BY: JEFF TIEMAN
Mr. Tieman is communications director, Covering a Nation, Catholic Health Association, Washington, DC
In his September 15 address to the nation, President George W. Bush said that Hurricane Katrina exposed in the Gulf region "deep, persistent poverty with roots in a history of racial discrimination, which cut off generations from the opportunity of America. We have a duty to confront this poverty with bold action."1
The president was right — both about the poverty itself and the need to confront it with bold action. The poverty Bush spoke of isn't limited to New Orleans or the Gulf region; it is prevalent in Los Angeles, Chicago, New York, Washington, DC, and in rural and urban areas everywhere in between.
Katrina reminded us, with vivid, difficult images, what it can mean to be poor or disenfranchised: not having a way out of town when an evacuation order is given; forced to gather in a squalid place for shelter, without proper access to food, water, and sanitation; left without the resources or skills needed to rebuild lives.
As the rebuilding and relocation efforts move forward, the Catholic community and the nation overall cannot — must not — forget the poignancy of those images from New Orleans, and the potency of the message they carry.
What Katrina Uncovered
First and foremost, that message is one of awareness. Nobody begins to solve a problem they do not first acknowledge or accept. In calling for bold action on poverty, Bush signaled to the nation that we need a new, sustained, national conversation about the poverty among us and about how we should address it. With the president's clear statement concerning the high priority this event has set for the nation, the question is not whether we begin a new dialogue but rather how we do it, and what results we can expect from it.
The mandate for this conversation comes directly from the Catholic tradition of ensuring that those with the least are represented and cared for. Within this mandate, there is no room for a decision about whether to address the issues affecting those who are poor or disenfranchised. For too long, the interests of these groups have been obscured by other events and policy decisions. It is time to raise the volume in this conversation, and to work on a continuing basis to make sure we are audible.
In the immediate aftermath of Katrina, the faith community played a prominent and substantial role in providing relief, reaching out to those most at risk, helping to coordinate response in a chaotic and challenging environment. Catholic Charities USA and other groups stepped up to address, as soon and effectively as possible, the needs of those uprooted.
"If only we could carry that passion forward with regard to the injustice of people's inability to afford a basic level of health care," says Sr. Judith Ann Karam, CSA, president and CEO, Sisters of Charity of St. Augustine Health System, Cleveland.2 "People responded to each others' rights for basic necessities after Katrina." Health care is a basic right, too, she says, and calls us to "come around the table and address this significant issue that affects people's dignity."
Poverty, like lack of access to health care, affects one's dignity. Poverty is by no means new in this country, and this is not the first time our leaders have stated the importance of confronting it. What Katrina did was something that no politician or activist can — it showed us all, in great and painful detail, that poverty is not merely an economic problem but an obstacle to living a dignified, healthy life.
Statistics do not tell the same story images do. A picture is worth 1,000 words, as the saying goes. The challenge, then, is to prevent the images that inspired Bush's words from slipping into the oblivion of the news cycle and, ultimately, out of the public conscience once again. As disturbing as it was to learn that our fellow citizens live in conditions many of us did not know existed in this country, even these powerful lessons can be overwhelmed by the news of the day, or simply by the passage of time. We must not let that happen.
If Katrina's winds swept away the curtain that hid the poverty in our midst, it also helped expose a situation that will only get worse, a situation that existed well before the warm ocean waters sent a violent storm to our shore. Consider a recent survey conducted by the Kaiser Family Foundation, in cooperation with Harvard University and the Washington Post.3 For the survey, conducted between September 10 and 12, interviewers asked questions of 680 randomly selected adult evacuees living in Houston shelters.
Here, according to the survey, is a snapshot of the evacuees' situation before the hurricane:
- Seventy-two percent of the interviewees said they had no insurance to cover their property and other losses
- Sixty-eight percent did not have a checking or savings account.
- Thirty-two percent reported an annual income of less than $10,000; only 12 percent annual incomes above $30,000.
Nationally, some 15.6 percent of the population does not have health insurance. Among evacuees surveyed, 52 percent reported having no coverage when the storm hit. Once it did, the outlook grew even dimmer.
"Undoubtedly, Katrina has raised both the number of people in poverty and the number of uninsured living in the states hit by Katrina, as well as in the states of refuge," concludes the Kaiser policy brief based on the survey results.4 "An estimated 400,000 jobs have been lost; many of those who lost their jobs have lost not only their source of income but also the health insurance coverage that their former employers offered."
Potentially compounding that problem is a recent change in bankruptcy law that was designed to prevent filings by people who seek unnecessary protection, but which could have the effect of thwarting relief for people who genuinely need it.
"Many once-solvent Katrina victims are likely to be caught up in the net intended to catch deadbeats," the New York Times reported.5 "Think of the position of these debtors, many of whom would have not had to file bankruptcy" in the absence of a storm, Lynn M. LoPucki, a law professor at the University of California Los Angeles, told the Times.
Even if they do not land in a situation where bankruptcy becomes the only option, many people displaced by Katrina are likely to continue struggling to get health care — or struggling to pay for it. Instead of seeking care in physicians' offices or clinics well suited to the delivery of primary care, many such victims are likely to look for it in an emergency room setting.
Among the evacuees surveyed by Kaiser, 46 percent said they mainly get their health care at a hospital, versus only 20 percent who said they visit the doctor's office. This trend is not likely to change as hurricane victims settle in areas with which they are not familiar and face the administrative hurdles standing between them and the services they need.
Misplaced Priorities?
What does all this say about the future of poverty and health care in America? At the very least, it suggests that we need to reevaluate our priorities as a nation and reconsider what we believe to be the proper role of government.
We have already learned for certain that the government plays a central and important role in disaster response, recovery, and rebuilding. What we still have to learn is what role our citizens will expect the government to play in addressing the issues uncovered by the hurricane: deep-seated poverty, lack of access to health care, and ongoing racial disparities.
"Many were struck by . . . poverty, at times shameful, in rich America," Archbishop Paul Cordes told Vatican Radio during a visit to Louisiana and Mississippi to express Pope Benedict's solidarity with the victims.6 In the "rich America" Cordes speaks of, 37 million people live in poverty, up 1.1 million from 2003. Forty-six million people, more than 8 million of them children, do not have health insurance.7 Living without proper access to shelter, food, clothing, and medicine strips people of their dignity, and it runs counter to both Catholic social teaching and the American ethic of equality of opportunity. It is difficult to get back on your feet when the prerequisites of education and a healthy home are not in place.
Following Katrina, Bush noted, many Americans witnessed "poverty that they had never imagined before. And we need to address that, whether it be rural or urban."8 He cited improved education, increased home ownership, and encouragement of minority-run businesses as steps he has taken in that direction.
Again, the president is correct. We can make incremental improvements, and must always do so. At the same time, a broader discussion of how these issues fit together and represent a frayed safety net must also begin to take place in earnest. We cannot afford to wait for a health care hurricane to develop — perhaps in the form of employers dropping coverage en masse because they can no longer afford the premiums — before we repair a broken system.
"Sure, we need to think about how to rebuild New Orleans, but we also need to reconstruct a sensible health care system," wrote Nicholas Kristof in a recent column.9 "And that task is urgent, for one study suggests that more than 18,000 Americans will die this year as a consequence of not having health insurance."
We Americans have a duty to ask ourselves why our system marginalizes people to the extent that they die because they were not insured. It would be a disservice not only to the poor and vulnerable but to the nation itself if we neglected to engage in a meaningful conversation about the incontrovertible need to care for those among us who, for whatever set of reasons, cannot completely care for themselves.
Faith can be a guide in this process. It certainly was for those displaced by Katrina. According to the Kaiser survey, 81 percent of evacuees said that the hurricane experience strengthened their religious faith. An even greater share — 92 percent — said religion has played an important role in coping with the crisis.
Now we need to ensure that our faith and values are echoed in the conversations taking shape. We should hold the president to his word that this country will confront the pressing issue of poverty and the problems that stem from it.
"We who have so much shouldn't take our faith for granted, but should use it to help others who do not have what we have," says Sr. Judith Ann.
NOTES
- George W. Bush, "President Discusses Hurricane Relief in Address to the Nation," New Orleans, LA, September 15, 2005, available at www.whitehouse.gov/news/releases/2005/09/20050915-8.html.
- Judith Ann Karam, telephone conversation of September 27, 2005.
- Richard Morin and Lisa Rein, "Some of the Uprooted Won't Go Home Again," Washington Post, September 16, 2005, p. A1, available at www.washingtonpost.com/wpdyn/content/article/
2005/09/15/AR2005091502010.html.
- Kaiser Commission on Medicaid and the Uninsured, Addressing the Health Care Impact of Hurricane Katrina, Washington, DC, September 2005, p. 1, available at www.kff.org/uninsured/upload/7387-2.pdf.
- Mary Williams Walsh and Riva D. Atlas, "Storm Victims May Face Curbs on Bankruptcy," New York Times, September 27, 2005, p. 1.
- CNN.com, "Pope's Katrina Envoy: 'Shameful' Poverty in U.S.," September 18, 2005, available at cnn.com/2005/us/09/17/katrina.pope.ap/.
- U.S. Census Bureau, Income, Poverty, and Health insurance Coverage in the United States: 2004, Washington, DC, August 2005, pp. 9, 16, available at www.census.gov/prod/2005pubs/p60-229.pdf.
- George W. Bush, "President Discusses Hurricane Effects on Energy Supply," Washington, DC, September 26, 2005, available at www.whitehouse.gov/infocus/energy/.
- Nicholas Kristof, "A Health Care Disaster," New York Times, Op/Ed page, September 25, 2005.
Copyright © 2005 by the Catholic Health Association of the United States
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