Twenty years after 9/11: a health worker perspective

This is a guest post on the 20th anniversary of September 11, 2001, by Seiji Yamada, MD, a family physician at from the University of Hawai'i John A. Burns School of Medicine

All those of us who are old enough recall what we were doing when we heard of the attacks of September 11, 2001. Since I live in Hawaiʻi, I was awakened by a friend living on the East Coast. He called to tell me to turn on my TV. When I did so, I saw the two towers of the World Trade Center on fire. I then watched the towers collapse.

On the following day, the University of Hawaiʻi Department of Family Practice (before the name was changed to Family Medicine) held a debriefing session with all staff, residents, and faculty in attendance. We came to some conclusions that we wrote about in the medical school newsletter:

We are humans before we are healthcare workers; our humanity is still a core component of our effectiveness as healers. Thus, our presence and genuineness, in the form of compassion and, when appropriate, openness about our own feelings, are therapeutic. When we can share some of our feelings about a recent disaster, it encourages a healing partnership by making the relationship less hierarchical. . . .

 

We must seek productive ways that translate our responses to distant suffering into a medicine more responsive to the suffering before us.  In this way, we can strive to incorporate social justice, equality, and compassion into both the practice of medicine and into the political response to acts of jarring violence.  We suggest that we should feel, think, and act not as members of a particular ethnic group, religion, or nation - but, rather, as humans.[1]

One participant, a Muslim and Arab woman, was silent through most of the session, but at the end, she related that she first wanted to hear what others had to say. She told us that she had grown up with, and constantly lived with anti-Muslim, anti-Arab sentiments being expressed around her – such that she often found it most prudent to hide her ethnicity.

We wondered what the future would hold.  Would this tragedy make Americans ponder why their country is hated by many around the world?  Or would the U.S. hunker down like Israel and embody the national security state, arms pointed in every direction?  The fearful consensus was, as has been borne out, that this trial would only serve to strengthen the impetus to meet force with force.

Indeed, 9/11 was followed by much flag-waving and George W. Bush’s declaration of a “War on Terror.” As the mastermind of the September 11 attacks, Osama Bin Laden (a Saudi), and the training camps of Al-Qaeda were in Afghanistan – the U.S. military began to plan for an assault on Afghanistan.

Richard Horton, the editor of The Lancet, wrote in a commentary published on October 6, 2001, suggesting that “The war against terrorism, announced by President Bush and endorsed by western political leaders in the immediate aftermath of the Sept 11 assault on America, will fail.” He suggested instead that “health, development, and human rights” be the objectives of a public health approach to Afghanistan.[2]

The U.S. started bombing Afghanistan on October 7, 2001.

I attended the American Public Health Association in Atlanta in late October 2001. Against the backdrop of daily bombing runs projected on the megascreen of the CNN Center, I thought that I might find fellow health workers opposed to the war. After all, UN agencies such as the World Food Program and UNICEF had been drawing attention to the humanitarian crisis in Afghanistan that pre-dated 9/11. Severe drought and twenty years of war in Afghanistan had led to conditions bordering on widespread famine. Shouldn’t public health workers, who are concerned about the health and well-being of people, oppose the U.S. war on Afghanistan?

I buttonholed Victor Sidel, grand old man of social medicine, and invited him to chat over a coffee. His take on bombing Afghanistan was, “The U.S. has to do something.  It can’t stand by and do nothing.” He criticized what he saw as my pacifist stance.[3]

It has taken nearly 20 years for the U.S. to leave Afghanistan. September 11 also served as one of the pretexts for the Iraq War of 2003-2011. All told, the first ten years of the “War on Terror” took on the order of 1.3 million lives.[4]

Since September 2001, we have endured twenty years of U.S. invasions of Afghanistan, Iraq, and wherever else the U.S. deploys its Special Forces, whether it is Africa or the Philippines. Twenty years of drone attacks, reaching its height under “Hope and Change” Obama, who devoted his Tuesday mornings to choosing the week’s targets for extrajudicial assassination (“Sorry about the wedding party collateral damage”).  Twenty years of torture chambers at Guantanamo and Abu Ghraib and Bagram Air Base and those hidden black sites around the world (“Yeah, Gina Haspel, you sure did a bang-up job running that black site in Thailand - we’re going to give you the top job of CIA Director”). Oh, Julian Assange, Chelsea Manning, Edward Snowden, do you think you’re going to let the people know what’s really going on? Well, for your troubles, you’re going to be psychologically tortured and placed in solitary confinement or exiled.

One economic sector saw its stock prices jump upward after 9/11, those of the arms manufacturers. As soon as the generals who oversaw the destruction of Afghanistan and Iraq and Libya retired from the U.S. military, they moved straight onto the boards of the weapons manufacturers. Lloyd Austin went from being commander of CENTCOM to the board of Raytheon. Meanwhile, the other pillar of the U.S. economy was the gambling house of debt financialization. When the casinos (i.e., the investment banks and their insurers) couldn’t cover their own debts and crashed the world economy, the U.S. taxpayers (via Congress) bailed out the banks, and workers were foreclosed on their houses. Subsequently, the Affordable Care Act (ACA, or ‘Obamacare’), touted as expanding the social good of health care to more people, essentially turned it over to the insurance and pharmaceutical industries.

However much the fabric of U.S. society has deteriorated in the twenty years since 9/11, it does not compare with the deliberate kinetic destruction wrought on the health services, access to water and food, infrastructure, and economies of Afghanistan and Iraq. Prior to the Gulf War (1991-1992, waged by George H.W. Bush), Iraq had been a thriving society, a leader in science in medicine in the Arab world. [5] Now, subsequent to the U.S. invasion (2003-2011, started by George W. Bush and Dick Cheney), and the war against ISIS (2013-2017), Iraq is a shambles. And thanks to Donald Trump’s utter incompetence, George W. Bush is now looked upon as a statesman. We are reminded that the U.S. destruction of the Middle East has been going on for much longer than the past twenty years. As Noam Chomsky often says, massive reparations are in order.

As noted by Chris Hedges, as the U.S. leaves, Afghanistan is, like when the U.S. invaded, in the midst of another humanitarian crisis:

Things are already dire. There are some 14 million Afghans, one in three, who lack sufficient food. There are two million Afghan children who are malnourished. There are 3.5 million people in Afghanistan who have been displaced from their homes. The war has wrecked infrastructure. A drought destroyed 40 percent of the nation’s crops last year. The assault on the Afghan economy is already seeing food prices skyrocket. The sanctions and severance of aid will force civil servants to go without salaries and the health service, already chronically short of medicine and equipment, will collapse.[6]

As Hedges points out, the response of the civilized world is to freeze the assets of the Afghan central bank and deny the new government access to loans or grants.

In retrospect, it is obvious how the desire for revenge in the immediate aftermath of 9/11 has led us to where we are now. What if, instead, the pain engendered by 9/11 had encouraged us to recognize the pain of others - those who suffer from hunger, poverty, ill health, and exploitation? What if narrative and images death and destruction had prompted us health workers to demand an end to war?[7]

What if we had sought instead to alleviate social ills and sought to ensure clean water, good nutrition, education, and health? Might we not all be better for it now?

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[1] Yamada S, Maskarinec G, Bohnert P, Chen TH.  In the aftermath:  reactions to September 11, 2001.  News from the John A. Burns School of Medicine 2001 Winter;2:1-2. https://www.researchgate.net/publication/354116332_In_the_aftermath_-_reactions_to_September_11_2001

[2] Horton R. Public health: a neglected counterterrorist measure. Lancet 2001 358:1112-1113.

[3] Yamada S. On The Responsibility of Health Workers to Oppose the War. ZNet. Nov. 2, 2001. https://www.researchgate.net/publication/354116411_On_The_Responsibility_of_Health_Workers_to_Oppose_the_Afghanistan_War

[4] International Physicians for the Prevention of Nuclear War. Body count: casualty figures after 10 years of the “War on Terror” Iraq Afghanistan Pakistan. 2015 March: International Physicians for the Prevention of Nuclear War. https://www.psr.org/wp-content/uploads/2018/05/body-count.pdf

[5] Yamada S. Health workers and the Afghanistan-Pakistan War. ZNet.  December 14, 2009. Reprinted at Medicine and Social Justice. January 11, 2010. https://medicinesocialjustice.blogspot.com/2010/01/health-workers-and-afghanistan-pakistan.html

[6] Hedges C. The Empire does not forgive. ScheerPost. August 30, 2021. https://scheerpost.com/2021/08/30/hedges-the-empire-does-not-forgive/

[7] Yamada S, Smith Fawzi MC, Maskarinec GG, Farmer PE.  Casualties:  narrative and images of the war on Iraq.  Int J Health Services, 2006;36(2):401-15. http://web.mit.edu/humancostiraq/further-reading/casualties.pdf

Medicare: We need to expand it, not cut it!

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Medicare is big news lately. Saving Medicare, cutting Medicare, reforming Medicare. Medicare has become a part of the political right’s effort to roll back all programs that were implemented in the 20^th century to help provide any safety net for Americans. I was going to say “most vulnerable Americans”, but actually many of these are programs for all Americans. The prime examples, of course, are Medicare and Social Security, often seen as the “third rail” of American politics which cannot be touched because they are so wildly popular. They are particularly popular with those who most benefit, primarily seniors who vote in very high proportions. These “entitlements” (a word that is often used by those who oppose them as a negative, but it is not) are considered so core by their recipients that they “forget” they are government programs (as in “keep the government’s hands off my Medicare!”).

So the proposal of Paul Ryan, the chair of the House Budget Committee, to essentially privatize Medicare by giving out vouchers for recipients to purchase private insurance, was heralded as “bold” by many commentators. Perhaps it was, although Ryan himself is backing away from this “bold” stand, as are most other Republicans.  Sure, sometimes “bold” is stupid, leading a charge into impossible odds (“into the valley of death rode the 600[1], but it has the implication of “heroic”, doing the right thing even in the face of certain defeat. Ryan’s plan wasn’t heroic. It was mean and callous and another part of the effort to make sure that our national policies benefit only the wealthiest among us.

The Ryan plan is terrible because it does not ensure health care but (and only in its most positive formulation) insurance coverage – it would provide vouchers to purchase private insurance. But the vouchers won’t cover any reasonable health insurance plan (remember, all health insurance is not good health insurance), certainly nothing compared to the current benefits covered by Medicare. And as any health insurance purchaser (employer or individual) knows, the cost of health insurance keeps going up. When Medicare was passed in 1965, it was because our society finally recoiled in horror at the reality of older Americans, who had worked all their lives, finishing out those lives in sickness and indignity and bankruptcy without health coverage. That need has not changed.

But Rep. Ryan’s plan, designed to gut Medicare, isn’t the only bad one. Senator Joseph Lieberman of Connecticut has proposed raising the age of eligibility for Medicare from 65 to 67, again to save money. This plan was debunked by Paul Krugman (“Medicare saves money”, NY Times June 12, 2011), who cites the work of “… the health economists Austin Frakt and Aaron Carroll [who] document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.” This is exactly the point I made in the recent blog “The real face of lack of access to health care”, June 19, 2011; not covering people for a period of time doesn’t save money because those people “save up” their health problems for when they are covered, and often need more expensive care.

Needless to say, Senator Lieberman took umbrage and responded with a letter to the Times which did not effectively address any of Krugman’s criticisms. His position was supported by a letter from the Executive Vice President of America’s Health Insurance Plans, the health insurance company trade group. Krugman’s criticism was supported by all the other letter-writers, including Harvard Medical School Professor and former New England Journal of Medicine editor-in-chief Marcia Angell, MD. More recently, in the Times’ “Opinionator” blog, Notre Dame philosopher Gary Gutting (“Medicare facts and convictions”, June 22, 2011) analyzes the method of argument (rhetoric) being used by the “two” sides of the debate, Ryan’s and President Obama’s (accepting Ryan’s concept that these are the only two sides). He decides that the key difference between them is one of beliefs, not data; that is, what you believe is the right thing or the way to do things determine how the problem should be addressed, not the facts, which seem to Gutting not to be really where the disagreement lies. “We can and should argue about convictions,” he says, “but this can seldom be done fruitfully in the context of specific policy disputes.  Once we’ve pushed the debate on Medicare or any other policy matter to the point where convictions become the sole basis of disagreement, it is time to vote.”

I agree that the issue is one of convictions, or belief systems. It is about whether we want to live in a society where there is come collective social responsibility or a society in which everyone is on their own.  Republicans tend to state their convictions in the language of “big government is bad”. As an abstract concept, this can resonate with working people who are struggling to support their families and feel that their taxes are too high. But this misses the fact that only through the action of government can the collective interests of the vast majority of us begin to have any weight against the vast wealth of those who fund Ryan and his colleagues (well, for some of us there are unions, but there is a nationwide campaign, well-funded by a few billionaires such as the Koch brothers, to gut any strength they have; “exhibit one” being in Rep. Ryan’s home state of Wisconsin). The Supreme Court has been a huge enabler of this movement through its decisions in Citizens United, making corporations “people” with unlimited ability to use their money to influence the political process, and the recent Walmart sex-discrimination suit in which they have severely restricted the ability of regular people to join cause to oppose those big corporations through class-action lawsuits.

The critical flaw in all of these discussions is that the core issue for Medicare is financial: that it costs too much and those costs need to be controlled by some means – whether privatization (Ryan), increasing the age eligibility (Lieberman), finding fraud (whether real, as the organized crime groups stealing billions of dollars for completely fake claims, or inadvertent minor mistakes made by doctors and hospitals “uncovered” by bounty hunters), or some other plan. Yes, it is true that the costs of Medicare are rising, maybe too high (depends on your “convictions”), and it is likely, under its current funding mechanism, to go bankrupt. This, however, is not a problem with Medicare but rather with health-care costs overall. They are rising, in this country and all over the world, as the availability of new technologies allow us to do many more things – very expensively.

 As Krugman points out, relative to other forms of health coverage Medicare is cost-effective, with much less overhead than the private sector. Cuts to Medicare alone only limit the access of those non-high-income seniors who are dependent upon it and skirt the need to address rising medical care costs. Indeed, the ways to do that (having boards that can evaluate the evidence to permit Medicare to pay only for effective procedures; limiting insurance company and drug and device maker profit; reducing the enormous payments to the highest-income medical specialists and to many specialty hospitals) have been opposed by those same colleagues-of-Ryan who propose cutting benefits to the elderly.

Rather than raising the eligible age for Medicare, or providing vouchers to buy private insurance, the right answer, fiscally as well as morally, is to expand Medicare to include everyone. It would decrease costs as people no longer put off early diagnosis, prevention and treatment. It would allow, through a single insurer, regulation of the excessive costs addressed in the paragraph above. Sure, it would cost the government more, but most of that would be covered by the money currently going to buy private insurance, and the waste engendered by the administrative structures of providers seeking to get paid and insurers seeking to avoid paying (see A Modest Proposal: Bribe the Insurance Companies, August 23, 2009). And a rise in taxes, not for most people but for those wealthiest who saw their taxes cut in the Bush years by trillions of dollars so that now the top tier and biggest corporations pay less than 15% in taxes, way lower than the middle class.

If someone complains that they do not have enough money to feed and house their children, most of us would at least feel sorry for them. But if we then find out that the reason is because they are spending almost all of a good income on alcohol, drugs, and gambling, that sympathy pretty much disappears. As a society we have done the same thing. We have dropped tax rates, especially on profits from stocks (capital gains) and bailed out the financial industry so their titans would not lose much on their gambling debts. This has led to millions of job losses and home foreclosure – people not having enough money to feed their food and children. We need to fix it, and use that money to provide health care for our people rather than profits for the gamblers.

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[1] Tennyson, “The charge of the light brigade”, 1854.

ACA, ACOs, and Meaningful Competition

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Criticisms of the new health law, the Affordable Care Act (ACA), have come from all sides. While many of them are justified, they also miss many of the law’s positives. It doesn’t assure the reliable, cost-controlled security of a real universal health insurance program, but it will lead to coverage of tens of millions of more Americans, and will eliminate the ability of insurance companies to engage in health risk underwriting, the practice that allows them to deny coverage to those with pre-existing conditions. These are points that the President made in his recent interview on Jon Stewart’s Daily Show. "Individual mandates", i.e., forcing everyone to buy insurance, while it is a touchstone for the right and is the issue found unconstitutional by a Virginia federal judge (and which will probably go to the Supreme Court), was the price that insurance companies demanded for assuring coverage for everyone. As I have often written, you have to have all the healthy people in if you are going to cover the sick; there are many more healthy, but all of us can become sick.

Apparently, a lot of people understand this. A recent poll by Marist College and McClatchy newspapers shows a majority (51%, but still a majority) of Americans want to continue (16%) or increase (35%) the benefits of ACA, with 44% going the other direction. “Among groups with pluralities who want to expand it: women, minorities, people younger than 45, Democrats, liberals, Northeasterners and those making less than $50,000 a year. Lining up against the law, 11 percent want to amend it to rein it in; 33 percent want to repeal it. Among groups with pluralities favoring repeal: men, whites, those older than 45, those making more than $50,000 annually, conservatives, Republicans and tea party supporters.” OK, these are the “usual suspects”, except that it amazing and saddening to me that older people who are receiving Medicare can be opposed to expanding benefits to others. Maybe they are just ignorant of Medicare and the current law (as reflected in “Keep the government’s hands off my Medicare!”); this is also sad, but would explain what would otherwise be an enormously, almost immoral, selfishness. Yes, more educated Medicare recipients are concerned that the benefits for that program will be scaled back (and there are unquestionably threats to do so!) but this does not justify opposition to extending those benefits to the rest of the country.

A new set of problems is described by Robert Pear in the New York Times, on Sunday, November 21, 2010, “As health law spurs mergers, risks are seen”. The focus of his article is the planned “accountable care organization” (ACO), a relationship between one or more hospitals (or “health systems”), doctors, nursing homes, and home health care agencies. The idea behind creating ACOs is that, by coordination of care and sharing of information, people’s health can be improved and money can be saved. There is a lot of sense to this approach. If a patient is discharged from a hospital to home, or to a nursing home, and there is more sharing of information with the home health agency, or nursing home, or the primary care doctor who will be responsible for care when they leave the hospital, there is greater likelihood that there will not be lapses in the patient’s care. Similarly, if the person’s health deteriorates to the point of needing to be re-admitted, it would be best if 1) all that could have been done in the non-hospital setting to possibly prevent that from happening was done, and 2) all the information about what was done was transmitted to the hospital.

The organizations most cited by health reformers as having been successful in controlling costs and improving quality are those that are already “integrated”, where the system that owns the hospital(s) also employs the physicians and controls the nursing homes and home health care agencies, or else has very close and dependent financial relationships with them, such as Intermountain Health Care, Geisinger Health System, and Kaiser-Permanente. Information – and money, including money saved by having fewer expensive readmissions, is shared among the various participants. So ACA creates financial incentives for others to create such relationships, the ACOs. The issue raised in Pear’s article are that many forms that these ACOs might take run the risk of violating existing laws that are in place to prevent kickbacks, monopolistic practice, and other forms of corruption. For example, it is illegal for a health system for offering contingency payments a physician who is not an employee – such as for admitting patients to the hospital, keeping stays shorter, etc. This makes sense too.

So we have two conflicting things that “make sense”: greater collaboration and aligned incentives can create greater efficiency and save money, but they can also lead to oligopoly and corrupt relationships. Monopoly is more efficient, but creates the opportunity for exploitation. Modern business practices, based on the work of people such as W. Edwards Deming[1], emphasize the importance of long-term relationships with suppliers so that they can learn and better meet your needs over time, something there would be no incentive to do if doing so cost them money, and you were likely to pull your business the next year because someone else bid lower. Governments usually have policies requiring contracts given to the lowest bidder, but there is a danger that the work will be of lower quality.

Much of the criticism of ACA from the “right” has been about lack of “choice”, but as we look at implementation of the health care law, we need to be careful that ideology does not trump actual health outcomes. Two recent studies show the risks of the “law of unintended consequences” of policies that encourage consumer choice and a market approach to health coverage. In “Health care use and decision making among lower income families in high-deductible health plans”[2], Kullgren and colleagues demonstrate that, in fact, as might be anticipated, poor people who choose to spend less out-of-pocket money by enrolling in such high-deductible plans pay the price later in not accessing health care and having poorer outcomes. Millet, et al, in “Unhealthy competition: consequences of health plan choice in California Medicaid”[3], show that, perhaps less intuitively, Medicaid (Medi-Cal) patients in California counties where they have a choice of plans are less likely to be enrolled all year than where they do not have such choice, and “Potential benefits of health plan choice may be undermined by transaction costs of delayed enrollment, which may increase the probability of hospitalization for ambulatory care-sensitive conditions.”

Ideally, a single-payer, Medicare-for-all, system eliminates the risks that people will not enroll or have gaps in enrollment, that there will be people left out, that people will, for understandable and reasonable short-term financial reasons, make choices that can have long-term adverse effects on their health, and that there will be different standards for quality of care for people with different insurance. But even that does not address the system of provision of care. The ACA law seeks to encourage communication and efficiency, but critics see danger in merger and oligopoly, which could limit options for consumers and in itself create risks to health care access and quality.

What could the solution be? One might be to have cooperative relationships with open-source access to information. Thus, your health information would not be in the control of a given hospital, health care system, or doctor, but rather be controlled by you, and made available to whichever provider – hospital, doctor, nursing home, etc. -- that you chose to provide your care. The information would not be in proprietary electronic medical record format, but rather in an interoperable format that could be utilized by any provider. Incentives could exist globally, not simply within a single organization, to produce the highest quality care rather than the highest profit margin. This would be an excellent example of real competition.

[1] See Mary Walton, The Deming Management Method, Berkeley Publishing Group, New York (originally published Dodd Mead, NY, 1986).
[2] Kullgren JT et al., “Health care use and decision making among lower income families in high-deductible health plans”, Archives of Internal Medicine, 2010;170(21):1918-25. (Hyperlink is to abstract as full text not available free on line.)
[3] Millet C, Chattopadhyay A, Bindman AB, “Unhealthy competition: consequences of health plan choice in California Medicaid”, American Journal of Public Health Nov2010;100(11):2235-40. (Hyperlink is to abstract as full text not available free on line.)
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Obama and the Seder: Freedom and Multiculturalism

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The New York Times on March 28, 2010 had a front-page article on the Seder planned at the White House for this year, apparently the second annual one (not counting the impromptu one during the campaign two years ago) – “Next year in the White House: a Seder tradition” by Jodi Kantor. I became a little teary reading it, but I tend to do that about things that are about bringing people from different backgrounds together, sharing, and finding common-ness. Just as I tend to get furious and angry about those who sow distrust, difference and divisiveness. I was going to say “sow hate”, but it’s hard to attack people and say you’re against hate, although it is their hatred I abhor.

The Seder is the celebration of Passover, marking the story of Exodus, the liberation of the Jewish people from slavery in Egypt. Its significance for African-Americans who were in slavery in this country is obvious, and was obvious to the slaves who were being converted to Christianity and learning this story as they suffered in bondage; many of the spirituals they created used the thinly-veiled metaphor of the Israelites in captivity. Thus it should not be surprising that it is the first African-American President who brings the Passover tradition of the Seder to the White House, or that it is attended by “mostly Jewish and African-American guests”. Nor is it surprising that the event is a “ritual that neither the rabbinic sages nor the founding fathers would recognize.” Hopefully this will not matter to those Jews who observe the Passover with the fully religious celebration, although it may offend some of those who are interested only in division and distrust. I was once warned, on being invited to a Seder, that this was a “Jewish” holiday, and that the host would not enjoy bringing in references to those “others”.

At least that host was aware that many people do. It was certainly true in the secular tradition in which I was raised, in which Passover, not Rosh Hashanah or Yom Kippur which are the High Holy Days of the Jewish religion, was the main holiday precisely because it honored liberation and appealed to larger human hopes. It was true of our Seders, in which “Go Down, Moses” was as integral a tune as “Dayenu”. In addition to remembering the enslavement of Jews and African-Americans, remembrance of the Holocaust was of course central, with particular focus on the Warsaw Ghetto Uprising* of 1943 (a 40-day armed resistance to Nazi deportation of Jews from the Ghetto, the final episode beginning with a Nazi attack on Passover eve), was a part of our Seder having occurred not very long in the past. In modern secular Seders, the plight – enslavement, genocide, torture, especially when it is conducted by religion or ethnicity or gender or race or sexual orientation – is remembered and condemned.

Of course, the story of the Exodus is also a story of ethnic exceptionalism – the name of the holiday comes from the story that the Angel of Death “passed over” the houses of the Israelites, smeared with lamb’s blood, as he systematically killed the first-born son in the house of the Egyptians. But it is the story of the liberation, of the undying hope for freedom in the human spirit, that is its most important characteristic, that resonates most for me and many others (possibly including those at the White House Seder). In a world of individualism, group-ism, exceptionalism, it is important that we remember that we are all people, and all in it together.

I recently posted on this blog’s “sister” Facebook page a quote from “The Volunteer” the journal of the Archives of the Abraham Lincoln Brigade (ALBA), the group focused on remembering and documenting the participation of Americans as volunteers on the side of the Republic in Spanish Civil War. It was about the effort to identify a black volunteer (Mystery Photo: Gift to Obama Puts ALBA in the Spotlight) in a photo taken by Catalan photographer Agusti Centelles that his children wanted to send as a gift to President Obama. Although not yet identified by name, the soldier is apparently Afro-Cuban, not African-American. But, the article by James Fernández and Sebastiaan Faber, continues:

“In the end, of course, who he was is not that significant —nor, for that matter, which nation issued his passport. National identities were of little importance in the Spanish Civil War. The almost 40,000 volunteers resisted being singled out as heroes; they had joined an international, multi-ethnic and multi-racial coalition because they believed fascism was a global threat that demanded international solidarity, and they went to Spain despite the fact that many foreign governments opted for non-intervention.”

On the blog page I ask “Could there be anything more beautiful?” I mean not only the fight against fascism, but at a deeper level: Can we maintain our own identities and traditions but understand that, at our core, we are the same?

*Many of the links are to Wikipedia entries, because they are well-know and easily accessible. There are much better and more authoritative sources, however, for spirituals, the Warsaw Ghetto Uprising, the Spanish Civil War, and the other links
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Haiti and Health Reform: We need real leadership

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There is a lot bad in the world, and compared to people in many places, people in the US are doing OK. The most obvious and well-covered venue of desperation is Haiti, where the earthquake smashed a country that had been set up for failure, figuratively raped and pillaged by wealthy nations, including the United State, for two centuries. Less publicized is the horrific situation in the Congo, characterized by literal rape and pillage as painfully described by Nicholas Kristof in his New York Times Op-Ed January 31, 2010, “Orphaned, Raped and Ignored”. I won’t repeat the details – it is a must-read – but he leads with “Sometimes I wish eastern Congo could suffer an earthquake or a tsunami, so that it might finally get the attention it needs. The barbaric civil war being waged here is the most lethal conflict since World War II and has claimed at least 30 times as many lives as the Haiti earthquake.” And, worse, provides details that almost make one hope that with him.

The American people have responded in a truly humanitarian way to the crisis in Haiti, and it gives me new faith in the American people, if not their leaders. Many of us who have money have written checks and made pledges, but so have those without. People on fixed incomes have sent their last $5 or $10. Writing about her volunteer work with Heart to Heart in the Kansas City suburbs a week or so ago, my friend Pat Kelly writes:

“The number and type of people donating goods to the Heart to Heart trailer this afternoon was moving in itself. The live broadcaster from 1540 AM, a local Hispanic radio station wound up hauling boxes with two members of his family who decided to stay and help. Hispanic families, clearly not wealthy, driving very minimal cars, opened their trunks which were full of bottled water, canned goods, toilet paper. Cars with three infant seats in the back seat pulled out bags and bags just purchased from Target and Walmart with soaps, alcohol, hygienic products. Three different guys in lawn service pick-up trucks stopped by with checks or cash. African-American couples, mostly older, had full back seats of donations. There were at least three times as many Blacks and Hispanic donating as Whites--and this was on Shawnee Mission Parkway at Roe, not in the urban core.”

Yes. These people understand what hard times are. Understand how important it is to share and to help and to give. It is a wonderful response, the only comprehensibly human response, people giving all that they have to give. It is also something the bankers, and too many of the privileged in our national leadership either do not understand or reject. In their selfish cruelty they may disparage such giving as weakness, but of course they are wrong; generosity and caring and social consciousness are strength.

And so what will this mean for health care reform bill, I have no idea. Despite being made fun of by everyone from Barack Obama to Jon Stewart, the Republicans are going to continue to revel in being the “party of no”, of sitting on their hands and glowering at the State of the Union, of being completely uncivil when the President walks into their den, and hoping (no, believing) that acting in this way is going to get them “street cred” with the American people. They are, as identified by Frank Rich (“The State of the Union Is Comatose”, NY Times January 31, 2010), the “unpatriotic opposition”.

May it will; maybe the majority of the American people are attracted to mean looking white guys with their arms folded, responding to controversy in a manner that suggests they haven’t had a thought in a long time, but I don’t think so. Because so many of us are, as our response to the crisis in Haiti demonstrates, a caring people. On the other hand, it could be their only available strategy, since every time they trot out “facts” they are completely wrong, and a lot of folks seem to have the bad taste to want to point this out. So, at this point, I will wait and see what happens. There is a better solution – Medicare for all, pass it, let it happen, let the Republicans and insurance companies choke on their bile, and let us move forward. Obama gave a good speech; it is time for him to follow it up.

Health care is only the start. Dealing with the financial industry, in a firm and decisive manner, is also on the agenda. There have been many references to the administration of Franklin Roosevelt, and in particular the aggressive investigations led by Ferdinand Pecora. Citing the actions of a more recent president, Frank Rich’s January 24, 2010 column “After the Massachusetts Massacre”, describes John Kennedy’s dressing down of Richard Reeves, the president of US Steel, in 1962. I look, however, to an even earlier president, Theodore Roosevelt, who broke up the Standard Oil monopoly. If we have banks that are “too big to fail”, the obvious solution is: let’s not have them; break them up. I think that the fact that the one thing that everyone from every sector can agree on is that the banks and financial sector is comprised of heartless, evil people whose greed plunged our nation and world into the worst financial crisis since 1929, it is time to take strong action. Who will oppose it save the Geithners and Summers’? Here is another opportunity for the Republicans, who have been playing populist like they were George W. Bush paintball warriors; they can rush to the defense of Goldman Sachs and Citigroup and see if the American people support them. I don’t think so.

President Obama said many good things in his State of the Union speech (and some not so good ones), but he needs to follow these statements up. Rich (Jan 31) suggests “Obama should turn up the heat on both the G.O.P’s record of fiscal recklessness and its mad-dog obstructionism. He should stop paying lip service to the fantasy that his Congressional opposition has serious ideas to contribute to the cleanup. Better still, he should publicize exactly what those ‘ideas’ are.” His budget proposal is not encouraging, emphasizing increases in defense spending and decreases in domestic services.

There is a lot to do, and there are leaders who get it. As an underlying assumption, I believe that the best statement was: “In these difficult times, the government believes it is important to continue working toward a society in which people feel a sense of togetherness, respect one another and share responsibility.” Absolutely.

Of course, that was not President Obama, but Queen Beatrix of the Netherlands in her Speech from the Throne (NY Times, January 27, 2010). But I keep hoping that the US can also have leaders who can get it, and can act on it. What would be really wonderful is if they could act as nobly as the plain folks in Kansas City.
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