The State of Opportunity

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." 

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.

The Promise of Opportunity

Taking another look at "New Progressive Voices," a collection of essays outlining a new long-term, progressive vision for America, today we turn to our Executive Director, Alan Jenkins', contribution.

The piece paints a bleak picture.  Alan outlines many of the problems facing regular Americans today.  Many people are having trouble getting a job that pays a living wage, paying for health care, and getting their children into quality schools.  Tying this together with the present high rates of incarceration, all signs point to a general lack of opportunity in America.

In keeping with goals of this essay collection Alan's essay, "The Promise of Opportunity," strives to give concrete solutions to these communal ills.  Alan's essay suggests making "opportunity" a metric by which to consider the viability of federal programs.

As with the environmental impact statements currently required under the National Environmental Policy Act, the relevant agency would require the submission of information and collect and analyze relevant data to determine the positive and negative impacts of the proposed federally funded project. Here, however, the inquiry would focus on the ways in which the project would expand or constrict opportunity in affected geographic areas and whether the project would promote equal opportunity or deepen patterns of inequality.

While the measures of opportunity would differ in different circumstances, the inquiry would typically include whether the project would create or eliminate jobs, expand or constrict access to health care services, schools, and nutritious food stores, foster or extinguish affordable housing and small business development. At the same time, [these Opportunity Impact Statements (OIS)] would assess the equity of the project's burdens and benefits, such as whether it would serve a diversity of underserved populations, create jobs accessible to the affected regions, serve diverse linguistic and cultural communities, balance necessary health and safety burdens fairly across neighborhoods, and foster integration over segregation.

To read the full article, click here.

Announcing "New Progressive Voices"

The Opportunity Agenda is pleased to help announce, on behalf of the Progressive Ideas Network, the release of a new collection of essays outlining a new long-term vision for America.

"New Progressive Voices: Values and Policy for the 21st Century" brings together leaders from a wide array of organizations, of different backgrounds, to present a bold, progressive agenda for America's future.  Integral to the project is a commitment, not to just presenting a new direction, but also realistic approaches to solving our collective problems.

From the collection's introduction:

In recent decades, progressivism has faltered. It was conservatives who developed and moved the big ideas, while progressives triangulated, tweaked, and tinkered. Since the 1960s, progressives have been running on the fumes of the New Deal and Great Society, confining themselves largely to narrow issue silos and poll-tested phrases and positions. Content to play defense in many of the major political battles of the day, they have all too often been cowed into submission by the vitality and confidence of the other side.

Now that is changing. Instead of obsessing about what we are against, progressives have begun to think about what we're for -- to prepare once again to play our role as agents of bold ideas and political and social transformation. Finding new confidence and imagination, we have begun to renew our intellectual capital. The essays in this volume draw on that new store of capital to sketch the outlines of a progressive agenda for 21st-century America.

Our own Executive Director, Alan Jenkins, contributed an essay to the collection.  You can read "The Promise of Opportunity" here.

What's AIG got that your child doesn't?

If you've watched a news show, listened to the radio, picked up a newspaper or even just watched The Daily Show this week, you know that Wall Street is in trouble.  Years of irresponsible speculation and reckless lending policies--including the targeting of subprime mortgages in America's most vulnerable communities--have contributed to the threat of bankruptcy of some of the biggest names in banking and insurance.  Bear Sterns.  Fannie Mae.  Freddie Mac.  Lehman Brothers.  Merrill Lynch.  AIG.  You may not have heard of all of them before, but chances are that you've heard of one of them, and the chances are even bigger that they have, somewhere along the road, been involved in your own financial situation, whether it is as an investor in the bank that lent you your mortgage or as the manager of your 401(k) or pension.  Long story short, this is really big news with potentially huge impacts on every sector of American life and the economy.  And as big news, the reporters are covering it, just as they're also covering the fact that the Federal Reserve, an independent government agency entrusted with managing America's monetary policy (mainly through deciding interest rates), has bailed out a few of these large investment banks to the tune of over $300 billion.

I'm no economist, but the economists who are talking about these bailouts right now generally appear to believe that they are necessary.  The fabric of the American economy is so interwoven that we cannot simply allow major segments of our community to fail without repercussions for the rest of us.  Undoubtedly, there should be reprecussions for bad behavior, and the current critiques of the lack of accountability for these banks and their managers are very persuasive.  Just as America cannot succeed without broad support of the common good, it cannot succeed without accountability, transparency, or justice.  Responsibility in America cannot just be to ourselves (or our stockholders), it must be to each other as well.

Of course, this interconnectedness isn't only true for large investment banks; this is true for all of us, from the largest to the smallest.  That's why it's disappointing to see that as the Federal Reserve takes action to keep our financial sector in one piece, our elected official in Congress and the Administration are not providing parallel support to American families and children.  Apparently frozen until next year is consideration of expanding the State Children's Health Insurance Program, which provides access to health care for about 7 million children.  One of the most successful government programs, the Children's Health Insurance Program has reduced the number of uninsured children by around 3 million, and, as I wrote a couple of weeks ago, is credited for helping with the reduction of the number and percentage of uninsured from 2006 to 2007.  Similarly, we've yet to see a federal response to the

So my question is, what's AIG got that your child doesn't?  True, this isn't exactly comparing apples to apples; the Federal Reserve's independence allows it to act in ways that are more difficult for Congress and the Administration.  Nonetheless, the social contract of America which has made this country strong is one of mutual security, the guarantee that our elected officials will work to insure our ability to provide for the health, food, education and other basic needs of our families, neighborhoods, and communities.  Almost a century ago, when financial crisis also created hardship for Americans across the country, the government responded not with bailouts, but with a program of hope and support, a set of policies that did not seek to provide for American's basic needs, but rather to assist us all, as families and as a national community, to get back on our feet.  Legacies of those policies live on today, responding to high fuel prices with the Low Income Home Energy Assistance program and to skyrocketing food prices with the Women, Infants and Children nutrition program for mothers and their children, the Commodity Supplemental Food Program for senior citizens, and the Emergency Food Assistance Program that supports food banks.  At only a fraction of the cost of the recent investment bank bailouts, there is an opportunity for our elected representatives to not only guarantee and uphold the core American value of economic and community security, but to help stimulate the economy as well.

Labor Day Health Blog

In lieu of the regular Monday Health Blog Round-Up, I'd like to take a moment to reflect on our observation of Labor Day yesterday, and how the history of the holiday reflects upon our current health care crisis.

Labor Day was first conceived of in 1882 by the Central Labor Union of New York City, a coalition of trade unionists who later joined with the American Federation of Labor.  But it was not until twelve years later, on June 28, 1894, that Congress made Labor Day a national holiday, eventually adopted by all 50 states.  What was the catalyst for the "day off for the working man," and how is all of this related to our current health care crisis?  What follows below is a discussion of the key national values mobility, security, opportunity, and how government can (but sometimes fails to) defend the American Dream.

The catalyst, it turns out, may sound somewhat familiar.  Irresponsible speculation by banks encouraged over-development by speculators, creating an economic bubble.  When the bubble burst, thousands of businesses and hundreds of banks lost everything, resulting in a massive recession where unemployment skyrocketed and many American families wondered about how to make ends meet for the most basic of necessities.  After massive protests (some ending violently) subsumed the industrial centers of the Midwest, Congress felt a need to act, and Labor Day, in recognition of the contributions of working families, was what they came up with.

Now, Labor Day is a fine holiday; I enjoyed it myself by making a chuck roast that turned out wonderfully.  But the history that bears some worrying parallels to our current economic conditions (a downturn as result of over-speculation by banks and developers, though housing in our case rather than railroads) brings up some questions about how we view labor (with a small "l") in this country.  America is based in the core ideal that when folks work hard, not only should they be able to barely make ends meet, they should have the opportunity to advance and fully participate in the social, economic and political.  Put another way, this is the promise of Mobility, the element of the American Dream that says not only should we ensure that the lives of the next generation is better than our own, but we must make sure that our institutions allow for all of us in our own lifetimes to pursue a better life for ourselves, our families, and our community.  A poor economic environment should not be an excuse for the government to fail to stand up and protect this right; the government has, at its best moments in history, defended the American value of mobility, by creating more jobs, by helping those who have fallen on the hardest times get back on their feet, by helping communities to find new paths in new economies through government-aided infrastructure and supportive programs.

The role of the government is to appease unrest with another national holiday; it is to provide Security.  I don't mean security in the sense of having a strong national defense and valuable alliances and partners abroad, though that is important as well; this sense of security is that we, our families, and our communities are entitled, as part of the social contract of the United States, to be secure in our health, our homes, our most basic human needs that afford us our most invaluable human dignity.  And here we find the roots of the answer to the second part of my question above, as to how the history of Labor Day relates to health care.

By any measure, Congress's response to the labor protests of May 1894 was inadequate.  A holiday didn't change the fundamental inequities of the new economy; it didn't reduce unemployment (the highest estimate being 18.4%), create new jobs, or protect Americans struggling to survive despite working hard to build the new infrastructure of our country.  "The Panic of 1893" that had precipitated the events of 1894 had been preceded two decades earlier by "The Panic of 1873," and would be followed by The Great Depression of the 1930s.  In these cases, the government had seen the problem before, knew that Americans required their assistance to fulfill the dream of opportunity, security, and mobility, but failed to act.  It was only after a government that recognized the American promise to aid our neighbors and to strengthen our national community acted to create jobs and programs to assist those hardest hit to recover that the nation once again began moving in the right direction.

And so, we finally come to health care.  There is a crisis in America, only partly due to the recent bursting of the housing and real estate bubble, but a problem that has been underlying for quite some time.  Almost 46 million Americans are uninsured, and 25 million Americans are underinsured, meaning that despite having insurance policies, they don't receive the health care that they need when they need it due to insufficient coverage.  In a system where health care is tied so closely to employment, the downturn in the economy is foreboding, signaling a possible worsening of this crisis.  And yet, in some good news last week, the percentage and number of uninsured actually dropped from 2006 and 2007, from 15.8% to 15.3%, and from 47 million uninsured to 45.7 million.  The cause?

The expansion of a the federal Children's Health Insurance Program, ensuring nearly one million more children.

A government for the people is one that responds in times of need to protect our core American Values.  Now is time for Congress to defend those values not with another holiday, but with real, practical solutions to key issues such as health care.  What we need now is something much more than another day of barbecuing.

The Ramifications of Tax Shelters for America

Our friends at the American News Project have posted a video on the usage of tax shelters by the super-rich.  "Super-Rich Tax Cheats" shines a spotlight on the $1.5 trillion currently estimated to be hidden off-shore from the IRS by the very wealthiest of Americans. 

Senator Norm Coleman (R-MN) estimates the resulting lost tax revenue at approximately $100 billion.  The video puts this number into context by showing what the government spends on other programs.  This is more than the federal government spends on education and training ($89.9 billion).  It's triple what is spent on the environment and natural resources ($33.1 billion) and almost five times more than what we spend on temporary assistance for needy families, or TANF ($20.9). Besides looking simply at people clearly breaking the law, the video also has a short segment with Warren Buffet, one of the world's wealthiest men, arguing for tax fairness.  This is key if our nation is to be stronger and we are to truly come together as a community.

You can watch the video at the Huffington Post.

Thursday Immigration Blog Roundup

•    Department of Homeland Security officials have come out in support of a Center for Immigration Studies report that claims that border control measures are the cause of a decrease in immigration to the U.S.  However, the Center for Comparative Immigration Studies at University of California, San Diego has rebutted those claims and determined that the border patrol apprehends fewer than half of the undocumented immigrants that come into the country through the Mexico/U.S. border.  According to The Huffington Post, the Center for Immigration Studies (an anti-immigrant advocacy group) and the Department of Homeland Security failed to consider reasons other than border control measures that explain why immigration to the U.S. would naturally decline:

When citing the decrease in both apprehensions at the border and remittances sent by workers in the United States to family members in Mexico, Chertoff also failed to consider the fact that undocumented immigration naturally decreases when the U.S. economy is in recession. [Director of the Center for Comparative Immigration Studies Dr. Wayne] Cornelius' report shows that undocumented migration clearly responds to changing U.S. economic conditions, with significant decreases during economic downturns such as the one we are in now.

Moreover, Chertoff’s border control measures are completely inconsistent with the fundamentally positive effect immigration has on American communities.  Providing opportunity for immigrants has been a core value in the U.S. since its founding.  To see more immigration myths dispelled, read The Opportunity Agenda fact sheet, Immigrants and Opportunity.

•    In one of last month’s blog roundups on The State of Opportunity, a story about a sheriff in Maricopa County, Arizona appeared.  That same sheriff, Sheriff Joe Arpaio, is in the news once again.  An editorial in The Washington Post discusses how  “Sheriff Joe” and his officers have been continuing the “policing strategy” of locking up all Hispanic people they encounter, regardless of if they have any evidence that they are undocumented immigrants or have committed any crime.  According to Arizona Central, Phoenix Mayor Phil Gordon has had to resort to calling for a media mobilization against Arpaio:

"He (Arpaio) has become the false messiah," Gordon said. "But when the light is shined on him, people will see that he isn't helping to fight illegal immigration and he's just making the situation worse. You've got an individual with a badge and a gun who's breaking the law and abusing his authority."

We need real solutions, ones that are brought about by comprehensive immigration reform and promote opportunity for all, not a gross miscarriage of justice carried out by a rogue officer like Arpaio.

•    Thankfully, not all police officers feel the same way Arpaio does - George Gascón, a former assistant chief in the Los Angeles Police Department, has written this op-ed for The New York Times.  In it he argues that using local police officers as a means to enforce federal immigration policy will ultimately lead to the public, particularly in communities of color, distrusting the police department:

Here in Arizona, a wedge is being driven between the local police and some immigrant groups. Some law enforcement agencies are wasting limited resources in operations to appease the public’s thirst for action against illegal immigration regardless of the legal or social consequences…

If we become a nation in which the local police are the default enforcers of a failing federal immigration policy, the years of trust that police departments have built up in immigrant communities will vanish. Some minority groups may once again view police officers as armed instruments of government oppression.

•    The effects from the ICE raid in Postville are still being felt, reminding us just how detrimental this raid was to the Iowa community and America as a whole.  The Des Moines Register is reporting that the new employees at the Agriprocessors plant have had a significant, negative effect on the local community:

The impact is evident: New laborers are changing Postville. The Agriprocessors Inc. meatpacking plant, the site of the immigration raid, once employed men and women with families. Now, its workers are mostly young, single people with no stake in the community and nothing to lose…

The rise in crime has strained Postville's tiny police department. One night in June, the calls were so numerous that police asked the local bar to close early.

A protest rally also took place in Postville last weekend – it was documented in a video, which is now available on YouTube.