Justice Roberts Foresaw The Ensnarement of Health Professionals By Alito’s Radicalism.

Posted on | June 28, 2023 | 5 Comments

Mike Magee

We all need affirmation and encouragement. That is why I was so grateful to receive a range of positive feedback on Hcom’s recent focus on the role of health professional oaths in supporting the foundations of democracy.

One global health care leader wrote, “Thank you for your message and all the lovely pieces you publish. You give deep insights into political, historical and cultural contexts of medicine and health that we often overlook or miss to understand.”

A U.S. thought leader in Medicine commented, “Great review of the oaths and ethical principles of medicine and nursing which are sadly being chipped away by perverse incentives, especially of corporate medicine and greed.”

And finally this, from a highly respected health policy expert, “I very much appreciated this most recent posting and agree with your three major points. While I very much share your concern with the never ending (it seems) attempts by conservative legislators to interfere in various ways and intrude on the patient-physician relationship, I would also agree that the corporate intrusion into health care and the daily practice/delivery of medicine by physicians and nurses is a far more dangerous intrusion from my perspective.”

As I have aged into my current role, as observer/commentator/recipient of care, I have begun to appreciate that health professionals are not “separate from”, but “makers of” democracy. Government, after all is “the institutional authority that rules a community of people.” To what end? “To maintain order and stability, so that people can live safely, productively, and happily.” The ultimate goal? “To protect the individual rights of liberty within conditions of order and stability.” And therein lies the tension.

Negotiating that divide, especially when two rather than just one life is at stake (as in pregnancy), is a remarkably personal, individualistic, private and complex undertaking. That is why, for many decades, it was entrusted to individuals and families supported by health professionals. A careful reading of Roe v. Wade, with its boundaries defined by three separate trimesters, was a compromise – not perfect, but workable in a real world with real people.

Authentic democracies are based on a constitution and are limited in the interest of maintaining as much individual freedom as is orderly possible. That is why, democratic constitutions around the world (including our own) purposefully “restrain and harness the powers of government…to secure the freedom and common good of the people.”

Written constitutions are not an ultimate failsafe. After all Nazi Germany, Fascist Italy, and the Soviet Union all had them. Rather it is actions, not words, that matter. Do you live up to your constitution?

Freedom to make choices – in what you do and what you say – is what liberty is all about. Civil liberties are liberties defined to be within our laws, created by our elected representatives, which govern a civil society under our constitution.

Liberties are not a green light to do anything you want. As experts attest, “Neither freedom of thought nor freedom of action is secure in a lawless or disorderly society.” And yet, controlling government over-reach and intrusion on individual’s liberties was, and remains, a primary risk to the function of our constitutional democracy.

James Madison acknowledged as much in a letter to Jefferson in 1788: “It is a melancholy reflection that liberty should be equally exposed to danger whether the Government has too much or too little power; and that the line which divides the extremes should be so inaccurately defined by experience.”

Justice Alito was well-aware of the potential political fallout when he first leaked the draft of the majority opinion in the Dobbs case. Since then he has made it clear that his respect for Stare decisis (Latin for entrenched legal precedent) was by no means etched in stone, and added insult to injury by offering a “what about” comparison to the reversal of the historic Plessy v. Ferguson “separate but equal” decision that had codified the legality of segregation.

What Alito and his majority did was go all in on an open door policy for radicalized Trump-supporting state legislatures to assault the core liberty of women over decisions related to their bodily autonomy. At the same time, they facilitated the ensnarement of health care providers into criminal territory, and endangered the very patients doctors and nurses had sworn an oath to protect.

One year after the Justice Alito led Dobbs’ decision, Red states have aggressively followed his lead. Abortion is now banned (with some exceptions) in Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. Additionally, abortion in banned after 6 to 15 weeks of gestation in Georgia and Nebraska. Florida and North Carolina have bans that have not yet been implemented. Indiana, Montana, Ohio, South Carolina, Utah, and Wyoming have bans that are are tied up in court.

Chief Justice John Roberts attempted to steer Alito and his followers down a third path on Dobbs but failed. He stated that the “dramatic and consequential ruling is unnecessary to decide the case before us,” believing that a partial move toward a 15-week ban might be justified by the science, and that opening up the state floodgates by eliminating Roe v. Wade would destabilize our democracy.

Ironically, our constitution was designed, in the interest of individual liberty, to restrain “tyranny by the majority.” And yet the threat that has brought us to our constitutional knees in modern times is “tyranny by the minority.” Guided by religiously motivated adherents to white supremacy and patriarchal rule, a small cabal of conservative legal scholars, over a two-decade span, have redirected one of the three branches of government, toward a singular target – the overturn of Roe v. Wade.

With their success, this small band of emboldened outsiders and insiders are poised to undermine other personal liberties by exploring book banning, gender based restrictions of freedom of speech, and public funding of private and religious ventures.

Doctors and nurses, and the patients we care for, find ourselves caught in the middle of this battle, not by choice, but by necessity. We are, in fact, practitioners of democracy, perched perilously between liberty and order. Rather than shy away from conflict now, it is the time to speak up and stand tall.

The Danger to Our Democracy in Moving Nurses and Doctors From The Front Line.

Posted on | June 21, 2023 | 2 Comments

Mike Magee

The 4.2 million registered nurses and 1 million doctors in America who are agents of democracy are being sidelined, with a noticeable negative impact on the health of our representative democracy. As such, we must be careful how we select, train, and utilize this resource, and take care to expand rather than diminish their personal human contact with our citizens.

The three most prominent missteps are:

Corporate Dislocation – To assure maximum reimbursement, doctors and nurses are routinely asked to prioritize time and contact with data over time and access to patients.
Health technology and AI Substitution – Rather than engineering solutions to expand real-time patient contact, most innovations are further distancing patients from healthcare professionals.
Legislative Intrusion – Complex medical decisions, long entrusted to the patient-health professional relationship to negotiate, are being transferred to ultra-conservative legislators.

We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. Winston Churchill famously wrote, “Democracy is the worst form of government, except all those other forms that have been tried from time to time.”

The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community based action.

The argument against democracy is that it is inherently inefficient and corrupt, makes unwise decisions, handicaps excellence and ingenuity, overplays equality, over-encourages dissent and division, and erodes authority.

One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being.

Nations tilt one way or the other. America clearly leans toward individualism, while a country like Japan favors the communitarian version of democracy. Blending personal and public interests is complex. In health, one might argue, this tension led to our dual system – one, largely profit driven, interventional and science discovery based, and the other largely public, preventive and focused on communitarian public health.

Both nursing and medicine have embraced professionalism, and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole. These lists of promises or pledges, their language and priority ordering, helps reveal both the history and intent of these noble professions.

Of course, the most famous oath in Medicine is the Hippocratic Oath reaching back some 2000 years to Greece. In pledging to a grouping of ancient deities, it recognized that interventions should “do no harm,” and that confidentiality was paramount. By 1964, this oath was sufficiently out of date that many medical schools embraced an updated version written by Louis Lasagna, MD, an historical luminary in the creation of the Medical-Industrial Complex.

Not surprisingly, top line status in that Oath reads: “I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

The “art of medicine” and the avoidance of human arrogance earn line 3 and line 4 mentions:

(3) “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

(4) “I will not be ashamed to say ‘I know not,’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”

The final pledge in the Lasagna oath suggests a role in communitarian democracy: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

Over the past half century, the Oath has continued to be refined, and in some cases rewritten. For example the Penn State 2022 Oath gives top billing for the first time to the patient, with the oath to them, not to the gods: “By all that I hold highest, I promise my patients competence, integrity, candor, personal commitment to their best interest, compassion, and absolute discretion, and confidentiality within the law.”

Arguably the most balanced, comprehensive, and modern Oath for Medicine however dates back to 1948, and has undergone six revisions since then. It is the work of the Geneva based World Medical Association. Its list of pledges in their Declaration of Geneva in order of appearance include:

the service of humanity
patents first
patient autonomy and dignity
respect for human life
absence of bias or prejudice on any basis
commitment to patient privacy
guided by professional conscience and dignity
honor the noble traditions of the profession
respect and gratitude to teachers, colleagues and students
share knowledge to advance health care
commit to personal health and well-being
never violate human rights.

Nursing has also relied on professional Oaths. The first was the Nightingale Pledge, created in 1893 by the Farrand Training School for Nurses and named after Florence Nightingale. It is believed to be based on the Hippocratic Oath, and was modernized in 1935. In the 1950’s, the American Nurses Association (ANA), created a formal Code of Ethics, which largely supplanted it, and in 2015 added 9 pledges to its four pillared Code which celebrated Autonomy (patient self-determination), Beneficence (kindness and charity), Justice,(fairness) and Nonmaleficence (do no harm).

Nursing’s 9 Provisions (or Pledges) commit to: compassion and respect, patient-focus, advocacy, active decision making, self-health, ethical environment, scholarly pursuit, collaborative teamwork, professional integrity and social justice.

John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.”

It is largely self-evident that the more than five million health professionals, engaged and embedded in communities across this land, possess stated values that closely align with those of a healthy democracy,

These health professionals should be encouraged to live up to the values they pledged in their Oaths. After all, these jobs are tough on body and soul. But this is the job they signed up for.

At the same time, we as a nation should guard against the destruction of our Democracy from within. One of the surest ways to do that is to, by profit-driven design or political malfeasance, remove our nation’s nurses and doctors from the front line.

Category: Uncategorized
Tags: ama > ANA > Democracy > ethics in medicine > health and democracy > healthy democracy > Medical Oths > Nursing Oaths

Nurses and Doctors: Defenders of Democracy.

Posted on | June 14, 2023 | 2 Comments

Mike Magee

My recent post, featuring North Carolina’s K-12 lesson plan on “The Rule of Law,” broke records for traffic, but drew this admonishment from one subscriber, “This is a strange post for a health care blog.”

Since focusing on the social science of Medicine in the 2000 in Philadelphia, it has been an uphill battle to convince leaders in and out of Medicine that doctors and nurses are critical to the success of democracy. Recently, I’ve come to the conclusion that this may have more to do with a general lack of knowledge of democracy and its workings than a misunderstanding of the stabilizing effect of professional doctors and nurses.

What is democracy? For an answer I turned to John J. Patrick PhD, professor emeritus in history, civics and government at the Indiana University. In his “Understanding Democracy,” he explains that democracy as we know it is a “startling new development.” The practice of rule (krater) by the people (demos), or “demokratia,” dates back 2500 years to Athens, Greece. Citizens did rule by majority vote, but only free males of Greek descent could rise to the status of “citizen.” In those days, individual freedoms took a back seat to unconditional support of the city-community.

Establishing a modern democracy in America has been a bit of a struggle. Our concept of a “representative democracy” allowed elected representatives to act on behalf of the citizens with the goal of achieving “majority rule in tandem with protection of minority rights.” By 1920, democracy was somewhat more inclusive and slowly gaining global recognition as a form of government. At the time, there were 15 democracies worldwide. But by the end of the 20th century, there were 100 representing 2/3rds of the global population.

The ascendant nature of democracy reflected changes and adjustments of the ancient model. Dr. Patrick has highlighted a few of those changes including:

“Democracy in our world implies both collective and personal liberty.”
“Differences in opinions and interests are tolerated and even encouraged in the public and private lives of citizens.”
“Unlike democracy in ancient times, which directed citizens primarily to serve the community, the primary purpose of government in a modern democracies is to serve and protect all persons under its authority and especially to secure their inherent rights to liberty and safety.”
“In an authentic democracy, the citizens or people choose representatives in government by means of free, fair, contested, and regularly scheduled elections in which all adults have the right to vote and otherwise participate in the electoral process.”
“Popular sovereignty prevails; the government rules by consent of the people to whom it is accountable.”

Democracies are anchored by Constitutions which define the the responsibilities of the various counter-balancing branches of government, and jury a system of laws or rules that apply to all citizens. The Constitution defines the limits on the power of government. It is a tricky balance. The democratic government must be powerful enough to maintain law and order. Yet it must be sufficiently restrained to avoid oppressing individual liberty.

Federalist No.51, dealt with this delicate balance, stating: “If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed, and in the next place oblige it to control itself.”

Dr. Patrick suggests that the rapidly expanding popularity of democracy as a form of government is its promise to deliver “ordered liberty…combining liberty and order in one constitutional government…an authentic democracy.”

This requires confidence and trust that is able to reach down into the community. It requires liberal amounts of compassion, understanding and partnership. It requires real time processing of individual fears and worries. And it requires hope.

The roughly 1 million physicians and 4.2 million Registered Nurses at their best, deliver all of the above to all comers. They are neither saints nor sinners. They are human. Those of us who have spent time educating and managing this workforce, have appealed to their sense of professionalism and their oaths of duty. We’ve reinforced that living under our impossibly high expectations is, after all, what they signed up for. Historically, in most cases, they have delivered beyond our expectations.

But as this morning’s New York Times headline, The Moral Crisis of America’s Doctors, spotlights, there is growing concern that the monetarization and corporatization of nursing and medical professions by hospital and insurance power houses, have seriously undermined the mental health and ethical effectiveness of health care professionals. The pandemic has only heightened the crisis.

I see health professionals as front-line educators and defenders of democracy. As Dr. Patrick notes, “If there would be ‘government of the people, by the people, and for the people’ – Abraham Lincoln’s pithy phrase about the meaning of democracy – then there must be education of the people about what it is, how to do it, why it is good, or at least better than the alternatives to it.”

But learning in democracy, as in health care, is an intimate affair. It requires that people “touch each other.” As Ralph Waldo Emerson wrote long ago, “To interpret Christ, it needs a Christ…to make good the cause of freedom against slavery you must be…Declaration of Independence walking.” Health professionals must be encouraged to continue to “walk the walk.” Neither AI, nor the latest mRNA technology, can cure “what ails us.” The solutions are distinctly human.

Category: Uncategorized
Tags: Democracy > doctors > Federalist No.51 > healthy democracy > John J. Patrick PhD > nurses > rule of law > understanding democracy

Trump Earns a Dunce Cap in North Carolina.

Posted on | June 11, 2023 | 4 Comments

Mike Magee MD

Events over the past year clearly have confirmed that we are a “work in progress” even as we stubbornly affirm our good intentions to create a society committed to “life, liberty, and the pursuit of happiness.”

With the Dobbs’ decision, our Supreme Court has unleashed long-abandoned regressive state laws designed to reinforce selective patriarchy and undermine the stability and confidence of America’s women and families. As a result, our nation’s health professionals, and the patients they care for, potentially find themselves “on the wrong side of the law.”

It calls to mind the well-worn phrase of mothers everywhere to their bossy children, “Who died and left you boss?”

Since our former President, on the eve of his latest indictment, decided to deliver a message to North Carolina Republican supporters this past weekend, claiming that he was engaged in the “final battle” with “corrupt” forces, most especially the “Deep State” that was “out to get him,” I decided to fact check his claims with the kids of North Carolina.

North Carolina’s K-12 lesson plan, titled “The Rule of Law,” begins with the Teddy Roosevelt quote, “No man is above the law, and no man is below it” from his 1903 State of the Union address.

In the very first paragraph, the plan affirms that law is fundamental to societal health stating:

“Every day, we are touched by rules and laws. They pervade every aspect of our lives, from traveling on the road to shopping at the mall. In this lesson, students will explore the rule of law in American democracy and its impact on every individual. Through class discussion and role play, students will gain an understanding of:

what the rule of law means in terms of American government,
the functions laws play in our society, and
the role all citizens and community members, from a student to the President, play in adhering to and upholding the rule of law.”

The plan cues up questions that students will need to address, including:

“From when and where does our system of law originate?”
“What functions do laws serve in our society?”
“What role does our government’s separation of powers play in ensuring adherence to the rule of law?”
“Why is an independent judiciary fundamental to the rule of law?”
“How might our society be different if we had no laws?”

A bit further on, students are informed that:

“The rule of law is basically an agreement that everyone will play by the rules. This allows us to enjoy a more peaceful and safe existence. The rule of law also ensures the protection of certain rights for each of us. Ideally, the rule of law applies equally to everyone, meaning you are treated fairly and equally, under the same set of rules, regardless of who you are.”

The curricular plan then explores laws themselves helping students to uncover these insights:

“How do laws affect each of us? What functions do laws serve in our society? Ensure students discuss the following functions of laws:

1.“Laws serve as standards of conduct and dictate the ways people should behave and what activities are permitted or prohibited under certain conditions (e.g., drinking under age, driving, speeding, etc.)
2. Laws maintain order, ensure predictability, and provide security (e.g., they require that people drive on a certain side of the road; they require that people pay for services rendered.)
3. Many laws in America grant and protect particular individual rights and freedoms, ensure equality, and advocate for the common good.
4. Laws also guarantee certain benefits to citizens (e.g., schools, health services, etc.)
5. Laws assign responsibilities to citizens (e.g., paying taxes.)
6. Laws define what duties the government will perform and can also limit the power of governmental officials.
7. Laws can facilitate different forms of change (e.g., toxic waste disposal, anti-discrimination, prohibition of spousal abuse, etc.)
8. Laws are used to manage different forms of conflict, relying on courts, lawyers, and judges for such.
9. In summary, laws serve many different purposes. Ideally, laws should be well designed to ensure justice; they should be designed so that the average citizen can interpret, understand, and thus follow them.”

Finally there is a homework assignment. Students are provided with a copy of chapter 28 in Justice Sandra Day O’Connor’s “The Majesty of the Law,” to read.

In follow-up, the teacher is instructed to ask students: “When Justice O’Connor writes, ‘A nation’s success or failure in achieving democracy is judged in part by how well it responds to those at the bottom and the margins of the social order,’ what message was she conveying and how does it relate to the rule of law?”

Category: Uncategorized
Tags: Civics Lesson > Deep State > K-12 Lesson Plan > North Carolina > The Rule of Law > trump > Trump indictment

Patient-Physician Relationship Finds Itself At High Noon On Fifth Avenue.

Posted on | June 7, 2023 | Comments Off on Patient-Physician Relationship Finds Itself At High Noon On Fifth Avenue.

Mike Magee

If there is a silver lining to the Trump assault on decency and civility, it is our majority response to this “stress test” of our Democracy, and the sturdiness (thus far) of our Founders’ vision. And right in the center of this battle is the patient-physician relationship.

It was, after all, a long shot when Alexander Hamilton, under the pen name Publius, published Federalist No. 1 on October 27, 1787, writing: “It has been frequently remarked that it seems to have been reserved to the people of this country, by their conduct and example, to decide the important question, whether societies of men are really capable or not of establishing good government from reflection and choice, or whether they are forever destined to depend for their political constitutions on accident and force.”

Two weeks before the Iowa caucus in 2016, Trump himself sided with “force” and signaled a rocky road ahead when he stated in Sioux City, Iowa, that “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK? It’s, like, incredible.”

In so doing, he was taking on medieval jurist, Henry de Bracton, who wrote in On the Laws and Customs of England in 1260 that “The king should be under no man, but under God and the law.”

Of course, Trump, while representing our Executive branch, was not acting alone. He was supported by members of our Legislative branch as they successfully stacked the Judicial branch with religious conservatives. The net impact was this past year’s overturning of Roe v. Wade, and a Christian Evangelical legislative windfall (and subsequent political backlash) in multiple Red States across the union.

This too was foreseen by our Founders. In 1799, Thomas Jefferson, in a letter to James Madison, warned that “The executive in our governments is not the sole, it is scarcely the principal object of my jealousy. The tyranny of the legislatures is the most formidable dread at present, and will be for long years. That of the executive will come in its turn, but it will be a remote period.”

Without the law, there is no society. President Teddy Roosevelt made this clear in his 1903 State of the Union address when he said. “No man is above the law and no man is below it; nor do we ask any man’s permission when we require him to obey it. Obedience to the law is demanded as a right; not asked as a favor.”

In the current assault on Roe v. Wade lies buried an assault not only on Democracy, but also on women’s rights, their autonomy, and on the integrity of the patient-physician relationship. In pushing patriarchy, and MAGA Republican dominance, a fringe minority is willing to bend the law to their favor, and undermine the health of our nation.

On June 24, 2022, Roe v. Wade was overturned. Only 5 months later, Indianapolis physician Dr. Caitlin Bernard was hauled into court to face a judge in response to a complaint filed by Indiana Attorney General Todd Rokita that the doctor had violated state law requiring notification of police and child welfare officials in cases of child abuse.

The 10-year old child involved had been raped by a 27-year old Ohio man who was under arrest. Ohio’s 6-week “fetal heart beat” abortion ban (which took affect after Roe v. Wade was eliminated) resulted in the child’s parents being forced to cross state lines and seek help in nearby Indiana. After the 3-day required waiting period, Dr. Bernard provided care necessary for a medical abortion. As her attorney stated, “Dr. Bernard is a skilled and competent doctor, and I would submit that she is exactly the doctor that people would want their children to see under these circumstances.”

She, and her fellow doctors across the nation, provide compassion, understanding, and partnership to Americans from “sea to shining sea.” But less well recognized is their function in providing health to our Democracy in three ways. First, they process the nation’s fear and worry on a daily basis, which might otherwise rise to destabilizing effect. Second, they reinforce linkages between individuals, families, and their communities, pointing those in need to resources that might help. Third, they reinforce a sense of hopefulness. If not a cure today, perhaps one just around the corner.

Extreme MAGA Republicans have inadvertently awakened deeply buried and historic fears and resentment. As historian Lawrence Friedman put it, “The American Revolution, whatever else was at issue, fed on resentment against English oppression….Criminal laws are one of the levers the government uses to exercise its power over the individual, over the ordinary citizen…the British had abused criminal justice, and were impairing the rights of the colonists….The leaders of the Revolutionary generation felt strongly that there had to be safeguards against abuse of criminal justice, or the use of criminal process to crush political dissent – the offenses King George was blamed for.”

Trump, no doubt, remains anxious to test out his theory with a last stand “in the middle of Fifth Avenue.” But in the process, he has fast-walked his followers into a position of state government over-reach, which places low-level bureaucrats at the patient’s bedside, criminalizes doctors and nurses, and leads the former “Sons of Liberty” into King George’s (or Donald’s) waiting arms. How hard will the AMA Federation push back?

Category: Uncategorized
Tags: 10-year old Rape victim > Dobbs case > Dr. Caitlin Bernard > Federalist No.1 > Henry de Bracton > Ohi abortion law > Roe v. Wade > Teddy Roosevelt > Todd Rokita > trump

President Biden Tripped On Stage This Week, But (Women Know) He Is Poised To Deliver A Knock-Out Blow In 2024.

Posted on | June 2, 2023 | Comments Off on President Biden Tripped On Stage This Week, But (Women Know) He Is Poised To Deliver A Knock-Out Blow In 2024.

Mike Magee

As the saying goes, “History repeats!” This is especially true where President Joe Biden’s management of complex political challenges is concerned. Tonight he’ll address the nation at 7 PM as he signs an historic bipartisan agreement that extends the debt limit and advances our national economy. And though he took a spill at a commencement address this week, he hasn’t lost a step when it comes to carrying the day under the most challenging political circumstances.

With age, comes experience. Consider for example the past three decades in health care. It is striking how many of the players in our nation’s health policy drama remain front and center. And that includes President Biden who’s comments on the 12th anniversary of the passage of the Affordable Care Act (Obamacare) centered on women and children:

“The ACA delivered quality, affordable health coverage to more than 30 million Americans — giving families the freedom and confidence to pursue their dreams without the fear that one accident or illness would bankrupt them. This law is the reason we have protections for pre-existing conditions in America. It is why women can no longer be charged more simply because they are women… And it is the reason why parents can keep children on their insurance plans until they turn 26.”

On March 23, 2010, President Obama signed the Affordable Care Act into law initiating a decade long war with Republicans on two fronts. First, in Congress, Republicans voted to repeal the law more than 60 times, all unsuccessfully. The most dramatic attempt came on July 28, 2017 when John McCain teamed up with two women Republicans, Lisa Murkowski and Susan Collins, and managed to appear in the chamber near death from brain cancer to provide a camera ready “thumbs down” to the Trump/McConnell effort.

Over this same decade, Republican-led states in parallel had attacked the law on Constitutional terms, chipping away at the statutes, without offering an alternative. Opponents termed the act “Obamacare” as if it were a pejorative label. The President turned that on his critics stating, “I have no problem with people saying Obama cares. I do care.”

“Repeal and Replace” became the rallying cry of Republicans. They didn’t succeed.

Quietly and deliberately, at the same time, a conservative cabal built a vertically organized “Justice Mill,” patiently laid the groundwork for a separate deadly attack on health care that did succeed. Coordinating installation of three Trumpist judges, with selective judge-shopping in an engineered Texas lawsuit, the same people who unsuccessfully attacked Obamacare, successfully overturned Roe v. Wade. The fallout from this disastrous decision continues to play out on the state level.

In their way, stands the very same President Biden who a year ago spotlighted these achievements.

“Thanks to the American Rescue Plan, ACA premiums are at an all-time low, while enrollment is at an all-time high.”
“Four out of five Americans can find quality coverage for under $10 a month, and families are saving an average of $2,400 on their annual premiums.”
“… increased enrollment to a record high 14.5 million Americans … including nearly 6 million who enrolled for the first time…”
“…an additional 18.7 million low-income Americans now covered by Medicaid expansion.”
“…the HealthCare.gov enrollment rate increasing by 26 percent for Hispanic Americans and 35 percent for Black Americans.”

Tonight our President will do the same for his most recent legislative victory. But those who have labored in the shadows for decades to reassert patriarchy in America by eliminating women’s freedom and control over their own health decisions are now all too aware that Joe Biden has not lost a step when it comes to politics. And his eyes are squarely on their over-reach with Roe v. Wade, and the coming 2024 election.

Sophia Loren, now 88 and vibrant, could have easily been visualizing Joe Biden when she said, “There is a fountain of youth: it is your mind, your talents, the creativity you bring to your life and the lives of people you love. When you learn to tap this source, you will truly have defeated age.”

Category: Uncategorized
Tags: aca > aging > extending US debt limit > leadership > Obamacare > President Biden > Roe v. Wade > Sophia Loren

Urban Land Tenure Security as a Measure of Health

Posted on | May 30, 2023 | Comments Off on Urban Land Tenure Security as a Measure of Health

Mike Magee

“The title of our lands is free, clear, and absolute, and every proprietor of the land is a prince in his own domains, and lord paramount of the fee.”
Jesse Root, Chief Justice of the CT Supreme Court (1798)

When it came to social hierarchy and family position, land was the ultimate measure of success and influence in Great Britain. But by the time of the American Revolution, our Founders were already fast at work dismantling Primogeniture (“the right of succession belonging to the firstborn child, especially the feudal rule by which the whole real estate of an intestate passed to the eldest son.”) It had already largely disappeared in New England, and was gone in the southern colonies by 1800.

In its place, the colonists envisioned a “free and mobile market,” where land could be traded like money and other goods. To do so, the original land grants and “feudal tenures” were obliterated, and their legal documents swept clean by the new law of the land. The decisions on ownership were made locally, empirically and by “common wish” of those in power.

Property was meant to be traded, fast and furious, but most of all put to “productive use” in a young nation obsessed with rapid growth. As legal historian, Lawrence Friedman, suggested, “In land lay the hope of national wealth; for countless families, it was their chance to make some money. The land, once it was cleared of the native peoples (by hook or by crook), and properly surveyed, was traded with speed and fury. Speculation in raw lands was almost a kind of national lottery.”

Secure possession of land rapidly and dramatically segregated the “have’s” from the “have-not’s.” By the end of the century, industrialization and urbanization, fueled by Black flight from white southern segregationists and immigration from Europe and Asia, had escalated the growth of cities lacking required housing and infrastructures to support health and safety. The scientific revolution, a new Sanitary Movement, and the beginnings of government regulations together began to address infectious diseases and unsafe food and water.

More than a century later, urbanization (primarily as a source of jobs and access to power) has lost none of its appeal. Consider the fact that in 2012 there were about 7.0 billion global inhabitants with 49% rural and 51% urban. In 2023, we topped 8.0 billion, but 57% are now urban. By 2030, we’re projected to reach 9.0 billion with 2/3rds living in cities. The cities themselves are growing in number and size. There are now 512 cities worldwide, primarily on coastal plains, with populations over 1million.

Under ideal circumstances, this urban migration to concentrated land dwellings could serve our human population well – with jobs, clean air and water, transportation, housing and education, health care, safety and security. But without investment and planning, they can be a harbinger of poor health, and ultimately a death trap.

Recognizing this threat, urban geographers and public health professionals are increasingly collaborating in the creation of a common language and set of measures or determinants to gauge the success of governmental investment and action. One area of recent common focus is “urban land tenure insecurity” as a contributor or determinant of poor health outcomes.

The researchers are attempting to put together a complex puzzle to answer the question, “Do variations in land tenure security and variations in health outcomes relate to each other?” What urban geographers have already established is that “livelihood, well-being and quality of life” are elevated by housing security in “formal settlements.” These sites have laws that ensure rights of dwellers as a hedge against homelessness, and a range of services that promote “employment, housing security, political participation, education, protection from environmental risks, and access to primary health care.”

In contrast, informal settlements place inhabitants at risk on multiple levels. First, by definition these sites lack the planning and infrastructure to support the populations who have congregated in this location. Second, the uncertainty of basic safety and security (literally “a roof over your head”), and the implied threat of forced displacement and instantaneous mobility, makes “setting” down roots much less likely. This undermines investing in community and support systems necessary for physical health. Finally the stress and disruption ever-present in these informal settlements ensures high burdens of mental health disease.

Land, then, does remain the “ultimate measure of success” in modern times. But the success and influence engendered in secure housing and settlement has little to do with “overlords”, but much to do with access – to secure housing, healthy food, clean air and water, a job and transportation, recreation, and human relationships. And all of the above are enhanced by access to settled neighborhoods with access to health care.