the sad red earth

Who said, “To err is human, to be defensive about it divinely oblivious”? Oh, that was me. Not exactly the arresting pith of its model, but it begins my point.

It is always bracing to observe the response to criticism of those who devote themselves professionally to the analysis and criticism of others. News organizations, paper, televised, or blogged (they’ll flame your ass) commonly stiffen their prissy irreproachable spines when challenged themselves. Fox News will organize grassroots demonstrations and coordinate memed segments across its infotainment programming report and let you decide.

The other day I referred to developments that are undermining the hard-earned credibility of human rights organizations. One is the imbalance of focus on Israel. The other is the gradually altered and ideologically misdirected, current conception of their mission. Both developments emerge from the same source.

“When lying on to paper human rights can hurt”, poster created by Simone Verza, Italy, for the Good project

Most recently, there has been a lot of attention on Human Rights Watch.  The culminating criticism, as I said, was the condemnation by its founder and twenty-year executive director, Robert Bernstein, of HRW’s bias against Israel . Prior to that there was the revelation that HRW’s Mideast military analyst, Mark Gelasco, is a collector of World War II military paraphernalia, with a particular passion for Nazi regalia. Just before coming to HRW, Gelasco served in the Pentagon, where among his duties was that of performing remote guidance of laser-directed bombs to their targets. He told the Washington Post that the transition had not been easy: “It really dawned on me that these aren’t just nameless, faceless targets.” Might HRW better have hired a Mideast military analyst – who has to monitor the military actions of Israel – who didn’t have a fascination with Nazi symbolism, and who hadn’t needed to learn after his military service that those under his fire were not “nameless, faceless targets”?

Still earlier, there had been the controversy over Sarah Leah Whitson, HRW’s Middle East and North Africa director, who when she was hired by HRW was serving on the Board of the American-Arab Antidiscrimination Committee, which advocates for the Palestinian and other Arab positions. In June of this year she published an editorial in the Los Angeles Times advocating the removal of Israeli settlements and compensation to Palestinians for related losses. David Bernstein has highlighted the matter of Whtston’s prejudicial pitch to potential Saudi donors at the expense of Israel. Joe Stork, Whitson’s deputy, has a similar partisan history. Just last year HRW hired in this division Nadia Barhoum, who at Berkeley belonged to Students for Justice in Palestine and vocalized all the fully partisan Palestinian rhetoric. Might HRW more wisely have chosen as it regional director a person who did not have a partisan history regarding the disputes she would monitor, and who would not editorialize in newspapers regarding issues of the prevailing disputes? Not hired every significant figure in this division from among the partisans of one side in disputes these officials would monitor?

Are these questions of propriety not those that would draw cynical consideration from any party in any context – except those who were already partial to the findings of those criticized, and, of course, those criticized?

How does HRW respond to these concerns? With complete defensiveness, acknowledging no error in judgment or practice, just as the many states it sets itself up to judge. How does it respond to Bernstein, its founder, a man of justly earned reputation? It dismisses him in a letter to the New York Times distorting his argument as one calling for Israel to be held to a different standard from that of other countries and for HRW to report only on closed societies. Bernstein made neither argument; however, the argument he did make, that the difference between open and closed societies be acknowledged in the nature of HRW’s work, in order to avoid the kind of moral equivalencies that banish meaningful distinctions – that argument goes disingenuously unaddressed in HRW’s dismissive write off of its founder.

Of course, Bernstein’s concern about moral equivalence is more than justified by reality. It is reflected in the deplorable nature and constituency of the U.N. Human Rights Council. Worse, it is evident in the very nature of the, not indiscriminate, but discriminatory attention paid to Israel, by the U.N, HRW and many others. Part of the argument with Bernstein was over what imbalance may or may not be demonstrable in HRW’s reporting on Israel. Z-Word Blog spared me the completion of an identical search of HRW documents. Note the numbers, and the additional sleights of argument that Z-Word identifies. Note something further: go to the HRW site and do a search on, say, Sri Lanka, or Chechnya. Compare those numbers to Israel’s. Consider that widely varying estimates place civilian deaths during the two Chechnyan wars at anywhere from 50-250,000 thousand. Consider that civilian deaths in Sri Lanka since 2001 are reported as nearly 12,000. Consider that composite estimates of civilian deaths in Afghanistan since 2001 directly attributable to U.S.-led military actions ranges from 5,300-8,100. Compare those to the number of civilian deaths in Israeli-Arab conflicts over a sixty year period.

Why, then, the incessant focus on Israel, on even the Israeli-Palestinian conflict?

It is in the nature of what the major human rights organizations, not just Human Rights Watch, have become, in contrast to what once they were. When Amnesty International was founded by Peter Benenson and six others in 1961, it was to promote organized letter writing campaigns on behalf of those who later would become officially designated by AI as “prisoners of conscience,” individuals who had been imprisoned by their governments because of their attempt to exercise what were already considered in most of the world, outside of closed societies, basic human freedoms. The individual human being in all of his or her natural autonomous liberty crushed beneath the boot of a repressive tyranny and removed from the world to languish in dark obscurity, even until death, forgotten.

But because of AI, if it could help it, not forgotten.

Human Rights Watch grew out of Helsinki Watch, the organization set up to monitor Soviet compliance with the 1975 Helsinki Accords. Most of the articles governed relations between the participating states. One article, VII, enunciated a “Respect for human rights and fundamental freedoms, including the freedom of thought, conscience, religion or belief.”

These beginnings, for Amnesty International and Human Rights Watch, in comparison to the overreaching ambitions that drive their work today, are almost quaint in the consideration.

About those ambitions, their sources, motivations, and goals, next time…

AJA

This entry was posted on Friday, October 30th, 2009 at 6:36 am by A. Jay Adler and is filed under The Political Animal.

When the infamous 1975 United Nations resolution 3379 declared that “Zionism is a form of racism,” 25 nations sponsored the resolution and an additional 47 voted for it. Thirty-two nations abstained from the voted. Only 36 countries voted against it. It was not until 1991 that the resolution was revoked. Certainly, many nations had experienced a change of perspective, significantly because of the passing of the Soviet Bloc, which was, at the time of 3379, at a Zenith of influence over the postcolonial Third World. It was also true that Israel had never slackened in its contempt for the resolution, a contempt symbolized by then Israeli U.N. ambassador Chaim Herzog’s tearing the document in half following his verbal denunciation of it . More practically – playing the world and one’s measure of power in it, as any country, and Israel, must always – Israel refused to participate in the 1991 Madrid Peace Conference without a revocation of 3379. The resolution nonetheless stands as one of the greatest stains on the U.N.’s historical record, alongside the racist 2001 World Conference Against Racism and the historical realities of the defunct U.N. Commission on Human Rights and its successor Human Rights Council. The latter the United States regrettably, foolishly joined under the Obama administration. Some day the U.S. will  have to leave the Council, as it did the Commission.

The point here is that it took 16 years to overcome the official declaration of 3379, and not merely through the turned hearts of U.N. member states. The truth won out because of steadfast  commitment to it and defense of it. Though 3379 was not itself the cause, that zenith of human rights perversion symbolizes a turning point in the political culture that produced it.

Within that historical context, it is necessary to reach some recognitions about the vote of the Human Rights Council to endorse the Goldstone Report. About the shabbiness of the Goldstone commission’s formation, membership, procedures, and predestination I will say nothing. Others are saying it comprehensively and well; you can find links to some of these actors in the “Wish I’d Said That” box to the right. About the human rights records of the Council members I also will say nothing. They are well known, and any who ignore or excuse these records – in themselves or in the context of judgments against Israel, and the concurrent absence of even consideration of so many other conflicts and systemic violators of human rights – are not subject to reason on the topic anyway.

Consider this: of the 47 countries currently serving on the Human Rights Council, only 9 of them were member states that voted against resolution 3379 in 1975. Six members of the Council were not then U.N. member states, and I cannot, in my quick review, account for the votes of two nations. Of the 47 current Council members, then, at least 30 either voted for resolution 3379 or abstained in the vote. (Twenty-one voted for it, nearly half the Council membership.) Thirteen of them either voted against, abstained in, or were conspicuously absent during the 1991 revocation vote.

This is the United Nations Human Rights Council. This is the historical record.

During the past several years, when it has become de rigueur, in the manner of Mearsheimer and Waltz, to complain that one cannot freely criticize Israel without attack and denunciation from the “Israel Lobby,” the reality is that attack on Israel had already become a prevailing manner and subject of left political discourse. Broadsides, campaigns of disinformation, boycotts, openly anti-Semitic blogs and writers dedicated to the termination of a Jewish state, anguished cries, now, from some liberal Jews themselves (and Yaacov Lozowick’s deft dismissal) about the quicksand upon which the reclamation of a Jewish nation now is perceived to stand – all fill the air. So much so that even well-known NGOs and human rights organizations have been long swept up in the current. We have achieved a new Zenith in anti-Israel sentiment, bias, and impassioned obsession and demonization. Read England’s Guardian and its comments and then draw yourself a bath with an abrasive cleanser.

Benjamin Netanyahu, September 2009 U.N. Speech

But as the anti-Semitic achievement of 1975 was revealed to be, over time, the signpost to a different destination from what was then believed, I think 2009 may come to be seen in the same way. The utter bias of the Goldstone Report, in its very conception, will stand out over time. Consider that while Goldstone accuses Israel of war crimes, British Colonel Richard Kemp, appearing before the Human Rights Council, declares

The IDF did more to safeguard the rights of civilians in a combat zone than any other army in the history of warfare.

As during the Soviet era, one must ask, who is Winston Smith and who Big Brother? Who seeks to live in peace and who serves the big lie that for Palestinians to live every day at war is better than to live in peace? Who looks for the truth and who into the looking glass?

The voices and forces in opposition to the hatred, as the growing resistance to Goldstone reveals, only increase in reason and steadfastness. Netanyahu’s speech before the U.N. – separated from any predisposition against him, greater for some than any dislike for Ahmadinejad – will increasingly be noted for its own modern commitment to the future and old verities, as well as for its courage sanely to speak the truth in the face of the modern form of an ancient lie.

from the Hamas Covenant

The courage of Robert Bernstein in denouncing the bias of the organization he founded and led for twenty years – Human Right Watch – is a critical moment in the history of the human rights movement, which has been derailed, partly by its obsessive focus on Israel and an ideological loss of bearings. And much of the unreason in current considerations of Israel derives, aside from the deep well of anti-Semitism from which there are always those ready to draw, from ideologically misdirected conceptions of human rights.

Wrote Bernstein in his New York Times Op-ed:

At Human Rights Watch, we always recognized that open, democratic societies have faults and commit abuses. But we saw that they have the ability to correct them — through vigorous public debate, an adversarial press and many other mechanisms that encourage reform….

When I stepped aside in 1998, Human Rights Watch was active in 70 countries, most of them closed societies. Now the organization, with increasing frequency, casts aside its important distinction between open and closed societies.

Nowhere is this more evident than in its work in the Middle East. The region is populated by authoritarian regimes with appalling human rights records. Yet in recent years Human Rights Watch has written far more condemnations of Israel for violations of international law than of any other country in the region.

Israel, with a population of 7.4 million, is home to at least 80 human rights organizations, a vibrant free press, a democratically elected government, a judiciary that frequently rules against the government, a politically active academia, multiple political parties and, judging by the amount of news coverage, probably more journalists per capita than any other country in the world — many of whom are there expressly to cover the Israeli-Palestinian conflict.

Meanwhile, the Arab and Iranian regimes rule over some 350 million people, and most remain brutal, closed and autocratic, permitting little or no internal dissent. The plight of their citizens who would most benefit from the kind of attention a large and well-financed international human rights organization can provide is being ignored as Human Rights Watch’s Middle East division prepares report after report on Israel.

Human Rights Watch has lost critical perspective….

Only by returning to its founding mission and the spirit of humility that animated it can Human Rights Watch resurrect itself as a moral force in the Middle East and throughout the world. If it fails to do that, its credibility will be seriously undermined and its important role in the world significantly diminished.

About that credibility and its undermining, next time…

AJA

This entry was posted on Wednesday, October 28th, 2009 at 5:57 am by A. Jay Adler and is filed under The Political Animal.

Three blocks from The Julia Dean Photo Workshops

Photography by Julia Dean

This entry was posted on Tuesday, October 27th, 2009 at 6:06 am by A. Jay Adler and is filed under A Blue Guitar.

Photography by Julia Dean

This entry was posted on Monday, October 26th, 2009 at 4:59 am by A. Jay Adler and is filed under On The Road.

Music: “Waltzing Matilda,”* sung by Tom Waits, 1977

*Australian slang for travelling by foot with one’s goods in a “Matilda” (bag) slung over one’s back.

This entry was posted on Saturday, October 24th, 2009 at 2:47 pm by A. Jay Adler and is filed under A Blue Guitar.

My apologies to the amiable, the adversarial, and the amiably adversarial, all alike, for my delay in acknowledging ShrinkWrapped’s healthcare reform Wrap Up and in offering some sought after replies. Unfortunately, this generic academic was off engaging the real world of which he is otherwise so woefully ignorant. Generic academic, doubling as generic liberal, chooses to inform his kindly medicinal presence (Zounds, man, but my head, it doth hurt!) that regarding his ignorance of economics, particularly the real-world variety, GA has managed three businesses in his lifetime, two of them to success (it being the failures, or course, that truly educate). But this being only Shrink and Scribe’s second date, there is still so much to learn about one another. As to GA’s knowledge of medicine, well, he will presume to remind the good practitioner of physic that just last month GA was in an emergency room!

To clean up loose ends, commenter Neil offered a clarification that did its job, for which I thank him, and focused his point:

In studies of survival rates in cases of critical care (the “really get sick” situation) such as some types of cancer, U.S. outcomes are head and shoulders above other countries with more communal health care systems. Unfortunately, these are the sorts of capital-intensive interventions that are likely to be limited by any health care spending bureaucracy.

This raises an issue on a matter of equity that often seems to concern conservatives. They, including if I understand him, SW, fear a diminishment of high-end care in the drive to provide equity in what they would consider middling care. There is resistance to subsidizing others, perhaps at all, but more particularly if it sacrifices the possibility, in principle, of any individual receiving the best possible care if needed. However, viewed conversely, in Neil’s formulation above, are not many individuals systematically required to receive lesser care – and no insurance protection (our current condition) – so that, in reality, only some individuals may have access to these capital-intensive interventions? Why should these individuals assent to such a system?

I applaud Neil for being inventive in his HSA idea. As the one-time business man and pragmatist I always am, I am always open to inventiveness, which I never oppose as a matter of ideology. It would be interesting to see the numbers crunched on the idea.  However, when Neil writes

The simplest thing would be to expand the Health Savings Account program to allow greater yearly tax-advantaged individual contributions to the HSA account

I confess to having the same reaction I always do when conservatives propose as a solution to economic disadvantage – in this matter, the inability to afford insurance premiums – the later tax advantage of contributions to some sort of private account. Who, I wonder, is not living in the real world?

When he concludes that the winning outcome of his plan is that

The right gets increased freedom and responsibility, the left gets an increased safety net and higher taxes.

I applaud as well his humor in suggesting that for the left higher taxes are not simply a means but a very end of social policy. We’ll pursue a booking for him at the Laugh Factory. Although, on the matter of humor, Neil supportively cites commenter Naomi (permission granted to breathe) citing the honorable John Ensign on the subtraction of auto and gun deaths from U.S. healthcare outcomes, when I would wager a bet (note what follows) that Naomi’s tongue was planted nowhere but in cheek.

MaxedOutMama disagrees with me on the nature of insurance as gambling, by citing its social usefulness and frequent economic efficiencies. However, I assented to these characteristics at the start. What I did was challenge whether every insurable circumstance should, as a matter of policy, be insured. The definition of “gamble” in the American Heritage Dictionary is

1. To bet on an uncertain outcome, as of a contest.
2. To play a game of chance for stakes.
3. To take a risk in the hope of gaining an advantage or a benefit.
4. To engage in reckless or hazardous behavior: You are gambling with your health by continuing to smoke.

MOM seems, perhaps, to focus her position on the fourth definition, but the first three apply to almost every kind of insurance as much as to gambling, and they apply to the insurer as well as to the insured, though it is the case, as another commenter offered, that for the gambling to sustain itself, the house must always win over the full spread of chances.

Additionally, MOM seeks to know

whether you would be wiling to accept a Medicare payroll tax of between 17.5% to 20% for the sake of establishing a true single payer system? I realize there would be caveats in your mind either way – you’d want to know more about the proposal before signing on, as would I.

But I would really like to know whether that is acceptable at all to you. So far my surveys on this point have not provided any support for the idea that the US population is willing to accept a public health care system. I asked on DU a number of times, and most people rejected it.

With all the caveats MOM anticipates, and believing the essential intent of her question to be one of my willingness to pay more myself in order to achieve greater equity in healthcare access, I have two answers. The first answer is that, based on the change in my own insurance to which I referred in The Open Mind II: Riposte, I am already about to pay more for the same, or the same for less, depending on how one considers it, without achieving any greater equity in access. The second answer is “Yes.”

Beyond that I am as duly impressed as is SW by MOM’s immersion in the numbers and particulars of the health matrix – indeed, the numbers in many areas, as I discovered by checking out her blog. I am impressed by her undoctrinaire and pragmatic assertion of the health need to cover the health needs of those who are in the country illegally but whose presence is accepted. I do need to point out – in the context of the sausage factory of contention that produces legislation – that it was only in a vain attempt to court Republican support, and in order to prevent further public conservative eruption, that Obama so vocally excluded such coverage from any plan he would accept. Nonetheless, I agree with SW that MOM should be eyeing a congressional seat. I might even, with all proper prophylactic protection against the nomenclature, do a Lieberman if she did.

Finally, to give SW the truly last word, I think it is essential to his argument that all currently proposed reforms will stifle innovation, diminishing both the high end of care and the ever improving general level of care that will, as a matter of economy, trickle down from it. He states in his Wrap Up.

I would like everyone to have access to the finest medical care our nation has to offer.  Unfortunately we cannot afford to make such care available.  As Neil notes:

The next best option is to create a system which allows “good enough” care for the maximum number of people while also enabling the innovation that will continually make such care cheaper and better over time.  The current iterations of Obamacare will do neither.

When you argue for universality rather than letting market forces increase the supply, you are implicitly saying that it is better that we all make do with less, rather than let anyone have more. People will die from this. Almost certainly more people than will be saved by universality.

AJA

This entry was posted on Friday, October 23rd, 2009 at 6:43 am by A. Jay Adler and is filed under The Political Animal.

I’m not a pundit, but I play one on my blog, and, it must be said, for a good deal less money than the television variety, though I could pretend to the same priceless knowledge in all fields. Let me teach Peter Orszag a thing or two about healthcare financing. Allow me to analyze the flaws in the numbers of the Congressional Budget Office. Watch me put the spank on David Gratzer.

I think not.

There an army of people (two, in fact) more qualified than I to analyze a national economy’s money flow, and that of several nationwide industries’, in order to argue for this adjustment in the tax code or that in eligibility, producing x amount of cost benefit or y amount of health system apocalypse. Some of them do it for an interested party, some for government and think tanks, some from arm chairs. Some of the cushion dwellers may actually know a thing or two. I wouldn’t bet against it. I’ve got a cushion of my own. Pick your favorites and believe them, because that is all that most people can do. It’s a representative democracy for a host of reasons, and that’s one of them.

A policy vision will appeal and make sense to you or not. Elements of plans will seem reasonable or ridiculous. Take the idea of taxing “Cadillac” plans at the insurer level, to encourage employer-consumers to price shop for more cost-effective plans. Do not trust your tax preparation to proponents of this idea. Through my employer, I happen to be a beneficiary of just such a luxury vehicle. Or I was. My employer and my union, with the voted endorsement of the membership, have very recently agreed to end our self-sustaining plan in order to participate in a plan representing a far larger pool of educators. The writing – and, if nothing else, educators can read – was on the wall. The costs were unsustainable. The change will produce substantial annual savings to be utilized elsewhere. Our benefits, though not insignificantly diminished, are still far better than most. Now we are in a Buick Regal. One doesn’t need to be Paul Krugman to see that the tax on the insurers would produce higher premiums and/or reduced benefits to the insured – and on what planetary basis do proponents of this tax believe that businesses are not already seeking to lower their burdensome health insurance costs, by price and benefit shopping, as did my employer, as well as my union?

However, I prefer to play a different role. I like to examine how we argue about matters. I like to look at fundamental assumptions. After all, the self-acknowledged non-experts need a basis upon which to place their trust, with the understanding that almost no one deserves it, but somebody has got to get it.

To begin, what’s this about “Obamacare”? As a student once said to me a long time ago, “Why you gotta take it there? Why’s it gotta be all that?” With all due consideration to mi amigo en el discussion, this strikes as a bit of reflexive, partisan demonization. Many elements in society have been seeking healthcare reform for a very long time. The failed effort at it was a centerpiece of the Clinton administration. Many names – that of Kennedy, for instance – are far more associated with the history and the policy initiatives of healthcare reform. Perhaps the greatest criticism leveled against Obama from those on his own end of the political spectrum has been his disinclination clearly to commit himself to a fixed set of policy reforms. So why Obamacare?

One doesn’t need to have been glued to any variety of LCD over the past near ten months to have observed the intent of various forces on the right to embody in Obama a full range of conscious, unconscious, and hysterical fears. Some of this effort has been politics as usual, some, perniciously, has not, and not all of the efforts are related to each other. But personalizing the current, multiple plans produced by the two houses of congress via the usual sausage assembly of conflicting and even undermining political interests as Obamacare does nothing to further or enlighten debate, and serves only to prejudice the mind and disable objective consideration. Favor the longstanding liberal drive for reform or not, it is not embodied in Barak Obama, it does not emanate from him, it is not expressive of his special influence, however one perceives it. It is the expressed desire of many tens of millions of Americans. Obama is not the fearsome leader of this movement. He is a follower chosen to play a temporary leadership role. But Obamacare does manage to conjure for a primed audience a dark and frightening agenda.

One of the too rarely considered distinctions in the current debate – how words do matter – is that between health insurance reform and healthcare reform. Now let’s be clear that whatever bill passes – and it seems nearly certain that something will pass – it is likely to truly please no one. It won’t be any of the models that genuine proponents of reform really want, and it will contain a variety of components that those who have always actually opposed reform, and who sought to water it down and to protect the interests of the insurance industry, will complain are, in fact, in toto, destructive to the system. That said, SW cites John F. Opie correctly remarking that risk and coverage are the two fundamentals of insurer’s business model. “Tamper with either of these,” says Opie, “and you destroy the business model of insurers.”

Oh, dear. Wouldn’t want to do that.

One needn’t be a socialist, and can even believe mightily in the creative and innovative engine of private enterprise, and still pause to consider the essential nature of the enterprise to insure. Insurance is gambling dressed in civil finery. Actuarial tables are card counting. Unlike gambling, insuring can perform a useful social function (if one wants to discount the social usefulness, in personal pleasure, of non-addictive gambling), but there is no reason to accept without consideration the notion that because a thing can be insured, it should be insured (anymore than the notion that it is a social good that because something can be securitized – like a pool of subprime mortgages – it should be securitized, and then, further, that security insured against loss). I’ll bet a buck against your house your spouse croaks by the end of the hour. Oh, no, I meant I’ll insure him. I’ll offer you the value of a house, say two hundred thou, if he does, and you make a premium payment of a buck an hour.

SW writes, “Our insurance system hides the true cost of insurance and has engendered the belief that medical care is, or should be, essentially free.  A variant is the shibboleth that ‘healthcare is a right not a privilege.’” I agree. The insurance system also hides, though its longevity and ubiquity, the question for many people of whether it is intrinsic to the concept and practice of healthcare that people be insured for it at all. In small, sparsely and dispersedly populated, technologically less advanced, or poor societies, or in combinations thereof, people’s medical fates are perforce an individual risk. Those economically raised above the norm can attempt to manage that risk more successfully than do others, health insurance being one form of risk management. Overcome all of those obstacles to group interest and cooperation, as has the United States and most other wealthy nations, and one has the opportunity to substitute for the short, nasty, and brutish reality of the only empirically demonstrable right – to meet one’s end – the, not entitlement, but enlightenment of a joint effort to protect life as long as possible against natural or accidental close. It is fundamental to the notion of the nation-state that it is organized for the mutual protection of its members against aggressive threat to life, both external, through a military, and internal, through policing agencies. It is commonly agreed that these functions are properly authorized, if not fully a function of, some level of government.

There is no reason why a society should not consider the appropriateness of conceiving healthcare – protection against those natural and accidental threats to life – in a similar manner. Having achieved a sufficient level of affluence, and overcome those natural obstacles to joint effort, a society can contemplate the cost of such an endeavor and the required distribution of resources to various essential sectors – research, equipment manufacture, pharmaceutical, delivery, and so on. But it is in the very conception itself that it exclude no one, and one is hard pressed, having conceived healthcare outside the constrictions of prevailing practice and assumption, to discover any essential or even useful role for insurance. Insurance company marketing costs and profits develop no component of care and add no value to it. Once the decision is made that the mutual benefit of healthcare will be assumed as a joint effort, developed through policy in any number of possible formulations, those who can crunch the numbers to determine the available and future dollars available need not consider their flow through insurance companies or the useless percentage remaining with them.

That’s a conception. Reality will not remotely match it, no to start, maybe not ever – not because the concept is inherently unrealizable, but because of the forces arrayed against it. That is in the nature of the political process. Our founders thought the checks and balances of not only government branches, but of contending forces was productive of stability. Maybe so. Demonstrably not always productive of coherent policy. Among the strengths of a well-run business is the capacity, in management structure, to see a business plan, wholly envisioned, through to its coherent realization. Democracy, imperfectly and democratically, offers little such opportunity. The political reality is that opponents of healthcare reform would never allow such a coherent vision to be enacted unmolested. Proponents must pass what they can achieve, and build on it. Waiting fifteen years again for another bite at the healthful apple is not an acceptable option. Historical studies have shown that almost all nation’s adopting some form of universal health system have done so not by any sweeping reconception and institution of a new system from the ground up, but by adapting change to existing structures. That seems bound to be the course in the United States.

Shrink says, “There are reasons people from around the world come to America for care that they cannot receive at home.” Indeed, we have the some of the best, and most expensive, healthcare in the world. If one can afford it, one may come for it. The advantages of affluence have never been in question. But no one comes to the United States for the healthcare system. If SW does not think the healthcare system is discriminatory, it is, it seems clear from his argument, because he doesn’t think variance in access is discriminatory. Most Americans disagree. Everyone knows, too, that the emergency room for non-emergency care is neither cost-effective nor productive of long term health.

The variance in access is not just demonstrable in the nature of the care sought and delivered, but in the care that isn’t. When I worked in support of universal healthcare in Minnesota in the early nineteen nineties, I heard countless stories from parents who purchased no insurance in order to pay the rent, and sometimes none for their children either, for which they felt great guilt. No care there but for emergency rooms, and sometimes – who knows to what detrimental end – not. Regular readers of the sad red earth know that several weeks ago I suffered a severe blow to the head in a biking accident very far from home (accounting, no doubt, for an array of recent dsfunctions.) Because of my excellent health insurance, I didn’t hesitate to go to an emergency room, where I was given a CT scan. All, thankfully, was well, though my skull hurt for over a week, and that was with a helmet. I received just two days ago a copy of the bill to my insurance company for the ER visit – over $4400. Under other circumstances, unemployed or low paid and uninsured, I don’t go to the ER. I can’t afford it. I take my chances because I think I must, and I suffer the hematoma and die.

One doesn’t get the protection of the military or the police based upon an ability to pay. One’s life is protected as part of the social contract, without exclusions. So it can be through a different conception of healthcare. Supply and demand are fundamental to markets. But markets are neither the sum of human life nor the structure of reality. They’re not Kant’s noumenon.

SW says “Obamacare treats the healthcare pie as a zero sum system.” Well, we know it is five different congressional plans to which Shrink refers, not Obama anything. But then he writes,

Healthcare:

1) Affordable

2) High Quality

3) Universal

Pick two of the three…

That formulation is the whole zero sum pie right there.

This entry was posted on Wednesday, October 21st, 2009 at 4:25 am by A. Jay Adler and is filed under The Political Animal.

For round two of our stirring exercise in blogocracy, ShrinkWrapped begins by arguing in the negative-affirmative, so to speak. Resolved: Obamacare is a danger to American healthcare delivery. As before, for SW’s round, comments here at the sad red earth are closed. Liberals and progressives of all becoming stripes, healthcare wonks, and every kind of reader of good cheer and profound common sense are all encouraged to vigorously and civilly deposit their couple of pennies over at Shrink’s jam-packed antechamber. I will attempt a reply in the next day or two.

The Open MInd II: The Dangers of Obamacare

This entry was posted on Monday, October 19th, 2009 at 9:42 am by A. Jay Adler and is filed under The Political Animal.

Penelope came with a house. We were renting from a friend and part of the deal was that if the friend rented to us, we had to take her dog. We already had Homer, a big lug of a part-Shepherd mutt, smart because obediently eager to please, but otherwise a very dopey beta. I didn’t really want Penelope. I’d convinced Julia to agree to a second dog – having two, I knew from experience, triples the reward – but I’ve preferred to raise them from puppyhood, and Penelope was already two. I was like a prospective parent wanting to produce his biologically own rather than adopt. But Julia wanted Penelope. We had, in fact, known her as a puppy. I agreed.

We changed Penelope’s name from the original because Homer needed his faithful companion, and as it turned out, his mother, his boss. They fell in love the moment they met, instantly play-fighting with each other as they still do nine years later, and as they do with no other dog.

You never know the extent of a creature’s capacity for love until you experience it. I include the human. It was true that Penelope was moody, as had been her former owner. She is inclined toward dark, enclosed, womb-like spaces. Once, in those early months, I lost her for hours before discovering her habit of retreating to the crawl space beneath the house. Otherwise, however, she did what dogs do among their humans. There was no reason to believe that she was not already ours. But one evening while Julia and I sat on the sofa watching television, Penelope did an extraordinary thing. In an act of exuberance as yet unseen, she suddenly leapt onto an arm of the sofa, then jumped onto the top of the backrest behind our heads, and proceeded to attack our heads. She licked us frantically all over our tops, moving in rapid fashion from Julia to me and back again, licking hair and flesh, and when we turned our heads up to her to see and grasp what was happening, lathered our faces with her tongue as if the precious supply of us might run out.

That was the day. Until then she had allowed us to care for her. What choice had she? But as of that night, she told us, she was fond of having us around. Homer loves the one he’s with who strokes him. If we hadn’t fixed him, he’d star in HBO’s canine Californication. But Penelope’s love is true, and it is for us.

Homer and Penelope are city dogs. Unlike other dogs we’ve had, before this past year these two had seen none of the country. This year, though, Homer and Penelope sniffed America and found it pungent and varied, worth a lifetime to nose around in. The fifty states, they now know, are states of aromatic intoxication.

We already knew that Penelope had a bent to hunt down critters. She’d ferret out mice from deep in the backyard vine. She’d leave at the backdoor for us to find a baby possum or two who hadn’t played their names well enough. Several months ago, though – that late along in our life with Pee (or PenelePerson, the names go on) – on the banks of the Mississippi, I was talking with a fellow traveler, and offered up my usual speculations on Penelope’s muttigree, including Akita. Oh, no, said the Missourian, who knew her dogs better than I, She’s Shiba Inu. Not all, but mostly. Check it out online.

And so I did. And so she is. The Shiba Inu is a Japanese dog, a smaller cousin of the Akita. It is one of the oldest breeds, genetically traceable to the third century BCE. Shiba’s are extremely smart and talkative – and they were bred to hunt small animals out of brush and shrubs. They have a driving attraction toward prey. This is Penelope.

Though Penelope is eleven and a half now, this year has made her three again. When we walk her in woodland, up hills, across gullies and dry creeks, passing over leaf, branch and all the detritus of forest floor, she is a wound spring unsprung. Slowing down at home, on the road now she is reborn. Nose to the ground, turning in an instant, heading this direction, heading that, picking up a scent, catching a new one, on a mission, always on a track to something, she is unstoppable. She runs deep into the woods after a squirrel, a rabbit, out of site, reappears, as I continue on my walk, somewhere along the way, finding the path back to me, but still seeking, running and seeking, her face alight with the pure pleasure of her being. Her being, in this moment, is to pursue, and that takes her to the next moment, after which there is nothing, only the now and the next, which is now again.

How to be in the now – I tried to write about it in “A Stone in Water.” In that poem, however, I considered the moment as stillness, as stasis, followed by the next unmoving moment. It was Zeno’s arrow, arrested in flight. Dog lovers know the Zen of Dog is different, maybe better. So tells us Mark Doty, in “Golden Retrievals.”

And so we press on through the trees, beside a lake, in direction of a meadow, Penelope ahead in flight, bounding, with her, all care away. Along the line of our march there is no regret, no aspiration beyond the apogee of the sun, no ambition thwarted but that of never to stop. When, some year not far off, she is gone from us – if not literally, then in bone and tissue, she will have left in stride, at every instant in the now and hunting the next, living, in the fullness and pleasure of what she was meant to be, the now of the next, in pursuit and in progress, aloft and alive.

AJA
Photography by Julia Dean

This entry was posted on Sunday, October 18th, 2009 at 5:01 am by A. Jay Adler and is filed under On The Road, The Singularity.

Shoot it Jimmy

Our orchestra
is the cat’s nuts –

Banjo jazz
with a nickelplated

amplifier to
soothe

the savage beast –
Get the rhythm

That sheet stuff
‘s a lot of cheese

Man
gimme the key

and lemme loose –
I make ‘em crazy

with my harmonies –
Shoot it Jimmy

Nobody
Nobody else
but me –
They can’t copy it.

William Carlos Williams: from Spring and All, 1923

*Ink runs from the corners of my mouth
There is no happiness like mine.
I have been eating poetry.
~Mark Strand, “Eating Poetry,” Reasons for Moving, 1968

This entry was posted on Saturday, October 17th, 2009 at 9:13 am by A. Jay Adler and is filed under The Singularity.