but also with estimates made by non-government experts in 1972.

Greater Costs

For at least two years, non-government groups such as the Child Welfare League of America and the National Council of Jewish Women have been testifying that costs of decent day care are much higher than the amounts federal officials claim are needed. 14 Many of those estimates were discounted out of hand especially by federal agencies because they came from groups and individuals which were "biased." "Biased" can mean an interest in the well-being of children regardless of budgetary implications. "Biased" can be applied to those who insist on standards; one OCD official labeled opponents as "unrealistic" and "pie-in-the-sky."

15

Because of the questions raised about "bias," it was particularly helpful when Mary P. Rowe, an economic consultant for a firm which had prepared a report on day care for the Nixon Administration, testified to the accuracy of the higher estimates. Rowe said: "... day care pro

Photo by: Marianne Gontarz

The Office of Child Development is recommending that a maximum of $1000 be budgeted for care of a preschool child in "Family Homes."

Admittedly, the White House and the Office of Management and the Budget are exerting strong pressures on the Office of Child Development and other federal agencies to hold down the costs of all programs. The utilization of family day care planned by the Nixon Administration under the welfare reform bill H.R.1 makes it clear that there is a great deal of money at stake. The plans for implementing H.R.1 would have provided day care for 450,000 additional children, 150,000 of them of preschool age." HEW projected that a maximum of 20% of preschool children would be served in day care centers. At least 80% - 120,000 children would receive non-center care."

17

18

Computing the cost of providing the cheapest kind of family home care for those 120,000 children using OCD's own figures yields a price tag of $120 million.

If one computes the cost of providing care for the same number of children using Rowe's estimates, it is clear why Administration officials have been arguing about definitions and standards.

To make the comparison as fair as possible, let us assume that Rowe's lower estimates of increased cost are sufficient, and that prices of services have only risen 10% from 1967 to 1972. Granting that substantial difference, the following are Rowe's cost estimates for one year's "family care" for those same 120,000 children. Minimum Quality

Acceptable Quality Desirable Quality

$187.8 million $268.2 million

$313.1 million

For budget reasons alone, the federal government is unlikely to admit that quality day care (as outside experts define quality and cost) is necessary. For those 120,000 children alone, the increased cost of day care would be at least $67.8 million (for minimum quality care), would proba

51

bly be $148.2 million (for acceptable quality care), and could reach $193.1 million (for desirable quality care).

Every Administration seeks to hold down spending and the Nixon Administration is no different. Faced with the choice between sacrificing what has become the Administration's number one domestic legislative priority and holding costs down, there was no real choice. President Nixon has vetoed legislation which would increase costs. The Nixon Administration has impounded funds which were appropriated to serve children and protect children: school lunch funds were impounded; money for the Lead Paint Poisoning Act of 1971, a program to reduce the incidence of lead paint poisoning in children, was withheld.

The Administration was not only faced with a need to reduce the costs of day care services. It also needed to change the standards which dated from September 23, 1968, because unilaterally implementing them would almost double the cost of day care under H.R.1.19

Implementation

Finally, even if the Administration succeeded in redefining quality day care and changing the regulations governing its operation, one difficulty remained. The Administration needed to find some way to deliver its brand of day care.

The federal government's answer was to set firm prices for day care services, and allow individuals and groups to work out the details of buying day care services. If the prices set were so low that some people would refuse to bid for the "day care business," then that would not be the federal government's responsibility. If the price ceiling meant that wages had to be below the federal minimum or that the number of children per child care worker had to be increased until the prices-profits ratio was acceptable, that would not be the responsibility of the federal government. If private entrepreneurs were the only providers of day care services willing to contract to deliver services at a price which means cheap labor and poor care, then that would not be the federal government's responsibility.

The emergence of private entrepreneurs as the sole potential long-term bidders for day care services contracts recalls the early days of other human services programs Medicare and Medi

caid. Laws designed to provide care for the aged all too frequently led to profiteering. Medicare-Medicaid health care, especially for the poor, the nonwhite, and rural people who need services most, was delivered under separate circumstances and was of unequal quality. Abuses accumulated to the point where the following were written into the law governing Medicare and Medicaid:

1) 100% Federal financing of nursing home inspections;

2) HEW disclosure of information concerning Medicare agents and providers is required; 3) disclosure of ownership information of nurs ing homes (intermediate care facilities) is required, 20

Three years of surveying private entrepreneurs has led to the conclusion that their performance in delivering day care services would be similar to the performance of the Medicare-Medicaid businessmen who profiteered. If the federal government is determined, as it appears, to subject children to the same fate older Americans suffered, that is a great human tragedy.

Perhaps, to serve the public interest partially, the federal government will make enough advance preparations to prevent a repetition of the same economic opportunism that took place under Medicare and Medicaid. These minimum steps should be taken: 21

1) standards for day care services strong enough to ensure that children receive care at least as good as is provided in an ordinary "good home;"

2) federal financing of day care service licensing and inspections;

3) assurance that reimbursement for day care services rendered is equitable for the type of care provided;

4) provisions requiring HEW regularly to make information public with respect to day care services, agencies and providers of day care services;

5) provisions allowing for withholding payments for day care services to terminated day care service providers; 6) provisions providing for mandatory independent professional review to determine proper child placement and refer

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ral of children to day care services and care of children in such services; 7) provisions requiring disclosure of ownership of day care facilities and services; 8) provisions requiring public disclosure of information concerning survey reports of day care service providers;

9) provisions providing a penalty for failure to provide required supplementary services as stipulated by other legislation relating to children;

10) provisions limiting federal payments for disapproved capital expenditures; 11) provisions providing for termination or suspension of federal payments to a provider found to have abused the program;

12) provisions establishing penalties for soliciting, offering or accepting bribes or kickbacks, or for concealing events affecting a person's rights to benefit with intent to defraud, and for converting benefit payments to improper use; 13) provisions establishing false reporting of a material fact as to conditions or operations of a day care facility as a misdemeanor subject to fine, imprisonment, or both;

Despite these findings, there will be pressures to repeat the disastrous mistakes made with Medicare and Medicaid by utilizing the profit-making providers to deliver day care services. For that reason, actions should be taken to reduce the incidence of economic waste. If programs will not be humane, at least they can have a measure of fiscal integrity. Nothing short of a repetition of the Medicare-Medicaid nursing home and health care tragedy is likely to convince public policy makers to design day care programs which will reduce or avoid the worst sort of waste - the destruction of

children's personalities and lives.

FOOTNOTES

'The preparation of this material was made possible through the resources provided by The New World Foundation, The Ittleson Family Foundation, The Field Foundation, The George J. Hecht Foundation for Children, The Haffenreffer Family Fund, as well as those of the Child Welfare League of America, Inc.

The opinions expressed herein are those of the author and do not necessarily represent those of the Child Welfare League of America.

2 See Bertram M. Gross' "Friendly Fascism: A Model for America," Social Policy, Nov/Dec. 1970, pp. 44-52, and Elizabeth Wickenden's "H.R. 1: Reform or Control?" (Personal Memorandum dated June 30, 1971. Mimeographed; four pages.) Wickenden's paper discusses attitudes which still prevail among policy makers even though the more punitive features of the "welfare reform" bill she discusses were not enacted during 1972.

3 "More than half of all mothers with children between the ages of 6 and 17 are jobholders. About one-third of all mothers with children under the age of six, totaling over 4%1⁄2 million women, are in the labor force. Most working mothers seek jobs for compelling economic reasons." (Emphasis added.) Windows on Day Care by Mary Dublin Keyserling.

The debate over "quality" and "costs" of day care services has been very intense. Most participants have utilized definitions and budgetary estimates primarily to defend their particular position on issues. The Senate Finance Committee's estimate was $744 for the cost of child care under programs funded by Title IV-A of the Social Security Act. (See page 32 of Child Care Data and Materials, a Committee print dated June 16, 1971.) The $744 figure was arbitrarily raised to $800 to reflect the difference between Fiscal Year 1972 and 1973 prices.

5.A helpful brief explanation of provisions allowing for child care deductions in current law is contained in H.R. 1 Social Security Amendments of 1972, Brief Description of Senate Amendments, a Committee print dated October 11, 1972, pp. 73-74.

• There are 10,777,000 children that are "unaccounted for" in the statistics showing numbers of children in care. An information sheet prepared by the National Welfare Rights Organization says: Congress concludes after looking... (at the statistics) ... that it must be the 'extended family' that is caring for the millions of children who apparently are not receiving care now. NWRO knows better. In so many states, with benefits cut back and with repression the rule, mothers just cannot find any child care but have no choice but to take whatever jobs they can find. They make such arrangements as they can. They call home and 'check on' their children. They put the house key on a string around their child's neck. They have older children 'look after' younger children as best they can." (Quoted from a mimeographed, undated sheet entitled "THE STATE OF CHILD CARE.")

Slavery is not too strong a word for opponents of H.R. 1, as Wickenden observed in her "HR 1: Reform or Control?" (page 3). Wickenden wrote: "To its opponents

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this effort to coerce cheap labor and compliant behavior is seen as the cultural equivalent for modern times of the historical instruments of slavery and the plantation system. "Even though the more objectionable features contained in the Senate-passed and House-passed versions did not become law during 1972, the attitudes which were responsible for those features being drafted are likely to persist for several years.

The previous footnote explained the rationale for referring to H.R. 1 in terms of "peonage." To the author, nothing describes the use of federal blood-typing laboratories and the other provisions added to H. R. 1 by the Senate Finance Committee so succinctly as "a police state." At the very least, one would have to admit that there is a very great potential for abuse of basic civil liberties in the system proposed by the Senate Finance Committee.

9 Sen. Ribicoff is quoted as describing the forced-work provisions of H.R. 1 as "slave-fare" in "Welfare Compromise Killed; New Reform Bid in Doubt," The Washington Post, Oct. 4, 1972, p. A 16.

10 Child Care, Senate Finance Committee, September 22-24, 1971, p. 107.

11 Ibid., p. 302

11 The $1000 cost is for the care of a child of pre-school age (3-6 years) in a "family home," to use the language of the paper.

13 op. cit., p. 227.

14 Child Welfare League of America and National Council of Jewish Women testimony given on August 24 and 25, respectively, estimated costs to be significantly higher than the $1,600 figure being used by the Adminis tration. CWLA estimated the comparable type of care would cost $2,234 at 1972 prices; NCJW's estimate was $2,200. (See FAMILY ASSISTANCE ACT OF 1970, Hearings, Part 3, a Senate Finance Committee CWLA quote, see p. 1540; NCJW quote, p. 1409.)

"

15 Dr. Edward Zigler, the first Director of the Office of Child Development, is quoted in "Nixon's Child Care Expert Resigns," The Washington Post, July 15, 1972, p. A 2, as saying his greatest frustration was the failure to bridge the gap between child care advocates with their 'pie in the sky' politically unfeasible plans and government officials 'who would be perfectly satisfied with custodial day care.' "The dilemma of a person in Dr. Zigler's position is clear. Most non-government groups were calling for day care which would cost around $2,200 per year. Some fiscal conservatives were pressing for day care costing $1,100 per year. Dr. Zigler and his staff were sincere in their belief that the $1,600 level was as good as could be politically obtained. The fact that $1,600 care is not as damaging and not as obviously custodial as care costing $1,100 never came through clearly during the heated debate over costs.

16 Note 10, page 277.

17 Note 10, p. 216.

1 Ibid., p. 266.

19 There was substantial differences of opinion within

the Senate Finance Committee regarding the kind of child care to be provided under H.R. 1. Sen. Ribicoff proposed that at a minimum child care should meet the existing requirements set in 1968; he matched his proposal with an increase in the spending from $700 million to $1.5 billion for the same number of children. Fiscal conservatives on the Committee, like their counterparts in the Nixon Administration, know the impact of decent standards. In one Committee print, "Material Related to Child Care Legislation," dated July 23, 1971, federal child care standards are cited as a "barrier to expansion of child care." An illustrative sentence (p. 14) reads: "Since staffing costs represent 75 to 80 percent of child care center costs, and since more staff is required under the Federal standards than under the licensing requirements of almost all States, federally shared child care costs may be expected to become rather higher than present costs in the States." There is one other additional sentence (p. 14) which has ominous implications, in terms of the quality of care children receive. "Draft revised standards have been circulated for comment."

Two types of revised standards have been developed by the Administration's Office of Child Development, both of which would have the effect of lowering the number of staff required in day care services. One type of standard is a new "Federal Day Care Requirements," a draft circulated in June, 1972, which would reduce the cost of federally-supported day care. Another type of standard, aimed at reducing the staff-child ratios in those States with good requirements, was developed as part of a project called the "Model Day Care Coding Licensing Project."

Non governmental groups and individuals have consistently opposed promulgation of these two quality-cheapening documents.

10 These suggested provisions are derived from Medicare-Medicaid Amendments approved by the Sen

ate-House Conferees, contained in H.R. 1 Social Security Amendments of 1972 as Approved by the Conferees, a joint publication of the Senate Finance Committee and House Ways and Means Committee, Oct. 17, 1972, pp. 9-25.

21 There are additional recommendations contained in the Senate-passed version of H.R. 1 relating to Medicare-Medicaid which were not suggested here because they failed to survive the Conference. One suggestion that has been made to improve Medicare-Medicaid would be useful for day care services as well, that is the establishment of an Inspector General. A brief description of such an Inspector General for Medicare-Medicaid is contained in H.R. 1 Social Security Amendments of 1972, Brief Description of Senate Amendments, op. cit., pp. 15-16.

22 The proposal for the League's project assumed that it would be possible to identify a commercial operation which could be pointed to as a model. According to the proposal, "The first case history, hopefully, will describe the development of a franchise operation which combines adequate services to children with a fair return on capital and time to franchisor and franchisee." (See "PROPOSAL TO STUDY AND REPORT ON THE IMPACT OF FRANCHISED DAY CARE ON THE QUALITY OF CHILD CARE SERVICES," mimeographed, 1970, p. 18.) No such franchisor could be found during the course of the study.

Photo by: Lyn Gardiner