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.

Give the kids the money

Most Americans realize that our public school system is in miserable health. The debate is over whether and how our schools can be brought back from the precipice of ruin. Some hold out hope that we can jolt the system back to life with some competition from voucher programs -call that the defibrillator: no big rescue attempted, but maybe worth a shot before one shuffles off the ol' mortal coil. In that analogy, a solution involving a more robust income tax would be the equivalent of, I dunno, stem cell research: probably the best chance at reversing the real damage, but the very notion seems to offend conservatives to the core. Basically, convincing Americans that the public school system needs reform is easy. Now get them to admit they might need to cowboy up for the bill, and watch the room clear out.


Stories like this give me some encouragement:

A small group of pupils from the Students for an Equitable Education, a new youth organization working to change Illinois' school funding system, joined the "Riding for Reform" bus tour. Pupils went to the state's capital to rally for change in education funding.

...

To hear these pupils' cries, Blagojevich sat down with SEE to discuss alternative routes to cover the costs of public school education. SEE members said they would like to see the state look at increasing income taxes instead of relying heavily on property taxes.

If this were to happen, SEE members said school districts wouldn't be defined by the wealth of the communities they serve. Instead, they said, pupils across the state could receive a fair and equal public education.

The call for more money to balance out the rich and poor school districts is a common one. Illinois has a relatively low income tax, according to the Illinois State Board of Education. As a consequence, the state's share of funding kindergarten through 12th-grade public education is 37 percent, ranking it 48th in the nation. Illinois property taxes, on the other hand, are significantly greater than in other states.

Illinois' scheme-as-described is pretty common, and it's too bad. America's poorest communities should not be anchored to it's poorest schools, nor should the least wealthy members of our society be footing high-proportion property taxes just so their kids can get an education that at least approximates what their wealthier counterparts can comfortably afford. And within those parameters there does not seem to be an alternative to redistributive taxation. But as these cool kids point out, an alternative is not needed. We know what will work. So why aren't we doing it?

By the by, I muddled through Illinois' mess of a public school system until I was 8. So, y'know, represent or whatever. I never thought too highly of my schools there, until I moved to Texas, where I learned that the good folks in the Land of Lincoln were amateurs when it came to devastating poor schools.

Sharing the burdens

Child Care Tax Credit programs like the one being expanded by Bloomberg and Spitzer in New York City are just one of many examples of how entrenched the mentality of non-cooperation is in our country's political climate. I would absolutely rather have these programs than not have any public support available for Child Care. But like so much of our social service system, they recognize the need for assistance in fulfilling social roles as a deviation from the 'norm' of functional citizenship. This statement typifies the mentality:

"Access to quality childcare in New York City has become cost prohibitive for
far too many families," said Governor Spitzer. "The Child Care Tax Credit will
support struggling low-income families who are currently forced to trade off
child care costs against other important priorities such as the chance to work,
put food on the table and pay health care costs. At the same time, this law
addresses the needs of young children in these families by helping them gain
access to the quality care and early learning needed to succeed. "

What is objectionable in this is mainfestly not that it offers support to poor families. But I do find it troubling that the program only applies to poor families. Difficult decisions in balancing work and home lives affect all families. Certainly, their stakes are much higher for the poorest people in this country. But recognizing that raising the next generation is a crucially important endeavor to be taken up by asociety rather than by isolated units defined by their position in the housing market, we ought to be willing to extend the structures of social report to all caregivers. The status quo stigamtizes social assistance by associating it with a failure to meet responsibilites. That a caregiver has to turn to child care services is supposed to signify an inability to do the work that a responsible family unit could manage on its own. Programs like these show that we may be willing to forgive these breaches of social obligation when there is a good "excuse" - like poverty - but the general expectation is that most people can and should be doing this work on their own.


In Why Social Justice Matters Brian Barry extends a similar argument to disability payments. These allowances are made in recognition of the difficulties faced by people who must take on the challenges of social life despite mental or physical handicaps. That a person with an extraordinarily high income might still be better off in most ways than an "able" person of a lower class is immaterial. People should not be penalized for morally arbitrary qualities, society should support the offsetting of any hindrances to full participation. Any recognition of the relativele privileges of the upper-class disabled person would, in a just society, be recognized through her or his participation in a progressive tax regime, not by ommitting her or him from an important social service. I think the same should be true of child care credits. Having a child may not be morally arbitrary in the same way that being born with or later acquiring a disability is. But having children does hinder autonomy in career-paths, political participation and other time-intesive arenas of human life. And whether they are partnered or not, women invariably end up doing most of the work of childcare. A great and overlooked source of de facto sex discrimination is the expectation that when a family must make sacrifices in personal freedom and lifestyle to do the work of child raising, those sacrifices tend to be asked of women, who have been socialized to accept those burdens. The more socialized child care becomes, the more it would be possible - whether by taxation or other means - to demand that men carry a proportionate amount of child care's burden.


In any event, the credit should recognize the value and difficulty of the work being done not the relative capacity of the person to perform the task. This frame certainly takes amore cooperative tact to family life than most Americans are willing to recognize, and indeed to morality generally by moving towards a system in which the only obligations which we can confer upon others are those which we are willing toadopt mutually. The family has, in many respects, come to be portrayed as a self-sustaining social atom. There are so many romanticized depictions of families struggling through adversity that we tend to expect that a dedicated and loving family can do just that, regardless of the support structures in place. In the end its a fiction as deceptive and politically specious as the "by-the-bootstraps" blustering of social conservatives. Our policies should not be in the business of reinforcing fiction, rather they should be carefully designed to reflect the day to day struggles of people working hard across the country to provide care where it is needed.

Costs of living

Much political rhetoric on poverty invokes the "vulnerability" of the poor. It's an appropriate term, I think. It does not hold that the poor are helpless or that they are necessarily victims. Neither does it deem poverty a source of shame. What it does emphasize is the capacity of the poor to become victims. The support structures that middle-class Americans enjoy and take for granted cannot be depended upon by those who live on so little. Simple things like health care or a well-funded school that can be so crucial in preventing something like childhood asthma or being held back a year in school from developing into a life-long impediment to success. And I think that, as those examples illustrate, no one is truly more vulnerable than children living in poverty.

The Annie E. Casey Foundation - which takes it's mission to be "helping vulnerable kids & families to succeed" has released it's KIDS COUNT report on children living in poverty. The extensive research reveals a lot of heartbreaking information about the inequalities that are weighing down so many lives.

Local newspapers from Indiana to Michigan are already running stories on the plight of poor children in their states. Perhaps this information will act as a corrective to the apathy with which poverty is treated in so many states. My home state of Texas ranks worst in the nation for children living without health insurance - 1 in 5 children under the age of 18 are not covered for health insurance at any point during the year. What makes that figure all the more troubling is that I know how stricken by inequality Texas is. We have wealthy metropolitan suburbs, communities soaked in oil money. And we have cities, especially along the border where stable jobs and decent pay are too hard to come by. Where people still can't expect to take home more than six dollars for an hour's labor. We have rural areas, where agriculture has been sidetracked to agribusiness and tiny underfunded schools have to service two or three counties worth of impoverished kids. These are the places I lived in and traveled through before leaving to college. And I know that in these places it would be met as a welcome improvement if 1 in 5 kids could be insured.

Growing up my sister had a lot of trouble with allergies. She was sick a lot. In the worst patch, which lasted about two years, she missed so many days that we had to petition the school to let her pass. But she got a lot better after that because we did have a good insurance plan from my Dad's government job, and we could take her to a specialist. She also had a speech impediment but there was a teacher at the magnet school who counseled here through that. She's fine now. You would never know she had those problems. For a family without the support that we had, her health problem could have become more serious. She could have been held back and given up on by the education system. She could have had to deal with the consequences of her speech problem for her whole life - stigmatized in classrooms and in interviews for jobs, But we had the material support we needed and now she is going to graduate in the top of her class and go to college next year.

I haven't been back to Texas in awhile. I now reside in Minnesota most of the year. Coincidentally, Minnesota consistently ranks lowest on all the indicators of child poverty. By and large our children are insured, our families make enough money to get by. I've come to like a lot about Minnesota. I even think about living there after I finish school. The people are more tolerant than in Texas, and yes, more liberal. Minneapolis-St. Paul have everything I would want from a city. And even the winters aren't so bad when you've got the right people to share them with.

But as I start to seriously think about what I am going to do with my life, part of me feels that I need to return to Texas. To organize those communities that are so neglected, and so vulnerable, and fight for justice. For a more egalitarian Texas. It wouldn't be easy - not in terms of politics, and not in terms of lifestyle. But how can I turn my back on my home? What am I doing organizing for homeless people and immigrants in Northfield when there are even more poor immigrants and people without homes back in my hometown who don't have a couple thousand idealistic college students willing to go to bat for them? The Texas Republicans won't help them. The Texas Democrats won't fight for them. And our President thinks programs like S-CHIP are irresponsible - as though there could be anything more irresponsible than allowing children to grow up without food and medicine and a decent place to learn. It might take a whole life to just lay the groundwork for a progressive movement in Texas. But if no one is willing to do that work, then there really is no hope. I got out of Texas because I was one of the lucky ones who was never made vulnerable by inequality. That's why, when I'm done with school, I'm going to be able to live wherever I want. Do something I love. That's why I'm even in school right now. And so maybe the only right thing to do is to go back.

WAY awesome Bangladeshi kids (OR: Community Power and the Domestic Sphere, if that's more your style)

Utterly swamped with work over the past couple days, I hate that I left whatever readership the fledgling blog (can I call it a blogling?) has acquired at this point on a bit of a hiatus. But someone's got to make sure that crazy people don't become the Surgeon General. All the worse, I left y'all on a down note with the post on domestic violence. But fear not, I'm back and I have good news.

In an incontrovertible display of badassery, local Bangladeshi children intervened to stop one of their classmates from being forced into marriage by her father.

Classmates of a 13-year-old Bangladeshi school girl due to enter a forced marriage have united to stop the ceremony going ahead, police say.

Around 50 pupils in the town of Satkhira took to the streets to demand that Habiba Sultana's wedding be called off, they say.

Pupils even submitted a petition to police urging them to take action.

Apparently, the police actually acted on the demands of the children. After summoning the father and ordering him to cancel the marriage, they forced him to sign a bond in which he agreed not to wed his daughter while she was still a child. Child marriages are illegal in Bangladesh.

Though I certainly don't want to be read as saying that arranged marriages are morally equivalent to domestic abuse, I think there are grounds for comparison between what went right in this instance and what so frequently goes wrong in addressing domestic violence through the courts in the United States (see the post below for more on that).

In both instances, a powerful male is enabled by familial power dynamics to exert nearly uninterrupted power within the home. The article about Sultana notes that she did not resist the marriage herself because she was too afraid. Fear of violent reprisal from the abuser is a frequently cited reason for not resisting domestic violence - and a good one: women who attempt to fight with or flee from their abuser are more likely to be seriously injured or killed.

What makes all the difference in countering male power in the domestic sphere is the existence of a community power structure that women and children can access. The United States' divorce and custody courts, as the past article showed, are all too frequently not part of such a power structure. When they decide not to investigate claims of abuse, they cut off women and children from the possibility of intervention and leave the abusers power unchallenged. What went right in Bangladesh was that the police were willing to do just the opposite (although under considerable pressure - 50 of anyone at your local police station, even 13-year-old children would be difficult to ignore). But that also goes to show the importance of informal community power dynamics in protecting victims of mistreatment within the home. Because Sultana could relay her fear about her father and the marriage to her classmates, they could intervene on her behalf. Ultimately, what made the community power structure a benefit to Sultana, rather than the hindrance that community and state power structures so frequently are, is that there was synergy between Sultana's immediate social network and the state agency, which made the police susceptible to the demands of the community.

I think the moral of this story may well be the (not terribly surprising) revelation that democratic community power structures can alleviate domestic violence by permitting women and children to seek interventions which balance out the inegalitarian power relationships of the domestic sphere. Letting bureaucrats and judges make top-down decisions without any accountability simply doesn't give women and children the stake in the system that they need. So democratization all the way down, all around. (Though all said I'm not entirely thrilled by imagining a world where you can get your abuse claims promptly investigated but only provided you can marshal a batallion of angry women to kick ass at the courthouse). So that's the moral if your a theory hack anyway. A less academic lesson is simply that those kids are made of 100% awesome, and its always uplifting to see young people organizing to give power to the powerless. I hope their parents are proud.

Defending What's Theirs: Men, Control, and Custody

Marrie Tessler, of Woman's eNews, has written a piece on the legal obstacles that keep children in the custody of abusive parents. It reads like an article pulled from any newswire, dryly relating the research on each side of the issue, but the unadorned prose still packs an immense emotional wallop derived entirely from the unsettling facts.

It opens with this claim: "Research indicates that abusers seek sole custody more often than nonviolent parents, and they succeed about 70 percent of the time."

At first I was shocked. But there is really nothing surprising about that sentence. The psychological research that has been done one abusers makes one thing clear - control is at the center of the abusive mentality. The two most common types of abusers are "cyclically emotional volatile perpetrators" and "over-controlled perpetrators." The latter group seeks to maintain control in the family, and utilizes psychological abuse more often than physical violence. The former develop emotional dependency on their victim, but (possibly as a reaction to an actual or perceived inability to maintain attachment) experience intense feelings of shame, fear, abandonment and anger toward the victim which are dispelled through acts of violent aggression. These are the abusers most likely to display contrition between violent episodes. They are also the most likely to commit violence of escalating severity with each cycle.

The possessive, controlling and emotionally dependent nature of the abuser would explain the increased likelihood to fight for sole custody of the child. And the abusers often win, because courts are unwilling to spend the time or money to investigate claims of abuse:

"It's very common for people to make recommendations in child protective cases and child custody litigation without ever looking at clinical evidence of child abuse, spouse abuse or trauma," says Robert A. Geffner, who directs the Institute on Violence, Abuse and Trauma in San Diego's Alliant International University.

It is disturbing how little voice women and children have in our judicial system when the demands of expediency in resolution issued by men suing for sole custody can convince a judge to ignore the likely fact they will be sentencing a child to spend the remainder of her or his youth in the care of a pathological abuser. The need to standardize judicial procedures for investigating abuse claims is apparent. But as the article points out, moves by "fathers' rights" activists oppose much of the legal work being done in that area, claiming that it unfairly puts fathers on the defensive when claims of abuse surface. Even when children themselves are willing to testify - often an excruciating experience that entails reliving the shame, degradation and physical pain of abuse - some are discredited based on the APA-rejected theory of "parental alienation syndrome", which holds that mothers brainwash their children to testify against their fathers.

This bizarre rhetoric underlies the proprietary lens through which many men view family: as an acquired signifier of social status or achievement, which he has a right to maintain control of once he has labored to build or earn it, as though familial bonds were governed by some twisted Lockean scheme of patriarchal acquisition. The data on abusers points toward such a mindset. Consider the psychological profiles, in which men feel embarrassed or hurt at their lack of attachment to their family. Whether or not this is consciously viewed as an injustice akin to theft of property, the violent response suggests an active desire to reassert the level of attachment that the male perceives to be proper. That men who control more of a family's income than their spouse are more likely to commit violence verifies that the concepts of ownership, input, desert and power have places in the psychology of abusers, as does the fact that men who are dissatisfied with their perceived power in relationships are more likely to commit abuse. The overlapping issues of economic power, emotional dependency, attachment and control that underly abusive relationships suggest that patriarchal conceptions of property and family are perfectly relevant to the intractable problem of domestic violence.

Moreover, the intervention of "fathers' rights" activists reminds us of a crucial fact that can never be understated in discussing abuse: most abusers are men. One commenter on Alternet accuses the article of spreading "the same old anti-father lies that we've been hearing for years", and angrily objects that "the abusers are not only men." And the second part, at least, is true. Domestic abuse is a crucial issue no matter who commits it. But a well-regulated and consistent process for investigating abuse would not do anything to hurt men, and would, in fact only help men who were living with abusive women.

Meanwhile, the reverse-victimization rhetoric employed by many men obscures the facts that violence is overwhelmingly committed by men against women and children, and that women are more likely to be economically dependent on the male abuser and thus less able to flee with their child. The response of men to the domestic violence that their gender overwhelmingly commits cannot be defensiveness, nor can it be to make clutches for legal power to silence the claims of women and children. It seems ridiculous to state that rule bluntly, but when men respond to the violence that results from their desire for familial control by reasserting their desire for legal control, I feel that it has to be said.

Via Alternet.