Sunday, January 31, 2010

In Defense of Antidepressants

Regular readers will know that I have mentioned many times in many prior posts that I have bipolar disorder. Some time ago I reached a conclusion within myself that the best way to counteract the still prominent stigma of mental illness and with it the misinformation based on fear and misunderstanding was to offer myself as a concrete example. I must admit, though, that I never thought I'd need to speak out against anyone or any column that at least concedes that treatment would be necessary, assuming, that is, that it worked. Most resistance I face and most assumptions I refute are mainly a product of people who, as they inevitably put it, don't wish to be a slave to a pill or who think that anyone who has to rely on medication to solve his or her problems must have some deficiency in inner strength, independence, or both.

Begley's article in Newsweek entitled "The Depressing News about Antidepressants" contains much truth, but its underlying assumption that antidepressants aren't worth the risks involved and might be more harm than good only provides more justification for people of such stripes. Fear and unwillingness to seek treatment are the biggest of stumbling blocks to health and the idea that someone whose quality of life is suffering mightily might not reach out and seek a highly available and usually quite effective means of obtaining an otherwise normal life distresses me greatly.

Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

This is an unfair across-the-board characterization of psychotropic medication as a whole. The true problem here is the typically 21st Century liberal sensibility of the back-to-basics, return-to-the earth holistic treatment movement which casts doubts regarding the efficacy of all modern medicine aside from the obviously irrefutable (and sometimes not even then) . A misunderstanding of the basic elements of psychiatry leads many on a series of wild goose chases and frustrating avenues towards health that, in my opinion, could be better resolved through visiting a medical professional. To wit, the brain is a very complex organ, one still frequently beholden to mysteries and theories in place of solid data. Though we might have a good grasp on treating certain diseases, in this instance we only can work with the information and biological advances currently available. This goes for schizophrenia, senile dementia, and migraine headaches.

We have observed recently that though many might clamor for change in the abstract, or as long as it doesn't happen to them personally, the prospect of individual change promises only the unknown. That which we cannot perceive easily is often frightening and distressing, but those who know intuitively that the life they are living is not the one they need while simultaneously recognizing also that they don't have to feel the way that they do, psychotropic medication is a godsend. Sometimes, but rarely, one finds an instant fit with the first drug prescribed, but trial and error is necessary for those who strive for lasting health and stability. I myself have been on twenty-four different meds over the course of roughly fifteen years, and while I take care to note that I have a very severe and very rare case, I am not completely unusual in some respects. I long ago accepted this as the reality of the situation as to all of us who seek to find a balance between illness and health. Finding the proper medication cocktail is a bit like visiting a psychologist. One rarely finds a good fit the first go round, though not always.

Even Kirsch's analysis, however, found that antidepressants are a little more effective than dummy pills—those 1.8 points on the depression scale. Maybe Prozac, Zoloft, Paxil, Celexa, and their cousins do have some non-placebo, chemical benefit. But the small edge of real drugs compared with placebos might not mean what it seems, Kirsch explained to me one evening from his home in Hull. Consider how research on drugs works. Patient volunteers are told they will receive either the drug or a placebo, and that neither they nor the scientists will know who is getting what. Most volunteers hope they get the drug, not the dummy pill. After taking the unknown meds for a while, some volunteers experience side effects. Bingo: a clue they're on the real drug. About 80 percent guess right, and studies show that the worse side effects a patient experiences, the more effective the drug. Patients apparently think, this drug is so strong it's making me vomit and hate sex, so it must be strong enough to lift my depression. In clinical-trial patients who figure out they're receiving the drug and not the inert pill, expectations soar.

As for the clinical trials of varying effectiveness mentioned in the article, I had a much different experience. Beginning in late 2008 into last year I spent nearly six months in-patient at the National Institute of Mental Health (NIMH) in Bethesda, Maryland. I can't say that I ever doubted the antidepressant effect of any or all of the existing trials and protocols that were being performed on site. My reservations mainly were that the process of research was so minutely calibrated and overcautious that psychiatrists and researchers took huge pools of patient data samples before publishing their studies. Individual results were secondary to examining a whole cloud of results and then proceeding warily from there. Often long-term studies ran not just for months, but for years. The focus of each was equally narrow, examining a relatively small number of variables on a very particular desire effect. This makes for safe science and prevents results from being challenged or questioned, but it doesn't exactly advance the discipline and the available scholarship at anything more than a snail's pace.

A particular study I observed as a patient comes to mind. Participants were given the drug ketamine, known to vets as a tranquilizer and anesthetic and a few generations of recreational drug users as Special K. The drug was administered in the form of an IV infusion. The injection was given, mild hallucinatory and/or dissociative side effects subsided after a few minutes, and then almost every patient who underwent the protocol experienced a very pronounced anti-depressant effect. The effect lasted only four or five days in a row, and each day that passed promised less and less of an impact at counteracting depression. Only a single active injection of ketamine was given during the entire study as a whole. The point of the study was to measure how long one treatment achieved its stated purpose, to what degree, and at what point the patient returned to a state of full depression. After the first and only injection that quite clearly wasn't placebo wore off, patients naturally went back to being depressed. Those who felt a pronounced lifting of mood and depressive symptoms knew instantly that the next injection was going to be placebo, regardless of what the nurses or doctors informed them to the contrary.

Those who wish to vent at the pharmaceutical industry for its role in nixing health care reform have a worthy target, but I find more deplorable the means by which it artificially inflates cost of medication, meaning that without insurance, the price of a month's worth of prescription drugs start at the hundreds of dollars and sometimes are priced in the thousands. I myself would have to pay $1000 a month minimum if I didn't have basic coverage and in prior posts I have noted the needless complexities I encountered achieving even that. Certainly it sets prohibitive cost and pushes product, regardless of quality, effectiveness, or grounding in solid research to make money. This is a travesty of the highest order, but I have never in my own life encountered more than a bare minimum of people with mental illness who were not substantially improved by medication, once they found the optimum possible cocktail.

What I have found much more prominently among those with mental illness who have gone off their meds altogether or have only given them a cursory trial is that they couldn't handle the initial side effects or felt discouraged that a single medication either didn't work well, or worked up to a point and then petered out. I am always suspicious of people who push diet regulation or therapy or some combination thereof in place of pills because I can count on one hand the number of people that have adopted that routine and found it wholly sufficient. I have known scores of people who have mental illness over the years because I have been hospitalized at least thirteen times myself, have participated in support groups, and have ended up being curiously inclined to seek company with people who also have mental illness, whether I knew it up front or not. I am a big proponent of therapy in addition to medication because it has helped me out tremendously over the years, but I know that I can never stop taking my meds, ever, for any reason. It is for this reason that when I encounter any article like Ms. Begley's that I feel a compulsion to tell the whole story as I understand it to be.

So, having seen for myself the tedious and sometimes unnecessary safeguards employed, I recognize that much of this delay and frustratingly incremental progress is unavoidable. The existent understanding of brain function and its impact upon mental illness is measured in inches, rather than miles. It is accepted that certain chemicals and neural pathways associated with them determine emotional well-being and mental health, but aside from that, medications have often been developed that use existing treatment regimens to treat disorders, but aim to lessen side effects than try new chemical structures or neurotransmitters. I suppose one could obsess about the unforeseen consequences that daily medication use promises, negative impacts upon the body as a whole that we might not recognize for decades to come, but I'm much more interested in being able to go about my daily tasks unhampered by my disease. Three hundred years ago, after all, the conventional treatment to address physical ailments was bleeding the patient white to release toxins. We laugh now at how primitive and even barbaric a practice that was, but for those who lived in those times, that was all they knew. We can only go with that which we know, and returning to the past or refusing to embrace the newest solutions promises nothing any more or less solid. All of our choices are half-chance, the same as everything else.

Quote of the Week

"Everything is funny as long as it is happening to somebody else."- Will Rogers

Saturday, January 30, 2010

Friday, January 29, 2010

Narrowing the Gap Between the Industrial Age and the Information Age

During the State of the Union address, President Obama noted what a slew of other previous Presidents have noted--that the United States of America needs to start exporting goods again. Few people can disagree with a statement like this, but what Obama, nor any of his predecessors have ever discovered is precisely what one would need to trade with other countries and in what form this new invention would take. If were wise enough to know, I'd probably be well on my way to being a very wealthy man, so I don't underestimate the challenge in front of us. However, though I believe that the capitalist system caters more to the selfish side of us more than the altruistic one, with selfishness does come innovation for the sake of maximum material gain, and in that regard, perhaps our basest instincts might come to everyone's aid, at least for a time.

Careworn phrases like "good old fashioned American ingenuity" have been utilized over and over again for at least a century, insinuating strongly that there was no problem beyond our grasp which would not eventually render a solution. And, honestly, I don't think that this mode of thought nor of rhetorical framing has ever really gone away altogether. But what I do think is that we don't often look for these signs so much for where they are so much as where we think they ought to be. Everyone can drive by and see the looming, titanic mass of buildings that house a paper processing plant or a textile mill, but the more subtle evidence of, say, a software design firm is much less visible to our senses and our psyches. Even though we may be headed towards a purely service-based economy, other developing nations are only now in the process of beginning their industrial phase of growth. Though our example might be the means by which they set their sights and chart their course, one must also crawl before one walks.

If we were all more or less on the same page the whole world round regarding economic parity, then exporting commodities would be a much easier task. Right now we do retain some residual elements of an earlier day, but often our products can't compete globally because they cost more to produce and thus they cost more to purchase. I honestly believe that we can be indebted to one of two stances in this instance, but not both. Either we pay people more in line of a fair wage, granting them adequate benefits--- recognizing that this will ensure that many countries can always buy what they need at a cheaper price from another source, or we slash costs to the bone and with them salaries and benefits. It goes without saying that I would never advocate the second position, but for the future going forward that model might be the only option that makes our products look attractive and compelling to another country or region's buyer, based on the current state of affairs as they exist today.

Speaking specifically about food, for example, I note that our own cultural attitudes are often to blame for much of the disparity. The more affluent among us can afford to be socially conscious by means of pocketbook and pay two times as much for products at a Whole Foods or a locally-grown produce Farmer's Market. The poorest, of course, simply aren't afforded this option. Americans might cut corners or scrimp to buy a wide screen television or to save up to take a vacation, but never towards food. Food is always supposed to be readily available, unquestionably cheap, and supremely varied. Organic food is a kind of innovation of sorts, since though its stated purpose is to use older methods of cultivation, it still combines elements of more modern technological strategies with the tried-and-true methods of a different time. Though it would never willfully adopt this label, organic food is itself a hybrid concept---one that seeks the middle ground between old and new.

These, of course, are previously established channels and instances. As for what product or products would find favor among the consumers of the globe, one assumes upon first thought that the most likely innovation would come in the form of some new technological breakthrough, one perhaps tied closely to the computer or the internet. However, like organic food, perhaps it would be best to seek for something with a foot in old ways and a foot in newer formulations. The most enterprising soul would be wise to recognize that products can be designed purely with the intention of always having a reliably steady stream of buyers and demand, or that they can be modified in the hopes of both making money and pulling in less developed countries and regions more economically in line with ours. Straddling the gap between the way it has always been and they way it needs to be is partially why we are at the impasse in which we find ourselves. While I do believe that the phrase "ethical capitalism" is a complete oxymoron, I do also recognize that if we are left with a system unable to be discarded for quite some time, it would be much easier if we limited as many disparities and points of difference between people as we could, since then it would be able for us to better address the remaining and still quite numerous problems left over.

We are still in the middle of a shift between an industrial economy and an information-based one, but at times our benchmarks and guideposts are indebted to a by-gone epoch. Nostalgia is strong and so is the resistance to the way things were always supposed to be. For instance, I grew up in Birmingham, Alabama, a city which was forced to completely reinvent itself after the collapse of its native steel industry in the 1970's. In so doing, it embraced banking and a world-class health care center based around a university, both of which are the two largest employers in the metro area. We might be wise to emulate their example, which is far from the only instance that a city teetered on a knife's edge between survival and disaster and managed to righted itself.

It is a short-sighted, short-term gain over long-term ultimate resolution means of thinking that got us into our current mess. American must learn that delayed gratification provides temporarily discomfort but eventual, eternal satisfaction. Greed drives humans to go for the quick cash-in and the gravy train, instead of a more modest, but still very satisfying profit. I don't ascribe to a theory of American exceptionalism because I am too aware of the times at which we fall short, though I also recognize that we are far from the only country, society, or culture which has a tendency to opt for the quick fix rather than engaging in the soul-searching and introspection which leads towards true resolution. Lasting success is based on hard work and research, not the accidental score.

Neither do I count myself among the numbers of those who adopt a cynical tact towards American identity and greater purpose that seeks fault first and rarely gives room for success. Somewhere between those who believe that our best days are yet to come and those who assert that we are soon going the way of the UK into second-tier country status is something close to the reality of the situation. Still, what we require right now is a new kind of skill set, one willing to work with existing trends, rather than fight them, build up native industry without seeking salvation in the form of a foreign company with an open checkbook, pay a bit more than usual for household staples with the understanding that increased cost doesn't always mean money wasted, and recognize that in a truly fair world, it shouldn't matter who is number 1 or number 500. If money is what makes the world go round, we can't begin to get any other unfair construct in check until we ensure that monetary policy levels the playing field. Real equality does not trickle-down and it never will.

Thursday, January 28, 2010

Reform Often Depends on Individual Choice, Not Collective Demand

A friend of mine recently visited, and while she was here, she shared an interesting story. For many years, beginning in childhood, she was sure that her chosen career path was that of an engineer. So, of course, when she started undergrad, she majored in engineering, quickly finding that she was the only female currently enrolled in the department. This reality didn't really surprise her, since she had always felt comfortable in male-dominated spaces and in many ways considered herself one of the boys. Her passions had always been those where female attendance had been sparse, so she'd long ago accepted the reality without complaining, or in honestly feeling as though she had much need or desire to question the status quo as it always had been.

However, with time she recognized that engineering was not for her. This had nothing to do with gender disparities and everything to do with the fact that she found her course of study ponderous and uninspiring. In the meantime, she had taken a few anthropology courses as electives and had fallen in love with the subject. After giving the matter much thought, roughly halfway through attaining her degree, she made plans to switch majors. Even though it delayed her graduation date and required her to take more hours, she was prepared to make a sacrifice. Still, her heart had led her away from what she had assumed would be her life's passion and as a result she was more than willing to do the extra work necessary to move in a vastly different direction.

The decision didn't sit well with one of her engineering professors, who was the sole, if not one of a very few female instructors in the field. My friend was informed that, whether she recognized it or not, the very fact that since she was the only matriculating female enrolled in that course of study, this meant that she was a trail-blazer; if she left, the whole hopes and dreams of those who wished to establish gender equality within the engineering department, to say nothing of the work world, would be utterly dashed. My friend took quite a bit of liberty with this statement and shortly thereafter left for Anthropology, just as she had originally planned. In so doing, she didn't discount what the professor said, but simply stated that she was unwilling to be unhappy in a subject she had come to dislike, especially when she knew inside herself that she might find true success and certainly true contentment elsewhere.

As much as we might like to see complete gender, racial, and sexual orientation parity across the board (and I certainly do, too) I think we have to take into account that our collective dreams sometimes take a secondary role to an individual's desire to pursue his or her own. When we hang the entire hopes of a movement upon the shoulders of one person, no matter how strong and broad we think they might be, for any reason at all, this places an inordinate and disproportionate amount of expectation upon a flawed and very human being. To some extent, every minority in a majority setting lives in a fishbowl and has his or her actions minutely scrutinized. None of this is especially fair, but when so much of our own identity depends on how we define ourselves as unlike others, rather than focusing on similarities between us and others, then it might be understandable, though not necessarily justified, why we fall prey to this kind of thinking.

To expound upon that which I am saying, I am not attempting to let anyone off easy. It is true that for all of the post-racial talk, Barack Obama is the first Black President. We all knew that going in and we always will. In the beginning, which seems like a least a decade or so ago, I was willing to concede to him the benefit of the doubt, but now I like so many have become openly critical and impatient with his leadership abilities. That he continues to poll highly with African-American voters and not necessarily with Caucasian voters is, I think, a very complex dynamic that can't be reduced to merely a matter of race and racial identity. Any minority which historically has had its concerns placed at a lower priority to that of the majority is bound to believe that even a candidate with flaws is at least is testament to the fact that a major hurdle has been crossed; that it finally one of its own reached that which is still the most powerful position on the face of the Earth. I have no doubt that when a female becomes President or an openly gay candidate reaches the highest office in the land, there will be this same unshakable sense of loyalty and devotion among those of a similar persuasion and identity, no matter what the larger political climate either for or against this person may be.

Still, excusing bad policy decision and being a constant apologist for any elective official at any time, for any reason, is not the best of strategies. For the most part, aside from a few true believers, we have not fallen prey to this trap in our age. But what we have done is assumed at times that one African-American lawmaker can wipe away centuries worth of racial strife and tension. The Obama Effect is, to my reckoning, largely minimal and perhaps more a product of wishful thinking than much in the way of substance. Likewise, the first female to be referred to as Ms. President will likely encourage the media and others to ponder whether her election portends greater gender equality or perhaps even leads women to embrace occupations or spaces long designated for and peopled by men. Likewise, the first gay Chief Executive will encourage many to hope that perhaps homophobic attitudes might be finally be waning and will simultaneously foster a thousand human interest stories of LGBT young adults who followed the example of the President and decided to come out and live openly.

In writing this post, I don't seek to tongue-lash or to chastise those who rightly strive for a fairer state of affairs. This is what we are all seeking to one degree or another. Rather, I think perhaps the problem is when we assume that one single woman, man, or minority with a singular talent can by himself or herself crack the glass ceiling, end a history of racial inequality, or sound an end to homophobia. Even when this person, whomever it may be, makes makes significant strides, we become disillusioned when he or she she alone can't quite bust through, failing to recognize that a collective effort is the only means by which any adequate reform movement has ever been accomplished. I firmly believe that the entire process starts with one woman, one man, and/or one minority, bold enough to step into unfamiliar and sometimes unwelcoming spaces. Yet, and this cannot be stressed overmuch, without those courageous enough to both correctly emulate their example and in so doing follow their lead, the ultimate objectives espoused will often remain unrealized.

I recognize that it is easy to become impatient with the slow progress of reform. But we oughtn't let our sense of desperation and desire supersede any individual's freedom of choice. It is a constant temptation to search for ammunition in every corner to hurl at one's enemy, but I believe that this impulse must be kept firmly in check. There may not be any such thing as a fair fight, but alienating allies or potential allies is not the best of strategies. When the world seems full of roadblocks and detours, we all can lose our heads and let hostility and spite guide us in directions we will probably later regret. Anger may have a function, but anger rarely stays on course, instead it gives no quarter to anyone for any reason, and thus it has been the undoing of many a worthy endeavor.

Returning to the anecdote upon which I began this post, perhaps soon the disappointed female professor will find another woman in the department upon which to set precedent and and in so doing encourage others to participate and take a seat at the table. Though my friend might be relatively unusual, she is far from the only woman not intimidated by being outnumbered and not especially uncomfortable in a boy's club or a man's world. And, as I conclude, I have always been able to see far enough into the future to know that lasting gender, racial, and marriage equality is within our grasp, though its progress rarely presses forward at a fast enough clip for our or anyone's satisfaction. In the meantime, we continue to fight the good fight and advocate for that which we know we need. I hope we always do.

Performance Video

On another busy day, I offer to you a new performance video in place of a post.

Wednesday, January 27, 2010

Conservatism is Often Less than Compassionate

Flying somewhat underneath the radar this week has been a controversial remark made by South Carolina Lt. Governor Andre Bauer (R). Last week, the Lt. Governor of the Palmetto State made a particularly toxic and highly offensive remark regarding the nature of assistance programs designed to aid the poor and disabled.

"My grandmother was not a highly educated woman, but she told me as a small child to quit feeding stray animals. You know why? Because they breed! You're facilitating the problem if you give an animal or a person ample food supply. They will reproduce, especially ones that don't think too much further than that."

I've mentioned this before, I know, but at that instant my mind couldn't help but flash back to a particular quote made by Earl Butz, Secretary of Agriculture under Richard Nixon and Gerald Ford.

The only thing the coloreds are looking for in life are tight pu**y, loose shoes, and a warm place to s**t.

I think conservatives assume that welfare services and the safety nets provided to those living at or near the poverty line are some kind of all-you-can-eat buffet line whereby some dubiously defined underclass can stuff themselves silly on taxpayer funded giveaways. The most obvious response to this is, of course, that they are desperately needed, often life-saving, otherwise unavailable options which those with adequate means already have and as such frequently take for granted. But for some reason this isn't sufficient enough in and of itself to satisfy the concerns of the average GOP voter or elected official, so perhaps a description of the incredible limitations of welfare agencies needs to be noted once more. As you will see, one can either decry them as money drains or lament their inefficiency, but certainly not both.

Social service agencies and welfare services are almost always underfunded, meaning that they are also almost always understaffed. Without enough manpower to answer phones, attend to daily business, and keep things running smoothly, the average applicant must be persistent and also must be his or her own advocate. Often it is necessary to spend hours on the phone attempting to find someone who either knows to even be connected to a competent worker who has had enough experience with the system to know how to properly process a claim or initiate a service. Those who lack the patience or the time are often left out altogether. The working poor don't have the luxury of being able to devote more than a small fraction of their time to sign up for basic services and have to divide their attention among demanding, often thankless jobs, and the constant time and energy drain that is known as parenthood. Those with families and dependents often are the ones who need these services the most, but can't carve out extra time in already busy, over-booked schedules. Regarding food stamps, which supply one of the most basic of all human needs, what transpires often is that deserving individuals don't have the time to come into an office or wait for hours, or have great difficulty scheduling a block of time in which to speak on the phone with a worker to complete the process.

Social service agencies and welfare services are dependent on state and local tax revenue, and though the amount of funding varies from city to city, county to county, and state to state, most are barely able to absorb the needs of the less fortunate in good economic times. In bad economic times, budgets are stretched to the gills, the deficiency in number of workers needed is much more visibly pronounced, and as a result the system quickly grinds to a halt or at least a slow trickle. In situations like these, with three and four times as many applicants in the pipeline, it takes even longer to obtain even the minimum and it may mean that three and four times as much effort and persistence is needed until one finally receives a place on the rolls. When budgets are tight, it also means is that coverage for any service can be terminated at any time, for any reason, based on some mysterious internal audit or the flimsiest of justifications, all implemented based on the compulsion to save money and keep from depleting the General Fund.

Speaking to my own recent experience, just to obtain a referral to a clinic that treats basic physical ailments the way any GP would took two frustrating days on the phone, whereby I called at least seven different numbers and spoke to close to ten people. Eventually I finally, quite by chance, stumbled across the right person who finally got everything in order. I was told at the time that the reason for the vast amount of confusion was, in part, a result of the fact that low salaries at certain centers designed to direct patient inquiries meant that there was always quite a bit of turnover. Since the system itself was complex, it often took a while before any worker properly understood it enough to convey accurate information to anyone. Though I am thankful for my success, I couldn't help but think about all the others who found themselves with blood pressure raised high enough for long enough to set aside any subsequent efforts to see a doctor. It is no wonder that the rates of easily preventable conditions are high among the working poor, since if it takes this degree of effort, I know many will go without rather than undergo what at first seems like a fruitless search.

This leads me to my next point, at which I discuss another barrier to obtaining needed services---senseless complications and poor networking between agencies. Many times these are products of all the barriers I have stated above, but what this also reflects is our compulsion to micromanage the affairs of the poor. Not only that, we wish to control their lives because many of us believe that they are clearly up to no good and only a step above either common criminals or lazy ne'er do wells with nothing so much as ambition or drive. I wouldn't exactly call this tough love so much as I would call it punitive retribution. One needs only look at the ACORN matter to see evidence of that. Conservatives saw exactly what they've always wished to see in that case, confirming their own darkest suspicions in the process. I honestly believe if it were up to them, many would do away with all taxpayer funded programs designed to assist the less fortunate among us, unsympathetically remarking like Herbert Hoover that these services ought to be the domain of churches and faith-based organizations, but certainly not of government.

Where one sees frustrating evidence that the right hand doesn't know quite what the left hand is doing in any circumstance, or that everyone's not quite on the same page, it is tempting to deem it indisputable proof that larger government is both a waste and a headache. This is what drove the Tea Party protesters to spout off and also motivated those who feared and still fear the enactment of some nebulously defined, super scary government-controlled health care plan, but I counter that assumption by noting that with an adequate amount of funding, an adequate amount of staffing, a moderate amount of reform, and a network of customers of ample economic means, the system would run far more efficiently. Most people who are used to medicine on demand would simply not stand for the degree of complication and delay as currently exists, and money has a way of smoothing out many of the kinks in any system. Not all of them, of course, but many. Money has a way of giving people a reason to stay in a job for more than a short time and encouraging competent management that would attend to the needs of a much more educated, much more affluent demographic that would expect more and not a group of citizens who have unfortunately long come to expect that the few concessions thrown them will be of inferior quality.

Returning to the system the way it is today, the elephant in the room, naturally, is a very pronounced element of racist and classist assumption. Since discrepancies between wage earnings are still very pronounced between Whites and Blacks, most who qualify for and use safety net programs are poverty-line African-Americans, and more recently a rapidly growing number of Latinos. Most, but not all, of course. In my experience, I was the only White person applying for food stamps and the only Caucasian seeking treatment and prescription drug coverage. As we well know, nothing instigates GOP ire faster than the notion of welfare cheats or avoidable drains on Good Honest American Taxpaying Citizens™, as seen above with Mr. Bauer. I'm not quite sure what I find more offensive about his remarks, the dehumanizing element reducing poor Americans to feral animals, the element of eugenics which suggests that poverty could be reduced or eliminated by means of forced sterilization or starvation, or the implication that all those in need are simple-minded strays who aren't concerned with anything much more than just reproducing and creating burdens for humans who have to take the time and effort to keep their numbers in check. I've heard some fairly creative theories for population control and elimination of inferior races, but yours, Mr. Bauer, is not one of them.

The real enemy here is not conservatism, or liberalism, or an entitlement mentality, or even an underclass. The issue is equality, pure and simple, or should I say the lack thereof. I will be honest here. I was raised by a Father who placed complete faith in Ronald Reagan and his view of the waste and graft of welfare and with it a simultaneously dismal opinion of the efficiency of any government program, regardless of its stated purpose or function. Indeed, there was a time where I myself held similar beliefs. But though I had changed by tune well before then, my eyes were truly opened when it came my time to use these same basic lifelines granted anyone who qualifies. I recognized quickly that had I not been born into a middle class, highly educated family, I might not have been able to chart my way through a very convoluted system and obtain the services I needed along the way. Working the system requires a good bit of guesswork and tremendous amount of trying to successfully solve a problem with multiple unknown variables.

The system is not designed for the undereducated and the impoverished, rather it is a construct of those whose job description clearly must include a love of complicated solutions for simple problems and an insistence upon a variety of completely unrealistic constants, like minimal turn over among workers on the front lines and at the field office. Again, equality in pay would do much to keep that in check, as would a system that was put together with greater skill and dexterity. I'm not arguing that throwing money at a problem is any adequate means to fix it, but what I am saying is that if each of the individual pieces of the system were designed with the ability to be revised easily and as the situation demanded, and if those who worked this system took a job as a career, not just a vocation, then many of these problems could be eliminated.

If these social service agencies and welfare programs were run like a business in the private sector, they would have gone bankrupt years ago, but the fault here is once again that we honestly must not really have much regard for human life, particularly for those "not like us" for whatever reason. Oh sure, we'll give money to Haiti and vow to offer our services in any way that we can. I don't mean to come across as cynical regarding anyone's motivation to assist the victims of that battered island nation. The outpouring of help would soften the heart of even the most bitter person, but many will see Haiti as a one-time, special occasion. I live in the District of Columbia and in a relatively small area based on surface area both the richest of the rich of the poor living side by side. The ostentatious wealth of Georgetown is countered by the desolation of Anacostia and recently gentrified areas like Columbia Heights or right near by the Capitol paint an even starker view of the discrepancy. As I've seen the money rolling in to be sent to Haiti, I can't help but wonder what even a fraction of that outpouring could do for the District's poor, and especially for those infected with HIV/AIDS since the District itself has an obscenely high number of cases that put it on par with an African nation, not a region within the borders of the United States.

Any system designed to assist those without our fundamental advantages depends upon the cooperation of those farther up the totem pole, and if our checkbooks, if not our hearts are closed to them, then the system will always be insufficient and dysfunctional, poverty will always exist, disparities will always exist between race and class, and so too will the desperate attitudes that lead to drug addiction and crime. The life we save might be our own someday. So yes, in this instance we do it to ourselves, and that's what really hurts the most. And we do it by not recognizing that it is within our power to treat the cause of the problem, much like medicine would in counteracting a disease. For example, one can treat strep throat with an aspirin, but that only takes into account the effect. Treating the cause often requires a shot of penicillin, and once it has made its way through the blood stream, healing begins and pain ends. Aspirin might be far cheaper than a cost of a doctor's visit without insurance, but it will merely mask or temporarily delay the pain of the sore throat. With time, it wear off, the pain returns, and the need to take more returns. The disease itself remains and will remain until it is properly treated.

If conservatives are so indebted to scripture and to their assertion that we ought to be a Christian nation, I wish they'd keep these passages below in mind.

For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.'

"Then the people who have God's approval will reply to him, 'Lord, when did we see you hungry and feed you or see you thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?' "And the King will say, 'I tell you the truth, when you did it to one of the least of these my brothers and sisters, you were doing it to me!'

Tuesday, January 26, 2010

Somewhere Between Two Hypocrisies Lies the Truth

I recently came across, through a YouTube video, a rather unique French public service announcement. It encouraged heterosexual men to protect themselves against HIV/AIDS by using a condom before engaging in sexual contact. Predictable enough subject for a PSA, one might think, but the video's concept was both amusing and novel. While the American mind would likely appreciate the humor, it would also deem it too graphic to be aired on network television and probably cable as well. American liberalism has, I realize, a long standing Francophone tradition, just as American conservative thought has an equally lengthy history of criticizing it, so my point is not to cater directly to either camp. Somewhere between the two is something close to the truth and as such I seek to find it.

To get to my point, in France, sex is everywhere, and yet attitudes towards sexuality in one's personal life are often more traditional than in the United States. While on the continent, one often encounters nudity on billboards, street signs, and shop windows while out and about, but the attitude of most residents is that the body is a natural entity, as are public depictions of it without the benefit of clothes to disguise the objectionable parts. To us, of course, the only truly socially acceptable manner of presentation regarding the unveiled human body is in the art gallery and even then some people have been known to register their visible discomfort. Furthermore, we deem nudity or frank depictions of nudity in any form to often only be granted as a privilege based on reaching a certain age and with it some perceived degree of maturity, believing that children and minors ought not to be exposed to its supposedly corrupting influences until the age where they can make an informed decision whether or not to partake. Put that way, it sounds almost as though nudity is some health hazard, like smoking or consuming too much alcohol. Still, for all the energy we expend spinning out cautionary tales and guilt-laden commandments, one would think we ought to expect more for our efforts.

The hookup culture of unashamed and relatively guilt-free casual sex encounters is far less pronounced in France than here. If anything, their conception of sex and sexuality is often more traditional, more cautious, and less driven towards the impulsive or the immediate. Americans often seek to shame those who engage in sexual contact before marriage, particularly young women, and frequently deems women of any age who do not apologize for being openly sexual beings as sluts and whores. Still, despite all the lip service, Americans break these taboos constantly in their own lives, regardless of age, race, or class identification. Whether it's Bristol Palin or the woman who lives one apartment over, this peculiar brand of public condemnation and private repudiation could not be more typically American or more typically worthless. One could even argue that the frequency of sexual encounters in one's life is often directly proportional to the amount of contradictory scare tactics one hears and then promptly ignores wholesale.

Here in the United States, sex is also everywhere, but ours is a kind of teasing, taunting kind of constant peep show. Unlike the French and other cultures, we have confused sensuality with sexuality, so that every inch of exposed skin one encounters must obviously mean one thing and one thing only. We can't appreciate the body in any kind of cerebral sense without our minds taking us towards one inevitable, ultimate conclusion. In America, depictions of sexuality are a constant strip-tease, where with the passage of time and the passage of years, one sees a bit more skin or a bit more obvious suggestion than before. True nudity, of course, is still very much off-limits, but this doesn't mean that the psychological impact is any less pronounced. This might explain why we hold this hypocritical discrepancy that forces us to adopt a double life of sorts---an on-the-record scripted and diplomatic personage and an off-the-record real self that is unguarded, occasionally bawdy, and completely authentic. While it is true that boundaries and moral convictions exist for a very good reason, it doesn't seem to me that they serve much of a purpose in this context. Prohibition, after all, was also based on these same principles, and was totally ignored by many who felt no shame in flaunting the fact that they were more than willing to quite visibly break the law.

Lest some miss my greater intent, the point is not to glorify French culture without taking into account its shortcomings, too. Every person and group of persons has good qualities and bad qualities, of course. I recall that during Bill Clinton's impeachment trial, the French were openly contemptuous and uncomprehending of Ken Starr and the Republican lawmakers who sought to use Clinton's adulterous affair with Monica Lewinsky as a means to remove Clinton from office. The French way of looking at the proceedings was an incredulous kind of response---all politicians cheat on their wives or partners, so why was this proceeding anything particularly special or worthy of scorn? Theirs is often a much more cynical country regarding the sanctity of marriage vows, because it is believed by many that any man will stray given half the chance. Indeed, some believe it to be purely a matter of course. Politicians are corrupt, men cheat, marriage often fails, sexuality isn't that big of a deal, and that is that.

Though Americans do at times consider themselves to be a skeptical, if not cynical people, I do not believe we have reached this same point quite yet. While the French might expect the worst as some kind of fatalistic inevitability, we, however, hold those in the public eye and ourselves to impossibly high standards approaching perfection itself. Therein lies the problem. Here, women are held to an exacting measure of complete purity in their personal conduct and especially in their sexual behavior and sexual lives. Politicians can only pass muster if they measure up to a series of microscopic litmus tests regarding a maddeningly wide variety of different interlocking factors. Marriage is a virtue, even though fully fifty percent of them fail---even though adultery is widespread, and even when many people have been married multiple times because many don't think lesbians, gays, bisexuals, and transgenders ought to despoil this sacred institution and solemn lifetime commitment even further. While we may be king hypocrites, they are supreme pessimists, assuming nothing so much in the way of good outcomes, so as not to never be disappointed when anything other than the worst case scenario comes to pass. Between these two extremes is the understanding that both triumph and failure are inevitable and that the only thing ever granted us is the ability to accept them as they are and to live life as it comes.

So one would hope that French attitudes towards sexuality, at least, might merit contemplation with us, though I recognize that so long as we chase this impossible ideal of perfection, few will give it more than cursory consideration. We are too rough on ourselves and on others and we haven't adjusted our sights or tempered our expectations in tune with reality. We work ourselves to death and expend too much time and effort in lashing out at those who seem to be overstepping the rigid boundaries we've demanded that no one dare to cross for any reason. We are in love with being the gatekeeper. We are masters at "do as I say, not as I do", and if the latest person who advances this notion happens to be important, famous, or politician, he or she expects that those who discover their real selves ought to cover up or agree to hide these facts from public knowledge for the sake of propriety. We do not suffer fools especially well in this country, and while a part of us never forgives those who transgress or fall short for any reason, there's another part of us who loves the idea of the reinvention or the comeback. In short, we are Americans, and as such we are some cross between hypocrisy and paradox. Mixed messages and schizophrenic cultural expectations just seem to go along with the territory. Even so, one would hope that eventually we can simplify or at least make less complicated our national character. If we wanted to really move towards progress, this might be a good first step.

Monday, January 25, 2010

Impolitic Approaches and Impatient Voters

What I have noticed recently in conversation with others is that a "throw the bums out" attitude has been vocalized with greater frequency and with a growing volume. While it is still not the majority opinion, since many cling to a belief that the Democrats in Congress will eventually get their act together, assuming Health Care legislation stalls and dies, even the run-of-the-mill Democratic voter will not reward them for their incompetent approach. He or she is likely to vote Republican, to contemplate third party options by means of protest, or to stay home on Election Day. Cautious and often skeptical attitudes have proven the most helpful as the best means of dealing with such a rude and abrupt reality check, though my sympathies mainly go out to the true believers and trusting optimists now in a state of shock. Those who are never satisfied with any resolution and cast dispersions so as never to have to experience the pain of disappointment will always come out of the woodwork in times such as these, but theirs is an especially hollow victory.

One couldn't completely remove all the current available legislators from office and replace them with new faces in one election cycle, of course. Even if such a thing were technically possible, the existing system is too complex and convoluted; as such there is a need for at least a majority of veteran lawmakers who know where all the bones are buried. A populist response that vocalizes a complete frustration with the status quo needs to be tempered with the reality of the framework which which we have to work. There will always be a need for real change, but radical strategies rarely produce lasting benefits. I have always found it deeply ironic that for all of the effort expended in the radical Jacobin phase of the French Revolution, arguably the only real lasting and permanent measure that has stood the test of time is the Metric system.

We know now that progress often is delayed and stymied by a me-centric attitude of simple selfishness and with it pandering to financial gain and political advantage. We saw it this summer in the hordes of Town Hall Forum fanatics screaming and gyrating that no one was going to take away their coverage or put the government in charge of their health. Though it is certainly true that without health and well-being, no other life goal or ambition can be accomplished easily and sometimes at all, in this case many voices were afraid of losing the right to instant gratification and immediate care. Those who have faced a more than thirty-minute wait at a walk-in urgent care center and have disgustedly strode out the door are the perfect example of this way of thinking. Those who get a second or third opinion and cherry pick the diagnosis that best agrees with their sensibilities underscore my larger point. By contrast, the low-income government plan that I have no choice but to use schedules appointments for GPs four and five weeks out, and even urgent care clinics don't accept my coverage, but the reality of it is that it doesn't have to be this way. It doesn't have to be this incompetently managed and poorly networked. Most people wouldn't stand for it if this was their situation, and when enough people raise enough a stink, politicians are forced to take note. How they respond, of course, can never be predicted ahead of time.

I suppose at this point I could point the finger of blame towards some generational mindset or cultural deficiency, but that would be too fatuous a comparison and too easy an argument. It is true that we are beholden to an insistence that certain privileges ought to be within our birthright purview; this mentality can be observed in the decision making and consensus building process of Senators and Representatives. Many excuse their own selfish demands by stating that they are merely advancing the point of view of their constituents. This might be so at least on its face, but simultaneously romantic and Paternalistic notion of another age asserted that the role of the foremost deliberative body in the United States was that lawmakers were the supreme adults of the system as a whole. As such, these grey-bearded and wizened elders wisely wielded authority by taking into account the unique concerns of places and personalities. That was, of course, the mythology of a by-gone era, and in this cynical age, we are good at seeking first the Kingdom of Lies.

Last week cannot be spun or softened into something it is not. It was a disaster for both party, party faithful, and all lovers of reform. We have pointed fingers and let the desperate-for-revenue mainstream media go to town by using the Massachusetts defeat for its own purposes. In so doing, we have articulated a growing sense of weariness with a dream once seemingly so close at hand that has since shrunk in the heat of heavy scrutiny like a raisin in the sun. Still, I often think about the developmental theorist Jean Piaget and his theories of learning. Though Piaget's observations primarily dealt with children, postulating how they observed and processed information, I have often been intrigued by his assertion that it is only through disequilibrium, when everything is topsy-turvey and the previous strategies for comprehending the world around us are no longer helpful or valid, that true learning can begin. Disequilibrium has many incarnations but it should nonetheless never be confused for chaos, temper tantrums, or an all-out retreat, but nonetheless when the world is turned upside down, we have a fresh opportunity to learn from our mistakes.

I myself could never be confused for an optimist, but if it takes the loss of what was apparently more a psychological advantage super-majority than a mandate for cooperation and forward progress, then we are presented with an excellent opportunity for reflecting and beginning again. This new strategy rightly encourages a kind of urgency not present when, at least at face value, things were more stable and footing was surer. The success or failure of subsequent reform measures will depend on whether individual designs can ever take subordinate position to that of the entire nation's needs. President Obama often notes that reform is not about him and never has been about him, but it seems that several Senators and Representatives do not think in the same terms. Indeed, they should certainly think in these terms, else they have none of their own in a few short months. If humility has a way of putting priorities in order, I would hope that several Senators hoping to write their name large in history now recognize that taking the credit is not nearly as important as pushing the bill through.

I and others have begun to recognize that this country is slowly, haltingly advancing towards the very Parliamentary system our Founders eschewed. As formerly good British citizens, those who proposed and set into place our existing system observed first-hand legislative upheaval, awkward coalition-building, factionalism, calls for the Prime Minister to resign, pushes for a new General Election, and the power plays that went on behind the scenes. The new government they proposed, conceived in a the spirit of Enlightenment liberty, would not fall prey to these same divisive tactics. We have noted extensively ever since that this was not one of their best ideas to have seen the light of day. Perhaps we need to make a major overhaul, even though adopting a true Commonwealth system would necessitate that we scrap the idea of electing a President directly, leaving that decision up to party leaders. In that setup, the roles are reversed and the electorate votes for party more than personality.

One of the commonly attributed advantages to parliamentary systems is that it is often faster and easier to pass legislation[1]. This is because the executive branch is dependent upon the direct or indirect support of the legislative branch and often includes members of the legislature. Thus, this would amount to the executive (as the majority party or coalition of parties in the legislature) possessing more votes in order to pass legislation. It could be said then that the will of the people is more easily instituted within a parliamentary system.

In addition to quicker legislative action, Parliamentarianism has attractive features for nations that are ethnically, racially, or ideologically divided. In a unipersonal presidential system, all executive power is concentrated in the president. In a parliamentary system, with a collegial executive, power is more divided.


Still, a Parliamentary system is often antithetical to a peculiarly American perspective. To wit, The excitement of directly electing a President is that sole attention falls upon a single person or, in the beginning, group of persons. With this comes also an unfortunately obsessive and microscopic focus on one focal point and as such, cults of personality often spring up around Presidential candidates. There is also something intrinsically anti-American in this idea of party insiders picking the head of the government, something that hearkens back to oft-reviled smoke-filled rooms and with it lack of transparency and accountability to the whims of the voting public. It is for this reason that we will likely never adopt or at least never adopt wholesale, this sort of apparatus. Yet, as some have pointed out, with a now much more fickle public, one increasingly driven to third-parties and independent identification based on weariness with the two-party system, we are stuck in a halfway state between the two. While the Independent voter may be a free agent instead of feeling more inclined to identify with a particular third-party than an R or D, even those who would otherwise be counted on to reliably vote for either a Democrat or Republican are now contemplating getting behind whichever party can re-establish economic health and with it job security.

If we thought in terms of party rather than nominal head, we might have a better realization that consensus process is more powerful than individual desire and individual leadership. Once again, our mythology betrays us. When Barack Obama began his meteoric ascent to the top of the heap, many conservative voices snidely condemned his movement as Messianic, as though he was the new Jesus. In it, they may have been reflecting the reality that we built our own Christ figures along the same lines, since the motif of one person coming from nowhere to save the world from itself is so integral to cultural expectation. But beyond that, humanity has always sold into a belief that one being, one entity, or one figure might redeem our metaphorical and literal sins. The only requirement is belief and with it the desire to follow the example set in place. Though we may not consider ourselves religious people, we are still beholden to a religious construct.

If either party had made much in the way of headway or in actually accomplishing anything, voters might be accused of being fickle. This mindframe is not without precedent, and indeed populist anger once threatened to undo the entire system at several points in our country. At which point it was usually violently crushed or divided amongst itself through sabotage. What usually happens with any grassroots movement based in anger and dissatisfaction that the groundswell of public sentiment has its apex, is rendered toothless through outside force or through a lack of coherent strategy and cohesion within itself, then is sanitized and adopted into the platform of one party or the other. Right now we have an electorate behaving as though we have a Parliamentary system in place, but, and this is crucial, a system without any kind of majority mandate. Though this came as a result of bad governing, the question remains as to how we're going to reconcile our desires with the existing structure.

While the immediate loser is the party in power, the GOP should also recognize that if it manages to obtain control of one or both chambers in November, it will be expected to accomplish miracles and an impatient electorate will not give them long to do it. Prior conventional wisdom held that one never changed horses in midstream, but today's voters have at least contemplated the idea. And in my own personal opinion, they would be making a supreme mistake because as divided and dysfunctional a caucus is the Democratic Party, the Republican Party is even worse. We have managed to make the problem worse, but I trust the Democrats to minimize the damage. As we have seen, one election does not mend decades worth of rips to the sail.

Sunday, January 24, 2010

Quote of the Week

“Many of the great achievements of the world were accomplished by tired and discouraged men who kept on working.”- Author Unknown

Saturday, January 23, 2010

Friday, January 22, 2010

The End of Brand Loyalty

For all the recent flurry of speculation and analysis regarding the Democratic Party's shockingly sudden decline in power, one particular metric has never been adequately explored. Though it is certainly demoralizing that in merely twelve months a feel-good sugar high of optimism has given way to despair, airing our grievances should quickly give way to building strategies for the times going forward. We have learned quickly that party identification can never be taken for granted and that the American people want results, not gridlock. 2008 was seen by many (and indeed, me, for a time) as a realigning election along the same lines as 1980, but it seems that Obama's coattails are really only his for the riding and that personal charisma and stirring rhetoric are subordinate to results in the grand scheme of things.

A year ago, many looked at FDR's first term as a yardstick for comparison, hoping to see notable similarities between the two. Now we are recently looking instead at the 1936 election, as it was a referendum on the New Deal itself. Some are wondering why the American electorate hasn't responded with complete faith in the Democratic Party, since the current economic climate is still primarily a result of incompetent Republican mismanagement. But there are two large differences between 1936 and 2010, or for that matter, 2012. To begin, FDR managed to pass a dizzying number of reform measures through Congress in a relatively short period of time. President Obama, by comparison, has only managed a handful of them, the most ambitious of which, health care, has been thrown into doubt by an unforeseen, but not totally unsurprising development. Second, and perhaps the most important of all, today's voter does not function on the principle of brand loyalty to party, which Roosevelt used to carry him to four successive terms in office.

Strictly Democratic households or Republican households, once commonplace, are increasingly a thing of the past. Generational traditions of voting for a single party based almost exclusively on cultural, ethnic, or regional identity are no longer observed strictly. The solidly Democratic South of FDR's time once cast its ballots in more or less lockstep, and even though the Deep South has become the last remaining sure-fire base of support for the GOP, if one digs deeper into that assumption, one discovers much in the way of enlightening nuance. While the majority of Caucasian residents usually vote for Republican candidates, one must not overlook the impact of a sizeable African-American minority which almost always votes Democratic. Moreover, city-dwelling white liberals and moderates frequently cast their ballots for a Democratic candidates as well. Alabama is much closer now to a two-party state than it ever was before, when Republican opposition was nominal and the Democratic primary was the de facto general election, since November's balloting for state office was a mere formality to crown the winner. One has to perhaps have lived in the state to realize just how significant a development this really is.

Still, viewing matters through a two-party lens, regardless of state or region is not wholly sufficient either. Though third-party candidates have been part of the political landscape since the beginning of the Republic, it wasn't until Teddy Roosevelt's Progressive (Bull Moose) Party of 1912 and Eugene Debs' series of respectable showings as the perennial Socialist Party's candidate that third-parties began to gain traction across the board, not merely as a protest vote against the policies, planks, or candidates of the major parties. George Wallace's 1968 run was probably the most successful in recent memory from a strictly electoral college standpoint, but Ross Perot's 1992 Washington outsider campaign garnished a surprise first-place showing in the polls for long enough that it led many to speculate, in all seriousness, what a presumptive Perot presidency might look like. 1992 is likely the point in which Independent voters became a force to be reckoned with, and when pollsters, politicos, and the like began to incorporated them in their greater analysis of voting demographics and trends, so too did many recognize that times had changed forever and that the electoral map of old had been redrawn.

To underscore my larger point, by means of comparison, let's look at the 1936 Presidential Election, in which incumbent Democrat Franklin Delano Roosevelt sought re-election to his second term in office. In particular, let's examine the popular vote returns of the state of Alabama.

F. Roosevelt (D): 238,136 86.4%
A. Landon (R): 35,358 12.8%

Two third-party candidates won less than 1% combined of the total number of votes cast for a total popular vote of roughly 2,150.


In that particular cycle, Roosevelt won every single Alabama country except for one, Winston. Winston County was a hotbed of Republican support, very much analogous to the rest of the state, which stemmed from the fact that it remained loyal to the Union during the Civil War, winning it the title of "The Free State of Winston". For years, Winston County was the only real center of power for the Republican Party, and with it the sole source of opposition to the otherwise Democratic-dominated state. The state itself had never really recovered from the Civil War and after making tentative strives to rebuild itself, it was flung cruelly back into widespread poverty by the Great Depression. Since the Republican Party was deemed the party of big business and the wealthy, few Alabamians felt much in the way of allegiance towards it. My Grandmother expressed the views of many residents in those days by saying, "You only become a Republican when you get money."

Next, let's look at the 1996 Presidential contest returns from the same state, in which President Clinton sought re-election against Senator Bob Dole of Kansas and once more from Ross Perot.

B. Clinton (D) 662,165 43.2%
B. Dole (R) 769,044 50.1%
R. Perot (I) 92,149 6.0%

As you can see, Dole's margin of victory was dramatically far less than Roosevelt's based purely on popular vote, and the third-party candidate Perot managed to win nearly fifty times more votes than any other independent combined managed in 1936. The total number of votes cast in 1996 was roughly six times that of 1936, yet a third-party candidate managed a showing that would not have been possible earlier. Quite a bit changed in sixty year's time. The populace became more politically literate, more African-Americans were granted suffrage, the rise of cities fostered Progressive ideas and more liberal inclinations, Alabamians grew wealthier with time, and the number of registered voters increased as a result. However, along with all of these changes came a desire to vote not so much for a party but for a specific individual or particularly compelling cause, regardless of primary party identification.

This relatively recent development is both fortunate and unfortunate. It is fortunate because the Founders never intended for this country to be structured as a two-party system, meaning that most of the groundwork they set in place is based on unanimity of opinion, not factionalism. Despite this idealistic notion that we might all swear allegiance to one sacrosanct party, when two parties ruled and there were vast differences from state to state and region to region regarding the balloting behavior GOP voters and Democratic voters, there were often unwritten rules and assumptions upon which to base decisions and strategies. In short, with brand loyalty came predictability. Those of certain states, regions, and allegiances could be reliably counted on to cast ballots in time-honored ways. Policy matters, sloganeering, and coalitions could be built along ancient fault-lines. The system might not have been the fairest, but it was at least more manageable to some.

There had, of course, been many from the beginning who advanced a third, if not multi-party system as a fairer, more democratic alternative to the numerous limitations and inequalities of the existing system. Still, it took nearly two centuries before that clamor became loud enough that it was ever taken seriously. Even then, it took a massive backlash to an equally massive social justice movement to encourage people to set aside their long term allegiances and a few decades later a billionaire espousing populist rhetoric and more than willing to inject millions upon millions of his personal fortune to get his message and candidacy out to the public---to buck long held voting trends. This is the reality with which we are faced today. The American people want jobs and job security, and they increasingly don't much care what letter of the alphabet can manage it, so long as they are presented with a credible plan of action and an understandable means of presentation.

Backlash, of course, can only take one so far, and it seems that right now even economists and those handsomely compensated for their role as official soothsayer have yet to figure out how to put Humpty Dumpty back together again. The conventional wisdom held by many is that one ought not to change horses in midstream, but if the recent victory in Massachusetts means more than just one bad campaign or an angry electorate demanding renewed economic security and lasting health, then Democrats ought to be concerned. My fault is not with those who have done their best to bring about reform, but for those in the leadership who are not just bad managers, but also completely indebted to awful strategies of conducting legislative business.

In Lewis Carroll's Through the Looking-Glass, Alice has a conversation with Humpty Dumpty himself.

"I don't know what you mean by 'glory,'" Alice said.

Humpty Dumpty smiled contemptuously. "Of course you don't – till I tell you. I meant 'there's a nice knock-down argument for you!'"

"But 'glory' doesn't mean 'a nice knock-down argument,'" Alice objected.

"When I use a word," Humpty Dumpty said in a rather a scornful tone, "it means just what I choose it to mean – neither more nor less."

"The question is," said Alice, "whether you can make words mean so many different things."

"The question is," said Humpty Dumpty, "which is to be master – that's all."

Alice was too much puzzled to say anything, so after a minute Humpty Dumpty began again.

"They've a temper, some of them – particularly verbs, they're the proudest – adjectives you can do anything with, but not verbs – however, I can manage the whole lot! Impenetrability! That's what I say!

The American people want more verbs and less adjectives. Moreover, we are tired of passive voice towards our concerns and demand active voice above all else, since nothing weakens one's argument more than a million qualifiers as to why the rather straight-forward promise of change must come with so many strings attached or concessions made. The base can be counted on to usually gird up its loins and put aside its reservations to cast a ballot for Team Blue. But moderates, independents, and conservatives will not and one would think the most sensible means of keeping everyone inside a big tent that seems to be collapsing one tent peg at a time would be to find a strategy that caters to all without pandering or making empty promises to anyone. This is your mission, Democrats, if you choose to choose to accept it.

Thursday, January 21, 2010

Keeping It Simple Is Not Stupid

Recently I have been giving much thought to why Progressives and Democrats can't seem to accomplish more than the bare minimum regarding desperately needed reform measures, even when they have the luxury of substantial majorities in both public favor and legislative representation. The answer may lie in the prevalence of pointless, unwieldy levels of stratification. With these comes an isolating sense of separation---individual elements of the base often have a problem pulling together with one voice, and, for that matter, do all who would deign to fit underneath the big tent.

To many liberals, life must be overly complicated: specialized committees, committees within committees, identity groups, splinter identity groups from larger ones, rules for the sake of rules, rules set in place when one unforeseen problem creates friction with anyone for whatever reason, exacting policies based on good intentions that soon become headaches for all, and many other examples. It doesn't have to be this way. Overlap is sometimes a good thing.

As such, the true failing lies in the absolutely ridiculous complexity of how structure ourselves and how we have in many ways forgotten how to communicate with each other. For too long, information and strategies that could be used for the benefit of all have been isolated within specific single-issue oriented groups, each with its own nomenclature and particular phraseology. For too long, so-called experts carrying a briefcase, a PowerPoint slide, and a hefty speaking fee have been employed to enlighten other people of an unknown universe, when with major modification, we could easily understand the intersections and common ground which links us together, not the great unknown that keeps us at arm's length from each other.

This sort of set up directly reflects the nature of academia, since the merits, weaknesses, and structure of pertinent concepts are hatched there and exhaustively vetted. Just as I have recently discovered that the health care system available to low-income and disabled residents of Washington, DC, was written to be understood and effectively managed by policy wonks and the highly educated, not the poor and under-educated, so do I realize that so many of our grand goals are thwarted when they are neither designed, nor framed so that all might easily comprehend them.

To cite a related example, when I am speaking within Feminist circles, I know that there are certain terms, overarching concepts, and abstract notions that one needs a thorough education, keen mind, and a willingness to research on one's own time to grasp sufficiently. Much emphasis is given to an everlasting critique of Patriarchy and cultural practices which place women in a subordinate role, and from these comes a thousand deep conversations and leitmotifs. I can speak this language competently, with much practice, I might add, but I often can't help but wonder if any of these worthwhile ideas and highly involved strategies ever get out to the working class battered housewife or to the sex worker standing on the corner of a bus terminal, prepared for another night of a dangerous way to make a living.

In my own life, part of the reason I have been able to keep my health from being as debilitating as it could be is that I had access through education and relative affluence to know how and where I could do my own research about the condition. Now, years later, I can hold my own with any psychiatrist because I know and understand terms like selective serotonin re-uptake inhibitor, titration, GABA, dopamine agonist, and efficacy. However, these terms mean absolutely nothing to the average person, who must trust fully in a psychiatrist who then must translate their needs, their symptoms, and their expectations for treatment into a regimen of medications that is inexact even in the best of circumstances.

The likely outcome with anyone diagnosed with a psychiatric disorder is a tremendous amount of constant modifications, some slight, some major, and frequently a need to try an altogether new combination of medications, all of this in the hopes that one will stumble across the proper drugs in the proper proportion, eventually.

We humans are a peculiar breed. In the animal kingdom, one could argue that the average mammal attends to its own more readily and with less reservations than we do. Without romanticizing the primitive, it would seem that no other species on Earth usually has such profound reservations about reaching out to assist others. Though certainly other animals fight within themselves for food, mates, and resources, I often wonder if we are perhaps the most self-absorbed creatures the world has ever known.

We are given the gift, by God or by whichever belief or unbelief you espouse, to have the gift of a very complex, and very advanced organ at our disposal known as the brain. Yet, it seems to me sometimes that this supposed great gift can dispense evil and great suffering as easily as it gives rise to good and with it great gain for all.

As a person of faith, I sometimes wonder if this basic concept is a credible interpretation of the beginning of time as expressed in the Book of Genesis. So long as man and woman weren't aware of the greater complexity of all things, they lived nakedly, blissfully in paradise. But once temptation arrived in serpent form, suddenly they recognized that reality was not nearly so simplistic and easy to swallow. Christianity and other religions teach that humanity was created in God's image, and if that is the case, perhaps we are caught in some still unresolved eternal polar tension between our ability to sense and structure things in advanced shades of grey versus our relatively straightforward mammalian biological imperatives and compulsions. Some have even implied that the human condition is imperfect particularly because we have divine elements seeking to function within imperfect organs, namely our brain.

While on the subject, I am reminded St. Paul's second letter to the Corinthian church. It seems that the church had fallen prey to smooth talk, false teachings, and a distortion of the faith itself. Much of the passage I am about to cite, as you will see, is written quite sarcastically, its target primarily those who deceive others, not those who had been unwittingly deceived.

However, I am afraid that just as the serpent deceived Eve by its tricks, so your minds may somehow be lured away from sincere and pure devotion to the Messiah. When someone comes to you telling about another Jesus whom we didn't tell you about, you're willing to put up with it. When you receive a spirit that is different from the Spirit you received earlier, you're also willing to put up with that. When someone tells you good news that is different from the Good News you already accepted, you're willing to put up with that too.

I do not think I'm inferior in any way to those "super-apostles." Even though I may be untrained as an orator, I am not so in the field of knowledge. We have made this clear to all of you in every possible way. Was it a sin for me to lower myself in order to elevate you by preaching the gospel of God to you free of charge? (Italics mine) I took money from other churches as payment for my work, so that I might be your servant [at no cost to you]. And I will keep on doing what I am doing in order to cut the ground from under those who want an opportunity to be considered equal with us in the things they boast about. You gladly put up with fools since you are so wise!

Even those who do not believe in a higher power or in Christian terminology can understand the general message here. To get down to the heart of the matter, our own selfish goals, ego, and pride are largely responsible for the complications that separate us from others. When we throw up barriers for whatever reason, we cause others who might use our knowledge and insight as a helpful resource to stumble or to fail outright. The intent initially may not be to isolate information inside very specific spheres of influence or schools of thought, but very soon this is its inevitable end result.

If we were speaking of a purely Christian point of view, we would concede that no believer should be discouraged from taking an active role in the faith, nor turned away from membership in the body as a whole based on any perceived deficiency or lacking of any kind. Sometimes putting walls up is an unconscious decision made out of a desire for protection, sometimes it is a response to feeling unappreciated and discounted by society as a whole, and often it is a reactive measure that replicates itself a thousand times once established. Like some untreated cancerous cell, walls and barriers become duplicated a thousand times over, leading to factionalism within factionalism, specificity within specificity, and minutia within minutia.

The Left has adopted this formula time and time again under the pretense of being sensitive and accommodating to every possible group with a semi-unifying basic agenda. But what this ends up doing is placing the individual concern first, and ignoring the basic humanity that draws us together. The current generation in power embraced post-modernism with open arms, not recognizing that simply denoting a specific circle of influence means also that one ought to get to take the time to understand its core philosophy as part of the bargain.

We can advance LGBT rights, for example, but if we don't really make an attempt to listen, really listen to LGBT citizens and to their reflections and concerns, we are wasting our time. Recently, a controversy has sprung up within Feminist spaces that criticizes men who make very ill-informed, very glib pronouncements of what the greater movement (and women themselves) needs to do. These forceful pronouncements are almost always set out in condescending fashion, without, of course, truly understanding where women are coming from and without much specific understanding their particular grievances. Some have denoted this as "mansplaining".

I do know the resolution of this issue ought be a two-way street, since any exchange of information needs both a talker and a hearer. Though some may disagree with me, I also assert that Feminist circles would be wise to modify, but not water-down, nor soften their message to reach maximum exposure with the world outside of it. This might be accomplished by consciously seeking to move away from the complications of heady terminology and abstract discussions. This doesn't mean voices should be silenced for any reason or that women ought not speak first and speak often in so doing. Nor does this mean that the dialogue must be dumbed down. What it does mean, however, is that that communication requires an equal sense of that which must be said and that which must be comprehended.

I sincerely believe that women's rights have a relevance and a pertinence which needs to be added to the daily discourse, but I do also know that doing so requires that it keep the extensive cerebration within itself and the cut-and-dry to those outside. But lest one feel like I am picking on Feminists (which I am honestly not), this goes for every single-issue, shared identity, or niche group with liberal sensibilities. Just because we seem to enjoy making things complicated for perverse reasons as yet unknown, doesn't mean that we should.

The true failing in all of these cases lies in the absolutely ridiculous complexity of how we structure ourselves. To reiterate once more, for too long, information and strategies that could be to the benefit of all has been isolated within specific issue-oriented groups, each with its own nomenclature and particular phraseology. This directly reflects the nature of academia, since these concepts are hatched there and exhaustively vetted. In that profession, segregated subject areas and ultra-specific foci are considered necessities within a field of study to encourage subsequent analysis. However, this particular structure is anathema to greater progress beyond the world of professors, scholars, and students.

Wednesday, January 20, 2010

The Poor Need Health Care, The Rich Need to Take Note

The circular firing squad over the defeat of Martha Coakley and what this means for the Democratic Party and Health Care Reform got underway a couple days ago. I've said my bit, and have nothing further to add, but I'd rather address the potential challenges facing reform aside from the loss of a seemingly filibuster-proof majority. It is now absolutely imperative we push forward and bring a bill to President Obama's desk. Our backs may be against the wall, but perhaps it will take abject panic and fear to rouse our complacent, weak-kneed Democratic legislators towards the goal. If it takes the shock and dismay of a humiliating defeat to break the logjam, then so be it. I'm not concerned with speculating as to how we got here; I am instead consumed with what we learned from it and how we will use this tough lesson to think of others and their needs rather than ourselves.

What I have noticed in my own struggles to obtain low-income health insurance is how class and race ensure that government subsidized plans are underfunded and often dysfunctional, but money (or the lack of it) seems to be the most powerful determinant of all. What many have noted is that basic selfishness is what threatens to derail any efforts towards changing the existing system---namely that people who have always had sufficient coverage do not understand the limitations faced by those who do not. We can call that privilege if we wish, but that term has always seemed accusatory to no good end to me, and my intent is not to chastise anyone but to make many aware of the challenges in front of us that never get much in the way of attention. In my own life, I can say that I have now seen how the other half lives for the first time ever, and I noted that they live lives severely impeded by the tremendous limitations and senseless complications of the existing system.

I have been unemployed or at least severely underemployed for several months. As a result, I had no choice but to file for government assistance. When I was finally granted food stamps I signed up as well for a local DC funded health insurance plan. What I have discovered in the process is that since the Recession hit, social service agencies in DC have been swamped by new applications for every existing option currently offered. According to one worker with whom I spoke, claims have tripled since the bottom began to fall out of the economy. The system was barely able to manage the number of filings in more stable times, and now it has in large part ground to a halt if not slowed to a trickle. New claims are supposed to be processed in no more then 30 days from approval, and I was forced to make several time-consuming, additional calls to the proper department to even get the coverage activated. Those without the time or without the persistence likely will be granted nothing at all and this simply should not happen.

My great point is that without the infrastructure in place, it doesn't matter how many people to whom we grant coverage. Ensuring that everyone can get their teeth cleaned, fillings filled, broken bones set, flu-like symptoms properly treated, diabetes regulated, or depression adequately under control is the ultimate goal, but we must also be sure to build a sufficient number of clinics, medical centers, doctor's offices, dental hygiene practices, well-stocked pharmacies and all the rest. They must be built in proper proportion to need and since humankind has never been able to curtail its zeal for making money at the expense of the health of the financial system, we need to devise strategies to build these things for both good times and bad.

In DC, the low-income, government-funded system forces the poor and/or disabled to a handful of centers scattered across the District itself. Visiting a private doctor or specialist is not an option, since coverage is only granted to those who use these designated centers. Likewise, pharmacies and medication dispensation function under the same parameters. Using Walgreens, CVS, Rite Aid, or other commercial medication fillers is not allowed under the plan. Though there are a score of specific pharmacies which take the DC plan, in my case, there is only one pharmacy in the entire District that fills psychiatric medication, and for me it is a 35 minute trip, one-way via public transportation and then by foot. The pharmacy itself is attached to a Mental Health services clinic which is the sole site whereby psychiatric care is provided for a city of roughly 600,000 people.

Without enough workers to process claims, grant coverage, manage medical records, or attend to even the most basic of needs the system is essentially worthless or at least incredibly inefficient. Without enough revenue allocated by governments from taxation or other means, it doesn't matter how snazzy or up-to-date is any system designed to speed up or modernize the system. Window dressing is window dressing. Without the money to properly stock a pharmacy, medications will be obtained on a priority system and as such, meds that are rarely prescribed or are very expensive will rarely be on hand when needed. For example, one of my medications, Parnate, is an MAOI inhibitor. Parnate is a very powerful anti-depressant that is infrequently prescribed because with it comes potentially dangerous, even deadly side effects if I do not take care to abstain from eating certain foods. As you might expect, it is not one of the more common prescriptions, but it is essential to my lasting health and quality of life. A commercial pharmacy usually has it in stock, or if it does not, it can be quickly ordered or is certainly in stock at some other store in the immediate area. With the government-subsidized pharmacy I must use, if that particular drug is available at all it is due purely to chance and luck, and if it needs to be ordered, it may be a week or more before they have it in stock.

Regarding visits with a GP, specialist, or other specific health practitioner, some clinics and centers accept walk-ins or schedule appointments within a reasonable time frame. Some do not. For those who need surgical procedures or more invasive treatment, one might be expected to wait months. When I still lived in Alabama, there was approximately one Medicaid-accepting clinic for the entire state that performed the procedure, and as such when it came time for me to have a very routine, non-invasive treatment, I was booked four whole months in advance. In more affluent, usually blue cities and states, the wait time is often less, but it can still be a bit on the lengthy side. As for me, I found to my utter dismay that my coverage was terminated before the procedure could be even performed after the clinic filed and billed Medicaid for the cost of the preliminary screening. Someone must have realized that to save cost I was not what they deemed a "high-priority" need and thus I could be safely removed from the rolls to save money in what was a system already in danger of being completely depleted of funds.

An important distinction needs to be drawn here. The DC-based coverage I have been talking about is different from Medicaid or, for that matter, Medicare. This coverage augments or seeks to provide coverage to those who either have Medicaid/Medicare or cannot get approved for it. This is why the rules, parameters, and hoops to jump through are more severe. Medicaid usually allows a person to pursue more orthodox means of seeking treatment. Though some medical practitioners do not accept it because it usually pays out less than a gold standard coverage plan through a private insurer, many do. Again, money is a big factor at play. If Medicaid were capable of paying out at a sufficient rate, everyone would take it. If it wasn't at times forced to pay out much later than a private carrier or even being forced to issue IOU's when monetary shortfalls and partisan bickering delayed enactment of a satisfactory state budget, then it certainly would be on par with usually employer-based coverage.

Yet, it is very disingenuous at best for those who oppose health care reform to stubbornly dig in their heels and express haughty indignation that they are NOT going to have "the government" take away their right to choose their doctor. The only way this would ever happen for most is if they lost their insurance altogether, lost all their personal savings, and lost the ability to come up with the money to see a well-compensated physician and/or specialist. Their worst-case-scenarios and numerous reservations are true only for those living in abject poverty, or at or below the poverty line. The wealthier among us have any number of lifelines, be they family, co-workers, friends, fellow members of a particular group or club, or other sufficient means. Those at the bottom have none of this upon which to rely. Friends, family, and others are just as impoverished and less fortunate as they are, and they have no choice but to take and use what they can get. And taking what they can get means dealing with a system that is convoluted, needlessly complex, inconvenient at best, and regimented to such an authoritarian degree that even obtaining the minimum often is an exercise in debasement.

If ever we had a need for revolutionary reform and change, now would be it. Decades after a declared War on Poverty, we still have many battles ahead of us. We haven't really given this matter anything more than perfunctory attention, and we haven't really allocated resources of any significant means to this very pertinent cause. Doing so would require us to understand exactly how fortunate we are to have been granted, by complete luck and chance, the socio-economic status of which we were born. For some quirk of God, fate, or nature we do not get the right to choose our parents or to choose our upbringing. But we do have the obligation to see to it that those for whom daily adversity is not an abstraction have the same rights that we frequently take for granted. I am not seeking to lecture, nor to hector anyone, but rather to strongly emphasize that our continued success as a people, a party, and a movement demands that we seek to assist the poor and the less fortunate. Our wallets, billfolds, and bank accounts couldn't open fast enough to provide aid to suffering Haitians. If only this were possible for our own poverty-stricken citizens, many of whom struggle through conditions not that dissimilar to those we now view through heart-wrenching news reports and graphic photographs. After all, it might be you someday who faces the disquieting realization that our health care system is designed for the wealthy, by the wealthy, and in so doing realizes just how much you took it for granted.