How did we get into this fix?
It's easy to blame the insurance industry, the American Medical Association, and other special interests that have poured huge sums of money into an all-out propaganda campaign, and surely they deserve part of the blame. And another part certainly lies with members of Congress, some of whom have had the gall to suggest that there's nothing wrong with our health-care system that a little bit of tinkering here and there won't fix. But the principal responsibility for the failure of health-care reform - and it's obvious now that it is a failure - lies primarily with the Clintons and their slavish worship of the great Moloch of American political economy, the Market.
It was the Market that made a mess of our health-care system in the first place, basing decisions about who wall receive adequate care and who won't on ability to pay, and resolving fundamental questions of life and death in terms of profitability. It was the drive for money by health insurers, pharmaceutical manufacturers, physicians, and hospitals-by the entire health-care industry - that created a system costlier by at least half than any other on the planet. And this was that system that the Clintons were determined to preserve intact.
Real health-care reform has never been on the Clinton Administration's agenda. A single-payer plan something like Canada's effective system was ruled out of bounds at the very outset-before Hillary Rodham Clinton's task force held its first meeting. It was deemed "impractical," "politically naive," "self-defeating." The presumption was that the insurance industry-which treats no patient, cures no illness, heals no wound-was absolutely essential to health care, and that any attempt to dispense with that industry's services was foredoomed. There was no way, it was argued, that the Government's "faceless bureaucrats" could perform the tasks now handled by the faceless bureaucrats of private insurance. And there was no way that the American people - or their legislators - could be enlisted to overcome the insurance lobbyists. It was one thing to harness the President's effective campaign skills in an all-out effort to win Congressional approval of the North American Free Trade Agreement, but it was quite another to have him go the full distance for genuine health-care reform.
Once a single-payer plan - which would preserve a full measure of patient choice and assure universal and equitable coverage at significantly lower cost than our present system demands-was ruled out of bounds, it was inevitable that we would wind up with the cumbersome, complex, costly, and all but incomprehensible legislation that now has members of the House and Senate shouting past each other while a dazed and disillusioned public stands on the sidelines. In an attempt to cobble together a scheme that would meet all possible objections while serving all possible special interests, the Administration built a 1,300-page-plus monstrosity that commands no support and has no constituency (except, perhaps, for organized labor, which has always expressed strong preference for the single-payer approach but now gives its lukewarm backing to the Clinton plan, assuming - correctly - that it won't get anything better).
Despite the Clintons' exertions in behalf of the sorry compromise that is now the Administration's official health-care plan, it is slipping steadily in the public-opinion polls. It seems, in fact, that the more the Clintons push their program, the fewer people back it. Though there is all but universal agreement that something needs to be done about health care in the United States, fewer than 50 per cent of those polled now see any kind of relief in the Clinton plan. In a comment echoed by many members of the House and Senate, Representative Richard H. Lehman, a California Democrat, told The Washington Post, "I don't think we can pass a plan without broad public support, and I don't think that's there now."
One of these years, when Americans are ready to insist on it, we'll have real health-care reform in the United States. We'll have universal coverage that provides equal care to everyone, regardless of ability to pay, or medical history, or current prognosis. We'll be able to afford it because we will have stripped from the system the parasites who feed on it now. Until then, we'll have little more than hype and hustle and health care in abundance for the rich.
It's maddening to watch the Clinton Administration toying with plans to help the poor, moving money around in the Federal budget like a pea under a shell.
At times the President's words indicate he understands the problems of impoverished Americans, and might even be prepared to do something about them. No one hates the welfare system more than the people who are trapped in it, Clinton said in his State of the Union address. Despite the stereotypes and stigma attached to being on welfare, most recipients are people who work hard at low-wage jobs, living precariously from paycheck to paycheck until they are pushed out of the work force by illness or accident or a lack of affordable child care. Clinton has described how people who are stuck at the bottom of the economic ladder find themselves slipping off and climbing back on and slipping off again - never able to get ahead. Their problems are compounded by an irrational welfare system that spends most of its time and money making sure people don't have jobs that make it illegal for them to collect benefits, and that penalizes them for working - sometimes taking away a dollar in benefits for every dollar earned - and offering health care only to those who don't work.
Meaningful welfare reform has to tackle the problems of the working poor. We have to do something about the vicious cycle of poverty, and we have to "make work pay," to use Clinton's words. Fair enough. So what does the Administration propose? Now on the table is a plan to finance work and job training programs by taxing welfare checks, food stamps, and housing assistance, and cutting off Social Security to elderly immigrants - that is, reducing social services and increasing the tax burden on the poor.
The cuts Clinton is proposing are comparable in scale to the trimming social programs took under President Reagan in the 1980s, according to Jason DeParle of The New York Times. The Administration argues that the hardship caused by pulling away social services will be offset by the new opportunities offered under Clinton's welfare reform plan. But there is little reason to believe it.
For the most part, Clinton's "reforms" amount to expanded job training and work programs for the poor, which entail heavy administrative costs. "You're taking money away from poor people to hire social workers," Representative Robert Matsui, Democrat of California, told The Times. "It's foolish for them to even consider these alternatives."
Nor does a recent Wall Street Journal story inspire confidence. Under the headline, Ticket To Nowhere: Job Programs Flunk at Training, But Keep Washington At Work, The Journal reports, "No area better illustrates the sprawling, redundant Federal bureaucracy than job training." Job-training programs around the nation are a joke on participants, according to the story - they are costly, they train people for jobs that don't exist, and most participants end up no better off after enduring the often humiliating, superficial curricula. But "myriad committees, Cabinet secretaries, and bureaucrats" keep the programs alive, for the sake of the power they confer on their sponsors in Washington.
The bitter truth about many Federal antipoverty programs is that they are a political game, played out in Washington at the expense of the poor. It's not that the Government can't do anything about poverty - it can. But addressing unemployment and the need for a living minimum wage is a lot more difficult than moving the shells around, and letting the chumps pay.
Violence in Colombia
The worst massacre in five years in Colombia has been followed by a new military crackdown in the banana-producing region of Uraba.
Colombian officials blame infighting among leftist rebels for the massacre. But past investigations into political violence in the area have indicated that the Colombian military and right-wing paramilitary soldiers are responsible for much of the bloodshed.
In any event, the crackdown - including the arrest and imprisonment of the mayor of Apartado, where the massacre took place, and two other members of the popular Patriotic Union party - is cause for grave concern. Colombia's president, Cesar Gaviria, has announced that he will appoint military mayors in the area, and troops are now occupying Uraba.
Human-rights monitors in Colombia fear that Mayor Nelson Campos Nunez, party leader Naun de Jesus Urrego, and Jose Antonio Lopez, a candidate for the regional Chamber of Deputies, are in danger of their lives. The three men were taken into custody on the strength of testimony by anonymous witnesses (a practice permitted under Colombia's new constitution) and are now being held in isolation in Bogota. Their detention follows a long pattern of persecution of local officials who belong to the leftist Patriotic Union.
Members of the Patriotic Union have frequently denounced military death-squad activity in Colombia, called for land reform, and insisted on an end to the government's neoliberal economic policies, which excerbate the misery of the rural poor. In return, the government has repeatedly sent in troops to deal with protesters and "subversives," and a pattern of arrests, assassinations, and disappearances has decimated the leadership of the popular political party. In this election season, it seems that the pattern is continuing.
The Permanent Committee for the Defense of Human Rights-a respected human-rights group in Colombia-is calling for international observers to attend the upcoming elections in Uraba, and for the international community to keep a close eye on the fates of the local officials now in custody in Bogota.
Political pressure from within the United States can also significantly affect the human-rights situation in Colombia. Colombia is the largest recipient of U.S. military aid in this hemisphere. Several members of Congress, concerned with the poor human-rights record of the Colombian military, have supported efforts to shut off U.S. military aid.
But our Government is a long way from taking responsibility for its part in the violence in Colombia. Recently, the State Department expressed willingness to back President Gaviria for the position of Secretary General of the Organization of American States. Peace activists in the United States are organizing a letter-writing campaign to Secretary of State Warren Christopher, President Clinton, and members of Congress, pointing out Gaviria's disturbing human-rights record and opposing his nomination for the post.
Free Speech for Rappers
Congress has a lot of serious business to deal with this year-the Federal budget and the deficit, health-care reform, welfare reform, dismantling the huge military apparatus that America built up during the Cold War years, rebuilding the infrastructure that we allowed to decay and crumble while we were pumping money in to the military. With all that on its plate, why is Congress wasting time on things that are none of its business in the first place?
In recent weeks a House committee has been holding hearings on whether to require rating labels on "gangsta rap" records, discs, and tapes. Even those who dislike this particular art form are entitled to wonder what right our national legislature has to set standards for music lyrics. There is, after all, the First Amendment, which protects freedom of speech.
Yolande Whitaker, a performer better known as Yo Yo, delivered some sensible testimony to a House Energy and Commerce subcommittee. She said, "Being from the 'hood-neighborhood-I can tell you that violence didn't start from a cassette tape that might have been popped into a home or car stereo system. We are the product of America." And Don Cornelius, a music producer, said he thought we should be far more concerned about eliminating poverty, violence, despair, and hopelessness from low-income African-American communities than about gangsta rap.
It would be comforting to know someone in Congress was listening.
The Ultimate Insult
Here's a curious detour on the famous high-tech information superhighway: As more and more individuals, organizations, and business enterprises communicate with each other by computer, official law-enforcement and surveillance agencies are finding it difficult to tap our telephones or read our mail. Computer messages, transmitted by digital code, are much harder to intercept than regular telephone or postal communications.
The Clinton White House has a solution. It wants Congress to enact legislation that would force telephone and cable television companies to install special computer software on their networks that would make it easier for the spy agencies to tune in.
For obvious reasons, civil-liberties organizations and other public-interest groups aren't crazy about the idea. Marc Rotenberg, director of Computer Professionals for Social Responsibility, says Congress has no right to enact a law that makes it easier to wiretap. And others point out that it's not just a matter of eavesdropping but of keeping tabs on the movies we watch and the merchandise we order.
The New York Times reports that the kind of technical changes demanded by the Clinton Administration would cost the electronics industry about 300 million, and that cost would inevitably be passed onto consumers.
That's the ultimate insult-we're going to wind up picking up the tab for having our own privacy invaded by our Government.
'Machinery of Death'
Better late than never. Since Justices William Brennan and Thurgood Marshall left the Supreme Court, there has been no principled voice raised consistently in opposition to the death penalty. Now there is.
Justice Harry Blackmun, a veteran appointed by Richard Nixon in 1970, has changed his mind. From this day forward," he wrote in late February, "I no longer shall tinker with the machinery of death."
He declared, as Brennan and Marshall did before him, that capital punishment is unconstitutional. And while this has no legal effect, since the rest of the Court disagrees with him, it offers the hope that sometime in the Twenty-first Century, the Court will enter the Twentieth. Among industrialized nations, the United States stands alone with South Africa and Japan in extracting the ultimate punishment for crime, and American courts do it with stunning irrationality. In a nation that suffers tens of thousands, probably hundreds of thousands of murders each year, fourteen people were executed in 1991. Thirty-one in 1992. Thirty-eight in 1993.
There never has been a doubt that the death penalty is "cruel." Dead is dead, after all. How can there be a doubt that it is "unusual," with statistics like those?
A majority of Americans continue to support the death penalty, but that shouldn't stop the Court from upholding the Eighth Amendment. The Justices should follow the lead of the people closest to victims. The Buddhist monks in Phoenix prevailed in asking for life for the murderers of nine of their colleagues (On the Line, March issue). And David Gunn Jr. successfully pleaded that a Florida court not consider death for the anti-abortion murderer who shot his father in the back last year outside a Pensacola clinic.
When will the Court, and society, listen to Harry Blackmun, David Gunn Jr., and some Buddhist monks?
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|Title Annotation:||health care reform will be disappointing|
|Date:||Apr 1, 1994|
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