I have minimal time for a post today but despite my concern about the rush by the Democrats to pass a horribly misguided and bloated healthcare bill and the possibility of the EPA taking it upon itself to attempt to regulate our breathing (via CO2) I suspect the best, or worst, of Barack Obama is yet to come. We still do not know how he will react in a crisis. Although the administration has been trying to leverage a sense of crisis for the last year (so as not to let any opportunities go to waste) Obama has not yet had to deal with a truly disruptive international incident. We may be lucky and the Iranian people may yet remove the most likely source of instability in the world but it is equally likely that another war will break out in the Middle East either via miscalculation, accident, or design. As the Mullahs feel more desperate the possibility of war can only increase.
At the same time, the world has a habit of surprising us with its crises. Here are some of my worries as 2009 draws to a close:
How would Obama respond to a terrorist attack with mass casualties? What about an attack involving a recently released inhabitant of Gitmo?
How would Obama react to a war in the Middle East in which Iran closes the Strait of Hormuz? (even without successfully closing the Strait, the price of gas would sky rocket at the mere threat.)
How would Obama react to another North Korean nuclear test?
How would Obama react to a sudden collapse of the dollar? (It has been slowly decreasing in value but such a decrease could easily accelerate with a significant Bond Auction failure.)
The problem for the next few years is going to be how to manage America's increasingly impaired ability to manage conflict. We cannot afford to continue to police the world and need to find ways to spread the burden. Can we come to a workable relationship with the Chinese, who have a notoriously amoral foreign policy and may still see the world as a zero sum game?
In all of my concerns, the wild card is some disruptive technology that matures in a surprising way or more quickly than expected. Any suggestions?
These are a few of my worries in this, my last post of 2009. I would be interested in hearing from my commenters where and what they suspect will be the source of the crisis that will finally start to answer the question of how Barack Obama would respond to the 3AM phone call.
Regular blogging will return on Monday, January 4th, 2010. The 21st century is well underway. Miracles will be arriving and occurring on an increasingly irregularly regular basis as we move further into this young century. It should be a fascinating, at times exhilarating, and at times terrifying ride. Put on your seat belts and hang on.
For all my Christian friends and readers:
A major archeological discovery just before Christmas could explain what life was like for Jesus and the Jewish community of Nazareth in which he grew up.
Just 100 meters from the Church of the Annunciation, archeologists have exposed the remains of several walls of a house thought to date to the first century. It is the first time that archeologists have found remains of dwellings in Nazareth from this period.
We are living in amazing times. Our urge to build and know remains just slightly greater than our urge to destroy and blind ourselves; the swings between the two extremes can feel like societal manic-depression at times.
This story was count as belonging to our urge, our need, to know. Fascinating and potentially wonderfully enriching.
Progressives imagine that government workers, free from the evil profit motive, are able to perform their selfless functions for the good of their subjects, unworried by the need to save money to line the pockets of their masters. (Why so few Progressives are able to generalize from their experiences at the DMV remains a mystery for another time; perhaps they don't own cars or ever drive?) Consider: [HT: John Hinderaker]
According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%
It actually gets worse. In their zeal to ferret out fraud and waste, the apparent cause of of all government deficits without which, we are assured, we would certainly be able to have a surplus in our budget, Medicare treats its providers as potential criminals, all of us apparently attempting to maximize our profits by charging for unnecessary tonsillectomies, phantom services, and the like. Two years ago, when I still accepted Medicare coverage (though had stopped accepting new Medicare patients) I was audited by Medicare. I was asked to supply detailed notes on every one of my Medicare patients (4 patients, at that time) for the prior 3 months and asked to justify my billing code. I had been billing for 90807, Psychotherapy, 45 minutes, with Medication Management; all of the patients were on various medications and part of my sessions always included an assessment of the efficacy of the approach, though I did not formally note or evaluate their reactions to medication. Please note that this was how I was trained and billing for such services had been unobjectionable for the last 25 years. Apparently, unbeknownst to me, Medicare had decided to challenge payments for 90807 (Psychotherapy, 45 minutes, with Medication Management) because they thought my patients were only receiving 90806 (Psychotherapy, 45 minutes, without Medication management). Unless I could prove I was managing my patient's medications every week when I saw them (perhaps I could have taken their BP or asked some perfunctory questions about side effects?) I was committing Medicare fraud; the notices (there were many, in part because I am not terribly assiduous about my paperwork) detailed all the punishments I was risking if I did not comply with their audit request and failed to document 90807.
Here is the best part: The difference between 90807 and 90806 was ~$3.50 a session. It was likely I was overcharging Medicare by as much as $12.25 every week! (Two patients had supplementary insurance so paid the full $3.50 difference; another had the means to pay the difference; the fourth patient had very little money and could not afford to pay his half of the Medicare acceptable fee.)
Under the new Medicare guidelines, I was guilty as charged until proven innocent. I sent in my notes (scrubbed of any important information) and was told that I was only allowed to bill for 90807 on average once a month for my patients based on my documentation. Over a 3 month period, I had overcharged Medicare by almost ~$150! I had the right to appeal but just sent them a check. Considering the number of letters sent back and forth necessary to threaten me to gain compliance and the time spent perusing my submitted notes, I suspect Medicare lost money on the exchange. However, a bureaucrat somewhere was earning his pay!
(Ignorance of the law is no defense, and I freely admit that I never read the notices Medicare sent me, seemingly several times a month, about changes in their billing. I had neither the time, nor the interest in keeping up with Medicare billing; they paid less than I would accept from a new patient and I only had continued in the system for my legacy patients. The less I had to do with them the better I liked it. I did not believe in abandoning patients simply because they could no longer afford my fee and accepted Medicare in full for their treatment. Since Medicare authorized a low fee, and only paid 50% of that, unless the patient had supplementary insurance, I was not about to get rich treating Medicare patients with Psychotherapy. I could make a lot more money seeing patients for Med management under Medicare and/or private insurance; I could see many more patients and since the fee for Psychotherapy is much less on an hourly basis than the fee for Med management, the volume would bring in much more money. Unfortunately for me, I prefer treating people as if they are more than a collection of neurotransmitters; a quaint approach admittedly and not a good fit for everybody.)
Hidden within the new healthcare bill is a change in status for insurance companies from independent, for profit entities, to something more along the lines of a public utility, with rates set by anonymous boards, insulated from public reaction by the usual layers of bureaucratic obfuscatory edifices. Insurance companies have always defaulted in their rates to converge on Medicare fees. With the new government control of the insurers (who gain a new, captive group of healthy rate payers, ie guaranteed profits, while giving up risk and freedom; the insurance companies are not at all unhappy with the bill and that should be informative) we will all be the beneficiaries of a system which is designed to see patients and Doctors as adversaries costing money for no benefit to the bureaucracy.
Don't say I didn't warn you.
During the last few years of the Bush administration there was general agreement that the level of partisanship and partisan vitriol was beyond anything seen since the days of the Vietnam War. If anything, the level of partisanship under Barack Obama, Nancy Pelosi, and Harry Reid has further escalated. Major legislation is pushed through despite the lack of even a fig leaf of bipartisanship, and against the wishes of a large majority of American voters. The Left is disappointed in the healthcare bill because it appears to reward some of the very corporate "villains" they detest the most (insurance companies, Big Pharma) while the right is angry and worried that the healthcare bill represents an attempt to fundamentally change the nature of the country. Mickey Kaus summarizes: [HT: Glenn Reynolds]
Today's left and right anti-Reid activists have a common enemy in corporatism, the easy alliance between Big Government and entrenched, favored too-big-to-fail businesses (Aetna, AIG .... ) that threatens to give us all the inequality of capitalism with all the dynamic innovation and accountability of socialism.
For those who are currently running the government, even the risk of electoral disaster in November 2010 does not impact their decision to force through major legislation that will disappoint friend and foe alike. Since the First Rule of Politics is to get elected and the Second Rule is to get re-elected, how can we understand the seeming suicidal behavior of the Democrats?
[For those who correctly opine that the Republicans did much the same thing when they were in office, ie they attempted to enlarge the size of government and the power of the bureaucracy, too, just with a different partisan valence and less assiduously. I would suggest that this increases the likelihood that my assessment, to follow, is credible.]
First a slight digression. I have written quite a bit on Societal Regression, the tendency for a society to retreat from the messy dynamic instability of democratic governance to more primitive, zero-sum governance (authoritarianism, totalitarianism) in the desire for security or in response to dangerous threats to the system. Many sophisticated commentators have written persuasively that al Qaeda and other manifestations of radical Islam are a result of the dislocations caused by modernity for relatively primitive, tribal cultures. The recourse to violence and power plays in response to marginalization is a very old story.
With that as preamble, I offer a possible diagnosis of the paradoxical present: Just as people are becoming exponentially more empowered by the acceleration of our technology, we have a response from the ruling classes in Washington (Democrat and Republican alike, though with some signs that parts of the Republican establishment are becoming aware of their contradictions) seeking to increase the centralization and concentration of power into the Washington establishment.
In other words, the Bush administration attempted to impose its vision of centralization upon a globalizing world via the use of military force. They did not succeed. Now the Obama administration is repeating their underlying dynamic, using government power over the American people in an analogous manner. They are attempting to centralize decision making under their aegis; this is noxious to the American people who will respond electorally. Beyond any electoral response, Obama will fail in the long run because the trend is away from centralized power and control just as Bush failed for much the same reason, though in a different neighborhood using different means.
[For those who believe that technology will be used by the state to enslave its people, I would suggest that this cannot work for long. Any government that imposed the requisite totalitarian regime in order to maintain its power would soon find itself going bankrupt. (North Korea would be exhibit A.) The Chinese have discovered that an open economy is necessary to create the excess wealth necessary to support a modern state. A closed economy would be one which would not generate enough wealth to bribe the people adequately to maintain control. A slow descent into poverty would be assured. At the same time, empowering and liberating technology developed elsewhere would eventually come to the enslaved country via increased connectivity, the power could never be maintained in the center for long.]
Many people who study the impact of modernity/globalization on society have noted that decentralization is a certainty as we continue down our path. There may be detours along the way but the inevitable loss of power and authority that is a part of the current technology enabled progression is unmistakable. We see this in Climategate, where those who were the "authorities" have been seen to be subverting science in order to preserve and enlarge their authority even as the Internet undermines them by the day. We see this as well in the current polling that places the Tea Party movement more favorably than either the Democrat or Republican Party.
We are living in in a time of near constant churn. Disruptive technology, which used to appear once in a generation, now affects each of us in very personal ways on an accelerating basis; it often feels as if there is no predictability from one day to the next for many people. Our jobs are insecure; at any moment we could become victims of the changing economic environment, and the jobs that are lost are probably never coming back. More and more of us are becoming "augmented humans" with more and more of our mental capacity externally enhanced; most of us already have external auxiliary memories (Google, et al) and auxiliary cognitive functions (iPhone apps, computer programs).
Americans have always been a people whose political philosophy might best be summed up as a struggle for the right to be left alone; at the same time that our technology is giving us all a greater degree of control over many of the details of our lives (with much more control to come) those who have made it their life's ambition to control the levers of power, ie government, are reacting as if they had better seize control of as much as they can while they still can.
John Robb talks about Resilient Communities emerging as a response to the negative effects of globalization (international crime, terrorism) . Resilient Communities could also arise as a response to the negative effects of government and the inevitable failures of essentially bankrupt governments.
Power and control are atomizing. In reality the illusion of Pax Americana that prevailed from the 1980s until its collision with reality in the "oughts" depended on the existence of effective nation states; now it is increasingly clear that starting from the international sphere but devolving to smaller and smaller units of measurement, central control cannot succeed. It is no surprise then, that those who have attached their lives, their fortunes, and their secular honor (with apologies to our founders) to international and national central control would desperately attempt to enhance that control; the tide of technological man is running against them. It is now all about power; they must either crush their opponents or face ruin.
A very annoying meme promulgated by those who support healthcare "reform" is that the opponents have no ideas how to improve the system. This is disingenuous at best. John Steele Gordon offers a non exhaustive list of easily accomplished, proven effective, means to increase efficiencies and decrease costs in our system:
But I was struck by one thing that Brooks wrote: “The fact is, nobody knows how to reduce cost growth within the current system.”
Of course we do.
Allow people to buy insurance across state lines and thus escape unwanted mandates and such economic idiocies as “guaranteed issuance.” If New Yorkers could buy health insurance in Connecticut, their insurance costs would drop by 40 percent overnight. How’s that for reducing costs, Mr. Brooks?
Read the whole thing.
Atul Gawande Became a staff writer at The New Yorker in 1998. Also a surgeon, he completed his surgical residency at Brigham and Women’s Hospital, Boston, in 2003, and joined the faculty as a general and endocrine surgeon. He is also an associate professor of surgery at Harvard Medical School, an associate professor in the Department of Health Policy and Management at the Harvard School of Public Health, and the associate director of the B.W.H. Center for Surgery and Public Health.
Dr. Gawande is an Academic Physician, a rare breed that tends to understand Medical Practice from a rather unique point of view far removed from the reality of most Medical practices. Academic Physicians tend to support single payer healthcare (which most of them already practice under, ie they are usually salaried employees of large institutions.) This does not invalidate their recommendations but it should be understood that they operate in a different environment than most American Physicians. Dr. Gawande addresses one of the key issues in Medicine and healthcare: [All emphases mine-SW]
The health-care bill has no master plan for curbing costs. Is that a bad thing?
Cost is the spectre haunting health reform. For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage. Those gaps have widened to become graves—resulting in an estimated forty-five thousand premature deaths each year—and have forced more than a million people into bankruptcy. The emerging health-reform package has a master plan for this problem. By establishing insurance exchanges, mandates, and tax credits, it would guarantee that at least ninety-four per cent of Americans had decent medical coverage. This is historic, and it is necessary. But the legislation has no master plan for dealing with the problem of soaring medical costs. And this is a source of deep unease.
Health-care costs are strangling our country. Medical care now absorbs eighteen per cent of every dollar we earn. Between 1999 and 2009, the average annual premium for employer-sponsored family insurance coverage rose from $5,800 to $13,400, and the average cost per Medicare beneficiary went from $5,500 to $11,900. The costs of our dysfunctional health-care system have already helped sink our auto industry, are draining state and federal coffers, and could ultimately imperil our ability to sustain universal coverage.
What have we gained by paying more than twice as much for medical care as we did a decade ago? The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don’t. Improvement in demonstrated medical outcomes has been modest in most fields. The reason the system is a money drain is not that it’s so successful but that it’s fragmented, disorganized, and inconsistent; it’s neglectful of low-profit services like mental-health care, geriatrics, and primary care, and almost giddy in its overuse of high-cost technologies such as radiology imaging, brand-name drugs, and many elective procedures.
The rest of the (very long) article draws an analogy between government intervention in agriculture and the resultant (or concomitant) increase in agricultural productivity to the introduction of (increased) government intervention in Medicine. Whether or not the analogy is convincing I will leave up to the reader. It seems to me that in Agriculture, where price signals are hidden or distorted by government intervention, we suffer market dislocations. (It is not a coincidence that corn syrup seems to be in half the food sold in supermarkets these days.) In Medicine, we already know that hiding or distorting price signals distorts the delivery of care and the type of Medical care offered. To his credit, Dr. Gawande notes that Tort reform is conspicuous by its absence in the bills being discussed, though he does not make note of the fact that such an absence supports the notion that once politicians have increased control over our healthcare system, politically motivated distortions will become increasingly problematic.
Beyond those quibbles I found myself becoming quite irritated at the assumptions in the article. The "estimated forty-five thousand premature deaths each year" from the lack of insurance coverage is one of those statistics that makes its way into the conventional narrative, but falls apart upon closer inspection. The original study purporting to find the number is riddled with caveats and uncertainties. Further, access to government insurance also has its share of "premature death" associated with it:
Let's be clear; any preventable death is a tragedy: the loss of someone's sister or brother, father or mother, spouse or lover.
Yet the study doesn't claim that the deaths it estimates among the uninsured are preventable, only that they are "associated with" lack of health care.
By contrast, a comprehensive study of over 35,000,000 -- yes, that's million -- acute care records over a recent three-year period concludes that preventable medical mistakes actually cause a similar number of deaths in the government-run Medicare program. The sixth annual HealthGrades Patient Safety in American Hospital Study examined records "among Medicare patients at virtually all of the nation's 5,000 non-federal hospitals" from 2005-2007 and determined that over 92,000 deaths were attributable to medical errors, about the same as the average estimate in the uninsured study.
It can never be repeated often enough: Correlation is not Causation!
No one is denied medical care in America. Unnecessary death can result from patient's inattention and poor self care, poor Medical care, delayed treatment, and a whole host of other reasons. Lack of insurance is on the list but it is not at all clear that it is the most important or even a major cause of premature death.
There are certainly situations in which people lose insurance or have difficulty gaining insurance and there may be some fairly simple ways to make insurance coverage more affordable and more widely available. Just allowing insurance sales across state lines and eliminating most mandates in insurance would do a great deal to lower costs, yet the bill actually goes in the opposite direction.
The other charge, that we pay too much for too little is also worth questioning.
The preliminary number of deaths in the United States for 2007 was 2,423,995, representing a decrease of 2,269 from the 2006 total. The estimated age-adjusted death rate, which accounts for changes in the age distribution of the population, reached a record low of 760.3 per 100,000 U.S. standard population, 2.1 percent lower than the 2006 rate of 776.5.
The magnitude of the decreases in mortality (which are significant unless specified otherwise) by age group is):
* Under 1 year (0.6 percent, not significant)
* 15–24 years (2.4 percent)
* 25–34 years (1.4 percent)
* 35–44 years (3.1 percent)
* 45–54 years (1.8 percent)
* 55–64 years (1.7 percent)
* 65–74 years (2.7 percent)
* 75–84 years (1.9 percent)
* 85 years and over (2.1 percent)
This is only part of the story. Consider this example of Medical progress:
It should be possible to use therapeutic vaccines to create both cheap and effective drugs for diseases like cancer and allergies. One problem in developing such vaccines has previously been the lack of adjuvants, substances that make vaccines more effective. However, there has now been a major breakthrough in this area. “We have made a very important breakthrough by managing to identify a substance that is biologically degradable and that exhibits considerably higher activity than the adjuvants that have been used in the past,” says Lars Hellman. “These new and highly promising findings are an important step toward developing more cost-effective drugs for some of our major public health diseases,” he says.
Many of the treatment methods that are developed today for allergies, cancer, and autoimmune diseases are based on the use of so-called monoclonal antibodies. The cost of these protein pharmaceuticals is high, between 15,000 and 150,000 dollars per patient and year, and long periods of treatment are often needed. Therapeutic vaccines contain no pre-produced antibodies but rather stimulate our immune system to produce its own therapeutic antibodies. They are considerably less expensive to manufacture than the drugs that are now being produced.
There are two important points that are germane to the discussion of medical progress and Medical costs. Monoclonal Antibody (MA) treatment is extraordinarily expensive yet it also offers treatment, cures and relief of symptoms, that are unavailable with older technology. There are many people alive and well (or better) today because they were fortunate enough to live in a time when Monoclonal Antibody treatment has become available. At the same time, if everyone who could benefit from MA were to receive it, we would be facing a greater healthcare cost crisis than we already do. Yet, the article today also pointed out that as our knowledge has increased, a team of scientists in the Department of Cell and Molecular Biology at Uppsala University may have found a way to use the knowledge that originated in studies of the immune response to disease (which led to the development of MA) to find a much less expensive way to do the same thing that now only MA can do. The financial savings will be marked and welcome. Yet this is not the end of the problem. Once the very expensive MA treatments for various Cancers and other amenable illnesses are replaced by much less expensive treatments, we will have a large cohort of patients, getting older by the day, staying within the system until the time at which they develop a new condition which will be difficult to treat and manage; in due time these new conditions will be approached with novel, very expensive treatments, with escalating costs, until the day a new research group devises a novel treatment approach that is even more expensive, and curative, eventually replaced by a less expensive treatment which comes into widespread use (because it is now affordable) and the cycle continues.
Generally, people do not want to die prematurely (and one definition of "premature" might mean, for any particular individual, "I don't want to die as long as I am in reasonable health and can find joy in my life without too much discomfort.") As long as we continue to "Rage, rage against the dieing of the light" Medical costs will have to increase. There are a limited number of ways to moderate the cost of healthcare:
We can moderate the increase by stopping the advance of Medical care and effectively lowering our life expectancy. Medical innovation is extremely expensive, not least because of all the regulatory hurdles placed in its way.
We can ration care via government edict, by establishing a hierarchy of diseases for which government insurance must pay; politics dictating treatment options.
We can ration by limiting availability to all via a diminished supply of Doctors willing to accept government established reimbursement rates; already occurring in Medicare and Medicaid and likely to accelerate as more, sicker patients enter the government run system.
We can ration via the market place, which has the advantage of accelerating Medical research because of the promise of riches for the developers and discovers of new and effective treatments; this would be immeasurably helped by also increasing market price signals for Medical care (which means increasing people's awareness of the real cost of services and increasing the portion of the price over which they have control)
Because too many of us do not want to die prematurely, the cost of Medical care can only go up at an accelerating pace. The current bills appear to do nothing to increase price/cost transparency and will therefore worsen a difficult situation. At the same time, a great deal of power will flow from the individual patient-family-Doctor triad to a patient-government bureaucrat-family-Doctor tetrad. (I recognize that the insurance companies are involved in the patient-family-Doctor triad but in a conflictual situation, the government can step in to override the insurance company. Once the government effectively replaces the insurance company, there will be no such recourse.)
For all those desirous of universal healthcare, be careful what you wish for. You might not be happy exchanging an expensive system that has managed despite all its inefficiencies to continually increase our life expectancy for an expensive system that inherently interferes with that very process.
The idea of Principia Liberalis was to explore the roots of those partly different perceptions of reality ShrinkWrapped and I have of the world. I say partly because, of course, like most humans, we share a lot in our perceptions. I think he and I may even share more than that. But there are profound political differences. Shrink and I can play Cross Fire with each other. It had a pretty good run on CNN, and we all know what a lasting contribution it made to political discourse and to the deepening of our political understanding. Why not, instead, as some readers had suggested, see if we can determine where we part ways, which entails, as fundamental to the process, reaching back far enough in our grounded or ungrounded beliefs about the world to some ground we might actually share. Otherwise we are still suspended in the ideological air shouting at each other, with no idea how I came to hang here, and he got to floating over there, from the ground, wherever it is, on which we both began.
Now, it is abundantly clear from our exercises in posting thus far that some conservatives reading along believe they already have the various answers to that, accordingly, not so open question. Engagement, then, with any ideas I proffer, is not required. This is unfortunate, because in those instances, where people have engaged me, there have been some interesting exchanges, some modest agreements, and even surprising discoveries. Others, however, are content to rant the rants they’ve got down about as good as The Boss has got his 70’s playlist down, with their versions of “Born to Run” ready to play in their sleep. So it is that, while I write at the end of the introduction to my list of principles
I offer one closing, guiding principle for reception of this effort: note its subtitled denotation of “a” liberal. Your humble and fallible servant is neither the face nor the voice of “liberalism.”…There are others willing to play that role; I think and speak for myself
we hear quickly from one reader, “Number 24 says terror and tyranny must be opposed and freedom and democracy defended. Liberals do not believe any of that” and I am upbraided by another – suffering from a loss of faith in the whole endeavor and, oh, dear, me – “And who died and put AJA in charge of speaking for liberals?”
One complainant for whom complaint is like an attempted take down at the knees, to avoid confronting the ideas head on, pretends to counter by noting that I did not define “justice,” as if a blog post intended to spark discussion were an essay in political philosophy. It is worth noting, against this devastating take down, the preamble to the Constitution of the United States:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
You will search in vain through the Constitution – a pretty substantial document, I hear tell – for a definition of justice, or for that matter of “the general welfare,” though the authors were rather clear about the meaning of “people,” in whole or in part – so that while the Constitution set forth a wide range of principles of government that so many Americans found disappointingly agreeable at the time, history reports they found enough to fight about later on.
Similarly, to charge my principles with being a “jumble” or my thinking with being “sloppy” without offering reasoned analysis of the principles in order to demonstrate the incoherence of the jumble or the slapdash of the sloppy – and I am, I assure my valued readers, quite prepared to argue to the contrary – is to offer only the pretence of argument. It is not argument, particularly as it shifts focus to me and my generic liberal intellectual inadequacies and the assertion of my objectionable personal qualities. It is, instead, beer spritzing from the cheap seats. The beer drinkers may think the beer a fine conservative Doppelbock – all seriously bottled in disdainful condescension and advertisement of pedigree – but it is a spritz nonetheless. It’s okay that there are cheap seats and that people spritz from them – a full, rowdy stadium makes the contest more exciting. But cheap-seaters do not win the game. They do not even play in it. I am grateful, however, for current, lively examples of what is referred to in logic as shifting the ground and simple evasion, that I may offer them to my students, along with clear representations of ideocentrism.*
I am, of course, equally appreciative of the patronizing compliments for my willingness to discuss my beliefs, so unlike, it is claimed, the typical boorish liberal – as if I were Kasper Hauser being readied for A Report to an Academy. As many of us are likely to entreat at the moment of ultimate extremity: “Spare me.”
The ideas, ladies and gentlemen, the ideas.
SW rightly observes of many of my principles that the proverbial devil will be in the details. We needn’t necessarily look too far, however. Of my second and third principles –
2. Human beings aspire to the good and are drawn to the bad. They are both. There is no evidence to conclude which will ultimately rule in them.
3. Human history is both sublime and horrific.
Shrink responds “Who could disagree?” In fact, I think he will agree on reflection, with regard to 2, many people. Many people believe in the essential goodness of human beings. Many people of various religious traditions so believe, that despite human weakness, the essence is good. The utopian tendencies that lead, at an even more modest level, to what conservatives tend to believe is an inordinate trust by liberals in the efficacy of big government begin in this faith. Just the other day, in responding to my post Obama Abroad: Liberal, Moderate, Careful Shrink cited Richard Landes’s definition of Liberal Cognitive Egocentrism:
The projection of good faith and fair-mindedness onto others, the assumption that “other” shares the same human values, that everyone prefers positive sum interactions. In a slightly more redemptive mode, LCE holds that all people are good, and if only we treat them right, they will respond well (emphasis added).
Principle 2 asserts none of this.
In relation, regarding principle 3, while it may appear to offer a self-canceling form of balance – as is the presentation of many of the principles – this is not the case. Much debate between the left and the right is conducted at either/or extremes. The balanced ideation of these principles is intended, meaningfully, to avoid that unproductive procedure. To assert that human history, and the humans who produced it, as agents, has been horrific, sensibly requires of us that despite any countervailing sublimity in human achievement, the awful tendencies of humans be invariably considered in our political and other thinking, without illusion. In his post yesterday A world well saved, Norm Geras at Normblog makes the parallel argument with regard to our better graces.
Principle 5 states
5. There is such a thing as evil. It often conceives of itself as a good.
SW replies that “the statements seem pretty self evident” and that “one must inquire by what guidelines would Jay delineate good versus evil?”
I do not think the statements, particularly the second, to be so self-evident. After 9/11, from some of the very quarters that Shrink would criticize (and in which criticism I would join him) came much oddly sanctimonious and ironic derision of the notion of evil. The idea of evil is frequently conceived – and then extended into caricature – as a self-knowingly malevolent force, in the manner, for instance, of Milton’s Satan: “Myself am Hell.” If not quite so definitively self-aware, there is, indeed, such evil in the world. However, the history of Utopian totalitarianism, as well as of military coups and tyranny and the theft by leaders of the liberties of their people in order to “save them,” they often sincerely believe, from some greater threat is a history of a far more complex and insidious form of evil.
The guidelines I rely on, with my fellows, in delineating good from evil – without being required to transform a blog post into a treatise – are the patient practice of reason in conjunction with natural human empathy. Shrink raises the concern of “moral equivalence and moral relativism” and claims that “one clear difference between Liberals and Libertarian/Conservatives resides in just this fact, the Libertarian/Conservatives do believe there is an absolute basis for distinguishing good and evil.” I think this is counterproductive generalization. I agree that the area of his concern is to be found predominantly (not exclusively – relativistic ideas have become pervasive within many poorly conceived sets of beliefs) on the left. However, while an absolute grounding of morality in religious belief is found throughout the political spectrum, I think it fair to claim that it predominates on the right, and moral absolutism founded in religious belief – unless God speaks to one in a manner the rest of us can overhear, or one was present at the deliverance of the tablets to Moses – is a faith casting a shadow far longer and larger than any faith in big government.
Shrink cites my principles 7-14:
7. Nations, like people, are responsible for their actions. They act as historically and legally conceived and constituted entities, and they are responsible as historical and legal entities.
8. The animating determinant of historic national responsibility is in the living consequences of past acts: no continuing consequences, no conceivable responsibility.
9. The past cannot be undone, but the future can be different; this is accomplished through understanding and acknowledgement of the past and accountability for it.
10. Accountability for the past is policy for the future.
11. The colonial epoch is ended. Its consequences are not.
12. Victors record history. This does not make the history false. Neither does it make it true.
13. Conquerors leave the past behind more easily than the conquered. This is because the conqueror owns the future.
14. To have been conquered or oppressed, to be weak, does not ennoble a people before or after the fact; the acts of a conquered, oppressed, or weak people are not legitimized by those conditions. Neither is the injustice of their conquest, oppression, or weakness abused, or the justness of redress, negated by their imperfection.
He sees in them a reflection of my interest in Native American issues (and, in fact, the issues of indigenous peoples in general). He is right to see this, but the principles go beyond them to encompass the continuing political ramifications, worldwide, of the colonial era. Shrink states, “Again, there is little to object to on the surface.” I think otherwise.
Principle 7 asserts the well established notion, internationally, of national responsibility. Principle 8, further, states that the responsibility is enacted by the “living consequences” of past acts. Principle 9 calls for acknowledgement of the past, leading to accountability, and principle 10 affirms that this accountability is the basis for future policy. Principle 11 turns from what might be a more limited national sphere to a wider, international realm. Principle 12, while balanced in form, challenges any notion that victory affirms the truth of its narrative or the values that inform it. Principle 13 is a partial response to the historically simplistic “move on” argument regarding the cultural condition of conquered and colonized populations. In some contrast, principle 14 avers, contrary to the animating sympathies of much anti-imperialist and postcolonial ideology, that disadvantaged (for whatever reason) populations are not by virtue of that relation to power ennobled and affirmed in their political actions and programs.
In truth nearly all of those principles, particularly the first four, which received focus then, were problematic, even strongly objectionable to many of the conservative readers who commented during The Open Mind 1 discussion of Native America.
In his first response to my principles, SW referred to 22 and 23:
22. Government is neither good nor bad. It is necessary. Neither is its size good or bad. It should be the size necessary to fulfill the responsibilities judged to be appropriate to it. Government is best assigned those responsibilities that are necessary to the commonweal above what is necessarily optimally efficient, though it need not be an enemy of efficiency. Sources of optimal efficiency cannot concern themselves with the common good whilst remaining optimally efficient; they must be managed when applied to the common good so that a balance is achieved between efficiency and the breadth of the benefit they deliver.
23. A breadth of interests entails a breadth of power to protect them. A breadth of power generates its own interests. Even a benign power will be caught in this cycle of mutual reinforcement. Imperial behavior, conceived only as protection of interests, can expand innocently and then be justified, in the maintenance of an imperial nature, as a necessary protection of interests.
Wrote SW, Jay “imagines a government designed to solve certain problems, with enough power and size to adequately address the particular issue, with minimal interests of its own which might skew its ability to act in the dispassionate service of its people.”
If such is the appearance, I correct it. SW asserts that I somewhat contradict 22 with 23; however, I was not focused on, nationally, the size of government in 23, but, internationally, a tendency toward a form of empire. I addressed this subject at somewhat greater length in Obama in Oslo: Power without Empire.
Shrink is right, of course, to perceive the same application to government size. I agree with it. However, the tendency among conservatives is to focus on human imperfection in the practice of government, and the accretive nature of power in the hands of government, while remaining far more sanguine about the same issues in the marketplace. As principle 22 suggests, as governments tend toward the accumulation of power, theoretically optimally efficient systems tend only toward optimal efficiency, and when they involve human beings are subject to the influence of the same human imperfections. Note today’s report on Intel’s monopolistic practices.
Finally, for now, on the matter of justice:
18. The greater the justice, the greater the harmony. All oppositions are not enemies; the reconciliation of many oppositions leads to greater harmony and greater justice. This does not mean that all claims are valid, all positions legitimate, or that all demands should be met: many claims, positions, and demands are themselves unjust and destructive of harmony.
My interest here was in opening up discussion on a single issue – a belief in an inherent opposition between the interests of the individual and the group that appears to be, in fact, a shaky common ground for many on the left and the right. I think that a belief worth challenging.
AJA*ideocentrism (a neologism devised independently by me and others): a belief in the superiority of one’s ideas so fixed that one is unable to credit opposing ideas as worthy even of sustained exploration. An ideocentric individual might make, for example, the fatuous statement that “Conservatives believe in human reason,” implying, in the context, that liberals do not believe in reason, or perhaps only, one might presume, in monkey or canine reason.
As ususal, comments here are closed; please leave any comments at Jay's site.
Since the time of Freud, accelerating with the Women's Movement (which, though it has gone too far in many respects, was invaluable in enabling our culture to optimize our human potential) we have understood mature, adult sexuality to include a number of important elements. Among those elements are autonomy, freedom with responsibility (heavily eroded though it has been since the 1960s), and at its highest level, sexual relations as a mutually enhancing experience expressing the deepest intimacies between two people. In this conception, adults were offered greatly enhanced freedoms to engage in the most casual sexual relations but it was well understood that physical intimacy without emotional intimacy represented an imitation of adult sexuality rather than its full expression.
In contrast, when adult sexual freedom is restricted within a culture, it leads to the fetishization of sex and the perversion of relationships, where the sexual partner is turned into a mere need satisfying object whose own individuality and independence are truncated. This is most obvious in very traditional tribal cultures which restrict interactions between young adults and proscribe sexual relations in significant ways. [Please note this is not invariant; many people find long term deepening relationships in the most repressive tribal societies, but this is far more difficult to achieve in highly restrictive societies.]
In my series on The Arab Mind, I discussed some of the Psychosexual pathology that is intensified in a setting of increased male infantile narcissism, devaluation of women, and abuse. The boys tend to grow up to be insecure men, fearful of women (who retain the infantile omnipotent core inherited form the earliest relationship to the mother) and disdainful of women specifically because of their power. It is no surprise that the highest per capita frequency of internet searches for porn are found in Arab countries. As a young Saudi man once told me in a personal communication, "everyone I know surfs the net for porn all day long."
Women, on the other hand, develop under the influence of profound distrust and disdain of their sexuality along with specific assaults on their autonomy. Mothers who see their only avenue to status as the production of Jihadi martyrs are a common outcome.
Foreign Policy magazine has an article describing Hezbollah's successful approach to leveraging this pathology in ways which enhance its stature and enlarge its power. [HT: SW reader DH]
The Militarization of Sex
The story of Hezbollah's halal hookups.
Mohammad, a 40-year old Lebanese Shiite who lives in Hezbollah's stronghold in Beirut's southern suburbs, was holding forth on the virtues of resistance, loyalty, and sex. "You could create the most loyal army by providing political power, social services and fulfilling the desires of your men -- namely, sexual ones," he declared.
"And Hezbollah has been very successful in this regard," Mohammad continued. It is hard to disagree. Hezbollah liberated South Lebanon from Israeli occupation, expanded the Shiite community's political power within the country, and has provided social services, such as health care and education, to its constituency since the 1980s. Today, it is also working to fulfill the sexual needs of its supporters, though a practice known as mutaa marriage.
Mutaa is a form of "temporary marriage" only acceptable within Shiite communities, one that allows couples to have religiously sanctioned sex for a limited period of time, without any commitments, and without the obligatory involvement of religious figures. In conservative Muslim societies known for their strict sense of propriety, mutaa offers an escape clause. The contract is very simple. The woman says: "I marry myself to you for [a specific period of time] and for [a specified dowry]" and the man says: "I accept." The period can range between one hour and a year, and is subject to renewal. A Muslim woman can only marry a Muslim man, but a Muslim man can temporarily marry a Muslim, Christian, or Jewish woman, as long as she is a divorcée or a widow. However, those interviewed for this article confirmed that Hezbollah-the "Party of God"-has allowed the practice to spread to virgins or girls who have never married before, as long as the permission of her guardian (father or paternal grandfather) is obtained.
While mutaa marriage has been used to offer religious justification for prostitution (a particularly charming device of the Iranian Mullahs) it is far more than that in Southern Lebanon:
According to Shiite writer and activist Lokman Slim, Hezbollah party members are not allowed to practice temporary marriage for security reasons, unless assigned by the party to do so. "We should make a clear distinction between Hezbollah as an organization and Hezbollah as it runs the community's culture and social affairs," Slim said.
But for everyone else, Hezbollah apparently decided to expand its support for this practice after the 2006 war, to maintain its support base and keep the Shiites in Lebanon under its control. "After the 2006 war, Iranian money came to Lebanon in abundance, and money opened the door to sexual luxury that could not be ignored or controlled," noted Slim. "Therefore, Hezbollah decided it is easier to allow sex under certain religious titles in order to keep the control over the community."
And, if the way to a man's heart is through his stomach, the way to a man's political allegiance is often through a different part of his anatomy:
With his designer jeans, trendy haircut, and sharp sense of humor, Ali seems to be an unlikely Hezbollah supporter. He has always supported the resistance and what Hezbollah has achieved in this regard; however, in the last couple of years, he has developed a strong support for Hezbollah on issues he was previously critical of, such as its affiliation with Iran, involvement in domestic politics, and its religious rhetoric.
Coincidently or not, these developments took place as he was drawn to practice temporary marriage. In his southern village, it is difficult to meet girls and have normal relationships with them, and he acknowledges that getting closer to the party's social network has helped him meet more girls who were open to this kind of marriage. Gradually, Ali stopped drinking alcoholic beverages, took up praying and fasting, and never skipped a Hezbollah's rally or village events, where he also meets potential "wives." However, it is obvious that the slickly dressed Ali never gave up his love of fashion.
Of course, women gain their own rewards from the practice of mutaa:
It is, of course, not only men who take advantage of mutaa. Zahra, a fully veiled 25 year-old Shiite woman who is completing her master's degree in English literature, comes from a family of Hezbollah supporters and party members, and has been a lifelong Hezbollah member herself. She explained that she practices temporary marriage because it is a religious duty.
"I take good care of myself, and make sure I look perfect every time I go into a mutaa marriage because I should please my husband, temporary or not," she said. "It is my religious duty to do so. God allowed this kind of marriage for a reason, and I never question God's wishes."
Zahra is divorced and believes that Islam has acknowledged sexual desires for both males and females, which is why temporary marriage is permissible. "It is also a religious duty to fulfill your sexual desires," she insisted, noting that temporary marriages with women whose husbands had been killed fighting Israel were especially encouraged. "[T]hose who satisfy widows of martyrs have more reward in heaven," she said.
Mutaa may well be the Shia not-so-secret weapon against Sunni Islam, especially the puritanical form practiced by the Saudi Wahhabi sect that dominates Sunni Islam. What makes mutaa perverse is the lack of autonomy. All mutaa marriages must be sanctioned and controlled by Hezbollah, whether the disguised prostitution or the temporary, high status marriage with widows of martyrs. As well, a marriage in which there is a third party, a quasi-state which enforces its rule with overt violence and threats of violence, is a marriage which cannot foster adult intimacy but maintains its subjects at the level of adolescents using one another for their own needs. Dependants whose sexual pleasures are effectively controlled by another can never become autonomous adults and can never become a threat to their rulers.
Moore's Law in action:
One way to illustrate your good fortune of being a holiday shopper today is to measure the cost of goods by the number of hours it takes working at the average hourly wage to earn enough income to purchase typical consumer products at their retail prices, and then compare the “time cost” of goods from the past to today’s “time cost” for similar items.
Compare and contrast:
And note, there is no comparison between the capabilities of current technology versus 50 years ago; now extrapolate 50 years ahead. It boggles the mind, doesn't it?