Askew Institute at the University of Florida -- Gainesville
The text of a speech given by David Lawrence Jr., president of The Early Childhood Initiative Foundation, on Sept. 15, 2006 before the Askew Institute at the University of Florida in Gainesville.
We’ve heard from the experts this past day, and now you get a break from that. What I want to do this noontime is share some history, some humanity, some straight talk, and a way to approach the future. And I want to make this quite “personal” as well as “professional.”
You have before you someone who, at age 64, has never stayed overnight in a hospital. Someone who regularly sees four M.D.s and a dentist, for each of whom I have great respect – and affection. Someone who takes four pills in the morning, and three at night, and brushes his teeth both morning and night.
I am one of nine children, all of whom were graduated either from this university or, forgive them, that place in Tallahassee! Someone who grew up on a farm until I was 14 and can remember vividly house calls from kindly, graying, balding Dr. Thompson.
Married almost 43 years to someone I love even more than the day we were married, I am the father of five children – ages 41 to 21 – and the grandfather of three and would be absolutely delighted to have many more. We have been blessed in our family with good health and good health care and a not unusual set of medical moments – in the instance of our own family, pregnancies and miscarriages, a hip replacement (at a retail cost of $68,000) for my wife, and so on. We are not especially blessed with “good genes” (whatever those are), and there is a considerable history of cancer in my family (including both my father and mother). We have had our share of sorrow, including a son-in-law who died suddenly and very prematurely from choking. Who among us escapes this life without pain that cuts deeply, never to be forgotten?
I am, to be sure, a slightly driven person, convinced that life is short, and I take to heart and soul the words of the long-lived playwright and social reformer George Bernard Shaw: “This is the true joy in life: Being used for a purpose recognized by yourself as a mighty one, and being a force of nature instead of a feverish, selfish little clod of ailments and grievances, complaining the world will not devote itself to making you happy. I am of the opinion that my life belongs to the whole community, and as long as I live, it is a privilege to do for it whatever I can. I want to be thoroughly used up when I die; for the harder I work, the more I live. I rejoice in life for its own sake. Life is no ‘brief candle’ for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it to future generations.”
If you knew me, you could not be too surprised that I missed not one day of work in 35 years at seven newspapers. (I confess that I came in sick sometimes, infected all sorts of other people with my ailment of the moment…they called in sick…but I showed up always. I am not recommending this as a recipe for productivity in American work life!)
My life since I retired from newspapering has focused on children – all children – especially in the early childhood years. Powerful and important longitudinal research tells us not that the only learning years of one’s life are to be found in the earliest years – people, indeed, do learn all their lives -- but rather that there are windows wide open during those early years, and never again will so many windows be open quite so wide. I came to understand that it was not only about intellectual and physical growth, but matters, too, of social and emotional development. And I came to understand that all children need a blend of health and education and nurturing – and all must be high quality because only real quality leads to real outcomes. When I “retired” almost eight years ago, I focused mostly on matters of education, including child care and preschool and parent skill-building, but I have come to understand the absolutely vital nature of a “medical home” for all children. I am still learning about such matters, and much else, and hope never to stop learning.
I am a reader of books, seemingly always have been, read at least a book a week, a good chunk of which focus on history. My observations today are framed in the context of the past going forward. It is in that spirit that I quote from a book I read these past few years:
“Little Antanas was not smiling just now, being a mass of fiery red pimples. He had had all the diseases that babies are heir to, in quick succession, scarlet fever, mumps, and whooping cough in the first year, and now he was down with the measles. There was no one to attend him but Kotrina; there was no doctor to help him, because they were too poor, and children did not die of the measles -- at least not often. Now and then Kotrina would find time to sob over his woes, but for the greater part of the time he had to be left alone, barricaded upon the bed. The floor was full of draughts, and if he caught cold he would die. At night he was tied down, lest he should kick the covers off him, while the family lay in their stupor of exhaustion. He would lie and scream for hours, almost in convulsions; and then, when he was worn out, he would lie, whimpering and wailing in his torment. He was burning up a fever, and his eyes were running sores; in the daytime he was…a plaster of pimples and sweat, a great purple lump of misery.”
That book is called “The Jungle,” and it was written a century ago by Upton Sinclair. The setting is Chicago, but it could have been anywhere in America.
Life back then, to quote a New York Times magazine cover story, bespoke of “crowded living conditions, dangerous workplaces, inadequate sanitation and infrastructure in cities and pollution and infectious disease like typhoid fever and cholera that exacted a huge toll on the oldest and youngest in society. Since then, a century’s worth of advances (have) yielded remarkable results. Antibiotics were developed. Anesthesia was improved. Public health programs like mosquito control and childhood immunizations succeeded in reducing or even eradicating diseases like malaria and polio in this country. Congress passed legislation regulating the quality of food and drugs and assuring that safety and science guided medical developments. Workplace and product-safety standards resulted in fewer deaths and injuries from accidents. Effective campaigns cut tobacco use and alcohol abuse. Employers began providing some workers with health care coverage, primarily for hospitalization costs. And to aid some of those left out, President Lyndon B. Johnson persuaded Congress to establish Medicare and Medicaid to address the poorest, sickest, oldest and highest-risk patients in our society. As a result of these accumulated gains, life expectancy grew from 47 years in 1900 to 77 years for those born in 2000.”
Yet for all those gains, how do we remain a nation now of 300 million people that fails to fulfill this country’s promise (and our decency) to millions of our neighbors? For just one example, how could 46 million Americans, among them 3.5 million Floridians, be without health insurance? How can this be in the richest, most powerful country in the history of the world? We live in a time of rapidly escalating health insurance costs. We spend one of every six dollars of GNP on health care. Increasingly, the middle class cannot afford health insurance. And while we are the world leaders in skilled medicine, an estimated 100,000 Americans die each year because of medical errors. Meanwhile, America’s prices for the same services are higher than elsewhere in the world…so are our administrative expenses…and, yes, we also do more complex and specialized procedures.
To quote the former House Speaker Newt Gingrich: “Politicians like to say that the United States has the best health care system in the world. Actually, what we have right now is the best medical talent, technology and facilities in the world – but the system that delivers our care is badly broken.”
How could the system for health care in our great country be so badly broken? How is it possible that among the world’s most industrialized nations, the United States is No. 1 in gross national product, No. 1 in the number of millionaires and billionaires, No. 1 in military and health technology, yet this very same country ranks behind 47 other countries in life expectancy and No. 42 in infant mortality? It is not that we skimp on the dollars -- indeed, we pay far more per capita for health care than any other industrialized country in the world – but rather that we spend billions in wasteful and inefficient ways.
Are we not a better people than this? Could we not have a vision and an approach that embraces all? That is my message.
Listening this morning to Jennifer Tolbert of the Kaiser Foundation and other speakers talk about this acronym-overwhelmed world, I am reminded how devilishly complex our so-called “system” is. And if I have trouble understanding this after a full day of discussion, just imagine how overstressed, overworked parents must feel. I also fully realize that we do not live in simple times, and what I bring you today is not a “solution,” but rather an “approach,” a way of looking at this challenge. Unless we share a vision, and unless that vision embraces all, we are doomed to nibble on the margins of progress. This is not socialism, ladies and gentlemen. Nor radicalism. Nor revolution. Rather, this is basic American fairness.
- For one, good people are increasingly not putting themselves up for public service, nor encouraging and helping other good people to run for office. What a mistake. I certainly don’t want to be insensitive to anyone, but I’ve read enough and heard enough about the history of Cuba to understand that too many good people decided politics was “dirty,” and therefore didn’t get involved. The result was the likes of Machado, Batista and Castro. My point here is not about the history of Cuba, but rather of the lessons of history for all of us – and my concern that the ethos of unselfish and elected public service is being diminished in our own community and our own country.
- Number two, we lead far too separate lives. We are certainly not a “melting pot,” nor really is anywhere else in America. At our best we could be a tasty salad. I would ask, as one test, for each of us to ask ourselves: Whom did I have in my home in the past year? We talk a “good game” of diversity yet too often remain most comfortable with people like ourselves. To overcome that – and be an example to America -- we must confront ourselves.
In my own early childhood work, I have focused not on “programs,” though those are important, but rather on building a “movement.” A movement for everyone’s child is basic American fairness. The American dream embraces all children because all children need all the basics. This is not the forerunner to a “nanny state.” Nor is it one-size-fits-all thinking, most certainly not a re-run of the Clinton-Magaziner efforts of the early Nineties. It is, instead, basic decency for, and wise investment in, all Americans.
Understanding that word “movement” is crucial to understanding the opportunity before all of us. Here is how it most often works. Most people – good people, so well intentioned -- focus on one corner of the community, or another, or focus on families of one income level or another. Then the rest of the people say, “Oh, I understand it is about those people.” But, in fact, building a “movement” – rather than a “program” -- is about everyone. The poor need more help, of course, but the way to help them the most is to help everyone.
Let me give you an example of the thinking-about-everyone approach: Florida, as many of you know, has a law that lets voters in counties decide if they want to raise their property taxes by a half-mill or a mill to provide a dedicated funding source for children. My own community tried to go that route back in 1988. Then State Attorney Janet Reno and other good people led the campaign, arguing that the community ought to help the most neediest. It failed, 2-1. In 2002, after 22 months of hard work, it was back on the ballot. This time we made the case that this would be about everyone’s child, while certainly acknowledging and understanding the obvious: That is, certain children and families do need more help. We passed it, 2-1. This year we will spend more than $70 million extra dollars, administered by an independent private-public board (called The Children’s Trust), on early intervention and prevention.
I give you an example of the difference what we call The Children’s Trust can make. In the place where I live there are 335 public schools (and about 50 charter schools). Those public schools have been served by a total of 19 nurses and 24 health clinics. (Most of you, like me, probably grew up in a time when there was a nurse in every school. But in recent years, in pursuit of other education priorities, school systems across the country have eliminated nurses, art, recess and more. What a shame. How can unhealthy children learn?)
Anyhow, and because of this dedicated funding source called The Children’s Trust, we have developed a collaboration with the school system and the health department. The leader of this effort has been a member of The Trust board and a pediatrician, Dr. Judith Schaechter, a superb person who is with us today. By the end of this year, we will have at least 80 schools with health teams (consisting of a health tech who can give shots and do wellness exams and more, a nurse or nurse practitioner, and someone with a master’s in social work because so many of the health issues are about social and emotional development). Over the next 4 ½ years, the intention is to have a health team in every single Miami-Dade public school. That’s what thinking about everyone can mean.
I am getting too old to think that progress, real progress, is defined by some more people, some more schools. We will get to the only honorable, the only ultimately realistic approach to health care when we think about everyone. You have before you a genuinely registered Independent, someone whose work crosses any party lines, whose work transcends any labels of “liberal” or “conservative.” I cannot forget the example of Massachusetts where, just earlier this year, a distinctly Republican governor and a quite Democratic legislature figured out how to make health care available for all.
Here in our own state, I say fully in the spirit of straight talk, we had a budget surplus this year of hundreds of millions of dollars…and the governor and the Legislature did figure out how to eliminate the taxes on stocks and bonds and liquor by the drink…and yet, somehow, we didn’t figure out a way to make sure that we did something abut the 600,000 children in our state without health insurance. My God, surely we are a better people than that. Lest you think that I believe this to be solely a state issue, let me emphasize otherwise. The President of my dreams would embrace everyone. Leadership, real leadership, is so crucial, Medicare, for example, would not have come to pass, finally, without Lyndon Johnson. Teddy Roosevelt, one of our greatest Presidents, defined leadership as “to dare mighty things.” I yearn for leadership in the spirit of the governorship and life example of Reubin Askew. Nor is it, first, a matter of money. I am tired of discussions that involve the word “discretionary.” Children, I remind us all, deserve better than our “discretionary” help. (It’s worth noting that we have figured out, for instance, how to invest $5 billion each and every month to try to bring democracy to Iraq…yet have not yet figured out how to do minimally right by the children of America.) Rather it is a matter of vision and will. To quote David Shipler in his book, “The Working Poor”: “Our understanding of the problems is ahead of the skills we have acquired to solve them, and the skills are ahead of our will to act.”
Lest you label me naive, and I may be sometimes, please know that I will never be embarrassed to have an optimistic, idealistic soul…or, for that matter, a pragmatically naïve approach to life.
Yes, this is tough to do. Then again, suffrage wasn’t easy. Social Security wasn’t easy. Diminishing racial barriers, for all our progress, remains far from done. Medicare wasn’t easy.
My friends, could not we in Florida, could not we in America “own” a portrait of what we would want for every child, every American? Could we not see this as a wise investment in their future and our own? Is it not basic American fairness that everyone have a real chance to succeed?
Could we not agree on a vision, a strategic plan and a combination of public and private incentives and investments to get us there?
Do you not weary, as I do, of an America where “fairness” so often is judged by what level of “poverty” or “near poverty” that people find themselves? Do you not weary, as I do, of government’s present prisms of 150 or 185 or 200 percent of poverty? Are we not a good enough people to figure out how to make sure no one is left out of America’s fair share?
I think we could. And I hope we will.