Tag Archives: health care

The DeMarco Factor

There is a lot that is pretty cool about my new, full-time position at the university.

I mean, I get a parking pass. For real.

I love my students and my colleagues, and I love the magnolia tree outside my window.

I love that tree A LOT.

But the very best thing, hands down?

The review copies of books.

It’s like Christmas every time I have a new text to select for a class, and those catalogs are like treasure maps.

It’s hard to keep up with all of the good publications coming out, and my students would cry foul quickly if I tried to assign everything that I think is worth their time to read, but it’s still pretty incredible.

One of the books that I previewed for this semester’s Advanced Advocacy Practice course is The DeMarco Factor, a sort of case study of a particularly effective advocate for health investments and equity in Maryland. It’s so hard for my students to conceptualize what advocacy really looks like, and to think through how they can apply their social work skills to its practice, and so I think there’s great value in humanizing the whole endeavor.

It’s very readable and quite well-received, but here are some of the highlights, as you’re weighing whether it makes it on your summer reading list.

  • Another point for social work relationship skills, in the advocacy context: There’s so much here about the importance of personal connections in moving policy, especially in the face of political and social odds. I feel vindicated, really, in my continual exhortations to my students that they were born for this. One observer calls DeMarco a ‘mythmaker’, capable of connecting with people so that they believe that they are capable of even the grandest political wins. If that’s not empowerment practice, I don’t know what is.
  • It takes campaigns: What I appreciated most about this book is the demystification of the advocacy process, without ‘simplifying’ it. If anything, there’s an increased understanding of the sophistication needed to develop and execute an advocacy campaign, including the process of running a public awareness component to galvanize support and the development of an electoral strategy to influence who’s sitting in the decision maker seat. But it’s not smarmy or murky or opaque at all. It’s an intervention, not that dissimilar from the interventions that we implement all the time, to induce change. Again, we can do this.
  • In building power (and you must), intensity matters: If we want to build enough power to induce policymakers to follow our prescriptions, we need far more than just public opinion on our side. We’ve really already met that threshold on a lot of our issues, and yet we’re clearly not winning many of them. What we need is fervent support, support that will convince elected officials that there will be a price to pay for failing to deliver. Policymakers will only listen when we make them. That is power.
  • You can work your model, on issue after issue: That’s the core takeaway from this book, I think, given that the central figure–Vinny DeMarco–has successfully executed advocacy campaigns on a variety of progressive issues in Maryland. Using the same modus operandi, more or less, he distributes resolutions to get organizations on board, shops policy models that can test the political waters, demonstrates economic impact, works his relationships to build powerful alliances, and uses a combination of polling, grassroots agitation, and insider politics to get to the victory. It worked on gun control, tobacco control, health care reform…we can win on anything, with the right approach.
  • We can be players: We may not all want to be power brokers the way DeMarco became. We shouldn’t. But there is more than one path to power. My favorite passage in the book, which I find really inspiring, is this: “It’s intimidating because you know that, no matter where you go in your district, or in your church, or in your world, you’re going to hear about his campaigns on behalf of the children and families of Maryland” (p. 45). To this, we should all aspire.

There’s no great utility in lionizing a particular advocate, and I don’t think that was the author’s intention with the book. What it says to me is that public interest advocacy is a noble profession and an art form, but one that can be studied and learned, to our own advantage as advocates and in service of the causes we care about.

I’m glad that there is a Vinny DeMarco, for the people of Maryland, and I’m glad to know about him, so that I can be the most skillful, powerful advocate I can, here in my own backyard.

The What: Investments in Public Health

Usually, this blog is more about the how of policy advocacy and social change, than the what.

I mean, sure, you know where I stand on a lot of issues.

But, for the most part, I use this space to talk about how we pursue change, how we organize, how we work with elected officials, how we use the vehicles available to us to pursue our visions of justice…whatever those visions of justice may, specifically, look like.

But, for this week, I’m turning to a list of post ideas that are more about what our policies should be, than about precisely how we get there.

Basically, they are issues that have been bugging me, and so here they are. It’s “the what” week, all week.

Today, I’m thinking about cholera.

We have the technology now to make devastating diseases like that history and, yet, they’re not.

All because we don’t invest as we should in sanitation, in public health information-sharing, in early detection, in research.

In other words, budget retrenchment could literally kill us.

The Ghost Map makes this point, when it calls London’s sewer system one of the great triumphs of the modern age.

Our technical capabilities today demonstrate that we can respond to environmental and health crises with massive projects that are feats of engineering and impressive displays of collective will.

Emphasis on the can.

Not necessarily the will.

Today, technology enables the city of New York to know that, during a power outage, people need information about safe insulin storage, because there’s a telephone system people can use to report problems and ask questions, and because those data can be collected and analyzed efficiently. As described in the book, we’re keeping ourselves safer and making our lives better by “amplify(ing) the voices of these local experts” (p. 225).

We can build maps online that show, immediately, where there’s an outbreak, or a water main break, or any other kind of natural or unnatural breakdown that threatens our health.

John Snow could not have imagined the capacity we take for granted today.

And, yet, there is a real risk that global economic policies will endanger all of our lives by forcing austerity measures on governments in the developing world. As they disinvest in public health, threats cross borders. Too many children in the U.S. fail to get critical immunizations–not just because their parents object, but also because too many of our children lack regular access to medical care. We need to update our waste-removal and recycling systems and ensure that our disease detection infrastructure is up to the task of evolving illnesses.

We have built the finest tools we can imagine, and our ability to use them continues to grow nearly exponentially, yet they will atrophy if we don’t continue to invest, in the hardware and software and people power needed.

That’s why we have to see our public spaces, and the revenue that sustains them, as critical investments in our collective well-being. Truly, combating dangerous retrenchment isn’t just about ‘quality of life’. It’s also just about life.

Taxes as anti-cholera insurance.

Maybe that’s a frame we should try.

One year later: Health care and our “Reform Reality”

On March 21, 2010, one year ago today, my husband and I stayed up late watching the debate on health care reform stream on his computer. Even though I’d read all of the analyses about the advance vote count, I think I still held my breath when the roll call was winding down.

No, of course it’s not a perfect bill.

There were several versions I preferred to what finally passed, and I’m not excited about how long some of the most significant pieces will take to be fully implemented, especially as the country continues to grapple with rising entitlement expenses, a lagging economy, and frustration with Congress.

But still.

My kids will be able to stay on our health insurance until they actually finish college. I don’t have to worry that my genetic blood disease will make us lose our insurance. SCHIP is protected. We’ll see increases in preventative care investments. We’re closing the “donut hole” gap in Medicare prescription drug coverage. We’re trimming cost excesses in Medicare Advantage. We will finally stop losing ground, at least, on the rising ranks of the uninsured.

It’s better.

And, in addition to the tangible improvements it makes in our health care “system” (what we have now can’t really accurately be called anything like ‘systematic’!), health care reform also represents a triumph of policymaking against tremendous ideological, fiscal, and political odds. I don’t believe in the “better than nothing” school of thought, much, because I’ve seen too many cases where settling for a little meant that we never saw a lot.

But this is better.

And, so, on the one-year anniversary, when the vast majority of health care reform’s provisions are but directives to be specified and analyzed and codified by regulators within the Department of Health and Human Services, between now and 2014, I’m spending some time checking out the Reform Reality site created by the Health Care Foundation of Kansas City (for which there are billboards all around my town!).

It’s a fully interactive site, with options to click to see how health care reform’s provisions affect those with different current positions in the system today. The content is similar to other sites, but I think it’s easier to engage here. You can see some of the expected fiscal impact, check out how reform aims to improve our nation’s health status (which is, after all, the ultimate measure of the success of any health care system), and link to organizations locally and nationally working on the aftermath of that day last March.

Check it out, and then I want to hear from you. What do you think about health care reform, one year out? Where do you hope we are one year from now? What about health care reform excites you the most, and what were your greatest disappointments?