Spring 1997 - Editor's Column: The Era of Reform: False Promise, Public Peril

xxAACP Newsletter, Volume 11, Number 2, Spring 1997

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Editor's Column: The Era of Reform:
False Promise, Public Peril

Over the past several years we have heard much about the need for reform. Few would disagree that many of our public systems were not working efficiently, and in many cases they were not working effectively. Many complained that government could simply not run social services effectively while others espoused the notion that we simply had not adopted appropriate program designs to address the needs of the population. Whatever the perspective on the cause of our troubles, it was becoming increasingly clear that social programs designed to improve the plight of the poor and disabled were costly and often failed to significantly improve the quality of life for the populations with which they were involved. Moreover, the impact of social decay on middle and upper class citizens was increasingly realized, even if by perception only. One of the results of these circumstances was a polarization of our society, accentuated by the widening gap between righ and poor in our nation.

Health care financing and welfare were two of the systems most often targeted for change and other governmental systems which were perceived to be inefficient or unwieldy added fuel to the fire of reform. We began to see politicians from all parts of the political spectrum calling for change. Reform implies the correction of evil or errors, to remove faults or abuses, to change or transform an ineffectual concept or system to one that is more likely to achieve a desirable out come. In that the concept of change is central to the idea of reform, reform movements have often been associated with progressive politics. The right side of the political spectrum has often eschewed change in favor of maintaining status quo. The power of reform movements are generally decided by a face off between the forces that wish to change perceived evils and forces that benefit from or otherwise see advantages in some or all aspects of the circumstances under consideration. As we consider the course of reform movements for health care and welfare, many of us can be seen standing on the sidelines, scratching our heads, and wondering what went wrong.

What we have seen is a series of changes masquerading as reform, when in fact what we have gotten is another helping of the same, only more so. Change is reform only if it corrects flaws and abuses. The changes we have seen appear to have only made matters worse in many respects. In health care, early hopes for universal coverage of adequate health care and prevention efforts across all sectors of society and all categories of illness, hopes to eliminate administrative waste and incentives to profit inappropriately from the provision of services, and hopes that services and resources would be distributed more rationally and that health care would finally be recognized as a right and entitlement in our society, were quickly dashed. Corporate interests lost no time in protecting their interests and unleashed a campaign of high magnitude to defeat these hopes for reform. As a result, we are currently comtemplating a scenario in which we have an ever growing number of citizens who have little or no health coverage (now estimated to be almost 40 million), we continue to have separate standards and systems for the wealthy and the poor, we have unprecedented administrative waste, we have seen health care management companies reap unprecedented profits through the introduction of "cost saving" measures, and we have made little progress in achieving parity for mental health and substance abuse treatment. The entities currently administering health care have changed dramatically, but is this reform?

Perhaps a true reform was achieved for welfare. Let's take a look. Our goals for welfare reform would be to create a system that would give hope and respect to recipients, would provide jobs and income for those able to work without penalty, would provide training and opportunity to persons from distressed communities, would stabilize families, and would provide for care of recipients' children so that meaningful employment would be possible. We would want to protect the health of recipients and their children so that they were able to become productive contributors to our society and economy.

Have we achieved these aims with current legislation? We have asked the states to take care of their own poor and we have mandated that they work. There is no mandate that jobs provide health insurance to their minimum wage employees, and there are no indications that opportunities for training and self improvement have significantly improved. The distress of our distressed communities seems destined to linger yet longer. As with health care "reform", while it may be true that we are ostensibly spending less money, there is little else here that reminds us of what we could genuinely call reform.

As health care professionals, instead of hope, we feel despair. How should we react to this failure of meaningful reform? The people we serve are faced with greater obstacles to recovery or rehabilitation than ever before. The children we see in our clinics are sinking deeper into poverty and those that are in the greatest distress are finding it more difficult to meet the criteria for benefits. As these children become adolescents, they will seek ways to escape the immediate torment that they experience, because they will see little hope for their futures. The mothers of these children, who sometimes bear the responsiblity to raise them alone, are being told that they must find work regardless of the fact that they will be forced to leave their children alone, uncertain of who will protect them and teach them. The men from these distressing circumstances will continue to find drug trafficking and other crimes one of the few viable alternatives when their eligibility for benefits and access to treatment for substance use diminish. As these men are placed in an ever expanding and increasingly expensive prison system, the family life and social structure of their communities will continue to deteriorate.

The promise of reform has been a false one, and we feel betrayed once again by a political establishment that appears to be too self serving and short sighted to make rational choices to guide our nation and protect our future. We should not be fooled when politicians speak to us about reform. They are likely referring to legislation that can do no more than place a bandaid on a gaping wound. As they attempt to repair this disabled vessel well enough to keep it afloat, who is that making off with the cargo from the hold? Who is it that sits back belching with self satisfaction after feasting on the spoils from the heart of our nation? Who will it be that will rise and say that this will not be tolerated any longer, that the health and the future of our nation hangs in the balance?

Wesley Sowers, MD
Editor

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