Accountable: Making America As Good As Its Promise

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9780743582087: Accountable: Making America As Good As Its Promise

Accountable provides real-life examples of how crucial issues -- including health care, education, the economy, unequal justice, and the environment -- manifest themselves in our communities. The book demonstrates the urgent need to hold politicians and ourselves responsible, because the stakes have never been higher. Accountable examines present-day conditions and the consequences for America. At its core, this book is a tool with which the community can evaluate the successes or failures of its political leaders and of itself. This insightful book acknowledges the mistakes of the past while offering hope and inspiration for a better future.

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About the Author:

Tavis Smiley is a nationally known intellectual, activist, political commentator, entrepreneur, and radio and television personality.  He founded the ground-breaking and historic State of the Black Union series.  Mr. Smiley has authored several best-selling books, including The Covenant and The Covenant in Action.

Excerpt. Reprinted by permission. All rights reserved.:


Health Care and Well-Being

Who Holds the Cure?

He who has health, has hope. And he who has hope, has everything.

-- Arabian Proverb

In order to change, we must be sick and tired of being sick and tired.

-- Author Unknown

Covenant One

Securing the Right to Health Care and Well-Being

Carol Ann Reyes: Dumped in America

It was a cool Monday evening in late March 2006 in Los Angeles, months away from the sweltering summer when the infamous L.A. smog is at its worst. Traffic was moving swiftly along South San Pedro Street near East 5th Street in the downtown area known as "Skid Row."2 Known also as the Nickel because of its location along 5th Street, Skid Row is "home"to one of the largest populations of homeless people in the United States. Also known for its tough streets, the Nickel this evening seemed like just another day in the neighborhood, the county's 74,000 homeless seemingly unaware of the headlines of the day.

While they may have been unaffected by the flap over President Bush's wiretapping program or the third-year-almost-tothe-day commemoration of the war in Iraq, L.A.'s homeless were dealing with conflicts that hit closer to home.

One of them was Carol Ann Reyes, a transient Los Angeles resident who spent most of her time not on Skid Row but in a Gardena public park 16 miles south of the city, supporting herself by collecting recyclable bottles and cans. Three days earlier, an ambulance had transported Reyes west across Rosecrans Avenue through Compton to Kaiser Permanente's Bellflower Medical Center for treatment of abdominal pains and injuries resulting from a recent fall. Sixty-three years old, homeless, suffering from dementia and other physical ailments, Reyes remained at the hospital until a decision was made that she had been there long enough.

Though she still had a fever, persistent cough, and perilously high blood pressure, Reyes was discharged by hospital officials without their prescribing medication for her high blood pressure or even taking time to locate the clothes she'd worn upon admission. They simply called a cab, placed her in it donning her hospital gown and slippers, and paid the driver to take her 16 miles north of the hospital to Skid Row, presumably because it is the location of many of the city's homeless shelters.

Hospital officials claim to have called Union Rescue Mission, a wellknown shelter on Skid Row, to let them know that Reyes was on her way. Video surveillance footage taken that evening contradicted the directions, showing the taxi driving along San Pedro, making an illegal Uturn, opening the door, and literally dumping her onto the Skid Row streets.

Reyes wandered about in the street and on the sidewalk, lost, without any money, identification, or medical information until a Union Rescue Mission worker noticed her and ushered her to safety and the warmth of a bed. Days later when the news of this story broke, a tearful hospital vice president of communications apologized to her and to the community, vowing that this would never happen again.

But will it? Carol Reyes was not only dumped onto the streets by that taxi; she was dumped by Kaiser Permanente, she was dumped by our failing health care system, and she was dumped by America. And in the year after Reyes' case made headlines, police were investigating 10 different hospitals for allegations of patient dumping on Skid Row, including a paralyzed man found crawling in the streets without a wheelchair and with a broken colostomy bag.

Reyes is just one example of millions of Americans, either uninsured or underinsured, who have been abandoned.

Who should be held accountable for this maltreatment? Who will be accountable the next time?

The Covenant opens with a chapter, "Securing the Right to Health Care and Well-Being," positioning it as the first and most important covenant. And while the health care crisis in our nation disproportionately affects people of color, to be sure the crisis is an American one -- red, white, and blue -- pulling at the very fabric of our flag.

There is a proverb that says: "When you are not your natural self, you don't do anything well." This elder wit is trying to tell us that physical weakness prevents accomplishing anything and everything that otherwise might be done. Indeed, when a family member is sick, all other concerns -- education, employment, justice, democracy -- pale in comparison. Moreover, when a community is sick, that can threaten the economy, the stability, and, depending on the breadth of the problem, the very survival of a nation. And when a nation is sick, as we have seen with the devastating impact of HIV/AIDS in Africa, it can threaten an entire continent and ultimately humanity.

Few would argue the moral integrity of the aspirational concept of health care as a fundamental human right. It is arguably more important than other socalled fundamental rights -- the right to freedom of expression or religious belief. And the right to life, possibly the most important of our fundamental human rights, would certainly be rendered meaningless without a complementary right to health care.

But in America the notion of universal health care and the varied and complicated paths to its achievement have become some of the most vexing and problematic issues of our time. The health care crisis in this country was a pressing political issue throughout the 2008 presidential election. As we inaugurate the second president of the new millennium, it remains the most intractable domestic policy issue, a problem we have been trying to solve since 1914.

A Century of Health Care

In his new book, Critical: What We Can Do about the Health-Care Crisis, former Senator Tom Daschle of South Dakota presents a well-researched, exhaustive inventory of America's history of seeking health care reform. The cacophony of today's health care debate does little to remind us that this discussion has been underway in America for 95 years. Daschle explains the early debates during the Progressive Era (1890s-1920s), when reformers sought free medical care and related benefits for workers. All such efforts failed, with opponents decrying national health insurance as socialized medicine. It was the first real national debate on the issue, setting the stage for interest groups -- both for and against -- to become firmly entrenched in their positions.

During the Great Depression, America had another opportunity to reform the health care system when an advisory committee recommended that President Franklin D. Roosevelt create a system of universal health care as part of his landmark Social Security Act. But Roosevelt decided not to push for a health insurance add-on to Social Security, worried that opposition from the American Medical Association would sink his entire legislative reform effort.

Roosevelt's decision set the stage for the evolution of both the dominance of employer-sponsored health care programs in the United States and the continuing difficulties faced by the millions who remained uninsured, unable to secure protection against the growing cost of illness. Our employment-based system of health care became institutionalized during the World War II era and in the decade following, as the federal government enacted laws that made such plans favorable for the purpose of taxes and labor relations. Today, employer-based health care remains the most prominent form of coverage. This coverage, however, is completely voluntary for employers to provide, and it has shrunk in recent years. In 2000, 65 percent of employees received employment-based coverage; a mere seven years later, just 59 percent were covered, resulting in more than 2 million more people without coverage.

Health care reform remained on the national agenda for most of our presidents in the post-WWII era and beyond -- Harry S. Truman, John F. Kennedy, Lyndon B. Johnson, and Richard M. Nixon. Under Johnson, the nation saw the passage of Medicare, "the largest expansion of health care coverage in American history." Medicare guaranteed medical coverage to the disabled and those over age 65, representing a positive first step towards health care reform. Despite this progress, millions of people under 65 remained uninsured, and subsequent attempts to deal with the crisis by Presidents Nixon and Carter, as well as Massachusetts Senator Edward M. Kennedy, failed.

In the 1980s, managed care began to emerge as a beacon of hope. President Nixon signed the HMO Act in 1973, designed to encourage the private sector to create group practices that would be well managed, costeffective for insurance companies, and more affordable for the insured. The initiative provided the opportunity for a Republican administration to propose an alternative approach that would take the steam out of Senator Kennedy's push for national health insurance. And with the cost of employer-based benefit plans exploding, the "HMO march" began to pick up speed in the 1980s and early '90s. By 1993, 51 percent of all workers received employer-sponsored health insurance provided by some form of managed care plan.

American workers were content by and large with the HMO model as employers began to rely more and more on the concept. Presidents Ronald Reagan and George H. W. Bush largely ignored the health care crisis during the 1980s.13 Even President Bill Clinton's failed universal health care plan, led by First Lady Hillary Rodham Clinton in 1993, was modeled after HMOs.

As time passed, managed care began to reveal that it might not be the panacea that America had been looking for after all. Some consumers grew frustrated with the way managed care providers impinged on traditional doctor-patient relationships, denied coverage of expensive illnesses such as AIDS and cancer, and refused to pay ...

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Tavis Smiley
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