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Quite the World, Isn't It?

The high cost of health care, and the ruin of a society

Time magazine has a lengthy and significant (at least the section I read; too long for one sitting on a busy day) article by Steven Brill on the absurd economics of the modern American health care, from eye-boggling markups on over-the-counter painkillers delivered in an emergency room to the massively inflated salaries of top executives (not to mention doctors). It’s an issue Los Angeles Times columnist Steve Lopez tackled last year, but it needs tackling again. And again. Until we are finally moved to do something about the indefensible pricing practices within health care.

This is the biggest force behind our crisis over access to health care; the cost of medical delivery drives up the costs of insurance (not to mention the rapacious nature of the insurance companies). Yet the power of the health care lobby makes any sort of reform or control politically difficult. Add to that the mystery of the profession; we tend to exalt doctors to a near-religious extreme, and take it for granted that after years of study they are entitled to wage levels exceeded only by CEOs.

We need to fix this. We could start by requiring medical providers cough up a price list before medical care begins. I rejected knee surgery last year in large part because the surgeon’s office would not respond to my requests for information on how much the elective procedure would cost me and my insurance company. They assumed I would just give them carte blanche to charge whatever they felt like.

In what other business, or service, is it not common practice to know the cost up front? And to be able to shop around, thus introducing to the system the thing free-market zealots love most, competition? Yet managed care rules jack up the costs if you try to shop around for doctors outside your insurance system. While the managed-care groups negotiate lower rates, many of us know too well that we often get bills from our doctors for costs above the negotiated rate. And we pay it.

I’ve long believed that by focusing on affordable health care insurance, we have missed the real issue: The cost of health care itself. It is morally reprehensible that in a society as large and vibrant as ours, people who fall ill risk financial ruin to get healthy. In fact, medical bills are the leading cause of personal bankruptcies. How is that healthy for a society, or an economy, let alone an individual?

Even more reprehensible is the immoral practice of holding health, and life, hostage to a profit margin. We are a society of people, not corporations. We should act like it. Read More 
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About that Super Bowl farmer/Paul Harvey/truck commercial

When the ad popped up during the Super Bowl last week, it struck me as slick manipulative marketing, down to the models-cum-farmers. I mentioned at the time that it must have taken some effort to have done the whole bit on American farming without mentioning the people who do the actual farming, migrant laborers from Mexico.

But this bit gathers up the whole mess of oversights and willful disregard of reality in one piece of razor-sharp satire. Enjoy.
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And you think you want to get away from it all?

There are a lot of things in this bizarre world to be fascinated by, and this week's entry is the details from this piece at Smithsonian about a reclusive family of religious Russians who, seeking escape from violent persecution, disappeared into unimaginably harsh Siberian interior. And for more than 40 years had no contact with anyone else.

So complete was their isolation that they missed World War II, and such technological advances as cellophane: "Lord, what have they thought up—it is glass, but it crumples!" But they figured out satellites, because they saw them hurtling through the night sky, whose darkness you can only imagine given the hundreds of miles between the family's hut and any significant light pollution.

The family, then consisting of two parents and two young children, fled into the wilderness after the father's brother was shot dead by a communist patrol as he stood beside him at the edge of their remote village:
That was in 1936, and there were only four Lykovs then—Karp; his wife, Akulina; a son named Savin, 9 years old, and Natalia, a daughter who was only 2. Taking their possessions and some seeds, they had retreated ever deeper into the taiga, building themselves a succession of crude dwelling places, until at last they had fetched up in this desolate spot. Two more children had been born in the wild—Dmitry in 1940 and Agafia in 1943—and neither of the youngest Lykov children had ever seen a human being who was not a member of their family. All that Agafia and Dmitry knew of the outside world they learned entirely from their parents' stories. The family's principal entertainment, the Russian journalist Vasily Peskov noted, "was for everyone to recount their dreams."
But if the family's isolation was hard to grasp, the unmitigated harshness of their lives was not. Traveling to the Lykov homestead on foot was astonishingly arduous, even with the help of a boat along the Abakan. On his first visit to the Lykovs, Peskov—who would appoint himself the family's chief chronicler—noted that "we traversed 250 kilometres [155 miles] without seeing a single human dwelling!"

Isolation made survival in the wilderness close to impossible. Dependent solely on their own resources, the Lykovs struggled to replace the few things they had brought into the taiga with them. They fashioned birch-bark galoshes in place of shoes. Clothes were patched and repatched until they fell apart, then replaced with hemp cloth grown from seed.

The Lykovs had carried a crude spinning wheel and, incredibly, the components of a loom into the taiga with them—moving these from place to place as they gradually went further into the wilderness must have required many long and arduous journeys—but they had no technology for replacing metal. A couple of kettles served them well for many years, but when rust finally overcame them, the only replacements they could fashion came from birch bark. Since these could not be placed in a fire, it became far harder to cook. By the time the Lykovs were discovered, their staple diet was potato patties mixed with ground rye and hemp seeds.
Remarkable. And well worth your time to go read the piece. Read More 
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On the pervasive nature of hatred, guns, and violence

It almost feels like ancient history now, given what's happened since. In August, a troubled man by the name of Wade Michael Page walked into a Sikh temple in Wisconsin and opened fire. He killed six people and wounded three others before a policeman wounded him. Page then turned his gun on himself before he could be captured and questioned. There was no note or other message and authorities still don't know what moved Page to enter a place of peace with such violence, but focus immediately went to his white supremacist beliefs and the hate-filled music he performed.

Man, did that bring up memories. This is a piece I wrote in the new issue of Orange Coast magazine on the links between Page and Orange County, and the persistent nature of racial hatred. In writing it, I couldn't help but think of the slaughters that have happened both before and since Page's rampage here in the land of the free and the home of the brave. Rampages that more often than not involved weapons bought legally.

And it's also worth noting that three days before this article went live on the internet, another gunman opened fire on the innocent after apparently murdering his sister and torching his neighborhood. Yet as a body politic, we do nothing. This is madness.

From my story:
The photos don’t portray Orange County at its finest. In some, you can see Wade Michael Page, his head shorn to stubble and his arms covered with tattoos, churning away on a guitar. Other skinheads stand next to him on stage, their chests and arms a mishmash of inked symbols, including what look to be a swastika and a Confederate flag. One picture is from a gig Page played in 2011, but others date back a decade, to when Page made Orange County—and its fringe hatecore music scene—his home.

It’s chilling to realize that the chunky guitarist in the photo would open fire at a Sikh temple outside Milwaukee last August, killing six people and wounding three others before, already wounded by an officer, taking his own life. But it’s more frightening to sense the sweep of time, and the persistent nature of hate and racism captured in those photos.

I first began writing about the hate movement a quarter century ago as a reporter for The Detroit News. Robert E. Miles, a former Klansman and one of the conceptual forces behind the modern white-supremacist movement, lived in Michigan. “Pastor Bob” preached a virulent religion known as Christian Identity in which Jews are seen as Satan’s soldiers, and God supposedly created blacks from mud to serve whites. Miles also once told me he saw himself as something akin to the Johnny Appleseed of white supremacy, sowing the seeds of racism wherever he went. He believed the white race would be preserved through “leaderless resistance”—by lone wolves primed to strike on their own, leaving no conspiratorial trails for prosecutors to follow. And the most fertile grounds, Miles believed, were prisons and the military.
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On Newtown, and a national soul of violence

A 20-year-old man shoots his mother dead in her home, straps on a bulletproof vest and drives her car, with her guns, to her school and kills 26 more people before killing himself. Mike Huckabee says it happened because "we've systematically removed God from our schools. … Should we be so surprised that schools would become a place of carnage?"

No, Mike, that's not why it happened. And I’m sure I speak for many more than myself when I say, shut the hell up.

In the hours after yesterday’s murders in Connecticut, as the nation waited for the confusing details to settle out, calls ricocheted around social media for serious federal efforts at gun control. The White House demurred, with spokesman Jay Carney saying “today is not the day to, I believe, as a father, a day to engage in the usual Washington policy debates. I think that that day will come, but today is not that day.” The right accused the left of politicizing the shootings, though the inane chatterboxes were notably quiet on Huckabee’s little moment of absurd politicking and assertion of extremist religious fundamentalism. Most Americans simply grieved and fumed.

This “politics is inappropriate now” theme is indefensible, and disingenuous. When 20 kids and 7 adults are killed in one fell swoop as a direct result of federal gun laws, what else should we be talking about? In fact, it’s awfully damn late to be having this discussion. But Carney is right in one regard. “The usual Washington policy debates” are not what we need, because we’ve been having them for years. The National Rifle Association controls the agenda for that discussion despite an overwhelming desire by Americans for gun control. Our elected representatives have proven, on every issue of significance to the health and well-being of the country, incapable of shaking themselves free of corporate and lobbying money and effecting policies for the common good. Gun control is no different. (I’m waiting, after the Citizens United decision declaring corporations are people, for the Supreme Court to grant guns the same anthropomorphic powers).

So as frustrated as we are over this insanity, we cannot look to our political representatives – nor, judging by Carney’s statement, our president – to do anything of substance on this issue, whether we discuss it now or later. We’ll sit glued to the TV and the internet for updates over the next few days, hear the chilling stories of teachers acting heroically, and embrace that cliché of lost innocence among the survivors. We’ll engage in internecine squabbles over incidental aspects such as should the TV reporters have interviewed kids at the scene, whether the media should have published or aired the wrong name of the gunman they ferreted out from police sources. We’ll argue whether God, in a political snit, had indeed forsaken those children.

But we won’t do anything about the core, propelling problem. We are a nation of violence. Our entertainments reflect our soul, from treating vicious street fights as sport to building a video game industry around playing war. From television shows based on murder to football heroes anointed by their brutality. Song lyrics equate masculinity with a predisposition to kill and we flock to movie theaters to watch movies about hit men.

Small wonder that it plays out in our daily lives and governmental policies. A driving error on the freeway can draw gunfire. In most states, our response to murder is to kill the killer. Online comments on news stories about a particularly heinous crime invariably are filled with vindictive - and anonymous - calls for violent retribution, which is equated with justice. Anonymity, it seems, reveals our darkest instincts

Our entertainments don’t cause our violent outbursts; they are a symptom of how we, as a society, engage the world. It has nothing to do with not teaching the Bible in schools, as Huckabee and his fellow religious extremists would have it. Same as Katrina had nothing to do with sin in New Orleans and AIDS has nothing to do with God’s vengeance on gays. Our murders are the willful acts of our fellow Americans, personal expressions of our violence-obsessed culture. They are, indeed, us.

But let’s not talk about that now. It would be inappropriate. Let’s wait for the next time, shall we? Read More 
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Some thoughts on unions, and the battle for relevancy

As you can imagine, I've watched the events unfold in Michigan this week with a deep sense of dismay, and not a little anger. It also gave me pause to think about how organized labor has become the scapegoat for the nation's economic ills.

Labor has, for the most part, lost the PR battle with big business. From my piece today in The Daily Beast:
Somewhere along the way, unions became the scapegoat in these fights. They drive up the cost of doing business, we hear, though unmentioned is that higher wages mean a stronger local economy. Unions are corrupt, we hear, though that’s a hard stone to cast for anyone living in a glass mansion built by the banking and investment industries, or with the ill-gotten gains from corporate insider trading. Even odder is to hear that argument from working-class people, who have bought into the notion that “right to work” actually has something to do with workplace freedom.

This is where the union movement has its biggest problem, not with the wealth of the Koch brothers and their stealth campaign to undermine unions, significant as that is. It’s in persuading working America that organized labor isn’t the stuff of history, that they do indeed need the mutual protection of collective bargaining, and that embracing “right to work” is against their best interests, not a blow for personal choice.
I didn't get into it in the piece for space reasons, but another facet of this is labor's tight relationship with the Democratic Party, which I suspect costs it some support among the growing political independents. Remember, it was the Democrats in the Clinton Administration who brought us NAFTA, and the Obama administration has done little to counter the flow of jobs overseas despite the emphasis Obama placed on that issue in both elections. Yes, the Democrats are better for organized labor than the Republicans, but the GOP sets a low bar for comparison.

Coincidentally, I just finished writing about the William McKinley administration in the manuscript for my Jones's Bones: The Search for an American Hero book. Just over a century ago, the Republicans paid significant attention to the plight of the working class. That began to erode quickly over the next few Republican presidents, but it has been nice to mire myself in a time when workers weren't the scapegoat - even for the Republicans - for the effects of governmental and corporate policies that have left the economy in shambles. Read More 
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On Walmart, HSBC, and the irrelevancy of laws and morals

So Walmart says it bears no responsibility (transparently false) for the Tazreen garment factory fire in Bangladesh because the work was being done under orders from a subcontractor, and without Walmart’s permission. And HSBC is going to buy its way out of potential criminal charges over allegations of illegally moving money for drug dealers and nations under international sanction, because to send guilty bankers to jail might endanger the massive bank’s existence.

When committing an immoral act, or an illegal act, has no consequence, why have morals or laws at all?

We have in recent decades seen a massive swing by various levels of government to put corporate and financial interests ahead of the interests of people. It’s a major propellant in the move to globalism, removing barriers to the flow of goods and cash that allows corporations more freedom to operate. But their freedom has led to a sharp decline in the health and vitality of American communities, from the standards of living that have crumbled across much of the country, to the education and health of our citizens. And it is in part because the people making decisions at corporations know they most likely will get a pass from the legal system and, of they are not caught, a bionus from their bosses.

Instead, in the case of HSBC, there will be a fine, maybe a lost job or two for show, and then business as usual. With the fine not coming from the pockets of the miscreants, but from the shareholders.

From the New York Times this morning, on HSBC:
Given the extent of the evidence against HSBC, some prosecutors saw the charge as a healthy compromise between a settlement and a harsher money-laundering indictment. While the charge would most likely tarnish the bank’s reputation, some officials argued that it would not set off a series of devastating consequences.

A money-laundering indictment, or a guilty plea over such charges, would essentially be a death sentence for the bank. Such actions could cut off the bank from certain investors like pension funds and ultimately cost it its charter to operate in the United States, officials said.
And from a separate item on Wal-Mart’s Nixonian evasions of responsibility:
Scott Nova, executive director of the Worker Rights Consortium, said the new documents raised additional questions about Walmart’s role at the factory.

“If Walmart’s claim that they were the victim of one rogue supplier had any shred of credibility, it’s gone now,” he said. “Walmart is limited to one of two options — to say, yes, we know these suppliers were using the factory or, two, we have no control over the supply chain that we’ve been building in Bangladesh for more than 20 years.”
Nope, wasn't us, Walmart says, it was those uncontrollable subcontractors who do our bidding to drive down costs to keep our goods low-priced for the American consumer. And the consumer is always right.

You know, we vote with every dollar we spend. So spend more wisely. And morally. And, dare I say, righteously. Read More 
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On 38 Nooses and the invisible past

The Los Angeles Times this weekend carries my review of Scott W. Berg's fine new work, 38 Nooses: Lincoln, Little Crow, and the Beginning of the Frontier's End, about the U.S. Army's legally sanctioned mass execution of men from the Dakota tribe in what is now Minnesota, and in the midst of the Civil War.

Readers of my books will recognize a certain sympathy for such overlooked moments of history. When I was telling my wife about Berg's book, she said it sounded like something I'd write. And it is -- this is a subject I would have loved to tackle. In fact, it overlaps slightly one of the chapters in my current project, Jones's Bones: The Search for an American Hero, which touches on the U.S. government's treatment of Native Americans in Alabama, Georgia and Florida some 40 years earlier (trust me, it all connects up).

The hanged men were participants in a flash war, an uprising, really, by the Dakota against racism and the white settlers encroaching on their land, and against the U.S. government failure to observe the treaties it had insisted on, including skipping a contractual payment. The uprising was quickly suppressed, and to the victors go the definition of what is a crime. From my review:
A hastily convened military tribunal lasting only six weeks found 303 warriors guilty of murder and sentenced them all to hang, based on sketchy evidence and a broad definition of culpability (warriors firing weapons in a military encounter were condemned as murderers with no evidence they hit a target, military or civilian), plus a firm belief by the whites that the region should be cleansed of its native inhabitants.

Because the sentences were from a military tribunal and not a civilian court, the president had to sign off on them. Lincoln appointed two men to review the verdicts and whittled the execution list to 39 warriors whom he believed had massacred whites. One was later reprieved, bringing the final list to 38.

And on the morning after Christmas 1862, in a public display of revenge, all 38 men were hanged in one single drop from a massive four-sided gallows erected in Mankato, about 85 miles southwest of St. Paul.

It was, Berg reports, the largest legally sanctioned execution in American history, a staggering event whose significance has been overshadowed by the Civil War even as it stands as a telling moment in America's westward expansion. Read More 
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The fine line between tax incentives and extortion

The New York Times is publishing some strong work diving deeply into a practice that I've long found bizarre, and corrosive to stable communities - the granting of tax incentives to companies to attract development, or to keep them from leaving.

I wrote about this, but not with much depth, in my Detroit: A Biography. Former Detroit mayor Coleman A. Young, even as he took part in the bidding, used to argue that communities competing against each other for corporate investments does nothing but reward corporations. He was right then, and the problem continues. Corporations play local governments against each other to gain the best tax-reduction deal they can, often just shifting the jobs from one site in a metro area to another. And when the commitment expires (or sometimes before, as the Times reports), the companies pull out anyway. Ultimately stockholders benefit, but the community the business abandons suffers; the community that wins the business suffers in increased infrastructure costs and reduced tax support; and that second community suffers again when the corporation's next move is overseas.

The practice ought to be banned, but good luck getting any such measure through Congress (and it would likely face a Constitutional problem over states' rights anyway). The practice is yet another example of governmental support for corporations and businesses ahead of communities. And yes, I know these deals create jobs, but as the Times analysis shows, the cost does not equal the benefit. From the story:
A portrait arises of mayors and governors who are desperate to create jobs, outmatched by multinational corporations and short on tools to fact-check what companies tell them. Many of the officials said they feared that companies would move jobs overseas if they did not get subsidies in the United States.

Over the years, corporations have increasingly exploited that fear, creating a high-stakes bazaar where they pit local officials against one another to get the most lucrative packages. States compete with other states, cities compete with surrounding suburbs, and even small towns have entered the race with the goal of defeating their neighbors.

While some jobs have certainly migrated overseas, many companies receiving incentives were not considering leaving the country, according to interviews and incentive data.
The Times also put together a searchable database of the concessions. It's a sobering overview of a misguided practice, and one that adds yet another layer of financial stress to communities reeling under the recent recession; balky hiring by companies hoarding cash instead of investing; unfunded state and federal mandates; and this bizarre expectation of voters that they shouldn't have to pay for basic services.

It's a mess, and one without easy solutions - and no discernible political will. Read More 
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On Lincoln, and the touchstones of history

I found a bit of history in my pocket the other day.

We have a couple of receptacles in the house to hold loose change for an eventual run to the credit union. One gets the silver (these are colors, not content) and the other gets the copper pennies. I pulled a small handful of coins from my pocket and, as I began separating them, noticed that one penny had a couple of wheat stalks on the back, curled around the inside edge of the coin. That meant the coin was at least as old as I am (the current Lincoln Memorial design was adopted in 1959). Flipping it over, I found the date – 1940, with the tell-tale “s” below the year meaning it was minted in San Francisco.

You don’t stumble across many coins that old in circulation these days. As coins go, this one’s not worth much to collectors (maybe a dime). The U.S. mint in San Francisco cranked out nearly 113 million pennies that year, so they aren't rare, and the one that cropped up in my change is far from mint-condition. The edges are slightly worn, and the front has a thin layer of shellac over it, as though it had been part of a display at some point.

Yet the coin represents more than a single cent. It is a touchstone to the past. The year this particular coin was minted, Hitler’s Nazi Germany – with Paris already in its control – began a nine-month bombing blitz of British cities. Americans, with vivid memories of the last European war just two decades earlier, wanted to remain neutral. President Roosevelt, fearing what the fall of England would mean for Europe, and the world, hatched his “lend-lease” program to aid the British without committing U.S. troops. That came just a few months after the U.S. Congress, fearful of fascist and communist infiltrators, enacted the 1940 Smith Act, the law that lies at the heart of my second book, The Fear Within: Spies, Commies, and American Democracy in Trial.

So this coin came into the world near the onset of a nearly all-encompassing global convulsion of violence. The world has changed since then. It's become more crowded, more polluted, more complicated in many ways. But it’s unchanged in that we as a species can’t seem to find a way to avoid killing each other in encounters personal, national, and tribal (be the bonds faith or blood).

Maybe that’s our curse, as a species, and as a nation. Over more than 235 years, we have rarely been at peace, from the "pacification" of the native tribes to fights with Mexico, to skirmishes in the Pacific to that massive war among ourselves. And that's just the first century. It's a staggering list to contemplate.

Of our most common four coins, three feature war presidents - the Lincoln penny, the Roosevelt dime, and the Washington quarter. Washington obviously was a general before the nation was founded, and even though he was the first president, it is as the hero of the revolution that we remember him. Jefferson, on the nickel, was part of the Revolution but is remembered mostly for his role in writing the Constitution and expanding the nation. But the bulk of the national medals - our coins - that we carry around are physical reminders of wars past.

And Lincoln, of course, came to a violent end, which means the most common coin in American currency bears the likeness of a murder victim.

It’s funny the kind of history you can find in the change in your pocket. Read More 
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