Tag Archives: Health Care

#211: New Jersey 2017 Ballot Questions

This is mark Joseph “young” blog entry #211, on the subject of New Jersey 2017 Ballot Questions.

New Jersey tends to be blase about our off-year elections–no President, no United States Senators, no United States Congressman, why bother going to the polls?  Yet as we noted this year the election is not insignificant.  Every State elected office is on the block, from our Governor and Lieutenant Governor to all forty of our State Senators to all eighty of our State Assemblymen.  Additionally, there are two ballot questions put forward, asking the voters to approve spending more money.

That’s certainly more than we can cover.  We have already examined the gubernatorial race, and promised to return to look at the ballot questions.  There are two:

  1. The Bonds for Public Libraries Measure;
  2. The Revenue from Environmental Damage Lawsuits Dedicated to Environmental Projects Amendment.
AppleMark

The Bonds for Public Libraries Measure has tremendous support; more than half the members of the State Assembly are listed as sponsors of the bill.  It passed both houses overwhelmingly, and was signed by Governor Christie.  However, the few objectors have some good points.

Approval of the question would allow the state to issue bonds in the total amount of one hundred twenty-five million dollars, the proceeds to be used as matching funds for projects within the state to build, equip, or expand public libraries.  Those grants would have to be matched by like amounts from local governments and/or private donations.  Despite the increasing use of the internet for many of those resources for which once libraries were the primary providers, the library system continues to be important and to update itself to modern needs.  It thus makes sense to continue to support our libraries.

On the other hand, New Jersey is already in the top five states for per capita expenditures on libraries; we have one of the best library systems in the country.  The words “issue bonds” really mean “borrow money at interest”, and would be committing the state to repay one hundred twenty-five million dollars plus interest over the years ahead.  It is worth asking whether there would be sufficient return on the investment.  That is, would we be getting our money’s worth?

I am inclined to think not, but I rarely use the libraries and do not have a card.  I also think that our county library is well funded and well equipped, and while I can imagine (but do not know) that there are urban areas in the state with underfunded libraries, the matching funds clause will make it at least challenging for these areas to take advantage of the benefits.  If we had the money, it might be money well spent, but to borrow money for that which is not a problem is looking to make a bad fiscal crisis worse.  It’s like the family that can’t keep up with the mortgage taking out a second mortgage to pay for a vacation.  We don’t really need this, and we probably can’t afford it.

The Revenue from Environmental Damage Lawsuits Dedicated to Environmental Projects Amendment is about creating a “lockbox” for certain state income.

If you remember the ballot questions last year, you may recall that the issue with the fuel tax question involved whether to “dedicate” that income to transportation matters.  That question of dedicating specific funds for specific purposes arises again in this question, and with a more solid basis.

New Jersey has held the lead in industrial waste and toxic waste sites over the decades.  Periodically the State sues offenders, and either in awards or settlements often collects millions of dollars.  Cases related to the pollution of the Passaic River brought three hundred fifty-five million dollars from defendants.

The State is in one sense like any other plaintiff.  If you’re injured in an automobile accident and win a substantial settlement in a lawsuit, we might think that this is going toward your long-term medical bills–but if you want to spend some of it on a new car, or a Jacuzzi®, or a vacation, it’s your money.  You might in the long term wish you’d saved it for medical care, but no one is going to force you to do that.

In the same way, once the State has won a lawsuit or obtained a settlement from one, it can do whatever it wants with the money.  We might think that the money from the Passaic River lawsuits would go to clean the Passaic River, or at least to meet other environmental needs in the area.  Some of it of course would pay the legal fees for the suit, but ultimately the reason for the money is the damage done to the environment, and so the money should repair that damage.  However, just like you, the State is not so constrained.  Of that three hundred fifty-five million dollars from the Passaic River damages, Governor Christie applied two hundred eighty-eight million to the general funds to balance the budget.  A substantial number of Democrats in the state legislature believe that that should not be allowed, although the Democratically-controled legislature did approve his budgets.

Approval of this question would pass a constitutional amendment which would restrict the use of such monies to environmental purposes.  It would allow up to ten percent of such income to be spent on related government agencies such as the Department of Environmental Protection, and would allow the legal costs of prosecuting such cases to come out of the funds, but the bulk of it would have to be spent on the environment, reclaiming damaged areas and protecting others.  Many think the amendment makes sense.

On the other hand, had such a restriction already been in place, we would have been looking at a two hundred eighty-eight million dollar budget shortfall.  That means either the State would have had to raise two hundred eighty-eight million more dollars through taxes or it would have had to cut a like amount in services, or some combination of the two.  The big ticket items in the New Jersey budget are education (about thirty percent) and Medicaid (almost twenty-five percent).  There is not a lot of fat in the budget to cut.

Further, while there is merit to the notion that money collected as legal damages for harm to the environment ought to go to environmental care and repair, there is also a significant question concerning the consequences of sequestering that money.  Damage to the environment almost always means secondary damage as well–damage to public health, damage to infrastructure, economic damage.  If my accident prevented me from finishing college, the damages I won in the law suit will, among other things, cover the fact that I was unable to finish college.  The damages from these environmental lawsuits ought to be available to pay for the injury inflicted to the State beyond the first level of harm, covering these other losses.  Sequestering the money in a “lock box” prevents the state from using it to meet needs that might well be consequential to the damage.

Desite the merit in the idea, I think it ultimately a bad choice.

Those are the questions on New Jersey’s ballot this year.

#176: Not Paying for Health Care

This is mark Joseph “young” blog entry #176, on the subject of Not Paying for Health Care.

img0176Bill

I am not certain whom to blame for this; I don’t know whether it was a passing comment in conversation or a post in an online discussion or an article, but someone presented to me the suggestion that no one should ever be denied health care because he or she could not afford it.  I also have the feeling that the word “entitled” was used, as in “everyone is entitled to receive needed medical care”.

It is a noble idea, but problematic.

I don’t know what you do for a living.  Maybe you don’t.  Maybe you sit home and collect government checks–and I mean no disrespect for that, as I know people who receive social security because they are too old to maintain a regular job, or disability because they are too infirm sometimes to get out of bed, and I think it a wonderful thing that we provide money to support these people.  If we are supporting you because you are unable to support yourself, if you are a “burden on the taxpayers”–well, we the taxpayers have decided that it is worth a bit of our money to care for you.  But odds are good that most of you “have jobs”, do something that brings in the money some of which goes through the government to those who do not work.  We think that the elderly and the infirm are entitled to our support, and we use that word–entitled–athough usually as a noun, entitlements.

We also think such people are entitled to free and discounted medical care, which we also pay to provide.  Our idea of what people need, and therefore that to which they should be entitled, keeps growing.  People need, and are therefore at least in some places entitled to, cellular phones, Internet access, college education, transportation, and the list is growing.

I like the idea of entitlements; I’d like to be entitled.  People need clothes.  It would be nice if I could walk into a clothing outlet and help myself to jeans, shoes, shirts, socks and underwear, maybe a nice suit for special appearances.  I’m not permitted to wander naked, and wouldn’t particularly want to do so anyway, so that makes clothes a need.  No need to pay; I’m entitled.  If you work in garment retail, don’t look at me–I get my clothes free.

I also need to eat; what if I can’t cook?  Let me walk into a restaurant and order from the menu, have someone bring me food.  I am entitled.  If you’re the waitress, don’t expect a tip–I am entitled.

There isn’t a public bus within five miles of my home, and frankly almost everywhere I need to go, other than the hospital, is over there on the bus routes.  Transportation is a need around here, and one for which the government provides for the elderly poor.  Perhaps I should be entitled to a free ride whenever I want to go anywhere–call someone on my free phone and have them transport me to the store or the doctor or the movies, wherever I need to go, and then take me home again.  The driver should provide this, because I’m entitled.  Or perhaps I should just walk into a showroom and pick out my free car, and take it to the gas station for free gasoline.

You get the idea.  It would be nice if everything in the world were free, but then, who would pay for it?  Medical care is not free in the sense that it has no cost.  Even apart from whether drug companies are overcharging for medicines or whether hospitals, doctors, nurses, and other medical professionals are making too much money, medical care costs money.  The drugs are made from materials through chemical processes that are not always simple, and in facilities that are designed to prevent contamination as much as possible–costs, even without the people.  Patients are treated not only with medications, but with often very expensive diagnostic and treatment equipment (Computer Axial Tomography and Magnetic Resonant Imaging are very expensive, and are fairly standard in emergency room diagnostics).  Again, facilities can be expensive as well.  Much of the equipment is computerized.  The machine which automatically takes your blood pressure costs more than a typical laptop computer, but in the long run saves money over having a person come into your room every fifteen minutes to do the job; the machine that measures the medicine as it goes into your arm is another small computer.  Even the furniture is sophisticated–a hospital bed is capable of doing many things the typical patient is not aware that it does, and costs considerably more than most of the admittedly usually more comfortable beds patients have at home.

So maybe we’re overpaying the people–but what do we require of them?

If your doctor has been working for two decades, it is likely that his student loan debt still exceeds the amount you owed fresh out of college.  Further, medical professionals–not just doctors–are required to take continuing education classes, to keep up with current knowledge in the field.  Usually they have to pay for these classes.  They also have to be recertified regularly in a host of areas, depending on their particular fields, from starting IVs to running a “code” (“Advanced Cardiac Life Support”), requiring classes and tests to ensure they know current best practice.  Even so, medical knowledge is advancing so fast that it is said you are more likely to get the best care from a newly licensed graduate than from a seasoned professional with a decade or more of experience.  Your doctor spends a substantial amount of his “free time” on continuing education for which he pays.

Because we allow patients to sue doctors, doctors also pay for malpractice insurance.  It is likely that your obstetrician/gynecologist pays more for his malpractice insurance every year than the market value of his home.  There is no easy fix for this–but that’s probably another article.

The point is, everything we give away “free” to anyone costs someone something–you can take money out of the equation entirely, if you like, but it still comes to the three basics of economics, land, capital, and labor, and that has to come from somewhere.  We can give more of our money to the government and have the government provide more things “free”.  Indeed, we can give all our money to the government and have the government provide everything “free”.

There is a name for a system in which everything is free.  It’s called socialism.  In its purest form, everyone of us works as hard as we can at whatever we can do, and every one of us is free to help ourselves to as much of everything as we can reasonably use.  The pure form doesn’t work for the fairly obvious reason:  if you were told that you can have as much as you think you need in exchange for working as hard as you think you can, just how hard would you work and how much would you need?  Thus we have the practical form, in which someone is given the responsibility of overseeing how much you work and how much you take, in which you work as hard as your overseer thinks you can and take as much as your overseer thinks you need.  When that’s a private sector system we call it slavery; when it’s run by the government we call it communism.  Either way, if you want the government to provide everything free, you have to expect to pay for it somehow.

Of course, the people who say that medical care should be free don’t mean it should be free for everyone.  They mean it should be free for those who can’t afford it.  But then, who can afford medical care for calamitous conditions or events?  Who gets to decide what you can or cannot afford?  Does the fact that you own your house mean you can afford medical care up to the equity you have in your house, since of course you could sell the house and move your family to the street to cover the bill?  If you own a small business, does that disqualify you from free medical care, even if it’s running in the red?  Who gets free medical care?  Who is entitled to it?  Who has to scrape up the money for the bills or suffer for it?

Free medical care for everyone is a wonderful idea.  It is also an expensive one, one that will cost every one of us a fair amount of money and may change the quality of our medical care going forward.  If we want to go that direction, let’s at least consider ways to do so with the least amount of upheaval.

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#173: Hospitalization Benefits

This is mark Joseph “young” blog entry #173, on the subject of Hospitalization Benefits.

This is not about health care or health care coverage.

Some of you are aware that I was recently hospitalized twice within two weeks.  It started on a Wednesday afternoon, when someone needed a ride to a clinic and I thought while I was there I should get an opinion about a previous umbilical herniorhaphy that was not doing well.  The people at the clinic desk said they could certainly look at it, but it would almost certainly require tests which they were not equipped to perform, so I should go to the emergency room.  I did, and indeed they performed the obvious test, having me drink the contrast and wait around for it to work through my digestive tract so they could get a clear Computer (Axial) Tomography (C(A)T) image.  Hours later someone was poking at my belly, and said that this might be very serious and he did not think we should wait until morning, so despite the fact that he and I both wanted to go home and the anaesthesiologist had already done so, I was to be prepped for surgery.

Ilford Hospital chapel windows.
Ilford Hospital chapel windows.

I’m told that the condition was not as bad as feared, and the surgery went well–so well in fact that I was placed on clear liquids in time for Thursday breakfast, and on full diet by Friday morning, and was discharged after supper on Friday.  There were the usual restrictions about lifting and driving and the like, but in the main I came through well–except that my arm hurt.

The pain in the arm was apparently related to the IV site, that is, the place where they had connected the intravenous feed to give me such medications as were deemed necessary post-surgery.  I think every nurse that looked at it said it did not look good and she (or he) was going to move it when there was time, but they pushed me through so fast that it was out before anyone had the time to start one somewhere else.  Below the site (further out into the extremities) my arm was swollen and inflamed, painful to the touch and when moved in certain positions.  I was also having some difficulty breathing and a worsening cough.  Respiratory problems do not normally alarm me because I have allergy-related asthma and the list of allergies which aggravate it include just about anything that has a smell other than real food (artificial food scents can be trouble, particularly if they are linked to smoke as in incense or candles).  However, I have a history of pulmonary embolism, which is a condition in which a blood clot usually from an extremity migrates to the lung and lodges there, and thus there was at least the chance that the swelling in the arm and the respiratory trouble were related.  It thus called for more tests, and again of a sort that required a visit to the emergency room.  This time the CT scan was of my lungs, and there was an ultrasound of my arm, and the major conclusions were first that the two problems were not connected, but second that there were definitely two problems that needed to be addressed.

There was no evidence of a pulmonary embolism, but there were some small clots in the veins in my arm which could be problematic and were going to require treatment.  There was also a shadow in my lung which the emergency room doctor took to be a very mild pneumonia, but of concern because it might have been contracted in the hospital, and if you get an infection in the hospital it is likely to be a serious microorganism.  My wife, the registered nurse who would rather have me home where she can tend me herself, argued that there was not much they could do in the hospital that she could not do for me at home, and this is where it gets weird.  The emergency room doctor said that the treatment for the clots was going to involve heparin injections, a drug that ought to be monitored fairly closely as it really does promote bleeding, and so I would have to be admitted for the heparin.  However, before I got the first shot of heparin or got moved out of the emergency room to an inpatient bed, the order was changed and I was put on the very expensive (mostly covered by my wife’s employee health care coverage) new drug Xarelto, which is taken P.O., that is, per orum, by mouth.  So I did not have to be in the hospital for that.  However, because the pneumonia might be some drug-resistant organism they were planning to treat it aggressively, with vancomycin and cefepime, two IV antibiotics, instead of oral antibiotics, so the reason I had to be admitted had changed.  Still, I was admitted, and I was not complaining because this time they were going to let me eat, and Elmer Hospital has mostly decent food, and I don’t have to cook it or do the dishes.

The next day the specialists appeared.  The hematologist said in essence that the Xarelto had been cleared through our prescription plan, so as far as he was concerned I could go home and take the medication there, as long as I came to see him in four to six weeks.  The pulmonologist was even more optimistic:  the lung shadow on the CT scan was identical to that in a scan from 2012, and I did not have even the slightest touch of pneumonia, the antibiotics were unnecessary, and I could go home any time.

It was still another day before that got through the red tape so that the hospitalist overseeing the whole case ordered my discharge, but in essence I was not really very sick.  I still have to get the staples from the surgery removed and see the hematologist, but the surgeon did stop by and look at the incision during my stay and said that I am permitted to drive, so I am overall on the mend.  (The staples were removed at his office today.)

And at the risk of stealing a line from Arlo Guthrie, that isn’t what I came to talk about today.

In the wake of these hospitalizations, many people, some of them readers, some connections through social media, some “real world” connections, have mentioned that they were, have been, are, or would be praying for me.  They fall into three categories, that I’ve noticed.

First, there are people who mentioned that they are always praying for me.  Prior to this I could not have named more than one person (my wife) whom I could say I knew was praying for me regularly or consistently.  I’m sure my grandmother was, years ago.  This aspect of having someone praying for you, when you are in ministry (as I am–Chaplain of the Christian Gamers Guild and Christian teaching music ministry), is very important.  Pastor Ern Baxter once told of how his grandmother always prayed for him and he never really gave it much thought, as he had been seminary trained in how to preach and had the necessary skills–until the day his grandmother died and he went to preach a sermon and found nothing.  He told his congregation, right then, that he had never appreciated his grandmother’s prayers until that moment, and now she was gone.  Someone in the congregation rose and said, “Pastor, I’ll be your grandmother.”  She prayed for him, and he said thereafter he kept an army of praying grandmothers to support his ministry.  So to discover that there are people I did not know were praying for me is an encouragement.

Second, there are those whom I know pray and who probably are not usually praying for me, who having heard of my hospitalization turned some of their prayerful attention my direction.  Some of these people I have not met outside the Internet, or only met once or twice.  Many of them have ministries of their own.  That they have raised prayers on my behalf tells me that they care, that I matter to them at least enough that they noticed my condition and put some prayer into it.  It means there are people out there who will support me, at least with prayers, when it is needed.  That, too, is an encouragement.

Third, there were some people praying for me through these events whom I would not have guessed were praying people.  Some are people who do not express much of a belief in God in our interactions.  Some are people with whom I have only recently reconnected after decades who have seemingly found faith in the interim.  This, too, is an encouragement, as it tells me that these people are not lost, that they are praying, connecting with God, and while I am always hesitant to say that I know any individual is saved, it is good evidence that they might well be.  After all,

he who comes to God must believe that He is, and that He rewards those who diligently seek Him,

in part because who would pray who did not believe at least that much?

So I thank you all for your prayers and encouragement, and now I return to that long “not what I wanted to say” part at the beginning.  One of the lessons I learned many years ago came from II Corinthians 1:11, which in the Updated New American Standard Bible reads

…you also joining in helping us through your prayers, so that thanks may be given by many persons on our behalf for the favor bestowed on us through the prayers of many.

That is, the reason God wants us to agree in prayer, and is more likely to answer prayers when many agree, appears to be that way when the prayers are answered all those people who asked will all say thank you.

Thus your prayers on my behalf have obligated me to let you know that God has been healing me, I am improving rapidly, and there is cause to give thanks.

Thank you.

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#172: Why Not Democracy?

This is mark Joseph “young” blog entry #172, on the subject of Why Not Democracy?.

As I was writing the previous web log entry, #171:  The President (of the Seventh Day Baptist Convention), I was reminded that we, in the United States of America, do not live in a democracy.  We live in a representative republic.

That fact was brought home to a lot of people in the recent Presidential election, some of whom are still reeling from it.  I have heard many complaints, mostly from young people, that our elected President did not win the majority of the voters, and therefore does not represent the majority of the people.  (It is at least worth mentioning that the actual vote totals will never be certain:  the vote count was never completed in quite a few voting districts because the total would not have changed the Electoral College outcome in those states.)  We should, they insist, change to a more democratic system, in which every vote counts the same.

We could do that.  Things are a bit more like that in other countries, particularly Israel where everyone votes for whatever parliamentary representatives they want and the entire country is treated as a single district.  Even England’s system is more democratic than ours.  However, note that in these countries the voters do not vote for their chief executive–they vote for their legislative representatives, and these in turn choose the chief executive.  Sure, British Prime Minister Theresa May campaigns for the position, but she does so by touring the country telling voters to support their local Conservative Party candidates for Members of Parliament, who in turn vote her into the Downing Street office.  It is still not strictly democratic, although by taking the vote for head of government away from the people and giving it to their elected representatives it actually becomes a bit closer to it.  However, it still can produce the outcome that the party in power, and thus the chief executive, did not actually have the majority of the votes.  It is a flaw of representative government, but representative government is the only way to avoid having every citizen in the country vote on every law.

The electoral map of the 1824 Presidential election, in which Andrew Jackson took the clear plurality of both the popular and the electoral vote but not the majority of either, throwing the decision to the House of Representatives, who selected John Quincy Adams to serve.
The electoral map of the 1824 Presidential election, in which Andrew Jackson took the clear plurality of both the popular and the electoral vote but not the majority of either, throwing the decision to the House of Representatives, who selected John Quincy Adams to serve.

There are, of course, other ways to achieve a more democratic election of the President of the United States.  People have been complaining about it since at least the 1824 election, when the failure of Andrew Jackson to gain fifty percent in the Electoral College resulted in John Quincy Adams, with less than a third of the vote, being selected for the office by the House of Representatives (the only time in history where no candidate obtained fifty percent of the Electoral College vote).  Some years ago when we were examining the Electoral College in detail in connection with Coalition Government, we noted one suggestion, that each state allocate its electoral votes based on the percentage of voters supporting each candidate–and why that would never be enacted.  More recently, someone proposed that states begin changing their system for apportioning electoral votes such that the votes within the state were irrelevant, that each state would give all its electoral votes to whomever won the popular vote nationally.  That would achieve the desired “democratic” outcome.  It would prevent situations like that of the recent election.  The question is, do we want that?

The first point that should be recognized here is that the majority always wants the democratic system.  That’s because in a democratic system, the majority can always impose its will on the minority.

Of course, that often happens anyway–but many great strides forward in these United States have happened precisely because minorities were empowered.  Certainly it is sometimes the case that majorities become entrenched, resisting necessary change until overwhelmed as public opinion shifts, but it has also been the case that minorities have used the system to gain a voice within the process.  There is something called the tyranny of the majority, when minority voices and positions are overwhelmed and trampled by majority opinions.  Our system was designed in part to prevent that.  There is also a tyranny of the minority, when a small group prevents the majority from doing what it deems right through legal intervention, and our system is supposed to prevent that, as well.  Our system produces gradual change by trying to keep everyone somewhat satisfied.  Younger people are less patient, wanting rapid change.  Older people have usually learned that not all change is for the better, but all change has unintended consequences.  Our country advances a bit, then eases back, then advances again, feeling the path carefully.

Meeting of the Electoral College in Ohio, 2012.
Meeting of the Electoral College in Ohio, 2012.

Many other countries have suffered from what we might call “rapid cycling”.  Because they are so controlled by the majority, and because the majority is mostly in the middle shifting a bit to one side and then to the other but the politicians tend to be at the extremes, it is common for one party to be voted into office, make major changes to everything, upset the bulk of their constituents who only wanted things to change a little and don’t like the unanticipated parts, and so be voted out of office and replaced by an opposing party which proceeds to repeal everything the first party did and pass its own extremist programs, leading to its failure at the polls and the return of the original party, or often yet another party, whose agenda then dominates.  Remember, as we have often mentioned in connection with coalition government, we are not in our chosen parties because everyone in those parties agrees with us on every point; we are there because we have agreed to support each other on those points each of us think important.  That means some of the things you want your party to do other members of your party strongly oppose–the Progressive wing of the Democratic Party wants open borders, but the Labor wing definitely does not; the universal healthcare driven through by the Democratic Progressives has gone very badly for labor unions, whose members lost much of their superior healthcare benefits under the program.  Majority opinion is more fickle than a twelve-year-old girl’s crushes.  Democracy leads to such rapid changes.  People think they want one thing, but when they start to see where that leads, they change their minds and want something else.

Our system does not always give us stability.  In recent years the fracturing of political opinion has led to some very unstable situations.  However, rapid change is always unstable, and we have seen much rapid change over those years.  The system is working to slow the change, to keep things at a pace people can accept.

A more democratic system would not be a better one.

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#152: Breaking a Habit

This is mark Joseph “young” blog entry #152, on the subject of Breaking a Habit.

We all have habits.  It is actually a positive feature of our design:  we can harness this habit process to give ourselves good habits, like habitually buckling our seatbelts, or brushing our teeth, or saying prayers when we hear sirens.  Yet we tend to notice habits when we develop harmful ones–the regular drink at the odd time, the tendency to snack while working, and of course one of the big ones, smoking.

It was smoking that caused me to think about this, because I know several people who smoke and really can’t afford the cigarettes, and because of my father.  I can remember him smoking when I was a boy, and I can remember that my mother said he had a hard time quitting.  In the last years of his life he shared with me two things, one the way he managed to quit, and the other a technique he had recently seen in a newspaper that would work well with his own.  He seemed at the time eager that I should pass these to smokers I knew, but on reflection it occurs to me that these are good ways to quit just about any habit–and my theology tells me that we all have habits we ought to break, and we all have trouble breaking them.

img0152cigs

The difficulty, it seems, is that it is just about impossible for any of us to say to ourselves that we will never do something again, and then stick to that.  It’s the reason you’ve probably already broken at least one of the New Year’s Resolutions you made yesterday.  It may be that angels who live in eternity can make irrevocable choices, but those of us stuck here in this time zone do not have that ability.  And therein lies the key to beating the habit:  recognize that you can’t decide never again, and deal with right now.

My father explained to me that he never quit smoking.  He had in previous years won bets against people who were trying to quit smoking, which were in essence that he could go longer without a cigarette than they would.  One day he applied that to the long haul.  For over fifty years he never quit smoking, never told himself he was quitting, he just always decided that he didn’t need a cigarette right now, every time he wanted one.  You don’t quit smoking, you don’t break a habit, by deciding right now that you will never do it again; you break it by deciding that you won’t do it now, even if maybe you’ll do it later.  When later becomes now, you make the same decision, because you can almost always decide that now is not a good time for a cigarette, that you can have one later when the time is better, and never decide that the time is better.

So that’s how it’s done.

The other part is worth mentioning, particularly for people who have failed before.  Failure is not necessarily a disaster; it only means that you start again.  The suggestion that was made was that you keep score and play against yourself.  Keep a notebook, or get some kind of “app” on your phone that lets you record this.  Every time you indulge the habit–have a cigarette, or if that’s not your habit, raid the icebox or take a drink–write down the date and time, and do the math:  how long has it been since the last time you did this?  That’s your score.  Keep track of your best score, and try to beat it.  If you have gone four days without a cigarette, but your personal best on record is six days, tell yourself you can beat six days, even if it’s only six days and one hour, and put off that smoke until you’ve bested yourself.  Then you have a new record, a new best to beat.  You’ve also proved that you can go that long, and if you stick to it you’ll be going months without a mistake.

This is nothing new, really.  It’s part of why they have that litany at the beginning of every speech at Alcoholics Anonymous: this is who I am, I admit I have a problem, and at the moment my streak is this long.  When it has been three years since you’ve had a drink–or a smoke, or an unscheduled snack, or whatever your habit is–you have some sense of accomplishment in the number.  No one says it will never be a temptation; it’s only that practicing resisting that temptation makes you better at it; setting goals you know are achievable because you have done nearly as well before, and dealing with the problem in the present instead of in the hypothetical, all make that resistance easier.

So I hope this helps you quit the habit, whatever it is.

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#137: Conservative Penny-pinching

This is mark Joseph “young” blog entry #137, on the subject of Conservative Penny-pinching.

Over a year ago, I addressed the the notion that people who are against abortion claim to be concerned for the lives of the unborn up to the moment they are born, but after that they no longer care.  Then just over two weeks ago I was at a gathering where someone made exactly that claim, and I realized something–something I hadn’t felt when it was merely arguments on a page:  the assertion that people who are against abortion are unwilling to do anything to help the born is not only untrue and irrelevant, it is insulting.

Why it is untrue and irrelevant is covered in that previous article, web log post #9:  Abolition.  Because of the way the meeting dissolved then I was unable to call his attention to that response; knowing, however, that I would see him again, I printed it and delivered it to him two weeks later.

img0137pennies

His response was civil, even friendly.  However, he kept saying that “they” were taking all the money away from helping people, from helping young girls who were just children having children.  I asked him who “they” were, and he said “conservatives”; I pointed out that the people mentioned in the article, working hard to provide assistance to exactly those people, were in the main “conservatives”, but his feeling was that it was not “those conservatives” but some other group of “right wing conservatives”.  Having worked with those people, I observed that some of them were certainly “right wing”.  Yet he insisted that there was this conservative effort to take money away from helping the people who needed it.  It was not at all clear just who was taking what money from whom, but he was certain it was being done, and being done by “conservatives”.

If we’re honest, we have to admit that there are a lot of people who don’t care about the poor, and indeed many of them are “conservatives”.  At the same time, many of them are “liberals”–I don’t see a lot of Hollywood millionaires giving ninety percent of their income to charities, or spending their evenings working in soup kitchens or at homeless shelters.  There are also a lot of people who do care, at both ends of the spectrum and through the middle.  Not every liberal politician who argues for aid to the poor does so because he cares; some do it because they want votes.  Wealthy liberals who call for more government spending on welfare programs are not really offering to give their own money to these, but suggesting that the government should give them more of yours.  Conservatives are wrong to think that all liberals pretend to care about the poor in order to use them to advance socialist and progressivist policies; yet it is equally wrong to think that this is not true of any.

However, in our conversation I couldn’t help feeling that, at least in part, he meant conservatives were taking money away from Planned Parenthood.  You don’t have to be too far to the right of left-wing progressivists to believe that the government should not be funding an organization that in turn promotes and funds the slaughter of children.  The argument has been made that Planned Parenthood spends none of its government-granted money on abortion services, but as we noted in post #2:  Planned Parenthood and Fungible Resources, no matter how they do their accounting it is evident that they could not spend as much on abortion as they do were their other programs not subsidized by federal money.  Certainly people who believe that killing unborn babies should be criminal are going to cut funding for any program that promotes the practice.  That does not mean that these people have no interest in helping pregnant teenagers and others struggling with unexpected pregnancies, any more than that those who want to bring an end to capital punishment and stop funding executions have no interest in stopping murders and other violent crimes.  You will say that it’s not the same thing, and in a way you’re right, and in a way you’re wrong.  If you tell me that grapefruit juice is not orange juice, you are certainly correct; if you tell me that because grapefruit juice is not orange juice it therefore is not citrus juice, you are mistaken.  It is quite possible to be very much in favor of a stated objective, whether it is helping pregnant women or reducing violent crime, and still object to a specific method of achieving that objective, whether it is killing unwanted children or terminating murderers.  It is quite possible to want to do something about a social problem without resorting to an extreme measure like killing people.  It is also possible to believe that such an extreme measure is appropriate and necessary for one type of problem but not for another.  The problems are not identical; only the solutions are similar.

Of course, some people argue that the unborn are not actually people.  To his credit, he did not suggest that; he rather suggested that they were unwanted human beings that should not be forced to come into a world that does not want them.  It strikes me that this is very like an ambulance crew saying they’re not going to take this injured homeless person to a hospital because he’s a worthless human being and he might as well just die anyway.  It is rather arrogant for any of us to put a value on someone else’s life, whether or not that person has yet smelled air.

Perhaps, though, he is not talking about abortion funding; perhaps he is talking about welfare.  In thinking about this issue I did a bit of research, and learned that the Federal debt is presently increasing by about one trillion dollars each year.  The population of the United States is a bit above three hundred twenty-five million, so that’s about three dollars for every person–every man, woman, or child, legal or illegal, in the entire country.  Of course, those who are in the country illegally aren’t going to pay that, and there is not much logic to expecting those who are receiving the benefits to pay part of that.  At some point we are going to have to stop spending as much or find a way to collect more.

So where could we cut it?

The total federal budget for 2017 is just above four trillion dollars–that’s four thousand billion (4.1472 trillion).  Sixty percent of that–about two trillion five hundred million–goes to what is loosely called “welfare”, that is, money that goes to taking care of people who can’t afford to take care of themselves, that “safety net” about which we are always talking (2.4971 trillion).  In fairness, the biggest piece of that–a bit less than one trillion–is social security (972.6 billion), which includes all those retirement checks and the federal disability program (and the salaries of the people who run it), giving a meager income to people who genuinely cannot or can no longer work.  More than a trillion goes to medical assistance, that is, Medicare (605.0 billion) and Medicaid (527.4 billion) including the Obamacare expansions, providing health services to people who cannot otherwise afford them.  Less than half a trillion goes to everything else we loosely consider “welfare”, social support services (392.1 billion).

It is argued that we should cut our outrageous military spending, but that outrageous military spending is less than a trillion dollars (0.8536 trillion), less than the medical care spending, less than Social Security.  We’ve been working on reducing military spending for a long time, and it is a much smaller portion of the budget than it was in the past–but in that time our “entitlements” and “welfare” programs have exploded to take the largest share of the budget.  Together, that’s over eighty percent of the budget; all other programs combined come to only seven hundred ninety-six and a half billion dollars, less than twenty percent, less than the military portion.  Saving money there is a bit like trying to make a package lighter by using less tape to seal it.

It is not unkind for me to cut my son’s allowance in order to pay the utility bill; he might think I should pay less to the utility company, but he would be upset if we said we couldn’t afford to run his video games or heat the water for his showers.  That national debt that’s going up another trillion dollars this year is very nearly twenty trillion already–sixty dollars for every person within our borders.  We keep saying that we’ll pay it off when things get better, but they’re getting worse and the amount is increasing like a bad debt owed to a loan shark.  Economists argue about whether it is bad for nations to go into debt, just as they argue about whether it’s bad for people to go into debt, but although we’ve at times managed to reduce the debt we have not paid it off entirely in a long time, longer than my lifetime, and the people who are lending us the money (what, did you think we borrowed it from God?) are beginning to think maybe we’re not so good a risk as they once thought.  Many economists assert that a high national debt depresses the economy, raises the prices of goods, and reduces the availability of jobs.  Somehow we have to reduce our spending.  It certainly is important for us to help the poor, but this ongoing forced philanthropy might not be helping so much as we want to think, and can’t continue at this level forever.

One way or another, there is going to be less money for those in need, because the way things have been going there has been less and less money for all Americans.  We laugh when in Fiddler on the Roof Nahum the Beggar complains to Lazar Wolfe about the smaller donation he gave this week, “So if you had a bad week, why should I suffer?”, but the truth is that when the rich have less money, everyone has less money, and when we make the pie smaller everyone’s piece gets smaller.  Not everyone can work; not everyone can contribute to the productivity of the nation–but if we don’t find a way to get more people working productively, there won’t be enough money for those who can’t.

Someone once challenged the original Mr. Rockefeller that his millions (which were then worth a lot more than they would be today) should be shared among everyone.  Rather than arguing the point, Rockefeller agreed, reached into his pocket, and handed the man a dime as his share.  If you stripped the top one percent of everything they owned and gave it everyone else, it would be a small amount divided so many ways, and there would be no comparable wealthiest people to rob the next year.  You cannot feed the poor by robbing the rich; you have to teach them to fish, that is, give them jobs, not money.  How to do that is much debated, but it seems that part of it has to be to reduce the amount the government is spending, and the obvious place to do that is where it is spending the most.

That hurts, but it may be necessary.

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#63: Equal Protection When Boy Meets Girl

This is mark Joseph “young” blog entry #63, on the subject of Equal Protection When Boy Meets Girl.

United States Supreme Court Justice Ruth Bader Ginsburg does not like the Roe v. Wade decision.

To many, that will sound like nonsense.  Ginsburg is the anchor of abortion rights on the United States Supreme Court, and Roe the seminal case which recognized, some would say created, such a right.  Yet Ginsburg does not disagree that there is such a right; she disagrees regarding the basis of that right, and thus with the reasoning of Roe which is its foundation.

Roe v. Wade is in essence a Right to Privacy case.  Beginning with Griswold v. Connecticutt, in which the court found that the state could not criminalize the act of teaching couples how to use contraceptives in the privacy of their own bedroom, the court inferred that the First Amendment protections of freedom of expression, Fourth Amendment protections against unreasonable search and seizure, and Fifth Amendment protection against self-incrimination, implied a right to keep one’s personal matters private.  There were several intervening cases which extended that, and there have been others arising since Roe, but in Roe the argument was that the decision to have an abortion was a medical decision between a woman and her doctor, and as such was a private matter in which the government should not interfere without a very compelling interest.

Ginsburg disagrees.  That argument, she claims, makes a private and personal decision a matter to be discussed with a doctor–a paternalistic oversight that according to Ginsburg violates the fundamental right at stake.  She claims that a woman’s decision should be autonomous, something she decides without involving anyone she does not wish to involve.  She makes it an Equal Protection right, covered largely by the fifth through tenth amendments.  Her assertion is that a woman should have the autonomous right to decide whether to bear a child, unimpeded by any considerations including medical ones, because it is solely the woman’s problem.

Ginberg’s reasoning presents serious challenges for those who oppose abortion.  If her line were adopted, current efforts to regulate abortion providers and facilities would be unconstitutional.  As the decision stands, if abortion is a privacy right as a medical decision on the advice of a medical professional, it is completely reasonable for reasonable regulations of the medical profession to restrict access to abortions based on the government’s regulation of health care.  If it is an autonomous right under equal protection, then a woman in theory should be able to have a doctor or anyone she chooses perform one in the privacy of her own bedroom without any government involvement at all.  Yet Ginsburg’s position suffers from some other problems.  She believes she is defending the concept that a woman should be treated exactly as a man would be in the same circumstance, but (apart from the fact that men would not be in exactly the same circumstance) the treatment of men in this circumstance is already worse than the treatment of women, viewed from the perspective of individual autonomy and equal protection.

Ruth Bader Ginsburg official United States Supreme Court portrait.
Ruth Bader Ginsburg official United States Supreme Court portrait.

Let’s look at the situation:  boy meets girl.  We’ll call our girl Ruth, for Justice Ginsburg, and we’ll name the boy Tony, in memorium of the recent passing of her good friend, colleague, and adversary Justice Antonin Scalia.

Ruth and Tony meet, maybe at work, maybe at a party, maybe at school or in the neighborhood.  They like each other, and start seeing each other.  They find themselves attracted to each other.  Human physiology being designed to promote reproduction, at some point they have desires to have sex.  At this point they are just about equal, as far as reproductive rights are concerned.  Some argue that Tony is disadvantaged in that his drives are stronger than Ruth’s, but there aren’t many ways to test that.  Ruth might have more resistance to those drives because the consequences are more direct for her, but in essence it is within the power of each them them to choose, autonomously, not to engage in sex.  It is also within their power to choose, jointly, to risk a pregnancy.

Yes, Tony could rape Ruth; Tony could coerce Ruth by some other inducement.  Women are raped fairly often, usually by men, sometimes by women.  Men are also raped, by men and sometimes by women, but considerably less often–although more often than reported.  Men are more embarrassed about being raped than women are, and so less likely to report it; and they are taken less seriously when they do, partly because some people think a man can’t really be raped by a woman, and partly because men who have never been raped by a woman somehow think they would enjoy it.  Rape, though, is a separate issue:  anyone who has been raped has had rights fundamentally violated, quite apart from the problem of potential pregnancy.

If Ruth and Tony agree to engage in sex, suddenly the entire picture changes:  they no longer have equal reproductive rights.  A significant part of that is simply technological.  Either of them could have an operation rendering him or her permanently infertile, which is generally a drastic step few want to take and is a considerably more expensive and difficult (but ultimately more reliable) procedure for Ruth than for Tony.  Barring that, though, Tony is limited to the question of whether or not to use a condom–a prophylactic device with a rather high failure rate.  Ruth’s equivalent, a diaphram, is a bit more difficult to get (must be fitted by a gynecologist) but considerably more effective; she also has several other options.  Usually she would use spermicide (sometimes known as “foam”) with a diaphram, but she can also use hormone treatments, usually in pill form but sometimes as implants, that disrupt her ovulation cycle.  All of these options have varying probabilities of preventing conception; there are other options.  Intra-uterine devices (IUDs) usually reduce the chance of conception but also prevent or sometimes disrupt implantation, causing a spontaneous abortion–what in popular jargon is called a “miscarriage”, but at so early a stage that pregnancy was not suspected.  In all these ways, all the reproductive rights are on Ruth’s side:  if she chooses not to become pregnant, she has an arsenal of ways to prevent it.

However, young lovers are often careless.  Birth control is so unromantic, so non-spontaneous.  The young suffer from the illusion of invulnerability, that they are the heroes of their own stories and everything is going to work according to their expectations.  People have sex and don’t get pregnant; some couples try for unsuccessful years to have a baby.  A pregnancy is often a surprise, even for those who want it.  People take the risk, and Ruth and Tony might lose.  So now there is a baby on the way, as they say, and again Ruth’s reproductive rights are more than equal to Tony’s.  She can choose to carry the child to term, or to have an abortion.  He has no say in the matter, even if he is her husband.  She might include him in the decision, but it is her decision; she does not even need to inform him that there is a decision.  She can end the story right here.  He cannot.  He has no say about his own reproductive rights.  He cannot say, “I do not want to be the father of a child; terminate it.”  Nor can he say, “I want this baby, keep it.”  He does not, in that regard, have equal protection.

Maybe he does not care; maybe he figures it is her problem.  However, it is not just her problem–it is also his problem.  The inequities are not yet quite done.  If Ruth decides not to have an abortion–exercising her reproductive rights and overriding his–the child is born.  At that moment Ruth has yet another choice:  she can keep the child, committing herself to the difficulties and expenses of raising it, or she can absolve herself of all further responsibility, agreeing never to see the child again, by putting it up for adoption.  I do not want to minimize the agony of that choice, but it is her choice–it is not his choice, and he has no say in the matter.  His reproductive rights are not equally protected.

In most cases, if she chooses to surrender the child for adoption, he has no say in the matter; he cannot say it is his child and he wants to keep it.  That, though, is only half the problem.  If she decides that she wants to keep the child, she can sue him for child support–and indeed, if Ruth is poor enough that she files for public assistance from the state, most states will find Tony and force him to make child support payments, and jail him if he fails to do so.  It is his responsibility to support the child if she says it is.  He can claim that it is not his child–the tests can be expensive, but there is an avenue to avoid false claims–but we already agreed that it is his, so he is going to have to support it.  She had a choice; he has none.

So by all means, let’s think of abortion as an Equal Protection issue.  Men are not protected in this nearly as well as women.  A lot of things would have to change to get there.

In addition to web log posts with the Abortion, Discrimination, and Health Care tags, see also the articles Why Shouldn’t You Have Sex If You Aren’t Married?, and Was John Brown a Hero or a Villain?

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#36: Ligation Litigation

This is mark Joseph “young” blog entry #36, on the subject of Ligation Litigation.

Let me begin with ideas that might not seem immediately on-topic.

You are certainly welcome to stay for supper.  You’re in luck–we do not often have a roast, but someone gave us this boneless pork loin, and it’s almost finished roasting…what’s that, you don’t eat pork?  Well, I’m very sorry.  Unfortunately, I roasted the carrots and potatoes and onions in the same pan, so if that’s a problem, I’m not sure what to say.

Maybe I could scrounge something up for my unexpected guest, but really, my extended hospitality is to share what I have, not what I don’t have.

Just relax, we’ll reach the hospital in a few minutes.  What?  Yes, I have morphine.  No, I can’t give you morphine; it would be illegal, for one thing.  A doctor has to say that you should have it.  Of course I care that you’re in pain, but I’m not going to risk my job to give you something that quite possibly you shouldn’t have.

Of course, I could give the morphine–I am certainly physically able to do so–but there are good reasons for me not to do so.

No, I’m not going to go deer hunting with you.  I know it’s legal; I know it’s even considered necessary:  in a world in which we have decimated the predator population we must also kill the prey animals or they will overpopulate and starve themselves.  Kill them if you wish, but please don’t ask me to be part of it.  I don’t really enjoy killing animals, and I do not want to become the kind of person who does.

I’ll have to think about whether I’ll eat your venison, and obviously I know that someone kills the meat I do eat, but it doesn’t have to be me.

Mercy Medical Center in Redding, California
Mercy Medical Center in Redding, California

Rebecca Chamorro, mother of a third child, is suing Mercy Medical Center in Redding, California, a two hundred sixty-seven bed hospital sponsored by the Sisters of Mercy of Auburn.  She claims that the hospital violated her rights by refusing to permit her doctor to perform a tubal ligation while delivering her third child by caesarean section.

The hospital claims that such an operation violates the “ERDs”, that is, the Ethical and Religious Directives for Catholic Health Care Services, a document of health care directives established by the United States Conference of Catholic Bishops.  The document bans abortions; I presume it also bans euthanasia, although I have not read it (being neither Catholic nor employed in a medical facility).  It lists these things as “intrinsically immoral”, and includes on that list direct sterilizations, certain prenatal genetic tests, and most forms of contraception.  The Catholic Church maintains that children are a gift from God, and participation in sexual relations is an open invitation to God to give that gift; therefore refusing the gift or misusing sex for something other than reproduction is an affront to God.

Obviously, you may disagree with the Roman Catholic Church.  Even many Christians of other denominations, including many (but not all) conservative Christians among the Evangelicals, the conservative Lutherans, and the Eastern Orthodox churches, allow many forms of birth control while remaining adamantly opposed to abortions and abortofacients.  That, though, is not the point.  The point is whether a Roman Catholic hospital should be forced to permit the use of its facilities and equipment for procedures it regards immoral.

The plaintiff’s primary argument is that the refusal to perform legal medical procedures is discriminatory.  There is a sense in which it is not–the same restrictions against tubal ligation also apply to vasectomies–but the argument is that pregnancies are unevenly discriminatory (much more of a burden on women than on men) and thus the refusal to assist in their prevention is unevenly discriminatory.  This, though, is founded on the premise that the hospital is a public institution offering a commercial service–and that’s not exactly true.

At one time all, or nearly all, hospitals were run by religious orders, most of them Roman Catholic.  The nursing staff of such hospitals were nuns–volunteers who devoted their lives to the service of others through the church, tending the sick, compensated essentially with room, board, and basic necessities.  Priests served as doctors, in a time when only a few went to university and those who did were doctors, lawyers, or priests, with some overlap.  People supported the hospitals with their gifts; patients were treated based on need.

Certainly the world has changed.  Hospital staff now includes many employees, most of them paid and not all of them Catholic, although many Catholic hospitals are still staffed in part by nuns and other volunteers.  Medicine is overseen by licensed physicians, because laws forbid the practice by those who do not have such licenses.  However, the mission has not changed, nor the motivation:  to help sick people heal.  These are non-profit hospitals, and the church runs them voluntarily to help the sick.

If you complained that I did not make something special for you as an unexpected dinner guest when you did not want to eat my roast pork, I would politely suggest you find somewhere else to eat.  If you complained that I did not give you morphine on the way to the hospital, I would tell you to talk to my lawyer.  If you complained that I was unwilling to go deer hunting with you, I would tell you to go–well, I wouldn’t, because I’m not like that, but it would put a serious damper on our friendship.

The Roman Catholic Church, of its own volition, offers medical care to persons in need.  They offer more charity care than most hospitals, although they welcome paying patients and insurance programs.  However, they are specific about what care they do–and do not–offer.  If you don’t like it, there are other hospitals.  If it is inconvenient for you to travel to a hospital that is willing to provide the services you desire–and note that this is in no sense an emergency situation here, it is not as if the hospital is refusing life-saving treatment to a patient brought in to the emergency room–then it is apparently inconvenient for you to get the elective procedure you desire.  That seems fairly straightforward to me.

I am concerned that any other answer ultimately becomes an imposition on the faith of the Roman Catholic Church, and indeed on other religiously-affiliated medical facilities (and many churches support these).  It is a small step from asserting that the hospital must permit sterilization procedures it find immoral to asserting the same about abortions; and if (or more likely when) it becomes legal, it is a small step beyond that to requiring hospitals to permit euthanasia in their facilities.

If that happens, I am fairly certain the Roman Catholic Church will close its many hospitals and look for some other way to help needy people.  A two hundred sixty-seven bed homeless shelter might be a great help.

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