Becerra Supports ‘Medicare for All,’ and Could Help States Get There
Waivers can expand health care offerings without need for congressional approval, but the challenge will be how to pay for them.
by Sarah Kliff - NYT - December 10, 2020
Xavier Becerra has long supported moving the United States to a “Medicare for all” system. As President-elect Joe Biden’s pick to run Health and Human Services, he may have opportunities to speed up such a transition.
The Health and Human Services secretary oversees an array of waivers that states can use to cover new groups or provide different types of health plans. Because these waivers do not require congressional approval, they could become a crucial policymaking tool for the Biden administration if Republicans retain control of the Senate.
“Without a Senate majority, it will be hard to advance some of the fundamental planks of the administration’s plans,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. “That’s where the waiver authority becomes important.”
The health system’s future was a major dividing point in the Democratic presidential primary. President-elect Biden has supported the idea of a public option: a government-run health plan that all Americans could choose to buy into — but not the Medicare for all system proposed by Senator Bernie Sanders of Vermont, which would eliminate private coverage and move all Americans into a public plan.
Some of the waivers can work through the Medicaid program, which has authority to allow states to cover additional groups or to provide enhanced health benefits.
Others can go through the Affordable Care Act, which has a section that allows states to bundle their different sources of health law funding — such as the individual premium subsidies that residents would receive, or tax credits that would go to small businesses — and take those dollars as a lump sum to finance a different type of health system. States do have to meet certain requirements: They cannot increase the uninsured rate, and their plan cannot require additional federal money.
Which types of waivers get approval often depends on the policy preferences of the administration and the Health and Human Services secretary. The Trump administration has typically approved waivers that tighten eligibility for public health programs, such as those requiring Medicaid recipients to work to receive health coverage.
The waivers approved by Mr. Becerra as part of the Biden administration would most likely be different, and could reflect his long track record of supporting single-payer health care. He endorsed the idea as a first-term congressman in 1994 and sponsored Medicare for all legislation four times during his 12 terms in Congress. In 2017, he reiterated that he “absolutely” supports a policy that would move all Americans to one government-run health plan.
“He’s been on the record as a supporter from his time in the House,” said Representative Ro Khanna, a California Democrat and a prominent advocate of Medicare for all. “He was sponsoring this at a time when it was not very popular to support it.”
Most observers expect Mr. Becerra and the Biden administration to be amenable to waivers that expand health coverage in small and large ways.
Climate Fwd:: Our latest insights about climate change, with answers to your questions and tips on how to help.
“Waivers are discretionary for the secretary,” said Patricia Boozang, a senior managing director at the consulting firm Manatt Health. “There’s a lot of innovative ideas that states have around expanding coverage and making it more affordable.”
Illinois, for example, applied in November 2019 for a waiver to give mothers of newborns Medicaid coverage for one year after giving birth. The Trump administration has not acted on the request, but some observers expect it to get a fresh look and quicker approval after Mr. Becerra takes over the health agency.
States will also have the opportunity to pursue more experimental and larger coverage expansions. Many experts believe that Mr. Becerra’s waiver authority would easily allow a state-level public option to move forward. Nevada, Colorado and Connecticut have all considered the idea in recent years, and President-elect Biden supported the idea in his 2020 campaign.
“I think a lot of states are dusting the cobwebs off some old plans and thinking about, how can we use these waivers,” Ms. Boozang said.
An enterprising health secretary, working in partnership with a state, could also go even further. Some experts believe that a combination of Medicare, Medicaid and Affordable Care Act waivers could allow a state to build a single-payer plan with all of its federal health dollars.
Vermont had planned to do that in the early 2010s, and had identified waivers to create a state health plan to cover all Vermonters. The state held monthly meetings with the Obama administration to hammer out how to use federal waivers to set up its new health system.
“They gave us all the waivers we needed to get it done,” said Peter Shumlin, the former governor of Vermont who led the state’s effort. “I hope the Biden administration will work with states to innovate, too.”
The state’s plan fell apart, however, when it concluded that the tax increases necessary to create the program were politically infeasible.
This speaks to one weakness of much of the waiver process: Though states can use their federal funding in new ways, they typically cannot receive additional money. Any extra dollars they need would have to come either from raising taxes or cutting something else in their budget.
In the case of Vermont, the small state estimated it would need $2.5 billion in additional funds to start a single-payer health system — an amount larger than its annual budget.
“When health costs are often rising two or three times faster than income, there is no magical way to pay for the system,” Mr. Shumlin said. “That is what we ran into.”
The hardest part of moving single-payer health care forward this way may be finding a state that wants to step up and try again. The coronavirus has significantly strained state budgets; many states are now exploring cuts to their Medicaid programs rather than thinking about ways to expand coverage.
“The math is very tough,” Ms. Hempstead said.
A few states have shown at least some interest in taking on the issue, but none are poised to pursue a federal waiver.
In its 2018 session, the New York State Assembly passed a bill to create a single-payer system, but the effort died in the Senate. In California, Gov. Gavin Newsom ran his most recent campaign on a single-payer platform and established a commission on the issue in January. One of his first acts as governor was writing a letter to President Trump trying to ascertain what federal flexibility existed for states that wanted to create universal coverage.
But Governor Newsom had to turn his focus this year to fighting the coronavirus pandemic, and has scaled back budget proposals meant to expand coverage to more Californians — a sign of how challenging major health reform may prove as states continue to battle a public health crisis.
https://www.nytimes.com/2020/12/10/upshot/becerra-medicare-for-all-waivers-hhs.html
Bryan Stevenson — Love is the Motive
Krista Tippett, host: How to embrace what’s right and corrective, redemptive and restorative — and an insistence that each of us is more than the worst thing we’ve done — these are gifts Bryan Stevenson offers with his life. He’s brought the language of mercy and redemption into American culture in recent years, growing out of his work as a lawyer. It’s a pleasure to draw out his spirit and his moral imagination as we feel our need for healing to become a whole society.
[music: “Seven League Boots” by Zoë Keating]
Bryan Stevenson: I am persuaded that hopelessness is the enemy of justice; that if we allow ourselves to become hopeless, we become part of the problem. I think you’re either hopeful, or you’re the problem. There’s no neutral place. We’ve been dealing with injustice in so many places for so long. And if you try to dissect why is this still here, it’s because people haven’t had enough hope and confidence to believe that we can do something better. I think hope is our superpower. Hope is the thing that gets you to stand up, when others say, “Sit down.” It’s the thing that gets you to speak, when others say, “Be quiet.”
Tippett: I’m Krista Tippett, and this is On Being.
Bryan Stevenson’s book Just Mercy has been a bestseller for years, and was made into a movie. The Equal Justice Initiative that he founded in 1989 has won major legal challenges — including before the Supreme Court — for people unfairly on death row, people who are mentally ill and incarcerated, and children being tried as adults. And in recent years, the Equal Justice Initiative has again broken new ground by creating the National Memorial for Peace and Justice and The Legacy Museum in their city of Montgomery, Alabama.
Tippett: I was very intrigued, when I went back to Just Mercy, getting ready to speak with you, that I had forgotten that you quote Reinhold Niebuhr at the beginning of the book, the public theologian of the last century, saying, “Love is the motive, but justice is the instrument.” And I feel like that’s something you didn’t learn at law school, [laughs] but that came from your life.
Stevenson: Well, in many ways I think it’s the background of my family and a larger segment of the Black community, the Black experience. And I appreciate you asking about that quote, because I think I’ve increasingly recognized that we have to be intentional and explicit in our affirmation of the power of love. I don’t think it often comes up when we talk about these dynamics that are so critical …
Tippett: Serious things.
Stevenson: … but in recent years, I really have been talking about it more and more and more.
And what’s interesting is that when I grew up, I never really talked much about my family. I didn’t talk much about background or anything. You’re in the middle of trying to navigate all these challenges — as I’ve said before, I started my education in a colored school. And we were just trying to navigate the challenges of integration. But for me, it really begins with this larger family narrative. My great-grandfather was enslaved in Caroline County, Virginia, and learned to read while enslaved. And I never really thought about that, until later. But I just started thinking about the kind of hope, the kind of vision it took, to believe that one day you’re going to be free, even when nothing around you indicates that freedom is likely for enslaved Black people in Virginia in the 1850s.
Tippett: We don’t think about that, do we, that they couldn’t see the beyond of it.
Stevenson: Exactly. And yet, he had that hope, and he learned to read, and he loved it so much that he wanted to share it with others. So my grandmother would talk about how, after Emancipation, other formerly enslaved people would come to their home, and he would stand up and read the newspaper each night. And she would sit next to him, because she loved the power he had to engage people, to make people feel calmer or more informed. And she would use that word, “love.” And it has absolutely shaped my work more and more.
Tippett: You quote your grandmother a lot. She’s very quotable. She’s clearly a very formidable woman.
Stevenson: She had a very long view. I think she understood the power of an eternal witness. That’s the thing I appreciate about my grandmother. She actually interacted with us in this way that was meant to be eternal And I think she was brilliant at achieving that, in both the things she said, but also in the things she did. And I meet a lot of older Black people, in particular, that seem to have that instinct for creating these memories that just shape you for the rest of your life.
Tippett: So you speak occasionally, and I think very much, these days, about that long arc of the moral universe, that sense of time and that sense of the work ahead of us, generationally, in this country — in our world, too, but in this country. And I do feel like that is in relief now. And so what I really want to do, as we keep speaking here for this hour or so, is really draw out your perspective on that, through the particular place that you have inhabited in your work and in our society — where you’ve been proximate, to use your language.
Tippett: And then pushing closer and closer to what are the root causes, what’s behind this, and this relentless moving towards the heart of the matter and wanting to address this, because could you ever have imagined, when you started the Equal Justice Initiative, which was about being a lawyer and working with people on death row, that then today, somebody would go to your website and there’s a memorial, and there’s a museum? [laughs] So I’m curious, if you reflect at this remove on that evolution, what’s that been about, at heart?
Stevenson: It’s such a terrific question, because you’re absolutely right, this has definitely been a journey of discovery. Had we succeeded with just providing legal services to people and achieving the things that we thought needed to be achieved, we wouldn’t have kept looking. But of course, that wasn’t sufficient. And so you keep digging. And I would not have imagined that today, I’d be working on a museum, a memorial, and these reports.
But it really was about a decade ago, I guess, or maybe twelve years ago, that I began to question whether the law was enough. And it was largely triggered by this awakening that, even though I’m a product of Brown v. Board of Education, about twelve years ago I realized that I don’t think we could win Brown v. Board of Education today.
Tippett: Gosh.
Stevenson: I don’t think our court would do anything that disruptive on behalf of disfavored people, on behalf of marginalized people. And that terrified me. But it also energized me to recognize that we were gonna have to get outside the court and create a different consciousness. The question for me is, why wouldn’t we win? And it’s because we haven’t really reckoned with these larger issues of what it means to be a country dealing with our history of racial inequality.
Tippett: Right. And I think that language you used, about — even you, because you are a product of this culture, as well, when you thought about people in prison, you didn’t think about their humanity. You thought about what they’d done. And even how you use — you speak a lot about the “narrative” — even how we use the language of, it’s not somebody who stole something, it’s a thief. It’s a murderer.
And also, somewhere you said you started to see that slavery doesn’t end, it evolves. And you go back to lynching, and there’s this presumptive criminality just by virtue of being Black, that then turns up in who is in our prisons and who’s on death row. And what you uncover is this callousness — extreme callousness and coarseness and dehumanization that is so at odds with who we want to think of ourselves and want to be, I believe, as a country.
Stevenson: And I think a lot of it has to do with how we’re governed, how we’re acculturated. I think in the 1970s, part of what happened is that our political leaders began relying on the politics of fear and anger as a way of shaping policy. And so we declare this misguided war on drugs: we say that people who are drug dependent and drug addicted are criminals, and we’re gonna use the criminal justice system to respond to that problem. Now, we could have said and should have said that people suffering from addiction and dependency have a health problem and we need a health care response. But that’s not gonna generate the kind of energy that demonizing people for addiction will.
That’s how we got to the point where we were putting people in prison forever, life without parole, for writing a bad check. I’ve represented people who were serving life without parole for simple possession of marijuana. Taking away the minimum age, or trying children as adults. When you step back and you think about it, it makes no sense. And there are 13 states today that have no minimum age for trying a child as an adult. And you can’t really rationalize that unless you are distracted by these narratives of fear and anger.
And I think that is part of the condition that gives rise to the brutality and the cruelty that I’ve seen in my work; and of course, when you are governed by fear and anger, when you’re shaped by fear and anger, you tolerate things you would never otherwise tolerate. You accept things you would never otherwise accept.
And I think, for me, getting at that, pushing people to step back from fear and anger, getting people to think more critically about this larger legacy of racial inequality, is the priority now. And that’s what led me into the racial justice work that we’ve been doing, and this effort at trying to pull apart American history in a new way, in a different way than the way we have tended to hear it.
Tippett: As something we have to reckon with, must reckon with on our way to reckoning with all of that, all of these, what in fact are consequences.
Stevenson: And so the reckoning that has to happen in this country has to be rooted in a moral awareness, a moral awakening, a consciousness that evolves in a way that we begin to do the things that we must do, if we’re going to not only save the country, but save ourselves.
And this is where, for me, faith traditions become so important, because in the faith tradition I grew up in, you can’t come into the church and say, “Oh, I want salvation and redemption and all the good stuff, but I don’t want to admit to anything bad. I don’t want to have to talk about anything bad that I’ve done.” The preachers will tell you, it doesn’t work like that. You’ve got to first repent, and you’ve got to confess. And they try to make you understand that the repentance and confession isn’t something you should fear, but something you should embrace, because what it does is open up the possibility of redemption and salvation. And we have a very religious society, where we talk about these concepts on Sundays, on Saturdays, whatever, but we haven’t embraced them. We haven’t employed them in our collective lives. And I think that has to change.
[music: “Nothing Nothing At All” by Blue Dot Sessions]
Tippett: I’m Krista Tippett, and this is On Being. Today, with lawyer Bryan Stevenson.
[music: “Nothing Nothing At All” by Blue Dot Sessions]
Tippett: I see you having played a role, having a voice that is so important — and I’m not sure that people point this out to you — bringing a word like “mercy,” using the language of “redemption.” This is significant. You went to law school because — you and I are about the same age — that’s how you were gonna change the world, right? Changing legal structures.
Here’s something you wrote — and I’m pretty sure this is from Just Mercy — which gets at the life-giving possibility in us picking this up. You said, “We are all implicated when we allow other people to be mistreated. An absence of compassion can corrupt the decency of a community, a state, a nation. Fear and anger can make us vindictive and abusive, unjust and unfair, until we all suffer from the absence of mercy. And we condemn ourselves as much as we victimize others.” You end this by saying, “We all need justice,” you said, “the closer we get to mass incarceration and extreme levels of punishment.” But I think, in wider and wider circles, we see this. “It’s necessary to recognize that we all need mercy, we all need justice, and — perhaps — we all need some measure of unmerited grace.”
Stevenson: I really believe that. I really do. And I think, for me, it makes it easier when I have to challenge people, when I have to go into places where there’s a lot of hostility, where there’s a lot of resistance, where people look at you as if you’re evil. It makes it easier, because I’ve never thought what I do, I do just for my clients, or I’m doing just for the people who I represent or the people who know I care about them. I’ve always felt like my work, our work, is for everybody. That is, we’re trying to save everyone from the corruption, from the agony, of living lives where there is no mercy, where there is no grace, where there is no justice — where we are indifferent to suffering. Those kinds of lives ultimately lead to violence and animosity and bigotry. And I don’t want that for anybody.
And I do talk a lot, obviously, about my clients; those are the people I have to advocate for, and when I say that each of us is more than the worst thing we’ve ever done, I am thinking specifically about them, but I’m also thinking about everybody else. I believe that for every human being. I think if someone tells a lie, they’re not just a liar; that if someone takes something, they’re not just a thief. If you kill someone, you’re not just a killer. But it’s also true, a nation that committed genocide against Indigenous people, a nation that enslaved Black people for two and a half centuries, a nation that tolerated mob lynchings for nearly a century, a nation that created apartheid and segregation laws throughout most of the twentieth century, can also be more than that racist history suggests.
Tippett: That worst thing we did. You always say that none of us is defined by the worst thing tha …
Stevenson: Exactly. And that’s the reason why we ought to find the courage to acknowledge the wrongfulness of those things so that we can then embrace what’s right, what’s corrective, what’s redemptive, what’s restorative. And I do want that for everyone.
Tippett: So you gave the commencement address at Harvard Law School, your alma mater, which I think you said you’d never turned up to graduation when you actually graduated from there.
Stevenson: [laughs] That’s true.
Tippett: You were off pursuing your found vocation.
Stevenson: Yes, exactly.
Tippett: I feel like you offered some — this is America, I bet you get in conversations like this all the time, too: people say, “What do I do? Give me a tip,” or, “What’s the first step?” [laughs] But you did actually lay out a four point program, which I think is helpful, understanding that this is not a four point program for what you do this week, but stepping onto that long arc of the moral universe. And the first part is about “staying proximate.” Your grandmother, again, said to you, “You can’t understand the most important things from a distance, Bryan. You have to get close.”
Stevenson: And for me, it is an important idea. It’s interesting, because in science and in research, proximity is baked into the very heart of the discipline. If we create a vaccine for COVID, if we create a cure for this virus, it’s because the researchers and scientists understand the details of this virus with such precision and clarity that they’ve been able to create an answer. Innovation comes, in science, by the people who are able to pull something apart with such insight and knowledge that they can then innovate, and they can create new — it’s how we make progress. And I think the same is true in the justice sector: that we cannot make progress in creating a more just society, healthier communities, if we allow ourselves to be disconnected from the people who are most vulnerable: from the poor, the neglected, the incarcerated, the condemned. If you’re trying to make policies in the criminal justice space but have never met someone who’s in a jail or prison, you haven’t been to a jail or prison, you’re going to fail.
I think sometimes when you’re trying to do justice work, when you’re trying to make a difference, when you’re trying to change the world, the thing you need to do is get close enough to people who are falling down, get close enough to people who are suffering, close enough to people who are in pain, who’ve been discarded and disfavored — to get close enough to wrap your arms around them and affirm their humanity and their dignity. And that’s why, whether you graduate from Harvard Law School, you graduate from college, whether you’re a social worker or a teacher, you should not underestimate the power you have to affirm the humanity and dignity of the people who are around you. And when you do that, they will teach you something about what you need to learn about human dignity, but also what you can do to be a change agent.
Tippett: They will show you.
Stevenson: They will absolutely show you.
Tippett: Proximity will reveal the — yeah. And another of your pieces of counsel is: Be willing to do inconvenient and uncomfortable things, which may also entail getting what feels like unsafe. And we are so segregated in so many ways in this society, so thrust together with people who are like us, that I feel like getting proximate in this culture may often mean getting uncomfortable …
Stevenson: Absolutely.
Tippett: …and inconvenienced.
Stevenson: I think it requires a kind of intentionality. I mean, human beings are biologically programmed to do what’s comfortable. We do what’s convenient. It’s just how we get through.
Tippett: What feels safe.
Stevenson: Which means that to do something uncomfortable or inconvenient, we’re gonna have to make a choice. We’re gonna have to make a decision to do what everything around us is telling us we shouldn’t do.
But it is that process that yields progress. Athletes understand this. Every great performer understands that the path to greatness requires an uncomfortable commitment, sometimes even a preoccupation, with the skills necessary to deliver the artistry that you want to deliver. And I just think the same is true when we’re trying to increase the health quotient, increase the justice quotient, in the communities where we live.
[music: “Dirty Wallpaper” by Blue Dot Sessions]
Tippett: After a short break, more with Bryan Stevenson. You can always listen again, and hear the unedited version of every show we do on the On Being podcast feed — wherever podcasts are found.
[music: “Dirty Wallpaper” by Blue Dot Sessions]
Tippett: I’m Krista Tippett, and this is On Being. Today, exploring Bryan Stevenson’s spirit and his moral imagination. He’s brought the language of mercy and redemption into American culture in recent years — through his book Just Mercy and his tireless work as a lawyer for people who, as he says, have been defined by the worst thing they’ve ever done: people unfairly on death row, people who are mentally ill and incarcerated, and children being tried as adults. The Equal Justice Initiative that he founded in Montgomery has also created the groundbreaking National Memorial for Peace and Justice and The Legacy Museum.
Tippett: I’m so relieved that the election is over. Just setting aside the actual details of the election, [laughs] which are significant, but also because I just feel like 2020 — March, April, May, just those months alone — it laid out so much for us to just dig into.
Stevenson: That’s right, because that’s the other thing I talk about is, you have to be hopeful. And I do think that’s important in this moment, as well, because there’s so much that we see that is dispiriting.
We do these web articles at EJI. We post stuff, and we do a daily calendar thing. And I was just working on one today, about some of these comments by law enforcement officers over the last couple of weeks, and I just find it heartbreaking. We had a police officer in Alabama say, “Join me. I’m going to Washington. I’m gonna shoot Democrats. I’m gonna kill these socialists, and we’re not gonna leave any survivors.” And some of this rhetoric — it was a police officer in Wilmington, North Carolina, that welcomed a war, and he couldn’t wait to kill Black people. And you read some of this stuff, and it’s so disheartening to imagine that we have people who carry those kinds of sentiments in positions like that.
But I do think it’s important that we stay hopeful about our capacity to overcome that bigotry. And I am persuaded that hopelessness is the enemy of justice; that if we allow ourselves to become hopeless, we become part of the problem. I think you’re either hopeful, or you’re the problem. There’s no neutral place. Injustice prevails where hopelessness persists. And if I’ve inherited anything from the generation who came before me, I have inherited their wisdom about the necessity of hope.
Tippett: I think you meant “justice prevails where hopefulness persists.” Is that what you …
Stevenson: Injustice persists —
Tippett: Injustice prevails where hopelessness persists, yes, OK.
Stevenson: [laughs] It’s a lawyerly way of saying something that should be said a lot — but I say it that way only because we’ve been dealing with injustice in so many places for so long. And if you try to dissect why is this still here, it’s because people haven’t had enough hope and confidence to believe that we can do something better. I think hope is our superpower. Hope is the thing that gets you to stand up, when others say, “Sit down.” It’s the thing that gets you to speak, when others say, “Be quiet.” I never met a lawyer until I got to Harvard Law School. I had the hope I could be something I’d actually never seen anybody like me be. We built this museum and memorial — I didn’t know anything about museums and memorials, but I had this kind of idea that we could create a space that might be a truth-telling space, that might help people reckon with this past. And because we had this hope — even starting an organization like this in a place like this, it didn’t make sense, if there wasn’t a hope dynamic pushing you.
And I think we have to have that. I get worried when I meet hopeless teachers or hopeless lawyers or hopeless politicians or hopeless advocates. Those are people who are not going to help us advance justice in the world.
Tippett: The other thing to say about that, or one other thing to say about — the example you gave of the people who are the most hateful and the most consumed by that fear and anger so that they have become it, they’re the ones who get quoted in the newspaper. They represent an extreme. So for me, one of the humbling things, one of the many humbling things about this year is really, really knowing myself to be white and interrogating what that means. And I insist on using the language of “we,” thinking about that long arc, because our descendants are going to see a “we,” an “us.”
But — but — the white “we” has a lot of work to do in this country, right? And it’s easy for people who feel, I don’t know, a little bit more enlightened — it’s easy for white people to start pointing at the bad white people, like that person you just mentioned. And that doesn’t get us anywhere …
Stevenson: It does not.
Tippett: …because we all have work to do. And so I’m curious about how you apply what you learned on death row [laughs] or working with people who are criminals or being treated as criminals by our justice system, that none of us is defined by our worst actions. I feel like that is such an important equation for our common life right now.
Stevenson: Well, I think you’re absolutely right. And I am more interested in what the “we” does, what the collective “we” does, than what the outliers do. And I think one of the challenges of this era of social media is that everybody has a platform, and we do tend to highlight and emphasize the extreme voices and perspectives. I think media does that, I think the larger culture runs to that, but I do think it’s important to push back against that, even as we think about how to repair much of the damage that has been done.
During the 1950s and ’60s, you had all of these people engaging in horrific criminal acts — the white men who killed Emmett Till, who killed the civil rights workers in Selma, who blew up the church. And twenty, thirty years later, we thought that the response to that should be: We should go prosecute those people. And then we had these prosecutions of older white men in ‘80s and ‘90s, who were Klan members, and we thought that if we convicted them that we could exonerate the society. And I’m not opposed to those convictions or to those prosecutions, but I think it’s a mistake to think that they acted in a setting where only they were culpable. It was the politicians who gave permission to people to talk and think and believe these thoughts. It’s the larger we who created an environment where we were saying, “Segregation forever.”
And just as then, we are now. When we give in to rhetoric and we start talking about using violence to silence those whose positions and opinions we disagree with, when we engage in rhetoric that tries to legitimate the conduct of people who are advancing ideologies that are destructive and violent and bigoted, we become complicit. And we have to understand that.
And it’s not just the people have power, the elected officials — it’s everybody else, because we give those people the power that they have. And in our museum, we really thought about this, because when I started talking about enslavement, the first thing you’d say is, “Well, my people never owned slaves,” as if somehow that exonerates them.
The political consequences of driving six million Black people out of the Deep South, into the margins of communities in the North and West, are evident in the political contours of our society today. The legacy of segregation. And we try to run from it: “I didn’t do that.” I can’t do that. I have to own that.
Tippett: And you especially can’t do it if the goal is not just the punitive, or just the getting justice in a narrow sense; if the goal is repair and repentance and redemption.
Stevenson: That’s exactly right. That’s exactly right. And in fact, what you ought to be doing is thinking about, OK, in what ways am I contributing to this? We have a project that we’re starting — it’s called the Truth and Justice Project. And we’re actually gonna be working with institutions, asking them to focus on their institution — to step back, put aside all the global stuff. And it began, really, in 2018 when we were opening the memorial. The local newspaper, the Montgomery Advertiser, was kind of complaining a little bit. They said, oh, we know you’re gonna talk to The New York Times and The Washington Post and all of these other — but you won’t talk to us. [laughs] And I said, well, let’s have a conversation about that.
And we showed them their coverage, their media, their coverage of lynchings that took place in this area, early in the twentieth century. And you read it, and it breaks your heart. They were absolutely encouraging this violence. And I said, “If you ask me why don’t I trust you, it’s rooted in my knowledge of this history.”
And we started a dialogue, and the editor didn’t know about any of that stuff, but when we confronted him, he says, “You know what? We have to apologize.” I said, “I think that would be really powerful.” And on the opening, they did this massive headline, massive frontpage, a whole edition dedicated to apologizing for their role in contributing to racial terror, lynchings, in this community. And it was really powerful. And I thought, well, after the Montgomery Advertiser did this, lots of newspapers are going to do that. And the truth is, nobody else did it. And that’s because that instinct to not tell the truth if you don’t have to, to not confront these problems, is so powerful.
But this project that we’re doing is a project that is going to encourage these institutions to do exactly what the Advertiser did in that setting. We have banks that denied mortgages and loans to Black veterans after World War II and created the wealth gap that we still see today. And I think they need to own that. We have institutions in this country that refused to provide coverage on insurance plans when Black people were forced off their lands as a result of racial violence. And I think we need to own that. We’ve got railroads —
Tippett: I think of Marilyn Nelson. Do you know her? The poet? She’s been working with a church in Connecticut, a church in Connecticut that’s going back to their original documents and how many slaves the pastor owned.
But I love this. I think this is a move — we did something just a couple weeks ago with John Biewen, just talking about — and he grew up in Minnesota — talking about being white, and just interrogating the history of your town. And in fact, the history of his town is where the greatest massacre [Editor’s note: Mankato, Minnesota, John Biewen’s hometown, was the site of the largest mass execution in U.S. history.] in American history came, of Indian tribal peoples, signed by, set forth by Abraham Lincoln in the middle of the Civil War. But just uncovering that, just as we would in a family, if we wanted to heal our family, we would start to tell the truth about what really happened.
Stevenson: Absolutely. And it’s the way we get better. Twelve-step programs are built on this idea that first, you have to acknowledge the problem.
Tippett: Confession.
Stevenson: Confession: “I am an alcoholic.” If you’re unwilling to say that, AA can’t help you. And we are a society that has been racially unjust. And we have to be willing —
Tippett: We haven’t even said it out loud.
Stevenson: We haven’t said it out loud. Part of the idea for the museum was, I went to the Holocaust Museum. You get to the end of that — it’s a narrative museum. We don’t have many cultural spaces in this country that I defined as narrative spaces. The Holocaust Museum is an exception, and when you get to the end of the Holocaust Museum, you’re motivated to say, “Never again,” regardless of what your background is.
Tippett: I’ve heard so many people who speak about coming to your museum, to the lynching — do you call it The Lynching Museum?
Stevenson: It’s actually two institutions —
Tippett: There’s a memorial, right?
Stevenson: So The National Memorial for Peace and Justice is the institution that honors victims of lynching. The Legacy Museum is actually the institution that tells the stories —
Tippett: Enslavement to mass incarceration.
Stevenson: Yes, exactly.
Tippett: But people speak about that the way they speak about making a pilgrimage.
Stevenson: And for me, that’s really important. I think the journey is important. Going to the Apartheid Museum in Johannesburg, the Holocaust Memorial in Berlin, were transformative experiences for me. And I think this country needs that kind of transformation, that kind of reckoning. And unfortunately, we’ve made it harder than it needs to be, but that doesn’t mean that we can’t do it. And that’s certainly what we’re trying to achieve in our spaces.
Tippett: So one of the weird things about the world right now is that I’m in my basement, and I don’t have a clock right here, which I would have in the studio. So can you tell me what time it is?
Stevenson: [laughs] I think we are ten after the hour.
Tippett: 3:10, OK. So can we keep going for fifteen minutes or so?
Stevenson: Sure.
Tippett: There’s a story you tell that I love, about when Rosa Parks used to come to town from Detroit, and she had some friends there. And you knew these women, and one of them was Johnnie Carr, I guess the driving force behind the Montgomery Bus Boycott. And they would invite you — not necessarily to take part, but to listen — [laughs] and that Rosa Parks asked you, at some point, to tell her about the Equal Justice Initiative. And what did she say?
Stevenson: Well, I was really privileged to be nurtured by this community of mostly women, who had been so staunch and resolute to achieve justice. And yes, Miss Carr invited me to go over to a woman named Virginia Durr. Virginia Durr was a white woman whose husband, Clifford Durr, had represented Dr. King. And she lived in a part of Montgomery called Cloverdale. And Miss Carr told me Miss Parks was coming to town, and she said, “Do you want to come over and just listen?” And I said, of course. And then every now and then, she would do this: she’d say, “Bryan, what does the word ‘listen’ mean?” And then [laughs] I’d have to explain that I knew I wasn’t supposed to say anything.
And I remember that day so clearly. I sat out on Ms. Durr’s porch with Rosa Parks and Miss Carr, and they just talked and talked and talked. And the unbelievable thing about their conversation was that none of them were talking about all the extraordinary things they had done in the ‘50s and ‘60s and ‘70s. When Miss Parks left Montgomery, she went on to work with John Conyers — she went on to do a lot of work in the social justice movement. She was involved with Malcolm X; she was involved with a lot of people, trying to advance racial equality, after Montgomery. But they weren’t talking about any of those things. They were all talking about the things they still wanted to do. And there was this hopefulness in their conversation, and it was so powerful. And I just sat there, [laughs] soaking it in.
And so when she turned to me and said, “OK, Bryan, now tell me about the Equal Justice Initiative. Tell me what you’re trying to do,” the first thing I had to do was to look at Miss Carr to see if I had permission to speak. And she nodded, [laughs] and then it just came tumbling out of me. I started giving Miss Parks my rap. I said, “Well, we’re trying to end the death penalty. We’re trying to help people on death row. We’re trying to challenge conditions of confinement. We’re trying to help the mentally ill. We’re trying to help children. We’re trying to help the poor.” I’m just throwing all of these things out. [laughs] And when I finished giving her my rap, she looked at me and she just said, “Mm-mm-mm. That’s gonna make you tired, tired, tired.” [laughs] And Miss Carr leaned forward and she said, “That’s why you’ve got to be brave, brave, brave.”
And I’ll never forget it, because I do think, in many ways, what these women taught me was the necessity of courage if you’re going to advance justice, if you’re going to be even a complete human being. Sometimes it takes courage to love — to just be who you should be to the people you care about.
Tippett: I guess you’re legendarily hardworking, dedicated, devoted to your vocation, which is what I want to call it. How do you stay brave? How do you nurture that in yourself? Because I know — there’s a moment, and you speak about this, about realizing — you were, I think, at the execution of someone — Jimmy Dill, is that right? Am I remembering that right?
Stevenson: That’s right, yep. That’s right. That’s right.
Tippett: Thinking and dwelling on, reasonably, the brokenness all around you — in the system, in the people — and then understanding that that brokenness was in you, and that in some way that doesn’t make a lot of rational sense, that that realization was part of what kept you connected and kept you going.
Stevenson: I do think what sustains me is this knowledge I have that it’s really the broken among us that can contribute a lot to our quest for full, equal justice. When you’re broken, you actually — you know something about what it means to be human. You know something about grace. You learned something about mercy. You learned something about forgiveness. It’s the broken among us that can teach us some things. And knowing that you don’t have to be perfect and complete gives you a way of moving through challenge that would be hard if you think that that’s not something that’s possible.
And so I tell my young staff, you can’t do this work, you can’t be in some of the painful places we’re in, you can’t hold children who’ve been abused, and not be impacted by that. You’re going to shed some tears. You are. And you’re gonna be overwhelmed, you’re going to get tired, you’re gonna get pushed down — all of those things are going to happen, and it doesn’t mean you’re weak. It doesn’t mean that you’re not up to the task. It doesn’t mean you’re incompetent or incapable. It just means you’re a human being. And that’s what I want: I want human beings.
And so what sustains me is, in part, this knowledge that I can’t always feel confident and sure and clear; that there are gonna be times when it’s uncertain what’s going to happen. And I’ve tried to appreciate that.
And I do feel, at times, lifted up by the spirit of people who have endured way more. I talked to John Lewis just before he passed away, and it was such an honor knowing him. And I was just saying to him, “I feel so privileged, as a result of what you did.” And I told him, “I’ve had hard days; I get death threats and all that kind of stuff. But I’ve never had to say, ‘My head is bloodied but not bowed,’ like you did.” And when you realize that those injuries created spaces that some of us could occupy, that were a little less violent, you begin to appreciate what you can do and why you shouldn’t feel overwhelmed and why you shouldn’t feel knocked down.
When we opened the memorial in 2018 — I’ve been talking about this a little bit more. It was just such a surreal experience to have 25,000 people come to Montgomery to see these spaces that we had created. And I wanted everything to be perfect; we had all of these great thinkers and civil rights activists, and musicians were coming to perform. And on the morning of the dedication at the memorial, it looked like it was going to rain. And I’d been just terrified at the idea that it would rain and mess up this experience. I was so worried about it and the clouds were just getting darker and darker.
And just as I was getting ready to stand up to speak, I mean, the clouds just opened up, and all of a sudden, it was a downpour. And this thing I had been dreading, all of a sudden became something completely different. And I was listening to these raindrops hit the top of this memorial, and looking up at all of these monuments, which are dedicated to lynching victims. And all of a sudden, I had this awareness that this wasn’t something I should fear, that this wasn’t something I should dread. In that moment, it didn’t sound like rain hitting the top of the memorial. It sounded like tears being shed by the thousands of Black people whose lives have never been honored, whose names have never been mentioned, and it sounded like they were shedding tears of joy that there was this moment of reckoning.
And that’s the gift I think I’ve been given by this legacy, by this ancestry that celebrates struggling for justice, that honors struggling for justice, and I hold onto that. I do. And it sustains me in times when I need it, and absolutely compels me to keep doing as much as I can.
Tippett: I do have to say, you use the word “beauty” a lot. I also have this sense, you see the beauty that comes from what happens to people when they come to the memorial, the beauty that comes from truth-telling. And I just sense, delving into you, that that also sustains you, whether you’re even conscious of that or not.
Stevenson: Oh, it absolutely does. I feel like that’s the great joy of my work, is that I find beauty in places where people think beauty can’t exist. I’ve found it on death row. I’ve found it in the lives of people who’ve been told that they’re so beyond hope and redemption and purpose that they should be killed. I’ve found it in places of extreme poverty. I’ve found it in places that have gone through incredible challenges as a result of injustice and bigotry. And yet, there it is.
Tippett: So here’s my last question. I think a lot about what are the callings for this time — callings, being alive at this time? And I think there are so many of them. And I hear one in your phrase, “we have to be stone catchers.” [laughs] I wonder if you would just reflect on what you mean when you say that, and if there’s a way you would want to expand on “callings,” for this time.
Stevenson: Well, I do think we’re at a time when it’s just become so easy to judge people in these really harsh and extreme ways. And even people of faith have been pulled into this habit, this instinct for condemning the others who don’t share their beliefs and views; for reducing people to their worst act. And I’ve always been struck by that parable, that Scripture, that story where Jesus encounters the woman who has been caught in adultery. And what’s powerful about it is, no one says, “Oh, she didn’t do it.” It’s not an innocence story. That’s not part of it. And those who are there to judge her say that the law says we should stone her to death. And the scripture reveals that Jesus says, well, let he of you that is without sin cast the first stone. And they’re convicted by that, because they know that none of them is sinless, and they one by one put their stones down and they walk away. And then Jesus says to the woman, go, and sin no more. And it’s a powerful story about mercy and redemption and grace, and what I’ve realized is that in this era, I don’t think our righteous would put their stones down. I think that we have too many people who would, despite that exhortation, would still cast the stones. They feel insulated from the hypocrisy and judgment that that implies.
And so I think it’s incumbent on some of us to intervene, to catch the stones. It doesn’t mean that those vulnerable should be condemned; it just means that some of us are going to have to be stone catchers. And that’s the idea that I’ve come to embrace, is that just because people won’t recognize what the right and just thing is to do, that it’s not right and just to cast those stones, doesn’t mean that that’s the end of the struggle. We have to stand up. We have to stand in front of those who are vulnerable and we have to catch those stones.
And I think that is one of the callings for this moment, and I think the other calling, for me, is that we have to begin this process of truth-telling, that we have to recognize that we can’t get well if we don’t identify, if we don’t diagnose the disease. We have this instinct for quick-fix and quick-cure. And if you don’t know what’s wrong with you, you’re not going to know whether the cure that you’ve been prescribed is sufficient. And I think this process of diagnosing the many ways that we are not healthy is not something we should fear but something we should embrace, because once we’ve done that, I think we have the capacity, the genius, the strength, the ingenuity, the wherewithal, to begin to address these maladies, this illness, and emerge as a healthier society, a healthier nation, a healthier place in the world, for everyone. And that’s what animates the work we’re trying to do now.
[music: “Gbfisysih” by Blue Dot Sessions]
Tippett: Bryan Stevenson is the founder and executive director of the Equal Justice Initiative based in Montgomery, Alabama. Find out about everything they do at EJI.org. He’s also Aronson Family Professor of Criminal Justice at New York University School of Law. His book is Just Mercy: A Story of Justice and Redemption.
[music: “Dirty Wallpaper” by Blue Dot Sessions]
The On Being Project is Chris Heagle, Lily Percy, Laurén Dørdal, Erin Colasacco, Eddie Gonzalez, Lilian Vo, Lucas Johnson, Suzette Burley, Zack Rose, Colleen Scheck, Christiane Wartell, Julie Siple, Gretchen Honnold, Jhaleh Akhavan, Pádraig Ó Tuama, Ben Katt and Gautam Srikishan.
The On Being Project is located on Dakota land. Our lovely theme music is provided and composed by Zoë Keating. And the last voice that you hear singing at the end of our show is Cameron Kinghorn.
On Being is an independent nonprofit production of The On Being Project. It is distributed to public radio stations by WNYC Studios. I created this show at American Public Media.
Our funding partners include:
The Fetzer Institute, helping to build the spiritual foundation for a loving world. Find them at fetzer.org.
Kalliopeia Foundation. Dedicated to reconnecting ecology, culture, and spirituality. Supporting organizations and initiatives that uphold a sacred relationship with life on Earth. Learn more at kalliopeia.org.
Humanity United, advancing human dignity at home and around the world. Find out more at humanityunited.org, part of the Omidyar Group.
The George Family Foundation, in support of the Civil Conversations Project.
The Osprey Foundation — a catalyst for empowered, healthy, and fulfilled lives.
And the Lilly Endowment, an Indianapolis-based, private family foundation dedicated to its founders’ interests in religion, community development, and education.
https://onbeing.org/programs/bryan-stevenson-love-is-the-motive/
Obama’s Curious Cautiousness
He is a great politician, but he is not an activist.
by Charles Blow - NYT - December 2, 2020
Barack Obama continues his rather strange mission to confront and correct young liberal activists. It is an odd post-presidential note: A man who is beloved and admired on the left is using his cultural currency as a corrective against those who are on a quest for change.
Wednesday morning on Peter Hamby’s Snapchat show, “Good Luck America,” Obama said this:
“If you believe, as I do, that we should be able to reform the criminal justice system so that it’s not biased and treats everybody fairly, I guess you can use a snappy slogan like ‘Defund the police,’ but, you know, you lost a big audience the minute you say it, which makes it a lot less likely that you’re actually going to get the changes you want done.”
It was not the first time Obama had taken aim at these young activists. Last year he also took a swipe at wokeness and “call-out culture,” saying, among other things: “If all you’re doing is casting stones, you’re probably not going to get that far. That’s easy to do.”
That speech got him an amen from Ann Coulter, who tweeted: “Good for Obama. (Not sarcastic!)”
These chastisements by Obama delineate the difference between the politician and the activist.
The politician may be popular, but the activist will rarely be. The politician can unify, but the activist often divides. The politician seeks to unify people around a set of beliefs. The activist seeks to right a wrong that has been held up by a set of beliefs. In short, the politician navigates the system, while the activist defies it.
The politician builds a coalition by using middling philosophy and policies that appeal to the most and offend the fewest. The activist is driven more by purpose, morality and righteousness.
There is a reason most of our greatest activists in America never became politicians: They would have had to compromise too much of themselves and their causes.
The Interpreter: Original insights, commentary and discussions on the major news stories of the week.
Of course, as a political matter, Obama is right in a way. He is looking at the path to legislative and public opinion success. To take that path, the power structure can’t be so much confronted as coaxed. Those who do not recognize your full humanity must be convinced rather than condemned.
But that all feels like cowardice and accommodation to the activists. They are right, after all. Policing needs to be restructured in this country. Part of the reason so many unarmed Black people are killed at the hands of the police is that policing itself has become sick and corrupt; it has become bloated and impervious to prosecution.
I believe that Obama recognizes this, too, to some degree. But to the politician, baby steps are still progress. Winning the hearts and minds of the populace in that tradecraft, it is the way — the only way — they believe that progress is made.
Possibly.
But it is also true that it is often the presence of an extremist wing — I say extremist here only because that is the way the opposition sees strident activism — that makes successes of the moderate position possible.
Part of the reason the civil rights movement led by Martin Luther King Jr. could be so successful was the existence of the more radical — and less widely acceptable — Malcolm X.
Booker T. Washington was elevated because he was willing to forgo political power at a time when Black people outnumbered white people in some Southern states and were near a majority in others. The idea of Black political power and possibly even Black dominance had sent shock waves through the white South and animated white terror in the region.
This moment needs the radical young activists. It needs them to push far and hard. It needs them to confront the power structure, to stare it down, to demand its dismantling.
Obama is a good man and a great politician. History will always record him as such. But he is not an activist. He is not the person who can or will push for the immediate alleviation of oppression. That is just not who he is or how his power was derived. He is above all else a practical, left-of-center moderate.
His presence as president was his greatest symbol of change: a smart, competent Black man, devoid of personal scandal, who brought class and professionalism to the White House. He changed the idea of what was possible to America — including its children — and enshrined Black excellence at the highest level of government as just another normal thing.
That simple act, him doing his job well, was monumental in the quest for racial progress.
But none of that negates the legitimate cries of the activist that much more must be done, that Obama altered a racial image, for the better, but wasn’t able to alter the system of oppression. That was always too much of an expectation. No one can correct 400 years in eight.
But in their approach, the activists are right. I have no problem with “Defund the police.” I know that it means to reallocate funding so that social services and policing are properly weighted. If people are offended and “lost” because of that, they were actually lost before the phrase was uttered.
https://www.nytimes.com/2020/12/02/opinion/obama-politics-activism.html?
Who knew a pandemic could reduce health-care spending?
by Megan McArdle - Washington Post - December 2, 2020
I used to say that the only proven way to actually reduce health-care expenditures was to have a major financial meltdown. Now, 2020 has unexpectedly shown us another way to do it: have a pandemic.
Let me expand on that a little. During the Great Health Care Wars of the early 21st century, I developed a certain personal specialty in explaining that no matter how wonderful single-payer health care might be in other respects, it wouldn’t reduce U.S. health-care spending to European levels (which can be half or less what the United States spends).
Fundamentally, every cost you want to wring out of the system is someone else’s income, or perhaps, their only hope of escaping a dreadful disease. Often, those someones make very sympathetic figures when they appear on your local telecast, weepily complaining that the government is killing patients. This political reality made it hard for either the government or private insurers to actually reduce what they spend on our health care.
Moreover — and this is the important bit — we aren’t the only country that has this problem. Look abroad and you’ll realize almost no developed country has ever managed a sustained reduction in its health-care spending — though Greece had a debt crisis that forced the government to dramatically slash what it was spending on almost everything. Many countries restrained the rate of growth better than we did, but, eventually, we developed some discipline, and our health-care costs are no longer growing particularly fast, compared with others.
Unfortunately, we’re still stuck at a high level, thanks to our earlier profligacy. And politically, it has seemed that the only way to muster the will to actually cut the level of health-care spending, rather than restraining its future growth, would be to run out of money, so that international lenders, rather than politicians, would end up controlling what the government could spend.
Then along came the pandemic, and it turns out there’s another way, which is to have your country ravaged by a deadly infectious disease. That is definitely not what I would have predicted in March.
There are a few observations that can be drawn from this. The first, and most obvious, is that despite its terrible costs, this pandemic has not been as bad as many historical plagues; I doubt our spending would have dropped if we’d been dealing with the Black Death. This is exceedingly small comfort, but I’m ready to count even tiny blessings.
The second is that the decline is presumably a result of deferred care, and therefore temporary. When people are vaccinated, and caseloads fall, they’ll probably start going back to the doctor as much as they ever did. And possibly more, if deferring care has caused their medical conditions to spiral into much larger problems that are more expensive to treat.
But note, I said “if.” We’ve never before run an experiment where a huge number of Americans just stop going to the doctor for a year. We don’t know exactly what sort of care they’ve put off, or how much that matters. And it is at least possible that we’ll find out that some of those routine medical visits just didn’t help as much as is generally assumed.
Even before the pandemic, there was, for example, a lively debate over early cancer screening, because while it might be helping us catch a lot of cancers when they’re more treatable, it might also be fooling us into thinking our screenings and treatments work better than they do, since people whose cancer is caught earlier will “survive cancer” longer even if the treatment does nothing at all.
We might also find that though delaying care harmed people, boosting innovations like telemedicine offset those harms. I can’t say I think that’s the most likely outcome, but I won’t rule it out without more data.
Which brings me to my final observation: The universe is damn complicated, and even our seemingly most obvious and indisputable guesses at the future will often be unraveled by effects we failed to foresee. Yes, I might have predicted toilet paper shortages in the early days of a pandemic, but if you’d asked me about health-care costs and house prices, I would have said the former would go up and the latter down — the exact opposite of what has happened.
We should always leave room for a fair amount of surprise in our mental models of the world. Now that I know bothpandemics and currency crises can reduce health-care spending, I suppose I’ll have to leave room for the possibility that there are other ways I haven’t guessed, hopefully less awful, and more amenable to reason.
Supreme Court to Hear Case on Trump’s Medicaid Work Requirements
The case, which could become moot if the Biden administration eliminates the requirements, will be scheduled to be heard early next year.
by Adam Liptak - NYT - December 4, 2020
WASHINGTON — The Supreme Court on Friday agreed to decide whether the Trump administration may impose work requirements on Medicaid recipients, an issue that could become moot if the Biden administration eliminates the requirements.
In February, a unanimous three-judge panel of a federal appeals court in Washington struck down the requirements, which would have denied health care coverage under Medicaid to poor people in Arkansas and New Hampshire unless they were working, volunteering or training for a job.
The appeals court said the approval of the requirement by the health and human services secretary, Alex M. Azar II, was unlawful — “arbitrary and capricious,” in legal jargon — because he had failed to consider how it would advance Medicaid’s goal of providing health care to poor people.
Congress had sought “to provide health care coverage to populations that otherwise could not afford it,” Judge David B. Sentelle wrote for the court. “Importantly, the secretary disregarded this statutory purpose in his analysis.”
The case, Azar v. Gresham, No. 20-37, will be scheduled to be heard early next year.
In urging the Supreme Court to hear the case, Jeffrey B. Wall, the acting solicitor general, said the government should be permitted to test new approaches to the Medicaid program, particularly in light of its expansion under the Affordable Care Act.
The appeals court’s ruling, he wrote, “threatens to impede innovations that may make states’ Medicaid programs more effective and sustainable” and “casts a shadow on multiple other states’ approved or pending demonstration projects.”
Mr. Wall wrote that requirements similar to the ones blocked by the appeals court had been approved or were pending in 17 other states.
Lawyers for the challengers told the justices that the administration’s timing was particularly poor.
“During a pandemic in which 50 million Americans have filed for unemployment and nearly 12 million have lost employer-sponsored health insurance,” they wrote, “the secretary of health and human services asks this court to revive demonstration projects that would allow states to kick people off Medicaid for failing to seek and obtain jobs that are not there.”
The rules require “able-bodied” adults to report to their state every month that they have worked, searched or trained for a job, taken classes or volunteered in order to keep Medicaid coverage. Administration officials have said that working is correlated to good health and that it helps people avoid poverty and government dependence.
The appeals court questioned that reasoning, saying it was not supported by the law’s goals.
“The text of the statute includes one primary purpose, which is providing health care coverage without any restriction geared to healthy outcomes, financial independence or transition to commercial coverage,” Judge Sentelle wrote.
In Arkansas, more than 18,000 people lost coverage before the work requirement was blocked. Some people with jobs lost coverage because they did not know about the rule or failed to report their work hours to the state.
https://www.nytimes.com/2020/12/04/us/supreme-court-medicaid-work-.html?
As Hospitals Fill With COVID Patients, Medical Reinforcements Are Hard to Find
"Hospital capacity is almost exclusively about staffing," said Dr. Lisa Piercey, who heads the Tennessee Department of Health. "Physical space, physical beds, not the issue."
When it comes to staffing, the coronavirus creates a compounding challenge.
As patient caseloads reach new highs, record numbers of hospital employees are themselves out sick with COVID-19 or temporarily forced to stop working because they have to quarantine after a possible exposure.
"But here's the kicker," said Dr. Alex Jahangir, who chairs Nashville's coronavirus task force. "They're not getting infected in the hospitals. In fact, hospitals for the most part are fairly safe. They're getting infected in the community."
Some states, like North Dakota, have already decided to allow COVID-positive nurses to keep working as long as they feel OK, a move that has generated backlash. The nursing shortage is so acute there that some traveling nurse positions posted pay of $8,000 a week. Some retired nurses and doctors were asked to consider returning to the workforce early in the pandemic, and at least 338 who were 65 or older have died of COVID-19.
In Tennessee, Gov. Bill Lee issued an emergency order loosening some regulatory restrictions on who can do what within a hospital, giving them more staffing flexibility.
For months, staffing in much of the country had been a concern behind the scenes. But it's becoming palpable to any patient.
Dr. Jessica Rosen is an emergency physician at St. Thomas Health in Nashville, where having to divert patients to other hospitals has been rare over the past decade. She said it's a common occurrence now.
"We have been frequently on diversion, meaning we don't take transfers from other hospitals," she said. "We try to send ambulances to other hospitals because we have no beds available."
Even the region's largest hospitals are filling up. This week, Vanderbilt University Medical Center made space in its children's hospital for non-COVID patients. Its adult hospital has more than 700 beds. And like many other hospitals, it has had the challenge of staffing two intensive care units — one exclusively for COVID patients and another for everyone else.
And patients are coming from as far away as Arkansas and southwestern Virginia.
"The vast majority of our patients now in the intensive care unit are not coming in through our emergency department," said Dr. Matthew Semler, a pulmonary specialist at VUMC who works with COVID patients.
"They're being sent hours away to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion."
Semler said his hospital would typically bring in nurses from out of town to help. But there is nowhere to pull them from right now.
National provider groups are still moving personnel around, though increasingly it means leaving somewhere else short-staffed. Dr. James Johnson with the Nashville-based physician services company Envision has deployed reinforcements to Lubbock and El Paso, Texas, this month.
He said the country hasn't hit it yet, but there's a limit to hospital capacity.
"I honestly don't know where that limit is," he said.
At this point, the limitation won't be ventilators or protective gear, he said. In most cases, it will be the medical workforce. People power.
Johnson, an Air Force veteran who treated wounded soldiers in Afghanistan, said he's more focused than ever on trying to boost doctors' morale and stave off burnout. He's generally optimistic, especially after serving four weeks in New York City early in the pandemic.
"What we experienced in New York and happened in every episode since is that humanity rises to the occasion," he said.
But Johnson said the sacrifices shouldn't come just from the country's health care workers. Everyone bears a responsibility, he said, to try to keep themselves and others from getting sick in the first place.
https://www.medscape.com/viewarticle/941865?nlid=138557_4622&
MaineHealth Scaling Back Elective Surgeries At Hospitals
by Patty Wight - Maine Public - December 4, 2020
Hospitalizations for COVID-19 in Maine reached another record high Friday, with 164 people in hospitals across the state. The surge has prompted MaineHealth's hospitals, including Maine Medical Center, to scale back elective surgeries starting Monday.
Chief Medical Officer Dr. Joan Boomsma says the focus is on surgeries that can safely be delayed and require inpatient beds.
“Starting on Monday, we’re going to postpone enough surgery to free up about 18 additional beds,” she says.
Boomsma says that will also allow staff to be redeployed to support the growing number of COVID-19 patients. Maine Medical Center currently has about 40 such patients.
A month ago, there were 30 COVID-19 patients hospitalized statewide.
No comments:
Post a Comment