ETHICS AND POLITICS

Meaning comes from moral responsibility. Moral responsibility comes from the demand by the Other upon me. The Other’s demand rests solely on that Other’s confrontation of me, her announcement, by her mere presence to me, that I am obliged to her. She brings that demand to me, thus making me responsible, and thus making me meaningful.

Politics, the management of the community, rests upon this responsibility. I am unconditionally obliged to each and every human being that presents herself to me. This is precisely the meaning of the American ideal stated in the Declaration of Independence: “We hold these truths to be self-evident, that all men are created equal, and that each is endowed by its creator with certain unalienable rights…” Our obligation to recognize the unalienable rights of each and every human being is self-evident, that is to say, established without doubt or question. To hold to that ideal is what it means to be an American.

Since I am confronted by more than one person, I have necessarily to husband my limited assets to most effectively serve the multiplicity of unconditional demands upon them by this community of people. In a community, this husbanding is the purpose of politics. Politics exist in service to the unalienable rights of the members of the human community
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When politics forgets this purpose, when politics operates for itself rather than for the people, it necessarily becomes a tyranny, a rule of the community in complete disregard of the people it was invented to serve. It operates in secret, so as to deliberately ignore the needs of the people. It operates to limit, rather than protect and expand, the rights of the people.

These are the marks of political tyranny: secrecy, disregard of the voice of the people, and limitation of the people’s rights. Political tyranny would call for the restriction of the right to vote, restriction of access to education, medical care and the other elements vital to the protection and growth of the people’s rights.
This is precisely what we are seeing today in America as the result of a political climate ruled by power and wealth. The demand for voter i.d.’s clearly prevents vast numbers of people from voting, or at least makes it sufficiently difficult to assure that vast numbers of people will not vote. Anti-union laws make it difficult, and in some instances impossible, for working men and women to have the bargaining power necessary to achieve a living wage. Reductions in funding for education and medical care are a direct assault on the inherent right of the people to those necessities. Huge and thoroughly unnecessary tax breaks given almost entirely to the already wealthy assure a concentration of power in the hands of a few to the detriment of the vast majority of the community.

Politics, left to itself, does not moderate the quest for power. It must, and it will, finally assert absolute power over the entire community. That is the definition of tyranny. Sadly, throughout history, with only the rarest of exceptions, the response of that community has been violent revolution. Politics makes the unfortunate assumption that it will be always equal to that violence, and so responds to objections to its power with that violence. We have seen it in America over and over, from the trampling of Hooverville by the MacArthur-led military to such anti-union massacres as those of Ludlow, Lattimore, Butte and Hazelton.

When this suppression of the fundamental American ideal happens, as it is happening now, the sole question is whether it can be stopped before the people rise up to violently oppose it. It can be stopped peacefully, by the vote. That is why those who exercise this power politics restrict the vote and pack the courts with judges and justices willing to perpetuate the tyranny. The single great hope was best put in the aphorism attributed to Abraham Lincoln: you can fool all of the people some of the time and some of the people all the time, but you cannot fool all the people all the time.

So we will get it right eventually. We will, eventually, return to service to the American ideal. My prayer is that we will be able to do so peacefully

DEJA VU, KIND OF

The world is a mess. Regional wars are devastating several countries, and there is a serious threat of escalation, involving the major powers of the world. The wealth of the world is being concentrated in the hands of a very few, and those few are using the power of that wealth to gather yet more to themselves. The rights of the average citizen are threatened by limiting, or even eliminating, the right to vote and the right to organize. The stock market, having sustained a crushing blow from the misconduct of the financiers, is booming, and jobs are increasing, but wages are stagnant or even falliing. Funds for education and health care are being slashed. The middle class is disappearing, and the window of opportunity for youth is growing smaller and smaller. Bigotry is on the rise, and there is a demand to close American borders to essentially all foreigners, particularly those of another color or religious persuasion. Politics consists mostly of vicious attacks by each side on the other, and government, including both the legislatures and the courts, are almost completely controlled by the rich and powerful. More and more, the voices of dissent are being silenced or excoriated in the media as communists and terrorists.
Do you recognize this picture? It is America, and the world, but it is that world in 1900. The regional conflicts, and the various interwoven web of alliances caused by those conflicts, would draw the world into global war. The robber barons — Rockefeller and Morgan and Hill and the rest — were reaping millions on watered stock and other flimflams. Unions were being restricted by legislation, and even the right to peaceably assemble was under attack.
The comparison of that time to our own is, thankfully, not quite as close as it might appear. We have, since that awful time, passed laws and installed policies that have increased opportunities for the less advantaged and decreased the effects of bigotry. We have created programs that make education and health care more readily available. We have increased the rights and opportunities of women and people of color. The comparison, while uncomfortable, is not by any means complete.
Not yet. The disturbing thought here is that the recent political landscape makes one feel that we are moving backward, giving up the gains we made in human rights, limiting opportunities, restricting the vote, allowing wealth, and therefore power, to be once agains concentrated in the hands of a few.
Why? Why would we move back to a time and a set of policies that we know will end in injustice and perhaps even violence? The answer is, I suggest, far deeper and far more personal than the far too easy answer that it is the damned rich people, the damned Koch brothers, the damned capitalists. I suggest that the answer is in each of us. The answer is that the prime, the natural, the instinctive motive for our actions is self-interest. Graham Greene, in his masterpiece The Heart of the Matter, observed that each of has inside a little dictator who would wish serious damage to others just for our own convenience. We each, deep down and at base, want the world to operate in our favor. In a sense, we are each little Koch brothers, wanting to feather our own nests more and more, no matter how big that nest is at the moment. And since, as Plato so brilliantly observed in the Republic, politics is nothing but the individual “writ large”, we are constantly tempted to follow political policies that further our own interests. In sum, we have met the enemy, and it is us.
What makes us, humans, great, what gives us a hope, is that we are also the beings that recognize a calling beyond ourselves. That call is enshrined in the Declaration of Independence. We recognize, we hold without any doubt, that all humans are created equal, that all humans have inalienable rights. As long as those ideals are preserved, we will inevitably be drawn back away from self-interest, both individually and politically.
Want proof? List for yourself your real, honest to God heroes. Find any Koch brothers on your list?

The R Word

A large part of my misspent youth was taken up with the study of Roman and Greek language and culture, their history and their philosophies. One of the great mysteries of both the Roman and the Greek civilizations is why such civilizations, so carefully grounded and structured, should so completely collapse. The same question coud be asked, and has been asked by scholars far greater than I, about the many other great civilizations scattered through the pages of history — Egypt, China, India, the Mayans, the Aztecs, the Incans, and likely a host more.

I have no doubt that there is no one easy answer, but I think it likely that there is one element common to all of them. Each of these civilizations began as a system created to recognize and protect the rights and needs of its citizens, but, as time went on, some group within it gradually modified the system to enrich that group to the detriment of the other members of the civilization. The privileged group, finding itself successful in so enriching themselves, just continued to thus pervert the system until finally they had so thoroughly alienated the other members of the society that those other members had no alternative but to bring down the entire system.

To put that briefly, each one of these once proud and noble institutions were perverted by greed, and each was then destroyed by some form of revolution.

This raises an obvious question. Why would the privileged group let that happen? Why would that privileged group, in effect, kill the goose that laid the golden egg? Why would not this group who had figured out how to have the system work to its profit and advantage not have the foresight and prudence to provide at least enough goods and services to those not so privileged to keep the system going?

There is more than one answer to that question. The first is the truism that you don’t have to be intelligent or wise to take advantage of others. You just have to be more powerful. You have, for instance, to be willing to break the ordinary rules of morals and society. You have to lie, cheat, steal, bully. You have, in other words, to violate the fundamental principle of all society, that the rights of each member of a given society are inviolable.

One other reason stands out. Greed is an addiction, and, like all addictions, it knows no bounds. The drunk may know that he or she is destroying himself or herself by continuing to drink, but the addiction pushes the addict to keep doing it. Greed does exactly that. The robber baron John D. Rockefeller was asked, when he was in his eighties, when he was going to retire. He is said to have responded, “I just need a little more.” When he said it, he was the richest man in the world. On a lesser scale, that is what happens to everyone who suffers the addiction of greed, who defines himself or herself by the amount and character of his or her possessions. You have a used Chevy, and you want a new one. You get a new Chevy, you want a new Cadillac. You get a new Cadillac, and you want a new Mercedes, then a new Jaguar, then a new Ferrari, a plane, a bigger plane, a yacht, a bigger yacht, a mansion, a bigger mansion. And, in that mad pursuit of newer and fancier things, you never stop to ask what price others may be paying to feed your addiction.

To succeed in feeding this addiction of greed, you have, at some point, to limit the rights of others. There is, after all, only so much wealth in the world, and for you to get more than your share, you must assure yourself that others get less and that those others cannot take what you have away. You have, for instance, to limit their voice in government. So you would want to limit the right of the people to vote. You would need to pass legislation, for instance, limiting the hours of voting, and perhaps requiring some kiind of registration process that would make it difficult for the less wealthy to cast a vote. You would also have to limit the distribution of wealth, and to loudly decry all attempts at such distribution as evil, as, for instance, a communist plot. You would have to cut taxes and, accordingly, cut the benefits provided by government for such things as health and education. You would have to limit the ability of the people to organize. So you would have to pass laws limiting and even prohibiting the right to form collective bargaining units. Utlimately, you would have to pass laws even limiting or prohibiting the right of the people to assemble and protest. And you would have to do all of this while convincing the people somehow that it is all in their own interests.

If you are very good, you can get away with that for a while. Eventually, however, the people are going to notice that they are being disadvantaged. The middle class, for instance, might notice that their once prosperous position was slipping, that they were not profiting as much as they once did and that their number was shrinking. The poor would definitely notice that they were getting distinctly poorer, that their children were going hungry, that their schools were deteriorating or even being closed for lack of funds, that basic health care was too expensive for them, that the cost of even basic goods was rising beyond their ability to pay.

Like a tree rotting from within, the society would look pretty much intact for a long period of time. Inevitably, though, the day would come when some event would bring it down. The power exercised by that privileged group, political, financial, and likely in the end military and police, would fail. The people would have had enough, and the people would rise up. Revolution.

Revolution. That terrifying word. It always appears suddenly, as if it were a total surprise. In hindsight, of course, it is perfectly predictable. The French royalty knew it. “Apres moi le deluge,” said Louis XV. After me the deluge. The British likely had a sense of it when they responded to the grumbling about taxation by introducing more troops into the colonies. The czars likely knew it, or at least those around them certainly did. Nevertheless, history tells us over and over that revolution is the inevitable consequence of the addiction of greed.

We are, in the United States today, seeing all the signs of the addiction of greed. Those in power are serving monied interests more than anyone else. They are limiting the right to vote, the right to organize, the right of access to education and health care. They are being allowed to give money a greater voice in the legislative and political processes. And, through all of this, there is no sign whatsoever that those in power see any kind of limit to their accretion of power. They feel no need to moderate their pursuit of increased advantage of others. The ruse, they think, is working and will continue to work.

It won’t, of course. Like the Greeks and Romans and all the others, it will devolve into oppression and, ultimately, revolution. I am not here advocating revolution. There are a thousand ways to avoid it, and the pain visited on a society by revoluiton is abominable. I am, rather, stating a fact. We are witnessing, today, now, right now, all of the signs of the devolution of our society, of that commitment to the rights of every human being that made us unique and admired and respected throughout the world. We are approaching a point of critical mass, a point of no return, a point at which the people will find themselves so oppressed and so ignored by the system that they have no other option except revolution.

Call me chicken little if you wish. Tell me that it is only a pendulum, that we are only in a conservative phase and that it will swing back as it always has. I will surely want to agree, and I will carry that hope. I have, however, lived long enough to know what the pendulum feels like, and I don’t feel it now. I feel the rot inside the tree. I love my country. I see no greater ideals than the inalienable rights of every human being on which our government was based. I feel, however, the hands of greed pressing around the throat of those ideals, and I know too well the madness that that way lies. Somewhere off in the distance I hear the tramping of the boots of the oppressed. It is not too late. It can be stopped. We can have our country back, but greed will not give it back without a struggle. Citizens, unite in peace, or you will surely, in some near or distant future, unite in violence, in revolution.

THE COST OF HEALTH CARE: AN IMMODEST PROPOSAL

The issue of health care in the United States is presently a political football, and, because it is seen as a useful political tool, current discuuion of the topic, if one can call them that, bear little resemblance to reasoned discourse. If one were able to put politics aside and view the subject on a rational basis, two things about health care in the United States would appear inescapably true. The first is that we do, in fact, have a system of universal health care in the United States. Some way or other, if you get sick enough, you will get medical treatment of some sort. The second inescapable truth is that, for our Byzantine and hole-riddled health care system, we pay far more than any other developed nation in the world.

From these two inescapable truths, there comes one inescapable conclusion. The real core issue in health care is not whether we should have a system of universal health care coverage. We have that, willy nilly. To twist the old saw about philosophy, not to have a system of universal health care is to have a system of universal health care. The real core issue is how to make one’s systme of health care cost efficient. The need for health care is universal, like air and water. There is no question as to whether we should pay for it. We will pay for it, are paying for it, whether or not we do so in a rational manner. The only subject open for rational discussion is how we might provide adequate health csre in the most cost-efficient fashion.

When one approaches the subject of health care in the United States in this reasoned fashion, an odd paradox appears. One of the problems with the cost of health care in the United States is that, rather than too little insurance, we have too much. A large segment of the population is covered by a multiplicity of policies for medical expense. To illustrate, suppose that a truck driver gets injured in a multi-vehicle accident while in the course of his employment. He likely has medical insurance to cover his medical bills. He also has coverage for these bills through worker’s compensation insurance. He also has a medical pay provision in his truck insurance to pay the bills. Each of the other vehicles also has a medical pay provision to cover the same bills, and each of the vehicles’ liability insurance coverage has exposure for the bills. If the truck driver’s injuries are sufficiently severe, he might also end up with coverage from Medicare and/or Medicaed.

Each one of these various policies was underwritten with the potential for the truck driver’s bills in mind, and therefore coverage for this one set of bills was redundantly charged in the premium of each of these policies. There is, however, a far greater expense that arises from these redundancies. Each of these insurers, aware of the likelihood of other available coverage, have place in its policy a provision excluding payment where other coverage is available and allowing it to recover any payments it made if it is determined that another coverage is applicable. This is generally referred to as a subrogation clause. So, for instance, if the truckdriver has his bills paid by his medical insurance, that company may puruse the worker’s compensation insurer for reimbursement. If the accident is determined to be the fault of one of the other drivers, then the worker’s compensation carrier can pursue the liability insurer of that other driver. Each one of these insurers has an entire subrogation department dedicated to the pursuit of this kind of reimbursement.

The utter wastefulness of such a system may be illustrated by a simple thought experiment. Imagine that there were only two insurers in the entire world. Imagine that the two insurers were of identical size and ability. They each carried the same lines of coverage. They each had the same number and type of clients, and they each had the same number and kinds of claims. They each had subrogation departments of identical quality and diligence, and they each achieved the same success in pursuing their subrogation rights. What would be the net result of their efforts? Zero. Each would extract from the other the same amounts in subrogation. However, each would also pay for the entire machinery of its subrogation department, and each would suffer the expense of responding to, and defending against, the subrogation efforts of the other. So each would undergo the expense of a large bureaucracy that, in the end, produced absolutely nothing.

That, in net effect, is what is happening in the insurance industry in the United States today. Multiple policies are charging premiums calculated upon exposure for the same medical bills, and the claims on each of these policies are referred to a subrogation department where efforts are made to obtain reimbursement from some other policy, the issuer of which is, in its turn, handing the matter over too its own subrogation department. By and large, these multiple efforts work, in the end, to cancel each other out, leaving only the substantial cost of each of the subrogation departments.

You need to be in this sytem to realize how wildly inefficent it is. Whole law firms exist solely to pursue suborgation claims. There are people, many, many people, who do nothing but make phone calls all day long to identify and pursue subrogation claims, and that means that there are many, many people who have to answer those calls. There is likely no way to quantify the cost of these efforts, but it is safe to say that all of it is very expensive and, as is evident, all of it is, in the end, an utter waste of time and money.

In all modesty, I suggest a simple solution. First, we need to install a reasoned program of universal health care coverage. The details of its structure and funding are subject to rational debate, and politics will likely play a central role in shaping the details. The point is that the universal health care that we have is in dire need of revision on a rational basis. Universal health care is inevitable. Cost efficiency is possible only if we reconstruct the system along rational lines. My own preference is to run it like a utility. We all seem somehow to pay for water and electricity. So divide the country by a grid, and sell of the segments to the highest bidding provider or insurer. Give the highest bidder a monopoly in the areas they purchase, and put a public service vommission in place to control profits.

Then — outlaw subrogation. Remove medical expense as an item of recovery in all litigation. Since all medical expense is paid, it is not to be considered an item of loss. So, for instance, medical expense cannot be claimed as an element of award in personal injury claims, medical malpractice claims, products liability claims or premises liability claims. This should result in a drastic reduction in the cost of malpractice insurance for doctors and for products liability insurance for manufacturers. In worker’s compensation, it is estimated that about 60% of the moeny paid for work injuries goes for medical expense. Therefore, if subrogation is outlawed, all employers should experience a very substantial reduction in the cost of worker’s compensation insurance. Not only that, but the cost of running an insurance company should be greatly reduced, since the entire subrogation department would be eliminated. There would, in other words, be across-the-board savings to individuals, professionals and cocmpanies that would remove an appreciable part of their costs and make them more competitive in the global market.

There is likely some way to quantify the extent of savings that would be realized by eliminating subrogation, but at the very least it would reduce the country’s entire real cost of medical care by ten percent. If one accepts the estimate that medical expense in America is over a trillion dollars per year, that would mean a saving of one hundred billion dollars or more. This is a saving that is not just reasonable. It is dictated by reason, and, if we ran our country on the principles of reason, it would be easily done. Until we install something like a reasoned universal health plan, however, we will continue to carry this worthless and expensive burden.