Of Tobacco, Sin Taxes and CVS

Yesterday's New York Times  carried a story about CVS stores deciding to not carry tobacco products in a significant number of their stores and, in fact, charging a surcharge to customers who opted to stop in CVS stores which do continue to carry tobacco.  This is because CVS is evolving from a drug store to a provider of health care (via it's nurse practioners, Doc-in-a-Box) stop in clinics for sore throats, blood pressure monitoring etc. CVS is now a big player in mail order pharmaceuticals, through which insurance plans reduce costs by contracting with a big player who can negotiate with pharmaceutical companies. 

So this company, which had humble beginnings in Lowell, Mass and then acquired a group of drug stores in suburban Washington, DC, has continued to merge and grow and gobble up health related corporations and is now a conglomerate of health related companies. No doubt it will soon be offering health insurance. 

The interesting thing is how it's corporate strategy, as a health care provider drove it to do something which could actually lose it money in the short run--refuse to sell tobacco products. But even that was a financial calculation. In the 1960's or even 1980's around 40% of Americans smoked; now it's down to 18%, so throwing aside a dwindling market in hopes of looking good to a bigger demographic makes dollar sense. 

In "West Wing" something similar in a political calculus was portrayed: Josh, the President's assistant, lets loose a torrent of invective against some balky Congressmen who are refusing to vote out of committee  funds for a lawsuit against tobacco companies. He gives a very Aaron Sorkin speech about all the kids who will start smoking and all the people who will die from smoking, trying to shame the Congressmen, some of whom are Democrats, into funding the Justice Department's suit.  Some of them object, on principle:  How can you sue the tobacco companies for trying to deceive the public about the dangers of smoking when you'd have to be deaf, dumb and blind not to know about the dangers and every package carries a warning from the Surgeon General? 

It is curious watching this, knowing how that actually played out: The tobacco companies wound up having to fund lots of programs, had to pay for some of the healthcare problems attributed to smoking, so, in the end, the companies had to accept a share of the responsibility for making a product which injures people.  Not that the companies were alone in the blame, but they were part of it and they had to pay a share. So Josh was wrong but he was also right, as judged by the outcomes.

Later, Josh realizes that politically, he made a mistake by getting the Congressmen to vote out the money--it wound up giving them cover for their upcoming elections. Some of the Republicans proved to be vulnerable because their constituencies had changed to an anti smoking sentiment and their resistance to suing the tobacco companies might have cost them the election as "nicotine pushers."  In the end, Josh had saved Republicans in key swing states by making them do the "right" thing.

Which reminded me of that visit Fred Rice made to the Hampton Democrats where he defended lowering the tax on cigarettes in New Hampshire. "We'll make less per package, but people from Massachusetts will come across the border for cheaper cigarettes, so we'll wind up making a lot more. Fewer cents per package, but a lot more packages. Lower profit margin but way higher volume."

"So, what you are proposing," someone asked him. "Is to export lung cancer to Massachusetts?"

"Well," Fred Rice said with palms held upward. "Cigarettes are legal."

That made sense to Fred. If they are legal then profiting from taxing a legal product is nothing to be ashamed of.

"The thing is," his interlocutor persisted, "We tax some things to drive behavior, to reduce their use, to motivate people to avoid expensive, destructive habits."

"They are legal," Fred repeated. 

And that is all that matters, where money is concerned, as far as Fred Rice could see.

Of course profiting from something legal may not be enough of a cover in politics.
The question is: is that still all that matters in commerce?

New Hampshire Summer

Looking out my study window, I see my neighbor and her daughter kneeling in their vegetable garden: leafy things, lettuce, spinach seem to be doing well, but the tomatoes are not yet there. 
This morning, my baseball game ran from 9 til noon and I drank three quarts of Gatorade. It was hot enough I did not need to pee after three quarts, which meant, over the course of the game, I was three quarts down.
After the game, I took my bicycle down along Route 1 A, which hugs the sea coast. I had ridden this road hundreds of times, but had never taken the "Beach Access" streets in Rye until today.  This provided something of a shock. 

It was low tide at 3 PM and the side streets crossing 1A were jammed with cars and the owners and passengers of all those cars were on the sandy expanse on the other side of the cottages which line the road and block the view of the ocean and beaches.  From Hampton through North Hampton through Rye, beaches were packed, but you could never tell it from the road. New Hampshire is unusual this way.  You would never know how much humanity is flocking to that surf, traveling the coastal road. 

There are berms and sea walls and even a walled off Beach Club, and coves, lots of coves, where bathers pick their way down the rocky banks to a strip of sand. 

Some hardy souls, mostly New Hampshire natives I am sure, actually swim in the water, which is now warm enough to not turn white skin blue in under two minutes. 

It stays light until almost 9 o'clock now and the sun is up  by 5 AM. 

I'm pretty sure winter is over. 

Becoming a Cohesive Group: Movie Night at Hampton

Lincoln Chaffee As Captain of the Wrestling Team

Hampton, New Hampshire Democrats have been meeting for some years monthly, usually in the basement of the Methodist church, or in a room at the town library, but this year Chris Muns, the president of the group, decided the meetings lacked something and he initiated a "movie night."  

The meeting is usually attended by about a dozen people, but movie night drew more than twice that number. It had been advertised in the Hampton Union newspaper and popcorn was provided, along with bottled water. The demographic of the group divided neatly into the half which was older than 80 and the half in the 50 something range.  Everyone sat on the padded folding chairs which can accommodate the human skeleton comfortably for about 30 minutes before low back pain emerges. 

Last night the assemblage remained in their chairs for over two hours.

Before the movie, Lincoln Chafee, a Democratic candidate for President of the United States visited and he gave his stump speech for about 10 minutes before the movie, and then left. Before leaving, he fielded a few questions, in particular he denied he ever supported privatization of Social Security, which Wikipedia said he had. His voting record in the U.S. Senate had been reviewed by some of the audience, so they knew he was for gun control, against the death penalty, for same sex marriage and he was the one Republican Senator to vote against the war in Iraq.  Then he became a Democrat. So he was on friendly ground. He was not at ease. He seemed just a little too fragile--his voice quavered when he talked about post traumatic stress syndrome among soldiers.  I could believe he felt great sympathy for their suffering; I was not convinced he had the steel to fight Republicans. On the other hand, he had been captain of the Brown University wrestling team, so one might expect he had some steel in him, even if being captain of that particular wrestling team was not like being captain of, say, the Iowa State team.  He certainly radiated empathy for the underclass and the under-served. I did not see as much fight in him as I was looking for.

The movie, Food, Inc. explored the nexus of politics, science, technology, mores, and government policy which underlie our American industrial food chain. It was a sobering affair, but its effect was dissipated a little by a tendency to veer toward the screed, the polemic. A little too much, "the big corporations don't want you to see this..." sort of thing. It also included a segment on the death of a child from pathologic E. coli in hamburger meat. Sad as this case was, it is not clear it signifies callus disregard of public health by moneyed interests. It is likely true government meat inspection has been bought out by corporate meat packers, but this is nothing new in public health and is more a problem with the vulnerability of low level government hacks than with corporate avarice. 

When I was a medical student, I went on a field trip with a New York City meat inspector. We arrived at a packing plant and the inspector never left the office of the plant manager. We all got posters to take home and hang in our dorm rooms. 

My professor of Public Health asked me what I had learned from my day with the meat inspector.
"Nothing," I told him. "We never even saw where they handled the meat. They could have been dragging meat slabs across the floor and we never would have known. It was a total waste of time. If that is what passes for meat inspection, I'm going vegetarian."
"Then you did learn what we sent you out there to learn," the professor said.

Food, Inc. shows a part of America which is not comfortable to think about--apart from the way cows are stuffed together, standing in their own manure so they need prodigious doses of antibiotics to prevent overwhelming infection, and for chickens it's even worse, there is the way food workers are treated, not much better than the animals they kill and butcher. There is collusion between corporate bosses and immigration officers which allow for meat processing plants to function with low wage illegal workers; there is the "company store" system by which chicken farmers get deeper and deeper in debt to Tyson's Corp.; there is the outrage of Monsanto being able to sue into oblivion the farmer whose fields get pollinated by Monsanto genes, blown in from neighboring farms; there are the  bizarrely unconstitutional laws which make it a felony to criticize Colorado meat or vegetables from a variety of states, the so call "veggie libel" laws. 

The octagenarians did not leave their seats watching chickens getting decapitated, or cows being conveyed on hooks above a butchery. When the movie was over, there were a few expressions of outrage and people walked over to the table with the water bottles and drank the way cops used to drink stiff shots of whiskey after a tough day on the beat. 

Old people talked with young people and bonding occurred among Democrats. 

Chris Muns had been successful. He had stirred the pot. 

Toy soldiers and Real Patriotism

 Now, what are they? Men at all? or small movable forts and magazines, at the service of some unscrupulous man in power? Visit the Navy Yard, and behold a marine, such a man as an American government can make, or such as it can make a man with its black arts — a mere shadow and reminiscence of humanity, a man laid out alive and standing, and already, as one may say, buried under arms with funeral accompaniments, though it may be

    The mass of men serve the state thus, not as men mainly, but as machines, with their bodies. They are the standing army, and the militia, jailers, constables, posse comitatus. In most cases there is no free exercise whatever of the judgment or of the moral sense; but they put themselves on a level with wood and earth and stones; and wooden men can perhaps be manufactured that will serve the purpose as well. Such command no more respect than men of straw or a lump of dirt.
--Henry David Thoreau


Today is the 4th of July. Thomas Jefferson died on July 4th, 1826 at his plantation in Virginia, and, improbably, his fellow revolutionary and comrade, John Adams, died in Massachusetts the same day. Now those two were Patriots. Even the least mystical and most cynical among us must admit, dying on the 4th of July, before the internet and instant communication, hundreds of miles apart, after all they had done to get America started, having risked hanging for treason against the king--that may just mean something. 

This is a day for ceremonies of faith, patriotism, emotion. The military is good at ceremonies; they relish ceremony and get all into it, especially ceremonies of death. "Duty, honor, country." Who has heard those words at a military funeral and remained dry eyed?

But, what I don't get is the robotic movements of the soldiers. They try to transform themselves into machines with those stiff, jerky little movements, like boys impersonating solemnity.  Why do we want men imitating machines?

I understand, I think, the importance of indoctrinating the sense of team, of group in a bunch of men (and now women) who have to run ahead into danger. There are ways of getting people to forget themselves, to push aside 18 years of conditioning at self preservation to get to a place where your relationship to the group becomes transcendent. Unit cohesion is not an empty phrase when you are under fire. I get that.

But I do not get the emptiness of robots as an ideal.

For me, and I know I'm repeating myself, but whatever patriotism is, it cannot be easy; it cannot cost nothing or demand no real sacrifice.  So putting your hand over your heart at the ball game when they are playing the national anthem, or pledging allegiance to the flag, or wearing an American flag lapel pin are not patriotic acts or gestures. These things cheapen patriotism. They suggest patriotism can be risk free and easy.

The most patriotic thing I do every year is to pay my income taxes, without grubbing for every last deduction or listing questionable deductions or not reporting income. That involves some, however minor, sacrifice and faith.

Whatever patriotism is, it begins deep within the mind, some would say the soul, and it surfaces in action, but not pre formulated action on a script written for you by others. It's not a performance and has no artifice. And it means something. 

The Rich Are Different

Fitzgerald: You know, it's true: The rich are different.
Hemingway: Yes, they have more money.


Let us now praise Donald Trump.  He is God's gift to the Democratic Party and to the great huddled masses yearning to breathe free. He is the crystal through which we can see what makes the rich so different.  Visible through him is that arrogance of the elect. 

At it's most elemental, it is the sense of entitlement, that conviction which has sustained generations of royalty and aristocracy that they are blessed because they deserve to be blessed. "God is my right." Or, maybe, in the 21st century: "God is the Right!"

Rush Limbaugh has it. Trump excels at it. Anyone can make it in America, if only he works hard enough. The corollary to that is: Anyone who does not make it, simply has not worked hard enough, so don't pity the slackers: They deserve their hard lives.

In feudal society, you needed a gilded church to tell the squalid masses the reason they lived in huts while the kings and barons lived in palaces was God wanted it that way. In America today, there is the myth of "deserving" rich. We put them through various non life threatening but demanding gauntlets (college, law school, medical school) and they get the sense they've struggled to earn their places among the elite and so they feel entitled to the glittering prizes they've won.  Of course, what they are blind to is although they worked hard to get rich, they were placed on third base and thought they'd hit a triple. I love that image. 

So, smugness reigns among the deserving elite.  And the Donald epitomizes all that.

My grand parents lived in what would now be considered poverty, but everyone around them was in the same state and they did not feel diminished, ashamed, or really much deprived.  They caught the occasional glimpse of the passing limousine, but that was not a problem for them. The world of speak easy's and flappers and the roaring 20's was simply beyond their imagination; their children could read about it in Fitzgerald and Hemingway, but it was not a world which beckoned or seemed possible. They were simply happy to be living in peace with nobody shooting at them or shelling their homes, to have work and to have enough to raise their kids. 

How would they have reacted to a Donald smirking at them from the television, telling them they were losers and deserved to be?

May It Please the Court: Social Change and SCOTUS

Ms. Maud pointed out one of the most fascinating aspects of the rulings of this past week: The apparent contradiction of Chief Justice Roberts, who sided with the liberals on Obamacare and issued a bitter dissent on gay marriage.

Mad Dog spent a worthwhile hour reading the actual texts of the Chief Justice's opinions and the text of Justice Kennedy's decision.

In the case of Obamacare, Roberts saw clearly past the clever arguments which convinced Justice Scalia: The Supreme Court's job is to clarify what the law is, especially when the Congress, which has the power to write the law is inept enough to leave something ambiguous. The clear intent of Congress was to improve and extend medical care,  not to destroy it, a simple observation Roberts used to destroy all the machinations of Justice Scalia who fastened on a few inelegant words to suggest what the Congress really had said was more important than what it clearly had meant to say.

"Words no longer matter," Scalia fumed, as if what is really important is the game rather than the effects of law on the lives and health of millions.

When you read Roberts on Obergefell, the gay marriage case, it's all about the court being humble and not legislating from the bench, not imposing on those states where the majority disapprove of gay marriage the will of "lawyers" i.e., the Supreme Court justices.  Until and unless the majority of people in a given state will gay marriage into being by voting for it, the Court has no business imposing a new definition of marriage upon them.  You cannot tell people who hold different opinions what to think. Roberts is profoundly uncomfortable with becoming the agent of change. He is, in that sense, one of the most conservative members of the Four Horseman. In that sense, he is entirely consistent and predictable, and siding with the intent of Congress on Obamacare is the conservative thing to do, while voting against gay marriage is the conservative thing.

Kennedy is more interesting.  Ms. Maud has suggested we might save a lot of time and effort if we simply presented cases to Justice Kennedy, since you know where the other eight justices are going to go before the votes. Kennedy is always the wild card.

In his opinion, Kennedy lays down his arguments carefully and forcefully and with great clarity. Injustice, he notes, is often unrecognized at the time; it is only once change has occurred how clear injustice had been. Thus was it with "separate but equal" when Black school children were bused to inferior schools. Brown vs the Board of education changed that and that change came from the Court after decades, generations of Congresses failed to right that injustice.

As Kennedy pointed out, the rate of change is important when it comes to injustice--justice delayed can be justice denied.  If we wait for the citizens of each state to come around, many lives could be lived and ended before justice is done and all those who were not given justice would suffer their whole lives. 

Kennedy builds his case by noting the fundamental attitude toward homosexuals underlies the resistance to allowing them to claim the "benefits" of marriage. Homosexuality was considered a disease, a deformity of character and homosexual acts were criminalized. It is not really that the Bible tells us homosexuals should be stoned to death that motivates the refusal to allow gay marriage but a fundamental revulsion to what homosexuals are and what they do. Kennedy claims this attitude has changed and laws should change with attitudes.

Tracing the history of the Court in cases involving intolerance and marriage, Kennedy notes state laws once forbid inter racial marriage and this was clearly an example of how hate found expression in marriage laws. The same can be said of hate and homosexuality and marriage law. Some people simply hate the idea of allowing other people to do what they want to do, to love who they want to love. As if it is any of your business who I love and how I express that love.

Kennedy asserts attitudes have changed across the country and the Court is  not really imposing a new attitude but reflecting that change.

This is is weakest argument. Attitudes have changed across the country, but not in all parts of the country. In Mississippi, Alabama, South Carolina, Gerogia, Louisiana attitudes have not changed and likely will not change among enough citizens to ever allow gay marriage. Even in Black churches, perhaps especially in Black churches, the very people who were hurt by the intolerance of others when it came to race, refuse to tolerate homosexuals.  Justice Roberts would say, well until those people have a change of heart, it's not up to the Supreme Court to force them to change their hearts and minds. Just Kennedy looks to past racism and says, "Oh, yes it is. There are times we have to bring people along and tell them their attitudes are unacceptable not as Alabamans or Baptists but as Americans."

When it comes to state laws, we must appreciate state borders are, after all, pretty much artifacts of history and they are anachronisms.  We told people in these states they could not do as they pleased, could not live in an antebellum world of delusion and hate and had to come along with the rest of the country into a new world of tolerance and justice, and, not entirely, but for the most part, forcing White Southerners to accept the humanity of Black Southerners was good for both.  As James Baldwin once noted, slavery hurt the master as well as the slave--it may have hurt the slave a lot more, but it did hurt the master.

The fact is, the White Dixiecrat South was a dark, festering abscess of hate and ignorance and the sunlight of enlightened tolerance, while it did not root out all the pockets of disease, did succeed in cleaning up most of it, and the country was the better for it.

From the Civil War onward, we have had the temerity to tell people in the South and elsewhere that what they do locally affects us all nationally. As Thoreau once observed, injustice anywhere is an affront everywhere; tolerating injustice and allowing it to burn in the basement or the attic threatens the entire house.

Something very similar is true for the hate and intolerance directed at homosexuals in the Bible belt. Once formal, legal protections are extended to this reviled underclass, the haters and their children will see tolerating those they find repellent does not harm them. They can live with people they may detest on one level and yet function and even find things they like about those nasty people.

Kennedy unabashedly embraces the idea that sometimes the Court, when it sees one group being oppressed by another simply has to take the lead in righting that wrong. It cannot allow the playground bully to subjugate and intimidate; it must act to protect those who are being beaten up.

For Roberts, the playground bully must be tolerated until he has a change of heart or enough of his classmates persuade him to behave more in a more civil manner. For Kennedy, there is a reason for a higher authority, namely the Court, to exert it's authority to intervene.

Obamacare and the Court

"Obviously, Congress acted to improve health care not to destroy it."
--Chief Justice Roberts

Just when you thought those four horsemen of the Conservative apocalypse on the Court would wrest complete control of the government and the commonweal of the nation from Congress and from the White House, Chief Justice Roberts actually acted like a grown up rather than an ideologue and voted with Justice Kennedy and the liberal wing to smack down opponents of Obamacare, who were smirking over their own cleverness, trying to play "Gottcha" with the wording of the law.

The Republic may survive another day.

More important, millions who have benefited from Obamacare and there are far more than expected, will actually live better lives because the Court (not Scalia, Thomas, Alito) voted to protect those who need protection rather than sneering at them.