Me Too

By Melissa Finnegan

#metoo

I know, I know, I’m late to this party.  I’ve seen the hashtag go by and each one has resonated with me, but I didn’t feel the need to join in myself.  I've never been a victim of sexual assault (thankfully) and I didn’t feel like any harassment I’ve experience really warranted adding my voice to the chorus.  Because, in many ways, I’ve stopped recognizing it as harassment.

Yesterday, as my husband Patrick and I were wrapping up our day, he was watching clips from The Daily Show while I put away some painting supplies.  On my way to the basement I heard a female correspondent say “When it comes to sexual harassment, every day women are going through an obstacle course.  It’s like a ‘tough mudder,’ but instead of mud, it’s dicks.”  And it hit me.  Yes.  Yes we are.  That statement reminded me of an event that I had honestly forgotten about that had happened that morning.  At 8:30 am on a Wednesday, on my way to work, while I was wearing a conservative skirt and sweater, a van full of guys started hooting and hollering at me.  I rolled my eyes, kept going, and forgot about it.

And that’s how insidious it is.  It becomes a normal part of your day.  The constant navigation of the obstacle course.  Ignore the guys in the van.  Scan the men on the bus, looking for a threat.  Be hyper-aware of who’s around you at the bar.  It’s a constant background noise of vigilance that is so ingrained in so many women, we’re no longer consciously aware that we do it.

It’s even worse than that.  The fact that it’s so commonplace means that subtle escalations don’t seem to be that bad.  Get used to the hollering on the street and, suddenly, having your butt grabbed in a bar or while walking up a staircase isn’t that surprising.  And you shrug it off.  A guy at work gives you a full body look-over and leers, and later you laugh about it with your friends.  And on, and on, and on.  Each increasing level of harassment or borderline assault is less shocking because all the “lower level” harassment has just become so normal.

And it starts young.  I recall a friend of mine recounting how she watched older teenagers checking out her 12-year old.  Twelve.  And I wasn't surprised by that because, yeah, that’s when I seem to recall my first awareness of this part of reality as well.  That’s when I first started to learn how to navigate the obstacle course.

It’s important that we remember and tell these stories. Because the men in our lives, the good men, who would never dream of grabbing someone or yelling at them from a car, often don’t understand how pervasive this is.  Poor Patrick, the first time he was with me while someone drove by and cat-called me, he was so floored.  He was absolutely shocked that people actually do that.  And all I could do was look at him and say, “yeah, this happens all the time.”

So yes, #metoo.  #AllOfUs.  This is the world we live in and the world we’ve come to accept.  It’s a normal part of life that we don’t think about until someone stands up and says, “hey, this is not ok.”  Until we all stand up and say “IT'S NOT OK.”

This post represents the opinion of the author in her personal capacity and should not be construed as the official position of any agency, organization, or contractor by which the authors are presently or have been previously employed.

Reaction Roundup: The Firing of FBI Director James Comey

Two of the Ad Hoc Standing Committee’s contributing writers offer brief opinions on Trump’s firing of FBI Director James Comey.  While events continue to unfold rapidly in the wake of the dismissal, the act itself of firing carries some weighty implications, to which we turn our attention.  

Mel: What concerns me the most about this situation is that it is yet another example of President Trump’s tendency to act first and then ask questions or seek advice later.  His administration appears disorganized and chaotic because his staff is constantly required to react to the whims and caprices of a Commander in Chief who shoots from the hip with little to no context, forethought, or engagement.  President Trump fired Comey because he wanted to; it doesn’t matter if it was because of the Russia investigation, the Clinton emails, or because he didn’t like the tie Comey wore on TV.  What matters is that the President decided to do something drastic and went ahead and did it with – apparently – little thought given to its ramifications.  And then he was surprised when accolades didn’t come pouring in like he had anticipated.

The reason I find this concerning is because, for certain domestic political-institutional issues like this one, it’s largely insider baseball that political pundits like to talk about endlessly on TV, but with which the general public really doesn’t concern itself.  I doubt most Americans really care about who the head of the FBI is or, really, who he’s investigating at any given time.  It should matter to them, but I doubt that it does.  What I’m worried about is if President Trump is allowed to continue this pattern of impulsive action before reflection in the international sphere.  Foreign governments are significantly less, shall we say, understanding of spontaneous decision making than the general American public.  Missteps like this in the international arena could have much more dramatic consequences than pundits complaining on MSNBC.  Misread intentions can lead to people getting killed.  Unfortunately, it doesn’t appear that anyone in the Trump Administration is willing – or able – to address this particular aspect of President Trump’s leadership style.  At some point, he will shoot from the hip on the international stage and we will be left with the fallout.  Hopefully it can be contained.

Patrick: Admittedly, my first reaction was tongue-in-cheek, something along the lines of  “Huh.  How ungrateful.”  Although there are convincing reasons to believe that Comey severely mishandled Clinton’s email investigation (example), to be fair, he appeared to be proceeding in some good faith with the investigation into Russia’s interference in the 2016 election.  Comey’s apparent unwillingness to operate as a political loyalist reportedly infuriated Trump, whether the president thought Comey was too soft on Clinton; Comey continued to pursue the investigation into Russian interference in the 2016 elections; Comey refused to back off the Flynn investigation when asked; or Comey refused to pledge personal loyalty to Mr. Trump (example 1, example 2).  Put in context with Trump’s conduct up to this point, the firing and subsequent fallout tell me three main things:

(1)  Trump acted impulsively.  Echoing Mel’s sentiment above, I believe this decision was not a premeditated one.  Although Trump’s irritation with Comey has reportedly been growing, the decision certainly came as a surprise to Trump advisors.  The White House communication strategy on Comey’s dismissal is practically non-existent and the communications team was apparently unprepared for the negative fallout.  As Comey was seeking additional resources for the investigation prior to his sacking, the decision may also have been made in a moment of panic. 

(2)  Trump believes he is still CEO, not the president.  This incident is one of a series in which Trump has been enraged and mystified when he is politically thwarted.  He is accustomed to obedience in his previous life as a CEO in a centralized corporate structure built around him specifically, a mentality that he brought with him to the White House.  Comey was not toeing the company line to Trump’s satisfaction and was therefore terminated.   Trump will – presumably – replace him with a more on-message director.  In a governance context, however, this mentality arguably undermines the accountability mechanisms and division of powers on which democracy is based. 

(3)  Accountability depends on the Republican Party.  Trump’s obvious reason for dumping Comey is to replace him with a director who will steer the FBI’s efforts away from the Russian connection.  Confirmation of a new FBI Director requires a simple 51-vote majority in the Senate, where Republicans hold 52 seats.  Although some Republicans have voiced concern about Comey’s termination, it remains to be seen what kind of director they will approve.  Additionally, while former FBI Director Robert Mueller has now been appointed by the Justice Department to lead the investigation in a special, independent capacity, it remains to be seen how much autonomy and cooperation he will receive.  

This post represents the opinion of the authors in their personal capacities and should not be construed as the official position of any agency, organization, or contractor by which the authors are presently or have been previously employed.

Healthcare in the United States: What Is The Problem?

By Melissa Finnegan

 

For quite some time now our country has debated the successes and failures of the Affordable Care Act (ACA) and the proposed Republican replacement plan, the American Health Care Act (AHCA).  The bulk of the conversation has centered on the cost of health insurance.  Premiums are too high and unaffordable for many.  Who has access?  What's covered and what do the networks look like?  Should everyone be required to have insurance?

Years ago, as a brand new graduate student at the Humphrey School of Public Affairs, I took a class entitled Introduction to Policy Analysis with Dr. Sam Myers.  Dr. Myers lectures in much the same way a Baptist minister preaches.  It's enthusiastic, loud, and memorable.  It’s also designed to make you focus on deeper truths.  As a result of that class, one phrase is forever burned into my brain: “What. Is. THE PROBLEM?!

In consideration of that fundamental question, I argue that the cost of health insurance is not the main problem we need to solve.  It is a symptom of the real problem.

So what is the problem?  Healthcare costs in the United States are entirely too high and there are not enough structures in place to address them.  Steven Brill’s detailed exposé of medical costs in Time Magazine demonstrates how wildly inflated pricing devastates many patients and their families.  Until we can get the escalating cost of healthcare under control, health insurance premiums will continue to go up.    It won't matter if we continue with the ACA or repeal it and adopt the AHCA; the more expensive care is, the more insurance costs will rise to pay for it.

The misunderstanding of the problem is so pervasive that it's even invaded Google.  I entered the search phrase "average cost of health care" and the first page of results were all for sites addressing the cost of health insurance.  Not the question I asked.

I did finally find the information I was looking for and it doesn’t look good.  According to data from the Organisation for Economic Cooperation and Development (OECD), the United States spends more on healthcare, per capita, than any other industrialized nation in the world.  But that spending does not translate into our population being healthier.  As shown by the OECD chart below, the United States is a clear outlier in terms of life expectancy related to per capita health spending.

One of the drivers of high health care costs is pharmaceutical drugs.  For example, according to a study conducted by the Minnesota Department of Health, approximately 20% of healthcare spending in Minnesota in 2013 was for pharmaceuticals.  Between 2009 and 2013, prescription drug spending rose 20.6%.  Developments in Minnesota are reflective of national trends; a recent federal health report found that prescription drug prices rose 12.6% in 2014.  One can only imagine how that these prices have grown in the past few years.  

But it's not just drugs alone.  As a pregnant woman, I'm especially interested in the cost of giving birth.  Luckily, I'm insured by my employer, but many people are not.  According to a Truven Health Analytics Marketscan Study, the average payment for a vaginal birth for someone with employer insurance is $12,520.  This price includes pharmacy fees, radiology/imaging fees, laboratory fees, professional services fees, professional anesthesiology fees, and facility fees.  

Notice I said "average payment" and not "average cost."  That's because how much is paid by the consumer is related to the type of insurance they carry.  The payment rates are entirely different depending on if the patient is on private insurance vs. Medicare or Medicaid.  Private insurance plans tend to pay more.  This is why, for example, the CEO of the Mayo Clinic recently admitted that, all other things being equal, Mayo will prioritize patients with private insurance over those on public programs.

So how do we address the real problem?  How do we bring healthcare costs down to a manageable level and, as a result, reduce the cost of health insurance?  There are a variety of options, including prioritizing public health efforts that help prevent people from getting sick in the first place.  Regulatory structures could set rules and guidelines for pricing. Also under consideration is movement away from a fee-for-service structure, where items are paid for on an à la carte basis.  In this model, providers make more money based on the number of services they provide, as opposed to results and outcomes.

My ultimately point is that we shouldn’t assume that erasing the ACA or resisting the AHCA will solve the deeper problem of healthcare costs that the United States is currently facing.  There is no question that the health insurance market needs to be addressed, but focusing only on that symptom without addressing the underlying problem is essentially putting a band-aid on an amputation.

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This post represents the opinion of the author in her personal capacity and should not be construed as the official position of any agency, organization, or contractor by which the author is presently or has been previously employed.

 

The Human Rights Apocalypse? Or Evolution?

By Patrick Finnegan

“International Human Rights Law” may not be a common household expression in the United States, but its effects are felt here and around the world.  For example, many of the legal challenges to the second Bush Administration’s use of torture on “War on Terror” detainees were not only based on U.S. law, but also on U.S. treaty obligations as defined by the UN Convention Against Torture and the Geneva Conventions.  Advocacy groups, policymakers, and others in the U.S. routinely invoke human rights law in regard to other issues too, such as immigrant rights and the use of drone strikes.  In some countries, human rights treaty obligations are automatically incorporated into domestic law after ratification, making them a critical part of national legal and political processes.

Treaty obligations, of course, do not necessarily lead to respect and compliance.  Even before Brexit and the election of Donald Trump, international policymakers and academics began to question the continuing relevance of international human rights.  In the wake of Donald Trump’s election, BBC journalist Imogen Foulkes penned a piece titled with the stark question, “Are we heading towards a ‘post human rights world’?”  She asks if human rights treaties will continue to be relevant in an era of brazen violations, widespread displacement, and rising nationalism.  In the academic world, there is a strain of thought, perhaps best embodied by Professors Stephen Hopgood and Eric Posner, that suggests that international human rights law as we know it will soon come to an end.  

Posner’s arguments mostly focus on what he sees as the human rights regime’s ineffectiveness and relative lack of enforceability, as well as the excess proliferation of treaty obligations.  Hopgood emphasizes the disjuncture he sees between the global aspirations of human rights and the dependence of the movement on Western power.  He argues that, not only do states frustrate the noblest aspirations of human rights-based universality, but also that states are – ironically – integral to the growth of the entire paradigm.  In Hopgood’s framework, the rise of hard-edged nationalism on both sides of the Atlantic underscores this fundamental problem.  Both Posner and Hopgood contend that human rights as a field is plagued by a hubristic sense of world-saving self-righteousness.  Although they come from different perspectives (and most likely different politics), Hopgood and Posner both argue, essentially, that human rights as we know it is on an inevitable countdown to irrelevancy, if not total collapse. 

I’ll grant that these are provocative theses that are worth some real consideration.  They should not, however, be read with an uncritical eye.  Other scholars and practitioners with more experience and wisdom than me have commented on the details of both arguments, notably Marsha Freeman, Michael O’Flaherty, and Beth Simmons.  I would like to highlight bigger-picture differences I have with the “human rights apocalypse” thesis. 

Essentially, I think that Posner and Hopgood’s arguments fail to adequately entertain the possibility of evolution of the international human rights paradigm, in both theory and practice.  Posner and Hopgood seem to feel that, in the face of strong winds of global geopolitical change, human rights will break rather than bend.  But this view assumes an excessively doctrinal and caricatured image of what human rights advocacy actually looks like in the real world.  While there are certainly rigid utopians in the human rights crowd, I think there is a strong and growing belief among both scholars and practitioners that human rights principles serve as a broad moral, legal, and political framework for the discussion of how people should be treated by authority and by each other.  Yes, there are minimum standards and prohibitions on certain practices, like torture.  But within that framework, there are a range of viewpoints and plenty of room for healthy debate.  Human rights does not have a strict policy prescription for every situation; rather, it is designed to shape law and policy.

Other global paradigms have arguably evolved and changed with the exigencies of the times.  Why not human rights?  In his reply to Hopgood, Michael Barnett discusses the imperialistic 19^th century origins of modern humanitarianism.  If – arguably – a fair bit of evolution has occurred to make humanitarianism more universal and less paternalistic, why couldn’t human rights do the same? Barnett might counter that humanitarianism has the much more modest goal of relieving immediate suffering in emergencies while human rights are utopian in nature.  But human rights implementation isn’t the same for every right or category of rights, let alone for every organization.  Indeed, the economic, social, and cultural rights paradigm acknowledges that states may not have the resources to instantaneously achieve minimum standards of food, housing, healthcare, and shelter.  Article 2 of the Covenant on Economic, Social and Cultural Rights obligates each state party to work toward the full realization of such rights “progressively” and “to the maximum of its available resources.”  So while there is a clear moral obligation to move forward, there is also room for contingencies.

My own experience with human rights defenders suggests that they are often more circumspect in their expectations than Barnett, Hopgood, or Posner would give them credit for.  Many of these practitioners and scholars, I think, can see human rights as a useful space for discussing how people should be treated, and not one that necessarily prescribes a rigid set of rules applicable in the same way in all circumstances.  It is an unfair simplification to paint the human rights movement with a broad brush as bleary-eyed universalists who fail to account for local context.  Amnesty International, the world’s largest human rights organization, recently undertook a major strategic reorientation to support local human rights groups, while ensuring that Amnesty is accountable to and does not displace them.  Another example is the approach of The Advocates for Human Rights, an organization with which I have been involved for over a decade.  The Advocates operates on a framework of strong respect for local partners, only going to countries where it is invited.  The Advocates’ staff and volunteers do not overtake local efforts, but rather enhance and empower them through capacity-building and training as requested. 

I also think that Barnett and Hopgood build an artificial wall between what Hopgood calls “human rights” (broad principles or a “secular religion”) and what he calls “Human Rights” (the treaty bodies, NGOs, and attendant “industry”).  For example, survey work by Professor James Ron and colleagues suggest that there is broad popular support for human rights advocacy in places like India, Mexico, Morocco, and Nigeria.  Moreover, additional research in Mexico by Ron and his colleagues found evidence that this support is backed by a willingness among the Mexican public to donate to human rights organizations.  Together, these studies provide some evidence that there is an affinity for human rights principles, as well as a concrete demand for advocacy and related services, in the Global South. 

It is true that international human rights law often cannot be enforced as consistently, effectively, or systematically as national law.  But this doesn’t mean that human rights are not a valuable political and legal tool.  The work of Professors Beth Simmons and Kathryn Sikkink makes a strong case for how domestic human rights advocates use international human rights as leverage for local demands for better treatment and respect, including demands emphasizing social justice.  Interestingly enough, Hopgood offers social justice as an alternative to “Human Rights” after they meet their demise.  But human rights and social justice are often bound together – if not synonymous – in advocacy campaigns.  Economic, social, and cultural rights are an integral part of the international human rights regime.  Even if, arguably, Western countries prioritize civil and political rights, the fact is that economic, social, and cultural rights matter a great deal to many organizations, advocates, scholars, and others around the world.

I would argue that the “human rights apocalypse” perspective grossly underestimates the salience and power of the ideas captured by human rights, as well as the ability of the enterprise to evolve over time.  We will never stop having fundamental discussions of how people – by virtue of their humanity – should be treated by authority and by each other.  The recent surge in populist nationalism in the West underscores the urgency and relevance of such discussions.  Therefore, while human rights may evolve and come under challenge, they aren’t going into the dustbin of history any time soon.