Why I Hate Twitter (and other thoughts on Social Media)

Social media is ubiquitous.  Human beings are social animals, so it is logical that social media serves a purpose at some basic level of human need.  But with so many different forms available and the distractions growing exponentially, perhaps it is useful to take a close look at social media and understand what it accomplishes and what it may indeed damage in our human social fabric.

In the beginning, there was letter writing.  This was the original social media. Before letter writing the only way to interact with another human being was to engage them verbally, face-to-face.  Letter writing probably emerged as a way to communicate when people were not close enough to meet.  But as time progressed, writing a letter became something more than just a substitute for a conversation – it became a way of expressing one’s thoughts more profoundly and preserving them.

Letter writing required time and effort – finding pen (or quill) and paper, addressing some form of envelope or package, and interacting with some form of letter carrier system.  Thus, a letter was generally not simply a short note, but rather a thoughtful short (or even long) essay.  After all, every letter had the possibility of permanence, of being a legacy of some sort. Moreover, the number of letters one could generate was relatively limited, and it seemed prudent to avoid wasting one’s energy on frivolous or meaningless output.

When you are speaking in real-time with another person there is no opportunity to carefully consider the topics at hand and employ all of one’s logical and emotional faculties in crafting responses.  There is simply not enough time.  A letter allows one the time and distance to explore an idea, sorting and weighing all of its components and antecedents, and finding the best way to articulate the result.

So letters became a way for people to interact with some depth, and we have volumes of historical letters – love letters, philosophical letters, letters of scientific inquiry, letters of conviction, humorous letters.  These inform much of the history of the human race.  They are a wonderful testament to the inventiveness and profundity of the human spirit.

But once the computer entered into our lives, the letter was soon replaced by email.  With the logistical overhead now virtually eliminated (no paper, no envelope, no stamp, etc.), the nature of this ‘letter’ changed dramatically.  A few words or a phrase could be typed and fired off with minimal effort. Email took away the motivation to carefully nurture thoughts and emotions before committing them to pen and paper.  It resulted in an exponential growth of remote, indirect communication, but it also cheapened it.

An email has no aura of permanence, even though it can of course be preserved and is occasionally a very embarrassing or damning piece of evidence.  Its ephemeral nature and ease of composition allows us to indulge our laziness.  We lose the discipline of organized thought and careful word crafting.  Email is generally a throwaway.

With the rapidity that has characterized this age of information, email soon spawned many new digital children –  initially texting and various forms of chatting through messenger services, and later the plethora of social media that now inhabit our personal devices – facebook, twitter, youtube, linkedin, snapchat, instagram and many others.

Many of these social media involve a different type of social interaction than traditional letter writing or even email.  Facebook, youtube, snapchat and Instagram all are primarily photo and video sharing, with some comments, humor and messages tossed in.  To some extent, these replace and extend the old social custom of inviting friends over to see your vacation slide show or home movies.  It is interesting to recall how painful these episodes were and how often they were ridiculed, yet we now willingly, or let us say, addictively, subject ourselves to an endless parade of photos, memes and videos day and night.

Much could be written about whether the proliferation of these photos and videos and their subliminal messages and ‘likes’ enhances our friendships, or about its effect on our self-image or happiness.  To the extent that these media allow us to maintain relationships or re-discover them, they offer some benefit.  But do we really want to immerse ourselves superficially in so many outside lives – voyeuristically participating but not truly sharing any of these experiences?   I have read studies that indicate that the addictive nature of facebook and other similar social media leads to depression and insecurity, as we find ourselves confronted with the dream world of our peers that often overshadows our own mundane existence.

But to me, the worst offender in the world of social media is twitter.  This form of social media is the lowest common denominator, the ultimate sound bite, the catalyst and amplifier of rage, indignation, spite, pretension, and mockery.  As opposed to a sincere, careful attempt to address an issue or develop an idea through an essay, article or blog, a tweet is a loose cannon, a reflexive and trivial missive, a cynical ploy to get views and provoke responses.  It does not seek to be thoughtful or erudite, only perhaps clever and provocative.

For politicians and celebrities of all stripes, twitter is another way to stroke one’s ego – the very thought that thousands or even millions of people hang on your every word, however banal and self-serving, is intoxicating.  Who are the legions of followers? Do they have so little of substance in their own lives that they must grovel in the twitter feed of potentates like peasants at a coronation?

And then there is the ‘fake news’ and the fantasies, conspiracies and hysteria that seep through social media like poison gas across a battlefield, sinking deep into the neurotic brain tissue of the masses and destroying all rational thought and analysis.  Twitter is the ultimate tool of the demagogues and their henchmen.  One has only to look at the corrosive effect of our tweeter-in-chief to understand that twitter is more foe than friend.

Social media is the modern Pandora’s box, the genie that will never, ever be stuffed back into its bottle.  It is, in my view, a recipe of one part goodness for five parts woe.  Is it not better to nurture a small number of deep social relationships than a surfeit of shallow ones?  At the risk of sounding curmudgeonly and like a sad voice crying in the wilderness, I say the arrival of the social media panoply is not cause for celebration, but rather a warning bell for our society, our relationships and our future. 

Ignorance: No Longer Bliss!

Americans are wonderful, energetic people.  We work hard, play hard and are typically friendly and generous.  But we have always been a bit ignorant.  Even though we have many of the world’s best scientists, mathematicians, computer programmers, economists, doctors and social scientists, and conduct much of the world’s research, on average we are woefully ignorant when compared to other industrialized nations.

We are proudly illiterate in geography, as so many studies have revealed.  Why learn about the rest of the world when so few of us will ever travel outside the country?  We have little use for foreign languages, probably for the same reason.  Less than 1% of Americans are proficient in a foreign language that they studied in the classroom.  Travel to Sweden and you will find that even farmers who rarely venture from their towns and villages can speak flawless English and perhaps French as well.

What about history?  Well, it seems that Americans know almost nothing about world history, and damn little about our own American history.  Even college students demonstrate depressingly little knowledge of history or any of the other social sciences, probably because they are primarily focused on football games, frat parties and an occasional business course (forgive me for a little spiteful hyperbole . . . . )

When it comes to math and science, the ignorance goes into warp drive!  Most Americans cannot do basic percentage arithmetic (calculating profit margins, discounts, etc.).  Most haven’t the faintest clue how all of the technology at their disposal works and are more or less helpless when it goes awry. 

Almost half of our citizens believe that God created the earth and human beings in their present form less than 10,000 years ago, a belief that flies in the face of two centuries of acquired knowledge in multiple scientific disciplines – geology, climatology, biology, genetics, etc.  This is compared to other industrialized nations, where generally less than 20% have a similar belief.

Why are Americans so ignorant?  One would think that with our wealth and freedom and energy and ingenuity that we would be the most knowledgeable country on earth!  But almost the opposite is true – we are indeed one of the least knowledgeable, and seemingly proudly so!

One might argue that for much of our history our ignorance was reasonably well-suited to the task at hand – we focused our energy and intellect on taming the land and building a formidable commercial engine to stimulate business progress and lifestyle improvements. We disdained the elitism and classism of our European forbearers, perhaps with the attitude that spending much time in intellectual pursuits was a waste of time and a distraction from the pursuit of material gain and being productive.  Ignorance was, for the time, bliss.

But over the last 100 years or so, as our nation has found its fate interwoven with that of the rest of the world’s in an ever more complex economic, political and scientific web, that ignorance has become a rather large liability.  Many of our citizens were easy prey for demagogues such as Huey Long, Father Coughlin, Joseph McCarthy and George Wallace.  Need I say that there is one more to add to this list?

When the Internet emerged as the great intellectual equalizer, there was hope that our citizens would tear themselves away from NFL football and reality TV shows just long enough to acquire a new awareness of the world around them.  But alas, in a sad but beautifully ironic twist, the Internet is doing just the opposite – it is serving up steaming piles of pseudo-knowledge that catalyze our citizens’ deepest fears and insecurities.

Manipulation of the mob has always been the goal of those that seek power and ignorance is its strongest ally. Now the Internet and social media provide a mouthpiece that reaches across the entire planet.  Our own made-in-America ignorance, once so innocent that it was almost quaint, is still rampant, but sadly it is no longer blissful.  If we are to avoid devolving into a banana republic of warring factions and paralyzed government, then we must seek out reputable sources of information and seriously embrace the responsibility of being world citizens.

Revolutionary Zeal

It must be discouraging these days to be a revolutionary!  What ideology can a revolutionary seriously embrace in this modern age? Is the age of revolution over?

Communism has lost its allure in the past thirty years or so, and capitalism has ascended to an unrivaled position as the king of the ideological hill.  In the U.S., Marxism and communism were only ascendant for a relatively short period of time during the first half of the 20^th century.  But aggressive repressive measures in the 20’s and again in the 50’s eliminated much of the popular support, even among intellectuals.

Socialism, which many in our country equate with communism, has also taken on pariah status in the post-Reagan political climate.  The mere coupling of the words ‘socialized’ and ‘medicine’ is enough to doom any effort for single payer healthcare!

But if we can for a moment cast aside our reflexive disdain for anything that hints of communism, it may be illuminating to try to understand why Marxism and all of its associated ‘isms’ appealed to so many people and whether there is something to be learned from the revolutions and upheaval that they spawned.  We have no doubt done these concepts something of a disservice by only viewing them through the lens of the violence and death that accompanied them.  After all, there is plenty of death and violence that one may lay at the feet of capitalism as well!

The world is not a perfect place, and there must always be people who dream of making it better than it is.  These are idealists.  Social, political and economic systems are the currency of dreamers, of idealists.  Without idealists, the world would never have progressed beyond the chaotic and tyrannical states that defined civilization for millennia.

Today finds the world in a more peaceful and economically stable state than ever before in history, despite a seemingly endless depiction of bad news in the media (which is merely performing the service that we demand –  that is, keeping a fickle public titillated with violence, sex and tragedy).  The simple fact is that less people die each year in violent conflict than ever before.  Less people die from starvation and disease.  There is less slavery (although it does still exist!), less persecution of minorities, less subjugation of women and more freedom of expression.  Even natural disasters have less impact than before, although this trend may be reversed as we produce more in the future through our impact on climate.

We continue to face many diverse challenges in terms of keeping conflict at bay and providing secure and stable environments for people around the world.  There are religious extremists and a few rogue states, and tensions between the great powers (Russia, China and the U.S.) are re-surfacing.  But clearly the last great hurdle in achieving a more peaceful and healthy world is the lingering social and economic inequality across all populations. 

In the developing world, there has always been a very small class of wealthy oligarchs – a plutocracy – that receives most of the wealth of the nation.  The good news that large numbers of people across the world have slowly clawed their way out of dire poverty does not change the fact that the political, social and economic structures in the developing world are generally rigged and corrupt, primarily benefiting a very few.  Sadly, there seems to be little or no improvement in this regard in most developing countries over the last 50 or 60 years.  Paul Theroux, a travelogue author of some renown who was a Peace Corps volunteer in Africa in the early 60’s and then made an extensive tour again in 2005, made a strong argument that Africa is actually in a worse state now than when he was there just after most states had claimed their independence.

Perhaps even more disturbing, there appears to be an increasing chasm between rich and poor in many developed nations that had previously built up very strong middle classes and seemed to be on the path to a very equitable distribution of wealth and opportunity.  There are several factors in this sad trend – automation, globalization/outsourcing, the gradual weakening of unions, and the extreme stratification of salaries to name a few.  This chasm has led to populist, nationalist and anti-globalization/anti-immigrant movements that threaten to re-route or even blockade the march to global peace and harmony.

Can the world continue to become more just and equitable in a steady, peaceful manner?  Are inequities, corruption and poverty entrenched and intractable, or can they slowly be eliminated by good people with noble motives?

Will the poor, as Jesus famously said, ‘always be with us’?  Well, as a side note, what Jesus actually meant in that passage is subject to much debate.  But it does beg the question – is income and opportunity disparity an inevitability?

Even generally good people with good intentions contribute to the bias in opportunity and wealth.  I do not take bribes or take part in any outright corrupt business practices, but I am complicit in certain areas of elite privilege.  For example, I readily take advantage of networking and connections to find jobs or opportunities for my family and friends.  I use my resources to provide advantages for my children in education and experience that others do not have.  These are relatively small things, and it is natural for a parent or friend to do such things, but who can argue that these small actions do not insidiously preserve the exalted positions of those with power and wealth?

And if these seemingly innocuous actions contribute to the continuing reign of the elite, then one can only guess at the impact of more venal efforts to rig the system.  The powerful and wealthy will naturally do everything they can to preserve their status, and they have many effective tools at their disposal.  Even very ethical people find it easy to rationalize their indiscretions.  The less ethical don’t even pretend.

The highly vaunted meritocratic nature of our society can certainly benefit high achievers and risk takers, but it is likely that this phenomenon has a narrow effect – mostly on a small group of top performers.  The bulk of the population is not particularly mobile either upwardly or downwardly due to factors of birth, family, education and social status.

Liberty and freedom are the most highly prized attributes of our society for many good reasons.  But they also contribute to some of our problems. We chafe against rules that dictate our behavior.  We believe that our good deeds must be done voluntarily, not forced by government or societal regulation.  For example, we are not forced by law to recycle.  It is voluntary.  We are reluctant to allow the government to dictate the gas efficiency of our vehicles – we love our SUVs!  We are free to send our children to expensive pre-schools, private schools and elite universities, and to organize internships and job opportunities through our connections.  We are free to separate ourselves from the poor and live in gated communities.  We are free to keep most of the money we get from our jobs or investments, regardless of how absurd the amounts may get.  These freedoms give the rich and powerful, and even the middle class, an incredibly potent tool to maintain their status and wealth.

If societies are indeed somewhat static and the inequities resistant to improvement, then the possibility of revolution arises.  The downtrodden are long-suffering, but eventually they will not be placated with empty promises of future good things.  The trickle-down, all-boats-rising tide of human development is a more comforting illusion to the consciences of the rich than to the hopes of the poor.  At some point, it all begs credulity.

Marxism emerged as a product of the industrial revolution in the euphoric vein of other scientific and pseudo-scientific theories.  The Age of Enlightenment seemed to guarantee that the physical world, and indeed, all human endeavor, could be understood by analysis of the laws of physics, chemistry, geology, evolution, or, in the case of Marxism, the laws of dialectic materialism and economics.  Much of the allure of Marxism, and consequently, communism, came from its apparent scientific inevitability.

The industrial revolution had also put human misery and injustice in stark relief for all to see.  There appeared to be no way to ‘evolve’ into a more equitable society and the capitalist class seemed hardened and intransigent.  Class warfare leading to a dictatorship of the proletariat sounded like a relatively good deal to factory workers performing 12 hour shifts six days a week under inhumane and dangerous conditions!

The first waves of revolution and union organizing had a sobering effect on the business owners and they slowly and reluctantly began to accede to some of the workers’ demands, while also aggressively pulling all of the levers necessary to brutally eliminate all revolutionary activities.  This shifted the balance just enough to avoid full-scale communist revolution in most of the industrialized world, where higher wages and better general living conditions tempered the revolutionary zeal.   But revolutionary ideologies and movements found fertile ground in the developing world, where poverty was horrific and injustice even more entrenched. , These revolutionary efforts were often buttressed by independence movements seeking to shed colonial or imperialist control.

In the west, we have found it convenient to characterize social and economic revolutions as ‘evil’, noting the reigns of terror, the purges, the lack of freedom and the frequent famines.

But for the revolutionaries who believed they were remaking the world into a better place, the ends justified the means.  They were merciless, but they believed they were heeding historical lessons that necessitated their behavior.  For example, Lenin saw how the generous treatment of the bourgeoisie by the Paris Commune in 1871 backfired and resulted in wholesale slaughter of the communards once the reactionary forces rallied.  He was not going to make the same mistake and thus the so-called ‘Red Terror’ was initiated.

Committing horrific acts (‘evil’) for a perceived greater good is something every society does and somehow justifies.  The Allies civilian bombing of Germany and Tokyo, which resulted in the deaths of millions of ‘innocent’ civilians, is a perfect example.  One man’s evil is another’s heroism.  In the view of revolutionaries, imperialists, militarists, fundamentalists and other zealots, there are no ‘innocent’ people.

A similar paradox can be detected in our view of freedoms.  We cannot comprehend how the Soviet Bloc and Cuba could justify preventing their citizens from emigrating to Western countries or how they could impose such rigid control of their societies.  But if you have the goal of creating a new society and radically changing the behavior of people – eliminating greed, competition, nepotism and selfishness – then it is expected that many will want to flee and it is the duty of the state to ensure that they stay and participate in the revolution.  From the perspective of the revolutionary, the curtailment of freedom is worthwhile if the ultimate goal is achieved – the new human and the new state! 

Sadly, none of the communist revolutions have had much success in achieving this goal.  Violence seems to beget more violence, and it generally produces ruthless leaders prone to megalomania and paranoia.  Additionally, the centralized planning and control of economies, and the elimination of individual ownership of businesses and property, produced very poor economic results.  Either the ‘new man’ was never properly formed, or it may simply never be possible to create such a being given the idiosyncrasies of human nature.

But the notion of human beings sharing the earth and its bounty in a more equitable fashion can still stir the soul. The current stymied state of progress in social justice has begun to spark new revolutionary movements.  Marxism will no longer be the foundation of such movements and to date no adequate replacement has been proposed.  Like the Populist movement, modern revolutionaries are more likely to define themselves in terms of what they detest than what they embrace – Occupy Wall Street and the Antifas are good examples.  This type of revolutionary model is more angry than romantic, and will struggle to attract the necessary critical mass for any real change.

What seems clear to me is that violent revolution is no longer a good option for achieving positive change.  Violence amplifies the unpleasant traits of humankind and destroys the civil basis for progress.  Instead, we must slowly chisel and grind away at the stone of society like a renaissance sculptor, trusting that a form of great beauty will eventually emerge. But part of this effort to free our better angels must be a more enlightened understanding of the history of human revolution and the quest for social justice.  As in all human endeavor, much evil was afoot, but there were also many noble intentions.  We must learn from all of it.

Sickness and Injury

I have hurt my back again.  I cannot bend over without sharp pains and I am unable even to put on socks or shoes without help.  I have started my McKenzie exercises and hopefully this will accelerate my recovery.  I have had episodes of this nature every 7 to 10 years since my college days, when I played a handball match on a cold winter’s day without warming up adequately.  Some of these episodes curtailed my activity for months, but more recently I have been able to limit the impact to 4 or 5 lost days and then a week or two of limited disability.

I seem to fall prey to many ills!  I say this not to court pity or sympathy, because I don’t really find those things very helpful. It is simply a fact.  My primary malady, a disease I have had all my life, is PCD (primary ciliary dyskinesia).  The cilia in my lungs and sinuses do not ‘wave’ as normal cilia should, but simply ‘vibrate’.  I saw this with my own eyes under light microscopy when I had this diagnosis confirmed in 1999 at the University of North Carolina. Before that I was uncertain why I was getting sick all the time.

The lack of ciliary motion means that the stagnant secretions in my respiratory tract are enthusiastic hosts for bacteria! Thus, I have had a lifelong battle with respiratory infections.  I carry antibiotics wherever I go and have had long periods when I was continuously on antibiotics.  One year my diary logged over 80 days when I had a fever.

I was fortunate to grow up in the golden era of antibiotics, and I was very active athletically all my life, or I might be far worse off.  My lung function is currently about 70% of the expected for my age. I run several times a week and do daily nebulizer treatments to stave off additional damage (bronchiectasis due to colonized bacteria).

As if this wasn’t enough of a reminder of my mortality and all-to-human frailty, in about 2005 I began having serious migraine problems.  No one in my family has a migraine history, and I had never had one before.  At first, they came infrequently, but slowly they became more frequent and now I must take medication (triptans) between 7 and 15 times a month to abort the episodes.  If I am not quick enough, the ensuing migraine is totally disabling and I end up in an agonized state, vomiting and losing anywhere from 12 to 20 hours of life!  Fortunately, I have become quite adept at managing this and I rarely succumb to the full migraine these days.  But I have had to give up alcohol, chocolate and a variety of other foods that are guaranteed triggers for this condition.  I have now added triptans to the pharmaceutical lifeline that I carry with me everywhere I go.

But it doesn’t stop there!!  In my efforts to identify a cause for my migraines I became aware of the fact that I have degenerative disk disease in the cervical spine (my neck).  It is unclear whether this is in any way connected to my migraines, or whether the more or less permanent sinus infection in my frontal sinuses plays a role.  At any rate, in the last year this has become an additional nemesis and I have daily pain in the area of my cervical-thoracic junction.  Physical therapy has helped a little but not much.

It is easy to fall prey to self-pity when one is sick or hurt, but it is hard and futile to indulge it over the long term.  I know that there are multitudes who are far more stricken with health issues than I am, and I know that my own life has been blessed with undeserved good fortune on many fronts.  We all battle with our own individual demons and we can only guess at the circumstances that others must face, which can be both visible and hidden.

Life goes on, doesn’t it?  And to be quite honest, I don’t really feel like my quality of life is any worse for all of the problems that I face.  Somehow my psyche adjusts for the pain, discomfort, lost days and other ramifications of these health impairments.  I am always aware of them – asking myself off and on throughout each day, as I have always done, whether I am starting to get a respiratory infection or whether the first signs of a migraine are present – but somehow this awareness does not generally weigh me down or depress me. 

This is the beauty of the human spirit!  It can seek joy and optimism even under fairly challenging circumstances, and reward its owner with a relatively positive life experience.  I hope and trust that I shall be able to carry on with the courage that each life imbues on its mortal denizen.  And I will seek every interesting and fulfilling moment that the rest of my life can provide!

Thoughts on Monuments to the Confederacy

The events in Charlottesville and the ensuing disappointing response from President Trump (which later was doubled down to a frightening defense of the hate-mongers who initiated the violence) have dominated the news in recent days.  No doubt there are some, perhaps many, who once again lay blame on the ‘fake media’ for misinterpreting Trump’s remarks or for whipping the 'libs' into a frenzy on this issue.

The march of the white supremacists and neo-Nazis in Charlottesville was prompted by the prospect of the city taking down a statue of Robert E. Lee.  This poses a question about the general purpose and value of such memorials and whether there is indeed a justification for removing them.

At first blush, one may think that it is foolish to try to erase the past by taking down memorials of Confederate heroes.  Isn't this a part of history and doesn't the south have a right to celebrate its war heroes?

But as I have thought more deeply about the question of civil war memorials and honoring historical events and people, I have come to the conclusion that most of these monuments should indeed come down.  There is of course the danger of trying to ‘purge’ historical memory or rewrite history.  But in reality, the monuments extolling the virtues and heroic efforts of Confederate leaders are the real ‘whitewashing’ of history.

The simple fact is that the primary reason, the casis belli, for the Civil War was slavery.  The Southern nostalgia for the pre-Civil War era and its sentimental regard for confederate soldiers is misplaced at best and a complete delusion at worst.  The ‘lost cause’ was not the genteel way of life that one sees in romantic mythology like ‘Gone With the Wind’ and it was not states’ rights.  The ‘lost cause’ - the primary reason that the south seceded - was to avoid what they saw as the inevitable abolition of slavery were they to stay in the Union.  Pure and simple.

Was it tragic that millions of young men lost their lives and that terrific hardship was visited upon the south?  Of course it was.  Were there heroic men, heroic gestures and heroic sacrifices in the war?  Of course there were.  Just as there were many heroic deeds by German soldiers in World War II.  But do you see monuments and statues in Germany extolling the virtues of their soldiers and the ‘lost cause’ of the third Reich? 

It was a bitter pill to swallow, but the Germans faced up to the fact that the best way the suffering by their own people in WWII could be idealized, memorialized or sanctified was to put up monuments honoring the truly helpless victims – the Jews and the Gypsies and all the others that the Nazis exterminated.  And the best way to honor the suffering and sad loss of so many Germans was to vow to never let hatred, extreme nationalism and prejudice take root again in German culture.

This should have been the approach of the post-Confederacy south – an honest recognition that an immoral embrace of human slavery was the cause of their downfall - not the propagation of a myth about a noble ‘lost cause’ and the tragic destruction of the plantation lifestyle, which quite frankly was only possible because of the horrific enslavement and exploitation of Africans.  Monuments are, to put it simply, not appropriate.

A Tribute to Glen Campbell

Glen Campbell died yesterday.  He was 81, but had suffered for a lengthy period with Alzheimer’s.  For many reasons, he inhabits a special place in my musical constellation.

I first became aware of his music when his big trio of hit records crossed over from country to pop – Galveston, Wichita Lineman, Gentle on my Mind.  I was in my rock and roll prime, a high school student with little patience for slick pop songs or overly orchestrated ballads.  So of course I was dismissive of him and his music.  But something in his voice and the songs captured my attention much more acutely than the typical pop song and I found myself furtively seeking out his songs on the radio.

In early 1979 I stopped in Reno for the night with my Mom, who had joined me on my way out to California to report for duty with the USS Seawolf.  She suggested we go to a Vegas-style show with Glen Campbell and I acquiesced, though not particularly eager for what I thought would be a stylized and phony glamour display.

Much to my surprise, for the next three hours I was mesmerized by the talent and energy that this amazing man displayed.  He played the guitar and the banjo with effortless virtuosity and his singing was powerfully melancholic and inspiring.  He performed songs from numerous genres, including a medley of Beach Boy tunes from his days replacing Brian Wilson on one of their tours in the mid-60s.  The range and breadth of his repertoire astounded me.  When he sang his trademark Wichita Lineman, I could feel the aching need and loneliness of every human being in those perfect lines:

 ‘and I need you more than want you, and I want you for all time’

I left that Reno theater with a stunning epiphany.  All my prejudices and pretensions were false!  Glen Campbell was not some glitzy country crooner, but rather a musical genius and he had a much more profound message and impact than I could ever have imagined.  I soon discovered that Glen had been one of the most sought after studio musicians in LA in the 60's and that he was considered one of the era's best and most versatile guitarists before his singing led him to stardom.  I had totally misread him!

But it wasn’t just Glen Campbell that I had been wrong about.  I suddenly realized that the depth I had missed in him was also the depth I was missing in every person I was too smug to learn more about or too busy to engage with.  Not many people have the amazing talents that Glen had, but everyone is deeper and more interesting than we realize – and has more to offer than we are apt to believe.

Last night I listened for hours to youtube videos of Glen’s canon, tearing up as his aching, yearning tenor and flawless guitar filled my heart.  I saw snippets of his farewell tour, when the ravages of his Alzheimer’s had taken much of his mental acuity, but somehow his singing and playing fought through the haze and shone brightly.

I am grateful for the life and music of Glen Campbell, and in debt to him for teaching me an invaluable lesson about people and prejudice.  

The Market-Based Healthcare Fallacy

One of the primary goals of the Republican effort to ‘repeal and replace’ Obamacare is to achieve so-called ‘market-based’ healthcare.  In the conservative world view, every complex social problem can be solved by the magic of the ‘free market’.

Of course everyone understands that government tends to be bureaucratic and inefficient and that market-based, competitive industries are preferable to monolithic, centrally-controlled bureaucracies.  But selling toothpaste and providing healthcare are two very different things, and there are certain things in a society where market forces are not as efficient nor as compelling.  For example, we do not generally outsource our military to the free market or our legislature (though perhaps that might be a good thing . . . ).

The free market and associated market forces work best on commodities, products or simple services in direct buy/sell relationships.  A consumer purchases a product or service based on a combination of quality and price, and the competition for the consumer’s dollars causes the supply chain – retailer, manufacturer, etc. – to become more efficient and the products and services of higher quality to earn the business.

But healthcare is not a simple buy/sell relationship.  Consumers do not directly buy healthcare services – they are too costly.  Instead, a consumer buys an insurance plan that pays for the services.  But how much healthcare service a consumer utilizes is a complex interplay between healthcare providers (doctors and hospitals), the patients (consumers) and the insurance companies.  Efficiency, quality and cost reduction are not simple concepts here.  Having a consumer visit doctors less frequently or having the doctors prescribe fewer tests or drugs might seem like good cost reductions and improvements in efficiency, but the result might be long terms problems and massive increases in the cost.  It is not likely that these very nuanced and long term aspects of the healthcare relationship will be comprehended and improved by a short-term, profit-oriented market approach.

When we talk about market-based healthcare, we are talking about competing healthcare insurance programs.  At first blush, this sounds like a good thing – as insurance companies compete for healthcare dollars they would in theory become more efficient and find cheaper ways to deliver healthcare for their customers. 

But the question is how would they reduce those costs and gain efficiencies?  The insurance companies have four primary cost factors – (1) their own administrative costs, (2) hospital costs, (3) physician costs and (4) the ‘use’ of the insurance by their customers – i.e. how sick they are and how much healthcare they utilize.

The easiest and most lucrative way for insurance companies to be more competitive and ‘efficient’ is for them to control the 4^th factor – how much their customers utilize – by enrolling a relatively healthy set of customers, excluding people with chronic healthcare problems and denying or restricting services.  This is what insurance companies have been doing for years. 

A relatively small amount of benefit can be obtained from controlling the first factor, administrative costs, though I imagine it is the one advantage that this structure has over a single payer system. 

The insurance companies can pay hospitals and doctors less and insist that they become more ‘efficient’, but that is a very indirect process and it is not at all clear that a multiplicity of insurance companies with varying schemes of healthcare policy can impact those areas as well as a single payer with a unified vision can.

Giving the insurance companies and consumers a ‘free market’ with few restrictions will work great for the healthy and those who work for generous employers who are willing to foot the bill for great healthcare benefits.  But as seen in the past, this system will be a nightmare for people with chronic issues or sudden catastrophic illnesses, or those who are under- or un-employed.

A fairly large percentage of U.S. citizens already receive healthcare from a single payer system – the U.S. military, government, Medicare and Medicaid – more than 30% of the population.  No one will claim that these systems are efficient, and their costs continue to grow dramatically.  But that is the challenge that all healthcare provisioning systems face in a time of increasing human longevity and medical complexity.

The biggest question that Americans need to answer about healthcare is whether our society is obligated to provide at least a minimum of healthcare to every member.  If the answer is yes, then a single payer system available to all, with a private insurance system in parallel would probably be the best way forward.  We need only to look at the EU healthcare systems for excellent examples.  These systems are far from perfect, but they are generally valued by their constituents as preferable to the U.S. system.

A market-based healthcare system would almost certainly not be the panacea that our conservative members of congress claim it will be.  This is one area where capitalism’s profit motive will create more problems than it will solve.  Medical costs will ultimately need to be reined in, but the free market is not the mechanism to accomplish this.  Medical providers and community health experts need to drive the future of healthcare, not accountants and MBAs!