Howard Dean's essay, "How the Poor Live Now":

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.

Governor Dean continues with an analysis of how the past two decades have drastically changed America's attitudes toward--and solutions for--poverty.

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: http://blog.deanforamerica.com/archives/002289.html#more

when Vanity Fair appeared in my mailbox this month. I rarely have time to read it anymore, but this issue is a keeper. Great essay by Dean, and some great stuff by Graydon Carter too.

but I would really like to hear Dean's consideration of how exactly CAPITALISM could actually foster equality for all people.

It seems the capitalism model banks on a certain portion of poverty-striken have-nots.

I am not an economist, but I am darn sure moving closer to being a SOCIALIST. I would love to hear a staunch capitalist's explanation for how capitalism can fill those gaps. I don't think it's possible.

it references the basic concept that unless you include it you will not get the Republicans you need to go along with any of it. Case in point. Talked to a guy who is thinking of running for office the other night. My friend referred him to me. I had reason to believe he was a Democrat, so wanted to see what he was doing to bolster his candidacy and see where he stands, etc. Turns out, the guy is a Republican- for economic reasons. He said he's socially liberal but "fiscally conservative." I talked to him about disability issues and the serious lack of economic justice being doled out by his party in that respect. He said that the government has a role to play, but it has to stay within the "American model."" whatever that means. Anyway that conversation and others I have had along with watching the Rockefeller pubs give me the impression that as long as you include mainstream capitalism a little bit some of them will get on board. These are the people you HAVE to be able to court to get something like universal healthcare to actually pass in Congress.

I followed your link...is that the total article? If there is more in Vanity Fair, I will read it. His thinking is a trifle muddled, with his obligatory genuflections to capitalism, which in its' pure form would let the poor die unless private charity saved them, but it's a beginning. What is his point with "community based solutions?" I am tempted to write it off as a nod to "welfare as we know it today" (block grants to states; no Federal safely net) but will withhold opinion till I find out more. At least he is mentioning the issue, for which I give credit.