Sunday, January 19, 2014

Hiroo Onoda: Get Over It




Mrs. Haversham, of Great Expectations is the example of the woman who cannot move beyond disappointment about whom most American school children learn. But there are other, mostly fictional, examples of people, mostly women, who cling to a vow or a hope beyond reason. Joan Baez's first album had a haunting song about a woman who waited 16 years for her lover to return, but when he did, it turned out he had forsaken her while she had waited. Madam Butterfly waited for her naval officer. 
In most cases, we suspect the personwho clings to a promise or a vow beyond reasonable expectation, who clings when the steadfastness seems self sacrificial, has something wrong with her, or with him. 
In this world, the individual who cleaves tight to a proposition despite sea changes in the world around him (or her), is a rarity.
In a sense, the idea of marriage is based on this fidelity to a vow, til death do us part, even after it is apparent clinging to the vow, has been "for worse."
If we have come to suspect psychopathology in some forms of fidelity then we have to come to doubt the proposition that any form of fidelity to a promise made early in life may be a form of neurosis: but that would include the marriage vows.

So, when Hiroo Onoda died, his story still fascinated across time and across cultures.
Onoda was the Japanese lieutenant who remained in the jungles of the Phillipines for 29  years after the end of World War II, claiming he did not believe the war was over and he was remaining faithful to his orders not to surrender until and unless his commanding officer specifically returned to order him to stop fighting.

When you think about it, you know he must have known, or strongly suspected.  the war had ended--when no more soldiers appeared to fight him, when no more ships bombarded his island, when the only people left to fight were villagers and policemen. 
You know he could have slipped into a village and ascertained there really was no more war going on. He must have known the fighting had stopped.

But he continued the fight, knowing hostilities had stopped and he was the only one who still fought on.

Jesse James and  other bands of Confederate soldiers continued to act as marauders after the American Civil War, but the local population came to think of them as simple criminals.  Citizens sent police, not the Army after these die hards. 

When Onoda finally emerged from the jungle and his former commander arrived to deliver the order to cease and desist, he was returned to Japan, to a Tokyo which had glass skyscrapers and he was greeted as a hero. Here was a man who had not embraced the culture of avarice, creature comforts and money, a man who had lived in the jungle, in discomfort, because of fidelity to a sense of honor.

It must be telling, however, that he lasted only a year in the Japan he found on his return, then moved to Brazil and married a Japanese woman there, returning to Japan 10 years later to open a survivalist school, and the story became one which sounds like a man finally cashing in. 

It all reminds Mad Dog of the Japanese student who  studied in the stacks of his college library. He would arrive as soon as the library opened in the morning and stay until it closed at night, coming and going only for classes and meals. Mad Dog knew the Japanese student did this, because Mad Dog was doing the same thing. 
But what Mad Dog did not at first appreciate was that the Japanese student was doing this in a tacit competition. 
 Mad Dog caught this student looking in Mad Dog's direction, as 10 PM approached, often enough that he began to suspect.  One Saturday night, at 9:30,  Mad Dog gathered his books up, put on his coat, took the stairwell down one flight of stairs. The library closed at 10 PM on Saturday. Mad Dog never left before 10 PM, but just to test his own hypothesis, that night Mad Dog cleared out his stuff from his study carrel 30 minutes early. He waited in the stairwell for 10 minutes and returned to his carrel, looked down the row of carrels to the carrel occupied by the Japanese student, and saw the student had cleared out.

In retrospect, Mad Dog realized his own devotion to study and isolation was more than a test of will; it occurred against a background of no other really tempting options, and in a state of neurosis.

And Mad Dog wonders whether or not most or all fidelity is like that. As Oscar Wilde said:   "I can resist anything but temptation."

We project a set of heroic features on a man and his story, but, in the end, extreme behavior often looks more like simply eccentricity, sometimes simple social inadequacy dressed up as strength of will. 

And if that applies to the man who chooses to remain in the jungle, does it apply less to the woman who stays loyal to a husband who has moved on psychologically, or to a marriage which has become little more than a habit?

When young soldiers pledge themselves to each other, when they fight for survival together,  that loyalty is functional, self preserving. But they do not expect to carry sacrifice forward for thirty years. They anticipate a battle "for the duration," but the duration is expected to be relatively brief.

But what do we do with people who remain loyal to one idea for an unreasonably long time? And what do we say about institutions which depend on this sort of vow taking?
Obadiah Youngblood,  "Feeder Canal"



Sunday, January 12, 2014

New Hampshire: Liberal Arts in a Conservative State

Surfers' Cove Rye New Hampshire--Obadiah Youngblood


Mad Dog has been trying to wrap his mind around the experience of New Hampshire. A great deal of it has to do with ideas that coalesce around three observations:
1. Many people here grew up in families with more than four children. For them, there was never the prospect, the ambition of going to college as a pathway into the future.
2. For many living in the Seacoast now, their jobs, their livelihoods do not seem to have been dependent on what the college experience offered: They are, whether they are producing things or selling things, simply managing information, using computers. And what they know about computers they did not learn in any sort of school, public or private.
3. Those who are struggling, working two jobs, living paycheck to pay check do not blame anyone or anything beyond themselves for their tough lives, but when they do, they blame some amorphous Big Brother government, which, somehow seems to them to be at the root of all evil.

Mad Dog spent most of his life in the Washington, DC area, a city surrounded by close in suburbs in Maryland in Virginia where almost everyone went to college, most had graduate degrees, and all hoped and expected to send their children to college, and not to just to college but to "elite" colleges, where, they believed, their children's future and fortunes would be made by what they learned there and who they met there.

For the most part, Mad Dog has come to believe, both groups, the blue collar New Hampshire Yankees who cynically dismiss the value of college, or of any organized, meaning public education and the white collar Washingtonians, who worship at the alter of the Ivy League--are fundamentally wrong.

The college crowd seems unfazed by the realization that the economy they graduated into and the future for which college prepared them was fundamentally the wrong one. Few, if any, colleges prepared students for the revolution which was fomented by people who either never went to college (Steve Jobs), or who looked around Harvard and concluded the faculties were clueless and left (Bill Gates and Mark Zuckerberg.) College was then and still is a place to get your ticket punched, but the actual experience, until recently at least, did little to really prepare students for life, because the faculties were simply not competent or connected enough to see what life outside the academy held.

On the other hand, the blue collar crowd never learned to question, one of the things which might occur in college.  The blue collar crowd listens to Rush Limbaugh, watches Fox News, listens to the men down at the barber shop or the hardware store and cannot think to challenge the stuff they hear. And for some reason, they do not watch Stephen Colbert or Jon Stewart.

One thing Mad Dog realizes is he is out of touch with what UNH has to offer and he will attempt to remedy this by surfing the UNH website. He has been impressed by the credentials of the faculty--state college jobs must be good jobs, judging by the numbers of UNH faculty who hail from brand name schools, bringing their high priced merit badges to the Granite State.

But what are the citizens of New Hampshire getting for this investment?
Can graduates of UNH cut through the choppy waters they face, downstream?
White Water--Obadiah Youngblood
 

Monday, January 6, 2014

New Hampshire, Fair and Free

North Hampton Rocky Beach--Obadiah Youngblood
Mad Dog considers himself lucky to be living in New Hampshire. But watching the legislature dither over whether or not to provide its citizens with health insurance is painful to behold. It's one thing when you see old time New Hampshire codgers struggle with the idea of agreeing to taxes and a government which actually has ambitions to help its own citizens--they look quaint and honest and plain spoken.

But it's quite another when those tough old Yankees start to look like superstitious ignoramuses, clinging to some mystical, religious notion that we shouldn't help our neighbors because it makes them weak and it makes us enablers.

The big argument against accepting federal dollars (which Granite staters have already paid into the federal coffers) is that, down the road, some day, it will  have meant we have actually bought into the notion we might get involved with the federal government. As if we have compromised our virtue by allowing the local woman of easy virtue to contribute to our collection for widows and orphans.

It puts Mad Dog (pictured below) into a funk.

Saturday, January 4, 2014

What's Eating The Right Wing Now?

Tweedle Dee and Tweedle Dom: Aka Koch Bros.

Have you noticed how quiet the Tea Party has been lately?  Is it just that Mad Dog has not been paying attention or is it simply that Congress is not in session?

They are still out there, even when you don't see them. But you know they are there, like cockroaches, busy, unseen, ready to come out when they think the time is right.

President Obama has been taking punches on the roll out of Obamacare, but now, as more and more people have locked down policies, you are, at least if you listen to NPR, beginning to hear stories from more or less ecstatic people who have health insurance, who either never had it before or who had dreadfully inadequate policies.

If this keeps up, people might just get to like having health insurance; they may even get to depend on it like Medicare and Social Security, and if that happens, people may just begin to believe government is good for something.  And if the government is good for something, then what can those anarchists in the Tea Party sell?

Well, maybe  they can always try to kill Obamacare with a thousand cuts and bleed it anemic until people start to dislike it  because it cannot run up the mountain in its weakened state.

Presumably, Ted Cruz and Eric Cantor and the entire Congressional delegations from South Carolina and Texas and Arizona are huddling with the Koch brothers and Carl Rove and other luminaries of the Tea Party Thought Palace, rehearsing their songs.

Charles M. Blow, notes in today's NY Times that 43% of Republicans (Pew Research) are now "staunch conservatives" in terms of their ideas on the size and role of government, economic policy (trickle down good,  government rescues bad),social issues (gay marriage, bad, guns good, government restrictions bad) and moral concerns (Heaven only knows what constitutes moral concerns in Tea Party Republican eyes nowadays.) A majority of these "staunch" types watch Fox News regularly.

 Of white evangelical Protestants 73% disbelieve evolution. This is in contrast to all Republicans, of whom 54% believe in evolution.  This means 73% of evangelicals and 46% of all Republicans believe "humans and other living things have existed in their present form since the beginning of time."

Billy O'Reilly has been inveighing against the "War on Christmas," which he hears in the greeting "Happy Holidays" as opposed to "Merry Christmas."  Newt Gingrich picked up the Christians-under-attack theme, "There's a lot more anti-Christian bigotry today than there is concern on the other side, and none of it gets covered by the news media." Apparently, Mr. Gingrich does not watch Fox News.

Tea Party Republicans, which is to say, Republicans, or at least 43% of Republicans, the staunch set,  depend on anger, resentment and a sense of having been wronged.  (Actually, Mad Dog would like to know who those other 57% of Republicans are who are, who are not staunch. And who represents them? John Boehner? Mitch McConnell? How are these guys different from staunch?) Republicans are the party of anger. 

This is not the first time the Republican party has been the party of grievance. Of course, there was the McCarthy era Republican party of Who-lost-China?  and deep paranoia. But, originally, when the Republican party emerged from the Whigs, and nominated Abraham Lincoln, a lot of them were abolitionists, and being angry about slavery, even today, more than 150 years later, that seems appropriate. But there is a world of difference between being angry about slavery and being angry about Obamacare.

During Mad Dog's youth, there was the war in Vietnam. America was killing peasants in their rice paddies, burning babies with Napalm, and sending off its sons from America to die for "honor" and glory and to "fight for freedom" and to "defend our country."  That was something to get mad about. Republicans weren't bothered by all that then. It was disaffected Democrats who roiled about Vietnam. It was Democrats who served notice on their own sitting President he would not be renominated and it was Democrats who rejected the candidate of smoke filled rooms, Hubert Humphrey, because he supported the war in Vietnam, and it was Democrats who self destructed and handed the election to Richard Nixon because Democrats were angry at their own for having blundered into Vietnam.

But what issue today rises to the level of evil reached by the institution of slavery or  war? The War on Christmas?  Gun control?  Teaching evolution in schools? 

Mad Dog must be missing something here. But what have the Republicans got to get America boiling mad about now?








Sunday, December 29, 2013

Republican Orthodoxy: You Match 'Em Quiz

John Boehner
Carl Rove
Ted Cruz

John Q. T-Party





Okay:  It's time for one of those end of the year quizzes.  Let's play, "Who Said That During 2013?"

Match the statement to the Republican who said it: 
1. "Jesus never once admonished government to create social justice. He admonished us personally to be our brother's keeper...Our nation's founders, creators of the American Dream, did not form the Constitution based on social justice and inclusivity, but on the pursuit of happiness and equal opportunity...It is a personal responsibility to be our brother's keeper...It is easy to palm off our neighbors to the government."

2. "Society...does not have an obligation to even the playing field. Those who choose to be needy [italics added]over choosing to be responsible are literally robbing from people who have no choice."

3. "Our welfare system has created the fatherless black child trapped in a prison of violence and hopelessness. Before the invasion of The Great Society, the African American family was intact. Check the statistics of the 1950's versus those since the act creating the Great Society in 1965. Watch the news in Chicago, Detroit and Los Angeles. We have slipped from ghetto to the new plantation... And we want to broaden this failure by forcibly taking hard-earned money and giving it, rather than jobs, to more people? It is morally reprehensible. So, what would Jesus say?"

4. "There is hard-earned dirt under my fingernails, and I have never had the luxury of getting callouses on my behind rather than my fingers."

Mad Dog may indulge himself over the next few posts, as the spirit moves, to deconstruct each of these jewels, which as a group are a delicious screed against that most foul bogeyman which delights and titillates the dark cockles of the Tea Party heart: The Welfare Queen, immortalized by Ronald Reagan, as that reprobate who gamed the welfare systems for "hundreds of thousand dollars a year," and drove a Cadillac, laughing all the way to the bank while her fellow citizens worked hard to support her profligate ways with their taxes. (More on her to come, stay tuned.)

But for now, Mad Dog admits the answer to the quiz is: None of the Above, or, alternatively, "All of the Above" because, while this was all written by a single author, one Ramona Charland, of Portsmouth, in a letter to the Portsmouth Herald; she was wittingly or unwittingly quoting chapter and verse from the same text, the Republican Bible, the book of Tea Party Pslams, aka The Book of Sore-man.

And, yes, Mad Dog, got a new software program as a Christmas present--what would Jesus say?-- from one of his sons, so he can now create cartoons which, eventually, will be a lot more polished than his old hand drawn attempts. Still working on the software, and it's tons of fun.

Tuesday, December 24, 2013

Obamacare: Hey It Works For Me

Van Gogh




Okay, here's an early Christmas present. The phone rings at 10 o'clock at night and the caller ID shows it's our thirty something son. 
He  is living his bohemian life in Brooklyn and we worry about him. 
We have told him how important it is he have health insurance. He shrugged that off, being young and invulnerable as he is.
But my wife appeals to him on the one level she knows will appeal to him. From early youth, this particular son has been a person who feels responsible for the rest of humanity. Give him a $5 bill for his lunch money for a week and he gives it to a pan handler on the street and he eats crackers and ketchup from the school cafeteria that week.
 When his younger brother found a living sand dollar on the beach and proceeded to carry it  home to show his mother his living treasure,  the good son lambasted him the whole way home, saying the sand dollar would die out of the water, would die just so the younger brother could have the pleasure of showing off  it to their mother. 

So his mother, my wife, appeals to that most reliable, entrenched part of him--concern for others:  "Look," she says, "If you get hit by a truck and wind up in the ICU at $50,000 a day, you know your father and I will not just let you die there. We will have to mortgage the house and go bankrupt trying to save you. So, do us a favor, get yourself health insurance."
So he got a policy called a "catastrophic" policy which covered almost nothing and cost $800 a month--a major part of his budget. His rent costs $800 a month.

Now, it's a phone call from New York at 10 PM. 
A phone call at 10 PM from this son could not be good. 

But, he sounds happy. Not just happy, euphoric.
He had got on the Obamacare website, got a policy for $300 a month which covers just about everything you can think of, including dental. He has not seen a dentist in 5 years. (News to us.) 
Of course, he lives in New York, where there are many insurance companies competing for business, not New Hampshire, where there is no competition, where Blue Cross has a monopoly. 
But for him the unsung truth, Obama care has proven a great blessing.
We'll see if his anecdote is more representative than the other anecdotes we have been bombarded with in the Times and the Portsmouth Herald.

Saturday, December 21, 2013

Strip Searching Again. This time Dr. Khobragade. The New York Times is All For It.

He bemoaned that public outrage was focusing not on Khobragade's alleged treatment of the housekeeper and her spouse, but on the U.S. government's treatment of the diplomat.
"Is it for U.S. prosecutors to look the other way, ignore the law and the civil rights of victims (again, here an Indian national), or is it the responsibility of the diplomats and consular officers and their government to make sure the law is observed?" he asked rhetorically.
Bharara defended the handling of the arrest and custody, though his office was not involved. "Khobragade was accorded courtesies well beyond what other defendants, most of whom are American citizens, are accorded," he said. "She was not, as has been incorrectly reported, arrested in front of her children. The agents arrested her in the most discreet way possible, and unlike most defendants, she was not then handcuffed or restrained."
In addition, she was allowed to keep her phone and make calls to arrange personal matters, including child care, he said.
"Because it was cold outside, the agents let her make those calls from their car and even brought her coffee and offered to get her food. It is true that she was fully searched by a female deputy marshal -- in a private setting -- when she was brought into the U.S. Marshals' custody, but this is standard practice for every defendant, rich or poor, American or not, in order to make sure that no prisoner keeps anything on his person that could harm anyone, including himself. This is in the interests of everyone's safety." [italics added]

--CNN report about the arrest

There are all sorts of issues connected to the arrest of Devyani Khobragade in New York.
She is (or may be) a diplomat from India and may or may not have diplomatic immunity. New York accuses her of abusing a domestic worker by underpaying her. She is not accused of human trafficking or selling the worker in to a life of prostitution, but of underpaying her.

1. The arrested woman was strip searched and had her vagina probed, just in case this mother and diplomat was carrying a concealed switch blade in her vagina. Just in case she carried an explosive in her vagina, with which she might harm some of the other prisoners (or herself !)  Of course, this is a legitimate concern for the New York prosecutor, because, Heaven knows, this woman, who apparently had just dropped her child off at day care might have known the arrest was coming and loaded up her vagina to do battle at the jail. Might have locked and loaded that very morning. 

You never know.

Some have described this as "finger rape" in jail. Some would not. It's just what every female American citizen can expect when taken into custody by their government at any time in any jail. Ain't not big thing, according to the New York state prosecutor. A little vaginal probing, stripping. Endorsed by Justices Scalia, Roberts, Alito and Thomas, too. They are all for it. Got to protect those jailors from dangerous criminals like Dr. Khobragade. Feed her coffee and doughnuts  first, just to get her in the mood.

2. The New York Times ran an editorial supporting the state, saying the treatment befitted the crime. Of course, the venerable Times completely ignored the idea of punishing (by finger raping and stripping) someone who has been only accused and not convicted of a crime. One might ask what was in the coffee of the Times editorial board that night. 

3. Diplomats are typically protected from dingy cells and in jail genital manipulation.  Mad Dog recalls a conversation he had with an American foreign service officer some years ago. Mad Dog was speaking to this foreign service officer because the son of a Mexican diplomat had crossed the double yellow line on a Friday night, in his car, which was loaded with eight other teenagers. There may or may not have been drinking involved. 
You guess. 
And the car wound up in Mad Dog's windshield. Mad Dog's wife, riding in the passenger seat was air lifted to the trauma center, unconscious, spent two weeks in intensive care and did not walk without crutches for six months.
 Mad Dog had to hire an in house au pair to care for his 9 month and 2 year old sons, and Mad Dog was just starting his practice in Washington, DC and did not have the money to pay for his wife, his sons and still try to go to the office and hospital.  
The son of the diplomat was not arrested at the scene. The police told Mad Dog the father arrived "waving his diplomatic card around like it was a credit card," and the father took him home, leaving the wreckage of the two cars and the seven other injured teenagers behind. 
"Well," the American foreign service officer told Mad Dog, "If we don't honor the diplomatic protection here, our foreign service officers in Mexico, Turkey, Beirut and the Soviet Union are all exposed."

Not only could Mad Dog not see the son locked up, Mad Dog could not sue the father. 

Diplomatic immunity. 

But here today we have a diplomat (or some family member) finger raped before she is even tried in court for a non violent crime.

(And the New York Times sees nothing wrong with this and upbraids the Indians for getting angry.)

America looks at the rest of the world and sees barbarians. 
What do the Indians and the British think, when they look at America and see Texas executing people with all the abandon of an afternoon barbecue?  What do they think when they learn women, a mother having dropped her child off at day care, is hauled off for a strip search in an American jail?

What do Americans think about strip searching?
Oh, won't happen to me. Won't happen to my wife or daughter. 
Not my problem.
Live free or die.

Wednesday, December 18, 2013

The Most Wonderful Time: When the Seabrook Plant Blows


Hey boys and girls! It's what we've been looking for in our mailboxes all year, and it's finally here: Our 2014 Emergency Public Information Calendar (for neighbors of the Seabrook Station) "DO NOT DISCARD. SAVE FOR USE DURING AN EMERGENCY."

And what a wonder of invaluable information it is! My favorite is the Emergency Bus Information map for Hampton. When those sirens go off because the power plant is melting down, just go right out to Route 27 and wait for the bus to safety. (18 pages of emergency bus routes from the surrounding towns. What haven't they thought of at the power plant emergency planning office?)

Just climb on board. 
Don't need no luggage. 
All you need is faith. 
Hear the diesels humming. 
There's a bus a coming, 
Just thank the Lord.

It is reassuring to see that they plan to evacuate towns as far away as Dover and Rochester. Makes one feel better about living just two miles as the crow flies from the plant.  Wouldn't matter if you lived at a "safe distance." The safe distance appears to be Canada.

Oh, and what to take with you when the siren goes off. Things I would not have thought of: 1. Dentures  2. Toothpaste 3. Medical insurance card --we might radiate you, but nobody's going to treat you for free. 

If things get, how shall we put this? Constricted. Just shelter in place. "Keep pets inside. If you are in your car close the windows." 

And do not breathe more than necessary.

 "Remember, in an emergency, you will be better prepared if you know how to help yourself and others, as well as how to receive help from others." 

There are some lovely photos in this calendar: Look at July, with the picture of gentry getting on board the Portsmouth Electric Railway car, which apparently ran from Rye to Portsmouth. Look at those folks. There was a time along the seacoast when living was elegant. Those folks did not have to worry about a nuclear power plant blowing up. Judging from their clothes, they were living about maybe 1900:  All they had to worry about was Diptheria, tetanus, pertussis, measles, strep bacteria, influenza, polio, world wars, and crop failures. 

Life was simple then. No worries about computer viruses and nuclear power plants. 


 


Tuesday, December 17, 2013

The Private Sector vs The Government in Health Care

One of the core Republican Tea Party tropes is that "Government cannot do anything right; the private sector, motivated by profit and competition is always more efficient and effective."

Obamacare's troubled roll out has played into this cant, and Republicans have been frothing and delighted.

The problem is, the profit motive is not always the most functional motive: Consider medicine.

In medical school, nascent doctors are taught relentlessly what constitutes good medicine: Every medical student admits patients to hospital and each new patient begins a series of quality control exercises, as the student presents the case to the ward attending and to each attending who visits the patient from each specialty. So a diabetic admitted for chest pain who is found to have an infection of his big toe will get seen by the ward attending, the attending cardiologist, the attending infectious disease faculty. Every chart note the student writes, every presentation he makes is reviewed by his intern, his resident, his attending, the specialists, the faculty member who hears the case presented at morning report. Feedback is critical, constant, valuable. 

You learn, through this process to judge quality: the infectious disease consult who sees the patient for his toe infection should cut away the dressing from the toe, inspect it daily, to see how it is healing or not.  Some attendings are lazy. They don't remove the bandage, which often takes time to search for the nurse for a kit to use and then to rewrap. Some never fail to examine the toe. That is quality care. The doctor who does not unwrap the toe may miss the fact the antibiotics he has ordered are not working.  He may save time by not unwrapping, and he may be able to see twenty five patients on his rounds, and bill and profit more than the plodding doctor who does it right, but the rapid moving, lazy doctor is not practicing high quality medicine. The doctor who sees fewer patients, unwraps every toe, bills less, but does more good.

Mad Dog has worked for medical care organizations in which the work the physicians do is never reviewed for quality by another doctor. No chart note is ever read, not case is ever required to be presented. No conference to review performance is ever done. The only metric that matters  in such organization is the metric of dollars in and dollars out. When contract renewal negotiations occur, there is never a mention of whether you unwrap toes, examine hearts or lungs because the contracts are negotiated by MBA types, not doctors. And the MBA types don't have any mechanism to check which of the doctors they are negotiating contracts with are practicing low quality medicine and who is high quality. But those MBA's can add up dollars just fine.

There is a big push in medicine now for "quality metrics" which often means some easily quantifiable thing which can be collected easily, with a minimum of effort, by an entry level staff person and plugged into a spread sheet. The glycohemoglobin fits all these criteria.  It is a number which tells how high the blood sugar as been for the past three months.  Want to know if a doctor is good at treating diabetes? Add up all his patients' glycohemoglobin, divide by the number of patients and presto: Quality assessment.

The problem with such easy metrics is they can always be gamed. They invite gaming.  So the organization announces you will be judged by glycohemoglobins: What to do?  Well, first fire all your overweight, non compliant, under performing patients. Or send them to some other doctor, an endocrinologist or a nurse practitioner; let someone else carry these neer do wells. Keep all your thin, compliant diabetics with their good glycohemoglobins and you look great. 

The problem with this good assessment of diabetic control is that it attributes to the physician the entire burden of the outcome. Doctors may find themselves in the same position as  teachers in the South Bronx, the poor  scores of their students do no mean they are bad teachers; these teachers are not working with cooperative subjects. Doctors who work with patients who cannot or will not do the things they need to do to control blood sugar, who are judged by poor results,  know they can do nothing to affect those results. So they will game that system.

All this is happening because the wrong people have been given the task of judging doctors. MBA's can only judge how much money the doctor brings into the coffers.  CPA's and economists might dream up a metric or two which sounds reasonable, but they cannot see where the metric fails and how it can be gamed. 

Health care systems, whether they are for profit corporations, or "voluntary hospitals" are all failing in the same way: They have excluded the very people who can judge the work of the doctors in the system, namely other doctors. 

The emergence of the profit motive as the driving force in medicine, combined with the flight of doctors from being independent shop keepers to hired help has meant the culture of business has, by default, assumed control of the way doctors are evaluated, paid and ultimately what kind of quality they provide their patients. 

Next time some Republican says,  "Keep your government hands off my Medicare, get the private sector control of medicine, let the profit motive prevail,"  just tell them government may not be as efficient as we'd like, but it is still worlds better than profit driven private companies. At least the government has the motive of providing good health care. The company cares only about the bottom line.

Much as doctors love to complain about Medicare, they mostly agree Medicare generally does what is best for the patient.  The private insurance company will deny a diagnostic test for its customer, knowing that two years later the patient may be much sicker because the diagnosis was missed. But, two years later the customer will likely have another insurance company, and paying for his illness will be that company's problem. Medicare knows they are stuck with every patient for life. 

So Medicare will pay for a pair of shoes designed to prevent ulcers on the feet of diabetics. The shoes may cost $100 a year. A single visit to the ER for a foot ulcer is $500. Medicare makes the investment because keeping the patient out of the hospital is cost effective. The private insurer is hoping to keep the patient out of the hospital only for the term of the policy. 

Democracy may be the worst form of government ever devised, as Churchill noted, except for all the other forms of government which have ever been tried. The same may be true of government guided medicine--the worst form of management except for all the other forms which are currently out there.




Sunday, December 15, 2013

The Constitution Is Only A Rough Draft

A Well Regulated Militia

This week's New Yorker Jeffrey Toobin notes that the Constitution is America's Holy Book, that both conservatives and liberals avow they are the true defenders of the founding fathers' holy words and their opponents are trying to thwart the intentions of those divinely inspired, bewigged 18th century gentlemen (and they were none of them peasants) who assembled in Philadelphia. 

In fact, as a law  professor named Sanford Levin has pointed out, the document set forth a plan which was a political compromise, with morality often absent, to wit, the enshrinement of slavery (with slaves, referred to as "other Persons").

In many ways, the political compromises which were made in the late 1700's still thwart us today:  A representative democracy, if that's what we are aiming for, should, ideally, represent the people who live in the nation rather than some artificial constructs, which are, after all, what states are. (There is a wonderful book about how states got their boundaries, and if ever you doubt the artificiality of states, read that.)

The notion of states ultimately stood in for real divides among the people of the nation:  In the 1800's states which raised cotton and kept slaves were different from states which did not. Today, there are rural to wilderness states with few people but lots of land and resources, and it is the people who control those resources and that land which get a commanding voice in the U.S. Senate. 

The idea, expressed by Orin Hatch of Utah, that the populous states of California and New York could rule Utah, Wyoming and Montana is horrifying to the people living in those states, who believe only they should control the water, the gold, the silver, the gas and oil on their "property." And that's, in essence, the idea of a state, the people in that geographic area have fenced off the land as "ours" and everyone else is trying to take their rights to use that land as they see fit. 

Toobin notes that in 1787 Virginia, the largest state, had eleven times the population of Delaware, the smallest. Today, California has seventy times more people than Wyoming. And yet, the people of Wyoming get to control resources, get to align themselves with other wilderness states to prevent meaningful gun control. 

If Mad Dog had his way, and if we really decided we need states, he would create a single state out of Montana, Utah, Wyoming, Idaho, Nevada. The Northern Virginia suburbs of Washington, D.C., and a part of Maryland from those suburbs up through Baltimore would form another. Upstate New York would become part of Vermont, and populations which share common concerns and problems would be bound together.  This would likely mean retrenchment every twenty years, but at least we could avoid the absurdity of Albany, New York controlling New York City.

If state boundaries were eliminated tomorrow, if we all became simply "Americans" then we could people in Idaho, they do not have a right to their AK 47 attack rifles and grenades.  

But Delaware, Rhode Island and likely Vermont and New Hampshire might not have joined the union if people in those states, who thought of themselves as being from those states, were told they would be represented according to their numbers rather than according to  their property.

In fact, those hallowed founding fathers did not trust the hoi polloi to govern themselves, so they created a Senate which could be controlled by the landed gentry, the wealthy and the well connected, and which could nullify whatever the rabble in the House of Representatives tried to enact as law.

We are not, and were never intended to be a democracy. "This has never been a democracy. This is a representative republic, with heightened democratic principles," Orin Hatch says. 

Through time, the revered checks and balances have thwarted change: For part of our history it was the Senate, which blocked emancipation of the slaves, then civil rights, then Clinton's health care reform.  Then there was the Supreme Court, which confirmed slavery in the infamous Dred Scott case, and which blocked changes to Jim Crow and recently made stealth political contributions a protected form of free speech. 

The government, as our founding fathers handed it to us was designed to accomplish little. That's what "checks and balances" is all about. 

That is why the Tea Party canonizes the founding fathers. If you believe government is bad, if you believe that government is best which governs least, well then, the Constitution is your Bible and Thomas Jeffferson and his fellow slave holders your apostles. 
All Men Created Equal. Except the Slaves

That may have worked well in the 18th century, when there was really very little which any government could do for its people other than to tax and wage wars against other governments. There were no medical schools to fund, no hope of curing cancer or infectious disease, no way of  doing any meaningful public health. They could build roads, locally, but there were no bulldozers, no bridges which could span large rivers, and no airports, no need for air traffic control. There were no automobiles to power with gas lines, and no internet, no computers, no mass communications beyond newspapers, no telegraph, no railroads, no labor unions (although we may soon join the 18th century in that respect) no hospitals which we would recognize as hospitals, no real pharmaceutical industry, no public education, and the few universities which did exist taught mainly Latin, Greek and theology. 

The men who signed that parchment with quill pens did make a giant leap in thinking: They recognized the idea you needed a king to govern was absurd. But then, they had seen England's Parliament.  They were, for the most part, ordinary men of their times, who found some extraordinary men, like Franklin, Jefferson, Adams, Madison and Hamilton to lead them.  What they cobbled together almost fell apart because they had sewn their fabric with the poisoned threads of slavery, states rights, property, male dominance, class suppression, aristocracy and indentured servitude. 

Lucky for us, Abraham Lincoln found his voice and his chance.

President Obama has been hamstrung by what those dead white men left him. 

So have we all.

Thursday, December 12, 2013

Obamacare Takes Root

Norman Rockwell

This morning, NPR aired a story following a thirty-something man as he  tried to work through the Obamacare website. NPR followed him through his first frustrating encounters, then as he gradually wended his way through the web, and finally as he discovered a plan which would work for him. The plan costs about $180 a month, more than $200 a month less expensive than his current plan and it covered his prescriptions, had minimal co-payments and deductibles and was overall way better. In the end he phoned the insurance company, Unity, which would be his new insurer and they confirmed the good news, which he could hardly believe.
"The really funny part, " he said in the end, "Is that it was Unity which rejected me a year ago, because I'm diabetic. Now they are giving me way better coverage at a fraction of the cost."


Family Plan

This, of course, is an anecdote. It's the kind of reporting that is easier because you do not have to fight through statistics and computer screens and try to draw conclusions which are supported by statistics. And, as they always say in journalism, it's got the "human dimension." You can follow the individual. The problem is, how do we know whether or not that individual is representative of a larger trend?

If he is, then the Republican party, and people like Fred Rice and Nancy Stiles should, eventually be in big trouble, if voters remember how they tried so hard to prevent this leap forward in healthcare. 

Of course that's a lot of "if's."  If Obamacare works this well for the millions. If voters remember who tried to prevent it and who made it happen.  If voters go to the polls.

John Singer Sargent 

But, if this sequence occurs, it will be good for a lot of people, and it will be a huge step forward for the nation. 

Sunday, December 8, 2013

Fried Rice



"We face a $17 trillion federal deficit and $128 trillion in unfunded liabilities. Continuing to look to Washington as a bottomless pit of money that we can draw on just by complying with increased federal conditions is irresponsible and leads to greater dependence on government for everything in our lives."

--Fred Rice, Republican Delegate House of Representatives, New Hampshire

Whenever people start throwing around big numbers, you can be pretty sure they have no idea what they are talking about. When they talk about thousands, they may have some inkling; millions, they are in a fog; billions, they are listening to someone else; trillions, they haven't the faintest idea.  There is a strong inverse correlation between large numbers and solid evidence.

--Mad Dog, Hampton New Hampshire Democrat

Fred Rice voices the standard Tea Party Republican tripe when he says we cannot afford Medicaid for our New Hampshire citizens, and we cannot afford health care for our nation. The line is so old  and wrong it is like a worn out pair of shoes: leaky, inadequate, but  comfortable.

Here's how it goes:  We are spending more money than we can afford. This will result in catastrophe, not necessarily today, but tomorrow, when the bill comes due.If we agree to this Medicaid thing, then we will be involving ourselves more with the federal government, and that is always bad. The federal government is bad. Government is bad. Someday, when the bill comes due, we will be owned by the Chinese, and our grand children will have to learn Chinese. They will be working for Chinese companies, living in dormitories next to the factories and they will live in a soulless country where there is no free market. Government spending is always bad. If we had only not spent government money during the Great Recession, we'd be oh so much better off. General Motors would have gone bankrupt, but that would have only hurt the unions, so that would have been a good thing.

One advantage of mouthing this line is that it is easy to remember and it never changes and it sounds homey and has the ring of truthiness.

Only problem is, it is total rubbish.

We have the money.  Medicare is not,  and never has been,  and in the foreseeable future will not be in economic trouble. Social Security is not in danger of default, unless the Republicans drive it in that direction. Medicaid will not bankrupt the state of New Hampshire, especially given the federal government's generosity when it comes to this program. (Of course, Mr. Rice knows the federal government is just trying to trick us into taking part in this program so it can control us later.)

What Mr. Rice and his Republican colleagues really fear is not that Medicaid will hurt New Hampshire, but that New Hampshire will come to love Obamacare as much as it loves Medicare, and maybe, just maybe, New Hampshire voters will remember who tried to give them health insurance and who tried to stand in the way.

Remember, expanding Medicaid is not a way to help the few, but the many. The reason we worry about denying Medicaid to fellow citizens is not because we care so much about those who need Medicaid. What we really care about is if we don't insure those Medicaid eligible people, they will go to the Emergency Rooms, where they will run up the bills for all the rest of us. 

As for Mr. Rice, as an example of a specimen of this Republican species, we must always remember that Mr. Rice has (and continues) to insist that building a motorway along the abandoned railroad line between Hampton and Portsmouth would be better for the environment than building a bicycle path.  You see, Mr. Rice informs us, the new two lane road would reduce traffic along Route 1, and with fewer cars, there would be fewer cars idling their motors at traffic signals and that would reduce emissions and seacoast air would be cleaner.  So there you have it: Worried about air pollution? Build roads.  Build roads and the roads will carry fewer cars. (If you build it, they will not come. Roads are good. Roads do not simply fill up with more cars if you build them--they empty out.)

Mr. Rice is probably not, at heart, a bad sort. It is true, he voted for lowering cigarette taxes because his unfailing economic compass told him if we lower taxes we could sell more product and if we sold more product, even at a lower price, we'd make more money. When confronted with the question about why we tax cigarettes, what we hope to accomplish, he looked like a deer in the headlights. Why? To make money, of course. But do we not hope to diminish the use of cigarettes by taxing them? Are we not concerned with the health of the citizens of New Hampshire?  Well, Mr. Rice replied, what we are really going to see is all those Massachusetts residents will drive across the border for the cheap cigarettes. So, Mr. Rice was asked:  "Are we trying to export our lung cancer to Massachusetts?"

Mr. Rice replied, "Well, cigarettes are legal aren't they?"

Fellow citizens of Hampton, do we not have a single human being willing to stand in the next election against Mr. Rice?  Can we not rid our town of this vexatious priest of Republican obtuseness? 

The man, plainly put, is an embarrassment. And he represents Hampton! People up there in Concord must look at him, listen to him and say, "Do they still have lead in the drinking water in Hampton?"

Sunday, December 1, 2013

Ms. Liasson, Mr. Obama and Death by A Thousand Cuts






Mara Liasson first grabbed Mad Dog's attention during the 2008 Presidential campaign, when her pieces for NPR got Mad Dog frothing at the mouth and in risk of being taken away by the Humane Society as a rabid canine.

What she would do was subtle, but effective. A piece about Sarah Palin would have several extended clips of Ms. Palin delivering zinger after zinger, invectives against Mr. Obama and, with five seconds left, Ms. Liasson would  squeeze in, dismissively, a  terse summary of what Mr. Obama had said in response. So it would go something like this: 

  Sarah Palin clip:  "Senator Obama has insulted not just every soccer Mom in this great country of ours, but he has betrayed his own sexist attitudes about women when he snidely said you can put lipstick on a pig but it's still a pig. Well, I don't think I resemble a pig, and that's unworthy of a serious candidate for President of this great country of ours."
  Ms. Liasson:  "Mr. Obama replied Governor Palin had used the lipstick imagery first, so it was fair game."

And so on.

Over the past five years, Ms. Liasson's  antipathy toward the President has become increasingly apparent.  Now is a slow news stretch with Congress on recess,  and when dead calm strikes, reporters start interviewing each other.  Ms. Liasson was asked to comment on what the Obamacare website fiasco means for Mr. Obama's Presidency and Ms. Liasson told her NPR listeners:
1. Mr. Obama's "signature" (read that as "only") accomplishment has been the passage of the health care law.
2. The law is now moribund, owing to the catastrophic breakdown of its website.
3. Mr. Obama's Presidency will never recover from this blow.
4. He has nobody but himself to blame because this is simply a matter of incompetence. 

President Obama, one might conclude listening to Ms. Liasson, may as well pack it in.  He has been a thoroughly worthless President and he should resign in disgrace. 

During the last Presidential debates, Mr. Romney informed Jim Lehrer that as President Mr. Romney would defund public television and public radio because it is anti-American for the government to spend money on things the private sector can do. 

Apparently, National Public Radio panicked. We need to appease those conservatives, who think we are a sort of Fox News for the left.  So, we'll put forward a few really rank conservatives and then we can claim we are "balanced."

Mad Dog has no problem with that. Just call a spade a spade. 
Just say:  "And here is NPR's answer to Rush Limbaugh: Mara Liasson." 
 

Tuesday, November 26, 2013

New Hampshire Medicaid: Chris Muns and Nancy Stiles



So here's the thing about Medicaid: Most people do not want to think about it.
Most people do not want to think about prisons, either.
These are things which happen to other people and we have enough to think about when it comes to things which might happen to our own selves.

So, when Obamacare (now the Affordable Care Act) gets passed, New Hampshire gets offered a lot of dollars if it will only sign on, but Republicans in New Hampshire, particularly Republicans in the Senate, like Nancy Stiles, see treachery in these dollars, and they know those are tainted dollars, dollars likely to lead us down some dark, sinister road to perdition. These are dollars with Democratic fingerprints all over them, and they vote to refuse the money, on principle. On the principle that no money from Democrats, even if it goes to New Hampshire citizens, can be good money.

But, as Mad Dog has said, Medicaid is  not something most people in New Hampshire care about, because Medicaid is for poor people, welfare queens, people who are not willing to work, people who would accept government charity, people who are lazy and undeserving. 

Even if all that were true, there is a problem with the Republican position: When those lazy, undeserving people get sick, they do what?  They go to...you guessed it, THE EMERGENCY ROOM.  And guess who pays for their care?  The deserving, upright, hard working citizens of New Hampshire. 

It's not a direct tax bill you see on April 15th, but that does not make it any less real.

Think on that, Granite staters.

As Chris Muns said, rather forlornly, after Nancy Stiles voted with her Tea Party friends to reject federal Medicaid funds, these Republicans don't care who they hurt, or how crazy their position is, from a public policy or public health viewpoint--they only care about an ideology:  Government is bad. Democrats are bad. Democrats handing out money is doubly bad. Bad. Bad. Bad. 

The question is, do the good folk of New Hampshire really want to be led by fundamentalists?  



Saturday, November 16, 2013

Mad Dog and Marijuana



Mad Dog must admit, from the outset, he does not smoke marijuana, has never given it a fair try, has never smoked cigarettes, although he once tried and found the experience uninspiring, does not drink caffeinated drinks, cannot tolerate much alcohol, although he has tried to develop a taste for wine and beer, just cannot.

(In fact, Mad Dog married a Jack Mormon, whose entire family can regularly drink Mad Dog and all his relatives under the table.)

Having said all that, Mad Dog may not be qualified to say much about marijuana, but that will not keep him from trying.

Patrick Radden Keefe's article about Mark Kleiman and the legalization of marijuana in the state of Washington, which appears in the Nov 18 New Yorker, triggered a potent memory in Mad Dog.

Sometime in the mid 1990's Mad Dog received a notice to report to  the Rockville, Maryland Courthouse at  the Montgomery County seat for jury duty. Mad Dog's initial reaction was dread and anger: Mad Dog was in the private practice of medicine and if he were taken out of his office for a week he would have trouble meeting his payroll, his rent and his expenses, while most of the members of the jury pool would be getting a free holiday from their government and corporate offices. 

But when Mad Dog was seated for a trial the judge assured everyone this would be a one day trial and Mad Dog quickly became enthralled by the experience:  The defendant was seated at a table in the courtroom and the jurors filed in and took their places in the jury box. Mad Dog was the 13th juror, the alternate juror.

Looking around him at his fellow jurors, and then across the room at the defendant, Mad Dog could see immediately this defendant was marked as clearly "guilty" and stood next to no change of acquittal. The jurors looked much like Mad Dog, white, dressed in the wardrobe of  Ann Taylor, Brooks Brothers, Talbot's, Barney's--white bread through and through. Guido, the defendant hand been cleaned up for the occasion:  clean shaven,  dark slacks and a new, pressed shirt, but the clean up would not help Guido, whose dark, slicked back hair and Hispanic/Mediterranean features marked him as guilty, guilty, guilty.

The judge asked the jury if anyone knew of any reason he or she should not hear this case of the sale of marijuana. Mad Dog raised his hand and the judge told him to approach the bench and they turned on some white noise machine and the prosecutor and the public defender flanked Mad Dog as Mad Dog explained to the judge Mad Dog did not believe selling or using marijuana ought to be illegal.  The judge asked Mad Dog, "But if the state could prove to your satisfaction the defendant did in fact sell marijuana and that selling marijuana in Montgomery County is illegal, could you find the defendant had violated that law?"  Mad Dog had to admit, meekly, he could. That satisfied the prosecutor and Mad Dog was told to go take his seat. 

The only witness for the prosecution was a florid faced Montgomery County detective named O'Shaunessey (or something Irish) and he testified he had been sitting in his car, with a delicatessen sandwich on a waxed paper wrapper in his lap, looking through binoculars at the housing project buildings 150 yards away, across a playground and walkways. He was on a stakeout on a separate case, looking for some felon, when he saw a young man in a red tropical shirt drive up, park and start talking to Guido, who had been working with his brother, under the hood of his car. Guido reached into his pocket pulled something out and slapped the hand of the red shirted guy and Detective O'Shaunessey knew, from years of observation, he had just seen a drug deal go down, and the pass off of a packet of something illegal and the exchange, with another hand slap of cash. 

O'Shaunessey reached for his radio and rained down mayhem upon the playground and environs of this housing project,  as half a dozen Montgomery county police and detectives swarmed over the grassy knoll, guns drawn, brushing aside squalling infants, and young children, and their mothers and nannies, as they raced across the 150 yards, toward Guido, his brother and the unfortunate buyer in the Hawaiian Punch shirt. 

By the time the cops reached the scene of the crime, Guido had disappeared into his apartment building and the cops arrested his brother, who had just lifted his head from under the hood and was bewildered, thrown to the ground, arms pinned behind his back, handcuffed and told he had just sold some drugs to the tropical shirt felon.

Guido then emerged from his apartment and breathless cops realized they had arrested the wrong guy and they arrested Guido. It is not clear how long Guido's brother had his arms pinned behind him. 

Presented to the jury for their viewing pleasure and edification was the roll of cash found in Guido's pocket, the cell phone he carried. Guido had no drugs on his person. Hawaiian Punch had a packet of marijuana in his pocket.

The prosecutor held up the roll of cash and the beeper confiscated from Guido at the scene and said, "This money, this beeper, which is used by drug dealers to set up sales,  is all the evidence, taken with Detective O'Shaunessy's testimony, you need."

Now the beeper as an incriminating article struck Mad Dog as particularly bogus. Mad Dog ran an inner city clinic in Washington, D.C. and every 13 year old carried a beeper. Most of these beepers were not even operational--that would have meant a monthly bill and required a credit card. They were simply status symbols. If you had a beeper, you were cool, a player. The prosecution never even established Guido's beeper was activated. The roll of money, Guido's lawyer explained, was no crime, no indication of venality. Guido, like many project people, had no bank account, no checks and lived on a cash economy and the arrest occurred on a Tuesday afternoon, and Guido had just been paid.

Guido's public defender made one tactical error, by saying Guido had purchased the beeper because his girlfriend was pregnant and he needed to be reached when she went into labor, which suggested to the white, upper class Montgomery County jurors: A/ Guido had fathered a child out of wedlock  B/Guido did not live with the mother of his child and C/ Guido likely did not support the mother. D/ The mother was likely some 13 year old child, living with her parents, who would not allow Guido near her except for the event of the delivery, because they knew Guido was a no good scum bag, a point of view the jurors, at a glance, could readily understand.

To Mad Dog, if the story were true, it suggested at least Guido intended to do the puffing and panting with the mother of his child at the delivery.

Probably none of these assumptions was true.  But the fact all these assumptions were in play suggests an explanation why the vast preponderance of convictions for marijuana sale and possession occur among the underclass in America although the numbers of middle and upper class children and people who use the drug vastly outnumber those in the underclass who do.

After the testimony, the judge instructed the jury which rose to go deliberate in the jury room and Mad Dog prepared his impassioned argument for acquitting poor Guido,  when he heard the judge call his name and summon him to the bench. The judge said, "Those also serve who only watch and wait." And the judge dismissed Mad Dog, who would not be allowed in the jury deliberations with the 12 real jurors.

In the hallway, the prosecutor and the public defender collared Mad Dog to ask how he would have voted. Why these two were so interested escaped Mad Dog. But they were 20 somethings and they had done at least some work on the case, and it was a game to them and they wanted an early signal about who might win. 

"I'd have voted to acquit," Mad Dog told them. "The cops arrested the wrong guy initially which speaks to confusion about who actually saw what when. And no drugs were found on Guido. No packet was actually seen through the binoculars. In fact, the major risk to public safety that day was all the police with their fingers on their triggers, running around among a dozen children on the playground. If anyone should have been charged, it should have been O'Shaunessey for reckless endangerment."

The prosecutor told Mad Dog, the only other juror he had as a choice for  the 13th juror was someone who had been convicted of marijuana possession a decade earlier. So Mad Dog, even after his statement to the judge looked like a better bet. Even in that white bread county, they couldn't find 14 people who had never used or admitted to using marijuana. 
 

So Guido went down, found guilty, found guilty by a jury of his peers, convicted of selling a packet of marijuana, sent off to jail, missed the birth of his son, likely lost his job at Jiffy Lube. 

The whole concept of being tried by a jury of your peers, as Mad Dog understands it, arose in English law and was incorporated by the English colonists who wrote the American constitution. No peasant wanted to be judged by a jury of disdainful aristocrats who would not know about the status symbol value of a beeper (or its 18th century equivalent) among the peasants. But that jury of your peers thing has been perverted by the complexities of class and class resentment and disdain in America today. So the poor get tried in front of a jury of their betters and they get sent to jail more or less ruthlessly and ineluctably. 

Maybe he's moved to Washington State by now, where he would likely be arrested even today, for selling marijuana on the black market.  

As Keefe observed in the New Yorker:  "When legal marijuana goes on sale, sometime next spring, the black market will not simply vanish; over-the-counter pot will have to compete with illicit pot. To support the legal market, Kleinman argued, the state must intensify law-enforcement pressure on people who refuse to play by the new rules."

It's third season of the wire, coming to real life, where Major Howard Colvin's experimental "Hamsterdam" emerges on the streets of Washington state. As David Simon and the Wire ensemble so intricately and clearly showed, the results of drug legalization, even for the most benign drug, marijuana, will likely not be pretty and will create new problems. 

Hopefully, the new problems will be less damaging than the current problems. But watching that third season should be required viewing for legislators from New Hampshire to California.

It's all right there, in the good book called "The Wire," if anyone would actually brave up and watch it.




Wednesday, November 13, 2013

Is America More Dysfunctional Now than Ever?




With all the talk about the staggering start to Obamacare, with the crumbling of the middle class, the emergence of gridlock as a permanent state of Congress, the capacity of a few Southern states to throw a wrench into the gears of the federal government, we hear  a lot about how things are simply not working, dysfunctional and blame is assigned depending on your Republican or Democratic roots.

But, the fact is, banks are lending. Maybe to the wrong people, maybe for the wrong projects, but they are in business. Insurance companies (outside of health care insurance) are doing business and cheating their customers just as happily as they ever have. Automobiles are being made, sold, crashed, replaced. Hospitals are doing surgery, admitting patients, discharging at least some of them.

The military has found wars to fight, and although they are winding down some wars, new opportunities for dropping bombs, shooting guns, air lifting troops to war zones will inevitably present themselves. Career advancement in the military may not be as rapid or assured as it was when the armed forces were larger, but in the era of eternal war, which has persisted since WWII, things look good for the military's long term prospects.

Our infrastructure may be crumbling, but, eventually, unless the Tea Party wins more elections, the government will get around to refurbishing bridges, roads, telephone and power lines. 

Fracking may pollute under ground aquifers, but we are likely to be less hostage to Saudi sheikhs and we may be more energy independent and we may even use methane, wind and sun power better someday.

When you look at the 1860's, with open rebellion from the states which became the Tea party states, or at the 1960's, when boys were torn from the bosoms of their families, sent to Vietnam and killed, today's mercenary armies look much more benign--at least for the 98% of people who know they will never have to wear a uniform and shoot a gun in combat.

It may not be the worst of times/ best of times, but, for now our problems are mostly financial, and financial problems were worse in the 1930's.  Just about every problem we face now, was worse at some other decade in our history.

Of course, it will take only one terrorist with a nuclear bomb to undo this rosy picture, and we ought not tempt fate.

But we ought not despair. History can be a wonderful nostrum.