With the recent changes in elected officials in our country, I have been thinking a lot about this theme. What seems so obvious to me but not to many others (especially in my age group- so frustrating!) is that idealism and realism are NOT THE SAME in politics. How is this not intuitive? Anyone who has taken statistics knows the expression "correlation does not equal causation." Let me amend that idealism does not equal realism!! They are actually totally opposite terms in my mind. Not that I'm jaded.
In undergrad a professor told me the expression that was something to the effect of, "when you are young if you are not politically left-ist you have no heart; when you are older if you are not politically right-ist you have no brain." This is exactly what I mean about idealism vs. realism. Let me explain why I am thinking about this.
So I have a professor who teaches Multicultural Counseling (amongst other courses) in my graduate program. As a part of her required syllabus she wants us to attend a political advocacy training session at the American Psychological Association headquarters in Alexandria, VA, this coming Tuesday. Which is great. HOWEVER, it also recently came to my attention that after this training, we will be required to go to Capitol Hill and advocate for bill HR 3014 on the Health Equity and Accountability Act. So. We are required to advocate for HER political agenda. No problems with that, right? Obviously wrong.
First of all, this is manipulation. 99% of my classmates are going to not read the legislation and blindly advocate for a bill about which they have no idea nor opinion because our professor made it an assignment. No one wants to make s**** for the professor (plus I think in general we are a Nation of blind policy followers). So a bill is getting support because she is manipulating a class who in true form neglects to think for themselves. Second of all, as the professor for the multicultural counseling class, this professor herself claims to be very multiculturally aware. This requires respect, awareness, knowledge, etc for all viewpoints, according to her (does it not, class?) This is what she preaches to us. So explain to me how it is not hypocritical for her to expect is to be sheep and follow her political beliefs. Explain to me how this is being respectful or even aware of differing political beliefs in her classroom. You can't because it isn't. Now any of us who do have the ability and gumption to think for ourselves are in the awkward position of being difficult and standing up to our professor, even to the point where our grades are in jeopardy.
So idealism vs. realism. The bill, and in my opinion much of the current, new and promised policy of our new administration is idealistic. Thus, by definition, it is not realistic. Which is a better policy to enact? Logically only the realistic will work. However, those of us with enough of our brains about us to think this way are heartless because obviously views on policy equate personal values.
The bill she is asking us to support is about extending mental health services to under served, minority populations. Great. Wonderful value. I have no problem with this value. But this is not the same as policy! The value is idealist, therefore corresponding policy cannot be! Idealistic policy does not work! (even ultimately turning socialist, right?) Nothing about the policy is realistic, but because I voice this, I do not have a heart and obviously don't care about diversity. SO FRUSTRATING! In an effort to attack this issue in some way shape or form, I have been reading the bill, public opinion, scholarly and newspaper reports about the bill all day. I put together a list of problems with the bill. Since nothing I found online did this (having to do with avoiding the values judgment?) I feel the need to. The eight-points I argue are below for your consideration. The format is first a statement from the bill, followed by an argument for that statement. And please, USE YOUR HEAD AND THINK ABOUT THINGS!!! Just because it sounds "so nice!" does not mean it will actually help anybody, so you are not automatically a nice person for supporting it. Just kind of a lemming (because we need more of those.)
Points against HR 3014:
1) “Provides for grants for strategies to eliminate racial and ethnic health and health care disparities.”
“Health Equity and Accountability Act of 2007 - Amends the Public Health Service Act to require the Secretary of Health and Human Services to establish the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care.”
Where is the funding coming from? Either me or the mental health agencies; neither of us have money to spare nor need to be told how to use what we do have (why does the government never trust the individual to spend their own money appropriately!? I work hard for my own money and choose how much I can afford to share and who to share it with- the government has no right to make this decision for me; this sounds like socialism!!!)
2) “Improving racial and ethnic minorities’ access to primary care services.”
Should the government have the right to force businesses to pay for additional mental health insurance plans? If so, the businesses will have to limit the number of people they can afford to hire. The first employees to be cut will be the entry level folks, which are typically the minority types listed as in need for advocacy.
3) “Requires the establishment of an Office of Minority Health within specified agencies.”
Where does the money come from to hire the required multicultural liaison to make sure the policies stipulated in the bill are followed? From the agency. This ultimately takes money from the agency reducing the number of cts they can see or reducing the salary of the already underpaid therapists at any federally funded agency. This means:
a. Therapists will quit/leave/be fired from the agency.
b. Other important agency projects such as individual agency plans to reach out in the best way possible to the particular needs of their local communities, will be abandoned in place of the more blind government stipulations.
c. More therapists will opt for independent practice where many/most don’t take insurance further reducing the available services for those underserved.
4) “Provides for the establishment of health empowerment zone programs in communities that disproportionately experience disparities in health status and health care.”
Adding more regulations does not mean change will happen, but it does mean the government gets more control over what goes on in your agency. Just by giving us a list of rules does not change the knowledge base or ability of anyone/thing in the center to reach out to those underserved. Rather, it makes the agency struggle to meet specific number requirements leaving the original problem mostly unsolved (i.e. did we get at least 8 Latinos through the door this month? Never mind if we helped them, spoke Spanish, etc.)
5) “Directs the President to execute, administer, and enforce provisions to address environmental justice in minority and low-income populations.”
This is giving the government more power which I am slow to do unless I feel that it is absolutely the best and only solution. I don’t believe it is so in this situation.
6) “Requires the Secretary to establish: (1) an Office of Health Disparities within the Office of Civil Rights; and (2) civil rights compliance offices in each HHS agency that administers health programs.”
Is this the best solution to this problem? I don’t think so. Better solutions:
a. New standards and ethics of practice from professional organizations (requires no/MUCH LESS money to enforce, can include the important educational pieces)
b. More education for agencies based on particular agency needs (i.e. does this center need Spanish language classes? Does this need to expand to more accessible locations in the inner-city?)
c. Individual therapists and agencies taking it on themselves to offer sliding scale, reduced fee, or pro-bono sessions for underserved populations
d. Individual agency programming to reach out to underserved communities (energy and funds going here rather than trying to meet blanket and federally enforced expectations).
7) “Directs each federal health agency to implement a strategic plan to eliminate disparities and improve the health and health care of minority populations.”
This entire bill pays homage to the never-ending problem of the government thinking it knows best what is better for everyone. This is specifically NOT the case when considering diversity, because this will not be universal so federal standards are myopic and do not apply. Therefore the government is not in a place to create and enforce regulations about strategic plans to reach out to the diversity minority populations.
8) “Enhancing diversity in the healthcare workforce.”
I have a problem with the stipulation to enhance diversity in the mental health workforce because I feel that this discriminates against me. Directly, if this goes into effect, as a white female, I will automatically be LESS QUALIFIED BY NO FAULT OF MY OWN (reverse discrimination?) to be hired into a federally funded agency. If there is a specific criterion for a certain number of multicultural individuals in a federally funded agency that trades traditional hiring techniques such as choosing the most qualified, to doing your best to number-grab. It also has no regard for diversity populations in which the center is located (i.e. is four white people and one Latino representative of the population in this city more than one Asian person, one Latino person, and one white person? Etc). This also assumes that multicultural training and education are worthless (i.e. in lieu of multi-culturally competent counselors as a recommendation/requirement, we are just going to judge based on background; in other words multicultural competence doesn’t better qualify someone to work with diverse populations; rather they must be a member of that group to understand/be able to help). This should not be federally regulated, by decided based on needs by individual community centers.
