Category: Social Issues

May the Best Budgeter Win

A few months ago (yeah, I know), I picked up a copy of The Medieval Military Revolution (Barnes & Noble 1998 – originally written in 1995 — Edited by Andrew Ayton & J.L. Price).  Been sitting on my shelf, inherited from TR, yet unread.  I was looking for something I didn’t find there, but I came across this thought in the editor’s introduction:

Those that live by the sword shall die by the sword, and this can be applied in a sense to governments and even states as well.  States went bankrupt, at least technically, through the cost of war, and the fiscal strain of long-term involvement in warfare was perhaps the single most important threat to political stability even in this most turbulent of periods.

In this case, the editor is writing about the mid-16th to mid-17th century.  But every century has its nations, and the realities of economics and defense don’t disappear over time.

When I was in high school economics, I can remember people trying to argue that somehow the US’s national debt just didn’t matter.  We were too big to fail, or by some bit of magic we could borrow as much as we wanted and nothing would really happen . . . it was bizarre. Didn’t make sense then, and still doesn’t.  I suppose we could always stiff our creditors in the end, but even that has its consequences.

The US is a mighty wealthy nation.  Wealthy people can waste a lot of resources and not feel the consequences the way poorer neighbors would.  But there are limits to our wealth.  We can’t just magically spend on anything we decide we want — even we must pick and choose.

***

And anytime we borrow? We have to pay it back out of future wealth.  The only time borrowing fuels growth is when the money borrowed is invested in something that makes us more productive. The hallmark of a chronic debtor, of course, is the conviction that every debt really was necessary, really did make the debtor ‘better off’.

But reality isn’t so.

In the current economic quagmire, households, businesses, and governments that had previously acted prudently and with fiscal restraint are managing fairly well.  A neighbor was laid off, but fortunately he had savings, was living beneath his means — he has a little cushion to get by while he looks for a new job.  The greatest crises today are coming among those who were massively in debt a year ago or more, and don’t know how to get by without yet more debt.  (Or, of course, stiffing their creditors.)

–>  Not talking here about those families and businesses that did everything ‘right’ during the flush times (which were not, for them, all that flush), but still struggle today.  Not talking about those whose reverses have been far greater than anyone could plan against.  Prudence today won’t withstand every possible storm tomorrow. But it sure improves your odds.

***

So I’m a bit alarmed by the current rush to spend, spend, spend.  Oh and it isn’t a democrat’s problem — I had a pit in my stomach prior to the presidential election, knowing that I could count on either party to be just as irresponsible.  I’m alarmed by things like trying to create new government-sponsored insurance programs *for people who already have health insurance*, when we haven’t sucessfully put together a program for those who don’t.

–> Frankly I’m really dissappointed in the democrats, because they aren’t actually coming through on helping people who actually need help.  Tons and tons of spending on vague programs to ‘stimulate’.  Er, how about we just get everyone who needs food fed?  Houses for *actual homeless people*?

A more personal example: I’ve a friend who has an undiagnosed breathing problem. She *stops breathing*.  She can’t afford a doctor’s visit to diagnose the problem.  Mmn . . . how ’bout we stimulate the economy by making it possible to get in for a doctor’s appointment if you’re a person who can’t work because you can’t, uh, breathe reliably??  That cash would trickle into the pockets of a receptionist, a maintenance guy, a lab worker, an MD — *and* we’d have a person who might be able to breathe all the time? And thus be able to go get a job? Hmmn?

***

End of the rant.  Have a good week.  Soon as I find my lost book, I’ll have a review up on the other blog.  Meanwhile am trying, as always, to clean the house, educate the children, exercise the ol’ mind, body & spirit, and all that other vocation-y stuff.  Hope y’all are doing well.  Oh, and hey, to keep you busy during my slackerlyness, here’s another cornucopia of social-issues rants: http://www.frontporchrepublic.com/ . Thanks to Bethune Catholic for the link.

When Even the Buildings Are In Denial

For a cornucopia of social-issues posts, check out the Blogging Against Disablism Day blogfest.   I’m running behind on my own contributions, but I wanted to talk for a minute here about dumb architecture.  Not merely bad in the sense of ‘ugly’, for I must grudgingly admit that ugliness is in the eye of the beholder.  But dumb as in ‘doesn’t work’.  Buildings that don’t meet the needs of the people who use them.  Or would use them, if only they were useful.

What stuns me is not that there was a time when buildings were not made to be wheelchair-accessible.  There was, after all, a time when wheelchairs, like indoor plumbing, just weren’t a significant part of most people’s lives.  Would have been nice to have such conveniences, but you didn’t.  Too bad.  The architecture of those eras reflect that, and retro-fits to modernize can be a bit clumsy.  (But worth it!  In both cases!)

But I am continually amazed that we don’t, as a society, seem to have caught on to the bit about how people — all people — ought to be able to get in and out of a building, and even move around in it.  I’m reminded of when I lived in a little ground-floor room in Paris and that had a window that let out onto a courtyard.  I hosted a party at the end of the school year, and fully expected that my guests, if they wanted to relax on the grass outside, would simply climb through the window.  I was stunned to discover that not everyone includes climbing through windows as part of their traveling repertoire.

But I was young then.  I was not an architect, not even a builder.  My assumption that anyone (among my guests, who were all walking-around kinds of people) could and would climb through windows was naive and a bit self-centered.  I assumed that if I could do something, everyone else could, too.   Somehow you would think that building professionals would have grown passed that point.

I am fortunate to live in a home that was designed to be moderately wheelchair accessible.  Not perfectly so, but better than average.  One of the previous owners did a few renovations to make it even better.  And the sordid truth?  It isn’t that big of a deal.  Any grown-up who has, say, studied architecture, ought to be able to whip out fairly accessible homes without too much difficulty.  There’s nothing really magical about it.

[Tuning a building to the precise needs of a particular individual or family?  Yes.  That takes some doing.  But being able to get far enough into the ballpark that the residents can easily take it the rest of the way?  Not nearly so hard. ]

And curiously, I think that defaulting to accessible architecture would bring down construction costs.  Here’s why: in order to make a home wheelchair-friendly, you can’t crowd it up with a bunch of built-ins.   And built-ins — cabinets, counters, shelves, drawers, even closets and extraneous doors — these are things that drive up cost.

So why aren’t modern American homes built to a default level of accessibility?  It isn’t a lack of space — our homes are larger now, on average, than they were fifty years ago, and have fewer residents.  It isn’t that everything goes to two stories, and it’s just so hard to make a two-story home accessible.  If that were the case, a) single-story homes *would* default to accessible design, and b) two-story homes would still have an accessible first floor.  (After all, even if I don’t have a ground-floor bedroom for my wheelchair-using visitor, it sure is nice for that person to at least be able to *get in front the door*.)

So I’ve got to assume a sort of perpetual adolescence on the part of our building industry.  Not surprising in a culture that worships youth and beauty and vigor — I’ve known people with gray hair and grandchildren to openly deny they were ‘old’.   So I suppose if you are going to great lengths to fight any appearance of mortality or even maturity, intentionally purchasing a wheelchair-accessible home isn’t going to help you keep up the facade.  And for a builder, suggesting someone might actually want such a building some day is going to about as popular as my letting slip to my gray-haired companion that no, she was not actually all that young anymore.

It’s a sad kind of denial.  As I rode through the countryside yesterday on the way home from a family reunion, I was myself a little surprised at how many homes had a ramp tacked on to the front.   More informative than riding through the city, because in the country you aren’t likely to move when your house doesn’t fit your needs anymore, you just try to adjust your house as best you can.

Not the end of the world — a slapped-together plywood monstrosity of a ramp isn’t particularly attractive, but as I said, this post isn’t about beauty.   Look inside our family farmhouse, and the bathroom — converted from a bedroom, I think — betrays that same problem of The Home That Had To Be Brought Into the Present.

But there reaches a point when you’ve got to lose patience with builders and architects who are still building for Some Other Era.  Be a grown-up, builders. What you build, people *will* buy — most of us haven’t got a choice but to purchase what is on the market.  It falls to you to lead.  Recognize that humans are frail, mortal.  That not everyone can climb through the window.   And it just isn’t a good building if people can’t use it.

routine care and the uninsured

Anna in the combox on my last post points out that I glossed over the importance of routine care as a cost-savings measure.   She shares a specific example of a family member’s costly (and potentially deadly) health problem that could have been caught and treated earlier via routine care.   WSJ this morning has an article about the large number of clients health insurers are losing to layoffs.

–> Given the cost of privately-obtained insurance, and given that an unemployed person will naturally put off lower-priority expenses, the layoffs *will* mean people skip on routine care that could have saved much time and distress.

***

What’s the solution?  I don’t know.  It’s really tempting to, say, add some kind of health care aid as part of unemployment compensation. It seems pretty simple – in addition to that paltry sum of unemployment payments, you get a packet of health-care stamps or some such thing.

Objections?

Doing so creates an incentive to not return to employment unless it provides a better package than the unemployment package.  The way our unemployment system works now, we assume that you were pretty pulled together before you were laid off — you kept yourself healthy, you are up-to-date on your physical, you have some emergency savings, you weren’t living above your means.  Unemployment payments are, in my state anyway, a little something extra to tide you over while you scramble for a new job, any job.

Most Americans, it turns out, aren’t actually living this way.  Americans are, on average, in poor health, they haven’t got savings, they are in the habit of using credit all the time.   Not poor Americans, *all* Americans.   Conservatives have a well-trained stinginess-reflex that recoils at the thought of aiding and abetting these bad habits.   Liberals, on the other hand, might recognize the need for change, but observe that you won’t have much chance for self-improvement if you’ve just dropped dead.

My intuition is that the solution lies in the middle.  It is reasonable to set up some mechanism for providing routine preventative care and emergency health care to people whose situation falls outside the norm.  Whether due to temporary unemployment or some tragic longterm problem.  We should think about how to do so efficiently. (Health care stamps? Clinics? Private Charities? Insurance vouchers? School nurses? So many possibilities.)

And then, separately, we need to be working on addressing the myriad problems that are making our health care crisis so much more onerous than it ought to be.

Taking Apart Health Costs, part II

The other week I made some opening remarks.  The next thing I want to do is look at the different kinds of health care costs.  I think costs can be divided into three different categories:

-Well Visits / Routine Care

-Minor mishaps

-Major events

Cost-wise,  each of three works differently.  From an insurance point of view, the funding of each category of costs ought to work differently.  Today I’ll look at the first type of health care cost, routine care.  Then I’ll take on the other two categories in turn, in subsequent posts.

***

“Well Visits” or Routine Care

This kind of health care is what you do to keep yourself healthy.  The periodic physical or well-child visit, vaccines as appropriate, routine screenings like getting your cholesterol checks, or having the dermatologist look for suspicious moles.

As with all health care, exactly who needs what and when is debatable.   One real challenge for managing a nation’s health care needs is deciding what those needs are. If you happen to agree with the manager of your health care plan, you are going to be fairly happy.  If you find that your health care plan covers — even insists — on care you don’t want, and will not cover the care you do want, you won’t be so happy.

–> Fondness for nationalized health care plans, or for company-sponsored plans, often divides based on that question.  Any just health care system will find the right balance between protecting a legitimate amount of disagreement, while neither blindly funding true quack treatments, nor refusing care that could reasonably be needed.  No easy task.  I am leery of anyone who claims this is easily determined, and that the rest of us should just go along.

A second point to remember is that our current models for administering routine care — and thus the costs associated with that care — are not set in stone.  Some of the tasks of well-care could be done by the individual — such as tracking your own family’s weight and height.   Where a health care professional is required, models for economic delivery of routine care should not be dismissed.  There is much to be said for the corner pharmacy running flu-shot clinics, or the local hospital dispatching a team of cholesterol-checkers for a one-day-blitz at the company cafeteria.

–> When we look at health care reform, we should be willing to think outside the box about ways to reduce costs, but also allow that some patients really do need a level of closer monitoring and hand-holding.

The good news is that patients won’t generally double-dip if there are multiple venues for the same kind of care — no one gets a flu shot at Walgreens *and* from the doctor’s office, just because both are available.  What we sometimes think of as ‘scattershot’, really is not.  A patient will reliably avoid excess poking and prodding, and given multiple choices for receiving routine care, will usually pick the one most suited to his situation.

On the topic of routine care, we should go ahead and acknowledge that some elements of well-care are most important as compensation for poor behavior.  A good health care system will combat these problems at the source.  In other words, a good health care system might involve making it possible for kids to walk to school and play outside more.

–> No no! I am *not* suggesting the Department of Transportation become an office of a National Health Bureau!  What I am suggesting is that ‘health care reform’ is much more than creating a national insurance program.  By their nature, the nations’ health concerns need to be attacked from multiple angles.  One element of managing routine health care costs is to be looking for ways to reduce the need for preventative care.

Try not to squirm as I observe: we should not overlook our nation’s moral climate when trying to find ways to reduce health care costs.   I don’t say leave people hanging out to dry because of their past mistakes; but by all means, do help avert disaster and instruct on avoiding more problems in the future.  A legitimate part of routine care is education and assistance in adopting healthy behaviors.

***

After all this attacking of health care costs from without and within, we are still left us with some routine well-care that is useful and well worth our while.  Having acknowledged that your list of the right and good may be different from mine, assume for the rest of this article that when I talk about ‘routine care’ I am referring to those well-care practices that you happen to think are money well spent.  Here are some observations specifically about the nature of these types of costs:

The payoff is not immediate. Break your leg, and you have no doubt that the services of a good bonesetter are well worth your while.  Spending $120 for your physician to tell you your toddler looks normal?  Might make you feel good, but when money is tight, you are going to be tempted to just look around at the local playgroup and be content your kid looks okay and seems normal enough.  If you haven’t dropped dead yet, what’s another month or two before going in for that physical . . .

. . . And frankly, most people who go in for routine care didn’t end up “needing it”.   For every baby saved from disaster by a routine a well-visit, there are plenty that could have skipped the appointment and been the none the worse.  At the height of the polio epidemics, most people managed just fine without the vaccine.  Trouble is, if you’re the one who did need the care, you would have been sunk without it.

–> So when we look at the benefits of routine care, we have to acknowledge that we are checking all in the hope of saving some.  Well worth it.  As a result, we have to overcome our natural stinginess — towards ourselves and towards others.

***

Currently, there are three ways to pay for well-care in the United States.  One is to have the care paid for by an employer-sponsored health care plan.  The second is to qualify for a government-run program.  The third is to pay for it yourself (or persuade a loving friend or relative to pay it for you).  Each of these is valid.

Employers have a legitimate interest in ensuring employees and their dependents receive routine care.  The expense up front can pay for itself by saved sick days and avoiding more expensive treatments down the road.  It is not unreasonable to continue to allow employers to subsidize health care costs.

The government likewise benefits from a healthy populace, for the same reason.  Healthy citizens are productive citizens who can contribute to wider society.  Two obvious cautions:

1) The US government does not have a perfect track record in its management of other efforts.  We would be unwise to assume it will be able to manage a national health care system any better than it can manage any other department.

2) As with employers, the utilitarian interest is limited.  The government benefits greatly from cultivating intelligent, hard-working, highly-capable individuals.  There is a temptation to limit care only to those who show promise, and discretely push aside those who don’t offer sufficient promise for future contributions.   The current rate of abortion for children diagnosed with Down Syndrome is telling.  There is already a strong tendency in our country to consider life itself as really only appropriate for those who offer the rest of us more perceived “benefit” than cost.  There is no reason to think that government-run health care will be anything other than a reflection of wider society’s values.

Individuals and their immediate relations are the obvious primary beneficiaries of routine care.  Well it is reasonable for the government or employers to fund routine care when individuals might otherwise neglect it, the cost of routine care properly belongs to the individual. The most effective health care system, in my opinion, will help individuals make wise decisions on which routine care is needed, and provide a convenient means of setting aside funding for that care.

***

What about Insurance?

Health “insurance” for routine care is a misnomer.  There is no ‘insurance’ to it.  Insurance is the pooling of risk.  I pay homeowner’s insurance so that in the unlikely event that my house catches fire, I can benefit from the my neighbors’ contributions to the insurance program,  and thus receive money to rebuild my home.  With true insurance, all participants contribute a share of the cost of one person’s disaster.  If I’m lucky, I’ve ‘thrown my money away’ — I’ll never collect.  If I’m unlucky, I can be rescued from an emergency I never could have saved for on my own.

Routine care, in contrast, is an expected cost.   It’s not a question of ‘whether I will want a tetanus shot’.  I want one.  Someone has to pay for it.  Likewise there is no magical cost savings by having 100% of newborn babies get their well-visits paid for by the insurance company.  In a perfectly run nationalized health care system, the cost of routine care is exactly the same as if each of us just paid out of our own pocket.

In the case of routine care, all that an insurance program does is act as a middle man.  Now there can be benefits to middle men.  My insurance program (Blue Cross Blue Shield) regularly pays a lower rate than the retail price on my medical bills.  Even when my insurance “doesn’t cover” a particular service, I only have to pay the ‘negotiated rate’, effectively cutting my cost in half over the list price.  Kind of a Sam’s Club for health care.

–> To the extent that an insurance program is providing an effective tool for matching health care consumers and providers, it is a worthy organization.  Just like your local grocery stores is ‘merely a middleman’ that makes it a lot easier and more efficient to feed your family.  But insurance is no more the means of getting health care than the grocery store produces food.

Now one advantage of an insurance program is that it forces you to set aside the cash.  If you are a poor saver, purchasing an insurance policy that bundles routine care with your other health care needs is a way of tricking yourself into saving for routine care. Indeed, the company selling you an insurance policy for non-routine care has an interest in motivating you through low co-pays to get to the doctor early and often, in the hopes of warding off a more expensive condition down the road.  Kind of like your home insurance company benefits if you install a sprinkler system (to put out house fires), and replace that old wiring before it catches fire.

–> But all the same, the routine care you need is not an insurable risk, it is a regularly scheduled expense.  For this reason, if ordinary workers cannot afford to pay routine medical costs out of pocket, the problem lies elsewhere than a lack of insurance.  Maybe costs are too high.  Maybe the workers aren’t earning a living wage.  Maybe workers are lousy at managing their money.  Insurance programs may or may not turn out to be the easiest way to compensate for the underlying problem.  But lack of “insurance” coverage for routine care is not, in itself, the problem, and more than lack of food insurance is the reason people are malnourished, or lack of clothing insurance is the reason I dress so shoddily.

Keep in mind: There will always be people who cannot pay their ordinary expenses.  People who cannot, for whatever reason, pay their own food and housing bills, likewise will need assistance paying for even routine preventative medical care.  “The poor will always be with us” and all that.   We should distinguish these ought-to-be-exceptional cases from the needs of ordinary citizens.   There is a place for soup kitchens and food stamps; there is a place for charitable health clinics and health-care stamps.  But we shouldn’t therefore assume that the whole country needs to sign up for charitable relief.

***

All that rambling to summarize just a few points:

Routine Care costs can be reduced, but not eliminated. We will get a lot of bang for our health care efforts by working to find ways to reduce our need for routine care, and to delivery efficiently what care is needed.

Routine Care costs go to 100% of citizens. By its definition.  There is no risk to be pooled. What we think of as “insurance coverage” for routine care is actually just a means of either forcing ourselves to pay for the care, or getting someone else to pay for it instead.

There are multiple beneficiaries to routine care. The primary beneficiary is the individual receiving the care, and a just health care system makes makes it simple and convenient for the individual to access affordable routine care.  But there are times in places when others benefit, and it is reasonable to allow those others to pay for that care.

***

So what do I think about “Insurance” Programs for routine care? I think they have their place, as part of a multi-faceted approach to providing health care.  But we should recognize them for what they are — savings plans, middle men, and cost-shifters.  We should consider whether other changes that facilitate individual health-care savings would be more effective.

And what do I think is the number one thing-we-haven’t-tried-yet that is worth exploring? Price lists.  Publicly posted.  Not just the ‘list price’ but the agreed-on prices for different classes of consumers.  I think we kid ourselves about ‘managing health care costs’ when virtually nobody even knows what those costs really are.

Taking Apart Health Care Costs, intro

Busy day on the WSJ’s editorial page.  Top center is a nice letter-to-the-editor proposing a realistic compromise concerning mark-to-market and regulatory capital.  See, I knew I wasn’t crazy.

Jim Curley will be thrilled to see someone else advocating for smaller businesses, down in the lower right hand section of the letters.  Not sure how one would make it happen, but there is a valid point: if a business is “too big to fail”, it is too big.   You can’t have your whole economy living and dying on the wisdom of a single CEO or board of directors.  An alternate view: maybe no company is too big to fail.  You can let it be big, as long as you are willing to let it fail.  Something to think about it; I don’t have a fully-formed opinion yet.

And then the topic I do want to cover today is introduced in “National Health Preview”, a critique of Massachusetts’ health reform results.  Not supportive to say the least.

***

Health care reform and universal health care coverage is a thorny issue, and I wanted to break apart the cost structure, and maybe add a few other comments, to help us think about it.

The first thing to keep in mind, and forgive me for stating the obvious, is that someone has to pay for it. I say so because health care is expensive, and if you won’t or can’t pay your own bill, it comes out of your neighbor’s pocket.  If you are a person who has good health care coverage, can pay your own bills, and lives comfortably, take a look at your budget.  What several thousands of dollars a year in other spending are you willing to give up so that your less-fortunate fellow citizens can enjoy the same health care benefits you do?  A less expensive car?  A smaller house?  You have to be willing to sacrifice, if you really mean to provide everyone in America with the health care that we tend to consider our due.

And that leads to a problem: Everyone dies. And bunches of us won’t do it on the cheap.  A lot of us are going to die after a long illness that can be treated for a time, to prolong our life and make it more comfortable.   What is an an extra year of life worth?  It is priceless.  How much is it worth to ensure that you or a loved one does not suffer needlessly in the final days, months, or years of your life?

–> When it comes down to it, our wants and needs for health care are almost unlimited.  And a sordid reality is that there is already a tendency to resort to euthanasia when the money runs short.   A health care solution that encourages people to die early so as to ‘not be such a burden on society’ is not a health care solution, it is a nazi regime.  Whatever we do, we need to guard against this vigilantly.

Making all this even more complicated, is that medical science is far from exact. Not only do we wonder whether it is worth the expense to give mom that chemotherapy, we aren’t even sure whether chemotherapy is really what she needs.   And she might or might not want it as part of her treatment, no matter how beneficial the rest of us find it.

–>  As a result of this, nationalized health care systems are very popular with people whose alternative is no treatment at all.  But those who can afford to pay for the treatment of their choice (or would be able if only they weren’t being taxed to pay for everyone else’s treatment) often beg to differ with the medical bureaucrats’ decision over what treatment is the best one.  A just health care system would take into account both sets of concerns.

Likewise, there is much argument about what deserves to be covered as a ‘health care cost’ and what does not.  For example, under a typical insurance program in the US today, it is pretty easy to get coverage for a surgery that will restore your ability to use an injured leg.  But coverage for adaptive equipment that compensates for the loss of use of that same limb can be ridiculously difficult to obtain.  Even if the equipment in question costs less than the surgery.  Not proposing here that we use equipment instead of surgery.  Am proposing that part of the equation is a review of what we mean by health care, and what our goals are.   A just health care system extends benefits fairly, not treating some conditions as more privileged than others.

Finally, we should keep in mind that like all problems, health care issues need to be attacked from a thousand angles.  This or that program by itself won’t fix everything.  You have to constantly be looking at malpractice issues, at the system for educating a licensing medical professionals, at the management of costs, at the way our health care businesses are organized, all of it.  Insurance programs are only one part of the picture.

***

Enough for today.  I’ll keep going in the next installment.  Have a good weekend.

About that international dateline . . .

I’m looking at my schedule for the weekend, and estimating that ‘Friday’ will show up on this blog sometime Monday afternoon.

Meanwhile, my thought for the weekend:

How ’bout a square-feet-per-occupant guideline on that housing bailout?  Not persuaded that the bailing-out is the best way to proceed.   (Said by a person who is very keen on affordable housing and owner-occupied housing.)  But I’m certainly sympathetic to those who were faced with the choice of ‘if you want to own a home, you have to buy at this ridiculous price’.   We were fortunate not to have needed to relocate during the big bubble.

So my thought is this: If I am going to be subsidizing your housing, I would like it to be reasonable housing.  Kind of rankles to imagine someone went out and mortgaged a McMansion, and I have to pay taxes to make sure the poor folks don’t have to downsize to a house like . . . mine.  Just envy speaking, don’t mind me.

Plus I’m curious to see what the government would come up with as a ‘normal’ home.

Book Review: Embryo

Embryo: A Defense of Human Life

by Robert P. George and Christopher Tollefsen

Doubleday, 2008

ISBN 978-0-385-52282-3

(Available as an audiobook on audible.com.)

The truth is, I picked this book up because I am a Chris & Laurie Tollefsen fan. Yeah, yeah, their philosophy is good (who knew!), but what I really like is them. Their cooking, their conversation, their de-cluttered home – hard not to like people who excel you in every way, and have the courtesy not to point it out. Not that I wasn’t interested in the book, of course. But I don’t think I would have trudged to my local catholic bookstore and actually bought a copy without that personal connection.

Wow. Way worth it. Even if there is no hope whatsoever of any kind of culinary benefit to you for reading this book, you still ought to read it. Even if you aren’t pro-life. And in particular if you aren’t catholic, because it is not a book about catholic (or even theist) perspectives on the topic.

–> If you are catholic, you should read it so that you can speak intelligently to people who want to understand your position on the proper treatment of human embryos, but who aren’t particularly interested in arguments that begin ‘Well, the Pope says . . .’.

Why Philosophy? Philosophy*, as I understand it, is more or less the study of What People Think About Things. For example, how should I treat my fellow human beings, and why so? This is a philosophical question. It can be answered with respect to God, of course, but if you are person who doesn’t believe in God, you still may have an opinion on right and wrong behavior, and probably even some good reasons for your opinion. In this book, George & Tollefsen argue that human embryos deserve ‘full moral respect’ – that is, that they share certain fundamental human rights along with the rest of the species (that’s us). They lay out the reasons for their opinion chapter by chapter.

What’s in the book? And am I smart enough to read it?

The opening chapter, “What is at Stake in the Embryo Experimentation Debate” is a sort of presenting of the situation. It will help tremendously here and throughout the book if you have a passing awareness of the public debate on the topic, and a little bit of familiarity with philosophical terms. The text is eminently readable – very clear and precise, and with quick prose given the technical nature of the topic — but this is not Embryos & Philosophy for Dummies. (Someone please suggest a link for those who want to do the pre-req reading. If nothing else, reading the Secondhand Smoke blog for a few weeks might help.)

Likewise, the second chapter, which lays out the biology of embryonic development, really requires that you have completed high school biology and have some vague recollection of what you learned on the topic. If words like “RNA” and “meiosis” ring a bell, you’re good. Don’t worry if you can’t exactly define them just now; as you read your memory will be refreshed and it will make sense again. It may be a little bit of work to follow the detailed explanations, but you can do it.

After answering the question of ‘is it a little tiny human being?’ in the embryology chapter, George & Tollefsen move onto the philosophical question of what to do with those tiny beings in the remainder of the book. Topics covered include things you might not have known people doubted, such as “What is a person?” (Once a person always a person? Or does your personhood come and go according to this or that factor? It is a relevant question, and one that apparently folks have some interesting ideas about.)

And then, once they’ve established their reasons for thinking that not only are embryos human beings, but they are, in fact, human persons, the book proceeds with building the arguments for what rights persons have, and therefore how they ought to be treated by all the other people.

Who should, and should not, read this book?

This is an important and useful book, regardless of your opinions on the topic. If you beleive in the human rights of embryos, it will help crystallize your thinking and recognize why others may disagree. If you don’t beleive in such rights, it will help you understand the logic of people who do. So it is a book that facilitates the mutual understanding essential to any hope of finding common ground.

And it is particularly useful because it is not a religious book. You may, of course, have religious reasons for your opinions, but those reasons won’t make much sense to people who don’t share your religion. Embryo argues that respect for the rights of the human embryo is not the province of any particular religion, but is in the same category of fundamental human rights that people of any religion or no religion at all tend to agree on.

–> And here is an important caveat: This book assumes that you are not a Nazi. If you need someone to explain to you why people deserve the same rights regardless of race or religion, you need to get that explanation elsewhere.  This book assumes you already hold that view. Likewise, it assumes you understand the difference between people and animals.  If you think it is okay to eat people, or to do deadly medical experiments on them without their full informed consent, again, you need to look to some other work to understand why this is, in the view of the rest of us, not so.

I warn you of this, because George & Tollefsen really do hit a tremendous variety of arguments against their opinion, and deal with them respectfully and thoroughly. [Do you wonder, for example, whether you are really the person who inhabits your body, or if ‘you’ is something else? They address this possibility.] But these two particular views I mention above (not a nazi, people are not fodder for your whims) are assumed, and at times even central to their arguments.

For nearly all readers, this shouldn’t be a problem, I hope. But I am aware that ‘nearly all’ does leave out a select few.

**

In summary: Highly Recommended. Well written, thorough, examines the debate from every angle. The tone is charitable and friendly, at times even humorous. Deserves to become a standard work on the topic.

*I mention this because if you are like me, you may not really have that clear of an idea of what exactly it is philosophers do. I’m just starting to catch on. And it’s relevant to this book review, because you can’t really know what is in the book if you don’t understand what Philosophy means, or at least what it seems to mean in this context.

Book, er, Podcast recommendation – Disability & Social Justice

It’s a quiet afternoon.  Big kids are at friends’ houses, the baby is napping, the house is all yours.  The kitchen could use some attention, but that’s never bothered you before.  What you need is to settle down in the recliner with a bag of chocolate chips and a philosophy podcast.

Specifically this one: Chris Tollefsen’s talk on Disability and Social Justice, given at Anselm College this fall.

Count me in the ranks of the philosophically ignorant.  Historically my efforts at studying the topic have been met with disaster.  (As certain of Dr. Tollefsen’s colleagues can attest, if they have not supressed the memory.)  And I’ll admit very plainly that there were bits of this talk where I just did my best to pay attention, and hope that sooner or later it would start making sense again.  Because I couldn’t follow all the references quickly enough — what I really needed was a transcript I could read slowly, but so far no luck searching the internet.  Have a tried contacting the author? Of course not.  That would be logical.  But next time I see him I’ll put in my request.  Honestly I hesitated to do so because I was concerned it would be either too difficult or not quite my thing, or both.   Didn’t want to bother a perfectly good philosopher just to satisfy my curiosity. But now I know better.   It was challenging for me to follow, but not too much to make it worth the effort.

So, if it isn’t too hard for me, it isn’t too hard for you, either.  Indeed since 80% of my readers are smarter than me, it should be a piece of cake for most of you, and the other one can manage at least as well as I did.  When it gets to a bit where you start to lose track of the ideas, just hang in there, because more good stuff is just around the corner.  Do allow a bit of time to listen, it is a fairly long talk.  And allow for some quiet, you need to be able to pay attention and think.

–> Handy tip:  The inaudibly asked questions (during the Q&A at the end) are all fairly long.  You can safely run your trash to the curb while you wait to hear Dr. Tollefsen’s reply, assuming your curb isn’t too far away.

So what’s in this podcast that makes it rate my monthly recommended reading (er, listening) post? If I understood him correctly (debatable point), his argument went something like this:

-Interdependence is normal for human beings.  The idea of ‘self-sufficiency’ cannot be applied to people in a meaningful way.

-We tend to think of government being a contract by and for citizens.  That is, people who are capable of consenting to their government and interacting with it.

-Not so.  Government exists to provide for the human needs that individuals and social groups (family, friends, church, etc.) are unable to provide themselves.  Think: protection from enemies, etc.

–> Government as a contract between citizens is a *form* of government, not the purpose of government.

-Understanding this gives us a more accurate way of addressing the needs of people who are disabled, who are dependent on others for care (for whatever reason), as well as those to whom the caregiving responsibilities fall.

Also in there: Why one of the legitimate roles of government is to provide a moral environment that promotes virtue.  (Answer: we are unable to do it for ourself.  We cannot individually create the environment in which we live, we need the cooperation of wider society).  And how this fits into the challenge of providing for the needs of caregivers and the cared-for.

Worth listening for: The comment on how providing for the needs of people with disabilities, caregivers, and others fits into the balance of providing for other legitimate demands on the government.  It’s quick and at the end, but provides some helpful perspective.

And much, much more.  Check it out.  Not just to see how badly I mangled a perfectly good philosophy lecture, but in order to enjoy the lecture itself.

Humor: How to Identify

In my goofing off I noticed a bit of discussion today about whether this weekend’s SNL was funny or  offensive.  Haven’t seen the episode, and have other more important internet laziness calling my attentions, so I won’t.  [Why would I want to watch something that a number of very sensible people tell me is objectionable, anyway?  When I could be reading more back-issues of Dr. Boli?  Pretty easy decision for me.]

All the same, as parents of an eight-year-old boy, the SuperHusband and I have had many opportunities to reflect on what does and does not constitute humor.  A few thoughts, not very well edited because my goofing-off time is coming to an end, and I want to just get the ideas out there today.  But here for you to ponder however confusedly, while I go make dinner and clean the house:

Humor is based on comparison. The comparison can come in many forms, but it is always there.  In a pun, it the similarity in sound between two words or phrases, combined with an apropos meaning given the context of the joke. (Why is the baker cruel? Because he whips the cream and beats the eggs.)  In slapstick humor, it is a comparison between what should have happened (walked through the door unharmed) and what did happen (a bucket of water fell on my head).   In satire, the comparison is built by taking what we know to be true about a person, and applying it in an extreme (play Sarah Palin as if she’s even flightier-sounding than she really is) or out of context (Bob Dole runs a daycare).

–> In order to understand a joke, one must be able to recognize the comparison.  This is why, say, philosophy jokes have a very limited audience.  They may be hilarious, but few audiences have the knowledge required in order to catch the comparison on which they hinge.  Usually, though, even when the audience doesn’t ‘get’ a joke (that would be me, listening to my peers tell philosophy jokes), they are merely puzzled, not offended.

So what distinguishes between a joke that is truly offensive, and one that really was funny, but the audience had no sense of humor?

Sore topics aren’t funny when the joke is told by the guilty party to the offended party.  Even if they are otherwise fair game. Double standard? No.  It’s a violation of the comparison rule.  It isn’t a joke if it is really happening, or likely to happen.

This poses a real problem for the modern satirist, as the things we joke about now seem to come true dreadfully quickly.  To review real quickly as we develop our main point, a couple of examples of possibly funny versus not funny, based not on teller, but on the premise that it isn’t a comparison if it is the literal truth:

Possibly funny: The CIA is going to subject captured enemy combatants  to Wheelock’s Latin in order to get them talk.    Not funny: ‘Jokes’ about actually torturing people, that are based on real torturers committing their real crimes on their real victims.

Possibly funny: Jokes about other species engaging in suicide.  Not funny: Most jokes about humans engaging in suicide.  (This used to be possibly funny, because it wasn’t true.  But now that large segments of the population have decided that suicide is acceptable — it isn’t — there are very few suicide jokes left.  None come to mind.  On the other hand, you can now joke about judges who declare people must stay alive until their natural death, since that is, sadly, now parody.  Hopefully only temporarily.)

So, getting back to our main issue: if I tell my eight-year-old, “Don’t touch my chocolate or I’m selling you to the salt mines”, it’s humor.  He knows I would never, ever, sell him to the salt mines.   But if I say, “Or no dessert for you,” it is not humor.  He knows that missing out on dessert is a very real possibility, based on his parents’ past behavior.

–> For this reason, parents who do sell their children to the salt mines have fewer humor options than average.  Virtue has its rewards.  Which leads to the next point:

Humor Depends on the Teller’s Credentials In most circles, one can safely tell accountant jokes, because there is very little anti-accountant persecution.  It is generally assumed the joke is well-meant poking of fun.  (Even though, in fact, most accountant jokes fall flat.  Not because accountants aren’t a lively bunch, full of interesting fodder for the satirist, but because the general public is woefully ignorant of the true esprit of the accountant, and tends to rely on the same tired and shallow assumptions decade in and decade out.  But lame humor is not necessarily offensive.  We’ll chuckle politely for you, or at least kind of twitch the lip a little to acknowledge you spoke.)

In contrast, when a group of people is subject to discrimination, hate, condescension, or other meanness in the wider society, it becomes necessary for the joke-teller to prove beyond all doubt that no derision is meant by the joke.  If this criteria can’t be meant, the joke is probably going to be received as offensive.  (This is a shame, because it deprives many innocent people of perfectly good humor.  But it is the reality all the same — our sins affect others more than we realize.)  So, for example, among southerners, humor about the idiosyncrasies of southern life is quite funny.  Told by a southerner to others? Still funny.  But told by damn Yankees people not from the south, the same jokes can be received as offensive, for there is a certain amount of cultural history that can leave one wondering whether the joke is meant as true humor, or as a veiled insult.

–> SNL treaded on dangerous ground, because they are part of a group known as the “mainstream media”.  And the mainstream media is notorious for producing all kinds of garbage that is offensive to people with disabilities (and thus to anyone with the ability to detect nonsense).  Therefore, if SNL meant to be genuinely funny, it had to prove beyond all doubt that it was not engaging in the same obnoxious blather that its colleagues churn out so regularly.

This phenomenon leads to a general rule, that one can only make fun of oneself and one’s own group.  This rule is not, however, strictly accurate. Both for the reason that a) it is possible to insult oneself and that b) it is possible to be a person of goodwill and good sense towards others.  So, even southern accountants can tell offensive southern accountant jokes (but not on this blog, I hope), and even non-southern, non-accountants can tell enjoyable southern accountant jokes.  (Don’t expect to see a compendium of such jokes published any time soon, however.)

All that said, certain groups of people have experienced such shoddy treatment at the hands of others that their sense of humor has been injured.   As it is not especially difficult to identify shoddy treatment present or past, it behooves others to be mindful of the lingering pain, and politely go find some other topic for one’s jokes.  Humor is part of the healing process, but humor inflicted from without is generally not the healing type.

What is especially egregious about the SNL fiasco?  Chances are the SNL writers didn’t even realize they were dealing with an easily-offended audience –> which is to say, with a group of people who has consistently received ill-treatment at the hands of wider society.

On the one hand, it’s a bizarre problem, given that eugenics movement and the ensuing marginalization of people with disabilities has been around for nearly a century and half now — plenty of time for an SNL writer to develop an awareness of the problem.  (And even, perhaps, to care enough about it to write some good satire on the topic.)  On the other hand, it proves the point: the whole complaint is that people with disabilities are marginalized in our society.   To the point that SNL doesn’t even know you’re there.  Let alone that you are mighty touchy just now.

–> Good humor requires you to know your topic.  Because humor depends on the comparison, an inaccurate comparison makes for poor humor.  Listen to a four-year-old try to tell a riddle. Very painful.  Poor child doesn’t quite know what a pun is yet, and therefore just tries for any random silly words that come to mind.  (Four-year-olds, on the other hand, understand slapstick quite well.)  And this same knowledge that makes for good humor is also what keeps you from being offensive, because you will know that you are dealing with a potentially sore topic.  The SNL writers offended because they tread on ground they didn’t know.

The good news is, this is knowable ground.  There are so many directions SNL could have taken the Paterson joke that would have been genuinely funny.  Funny in a way that resonated with the subject audience, and brought reality to tlhe attention of the general public.   Which is what good humor does.

Rationing Health Care

I forget which of the several great blogs I owe thanks to for pointing me to Secondhand Smoke.  Good coverage of ethical issues, and over the past week there have been a few posts specifically on health care and end-of-life decisions.  Look here for a brief report about how the British healthcare system rations expensive medicines.  And here is an article about a family that wishes to dehydrate-to-death a family member who has become severely disabled by a stroke — of significant concern is the cost of nursing care for the patient.

I wanted to point out two issues that these articles raise:

First of all, making cost-versus-benefit decisions about medical care is normal and rational. Resources are limited, and both length and quality of life can be subject to opportunity costs. As a wife and mother, frankly I’m all about making this life’s inevitable suffering and end as frugal as possible.   There are times when my family’s money is better spent on some other purpose than my medical care.

Forgive me if I shock you, but shouldn’t my money be spent on my happiness?  If I find greater marginal utility in spending $10,000 on college tuition for my children, rather than on a year’s supply of a prescription drug of doubtful longterm benefit, do I not have the right to spend my money as I see fit?  If it is acceptable for me to give up my life of housewife luxury in order to toil away in a fluorescent-lit cubicle farm, in order to provide some perceived good for my children, am I not also allowed to give up that same number of days of housewife luxury, for the same benefit to my children, if instead of a cube farm I find myself suffering at home, or in purgatory, doing some kind of work arguably no less valuable than whatever clerical job I might have gotten in the first case?

So what’s wrong with a nationalized health care system making rationing decisions?  The same thing that would be wrong with a command economy telling me I am required to take that clerical job.  These are my decisions to make.   The catholic name for this principle is ‘subsidarity’.  From CCC 1883:

Socialization also presents dangers. Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good.”

Any health care system that violates the principle of subsidarity — taking health care decisions out of the hands of the patient and making them subject to the preferences of the state — is not morally sound.

The second point that came to me, especially reading about the beleaguered stroke patient, is that we as a culture seem to have lost all concept of responsibility for caring for family members.  Let me be the first to say that I find nursing to be icky work.   There’s good reason I went into accounting and not health care.  I can barely stand to change my own kids’ diapers, why would I want to change anyone else’s?

But contemporary America has decided to completely forget about the work of caring for the helpless.  All those housewives who ‘don’t do anything’?  They’re, um, taking care of other people.

–> Ever notice that if you don’t take care of your own children, you have to pay other people to do it?  It’s because childcare is actual work.  Same story with making dinner, vacumning, cleaning toilets, all that stuff.  When people decry the ‘high cost of childcare’ I want to shake their shoulders.  Don’t you know that the nice lady who keeps your kids for you has to feed herself and her family, too?  There isn’t a ‘cheap’ method of caring for children.

And the same is true of nursing care.  Fine and good if you as a family have decided that expensive hospitalization and advanced medical procedures are not how you wish to spend your money for the care of ill family member.  But you can’t anymore decide that therefore *nobody* should feed the poor guy, just because you don’t want to pay someone to do it for you — anymore than you could decide that since daycare is so expensive, just leave the baby home alone and unfed while you go to work all day.

And now we’re back to subsidarity.  You can’t have it both ways.  Does the state have a responsibility to pay for the care of your children?  Then you have given up your right to decide how that child will be treated.  Does the state have a responsibility to care for your elderly, disabled, father?  Than you again have turned over your rights.  Because these are, fundamentally, your rights.  Your rights, and your responsibilities.

We are slipping more and more from the notion that the state has a legitimate role in assisting the most weak and vulnerable among us — the orphan, the childless elderly, the abandoned and helpless — to thinking that the state has the obligation to care for all of us.  It isn’t so.  What the state does for those most in need, it does on our behalf — the church, or some other private group or individual, could as easily do the same.  In a secular nation, it is not unreasonable that our government be a logical choice for representing us in these works of mercy.

But they are, all the same, our work.  Our responsibility.  We have a collective responsibility to the poor in our communities.  We have an individual responsibility for our own family members.  And claiming and fulfilling that responsibility is the only way we can hope to hold onto our freedom.  Which I suppose makes a homeschooling housewife a rather patriotic sort of worker.