Tuesday, December 14, 1993

Female Support Systems: Buffering The Effects of Patriarchal Oppression

An Analytical Paper based on Incidents In The Life of a Slave Girl by Harriet Ann Jacobs and Lakota Woman by Mary Crow Dog

Since Europeans first invaded the New World five hundred years ago, America has been a patriarchal society. Men have held most of the strings of true power, occupying central positions in the ownership and management hierarchies of government, business, educational institutions, and the church. The system of patriarchal control derives its greatest strength from the false notion that there are two distinct spheres of human activity. The first is the public sphere of politics, business, etc., which is meant to be the domain of men; the second is the domestic sphere of raising children, cooking, and housework, supposedly ordained to be the domain of women.

Patriarchy thus has served the interests of all males by providing a legitimate social framework for men to avoid primary responsibility for performing some of life's hardest, most repetitive daily work, as well as denying women full access to opportunities that might place them on an equal footing with men in their intellectual, personal, and sexual relations, such as education and economic independence. It has also specifically served the interests of elite males by functioning as a mechanism of social control. Although the majority of men in America and throughout the world are economically exploited by a capitalist ruling class, under the ideological frameworks of male-dominated societies, even the most oppressed males can always feel superior to the women in their lives.

Compelling narratives of resistance to such oppression include works by Harriet Ann Jacobs (Incidents In The Life of a Slave Girl), Mary Crow Dog (Lakota Woman), Charlotte Perkins Gilman (The Yellow Wallpaper and Other Writings), and Agnes Smedley (Daughter Of Earth).

Collectively, these four largely autobiographical narratives reveal how different American women living in different times were forced to confront sharply diverging oppressive experiences under an omnipresent patriarchal system. A close reading of the texts reveals that all four women authors responded to and resisted the individual circumstances of their oppression in often similar ways.

One of the most recurring paths of resistance shared by these women authors was to buffer themselves from the system's most debilitating and dehumanizing effects. This was often done by forming close friendships with others around them who were being similarly oppressed for reasons of gender, namely, other women. By closely examining two of these narratives, Harriet Ann Jacobs' Incidents In The Life of a Slave Girl and Mary Crow Dog's Lakota Woman, I hope to provide an overview of how women's friendships with other women helped create protective social enclaves - female support systems within an overall gender-oppressive social order.

Mary Crow Dog's resistance was shaped from early on by the examples set by strong, independent women in her own family. Her grandmother, although a staunch Catholic and very set in her beliefs that "she was helping me (Mary) by not teaching me Indian ways" (Crow Dog, p 22), was very influential in making Mary aware of her heritage.

"When it came to basics, (she was) all Sioux, in spite of the pictures of Holy Mary and the Sacred Heart on the wall...She also spoke the Sioux language, the real old-style Lakota, not the the modern slang we have today. And she knew her herbs, showing us how to recognize the different kinds of Indian plants, telling us what each of them was good for" (Crow Dog, p 19).

She also learned of traditional Sioux ways from other female members of her family, such as her great aunt, and Elsie Flood, her grandmother's niece. Elsie Flood was a medicine woman, a "turtle woman," and she was very instrumental in Mary's early spiritual development (Crow Dog, p 23-25).

Her mother, although at first adamantly opposed to Mary's involvement with the Native American Church and the American Indian Movement (AIM), later expressed support for the choices her daughter had made. This conversion took place after the birth of Mary's daughter at Wounded Knee and her subsequent arrest and separation from her baby (Crow Dog, p 167). The potential inherent in female solidarity was underscored by this event. It was a time of crisis sparked by the system's injustice and intimately connected to the gender-specific oppression her daughter faced that resulted in this reconciliation.

A fairly well-developed female support system sustained Harriet Ann Jacobs (writing under the pen name Linda Brent) throughout her struggle against the hardships of slavery. Her early life was similar to Mary Crow Dog's in that she was blessed with a family network of close female relatives, several of them strong, independent women who she could model her own behavior after.

Harriet's grandmother, or "Aunt Marthy," as she was known, was the most notable. The daughter of a South Carolina planter who was freed upon his death but then captured and sold back into slavery (Jacobs, p 3), Aunt Marthy was extremely intelligent and hard-working. She hired out her baking services to other households in her mistress' community, saving the profits in order that she might eventually purchase her children (Jacobs, p 4). Upon her mistress' death, it looked as if Aunt Marthy might again be sold, but instead she benefitted from the kindness of another woman. She was purchased for $50 by the seventy-year old sister of her deceased mistress, who then proceeded to free her (Jacobs, p 10).

Through unrelenting toil, Harriet's grandmother was able to purchase her own house (p 15). Later, as Harriet grew older, this would be a place where she would take frequent refuge from her daily routine of servitude to her cruel master, Dr. Flint. When Harriet finally escaped from slavery, at the age of twenty-one (Jacobs, p 100), her grandmother's household became an even more literal place of refuge for her, as she hid in an attic crawl space above Aunt Marthy's shed for seven long years.

Harriet's Great-Aunt Nancy was also one of Dr. Flint's slaves. She provided Harriet with constant support and assistance during the years she spent as a slave, and an important refuge from her master's attempted sexual advances (Jacobs, p 31). She encouraged Harriet in her hopes for freedom, consoled her in times of distress and served as a source of information for her concerning Dr. Flint's doings during the period of Harriet's confinement.

Harriet's relationships with women beyond her circle of relatives and the important roles they played in her fight for freedom reveals the possibilities for struggle inherent in such a female community of resistance. Her close slave friend Sally aided her when she ran away from Dr. Flint's plantation (Jacobs, p 98). During her concealment at the house of a (female) friend of her grandmother's, a slave named Betty assists her repeatedly and conceals her presence from other less trustworthy slaves (Jacobs, p 101-114). Her friend Fanny escapes towards the end of Harriet's confinement in her grandmother's garret, and provides her with much needed company and support during their mutual voyage Northward as stowaways (Jacobs, p 153-164).

In particular, her relationships with white women show how the female solidarity created in response to one form of oppression carried over into another battleground. When Harriet's free-born lover wanted to purchase her, she enlisted a woman friend of her master's to intercede and try to persuade Dr. Flint to sell her (Jacobs, p 37-38). Dr. Flint's great aunt Miss Fanny, the woman who had manumitted Harriet's grandmother by purchasing her for $50, maintained an ongoing interest in the condition of her children and grandchildren (Jacobs, p 91). A friend of Harriet's grandmother who had known her from childhood, whose husband was a slaveholder himself, was the first person to hide Harriet immediately following her escape (Jacobs, p 101). Mrs. Bruce, who employed Harriet in the North after hes escape from slavery, became her close friend and supported her attempts to overcome racial prejudice and discrimination (Jacobs, p 180).

The numerous white women, Southern and Northern, who reached across racial lines to help Harriet at various stages of her struggle is in keeping with the massive female involvement in the anti-slavery petition-gathering movement of the 1820s and 1830s (Zinn, p 121). It suggests that women responded to the patriarchal oppression their sex resigned them to by finding common cause with victims of other forms of injustice.

In contrast, Mary Crow Dog's relationships with white women were fewer and less important to her narrative. When she was seven or eight, she made friends with a little white girl, still untainted by the racism of her parents, whose mother chased Mary out of her house with a butcher knife. (Crow Dog, p 21) When her husband Leonard was imprisoned in a maximum security prison in Lewisburg, Pennsylvania, she lived with a white couple in New York order to be near him (Crow Dog, p 112). In 1969 or 1970, Mary met a white girl around eighteen or twenty years old who had hitchhiked onto the Rosebud Reservation from New York.

"She was different from any other white person we had met before...I think her name was Wise. She was the first real hippie or yippie we had come across. She told us of people called the Black Panthers, Young Lords, and Weathermen. She said, 'Black people are getting it on. Indians are getting it on in St. Paul and California. How about you?' She also said, 'Why don't you put out an underground paper, mimeograph it. It's easy. Tell it like it is. Let it all hang out.'" (Crow Dog, p 36).

It was this meeting that inspired Mary and her full-blood friends Charlene and Gina to rebel against their Catholic mission school's power structure by publishing just such an underground newspaper.

For Mary, these white women (and others who she met through movement activities) were the exceptions. Most whites, men and women alike, who she encountered growing up in the Dakotas were racist and incapable of true empathy or solidarity with the battles she faced as an Indian woman. The real source of the strength she derived from her own female support system came from her close relationships with Indian women. Her Catholic school friendships with Charlene Left Hand Bull and Gina One-Star (Crow Dog, p 36-37) helped her to realize she was not alone in her suffering at the hands of the school authorities, and encouraged her to rebel. She became close friends with a Blackfoot woman named Bonnie from Seattle (Crow Dog, p 50) who she shoplifted with and experienced sexual harassment. Her closest friend was a MicMac Indian named Annie Mae Aquash, who Mary met at the occupation of Wounded Knee, and who was later killed under suspicious circumstances. "She (Annie Mae) was a remarkable woman, strong hearted and strong-minded, who had a great influence on my thinking and on my way of life." (Crow Dog, p 138-139).

On one level, Mary Crow Dog faced more hardships than Harriet Ann Jacobs in her struggle against sexism because patriarchy was also present in her own culture. This is not to suggest that male domination was absent in the slave community Harriet sprang from, simply that under slavery, male domination in the form of unequal division of physical labor and sexual exploitation between male and female slaves was imposed from above, an injustice inherent in the slave system itself. For Mary Crow Dog, the broader white society was patriarchal, but in some respects, so was her own culture. The traditional Sioux view of women's role in society and religion was somewhat more open and accomodating than white society's, but there were limits.

"Just as men competed for war honors, so women had quilling and beading contests. The women who made the most beautiful fully beaded cradleboard won honors equivalent to a warrior's coup. The men kept telling us, 'See how we are honoring you...' Honoring us for what? For being good beaders, quillers, tanners, moccasin makers, and child bearers. That is fine, but..." (Crow Dog, p 66).

She articulated her own rejection of this ideology. "Some of those old macho Sioux proverbs like 'Woman should not walk before man' I did not think were meant for me" (Crow Dog, p 200). However, it deprived her of a cultural support system that would have complemented the relationships that comprised her female support system.

Despite what the corporate-owned media would like us to believe, the fight for equality between the sexes is hardly won. American women still face sex discrimination at nearly every level of society, and still must struggle daily against the all-pervasive patriarchal mythology which would resign them to lives spent barefoot and pregnant in the bedroom and the kitchen, forsaking education and employment to focus on wifehood and motherhood. This ongoing struggle has characterized American women's history since our country's inception, and in the process has crippled many women's lives and minds.

However, as happens so often when the indomitable human spirit is faced with oppression, some women have always endured, fought back, and triumphed against the patriarchal system bent on destroying them. We can find extensive evidence of this resistance in the lives of such American women as Harriet Tubman, Sojourner Truth, Emma Goldman, Mother Mary Jones, Jane Addams, Susan B. Anthony, Elizabeth Cady Stanton, Margaret Sanger, Helen Keller, Elizabeth Gurley Flynn, Rosa Parks, Mrs. Fannie Lou Hamer, and countless others (Zinn, p 322-339). To this list, the names of Harriet Ann Jacobs and Mary Crow Dog should be forcefully added.


Incidents In The Life of a Slave Girl (1861) by Harriet Ann Jacobs

Lakota Woman (1990) by Mary Brave Bird (formerly Mary Crow Dog)

A People's History of The United States (1980) by Howard Zinn

Monday, November 29, 1993

Unintended Consequences of U.S. Involvement in the Korean War

The U.S. Response to the Korean Invasion of 1950: A Study of Predetermined Policy Implementation and Unintended Consequences

On June 25, 1950, the Cold War turned hot. The battleground was Korea, a country divided into U.S.-Soviet spheres of influence since 1945, and hostilities were initiated when North Korean troops crossed the 38th parallel and invaded South Korea. Acting on the assumption that the North Korean government was a Kremlin puppet regime, and the invasion therefore a clear case of Soviet-backed Communist aggression (Hunt, p 5), the U.S. response was swift. President Truman committed U.S. air and naval forces to the defense of Korea on June 27, and ordered U.S. ground troops based in Japan to proceed to Korea on June 30 (Ambrose, p 121).

However, the U.S. response to the June 25 invasion also included a series of other regional foreign policy steps which went far beyond what was necessary for the immediate defense of South Korea. The U.S. Seventh Fleet was dispatched to the waters surrounding Formosa (Taiwan), ostensibly to prevent any Chinese communist attack on Formosa. U.S. forces stationed in the Philippines were strengthened and increased military aid was provided to the Philippine government, at the time engaged in crushing the nationalist peasant Huk movement (Ambrose, p 119/Document 14). U.S. military aid was also further extended to the French, then fighting Ho Chi Minh's nationalist Vietminh in Indochina.

Taken together, these additional steps lend credence to the hypothesis that the outbreak of fighting in Korea presented U.S. policymakers with a pretext for implementing previously-agreed upon Cold War foreign policy objectives. Meeting with President Truman and his other advisors on June 25 and 26, Secretary of State Acheson was quick to spell out the numerous additional steps he thought should be taken to ensure regional security as part of the U.S. response to the Korean invasion, obviously initiatives long-planned and agreed to without debate or surprise from the President.

No wonder, since they fit perfectly with the foreign policy prescriptions contained within the Truman Administration's own NSC 68 of April, 1950, which essentially called for the U.S. "to assume unilaterally the defense of the non-Communist world...to assume the role of world policeman" (Ambrose, p 113). This meant a doubling or tripling of the U.S. defense budget, which stood at less than $13 billion in 1950 (Ambrose, p 112).

At this point in Cold War history, two of Truman's political objectives converged: the need to justify such greatly increased defense expenditures and his political need in the face of then-emerging McCarthyism to prove to the country that he and the Democrats were not soft on Communism. A Communist tide seemed to be rising in the Far East: Japanese Communist demonstrations against American military bases in Japan; the fall of China to the CCP and subsequent Nationalist retreat to Formosa, where a Chinese Communist invasion seemed imminent; full-scale civil war in Vietnam between the French and Communist/Nationalist Vietminh; "petty dictator" Syngman Rhee's loss of popular support in U.S.-backed South Korea and growing demands for immediate unification from the Communist-controlled North (Ambrose, p 116-118). It was obvious to Truman that bolstering his anti-Communist credentials and "the whole package envisioned in NSC 68, in short, could be wrapped up and tied with a ribbon by an Asian crisis" (Ambrose, p 116).

This does not imply that the North Korean invasion was a U.S.-fabricated event, as most historians have labeled the Tonkin Gulf incident of 1964 - although a case could be made that U.S. officials such as Secretary of State Dean Acheson may have encouraged the North Koreans to act by making public statements to the effect that South Korea was strategically peripheral to the U.S. Nor does it point to the existence of a conspiracy in the Truman Administration to hide these other regional foreign policy initiatives from the U.S. public. The additional steps taken by the U.S. in the days following June 25 were initially justified as necessary in case the Korean invasion was only a prelude to a wider regional conflict (Hunt, p 5). In any event, these measures were all in keeping with previous publicly stated U.S. Cold War containment aims.

Regardless, these additional security measures had long-range consequences for U.S. foreign policy. Specifically, increased military and intelligence aid to the Philippine government resulted in U.S.-guided suppression of the nationalist Huk movement, a peasant movement based more around legitimate land reform grievances than Marxist-Leninist ideology. It laid the groundwork for direct U.S. involvement in the election of a string of Philippine rulers more responsive to U.S. interests than the interests of their own people, the first being Ramon Magsaysay (elected in 1953), and later, the corrupt dictator Ferdinand Marcos (Bonner, p 38-44).

In Vietnam, the extension of U.S. military aid to the French announced by President Truman on June 27, 1950 marked the beginning of three decades of tragic U.S. involvement in Indochina. This particular initiative, ostensibly aimed at containing communism and thus protecting U.S. interests, would ultimately bear fruit in the form of more than 58,000 American lives lost, over 300,000 wounded, an estimated 1.6 million civilian and military Vietnamese deaths, more than 2 million killed in Cambodia during the turmoil of the 1970s, and a total cost to the U.S. government over twenty-five years of more than $150 billion in pre-1975 dollars (Vadney, p 341).

The preceding facts and statistics underscore the lesson inherent in this tale of unintended consequences. In the long-term interests of our nation's security and relations with the world around us, American policymakers must learn the wisdom of allowing policies conceived behind closed doors to undergo vigorous public debate before proceeding with their implementation.

Monday, November 15, 1993

The War in Vietnam Was Censored by the Mainstream Media

The U.S. press, particularly television news, is credited with bringing the Vietnam War home to millions of Americans, thus inciting their impassioned opposition. Walter Cronkite's doubts about the war, which he voiced on-air following the 1968 Tet offensive, are often considered to have turned the tide of public support against the war.

However, before mid-1967 not even tentative criticism of U.S. war aims or policies appeared in the mainstream media. Even when many respected sources began to express their dissent, the media continued to give the administration's views on the war the largest amount of coverage.

From 1945 to 1954, the United States spent several billion dollars supporting a ruthless French colonialism in Vietnam, but the American public was never informed of this. In the following decade Washington assumed full responsibility for the maintenance of the South Vietnamese right-wing dictatorship, but the public neither read nor heard a word of debate in the media about this major policy commitment.

In 1965 the U.S. government began a massive buildup of ground forces in Vietnam, but Americans were told the troops were merely a small support force. The New York Times and other major news agencies knew the real nature of the escalation but felt it was in the "national interest" to keep this information from the public.

As press critics have pointed out, the media, with few exceptions, censored the worst of the war, saying almost nothing about the massive saturation bombings of Vietnam, Cambodia, and Laos, the "free-fire" zones, U.S.-sponsored torture, the Phoenix death squad program, the massive destruction of Indochinese rural life, the indiscriminate killing of the civilian population, and the dumping of 12 million tons of Agent Orange and other toxic chemicals on the countryside.

Even in the final years, media coverage was remarkably unwavering in its support for the war. A survey of the editorial stance of thirty-nine leading American newspapers at this time found that while several eventually became more critical of the U.S. military escalation, not one advocated withdrawal from Vietnam, despite the strong antiwar sentiments expressed by millions of people in the U.S. and abroad.

A study of TV coverage between 1968 and 1973 found less than a quarter of the stories of a 180-program sample concerned Vietnam, and only rarely did the stories include pictures of combat. Pictures of the dead or wounded were featured in only about 2 percent of war-related reports; American battlefield dead were never shown; body counts appeared only as pictureless statistics. A study funded by the U.S. Army in 1988 rejected the notion that negative press coverage was responsible for eroding public support for the war. The American people were alienated not by the news coverage but by the casualties.

After the war, the news media tried to put the best face on U.S. involvement, describing it as either a well-intentioned venture gone awry or a foolish mistake.

"Left out of this view was any thought that (our leaders) had waged a horrific war in support of a dictatorship and against a largely civilian population to prevent a popularly supported but (communist) social order from gaining power." (Parenti, p 176).

Relying on the establishment news media, America was left with the impression that the U.S. defeat in Vietnam, rather than the murderous intervention itself, was the only thing Americans needed to regret.

Source: Inventing Reality: The Politics of News Media by Michael Parenti (1986)

Thursday, November 11, 1993

Fire From The Mountain by Omar Cabezas: The Mountain as Revolutionary Motivator

Everyone needs some sort of meaning in their lives. Humanity's search for guiding principles around which to structure and make sense of our existence on earth is perhaps our oldest intellectual pursuit. For some, this meaning is found in adherence to religious beliefs. The notion that a higher spiritual order exists is a powerful one. To think that our earth and all its inhabitants were created by a supreme being provides many people with the universally sought after sense of being a part of things, of having some understanding of the true meaning of life.

For the revolutionary social movement, religion may play a part in providing a pre-existing framework around which to organize recognition of and resistance to whatever injustices the movement is battling. It is likely, however, that during the course of the struggle, alternative conceptions of life's meaning will also need to be formulated. There are many reasons why people might need additional, more temporal motivations beyond religious ones in order to engage in revolutionary activity, if only because not everyone believes in religion!

Religion is also a contradictory social force; on one hand, most religions are theoretically forthright in condemning injustice, but in everyday practice tend to be conservative and status quo-affirming. Some faiths go as far as to proclaim that if injustice exists, it must be God's will, and in any event, things will be better for true believers once they reach the afterlife. In this respect, religion offers little hope as a motivating force for earthbound social revolution.

As revealed in the pages of Omar Cabezas' Fire From The Mountain, the Sandinista revolution in Nicaragua found inspiration and motivation from a variety of sources. Their revolution was not anti-clerical in nature; indeed, like many Latin American social movements of the 1960s and 1970s, it drew particular strength from the emerging doctrines of liberation theology, which harkened back to early Christianity's emphasis on confrontation with earthly injustice. But the revolution was also a very temporal one, drawing on a nationalist, patriotic tradition of resistance to outside occupiers and internal tyrannies, and hopes for socialist-oriented redistributive economic measures (although not all Sandinistas were Marxist-Leninists).

The nature of the Nicaraguan revolution thus almost mandated that its participants maintain a very down to earth, temporal focus on the revolutionary struggle. This is not to say that the Sandinistas came to see the revolution as an end in of itself, but that they had to remain tightly focused on their daily functioning as guerrillas if they were ever to realize the revolution's broader goals. It was a reality of the struggle made even clearer by the overwhelming nature of the odds they faced, as evidenced by Cabezas' bravado-tinged but truthful admissions that "to decide to join the Frente in those days...was a very extraordinary thing to do, I really believe that" (p 14), since "the Frente was just a few people and probably didn't exist outside of Managua, Leon, and Esteli where a few, bold heroic people had taken up the challenge of history and started to work" (p 15).

Thus, there had to be some primal, temporal motivating force that the revolutionaries could bring to bear on themselves and their recruits in order to maintain a disciplined focus on the struggle, in the true spirit of the Sandinista slogan "Free Homeland or Death." For Cabezas and many of his guerrilla counterparts, this motivating force came from the myth of the mountain.

"When I left for the mountain I went with the idea that the mountain was a tremendous power. We had this myth of the companeros in the mountains, the mysterious, the unknown...and in the city both the people in the underground and those of us working legally always talked about the mountain as a sort of mythical force. It was where our power was, and our arms and our best men; it was our indestructability, our guarantee of a future, the ballast that would keep us from going under in the dictatorship; it was our determination to fight to the end, the certainty that life must change." (p 17)

But the mountain was more than just a source of hope to the Sandinistas. Cabeza came to realize this by coming to grips with his disillusionment when he finally ascended to the main guerrilla camp, and discovered there were no more than fifteen or twenty other Sandinistas in the mountains at that time (p 80-81). Ultimately, the mountain's strength sprang from its transformative powers.

By going into the mountains and undergoing rigorous, unrelenting physical and mental guerrilla training, the first Sandinistas were able to transform themselves into a true revolutionary vanguard, disciplined and totally committed to the struggle. The mountain's power was not merely symbolic, but rather, sprang from the concrete changes it affected in the men who sought refuge in its folds. It was this unswerving focus on the revolution, and the simultaneous rejection of the Sandinistas' past lives that it demanded, that rested at the core of the mountain's power to be a revolutionary motivating force.

The process of transformation began for Cabezas when he first set foot on his physical trek into the mountains.

"And there my Calvary began...a new phase began in my physical life, in my beliefs, in the development of my personality, in everything, in maturity, in everything, everything" (p 53).

It would ultimately involve the endurance of great physical and mental hardships, leading to a toughening of Cabezas' physical strength, agility and stamina, a hardening of his mental resolve and convictions, and ultimately, a wholesale rejection of his former life, replaced by an unswerving focus on the revolutionary struggle.

The physical hardships were many. Marching through the brush and jungles of the mountain provided an abrupt introduction to the rigors of guerrilla life for Cabezas. By dawn of his first night in the mountains, marching with a pack weighing twenty-five pounds, "I was half covered with mud, soaked to the skin, my hands were totally screwed, and wewere starved" (p 57). The guerrillas had to obey many time-consuming and physically debilitating rules in order to escape detection by National Guard patrols, such as not breaking branches (p 58-59), or leaving only one set of footsteps while marching, "over rugged topography...sometimes for half a day" (p 62). All trace of fires had to be hidden (p 71), and to take a shit meant digging a hole and wiping yourself with leaves (p 73-74). Sometimes they would march on the slopes of ridges, rather than the highest ground, "of course the hardest possible place to march" (p 129). Cabezas develops lesymaniasias, or mountain leprosy, which further adds to his sense of physical trial (p 106-109).

Hunger was also a constant companion of the guerrillas. At first a disgusting proposition, eating monkey meat eventually became an everyday fact of life (p 66-70). The guerrillas were lucky, in fact, to eat meat. Usually, rations on marches were more along the lines of "three pathetic tortillas and a few beans for the lot of us, a little bite for everybody" (p 73). "When the meat was gone, we started in on the powdered milk. At first the ration was three little spoonfuls, which we ate as it was, as powder" (p 131).

As unbearable as they were, these hardships physically transformed the Sandinistas who struggled to survive in the mountains. They became physically hardened, and better able to endure the hardships that would lie ahead of them. "Gradually you are mastering the environment, learning to march. Your legs are getting stronger. You learn how to swing a machete...this, in a way, was what helped to forge in each of us the steel that was needed to overthrow the dictatorship" (p 84-85).

The mental transformation that the mountain made possible was just as important. Paradoxically, while the rigors of guerrilla life toughened and hardened the Sandinistas both physically and mentally, it also heightened their sensitivity and capacity for empathy. As Cabezas poetically claims, it was as if "the lack of sugar had created a great inner sweetness, which made it possible for us to be touched to the quick, to make our hearts bleed for the injustices we saw" (p 85). Again and again, Cabezas explains how the guerrillas became like animals in the wilderness, "a few more creatures of the mountain" (p 84), "like animals, prowling in our natural habitat" (p 90).

In the process, their senses were sharpened.

"Day by day you make out the sounds of nature with more clarity and precision, all kinds of sounds...the same thing happens with your eyesight...the same with your sense of smell" (p 101-102).

As happened with their senses, the guerrillas' sense of revolutionary purpose and motivation was similarly heightened. When inspired to find the strength within himself to go further by his superior Tello's exhortations about the "new man," Cabeza realizes that "sometimes not being clear about things makes you give up at the first sign of tiredness, or back down before the first obstacles. It's not true; a man can always give more" (p 94). "And so a spirit was forged that enabled us to endure all the mental and physical hardship. We were developing granite wills in the face of the environment" (p 85).

The physical and mental transformations the mountain effected in the guerrillas were what made the final transformation possible, allowing them to shed their past lives completely and focus solely on the revolutionary struggle. This process began with the casting away of habits and behaviors necessary for survival in the city, but hindrances in the mountains. Cabezas learns no longer to clean his bag when it gets dirty (p 59), his hair gets longer, he "belches right in front of everybody" (p 84). Slowly but surely, the sights and sounds of city life fade from his memory (p 83).

He realizes that in order to become the "new man," fully committed to the revolution, he must kill the old man within himself (p 94). But this will come at a cost, at the cost of "the destruction of his faults, of his vices" (p 94). Cabezas reflects on the nature of his previous life, doing aboveground work for the revolution but falling short of total commitment. "Don't forget where I was coming from - drinking, staying up late, smoking, eating junk, never exercising, then all of a sudden, bam! I was right in the middle of something that called for men" (p 64). And finally, it is his experiences in the mountains that allow him to make this total commitment to the struggle.

"The mountain and the mud, the mud, and also the rain and the loneliness...all these things were cleansing us of a bunch of bourgeois defects, a whole series of vices; we learned to be humble, because you alone are not worth shit up there. You learn to be simple; you learn to value principles. You learn to appreciate the strictly human values that of necessity emerge in that environment. And little by little all our faults faded out"(p 86).

Even before he left for the mountain, Cabezas had felt committed to the revolution. "Once you join (the struggle), and as your work and responsibilities multiply, it's like entering a whirlwind...and you're in to the hilt - you're totally screwed! - and glad of it" (p 13). Yet after his experiences there, Cabezas' commitment would become all consuming.

"That present, though it existed here, did not belong to me. It was the past...and it was too late to recover it, since I wasn't going back. I wasn't going to be able to see my mother or my brothers. I would have to see them on down the line, in the future" (p 215-216).

The mountain became Cabezas' ultimate revolutionary motivation; not as symbol but through the mental and physical transformative struggle it forced him to endure.

Source: Fire From The Mountain: The Making of a Sandinista (1986) by Omar Cabezas

Friday, October 15, 1993

Will Clinton's Health Care Reform Plan Work?

Nearly three weeks have elapsed since President Clinton outlined his Administration's health care reform proposals in his Sept. 22 address before a joint session of Congress. During this time, a diverse collection of players has been jockeying for position - lawmakers, consumer groups, medical industry representatives, unions, small and large businesses, doctors - all of them with interests at stake in the debate. Affected parties who sense that their interests are threatened have been voicing a steady stream of reservations about various aspects of the Clinton plan.

Let us view this tableau of discontent and protest from the perspective of the policy analyst. It is clear that we are already seeing glimpses of what might happen to the Clinton plan if it reaches the stage of actually being carried out, its directives translated into action and results - in other words, the implementation phase of the policy process.

The policy process does not end when legislation is voted on and passed. In fact, building a consensus to ensure passage of laws is only half the struggle. The remaining half of the process is the policy implementation phase. It is here that the ultimate effects of any given legislation are shaped and determined. Legislators can not simply conjure policy into being - in order to implement the laws they make, agencies and bureaucracies must be created, staffers and administrators hired, information made available to the public, monies and resources dispersed, etc. Without proper implementation of policy, true in spirit to the legislative intent which created it, no policy can succeed in its ultimate goals - making a difference, changing lives and circumstances, altering the status quo.

As outlined by Bullock and Lamb, there are several variables that analysts and social scientists have agreed are crucial to the ultimate success or failure of a given policy's implementation. These variables include policy clarity, specificity of standards used to evaluate the policy, presence of an enforcement agency, enforcer commitment, attitudes of those who benefit from the policy, monitoring, commitment of the enforcement agency's superiors, administrative coordination, costs and benefits, and direct federal involvement. We will explore how each of these variables has implications for the ultimate fate of Clinton's reform proposals. Briefly, we will also look at how health care reform might be affected by some of the implementation "games" as conceived by Bardach, i.e., problems that can arise when actors connected with the implementation phase decide to throw wrenches into the works.

The need for policy clarity means that the actors responsible for implementing policy (i.e., agencies or bureaucracies) must have clearly defined policy goals to work with.

The central problem with any discussion of Clinton's proposed health care reforms is that even at this point, the Administration's plan is still up in the air. In order to better deal with the initial flurry of opposition to some of the plan's elements and vague funding mechanisms, hasty finetuning is now underway and consequently, the plan has still not been presented in final legislative form to Congress. In order to weather the long months of political struggle ahead, the President and Mrs. Clinton have both repeatedly served notice that "the only (inviolable) parts of the proposal are the overarching principles, which call for security, responsibility, simplicity, choice, savings, and quality." (NYT, 9/28/93, p A10) These terms may only be soundbites designed to ensure that whatever compromises are eventually made, none that deviate too far from the President's plan will be considered politically feasible. However, by signalling that everything is still on the table, the emphasis on these six principles conveys a sense of vagueness that does not bode well for policy clarity.

The fifty state governments will ultimately be responsible for implementing President Clinton's reforms. His plan saddles them with a "mind-boggling array of new duties" (NYT, 9/23/93, p A1), everything from establishing new regional health care alliances to buy insurance for their residents, to paying subsidies to help poor people and small businesses buy their insurance (using state and federal money), to collecting the huge amounts of data needed to measure and compare the quality of care within their borders. In many areas, Clinton's plan does not give states clear instructions on how to accomplish these goals, such as how to "make sure that 'all eligible individuals,' including homeless people, drug addicts, and residents of remote areas, enroll in a regional alliance." (NYT, 9/23/93, p A12)

Specificity of standards means there must be reliable standards by which to measure the effects of a newly implemented policy. One of the most important standards by which the success of health care reform will be measured is how good a job it does in slowing the increase of health care costs, which have been spiraling out of control. In this regard, at least, the plan has built in specificity of standards. Since Clinton's proposed regional health alliances will all offer consumers a standard set of health benefits packages, cost comparison among plans and alliances will be relatively easy.

A similar specificity of standards exists in the plan's main funding mechanisms. There are four of them: savings to be realized through decreased Medicaid and Medicare expenditures (1), estimated revenues from taxes on tobacco products (2) and taxes on companies who opt to continue insuring their own employees instead of joining regional health alliances (3), and estimated increased tax revenues from economic expansion made possible by lower health care costs to businesses (4). Any deviation from these funding estimates once the plan is operational (for example, if people buy less tobacco products because of the level of tax, therefore generating less actual tax revenues) would likely be detected immediately.

Unless voluntary compliance with a policy's directives can be guaranteed, there is a need for enforcement agencies to be set up, charged with enforcing compliance. This need is particularly great in complex policy situations like health care reform, a reform process that will touch millions of people, thousands of institutions, and require them all to change long-established ways of doing things. On this count, which usually involves the creating of new bureaucracies, there is little doubt that the Clinton plan will fail to deliver.

"In (some) ways Mr. Clinton would make the system even more complicated. He would create new agencies and a complex new apparatus to buy insurance. There would be regional health alliances, health plans, a powerful National Health Board, a new Federal advisory committee to assess the reasonableness of new drug prices and a new Government agency to decide the number of young doctors entering each medical specialty." (NYT, 9/24/93, p A10)

On paper at least, these enforcement agencies will be charged with the responsibility of overseeing compliance with reform. The crucial question, however, is just how will compliance be achieved? If cost savings are less than projected in certain areas of the plan, what happens? "The government could withdraw subsidies to small businesses and low-income households. Or it could take over the operation of health alliances that failed to meet targets for saving, thus acknowledging failure of the plan's fundamental structure. As with nuclear weapons, it is hard to imagine use of such penalties. Determined efforts to reach the saving targets are likely to provoke a backlash from providers and patients." (NYT, 9/22/93, p A21)

There are several dimensions to enforcer commitment, or the willingness of those who actually staff enforcement agencies to carry out the enforcement of policy. Policy must be a priority for either the enforcement agency as a whole or individual staffers. There is also the question of agency co-optation, or the "capture" of an agency by the very forces it is supposed to be regulating. This can come in the form of representatives of the regulated being chosen to lead or serve in regulatory agencies, or interest groups exercising undue influence over the agencies that regulate them through their allies in legislatures.

There is a very real danger of such co-optation befalling the regional health alliances or other new regulatory agencies created by the plan, simply due to the complexity of the health care delivery system itself and the technical knowledge that will be demanded of people overseeing and dealing with the consequences of reform. However, the Administration insists:

"Consumers will be safeguarded by the requirement that the alliances' boards include equal numbers of representatives of employers, consumers, the self-employed and other covered groups. They would not include people associated with health care providers, law firms involved with health care, pharmaceutical companies or suppliers of medical equipment or services." (NYT, 9/25/93, p 8)

Attitudes of intended policy beneficiaries are crucial; their support, opposition or disinterest translates into varying degrees of pressure on legislators to act on a given policy when results of implementation are reviewed, and often means the difference between policy life or death. The reactions of key intended beneficiaries of health care reform such as doctors, older Americans, business owners, underinsured Americans, etc., will be the determining factor in the plan's eventual success. Of course, if the plan works well, it stands to reason that public reaction to it will be favorable. Currently, however, although Clinton's plan has the support of a majority of the public (with 61% saying they were willing to pay higher taxes so that all Americans would have guaranteed health insurance, even before Clinton's Sept 22. televised health care address) (NYT, 9/22/93, p A1), reaction from some intended beneficiaries is decidedly mixed. Doctors, for example, are split in their opinions of the plan roughly along lines of those who are still privately employed (hesitant about reform) and those who already draw salaries working for clinics, hospitals, group practices and HMO's (welcome the proposed changes). (NYT, 9/24/93, p A11)

The remaining five variables crucial to policy implementation are monitoring of policy compliance, commitment of the enforcement agency's superiors, administrative coordination, policy costs and benefits, and direct federal involvement. These are all relatively less central to the implementation of health care policy than the first five, for various reasons. Monitoring of policy compliance will be subsumed in the duties of policy enforcement as carried out by the regional health alliances and new health regulatory agencies created by the plan.

Commitment of the enforcement agency's superiors means, in the case of health care reform, the extent to which the Clinton Administration has committed itself to the enterprise, which is to say totally. This commitment is borne out of a widespread sentiment in the country at large that the health care delivery system does need reforming. It is a public mood that could shift, of course, and turn against health care reform, if during the process of implementing the Clinton plan things go awry.

Administrative coordination is important as it relates to the extent that agencies in the government with overlapping jurisdictions are able to cooperate on policy implementation. It will be important in areas where HEW has to work with the proposed National Health Board, other new regulatory agencies, and the regional health alliance boards.

"Mr. Clinton's proposal would open a new chapter in the history of Federal-state relations, placing huge new obligations on the states to run a social welfare program that would dwarf Social Security in terms of money." (NYT, 9/23/93, p A12)

Interesting problems could arise in matters involving coordination between state governments and the regional health alliances, because the health alliances will themselves be handling more money than most state governments!

Policy costs and benefits generally refer to the consequences of compliance or non-compliance with a given policy. The Clinton plan imposes increased tax costs on businesses who opt out of the regional health alliances, costs on individuals who choose more generous packages of health benefits than the norm, and various other measures intended to induce businesses and consumers to comply with the plan's reforms.

Finally, direct federal involvement refers to the extent which the federal government itself will be actually implementing policy.

"The Federal Government will have to issue dozens of new regulations translating any new law into terms that can be applied to doctors, hospitals, clinics, and insurance companies. But every state will need to pass legislation filling in details of the Federal framework." (NYT, 9/23/93, p A12)

Actions by the new National Health Board and other new health regulatory agencies notwithstanding, the bulk of Clinton's reforms will be implemented at the state level, by state governments and the new regional health alliances.

A final look at some of the implementation "games" as conceived by Bardach, and how they relate to implementation of health care reform. These games describe problems that can arise when actors connected with the implementation phase of the policy process decide, for various reasons, to derail or hinder successful policy implementation. Three games are of particular interest to us: Easy Money, Up For Grabs, and Piling On. Easy Money describes what happens when private sector elements find they can take undue advantage of the government trough via involvement in some public program, and by ripping the program off manage to circumvent or subvert any goals policymakers may have had of getting a good job done cheap. There is already concern that some businesses may begin to play a variety of Easy Money called the "subsidy game" once Clinton's health reforms pass. Since the Clinton plan would subsidize the purchase of health insurance for businesses with less than fifty employees, the fear is that some medium-size businesses will re-organize into smaller firms, in order to take advantage of the subsidies.

Up For Grabs is a predicament similar to the situation that confronts a regulatory agency in danger of being co-opted by the interests it is supposedly regulating. It happens when a policy mandate is formulated that "may have been the result of strong pressures on government to do something about what is generally perceived to be an urgent social problem, even though no one quite knows what ought to or could be done." (Bardach, p 90) Sounds almost like health care reform, doesn't it. As previously stated, regardless of the Administration's assurances that consumers will be given equal or greater representation than medical insurance and pharmaceutical industry representatives on regional health alliance boards, the whole spectrum of new agencies and deliberative bodies responsible for overseeing reform will be very much Up For Grabs. The five giants of the medical insurance industry - Prudential, Cigna, Aetna, Travelers, and Metropolitan Life - as well as the more than 70 Blue Cross and Blue Shield plans and dozens of already established HMO's have already staked out enormous victories in terms of the plan's general outlines, which assign them all central, very profitable roles.

Finally, there is a game called Piling On. This describes what happens when onlookers see a new program gathering speed, and attempt to use it for the advancement of their own political objectives. The obvious way in which this game is now being played with respect to health care reform is on the issue of abortion. The federal government has blocked abortion subsidies to poor women since 1981, through a series of anti-abortion amendments sponsored by Rep. Henry Hyde, (R-IL). The most recent attempt to defeat the Hyde amendment by passing a national pro-choice bill went nowhere. Pro-choice advocates are now attempting an end run around their most recent legislative defeat by insisting that abortion be covered under the Clinton health care reform package, regardless of whether or not doing so would jettison the bill's chances of final passage. This development presages a trend which will undoubtedly intensify during implementation of reform. Interest groups will likely mobilize to have benefits added to the plan's standard coverage package which are not currently covered, i.e., dental and eye care for adults, hearing aids, in-vitro fertilization, etc. With the addition of every added benefit, the plan's costs will increase, growing heavier and heavier under its burdens and edging ever closer back to the state of spiraling health costs which occasioned reform in the first place.

In closing, I'm sure glad I'm not the one responsible for eventual implementation of Clinton's health care reforms. I hope they work, and they look somewhat more promising when analyzed in terms of variables important for successful implementation, but there are too many games that could be played, too many pitfalls - I guess the whole thing is still too much of a Rube Goldberg contraption for me.

Attitudes of (intended) program beneficiaries: a short case study

"'One of my main reasons for being a doctor was I wanted to run my own clinic', said David Williams, 24, who is from a suburb of Salt Lake City and is interested in rural medicine. 'I wanted to do it on my own, and it sounds like he's trying to force all doctors into larger health care organizations instead of allowing any kind of entrepreneurial spirit in doctors.'" (NYT, 9/24/93, p A11)

"The uneasiness elsewhere in the nation over the proposal dates to a bygone idea of health care, Dr. Crosson (a doctor employed by Kaiser Permanente, the nation's largest HMO) said. 'Most people have grown up with a clear vision of what medicine is about,' he said. 'It's one physician...practicing by themselves in a small office with a nurse.' But with technological advance, Dr. Crosson said, 'the black bag could not hold all the tools of the trade, the small office could not contain all the tests and interventions a patient could need.' Thus group practices became more common and 'the new challenge became how to deliver that complicated care in a way that's still personal.'" (NYT, 9/24/93, p A11)

"A giant national health care system, many (medical students) feared, would only aggravate a trend toward having to practice medicine by bureaucratic decree, whether from the government or a private insurer." (NYT, 9/24/93, p A11)

"Other (insurance company) employees were skeptical that a vast new Government bureaucracy could streamline anything, let alone medical care paperwork. They said the most up-to-date HMO's already had more ambitious goals, like getting rid of all paperwork." (NYT, 9/24/93, p A11)

"While poor people worry that their needs may be neglected, state officials, for their part, fear that the Clinton plan may duplicate a fundamental problem of Medicaid: the proliferation of Federal mandates without enough Federal money to pay for them." (NYT, 9/23/93, p A12)

Thursday, October 14, 1993

Incidents in the Life of a Slave Girl by Harriet Ann Jacobs

Over the nearly two and a half centuries that human chattel slavery existed in North America, its primary victims were the African slaves whose lives were shackled and destroyed. Transported to the New World in chains, held in bondage for generations - there can be no question that their sufferings were incalculably immense. Nor is it untrue that white slaveholders profited greatly from their labors and thus materially benefited from the slave system.

At the same time, however, in seeking to catalog the full range of sociological effects that slavery's existence spawned, we must not forget that the South's "peculiar institution" also poisoned the lives of its supposed masters. The culture of almost unspeakable brutality that slavery created trapped slaveholders and their families in webs of barbarism, indecency, and ignorance, just as surely as it trapped slaves in lifetimes of misery and hardship. Anyone who wants to understand the complex history of relations between black and white Southerners has to go back to the conditions of slavery, and see how both races were scarred by its oppression.

Harriet Ann Jacobs' autobiography, Incidents in the Life of a Slave Girl, was first published in 1861. She wrote it under the pen name Linda Brent. At that time, Jacobs was forty-three years old. She escaped from slavery at the age of twenty-seven, after spending nearly seven of those years hiding in a small garret above a shed in the South Carolina community where she was born (p 151), almost within sight of her master's home. This narrative conveys a wealth of information about the oppressive conditions endured by Jacobs, her family, and other slaves she knew. It also sheds fairly detailed light on how the mechanisms of slavery functioned to perpetuate its hegemonic reign by exploiting class and gender fault lines among whites who were themselves harmed by the existence of slavery.

Slavery could not have preservered for so long without the support of the mass of white southerners, i.e., those whites who were not part of the planter elites. Most poor whites in the South did not own slaves, and thus did not benefit in direct, material ways from the existence of slavery. If anything, the danger was that elements of the "low whites" would begin to recognize how slavery was contributing to their own economic domination. "The power which trampled on the colored people also kept themselves (poor whites) in poverty, ignorance, and moral degradation" (p 65).

Planters who owned slaves were able to amass enormous amounts of wealth, accumulated capital that was then put into service vis-a-vis land speculation, and control of banks, retail and manufacturing concerns. These were all advantages that poor whites lacked, could not help but resent, and which together formed a framework of economic oppression that directly harmed them. Something had to be done to prevent poor whites from looking too closely at the roots of their own lowly economic status and finding common cause with the enslaved blacks.

The ideological trappings of white supremacy served to keep these whites in line. Slavery's hegemony was propped up by the construction of an elaborate, racially ordered social system. Its message to poor whites was that no matter what their status was in relation to rich planters, they were still superior to the wretched mass of black slaves and always would be.

On occasions when the slave system felt threatened, such as during the aftermath of Nat Turner's rebellion, in late August, 1831, poor whites would be given opportunity to directly exercise this right of racial superiority. Poor whites were organized into companies and patrols (under the command of rich planters, naturally), and given license to freely plunder the homes and quarters of all colored people in the area, slave and free alike.

"It was a grand opportunity for the low whites, who had no negroes of their own to scourge. They exulted in such a chance to exercise a little brief authority, and show their subserviency to the slaveholders" (p 65).

How the poor whites responded to their own impoverishment was revealed by their reactions to the bedding and table cloths, silver spoons, and preserves discovered when Jacobs' grandmother's house was searched for arms and other evidence of insurrection.

"'Look here, mammy,' said a grim looking fellow without any coat, 'you seem to feel mighty gran' 'cause you got all them 'ere fixens. White folks oughter have 'em all." (p 66).

Their poverty bred resentment, which was channeled into jealousy of and hatred for the slaves and freedmen who lived in anything but utter squalor. Thus, the slave system's hegemonic rule was skillfully maintained through hidden ideological control. Racism and the doctrine of white supremacy were used as clubs to blind poor whites from seeing their own economic interests.

Elite white women in the South also suffered (in a qualified and very particular sense) from the perpetuation of injustice and exploitation that slavery engendered. The wives, sisters, and daughters of slaveholders were forced to exist in a society where the sexual exploitation of slaves made a mockery of marital vows. Pain and disharmony were sown among the families of "privileged" white Southerners whose lives were supposedly being enriched by slavery.

"The young wife soon learns that the husband in whose hands she has placed her happiness pays no regard to his marriage vows. Children of every shade of complexion play with her own fair babies, and too well she knows that they are born unto him of his own household. Jealously and hatred enter the household, and it is ravaged of its loveliness." (p 35).

Most slaveowners' wives probably responded as Mrs. Flint did when she learned of Dr. Flint's plan to have Linda (Harriet Jacobs) sleep in his room, ostensibly to keep watch over his youngest daughter (p 31-32). Being confronted by the realization that their husbands were having sexual relations with slave women in most cases did not translate into a lessening of support for slavery as an institution among slaveowners' wives. Here, the hegemonic system of white supremacy intertwined with the framework of patriarchal domination that ordered American society. Rage that might have been directed at the institution of slavery was thwarted, run through an ideological wringer of notions about romance and rivalry, and instead transformed into feelings of simple jealousy and hatred, directed against the slave women who had been raped by their husbands.

"She (Mrs. Flint) pitied herself as a martyr, but she was incapable of feeling for the condition of shame and misery in which her unfortunate, helpless slave was placed" (p 32). Their cruelties towards these women, who they saw only as "rivals," undoubtedly increased, and the slave system was strengthened, not weakened.

If the poor whites and elite white Southern women whose interests were not served by the slave system had ever revolted, the foundations of slavery might have collapsed long before the Civil War. It was thus essential that coherent ideological constructs be present to gloss over inconsistencies between slavery's professed benefits to all Southern whites and the day-to-day realities of its sexual and economic exploitation.

Paradoxically, the only elements of the slave system that could have turned wives against their slaveowning husbands and poor whites against their rich planter "masters" instead served to harden the hearts of Southern elite white women and poor men even further against their human sisters and brothers in bondage.

Source: Incidents in the Life of a Slave Girl (1861) by Harriet Ann Jacobs

Monday, October 4, 1993

Who Will Decide the Fate of Clinton's Health Care Reform?

It is mid-September, 1993. In one week, President Clinton will outline his long-awaited plan to reform the U.S. health care system. The vehicle will be a major address before a joint session of Congress, a speech which many people will view as a crucial test of Clinton's presidency. But for several days now, key elements of the health care reform plan have already been the subject of heated public debate. Unauthorized copies of the nearly-completed proposal were made by congressional aides and leaked to major media when lawmakers were allowed a preliminary look at the plan's details.

For months, and in some cases for years, the key actors in this debate have been jockeying for position and mobilizing for action. Now, their movements are entering the glare of public scrutiny. Rhetorical arguments are being constructed on all sides by those who have the most to win and/or lose in the coming debate. In order to understand what is at stake for all of us in the fight over health care, as Americans and as policy analysts, we must understand two things: who these key players are, and where their primary interests lie.

To these ends, it is useful to first think about the health care debate in the broadest possible terms. Three key legislative forces will be involved - the Clinton Administration, rallying behind its 500-member Health Care Reform Task Force, the Republican opposition in Congress, by nature hostile to Democratic policies, and the Democrats in Congress, themselves split along conservative/liberal ideological lines.

These three forces are in the process of coalescing into three further, somewhat overlapping circles of political support. The first is made up of those who favor the Clinton Administration's plan and want to see it enacted largely intact. The leading spokespeople for their cause are the President and his First Lady, Bill and Hillary Rodham Clinton, and Ira Magaziner, the Health Care Reform Task Force's senior policy advisor.

The second circle is composed of those lawmakers who are hostile to the aims of Clinton's plan and would like to see alternative but more conservative "solutions" to the health care crisis implemented, solutions less disruptive to the current practices and profits of the medical and insurance industries. Here, think of Sen. Bob Dole, the Senate majority leader and ranking Republican opposition figure, Sen. John Chafee, author of a Senate Republican alternative health care reform bill, and Rep. Dick Armey of Texas, the third-ranking House Republican and a staunch critic of Clinton's plan.

The third such circle involves lawmakers who are wary of the Clinton reforms mostly because they do not go far enough towards laying groundwork for a Canadian-style, single-payer system of government health care involvement. These mostly Democratic lawmakers support what are considered to be more "progressive" or "liberal" alternatives to the Clinton reform package. Sen. Paul Wellstone of Minnesota and Rep. Henry Waxman, D-Calif., are perhaps the most visible Congressional actors in favor of this course. Legislation in support of a single-payer system currently has 80 Democratic co-authors in the House of Representatives.

Behind these three shifting coalitions of lawmakers are various specialized blocs of the American public. Each circle of political support derives its political strength from different coalitions of special interests, i.e., individual groups who would be most affected by any changes made in U.S. health care delivery.

Thus, the first circle includes mostly parties likely to benefit somehow from enactment of Clinton's reform package. There is the Administration itself, which can expect widespread public gratitude for any successful reforms that improve the nation's access to health care. It also includes moderate Congressional Democrats, and some liberal Republicans in Congress, all of whom find common ground in wanting to steer a course between more conservative, "status-quo" oriented or liberal, "disruptive" approaches to industry reform. Moderate-leaning consumer groups such as Families U.S.A. have voiced support for the plan, mostly for the same reasons as these moderate lawmakers.

Support for the President's plan has also come from significant numbers of large corporations. In recent years, many have become fed up with the rising costs of providing health care benefits to their employees and are now only too happy to let the Government step in. This support for reform measures from big business is crucial to the Clinton plan's chances for success. It is an element of support which was non-existent in the past few decades during other periods of debate over health care reform.

The forces arrayed against a Clinton Administration engineered overhaul of the nation's health care system are united by varying interests. The rhetoric adopted by most Republicans, and a view more honestly shared by conservative Democrats and liberal Republicans who may want to see modest health care reforms pass, is that they are concerned about the plan's effects on small business and on the rights of ordinary Americans to choose their own doctors.

On a political level, however, it must be remembered that the overriding objective of most congressional Republicans is to gain political advantage from the battles ahead. Thus, despite talk of bipartisanship, the preferred Republican outcome of this debate would be to defeat the president's plan outright, or force compromises which will doom the plan to eventual failure and with it, the Clinton presidency.

Insurance companies, pharmaceutical manufacturers, and overpaid medical specialists are concerned primarily with ensuring that reforms do not cut too heavily into their individual profit margins. The National Federation of Independent Business, the nation's largest organization of small businesses, has also taken an extremely active role in opposing Clinton's plan. Led by a former director of the national Republican Party's executive finance committee, Jack Faris, the Federation finds fault with the plan's provisions for most employers with over 50 employees to pay 80% of their workers' health care benefit costs.

However, within the industry most directly affected by any eventual health care reforms, the medical insurance industry, there are important divisions. Under the Clinton plan:

"...most of the nation's 500 or so health insurers are likely to be driven out of the field, and among the likely beneficiaries would be the five giants of industry - Prudential, Cigna, Aetna, Travelers, and Metropolitan Life - as well as the more than 70 Blue Cross and Blue Shield plans." (New York Times, 9/19/93, p 1)

So while most smaller health insurance companies are opposing the Clinton plan tooth and nail, coordinating their efforts through an industry-wide organization called the Health Insurance Association of America, the industry's largest players are quietly supporting the plan's general outlines. For these giants, the Clinton reform prescription would be a goldmine.

Finally, there are those in Congress and the country at large who favor moving towards a Canadian-style, single-payer system of health care payment. Under such a system, the government would assume the role now played by private insurers in reimbursing doctors and hospitals for patient care. The Clinton Administration has stated its strenuous opposition to this option because of the turmoil it would bring in eliminating virtually the entire U.S. health insurance industry, including the industry giants which are protected and given near-monopoly powers under its own plan. In addition to advocacy by progressive Democrats in Congress, a single payer system derives public support from most major unions and most elements of the U.S. progressive movement. Polls have shown that the more the general public is told about how the Canadian system functions, the more people tend to favor U.S. adoption of a similar plan.

Also included in this circle are additional Democratic critics of the Clinton plan, who are less in favor of a single-payer system than they are critical of the Administration's assertions that cost savings will result in Medicare and Medicaid savings of two to three hundred billion dollars over five years. These Democrats, like Sen. Daniel Patrick Monyihan of New York, should be distinguished from more moderate or conservative Democrats in that they are more disposed to support the President's plan over Republican alternatives.

This brief description of the three circles of political support currently squaring off over health care reform is by no means exhaustive. Many other players are involved, and rightly so, since this debate directly involves players in 1/7 of our nation's economy, and whose policies and actions directly affect all the rest of us. Some important actors have yet to declare their allegiance to one of the three circles, such as the American Medical Association, the nation's largest association of doctors, and the American Association of Retired Persons, or A.A.R.P., the nation's largest senior citizens' organization.

Complex interplay between all actors and an ever evolving clash of alliances and strategies will characterize the debate as it continues to unfold, certainly one of the most important legislative and public policy struggles of the twentieth century.

Friday, September 17, 1993

Our English Cousins Versus The Huns: Anti-German, Pro-English Bias During World War One

The U.S. Political Context of Wilson's Decisions for War

An interlocking set of anti-German and pro-British biases shaped and guided President Woodrow Wilson's policies towards the belligerents of World War One from the war's very beginning. These biases existed in the nation at large and were shared by Wilson personally. In his address to the nation of August 19, 1914, Wilson urged that America be "impartial in thought as well as in action." Contrary to this publicly stated claim, however, he embarked on a three-year course of action which favored Allied war interests at almost every turn, culminating in U.S. intervention in the war on the side of the Allies in 1917. The reasons for the existence of these biases are complex and varied, and I will touch on some of them here.

Pro-British sentiment in America had been steadily building since the early nineteenth century. This was partially due to the growing influence of racial ideology, which portrayed America and Britain as Anglo-Saxon partners in a "trans-Atlantic community of English-speaking people" (Hunt, Traditions, p 28). Powerful U.S.-British ties already existed due to America's initial British heritage, and were strengthened through intermarriage among the two nations' elite circles. In the decades leading up to 1914, Great Britain seemed to anticipate the intensification of conflict between the imperial powers of Europe. Accordingly, "London carried on a long-standing campaign to cultivate the U.S. as an international power" (Hunt, Redefining, p 6). British leaders set about resolving most disputes with the U.S., and most importantly, conceded authority to the U.S. regarding Latin American affairs.

By contrast, the U.S. increasingly viewed Germany as a "threatening competitor" (Fry, p 3) in the decades leading up to WWI. The Venezuelan crisis of 1902-03, in which German, Italian, and British ships blockaded that country's main harbor, was seen as an opportunity for the Germans to further their empire-building aims by establishing a presence in the Caribbean. Racial ideology combined with American distaste for the autocratic nature of the German state as forged by Bismarck to ensure that "by the turn of the century, Americans increasingly pictured them (Germans) as latter-day Huns, prone to the aggressive, even brutal behavior characteristic of a militaristic and autocratic system" (Hunt, Traditions, p 29).

A survey of American newspaper editors conducted for Literary Digest magazine in November, 1914 revealed that "189 editors favored the Allies, only 38 Germany, with 140 not yet clearly committed" (Hunt, Redefining, p 6). This pro-British bias on the part of the nation's press was evident even before news of the German "rape" of Belgium and such incidents as the sinking of the Lusitania occurred. Later, in late 1916 and early 1917, the press would eagerly lead the charge towards war. As Senator George Norris (R-NE) pointed out in his April 4, 1917 speech opposing U.S. involvement in the war, "a large number of the great newspapers and news agencies of this country have been controlled and enlisted in the greatest propaganda that the world has ever known, to manufacture sentiment in favor of war." Norris singled out U.S. economic interests who were profiting from the Allied war trade as being responsible for this pro-war propaganda effort.

From 1914-17, U.S. companies conducted more than $12 billion worth of trade with the Allies, compared with less than $1 billion with the Entente powers (Hunt, Redefining, p 7). Furthermore, by 1917, U.S. banks had directly loaned $2.3 billion to the Allies, and only $27 million to Germany (Hunt, Redefining, p 7).

President Wilson himself was an Anglophile, identifying much more strongly with the British than the Germans. In a December, 1914 New York Times interview, Wilson revealed his views on the geopolitical aims motivating the two belligerents. "It seems to me that the government of Germany must be profoundly changed," Wilson said, before implying that in contrast to Germany, Britain would be the preferred victor because she had no further empire-building desires.

Wilson further betrayed his own pro-Allied sentiment by the steps he took in acquiescing to the British blockade of the continent. He strongly condemned Germany's use of submarine warfare, writing that it "disregarded rules of fairness, reason, justice, and humanity." However, he registered only weak protests against Britain's violations of international law by disguising their vessels with neutral flags. Finally, his closest advisers, Col. Edward House and Sec. of State Robert Lansing, were virtually committed to U.S. intervention on the Allied side. Time and time again, the actions both took in their official capacities were in service of this overriding goal.

Thus, the general anti-German, pro-British sentiments and elite economic interests in the nation at large found echo at the highest levels of American policy making. It is little wonder that the U.S. eventually entered the First World War on the side of the Allies, only that it took as long as it did.

How the Media Manufacture Consciousness and Consent

How do the mass media interact with politics, and in doing so influence the public's political views? In my view, decades of debate over whether or not mass media actually have the power to change people's minds and influence their opinions seem to have missed the point. The real story behind mass media's power is its agenda-setting function.

An old saying goes, the media may not be able to tell us what to think, but they can tell us what to think about. It seems clear that the nation's "public agenda" is almost wholly shaped and determined by how much attention the media decide to give to specific issues and world events. But I think the process of agenda-setting goes deeper than this.

It is not only about determining that the public mind will be focused on issues such as NAFTA, U.S. health care reform, and the Israeli-Palestinian peace process at any given time. Ultimately, the media's agenda-setting power derives from the effects of accumulated media exposure on the general public, over time, and how this accumulated exposure literally creates and shapes our world views. In telling us what to think about, perhaps the media really do manage to tell us what to think, period.

In my understanding of how media work, I choose to emphasize the agenda-setting function of media and somewhat discount the "direct effects" or "magic bullet" theory of media power. However, I also find fault with the so-called "minimal effects" theory. This theory holds that media have little or no effect on people's views, and often dovetails with research into what is broadly known as "media uses and gratifications." Briefly, both these theories postulate that people expose themselves to media in selective ways, giving more attention to information that conforms to their already established views. The problem I have with these theoretical approaches is that they ignore the process by which a person's "already established views" are established in the first place. In part, they come from one's accumulated prior media exposure, from the time of birth onwards.

The media are channels through which people receive information about the world, and thus must be viewed as essential elements in the socialization process that we all undergo in learning about our world. Even other elements in the process of socialization (i.e., family, school, church) are themselves subject to media influences. To understand more about the process by which prior media exposure builds on itself and continually shapes our perceptions, a look at dissonance theory proves helpful. When we encounter information that is at odds with our previously held beliefs, dissonance results, and we are likely to reject that information. Thus, our accumulated media exposure constructs a set of unconscious mental boundaries for each of us. Our minds are unlikely to stray beyond these bounds when exposed to opinions that contradict the accumulated conventional, mainstream views fed to us over time by the media.

So rather than having little or no effects on people's opinions, I contend that over time, the mass media effectively shape people's entire world views. The net effects of accumulated media exposure is to indoctrinate people with a detailed vision of how the world works, how they fit into the world, in short, what it all means. This all falls under the broad rubric of agenda-setting.

In thinking about various other theories of mass media effects, I find some validity in the premises shared by news diffusion and multi-step flow models. We live in a technologically, socially, politically complex, sensory overloaded, late-stage industrialized nation, and it is estimated that only half of our adult population is functionally literate, and only a quarter of our citizenry highly literate. It seems obvious that some information reaches various sections of the population and not others, or at different times, and may encounter interpersonal transmission between different groups along the way (i.e., between so-called opinion leaders and others). In a time of ever increasing social isolation and extinction of opportunities for people to communicate with one another, however, such interpersonal transmission may be occurring less and less frequently.

However, I see these theories more as communication models than effect theories. They are diagrams which describe how some information is transmitted from initial sources to eventual audiences. They don't do much to explain how this transmission affects the content of the messages themselves, except to hypothesize that the people who act as intervening transmitters color messages with their own individual biases. More important, I think, is to go back to the communication source and look at the information being transmitted in its "original" form.

In order to understand how the mass media truly affect politics by shaping people's world views, it is necessary to have insight into the pressures and constraints that themselves shape the news, information, and entertainment the mass media transmits. My argument is that the mass media are to the social, political, and economic status quo in our country what the dictator's boot is in totalitarian regimes around the world. That is to say, they are the single most important factor in maintaining the status quo in today's America.

Why is this? I think it is because the world view that the media indoctrinates in people through accumulated media exposure is a very status-quo affirming one. The pressures and constraints that shape this world view and thus color the news and information we receive stem from the interests of those who ultimately control the mass media, i.e., their owners. At this point in time, our nation's mass media are almost all controlled by an ever more concentrated group of global corporations (Bagdikian, The Media Monopoly). These corporations are profiting greatly from a global status quo characterized by an almost unfettered international capitalist order, and thus have powerful interests in maintaining said status quo.

An extraordinarily complex web of organizational, ideological and other factors governs the manufacture of such status-quo affirming news and information. The oft-repeated charge that the media has a liberal bias derives much of its credibility from surveys of reporters. Individual reporters may be relatively liberal, but what really matters are the political, social, and economic worldviews of their editors and bosses.
"Surveys show that daily newspapers endorse Republican presidential candidates over Democratic ones at about a six-to-one ratio. Surveying 'eighty-four systematic studies,' one media critic found 'a very high correlation' between editorial slant and news coverage, with political bias in the news being 'overwhelmingly pro-Republican and pro-conservative.' Despite the talk about a 'liberal conspiracy' in the press, 'the real question is how liberal electoral politics survives at all with the overwhelming opposition of the conservative press.'" (Parenti, Inventing Reality, p 14)

The dynamics of self-censorship usually serve to keep reporters in line, i.e., prevent them from pursuing too many stories that may be in the public interest but offend powerful interests and are likely to be killed by their editors. Most journalists come out of the same graduate schools, anyway, where they learn to look at the world in similar ways. Those reporters who spend time covering people in positions of power are likely to start seeing things from their perspective. For the most part, journalists in the upper echelons of mass media have become very highly compensated, and themselves are part of our country's economic elite.

I don't see a "media conspiracy" of some sort behind this state of affairs. Rather, I see the role that the mass media play in creating conservative, uninformed world views and influencing our political beliefs as a natural outgrowth of their control by powerful private business interests.

I don't prescribe total government control of the mass media as the solution to this problem. Yet I do believe that hope lies in organizing enough Americans to eventually take back the airwaves and create truly alternative mass media channels. When this occurs, and the accurate, truthful dissemination of essential information is ensured, freed from the economic and status-quo affirming constraints of today's corporate-controlled mass media wasteland, then and only then will the media be functioning as it should in a true democracy.

For reasons of space and clarity, my emphasis on the mass media's agenda-setting role excluded mention of a much more direct way in which the mass media has affected politics in our country. However, I feel the subject is important enough to merit a short postscript.

In the four decades since its widespread introduction, television has become the dominant arm of the mass media. During this period, it has succeeded wildly in diverting the attention of most Americans from our nation's problems and how we might best go about solving them. Television has come to play an invaluable role in keeping most Americans docile and passive citizens, unable to figure out why so much is wrong with our country and the rest of the world and what to do about it.

Watching television displaces social and community life, reducing opportunities for people to get together and talk about any one of the hundreds of grievances they might share, thus reducing the likelihood of political activism and organization. If reading involves mind exercise, watching television causes the mind to atrophy and die. The average American watches more than four hours of television a day. No study of mass media effects on politics would be complete without recognition of this chilling reality.


Bagdikian, Ben H. The Media Monopoly, 3rd ed. Boston: Beacon Press, 1990.

Parenti, Michael. Inventing Reality: The Politics Of News Media. New York: St. Martin's Press, 1993.

Wednesday, September 8, 1993

Why Health Care Reform's Time Has Come

It is Labor Day, 1993. Over the weekend, senior Clinton Administration officials announced the broad outlines of their health care reform proposal which will be formally introduced later this month. The plan is nine months in the making, and has been painstakingly crafted by First Lady Hillary Rodham Clinton's 500-member Health Care Reform Task Force. It promises to extend a standard package of health insurance benefits to all Americans. The plan represents the single biggest government health care initiative since 1965, when Medicare became law as part of Lyndon Johnson's Great Society legislative program.

So how did the issue of health care reform reach this advanced stage? It is a top priority of the highest elected office in the land, with congressional action on the matter imminent. Newspapers and magazines are full of articles and commentary on the subject. Dozens of books have been published on the U.S. health care system in the past few years. Television devotes similar attention (through the limited newshole it has) to problems with health care and the Administration's proposed reforms. At this moment in time, health care reform is obviously very high on what we can call the "public agenda." But how did it get there? Why health care reform, and not any one of the other urgent, pressing problems our nation now faces?

The answer is that within the past few years, key events have occurred which created the necessary conditions for national health care reform to move to center stage. In the words of John Kingdon, a convergence of problem streams, policy streams, and political streams has recently occurred, thus opening a window of policy opportunity. If we understand these key events, we will understand why health care reform's time has come.

The issue of national health insurance was first placed on the public agenda by Harry Truman during his 1948 re- election campaign. It then endured decades of fruitless debate, with any proposed changes to the U.S. system of private medical practice promptly labeled as steps toward "socialized medicine." Gradually, the system evolved which exists today. U.S. doctors collect fees for services rendered to patients, mostly paid by medical insurers through an elaborate system of private, largely employer-provided medical insurance. Health care costs have skyrocketed, for several reasons.

"Doctors are rewarded for providing lots of services, even if unnecessary, to patients who don't mind because they only pay a fraction of the bill. And because patients choose their doctors, insurers are unable to negotiate treatment and fees." (NYT editorial, 6/15/91)

Workers who hold jobs with no health benefits and unemployed Americans together number more than 35 million people who lack any health insurance, and more than 60 million more Americans are underinsured.

"Tens of millions (more) are frozen into their jobs in order to retain existing benefits, and many cancer survivors, diabetics, AIDS patients, and others are classified as "uninsurable." Unionized retirees are finding their benefits unilaterally cancelled. And most people are struggling to meet the rising cost of deductibles and co-payments." (Mother Jones, May/June 93, p 18)

National health care reform briefly surfaced on the public agenda in the early seventies. Its leading proponent was Sen. Edward Kennedy (D-MA), who may have been in search of a "serious" issue to stake claim to, and thus deflect criticism that his only qualification as a perennial presidential aspirant was his last name. President Carter proposed fairly comprehensive health insurance reforms in 1978, but the package ultimately went nowhere, mainly due to Carter's inability to get along with the Democratic Congressional leadership. Health care reform again appeared as an issue in 1983, during debate over President Reagan's 1984 budget. This debate centered around Reagan Administration reform proposals that would have in part made Medicare and Medicaid patients pay more of the costs of their routine care. This "reform" plan also went nowhere.

A bipartisan commission was established by Congress in 1986 to explore the issue of health care reform. Known as the Pepper commission, it was led by former Iowa Gov. Robert Ray, a Republican, and former U.S. Rep. Paul Rogers (D-Florida). In early 1989, its findings were released, calling for a so-called "pay-or-play" system which would require employers to cover their own employees or pay into a fund to cover uninsured workers. Soon afterwards, this concept was embodied in the form of legislation introduced by Sen. Edward Kennedy (D-MA) and U.S. Rep Henry Waxman (D-CA), also in early 1989. The Kennedy-Waxman bill ultimately fell victim to public furor over another element of health care reform during the summer and fall of that year. Senior citizens mobilized to have Congress repeal legislation which increased Medicare taxes on the wealthiest retirees in order to pay for universal catastrophic illness coverage. In the wake of this largely unforeseen revolt, prospects for legislative action on other health-related measures was temporarily dimmed.

However, by 1991, health care reform was back on the Congressional agenda. In June, 1991, a retooled version of the "pay-or-play" Kennedy-Waxman bill, dubbed "AmeriCare," was introduced in the U.S. Senate by Kennedy and Senate Majority Leader George Mitchell (D-ME). Democrats were clearly looking to the upcoming 1992 Presidential race. Party leaders admitted freely that they saw health care reform as an issue with potentially broad appeal to middle class voters, now that increasing numbers of blue and even white collar workers were joining the ranks of the uninsured. One possible 1992 Presidential aspirant, Sen. Jay Rockefeller (D-W.V.), was attempting to make health care reform hisÿissue, and in doing so ensured wide mention of the arguments for reform in his press coverage at the time.

Undoubtedly, though, the biggest public push that health care reform received all year occurred on the morning of November 6, 1991. It was on this day that the country woke up to discover that Dick Thornburgh, the former Governor of Pennsylvania who had resigned as President Bush's Attorney General to run for former Sen. John Heinz' (R-PA) U.S. Senate seat in Pennsylvania, had lost by a 60-40 margin to a Democrat, a little known former college president named Harris Wofford.

Wofford had been appointed to fill the vacant Senate seat by current Pennsylvania Gov. Robert Casey, so he was technically the incumbent, and he was assisted in no small way by the efforts of his campaign manager, a political strategist named James Carville. But an anti-incumbent mood was blowing in the country, and Carville's political brilliance was still relatively unknown. The real significance that political observers and media pundits derived from Wofford's victory was the electoral potency of the health care issue. Wofford had campaigned aggressively in favor of reform, running commercials in which he said that "if criminals have the right to a lawyer, then every American ought to have the right to a doctor."

Immediately, Democrats sensed that here was an issue they could win with. The Republicans sensed the same, for within days after the election, the Bush Administration had announced that its own plans for comprehensive health care reform were imminent. From this date on, the media debate over America's health care system ballooned. Health care reform did become an issue in the 1992 Presidential race, and voters' sentiments that a Clinton Administration would be more likely to propose real reform than any other undoubtedly played an important role in his ultimate victory.

It would be misleading, however, to suggest that average citizens' concern over more expensive, more elusive health care coverage and the resulting pressure they brought to bear on elected officials were the sole reasons that reform found its way onto the public agenda. After all, large numbers of Americans had been medically uninsured for decades, and time and time again, legislation had been proposed to remedy their situation. The final, and some would argue deciding factor which threw the current cycle of health care debate onto the public agenda has been the needs of big business.

By the late eighties and early nineties, large corporations essentially became fed up with paying for health care benefits for their employees. For example, General Motors is the largest private purchaser of health care in the U.S., spending $3.7 billion on care for its employees in 1992 alone. Because of rising health care costs, many companies scaled back such health benefits, increased the premiums paid by employees for plans, or canceled them altogether. Companies also began to abdicate responsibility for providing employees with health insurance by replacing more and more of their full time workforces with temporary employees who were not entitled to benefits.

Businesses began to realize, however, that the problem they faced was national in scope, and ultimately not responsive to individual, in-house corporate health benefits reform initiatives. In an April, 1991 Gallup survey of "chief executives of the nation's largest companies," conducted for the Robert Wood Johnson Foundation and duly reported in the New York Times, fully 91% of executives surveyed said that a "fundamental change or complete rebuilding of the nation's health care system" was needed.

A New York Times article of May 19, 1991 entitled "Demands to Fix U.S. Health Care Reach A Crescendo" provided an example of how even though the needs of business accelerated the consideration of health care reform onto the "public agenda," this element of the story was downplayed. The article begins by cataloguing the failures of the current health care system, as it affects most of the ordinary people who fall through its cracks.

"The American health care system is the most expensive in the world, but for those not in its mainstream, the care it offers is among the most unsatisfactory. Americans pay $700 billion a year for health care but 34 million of them remain uninsured. Life expectancy in the U.S. is shorter than in 15 other nations, and infant mortality is worse than in 22 other countries." (New York Times, 5/19/91, Sec 4, p 1)

Buried late in the same article are the complaints of business about the spiraling costs of health benefits.

"For businesses, tension is rising. Companies watch as health care spending devours ever larger portions of their profits. In the 1960s, businesses spent about 4 to 8 cents of each dollar of profits on health care. In 1990, it was 25 to 50 cents of each dollar." (New York Times, 5/19/91, Sec 4, p 1)

A legitimate complaint, certainly, but more revealing of just how important it had become by 1990-91 for large corporations to start lobbying in favor of some type of government reform of the current health care delivery system.

A final word about agenda control with regard to this issue. The U.S. industry with the most at stake over any type of health insurance reform plan is, of course, the medical insurance industry. There are two dozen large such insurance companies, and hundreds of smaller ones. The industry's worst nightmare is that popular confidence in and support for the current health care system might decline to the point where public pressure would build for what is known as a "single-payer" system. This is the health care system in place in Canada. Instead of billing insurance companies for services rendered to patients, doctors send their bills to just one payer - the government. This system is not "socialized medicine" as it exists in the U.K., where doctors work for a government health service. Physicians remain in private practice - the insurance middlemen are simply replaced by a government agency.

"In the U.S., twenty-two cents of every health-care dollar are spent on administrative costs, overhead, and insurance company profits; in Canada, that figure is ten cents. The twelve-cent difference could mean more than $90 billion in savings for the United States, enough to provide coverage for all uninsured Americans and tens of millions who are underinsured." (Mother Jones, May/June 93, p 21)

A single payer plan would also put the whole medical insurance industry out of business, because the government would collect monies that citizens would normally pay out as premiums in the form of taxes.

Polls done for Bill Clinton during the 1992 campaign revealed that approximately 33% of voters supported national health care reform along the lines of the Canadian system, and the more that other voters found out about it, the higher support levels went. The main tactic used by the insurance industry to prevent public support from building around a single-payer system has been to ensure that other, competing "reform" plans would be central to any health care reform agenda.

Consideration of a single-payer system was thus bumped off the table almost immediately as too unworkable and disruptive to the U.S. economy. It has also been alleged that the insurance industry has actively worked to discredit the Canadian system by feeding exaggerated stories to the U.S. media about the system's supposed deficiencies - waiting lines, lack of access to sophisticated technology, etc.

The centerpiece of the Clinton Administration's Health Care Reform Task Force proposal is "managed competition," a plan involving the formation of large, regional, managed-care health corporations similar to present HMO's but bigger. Managed competition preserves the role of the insurance industry in the health care system, and thus achieves the industry's main goal of ensuring its own survival through blocking public consideration of a single-payer plan.

The concept of managed competition itself dates to the mid-1970s, when it was designed by an informal think tank known as the Jackson Hole Group, essentially a group of insurance industry heavyweights and representatives from organizations like the American Hospital Association and the Pharmaceutical Manufacturers Association, looking to ensure a rosy future for their respective profit margins. President Clinton himself has stated his unswerving opposition to the concept of a single payer plan, saying that managed competition is the only option.

Thus ends the story of how health care "reform" has been added to the public agenda. With knowledge of how it got there and who its biggest backers currently are, I can't say I'm very confident about its eventual ability to improve the health of America.

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