come and give you a helping hand," a lay preacher in Maryland recalled of his boyhood neighbors in rural North Carolina. "They weren't relatives, but just like relatives."
These seniors were talking about an informal safety net that turned their neighborhoods into a kind of extended family. Now that they need its support, they feel the loss acutely. "We knew everybody on our street, and everybody looked out for each other," says Esterlene Colbrook, a retiree in Miami, of her old neighborhood there. "If you had to go to the store, you didn't have to worry about baby-sitters. You just called across the street and said, 'Watch out for the children.' That was my raising. That's what I was used to. Everybody on the street was kin to each other."
It is common today to dismiss such memories as nostalgia. But though the good old days were not always so good, there was probably more social cohesion--an element in the "standard of living" omitted from official definitions of that term. The nation counts Fritos consumed each month, to the last bag. But no agency tracks the plight of neighborhood culture and informal exchange. The decline is clear enough, however. A recent J. Walter Thompson poll, for example, confirmed what many Americans sense: almost three out of four Americans do not even know the people who live next door; and two-thirds said they never give time to community affairs. There are exceptions, of course, such as the way gays have formed networks of support with people with AIDS. But these draw attention today for the very reason that they are so different from the disjointed norm.
The right has seized upon the nation's brooding sense of disconnection and turned it into an emotive political fable. Once there were happy families and solid neighborhoods. Then came the government with its social programs. Crime, decay, and moral dissolution were the inevitable result, or so they say.
Of course, the decline of traditional ties hardly began with the Great Society. The bonds of family and community have been eroding in America almost from the day the Pilgrims landed. The early settlers tried to build cohesive communities on the old-world pattern by clustering homes around a commons. But with empty land beckoning to the West, it was not long before the sons were setting out on their own. To some degree, the westward migration consisted of whole communities, rather than individuals. But the centrifugal pull of the frontier could not be resisted for long.
It is a familiar story, yet one somehow forgotten in the political mythologizing on the right. Great successive waves of technology shattered the isolation and necessity that had held together settlements in the wilderness. With railroads, telephones, cars, and radio and television, locality counted less as a constraint, or as a support. Step by step, the function of culture was turned upside down: to promote things new rather than to preserve and protect things old.
In this new world, Americans could continually redefine and reinvent themselves; the Lone Ranger, not the townsfolk, is the bearer of our national myth. Strangely, the recent presidents who tried to claim the banner of "traditional values" in fact were exemplars of the process that helped tear these apart. Ronald Reagan left his small town in Illinois to seek his fortune in the Gomorrah of Hollywood. George Bush left his patrician Connecticut family to try to reinvent himself in the Texas oil business. Few industries had more to do with the upheavals of traditional values than did movies and oil.
What Dan Quayle says about "Murphy Brown," for example, used to be said about the automobile. Near the dawn of the automotive age, a juvenile judge cited in Robert and Helen Lynd's classic study Middletown called the new vehicle "a house of prostitution on wheels." Of thirty girls brought before his court on sex crimes, the location in nineteen had been a car.
THE UNSENTIMENTAL MARKET
Such trends were primarily the product of the market, which disrupted many of the basic rituals of family and community life. The family dinner table became McDonald's while visits on the front porch became a VCR. Television is probably the prime example of the disruptive effect of the market upon traditional social bonds. Lost in the fracas over "Murphy Brown" is TV's biggest impact: the time it consumes. The hours that Americans spend in front of the tube each day are hours not spent coaching little league, helping with homework, attending PTA meetings--all the things conservatives say would flourish if government got out of the way. When televisions were shown at the 1939 World's Fair, a skeptical New York Times writer wrote that "the average American family doesn't have time for it." Now there's time for not much else.
While conservatives bemoan the breakdown of traditional authority, they curiously omit the effect of the commercial invasion of family life. "We didn't have the radio and TV," Esterlene Colbrook says of her childhood home. "So you would love to sit next to your grandmother so she could tell you the old stories. When you came in at night to go to bed, you would always cling to grandmother, because that was the best entertainment."
Grandparents had something children wanted desperately: stories and information about the adult world. Today this generational tie has been displaced. "Now it's the TV and [the kids] don't have time [for us grandparents]," Colbrook says. "They don't even see you. And then we feel real lonely. It's the gap between us now."
The ties between generations were part of an economy--the nonmarket economy of family and neighborly exchange. It is America's hidden rustbelt, its decline overlooked in the computations of economic growth and gain. Even as America and other industrial nations endeavor to revive the growth of their market economies, they need to find ways to rebuild the nonmarket sector that growth has tended to displace.
Elderplan is a health maintenance organization (HMO) for seniors in Brooklyn that has found a way to reinvent the nonmarket economy in a conventional health care setting. Elderplan began as an experiment, one of several so-called "Social" HMOs funded by Congress in 1985. The original idea was to tack social services onto the HMO model, thereby preventing medical problems and reducing costs. (Old people often stay in hospitals much longer than necessary because they have no care at home.) But Elderplan soon ran up against the familiar wall. Social services cost money too, and there just was not enough money to meet the need.
So it decided to enlist its members in taking care of one another, thereby turning service recipients into service providers through a form of time barter called Time Dollars or Care Shares. For each hour members spend helping one another, they get a credit in a computer bank on which they can draw when they need help themselves.
Herbie Fine is a member who took hold of this new system with a passion. A widower and retired movie-film developer in his mid-seventies, Mr. Fine devoted much time to caring for other members in their nineties. He would take them to hospital emergency rooms in the middle of the night, do the shopping, call or visit almost every day. He called these partners "boychiks," a Yiddish word of affection. Then Herbie fell ill and was confined to his apartment. Elderplan members came to visit every day and made sure his needs were met. "What is [Elderplan]?" Herbie says. "It's helping one another out. Like a family." Not many Americans would describe their insurance company in such terms.
There are thousands of Herbie Fines today, involved in networks like this throughout the country. In the barrio of El Paso, impoverished Mexican immigrants are paying for medical care at a local clinic by helping in public health projects and providing rides to the clinic. In the old Cuban neighborhood of Miami, retirees are staffing a day care center for working mothers, gaining credits that they can use to obtain help from the parents on weekends. Increasingly, these programs are expanding to build bonds between generations. In Washington D.C., for example, high schoolers are doing yard work and the like for seniors; then they donate their credits to other seniors in need.
Historically, people have often resorted to barter in times of need. During the Depression, a few men living in a sewer pipe in Oakland, California, started a system called the Unemployed Exchange Association (UXA) that grew into a statewide barter network involving over 100,000 members. But such networks generally decline when the money economy revives. The New Deal and cash-paying jobs provided by the Works Progress Administration brought the UXA system down. Service banking is different, because it is not a substitute for the market economy. Rather, it replicates the social bonds that once flourished outside that economy--in the nonmarket economy--by functioning as the informal memory bank of small towns in which good deeds are recorded and eventually returned. (For this reason the IRS, in two regional rulings, has classified the Time Dollars as tax exempt.)
At the simplest, most practical level, the service bank multiplies the care that Elderplan can provide. Human liabilities become productive assets, when freed from the economist's money-centered way of defining these. The service bank also cuts costs by enabling members to stay at home, instead of nursing homes and long custodial stays in hospitals, both of which are horrendously expensive. (Some three-quarters of the federal medicaid program goes to the elderly, much of that for nursing homes. Those expenditures will practically double between 1991 and 1997.) Elderplan passes along this benefit in a tangible way, by allowing members to use service credits to pay one of their four quarterly HMO premiums.
The service bank improves the quality of care as well. A major problem in the social service field is that seniors don't want social workers or other professionals in their homes. The problem is especially severe for women living alone. "They don't want to talk to some young girl in her thirties about the death of their husband," says Dorothy Gochal, an Elderplan member who understands because she lost her husband too. "Most psychologists in the field are men," she adds. "For women, that turns them off--they think of them as grandsons."
Through the service bank, many seniors become more receptive of care. Someone like Gochal can enter the lives of fellow members because she approaches them not as a professional but as a friend. The service bank dynamic also removes the stigma of charity because members who receive help undertake an obligation to repay, if they can. (Even housebound seniors can provide "telephone reassurance"--friendly calls--to shut-ins.) At the same time, people our society defines as passive consumers of professional services suddenly become active participants, with all the benefits to health and outlook that brings. Seniors in particular get something that America generally denies them: a sense that they are useful and needed. "When you give to someone, you get so much in return," says Ray Hughes, a retired merchant seaman in the program. "You want to keep going."
Critics of service banks have come mainly from the ranks of traditional volunteer agencies and social service professionals. The prospect of self-help among what they call their "client populations" can throw such people off stride, but they often cast their opposition in terms of purity of heart instead. These networks violate the spirit of volunteerism, they say, by giving a "reward" for deeds that ought to be done for free. "We feel that one of the basic tenets of volunteer service is not receiving a quid pro quo," an official of the American Red Cross proclaimed at congressional hearings on service banking.
Of course, such professionals enjoy a generous quid pro quo of their own, in the form of salary and benefits, and nobody claims it sullies the purity of their work. But leave that aside. What's so wrong with a system in which good deeds are returned? Wasn't that the premise behind the barn-raisings and husking bees on the frontier? Volunteerism is fine for the affluent. But people who live, say, in the black precincts of Miami have needs as well as time. "I had experienced other forms of volunteerism but none of it paid back the individual," says Carrie Meek, Florida's first female black senator, who helped start a thriving network in Miami and who was recently elected to the U.S. Congress. "Many of [my constituents] are so poor, and times are so hard, the only way they can exist is by sharing."
There is a subtle sexism to the argument that volunteers should never be rewarded. The nonmarket economy traditionally is the realm of women, and one of the reasons it has been invisible in American life--and ravaged so casually--is that women's traditional roles have been chronically devalued. Carolee DeVito, a professor of community health who oversaw the service banking network at South Shore Hospital in Miami, put it bluntly. "Most volunteers are women," DeVito told a critic at a gathering of the American Public Health Association. "And it is sexist to trivialize all this work by calling it 'volunteer.' Service credits legitimatize the worth of that time."
In practice, most participants do not worry much about the credits, and many hours go unreported. In fact, the service banks provide a case study in the limitations of narrow economic reasoning premised on the notion of profit-seeking individuals. Money, it turns out, can be a disincentive as well as an incentive. Members are emphatic that they wouldn't do for money what they are eager to do for the satisfaction of helping. "I would be a lousy doctor," Herbie Fine says. "I wouldn't charge anybody nothing. I'd say, `Call me anytime.' My name is Fine. I want to keep it fine."
BARRIERS TO CHANGE
No legislation is needed to start service banks. They are a grass-roots mode of exchange--an amplified version of the neighborhood baby-sitting club--that can work in virtually any setting. In the Anacostia section of Washington D.C., for example, a retiree used a service bank to turn her senior citizen's building into a bustling community of care. It does take money to run a large-scale bank, however, and most of the early networks were launched with help from state governments or foundations.
The experience to date provides a cautionary tale. Right-wing ideologues need to realize the importance of what lies outside the market and that government can help rebuild this nonmarket realm. But social service professionals must realize that some of their proclivities can be destructive in this regard. Such professionals often show an instinctive affinity for institutional solutions and expert "interventions" that can cause them to disparage any model based on self-help.
Florida provides a case in point. In 1985, Senator Meek gained enactment of a bill that required the state's Department of Health and Rehabilitation Services (DHR) to conduct a one-year experiment in service banking. Florida has a highly developed bureaucracy for the aging that saw this initiative as both a nuisance and a threat. What ensued was a grim parody of the bureaucratized social service mind.
First DHR tried to stymie the bill with an inflated fiscal impact statement. When that didn't work, the agency literally buried it with paper: ten-page questionnaires for participants, with thirty pages of instructions; criminal checks and fingerprinting for elderly participants; prohibitive workers' compensation requirements. The service bank was required to plug into a clunky and outdated state computer system, and there was endless worrying over who would "guarantee" the credits that volunteers earned. The agency insisted on a "means test," of course, to guard against the unthinkable possibility that a senior might provide some help to another who was not, by the official definition, "truly needy." All this to enable seniors to drive one another to the supermarket or provide some help around the house--something people used to do without a second thought.
Finally, after almost a year of inventive inaction, the agency finally got around to issuing a small grant of $3,000. (Most of the $50,000 appropriation for the program was used to produce red tape.) But by then, only a few weeks were left in the fiscal year, not enough to even get the experiment off the ground. So the department took its remaining money and funded a consultant's report on why the concept would not have worked, even if it had been tried. Without intending to, the report articulated the bureaucracy's aversion to the concept of self-help. "Volunteers are least suited to the types of services required for [service bank] programs," the report solemnly intoned, "specifically personal care, homemaker, health support, and in-home services in general"--precisely the kinds of neighborly supports that members of Elderplan and other service banks are providing for each other every day.
Today the consultant's pronouncement sounds ludicrous in Miami. With a foundation grant and some VISTA volunteers, a number of community organizations there decided to go it alone. As director, they hired a former international banker, Anna Miyares, who took a big pay cut to become a banker of good works. She built the program from nothing to over 1,000 participants, who are recording over 10,000 hours of service a month (and serving many more). So dedicated is Miyares's staff that when the VISTA grant expired, they decided to stay on without pay.
Miyares combines professional management skills with a lyric vision of the traditional Cuban family--"going back to the roots," she says, "where neighbor used to help neighbor, where neighbors used to trust neighbors." Today she's with the Washington, D.C.-based Time Dollars Network, organizing service banks nationally, while moving the Miami program into a new expanded phase. The Dade County Public Schools are planning a day care center for teachers and teenage mothers, staffed with retirees earning Time Dollars. The Miami Office on Aging is giving bonus points for grant proposals that include service banking. And in the wake of Hurricane Andrew, Miyares is organizing neighborhood patrols, clean up crews, and day care centers, based on the service bank model. In a time of triage of social programs, the people involved in Miami and other service banking networks have the buoyant sense of being in on something new. "I'm excited for this program," says Esterlene Colbrook, one of the VISTA workers, whose office is now the trunk of her car.
Bureaucratized social service is just one obstacle to this kind of community-building. Others come from Republican budget-cutting and corporate short-sightedness. Missouri and Michigan, for example, both launched service bank efforts on a decentralized model. In Michigan, local programs were linked through a kind of statewide automated teller network; you could help an elderly neighbor, for example, and transfer the credits to your parent in another city. In Missouri, the Human Services agency didn't even bother to issue regulations the first year.
Despite promising starts, Republican administrations axed both experiments in budget-cutting exercises. In San Francisco, meanwhile, the budget cutters were corporate. The Pacific Presbyterian Hospital there was running a Time Dollar bank at its senior center in the city's Mission district. Participants were so enthusiastic that they were recruiting new members on city buses. Employees at a local bank were volunteering and donating their credits to needy members. But when the hospital was sold, the new owner promptly pulled the plug.
THE WIDER LESSON
Reciprocal exchange is a natural social mechanism, not an invention of the policy schools. As such, it can bring to community building the kind of spontaneous growth dynamic usually associated with the economic marketplace. Labor unions could use it to expand their services to members and add a dimension of organizational cohesion to the monetized benefit packages they now bargain for. HMOs, neighborhood medical clinics, and senior citizens buildings can follow the Elderplan model and become communities of care.
The next frontier is local government. Some years back, a few local governments enabled low-income people to pay off part of their property taxes in service rather than money, and there is no reason why this concept cannot include the whole population. Lawyers could provide legal help for the needy, accountants could help struggling nonprofits, and so on down the line. In the tradition of the volunteer fire department, passive taxpayers would become active citizens, and local services would become something to get involved in, not merely something to pay for.
At the federal level, the equivalent is national service, which could function as local service. Congressman Dave McCurdy of Oklahoma and Senator Sam Nunn of Georgia have sponsored a National Service Bill that would convert student loan programs into public service programs. Instead of going out into the world with huge debts, young people would do public service work (including military service) for a set number of years and get their educations for free (Bill Clinton supports an optional version).
The right calls this servitude. Yet that's a description of the current system, which turns students into an indentured army for the corporations and investment houses of the land that pay salaries high enough to meet the payments on student loans. National service would change that pecuniary relationship into one of shared social experience. It would bring a measure of reciprocity to our national life. Moreover, by exposing thousands of young people to the actual workings of government, it would do more to bestir civic involvement than any campaign reform that the Congress could devise.
What people value, they keep track of. It is revealing, therefore, that for all their lecturing about traditional values, the Reagan and Bush administrations offered no ideas for keeping track of the realm of social interaction that actually embraces these. The government could tell you all about the money supply but nothing about the traditional modes of exchange they say they care so much about.
The federal government should develop indicators for the nonmarket economy the way it charts the GNP. Then it should require nonmarket economic impact statements for new and existing laws, similar to the economic and environmental impact statements currently required. Such analyses would make legislators and regulators think about their actions in a new way. They would begin to see how, up and down the policy spectrum, America rewards mobility and social disruption rather than cohesion and staying put. The tax laws are a prime example. There are deductions for moving expenses but not staying expenses, for example. Accelerated depreciation rewards turnover in real estate rather than patient holding.
Why not have decelerated depreciation that rewarded investors who were in for the long haul? Similarly, homeowner deductions could increase or at least stay even the longer the property is held. Better still, there should be a homeowner (and renter) allowance that is geared to income rather than to the price of a house. The current system gives most to those who have (and borrow) most, which is both unfair and destructive to the nonmarket realm.
A whole range of proposals would appear in a new light. Family leave legislation, for example, would be seen as a way to rebuild the nonmarket sector by encouraging family care instead of professional social services. The right takes great pleasure in chastising Sweden as a welfare state. Yet it is actually ahead of the United States in seeking to revive the informal channels of care. The family leave law is a key part of this effort.
Perhaps most important is something the nation doesn't even have-- a neighborhood policy. The right speaks often about family policy; it pushes industrial policy in the form of enterprise zones. But neighborhoods--the area in between--is where the social glue either holds or doesn't. For twelve years the Reagan and Bush administrations have acted as though the problem doesn't exist.
The status of the nonmarket economy is much like that of the environment before Rachel Carson's Silent Spring. Just as the nation once assumed the natural habitat had an infinite capacity to absorb the effluents of a consumerist culture, so too we have assumed that the nonmarket economy could absorb forever the toxicities of the monetized economy--in both its commercial and governmental forms.
For many years, this degradation could be papered over with monetized services provided by government and by the growth that provided the needed revenue. But, in the future, this may be neither possible nor wise. The chronic budget shortfalls in both state and local governments are not just the result of tax cutting and recession. They reflect as well a growing imbalance in the need for monetized services and the capacity of the economy to spin off revenues for these. Even nations with healthy market economies and unusual degrees of social cohesion--Sweden and Japan, for example--feel that they are reaching the limits of their ability to make up in cash services for the erosion of traditional social bonds.
The nation isn't going to return to the Norman Rockwell days. Nor, on balance, would most Americans want to. But there is a need to revive some of the qualities of that world--the informal exchange and neighborly help and care. This is much more than volunteerism, more too than Points of Light. "A million points of light, or whatever he's talking about--there's nothing practical about it," says Rebecca Peters, a participant at Elderplan. "With [Time Dollars], people might actually be able to do what he's talking about."
Restoring the informal networks of exchange requires public policy. After all, market economies don't just happen; they need a matrix of complementary institutions, both public and private, as the Poles and other Eastern Europeans are now discovering. The nonmarket economy is much the same.
Community is not hydroponic. It does not grow in the gaseous air of political speechifying about values. Nor does it arise from enterprise and ownership alone. Community requires particular kinds of enterprises; it requires neighborhoods that have a real function and don't just serve as loci for consumption.
In the nineteenth century, the invention of the corporation enabled the nation to mobilize enormous resources for the industrial age. Ambitious programs of "internal improvements" provided the physical infrastructure in which the market economy could flourish. That same attention to social infrastructure is now needed in the arena of neighborhood and community life, and Time Dollars are a promising example.