The public relations spin doctors for the U.S. health insurance industry, who are probably busy at work concocting the script for a TV commercial or Internet ad to sink comprehensive health care reform in 2009, ought to think again.You may remember the fictitious couple, Harry and Louise, who appeared in a 1993 insurance industry ad that helped deliver a death blow to health reform that year. But that kind of disinformation won’t work in 2009. One of the main reasons why: HCAN, or Health Care for America Now, which is made up of more than 150 organisations, including the National Education Association, American Academy of Pediatrics, AFSCME, SEIU, U.S. Action, National Council of La Raza and many others. This burgeoning coalition, launched last week, is dedicated to fighting for affordable, quality health care coverage for all in the United States – a dream deferred, if ever there was one.

You can be sure that HCAN’s network of activist pediatricians, teachers, small business owners, unionised workers, independent contractors, people with specific illnesses, and so many others will be tireless in making the case that every one of us deserves the security of affordable, quality health care we can always count on, especially when we need it – when we are sick, out of a job or changing jobs – always.

Since 1993, the private health care industry’s “solution” that markets – and not government regulation – should solve the health care crisis has failed miserably. In fact, America’s health care problems have grown worse, not better, over the past 15 years. In 1993, 38 million Americans – nearly 16 percent of the non-elderly population – were uninsured for a full year. Today, at least 47 million have no health care coverage, including nine million kids, accounting for nearly 18 percent of Americans under 65. And tens of millions more Americans of all ages who are “insured” have inadequate coverage or are uninsured for part of a year. Despite various permutations of managed care, preferred provider networks and high-deductible plans – to name a few industry “solutions” – health inflation far outstrips the cost of living, not to mention the purchasing power and incomes of average Americans.

We know now from the Institute of Medicine that quality care is elusive, despite the high price we pay for health care, more than in any other nation. We know that uninsured individuals are more likely to put off care, become needlessly ill and die, and we know that at least 18,000 Americans die each year because they lack health coverage. We know that most of the uninsured are in working families, headed by people who earn modest incomes, and we know that Hispanics and African-Americans are among the hardest hit when it comes to health care in the U.S., contributing to racial disparities in health outcomes. In short, we know too much not to wage the most effective fight possible for a goal that so many have sought to achieve in the United States for so long.

That’s why Atlantic recently approved a major grant – one of the largest for advocacy ever made in the U.S. – for HCAN, and why we hope you’ll join or support this coalition to make certain that every member of Congress and every candidate for the House, Senate and White House understands that meaningful health reform is an essential action item in 2009. To win this fight, HCAN is organising visits to hundreds of members of Congress, running paid ads, organising public events and generating press coverage. HCAN is keeping pressure on U.S. leaders by asking them to declare which side they are on – the side of the majority of Americans who want affordable, quality health coverage for all; or the side of the private insurers, who want a free hand in maximizing their profits. Most crucially, HCAN insists that real reform must provide us with a choice: keep the insurance we have, or choose another private plan or a fully public plan with which private companies will be forced to compete on price and quality.

As Stuart Schear, our Communications and Policy Executive and a veteran of many efforts to improve access to health care, puts it: “No matter who we are, how sick we are or how little we earn, every one of us deserves affordable, quality health care coverage, and HCAN is ready to fight to win in 2009.”

In the past, powerful health industry lobbies have put supporters of coverage for all on the defensive, so Atlantic is also supporting the Center for American Progress (CAP), a progressive think and action tank, to develop rigorous critiques of industry and conservative proposals that would force most Americans to pay even more for less health care. Working with HCAN and other partners, CAP plans to put the proponents of these unacceptable “solutions” on the defensive, which is exactly where they ought to be if we are to win.

At Atlantic we view health care not just as a matter of desirable social policy, but as a human right. In addition to our ongoing efforts in the U.S. to support health care coverage for children and quality chronic care for older adults, we work to improve health care systems, particularly in underserved rural areas, in South Africa and Vietnam. And, like our partners in HCAN, we understand that, for most Americans, health care is both an economic issue and a very personal one, too. American business owners, small and large, want to provide quality coverage for their employees at an affordable and predictable price. Manufacturers, exporters and their employees don’t want their products to be more expensive than those of foreign competitors because of the high price of health care. And those of us who are ill or love someone who is ill want to know that we can afford needed care without bankrupting our families.

Take David White, who owns a small auto-repair shop in Bar Harbor, Maine, who said he was “proud” to have always paid the entire cost of platinum health coverage for his employees, until his insurance costs doubled in just two years, outstripping his firm’s twelve percent increase in gross income. “To make up the difference,” he explained, “I had to do three things… choose a less costly plan, raise our rates, and lay off one person for six months… I was literally in tears, laying this out to my men.”

Or think about Michael of Phoenix, Arizona, who sent this note to HCAN: “I am 60 years old and self-employed with a small business. I had cancer 15 years ago, was treated and had no recurrence. Nevertheless, I cannot buy any medical insurance that will cover me for any type of cancer. I have an expensive high deductible policy for other illnesses, but I'm one other cancer [diagnosis] from bankruptcy.”

Or ponder the situation of Gillian of Altadena, California, who wrote to HCAN: “Our son broke his neck in a swimming accident in 2005 and instantly became a quadriplegic. We were ‘under-insured’ since my husband had been laid off and had just started a new job… We had an accident policy through his high school which soon ‘maxed out’. I had to stop working to care for our son. Managing his care and advocating for our son through state agencies became a two-year, unpaid, full-time job for me.”

These are just some of the stories that were shared last week when HCAN kicked off its campaign in more than 50 cities across the country, including 38 state capitals, as well as Washington, D.C. HCAN is working to make sure that our leaders and tens of millions of Americans understand these stories and their meaning for all of us. When the next insurance industry advertising copywriter tries to trick us into believing that it is somehow against our interest to regulate private health plans and to ensure that they cover us all, HCAN will be ready. This time, we stand a chance of repairing the most gaping hole in the U.S. social safety net.

Visit www.healthcareforamericanow.org and get involved!

Gara LaMarche
gara@atlanticphilanthropies.org

Links to organisations mentioned in this column:

• Health Care for America Now!
• Center for American Progress

Now that both major parties in the U.S. have presumptive nominees for the Presidency, it seems like a good time to share some thoughts on the relationships between philanthropy and government – relationships that Atlantic has considerable experience with in each of the countries in which we operate.

In the just society in which we all wish to live, government, business and the nonprofit sector all have key roles to play. We operate in a societal ecosystem where the economic and social health of all will be damaged by weakness in any of these elements. But right now in the U.S., there is an imbalance in this ecosystem. We need to restore a strong social welfare role for government, which is the only institution that is both democratically controlled and can deliver, to use a philanthropy buzzword, at “scale.” And we also need philanthropy that puts much more advocacy muscle behind the replication of its successful demonstration projects, and that recognizes the most sustainable investments are in strong organisations and experienced community leaders who can direct their energies and resources not just to the public policy needs of today, but those of the years to come, many of which we can’t yet see.

For various reasons, philanthropy has too often in the last several decades kept an arm’s length relationship with government and public policy. That has to change if we are to have any hope of making real progress on many of the leading challenges of our time:the reduction of poverty and the expansion of health care access, achieving a society that empowers and cares for the young and the old, providing justice and inclusion for immigrants and restoring or strengthening civil liberties.

For its part, government has experienced a steady loss of confidence in the last few decades, some of it well-earned, borne of failing schools and opaque and unresponsive bureaucracies. Here in the United States, for instance, we wouldn’t need to support programmes like Single Stop, which helps low-income families get counseling to obtain the benefits to which they are legally entitled, if government always worked as it should. And we wouldn’t need to spend resources making sure the state of Florida actually implements the restoration of voting rights for former prisoners, if government always worked as it should.

Fortunately these trends are beginning to turn around. Both Presidential candidates, for example, favor a stronger, affirmative role for government in many areas, and both have had engagement with foundations at various levels, Obama even having served as a trustee of the Chicago-based Joyce and Woods Foundations. And to judge from the strongly positive reaction to a recent Atlantic Reports on why foundations should fund advocacy efforts, there is much more interest and activity in philanthropy in cutting-edge public policy work. But there is still a ways to go.

Foundations can innovate, demonstrate, spur, fill in gaps, foster knowledge, identify talent, and do many other things that contribute to the betterment of society. But they cannot through their own funds alone begin to feed the hungry, care for the sick, and educate for participation in contemporary society many millions of young people. By definition their role must be catalytic.

In my first year at Atlantic I’ve learned much about models of working with government from Atlantic’s staff in the other geographies in which we make grants, and they illustrate to some extent the relationships between government and philanthropy in the U.S.In the Republic of Ireland, there is little tradition of investigative journalism and few think tanks to influence policy. Civil servants are of a generally high quality, and government is very centralized, so we form relationships with them – with the permanent government, as it were. This has paid off in co-investments by Atlantic with the Irish government in youth development programmes, and in the appointment of key ministers to advance the concerns of older adults in both the Republic of Ireland and Northern Ireland.

In South Africa, our Population Health programme negotiates with the national Department of Health to support some the costs of upgrading nursing training facilities, and our Reconciliation and Human Rights Programme has partnered with the Department of Land Affairs to provide legal advice and support to farm-workers who face illegal eviction. The Legal Aid Board, which provides legal support for indigent people, has entered into a partnership with our grantee the Association of University Legal Aid Institutions to provide support in some rural areas. The Department of Social Development provides support to some advice offices in the Western Cape which also receive support from Atlantic, and the Department of Education matched an Atlantic grant to build a Life Sciences Complex at the University of the Western Cape.

In Viet Nam, of course, the government’s role is quite pervasive, and Atlantic’s programme has to interact quite closely with it. But there are many levels of government, and depending on projects’ needs and administrative requirements, and we work with the appropriate level of government as needed. In Viet Nam this ranges from public health programmes such as mandating motorcycle helmets to dramatically reduce traffic fatalities to co-financing the upgrading of rural commune health clinics. The Ministry of Health is also our partner in raising needed matching funds for large projects such as the National Hospital of Pediatrics. Through Harvard University, we also assisted the Ho Chi Minh National Political Academy in creating more effective HIV/AIDS policies in their home localities. At times, we also press the Office of the Prime Minister and Deputy Minister to facilitate progress and overcome administrative hurdles.

Here in the United States, Atlantic’s relationship to government has taken two forms.The first is in a sense adversarial.We fund organisations that monitor, criticize and sue the government, like civil rights groups fighting draconian restrictions on immigrants cropping up all over the country, and civil liberties lawyers challenging Guantánamo, where our grantees had a big win in the Supreme Court recently and warrantless wiretapping. The second is an attempt at partnership, from working with the U.S. Labor Department to provide more employment opportunities for older adults in economically challenged regions of the country, to the State of New Mexico and the cities of Oakland and Chicago to match our investments in integrated services for middle school students.

We are of course in the throes of a Presidential campaign like none in recent memory, with higher turnouts and passions all across the country, and many people – including many younger ones who have not connected with the political process before – deeply engaged in choosing their government. The new administration, whatever its character, will be a fresh and important test of how foundations “get” advocacy for policy change. If John McCain takes office, some vital national issues may be in play, such as immigration reform, torture, and other post-9-11 civil liberties and human rights issues. If Barack Obama is inaugurated come January 20, there are additional opportunities to advance a progressive agenda, beginning with universal health care, the gaping hole in the U.S. safety net. To help advocates lay the groundwork for reform, the Atlantic board last week approved a $10 million grant to Health Care for America Now, a new national campaign to ensure that quality, affordable health care coverage for all is debated as an issue in 2008 and achieved in 2009. The campaign, which will be launched on July 8 in Washington, D.C. and in 44 states, is bringing together the nation’s most politically active labour unions, dozens of national organisations, and women’s groups, and is also being supported by thousands of doctors, nurses, small business owners, netroots activists, faith-based organisations and community organizers across the country.

Any new administration has a relatively short window to advance its agenda, and I would not want to look back on 2009 and 2010 and feel that Atlantic and other funders concerned with human rights and social justice did not do everything in our power to support advocacy groups in taking advantage of this moment, supporting and pushing the new administration as appropriate.

Gara LaMarche
gara@atlanticphilanthropies.org

This column was adapted from remarks made at the Annual Meeting of United Neighborhood Houses on June 11 in New York.

Related links:

• Single Stop
  
• Legal Aid Board
  
• Association of University Legal Aid Institutions
  
• University of the Western Cape
  
• Viet Nam National Hospital of Pediatrics
  
• Harvard University/ Ho Chi Minh National Political Academy
  
• Health Care for America Now
  
• United Neighborhood Houses

Last week was a dramatic one, on both sides of the Atlantic, in the battle to preserve fundamental human rights against the recent disturbing tendencies of two of the world’s leading democracies to invoke fear of terrorism to claim extraordinary and excessive powers. In the United States, the Supreme Court ruled in Boumediene v. Bush, by a narrow 5-4 majority, that the foreign nationals held in U.S. prison camps at Guantánamo Bay have a right to pursue habeas corpus challenges to their detention. In the United Kingdom, Parliament approved Prime Minister Gordon Brown's proposal to increase the lawful period for detention without charges from 28 days (which is unacceptable to begin with) to 42. Atlantic’s grantees have been on the front lines of the struggle to preserve fundamental human rights in these cases and campaigns.

“The Bush Administration’s system of injustice is starting to crumble,” declared Jameel Jaffer of the American Civil Liberties Union, which filed a friend-of-the-court brief in Boumediene (see link below). At issue in the case was whether the now-270 detainees at Guantánamo, some of whom have now been held for six years without charge or trial, can be denied any meaningful right to challenge the legality of their imprisonment. Justice Anthony M. Kennedy wrote for the court, “The laws and Constitution are designed to survive, and remain in force, in extraordinary times. Liberty and security can be reconciled; and in our system they are reconciled within the framework of the law.”

Against these stirring words was the acid dissent of Justice Antonin Scalia, fanning the rhetorical flames even more than usual:“The game of bait-and-switch that today's opinion plays upon the Nation's Commander in Chief will make the war harder on us. It will almost certainly cause more Americans to be killed.” Distressingly, given his earlier record of opposition to torture and other human rights abuses of the Bush Administration’s post-9-11 policies, and signalling that basic human rights guarantees could become a “wedge” issue in the Presidential campaign, Senator John McCain called the decision “one of the worst decisions in the history of this country.”Going one better, former House Speaker Newt Gingrich called Boumediene “worse than the Dred Scott decision,” the notorious 1857 Supreme Court ruling that held that slaves could not be citizens or sue in court, and that Congress could not prohibit slavery in federal territories – that, in short, that slaves were “inferior beings” who had “no rights that the white man was bound to respect.”

It’s perverse to compare Boumediene, in which three of the Justices in the five-person majority were appointed by Republican Presidents, with Dred Scott, when the historical analogy is precisely opposite. The Administration argued that the human beings at Guantánamo had no rights the U.S. was bound to respect, and the Justices properly and courageously drew the line. But that a prominent political figure could make that comparison with a straight face shows just how much work there is to do to restore the damage done by the abuses perpetrated and tolerated by the United States in the last seven years.

The Center for Constitutional Rights, another key Atlantic grantees, has been sending habeas counsel to represent the prisoners at the base since winning the first Guantánamo case, Rasul v. Bush, in 2004, and has been responsible for organizing and coordinating more than 500 pro bono lawyers across the country in order to represent the men at Guantánamo, ensuring that nearly all have the option of legal representation. The Center was co-counsel in Boumediene, and you can read more on its website.

“The Supreme Court has finally brought an end to one of our nation’s most egregious injustices,” said CCR Executive Director Vincent Warren. “By granting the writ of habeas corpus, the Court recognizes a rule of law established hundreds of years ago and essential to American jurisprudence since our nation’s founding. With habeas you never would have had these men—so many of whom have been cleared of any wrongdoing—locked up and abused because no court was watching. In those cases, the government will now have to put up or shut up: it will have to show an impartial judge enough evidence to justify detention. This six-year-long nightmare serves as a lesson in how fragile our constitutional protections truly are in the hands of an overzealous executive.”

The Boumediene decision marks the third time the Court has rebuked the administration’s lawless actions at Guantánamo. The government has repeatedly delayed in applying previous rulings.

In Britain, the rights of detainees did not fare so well in the political process.

The government pulled out all stops to win the vote, which became in Prime Minister Gordon Brown's view a critical test of his fading political viability, and the margin of success in the razor-thin vote was provided, ironically, by the Democratic Unionist members from Northern Ireland.

Though Atlantic no longer maintains a funding program in the U.K. outside Northern Ireland, we thought it important to support the opposition to Prime Minister Brown's plans when he announced them last summer, because any incursions on basic rights of detainees in Britain, as in the U.S., will be cited and copied by repressive regimes around the world as a justification for their own abuses. We provided a grant to the British civil liberties group, Liberty, which fought a valiant campaign, "Charge or Release," against the measure. You can read more on Liberty's website.

I was in London the day after the vote in Parliament, and visited the rabbit-warren-like offices of Liberty, whose tenacious and eloquent Director, Shami Chakrabarti, paid tribute to “the brave parliamentarians of all stripes who held their nerve against the pressures of party politics and the terrorists’ attempts to provoke us to abandon our values.” Fielding calls from the media and urgent messages from staff and allies, Chakrabarti lamented that “recent years have shown how forgetting Britain’s moral compass has left our country less safe; so on to the House of Lords—once more the guardian of fundamental rights.”

Liberty’s aggressive and creative fight against the proposed law demonstrated that the government had offered no evidence for extending what is already the longest pre-trial detention period for terror suspects in the western world, not “a single instance in which an investigation has failed because they ran out of time.”They won the battle of public opinion, if not yet the vote.

A surprise development the day after the vote was the resignation from Parliament of Tory Shadow Home Secretary David Davis, forcing a by-election that could be a referendum on what he called “the insidious and relentless erosion of civil liberties in Britain.”

Atlantic will continue to support Liberty in its campaign to stop the 42-day detention plan. In the U.S., we have joined with the Open Society Institute and other funders to build on the heroic work of advocates during the last seven years in a coordinated campaign to use the coming election and transition to reconstruct core civil liberties and restore proper limits on executive power. All over the world, no matter what the fears and pressures, no matter how unpopular the victims or how disturbing the crimes of which they may be suspect, there must never be anyone whose rights we are not bound to respect.

Gara LaMarche
gara@atlanticphilanthropies.org

Links to organisations mentioned in this column:

• Center for Constitutional Rights
• Liberty
• ACLU Amicus Curiae, Boumediene v. Bush (PDF)