April 5, 2024

Dear Interested Readers,

 

What Dr. King’s Experience Might Suggest About Improving Healthcare

 

April 4, 1968, seems a lifetime ago, and yet I remember it more clearly than most days of the last year. If you had asked me where Dr. King was, I think I would have known that he was trying to help the sanitation workers in Memphis, but I would not have known yet that the night before he had essentially predicted his imminent assignation in his “I have been to the mountain top” speech. 

 

The image Dr. King created with his reference to Moses on Mount Pisgah was one of certainty of ultimate victory. It is moving to realize that if his death was the price of that victory he was willing to pay it. There had been a previous attempt on his life, a nearly successful stabbing in the chest in 1958. There were many threats to his life and his family as attempts to stop his campaigns for civil rights which included the bombing of his home. Rather than getting protection from law enforcement, King was under constant surveillance by J. Edgar Hoover and his FBI.

 

In 1967 Dr. King took some time off to “reset” the objectives of his non-violent movement. During that time off he wrote his last book, Where Do We Go from Here: Chaos or Community? The peak of the Civil Rights movement occurred with the passage of the Civil Rights Act of 1964 and the Voting Rights Act of 1965. Many of Dr. King’s liberal white supporters in and out of government seemed to consider that their job was done. The passage of the laws was a great start, but the economic realities experienced by most Black Americans did not immediately improve. Within the Black community, Dr. King was challenged by the young militant activists who were abandoning the “non-violent” strategies that King had adopted from Gandhi in favor of the new aggressive strategies of  Black Power. 

 

In the book, King paints a realistic picture of the moment. He affirms his belief in peaceful protest as the most effective strategy that might bring forward the moment of triumph that he envisioned in his “I Have A Dream Speech” delivered in front of the Lincoln Memorial on the Mall in Washington in August of 1963. After cataloging accomplishments and recognizing the growing divisions within the movement, King boldly describes the next evolutionary phase of the movement. He answered his own question, “Where do we go from here?” His answer was to recognize the universal oppression of poverty and to assert that America’s wealth was adequate to abolish poverty. He advocated for a system of universal basic income. Universal access to quality healthcare was certainly part of his vision, but he also pointed out that within the non-violent philosophy, further progress required growing political power.

 

If “The Deam” was ever to become true, people who cared about the future of America’s journey toward justice and equity needed to move from protests in the streets, boycotts of racist businesses, and “sit-ins” at lunch counters to positions of political power and policy creation at all levels of government and society. He was right then, and he is right now. 

 

We all know what happened. Dr. King was assassinated. We lost our way in Vietnam. We have never achieved healthcare or economic equity although I like to think that he would advise us that we can still rescue and resuscitate the dream. King posited that the move toward the political power needed to achieve societal change must be motivated by hope, love, and a sense of fairness. He was convinced that no society could remain great if it existed on the exploitation of many of its citizens. 

 

When I read Dr. King’s book it occurred to me that there were some parallels between that moment in 1967 in the aftermath of the successful civil rights legislation and this moment in healthcare now post passage of the ACA. I fear that many of the people who made that legislation possible have lost their enthusiasm for finishing the work of creating universal access and healthcare equity. In the late 60s, the War in Vietnam helped derail Dr. King’s movement. Challenges to the ACA in the Supreme Court and the election of Donald Trump in 2016 had a somewhat similar impact on our Triple Aim dreams. 

 

We should be encouraged by Dr. King’s positive belief that someday we will have an equitable society. In August 1967, Dr. King delivered an address in Atlanta at the celebration of the tenth anniversary of the founding of the Southern Christian Leadership Conference that was also entitled “Where Do We Go From Here?” The speech contained many of the points that he published in the book of the same name that called for a move toward power. I have bolded some important words from the speech.

 

Now another basic challenge is to discover how to organize our strength into economic and political power. Now no one can deny that the Negro is in dire need of this kind of legitimate power. Indeed, one of the great problems that the Negro confronts is his lack of power. From the old plantations of the South to the newer ghettos of the North, the Negro has been confined to a life of voicelessness and powerlessness. Stripped of the right to make decisions concerning his life and destiny he has been subject to the authoritarian and sometimes whimsical decisions of the white power structure. The plantation and the ghetto were created by those who had power, both to confine those who had no power and to perpetuate their powerlessness. Now the problem of transforming the ghetto, therefore, is a problem of power, a confrontation between the forces of power demanding change and the forces of power dedicated to the preserving of the status quo. Now, power properly understood is nothing but the ability to achieve purpose. It is the strength required to bring about social, political, and economic change. Walter Reuther defined power one day. He said, “Power is the ability of a labor union like UAW to make the most powerful corporation in the world, General Motors, say, ‘Yes’ when it wants to say ‘No.’ That’s power.”

 

He also recognizes that power alone is dangerous and must be coupled with love:

 

Now, we got to get this thing right. What is needed is a realization that power without love is reckless and abusive, and that love without power is sentimental and anemic. Power …at its best is love implementing the demands of justice, and justice at its best is love correcting everything that stands against love. And this is what we must see as we move on.

 

Dr.King’s logic is founded in human values and his recognition that inequity must be addressed. I believe that is just as true on the 56th anniversary of his death as that day in August 1967. We still face the question, “Where do we go from here?”

 

I want to say to you as I move to my conclusion, as we talk about “Where do we go from here?” that we must honestly face the fact that the movement must address itself to the question of restructuring the whole of American society. There are forty million poor people here, and one day we must ask the question, “Why are there forty million poor people in America?” And when you begin to ask that question, you are raising a question about the economic system, about a broader distribution of wealth.

 

He may be predicting his own death [I continue to bold important thoughts] as he looks into the future and the personal sacrifices that may be required:

 

And I must confess, my friends, that the road ahead will not always be smooth. There will still be rocky places of frustration and meandering points of bewilderment. There will be inevitable setbacks here and there. And there will be those moments when the buoyancy of hope will be transformed into the fatigue of despair. Our dreams will sometimes be shattered and our ethereal hopes blasted. We may again, with tear-drenched eyes, have to stand before the bier of some courageous civil rights worker whose life will be snuffed out by the dastardly acts of bloodthirsty mobs. But difficult and painful as it is, we must walk on in the days ahead with an audacious faith in the future.

 

At the end of this speech, as he did in others, he makes the famous reference to the long journey toward justice and confirms his belief in the ultimate victory of the cause of equity.

 

Let us realize that the arc of the moral universe is long, but it bends toward justice. Let us realize that William Cullen Bryant is right: “Truth, crushed to earth, will rise again.” Let us go out realizing that the Bible is right: “Be not deceived. God is not mocked. Whatsoever a man soweth that shall he also reap.” This is our hope for the future, and with this faith we will be able to sing in some not too distant tomorrow, with a cosmic past tense, “We have overcome! We have overcome! Deep in my heart, I did believe we would overcome.” 

 

I have to believe that his vision of justice is consistent with our efforts to improve equity in healthcare because in 1965 he had said:

 

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” 

 

An April Blizzard Is Never A Good Thing

 

My neighbor took the picture that is the header for this post. It is easy to see that a big pine tree came down in the storm we had from Wednesday night through late Thursday that dropped 14 inches of heavy, wet, gloppy snow on us. If you look closely over the “care” in Healthcare, you can see downward-slopping electrical lines. I know that the event occurred at 7 AM because various alarms started beeping to tell us that we had a problem. At the same time our “plow guy” was making the first of several passes at our drive in an attempt to stay ahead of the accumulating snow. When he realized that the line was down, he left his truck at my house and called for another truck to come pick him up. One thing that most people in New Hampshire know and respect is that you don’t drive over downed lines unless you have a death wish. The tree came down because of the combination of poor maintenance by the electric company plus the heavy snow and winds of 40-50 MPH. 

 

On Wednesday before the storm, I pushed my rolling walker the quarter mile from my door to where our road intersects the main road going into town. The tree fell near that intersection. We are the last house on the road which “dead-ends” at the lake which meant that until the lines were repaired we were trapped. At the time of my round trip of a half-mile, we were enjoying the last few hours of three consecutive days of warm spring-like weather. Most of last week’s snow had melted. 

 

My wife was along for the walk “just in case” I might have a problem. As I was trudging along, she commented on all of the old trees along both sides of the road that had been marked for removal by the electric company more than a year ago. She speculated about the likelihood of one of these trees coming down with the storm.

 

Marking trees that need to be removed to prevent an outage does no good if the marking is not followed tree removal. I see a similarity between the electrical company’s failure to remove the trees that were a threat, and our collective failure to adequately manage people with risks for various medical problems. It is an example of waste and folly to neglect potential problems. 

 

I don’t know if the pine tree that came down had been marked for removal. It may not have been marked because most of the marked trees were hardwoods. The possibility that an unmarked tree might come down is also analogous to medical management where we often see people with an unexpected acute event because of a “failure to diagnose.”

 

Now that the storm has passed, I hope that we have had it with winter. A few weeks back I was concerned that winter was over too soon. It was foolish of me to ever imagine that my requests and wants might have any impact on the weather we get. There has always been uncertainty when it comes to the weather. The lesson from the weather this year is that global warming has increased that uncertainty and the old norms are becoming less reliable predictors as the volatility in the weather increases. As warmer oceans put more moisture into the atmosphere, more moisture means more violent and volatile weather.

 

My fear is that more and more people will begin to believe that we are well past a point of no return with global warming and that efforts to slow climate change are a waste of resources. It is hard for people to accept that as bad as it is, it will get worse. Buying more generators and air conditioners may be good short-term coping measures, but I fear they are attempts at palliation that give us temporary relief as things get worse and worse.

 

Our oceans are a huge “heat sink” that up till now has buffered the impact of global warming. Any doctor or nurse who can remember their studies of physiology understands change can occur at a geometric, not linear rate when the capacity of a major buffering system is saturated. 

 

Dr. King’s analysis in his book Where Do We Go From Here is as applicable to the weather as it is to our system of medical care. Those who benefit from the excesses of the status quo will not usually set their self-serving agendas aside in favor of others. They will use whatever power they have to control policy to protect their interest. If meaningful lasting change occurs, it will be because of a shift in political power toward those who put the concerns of the whole community ahead of their self-interested short-term benefits. 

 

In my mind, the state of our healthcare system and less volatile weather should be greater concerns during this year’s election than what is happening at the southern border or the rate of inflation.  We have about seven months of volatile political weather ahead of us. During these coming months, I will continue to remind you that you should be trying to decide which candidate advocates policies that will build a more equitable community for those of us here now and for those who will follow us. 

 

The same weatherman who accurately predicted Thursday’s storm is telling me that we will be back to more spring-like weather this weekend.  I hope that I will be able to push my walker on a clear and dry road and that you will be enjoying some fine spring weather wherever you might be. 

Be well,

Gene