Health Care Reform Blues

With reform unlikely to happen before the August recess, the likelihood of reform becomes less clear. After swings in momentum both for and against reform over the past few months, it has been interesting to see how quickly some ideas have fallen away under pressure, and how others continue to be recycled and brought back to the fore. It seems likely that we will have some sort of "reform" at this point, in that a bill will likely be passed by both the House and the Senate and signed by Obama. The question is will there be any actual valuable reform to a problematic and burdensome system or will it merely push off necessary reforms for another decade or so.

I think one of the most interesting developments has been that the Republicans in both the House and the Senate have decided to drop developing their own bill, after promising to do so since the beginning of the reform effort. While I can understand the desire to focus all of their attention on the current resolution being discussed, it seems that they are only falling into the trap of being the "party of 'no'" label which has been wielded against them expertly during the current Congress.

I also think it is dangerous for the Republicans to place so much hope on the Blue Dog Democrats. While allies on some issues, they are, at the end of the day, still Democrats. They know they can only push so far before they overstep their power and incur undesirable repercussions (such as the bill being moved to the floor without a committee vote). The Blue Dogs may claim that they are the beacon of fiscal conservatives and small business, but there are many ways to allay their fears and still have a bill that will be faced with obstructionism by Republicans.

I am often surprised that the current bill, even in its most liberal versions, is itself a comprise; not necessarily a good one. Many Americans, rightly in my view, favor an even more robust public system than is currently written into any of the House or Senate versions of the bill being floated around. The high costs of care (as I have discussed in previous posts) are not simply due to the high-cost treatments or expenditure disparities. They are in large part due to the cost of "doing business" under a for-profit system of health care. One of the key advantages of a single-payer system is the sense of solidarity that it brings amongst those involved. When people are all paying into the same system, there is an acknowledgement that while some are paying more, it is often for the greater good.

One final point about perceptions of U.S. health care. It is often stated, without any support, that America has the best health care in the world and that people from other countries flock here due to long wait times elsewhere. However, both these characterizations are false; but more importantly, they indicate that the debate is simply focused on the wrong sets of issues. Even if the U.S. had the best health care in the world and people did come for care unavailable in their homelands, simply stated, the U.S. health care system is unsustainable. Right now our costs continue to rise much faster than either the economy or costs of living. As health care continues to eat up revenue, we will be forced to cut other programs to pay for the bloated and overpriced care we provide, while still having worse health outcomes (and worse quality of care, in many cases) than countries with cheaper, more sustainable systems. To pretend that the problem is only quality and access fails to address that it is the costs that will become increasingly prohibitive and untenable.

Political Poetry

I have been becoming more interested in political poetry as of late. I never had much interest in poetry but had come across a few poems in my undergrad that I had really enjoyed but never really followed up on. Some of my favorite authors have poetry but I never really dug into it. Lately, I have found that poetry can tell of human suffering and crushing inequalities in a way regular writing just cannot. Here are some highlights.

The Nobodies by Eduardo Galeano

Fleas dream of buying themselves a dog, and nobodies dream
of escaping poverty: that one magical day good luck will
suddenly rain down on them- will rain down in buckets. But
good luck doesn't even fall in a fine drizzle, no matter
how hard the nobodies summon it, even if their left hand is
tickling, or if they begin the new day with their right foot, or
start the new year with a change of brooms.
The nobodies: nobody's children, owners of nothing. The
nobodies: the no ones, the nobodied, running like rabbits,
dying through life, screwed every which way.
Who don't speak languages, but dialects.
Who don't have religions, but superstitions.
Who don't create art, but handicrafts.
Who don't have culture, but folklore.
Who are not human beings, but human resources.
Who do not have names, but numbers.
Who do not appear in the history of the world, but in the
police blotter of the local paper.
The nobodies, who are not worth the bullet that kills them

Let American Be America Again by Langston Hughes

Let America be America again.

Let it be the dream it used to be.
Let it be the pioneer on the plain
Seeking a home where he himself is free.

(America never was America to me.)

Let America be the dream the dreamers dreamed-
Let it be that great strong land of love
Where never kings connive nor tyrants scheme
That any man be crushed by one above.

(It never was America to me.)

O, let my land be a land where Liberty
Is crowned with no false patriotic wreath,
But opportunity is real, and life is free,
Equality is in the air we breathe.

(There's never been equality for me,
Nor freedom in this "homeland of the free.")

Say, who are you that mumbles in the dark?
And who are you that draws your veil across the stars?

I am the poor white, fooled and pushed apart,
I am the Negro bearing slavery's scars.
I am the red man driven from the land,
I am the immigrant clutching the hope I seek-
And finding only the same old stupid plan
Of dog eat dog, of mighty crush the weak.

I am the young man, full of strength and hope,
Tangled in that ancient endless chain
Of profit, power, gain, of grab the land!
Of grab the gold! Of grab the ways of satisfying need!
Of work the men! Of take the pay!
Of owning everything for one's own greed!

I am the farmer, bondsman to the soil.
I am the worker sold to the machine.
I am the Negro, servant to you all.
I am the people, humble, hungry, mean-
Hungry yet today despite the dream.
Beaten yet today-O, Pioneers!
I am the man who never got ahead,
The poorest worker bartered through the years.

Yet I'm the one who dreamt our basic dream
In the Old World while still a serf of kings,
Who dreamt a dream so strong, so brave, so true,
That even yet its mighty daring sings
In every brick and stone, in every furrow turned
That's made America the land it has become.
O, I'm the man who sailed those early seas
In search of what I meant to be my home-
For I'm the one who left dark Ireland's shore,
And Poland's plain, and England's grassy lea,
And torn from Black Africa's strand I came
To build a "homeland of the free."

The free?

Who said the free? Not me?
Surely not me? The millions on relief today?
The millions shot down when we strike?
The millions who have nothing for our pay?
For all the dreams we've dreamed
And all the songs we've sung
And all the hopes we've held
And all the flags we've hung,
The millions who have nothing for our pay-
Except the dream that's almost dead today.

O, let America be America again-
The land that never has been yet-
And yet must be--the land where every man is free.
The land that's mine--the poor man's, Indian's, Negro's, ME-
Who made America,
Whose sweat and blood, whose faith and pain,
Whose hand at the foundry, whose plow in the rain,
Must bring back our mighty dream again.

Sure, call me any ugly name you choose-
The steel of freedom does not stain.
From those who live like leeches on the people's lives,
We must take back our land again,
America!

O, yes,
I say it plain,
America never was America to me,
And yet I swear this oath-
America will be!

Out of the rack and ruin of our gangster death,
The rape and rot of graft, and stealth, and lies,
We, the people, must redeem
The land, the mines, the plants, the rivers.
The mountains and the endless plain-
All, all the stretch of these great green states-
And make America again!

United Fruit Co. by Pablo Neruda

When the trumpet blared everything

on earth was prepared
and Jehovah distributed the world
to Coca-Cola Inc., Anaconda,
Ford Motors, and other entities:
United Fruit Inc.
reserved for itself the juiciest,
the central seaboard of my land,
America's sweet waist.
It rebaptized its lands
the "Banana Republics,"
and upon the slumbering corpses,
upon the restless heroes
who conquered renown,
freedom, and flags,
it established the comic opera:
it alienated self-destiny,
regaled Caesar's crowns,
unsheathed envy, drew
the dictatorship of flies:
Trujillo flies, Tacho flies,
Carías flies, Martínez flies,
Ubico flies, flies soaked
in humble blood and jam,
drunk flies that drone
over the common graves,
circus flies, clever flies
versed in tyranny.

Among the bloodthirsty flies
the Fruit Co. disembarks,
ravaging coffee and fruits
for its ships that spirit away
our submerged lands' treasures
like serving trays.

Meanwhile, in the seaports'
sugary abysses,
Indians collapsed, buried
in the morning mist:
a body rolls down, a nameless
thing, a fallen number,
a bunch of lifeless fruit
dumped into the rubbish heap.

(Translation by Jack Schmitt)

Militant by Langston Hughes

Let all who will
Eat quietly the bread of shame.
I cannot,
Without complaining loud and long.
Tasting its bitterness in my throat,
And feeling to my very soul
It's wrong.
For honest work
You proffer me poor pay,
for honest dreams
Your spit is in my face,
And so my fist is clenched
Today-
To strike your face.

A Must Read For Everyone

I just finished Mirrors: Stories of Almost Everyone by Eduardo Galeano. I am amazed at how much I learned from the book and how lyrical and engaging the entries were. Galeano takes on all of human history, and even a little pre-history, through short entries that engage with anything and everything: major events in human history, famous (and infamous) historical figures, great people whose names are now lost to history, etc. His populist approach and keen sense of history create a rich and engaging view of how things have changed over time but how discrimination, hate, and violence have always marred our actions. Heather and I were lucky enough to attend his reading the week the book came out a month or so ago. I have never seen the bookstore, Politics and Prose, so packed full of people (and they bring in some huge names for readings). Some excerpts from the book:

Brief History of Civilization

And we tired of wandering through the forest and along the banks of rivers.

And we began settling. We invented villages and community life, turned bone into needle and thorn into spike. Tools elongated our hands, and the hand multiplied the strength of the ax, the hoe, and the knife.

We grew rice, barley, wheat, and corn, we put sheep and goats into corrals, we learned to store grain to keep from starving in bad times.

And in the fields of our labor we worshipped goddesses of fertility, women of fast hips and generous breasts. But with the passage of time they were displaced by the harsh gods of war. And we sang hymns of praise to the glory of kings, warrior chiefs, and high priests.

We discovered the words "yours" and "mine," land became owned, and women became property of men and fathers the owners of children.

Left far behind were the times when we drifted without home or destination.

The results of civilization were suprising: our lives became more secure but less free, and we worked a lot harder.

Thales

Two thousand six hundred years ago in the city of Miletus, an absentminded genius named Thales liked to go for a stroll at night to gaze at the stars, and as a result he frequently fell into the ditch.

Perhaps by asking the stars, Thales discovered that death is not an end but a transformation, and that water is the origin and meaning of all life. Not gods, water. Earthquakes happen because the sea moves and disturbs the land, not becasue of Poseidon's tantrums. The eye sees not by divine grace, but by reflecting reality the way the river reflects the bushes on its banks. And eclipses occur, not because the sun hides from the wrath of Olympus, but because the moon covers the sun.

Thales, who had learned to think in Egypt, accurately predicted eclipses, measured with precision the distance of approaching ships on the high seas, and calculated the exact height of the Keops Pyramid by the shadow that it cast. One of the most famous theorems is attributed to him, as well as four more, and it is even said that he discovered electricity.

But perhaps his greatest feat was of a different kind: to live godless, naked of any religious comfort, never giving an inch.

The Loser

He preached in the desert and died alone.

Simón Rodríguez, who had been Bolívar's teacher, spent half a century roving Latin America on the back of a mule, founding schools, and saying what no one wanted to hear.

A fire took nearly all his papers. Here are a few of the words that survived.

• On independence:

We are independent but not free. Something must be done for these poor people, who have become less free than before. Before, they had a shepherd king who did not eat them until they were dead. Now the first to show up eats them alive.

• On colonialism of the mind:

Europe's know-how and the prosperity of the United States are for our America two enemies of freedom of thought. The new republics are unwilling to adopt anything that does not have their stamp of approval... If you are going to imitate everything, imitate orgininality!

• On colonialist trade:

Some think prosperity is seeing their ports filled with ships - foreign ships and their homes turned into storerooms for goods - foreign goods. Every day brings another load of manufactured clothes, down to the caps the Indians wear. Soon we shall see little golden packages bearing the royal coat of arms containing 'newly processed' clay for children accustomed to eating dirt.

• On popular education:

To make students recite by rote what they do not understand is like training parrots. Teach children to be curious so they learn to obey their own minds rather than obeying authorities the way the narrow-minded do, or obeying custom the way the stupid do. He who knows nothing, anyone can fool. He who has nothing, anyone can buy.

Criminology

Every year, chemical pesticides kill no fewer than three million farmers.

Every day, workplace accidents kill no fewer than ten thousand workers.

Every minute, poverty kills no fewer than ten children.

These crimes do not show up on the news. They are, like wars, normal acts of cannibalism.

The criminals are on the loose. No prisons are built for those who rip the guts out of thousands. Prisons are built as public housing for the poor.

More than two centuries ago, Thomas Paine wondered:

"Why is it that scarcely any are executed but the poor?"

Texas, twenty-first century: the last supper sheds light on the cellblock's clientele. Nobody chooses lobster or filet mignon, even though those dishes figure on the farewell menu. The condemned men prefer to say goodbye to the world with the usual: burgers and fries.

Health Care is a Human Right

With all the discussion of health and health reform, some key facts have been overlooked and, for the most part, insufficiently examined in the debates. While there has been some acknowledgement of the high cost of treating chronic diseases, rarely is it raised that treatment of these diseases accounts for 75 cents of every dollar spent on health care in the U.S. This fact helps us understand that while coverage for everyone is a crucial and fundamental right, the goal of keeping down costs requires more acute awareness of where the money is actually spent.

Another key fact that is discussed infrequently is the high concentration of health care expenditures in a small population. A recent study found that five percent of Americans are responsible for nearly HALF of all health spending in a given year. An earlier study found that it was over half. Also, almost half of the U.S. incurs little to no health care costs and thus the other 50 percent make up about 95% plus of the health care spending. This concentration is interesting at other levels as well. The top 30 percent of spenders make up 90% of health spending; while the top 10 percent make up nearly 70%.

These statistics speak the need for a more holistic view of reform. Increasing quality, decreasing costs, and expanding coverage all are worthy goals but they cannot be goals divorced from the social reality of health care needs. Both studies find that the elderly are more likely to bear the burden of high expenditures. Also, they found that people with chronic conditions had much higher out-of-pocket expenses than average. Better, more cost-effective treatment is needed for these folks. Often their situation is compounded by the fact that they may reach their lifetime spending cap and lose coverage. In turn, due to pre-existing conditions clauses, they may have an extremely difficult time getting other coverage, and if they do it will be exhorbitantly expensive until they are so drained of money they can qualify for Medicaid.

All these factors indicate the importance of having a coherent, nationally focused health care reform. The reform must be tailored to meet the needs of different populations and levels of care. However, everyone should have to have insurance; at the very least, catastrophic coverage. It is in the best interest of the long term health of the American people and in the best interest of our financial well-being, both individually and as a society. People without insurance coverage that require medical treatment incur higher costs and are much more likely to face bankruptcy as a result. Of course, there must be subsidies to help those who would not be able to afford coverage themselves.

During the current health care reform I have continually been dismayed by the process and how easily many of those involved lose sight of the overall goals and the purpose reform serves. We don't need reform for the sake of reform. Sure the system is broken, but a patchwork solution will only push the need for a more significant reform off the radar for another decade or two. We have hard decisions to make. Until we face those decisions with a sense of history and an eye to the future, we will continue to create policy that only serves to line the pockets of those who are currently abusing the system.

Simply Unconscionable

As many have probably heard by now, Dr. George Tiller has been murdered in his own church today, most likely by a right-wing extremist. Dr. Tiller happened to perform abortions, including some of the extremely rare late-term abortions in the U.S. Though abortion is legal, there are clearly many in America that would rather scare women and their doctors back into the dark ages in terms of reproductive care. Gruesome images of aborted fetuses, 24-hour surveillance of clinics, and websites dedicated to outing anyone who visit those clinics are only some of the scare tactics these nouveau-fascists use to intimidate and harass. Their callous disregard for human life around the world and laser-focus on abortion smacks of hypocrisy at best and mindless, savage hatred at worst. Their "pro-life" stance extends only to abortion, not to real issues that would save lives around the world or improve the lives of people suffering here in the U.S. 

Anti-choice activists lack of nuance and understanding is most clearly shown in their disdain for sex education and attempts to block any sort of abortion rights or access. There will always be the need for abortions. While the number will fluctuate over time, it has overall decreased significantly since the 1980s even as the U.S. population has increased rapidly. With better sex education and improved birth control methods, that curve is likely to keep declining. Women would much rather be able to use the variety of birth control methods to keep from getting pregnant rather than have to resort to abortion. Abortion is often the last resort of people who simple had no other option. Those with any empathy at all can imagine an infinite number of situations where a woman would not be able to access or utilize birth control. Lack of affordable birth control is one of the major reasons that the vast majority of abortions are received by poor and low-income women. Other countries handle this better by providing free access to birth control and training on how to use out. However, even the most effective birth control isn't fool-proof and accidents will happen. Women and their doctors should have all the tools available to make the right decision for them. This is not simply a matter of morality and common sense, this is a matter of women's basic human rights. 

A World of Gray

Contrary to the views of many, one of the biggest signs of political maturity, for me, is not moderation of your views over time but understanding that issues are much more complex than how they are presented. We often hear about issues at their lowest common denominator; with only buzzwords and soundbites to think about. People often discuss that the truth is somewhere "in the middle" between two perceived extreme positions. Often reality lies somewhere else completely. For nearly all issues of importance, there is no simple dichotomy of options. While most people lack the time or the incentive to come to fully understand the complexities of a particular issue, it is easy to understand how people increasingly talk at each other instead of to each other. When people are coming from completely different world views with large informational asymmetries, it is difficult to have a serious discussion.

Part of this problem lies with the current media, but also schools at all levels, and our political leaders also don't make things any better. The American people are often treated as less capable and intelligent as they really are. I have often agreed of the sentiment that Americans are too dumb and lazy to engage politically. Though I believe this premise is off target. It isn't that Americans are either dumb or lazy; or if they are, it isn't because of their individual actions alone. Just as there are large structural factors that lead to poverty and poor health, there are equally important factors that lead to a lack of intellectual sophistication or a deep engagement with civic, social, political, and economic issues. Often the causes interconnect and compound each others. Some examples include poor quality schools, acute and chronic childhood stress, penalization of the working class and the working poor, and virulent economic and social inequality. These are just some of the many forces that stunt development and hinder progress throughout the life-course.

Until we come to understand the social causes and the social reasons, we will continue to "blame the victim", as it were. Your average American has little real training in critical thinking or even basic empiricism, and this hinders their ability to sift through the noise and then incorporate information into a coherent worldview. Often, they don't have the time either. Probably most importantly, having a complex understanding of a particular issue or set of issues does your average citizen little in the long run. Unless it is something they do for work, the knee-jerk reactionary position they read in a flyer or hear on the radio is sufficient to engage with the debate, even if superficially. Adding layers of complexity can even lead to a fatigue as you realize that the change you desire will require much more than a petition or a protest.  Part of this is also the way our political system is set up. A couple big reasons (which I have discussed in previous posts) include the lack of risks of non-voting and the much heavier time investment required for Americans than for Europeans in countries with parliamentary systems that have coherent party systems.

Next time you think "stupid Americans", take a step back and look at it socially. It is much better to think "why would someone believe/do/say this?” Once we come to see that peoples’ actions and views are the result of a multiplicity of forces and experiences, we can begin to empathize and identify that the ignorance is the problem, not that the person is fundamentally flawed. We all have the capacity to learn and grow. When I hear someone deride another as a hypocrite or a “flip-flopper”, I become uncomfortable. Has there not been a time when each of us has realized our previous view was flawed or inaccurate or that in practice some of our ideas are not practical or desirable. As one of my best teachers said “everyone has the right to be a hypocrite.” By this she meant everyone has the right to grow and change and even contradict themselves in life. When we begin to internalize that lesson we see that maybe things aren’t so black and white, for others as well as for ourselves. 

Immature Politics

While I try to remain optimistic about the political landscape and the possibility that Americans are capable of understanding complex issues, something like the "Tea Party" protests come around to shake that optimism. I am a huge fan of populist anger and outpourings of that sentiment, however these recent protests don't meet those standards. The intellectually lazy and misguided protests were organized around an extremely wide range of issues, some more disturbing than others.  Some issues (though the whole thing lacked a coherent message) included socialism (seriously, are you kidding me), communism (where are you people getting this), big government, and the always easy target "high taxes." The protests seemed less like a coherent statement and more like a temper tantrum for an increasingly marginalized and powerless wing of the Republican party.  It is pretty easy to have a protest against such strawmen and pretend that it moves any discussion forward. I am always amazed by the people protesting these issues and how little they understand about the role of public spending in all aspects of their life. Everything from the safety of our food, to our education system, to the roads we drive on are all dependent on government subsidies. Many often pretend that it is the market that allows this to happen, but there is no part of the market that is not dependent on government regulation and subsidies, either directly or indirectly. Taxes are a necessity and the best we can do is ensure the accountability of the spending and push for more transparency. Working to assess the quality of the spending and adjusting public policy accordingly allows for a more coherent and effective system. 

However, as people who actually study these issues will tell you (as opposed to those taping tea bags on a hat), much of the problem of the perceived "high taxes" is a result of the increasingly regressive tax system in the U.S. As a result of tax cuts and increased legal loopholes, the wealthy in the U.S. are paying less in taxes than they did during the Eisenhower administration. By one analysis, reverting to a more progressive tax system would bring a net revenue of $450 billion dollars a YEAR. While raising taxes during a recession is not a good idea, it is something that will have to be addressed at some point, hopefully in the near future. A more progressive taxation system would benefit all Americans. Decreasing the massive inequalities in the U.S. would do a world of good in a variety of areas. Inequality negatively affects things like health, anxiety, social activity, political involvement, and social well-being. A real tax agenda would work to create a tax code that is fair for all but progressive in focus. However, my optimism for such a system is extremely low. Tax issues are complex and I don't hold much hope that the public will come up to speed quickly (or at all), particularly given the media's lack of complexity on the issue (given their barron's are among the wealth elite that benefit from the current system).