On Monday, Judge Henry Hudson of the federal district court in Richmond ruled unconstitutional the provision of Affordable Health Care Act that would require all Americans to carry health insurance. A few days earlier, almost as though he expected such a setback, Jim Mangia, President and CEO of St John's Well Child & Family Center, said "There couldn't be a more challenging time to do this work," as he welcomed almost 1,000 community members and service providers to the LA Convention Center on Friday, December 10--International Human Rights Day--for the second South LA Health and Human Rights Conference.
As reported here last year, the first conference in June 2009 reframed access to health care, including behavioral health services, as a human right and recognized that access to housing, education, employment, fresh food, environmental and public safety are integral to good health. The Declaration that emerged from that event was released publicly one year ago and this year's conference was intended to move signatories "from declaration to action."
Before I go on to the many challenges, I should follow the lead of Second District County Supervisor Mark Ridley-Thomas who reminded us, "Given where we were a year ago, there has been significant progress. We should not allow people to drown out our successes." Martin Luther King, Jr. Hospital reopens in 2012. This June, South LA will see the opening of a public health clinic, and of a new emergency room suite at Harbor-UCLA -- an ER where, incidentally, a woman recently waited 24 hours to be seen while other patients fought for a place to sit as there weren't enough chairs to go around. These new facilities are at least a step in the right direction for a neighborhood that has been designated by the federal government as MUA/MUP, i.e., a Medically Underserved Area/Medically Underserved Population.
Now, the challenges:
Dave Regan, executive vice president of the Service Employees International Union (SEIU) who also serves on the Health Care Division Steering Committee, said he hopes to train and deploy 5,000 health care workers to do outreach and defend reform against attacks from the incoming Republican Congress.
But defending Affordable Care is not enough. We can't leave implementation up to others but have to start planning now, said Robert Ross, president and chief executive officer of the California Endowment, a foundation focused on the health needs of underserved Californians and one of the sponsors of the conference. "Get folks enrolled," he said, aiming for 100% enrollment in California. "We need to educate the public." In doing public opinion polls, the foundation learned the extent to which people had been deceived or confused.
Several days later, on Tuesday, the California Endowment as part of its Center Scene public programming, exposed how deception happens by hosting Wendell Potter, former insurance company executive and PR man, whose new book, Deadly Spin, gives an insider's view of how insurance companies influence opinion and policy.
Potter sees himself now "making amends," and has publicly apologized to Michael Moore for trying to discredit him and his health care documentary Sicko. One example of spin: Insurers now get generous subsidies from the federal government for participating in Medicare Advantage plans. Under the Affordable Health Care legislation, these subsidies are reduced, but, Potter explained, the insurance companies mounted a campaign telling seniors that it was their own personal benefits that would be cut.
Potter has an interesting take on Judge Hudson's decision. He thinks the mandate for individual coverage, in the absence of a competing public option, amounts to a "profit protection and enhancement plan" for insurance companies. He wondered if Republicans will realize they are pushing an agenda that cuts into the profits of the companies that spent millions putting them in office.
During two decades in the health care field, Potter saw nonprofit hospitals overtaken by the proliferation of for-profit businesses. Insurance companies divested themselves of other divisions and focused on health insurance as the most profitable area. Patient care got a smaller share of resources, not only because of astronomical salaries to top executives and the costs of advertising and public relations, but the "relentless pressure from Wall Street." When you're for profit "you have to meet Wall Street's expectations and profit expectations of your investors and you have to report every three months." It means health insurance corporations focus on the short-term stock prices and profits instead of health care.
This distorted emphasis leads to the transfer of more costs to consumers. At Friday's conference, Dave Regan reported that some of his union members now face a contract battle at Centinela Hospital which is owned by Prime Health Care--a family business and the second largest hospital system in California. The company wants to increase the employee share of premiums for family coverage by an additional $600/month. Workers can't afford so substantial an increase and are now looking to a situation where they, as health care workers, won't be able to afford health care coverage for their own kids.
Howard Kahn, instrumental behind the Children's Health Initiative of Greater Los Angeles and CEO of LA Care Health Plan which serves 800,000 low-income county residents, points out that health care itself only accounts for only about 20% of health outcomes. Genetics are important. But so are environmental factors and individual behavior which underlines again the interrelatedness of all human needs. Housing, education, employment, reliable buses (especially at night), child care, stoplights at dangerous intersections, safe parks where kids can exercise and play--without these, there's a negative impact on health.
To take Mark Ridley-Thomas's advice and focus on some success stories, think about conference panelist Robert Smith, an ex-felon who beat his substance-abuse problem and the odds after going through a program at the Midnight Mission. Smith landed a job with Regal Theaters because community organizations including SAJE (Strategic Action for a Just Economy) pressured the businesses at LA Live to hire local workers. Through his own efforts and work ethic, Smith was soon promoted to supervisor.
We learned that criminal records that so often stand in the way being hired can in some cases be expunged and advice and assistance is available from the Pepperdine Legal Aid Clinic at the Union Rescue Mission. Juvenile records can be sealed, but you must go through a process; it doesn't happen automatically.
The Community Rights Campaign recently won a concession from LAUSD -- a moratorium on truancy and tardiness tickets that led to expensive fines and often juvenile detention and even jail. (Though the school district's new plan for Attendance Improvement Centers raises concern as parents must pick their children up at the end of the day and if working parents can't get there in time, the kids are removed by the police.)
An example of hope and possibility came from special guest speaker, Violeta Menjívar, vice minister of public health and welfare of El Salvador, a former member of the FMLN (Frente Farabundo Martí para la Liberación Nacional )rebel movement. During the civil war, she provided medical care both to the FMLN as well as to government soldiers because, as she said with a sly smile, "the FMLN observed the Geneva Conventions." Describing her country as "small in territory but not in spirit," she reported that in the year and half since Mauricio Funes -- also formerly of the FMLN -- took office after his election as president, the new administration has rebuilt two hospitals which had been left undone due to corruption and the siphoning off of public funds. She is working to reverse the privatization of health care that occurred when public health budgets were cut, leaving care only for those who could pay for it. Her department is now implementing plans for preventive care, expansion of primary care, and expansion of basic free medical services to the rural areas where up until today none were provided.
The progressive administration is instituting price regulation on prescriptions medicines. El Salvador--one of the poorest countries in the hemisphere -- has also had the highest prices for prescription drugs which I would say can be traced back to the Central American Free Trade Agreement -- CAFTA -- with protectionist provisions that benefit Big Pharma by delaying the introduction of generic drugs. (Similar, barely noticed provisions are written into the proposed Free Trade Agreement with Colombia that has fortunately been stalled in Congress for other reasons for several years.)
More international perspective came via Deborah Borden who ended up homeless on Skid Row seven years ago after losing her job and health insurance. Now she's an organizer with LA CAN (Los Angeles Community Action Network). Deborah recently gave testimony about human rights abuses in Los Angeles to the United Nation's Periodic Review in Geneva, Switzerland and was part of the team that coordinated the visit of Raquel Rolnick, Brazilian architect, urban planner, and professor, sent by the UN to investigate and report on adequate housing in the United States as a component of the right to an adequate standard of living and on the right to non-discrimination.
Rolnick's report, presented in March, found "significant cuts in federal funding for low-income housing, the persistent impact of discrimination in housing, substandard conditions such as overcrowding and health risks, as well as the consequences of the foreclosure crisis." Specifically, she noted that over the past decade there has been a net loss of approximately 170,000 public housing units while "Each year, the federal government spends more than three times as much on tax breaks for homeowners–with a large share of the resulting tax benefits going to upper-income households–as it spends on low-income housing assistance.”
And "housing is not simply about bricks and mortar," she wrote, "nor is it simply a financial asset. Housing includes a sense of community, trust and bonds built between neighbors over time; the schools which educate the children; and the businesses which support the local economy and provide needed goods and services. Government policy has sometimes resulted in tearing apart this important sense of community, removing a source of stability for subsidized housing residents, and engendering a sense of mistrust of Government regard for their interests."
Indeed, at the end of the conference, about 200 participants traveled to Flower and 23rd to demand that community interests be taken seriously by the City Council. A young woman named Genesis sat in her wheelchair in front of the parking lot where the Los Angeles Orthopaedic Hospital used to stand and where she saw her doctors until the facility was demolished. Now, explained her mother, Sandra Matamoros, they must take three buses and travel three hours for the specialized care her daughter needs. The site is still zoned exclusively for medical and educational use, however real estate developer Geoff Palmer is asking the City Council to rezone it so he can move forward with the Lorenzo project and build luxury housing on the site. (Palmer is known for suing the city so he could get out of providing any affordable housing in his other faux-Italian developments: the Medici, the Orsini, and Pieri I and II.)
"No to luxury housing!" chanted the crowd. In South LA, the pressures of gentrification and loss of income now have two and three families sharing apartments that would be a tight squeeze for one. Even so-called "affordable housing," is beyond the reach of most when you consider that Los Angeles considers a living wage to be $12/hour. Though it beats the minimum wage, it still means a monthly income for a fulltime worker that, after taxes, won't go much further than market rent on a one-bedroom apartment leaving open the question of how to cover transportation to and from the job, food, clothing, utilities, school supplies, medical care for a family and all the other necessities for a normal, healthy life.
The challenges for the people of South LA are immense so it's essential to be, with a nod to Violeta Mendívar, big in spirit. At the contested site, many of the demonstrators were smiling. They had each other, after all, and the support of community organizations like SAJE, like LA CAN, like Esperanza Community Housing.
As Mark Ridley-Thomas told us, "if you want Movement to go forward, you have to celebrate it and not let anybody rob you of your joy."