Archive for the 'politics' Category

Hope is Cheap

Sharon October 9th, 2009

Wow, that’s a backhanded compliment.  Here, President Obama, have the Nobel Peace Prize.  Everyone will know you didn’t earn it, or do anything to deserve it, but you seem like a nice man, and well, we really hated your predecessor.  So you get a special award just for not being him, kind of the Miss Congeniality for world leaders.  Either that or the Nobel Prize Committee was under the impression that our bombardment of the moon was actually subduing some enemy. 

Tough day for peace, y’know.  More troops and drones to Afghanistan, more money in a military budget that is by a whole lot the largest in the world, more rumblings with Iran….  But hey, the first black president is also the first black president to win the nobel peace prize, so things must be looking up.  I’m hoping they give him the the faux-nobel for economics next – if we give him enough awards, he’ll have to do better!  Or the Heisman trophy.

The only real explanation is this – the nobel prize nominees, made up of the world political elite, the most educated people in the world, and prior winners have no freaking idea what to do next.  They are all hoping that a resolutely-middle-of-the-road guy who got to be president in the US has a plan, and some hope for the future.  They hope if they give him a prize he hasn’t earned he’ll live up to it.  Just as a lot of us hoped that if we started with big expectations, he’d live up to them.

So far, not so much.  And that kind of hope is cheap.  But apparently, so is the definition of peace.

Sharon

A Tale of Two Hospitals

Sharon August 10th, 2009

We spent a rare weekend away from the farm, visiting family near Boston, and just relaxing.  It was lovely.  Meanwhile, I was only half paying attention to the news, but couldn’t help noticing the millions of people all over Europe and throughout Canada who were rioting, demanding an American-style health care system to free them from the deep tragedy of theirs.  Oh, wait, maybe I wasn’t ;-) .

 What I was watching was the inanity of the protests against “socialized” medicine and the crazy objections to the idea that poor people shouldn’t die sooner than rich ones.  The emphasis is mostly on a tiny number of examples, many of this false or based on incorrect assumptions, of people who are in some way unhappy with their European or Canadian health care systems.  Now I’m pretty sure if we worked at it, we could find an equal or perhaps even greater (gee, how unlikely is that) number of Americans displeased by their health care system, but you’d never know that.

I was thinking about this as I sat visiting with my aunt, who had recently returned from a summer trip to Ireland, where she had sojurned with her 88 year old mother and 9 year old daughter.  Now her daughter “Lucy” has epilepsy and a number of other disabilities, but hadn’t had a seizure in several years.  While they were travelling in rural Ireland, however, Lucy had a sudden, severe seizure, and my aunt got to experience British medicine first hand.

My aunt’s commentary on this was fairly simple.  She noted that in America, when you enter an emergency room, you are asked three things – your name, the nature of the complaint, and how will you be paying for this.  When she and her daughter arrived by ambulance at the emergency room in Ireland, she was asked, again, three things.  Her name, the nature of the complaint, and would she like a cup of tea?

The experienced with National Health, she observed, was hugely different from that of American hospitals after Lucy’s seizure – instead of doing dozens of tests on Lucy, they did one, the relevant one.  As Lucy was showing signs of recovery that evening, they held her for observation and released her, rather than insisting she remain in hospital for several extra days, just in case, as has happened in the US.  She was seen rapidly, the emergency room was calm and the doctors responsive, and despite the fact that they were not British citizens, there was no charge.  Like everyone I know who has ever experienced any kind of national health system, my aunt’s reaction was that if we did half as well, it would be a huge improvement.  My own observations on that front are similar.

And this, of course, is the clincher – I’ve never, ever, ever heard anyone, from any country with any kind of national health service suggest that they would rather live under the US system.  Not one. 

Contrast Lucy and my aunt’s experience in an emergency room with my last experience in an ER.  My husband’s grandmother, a few months after the death of her husband, took a wrong turn in the dark while visiting her cousin for Passover, and fell down a flight of stairs.  She broke her neck, her leg and her collarbone.  When one says she “broke her neck” it sounds as though she must have died instantly, but that’s not the case.

What happened is this – her elderly cousin, sole caregiver for her husband who had had a stroke, rode to the hospital with her, after calling us to come.  We were visiting my MIL across NY City, and I immediately got up in the night, dressed and took a cab to Queens from Manhattan.  By the time I arrived at the hospital, Inge’s cousin had returned to her husband, because he could not be safely left alone.  When I arrived, she’d been at the hospital for an hour, without a single person examining her. She was still strapped to the stretcher, in an ice cold room without a single blanket (she was wearing only a light nightgown, which was up above her waste, where she was completely exposed), and was weeping with pain and cold.  When I finally managed to orient her, and asked a nurse to attend to the fact that she was in acute pain, the nurse said “Oh, yes, she had a fall, I’m sure she’s just sore.”  This was in reference to an 80 year old woman who had fallen down a long flight of stairs, and who had a visible broken bone, as no one can keep their leg at that angle.

I finally got her warm (she was in shock, very easily recognizable, dangerous and totally ignored) and pain medication, and she became lucid.  A doctor, coming to examine her (three hours after arriving) said that even though the CT scan machine was occupied and even though she was having head and neck pain, he thought she probably didn’t have any serious neck injury, and he sat her upright for her examination, even though that’s just about the first thing anyone learns when they do any medical examination – never jostle a head or neck injury about.   He told her she’d just need light surgery for her broken leg (missed the collarbone entirely, along with the neck injury) and that she could be released to rehab the next day.  I was the one who insisted that she have her neck scanned, and, of course, it turned out that she had a severe break.

We spent 12 hours in the emergency room with beds literally so closely crammed together that there was no room for a chair, and chairs were forbidden.  I was 3 months pregnant with Asher, and I stood on my feet for 11 consecutive hours, until Eric’s father arrived to take over attending her.  She was finally admitted, after the neck injury and collarbone were detected. 

Eric’s grandmother was slightly deaf, and when forced to lie flat on her back, often couldn’t understand what was being said to her.  When she realized her neck was broken and she would require massive surgery to repair it, she was very concerned that her wishes that no heroic measures be taken be respected if it seemed likely she would die.  My husband and I were the bearers of her power of attorney, and asked that it be invoked, and she agreed – we asked the hospital employees to make absolutely sure they were familiar with her documentation (which we had on hand, sent over by her attorney), and that before any major medical procedure occurred, we be consulted.  They agreed.  Then, during the early hours of the morning, while my husband and I were asleep (and yes, they knew our number) during some action that a nurse took, her neck was jarred further and my husband’s grandmother went into spinal shock.  Without our consent she was put on a ventilator and kept alive against her intentions, expressed will, every request, our request and all documentation.

Arriving at the hospital the next morning, my husband and I and her daughter spent the day trying to get the ventilator removed so that Inge could die in peace as she had always wished.  The doctor who had put her on the ventilator against her consent had “ethical issues” with letting her do as she had chosen, and as we had asked, and was in surgery and would not deal with her.  She was in a great deal of pain, and very clearly able to express her wish to let go.  Despite the fact that surgery to repair her neck injury was admittedly now impossible, despite the fact that even before she was an 80 year old woman in mixed health and there was an excellent chance she would not have survived the surgery, despite the fact that the hospital had demonstrably contributed to her condition by handling her roughly and moving her neck without support before they were certain of the extent of her injuries, despite the fact that she lacked the will and desire to live as a quadrapelegic, they felt they knew best.  I’ve rarely felt so much despair and anger at anyone as I did dealing with the hospital in this case.  I felt we’d failed her – Eric and I had promised her that this would not be the kind of death she would have.  I remember weeping hysterically in the hallway, after the fourth or fifth doctor came along to cover the legal ass of the hospital and showed absolutely no concern for Eric’s grandmother or her wishes.

Finally, after a very long, miserable day, Inge was removed from the ventilator on which she should not have been placed, and allowed to die.  She had incurred tens of thousands of dollars in medical costs, received terrible care, and was kept waiting even for death, by the estimable American medical system so many people are fighting so foolishly to keep. 

What’s notable about this story isn’t the story itself, it is that I could actually tell two or three other ones about the American medical system, but won’t, for lack of space.  I could, for example, talk about why my son, at 6 weeks old, was admitted to a hospital to be treated for a disease he did not have, and for which the only evidence was a screw up by two separate lab technicians.  In the meantime, he was tortured – he had 6 spinal taps in a matter of a few days, and we consented, because every time we questioned the doctors, we were told he would die if we took him out of the hospital, and it would be our fault.  And no, I do not exaggerate here. 

I could tell other stories, belonging to friends and family – but all of them are mostly the same – they talk about a health care system where doctors, nurses and administrators have been forced to be so fearful of a lawsuit that they run up costs beyond reason, but where competence and kindness cannot be rewarded.  I could tell more stories of long waits to see specialists (we’re always threatened with waiting – but I’ve never waiting longer in any country than the US to see people), of bankruptcies, and early deaths, and more commonly, unnecessary suffering. I could tell you terrible stories that work in every direction – of doctors driven out of practice by escalating insurance costs and huge amounts of paperwork, of patients deprived of basic medical care, of desperation.

And I can’t tell you those stories in other countries, not because there are no horror stories, not because no one in any other country has ever had a bad experience with medicine, or wanted something they could not have – but because en masse, there is no one who would choose the American system over any other rational system.  If you can name a large population from a developed country with national health care clamoring for an American style system, please, enlighten me.  Instead, what I hear overwhelmingly from across the world (and have heard for decades) is Thank G-d we don’t have American health care.

The big question, of course, is whether we can afford it.  Well, if you’ve been watching the news about Fannie Mae and Freddie Mac, you will see that they are slowly but definitely sinking into the sea, and about to create an economic crisis far greater than anything Bear Stearns or Lehmans ever could.  We will certainly spend money we can’t afford on that.  There will almost certainly be more stimulus we can’t afford.  There will certainly be more bank subsidies we can’t afford.  We are spending money in Afghanistan and Iraq we can’t afford, at huge cost to human lives and to the nation.  Our whole world is things we can’t afford.

The difference is this – a reasonable health care system actually gets us something. It will save us billions in wasted ass-covering.  It will give people access to a basic need – everyone gets sick or hurt eventually.  It will create a society of greater equity and lower suffering.  Of all the things we cannot afford, it is the only one proposed that’s really worth having.

Sharon

Equity, Equity, Equity

Sharon November 3rd, 2008

The day before the election, I suppose I should write a post about who I think you should vote for for president.   Yawn. The thing is, is it really going to shock anyone that a New York leftist prefers Obama?  Did you really need me to say it?  I’ll probably actually vote for a third party candidate, since my vote here in New York is worth jack, but if I voted where my vote counted, I’d vote Obama. 

Now that we’ve dispensed with that, let’s get down to the real issues, the real questions that are going to face our country.  We haven’t been able to do that, since this election has been taking over the public discourse since G-d gave the Torah to Moses, but it is time to get over that.  The single biggest issue facing the next president – and he’s going to have to deal with it one way or another – is going to be the question of Equity.  That’s a subject that hasn’t made it to the national table in a very, very long time. 

Why equity?  Well, first of all, we’re entering a major Depression, not a little tiny economic downturn, but a crisis.  And what happens in major economic crises is that people get very poor, often hungry, cold and scared, and they get angry.  And there’s a lot to be angry about.  Over the last thirty years, real wages have fallen and wealth has concentrated – and it is being rapidly concentrated further by the massive reallocation of what remains of our wealth into already wealthy hands.   One of the reasons I think that McCain/Palin’s “Obama will share the wealth” narrative has failed to put them in the lead is simply this – more and more Americans are suddenly realizing that they may soon have more in common with the people who need to be shared with than with the ones who lose.

Now I should take this moment to demand government action – to begin programs and tax relief that allocates wealth around. And such may happen.  But I’ll tell you a secret – I think it would be great if the government led the way on this subject – it would alleviate a lot of suffering.  But in the end, I think the result will be the same whether they lead or whether they follow.  Because if they wait for Americans to take up pitchforks and torches, the shifts will be even more radical – and that’s not a bad thing either.  As historian Sheldon Wolin observes, almost all the major shifts to greater sharing of wealth and power have come in response to the anger of the people.  Howard Zinn argues that FDR’s Great Society came about simply because people, acting in response to the exigencies of the Depression discovered their remarkable power – and the government responded to ensure that no one noticed that the ruling class might not be needed at all.  One way or another, hard times mean that equity issues are coming to the table.

The truth is that most research about hard times shows that most people are willing to do what is necessary to deal with a situation – but their primary concern is equity – justice and fairness.  That is, people will make do with rationing, with great burdens and difficult times - they will even find coping mechanisms and what historian Timothy Breen calls “rituals of non-consumption” that compensate them for the consumption they used to engage in.  What they won’t tolerate is injustice and unfairness.  This is the conclusion of a recent book about Britain during and after WWII, reviewed here:

“Two fundamental, timeless lessons emerge from the whole experience. First, that most people will broadly accept straitened times if they are genuinely convinced of their necessity and that there is no alternative. Second, that social cohesiveness during such an unwelcome turn of events will rest to a large degree on the extent to which the pain is administered on an equitable, transparent basis. Even so, should the economic downturn prove severe, it is still likely to be a psychic shock for anyone under, say, the age of 40, for whom the austerity years are not even a folk memory. The process will be a huge challenge to the legitimacy of our democratic political system, though not inconceivably may do wonders to strengthen and reaffirm that rather frayed legitimacy.”

 I found the same thing when I researched the question of whether some kind of rationing system could ever be brought to the general public – in fact, historically people have even liked rationing, when they felt its primary role was to make sure that pretty much everyone labored under the same constraints – and their fury knew no bounds when those constraints were violated. 

But there are other reasons equity is going to have to come to the table.  The first is climate change.  Over the last year, most of the major nations of the Global South that contribute most to global warming have simply declined to make major cuts in their emissions.  Why?  Because without equity, they are being asked to impoverish their citizens while we are being asked to turn the thermostat down – unless the question of a fair share comes to the table.  The truth is that we will not address climate change until we address the question of equity at an international level.  Nearly everyone would rather not discuss this – but it will come to the table, sooner or later, simply because we have no choice. I hope it will be sooner not later, but climate change will push itself onto the world agenda – and into our daily lives.  And at the root of climate change is the recognition we cannot go on as we are.

Then there’s the food issue – Aaron Newton and I have just completed editing a book about the question of whether and how the world and this country can feed themselves in a warming world, in the face of rising energy costs.  And what we’ve concluded is simply this – the issue comes down to equity.  In the end, the central question of our times is going to be food allocation – as I put it the other day “Is there dinner?  Do I get any?”  And the only way to address the food crisis - a crisis that is only going to get bigger as time goes on – is this.  To make sure we deal with the question of what constitutes a fair share – that we divide the work and the food more justly than we have, not in the perfection of human nature, not in an ideal world, but in this one.   And this problem isn’t just going to play out on the world level – although it will do that too as very angry people who recognize that the deaths of their kids and their lives of poverty were created, in part, by the actions of those who fed food to their cars and were willing to see them die so they could keep on the road.

One of the remarkable things we’ve found in our research into food systems is this – in any place that has had to or wanted to radically reduce its use of petrochemicals in agriculture, what is really rapidly discovered is that you can do that – but not on a massive scale.  In Cuba, in the Soviet Union, in shifts to organic production in the US and UK, generally speaking what shows pretty clearly in the research is this – you can farm with few or no chemical inputs, whether you do it because you want to or because you have to (and we suspect many of us will have to) – but not rapidly on massive farms of thousands of acres – period.  Huge scale agriculture is simply not amenable to rapid shifts away from fossil fuels – so if we are to deal with our current crises, and keep food coming in, we’re going to have to make sure that land is in the hands of people who can grow food on it on a reasonable scale.  That means one of the great questions of the coming decade is this – how will the people get access to land to grow food on.  And that, fundamentally, is an equity question too – particularly as foreclosure pushes more and more people out of the pieces of land they could be growing on.

The word socialist has been thrown around a lot during this campaign, mostly because people really do think that the only choices in figuring out how to live are capitalist and communist/socialist.  I think that’s a fundamentally false way of thinking about this – first of all, we all know that all economic systems are hybrids (lord knows, I’m not sure you can even call our economic system capitalism anymore) – there is no pure socialism, no pure capitalism in practical reality.  Those nuances we ignore matter.  For example, greater equity could be achieved by removing some of the private from private hands, or it could be achieved through a capitalist distributist model, in which who gets to hold the private is limited.

But in some ways, I think that the capitalist/socialist discussion misses the point.  In the interview we did with her for our book, Helena Norberg-Hodge, author of _Ancient Futures_ and _Bringing the Food Economy Home_ made what I think is the essential point -  that scale matters as much as economic system:

“…I think it’s very important that we realize that communism or capitalism or even socialism are all large-scale, centralized systems and therefore I prefer not to talk about the problem as being capitalism.  The reason why I don’t is that it in many minds conjures up the notion that socialism or communism are better and I personally believe that the intentions behind communism and socialism are broader and in a certain way more noble, but I don’t think it’s just that the centralized power they entail, in both socialism and communism, was the problem socially, but I also see them as fundamentally anti-ecological, because they were top-down, centralized systems that also then foisted monoculture in terms of agricultural production, but when we talk about agricultural production, we’re basically talking about all the activities from which we derive our basic needs: forestry, for building, fiber, building materials.”

Norberg-Hodge’s argument, which I entirely agree with, is that the whole discussion finally misses the point.  What is needed will be a hybrid again of private and public resources, of things we call “socialist” and those we call “capitalist” but the salient point is this – that power, and autonomy and what really matters have to be more widely distributed, the scale of management radically reduced and that equity, in the end, is more about the right to self-governance than whether we reduce taxes or reallocate wealth that way.  The central problem will be how to get the tools of self-sufficiency – the ability to feed and clothe and care for yourself into ordinary people’s hands again. 

And that provides a measure of an answer to the problem of how we will deal with equity on a world scale as well – because in the end, I think the truth is that there’s no real way to deal with the question of equity without changing the typical American lifestyle.  The good news is that a lot of us are vaguely (or more than vaguely)  uneasy about the changes that our lifestyle has wrought in our lives anyway – it is an oversimplification to say they haven’t made us happier, because it is more than that – they not only haven’t made us happier, they haven’t made us better.  And that may be the really salient point – that one of the things that would make us happier is the sense that we’re living a more ethical, more just, more natural life, and that we have more power of over our own destinies.  And that’s not possible without dealing with the equity question.

The really good news is that dealing with equity isn’t a one directional loss – it isn’t that if Americans start living a more equitable life they simply lower their standard of living.  They raise our access to power, to self-sufficiency and the confidence in engenders.  Greater equity gives us institutions on a scale we can comprehend and a richness in connection to the world around us.  It is truly a little bit about using less – but even more about being richer.

I hope, personally, that Obama wins the election.  But even if you don’t share my hope, the thing that I’m really hopeful about is this – that in some senses, it doesn’t matter who wins, because we’re going to require whoever “leads” to follow our lead, to address the equity issue.  Presidents come, and thankfully, this president is going.  But presidents are only presidents – the people, well, that’s something else.

 Sharon