Sometimes

Sometimes when I see a headline of yet another senseless shooting;

sometimes when I hear a politician make outrageous remarks with the clear objective of getting headlines;

sometimes when I see incomprehensible numbers of refugees and migrants desperately seeking safety;

sometimes when I hear a CEO try to justify the fact that his salary is 350 times that of the average worker in his company;

sometimes when I hear someone claim that the science of climate change isn’t yet ‘settled’;

sometimes when I see another video of a policeman shooting an unarmed man;

sometimes when I hear of a random shooting of a policeman;

sometimes when I reflect on the hopeless nature of Mideast violence;

sometimes when the inevitability of human conflict seems overwhelming and the results seem to be growing ever more catastrophic . . .

I start to despair.

But then I find these prophetic words: 

“We cannot understand the moral Universe. The arc is a long one, and our eyes reach but a little way; we cannot calculate the curve and complete the figure by the experience of sight; but we can divine it by conscience, and we surely know that it bends toward justice. Justice will not fail, though wickedness appears strong, and has on its side the armies and thrones of power, the riches and the glory of the world, and though poor men crouch down in despair. Justice will not fail and perish out from the world of men, nor will what is really wrong and contrary to God’s real law of justice continually endure.” – Theodore Parker, Unitarian Minister, Abolitionist, Transcendentalist 1810-1860.

And I am somewhat comforted.

Indeed, for all of its evils and failings, the world is becoming more moral, more tolerant, more equitable.  There are many challenges, and the practicalities of creating less war and more social justice are daunting, but the recognition of what is right and good is widespread, and we need only find the courage and energy to put conviction into action.

Indeed, the fact that civilization has triumphed in no small measure over chaos, war, selfishness, vengeance, envy, demagoguery and greed is a miracle of the first order.  When one observes the rage that appears daily with such minute cause on our roadways, one can only marvel at the fact that we have a society that functions as well as it does.

Think of the ways that our morality and social conscience have been transformed!  We no longer view war and conquest as something to celebrate.  We are repulsed by the idea of slavery.  An ever-increasing part of the world respects women and provides them opportunities to live any type of life they choose.  We are becoming more accepting of religious and cultural diversity (the recent populist and anti-immigrant fever notwithstanding).  We seek to comfort and aid the disabled, mentally ill and sick rather than cast them out coldly into the dark.

Sadly, though, the change does not come fast enough.  What can an individual do to hasten its progress?  We are confronted daily through all manner of media with all of the remaining evil and misery in this world and it is intolerably discomforting to be aware of it and do little or nothing about it.  This is the anguish of the modern age.

The only recourse for most of us is to lead our lives in good faith, resisting the impulses that we know will contribute to injustice or hostility, and play whatever small role we may be offered in helping our fellow human beings along the way.

Healthcare Challenges

Last week’s attempt to repeal Obamacare and replace it with what by pretty much all accounts was a rather pathetic package of half-measures, brings the challenges of healthcare back into clear focus.  Unfortunately, the solutions to these challenges are not nearly as clear as the challenges themselves.

Healthcare is a multi-layered problem, which makes it particularly resistant to easy fixes.  Cost and efficacy are interwoven in a complex web.  There are numerous basic contradictions or paradoxes at the heart of the issue.  Here are some of them:

Should healthcare be considered a right for every citizen, regardless of income level or status?  I find it difficult to understand how one can argue against this proposition in a modern, developed nation.  One can debate how much healthcare is guaranteed, but basic healthcare should be provided for everyone.  Someday soon we will be shocked that we once allowed people to go bankrupt with healthcare expenses or denied life-saving measures to people who could not afford them, just as we are now amazed that we once condoned slavery.

Should everyone in society participate in healthcare insurance?  This also seems irrefutably logical to me.  If we are willing to require participation in a social security system and medicare system for later years, then it only makes sense to extend this to the entire lifetime of healthcare provision.  How else can we conceivably fund the care of the sick if we do not have full participation?  This is simply an extension of the basic concept of shared risk and communal responsibility.

Do patients have certain obligations as recipients of societal healthcare?  Of course they do!  They should use this scarce and finite resource wisely, being careful not to waste it on frivolous practices.  They should attempt to lead healthy lives so as to minimize their own necessary usage of healthcare.  They should diligently follow the instructions of their healthcare providers. 

Is there any way to motivate or even force people to act responsibly in this regard?  That is a more difficult question.  There must be certain safeguards put in place to monitor and control usage.  Co-pays, deductibles and various other financial mechanisms should be carefully crafted to ensure that healthcare usage is not frivolously engaged, but also is available and encouraged when truly needed.  Moreover, there should be a strong public service ‘indoctrination’ for every citizen about how to lead healthy lives and how to use healthcare services effectively and economically.

There is a fine line between encouraging citizens to use healthcare services energetically to minimize disease and using it too much as a self-indulgence. 

What kind of responsibilities do healthcare providers have?  They must have both ethical and economic incentives to provide the best possible healthcare with as much frugality as possible.  These are often contradictory goals and fine tuning them will be a constant and intricate process.  ‘Playing it safe’ for a healthcare provider will often mean ordering excessive tests.  But with the threat of malpractice lawsuits ever-present, it is difficult to curb this tendency.  Malpractice reform seems to be necessary if we are to control the arms race of lawyers and doctors/hospitals.  Doctors must have the freedom to manage their patients and their practices, but they must also be held to reasonable standards of both patient care and healthcare expense.

End of life expense control must become a priority, or we will be spending a large percentage of our medical dollars on a period of life that quite candidly provides very little return on investment.  The predisposition of elderly people to over-utilize medical services is well known, whether out of boredom, loneliness or understandable frustration with a rapidly deteriorating body.  Hard decisions have to be met regarding how much healthcare can be provided for an ever-increasing number of senior citizens.

The concept of free market components of healthcare has been trumpeted as the way to control costs, avoid bureaucracy and increase efficiency.  In general, competition does indeed create more efficient delivery of goods and services.  However, here again there are paradoxical elements that make a free market approach somewhat problematic.

Insurance companies will naturally attempt to increase profits by limiting what procedures or care they pay for and limiting their clientele to the healthy rather than the sick.  If we are to create free market conditions, then the rules must be constructed such that any profits are derived from efficiencies in healthcare delivery and management, not from limiting care or rejecting people with less fortunate health profiles.  This, of course, is not easily tracked or accomplished.  There are certain aspects of society that do not easily lend themselves to free market implementations.  For example, we would never allow our military defense to become a free market commodity.  We have seen that private prisons are also not necessarily a panacea. The question is whether healthcare falls into this category as well.  The fact that we spend more dollars per person in the U.S. for healthcare than other developed nations with single payer systems certainly begs this question.

If our leaders would evaluate the healthcare challenge as a policy issue and avoid the polemics and demagoguery, then it might be possible to craft a plan that can meet the needs of society without the expense spiraling out of control.  There are numerous reasonably successful models in Europe and Canada to analyze.  The U.S. may be different than those nations, but it can certainly learn from them if we can for once humbly acknowledge that we are not always the most perfect nation on earth!