Wednesday, March 17, 2010


For all you "fix it later" folks: Remember the Civil Rights Act of 1991? Women shortchanged in Title VII remedies "so that we can pass the bill"? In exchange for accepting an albatross, we were promised that the cap on damages in sex discrimination cases would be "fixed immediately." Well, it's nearly 20 years later... and we're still 2nd class citizens under Title VII.

Within the realm of health policy: When Medicare was enacted it was supposed to be the proverbial "foot in the door"... But we couldn't even get kiddicare as an "improvement." US policy history in general does not show that small steps ever lead the way to broad social provision in the structure of programs. We have been able to add previously excluded groups to coverage within existing frameworks -- teachers and domestic workers added to Social Security, eg. But in the current health care proposal, the framework is the problem. It's a framework that unleashes or approves concatenating inequalities in health provision, as well as in personal autonomy. There is no reason to believe that a for-profit, employer-based health care system based on coerced individual enrollment in private coverage can be "fixed," when the only way to provide socially just coverage is through a not-for-profit, not-employer-based, public system of health provision for all.

Fool me three times...?