The Politics of Health Care. Two Rights Don't Make a Wrong

Over the course of eight years I had conversations with my wife's doctor about the issue of health care on many occasions during her appointments. He was a Rush Limbaugh fan and I am a social liberal with moderate fiscal leanings. It probably had  a negative impact on her health care but he and I enjoyed our little debates too much to resist temptation. One thing that become clear to me over those years was the fact that our arguments consisted of policy minutia and political talking points. We never got to the heart of what needs to be decided by our country. You see it really boils down to a very simple choice on two points of view. The question is not so much how to deliver healthcare, but how our society wants to define the nature of healthcare. Is healthcare a commercial product or a public service? How you answer this question gives a very clear and simple answer to how health care should work.Putting ethical arguments aside, I want to focus on basic system efficiency.

The conservative point of view is that the free market will create efficiency by lowering cost and increasing quality. If health care is treated as a product they are right. But it would have to be a true free market. Mandatory care laws would have to end. A TV manufacturer can not be efficient if he gives away some TV's and then charges twice what they are worth to the next customer to make up the difference. Propping up unprofitable institutions like hospitals with public money would have to end. The only function of government would be to regulate product safety and ensure honest business practices just like other industries. The result would be like the health care system of Thailand. Low costs and high quality, more affordable to the average American than the current system. Only the bottom tier of the socio-economic ladder would be excluded, depending on private charity for health care. Conservatives feel that private charity would be well funded when private citizens have more discretionary income from the savings of this approach and they might be correct. The only way to know would be to implement the changes.

The progressive point of view is that health care should be a public service like police or public schools and this approach would yield greater efficiency in cost and quality. If health care is treated as a public service they are also correct. Most components of the health care system would become public institutions without any profit motive. Health care workers would become civil servants with set salaries determined by legal statute rather than market forces. Suppliers like drug and medical device manufacturers would be required to prove efficacy, meet price points and engage in competitive bidding like other government contractors. Like any other public system it would be funded by progressive taxation based on an individuals ability to pay and provide equal services to everyone. This would be like the systems of Europe and Canada. They provide a high quality of care at a very low cost and would be much more affordable for a majority of Americans than our current system.

Obviously I've excluded a lot of related issues for the sake of clarity. My purpose is to point out that like most of our politics, our politicians rarely present us with clear and simple choices even though they know that is what lies behind their rhetoric. The fault lies not in our politicians but in ourselves. Our inability as a nation to reach a clear consensus on any subject leads to politicians offering us policy choices that appeal to multiple constituencies with often opposing interests. We try to have everything both ways and that leads to situations like our current healthcare system, a misbegotten hybrid of the two systems I outlined above and arguably worse than either one. We must resist the temptation to always view our opinions as right and the opposing view as wrong. More often than not they are differences of vision, not truth. Which vision best represents us as a people? Also I would remind you that nothing in our system is cast in stone, not even the Constitution itself. Anything can be altered through a consensus of political will. Think of prohibition or women's suffrage. The quickest way to determine if a policy is flawed is to allow it to be implemented and out of that experience comes true national consensus. The world is not going to end if the other party wins. We've survived multiple wars, epidemics and natural disasters. There is no political choice that we cannot survive or recover from. A friend of mine related her fear of the future her child might inherit. Such fear is misplaced. Any nation we choose to build can and will be un-built by our children and reformed in their image. This is the power and beauty of the American experiment, always fluid, always changing and arcing towards a future that can always be improved. But I think the first step towards that future is to have clear conversations about our choices with out the distorting lenses of fear and anger.

In memory of Dr. Michael Moore, good friend and loyal partisan. I will always miss you.

Opposing Gay Marriage: It's All About The Sex

For people who oppose gay marriage it really is all about the sex. This is not a particularly illuminating statement. Comments like the recent statement by Paul Stam, a republican representative in the North Carolina house, are pretty clear. According to Stam, “What I’m saying is, you cannot construct an argument for same sex-marriage that would not also justify philosophically the legalization of polygamy and adult incest,”. We frequently hear similar statements from conservatives that homosexuality leads to pedophilia , heterosexual sodomy, bestiality, and any other kind “unnatural” sex that you can name. Liberals tend to find these lines of reasoning rather odd. After all there is nothing preventing gays from having sex outside of marriage, not that conservatives wouldn’t love to bring back anti-sodomy laws, but that’s a discussion for another time. There are no prohibitions against gays having children and exposing them to the supposedly corrosive effects of a sinful lifestyle. Why the opposition to marriage? Marriage doesn’t alter behavior or household arrangements, it only changes the legal status of the couple. What liberals miss is that for religious conservatives it’s not about the status of the gay couple, it’s about the status of the sex. What really concerns the religious right is the relationship between sacredness and sex.
The traditional Christian view on sex, dating back to Augustine, is that sex is only a sacred act when it occurs in the context of marriage. Augustine writes in The Good of Marriage, “Marriages also have the benefit that sensual or youthful incontinence, even though it is wrong, is redirected to the honorable purpose of having children, and so out of the evil of lust sexual union in marriage achieves something good. Furthermore, parental feeling brings about a moderation in sexual desire, since it is held back and in a certain way burns more modestly. For a kind of dignity attaches to the ardor of the pleasure, when in the act whereby man and woman come together with each other, they have the thought of being father and mother.”  For Augustine, sex was inherently sinful but in the context of marriage “a kind of dignity” is attached to the sexual act and transforms it from something sinful to something divinely sanctioned. We must trace this thinking to Augustine, because it doesn’t come directly from the bible. Without going too deeply into scripture, there are basically three instances, dealing with sex and sin. I am omitting Paul’s comments on sex because they represent his own personal interpretation of scripture and would require a complete post in their own right. The three biblical references are the sixth commandment, “thou shalt not commit adultery”, the implied sin of sodomy in the Sodom and Gomorra story, and the stoning of the prostitute in the new testament. It’s not clear that any of these are a prohibition on extramarital sex. Adultery is more of a property issue, not having sex with someone else’s woman, whatever her marital status. It was not considered sinful in that context to have sex with one of your unmarried slaves for instance. I will not try to argue that male gay sex was not considered sinful, there are plenty of sources outside of the Bible to confirm it, however it is not clear that sodomy with a woman was sinful per se. The sin of the prostitute is of course adultery, but in the context previously noted. I should point out that no one is stoning her johns. The sin is only hers because she’s having sex with another woman’s husband. The men get a pass since the prostitute is not someone else’s property. Again, extramarital sex doesn’t seem to be a problem biblically.
So how does all this play in to the gay marriage debate? Basically the Christian right is fearful of sanctifying what they consider to be a sinful form of sex. If gays are allowed to marry the impression might spread that gay sex can be a transcendent and holy experience. The notion that the physical bonding of two gay people in a deep act of love might be pleasing to God is just too much to bear. For those of us who long ago de-coupled the sanctity of sex from marital status, this line of thinking is just peculiar. I have certainly had sexual experiences outside of marriage that I would describe as being transcendent and others that were decidedly motivated by lust. I’m sure there are plenty of people in loveless marriages that would describe their sexual experiences as purely physical and anything but holy. For me the definition of sacred involves any experience where my own individuality is transcended. To put it in Christian terms, it is any occasion when the holy spirit is present. Unless I’ve gotten my theology wrong, I’m pretty sure there are no Christian teachings that people and churches get to choose where and when the holy spirit makes an appearance. Only God chooses that. If that place happens to be a gay couples bedroom, then who am I to question it?

A Simple Proposal to Decrease Income Inequality

The Center on Education and the Workforce recently issued a report on the future of jobs available in the American economy based on education. The report notes that in 1970, 74% of middle class jobs were held by workers with a high school diploma or less. At the current time that figure hovers around 40% and the report predicts that by 2018 the number will fall to 37%. The reasons for this are fairly well understood. The restructuring of the American economy away from manufacturing and toward a technology and service economy are often cited as major contributors. This process, begun in the 1970's, has resulted in a huge increase in income inequality that currently ranks the U.S. near the bottom of the Gini scale as explained in this Atlantic Monthly analysis. Income inequality matters. The Gini scale has been in use for a century and has proven to be one of the best predictors of social instability and economic performance. Nations with high inequality perform much more poorly in terms of economic growth, are more prone to political unrest, and exhibit a general decay in social cohesion. The recent rise of the Tea Party and Occupy Protests should provide ample evidence to everyone that this is not a problem of one particular political party or class in our society. This is everyone's problem. The solution, oddly enough, is neither new nor mysterious. Upward economic mobility is the traditional answer and in fact, created the stable, prosperous society we once enjoyed between the second world war and the 1970's. This stability grew directly out of the New Deal's contract with America and it's focus on education. The basic contract was the promise that everyone should be given access to a public education that prepared all for a well paying job. For many decades our society delivered on this promise. Our education system became the envy of the world and a high school diploma provided the gateway to the middle class. That contract is now utterly broken. The current gateway to prosperity is a college education and it is not free. Political remedies to maintain upward mobility in the last 30 years have come in the form of  patchwork policies, mostly in the form of grants and loans, to increase college enrollment. The assumption has been that by ensuring more people received a secondary education, they would be prepared to participate in the changing economy. Our current economic crisis has laid bare the failure of these policies. Our primary education system has devolved into a system to prepare students for college and is no longer tasked with providing a complete, much less useful, education. Colleges and universities have been tasked with a job they were never designed for, to provide the minimum primary skills to enter the U.S. economy. The result of this has been a declining public education system that has lost it's focus and an increasingly inefficient secondary system with rising tuition, increasing student debt, and declining graduation rates for the poor. It would be naive to think that the remedies for this state of affairs will be anything but complex and politically difficult but we have to start somewhere. Therefore I make this simple proposal. We restore the promise of a primary public education. We must promise that anyone who graduates from our public schools should qualify for 70% of the well paying jobs in our economy. We must re-establish the old Jeffersonian ideal of a public education. Every person should be equipped, at the public expense, with the minimum education required to participate in our democracy as a good citizen. Good citizenship includes participation in the economic life of our nation as well as the political. This is the basic doctrine of fairness. The only barrier to achieving a middle class life in our country should be the willingness of our citizens to participate in the economy to the best of their natural ability. The goal of public education should be to foster this doctrine. Secondary education should be just that, additional training for the specialists in our society, which by definition means the few and not the many. The average person should not be required to go into debt just to make a decent living. Perhaps we should expand the time in public systems by two years. We could make a year of preschool at the front end a standard part of the curriculum. An additional year could be added to high school and graduation delayed. Students could be given the option of pursuing career specific training in the final two years of public school. Schools could base the curriculum on existing skills and aptitudes, similar to the technical programs of the past, instead of trying to "catch them up" for a college education they can't afford and some have little hope of completing. Private technical schools and community colleges might partner in these programs. Maybe there needs to be increased focus on creating good jobs in the economy that require more moderate skill sets. These are just ideas and better ones will come from those with more expertise than I. The real point is that we need to restore the promise that public schools will provide the primary education in our country. Not the education most will happen to receive based on vague political policies, but the truly primary education most will need to participate fully in the American enterprise of democracy.

Secular Music, Sacred Music: A Brief History part 1.

For the full extent of my musical life I’ve swum in two streams, the sacred and the secular. My first experiences as a performer, like many musicians, was in a religious context. Whether I was working in the pop idiom or the classical, I’ve always found myself constantly crossing what has become an increasingly odd divide. Odd, because over the course of time, the meaning of secular and sacred has changed. In its original meaning, secular(from the Latin saecularis) referred to being of the age, reflecting a specific time and place, temporal in nature. In medieval Christianity this contrasted with the sacred, things associated with an omniscient god, beyond space and time, non-temporal in nature. Music was classified in this way of thinking by it’s source, not it’s content per se. If it was created as the result of a revelatory experience, meaning a divine source, it was considered sacred. If it was the product of the rational mind, and therefore derived from a human process, it was considered secular.
      By Bach’s time the definition of sacred music had changed in western Christianity. It was now thought of as music specifically created for religious use. The method of creation for Bach was from the rational human mind in both cases. There is no difference between the musical content of the Brandenbhurg Concertos and a Bach mass. The same can be said for Vivaldi, Handel, or Mozart. The sacredness of music was derived primarily from the purpose of it’s creation, not the process.
     The current state of affairs for protestants dates to the reformation and a trend begun by Martin Luther himself. Luther wanted to replace the Catholic music cannon with one that reflected the new reformed theology. The musical content became incidental and the theological meaning of the piece took center stage. His emphasis was therefore on the message and that was contained in the lyric. To keep things simple, Luther adapted his lyrics to the popular tunes of his time. This was a direct contrast to the Catholic musical culture of trained choirs and musicians. These were hymns, in the musical style of the people, for a religion that belonged to the people, not the institutional Church. Fast forward a few centuries.
     In the late fifties and early sixties things began to change. We started to get singing nuns with their folk tinged kumbaya style that still makes many of my generation cringe and brings a sentimental sparkle to our parent's eyes. Then things changed again. In the late sixties, when the Jesus Freak movement started, a few artists already part of the popular music business become avid followers of Christ in the evangelical mode. These pioneers used their pop music writing skills and turned them to religious purposes. They created music that sounded just like the popular rock music of the time but contained religiously themed lyrics. Some early acts that come to my mind are Larry Norman, Randy Stonehill and Liberation Suite. Even mainstream artists got caught up in this movement resulting in projects like Blind Faith and Dylan's Slow Train Coming. By the mid-eighties I was seeing Christian acts in the recording studio on a regular basis. The most interesting one I recall was a heavy metal hair band, comprised of hispanic Catholic guys, who were on a mission to spread the word of Jesus. Complete with leather pants, hair spray, makeup, and tattoos. It was a sign of things to come.
     At this point in time, Christian music makes use of the entire range of styles in popular music often including the attendant fashion sense of their secular counterparts. Simply insert a religious message in the lyrics and the music becomes holy. This is the modern concept, at least for many Christians, of what sacred music is. In my next post I’ll comment on why I think this view of secular versus sacred actually hinders an understanding of the true role of the divine in music.

Life, Love, Mystery, that's what it's all about.

Two Executions and Memories of Jasper Texas

Recently two men were executed in two different southern states. One, Troy Davis, was believed by many to be innocent of the crime he was punished for. The other, Laurence Brewer, confessed openly to his participation in one of the most heinous murders in recent memory. For Davis there was a great wailing and gnashing of teeth from the usual quarters of death penalty opponents, putting forth the argument that every life is sacred and of equal moral consideration. In Brewer’s case there was no such display of moral outrage, no cries for mercy, nothing at all. Just a few small articles that disappeared from the media sphere as quickly as they arrived. I too oppose the death penalty for various reasons but the hypocrisy of it’s most vocal critics doesn’t escape me. It’s apparent that in their moral calculus, the life of Troy Davis had far more value than that of Laurence Brewer. The death of an innocent is indeed tragic, but no more so than the death of the thousands of civilians lost, inevitable collateral damage in the two wars we’ve been waging in the middle east. Then again there is the life that Brewer took, James Byrd Jr., dragged to death behind a pickup truck on a lonely logging road in east Texas. I too struggle with the moral calculus of the constantly overlapping tragedies of this world and the balancing of justice’s scales.

Brewer’s execution opened up a more personal connection for me. One that was not directly related to the death penalty. It brought back memories of my visit to Jasper Texas. Jasper is a small community in east Texas where the murder of James Byrd occurred. It was also Laurence Brewer’s home town. I went there on a contract job a few years after the infamous murder occurred and the memory was still fresh in every ones mind. East Texas is a beautiful region of rolling hills, pine forests and massive lakes and wetlands. Although rich in natural beauty, the region is also economically barren. Most communities there are among the poorest in Texas. Because of the lack of opportunity many communities have opted to allow the state to build prisons in the area in order to create more jobs. One such facility is near Jasper. It was in this prison that Brewer met his two future partners in murder. Although I have encountered overt racism in east Texas I never saw it in Jasper. By east Texas standards it is a progressive community when it comes to race relations. Jasper is also a community of contrasts. Just outside of town lies Sam Rayburn lake and hundreds of acres of old growth pine forests. The natural beauty of the lake has attracted developers and there are a number of upscale neighborhoods that cater to wealthy retirees and vacationers. Many members of the Jasper community have become wealthy due to this development boom. In the midst of this the majority of residents still suffer from the grinding poverty that plagues the region. This economic malaise effects the majority black population most, but there are many whites whose prospects are hardly better. I had a direct encounter with the reality of poverty in Jasper. I was camped at the time in an RV at one of the parks located in the deep piney woods near the lake. It was the perfect place to cook on an open fire so I decided to pick up a good steak at the local grocery. An occasional treat for me but not a rarity. At the checkout a young black man, about nineteen years old, was bagging my purchase. He was a huge strapping fellow but he had an open face and a quiet gentle manner to his voice. He asked what kind of steak I was purchasing and I told him “It’s a T-bone”. He then explained that he had only had steak once in his life and wasn’t familiar with the various cuts. I asked him further about his one time experience and a story emerged. “My family took me to the city when I graduated from high school and we gots to eat at Golden Corral, since I is the first one that ever finished high school.” Given my background, I had a hard time wrapping my head around the concept of dining at a budget friendly family restaurant as a once in a life time peak experience, but that was this young mans reality.
It’s a reality that Laurence Brewer and James Byrd also shared. They where both kindred souls in that sense. Both grew up in grinding poverty, both received a sub standard public education, and both faced a future with no prospects for a better life. Laurence became a petty thief and drug dealer ultimately ending up in the Jasper prison. James worked odd jobs and manual labor until disability forced him to live on the $800/month or so that SSI provides only as long as you own no significant assets. That’s why a car less Byrd accepted a ride from Brewer and his companions the day he was killed. As it happens I was working with another young man in Jasper who also had a connection to an east Texas prison. He was previously employed as a guard at Huntsville, a notoriously violent prison located in nearby Huntsville Texas. One day during a break from work he related a recent experience he had while driving in Houston traffic. Someone cut him off and he pulled out his service handgun from under the seat, cocked it, and pointed it at the other driver. It was only in the moment before pulling the trigger that he became conscious of what he was about to do and stopped himself. He went on to explain that the only way to survive in a prison environment was to assume that an inmate was about to kill you at any opportunity. You have to be prepared to meet violence with violence at every turn without hesitation. After a time it becomes instinctive. My coworker was suffering from the same kind of PTSD that soldiers often succumb to. He had been so damaged by his prison experience that he had to get rid of his gun for fear of killing an innocent bystander by mistake.

If the prison experience produces violent side effects in guards the impact on inmates is orders of magnitude greater. When Laurence Brewer entered prison, he entered a world where lethal violence is a daily fact of life. The only way to survive in such a place is to align yourself with a prison gang and he quickly aligned himself with a white supremacist group. Gangs in prison generally divide along racial lines and the racist hatred cuts in all directions, white-black, black-Latino, etc. By all accounts Brewer was a petty criminal when he entered the Jasper prison, but as often happens, he emerged a violent criminal that placed no value on human life. This shouldn’t come as any surprise. A life of poverty tells an individual that the society at large places no value on your life. If it did, it would correct the social deficiencies that keep you poor. When society places no value on a person that individual soon stops valuing his own life and often engages in deviant behaviors as a result. If you place that same person in prison he will cross the final Rubicon and reach the state where human life is valueless in general. For such a one cruelty and murder come easily. And what about our role in these stories? Are we culpable for allowing the conditions that lead to these tragedies? Make no mistake this not a story about Jasper Texas. It’s a narrative that plays itself out over and over in every community of our nation. Often in our own back yards and worse, it usually it doesn’t even garner our attention. The sad truth is that the lives of both Brewer and Byrd where discarded by us long before their deaths attracted media attention. Jasper will always serve me as a reminder that the moral calculus of justice is difficult to solve.