Beyond hope

I am certainly excited over the passage of the health care reform bill this week. I will feel much better when the reconciliation bill, with the necessary changes, is passed and signed. It's about time that this country started moving down a path towards true civilization.

With that said, there is a lot of uncertainty that prevents me from feeling the kind of elation that I thought I would have felt. My feelings are captured perfectly by these lines from the poem "we are running" by Lucille Clifton:

oh pray that what we want
is worth this running,
pray that what we’re running
toward
is what we want

The reform is imperfect, we all know that. There are at least two general directions I can see this going. The imperfections can be used to foster more discontent among the fear-filled bigots (especially among those who believe that our president is a socialist, marxist, communist Muslim). As much as I would like to ignore these folks, fear is a great motivator for getting people out on election day. And complacency keeps folks home. Juxtapose the two in any given election and you get Scott Brown elected to the Congressional Senate. Every increase in reactionary, right wing ideologues there are in policymaking positions, the greater the chance that this much needed reform is repealed, or worse, crafted to not work.

Or we can insist that the imperfections be monitored closely, rooted out, and fixed. Ask the question "what would make this fail" so that we can identify those "unforeseen" consequences and then proactively address them.

We can be sure that those who oppose this reform for whatever reason are prepared to do whatever it takes to repeal or cripple it. If the last year has shown us anything, it is that we must move beyond hope. We must act. Act to rebut the misinformation and lies. Act to deny going back to system in which people lose their homes or their lives but for lack of health insurance. Act to continually improve this imperfect system we call the USA.

Hope is not enough anymore. We need to seize the sense of possibility that we felt in November 2008, when it was evident that the world really was changing for the better. Now we need to make that change happen. Part of that means moving past the uncertainty, past the grief or anger that the bill wasn't sufficiently comprehensive or efficient for your taste, and past the certainty that your favored solution was the only acceptable solution. If we cannot work together to take what we've been given and change it for the better, then you can be sure that we will lose it.

P.S. Don't forget to fill out your census forms. And then mail them back. And also, tell your neighbors. The due date is March 30.

Random thoughts on the week's news

Anti-Obama/Tea Party/Right wing nutcases argue that the health care legislation that passed last night is unconstitutional because it would force people to buy a health insurance under "threat of financial punishment."

-Where were these people when Congress passed a law that requires everyone to either buy a digital TV or buy a digital converter box for their analog TVs?

-Are these the same people who are upset that they are required, under penalty of law, to send their children to school?

-I am curious if these are the same people who are upset that they have to purchase clothing if they want to walk about in public.

And indeed, you are not required to purchase anything. If you choose not to purchase health insurance (or take advantage of the subsidies available to you), then you can pay a fee into the health system that must make itself available, as required by law, when you end up in the emergency room.

You call it punishment. I call it contributing to the system.

Interesting health facts

Many people seem to have lost their sense of reason this summer. Perhaps it's a side effect of climate change. Or a slow news cycle. Whatever it is, we have people fomenting at the mouths over the proposal to ensure that every resident in the U.S. has access to the health care they need, when they need it. I would hope that whatever conversations can be had around whether and what kind of health reform we are to have in this country, it is based around facts rather than fear and lies.

In response to a recent discussion (well, one person was discussing, the other was ranting), I thought I'd provide some facts about health and health care in the U.S. I randomly chose North Carolina to compare to Massachusetts, Vermont, and Wisconsin. Massachusetts was chosen because we have a mandatory health insurance law and provide support and subsidies not too dissimilar to the controversial "public option." Vermont has a small, rural population and a well-regarded system of integrated health care. Wisconsin has been on the forefront of social health and welfare experimentation for decades, particularly in extending health care benefits to children. Whatever health reform gets passed, it will likely incorporate different elements of the systems found in these states.

Below are comparative rankings derived from Kaiser State Health Facts website. The Kaiser Family Foundation is considered one of the most credible sources of comparative health information.

% non-elderly uninsured (in order of most to least insured):
Massachusetts: 1
Vermont: 36
Wisconsin: 7
North Carolina: 44

% reporting that they could not see a doctor because of cost (in order of highest to lowest access to care)
Massachusetts: 2
Vermont: 15
Wisconsin: 5
North Carolina: 45

% adults who visited a dentist or dental clinic within the past year (in order of highest to lowest dental visits)
Massachusetts: 2
Vermont: 8
Wisconsin: 16
North Carolina: 33

Infant mortality rate (in order of lowest to highest infant mortality rate)
Massachusetts: 2
Vermont: 6
Wisconsin: 19
North Carolina: 44

Stroke and other cerebrovascular disease deaths (in order of lowest to highest):
Massachusetts: 10
Vermont: 12
Wisconsin: 26
North Carolina: 46

Per capita health spending (in order of highest to lowest spending)
Massachusetts: 2
Vermont: 9
Wisconsin: 16
North Carolina: 30



So what have we learned here? The states that make the effort to provide access to health and medical care, as Massachusetts, Vermont, and Wisconsin do, have better outcomes. Indeed, on these randomly chosen measures of access, utilization, and health status, these three states consistently rank in the top 33-50 percentile. North Carolina, on the other hand, has comparatively less access, and also poorer health. This state consistently ranks in the bottom third. Interestingly, Vermont has a relatively low rate of health insurance, and yet still ranks higher than North Carolina on every other measure.

So access to health insurance matters, but it isn't the whole story. The structure of the health care system is equally important. That is a conversation that we have not yet had the opportunity to have.

As the per capita health expenditures shows us, we also see that ensuring good access requires that we spend a little money. As these measures of health status show us, it appears to be good money spent.

"I want my America back"

By now we have all heard and possibly seen the widespread disruption that has been occurring in health care reform forums and town halls across the country. The nuttiness of it all makes me want to laugh and cry at the same time. The claims about death panels are so patently ridiculous that you can only wonder how many tin foil hats these folks have in their closets.

We all know by now too that these antics have been carefully and widely promoted by the conservative organizations FreedomWorks and Americans for Prosperity. The "best practices" memo distributed by these organizations gives its supporters the strategies for disrupting the meeting. Participants are supposed to "yell back" and have someone else follow up with a "shout out". I'm not sure how they are supposed to reconcile this with the very next instruction: "Don't carry on and make a scene - just short intermittent shout outs." Yell at people out of turn, but don't make a scene. If the descriptions of these events are any clue, it seems like people are having a hard time doing that.

Nevertheless, this woman, at an town hall meeting with Arkansas Representatives Mike Ross and Vic Snyder, followed this advice to the letter:

"At this point in my life, I have never seen my America turned into what it has turned into, and I want my America back. And I don't think the Representatives and Senators are gonna be able to do it. I'm scared!"
(click here for the video; this woman's comments start at 1:16)

Let us set aside the fact that these boisterous, "spontaneous" expressions of opposition have been carefully orchestrated by well funded astro-turfing organizations. I have no doubt that this woman is sincerely afraid. The question is, what has America turned into that she is so afraid of? An America where everyone has the option of obtaining health care? An America where insurance companies cannot deny necessary care? Or is she afraid of an America that elects black presidents? An America that, as the Daily Show "correspondent" put it, is becoming darker?

When I first saw this particular clip (admittedly on the Daily Show) I could not help but think about the crowds taunting and screaming the Little Rock Nine as they tried to go to high school.

Photo courtesy of the National Park Service

It seems to me that fears expressed by this woman in Arkansas (and others) are the same kind that prompted Hazel Bryan Massery (and others) to harass Elizabeth Eckford back in 1957. The kind of bigotry that has haunted Massery since this photo came to symbolize the challenges we faced as a nation in overcoming racism. Her apologies to Eckford later in life, and her apparent life long quest to make amends were, in the end, never totally accepted by anyone. She will likely always be remembered as the person in the picture above.

Hazel Bryan Massery's transformation was possible in large part because she was aware of her racism. Her actions captured in the photo above were clearly intended to maintain a position of racial supremacy. It is this conscious racism that has likely allowed her to rethink her views, change her attitudes, and attempt to make amends (however clumsy and self-serving).

I believe that the fear that the woman in Arkansas expressed at that town hall meeting has nothing to do with health care reform. We know that the misinformation and hysteria seen in the health care forums and town halls is orchestrated by conservative organizations fronting for lobbyists of the health care and pharmaceutical industry. We know that it is fomented by greedy media pundits like Glenn Beck, Britt Hume, Bill O'Reilly, Rush Limbaugh, and Newt Gingrich, and supported with the forehead slapping stupidity of weekday morning mainstream media TV shows. Unfortunately, the lies peddled by these info-tainment whores obscure the underlying bigotry on which they are based.

The fear expressed by many of these protesters has everything to do with racism and bigotry. Sadly, I doubt the woman in Arkansas is even aware of the racism inherent in her fear.