Sunday, November 14, 2010

Detroit, dialysis and special needs

Charlie LeDuff has written an essay on the state of the worst bits of Detroit. If you're feeling sturdy, you can follow it with a Robin Fields review of the state of America's universal care system for dialysis provision.

Have you read them both? No, Scotch is not a good solution.

Both essays made my skepti-sense tingle. It feels like we're missing some context, that we're probably getting a simplified view. The dialysis experience described here, for example, is not what the insured middle class gets. Even so, I think there's fundamental truth in both stories.

The dialysis problem feels most "easily" fixable. Health Care Reform, once it survives Limbaugh and Palin, can absorb this isolated program. Yes, it will survive. Mega corporations are now pivoting to life in a post-HCR world. They control Limbaugh, he will do their will.

Detroit is harder. Everyone who can leave has left. The remainder are the disabled and the children of the disabled, enmeshed in a nest of poverty. To a first approximation, it's a densely concentrated adult special needs community, with a high concentration of special needs in children as well. (I know a special needs community well. You would be wrong to read this as a condemnation.)

I think there are fixes for Detroit. We need to look for lessons from New Orleans pre and post Katrina, lessons from the most impoverished aboriginal communities, and lessons from war ravaged cities like 1980s Lebanon and 2010 Baghdad, lessons from 1970s Harlem. Detroit can be improved, but it will take decades ...

Slow hard work. There is no lack of challenge in the world.

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