Op-Ed: Partisan Loyalties Obscuring the Debate for Health Care

The "public option" component of the Obama administration's push towards mandatory health care provision is drawing heat from critics. A lot of the complaints about the public option actually come from a misunderstanding of what the term means.
Having a public option does not mean that the government will be the sole provider of health insurance. Obama has not proposed doing away with private insurance; rather, he has proposed a public insurance plan that will provide affordable coverage to many Americans who are currently uninsured, and who cannot afford or obtain private insurance.
Many opponents to the public option call it "socialist" health care. They are confusing the public option with single payer health care, an system for health care provision that was really never on the table for the U.S. . The single payer system, which exists in many OECD countries including the U.K., Canada, and Australia, is a system where there is one provider of health care insurance (either private or public) who collects all health care fees and pays all health care costs.
Progressives know that a single payer system could never work in the U.S., given the political sway of pharmaceutical and insurance interest groups. Up until Obama's most recent address on health care, they were settling for the public option as the next best thing. Now that Obama no longer insists on a public option, those on the left are disappointed in him, and the provision of public health care has become less an issue on how to most efficiently provide it and more an issue of loyalty to party ideology.
In the partisan playground of American politics, it is unclear what the Americans want in their health care system when arguments for or against the public option are veiled in standard partisan arguments of more or less government.
I would argue that the U.S. has been the black sheep among OECD countries regarding universal health care provision because the question of who deserves health care and on what conditions has never strongly entered the debate. The real issue is: do we believe that all American citizens should have health care?
We know that at least 18% of Americans are uninsured. Private insurers are able to deny coverage to Americans with pre-existing conditions, forcing many to become bankrupt to bay their hospital bills. We know that our system of employer-provided health care is a product of history and not common sense.
So what's keeping us from changing? Could it be that we don't see health care as a universal human right? Do we, as Americans, think that if you can't pay for it you don't deserve it?
Many single payer systems in other countries have morality worked into the structure of health care delivery. In Canada, the abolishment of private providers ensures that all Canadians achieve the same amount of health care, and for better or for worse, most Canadians are proud of the equity principle inherent in their system. Some countries also distribute health care progressively. In Australia's Medicare system, the ethic is that "all Australians should contribute to the cost of health care according to their ability to pay."
Some countries are similar to the U.S. in that they have multi-payer systems - systems where both the public and private sector provide health care. The contrast is that in these countries there is a social safety net; a majority of citizens can access affordable, publicly provided health care if they need it. In France, 90% of all citizens are covered for basic services, and in Germany and Japan, health benefits are mandatory and co-financed by employers and the government.
Countries like France, Germany, and Japan show us that we can still offer a public option and have private insurers at the same time. The American health care debate is so mired in left versus right ideology that we can't understand what a mixture of public and private sector insurers could look like. We also aren't able to frame health care as what it should be: a public good.
As Obama said during his address on health care, "That concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. "Perhaps it will take nothing less than a moral invocation to get us past the partisan politics. When we soften the debate by thinking of real people needing care, then health care can be framed as a human right rather than a political stance.

Grantee Partners Working Against Exploitation

Submitted by Megan Kauffmann Thursday, August 13, 2009 - 5:24 PM Region Sub-Saharan Africa
Bamako, Mali - Nearly 30 young men were hauling wood, welding, and bustling around what looked more like an open-air high-school theater set under construction than an assembly line. But an assembly line it was, for a carpentry factory. The owner of the small factory, which is locally called an atelier, supervises over 100 apprentices, who work six days a week for at least ten hours a day, receiving a little money “every now and then” for their work.
This is what my colleague Milena Mikael-Debass, GFC’s program associate for Africa, and I saw when we traveled to Commune 5 in Bamako to take a look at GFC Sustainability Award winner Association Jeunesse Actions (AJA) Mali’s activities with young apprentices. In this community, AJA Mali offers afternoon sessions in basic literacy and numeracy for young adult apprentices who have had little or no exposure to school. Most of these apprentices are between the ages of 16 and 25, and these afternoon classes are the only chance they have to learn basic skills, such as how to write their names and how to write out receipts and bills.
Sometimes the owners of these ateliers are reluctant to allow the apprentices a break to attend the classes. When we came to visit this particular atelier, only three or four of the 30 or more apprentices attended the class. The AJ,A Mali teacher informed us that he rarely sees the same faces from week to week.
When we interviewed the apprentices, most had been working at the carpentry atelier for more than two years, and one 17-year-old had been there since he was a young child. The director of AJA Mali told us that it is not uncommon for the apprentices to stay at the ateliers for up to fifteen years without learning anything about methodology or the process of fabrication.
When I reflected on how seldom the apprentices were paid, the long hours they worked, and the fact that the only full-time, paid employee in the entire operation of over 100 workers was the owner, it became obvious that the atelier was exploiting them. I wondered how long the learning process took, and what tools these young people would need to strike out on their own. This was exactly the same thought process that AJA Mali had gone through, and the group created these classes as a response.
While AJA Mali does not have the ability to stop the exploitation, the organization tries to help young apprentices acquire the skills they need to be independent earners. It provides them with entrepreneurial and market study skills in addition to basic education. AJA Mali is filling a role that no other organization is—that of intervening in the lives of these apprentices and providing options for them.
In Mali, the ministry of education is impoverished, and as a result teachers continuously go on strike for better (or any) pay. The strikes disrupt class regularity and dimnish the quality of education for young people. Those who can afford to send their children to private school, while those who can’t afford private school end up letting their children stay at home, sending their children to live elsewhere, or sending their children to the ateliers to learn a trade.
Understanding these constraints puts AJA Mali’s insistence on “educational accompaniment” programs into context. It was inspiring to see this group’s work and understand, after visiting the carpentry atelier, the cultural norms that AJA Mali is up against—making its activities that much more revolutionary.

The importance of transparency for NGOs in Nigeria

The Importance of Transparency for NGOs in Nigeria

Lagos, Nigeria – Having only spent a few days in Lagos, Nigeria, I can’t claim to be an expert on how deep or severe government corruption and efficiency is in this city or country. However, I’ve spoken to many people and asked about their views on all levels of government in their country, and I can say that a general sentiment is that NGOs and the private sector fill an important void by providing services that the government does not.
Private-sector participation in development has already been recognized widely as a global trend, but because of the special mix of hugely profitable private industry and corrupt government officials in Nigeria, the role of the private/NGO sector in providing basic services like water pipelines, roads, and schools is even more crucial to development here than it is in some other West African countries.
A couple of Nigerians told me that government officials sometimes require that private industries establish schools or other development projects as a condition for setting up shop in Nigeria. These kinds of requirements allow private industries to improve their image of corporate social responsibility, and they have the positive effect of improving efficiency and allowing infrastructure to be built more quickly. However, these requirements also allow the government to avoid fulfilling its responsibilities to the public, shifting them instead to the private/NGO sector.
The NGO we visited in Lagos, GFC grantee partner Friends of the Disabled, spends as much time creating brochures for and arranging visits with private companies in the country as it does petitioning the government for funds. Friends of the Disabled’s mission is to help the hearing impaired become self-reliant and accepted in society, and the director has been lobbying the government to include sign language curriculum in public schools. She has to walk a very thin line between negotiation and advocacy, as the future of her organization depends upon government approval.
My experience in Lagos has led me to believe that in countries that have less transparent governments, the ability of GFC’s grantee partners to leverage private funding is incredibly important, as this is likely to be the fastest means of helping them grow as organizations when the government is unresponsive.