Thursday, August 13, 2009

Better Civil Discourse AND a Better Health Care System







About five years ago, Dallas dealt with health care. Well, we dealt with it in the microcosm, compared to the massive reform debate our country is undergoing today. That is, if can call this a debate. Debates usually have a point of view vs. an alternative proposal as opposed to the hysterical reactions we are currently witnessing.

Dallas' health care challenge dealt with the budget of Parkland Memorial Hospital, which also happens to be the county hospital. Attempts to balance the hospital's budget were resulting in the proposal of cuts by our county court appointed board of managers, cuts which would have severely curtailed services to the poor. Arguments supportive of these cuts included scapegoating undocumented immigrants and knee jerk suppositions about who was actually a 'burden' on the county's health care budget.

At the time I was still a pastor and heavily engaged in working with Dallas Area Interfaith, one of a network of community organizing initiatives affiliated with the Industrial Areas Foundation. Our tactics differed significantly from the shouting, heckling, disruptive affairs we see in the town hall meetings across the country today.

We actually took the time to talk to county judges, health care professionals, including Parkland's amazing CEO Ron Anderson. We talked to members of the board of managers. We talked with Parkland's CFO who tutored us on the hospital's budget. We talked with our neighbors, church members and with one another. The conversations were across a broad cross section of the city and county: black, white and Hispanic; Republican and Democrat; in the southern part of the county which tends to be working class to poor and the northern portion of the county which tends to be more affluent.

And we learned...

We learned that Parkland's revenue shortfall wasn't caused nearly as much by undocumented immigrants as it was by people in more affluent northern counties. In these counties the officials had recalculated the poverty rate in such a way as to enable them to close their county hospital. The result? Poorer residents in those counties, primarily the formerly middle class residents who were already feeling the impact of flattening wages and lay-offs long before the recession became 'official', sought health care in Dallas County and didn't pay! We also realized that the hospital was indeed overburdened by families who used the county hospital as the substitute for a primary health care physician (no new discovery, but astounding when you listened to the story of people who waited in the emergency room for 10 plus hours to receive treatment).

The answers were pretty simple, but long term: more Community Health Care Clinics and a regional health care system. We didn't barnstorm town hall meetings, we registered for our time to speak. We made our statements and left in an orderly fashion as a group. We wrote op-ed pieces and printed accounts of our meetings in church bulletins and continued the conversations.

Finally, and the thing of which I am most proud, we invited the board of managers to come to my church and hold a 'town hall meeting'. In South Dallas, in one of the poorest communities, the board of managers changed their agenda and held a meeting in the evening to hear about the impact of their proposed budget cuts from the people who would be most affected by them.

Approximately 300-350 people showed up (normally a board of directors meeting held in the early afternoon at Parkland, might have a handful of people, most of them medical professionals). In orderly fashion, the poor, the elderly, their relatives and church members told their stories and asked their questions. Not only were the people orderly, but the board of managers was attentive and respectful.

The proposed budget cuts were rescinded and Dr. Anderson, whose job was on the line, was safe and has remained one of the premier hospital administrators in the country. On the drawing board: a new, larger county hospital.

The current health care debate is much larger, much more volatile than this county hospital controversy. The issue is volatile because it is moral, economic and political. But the current debate is rooted in the same issues: limited access, skyrocketing public costs and the economic and social costs associated with doing nothing, or doing something ineffectively. Citizens can be a part of the solution. But not if they appear to be some out of control mob. Anger is an appropriate and useful emotion, but if it is not channeled into useful public debate and action it comes off as puerile, impotent rage. Tension can be understandable and appropriate. Misinformation and disinformation fueled by rich, talking head entertainers and lunatic leaders searching for a lunatic fringe to whom they can appeal is simply a sad commentary on what we believe about democracy. Appeals to the visceral and base instincts with talk of 'death panels' and 'euthanasia', ultimately leaves this country weaker because it makes civil discourse difficult.

Talk of 'socialised medicine' by those who have received a public education, protection in the form of public safety and drive to these town hall meetings on public roads, or call in to radio talk shows on public airways, while shouting 'keep your hands off my Medicare' , make protesters seem out of touch and ill informed, if not plain ridiculous.

Its not necessary to agree with any of the current health care proposals. But it is necessary to be a part of the process and do more than just shout at the rain.

This is one thing I know: five years after the Parkland incident I am proud to have worked with my fellow citizens on this issue. We didn't just get attention, we got respect. I really don't know if five years from now, some of these people showing up at these town hall meetings will be able to say the same thing, no matter the outcome.

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