Friday, August 29, 2008

Fifteen days of blogging for health care reform: The bridge to EPT

Guest post by Skylanda.

Where the dusty border town of Juarez butts up against the jutting mountains to the north, there is a bridge. On one side of this bridge lies Mexico, and on the other lies the city of El Paso, Texas. A place whose name itself invokes journey, transition, a throughway to greater things: The Passage.

Women on the south side of the river that divides the wealth of the north from the churning poverty and violence of Ciudad Juarez gather to watch and wait. These women walk heavily, bellies swollen with child, often in the night, often alone. When labor pains come fast and hard and strong enough to promise imminent delivery, these women make for the bridge. Border patrol will pick up most of them; if they are picked up short of the bridge, they are transported to a hospital back on the Mexico side to birth their children. If they make the bridge, they are transported to the north side and the babies born of them - born on American ground - become American citizens by right of birth.

This is something of an apocryphal tale. I have never seen this bridge, or met these women, nor can I verify for certain the veracity of these stories. I only hear tell of them from the residents who rotate through the labor & delivery floor there in El Paso. But it is a useful tale, one that silhouettes race and class and gender against the background of globalization as clearly as a nine-month gravid belly silhouettes out, against the desert heat of the borderlands under a moonless August night like tonight, back-lit by a Border Patrol spotlight.

In 1981 a cadre of radical feminist women of color published the anthology titled This Bridge Called My Back. It’s an aptly titled book, and the name came to mind when I first heard about the bridge to EPT. On the backs of these women, the layered complications of globalization are played out. These women bridge nations for their families; their flight during the pain of labor is a valiant attempt (from one perspective; a sneaky ploy from the other perspective) to drag their families into a relative sort of wealth in a manner that their men cannot, nor would they likely be asked to. On their backs intersect every complication of their gender, their minority race, their humanity-defying poverty. In the pangs of labor, outside, on the run, they become the reflection of everything unjust about a stratified world of haves and have-nots, and a mirrored view into the never-dead but ever-ephemeral hope that one day, somehow, life can be better.

The story of these women, when I first heard it, gave me pause to remember what the fight for universal care is about, and what it is not about - what it means to merely operate a universal payment system versus what it means to institute a social movement that pushes toward real social change. It is difficult to imagine - never mind articulate - how universal health care can be a part of that move toward equality and justice, so I’ll take on an easier task: the task of defining the things that universal health care cannot be if it is to play any role in the universalization of human rights.

And so, these are the things that universal health care is not:

Universal health care is not a system that claims to cover every person, but with a benefits package that circumvents one of the single most common services needed by half the adult population. This is why I will not get behind any pro-life candidate who talks out one side of his mouth about abstinence-only education and out of the other about covering the uninsured; if you’re not covering reproductive health services, you are not offering universal coverage.

Universal health care is not a system that reimburses for its covered citizens but leaves hospitals and clinics out in the cold for care of undocumented patients. It’s hard to advocate that the US government pay unlimited health care costs for people crossing borders illegally, but care for people who pick your grapes, clean your office building, and mow your lawn without benefit of legal status has to be covered in some measure. The most marginalized people are also some of the least likely to be able to pay, and the infrastructure that cares for them needs to be maintained as well as the infrastructure for legal, documented workers.

Universal health care is not a system that tackles the price tag of health care without at least some nod to the radical health disparities increasingly apparent in our nation today - why African American women and their babies die in the peripartum period at a rate that stands out like a sore toe compared to the rest of the nation. Why decades of increasing life span has suddenly reversed for women in the poorest mountain states of the south and east. And what the system needs to do to produce equitable care - toward equitable outcomes - for the people most affected by the disparities.

Universal health care is not an excuse to promote nationalism, exclusionary stances, an us-for-us and them-alone policy. If we didn’t want to cope with an influx of undocumented people, we should not have set up the border region as our own personal sweatshop, and we should not have built our agrarian and light-industrial economies on the backs of immigrant labor. The price we pay for being wealthy and well-funded is that our services are desired by those whose resources are so minimal as to be non-existent; we either accept a certain price tag on that privilege, or we decide to drop our care standards to the lowest denominator common to both sides of the border region so that people stop coming across. I would like to suggest that the latter is not an idea any of us would choose to live with.

Universal health care is not a foundation on which to build a healthy class of cannon fodder for the next military incursion into the next hotspot of global tension.

Universal health care is not a means to reinforce a global norm of inequality.

Universal health care is not simply another means to prop up wealth in the world’s core economies on the backs of the poor, the children, and the women of the peripheral economies.

It is up to the ambition of our collective conscience - and the hard work of concrete planning - to imagine up what universal health care can help make of America. I’ll keep my thoughts to myself on this one, and let yours do the work of imagining where a profound move toward taking care of our own might take us.

Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.