The closer you look at the current economic crisis, the more harrowing it becomes.
The focus in the presidential campaign has been almost entirely on the struggles faced by the middle class — on families worried about their jobs, their mortgages, their retirement accounts and how to pay for college for their kids.
Each nauseating plunge in the Dow heightens their anxiety. Each company that goes under and each government report showing joblessness on the rise intensifies their fear.
No one knows how to quell the uncertainty. And no one is even talking about the poor.
Alan Greenspan, uncharacteristically befuddled, went up to Capitol Hill on Thursday and lamented that some sort of fissure had erupted in his previously impregnable worldview. For Mr. Greenspan (“I still do not understand exactly how it happened”), this is a moment of intellectual anxiety.
But if we are indeed caught up in the most severe economic crisis since the Great Depression, the ones who will fare the worst are those who already are poor or near-poor. There are millions of them, and yet they remain essentially invisible. A step down for them is a step into destitution.
Listen to Dr. Irwin Redlener, president of the Children’s Health Fund, which he founded with the singer-songwriter Paul Simon to bring health services to poor and homeless children:
“First of all, at least in the short term, we can expect more families will become homeless as foreclosures continue to mount and jobs become harder to hold and more difficult to find. As jobs disappear and employers begin trimming expenses, we can foresee people losing health insurance, swelling the ranks of the medically uninsured.
“I don’t think the health care system can bear another five million or more people uninsured and economically fragile. More people without insurance will crowd into the nation’s hospital emergency rooms when medical problems become too severe to ignore or there is no other access to basic health services. Such a trend will have a seismic impact on our health care system.”
Few Americans have noticed, but a tremendous number of hospitals, from Boston to Los Angeles, are in serious, even dire, financial trouble. A survey of 4,500 hospitals by the New York consulting firm Alvarez & Marsal found that more than half were technically insolvent or at risk of insolvency.
The current economic downturn, combined with an anticipated surge in patients without health insurance, will only worsen what is already a crisis.
The nation’s financial system was all-but-overwhelmed by the mortgage crisis because none of the nation’s leaders paid serious enough attention to the widespread symptoms of what turned out to be a metastasizing disease.
A similar situation exists on a number of important fronts right now: the deteriorating national infrastructure, the woefully inadequate public school system, our self-defeating energy policies, health care. Symptoms of serious trouble are staring us in the face, but no one is mounting an adequate response.
When a new president takes office in January, the temptation will be to delay bold action on these fronts until the overall economic situation improves. That is the kind of mistake (like ignoring the housing and credit bubbles until it was too late or refusing to heed the pre-Katrina warnings in New Orleans) that opens the door to additional crises.
The Alvarez & Marsal study noted that at many community hospitals the physical plant itself is in bad shape because capital funding had to be curtailed because of budget shortfalls. “There are scores of hospitals that are slowly asphyxiating and slipping into insolvency,” the report said, “as they divert capital dollars to fund operations.
“For most of these hospitals, it is only a matter of time before they hit a ‘sudden’ liquidity crisis and cannot make payroll without entering insolvency and being forced into restructuring their finances and operations.”
Dr. Redlener, who is also a professor at Columbia University’s Mailman School of Public Health, said: “The federal government currently strains to pay hospitals more than $35 billion each year to cover the costs of the uninsured. That money comes from general tax revenue, and it is a budget line that will need to be increased if we don’t want to see an epidemic of hospital closures.”
Most important, of course, is a revamping (in a sane way) of the health insurance system.
There are no good scenarios in the offing. The markets are in turmoil. Banks are being nationalized. The U.S. auto industry has the look of a jalopy with four flat tires.
The evidence of decline and decay is everywhere around us. There has never been a time since World War II when the nation was more in need of a presidential administration with a comprehensive vision and the ability to lead on several fronts at once.http://my.barackobama.com/page/dashboard/public/gGWdjc
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