Manifesto

April 26th, 2012

Occasionally I read or hear something about which a response leaps to mind. Most of the time I let it pass because my response seems unlikely to be successfully transmitted to the originator of the comment. It occurs to me that I have a platform on which I can comment, and so I think I will do so, for what it’s worth to anyone who might stumble across this blog.

Thoughts on “Thanksgiving”

November 23rd, 2012

This morning, so called “Black Friday,” the following quote was forwarded to me:

“Only in America would people kick and claw the shit out of each other over cheap merchandise only hours after being thankful for what they already have.  We need to add a companion holiday.  Thanksgiving … and Morehaving.  Oh, wait.  That’s Christmas.” — Weedlord Bonerhitler

This prompted some introspection. In the past year or so, since I have attained sanity about my beliefs (or lack thereof), the Thanksgiving holiday has also undergone a rethinking. It is appropriate to be mindful (at least once a year, but hopefully constantly) of everything that contributes to my state of well-being. When I used to give credit to a supernatural being for them, it was an excuse to not be truly mindful. When you are not mindful, your mind is cluttered with all sorts of trash, but still seems to be constantly dissatisfied, hence the constant need to accumulate “more.” I still occasionally desire something that I perceive will add to my will-being, but increasingly it isn’t a new possession. In fact, shedding possessions seems to bring me closer to attaining what I desire. And, often, attaining it only requires a change in my state of mind, or in my habits.

Slip Slidin’ Away

May 8th, 2011

Occasionally a phrase or song gets stuck in my thoughts and can’t be easily dislodged. A recent conversation with a new acquaintance brought this Paul Simon tune to mind and now it plays on a repeating track in my mind. Let me tell you how this all came about.
My new acquaintance, let’s call her Judy, revealed to a group of us that she is a three-time cancer survivor. After basking in the rejoicing of her friends at this remarkable fact, she added the de riguer proclamation that she was thankful to god for healing her. Ordinarily I would let a comment like this pass for fear of provoking a confrontation, but lately it seems important to speak my mind, and so I spoke up and said that god had nothing to do with it, that it was due solely to natural causes, modern medicine, and her own personal resiliency. I pointed out that, if indeed god were to get credit for it, then god would also have to be given the blame for all those who are not healed and suffer and die. You can’t have the one without the other, and since I didn’t think she wanted to blame god for all that other grief and suffering, then she should admit that god had nothing to do with her healing. Surprisingly, Judy understood and agreed. She said that it was true and that she felt that her attitude, research, diet and staying involved with her treatment were responsible.
Another member of the group tried to insert the standard line that those who believe in god would say that it was all part of gods plan, and that for the others it must have been their time to “go.” It was at this point that I wanted to start singing “slip slidin’ away.”
At the point when believers in god are faced with this kind of dichotomy, they slip from reasonable conversation to a place of discourse where reason no longer has purchase. The only answer to the problem of why their supposedly all-powerful, all-knowing, supremely-loving god allows all the horror, misery, pain and suffering that exist, is that god has some mysterious plan which accounts for it. And there they go “slip slidin’ away.” It’s no use asking how they know about this plan, any more than asking them how they know there is a god. They will insist that the reason they believe it is not because someone has previously told them it is so, but at the same time are unable to identify how they could possibly know about it without someone having told them. It’s no use asking them for evidence of its existence. They will say that they don’t need evidence. They just know it. And in this strange universe of thought, otherwise highly intelligent people can’t seem to see the illogic of their statements.
One question alone should disabuse them of this thinking if they profess to be reasonable people. “How could any being be described as loving whose plan allows for the widespread rape, torture and killing of little girls in the Congo (DRC), at least if that being had the ability to prevent it? We would vilify a president who would allow such a thing to occur if he had the ability to stop it. We would ridicule anyone who tried to excuse him by saying that he must have a plan that explains it. How can we then not ridicule someone who says the same thing about a god? And how could anyone revere and worship such a god? In fact, why would someone want to imagine that such a god exists? Not me! Not anymore!

Rethinking Safety Net — Part 1

September 29th, 2010

Thomas L. Friedman made a comment in his op-ed piece in the New York Times on 9/28/10 to which I had an immediate negative reaction. Then I began to think, (which is a happy result after reading reasonable statements) not only about the statement, but also about my reaction.

Friedman concluded his call for a better plan from our leaders to use our diminishing resources in the most efficient way possible to get back to our core national competency, by stating some requirements needed to implement such a plan. The one that provoked my reaction was “to reduce some services — like Social Security.” Now perhaps his true meaning might have been more apparent had he stated it a little differently, i.e. using the word “reduce” conjures up images of a society insensitive to real needs of the elderly. However, what I believe to be the underlying point, that no society can afford unbridled spending on even the most justifiable programs, is valid and should be seriously considered. Instead, I immediately wanted to dispute it. I wonder why.

One probable reason is my fast approaching eligibility for Social Security payments. As most people do, I feel that the benefits, for which I have been paying my entire working life, should become available to me as promised. Never mind the fact that politicians have been spending these payments, instead of saving them in anticipation of the needed payout, and never mind the fact that, if the truth were known, I could probably get through the rest of my life without them, I want to get that which has been promised and for which I have paid. Whether that feeling is reasonable or not is not the reason for my current musings.

It seems clear to me that the financial and political difficulties which the country faces now, and probably will face for the foreseeable future, require a new look at the entire subject of our responsibility to care for those in our society who, for whatever reason, cannot survive without help. In this process we cannot avoid some questions for which answers don’t come easily. Who are the people who should be helped? What mechanisms should be in place, not only to help them, but also to insure that the system is not abused? Who should pay for this help, and how should the funds be raised? How can we recover from the errors we have made in the past, and avoid those that have been made by other societies who have attempted to reach the same ends? I won’t pretend to have satisfactory answers for any of these questions. However, I do have thoughts about some of them that I would like to share. Reaching acceptable answers won’t be the work of a single mind, but the collaborative effort of many. Please join in with your thoughts. Since many books have been written discussing these questions, and since I have no interest in writing another, I won’t wait until my thoughts have been carefully vetted and have resulted in final conclusions, I will add them as they come to me, for better or worse.

Beginnings of reason

September 28th, 2010

I have recently come to the realization that something which I had been taught to believe without questioning, and to which I had subsequently held without any evidence of its veracity other than what I had been told, should no longer be assumed to be true. And I am now amazed that an intelligent person like me, who relies heavily on a highly developed sense of logic, would not have come to that realization many years ago. I’m sure a cogent explanation is available somewhere in print, but I haven’t read a completely satisfactory one yet, and so I have decided to try to write one myself. For what it’s worth, here is my attempt. I make no pretense that this is a scholarly document, and so, as much as is possible and advisable, I will avoid getting too technical or attempting to provide citations to support its accuracy. I welcome readers to investigate for themselves anything their own logic questions and to report the results to me.

I’ll start with an infant’s first experience of the world. As the senses develop and begin to report their findings to the brain, it develops the capability of relating them to each other and, using those relationships, to transmit instructions to other areas of the body. At some point this process seems to develop into what we refer to as reasoning thought, e.g., “My sense of touch has been strongly actuated. Muscles, move until it is no longer actuated.” And the baby squirms within the womb. Much of what we can later identify as reasoning begins at a rudimentary level as soon as the brain begins to develop. The sense of touch is joined by hearing, and, no one knows for certain when, smell, taste and sight begin to be included.

When the infant emerges from the womb, this process continues. Ideally, the touch, smell, sound, and taste that have, to this point, been the most comforting, are joined with a sight, which the brain combines to form the concept, “Mother.” Soon the brain learns that, upon hearing a certain sound, and using its developing location skills, when it tells the head to turn, it brings all the senses into alignment on the “Mother” concept. The infant will continue moving its head as long as it hears that sound until the sound is joined by sight. Thus, at a very rudimentary level, the brain is beginning to “fact check” the world. Very early on this process is strong. It takes a period of conditioning to break the child of inherently attempting to bring learned concepts into coherence. E.g., Dad turns on the computer and connects with Mom using Skype. Mom speaks and the infant turns to look and visually confirms that it is Mom. However, as the child develops, the child will try to relate sight with other senses. At this point you can see confusion arise. “Something is wrong. I can see and hear Mother, but I can’t smell or taste her, and when I feel, it doesn’t feel like I’m used to Mother feeling.” The brain area that attempts to bring the senses into coherence becomes strong very early in development.

Adults make many sounds that make no “sense” to an infant. In time, some combinations of sounds are accompanied by other senses and the infant begins to associate these sounds with previously developed concepts. One combination seems to relate to the “Mother” concept. Soon, when that “Mama” sound is made, the infant adds the new concept of sound combinations to the “Mother” concept. Soon, when anyone makes this sound, the infant will “reason” that the sound means the same thing as the entity its senses have already identified as “Mother.” And if someone says, “Mama,” when referring to anyone else, the child becomes confused. The already developed “coherence” tester in the brain sends out an alarm: “I know what that sound means, and I don’t see or hear the entity to which that sound refers.”

I have gone through this tedious process in an attempt (admittedly in an amateurish way) to describe the development of that magnificent area of the brain which “fact-checks” input, including words, and attempts to make “sense” of it. In fact, scientists attribute this ability of the brain as a main reason for the survival and eventual dominance of the otherwise inferior animal known as Homo sapiens. Where that process evaluates the attempt to make reliable inferences from a conceptual world, we use the word “logic” to describe it.

I wonder why that logic has not challenged concepts that we have been told to believe, irrespective of their cohering with our senses, or with any other independently developed concepts. Or, to put it more simply, why have we developed the ability to, in some circumstances, bypass this “bullshit” alarm area of the brain?

One conceivable answer is expedience. When something is flying at my face, routing the visual input through the “bull-shit alarm” before taking action will soon result in serious damage. The brain has developed ways to transfer certain input into muscle commands for body preservation. E.g., I don’t think when the temperature of the surface I have just touched is 450˚. My hand instantly moves.

Finding a reason for the tendency to bypass logic when dealing with certain concepts is much more complicated. Returning to the infant analogy, we need to investigate the mental concept of “trust.” Clearly, there are many inputs which infants are not equipped to evaluate. They react instinctively to loud sounds. Soon, they react to certain words, connecting them to concepts. When anyone says hot, they react. However, their reaction to other words may depend on the identity of the person speaking. They learn that the word “no,” spoken by Mom, means one thing, while spoken by someone else, i.e. Dad, it means something else. Hopefully, if the parents are consistent, infants learn reliable information about many concepts without having to go through painful, if not deadly, personal experience. Infants learn to rely explicitly on the words the parents use, because they suffer the negative results when they don’t. E.g., Mom says, “Hot, don’t touch,” and, if the infant ignores the words, pain results. In this, and many other ways, infants learn to “trust” spoken words. This trust is usually conferred on all adults. Auntie Faith says, “Hot, don’t touch,” and the infant draws back its hand.

As the infant becomes a child, this trust is continually strengthened, not only by positive and negative experience, but also by developing communication skills. Parents tell children to do or not to do certain things and give reasons why. So children, receiving new information, begin to expect reasons why, in other words, for evidence of veracity. The child may ignore the information if no reason is given, or if the reason doesn’t mean anything relating to the world the child is experiencing. This presents a dilemma for parents. On one hand, they want the child to trust implicitly what they say, but they also want the child to learn not to trust what all adults say. The parents try to construct a hierarchy of trust in the child, with parents at the top, and people you don’t know, strangers, at the bottom. The child learns not to accept candy from strangers, but it is OK to accept it from familiar people. Obviously this hierarchy is not perfectly reliable, since children can be harmed by familiar people as well as strangers.

The previously mentioned “bullshit” area of the brain continues to develop. Children, at some point, begin to question what they are told and seek evidence of its veracity on their own. I told my grandson that the skin incision that caused the scar that I showed him didn’t hurt because the doctor gave me a shot first. He looked askance at me, since he knows from experience how much it hurts when his arm is cut, and said: “Are you lying to me, Papa?” Truth and lies become a very important part of children’s lives. They are rewarded for truth and punished for lies. And so the ability to tell the difference becomes very strong. In many ways it becomes the most important survival trait children learn.

One very important fact is that children make truth distinctions based solely on relevance to the real world. If something has no real consequences to them, they will ignore it. If you tell them to straighten their room because it will look nicer, they will likely pay it no mind. If you offer to buy them a desired toy or food, you can get them to do that and much more. It should go without saying that reward and punishment are the two most useful tools for teaching children.

I promise soon to tie all this in to my overall point, but first I need to say one more thing. The concepts of death and infinity (forever) are ones that take some time to develop in a child, and even longer to register with the same importance that they hold for adults. Children may lose things, pets, and people, but until they understand the concept of forever, the losses don’t carry the all-important meaning they will someday carry. In fact, many concepts, to which adults have attached great significance, have little meaning to children. Adults fear death, and take extraordinary care to avoid those things that can lead to it. Children, on the other hand, because they don’t understand that death means being gone “forever,” don’t have the same fear and might not be as motivated as adults at the potential for death.

Trying to teach children to do or not to do something that goes against the values they have learned is very difficult. Sharing is a good example. Adults know that it is an activity that enhances children’s ability to prosper in a social world. But children learn ownership very early and only through extended effort do they learn to share. This is also true of other desirable traits. So, telling children to “be good” has little effect if it doesn’t coincide with their own perceived self-interest.

Here is where some parents face a dilemma. How do they teach important traits before children understand their later importance? One tried and true way is by creating stories utilizing invented characters whose actions both are interesting to children, and demonstrate the desired traits. One example is the story of Santa Claus, which occurs in many variations in many cultures. Although it is often embellished, as are most stories, the basic concept is of a magical character who can monitor the behavior of all children and reward them if they are “good,” and punish them if they aren’t. Adults justify telling children these invented stories because they have the effect of teaching them concepts adults find beneficial. A concise word for this practice is “myth.”

At some point in their lives, most children learn or are told that “myths” aren’t actual representations of the real world. Despite the distrust that naturally arises in children when they learn that adults they have been taught to trust have been, in effect, lying to them, adults don’t seem to be easily dissuaded from perpetuating these myths. Perhaps adults take a perverse pleasure in the gullibility of children, or they convince themselves that the ends (teaching desired behavior) justify the means (lying to their children, and thus helping to create distrustful youth). Most parents don’t seem to be affected by the deep resentment children harbor at this mendacity.

Finally we come to the subject that motivated this dissertation. It is a myth that many people, for a multitude of reasons, perpetuate. This myth is invoked early in life in an attempt to teach children to “be good.” It is one that involves an invisible character that can monitor their behavior and reward them if they are good and punish them if they are bad. Sound familiar? No, we already mentioned Santa. In variations of this myth, adults have used as many names as there have been cultures since the beginning of recorded time. Here are some names you may or may not recognize: Marduk, Atum, Elohim, Mbombo, Nanabozho, Unkulunkulu, Vishnu, Shiva, Brahma, Jawah, and God. The stories about these entities are as varied as their names. Granted, not all of them are specific in the way described above, but they do share many common features, the most common of which is the teaching that belief in them is required solely on the word of other people. In all cases, some person or group created stories to explain something for which they needed an explanation. If other people believed the stories, then the myths were perpetuated. And in every case children are taught to believe them explicitly. More importantly, children are taught not to pay any attention to anything “strangers” say about these myths. They must “trust” that their parents and the other adults in their life know best.

The significant difference between these myths and the, perhaps more innocent, ones of Santa, the Tooth Fairy, the Easter Bunny, etc., is that the adults who are teaching them to children have actually convinced themselves of their veracity and so insist on credulity even when the well developed “bullshit” area of the brain rejects the illogic of them. In order to deaden their own “bullshit” indicators, these people create elaborate reasons why it doesn’t matter that the myths don’t make sense. In fact, they often elevate to the highest moral value the acceptance of the myths with the full knowledge that there is no evidence of their veracity. A word has been created to identify this acceptance without evidence. It is called “faith.” And by pounding into children from the time they are infants the concept that some ideas must be accepted on “faith,” in other words, without questioning the word of the people espousing the ideas, the “bullshit” indicator in the brain is methodically deadened, so that, by the time a person reaches the age where their lives are required to be governed by reason and logic in every other area, they have learned not to do so in this one area.

Why do people choose to perpetuate the myths about their deities? First, it is because people fear death, and so grasp at any promise of a mechanism, no matter how fantastical, whereby they perceive they can escape it. This also explains why it is so difficult to excite children with deific ideas. They don’t understand the “forever” nature of death, and so don’t pay much attention when told not to do something, the result of which might be death. And so parents and other “caring” adults must spend an inordinate amount of time and energy indoctrinating children into their myths. And they use all the tools available to them; scaring them in whatever ways children have already learned to fear (god telling fathers to stab their children, fiery destruction of “evil” people, disobedient people swallowed by huge fish or magically turned into statues made of salt, etc.), enticing with promises of wonderful rewards for obedience, and repetition of mythical concepts so constantly that children become mesmerized by them. Is it any wonder that it is so difficult for a person to shake loose of this indoctrination and re-activate the “bullshit” indicator?

So, now I have proposed an explanation for why an intelligent person like me, who relies heavily on a highly developed sense of logic, would not have, at the same time as I rejected the existence of Santa Claus, also rejected as “bullshit” the myths about other invisible beings that had been pounded into me since I was born.

Current Issues: Health Care

February 12th, 2010
Over the past few months my thoughts on a number of issues have fluctuated and been influenced by events and information. I’ve decided to put down my thoughts to clarify them for myself and to provide a springboard for discussion, should any thoughtful, reasonable person wish to engage with me. I think it would be useful to see if I can isolate areas where most, if not all, reasonable people can agree, and then try to build cohesive conclusions based on those areas.
Many of the areas of interest are interconnected, but it will still help to discuss them separately, and draw attention to connections when it is needed.
I choose “Health Care” as the first subject.
Any who claim that their own health care is perfect and reasonably priced are either unaware of its cost, or so rich that cost is of no consequence. The rest of us agree that either our care is not as good as it could be, or that its cost is out of proportion to its quality. International statistics show that many countries receive a higher standard of care than we receive in the U.S. In many of these countries, the percentage of income spent on health care is significantly less than our average. The question occurs: “Why is this so?” Let’s discuss some reasons.
1. Cost of Insurance.
Many Americans cannot afford to pay for a reasonable level of health care. Few would be able to afford, out of their own pockets, the costs of major surgery or illness. And the mechanism that we use to spread these costs across the population, insurance, is also beyond the means of many millions of Americans.
For some, age or health conditions have made them uninsurable under current insurance practices. The inability to get insurance is a scary situation. It can lead to lack of timely treatment for serious medical conditions, thus seriously compromising the effectiveness of eventual treatment. Fear of financial ruin, should a major crisis occur, is ever present. I can testify to the truth of this, since I am one of these people.
For other people, the cost of a medical insurance policy is prohibitive. If you are jobless, working at minimum wage, or working for a company that does not provide employee medical insurance, buying an individual medical insurance policy costing many thousands of dollars a year is just not be possible.
It may be easy to ignore the problem of uninsured Americans unless you or someone you know is directly affected, but the effect of the problem on the overall cost of medical care should make us take more notice of it. Some of these uninsured will need and receive care, and others will suffer and possibly die for lack of it. For those who do receive care, it is often made more expensive by having been delayed, and by being provided at emergency facilities, which are the most expensive providers. The costs of treating those who can’t afford to pay must be passed on, and the final effect is a significant cost increase for all those who are paying. This is to say nothing about the cost to society of the misery and despair of those for whom care is not provided.
2. Cost of Health Care
Neither the government nor the natural forces of the market seem able to limit the rise in cost of some components of health care.
The natural desire for profit by companies who invent medical devices or create new medicines results in pricing which is limited only by their users’ ability to pay. If each individual user were faced directly with the cost of each product used, it might be possible to make informed cost/benefit decisions. However that almost never occurs. Instead, there are many layers between the original provider, and the final recipient of the product. There is no direct consumer pressure to hold down costs in these intermediate layers, because the consumer is not exposed to them. For example, doctors and hospitals use devices and medicines out of necessity, but have little motivation to control their costs. And, individually, they have little leverage to do so even when they try. They then pass on those individual costs through a general charge for the service provided.
When the government is a payor, as with Medicare, it attempts control by mandating costs for which it will pay. However, that cost control has little effect on the originator of the cost. Usually the providers just pass the unreimbursed portion of the cost on to the rest of the users who don’t have any power to resist.
Where an insurance company is the payor, it would seem more likely that there would be an attempt at cost control, and often there is some. However, the main interest of the insurance industry is to protect and maximize its profits, and to control costs to the consumer only within the context of keeping premiums within affordable limits. The crux of the problem here is that, since most insurance premiums are at least partially paid by employers, the final users are still buffered from understanding individual costs, and so have little power to affect them. Also, the operative word is “affordable.” Premiums have consistently risen at a much grater level than salaries with which to pay them. And so, to avoid cutting wages, more and more employers either reduce or eliminate insurance coverage.
There is one more significant factor adversely affecting the cost of health care—lack of information. Everyone, provider and recipient, wants the best health care possible. The natural desire of providers to identify and provide the best care is heightened by fear of the results of not doing so. The legal system in the U.S. makes the penalty for providing substandard care severe. And it leaves the judgment of the standard of care, and the penalty for not providing it, up to juries, whose expertise is often questionable, and whose motivation is often slanted toward the injured party. This problem is further heightened by the mechanism for insuring providers against these awards. As mentioned above, the motivation of insurers is to maximize profits. Costs of large malpractice awards can be absorbed only by higher premiums, which then raise prices for the consumer.
If there was cohesive information identifying standards of effective care which could be relied upon by providers and consumers, and if the mechanism for punishing providers who failed to live up to these standards was information available to consumers about the level of care they provide, much could be done to limit the spiral of health care costs. But that information is not now readily available. Each provider, hospital, locality and state has its own responsibility for creating standards, and the natural result is great discrepancy in those standards around the U.S. And here too there is no mechanism for cost containment.
3.  Quality of Health Care
First, let’s state the obvious. For those with sufficient resources, quality health care can be purchased almost anywhere in the world. That exposes the crux of the problem. When costs swell at a rate far in excess of the inflation rate year after year, fewer and fewer people have sufficient resources to pay for quality care. As individual ability to pay diminishes, the inevitable result is a commensurate drop in the quality of care accessed. So there is an increasing gap between what everyone wants, and what most people get.
There are those with a vested interest in convincing us that we have the best health care system in the world and that nothing should be done that might jeopardize it. Because they are partially correct, the best is available for those who can afford it, they are able to cow us into inaction. But the reality is that for most people the level of health care they actually get is far below their dream of quality care. And for tens of millions of us health care of even minimal quality is unavailable because it is unaffordable.
I conclude this portion by stating that it is apparent to me that change in the health care system in the U.S. is INEVITABLE. The only things to be determined are how that change occurs, who decides the nature and extent of the change, and who benefits from it.
Those factors will be discussed in my next essay.

Over the past few months my thoughts on a number of issues have fluctuated and been influenced by events and information. I’ve decided to put down my thoughts to clarify them for myself and to provide a springboard for discussion, should any thoughtful, reasonable person wish to engage with me. I think it would be useful to see if I can isolate areas where most, if not all, reasonable people can agree, and then try to build cohesive conclusions based on those areas.

Many of the areas of interest are interconnected, but it will still help to discuss them separately, and draw attention to connections when it is needed.

I choose “Health Care” as the first subject.

Any who claim that their own health care is perfect and reasonably priced are either unaware of its cost, or so rich that cost is of no consequence. The rest of us agree that either our care is not as good as it could be, or that its cost is out of proportion to its quality. International statistics show that many countries receive a higher standard of care than we receive in the U.S. In many of these countries, the percentage of income spent on health care is significantly less than our average. The question occurs: “Why is this so?” Let’s discuss some reasons.

1. Cost of Insurance.

Many Americans cannot afford to pay for a reasonable level of health care. Few would be able to afford, out of their own pockets, the costs of major surgery or illness. And the mechanism that we use to spread these costs across the population, insurance, is also beyond the means of many millions of Americans.

For some, age or health conditions have made them uninsurable under current insurance practices. The inability to get insurance is a scary situation. It can lead to lack of timely treatment for serious medical conditions, thus seriously compromising the effectiveness of eventual treatment. Fear of financial ruin, should a major crisis occur, is ever present. I can testify to the truth of this, since I am one of these people.

For other people, the cost of a medical insurance policy is prohibitive. If you are jobless, working at minimum wage, or working for a company that does not provide employee medical insurance, buying an individual medical insurance policy costing many thousands of dollars a year is just not possible.

It may be easy to ignore the problem of uninsured Americans unless you or someone you know is directly affected, but the effect of the problem on the overall cost of medical care should make us take more notice of it. Some of these uninsured will need and receive care, and others will suffer and possibly die for lack of it. For those who do receive care, it is often made more expensive by having been delayed, and by being provided at emergency facilities, which are the most expensive providers. The costs of treating those who can’t afford to pay must be passed on, and the final effect is a significant cost increase for all those who are paying. This is to say nothing about the cost to society of the misery and despair of those for whom care is not provided.

2. Cost of Health Care

Neither the government nor the natural forces of the market seem able to limit the rise in cost of some components of health care.

The natural desire for profit by companies who invent medical devices or create new medicines results in pricing which is limited only by their users’ ability to pay. If each individual user were faced directly with the cost of each product used, it might be possible to make informed cost/benefit decisions. However that almost never occurs. Instead, there are many layers between the original provider, and the final recipient of the product. There is no direct consumer pressure to hold down costs in these intermediate layers, because the consumer is not exposed to them. For example, doctors and hospitals use devices and medicines out of necessity, but have little motivation to control their costs. And, individually, they have little leverage to do so even when they try. They then pass on those individual costs through a general charge for the service provided.

When the government is a payor, as with Medicare, it attempts control by mandating costs for which it will pay. However, that cost control has little effect on the originator of the cost. Usually the providers just pass the unreimbursed portion of the cost on to the rest of the users who don’t have any power to resist.

Where an insurance company is the payor, it would seem more likely that there would be an attempt at cost control, and often there is some. However, the main interest of the insurance industry is to protect and maximize its profits, and to control costs to the consumer only within the context of keeping premiums within affordable limits. The crux of the problem here is that, since most insurance premiums are at least partially paid by employers, the final users are still buffered from understanding individual costs, and so have little power to affect them. Also, the operative word is “affordable.” Premiums have consistently risen at a much grater level than salaries with which to pay them. And so, to avoid cutting wages, more and more employers either reduce or eliminate insurance coverage.

There is one more significant factor adversely affecting the cost of health care—lack of information. Everyone, provider and recipient, wants the best health care possible. The natural desire of providers to identify and provide the best care is heightened by fear of the results of not doing so. The legal system in the U.S. makes the penalty for providing substandard care severe. And it leaves the judgment of the standard of care, and the penalty for not providing it, up to juries, whose expertise is often questionable, and whose motivation is often slanted toward the injured party. This problem is further heightened by the mechanism for insuring providers against these awards. As mentioned above, the motivation of insurers is to maximize profits. Costs of large malpractice awards can be absorbed only by higher premiums, which then raise prices for the consumer.

If there were standards of effective care which could be relied upon by providers and consumers, and if the mechanism for punishing providers who failed to live up to these standards was to publish information about the level of care they provide, much could be done to limit the spiral of health care costs. But that information is not now readily available. Each provider, hospital, locality and state has its own responsibility for creating standards, and the natural result is great discrepancy in those standards around the U.S. And here too there is no mechanism for cost containment.

3.  Quality of Health Care

First, let’s state the obvious. For those with sufficient resources, quality health care can be purchased almost anywhere in the world. That exposes the crux of the problem. When costs swell at a rate far in excess of the inflation rate year after year, fewer and fewer people have sufficient resources to pay for quality care. As individual ability to pay diminishes, the inevitable result is a commensurate drop in the quality of care accessed. So there is an increasing gap between what everyone wants, and what most people get.

There are those with a vested interest in convincing us that we have the best health care system in the world and that nothing should be done that might jeopardize it. Because they are partially correct, the best is available for those who can afford it, they are able to cow us into inaction. But the reality is that for most people the level of health care they actually get is far below their dream of quality care. And for tens of millions of us health care of even minimal quality is unavailable because it is unaffordable.

I conclude this portion by stating that it is apparent to me that change in the health care system in the U.S. is INEVITABLE. The only things to be determined are how that change occurs, who decides the nature and extent of the change, and who benefits from it.

Those factors will be discussed in my next essay.

To This We’ve Come?

November 9th, 2009

Periodically I am tempted to believe that sanity has a chance on this planet, and then I come across a conversation like this one among “friends” on Facebook.
Person 1: “DC Sniper will finally Die.. What a shame the families of the victims arent able to execute him the way THEY see fit”
Person 2: “Good idea! what is a good way?… i think via the televsion is MEGA!!!”
Person 3: “I watched a movie on that f**ktard and his little friend the other week …hope they line him up against a wall and shoot him !!!
Person 1: “stephen they are gonna use lethal injection which is more costly than a bullet in the head”
Person 4: “I wish they had firing squads or hangings here in the US!”
Person 3: “That is sooooooo wrong !!! why cant he die the same way he took the life of all those innocent people!!”
Person 1: “personally i’d say break every bone in his body but the neck let em heal without pain meds for each victim then place a bullet in each joint then 2 in the head”
Person 3: “sounds sweet to me !! Im with you there Joe :) ” (editorial coment: a SMILEY!!! really???)
Person 5: “whats the link to the most recent info on this??”
Person 1: I just saw an update on Fox News that the Supreme Court has rejected his request to have his execution delayed check out www.foxnews.com should be a story there”
Person 5: “cool thanks.”
End of conversation.

I am almost speechless, literally. “Fox News,” that defines “contradiction in terms.”

Are there really people who believe we should create a society where every perceived injustice or injury should be avenged in kind? (rhetorical question, in light of the previous conversation, and the constant deafening rhetoric on Fox)

Do none of them even once think about what it would be like to live in the society that follows their views?

I would wager that most of the participants would call themselves “Christians.” What translation of the Gospel changes “Love Mercy” to “Avenge all wrongs?”

I’m sorry Tolle, but I see in this no evidence of awakening to a new earth, but only a descent to an actual hell on earth.

Parenting

March 20th, 2009

I think that the eternal dichotomy of life is best exemplified in parenting. Juxtaposed in time are, on one hand, the joys of watching the accomplishments of your children which might in some small way reflect knowledge and behaviors that you exemplified and taught, and on the other hand, the painful realization that, as they reach maturity, they will listen to, seek out and value advice from almost any source (including unproven, uncaring sources on the internet), but will not only not seek out, but actually resent advice from the ones who may be able to provide expert advice and who care deeply about its effectiveness.

Knowing why this is so doesn’t make it any less painful for parents. And one wonders if it might explain some of the ills of our society. We hold independence in high regard which results in children loosing connection with their parents and their greater family. I hear stories about societies where a healthy balance is achieved between reaching adulthood and still valuing the experience of parents, grandparents, and the greater family. I don’t see that happening here as a rule, and I don’t consider that a societal advance.

Thoughts on Gaza

January 21st, 2009

What a morass has been made of Gaza. The Israeli invasion seems clearly designed to demoralize the residents of Gaza. How else could you explain the complete razing of a town because a few Hamas fighters used one or two houses for firing at the Israelis. This seems so wrong-headed to me. Removing all vestiges of hope from people only increases their willingness to support radical solutions.

On the other hand, as sympathetic as I am of individual Palestinian tragedies, the citizens of Gaza must accept the results of the actions taken by the government they have elected. As much as we would like to, we US citizens cannot escape responsibility for the disastrous policies of the prior administration because we elected them. The Gazans reap the results of electing Hamas as their leaders. No government can freely bomb another nation and not expect that country to act to protect its citizens. Citizens of Gaza who suffer from the actions of the Israelis acting to protect their country cannot escape their collective responsibility for their own stiuation.

So the demoralized Palestinians see no option but the radical Hamas. Hamas can only justify its existence by continuing to attack Israel. Israel defends itself by attacking Gaza and wiping out its towns, and the vicious cycle continues.

Palestinians and Israelis must awaken to the awareness that violence is insane and only perpetuates itself. Only then will their common humanity prevail.

Musing 090119

January 19th, 2009

I still haven’t totally come to terms with what I intend in this blog. My tendency is to write only when I can say something I think others will be impressed with, which rarely occurs. Even then, I seem to need it to be concise and well thought out. Again, that means that it just doesn’t get done. I think I will try to do more of what I am doing here, just musing. And I hope anyone who stumbles across my musings will understand and accept them just as if we were face to face in conversation. If you know me, you can interpret the musings with the filter of what you know about me. If we aren’t acquainted, it may take you a while to get used to my inconsistencies and opinions, if you choose to stay at all.

I have also decided to try not to second-guess myself. If I change my mind about something, I will not delete the original opinion, but will just add the new thought. So, for instance, although I now feel I was a bit too passionate in my response to Obama choosing Warren to provide the invocation at his inaugural, I will leave the original passionate statement and add a less passionate opinion as it occurs to me.

In other words, I will not try to make this into the “Huffington Post” or any other site where the erudite gather, but will keep it as a personal thought diary.