Coincidence?

With the Republican Party flailing and try to find its way in an evolving political landscape, the election of Michael Steele, the first African-American to lead the party, smacks of the Palinism (picking someone because they bare a superficial resemblance to some popular candidate) that seems to be pervading Republican decisions. While I hope the move is a genuine sign of change, I hesistate to imagine that being likely. With around 95% of African-American voters voting for Obama and, similarly, an overwhelming majority of Latinos (around 66%), Republicans have a lot of work to do in order to appeal more widely. As the U.S. demographically shifts to being a minority majority country, the increasingly white, rural, ultra-conservative, and xenophobic GOP of people like Rush Limbaugh will not suffice. At this point I honestly can't imagine how this change would take place, and it will take a lot of soul-searching on behalf of Republican leaders to bring about such a large change in strategy. 

However, though Democrats clearly came away with a huge victory this year, supporters need to be wary here as well. While many in the Democratic party speak of grassroots change and reference progressive issues, when the time comes to defend those issues, they are often forgotten. The most recent example was a provision in the stimulus package that would have subsidized birth control and family planning services for the poor. This measure was lambasted as shelling out millions of dollars, when in actuality, all real estimates highlighted that it would save the U.S. far more money than it would cost. At the first sign of protest, Democrats dropped this provision from the bill without so much as a fight, only to not even be able to garner ONE Republican vote for the stimulus in the house. This rapid capitulation doesn't bode well for the rest of the session, I hope I am proved wrong.

I guess it doesn't take long for optimism to die...

National Health Policy Conference 2009!!!!

This Monday and Tuesday I will be attending the National Health Policy Conference, here in downtown Washington, D.C. It is really exciting for me because the scheduled sessions look really great. It will also be the first official function were I will be going as a GAO employee. There are a few other people from GAO going (GAO has a lot of great opportunities to attend conferences and other professional education events) and I am really looking forward to seeing how it goes. There are a lot of people scheduled to be at the conference that will be playing a critical role in any upcoming health care reform and so it will be neat to see how it unfolds.

I am also excited that it will be one of the first places that I will be handing out my business cards. It is nice that at GAO I have the flexibility to be away from the office for a couple days and still have it considered work.  I am probably most excited about Jeanne Labrew, the Deputy Director of the White House Office of Health Reform, being there. She co-authored Critical recently with Tom Daschle and will be playing a very key role in health reform. It will be interesting to hear her take on when the process is likely to start. Also, Senator Max Baucus and Representative Pete Stark, who both chair crucially important committees on health, will be present. While there have been differing signals on how quickly health reform will move, it will be exciting to watch it unfold, and to play a role, even a minor one, in that reform.

Capital City Lights

It has been really fun to be in D.C. over the inauguration. While Heather and I didn't end up making it to the inauguration (we gave up after seeing how crazy the crowd was at our Metro stop), we have really enjoyed the build up and being able to feel like a part of the excitement. The job I am in really provides for an opportunity (and responsibility) for keeping up to date on what is going on in Washington. I am continually amazed at how proximity allows for such a different level of knowledge and understanding of the relevant issues. It is still neat for me to see all of the events going on (like the set up for one of the inaugural balls right across the street from where I work). Also there always seems to be some sort of protest going on in D.C. Heather and I have had a great time taking it all in and making time to do fun things.

It has also been really exciting to be here as the Congress gears up in the New Year. There is a real sense of excitement and opportunity. There also appears to be a chance for some actual bipartisanship. However, it is clear that the old dysfunctional working relationship between Democrats and Republicans continues to simmer just under the surface. It is easy to understand why Americans get so frustrated with Congress. It appears there is some truth to the notion that being in Congress too long skews your priorities. It seems that many Senators and Representatives on both sides of the aisle are more focused on spurning their colleagues than creating quality public policy.

This focus on rivalry and partisanship plays a large role in Americans generally having such a poor opinion of Congress, with recent approval ratings around twenty percent. It is hard to imagine that changing significantly unless Congress changes the way it functions. It is hard to tell at this point if the bipartisanship is genuine or if it was just a period of good feelings that will soon be replaced with tired rhetoric. I am much more optimistic than usual about these matters, maybe because I am now a part of Congress. 

Driving out to the FDA yesterday from the GAO building reminded me how beautiful the city is and how little driving I have actually done around it. Heather and I will definitely have to do some exploring by car at some point. I am so used to seeing the Metro as my main mode of transportation that I don't even consider driving for anything other than going further away from D.C. I am sure Heather will get some great pictures out of it.

Fairness vs Injustice

Issues of race, gender, and ethnicity have been a hot issue in recent weeks. Many in the media are writing about whether the election of Barack Obama represents the beginning of a "post-racial" America. This notion, that race no longer defines a person's status and trajectory, is in theory interesting but in reality serves only to further marginalize those who suffer under the yoke of injustice. The very fact that it is such a big deal to elect an African American president speaks to the fact that we have not come as far as many seem to hope. 

Race and ethnicity have always been tricky and taboo subjects not only in the U.S. but around the world. Most people take race as a given category that people fit into, largely ignorant of the fact that races and ethnicities are socially constructed. By socially constructed I am referring to their origin in the historical context in which the categories are created and then changed over time. For example, in many countries in Latin America, race is viewed extremely differently. In some countries there are fifty or more gradations of perceived ethnicity on a spectrum of white, black, and indigenous. In many of these countries, while skin color is taken into account, other factors like wealth, dress, and social status serve to determine a person's "true" ethnicity.

We often lose sight that when we talk about someone being African-American or White, that these categories lack real meaning and are just the most current incarnation of labels. To try to homogenize such diverse groups of peoples into simple categories often leads to spurious assumptions. For example, the issue of hypertension in African Americans is often tied to a variety of things, from genetics to adaptive selection during slavery. However, these simple notions break apart when we understand that genetic differences between any two given African Americans are larger than between any given African American and a person of any other race. We know definitively that the genes that affect skin color have nothing to do with hypertension, particularly on the large scale that is proposed. However, social forces have been found to be the most likely candidate for being the reason for higher rates of hypertension. Feelings of stress/anxiety and perceptions of discrimination have been found to play a major role in creating higher rates of hypertension among almost all populations. This has been found to be particularly true among African Americans. I don't for a moment want to imply that just because these categories are socially created that they do not have power. They have real power in how people are treated, how they are perceived, and even how they perceive themselves. However, their overwhelming power does not mean that knowing they are socially constructed is fruitless. It allows for a better understanding of what can and must be done to bring about a more just and equitable system.  

I don't want any of the above to take away from the overwhelming happiness I feel about Barack Obama being elected President, but we have to keep in mind the vast inequities suffered by African Americans and other marginalized populations. There is much work to be done, and understanding where we stand is a good place to start.

Books!!

It is an interesting time to be in Washington D.C., particularly working on issues of health and health care. I look forward to seeing how things play out with so much talk of health reform going around. I recently picked up a few books and reread some old ones that I think help create a good foundation of knowledge about the challenges and possibilities for health reforms in the coming years. I wanted to highlight four that I think are great reads:

The first and probably most approachable book is Critical: What We Can Do About the Health-Care Crisis by Senator Tom Daschle (with Greenberger and Lambrew). This book is a good primer for the upcoming health care debate, and is extremely timely (making it somewhat hard to find at a bookstore...) given that Daschle will likely be the next head of the Department of Health and Human Services. Daschle, an experienced former Senator, brings a unique perspective to the discussion and highlights the plight of real Americans using poignant and illuminating examples from people he has interacted with during his long career of public service. The book does a good job providing a clear overview of what must be taken into account and what reforms should be made. It is written in a very engaging manner and would be a great read for anyone even vaguely interested in one of the possibly largest overhauls to the U.S. government in history.

The second book is Health Care at Risk: A Critique of the Consumer-Driven Movement by Timothy Jost. Jost is a law professor but the book reads more like a thriller (well, maybe not for most people...). He paints a clear picture of the rise of the consumer-driven health movement and highlights its intellectual as well as political origins. While it would seem that consumer-driven health would be the focus of the book, in fact, that is only one part of the overall story. Jost constructs the most clear and concise narrative I have found about the rise of the current U.S. health care system and how truly exceptional (not in a good way, by most accounts) the American system is. He does a good job identifying the common conceptions that people have about health care and the possible solutions. His analysis questions many of these assumptions and forces us to think critically about the goals of health care and what those goals would mean for reforms.

The third book is Governing Health: The Politics of Health Policy by Weissert and Weissert. The book is the best source I have seen that lays out the different actors and interests that play a role in the health care debate. Each of the key players (Congress, the President, interest groups, etc.) is explored at length, including their often contradictory and nuanced stances and perceived interests. Written by two political scientists, the book provides an excellent overview of the factors that are likely to come into play during any health care debate, particularly one that would entail wide-ranging reforms to the system. The actual policy process is also highlighted, something that is often discounted when people talk about what should be done when it comes to health. Taking into account the feasibility of particular reforms will be key for the new administration and any advocates of reform.

The final book is Why Are Some People Health and Others Not? The Determinants of Health of Populations, edited by Evans, Barer, and Marmor. This classic book is a personal favorite. It expands the notions of health away from just health care by examining the importance of how society is structured and its implications for health. The book highlights growing congruence among a number of fields that identify health issues that cannot be explained simply by differences in care or sanitation or wealth. It highlights the importance of factors like hierarchy, genetics, and structural issues that play an important role in determining not just health outcomes but also opportunities for care and even understandings of what it is to be sick. Many of the ideas underlying this book played a key role in my graduate work.

If there are any books that you have found helpful to understand health or health care, please let me know as I am always looking for new sources on the subject.

Another Day in D.C.

It is strange having a career. In most ways it is unlike anything else I have ever done before. There aren't a set number of years I will be here and there is no final product that will complete it. I am really enjoying everything about the job so far and am optimistic about it continuing that way. I am consistently amazed by how happy people are in their different positions at GAO. One recent announcement was of the retirement of a person that had been with the GAO for forty-one years. It is amazing to think that if I were to work there that long I would be sixty-seven at retiring. It just seems so far away. Similar stories of long tenures at the GAO are not uncommon. One of the other analysts was saying that, statistically, if you stay at GAO past three years you will be there for your whole career. I am beginning to really understand how that is possible. The GAO prides itself on being a model federal agency and is constantly trying to improve itself. Despite the high expectations that are placed upon workers there is an atmosphere of calm and relaxation at all levels. Each worker is treated with respect and expected to carry out there work with little supervision. Understanding what its like to be treated as a professional is not something that comes easy after working at places where you had to document how your time was spent.

Another thing I have really come to appreciate about GAO is truly how flat the organization is hierarchically. When I heard this comment in my interview I was intrigued but skeptical. Over the past month it has become clear how true this really is. The people at the top of the organization are all approachable and engaged, which must be a hard thing to juggle considering the GAO overall has around 3,000 employees and the Health Care team has over 200. I had a really great meeting with the Managing Director of the team, in which it was made clear that everyone was accountable to each other, especially those at the top. Another interesting thing there are surveys of both the analysts and the management that foster discussion about what each can do better to make continual improvements. Both the analysts and the directors seem to really think that these measures have really helped keep people engaged and aware of what needs to be improved as well as what is going quite well.

After leaving work today, I took advantage of the warmer temperatures (40s today up from 10s over the weekend). I walked over to a nearby bookstore and picked up a couple new books and spent some time at the cafe. It still feels so funny when walking a couple blocks to pass by Chinatown, the National Portrait Gallery, the Spy Museum, the Ford Theater (where Lincoln was assassinated) among other nationally important sites. It is still hard to wrap my head around all of the things that exist within blocks of where I work and live. It is hard to imagine how long it would take to hit all the things Heather and I have talked about visiting. Looking back, Heather and I took a risk coming out here with only our M.A.s in hand and some idea of what we wanted to do. I could never have imagined it would work out as well as it has.

Like A Real Adult

This week I received my business cards at work. Honestly, I was pretty excited about it. The ones that I received from the people during my interview looked really cool and I couldn't wait to get my own. There is something special about having a real business card. I think the cards came out quite well. Now I just have to start meeting important people to give them to.