American Exceptionalism, Mr. Obama, Mr. Putin

Whoever wrote the op ed for Vladimir Putin appearing in today's New York Times did a masterful job and credit must go to Mr. Putin for being smart enough to sign it.

In his last paragraph he addresses what must be in the minds of many Europeans and Africans and South Americans: Americans think of themselves as special. American conservatives,  in particular, have bally hooed this idea that Americans are "exceptional" in today's world and throughout history. 

What this leads to, Mr. Putin is saying, is the idea that Americans, being exceptional, ought to follow their own star and act in exactly whatever way they see fit, because they have some special vision, not shared by mere mortals elsewhere on earth.

When Mr. Obama used that phrase during his Tuesday evening remarks, it rang out to Mad Dog, just as it did, apparently, to the Russians. "That is what makes us exceptional," must have been a slap in the face to the Russians, and the Brits. We are better and different and wiser and more clever than you, so we do exactly what we want to do.

Of course, Mr. Obama was doing the thing Democrats do--he was trying to co opt a phrase all the Fox people love, and show he is the biggest gun in town. Nobody can accuse the Democrats of being wimps, although the Republicans do, every day.

Mad Dog is not saying America should confine itself to whatever the United Nations decides, but Mad Dog agrees fully it is a dangerous think to insist you are somehow different, meaning above, all other people on the planet.

The Germans told themselves they were the Master Race. British aristocrats told themselves they were exceptional--the cream that rises to the top, naturally. Southern plantation owners thought they were meant by God to rule over the Black race and the poor white trash who did not own plantations.

Mad Dog does note, and humbly, because he has no thorough going background in world history, but, to Mad Dog's knowledge, no other country in the history of the planet has ever fought a war to free a derided, enslaved underclass, at such cost. To this date, as far as Mad Dog knows, more Americans were killed during that Civil War than in all the wars the nation has fought, combined.  

So, in that history, we are different. But that doesn't mean we are exceptional in 2013. 

We are just living here in Lake Woebegone, where all the children are above average.

Greenway From Hampton to Portsmouth

The corridor toward Portsmouth

The tracks are now gone

The pathway ends at Route 33, Portsmouth, near the graveyard

Last night Mad Dog attended a Greenway meeting withpeople who have worked on the project which would unite Hampton with Portsmouth using the now abandoned rail road bed,   which runs from Boston to Portsmouth, through Seabrook, past the nuclear power plant, past Foss manufacturing, behind Depot Square,  behind the Hampton Hannaford's and on past the old railroad station in North Hampton and on to Rye and Portsmouth.  

Most of the people there were there because they carried in their hearts the burning desire this would become the one protected corridor where kids and families could ride bikes, push strollers completely protected from cars, a safe place where only muscle power propels healthy bodies. 

Because the owner of the land, a company called "Pan Am, " has apparently decided it wants to sell this track to the state of New Hampshire, and because the state could "buy" it with little out of pocket expense, the dollars  mostly coming from Federal programs to promote "green" alternatives and from highway tolls, the prospects for the transfer of this corridor from private to state hands looks promising. 

There have been euphoric  letters to the editor in the Portsmouth Herald about how wonderful a protected space would be for families and bikers--a unique resource in a pedestrian unfriendly Seacoast,  where the car and the motorcycle are king.

But then Fred Rice, a House of Representatives Republican, began his 10 minute monologue about his vision for the former railroad bed : He would make it a one or two lane motorway, with a little bike path running alongside the road. As he has said, before, this would reduce air  pollution, because it would diminish the "congestion" on Route 1 and all those idling motors and their exhausts would vanish, and it would create a commercial corridor with stores springing up all along the roadway.

Fred Rice would pave paradise and put up a parking lot.

Fred Rice knows the best use of land on the Seacoast to to build roads, because roads are...GOOD! And roadside commerce is inevitable. 

Mad Dog objected that: 
A/ Building new roads does not diminish traffic congestion, especially if you are talking about a two lane road. Building more roads just attracts more cars and, presto, your new road is congested.

 B/ Reducing air pollution by building more motorways as opposed to providing a path for bicycles is a very strange notion. Are cars less polluting than bicycles? Does Mr. Rice have any studies for that one?  

C/What makes Mr. Rice think there is enough business to support new stores along his motorway?  Is Route 1 such a successful corridor we need more asphalt for even more stores?  Mad Dog sees enough boarded up stores along Route 1 to make him question Fred's happy picture of a booming commercial corridor along a smaller road when the big road isn't doing all that well.

Mr. Rice does not answer such questions. He simply continues talking, as if simply wishing will make it all come true.  He is a man mired in the discredited certainties of the 1950's when building roads was a pathway to prosperity. Fred Rice is still back in the 20th century, with Eisenhower, wanting to lay down as much concrete as possible across the entire country. 

The folks who want that land transferred from private to public hands grew nervous: At least Mr. Rice wanted that same goal to be achieved--the goal of transferring the land to public ownership. The planners shut down the dog fight. Let's just get the land first. We can argue about what to do with it later.

The problem is, Mr. Rice has nothing else to do but go to government committee meetings, so he would stand a pretty good chance, by simple persistence,  to push his idea of a nice new motorway between Hampton and Portsmouth through all the committees in Concord, past all the commissions--Fred Rice will attend every meeting while the rest of us are at work, and before we know it, we'll have the Fred Rice parkway to reduce air pollution through the wonders of the combustible engine.

Let us hope, if the transfer occurs, we can get Democrats from Hampton to Portsmouth, out on that trail, from which the railroad tracks have now been removed. Once people start walking it, riding their bicycles on it, the possibilities may kindle enough ardor among young families, they'll actually organize to prevent the transformation of a potential parkland into another motorway.

 

Mr. Obama, Mr. Woodrow Wilson and the Idea of a Heavenly Father

Mr. Obama has not been able to convince the Brits nor, apparently any other ally or potential opponent, to slap the despot in Damascus for using chemical weapons.

He is having a hard time, across party lines, convincing his own Congress to allow him to reign down vengeance from the skies upon the user of chemical weapons.

His argument is that if we don't draw the line here, and if we allow desperate dictators to believe they can use chemical (or nuclear) weapons with impunity, well then, those desperado's will go ahead and do it and it will be open season for the use of any sort of biological, chemical or nuclear weapon. So,  he argues, it's a matter of weakness encouraging brazen action from the miscreants--the old Chamberlain at Munich trope.

The two major reasons not to buy this:  
1. It depends on the psychology of deterrence. We are trying to get into the minds of people like Assad, or Hitler or Mussolini or even, not to use an invidious comparison, Ho Chi Minh. And the fact is, we ought to know by now, people like this, or common street murderers do not get deterred by deterrence. They always make a calculation, and decide they can do their worst and it will be more likely to benefit them than to come back to hurt them.  
2. It invokes the idea of a Heavenly father looking down from above and saying, this is bad. This is hideous. I will punish the transgressor. We must try to play that role on earth.  It is entirely consistent with the moral argument that wrong doing by human beings, violation of one human being by another, must result in punishment for the wrong doer.

The fact is, punishment for the wrong doer, whether it comes in the form of armies crushing their empire and putting their heads on stakes or in the form of a court in the Hague, occurs less frequently than the outcome of those wrong doers staying in power, unpunished and, in fact, in some cases, writing the history.

The Nazi thugs on trial at Nuremberg smugly shook their heads, crossed their arms across their chests and said, "The victors write history."  Which is to say, in their minds, if they had won, all the concentration camps and mechanized murder would have been justified as the price of imposing the world order of a thousand year Reich.

Woodrow Wilson, the minister's son, tried to preach morality to a post World War One world and he got no takers, either in Europe or at home. Of course, the world had moved on in some places--flappers danced and liquor flowed in the States and in Europe economies collapsed, and the next war with even more monstrous leaders and outcomes occurred. 

But there is no reason in history to believe if Wilson's moral universe had been voted for, the world would have been any different.

Labor Love's Lost

In retrospect, we couldn't have asked for a better Republican candidate than Mitt Romney, who, in the end really did encapsulate the Republican belief system, all rolled up into a single, every-hair-in-place emblem of the Haves.

In centuries past, when peasants saw the king ride by in his gilded carriage and asked why he should live in such opulence when their own children were in rags and underfed, the answer from the king's people was the king deserved his place and privileges because God wanted him to have all that, and the implication was God wanted your children in rags, living in hovels.  To be high born was evidence itself--if you were put in a position of such privilege God must have willed it.

Romney embodied the modern day version of this reply. Rich guys like him deserved their fortunes because they have been the "risk takers."  They won big because they bet big.  Those feckless, cowardly, indolent, no-ambition types who make up the bottom 99% deserve to be living in those overpriced, shabby houses, working two jobs because they are the "takers," not the makers.

For the rich to justify their own good fortune, they have to do two things: 1. Justify their wealth as just reward  2. Demean those losers who have not achieved the upper 1%. 

Of course, politically, it is also useful to suggest that you, Joe Sixpack, will not be in the lower 99% for long--your day is coming. You will get pie in the sky right here on earth, if you just vote Republican because you will win big and no damn government will take away your winnings.

The proof of the validity of this approach is the large numbers of white, economically struggling males who vote for Romney, Rand Paul and every other Rush Limbaugh endorsed Republican--if they are that stupid, they deserve to be stuck with the loser's share.

But  really intrigues Mad Dog is this concept of "risk taker."  Mitt Romney was born on third base. He never took the risk of stepping up to the plate. If he failed, he was not going to lose his home, his wife, see his kids shipped off to relatives.  He, like so many other self made men were born rich and yet they talk about "taking risks" and putting themselves on the line.

In fact, if you really look at the lives of those Republicans who ballyhoo the "risk taking" behavior which entitled them to reap huge rewards, there was never much risk there.

Donald Trump risked only being less rich.

Mad Dog fondly remembers the CEO of his hospital, a dyed in the wool Republican, who ranted about Democrat takers.  This guy never took risks in his  own life and accepted what the government and later what corporate employers handed him. This CEO went into the military after high school, went to college on a GI bill, worked for big corporations his entire career, always an employee, always with a paycheck, never having signed a lease for his own office, never having met a payroll from his own revenues, never having dealt with regulations or licensing which might shut down his business.  He was the classic "salary man."  And he talked about risk!

Mad Dog, having run his own business for decades, is never more amused to look at all the "risk takers" out there who don't have the faintest idea what real risk is.

Real risk is jumping out of the plane with no reserve parachute. If your plan A doesn't work, they will peel you off the pavement. 

And through all the years  of real risk, Mad Dog did not consider taking a risk a great test of character. He would very much have liked to not have to take the risks he took for his business. At the point those risks became simply more than they were worth, he sought out an employed position and became a salary man. 

There are risks in being an employee--companies change their plans and jettison employees like so much dirty dishwater--but the risks in small business still tower over the pale risks of the rich guy who starts a company and thinks himself a tough guy for working hard and risking somebody's money, not his own.

Next time you hear somebody talk about entrepreneurs, risk takers, the captains of industry, ask about what they really risk, in personal terms, if the enterprise fails. For many, the structure of the deals leaves them unscathed, at no risk for personal financial embarrassment. Losing a business, in many of these start ups is just losing at a game. 

For the wage earner who goes to work one day and is told he's out of a job, it's not the same. He doesn't know where his rent or car payment or grocery bill money will come from. He is desperate in a way the capitalist never has known. 

 

Sarin Gas, Syria, Belief, American Exceptionalism and Morality

Americans who died to free others

Jews who died when nobody cared

How do we know what happened?

Mad Dog has followed the putative Sarin gas attacks, said to be launched by the Syrian government with a sense of ambiguity to which Mad Dog is not accustomed.

Usually, Mad Dog, when in doubt, can simply ask himself not "What would Jesus do?" but "What does Rush Limbaugh, Rand Paul or Mitch McConnell say?" and then your path is clear.

In this case, Mad Dog finds himself in the position of having to puzzle out his own solution.

There seem to be two major considerations: 1. Can we believe the Syrian government used Sarin gas to kill its own people?   2. If we believe the answer is yes, what should we want the American government to do about it?  The classic two phase process of a criminal trial:  Is there reasonable doubt of the guilt? Then, if not,  what should be the penalty?

Lots of things come to mind about the question of guilt:  "The Newsroom" has just presented episodes in which the problems of establishing believable evidence were presented in bold relief. We all remember the weapons of mass destruction which never were in Iraq. In the age of images, cell phones and omnipresent video and surveillance, we have come to expect photographic evidence at the scene of every crime. When we see the photos, we believe. 

Of course, visual images may mislead, but seeing is believing, unless you are a Holocaust denier, unless you have a strong drive not to believe.

But let us say, for the moment, we believe Syria is guilty as charged. One of the key issues in most American courts is, "Do we have jurisdiction?"

Ah, that is the sticky wicket. 

Mad Dog is not sure when Hitler started gassing people in concentration camps. But let us suppose he began in 1940. Would the U.S. have had jurisdiction to intervene there?  The historical answer is no. It was only after the bombs fell at Pearl Harbor we got jurisdiction to intervene, and when we finally uncovered the bodies at all those camps throughout Germany and Poland, we loudly proclaimed: This is why we fight. We are the force of good against the forces of evil. 

But, suppose Hitler had never invaded France, never threatened England and  suppose Japan had raped Nanking,  but never dropped any bombs on us? Suppose Hitler had simply stayed home, methodically rounded up and gassed all the Jews, gypsies, dissenting Catholics and other "unwanteds"  would the United States have sat on its hands? Should the United States have stayed home and minded its own business, as many , including that great moral paragon, Charles Lindbergh, exhorted us to do?

Emotionally, Mad Dog is inclined to say, "No." 

What makes the United States different is we are the only nation on the planet which has ever tried to embody God's terrible swift sword.  (At least since the crusades--but who believes any of those were really about God?)  What other nation has fought a civil war of such savagery and completeness for the purpose of rescuing an underclass, for the purpose of saving those who could not save themselves?

Of course, there were plenty of union soldiers who had no interest in freeing slaves--maybe the majority at some point--but the animating reason for that war was to end slavery, to rescue those under the lash.  As Lincoln said, at the White House, when he was introduced to  Harriett Beecher Stowe, the author of Uncle Tom's Cabin, which provided the image of slavery imprinted in the minds of so many Northerners, "So, this is the little lady, who wrote the book, that started the great big war."  Lincoln repeated this acknowledgement in his Second Inaugural address.  Everyone knew that slavery was the cause of the war he said, we all just hoped it wouldn't come to war.

So sometimes, our sympathy for what happens to others pulls us into doing things we wished we didn't have to do.

But where does that moral imperative end?

Thousands were slaughtered in Rwanda and we did nothing. 

Why should we act in Syria?

Of course, had we not acted impetuously, without thinking enough, in Iraq and Afghanistan, we might have more energy for outrage now. 

But we have squandered our rage on countries where it had little positive effect. It's not like we captured Baghdad, instituted Reconstruction and transformed a nation. It's not like we have changed the culture in Afghanistan, not to mention Pakistan or any other stan.

Where has our outrage led us in the last hundred years?

In fact, the irony in all this is it was not moral outrage that moved us to action in embarking on the crusade of World War II. It was only after we had got into the war and won it we discovered we were such moral paragons, once we got the cameras into the concentration camps our armies had no idea were there.

Now we hear we cannot allow any nation to use lethal gas, or the restraint which kept even Germany, as it was reeling from the Russian invaders from the East and the Allies from the West, did not use.  But, in fact, the likelihood is, poison gas has not been used because it would have not been effective, not because desperate despots were afraid of the consequences of using poison gas. If gas were effective, well, the victors write the history.

So, if we attack Syria in some way because it used poison gas, deterrence is not an argument.

Moral outrage is an argument. But why are we more outraged about Syria than we were about a dozen other outrages over the past 70 years?

Maybe the mistake was saying we ought to be doing something about our outrage, other than expressing it. 

Having said all that, Mad Dog wishes his country had entered WWII because of the conviction Hitler was rounding up helpless people and gassing them in concentration camps. 

Trouble is, this country, when Hitler was foaming at the mouth, spewing invective at all the inferior races, this country had bottled up its own "colored" in ghettos, excluded them from everything from water fountains to bathrooms and even Eleanor Roosevelt, at least in her youth, thought Jews were money mad and sleazy.  We were no paragons of virtue, by 21st century standards, we were simply less horrific than Hitler and his gang.

Success in the Age of Superficialty: Colbert, Andrew Hacker, Stephen Colbert

Professor Andrew Hacker

"Why is the crushing debt [from Princeton] any better than the crushing debt from the on line colleges?"
      --Stephen Colbert to Andrew Hacker

Here is the link:
http://www.colbertnation.com/the-colbert-report-videos/351585/august-25-2010/stephen-colbert-university---andrew-hacker?xrs=share_copy

Apparently, Stephen Colbert has a smart staff--they found exactly the right man to ask that question. Hacker, the professor of government at Cornell, then Queens College, a graduate of Amherst, Princeton and Oxford has, for years, been asking what the elite universities offer in terms of success that other, less exalted colleges do not.

For years, Hacker attempted to track the lives of the graduates of Princeton, class of 1962 to see whether  they really did get their tickets punched or whether the promise of that catapult into fame and fortune fizzled.  Princeton, of course, was not cooperative. Administrators there likely saw no benefit to themselves from such an inquiry. The outcome, if positive would support a claim they could make without the inquiry, but if negative, it would not be good marketing.

Of course, Hacker pushed on any way and he found what he was looking for--graduates did no better, in terms of money, careers than graduates of Queens College. Or so he says. Princeton can challenge him on that, but certainly will not. 

Mr. Obama has proposed directing government aid only to those colleges which can demonstrate by objective criteria that the outcome of graduating from their institutions is better than not having attended college at all and hopefully, the better the outcomes the more money the colleges would get.

The problem is, what outcomes? How do you measure success? How much of a person's success in life is attributable to the education they got in college? 

 Hacker pointed out there is a clear divide in lifetime earnings between college grads and those without B.A. degrees, but that does not mean this is a result of what happened in college. Kids who go to college come from ambitious families, families with resources to help them after college, resources which may open doors to careers. Kids who go to college may be more ambitious, possibly in some ways brighter and more self motivated and with those qualities, they would have done well, with or without college. Or, the BA degree may be used by big companies as an arbitrary "qualification." Thus the welder at the GE airplane engine plant who as a BA degree from the University of New Mexico gets moved up to management over the more talented, smarter guy who has no college degree. 


It is probably a different question to ask whether a BA is worth it, versus whether or not a BA from Princeton is worth any more than a BA from Queens College. 

A graduate of Sidwell Friends School (SFS) recently observed, "In some ways the hyper competitive schools waste talent. There are outstanding people who look just average and are pretty much dismissed at Sidwell who wind up digging themselves out of a hole."

He noted that most of his friends at Columbia College of Physicians and Surgeons who had come from  Princeton, MIT or Yale were admitted off the waiting list. They had been competing for their A's in organic chemistry and only the top 10% were going to get those A's. At Bowdoin or Hopkins, they would have been in that top 10%. 

He points to his friend who was thought to be something of a failure at SFS, wound up at University of Wisconsin, from which he got into Harvard Law and launched a very impressive career at Covington and Burley in Washington, DC.

Another SFS student, who slumped off to University of Maryland, rebounded to Yale Law, and is now a master of the universe in silicon valley.

 Another, who was thought to be feckless at SFS, went off to Vanderbilt, where he slept through most classes, majored in economics and philosophy and thought neither was worth much, but he stayed up nights, learning programming and he now runs an exploding start up, Simply Measured, in Seattle.  He learned nothing of any ultimate value from his teachers at SFS (which a few exceptions), nothing of any value from his professors at Vanderbilt. They were masters of their own fields, but their own fields had nothing to offer this student. This SFS semi failure had an idea:  Billions are spent on advertising every year in this country, but how can you know if any of that advertising results in sales, or even in brand recognition?  He devised a way of using software to assess these outcomes. None of his professors would have had a clue.

The teachers at SFS were disappointed in  his graduating class, because only 4 of the 100 graduates got into Yale. Two of these four graduated #1 and#2 at Yale--one went to Google Inc the other to a PhD in biology.  They look like successes. But what of those other students, who disappointed the SFS faculty--the lawyer in Silicon Valley, the Washington lawyer, the Seattle entrepreneur?  It might be argued the kids who went off to Yale were so obviously bright, they didn't need the SFS faculty--the other kids, not as obviously bright were failed by the school.

Or maybe the experience of failure at SFS put fire in their bellies--they had more to prove.

Mad Dog thinks of his own brother, who did not get into Yale. His best friend did. They graduated from the hyper competitive Bethesda Chevy Chase High School and the Yalie majored in physics, started his physics career,  hated it, and wound up running a lawn mowing service in Florida. The brother, who had to "settle" for Cornell, went on to medical school, became chairman of an academic department at Duke School of Medicine, and by all measures had a stellar, productive career. 

Mad Dog's senior prom date could not get into Wellsley  or Smith or Mount Holyoke, and had to go off to Carnegie Tech,( before it became Carnegie Mellon.) Mad Dog  knew, from years of conversations and classes with her, she was one of the brightest people he had ever met. But the teachers at the hyper competitive Walt Whitman High School (Bethesda) missed that. They also missed her burning ambition and likely that rejection spurred her on--she excelled at Carnegie, transferred to Barnard, went to Columbia Law, became chief counsel for a major film studio, then for a financial Goliath,  and in terms of sheer dollars accumulated, she is worth more than all the graduates of Ivy League schools from her Walt Whitman class combined. 

So what do all these stories mean?  

Today, the fashionable question is: "Sum it up in six words."  (Where did they get the number six?" ) If you can't tweet it in 140 characters, forget it. We are not listening.

What is means to Mad Dog is that our processes for evaluating "Human Resources" are very flawed.  In fact, one might argue, what the faculty at SFS, B-CC High and Walt Whitman, not to mention Princeton and Yale can identify are the people who will be excellent worker bees, supporting the really successful people who were dismissed as irrelevant, for whom the worker bees will be working.

Of course, there are other stories, the meaning of which is not yet clear to the Mad Dog's son, clearly the most academically talented member of his clan, looked around at his classmates at Walt Whitman and declared he was not going to go to a "snob school" for college. He went off to NYU, the Gallatin School within that NYU, where he was allowed to create his own major. ( People there created majors like "Chemistry and Dance" and it was never clear to Mad Dog what exactly his son majored in. He seemed to take a lot of music theory.)  He was required to read a list of "great books," or a central canon, and walking down the street in discussion, he listened so some remark the Phantom made, and he said, "Oh, well, that's just Freud."  Mad Dog had never read Freud, but the son explained the point Mad Dog had made was well elaborated in Civilization and It's Discontents. So, NYU had exposed this student to something. He graduated, worked for a Nielsen company, took piano lessons, quit his job, makes a living today teaching piano in New York City.

Whenever Mad Dog expresses concern for his son's long term financial prospects, his wife reminds him--Well, he could have gone to Stanford.  That is an allusion to his son's good friend from Whitman, who worked hard, got into Stanford where he  realized he would have to grind away another 4 years of his life doing work he hated or, at best, found irrelevant. So he dropped out, considered himself a failure, died of a heroin overdose at age 28. 

What can one conclude from all these life stories?  Mad Dog does not know.

Maybe George Packer (The Unwinding) is right to suggest there is something rotten at the core of a society which doesn't know what good is.

Leaning Forward, Rooted in the Past

As we get older, we become acutely sensitive to sounding like the old gomers we remember from our own youth, men and women who complained about how things had changed, and not for the better, how old values have been forsaken, and how the world is deteriorating.  
When we were young, we suppressed smiles at these remarks, thinking, oh, these old timers, complaining about progress.

Now, of course, we have a basis for comparison of old values of our own to the  new values and one can understand some of the old timer's dismay.

From the point of view of Mad Dog, much of this has to do with a change in the value of service toward a value of financially hard nosed reality.  In the case of doctors, one can talk about the value of putting the patient first, but if you do not put yourself first as the doctor, you will not survive to help any patient, say the new "thought leaders" who direct medical care delivery systems.

It's the same idea you hear when the flight attendant is giving the talk about what to do when the yellow oxygen masks drop down from the airplane ceiling--"If you are traveling with a child, put your mask on first and breathe before applying the child's mask." What she is saying is, you are not going to be able to help the child if you are unconscious from lack of oxygen. In the same way, if you do not ensure your own practice is on a strong financial footing, you cannot help your patients.

But in the case of the medical systems now being developed, Mad Dog thinks what he is seeing is the physician has the yellow mask clamped to his own face and is not inclined at all to think about putting the mask on that child, except as an after thought. 

Thus, the patient is kept in the waiting room and not allowed to go back to the exam room to see the doctor until all the paperwork is done, all the forms in place lest there be a chance the doctor's office will not be reimbursed fully.

There is the gastroenterologist whose secretary makes sure she collects the full $1,500 payment, cash, before she allows the patient to cross the threshold to the rear office for his colonoscopy.

There is the pharmacist who will not hand over the insulin, unless all the paper work is in order for payment, even it means the patient will have to go without it.

The patient in the emergency room is protected against the pay me first imperative because that is such a dramatic example--how can you let the man bleed out because he doesn't have his insurance card?

But there are much more pervasive and destructive forms of this sort of mentality--this is a business; we are not here to be heroes or saints or pillars of the community. We are in business and that is that.

So the new graduate doctor will take your phone call over the weekend, if you dial through the special line which will charge your phone bill $25 for the call, a fee send along to the doctor. It is the new airline model of medical care.  You pay for each blanket, each bag of peanuts, every time you go to the bathroom at the end of the airplane.  The basic service is transportation. Toilets cost money, and you pay for that.  Look over your hospital bill and see if that $5 aspirin and that $25 gauze pad don't look a lot like the $2 charge for using the bathroom on the airplane. 

At some point, the attention to the money end of medicine gets in the way of the relationship. 

Hemingway remarked how much easier dealing with people was in France, where everything was on a monetary basis, compared to Spain, where ideals of love and respect and duty got in the way of the simplest transaction. In France, he said, he tips a waiter well, and the next time he goes the restaurant, he gets a better table and prompt service.  In Spain, he could not even get a good hotel room for the bull fight weekend without establishing his bone fides as a true bull fight aficionado with the inn keeper. 

So, the idea of getting to know a patient, the idea of going to bat for a patient, for clearing the way for a patient through the medical maze may be ridiculously sentimental and may have no place in the modern, efficient mode of medical practice.

Oh, well, Mad Dog grows older and the world colder.