LA Philanthropy Watch

All right, this post has nothing to do with the nonprofit sector in Los Angeles.  Perhaps it’s because I’m an avid runner, but during Thursday’s morning commute I was cheered by a story I heard on NPR’s Morning Edition.

Sacha Pfeiffer of WBUR reported on a women’s fitness center, run by the nonprofit Healthworks Foundation, in a working class neighborhood (Boston’s Codman Square).  Membership fees (up to $30 a month) are on a sliding scale, based on income; one woman featured in the report pays only $10.

The story (”Nonprofit Gym Helps Low-Income Community Get Fit,” June 17, 2010), which began by noting an epidemic of obesity and diabetes in many low-income neighborhoods, featured a quote by Bill Walczak, who helped raise the money to build the gym.

“In middle-income communities, there’s somehow an expectation that you’re going to have access to gyms,” he said. “When you’re in a low-income community, that stuff doesn’t exist.”

Perhaps this inequity isn’t what immediately comes to mind when we think about issues of social justice – but good health bestows such a wealth of benefits that providing access to an affordable gym for 700 women, and after-school programs for children, is an eminently worthwhile endeavor for a nonprofit organization.

“For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.”

This is how David Leonhardt begins his article (”In Health Bill, Obama Attacks Wealth Inequality,” New York Times, March 23, 2010), which puts this legislation into a larger historical and social context.    The law marks an attempt to chip away at trickle down economics and to assist the American middle class, which has seen real income stagnate since 1980 (while the real income of the top one percent of Americans has doubled).

This morning’s Los Angeles Times provides: a Q&A on the new law (”What’s in it for you?” by Phil Galewitz), profiles of four people affected by the law (”Profiles in coverage,” by Tammy Worth and Lisa Zamosky), and a look at changes in Medicare coverage (”Medicare ‘doughnut hole’ will close in new healthcare plan,” by Christopher Weaver).

With this post, marking the success of health care reform, I am pleased to turn the attention of LA Philanthropy Watch away from this battle, which this blog has followed for many months.

On July 22, 2009, I posted a critical review of “The War on Philanthropy,” an article in Commentary by David Billet, which argued that President Obama was hostile to nonprofit organizations.  The article was a concerted attack on a proposal by the White House to raise taxes on the nation’s most affluent households in order to provide health insurance for middle- and working-class families.  In asserting that the top 1.2 percent of American households should not have to pay marginally higher taxes, Mr. Billet gave no consideration – even in passing – to the tens of millions of Americans who lack basic health insurance.

On August 13, 2009, I wrote about a health care rally and prayer vigil in my neighborhood staged by LA Voice – the first of many posts on local nonprofits and community organizers advocating for health care reform.   By mid-October, I had decided to offer coverage of the health care reform fight – with or without a local angle to the story.   As I noted in a subsequent post:

“What does this have to do with the nonprofit sector?  Just this: charity – with any number of free clinics – is not an argument against health care reform.  A system that leaves 46 million Americans without health insurance, and offers emergency rooms and community clinics as alternatives, is dysfunctional.

The for-profit marketplace cannot provide basic health care to tens of millions of Americans.  This is a textbook example of a market failure. The nonprofit sector – with vision and generosity – has stepped into the breach.  But uninsured individuals and families continue to be ill-served by this arrangement.  And the clients and communities served by many social service organizations are disproportionately affected.

Basic social justice demands action by the public sector – the government.”

“If we don’t pass the bill, how do we explain that to the American people?”  asked House Speaker Nancy Pelosi. “We as Democrats with two Houses and the White House could not make this historic decision to go forward?”

Ht: Greg Sargent who links to two health care policy wonks, Ezra Klein and Jonathan Cohn, on the esoteric “deem and pass” legislative strategy the Speaker intends to follow.  (This is really inside baseball: even more esoteric than the Senate’s filibuster rules.)

Update: Marc Ambinder takes a closer look at the “deeming” strategy this morning at the Atlantic; he says it is a venerable procedure, consistent with the rules of the House and (contrary to the editorial writers of the Wall St. Journal) with the Constitution.

(Image of Nancy Pelosi at the recent bipartisan health care summit making a fist to make a point.  She should keep that fist clenched until she has rounded up enough Democrats to pass the bill – or deem the bill passed.)

“The main lesson to draw from Thursday’s health care forum is that differences between Democrats and Republicans are too profound to be bridged. That means that it is up to the Democrats to fix the country’s dysfunctional and hugely costly health care system.”  (”After the Summit,” New York Times, Editorial, February 25, 2010)

This could not be clearer.  There is a fundamental divide between the two national political parties.

The Republican leader in the House believes Americans have “the best health care system in the world.”  It certainly is among the best – if you are rich.  Canadian premiers and Arab royal families may come to the U.S. for care.  But Americans of more modest means are likely to find themselves with more limited insurance options.

If you have any preexisting conditions – which might include a bout of cancer, diabetes, a heart condition, asthma, a prior pregnancy, a previous injury, certain allergies, some skin conditions, and so on and so on – you may be virtually uninsurable.  If you lose your job, you may lose your health insurance.  And for a small business owner, or a family purchasing a policy unrelated to an employer, if policies are available, the cost of minimal coverage with high deductibles is likely to be steep.  If you can’t afford it, you do without.

The market – relying on private insurance companies seeking growing profits – cannot solve these problems.  The Republican answer is – well, they don’t have an answer.  Their response is: that’s an individual problem (or a family problem); it’s not a problem for government to solve.

“Vice President Joe Biden argued that the debate over the White House’s health-care proposal was ‘a philosophical echo of the debate on Social Security.’ That’s exactly right and important: Opponents of social security said provision for retirement was something best left to individuals and the private sector. Mandating that everyone contribute toward their retirement, they argued, was wrong. But once social security was passed, Americans did not want to turn back. It’s an enduring program. Many who oppose a government guarantee that everyone will have health coverage — and that is where the Obama proposal will eventually lead — fear the same result: once it’s passed, this program will be too popular to repeal.” (”What the health-care summit taught us,” E.J. Dionne, Washington Post, February 25, 2010)

Thus, Republicans staunchly oppose health care reform.  Can a Democratic Congressional majority pass health care reform that a Democratic President pledged to bring during his campaign and made the centerpiece of his first-year domestic agenda?   We’ll find out.

Editor’s note: Anyone who isn’t a regular reader may wonder about this blog’s coverage of health care reform.  The United States stands virtually alone among the world’s elite nations in its failure to guarantee basic health care for its citizens.  This is an issue of social justice, affecting all Americans of modest means.  It affects the clients of social service and health care agencies, which I regard as near the vital center of the nonprofit sector.  So – although this issue is not LA-centric, nor is its focus on the nonprofit and voluntary sector – it is a cause that LA Philanthropy Watch has embraced since last summer (after I wrote a commentary on a funding proposal for health care reform that had attracted prominent opposition among trade associations in the sector and a number of nonprofit organizations).  Having broken the ice by advocating for health care reform, I made a decision to continue covering the issue.  I anticipate health care reform legislation passing, or failing, within the next month or two – at which point I will move on.

(Image of health care reform summit from White House website.)

Last night, in the State of the Union address, the President said this about health care reform:

Now, let’s clear a few things up.  (Laughter.)  I didn’t choose to tackle this issue to get some legislative victory under my belt.  And by now it should be fairly obvious that I didn’t take on health care because it was good politics.  (Laughter.)  I took on health care because of the stories I’ve heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who’ve been denied coverage; families –- even those with insurance -– who are just one illness away from financial ruin.

After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans.  The approach we’ve taken would protect every American from the worst practices of the insurance industry.  It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market.  It would require every insurance plan to cover preventive care.

And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make kids healthier. (Applause.)  Thank you.  She gets embarrassed.  (Laughter.)

Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan.  It would reduce costs and premiums for millions of families and businesses.  And according to the Congressional Budget Office -– the independent organization that both parties have cited as the official scorekeeper for Congress –- our approach would bring down the deficit by as much as $1 trillion over the next two decades.  (Applause.)

Still, this is a complex issue, and the longer it was debated, the more skeptical people became.  I take my share of the blame for not explaining it more clearly to the American people.  And I know that with all the lobbying and horse-trading, the process left most Americans wondering, “What’s in it for me?”

But I also know this problem is not going away.  By the time I’m finished speaking tonight, more Americans will have lost their health insurance.  Millions will lose it this year.  Our deficit will grow.  Premiums will go up.  Patients will be denied the care they need.  Small business owners will continue to drop coverage altogether.  I will not walk away from these Americans, and neither should the people in this chamber.  (Applause.)

So, as temperatures cool, I want everyone to take another look at the plan we’ve proposed.  There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo.  But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.  (Applause.)  Let me know.  Let me know.  (Applause.)  I’m eager to see it.

Here’s what I ask Congress, though:  Don’t walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  (Applause.)  Let’s get it done.  Let’s get it done.  (Applause.)

Well, actually the headline of the day:

Scott Brown Wins Mass. Race, Giving GOP 41-59 Majority in the Senate

From the Village Voice via Talking Points Memo.

(Image of Scott Brown from a screen grab of “Momentum,” a Brown TV ad 0n YouTube.)

From Daily Kos TV.

The exchange:

STEPHANOPOULOS: What is the strategy on health care going forward?

OBAMA: Here’s one thing I know, and I just want to make sure that this is off the table. The senate shouldn’t, certainly shouldn’t try to jam anything through until Scott Brown is seated. The people in Massachusetts spoke. He’s got to be part of that process.

Without comment:

“I have two reactions to the election in Massachusetts. One, I am disappointed. Two, I feel strongly that the Democratic majority in congress must respect the process and make no effort to bypass the electoral results. If Martha Coakley had won, I believe we could have worked out a reasonable compromise between the House and Senate health care bills. But since Scott Brown has won and the Republicans now have 41 votes in the senate, that approach is no longer appropriate. I am hopeful that some Republican senators will be willing to discuss a revised version of health care reform. Because I do not think that the country would be well served by the health care status quo. But our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened. Going forward, I hope there will be a serious effort to change the senate rule which means that 59 are not enough to pass major legislation, but those are the rules by which the health care bill was considered, and it would be wrong to change them in the middle of this process.” — Barney Frank

Statement from Congressman Barney Frank, following Republican Scott Brown’s victory in the race to fill the Massachusetts Senate seat of the late Ted Kennedy, read last night by Rachel Maddow.  Via Talking Points Memo.

(Photo of Barney Frank via Wikimedia Commons.)

At just after 1:00 a.m. ET the U.S. Senate voted 60-40 to overcome a Republican filibuster of the health care reform package put together by Majority Leader Harry Reid, Igor Volsky reports at the Wonk Room of the Center for American Progress.

“This bill ‘acknowledges finally that health care is a fundamental right,’ Reid said before the vote. It’s ‘a human right, not just a privilege for the most fortunate.’ Sen. Tom Harkin (D-IA) insisted that ‘this is not the end of health care reform. It’s the beginning. But we must make this beginning in order to fulfill that dream and really make health care a right, not a privilege.’”

A fundamental right: that’s what this debate is about.  No one should have to rely on charity to get health care, or to forgo basic health care when in need – if we affirm health care as a right.

Government – federal, state, and local – has a role to play in providing health care.  Peter Manzo alluded to this central role in a discussion of California’s state-run Healthy Families Program, which received a multimillion dollar philanthropic contribution; 200,000 children were a risk of losing coverage as a result of the state budget crisis, until a private foundation stepped in.  Yet the state’s fiscal deficit continues to grow.  “This situation dramatically makes a point we’ve known about philanthropy all along – there is no way private philanthropy can pick up the slack when government, which was designed to be our common commitment, retreats.”

Peter Manzo’s essay, “Pounds of Cure,” appears in UCLA’s Center for Civil Society report, “Resilience & Vulnerabililty: the State of the Nonprofit Sector in Los Angeles 2009 Report.”

(Image of Hippocrates from Wikimedia Commons.)