Tugging our collective conscience

Sometimes a photograph captures the inhumanity of the world in a way that words never could. Such was the case this week with the searing shot of Óscar Alberto Martinez Ramírez and his 23-month-old daughter, Valerie, face down in the muddy Rio Grande, after they had drowned in their determined quest for refuge in the United States.

The photo by Julia Le Duc, first published in the Mexican newspaper La Jornada then distributed around the globe by the Associated Press, was haunting in its detail. The toddler's right arm was curled around his neck. His black T-shirt was wrapped around her to hold her close as they crossed the river.

It was the most universal of human interactions: parent protecting child against danger, and child clinging to her ultimate source of safety. For the child's mother, who watched her loved ones swept away in the current, it was the most unthinkable of horrors.

It should tug at the conscience of all Americans.

The Salvadoran family had wanted to seek asylum the safe way — the legal way, as prescribed in U.S. and international law — by presenting themselves at the port of entry. The international bridge at Matamoros, Mexico, was closed that day. So they took a risk, as so many desperate refugees do, too often with tragic results.

That heartbreaking sight puts in perspective the U.S. customs policy of “metering” — severely reducing the number of migrants who can request asylum on any given day — and the Trump administration's expressed intent to discourage people fleeing crime and poverty for a better life by complicating their options for legal entry. The 25-year-old Martinez had struggled to support his family on $350 a month working at a Papa John's in El Salvador.

“They went for the American dream,” his mother said.

This is not the first time a photo of a child has commanded the world's attention on crisis: there was the lifeless 3-year-old Syrian boy on the beach after the sinking of a refugee boat in 2015; the blood-and-dust-covered Syrian 5-year-old pulled from a building bombed by the Russians the same year; the starving Sudanese girl being eyed by a vulture in 1993.

This one is on us. We can't look the other way. We must challenge the policies that led them to the river.

San Francisco Chronicle


Battling high health care costs

The Trump administration continued to nibble away Monday at the problem of high healthcare costs, unveiling a set of proposals to bring more transparency to the industry's byzantine pricing practices. But like just about everything else the administration has done on healthcare affordability, the proposal would strike at best a glancing blow to rising costs. And paradoxically, it could wind up raising prices for some patients.

It's hard to argue with the idea that people should know how much their care will cost before they receive it, not after. The White House proposal would address that directly, administration officials said, by requiring insurers and healthcare providers to tell patients in advance what their out-of-pocket costs would be.

The initiative's main effort to hold down healthcare costs, though, would be to require hospitals to clearly and publicly disclose how much people actually pay for services there. In theory, people seeking non-urgent care — a knee replacement, say — could use the information to shop around for the most affordable hospital, promoting the kind of competition that drives down prices in normal markets.

It's not at all clear how helpful the information will be, however, in part because the proposal doesn't specify how much detail hospitals would have to release about their prices. The less detailed the hospitals’ price lists are, the less help they give consumers to shop around. But the more detailed they are about the prices negotiated with insurers, the greater the risk that hospitals will discover when they're charging less than their competitors and raise their prices accordingly.

Beyond that, Americans pay a relatively small percentage of their healthcare costs out of pocket, even with steadily increasing deductibles. They typically depend on their doctors to tell them exactly what care they need. What's more, if they're seriously injured or ill, they may be in no position to look around for care. And in many communities, there aren't enough hospitals or physician groups to support real competition. All of these factors shield the healthcare industry from the sort of consumer pressure and market forces that the Trump administration wants to unleash.

Making a major dent in healthcare costs would require the administration to take a much bigger swing at the way healthcare is delivered and paid for in the United States. Why do we spend so much more than the residents of other countries do, even though the care doesn't yield consistently better outcomes? It's not because prices are hidden. The president's proposal may prove helpful, but only on the margins.

Los Angeles Times

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