OK, some of the conservatives who are arguing to repeal the ACA are heartless opportunists. But all of them? Probably not. So, what mindset could possibly justify such an action?
Let’s start here: Do you believe that everyone deserves to own a car? Not just that they have the right to purchase one if they can, but that they have a right to have a car, and if they can’t afford it, then it is up to us, their community, to provide it.
Keep in mind that if you answer “No, people don’t have a right to car.” then some people, probably a lot of people, will go without one. And that means they will not be able to get a good job that requires a commute. They won’t be able to take their children to enriching after school programs. If they need to go to see a doctor right away, but not in such a hurry that they would call an ambulance, they will have to spend hours on public transportation while they are sick. They will feel undervalued by a society that glorifies car ownership, and the joy and freedom and convenience that it brings.
Not convinced? Me neither. Car ownership isn’t a right. (It does, however, point to a responsibility on our part for good mass transit.)
When you decide some good or service should not be available “by right,” you are accepting the fact that some people won’t have access to that good or service. That is what happens in a marketplace. Some people win and some people lose.
And that isn’t just a side effect of a market. That is crucial to the good functioning of a market. It is the competition to win, to avoid losing, that stimulates the best response from the marketplace, that creates the efficiencies for which markets are praised. If there are no losers, then the market won’t produce what it promises – efficiency and a promotion of liberty. (More on this can be found in earlier blog posts on “Vouching for healthcare,” parts 1 through 5. These were posted in September of 2015 through June of 2016.)
So, now think like a conservative. You don’t believe that the government has a responsibility to provide health care to everyone. It is not a right, but a service to be purchased in a marketplace. This will mean that some people have less healthcare, and some people will have more. Losers and winners. Since you are not heartless, you will be in favor of some kind of “safety net” so that the worst off are taken care of to some extent. But it can’t be an extensive governmental program or you won’t get the benefit of the marketplace.
And it is those benefits that you want very much to achieve. You want to lower the price of health care, increase the quality of health care, and, overall, create a better match between the true needs of health care consumers and the health care that is available.
If people compete for health care, this will stimulate health care providers to offer care at a lower price. It will also encourage providers to offer better care, care that is most appropriate and of higher quality. By empowering the health care consumer, we get higher quality and more appropriate health care at a lower price.
And some health care providers will get very good at giving high quality care at a reasonable rate. They will expand their capabilities, thereby employing more people. And their increased size will bring economies of scale that will benefit their employees, their investors and everyone who purchases care from them. The benefits of a marketplace trickle down to all of us.
Unlike manufacturing, where the benefits of bigness were shipped oversees and trickle down in other countries, health care is confined to a locale, so the benefits of the marketplace will accrue to the specific community where the care is given.
Health care costs are rising at two or three times the rate of inflation. We pay the most (by far!) of any rich country for our health care, without a corresponding increase in the quality of our lives. In fact, cheaper care in a number of other countries produce better results. A well-meaning conservative would argue that we could lower health care costs and increase the quality of our health care outcomes by empowering the consumer, by eliminating the government programs for health care and returning it to the marketplace.
The cost to society of these benefits is to accept that some people will not get sufficient care. But, to use a cliche, the fact that some people will suffer from a lack of health care is not a bug, it is a feature of the marketplace. It is the price we pay for all of the benefits we reap from returning health care into the marketplace.
You and I accept the idea that some people’s lives will not be as rich as ours because we don’t give everyone a car. A conservative believes that we, as a society, would be better off if we accepted some health care disparities in return for lower costs and higher quality.
That is why the central issue of this debate has to be “Is health care a right?” If so, then the community, through its agent, the government, must assure that everyone gets care. If not, then we are left to fight over how much disparity we can accept.
I think American public has made clear to Congress that they aren’t willing to have millions of people, real people, our relatives, friends and neighbors, lose their health care in exchange for the illusive promises from “returning care to the marketplace.” And I think Americans are very, very close to accepting the idea that health care is a right, not a privilege.
By the way, keep in mind that the ACA, even when fully implemented, was going to leave 30 million people in the US without health insurance. By passing the ACA, we as a country decided that we could live with one of out ten of us not having care. How did that happen? In part, because people didn’t understand that this would be the result, and in part because we didn’t have the public discussion in 2009 about whether health care was a right.
Yes, some of the players in this drama are mean-spirited and heartless. Shame on them and their supporters. But some conservatives think they are doing what is best for society as a whole. They are wrong in two ways. First, health care doesn’t work well in a marketplace. And, more importantly, it is a birthright that the community should promise to every child born. This means that markets are a very bad way of assuring that everyone gets care. (Evidence – the one big problem with the ACA is the health insurance exchanges or marketplaces.)
Ultimately, if we engage in the debate over whether health care is a right, we are going to have to face the question about where rights come from, which many of my liberal friends don’t want to talk about. I have proposed to start that uncomfortable conversation at the next annual meeting of the American Public Health Association. Lets see where that leads.
Addendum as of October, 2017: My proposal to talk about "where a right to health care comes from" was rejected by my colleagues in the Ethics Section of APHA. That is the fourth time I have tried to have this conversation at the APHA Annual Meeting, and the fourth time it has been rejected. I give up.
Tuesday, July 18, 2017
Tuesday, May 2, 2017
Two questions: Trump’s supporters? Trump?
Have you ever been so mad that you took a whack at something? Maybe physically, like pounding the wall or slamming the door? Or maybe verbally, by saying something vicious to someone?
Me, too. Not proud of it, but it makes me human.
However, after I calm down, I am able to think about my anger and what I did. I might decide I was absolutely right to be angry, or I may feel shame for the damage I have done. Or both. I may end up apologizing to someone. But what ever comes next, I have thought about it.
So, I get that Trump’s supporters were angry and frustrated. Senator Warren, in her ubiquitous appearances on behalf of her new book, points out that from the 1930's to 1980, 70% of the increased wealth of the country went to the bottom 90% of us. From 1981 to the present, all of the increase in wealth is going to the top tier of the income distribution. The rest of us have received none of that.
During that latter period, almost all of our politicians have promised to fix the problem. And then they have done almost nothing, or have made it worse. They lied, repeatedly and with no apparent shame.
Suffering from this injustice and then being lied to about it made a lot of people mad. And they wanted to lash out, to strike against the problem and the liars. So, they voted for Trump, the guy who clearly had not created the problem and who was promising to fix it. In fact, the only person, they believed, who had a chance to fix it.
I get that. I have been that angry, that frustrated. I will restrain from criticizing his supporters for the initial action. I have spent no time in their bubble, but I think I understand their motivation.
But it is now time to stop, calm down and reflect.
Instead, 96% of the people who voted for Trump are happy with how he is doing. Maybe you get a pass for voting for someone with Trump’s obvious faults, but there is no basis for continuing to believe in him.
Therefore, I have to call them to account for their continuing support.
Donald Trump is small-minded, bigoted, ill-read, uneducated, inconsistent, uncontrolled, narcissist. He has little impulse control and no ability to think strategically. He is attracted only by people with power or with money or with big breasts. He doesn’t understand what he doesn’t understand. His positions are adopted from the last person he talks to or that last cable show he has watched.
At some point, the people who saw him as a knight riding forth with their banner of righteous indignation must now look at him anew. Shame on you if you can’t see past your hopes and look at the actual person that we elected.
So, I am done making excuses for his supporters. They have had 100 days to come to their senses. That they haven’t is completely unacceptable.
I supposed the second question is somewhat answered by my discussion of the first. What should I make of Donald Trump?
My visceral reaction has been that he is exactly what he appears to be, an incompetent narcissist, in way over his head. But I have tried to give him some benefit of some doubt. Maybe he will start listening to the people around him. Maybe he will start doing his homework. Maybe he will start developing strategic and tactical plans to address our national and international concerns.
He, too, got 100 days to show me that I was being too critical, that I should hold out some hope. That period is now done. He is what he appears to be:
• Who knew how complicated health care was?
• Andrew Jackson, instead of being a vicious genocide, is a model of leadership who wouldn’t have made the same mistakes as did that Lincoln guy.
• Obama personally ordered surveillance of me. Sad.
• We are going to have a beautiful health care bill passed by the Republicans, which will lower costs, provide health care for everyone, and protect those of us with pre-existing conditions.
• We will build the Wall.
• We will act against millions of undocumented immigrants, and keep fighting in the courts to exclude more immigration by Muslims.
• My life before this was hard, but who knew this job would be harder.
• My inaugural crowds were monumental, bigger than any before.
• My electoral college victory was historic.
• My popular vote would have been higher, had it not been for millions of people voting illegally.
• My tax cut will be the biggest in history.
As of today, I am done. My little sliver of hope was none too large, but it is now gone. He is who he appears to be. And we have to resist him at all costs.
What will that resistance take? That is my next topic.
Me, too. Not proud of it, but it makes me human.
However, after I calm down, I am able to think about my anger and what I did. I might decide I was absolutely right to be angry, or I may feel shame for the damage I have done. Or both. I may end up apologizing to someone. But what ever comes next, I have thought about it.
So, I get that Trump’s supporters were angry and frustrated. Senator Warren, in her ubiquitous appearances on behalf of her new book, points out that from the 1930's to 1980, 70% of the increased wealth of the country went to the bottom 90% of us. From 1981 to the present, all of the increase in wealth is going to the top tier of the income distribution. The rest of us have received none of that.
During that latter period, almost all of our politicians have promised to fix the problem. And then they have done almost nothing, or have made it worse. They lied, repeatedly and with no apparent shame.
Suffering from this injustice and then being lied to about it made a lot of people mad. And they wanted to lash out, to strike against the problem and the liars. So, they voted for Trump, the guy who clearly had not created the problem and who was promising to fix it. In fact, the only person, they believed, who had a chance to fix it.
I get that. I have been that angry, that frustrated. I will restrain from criticizing his supporters for the initial action. I have spent no time in their bubble, but I think I understand their motivation.
But it is now time to stop, calm down and reflect.
Instead, 96% of the people who voted for Trump are happy with how he is doing. Maybe you get a pass for voting for someone with Trump’s obvious faults, but there is no basis for continuing to believe in him.
Therefore, I have to call them to account for their continuing support.
Donald Trump is small-minded, bigoted, ill-read, uneducated, inconsistent, uncontrolled, narcissist. He has little impulse control and no ability to think strategically. He is attracted only by people with power or with money or with big breasts. He doesn’t understand what he doesn’t understand. His positions are adopted from the last person he talks to or that last cable show he has watched.
At some point, the people who saw him as a knight riding forth with their banner of righteous indignation must now look at him anew. Shame on you if you can’t see past your hopes and look at the actual person that we elected.
So, I am done making excuses for his supporters. They have had 100 days to come to their senses. That they haven’t is completely unacceptable.
I supposed the second question is somewhat answered by my discussion of the first. What should I make of Donald Trump?
My visceral reaction has been that he is exactly what he appears to be, an incompetent narcissist, in way over his head. But I have tried to give him some benefit of some doubt. Maybe he will start listening to the people around him. Maybe he will start doing his homework. Maybe he will start developing strategic and tactical plans to address our national and international concerns.
He, too, got 100 days to show me that I was being too critical, that I should hold out some hope. That period is now done. He is what he appears to be:
• Who knew how complicated health care was?
• Andrew Jackson, instead of being a vicious genocide, is a model of leadership who wouldn’t have made the same mistakes as did that Lincoln guy.
• Obama personally ordered surveillance of me. Sad.
• We are going to have a beautiful health care bill passed by the Republicans, which will lower costs, provide health care for everyone, and protect those of us with pre-existing conditions.
• We will build the Wall.
• We will act against millions of undocumented immigrants, and keep fighting in the courts to exclude more immigration by Muslims.
• My life before this was hard, but who knew this job would be harder.
• My inaugural crowds were monumental, bigger than any before.
• My electoral college victory was historic.
• My popular vote would have been higher, had it not been for millions of people voting illegally.
• My tax cut will be the biggest in history.
As of today, I am done. My little sliver of hope was none too large, but it is now gone. He is who he appears to be. And we have to resist him at all costs.
What will that resistance take? That is my next topic.
Thursday, November 10, 2016
November 8, 2016: What I know. What I don’t know. What I need to find out.
I am still a bit stunned by the election. Did we really do that? Is this really the country I thought I had been living in? How do I make sense of this? What do I do now?
So, I have been listening and reading, talking to friends, family and colleagues, trying to take stock. It seems my thoughts fall into three categories: What I know, What I don’t know, and What I need to find out. (I am still working on “What do I do next?”)
What I know
1. This was complicated. There was no one thing that accounts for this election result. Trump had to be good at what he does. Clinton had to be sub-par. The media had to play its role in gracing Trump and treating Clinton with undeserved moral equivalence. Bernie’s folks (and I am one) had to feel disaffected and unmotivated. Trump voters had to show up. I would like to come to some quick understanding of what happened and why, but I suspect this will take some time to sort out.
2. Enthusiasm beats professionalism. Trump had a clear “enthusiasm gap” over Clinton. One of the commentators on PBS said that this was an election between Trump’s ability to generate enthusiasm and Clinton’s ability to manage an expensive, highly professional, data-based, modern political campaign. Ask any political professional which they would rather have, he said, a great “ground game” or terrific enthusiasm. Enthusiasm beats professionalism.
There was a clear enthusiasm for Trump. He pulled together the Republican coalition, getting almost as many votes as did Romney in 2012 and McCain in 2008, and that energy was missed by the pollsters and pundits. Oddly, he did his job.
Clinton suffered from less enthusiasm. She got 7,000,000 votes less than Obama did in 2012 and 10,000,000 votes less than Obama in 2008. Depending on where those votes were, that was probably the difference in this election. And 42 percent of women voters did not vote for the first serious female candidate for the presidency. And they voted for a serial practitioner of sexual assault! She underperformed, and it cost her (and us) the election.
3. Republicans came home. I think the winning coalition that Trump put together was the traditional Republican base (minus the surprisingly small number of people who usually vote Republican but couldn’t stomach voting for him), plus a whole lot of very enthusiastic, working class white people suffering economic and cultural distress and anxiety, plus a smaller but highly visible“basketload of deplorables,” assorted xenophobes, islamophobes, homophobes, racists, anti-Semites and just plain ignoramuses. Were there enough anxious white folks and racists to win? I don’t think so. The fact that the Republican party “normalized” Trump (with help from the unbelievable combination of Putin’s trolls and hackers and Comey and his FBI colleagues) allowed Republicans to “come home,” and vote for “our candidate.”
4. We are all living in bubbles. I am. You are. All those Trump voters are. Look at the map of who won which counties around the country. Rural people voted overwhelmingly for Trump. In every state, not just in the “red states.” Most “blue states” are largely red, when looked at county by county. These people don’t know many minorities or Jews. They disproportionately listen to Fox News, if they listen to the news at all. They are more likely to doubt that global warming really exists. They are much more likely to be mourning the loss of a lifestyle that centered around a good job at the factory and a Christian church. They are less likely to be college educated.
Or at least I think that is who they are, because I am inside my bubble – college educated urbanites, heavily Jewish, lots of minority friends and colleagues, worried about climate change, listening to NPR and MSNBC, wondering whether to eat Thai or Vietnamese tonight. We live in the tiny, but heavily populated blue islands in the sea of red on that map. I don’t know anybody who voted for Trump, but half the people in the country did. All of them live outside my bubble.
The people in those red counties have absolutely no idea what my life is like and what my concerns are. Nor do I understand their life and troubles. Mutually exclusive bubbles.
5. We are all desperate for leadership. People who stand for something. Who know their own values and share them well. Who are willing to make tough choices and withstand the consequences. We are kind of done with triangulation and nuance.
While I continue to doubt whether Trump actually believes much of what he said, he sounded like he was sure of his positions. And he didn’t seem uncomfortable that they might draw criticism; in fact, I think he fed off the criticism.
Clinton was careful. Lawyer-like. Guarded. Precise. She came across to me as insincere, not frank. She talked a good game about taxing the rich, but she wouldn’t let us hear what she said to the rich in those highly paid speeches. How hard is it to say “Boy, I really screwed up when I decided to put those emails on a private server. I wanted to protect myself and my communications, but look at the mess I created. My bad.” I think distaste for her lack of sincerity was magnified in the rural bubbles.
I have said in earlier blogs how important leadership is to change public policy when you are up against the rich and powerful. See my original argument in favor of Sanders, here:
http://danswartzman.blogspot.com/2016/02/my-heart-says-sanders-but-so-does-my.html
And here is my critique of Clinton and Jeb Bush on their lack of real leadership and my admiration for Sanders’ and Trump’s skills:
http://danswartzman.blogspot.com/2015/08/what-do-trump-and-sanders-have-in-common.html
Real leaders take strong positions on tough choices. This is what we want, and Trump offered it. Half of us were unmoved by his brand of leadership; the other half elected him.
6. We all share some anger. I am angry that millions of people lost their homes, and tens of millions of people were “under water” because of the economic disaster of 2008, while the people whose greed and arrogance caused it were bailed out and given bonuses and not one of them served time in jail.
I am angry that the Obama administration missed the opportunity to argue for universal health care back in 2009, which might have made the Affordable Care Act something that lots of people could love. I am angry that his chief of staff, Rahm Emanuel, yelled at people like me who didn’t get on board with the compromise they were making with the health insurers, the pharmaceuticals, the hospitals and the doctors, calling us “fucking retards.” That compromise was the much unloved ACA.
I am angry with the Republicans who decided to obstruct everything that Obama tried to do, and then had the chutzpah to criticize him because he couldn’t get anything done.
Out in the rural bubble, they are angry and fearful, too. White men, in their middle years, are the only demographic in the US whose rate of death is increasing. Everyone else’s death rate (the poor and minorities included) is going down. And the cause of these extra deaths are suicide, drug overdoses and alcoholism. Something is very, very wrong with that population. And Trump gave voice to their anger and their fear, and promised to make things right, to make things great again.
We are an angry population, angry about different things, all inside our bubbles.
What I don’t know
1. Who ARE these people? I mean the 59,000,000 Americans who voted for Trump. Are they uneducated, ignorant red-necks with guns? Are they hurting and anxious? White men, stewed in the subtle or not so subtle racism and sexism of the last 100 years?
President Johnson, after he signed the Civil Rights Act in 1964 famously told his press secretary, Bill Moyers, "I think we just handed the south to the Republicans for the rest of my life and yours." So true. In the next presidential election, Nixon’s Southern Strategy began the change from the Democrats’ “Solid South” to the red-tinged map we see today. In the early part of the 20th Century, it was racist Democrats who ran things in the South, while the Republicans were the “party of Lincoln.” After 1968 and into the new century, the bigots found a home in the Republican party.
Some amount of support for Trump was based upon bigotry, racism, anti-Semitism. How dare a black man be President of the United States and tell us what to do? And now you want us to vote for a woman? How much of his support was based upon this? If a lot, then it is easier to discount his constituents. If not as much, then we need to find out why else they thought to support such a man.
2. Was this what Wallace and Perot were trying to tell us? George Wallace was the last third party candidate to capture electors when he won five states in 1968. His message was heavily clothed in racism, but it was also a screed against the “pointy headed bureaucrats in Washington” who didn’t listen, who didn’t know much, who had too much control over our lives. Ross Perot, in 1992, captured 19% of the popular vote with a message that the Republicans and the Democrats were equally incompetent and unwilling to address the real problems the country was facing, such as the deficit and the movement of jobs to other countries. He warned of the “giant sucking sound” of jobs being pulled into Mexico.
Don’t those sound like familiar themes? I’d like to understand the history of these ideas, some of which were faintly echoed by Sanders.
3. Where were the Millennials? The Millenials are now the largest generation, passing by us Post-War Baby Boomers this last year. Yet only a fraction of them came out to vote in this critical election. (We won’t know the percentage for a while.) This is their future we were fighting over; among adults, they will spend more years in this future than anyone else. I can not imagine an adequate excuse for their not taking the time to vote, when the choice was so stark.
Maybe some will say “We couldn’t see voting for Hillary.” Well, how did that work out for you?
I didn’t care for Bill Clinton in ‘92 (his “Third Way” was responsible for accelerating the rightward, neoliberal drift of the Democrats), but I voted for him. John Kerry was a terrible idea (wooden, out of touch with ordinary people, a centrist at a time we needed a leftist critique of W), but I voted for him. Clinton was not my first choice this year. And I can think of a lot of reasons to not want to vote for her, but there is one good reason to have done so, and he is now the President-Elect.
Millenials, your parents have been doing everything they could to guard your future, to try to assure your safety and prosperity. One way they did those things is by voting. But you are the largest group of adults now. It is your turn. Where the hell were you?
What I need to find out
1. How is it that facts don’t matter? Yes, we are in different bubbles, but why is it that facts don’t matter over in their bubbles? I am a religious person, but evolution is science. I am skeptical of technical expertise with a financial interest, but climate change is really happening. (If you are 31 years old or younger, you have never lived in a month that was below average in global temperature.) The economy is, at the national level, doing very well, with steady if slow growth and almost “full employment.” Yes, there are pockets of anxiety and despair over lost manufacturing jobs, and there are still many, many poor people, but Trump’s assessment of the state of the economy was completely counter-factual. How does that not matter?
2. Could we find enough things that we are all angry about to forge new coalitions? The only way that the average person (which we mostly are) can win against the rich and powerful is through social movements. And social movements usually require coalitions. Since the people in my bubble are angry and the people in those other bubbles are angry, might there be sufficient overlap to support some joint efforts?
3. How do we bridge the gap between the rural and the urban? Joint efforts would require us to burst our bubbles and find common ground. How would we do that? Is that even possible?
4. Did Putin and the FBI have pro-Trump agendas? Russians were in contact with the Trump campaign. They hacked Democratic emails and released the results with a mind towards affecting the election. Russian hackers and trolls issued fake news and fake comments on online forums. Before we do this again, we need to figure out a way to identify similar efforts and either stop them or call full attention to them.
The FBI has to be investigated to see if what appears on the surface to be true, that they had a secret desire to tip the scale for Trump, is actually the case. If so, people have to be fired, and better rules have to be put in place and enforced. (I know – what are the chances either of these are going to be examined during a Trump Presidency, but we still need to know. Hey, mainstream media, these might be good subjects for the kind of hard-hitting investigative reporting that only a paltry few of you did during the campaign.)
5. Is it time to do away with the Electoral College? Al Gore and Hillary Clinton were both supported by a majority of voters (actually a plurality if you include votes for other parties). Yet they lost. This is because of the Electoral College. This is in the US Constitution, put in by the elites of the time to guard against their loss of power to the hoi polloi to whom they were giving voting privileges. It was also a way to keep support for the new Constitution among the less populated states in the south by giving them a disproportionate share of the vote.
Quick primer – Each state is given “electoral votes” equal to the number of members of Congress they have, plus two for their two Senators. So, since the least number of members of Congress a state can have is one (like Wyoming, Alaska, Delaware), then the least number of electoral votes that a state can have is three. (The District of Columbia also gets three electoral votes.) When the citizens of a state vote for President, they are actually voting for a slate of “electors” who are more or less committed to vote for the winner of the popular vote in that state. These electors meet (figuratively referred to as the “Electoral College”) in December, where the 538 votes for President are cast, and the President is actually elected.
Of course, this is patently against “one person, one vote.” California has 38,000,000 residents, and 55 electoral votes (53 members of the House of Representatives and 2 Senators). That means each elector represents 691,000 people. In Wyoming, there are only 583,000 people, and they have three electors. Each of those electors represents only 194,000 people. That isn’t fair, but that is what the Constitution calls for. Without it, the smaller of the original thirteen states wouldn’t have ratified the Constitution, and we wouldn’t have a Constitution.
Trump lost the popular vote, but since more of his vote came from smaller states with disproportionately higher numbers of electors, he won the presidency. That is why this is coming up again. (It wasn’t a big part of the conversation back in 2000, because we were all expressing our outrage over the Supreme Court’s coup in favor of Bush.)
Most of the time this doesn’t matter. The winner of the Electoral College vote is almost always the winner of the popular vote. Only 4 times has it been otherwise. Trump, Bush 43, Benjamin Harrison in 1888 and Rutherford Hayes in 1876.
But this might start happening more often, particularly given the realities of the red/blue division in our country. Should we change this?
It is an easy question to pose, and a quick response might very well be “Well, of course! It is fundamentally undemocratic.” But a slower analysis yields different insights. There are many parts of our democracy that don’t operate on a “one person, one vote” rule, and for good reasons. Like the Senate, where every state, regardless of size, gets two Senators. And the Senate filibuster, where 41 Senators can stop the majority in advancing legislation. (We are going to be very happy for that undemocratic procedure in the next four years.)
The Supreme Court isn’t representative in any way, and yet it has enormous power over us and our government. I remember being made to write an essay back in 11th grade about “majority rule and minority rights.” That is a critical balance within our democracy. We let such things go only after very, very careful thought.
And a popular vote would change, drastically, how we elect Presidents. Small states would be largely ignored, and the big population centers would get all of the attention. Sounds good to me, in my “big population center bubble,” but it would cut out lots of people in those red counties from the process. Are they likely to agree to this?
The cost of elections would go up, way up, because every large population center would be in play, as opposed to now, where places like New York City, Los Angeles and Chicago are not targeted because they are in states that are going to vote reliably for Democrats. Without an Electoral College, candidates would have to advertise in every single large media market. And since the entire country would be “in play,” candidates would have to advertise all over the country. The importance of money in politics would increase, when most of us are wishing it would decrease.
And what would happen if we had a really, really close election? What if less than a percentage point separated the candidates? The chances of error are very high when elections get that close. Would we need a nationwide recount? In 2000, the difference between Gore and Bush was less than a half of a percent. And this year, the difference was one fifth of one percent. We don’t have any idea how to do a nationwide recount, putting aside the cost and uncertainty of such a thing. Virtual ties are possible within the Electoral College, but it has never happened, and there are provisions for a swift and certain resolution. (If you don’t know what they are, you didn’t watch the last season of “VEEP” on HBO.)
Doing away with the Electoral College would require a constitutional amendment. Good luck with that. But there are easier ideas to implement. The electors are not bound to vote for the candidate that wins their state. (That is how the elite in 1789 were going to be able to control the hoi polloi.) So, every state could pass a law saying that their electors were bound to vote for the winner of the popular vote. That might work.
I don’t know where I stand on this issue. Like the whole analysis of this election, it is complicated. But we ought to look at this and make a decision to change or not.
6. Is this moment in history we are beginning to face any worse than the Vietnam War era or Nixon and Watergate? I am old enough to remember the terrible conflict caused by the Vietnam War, a long-running civil war that we stepped into out of misguided “anti-Communism” and the cowardice of our government in not wanting to be “the people who lost Southeast Asia.” We marched on the freeways. We hanged our elected leaders in effigy. We talked seriously about revolution. (At least we did in my little bubble.) We lost faith in our government, who systematically lied to us for years and years. The four innocent students shot dead in Ohio at Kent State University by National Guardsmen in May of 1970 was a turning point in my own moral and political development.
Nixon continued that war, in fact escalated it with horrific bombings, and yet lied and lied. Re-electing him was a tragic mistake, but we did it in one of the great landslides of all time. (This was my first presidential election. Not an auspicious start.) But Nixon’s extraordinary shortcomings, his extreme and vocal bigotry, his paranoia in the face of what he thought were his “enemies,” his almost complete disinterest in domestic policy as he tried to play what he thought was his monumental role on the world’s stage, and his fundamental dishonesty in covering up the aftermath of the Watergate burglary all brought him down, the only President to resign from office.
We survived those times, although not without long-lingering doubts and aching scars. Will a President Trump be any worse? I fear yes, but maybe not. Those were truly awful times.
And now?
I don’t agree with those who say that we should hold out an olive branch to the Trump administration and give him a chance to show that he can do some good in his new office. Maybe he will grow into the job?
Poppycock. I know who this man is. Thanks to the ridiculous, ratings-fueled coverage of him by the media over the last 18 months, there is very little I don’t know about him. He is a narcissist with a short attention span. He is ignorant about the problems we face and about the workings of government. As some one said to me, he has taken command of a 30 ship aircraft carrier fleet and thinks he is going to be driving a motorboat. He is guilty of repeated sexual assaults, and of bragging about it. Damn, I even know what he thinks of the size of his penis.
I was wrong about the likely outcome of this election. Maybe I will be proved equally wrong about the Trump Administration. But I don’t need to give him a chance. He had plenty of opportunity to demonstrate good will during the campaign and never came close. The ball is in his court. Prove to me that you deserve my support. I’ll listen, but I won’t stop fighting you at every turn as a signal danger to our country and to what I believe in, until you convince me otherwise.
And now, for a time, I will continue to grieve. For the tens of thousands of people who will be denied the right to vote because of Republican efforts to suppress their votes. To the hundreds of thousand of immigrants who, like all of our parents and grandparents, want a chance to live and work in our terrific country. For the millions of women who may be denied their reproductive rights. For the many millions of middle class taxpayers who will continue to pay more than their share because the rich will get more tax cuts. For the many millions of small investors and holders of bank accounts and credit cards who will be, again, at the mercy of Wall Street after Dodd-Frank is repealed. For the 11 million undocumented aliens who will now live in desperate fear from every knock on the door. For the more than 20 million beneficiaries of the Affordable Care Act who will, once again, be without health insurance.
For the many, many millions of people around the world who looked to America for leadership in the formation and the preservation of democracy, who looked to us as diplomats first, and as warriors only when necessary. And for the hundreds of millions, maybe billions of people, who will pile up in the northern countries of South America and Africa, fleeing starvation and pestilence because their homes are uninhabitable and their land is arid and their animals have died due to climate change, begging us to be let into the richer Northern Hemisphere.
And to all of us, who will now spend the next two generations subject to the rulings of a Supreme Court stacked with knee-jerk conservatives who will continue the behavior of the last 30 years, advancing a political agenda, covered brazenly, shamelessly with the good names of “justice” and the “rule of law.”
But grieving ends. And the fight continues. More on that soon.
So, I have been listening and reading, talking to friends, family and colleagues, trying to take stock. It seems my thoughts fall into three categories: What I know, What I don’t know, and What I need to find out. (I am still working on “What do I do next?”)
What I know
1. This was complicated. There was no one thing that accounts for this election result. Trump had to be good at what he does. Clinton had to be sub-par. The media had to play its role in gracing Trump and treating Clinton with undeserved moral equivalence. Bernie’s folks (and I am one) had to feel disaffected and unmotivated. Trump voters had to show up. I would like to come to some quick understanding of what happened and why, but I suspect this will take some time to sort out.
2. Enthusiasm beats professionalism. Trump had a clear “enthusiasm gap” over Clinton. One of the commentators on PBS said that this was an election between Trump’s ability to generate enthusiasm and Clinton’s ability to manage an expensive, highly professional, data-based, modern political campaign. Ask any political professional which they would rather have, he said, a great “ground game” or terrific enthusiasm. Enthusiasm beats professionalism.
There was a clear enthusiasm for Trump. He pulled together the Republican coalition, getting almost as many votes as did Romney in 2012 and McCain in 2008, and that energy was missed by the pollsters and pundits. Oddly, he did his job.
Clinton suffered from less enthusiasm. She got 7,000,000 votes less than Obama did in 2012 and 10,000,000 votes less than Obama in 2008. Depending on where those votes were, that was probably the difference in this election. And 42 percent of women voters did not vote for the first serious female candidate for the presidency. And they voted for a serial practitioner of sexual assault! She underperformed, and it cost her (and us) the election.
3. Republicans came home. I think the winning coalition that Trump put together was the traditional Republican base (minus the surprisingly small number of people who usually vote Republican but couldn’t stomach voting for him), plus a whole lot of very enthusiastic, working class white people suffering economic and cultural distress and anxiety, plus a smaller but highly visible“basketload of deplorables,” assorted xenophobes, islamophobes, homophobes, racists, anti-Semites and just plain ignoramuses. Were there enough anxious white folks and racists to win? I don’t think so. The fact that the Republican party “normalized” Trump (with help from the unbelievable combination of Putin’s trolls and hackers and Comey and his FBI colleagues) allowed Republicans to “come home,” and vote for “our candidate.”
4. We are all living in bubbles. I am. You are. All those Trump voters are. Look at the map of who won which counties around the country. Rural people voted overwhelmingly for Trump. In every state, not just in the “red states.” Most “blue states” are largely red, when looked at county by county. These people don’t know many minorities or Jews. They disproportionately listen to Fox News, if they listen to the news at all. They are more likely to doubt that global warming really exists. They are much more likely to be mourning the loss of a lifestyle that centered around a good job at the factory and a Christian church. They are less likely to be college educated.
Or at least I think that is who they are, because I am inside my bubble – college educated urbanites, heavily Jewish, lots of minority friends and colleagues, worried about climate change, listening to NPR and MSNBC, wondering whether to eat Thai or Vietnamese tonight. We live in the tiny, but heavily populated blue islands in the sea of red on that map. I don’t know anybody who voted for Trump, but half the people in the country did. All of them live outside my bubble.
The people in those red counties have absolutely no idea what my life is like and what my concerns are. Nor do I understand their life and troubles. Mutually exclusive bubbles.
5. We are all desperate for leadership. People who stand for something. Who know their own values and share them well. Who are willing to make tough choices and withstand the consequences. We are kind of done with triangulation and nuance.
While I continue to doubt whether Trump actually believes much of what he said, he sounded like he was sure of his positions. And he didn’t seem uncomfortable that they might draw criticism; in fact, I think he fed off the criticism.
Clinton was careful. Lawyer-like. Guarded. Precise. She came across to me as insincere, not frank. She talked a good game about taxing the rich, but she wouldn’t let us hear what she said to the rich in those highly paid speeches. How hard is it to say “Boy, I really screwed up when I decided to put those emails on a private server. I wanted to protect myself and my communications, but look at the mess I created. My bad.” I think distaste for her lack of sincerity was magnified in the rural bubbles.
I have said in earlier blogs how important leadership is to change public policy when you are up against the rich and powerful. See my original argument in favor of Sanders, here:
http://danswartzman.blogspot.com/2016/02/my-heart-says-sanders-but-so-does-my.html
And here is my critique of Clinton and Jeb Bush on their lack of real leadership and my admiration for Sanders’ and Trump’s skills:
http://danswartzman.blogspot.com/2015/08/what-do-trump-and-sanders-have-in-common.html
Real leaders take strong positions on tough choices. This is what we want, and Trump offered it. Half of us were unmoved by his brand of leadership; the other half elected him.
6. We all share some anger. I am angry that millions of people lost their homes, and tens of millions of people were “under water” because of the economic disaster of 2008, while the people whose greed and arrogance caused it were bailed out and given bonuses and not one of them served time in jail.
I am angry that the Obama administration missed the opportunity to argue for universal health care back in 2009, which might have made the Affordable Care Act something that lots of people could love. I am angry that his chief of staff, Rahm Emanuel, yelled at people like me who didn’t get on board with the compromise they were making with the health insurers, the pharmaceuticals, the hospitals and the doctors, calling us “fucking retards.” That compromise was the much unloved ACA.
I am angry with the Republicans who decided to obstruct everything that Obama tried to do, and then had the chutzpah to criticize him because he couldn’t get anything done.
Out in the rural bubble, they are angry and fearful, too. White men, in their middle years, are the only demographic in the US whose rate of death is increasing. Everyone else’s death rate (the poor and minorities included) is going down. And the cause of these extra deaths are suicide, drug overdoses and alcoholism. Something is very, very wrong with that population. And Trump gave voice to their anger and their fear, and promised to make things right, to make things great again.
We are an angry population, angry about different things, all inside our bubbles.
What I don’t know
1. Who ARE these people? I mean the 59,000,000 Americans who voted for Trump. Are they uneducated, ignorant red-necks with guns? Are they hurting and anxious? White men, stewed in the subtle or not so subtle racism and sexism of the last 100 years?
President Johnson, after he signed the Civil Rights Act in 1964 famously told his press secretary, Bill Moyers, "I think we just handed the south to the Republicans for the rest of my life and yours." So true. In the next presidential election, Nixon’s Southern Strategy began the change from the Democrats’ “Solid South” to the red-tinged map we see today. In the early part of the 20th Century, it was racist Democrats who ran things in the South, while the Republicans were the “party of Lincoln.” After 1968 and into the new century, the bigots found a home in the Republican party.
Some amount of support for Trump was based upon bigotry, racism, anti-Semitism. How dare a black man be President of the United States and tell us what to do? And now you want us to vote for a woman? How much of his support was based upon this? If a lot, then it is easier to discount his constituents. If not as much, then we need to find out why else they thought to support such a man.
2. Was this what Wallace and Perot were trying to tell us? George Wallace was the last third party candidate to capture electors when he won five states in 1968. His message was heavily clothed in racism, but it was also a screed against the “pointy headed bureaucrats in Washington” who didn’t listen, who didn’t know much, who had too much control over our lives. Ross Perot, in 1992, captured 19% of the popular vote with a message that the Republicans and the Democrats were equally incompetent and unwilling to address the real problems the country was facing, such as the deficit and the movement of jobs to other countries. He warned of the “giant sucking sound” of jobs being pulled into Mexico.
Don’t those sound like familiar themes? I’d like to understand the history of these ideas, some of which were faintly echoed by Sanders.
3. Where were the Millennials? The Millenials are now the largest generation, passing by us Post-War Baby Boomers this last year. Yet only a fraction of them came out to vote in this critical election. (We won’t know the percentage for a while.) This is their future we were fighting over; among adults, they will spend more years in this future than anyone else. I can not imagine an adequate excuse for their not taking the time to vote, when the choice was so stark.
Maybe some will say “We couldn’t see voting for Hillary.” Well, how did that work out for you?
I didn’t care for Bill Clinton in ‘92 (his “Third Way” was responsible for accelerating the rightward, neoliberal drift of the Democrats), but I voted for him. John Kerry was a terrible idea (wooden, out of touch with ordinary people, a centrist at a time we needed a leftist critique of W), but I voted for him. Clinton was not my first choice this year. And I can think of a lot of reasons to not want to vote for her, but there is one good reason to have done so, and he is now the President-Elect.
Millenials, your parents have been doing everything they could to guard your future, to try to assure your safety and prosperity. One way they did those things is by voting. But you are the largest group of adults now. It is your turn. Where the hell were you?
What I need to find out
1. How is it that facts don’t matter? Yes, we are in different bubbles, but why is it that facts don’t matter over in their bubbles? I am a religious person, but evolution is science. I am skeptical of technical expertise with a financial interest, but climate change is really happening. (If you are 31 years old or younger, you have never lived in a month that was below average in global temperature.) The economy is, at the national level, doing very well, with steady if slow growth and almost “full employment.” Yes, there are pockets of anxiety and despair over lost manufacturing jobs, and there are still many, many poor people, but Trump’s assessment of the state of the economy was completely counter-factual. How does that not matter?
2. Could we find enough things that we are all angry about to forge new coalitions? The only way that the average person (which we mostly are) can win against the rich and powerful is through social movements. And social movements usually require coalitions. Since the people in my bubble are angry and the people in those other bubbles are angry, might there be sufficient overlap to support some joint efforts?
3. How do we bridge the gap between the rural and the urban? Joint efforts would require us to burst our bubbles and find common ground. How would we do that? Is that even possible?
4. Did Putin and the FBI have pro-Trump agendas? Russians were in contact with the Trump campaign. They hacked Democratic emails and released the results with a mind towards affecting the election. Russian hackers and trolls issued fake news and fake comments on online forums. Before we do this again, we need to figure out a way to identify similar efforts and either stop them or call full attention to them.
The FBI has to be investigated to see if what appears on the surface to be true, that they had a secret desire to tip the scale for Trump, is actually the case. If so, people have to be fired, and better rules have to be put in place and enforced. (I know – what are the chances either of these are going to be examined during a Trump Presidency, but we still need to know. Hey, mainstream media, these might be good subjects for the kind of hard-hitting investigative reporting that only a paltry few of you did during the campaign.)
5. Is it time to do away with the Electoral College? Al Gore and Hillary Clinton were both supported by a majority of voters (actually a plurality if you include votes for other parties). Yet they lost. This is because of the Electoral College. This is in the US Constitution, put in by the elites of the time to guard against their loss of power to the hoi polloi to whom they were giving voting privileges. It was also a way to keep support for the new Constitution among the less populated states in the south by giving them a disproportionate share of the vote.
Quick primer – Each state is given “electoral votes” equal to the number of members of Congress they have, plus two for their two Senators. So, since the least number of members of Congress a state can have is one (like Wyoming, Alaska, Delaware), then the least number of electoral votes that a state can have is three. (The District of Columbia also gets three electoral votes.) When the citizens of a state vote for President, they are actually voting for a slate of “electors” who are more or less committed to vote for the winner of the popular vote in that state. These electors meet (figuratively referred to as the “Electoral College”) in December, where the 538 votes for President are cast, and the President is actually elected.
Of course, this is patently against “one person, one vote.” California has 38,000,000 residents, and 55 electoral votes (53 members of the House of Representatives and 2 Senators). That means each elector represents 691,000 people. In Wyoming, there are only 583,000 people, and they have three electors. Each of those electors represents only 194,000 people. That isn’t fair, but that is what the Constitution calls for. Without it, the smaller of the original thirteen states wouldn’t have ratified the Constitution, and we wouldn’t have a Constitution.
Trump lost the popular vote, but since more of his vote came from smaller states with disproportionately higher numbers of electors, he won the presidency. That is why this is coming up again. (It wasn’t a big part of the conversation back in 2000, because we were all expressing our outrage over the Supreme Court’s coup in favor of Bush.)
Most of the time this doesn’t matter. The winner of the Electoral College vote is almost always the winner of the popular vote. Only 4 times has it been otherwise. Trump, Bush 43, Benjamin Harrison in 1888 and Rutherford Hayes in 1876.
But this might start happening more often, particularly given the realities of the red/blue division in our country. Should we change this?
It is an easy question to pose, and a quick response might very well be “Well, of course! It is fundamentally undemocratic.” But a slower analysis yields different insights. There are many parts of our democracy that don’t operate on a “one person, one vote” rule, and for good reasons. Like the Senate, where every state, regardless of size, gets two Senators. And the Senate filibuster, where 41 Senators can stop the majority in advancing legislation. (We are going to be very happy for that undemocratic procedure in the next four years.)
The Supreme Court isn’t representative in any way, and yet it has enormous power over us and our government. I remember being made to write an essay back in 11th grade about “majority rule and minority rights.” That is a critical balance within our democracy. We let such things go only after very, very careful thought.
And a popular vote would change, drastically, how we elect Presidents. Small states would be largely ignored, and the big population centers would get all of the attention. Sounds good to me, in my “big population center bubble,” but it would cut out lots of people in those red counties from the process. Are they likely to agree to this?
The cost of elections would go up, way up, because every large population center would be in play, as opposed to now, where places like New York City, Los Angeles and Chicago are not targeted because they are in states that are going to vote reliably for Democrats. Without an Electoral College, candidates would have to advertise in every single large media market. And since the entire country would be “in play,” candidates would have to advertise all over the country. The importance of money in politics would increase, when most of us are wishing it would decrease.
And what would happen if we had a really, really close election? What if less than a percentage point separated the candidates? The chances of error are very high when elections get that close. Would we need a nationwide recount? In 2000, the difference between Gore and Bush was less than a half of a percent. And this year, the difference was one fifth of one percent. We don’t have any idea how to do a nationwide recount, putting aside the cost and uncertainty of such a thing. Virtual ties are possible within the Electoral College, but it has never happened, and there are provisions for a swift and certain resolution. (If you don’t know what they are, you didn’t watch the last season of “VEEP” on HBO.)
Doing away with the Electoral College would require a constitutional amendment. Good luck with that. But there are easier ideas to implement. The electors are not bound to vote for the candidate that wins their state. (That is how the elite in 1789 were going to be able to control the hoi polloi.) So, every state could pass a law saying that their electors were bound to vote for the winner of the popular vote. That might work.
I don’t know where I stand on this issue. Like the whole analysis of this election, it is complicated. But we ought to look at this and make a decision to change or not.
6. Is this moment in history we are beginning to face any worse than the Vietnam War era or Nixon and Watergate? I am old enough to remember the terrible conflict caused by the Vietnam War, a long-running civil war that we stepped into out of misguided “anti-Communism” and the cowardice of our government in not wanting to be “the people who lost Southeast Asia.” We marched on the freeways. We hanged our elected leaders in effigy. We talked seriously about revolution. (At least we did in my little bubble.) We lost faith in our government, who systematically lied to us for years and years. The four innocent students shot dead in Ohio at Kent State University by National Guardsmen in May of 1970 was a turning point in my own moral and political development.
Nixon continued that war, in fact escalated it with horrific bombings, and yet lied and lied. Re-electing him was a tragic mistake, but we did it in one of the great landslides of all time. (This was my first presidential election. Not an auspicious start.) But Nixon’s extraordinary shortcomings, his extreme and vocal bigotry, his paranoia in the face of what he thought were his “enemies,” his almost complete disinterest in domestic policy as he tried to play what he thought was his monumental role on the world’s stage, and his fundamental dishonesty in covering up the aftermath of the Watergate burglary all brought him down, the only President to resign from office.
We survived those times, although not without long-lingering doubts and aching scars. Will a President Trump be any worse? I fear yes, but maybe not. Those were truly awful times.
And now?
I don’t agree with those who say that we should hold out an olive branch to the Trump administration and give him a chance to show that he can do some good in his new office. Maybe he will grow into the job?
Poppycock. I know who this man is. Thanks to the ridiculous, ratings-fueled coverage of him by the media over the last 18 months, there is very little I don’t know about him. He is a narcissist with a short attention span. He is ignorant about the problems we face and about the workings of government. As some one said to me, he has taken command of a 30 ship aircraft carrier fleet and thinks he is going to be driving a motorboat. He is guilty of repeated sexual assaults, and of bragging about it. Damn, I even know what he thinks of the size of his penis.
I was wrong about the likely outcome of this election. Maybe I will be proved equally wrong about the Trump Administration. But I don’t need to give him a chance. He had plenty of opportunity to demonstrate good will during the campaign and never came close. The ball is in his court. Prove to me that you deserve my support. I’ll listen, but I won’t stop fighting you at every turn as a signal danger to our country and to what I believe in, until you convince me otherwise.
And now, for a time, I will continue to grieve. For the tens of thousands of people who will be denied the right to vote because of Republican efforts to suppress their votes. To the hundreds of thousand of immigrants who, like all of our parents and grandparents, want a chance to live and work in our terrific country. For the millions of women who may be denied their reproductive rights. For the many millions of middle class taxpayers who will continue to pay more than their share because the rich will get more tax cuts. For the many millions of small investors and holders of bank accounts and credit cards who will be, again, at the mercy of Wall Street after Dodd-Frank is repealed. For the 11 million undocumented aliens who will now live in desperate fear from every knock on the door. For the more than 20 million beneficiaries of the Affordable Care Act who will, once again, be without health insurance.
For the many, many millions of people around the world who looked to America for leadership in the formation and the preservation of democracy, who looked to us as diplomats first, and as warriors only when necessary. And for the hundreds of millions, maybe billions of people, who will pile up in the northern countries of South America and Africa, fleeing starvation and pestilence because their homes are uninhabitable and their land is arid and their animals have died due to climate change, begging us to be let into the richer Northern Hemisphere.
And to all of us, who will now spend the next two generations subject to the rulings of a Supreme Court stacked with knee-jerk conservatives who will continue the behavior of the last 30 years, advancing a political agenda, covered brazenly, shamelessly with the good names of “justice” and the “rule of law.”
But grieving ends. And the fight continues. More on that soon.
Tuesday, July 12, 2016
Revisiting the "urge to care for the other"
I am redoing one of the classes I teach at Loyola, on “Health Care in America.” I have decided to start the class with a more rousing call to "moral imagination," suggesting to the students that, if they want to change things for the better, health care is a great place to do that, since we are going to be going through lots of changes in health care, no matter what.
I want to present the class with an argument about why they should care about changing health care for the better. It boils down to responding to our “urge to care for the other.” To provide them some background, I am going to have them read a number of blogs that I posted in February, March and April of 2015. These postings offer an explanation of why we might care for “the other” and where that urge might come from.
As it turns out, because these were some of the first blogs I posted here, they have not had much viewership. So, I decided to send you all a message, encouraging you to dig back a bit, and see if those of you who have come lately to the blog might be interested in these earlier postings. Here is the list. (They are best if read in this order.) I look forward to hearing what you think.
Caring for “the other,” Part 1 – Why do we care?
http://danswartzman.blogspot.com/2015/02/caring-for-other-part-1.html
Caring for “the other,” Part 2 – Real, abstract, related, unrelated
http://danswartzman.blogspot.com/2015/02/caring-for-other-part-two_16.html
Does the “urge to care” come from biology?
http://danswartzman.blogspot.com/2015/02/does-urge-to-care-come-from-biology.html
Does the “urge to care” come from culture?
http://danswartzman.blogspot.com/2015/02/does-urge-to-care-come-from-culture.html
Beyond nature and nurture
http://danswartzman.blogspot.com/2015/02/beyond-nature-and-nurture.html
Life is not perfectible
http://danswartzman.blogspot.com/2015/02/life-is-not-perfectible.html
“Giving in” to perfectibility and the path to fundamentalism
http://danswartzman.blogspot.com/2015/03/giving-in-to-perfectibility-and-path-to.html
The inevitability of uncertainty
http://danswartzman.blogspot.com/2015/03/the-inevitability-of-uncertainty.html
“Only in our limits do we find our freedom”
http://danswartzman.blogspot.com/2015/03/only-in-our-limits-do-we-find-our.html
Thinking INSIDE the box
http://danswartzman.blogspot.com/2015/03/thinking-inside-box.html
Giving up
http://danswartzman.blogspot.com/2015/03/giving-up.html
Why secular idealism is insufficient
http://danswartzman.blogspot.com/2015/04/why-secular-idealism-is-insufficient.html
Faith
http://danswartzman.blogspot.com/2015/04/faith.html
I want to present the class with an argument about why they should care about changing health care for the better. It boils down to responding to our “urge to care for the other.” To provide them some background, I am going to have them read a number of blogs that I posted in February, March and April of 2015. These postings offer an explanation of why we might care for “the other” and where that urge might come from.
As it turns out, because these were some of the first blogs I posted here, they have not had much viewership. So, I decided to send you all a message, encouraging you to dig back a bit, and see if those of you who have come lately to the blog might be interested in these earlier postings. Here is the list. (They are best if read in this order.) I look forward to hearing what you think.
Caring for “the other,” Part 1 – Why do we care?
http://danswartzman.blogspot.com/2015/02/caring-for-other-part-1.html
Caring for “the other,” Part 2 – Real, abstract, related, unrelated
http://danswartzman.blogspot.com/2015/02/caring-for-other-part-two_16.html
Does the “urge to care” come from biology?
http://danswartzman.blogspot.com/2015/02/does-urge-to-care-come-from-biology.html
Does the “urge to care” come from culture?
http://danswartzman.blogspot.com/2015/02/does-urge-to-care-come-from-culture.html
Beyond nature and nurture
http://danswartzman.blogspot.com/2015/02/beyond-nature-and-nurture.html
Life is not perfectible
http://danswartzman.blogspot.com/2015/02/life-is-not-perfectible.html
“Giving in” to perfectibility and the path to fundamentalism
http://danswartzman.blogspot.com/2015/03/giving-in-to-perfectibility-and-path-to.html
The inevitability of uncertainty
http://danswartzman.blogspot.com/2015/03/the-inevitability-of-uncertainty.html
“Only in our limits do we find our freedom”
http://danswartzman.blogspot.com/2015/03/only-in-our-limits-do-we-find-our.html
Thinking INSIDE the box
http://danswartzman.blogspot.com/2015/03/thinking-inside-box.html
Giving up
http://danswartzman.blogspot.com/2015/03/giving-up.html
Why secular idealism is insufficient
http://danswartzman.blogspot.com/2015/04/why-secular-idealism-is-insufficient.html
Faith
http://danswartzman.blogspot.com/2015/04/faith.html
Wednesday, June 29, 2016
What the hell is going on? Globalization plus austerity.
It does feel like events in Europe, with the decision to Leave and the rise of nationalist, right-wing movements, are similar to what is happening in the US with the almost inconceivable rise of Trump. What is happening?
Lots of media response to that question. Here is something I think we need to consider.
Globalization is a “net” benefit
Globalization may be a net benefit for modern industrialized societies. We are usually told that open markets around the globe add one or two percent to the net wealth of people in America. That is a good thing.
But note that that is “net” wealth. Some of us benefit a lot, and many of us bear the burden of those benefits. To see more on this argument, check out my posting on “Thinking carefully about free trade.” If many people make scads of money, that might outweigh the widespread problems that globalization causes, when everything gets added up. But just because there is a positive sum doesn’t mean that there isn’t a lot of pain happening. Here is that discussion:
http://danswartzman.blogspot.com/2015/07/thinking-carefully-about-free-trade.html
The elusive “good living”
So, the last three or four decades of globalization have made fortunes for the wealthy and a good return for the upper-middle class. But middle and working class people in the US whose jobs were imported are suffering from their losses. The “good living” that could be had with skills, hard work and a high school diploma is not remotely as available as it was 50 years ago.
No wonder that people paying this price for other folks’ increase in wealth are angry, frustrated, scared, susceptible to demagoguery, following a huckster with no credibility, but who offers them promise and hope. Less educated white men are demonstrating their despair in the most flagrant way possible, by killing themselves, by drinking themselves to death, by succumbing to drug overdoses.
A “rising tide” does not appear to lift all boats; it seems to be swamping too many of our neighbors. If the country is going to continue to promote globalization because it makes us, as a whole, more wealthy, we have to share that wealth with those who know only the pain.
But, I have heard pundits say, what can we do about this? Retraining? Maybe, but not the easiest prescription for 50-something laborers with little education. Increasing programs like the Earned Income Credit, paying for it with taxes on those who benefit from more trade? Might work, but difficult to pass in today’s political climate.
The obvious answer, to me, is government works programs. Fifty years of Republican efforts to “starve the beast” have resulted in a crumbling infrastructure in need of trillions of dollars of maintenance, repair and rebuilding. Just the sort of thing that skilled laborers and craftspeople could do to earn a living, doing something useful for their communities.
Folie de beaucoup
Ah, but we can’t do that because the entire community of industrialized countries is suffering from a “folie de beaucoup” called Austerity. We have to limit government spending, we are told by “serious people,” because we have to keep down the national debt. This is a largely unchallenged shibboleth held sacredly among the right, the center-right, the center-left, and the mainstream media.
Pick at random any column by Paul Krugman, our most consistent and erudite spokesperson for modern Keynesianism, and you are likely to read a thorough refutation of this position. At a time when the US government can sell bonds at virtually no interest, this must be the moment to start a program to rebuild our infrastructure and to promise work to those who are paying the price of globalization.
Hillary has proposed a $275 billion program, but that is too timid and insufficient. Sanders proposed $1 trillion over the next five years. Still not thinking big enough.
The American Society of Civil Engineers, in their 2013 report card on American infrastructure, estimated the need at $3.6 trillion by 2020. No wonder they rated the US infrastructure gap at a D+.
How much and how soon?
OK, I don’t know how much we can afford and over what time period. But I believe that as long as we ignore the real pain and hopelessness caused by globalization, and as long as we continue to pay homage to the gods of Austerity, we are not going to address the growing anger and disaffection of tens of millions of Americans and hundreds of millions of Europeans.
If we want the millions of people who voted for Leave and who are promising to vote for Trump to rejoin the rest of us in working towards common and reasonable goals, if we want to keep them alive, we have to promise them hope, a way forward, a job and a way to make a respectable contribution to the good of the whole.
Globalization, but no more Austerity. Let’s make global plans, but let’s also make sure that everyone benefits by making big plans that stir faith and trust. And let’s keep our bridges from falling down on our heads.
Lots of media response to that question. Here is something I think we need to consider.
Globalization is a “net” benefit
Globalization may be a net benefit for modern industrialized societies. We are usually told that open markets around the globe add one or two percent to the net wealth of people in America. That is a good thing.
But note that that is “net” wealth. Some of us benefit a lot, and many of us bear the burden of those benefits. To see more on this argument, check out my posting on “Thinking carefully about free trade.” If many people make scads of money, that might outweigh the widespread problems that globalization causes, when everything gets added up. But just because there is a positive sum doesn’t mean that there isn’t a lot of pain happening. Here is that discussion:
http://danswartzman.blogspot.com/2015/07/thinking-carefully-about-free-trade.html
The elusive “good living”
So, the last three or four decades of globalization have made fortunes for the wealthy and a good return for the upper-middle class. But middle and working class people in the US whose jobs were imported are suffering from their losses. The “good living” that could be had with skills, hard work and a high school diploma is not remotely as available as it was 50 years ago.
No wonder that people paying this price for other folks’ increase in wealth are angry, frustrated, scared, susceptible to demagoguery, following a huckster with no credibility, but who offers them promise and hope. Less educated white men are demonstrating their despair in the most flagrant way possible, by killing themselves, by drinking themselves to death, by succumbing to drug overdoses.
A “rising tide” does not appear to lift all boats; it seems to be swamping too many of our neighbors. If the country is going to continue to promote globalization because it makes us, as a whole, more wealthy, we have to share that wealth with those who know only the pain.
But, I have heard pundits say, what can we do about this? Retraining? Maybe, but not the easiest prescription for 50-something laborers with little education. Increasing programs like the Earned Income Credit, paying for it with taxes on those who benefit from more trade? Might work, but difficult to pass in today’s political climate.
The obvious answer, to me, is government works programs. Fifty years of Republican efforts to “starve the beast” have resulted in a crumbling infrastructure in need of trillions of dollars of maintenance, repair and rebuilding. Just the sort of thing that skilled laborers and craftspeople could do to earn a living, doing something useful for their communities.
Folie de beaucoup
Ah, but we can’t do that because the entire community of industrialized countries is suffering from a “folie de beaucoup” called Austerity. We have to limit government spending, we are told by “serious people,” because we have to keep down the national debt. This is a largely unchallenged shibboleth held sacredly among the right, the center-right, the center-left, and the mainstream media.
Pick at random any column by Paul Krugman, our most consistent and erudite spokesperson for modern Keynesianism, and you are likely to read a thorough refutation of this position. At a time when the US government can sell bonds at virtually no interest, this must be the moment to start a program to rebuild our infrastructure and to promise work to those who are paying the price of globalization.
Hillary has proposed a $275 billion program, but that is too timid and insufficient. Sanders proposed $1 trillion over the next five years. Still not thinking big enough.
The American Society of Civil Engineers, in their 2013 report card on American infrastructure, estimated the need at $3.6 trillion by 2020. No wonder they rated the US infrastructure gap at a D+.
How much and how soon?
OK, I don’t know how much we can afford and over what time period. But I believe that as long as we ignore the real pain and hopelessness caused by globalization, and as long as we continue to pay homage to the gods of Austerity, we are not going to address the growing anger and disaffection of tens of millions of Americans and hundreds of millions of Europeans.
If we want the millions of people who voted for Leave and who are promising to vote for Trump to rejoin the rest of us in working towards common and reasonable goals, if we want to keep them alive, we have to promise them hope, a way forward, a job and a way to make a respectable contribution to the good of the whole.
Globalization, but no more Austerity. Let’s make global plans, but let’s also make sure that everyone benefits by making big plans that stir faith and trust. And let’s keep our bridges from falling down on our heads.
Monday, June 13, 2016
Vouching for healthcare, Part 5
Vouching for healthcare, Part 5
Many years ago, when Calabresi and Bobbitt wrote Tragic Choices, they said that whether you allocate resources in a market or through political means, you run into “fundamental flaws.” This blog thread on vouchers for healthcare benefits is based somewhat upon this notion.
Markets have flaws
As we demonstrated earlier, ideally markets have two benefits, liberty and efficiency. They allow everyone to decide which trades to make, and they create more happiness without having to increase inputs.
Markets also have three fundamental flaws:
1. They overweight the prevailing distribution of resources. If you are poor to begin with, you won’t be able to bargain your way to prosperity.
2. They overweight individual preferences over preferences of the community. There is no “we” in the marketplace, so what we want is subordinated to what “I” want.
3. They overweight the instrumental over the intrinsic. Since markets are based on voluntary exchange, they give weight to that which is exchangeable, like instrumentalities, rather than what is valuable in and of itself, like intrinsic values.
Political allocation systems may avoid the market’s flaws
Turns out, we can avoid some of these problems by using political means to distribute resources, but we run into another set of fundamental problems.
But first, what do we mean by political allocations? Any allocation system that uses power is a political allocation system. So, back to our “hats” example, if you get a particular hat because that is what the king decrees, or if you get a hat because that is what you were able to take and hold through force, these are political distributions. As are distributions through the actions of committees or a hat commissar. The same if we had a direct democracy, and allocated hats through a town meeting.
The political allocation system we discuss most in the US is our representative (at least on paper) democracy. If a legislature or a regulatory agency determines who gets which hats, this is a political allocation.
Note that political allocations can change the prevailing distribution of resources. The decision maker can simply choose to overcome an inequitable distribution, and give the poor more. Simply? Well, apparently not so much.
And politics can overcome the will of the individual. Politics enables the community, which can tell the individual what the community desires him or her to do.
And if the community is set on a particular intrinsic value, like equity or impartiality, it can superordinate that value above any transactional benefits.
But political allocations have their own flaws
The one benefit of political allocation is that it is directable. Politics includes the potential to choose. (We will see in subsequent blogs that our current governmental actors are systematically avoiding the making of choices, but that is for a future discussion.)
However, political allocation systems, such as government decisions, have three fundamental flaws:
1. They overweight the community over the individual.
2. They are inherently inefficient.
3. They carry the “Burden of Explicitness.”
Danger to individual liberty
Let’s look at the first of these. The community, through its agent, the government, can coerce the behavior of individuals. What “we” want becomes enforceable against “me.” We know this because we are all forced to pay taxes, we are all forced to hire people without using our prejudices, we are all forced to bend our property rights to the will of the zoning board. Governments can, of course, make me do things and prohibit me from doing others.
One of the problems with empowering the community is that it can too easily overcome the will of the individual. If you go down this route too far, you can enter a Stalinist nightmare, where the will of the community (as expressed by the elite in power, of course) justifies extreme, even deadly sanctions against the individual. Think Mao’s Cultural Revolution of the 60's.
This is the essential fear of Libertarians. “We must have as little government as possible, because too much government is a danger to our liberty.”
When I heard Calabresi discuss these ideas forty years ago, he argued that this concern about the danger of unbridled governmental power was what tipped him towards market-based solutions to as many problems as possible. I imagine that such concerns are at the base of much “Neo-liberalism.”
If we allocate bicycles through government, we need to set up a bicycle commissariat, and which bicycle I get will be a function of that bureaucracy’s decisions. I don’t get to choose which I want. I buy the bicycle that is made available by the government.
That loss of liberty is regrettable, but under certain circumstances, probably acceptable. Many of us would support a government ban on the sale and ownership of assault weapons. That is a threat to the liberty of those who want them. But so is a ban on tanks and missiles. So, too, are speed limits, and requirements to immunize, and the need for nutrition labeling, and zoning ordinances. All of these are restrictions on the will of the individual that we, as a community, are relatively comfortable with. (Well, not all of us. Strict libertarians would consider many of these restrictions odious. OK, maybe not a prohibition on tanks.)
What “I” want versus what “we” want
So, we want to empower the community and its values, and we know that doing so is a potential threat to the values of each individual. If the threat to the individual is too great, as with reproductive rights or a universal right to be married, we choose to let the individual decide.
Sometimes, “we” win. And sometimes “I” win. That is one of the most difficult tasks of democracy, making exactly these choices between the public will and the private will. If we let markets decide on healthcare, things that the group wants (prevention, equitable distribution of healthcare resources) may be subordinated to what the individual is willing to pay for with his or her voucher. If we use government, we run the risk of infringing on liberties (like choosing my own doctor or deciding what medicine I am willing to pay for) that are important to some people.
We are starting to see that there is no such thing as a perfect allocation system. Markets have their problems. And governmental allocations have their problems. We will have to choose which set of problems we prefer.
But political resource allocations are inherently inefficient. Is that acceptable? We will discuss that next.
Many years ago, when Calabresi and Bobbitt wrote Tragic Choices, they said that whether you allocate resources in a market or through political means, you run into “fundamental flaws.” This blog thread on vouchers for healthcare benefits is based somewhat upon this notion.
Markets have flaws
As we demonstrated earlier, ideally markets have two benefits, liberty and efficiency. They allow everyone to decide which trades to make, and they create more happiness without having to increase inputs.
Markets also have three fundamental flaws:
1. They overweight the prevailing distribution of resources. If you are poor to begin with, you won’t be able to bargain your way to prosperity.
2. They overweight individual preferences over preferences of the community. There is no “we” in the marketplace, so what we want is subordinated to what “I” want.
3. They overweight the instrumental over the intrinsic. Since markets are based on voluntary exchange, they give weight to that which is exchangeable, like instrumentalities, rather than what is valuable in and of itself, like intrinsic values.
Political allocation systems may avoid the market’s flaws
Turns out, we can avoid some of these problems by using political means to distribute resources, but we run into another set of fundamental problems.
But first, what do we mean by political allocations? Any allocation system that uses power is a political allocation system. So, back to our “hats” example, if you get a particular hat because that is what the king decrees, or if you get a hat because that is what you were able to take and hold through force, these are political distributions. As are distributions through the actions of committees or a hat commissar. The same if we had a direct democracy, and allocated hats through a town meeting.
The political allocation system we discuss most in the US is our representative (at least on paper) democracy. If a legislature or a regulatory agency determines who gets which hats, this is a political allocation.
Note that political allocations can change the prevailing distribution of resources. The decision maker can simply choose to overcome an inequitable distribution, and give the poor more. Simply? Well, apparently not so much.
And politics can overcome the will of the individual. Politics enables the community, which can tell the individual what the community desires him or her to do.
And if the community is set on a particular intrinsic value, like equity or impartiality, it can superordinate that value above any transactional benefits.
But political allocations have their own flaws
The one benefit of political allocation is that it is directable. Politics includes the potential to choose. (We will see in subsequent blogs that our current governmental actors are systematically avoiding the making of choices, but that is for a future discussion.)
However, political allocation systems, such as government decisions, have three fundamental flaws:
1. They overweight the community over the individual.
2. They are inherently inefficient.
3. They carry the “Burden of Explicitness.”
Danger to individual liberty
Let’s look at the first of these. The community, through its agent, the government, can coerce the behavior of individuals. What “we” want becomes enforceable against “me.” We know this because we are all forced to pay taxes, we are all forced to hire people without using our prejudices, we are all forced to bend our property rights to the will of the zoning board. Governments can, of course, make me do things and prohibit me from doing others.
One of the problems with empowering the community is that it can too easily overcome the will of the individual. If you go down this route too far, you can enter a Stalinist nightmare, where the will of the community (as expressed by the elite in power, of course) justifies extreme, even deadly sanctions against the individual. Think Mao’s Cultural Revolution of the 60's.
This is the essential fear of Libertarians. “We must have as little government as possible, because too much government is a danger to our liberty.”
When I heard Calabresi discuss these ideas forty years ago, he argued that this concern about the danger of unbridled governmental power was what tipped him towards market-based solutions to as many problems as possible. I imagine that such concerns are at the base of much “Neo-liberalism.”
If we allocate bicycles through government, we need to set up a bicycle commissariat, and which bicycle I get will be a function of that bureaucracy’s decisions. I don’t get to choose which I want. I buy the bicycle that is made available by the government.
That loss of liberty is regrettable, but under certain circumstances, probably acceptable. Many of us would support a government ban on the sale and ownership of assault weapons. That is a threat to the liberty of those who want them. But so is a ban on tanks and missiles. So, too, are speed limits, and requirements to immunize, and the need for nutrition labeling, and zoning ordinances. All of these are restrictions on the will of the individual that we, as a community, are relatively comfortable with. (Well, not all of us. Strict libertarians would consider many of these restrictions odious. OK, maybe not a prohibition on tanks.)
What “I” want versus what “we” want
So, we want to empower the community and its values, and we know that doing so is a potential threat to the values of each individual. If the threat to the individual is too great, as with reproductive rights or a universal right to be married, we choose to let the individual decide.
Sometimes, “we” win. And sometimes “I” win. That is one of the most difficult tasks of democracy, making exactly these choices between the public will and the private will. If we let markets decide on healthcare, things that the group wants (prevention, equitable distribution of healthcare resources) may be subordinated to what the individual is willing to pay for with his or her voucher. If we use government, we run the risk of infringing on liberties (like choosing my own doctor or deciding what medicine I am willing to pay for) that are important to some people.
We are starting to see that there is no such thing as a perfect allocation system. Markets have their problems. And governmental allocations have their problems. We will have to choose which set of problems we prefer.
But political resource allocations are inherently inefficient. Is that acceptable? We will discuss that next.
Thursday, March 31, 2016
If healthcare is a right, where does it come from? And what should we do about it?
I believe in a right to health care. I think this is one of a number of birthrights that attach to all children. And everyone I have ever met is somebody’s child.
This makes a huge difference in the policy arena. If healthcare is a commodity, a service that is purchased, a privilege to be earned or afforded, then it is completely possible to decide that some people get none, that some people get a lot, and that everyone else will fall in between, mainly a function of their financial situation, but probably also due to matters of race, class and gender. Limits are easy to find when it is something you purchase.
What if it is a right?
If it is a right, then it is a “call” upon the larger society: “You must care for me when I am sick.” But no society can ever provide 100% of the care desired by 100% of the population. There simply isn’t enough time, energy and money. Therefore, each society has to make tough choices about how much care they are willing to give and to whom and under what circumstances.
I think most wealthy enough societies will meet almost all of the healthcare demands of their children, and then start to make tough choices at the other end of life. Along the way, there will be some limits, like with cosmetic surgery (not after trauma or disease, but strictly for appearances). And some communities will decide that certain treatments are so unlikely to help that they won’t pay for them, while other societies might make a different evaluation.
But what is clear is that if healthcare is a right, then it is up to the government to provide it, since the call is upon the community, and the government is the agent of the community. That is what TR Reid, the author of The Healing of America, found in the countries he visited, that they started with the notion that healthcare is a right, and that led them to universal coverage.
Lots of politicians have said the words – healthcare is a right – but they have not worked towards policies that are consistent with those words. Obama has said that he thinks healthcare is a right, but the ACA is not based upon such a principal at all. Sanders is the main person making the connection between the idea and the policy that follows from the idea.
Where do rights come from?
That is an easy question for me to answer, but I have found it so tough for others to answer it that they don’t even want to be asked the question.
As a public health ethicist, I have found that almost all of my colleagues in the field think that health care is a right. In fact, a famous public health leader (Jonathan Mann) won quite a bit of acclaim for his argument that the basis of public health ethics was “human rights.” But I have found almost no one amongst my colleagues who wants to discuss where such rights come from. Either they hem and haw, or they mention something about the Universal Declaration of Human Rights, from 1948. But were there no rights before that?
In the Declaration of Independence, we say that:
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights – that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed."
The existence of these rights are “self-evident.” You don’t need to conduct research on this. These rights exist and we know that their existence is obvious. Such rights are often referred to as “natural rights,” those rights that arise from the nature of what it means to be human. They are inalienable (inseparable) from any human being, by virtue of his or her humanity.
And we get these rights from our Creator. Some of you, who believe in a personal God, accept this as a direct statement.
For people like me, who have a strong concept of Transcendent Meaning, but do not believe in a purposive entity named “God,” then this is really a metaphor. For me, this means that there is a transcendent reality from which we draw meaning, and that the experience of this transcendent reality and the understanding of that meaning is what I label as “the holy.”
A religious gesture
But whatever we call that which exists within Transcendence, we are making a religious gesture. It is a spiritual commitment to the existence of Transcendent Meaning. Our lives have meaning, and one of the things we know about that meaning is that every society owes its members certain rights, and that the government is assigned the duty of providing for those rights. (That part of the Declaration is usually not included when this section is quoted. More neoliberalism, I think.)
And among these rights are the right to life, liberty and stuff. (The Founders really were referring to property rights, but thought that wasn’t gentile enough, so they used the euphemism of “pursuit of happiness.” It is intended to mean a right to own stuff.) Among these rights, but not only those rights mentioned.
So, if there are such rights beyond these three, we as a community have an obligation to figure out what they are; we need to make exactly those choices. And the basis for those choices ends up having to be our belief in Transcendent Meaning.
My assumption is that my colleagues don’t want to talk about where rights come from because they don’t want to have a conversation about religion, most (but not all) of them being atheists or agnostics, as are so many intellectuals today.
What if rights aren’t transcendent
If rights aren’t transcendent, if they are only material, then they are only the result of our agreements to uphold certain of them. And agreements made can be unmade. Non-transcendent rights are, therefore, dangerously ephemeral.
Plus, if you want to condemn the practices of horrible people around the world, you need something I have referred to as “Transitive Morality.” (From an earlier blog post.) We have to be able to say that the third of the world that denies the dignity of women is morally wrong in doing so, and that they must change. And that “must” must be based upon something other than a handshake. It has to be based upon the moral ground that comes from the community agreeing to recognize the transcendent source of such moral values.
Otherwise, who are we to judge these misogynists? After all, it is only their culture.
But, of course, the oppression of half the race is not a matter of mere culture. It is a call to the rest of us to act on behalf of the oppressed. It is a call to us, because those women have rights that are being denied. And we may act because those rights have a basis in Transcendent Meaning.
I do think healthcare is a right, and I am comfortable with the religious origins of my views. And I feel the call to act. Anyone else feel the same?
This makes a huge difference in the policy arena. If healthcare is a commodity, a service that is purchased, a privilege to be earned or afforded, then it is completely possible to decide that some people get none, that some people get a lot, and that everyone else will fall in between, mainly a function of their financial situation, but probably also due to matters of race, class and gender. Limits are easy to find when it is something you purchase.
What if it is a right?
If it is a right, then it is a “call” upon the larger society: “You must care for me when I am sick.” But no society can ever provide 100% of the care desired by 100% of the population. There simply isn’t enough time, energy and money. Therefore, each society has to make tough choices about how much care they are willing to give and to whom and under what circumstances.
I think most wealthy enough societies will meet almost all of the healthcare demands of their children, and then start to make tough choices at the other end of life. Along the way, there will be some limits, like with cosmetic surgery (not after trauma or disease, but strictly for appearances). And some communities will decide that certain treatments are so unlikely to help that they won’t pay for them, while other societies might make a different evaluation.
But what is clear is that if healthcare is a right, then it is up to the government to provide it, since the call is upon the community, and the government is the agent of the community. That is what TR Reid, the author of The Healing of America, found in the countries he visited, that they started with the notion that healthcare is a right, and that led them to universal coverage.
Lots of politicians have said the words – healthcare is a right – but they have not worked towards policies that are consistent with those words. Obama has said that he thinks healthcare is a right, but the ACA is not based upon such a principal at all. Sanders is the main person making the connection between the idea and the policy that follows from the idea.
Where do rights come from?
That is an easy question for me to answer, but I have found it so tough for others to answer it that they don’t even want to be asked the question.
As a public health ethicist, I have found that almost all of my colleagues in the field think that health care is a right. In fact, a famous public health leader (Jonathan Mann) won quite a bit of acclaim for his argument that the basis of public health ethics was “human rights.” But I have found almost no one amongst my colleagues who wants to discuss where such rights come from. Either they hem and haw, or they mention something about the Universal Declaration of Human Rights, from 1948. But were there no rights before that?
In the Declaration of Independence, we say that:
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights – that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed."
The existence of these rights are “self-evident.” You don’t need to conduct research on this. These rights exist and we know that their existence is obvious. Such rights are often referred to as “natural rights,” those rights that arise from the nature of what it means to be human. They are inalienable (inseparable) from any human being, by virtue of his or her humanity.
And we get these rights from our Creator. Some of you, who believe in a personal God, accept this as a direct statement.
For people like me, who have a strong concept of Transcendent Meaning, but do not believe in a purposive entity named “God,” then this is really a metaphor. For me, this means that there is a transcendent reality from which we draw meaning, and that the experience of this transcendent reality and the understanding of that meaning is what I label as “the holy.”
A religious gesture
But whatever we call that which exists within Transcendence, we are making a religious gesture. It is a spiritual commitment to the existence of Transcendent Meaning. Our lives have meaning, and one of the things we know about that meaning is that every society owes its members certain rights, and that the government is assigned the duty of providing for those rights. (That part of the Declaration is usually not included when this section is quoted. More neoliberalism, I think.)
And among these rights are the right to life, liberty and stuff. (The Founders really were referring to property rights, but thought that wasn’t gentile enough, so they used the euphemism of “pursuit of happiness.” It is intended to mean a right to own stuff.) Among these rights, but not only those rights mentioned.
So, if there are such rights beyond these three, we as a community have an obligation to figure out what they are; we need to make exactly those choices. And the basis for those choices ends up having to be our belief in Transcendent Meaning.
My assumption is that my colleagues don’t want to talk about where rights come from because they don’t want to have a conversation about religion, most (but not all) of them being atheists or agnostics, as are so many intellectuals today.
What if rights aren’t transcendent
If rights aren’t transcendent, if they are only material, then they are only the result of our agreements to uphold certain of them. And agreements made can be unmade. Non-transcendent rights are, therefore, dangerously ephemeral.
Plus, if you want to condemn the practices of horrible people around the world, you need something I have referred to as “Transitive Morality.” (From an earlier blog post.) We have to be able to say that the third of the world that denies the dignity of women is morally wrong in doing so, and that they must change. And that “must” must be based upon something other than a handshake. It has to be based upon the moral ground that comes from the community agreeing to recognize the transcendent source of such moral values.
Otherwise, who are we to judge these misogynists? After all, it is only their culture.
But, of course, the oppression of half the race is not a matter of mere culture. It is a call to the rest of us to act on behalf of the oppressed. It is a call to us, because those women have rights that are being denied. And we may act because those rights have a basis in Transcendent Meaning.
I do think healthcare is a right, and I am comfortable with the religious origins of my views. And I feel the call to act. Anyone else feel the same?
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