Technology-R-Us?

Among the recurring elements of what my sons call “family photos”  are the iPhone pictures snapped at family get-togethers in which we’re all looking at our iPhones. My youngest son (who is one of the worst offenders) usually labels those pictures “warm family moments” or something equally sarcastic.

I don’t think my family is unique. Enter an elevator or restaurant, or just walk down a city street, and most people you encounter are staring at the small screens. That reality–and it certainly seems to be a universal reality–raises the question: what is this seductive technology doing to our brains?

Ezra Klein recently addressed that question in an essay for the New York Times.

I am of the generation old enough to remember a time before cyberspace but young enough to have grown up a digital native. And I adored my new land. The endless expanses of information, the people you met as avatars but cared for as humans, the sense that the mind’s reach could be limitless. My life, my career and my identity were digital constructs as much as they were physical ones. I pitied those who came before me, fettered by a physical world I was among the first to escape.

A decade passed, and my certitude faded. Online life got faster, quicker, harsher, louder. “A little bit of everything all of the time,” as the comedian Bo Burnham put it. Smartphones brought the internet everywhere, colonizing moments I never imagined I’d fill. Many times I’ve walked into a public bathroom and everyone is simultaneously using a urinal and staring at a screen.

Klein referenced several of the 20th-century media theorists, including Marshall McLuhan, Walter Ong and Neil Postman, who “tried to warn us.” And he quoted Nicholas Carr’s book, “The Shallows: What the Internet Is Doing to Our Brains.”

The very way my brain worked seemed to be changing. It was then that I began worrying about my inability to pay attention to one thing for more than a couple of minutes. At first I’d figured that the problem was a symptom of middle-age mind rot. But my brain, I realized, wasn’t just drifting. It was hungry. It was demanding to be fed the way the Net fed it — and the more it was fed, the hungrier it became. Even when I was away from my computer, I yearned to check email, click links, do some Googling. I wanted to be connected.

Sound familiar? It sure does to me. And it resonated with Klein, who was particularly struck by the word “hungry.”

That was the word that hooked me. That’s how my brain felt to me, too. Hungry. Needy. Itchy. Once it wanted information. But then it was distraction. And then, with social media, validation. A drumbeat of “You exist. You are seen.”

How important is the choice of the platform–the medium–through which we receive messages? Like Klein, I’d always supposed that content is more important than the medium through which we access that content, but the theorists he cites beg to differ.

McLuhan’s famous insistence that “the medium is the message” reflected his view that mediums matter a lot–in fact, that they matter more than the content of the messages being conveyed. Different mediums create and communicate content differently, and those differences change people (and ultimately, society). As Klein concedes, “oral culture teaches us to think one way, written culture another. Television turned everything into entertainment, and social media taught us to think with the crowd.”

Like several commenters on this blog, Klein has been influenced by Neil Postman’s “Amusing Ourselves to Death.”

McLuhan says: Don’t just look at what’s being expressed; look at the ways it’s being expressed. And then Postman says: Don’t just look at the way things are being expressed; look at how the way things are expressed determines what’s actually expressible.” In other words, the medium blocks certain messages.

Postman was planting a flag here: The border between entertainment and everything else was blurring, and entertainers would be the only ones able to fulfill our expectations for politicians. He spends considerable time thinking, for instance, about the people who were viable politicians in a textual era and who would be locked out of politics because they couldn’t command the screen.

Later, in this very long essay (which is well worth your time to read in its entirety,) Klein makes an important point:

There is no stable, unchanging self. People are capable of cruelty and altruism, farsightedness and myopia. We are who we are, in this moment, in this context, mediated in these ways. It is an abdication of responsibility for technologists to pretend that the technologies they make have no say in who we become.

I wonder: what have we become?

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Getting Out The Vote

Several years ago,  my husband and I took a week-long cruise on a small boat that accommodated only eleven passengers. One of those eleven, as it happened, was a retired professor of public administration from Australia, and we had several fascinating exchanges about policy differences between our two countries.

One of those differences involved elections.

In Australia, the law requires  that every citizen vote. I initially recoiled at that suggestion; surely, people too disinterested to go to the polls  unless required to do so would cast uninformed ballots…but the more I thought about  it, the more Australia’s system appealed to me.

Many democratic countries evidently require people to vote, and fine those who don’t.  (Actually, as I understand it, what is mandatory is appearance at the polls. In many systems, there is apparently something akin to a “none of the above” option that will fulfill the legal obligation.)

Requiring citizens to vote would help ensure that election results mirror the preferences of the entire population, not just those sufficiently motivated to express those preferences at the polls. At least some percentage of the currently disengaged would take more interest in government and politics–knowing that they would have to cast a ballot, at least some Americans might make an effort to know something about the people on that ballot and (gasp!) even the system within which they aspire to operate.

Arguably, universal turnout would require candidates to craft more inclusive messages, since targeting an ideological sliver would no longer be the path to victory. (Targeting one’s base is one reason for our currently polarized politics.) Candidates and parties would also save a lot of money and effort currently spent on get out the vote efforts.

So what are the cons, the arguments against mandatory voting?

Requiring people to vote would assure the participation of low-interest, arguably uninformed people, “alphabet voters” who would simply check a box in order to avoid a fine. (You can lead a voter to the polls, but you can’t force him to think.) Even a token fine would fall most heavily on the poor and disadvantaged–the very people who have difficulty getting to the polls in our current system.

At least one scholar has suggested that–rather than making voting mandatory (which America will do when pigs fly)–we should work to make elections more competitive, because turnout increases when voters have meaningful choices. Gerrymandering currently makes that solution untenable.

Gerrymandering is also a huge disincentive to voting; when you are convinced your vote won’t count, you are understandably less likely to make the effort. And because Republicans have been far more successful in gerrymandering (not that Democrats don’t try–they just aren’t nearly as good at it), the people who are least likely to vote are the people most likely to vote Democratic.

A recent study of turnout should be filed under “read it and weep.”

A new study from BYU and the University of Virginia analyzed 400 million voter records from elections in 2014 and 2016 and found that minority citizens, young people, and those who support the Democratic Party are much less likely to vote than whites, older citizens, and Republican Party supporters. Moreover, those in the former groups were also more likely to live in areas where their neighbors are less likely to vote.

“We’re finding that the circumstances of other citizens who live around you plays an important role in voter turnout,” said Dr. Michael Barber, BYU professor of political science and co-author of the study. “Much of the country is segregated—especially by race and partisanship. Minorities are more likely to live around other minorities who are also less likely to vote. The same is true of voters of both parties. These patterns can create a situation that results in persistent patterns of lower turnout in certain communities for a variety of reasons.”

The study found that, in 2016, White citizens voted at a rate of between 9 and 15 percentage points higher than Black citizens, Asian citizens, and Hispanic citizens. In 2014, the gaps were even higher, with Whites voting at a rate 9 to 18 percentage points higher than minority groups. There were similar gaps in political party turnout, with Republicans  more likely to vote than Democrats.

Unsurprising but depressing, the data also confirmed that the voting rate of citizens 60 years old or older was roughly 40 percentage points higher than that of citizens 30 years old or younger.

If those demographic gaps in turnout narrowed–or, with mandatory voting, disappeared– a significant number of districts that have been gerrymandered by partisans would no longer be safe–after all, the people drawing district lines must depend upon previous turnout data. They have no way of knowing the political preferences of the people who didn’t bother to vote.

Increased turnout could save American democracy.

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Religious Chutzpah

Regular readers of this blog will have noticed that–ever since the Supreme Court’s decision in Dobbs—I’ve been harping on the evisceration of a doctrine called “Substantive Due Process,” also known as the right to privacy. Without going back through the jurisprudence that established that doctrine, let me just paraphrase it: government must respect citizens’ right to make our own decisions about how to live our lives, so long as  those decisions aren’t harming others.

Decisions about procreation are hardly the only areas protected from government overreach by the Bill of Rights. Your choice of religious conviction and my choice not to be a believer are both protected–mostly by the religion clauses of the First Amendment, but also by a right to privacy that keeps government from dictating so personal a choice. Religious liberty is based upon that same respect for the integrity of the individual conscience.

However, the current Court seems intent upon elevating the rights of believers over the rights of the rest of us.

Just this last term, the Justices permitted a theatrically pious coach to pray on his school’s fifty yard line, and ruled in favor of a Christian group wanting to raise its flag at Boston’s City Hall.

The Hill has reported on a pending lawsuit  encouraged by earlier Roberts Court cases that weakened the wall between church and state.

A Texas lawsuit that hopes to eliminate mandated health insurance coverage of birth control, HIV medication, sexually transmitted disease (STD) testing and more has quietly been pushing forward through the court system and could eventually end up in front of the U.S. Supreme Court.

In the case of Kelley v. Becerra, two plaintiffs from Texas argue that the current structure of the Affordable Care Act (ACA) mandates health insurance providers to cover certain preventative care they argue they do not need and that conflict with their religious beliefs — specifically, contraceptive coverage, STD testing and HIV medications Truvada or PrEP.

One of the lawsuit’s arguments leans on the Religious Freedom Restoration Act, which states governments should not substantially burden religious exercise without a compelling justification. Plaintiffs argue this right has been violated as both are Christian and unwilling to buy health insurance that subsidizes, “abortifacient contraception or PrEP drugs that encourage homosexual behavior and intravenous drug use.”

The lawsuit also takes issue with how the ACA defines preventative care, a decision-making process that has been assigned to various groups, including the Advisory Committee on Immunization Practices, the Preventative Services Task Force and the Health Resources and Services Administration.

If these religious zealots prevail–and they probably will at the District Court level, since they’ve filed the case in the courtroom of the radical Texas judge who previously ruled that the ACA was unconstitutional–health insurers would no longer be required to cover preventive care with no copay. They could either opt out of offering those services altogether, or begin charging for them.

Currently,most health insurance plans include coverage of preventative care like birth control and HIV medicines. Plaintiffs complain that their options for plans without those elements are few and far between, denying them freedom to exercise their religious beliefs.

Health care providers have raised alarm bells over Kelley v. Becerra, like the American Medical Association (AMA), alongside 20 other medical trade groups, which stressed how popular the preventative care measure of the ACA has been — with an estimated 151.6 million people receiving free preventative care in 2020 alone.

An adverse ruling would mean millions of Americans would lose access to “vital preventive health care services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, obesity, diabetes, preeclampsia, and hearing, as well as well child visits and access to immunizations critical to maintaining a healthy population,” wrote the AMA.

A coalition of 20 attorneys general has also filed an amicus brief in Kelley v. Becerra arguing–among other things– that public health outcomes have significantly improved since the ACA’s preventative services provision was implemented.

Let’s give the plaintiffs the benefit of the doubt, and accept that these provisions–provisions that have improved the health of millions of Americans– are contrary to their “sincerely held” religious beliefs. Do they not have options other than denying critical health care to Americans who are currently benefitting from access to preventative care? Couldn’t they establish a “faith-based” insurance company that would cater to their needs? (Such a company would have a strong argument for being exempted from the federal requirements they insist are inconsistent with their religious doctrines.) Or they could opt to self-insure.

Instead, they argue that their religious “rights” trump the health of millions of Americans  who currently have free access to cancer screenings, birth control and childhood vaccinations. (Google chutzpah.)

If they prevail, thank the current “Christians” on the Supreme Court.

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Meanwhile…

On the Late Show, Stephen Colbert has a recurring comedy bit he calls “Meanwhile.” Not part of the opening monologue, it’s a collection of brief–usually weird or ironic– items culled from the news of the day.

But “meanwhile” also has application to those of us who are fixated on contemporary threats to America’s Constitution and democratic norms. While we worry about the increasingly bizarre behavior of our fellow-Americans who live in a fact-free reality of their own devising, we ignore or just miss the daily challenges posed by technology–everything from the way social media is altering attention spans, to the mounting inability of the nation’s utilities to cope with the damage being done by climate change, to the rush to turn our highways over to self-driving vehicles.

That last item–the (debated) imminence of self-driving cars– is just one element of another under-appreciated threat: the loss of millions of jobs, and the issue of how we will handle the transition to a world where most labor (not just manual labor) is performed by machines. An enormous amount of research suggests that, sooner or later, AI–artificial intelligence–will replace a significant percentage of tasks that now require human performance.

It is easy to “pooh-pooh” those predictions, and to dismiss the likelihood of significant social disruption, by pointing out that someone will have to produce and program those machines, and noting that past technological progress has created as well as destroyed jobs. The cheery optimists insist that nothing is certain, so why worry? (Tell that to the estimated five million people who make their livings driving…)

The Brookings Institution has weighted in. In a paper aptly  titled “Preparing for the (non-existent) future of work,” the researchers write,

We analyze how to set up institutions that future-proof our society for a scenario of ever-more-intelligent autonomous machines that substitute for human labor and drive down wages. We lay out three concerns arising from such a scenario, culminating in the economic redundancy of labor, and evaluate recent predictions and objections to these concerns. Then we analyze how to allocate work and income if these concerns start to materialize. As the income produced by autonomous machines rises and the value of labor declines, we find that it is optimal to phase out work, beginning with workers who have low labor productivity and job satisfaction, since they have comparative advantage in enjoying leisure. This is in stark contrast to welfare systems that force individuals with low labor productivity to work. If there are significant wage declines, avoiding mass misery will require other ways of distributing income than labor markets, whether via sufficiently well-distributed capital ownership or via benefits. Recipients could still engage in work for its own sake if they enjoy work amenities such as structure, purpose, and meaning. If work gives rise to positive externalities such as social connections or political stability, or if individuals undervalue the benefits of work because of internalities, then there is a role for public policy to encourage work. However, we conjecture that in the long run, it would be more desirable for society to develop alternative ways of providing these benefits.

You can download the entire paper at the link.

The likelihood that much of world’s work will eventually be done by machines that don’t get sick, don’t need benefits, and can work 24/7 is part of what leads me to support a Universal Basic Income– an “alternative way” of providing a social infrastructure.

Analyzing America’s current polarization provides another argument for a UBI.   As political rhetoric makes clear, policies intended to help less fortunate citizens can be delivered in ways that stoke resentments, or in ways that encourage national cohesion.  Currently, we’re stoking resentments. (Consider public attitudes toward welfare programs aimed at impoverished communities, and contrast those attitudes with the overwhelming majorities that approve of Social Security and Medicare–universal programs to which virtually everyone contributes and from which virtually everyone who lives long enough  benefits.)

I’ve previously observed that we don’t hear angry accusations that “those people” are driving on roads paid for by my taxes.  Beneficiaries of programs that include everyone (or almost everyone) are much more likely to escape stigma. If work disappears for a significant percentage of our population, an approach that doesn’t require lawmakers to pick and choose who deserves help would be far less likely to tear the country further apart.

Of course, the armed and dangerous Americans who currently live in crazy-town may make attention to these “meanwhile” matters irrelevant. They involve questions of governance that they disdain, because they involve how best to achieve the common good, and they have absolutely no interest in helping anyone but themselves.

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Affording To Live…

GOP lawmakers–including, of course, Indiana’s two Senators–recently blocked a Biden Administration effort to cap the price of insulin for Americans with private health insurance. (Americans on Medicare will see their out-of-pocket costs decline, thanks to other provisions of the Inflation Reduction Act.)

GOP opposition to the measure, which I can’t help thinking of as a manifestation of the Republican “Let them eat cake” approach to policymaking, reminded me of a recent discussion with my sister. Her doctor had rordered some medical tests, and when she  was scheduling them, she was told that one of them–a test for cancer!–wasn’t covered either by Medicare or by her private insurance. The test was $300, and she told me that her first thought was “I can afford this, but what about all the people who can’t? What about  people who don’t have an extra $300 but do have cancer?”(Fortunately, she didn’t.)

This conversation, rather obviously, wouldn’t have occurred in most Western democracies, because in those countries, health care isn’t just for people who can afford it.

When it comes to capping the price of insulin, the influence of Big Pharma–particularly Indiana’s own Eli Lilly–was front and center with the GOP.

Lilly’s enormous profits owe a lot to the high price of insulin. That’s especially ironic, given the generosity of those who first held the patent.

Before the 1920’s, a diabetes diagnosis meant a death sentence for people all over the world. The main treatment was starvation diets to prolong the inevitable.

In 1920, a Canadian physician and scientist named Frederick Banting began working on an idea to isolate and extract insulin. He worked in the laboratories of J.R.R. McLeod, a professor of physiology at the University of Toronto. The medical student Charles Best aided him in his work to test out insulin on dogs. Chemist James Collip worked with Banting and Best to purify and refine insulin for clinical trials in humans.

On January 23rd, 1923 Banting, Best, and Collip were awarded the American patents for insulin. They sold the patent to the University of Toronto for $1 each. Banting notably said: “Insulin does not belong to me, it belongs to the world.” His desire was for everyone who needed access to it to have it.

In order to make insulin widely available, Eli Lilly, Sanofi and Novo Nordisk were given the right to produce it, and they’ve turned it into a massive profit generator. As the linked article reports, “by 1923, insulin was the highest-selling product in Eli Lilly’s history, and profits from it accounted for over half of the company’s revenue.”

And that brings us to the recent refusal of Indiana’s Senators and other GOP recipients of Lilly largesse to ensure insulin’s affordability.

As The Intercept reports, Lilly Endowment–ostensibly separate and independent from the company–is not neutral when it comes to funding entities opposed to controlling the price of medications. The Endowment,”led in part by former Eli Lilly executives and still financed by corporate stock options” funds think tanks that “work to shield corporations from taxation or government regulation,” and has given millions of dollars to libertarian groups that lobby against price controls on insulin, categorizing those recipients as “community development organizations.” (The Endowment is also the largest shareholder of Eli Lilly, Inc., holding 104,161,053 shares worth approximately $31 billion.)

The Federalist Society, for example, has received over $1.5 million from the charitable arm over the last decade and is listed under “community development” grantees of the Lilly Endowment. The Washington, D.C.-based group is a professional society for conservative attorneys, with an eye toward pro-business ideological positions.

The Federalist Society funds included a $150,000 grant last year, at the same time that the group was sharply criticizing a new Minnesota law that forces manufacturers to provide free or affordable insulin to low-income residents. The law “[inflicts] an injustice upon companies that are regularly demonized in the media,” an attorney for the Goldwater Institute writes on the Federalist Society’s website.

Last year, Eli Lilly collected over $2.4 billion in revenue from its insulin products, including the brand Humalog, with roughly $1.3 billion of that from U.S.-based sales.

“One vial of Humalog (insulin lispro), which used to cost $21 in 1999, cost $332 in 2019, reflecting a price increase of more than 1,000%. In contrast, insulin prices in other developed countries, including neighboring Canada, have stayed the same,” wrote S. Vincent Rajkumar in the journal of the Mayo Clinic in 2020.

There’s much more detail in the linked article, and I encourage you to click through and read it. That said, the real issue is the one my sister identified: if government is supposed to provide a physical and social infrastructure within which citizens can flourish, isn’t access to health care and lifesaving medication as essential a part of that infrastructure as police, firefighters, roads and bridges?

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