Essentially Contested America

Should we consider the health care reform act, which President Obama signed into law today to be a civil rights act? There is good reason to do so. Though the Act is far from perfect, it does represent a commitment by Congress to expand access to a fundamental human right. Article 25 of the Universal Declaration of Human Rights states that “Everyone has the right to a standard of living adequate for the health and well being of himself and his family, including . . . medical care.” Martin Luther King called access to medical care a civil right. Though our Constitution does not include a right to health care (or any other substantive economic rights), it does give Congress the authority to create such rights. And, in a speech after the passage of the Act, House Speaker Nancy Pelosi invoked the Declaration of Independence’s statement that all people are guaranteed a right to “life, liberty and the pursuit of happiness.” Before the vote, Pelosi and other congressional leaders marched through protesters hurling racial epithets, an act that self-consciously harkened back to civil rights demonstrations of the past. The Act falls within the tradition of Congress enforcing the rights of social citizenship – economic rights that are essential preconditions to one’s ability to exercise other civil and political rights.

Strangely, opponents of the Act also think the Health Care Reform Act is a civil rights act, and argue that this is a reason to oppose it. In February, Rush Limbaugh called the Act a “civil rights act,” a “reparations” bill which people should oppose. Last week, Newt Gingrich compared the Act to the 1964 Civil Rights Act, arguing that Obama’s support of the Health Care Reform Act would wreck the Demcratic party like Lyndon Johnson’s support of the 1964 Act did.

How ironic! I have always thought of the passage of the 1964 Civil Rights Act as one of the great moments in American history. I also thought that as a society we had achieved a consensus that civil rights were a good thing. What could Gingrich possibly mean by his critique? Johnson was re-elected by a landslide in the fall of 1964, and he relied on that mandate to push through the Medicare Act and the 1965 Voting Rights Act the next year. When Gingrich says the 1964 Act wrecked the Democratic party, could he be referring to the fact that after passage of the Civil Rights Act, many of the pro-segregationist southern Democrats became Republican, eventually turning the South from a solid Democratic block to the solid Republican block we have today?

If so, why would Gingrich want to remind us of the southern Republican party’s roots in segregationism and racism? It’s hard not to see a connection between Limbaugh and Gingrich’s remarks and the racial slurs hurled by protestors against the African American and Latino members of Congress on Sunday. Like Congress’ tradition of expanding human rights in acts like the 1964 Civil Rights Act, the Social Security Act and the Medicare Act, there is an equally strong tradition of using race baiting as a tactic in American politics. One of the vestiges of segregation in our society is the racial disparity that still exists in our health care system. If this act helps to remedy this disparity, then it truly is a civil rights act.

This week, I have ahad a taste of what it might be like not to have health insurance for members of my family. Fortunately, my experience did not involve uninsured children, but instead an uninsured dog. My puppy, Owen, just turned 6 months old and he does not have health insurance. Being a risk adverse person, I investigated the insurance options when we got Owen. However, I soon learned that health insurance for dogs is prohibitvely expensive. Even simple catastrophic coverage cost at least $30-40 per month (For those who don’t know, “catastrophic insurance” is insurance that covers only “catastrophically” expensive health care for illness or injury), and regular health insurance coverage for dogs is simply not cost effective.

Last week, Owen had surgery. Fortunately, the surgery was routine (OK, we took away his ability to father puppies) and surgery for dogs is a lot less expensive than surgery for humans. Still, I paid several hundred dollars for his care. I had to make some tough decisions, such as whether to pay extra for the less invasive, less painful laser surgery, and how much to spend on pain medication (not to mention our worries about breaking or chipping the cone on his head – an added expense). Furthermore, when Owen’s stitches started bleding on Saturday afternoon, we had to decide whether to take him to the Emergency Animal Care and pay another large sum, or wait until Monday to have him re-checked by his regular doctor for free. Since Owen is, after all, a non-human animal, and since he continued to romp happily (as much as he could with a cone on his head), we decided to wait until Monday.

This experience got me thinking. I have a friend who is pregnant who only has catastrophic health insurance. I have another friend who has children and no health insurance. I imagine how hard it must be to make health care decisions for them. Wait until the cheaper doctor on Monday or go to the ER? Purchase the highest quality, least pain method of surgery or opt for the cheaper and plan to do lots of handholding? These decisions can’t be easy – indeed, they must be agonizing for the millions of uninsured parents with uninsured children in this country. I am lucky. Only my dog is uninsured. But I sure do feel for the many others are not so lucky.

This may be an overly saturnine observation, but it seems that the United States is no longer governable–if by “governable” one means implementing the positions that win elections. The current Health Care Reform crisis is one of many such examples, but there are others also. Indeed, it’s a good test case. If we get a bill will it be one that favors the people or the Health Insurance companies? Four out of five congressional committees reported bills including a public option. One would think a public option is a sure thing. Right? Not necessarily. This fiasco turns off even those citizens who for the first time and who turned out en masse to support a candidate for president. How will this president reward them? Bold, courageous action is required, not politics as usual.

How will the so-called “trigger” work? What will insurance companies need to do to avoid the trigger? Will the trigger have “teeth”? And what will “teeth” amount to? No one seems to take these questions seriously. As such, the trigger seems to be a gimmick providing cover for those who oppose a public action. There is no substitute for a public action. With a public option, it will be apparent whether choice and cost-effectiveness works. Without one there will be no baseline for determining whether insurance companies will be kept “honest.”

It’s been quite a week. I watched folks marching in the Labor Day parade carrying “Health Care Now” signs, and heard an enthusiastic crowd member call out, “Health care yesterday!” I talked to my friend whose husband lost his job about her difficult decision about whether or not to take her son to the doctor for an ear infection since it would cost over $100. I think of my friend who was just diagnosed with cancer. Thank goodness she has health insurance – I can’t bear to think of her having to forego treatment, as so many have who can’t afford it and lack the insurance to pay for it. I think of my friend with the severely disabled daughter who can’t move because after years, she finally got her daughter on state supported health care. I think, maybe relief is finally here for her and the 46 million uninsured in this country.

Yesterday, President Obama said that health care reform is not just an economic issue, it’s a moral issue. I agree. Why do the people who suffer bad luck such as loss of job or severe illness then have the further bad luck of not being able to afford health care? It’s just not fair, and it’s not in this way in any other advanced industrialized nation. Health Care (Reform) Now? I sure hope that it will be here soon.

Bill Moyers is quickly becoming the most sane and balanced progressive American voice. Check out the conclusion to his most recent Journal.

September 4, 2009

BILL MOYERS: The editors of THE ECONOMIST magazine say America’s health care debate has become a touch delirious, with people accusing each other of being evil-mongers, dealers in death, and un-American.

Well, that’s charitable.

I would say it’s more deranged than delirious, and definitely not un-American.

Those crackpots on the right praying for Obama to die and be sent to hell — they’re the warp and woof of home-grown nuttiness. So is the creature from the Second Amendment who showed up at the President’s rally armed to the teeth. He’s certainly one of us. Red, white, and blue kooks are as American as apple pie and conspiracy theories.

Bill Maher asked me on his show last week if America is still a great nation. I should have said it’s the greatest show on earth. Forget what you learned in civics about the Founding Fathers — we’re the children of Barnum and Bailey, our founding con men. Their freak show was the forerunner of today’s talk radio.

Speaking of which: we’ve posted on our website an essay by the media scholar Henry Giroux. He describes the growing domination of hate radio as one of the crucial elements in a “culture of cruelty” increasingly marked by overt racism, hostility and disdain for others, coupled with a simmering threat of mob violence toward any political figure who believes health care reform is the most vital of safety nets, especially now that the central issue of life and politics is no longer about working to get ahead, but struggling simply to survive.

So here we are, wallowing in our dysfunction. Governed — if you listen to the rabble rousers — by a black nationalist from Kenya smuggled into the United States to kill Sarah Palin’s baby. And yes, I could almost buy their belief that Saddam Hussein had weapons of mass destruction, only I think he shipped them to Washington, where they’ve been recycled as lobbyists and trained in the alchemy of money laundering, which turns an old-fashioned bribe into a First Amendment right.

Only in a fantasy capital like Washington could Sunday morning talk shows become the high church of conventional wisdom, with partisan shills treated as holy men whose gospel of prosperity always seems to boil down to lower taxes for the rich.

Poor Obama. He came to town preaching the religion of nice. But every time he bows politely, the harder the Republicans kick him.

No one’s ever conquered Washington politics by constantly saying “pretty please” to the guys trying to cut your throat.

Let’s get on with it, Mr. President. We’re up the proverbial creek with spaghetti as our paddle. This health care thing could have been the crossing of the Delaware, the turning point in the next American Revolution — the moment we put the mercenaries to rout, as General Washington did the Hessians at Trenton. We could have stamped our victory “Made in the USA.” We could have said to the world, “Look what we did!” And we could have turned to each other and said, “Thank you.”

As it is, we’re about to get health care reform that measures human beings only in corporate terms of a cost-benefit analysis. I mean this is topsy-turvy — we should be treating health as a condition, not a commodity.

As we speak, Pfizer, the world’s largest drug maker, has been fined a record $2.3 billion dollars as a civil and criminal — yes, that’s criminal, as in fraud — penalty for promoting prescription drugs with the subtlety of the Russian mafia. It’s the fourth time in a decade Pfizer’s been called on the carpet. And these are the people into whose tender mercies Congress and the White House would deliver us?

Come on, Mr. President. Show us America is more than a circus or a market. Remind us of our greatness as a democracy. When you speak to Congress next week, just come out and say it. We thought we heard you say during the campaign last year that you want a government run insurance plan alongside private insurance — mostly premium-based, with subsidies for low-and-moderate income people. Open to all individuals and employees who want to join and with everyone free to choose the doctors we want. We thought you said Uncle Sam would sign on as our tough, cost-minded negotiator standing up to the cartel of drug and insurance companies and Wall Street investors whose only interest is a company’s share price and profits.

Here’s a suggestion, Mr. President: ask Josh Marshall to draft your speech. Josh is the founder of the website talkingpointsmemo.com. He’s a journalist and historian, not a politician. He doesn’t split things down the middle and call it a victory for the masses. He’s offered the simplest and most accurate description yet of a public insurance plan — one that essentially asks people: would you like the option — the voluntary option — of buying into Medicare before you’re 65? Check it out, Mr. President.

This health care thing is make or break for your leadership, but for us, it’s life and death. No more Mr. Nice Guy, Mr. President. We need a fighter.

The word is that President Obama will crack down on the progressives on health care reform. Hopefully, the progressives won’t crack. The President seems to be capitulating to the notion that any health care reform bill is better than none. But that’s, at best, a political calculation, not a commitment to principle. Obama promised to be different. Let’s see whether he can keep his promise.

Will President Obama go the way of George H.W. Bush? There’s speculation that the president will not keep his promise to include a public option in the health care reform bill. That’s more than unfortunate. Moreover, word has it that the anti-rescission provision might fail as well.  Fully aware that the president is rescission by difficulties few presidents ever faced, failure to keep his promise can be devastating to his presidency. Surely any hope of being a transformative president seems already gone. The forces that have killed universal health care for the past half century will simply be emboldened by another victory. It would be better for the president to serve one term fighting for principle than hanging on to two terms by playing politics. Yet, he might not even succeed at that. The House progressive caucus has threatened not to support such legislation. Failure all around. A bad bill is not better than no bill at all. The president must resist a bill that includes a so-called “triggering” mechanism for a public option if the insurance companies do not control costs is a bad bill. There’s no way to guarantee compliance. It’s simply cosmetic. I sympathize with the president. But consensus-seeking is an inappropriate strategy when one hasn’t a partner in the consensus-seeking enterprise. Standing for principle, committing oneself to health care reform that is fair, cost-efficient, and universal, even if it fails, is better than a self-congratulatory bill that is unfair, doesn’t contain costs, even it covers more Americans.  How valuable is a bill that doesn’t preclude rescission of coverage? What kind of coverage is that? Please Mr. President take the high road. Keep your promise to principle. Even if we lose at least we will at least know what we’re fighting for?

As I watched Ted Kennedy’s funeral and listened to the coverage of his life and death last week, I heard the phrase “the end of an era” so many times, it convinced me that people should stop using the term “the end of an era.” What does an “era” mean? According to the Oxford English dictionary, an “era” is defined as “a system of chronology reckoning from a noteworthy event.” Perhaps the commentators mean their observation to refer to the era beginning with the birth of Joseph Kennedy Sr.’s children. True, a genertion of Kennedy brothers had passed away now, ending the era of that generation of the Kennedy brothers. True, many of us (including myself, born the year that Ted Kennedy entered the Senate) cannot remember a time when Ted Kennedy was not in the Senate. True, thousands of liberals in America can no longer count on Senator Ted Kennedy to always speak for us in the Senate, and never apologize for being liberal. But what is the point of calling this an “era?’ What more do we learn from this phraseology?

Perhaps those who called Ted Kennedy’s death “the end of an era” intend announce the end of liberalism in America that was most prevalent in the 1960s but lingered until Ted Kennedy’s death. If that is the case, then I must, most emphatically, object, not only to the phrasing but to the sentiment behind the phrase. There remains a strong progressive tradition in the Democratic party, shared by many members of he general public who dop not affiliate themselves with that party. The progressive tradition was most recently re-affirmed by the election of President Obama (with Ted Kennedy’s crucial support) and his numerous Demcratic colleagues in Congress. It is reaffirmed in the polls that show that despite months of the healthcare industry spending over a million dollars a day to fight health care reform, the American public still strongly supports it, and still demands a change to our health care system. So, let’s put an end to this talk about “the end of an era” and concentrate on what we need now. There’s never an end of the era of need for the poor and middle class folks in this country who demand health care reform.

Despite his best intentions President Obama’s attempt at consensus and bipartisanship over health care reform is over. In order to achieve bipartisanship one needs a partner willing to embrace bipartisanship.  The Republicans have no interest in doing so. Defeating Obama is more their taste. It’s now time, it’s now well past time, for President Obama to fashion a Democratic bill, including the public option, if he hopes to have a health care reform bill at all. I admire the President’s attempt at consensus, but consensus cannot be the final end in itself, especially when something as critical as health care reform is concerned. If one has the votes, but lacks a partner, one must act alone, which is unfortunate, but it’s necessary all the same. What we haven’t seen is Obama, the fighter, and as in any political struggle sometimes fighting is all one has. In short, politics is war by other means. Ultimately, Obama will be judged by how well he can wage war over this definining. essential issue.

How can profit be the driving force in the health care industry? The contrast between human health and making money is as stark as human safety and making money.  Imagine if police departments or fire departments were privatized and unregulated by government. Suppose further they were paid by how many crimes they prevented or criminals they caught. Such private entities would have an enormous incentive to directly or indirectly encourage crime. Similarly, private hospitals make their living from the number of beds they fill. There’s not much incentive to increase wellness just to treat illness.  As illness decreases these hospitals lose profits. The analogy is far from complete, but the point nevertheless is this. Absent socialized medicine profit will exist in medicine, but profits for doctors and other health care providers and profit for health care corporations are vastly different entities. It is Wall Street that keeps costs rising and prevents universal care. The public option is a minimal attempt to counteract the devastating effects of shareholders, who must be fed with the health and wealth of the nation, on the health care system. Yet Americans have been so brain-washed against this option that it is unlikely to succeed unless President Obama realizes this is a battle he can’t afford to lose.