Wednesday, November 28, 2007

The Unhappiness of Jack Bauer

Not long ago “Hustle,” a BBC television series, was taken to task by a reviewer in the New York Times. She faulted it for presenting a fantastic image of contemporary London. It was too affluent to be believable, she thought, in light of British “decline.” Obviously she hasn't been to London lately. But quite apart from the question of empirical accuracy, the British have always trafficked in fantasies of affluence, just as much as Americans – perhaps even more than Americans, certainly differently than Americans. Crime and espionage movies and television are cases in point. Compare James Bond or John Steed and Emma Peel (of “The Avengers”) with Jack Bauer (of “24”). Bond wanted to save the free world, but only on the condition that he have a very good time while doing it. Steed's and Peel's Champagne hours made it clear that the idea was not merely to safeguard the West, but to do so with downright witty aplomb. To “defend” Britain while losing the ability to do what made life worth living would be the ultimate defeat, and for the British the good life is inseparable from class, style, and plain fun. Bauer, in contrast, is an utter mess. Has he even once made a witty (or even flirtatious) comment? Has he smiled, other than sadistically? The only women he telephones are his daughter and various computer operators at CTU. For him, the pursuit of justice and rightness and goodness is so consuming as to leave not one of the 24 hours in the day available for pleasure. Bauer is an icon of what the American Empire has come to: it’s just no damn fun anymore. It's all work, dangerous work, all the time, 24/7.

Monday, November 26, 2007

Who cares about politics?

Last month, the New York Times published an article on the presidential candidates' clothing – not what they're wearing (although that's been analyzed too) but what they're selling. Mostly, candidates sell themselves, but they're also selling T-shirts, hats, bumper stickers and buttons. Conversely, they're buying ad space: all over American's bumpers and bodies. The Times article was specifically about whose cars and chests they're targeting: Obama's pink baseball tees are a clear pitch to young women, while the target audience of Clinton's "Wellesley Women for Hillary" lapel pins is obvious (what's not so obvious to me is who's wearing lapels at a women's college.) I'm all for catering to outside-the-mainstream constituencies if it will make our government more representative. But what's missing here is any substantive appeal to these voters, implying that their allegiance can be bought by pink baby doll tees. Where are the articles on how Clinton's health care policy will affect young women or Obama's plans to improve education?

It doesn't matter if the President of The United States of America has good taste or good hair. It doesn't matter if the president is black or white or a woman. What matters is whether, by the next election, America will be stronger, wealthier, more respected, safer, healthier and happier. The candidates all know this, the people at the New York Times certainly know this, and I think most of America, if they bothered to ask themselves, would realize they know this too. But it doesn't make for great reading, and you can't run photos of pink T-shirts alongside it. It's more fun to criticize a candidate for yesterday's slip of the tongue. Comparing candidates' war chests is like a game. Analyzing the colors of their ties and suits makes for aesthetically appealing news reports. Taking 7-second sound bytes out of context provides instant gratification. It's all a lot sexier than reading and listening carefully to their plans and positions.

And so voters wind up reading and watching coverage of politics instead of government until they can't distinguish between the two anymore. And then we end up with articles like this one in the Times, reporting on what amounts to meta-politics that in the end really shouldn't matter at all.

But in the short-run, and perhaps to the detriment of our country, it does matter. The candidates, all of whom probably genuinely believe that they would be the best president for America, are willing to pander to voters' shallow sides in order to get elected. They know it's not really about the merchandise, but they also know that it won't matter if they campaigned "ethically" if they don't get elected. Isn't it better to sell out first and change the world later than do neither?

That's a question for another time. For now try this experiment: visit your favorite candidate's website and try and determine where he or she stands on "the issues." For an added challenge, try and find a position on issues that aren't high-profile partisan ones (a.k.a. gay marriage, Iraq, immigration, etc.) Try and find a vision for the future of America. If I could find one candidate who gave me that information before asking for my (monetary) support, he or she might actually stand a chance of earning my vote. As it stands, I remain "undecided."

Tuesday, October 30, 2007

Blackwater Blues: Vigilantes in Iraq

The use by Coalition forces in Iraq of what essentially amount to irregular forces (contract companies, outsourcing agencies) adds a further dimension to an already spiralling conflict. In Iraq, citizens face the prospect of kidnap and lightning massacres. They face the prospect of searches by nervous, semi-literate Coalition forces all too eager to impress with their furniture destroying skills. Or they may well be killed by jerky, trigger-happy irregular forces that work for private contract companies. Outsourced sentinels who work for such companies as Blackwater USA have taken it upon themselves to add to the daily complement of casualties, of which seventeen were added to in September.

Recent developments have not taken the case much further. A spokesman for Blackwater has made the predictable claim about this incident in Nisour Square: they were shot at. In a war zone, it may not be unusual to be shot at, but the employees of Blackwater are happy to derive profits from Iraq as if it were Las Vegas, a roulette wheel without lethal consequences.

They should know better. Blackwater has a history: four of their number were ambushed and killed by insurgents in Fallujah in March 2004. Families of the deceased subsequently filed wrongful death suits against the company for unnecessarily endangering them.

But Mammon is God on Blackwater’s book balances, and the accountant remains American power. This may change in time, when that power is exercised more responsibly. This is not set to happen soon. A soil that allows such buccaneering as that of Halliburton to thrive in is a putrescent one in need of good aeration.

Perhaps it's a sign of imperial overstretch: from the metropole, commanders now seek, not regulars to kill or die for them, but auxiliaries whose loyalty extends as far as their pay cheque. Blackwater is, in fact, responsible for guarding American diplomats. They wear the uniform of modern condotierri; they menace the local populace with their ‘protective’ services. They may be nationals of the country in question (U.S., Britain, Australia), and they kill with the know-how gathered from the services of those respective forces. Blackwater tends to have an appetite for former navy SEALs and the Rangers.

These mercenaries turn the spotlight back on the rules of engagement. The law of war, already eviscerated under the aegis of the ‘war on terror’, offers few clear answers. Should we feel pity if a number of Blackwater be taken by insurgents or any member of the local resistance forces, held hostage and killed?

The scenes of torment beamed around the world of foreign nationals who fall into hands of the lucrative kidnapping (and beheading) industry tug the heartstrings. The case of aid-workers and doctors, maybe; the case of mercenaries and contract workers who tend to be better at firing a gun in anger than building a bridge may be different. A contract with Blackwater means far less than an oath to Hippocrates.

When the U.S. Justice Department looked at the law on ‘irregular’ combatants (a record noted in Karen Greenberg’s and Joshua Dratel’s The Torture Papers), their conclusion was that the Taliban and Al Qaeda operatives fell into a chasm, a legal purgatory. It was for the president to decide the status of these combatants, and given Bush’s elevated understanding of linguistics, it was a tall order. Loopholes abounded in customary international law and the Geneva Conventions: the combatants were not uniformed (read the views of Deputy Assistant Attorney-General John Yoo and R. J. Delahunty, memorandum dated January 9, 2002), and they were not in the employ of a stable centralised authority, a recognisable government.

Yoo and Delahunty might as well have been describing Iraq. Awash with anarchical elements that are establishing a murderous equilibrium, Blackwater now looks as respectable as any other foreign fighter keen to stake a claim at martyrdom in Iraq. But their employees ought to take more precautions: violence, claimed Herodotus, is the driving force of history. It takes little to imagine what form that will take.

Tuesday, September 4, 2007

Bush and Brown: Revising the Anglo-American Relationship

The American-British relationship is a contingency. Despite appearances of being firm, it is subject to revaluation and remodelling. The new British Prime Minister is no exception to this. Your allies once burned the Library of Congress (perhaps with sufficient cause), and used American power as a shield to consolidate an empire. The Anglophones may be, as Winston Churchill suggested in his A History of the English-Speaking Peoples bound by the same language and cultural ties. But this is hardly an insurance against disagreements.

A historical prĂ©cis may be useful. Rudyard Kipling famously extolled a white man’s burden he hoped Americans would share; Theodore Roosevelt found much in common with the empire-building Cecil Rhodes, sharing a common dislike for the darker races. But another, somewhat more bristling side of the relationship was never far away. Historian Edward P. Crapol on economic nationalism (see his America for Americans) suggests the innate hostility that existed in parts of the United States towards Britain just as empire builder as Rhodes was waxing lyrical about it. (This imperialist junkie did allow 32 places for American recipients of the scholarship that bears his name.) Economics played a hand, as it would during the interwar years: the fear that Britain was exerting a threatening influence over the range cattle industry and other fields of foreign capital investment.

The populist movements which yielded rich electoral rewards for that grand populist William Jennings Bryan were largely inspired by antipathies towards Britain. It was all and good that Americans and Brits were proud, sterling whites with a penchant for civilising, but that was not always enough. Other works, John E. Moser’s being prominent amongst them, move the debate forward, seeing the British in the interwar years as a lion whose tail was twisted.

A joust conducted through the mail on December 1919 between a certain Dwight M. Lowrey and Senator William E. Borah of Idaho, implacable opponent of the Versailles Treaty and the League of Nations, sheds light on what would become common themes in forthcoming global struggles. Lowrey, in responding to Borah’s oration that month attacking the League, found various references in the Senator’s speech to British colonial rule discomforting. “India and Egypt under British control, and to Ireland, an inseparable part of the great Commonwealth of Great Britain and Ireland, awake doleful memories of old High Tariff harangues, German propaganda, and Sinn Fein [sic] delirious and seditious extravagances.”

Lowrey, wearing ideological goggles with a clear imperial tinting, argued that, “The spirit of the British Empire is freedom, not mastery.” The task of finding “A modern instance of spoliation under the Union Jack” would be “difficult”, and it was a task he did not endure for long. Borah, on the other hand, was happy to undertake it: “India sweltering in ignorance and burdened with inhuman taxes after more than 100 years of dominant rule; Egypt trapped and robbed of her birthright; Ireland with 700 years of sacrifice for independence.” Such language ignored the values of English thrift and administrative skill. Indian oppression was not quite right, argued Lowrey: the English were simply prudent to re-enforce existing hierarchies in the name or order. One form of social class stratified consciousness is just as any other, or so Lowrey would have us believe. The battle continues to rage today.

Recent directions seem to point to a revision of this relationship between America and Albion. The new staffers in Downing Street suggest a vigorous spring-clean of tried truths: going it alone, or with a few Anglo-centric partners in international relations, may not only be dim, but destructive. International Development Secretary David Alexander snorted against “unilateralism”, preferring “new alliances, based on common values.” (For the speech go to: On Radio 5 Live (13 July 2007), he stubbornly insisted that, “We will not allow people to separate us from the United States of America in dealing with the common challenges that we face around the world.” Britain will be both with the Americans, and with the others, a testy balance to say the least.

On Iraq, the tensions are mounting. 5,500 British soldiers looks somewhat less impressive than 45,000, but the reduction has been taking place for months. The aim is ultimately something the Americans will have to yield to: the transfer of full sovereignty to the Iraqis. The American Right (or at least sections of it) are sniffing out for signs of a betrayal. American military officials speculate on British failure in Basra, a convenient distraction from the clay-footed imperialism that operates in other parts of the country. General Jack Keane has been labouring in the frontlines against his British counterparts: British policy in Basra has bred, he told the Daily Telegraph (24 August), nothing less than “gangland warfare”.

There is much to be said on how the British might affect the policy in Iraq, though holding up in Basra and hoping for the best is hardly a sound advertisement for success. George Michael’s animated antics in Shoot the Dog featuring a canine Blair fetching the White Lawn Frisbee thrown by an intellectually challenged Bush may not be applicable to Brown. He has already eschewed Bush-nosing with care. Withdrawing now will leave the American-led forces in the lurch, despite the diminishing returns of the British garrison. If they do, Britain will have entered another phase in its long-term association with Washington.

Monday, August 27, 2007

Bye bye, Alberto Gonzalez

Attorney General Alberto Gonzalez will resign after much controversy which has plagued his tenure. Gonzalez has been dragged through the mud repeatedly by Democrats and civil liberties groups. His departure is no surprise.

What we all may have forgotten is that Alberto Gonzalez was the first Hispanic/Latino Attorney General. That is a tremendous accomplish. Partisan politics aside, he should be a hero to the Hispanic community. He may have been overly conservative or perhaps too easily swayed by Karl Rove, but he did serve this nation during a very difficult time for the Bush Administration and should be a hero to many Hispanic youth.

Drawing a line between respecting a man for his accomplishments and despising him for his horrible indiscretions is difficult. Hopefully history will not through the baby out with the bath water. Gonzalez made mistakes and he is a member of an Administration that does not have a lustrous track record, but he is still a success story. Civil rights and liberties have not been an area of success for the Bush Administration. It should come as no suprise that Alberto Gonzalez was not eagerly protecting rights. We knew he would not. Through all of this though, he has lived the American Dream.

I am offended by his judgment, a damaged Department of Justice, and the Bush Administration, but I respect a man who has given Hispanics a goal. Much like L. Douglas Wilder and Elizabeth Dole blazed trails, so too has Alberto Gonzales. We ought to pull the pearl out of this ugly mollusk of a story and embrace what we can. Condemnation and unfettered disgust does not good policy make, nor does idle ranting spark change

Sunday, August 26, 2007

As everyone knows, is a web-based communications network featuring software tools that enable its members to create “profiles” of themselves, that is, public personae, not only in the form of verbal information but also by means of a variety of expressive media such as digital images, video, and music. Indeed, the sheer act of presenting (or representing) oneself is a central activity of MySpace members. In addition to profiling themselves, however, members may also attract other members, who become their “friends,” and contact friends already in their network. Contact takes the form of posting commentary and testimonia on profiles (which are retained or deleted at the profiler’s discretion), which may then be commented on in turn by the profiler or others. The effect is to bring into being a “community” – if that is the right term – that is powerfully centered on individuals and their performance, through the expressive media available to them, of their own personalities. There is nothing necessarily “confessional” about this, though the occasional confession may take place. The atmosphere is more akin to the theatrical: what matters are the style, the stance, the intensity, and attraction of the personalities who appear to one another. Because the performances of their identities are “witnessed,” albeit virtually, by others, the question of who one is has as much to do with the opinions of others as with the raw data of one’s own profile. Seeing and being seen, in other words, or what the social interaction design theorist Adrian Chan characterizes as “presence” – presence constituted through the participation of witnesses who form judgments and comment on what they see – is what matters.

What sort of a “space” is MySpace, then? Some have pointed out that it is not a public space, because the kind of talk that goes on in it is anything but rational deliberation aimed at reaching a consensus on a matter of common concern. (When I asked my 16-year-old daughter whether anyone on MySpace discussed politics, she looked at me in silence but with an expression of grave concern for my mental well-being.) But this is to invoke an overly narrow conception of public space and its value.

For a more expansive perspective, we can turn to the insights of Hannah Arendt. For Arendt, the point of establishing a public space is to enable the experience of freedom and the appearance of individual distinction. Freedom ¬– that is, spontaneous, creative, unscripted activity in speech or deed – is possible to the extent that purely instrumental enterprises, activities that are valuable and meaningful only because they contribute to the achievement of a pre-established goal, are excluded. That exclusion is in large part what constitutes a public space. The participants in a public space come together for the sheer intrinsic pleasure of interacting with one another – seeing and being seen. Since nobody is in charge, there are neither leaders nor followers, but only peers who are at the same time actors and who might, if they are sufficiently impressive, become leaders of a sort and for a time. What matters here is the quality of an actor’s performance, above all his performance of his identity. That, of course, is a matter of taste, an aesthetic judgment, and Arendt insisted that the kind of commentary appropriate to what goes on in public is closer to literary criticism – how does this or that strike us, what does it mean? – than to the application of universal principles in accordance with the rules of rational argumentation.

To a great extent, this is the world of MySpace. Undoubtedly, there are many members who are more concerned with blending in than standing out, and so have little interest in what Arendt characterized as the “fiercely agonal spirit” that dominated what was for her the exemplary public space of the ancient Athenian polis. Nevertheless, agonism is very much on offer in the drive towards self-display, to distinguish oneself from others, to be noticed, to attract an audience, and to do so, again, in freedom – in a non-regulated environment where the only authority is that constituted momentarily by the expressed judgments of witnesses, such that whatever consensus might temporarily be achieved could be undermined at any time by the introduction of a fresh point of view.

As the digital communications theorist Danah Boyd has pointed out, it is no accident that it is young people, primarily teenagers, who have flocked to MySpace. Of course, they call what they do there “hanging out” and being “cool,” not the enactment of freedom. But perhaps they should. Their lives are, after all, profoundly characterized by the two elements that Arendt found most inimical to freedom: subjection to an external, undebatable goal, and regulation by means of rulership and rules. From school to home, this picture changes very little for today’s teenagers, for whom the steady parental and political drumbeat to organize their entire lives according to the imperative of enhancing their future marketability must be very close to unbearable.

Readers of Arendt, however, will no doubt be thinking at this point that Arendt herself was adamant that children must be protected from the potential calamities of the public sphere and its freedom. The public sphere is, she pointed out, essentially anarchic, because no one can predict or control the consequences of what is said and done there. Who one is as a public figure depends on reputation, and a reputation can go overnight from good to bad. Adults can decide to take on the risks of appearing in public, but children need a stabler, safer, more predictable world.

If it were only a matter of reputation, we might be inclined to regard Arendt’s views on children as merely quaint. Today’s teenagers cannot avoid an education in freedom – that is, in imagination and spontaneity – for nothing less will equip them with the spiritual resources to find meaning in a cold and lonely society (certainly not Creationism or Intelligent Design). But as the news media and politicians have lately insisted, there are other dangers that come along with the freedom of expression and communication provided by sites like MySpace – though it is also clear that these dangers have been hysterically exaggerated. Education, awareness, and forms of accountability are clearly in order. But it would be a travesty if, in the name of safety and security, measures were taken to suppress the very features by means of which MySpace shelters freedom for self-assertion and self-development for a generation badly in need of it.

Thursday, August 16, 2007

LA on my mind

Louisiana has been through a lot in the last couple of years. There have been scandals of government abuse regarding FEMA money and shoddy disaster relief efforts across the board. The New Orleans Saints had a heroic season where they all but pulled out a miracle that the city so desperately needed.

Alarming still is the rate at which Cajun/Creole culture is disappearing in the lower part of the state. I mean to say that the state is actually disappearing. Over the years, the Mississippi River that has showered the delta with new sediment has been so diverted as to prevent the natural replenishment of this coastal environment. More wetlands are being lost every year than most people would even fathom. The numbers are staggering indeed, but it's not numbers that matter. It's people and living things.

Destroying an ecosystem is tantamount to murder. Sure development must occur and the re-routing of the Mississippi River has had advantages, but the failure to manage environmental concerns while watching development take place is shameful. We ought to think about the unintended consequences of our attempts to change the natural course of things.

As the bayous are vanishing, so too are the shrimpers, artisans, oil workers, and others who make up the distinct cultural phenomenon of bayou existence. We're not only losing land, but we're also losing people as land washes away into the ocean and young generations move north.

Louisiana brings together an interesting array of questions that touch upon development needs, ecosystem management, tourism policy, and cultural appreciation. The issues at play are too complex to discuss in any one place and have been the subject of many books and articles. I hope that Louisiana and its bayous are on the minds of all United States citizens as we think about our policy priorities.

Are we even talking about the same Massachussetts?

Michael Tanner of CATO is waxing smug because the Massachusetts plan for universal health care is facing some trouble as deadlines approach. The uninsured in Massachusetts have four months to buy insurance, or they'll face a tax penalty. But as things stand now, "of 170,000 people who are uninsured but have incomes too high for subsidies, only 17,500 have complied with the mandate so far." Tanner claims that CATO called this one in the air - the mandate was unenforceable and they knew it. To bolster the tanks "I-told-you-so" cred, he directs us to his earlier writing on the subject, noting,

"Someone should have pointed out that the Massachusetts mandate is probably unenforceable and almost certainly not going to achieve universal coverage. Oh, that’s right, we did."

Funny thing is, his earlier piece says absolutely nothing about enforceability. In fact, the extensive hand-wringing over allegedly severe restrictions on consumer and employer choice seem to belabor the worry that the Bay State Politburo might enforce it's social experiment all too well (ominous music, lightning).

Interestingly enough, the criticisms that CATO did make turn out to be pretty far off the mark when we consider what's actually going on in Massachusetts.

Criticism 1: " The individual mandate opens the door to widespread regulation of the health care industry and political interference in personal health care decisions."

Now I could always be wrong, but I am almost positive that was the point of passing a regulation on the health care industry. Y'know? So, conceded, I guess.

Criticism 2: " The act's subsidies are poorly targeted and overly generous."

Actually, no. The MSNBC article that Tanner links to (see "trouble", above) reports:

About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance — but too low to afford the lowest-cost unsubsidized plans.

The Massachusetts plan is fading in the stretch because the subsidies aren't extended generously enough. For too many people, the mandate has become a choice between paying insurance premiums or paying for their housing or groceries. It takes a willful ignorance of reality to make Tanner's claim. I don't know how to make this any clearer: people are not refusing to enroll because the market is over-regulated. They are refusing to enroll because the current market is cost prohibitive for the working poor of Massachusetts.

Criticism 3: "The Massachusetts Health Care Connector, which restructures the individual and small business insurance markets, is a form of managed competition that has the potential to severely limit consumer choice."

Again, point ceded. Consumer choice does get sidelined by a mandate to purchase insurance. But does this have anything to do with the failure of each Massachusetts citizen to enroll? The market restructuring should be a boon to providers - faced with the threat of fines (a clumsy method of implementation in my opinion), employers and individual buyers have an extra incentive to spend money on premiums that they might have chosen to hold onto before.

Criticism 4: "The act imposes new burdens on business and creates a host of new government bureaucracies to manage the health care system."

I did read a piece talking about some delays in processing caused by a deluge of applicants as the deadline nears... somehow I doubt that's what Tanner was getting at. If you read the MSNBC article, some small business owners are miffed at having to take on the costs of insurance. One restaurateur is perfectly livid. But no examples are given of any businesses actually tipping into bankruptcy from the requirement, while we know that hundreds of thousands of Americans declare bankruptcy annually from insurmountable medical fees. That observed, I'll ad that I'm currently working for a restaurateur who gets ticked when I remind him that he has to pay me the minimum wage. So my sympathies for small businesses are diluted. Small -time capitalists do have a lot of troubles to face, but the idea that they are totally incapable of cutting profits to care for their employees is a myth.

In any event, taking all four criticisms into account reveals that contrary to the CATO blog's current swagger, Tanner's actual predictions are either ideologically driven truisms that are immaterial to the current dilemma faced by Massachusetts - or - in one case, an ideologically driven policy criticism that succeeds in nailing the exact opposite of what is actually going on.

I'll note in closing that I am not a devotee of Plan Massachusetts. I do not think it goes far enough. And I think it leaves an awful lot of power and economic privilege to insurance companies, most egregious being the lack of a cap on annual medical expenses as a proportion of income. Not to mention, every one of the issues at hand - from burdening businesses to non-compliance due to a cost-prohibitive market - are issues that would not exist in a nationalized system funded by a progressive tax scheme. In theory, I'm open to alternatives to a system like Canada's, but I'm seeing few practical reasons to maintain that position as of late. But I'll stick to my guns: I just want to see every person have access to affordable health care. So ideological implications aside, I do hope the Massachusetts plan succeeds. Let the CATO crowd preemptively notch their belts based on who-knows-which facts - the reality based community will keep watching and hope for the best.

Tuesday, August 14, 2007

No, but seriously, what is your proposal for health insurance?

It's way past official Giuliani simply does not care about health reform. Because anyone who understood the magnitude of the health care disparities in this country would not seriously believe that a plan like this could make a significant impact on the number of uninsured Americans. Then again, it is not designed to - the plan "does not even cite universal coverage as a goal." Giuiliani's plan strikes out right there and not just in the opinion of raving Leftist ol' me, but in the opinion of all 69% of Americans who agreed in November of 2006 that the government has a responsibility to guarantee coverage for everyone. Yet another example of how far out of the mainstream so-called-moderate Republicans truly are when it comes to social policy. And tactically speaking, If Giuliani manages to wrest the Republican nomination away from Romney, any Democrat who runs against him should be making health care the strongest part of their campaign.

That crucial flaw bracketed momentarily, Giuliani's plan does not aspire to alter the current market-based system much at all. It comes down to a Health Insurance Credit and a tax deduction for low income families. Both of those proposals, fortunately, would alleviate some of the tremendous burden that poor Americans face when purchasing health care - although we have to hope that Giuliani is more generous with the eligibility on those than he was with, say, welfare, food stamps, subsidized housing and essentially every major social service offered in NYC under his mayorship.

All the same, what Giuliani is offering fails on two critical counts - highlighted by Matt Miller's recent piece in Time. First, for whatever aid it provides them with, Giuliani's plan still holds out that " individuals' buying their own solo health insurance can be the answer to the problem of the uninsured." Without any new mandates, health insurance companies are still free to reject clients with a history of illness (and these are the men and women who need insurance most) or to cheat their poorest customers out of any real coverage by offering plans with low premiums but through-the-roof deductibles that render the plan useless. Secondly, Giuiliani does not "support limiting a family's annual exposure to medical costs to some reasonable percentage of its income." In fact,

Giuliani actually boasts of an approach certain to hurt people. His health-care tax deduction, he gushed in Iowa recently, "allows you to go out and buy cheaper and cheaper policies [because] you can have higher and higher deductibles." When Americans earning $25,000 a year get sick and end up paying $10,000 or more in hospital charges, their "affordable" insurance courtesy of Giuliani will become a ticket to bankruptcy.

Avoiding political hyperbole is nice, but any critical analysis of what America's Mayor has put on the table for health care reform makes it clear: Giuliani does not care about poor and sick Americans.

Monday, August 13, 2007

Death in Detention

Via Kaiser Network:

A 23-year-old HIV-positive person, Victor Arrelano, recently died while in custody at an immigration detention center in San Pedro, Calif., the Los Angeles Times reports. Arrelano's family plans to file a wrongful death suit against the U.S. government that claims Arrelano was denied vital medical treatment while in custody. According to the Times, the case highlights an "inadequate, even dangerous, medical system for the nearly 30,000 undocumented immigrants in custody nationwide."

Attorneys for Arrelano's family say that while in custody, Arrelano's condition deteriorated to the point that fellow detainees urged staff to provide medical care. Roman Silberfeld, the family's attorney, said that 70 detainees signed a petition urging that Arrelano receive medical attention. When Arrelano's condition became critical, he was transferred to a San Pedro hospital and died several days later, according to the Times. Lorri Jean -- chief executive of the Los Angeles Gay and Lesbian Center, which provided treatment to Arrelano two years ago -- said she has "no doubt" Arrelano died because he was "denied the medications that [he] needed to stay alive." Jean said that she and her staff on Monday will discuss Arrelano's death and their concerns about treatment at the detention center with Rep. Henry Waxman (D-Calif.), the Times reports.

Immigration and health services officials on Friday defended the quality of medical care provided at dozens of facilities nationwide. They would not discuss individual cases because of privacy concerns, the Times reports.

This should come as shocking news to anyone who reads it. There is no standard by which human rights are judged in which it is acceptable to deny a detainee - someone who is quite obviously incapable of accessing their own medical care - needed assistance. Of course, I doubt an unadulterated sentiment of outrage or even sympathy for the victim will be demonstrated by Americans, since the victim, being an HIV positive man and an illegal immigrant, happens to be in not one but two categories of people who are vilified, feared and marginalized by conservative Americans.

Whether or not this country is ready to take up responsibilities to its immigrant populations, there should be absolutely no question that when we detain someone we become accountable for their health care. Only the most extreme of nativists would propose the death penalty for violating immigration laws. And yet that is essentially what Arrelano received.

Sunday, August 12, 2007

Apparently the safety net is only catching men

A recently released report by Academy of American Actuaries finds that more elderly women (40%) than men (28%) depend on Social Security to survive their retired years. They are also receiving smaller payments than men due to a variety of gender differences in American work culture. The end result is dismal though - the Social Security disparity is just one more factor contributing to high rates of poverty amongst senior women.

The causes are legion and not all of them reflect poorly on America's gender divide. For example the fact that women tend to live longer after their retirement should come as a welcome sign of progress in women's health care. Yet this seemingly benign fact means women get hit twice in the income department: they have to depend on payments longer, and they are more likely than men to spend some of their retired years single.

Some of the factors are more troubling - women still aren't reporting as much earned income as men. That should be a surprise to no one. That women are still taking a great deal of temporary leave from the workplace is not inherently unsettling, but it should raise questions about why men are still not doing their share of child-rearing, and why there is not some formula to reward mothers for their work when it comes to claiming social security.

And really, that point - revising the formula - is the most salient priority to be gleaned from the report, which in itself simply reflects a great deal of what we already know about gender and work in America. I think advocates for work parity will be unsurprised by just about every factor highlighted in this article, and they will appropriately continue to fight for reform. What the report should tell the people working to dispense Social Security payments is that a gender-blind formula like the one we have know is simply inadequate. If women are inordinately performing the uncompensated labor of child-care and are still facing discrimination in salaries, then a formula for Social Security payouts ought to be cognizant of that fact. The American workplace is still not a place where women are equal to men. Until it is, our social services will only consign more elderly American women to poverty if they insist on conflating gender equity with gender neutrality.

Friday, August 10, 2007

Sick and tired of racism?

Two studies, both concerning Asian Americans, found evidence of a causal connection between discrimination and depreciated health. The first study examined experiences with discrimination amongst Korean immigrants to the United States and measured those findings against the mental health quality of the subjects. "Researchers found that both overt and subtle discrimination seemed to influence participants' mental health. Overt discrimination was associated with the erosion of positive mood, while subtle racism was associated with symptoms of depression, possibly because more subtle forms of discrimination create 'ambiguities in terms of social identity.'" A second study looked at the impact of discrimination on chronic illness. They observed associations between discrimination and various respiratory, cardiovascular and pain-causing conditions, concluding:"that the everyday perceived discrimination minorities experience could cause stress that can lead to chronic illnesses."

Studies like these have a lot of interesting implications. They illustrate the extent to which cumulative disadvantages still track to characteristics like race not simply because of class conditions, as some materially inclined post-racists may conjuncture. but as a tangible result of discrimination that is currently happening. They also raise a tough moral dilemma for proponents of a health system like the one in the status quo (though I will admit now they do not go far enough to establish the moral necessity of a completely socialized health system).

If we take up the meritocratic position held by many (though certainly not all) opponents of socialized medicine which states that people's capacity to afford health care should, and more or less does, track to decisions about work, education and life-path that people have freely made themselves the status quo would be easier to accept. As one anonymous interlocutor put it in an online forum, claims that the 40 million or so uninsured Americans represent a failure of distributive justice suffer from "
a lack of true knowledge as to why those "40 million" are uninsured (here's a hint - a significant number choose to be that way for a variety of reasons beyond "I can't afford insurance") and we start getting down to the real issues at hand." Following this argument to it's conclusion, the quality and cost of a person's health care, and indeed whether a person has any at all, is just if it indexes to that persons choice. So if I choose to remain unemployed or to become obese then I deserve whatever hardships come my way in the market-based health system. Bracketing the (numerous) complications that employment, obesity and the like raise in terms of cumulative disadvantage, we will take that idealized, rationalist approach and put to it the question of race.

A Korean American who either (1) suffered from a mental health disorder as a result of discrimination or (2) suffered from a chronic illness as a result of stress caused by discrimination would face considerable difficulty in paying for health care. At best, our hypothetical Korean would pay much higher premiums and/or deductible and face still higher expenses in treatment. At worst, she or he might be totally unable to find a provider, as many people with chronic and mental illnesses are.

Now, in this person's case there is absolutely no sense in which she or he could be said to have "earned" discrimination, even indirectly by putting oneself in a risky position. Yet she or he may well be priced out of insurance simply as a result of a prejudiced society. Why should our Korean have to face inordinately high costs of health care - or worse, go without any - simply because living as a Korean in a racist white society is difficult?

The moral dilemma illustrated by these studies, put simply, is that there are systematic inequalities in the allocation of health burdens in our society, which impose costs on the people burdened with them that are, as Rawls would have said, arbitrary from a moral point of view. Yet we ask that those people face the costs with whatever resources they can cobble together (forgetting for now that their capacity to do so will be inhibited by their health conditions ). Why shouldn't all members of a society marked by inequality that is arbitrary (morally) and systematic (distributively) have some obligation to contribute to offset those disadvantages?

Giving Good Face: What Jeremy Bentham and Facebook Have in Common

All that is needed, then, is to place a supervisor in a central tower and to shut up in each cell a madman, a patient, a condemned man, a worker or a schoolboy.
--Michel Foucault, Discipline and Punishment, 1977

A message popped up in September 9 last year for those lucky enough to see it. It was scripted by a self-made millionaire (or billionaire?), one of those flip-flop wearing college drop-outs Marc Zuckerman:

When I made Facebook two years ago my goal was to help people understand what was going on in their world a little better. I wanted to create an environment where people could share whatever information they wanted, but also have control over whom they shared that information with. I think a lot of the success we've seen is because of these basic principles.

It was also an apology. He had failed to explain the new features of his networking system to subscribers. He was merely ‘trying to provide [them] with a stream of information about your social world.’ What were these features? The ‘Media-Feed’; the ‘News-Feed’. We could effectively chart the everyday lives of fellow human beings on the network. One could see, in chronological fashion, instant updates across the entire network one was a member of. You could see when a new ‘friend’ was added, what time it took place, which date it occurred on.

Then there is the ‘poke’ facility. It is one Zuckerman has been kind enough to offer his users. In most cultures, it is an affront. There is a sexual sting in the statement. My personal space is violated; my dignity is affronted by the conceit of familiarity: do you really think you know me? My virtual space, however, is another matter. My comfort zone is global (at least across networks). Anyone who is part of this system can see me; can ‘poke’ me.

The Facebook facility keeps company with other public forums where information about individuals is shared. Myspace and Xanga – programs which espionage agencies would have saved millions had they pioneered them during the 19th and 20th centuries – jostle on the cyberspace platform for paramountcy. Users of the facility have complained (some did even before the Zuckerman statement): Facebook displays too little, cordoning off access to certain members; or, Facebook has become too informative.

This year, Facebook became saviour – survivors of the Virginia Tech massacre ‘facebooked’ (a now common and obscene verb) fellow students telling them they were ‘OK’. ‘Facebook saved me’ became a catch-cry. It is a matter of time before Facebook messages appear in lieu of flowers at a funeral.

Three decades ago, Big Brother was the enemy. Now, with the proclaimed defeat of ‘totalitarian’ communism, the surveillance culture has moved into private life with our consent. The spawn of Solzhenitsyn’s Grand Strategist or Orwell’s Big Brother are dead; we have nothing to fear. Our quibble is which surveillance feature we want. Big Brother is an invitee – and not merely in the capsule of human drudgery and slime called ‘the Big Brother house’. On the contrary, we like surveillance – take the British as an example. We like accountability, so we like people watched. We are watched to protect us from our more sinister motives.

So, employers now look at Facebook. They even issue advertisements on it. They hire and in some cases fire on the basis of a Facebook profile. Universities scan the profiles of their students.
Facebook, Zuckerman assures us, issues its own privacy controls. We have choices as to what to put on our profile. Apparently, the democratic preserve is maintained: we can choose, so we are free. It is the classic American exposition of the human condition of freedom: ‘As long as you can vote, we are free’. ‘As long as you can decide what to disclose, you are free.’ ‘I am free because I can adopt the Fifth Amendment.’ ‘I am free to profile myself on Facebook.’ We do not have to let our political views be known; we do not have to disclose our political interests, but it is advisable to do so. We do not need to know if we like men or women, but of course, we want to.

Facebook has ushered in a revolution, and a failed one at that. It is much like the panopticon – ‘all-seeing’, that surveillance device the English utilitarian philosopher Jeremy Bentham pioneered in the nineteenth century for penal reform. Zuckerman shares more with Bentham than he realises: a desire to improve the quotient of pleasure in society; a desire to maximise the network for the common good. As Bentham commences his study on penal reform, he calls his device the panopticon ‘or the inspection house’.

In 1975, Michel Foucault added his gloss to Bentham’s Panopticon Notes. For Foucault, the major effect of the Panopticon is: ‘to induce in the inmate a state of conscious and permanent visibility that assures the automatic functioning of power.’ The prison inmate ‘is seen, but he does not see; he is the object of information, never a subject in communication.’

There are subtle differences. Members of the networks have become inspectors, just as they have become prisoners. People do ‘communicate’ with each other. It is a brilliant seduction: to give the means of surveillance to everybody in order to legitimise it. We see but we are also seen (at stages). We relinquish ourselves to others, but have the luxury of indulging in everyone else’s surrender of secrecy.

Perhaps it is time to return to personals that do not reek of voyeuristic profiling and ‘pokes’. Consult the London Review of Books instead: ‘I celebrated by fortieth birthday last week by cataloguing my collection of bird feeders. Next year, I’m hoping for sexual intercourse. And a cake.’

This article first appeared on Counterpunch, August 7, 2007.

Thursday, August 9, 2007

The Visible Vote

I'm going to live-blog the Visible Vote forum that LOGO and HRC are hosting. All of the Democratic candidates - excepting Biden and Dodd - will be appearing to discuss issues of concern to lesbian, gay, bisexual and transgender people and their allies. I've also submitted some questions, mainly at the intersection of health policy and LGBT rights. But my guess is they're a bit on the wonkish side for a general debate.

The hosts: Journalist Jonathan Capehart, singer Melissa Etheridge, and HRC President Joe Solmonese. You can stream the debate live here.

Obama is up first.

9:06 PM - Obama draws an analogy between the outsider status he has often confronted due to his racial and ethnic heritage and the marginality faced by LGBT people. He argues strongly from anti-discrimination/civil rights framework for civil unions that are legally equivalent to marriage. He wants to leave marriage up to individual religious denominations. One of the panelists presses this - what about civil marriage?

9:08 PM - Obama just concern trolled the gays. He said they should choose their battles, and maybe the lack of access to civil marriage isn't the one they should focus on. He also said that whether or not civil marriage was available to same-sex couples was mostly a semantic issue. That does not sit well here. He actually comes of as dismissive and patronizing.

9:15 PM- One of the hosts, Mr. Capehart, raises the issue of homophobia in the black community. Barack responds that he has previously addressed to black audiences the impediment that homophobia has raised in adequately responding to the crisis of AIDS amongst black Americans. He also laments the use of homophobia to fragment progressive alliances between blacks and LGBT people. He is very good on this issue. His answer is very thoughtful and considered. I believe him when he says he will advocate for LGBT people not solely when he's on the burner before America's wealthiest gay rights group.

9:22 PM - Edwards steps up to the plate. I've previously blogged (quite unfavorably) on his discursive representation of LGBT people in public debates. Let's see how he does tonight.

9:24 PM - Melissa Etheridge has a great moment where she touches on the solidarity she feels with Elizabeth Edwards in their mutual struggle with cancer. She pivots from there to the incredible privilege she and Edwards share in being able to afford their expensive treatments. She asks if Edwards understands that the health care crisis hits LGBT people especially hard given that they cannot depend on employers and spouses to provide health care for them like most Americans.

Edwards answer is okay, but not impressive. He plugs his universal health care plan. Then he discusses his empathy for the large portion of LGBT people who are homeless as a result of discrimination. He does touch on an actual answer - between his stances on civil unions and his universal health care plan he'd see the problem addressed. He doesn't seem to have much to say about LGBT health at all, and is instead trying to soundbite on as many issues as possible.

9:29 PM - Edwards states, albeit equivocally, that he would support education about sexuality in public schools that emphasizes the naturalness of homosexuality and the need for tolerance. He comes across as empathetic, but admits he hasn't thought through the specific policy issues involved. It shows.

9:31 PM - Why, oh why, has Edwards spent the past three minutes talking about Anne Coulter?

9:33 PM - Edwards takes the first transgender specific question of the night - how would he react to the knowledge that one of his staffer was trans-identified and planning to transition? Edwards replies that he would be tolerant and as supportive as he could be (fair enough), and expresses his support for a transgender inclusive federal ENDA. This is his strongest answer yet.

9:35 PM - Edwards is finally taking on the marraige question. He says that he cannot impose religious views, that he believes in equality to his core and that he can understand why anything short of full equality before the law will be seen as a sleight to the LGBT community. But he doesn't give a direct justification for his policy. So he is asked for one, in a question that strongly indicts his "I'm on a journey" crap. His answer... is that Don't Ask Don't Tell ought to be repealed. Very disappointing.

9:41 PM - Kucinich takes the stage to the warmest welcome of the night. Right away Capehart points out that Kucinich seems to stand with the LGBT community on every issue. He then asks Kucinich why he stands in such a minority amongst candidates in his support for same-sex marriage. His response, simply, is that he stands for true equality. Capehart takes this and runs - is Kucinich saying that Obama and Edwards, who speak for equality as well, have jettisonned the LGBT community for political reasons. Kucinich takes the high-road and doesn't endorse Capehart's theory, but he gives a great answer on the role the federal government can play as an agent for social change.

9:47 PM - Kucinich is still getting a lot of flattery. The moderator calls him "evolved." Kucinich accepts the compliment. He says his role is to help all Americans "evolve" with him. He also emphasizes that his path is easy - he just has to listen to LGBT people and then act. They are the ones who have to struggle courageously with discrimination. How can he not help them? Kucinich understands solidarity, I'll say that.

9:49 PM - Are you serious? I guess this can't be a cakewalk the whole time, so Etheridge (after endorsing Kucinich's candidacy to his face) throws him a question on medicinal marijuana, citing the pain caused by AIDS and cancer in the gay and lesbian communities. Kucinich says - yes. He does not waffle. Just, yes - as a matter of compassion our approach to marijuana should be informed primarily by health policy not criminal justice. He also plugs his health care plan: the only universal single payer health care plan proposed by a candidate, the only one that is not-for -profit. Nice, but he sure swallowed a heck of a soundbite on the pot question.

9:52 PM - The panelists seem to concede that Kucinich can't win this as much as they'd like him to. They ask if he is electable. Kucinich is giving a terrific answer. He replies that middle America does believe in tolerance and equality. He'd like to lead that America, but at the same time his candidacy is not just about representation - it's also about transformation. He is trying to transform and persuade even as he positions himself for the White House.

9:54 PM - Now Kucinich gets the wonkiest question of the night: will he make HIV/AIDS prevention funding part of Ryan White? For those not in the know, Ryan White Care Act is the source of most federal funding to care for people living with HIV/AIDS but does not cover preventative care. Kucinich says he would advocate for that. Succinct, but he doesn't seem prepared to talk in detail about Ryan White, so he just talks about health care generally for awhile. Not a stellar answer.

9:59 PM - Kucinich's closing remarks are very eloquent. He talks about love and his wife, transformation and equality. I'd like to point out that Kucinich is the candidate who has talked least about "tolerance." He never uses the word. He talks about equality a lot, love almost as much and occasionally uses the word justice. But he is not talking about tolerance. It does not seem rehearsed, he just seems to be past that point. I'm consistently impressed by this man, and tonight is no exception.

10:05 PM - Now Gravel is on. He gets a question about how, as a member of his generation, he talks about his support for LGBT rights generally and same-sex marriage specifically. He answers that most of his generation is wrong, and in time the issue will not be one.
Gravel blames demagogues for dividing America on marriage equality. He thinks most Americans, if they followed their sense of fairness, would support marriage.

10:08 PM - Interesting and ballsy: Gravel calls out LGBT voters for supporting people like Clinton and Obama when candidates like himself and Kucinich are doing the hard work on LGBT issues. Point taken, sir.

10:10 PM - Capehart turns the blade at Gravel: Why aren't you as popular as Clinton and Obama with LGBT voters? Gravel seems to backtrack and acknowledge that there is a political liability that he does take on by supporting LGBT equality. And he says he does not want the support of Democrats who are not willing to take on that liability as a show of solidarity.

10:13 PM - Gravel has talked a lot about politics and public opinion. This is working against him because he isn't getting to talk much about the range of issues that Edwards and Obama did. He comes off as committed, but not particularly informed.

10:14 PM - Gravel is talking about nuclear testing in the Pacific? He's also kind of being a dick to Joe Solmonese, but that's probably okay since no LGBT activist worth their rainbow stripes actually likes the HRC.

10:17 PM - So now Gravel is giving a great schpeel on the prison system, the war on drugs and de-criminalization. It's decent enough... but unfortunately the question was about HIV/AIDS in the inner cities. Not particularly convincing.

10:19 PM - Now it's Richardson's turn.

10:22 PM - Richardson's "concern troll" is a lot more convincing than Obama's. He talks about using winnable battles against hate crimes, against No Child Left Behind (which he points out hurts good sexuality education and anti-bullying work). But he emphasizes using these battles to build the community of allies concerned with LGBT support and to transform public consciousness. He sounds like a realist, where Obama and Edwards just sounded evasive.

10:25 PM - Richardson apologizes the "miracon" gaffe, and minimizes. He wants to talk about his record, which is impressive (pioneering support for transgender rights, working against hate crimes, and moving aggressively for domestic partnerships and against DOMA). He is tremendously focused on talking about (1) what political goals are achievable for LGBT issues, (2) what his political record is and (3) how the community can move forward.

10:28 PM - Now Richardson takes a hypothetical: if you could sign a marriage act into law, would you? This is a great question because it challenges Richardson's position, which is the "achievable" bit keeping his own stances out of the picture. He dodges a lot, before finally saying that he isn't "there yet." Saw that coming. I think Richardson still comes off great. He admits that he isn't there, but neither are most Americans. And he seems to have really thought about how he will transform American politics for LGBT people. He has a plan.

10:31 PM - Interesting. Richardson says at first that homosexuality is a choice. Then he waffles. But his answer, that he continues forward with, is that categories don't matter. LGBT people are people, and whether they have chosen, been acculturated, or been born a certain way then they should not give up their rights. I agree. But I also agree with Etheridge's answer that it is alienating for LGBT people to be told that they have chosen their identity when their personal narrative reads otherwise. When pressed, Richardson makes it clear that he is about politics, not identity. He can't say what homosexuality is like, or what being transgender is like - but he can offer political protection. This is actually where I stand as well. There is no need to define identity to make a political coalition. I respect a man who demures from doing so, especially when he has the humility not to define the identities of others.

10:36 PM - And here comes Clinton, closing out the show.

10:38 PM - Mr. Solmonese asks why Clinton has never introduced legislation against Don't Ask Don't Tell, being a vocal advocate against it for so long and given her place on the Senate committee working on military issues. She basically answers that the political climate is wrong and we need an executive branch that will accommodate the change (or at least not veto the bill).

10:42 PM - Clinton isn't against same-sex marriage, she's just really for civil unions. Ick. She says equality matters, and civil unions can provide full equality. She wants states to make decisions. But she is personally against same-sex marriage. Her position is much like Edwards and Obama's: she doesn't have a plan to provide justice for LGBT people, but she sees the country moving in that direction and will not obstruct that movement. But she is herself unwilling to take the position (and political risk herself).

10:45 PM - Clinton says the states are better battlegrounds for LGBT people than the federal governments. I'd agree if so many states hadn't explicitly repudiated that hypothesis with bblatantly discriminatory statutes last November.

10:47 PM - Next to Kucinich, Hilary is doing the best job of answering the questions she is asked. But her discussions is kind of wonky, she talks a lot about the powers that be - not the powers the she will use and the moves she'd like to make for LGBT people. She also isn't talking much about her record, other than emphasizing her record with HRC (oh boy). She is coming off as a political advisor and something of a political historian even. In apologizing for the conditions facing LGBT people now she gives phenomenally informed answers on why their legal position is the way it is. But she seems lacking on vision, on a gameplan, and on a record. She understands the political waters, but doesn't know where she wants to swim.

10:50 PM - Clinton says she wants to reverse the "mean-spirited assault" political assault on LGBT people. Other than that, she doesn't seem to have much to offer.

Commentary: I loved the format. Very intimate, like a conversation. Questioners could follow-up easily, and answers were lengthier. The answers were even more substantive, where the candidates wanted them to be. I applaud the planners for that. I really feel like I know where each candidate stands.

Kucinich was clearly the star of the evening. Richardson would be my second - he isn't on my page on all the issues, but I know exactly what he'd do for me as a gay citizen were he to sit in the White House. Obama performed well when talking about race, AIDS and progressive coalitions. But his answers on marriage were nearly offensive. Gravel was alternatively solid and way off topic. Clinton just didn't seem to have much to say other than that she wanted to support LGBT people but needed to change the political climate to do that effectively. Edwards was awful.

There's an exit poll on the LOGO site seeing how people felt. I'd expect to see it swing a bit now that the debate has ended. But here's the breakdown:

Question: Who's your candidate?

1. Barack Obama (37%) - My 2nd choice candidate, 3rd best performance tonight
2. Dennis Kucinich (24%) - My 1st choice candidate, 1st best performance tonight
3. Hilary Clinton (19%) - My 4th choice candidate, 5th best performance tonight
4. John Edwards (9%) - My 5th choice candidate, worst performance tonight
5. Bill Richardson (5%) - My 3rd choice candidate, 2nd best performance tonight
6. Mike Gravel (4%) - My 6th choice candidate, 4th best performance tonight

Question: What's your issue:

1. LGBT Rights (40%) - my 2nd choice out of the poll
2. Health Care (31%) - my 1st choice out of the poll (and 1st overall in this election)
3. Gay Marriage (29%) - my 3rd choice out of the poll (and important overall, though I'd be hard pressed to rank it precisely)

Invisible and barely getting by

The rhetorical weight swung hardest in debates over socialized medicine is the ghastly number of Americans - over 40 million - who live without health insurance. Overlooked too frequently are the stories of Americans who can afford health insurance, but not comprehensive health insurance, who spend their entire lives fighting with their providers over plans, omissions, coverage gaps and reimbursements. They often find that themselves uncovered and unable to pay for crucial medical treatment and preventative care. What I found most powerful about Moore's SiCKO was not it's celebration of nationalized systems in Canada and Europe, but the haunting portraits of insured Americans for whom the system does not work.

Take for example, childhood immunizations. New reports indicate that children who are underinsured (as opposed to fully insured or uninsured) are the least likely to get vaccinations on time and at affordable rates. Working class families are left to choose: pay thousands for the injections, or let their kids go without critical preventative medicine. For families with good plans, the costs are covered - but many providers simply don't cover the vaccinations. And for those without any insurance, there's Medicaid and the FQHC system. As with so many other places in the American class system, its those who barely get by who feel the squeeze.

All the same, libertarians like John Stossel lambaste the type of government guidelines for providers that would close these coverage gaps:

Does it never occur to the progressives that the legislature's intrusion into private contracts is one reason health care and health insurance are expensive now? The average annual health-insurance premium for a family in Wisconsin is $4,462 partly because Wisconsin imposes 29 mandates on health insurers: Every policy must cover chiropractors, dentists, genetic testing, etc.

Absent those "intrusions", however, the full cost of health care is passed on to the people who are not able to pay, but who all the same are not the listless hordes of welfare-state-dependents that libertarians like to deride (a blogger at KXMC seems convinced that anyone who can't afford to pay for every health expenditure is a "lay-about").

Free marketeers and fiscal conservatives don't like to discuss the working poor because they defy easy stereotyping: they don't have much money but are demonstrably hard working; they pay taxes but still need state assistance. They make visible the long spectrum between dependency and autonomy that rabid individualists can't seem to grasp as the fundamental quality of social life.