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).

More Hoovers than a Vacuum Store

Republicans are once again harping on the deficit like it actually means something in the short term. In their attempt to be the oppositional party, they have taken up the failed notions of Herbert Hoover in trying to balance the budget at the time of a severe economic downturn. Mainstream economists (I am still not sure why we are listening to them given recent events...) acknowledge that the actions of Hoover certainly increased both the depth and length of the Great Depression. Most economists recognize that short term spending to stimulate lending and thus allow capital for projects is a key step for any recovery.

In related news, Bushvilles are springing up across the country. I am still amazed that people don't understand that when you cut social services and depend on private charity you are setting yourself up for disaster. Many private charities and non-profits depend on donations or membership fees which decrease in a downturn, particularly one as severe as this. Combined with a lack of adequate social services, it is not surprising that people are having to turn to tent cities in hopes of weathering this storm.

The most disheartening thing about this recent trend is that once someone becomes homeless it often begins a cycle that is difficult to break. Because they have no permanent address it is extremely hard to get a job; without a job, income is difficult to come by (except through illegal and often dangerous means). This is compounded by the rapidly rising unemployment rate. While no one is a fan of paying higher taxes, clearly the U.S. is failing it citizens in a variety of ways. Demanding these tent cities be removed only pushes these people out of the small amount of safety they had as a group. While some are saying we are reaching the bottom of the downturn, I remain skeptical. For all our sakes, I hope they are right.

You Can't Kill an Idea

As we approach the fiftieth anniversary of the failed uprising in Tibet and the one year anniversary of the crackdown on Buddhist Monk demonstrators, tensions are running high in the region. It is amazing that despite China having one of the largest armies in the world, they are utterly afraid of a relatively small group of monks. The fact that all foreign journalists and international tourists are being kept out of the region at this team speaks to their ongoing concern about what more protests could bring. Though I was extremely disappointed by Hillary Clinton's lack of providing either carrots or sticks for improved Chinese treatment of Tibet, I was sadly not surprised. This unwillingness to press for Tibet's independence (or autonomy, or even well-being) is one (of many) of America's major foreign policy failings. 

Many apologists for the policy argue that due to our need for China to buy up our debt and help stabilize the region, we cannot denounce their policy for fear of backlash. As any student of international relations can tell you, this simple dichotomy of do nothing or incur the full wrath of China is a false one. There are many gradations in policy that could be used to thaw relations and tie Tibet to other issues where there is mutual interest between the U.S. and China. One of China's biggest fears is international perception of the Tibet issue. Having closed door conversations on the matter that lead to an actual softening of China's position could be an advantageous option for all sides. 

One thing is for sure, we must not fall into the same malaise and inertia that has kept our human rights policy so anemic. We have a president that believes in the rule of law and inspires people around the world. America has the obligation to continue to provide hope to those in duress. We must not turn our backs on causes we know are just. We can no longer sustain regimes like Saudi Arabia, Sudan, Myanmar, North Korea, and many more to continue on the path they are on. Increased diplomatic efforts must be used to forge consensus on shared goals and to facilitate slow, positive changes to happen in these countries. By sustaining these regimes, we only increase the difficulties we will face when we are forced to deal with them eventually and further the suffering that those oppressed by these regimes experience. 

The Dalai Lama puts it well:

If you can, help others; if you cannot do that, at least do not harm them.

Our callous disregard for the consequences of our actions cannot continue. Though change won't happen overnight, we must act in positive ways to increase the well-being of those least capable of doing so themselves. 

Times Are Tough

It is hard to believe how things have crumbled so quickly: The economy, housing, banking, employment, the stock market, consumer confidence, and the list goes on. The fact that the GDP recently sunk 6.2% indicates that this current downturn may be more severe than most were anticipating. In downturns like this it is those individuals at the margins, the poor, the sick, those without adequate job skills or training, that are the most affected. When I hear bankers who receive government help complaining about their salary being capped at $500,000 I can't help but cringle. The people are increasingly being asked to support the poor business practices of these banks and other industries that were paying exhorbitant amounts for sub-par performance. These excesses were cheered by many during better times as proof of America's superiority. When CEOs are making 400 times the amount earned by the lowest paid workers in their company something is extremely wrong. For the last twenty to thirty years both the share of wages and actual wages have become increasingly concentrated at the very top.

This concentration of wages and wealth has led to an increasingly untenable situation. The rise of underemployment and poor quality work laid the groundwork for the current depth and breadth of the current downturn. After peaking at nearly 30% in 1979, the unionization rate of the U.S. has steadily fallen by half to less than 15%. While the U.S. has always had among the lowest unionization rates, the steady decline has been coupled with an increase of part-time and full-time work without benefits or worker protections. Combined with a culture that pushes consumption over conscience, it is not difficult to imagine how so many Americans were in a precarious situation even before the downturn. Even as the downturn was in its earliest stages, many dual-earner families were increasingly having to add additional part-time work to cover the increased costs of gasoline and other consumer goods. Others were taking part-time jobs in fear that their main source of income may not be as reliable as they had believed. 

Americans must come to see that working together in solidarity and demanding adequate treatment as workers only serves to strengthen our position, not weaken it. The pittance that is paid in union dues serves not only to increase your power over your work, but increases the standards across whatever industry you are a part of. The greatest gains of non-unionized workers in the twentieth century have been as a result not of employer benevolence, but as a result of workers organizing in other places, but in the same industry. The employers knew that once these non-unionized workers saw the disparities, they would also begin to organize. This led many companies to improve their conditions if only to delay unionization at their own plants.

While unionization is only one piece of the larger picture, it remains one of the best tools workers have to increase the accountability of companies to workers and to society more broadly. The fact that the car companies are blaming their union contracts for their economic woes only shows how inadequate their business model had become, all while paying their CEOs and other top-level managers ridiculously high wages. Luckily, Obama is much more aware of the value of labor than most presidents in recent memory. Giving American workers a say in their workplaces can only improve the economy, their work, and, most importantly, their lives.