Tuesday, March 30, 2010
Health Care Addiction
Akafred notes that however much we protest not liking more government involvement in health care, we are likely to quickly grow addicted to any little thing it provides for us - even if the whole deal is a net loss.
Supply-Side Religion
It seems every time I go over to First Things I kick myself for not going more regularly. The sociology of religion is profoundly annoying to many believers, because by design it leaves out all the invisible and unmeasurable actions of God - in some sense the whole ball of wax of what church is about - to focus on the behavior of the religious according to purely secular factors. I find that quite useful myself. Determining what part of our individual and collective behavior is entirely of this world, and not different than what one would find in secular groups, allows us to cease kidding ourselves about things spiritual. If members of political parties, service organizations, and nonprofits treat belonging to those groups in similar manner to how churchgoers treat theirs, it is possible - even likely - that we are viewing human nature, not God's nature, in the behavior.
The current issue has an article The Prophet Motive by John Lamont. He lays out the traditional theories of religious adherence - the secularization thesis of Durkheim and Weber, then the newer rational choice (free market) model of Finke and Stark - and shows brisk contrary evidence to both. However useful each might be, they clearly don't explain everything. Lamont finds the supply-side explanation of Reginald Bibby much more powerful.
The current issue has an article The Prophet Motive by John Lamont. He lays out the traditional theories of religious adherence - the secularization thesis of Durkheim and Weber, then the newer rational choice (free market) model of Finke and Stark - and shows brisk contrary evidence to both. However useful each might be, they clearly don't explain everything. Lamont finds the supply-side explanation of Reginald Bibby much more powerful.
Because of the long-term exchange relations that religious organizations require, people are forever paying the costs in the here and now while most of the rewards are to be realized elsewhere and later. As a result, humans are prone to backslide, to get behind on their payments. . . . Thus, other things being equal, people will always be in favor of a modest reduction in their costs. In this fashion, humans begin to bargain with their churches for lower tension and fewer sacrifices. They usually succeed, both because it is those with the most influence—the clergy and the leading laity—who most desire to lower the level of sacrifice and because each reduction seems so small and engenders widespread approval.A good read, with much to think about, particularly in terms of the American and Western European histories of churches.
This process leads churches to lower the standards required for membership. This pleases people in the short run, but in the long run, after the effects of lowered standards make themselves felt, it drives them away.
Funeral Reading
Justin Wilson's funeral is Wednesday. Chris is in Florida with the family.
He will be reading something for the ceremony, a short piece by another Marine which he found appropriate. Those who know Chris know that speaking before a group is already pretty amazing. He has always been extremely reticent about such things. Well, that's one of the changes the Corps has brought out in him. He spoke at church after getting back from basic training, thanking everyone for their prayers - I was pretty stunned.
He posted he piece he is reading on his Facebook page. It includes the phrase "to kill for those who cannot kill" - that jumped out at me. My civilian, ex-liberal, evasive self reacted badly to that in the first instant. You're supposed to say defend those who cannot defend themselves, it sounds...well, nobler. My second thought was of course you have to think that way if you're a serviceman. They have to be artificially blunt, outside of the rules of usual discourse, to do their job. But reading Chesterton recently allowed me to think it through farther. It's not just artificially blunt for a soldier's purpose. It's the reality. When we think honestly about justice, we see that there are people who must be stopped from committing injustice. And if they won't stop, they have to be killed. Soldiers take on not only that risk, but that burden. They act on behalf of those who cannot, or dare not.
As I don't imagine people go back and keep up with comments sections here that often, I mention that Terri from Wheat Among Tares heard about Justin's death on the radio while she was down at her father's house in Florida. It gave her an eerie feeling to connect that radio story with the son of a blogger she follows in NH. It is eerie. The threads which connect us to each other in this life are surprising and odd.
He will be reading something for the ceremony, a short piece by another Marine which he found appropriate. Those who know Chris know that speaking before a group is already pretty amazing. He has always been extremely reticent about such things. Well, that's one of the changes the Corps has brought out in him. He spoke at church after getting back from basic training, thanking everyone for their prayers - I was pretty stunned.
He posted he piece he is reading on his Facebook page. It includes the phrase "to kill for those who cannot kill" - that jumped out at me. My civilian, ex-liberal, evasive self reacted badly to that in the first instant. You're supposed to say defend those who cannot defend themselves, it sounds...well, nobler. My second thought was of course you have to think that way if you're a serviceman. They have to be artificially blunt, outside of the rules of usual discourse, to do their job. But reading Chesterton recently allowed me to think it through farther. It's not just artificially blunt for a soldier's purpose. It's the reality. When we think honestly about justice, we see that there are people who must be stopped from committing injustice. And if they won't stop, they have to be killed. Soldiers take on not only that risk, but that burden. They act on behalf of those who cannot, or dare not.
As I don't imagine people go back and keep up with comments sections here that often, I mention that Terri from Wheat Among Tares heard about Justin's death on the radio while she was down at her father's house in Florida. It gave her an eerie feeling to connect that radio story with the son of a blogger she follows in NH. It is eerie. The threads which connect us to each other in this life are surprising and odd.
Monday, March 29, 2010
Christian Witness
A friend sent me a youtube clip of Gabe Lyons being interviewed about his book Unchristian. I think I'd like the lad. His premise is that nonChristians in his generation have negative images of Christians that interferes with their even consider the claims of Christ.
Favorite topic of mine. The immediate conclusion everyone draws, without it going through their logical processes, is that the kids are right, and Christians should stop doing all this dumb stuff and start acting like Christians, and more people would believe in Jesus.
I haven't seen any evidence for that in my Christian lifetime. I have been in places where the Christians are annoying, rigid, and hypocritical, and in places where they are meek, winsome, and sincere - and of course the wide variety of in-betweens and combinations. I have known Christians who were giants of generosity and kindness who had no visible effect on those around them. I don't say it never has any effect, for conversion stories are full of descriptions of inspiring figures who maintained their faith under pressure and caused others to think. We should certainly guard our behavior as if it all depended on our character.
But it doesn't. It's 90% sales job against us, and the young are particularly susceptible to adopting attitudes around them. We swim against a great tide, and all we can hope is to rescue a few.
Politically liberal Christians like to believe this myth because they want more space for their politics in the national conversation. Evangelical die-hards like the myth because it tells them if everyone just behaved better all would go right. Nonbelievers like to have someone else to blame for their unbelief. Mainstreamers, groups raising money, fundamentalists, church drop-outs, cultists, preachers inspiring the faithful, church planters - absolutely everyone has a reason why this myth tickles their ears. We want it to be true.
Doesn't make it true.
Favorite topic of mine. The immediate conclusion everyone draws, without it going through their logical processes, is that the kids are right, and Christians should stop doing all this dumb stuff and start acting like Christians, and more people would believe in Jesus.
I haven't seen any evidence for that in my Christian lifetime. I have been in places where the Christians are annoying, rigid, and hypocritical, and in places where they are meek, winsome, and sincere - and of course the wide variety of in-betweens and combinations. I have known Christians who were giants of generosity and kindness who had no visible effect on those around them. I don't say it never has any effect, for conversion stories are full of descriptions of inspiring figures who maintained their faith under pressure and caused others to think. We should certainly guard our behavior as if it all depended on our character.
But it doesn't. It's 90% sales job against us, and the young are particularly susceptible to adopting attitudes around them. We swim against a great tide, and all we can hope is to rescue a few.
Politically liberal Christians like to believe this myth because they want more space for their politics in the national conversation. Evangelical die-hards like the myth because it tells them if everyone just behaved better all would go right. Nonbelievers like to have someone else to blame for their unbelief. Mainstreamers, groups raising money, fundamentalists, church drop-outs, cultists, preachers inspiring the faithful, church planters - absolutely everyone has a reason why this myth tickles their ears. We want it to be true.
Doesn't make it true.
Saturday, March 27, 2010
President's Bracket
There can't be many brackets in good shape at this point. ESPN tells us that Obama's is in the top 12% - which means, BTW, that he's at exactly the 88th percentile or they would have reported it differently - and good on him for that.
I don't recall sports journalists being interested in Nixon's opinion, and he knew a lot of baseball and football. Or Gerald Ford's, who played football for Michigan. Or Dutch Reagan, who had been a baseball announcer. Or Bush 41, who played 3B for Yale, or Bush 43 who had owned a baseball team (and whose believing Sosa was on the downside of his career looks less laughable now that the steroid info has come out).
In 2009, they even went back and asked ex-President Clinton for a bracket. He didn't do too badly, as I remember.
Curious.
I don't recall sports journalists being interested in Nixon's opinion, and he knew a lot of baseball and football. Or Gerald Ford's, who played football for Michigan. Or Dutch Reagan, who had been a baseball announcer. Or Bush 41, who played 3B for Yale, or Bush 43 who had owned a baseball team (and whose believing Sosa was on the downside of his career looks less laughable now that the steroid info has come out).
In 2009, they even went back and asked ex-President Clinton for a bracket. He didn't do too badly, as I remember.
Curious.
Guitars
Akafred mentioned seeing Jose Feliciano in concert and hearing him do a lightedhearted number about Chicano versions of commercials. Sounded like fun, but I couldn't find that one. It did give me a chance to listen to a lot of his numbers, though
And good clean guitar work always puts me in mind of this tune
Yeah, better than the original. Who woulda thought?
And good clean guitar work always puts me in mind of this tune
Yeah, better than the original. Who woulda thought?
A Note Of Interrogation
Such passages have no purpose except to insinuate a chill of doubt - a chill which the writer himself has caught he knows not where. They will generally be found to end with a note of interrogation. It does not say "We cannot win," but "Can we win?" The note of interrogation is more dangerous than any dogmatic pacifism or decisive treason, because it is closer to humanity, yet none the less close to hell. For it was in this fashion of false inquiry that human nature itself was betrayed; and I could fancy that men drew the Tempter with the curves of a serpent because they can be twisted into the shape of a question mark.I recognised the question-mark technique the moment GKC mentioned it, for it has been standard on the covers of Time and Newsweek as long as I can remember. The insinuation under the pretense of opening discussion is standard journalist fare titling editorials or "special reports" on the TV news. Can Bush Recover? Can We Still Win in Iraq? Are Americans Too Fat? Like Iago, they make all accusations by making none.
GK Chesterton "Milk and Water Pacifism," 1917
OTHELLO. Indeed? ay, indeed. Discern'st thou aught in that?Or, as Chesterton notes, it is the techiques of the earliest tempter.
Is he not honest?
IAGO. Honest, my lord?
OTHELLO. Honest? Ay, honest.
IAGO. My lord, for aught I know.
OTHELLO. What dost thou think?
IAGO. Think, my lord?
OTHELLO. Think, my lord? By heaven, he echoes me
As if there were some monster in his thought
Too hideous to be shown. Thou dost mean something.
1 Now the serpent was more crafty than any of the wild animals the LORD God had made. He said to the woman, "Did God really say, 'You must not eat from any tree in the garden'?" Genesis 3:1The discussion is immediately framed in a manner calculated to elicit doubt, without providing any reason for doubt.
The answerer, of course, has the heady conceit of believing he has doubted and asked questions all on his own.
Should I add this one to my Cultural Tribes series?
Gotcha.
Friday, March 26, 2010
Chesterton On Chivalry in War
Chesterton had read an essay in The Nation (yes, the same one), "On Chivalry In War," and wrote an answer to it. The article included the sentences "In the eighteenth century Swift and Voltaire were singular in thinking that war is fundamentally criminal. To-day we all thinks so." Chesterton replied,
Do not wonder when people cannot seem to make the elemenary distinctions between our actions and those of our enemies, such as Kennedy suggesting that Abu Ghraib was the same under Saddam and the US. Its first motive is not so much treason or an oversensitive conscience as a refusal to admit there can be anything redeeming or just about any war. All wars must be regarded as essentially evil because they are essentially terrible; thus all justifications for a war must be undermined, and any claim that we have acted with general restraint and nobility must be squelched.
This is one of the ways that people who are against war prove that they are more moral than thee. "Courage" must mean the mild inconveniences they face being disliked and hounded by those they have disliked and hounded for years; not courage in pain and danger in the Middle East.
In that case it would be truer to say that to-day we all flatly refuse to think. War, like weather, cannot in itself be either criminal or saintly;He goes straight at this idea, even more popular in our day.
In this matter, as in many others, I am on the side of the vulgar majority. But I realise that there is an aristocracy of intellectuals who are quite spontaneous and sincere in the disgust which I describe; and who, while they are too intelligent to be content with merely praising peace, are infuriated by anyone praising war.Heck, that attitude is now so firmly embedded in the culture of the west that even I have some of it.
Do not wonder when people cannot seem to make the elemenary distinctions between our actions and those of our enemies, such as Kennedy suggesting that Abu Ghraib was the same under Saddam and the US. Its first motive is not so much treason or an oversensitive conscience as a refusal to admit there can be anything redeeming or just about any war. All wars must be regarded as essentially evil because they are essentially terrible; thus all justifications for a war must be undermined, and any claim that we have acted with general restraint and nobility must be squelched.
This is one of the ways that people who are against war prove that they are more moral than thee. "Courage" must mean the mild inconveniences they face being disliked and hounded by those they have disliked and hounded for years; not courage in pain and danger in the Middle East.
Black Swan?
There are occasional commenters on righty blogs who suggest that revolution, including possible violence, may be in store for us. I have little patience with this, not because I find it horrible, but because I find it silly. Yet it occurs to me that my reasons for thinking it silly are no better supported than the reasons other find it likely. A Man from Mars would likely say "I don't see that either of you are offering very convincing reasons for your premise." So the likelihood revolution, in the sense of "dramatic change in how we live" rather than "guys firing out of windows," seems worth considering. The guys shooting out of windows part seems too incredible to me to consider, and so I will pretend for the moment that it is so incredible as not to be discussed. There is a nagging thought at the back of my brain that says "it seemed incredible to many who had it come upon them nonetheless," but I bury that. This is not that sort of country, where presidents get assassinated or enemies blow up our buildings.
As usual, I will clear up some debris first. Violence tends to come off the left instead of the right in this country, and in most western nations. The usual pattern is that people who believe themselves gentle make excuses while thugs get violent. Then the incidents go down the memory hole. It is not always even true lefties who commit the violence, but any member of the grievance lobby who believes The Right is responsible for their unhappiness in some way. And as progressives certainly believe that is true, at any rate, they give encouragement to such, even folks with very illiberal values. The enemy of my enemy is my friend and all that.
Nonetheless, there is a strong defensive posture of violence on the right, touchy and suspicious, saying "We'll be ready." This is felt by those on the left as similar to peasants with pitchforks, or storming the Bastille, but that is almost a complete misunderstanding by them. It is likely a projection, in fact - a supposing that their anger must be like my anger, and my anger goes on offense.
Yet other revolutions, less than stormings but more than realignments, may be more possible than I would have thought. In NNT's The Black Swan, Taleb relates that Lebanon was thought to be a balanced and stable place despite the conflicts around it. When political upheaval came, many Lebanese tooked up temporary residence in hotels in Cyprus to wait it out, expecting a return to the normalcy that had prevailed for centuries. They are still there in hotels, decades later. (Excerpt)
So. Inertia is powerful, and Washington tends to run on as it always has, suggesting that this is all just a lot of noise and things won't change much. That's first-class proof, isn't it? Second, people have been predicting imminent cataclysmic changes as long as I can remember - likely race wars, class wars, Christian apocalypse, environmental destruction, population explosion, currency meltdown, oil crises, you name it, someone has looked at it and announced that doom is nigh. So that proves... okay, no it doesn't, but it suggests... well, even that's a little strong. What it suggests is no one wants to look stupid by predicting disasters that don't happen, so it's socially safer to predict no disaster is coming.
Third, we've had politicians who lie before, so we can live through that. And we've had economic crises, so we'll get through that. And we've had enemies and gotten through that, and we've been divided and gotten through that, so, so... I mean, this is nothing new. Americans argue about things and sometimes we have wars and depressions and stuff, but...
Fourth, America is destined to be around for a long time, right? And so far it has been. It was here yesterday, it's here today. Won't God just make sure that whatever we do, He'll keep us going, because He really needs America in order to... do...something. And fifth, a lot of those people predicting disaster are clearly weird, so we don't have to believe them.
History does not, in fact, repeat itself. Some actions tend to produce certain results, and it is wise to know that, but this precise combination of events has never occurred. Not in ancient Greece, not in Medieval Venice, not in the USSR, not in any of the American decades. Each day is new, and uncharted.
As usual, I will clear up some debris first. Violence tends to come off the left instead of the right in this country, and in most western nations. The usual pattern is that people who believe themselves gentle make excuses while thugs get violent. Then the incidents go down the memory hole. It is not always even true lefties who commit the violence, but any member of the grievance lobby who believes The Right is responsible for their unhappiness in some way. And as progressives certainly believe that is true, at any rate, they give encouragement to such, even folks with very illiberal values. The enemy of my enemy is my friend and all that.
Nonetheless, there is a strong defensive posture of violence on the right, touchy and suspicious, saying "We'll be ready." This is felt by those on the left as similar to peasants with pitchforks, or storming the Bastille, but that is almost a complete misunderstanding by them. It is likely a projection, in fact - a supposing that their anger must be like my anger, and my anger goes on offense.
Yet other revolutions, less than stormings but more than realignments, may be more possible than I would have thought. In NNT's The Black Swan, Taleb relates that Lebanon was thought to be a balanced and stable place despite the conflicts around it. When political upheaval came, many Lebanese tooked up temporary residence in hotels in Cyprus to wait it out, expecting a return to the normalcy that had prevailed for centuries. They are still there in hotels, decades later. (Excerpt)
So. Inertia is powerful, and Washington tends to run on as it always has, suggesting that this is all just a lot of noise and things won't change much. That's first-class proof, isn't it? Second, people have been predicting imminent cataclysmic changes as long as I can remember - likely race wars, class wars, Christian apocalypse, environmental destruction, population explosion, currency meltdown, oil crises, you name it, someone has looked at it and announced that doom is nigh. So that proves... okay, no it doesn't, but it suggests... well, even that's a little strong. What it suggests is no one wants to look stupid by predicting disasters that don't happen, so it's socially safer to predict no disaster is coming.
Third, we've had politicians who lie before, so we can live through that. And we've had economic crises, so we'll get through that. And we've had enemies and gotten through that, and we've been divided and gotten through that, so, so... I mean, this is nothing new. Americans argue about things and sometimes we have wars and depressions and stuff, but...
Fourth, America is destined to be around for a long time, right? And so far it has been. It was here yesterday, it's here today. Won't God just make sure that whatever we do, He'll keep us going, because He really needs America in order to... do...something. And fifth, a lot of those people predicting disaster are clearly weird, so we don't have to believe them.
History does not, in fact, repeat itself. Some actions tend to produce certain results, and it is wise to know that, but this precise combination of events has never occurred. Not in ancient Greece, not in Medieval Venice, not in the USSR, not in any of the American decades. Each day is new, and uncharted.
Thursday, March 25, 2010
Impolite Sympathy
Here’s where it’s infuriating working with progressives (not all of them). I am very careful at work to whom I mention Chris’s sad news about Wilson’s death in Afghanistan. Most folks, liberal or conservative, express proper sorrow or sympathy. All conservatives and more than 75% of the liberals get this. But I have already had a few people immediately inject their political view into it. Why don’t we just spend all this money on the war on health care? It’s a terrible war, we never should’ve gone there (that one was lying, BTW. She specifically mentioned how she had supported going into Afghanistan when she was telling me how pointless Iraq was about four years ago). They are not trying to lecture, they don’t think. They say this with appropriate sorrowful affect, as if they are expressing some sort of reasonable sympathy. However, one did get angry and haranguing at me, glaring meaningfully about Republicans – he spit the word out – who were always getting us into wars where people die uselessly. And this is out of the population of progressives I thought it might be safe to mention this news to.
I have often maintained that liberals do not so much disagree with others as absolutely not understand them. This is a great example. If you don’t just intuitively get why these are not actual expressions of sympathy – if you don’t feel deeply in your bones how inappropriate this is, then I submit that there is a basic level of human interaction that either never developed in you, or has died under the weight of some more artificial morality. It is your lack. It is your inadequacy. And you should STFU and ponder that.
I have often maintained that liberals do not so much disagree with others as absolutely not understand them. This is a great example. If you don’t just intuitively get why these are not actual expressions of sympathy – if you don’t feel deeply in your bones how inappropriate this is, then I submit that there is a basic level of human interaction that either never developed in you, or has died under the weight of some more artificial morality. It is your lack. It is your inadequacy. And you should STFU and ponder that.
Health Care
I have not weighed in much on the health care debate, though I have followed it closely. I consider some important aspects neglected by most people in the debate, and haven’t really known where to fit them in.
It’s good to have someone to set you back a bit, reminding you to go at first questions, rather than the ephemeral political debate. Loyal Achates, who can be found here, had the following comment on one of the posts about health insurance reform over at neo’s
Here’s my worry: Loyal Achates isn’t so much unusual as he is a canary in the mine. Health care costs are rising, not because of inefficiency or heartless business practices or stunning malpractice claims – though these all deserve significant attention – but because the products and services provided simply are very expensive. And they are going to get more expensive - much, much more expensive – for the foreseeable future. We can do magical things we were never able to do. We can keep people alive (such as a family friend with CF) far longer than we could. We can save people who simply died not very long ago. And it costs a fortune.
A little background on the American way of dealing with this. I was going to call this an interpolated palimpsest, but that's not quite accurate, and just pretend. (An example of the use of of interpolated palimpsest in context, from one of my favorite books. Scroll down to Test Paper I.)
The real division occurs because this post is too long, and I wanted to create a break somewhere. Here is good. Go get coffee or something.
The old method, still the norm in poor countries, is that you purchase the medical care, get some person or persons to purchase it for you, or you go without, with full consequences: blindness, incapacity, death. Who was expected to help you with this varied from place to place, but it was a much more restricted group than now. Your immediate family might be expected to impoverish themselves if necessary. Extended family, church, or neighborhood might have some expected moral (though not legal) obligation, which they might fulfill with contributions, organizing benefits, or providing care. The larger community had little expected responsibility. This was only a century ago. All those children’s books, plays, and movies about little Elizabeth who needed “an operation,” or “a specialist in New York,” and was languishing in misery as the family strained to be able to afford such a thing, was not so long ago.
The somewhat new method is that we spread the cost out over a large number of people, either through private health insurance or government provision. As rare conditions are by definition rare, it was thought to be fairer to be a society where everyone chips in to provide for the few who were in dire situations through no observable fault of their own.
Somewhere between these two methods was the foundation of hospitals, often by religious groups, which provided some free or reduced-fee care. Hospitals tend to be part of large health-care industry groups or attached to colleges (themselves often religiously founded) now, but we can still detect that solution through their names: Beth Israel, St. Mary’s, Baptist Hospital. No one was legally required to be generous, but it was a social expectation that all would be as generous as they could. Americans, especially religious Americans, considered it part of their self-definition to be open-handed.
For many reasons, some good, some bad, this has gradually shaded into government provision of many helps that were once voluntary charity. The lines are not sharp here. American colonial communities recognised some obligation to the poor in their midst, and towns, not churches even when the two were virtually interchangeable, would vote public funds for poor farms, doctors, hospitals. Through long eras when the great majority of citizens belonged to a formal religious group with might provide a conduit for giving, they allocated some of their giving via taxation, insisting on the generosity rather than leaving it to generous feeling. But in the end, it was the same amount of money for the community as a whole.
Did the Catholic voters fear the Methodist churchgoers wouldn’t pony up? I jest. The idea has grown in America that the government is the primary expression of the community’s values. This sense has increased rapidly as people stopped going to church, which is why secularists are far more likely to regard government help as the defining item in whether a community is generous or not. Those who regard the government as an impersonal hired entity don’t see it that way.
Despite the political rhetoric, most Americans have some of both values operating, and we are fighting over How much is enough/how much is too much? We have always had a mixed socialist/free market system. Until comparatively recently, almost no Americans thought that the common weal - in our current narrow sense of equalisation - was the dominant reason for government. But neither has "rugged individualism" been so central as we imagine. The frontier peoples banded together as soon as they could. The phrase does not seem to occur until the early 20th C. The conflict of values also brings in other, messier questions: If the government expresses the will of the people in charity, isn’t it just as fair that it express the will of the people in definition of marriage or beginning of life? An interesting philosophical question – and part of why we have a Constitution.
End of Interpolated Palimpsest. Back to our regularly-scheduled programming.
So the newest method, much present in America but more pronounced in other industrialised nations, is that the cost of everything is spread out over everyone. In theory, anyway. To the government-as-expression people, this seems the only fair way. There are half-a-dozen enormous questions in the health care debate, including what “everything” is and who “everyone” is; who is allowed to make money and how much; does gifting improve the general morals and/or does it promote the deterioration of responsibility.
But all these questions are going to be swamped under the practical consideration that will force re-examination. Health care costs are rising, and will rise no matter what we do or who is in charge. We can be efficient, preventative, empirically-driven, and wise to slow this, but we will not prevent it. We are moving into a time when every family has a Loyal Achates at some point, and then into a time when a majority of us come up against the need for a medical treatment beyond the means of any but the wealthiest to afford. Whether we’re paying for that out-of-pocket or just tossing in a co-pay while we all share the burden, as medical care improves, half of the citizenry (er, residents) will require something that costs two years’ salary to effect. The cost will not go away just because people deserve the care.
I very much hope to be wrong on this. Perhaps some truly magical medical advances will turn out to be cheap. Perhaps we will culturally decide that most of us don’t want to live beyond 100 anyway, and palliative care become the norm beyond 80. But more likely, a lot of us are going to want to live to 120 if we can, and if an expensive procedure is needed at 75 we will insist it be performed. And then get a few others at 90 and 110.
If you want to see a hockey-stick graph that’s real, don’t go to environmental sites, go to the health-cost info. It’s not just machinery and medicines, but skilled people putting in time. Obama’s opponents have complained “where is the money going to come from?” It’s a fair question, but it is going to come anyway, Obamacare or no. Unless our robot doctors and nurses become really good, really fast.
It’s good to have someone to set you back a bit, reminding you to go at first questions, rather than the ephemeral political debate. Loyal Achates, who can be found here, had the following comment on one of the posts about health insurance reform over at neo’s
Loyal Achates Says:It’s a very fair question. Even with the disclaimers that people can pretend anything on the internet and leave out important information, it remains true that there are people in situations much like this in our country. In fact, everywhere in the world. (And besides, I tend to think LA is truthful on this anyway.)
You know what? I’m one of the evil young people you’ve been talking about, and a leftist, and a supporter of health care reform. I do think it didn’t go far enough in extending universal coverage but I am willing to accept it as a step forward.
You know what else? I was born with a pre-existing condition - specifically, Tetralogy of Fallot. no insurance company in America will cover me, and my cardiologist tells me I’m going to need regular surgeries just to stay alive.
Would I be ‘free’ in a country where I was simply left to die because I couldn’t, at the age of 24, scrape together the $100,000 needed for the operation and subsequent hospital stay? You tell me.
Here’s my worry: Loyal Achates isn’t so much unusual as he is a canary in the mine. Health care costs are rising, not because of inefficiency or heartless business practices or stunning malpractice claims – though these all deserve significant attention – but because the products and services provided simply are very expensive. And they are going to get more expensive - much, much more expensive – for the foreseeable future. We can do magical things we were never able to do. We can keep people alive (such as a family friend with CF) far longer than we could. We can save people who simply died not very long ago. And it costs a fortune.
A little background on the American way of dealing with this. I was going to call this an interpolated palimpsest, but that's not quite accurate, and just pretend. (An example of the use of of interpolated palimpsest in context, from one of my favorite books. Scroll down to Test Paper I.)
The real division occurs because this post is too long, and I wanted to create a break somewhere. Here is good. Go get coffee or something.
The old method, still the norm in poor countries, is that you purchase the medical care, get some person or persons to purchase it for you, or you go without, with full consequences: blindness, incapacity, death. Who was expected to help you with this varied from place to place, but it was a much more restricted group than now. Your immediate family might be expected to impoverish themselves if necessary. Extended family, church, or neighborhood might have some expected moral (though not legal) obligation, which they might fulfill with contributions, organizing benefits, or providing care. The larger community had little expected responsibility. This was only a century ago. All those children’s books, plays, and movies about little Elizabeth who needed “an operation,” or “a specialist in New York,” and was languishing in misery as the family strained to be able to afford such a thing, was not so long ago.
The somewhat new method is that we spread the cost out over a large number of people, either through private health insurance or government provision. As rare conditions are by definition rare, it was thought to be fairer to be a society where everyone chips in to provide for the few who were in dire situations through no observable fault of their own.
Somewhere between these two methods was the foundation of hospitals, often by religious groups, which provided some free or reduced-fee care. Hospitals tend to be part of large health-care industry groups or attached to colleges (themselves often religiously founded) now, but we can still detect that solution through their names: Beth Israel, St. Mary’s, Baptist Hospital. No one was legally required to be generous, but it was a social expectation that all would be as generous as they could. Americans, especially religious Americans, considered it part of their self-definition to be open-handed.
For many reasons, some good, some bad, this has gradually shaded into government provision of many helps that were once voluntary charity. The lines are not sharp here. American colonial communities recognised some obligation to the poor in their midst, and towns, not churches even when the two were virtually interchangeable, would vote public funds for poor farms, doctors, hospitals. Through long eras when the great majority of citizens belonged to a formal religious group with might provide a conduit for giving, they allocated some of their giving via taxation, insisting on the generosity rather than leaving it to generous feeling. But in the end, it was the same amount of money for the community as a whole.
Did the Catholic voters fear the Methodist churchgoers wouldn’t pony up? I jest. The idea has grown in America that the government is the primary expression of the community’s values. This sense has increased rapidly as people stopped going to church, which is why secularists are far more likely to regard government help as the defining item in whether a community is generous or not. Those who regard the government as an impersonal hired entity don’t see it that way.
Despite the political rhetoric, most Americans have some of both values operating, and we are fighting over How much is enough/how much is too much? We have always had a mixed socialist/free market system. Until comparatively recently, almost no Americans thought that the common weal - in our current narrow sense of equalisation - was the dominant reason for government. But neither has "rugged individualism" been so central as we imagine. The frontier peoples banded together as soon as they could. The phrase does not seem to occur until the early 20th C. The conflict of values also brings in other, messier questions: If the government expresses the will of the people in charity, isn’t it just as fair that it express the will of the people in definition of marriage or beginning of life? An interesting philosophical question – and part of why we have a Constitution.
End of Interpolated Palimpsest. Back to our regularly-scheduled programming.
So the newest method, much present in America but more pronounced in other industrialised nations, is that the cost of everything is spread out over everyone. In theory, anyway. To the government-as-expression people, this seems the only fair way. There are half-a-dozen enormous questions in the health care debate, including what “everything” is and who “everyone” is; who is allowed to make money and how much; does gifting improve the general morals and/or does it promote the deterioration of responsibility.
But all these questions are going to be swamped under the practical consideration that will force re-examination. Health care costs are rising, and will rise no matter what we do or who is in charge. We can be efficient, preventative, empirically-driven, and wise to slow this, but we will not prevent it. We are moving into a time when every family has a Loyal Achates at some point, and then into a time when a majority of us come up against the need for a medical treatment beyond the means of any but the wealthiest to afford. Whether we’re paying for that out-of-pocket or just tossing in a co-pay while we all share the burden, as medical care improves, half of the citizenry (er, residents) will require something that costs two years’ salary to effect. The cost will not go away just because people deserve the care.
I very much hope to be wrong on this. Perhaps some truly magical medical advances will turn out to be cheap. Perhaps we will culturally decide that most of us don’t want to live beyond 100 anyway, and palliative care become the norm beyond 80. But more likely, a lot of us are going to want to live to 120 if we can, and if an expensive procedure is needed at 75 we will insist it be performed. And then get a few others at 90 and 110.
If you want to see a hockey-stick graph that’s real, don’t go to environmental sites, go to the health-cost info. It’s not just machinery and medicines, but skilled people putting in time. Obama’s opponents have complained “where is the money going to come from?” It’s a fair question, but it is going to come anyway, Obamacare or no. Unless our robot doctors and nurses become really good, really fast.
Tuesday, March 23, 2010
For Fans of "Lost"
Ben tells me he has picked out one of the clues from season one that has just showed up again, and thinks he can project a lot of its meaning. I'm trying to force his hand by writing this, so you'll go over to his Ten-Four Films blog (top of my sidebar) and pester him. It has to do with Watership Down, but I'm not going to repeat his comments beyond that.
Justin Wilson, USMC
Chris called this morning to say that his best friend "Wilson" had been killed in Afghanistan. We had heard about Wilson over the last year - never with a first name, but clearly someone Chris liked and spent time with. He had visited Justin's family in FL last year, and met his fiancee.
Fiancee. It just kills me to hear that word associated with one who died. Her name is Hannah. Prayers, please.
And his parents, of course. We immediately thought of them and how brutal it must be to have one's fears realized. We don't know more details. We are presuming an IED, because that is the most common cause of fatalities for drivers in Afghanistan.
Fiancee. It just kills me to hear that word associated with one who died. Her name is Hannah. Prayers, please.
And his parents, of course. We immediately thought of them and how brutal it must be to have one's fears realized. We don't know more details. We are presuming an IED, because that is the most common cause of fatalities for drivers in Afghanistan.
Budapest Tourist - One
Related to the adoption series, pictures I took in Budapest in 2001. Most of these were taken a stone's throw from our hotel. Really. The Hotel Berg, up on the Castle Mount, is about 50 feet from St. Matthias Church. And it is (was?) inexpensive.
Monday, March 22, 2010
Deconstruction
I ran across a marvelous quote today while trekking through the swamps of Paul De Man writing tor the Nazis, Jacques Lacan's impregnating his friend's wife, the general obscurantism and puffiness of Derrida, Foucault...a plague on all their houses. Jeffrey Mehlman, quoted in Alan Spitzer's Historical Truth and the Lies About The Past.
...are grounds for viewing the whole of deconstruction as a vast amnesty project for the politics of collaboration during WWII.
Subscribe to:
Posts (Atom)