Add a comment March 1st, 2010 by claudio
1. These days, the market is presented to us as capable of resolving all problems –even of protecting human rights; but the latter, basically through the façade of corporate social responsibility (see Human Rights Readers 190 and 191).
2. The market, it is said, must have access to everything. So people’s rights must all be ‘conveniently’ modified to allow the market unregulated access. But since thereby duties and obligations would be defined by the market, inequality will clearly be legitimized –and marginalized and powerless people will be further disenfranchised. Both equity and justice are thus ignored in this attempt and are being replaced by paternalistic ideas defined largely in market terms.
3. Even the judiciary is internalizing this ideology that looks up to the virtues of the free market thus promoting the logic of globalization and all the negative consequences it entails for human rights (HR). This de-legitimizes peoples’ justified struggles for human rights.
4. Both courts and parliaments the-world-over are today expected to be amenable to the dictates of the market. National laws, initially introduced to protect HR, are too often being ignored or even derogated.
5. Globalized capital, ever eager to extend its reach, has literally moved into an “accumulation-through-dispossession” mode by, among other things, taking the land, the biodiversity and the culture from communities, as well as by excluding vast sectors of the population from meaningful economic activity, from meaningful participation in decision-making, and by expropriating their resources. In short, globalization has become one of the engines of the maldevelopment we currently see.
6. In the prevailing paradigm, it is seen as fitting to sacrifice HR to facilitate the expansion of global capital and of the process of market globalization. As paradoxical as it may seem, the powers that be are using both HR and democracy as legitimizing pretexts for giving free reign to the free market and, in the same vein, to transnational corporations.
7. All in all, a new variant of the ruling paradigm is being promoted, with the creation of phony “market-friendly rights”, where the very concept of HR –and thus of rights violations– is severely restricted and distorted. In it, the individual becomes a consumer or a potential consumer, not a real holder of rights. The ultimate idea is to force a consensus on this interpretation of HR, in that way completing the deception. Those of us who are active in the struggle for HR simply must actively combat the ascension of such a new twist to the paradigm.
8. We therefore need to critically analyze this increasingly pervasive discourse of “rights”. Let’s call a spade a spade: It is ultimately being used to promote neoliberal interests.
9. To reiterate: The struggle for HR is a dynamic process of resistance and change that engages and transforms the existing unequal relations of power. HR can be achieved only through the involvement and empowerment of the community as a whole, particularly those whose rights are being violated.
Using HR standards one is using a powerful resource for transformative, action-oriented political change.
10. Ordinary people do not begin their struggle by inquiring how HR are defined in the international HR framework that their governments have ratified. It is from people’s day-to-day reality that they eventually come to identify themselves as bona-fide rights holders. Human Rights are then to become a tool for communities in their struggle to understand why their human dignity is being violated day-in-day-out. HR further help them identify who is responsible for the current state of affairs and what demands they have to place in front of those duty bearers.
11. Once in the struggle, rights holders are to move beyond single-issue struggles, i.e., largely ineffective and discredited tactics of protest against more restricted reivindications, and engage in a broader HR-based struggle.
12. This will entail embarking in a process of confronting and transforming unequal power relations and structures that are denying them the respect, protection and fulfillment of their rights.
13. Some key tools to use in this struggle will be: engaging in negotiations; in protest and resistance actions; in confronting not just the state, but also other actors (including corporations and development agencies); and in monitoring the progressive implementation of HR strategies.
14. Ultimately, the aim is to renegotiate the engagement of the people with the state and other duty-bearers.
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
_____________
Mostly adapted from C.R. Bijoy, Seedling, October 2007.
2 Comments February 26th, 2010 by Sophia Constantino
There has been much talk about Massachusetts since the victory of Senate Republican Scott Brown. Many have suggested this victory was a referendum on the Democrat’s health care reform “overhaul” awaiting a unified bill to be signed by President Obama. The centerpiece of this plan is a mandate, i.e., a legal obligation to buy health insurance, with subsidies for eligible groups, or else face a fine.
But what is the reform law enacted as Chapter 58 of the Acts of 2006 that Mr. Brown has inherited anyways? Is it really the “universal coverage” it was promised to be? The short answer is “no”.
The momentum for reform in Massachusetts in 2006 was spurred by the Bush Administration, who was insisting that the state reduce block funding of indigent care through the state’s free care pool or lose $385 million of Federal Medicaid funds. The state has an Uncompensated Care Pool that provides funds to hospitals and community health centers that deliver care to those without insurance coverage. This pool is funded by assessments on hospitals, health insurance premium taxes, and federal matching funds. As the number of uninsured people rose significantly in 2006, the financing for the pool became fragile and the Bush Administration threatened their federal funds if Massachusetts failed to reduce the money spent on “free care”.
So, with 657,000 uninsured residents, or 10.4% of the population, the Massachusetts Health Care Reform Act was born. At its center is The Connector, an independent state agency offering a “menu” of private insurance plans and assisting individuals obtain their insurance. For residents at or below 300% of the Federal Poverty Level (FPL), The Connector offers “Commonwealth Care”, where “customers” can choose a subsidized health plan based on a sliding scale. So this should expand people’s health care choices, right? Wrong. Not if your employer offers insurance. If so, you are not eligible for these subsidized plans. For all other residents above 300% PFL, and for small employers, The Connector offers “Commonwealth Choice”, a series of regulated, non-subsidized private plan options. Truly American, “Commonwealth Choice” allows you to choose from the Gold, Silver, Bronze, or Young Adult plans, so-rated depending on how comprehensive they are. But the bottom line is: you get what you pay for.
By way of example, the cheapest plan available to a middle-income 56-year-old now costs $4,872 annually in premiums. However, if the policy holder becomes sick, he or she must pay an additional $2,000 deductible before the insurance kicks in. Thereafter, the policy holder pays 20% co-insurance, (20% of all medical bills) up to a maximum of $3,000 annually. This totals to $9,972 dollars, if heaven forbid, the policy holder becomes ill. And we haven’t even begun to talk about “uncovered services”, that “affordable” policies Massachusetts-style are full of. For those, you are on your own, as you were before.
The plan also includes an “employer mandate”, that is, employers have some obligation to contribute to the cost of insurance, in 2008 an employer could opt out by paying $295 per employee and an individual could opt out by paying $912 yearly – as a fine. These surcharges were predicted to yield $45 million dollars annually, but totaled only $5 million in the first year of the program. In addition, individuals can apply to be excluded from the program, for “hardship waivers”, if they can prove at a court of law that there is no affordable option available to them. In 2009, 79,000 residents applied and were “exempted” based on these grounds. Or, in plain English, 79,000 individuals remained uninsured.
The financing for this reform comes from the fines mentioned above and funds diverted from the state “free care pool”, that is, from appropriations originally invested on safety net facilities for those without insurance.
Since 2006, the outcome from the Massachusetts reform has been costly and still has yet to address the issue of access to health care. Because, it is important to remember, health insurance is not health care, but rather a means to it. And whether insurance will or will not improve access to medically necessary care depends of course on what type of coverage it offers. In Massachusetts, as explained above, coverage depends on how much you pay, from “Cadillac” plans (if you have the money) to bare-bones plans, if you belong to the so-called generation of “invincibles” (the young, often cash-strapped).
In 2008 the cost of the program for the state, to pay the subsidies and administrative costs to run the program, was 1.1 billion dollars, and rose again in 2009 reaching 1.3 billion. More expensive than expected, the Connector itself adds an addition 4.5% administrative cost to each policy it brokers. To reduce the price for the state, even if not for patients, insurers have increased premiums and co-pays. As mentioned above, last year, as premiums rose 9.4% in 2009, 79,000 people who were not eligible for the subsidized Commonwealth plans were able to prove that they could not afford any other plan.
The Massachusetts reform does not change the cost of purchasing health insurance. In addition, the funding for these new insurance policies has replaced the “free care” system that included safety net clinics where low-income residents could receive care. Now these residents are required to pay co-pays at the clinics due to the elimination of state funding, and they simply can’t afford to do so. Therefore, this mandate to purchase a private product doesn’t achieve universal access to health care nor does it reduce the financial burden of disease on low- or middle-income families.
Steffie Woolhander, a professor of medicine at Hardvard, calls private insurance a defective product, one that leads people to bankruptcy and at the same time doesn’t provide the health care they need. She explains, “Once failure to buy health insurance is a federal offense, what’s next? A Ford Pinto in every garage? Lead-painted toys for every child? Melamine-laced chow for every puppy?” The idea here she’s exaggerating is that forcing residents to buy a flawed product they can’t afford, and that doesn’t provide what’s it’s supposed to, i.e. relief the “financial burden of disease”, is not a way to provide health care. Further, this mandate to buy a faulty product is no way to deliver “universal coverage” and Massachusetts should provide ample evidence for this.
But then, one does not need the over 2000 pages of legislation produced either by Congress or the Senate to realize why this is so. A much briefer paper of only 15 pages, written back in 2003, by four prestigious Princeton economists explains it very clearly. They studied why it is that the United States spends more than any other industrialized nation on health expenditures for the same amount of care, and concluded that “It’s the prices, stupid!” We may want to add to these extraordinary prices the close to 400 billion dollars in administrative waste generated by an extraordinary system built upon the idea of avoiding to pay for the costs of health care: private insurance policies.
Isn’t it time for U.S. policymakers to stop doing the same thing and expecting different results? Yet for for some odd reason, our President and many in Congress are “urging common ground” to go exactly in the same direction. Change we can believe in? Hardly.
Add a comment February 24th, 2010 by Sophia Constantino
I ask you to you join the Medicare for All Rally, tomorrow February 25, 2010 in San Francisco! This is an important time to be active and let President Obama know about Health Policy that really works!
At 10 AM outside the San Francisco Federal Building (90 7th St., between Market and Mission – Civic Center BART/MUNI) join activists from the California Physicians Alliance, California Alliance for Retired Americans, Gray Panthers, and Single Payer Now to let President Obama know that we want Medicare for All.
This will be a Sidewalk Summit to tell President Obama that the policy that meets his goals of bringing down premiums, bringing down the deficit, covering the uninsured, strengthening Medicare, and stopping insurance company abuses, is Improved Medicare for All.
On Thursday in Washington, DC, President Obama is meeting with Republicans and Democrats to search for solutions to our healthcare crisis. But once again the president and congress are not including any discussion of the only real solution to America’s health care problems – expanding and improving Medicare to cover everyone in America.
For further information:
Single Payer Now
415-695-7891
Add a comment February 18th, 2010 by Claudia Chaufan
The California Physicians Alliance (CaPA) would like to invite you to apply for the CaPA Medical Student Fellowship. The fellowship is a phenomenal, one-year, full-time, PAID position to work on healthcare reform and advance the single-payer movement. It is THE only fellowship of its kind in California and an incredible opportunity for those interested in health policy education, advocacy, and leadership. For further details please see our ONLINE APPLICATION.
The DEADLINE for the application is March 15th.
Please help us spread the word about this incredible opportunity by forwarding this email to:
1. Friends and listservs.
2. Deans and program directors.
3. Local campus career services.
Please contact us at CaPA.Fellow@PNHP.org if you have any additional questions.
Thank you!
1 Comment February 18th, 2010 by Claudia Chaufan
The following letter was sent to the White House on Feb. 9, two days after President Obama announced his plans to convene a bipartisan summit on health reform on Feb. 25 in Washington. Unsurprisingly, even if disappointingly, we’re still waiting for an answer.
February 9, 2010
President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Dear Mr. President,
Physicians for a National Health Program, an organization of 17,000 doctors who support single-payer national health insurance, respectfully requests that you invite one or more of our representatives to participate in your White House health care session on Feb. 25.
We note that in your call for the meeting you urged Republicans, Democrats and health policy experts to gather, go over all the options and “walk through them in a methodical way so that the American people can see and compare what makes the most sense.”
We would like to offer several of our members as health policy experts for this important task.
As you may know, two key research studies that helped drive the health reform process forward this past year – one in the American Journal of Public Health that found 45,000 deaths annually are linked to lack of health insurance, another in the American Journal of Medicine that found 62 percent of personal bankruptcies are linked to medical bills and illness – were the work product of Harvard Medical School research teams guided by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler.
Drs. Himmelstein and Woolhandler, who are also primary-care physicians in Cambridge, Mass., have had several other groundbreaking studies published in our nation’s leading medical journals, including one in the New England Journal of Medicine that shows administrative costs consume 31 percent of U.S. health spending, most of it unnecessary. They have also frequently testified before Congress on their research. We urge that you invite them to participate in the Feb. 25 meeting.
The presence of Dr. Margaret Flowers, our congressional fellow, would also enhance the meeting. Dr. Flowers, a Maryland pediatrician, has met with numerous members of Congress and testified before two congressional committees last year about the urgent need for single-payer health reform.
Finally, we ask that you invite our president, Dr. Oliver Fein, to participate. Dr. Fein, an internist and professor of clinical medicine and clinical public health in New York City, attended the March 5 White House Summit on health care. He is a past vice president of the American Public Health Association.
Detailed biographies and contact information for each of these doctors are available upon request. Please feel free to call me (312-782-6006) or e-mail me (ida@pnhp.org) should you need any additional information.
Add a comment February 13th, 2010 by claudio
We may be intelligent, but do we have the experience? If we do, it depends whether we learn-from and apply our experience! (F. Stern)
Those who cannot remember the past are condemned to repeat it. (Santayana)
1. When really committed to human rights (HR), civil society organizations and individuals in academia have to use their (new) power with intelligence and not overvalue any theory that promotes a sense of ‘universal responsibility’ based on the false pretense that it is primarily the intelligentsia who has to bring order to a world in disarray –no matter at what cost–“or we won’t be able to live in peace with ourselves”. Such theories do not only lead to potentially infinite disconnected interventions; they intoxicate our minds with the illusion that it is we who have the leading role in the ultimate crusade in favor of what is just and fair, making us believe that each campaign we embark-on is like the final and ultimate campaign that will end all miseries of the world. As part of a true global people’s movement, we have to learn to move from being-a-potential-power to being-a-real-power in world affairs; we have to liberate ourselves from simplistic general global objectives (i.e., a general globalism) that lacks a clear sense of direction and purpose lest we get tangled up everywhere. There are concrete things to do to get us to such a position of real power…and it is the actions of those most affected –and not just of the intelligentsia– that will ultimately count. (Paraphrased from Walter Lippman (1889-1974), former NY Times Editor).
2. If we do not heed the advise above, we always come up against the same limit: ‘it cannot be done’ from the ivory towers –no matter how hard we try. We need to let go of old patterns to let new forms emerge; forms that we can, in partnership with the most affected, test in small trials in mainstreet.
3. Committees our peers set-up in which those whose rights are being violated negotiate what really are compromises, more often than not, actually serve to defend the special interests of the conveners. I’d say this negotiating has reached its limits. We will not get anything more out of it. This, because we do not take into account the very important special interests at play. (Ultimately, the interests of those defending their old prerogatives play against the interests of those chronically under-represented and ‘under-voiced’ in negotiations, e.g., women, minorities, the marginalized). To foster real progress in HR, activists must know who the various interest groups are and what really ‘makes them tick’.
4. Furthermore, experience shows us that we need to denounce the discrepancy between the letter of the law (which often upholds idealistic and noble principles) and actual practice (which is either indifferent and insensitive or outright repressive and oppressive….even if passively).
5. In our struggle for HR, it is not enough to reject and oppose what the neoliberal Establishment stands-for –if it is not done in the name of making real structural transformations. Most of the time, the struggle is only advanced in the name of a sometimes single-issue opposition built around either a ‘defense of the environment’, of a rejection of ‘traditional morals’ or of just supporting piecemeal positions to address selected aspects of the faulty international social and economic order. Not so in the case of the HR-based framework. 6. Because of this, the following caveat has to be kept in mind: Contrary to what so many nowadays prophetize, manifestations of street euphoria in mainstreet (in Davos or in WTO meetings) do not have much of an ultimate political or HR transcendence. Instead of being real innovators, these alleged ‘avant-garde protesters’ with their rhetoric, and street revolutionaries with their slogans, are far away from the main body of claim holders and instead contribute to the banalization of the radical changes really needed. (I have found, they actually do not bother even to read on these matters or read very little). They often play to the hands of the Establishment without realizing they are party to a confused idealism that, in fact, governs their actual conduct –which has no real teeth. All this is anarchic, devoid of a center or action-direction and often does not even wield new ideas. These street revolutionaries should instead be looking for real transcendence by de-facto rejecting the market-controlled world we live in with its built-in social class prejudices and HR violations, i.e., not only should they protest verbally or physically, but have a HR-based-reasoned-action-agenda and a de-facto insertion in processes at grassroots level.* (Paraphrased from M. Vargas Llosa)
*:In a way, this is al challenge for us HR activists, i.e., to bring these potentially valuable strategic allies into the realm of real HR work.
7. The above non-systematic overview that comes from experience, but is brief to the point of a caricature, gives us pointers to what some of the important issues we need to tackle are when replacing the current paradigm by the one with the HR-based framework at its core. I invite colleagues in our readership to reflect on these points and to discuss them with peers. We have to bring these issues to a level of ‘impertinent consciousness’ where it bothers us not to act. (Sub-comandante Marcos)
8. To finish, I ask: How long will it take for the conventional literature to break with the current paradigm, conceived –and now guarded– by its protagonists who reside in the ivory towers of the world…who you and I well know?
Claudio Schuftan, Ho Chi Minh City cschuftan@phmovement.org
Add a comment February 4th, 2010 by bronxdoc
Our friends from the National Physicians Alliance (see prior postings) have passed on an invitation to their 5th annual meeting to be held March 13-15, 2010 in Long Beach, Califonia. For information and registration, please click on this link. To give readers of the Portal a sense of what some physician activists are up to, we are reprinting some of the conference schedule:
Leadership Development: Developing Skills to Lead as the Landscape of Health Care Changes
From national health care reform to community advocacy to clinical practice, physician leadership and engagement has never been more vital to the health of the nation. Recent successful examples have also demonstrated the benefits of physician leadership, advocacy, and engagement with community partners. This track will provide resources for communication, management and advocacy skills, civic engagement, community collaboration, and other tools that physicians can apply in a variety of settings. Community members are welcome to join and learn more about physician engagement. Session to include:
Advancing Health Care Through Civic Engagement
Kim Alexander, President, California Voter Foundation Carmela Castellano-Garcia, President CEO, California Primary Care Association Marc Wetherhorn, National Advocacy Director, National Association of Community Health Centers
Messaging, Media & Communications
Bob Crittenden, MD, MPH , Executive Director, The Herndon Alliance
Effectively Engaging with Your State Legislatures & Its Members
Progressive States Network – Speaker TBA
Educating State Legislators, Advancing Health Care Reform: Tools Physicians Can Use to Engage & Inform State Legislators About Federal HC Reforms
Progressive States Network – Speaker TBA
Models for Physician Leadership and Community Engagement
Bill Jordan, MD, MPH, NY Action Network – National Physicians Alliance
Aaron Fox, MD, MPH, NY Action Network – National Physicians Alliance
Issues on the Horizon: 2010 & 2012 Elections
Kim Alexander, President, California Voter Foundation
Serena Kirk, Senior Policy Advocate, California Primary Care Association
Practice Innovations: Practicing Medicine in a Changing World
What will the practice of medicine look like in ten years? How will reform change the way the average physician will practice medicine? This will be an instructive and interactive track will address these complex questions and many others by focusing on the following three areas: 1) Evidence Based Medicine (EBM), 2) Practice structure and financing, and 3) Information and Communications Technology. Sessions to include:
Evidence-based Medicine & Clinical Guidelines
Colin Kopes-Kerr, MD, JD, MPH, The Permanente Medical Group
Healthcare Planning and Strategy
Kevin Fickenscher, MD, CPE, FACPE, FAAFP, Perot Systems
Approaches in Chronic Disease Management
Susan Snyder, MD
High Quality Care for Disadvantaged Populations
L. Gordon Moore, MD
National Health Policy: Avenues for Involvement in Advocacy to Enhance our Country’s Health
With the potential passing of federal health care reform legislation a “wave of change” will alter the landscape of public health and healthcare in America. The National Health Policy Track aims to educate and mobilize physicians on the healthcare reform debate of 2009 and future directions for reform. Sessions to include:
Reforms that Reduce Costs Without Reducing Quality of Care
Thomas Rice, PhD, Professor, Department of Health Services; Vice Chancellor, Academic Personnel
UCLA School of Public Health
Political Solutions to the Obesity Epidemic
Deborah Cohen, MD, MPH, Senior Natural Scientist, Rand Corporation
Outcomes of Health Care Reform: Review of the Policy Debate
Josh Derr, Manager, Mayo Clinic Health Policy Center
Health Care Reform: Impact on Women
National Women’s Law Center – Lisa Codispoti, Senior Counsel
Federal Health Care Reform: How Physicians Can Help Their States Access Upcoming Opportunities & Resources
Progressive States Network – Speaker TBA
Global Health: Workforce Issues in an Ever-Evolving Global Health Landscape
The world has never been smaller, nor have global issues of health been more of a concern for physicians and advocates alike. With health care workers migrating to the Unites States for better opportunities, a shortage in these critical areas ensues. What can physicians do to ensure that we are thinking globally in our efforts to improve the health of our patient, our community and our world? Sessions to include:
The Global Workforce Crisis-Is US the Problem or Solution?
Richard Scheffler, PhD, University of California, Berkeley
Kate Tulenko, MD, MPH, Deputy Director at Capacity Plus/ IntraHealth
Health Policy Specialist at World Bank
International Health Workforce Issues
Amy Hagopian, MHA, PhD, Health Alliance International, University of Washington
In the Wake of the Storm: On the Ground in Haiti
Susan Partovi, MD, Professor UCLA School of Medicine
Director Homeless Healthcare Los Angeles
Trade and Health: The Impact of Health Worker Migration
Michelle Forzley, JD, MPH
Nuclear Non-Proliferation: The Physicians Role in Advocating Peace
Bob Dodge, MD, Physicians for Social Responsibility, Los Angeles
California Health Policy: Experiences & Experiments in State Policy and its Nationwide Influence
California has long been at the forefront of the ever-changing face of healthcare. Its struggles are often those of other states around the country, and the innovations and experiments in health care delivery have offered guidance to the rest of the nation, whether in success or in failure. With the ongoing budget crisis in the state and the potential impact of impending national health legislation, adding to other internal debates about border health, malpractice, medical marijuana, and disaster preparedness, now as ever, California will be watched by the nation. In the California health track we hope to stimulate learning, debate and exchange of ideas around these and other issues relevant to patients, providers, and policy-makers. Sessions to include:
Issues facing Community Health Clinics and the Underserved & Minority Populations
Michael R. Cousineau, PhD, Director Community Health and Family Medicine University of Southern California Castulo de la Rocha, JD, President & CEO AltaMed Medical Services
A ‘Reformed Single Payer’ in the Current Reform Era
E. Richard Brown, PhD, Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health, Principal Investigator, CHIS
Border States and the Uninsured: Immigration Issues for Health Care Reform
Michael Rodríguez, MD, MPH, Sr. Researcher, UCLA Center for Health Policy Research Professor, UCLA Department of Family Medicine
Krysten Sinema, MSW, Arizona State Legislator
Progressive States Network – Speaker TBA
Addressing Disparities Through Health Reform
National Women’s Law Center
Healthcare Crisis in a Bankrupt State: Can California Still Lead?
Herb Schultz, MPP, Senior Health Policy Advisor to the Governor
Sara Rogers, Health Legislative Advisor to Senator Mark Leno
Coordinating Across State Lines: Opportunities Presented by Health Care Reform
Progressive States Network – Speaker TBA
posted by Matt Anderson, MD
Add a comment January 31st, 2010 by claudio
Effective action requires not just an enthusiasm,
but calls for a close rapport with the disgruntled so
as to get them organized. (A. Robbins)
1. You may often have asked yourself as to whether your individual contribution in the field of health and/or nutrition makes or is making any difference. This, of course, depends. Alone, each of us is indeed helpless to change very much. Standing alone to-right-the-world’s-wrongs is a false ideal. We have thus plenty to learn from the lessons of mutuality or even of militancy. Individual concern (let alone compassion…) is just clearly less powerful than organized solidarity. (Tikkun) Or, to use an old adage, ‘divided we beg, united we demand’.
2. Sporadic, collective grassroots-organized acts are happening all the time –mostly the result of non-political and personal leadership initiatives. To make these acts really count and add-up to something, they need to be progressively channeled into new patterns of higher political meaning and political impact. Human rights activists are needed to lead the way in such a transition. This, because without continuity and follow-through actions, popular struggles will remain a heap of toothless words. (S. Ophir)
3. In the human rights (HR) context, two questions arise here: Are the fields of health and nutrition legitimate and good ports of entry for HR activism? And if the answer is yes: Are we ready for such a challenge?
4. If the answer is again yes, new forms of progressive HR learning and HR action are then needed in our line of work. Actually, to act effectively in the time before us, we need to first develop a more widely shared strategy that unequivocably points in the HR framework direction. When adopting such a strategy, we cannot merely denounce; we must also announce a new order –an order with more empowering-health-and-nutrition-alternative-actions. We must thus strive to become proactive, not merely reactive.
5. Today, together with the victims of health and nutrition rights violations, the inescapable challenge before us is to redefine the strategies we use in order to combat preventable ill-health, preventable malnutrition and preventable premature deaths. This invariably entails (simultaneously at the global, national and local levels) addressing and combating the social, economic and political determinants of the violations of the UN-sanctioned Right to Health and Right to Nutrition. Only thus will we be able to overcome the present crisis in overall development thinking and praxis we now are stuck-in in these two domains. (R. Boyte)
6. As an avant-garde, we not only need to reflect on new institutional ways of supporting grassroots HR initiatives, but we also need to become more proactive in organizing them, as well as helping generate new forms of HR knowledge and of practices-of-direct-democracy in local government. In the process, we also need to reassess the pertinence and the role of foreign aid and of private (non-official) international development cooperation in the fields of health and nutrition. This, to either reject both or to help redefine them so that they, once and for all, fit the demands of local communities. (S. Padron) If the latter cannot be done, yes indeed, it is high time poor countries begin considering turning down foreign aid.
7. Still proactively, we first need to help create a shared critical awareness of the immorality of the prevailing social, economic and political system responsible for the violations of the Right to Health and the Right to Nutrition we are basically left to deal with as health and nutrition professionals. For this, among other, we need to bring people both in the rich and the poor countries to a point where they become more vocal in their demands to change the mechanisms that lead to the conditions perpetuating ill-health, malnutrition, poverty and injustice. And this can only be achieved by creating a growing discontent that leads to a ‘constructive anger’ and to commensurate actions that address such injustice. Action along these lines is desirable (preferably preemptive rather than reactive), and should even be made an inescapable outcome of effective health, nutrition and development learning. The HR activist/educator thus has a key role in our midst.
8. If we are to be consequent with effective people’s empowerment, we will have to foster an authentic people-centered development (in our case using health and nutrition as a port of entry to HR issues). For this we will have to further:
i) move away from coercive or top-down practices involving any kind of ‘acceptance-as-a-fait-accompli’ (e.g., in family planning?), and move into consensus-building practices involving legitimate beneficiaries’ approval; ergo, do things departing from the-way-people-see-them in their own environment;
ii) revolutionize people’s expectations helping them to move away from fatalistic outlooks;
iii) help define a new type of collective, community sense of responsibility that replaces the prevailing individual identity;
iv) help legitimize and enforce all UN-sanctioned people’s rights;
v) increase the negotiation and bargaining capacity –or at least the defense capacity– of claim holders;
vi) as needed, aim at overcoming constraining local political structures (formal and informal);
vii) concentrate on changing the local inter-generational dynamics when required, and very specially concentrate on changing the role of women (our main contact in health and nutrition work) in overall development work;
viii) work with people towards the goal of ultimately controlling their own community resources, fighting for the resources they need from outside, and taking initiatives to shape their own future through a strengthened, militant organization;
ix) make sure people get access to relevant information, especially the type of information that will help them hold their government officials accountable; *
x) help redefine the roles and methods of so-called ‘participation’ shifting them towards methods of ‘empowerment’ –in our case in health and nutrition;
xi) constantly re-gather groups becoming marginalized, trying to make sure their special interests are accommodated in the general strategy;
xii) secure concrete short and long-term positive results for claim holders (with an initial emphasis on short-term results to foster self-confidence);
xiii) together with claim holders, monitor and evaluate said results, especially with regards to the degree of popular empowerment being achieved, as well as probing the equality of the benefits accrued; and
xiv) promote self-education with the aim of achieving faster results.
*: Information given to people for use through the fashionable ‘social marketing’ approach is definitely not the type of information conducive to any meaningful participation; social marketing simply does not bring about the needed sustainable structural changes –at best, it allows people to tolerate and cope-with an unjust situation. Social marketing tells people what to do, but not what for and why…
9. Only through the constant practice of such people-centered development activities –often through trial-and-error– will we overcome the limits of existing flawed development models and theories. (L. Padron)
10. In short, starting with/from our work in health and nutrition, we should all contribute, to the best of our abilities, to generate popular alternative development strategies with the corresponding set of tactics to implement them. But to make a difference, remember that standing alone changes little; so: Network with other like-minded activists in the HR field!
Claudio Schuftan, Ho Chi Minh City
cschuftan@phmovement.org
1 Comment January 28th, 2010 by Claudia Chaufan
By Margaret Flowers, M.D.
January 28, 2010
President Barack Obama|
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear President Obama,
I was overjoyed to hear you say in your State of the Union address last night:
“But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”
My colleagues, fellow health advocates and I have been trying to meet with you for over a year now because we have an approach which will meet all of your goals and more.
I am a pediatrician who, like many of my primary care colleagues, left practice because it is nearly impossible to deliver high quality health care in this environment. I have been volunteering for Physicians for a National Health Program ever since. For over a year now, I have been working with the Leadership Conference for Guaranteed Health Care/ National Single Payer Alliance. This alliance represents over 20 million people nationwide from doctors to nurses to labor, faith and community groups who advocate on behalf of the majority of Americans, including doctors, who favor a national Medicare-for-All health system.
I felt very optimistic when Congress took up health care reform last January because I remember when you spoke to the Illinois AFL-CIO in June, 2003 and said:
“I happen to be a proponent of a single-payer universal health care program.” [applause] “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”
And that is why I was so surprised when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation.
There was an opportunity this past year to create universal and financially sustainable health care reform rather than expensive health insurance reform. As you well know, the United States spends the most per capita on health care in the world yet leaves millions of people out and receives poor return on those health care dollars in terms of health outcomes and efficiency. This poor value for our health care dollar is due to the waste of having so many insurance companies. At least a third of our health care dollars go towards activities that have nothing to do with health care such as marketing, administration and high executive salaries and bonuses. This represents over $400 billion per year which could be used to pay for health care for all of those Americans who are suffering and dying from preventable causes.
The good news is that it doesn’t have to be this way. You said that you wanted to “keep what works” and that would be Medicare. Medicare is an American legacy of which we can feel proud. It has guaranteed health security to all who have it. Medicare has lifted senior citizens out of poverty. Health disparities, which are rising in this nation, begin to disappear as soon as patients reach 65 years of age. And patients and doctors prefer Medicare to private insurance. Why, our Medicare has even been used as a model by other nations which have developed and implemented universal health systems.
Mr. President, we wanted to meet with you because we have the solution to health care reform. The United States has enough money already and we have the resources, including esteemed experts in public health, health policy and health financing. Our very own Dr. William Hsiao at Harvard has designed health systems in five other countries.
I am asking you to meet with me because the solution is simple. Remove all of the industries who profit off of the American health care catastrophe from the table. Replace them with those who are knowledgeable in designing health systems and who are without ties to the for-profit medical industries. And then allow them to design an improved Medicare-for-All national health system. We can implement it within a year of designing such a system.
What are the benefits of doing this?
* It will save tens of thousands (perhaps hundreds of thousands) of American lives each year, not to mention the prevention of unnecessary suffering.
* It will relieve families of medical debt, which is the number one cause of bankruptcy and foreclosure despite the fact that most of those who experienced bankruptcy had health insurance.
* It will relieve businesses of the growing burden of skyrocketing health insurance premiums so that they can invest in innovation, hiring, increased wages and other benefits and so they can compete in the global market.
* It will control health care costs in a rational way through global budgeting and negotiation for fair prices for pharmaceuticals and services.
* It will allow patients the freedom to choose wherever they want to go for health care and will allow patients and their caregivers to determine which care is best without denials by insurance administrators.
* It will restore the physician-patient relationship and bring satisfaction back to the practice of medicine so that more doctors will stay in or return to practice.
* It will allow our people in our nation to be healthy and productive and able to support themselves and their families.
* It will create a legacy for your administration that may someday elevate you to the same hero status as Tommy Douglas has in Canada.
Mr. President, there are more benefits, but I believe you get the point. I look forward to meeting with you and am so pleased that you are open to our ideas. The Medicare-for-All campaign is growing rapidly and is ready to support you as we move forward on health care reform that will provide America with one of the best health systems in the world. And that is something of which all Americans can be proud.
With great anticipation and deep respect,
Margaret Flowers, M.D.
Congressional Fellow, Physicians for a National Health Program
Please join Dr. Flowers in urging the President to meet with advocates of real reform (improved Medicare for all) by calling the White House at 202-456-1111.
Tell them, “I’m letting you know that improved Medicare for all (HR 676) is better than the health bill proposed by Congress. Meet with Dr. Flowers and the Leadership Conference for Guaranteed Health Care about why.”
For more information relevant to President Obama’s health care related comments in his first State of the Union:
Going Down the Same Old Tunnel, By Steffie Woolhandler and David Himmelstein
Add a comment January 28th, 2010 by Claudia Chaufan
For Immediate Release: 1/28/10
January 28, 2010
Leno’s Single Payer Health Insurance Legislation
Wins Senate Vote 22 to 14
California OneCare Campaign
Reveals Massive Netroots, Grassroots Campaign
By a vote of 22 to 14, the California Senate today passed historic reform legislation, SB 810, that calls for sweeping changes in the financing of health care.
Under the bill, authored by Senator Mark Leno (SF), all residents would be covered by a true universal health care system, which would pay for all needed health services utilizing a “single payer” insurance system. Most residents would be required to pay into the system and all would be covered, with no additional co-pays, deductibles or exclusions for pre-existing conditions.
Comprehensive reform. Under SB 810, private insurance companies would be replaced by one non-profit health insurance fund. All services, including prescription medications and equipment would be paid by the single fund – hence the term “single payer”. All California residents will be covered with comprehensive, universal coverage for all necessary health care including doctors, hospital, medications, mental health, medical equipment, dental, eye care and more. Under the SB 810 legislation, hospitals anddoctors would continue to operate privately, while insurance would be financed publicly..
SB 810 is expected to be revenue neutral to the state and cost most businesses and residents less for the most comprehensive health care reform plan ever offered Americans.
A strategic Plan to WIN. Sponsors of the bill applauded the Senators who supported this victory and outlined coalition plans for a massive multimedia grassroots educational campaign to pass the bill through the Assembly later this year.
One key component of the campaign will be an historic multimedia advertising campaign that will feature a new 30-second TV spot every day for a year starring celebrities, political leaders, health care activists and victims. Some 60 spots have already been produced, featuring Lily Tomlin, Paula Poundstone, Elliot Gould, Ed Begley, Valerie Harper, Connie Stevens, Tracy Newman, Ken Howard, Ed Asner, Sheila Kuehl and more. Supporters will be invited to submit their own versions.
Massive Grassroots Education. Kicking off on March 1, the 365-day ad and grass roots organizing campaign will gain momentum during the most tumultuous political period in decades, including a key state primary and the November election for Governor, Senate and Assembly seats. The goal of the campaign is to achieve passage and approval of the legislation by a two-thirds super majority of legislators in order to pass the financing legislation to implement the legislation. Similar single payer bills were passed twice by a 62% majority of the California legislature only to be vetoed by Governor Schwarzenegger.
Californians will be invited to get active on line or join neighborhood events to educate others about the benefits of this major reform of our health care system. Leaders expect that California’s success with a single payer system will lead other states to adopt it as well.
California OneCare and the 365 Ad Campaign are a project of Health Care for All-California and supported by single payer advocacy groups nationwide.
DONATE TO GET SINGLE PAYER, UNIVERSAL HEALTH CARE IN CALIFORNIA. Please support the California OneCare 365 Ad Campaign. Help us produce a new thirty-second ad supporting single-payer health care on websites and television throughout California every day for one year. Click here to donate.
For more information, contact:
Andrew McGuire, Executive Director,
Health Care forAllCalifornia and the California OneCare Campaign
Phone: 415.215.8980
Ali Bay (California Senate)
916 651-4003
