Go After The System, Not The Individuals

So I read about the Immigration and Customs Enforcement (ICE) raids conducted at six meat plants in six states. (NYT, LATimes, WaPo) The idea of an immigrant round-up is disturbing in itself, but I was struck by the justification for these raids: workers at these plants had allegedly stolen identities of US citizens in order to work there, and thus they need to be deported. Really?? ICE is on a witch hunt for identity thieves in immigrants' clothing?

Going after workers themselves hardly seems like the way to change a system that basically promotes ID Theft. Many of the workers at the plants were suspected to be undocumented, and using falsified documents to work here in the States. I think it is wrong to pretend to be someone else. It is also wrong for companies to hire these workers in the first place. Companies across the country know that only the weakest of efforts are required to stay off the hook for hiring undocumented workers. A program called Basic Pilot verifies documents presented by a potential employee. And then it's over for the employer--they did not knowingly hire an undocumented immigrant once the program gives a green light. The fact is that the program shields employers by not . They can hire cheap labor and exploit workers, then when the feds come-a-knockin' the company shows that they used Basic Pilot. That makes the company free and clear...to go and replenish the labor force with new undocumented workers. Let's note that the company that owns the plants has not been charged. I guess that means it's looking to hire, if anyone is interested.

Deporting these individuals will probably have little effect on the future hiring of undocumented workers. Maybe the people who are actually stealing and selling other people's Social Security numbers should be targeted. Maybe the corporations so desperate to increase quarterly profits they prey on immigrants to cut labor costs should be targeted. Not only do the raids seem futile in terms of preventing future undocumented workers from being hired, it's also separating families and destabilizing communities. I think ICE was way off target with this one. There are better ways to prevent Identity Theft, and they don't include thinly veiled attacks on immigrants.

Many of us are looking for a way to reform the system by which new Americans can arrive and succeed here. There was a real outcry for progress last spring and summer. Yes, we want to keep offering the American Dream. Well, we're not really offering the Dream if we criminalize the very desire to achieve it. Rather than making systematic changes in labor and immigration policy, our federal government chose to turn a dear ear to our outcry, and go after individuals. In the near future, I hope to celebrate positive immigration reform. And I hope we realize that the path to citizenship cannot be paved with ICE raids.

Mixed Messages from the Supreme Court

Many of us who attended Monday’s Supreme Court arguments in a pair of school integration cases are still reeling with a mix of emotions—pride, dejection, hope, and, at times, outrage. 

In these cases, the Court will decide whether modest, voluntary efforts by Louisville, Kentucky and Seattle, Washington to keep their schools diverse and inclusive somehow violate the Constitution.  It seems amazing that this question is even before the Court, but Monday’s argument made clear that even these meager, uncontroversial efforts are very much in jeopardy.

As we waited on line outside the Court, it was inspiring to see a huge crowd of students, parents, and other everyday folks marching in the cold to support integration. 

As the arguments proceeded, it was heartening to see Seattle and, especially, the formerly-segregated city of Louisville, vocally defending their right to protect inclusion and the promise of Brown vs. Board of Education. 

And it was stirring to hear Justice Breyer’s eloquent explanation of why careful efforts to promote integration fulfill the core purpose of the 14th Amendment and are clearly constitutional.

The Court’s other three moderate members—Justices Stevens, Souter, and Ginsberg—appear to agree with Justice Breyer that these communities’ efforts are not just constitutional, but vital to the future of our increasingly diverse and interconnected society.

All eyes, however, were on Justice Anthony Kennedy who, with the departure of Sandra Day O’Connor, is now the ideological center of the Court and the key swing vote in cases like these.  Justice Kennedy began his questioning (in the Seattle case, which was argued first) in measured tones that seemed to reflect an effort to balance competing interests.  But as the two hours wore on, the tone and content of his questions were often troubling. 

Perhaps most distressing, Justice Kennedy seemed actively resistant to the reality that promoting inclusive and integrated education—which he appears to support as a compelling governmental interest—necessarily requires an intentional consideration of the demographics of the students who attend the schools. 

Kennedy repeatedly asked about school siting decisions (i.e., locating new schools in places calculated to draw an integrated student body), magnet schools, and other strategies that he presumed to be less focused on student’s individual characteristics.   But, as the lawyers for Seattle and Louisville pointed out, those communities had tested and considered a range of efforts, and found them to be ineffective.  And, as we’ve seen in voting rights cases, the drawing of attendance zones (like electoral districts) still requires a consideration of individual demographics. 

More hopefully, Justice Kennedy seemed impressed with Louisville’s successful transition from a community with enforced segregation to one in which residents and their elected officials are actively choosing integration.

Ultimately, it seems the key to how these cases are decided, will be whether Justice Kennedy accepts the reality of what’s required to achieve integration in any meaningful way.

The argument also offered plenty to be angry about.  First, there was the Court’s rejection of the NAACP Legal Defense Fund’s request, as a litigating “friend of the court” in these cases, to share the school districts’ argument time—a request that the schools supported.  The absence of a voice for communities of color or civil rights—and the presence of the Bush Administration, which is opposing the integration plans—created a stunning scenario: Two city school districts (one of them segregated as late as 2000) arguing with dissenting white parents and an anti-civil rights Bush Administration about the future of integration in America.  That there was no racial or gender diversity among the lawyers arguing the case made the scene all the more stunning.

Also striking was the fact that the Seattle and Louisville lawyers—though able and committed—were not constitutional or civil rights experts, nor were they experienced Supreme Court litigators.  The eloquence and expertise of Ted Shaw, Director-Counsel of the NAACP Legal Defense Fund, was especially missed at the argument.

Another source of outrage was the hostile and at times offensive commentary of Justice Antonin Scalia.  No one was surprised that Justice Scalia believes these plans to be unconstitutional.  He has never voted to uphold a program designed to promote diversity or integration in education.  But the tenor and content of his comments in Monday’s case were, at times, breathtaking.  Most striking was his implication that only a white-controlled school board could be assumed to have benevolent motives in adopting an integration plan, while the same action by a majority-black school board would be inherently suspect.  The following exchange—between Justice Stevens, Justice Scalia, and Solicitor General Paul Clement (who presented the Bush Administration’s position) reflects a bit of Justice Scalia’s position:

GENERAL CLEMENT: Absolutely. And it also has some real world consequences when we decide we're not going to apply the normal scrutiny we would to racial classifications just because we've made some -- I don't know based on what judgment that in this case, it is benign, so we can trust the local school officials.

JUSTICE STEVENS: Well, it isn't that we've made a judgment, the local school board has made a judgment which has a lot of experience under both systems.

GENERAL CLEMENT: There's a lot of experience in Brown, too, and those were local school boards, too. And I think the lesson is --

JUSTICE SCALIA: Do we know the race of the school board here? I mean, that was not -- how do we know these are benign school boards? Is it stipulated that they are benign school boards?

GENERAL CLEMENT: I missed that in the joint stipulation, Justice Scalia.

You can hear the full oral argument of the Louisville case by clicking here, and the Seattle case by clicking here.

The other remarkable theme that we heard from Justice Scalia, the Solicitor General, and Chief Justice Roberts was that considering students’ race to promote integration and inclusion is the constitutional and moral equivalent of considering race to promote segregation and exclusion.  This is just the kind of twisted analysis, detached from our country’s past, present, and future, that many Americans feared when they opposed Roberts’ elevation to the position of Chief Justice.

Justice Alito, for his part, was more nuanced in his questions, focusing on the details of the two plans.  But his questions also seemed strongly to indicate that he believes these plans to be unconstitutional, at least in their specifics.

So how should we think and talk about these cases in the months before the Court announces its decision?  We think it’s important to:

  • Point out the flawed logic and constitutional theory that underlay many of the Justices’         questions—as well as the Bush Administration’s position;
  • Hold up the enlightened comments of Justice Breyer and his moderate colleagues on the Court; and
  • Communicate our hope that Justice Kennedy will come to grips with the real life implications of this case and its importance to the future of our nation.

Looking forward, it will be important to encourage communities to promote integration to the full extent allowed by the Court’s decision, once it’s announced.  And, beginning next year, it will be crucial to demand of the new leadership of the Senate Judiciary Committee that they refuse to confirm judicial nominees who do not show an understanding of our nation’s history and current reality, or of the proper role of the Equal Protection Clause.

Bringing Human Rights Home

Alan's latest piece is now up at TomPaine.com.  Go give it a read, and listen to what New Yorkers think about human rights in our video on the left.

What if the world’s governments came together and agreed on the fundamental rights that every human being must have in order to enjoy basic dignity, opportunity, and
a meaningful life? What if their agreement was profoundly progressive,
recognizing civil and political rights like free speech, due process,
and non-discrimination, as well as economic and social rights like the
right to health care and housing, to organize, and to receive a living
wage for a hard day’s work? And what if they memorialized those rights
in a seminal document, from which more specific commitments and
enforcement could and did flow?

Most Americans would be surprised to learn that such a document exists. It’s called the Universal Declaration of Human Rights and it turns 58 years old this December 10—International Human Rights DayRead More>>

More School Cases Links

You can listen to audio of today's hearing via C-Span online, or read a transcript (pdf).

For the hardcore lawyer types, ACS Blog has the goods on Amicus Briefs and legal history of the issue, as well as a round-up of some interesting interviews you can stream online.  To their great round-up, I'd also add this radio program from The Mainstream Media Project.

In the print media, the Washington Post and the New York Times both feature articles covering demonstrations at the court today, while the Op-Ed page of the Times endorses the decision of the lower courts, which upheld the school districts right to create more diverse classrooms.  The Op-Ed frames the issue as a matter of states/local rights.

Don’t Call it Health Care Reform: Shifting the Responsibility to the Individual

Efforts to make Americans responsible for their own health care are popping up everywhere. My problem with these “individual responsibility” approaches to health care reform is that they neglect very real and high-impact circumstances beyond a person’s power. Lack of transportation, lack of health insurance, lack of dependable child care, and inflexible job schedules are just a few of those circumstances. Making a person solely accountable for their health lets too many people (ahem, government) off the hook for providing the necessary tools to make healthy decisions. The damage that this “do it alone” attitude can do is exemplified in two recent news stories.

Last week the Kaiser Family Foundation released a survey of people in “consumer-directed health plans” and found that the benefits of being a savvy health care consumer are overshadowed by the drawbacks. These new plans have very low premiums but very high deductibles. Instead of traditional plans where you might pay a small co-payment for a doctor’s visit or prescription medications while paying a larger monthly premium, these plans often require the consumer to pay out-of-pocket for these services until the coverage kicks in. The study found that half of the enrollees would switch out of the plan if given the choice. Additionally, the enrollees were twice as likely as those in traditional plans to report that they went without care due to cost.

The surveyed enrollees tended to be wealthier, better educated, and healthier than the average American. If traditional plans lose healthy and wealthy enrollees to the new plans, I can’t help but think that we all will experience some very negative effects of this division. A story in The Washington Post had a quote from Gail Shearer of the Consumers Union that really put the situation in perspective:

Instead of our health system moving towards one where we're all in this together, this type of option is leading to more splitting the population into different segments and, to me, that's an unhealthy thing," Shearer said. She added that poorer, sicker consumers could get left behind.

Another effort to make people “individually responsible” for their health comes from West Virginia by way of The New York Times. The state has reorganized the way it offers Medicaid by making enrollees pledge to be personally responsible for their well-being by doing things like getting regular check-ups, taking prescribed medications, and being on time to appointments.

“Those signing and abiding by the agreement (or their children, who account for a majority of Medicaid patients here) will receive “enhanced benefits” including mental health counseling, long-term diabetes management and cardiac rehabilitation, and prescription drugs and home health visits as needed, as well as antismoking and antiobesity classes. Those who do not sign will get federally required basic services but be limited to four prescriptions a month, for example, and will not receive the other enhanced benefits.”

I’m not a doctor, but wouldn’t those “enhanced benefits” be useful for all Medicaid patients? And wouldn’t those services go a long way for improving a person’s health—more so than a promise to be on time to appointments?

So why not offer the best possible care for all Medicaid patients, and start by putting community health centers in each community that that needs one. Keeping a clinic open late could do a lot to ensure that working parents can see a doctor after their kids get out of school and after traditional business hours. Making sure that physicians and staff speak the same language that their patients do could make the care accessible and more effective for people with limited English proficiency. Offering transportation to and from the doctor’s office would guarantee that those without a car could make it to their appointments without having to rely on (less dependable) mass transit. Those are just a few ideas that could go a long way towards helping people to make healthy decisions. Perhaps empowering people with these resources is scarier than just punishing people for lacking them, but let’s get over that fear and truly commit to promoting healthy behaviors.

Affirming School Diversity

This is a guest post by Robert Anthony Watts.

The (Seattle) plan does not segregate the races; to the contrary, it seeks to promote integration ... There is no competition between the races, and no race is given a preference over another ... The program does use race as a criterion, but only to ensure that the population of each public school roughly reflects the city’s racial composition.

--Judge Alex Kozinski, Ninth U.S. Circuit Court of Appeals
Appointed in 1985 by President Ronald Reagan

School officials and community leaders in Louisville, Kentucky (Jefferson County) have to be shaking their heads.

In 1975, Louisville was the scene of tumultuous, bitter civic strife as court-ordered busing was initiated to integrate the local schools. White parents rose up in furious opposition.  Buses carrying children were pelted by eggs and rocks. Police officers in helmets and riot gear worked overtime to protect buses and school children. The Ku Klux Klan held meetings and prominently took a role in opposing busing.

A funny thing happened in Louisville: the protests died down, tensions eased, and the idea of racially integrated schools gained wide support among blacks and among whites.  Over time Louisville school officials adjusted their plan to give parents much more choice and freedom in where their children attend schools.

In the history of school desegregation, the experience of the Jefferson County school district (the county and city merged its school districts in the early 1970’s) is one of the successes.  Indeed largely because of Jefferson County, Kentucky has the most integrated schools in the nation, according to the Harvard Civil Rights Project (pdf).

In 2000, the Jefferson County school district was released from federal court supervision after a judge concluded that it had removed “all vestiges” of segregation. Jefferson County could have returned to a “neighborhood” school plan. But given the prevailing pattern of housing segregation in Jefferson County (and in the nation), this option would have meant the end of integrated schools for 30,000 to 50,000 of the district’s 97,000 students.

What’s more, the community had come to desire integrated classes.  Parents wanted their children in classes with members of other groups.  Acting on its own, the Jefferson County school district decided to maintain its policy of creating integrated schools.

Today, the U.S. Supreme Court will hear oral arguments in a challenge to the Jefferson County diversity efforts and to similar efforts in Seattle, Washington.  Plaintiffs in each case have sued their school system alleging discrimination on the basis of race.

Fifty years ago in Brown v. Board of Education, the Supreme Court concluded that the 14th Amendment was intended to reject segregation and to bring the country together.  In the years since Brown, although de jure segregation has been largely eliminated, de facto segregation remains a barrier to creating opportunity for all Americans. In the last two decades, African American and Latino students have become more segregated from white students, according to a recent study by the Harvard Civil Rights Project (pdf).

No one knows the exact number of school districts and programs that could be affected by the ruling.  But dozens of school systems have programs and policies—often “magnet” programs—to create diverse schools and diverse classes.

What’s important is that most of these recent efforts have been implemented by local officials responding to the desire of parents to send their children to integrated schools.  In Seattle and in Louisville parents, students and community leaders strongly endorse diversity.   Also important is that plans like those in Louisville and Seattle are highly flexible plans in which race is one factor among several for how students are assigned to school.

These cases also allow Americans a chance to reflect on the importance of diverse schools in breaking down barriers and creating a society that allows everyone an opportunity to fulfill his potential.  As the United States becomes more and more multiracial, and as school officials ponder new efforts to create integrated classes, they can draw upon a broad body of research that reveals the many benefits of an integrated classroom.

A key finding—cited by Louisville and Seattle in their court briefs—is that integration produces educational benefits as well as societal benefits of increased racial and ethnic understanding.  Research also shows that racially diverse classes improve critical thinking skills for all students, and that learning in a diverse setting improves problem solving and communication skills for all students.

Other research findings conclude that:

  • Increased interaction among different groups is associated with lower levels of prejudice
  • Students who have attended integrated schools (including Jefferson County and Seattle) say integrated classes better prepared them for work and for public life.
  • Experiences in diverse classrooms allow people to work more productively with members of other groups.
  • White students in integrated schools display greater tolerance and less fear than white students in segregated schools.
  • Minority students who graduate from integrated schools are more likely to have access to social and professional networks that have traditionally been available only to white students.Diverse schools can be structured to make positive outcomes more likely.
  • Diversity efforts have resulted in modest improvements in reading and English for minority students.

Now that the United States has moved beyond the rancor and turmoil associated with court-ordered school integration, it would be sadly ironic if the Supreme Court places the breaks on voluntary programs like those in Louisville and Seattle.

Americans have made major progress in race relations since Brown.  Diverse schools have been part of that effort.  Americans have come to embrace diversity in great numbers.

The Supreme Court needs to affirm the importance of integrated classes.

Images of Opportunity

The Doors of Opportunity IIHere are The Opportunity Agenda, we are fortunate to have a strong partnership with the New School University in New York, where we teach a class on media and social justice, and work with some great professors who use our organization as a case study in their classes.  Most recently,
Professor Kit Laybourne used our organization as the "client" in his media production class.

Students in the class were tasked with producing an image that was representative of:

  1. an issue area in which The Opportunity Agenda was active; and/or

Redemption is in our Nature

one of the 6 Core Opportunity Values that we use as the basis of our framing. 

Students tasked with producing two images.  One of which contained text and could function as an iconic image on our blog or website when we cover a particular issue or message around a particular core value.  The second image was designed specifically for use by others.  It was to contain no text, and was meant to be a "blank canvass" that other nonprofit organizations or social justice activists could use to remix and reuse the images for their own work.  To that end, all images were to be original photos taken by the students, original graphic illustrations, or images found under a suitable creative commons license

Community Graphic

The results are in, and we're really please with the results.  I've created a Flickr set of the images and tagged the photos with a number of common tags - non profit, creative commons, etc.

I'd invite you take a look at the work the students produced, pass the
photos around, and use them in your own work.  If anyone has questions
about our process, usage rights, or recommendations on how we might take this to the
next level, please let me know.

All the images can be viewed here, on our Flickr page.

Schizophrenia at The Times; Unequal Treatment for the Patients

Over at the New York Times, it looks like the left hand doesn't know what the right hand is doing.  Readers today may have noticed a distinct schizophrenia between the Times coverage of New York State Hospital closures on the front page and on its editorial pages.  Unfortunately, despite two tries, the Times still fails to get the story right.

The front page notes that while the Berger Commission proposed closing 9 hospitals, other recommendations on "right sizing" 48 other institutions constituted sweeping change that could have profound effects on NY State health care:

The nine hospital closings, with five of them in New York City, have received the most attention, but other elements in the plan could have
greater effects. Stephen Berger, the commission chairman, said at a news conference that far more significant were the commission’s proposals to reshape dozens of other hospitals through mergers, downsizing, the elimination of some services and the addition of others.

“The reason this is a big deal is the 48 reconfigurations,” he said.

officials agreed with that assessment, and said they were taken aback by the number and detail of changes that some described as micromanaging.

Over on the Op-Ed page, however, the Gray Lady's editorial board praised the Commission for its "modest" and "courageous" actions in reigning in New York's wayward hospital system.  For the editors, the only real problem lies with the legislature - "cowards" who might choose to reject the courageous commission's recommendations. 

Both articles fail to note that the closings and restructuring will likely exacerbate existing health disparities - particularly in major metropolitan areas - and take jobs away from many health care workers.  Both articles also fail to note that the chance of the legislature rejecting the Commision's recommendations are next to zero due to a promised federal bail-out of the system (to the tune of $1.5 Billion) contingent upon the state's acceptance (pdf) and implementation of the commission's recommendations.

Our partners at New York Lawyers for the Public Interest covered this much more thoroughly and eloquently than I could.  Here is a letter they sent to Governor Pataki and Governor Elect Spitzer about yesterday's announcement:

Governor Elect Eliot Spitzer

Governor George Pataki

State Capitol
Albany, NY 12224

Re: The Commission on Health Care Facilities in the 21st Century’s Failure to Address Racial Disparities in Access to Health Care

Governor Pataki and Governor Elect Spitzer:

We write today because we are deeply concerned that the recommendations of the New York State Commission on Health Care Facilities in the 21st Century (the Berger Commission) did not fully address the disparate impact down-sizing of health care will have on already medically underserved communities
of color and poverty in New York City. Scant resources stand to be further depleted for communities that simply cannot withstand, and should not be required to withstand, any further reduction – particularly without any plan for building health care infrastructure to address the critical health needs in these neighborhoods. 

We appreciate the hard work that the Berger Commission has undertaken to tackle serious financial strains in our health care system. However, priority should have been given to addressing racial disparities in access to health care, disparities which have been known for decades, and which are intolerable in a modern society with resources such as ours.

The tragic disparities in incidence of disease, morbidity, and mortality have been known for many decades. During a period of economic trouble in the late 1970s, experts such as Alan Sager testified before Congress about the dangers of closing urban hospitals that were needed in medically underserved communities. In the early 1980s, communities fought the threatened closure of Sydenham and Metropolitan Hospitals serving Harlem.

In 1993, the now defunct Health Systems Agency (HSA) of New York City issued a final report, “A Framework for Primary Care Needs Analysis in New York City,” which documented gross disparities in access to care and severe health care shortages in communities of color.  On a national level, in 2003, the Institute of Medicine of the National Academy of Sciences issued a report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” which crystallized the need to address and remedy disparities in access to care. And, in 2005, Bronx Health Reach published a report, “Separate and Unequal: Medical Apartheid in New York City,” documenting extreme disparities in access to health care institutions in New York City. 

Why,after so many decades of awareness of the terrible problems with racial disparities in health status and access to care, does the state of New York propose a plan that fails to challenge, much less begin to fix, the dire state of our status quo when it comes to racial disparities in health status and access to health care?

Communities such as Central Brooklyn are medically underserved areas by any definition of the term, including the United States Department of Health and Human Services’ definition. Nonetheless, Central Brooklynhas recently suffered losses of critical hospital services. Why, after years of hospital losses and down-sizing in areas like Central Brooklyn, did the state of New York create a Commission that sets in motion further down-sizing without a concomitant mandate to tackle the problem of the underserved?

The debate to ensue around the Commission’s recommendations and the transition in leadership in 2007 presents us with a critical opportunity to focus, and to redirect resources to address critical health care needs in underserved communities in New York City and across the state. We ask that you work together during this period of transition to ensure that the Berger Commission’s down-sizing is not the legacy of this moment. We ask for a moratorium on closures and down-sizing in medically underserved areas until real plans are made for new institutions to fill in the gaps; until plans are created for conducting needs assessments; until plans for primary, ambulatory, and specialized care for underserved populations are developed. We ask that you follow the principle first do no harm.

The Crisis in Central Brooklyn

A number of communities of color in New York City do not have sufficient access to health care facilities or health professionals, resulting in well documented and extreme health disparities. Despite these shortages, the State has made the untenable decision to close financially struggling hospitals, but yet has
made no express commitment to preserve—let alone improve—health services in medically underserved areas, and the health of the poorest New Yorkers will only deteriorate and become a further burden on the safety-net hospitals that escape closure.

Without comprehensive community and health planning, closing hospitals is a short-sighted attempt at saving dollars, as it will immediately overburden nearby hospitals, and over time allow some of the sickest and the poorest to become much sicker.  Building access to primary, ambulatory and specialty care to treat and control chronic illnesses would have long term financial benefits for the state, but thus far the state has unfortunately not chosen to cast its sights in that direction.  Any workable solution to New York’s health care crisis, including the State’s Medicaid budget, must include community health planning and a needs assessment to ensure sufficient access to health care. Yet, the Berger Commission has taken none of these necessary steps before making recommendations that will irreparably change the State’s health care system. 

A prime example of the inequities in New York’s health care system can be found in Central Brooklyn, a medically underserved community that is approximately 90% African-American and Latino, and in some areas suffers an infant mortality rate approximately three times the rate in wealthier parts of Manhattan. The health risks to infants born in Central Brooklyn should come as no surprise given the shortage of hospitals and other providers in that area. Despite a surge in population over the last forty years, Central Brooklyn has experienced a 40% reduction in hospital beds during that time period, and recently lost desperately needed maternity beds at St. Mary’s Hospital (now closed) and Interfaith Medical Center Central Brooklyn, with a population of more than 350,000 women, now has only 104 certified obstetric beds. By comparison, the Upper East Side, with an 82% white population, and a population of only approximately 111,060 women, has at least 234 certified obstetric beds. The inequitable distribution of hospital resources has dire consequences: the Brownsville section of Central Brooklyn has an infant mortality rate of 12.2 infant deaths per thousand, while across the river in the Upper East Side, the infant mortality rate is a mere 3.7. These disparities should not be tolerated.

By approving the hospital closures and down-sizing in recent years in Central Brooklyn, which is already medically underserved, the State not only deprived African-American and Latino mothers of critical health care, but also treaded on federal regulations promulgated under Title VI, which prohibits actions with racially disparate impacts.  Given this landscape, the Berger Commission’s failure to propose community planning to redirect resources toward addressing critical health care needs in underserved communities is a missed opportunity.

The Berger Commission

Had the Berger Commission examined racial disparities and more fully taken community needs into account, the resulting recommendations could have included recommendations for the development of infrastructure in medically underserved communities. But instead, the Commission’s process lacked
transparency, public participation, and consideration of the most pressing problems in medically underserved communities – lack of access to care. 

It is unconscionable to change the State’s health care system fundamentally without a transparent process, public participation, and political accountability. Yet, the Berger Commission’s structure has resulted in a patently undemocratic process that disadvantages the residents of New York City. For example, despite having 42% of the State’s population, New York City was considered only one of six statewide health care regions.  New York City is underrepresented in the Commission’s body, which is equally represented by six regions, which may account for why five of the nine hospitals slated for closure are in  New York City.

An unelected body is effectively rewriting established public health law. Even the limited oversight that the Senate and Assembly retains over the Commission is illusory, as the legislature will not convene in regular session during the 26 days they have to debate and pass a resolution rejecting the recommendations.  It is telling that the state has devised a relatively quiet and unaccountable method for making these politically difficult choices about hospitals. Would that such imagination was applied to solving the problems of racial disparities in access to health care in this city and state.

A Call to Action

In reaction to the Berger Commission, the New York City Health and Hospitals Corporation has found that, “hospital closures could eliminate a major source of primary care and exacerbate existing shortages, particularly those experienced by low-income New Yorkers. This would worsen community health status, heighten disparities, and increase costly but avoidable emergency room and inpatient
utilization.”  The Boston School of Public Health has issued a report, “Closing Hospitals Won’t Save Money But Will Harm Access to Health Care,” warning of the short-sightedness of the Berger Commission.
The Save Our Safety Net Coalition, a group of community advocates and labor has advocated for repeal and re-tooling of the Berger Commission’s enabling legislation. The Primary Care Development
Corporation has issued a report calling for much needed investment in primary care for underserved areas. The message is clear: first do no harm. 

The Department of Health and the office of the Governor have the ability to envision creative solutions, and the power to execute them. We ask that you take this critical opportunity to focus, and to redirect resources toward addressing critical health care needs in underserved communities in New York  and across the state. We ask for a moratorium on closures and down-sizing of hospitals in medically underserved
areas until plans are made for new institutions to fill in the gaps, for conducting needs assessments, and plans for the development of primary, ambulatory, and specialized care for underserved populations. We ask that you do no more harm. After 40 years of neglect, medically underserved communities deserve your leadership now.

We would welcome the opportunity to meet with you to discuss plans for building health care infrastructure in medically underserved areas, and addressing the racial and ethnic disparities in health care in New York in the coming days.

For more information - including fact sheets, maps (of New York City), and reports, visit The Opportunity Agenda

If you would like to take action, you can send you comments to the state assembly here:


Or write to the New York Times about its coverage.

Dangerous and Unlawful

As some of our readers may know, today is a big day for the New York State Health Care System.  The Commission on Health Care Facilities in the 21st Century (aka the Berger Commission) released their recommendations on "right sizing" the New York State Hospital System.  The commission recommended closing 9 hospitals - 5 of which are in New York City.  While the practical effects of the commission's recommendations must still be

The Opportunity Mandate

I just want to add one thought to the great piece that our executive director currently has posted at TomPaine.com (which you should all go read). 

Alan makes the point that this election wasn't just about Iraq, but about the economy broadly defined as the opportunity for every American to get their shot at the American Dream:

Voters have clearly shown a yearning for a new domestic agenda. This
time, it’s not just the economy on voters’ minds, but something deeper
and more profoundly American: opportunity.

While the economy, narrowly defined,
may be relatively healthy, more and more Americans see our national
promise of opportunity—the idea that everyone in our country should
have a fair chance to achieve his or her full potential—moving farther
out of reach.

A recent CNN poll found
that 54 percent of Americans feel “the American dream has become
impossible for most people to achieve.” And 55 percent say they’re
dissatisfied with “current opportunities for the next generation to
live better than their parents.” A poll of American workers commissioned by Change to Win found that 81 percent believe “no matter what you hear about the economy, working families are falling behind.”

This rising sentiment is not only about economic conditions, but
also about national values like fair treatment, a voice in decisions
that affect us, a chance to start over after misfortune, and a sense of
shared responsibility for each other.

I think this is right, and just wanted to point out that it was also the main message in some of the Democrats more surprising pick-ups this November.  Jim Webb, who beat out George Allen, just published an op-ed in the Wall Street Journal calling for fairness in the economy.  Here's some excerpts:

This ever-widening divide is too often ignored or downplayed by its beneficiaries. A sense of entitlement has set in among elites, bordering on hubris. When I raised this issue with corporate leaders during the recent political campaign, I was met repeatedly with denials, and, from some, an overt lack of concern for those who are falling behind. A troubling arrogance is in the air among the nation's most fortunate. Some shrug off large-scale economic and social dislocations as the inevitable byproducts of the "rough road of capitalism." Others claim that it's the fault of the worker or the public education system, that the average American is simply not up to the international challenge, that our education system fails us, or that our workers have become spoiled by old notions of corporate paternalism.


Most Americans reject such notions. But the true challenge is for everyone to understand that the current economic divisions in society are harmful to our future. It should be the first order of business for the new Congress to begin addressing these divisions, and to work to bring true fairness back to economic life. Workers already understand this, as they see stagnant wages and disappearing jobs.


With this new Congress, and heading into an important presidential election in 2008, American workers have a chance to be heard in ways that have eluded them for more than a decade. Nothing is more important for the health of our society than to grant them the validity of their concerns. And our government leaders have no greater duty than to confront the growing unfairness in this age of globalization.

Hopefully Webb is right - and his colleagues take his concerns seriously.  The American people voted for change. They voted for a restoration of opportunity and the American Dream.  It's the responsibility of our newly elected leaders to make that happen.

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