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Is Cynicism More Disqualifying Than Ignorance?

I was somewhat reluctant at the time to ascribe any specific intent to Elizabeth Warren's DNA stunt, just focusing on what it said about her political instincts. In retrospect, because of subsequent choices, I see it as craven cynicism. I get that, "I have a plan for that!" is supposed to be her new brand, but obviously, a working plan isn't a central part of that. Her brand should actually be "Pandering Cynic". I now find myself wondering if even she thinks the policy she offers will do what she says it's intended to do. I've been saying in my head that I feel irrational anger towards her, but it's actually quite rational and specific.

My posting schedule has been off because I've been playing with the idea of submitting pieces for publication. I've been thinking a lot about how we talk about disparities and how the conversation is used as a cudgel against universal policy. The closest to a good faith version of this argument is usually made against Medicare fir All. It goes, "Look, of course I want everyone to have healthcare, but that doesn't fix the fact that Black mothers are 3 to 4 times more likely to die from childbirth than white mothers." I've thought for some time, "I'm not sure if that's true." I think people fundamentally misunderstand what systemic racism is and assume that challenging individual personal bias somehow challenges it. The central cause that people focus on when they attempt to address a racial disparity is typically white bias. The idea that the prejudice of individual health care professionals across the country somehow stacks up to create a systemic health crisis that disproportionately impacts Black women should be laughable under even the slightest inspection. The underlying argument reminds me of the idea behind Common Core, that it's possible to have equal systemic outputs with deeply unequal inputs just by shifting the blame onto the people delivering service. Teachers and doctors are similar in that the problems in their professions created by commodification with standards set by people with no professional training or experience are incredibly invulnerable to their professional suggestions. It's fitting that Elizabeth Warren's idea for addressing the racial disparity in maternal mortality applies the principles behind No Child Left Behind/Race to the Top to this matter of life and death.

I started seeing her as a craven panderer when she said that she supported reparations. I believe it was Benjamin Studebaker who pointed out that she has a white paper for everything except reparations, which speaks to her actual commitment to the idea. I think up until that moment I'd been under the impression that while she was incapable or unwilling to see the systemic reasons behind problems, causing her to provide inadequate solutions, her reparations stance made me assess her more clearly. The change reminds me of how I started referring to the "racist dog whistles" of Hillary's 08 campaign as her white supremacist campaign. It's about intent. The idea itself is already so amorphous while pretending to be serious. The only legislative idea related to reparations is for a commission to study the idea. It's not meant to be real. She offered nothing of substance that anyone would recognize as reparations. That, along with her culture as determined by blood science pandering made it clear how willing she was to use racial identity cynically. Her performance at She the People put it over the top.

 In their essay "Race, Class, Crisis: The Discourse of Racial Disparity and Its Analytical Discontents" Adolph Reed Jr. and Merlin Chowkwanyun noted that, "[t]aking racial disparity as a starting point can subtly coerce a univariate view that precludes attention to many overarching class dynamics" and later "[t]he discourse of racial disparity is, when all is said and done, a class discourse." It's important to consider the overarching class dynamics and the systemic causes that were missed when Warren said at the forum, "There is a specific problem, as you rightly identify, for women of color who are three to four times more likely to die in childbirth. The best studies that I've seen put it down to just one thing--prejudice."

Reed and Chonkwanyun predict this when they say, "[e]xplanations of the source of disparities tend to dribble into vague and often sanctimonious calls to recognize the role of race." It's an explanation that avoids any obvious concrete explanations to the point of outright ignoring them. It's Racecraft. Before we get to the underlying causes I have to ask, "Would prejudice be the cause for just the disparity or all Black maternal deaths and if it's the disparity how do we know which are caused by prejudice?" To suggest that it's prejudice that causes Black maternal deaths is to suggest that there must be something biologically different between Black mothers and other mothers, unless those best studies Warren references name prejudice as a general cause of pregnancy related deaths.

Her explanation doesn't account for how increasingly constrained women's autonomous decisions are around their healthcare and the number of Black women who live in and give birth in those states with the most intrusive laws. Many women who might have aborted unwanted pregnancies, or avoided them with better access to birth control are being forced to carry children to term. Many of the states where large numbers of Black women live have not passed Medicaid expansion or have limited healthcare for the poor in other ways. It should go without saying that Black women are disproportionately poor. 14% of Black women lack healthcare, I've had some trouble finding the number who can't afford to use their healthcare, but Black women are likely to have experienced some discontinuity of care during their lives. Black women are more likely to start prenatal care later. This is not the result of prejudice. It's not the result of personal bias. It's the result of systemic racism, the systemic deprivation of the poor. That's the class dynamic that her explanation precludes. What most people misunderstand about what we call systemic racism is that the race of those deprived is irrelevant. Focusing on the racial disparity, the statistical possibility of a negative outcome for Black people, obscures the fact that Black people are disproportionately poor; and that many of the negative outcomes impact far more white people. In this case, since maternal deaths are growing across the country, it's worthwhile pulling back to ask why that is happening, and if perhaps within that explanation lies a more credible reason for the disparity.

In 1990 one of the World Millennium Goals was to reduce maternal mortality by three quarters by 2015. The US is one of 13 nations that's still seeing its rate climb. The primary causes 30 years ago have all been reduced while other causes have grown. Hemorrhaging, though greatly decreased, is still a leading cause. The second and fastest growing cause is cardiovascular conditions. This heavily impacts women with chronic health conditions, like diabetes, hypertension, and obesity, which Black women are more likely to have. Implicit bias training would not erase chronic health conditions, a lifetime of responsive healthcare might. In the US close to a third of US births are by Cesarean section, the recommended international rate is between 15-19% of births. Greece more than doubles our rate while having less than half our maternal mortality rate, so obviously the number of cesarean deliveries is not explanation alone. What is instructive is the degree to which it's clear that the rate in Greece is driven by the high number of for profit institutions having medically non-determined cesareans by choice rather than medical need. A study in the UK found the cesarean rate in the reporting private maternity ward to be twice the national rate. To the degree that medically unnecessary cesarean deliveries are driving the rate, they are more likely to happen to poor women and Black women.

Warren's solutions, based on incredibly faulty causation, completely miss the mark. Rather than model her ideas on any of the successful efforts at reducing maternal mortality she chose the failed market based solutions of school "reform". What is most striking is that anyone who has studied this problem for even a moment knows that we don't even have an accurate accounting of maternal deaths, we have an estimate. The very "detail-oriented" Warren didn't even note this or plan for it. The reasons for this poor accounting are many, at the heart is a failure to invest in regular reporting and publishing of data from the states and review boards for maternal deaths. Warren's plans do nothing to address the huge gaps in information that we have around maternal mortality. Both Arkansas and California are looked to as leaders in dealing with maternal mortality with a focus on decreasing deaths from complications that result from repeated cesareans by decreasing the number of medically non-determined first cesarean deliveries and disseminating effective best practices.

It's not clear which research she's referencing but her suggestions match none that I've seen. What makes Warren's plan truly dangerous is that she would essentially fine the hospital where Black maternal rates don't decrease and reward the ones where they do. 75% of Black deliveries are in hospitals that serve majority Black and minority mothers. Not surprisingly, their rates are higher. How would removing economic resources from hospitals serving more high need patients help them decrease deaths from pregnancy? The reason for my anger is how insidious her pandering is, how deeply damaging. Her underlying analysis and offered solutions illustrate the degree to which she doesn't actually care about the problem while using it politically. Her analysis obscures the root causes and her solutions will lead to greater economic disparities in the places where Black women give birth which will lead to greater disparities in maternal mortality.

We're left with one of two conclusions, either Warren is too facile a thinker to be president, or she's willing to apply incredibly cynical political thinking to the lives of Black women for the sake of her personal ambition. I'm not sure which would paint her in a better light.


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