Wednesday, January 26, 2011

WHERE'S THE CARE IN HEALTH CARE?

January 27, 2011

Having delayed it a week in deference towards Representative Gabrielle Giffords, shot through the head in Tucson, the Republicans of the House brought up and voted en bloc to repeal the health-care bill signed into law just ten months ago. The measure is entitled "Repealing the Job-Killing Health Care Law Act." Job-killing? Killing, period? Now that's a lovely choice of words, considering the topic and the circumstances. But even something kinder and gentler — "job-eliminating" or "employment- effacing," for instance — wouldn't soften the Republican message that health-care legislation is about jobs, or about the deficit, or about taxation, or about states' rights — about anything but health.
As usual, the anything-but arguments are hardly compelling. Republicans contend that the law will "kill" jobs because businesses will let employees go rather than be burdened by either insuring them or paying an additional tax; Democrats say the effect will be minimal.
The ambiguity in the deficit argument is even greater. The Congressional Budget Office predicts that repealing the law will add $230 billion to the federal deficit over ten years, while the Republicans insist that keeping the existing law will add $701 billion. The fact made obvious by this divergence is that nobody really knows for sure. This isn't policy, it's politics.
But consider the case of Rep. Giffords. What will be the total cost of repairing her wounded brain and leading her to recovery — the hospitalization, the teams of medical specialists, the surgeries, the medications, and all the rehabilitation therapies — speech, occupational, physical - that will last for months or quite possibly years? The figure will be astronomical, and it will be paid for almost entirely by her federal insurance plan.
What of the 12 others wounded in the shooting? Five of them are over 65 and covered by Medicare. As for the rest, are there maybe some who have little or no health insurance? What will they and their families do?
Last month, Virginia federal judge Henry Hudson ruled that federally-mandated insurance coverage for almost all Americans, a key provision in the law intended to distribute the costs more equitably, violates the Commerce Clause of the U.S. Constitution. "Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market," he wrote. Virginia state attorney general Ken Cuccinelli, who brought the suit, remarked that "if the government can order you to buy health insurance, they can order you to buy a car, to buy asparagus, even cauliflower ... or join a gym. The power is expandable almost without limit if this is allowable and constitutional."
Two other federal judges have also weighed in on the question thus far, affirming the opposite, that the mandate is constitutional; so the issue is hardly settled. But while Cuccinelli's comment is just typically embarrassing Republican rhetoric (see "job-killing," above) the judge's sober analysis makes sense. Health insurance is no different from life insurance or homeowner's insurance; it's a product. How can the government compel people to buy it?
Health insurance is a commodity, "in the stream of commerce" — but the essential medical services it pays for are not. They are not a matter of choice, like cauliflower; they are a necessity.
Return to Rep. Giffords. When she was shot, the entire nation, and I daresay that includes the most libertarian opponents of health-care reform, focused single-mindedly on her condition and on the measures being taken by the heroic medical staff to save her life and restore her wholeness. In this tragic moment, health care suddenly was not about jobs or deficits or comparison shopping. It was about health.
And it's about us all. Rep. Giffords is exactly like the tens of thousands of people who will be hit with something just as unexpected and devastating this very day — a gunshot wound, a workplace accident, a heart attack, a diagnosis of cancer. Injury and disease are the absolute leveler, the one thing that eventually will afflict every single human being, from the billionaire to the indigent to the immigrant.
Despite its "laudable intentions," as Judge Hudson readily admitted, I believe the present law is flawed in preserving almost intact the role of insurance companies, reinforcing the notion that health care is product involving, in the judge's words, "an individual's right to choose to participate." It is not. Because it is a universal need, medical care should be considered a public responsibility whose burden must be shared by all. Like education, health care should be treated not as a commodity but as a civil right.

Thursday, January 13, 2011

TOMBSTONE

January 13, 2011

"I think we're the Tombstone of the United States of America," said Pima County Sheriff Clarence Dupnik after the Saturday massacre in Tucson.
Tombstone, the silver-mining boomtown-turned-tourist town 70 miles south of Tucson, holds a signal place in American mythology, with its macabre name, its historic reputation for lawlessness, and its told-and-retold story of the Earp brothers and the gunfight at the O.K. Corral — the epitome of all that was wild about the Wild West. Sheriff Dupnik, 30 years on the job and long noted for his blunt and sometimes contrarian views on hot- button social issues not necessarily connected to law enforcement, tapped into the well of mythology as few others could; after all, Wyatt Earp himself was once the sheriff of Pima County.
Sheriff Dupnik had his home state in mind, of course, and there's certainly some reason for it; Arizona has lost its fun- in-the-sun image of late. The passage of SB 1070, the strictest illegal-immigration state law in the nation, last April, ignited protests and boycotts throughout the country. (Dupnik said the law "is unwise, it's stupid, and it's racist" — "a national embarrassment".)
Also recently enacted were laws allowing Arizonans to purchase guns without a license and to pack concealed weapons without a permit, and prohibiting counties and municipalities from setting tougher regulations themselves. (Dupnik: "I have never been a proponent of letting everyone in this state carry guns under almost any situation, and that's almost where we are." An ironic sidelight on the issue came from Georgetown history professor Katherine Benton-Cohen, writing in Politico: By 1880, she notes, the town of Tombstone itself had outlawed the possession of all firearms.)
On January 1, a law went into effect withdrawing state funding from schools offering courses that are "designed primarily for pupils of a particular ethnic group" and that "advocate ethnic solidarity instead of the treatment of pupils as individuals" — a law which the state superintendent of schools said was specifically directed against the Chicano studies program in the school district of ... Tucson.
Perhaps even more than elsewhere, an atmosphere of rancor seems to have infused Arizona state politics over the last several years, beginning with those shouting-matches called "town hall meetings" over health-care legislation and continuing through the bitter midterm Congressional campaigns. "The anger, the hatred, the bigotry that goes on in this country is getting to be outrageous," Dupnik said after the shootings. "And unfortunately, I think Arizona has become sort of the capital. We have become the mecca for prejudice and bigotry."
Dupnik may be right about Arizona — it's certainly developing a reputation — but the myth of the West, of which Tombstone and the O.K. Corral are examples, is embedded in the American consciousness, containing themes of individualism, scorn for governmental control, hatred for outsiders, and the supremacy of the gun, all of which underlie much of the rhetoric of the Right.
Whether or not the Tucson shooter was acting out those Tombstone themes may never be known. Yet, as Dupnik remarked: "To try to inflame the public on a daily basis 24 hours a day, seven days a week has impact on people, especially who are unbalanced personalities to begin with."
For those of normal disposition, the rhetoric of anger is taken metaphorically and sublimated. For those who are "unbalanced," it can become an atmosphere of pure oxygen waiting for a match.
Wouldn't you think that the deaths of those six innocents would change a nation's mind about the common sense of gun control? Wouldn't you think that the wounding of those 13 others would demonstrate how vulnerable to fate we all are, and that medical care is not a commodity but a necessity and a right? Wouldn't you think that this horrifying event would at the very least sober people up about the dangers of incendiary words?
The answer is probably no. The myth of Tombstone will not die.

YULETIDE LETTER, 2010

Time is telescoping now. It's been 20 years since I moved to New York. The day I arrived here is as fresh in my memory as yesterday; what has happened in between is becoming a blur.
Driving through the South Bronx to St. Augustine's Church that September afternoon, nervously checking and re-checking the directions given me by Father Jeffers the pastor, I had day-mares of getting hopelessly lost and in big trouble, like Sherman McCoy in Bonfire of the Vanities. The crumbling housing projects on Webster Avenue, the burnt-out buildings, the blocks of vacant lots strewn with garbage and picked-over carcasses of cars — it was a social moon-scape, the world's symbol of the death of the American city. But the people I met from that very first day — struggling families, recover ing addicts, old men running numbers at the corner, children playing in the gushing fire hydrants — were among the warmest and most welcoming I've ever known. The Kingdom of Heaven is theirs.
Thanks in great part to the tireless work of the churches and their heroic ministers, who over three decades of agitation built housing, cleaned up the projects, brought in businesses, chased out drug-dealers, and made the city improve the streets, parks, schools, and hospitals, the South Bronx has turned the corner. You'd hardly know how hellish this place once was.
My sister Jeannie and her husband Rob from California, and Rob's sister Marsha and her husband Rod from Oregon came to visit in October, a wonderful week of sightseeing in ideal autumn weather. One of our stops was Ellis Island, where many of the people who built the Bronx — Irish, Italians, Jews, Germans — got their first taste of America. Their descendants, pros perous from years of hard work, fled to the suburbs as the area deteriorated in the 1960's. Now, with the housing stock expanding, new waves of immigrants are settling here — Central and South Americans, Carib beans, and most recently, West Africans. Storefront mosques are opening up, next to storefront Holiness churches. Men in kaftans and women in long gowns and veils are everywhere now, an interesting parallel to the traditional habits of Mother Teresa's nuns and the Franciscan friars, who serve the poor here.
Venerable St. Augustine's Parish, the spiritual home for immigrants for over 150 years, has added many West Africans to its complement of cultures, including Ameri can Blacks, Hispanics, Haitians, West Indians, and the Garifunas of Guatemala. Talk about diversity!
Though the parish has been given a reprieve from closing by the Archdiocese of New York, St. Augustine School is now on the endangered list. This year, enroll ment slipped below 200 because of the sagging economy and the allure of new charter schools opening nearby. To demonstrate their determination to save the school, the faculty voted to cut their already uncompetitive pay. To increase enrollment, the administration devised the most affordable tuition plan imaginable: 3% of family income. The median income in this area is only $16,000, so tuition for all the children in a median family would be only $48 per month. Since the policy was announced last month, over 50 new students have signed up. But the arch diocese wants a balanced budget, so the shortfall in revenue has to be made up by donors. If you're looking for a worthy cause to support, this is one. Visit their website at www.staugustinebx.com.
Food has always been a major issue in this impover ished community, but the dynamics sure have changed over my years here. One of the best things about the New Bronx is that supermarkets, once the dumping ground of turning meats and wilted produce, have been seriously upgraded. You still can't get arugula, a good steak, or sometimes even cottage cheese in them, but the selections are better and the perishables unperished. In addition, a farmer's market opened on McKinley Square right up the block last summer, run by students from a local charter school with an urban-agriculture theme. Set up to take food stamps, it did a roaring business, offer ing fruits and vegetables from small upstate farms and the school's own garden.
The St. Augustine Food Pantry serves over 400 people per week, and the days of dented canned goods and bricks of nasty surplus cheese are gone — now, thanks to the resourceful Food Bank of New York City, clients get fresh meats and produce and an often intriguing selection of products snagged from overstocks at Manhattan gourmet stores.
The chicken project at St. Augustine School continues. Last spring, Rafael, the school's custodian, who raised chickens in the Dominican Republic, slaughtered and dressed the aging first batch of 15 hens, which went to school families. The project has now expanded to 35 chickens, each laying an egg a day, distributed to the needy in the neighborhood.
Genesis Park, the community garden next to St. Augustine's rectory, welcomed several new gardeners this year, immigrants from El Salvador and the Dominican Republic, who had worked on farms back home and brought their skills with them. The garden yielded remarkable amounts of vegetables last season.
The bees did quite well too. Despite a six-week drought and heat wave that dried up the nectar sources in July and August, by fall I'd harvested 360 pounds of honey, still well above the average.
The South Bronx is still about immigrants, sharing their talents and industry with their neighbors. Part of the Christmas story tells of St. Joseph and his new family fleeing to Egypt to escape Herod's persecution. It's good to remember that the rolls of immigrants and refugees include the Son of God himself.

COMPROMISE OR COMPROMISED?

December 16, 2010

There are good and bad meanings to the word "compromise": one is to come to agreement through mutual concessions; the other is to undermine one's integrity by caving in to opposition. On the tax-cut deal now before the Congress, did President Obama engineer a classic compromise that gives each side an equal balance of things wanted and unwanted; or did he compromise himself, surrendering his principles for things he should have had anyway with more guts and better timing?
Compromise of principle is on the minds of both the left and the right. Many liberal Democrats are appalled that their president blinked in the stare-down with Republicans over extending the Bush tax cut for those making over $250,000 a year — another campaign promise come a-cropping. Republicans are delighted that what they said was absolutely non-negotiable was taken by the president as absolutely non-negotiable — a sign that if they keep saying "no" long enough and loud enough, he'll fold every time.
Some observers, however, do not perceive weakness but shrewdness in Obama's tax-cut proposal. David Brooks of The New York Times lauds the president for "returning to first principles" — the principles of working with the opposition, a centerpiece of his campaign and early presidency — not an ideologue but a "network liberal" in the line of Ted Kennedy, someone who believes that "progress is achieved by leaders savvy enough to build coalitions ... with people they disagree with." Obama's move, Brooks writes, was not a Clintonian shift of position from left to center, not a self-reinvention; instead, it was "standing at one spot in the political universe and trying to build temporary alliances with people at other spots in the political universe."
Announcing the proposal last week, Obama said as much: He continues to oppose the tax break for the upper class as a giveaway irrelevant to the recovery; but given the political circumstances, it was better to throw the Republicans this bone if they'd go along with things they themselves dislike — extending unemployment benefits, decreasing the payroll tax, maintaining the earned income tax credit — things beneficial to the middle class and at least marginally helpful to the economy.
There does seem to be something different in Obama's approach to the tax issue. In his early initiatives, notably health-care legislation, he naively expected bipartisan cooperation; then, frustrated by "no" at every turn, he had the Democratic Congress ram the bill through on procedural technicalities, alienating independent voters and sparking the Tea Party movement. This tax bill, by contrast, was pure horse- trading, real compromise, both agreeable and disagreeable to all, but with enough agreeables to make it palatable. Monday's test- vote in the usually deadlocked Senate — 83 to 15 to forestall a filibuster — was nothing short of remarkable in this paralyzed political climate.
Brooks thinks that "Obama has put himself in a position to govern again ..., reminding independents why they liked him in the first place."
Whether this will prove true for the rest of his term, especially with the power-shift in the new Congress, remains to be seen. Will voters see him as a Great Compromiser or as greatly compromised? Stickier issues than tax cuts await him.