Tuesday, August 26, 2008

A Humane Society

For a guy who claims not to value television, I watch a fair amount of it. It's a reward and sometime pacifier for my kids and helps my wife wind down after her long days. I frankly enjoy cooking shows, home repair and sci fi. The television is a part of our household and a regular feature of our lives. (I say "the television"---in fact, we have three of them.)

Often it's not the shows that interest me, but the juxtapositions made possible by channel surfing. Last night I came back from a bike ride to find my wife and kids watching an Animal Planet program about the Houston ASPCA. In the segment I saw, a tearful immigrant woman was being prosecuted for having neglected her dog to the extent that its collar had grown into the flesh around its neck, requiring surgical removal. Evidently a neighbor's call had prompted the visit from Animal Control.

By the end of the segment, the dog was returned to health and happily romping with a middle-class white family who clearly loved her. According to the narrator, this dog was one of twelve thousand neglected animals given new homes each year in the Houston area.

After we put the kids to bed, my wife and I watched a bit of the Democratic National Convention. We enjoyed the highly-polished retrospective feature on the life and times of Ted Kennedy (truly well done) then watched a bit of his live speech. It was either in that speech or in the prepared file footage that we saw Kennedy espouse healthcare coverage as a right for all Americans, not just for the privileged few. Something like that.

For all the talk of universal health care, I have to admit I've never given it much critical thought.

I was raised a dependent of the US Army, with access to all the free medical and dental care (and education) I needed as a child. Department of Defense doctors saved my life at least twice, free of charge: once from double pneumonia as an infant, and again from leptospirosis as a teen. Doubtless my immunizations and regular check-ups prevented other medical catastrophes.

I enjoyed this privileged care (arguably the best in the world) until leaving home as a young adult. Since then, I've worked for various state agencies and enjoyed similar benefits, almost magically provided by automatic deductions from my monthly paycheck.

Is this what universal healthcare is all about? If so, I am hardly in any position to begrudge my fellow Americans (heck, anyone anywhere) such a luxury. I would literally be dead without it.

Which brings me to the Houston ASPCA and the DNC and our increasingly humane society.

Considering the possible connections, I'm moved to wonder, How responsible to one another are we? How responsible are we to ourselves? How much of my own wellbeing can I be entrusted with? Should I have any choice?

The notion that bad outcomes can be managed, perhaps eliminated, is terribly compelling. It is so attractive we're willing to give up almost everything to pursue it. If choices can have negative consequences, then maybe limiting choice is the answer: Simply limit our choices to those that have only positive outcomes. Banish the rest.

Inescapably, this seems the goal of humane society.

But that goal has a flaw, and we are it. The whole world, if not the universe, is that flaw. We are creatures of a universe in which positive and negative outcomes (good and bad choices) are intertwined and interdependent. It is probably not the one we would have created for ourselves. But I'm frankly glad we didn't get the chance.

Every cultural good I can think of comes at the risk of bad consequences. Strong marriage. Bright kids. Fine art. Useful domesticated animals. Interesting, wholesome foods. Health. They all come, arguably, because of bad consequences and the choices we make to avoid them. None would spring up automatically on their own. None have ever been produced by official decree.

The ultimate strategy for eliminating neglected dogs (knows the HSUS) is to eliminate dogs. The ultimate healthcare strategy is to ensure that no child ever leaves his yard, no man takes a drink of alcohol or a bite of bacon, no one drives a car or smokes a cigarette. And yet by banishing these bad choices we are not magically transported into a world in which no bad thing can happen.

That's the kicker. We haven't left the Earth. We will still die. Even dogs will reinvent themselves, sulking around the piles of waste we will always make regardless how many laws prevent it.


PBurns said...

The beauty of the programs created by Democratic Presidents like FDR and Truman and LBJ ... and the beauty of so much of the very BEST of American Society when it works well, is that we have social safety nets, but they are not so well upholstered as to be HAMMOCKS.

If all you have is Medicare or Medicaid, you do not have all you wish you had in terms of health care. On the other hand, when push comes to shove, you can also get your wounds stitched, and the infection treated, even if you are indigent. If all you have is Social Security, you will not be able to retire to your dream life, but you may be spared a nightmare life in old age, jungled up in a hovel at the edge of town starving to death.

In short, the Democratic plan for this country is one that ENCOURAGES RESPONSIBILITY, but recognizes that not everyone will be responsible no matter how much we encourage them to be.

The public policy plan that the Democrats have embraced is that to be found in Genesis 41 in which Joseph instructs that people should save in the sunny days of their youth in expectation of the winter of their old age. And where should the people save? In Genesis, the instructions we are given by Joseph are to put our grain in government's warehouse.

This is the delivered wisdom of the age, and it has been what has worked well for more than 70 years for Social Security and more than 40 years for Medicare. This is what the Democrats believe.

The Republicans think something different, of course. They think we should give our money to the money-changers; the very people that Jesus threw out of the Temple.

As for the issue of dogs and animal cruelty, it's important to understand who we are watching on these canine-and-cat rescue shows, and who we are NOT watching. We are NOT watching the Humane Society of the U.S. -- they actually do nothing at the local level. We ARE watching either the local ASPCA (under contract from the City) or the local humane society (under contract with the City). In short, what we are seeing is not a CHARITY at work, but our TAX DOLLARS at work.

And, once again, what we are seeing is not a hammock, but a safety net.

The ASPCA cannot remove animals without cause, and they only step in when there are really serious problems. Humans are expected to feed, house, and provide medical treatment for their animals, and the ASPCA is there to encourage and educate folks about how to do that. Their core mission is to help enable personal responsibility. But when people are really, really irresponsible, the ASPCA and local humane orgaizations step in and rescue the animals. Animals are, to this extent, part of the Social Contract. But as with children and old folks, the unemployed and the homeless, the social safety net is not a hammock, because the goal is always to encourage and enable folks to live up to their personal responsibilities. Animals have to suffer a LOT before animal control carts them off in a carrier to rehouse them.

Will there always be a little misery in an American sdocial safety net system? Sure, but it's misery by design. We don't want people to get too comfortable in the safety net. After all, it's not meant to be a hammock.

The issue of national health care is, at its core, simply a question of requiring people to shoulder personal responsibility. Whether you are Democrat or Republican, Black or White, Urban or Rural, you will eventually get old and get sick. Because of that INEVITABILITY, we all have an obligation to pay for insurance (a kind of forced savings to offset a bad outcome, as in Genesis 41).

Now good people can, and do, argue over the mechanics of the savings plan we want to set up to provide health care for all. How big should the holes in the safety net be? That said, what should NOT be subject to debate is that the era of Free Riders should be over. The alternative to a national health care plan with preventive care is not doing nothing -- it's expensive emergency care provided by Medicaid and your tax dollars. Right now, companies like WalMart are sayin they have no obligation to their workers; that that's YOUR tab to pay in the form of Medicaid. And never mind if it's more expensive, more chaotic, less efficient, and less equitable than a simple employer mandate that recognizes that all people wille eventually get old and all people will eventually get sick.


Matt Mullenix said...

Hi Patrick,

I appreciate your noting the HSUS and ASPCA distinction. I didn't mean to confuse those organizations or the sources of their funding.

(I also appreciate your point that the social safety net is not supposed to be a hammock. Well put!)

That the ASPCA intends to "encourage and educate" people toward better care of animals is almost verbatim what one of the officers was quoted as saying.

But in the next breath he expressed his regret that in this case he wasn't allowed to do more. He was implying, clearly, that had the judge allowed it, he would rather see the woman punished.

The flipside of encouraging responsibility, whether its done by ASPCA officers or by lawmakers, is that many who would do so would also do more. Can you deny that the temptation toward controlling others' behavior is basic to human nature? Or that positions of authority do not make that temptation difficult to refuse?

As a parent, I encourage responsibility all the time. I try like hell even to mandate it. I could be called a tyrant, except that I love my kids like no tyrant ever loved his subjects. I think that makes a difference.

And yet, regardless how much I keep after them, I am steeling myself for the time (closer daily if not already here) when they will be beyond my influence. I know all my encouragements and desperate mandates have limited reach.

Would I enforce my view on them if I could? Even if it was for their own good? I would be tempted, mightily.

If I had the power of a state and the resources of a treasury, I would likely try my hand at it.

Fortunately for me (and them!) I am just a Dad. I can love them and advise them and wish them well, pick them up when they fall. But I cannot preserve them intact forever. Who would want that? I didn't want that for myself.

We celebrate freedom. We say it defines us as a people---defines all good governments and policies. We have many freedoms of movement, expression and commerce here.

What seems to be disappearing is an acceptance of freedom to make bad choices and to live or die by their consequences.

It's hard to sell that, I guess. But it's undeniably the state of existence in this world. To ignore the reality and impact of bad choices in the lives of my children is to deny them the most important thing I've learned so far: We have limits. Choices matter. "Death waits in us like a light switch."

I agree with the wisdom of Joseph. But the circumstances of his day were "save or perish." Now (for a little while, anyway) our circumstances are more like "save or be saved." There is no clearly superior choice. We mean well, but to the best of our ability we have denied ourselves the clarity of bad consequences.

Mike Spies said...

Patrick wrote:

"The issue of national health care is, at its core, simply a question of requiring people to shoulder personal responsibility. Whether you are Democrat or Republican, Black or White, Urban or Rural, you will eventually get old and get sick. Because of that INEVITABILITY, we all have an obligation to pay for insurance (a kind of forced savings to offset a bad outcome, as in Genesis 41)."

I think you have some pat (pun) answers to a problem that is more complex than your post here addresses.

I have been fortunate and done well (comparatively speaking), but others have not. There are literally millions of people in the US without health insurance. Many of them cannot buy health insurance. Not because they do not have the money (some do, some don't), but because no insurance company will touch them due to a medical problem. So what is their solution? Responsibility for themselves? Not when a single problem can cost hundreds of thousands of dollars - cost them all their savings and their house.

A woman (or man) who stays home and raises a family instead of working in the marketplace does not qualify for Medicare. Sorry, you didn't earn it, lady.

In the US our per capita spending on health care is TWICE what the next country in line spends, and our health care delivery doesn't make the top ten. I asked my brother (a highly respected physician and chair of radiology at Georgetown University Medical Center) and he said, "The healthcare system is broken." Most health care providers would agree.

The Democrats had a chance to fix the problems when Clinton was President. Hillary did not save the day, but retreated from the issue without accomplishing anything. It s not a question of politics, but national will and the way our government works...

Our government favors those who can push their way to the trough - Democrats or Republicans, it seems to make no difference.

NorCal Cazadora said...

Nice post, Matt - you articulate the dilemmas well.

Nuf said!

Rebecca K. O'Connor said...

In the end, I believe in capitalism. Bad doctors don't retain, let alone gain clients. Slow and crappy service does not get financially rewarded. I want a choice. End of story.

PBurns said...
This comment has been removed by the author.
PBurns said...

Mike, believe it or not, I helped write the very first bit of testimony given, back in the Clinton era, for national health care, and I also wrote the core "fact pack" used by the AFL-CIO to help sell the Clinton plan (I must have done a bang up job on that bit of work, eh?).

Your point is that insurance is supposed to be GROUP insurance. Of course it is. And let's make the group everyone; I am for that. That still doesn't mean everything is going to get covered; there is a difference between a necessity and a nicety. Why should Medicaid, for example, pay for Nexium when it is identical to Prilosec (one molecule turns left, the other right)? Why use a heart stent when new evidence suggests medication works just as well for far less money?

If folks want niceties (brand name rather than generic drugs, for example), you need to be able to step up to pay for that -- ditto for boob jobs, individual hospital rooms, etc.

A safety net should not be a hammock.

That point has nothing do with the scope of capitation or the number of people in an insurance pool. Obviously, the pool should be HUGE; the bigger the better for everyone.

I agree with you Matt, that there is a natural tendency to go to leislation or authoritarianism. We all do it because it seems to be the most direct way to get things done. I am against it as a general rule, however. For example, I am not for banning assault weapons in the hunting field; I am for laughing at the people who bring them. Shame and ridcule are powerful training tools. Ditto for the way people breed dogs, and the rich fantasy life they bring to breed histories -- I openly laugh at them.

At some point, however, there is a place to step in. How far and how hard to step in is always subjhect to debate, of course. Before apprenticeship in falconry, very bad things happened. Now fewer bad things happen. Was there too much regulation? Some would say so! That said, making it a free-for-all left the birds as collateral damage. The same sort of things happens in the area of children, the aged, the sick, and animals where the victims cannot step in for them. The state then becomes "the Equalizer" (to make an allusion to a great old TV show).

To put a point on it: I am OK with folks smoking, as it is suicide on the installment plan and cancer generally gets you when your kids are grown. I am OPPOSED to drunk driving (and drunkeness in general) because it externalizes the harm in a quantifiable and predictable fashion. People are not "paying the price" themselves -- they are making children, other drivers, and passers by pay the price. To put a sharper poin ton it: No one ever killed their neighbor because they smoked too many cigarettes; that cannot be said about whiskey.


NorCal Cazadora said...

Can we talk about how much insurance costs? And what a huge industry is is? And that perhaps we might be better off moving from the cadillac coverage to catastrophic coverage as the norm?

I saw a physical therapist last year who was $60 an hour when I paid cash, $250 when I used insurance because of the paperwork and delays (he said) and possibly also because well hell, the insurance will pay that much.

I too believe in safety nets for those who don't have the cash. But this whole system is just twisted and perverse.

I get "free health care" because I'm a state employee and my union has managed to convince the state that it exists for state workers' benefit (egregious, btw). But if I ran a small business and didn't have this ungodly gift from the state each month, I'd get catastrophic and pay cash for routine needs and in the end I would spend a LOT LESS MONEY than is being spent on my health care now.

It's not so much that I believe in capitalism, though I do. I just don't think the state is repsonsible for bringing perfect health and perfect teeth into my life, particularly when 99 percent of my day-to-day health is determined by my behavior - diet, exercise and rest.

I know, spoken like a healthy person, but that's how I feel.

Anonymous said...

Boy, most of this fancy health care talk is WAY over my head. That is true for many of us peasants out there. I FINALLY got a state job with health care(in my late 40's), but the previous 20-something years, I had to do what people have had to do for thousands of years---get well on my own, or die! L.B.

Matt Mullenix said...

Hi Patrick,

You bring up the falconry example, and I think it's a good one on the topic of regulation (necessary or un-; abused or well-managed).

The falconry regs (state and federal) have been a mixed bag from our perspective. Most of us generally agree the net effect has been positive, in that with regulation came official recognition and some federal protection for our activity.

Threats to legal falconry come mostly from bureaucratic reluctance to manage our small numbers, given the on-site inspections and paperwork involved. State agencies do the leg-work for us, and without the federal guidelines to follow (and the back-up of federal LE authority), some would certainly have taken the easy road and simply refused to sanction our sport.

On the negative side, state agency falconry coordinators and even federal regional permit offices have been notoriously inconsistent in regulating us. "Fiefdoms" abound, and abuses of power are commonplace by individual staff members charged with interpreting federal and state falconry guidelines.

Now that the USFWS is set to give up its regulation of falconry, I expect state coverage may fail in some cases and grow more arbitrary and draconian in others.

And yet: Despite these fears, most of us wanted the federal government out of the falconry business as much as practical. We would also welcome an end to local regulatory fiefdoms. (But none of us are too optimistic on that score.)

Regulation is a mixed blessing at best because falconry is a self-limiting activity.

The apprenticeship system is a longstanding tradition, mandated now but hardly any more effective for that. Success depends entirely today, as it did 5 thousand years ago, on the dedication of both the novice and master practitioner.

The hawks have not changed a bit. People have not changed any more so. The issues new falconers learn today are exactly those learned by novices in Shakespeare's time and thousands of years earlier.

What I agure to my peers is that an end to federal falconry regulation will require we pick up once again our own responsibilities for one another and for our own actions. We will no longer have our safety net (such as it was---the benefits of federal regulation of falconry are not measurable).

We will have to re-learn how to woo a mentor and re-learn how to teach a pupil. Some will fail. Failure will affect some toward improvement; others it will nudge out of the sport altogether. That's the way it has always been in this particular activity. It's just too hard to do it half-assed.

I think by in large, dropping the safety net will improve the general practice for those few still willing to work.