Illinois General Assembly Puts Pressure on Hospitals to Provide Charity Care

31 05 2012

The Illinois General Assembly is considering legislation, known as SB3261, to require hospitals that receive property tax exemptions to provide more than stabilization care (already required by the federal Emergency Medical Treatment and Active Labor Act, or EMTALA) to people who earn 125% or less of the federal poverty level in rural areas, and 200% or less in urban areas. The amount of free and subsidized care provided by hospitals has been a hot button issue in Illinois, and across the country, at least since 2007, when the U.S. Senate began a series of hearings on charity care, and in Illinois since a high-profile case involving Provena health care put hospitals’ tax exemptions in limbo. The legislation is an interesting approach to solving the problem of health care provisioning for low-income residents, given the immense shortfalls in Medicaid funding states have been facing since the freefall in tax revenue brought on by the Great Recession.

Hannibal Buress’ Intense Animal Furnace

30 05 2012

Bless Hannibal Buress. Years ago, when he was still in Chicago, I interviewed him for a short video/text piece I was working on about stand up comedy. I had met with a number of local comics and asked them if they could suggest other comics I could talk to. Without exception, all of them told me that the next big comic out of Chicago would be Hannibal Buress. Indeed, within a matter of what seemed like weeks, Buress had moved to New York to write for Saturday Night Live, which he followed with a writing stint at 30 Rock. In that time his profile exploded in the national standup circuit while he also become a favorite in the big city alternative rooms, thanks in part to his versatility as a writer and performer.

That versatility is no more on display than on his new record, Animal Furnace. Early on, Buress takes on an appallingly tone deaf review of his act in a college newspaper, which seems fitting because his style throughout the record is a marked contrast to the style he’d been pigeonholed into by critics–as an iteration of Mitch Hedberg, the beloved slow-roll, wordplay comic. Buress’ first record, My Name is Hannibal, is decidedly more slow-paced and playful, which played into Buress’ low-key personality.

So on this record, he busts out. Stories and anecdotes seamlessly incorporate jokes that build on one another up to sometimes angry, often indignant or frustrated (and always hilarious) conclusions, delivered at a quick pace and with high energy. Knowing Buress and being familiar with his first record, the style he exhibits on Animal Furnace comes across as Buress exhibiting his strengths as a performer, a comic’s comic who is increasingly mastering the form and a crowd pleaser who packs in jokes to keep the audience rolling.

Buress touches on some chancey topics, particularly a bit about rape statistics and dropping the c-word, which could cause some listeners to squirm, as they did me–something he addresses head on in his act. But as with many of the best comics, including Louis C.K., there are no teeth in the potentially offensive material–he isn’t trying to provoke people, to shock them for the sake of shocking them or to earn some kind of ironic street cred for being risque. To the contrary, Buress’ frustration with people’s hypocrisy, stupidity, racism, or plain old weirdness is just personal; disagreeing with his take on any given situation doesn’t make the way he presents it any less hilarious.

Along with John Mulaney’s New in Town, Animal Furnace has to be in the running for the best record of the year. The fact that both men are Chicagoans has nothing to do with my opinion in this regard.

Gas and Cigarettes and Addiction Funding

25 05 2012

So here’s an interesting problem for students of how cities operate.

Public health and public transportation are two of the marquee issues for planners, and they’re intertwined. Land use planners have recently turned towards policies that encourage walkability, bikeability, and “transit-oriented development.” Mayor Emanuel’s administration is currently undertaking an impressive, ambitious plan to introduce more than 100 miles of protected bike lanes, of the type found on Kinzie Avenue between Jefferson and Wells. Decreasing reliance on cars is a public health issue because it makes it easier for people to be active, and decreases vehicle emissions that pedestrians encounter as they move around the city. Similarly, the Affordable Care Act had provisions for public/private community health facilities with a focus on patient outcomes rather than fee-for-service models that merely encourage remedial care.

Two of the main sources of funding for public transportation and public health (particularly as the latter is undergirded by state Medicaid) are gasoline and cigarette taxes, respectively. You can see the immediate problem; the better transportation and health systems are designed, the more they must compromise the source of their funding. With transportation, this creates the most immediate problem: with increased volatility of gasoline taxes and a sharp increase in ridership, ill-equipped public transportation systems need more and more money to handle the increase (the fares are never enough to capitalize increased infrastructural capacity).

A brief by the American Public Transportation Association touches on this problem; as public transportation ridership increases, capacity needs increase even while revenues drop. Because fares will never be sufficient for real expansion of capacity, there’s a systemic knot that can’t be untied without a federal-state-local approach to overhauling the funding system.

Obviously, there’s a similar problem with the vice-and-obesity taxes on things like cigarettes, alcohol, and fast and junk food. Where these revenues are meant to fund necessities–community health care in particular–the fact that the tax exists as a “disincentive” to unhealthy decision making implies the outcomes we want–healthier city living–are not really priorities. The addiction persists.

“Scipio, Nasica” and the Advantage of an Ambiguous Name

22 05 2012

From the Doejo blog:

At a gallery in River North as I was reading Ramsin Canon’s “Scipio, Nasica,” I stood dazed, wondering if her road trip through Utah to find her real mother was fact or fiction—the accompanying art offered very cryptic clues. And after all, the only preface I heard of this show was that eight artists were paired with eight writers. But you didn’t know which came first, the writing or the design.

For the story and image, follow the jump.

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Protests: Merging Means and Ends

21 05 2012

Ugh. There’s no good way to go about this, particularly so soon after the protests have settled and the fact and myth detritus is yet to be sifted through. Forensics at this stage are dicey.

I’ve never been keen on protests as purely symbolic gestures, though I generally don’t criticize them, as speech acts have an (admittedly de minimis) inherent value in a republic. Protests qua protests typically serve as an internal act of organizing–honing organizational processes, identifying activists and leaders, developing messages, and serving the omnipresent need for “consciousness raising.” But protests as pure speech acts are ephemera–or, maybe better, phenomena–that should express organizational acumen and announce a program to the public, rather than being the program itself. In other words, an organization’s strength won’t come from protests; protests should be an expression of strength built as a result of direct action contending with the status quo.

The protests that unfolded over the weekend, particularly over the last twenty-four hours, reflect the lack of a means-ends connection. Their listing from an identifiable objective, perceived lack of focus, and disparate employment of means are a function of not having an objective–even a grand one, like Gandhi’s all-encompassing goal of an independent nation void of all forms of social violence–and thus being unable to calibrate their activities to that vision.

That said, the movement is nascent; it may well be that only through large-group action, even an amorphous action, can it begin to develop a vision through group consensus. That process will be a slow and meandering one, but its product may for that reason be a particularly adamantine one. What’s more, considered as speech acts, protests warrants evaluation on the content of the speech; insofar as the messages communicated to the public were of perverse public priorities, the immorality of endless foreign and domestic war, and the insularity of global leadership, the speech is at least reasonable, at best commendable.

Means and ends in movement building are inextricably linked. This is by no means settled, and it was a point of contention between Gandhi and his critics, between Bayard Rustin and Malcolm X.

The issue is this: is there a disconnect between means and ends, such that a movement’s tactics are only important inasmuch as they create conditions for implementing organizational goals? Or is the connection a necessary one–where the conditions arrived at will inextricably look like the tactics adopted?

This was Gandhi’s key assertion for the 40+ years he spent helping build the swaraj movement in India in the face of critics from both his flanks who argued respectively for cooperation with the British for gradual independence, and armed resistance to the institutions of British repression to force independence. Gandhi consistently and passionately argued for decades that whatever independence India achieved would look like the struggle that achieved it. For a stable state where all classes could truly participate in their own governance, where British inhumanity would not merely be replaced by high-caste or military inhumanity, only firm and unwavering participatory and strategic nonviolence could be employed as a tactic.
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Student Loans and Clientage

14 05 2012

Mike Konczal, a man after my own heart on most issues, posted a link to an article from the 1980s discussing the student loan system as a recrudescent form of the indentured servitude system that was once used a way to finance the importation of needed cheap labor. It’s a fascinating and prescient analysis, and it also reminds me of another troubling trend that has reemerged as a function of the accelerating concentration of wealth among fewer and fewer persons and institutions.

One of the most interesting things about the American Revolution that we don’t learn about in most high school curricula is the profound changes in social organization and relations that it wrought. Of particular interest to me is the breakdown of the patron/client system, a patriarchal system as old as the Roman republic. The breakdown of that system put stress on the ancient institutions of slavery and patriarchy and culminated in the civil rights movements of the 20th Century.

The patron/client system was so universal as to probably be invisible to the Revolutionary generation; indeed, many of them were practitioners of it, which you quickly realize if you’ve ever read their correspondence. Because of the way property, and through it institutional political power, was held, currying favor with “important men” either personally or through marriage was the standard way young ambitious men (and it was just men) moved up in the world. Before credit ratings and statutes forbidding negative job references without permission, access to the property and influence of important men was the only way, or rather the surest way, to secure the resources necessary to build a business, enter a profession, and be taken seriously in politics and even the arts.

Before the abolition of primogeniture and entail (first abolished by Georgia in 1777), wealth, particularly in the form of property, was difficult to dislodge. Thus the head of a household would inherit a typically undisturbed, massive estate, and the various dependents associated with it: not only household staff and laborers, but also the attorneys and middle managers who ran various enterprises, political allies who owed allegiance in return for appointments to desirable government commissions, and so forth. Communities, even in cities outside of the nascent dense industrial pockets, were structured this way. A young climber would identify himself in part by his association with a particular family and structure his life–his social obligations, clubs, career, education, and of course marriage–based on that association. Association with a family or group of families compelled a type of loyalty that is absent today, requiring from the client fealty to the political and business ambitions of his patron, up to and including whom he could vote for, marry, and entertain.

The immiseration of labor over the last forty years has brought us back to a similar, though much more impersonal, situation. The ambitious young person today, particularly in the professions, has a very narrow range of options for very practical reasons: the financing for meaningful education requires significant debt, and the jobs that allow for manageable service of that debt are concentrated in fewer and fewer firms and sub-fields. Professionals graduate with enormous debt that quickly becomes unmanageable if you do not go to work for a major employer, or have access to significant capital to start your own business.

Unpaid internships are the most stark example of this new patron/client program. Just getting a valued internship often requires connections either through a university that, in turn, requires wealth and connections to get into, or through a familial or social relation. These internships are often necessary to “build relationships,” i.e., curry favor, with one of the small coterie of institutions controlling immense marketshare. They’re also often subsidized by family wealth, reinforcing the representation of socially connected elements of the upper classes in the professions, political institutions, and the arts.

The need for debt to finance education is unique to those outside of the upper classes. In turn, debt places pressure on those individuals to contour their professional practices and social lives to secure favor with the comparably small social cohort that enjoys control over capital and how it is spent.

The result is much different from meritocracy. While not a mirror of the essentially hereditary and patriarchal patronage systems of pre-Revolution America (and pre-Augustine Rome), the debt requirement for access to the only institutions that grant any kind of economic security has impersonalized the patronage system while serving its basic function: to keep wealth within a particular social milieu, with a hefty cost of admission that requires de facto conformity with particular sets of values and norms that contribute to class cohesion.

Here’s a picture of my dog:

From the Liz Claiborne Canine Collection. Moda.

The Week That Was: The President and the Marryin’ Type

11 05 2012

The biggest news of the week in terms of volume of consumption was obviously the President’s leaked statement that he personally supports gay marriage, although he thinks it is a federalist issue best left to the states, rather than a constitutionally-sourced right. Adam Serwer as is his wont has a good analysis of what this actually means. Glenn Greenwald pronounces the statement as an unalloyed good thing deserving of credit, even if it is cynical election-time pronouncement, and quibbles with Serwer’s mild critique that as an expression of personal opinion, it’s less groundbreaking than some would have it. They’re not at opposite poles, merely elaborating on the penumbral effects of the President’s statement.

Obviously, the President of the United States announcing his support for marriage equality is a big deal. A generation from now, it won’t really matter that he did so in such a qualified way, or as an election play at a time when public support for same sex marriage is at an all time high and growing. Greenwald is right that those affected by current inequality and their allies have a lot to celebrate.

That doesn’t change the fact that the President is showing himself to be fundamentally dishonest. Those of us who have known Barack Obama since his days as a state Senator know that he publicly supported gay marriage as long ago as 1996, and that when he was running for Senate he told a local LGBT publication that while he supported marriage equality it was not “politically intelligent” to advocate for it, but rather should move incrementally; and that in 2008 he took it off the table by saying he did not yet support it. In other words, he lied; he lied to the country’s social moderates and conservatives in order to get elected.

The chattering class that has decided that their job is to think like political consultants defend this dissimulation by saying that it was the only way he could get elected. This reveals something about the President’s probity; it is non-existent. The same way he lied to the nation’s moderates and conservatives in ’08, he clearly lied to civil libertarians and the left wing when he talked about ending indefinite detention, scaling back executive power, encouraging whistleblowers, the PATRIOT Act, supporting a public option, worker free choice, and reigning in Wall Street. He lied to them because he wanted their support to get elected. He’s not, in other words, a brilliant political operator and visionary leader, but a mendacious panderer, so much so that his election-season pronouncements are not reliable. And that’s the major point. Obviously, he is willing to misrepresent his actual beliefs, sometimes completely, when it’s time to get elected.

His track record shows it, and this 360 degree turn, while good because it ends a harmful charade, reinforces that what he says when trying to get elected is not to be trusted. He will readily misinform the public about what he believes and what he will pursue once elected. His liberal supporters consider his lies to moderates and conservatives to be smart election season maneuvering, but for some reason expect us to take at face value his election-year economic populist left turn. Why though? The man is inveterate in this regard. He lied to the American public for nearly a decade about his position on marriage equality. And only now that the political risks have diminished considerably is he willing to the tell the truth. The act was a good one, and history will look kindly on it. But the volumes it speaks are less kind to the actor.

UPDATE: Dahlia Lithwick makes a great argument for abandoning cynicism. It’s a good argument, and it bears repeating that the President of the most culturally influential nation on Earth publicly supporting gay marriage is a good thing, something with profound psychological and social long-term effects. It is not that the statement is not a good and important thing that just as easily may not have happened. That cannot, though, change the fact that the President misrepresented his belief for political expediency, and that that fact implicates his character or, more practically speaking, is a compelling cause for serious doubt in his election time pronouncements.