Abandon critical thought, ye who enter here

Banning books and closing a successful Mexican American Studies program: How ironic is Arizona’s oppression of Latinos who simply wish to learn of oppression?


January 10, 2012. You have just settled into your chair in the Chicano studies classroom at a high school in the Tucson Unified School District. You are prepared for discussion concerning the historical struggles of your ancestors, when in walk several school officials with carts and empty boxes. An announcement is made by one of the officials that Mexican American Studies (MAS), the program in which you’re enrolled, has been terminated, and that your teacher will now box up your text books. You are initially stunned, then in disbelief, and finally in tears- like your teacher- as your text books are taken from your hands.

This story didn’t start on January 10, 2012. Nor did it begin when the state school superintendent, John Huppenthal, threatened the Tucson school district with the potential loss of millions of dollars in revenue if the MAS program were not closed, or even earlier when then state senator Huppenthal co-authored, with Tom Horne, the very law against ethnic studies he now used in crushing the program. This is a story with origins from long ago stemming from racial intolerance and fear (immigration-phobia) that has been building in intensity over time.

For Arizonans, it is yet another plunge deeper into a dark abyss. A New York Times editorial described this latest development:

The Tucson Unified School District has dismantled its Mexican-American studies program, packed away its offending books, and shuttled its students into other classes. It was blackmailed into doing so: keeping the program would have meant losing more than $14 million in state funding. It was a blunt-force victory for the Arizona school superintendent, John Huppenthal, who has spent years crusading against ethnic-studies programs he claims are “brainwashing” children into thinking that Latinos have been victims of white oppression. ¹⁾

The N.Y. Times editorial was critical of Huppenthal: If Huppenthal wanted to diminish resentment and treat Hispanic students as individuals, he picked a lousy way to do it. His action has Hispanic critics saying they feel their culture is under attack — and has students in a well-established, well-liked program feeling dejected. 2)	Native Americans Beware: Presumably, Huppenthal considers studies that discuss the oppression of your ancestors as “brainwashing,” too. And heaven forbid you consider the plight of some of your ancestors in terms of genocide…

Moreover, the editorial framed the action in light of the broader element of racism that permeates Arizona and its politics:

To say that Arizona’s Anglo and Hispanic populations have had multiple points of collision and misunderstanding is putting it mildly. Arizona, the state that also showed some of the most bitter resistance to a federal Martin Luther King holiday, enacted the first in a recent spate of extremist immigration laws and spawned the Minuteman border-vigilante movement. ³⁾

About Tucson and its Mexican American Studies Program

Nearly 53,000 students attend classes in the Tucson Unified School District (TUSD) where 60 percent, or approximately 32,000, come from Mexican-American families. The White/Anglo population is second highest, at 24 percent, followed by African-American, Native American and Asian American at 6, 4 and 3 percent, respectively. 4)		Logo for Tucson's Mexican American Studies Department

Several different ethnic study programs have traditionally been offered within the district, including Native American, Asian and Mexican American. As of May, 2011, more than 1,300 Tucson middle and high school students were enrolled in MAS. Ninety percent of those students were of Mexican American background, followed by five, two, and two percent for White/Anglo, Native American and African American ethnicities, respectively. ⁵⁾

Over its 13 year history, MAS steadily gained recognition as one of the state’s most successful programs, largely due its educational outcomes: graduation rates and testing measures have invariably showed Mexican American Studies students outperforming peers. ⁶⁾ Later, we will quantify both when we examine the results of the independent Cambium Report.

Tucson’s MAS was co-founded in the late 1990’s by Sean Arce, who was Director of the program at the time of its suspension. Under Arce’s leadership, MAS was sheparded through a court-mandated desegregation order and challenging stipulations in the ‘No Child Left Behind’ act. Interestingly, Arce has been compared to Esteban Ochoa, Tucson’s first Mexican American mayor who, in the 1870’s defied the Arizona territorial legislature by founding and funding Tucson’s first public school. Over the years and in collaboration with other educators, Arce has helped design curricula used in many ethnic or Mexican American Studies programs. ⁷⁾

As an educator, Sean Arce is nationally renowned and the MAS program is recognized for its educational excellence. According to Dr. Pedro Noguera, Executive Director for the Metropolitan Center for Urban Education at New York University,

"Anyone who has visited classrooms run by the Mexican American Studies program in Tucson would know that the goal is not to teach hate or sow division. Under the leadership of Sean Arce, the program has paved the way in helping students and teachers make connections between the school curriculum and the student's history and culture. These efforts have produced heightened student engagement and deepened their motivation to learn. Those who are serious about finding ways to help schools reach all students should support such efforts." ⁸⁾

Dr. David Stovall, from the University of Chicago, states:

“Sean's work is emblematic of a collective struggle to ensure the rights of students throughout TUSD to ask critical questions of themselves and society while making informed decisions based on such inquiry. By providing a model for young people to interrogate the disparities familiar to their conditions, they are simultaneously creating pathways to guarantee quality education for current and future students in the district. For these reasons and countless others, their program should serve as a national model for Ethnic Studies initiatives in K-12 education.” ⁹⁾

Arce also received accolades from Dr. Devon G. Peña, former Chair of the National Association for Chicana and Chicano Studies, who credits Sean’s intellect and administrative skills and says,

“Under (Arce’s) leadership, MAS-TUSD has become the nation's most innovative and successful academic and instructional program in Ethnic Studies at the secondary school level." ¹⁰⁾

However, perhaps the greatest testimonies come from those who have been in the classroom. According to Jesus “Tito” Romero,

"It wasn't until I had Sean Arce as a history teacher that I discovered what it meant to be as a student, and I soon realized that Mr. Arce had not only saved my life, but had changed and touched so many others. Mr. Arce has been in the business of saving lives for many years, whether he realizes it or not." ¹¹⁾

Jacob Robles, a 2008 alumni of MAS, also credits Sean Arce for changing his life:

"Mr. Arce greeted me like a neighborhood friend, and on the first day he immediately made the class room space something familiar and comfortable. It was easy to get us engaged. He made things funny, interesting, but also very serious. I had never had a teacher quite like him; he had all of the goofballs in the class quiet and listening. I was interested right away and knew I was in the right place. I am forever grateful for having Sean Arce as a teacher." ¹²⁾

Tucson’s Mexican American Studies program is not a one man show, though. Like any good administrator, Sean Arce must surround himself with teachers who excel. Literature instructor Curtis Acosta is one example.

In 2009, Acosta won the Martin Luther King Jr. Classic Dream Award, and in 2010, the Tucson High Magnet School Teacher of the Year. In 2011, Curtis Acosta was named winner of the University of Arizona Goodman Award, and he’s been a finalist for the University of Arizona's Circle K Teacher of the Year. ¹³⁾

Following the shooting of Congresswoman Gabby Giffords, CNN visited one of Acosta’s classes, where students were discussing Shakespeare’s “The Tempest.” CNN’s goal was to better understand the challenges in teaching in an environment where racial and immigration tensions have created a divisive atmosphere, and their report painted a very complimentary picture. ¹⁴⁾

Successful programs Like Tucson's Mexican American Studies exist because of the efforts of dedicated and talented educators like Acosta and Arce. That success, along with the sheer number of students who have graduated under the MAS banner, means the MAS program has many supporters.

Timeline of Events concerning Tucson's Mexican American Studies

That is not to say Tucson’s Mexican American Studies program has no detractors. Certainly there are none quite like Arizona state politicians Tom Horne and John Huppenthal.

It was Horne who first decided to take on the Tucson school district and its MAS program, largely after Dolores Huerta, who co-founded United Farm Workers with Cesar Chavez, gave a 2006 speech at Tucson’s Magnet High where she stated, “Republicans hate Latinos.” ^{15), 16)} Huerta came under immense fire for her comments, which became a rallying cry for Arizona Republicans.

While I found no supporting documentation, it is conceivable that a perception of liberal partisanship within MAS is one reason Horne decided to take it on. On June 11, 2007, as State Superintendent of Public Instruction, Horne wrote an open letter to the citizens of Tucson, declaring MAS should be terminated for three principle reasons:

• Curriculum (text books and course materials),
• Philosophy (people are individuals, not exemplars of racial groups), and
• Personal observations concerning what Horne saw as negative student reaction to a speech he perceived should have been non-partisan. (the Huerta speech?) ¹⁷⁾

In Huppenthal, then a state senator, Horne found a like-minded ideologue. Horne and Huppenthal are Tea Party Republicans, and for both the academic achievements of MAS apparently meant little versus what they perceived as a plethora of practices within the program which were more indoctrination than teaching, where American history was being transformed into stories of Latino oppression, and where curricula seemed more about inflating racism and agitation than informing or developing skills for critical thinking.

Together, Horne and Huppenthal pushed for passage of legislation (S.B. 1069) in 2009 that ultimately failed.

On February 26, 2010, Horne resigned from the Arizona region board of the Anti-Defamation League (ADL), stating he would not remain in an organization opposed to his proposed legislation. ¹⁸⁾ The head of the ADL, Bill Straus, commented:

“Tom obviously had a philosophical difference with the people on the board and me over the proposed ban on Latino-American ethnic studies programs like the one in the TUSD. There's a strong feeling of opposition to his attempt to rescind a program that has so obviously resuscitated the desire to learn in so many students." ¹⁹⁾

Later in the spring of 2010, just weeks after the passage of S.B. 1070, which placed Arizona in a national spotlight given it allowed police to question anyone they thought might be in the country illegally, Horne introduced House Bill (H.B.) 2281. Co-authored by Huppenthal, this time the measure quickly passed and was signed into law by Arizona Governor Jan Brewer. ²⁰⁾

Horne wrote a letter to TUSD interim Superintendent John Carroll on August 2, 2010 stating Horne was aware TUSD had declined to end any of its ethnic classes despite passage of H.B. 2281- which would take effect December 31. ²¹⁾

In November, 2010, Horne won election as Arizona’s Attorney General. Huppenthal replaced Horne, winning election as State Superintendent of Public Instruction.

On December 29, 2010, new TUSD Superintendent Dr. John Pedicone received a written request for public records concerning MAS pursuant Arizona Revised Statute (ARS) 39-121.01(D)(1). Collection of materials began immediately, while the next day, TUSD Board President Judy Burns sent a letter to Horne and Superintendent elect Huppenthal informing them TUSD’s governing board had adopted three resolutions “to ensure compliance with H.B. 2281 and A.R.S. 15-111 and 15.112 with the intent to implement ethnic studies programs and courses compliant with all applicable laws.” ²²⁾

However, on January 1, 2011- yes, on the New Year’s Day holiday- Horne issued a summary finding declaring the Tucson school district’s MAS in violation of state law. ²³⁾

Huppenthal, upon succeeding Horne as the state’s education chief, decided to establish his own facts on the matter. One of Huppenthal’s first actions was to commission an audit of MAS through Cambium Learning, Inc., at a cost of $170,000 dollars. ²⁴⁾ The purpose of the Cambium audit was three-fold: to determine

• If and how MAS is designed to improve student achievement,
• If statistically valid measures indicating student achievement occurred, and
• Whether MAS curriculum complied with A.R.S. 15-112(A). ²⁵⁾

Work on the audit commenced on March 7, 2011 with Cambium returning its final report on May 2. The results of the audit relative the stated goals are noteworthy:

Improving Student Achievement

Concerning student achievement, the Cambium report stated,

“MAS programs are designed to improve student achievement based on the audit teams’ findings of valuable course descriptions aligned with state standards, commendable curricular unit and lesson plan design, engaging instructional practices, and collective inquire strategies through approved Arizona state standards. Therefore, such visual evidence presented within the classroom observation and instructional context demonstrated effective use of curriculum to support student achievement.” ²⁶⁾

Cambium did issue recommendations in terms of improving curriculum. Among other things, three of nine MAS curriculum units were found to contain an “overabundance of controversial commentary inclusive of political tones of personal bias in the ‘Introductory’ sections of units.” Words that dehumanize or belittle were also found which should have been eliminated. Moreover, the auditors did not find an overarching document which “provided the integrated, comprehensive guidance needed to direct, monitor and assess effective curriculum implementation” nor documentation detailing “long and short-term goals within each course.” ²⁷⁾

Determine if Statistically Valid Measures Indicating Student Achievement Occurred

Here, the Cambium audit confirmed claims that Mexican American Studies students are high achievers: in their words, “there is a positive measurable difference between MAS and non-MAS students.” ²⁸⁾

Analysis of Arizona’s Instrument to Measure Standards (AIMS) over a six year period from 2005 through 2010 shows MAS students scored an average of 12 percent higher in reading comprehension, 11 percent higher on writing, and six percent higher on math. Over the same time period, graduation rates averaged 7.5% higher for MAS versus non-MAS students. ²⁹⁾

The Cambium report added,

“Many research-based practices that promote enhanced critical thinking and higher-order comprehension of difficult topics are in place and are used on a daily basis. Regardless of program, teacher effectiveness achieves results… Students learn to be proud, regardless of ethnicity, and are motivated to exceed and excel.” ³⁰⁾

Determine whether MAS curriculum complies with A.R.S. 15-112(A)

Here, the Cambium report found no evidence indicating

“… any classroom within the Tucson Unified School District was in direct violation of the law. In most cases, quite the opposite is true. Consider, if classes promoted resentment or ethnic solidarity, then evidence of an ineffective learning community would exist within each school aligned with MAS. That was not the case. Every school and every classroom visited by the auditors affirmed that these learning communities support a climate conducive to student achievement… Teachers collectively are building nurturing relationships with students and work to improve student achievement, attendance, and graduation. A culture of respect exists and students receive additional assistance beyond the regular classroom instruction in support of their academic learning.” ³¹⁾

However, when state Superintendent Huppenthal later issued his statement of finding, TUSD was declared out of compliance and was given 60 days to correct the situation; otherwise, ten percent of state funds would be denied. ³²⁾

How ironic, given the Cambium audit recommended it’s expansion. ³³⁾ Interestingly, the Huppenthal statement of finding made no mention of the Cambium Report other than reference to “a curriculum audit conducted by a contractor.”

Thus, even though Cambium’s audit was commissioned by Huppenthal, the Cambium findings stating MAS was in compliance with Arizona laws were essentially ignored. Instead, justification for Huppenthal’s finding primarily came from evidence collected through Arizona Department of Education audits directed by Huppenthal, and through an examination of material on the Mexican American Studies website. ³⁴⁾

Now think about that: Arizona’s Superintendent of Public Instruction is an elected office which essentially runs Arizona’s Department of Education (ADE). The problem with Huppenthal calling for an ADE audit of Tucson’s Mexican American Studies program is that Huppenthal, who held a strongly partisan perspective, and who helped author the laws and then sought the very position that could enforce them, is also in position to exert undue influence on the results of any internal ADE audits. Employees within Arizona’s Department of Education, like everyone else, have families to support, mortgages to make, and jobs which, in this economy, they certainly can’t afford to lose. Therefore, do you really think they’re going to tell someone like Huppenthal something he doesn’t want to hear?

At best, Huppenthal’s internal ADE auditing could supplement the independent Cambium report; instead, they were the foundation. Given Huppenthal’s long-standing public opposition to MAS, one must ask: Since Cambium didn’t deliver the facts he wanted, did he simply resort to manufacturing his own?

Others were certainly wondering about it. Take the editors at The Arizona Star:

State Superintendent John Huppenthal has decided that TUSD's Mexican American Studies program violates state law - but to get to his flimsy conclusion he had to ignore the clear findings of the outside auditors he hired to investigate the program in the first place.

He would be asked, repeatedly, about the specific provisions of the law he determined TUSD is violating- the one commonly known as HB 2281- and he would turn the conversation back to the curriculum development process.

It didn't make sense.

When you read the full audit, the problem is obvious. Huppenthal was proclaiming TUSD to have violated a state law, A.R.S. 15-112, while simultaneously releasing an independent audit that explicitly states that TUSD has not violated A.R.S. 15-112. ³⁵⁾

The Arizona Star editorial did agree with Huppenthal on one point: that the TUSD governing board has not done its job in terms of overseeing MAS curriculum. From their perspective, the relationship between the TUSD administration, some board members, and MAS faculty and supporters has eroded to the degree MAS now operates with too much autonomy. The Arizona Star editors concluded by writing, “The audit provides a window into MAS, a program that has administrative concerns but works for kids. Huppenthal, who revels in reports and information, should follow the data and support a program that shows results.” ³⁶⁾

Shortly after the Huppenthal finding was released, a motion for a stop-order was brought to the U.S. District Court by Richard Martinez on behalf of several MAS students and faculty including Curtis Acosta. The Tucson school district also appealed the Huppenthal finding.

In December 2011, Lewis Koval, an administrative law judge, ruled against the TUSD appeal stating, “MAS violated state law by promoting racial resentment, advocating ethnic solidarity versus treating students as individuals, and through existence of one or more classes designed primarily for one ethnic group.” Koval also ruled H.B. 2281 was legal since it had not been ruled unconstitutional. ^37),38)

Then, the new 2012 year had hardly begun when Huppenthal ordered ten percent of the Tucson school district's monthly state aid withheld until what time the district was in compliance. Estimates placed the potential loss in TUSD revenues at more than $1,000,000 per month. ³⁹⁾

Soon thereafter, the Tucson school board voted 4-to-1 to suspend the program. Adelita Grijalva, the lone vote against closing MAS, instead called for the school district to defend the program through a court challenge of H.B. 2281’s constitutionality: ⁴⁰⁾

"This is an issue that is not going to go away by this vote. When bad laws are written, they are usually picked up by other states. This is an opportunity to fight a bad law." ⁴¹⁾

Federal Judge A. Wallace Tashima, on January 10th, then denied the request for a stop order that had been brought by the group of MAS students and faculty. ⁴²⁾ However, Judge Tashima left open constitutional issues. Rulings on the constitutionality of H.B. 2281 are expected in February or March, 2012.

Oppressing Those Who Wish to Learn of Oppression

It is beyond the scope of this article to explore the varied ideological motivations of Horne and Huppenthal in regard to their opposition to Mexican American Studies. However, recent comments by Huppenthal concerning the teaching of history relevant ethnic oppression were readily available and are important to note.

Confiscation of text books accompanied the suspension of the MAS program, a matter we explore in the next section. One of the confiscated books was Paulo Freire’s “Pedagogy of the Oppressed.” Here is John Huppenthal from a recent broadcast concerning Freire’s work:

“That word "oppressed" (referring to ‘Pedagogy of the Oppressed’) is taken right out of 'The Communist Manifesto,' where… Karl Marx talks about the struggle of the history of man, the entire history of mankind being the struggle between the oppressed and the oppressors... The designers of the Mexican American Studies classes explicitly say in their journal articles that they’re going to construct Mexican American Studies around this Marxian framework with a predominantly ethnic underclass, the oppressed… filling out that Marxian model, and a predominantly Caucasian class filling out the role of the oppressor.” ⁴³⁾

Huppenthal has stated, per numerous press accounts, that MAS portrays history in a fashion that has ‘indoctrinated’ students, fosters ethnic resentment, and even prepares them for acts of violence or evil. In a Democracy Now! interview, Huppenthal talked of his one visit to a Mexican American Studies classroom where he saw a poster of Che Guevara on the wall and heard Ben Franklin characterized as racist. ⁴⁴⁾

At one point, Huppenthal stated,

“What we want to do is create a society in which everybody is working for a better tomorrow, not working to get even. We all know the evil that came out of the Balkans in Western Europe. So we want to make sure these students are educated and able to be critical thinkers in a variety of viewpoints.” ⁴⁵⁾

Whoa! Is Huppenthal insinuating that history as taught through MAS could somehow lead to that kind of violence? By ‘working to get even,’ did he truly mean revenge?

If so, shame on you, Mr. Huppenthal: ethnic studies programs are not the Western equivalent of fundamentalist Islamic madrasses designed to churn out terrorists; they are, in fact, the very opposite. If intended, such an implication is more than irresponsible; it is nearly criminal, given such misstatement of fact only panders to fear and results in furthering racial and ethnic division.

Or, to give benefit to doubt, was Huppenthal simply referring to equality while, unfortunately, making his comment in such a way that revenge could be construed?

On that level, I would suspect many, if not most, students graduating from ethnic studies programs become:

• Life-long learners driven to improve not only themselves but their friends and communities;
• Citizens who will challenge the status-quo, weigh alternatives, question authority, and stand for what they believe, and
• Humanists called to seek equality, justice, and the peace that justice brings.

Would not these be exactly the kind of students capable of ‘working for a better tomorrow?’

Or, is that really the problem, Mr. Huppenthal- Latinos working for a better tomorrow?

Unfortunately, that is the perspective of scholar Carlos Munoz, who accredits the closing of Mexican American Studies and the confiscation of its books as “an effort to return to the days of the 1950s, previous to the Chicano movement and other civil rights movements in this country, to try to ‘Americanize’ and re-colonize the minds of young people in the state of Arizona.” ⁴⁶⁾

“I think that’s the bottom line here. They want to put a stop to this process of producing young leaders that are going to speak truth to power, and are going to make a difference in the future in terms of turning the tide against racism and other things that are negative in Arizona.” ⁴⁷⁾

In the Aftermath of the Suspension

Immediately after the suspension of the Mexican American Studies program, students from several Tucson area middle and high schools organized and staged walkouts.

Incredibly, those students were then ordered to perform janitorial duties on the following Saturday. It was “an amazing message-- something right out of Newt Gingrich’s playbook,” as Roberto Cintli Rodriquez subsequently wrote. ⁴⁸⁾

Wakefield Middle School students who participated in a district-wide walkout January 23, 2012 found they were subsequently suspended from school. TUSD Assistant Superintendent Abel Morado said the students were not suspended for walkingout in support of MAS, but for past infractions or other unexcused absences. ⁴⁹⁾ At post time, it was unknown whether these student suspensions had been lifted.

Most controversial was the subsequent confiscation of MAS teaching materials: books, artwork, posters, etc. ⁵⁰⁾ Initially, seven books were removed:

• 500 Years of Chicano History in Pictures, edited by Elizabeth Martinez,
• Chicano! The History of the Mexican Civil Rights Movement, F. Arturo Rosales,
• Critical Race Theory, Richard Delgado and Jean Stefancic,
• Message to Aztlan,” Rodolfo Corky Gonzales,
• Occupied America: A History of Chicanos, Rodolfo Acuña,
• Pedagogy of the Oppressed, Paulo Freire,
• Rethinking Columbus: The Next 500 Years, Bill Bigelow. ⁵¹⁾

Bill Bigelow, author of “Rethinking Columbus,”said TUSD has shown “tremendous disrespect for teachers and students” by removing the book.

“(Rethinking Columbus) is a book that has sold over 300,000 copies and is used in school districts from Anchorage to Atlanta, and from Portland, Oregon to Portland, Maine. It offers teaching strategies and readings teachers can use to help students think about the perspectives that are too often silenced in the traditional curriculum.” ⁵²⁾

Bigelow noted the only other time a book of his was banned was in 1968, when apartheid South Africa banned “Strangers in Their Own Country,” a curriculum he had written which included a speech by Nelson Mandela. ⁵³⁾ Said Bigelow,

“We know what the South African regime was afraid of. What is the Tucson school district afraid of?” ⁵⁴⁾

Loss of money, probably. Rather than TUSD, Bigelow should have directed the question to Horne, Huppenthal and any others who signed or supported the legislation that led to the TUSD administrative decisions.

Beyond the initial seven, all of the approximately 50 books in the MAS curriculum were subsequently removed. ⁵⁵⁾ As Roberto Cintli Rodriquez wrote,

Teachers are being told to turn in the books that have not been "confiscated". This might strike the average person as odd: it's as if the presence of these books inside classrooms constitutes a distraction or bad influence. Apparently, students should not be able to even see those books in the classrooms. ⁵⁶⁾

Among the additional books in the MAS curriculum packed off to storage were:

• A People’s Guide to History, Howard Zinn
• Civil Disobedience, Henry Thoreau,
• The Tempest, William Shakespeare ⁵⁷⁾

Shakespeare? Really? Confiscating Thoreau’s book on civil disobedience? Howard Zinn? Well, rather than ‘white-washing’ the American story, Howard did write about the oppression which occurred in the history of building the United States. And that's a problem, Mr. Huppenthal?

Following the confiscation of text books, numerous press articles categorized the action as a ‘banning’ of books, a claim vehemently denied by the Tucson school administration. Officials claimed the text books had simply been taken to a supply repository, and that copies of all books were still available in libraries and other areas, just not in MAS classrooms. ⁵⁸⁾ A spot check of the library catalog by reporter Jeff Biggars returned one copy of “Critical Race Theory,” two copies of “Pedagogy of the Oppressed,” and 16 copies of “Rethinking Columbus” ⁵⁹⁾ -- which would now need to serve a student population of more than 50,000.

Lorenzo Lopez, a teacher at Tucson’s Cholla High School, charged the district with being less than forth-right in its characterization of the book removal:

“In regards to this double-speak about these books being banned, it is irrelevant if these books are banned from the entire district or just from our classes. If our kids can’t have access to that knowledge, and it was urgent that these books be removed immediately from our classes, they are, in effect, banned.” ⁶⁰⁾

Sadly, the forbidden books also had to be removed from teacher’s personal libraries, according to Pueblo High’s Sally Rusk:

“Our own personal copies were not to be on the book shelves either. It seems obvious to us that being made to take certain books out of the classroom — even when used as reference books and not class sets — is censorship. How can not allowing teachers to use these books, even as reference material in a traditional U.S. history course, not be interpreted as banning those books?” ⁶¹⁾

For scholar Carlos Munoz, the reason these books were banned is because they spoke truth to power:

Scholars of Mexican-American background and other… scholars of color, have collectively made a profound contribution to the body of knowledge of people of color in this country, and have documented and rectified a history that speaks the truth that this country has been historically an empire, a promoter of imperialism throughout the world… (Take) scholarship like Rodolfo Acuña’s incredible path-breaking book. He was the first one to put out a true history of America, in a sense that he documents, beyond shadow of a doubt, the nature of our society and how, in fact, Mexican-Americans in particular have struggled for social justice throughout the nation’s history… All this knowledge that ‘Occupied America’ represents, they (Arizona’s politicians) don’t want to acknowledge.” ⁶²⁾

MAS teachers are certainly scared, given an environment where anyone complaining about anything that may be construed as a violation to H.B. 2281 could result in loss of their job. ⁶³⁾

Yolanda Sotelo, who has taught at TUSD for thirty-years, was informed monitors would visit her classroom to ensure confiscated books were not being used and that any instructors who made assignments from prohibited titles would be reprimanded. She was told monitors would also evaluate classroom walls and posters. ⁶⁴⁾

School administrators have instructed teachers to simply avoid any lesson plans or books touching themes of race, ethnicity or oppression. ⁶⁵⁾

According to Curtis Acosta, the award-winning Mexican American Studies literature instructor,

“We’re filled with the vagueness the law is founded upon. No one knows what to tell us definitively when we ask specific questions.” ⁶⁶⁾

In yet another irony, the law’s vagueness has increased educational inequality in the Tucson school system, as it is only the teachers who worked in the MAS program who are now forbidden from teaching from the confiscated books. Other teachers in the district can- and are- using them. ⁶⁷⁾ An example is Tucson’s University High, where college-bound students have access to all curricular materials, including those forbidden to MAS. ⁶⁸⁾

Acosta often teaches Shakespeare’s “The Tempest.” Here he explains why he no longer may:

“What is very clear is that “The Tempest” is problematic for our administrators due to the content of the play and the pedagogical choices I have made. In other words, Shakespeare wrote a play that is clearly about colonization of “the new world” and there are strong themes of race, colonization, oppression, class and power that permeate the play, along with themes of love and redemption. We study this work by Shakespeare using the work of renowned historian Ronald Takaki and the chapter “The Tempest in the Wilderness” from his a book A Different Mirror where he uses the play to explore the early English settlements on this continent and English imperialism. From there, we immerse ourselves in the play and discuss the beauty of the language, Shakespeare’s multiple perspectives on colonization, and the brilliant and courageous attention he gives to such important issues.

However, TUSD is basing our compliance upon their appeal and (the court) ruling. Thus, I believe our administrators advised me properly when they said to avoid texts, units, or lessons with race and oppression as a central focus… (Staying) away from teaching “The Tempest” not only seems prudent, but intelligent. We also have not received confirmation that the ideas, dialogue, and class work of our students will be protected. In clearer words, if I avoid discussing such themes in class, yet the students see the themes and decide to write, discuss or ask questions in class, we may also be found to be in violation. The stakes are far too high since a violation of the law could cost the district millions, our employment, and personal penalties from the state for breaking the law.

Due to the madness of this situation and our fragile positions as instructors who will be frequently observed for compliance, and be asked to produce examples of student work as proof of our compliance, I cannot disagree with their advice. Now we are in the position of having to rule out “The Adventures of Huckleberry Finn,” “The Great Gatsby,” etc. for the exact same reasons.” ⁶⁹⁾

So, Huckleberry Finn’s gone, too? I suspect many Mexican American Studies teachers and students have been asking, “What’s the world coming to?”

What is obvious is the vaguely worded passages of A.R.S. 15-112(A) have placed Tucson’s Mexican American Studies instructors in a untenable position: incapable of teaching on many issues crucial to the development of critical thinking. Per university professor Jorge Mariscal, there will now be:

No critical thinking, no critical history, and no critical pedagogy for the new Calibans who must take their designated places in the market economy and forget their past. ⁷⁰⁾

That is the crime that Horne and Huppenthal have wrought.

Reaction to the Issues

There have been many interesting perspectives written in response to Arizona H.B. 2281 and the closing of Tucson’s Mexican American Studies programs.

The opinions that follow have been expressed far more eloquently than any encapsulation I may attempt. Here are a few:

Concerning the Suspension of the MAS Program

Anthropologist and author Tom Sheridan sees racial and poor fiscal ideology driving the closing of MAS. Rather than demonized, Sheridan sees a program that state official should be emulating elsewhere:

The recent dismantling of Mexican American Studies in the Tucson Unified School District represents the convergence of two disturbing trends in Arizona: 1) the systematic assault on Mexican society and culture and 2) the starvation of public education at all levels across the state.

Students enrolled in the program were more likely to graduate and much more likely than their peers to go to college. Instead of trying to replicate it in other largely Hispanic school districts, however, the Arizona Legislature passed Arizona Revised Statute (ARS) 15-112, which prohibited "a school district or charter school in this state" from offering courses that "promote the overthrow of the United States government" and "advocate ethnic solidarity instead of the treatment of pupils as individuals… If Arizona truly wants to nourish a "knowledge economy," TUSD's Mexican American Studies program should be applauded, not demonized. ⁷¹⁾

Dr. Roberto Cintli Rodriquez decries the censorship at the heart of the matter and what that censorship means for public education:

"This is an attack specific to Chicano studies, but at its core this act of censorship is a black eye to the U.S. educational system. It is a black eye to the very idea of education because the state and TUSD are attempting to determine what is valid knowledge- what is acceptable and what is unacceptable. This dangerous precedent gives the message that students are free to learn everything except what the state finds objectionable. This should be a concern to every human being anywhere." ⁷²⁾

Arizona Republic columnist Linda Valdez sees great value in ethnic studies and blames the racial nature of Arizona’s state politics for the closing of MAS:

Mexican American studies is an important element in teaching Tucson’s youth about human rights, and in fighting discrimination and ethnic resentment rather than fomenting it.

The underlying reason why Mexican American studies is being targeted in Southern Arizona is a political one. The fight to ban this particular ethnic studies program is one more in a long line of battles being waged against the state’s Latino population. ⁷³⁾

Luke Witman from the Tucson Examiner writes,

At a time when racial intolerance against Latinos in this country appears ever increasing, it seems that a program aimed at educating youth about the pitfalls of such intolerance is more valuable than ever. ⁷⁴⁾

English professor Joel Shatzky speaks to the irony of the oppression at hand:

That officials in Arizona believe that by closing down these programs and thus insulting those who have enrolled in them they will not increase a sense of oppression by Latinos and other ethnic groups, is as illusory as the words on a sign a colleague of mine hung in his office many years ago: "The flogging will stop when morale improves." ⁷⁵⁾

Then there is this from author Luis J. Rodriguez:

Let's be clear--adequate educational criteria needs to include several important aspects: 1) that information provided be factual and verified; 2) that this knowledge include varied perspectives and ideas; 3) that it be grounded in the historical record as well as vibrate with the experiences and stories of all peoples; 4) and that the content is real and relevant from a literary and educational standpoint to all students.

In such a classroom, even the Tea Party's views would be heard and debated. Why not the Ku Klux Klan's and Hitler's positions? But these should also be enriched with other views that challenge these and add to a student's treasury of learning--those of Frederick Douglass, Malcolm X, Cesar Chavez, Maxine Hong Kingston, Elie Wiesel, Leslie Marmon Silko... and many others.

A thriving educational environment allows reality into the curriculum and won't mediate or censor the truth. It is not about the idealized beliefs of a small minority, which the Tea Party is no matter how you look at it. The state has no right to determine what are the "right" ideas and which perspectives to cut out. Teachers who dare to expand the knowledge base of their students by continuing these classes and teaching from these texts can presumably be removed, perhaps even jailed.

That's worse than "group think," it's tyranny. ⁷⁶⁾

Concerning H.B. 2281

Richard Martinez, attorney for the Mexican American Studies program, is angry that a community-based program like MAS has been usurped by state mandate. Martinez sees racism as the primary motivation behind both the legislation and Superintendent of Public Instruction Huppenthal’s finding against TUSD:

"What has occurred here is that [Huppenthal] has taken away from our entire community a curriculum that was adopted by our school board, that was developed by our school district, and that had successfully operated for well over 10 years. It’s just part of the same kind of tactics that have been employed in Arizona reflected by [SB] 1070, the anti-immigrant perspective. It is the anti-Latino perspective that exists in this state." ⁷⁷⁾

Dr. Sonia W. Soltero, from DePaul University’s College of Education, frames the Arizona legislation as both anti-American and unproductive, unfortunately undermining an educational program that has been demonstrably successful:

The political move by the state of Arizona to make the teaching of a social studies curriculum illegal is both draconian and anti-democratic. A curriculum that offers the often ignored histories, experiences, and contributions of the largest ethnic group in the U.S., and presents different perspectives in literature, expands the knowledge and understanding of both Mexican-American and non-Latinos students. Without any empirical evidence, detractors claim that the Ethnic Studies Program promotes antagonistic relations between Mexican-American youth and mainstream society. By contrast, advocates of the program can point to empirically-based record of increased academic outcomes and graduation rates for students who participate in the program. ⁷⁸⁾

Tom Sheridan, speaking of the combined effects of S.B. 1070 and H.B. 2281 A.R.S. 15-112(A), writes:

There has not been such a concerted effort by Arizona state government to suppress Mexicans and Mexican-Americans since early statehood, when the Legislature attempted to disenfranchise Mexican voters and keep Mexican labor out of the copper mines. ⁷⁹⁾

Former educator Jame E. Garcia writes White/Anglo worries over the upcoming change in population demographics is why HB 2281 became law:

It happened because the state's Latino population has nearly doubled in the past 20 years and the right wing is angry and afraid that it is helpless to stop it. In one generation, Latinos will be 50 percent of the state's population and, short of declaring martial law and deporting everyone with brown skin, there's nothing anyone can do to prevent it. ⁸⁰⁾

Professor Jorge Mariscal, much like Garcia, wrote wondering whether Arizona’s attack on Mexican American Studies was less about ethnic studies and more about denying the right to education to the coming Latino majority? ⁸¹⁾

After all, as Garcia and Mariscal indicate, population trends show an ever-growing Latino presence in Arizona. The Hispanic population increased 5.5 percent over the past decade to 30.8% of the state’s total population, with a median Latino age of 25 years versus 43 for non-Hispanic whites. ⁸² In time, it is inevitable Arizona’s Latino population will become the majority.

Summary

Given the events that have transpired concerning Tucson’s Mexican American Studies program, it is difficult to summarize without focusing on the efforts of two men: Tom Horne and John Huppenthal.

If you want to know why MAS has been suspended, you simply need point to Horne and Huppenthal. It was this tandem which, unfortunately, had the will, drive, finesse and political power to make it happen.

It is unfortunate because a program delivering significantly positive educational outcomes was sacrificed in the name of an extremely partisan ideology. It is also unfortunate Delores Huerta made partisan comments in a public, non-partisan venue, for that sent Horne, and ultimately Huppenthal, on a political vendetta: the assassination of Tucson’s Mexican American Studies. Yes, both men talk of biased teaching, indoctrination, and a MAS program that racially divides students, but that is not only unfounded but a mask: one intended to divert attention from their ulterior motives. Frankly, if the pair made a mistake, it was Huppenthal’s hiring of Cambium Learning, Inc. for an audit where he could not control the outcome, or perhaps Huppenthal never really considered that Cambium’s evaluation might differ from his own. At any rate, Cambium’s final report countermanded Horne and Huppenthal’s predetermined course of action, so the report had to be ignored or, as Huppenthal later attempted, discredited.

The greatest tragedy in this story is the affect of the loss of Mexican American Studies on thousands of current and future Tucson students. That loss is at a minimum two-fold: loss of

• Knowledge concerning the history of Latino culture, its struggles for equality, and the oppression that has been suffered, and
• An environment conducive to group analysis, discussion and the development of critical thinking skills.

This is the irony of Horne and Huppenthal’s legislation: they have legally mandated the oppression of those who simply wanted to learn of oppression.

As someone commented in a reply to a blog: This law (H.B.2281) and everything that has been done to force it within Arizona proves that white people are still quite happily oppressing the rights of non whites. It's not history, it's called current events. 83) The “society in which everybody is working for a better tomorrow,” to borrow a phrase from Huppenthal, should apply to state legislators, too. However, in yet another irony, H.B. 2281 instead moves Arizona

closer to the realm of Dante’s inferno. Perhaps visitors to the Grand Canyon state arriving via highway deserve a more appropriate welcome: “Abandon critical thought, ye who enter here.”

Fortunately, all is not lost. Tucson attorney Richard Martinez filed a motion in late 2011 for a summary judgment on three constitutional claims relative H.B. 2281. Martinez has stated he hopes to hear the motion in February, 2012, and that there may be a decision by March. ⁸⁴⁾

Presuming the arc of the universe truly bends toward justice, Arizona H.B. 2281 will be ruled unconstitutional, Tucson’s Mexican American Studies will begin to pick up the pieces, and- someday soon- it will again thrive.


Updates

House Bill 2654, ‘An Act Repealing Sections 15-111 and 15-112, Arizona Revised Statues, Relating to School Curriculum,’ was introduced to the Arizona legislature by Representative Sally Gonzales. The resolution has support of the American Library Association ⁸⁵⁾ and Mujeres Activas en Letras y Cambio Social (MALCS), a national professional association of Chicanas, Latinas, Native American and Indigenous women. ⁸⁶⁾ However, no information was available on the Arizona House of Representatives website concerning the bill and its status as of February 5, 2012.

The American Library Association (ALA) issued a resolution denouncing the suppression of open inquiry caused by the closing of MAS, condemning the restriction to educational materials associated with MAS, and urging the Arizona legislature to pass Gonzales’ H.B. 2654. The ALA resolution came from the group’s mid-winter meeting in Dallas, Texas, where the ALA Office for Intellectual Freedom worked with various ALA committees in creating the statement. The resolution was passed by the ALA’s governing council on January 24, 2012. ⁸⁷⁾

One week later, more than two dozen organizations joined the American Booksellers Foundation for Free Expression in a statement of opposition to TUSD’s book censorship. Organizations joining the ABA’s Foundation included the Author’s Guild, American Association of University Professors, Association of American Publishers, the National Education Association, and 25 others. Their opposition is primarily based on first amendment rights and states in part, ⁸⁸⁾

School officials have insisted that the books haven't been banned because they are still available in school libraries. It is irrelevant that the books are available in the library… School officials have removed materials from the curriculum, effectively banning them from certain classes, solely because of their content and the messages they contain. The effort to "prescribe what shall be orthodox in politics, nationalism, [or] religion" is the essence of censorship, whether the impact results in removal of all the books in a classroom, seven books, or only one.

Book-banning and thought control are antithetical to American law, tradition and values… The First Amendment right to read, speak and think freely applies to all, regardless of race, ethnicity, sex, religion, or national origin. ⁸⁹⁾

Footnotes

¹ “Rejected in Tucson,” Editorial, The Opinion Pages, The New York Times, January 21, 2012.
² The New York Times, ibid.
³ The New York Times, ibid.
⁴ “Curriculum Audit of the Mexican American Studies Department, Tucson Unified School District,” Cambium Learning, Inc., May 2, 2011.
⁵ Cambium Learning, ibid.
⁶ Cambium Learning, ibid.
⁷ “Profile in Courage: On Frontlines of Arizona Crisis, Mexican American Studies Director Sean Arce Teached Nation an Enduring Lesson,” Jeff Biggars, Education, The Huffington Post, August 15, 2011.
⁸ Biggars, ibid.
⁹ Biggars, ibid.
¹⁰ Biggars, ibid.
¹¹ Biggars, ibid.
¹² Biggars, ibid.
¹³ “TUSD Banning Books? Well Yes, and No, and Yes,” Mari Herreras, The Range, Tucson Weekly, January 17, 2012.
¹⁴ “Tucson battles Wild West image after shooting,” John D. Sutter, CNN, January 13, 2011.
¹⁵ “Activists fire back at Tom Horne for comment over Dolores Huerta,” KVOA, February 23, 2010.
¹⁶ “Arizona Bans Ethnic Studies,” Jessica Calefati, Mother Jones, May 12, 2010.
¹⁷ “Curriculum Audit of the Mexican American Studies Department, Tucson Unified School District,” Cambium Learning, Inc., May 2, 2011.
¹⁸ “Horne resigns from board of ADL,” Deborah Sussman Susser, Jewish News of Greater Phoenix, Volume 62, Number 24, March 5, 2010.
¹⁹ Susser, ibid.
²⁰ “Banning ethnic studies won’t end idea,” James E. Garcia, The Arizona Republic, January 24, 2012.
²¹ “Curriculum Audit of the Mexican American Studies Department, Tucson Unified School District,” Cambium Learning, Inc., May 2, 2011.
²² Cambium Learning, ibid.
²³ “Statement of Finding Regarding Tucson Unified School District’s Violation of A.R.S. 15-112,” John Huppenthal, Office of the Superintendent of Public Instruction, Department of Education, State of Arizona, 2011.
²⁴ “Arizona’s Attack on Chicano History and Culture is Against Everyone,” Luis J. Rodriguez, Latino Voices, The Hugffington Post, January 18, 2012.
²⁵ “Curriculum Audit of the Mexican American Studies Department, Tucson Unified School District,” Cambium Learning, Inc., May 2, 2011.
²⁶ Cambium Learning, ibid.
²⁷ Cambium Learning, ibid.
²⁸ Cambium Learning, ibid.
²⁹ Cambium Learning, ibid.
³⁰ Cambium Learning, ibid.
³¹ Cambium Learning, ibid.
³² “Statement of Finding Regarding Tucson Unified School District’s Violation of A.R.S. 15-112,” John Huppenthal, Office of the Superintendent of Public Instruction, Department of Education, State of Arizona, 2011.
³³ “Arizona’s ‘banned’ Mexican American books,” Roberto Cintli Rodriguez, The Guardian, January 18, 2012.
³⁴ “Statement of Finding Regarding Tucson Unified School District’s Violation of A.R.S. 15-112,” John Huppenthal, Office of the Superintendent of Public Instruction, Department of Education, State of Arizona, 2011.
³⁵ “Huppenthal’s conclusion is way off base,” Editorial, The Arizona Star, June 17, 2011.
³⁶ The Arizona Star, ibid.
³⁷ “Tucson Schools Ethnic Studies Program Dismantled, Deemed Illegal,” Education, The Huffington Post, January 11, 2012.
³⁸ “Arizona’s Apartheid War Against Mexican American Studies,” Roberto Rodriquez, TruthOut, January 4, 2012.
³⁹ “Tucson Schools Ethnic Studies Program Dismantled, Deemed Illegal,” Education, The Huffington Post, January 11, 2012.
⁴⁰ The Huffington Post, ibid.
⁴¹ The Huffington Post, ibid.
⁴² The Huffington Post, ibid.
⁴³ “Debating Tucson School District’s Book Ban After Suspension of Mexican American Studies Program,” Democracy Now, January 18, 2012.
⁴⁴ Democracy Now!, ibid.
⁴⁵ Democracy Now!, ibid.
⁴⁶ “Banning Books in Tucson,” Dennis Bernstein, Consortium News, January 22, 2012.
⁴⁷ Bernstein, ibid.
⁴⁸ “Arizona’s ‘banned’ Mexican American books,” Roberto Cintli Rodriquez, The Guardian, January 18, 2012.
⁴⁹ “Students in walkout suspended,” Alexis Huicochea, The Arizona Daily Star, January 27, 2012.
⁵⁰ “Arizona’s ‘banned’ Mexican American books,” Roberto Cintli Rodriquez, The Guardian, January 18, 2012.
⁵¹ Rodriquez, ibid.
⁵² “Ethnic book ban even includes Shakespeare,” Rheana Murray, The New York Daily News,January 16, 2012.
⁵³ Murray, ibid.
⁵⁴ Murray, ibid.
⁵⁵ “Arizona’s ‘banned’ Mexican American books,” Roberto Cintli Rodriquez, The Guardian, January 18, 2012.
⁵⁶ Rodriquez, ibid.
⁵⁷ “Mexican American Studies Department Reading List,” Debbie Reese, American Indians in Children’s Literature, January 15, 2012.
⁵⁸ “TUSD Banning Books? Well Yes, and No, and Yes,” Mari Herreras, The Range, Tucson Weekly, January 17, 2012.
⁵⁹ “Tucson says banished books may return to classrooms,” Jeff Biggers, Salon, January 18, 2012.
⁶⁰ Biggers, ibid.
⁶¹ Biggers, ibid.
⁶² “Banning Books in Tucson,” Dennis Bernstein, Consortium News, January 22, 2012.
⁶³ “TUSD Banning Books? Well Yes, and No, and Yes,” Mari Herreras, The Range, Tucson Weekly, January 17, 2012.
⁶⁴ “Neo-Raccism in the Southwest,” Jorge Mariscal, Counterpunch, January 18, 2012.
⁶⁵ “TUSD Banning Books? Well Yes, and No, and Yes,” Mari Herreras, The Range, Tucson Weekly, January 17, 2012.
⁶⁶ Herreras, ibid.
⁶⁷ Herreras, ibid.
⁶⁸ “Neo-Raccism in the Southwest,” Jorge Mariscal, Counterpunch, January 18, 2012.
⁶⁹ “The ‘Madness’ of the Tucson Book Ban: Interview with Mexican American Studies Teacher Curtis Acosta on ‘The Tempest’,” Jeff Biggars, AlterNet, January 17, 2012.
⁷⁰ “Neo-Raccism in the Southwest,” Jorge Mariscal, Counterpunch, January 18, 2012.
⁷¹ “Attack on Mexican American Studies is shortsighted,” Tom Sheridan, Arizona Daily Star, January 18, 2012.
⁷² “Arizona’s Attack on Chicano History and Culture is Against Everyone,” Luis J. Rodriguez, Latino Voices, The Huffington Post, January 18, 2012.
⁷³ “Axed Mexican American studies program still polarizing Tucsonans,” Luke Witman, Tucson Examiner, January 15, 2012.
⁷⁴ Witman, ibid.
⁷⁵ “Educating for Democracy: Big Brother is Watching in Arizona,” Joel Shatzky, Education, The Huffington Post, January 16, 2012.
⁷⁶ “Arizona’s Attack on Chicano History and Culture is Against Everyone,” Luis J. Rodriguez, Latino Voices, The Huffington Post, January 18, 2012.
⁷⁷ “Debating Tucson School District’s Book Ban After Suspension of Mexiacn American Studies Program,” Democracy Now, January 18, 2012.
⁷⁸ “Profile in Courage: On Frontlines of Arizona Crisis, Mexican American Studies Director Sean Arce Teached Nation an Enduring Lesson,” Jeff Biggars, Education, The Huffington Post, August 15, 2011.
⁷⁹ “Attack on Mexican American Studies is shortsighted,” Tom Sheridan, Arizona Daily Star, January 18, 2012.
⁸⁰ “Banning ethnic studies won’t end idea,” James E. Garcia, The Arizona Republic, January 24, 2012.
⁸¹ “Neo-Raccism in the Southwest,” Jorge Mariscal, Counterpunch, January 18, 2012.
⁸² “Attack on Mexican American Studies is shortsighted,” Tom Sheridan, Arizona Daily Star, January 18, 2012.
⁸³ “TUSD Banning Books? Well Yes, and No, and Yes,” Mari Herreras, The Range, Tucson Weekly, January 17, 2012.
⁸⁴ “Mexican American Studies Legal Update Today,” Mari Herreras, The Range, Tucson Weekly, January 26, 2012.
⁸⁵ “Resolution Opposing Rewstriction of Access to Materials and Open Inquiry in Ethnic and Cultural Studies Programs in Arizona,” OIF Blog, Office for Intellectual Freedom, American Library Association, January 24, 2012.
⁸⁶ “MALCS Protests Arizona Ban on Ethnic Studies,” MALCS Executive Committee, Mujeres Talk, Mujeres Activas en Letras y Cambio Social, January 30, 2012.
⁸⁷ “Resolution Opposing Rewstriction of Access to Materials and Open Inquiry in Ethnic and Cultural Studies Programs in Arizona,” OIF Blog, Office for Intellectual Freedom, American Library Association, January 24, 2012.
⁸⁸ “Joint Statement in Opposition to Book Censorship in the Tucson Unified Schoold District,” American Booksellers Foundation for Free Expression, January 30, 2012.
⁸⁹ American Booksellers Foundation for Free Expression, ibid.

Why do we have profit in health care financing?

America’s for-profit, multiple payer system for financing health care might just be the stupidest idea ever conceived.


One look at America’s system for financing health care, a patchwork of multiple, for-profit payers, leaves the impression it must have been conceived by a rocket scientist.

How else to explain it? Certainly for-profit, multiple payer financing wasn’t conceived by an economist, an accountant or a fiscal conservative, because no true conservative or expert in the field would ever tolerate the current system’s inefficiencies.

After all, health care systems have one simple task: providing expedient and quality health care services for all. That is what, when push comes to shove in the form of an injury or illness, rocket scientists, economists, accountants, fiscal conservatives and the rest of us all want.

Logically, the mechanisms for funding such a system would be designed and optimized for fulfilling just that mission. Indeed, according to Dr. Philip Caper, founding member of Maine AllCare, the role of health insurance is exactly that:

“The purpose of health care financing systems is to facilitate the delivery of health care services, to protect individuals and families against huge medical care expenses and to avoid breaking the national bank while they do so.” ¹⁾

Note there’s no ‘making a profit’ in that list. There are reasons it is missing.

The Problem of Profit in Financing Health Care

Health management organizations (HMOs) like Kaiser Permanente, Aetna, United Healthcare, CIGNA, Humana, Blue Cross Blue Shield and others constitute the foundational core of our current for-profit, multiple payer financing of health care.

Unfortunately, it is a foundation built on sand versus rock, where much of the health care expenditure leaks away due to inefficiencies and waste. The sad fact is our profit-seeking private health insurers don’t even come close to delivering the return on investment that a public single-payer would in terms of:

• Efficiencies,
• Quality of services provided, and
• Universality of coverage.

Efficiency

One of the primary reasons Americans pay more and get less for health care is the extra large administrative overhead built into private for-profit health financing versus the same for a single-payer system.

All private health financing entities must devise a paper-shuffling system for managing personal accounts, securing premiums, and paying health providers. For a single-payer, one centrally administered system services all and delivers cost control, whereas in a system with multiple payers, each private insurer creates its own system where no two corporate systems are alike. The problem with this redundancy is the clinics and hospitals providing health care are also saddled with additional staff and administrative overhead simply because of the need to deal with the varied, ever-changing administrative systems of the multiple private payers.

Furthermore, unlike the governmental single-payer, the private health insurer accrues additional overhead in the form of:

• Marketing and sales
• Underwriting liability, and
• Profit

None of these contribute one iota to the amount or quality of health care; to the contrary, the need for such in the private sector, where none exists in a governmental single-payer system, only leads to less bang-for-buck for each dollar spent.

Moreover, the current trend towards exorbitant CEO and high-level executive salaries and benefits means additional revenues must be generated by private sector payers.

A 2003 study by the New England Journal of Medicine noted that administrative overhead consumes 31 percent of America’s health-care expenditures, ²⁾ a figure also used by Physicians for a National Health Program (PNHP). ³⁾

Contrast that to Canada’s governmentally-funded single-payer system, where administrative overhead is less than 17 percent. ⁴⁾ Or contrast it to our own Medicare program, a government-managed single-payer system, financed principally by taxes and publically mandated premiums, which insures many of those aged 65 and older and does so with only five percent administrative overhead. ⁵⁾

One of the stipulations of Obamacare, enacted by Congress in March of 2011, states that private health insurers must keep administrative overhead to less than 20 percent, a level that has led to considerable squawking from the private payers. ⁶⁾

Gee, too bad. The fact is, if the private health insurers can’t keep their administrative costs as low or lower than public single-payers then they probably shouldn’t be in business.

Interestingly, if the bureaucratic waste in U.S. health care could be cut to match Canadian levels, funding universal health care would cease to be an issue:

The U.S. wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured. Administrative expenses will consume at least $399.4 billion out of total health expenditures of $1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage. ⁷⁾

Physicians for a National Health Program (PNHP) essentially echo the same message: that a potential savings of more than $400 billion per year on paperwork alone is enough to provide comprehensive coverage to everyone without paying any more than Americans already do. ⁸⁾

Quality of Services Provided

It’s easy to understand why the for-profit motive of America’s private health insurers, which is to create share-holder (and corporate executive) wealth through maximizing profitability, adversely affects the quality of health services provided.

Take premiums. Profit-driven insurers will charge whatever the market will bear. In theory, the competition between multiple private insurers should drive down health-care costs: at least, that’s what proponents of private health financing continually tell us. In reality, that has not happened. According to the American Medical Student Association (AMSA), profits for the top 17 private health insurers rose by 114% between 2004 and 2007 compared to an average of just 5% for the S&P 500, while health premiums rose by 60% and the ranks of the uninsured by six million (note the increase in the number of uninsured came principally from citizens, not immigrants)! ⁹⁾ AMSA’s conclusion on this outcome speaks volumes concerning why ‘for profit’ has no place in health-care financing:

This situation- private insurance companies making record profits while health insurance premiums and the number of uninsured skyrocket- suggests that insurance companies have an incentive to price people out of health care to maximize profit. ¹⁰⁾

Certainly profit-driven insurers are motivated to implement measures that will either directly raise revenues or provide the equivalent through cost-savings.

Raising deductibles and co-pays is one means of raising revenue, while cost-savings may be achieved by limiting the services that are funded or limiting access to such services. This is accomplished by:

• Profiling to ensure health providers insure only the healthiest and least-risk prone, or charging higher premiums to those deemed less healthy,
• Denying insurance to those with pre-existing conditions,
• Retroactively dumping those who have filed claims by asserting their health care history was inaccurately stated, a practice known as “rescission”, and
• Establishing coverage conditions that limit or minimize what they actually
  pay out. ^{11), 12)}

Frankly, for-profit health insurers exist to generate profit: a mission for which they excel. The problem is their bottom-line driven mission undermines society’s broader need to finance expedient and quality health care for all.

Universal Coverage

The inadequacy of for-profit financing is probably most exposed when it comes to the issue of universal health care.

In 2010, the U.S. Census Bureau reported 50 million uninsured Americans, ¹³⁾ while a study by the Commonwealth Fund placed the number at 52 million with another 73 million who had trouble paying for their health care. ¹⁴⁾ Then, the U.S. Center for Disease Control (CDC) reported 59 million Americans were without health care coverage for at least part of 2010. ¹⁵⁾ These are staggering numbers for a society that totals 300 million, especially when contrasted to the situation in most other industrialized nations where health care is available for all.

Moralists would argue something is seriously wrong with any society that would leave 1 of 6 without health care. A statement by H.E Javier Perez de Cuellar, former Peruvian Secretary General of the United Nations, places the issue in perspective:

"A society is judged not so much by the standards attained by its more affluent and privileged members as by the quality of life which it is able to assure for its weakest members.” ¹⁶⁾

From a religious perspective, I do not know whether Perez de Cuellar was Christian, but certainly his comment echoes the essence of the Christian mandate to care for the least, the lost and the last. Given numerous right-wing politicians and pundits portray America as a ‘Christian’ nation rather than a pluralist religious melting-pot, and that, demographically, it is undeniably true that America is predominantly Christian, it begs these questions: Wouldn’t a Christian nation care for its weakest members? Or does a large segment of America simply want to claim Christianity while not actually being Christian?

After all, access to basic health care is a human right, per Article 25 of the United Nation’s 1948 Universal Declaration of Human Rights (UDHR):

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. ¹⁷⁾

The UDHR was neither covenant nor treaty so was not ratified by signatories, but many nations adopted it into constitutions or law. While that has not been done in the U.S., note that, per the U.S. State Department, the Universal Declaration of Human Rights is official U.S. policy:

The protection of fundamental human rights was a foundation stone in the establishment of the United States over 200 years ago. Since then, a central goal of U.S. foreign policy has been the promotion of respect for human rights, as embodied in the Universal Declaration of Human Rights. The United States understands that the existence of human rights helps secure the peace, deter aggression, promote the rule of law, combat crime and corruption, strengthen democracies, and prevent humanitarian crises. ¹⁸⁾

Furthermore, note the United States did ratify the U.N. International Covenant on Economic, Cultural and Social Rights, whose Article 12 declares signatories must recognize “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” and compels signatories to “create conditions which will ensure all medical service and attention in the event of sickness.” ¹⁹⁾

As documents signed by the U.S. under international law become part of the law of the land, in fact, America has been failing its legal obligations in terms of universal health care.

Naturally, there are those who, despite the legal, religious or moral arguments, dispute this right. Most Republicans are of this ilk, like Tennessee congressman Zach Wamp:

“For some people it's (health care) a right. But for everyone, frankly, it's not necessarily a right. Some people choose not to pay." ²⁰⁾

Wamp contends one-half of the more than 50-million Americans without health care coverage simply choose not to have it. He says they reject their employer’s health care because they don’t want any money deducted from their pay check. ²¹⁾

Personally, I don’t know anyone who has done that. Regardless, let’s literally play devil’s advocate. Suppose Wamp is correct in that some people decline health care because they don’t want to pay. What then to do concerning the other 25 million?

Jesus must have a diabolical twin in Wamp’s world. Take these two perspectives: Jesus as an individual needing health care, and Jesus as health care provider. In the first, if Jesus can’t pay, Jesus presumably dies; in the second, Jesus heals only if the sick are on a plan and the premium has been paid. Frankly, neither meshes with the essence of any scripture I’ve read; perhaps it derives from the Social Gospels of the Holy Bible: The Bush Translation.

The fact is, for-profit, multiple payer systems can’t easily accommodate universal health care. It’s like trying to put a square peg in a round hole; the mechanism is simply incapable of performing the needed task. Perhaps the best analogy on why private health insurers should be abolished comes from Dr. Philip Caper:

“They (for-profit insurers) are like a camel entered into the Kentucky Derby. No matter how much it is trained, how hard it tries, how hard it is whipped or who the jockey is, it never wins. It just wasn’t designed for the job.” ²²⁾

The recent U.S. health care reform commonly referred to as ‘Obamacare’ also falls short in getting the country to a state of universal health coverage. A 2010 report by the Congressional Budget Office (CBO) projects the program will take 32 million off the roll of the non-elderly uninsured by 2019, but that 23 million will remain uncovered. The CBO projects the rate of legal non-elderly citizens who are insured at that time will have raised from 83 to 94 percent. ²³⁾ Paying More for Less

The 34-member Organization for Economic Co-operation and Development (OECD) released its latest report on the state of international health care in November, 2011. While the study includes some statistics for 2010, for comprehensive comparisons one must generally look to the tabulations for 2009 or years prior.

Here’s the succinct summary: The U.S. pays far more for health care than any other OECD nation, but we get far less in return.

First, expenditures. Whether measured on a per capita basis, or as a percentage of gross national product (GNP), what America spends on health care is much greater than any other OECD member:

Total health expenditure, per capita, with parity on U.S. purchasing power (2009)
	United States	$7960
	OECD average	$3361
	Rank in OECD	Highest of 29 24)

Total health expenditure as percentage of gross national product (2009)
	United States	17.4%
	OECD average	9.7%
	Rank in OECD	Highest of 29 25)

The OECD also studied health care expenditure in terms of public versus private financing, and what is interesting is the U.S. ranked 27th of 28. That is, almost all other nations outspend the U.S. in terms of public financing of health care. In essence, due to America’s primary system of for-profit, multiple health insurers, the public outlay for health care is only 47.7 percent, whereas the OECD average is 72.2%. ²⁶⁾

U.S. spending on pharmaceuticals is also worth noting. There, America’s 2009 total expenditure on a per capita basis with parity on U.S. purchasing power shows $956 versus less than $507 for the OECD average. Moreover, the U.S. again trails the field, ranking last of the 25 nations where statistics were reported. ²⁷⁾

Obviously, spending more on health care is not necessarily bad as long as you get a lot more in return- but that’s not the case. Contemplate these statistics:

Life expectancy, total population, from birth (2009)
	United States	78.2 years
	OECD average	79.4 years
	Rank in OECD	25th of 32 28)

Obesity, percentage of population (2009)
	United States	27.7%
	OECD average	15.5%
	Rank in OECD	10th of 10 29)

Infant mortality, deaths per 1,000 population (2008)
	United States	6.5
	OECD average	4.6
	Rank in OECD	30th of 33 30)

Hospital beds per 1,000 population (2009)
	United States		3.1
	OECD average		5.3
	Rank in OECD		25th of 28 31)

Physicians per 1,000 population (2009)
	United States		2.4
	OECD average		3.2
	Rank in OECD		20th of 26 32)

It’s like the New York Yankees, the major league baseball club that has the highest payroll by far (approximately two standard deviations above the norm), somehow also having the worst record in baseball not just once, but year-after-year-after-year. It just doesn’t happen, yet the healthcare equivalent-- the U.S. system-- is exactly that type of nightmarish scenario which never ends.

To be fair, there are a few success stories. America is number two in terms of per-capita MRI capabilities, number two in the five-year colon cancer survival rate, and number one in the five-year breast cancer survival rate; ³³⁾ unfortunately, that is not nearly enough given our massive health care expenditure: we should expect to be at or near the top across the board.

The World Health Organization (WHO) has also analyzed and ranked health systems by country. The last WHO report was in 2000 and, although dated, its relative rankings remain insightful. At the time, overall health care rankings for these notable nations were: France (1), Italy (2), Spain (7), Austria (9), Japan (10), Norway (11), Greece (14), Netherlands (17), United Kingdom (18), Ireland (19), Switzerland (20), Belgium (21), Columbia (22), Sweden (23), Germany (25), Saudi Arabia (26), Israel (28), Canada (30), Finland (31), Australia (32), Chile (33), and Denmark (34). The United States? America was found at number 37, just ahead of Slovenia and Cuba. ³⁴⁾

Americans should be very angry given they spend 2.5 times more per person on health care than the rest of the world, and yet trail badly in virtually all the most important measures of public health.

Given the American love of capitalism, one would presume America loves analyzing cost-benefit ratios. If so… how come Americans put up with this??? The U.S. must demand a higher return on investment from its health care expenditure.

How and Why Other Countries Provide Better Health Care

The reasons why other developed nations provide better health care versus the U.S. are complex and vary greatly due to the nature of the system adopted by a country. However, inefficiencies and waste in America’s for-profit, multiple payer system are probably the biggest culprits in the crime that is U.S. health care.

Here is the perspective of Wendell Potter, Senior Fellow on Health Care for the Center for Media and Democracy and former Vice President of Corporate Communications at CIGNA, concerning the recent OECD study:

The OECD report is just the most recent evidence that Americans are not getting nearly as much bang for the health care buck as citizens of most other developed countries -- and even some countries in the developing world.

The OECD found that the United States spends two-and-a-half times more on health care per person than the OECD average. The U.S. even spends more than twice as much as France, which many experts contend has one of the best health care systems on the planet.

The average expenditure per person in the U.S. is $7,960, a third more than in Norway, the second highest. The OECD average, by comparison, is just $3,233. It is $3,873 in France.

Here are some reasons why: Hospital spending is 60 percent higher than the average of five other relatively expensive countries (Switzerland, Canada, Germany, France and Japan); spending on pharmaceuticals and medical goods is much higher here than any of the other countries; and administrative costs are more than two-and-a-half times the average of the others. ³⁵⁾

Other nations like France, Canada, the United Kingdom and Japan provide universal health care, deliver better medical outcomes, and are more cost effective while doing it versus the U.S., so it behooves Americans to understand how they have accomplished it. A synopsis of the health care system in each country follows where we see the mechanisms for health financing and delivery are unique to each. Commonality is found only in the end product: excellent health services, and, not surprisingly, popularity with the citizens who receive those services.

France

Northern Arizona University’s Paul Dutton encourages Americans to look to France’s model for universal health care versus concentrating on the Canadian model, which also has much to recommend. Dutton writes the French system achieved its 2000 WHO ranking on the basis of the health and longevity of the country’s citizens, its universal coverage, excellence in its health care providers, and the freedoms allotted its patients and providers. ³⁶⁾

Note the French have achieved excellence in health care at very little cost relative America: according to the OECD, the French spend, on a per capita basis adjusted for parity through U.S. purchasing power, just one-half of what an American does: the average French citizen spends $3978 in U.S. dollars on health care, while the average American spends $7960! ³⁷⁾

What is interesting is that, ideologically, the French are quite similar to Americans. Writes Dutton:

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States. That’s because the French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as “socialized medicine.” ³⁸⁾

For physicians there are significant differences between the respective systems:

Virtually all physicians in France participate in the nation’s public health insurance, Sécurité Sociale. Doctors only agreed to participate… … if the law protected a patient’s choice of practitioner and guaranteed physicians’ control over medical decision-making. Their freedoms of diagnosis and therapy are protected in ways that would make their managed-care-controlled U.S. counterparts envious. However, the average American physician earns more than five times the average U.S. wage while the average French physician makes only about two times the average earnings of his or her compatriots. But the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay much lower malpractice insurance premiums. ³⁹⁾

As Dutton notes, this begs an obvious question: Would American doctors support universal health care if it protected their professional judgment and came with an efficient and expedient system for billing and reimbursement? One would certainly hope so.

The French system has minimized administrative overhead to the point it’s system is much more efficient than America’s:

France’s doctors do not face the high nonmedical personnel payroll expenses that burden American physicians. Sécurité Sociale has created a standardized and speedy system for physician billing and patient reimbursement using electronic funds.

It’s not uncommon to visit a French medical office and see no nonmedical personnel. What a concept! No back office army of billing specialists who do daily battle with insurers’ arcane and constantly changing rules of payment. ⁴⁰⁾

So how did this French system come to be?

French legislators overcame insurance industry resistance by permitting the nation’s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market. The French system strongly discourages the kind of experience rating that occurs in the United States, making it more difficult for insurers to deny coverage for preexisting conditions or to those who are not in good health. In fact, in France, the sicker you are, the more coverage, care, and treatment you get. Would American insurance companies cut a comparable deal? ⁴¹⁾

Therefore, while health care financing in France remains private, it is highly regulated. Here’s another take on the matter from Dr. Philip Caper:

It is true that in many wealthy countries private insurance companies are used in the financing of universal health care systems. But they are generally little like American companies. They are regulated public utilities and are told by their governments who to insure, what to cover and how much and when to pay. Most are prohibited from making a profit, or profit is regulated, and are required to pay any willing provider. Not exactly the American model. ⁴²⁾

When we examine standard health care metrics, we see that outcomes given French health care financing significantly outshine the U.S.:

• Life expectancy, total population from birth: 81.0 years versus 78.2 (2009).
• Obesity: 11.2% of total population versus 27.6 (2008).
• Infant mortality: 3.9 deaths per 1,000 population versus 6.5 (2008).
• Hospital beds: 6.6 per 1,000 population versus 3.1 (2009).
• Physicians: 3.3 per 1,000 population versus 2.4 (2009). ⁴³⁾

Thus, even though the French implementation for health care financing and delivery differs from the U.S., its return on investment makes it well worth consideration as a model for emulation.

Canada

As Paul Dutton indicated, many Americans look to their northerly neighbor for inspiration on how to provide universal health care.

Financing Canada’s health care is done through a publically-funded, single-payer system whereas most providers of health care are private. Thus the financing of Canada’s health care is socialized whereas the clinics, hospitals and physicians responsible for delivering health care are capitalist.

The single-payer financing streamlines administrative overhead in billing and reimbursement because providers deal with only one agency versus the multiple payers that providers must accommodate in the U.S. That results in less waste: as previously noted, the percent of each health care dollar that goes to administrative overhead is 16.7% in Canada versus 31% in the U.S. ⁴⁴⁾ This is not to say there is no room for improvement. The 2007 National Physician Survey conducted by the Canadian Medical Association in partnership with the Royal College of Physicians and Surgeons of Canada found 46% of doctors saw paperwork or bureaucracy as major impediments to the delivery of care to their patients. ⁴⁵⁾

Savings are also achieved by a public system that has no need for marketing, profit or paying exorbitant C.E.O salaries and benefits. According to the OECD, Canada’s total health expenditure as a percent of gross national product is 11.4. That exceeds the OECD average of 9.7% but is vastly smaller in comparison with the U.S., where 17.4 percent is spent. On a per-capita basis with parity for U.S. purchasing power, Canadians spend just $4363 for health care versus $7960 for American counterparts. ⁴⁶⁾

Canadian public opinion strongly supports their publically-financed system. A July, 2009 Harris-Decima poll showed 82 percent of Canadians prefer their system whereas only eight percent would be willing to adopt the American model. ⁴⁷⁾ Reverence for Tommy Douglas, former Canadian Prime Minister and the father of Canada’s universal health care, is also insightful given he was chosen as the ‘greatest Canadian’ in a 2004 Canadian Broadcasting Corporation (CBC) contest. ⁴⁸⁾

As for metrics, Canada, like France, out-performs the United States:

• Life expectancy, total population from birth: 80.7 years (2007, last available) versus 78.2 (2009).
• Obesity: 16.5% of total population versus 27.7 (2009).
• Infant mortality: 5.1 deaths per 1,000 population (2007, past available) versus 6.5 (2008).
• Hospital beds: 3.3 per 1,000 population versus 3.1 (2009).
• Physicians: 2.9 per 1,000 population versus 2.4 (2009). ⁴⁹⁾

Thus, while the Canadian implementation for health care financing resembles America’s Medicare, it bears no resemblance whatsoever to the U.S. system of multiple, for-profit payers. However, its return on investment makes it a model well worth considering for emulation.

United Kingdom

The United Kingdom (U.K.), which consists of the sovereign nations of England, Scotland, Wales and Northern Ireland, provides a truly socialized model in that the state not only finances universal health care but generally owns the hospitals and clinics where medical care is dispensed.

The system is known as the National Health Service (NHS) in England, Scotland and Wales and as Health and Social Care in Northern Ireland. Core principles for the NHS are to:

• Meet the health needs of everyone.
• Be free at the point of delivery, and
• Be based on clinical need, not patient ability to pay. ⁵⁰⁾

In the NHS, each patient is registered to a general practitioner who is generally the patient’s first point-of-contact, other than for accidents and in emergencies. That doctor acts as a ‘gatekeeper’ for the system, where premiums do not exist because funding comes from taxation. There are no fees for hospital care, small charges for primary care prescriptions, and slightly greater costs for ophthalmic and dental services. Due to the design, there are no bills to collect or claims to review, so administrative overhead is greatly reduced. ^{51), 52)}

Indeed, a 2010 Commonwealth Fund study of health care for seven nations, including the U.S., ranked the U.K. number two in terms of efficiency trailing only Holland. Naturally, the U.S. ranked last in this category. ⁵³⁾

Critics of the U.K. health care system decry long waits and limited choice, to which the NHS has instituted some reform. Since the Wanless Report was issued in 2004, NHS has moved toward a primary health care (PHC) model that represents a more holistic approach, enabling a wider range of practitioners to provide health services- although doctors, dentists and midwives remain the core providers. ⁵⁴⁾

Like Canada, savings are achieved by a public system that has no need for marketing, profit or paying exorbitant C.E.O salaries and benefits. According to the OECD, the U.K.’s total health expenditure as a percent of GNP is 9.8: just one-tenth over the OECD average, significantly less than either Canada or France and substantially under the U.S. mark of 17.4%. On a per-capita basis with parity for U.S. purchasing power, the U.K. spends just $3478 for health care: again beating both Canada and France and way under the $7960 spent by Americans. ⁵⁵⁾

NHS remains a popular institution within the kingdom; it was popular at its inception in July of 1948, and its ideals remain popular today. ⁵⁶⁾ Interestingly, a 2008 Financial Times / Harris Poll study showed that nearly 60 percent of those in the U.K. feel NHS is “the envy of the world,” while only 15% would “completely rebuild the system.” ⁵⁷⁾

In health care metrics, the United Kingdom outranks the United States:

• Life expectancy, total population from birth: 80.4 years versus 78.2 (2009).
• Infant mortality: 4.7 deaths per 1,000 population versus 6.5 (2008).
• Hospital beds: 3.3 per 1,000 population versus 3.1 (2009).
• Physicians: 2.7 per 1,000 population versus 2.4 (2009). ⁵⁸⁾

Certainly the U.K.’s socialist approach to health care is the diametric opposite of the U.S. model, but its positive returns on expenditure leave it a system well worth considering for emulation.

Japan

The Japanese provide yet another variation for how to manage health care costs with excellence.

Japan employs a type of ‘social insurance’ program. All citizens are required to purchase health insurance either through their employer or a community-based, non-profit insurer, and public assistance is provided to those can’t afford premiums. The average cost for a family premium is $280 per month, with employers paying more than half. Co-pays are set at 30% per procedure, but the total monthly outlay is capped according to the patient’s income. Most health insurance is private, but tightly regulated, and doctors and most hospitals are privately owned. The cost for procedures is re-negotiated between the Ministry of Health and physicians on a bi-yearly basis. Doctors do not act as ‘gatekeepers;’ unlike the U.K., specialists may be seen as often as the patient likes. ⁵⁹⁾

In terms of fiscal outlay, Japan’s 2009 total health expenditure as a percent of gross national product was not provided by the OECD, but a three-year weighted average for 2006-2008 projects to 8.6: less than the OECD average of 9.7% and well below the U.K., Canada or France, and substantially under America’s 17.4%. Likewise, on a per-capita basis with parity for U.S. purchasing power, the three-year weighted average for health dollars spent comes in at only $3007: again easily beating the U.K., Canada and France, and far under the $7960 spent by Americans. ⁶⁰⁾

The Japanese like their health care system so much that, following talk of ‘new American-based free market reform’ earlier in the decade, opposition came from the Ministry of Health, Labor and Welfare (MHLW), the Japanese Medical Association (JMA) and public opinion: one poll showed “an overwhelming majority of the public does not want to reform the present system so that the quantity or quality of care one receives would come to reflect one’s ability to pay.” ⁶¹⁾
As for health care metrics, Japan also out-performs the United States:

• Life expectancy, total population from birth: 83.0 years versus 78.2 (2009).
• Infant mortality: 2.6 deaths per 1,000 population versus 6.5 (2008).
• Hospital beds: 13.7 per 1,000 population versus 3.1 (2009).
• Physicians: 2.2 per 1,000 population versus 2.4 (2008). ⁶²⁾

As with the other countries examined, Japan’s approach to health care also differs from the United States, but its return on investment makes it a system well worth considering for emulation.

Summary and Solutions

Trying to evolve the American health care system and change it ‘for the better’ will likely never be an easy task. Donald Light of the University of Medicine and Dentistry of New Jersey, Stratford, offers Americans some advice from lessons learned from the British experience:

The U.S. is the only remaining industrialized country without some form of universal access to medical services, in part because policy debates are driven by false, self-defeating beliefs. One such belief is that the U.S. cannot afford to cover the uninsured, when in fact a coordinated financing system is the key tool for holding costs down, and there are affordable ways to do it. Even the largest employers are unable to hold major cost drivers in check.

A second belief, held by the medical profession, is that they would lose still more power than they have already under corporate managed care. Yet universal health care systems elsewhere give the profession greater institutional powers.

Third, many believe that the only alternative to voluntary, market-based health insurance is a single-payer system financed by tax revenues, when there are a number of options.

Fourth, many believe that the United States is so large and diverse that any lessons one might learn from smaller and less diverse countries do not apply there, so why bother with possible lessons from anywhere else?

Finally, conservative policymakers and providers imagine that a universal health care system would mean low salaries, rundown facilities, poor quality, and endless waits to see a doctor, as with the British NHS. In U.S. policy debates, the NHS serves as a dreary image of everything one wants to avoid and might get if one actually developed a universal system that was equitable and efficient. U.S. journalists almost never describe the remarkable achievements or innovative and instructive reforms of NHS. One wonders, then, why any sensible reader should waste time on an article about the NHS.

Most of the NHS’s dreary problems… …stem from chronic underfunding and undersupply of personnel and equipment. Many universal health care systems avoid these problems. How well a system is designed must always be distinguished from how well it is funded; the NHS is quite well designed but underprovisioned. By contrast, the U.S. health care system is richly funded but designed so that it maximizes waste, inefficiency, and inequity. ⁶³⁾

‘Well built but under-funded’ was a recurring theme seen while researching NHS. On the other extreme, ‘Over-funded but poorly designed’ is an excellent description of the American health care system.

Frankly, when it comes to health care financing, that the U.S. model even exists simply dumfounds rational thought. One could actually believe a rocket scientist dabbling in accounting might be responsible, rather than the greedy corporatists who wanted, designed and now profit exclusively from it.

Whether measured as a percentage of GDP or on a per-capita basis, America spends far more on health care than any other nation. Unfortunately, it receives very little for its monetary outlay.

Reaching the highest levels of quality health care in the U.S. is far too often limited to the realm of only those who may afford it. Far too many citizens-- perhaps upwards of one-hundred million or more-- either have no health insurance, or at best, inadequate health coverage. Far too many Americans are only one job loss and one major medical bill away from being homeless. Even with the reform measures of Obama’s 2011 health care program, the notion of universal health care in the United States remains just that: a notion.

As the systems in France, Canada, the United Kingdom and Japan show, there are a myriad of ways that quality universal health care could be achieved with less expense.

Inefficiency in the U.S. for-profit, multiple payer system of health financing constitutes the primary reason America has an ‘upside-down’ health care system.

There is no scenario where the current unregulated, for-profit approach to health care financing may work.

If America desires to retain ‘private’ health care financing, the for-profit element must either be eliminated or very tightly regulated, as in France and Japan, with strong consumer oversight. In such a model, the future private insurers bear no resemblance to the current crop of private health financiers.

Otherwise, the option is a publically funded single-payer system, similar to that employed in Canada or the United Kingdom. Like those systems, an American single-payer solution would offer many promises:

• A single payment plan administered by a public agency
• Universal comprehensive health care coverage
• No out-of-pocket expenses
• Free choice of medical provider
• Public accountability versus corporate dictates
• Improved efficiencies and a higher return-on-investment
• A healthier and more productive society

Either solution would be confronted with extremely difficult road blocks, principally from the vast fiscal resources of the Washington lobby of the health care and pharmaceutical industries, and in a larger sense from the ideological mindset of those politicians and pundits who are beholden not to public opinion or the common good but to their corporate masters. In other words, the biggest road block is the ideology of the 99% in Congress who take their marching orders from the 1% of their constituency made up of the obscenely rich (the plutocrats).

These legislative school-yard bullies have screwed all hard-working Americans, regardless of how those Americans have voted, for decades. And that’s being gentle. In fact, Americans needlessly die daily from lack of or insufficient health care, or from delaying medical care because they feel they really can’t afford it, or because they were denied health care by an insurer or provider when they needed it most. Or, they slowly and prematurely die when loss of a job, the health care associated with that job, and an overwhelming medical expense combine to throw them out on the street. Actually, I suspect there’s a million ways a system that’s intended to “do no harm” does just the opposite.

What is the real human cost of America’s health financing fiasco? I haven’t a clue, other than a feeling it must be staggering.

Hopefully Americans will eventually see through the corporate and political propaganda, stand up to the bullies, and hold them accountable. Ultimately, real health care reform will come only when ‘We the People’ demand it. Don’t expect the likes of Bernie Sanders or Dennis Kucinich to be successful if carrying the torch alone.


Footnotes

¹ “Do we need health insurance?,” Dr. Philip Caper, Bangor Daily News, December 15, 2011.
² “Single Payer 101,” Kao-Ping Chua and Flavio Casoy, American Medical Student Association, 2008.
³ “Single-Payer National Health Insurance,” Physicians for a National Health Program, 2012.
⁴ “Single Payer 101,” Kao-Ping Chua and Flavio Casoy, American Medical Student Association, 2008.
⁵ “Do we need health insurance?,” Dr. Philip Caper, Bangor Daily News, December 15, 2011.
⁶ Caper, ibid.
⁷ “USA wastes more on health care bureaucracy than it would cost to provide health care to all the uninsured,” Medical News Today, May 28, 2004.
⁸ “Single-Payer National Health Insurance,” Physicians for a National Health Program, 2012.
⁹ “Single Payer 101,” Kao-Ping Chua and Flavio Casoy, American Medical Student Association, 2008.
¹⁰ Chua and Casoy, ibid.
¹¹ Chua and Casoy, ibid.
¹² “Do we need health insurance?,” Dr. Philip Caper, Bangor Daily News, December 15, 2011.
¹³ “Number of people without health insurance climbs,” Les Christie, CNN, September 13, 2011.
¹⁴ “Americans Without Health Insurance Rise to 52 Million on Job Loss, Expense,” Pat Weschler, Bloomberg, March 15, 2011.
¹⁵ “Report: 59 Million Americans Lack Health Care,” Joshua Norman, Health Watch, CBS News, November 10, 2010.
¹⁶ “Quotes,” Teaching Tolerance, Southern Poverty Law Center, 2012.
¹⁷ “The Universal Declaration of Human Rights,” Article 25, The United Nations, 1948.
¹⁸ “Human Rights,” Diplomacy in Action, U.S. Department of State, 2012
¹⁹ “International Covenant on Economic, Cultural and Social Rights,” Article 12, The United Nations, 1966.
²⁰ “Is health care a ‘privilege’ for some?”, Domenico Montanaro, First Read on MSNBC, March 5, 2009.
²¹ Montanaro, ibid.
²² “Do we need health insurance?,” Dr. Philip Caper, Bangor Daily News, December 15, 2011.
²³ “Estimate of the Direct Spending and Revenue Effects of a Substitute Amendment to H.R. 4872 aka Reconciliation Act of 2010,” Congressional Budget Office, March 20, 2010.
²⁴ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
²⁵ OECD, ibid.
²⁶ OECD, ibid.
²⁷ OECD, ibid.
²⁸ OECD, ibid.
²⁹ OECD, ibid.
³⁰ OECD, ibid.
³¹ OECD, ibid.
³² OECD, ibid.
³³ OECD, ibid.
³⁴ The World Health Report 2000,” World Health Organization, June 21, 2000.
³⁵ “Does the U.S. Have the World’s Best Health Care System? Yes, If You’re Talking About the Third World,” Wendell Potter, Common Dreams, November 29, 2011.
³⁶ “France’s model healthcare system,” Paul V. Dutton, American HealthCare Reform, August 11, 2007.
³⁷ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
³⁸ “France’s model healthcare system,” Paul V. Dutton, American HealthCare Reform, August 11, 2007.
³⁹ Dutton, ibid.
⁴⁰ Dutton, ibid.
⁴¹ Dutton, ibid.
⁴² “Do we need health insurance?,” Dr. Philip Caper, Bangor Daily News, December 15, 2011.
⁴³ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁴⁴ “Single Payer 101,” Kao-Ping Chua and Flavio Casoy, American Medical Student Association, 2008.
⁴⁵ “Cutting through the health system information fog: Royal College environmental scan,” Royal College of Physicians and Surgeons of Canada, August, 2009.
⁴⁶ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁴⁷ “Never mind the anecdotes: Do Canadians like their health-care system?,” Eric Zorn, Change of Subject, Chicago Tribune, August 6, 2009.
⁴⁸ “Tommy Douglas,” Wikipedia, 2012.
⁴⁹ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁵⁰ “NHS Core Principles,” About the NHS, National Health Service, November 4, 2011.
⁵¹ “Technology and Health Care in an Era of Limits,” Annetine Gelijns, U.S. Institute of Medicine, National Academy Press, 1992, pg 80.
⁵² “Sick Around the World: Five Capitalist Democracies & How They Do It,” Frontline, PBS, April 15, 2008.
⁵³ “NHS ranked most efficient in health care study, but ranked poorly in ‘long, healthy lives’,” The Daily Mail, June 23, 2010.
⁵⁴ “The NHS: what can we learn from history?,” Virginia Berridge, BBC History Magazine, January 12, 2012.
⁵⁵ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁵⁶ “The NHS: what can we learn from history?,” Virginia Berridge, BBC History Magazine, January 12, 2012.
⁵⁷ “Health Care Systems in Ten Developed Countries: The U.S. System is Most Unpopular and Dutch System Most Popular,” Harris Interactive (Harris Polls), July 7, 2008.
⁵⁸ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁵⁹ “Sick Around the World: Five Capitalist Democracies & How They Do It,” Frontline, PBS, April 15, 2008.
⁶⁰ “OECD Health Data 2011,” Organization for Economic Co-operation and Development, November, 2011.
⁶¹ “Japan’s Health Care System: Containing Costs and Attempting Reform,” Naoki Ikegami and John Creighton Campbell, Health Affairs, Volume 23, No. 3, May, 2004.
⁶² “OECD Health Data 2011,” Organization for Economic Co-operation and D evelopment, November, 2011.
⁶³ “Universal Health Care: Lessons Learned from the British Experiment,” Donald W. Light, PhD, American Journal of Public Health, January, 2003.