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Without a doubt, Texans are healthier than they have ever been. More than that, health in Texas has improved significantly since George W. Bush became governor in 1995. Look at these statistics:
• In 1994 there were 13.8 cases of tuberculosis per 100,000 Texans, but in 1999 there were only 8.2.
• In 1994 7.2 infants died per 1,000 live births. In 1997 6.3 died.
• In 1994 there were 129 cancer deaths per 100,000 Texans. By 1997 that number had dropped to 122.8, which was less than the national average of 125.6.
• In 1992 we had only 179 physicians per 100,000 residents. By 1998 that number had grown to 226.
• In 1992 there were 123 teenage pregnancies per 1,000 women. By 1996 that number had dropped to 113.
• In 1994 14.4 percent of adults said they had not seen a doctor in the past year because of cost. By 1998 that number had dropped to 12.7 percent.
Where did these statistics come from? I read them in an article on the front page of the New York Times on April 11. Interestingly, the point of the article was exactly the opposite of the one it’s possible to draw from those statistics. The headline of the article was “Bush and Texas Have Not Set High Priority on Health Care.” The article begins, “Texas has had one of the nation’s worst public health records for decades. More than a quarter of its residents have no health insurance. Its Mexican border is a hotbed of contagion. The state ranks near the top in the nation in rates of AIDS, diabetes, tuberculosis and teenage pregnancy, and near the bottom in immunizations, mammograms and access to physicians. But since George W. Bush became governor in 1995, he has not made health a priority, his aides acknowledge. He has never made a speech on the subject, his press office says.” How can it be that a news story comes to such harsh conclusions when facts cited in the story can lead to the opposite conclusion?
The answer is simple. George W. Bush, the governor of Texas, is running for president. As the campaign wears on, this is the kind of story that Texas is certain to be subjected to again and again. Undoubtedly the Gore campaign will use any imperfections it can find in Texas against Bush. But reporters from newspapers and television networks who come here will do the same thing. It’s a simple kind of story to do. The reporter finds a persistent problem in Texas, cites experts and statistics to show that the problem really does exist, and then asks the Bush campaign office what the governor did about the problem. Since the problem persists, whatever Bush may or may not have done was therefore inadequate, and the story can end with the implied conclusion that as governor, Bush was unconcerned, ineffective, or both. Bush’s record as governor certainly demands national scrutiny now that he is running for president, but examining it like this is a way to be both “fair” and on the attack. One purpose of a political campaign is to see how a presidential candidate defends his record from such attacks. But for someone living in Texas, whether he or she intends to vote for Bush or Al Gore, it’s going to be aggravating at best to see Texas portrayed as a backwater of contagion, bad government, and ignorance. And no one here needs to be told how easy it is to get the rest of the country, particularly the East Coast, to believe just that.
If the process behind this journalism is simple, real life is not. Behind the statistics lie all sorts of issues that the public never knows about. Take the now-familiar charge that Houston has become more polluted than Los Angeles. That is true—but only by one measure of pollution. It is not true by other measures. This leads to the first of several rules to keep in mind as we encounter the negative stories about Texas that will inevitably arrive in the coming months.
1. Think about priorities.
Public health means a lot more than delivering services to the poor, the notion of health care implicitly adopted in the New York Times article. In fact, experts in the field argue over the proper definition of just what public health does cover. One way of looking at it is that the chief responsibility of government lies in regulating what might be called the infrastructure of health. Texas sets and enforces standards for drinking water; it licenses hospitals; it regulates all sorts of health care professions (doctors, nurses, EMS personnel, massage therapists, even athletic trainers); it has offices that oversee asbestos, radiation, communicable diseases, abortions, milk and dairy products, retail foods, and dozens of other potential health risks; it is still trying to eliminate tuberculosis—and all of that is just a fraction of the routine but essential work that Texas and other states do. This whole health infrastructure is really what maintains public health. Perhaps it could be better. The quality of the air we breathe could be improved. But on balance I don’t think we’re doing that bad a job. When was the last time your drinking water made you sick?
Health care is so expensive and so basic a need that the federal government has traditionally provided much of the funding. The idea is that people in poor states shouldn’t be saddled with worse health than residents of wealthy states. Unfortunately Washington has been cutting back on some health care expenditures in recent years. Federal subsidies for immunizations fell from $13 million in 1998 to $9.38 million today. The preventive-health-care bloc grant—which funds cancer, diabetes, and heart disease outreach programs—fell from $9.1 million to $8.46 million in the same period. Furthermore, the public health problems associated with migration across the Mexican border are a national issue that falls disproportionately on the border states. The article even quotes a health care official saying exactly that but doesn’t push on to the natural conclusion: Texas shouldn’t have to take all the responsibility or blame for this situation.
3. The stereotype is that Texas is rich; in fact, Texas is poor.
Our per capita income is below the national average by more than 5 percent. Fifteen percent of our population lives in poverty (although that’s down from 19 percent in 1994). Thus our tax revenues are low. Our state and local taxes are $470 per capita less than the national average.
4. There is more than one way to run a government.
Texas is philosophically a low-tax, low-service state. We generally believe that the way to expand social services is to have a growing economy that generates more tax revenue instead of raising taxes. This method of government is the opposite of that of other industrial states, most of which have high taxes and high levels of social services. Our belief is that low taxes attract businesses and workers, and that prosperity and opportunity will solve social problems. That idea may be right or it may be wrong, but it was the case when Ann Richards, a Democrat, was governor and it is the case now, when George W. Bush, a Republican, is governor. There is no imperative from the voters to change.
5. No one is omnipotent.
Governors come and go, presidents come and go, but problems remain. I say this not as an excuse for governors and presidents but as a simple fact. The assumption underneath these stories will be that if only Bush had done what he should have, these problems at hand would be behind us. It’s the equivalent of asking why Clinton, after eight years as president, didn’t win the war on drugs. If, as the Times says, the Mexican border region is a “hotbed of contagion,” what exactly could Bush have done about it, aside from aiding the colonias, which he did? The border includes some of the poorest counties in the nation. Public services are overwhelmed on the Texas side and practically nonexistent on the other. Many of the worst health problems originate on the Mexican side of the border. They are beyond the reach of the state government or its governor.
6. The reporter will always quote some state official saying something dumb, but with any luck the official won’t be as dumb as he or she sounds.
In the health care article, that official was Dr. William R. Archer III, the commissioner of health appointed by Bush. He characterizes Hispanic women as telling him, “I want to be pregnant.” Since this and similar quotes appeared, he has been the subject of outraged national and local columns in which the authors call him a racist and insist that he be fired. Dr. Archer has spent enough time working in impoverished Third World countries that he shouldn’t have to defend his racial attitudes. It’s his nostalgia for the United States of the fifties and his insistence on a link between medicine and spirituality that try my patience with him. But, as he said in a speech at the annual meeting of the Texas Public Health Association, he believes “that the public health problems of the new millennium will be, more than ever, manifestations of behavior.” He is referring to drug abuse, HIV infection, teen pregnancy, and teen suicide. Of course, he’s right that changing behavior is necessary to defeat these plagues. And it is more effective, more useful, and more humane to regard these behaviors as problems of public health rather than as problems of law and order, as they have so often been in the past.
And finally, 7. After November it will all be over.
And the problems of Texas, which have been made to seem so apocalyptic and so inexcusable, will return to being what they really are—the urgent challenges of daily public life.