Thursday, January 21, 2010

Health Care Reform

I wouldn't give up on health care reform just yet, but I no longer think it will be the kind of real reform many hoped to achieve. What saddens me the most is that much of the rhetoric from the right has focused on the inclusion of a publicly-run option that would compete with private insurers. If they truly believed that a publicly-run option would ultimately be inferior, it is cynical to suggest that those seeking health insurance would choose that option in the first place.

I sound like a broken record but, as I have said many times, we already have a "public option" and have been paying for it for many years. When sick people have no insurance and no primary care physician to turn to, they turn to emergency rooms, the costliest way to deliver care for non-emergency, non-life threatening illnesses. Hospitals bill the uninsured emergency room patient who obviously cannot afford to pay; some of these patients who can't afford to pay make a choice between paying their hospital bill or their rent or mortgage. Many will pay the hospital and risk foreclosure. Many will pay the mortgage and fail to pay the hospital. Those of us with health insurance will watch their property values deflate due to foreclosures happening all around them. Many will watch their hospitals drop specialties that are not self-sustaining and instead rely on the overall income of the hospital to stay in business. Businesses do this all the time. Restaurants may lose money on some of the food they serve but make up for it by relying on beverage service to stay solvent. It's not that different for non-profit hospitals.

It's also convenient to overlook the fact that people with no insurance and no primary care physician are denied access to preventive care, typically the cheapest and best way to deliver care for common ailments - Type 2 diabetes, respiratory infections, etc. Untreated diabetes, for example, can certainly land someone in an emergency room because of the damage the disease can do to vital organs and even limbs.

If we end up with watered-down health care "reform", little will change. We will not spread risk, resulting in higher premiums for those with insurance. If that's not a part of paying for health care for the uninsured, I don't know what is.

If you do not believe that access to affordable health care is a moral obligation, I am sorry to tell you that it doesn't matter when it comes to what you pay for your own health care. We have a "system" right now that guarantees an economically inefficient delivery of care. The difference is that we had little control over its establishment - done piecemeal and without much debate. I wish we would all wake up and realize that it is better to elect people with the courage to replace the current "system" with an actual plan that makes getting and maintaining health care insurance possible for most, if not all of us. It turns out that we are sometimes our brothers' keepers, whether we like it or not. It's not a question of whether we do it piecemeal or comprehensively. Doing it comprehensively just sounds much more rational to me.

Sunday, January 10, 2010

Senator Reid & the Color Wheel

Harry Reid has just acknowledged and apologized for having referred to candidate Barack Obama in private as a "light-skinned" black with no 'Negro dialect'..." His intention, apparently, was to explain, in part, his prediction that Obama would become the nation's first African-American President. How depressing.


Senator Reid, however, is in good company. Don't forget that our current Vice President talked during the primary campaign about how his current boss was "clean...", etc., as if that should surprise anyone. I have to admit that Democrats (yes, I am Democrat but hope I am never lumped together with Senator Reid and still cringe when I think of someone like Joe Biden sounding so stupid when it is clear that he isn't) have frequently done more damage to themselves than any Republican could.


The notion that the President's particular skin color (perhaps Reid will now suggest that Benjamin Moore come out with "Obama Black" as an update to its color wheel) and speaking voice either gave him an advantage or wasn't as frightening to some white voters might very well be true. I don't think we will ever know because polls dealing with attitudes about race and color are notoriously prone to participants lying to pollsters in an effort to appear less racist than they truly are. But "Negro dialect"? Where has Senator Reid been in the last few decades except for Washington, D.C. and Nevada?


I am not a linguistics expert by any means but I'll venture a guess that there are hundreds of English "dialects", many of which are shared across racial lines and that come along with differently-accented English depending on region, etc. In my 45 years on the planet, 30 of them engaged in some kind of productive work, 20 or so of them in New York City, I recall a few white guys from New York City who actually said that they "admired" me for speaking English that they believed was "unaccented". I think what they really meant -- and acknowledged -- was that I had a relatively flat, midwestern speaking voice and that my accent sounded like national broadcast news types. I have rarely listened to my own voice other than my voice mail announcements but I suppose they are right. It was also somewhat cultivated. I was raised in far Upstate New York where many people sound like they live in North Dakota, speaking nasally rather than from their diaphragm, almost as if they are speaking through a tube. I realized pretty early on that it sounded unattractive to me. My parents, for whatever reason, did not sound like many Upstaters, most notably because they didn't drop their gerunds and their flat affect was not so flat that it sounded like I was in the movie Fargo.

Accents are clearly learned and a child's school experience can trump the way English is spoken in their own homes. I recall my sister, who is 15 years younger than I am but raised in the same community, began to sound like a local at about the age of 12 or 13, just like many of her friends did. Since I was sure that her IQ was far higher than mine and that she would have many different career choices to consider, I told her to cut it out, to at least say her gerunds (no more goin', seein', bein'), because people who would interview her for university placement and jobs might find it a distraction. Since her writing was nearly flawless at an early age, it just didn't match, at least to my ear. She took the advice. Is that elitist? Maybe. I thought it was practical. Some years later, a very successful college friend of my partner's dropped her local Bostonian accent for very similar reasons. She could be a news reader and you would never know exactly from where she hailed. The same is true for many of my African American colleagues and friends, many of whom can slip into and out of different accents at the drop of a hat. Reid was probably not entirely wrong in what he said. It was the way he said it that is unnerving.

It is so obvious that despite our status (crumbling a bit but still there) as the Leader of the Free World, we have made insufficient progress when it comes to our national fear of racial, geographical and ethnic differences, of discussing race or acknowledging our lack of understanding of how race infects our politics and interactions with each other in workplaces and our neighborhoods. I dropped whatever fears I had about that in my early 30s. I asked questions of some of my African American colleagues. They seemed quite happy to tell me their views. It helped me tremendously.


No one can say that Reid hasn't been on the progressive side of the coin on issues important to racial and ethnic minorities. I don't, however, think that should insulate him from criticism for remarks that (particularly) young people will hear. You can shut down a kid's ambitions pretty quickly by speaking before thinking and at the same time also teach a kid that it's okay to speak without thinking -- Reid is, after all, the Senate Majority Leader -- which just perpetuates the whole problem.

The President has accepted the apology and wants to move on. I believe him. Let's move on. Let's not forget, however, that there is no substitute for real communication outside the Beltway. When we don't understand something and have good motives, respectfully ask the question. It may shock the person being asked but if they know your motives are pure, they may admire your candor and give you a little free education. If they tell you the question offends them, apologize sincerely. There is nothing wrong with that.