What You Should Think About Theodore Roosevelt

June 1, 2011

“This country will not be a permanently good place for any of us to live in unless we make it a reasonably good place for all of us to live in.”

–Theodore Roosevelt

Imagine a former President, currently campaigning for a return to the White House, is shot in the chest.  Horrified aides prepare to transport him to the hospital.  An adviser begins to compose an apology for the candidate’s absence at a nearby rally.  The wounded man will have none of it.  An experienced hunter and soldier, he reasons that he would be coughing up blood if the bullet had penetrated his lungs.  Each of the fifty pages of his prepared remarks now sports a prominent bullet hole.  With blood seeping into his clothing, he goes on to address the crowd for a full hour and a half.

There is much more to Theodore Roosevelt than pure grit.  Yet this quality must be understood to make a start of understanding the man.  Almost all of his adult life was dedicated to identifying serious problems and charging headlong into the struggle to solve them.  Considered a frail child and subject to home schooling, he embraced the opportunity of Harvard life to reinvent himself.  So began a lifelong love of boxing as well as a deep interest in military history.  By graduation, he had established himself as physically formidable.  At the same time, he made a solid start on The Naval War of 1812, a historical book of uncommon detail and rigor for the times.

He went on to law school, though soon he gave up that pursuit to run for and win a seat in the New York State Assembly.  He was a prolific legislator, but it would not be long before he would face a challenge not at all of his choosing.  On February 14, 1884, both his mother and his first wife died, the latter unexpectedly.  Writing in his diary, “the light has gone out of my life;” even his spirit was not impervious to such a loss.  Unable to find further satisfaction in political wrangling, a few weeks later he sought a change of scenery by heading for the Badlands of the Dakotas.

Embarking on a new course, he became a cattle rancher, frontier lawman, and magazine correspondent.  His tales of life in what was then the “Wild West” proved popular among readers in New England.  His keen sense of ethics and relentless determination made him a threat to any outlaw in the region.  Though he befriended the legendary gunfighter Seth Bullock, Theodore Roosevelt remained a firm believer in the rule of law.  In an instance when no one would have faulted him for the exercise of vigilante justice, he instead transported a trio of thieves to a distant venue where a proper trial could be conducted.  Only after a severe winter wiped out his cattle herd did life in the Badlands no longer seem suited to this future President.

With his return to political life he embodied the spirit of a new progressive movement.  After an unsuccessful run for mayor of New York City, he took work as a federal bureaucrat determined to stamp out corruption and patronage at all levels of government.  His unyielding and sometimes downright pugnacious pursuit of fairness earned him a favorable public reputation.  He was later able to build on this reputation as president of the Board of New York City Police Commissioners.  There he faced tasks that anyone with less determination and force of personality could not hope to have accomplished.  Yet he left the department transformed in a myriad of constructive ways.

He would next return to federal service as Assistant Secretary of the Navy, using a brief absence of his superior (in conjunction with battleship Maine sinking) to prepare the nation for the pending Spanish-American War.  Yet planning and management were not enough for a man of action like Theodore Roosevelt.  He soon resigned his post, recruited over a thousand volunteers, and set out for Cuba as leader of a regiment that would become known as the Rough Riders.  His boldness and perseverance in that conflict was recognized with a nomination for the Congressional Medal of Honor, though an initial rejection meant that the award would not actually be bestowed until a posthumous ceremony held in 2001.

Now a bona fide war hero, his return to politics involved a quick rise to the very top.  As governor of New York, he continued to fight corruption while taking measures to address the problems of the poor and downtrodden.  William McKinley ran with Theodore Roosevelt as his Vice Presidential nominee in 1900.  At that time, the red-blue polarity of almost every state was inverted from what we see in the 21st century.  Republicans truly were the party of Lincoln.  Democrats continued to openly support candidates sympathetic to the de facto apartheid in place throughout many of the southern states.  The McKinley-Roosevelt ticket earned a solid victory against William Jennings Bryan’s appeals to archaic traditions and unscientific beliefs.

Still in his first year as President, William McKinley was assassinated.  At 42 years of age, Theodore Roosevelt was sworn in as the youngest President in the history of the United States.  Yet this youth did not prevent him from achieving greatness.  He immediately spoke out to promote more aggressive regulation of large corporations and to condemn corrupt dealings between government and business.  He answered John Muir’s call to conserve and protect many of America’s greatest natural treasures.  President Roosevelt even used federal power to resolve strikes by demanding fair treatment for the exploited working class.

After winning an easy landslide in the 1904 election, he continued to champion populist causes and govern in the public interest.  He pushed for regulations that dramatically improved the safety of the American food supply.  He opened the White House to reporters and provided regular briefings so as to better inform the public about the inner workings of government.  Theodore Roosevelt was the first American to win a Nobel Prize — a Peace Prize for his role in negotiating an end to the Russo-Japanese War.  He was also the first President to call for universal health care to become the policy of the United States federal government.

Though he did not run for reelection in 1908, he found the policies and practices of his successor intolerable.  William Howard Taft talked a good game when it came to promoting free and fair trade while regulating the excesses of big business.  Yet he was a new force in Republican politics — a dissembler closely allied with the tycoons of his time.  Even as he spoke of championing the causes of consumers and laborers, his actions served the interests of industrialists and speculators.  Initially supportive of Taft, Roosevelt belatedly came to understand that the sitting President embodied everything the progressive movement was dedicated to purging from political life.

So it was that Theodore Roosevelt set out to win a third term as President of the United States.  With primary elections a relatively new phenomenon, the contest for the Republican nomination was a complex and messy business.  Aware of imminent defeat at the 1912 Republican National Convention, Roosevelt pulled his supporters away from that gathering and formed the Progressive Party.  Declaring intent to oppose the “unholy alliance” between government and big business, Roosevelt generated enormous popular support.  After the failed assassination attempt, his movement became known as the Bull Moose Party in reference to his quip, “it takes more than that to kill a bull moose.”  Though he was ultimately defeated, Theodore Roosevelt earned the distinction of being the only third party candidate ever to finish second in a U.S. Presidential race.

Looking back at these events roughly a century ago, it is hard to imagine how much brighter history would have been if the Republican Party remained true to the principles of Theodore Roosevelt instead of allowing itself to be bought by the fortunes of the corporate elite.  While the Democratic Party became more and more principled, eventually supporting causes like social justice and civil rights, the Republican Party embraced those constituencies that no honorable public figure should ever service.  There is no legitimate place for corruption, sexism, racism, or homophobia in the political life of an enlightened people.  With prevarication supported by the deepest of pockets and the shallowest of scruples, they have provided a political platform on which voters driven by those motivations can continue to make a stand.

So the next time you hear someone refer to the Republican Party as “the party of Lincoln,” keep in mind that this assessment was not always wrong.  Once upon a time, they were champions of what Theodore Roosevelt referred to as the “square deal.”  Once upon a time, they believed in the value of scientific thought, the importance of environmental conservation, and the Constitutional directive to promote the general welfare.  Could such a transformation occur again?  Could the party of Palin and Gingrich ever hope to recover integrity and usefulness?  Stranger things have transpired in the history of American politics.

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What You Should Think About Public Health

December 16, 2007

“To wish to be well is part of becoming well.”

–Seneca

Many political insiders seem to be expecting a 2008 race in which a Republican and a Democrat both run hard on a theme of “I’m not Bush.” Though a real clash of ideas cannot be ruled out before the contenders are selected, a contest of hollow sloganeering and character assassination may be as likely as the framing of substantive differences between the candidates. This makes the impending primary process all the more important — it may be the high point of the process in terms of focus on actual policy positions.

When it comes to health care reform, there is little serious commentary from the Republican side. Most candidates are happy to shrug at public unrest.  The party faithful are thought to be more upset by the emergence of a new government program than news that no action is being taken to address the issue. There is some rhetoric about the importance of allowing market forces to solve the problem, but at this point in history that can only be interpreted as a denial of facts.  If market forces were a remedy for this particular problem, then how did it become so much more severe during decades of acquiescence to those very forces?

On the other hand, the core of support for the Democratic Party is concerned about the problem.  They are also largely unwilling to believe that medical self-sufficiency is a wise policy when it comes to cancer patients, accident victims, etc. Even talk of a true universal health care policy is not a problem on that side of the mainstream aisle. Yet, for better or for worse, there is a wide range of opinions.

Near the start of this blog I wrote that Senator Barack Obama has gone farther in politics without personally disappointing me than any other modern leader. While I would not go so far as to say that my disappointment with him is deep, it was disheartening to see such a principled figure conceding that his approach to health care reform would be influenced by the agendas of insurance providers and pharmaceutical producers. Perhaps he is being honest where others opt for political spin, but it seems to me both Senator Edwards and Representative Kucinich are sincere in their declarations of intent to implement a truly universal system.

Many Americans continue to define right and wrong strictly in terms of legality or illegality. This is not absolute — most people are some combination of stickler, pragmatist, and outlaw. Yet willingness to drive 10mph over the speed limit or retain the proceeds of a bank error is not at all the same as the vision to support significant political change. While there is a (clearly bankrupt) ideological basis for contending that profit should drive health care outcomes, there is also a natural tendency for people to believe that the way things are is right simply because it is the way things are.

The way things are right now involves a form of legalized racketeering. At the level of major enterprise operations, the insurance industry provides a service by pooling resources so that unfortunate outcomes do not have an economic ripple effect by disabling otherwise sound businesses. At the level of household economics, the insurance industry continues to collect profits while doing less and less to minimize the lasting economic drag caused by unfortunate outcomes. A case can be made that life, home, and even automotive policies still do more good than harm. To make the same case for health insurance requires a willful obliviousness to reality.

In the very best cases, health insurance adds little to the cost of receiving health care even as it promotes regular checkups and other preventative activities. Such best cases are endangered, if not already extinct, in the modern business environment. More typically, health insurance adds tremendous overhead to the cost of receiving health care even as it discourages consumers from making optimal health maintenance decisions. For most who are fully insured, fees associated with responsible screenings and checkups may act as a disincentive to making the best personal choices.

Then there are those many Americans who are less than fully insured. Catastrophic health insurance — low cost plans that only activate in cases of serious injury or severe illness — do even more to deemphasize prevention. For the millions who either lack the funds to obtain insurance or the will to dedicate so much money to the cause, the reckless trend is increased further. The most cold-hearted of analysts may argue that there is some sort of justice in the suffering of those who did not act with ideal forethought to provide for themselves. Yet the entire nation suffers not only for this major waste of human capital but also for the increased medical demand generated by underutilization of preventative capabilities.

“Things as they are” in the health care sector are more problematic still due to the role of private insurers. Estimates vary, but there is no credible dispute that hundreds of billions of dollars are spent each year to maintain vast bureaucracies of these corporate middlemen. Not a dime of that money goes to actually preventing or curing ailments. Resources greater than those required to sustain the war effort in Iraq are consumed simply counting the beans involved in medical commerce. This does wonders for the wallets of executives overseeing this parasitic industry, but very little for the well being of sick or injured Americans.

It is fair to argue that a single government bureaucracy would, in efforts to minimize waste and fraud, require its own bean counters. However, the ridiculous bloat of health maintenance organizations and insurers sucking the lifeblood, both literally and economically, from working Americans is clearly an order of magnitude greater than what would be required to oversee the administration of a health care system in which basic preventative and curative services were provided based on human needs rather than opportunities for profit.

Doing so would not eliminate profit where it continues to serve some useful purpose. In fact, profit incentives would be refocused on areas where real good would follow from their pursuit. Big pharmaceutical companies would no longer be rewarded for producing slight variations on old medicines then stimulating demand for a new brand name product. Yet a shift away from that form of profiteering would merely free up their tremendous resources to pursue much more beneficial endeavors.  Truly helpful products would continue to enjoy widespread demand from truly helpful physicians.

Ultimately the national health care debate comes down to recognizing that fundamental truth — it is the purpose of physicians to be helpful. Any reasonable compromise would still allow for elite clinics where the most gifted physicians could charge a premium for their services. Any reasonable compromise would still allow supplemental insurance plans for wealthy citizens unwilling to mix with “common” Americans in terms of medical commerce. Yet any reasonable compromise also would marginalize one huge service industry that adds no real value at all to the economy.  Any reasonable compromise also would drive another huge industry to restore clear focus to producing value while producing pills.

What America lacks in the realm of health care is not the human resources to improve outcomes nor the economic muscle to get the job done. What America lacks is the political will to cut out the cancer of private health insurance and rehabilitate the system of private pharmaceutical manufacturing. Insofar as we do have the national will to stop spending more to get less, there is a strong force driving us toward those very changes. Success will involve overcoming the tremendous influence two key special interests have on the political process, but surely there is plenty of strength to be found in struggling on behalf of the general interest.

As the Democratic primary season unfolds, so too may unfold the future of American medical commerce. With a range of proposals from modest subsidies to outright socialization of the sector, this is an area of great uncertainty. Still, this much is certain — any comparative analysis of public health reveals that this nation has a serious problem. It also reveals that many other nations have thrived through decades of relying on serious solutions to this same problem. Resistance to any effective course of action really overcome the desire to solve that problem here?


What You Should Think About Abundance

November 22, 2007

“Abundance never spreads; famine does.”

–Zulu proverb

To describe economics as “the study of scarcity” is reasonable enough, as far as gross oversimplifications go. On the other hand, to follow such an assertion with arguments about the world itself being nothing but a set of scarcities is just plain wrong. In many instances demand for a good or service does exceed supply. Yet there are also instances where it does not. As most of the nation overeats alongside family and friends on this Thanksgiving Day, it is hard to overlook one form of American abundance.

Agricultural outcomes in the United States have as much to do with market economics as a commercial airline flight’s safe landing is a function of the shifting winds. By that I mean disasters may occur naturally, but on balance it is a planned activity. Agricultural policy does not so much influence as directly shape shape the menus in our restaurants and the inventory on supermarket shelves.

Not only does this engineered abundance have trade advantages — it also addresses vital security and public health concerns. Despite all our science and technology, harvests can still be fickle. If an unexpected blight or a bad turn in the weather devastates output from a particular region or with a particular crop, others will have the strength to pick up the slack. However vulnerable depending on foreign oil may make us, it would be an even greater vulnerability to become dependent on foreign food.

This is not to say that agricultural imports do not have, legitimately, a vital place in modern agricultural policy. Imported foods contribute to dietary diversity, which tends to be a healthy phenomenon. Given our own surpluses, we retain the option to turn inward in time of emergency. Also, save for art and media, food commerce may be the most culturally influential form of trade. All in all, trading food with our neighbors in the world is good for us, good for them, and good for our relationships as well.

Still, because of the safety provided by ample production, it has long been American policy to support domestic food abundance. Everyone has the potential to benefit. In regions where delicacies are produced, less is consumed locally as staples can be shipped in from afar for less than the value of goods from a fresh harvest. This is a benefit for people rich enough to incorporate delicacies into their daily existence. For everyone else, it means that food prices tend to be low and agricultural price shocks caused by nature can be avoided through reasonable dietary change.

Today there is new thinking on American agricultural abundance. Serious policy analysts do not dignify anarcho-capitalist twaddle about going unplanned and exposing our national stomach to the full force of the elements. However, there is much talk of revising planning guidelines in order to address the obesity epidemic. Policies established in the first half of the 20th century are still shaping the food intake of Americans in the 21st century. In a complex “chicken and egg” relationship, growing consumer interest in a healthy diet is accompanied by growing expert interest in agricultural policy reforms.

These reforms would shift focus away from heavily processed items and promote health by making whole foods more available to consumers. If the alliance of officials and corporations pushing for reform has their way, the national strategy that coordinates planting, harvesting, livestock feed, livestock slaughter, etc. will maintain or even elevate the level of satisfaction provided by supermarkets and fast food chains while inverting a key relationship. Under standards established in the 1950s, raw materials suitable for heavily processed products tend to be highly abundant while raw materials suitable for service after minimal processing remain scarce.

This situation drives corporate activity such that fattening foods are where the easy money is. Turning that trend upside down rewards companies that were innovative in the pursuit of brand identities related to healthier eating while removing the incentive for entrenched entities to maintain a keen focus on stimulating demand for unhealthy food. Getting out of this rut is only possible because a long-standing policy of abundance places government in the proverbial driver’s seat. Just as American nutrition improved with the original wave of coherent national agriculture policy, pending reforms off up the prospect of a new wave of improvements to be followed by gains in childhood development and general national health.

In debates about health care policy, there tends to be an implicit assumption that the United States is incapable of doing what dozens of other civilized nations have already done — pursue systematic abundance to produce consistently superior outcomes than the nation endures at present. It is very much a failure to see the forest for the trees. It may not be possible to engineer a surplus of every possible health care good or service, just as it is not possible to maintain a nationwide surplus of every possible fruit and vegetable. Yet it is possible to undertake sensible coordination of activity and deliver a general abundance to the benefit of all.

Agricultural policy first worked its magic in the United States through an emphasis on cereals and dairy products. Once upon a time, a good bowl of Wheaties swimming in fresh milk was the epitome of health food. By the same token, in a nation where millions have no involvement with physicians and millions more only turn to modern medicine after experiencing a health crisis, just delivering universal preventative care would be an enormous step forward. No doubt there is more to public health than getting virtually everybody to participate in routine checkups, but that measure alone would enable tremendous gains. It would actually conserve medical resources by decreasing the extent of time potentially crippling problems go untreated. If labor productivity gets a boost as well, that is hardly cause for complaint.

Yet too much of today’s thinking is afflicted with misconceptions. It is a misconception to think that sound planning could not generate a useful degree of medical abundance. It is also a misconception to think that providing ever-greater advantages to America’s top income quintile will somehow cause their abundance to become some sort of universal phenomenon. The past three decades of American economic history constitute one monolithic denial of trickle-down theories. On the other hand, it does seem to be the case that hardships are not so clearly self-contained amongst America’s poor.

Infectious microbes are no less at home in the bodies of the rich than they are in any other human beings. Contagion has no respect for net worth. Also, since most of America’s economic dynasties rest on corporate ownership or other forms of working investment, the rich suffer from degraded returns on those investments even as the poor suffer more directly whenever preventable illness leads to lost productivity.

Then there is the question of atmosphere. Wealthy Americans do not take an oath to avoid ever having any empathy with working class citizens. Defense of the “right” of the rich to not support universal health care is also an attack on the “right” of those same people to be better protected from disease, enjoy superior returns on domestic investments, tap into a more fit labor pool when launching new ventures, and live in a generally happier society. There is no choice that is not a choice.

As we settle down to dinner this day, we do well to honor the tradition of expressing thanks for our blessings. Though not perfect, the existing collaboration of farmers, corporations, and bureaucrats has accomplished much in the feeding of our nation. Even with all its flaws, a “do more with less” approach to working the land seems to have succeeded in principle. Given the resources and financial inputs devoured by our existing health care institutions, it would seem American endeavors in that area are presently guided by a “do less with more” paradigm.

In truth, that reality is an unpleasant side effect of being misguided by a popular paradigm that forbids even discussing the pursuit of abundance in our capacity for healing. Yet I believe it is a pursuit well worthy of the effort, including the effort to dispel false narratives about unresolvable scarcity. Should we, as many other nations already have, manage to achieve useful abundance in medicine, then our nation will enjoy a new form of strength. Universal health care would be a particular relief to the poor, but its indirect benefits would substantially improve circumstances for the rich too. Were it part of the American way of life, then on future days of Thanksgiving we might all know one more blessing to be counted . . . or at least one more useful abundance to take for granted.


What You Should Think About Medical News

October 25, 2007

“The only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d rather not.”

–Mark Twain

Rarely a day passes without some new proclamation about the nature of a healthy diet. In some households this can produce grumbling about the overconfidence of doctors. Usually medical researchers are not at fault. It just happens that as the story passes through layers of intermediaries, it becomes distorted. Researchers publish with an eye toward being critiqued by peers. Popular medical journals borrow from this and publish with an eye toward keeping professionals up to speed. By the time someone involved with a general media organization decides to do a story about new findings, the emphasis is much more on storytelling than relating the actual findings.

In fairness, this is not just because original medical papers would be unpopular items in daily papers and television newscasts. Most readers would also find raw research uninformative. Competent dutiful science journalists build a bridge between general audiences and the original research. They assess it with expert eyes, then parse it in such a way that their own work is the most accurate and informative retelling their abilities permit. Generating interest with this model involves having some passion for the subject and being exposed to enough research as to have no shortage of genuinely fascinating topics.

I believe the emphasis on cutting corners does even more damage here than crass commercialism. Like a children’s soccer team, reporters in any given niche seem to act as a mob in pursuit of a single thing. After all, why stick your head in academic papers day after day when it is possible to skim somebody else’s report, perhaps glance at another document or two, put it in your own words, and still look like you’ve done the job of a diligent professional? When someone completely fabricates a report (or in Dan Rather’s case, when someone lets one fabrication slip into a report,) the result is scandal. Yet the “do just enough not to get fired” paradigm generates plenty of work that borders on scandalously poor quality.

On the other hand, commercialization is not blameless in all this either. It probably has much to do with a tendency to decontextualize statistics. For many conditions, risk of mortality is less than 1%. If eating a particular food causes a 0.08% chance of mortality to become a 0.17% chance of dying from that same condition, that food is far from toxic. Yet many editors would be much happier to oversee a report claiming “problem food doubles your chance of dying from <insert cause here>” than something like “this food may increase your risk of <insert condition here>.”

A difference like that may seem subtle. Yet a subtle difference in language combined with a dramatic difference in tone can turn a humdrum observation into an alarming report. I dispute the idea that alarming reports make for more popular news than fascinating observations (especially when the alarm is rooted in trivia.) However, I do understand production of fascinating science journalism is hard work, while making people scared of everything but their own shadows can be an easy day at the office.

Medical journalism in mainstream venues is especially problematic because it easily plays into a common misconception — immortality. Sure, everyone on the tall side of puberty should be well aware that death is a human inevitability. Yet how many people really think about it? How many people have come to accept the weight of such a thing? For many young adults, death is something that happens to other people. Even as the years take loved ones from most and provide personal close calls for some, this profound matter is still often left on the fringes of awareness. No doubt this is sensible and healthy — a constant preoccupation with death is generally regarded as one sign of a troubled mind.

Thus, in between the bombastic music and dramatic graphics, an ominous report about how this habit or that diet might have a 2% chance of causing your death is not typically met with the thought, “well, something’s got to do it.” The lack of context transforms new findings that only deserve a little consideration among those intent on a healthy lifestyle into some sort of dramatic threat to which all decent self-loving Americans must be strongly averse.

Of course, basic common sense has some say in the matter too. As legitimate information is transformed into unnecessarily dire warnings, the general public only develops a thicker skin as applied to medical risks. “So what if oil-based paint causes cancer when it seeps into groundwater? Last month ‘they’ said fried chicken could kill you!” goes the final interpretation of a story. The abstract “They” responsible for all expert opinions increasingly fades into background noise.

Commercial media then must strive harder to succeed in efforts to attract audiences through hyperbolic alarmism. The mechanism reinforces itself. This not only wastes people’s time by failing to provide more informative content; it also minimizes the impact of medical expertise when something that truly deserves alarm comes to light. Be it an obesity epidemic, overmedicated children, undermedicated hospice patients, etc. the medical issues of the day that should be a big deal sometimes get lumped in with the noise made about fresh research of trivial consequence.

One way to address this is simply to lose interest in those types of stories. If you go to the media to have an emotional reaction, both broadcasters and publishers offer up no shortage of excellent drama (or reality shows, for the shallow folks.) If you go to the media to become more informed, consider filtering out alarmism even if that means ignoring the majority of “health news” items. Of course, that approach is not for everyone.

In the alternative, get in the habit of digging the facts out of whatever journalistic coverage happens to encase them. Distinguish between research that quantitatively assesses risk and research that manages to establish a mechanism of causation. When practical, try to find out whether reports related to risk factors were normalized or based on raw data.

I would never deny that smoking is an unhealthy habit, but in a broad sample the higher mortality rate of smokers would be significantly attributable to a range of other factors from childhood nutrition history to occupational hazards. Without knowing what efforts have been made to factor out other influences, it is difficult to formulate any context for health risks ranging from the pesticides on apples to the tannins in Zinfandel. If you can get down to the facts without being moved by an emotionally charged presentation, then there is still much that can be learned from medical research . . . even after it percolates through the filters of commercial media.


What You Should Think About Mental Health Welfare

October 24, 2007

“The insane, on occasion, are not without their charms.”

–Kurt Vonnegut Jr.

There was a time when Western Civilization’s answer to obvious mental illness was to cram deranged individuals onto barges. In some ways this mode of thinking continued into the 20th century. One hundred years ago, it was thought that the most sensible thing to do with insane people was to lock them in asylums. Imprisonment without guilt is never a popular idea, but letting lunatics run wild is even less so.

Perhaps I should say, “was even less so.” As the politics of rugged individualism hijack so many debates about public policy, this one has also been turned upside down. All of the broad, and very real, consequences of depriving diagnosed psychotics of institutional support are waved away in order to focus on an absurd and bogus dichotomy between lower taxes on hardworking citizens or free benefits for do-nothing nut jobs.

Perhaps the public dialog has never been phrased in such stark terms. Yet public policy is clearly framed by such harsh thinking. Working hand in hand with majorities in Congress, President Bush was happy to make some progress in cutting spending not long after his inauguration. From coast to coast, residential mental health facilities were closed. Reduced funding also meant the most troubled patients would have less access to the most aggressive therapies. The warehousing approach to dealing with American mental illness had returned.

What makes this so objectionable is that the means exists today to achieve much better results. It is a penny-wise and pound-foolish approach that offers minimal institutional support in the most severe cases and none at all to garden variety schizophrenics. In the best cases, state and municipal governments act with foresight pick up the slack and maintain adequate services to meet the needs of, and minimized the harm caused by, mentally ill residents. In the worst cases, they pay a greater price dealing with these same individuals only after they have raised issues for emergency services and/or the criminal justice system.

Even as scholars, physicians, and chemical engineers continue to advance the human ability to treat psychological disorders; the role for America’s federal government in this process has been contracted. Humanitarian appeals often focus on the widespread use of prisons and criminal penalties as a means to deal with the problem of severe insanity. To be sure, there are few categories of tales more tragic than those of extremely troubled men and women, surrounded by brutality, denied any meaningful psychological support, essentially abandoned to the daily torments of their own madness.

Yet this is not merely a humanitarian issue. Many of these individuals could tend to some of their own needs in a different sort of institutional environment. Others could even lead healthy productive lives at liberty, requiring only the right sort of medication along with periodic oversight. A non-trivial amount of national productivity is frittered away in service to corrupt ideological nonsense taken from the “there ain’t no such thing as a free lunch” chestnut. Shortsighted public policy transforms a potential resource into an significant burden. Then there is the actual pain and suffering associated with the various crimes that abandoned psych patients commit as they transition from merely homeless to criminal convicts.

Of particular cause for concern at this point in history is the incredibly low amount of funding going into mental health care for returning veterans. Public figures and news reports have been going on for years now about the importance of readiness to deal with the psychological problems faced by soldiers returning to civilian life. Yet all this talk has been backed up by very little funding. In a good year these resources are still well less than 1% of spending on the war effort. Even worse, The Department of Veterans’ Affairs is apparently just plain incompetent when it comes to using what funds they do receive to upgrade mental health treatment capabilities.

The archetype of the homeless antisocial Viet Nam veteran, an angry beggar with visible injuries less shocking than the unmistakable damage to his pride, has strong resonance in our culture. This is not because of some sinister Hollywood plot to manipulate the American mindset. It is because Viet Nam was a particularly chaotic and pointless war, founded on lies, waged against savagely cunning enemies, and ultimately unsuccessful in the achieving the implausible objectives established by White House policies. In several crucial ways, it was more disturbing to its participants than typical wartime deployments.

Afghanistan presents a tricky case in that the war was launched with a clear purpose, some aspects of its management have been sensible, and the overall effort might yet be salvaged by more coherent policies of a future U.S. administration along with successes achieved by international partners in that effort. Yet it is still an occupation in which attacks could occur at any time from virtually anywhere. Suicide bombers, opportunistic snipers, convoy ambushes — combatants involved in action over there have more than a soldier’s usual reasons for coming back with nightmares.

Iraq creates a worst of both worlds situation. Insurgency tactics continue to involve surprise attacks, often with heavy civilian casualties. Participants in the original invasion force also must cope with the many civilian casualties inevitably resultant from Rumsfeld’s hasty plan of attack and barbaric rules of engagement. The Coalition Provisional Authority was more interested in placing control of Iraq’s oil fields in the hands of corporate profiteers than in restoring the basic institutions of civilized governance in that war-torn land. Regardless of however much soldiers in the field followed the politics of it all, they have been exposed to its consequences. It is impressive to see such dutifulness in the face the terrors they all must confront. Yet the unredeeming nature of the overall policy leaves them with no solace beyond that sense of duty in coping with the aftermath.

It would be excessively cynical to argue that the administration’s policy is, “let’s keep them in the fight over there so we don’t have to give them care over here.” Yet the interest in maintaining that fight is paired with a distinct lack of interest in providing that care. When it comes to the treatment of shellshocked warriors, minds and bodies forever scarred by acts of service to our nation, there is a convergence of moral imperatives.

Be it out of economic pragmatism, basic human decency, or a sense of obligation to those loyal in national service; there is no reason not to add much more funding and much more oversight to measures that will provide counseling and treatment to veterans deeply troubled by their experiences with asymmetrical warfare. Yet, setting aside the national service issue, the same arguments apply to all Americans with seeking treatment for some sort of mental disability. As a society we have the means to do much better than shove the lot onto itinerant barges. Why then would any national leader promote policies that regress the state of national mental health in such a downright medieval direction?


What You Should Think About Socialized Medicine

October 4, 2007

“Children are like wet cement. Whatever falls on them makes an impression.”

–Dr. Haim Ginott

Of all the episodes of American history that might be preserved by nostalgia, it is downright tragic that the Red Scare should survive into the 21st century. Not even the actual “Reds” Americans were made to fear lasted as long as the negative emotions inflamed by the likes of Joe McCarthy and Richard Nixon. Yet even now we see the most progressive public figures with a shot at the White House running scared from latter day redbaiters.

The term “socialism” is lobbed about like a grenade. It causes panicked flight with comparable haste too. While the rest of the civilized world becomes healthier, taller, more productive, etc.; my own people expose millions of children to risk of lifelong disadvantage simply to honor the lottery of birth. While the rest of the civilized world takes (mostly) sensible measures to reduce workplace absenteeism, preventable disability, and preventable death; the unthinking hatred of socialism that pervades our political culture generates huge obstacles to similar progress here.

These discussions bring to mind the truism, “there is no choice that is not a choice.” Such a statement goes beyond ironclad fact and into the realm of truth emergent from logic alone. Of course every choice is a choice, but what does that mean? Well, I would be surprised if most Americans in the upper income ranges actually would choose to live in a society with more contagion, more misery, and more death . . . all in the name of reduced taxes.

A false narrative holding that America’s wealthy are of one mind in opposition to socialized medicine feeds into the popular lie by which such policies are characterized as oppressive. To obstruct these initiatives has every bit as much impact on the freedom of people who want to live in a healthier society as supporting health care reform may impact the freedom of people who desire lower taxes. What I mean by “there is no choice that is not a choice” is that inaction thwarts the will of those who desire action no less than action thwarts the will of those who desire inaction.

All too often, critics of socialized medicine carry on as if secret police and state sponsored torture were at the bottom of some slippery slope that begins with taxpayer funded treatment for pediatric cancer patients. Now that recent history shows us the sort of personalities and policies that actually do nudge free peoples in the direction of fascism, a “tyranny of the majority” critique condemning social justice in medical care becomes all the more bizarre. Yet that criticism remains strong today, with far-reaching implications.

Both Hillary Clinton and Barack Obama have chosen to craft their health care proposals with an eye toward protecting the parasitic profiteers of the insurance industry. Because the existing situation enables many organizations to generate gargantuan piles of revenue without contributing any good or service of identifiable value to society, to challenge the status quo is to guarantee zealous lucrative support for one’s electoral rivals. Bribing a do-nothing industry into going along with overdue social change may not be as costly as maintaining a large scale military presence in Iraq, but it is still much more costly than taking direct action to address the medical needs of American citizens.

You don’t need your own car to be glad we have public highways, and you don’t need to be a plaintiff to be glad we have civil courts. Why then do so many people seem to swallow the argument that society as a whole would not benefit from measures that would much improve our standards of public health? Like so many other problems with a political dimension, a contributing cause is deliberate misinformation. When a patient has a long wait for an American doctor, it is accepted as good the physician was industrious enough to book a tight schedule. When a patient has a long wait for a Canadian doctor, it is regarded as a snafu “proving” the inferiority of government bureaucracy.

Yet American health care is already entangled in layer upon layer of complex bureaucracy. Corporations and governments are both organizations. I so wish the past several years had deprived all Americans of the myth that “government ought to be run more like a business.” The private sector has no monopoly on effective management, and federal programs are only run as badly as the leaders charged with operations or oversight manage to run them. If anything, people still enamored with a warped “corporations always do better than government” philosophy should be kept far from the halls of power, because that belief is a barrier to sound thinking in those jobs.

The purported advantages of the private approach — consumer freedom, self-optimizing efficiency, resources concentrated in the hands of the most effective healers — are largely phantoms of rhetoric. Shopping around is downright stupid in an emergency medical situation, and little enough of it occurs in matters of routine or elective health care. Market oriented thinking fails us in large part because the nature of illness and injury combine with the complexities of modern medicine to squelch the kind of unconstrained behaviors that drive a truly free market. Then there is the old saw about corporate research, as if producing yet another brand name cholesterol reduction pill or heartburn remedy was the alpha and omega of medical innovation.

The recent veto of a federal effort to better unite America’s children with America’s health care resources may be a bold stance based on principle, if one assumes irresponsible ignorance pervades the White House. In the alternative, it was a cruel stance based on the notion that sicklier American children are a small price to pay for perpetuating bogus narratives born out of the Red Scare. In the end, the entire nation pays dearly. Lack of access to preventative care creates additional need for curative care while lack of access to curative care promotes disability and death.

In light of all this, what should you think about socialized medicine? If you are actually thinking, then you will compare what is real over here to what is real abroad and recognize the opportunity for huge gains in public morale and public health. Long term economic growth tends to follow from sustained gains in those areas. The insurance industry funds robust misinformation campaigns that go far beyond financing the political campaigns of today’s redbaiters. If you remain rational and do not succumb to the fear they spread, there is much good to see in this idea.

I personally advocate socialized medicine because I believe a measure of taxation is reasonable for the purpose of alleviating preventable misery amongst America’s working poor, not to mention children of poverty as well as indigent folks. I understand pragmatic questions about the importance of caring for those who are not likely generate much future personal income. I find it distasteful to place such a low value on human life, but I also offer a better response than distaste.

Even someone who was fanatically dedicated to overall growth should align somewhere near my position. Proper treatment for children means a more capable workforce in the next generation. Proper treatment for today’s workers means more productivity in the near future. Even proper treatment for retirees, prisoners, and vagrants will tend to be less costly than cleaning up the public messes unchecked desperation or tragedy tend to produce. Like it or not, the reality is that we are all in this economy together. The sooner we recognize that reality, the sooner we can take action to capitalize on opportunities for a better future.


What You Should Think About Abortion Policy

October 2, 2007

“There are highly gifted spirits who are always infertile simply because, owing to a weakness in temperament, they are too impatient to wait out their pregnancy to term.”

–Friedrich Nietzsche

The politics of unwanted pregnancies is about as divisive as any aspect of American civic life. Most positions are rooted in strongly held beliefs. Passions run high, yet earnest rational advocates right across the spectrum all rest on sound thinking emergent from a coherent moral center. On at least one point there can be no compromise. Because passions run high, this is not an easy issue for “agree to disagree” peacemaking.

Fortunately, this document is not crafted to tell you what you should think about abortion. I have my own thoughts on why and when a product of conception ought to be recognized as a legal entity. However, those thoughts actually have marginal bearing on my opinions about policy. From the most stereotypical feminist to the most stereotypical fundamentalist, there is an enormous area of common ground. Pretty much every American would like to see a future in which fewer abortions actually take place.

A popular method advocated for achieving this goal is legal prohibition. While dragging the long arm of the law into this issue may satisfy some people on some level, it is just plain wrong to assume that prohibition actually discourages much of this sort of behavior. Did America stop drinking during the Prohibition? Have our laws regarding cocaine or sportsbetting or prostitution truly diminished the extent of those activities in our society? How’s that crackdown on crystal meth working out over the long term?

The brute force of legal prohibition can serve the cause of justice, but only when there is an identifiable victim that has been wronged. Car thieves ought to be punished for a number of reasons. The big two would be that innocent bystanders could come to harm if car theft victims became vigilantes and potential car theft victims enjoy greater security knowing something is being done to address the problem of stolen automobiles. Thus it would be good to incarcerate habitual car thieves even if a penal approach actually has little impact on the number of car thefts from year to year.

Legitimate assumptions about human spirituality can lead to conclusions that establish an identifiable victim of pregnancy termination. However, those assumptions are, by their very nature, religious. They deserve respect, but surely not to the extent that religious beliefs should be imposed on others by force. The beliefs of those who do not see abortion as murder deserve every bit as much respect as the beliefs of those who insist the former is a subset of the latter. Even if you believe something profoundly sacred is imparted on every human zygote just as fertilization begins, living in a free society still demands tolerance for others who believe differently.

Recognizing the reality of those beliefs means understanding that many Americans would regard a ban on abortion as less like a murder statute and more like a vice prohibition. In other words, there is no reason at all to expect that a national prohibition would result in a sustained long term decrease in the number of abortions performed on pregnant Americans. Looking at both the history of other prohibitions and the realities of our nation before Roe v. Wade tells us that prohibition would change things . . . but in no way for the better.

In fact, this confluence of horrors is an especially ugly picture. As with all illegal goods or services for which there is significant demand, a prohibition would provide opportunities for enterprising criminals. No society does well to create another reason desperate young women might seek business arrangements with thugs and gangsters. Driven beyond any hope of government oversight, an outright legal ban would merely trade safe medical care for a range of uncertainties. Among them would be numerous mutilations in back alley clinics, not to mention all the self-inflicted clothes hanger injuries. This helps who? How?

Fortunately, there are sensible alternatives to the wholly negative approach of criminalization. In fact, there is a broad range of tools wise leaders could utilize if they were intent on actually addressing abortion as a problem . . .

  • Maternity Laws — Compared to other nations at our level of prosperity, the United States makes an incredibly weak effort to discourage employers from firing or demoting workers who choose to carry a pregnancy to full term. It may be unfair to require all employers to comply with generous maternity leave policies, but it is an entirely reasonable imposition to make in large organizations, where competent management should make it practical to cope with the needs of pregnant employees. Giving young mothers protection from workplace discrimination and enhanced flexibility related to maternity would reduce the instance of abortions performed on women presently forced to make hard choices between ending a career or ending a pregnancy.
  • Prenatal and Neonatal Health Care — Just tending to the basic domestic needs of a newborn can involve a great deal of expense. Add 21st century medical bills to the equation and some women find themselves choosing between harsh poverty or relative material comfort. Anyone truly serious about preventing abortion should be truly serious about preemptively resolving that painful economic dilemma in favor of a live birth.
  • Effective Sex Education Curricula — There is nothing wrong with embracing a religious belief that unborn entities are equipped with a soul. However, no religious belief justifies ignoring the hard data on sex education outcomes. Programs that offer comprehensive information consistently produce lower rates of teen pregnancy than those that leave students largely in the dark about sexual practices, birth control techniques, etc. There is nothing wrong with encouraging young people to abstain from sex until later in life. However, sex education classes that cover only abstinence are a surefire way to drive up teen pregnancy rates, thus increasing demand for abortion.

There are other good ideas that belong in the mix, but those three each have the potential to be especially effective. It is true that some economic conservatives may object to expanding maternity leave or public subsidy of prenatal and neonatal health care. Then again, how serious can one be about preventing abortion if hostility toward any sort of social service spending is judged to be more important than making a serious effort to reduce demand for abortion?

By sidestepping the theological question, I cannot offer a comprehensive take on what you should think about abortion policy. Yet I believe it is long overdue that our national leaders saw the wisdom in sidestepping that intractable disagreement in order to forge common ground. Would even one percent of the population respond negatively to the poll question, “would you prefer it if fewer abortions were performed in the United States?” If we recognize that such a strong consensus exists, it follows logically that we should promote social change for purposes of dramatically reducing the demand for abortion.