Alexandria Goddard, Ariel Levy, Stuebenville Ohio

Alexandria "Brockovich" Goddard

This week's New Yorker has an article about the real America, the heartland, where 17 year old high school football players are knights and the adults are still mired in their own memories of high school, because as Alexandria Goddard, a local blogger who rode to fame on the back of an alledged rape has said, "Grown men. Twenty years out of high school and they're still reliving it. They can't get over that their lives suck."

Ms. Goddard has more piquant observations, but her main interest appears less social commentary than trying to dredge up a career as the Erin Brockovich of Steubenville, which is a phrase her new "agent" used to hype her new book about the rape which she hopes to monetize. She says "We do have a rape culture and violence against women."  Well, that sells. 

Ariel Levy, who writes about the Ms. Goddard, allowing Ms. Goddard to do all the damage which needs to be done to Ms. Goddard does buy the rape culture bit. "Worldwide , women between fifteen and four-four are more likely to be injured or die from male violence than from traffice accidents, cancer, malaria and the effects of war combined. This sustained brutality would be impossible without a culture which enables it; a value system in which women are currency and sex is something that men get--or take--from them."

Well, Mad Dog was with her, for a while, until the malaria got thrown in there. First of all, even without the malaria, Mad Dog's law of large numbers holds that once you get to really big numbers, like millions, you are almost always quoting studies which are wrong and you no longer know what you are talking about. You are saying this is a really big problem because I want it to be because I'm talking about it. 

The thing about malaria: It kills more peopel world wide than any other disease. That's a big number and likely has some meaning, even though death certificate data is almost completely unreliable and where malaria is killing people they don't even do death certificates.

But Mad Dog digresses. 

What interests Mad Dog is the whole problem of young women who get drunk and the young men who see their drunkeness as an opportunity.

Before everyone carried a smart phone, the young men tended to simply sneak off to a quiet room with the drunk girl/woman, but the smart phone has introduced a new dimension to this age old event: Now the young men are not content, in some cases, to avail themselves of a willing, if incompetent, partner, they film the event and brag about it. 

Oh, America! 

When George W. Bush confronted those nasty pictures from Abu Ghraib prison and he said, "This is not who we are," he, apparently, could not have been more wrong. This was exactly who we were and still are.

In the case of the prisoners, of course, there was no complicity. 
In the cases of the girl from West Virginia who may or may not have been raped in Steubenville, there was a problem of complicity--in that she reportedly was determined to get drunk and to  "go with" her accused attacker. 

Then there is also the crowd, the modern day Greek chorus, showing up in masks with signs outside courtrooms, posting photos of the accused males on line with a listing of their class schedules so others can show up outside classroom and chant "rapist." Thirteen hundred people "from across the country" showed up for a rally at the Jefferson County Courthouse, holding signs "Rape Is Not A Sport." Do these people not have jobs? What are they doing in Steubenville, Ohio? 

But then there is Goddard, who got to appear on "Dr. Phil"  and now describes herself as a "catalyst for change. I cause change." She describes the prosecutor in the case as "gravy legs" because "gravy spreads easily." That sort of came out of nowhere, except to say people often accuse others of what they see in themselves.  Ms. Goddard has moved to the Mojave Desert where she has a new boyfriend, a Marine Corps drill sergeant. She likes soldiers, cops and football players. "I got a little boyfriend and he's dark and delicious and twenty-six."

So, where was Mad Dog? He keeps getting distracted. Drunk girls. Football players who video and post themselves having sex, adults who never get past high school, psychologically, and Alexandria Goddard, who rockets to fame and gets herself an agent by blogging about it all.

Is this a fantastic country, or what?

At least it's not New Hampshire.



 

Kill Obamacare! Republicans with Pitchforks and Torches

Paul Krugman, writing in the New York Times yesterday, observed, with some amusement, the frantic efforts of the Republicans in the House to scuttle, amend, kill by a thousand cuts, Obamacare.

In the end, he concluded what is going on is more than simple pique, but a sort of panic.  Panic, that Obamacare may just yet work. It may, eventually, be as popular as the same program is in Massachusetts, as popular as Medicare and Social Security, the two other Democratic programs which people love and which the Republicans hate and have been trying to kill under the guise of saving them year after year.

Watching, "Prime Minister's Questions," the British version of CNN where the Prime Minister must answer questions from the opposition and from his own party in open, unrehearsed session, Mad Dog has long been struck by how many of the questions pertain to the operation of the National Health Care system. It is clear that once health care becomes a government program, a great deal of what government officials do gets devoted to health care.

Obamacare is not a single payor system, not government health care and Congressmen need not fear that they will be answering constitutents questions the way their British counterparts have to do.  But that might be part of the the reason for the hysteria on the part of Repbulicans:  Suppose, some day, we actually have to do something for the people who elected us! There would be no time for hob nobbing with the rich people, the Koch brothers, if we have to investigate why the clinic promised for our districts has been delayed or is looking threadbare.

President Obama got all he could out the the Congress he had when it came to Obamacare. But what he did is nothing close to what Medicare became. It simply corrected some of the most egregious violations of humankind by our current system:  It forbids excluding people because they are or might someday need medical care.  It may well reduce health insurance premiums.  But American medicine will remain a business, not a program.

The best we can hope for is, if the Republicans come to power in 2014 winning the Senate, and they repeal Obamacare, what will rise, eventually, to replace it, will be Medicare from cradle to grave.

Living Wage: The Concept

Any discussion of the "living wage" is fraught with emotional response. 

Mad dog has to admit his own bias here: His grandfather was a member of the International Ladies Garment Workers Union and fought for better wages and working conditions as a basic human right.

On the other hand, Mad Dog once ran a small business with two employees and his margin was very tight and salaries which got out of hand could easily have sunk that ship; salaries constituted  the highest cost of running that business. 

To Mad Dog's mind there is a significant difference between the Mom and Pop store which hires one or two employees and which operates on a tight margin and is vulnerable to a variety of market vicissitudes and a corporation like McDonald's, Walmart or Wendy's, which generates large numbers in terms of gross revenues and the main question becomes: Who has a right to divide up the distribution of these large incomes, and to what end?

Most of the arguments Mad Dog has seen in support the living wage strike him as irrelevant and immaterial: They center on the hardships low wages cause workers; they seek to evoke sympathy for workers in low skill jobs who have difficulty supporting families on low wages, which is not to say we ought not care about these people but we are still trying to focus on who is responsible for improving their lot--an employer or the government?

No, the issue which seems relevant  to Mad Dog is the question of what share of the reward for business done ought to belong to the employee? One side argues that the employer should seek to maximize the company's profit and to do this he needs to reduce his overhead ruthlessly, and wages paid are a substantial part of overhead. It is not the business owner's responsibility to be sure employees have a happy life--it is only his responsibility to be sure the company thrives. 

One may argue that happy employees ultimately benefit the company, so it is better for the bosses to pay more, but in the case of fast food restaurants, that assertion may well have been disproved over time and over many types of fast food franchise operations.  And, in any case, that's up to the bosses to discern.

The more relevant argument would be: If there is a "pie" of gross revenues, in any business, that pie would be impossible without labor. The worker sells his services to the employer, just as the meat supplier sells his raw material to the restaurant and the employee ought to be in a position to bargain for his services, just as the meat supplier is in a position to bargain for the price of his meat.  But under educated workers are typically in no position to bargain.  

The solution seems apparent: No living wage legislation is necessary as long as laws ensure the potential work force has the position to bargain, i.e., as long as unions are fostered by public policy.  

Laws ensure the local government gets its cut of the company's revenues, and laws ensure the federal government gets its cut. And the real estate people get their cut. And the accountants and the lawyers. Lots of people line up to get their cut, which the business owner understands is simply part of doing business.

But when it comes to his employees, the owners often seem to feel these are burdensome evil doers who are out to bankrupt him.

The corporations may argue that  increasing wages  will mean a loss of profits, but this simply means the distribution of monies will be shifted away from stockholders and toward employees, and there ought to be nothing immoral about that.

In fact, there may be social benefit to the shift of money from stock investors to workers. Mad Dog can imagine many benefits.

All the arguments from the bosses's side: Workers don't have to work for us, nobody is forcing them to work for us, if they don't like working in a city with low minimum wage, let them move out of town, etc, etc would be answered by a strong union. The union can say to the owners of businesses:  You don't have to hire any employees. That is your choice, but if you want to hire greeters for your store or if you want employees to flip hamburgers, well, then you have to deal with us. We'll make sure the employees get their cut of the gross income. Your net profit will be smaller, but try running a company without employees.

The Age of Superficiality

C.P. Snow wrote with insight about the different worlds, the different cultures of science and the humanities.  As his country, Great Britain, embarked upon a government run health service, this great divide was faced directly by the United Kingdom,  and the Brits continue to struggle with it.

The Brits, of course, have a fundamentally different class structure from ours, and that has directly affected the work force which delivers health care in the U.K.. Physicians as public employees can do well, if they are among the elite specialists, but they do not, in general, make as much money as their American counterparts; nor do they expect to. British high school students go directly into medical school at age 18 and they graduate with a MB, (Bachelors in Medicine.)  The vast majority go into primary care, and function on a level somewhere between our primary care physicians and our new class of practitioners non-physician providers of primary care. 

For the Brits, most doctors are decidedly middle class, and do not expect to be living in the biggest houses, taking luxurious vacations or driving expensive cars. They know this going in, and so  people who seek an upscale life do not go into medicine. Entering the medical profession in England is not a way toward social or economic upward mobility.

This is now occurring among primary care practitioners in the United States. There are new groups of people who have not gone to medical school who are setting up independent practices or joining practices with physicians who have not gone to medical school or done residencies. They can write prescriptions and do in office surgeries, but they have less training than doctors and they know they cannot charge as much as doctors. "Advanced Practice Registered Nurses" (who have gone to nursing school, then another 2 years in a training program) or "Physicians' Assistants" who have typically gone to college and then a 2 year program after college are two of the most numerous types of "practitioners" without doctor of medicine degrees.

The emergence of these different levels of practitioners-- nurse practitioners, certified diabetes educators, physician's assistants, certified nurse midwives-- came from many different places, but surely one interest group which gave rise to all this was the  university/medical school,  seeing another way to make money, minting new diploma holders.  They, of course, loudly proclaimed they were minting these diplomas for the most commendable reasons:  more practitioners were needed to meet an urgent need in the health care system: waiting times for appointments with doctors could be reduced if there were more providers of medical care. Increase the number of bodies in exam rooms available to see patients,  and waiting times would diminish.

And there was another benefit touted by the alternative practitioner model: since these practitioners were paid less, it would cost the system less. 
If less serious, simpler illnesses could be seen by the "barefoot doctor" equivalent, i.e., by people who trained fewer years and could be employed at a lower cost or could enter into private practice, but they would be reimbursed by insurance at  a lower scale, thus lowering overall costs of medical care in this country which spends more on medical care than any other without seeing a commensurate elevated level in the quality of that care.

The problem is, in our wild and wooly medical care "system" nobody has ever really bothered to critically evaluate  that hypothesis: Lower paid practitioners seeing patients will lower the overall cost of medicine.

What Mad Dog has seen from his worm's eye view is no such thing is happening. In fact, in medicine, more practitioners has always meant more referrals and more consultations and the patient who would have seen one doctor for a complaint now sees three.  In fact, lower cost practitioners may order more tests, may order expensive tests which are unnecessary . They often function as traffic cops, seeing large number of patients every day, and doing triage--the patient goes out with a referral to the cardiologist for his chest pain, the endocrinologist for his high blood sugar, the rheumatologist for his joint pain and the orthopedic surgeon for his knee pain.  It is possible these triage people actually add costs by charging for their match making services and then sending patients along to more expensive specialists at a greater rate than the physician who takes care of more problems in his office at the first visit.

In fact, consultants will say, behind closed doors, the number of inappropriate referrals they get from the barefoot doctors is much higher than they ever got before such a class of practitioner existed. Patients arrive with the wrong preliminary tests ordered, having had expensive tests done which did nothing to answer the real questions central to the solution of their cases. 

Alexandre Yersin

All the fuss about Obamacare, about electronic medical records, may well be much to do about nothing.  As long as the primary driving force of medical care remains commerce, the profit motive, everything else is nibbling around the edges. Each new group of practitioners will struggle with the same demands of costs, profits, overhead, cash flow and the needs of the patient will always remain secondary.

When Alexandre Yersin went to Hong Kong in 1898 to investigate the cause of the outbreak of plague, he established his lab in a bamboo hut . He collected samples as he was trained to do by Louis Pasteur. He had to work in a bamboo hut because the British, who ruled Hong Kong, had invited a famous Japanese scientist and his huge retinue and they installed this great man in a hotel and set him up in the largest hospital to do his work. He had the "big name." He was the man all the people in the British hierarchy knew. He was the man people in power listened to.
And he missed the organism cold. 
Yersin, working humbly in his hut,  knew the science, and he got the right bug, made the diagnosis, and he actually raised the first vaccine, the first effective treatment for the Black Death,  which once wiped out half the population of Europe and still lived among rats in the Orient, to emerge every few hundred years to wipe out a few cities.

The implacable thing about medicine is:  There is a correct diagnosis and there are incorrect diagnoses.  

So far, it appears to Mad Dog, the Atul Gawandes and the big names in  the world of health care delivery and health care systems have simply missed the diagnosis, when it comes to what ails the American medical delivery non system we all live with today.
Dr. Gawande, a very well meaning man, a MacArthur fellow and a surgeon at one of the Harvard hospitals, writes in the New Yorker and he is widely read by people outside of the world of medicine. Francis Collins, who heads an institute at the National Institutes of Health, but who has no idea what the practice of medicine in the trenches is all about,  says Gawande is one of his favorite authorities. President Obama reads his articles and he was thrilled by Gawande's article about two hospitals in Texas, one wasteful of resources, one efficient and lean. All we had to do was to follow Dr. Gawande's advice, and the whole health care system  could save billions. 

Sad to say, he, like the Japanese star,  chasing plague in Hong Kong, was chasing the wrong bug.

But how do you get the people who do not know the world of science,  who have the power of the purse, to know which scientist to believe?

Somehow, the United States government managed to figure out which scientists could build an atomic bomb before the Germans could.  After being outclassed by German engineers the entire war, the United States managed to gather a group of Italian, German ex-pats and  American scientists,  and they got it right.  The Japanese built a fighter air plane, the Zero, which was vastly superior to any American fighter. But the Japanese economy was only 1/20 as large as the American economy and the Americans could build 20 times as many airplanes.  America has been able to muddle through to the right answers, or at least to answers which worked well enough. 

But in the case of designing a system for health care delivery, we have not succeeded. It is easier to destroy than to create. We have been great at blowing up cities and destroying but not so good at creating life saving systems.

Part of this failure can be laid at the door of politicians who think of health care,  or resisting changes to health care,  as a vehicle for re election. Part of it can be laid at the door of well meaning people, who just cannot fathom what goes on behind the exam room door. 

The people in positions of power can persist in getting it wrong but saying it's all right.  Until that changes, we are pretty much stuck with the wrong bug.

 

Congress: Structural Defects

When discussing why the Republicans in the House of Representatives feel they can vote against a law granting a path to citizenship for the children of illegal aliens, children who, through no fault of their own, wound up growing up illegal in America, the analysts on National Public Radio noted that 75% of these Republicans come from districts which are so conservative and white that they are actually representing the will of their constituents, or at least in no danger if they vote against this bill.

Of course, as the demographics of the country change, voting against bills which are ardently supported by Hispanics or Blacks i.e., non whites, can, in a national election hurt Republicans, but all politics is local for Republicans. And how can this be? If the demographics of the country are shifting toward non white, how can the Republicans keep their death grip on the House?

This is a phenomenon which has to do with the details, and apparently the details play out this way: In a state like North Carolina, if you had a long, slender corridor which has a dense Black population, you can make that one Congressional district, so all the Black votes elect only one Representative, whereas, if these voters were not packed together, they would be voting in 3 different districts and their numbers would be sufficient to elect three Representatives to the House. 

Packing in North Carolina 

Or, in the case of Ohio, if you have a dense population of liberals living in a city, who could elect a liberal Representative, you can split these voters off and group a third of these voters in each of three surrounding conservative suburbs, so their votes are diluted and no liberal Representatives are elected.

Cracking in Columbus Ohio 

[NB: Illustrations are from Wikipedia]

So now we have not only the best Congress money can buy, but the most Republican Congress the Gerrymander can produce.

As a result, we can elect President Obama, but he is faced with a Congress which can block every action he recommends.  We have a Congress which believes in austerity budgets, which froths at the mouth about the fictitious bogeyman of "budget deficits" and balancing the budget , a Tea Party House which digs in its heels, determined to block every attempt at governing. We have a Republican Congress which is committed to anarchy and the Tea Party Way.

And this process is aided and abetted by a Supreme Court which, as a political legacy of 8 years of President Bush, will continue to support the Tea Party for the next 20 years.

We have no easy way to fix any of this, but one thing is sure: If even the good guys, like Senator Jeanne Shaheen cannot be persuaded to vote to change the Supreme Court, then we are truly lost.  The Democrats have looked into the eyes of the beast, across the aisle and they decided that the soft answer turneth away wrath. They have decided the worst thing they can do is to look confrontational, combative, unpleasant. They are confronted with a tiger and they pull from the scabbard at their side a large, white feather.

Knowing More About the Sea Monster

The best scene from "Downton Abbey" occurred around the dinner table, when Matthew, the lawyer (a decidedly not upper class occupation), in white tie, spars with the very upper class woman who meets her match in him:

MARY: I've been studying the story of Andromeda; do you know it?

MATTHEW: (suspiciously) Why?

MARY: Her father was King Cepheus, whose country was being ravaged by storms. And, in the end, he decided the only way to appease the gods was to sacrifice his eldest daughter to a hideous sea monster. So they chained her, naked, to a rock--

DOWAGER COUNTESS: (nervously laughs) Really! Mary! We'll all need our smelling salts in a minute!

MATTHEW: But the sea monster didn't get her, did he?

MARY: No. Just when it seemed he was the only solution to her father's problems, she was rescued.

MATTHEW: By Perseus.

MARY: That's right. Perseus. Son of a god. Rather more fitting, wouldn't you say?

MATTHEW: That depends. I'd have to know more about the princess and the sea monster in question.


Of course, this scene is the fantasy of any number of nerds who dream of winning the heart of a most attractive woman in the room by cleverness, but beyond that, there is an important point. Before rendering judgment, we need to know more.

There is, of course, always the question of whether or not we can ever know enough to render judgment on anyone.  In The Stranger, the protagonist finds himself a spectator at his own trial, fascinated by the portrait of this cold blooded killer, who has been motivated by racial animus in shooting dead an Arab youth on the beach. 

"It is always interesting, even in the prisoner's dock, to hear oneself being talked about. And certainly in the speeches of my lawyer and the prosecuting counsel a great deal was said about me; more, in fact about me personally than about my crime. I must admit that hearing oneself talked about loses its interest very soon. The Prosecutor's speech, especially, began to bore me...The only things that really caught my attention were occasional phrases...I noticed he laid stress on my 'intelligence.' It puzzled me rather why what would count as a good point in an ordinary person should be used against an accused man."

Mad Dog's father once commented, rather blandly, as if he was saying something obvious, "It is impossible to know another man's motivation." This was in the setting of a family court trial between Mad Dog and his brother in which Mad Dog described the actions of a third party, the circumstances surrounding it and the action, as if there were only one possible conclusion which could be drawn about this man's motivation.

Now we have the Tsarnaev Rolling Stone cover, which advertises an article putatively explaining or at least exploring, how a nice boy could help blow up innocent children. There is the Something About Kevin novel which explores the sense of detachment, the utter lack of sympathy for other people which allows a youth to shoot down defenseless classmates. 

This discussion--how human beings can be so remorseless as they slaughter others--comes up after every playground shooting, after random acts of terrorism.

But, this aspect of acting without pity, which seems to so confound the imagination strikes Mad Dog as something quite commonplace.  Look at the children at the Stratham fair who have raised their prize hogs and sheep, who they will hand over to be slaughtered soon enough.  Captain Spear tells Private Blythe, in "Band of Brothers," he has to learn to kill "without pity, without remorse. All war depends on it." The soldiers in "Full Metal Jacket" pose with the body of a Viet Cong soldier they have killed, grinning into the camera. They revel in describing themselves as a "lean, green, killing machine."  In war, this lack of sympathy, this joy in killing and in seeing yourself as an agent of death--I am become death--has obvious adaptive value. But in comfortable, peaceful American life, we think of people as "monsters" and "soul-less" for their absence of contrition.

George Zimmerman is either a racist thug or an innocent, if somewhat deficient police wannabe, depending on which fantasy you buy coming from the lawyers on the defense or the prosecution. Both lawyers are spinning a tale. Likely, neither lawyer's story has much to do with the much more complicated person who pulled the trigger killing young Mr. Martin.

We cannot know another man, so we spin simplified fairy tales about him--we depersonalized him as much as he depersonalized his victim, because we have to do that in order to act. 

There is a story in the photograph of the kids in a Detroit alley. We conjure one up, but we deceived ourselves if we think we have a real understanding of what that image means.  We conjure up a story which makes us feel better inside. That is what we do when we judge a defendant.

We want Tsarnaev to "show remorse." We want him to perform for us, like a trained seal, so we can feel better. 

Of course, our society is based on killing--we slaughter animals who have never harmed us every day and eat them at McDonald's.  We pay other people's sons and daughters to train to be killers--in the armed forces--and we shrug off the use of drones to kill people antiseptically and without trial. 

Some people believe we kill human beings when we scrape out an eight week bundle of cells from a uterus and they find that intolerable, but they have no problem voting to hang a man who has been voted guilty, correctly or not, by a jury.

At cancer hospitals, where patients die in substantial numbers every day, the nurses wrapping a body in a room will chat about what they want for order out lunch, where they are going for beer after work. The death of a human being is commonplace, part of the natural order of things. 

We always have to know more about the monster, but we are okay with acting in the absence of knowledge. 

The fact is, for an orderly society we dehumanize people and we opt to know less about them, all the time.  Why do we have SAT exams? Because we have large numbers of people to judge and we need an automated way to do that.  Even in the Bible, a king has to select a certain number of men to leave behind so he says he'll take the men who are kneeling by the river, bringing water to their mouths, but the others, who are lying prone, drinking directly from the water, are left behind.

We set up rules and systems to deal dispassionately with other people. 
The important thing is we not allow ourselves to judge ourselves better for it.
 


 

American Bankers Protect Their Bonuses: The Economy Be Damned

Writing in the New York Times, Gretchen Morgenson tells us a seamy tale about American bankers who are rolling out the big bucks to hire lobbyists to flood the offices of Congress to slit the throat of fledgling legislation in the nest, legislation which has been proposed by the Federal Reserve Board and the Office of the Comptroller of the Currency. 

What the legislation is aimed at accomplishing is to make the banks hold more money in reserve, for a cloudy day, so when their bad loans and mortgages and schemes come back to bite them, they won't have to turn to the government for another bail out, especially if the are the too-big-to-fail variety of bank, which can take the whole economy down with it.

Of course, the banks should and sometimes do require collateral and big bank accounts from people who they lend money to--they want to be sure the borrower has enough in reserve, so if they fail, the bank can get its share. But when the government says, you have to have enough reserve, so when you fail we are not left holding the bag, well that is just foul play!

"The design of the new capital requirement would be much harder for bankers to game. They did just that with other types of capital rules, such as those issued under the Basel regimen, the international system devised by regulators and central bankers," Morgenson says.

The reason the bankers are so alarmed about the government's new idea is it would affect the bonuses due the CEO's by affecting the calculation of of "return on equity" which boards of directors typically use to calculate bonuses. 

The mouthpiece for the bankers is none other than Tim Pawlenty, fresh off the stage of Republican presidential candidates, who says--what do you think he would say: this proposal "would make it harder for banks to lend and keep the economic recovery going." As bankers, we are only thinking about you. 

Jeremiah Norton, of the FDIC says, "It should not have been as difficult as it has been for the agencies to come together on today's leverage-ratio proposal, which hardly seems like a seismic shift in capital requirements and represents an attempt to address one of the core causes of the financial crisis."

Remember the financial crisis?  The bankers and the Republicans hope you do not. They are pretty safe in hoping citizens have short memories. What crisis? What bankers? What mortgage backed securities. What, me worry?