Thursday, July 31, 2014

Obama-Biden Transition Project Healthcare Proposal

The Obama-Biden Transition Project 
by Elyssa D. Durant, Ed.M. 

"We're often asked how we plan to take this unique moment in history - when a grassroots movement for change elected a president - and turn it into a force that can build stronger communities, block by block." -The Obama-Biden Transition Project

As I was thinking about how to respond to the numerous requests the Obama Transition Team that has been sending out to community organizers, political activists, advocates and non-profits across the country, I am reminded of the days I spent living on the Upper West Side of Manhattan.

At the time, in the mid to late 1990's, the American Sociological Association (ASA) held its annual conference in New York City. Prior to that meeting, they sent out a fact sheet that may be of interest to ASA members. In this sheet, they too described the same social conditions and asked their members to take note of the changes that occur at 96th Street.

Oddly enough, the very same area was undergoing rapid transformation and gentrification at the time Mayor Rudolph Giuliani took office. As described by the ASA and other political sociologists, the South Bronx is one of the most severely segregated and poorest Congressional Districts in the United States. The members of this community have been segregated into a hell plagued with sickness, violence and despair. Kozol argues that this strategic placement serves to isolate the rich from the realities they have thrust upon their fellow man. 

New Yorkers do not stroll through the streets of Mott Haven, and taxicabs take no short cuts through Beekman Avenue. Many taxicabs will not even venture past East 96th Street. Out of sight is out of mind.

There is no excuse for the living conditions of these children and their families. No person should be forced into an apartment that has a higher ratio of cockroaches and rats than to human beings.

These children are desperately in need of the best schools, yet we give them the worst. They have few libraries, few safe havens, few doctors, and few role models. 

They have every reason to believe that they are throwaway children and we have certainly not shown them anything else. The social services we have provided are a bureaucratic nightmare. People in need are treated as sub-human, and made to feel ashamed of being poor.

These are among the sickest children in the world. Americans claim to be dedicated to the children and fool ourselves into believing that we are doing them a favor by providing them with medical care, public education, and public housing. Yet, the quality of their neighborhoods speaks volumes of our sentiment and intentions.

Shortly after the publication of Amazing Grace, managed care rapidly moved onto the New York scene. 

Around the same time, the Mayor announced he would be closing some of the hospitals that served the poorest of the poor because of financial problems associated with payment and large trauma departments.

Kozol makes the point that people could attempt to gain admissions at a better hospital than Bronx-Lebanon; yet, the privatization of Medicaid made this completely impossible. 

Further restrictions on medical care are inevitable as a direct result of Medicaid managed care plans. The law is not designed to protect the poor, the fragile, and the disenfranchised.

This was made obvious in a recent conversation I had with a friend who practices emergency medicine on the elite Upper East Side of Manhattan. My friend works as a board certified trauma physician at a private hospital on the Upper East Side. The last black patient he treated at Beth Israel was famed rock singer Michael Jackson.

This is the reality. The best doctors treat the healthy and wealthy instead of the people who have the greatest need. They give no thought to the equitable distribution of services; they just file insurance claims and billing statements. Doctors should consider who stands to could benefit the most from their skill and experience. Perhaps we should invert the payment schedule so physicians and other health care providers should receive a higher rate of reimbursement for treating the most vulnerable populations.

Patients with the greatest need get the worst care.

Great teachers teach great students in great neighborhoods.

This makes no sense!

And we wonder why the division between the have and the have-nots continues to grow?

People often ask me why I am so angry about the living conditions of poor urban minorities. My response-Why aren't you? I cannot be the only one who places human kindness, dignity, and integrity above the lure of the almighty dollar!

We should feel enraged by the way we treat our own citizens. Children who did not ask to be born into poverty and substandard living conditions.

I have thought for many years that the system is upside down, and I become more and more convinced of that as I grow older.

To paraphrase the message of the new Windows Vista commercial, The Mayor's of Nashville's winning campaign.... it is all connected....

Clearly there is a level of inter-connectedness that exists between the various sectors of the American marketplace and economy otherwise Washington would not be at a complete standstill trying to figure out what to tweak, where, and just how much...

Did it really take a $700 Billion wake up call for our citizens to realize that that all is not well in America. It is time to get real about healthcare. It is time to get real about education. 

It is time to get real about the cost of education. It is time to get real about this god-forsaken war that we are still in! This country is in desperate need of a wake-up call, and we must develop a course of action that embraces a multi-dimensional approach and vast restructuring of the laissez faire way of regulating healthcare in the past.

Similarly, many different things influence the human condition by upsetting the delicate balance between those who can and those who do. We need to focus on improving the lives of those who might... People who can and do amazing things when given the chance. 

People who can excel under the right set of circumstances given the right support, the right guidance, the right tools, and the right opportunities. People who may not have the monetary (financial) resources to invest in themselves, their families, or their communities.

If we are to find some resolution to the unprecedented, simultaneous collapse of the economy, the market place and/or government and the collapsing housing market in United States, it seems obvious that people, the economy, healthcare, education confidence and faith in the American people it is time to take drastic efforts to strengthen our greatest asset and hope for the future: Our children! 

We must take action on a number of fronts to create some type of stability in our country, our economy, and the international marketplace. We need to start here, now, in our own communities, schools, and invest in ourselves.

Look at the facts; if we get healthy, they go broke! So let's shake it up a bit, and turn this sad state of affairs upside down!

I am not for sale, yet my healthcare company pimps me out based upon their ability to negotiate with fat cat for profit healthcare giants like HCA and First Health who are by no means the business to make people well! 

It does not take a rocket scientist to see the perverse incentive to keep people sick and dependent upon costly medications and treatment protocols.


Next year, I want Harvard to take in the worst students. Take the worst students who would not have made it past the front door of the admissions office. Take the worst students. Students who did not break a thousand on their SATs and barely made it through watered-down high school curriculum. Let them benefit from a first class education.

Guess what Harvard? The smart kids don't need you! They are already ahead of the game. 

We can sit them in a corner for a year or two because they do not need the Ivy League to succeed. By definition, they are already streamlined for success and they will no doubt be great with or without you!

There is no doubt that the prevalence of violence in urban neighborhoods affects the ability of children to perform well in school. There is a large body of empirical evidence that demonstrates the effects of chronic stress on memory and the learning process. 

Rather than taking the children out of these communities, we have constructed prison like buildings for them to attend school. They routinely have gunfire drills reminding them that danger is never far behind.

Children cannot learn in this environment. This constant stress triggers "hot-memory." Hot memory can be thought of as learning with your heart and not your mind. It is no wonder children perform inadequately in this environment. It is bad enough that children live in such conditions, must we educate in them too. If we want underprivileged children to learn and grow spiritually, we must create an environment that allows their cool memory systems to take over. 

It is only under these conditions that children will permit themselves to learn and develop their intellectual strengths.

We have failed to create a safe home environment for urban children, but we can give serious thought to creating a school environment outside of the community so they have fewer fear-driven hours each day.

It is any wonder that these children perform poorly in school. By every measure, these children are destined for failure. Their home life is less than enchanting, and they do not benefit from enriched environments and educated parents. Certainly, there are many dedicated parents who care about their children, but is that enough? 

When I was in school, children frequently asked the teacher, how this would help later in life. As a young girl in a suburban classroom, there was an unequivocal reply, but it could be argued that what children in the South Bronx need to learn cannot be taught in the classroom.

Studies consistently report lower academic achievement in urban neighborhoods like Mott Haven in the South Bronx. Children growing up in urban neighborhoods have a much higher incidence of posttraumatic stress disorder (PTSD). 

Most researchers believe this to be the direct result of living in stressed communities plagued with street crime and violence. 

The potential impact of chronic stress on academic performance and achievement is not known, but reading scores in neighborhoods like Mott Haven certainly seem to indicate some type of causal relationship. 

There is virtually no research on looking at the long-term effects of this inflated incidence of PTSD among urban populations. 

It is important to develop an understanding of the effects of fear on the academic performance of urban adolescents so we can begin to dismantle the myths regarding school performance and minority children.

Under these conditions, it is not surprising to learn that students also report pervasive feelings of fear and do not feel secure despite the added presence of security personnel on school grounds. 

For these students, school is a mere extension of the violent communities in which they live.

Since urban communities have many different sources of stress, it is important to examine how school policies contribute to the learning environment in public schools. 

The quick response has been to install weapons detectors and hire school security for urban schools. The presence of school security certainly affects the climate of American public schools and sends a symbolic message to members of the community, the world, and especially the students themselves regarding the role they are expected to play as they mature into adolescents and young adulthood.

The school rules mimic are not unlike those one might expect to find in a state prison. Students are rewarded for obedience and they are taught to follow the rules rather than to think critically. 

On the back of the No Child Left Behind legislation, we indoctrinate our youngest members of society with "core curriculum" and "Back to Basics." Students across the country are judged on their ability to regurgitate facts on high-stakes standardized tests.

Lesson plans are filled with repetition exercises and workbook pages rather than student projects or classroom discussion. We teach conformity, rules, and limits. 

We teach kids to be blind followers. The skills we are teaching are better suited for prison rather than the real world. Teachers are teaching the kids to follow rules, to conform, and to reward obedience rather than creativity.

The secured environment is an indication of the roles students are expected to play later in life. This is a lesson they will not soon forget. 

School rules and core curriculum makes classroom silencing an everyday event in the urban classroom. And as my list of "off-limit" subject matter grows longer each term, the need to bring such things into the dialogue becomes more and more apparent. 

I actually have a printed list of topics that I am forbidden to discuss in the classroom: The election, politics, race, religion, suicide, pregnancy. 

The more topics they add, the more relevant they become. The unspoken truth has becomes louder and louder the more we are silenced. There is a big pink elephant standing in the middle of my classroom! There is a big pink elephant in the middle of our community!

By focusing on student behavior rather than student skills, knowledge, and achievement, we are showing all members of the school, the community, and the children themselves that we have already given up. 

Together, the urban public school and the community it serves are a constant reminder of the perpetual cycle of poverty and the poor living conditions and social reality that continue to plague urban America.

Kozol makes it quite clear that there are several exceptional children in this community. There are probably as many exceptional children here as every other community around the country, yet, so few of them will make it out of the South Bronx. Kozol is careful not to dwell on the exceptional cases of children who successfully navigate their way into the main stream of society. Kozol does this so we do not develop a false sense of hope. If we cling to a few exceptional cases, we may come to believe that what we are giving enough to children like Anthony or Anabelle.

Clearly, we can do more. Failure should be the exception-not the rule. Success should be the norm, and until it is, we should not give up hope for these children.

This is our time to let our voices be heard. Any number of social justice agencies from, to Cover the Uninsured, to Families USA, Center for Community Change, Health Care for America Now; have opened the blogosphere so that everyday common folk like you and I can submit our opinions to the Transition Team in Washington.

They are begging us to participate, to give our opinions, to let our voices be heard. They need our help. Let us make this the country we are proud to call home. Let this be a new beginning for us all, and let us make this a land of real opportunity.

America claims to be dedicated to equal opportunity, yet equality is not sufficient in a urban communities. These kids need more. We need to think about equity, not equality. It is not enough to hide them away. Be silenced no more!

SUBMIT YOUR VIEWS ONLINE: The Obama-Biden Transition Project

Elyssa D. Durant, Ed.M.
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Elyssa D. Durant, Ed.M.