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The Opportunity Agenda

A Guaranteed Right to Health: The Key to Presidential Greatness

President-elect Barack Obama has renewed our hope as Americans that the promise of opportunity is revitalized, alive and well. But in order to secure his own legacy as the first great president of the 21st Century, and one of the greats in American history, he will need a grand undertaking equivalent to Abraham Lincoln's saving of the Union or Franklin D. Roosevelt's New Deal. Amidst the current economic downturn, it would appear clear what the momentous challenge and chance for long-lived admiration will be for an Obama Administration, and it is health care.  Not small bore reforms of existing programs or expansions around the margins of the popular State Children's Health Insurance Program (SCHIP) or Medicare, but a truly revolutionary sea change in the compact that the American government and their people share in relation to the health of the populace. As Steve Coll of The New Yorker comments:

The next Presidency has within its reach at least two generation-spanning causes: the need to jump-start a new energy economy, and, in so doing, help to contain climate change; and the need to enact a plan to provide quality health care to all Americans, and, in so doing, complete the project of social insurance that Roosevelt described in 1935. Each of these projects is urgent, but it is health-care reform that speaks more directly to the economic and human dimensions of the present downturn.

The accumulating failures in the country’s health-care system are a cause of profound weakness in the American economy; unaddressed, this weakness will exacerbate the coming recession and crimp its aftermath. A large number of the country’s housing foreclosures in recent years appear to be related to medical problems and health-care expenses. American businesses often can’t afford to hire as many employees as they would like because of rising health-insurance costs; employees often can’t afford to quit to chase their better-mousetrap dreams because they can’t risk going without coverage. Add to this the system’s moral failings: about twenty-two thousand people die in this country annually because they lack health insurance. That is more than the number of Americans who are murdered in a year.

As my health law professor once said, it is inaccurate to call what we have in the United States currently a "health care system," as there is nothing systematic or logically organized about it; it is, rather, more accurate to call what we have the "health care industry." And therein lies a core, fundamental problem with the way that many Americans are pushed into thinking and talking about their health care; it is common in the advocacy, policy, and newsmaker worlds to hear about "health care consumers." Health care, as one participant in the presidential town hall debate commented, is often thought of as a commodity in this country. But this is not a cheeseburger or a new raincoat that we are talking about; this is our health, the key to our economic security and ability to access the American Dream of boundless opportunity that President-elect Obama represents. Health, as President-elect Obama and the great lion of the Senate, Ted Kennedy, have both stated, is a fundamental right of Americans.

Without a guarantee to our right to health care, and the opportunity for good health that follows, many Americans are in danger of losing their jobs, and as Coll points out and as I have pointed out here before, their homes (up to 7 out of 10 foreclosures are caused in part by medical crises). Surely, if human rights apply as much here in the United States as much as it does abroad, the human right to the opportunity to meet the most basic needs for ourselves and our families--housing, feeding, and clothing ourselves--must be guaranteed. This is not only about 46 million uninsured Americans who cannot afford to purchase health care as "consumers," or about the 25 million underinsured Americans who, despite paying premiums, are at constant risk of bankruptcy should catastrophe or tragedy strike. This is about health writ large: the health of our American community, the health of the American economy, and, not the least of all, the health of the American Dream.

And, as it turns out, this is also about the health of the Obama legacy, and whether in that pantheon of the great American presidents, his name and memory will join the likes of Washington, Jefferson, Lincoln, and Roosevelt.

How Not to Blow It

It's hard to overstate the transformative moment that we're in as a nation and, particularly, as progressives. In just a few years, we've gone from the high point of conservative power to a stunning rejection of conservative federal leadership and the historic election of a progressive African-American president.

But the electoral sea change is just part of the extraordinary national moment. The financial meltdown and slide toward deep recession have crystallized Americans' anger over deteriorating economic security, stagnant mobility, growing inequality, and policies of isolation instead of connection. Americans are ready for a new social compact and a transformed relationship between the people and our government. They are calling for a new era of big ideas and different values than we've seen over most of the past three decades.

The electorate has shown an unprecedented willingness to overcome racial and ethnic barriers to take on daunting shared challenges. Young people, people of color, and low-income people turned out to register and vote in unprecedented numbers that bode well for a far more participatory and egalitarian democracy going forward.

Even before this year's remarkable events, opinion research showed a historic, progressive shift in Americans' views on issues that (not coincidentally) were barely mentioned in the election. Perhaps most striking is the shift on criminal justice and problems of addiction, where the U.S. public has moved broadly to support rehabilitation and treatment over incarceration and retribution, as well as assistance and integration for people emerging from prison.

But an unprecedented opportunity for progressive values and ideas is not the same as victory for a progressive social and policy vision. The stark challenges of rising inequality, faltering security, and broken systems of health care, immigration, and criminal justice are the same on November 5 as they were on November 4. What's changed is only the chance for transformative change.

History shows that progressives could easily blow this opportunity, just as conservatives blew their transformative moments after the 1994 elections and the attacks of September 11, 2001. A few principles can help progressives move from opportunity to realization in ways that profoundly benefit our country.

The Great Change

The sound of change still lingers amidst the towering skyscrapers along Michigan Ave and Adams Street.  And as the wind blows words around like confetti, lifting them up with every gust coming in off the Great Lake, tired and weary travelers stir from only a few hours sleep and breathe in the air of change.  And as President-Elect Barack Obama wakes with his family, and ponders the task set before him, one thing stands clear on this day after Election Day 2008--that is: America reclaimed it's vision of opportunity.   

The words were clear in his speech before hundreds of thousands of supporters standing on the soft weathered grass of Grant Park, and before a nation who watched on the television.  And for the late night cab drivers who drove around with their radios on, many of whom tired and weary travelers to a new land called America, the dreams of my own great grandparents came to life, exploding in high definition color.

Both candidates ran on a platform of change.  And there was no question that the end of the past eight years would bring about change.  It was written in the stars that shine bright over Lake Michigan.  And with the change in our hearts, like the change in our pockets, we purchased--as a nation--the debt that opportunity had been waged under for the past eight years; debt of individual greed over community values, debt of frozen liberties and fractured health equity, the debt of despair amongst New American families torn apart by a government who would rather see their dreams of hope and opportunity destroyed, rather then find real solutions to help immigrants come to America in search of opportunity.

The great change has begun.  And although it will take time to reach up and take the fruit from its branches, the labor of the harvest has shown its face by the millions.  And in saying, "Yes We Can," we have returned America from a nation of "Me The People," to a nation of "We the People." 

"No-Match" No Fair

Last week the Bush administration announced a renewed push to clamp down on undocumented workers.  Specifically, the rule would ask a federal judge to lift an injunction on the "no-match" rule.

The rule protects businesses from failing to respond to so-called "no match" letters sent out by the Social Security Administration stating that the number provided by an employee does not match the information in their database.  This may indicate the worker is undocumented but many are the result of clerical errors including, for example, women not updating last names after marriage.

Judge Charles R. Breyer last year warned that the plan would have "staggering" and "sever" effects on workers and businesses.  It's reasons such as this that have brought together not just traditional groups working for immigrant rights, such as the ACLU, but also the AFL-CIO, and the U.S. Chamber of Commerce.

Particularly amidst the recent sharp economic downturn, business leaders are concerned about the Bush administration's plan.  If this effort to lift the injunction against the "no-match" rule is successful, the government would ask up to 140,000 employers to check the social security numbers of 8.7 million workers.  Businesses must resolve discrepancies within 90 days or fire the workers.

Angela Amador, the Chamber's director of immigration policy is concerned about the costs of complying with this rule.  The Chamber's objections "[have] been about the cost of a badly thought out rule and the cost on legitimate businesses following all the rules and complying with it."

Groups such as the ACLU and the National Immigration Law Center are concerned that the plan would lead to racial profiling, discrimination, and the firing of people based on clerical errors.  They argue the Bush administration should work instead towards fixing the flawed database.

Rights and Wrongs on Health Care

In the second presidential debate, moderator Tom Brokaw asked the candidates whether health care is a privilege, a responsibility, or a right. John McCain answered privilege, while Barack Obama said that health care is a right. With nearly 46 million Americans uninsured, and millions more unable to meet their medical expenses despite having insurance, the notion of an American right to health care seems far from today’s reality. But a human right to health care is deeply rooted in our national history and values, and is broadly supported by the American people. It is an idea whose time has come.

After leading our country out of the Great Depression, Franklin Roosevelt voiced the connection between health care and the Founding Fathers’ vision of inalienable rights to life, liberty, and the pursuit of happiness. In his 1944 State of the Union address, Roosevelt explained that Americans have come to embrace a “second bill of rights” alongside the civil liberties set out in the Constitution. Those rights, FDR declared, include “the right to adequate medical care and the opportunity to achieve and enjoy good health.”

Four years later, the US played a leading role in creating the Universal Declaration of Human Rights. Article 25 of the Universal Declaration states that "everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including … medical care and necessary social services."

With the onset of the Cold War, the US shied away from applying economic human rights like the right to health care here at home. But some states have tried to keep the idea alive. New York State’s Constitution recognizes a right to systems that protect public health. And just this year, Connecticut passed legislation declaring that “equal enjoyment of the highest attainable standard of health is a human right and a priority of the state.”

A national opinion survey conducted by The Opportunity Agenda last year shows overwhelming public support for the idea that health care is a right. When asked whether access to health care should be considered a human right, a whopping 89% of Americans said yes, with 72% “strongly” holding that view.

For Americans, the right to health care is not only about personal health and economic security, but also about our shared values as a nation, including fairness, dignity, and opportunity for all. When asked why they support human rights, Americans’ most popular responses are “because it is important to treat people fairly and with dignity,” and “because America was founded on Thomas Jefferson’s belief that we all have rights that no government should take away.”

What would it mean for our nation to treat health care as a right instead of merely a privilege or solely a responsibility? Protecting the right to health care is less about the means of delivery than it is about results for everyday people. It means that any approach must realistically guarantee all Americans affordable, quality care, irrespective of where they live, what their health history is, what job they have, or whether they get laid off. It means that, unlike in our current system, the racial background of patients and neighborhoods should not influence the siting of hospitals and clinics, or the quality of care. And it means that neither insurance companies, nor HMOs, nor government bureaucrats get to decide whether Americans can get basic, necessary care.

To be sure, protecting the right to health care will require financial investment and sacrifice. But that investment will pay off many times over down the road. We’ll save lives among the 18,000 Americans who die every year for lack of health coverage. We’ll stave off bankruptcies from among the half of filings that stem from medical expenses. And we’ll save countless dollars as families who get preventative care avoid costly emergency room visits.

The 60th anniversary of the Universal Declaration of Human Rights is just 6 weeks away, on December 10, a month after Election Day. That’s a perfect time for a new president and Congress to renew our human rights legacy by guaranteeing affordable, quality health care for all.

Cross posted at OurFuture.org

Pre-Inventing History

You’ve got to admire the conservative echo chamber. In the shadow of a financial meltdown that McCain and Obama both (correctly) agree stemmed largely from a lack of governmental oversight of irresponsible corporate behavior, conservative spinmeisters are blaming the meltdown on too many loans to minorities, the Community Reinvestment Act, and the heavy hand of…wait for it…community organizers.

Read the entire post on BlogForOurFuture.

Framing to Win: Health Care is "a Right for Every American"

Are we "consuming" health care or realizing our "rights?"  The American public is ready for a new conversation; in fact, the conversation has already begun.  Are you speaking the right language to be a part of this new discussion?

In the second presidential debate last evening, Tom Brokaw asked of the two candidates a follow-up question, stemming from one woman's question of whether health care should be treated as a commodity.  Both candidates demurred from the initial inquiry, but Brokaw pressed them on his own follow-up: "Is health care in America a privilege, a right, or a responsibility?"  What caused many of us who have been following both campaigns and their proposed health care policies to sit up in our seats was Sen. Obama's answer, "Well, I think it should be a right for every American."  The reason to take notice isn't that a politician answered a question directly, impressive though that is, but the much more important reason is the re-framing of an issue long discussed on both sides as a consumer good.

Talking about health care and the opportunity for good health as a right, rather than a commodity, privilege, or responsibility, is something that advocates have shied away from, for a myriad of reasons.  But poll after poll, we find that most Americans far and near all believe that health care is a right, with a majority holding health care to be a human right.  Nationally, 72 percent of Americans strongly believe that health care "should be considered a human right.”  In New York state, fully 89 percent of New Yorkers believe that health care should be a right for all New Yorkers, with 70 percent believing that the government (federal, 41%; state and local, 28%) “mainly responsible for ensuring that everyone in New York gets the health care that they need.”  Likewise, over 90 percent of Connecticut residents believe that everyone in the state deserves a right to health care.

And now, in the midst of both a presidential election and a financial crisis, we have yet more evidence that the "right to health care" language works.  During the debate, the now-infamous CNN focus group armed with real-time dial rating tools found that the line describing health care as "a right for every American" was one of his strongest of the evening.  As reported by Alternet, “When Obama discussed health care as a right for all Americans, his numbers were through the roof. At one point, female respondents were dialing in at 100 percent approval.”

If that, along with all of the previous polling, is not enough to convince you that now is the time to start talking about health care as a right, consider that the financial crisis, and the loss of Americans' economic security, itself stems from health care concerns, something I wrote about last week.  But this week I give you a fresh example: a new article in Health Matrix, a scholarly health journal, reports that medical crises (and the resulting bills) are a cause of up to 7 out of 10 of all home foreclosures:

Our evidence suggests that medical disruptions are a major contributor to mortgage default, often striking in combination with other factors. Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%). We also examined objective indicia of medical disruptions in the previous two years, including those respondents paying more than $2,000 of medical bills out of pocket (37%), those losing two or more weeks of work because of injury or illness (30%), those currently disabled and unable to work (8%), and those who used their home equity to pay medical bills (13%). Altogether, we found that about 7 in 10 of our respondents either self-reported a medical cause of foreclosure, or experienced one of these indicia of medical disruptions in the years before foreclosure.

Approaching health as a human right is powerful because it reflects our, and the American public’s values.  It is also preferable to using a consumer approach for a number of reasons.  When health is framed as a consumer good that each of us must purchase at market rates, we reinforce a competitive, individualistic mindset, and suggest that people who lack quality health care are simply poor economic competitors.  In terms of the current home foreclosure crisis, this plays into the right-wing frame that the crisis is the fault of irresponsible borrowers, a far cry from the reality where most homeowners facing foreclosure have been struck by family medical misfortune or catastrophe.   Building broad, winning support for equal access to quality health care and for addressing health disparities requires a new frame of health care as a common resource that’s stronger and fairer when we’re all in it together:  a system that works for everyone when everyone’s included and that is our right to expect and demand.

Health Is Our Economy

As Congress continues to consider whether some version of a bailout of Wall Street is possible, there appears to be little focus in the debate on the underlying causes of the larger economic situation that the United States is in.  Our current predicament is not just about mortgages or the undercapitalization of the financial sector; it is also very much about the shift in priorities in this country over the last thirty years.  We have come a long way from the idea of The Great Society, a productive national community that not only took care of itself, but grows consistently stronger for having done so.  In the New York Times this past weekend, Ezekiel Emanuel, chair of bioethics at the National Institutes for Health, argues that in some ways, the current crisis is a symptom of "chronic problems," specifically the continued unfulfillment of our human right to health care:

[S]olving the deep problem of the economy cannot be done without solving the health care mess. Economic, tax and health care policy are inextricably linked. Middle-class incomes have hardly grown in 30 or more years (except for five years in the 1990s when health care costs were moderated), budget deficits are escalating and will only worsen and investment in education and other engines of long-term economic growth are declining.

These problems are all driven by health care. Rather than go to wage increases, almost all of the growth in workers' productivity has been swallowed up by rising health care costs.

Basic economic security cannot exist without good health, and without a foundation of economic security, our efforts to aspire to be a better nation--one that fulfills the interconnected promises of life, liberty and the pursuit of happiness--are in danger of proving futile.  As President Franklin D. Roosevelt said in his 1944 State of the Union address, “we have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence.”

Health: A Big Week For Equality

It's been a big week for equality, as Congress has passed two major pieces of legislation that move the country in the direction of equal access for all Americans regardless of disability.

The major headline which you have probably heard about is the passage of the Americans with Disabilities Act Amendments.  These amendments restore the spirit of the original Americans with Disabilities Act, which had come under fire from Supreme Court rulings that put people with disabilities in a Catch-22 situation.  As explained by Cristóbal Joshua Alex of the National Campaign to Restore Civil Rights:

In one case after another, the Supreme Court whittled away at the landmark Americans with Disabilities Act by ignoring Congressional intent and narrowly interpreting the definition of disability. [. . .] This created a Catch-22 situation: if a person is able to limit the effect of having a disability, say by taking medication or using a medical device, that person would no longer be covered under the Americans with Disabilities Act and employers were free to discriminate at will. The result has been devastating. Plaintiffs lose 97% of employment-related cases under the ADA.

The absurdity played out in courtrooms across the country where judges, following the Supreme Court precedent, ruled that people with epilepsy, cancer, muscular dystrophy, mental retardation and even blindness were not "disabled" under the ADA. But, as the bill's sponsor, Congressman Steny Hoyer points out, the ADA is not about disability, it's about the prevention of wrongful and unlawful discrimination.

The Amendments passed by an almost unheard of unanimous voice vote in both the House and the Senate.  The impressive victory was a result of all stakeholders in the process, business, labor, and advocates for people with disabilities, recognizing that they were all part of the same community and could find common ground to restore the anti-discrimination protections of the law.  When we unite around common American Values such as fairness and dignity, we can find commonalities with those who we might usually think of as our adversaries.

More good news came yesterday with the news that the Congress has also passed a long sought-after mental health parity bill that requires health insurers to treat mental health coverage on equal terms with physical health coverage.  The legislation passed in the Senate as part of a larger renewable energy bill by a vote of 93-2, and in the House by a vote of 376-47.  In the words of some of the Senators key to the passage of the legislation:

“This bill provides mental health parity for about 113 million Americans who work for employers with 50 employees or more,” said Mr. Domenici, who has a daughter with schizophrenia. “No longer will people with mental illness have their mental health coverage treated differently than their coverage for other illnesses like cancer, heart disease and diabetes.”

With this bill, said Senator Amy Klobuchar, Democrat of Minnesota, “we are eliminating the stigma and affirming the dignity” of people with mental illness.

Senator Christopher J. Dodd, Democrat of Connecticut, said, “Mental illness will no longer take a back seat to physical illness.”

Mental health parity was one of the signature issues of the late progressive champion, Senator Paul Wellstone of Minnesota, who died tragically in a small plane crash while campaigning for re-election in 2002.  His work, and those who have continued it, demonstrate that equality, opportunity, and dignity are American, not partisan, goals.