June 26, 2003
Every American Deserves Health Care
Following is an abridged version of the address given by Los Angeles County Supervisor Zev Yaroslavsky at the UCLA College of Letters and Sciences commencement ceremony on June 13.
First, let me congratulate each of you and your families on this milestone in your lives.
I vaguely remember my own commencement here on campus some three decades ago. If my memory serves me correctly, the commencement speaker was the foreign minister of the Ivory Coast, and, frankly, I don't remember a damn thing he had to say. I hope you won't have that same experience.
When I was a student here at UCLA between 1967 and 1972, I got a job as a referee for the intramural basketball league for $2.27 an hour. It was a serious job. After all, these teams were made up of John Wooden's rejects.
Before the first game, our adviser brought in a Pac 8 basketball referee to give us some advice -- there were only eight teams then. After all these years, I remember only one thing the ref said: "If you make a bad call during the game, whatever you do, don't ever admit it after the game, because you'll never live it down."
Well, that may have been good advice on the basketball court, but it's not necessarily good advice in life. Many a bad turn in history stems from the stubbornness that prevented a decision-maker from changing course, once he knew he was on the wrong course.
In her seminal work, "The March of Folly," the historian Barbara Tuchman defined folly as "a perverse persistence in a policy demonstrably unworkable or counterproductive." Tuchman deliciously speculates about how different the world might have been if decision-makers throughout world history had chosen change rather than folly as a course of action.
Would we still be singing "God Save the King" if George III had dealt more intelligently with the frustrations and aspirations of the American colonists? Would the Vietnam War have been averted or shortened if our leaders had not ignored evidence and their own instincts that our policy was unworkable or counterproductive?
On the other hand, how different would the world be today if Anwar Sadat and Menachem Begin had not decided in 1977 to junk a perverse policy that had spawned 30 years of conflict between Egypt and Israel? Or if Mikhail Gorbachev had not decided to abandon a decades-old policy of domination over Eastern and parts of Central Europe in 1989, as the Berlin Wall began to crumble?
Each of us as individuals is called upon daily to confront these kinds of choices in our professions and in our personal lives. Whether we step up as individuals says a lot about us as individuals, and whether we step up as a society says a lot about the kind of society we are.
We don't have to look half way around the world or 200 years back to find challenges we need to confront or choices we need to make. In this regard, I want to single out one of our country's most persistent challenges: health care. It is the preeminent domestic social issue of our time, and to say the least, we have not stepped up.
In America today, nearly 20 percent of all Americans go to bed each night without health insurance. Here in Los Angeles, a county of 10 million people, nearly 2.5 million of us are without health coverage -- that's one out of four county residents, including 800,000 children.
In the 1960s, we made the decision as a society to insure all of our elderly, but the rest of us were left to fend for ourselves. As a result, in Los Angeles, one out of three people under the age of 65 is uninsured -- no HMO, no PPO, no student health service, nothing to cover the costs of health care when they're sick.
If L.A.'s uninsured were their own county, they would be the third largest county in the United States; only Los Angeles and Cook County (Chicago) would be larger. In a society as rich as we are, this is not only inexplicable, it is unconscionable.
The adverse impacts of this gaping hole in American social policy fall most heavily on the working poor and their kids. The social implications of this failing are self-evident. Children who grow up without health care coverage are statistically less likely to ever participate in a ceremony such as this at UCLA or any other university. They will be less likely to get a decent job, and they will be more likely to develop medical problems earlier than the rest of us and more likely to die young.
Over the last century or more, our society has determined that every child is entitled, as a matter of right, to a K through 12 education. And, we have determined that every adult citizen is entitled, as a matter of right, to vote and elect his or her representatives. The time has come for our nation to guarantee that every American, as a matter of right, deserves quality health care.
Without a doubt, when it comes to health care policy in our country, the course we have been on is not the right course. This road has led to private and public hospitals downsizing and even closing. Counties like ours are being forced to shutter clinics and mothball trauma centers.
Public health is fighting for its life -- even at a time of heightened concern over bio and chemical terrorism. Most Americans are finding it more difficult to get access to the right doctor in a timely manner, while paying more for what shamefully has become a privilege.
The historian, Tuchman, argues that "there is always freedom of choice to change or desist from a counterproductive course if the policymaker has the moral courage to exercise it." Indeed, America and each of us as Americans need to summon the moral courage to change course and concede the obvious: health care should be provided to every American as a matter of right.
It is no sin -- indeed, it's a virtue -- to admit mistakes; to recognize that persistence in a failed policy is often more costly than conceding that change is necessary. In your careers and in your personal lives, you will find that summoning moral courage will, in the short run, be the harder choice. It will come at considerable risk to you professionally and often personally. You will be inundated with charts, graphs and rationalizations to justify the easy way out. But in retrospect, summoning the courage to do right will reveal itself as having been the easier course -- just because it was right!
In your personal and professional decision-making, be a human being, and be guided by your own humanity. Whether you become a screenwriter, or a business executive, or a teacher or a county supervisor, walk a mile in the shoes of those who will be affected by your decisions, and then see if you agree with your original call.
Our instincts and common sense dictate that health care, like voting and education, should be a right, not a privilege. Yet, as simple and as obvious as this may appear to most of Americans, America has yet to concede that it's been engaged in a counterproductive and unworkable policy. More importantly, unless we concede that change is necessary, we can never summon the courage to make it.
At some point, each of you will have the freedom to choose whether to persist in or change a rotten policy. What road you choose depends on whether, in Barbara Tuchman's words, you "have the moral courage to exercise" that freedom. The choice is yours, and the rest of us will be watching with great anticipation.
Congratulations and good luck!