Public Policy and Governance – Page 44

Unhealthy, Unwealthy, Unwise

When I was doing research for a former book–my first sabbatical project, back in 2007– I came across data confirming the relationship between individual and social health. It turns out that countries with strong social safety nets have substantially fewer social ills–not simply less crime, but also less divorce, fewer unwed teenager mothers, etc.

I thought about that research when I read a fascinating article shared by a reader of this blog.The article from Harpers Magazine was written by the son of a doctor who’d practiced for most of his career in Great Britain’s National Health Service–the NHS–and it compared his observations of that system to the reality he encountered after moving to the United States.

When I moved to New York, many things seemed strange. Among them were the crutches I saw discarded on the street, leaning against the hunter-green fences of construction sites or on the steps of the public library where I had an office. It felt like finding evidence of miracles: the lame had risen up and walked. Later I learned that people were often expected to buy such items, rather than being given or lent them by a health provider. Once finished with them, they naturally enough threw them out. I connected this in my mind to the chronically ill people I saw living on the street, many with mobility issues—people who seemed to need care and weren’t getting it, like the woman nodding out on the corner in a wheelchair, or the man wearing nothing but a hospital gown, looking as if he’d been discharged from a psych ward straight into Tompkins Square Park.

As a freelancer, I bought my own insurance—my second-largest expense after rent. Despite spending hundreds of dollars a month, I still had to hand over something called a copay to be seen by a doctor. When I expressed shock at this fact, my American friends laughed bitterly. Step by step, I was initiated into this strange new health culture, so different from the one I was used to. Why did I need permission from the insurance company if my doctor thought a treatment was necessary? This was a medical decision, wasn’t it? In that first year, I went to see a physiotherapist and realized that he was shamelessly upselling me, trying to persuade me to embark on a complicated and expensive course of treatment that I didn’t need. Oddly, this disturbed me most of all. I was used to a system where there was no incentive to do such a thing, and it felt like a breach of trust. Deep inside, I was still the doctor’s kid, conditioned to see medical professionals as benevolent authorities.

I began to hear horror stories: the uninsured woman who slipped in a gym changing room, knocking herself unconscious, then woke up and tried her best to stop the ambulance from coming, as she couldn’t afford the cost; the young musician who’d tried to set his own broken arm using instructions from the internet. Everything seemed absurdly marked up ($1,830 for a pair of orthotic insoles?), and hovering over us all was the threat of medical bankruptcy. It was mind-bending to think that I was one serious illness away from losing my life savings. I contributed to GoFundMe campaigns and began to experience something new, a low-level background anxiety.

That reference to “low-level anxiety” triggered my recollection of that long-ago research, because it found that individuals’ feelings of personal safety have a marked and important effect on the health of the overall society. People who feel secure in their persons and prospects are less suspicious, more neighborly, and less likely to engage in risky or anti-social behaviors.

Recent unwarranted shootings–the elderly man who shot a teenager who rang his doorbell, the homeowner who responded with a hail of bullets to an unknown car in his driveway–point to the negative aspects of a society in which “low level anxieties” are widespread.

The Harpers article traces the history of America’s health care failure–how we got here. The paragraph that best explains just where “here” is, is the following:

The U.S. health care sector is massive. In 2020, it amounted to 19.7 percent of GDP. In the previous (pre-pandemic) year, that number was 17.6 percent. The United States spends more on health care than any other developed country, and not by a small amount: $12,318 per capita in 2021. In the rest of the developed world the average is under $6,000. What do we get for all this money? Lower life expectancy and higher infant mortality than almost all other developed nations. Despite the huge deployment of resources, the system is, by almost every metric, a dismal failure.

It isn’t just a failure that harms individuals. We Americans pay extra for the social dysfunction.

Comments

What It’s All About

Remember that old song, “What’s it all about, Alfie?” The melody and refrain were running through my mind as I read Tuesday’s “Letter from an American” from Heather Cox Richardson.

One paragraph in that Letter in particular really summed up the contemporary American–and global–dilemma. Forget, if possible, the daily eruptions that are evidence of a diseased polity–the crazed “representatives” doing anything but “serving” in Congress; the almost daily mass shootings; the bizarre behaviors of state legislatures (and not just in Florida and Texas)…and the multitude of other examples.

Focus instead on the underlying dilemma, an existential contest that Richardson says is between liberalism and autocracy but might just as aptly be identified as a contest between good and evil. She began by reminding readers of the Trump agenda that plays to the GOP/MAGA base.

He offered its members the anti-Black, anti-immigrant, and antiabortion measures it craved, in exchange for utter commitment to his leadership. His drive for authoritarianism dovetailed with a religious movement to create a new ideology for the Republican Party, one that explicitly rejects democracy.

That argument, articulated most clearly by Hungarian prime minister Viktor Orbán, is that the secular principles of liberal democracy—equality before the law, free speech, freedom to go to church or not, academic inquiry, a free press, immigration, companies that can make decisions based on markets rather than morality—destroy virtue by tearing down the sexual and religious guardrails of traditional society. In order to bring that virtue back, right-wing thinkers argue, the government must defend religion and self-sacrifice (although it’s hard to miss that they’re looking for other people to make those sacrifices, not themselves).

Last week, on May 4 and 5, the Conservative Political Action Conference met in Budapest for the second time, and once again, Orbán delivered the keynote address. The theme was the uniting of the radical right across national boundaries. “Come back, Mr President,” Orbán said of Trump’s 2024 presidential bid. “Make America great again and bring us peace.” Orbán claimed his suppression of LGBTQ+ rights, academic freedom, and the media is a model for the world.

(Un)representative Paul Gosar (R-AZ) called Orban, “ a beacon.” Richardson reminds us that the Americans who celebrate this ideology are those who routinely attack immigrants, LGBTQ Americans, the media, reproductive rights, and education.

Florida, led by governor Ron DeSantis, has been out front on these issues, but other Republican-dominated states are following suit. Eager to stay at the head of the “movement,” Trump recently claimed that universities are “dominated by marxist maniacs & lunatics” and vowed to bring them under control of the radical right. “He will impose real standards on American colleges and universities,” his website says, “to include defending the American tradition and Western civilization.”

Needless to say, DeSantis–and Abbott, and the culture warriors in Red State legislatures very much including Indiana’s–have a very distorted picture of American tradition and Western civilization, one diametrically opposed to the expressed values of the nation’s founders.

The decision to hold the Right-wing CPAC convention in Budapest–for the second time!–is chilling enough, but the fact that Diego Morales–Indiana’s Secretary of State not only attended that gathering, but spoke at it, was a reminder of just how firm a grip Indiana’s MAGA Republicans have on the state. Morales joined Tucker Carlson (via video), unsuccessful Arizona gubernatorial candidate Kari Lake, and other members of American and international Right.

I’ve previously written about Morales, an election denier who should never have won his race against an infinitely superior candidate, Destiny Wells. (When he was nominated, James Briggs–then of the Indianapolis Star–called him “so broadly unacceptable that the selection must be setting some kind of record for political ineptitude.” Briggs evidently forgot that, in Indiana, unacceptable is now synonymous with “Republican.”)

Morales wraps himself in “conservative” rhetoric, but today’s Right is anything but traditionally conservative. I’m old enough to remember when “conservative” meant conserving the liberties protected by the Bill of Rights and the principles that Richardson correctly labels as inherent in liberal democracy—”equality before the law, free speech, freedom to go to church or not, academic inquiry, a free press, immigration, companies that can make decisions based on markets rather than morality.”

Those principles are what next year’s elections are all about. And as I observed in the book Morton Marcus and I recently published, I am reasonably confident that most American women (and a significant number of men who care about us) will go to the polls to endorse those foundational principles, joined by voters disgusted by gun fetishists’ mischaracterization of the 2d Amendment, and by still others fed up with Republican refusal to make the rich pay a fair share.

That, “Alfie,” is what it’s “all about.”

Comments

Kudos

The news isn’t all depressing, and it’s important to note the positive as well as the negative.

For example, every once in a while we get a reminder that there are a lot of admirable, authentic Christians out there, and they’re very different from the political posturers who use religion in service of something very different. In the run-up to Texas’ passage of a (clearly unconstitutional) bill requiring public school classrooms to post the Ten Commandments, one of those genuine Christians took issue with the performatively pious legislator sponsoring the measure.

He began by pointing to multiple ways in which the Texas legislature failed to live up to the dictates of those same Commandments, and concluded:

I know you’re a devout Christian, and so am I. This bill to me is not only unconstitutional, it’s not only un-American; I think it is also deeply un-Christian.

And I say that because I believe this bill is idolatrous. I believe it is exclusionary and I believe it is arrogant. And those three things in my reading of the Gospel are diametrically opposed to the teachings of Jesus. You probably know Matthew 6:5 when Jesus says, “Don’t be like the hypocrites who love to pray publicly on street corners. When you pray, go into your room and shut the door and pray to your father who is in secret.”

A religion that has to force people to put up a poster to prove its legitimacy is a dead religion. And it’s not one that I want to be a part of. It’s not one that I think I am a part of.

You know that in Scripture, it says faith without works is what? Is dead. My concern is instead of bringing a bill that will feed the hungry, clothe the naked, heal the sick, we instead mandate that people put up a poster and we both follow a teacher, a rabbi who said, “Don’t let the law get in the way of loving your neighbor.”

Loving your neighbor is the most important law. It is the summation of all the law and all the prophets. I would submit to you that our neighbor also includes the Hindu student who sits in a classroom, the Buddhist student who sits in a classroom, and an atheist student who sits in a classroom. And my question to you is, does this bill truly love those students?

It was Texas, so the bill passed anyway.

Speaking of public school classrooms, the recent announcement by Jennifer McCormick that she is running for governor of Indiana was another bit of very good news.

McCormick first won statewide office as a Republican, serving as Superintendent of Public Instruction. As Republican legislators became more and more divorced from sanity and unrepresentative of their constituents, especially with respect to public education, McCormick left the GOP.

In her announcement, McCormick “tells it like it is.”

“I’m running for governor because our political leaders have lost sight of the challenges they were elected to solve. They are defunding and politicizing our schools, burdening us with the nation’s highest gas tax, taking our rights away, and standing by as we pay the highest health care costs in the nation. It’s time for a leader who will put Hoosiers first. Together, we can restore common sense and put an end to the divisiveness that’s pulling our state backward,”

“I know we can move our state forward by fighting for our public schools, making health care accessible and affordable, and bringing good paying jobs to main streets across Indiana. I loved serving our state and look forward to the opportunity to continue meeting with Hoosiers who believe it’s time for change.”

The Indiana Capital Chronicle also quoted McCormick

“I’m running because it’s time Hoosiers are put first, protecting our rights and our freedoms. It’s time Hoosiers have a voice, and a leader who believes in empowering them to make their own decisions,” she said, also emphasizing Indiana’s need for “a champion for a high quality education system.”

That means increased access to childcare, universal pre-K, better K-12 funding and “beyond high school training and education.” She also vowed to expand “accessible and affordable health care,” and to focus on “safe streets” and “safe neighborhoods.”

As Superintendent, McCormick pushed back against the GOP super-majority as it persisted in attacking public education. She had the spine to leave what the Republican party had become. She would be an awesome governor–and she deserves the votes of every teacher, every woman who wants to control her own body, everyone who has an LGBTQ+ friend or family member…the list goes on.

If enough genuine Christians and actual conservatives refuse to support what the GOP has become, America might begin the long trip back to sanity and responsible governance.

Comments

Sunday Sermon

Today, I will be delivering a talk–shared below– to Danville’s UU Congregation, addressing our legislature’s assault on trans children.

_______________________
Let me begin this talk by quoting from the introduction of a recent article in the New York Times:

When the Supreme Court declared a constitutional right to same-sex marriage nearly eight years ago, social conservatives were set adrift.\

The ruling stripped them of an issue they had used to galvanize rank-and-file supporters and big donors. And it left them searching for a cause that — like opposing gay marriage — would rally the base and raise the movement’s profile on the national stage.

“We knew we needed to find an issue that the candidates were comfortable talking about,” said Terry Schilling, the president of American Principles Project, a social conservative advocacy group. “And we threw everything at the wall.”

What stuck to that wall was the issue of transgender identity, particularly that of young people. As the article went on to detail, the effort to restrict transgender rights has supplanted same-sex marriage as an animating issue for social conservatives. It has reinvigorated a network of conservative groups, increased rightwing fund-raising and set the Right’s agenda in school boards and state legislatures, including Indiana’s.

Nothing like fear of a demonized “Other” to gin up the troops….

I was asked to address the legal issues triggered by the Indiana General Assembly’s efforts to keep trans children from receiving appropriate medical care. I will do that—but before I do, I think it is critically important to point out that what we are experiencing in the U.S. right now, not just in Indiana, isn’t just an attack on the autonomy of women and the existence of trans people; it’s a political calculation that is also part of a wholesale attack by MAGA partisans on the Bill of Rights and long-settled principles of American jurisprudence.

The purpose of the Bill of Rights was—in Justice Jackson’s immortal words—”to withdraw certain subjects from the vicissitudes of political controversy, to place them beyond the reach of majorities and officials and establish them as legal principles to be applied by the courts.” Or, less eloquently, as I used to tell my students, the Bill of Rights answers a deceptively simple question: who decides? Who decides what book you read, what God you worship (or if you do), what politics you endorse, who you choose to marry, whether you choose to procreate…who gets to dictate what philosophers call your telos—the ultimate aims and objectives that you have chosen and that shape your life?

From 1967 to last year, America’s Courts answered that question by upholding a doctrine called substantive due process—often called the individual’s right to privacy or personal autonomy. That doctrine recognizes the existence of an intimate “zone” that governments have no right to enter— a set of personal decisions that must be left up to the individuals involved. That doctrine, first enunciated in Griswold v. Connecticut, recognized the libertarian principle embraced by the nation’s founders.

Those who crafted America’s constituent documents were significantly influenced by the philosophy of the Enlightenment, and its then-new approach to the proper role of the state. That approach rejected notions of monarchy and the “divine right” of kings (in other words, the overwhelming authority of the state) in favor of the principle that Individuals should be free to pursue their own ends–their own life goals–so long as they did not thereby harm the person or property of someone else, and so long as they were willing to accord an equal liberty to their fellow citizens.

When I was much younger, that principle, and the importance of limiting government to areas where collective action was appropriate—keeping the state out of the decisions that individuals and families have the right to make for themselves– was a Republican article of faith. It was basic conservative doctrine. Ironically, the MAGA folks who inaccurately call themselves conservative today insist that government has the right—indeed, the duty– to invade that zone of privacy in order to impose rules reflecting their own particular beliefs and prejudices.

That process requires the use of other inaccurate labels. We’re hearing a lot about “parental rights,” for example—but we sure aren’t hearing about the rights of parents who want to treat their children’s gender dysmorphia or who want their children to have access to a wide range of books, or to be taught accurate history. In MAGA world, parental rights extend only to parents who agree with them. (A more accurate label would be “parental privileges.”)

Indiana’s legislature has now gone home, but before they left, the culture warriors who dominate that legislature passed measures doing irreparable harm to trans children. That same gerrymandered legislature was first in the nation to pass an almost complete ban on abortion after Dobbs was handed down. It was the same legislature that ignored law enforcement warnings and passed “permit-less carry,” and the same legislature that has conducted a years-long effort to destroy public education in Indiana.

I think it’s really important to understand that denying medical care to defenseless trans children isn’t a “stand-alone” position. It’s part of an entire worldview that is anti-choice, pro-gun, anti-immigration, racist, anti-Semitic and homophobic, a worldview that is autocratic and profoundly anti-American. The good news is that it’s a worldview held by a distinct minority of Americans—and that minority has gotten substantially smaller since the recent judicial and legislative assaults on women and LGBTQ+ people. The bad news, of course, is that—thanks to gerrymandering– that minority controls far too many legislative bodies, very much including Indiana’s.)

What is my evidence for the assertion that these are minority positions?

According to a Pew Research Center poll conducted in 2021, before Dobbs, 59% of Americans believed that abortion should be legal in all or most cases, while 39% believed it should be illegal in all or most cases. In a Gallup poll earlier this year—after Dobbs— 35% of Americans said abortion should be legal under anycircumstances, and another 50% said the procedure should be mostly legal, but with some restrictions. Only 13% responded that it should always be illegal. (What’s that old saying? You don’t know what you have until you lose it…)

It isn’t just abortion.

In a 2021 Gallup poll, 56% of Americans said they believe gun laws should be stricter, while 43% said they should remain as they are or be less strict.

In a Pew poll from 2021, 60% of Americans said that immigrants strengthen the country, while 37% said that they burden the country.

In another poll that year, 70% of Americans supported same-sex marriage while only 28% said it should be illegal. That level of support explains why the GOP has shifted its main focus from same-sex marriage to transgender people; the public is less familiar with transgender people, so they can more easily be demonized.

With that background, let me turn to the legal issues. On April 5th, Indiana’s ACLU– joined by the national organization– filed a 47-page complaint challenging the discriminatory and cruel anti-trans measure signed by Governor Holcomb. Let me just read the opening paragraph of that Complaint:

Over the sustained objection and concern of medical professionals, Indiana passed Indiana Senate Enrolled Act 480, effective July 1, 2023, which prohibits transgender minors from receiving what the law labels as “gender transition procedures.” These prohibited interventions are evidence-based and medically necessary medical care essential to the health and well-being of transgender minors who are suffering from gender dysphoria, a serious condition that can lead to depression, anxiety and other serious health consequences when untreated. By denying this medically necessary treatment to minors, the State of Indiana has displaced the judgment of parents, doctors, and adolescents with that of the government. In so doing, the State has intruded on the fundamental rights of parents to care for their minor children by consenting to their receipt of doctor-recommended and necessary care and treatment. This violates due process. Additionally, by singling out for prohibition the care related to “gender transition,” the law creates a facial classification based on sex and transgender status, violating the equal protection rights of transgender adolescents. It also violates their bodily integrity and is fundamentally irrational, which violates due process. And, to the extent that it prohibits the provision of essential services that would otherwise be authorized and reimbursed by Medicaid, the law violates the federal requirements of the Medicaid Act and the Affordable Care Act. It also intrudes on the First Amendment rights of doctors and other practitioners.
Speaking of intrusions on Constitutional rights, the ACLU has also filed two cases challenging Indiana’s abortion ban. The first case argues that the ban violates Indiana’s constitution. In my view, the second case is the really important challenge—it’s based upon religious liberty. Your Unitarian Church—along with several other Christian denominations, the Jewish community, and an assortment of other minority religions– has an extremely important interest in both its argument and outcome.

I’m one of many people who are convinced that abortion bans are prompted by a desire to return women to a subservient status– but those bans are publicly justified by equating a fertilized egg with a human person. As doctors will confirm, that is a religious precept, not a medical one. It’s a belief held by some Christian sects, but it is at odds with doctrinal beliefs held by other Christian denominations and by adherents of other religions. In Judaism, the health of the pregnant woman takes priority over that of the fetus throughout pregnancy, and the fetus does not have equal moral status with the mother until the head emerges from the womb.

If the Indiana Supreme Court upholds the ban, it would be favoring one part of one religion over others—a violation of the First Amendment, and ironically, a violation of Indiana’s version of the Religious Freedom Restoration Act., or RFRA. As you will all recall, that act was passed in order to justify discrimination against LGBTQ+ citizens. (What’s that saying about karma??) I’m relatively optimistic about Indiana’s Supreme Court, since none of its justices appear to be clones of Clarence Thomas or Samuel Alito.

So here we are.

MAGA Republicans are waging culture war against a fundamental premise of American governance—what Justice Brandeis once called “the right to be left alone”—a premise that animates the Bill of Rights and for the past 56 years has been protected by the explicit doctrine of substantive due process—the premise that there are decisions government doesn’t get to make.

I may disagree with your choice of religion or politics or life partner, but my disapproval is irrelevant. Even if a majority of Americans disagree with your choices, in our system, they are yours to make. Absent harm to others, government must “butt out.”

The Indiana legislature’s assaults aren’t just against women or trans people—these assaults should be seen for what they are: an effort to overturn a fundamental principle of American government. And if that effort is successful, it won’t just be trans children who suffer. None of us will have rights that government will be obliged to respect.

Comments

Politics And Perception

Every so often, there will be a vigorous debate on social media that hinges on perception–is this dress blue or gold? What color are these shoes? The arguments can get pretty heated, with viewers insisting that those who see a different color must be defective in some way.

There are scientific efforts to explain these opposing views.(Apparently, when context/background varies, so will people’s visual perception.)

Context and background probably explain other differences in perception–for example, the prevalence of criminal activity.

The linked article from the Washington Post was prompted by the recent spate of irrational shootings–a teenager sent to collect his younger brothers, who rang the doorbell at the wrong house; a woman driver who pulled into the “wrong” driveway; cheerleaders who approached the “wrong” car in a parking lot.

Across the country this month, at least four men have opened fire on someone who’d stumbled upon their space, resulting in one death, two injuries and a car pocked with bullet holes. The apparent acts of snap-aggression have reinvigorated the debate around the prevalence of “stand your ground” laws in the United States and a pressing question: Why are people so quick to pull the trigger on strangers?…

Experts blame a cocktail of factors: the easy availability of guns, misconceptions around stand-your-ground laws, the marketing of firearms for self-defense — and a growing sense among Americans, particularly Republicans, that safety in their backyard is deteriorating. (emphasis mine)

Survey research confirms that fear of the “other”–and a growing belief that pretty much anyone could be a dangerous “other”–is more widespread among Republicans, who are also more likely to own guns. The gap is significant.

Since 2020, the share of Republicans who said that crime is rising in their community has jumped from 38 percent to 73 percent, according to the latest Gallup numbers from last fall. Among Democrats, that same concern climbed only 5 percentage points to 42 percent, marking the widest partisan perception gap since the polling firm first asked the question a half-century ago.

There is a reason Republicans are convinced that crime is growing: GOP strategists have encouraged Republican candidates to dwell on fear of crime and to level accusations that “woke” Democrats are insufficiently supportive of police and too protective of “those people.” (Here in Indianapolis, that strategy was employed by a Republican candidate in the recent primary, who won that primary largely by running repeated, offensive ads describing a violent hell-hole of a city most of its residents didn’t recognize.)

Not surprisingly, Rightwing media is culpable for spreading misinformation about crime.

The perception that life is getting more dangerous has spread on the right as GOP leaders and pundits repeatedly argued, without evidence, that immigrants and protesters are jeopardizing American peace. Conservative news channels have devoted more airtime to violence than their center- and left-leaning competitors: Over the past three years, for instance, Fox News anchors and guests spotlighted crime 79 percent more often than those on MSNBC and twice as much as voices on CNN, according to a Washington Post analysis of closed captioning…

So–what does accurate data tell us? (What color is that dress, really…)

A Washington Post crime analysis of 80 major police departments’ records found that reported violence across the country in 2022 was lower than the five-year average.

And over the longer term, the National Criminal Victimization Survey showed the number of people reporting sexual assault, robbery and other physical attacks is overall much lower now than in the 1990s and has not increased in recent years.

Homicides and thefts did rise during the pandemic, according to Centers for Disease Control and Prevention data —but even then, that rise did not reach the levels of the 1990s. (It is worth noting that when it came to homicides, states with stand-your-ground laws had a 55 percent higher homicide-by-firearm rate in the past two years than the states that didn’t have such laws.)

The 28-year-old grandson of the 84-year-old White man who shot Black teenager Ralph Yarl, told officers that his grandfather was perpetually “scared to death. It’s the paranoia and fear…. It was the 24-hour news cycle — Fox News, OAN, all that stuff — pushing the civil division. Everybody is just so scared all the time.”

Context and background.

It’s one thing when you see a gold dress and I see a blue one. It’s something else entirely when I see a neighbor looking for directions and you see one of “those people” looking to rob or otherwise harm you–someone posing a threat that requires you to get your (always handy) gun and “stand your ground.”

The politicians and media outlets inculcating paranoia in their drive for power and profit are every bit as guilty as the armed and terrified citizens they’ve encouraged to pull the triggers.

Comments