Wednesday, July 4, 2012

Poor? Sick? Here's Your Road Map!

Just three months after earning a Bachelor of Arts degree, I landed a grown-up job where the boss was not only unprofessional, but also reprehensible. He advised me that I would not be earning what men earn because men work to support a family while women work for “pin money.” He loved to brag that he’d earned an Ed.D. without ever having set foot in the university library. He also scratched in places men ought not to scratch in public, and at least twice daily, hacked up something, as life-long smokers do, off-loading it in the nearest trash can.

One of his most memorable sayings, oft spoken before large gatherings, was, “If you don’t like it, I’ve got a road map and a banana peel for you. Just don’t let the door hit you in the behind on your way out.” Vivid? Maybe. Team-building? Hardly. Professional? Never!

Indeed, this guy was so primitive and crude that I wondered what he’d done to reach his powerful post. Just how low had he sunk and how low had others reached to bring him up step by step?

But this archaic example of leadership is still alive, still standing in the way of progress. Sure, contemporary models may be more sophisticated and better dressed, even more polished in their phrasing, but they stand before us, espousing ideologies and offering recommendations that prove how indifferent they are to others. They are the Affordable Health Care Act (AHCA) opponents. They are the anti-immigration forces. They are the Tea Party and the current incarnation of GOP elected leaders, and, I suspect, they have a treasure trove of road maps and banana peels stashed close by.

Consider their reaction to the recent Supreme Court decision granting States the right not to expand Medicaid. At least ten State leaders have already announced that they will refuse the expansion because their states simply cannot afford such an expansion. This is as misguided as my first boss who thought that women have fewer responsibilities and therefore should not be paid equally for equal work and education.

The truth is that the federal government bears the cost of Medicaid expansion and health insurance exchanges at 100% in the first years of implementation and at 90% by 2020 (http://www.nytimes.com/2012/06/30/us/politics/some-states-reluctant-over-medicaid-expansion.html?_r=1&pagewanted=all). So States have no additional costs initially except, of course, the cost of suffering. AHCA’s Medicaid expansion provisions exist to insure 30 million uninsured Americans. In 2014, people whose income is 133% of the federal poverty level ($ 2,555 for a family of four in 2012) will qualify for Medicaid, and this policy change will bring health insurance to at least 15 million Americans (http:// www. nytimes.com/2012/06/30/us/politics/some-states-reluctant-over-medicaid-expansion. html?_r=1&pagewanted=all).

Without an expansion in Medicaid, not only will Americans be left without health insurance, but hospitals will be left without any reimbursement when they care for indigent, uninsured people. Turning away sick and injured people is antithetical to health care oaths. Turning a blind eye and deaf ear to suffering is antithetical to our humanity and certainly to the principles of religion represented by the story of the Good Samaritan. But hospitals cannot continue to provide care without funds from some source. Refusing to expand Medicaid will break down the health care systems in place. Should we accept political leaders who wish to drive us to the brink and shove health care, including its most needy patients, off the cliff, or as far as the next state that has expanded Medicaid?

Is that the goal? Should it be? By refusing to cooperate in health care for all, States will simply urge people to relocate, perhaps leaving behind the places with which they identify, possibly moving without family members who provide support and care, probably exhausting the meager resources the family has. With a gross family income of $ 2,555 and an approximate net income of $ 1,405, how will the family relocate, put down deposits for utilities, pay first and last month’s rent on a small apartment, and feed children? Apparently, those realities do not count in Washington or Republican-led states. Participating in a nanny-state is ideologically repugnant, but human need is not.

Candidate Romney has suggested something similar for immigrants: “attrition through enforcement;” i.e., making life so difficult that the immigrant has no choice but to leave (http://www.motherjones. com/mojo/2012/01/romneys-self-deportation-just-another-term-alabama-style-immigration-enforcement).  This is the solution that Arizona and Alabama have made law, and a path that the Supreme Court considered, only to strike down the Draconian measures in Arizona, granting the state the right to investigate citizenship status only that if the individual has been arrested for another crime. The Court then admonished and clarified that Arizona does not have the right to detain an illegal immigrant for deportation. That power and the final judgment still rest with the federal government according to its resources, both financial and human. In other words, the Supreme Court declared that States such as Arizona may not make human suffering its end goal even if the humans are not citizens.

I cannot condemn the Tea Party or Republican ideology for desiring a healthy federal budget, but I can condemn them for trying to balance the budget by denying the poor and needy. That path is cruel and unusual punishment. That path judges the merits of a human being and qualifies him for health care according to his earnings or legal status, creating an American caste system. It corrals poor people, including immigrants, pushing them into isolated neighborhoods, and it fails to provide an open gate into society, the so-called American Dream. The poor and disenfranchised must live or die within the confines of their diseases and injuries, within the confines of their legal status while those with better incomes, enjoying legal status for which they have done nothing but be born on a piece of soil, drive by, still employed because insurance helps them avoid bankruptcy if they become sick and secure in the knowledge that health care providers will agree to treat them because they have the proper papers.

I cannot recognize that path as anything the Founders sought. They came from a place where criminals condemned to die were not fed. Three out of four prisoners starved to death before reaching the scaffold. Yet they announced, in their Declaration of Independence, that all men are entitled to life, liberty and the pursuit of happiness, and we have evolved along that path, albeit imperfectly. African-Americans were not granted such rights until much later with the 14th and 15th amendments. Even then, they still needed to march to Montgomery across the Edmund Pettis bridge in Selma, Alabama, arriving bloodied and beaten to claim their right to vote. Their struggle continues, but today’s America is closer to its declared ideal. Let us not abandon that ideal. The sick and needy are surely entitled to walk the path toward life, liberty, and the pursuit of happiness. Our leaders should stop forcing a road map upon them.