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Tom's Musings

  • Sigh!

    January 4th, 2024

    One should be optimistic at the beginning of a new year. Turning the page and all that. Optimism is expected to bubble to the surface. Hmm, I find there is little optimism, however, in this household. Then, again, as I repeatedly say, I’m Irish, and we have a permanent cloud following us. So, I’m sitting here noticing the news items that cross my attention with increasing despair.

    This past year was another scorcher. Experts say that higher ocean temps suggest little change going forward. In fact, we might well pass the 2.7 Farenheit degree threshold (an increase above the pre-industrial global levels we are about to cross) that marks a tipping point on the way to climactic disaster. Oh, that’s something to look forward to … drought and starvation and massive migration culminating in societal collapse. You know, the end of civilization as we know it. How much fun will that be.

    There also was a letter to the editors in a Wisconsin newspaper referencing the fact that vaccinations against childhood diseases were in decline. The writer noted how prevalent rubella, measles, and whooping cough were in her childhood. There was even the occasional kid who wound up in an iron lung with polio. Science came along and relegated these childhood scourges to the dustbin of history. Now, political fear mongering is relegating science to the same fate. In climate change, we ignore science. In the battle against biological pathologies, we repudiate it. Good going! Well, killing off our children will help deal with the overpopulation problem. There is that.

    Then I notice yet another piece about how far ahead Trump is in the Iowa caucuses. I can only shake my head. It is one thing to be conservative. It is quite another to support a pathological narcissist who has no interest in governing at all, whose only interest is in promoting his own warped brand of ego gratification. Moreover, he does promise to destroy the pillars of our constitutional government in order to wreak vengeance on his enemies, real and imagined, usually those who believe in preserving radical traditions like fair elections and the rule of law. So, if you hate the American experiment, there is that. And this says nothing about his myriad of crimes and disgusting personal habits. What has happened to decency in this country? What has happened to basic common sense? When did America wake up and decide it wants to become a banana republic or worse … a totolitarian regime run by a mad man?

    And then I noticed a piece on India. I spent two years there in the late 1960s and watched as they struggled to realize Gandhi’s dream of an inclusive and secular society. It was a vision carried on by the ruling Congress Party in his name. Now, P.M. Modi and the BJP party are running things. They, like the Trump MAGA crowd, feed on tribal passions to pit one group against the other. They want this vast subcontinent to turn its back on inclusivity to become a Hindu national preserve. It is another form of nativism much like our white, religious evangelicals. The article went on to note that the man who murdered Mohandas Gandhi (who was a virtual saint to the Western world) is now being revered while the Mahatma is reviled as a secularist who sought peace among all communities. Imagine that … promoting nonviolence in the cause of love and understanding. How vile is that? But this tragedy does remind me that imbecility is not found only in America. You can go anywhere and find it.

    Yes, cursory glances through the headlines these days are not for the weak of heart. It is a damn good thing that I don’t follow the advice of the NRA and stockpile an arsenal of military grade weapons in my house. I might get so depressed as to pick one up and blow my own brains out.

    Sigh!

  • A New Year!

    January 1st, 2024

    New beginnings are typically a time for optimism. Yet, the prevailing disposition of those in my social orbit is decidedly pessimistic. My neighbors and associates routinely discuss exit strategies for when America slides into chaos or worse. All that may be idle chatter, of course, but the angst-ridden discussions reflect a deep, fundamental national pathology. We are no longer a confident nation.

    I’m not quite sure why the pessimism is so deep now. When I was born, the world was divided into deeply divisive ideologies (Facism, Communism, and democracy) embattled in a world conflict. When I came of age, America still practiced legal apartheid for minority citizens and faced urban violence as those treated poorly demanded their rights. It was not as if I could look back to some golden age when we all got along.

    And yet, there was a feeling of optimism back then. As I have oft mentioned, a poor and working class kid like myself could work his way through college and move up the socio-economic ladder. It was rather easily done. The opportunities available to white kids like me would soon be available to all, or so we imagined. We would see to that when we took control of the levers of power.

    What we could not envision was the backlash of the entrenched elite. From the days of the plantation owners of the South and the robber barons of the North, a small group of financial winners worked to employ government to maintain, even increase, their advantages. They were never unified, of course, and faced periodic backlashes, but this remains a constant in America’s political life … will government serve a wealthy minority or the majority.

    Today’s pessimism is based on the presumption that even the appearance of democracy will soon be swept away. The 2024 election increasingly is seen as a choice between a constitutional government, as imperfect as it is, and an authoritarian replacement adhering to the right-wing principles of white nationalism and religious extremism which would also serve the interests of the economic elite. Most neutral observers scoff at the dire predictions of a political apocalypse, but warnings even by sober analysts are increasing. Let us not forget what happened in Germany before Hitler assumed control.

    Still, it seems ridiculous to believe that the long experiment in American democracy might be abandoned, and not from an external threat but by internal choice. How could that happen?

    Well? We ought not forget that there has long been a strong authoritarian element in the U.S. The federal government routinely called out troops to protect the interests of industrialists in the late 19th century. The Palmer raids after WWI rounded up thousands of immigrants on specious charges of being threats and jailed or deported these poor souls. In the 20s, the KKK grew so large that it controlled several state governments and marched down Pennsylvania Avenue in the thousands. In the run up to WWII, many in the U.S. supported Fascist thought, and Hitler, the Silver Shirts and American Bund being examples. And let us never forget how the Communist hysteria of the 1950s led to McCarthyism and the crushing of free speech and thought in America. While the 60s generated a few leftist groups (the SDS Weathermen and the Black Panthers), hundreds of right-wing militia and hate groups continue to flourish to this day.

    No, a strong authoritarian streak has always been part of the American fabric. My take is that it is part of the price we pay for a heterogeneous society, one where diverse groups must compete and find a way to get along. That is never easy, of course, and leads to much finger-pointing and scape-goating. It is always easier to ‘blame the other guy’ than to seek common solutions. The American myth of individualism and the ‘strong man’ doesn’t help, suggesting that a dog-eat-dog world is the natural order of things. Cooperation, and notions of the common good, appear foreign to us.

    The choice before us in 2024 is whether we will continue to work toward a diverse, inclusive society (which we have never fully realized) or whether we acquiesce to being ruled by an economic and racial elite. The latter makes governing easier since diversity is ignored. But this ease of governing comes at an enormous cost … crushing the aspirations of the many who are not part of the favored group.

    The American choice is also a proxy for a larger, more global contest. Can we begin to work together on matters essential to the survival of the species or will be continue to spat over trivial, even meaningless, national issues. In the end, we are one people, floating on a precarious planet in an infinite universe. ♾️ Better that we understand how vulnerable is our situation and adopt a collaborative model of governance.

    Perhaps the American election in 2024 is a litmus test for our larger fates. If so, let us hope for a fortuitous outcome. Our very future may depend on it.

  • A year comes to an end … time to rethink priorities?

    December 30th, 2023

    We are approaching the end of 2023. I could say it is the best of times and the worst of times. That, however, would be engaging in hyperbole, and we have enough of that going in these days. No, this past year has been fine for the most part. People are working, wages are up, and inflation shows signs of abating. It is the future that remains murky.

    I am not going to comment on the overall state of the world. That would be above my pay range. But some things do bother me, and you few who read my scribbling are less expensive than a therapist. So, you are stuck listening to my ramblings. Aren’t you the fortunate ones?

    I’m struck by the fact that so few comment on the fact that life expectancy in the U.S. has fallen recently, the drop being more dramatic than any others seen in a century. Sure, Covid deserves blame, but we have not rebounded as robistly as others have. Robert Califf, Commissioner of the Federal Drug Administration, warned his colleagues as follows:

    America’s life expectancy is going the wrong way. We are the top health officials in the country. If we don’t fix this, who will?

    The numbers are sad, that is for sure. The life expectancy for males in the U.S. is 73.5 years. That may sound okay, but it puts us in 43rd place among countries where such things are accurately measured. A number of our peer nations have life expectancy rates north of the 80-year mark.

    Still, I wonder just how much blame, or responsibility, can be assigned specifically to public health officials. Yes, we have the most expensive health care delivery system in the world, by far. It is also true that our health outcomes are mediocre at best. And yes, our system is overly siloed, focuses on care by specialists, and treats prevention as being of secondary importance. All true. In many ways, our approach to health reflects our national obsession overall … which approaches and arrangements will generate the most remunerative bottom lines. A healthy population does not lead to high profit margins. Am I being too cynical here?

    I recall my brief conversation with the young surgeon who replaced my former ear doctor, an eminent surgeon who retired. (I have one ear that doesn’t work because of a tumor that has been removed.) I touched on these matters since I like chatting with professionals. He quickly dismissed my concerns with one observation. ‘Americans make poor lifestyle decisions.’ Of course, he was in a hurry (one must push the medical assembly line along after all). Thus, there was no time to explore what I thought was a convenient rationalization for our poor national health performance … blame the customer. But it got me thinking.

    Are there not other likely suspects to at least consider for our lower life expectancy rate. What about our insane gun policies? Our misreading (in my opinion) of the 2nd amendment has led us to become a carnage-ridden shooting gallery. We have 37,000 gun related deaths per year, just about as many American soldiers as were killed in the Korean conflict. The sop of guns saving lives doesn’t hold up to even a cursory scrutiny. The gun-related death rate in the U.S. is 4.52 (per 100,000). In Canada to our north, it is 0.62; In Germany it is 0.06; In Japan, it is virtually zero. Why the difference. In part, they have more sensible gun control laws while we are drowning in instruments of death.

    Our suicide rate is also high. By one measure, we rank 2nd only to Greenland on that score. But the numbers are fuzzy. Intentional opioid (and other drug-related) deaths are difficult to sort out from those that are accidental. Some, however, lump such intentional exits from life into a category of deaths due to despair. As we sink into our national abyss of anger and hopelessness, we tend to strike out … at ourselves and others. Remember that many of our political disputes are based on sheer anger, at one another, and at those forces we barely comprehend.

    Let’s back up further for a moment. What happens when a society becomes highly unequal, when more and more of the goodies are accumulated in the hands of fewer and fewer. That is where we are now. America has become the poster child for unequal economic outcomes. How many times have I pointed out that the share of income going to the top sliver of society has risen from less than 10 percent of the pie in the late 1970s to almost one quarter in recent years. This massive shift in wealth and power has become an axiomatic truth, something accepted as natural and fair even among many of the losers. How many struggling working class folk voted for Trump? They are angry and resentful, yet unclear about whom to blame. Republicans are most happy to provide convenient targets for their wrath.

    Of course, it doesn’t have to be that way. Public policies can address our fondness for dying early and our apparent willingness to push policies designed to make the filthy rich even richer. Only Americans would think this is a good idea. One example … our tax system reduces the gini- coefficient (the standard measure of inequality) by some 27 percent.

    You might think that is pretty good. But it is a rather weak performance when viewed globally. In terms of addressing the inequality issue (through taxes and transfers), we ranked 35th out of 44 countries. We barely beat out Russia. Greater concentration gives those at the top more power to control the rules that permit even greater inequality. Where does that end?

    Public spending in general can help equalize economic outcomes, especially if those outlays are for human capital (e.g., education and research) and infrastructure improvements. Again, we rank poorly on this measure. Some 37 percent of all our spending is for public purposes. In France, that rate is 58 percent. In Belgium, it is 54 percent. Again, it depends on how the money is spent but public expenditures in preventative health, in early childhood development, in quality childcare and education, and in labor market programs can do wonders in correcting our highly unequal outcomes which, in turn, threatens our cohesive social fabric.

    Let us face it. Inequality tears at our social fabric. It fosters suspicion and jealousies. It makes it easier for demagogues to play the divide and conquer game. The desperate losers fight with ever more conviction, if not desperation, over the remaining scraps.

    And that is what I fear looking forward. We won’t be addressing the real issues … premature deaths, unequal opportunities, a poverty of public investments in the future, climate change, and so forth. We merely will continue to fight among ourselves for meager advantages in a stacked game while the big issues and challenges remain untouched.

    I hope I’m wrong, but I doubt it. So, let me end with a hope that we work on getting the questions right. That would be my new year’s resolution … that we think hard and honestly about what we want to be as a society.

  • Epiphanies.

    December 25th, 2023

    Every once in a while we see something different in our world, perhaps unique. It likely is a perception or experience that we have embraced many times in the past which suddenly is … different. Sir Isaac Newton had seen many apples fall from trees until the day he went … aha! Presumably, Blaise Pascal looked up at the night sky one evening and now appreciated what he had been seeing in a unique way. As a man of 17th century science, he might have known that the array of lights twinkling above were merely stars. If so, they were no different than the sun around which our earth (and the other planets) orbited. On one of those evenings, however, his gaze led him to appreciate just how insignificant he was given the vastness of the universe out there. It impacted him profoundly by adding to his wonder at the natural world he thirsted to understand .

    He had what we think of as an epiphany! He saw the world in a different way. That night, he experienced a transformation in his world view. Namely, his position within the cosmos had been altered, dramatically rearranged if you will. Of course, his perception of what lay out there was hampered by the primitive technologies of his day. The pinpricks of light, no matter how many he could see with his naked eye, were only a fraction of those sun’s that lie within our own Galaxy… the Milky Way. It was not until early in the 20th century that we had any real appreciation of the immense vastness of our universe.

    I no longer recall the moment when I began to hold in awe what was out there in the night sky. It was many decades ago, and my sense of the universe in that moment had hardly progressed beyond Pascal’s. However, I do recall a more recent moment when I read something that shook the way in which I framed our cosmos or, more precisely, how I saw our significance (or, conversely, insignificance) in that cosmos.

    Not that long ago, our best imaging technology located what appeared to be an area of empty space in the universe. There seemed to be nothing there. Technology, though, keeps improving. We launched even better and more sensitive cameras that were positioned further out in space. Next, we aimed our new toys for an extended period at that empty spot. By nature, we are a curious lot and wanted to see if it was, in fact, empty space.

    It wasn’t. It turned out there were millions of galaxies where we had previously thought nothing existed. And there is the point. Our appreciation of the scale, the complexity, and the mystery of our world is increasing all the time … on the sub-atomic and the cosmological levels. And that is only within the universe we can experience and measure since, theoretically at least, many more parallel worlds might well be out there. Even within what we can imagine, we really don’t know how many galaxies exist (or how many worlds might support advanced forms of life). The best guess today is that there are two trillion galaxies, but the actual number may well exceed that estimate since our measured world keeps expanding exponentially. Each of those two-trillion galaxies contains billions of stars (our Milky Way contains 300 to 400 billion stars). Moreover, there are huge entities of matter and energy pulsating throughout the cosmos that, when captured in celestial images, puts the most ingenious abstract artist to shame. Bottom line, our known universe defies even our inadequate and cursory comprehension, never mind our full understanding. It is the most magnificent art form of all.

    So what! The cosmos is huge. Big deal! You could shrug your shoulders at the news. But even Pascal realized that his universe, as modest as it was, was impressive enough to reshape how he saw all life about him, including his position in that world. Once I had my own personal epiphany about the vastness and mystery of our larger world, I could no longer see things in the same way. Almost everything we see as so important on a daily basis suddenly shifts to a different order of importance. For example, all the lines we impose on our maps to divide nations suddenly seem silly. All the imaginary ways we separate races and ethnicities and tribes now appear patently ridiculous. All our spats over trivial differences in how we organize the world pale when we consider the majesty and mystery of the cosmos in which we live. Truly, God’s canvas (or whomever set all this in motion) is the greatest work of art imaginable

    Pascal had another epiphany even as he marvelled at what lay out there at the end of his senses. He recognized that our species was, as far as he could imagine, the only truly sentient beings around. Thus, his most famous aphorism … Cogito Ergo Sum. Until we prove (or discover) otherwise, we are the only creation of nature (or of some divinity) capable of appreciating the world in which we exist. This puts an enormous burden upon us. What if we are the only sentient beings with any ability to reshape the forces of the universe. What if what we sense as the divine is not some given or historical entity but something evolving … something like us. Perhaps we are an unfinished God, a divine work in progress. Think about that for a moment. We might be the most important game in town, and it is a huge town. If so, what sin would be greater than somehow screwing up the human experiment. I cannot think of any.

    Not long ago, at our weekly condo association social gathering, I got into a brief debate with a neighbor, an emeritus faculty member from the University (these academic types are everywhere). Oddly enough, we often stumble upon these lofty topics at our social gatherings. This one focused on the uniqueness of cognitive life in the universe. My debate opponent argued that the sheer improbability of evolving as humans, with all the billions of serendipitous events that were necessary to create advanced life, made it highly unlikely that other sentient beings exist. He thought we likely were the only game in our immense town. My response was to point out the billions of galaxies and trillions of stars and all the likely planets on which life might thrive. Basically, we have an untold number of petri dishes in which evolution can work its magic. I think the odds are favorable that we are not alone. But we just don’t know for certain, not yet.

    Of course, I hope there are others out there. If the universe is relying on us to figure things out and make things right, I fear we are in deep shit. Just consider how much time and effort we put into our daily sporting events and how little into things that matter … like climate change. That is enough to make one weep.

    No, my personal epiphany, first discovered upon looking at the universe around me, cannot be overstated. I soon stopped looking at religious narratives, no matter how emotional or compelling, for meaning. I began to look out there since it told us so much about ourselves and our possible role in the miracle of life. Our world is so immense, so awesome, that I find it difficult to conclude that all of this is absent greater meaning. Of course, determining meaning is a challenge laid out before us. One day, perhaps we will discover what that meaning is … if we don’t screw things up first.

  • T’is the Season!

    December 24th, 2023

    As a child, there was something special about Christmas. Sure, it was partly about the mystery of the Winter Solstice, when the globe’s rotational physics reaches its stretching point. I would wonder on occasion … what would happen if the earth’s axis did not self-correct? Inevitably, though, the subsequent days would grow longer, thereby suggesting warmer times ahead.

    And, of course, there was the anticipation of a brand new calendar year and all the hope attached to this annual ritual. Okay, nothing really changes as one year transitions into the next, other than an excessive intake of spirits along with too many easily ignored and ill-considered promises to remake one’s life. Still, the promise of newness and renewal adds something special to this season.

    Nothing, however, adds more magic to the season than the narrative surrounding Christ’s birth. As a kid, even a teenager, I was moved by the story. Wandering travelers, in particular the teen mother to be, are seeking shelter for the night as they return home to register for a mandated census. Consigned to a stable … magic happens. A bright light in the sky signals a momentous event. Wise men bearing gifts appear literally from nowhere. Even the lowly animals nearby are moved by events they might possibly apprehend but could never understand.

    I can yet recall one Christmas eve in Worcester Mass. I was a teen and had pretty much decided to enter a Catholic seminary that prepared male believers for foreign missionary work in the service of my faith. That’s right, the left-wing socialist you know and love had bought totally into the foundational Christian (i.e., Catholic) narrative. On this particular occasion, however, we were hit with two consecutive snowstorms that paralyzed the city. That Xmas eve, I recall walking (in the middle of the street) the two blocks to our local church. There were five Catholic churches in the area, divided by ethnic allegiance. My local one was Lithuanian. I cannot recall now if I was going to an event or just seeking the quiet presence offered by the smells (from incense and candles) as well as the special sentiments attached to this holy sanctuary.

    It was the journey to the church that has stayed with me. Any progress was labored that night. The snow was up to my knees, at least. Nothing was moving. The only audible sounds were faint Christmas music wafting from the tenements on either side of the road. It was the kind of classic wintertime scene ordered up by God explicitly for this season and for the purpose of making each of us reflect. The blanket of snow had been heavy, so everything was covered in undiluted whiteness with a few flakes yet descending from the darkness above. All was clean and pure … in fact, perfect. In that moment, I fully believed in my faith’s foundational myth, the story of Christ’s birth. I embraced all of its sentimental detail, facts that defied logic yet moved me. I must have been moved … that image has remained with me to this day.

    Over time, the magic of the moment, along with my simple beliefs, faded. I lasted a little over one year in the seminary. In the spring of 1994, I matriculated at Clark University, a very secular school designated as a den of atheists and Communists within the local Catholic community. Had I not detoured into my failed effort at sainthood, I never would have considered Clark. I would have gone to Holy Cross … a very good Jesuit institution but one well within the tentacles of my very Catholic cocoon. However, my life trajectory had been fundamentally ruptured by my detour to Clark.

    My earlier decision to leave the seminary increasingly became clear to me. I had never really believed in the Christ story. After all, that was based on second-hand, hearsay testimony by people who never witnessed anything first-hand. At best, this was questionable evidence that would never be admitted in a court of law. There are few, if any, primary accounts from reliable sources that Jesus was an actual, historical figure. Surely nothing definitive exists as to the timing and circumstances of his birth. The date of December 25 itself was picked out of a hat, most likely since it coincided with Pagan celebrations related to the winter Solstice and a tribal desire for new beginnings. Some scholars put the year at plus or minus 3 years from the agreed upon date. In any case, any real historical Jesus likely was a local rebel who traveled the land fighting the establishment and raising hell for the establishment. He would have been put to death as a troublesome revolutionary.

    But therein lies the real magic of the season. While the story handed down to us pulls at our heartstrings, that is not what is important. The message attributed to the Christ figure is what moved me as a young Catholic. In reality, it is the core message found in most major religious traditions, at least once you discard the surrounding nonsense. The message of love and doing good, especially for others you would normally ignore, is what inspired me as a young man. That message can yet touch me even as an old fart. It is universal and immutable.

    I can still tear up as I watch any version of Charles Dickens’ A Christmas Carol. Why? Because it is Christ’s message (whether or not he is responsible) in its purest form. Love one another. 💓 That’s it. That is all of it. Of course, throwing in a blanket of snow just for tonight would help a bit 🙄.

    Happy Holidays!

  • Bah! Humbug!

    December 22nd, 2023

    I’ve been focusing on political issues of late. Nothing wrong with that but this was intended to be an eclectic blog … covering serious and reflective themes with some humor occasionally thrown in. With the Christmas season upon us, perhaps it is time to shift away from political doom and gloom. Surely, there are other topics that drive me to a similar level of despair.

    Unfortunately, I must admit that the Yuletide doesn’t bring to me the normal quota of good cheer others claim for themselves at this time of the year. Perhaps my annual gift of coal from Santa had something to do with my Grinch-like attitude. Nooo, not that! I liked coal as a kid. We could use it to deface sidewalks and other public areas. Thinking on this matter a bit, my lack of good cheer emanates from other, perhaps more fundamental, sources. One possibility certainly is this insistance on gift-giving. Bah! Humbug!

    I never could quite accept the general approbation heaped on Ebenezer Scrooge. I thought his attitude toward Christmas sensible and even admirable. It struck me that there was more downside to this season than any joy or good cheer, forced or genuine. For example, the mandatory shopping requirements and card writing exercises always drove me to distraction. Now, I can write books and academic papers but am useless when writing Xmas cards. My good spouse made me do the cards for my family one year. To a person, they contacted her to get me fired. Besides not being able to read my cursive scribbling (I got several failure warnings in grammar school for penmanship), what they did manage to decipher was deemed total ‘drivel.’

    But back to the giving of gifts! It was not as if my gift list was long, a few at most. Still, the exercise drove me into deep pools of paralysis and then despair. Every year, I would fail to find the clothing sizes I put aside the year before for future reference. Even if I could find them, the shopping process itself brought me to my knees. While I could get up and give a talk before an auditorium full of people, even important people, dealing with a sales clerk brought me to my knees. They inevitably would ask … well, what does your wife like to wear? How am I supposed to know? That implies that I’ve been paying attention during the several decades of our marriage. Their subtle, but still disapproving look, is rivaled only by those young shits who work in tech stores. Those snotty geeks are always asking me about operating systems and mega-byte requirements when all I can handle is the on-off button.

    Let me give you an example of my shopping acumen 🛍. I would be known to go into a store when all my sweaters had become tattered and stained, the latter happening overnight it seems. So, I wander in the store helplessly until I find a sweater style and texture I like. I select one that fits and then find a clerk. ‘See this one,’ I tell her (or him), ‘I want the same sweater except in every color and pattern you have.’ I then would get the ‘are you nuts’ look. But I never cared. Depending on how many colors (and patterns) they have, I figure I’m now good for several years. 😅

    I suppose I could do the same for Xmas gifts. Find a size and style that works, then buy one in all the different colors and patterns available. Brilliant, no! I could have given my late wife one in the first year and store the rest of them for future years. A great plan except for one small flaw … she was never dumb as a sack of rocks. Just the opposite in fact. That ingenious plan would work with me … I am as dumb as a sack of rocks. But she would have seen through my plan in year two. Alas, I had to be creative each and every year, an impossible burden for a numb-nuts like me.

    The highlight of my shopping career probably occurred the year I was racing through the Mall as the clock was reaching zero hour. The next day we would begin the trek north to the Twin Cities to her family home to celebrate and exchange gifts. Why her lovely parents, and they were lovely indeed, had not retired to Florida remained a mystery to me. Oh, how many times did the car freeze over, or we found ourselves skating back to Madison on the ice rink that once had been Interstate 94. But the trips to the frozen tundra of Minnesota are another story.

    On this day, my panic level was higher than normal, though now I cannot recall why. I just didn’t think more expensive jewelry or fancy clothes would do the trick any longer. As the years passed, we became more affluent and had all the things we needed. Now we were into getting gifts that meant something, a concept way beyond my pay range. I was totally flummoxed that year until I came across a display of sewing machines. YES! All women like to sew, right? It was hard wired into their DNA. I read that somewhere. I whipped out the old check book and bought the most expensive machine they sold. Price was of no consequence when I was in full panic mode.

    Now, my lovely spouse was used to seeing me load small to medium-size boxes into the car for the trek up to America’s Siberia, otherwise known as Minnesota. She spied this big box (wrapped professionally at the store) with great curiosity. Until she could rip the wrapping off on Christmas Eve, she could only shake the box and speculate on what the contents might be. But she was stumped, certain only of the fact that her Prince Charming had outdone himself this time. As the hours ticked off to the moment when all would be revealed, a gloom settled over me. I wasn’t sure why or how, but I sensed I had screwed up big time.

    The moment arrived. She attacked the mystery box with the abandon usually reserved for a starving man being offered food for the first time in months. When the contents were revealed, her mother screamed in delight. Her sister-in-law screamed in delight. All the females present were ecstatic, screaming in delight. All but one! Mary’s eyes first widened in disbelief before narrowing in a look of total incredulity. If looks could have killed, they would have been affixing the toe tag to me at the morgue that very night.

    Her worst fears were now confirmed beyond a shadow of any doubt. She had married a total and complete doofus. You see, Mary’s mother, though without education herself, was a woman ahead of her time. She told her only daughter that, if she did well in school, she would be exempt from learning any domestic skills. Mary never looked back, eventually graduating law school with honors and becoming the Deputy Director of the Wisconsin Supreme Court. Along the way, she never learned any of those other skills, including sewing.

    To keep this narrative reasonably brief, I won’t bore you with the lessons she forced me to attend with her. Nor will I relate the excruciating story of our our joint effort to make a dress. Let me simply say that we got rid of this infernal machine in short order. One day, we were having drinks with several state workers. One of our female companions that day worked for a State Legislator and made little money. However, she had a keen interest in sewing. Our eyes brightened. Would she like a great sewing machine. ‘Oh, she would love a machine like ours but could never afford it.’ We rushed to correct her misunderstanding. We didn’t want any money. Hell, we would pay her to take it off our hands. She could not believe her good fortune. Neither could we believe ours.

    I made errors like this all the time. Some of us are born stupid and no amount of education can correct our initial handicap. As I recall, Mary only made one, not for Christmas but for our Anniversary which, as our poor planning ensured, happened just before Christmas. Now, she was in Law School at the time and had just finished semester exams. That is, she was distracted. We were at a fancy restaurant celebrating this happy occasion when she retrieved a small box. Hmm, I thought. ‘It wasn’t clothes. Perhaps she had sprung for that Rolex Watch I coveted.‘ I burst out laughing upon opening it up. It was a high-tech nose-hair trimmer. As she stammered for excuses, I assured her that this was likely the best gift I will ever get. In truth, I cannot recall ANY OTHER gift I’ve received, but have never forgotten that one.

    All I can say about Christmas and gift-giving. Bah! Humbug! An exercise in humiliation and agony for sure.

  • The notion of progress … linear or not!

    December 19th, 2023

    Kailash Kanoria recently posted a blog that summarized a set of transitional points during which the world as we knew it advanced in a sharp and unexpected manner, at least for a while and in selected locations. For example, the Renaissance turned western mankind away from an obsession with past ‘golden ages’ toward a more optimistic and human-focused future. The subsequent ‘age of exploration’ opened isolated societies to new possibilities of shared cultural experiences and ideas. The onset of the ‘scientific age’ further developed methods for understanding the world around us rather than relying upon divine or given truths. Each of these (and other) human transition points appeared to build on prior epiphanies and lead to the next set of insights. If true, can we assume progress is now linear and inexorable? Might we indeed anticipate an ever brighter future?

    Let us think about that prospect for a moment. If we look back over recorded history, we can find a number of moments and places where humans demonstrated considerable ingenuity and (relatively speaking) extraordinary insight. Such periods might be found in the Fertile Crescent (between the Tigris and Euphrates rivers), in ancient Egypt, in the Indus Valley, in the river valleys of China, and in Meso-America. In such places, civilization established conditions that enabled some members of society to consider questions beyond mere survival. A few members could focus on the arts and the more esoteric imponderables in ways that might explain the mysterious world about them. Ancient stone monolithic arrangements often speak to early efforts to understand and control the natural world.

    Somewhat more recently, we had the blossoming of philosophical and political thought during the Hellenic age in Greece, in the Macedonian and Persian empires, then the Roman Empire which extended from Britain to the Mid-east to be soon followed by the Byzantine empire after the collapse in the Roman West. Even then, the world did not fall into a total dark age. The Islamic Golden Age, centered in Baghdad, lasted for at least five centuries (7th to the 12th centuries) during which thinkers from all the known cultures in the world were encouraged to collaborate and advance human knowledge. In that age, there were many breakthroughs in mathematics (algebra was invented), astronomy (many stars were named during this period), human physiology, optics, poetry and the arts, and so forth. It was a kind of Renaissance in the middle-east..

    The Mongol hoard eventually sacked Baghdad, the center of this cultural revolution in science and thought. While Genghis Khan was a fierce, if illiterate, warrior, he was no dummy. His empire stretched from Eastern Europe to the Pacific Ocean. While it lasted, he introduced many reforms and innovations that anticipated the modern world. He instituted ingenious concepts in trade, communications, govrrnance, and financing that later were critical to sustaining more modern forms of enduring nation states.

    Still, we often think of the modern world as emerging during the European Renaissance of the 14th century. That explosion of new thinking and new ways of viewing the world was succeeded by the ‘age of discovery,’ the ‘age of early science,’ the ‘age of enlightenment,’ and finally our modern world. As noted, Kailish Kanoria recently posted a blog surveying these more recent Western ‘ages.’

    I think about this past and wonder. While we had many moments when civilization had enough going for it to spur a brief explosion of new thought and innovation, none of these endured over time. Some imploded due to natural causes or cultural disasters. Others were smothered and extinguished by more aggressive (if culturally inferior) neighbors. Even in our contemporary world, we have seen some nations with free thought and opportunities for human advancement. But that situation has never been universal. We inevitably see other parts of the world remain dark and mired in mythical or backward thinking. The world of science and progress and advanced might well be fragile and temporary.

    Here is my point, and my question. Despite the ephemeral nature of past explosions of learning, is this one likely to last? Are we finally on the path of linear and lasting progress? After all, the ‘singularity’ is supposed to be just years away. Humans then will join with machines to so that progress will be institutionalized in some permanent form where technology and human ingenuity combine in a synergistic and continuously evolving manner. A comforting thought, I think?

    Then again, we have all these signs that science itself, the foundation of our modern world, is now under attack. Politicians call for new forms of Christian nationalism to replace our secular democracy. The worst scenarios of the dystopian, yet prophetic, novel by George Orwell (1984) appear to be gaining traction. Even medical science is discredited as the wild assertions of wanna-be totalitarian types become the new truth. Demagogue’s, like Trump, rile up their conservative followers with unfounded fears of new threats everywhere, then suggest that only they can save them.

    Many believe the 2024 election is fundamental to the American experiment. Will Western society continue to evolve under a regime based on rationality and evidence or will we once again descend into darkness. Consider the following. The scientists in 10th century Baghdad who were perfecting mathematics and looking out at the world with increasing rigor probably saw no end to their relatively advanced view of reality and the natural world. Soon, however, it would all disappear with mere fragments of their advances resurfacing in Europe several centuries later.

    It is hard not to overlook the prognosis of famed astronomer Carl Sagan which he made shortly before his death in the 1990s:

    “I have a foreboding of an America … when technological powers are in the hands of a few, and no one representing the public interest grasps the issues; when people have lost the ability to set their own agendas or knowledgeably question those in authority; when, clutching our crystals and nervously consulting our horoscopes, our critical faculties are in decline, unable to distinguish between what feels good and what is true. We slide, almost without noticing, back into superstition and darkness.”

    He was talking about a future in his children or maybe grandchildren’s lifetimes. He was talking about today. I hope he was wrong, but I cannot say with certainty that he was.

  • Higher education … a thought or two on ‘doing policy.’

    December 15th, 2023

    Not long ago, a former colleague sent me a video clip that she needed my permission to use. In it, I expounded on the difficulties of doing what we call ‘public policy’ or the making of decisions impacting the broader good. During this aforementioned clip, I repeated a firm belief of mine … while doing policy may look easy, it definitely is not for the faint of heart. I even shared a favorite mantra of mine … the solutions of one generation are the scandals of the next. Problems we thought solved, or at least solvable, inevitably resurface again in even more intractable and diabolical forms.

    So called ‘wicked‘ policy issues are the worst. Such challenges involve confusing or contrary goals, disputed or non existing evidence, competing or incomplete theories, and proposed solutions that reek of contradiction and difficulty. Even where solutions are forthcoming, and an apparent concensus achieved, it is not long before shortcomings are realized and unintended consequences emerge. No one can anticipate all the effects attached to a policy change. We cannot calculate all the intricate interactions that either emerge with time or sense all the subtle, unexpected impacts that eventually manifest themselves.

    Such epiphanies were thrust upon me during the many years I was immersed in various welfare reform battles. In that contentious arena, one policy truism became an inescapable reality … it was impossible to please everyone. More likely, you would please no one. During those difficult days, I embraced another of my inviolable mantras … I knew I was approaching a truth on welfare reform when literally no one agreed with what I was saying. That made my professional road rather lonely indeed.

    Now, some policy dilemmas were technical in character and, by virtue of their character, were beyond resolution. For example, there was the ‘iron law’ of welfare reform. In this conundrum, you could not satisfy certain ends simultaneously no matter how hard you tried. For example, you could not design a reform package that would result in adequate welfare grants while achieving target efficiency and fostering a positive labor supply … at least within acceptable cost parameters and at the same time. It just couldn’t be done.

    Consider the following. You could achieve the goal of eliminating poverty by raising the welfare guarantee (what the beneficiary with no other income might receive) to sufficient levels. But then you would negatively impact positive labor supply expectations since beneficiaries would have little incentive to work. You might then fool around with what are called ‘marginal tax rates’ or the rate at which the benefits are decreased in the face of any earnings. Lower rates improve the reward for work (by putting more money in the persons pocket) but that erodes target efficiency … the proportion of welfare expenditures that go only (or primarily) to families below the poverty threshold. You might consider mandated work regimes, but those strategies quickly become budget busters. Just trust me on this one, you cannot resolve this small set of policy ends simultaneously. That is why the welfare debate endured for so long. [Note: these conundrums were resolved by pretty much ending cash welfare to poor families and accepting poverty levels higher than found in our peer nations but oddly enough acceptable to most Americans.]

    Complicating policy even more are our diversity of values. For better or worse, we are a heterogeneous society. That is, we do not have a common culture based on shared understandings. We don’t even come close. Our governing norms are diverse and often contradictory even at their core. We disagree about the nature of truth, about our views of false positives and negatives, about what constitutes worth and meaning. Some of us see people as basically good, and we tend toward positive reinforcements to enhance that goodness. Others of us see people as essentially evil and tend toward universal punishments to effect proper behaviors. Compromise across such different world views is difficult, if not impossible. And such divergent perspectives are everywhere across this strife-ridden land.

    The tendency for many (in America at least) to rely upon absolutes (an inability to engage in nuanced thinking) reflects on dimension of our national dilemma. Abortion is always evil and never can be tolerated for some. For others, it is a matter of basic individual choice and personal freedom. And for others, it is to be avoided when convenient, but we can consider the quality of life and other mitigating factors when deciding if it is appropriate.

    Another example: Is it better to incarcerate 10 innocent men rather than let one guilty one go free or just the reverse? We differ greatly on such hypotheticals, yet such primordial dispositions frame our sense of what constitutes justice. And another: Should we grab onto an ancient text written over hundreds of years by wildly different authors and then organized by a committee driven mostly by politics and insist it is God’s word that would trump even our nation’s Constitution. Or should we rely upon, and be guided by, centuries of thoughtful evolution that has resulted in the scientific method, something that has opened up an unfathomable universe to our understanding. Finding common ground is difficult when their are rifts within our foundational thinking … when claims of divine inspiration are deemed superior to rigorous thinking and advanced thought.

    The bottom line is this. Policy is hard because humans are involved. We sometimes can work together and solve intricate issues when they are technical in nature. We decided to put a man on the moon and did it. But those challenges that tap our human side are something very different indeed. We declared a ‘war on poverty’ and found that an unsolvable conundrum. Why? In part because we had fundamental disagreements on how people functioned and were motivated. We differed on the very nature of reality and truth.

    And so I looked upon the beleaguered Presidents of three top universities … Harvard, MIT, and Penn. These are very smart people with years of management behind them. But they wound up being crucified for their defense of the principle of ‘free speech’ on campus. How could an inviolable foundation of intellectual life, a sacred belief within academia, bring them so low. [Note: the President of Penn has resigned while the other two are under withering fire.]

    They fell from grace, not because they were crucified on the horns of a technical dilemma like the iron law of welfare reform. No, they ran afoul of a newer form of political persecution. In today’s gotcha world, the game involves putting leaders in impossible situations by confronting them with foundational beliefs that rub against one another with considerable fiction. Then, the inquisitors go in for the rhetorical kill. On either side of virtually all contemporary issues are partisans who hate those on the other side. This visceral animosity was made popular by Newt Gingrich in the early 1990s though previous versions existed (for example, in the pre-civil war 1850s). No compromise is tolerated. Governing is a zero-sum game. You lose if the other side doesn’t, even when they act on principle and for the common good.

    When power is everything and winning is all, intellectual niceties such as science and evidence easily are sacrificed. Okay, some science is yet trusted, where only technical issues are involved (a smaller and smaller set). Increasingly, even once protected areas of rigorous inquiry are subject to partisan nonsense. Medical science previously was looked to as a way of advancing our health and well-being. Recently, however, even the most respected medical scientists are vilified and threatened with jail simply because that keeps members of the conservative base angry and inflamed. When we cannot trust the best science, whom can we trust?

    While we try to govern and make decisions through accepted process and established evidence, it all comes down in the end to questions of trust. There is a great scene in the movie about the black woman who did the NASA calculations for the early space shots. When astronaut Scott Glenn had concerns about the numbers he was given based on computer algorithms, he asked that the ‘smart’ lady redo them manually. It was a matter of trust for him. Back then, he trusted a human over a machine.

    I was thinking about this trust issue recently in the context of the evidence that the long expected (theoretically) Higgs Boson sub-atomic particle exists. The only way to prove it involved sending beams of protons hurtling at each other near the speed of light. This required an apparatus so big and intricate that it crossed the borders of two countries in size and involved fiscal outlays and intellectual resources from some 23 countries. Even then, the effects of the collision only lasted a tiny fraction of a moment before decaying. Difficulty did not matter. Detecting this elemental particle was seen as a fundamental step toward confirming the ‘standard model’ of particle physics. It was extremely important to those who worry about such things. When they discovered this long sought particle about a decade ago at an immense costs (the large Hadron collider alone cost over $9 billion back when it was built), the entire world of physics rejoiced. And the rest of the world believed they had actually found something worth being excited about.

    But here is the thing. We mortals cannot verify that they found anything. In the end, we must believe their integrity and the scientific methods they used. Without such elementary trust, we risk reverting to a new ‘dark ages.’ We are in the atomic age because our leaders, driven by the necessity of war, believed in the math posed by a handful of scientists no one understood. We proceeded toward nuclear fission based on leaps of faith.

    The Presidents of the major universities now under attack had a much more difficult task. When they testified before Congress, they were going to be crucified no matter what they said. Still, it struck me that they remained true to their calling as they tried to make intellectually nuanced arguments that they must have known would satisfy no political extremists in the end. When asked repeatedly why some students could express the most hateful opinions and inflammatory rhetoric calling that called for violence against others, they waffled and danced and kept talking about context and freedoms. They may have been correct but, in today’s environment where only absolutes satisfy, they were doomed to ridicule at the least, outright sacrifice by others.

    I could not do any better. I would have defended free speech as a principle. I do believe that people have the right to say really stupid things and, if pressed, will fight for their right to be stupid. But I do have a line in the sand. I rather agree with the old adage that ‘you cannot shout fire in a crowded theater.’ (Was that Justice Brandeis?) Likewise, I don’t believe people can explicitly call for violence against others in public places and forums absent any cost. When you put others at imminent risk of physical harm or death, you have gone too far in my book. But that is merely my book.

    I might have tried something like that were I in their shoes. And I would have fared no better than they. In short, there are no acceptable responses to today’s political questions or some of our wicked policy challenges. And so, doing policy these days is still not for the faint of heart. At the same time, someone has to step up to the plate and try. Otherwise, we are doomed.

  • Higher Education … the luster has dimmed.

    December 12th, 2023

    There is an internet site that too often caters to readers who pose questions about elite schools. Is Harvard better than Yale or Princeton? Should they go to MIT or Cal Tech? Can they still get into an Ivy League school if they got one B in the 2nd grade? The variations on this theme are endless.

    I keep wanting to scream that any differences among these institutions, at least in terms of pedagogical advantages, are miniscule. What the interrogators really are asking is whether school A will offer them better social and economic contacts for success later in life than school B. To my mind, they could care less about education. They are obsessed with their prospects for securing economic advantages during their careers. They look upon their higher educational experience from a purely transactional perspective. Perhaps I’m being overly cynical, but that’s how it looks to me.

    My college career started about six decades ago. 😳 Okay, so we are talking pre history here. But things appeared very different back then, or so it seems to me. College was affordable, even for a working class stiff like myself. I made it through a pretty good private school with virtually no help from my parents. I recall getting some marginal assistance for one semester. My mother’s hand shook as she wrote the check. She probably was thinking that the money she was wasting on me could be going for more important things like beer and cigarettes.

    The important point is that higher education was affordable in the 1960s. Years later, when my Peace Corps group gathered and reminisced on such matters, we found it remarkable how many of us were from very modest circumstances, often the first in our families to try college. (The tuition at very good public schools in California was virtually free back then.) Yet, many of us managed to make it through excellent schools (e.g., Yale, Columbia, Berkeley) on our way to careers that made significant contributions to society. College was not only affordable, but proved a stepping stone to personal change and social fulfillment.

    I myself did not go to an elite school. After a stint studying for the priesthood in a Catholic Seminary (the Maryknoll foreign missionary society), I matriculated at Clark University located in my home town … then known in my circles as a den of Communists and atheists. But I could live at home, and they would take me in the spring semester. Recently, I came across an article which claimed that Clark was one of a handful of American schools that took in average students and transformed them into academic stars who wound up in academic careers at elite schools. That was me. I did not graduate in the top quarter of my high school class (admittedly a good school) and wound up as a Senior Scientist at the University of Wisconsin-Madison.

    My point is this. So many in my generation did not look upon higher education as a stepping stone to getting rich. I never selected courses based on their utility for some future, hypothetical career. Such mundane purposes never crossed my mind, even as my family pressed the notion that college would make me wealthy. No, I chose courses because (gasp!) they appeared interesting and I might learn something. Things like career trajectory and earning potential were decidedly secondary considerations. I, and my peers at the time, saw college as a place for learning and forming our lifelong values. It was an environment where we might become thinking beings. Fortunately, we were not disappointed.

    Decades later, I would run across a fellow ‘Clarkie’ from the 1960s. To a person, we would think fondly back to those days when we would spend hours debating the issues of the day and then remember that we better study a bit so they wouldn’t kick our fannies out. Back then, grades were earned and meant something. My GPA was good enough to graduate with honors. However, it would have been too low for me to make the cut for the U. of Wisconsin Masters in Social Work program where I now taught. (Note: they gave us admissions committee members some methods for adjusting GPAs from those early years when grades still counted. Today, close to 80 percent of grades at many elite schools are in the A range). In the committee, I would see endless 3.8 and 3.9 GPAs that would be accompanied by personal statements that were incoherent and, frankly, embarrassing.

    I recall those endless dialogues at Clark on the major issues of the day as the forum through which I sharpened my analytical skills and upgraded my ability to express myself. The conservative, Catholic, working class boy who merely accepted what he had been taught was replaced by a thinking young man who developed his own moral and intellectual center. I had to work hard as I concluded that the war in Vietnam was unsupportable. I did not merely accept the opinions of others. I had to convince myself of that conclusion. That process was very demanding but worthwhile in so many ways. All these decades later, I remain convinced that I was right.

    Clark was where my real education took place. And not just mine. All my closest friends at the time came from equally modest backgrounds. All (including my two girfriends from that era) went on to get doctorates. One of those close female friends later became a Dean at a major university and the other a research scientist. Everything seemed possible in those days when upward mobility was more the norm … before conservative orthodoxy subverted meritocracy with the neo-liberalism introduced by Ronald Reagan. All seemed possible, no matter how humbly born.

    As you know, I would end up working at an elite, research- oriented university. I helped run a nationally recognized research entity and taught policy courses at both the graduate and undergraduate levels. For many years, I also served on the Master’s admission’s committee for the School of Social Work. Beginning in the 1980s, I saw a fundamentally different student before me. They increasingly were debt-ridden and driven much more by career concerns. Who had time to learn and debate and refine one’s world view when you might end up homeless in a few years. The college experience was becoming more of a vocational experience and career training ground where deeper thought was now a luxury one could hardly afford to pursue. Moreover, college quickly was becoming enormously expensive even as many of our peer nations continued to offer higher educational opportunities at a nominal cost, if not free.

    Back in my day, ‘developing a philosophy for life’ was an important goal for a majority of college students. Over time, that goal was replaced by ‘making money.’ In recent times, the perceived importance of a college education among the young fell to about 40 percent … it had been about 75 percent. The percentage of high school grads headed to college has fallen by 8 percentage points recently, perhaps not a bad thing since at least half will drop out before completing their studies. The vocational ‘value’ of a diploma is eroded when too many have these pieces of paper of dubious worth.

    It strikes me that my generation (many of us at least) knew why we wanted the college experience. We wanted to embrace learning for learnings sake. Making money was the least of our concerns. Acquiring skills had some merit but we knew education would be a lifelong pursuit in an ever changing world. We wanted to figure things out for ourselves because we knew we had to. At Clark, I don’t recall any liberal indoctrination whatsoever. But I was encouraged to think things through on my own. I intuitively realized that the seeking of truth was a personal, even lonely, endeavor. That made all the difference in the world for someone who grew up in a world dominated by absolute truths. What a freaking gift!

    This is not what I started out to discuss. I wanted to explore the new orthodoxy on campuses as it has exploded across the news in recent days. But that will wait for a future blog … perhaps the next one.

  • Health care in America … markets and our vulnerable citizens.

    December 9th, 2023

    Another mantra I used in the Poverty & Policy series was ‘the test of a nation’s morality is how it treats its most vulnerable citizens,’ though I was far from the first to employ this quite expressive trope.

    Surely, the young and old count as vulnerable in any overall population. We often lump them among the worthy poor since their age makes it less likely, though not always impossible, to fend for themselves. Thus, society typically takes a paternalistic attitude toward their well being, or so we believe. We can’t let the young and old suffer, can we?

    let us take a quick look at how our health and related care systems deal with these more sympathetic subgroups. In short, not well. Shockingly, we find U.S. maternal and infant mortality rates among the highest, if not the highest, within OECD nations (generally those most like us economically). For example, the infant mortality rate in the U.S. is three times higher than the comparable rate in Japan. One might attribute such disparities to life style choices but that may simply be rationalizing away differential policy regimes.

    When you get into the teen populations, we find strikingly high rates of death by suicides and homicides. What are called assault deaths in the U.S. (often via guns) is some 2.7 times higher than the average among OECD countries. Death by violent means now ranks among the highest cause of death among teens. Widespread anomie and hopelessness coupled with the easy availability of weapons and dangerous prescription drugs leads to many early exits from life, some self-imposed and others a consequence of the casual carnage on our streets. Again, policy failures and/or indifference play a role.

    A quick detour to the other end of the age spectrum. Here, the policy response is a bit mixed. As far back as the 1960s, we passed Medicare and Medicaid during one of the brief spasms of progressivism in the U.S. Since the early 1980s, we have returned to form, relying more on market forces to provide efficient and equitable care to the elderly. After all, that is the inviolable truth according to neoliberal economic orthodoxy. Our fascination with markets now leads citizens to visit Canada for affordable drugs (if they can) and to take trips to Europe for joint replacements and other procedures available there at reasonable prices. The one contrary blip to the slide toward a conservative medical market in recent decades has been Obama care which caused outrage, anguish, and much screaming among conservatives.

    One result of this market-focused approach can be found in how we deal with those elderly needing more intensive care, what we usually term assisted living or enhanced service care. By one account, some 850,000 Americans get such help, and many more need it. But our system of care views this as a profit center for private interests. It has been estimated that half of all facilities providing such care have an ROI (return on investment) of 20 percent or more. Monthly charges range from $5,000 to $10,000.

    I have some personal experience here. My spouse had early onset Alzheimers. I could take care of her at home for a number of years but the time came when that proved very difficult, if not impossible. The initial cost of her care was about $5,500 per month, but her needs quickly increased with time. After some three years, the monthly charge was closer to $10,000 monthly. Fortunately, we had Long Term Care insurance (LTC), due to her prescient diligence on this matter. But, in a discussion with the facility CEO, I found that only a small minority of the residents were covered by such care, and not many had the kind of quality insurance we did. The vast majority were paying out of pocket.

    We face soaring costs for dealing with our aging citizens. Many can not afford costly institutional care leaving families to patch together home care as best they can. Again, differential policy regimes across countries are apparent. Most other countries act more aggressively to control prices and to expand care opportunities for the high-need elderly. Once again, we stand out among wealthy nations as relying upon the market to handle things.

    Here is my bottom line. We do need market forces to ensure a dynamic and vigorous economy. Few doubt that. But unfettered faith in markets is, frankly, unsupportable. The Adam Smith fantasy world of free individuals transacting in transparent and open markets to the collective advantage of all borders on the delusional. The imperfections in the medical market should be obvious to all. Who can negotiate the best deal when they experience a cardiac arrest event? How can the average citizen bargain for best prices when pricing is so convoluted as to defy logic? I have freaking Ph.D and I cannot understand the medical statements I get. Just this week I got a statement (not a bill) for an office visit from last June.

    Our over reliance upon market forces to deliver quality health care is a failure. Years ago, I read an illuminating book written by a journalist comparing approaches to health care across nations. The author used his own medical issue to see how he would fare under differing policy regimes. (There are 3 major approaches … national health services, single payor systems, and mandated insurance schemes. The U.S. has all three approaches depending on population in a patchwork system, a medical world that defies all logic.). Hands down, he found the American system to be the most opaque, inefficient, and mismanaged. Of all things, he found France to be the best.

    There are many things about the country into which I was born that confuse the hell out of me. Near the top of the list is this. Why do Americans pay so much for a such a substandard product? I ponder this every time I call for a doctor’s appointment in a medical rich community like Madison Wisconsin and am told the next available slot to see the doc is six months out. 🙃

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