Satu Catatan Mengenai Hubungan Antara Falsafah Dan Sains Sosial

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SATU CATATAN MENGENAI HUBUNGAN ANTARA FALSAFAH DAN SAINS SOSIAL

[Rencana ini berdasarkan nota-nota kasar kertas seminar di atas tajuk sama anjuran Jabatan Antropologi dan Sosiologi, Universiti Kebangsaan Malaysia, Bangi, pada 13 Oktober, 1982. Ia telah disiarkan dalam jurnal Akademia, No. 23, Julai, 1983.] Sungguhpun ilmu-ilmu sejarah, politik, ekonomi dan sosiologi bidang-bidang kajian yang popular di negara kita, falsafah, malangnya, langsung tidak digemari. Setakat ini tidak ada fakulti falsafah di manamana universiti dalam negeri ini dan tidak ada pula, setahu saya, sebuah persatuan falsafah. Ini menunjukkan masyarakat dan universiti-universiti kita sekarang tidak mementingkan falsafah. Sebenarnya, falsafah bila-bila masa pun amat penting. Tidak ada satu bidang ilmu, malah tidak ada satu perkara yang boleh kita perkatakan secara bermakna tanpa, setidak-tidaknya secara tidak langsung, menyentuh falsafah. Apakah sebabnya? Secara ringkas, sebabnya ialah kerana bicara manusia tidak dapat tidak mestilah mengenai Alam, Manusia dan Tuhan; dan topik-topik ini boleh diringkaskan lagi kepada masalah Kewujudan dan Hakikat. Masalah Kewujudan atau Hakikat masalah metafisika dan falsafah. Semua cabang ilmu baik sains tabii muhupun sains sosial memperoleh statusnya sebagai ilmu kerana pertaliannya dengan metafisika dan falsafah. Saya sedar ramai juga ahli sains yang menganggap metafisika sebagai tidak bermakna. Ahli-ahli falsafah pula berselisih tentang definisi dan fungsi falsafah. Bagi keperluan saya sekarang, saya akan menggunakan definisi falsafah berikut: Falsafah ialah ilmu yang paling umumilmu prinsip-prinsip pertama mengenai kewujudan; andaian-andaian mengenai hakikat muktamad. (D.D Runes, Dictionary of Philosophy). Walaupun ada aliran-aliran falsafah yang tidak menerima definisi ini, buat tujuan kita, definisi ini baik dan memadai. Kita boleh melihat daripada definisi ini bahawa bukan sahaja sains sosial tetapi semua ilmu dirangkumi dan mempunyai hubungan dengan falsafah, sama ada diakui atau tidak. Secara kongkrit, apakah hubungan di antara sains sosial dengan falsafah? Oleh kerana sains sosial mengkaji masyarakat dan masyarakat terdiri daripada manusia, satu soalan pokok yang tidak dapat dielak ialah: Apakah manusia? Adakah ia haiwan? Berapa banyakkah aspek kehaiwanannya? Apakah faktor-faktor yang membangunkan aspek bukan-kehaiwanan? Bagaimanakah timbulnya masyarakat dan kelompok-kelompok? Apakah undang-undang sejarah, sosial dan moral yang menyebabkan perubahan masyarakat? Apakah kedudukan, peranan dan hubungan kedamaian dan konflik dalam perkembangan dan perubahan masyarakat? Apakah corak-corak masyarakat yang telah lalu dan akan datang? Sejauh manakah peranan kebebasan dan takdir dalam kehidupan manusia? Apakah sifat hakikat muktamad? Soalan-soalan ini menunjukkan bahawa ilmu-ilmu sains sosial, sama ada kita suka atau tidak, tidak boleh berdiri sendiri. Ia terpaksa dihubungkan dengan sesuatu falsafah atau tanggapan mengenai kewujudan , walaupun ilmu-ilmu itu sendiri menafikan hubungan ini. Ini tidak bermakna bahawa seorang ahli sains sosial atau seorang ahli sains dengan sendirinya mesti juga seorang ahli falsafah. Ia bermakna seseorang ahli sains, termasuk ahli sains sosial, mempunyai tanggapan-tanggapan falsafah. Apakah tanggapan-tanggapan falsafah sosiologi di negara kita? Negara kita memiliki dua tradisi

intelektual yang besar iaitu tradisi intelektual Barat dan tradisi intelektual Islam. Malangnya, kebanyakan kita daripada tiga generasi selepas Perang Dunia Pertama, daripada generasi Tunku Abdul Rahman atau Ishak Hj. Muhammad hingga ke generasi Anwar Ibrahim atau Latiff Mohidin, terdidik dalam tradisi intelektual Barat. Tentunya ini bukan kesalahan kita; sejarah telah menentukan demikian. Tradisi ini telah membentuk bukan sahaja alam pemikiran kita, tetapi juga mempengaruhi kelakuan kita. Tradisi intelektual Barat, walaupun terbahagi kepada dua aliran besar (idealisme dan materialisme) mempunyai satu ciri yang sama, iaitu dualisme falsafah. Dualisme ini terletak pada pertengahan di antara fikiran dan badan, atau di antara kesedaran dan benda. Ia mempunyai akar umbi dalam falsafah Yunani lagi, tetapi mencapai bentuk yang jelas apabila Descartes (1596-1650) memulakan zaman moden dalam falsafah Barat. Dualisme falsafah ini mencetuskan dua aliran falsafah besar, iaitu idealisme dan materialisme, masing-masing dalam pelbagai pecahan yang diwakilinya, di satu pihak, oleh Berkely, Spinoza, Leibniz, Kant, Hegel dan Bradley dan di pihak lain, oleh Hobbes, Locke, Hume, Marx dan Russell. Kedua-dua aliran falsafah ini telah gagal menyelesaikan masalah hubungan di antara kesedaran dan benda. Dualisme falsafah ini telah menyebabkan perpisahan dan menghalang integrasi di antara dua kaedah saintifik, kaedah empiris dan kaedah teoritis. Ia juga telah menyebabkan perpisahan dan menghalang integrasi di antara sains dan agama. Kaedah empiris menumpu kepada pemerhatian, penyiasatan dan pengumpulan data dan menolak pewujudan teori, sementara kaedah teoritis pula menumpu kepada pembuatan teori dan mencari data untuk membuktikan teori. Perpisahan dan ketiadaan integrasi di antara dua kaedah saintifik dan perpisahan dan ketiadaan integrasi di antara sains dan agama bukan sahaja telah menyebabkan kemandulan dalam ilmu-ilmu, tetapi juga telah menghapuskan keseimbangan dalam kehidupan.(1) Sesuatu ilmu yang sihat mestilah menggabungkan kedua-dua kaedah saintifik ini. Tetapi penggabungan ini hanya dapat dilakukan oleh sebuah falsafah yang utuh. Persis inilah yang tidak ada dalam tradisi intelektual moden Barat. Francis Bacon (1561-1629) yang boleh dianggap bapa sains moden telah meletakkan asas sains dan pemikiran zaman Kebangkitan Semula di atas satu legenda atau mitos. Dalam bukunya On Principles and Origins (1623-24) beliau merujuk kepada sebuah legenda yang mengatakan Cupid ialah tuhan yang tertua dan wujud pada permulaan masa seorang diri bersama-sama dengan Kacau-Bilau (Chaos). Cupid, mengikut legenda ini, tidak mempunyai ibu-bapa dan Kacau-Bilau tidak mempunyai permulaan. Bacon mentafsirkan ketiadaan ibu-bapa sebagai ketiadaan apa-apa sebab dan dengan itu beliau meneka bahawa dengan Kacau-Bilau bermakna jirim muktamad adalah punca segala benda material yang wujud. Jirim muktamad ini, kata beliau, ialah satu benda positif dan tidak boleh dihuraikan dan mestilah diterima secara mutlak sepertimana adanya dan tidak boleh dinilaikan mengikut apa-apa ukuran terdahulu. Adalah mustahil, kata beliau, untuk mencari atau menggandaikan sesuatu sebab bila kita berhadapan dengan tenaga muktamad dan undang-undang positif alamkerana tidak lain yang telah merosakkan falsafah begitu banyak kecuali usaha mencari ibubapa Cupid: yakni ahli falsafah telah tidak menerima prinsip-prinsip benda sebagaimana terdapat di dalam alam, dan telah tidak menerima mereka sebagai satu doktrin positif bersandarkan kepada kepercayaan dari pengalaman-pengalaman; tetapi sebaliknya mereka lebih suka menariknya dari

undang-undang perbahasan, kesimpulan-kesimpulan murah dari logik dan matematik, dari anggapananggapan masyarakat dan khayalan-khayalan fikiran demikian yang melampaui batasan-batasan alam. (Urmson, 1960:310). Hobbes mengisytiharkan bahawa Alam raya, yakni segala sesuatu yang ada itu, jasad, yakni badan, dan memiliki dimensi-dimensi luas, lebar dan dalam; tiap-tiap bahagian badan juga badan, dan memiliki dimensi-dimensi serupa, dan seterusnya tiap-tiap bahagian alam raya itu badan, dan bukan-badan bukanlah daripada alam raya. Anggapan fikiran Renaissance menunjukkan bahawa yang wujud ialah dunia, dan tidak ada lain yang wujud kecuali dunia. Kepada sesiapa yang bertanya siapakah yang menjadikan dunia, jawapan yang telah dan sentiasa diberi ialah soalan ini tidak sah dan tidak saintifik! (Harris, !954:117-20). Bila Descartes, pengasas falsafah moden Barat, bertolak daripada skeptisme yang mengingatkan alGhazali, memperakukan kewujudan dirinya daripada aktiviti fikirannya Cogito, ergo sum: saya berfikir, maka itu saya wujud beliau meletakkan asas falsafah kepada dualisme Zaman Kebangkitan Semula yang sejak itu terus menghantui falsafah Barat. Mengikut Descartes, dunia terdiri dari dua zat yang berasingan: fikiran dan jasad. Dari kewujudan dirinya dan dunia yang terbatas dan tidak sempurna, beliau, melalui proses logik, mencapai kejayaan menerangkan kewujudan seorang Tuhan yang tidak terbatas dan sempurna. Dari dualisme Descartes, falsafah Barat menuju dua arah: dari arah fikiran, ke Fikiran Mutlak atau Idealisme, dan dari arah jasad, ke Jirim Mutlak atau Materialisme. Pada praktiknya, kedua-dua aliran tidak dapat dipisahkan secara penuh: idealisme Hegel merangkumi jirim dan materialisme Marx tidak menolak fikiran. Tradisi intelektual Islam kita, sebaliknya, tidak menghidap penyakit dualisme ini. S.H. Nasr berkata. Falsafah Islam didasarkan pertamanya kepada metafisika dan hampir semua risalah mengenai falsafah tradisional memperkatakan asal dan kesudahan benda-benda yang melampaui pengetahuan manusia. Ahli-ahli falsafah Islam adalah golongan yang pertama menjadikan perbahasan tentang wujudnya pokok falsafah dan berusaha menghubungkan tiap-tiap benda yang wujud kepada Wujud Murni yang menjadi punca semua kewujudan. Tambahan lagi, di dalam perut metafisika, mereka mengembangkan sebuah falsafah alam yang luas dalam rangka satu pandangan dunia umum, mengemukakan satu hubungan yang rapat di antara pelbagai bentuk dan cabang ilmu-ilmu sains serta menghubungkan jamak kepada tunggal (Dar, 1975:3). Ilmu-ilmu dan pelbagai aliran fikiran dilihat dalam satu gabungan kesatuan tauhid. Tidak wujud pertentangan di antara fikiran dan jasad dan tidak wujud pertentangan di antara agama dan sains atau di antara wahyu dan fikiran. Bagaimanakah para saintis dan ahli falsafah Islam menyelesaikan masalah dualisme ini? Daripada mulanya mereka tidak menghadapi masalah ini. Agama Islam telah mewujudkan, bagi mereka, satu pandangan hidup tauhid rasional yang meletakkan semua dan segala pada sumber dan asas kesatuan wujud.(2) Agama mereka juga menyuruh mereka mengkaji alam semesta sebagai tanda-tanda Tuhan, mengkaji sejarah sebagai bukti wujudnya undang-undang Tuhan yang objektif dan mencari ilmu di mana juga ia ada. Dengan mematuhi arahan ini, orang-orang Islam dalam beberapa abad Islam awal bukan saja telah mengkaji dan mengasimilasi fikiran-fikiran Yunani, Parsi dan India, tetapi juga telah melakukan penyelidikan-penyelidikan dan penyiasatan-penyiasatan original mereka sendiri. Dengan demikian, dalam masa tiga abad mereka telah berjaya membangunkan satu tamadun intelektual yang agung dan

kaya. Khazanah intelektual ini sebenarnya masih banyak terpendam dalam perpustakaan-perpustakaan di Eropah dan Asia Barat dan menunggu kajian oleh dunia moden. Satu daripada tugas besar yang perlu dilakukan dengan segera oleh sarjana-sarjana Islam ialah menterjemahkan dan menyediakan edisi-edisi saintifik bagi karya-karya ini. Tetapi, malangnya, tradisi intelektual Islam ini telah beku bukan sahaja di negara kita bahkan di seluruh dunia Islam selama kira-kira tujuh abad. Kemusnahan pusat empayar Islam pertama Baghdad pada 1258 Masihi bolehlah diambil sebagai permulaan kejatuhan tamadun Islam dan kemerosotan tradisi intelektualnya yang dinamik dan kreatif. Perlahan-lahan, melalui hubungan-hubungan Eropah dengan Islam melalui Sepanyol, Itali dan Sicily, Eropah mengambil ilmu-ilmu yang telah dikumpul dan dibangunkan oleh tamadun Islam hingga pada abad keenam belas Kebangkitan Semula Eropah telah bermula dan berlaku. Lalu pusat dan pimpinan tamadun dunia berpindah dari dunia Islam ke Eropah, dan ke Barat, sejak abad kesembilan belas. Pada abad kedua puluh pula tamadun Barat sedang memainkan peranan negatif dan positif untuk membangkitkan semula Islam. Dengan mendidik cerdik pandai Islam seperti Jamaluddin al-Afghani, Muhammad Abduh, Syed Ahmad Khan, Syed Ameer Ali, Muhammad Iqbal, Ali Shariati, Malek Bennabi dan Hassan Hanafi3 dan dengan membuat kajian-kajian mengenai pelbagai aspek tamadun Islam, Eropah dan Barat, mereka telah dan sedang memainkan peranan yang tidak kecil untuk membangkitkan semula Islam. Pada pendapat saya, masanya adalah tepat bagi pertemuan dua tamadun agung, dan, dengan itu, pertemuan semua tamadun. Falsafah moden Barat sedang di ambang pintu mencapai kejayaannya yang terbesar, iaitu penyelesaian dualisme klasiknya dengan falsafah organisme A.N. Whitehead (Harris, 1964:416-438). Pada pendapat saya, ini tidak dapat ia lakukan kecuali dengan pertolongan falsafah dan ajaran-ajaran Islam.4 Seperti telah kita sebutkan, falsafah Islam tidak pernah menderitai penyakit ini kerana al-Quran dengan jelas mengajar konsep kesatuan hidup. Penyelesaian dualisme tua dalam falsafah Barat ini, tidak syak lagi, akan membawa kesan-kesan yang besar kepada sains sosial dan cawangan-cawangan ilmu yang lain. Ia akan menggabungkan aliran-aliran falsafah yang bertentangan, idealisme dan materialisme, menjadi satu falsafah saintifik rasional yang utuh; menggabungkan kaedah-kaedah mengetahui yang bertentangan, kaedah empiris, kaedah teoritis dan kaedah luar deria, menjadi satu kaedah saintifik rasional yang dinamik dan kreatif; dan menggabungkan sains, falsafah dan agama. Penyatuan ini akan mempermudah dan mempercepatkan perkembangan ilmu, kerana kontradiksi dualisme yang selama ini menghalangnya sudah disingkirkan dari pemikiran manusia. Seperti telah dilihat, ahli-ahli fikir Renaissance mencapai gagasan falsafah mereka dengan berdasarkan pengalaman mereka, yakni apa yang mereka alami melalui pancaindera. Bertolak dari pengalaman mereka, mereka menggunakan akal fikiran untuk menarik kesimpulan-kesimpulan falsafah. Mereka sama sekali menolak agama dan kaedah-kaedah yang dipakai oleh tokoh-tokoh agama, misalnya nabinabi dan ahli-ahli sufi. Sebaliknya, ahli-ahli falsafah dan ahli-ahli sains Islam bertolak dari wahyu dan mencapai pengetahuan mengenai kewujudan Tuhan Yang Esa dan mengenai kesatuan alam. Walau bagaimana pun, mereka tidak pula menolak kewujudan alam yang relatif dan kejamakannya.5

Soalnya, apakah epistemologi yang berdasarkan pandangan dunia Renaissance ini munasabah? Adakah manusia mengetahui hanya melalui deria dan akalnya? Kita tahu bahawa deria dan akal hanya mencapai dunia yang bersifat material. Tetapi sejarah telah membuktikan kewujudan pengalaman-pengalaman di luar deria yang banyak, seperti pengalaman-pengalaman para nabi, ahli sufi dan mistik. Pengalamanpengalaman ini tidak boleh ditolak tanpa menodai konsep sains sendiri, yakni mengiktiraf kenyataan, walaupun bertentangan dengan kepercayaan-kepercayaannya sendiri. Juga telah ditegaskan bahawa ilham satu cara mengetahui di luar deria dan akal memainkan peranan penting dalam perkembangan bukan sahaja seni dan falsafah tetapi juga sains (Sorokin, 1963:247-48). Selain daripada itu, penemuanpenemuan mutakhir kaji fizik telah meragukan kebendaan jirim yang dipercayai oleh sains sejak abad ketujuh belas; sekarang atom tidak lagi bersifat material (Jeans, 1954:383). Lebih jauh dari itu, ahli kajifizik terkenal, Sir James Jeans, mengaku bahawa kita tidak akan memperoleh pengetahuan yang pasti mengenai sifat hakikat (1954:364).6 Jelaslah epistemologi lama yang membataskan sumbersumber pengetahuan kepada deria dan akal tidak meliputi semua pengalaman manusia yang sempit, dan tidak boleh menjelaskan masalah hakikat. Kita telah melihat bahawa in masalah falsafah bukan masalah sains sosial atau sains dalam ertikata satu bdang kajian terbats mengeani satu aspek hakikat, seperti manusia atau alam tabii. Sains Barat, termasuk sains sosial, seperti telah kita lihat, berlandaskan falsafah naturalisme atau materialisme, dan , dengan itu, telah memutuskan hubungan dengan alam spiritual atau supernatural. Dengan demikian, sains ini tidak mampu mencapai alam-alam spiritual atau supernatural. Inilah sebabnya ia menghadapi jalan buntu, seperti telah diakui oleh Sir James Jeans. Jelaslah bahawa jalan keluar dari kebuntuan ini ialah dengan kembali kepada kebenaran dan kepada jalan Islam yang lurus. Tetapi kembali kepada Islam tidak bermakna kembali kepada Islam popular atau Islam baka. Sejarah telah menunjukkan ada beberapa agama yang mengongkong ilmu pengetahuan dan akal. Bahkan dunia moden Barat yang lahir dari Renaissance persis adalah hasil perjuangan-perjuangan pahit menentang teologi Kristen yang menekan dan sempit. Sejarah demikian tidak boleh dan tidak akan diulang. Agama Islam yang dimaksudkan adalah agama seperti yang diterangkan dalam ayat-ayat Quran yang telah disebutkan. Daripada ajaran-ajaran agama seperti inilah kita boleh mengembang dan menyempurnakan suatu falsafah saintifik yang utuh yang boleh menjadi landasan kuat kepada perkembangan sains sosial dan malah semua ilmu. Footnotes: (1) Krisis di dalam pelbagai bidang ilmu dan kehidupan yang dihadapi oleh dunia moden sejak beberapa dekad lalu telah diceritakan dengan baik dan ringkas di dalam buku Sorokin (1941). Lihat juga satu siri empat artikel yang menarik berjudul Second Thoughts About Man dalam majalah Time keluaran 2, 9, 14 dan 23 April, 1973. (2) Ayat-ayat Quran yang menyatakan atau membayangkan hal ini amat banyak. Antaranya: Tiada kami ciptakan langit dan bumi dan segala yang ada di antara keduanya kecuali dengan kebenaran (46:3). Tidakkah mereka yang mengingkari kebenaran sedar bahawa langit dan bumi (pada asalnya) satu, kemudian kami pisahkan keduanya? (21:30). (3) Malek Bennabi dan Hassan Hanafi tidak begitu terkenal di negara kita. Yang pertama (m.1973) ialah

seorang sarjana Aljazair yang masyhur yang telah memainkan peranan penting dalam kebangkitan intelektual di Afrika Utara. Yang Kedua (lahir 1935) ialah seorang ahli falsafah Mesir yang radikal. (4) Seorang ahli falsafah moden Mesir telah berkata: The European conscience was divided into divergent trends, irreparably severed and disjointed. All efforts at synthesis between the two opposite trend failedA Human view is always unilateral despite gestaltism, integralism and totalism. Only Islam can direct the conscience to keep focus of things, the integrality of truth and to keep the balance between extremes. Islamic monotheism can guide the European conscience ini its wilderness and aberration and guide it towards the focus of reality. (Hassan Hanafi, 1977: 67-8). (5) Tiada Kami ciptakan langit dan bumi dan segala yang ada di antara keduanya kecuali dengan benarnya dan untuk satu tempoh yang ditentukan . (Quran,46:3) Katakanlah: Sekiranya samudera itu tinta untuk menuliskan kata-kata Tuhanku, pastilah ia kering sebelum habis kata-kata Tuhanku dituliskan, sekalipun Kami datangkan sebanyak itu lagi sebagai tambahan. (Quran, 18:109). (6) Banyak ayat Quran telah menjelaskan hal ini. Di antaranya: Tiada Ia tercapai oleh penglihatan mata, tetapi Ia mencapai segala penglihatan (6:103). Tiada suatu pun menyerupai-Nya(42:11). Katakan: Tiada siapa di langit dan di bumi mengetahui hakikat yang tersembunyi, kecuali Allah. (27:65). (7) Islam dalam ertikata intinya telah dijelaskan dalam Quran sebagai jalan yang lurus, jalan keselamatan, agama kebenaran, undang-undang alam, cahaya Allah, kebenaran dan sebagainya. Pimpinlah kami ke jalan yang lurus, jalan mereke yang Kaukurniakan nikmat, bukan mereka yang Kaumurkai, dan bukan mereka yang sesat. (1: 6-7) Hadapkanlah wajahmu dengan khusyuk kepada agama yang betul. Demikianlah naluri semula jadi yang telah diletakkan Tuhan pada manusia. Tiada perubahan dalam penciptaan Tuhan. Demikian itulah agama yang benar, tetapi kebanyakan manusia tiada mengetahui. (30: 30) Dialah Yang mengutus rasul-Nya dengan bimbingan dan agama kebenaran supaya ia mengatasi semua agama lain, walaupun tida disukai oleh orang-orang musyrik. (9: 33) Mereka ingin memadamkan cahaya Allah dengan mulut mereka, tetapi Allah hendak menyempurnakan cahaya-Nya, walaupun tidak disukai oleh orang-orang kafir. (9: 32) Dengannya (yakni Quran), Tuhan membimbing sesiapa yang mencari keredaan-Nya ke jalan-jalan keselamatan, mengeluarkan mereka dari gelap kepada terang dengan izin-Nya dan membimbing mereka ke jalan yang lurus. (5: 16)

Rujukan Sorokin, P.A. (1941). The Crises of Our Age, New York. Sorokin, P.A. (1964). Modern Historical and Social Philosophies, New York. Jeans, Sir James (1954). Some Problems of Philosophy. Dalam Saxe Commins & Robert N. Linscott (ed.). The Philosophers of Science, New York. Urmson, J.O. (1960). The Concise Encyclopedia of Western Philosophy and Philosophers, New York. Harris, Errol E. (1954). Nature, Mind and Modern Science, London. Dar, B.A. (ed) (1975). Reorientation of Muslim Philosophy, Lahore. Hassan Hanafi (1977). Religious Dialogue and Revolution, Cairo.

US Welfare System - Help for US Citizens


Federally funded and governed US welfare began in the 1930's during the Great Depression. The US government responded to the overwhelming number of families and individuals in need of aid by creating a welfare program that would give assistance to those who had little or no income. The US welfare system stayed in the hands of the federal government for the next sixty-one years. Many Americans were unhappy with the welfare system, claiming that individuals were abusing the welfare program by not applying for jobs, having more children just to get more aid, and staying unmarried so as to qualify for greater benefits. Welfare system reform became a hot topic in the1990's. Bill Clinton was elected as President with the intention of reforming the federally run US Welfare program. In 1996 the Republican Congress passed a reform law signed by President Clinton that gave the control of the welfare system back to the states.

Eligibility Requirements for State Welfare Program


Eligibility for a Welfare program depends on numerous factors. Eligibility is determined using gross and net income, size of the family, and any crisis situation such as medical emergencies, pregnancy, homelessness or unemployment. A case worker is assigned to those applying for aid. They will gather all the necessary information to determine the amount and type of benefits that an individual is eligible for. The Federal government provides assistance through TANF (Temporary Assistance for Needy Families). TANF is a grant given to each state to run their own welfare program. To help overcome the former problem of unemployment due to reliance on the welfare system, the TANF grant requires that all recipients of welfare aid must find work within two years of receiving aid, including single parents who are required to work at least 30 hours per week opposed to 35 or 55 required by two parent families. Failure to comply with work requirements could result in loss of benefits.

Types of Welfare Available


The type and amount of aid available to individuals and dependent children varies from state to state. When the Federal Government gave control back to the states there was no longer one source and one set of requirements. Most states offer basic aid such as health care, food stamps, child care assistance, unemployment, cash aid, and housing assistance.
Welfare is the provision of a minimal level of well-being and social support for all citizens, sometimes referred to as public aid. In most developed countries, welfare is largely provided by the government, in addition to charities, informal social groups, religious groups, and inter-governmental organizations.

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Welfare systems
France Main articles: Poverty in France, Social protection in France, French Fifth Risk Plan, Revenu de solidarit active, and Revenu minimum d'insertion

Solidarity is a strong value of the French Social Protection system. The first article of the French Code of Social Security describes the principle of solidarity. Solidarity is commonly comprehended in relations of similar work, shared responsibility and common risks. Existing solidarities in France caused the expansion of health and social security.
Germany Main article: Hartz_concept#Hartz_IV

The Welfare state has a long tradition in Germany dating back to the industrial revolution. Due to the pressure of the workers' movement in the late 19th century, Reichskanzler Otto von Bismarck introduced the first rudimentary state social insurance scheme. Today, the social protection of all its citizens is considered a central pillar of German national policy. 27.6 percent of Germany's GDP is channeled into an all-embracing system of health, pension, accident, longterm care and unemployment insurance, compared to 16.2 percent in the US. In addition, there are tax-financed services such as child benefits (Kindergeld, beginning at 184 per month for the first and second children, 190 for the third and 215 for each child thereafter, until they attain 25 years or receive their first professional qualification),[11] and basic provisions for those unable to work or anyone with an income below the poverty line.[12] Since 2005, reception of full unemployment pay (60-67% of the previous net salary) has been restricted to 12 months in general and 18 months for those over 55. This is now followed by (usually much lower) Arbeitslosengeld II (ALG II) or Sozialhilfe, which is independent of previous employment (Hartz IV concept). Under ALG II, a single person receives 382 per month plus the cost of 'adequate' housing and health insurance. ALG II can also be paid partially to supplement a low work income.
Canada Main article: Social programs in Canada

Canada has a Welfare state in the European tradition; however, it is not referred to as "Welfare", but rather as "social programs". In Canada, "Welfare" usually refers specifically to direct payments to poor individuals (as in the American usage) and not to healthcare and education spending (as in the European usage).[13] The Canadian social safety net covers a broad spectrum of programs, and because Canada is a federation, many are run by the provinces. Canada has a wide range of government transfer

payments to individuals, which totaled $145 billion in 2006.[14] Only social programs that direct funds to individuals are included in that cost; programs such as medicare and public education are additional costs. Generally speaking, before the Great Depression, most social services were provided by religious charities and other private groups. Changing government policy between the 1930s and 1960s saw the emergence of a Welfare state, similar to many Western European countries. Most programs from that era are still in use, although many were scaled back during the 1990s as government priorities shifted towards reducing debt and deficits.
United States Main article: Social programs in the United States

President Roosevelt signs the Social Security Act, August 14, 1935

In the United States, welfare is most often used to refer to means-tested cash benefits, especially the Aid to Families with Dependent Children (AFDC) program and its successor, the Temporary Assistance for Needy Families Block Grant. Sometimes, especially by critics of government social spending, it is used to refer to all means tested programs, including for example, healthcare through Medicaid and food and nutrition programs (SNAP).[15] AFDC (originally called Aid to Dependent Children) ADC was created during the Great Depression to alleviate the burden of poverty of families with children and allow widowed mothers to maintain their households. (New Deal employment program such as the Progress Administration primarily served men.) Prior to the New Deal, anti-poverty programs were primarily operated by private charities or state or local governments; however, these programs were overwhelmed by the depth of need during the Depression.[16] The United States has no national program of cash assistance for non-disabled poor individuals who are not raising children. The exception to this is permanent alimony, which is still administered in a handful of states including New Jersey, Florida and Oregon. Alimony Reform movements in these states are attempting to end this form of private welfare.http://money.usnews.com/money/personalfinance/articles/2013/01/23/taking-the-permanent-out-of-permanent-alimony

Overall decline in monthly welfare benefits (in 2006 dollars)[17]

In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act changed the structure of Welfare payments and added new criteria to states that received Welfare funding. After reforms, which President Clinton said would "end Welfare as we know it",[18][dead link] amounts from the federal government were given out in a flat rate per state based on

population.[19][dead link] Each state must meet certain criteria to ensure recipients are being encouraged to work themselves out of Welfare. The new program is called Temporary Assistance for Needy Families (TANF).[20][21] It encourages states to require some sort of employment search in exchange for providing funds to individuals, and imposes a five-year lifetime limit on cash assistance.[18][20][22] In FY 2010, 31.8% of TANF families were white, 31.9% were African-American, and 30.0% were Hispanic.[21] In a 2011 op-ed in Forbes, Peter Ferrara stated that, "The best estimate of the cost of the 185 federal means tested Welfare programs for 2010 for the federal government alone is nearly $700 billion, up a third since 2008, according to the Heritage Foundation. Counting state spending, total Welfare spending for 2010 reached nearly $900 billion, up nearly one-fourth since 2008 (24.3%)".[23] According to the U.S. Census Bureau data released September 13, 2011, the nation's poverty rate rose to 15.1% (46.2 million) in 2010,[24] up from 14.3% (approximately 43.6 million) in 2009 and to its highest level since 1993. In 2008, 13.2% (39.8 million) Americans lived in relative poverty.[25]
Italy Main article: Italian welfare state

The Italian welfare state's foundations were laid along the lines of the corporatist-conservative model, or of its Mediterranean variant[citation needed]. Later, in the 1960s and 1970s, increases in public spending and a major focus on universality brought it on the same path as socialdemocratic systems. In 1978, a universalistic welfare model was introduced in Italy, offering a number of universal and free services such as a National Health Fund.[26]
Sweden Main articles: Swedish Welfare and Social Security (Sweden)

Social welfare in Sweden is made up of several organizations and systems dealing with welfare. It is mostly funded by taxes, and executed by the public sector on all levels of government as well as private organisations. It can be separated into three parts falling under three different ministries; social welfare, falling under the responsibility of Ministry of Health and Social Affairs; education, under the responsibility of the Ministry of Education and Research and labour market, under the responsibility of Ministry of Employment.[27] Government pension payments are financed through an 18.5% pension tax on all taxed incomes in the country, which comes partly from a tax category called a public pension fee (7% on gross income), and 30% of a tax category called employer fees on salaries (which is 33% on a netted income). Since January 2001 the 18.5% is divided in two parts: 16% goes to current payments, and 2.5% goes into individual retirement accounts, which were introduced in 2001. Money saved and invested in government funds, and IRAs for future pension costs, are roughly 5 times annual government pension expenses (725/150).

Japan Main article: Social Welfare in Japan

Social welfare, assistance for the ill or otherwise disabled and for the old, has long been provided in Japan by both the government and private companies. Beginning in the 1920s, the government enacted a series of welfare programs, based mainly on European models, to provide medical care and financial support. During the postwar period, a comprehensive system of social security was gradually established.[28][29]
Latin America This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.
(March 2010)

History

The 1980s marked a change in the structure of Latin American social protection programs. Social protection embraces three major areas: social insurance, financed by workers and employers; social assistance to the populations poorest, financed by the state; and labor market regulations to protect worker rights.[30] Although diverse, recent Latin American social policy has tended to concentrate on social assistance. The 1980s had a significant effect on social protection policies. Prior to the 1980s, most Latin American countries focused on social insurance policies involving formal sector workers, assuming that the informal sector would disappear with economic development. The economic crisis of the 1980s and the liberalization of the labor market led to a growing informal sector and a rapid increase in poverty and inequality. Latin American countries did not have the institutions and funds to properly handle such a crisis, both due to the structure of the social security system, and to the previously implemented structural adjustment policies (SAPs) that had decreased the size of the state. New Welfare programs have integrated the multidimensional, social risk management, and capabilities approaches into poverty alleviation. They focus on income transfers and service provisions while aiming to alleviate both long- and short-term poverty through, among other things, education, health, security, and housing. Unlike previous programs that targeted the working class, new programs have successfully focused on locating and targeting the very poorest. The impacts of social assistance programs vary between countries, and many programs have yet to be fully evaluated. According to Barrientos and Santibanez, the programs have been more successful in increasing investment in human capital than in bringing households above the poverty line. Challenges still exist, including the extreme inequality levels and the mass scale of poverty; locating a financial basis for programs; and deciding on exit strategies or on the longterm establishment of programs.[30]

Latin Americas most recent shift in social policies

The economic crisis of the 1980s led to a shift in social policies, as understandings of poverty and social programs evolved (24). New, mostly short-term programs emerged. These include:[31]

Argentina: Jefes y Jefas de Hogar Bolivia: Bonosol Brazil: Bolsa Escola and Bolsa Familia Chile: Chile Solidario Ecuador: Bono de Desarollo Humano Honduras: Red Solidaria Mexico: Oportunidades (earlier known as Progresa) Panama: Red de Oportunidades Peru: Juntos

Major aspects of current social assistance programs

Conditional cash transfer (CCT) combined with service provisions. Transfer cash directly to households, most often through the women of the household, if certain conditions are met (e.g. childrens school attendance or doctor visits) (10). Providing free schooling or healthcare is often not sufficient, because there is an opportunity cost for the parents in, for example, sending children to school (lost labor power), or in paying for the transportation costs of getting to a health clinic. Household. The household has been the focal point of social assistance programs. Target the poorest. Recent programs have been more successful than past ones in targeting the poorest. Previous programs often targeted the working class. Multidimensional. Programs have attempted to address many dimensions of poverty at once. Chile Solidario is the best example.

New Zealand

New Zealand is often regarded as having one of the first comprehensive welfare systems in the world. During the 1890s a Liberal government adopted many social programmes to help the poor who had suffered from a long economic depression in the 1880s. One of the most far reaching was the passing of tax legislation that made it difficult for wealthy sheep farmers to hold onto their large land holdings. This and the invention of refrigeration led to a farming revolution where many sheep farms were broken up and sold to become smaller dairy farms. This enabled thousands of new farmers to buy land and develop a new and vigorous industry that has become the backbone of New Zealand's economy to this day. This liberal tradition flourished with increased enfranchisement for indigenous Maori in the 1880s and women. Pensions for the elderly, the poor and war casualties followed, with State run schools, hospitals and subsidized medical and dental care. BY 1960 New Zealand was able to afford one of the most well developed and comprehensive welfare systems in the world supported by a well developed and stable economy.

Critiques

Main article: Criticisms of welfare

Income transfers can be either conditional or unconditional. There is no substantial evidence that conditional transfers are more effective than unconditional ones. Conditionalities are sometimes critiqued for being paternalistic and unnecessary. Current programs have been built as short-term rather than as permanent institutions, and many of them have rather short time spans (around five years). Some programs have time frames that reflect available funding. One example of this is Bolivias Bonosol, which is financed by proceeds from the privatization of utilitiesan unsustainable funding source. Some see Latin Americas social assistance programs as a way to patch up high levels of poverty and inequalities, partly brought on by the current economic system. Some opponents of Welfare argue that it affects work incentives. They also argue that the taxes levied can also affect work incentives. A good example of this would be the reform of the Aid to Families with Dependent Children (AFDC) program. Per AFDC, some amount per recipeint is guaranteed. However, for every dollar the recipient earns the monthly stipend is decreased by an equivalent amount. For most persons, this reduces their incentive to work. This program was replaced by Temporary Aid to Needy Families (TANF). Under TANF, people were required to actively seek employment while receiving aid and they could only receive aid for a limited amount of time. However, states can choose the amount of resources they will devote to the program.

See also

Bet Tzedek Legal Services The House of Justice ClowardPiven strategy Constitutional economics Corporate welfare Economics terminology that differs from common usage Jobseeker's Allowance Right to an adequate standard of living Human Poverty Index Nordic model Social democracy Social liberalism Social market economy Unemployment benefits Workfare Welfare capitalism Welfare's effect on poverty Welfare state Welfare trap

References

R.M. Blank (2001). "Welfare Programs, Economics of," International Encyclopedia of the Social & Behavioral Sciences, pp. 1642616432, Abstract. Sheldon Danziger, Robert Haveman, and Robert Plotnick (1981). "How Income Transfer Programs Affect Work, Savings, and the Income Distribution: A Critical Review," Journal of Economic Literature 19(3), pp. 975-1028. R.H. Haveman (2001). "Poverty: Measurement and Analysis," International Encyclopedia of the Social & Behavioral Sciences, pp. 1191711924. Abstract. Steven N. Durlauf et al., ed. (2008) The New Palgrave Dictionary of Economics, 2nd Edition: "social insurance" by Stefania Albanesi. Abstract. "social insurance and public policy" by Jonathan Gruber Abstract. "Welfare state" by Assar Lindbeck. Abstract.

Nadasen, Premilla, Jennifer Mittelstadt, and Marisa Chappell, Welfare in the United States: A History with Documents, 19351996. (New York: Routledge, 2009). 241 pp. ISBN 978-0-41598979-4

Notes
1. ^ "Social Insurance," Actuarial Standard of Practice No. 32, Actuarial Standards Board, January 1998 2. ^ Britannica.com 3. ^ PBS.org 4. ^ Song Dynasty 5. ^ Robert Henry Nelson (2001). "Economics as religin: from Samuelson to Chicago and beyond". Penn State Press. p.103. ISBN 0-271-02095-4 6. ^ "Chapter1: Charity and Welfare", the American Academy of Research Historians of Medieval Spain. 7. ^ Crone, Patricia (2005). Medieval Islamic Political Thought. Edinburgh University Press. pp. 308 9. ISBN 0-7486-2194-6. 8. ^ Shadi Hamid (August 2003). "An Islamic Alternative? Equality, Redistributive Justice, and the Welfare State in the Caliphate of Umar". Renaissance: Monthly Islamic Journal 13 (8). (see online) 9. ^ The Poor Laws of England at EH.Net 10. ^ Liberal Reforms at BBC Bitesize 11. ^ "Federal Ministry of Family Affairs, Senior Citizens, Women and Youth". bmfsfj.de. 12. ^ Tatsachen-ueber-deutschland.de 13. ^ Parl.gc.ca 14. ^ Government transfer payments to persons, Statistics Canada, 8 November 2007, URL accessed 4 December 2007 15. ^ "Stimulus Bill Abolishes Welfare Reform and Adds New Welfare Spending". The Heritage Foundation. Retrieved 10 January 2013. 16. ^ Katz, Michael B. (1988). In the Shadow Of the Poorhouse: A Social History Of Welfare In America. New York: Basic Books. 17. ^ 2008 Indicators of Welfare Dependence Figure TANF 2.

18. ^ a b Deparle, Jason (2009-02-02). "Welfare Aid Isn't Growing as Economy Drops Off". The New York Times. Retrieved 2009-02-12. 19. ^ "Ending Welfare Reform as We Knew It". The National Review. 2009-02-12. Retrieved 2009-0212.[dead link] 20. ^ a b "Stimulus Bill Abolishes Welfare Reform and Adds New Welfare Spending". Heritage Foundation. 2009-02-11. Retrieved 2009-02-12. 21. ^ a b "Characteristics and Financial Circumstances of TANF Recipients - Fiscal Year 2010". United States Department of Health and Human Services. 22. ^ Goodman, Peter S. (2008-04-11). "From Welfare Shift in '96, a Reminder for Clinton". The New York Times. Retrieved 2009-02-12. 23. ^ Ferrara, Peter (2011-04-22). "America's Ever Expanding Welfare Empire". Forbes. Retrieved 2012-04-10. 24. ^ "Revised govt formula shows new poverty high: 49.1M". Yahoo! News. November 7, 2011 25. ^ "Poverty rate hits 15-year high". Reuters. September 17, 2010 26. ^ http://www.pitt.edu/~heinisch/ca_ital.html 27. ^ "Regeringskansliet med departementen" (in Swedish). Retrieved 2010-02-26. 28. ^ http://siteresources.worldbank.org/WBI/Resources/wbi37202.pdf 29. ^ http://www.jcer.or.jp/eng/pdf/Worawan.pdf 30. ^ a b Barrientos, A. and Claudio Santibanez. (2009). "New Forms of Social ,Assistance and the Evolution of Social Protection in Latin America". Journal of Latin American Studies. Cambridge University Press 41, 126 31. ^ Barrientos, A. and Holmes, R. (2007) Social Assistance in Developing Countries database, version 3.0, available from http://www.chronicpoverty.org .

Overview

Edit

In broad terms, the social sciences are those that aim for a rational and systematic understanding of human society. mile Durkheim sought to define social sciences as those that attend to a special sort of fact, which he called a social fact. In his book The Rules of Sociological Method he said that a social fact can be recognized by "the power of external coercion which it exercises or is capable of exercising over individuals, and the presence of this power may be recognized in its turn either by the existence of some specific sanction or by the resistance offered against every individual effort to violate it." Within the philosophy of social science, of course, that definition or any other is up for debate. What Durkheim meant to highlight, though, were the formal sanctions such as law, the informal sanctions such as shunning, and the norms of society that both sorts of sanction enforce. A competing account of the subject matter of the social sciences is found in Max Weber's Economy and Society in which he proposed that social action in a technical sense he defined was the fundamental building block of social phenomena or, as Durkheim would say, social facts.

Weber emphasized the understandability of social phenomena when considered at the level of the individual human beings involved. A contemporary work in the philosophy of social science that takes up the debate between Durkheim and Weber is Margaret Gilbert's On Social Facts. Drawing on insights from Durkheim, Weber, and a third founder of sociology, Georg Simmel, she argues that central social phenomena including social norms and social groups in a central sense are a matter of joint commitment.
. Terangkan kebaikan-kebaikan dasar ini. Dasar penswastaan telah dimulakan dalam era pemerintahan bekas perdana menteri Tun Dr. Mahathir Mohammed pada pertengahan 80-an. Dalam dasar ini agensi kerajaan telah dijual kepada syarikat untuk diuruskan sebagai sebuah syarikat. Dasar ini walaupun telah menerima pelbagai kritikan pada peringkat awalnya telah menarik perhatian masyarakat antarabangsa kerana kejayaannya dalam beberapa aspek terutama kewangan. Kebaikan dasar ini yang ketara ialah kerajaan mampu mengurangkan perbelanjaannya dalam menguruskan negara. Peruntukan yang sepatutunya diberikan kepada agensi kerajaan yang sudah diswastakan itu boleh disalurkan untuk kegunaan projek pembangunan lain yang lebih penting. Keadaan ini memastikan bebanan kewangan negara tidak menjadi satu alasan untuk tidak menjalankan sesuatu projek pembangunan. Dasar ini turut memastikan semua projek pembangunan berjalan lancar. Malah, tahap perkhidmatan agensi kerajaan yang sudah diswastakan itu akan meningkat dengan drastik. Peningkatan ini berkaitan dengan konsep keuntungan yang dipentingkan dalam pengurusan sesebuah syarikat. Agensi yang telah diswastakan itu akan memperoleh keuntungan jika prestasi pekerja dan perkhidmatan mereka ditingkatkan pada satu tahap yang jauh berbeza sebelum daripada dasar penswastaan dilaksanakan. Justeru itu, mutu perkhidmatan yang diberikan kepada rakyat akan meningkat dan menguntungkan mereka. Peningkatan tahap perkhidmatan ini secara tidak langsung telah menyebabkan wujudnya satu persaingan sihat antara pekerja dalam agensi yang baru diswastakan atau di dalam negara secara amnya. Persaingan ini akan menghasilkan satu budaya kerja yang luar biasa sehingga menyebabkan produktiviti sesebuah agensi yang sudah diswastakan itu bertambah dengan baik dalam masa yang singkat. Sememangnya, pekerja akan bersaing untuk memastikan mereka terus relevan di dalam agensi yang diswastakan tersebut. Tambahan pula, persaingan yang sengit ini sudah pasti menyebabkan peluang pekerjaan bertambah kerana sudah pasti lebih banyak peluang ekonomi terbuka dalam dunia yang penuh persaingan. Pelbagai idea baru turut terhasil melalui persaingan ini yang memerlukan satu tahap kemahiran kerja yang tinggi. Aspek ini mendorong pelbagai jenis pekerjaan baru terhasil di negara ini.

Selain itu, dasar ini memberi satu suntikan baru kepada imej negara. Masyarakat luar akan melihat Malaysia sebuah negara yang cekap dan efektif terutama dalam menguruskan negara. Kemampuan negara terjelma melalui sistem pentadbiran yang sistematik, pengangkutan awam yang menyeluruh, kemudahan bertaraf antarabangsa, dan sumber tenaga manusia yang berpengetahuan tinggi. Negara akan dianggap sebagai negara contoh dalam perbandingan pembangunannya. Secara amnya, memang dasar ini membawa kebaikan yang tidak terhingga. Syarikat seperti TELEKOM, TNB, dan POS MALAYSIA merupakan agensi kerajaan yang telah diswastakan dan telah menunjukkan peningkatan dalam perkhidmatan mereka. Perubahan ini dijangka akan terus berlaku dalam tahuntahun mendatang kerana sudah pasti mereka akan bersaing dengan syarikat-syarikat lain yang turut mahu mengaut keuntungan seperti mereka. . Dasar pengswastaan hospital kepada swasta sebenarnya bermatlamatkan kepada pengurangan beban kewangan kerajaan dan pengurusan yang lebih effisyen yang mana akan memberikan perkhidmatan yang memuaskan kepada penggua (pesakit). Tidak semestinya selepas pengswastaan, kadar bayaran yang d tanggung oleh pesakit/pengguna akan menjadi lebih tinggi sebab adanya terma & syarat yang telah ditetapkan yang memihak kepada pengguna, dan perjalanan serta pengoperasian hospitan akan dipantau oleh kerajaan.

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Performing your original search, "public health privatization", in PMC will retrieve 5 records.

Am J Public Health. 2006 October; 96(10): 17331739. doi: 10.2105/AJPH.2005.068007 PMCID: PMC1586133

Privatization of Public Services: Organizational Reform Efforts in Public Education and Public Health
Sarah E. Gollust, BA and Peter D. Jacobson, JD, MPH Author information Article notes Copyright and License information This article has been cited by other articles in PMC. Go to:

Abstract
The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health. THE INSTITUTE OF MEDICINES report, The Future of Public Health in the 21st Century,1 describes a system badly in need of reform. Underfunded and technologically immature, the United States public health system is characterized by quality problems, disparities across racial and socioeconomic groups, and unclear accountability within a fragmented authority structure.1,2 New threats, including bioterrorism, have brought attention to weaknesses in the public health infrastructure and the need to reconsider how public health services are delivered.3 5 We define public health system as the governmental and nongovernmental entities that together provide public health services encompassing the population-based core functions of assessment, policymaking, and assurance6; the related 10 essential services7; and, in many areas, the direct provision of personal health services to vulnerable populations.8 Because the public health system is not the only social system facing similar concerns, it is useful to examine how other public systems that share characteristics with public health have reacted to similar challenges. A particularly striking similarity is found in the public education system. The 1983 report, A Nation At Risk, characterized the education system as a rising tide of mediocrity that threatens our very future as a Nation and a people,9(p1) which ushered in more than 20 years of reform efforts. As with public health, commentators argued that education failures resulted from problems inherent in system design.10 Both systems tried to balance between centralized accountability and decentralized decisionmaking11,12 while struggling with inequities and the difficult task of measuring outcomes.12,13

To address these structural problems, each system has been experimenting with privatization options as the pathway to organizational reform. But the 2 systems have had divergent responses to privatization. In education, the debate over privatization is loud and contentious; in public health, the debate is barely audible. In education, scholarly and media arguments over privatization are common. By contrast, there have been only a few similar analyses of privatization in public health.1420 Even though the privatization tactics in education differ from those being pursued within public health, and there are certainly organizational differences between them, we suggest that the arguments within education, and the lessons learned, are meaningful for a public health audience. Analyzing the analogous experience in public education can broaden the debate about public health privatization and elucidate key issues for the public, practitioners, and policymakers to consider.
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BACKGROUND ON PRIVATIZATION
Privatization is the transfer of decisionmaking authority, delivery, or financing from a public to a private entity.21 Such shifts may occur by directly contracting out services to the private sector or may result indirectly from other arrangements, including partnerships with private sector entities and introducing competitive forces into government services.2224 Regardless of whether the private partner is nonprofit or for-profit, the consistent feature is that control of service delivery may shift to the private sector. These arrangements are neither new nor unique to public education and public health. Throughout its history, the US government has delegated responsibility to private partners to provide goods and services.22 Yet contracting out public services to nongovernmental organizations appears to be increasing in frequency. A 1988 survey of local governments found that a majority of larger cities and counties were contracting out vehicle towing and legal services, and nearly half were contracting out street light operation and waste disposal.25 A December 2002 Council of State Governments survey reflected states increasing use of privatization in education, health and human services departments, personnel agencies, corrections agencies, and transportation.26 For this analysis, we adopted the Public Health Foundations broad working definition of privatization, developed through discussions with public health professionals: Privatization encompasses those activities/services for which the state or local health department has reached a formal decision to withdraw from or contract out for provision of a public health service, in whole or in part, and a non-governmental entity has taken over responsibility for provision of that service. This may include development of formal partnerships with the private sector to offer public health activities/services not previously provided by the public health department.18(pp23)

In theory, privatization approaches are based on the premise that the private sector can deliver goods and services more effectively and efficiently than the public sector.27 In practice, however, the justification for public health privatization is not limited to expected efficiency gains.28 Recent empirical research conducted by Keane et al.20 demonstrates that local health department directors commonly stated reasons for contracting out services also include lack of capacity or expertise and the desire to forge collaborative partnerships. For any type of public service, shifting the provision of services to the private sector is not a simple solution. Privatization is complicated by many theoretical and practical challenges. (See Keane et al.s empirical articles for discussion of some of the challenges specific to local public health department privatization.15,20,29) First, there are rarely numerous competing sellers (i.e., contracting organizations), and the government may be the only buyer. Both parties are often interdependent entities instead of the multiple independent buyers and sellers that market theory requires for efficiency gains.27 Second, the public sector has other values besides efficiency that a private sector organization may not have, including effectiveness, responsiveness, and trust.22 Third, the process and outcome objectives of the public sector are often uncertain, making it difficult to draft unambiguous contracts. Public health exemplifies this challenge; its goals may be nebulous, and there are few satisfactory performance and outcome measures to evaluate public health service delivery.30,31 Fourth, there may be significant transaction costs associated with contracting out services that may outweigh potential gains.27 Finally, for some public private partnerships, shared arrangements may be difficult to operate in practice.22,32,33 Among public services, public health and public education in particular pose a common theoretical challenge for privatization because they can be characterized as public goods. Public goods have 2 essential properties: nondiminishability (or nonrivalry) and nonexcludability. When one person uses the service, it is not taken away from someone else, and it is difficult to prevent others from using it.34 Opponents of privatization argue that the government should provide public goods to ensure social equity.35 Both education and public health services exhibit public benefits: education conveys common language, skills, and behaviors; public health services offer community benefits of communicable disease control, environmental health, sanitation, health education, and vaccinations.15 A further complication is that each system simultaneously provides individuals with private benefits. Personal health services that the public health system provides (such as HIV testing and counseling) convey health care benefits exclusively to certain individuals, but also have public benefit.15 Similarly, as an individual becomes more educated, he or she receives improved employment prospects or income. In turn, the acquired skills can benefit the citizenry as a whole.36
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WHAT CAN WE LEARN FROM THE PUBLIC EDUCATION EXPERIENCE?


Critics of public schools performances have advocated shifting education delivery to the private sector as a reform strategy. Such strategies in education promote consumer choice by substituting new structures (including charter schools, magnet schools, and private schools) for traditional

public schools37,38 and using vouchers or tax credit systems for students to attend alternatives to public schools.39 Other strategies include contracting out services such as food preparation or transportation to private companies and relying on private management of public schools through for-profit educational management organizations.40 Critics of education privatization have argued that these approaches represent a war being waged on Americas public schools.41(p3) Supporters counter that these strategies can improve schools performance and satisfy parental preferences.37 The arguments for privatization in education can be summarized as improving efficiency, quality, equity, and professionalism. Giving consumers options beyond their local public school breaks the public school monopoly, creating competition that theoretically improves the quality of the education provided and forces schools to provide that education more efficiently.42 Others have argued that the market improves the quality of education because schools will respond to specific communities needs.43 Some suggest that private structures are more equitable, giving disadvantaged students choices beyond their local school districts and allowing families to become more engaged in education.44 Finally, if schools were more decentralized and less hierarchical, theory suggests that teachers would experience more professional autonomy and have better attitudes toward their work, improving the learning environment for students.37 Yet there are several major concerns about privatization. First, an important value of the public educational system is its role in promoting democracy, social cohesion, student achievement, and equity.40,45 Those services unrelated to the central values of education, such as transportation and food preparation, have been contracted to private companies with relatively little controversy, but the overall desirability of market forces in public education remains contested. Opponents argue that the quality of education will suffer if schools become increasingly specialized for niche audiences, because there will no longer be an emphasis on values common to all students. Second, there remain questions about how to ensure that alternative models are held accountable to the public and to the government and what mechanisms for oversight should be in place.12,46 Third, privatization may negatively influence teachers professional attitudes if educators become more concerned about their institutions competitive advantage than about doing what is right and sharing their expertise.45,47 Fourth, there are administrative problems that privateoriented reform models create. School choice models require that parents and students have adequate information to choose a quality school that fits their interests, but consumers do not reliably seek this information nor do schools readily make this information available. Information that does not reach students of all backgrounds raises concerns about exacerbating existing disparities.48 Finally, although improving equitable access to education has been promoted as a benefit of private models, others argue that these approaches may not improve access for students of lower socioeconomic status if there are no incentives to reach these students.39,44 Evaluations of the impact of privatization approaches in education on student performance are numerous, and their results are mixed.4951 Overall, there is little evidence to suggest that voucher or charter school programs have a significant positive or negative impact on

performance, either for students who choose the new options or for those who stay in public schools.52,53
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PRIVATIZATION IN PUBLIC HEALTH


Dan Beauchamp, in discussing the renewed emphasis on introducing the market into public health in the mid-1990s, warned that local and state health departments are placed at greatest risk by the politics of market populism.14(p76) Nonetheless, private organizations now compose a critical and valued part of the local and state public health infrastructure.54,55 Private agencies are increasingly performing public health functions, such as primary care services and chronic disease testing and treatment, as public health agencies seek to balance the personal health and population health services they can provide.11 Many approaches for reforming the public health system involve the creation of partnerships with nongovernmental and private entities to deliver public health services.56,57 Health departments have developed partnerships with managed care organizations,58,59 and many contract out service delivery to for-profit and nonprofit organizations.18,20 According to the authors of nationally representative assessments of public health privatization,8,15,20,28,60 local health departments contracting with private organizations to deliver public health services has become quietly and quickly commonplace.20(p615) Keane et al. surveyed local health department administrators from 1998 to 1999 and found that 73% of 347 local health departments had contracted with a private organization to perform at least one public health service (one that was either formerly performed in-house or a new service).20 During the past decade, local health departments have contracted out for primary care services, communicable disease control services, chronic disease testing and treatment, personal health services laboratory work, home health care, substance abuse services, health education, and environmental health services.61 Newborn screening is another function that has been shifting to a private contracting model for some state health departments, as screening capabilities have expanded.6264 Several studies have characterized these arrangements and analyzed their perceived benefits and limitations,15,18,60,65,66 but more work is needed to evaluate the impact these arrangements have on public health outcomes. The privatization arguments in education provide the context for understanding the implications of privatization in public health. For both systems, the potential benefits of privatization include improving efficiency, access, and quality. The most frequent positive outcomes local health departments directors cite for contracting out services include increased access to services, gains in expertise, and improved efficiency.15 Partnerships between local health departments and private organizations have the potential to sustain or expand public health activities,59 reduce redundancies and inefficiencies,65 build relationships within the community,67 and allow the local health departments to specialize on key functions or expand expertise.65 At the same time, concerns about shifting functions to the private sector relate to ensuring accountability, quality, and coordination.65 Local health department directors perceive the major negative effects of contracting out services to be loss of control and accountability for

services.15 Management of contracts becomes a major responsibility of the public sector employee,22 yet public health professionals may not be adequately trained for this function. Nearly half of local health department directors who privatized services reported an increase in the time their staff spent on administration and program management after privatizing those services.15 Evidence indicates that relying on private companies to deliver certain specific public health services may be problematic. The flu vaccine shortage of 2004 has been attributed to the governments short-sighted dependence on 2 companies for the production of the vaccine, with little governmental assurance of the vaccines availability.68 Keane et al. found that local health department directors are concerned that privatization introduces a loss of control that impedes their ability to respond to emergencies and communicable disease outbreaks.15 Keane et al. also raised concerns about contracting out environmental health services to for-profit organizations.69 In Pennsylvania, health centers in 3 counties were privatized on a pilot basis in 1997, contracting out services for HIV testing and counseling, immunizations, sexually transmitted disease screening, and tuberculosis screening and treatment. An initial evaluation by Lopez et al. describes concerns about accountability for the management of patients with tuberculosis, decreased access to sexually transmitted disease services, fragmented communication with the Department of Health, and potential weaknesses in responding to emergencies and disease outbreaks.66 Additional unease about shifting functions relates to equity. Just as there is concern that private schools may not serve the most vulnerable students, the private sector may be unwilling to serve the uninsured and underinsured populations who currently receive care from the public health care safety net. In some areas, there are few private sector entities to deliver safety net services. If health departments stop providing these services, it is unclear how these populations will receive needed services.17,18,32 A large majority of local health department directors interviewed in 2000 and 2001 believed that local health departments ought to provide personal health services to the uninsured and also deliver the population-based core functions.8 Achieving a balance between these 2 aims remains a significant challenge for local health departments, and public health at large, to address.8,70 Of equal concern are the ethical, pragmatic, and professional issues for public health practitioners raised by privatization (including some publicprivate partnerships) that have not yet been resolved. The National Association of County and City Health Officers has developed a tool to help local health departments make strategic decisions to balance the personal health and population-based services they provide,71 but this effort may not ameliorate practitioners concerns. In recent focus groups, public health practitioners reported confusion about selecting partners and expressed a need for ethical guidelines, especially in the context of scarce public resources.72 One study of safety net providers in Michigan identified publicprivate partnerships as a source of dissatisfaction, with several practitioners noting that such partnerships seem to favor the private entity.32 Finally, there is likely to be professional resistance to privatization strategies. More than one third of the local health department directors surveyed reported employee resistance to privatization.73 This resistance may emerge from employee concerns about a shift in the focus

and mission of their work and apprehension that contract workers will negatively affect the quality of services provided.18
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WHY HAVING THE DEBATE MATTERS


The Values and Mission of Public Health

At the heart of the privatization debates in both public health and education lies the need to clarify the mission and values of each sector to determine whether to divide public and private responsibilities and how to divide them. For public health, core values center on communal wellbeingdisease prevention and health promotion for populationsand distributional justice.74,75 Many believe that the mission of public health includes treating illnesses as well as their social and economic determinants.5,75 It is clear from previous empirical research that decisions made at the local health department level about the services that should be privatized confront the larger issues concerning the scope, mission, and values of the public health field.20,29 In their second survey study of local health department privatization, Keane et al. demonstrate that directors who perceive their mission to be limited to the core public health functions of assessment, assurance, and policy development were more likely to discontinue delivery of personal health services than were directors who held the belief that their departments should provide these services.28 Keane et al. explain these findings as a trend in public health toward adopting a managerial orientation that limits public health activities to the 3 core functions, thereby preserving resources for population-based services.28,29 Local health department directors stated that there are some population-based services that should never be delivered through the market, including communicable disease control services, regulatory services, and emergency response services.15 Instead of individual directors making local decisions about which public health functions should be privatized, thus suggesting normative positions on the scope and mission of public health, the conceptual and philosophical bases underlying these decisions should be deliberated openly. There should be criteria to determine which of the numerous public health functions must remain public and which can become the responsibility of private organizations.19 As political scientist Don Kettl noted, Just where the line should be drawn between the functions that are inherently governmental and those that can be legitimately contracted out is perhaps the most difficult puzzle of the publicprivate relationship.22(p210)
Inevitability and Desirability

One might argue, either from resignation of its inevitability or from conviction of its desirability, that shifting public health functions to the private sector is the most effective way of preserving the values animating the public health system. Even though partnerships and contracting with private organizations have been endorsed as inevitable and necessary mechanisms for delivering public health services,1,55 there are several reasons for provoking additional discussion.

First, the education debate demonstrates that an aggressive defense of public education has posed a challenge to privatization, triggering broad public and policy attention to strengthening the public system while promoting rigorous evaluations of alternatives. Second, the increasing use of privatization raises provocative questions about the future of public health that have yet to be adequately addressed: what public health services should never be delivered through private entities but must remain a governmental function? What are the criteria for deciding which functions can be shifted to the private sector? Who will be held accountable as the public role declines? What will remain of the public in public health over time? What are the implications of a weakened (or absent) public role in the system? Third, escalating the debate over privatization may encourage more systematic evaluations of whether the private sector is meeting its contracted public health responsibilities.
A Role for the Public

A major difference between the public education system and the public health system is their relative visibility to the public. In a 2002 public opinion poll, 69% of the public responded that the public education system should be strengthened instead of relying on voucher systems for children to attend private options. A similar proportion believed that reforming the existing public school system was preferable to finding alternatives.76 But what does the public believe about the public health system? In a 1996 Harris poll, even though 57% of respondents stated that government should be responsible for public health, less than 4% responded to a question about what public health means to you with answers that approximate the major functions of public health.77,78 More troubling is that 57% of respondents in a 1999 public opinion survey were unable to appropriately define public health.79 As voters and taxpayers, the publics expectation for the public health system is a critical, yet missing, component of the privatization debate. Taxpayers should demand efficient delivery of services but they should also expect a strong system that can protect them from public health threats. Without a full understanding of the value of public health, however, the public may not expect or support a continued governmental presence. In an effort to provide the public with accurate expectations of the public health system, the National Association of County and City Health Officers is developing and disseminating an operational definition of public health.80 If effective, this and other innovative methods of informing the public about the value and mission of public health are essential for continued public support and strengthening of the governmental public health system.
Alternatives

Aside from privatization approaches, there are undoubtedly alternative and innovative ways to reconceptualize and strengthen the governmental public health system. For example, regionalizing public health authorities in some areas might make service delivery more effective and efficient.81 To determine whether alternative structures are effective, evaluators must pay attention to the underlying mission and the public health functions the alternatives aim to provide.33 More work to assess the value and performance of public health systems must be done, so that limited public funds can be directed toward those services that will have the greatest impact on public health outcomes.82,83

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CONCLUSION
Public health professionals in the United States should continue to make their voices heard in the policy debate over privatization.84 Privatization raises fundamental questions about the essential public nature of public health, ensuring equity, and the appropriate scope of public health to balance personal health and population services. Privatization approaches, with their claims to improve efficiency, access, and quality, have an undeniable appeal, but they should be subject to rigorous research and evaluation. Political or ideological justifications for these arrangements are not sufficient when the health of communities is at stake.
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Acknowledgments
The authors thank the 3 anonymous reviewers for their valuable comments and suggestions. Human Participant Protection No protocol approval was needed for this study.
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Notes
Peer Reviewed Contributors Both authors contributed to the origination, analysis, and writing of this article.
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References
1. Institute of Medicine. The Future of the Publics Health in the 21st Century. Washington, DC: National Academies Press; 2003. 2. Baker EL, Potter MA, Jones DL, et al. The public health infrastructure and our nations health. Annu Rev Public Health. 2005;26:303318. [PubMed] 3. Fee E, Brown TM. The unfulfilled promise of public health: deja vu all over again. Health Aff. 2002;21:3143. 4. Lurie N. The public health infrastructure: rebuild or redesign? Health Aff. 2002;21:2830.

5. Gostin L, Boufford J, Martinez R. The future of the publics health: vision, values, and strategies. Health Aff. 2004; 23:96107. 6. Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988. 7. Public Health Functions Steering Committee, Public Health in America. 1995. Available at: http://www.health.gov/phfunctions/public.htm. Accessed June 21, 2006. 8. Keane C, Marx J, Ricci E. Local health departments mission to the uninsured. J Public Health Policy. 2003;24: 130149. [PubMed] 9. National Commission on Excellence in Education. A Nation at Risk. Washington, DC: U.S. Department of Education; 1983. 10. Frazier A. A Roadmap for Quality Transformation in Education. Boca Raton, Fla: St Lucie Press; 1997. 11. Wall S. Transformations in public health systems. Health Aff. 1998;17: 6480. 12. Hanushek E, Raymond M. Lessons about the design of state accountability systems. In: Peterson P, West MR, eds. No Child Left Behind? The Politics and Practice of Accountability. Washington, DC: Brookings Institution Press; 2003: 126151. 13. Handler A, Issel M, Turnock BJ. A conceptual framework to measure performance of the public health system. Am J Public Health. 2001;91: 12351239. [PMC free article] [PubMed] 14. Beauchamp D. Public health, privatization, and market populism: a time for reflection. Qual Manage Health Care. 1997;5:7379. 15. Keane C, Marx J, Ricci E. Perceived outcomes of public health privatization: a national survey of local health department directors. Milbank Q. 2001;79: 115137. [PMC free article] [PubMed] 16. Halverson PK, Kaluzny AD, McLaughlin CP. Managed Care and Public Health. Gaithersburg, Md: Aspen Publishers; 1998. 17. Drevdahl D. Social justice or market justice? the paradoxes of public health partnerships with managed care. Public Health Nurs. 2002;19:161169. [PubMed] 18. Bchamps M, Bialek R, Chaulk C. Privatization and public health: a report of initiatives and early lessons learned. Washington, DC: Public Health Foundation; 1999. 19. Avery G. Outsourcing public health laboratory services: a blueprint for determining whether to privatize and how. Public Adm Rev. 2000;60:330337. 20. Keane C, Marx J, Ricci E. Privatization and the scope of public health: a national survey of local health department directors. Am J Public Health. 2001;91:611617. [PMC free article] [PubMed]

21. Suleiman EN, Waterbury J. Introduction: analyzing privatization in industrial and developing countries. In: Suleiman EN, Waterbury J, eds. The Political Economy of Public Sector Reform and Privatization. Boulder, Colo: West-view Press; 1990:4. 22. Kettl DF. Sharing Power: Public Governance and Private Markets. Washington, DC: The Brookings Institution; 1993. 23. Osborne D, Gaebler T. Reinventing Government: How the Entrepreneurial Spirit Is Transforming the Public Sector. New York, NY: Addison-Wesley; 1993. 24. Dilger R, Moffett R, Struyk L. Privatization of municipal services in Americas largest cities. Public Adm Rev. 1997;57:2126. 25. Feigenbaum H, Henig J, Hamnett C. Shrinking the State: The Political Underpinnings of Privatization. New York, NY: Cambridge University Press; 1999. 26. Chi KS, Kelley AA, Perkins HM. Trends in state government management: budget reduction, restructuring, privatization and performance budgeting. The Book of the States. Vol 35. Lexington, Ky: The Council of State Governments; 2003:419427. 27. Sclar ED. You Dont Always Get What You Pay For. Ithaca, NY: Cornell University Press; 2000. 28. Keane C. The effects of managerial beliefs on service: Privatization and discontinuation in local health departments. Health Care Manage Rev. 2005; 30(1):5261. [PubMed] 29. Keane C, Marx J, Ricci E. Managerial and professional beliefs influencing public health privatization: results of a national survey of local health department directors. J Health Soc Behav. 2003;44: 97110. [PubMed] 30. Roper WL, Mays GP. Performance measurement in public health: conceptual and methodological issues in building the science base. J Public Health Manage Pract. 2000;6(5):6677. 31. Rohrer J. Performance contracting for public health: the potential and the implications. J Public Health Manage Pract. 2004;10(1):2325. 32. Jacobson P, Dalton VK, Berson-Grand J, Weisman CS. Survival strategies for Michigans health care safety net providers. Health Serv Res. 2005; 40:923940. [PMC free article] [PubMed] 33. Jacobson P. Form versus function in public health. J Public Health Manage Pract. 2002;8(1):9294. 34. Frank RH. Microeconomics and Behavior. 5th ed. Boston, Mass: McGraw Hill; 2003. 35. Greene JD. Cities and Privatization. Upper Saddle River, NJ: Pearson Education Inc; 2002. 36. Smith KB. The Ideology of Education: The Commonwealth, the Market, and Americas Schools. Albany, NY: State University of New York Press; 2003.

37. Chubb JE, Moe T. Better schools through new institutions: giving Americans choice. In: Chubb JE, Moe T, eds. Politics, Markets, and Americas Schools. Washington, DC: Brookings Institution; 1990:185 229. 38. Bast JL, Walberg HJ. Free market choice: can education be privatized? In: Finn CE, Walberg HJ, eds. Radical Education Reforms. Berkeley, Calif: Mc-Cutchan Publishing Corp; 1994. 39. Heise M. New school choice plans. In: Finn CE, Walberg HJ, eds. Radical Education Reforms. Berkeley, Calif: Mc-Cutchan Publishing Corp; 1994. 40. Levin H, ed. Privatizing Education: Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion? Boulder, Colo: Westview Press; 2001. 41. Bracey G. War Against Americas Public Schools. Boston, Mass: Allyn and Bacon; 2002. 42. Carnoy M, McEwan PJ. Privatization through vouchers in developing countries: the cases of Chile and Colombia. In: Levin H, ed. Privatizing Education: Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion? Boulder, Colo: Westview Press; 2001:151177. 43. Madsen J. Private and Public School Partnerships: Sharing Lessons About Decentralization. Washington, DC: Falmer Press; 1996. 44. Natriello G. Vouchers, privatization, and the poor. In: Levin H, ed. Privatizing Education: Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion? Boulder, Colo: Westview Press; 2001:263278. 45. Bottery M. Education, Policy, and Ethics. London, England: Continuum; 2000. 46. Manno B, Finn CE, Vanourek G. Charter school accountability: problems and prospects. Educ Policy. 2000;14: 473493. 47. Persell CH. Teachers and privatization. In: Levin H, ed. Privatizing Education: Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion? Boulder, Colo: Westview Press; 2001:279300. 48. Schneider M. Information and choice in educational privatization. In: Levin H, ed. Privatizing Education: Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion? Boulder, Colo: Westview Press; 2001:72102. 49. Rouse C. Private school vouchers and student achievement: an evaluation of the Milwaukee parental choice program. Q J Econ. 1998;113:553602. 50. Howell W, Wolf P, Cambell D, Peterson P. School vouchers and academic performance: results from three randomized field trials. J Policy Anal Manage. 2002;21:191217. 51. Americas charter schools: Results from the NAEP 2003 pilot study. Washington, DC: US Dept of Education. Available at: http://nces.ed.gov/nationsreportcard/pdf/studies/2005456.pdf. Accessed August 1, 2005.

52. Goldhaber D, Eide E. What do we know (and need to know) about the impact of school choice reforms on disadvantaged students? Harvard Educ Rev. 2002;72:157176. 53. Schemo DJ. Charter schools trail in results, U.S. data reveals. The New York Times. August 17, 2004: A1. 54. Halverson PK, Haley DR, Mays GP. Current practice and evolving roles in public health. In: Halverson PK, Kaluzny AD, McLaughlin CP, eds. Managed Care and Public Health. Gaithersburg, Md: Aspen Publishers; 1998:1141. 55. Halverson PK. Embracing the strength of the public health system: Why strong government public health agencies are vitally necessary but insufficient. J Public Health Manage Pract. 2002;8(1):98100. 56. Nicola R, Berkowitz B, Lafronza V. A turning point for public health. J Public Health Manage Pract. 2002;8(1):ivvii. 57. Lake J, Peterson E. An alternative structure for improving the publics health. J Public Health Manage Pract. 2002;8(1):7582. 58. Koplan J, Harris J. Not-so-strange bedfellows: public health and managed care. Am J Public Health. 2000;90: 18241826. [PMC free article] [PubMed] 59. Halverson PK, Mays GP, Kaluzny AD, Richards TB. Not-so-strange bedfellows: models of interaction between managed care plans and public health agencies. Milbank Q. 1997;75:113138. [PMC free article] [PubMed] 60. Keane C, Marx J, Ricci E. The perceived impact of privatization on local health departments. Am J Public Health. 2002;92:11781180. [PMC free article] [PubMed] 61. Keane C, Marx J, Ricci E. Services privatized in local health departments: a national survey of practices and perspectives. Am J Public Health. 2002;92: 12501254. [PMC free article] [PubMed] 62. Rinaldo P, Tortorelli S, Matern D. Recent developments and new applications of tandem mass spectrometry in newborn screening. Curr Opin Pediatr. 2004;16:427433. [PubMed] 63. Wilfond BS, Gollust SE. Policy issues for expanding newborn screening programs: the cystic fibrosis newborn screening experience in the United States. J Pediatr. 2005;146:668674. [PubMed] 64. Holtzman NA. Expanding newborn screening: how good is the evidence? JAMA. 2003;290:2606 2608. [PubMed] 65. Halverson PK, Kaluzny AD, Mays GP, Richards TB. Privatizing health services: alternative models and emerging issues for public health and quality management. Qual Manage Health Care. 1997;5:118. 66. Lopez S, Rhodes L, Herzenberg S. The Quiet Dismantling of Public Health. Harrisburg, Pa: Keystone Research Center; 1999.

67. Zahner S. Local public health system partnerships. Public Health Rep. 2005;120:7683. [PMC free article] [PubMed] 68. Grady D. Shortage was predicted. The New York Times. October 7, 2004: A33. 69. Keane C, Marx J, Ricci E. The privatization of environmental health services: A national survey of practices and perspectives in local health departments. Public Health Rep. 2002;117: 62117. [PMC free article] [PubMed] 70. Smith TA. From theory to practice: what drives the core business of public health? Presented at the Academy-Health Annual Research Meeting, June 27, 2005; Boston, Mass. 71. Ingoglia JN. Making strategic decisions about service delivery. J Public Health Manage Pract. 2004;10(3): 272274. 72. Reich MR, Hershey JH, Hardy GE Jr, Childress JF, Bernheim RG. Workshop on public health law and ethics I & II: the challenge of public/private partnerships (PPPs). J Law Med Ethics. 2003; 31:9093. [PubMed] 73. Keane C, Marx J, Ricci E. Public health privatization: proponents, resisters, and decision-makers. J Public Health Policy. 2002;23:133152. [PubMed] 74. Gostin LO. Public Health Law: Power, Duty, Restraint. Berkeley, Calif: University of California Press; 2000. 75. Mullan F. Don Quixote, Machiavelli, and Robin Hood: public health practice, past and present. Am J Public Health. 2000;90:702706. [PMC free article] [PubMed] 76. Attitudes toward the public schools survey. Survey by Phi Delta Kappa and Gallup Organization, June 5June 26, 2002. Available at: http://www.ropercenter.uconn.edu/ipoll.html (subscription required). Accessed July 24, 2005. 77. Centers for Disease Control and Prevention. Public opinion about public health: California and the United States, 1996. MMWR Morb Mortal Wkly Rep. 1998;47(4):6973. [PubMed] 78. Survey by Louis Harris & Associates, December 12December 16, 1996. Available at: http://www.ropercenter.uconn.edu/ipoll.html (subscription required). Accessed July 13, 2005. 79. Centers for Disease Control and Prevention. Public opinion about public health: United States, 1999. MMWR Morb Mortal Wkly Rep. 2000;49(12): 258260. [PubMed] 80. National Association of County and City Health Officers. Operational definition of a functional local health department. Available at: http://www.naccho.org/topics/infrastructure/documents/OperationalDefinitionBrochure.pdf. Accessed June 21, 2006.

81. Mays GP, Halverson PK. Disparities in the economic and organizational capacity to deliver public health services in the Delta. Poster presented at the Public Health Systems Research Meeting, Academy Health, June 25, 2005; Boston, Mass. 82. Mays GP, Halverson PK, Scutchfield FD. Making public health improvement real: the vital role of systems research. J Public Health Manage Pract. 2004; 10(3):183185. 83. Barry M, Bialek R. Tracking our investments in public health: what have we learned? J Public Health Manage Pract. 2004;10(5):383392. 84. Jacobson PD, Wasserman J. Missing in action: the public health voice in policy debates. J Public Health Manage Pract. 2001;7(3):ixx.

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Dasar penswastaan merupakan agenda besar-besaran dunia sejak diperkenalkan lebih 20 tahun lalu oleh kuasa kapitalis dunia iaitu Amerika Syarikat dan Britain. Dasar ini diperkenalkan oleh dua pengamal dari negara kapitalis iaitu Presiden Amerika Syarikat, Ronald Reagan dan Perdana Menteri Britain, Margaret Thatcher. Dengan sokongan organisasi-organisasi seperti Bank Dunia, Tabung Dana Antarabangsa, IMF dan Bank Pembangunan Asia, dasar ini berjaya memberi faedah yang besar kepada kerajaan yang melaksanakannya termasuklah dari segi pendapatan negara dan keutuhan politik. Dasar penswastaan adalah fenomena politik dan ekonomi yang dilaksanakan sebagai pemindahan kepentingan atau pelaburan tertentu kerajaan kepada sektor swasta. Dengan itu, kuasa membuat keputusan kini beralih daripada tangan orang ramai kepada pihak swasta atau pemilik baru organisasi awam. Malaysia menjadi antara negara terawal melaksanakan dasar ini di bawah pentadbiran Tun Dr. Mahathir Mohamad. Antara syarikat awam yang diswastakan sejak tahun 1980an termasuklah Syarikat Penerbangan Malaysia (MAS) dan Telekom Malaysia. Terkini, kerajaan juga berhasrat untuk menswastakan air negeri Selangor kepada Syarikat Bekalan Air Selangor (SYABAS). Proses penswastaan air Selangor kepada syarikat SYABAS ini mencetuskan reaksi daripada pelbagai pihak termasuklah kerajaan negeri Selangor, parti-parti politik serta golongan masyarakat. Keputusan kerajaan persekutuan untuk menswastakan bekalan air Selangor kepada SYABAS ini menjadi isu yang hangat diperkatakan kerana ia melibatkan kebajikan dan kesejahteraan rakyat Selangor khususnya mereka yang berada di sekitar Selangor, Lembah Klang dan Putrajaya. Pada dasarnya, saya melihat penswastaan merupakan salah satu langkah kerajaan untuk meningkatkan pendapatan negara. Ini kerana, penswastaan dilihat sebagai peralihan kuasa monopoli kepada pihak swasta untuk memaksimumkan keuntungan. Namun, dari sudut lain, ia akan memberi impak besar kepada masyarakat apabila penswastaan yang dilakukan hanya memberi keuntungan kepada pihak-pihak tertentu sahaja. Dalam hal ini, ketelusan pihak kerajaan dalam melaksanakan dasar ini amatlah memberi kesan kepada kesejahteraan dan kebajikan rakyat. ...............

Dasar Penswastaan tidak sepatutnya sampai membebankan rakyat. Penswastaan adalah satu-satunya cara yang amat berkesan untuk menyelesaikan masalah ketidakcekapan dan tidak produktif yang berlaku dalam perkhidmatan-perkhidmatan yang diuruskan oleh pihak kerajaan.Rungutan orang ramai terhadap kualiti perkhidmatan awam yang diberikan oleh badan-badan kerajaan sebelum ini telah mendorong pemerintah untuk menswastakan satu demi satu badan-badan kerajaan ini. Walaupun mutu perkhidmatan awam ini bertambah baik selepas ia diswastakan tetapi rakyat terpaksa membayar lebih mahal kepada semua khidmat yang diberi berbanding sebelum ia diswastakan. Sebagai contoh jika bayaran bil telefon sebelum diswastakan sekitar RM25.00 sebulan tetapi setelah beberapa tahun diswastakan untuk penggunaan yang sama harganya telah meningkat menjadi sekitar RM55.00. Dapat diperhatikan ia telah meningkat lebih dua kali ganda. Begitulah juga dengan bayaran elektrik dan air, semua bayaran meningkat apabila diswastakan. Apabila diswastakan, badan-badan ini kena memikirkan tentang keuntungan. Untuk member keuntungan kepada perniagaan, syarikat terpaksa mengenakan cas yang sesuai supaya kerugian tidak berlaku. Sudah tentu pengguna atau rakyatlah terpaksa menanggung cas yang dikenakan itu. Memanglah bagus kalau dasar penswastaan dapat memberikan perkhidmatan yang cekap dan terbaik kepada rakyat tetapi sepatutnya ia tidaklah sampai membebankan rakyat dengan bayaran-bayaran perkhidmatan yang tinggi. Kalaupun bayaran cas perkhidmatan yang dikenakan itu tidak mungkin dapat dikurangkan daripada harga sebelum ianya diswastakan setidak-tidaknya hendaklah sama seperti harga sebelum ini supaya ia tidak menambah beban kepada rakyat. Dasar penswastaan harus dilihat sebagai cara untuk menambah kecekapan kepada perkhidmatan awam tetapi bukannya sampai untuk mencari keuntungan yang akan membebankan rakyat. Keadaan bertambah malang menimpa rakyat jelata bila dasar penswastaan ini telah memperkayakan orang-orang yang memegang kuasa politik di negara ini. Pemimpin-pemimpin politik beserta suku sakatnya mempunyai kaitan rapat dan berkepentingan dalam semua projek-projek dan badan-badan kerajaan yang telah disawastakan itu. Mereka mungkin mempunyai hubungan secara langsung seperti menjadi pengerusi atau lembaga pengarah atau secara tidak langsung melalui pemilikan saham yang besar yang khas diperuntukkan kepada mereka. Sejak dasar penswastaan ini rancak berjalan, tidak kedengaranlah lagi pemimpin-pemimpin politik yang lantang memperjuangkan perit dan derita yang ditanggung oleh rakyat terhadap bayaran-bayaran mahal yang dikenakan oleh pihak-pihak swasta ini. Kalau dulu pemimpin-pemimpin politik digambarkan sebagai pejuang nasib rakyat tetapi sekarang pemimpin politik seperti menjadi seteru rakyat pula. Ini semua kerana gara-gara pemimpin-pemimpin politik telah mempunyai kepentingan dalam syarikatsyarikat swasta ini. Inilah buruknya akibat bila pemimpin-pemimpin politik terlibat atau berkepentingan dalam perniagaan dan syarikat-syarikat swasta. Keuntungan pada syarikat-syarikat swasta atau perniagaan yang dia terlibat akan juga member keuntungan pada dirinya. Perjuangan untuk membela nasib rakyat atau untuk meringankan masalah rakyat akan jatuh kepada nombor dua.

Sebagai Menteri yang bertanggungjawab kepada PLUS syarikat yang membina lebuh raya Malaysia, memang tidak boleh dinafikan Datuk Samy Vellu juga secara tidak langsung ada mempunyai kepentingan dalam syarikat pembinaan lebuhraya ini. Oleh itu setiap kali pihak PLUS memohon kenaikan bayaran tol lebuhraya, Datuk Samy Vellu tidak teragak-agak untuk menyokong permintaan PLUS itu dengan berkata, "permohonan oleh pihak PLUS untuk menaikkan tol itu memang tidak boleh ditolak lagi". Sepatutnya sebagai orang politik tentulah dia terlebih dahulu melihat kepada beban yang ditanggung rakyat di atas kenaikan tol itu tetapi ini tidak berlaku kepadanya. Akhirnya rakyat secara sendirian membuat protes hinggalah kerajaan terpaksa akur supaya kenaikannya dikaji semula. Kajian itu dibuat bukan dengan niat untuk mengurangkan beban rakyat tetapi lebih kepada untuk meredakan marah rakyat. Sebagai untuk menunjukkan perihatin kepada masalah rakyat dan pengguna, maka dibentuklah satu kementerian yang dinamakan Kementerian Hal Ehwal Pengguna yang tugasnya mengambil berat kepada masalah-masalah barang-barang keperluan pengguna. Seperti yang disebut sebelum ini, oleh kerana pemimpin-pemimpin politik dan orang-orang yang memegang kuasa aktif terlibat dalam perniagaan maka peranan kementerian ini untuk menjaga kepentingan pengguna tidak dapat berjalan dengan begitu berkesan. Tugas mereka akhirnya jadi seperti melepaskan batuk ditangga. Mereka tidak mungkin dapat memberi khidmat yang berkesan kerana mereka itu mempunyai kepentingan yang bercanggah. Sebagai contoh semasa perang harga minyak petrol sedang rancak berjalan, berkatalah Datuk Megat Junid menteri hal ehwal pengguna ini, "jika dibiarkan perang harga ini berterusan, syarikat minyak akan rugi dan mungkin tutup". Sebagai menteri hal ehwal pengguna sepatutnya dia sepatutnya suka perang harga itu berlaku kerana pengguna atau rakyat akan menikmati harga petrol yang rendah tetapi sebaliknya dia cuba menjaga kepentingan syarikat minyak.Bukanlah lebih baik dia menjadi Menteri Petrolium saja. Selalu saja kita mendengar pembeli-pembeli rumah marah-marah dan keciwa kerana rumah mereka gagal disiapkan oleh pihak pemaju rumah dalam masa yang telah dijanjikan. Mereka terpaksa membayar pinjaman kepada bank walaupun rumah belum boleh diduduki. Ini sungguh membebankan pembeli kerana dalam masa yang sama mereka terpaksa membayar sewa rumah. Yang bertambah malang lagi beban biawak hidup yang dipikul oleh pembeli ini bukanlah disebabkan oleh kesalahan pembeli itu sendiri. Ini tidak termasuk rasa tidak puas hati pembeli rumah terhadap kualiti rumah yang dijanjikan, masalah rumah terbengkalai dan sebagainya. Walaupun banyak aduan telah dibuat kepada pihak yang berkuasa seperti Kementerian Perumahan dan Kerajaan Tempatan namun keadaanya tetap juga tidak berubah dan jawapannya yang biasa diterima oleh pembeli bagi menyedapkan hati mereka ialah, siasatan akan dijalankan. Satu sebab tindakan tegas tidak diambil terhadap pihak pemaju yang tidak bertanggungjawab ini ialah kerana pihak yang memegang kuasa dalam hal perumahan ini juga mempunyai kepentingan dalam syarikat-syarikat pemaju perumahan ini samada secara langsung atau pun secara tidak langsung.

Tidak hairanlah kalau nasib pembeli-pembeli rumah ini tidak mendapat pembelaan, dan setiap undangundang yang digubal lebih berat melindungi pemaju dari membela pembeli. Selagi pihak yang memegang kuasa mempunyai kepentingan dalam projek-projek perumahan selagi itulah pembeli rumah tidak mendapat pembelaan yang sewajarnya. Jika pihak berkuasa benar-benar ingin melihat pembeli mendapat layanan yang baik kenapa tidak syaratkan kepada pemaju rumah supaya membina rumah dahulu kemudian baru jual. Kalau kereta yang berharga ratusan ribu ringgit boleh dibina dulu kemudian baru dijual kenapa rumah tidak boleh dibuatkan cara ini. Ataupun setidak-tidaknya pihak pemaju dikehendaki membayar bayaran bulanan kepada bank selagi pembeli tidak boleh menduduki rumah tersebut. Dalam masa rakyat sibuk dengan isu nasib buruk hak asasi manusia di Malaysia di akhir-akhir ini, pihak kerajaan BN pula cuba menonjolkan diri sebagai hero hak asasi manusia dengan cuba mencadangkan penubuhan satu suruhanjaya hak asasi manusia peringkat Malaysia. Langkah ini dilihat oleh pengkritik sebagai menutup tindak-tanduk pihak kerajaan yang telah banyak melanggar dan mencabul hak manusia itu sendiri. Pelaksanaan akta ISA yang mana akta seperti ini hanya wujud di tiga negara saja di dunia demokrasi itu jelas menunjukkan tidak prihatinnya kerajaan kita kepada hak asasi manusia. Apakah istimewanya demokrasi negara kita sehingga boleh menghalalkan akta ISA ini. Kepada pemimpin-pemimpin politik dan pemegang-pemegang kuasa seperti Malaysia isu hak asasi manusia adalah merupakan musuh yang boleh menggugat kekuasaan politik mereka. Tidak mungkin ada orang yang ingin mempertahankan musuhnya. Akhirnya suruhanjaya hak asasi yang ingin ditubuhkan oleh pihak kerajaan ini hanya akan menjadi kuda tunggangan yang akan menghalalkan pelanggaran dan pencabulan oleh pihak yang berkuasa ke atas hak asasi manusia itu sendiri. Contoh terdekat kita telah melihat BPR sebuah badan yang ditubuhkan bagimemerangi rasuah yang berlaku di Negara ini telah tidak dapat berjalan dengan berkesan bila ada kepentingan yang bercanggah. Oleh kerana adanya pengaruh kuasa politik, BPR tidak dapat menjalankan tugasnya denganbebas. Tambah malang BPR telah digunakan oleh pemimpin politik yang berkuasa untuk mengekalkan kuasanya. BPR boleh diarahkan oleh pemimpin politik ini untuk menyiasat rasuah musuh-musuh politiknya dan sebaliknyaboleh menahan BPR dari menyiasat kes rasuah suku sakat, rakan-rakan dan dirinya sendiri. Walaupun tujuan asal BPR itu bagus untuk membentuknegara yang bersih dari rasuah tetapi oleh kerana dia adalah badan yangdikuasai oleh pemimpin politik yang berkuasa maka BPR tidak dapatmenjalankan tugasnya dengan baik bila bercanggah dengan kepentingan pemimpin politik yang berkuasa. Begitulah juga dengan nasib yang berlaku ke atas makamah negara kita, kita telah menyaksikan peguam negara dan makamah telah menjadi tunggangan pemimpin politik yang berkuasa bagi memperkukuhkan kuasanya.Musuh-musuh politik yang menggugat ditelanjangi dan direka kesalahannya di makamah sementara salah laku rakan dan sekutu politiknya di halang dari dihadapkan ke makamah. Hakim tidak dapat membuat keputusan dengan bebas di makamah sebaliknya hakim hanyalah membaca keputusan

yang telah diberikan kepadanya. Walaupun makamah masih dianggap adil kepada rakyat biasa tetapi bila melibatkan pemimpin politik yang berkuasa makamah tidak boleh membuat keputusan yang bercanggah dengan kepentingan pemimpin ini. Bila terhakis kebebasan makamah maka terhakis jugalah keadilan makamah itu. Institusi polis juga tidak terlepas dari diperalatkan untuk menyekat kebebasan bersuara. Pihak polis berkuasa untuk memberi permit kepada pihak-pihak yang ingin mengadakan sebarang perhimpunan atas alasan kesalamatan awam. Kita tahu polis bukanlah satu badan yang benar-benar bebas. Ketua Polis Negara dilantik dengan restu Menteri dan Perdana Menteri. Perhimpunan yang bercanggah dengan kepentingan politik pemimpin yang berkuasa sudah tentu tidak akan mendapat permit polis.

Walaupun pada dasarnya rakyat negara ini boleh bebas berhimpun dan menunjuk perasaan mereka tetapi pemimpin politik yang berkuasa dapat menyekat rakyat dari berhimpun untuk menggugat kedudukannya dengan menggunakan kuasa yang ada pada polis ini. Akhirnya kebebasan berhimpun di negara kita ini hanya wujud secara teorinya saja, hakikatnya masih terdapat sekatan dan halangannya. Rakyat hanya mempunyai kebebasan untuk berhimpun dan menunjuk perasaan jika berhimpun untuk menyokong pendirian kerajaan. Dengan terhakisnya kebebasan makamah dan institusi polis yang boleh dipertikaikan kewibawaannya maka undang-undang yang boleh menyekat seseorang yang bertanding dalam pilihanraya jika dia melakukan kesalahan yang dijatuhkan hukuman oleh makamah melebihi setahun penjara atau denda melebihi RM2000.00 nampaknya tidak lagi relevan di dalam sebuah negara yang mengamalkan demokrasi. Kerana dibimbangkan undang-undang ini akan digunakan oleh pemimpin yang berkuasa untuk menghalang musuh-musuh politik beliau dari bertanding dalam pilihanraya dengan cara merekareka atau megada-ngadakan kesalahan mereka.

Media siaran di Malaysia juga samada yang diuruskan olehkerajaan atau pihak swasta jelas di kuasai oleh pemimpin politik yang berkuasa.Perlantikkan orang-orang yang mengetuai badan-badan siaran ini adalah secara langsung atau tak langsung mendapat restu dari pemimpin-pemimpin politik yang berkuasa. Di samping itu, kebenaran menerbit apa-apa juga media siaran adalah di bawah kuasa Menteri Dalam Negeri yang tidak memungkinkan berita-berita dan pandangan-pandangan yang hendak disiar dan dihebahkan berlawanan dengan kepentingan kementerian ini. Media siaran yang bebas adalah salah satu ciri yang harus ada dalam sebuah negara yang mengamalkan sistem demokrasi. Apalah yang kita hendak banggakan Malaysia sebagai sebuah Negara demokrasi sedangkan dalam masa yang sama pihak pemerintah cuba menghakis semangat demokrasi itu sendiri.

Cukupkah demokrasi itu hanya dengan peti undi saja? Apalah ertinya demokrasi tanpa adanya kebebasan bersuara, tanpa adanya kebebasan untuk berhimpun, tanpa media siaran yang bebas. Malah

SPR yang mengedalikan pilihanraya di Malaysia ini pun telah dipertikaikan ketelusannya oleh orang ramai. Dari masalah pengundi hantu, kesalahan pendaftaran yang ketara, pendaftaran dengan kad pengenalan palsu, undi pos yang meragukan hinggalah kepada sistem pengesanannya yang begitu lemah. Selain itu jawatan pengerusi SPR yang bertanggugjawab mengendalikan pilihanraya di Malaysia ini juga dilantik oleh pemimpin politik yang berkuasa yang sudah tentunya sukar untuk dipastikan dia dapat berkecuali atau bebas dalam urusan kerjanya itu. Sikap pemimpin berkuasa di Malaysia tidak mahu menerima pemerhati-pemerhati antarabangsa untuk memerhatikan perjalanan piliharaya di negara ini juga sungguh menghairankan kita. Apa ruginya kita membenarkan mereka datang untuk memerhati perjalanan pilihanraya kita malah kalau pilihanraya kita dapat diakui oleh mereka itu benar-benar bebas tentulah akan mengharumkan lagi nama Malaysia sebagai sebuah negara demokrasi yang baik di dunia. Kecualilah kalau pemimpin yang berkuasa ini ingin mengamalkan taktik kotor dalam pilihanraya tentulah dia ada sebab berasa takut untuk menerima pemerhati-pemerhati luar ini.

Pernah di satu ketika semasa isu menghapuskan kekebalan Raja-raja sedang memuncak, berkatalah pemimpin politik yang berkuasa ketika itu, "pemimpin politik kalau tak betul rakyat boleh turunkan dia dengan peti undi atau pilihanraya, tetapi kalau raja buat salah, tidak ada cara kita boleh turunkan dia. Itulah sebab kenapa perlu raja boleh dihadapkan ke makamah". Tetapi dengan berbagai sekatan dan halangan yang dikenakan ke atas rakyat sekarang ini, peluang untuk kita menukar pemimpin politik yang membuat silap melalui peti undi ini amatlah sukar malah hampir mustahil berlaku. Nasib demokrasi di negara kita pada masa mendatang nampaknya semakin sempit dan kabur. Wallahualam.

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