An Editorial by Howard Dean: "How the Poor Live Now" [View All]

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How the Poor Live Now

Howard Dean's essay, "How the Poor Live Now," appears in the December issue of Vanity Fair magazine. Dean looks at the current crisis of poverty in America through the lens of a physician and a governor. The magazine is on newsstands now, but the essay, excerpted here, is not availible at Vanity Fair's website.

Dean describes his experiences as a medical student at Albert Einstein College of Medicine:

Every day in the Bronx, I saw low-income patients who had left serious illnesses untreated because they couldn’t afford to go to the doctor. It was a terrible cycle being played out in slow motion before my eyes: a small, treatable condition appears; it goes unattended, grows into a serious health risk that finally erupts with a vengeance; and the patient lands in the emergency room. The bill is astronomical, and the family is bankrupted.

Any sane person could conclude that this was not the most efficient was for our health-care system to be run, nor the most humane. I had no doubts that capitalism was the best possible economic model (I had been raised as a stockbroker, after all), but there were gaps, inconsistencies, and plain cruelties that the market alone would never address, and not only in health care. It seemed to me that local communities and national government had roles to play in easing the pain of economic inequalities.

What we have seen since the 1970s is a governmental effort that has ended up directing even more wealth into the hands of those at the top, while the safety net for those at the bottom slowly frays. This has resulted not in a rising tide lifting all boats but in an ever shrinking middle class and a breakdown of out American community. Most critically at risk are families like Robert’s , which have had the odds against them from the beginning, and which now have no recourse available to them other than that offered by a government whose anti-poverty program, they feel, is rapidly becoming little more than “Get a job.”

If only it were that simple. Some American families are on the verge of permanent hunger in spite of the fact that the parents may be working not one but two or three jobs. Their problems are usually not limited to putting food on the table: many such families cannot house themselves or afford to seek treatment for their medical problems. Poverty knows no prejudice: my first patient on my first E.R. rotation in the Bronx was a 13-year-old African-American girl who was dealing with complications from an unwanted pregnancy; my first patient on my first E.R. rotation in Vermont was a 13-year-old girl in exactly the same circumstances, but Caucasian. The face of poverty is rural, it is urban, it is black, white, Hispanic, male, female, young, and old. It is an American face. These families work as hard as any of us, and many work harder than most, and yet many spend their lives one paycheck, one accident, or one medical emergency away from total financial ruin.

More on Dean's essay in Vanity Fair can be found at http://blog.deanforamerica.com