A Politics of Compassion

The rise of Donald Trump has brought about a decline in civil discourse and a rise in hatred such as I have not seen in my lifetime.  Depending on where you stand on the political spectrum, Trumpism has come to pass as a result of liberals’ demands for political correctness or as the consequence of conservatives’ insistence on ideological purity, with a host of other fault-finding reasons in between.

We seem obsessed with who is to blame for our current circumstances, and that seems very unproductive to me. What should consume us is the question of what we do next.  The forces that brought Trump to the fore are not going to disappear after November 8^th.  What, then, are we to do?

The way forward is a politics of compassion.

What does a politics of compassion look like?  It starts with our language.  Even as children we’re told that words matter, because they do.  This means that words like deplorables, idiots, and other degrading terms must be excised from our vocabulary when speaking about our fellow citizens.  And that’s not political correctness; it is an affirmation of the humanity of all Americans and a recognition that their emotions often have much less to do with racism, elitism, or ignorance than with their lived circumstances.

Inclusion is another key component of a politics of compassion.  It starts by having the humility to understand that we often don’t know what the best solution for a given problem is.  With that knowledge, we then make sure to include those who disagree with us in the political process.  This will be especially important should the Democrats win the Presidency and the Senate, even more so if they also take the House.  Regardless, there will be a temptation to move legislation forward without due regard for the legitimate concerns of people in the minority. We must resist this.

                     Watch: A simple but revealing look at how our politics have polarized

The biggest danger to our nation at this time is not whether the Affordable Care Act survives in its current form, or whether we successfully close the carried interest loophole; it is the widening fracture between Americans into sub-groups that, if allowed to continue, may well do irreparable damage to our country.

Finally, a politics of compassion demands empathy.  As President Obama said:

“Learning to stand in somebody else's shoes, to see through their eyes, that's how peace begins. And it's up to [us] to make that happen. Empathy is a quality of character that can change the world.”

Politics is all about managing change.  Where we go astray is using our politics to force change rather than guide it.  Force can, at best, compel temporary obedience.  Lasting change comes from leading by example.  One of our greatest presidents, Abraham Lincoln, excelled at putting himself in the place of others.  In fact, during what came to be known as the Lincoln-Douglas Debates, he even affirmed the basic, common humanity of slave owners, saying:

"... they [slave owners] are just what we would be in their situation. If slavery did not now exist amongst them, they would not introduce it. If it did now exist amongst us, we should not instantly give it up.... I surely will not blame them for not doing what I should not know how to do myself."

Now, this didn’t mean that Lincoln failed to stand for his principles, and a politics of compassion would call us to emulate his steadfastness for those things he believed were right. The challenge is to not be so arrogant as to think that we can never be wrong.

Prudent speech.  Inclusive policy-making. Empathy with our fellow citizens.  These form the core of a politics of compassion, and they are sorely needed from those who would lead our nation.

Call me naïve if you like.  But the ship of state is heading towards an iceberg, and what we’re doing now isn’t going to steer us clear.

All or Nothing

I participated in a forum recently entitled, “Courageous Conversations” which endeavored to get people to start talking about one of the most uncomfortable topics possible: race.  It was a good, if difficult, discussion, and afterwards it got me thinking about the subject in the context of the work I do at Casa de Salud.

As we welcome more immigrants and refugees of many different ethnicities, it is important not to lose sight of the African American population that remains grossly underserved. This cannot be a zero-sum game where we bolster services for one group at the expense – or at least without equal regard – of another.

I’ve written many times that a larger community of immigrants in the St. Louis region is a key component of the restoration of the city to its halcyon days as a growing, diverse, and economically flourishing metropolis. It remains crucially important to the entire nation.  But that’s not enough.

My daughter was listening to the “Hamilton” soundtrack the other day, and a lyric caught my ear: “We’ll never be free until we end slavery.” Translate that to the context of our country today, and I think the realization we arrive at is:  we’ll never thrive while there remains a great divide.

Real diversity and inclusion means that we’re ALL in it together, members of a caring community.  When we get that right, solutions to many vexing problems will surely follow.

Healthy Immigrants Lead to a Prosperous Nation

Access to quality healthcare is a basic human necessity, and the challenge of providing it with finite resources is particularly daunting for communities faced with large immigrant and refugee populations. Last year, as a USA Fellow with Eisenhower Fellowships, I traveled to Germany and Mexico to study their healthcare systems. Both countries face difficulties, but Germany, in particular, is feeling the strain of caring for immigrants and refugees, with more than 1 million having arrived in that country in 2015.

Trying to arrange healthcare for these arrivals, not to mention housing and employment, is incredibly difficult and the tension sparked by integration efforts is a key factor in the rise of far right groups, with their influence metastasizing across Europe. While the United States is not faced with a tidal wave of new arrivals, there are more than 42 million immigrants in our country, and like those in Germany or elsewhere, they are in need of essential services.

Key among them is healthcare. The Affordable Care Act has provided some relief, yet the uninsured rate for the foreign born still hovers around 27 percent, with Hispanics faring the worst at over 30 percent.

It is expedient to believe that this is a minor problem. It is not. By 2050, foreign born individuals will likely account for 20 percent of everyone who lives in the United States, and 82 percent of total population growth will be due to immigrants and their decedents. It is therefore absolutely crucial to the nation’s future that these new Americans receive access to care.

Given the slow-changing nature of our hugely complex healthcare system, not to mention the political moment we live in, some of the progress will need to come via innovative solutions and community-level efforts.

Fortunately, some of this is already happening. The Centers for Medicare & Medicaid Services is currently testing the Accountable Health Community Model. It will have three program tracks, one of which especially caught my attention with regard to care for immigrants. This particular track focuses on what is known as “community navigation services” which ensure that a patient’s needs are met after a medical referral. Based on direct experience at my clinic with the thousands of patients we help each year, navigation - the act of accompanying the patient to his/her appointments and acting as their advocate, then following up throughout their course of care - is a valuable tool to improve outcomes for patients. Navigators are particularly effective combating barriers like lack of insurance, limited English proficiency, poor health literacy and the unfortunate situations when immigrants are not treated with respect.

Another tool with which to serve immigrants is a medical home, somewhere they can access primary care and seek help to prevent disease. In this capacity, community clinics play a large role. They already serve over 23 million people at more than 9,000 sites located throughout all 50 states and U.S. territories, and it is likely that their importance will increase. Because of the barriers I mentioned earlier, immigrants tend not to seek help until they experience an acute situation. It is therefore especially important that they access care at a facility that spends significant time with them, doing a thorough intake so that potential problems (like diabetes) can be prevented through screening and wellness services.

Home visits are also effective. They eliminate one of the most difficult obstacles for immigrants - transportation - and have the added benefits of allowing a home assessment and incorporating family members in the health education part of the visit. Last year, diabetic patients enrolled in my clinic’s program saw their hemoglobin A1c levels - a key indicator of blood sugar levels over time - drop by more than two points on average. Each point dropped represents a 40 percent reduction in the risk of developing eye, nerve and kidney disease. This is great for the patient, but it’s also important for all of us. Diabetes and many other chronic diseases are extremely expensive to treat and manage. To the extent that we are able to bring chronic illness under control - or even better, prevent them from happening in the first place - we will lower healthcare costs and make care more affordable for everyone.

Perhaps what is most needed, however, is a change of mindset. Too many pundits and politicians continue pushing us to think of immigrants as “takers.” The opposite is true. In fact, immigrants are actually among the least likely to use healthcare, and are net contributors to the Medicare trust fund.

The experiences of the immigrants I meet today resonate deeply with me. My parents fled calamity in their home country of Cuba in the early 1960s for the promise of America.  My story is like those of countless people who started as immigrants and refugees and then became Americans. It’s a reminder that when we care for immigrants, we care for ourselves and our future.

Immigrants: They get the Job Done

One of the reasons I am so proud to be an Eisenhower Fellow is that the organization that administers the program, Eisenhower Fellowships, is chaired by General Colin Powell.  The man is the embodiment of American exceptionalism and his life story demonstrates the greatness of the United States in a way that a thousand editorials and videos could never do.

A significant part of that story is his immigrant background, which he talks about in an excellent piece he wrote for the Wall Street Journal. The biggest takeaway:  America stands to benefit from immigration as much as, if not more than, the immigrants themselves. And, in the midst of Missouri’s refusal to grant in-state tuition to “Dreamer” and DACA students, Powell reminds us that guaranteeing the opportunity of education to every child is not charity, but rather an investment in the nation’s future.

That theme is echoed by the Federal Reserve. During remarks made last month in St. Louis during the Official Monetary and Financial Institutions Forum, James Bullard, President of the St. Louis Fed, said that the United States would benefit from “a coherent macro-oriented immigration policy.”  He continued, “It’s a fantastic thing that people want to come to your country.  We should channel all that energy to get good macroeconomic outcomes.”

Welcoming immigrants has given this country access to immense talent, from Hamilton through Powell and all of the unsung others whose toil, sacrifice, and fortitude created this country where today you and I have the luxury of enjoying liberty and prosperity unmatched in the history of the world.  That is our legacy.  We must protect it.