I think it was Thomas Jefferson who said “eternal vigilance is the price of liberty.” He was right; and that vigilance can be taxing. Similarly, social progress requires persistence, and most of us tire of activism in the long run. “Cause fatigue” is human–but not helpful.
I’m beginning to see that fatigue in Indiana’s gay community. The national trend is toward equality; polls show that once my generation is dead, the fight for equal civil rights, including marriage, will be won. So a lot of well-meaning folks–gays and straight allies alike–are easing up on their support for the organizations doing the heavy lifting.
In Indiana, dwindling support can have very significant, very negative consequences: the right wing may yet get a constitutional ban on same-sex marriage on the ballot. And of course, Indiana still doesn’t protect even the basic civil rights of its gay citizens. So it isn’t a good time to let up on our support for groups like Indiana Equality.
There’s a lesson in the European efforts to manage the economic crisis that threatens to sink the EU. I’m just not sure what that lesson is.
Greece and Italy have replaced their political leaders with well-regarded technocrats–men whose skills and qualifications for office are professional and intellectual rather than political. It’s hard not to see this move from glad-handing politicians to technocrats as an increasingly inevitable feature of modern societies; in today’s highly complex world, where local and global issues are more and more difficult to separate, “Mr. Smith goes to Washington” is untenable. People in positions of public authority need a level of education and specialized expertise in order to function adequately.
The promise of technocratic governance is that it will be grounded in understanding of the challenges confronting public managers today, and better able to meet those challenges. The peril is that technocrats will be too removed from the citizens they serve–too smug in their specialized areas of knowledge to recognize the importance of the people skills that come so naturally to “retail” politicians.
We need leadership that brings both kinds of skills to the job. And those folks are rare.
I always read Masson’s Blog, and always find him insightful, but this morning’s post on the mis-named “Right to Work” proposal is an absolute home run.
In an era that elevates spin over accuracy, naming/framing all too often substitutes for describing. “Right to Work” is a wonderful example–who could be opposed to people’s right to work? It is phrasing that feeds into the American belief in individual rights. And as Doug Masson explains, it is a phrase that has very little relationship to the reality of the legislation.
As Masson writes,
The perniciously named “right to work” is a misnomer. What the law really does is use government authority to prohibit a certain kind of contract. As it stands now, employers and employees have the freedom to enter into a contract whereby one of the conditions of employment is that employees join a union or, at least, pay some equivalent of union dues so they are not tempted to be free riders, receiving union benefits without paying for them. So, it’s a contractual provision that is currently permitted but not required. “Right to work” is a limitation on this freedom to contract. The General Assembly tells employers that they are not permitted to make union membership a condition of employment.
This is typically dressed up as championing the rights of future employees who might not want to join a union as a condition of employment; but the oddity is that typically the advocates of this restriction on contracts are, in other contexts, champions of absolute freedom to contract and could rarely care less what a potential employee thinks about the conditions of employment set by an employer. (Don’t like that condition of employment? Fine, go work somewhere else.) But, when union membership comes up, horrors! Conditions that are pro-union or anti-gun are off the table, but pretty much anything else goes.”
I’ve been following the Sunday series in the New York Times in which Ezekiel Emanuel—vice-provost and Professor of Medical Ethics at the University of Pennsylvania, and former White House advisor—has been explaining high healthcare costs.
I particularly appreciated this week’s discussion, “Billions Wasted on Billing.” My husband and I are at the age when doctor’s visits become more frequent, and I have weekly opportunities to open envelopes to read incomprehensible jumbles of medical and financial jargon under the heading “this is not a bill.” Anyone having experience with mailings of any sort—bills, invoices, reminders—knows that it is impossible to generate and mail anything for less than $5-$7 dollars, once you account for clerical time, stationery and postage. I’ve never understood why the same not-so-informative information can’t be included when the actual bill is sent.
Emanuel’s column was not just about billing, but about all the other repetitive, duplicative paperwork that characterizes our current health care system. How many times do we fill out patient forms with the identical information? How many insurance claims must be completed in different formats by all those white-haired ladies in colorful smocks sitting behind the glass partitions in your doctor’s office?
What does all this cost, and how much of it is really necessary?
According to Harvard economist David Cutler, electronic billing and credentialing could save the system upwards of 32 billion dollars a year. Transitioning to electronic record-keeping would pay other dividends as well: it would allow medical providers to use existing anti-fraud detection methods currently used by credit card companies, and it would minimize the errors that are inevitable when data is manually entered. (No longer getting “this is not a bill” mailings would also have a salutary effect on my blood pressure.)
What Emanuel’s column did not address is the question why medical insurers and providers have been so slow to adapt to the electronic age. I think a part of the answer is the complexity of what passes for a medical system in the U.S.—a complexity that also bedevils efforts to conduct reasonable policy discussions about health care in general.
We’ve all joked about the senior citizen at the Town Hall meeting who shouted “keep government’s hands off my Medicare.” It’s true that most Americans do know Medicare and Medicaid are government programs. We know that taxpayers fund the (much-lauded) Veteran’s Administration. But how many of us understand the extent to which government currently funds pharmaceutical and medical research? Or how much state governments contribute to the cost of medical education? To public health programs? How many of us know what local government units spend for everything from ambulance service to charity care?
I like to think of myself as informed, but I certainly don’t know the answers to those questions. I was astounded a few years ago when, serving on an academic committee dominated by healthcare professionals, I learned that government at all levels currently funds between 60% and 70% of all healthcare costs.
The real question isn’t whether we should have a government system or a private one. We haven’t had a private, market-driven system for decades, and for good reason. Markets require a willing buyer and willing seller, each of whom has the necessary relevant information and the ability to exercise choice. The real question is how to identify the measures that will reduce healthcare costs and improve patient care and access. Right now, we pay 2 ½ times what the next most expensive country pays for a system that ranks 36th in the world.
Here’s a question I often ponder–a conundrum for which I have no good answer.
I know literally hundreds of wonderful people. They will help their neighbors, pick up litter, donate to help the victims of hurricanes. They’ll take food to bereaved families, mow the lawn of an elderly neighbor. Actually, I know very few people who aren’t genuinely nice. Some are smarter than others, some are more obtuse or self-involved, but I really think most people are basically decent.
So why do those same people often behave so badly in groups? Why do people who would never intentionally injure a neighbor or co-worker support collective actions having no other purpose than to hurt a particular group of people? Why do people in crowds act in ways they wouldn’t individually?
The “good Germans” in WWII come to mind, although that’s an extreme example.
I’m not talking about injustice or suffering that happens at a far remove–there’s a limit to how many “causes” people can focus on or care about, and as Jon Stewart has put it, most of us “have shit to do.” I’m talking about the otherwise nice people who dismiss bullying at the local school with “boys will be boys,” who excuse brutality by the local police because “they” probably had it coming, who enthusiastically support draconian measures targeting immigrants, or who want to discontinue public welfare for poor people because “recipients are all lazy good-for-nothings.”
I guess I’m talking about people who are generally ready to help a fellow human–but who define “fellow human” to exclude a lot of people–people they would probably help if they lived next door.
