The American political system is broken

The process of putting forth opinion pieces into the public space for debate is an important part of journalism, but typically the selected essays are within a certain bound of what we may call the ‘main stream’. From time to time, and more frequently of late, we find major publications putting into the public space opinion pieces that are so far from the center of normal discussion that they foster emotions of objection, or even anger, and foment arguments amongst the readers. We have today just such a piece presented in the New York Times, an article entitled “The American political system is broken” by Mehdi Hasan.

This article is so misguided in its thinking that it demands a response in an attempt to set things right. What makes it so interesting is that I happen to share the writers’ opinion as far as the premise: I do believe that the American political system is broken, but the reasoning behind the remainder of the article is fundamentally flawed.

We will start from the top:

Mehdi Hasan is a British broadcaster and author based in Washington. He is the host of “UpFront” on Al Jazeera English.

First we recognize that the writer is not American, but an outsider, which is all well and good, but does give us an understanding of his perspective. I am happy to have outsiders discuss our political system, but hopefully they too will understand that they are on the outside, and we all know where we stand. Next we see that the writer is based in Washington, which means that the writer is in the bubble. Finally, we see that the writer is a host on Al Jazeera, not exactly the most objective source of information in the world today. So three strikes already, and we have not even started on the opinion piece, but in the interest of fairness, we might as well let him get up to bat.

So we go to the piece:

Consider the following scenarios: What if Venezuela held a presidential election and President Nicolás Maduro claimed victory with fewer votes than his main rival? Or if Russian liberals won the most votes in the country’s legislative elections but failed to secure the most seats in the Duma? Or if Iranian authorities tried to prevent members of the country’s largest minority group from voting?

Can you imagine the howls of outrage from the White House press secretary? The pious calls from the State Department spokesman to respect the will of the people and protect minorities? Yet all of these undemocratic travesties occurred. Here in the United States, in front of our noses.

Much has been written since Election Day about the need to resist the “normalization” of racism and misogyny. Less has been said about the “normalization” of democratic dysfunction, the signs of which are all around us.

The main point of the article is that his side lost and he now wants to gripe about it. So he sets up the article with a few straw men that he can attack. This is all standard debating tactic. Let us proceed on to his arguments:

 Take the popular vote. Sorry, Americans, it’s just not “normal” for the candidate who came in second to be declared the winner of the race for the second time in the space of a mere 16 years. In 2000, George W. Bush was elected the 43rd president of the United States despite winning about 540,000 fewer votes than his Democratic opponent; in 2016, Donald Trump has been elected 45th president despite trailing Hillary Clinton by 2 million votes.

The writer clearly is still rubbing his wounds from the Bush v Gore loss in 2000, but that was sixteen years ago, so one would think that those scars would be grizzled and thickened by now. Not so, apparently, as the writer bewails that this is ‘just not “normal”’. Actually, we have a system: the electoral college. This system has been in place for well over two hundred years and has served us well. It is only after losing the game that he now wants to complain about the rules. We could go into a long discussion about the benefits and potential downfalls of this system, but the heart of the reasoning for this system is that we are a set of united states with different interests, resources, population, etc.

None of the other Western democracies have anything comparable to the archaic U.S. electoral college — which Trump himself once dismissed as a “disaster for a democracy” and which Americans across the political spectrum have been consistently in favor of abolishing — and therefore have not experienced anything similar over the same period. In the United Kingdom, for example, the last time a political party won the most seats in parliament while losing the popular vote was in 1974. Before that? 1951.

Here I will simply paraphrase: ‘It’s not fair! That’s not how things work at my house! Mommy?’

Take campaign spending. The United States continues to spend more on elections than any other country on Earth, with the 2016 race for control of the White House and Congress costing a record $6.8 billion. For comparison, consider India: With a population almost four times that of the United States, the price tag for the 2014 Indian parliamentary elections was almost $2 billion less.

Consider also the 2016 Senate race in tiny New Hampshire (population: 1.4 million), where an astonishing $120 million was spent by the two main candidates and their supporters. By contrast, in the U.K. (population: 64 million), where the 2015 general election has been described as the most expensive British election on record, the combined spending of all U.K. political parties reached … $60 million.

Every time the ‘progressives’ lose they start complaining about money. George Soros’ pockets apparently do not run deep enough. For comparison, the money spent making the Marvel Comics movies has been about $5.6 billion dollars. Ask yourself which is more important. Actually this campaign was remarkable for how little money mattered. We are starting to move beyond standard campaign spending on television advertising. The technological innovations which have connected us to ‘social media’ have created an entirely new phenomenon. Information, like water, is being spread as if it were a tidal wave crashing across the country and now we do not need to rely on a few spigots to obtain our supply. The ‘mainstream media’ who have controlled the water supply to date are in a tizzy after the deluge and do not know what to say. Forget it, Jake, its Chinatown.

Only in the United States is money considered “speech” and corporations classed as “people.” Most other democracies recognize the latter position in particular, to quote former U.S. Supreme Court justice John Paul Stevens, as undermining “the integrity of elected institutions” and the “cause of self-government.”

This is a canard. Money is money and speech is speech but to get speech disseminated to the people takes microphones, cameras, and transmitters, and those cost money. The two are intertwined. Whoever said it was a problem to have more speech? I mean if you have amplifiers drowning out my speech like Bill Clinton and Janet Reno did to people in Waco, Texas, then we might have a problem, but for the most part the more speech that is out there the better. The problem is that all of the ‘progressives’ political power is not based on intellect but on emotion, and the more we talk about things the more likely we will diffuse all the emotional drama and then the ‘progressive’ agenda will fall apart.

 Take turnout. The United States falls far behind most other developed democracies, coming 31st out of the 35 member states of the Organization for Economic Cooperation and Development (OECD). How many Americans are aware that more of them stayed at home on Nov. 8 than voted for either Trump or Clinton? Or that, despite the closeness of the race, turnout fell from 58.6 percent in 2012 to 58.1 in 2016?

Compare and contrast U.S. voter turnout with recent rates in OECD member states where voting is compulsory, such as Australia (91 percent), Belgium (87 percent) and Turkey (84 percent). “Of the five highest-turnout OECD countries in recent elections,” noted a recent Pew study, “three have laws requiring their citizens to go to the polls.” Few Americans are aware that the state of Georgia, in its pre-independence 1777 Constitution, made voting compulsory and “subject to a penalty.” Is it time for the United States to invoke the Georgia precedent?

People who are engaged in the politics of this country will vote. People who are not may choose not to vote. Again we come back to a question of personal choice. I would prefer that people who know nothing about the candidates nor their positions not vote, but everyone has a right to vote in our system.

Take voter suppression. It looks like U.S. politicians across the country have mastered the dark art of denying certain citizens their right to vote. According to the Brennan Center for Justice at the New York University School of Law, 15 states had new voting restrictions in place for the presidential election as “part of a broader movement to curtail voting rights, which began after the 2010 election.”

Consider the swing state of North Carolina. On the eve of the election, a federal judge said she was “horrified” by the “insane” process by which people were “being purged” from the voter rolls. In July, a three-judge panel ruled that the state’s 2013 voting law could only be explained by “discriminatory intent” and “hinged” on a concern that “African Americans … had too much access to the franchise.”

To be clear: Republican politicians have spent years trying to prevent black people from voting. To quote one longtime North Carolina Republican strategist: “Of course it’s political. Why else would you do it?” 

Now that we have finished the appetizers, we can get to the meat. What in fact we are finding is that politicians have long kept ineligible voters on the rolls. Dead people, people who have moved, and people who have multiple residences fill up the voter rolls with ineligible or duplicate entries. Is this intentional or fraud? Well, no – for the most part. If you have ever performed an internet search on yourself, you will likely have found a plethora of partial information with old addresses and phone numbers long forgotten. The ‘Motor Voter’ laws have put millions of people onto the voting rolls. Keeping voter rolls clean can be tedious work, but there are also advantages to keeping extra numbers on the voter rolls if you want to pad a vote count. Just stack up an extra set of ballots there, they are real voters I swear.

So we have now started to push back with some reasonable thinking. Why not just have people identify themselves when they come to vote? Then you will not have a problem with fraud anymore (cough). But joking aside, voter identification is very reasonable and a way to try to reduce the likelihood of shenanigans. At my polling place voters lined up very orderly and everyone showed their ID. Not a big deal. But supposedly there is this large population of oppressed African-Americans who do not have IDs. I guess they can’t buy beer. Would somebody, please, show me one of these poor lost souls? I would be willing to drive them personally to the DMV to get their free identification card.

We do not have a national ID card and I certainly would not advocate having one, but if you would like to vote it is very reasonable to ask that you have some sort of picture identification. The argument that asking for identification is suppression does not hold water. Anyone who cares to vote can. If there are problems with any individuals who have been ‘purged’ from the rolls for some reason, they may cast a provisional ballot and we can sort it out for each case. We do not have voter suppression, but in the real world there are people who think that they can mark a few extra ballots in somebody else’s name and get away with it.

To be clear: there are no black people that a Republican politician has stopped from voting.

Take gerrymandering. The practice of redrawing the boundaries of electoral districts to secure party-political advantage is neither new nor exclusive to the United States. Yet the difference is that gerrymandering in the United States is actively encouraged, to quote Harvard political scientist Pippa Norris, by “leaving the processes of redistricting in the hands of state politicians, rather than more impartial judicial bodies.”

Democratic systems that show little evidence of gerrymandering tend to be those that recognize the blindingly obvious connection between an impartial election management body and an impartial election process — Australia, for example, has the Australian Electoral Commission, Canada has Elections Canadaand the U.K. has four boundary commissions, all of which are either independent or operate at arms-length from the various executives and legislatures.

In the United States, however, the Republicans, who currently dominate state legislatures, have perfected the practice of gerrymandering, pulling off, in the words of investigative journalist David Daley, “the most audacious political heist of modern times.” Republican dominance in states such as Michigan, Wisconsin and Ohio, notes Daley, are a result of “maps that were drawn after the 2010 redistricting.”

I don’t like gerrymandering either, but it is the system that Democrats mastered for years to control the system. The problem is that Democrat policies have failed so badly that people have stopped voting for that side. Now the Republicans are in power, and the writer does not like the tables being turned. I am not opposed to some form of commission for redistricting, or even coming up with another way of selecting our representatives. Politicians will be politicians, and we have the Lord’s grace to comfort us.

Oh, my, my I have forgotten my manners. By name and affiliation I am to assume that the writer is of the Islamic faith, and may not understand grace. And here we come to one of the rifts that our multicultural world demands attention. We are a secular nation because we have given people the freedom to choose what religion, if any, that they want to follow. I suspect that most people don’t even put that much thought into it. But our Western societies share some Judeo-Christian values that are not necessarily, (although I believe them to be) universal. The values of fairness and justice should be held dearly, and despite all the chatter and alarm that is filling the ‘info-space’ I believe that they are.

Is this really what we define as democracy? Or is this, to quote the president-elect, a “rigged” system? Rigged not against Trump and the Republicans but against the poor, against ethnic minorities, against Democrats but, above all else, against basic democratic norms and principles and pretty simple notions of equality and fairness?

This isn’t a time for denial or deflection. The American political system is broken. Far from being the “world’s greatest democracy,” to quote President Obama, representative democracy in the United States seems further hollowed out with every election cycle.

And here we find the fundamental flaw in our writer’s essay. This is the core of the problem. No, I say, this is not what we define as democracy: this country is a representative republic. I am very sorry if you do not like our system, but to use a trite phrase that goes back to John Locke and An Essay Concerning Human Understanding, it is what it is. And a democracy it is not, despite Barack Obamas’ amateurish attempts at philosophy. The writer moans about the state of the system, and there definitely has been a rank stench emitting from the cesspool that is Washington, but the results of the recent election are not the problem; more hopefully, they will be the cure.

The real divide

So this debate has brought us to the political axis which has split America, and which, in the twenty-first century, is probably the most important political axis for us to consider. This axis splits across party lines as we have seen it during this election cycle shatter the traditional Republican coalition but also divide the Democrats as well. Arguments along this axis were also some of the strongest driving factors of the wars throughout the twentieth century. Where you stand ideologically along this axis largely determines how you feel about taxation, freedom, health care, and even immigration and globalism.

What is this all-important axis? It is the line that runs from communitarianism to individualism. The traditional Nolan chart of political preferences has labeled this axis as ‘authoritarian’ ↔ ‘libertarian’, which could be reasonable labels, although due to past abuse of these terms they have become contaminated with all sorts of confounding ideologies that give these labels certain liabilities in any pure philosophical discussion. In an attempt to be more precise in my language, which is a requirement when trying to make points clear, rather than ‘muddy-the-waters’ as so many pundits would prefer, I will stick to the ‘communitarian’ ↔ ‘individualist’ (C↔I) labels.

All of the major government systems can be placed along this axis, including communism at one end, socialism (Scandinavia) a bit further along the spectrum, other Western style liberal democracies (excluding Scandinavia and the United States) coming next, and finally the furthest along on the spectrum (at least among large nations) would be the American ‘experiment’ as defined by the founding fathers, if not as much the reality into what we have transmogrified the US system today. We could place anarchism at the far right of this axis.

Now we have added into this mix ‘Trumpism’, which I would argue we will not really understand for years to come as the president-elect appears to have not made up his mind about many things and has yet to implement any policy, but for the sake of argument I will use ‘Trumpism’ as we have come to know it during the election cycle. Unfortunately for those of us who tend to be of a libertarian mindset, this ‘Trumpism’ does not appear to be anything close to our traditional libertarian or individualist philosophy but rather seems a mishmash of populism, authoritarianism, moderate social liberalism, and free market ideology. What I can say is that this system is likely much closer to the original American ideal along the C↔I axis than anything that Hillary Clinton advocated, and certainly light years away from Obama’s politics of the past eight years, which has seemed hell-bent on transfiguring our society into some utopian progressive fantasy land way down on the left hand side of the axis.

As simplistic as the Nolan Chart is, and as hackneyed as it has become, it is still quite informative to examine this layout in order to cut through some of the propaganda that has been populated by all manner of unreliable sources, not the least of which has been the ‘mainstream media’.

You can take the quiz for yourself to see where you lie:

worlds-smallest-political-quiz

Here are a few variations I found with a quick search. Some I include only for their humor value. If you are not already very familiar with this chart, you will quickly get the idea. Political ideologies may also be mapped in many other ways, with just about any shape you can imagine having been used. The point of all of this is that a simplistic left/right, Democrat/Republican view of the world does all of us a disservice in these discussions.

Standard Nolan chart:

nolanchart

This is a very reasonable split-up of the chart including many of the views in modern American politics:

nolan-chart-majorphilosophiesAnother view of the chart with historical world philosophies:
nolan_chart

A more complex view of the chart (also rotated) with more views:

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Where the 2016 candidates + Obama stand:

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How most libertarians see the chart:

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One of my personal favorites with relevance to this current discussion:nolan-chart-subdivisions

 

One of my usual foils came at me with his opinion that individualism is really the attitude of the haves versus the have nots. To quote:

And I don't think your country of origin has changed its mind about how it provides for the group. Those provisions are not created from voluntary contribution, but by mutually agreed desire to have the system available for all. This momentary blip due to the foolish failure to recognize that generosity to the world, outside of people of like mind, is wide open to abuse by people whose countries have failed to provide decent standards of living. That blip must and will be dealt with and the social group will settle down and recreate the circumstances needed. 

That quality has not been achieved by personal voluntary contributions as you appear to believe is the way it should be, but by the social group imposing its collective will on individuals. IMO that is the biggest single error that the US has made in promoting its original statutes of liberty. Were your views to be implemented across the board, you would be unable to ensure that everyone, or anyone, paid their due share to the whole process of social conformity; no ability to impose taxes to pay for any services that are required, no right to call on people to help defend the nation in event of attack, no means of establishing some form of law and order or anything else that is needed to make the social group viable. That is the horror of personal rights and freedoms. In any good society, all rights and freedoms must be for the benefit of the group, in order that they may benefit the individual. Freedom of any form is dependent on the conditions pertaining, never something for the individual to take on for themselves, unless they are prepared to be made a pariah in their own group.

This is a straw-man argument. He has chosen not to recognize what I have said all along: that this axis is a spectrum, that where we stand along this spectrum at any given point in time is a subject of debate, and that this is precisely what we have our political system set up to debate in a civil manner. Instead, he insults me by saying that if I happen to think that we have strayed too far down in the communitarian direction that must mean that I am an anarchist, want NO government, NO taxation, and NO national defense.

Of course that is not my position, nor was it the position of our founding fathers, who very carefully set aside in our Constitution what they felt was the rightful place of government. And please do not also try to smear me with the common leftist canards that the founding fathers had slaves so we cannot appreciate anything they did or that slavery was enshrined in the Constitution so the document no longer applies. I do not condone what was done in the past regarding slaves in any way – we have moved beyond that way of thinking, from the African slave merchants who sold their enemies into slavery to the Western world which took advantage of the situation.

But what was done by the founding of the United States was that a government with limited powers, checks and balances, and all conceivable (at the time) design limitations was established and allowed to be tested as a system in the real world. And the result, which you can clearly see, is that the country flourished and has become very powerful.

On the other hand, communitarian government systems have been tried repeatedly over the past few centuries and have overwhelmingly failed. Not only have these governments typically had to kill large percentages of their populations to be put into practice, but they have required brutal totalitarian regimes with secret police to maintain. If the failures of the twentieth century are not clear enough evidence, just look at Venezuela, once a thriving country, abundant in natural resources, which has been now driven down to third-world status with large numbers of people unable to obtain food or medical care in that ‘progressive paradise’. As Margaret Thatcher famously said, “The problem with socialism is that you eventually run out of other people’s money.”

How many pogroms are needed, how many ‘cultural revolutions’, how many hundreds of millions of more people need to die before people can see the dangers of collectivism?

My arguments have always centered on a few things: 1) The American experiment established one of the few places on earth that people were free to generally do as they please, with a limited government and system of laws put into place to try to maintain that system; 2) All governments tend to grow, based on the self-interest of the people running the governments. If clear obstacles, laws, and checks-and balances are not put into place, all governments will tend to grow and slide down the axis towards more and more communitarianism, because government ‘experts’ always believe that they are smarter and better at making decisions than ‘common-folk’; 3) It is the place of the political system to help the people argue and decide just where on the axis between pure communism and anarchy that they wish to live; and finally 4) The science and economies of countries further towards the individual side of the axis will thrive, because they unleash the power of the people to create, explore, and build through the inherent incentives in the system (you keep what you earn, create, or build, and share it how you like), while the countries further towards the communist side will sink into excessive bureaucracy, corruption, and laziness due to disincentives to work (all property is to be equally shared, no matter how much effort each individual put into obtaining or creating said property).

Now, all of that being said I will grant that there are exceptions to the rule. Countries across the world differ in vast ways in their geography, natural resources, and most importantly in the beliefs, value systems, work ethic, and the intellectual and creative abilities of their populations. These differences will lead to different levels of achievement that can be reached by each country and their individual citizens. A serious problem in trying to measure various countries against each other, and even individuals within any given society against their compatriots or among people in the world at large is that ‘achievement’ itself is very subjective. I always laugh at rankings of, say, the United States’ position in the world on a measurement such as health care. ‘Health care’ itself is such a complex subject that any such ranking would be severely problematic unless it can be broken down into smaller subjects which are all encompassed under the blanket term. These rankings never measure what they purport to measure, but instead reveal the agenda of the people who have produced the report. We can, however, attempt to produce a ranking in objective measures, such as, say life expectancy or infant mortality, but if you read my recent essay on statistics you can see how even such ‘objective’ measures can still be highly subjective and be used to try to advance an agenda.

There are also plenty of examples of problems within the United States system, including all forms of corruption – fraud, graft, nepotism, breach of trust, exploitation of workers, (and on and on ad neuseum) – which occur in both the governmental and private sectors. I would argue that the smaller the government, the less opportunity for corruption. I do think that in a system with a healthy rule of law (something the Obama DOJ has apparently forgotten about) it is important to have enough power and ability to monitor corporations and punish misdoings. I also think that we tend to jail way too many people in the United States, but again my argument is that the underlying problem is that we have strayed from our founding ideals and favored safety and security over freedom.

One of the biggest problems in modern politics from my perspective has been the mixing of the ideas of globalism and free trade into the argument. The left wants globalism to help spread the wealth of the more advanced nations to all the people of the globe. The right wants free trade to be able to expand their markets. Both sides want immigration in order to advance their goals. This is all well and good in theory: I actually think that open borders and free trade are important concepts –  given that the people on both sides of the bargain share similar ideals, beliefs, and ethics. What has been lost on many of the coastal elites of all political stripes (the people I call the bubble inhabitants) is that the world is populated by people of vastly differing fundamental ideologies.

We currently have a large percentage of the world population whose fundamental religious texts call for all unbelievers to be killed, converted, or enslaved. These are the fundamental ideas behind the cult that is called Islam, and though the majority of the people who profess this faith may not believe what their leaders and religious texts call for, the fact that these tenets remain unchanged and ensconced in their ‘religion’ is problematic. If we are to accept these people into modern Western society, it is not unreasonable to ask them to reform their statements of faith.

We also have many large and powerful nations (i.e. China, Russia, Iran) who openly flaunt the deals which we make with them, knowing that the will of most of the Western democracies is weak and they can get away with it. This power differential does not lead to fair bargaining when considering trade agreements, nuclear deals, or immigration policy.

But who ever decided that ‘globalism’ has to be the way of the world anyway? I never got to vote on this topic. What we have is a group of oligarchs, i.e. the bubble inhabitants, who have taken control of the US government and used their power for self-enrichment, all the while telling the regular people in flyover country that what they are doing is inevitable, the wave of the future, and for the ‘common good’.

Enough of this rant. It is Thanksgiving. Time to focus on the many blessings in our lives that we can be thankful for.

Health Care

stethoscopeA subject which has been a focus of intense debate over the past decades has been health care. Part of the reason for the debate is that there has been a fundamental misunderstanding about what health care really is. Many people feel that health care is a ‘right’, but health care can never be a ‘right’ as we have historically understood rights. Our founding fathers properly described the rights that we have as human beings – the rights to life, liberty, and the pursuit of happiness. These are what may also be termed negative rights, meaning that they demand inaction. We fundamentally have life, liberty, and an opportunity to pursue happiness as long as no one (especially government) impedes upon those rights.

Other purported rights – the ‘right’ to education, the ‘right’ to health care, and the ‘right’ to a job being the most common that are debated – are positive rights, meaning that they require action on the part of other people to be fulfilled. I propose that a different term be used in our discussion of positive rights, in order to prevent confusion between the two. I would say that these are ‘expectations’. I believe that positive rights can never be considered true rights, because in order to honor those expectations, other people must be obligated and forced to work on your behalf. Therefore, while we can discuss whether or not to honor any of these ‘rights’, we can and should recognize that these are only ‘expectations’, and any effort made to honor those expectations should be considered a privilege.

So as long as we can agree that you do not have a fundamental right to health care, we can discuss what obligations a modern society should have towards its citizens. While I strongly believe that your own health care is your personal responsibility, I also recognize that through circumstances often out of your control you may not be able to pay for health care services. This is especially true for people who have been born with congenital diseases which may be very expensive to care for, and which may prevent those individuals from being able to work and provide for themselves.

Taking a pure libertarian position on this entails no government part in providing health care for its citizens, and making people rely on family and charity to provide for them. This, I believe is not only possible in theory, and desirable, but given government mismanagement of this issue for decades, and the amount of ignorance and misinformation that is present among our citizenry, this is not likely obtainable any time in the near future. People will need to weaned off the government teat, a process which will take many years, if it will ever be obtainable honoring our political system. People will always vote their pocketbook, and given the option to require others to provide for them, most people will select that option. Unless we are able to return to a system where everyone is required to pay some taxes, the people who pay few if any taxes will prevent true reform.

ppacaThe recent changes in the health care system, the Patient Protection and Affordable Care Act of 2010 (PPACA, or Obamacare) and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), are in my opinion, the exact wrong way to go about reforming the healthcare system. These laws make some basic assumptions which are deeply embedded in ‘progressive’ thought, but in my opinion make fundamental mistakes in understanding rights and human nature. These basic assumptions are: 1) that positive rights are true rights that all people ‘deserve’ and are entitled to; 2) that all patients and medical problems are essentially the same and can be treated through treatment algorithms decided on by medical ‘experts’; and 3) that physicians, or ‘treatment providers’ are all the same and are interchangeable, including using nurse practitioners and physician assistants in the place of medical doctors (MDs).

I have already addressed the first of these and will now try to explain why the remaining two assumptions are problematic. As for #2, while it is true that people are very similar in many respects, and often the treatment used for one person or medical condition will work in other cases, people are not widgets. There are hundreds if not thousands of factors that differentiate people from one another, and the best way to determine the treatment for any given person is for a qualified expert to examine and talk with that person. Some of the factors that go into deciding the correct treatment for any given patient include: What are the different options for treatment, and which one best fits the patients’ needs and desires? What other medical conditions do they have, and how will the treatment prescribed interact or interfere with other medications the patient is taking? Is the patient likely to follow the treatment course recommended? What are the patient’s expectations for the treatment? Is the patient able to afford the treatment prescribed? What are the side effects of the treatment and will these prevent the patient from finishing the treatment course?

All of these considerations must be taken into account when deciding on the proper course of treatment for any given patient. Trying to come up with guidelines and treatment algorithms has been the wet dream of progressive health administrators because these would eliminate the requirement for a skilled doctor to figure out how best to treat the patient. One of the biggest battles in medicine now is how to handle treatments which diverge from the guidelines which have been formed by ‘experts’. The dirty little secret of guideline based medicine is that the panels which come up with the treatment algorithms often have fierce debates about what is the proper treatment for any given condition. There are large areas of disagreement, and while the treatment guidelines usually are based on areas where consensus could be found, sometimes they are based on ‘majority rules’ and are deeply divisive.

Just as patients are not interchangeable, fundamental mistake #3 above is that medical providers can be treated as widgets in the system. The payment system in medicine already makes this assumption, which is deeply flawed and not reflective of reality. In truth, some physicians are very skilled and able to diagnose and treat patients very efficiently while others order a large number of laboratory tests and imaging studies in order to make a diagnosis. Some physicians are also better at making an emotional connection with their patients, a skill which I believe makes diagnosis and treatment much easier, while other physicians have trouble relating to their patients. Unfortunately, the current medical system we have in this country rewards the wrong things. Doctors are not paid to think, but are paid on the basis of the tests that they order and the procedures that they perform. Therefore, the unskilled doctor who requires a large number of tests in order to make a diagnosis actually gets paid more than the physician who does a complete examination and is able to make a diagnosis based on their very in-depth history and physical. The system forces doctors who know what they are doing to order unneeded tests in order to get a reasonable reimbursement for their time.

“So why do we not go to a capitated system, where doctors are paid a flat fee for each patient?”, the astute reader may ask. This type of system may in fact work, but there will always be bad players who see a lot of patients and order no tests in order to make a lot of money. This type of system also would encourage doctors to only see well patients who do not require much testing. The sickest patients who require a lot of care may be left out.

I do not pretend to have all the answers as to the best payment system which will reward the best doctors and help the sickest patients, but I do believe that doctors should be able to charge different amounts based on their skill. Just about every other profession in this country allows experts to charge more than novices. The time of the best, highly trained and experienced doctor in this country is certainly worth more than the time of the unskilled and unexperienced new graduate. But the current system pays the same for everyone. Therefore, the skilled and experienced doctor, in order to make up for the inability to charge more, must see more patients and spend less time with each individual patient than desirable. While the highly skilled and experienced doctor should be able to do this because they have become more efficient, the combination of less time with patients and increasing paperwork requirements means that mistakes will be made.

And this leads us to another area of discussion in the health care realm: medical mistakes. There has been a trend in recent decades of organizations such as the Institute of Medicine (now the National Academy of Medicine) to come out with studies showing a large number of ‘mistakes’ being made in medicine. If you dig down into the definitions of mistakes in these studies they often include such things as the patient being out of the room when morning medications were given, so the patient got the medicine at lunchtime. Other ‘mistakes’ include known interactions between medications that potentially could be avoidable, but the physician felt that the benefit of the medication outweighed the potential risk.

“So why are all these things labelled as mistakes?” you may ask. That is a very good question and goes to the agenda of the people doing the studies. The more that doctors can be marked and viewed as unreliable, the more oversight they theoretically need. This goes to the heart of the argument of people who want government intervention and control in health care. They believe that if they can label doctors as prone to making mistakes, then they can swoop in as ‘government experts’ to protect the citizenry from the ‘harm’ that doctors are inflicting on them. In truth, the only harm here is to the integrity of the medical system and the overall trust of people in their doctors, and this harm is being inflicted on us by the ‘government experts’.

We have a system in place for suing doctors for malpractice. We do not need another level of government oversight in medicine. However, the malpractice system desperately needs reform. Turn on the television at any given time and you will likely be inundated with commercials from lawyers who want to help people sue their doctors or the drug companies. Sometimes these suits are laughable, but unfortunately they will cause great expense, trouble, and damage to reputations in the meantime. For example, we have been blessed in medicine with a number of new replacements for warfarin for thinning blood. These new blood thinners can prevent potentially lethal blood clots from forming after surgery and can also prevent many strokes. How do they perform this magic? By slowing the coagulation system preventing the formation of clots. So if we prevent the formation of clots, what would be an expected side effect? Bleeding, naturally. The use of these anticoagulants has to be weighed on a scale of risk and benefit – clot prevention versus bleeding – and this calculation has been the basis for hundreds if not thousands of medical studies trying to find the right doses, delivery systems, and potential reversal mechanisms for these medications. This is what doctors do – this is our area of expertise.

Yet the trial lawyers want to sue the drug companies because some of the people who take these medications have suffered bleeding side effects. The lawyers know that they can play on emotion and drum up sympathy for the unfortunate patient who may have had a devastating side effect. The lawyers also know that they can often bully doctors, hospitals, and drug companies into settlements. Who benefits from these lawsuits? The lawyers clearly benefit, the patients less so. There needs to be a system in place for malpractice to be prevented and compensation for malpractice litigated, and we can even argue that there should be some sort of compensation system for the people who suffer known potential side effects of medications, but the current ambulance-chasing and hit-the-jackpot system is not it.

dtom

Certification Culture

certificateofquality

Clear evidence of our government bureaucracy run amok is found in the rapidly growing area of certification. Years ago people would get hired for a job, perhaps, but not necessarily after specific training in a vocational school, college, or university, and would then proceed to learn the trade through years of applied work. Trainees or apprentices early in their careers may have been designated as such, but the general public had enough common sense to determine whether someone seemed to know what they were doing and were worth employing for some specific task.

Through the ages systems have developed for the certification of people as experts in their particular trades. Early on these were guilds of successful tradesmen. Later various boards arose to certify and license doctors, pharmacists, and veterinarians. Attorneys are certified as fit to practice through their Bar Associations. There have been a number of factors which have contributed to the development of these certification systems including 1) a rapidly expanding knowledge base in society which has made it impossible for people to know enough to judge for themselves whether the people they want to employ actually know what they claim to know; 2) experts in various fields wanting to preserve the integrity of their profession from people who may try to claim expertise that they do not possess; and 3) governments wanting to protect citizens by providing a mechanism for determining whether people are the experts they claim to be.

In recent years, however, the certification system has become a behemoth with such complexity and momentum that attempting to even slow this monster, let alone begin to reign it in, is becoming a nearly impossible task. A quick search begins to reveal the size of the problem. In any given state the number of certified occupations runs into the hundreds: the state of Washington lists almost five hundred. Certifications run the gamut from accountants to zoologists, and just listing all of these along with their basic requirements could easily fill a book. You can become a certified aircraft fuel distributor, a certified tattoo or body piercing artist, a certified snowmobile dealer, a certified egg dealer, a certified East Asian medicine practitioner, or a certified fur dealer. There are certifications for firearms, fireworks, fire sprinklers, you you can even become a certified fire protection engineer. You even need certifications for your leisure activities: certified martial arts participants, wrestlers, kick boxers, and whitewater river outfitters. You can be a licensed seed dealer, shellfish harvester, waste tire carrier, or taxidermist. And lets only hope that Anthony Weiner found himself a licensed sex offender treatment provider.

“So why has this system gotten so out of control?” You may ask “Each of the factors driving these certifications that you listed before appear to be noble goals. Isn’t the whole certification system a good thing?” To answer these questions, we must reexamine the factors driving the system and explore their ‘dark side’. Each of these has what we could generously call a contraposition, or more cynically call their seamy underbelly or ‘dirty little secret’.

Let us start with #1 above. The human knowledge base is rapidly expanding to such an extent that even for your exceptional ‘Renaissance man’ or polymath cannot know everything. Theoretically, it may at one time have been possible for someone to know the sum of human knowledge, and over the years there have been a number of claims of people who in fact did so. These range from Aristotle in ancient Greece to Leonardo da Vinci, Athanasius Kircher, Gottfried Leibniz, Thomas Young, and Max Weber. Of course it is impossible for any of these men to have known everything known to humans in their time, but these well read individuals of high IQ and high capability at least could hold their own on just about any conceivable topic. No one in the last hundred years could make such a claim, and in recent decades just knowing the index has become a challenge. The extent of human knowledge continues to expand at exponential rates. In the future it may be possible for an artificial intelligence to once again know everything, but that is a discussion is for another time.

The problem is that knowledge is expanding at a rate that any system that tries to certify someone as an expert is out of date by the time it is established. Just as software standards run years behind the cutting edge of innovation, and are often useless by the time a standards organization can put them together, the certification tests in rapidly growing fields are hopelessly outdated. In my occupation, cardiology, the science has advanced very rapidly, and old standards of care are often being revised and retooled, if not overturned entirely.

This creates a huge quandary for the people who are making and taking the certification tests. If a newly published study overturns an old way of thinking, and a question about this particular topic appears on the recertification boards, how is a knowledgeable expert to answer? Do you answer the question with the knowledge as it was at the time the board question was likely written, or do you answer with the newer, and (presumably) more correct information in mind? This becomes even more of a conundrum for people who are performing research. These people may have knowledge that is not yet available to the general public, and so they may be forced to answer questions with information they know to be wrong. And the more cutting-edge an expert is, the more difficult this task becomes, and the more that expert may get ‘wrong’ on an outdated recertification board test.

An entire industry has now arisen in order to prepare people for the certification tests. A common theme of these board preparation courses is knowing what the proper ‘board answer’ is, regardless of the state of knowledge in that given field. So we have essentially built a surrealistic alternate reality of ‘meta-truth’ that needs to be studied and mastered in order to pass the board certification tests. And the saddest reality of this alternate universe is that the true experts – the people with the best, actual, cutting edge knowledge – are the ones who have the hardest time with it. The average schmoe who doesn’t keep up with what is really going on in any given field will probably do just fine on the test.

“So if it is so hard to figure out who really is an expert in any given field, why do we do it?” you may ask. Well now we get to the dark side of #2 above. Attaining a level of expertise in any field is difficult. It takes time, dedication, and will to become a master of a craft. People who have dedicated their lives to any particular trade tend to become very fond of the art of their work, and they want to defend that trade from outsiders who have not worked as hard as they have. This is a very natural human instinct, and there is not necessarily anything wrong with it.

However, it is not the master of any given profession who feels threatened by interlopers, it is the novice. The person who is least sure of their own ability will feel the most threatened by someone else’s ability to outperform them. And so the certification system tends not to be built by the best people in any given trade, but the worst, because they want to create a back-stop to prevent any others from overtaking their ‘turf’. It is these people who are so uncertain of their own skills that they must find some way, some badge, some stamp-of-approval from above to prove to people that they are worthy of their title. So they create a certification system that gives the illusion of expertise for all of the people who pass the bar. But we know that not all ‘experts’ are equal, and we should not pretend that it is so.

There is an old joke in medicine: What do you call the guy who came last in his class at medical school? Answer: Doctor. Part of the problem with branding everyone who passes the board exam as an ‘expert’ is that now the system can treat all of the doctors as interchangeable widgets. In our current system no doctor is allowed to charge any more for his or her services than anyone else, and the insurance industry and government can choose to pay whatever they like for those services. The doctors just have to shut up to get paid. In a just system, skilled doctors would be able to charge more than unskilled doctors. (Yes, this happens in some very small slivers of the industry such as dermatology and cosmetic surgery where society has determined that it is OK for ‘optional’ medical procedures to be paid for out of the system, but for most of medicine doctors are paid whatever the Medicare system determines to be enough.) If you want to see the best cardiologist in the world, shouldn’t you have to pay a premium? Or do you just want to leave it to chance as to whether you will get to see a top notch doctor versus the latest foreign medical graduate?

The Maintenance of Certification system (MOC), the Patient Protection and Affordable Care Act of 2010 (PPACA, or ‘Obamacare’), and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), all treat doctors as interchangeable widgets. You cannot charge more or less than anyone else, regardless of your level of service or expertise. The foreign medical graduate who assessed you from the doorway saying something you didn’t understand is paid the same as your best hands-on, attentive, caring, and emotive doctor. And the sad fact is that the doctors who really care and want to spend the time with you get paid the least, because they have put your care first, and are not in it for the numbers. The cold, quick, calculating doctor who works as a machine and never makes an emotional connection to any patient will get paid the best. Because time and thinking are not rewarded, but getting people through the door is.

This brings us to the dark side of #3 above, which is government enriching itself in the process of all of this certification. Each of these certifications requires a fee which must be paid to cover the costs of the test. But is that all it covers? Recent investigations of the depths of corruption in the American Board of Medical Specialties (ABMS) and their underlying partners in crime – in my case the American Board of Internal Medicine (ABIM) – have found that the people making these systems, who we have already determined are the least capable in their milieu, have been enriching themselves on the backs of the hard working doctors in the field. Not only do these ‘doctors’ (I use quotes because for the most part these people do not actually see patients) pay themselves high six-figure salaries, higher than most of their actually working counterparts, they lavish upon themselves benefits such as paid spousal travel, chauffeur driven town-cars, and condominiums. These governing bodies which must make up reasons for their own existence are just another manifestation of the bubble inhabitants who have controlled the system for their own gain. We are talking about millions, if not billions, of dollars that are at play and the sucking sound keeps coming from Washington, and in this case Chicago.

It is time to put a stop to this entire culture. We need to return to our roots and abolish the entire certification system. “What?” you ask “you mean even doctors and lawyers?” Yes, and Indian chiefs as well. Let us build a new system where people can be knowledgeable about and thus feel comfortable with the level of expertise of their brethren. But let us also build a system where the true expert can be paid his or her worth.

Driving

I have driven hundreds of thousands of miles in my life. I currently choose to drive a manual because I like the degree of control it offers on the operation of the car. I have also long self-maintained my vehicles and do not appreciate the decisions made by car-makers that have made it more and more difficult for me to maintain my own vehicle. I especially do not appreciate the role of government in making my car more difficult to maintain.

My first encounter with this was about thirty years ago when the air conditioner in my car stopped working as well as it previously had, due to slow leakage of freon from the unit. I decided to refill the freon in my A/C unit, but when I went to the parts store, I was told that I could no longer buy freon because it was considered a dangerous greenhouse gas. The government had determined that unless I had the proper certifications as a heating and cooling expert, I was not capable of safely refilling the freon in my car, and should therefore be prevented from doing so. I had to pay someone else to do what I was perfectly capable of doing myself because someone else decided that they were a better judge of what was good for me and the people around me than I was.

“But”, you may say, “freon destroys the ozone layer and should be handled by people who know what they are doing.” This goes to the fundamental question about where personal choice and personal responsibility affect the entire community, and where should lie the boundaries of what government can tell people about what they can and cannot do. Once again we find that the issue is not at all simple, and reasonable people may disagree about where the bounds should be. But this boundary is precisely what divides us in today’s politics and is giving so many people so much anxiety.

Yes, I agree that freon is not necessarily the best thing to have available to all people, because those who do not know what they are doing may release it into the atmosphere and this could affect everyone. Whether or not I buy into the entire argument about the ozone layer and global warming, you may be surprised to hear that I consider myself an environmentalist, as I believe that we should try to keep the environment as clean as reasonably possible, and indiscriminate pollution is not good for anybody.

But I also recognize that just because someone has a certificate from the government deeming them an ‘expert’ on any particular issue does not make it so. Passing some HVAC certification test cannot be that difficult, and given the time, money, and inclination, I could easily do so. There are also plenty of people who carry the certification of being an ‘HVAC expert’ who are complete idiots whom I would certainly not trust to fixing my air conditioner, and speak nothing of their ability to be stewards of the environment.

So what has the exercise of making people certify as HVAC experts done? It has 1) created a new level of bureaucracy; 2) made it more difficult and expensive for the average person to have comfortable and cool air; and 3) theoretically prevented the release of a dangerous gas into the environment by people who do not know what they are doing. I would argue that #1 and #2 are clearly bad, and #3 is clearly good. So we must try to balance these factors to decide if this is an exercise worth doing. This is the calculus of modern politics which factors deeply into who we are and what we believe. I am willing to accept the regulation of freon if you are willing to accept the fact the #1 and #2 are true, and also recognize that the bureaucracy itself has a conflict of interest when making these decisions.

We can go on and apply these ideas to many other aspects of driving and automobiles. It has become more and more expensive over the years to replace my car’s oil and oil filter, and the engine designers certainly have not made it any easier for me to do the job myself. The government has influence over the car manufacturers pushing them to make this more difficult and also charges disposal fees for handling used motor oil. These items all once again go into a personal calculation that I must make in trying to decide whether it is worth the time and trouble to do the job myself or to pay someone else to do it. Personally this decision has been made much easier by the fact that 1) due to advances in engine design cars do not need nearly the number of oil changes they used to; 2) car manufacturers have provided many of my oil changes as part of warranties purchased when I bought my cars; and 3) I have better things to do with my time than spend it replacing oil. But it is nice to know that it is a choice, and I would prefer that this choice not be taken away from me.

“But wait,” you may say, “it is the actions of the government that have brought about #1 and #2 above, and these have led to clear benefits for society.” To some extent I will agree. Government standards for car engines have in part driven the innovations in the industry, and the benefits include not only the time and trouble saved, but also through preventing people from throwing away their own used motor oil we can prevent carcinogens from seeping into the water table and damaging the environment and public health. There is a level of compromise we can find on these issues, and that is what the political system is all about. There will also always be kooks and fear-mongering on both sides of these issues, but hopefully we can find a moderate position and cooler heads will prevail.

The problem is that we cannot have these disagreements and discussions if a fair venue for the debate cannot be found, and more and more over the years the venue has been tilted unfairly to the benefit of the ones who are running the show. The thumb on the scale has been provided by the bureaucracy itself, which benefits regardless of the outcome of the debate.  To use the analogy of the casino, the house always wins. It is no accident that the richest communities in the country surround Washington, D.C.

This is where the United States has historically been able to differentiate itself from our European counterparts. From the time of our founding the American ideal includes a fundamental skepticism and distrust of government itself. That is why our system was built with a large number of checks-and-balances in order to try to prevent those entrusted with leadership from abusing their power. And to a large extent this has been a very successful experiment, with the country flourishing and leading the world in almost any measure imaginable. Standard of living? Check. Wealth? Check. Personal freedom? Check.

But then we start to run into a few places where our European counterparts may have us beat. Personal happiness? We do not necessarily top the list there. Time off for dedication to leisure, family, or other personal pursuits? Nope, we clearly don’t win there (although we could certainly argue that this is again a matter of personal choice). Health care? While I would argue that we clearly lead the world in the quality of health care that we can deliver, and we lead the world in medical innovation, we have not led the world in providing an adequate level of health care to all of our citizens. And herein lies the divide that we find in our modern politics. How much personal freedom do we need to sacrifice in order to maximize the benefit for all?

We will return to health care later, but let me get back to the subject of this current discussion, driving. President Obama notoriously created a sensation with his statement “You didn’t build that,” which was a revealing moment in his presidency. The statement showed where he stood on this spectrum we are talking about – community versus individuality – and was so divisive and inflammatory not just because it was dismissive of the beliefs of approximately half of the electorate, but mainly because it was delivered in such a condescending manner. Not only was Barack Obama claiming that he was right on this issue, but he was saying that anyone who disagreed with him was somehow a bad person, because they didn’t appreciate the contributions of others.

I will use the roads as the example here. Certainly I didn’t build the roads, and I owe a debt of gratitude to the people who did. Using the public roads is a privilege and part of the compact I have with my society. But where Barack Obama was wrong was making the assumption that the roads could only have been built by government. The road system could just as easily be an entirely private enterprise, where we pay a company for the right to use their roads. There are plenty of examples where companies provide services that could be controlled by the government. This again goes to the heart of how our political system is to be used, but if we are to use the system to help us decide these issues, when the government itself is abusing the public trust discourse breaks down.

You may not trust a corporation to run the roads in a way that is in the best interest of the public, and I may agree to some extent. But on the other hand, I do not trust government to run the roads in the best interest of the public, and I can give case example after case example of cronyism, nepotism, and abuses of power to back my point. This is where the prison experiments come back up (see my previous musings on this issue). Can we trust the government to do what is best for us? I would argue that while we need government in order to have a just society and to settle disputes, the pendulum has swung entirely too far in the direction of too much government. The people writing the rules and trying to make the public judgments also have had their thumb on the scale, creating an unfair system for their own benefit. We have gone way too far down the road of self-interest overriding the public good. Have we gone too far? I don’t know. The election of Mr. Trump is one step in trying to get back to where we need to be. It is clear to me that Obama and the Clintons represent a low point in the history of our country of how much some people have personally benefitted at the expense of others.

I didn’t build the roads, and I clearly benefit from them, but the government also decides in what way I am allowed to use the roads. I have personally driven hundreds of thousands of miles in my life. In my time on the roads I am personally responsible for at least three accidents where I have been at fault as well as several others where I was not at fault. Thankfully no one was seriously hurt in any of these accidents. Each of these accidents was a learning experience for me, and have contributed towards making me a more careful and attentive driver. I will not bore you with the details of the accidents, but I can tell you that speed was not a factor in any of them, while inattention was the major factor in most.

My driving privileges are currently on probation. This is due to an accumulation of points due to speeding, most recently leading to a charge of ‘reckless driving’ due to excessive speed. I can tell you that while there have been plenty of instances of me not being as attentive a driver as I should have been, none of my speeding tickets has had anything to do with inattention or (in my opinion) recklessness. You may disagree with this, and if so, to some degree I will concede that you may be right. There are reasonable limits for speed that can be set on our roads, and for the most part I will accept that if I speed and I get caught, it is my own fault and I need to pay the consequences.

But, on the other hand, a large portion of our speeding and other driving laws are in place for purposes of taxation. Many local governments fund themselves based on tickets and fines paid, and some nasty obstacles such as red-light cameras have been put into place purely based on profit motive, and not out of a sense of ensuring public safety. The most fair system would be one in which the departments of roads and transportation and the police could come together to determine what the rules and fines should be, while their funding would be dependent on the degree of satisfaction of their citizens and not on the amount of revenue they can generate. This, unfortunately, is not the system we have. Once again we find the heavy hand of government itself weighing down the scale in favor of more bureaucracy, more rules, and less freedom.

In a fair system people who drive slow in the left lane would be ticketed for causing traffic disruption, and people talking on their cell phones and texting would be fined for inattentiveness (this last point is becoming a reality). “What, what, what?” the astute reader may ask, “Aren’t you being hypocritical for first saying that people should be allowed personal choice, and now saying that people shouldn’t be allowed to talk on their cell phones while driving?” What I am saying is that all of these issues exist on a spectrum, all of these issues are difficult, and all of these issues require the political process in order to be worked out among reasonable people. But misuse of the political process for personal profit is unacceptable and should be rooted out with all available energy. Our current government has become too enchanted with itself – and too powerful – and we need to take a step back towards personal freedom.

Fair minded people can agree that a large part of the disagreement in this country is due to an abuse of power. We can go down through the range of issues, and I will point out how misuse of governmental power has led to corruption and is the antithesis of what it means to be an American. Voting rights? I will be happy to concede that in the past there have been both overt and covert attempts to suppress or deny the vote of women and minorities if you are willing to concede that Democrats have been disingenuous in their claims that voter identification laws are somehow racist and misogynistic. It is insulting to women and minorities to say that they are not capable of obtaining identification in order to be able to vote, especially given that in states where voter identification laws have been passed, there has been a mechanism put into place to provide free identification for those who cannot pay to obtain an ID. If the system were fair it would be easy to identify who lives in what district and who is able to vote. Credit card companies and banks somehow are able to keep track of when someone has died or moved, because they have a motive to do so. Government, on the other hand, maintains millions of dead people and duplicate entries on their voter rolls. Why? For precisely the same reason – they have a motive to do so. Politicians can use these millions of improper voter entries for their own purposes. “But, but, but,” you say, “there have never been proven cases of large scale voter fraud.” I agree, but if you think that voter fraud hasn’t happened I have some beachfront property in Kansas that I would like to sell you.

It does not take a large number of votes to swing an election. Look at recent national elections for the Senate and even for the presidency that have come down to a few hundred votes. We are a country of laws, and having a law saying that you need to prove who you are in order to vote is not a such a burden on which honest people can not agree. This is another issue that is easy to demagogue, but then again playing on people’s fears is what it takes for the left to win in this country. I would be willing to go along with a system we have seen around the world where we dip our fingers in indelible ink when we vote, but if such a system were put into place I would also invest in any company who makes a soap that could wash away that ink.

When I went to the Department of Motor Vehicles to have my license reinstated and renewed recently I was asked whether I was registered to vote. I of course answered yes, but was reminded of the Motor Voter Act of 1993. The National Voter Registration Act (NVRA) was an accomplishment of Bill Clinton and a triumph for Democrats. I actually think it is a fine law. But you can’t have your cake and eat it, too. If you want to register people to vote when getting a license, it is only fair to have to show a license to get to vote.

Personal choice

Gary wrote:

The implication of this, when interpreted in light of your analysis, is that people with college degrees aren’t “real people” who "are the people who understand where meat comes from and where trash goes”, and are not " doers and makers of all stripes”.




That seems like a stretch. I don’t think that having a college degree makes you less real, or less inclined to do or make things.   I DO think that a degree puts you less on the economic edge--less vulnerable, on average, to factory and coal mine closings, etc. I believe that vulnerability is really the major factor, which educational attainment serves as a proxy for.




However, while education and/or economics seem to be the strongest determinants of who we voted for, ethnic background and race are also major factors. Blacks and hispanics tended toward Clinton; blacks overwhelmingly so. The only major group that voted strongly for Trump when education is removed from the analysis is whites. (Though that was only slightly the case for white women, who voted 52% for Trump.[2]) This would seem to conflict with such assertions as the election not being about race “at all”. While the election was probably primarily about economics, there is evidence that non-whites do feel disproportionately alienated by Trump. Talk about banning Muslims from entering the country, and how a judge with Mexican parentage wouldn’t be fair, would obviously fuel such concerns. For many people, the thought of friends being deported due to being undocumented immigrants is quite negative. So asserting that the election is "not about race, class, or ideology at all” seems to be pushing the point too far. It could be about all these things, to various degrees.




I’d be interested in any further comments you may have to help me understand your position better.

Thanks for your points, Gary. I have been thinking a lot about the responses I have gotten and what I believe to be the true divide in the country.

My point in my takedown of the New York Times piece is that I agree that the divide is along an identity line, but not one that has been clearly defined in the past. The old identity lines have fallen along obvious demographic identity lines: race, income, education level, religion, etc. The writer of the New York Times essay argued that the line is not an ideological line, and to the point that it does not fall along the antiquated and staid definitions of left/right, Democrat/Republican, and liberal/conservative, I tend to agree. But what eluded the writer and to some extent still eludes me is exactly what the divide is. I have a deep sense of the divide, but putting it into words and defining it outright has been the challenge.

After further contemplation I have started to become convinced that even trying to distinguish this as an identity versus ideological line, as the NYT writer was asserting, is problematic. Because our internal sense of identity is highly interwoven with our personal ideologies. If I identify myself as a Christian, that also says a lot about what I believe, although from my years of self-identifying with atheists and agnostics, I can tell you that it is deeply personal and is not so simple as what any other ‘Christian’ could tell you about my belief.

So too do my identities as ‘white’, ‘male’, ‘straight’, and ‘American’ transcend the simple boundaries which are proscribed by simple demographic categorizations of these boundaries. As I have written before about sexual identification and sexual desire, I think that we are coming to understand that all of these categories are not simple yes/no, true/false bipoles, but that they all exist on a spectrum of degrees.

“What?!?” the rational and inquisitive person may ask. “How can you say that none of these are dichotomies, when they clearly are?” I can understand the bewilderment that this supposition must cause in some quarters and the degree of confusion, uncertainty, and fear that it may cause as well. But for the sophisticated mind it is not that difficult to understand.

Race is one of the easier ones to clarify. As we all know there is no such simple thing as “black” versus “white” or any other racial identity that we may want to throw into the mix. We are all admixtures of different bits of DNA from many different races over the years. Currently there are a number of different companies offering the service of taking your blood and sorting out the varying genetic markers to give you more of a sense of exactly what racial components you contain. For a while the Food and Drug Administration even tried to stop these companies from doing this on the grounds that this information is too dangerous for people to have for themselves. But it is only dangerous to you if you have a self-interest in keeping people divided into nice little categories, which is what I argue that the left has been trying to do for decades. Because if you can keep people divided into categories, you can manipulate them by demagoguery, which our politicians have become experts at doing.

So too you may manipulate people by playing on their fears of the ‘other’ with sex, religion, and so forth. What has made the left so angry about Donald Trump is that he successfully engaged in demagoguery against them, and they do not like having the tables turned in that fashion. I am not a fan of these tactics, either, and in that way do not condone the manner in which Mr. Trump managed to win the election, although I do have to respect the audacity of the move.

If the divide in our country is not along a simple demographic identity, where does it lie? Here we run into the problem of trying to define a new line where a clear divide does not exist. I have come to believe that the line is in fact ideological, but is goes very deep into one’s core identity. In fact, the subject that I believe is the dividing issue has been a driving area of controversy throughout our popular culture for decades and sits right in front of our eyes. It has driven much of the Apple/PC debate and has been the major plot line of several recent movie franchises.

Before I spell out what the divide is I will tell you that this area of identity drives consumerism, marketing, and fundamentally defines who we are as Americans. It has led to conflict over national security and drives how you feel about Edward Snowden, immigration policy, and the government as a whole. And as with all of the other divides I have mentioned thus far it is not simple, clean, or dichotomous. It exists on a spectrum along with everything else, but defines who you are, where you live, what you eat, and what you do for a living.

Where the divide lies is along the spectrum of self-reliance, personal choice, and personal responsibility. Let me give a few examples of how this plays out in our daily lives.

I have always considered myself a self-reliant person. I feel that I am capable of making the choices that are right for myself, and I do not need a lot of help in running my day to day life. This leads to problems at times because I am often too stubborn to ask for directions or to ask for help finding something in the grocery store. I should be able to figure these things out for myself, and it is only beyond a certain point of difficulty that I want to burden someone else with the responsibility of solving my problem for me. Never mind that there are often plenty of people available and willing to help me with these problems, it is up for me to decide when and where I will take advantage of the help of other people.

If you want to sell me something that contains a lot of options, the biggest mistake you can make is to tell me that you have picked out a package for me, to save me the trouble of doing it myself. If you do not present me with the options and let me decide what is right, I will have little or no interest in the product. That does mean that I will make the wrong decision at times, and I will have to live with the consequences. I am happy to have guidance when I recognize that someone else has expertise that I do not have, but that guidance is accepted under the condition that I trust that the other person is acting in my best interest and not their own.

I am capable of maintaining my own yard – cutting the grass, edging, re-sodding, mulching, etc. In recent years the amount of time required versus the payback in doing my own yard-work has fallen below a certain threshold of worth, and I have started paying a service to maintain my yard for me. If I do not like the way they are doing something, I can always tell them and have them change it, and if they are not willing to do it the way that I want I can always hire another company to do it for me. Giving up the task of yard-work was tough for me because I have always taken personal pride in the appearance of my house, and I have high standards for what I think is a job well done. I have to admit, now, however, that the crew that comes and cleans up my yard does a damn good job, and I am glad that I can spend that time doing something more productive. It is an investment well spent.

I also am capable of fixing things around my house. Our old water heater was causing us problems, and I replaced the thermostat which was unreliable. Later one of the heating coils went bad, and it was only after much struggle to remove the coil which had rusted into place did I hire someone to replace the entire unit. After the unit was replaced the hot water was not to my satisfaction, but I went and adjusted the thermostat myself. After several iterations of this process the water in our house is perfect to my and my family’s satisfaction, but I can always change it again in the future if I like. Again, I get people to help me when the balance of expertise required, money and time to be spent, and the hassle of getting the help works out in my favor. This is self-reliance, personal choice, and personal freedom on display.

I am capable of replacing light bulbs in my house and have done so for years. I recently replaced the light bulb in my in-ground hot-tub as well, but only after having to order a replacement from China on the internet. Why did I have to get a light bulb from China? Because the government has decreed that because of ‘global-warming’, incandescent light bubs are no longer permitted to be manufactured and sold in this country. Never mind that the replacement bulbs do not provide the adequate number of lumens to light my tub, and never mind that incandescent bulbs have done a good job of providing light for people for over one hundred years, some people in Washington felt that it was their job to tell me what I can and cannot do to light my tub. So they removed the choice (or thought they did) and made it much more difficult for me to go about having things the way that I wanted them. In the end, I got my bulb from China, cheaply ordered over the internet and shipped directly to my home, and now happily the bulb is providing excellent, poor-efficiency light for me and my family. Who is being hurt by this? The people who used to work in the light bulb factory here in the U.S. have been hurt. People in Washington got rich from the lobbyists. People in corporate management at General Electric have gotten rich from making people pay a lot more money for more expensive, inferior replacements to incandescent lights. The American public has been hurt because they are having to pay more and their choice has been reduced. We will get to ‘global warming’ and the supposed benefits to the environment by removing the choice of incandescent bulbs in a bit, but for the moment we can all probably agree that this benefit is at least nebulous and intangible, if not dubious. The tea-party movement arose in large part due to this government overreaching, and the Republicans who were elected had an opportunity to repeal the light-bulb legislation, but they chose not to do so. Why? I can only speculate, but I have to believe that big-money interests won the day, and the Washington elitists (the bubble inhabitants, as I have postulated) did what was in their own self-interest at the expense of the common folk. This issue was one of many that combined to making the tea-party movement lose its steam but went on to contribute to the election of Mr. Trump.

“But, but…,” you protest, “what about global warming?” Here we have an issue that is divisive precisely because is goes against personal choice and self-reliance. And, I would argue, an orthodoxy that is so deeply ingrained in the left that they cannot see that it is not proven science, but more of a religion. Global warming is a proxy war for anti-capitalists. They have not been able to win out by convincing people that capitalism, or at least personal choice, is bad, so they have invented other ways of trying to convince people. And in many ways they have been successful. And how could they not be? After all, the global warming nonsense has been taught to generations of children as God-given truth. I can distinctly remember being taught in fourth and fifth grade science about greenhouse gases and the dangers of global warming – and that was thirty five years ago.

“How can you, as a scientist, not believe in global warming?” you may ask. “You are intelligent and thoughtful, and besides the science is settled.” Aha, you see, therein lies the problem. The science is not settled, as no true science ever is. There are hypotheses, there is weight of the evidence, but there is never settled science. But global warming never was and never will be science, it is ideology. It has become a religion in and of itself, all the easier to buy into for people who have forsaken a belief in God. I am a skeptic, and a thinker, and self-reliant, and until you can show me the weight of the evidence I am not willing to buy into your ‘truth’. The science of global warming is very shaky, and the ‘climate scientists’ who sell this malarkey are not exactly the cream of the crop when it comes to scientists. I should know. I was raised by intellectuals and have been taught in some of the best schools in the country. I am more capable and intelligent than most of the people who have taught me over the years, not that I do not appreciate their assistance in helping me become who I am. But you can not tell me that the ‘climate scientists’ have some insight into the world that I do not have, and that they have some special knowledge which eludes me.

What I can definitively tell you, and which if you take away your ideological defenses what I hope can can agree with me are these ‘truths’: 1) Many of the people who work in academia and specifically climatology have an ideological bent that is to the left of average and is overall more anti-capitalist and anti-American than average; 2) Many climatologists are dependent on government and academia for their incomes and their grant money, so they have a personal stake in what they say and what they believe; 3) Statistics can be used to manipulate data to show almost anything you want them to show (we will discuss this more later); 4) There is a lot of demagoguery and self interest in the politics of global warming; and 5) The raw data of climate science is a lot more problematic than most climatologists want to admit.

So while I will leave it out there for debate as to whether global warming is: 1) indeed happening (I would say probably yes); 2) due to human activity on the planet (I would say almost certainly in part); 3) something we can change by a change in governmental policies, specifically through enactment of laws in the United States alone (I would say almost certainly not; 4) something through which a lot of bubble inhabitants have become fabulously wealthy at the expense of the common folk (I would say demonstrably so); and finally 5) something to continue to debate about (I remain dubious), I will say that there are a lot of people who need to rethink their own personal stand on this issue.

Again, it all comes down to personal choice. And now that this is getting very long (many people probably said tl/dr long ago) I will leave it at that for the time being. More later.

 

 

What Trump Exposed About the Coastal Elites

A significant emanation of hysteria has arisen from the left surrounding this election. Usually, this tripe can and should be ignored as being the emotional catharsis of ‘sore losers’; however, there are occasions when, amongst the compost for which the New York Times paper is fit, the analysis presented is so misguided and off-kilter that one must assume the writer to be either mentally unhinged or impossibly naïve to such extent that it arouses pity in the reader and, in a spirit of compassion, or at least condolence, a desire to set a fellow right.

It is in that spirit in which I have come to review and amend the following scribblings of what was purported to be ‘opinion’ – but should rather judiciously be labeled a ‘hack piece’ – which was graciously lavished upon us malcontents in flyover country by Mark Schmitt of New America, a veritable alabaster citadel of the Atlantic Coast effete elite.

We start with a promising title: “What Trump Exposed About the G.O.P.“, which for those of us who are interested in this particular parlour game of political punditry promises to possibly deliver some insight as to what in the hell the ‘#NeverTrumpers’ were thinking.

The introductory section, or ‘place-setting’, shall we say, of the piece is rather unremarkable:

The election of Donald J. Trump will bring as sharp a turn to the right as this country has seen since at least the election of Ronald Reagan — thanks mainly to the rare conservative control of Congress, the presidency and, before long, the Supreme Court.

But in a strange and unforeseeable way his campaign and election mark the end of the era in which American politics is defined by ideological conflict.

Ever since the election of Reagan 36 years ago, American politics has been marked by profound ideological division, increasing polarization and often paralysis. The ideologically coherent and often unyielding conservative movement represented the dominant theme, while liberals (many of whom wouldn’t even use that word) struggled to find a pitch as clear and appealing as the right’s message of lower taxes, smaller government and strong defense.

although, from a critical point of view, this last sentence begs the question of what word exactly ‘liberals’ would use to describe themselves. I suppose that ‘progressive’ is the word that most immediately comes to mind, although it should be pointed out that since the modern left is neither liberal nor progressive, we might as well describe them as ‘turquoise’, ‘mimsy’, or perhaps even ‘sesquipedalian’.

Now we come upon the opinion part of this exercise, henceforth to be known as ‘the hypothesis’:

The election of 2016 is the culmination of this ideological era, but ironically reveals its hollowness. The politics of 2016 breaks entirely along lines of identity: first race or ethnicity, followed by gender, level of education, urbanization and age.

The first mystery of the year was how Donald Trump won his party’s nomination, but more important, why 16 others, including popular governors and senators, lost. The answer is simply that all the others thought the key to the Republican base was ideology. Some, such as Senator Ted Cruz of Texas, styled themselves as the purest and most adamant of conservatives, others as just practical enough to deliver on conservative goals and one (Gov. John Kasich) as sort of a moderate. None of them clicked with the Republican base, simply because ideology wasn’t what motivated the base. It was always about identity, about them and us. Only Mr. Trump had that key.

Here we can pause and recognize that the man has actually discovered one nugget of the truth, but then as quickly he has found something, he has lost it again, suggesting right from the outset that we are dealing with a blind squirrel rather than an oracle. For as indeed the political breaks were along lines of identity, the writer immediately jumps to using an outdated leftist hierarchy of identity groups, missing the one and only identity that mattered this election year. Though it is not surprising that most of the media have been using outdated models for their prognostication, given that the Communist Manifesto hit its heyday almost exactly one hundred years ago and Alinsky’s Rules for Radicals is past due for mold remediation, it is nonetheless fascinating to see the depths of the cluelessness revealed here. Considering those of us here in Mudville today were not alive to witness for ourselves the mighty Casey, we can be thankful to the writer to have given us an example of such a devastating swing-and-a-miss.

So, you ask, just what is it that the writer was missing here? It is, in fact, the one identity group that the media elites cannot see from their own vantage point. To Flatlanders bubbles may appear as mere circles; for those away from the coasts they are usually thought of as transparent or at least translucent, iridescent spheres; but for the elites living in the bubbles we must remind ourselves of the attenuation coefficients and refractive indices which clearly befog their vision.

For the identity which is so elusive to our writer is right before us: the identity as ‘real people’. Call us ‘everyday men’ or ‘authentic Americans’ or ‘folk’, we are the people who understand where meat comes from and where trash goes – not from some empathetic position in intellectual space but from actual experience. We live where the rules meet the road and the time for academic preparation is over. We are doers and makers of all stripes. It is not about race, class, or ideology at all, but it is about substance.

At the end of the day, all of the globalists, communalists, speculators, and other spin-meisters must ask themselves what have I done today of substance, what have I done that matters? Because the stark reality of it all is that most of the effort has been spent towards building the bubble itself, reinforced with as much self-congratulation and insulation that borrowed Chinese money can buy.

But let us get on with the rest of this navel-gazing piece in which the Gray Lady has us mired:

Consider immigration, the concept that drove both the Tea Party and the Trump campaign. For most of the long campaign, the media thought that it was about immigration policy: comprehensive immigration reform versus border security and deportations. The Republican “autopsy” from 2012 concluded that Republicans should support immigration reform. But it turns out it was always just about immigrants, as in, people who aren’t like us, not policy.

That’s why Trump supporters were unmoved by reports that Melania Trump had worked in the United States without authorization, and it’s why Mr. Trump, in a late rally in Minnesota, declared that the state had “suffered enough” from the presence of Somali immigrants, a well-settled middle-class group in the state for more than two decades. It’s why Mr. Trump found his strongest support not in areas most affected by immigration but in aging states with the lowest number of foreign-born residents, such as Ohio, Iowa and Wisconsin, where immigration is mostly a distant symbol of otherness.

A repeated mistake throughout this campaign has been the assumption that all motivation is driven by racism and xenophobia, but we can forgive this misunderstanding if we recognize that this is the prism through which the left has always viewed the world. It is also problematic to disparage the people of states in which one would likely not deign to set foot. I would suggest a viewing of ‘Gran Torino’ for those who are lost. As for Mr. Schmitt I suspect that it is a hard day’s work that is a ‘distant symbol of otherness’.

Ideology had formed a kind of a comforting curtain around the more intractable divides of race and identity. Ideological conflict, as deep and irresolvable as it often seems, at least in theory, lends itself to persuasion and compromise, such as President Obama’s long quest for a “grand bargain” on spending and taxes. Ideology can help structure people’s engagement with politics, giving them clear preferences organized around a few core values.

But ideology can also be hard work — most people don’t have the time or inclination to decide if they are “liberal” or “conservative,” and what that means, or to fight about it.

The problem with most political pundits is that they do not have a clear understanding of why things are the way they are and what historical implications they contain. It is indeed quite unfortunate that our modern discourse has found itself entrapped in “liberal” and “conservative” camps, but these camps themselves were built by the bubble inhabitants. ‘Democrats’ and ‘Republicans’ are nowhere to be found in the founding documents or ideology of this country and the constraints of the modern two-party system have been built by a self-serving civil bureaucracy. I agree that most people don’t have the time or inclination to try to dovetail their views and shackle themselves into one of these two preselected confinements, but this says more about the problematic system than the people themselves. People do have a sense of right and wrong, and given a system that more fairly allowed representation of differing views we may have a more civil discourse.

What we need is a repeal of large segments of the code that drives our current bureaucracy. Were we able to do that, through the sawdust and mildewy encrusted remains we may be able to scavenge the hope and ideal that is America. For anyone who needs a reminder of what that America represents I suggest that you start your reading with Jefferson.

Most of the remainder of the article may be dispensed as more of the same hackneyed dribble, but the end of the essay does merit some further discussion:

Rather than a pragmatic fixer-upper, Mr. Trump now seems likely to be the vehicle through which the ideological right achieves its decades-old dream of undoing the Great Society and the Warren and Burger courts. But the victory that made that possible was based explicitly on identity, not ideology.

Here we have the fears of the writer unveiled, that a Trump presidency will lead to a repeal of civil-rights law, abortion on demand, and cradle-to-grave entitlements. I do not share those fears, because I believe that good will prevail. No honest person wants a return of racist laws, and compromises can be found on the other issues. Hopefully the scaremongering and other ‘progressive’ canards will fall by the wayside as this train moves along.

This brings us to a quick discussion of ‘rights’. I believe that we need new language to talk about the compact that citizens would like to have with government. Our founding fathers were quite astute when describing the rights to ‘life, liberty, and the pursuit of happiness’. I hear about all sorts of other perceived ‘rights’ such as the ‘right’ to an education, the ‘right’ to health care, and the ‘right’ to a job. These can never be ‘rights’ given to all, because they each require the work of another individual to be obtained. If you have a ‘right’ to health care you have then enslaved someone else to act as your doctor.

It would be more precise to say that because we live in a land of plenty we have an ‘expectation’ of a job, an ‘expectation’ of health care, and an ‘expectation’ of ongoing education for all of our people. But with expectations come responsibilities, and if you are going to take from the system you must put in real, actual work yourself. Working in and for the system is a privilege that should be appreciated, contained, and restricted, a thing some people i.e. the Clintons seem to have forgotten, if they ever believed it to begin with.

President Trump

Perhaps there is some hope for this country after all. Independent thinkers and rugged individuals throughout this land can rejoice – the tyranny of the nanny state just may be peeled back a little bit over the next few years.

Champions of the rule of law should also feel bolstered. There needs to be a house cleaning at the Department of Justice, and there will be bills to pay at the Internal Revenus Service as well as the Federal Bureau of Investigation. But this is also a time for grace – we do not need to tar and feather the Clintons, just put them in jail.

The damage to the media may be the hardest to repair. The organizations that we depend on to bring us information will have to be fundamentally transformed after this campaign. The outright lies told by much of the ‘mainstream media’, particularly the Washington Post, are an embarrassment to our country, and should be taught as examples of unethical practices in journalism schools for generations to come.

And in medicine this should give further encouragement to those fighting against the bureaucratization of clinical care. It is time to put caring for patients back into the spotlight instead of meaningless paperwork and administrative calisthenics.

Hopefully this catharsis after eight years of incompetent governance will lead to a new way forward where we no longer discriminate against people based on race and gender, but be able to recognize dangerous ideologies for what they are.

More leaks: Democrats target ‘near dead’

No

On Sunday, March 20, 2016, Sara Latham <slatham@hillaryclinton.com> wrote:


> 
> What do you think of this?
> Solid plan to add to increased turnout to counter Bernie whackos.
> 
> 
> 
> 
*From:* Gary HIRSHBERG [mailto:GHIRSHBERG@Stonyfield.com]
*Sent:* Friday, March 18, 2016 3:39 PM
*To:* John.Podesta@gmail.com
*Cc:* Jake Sullivan <jsullivan@hillaryclinton.com>
*Subject:* Thanks for whatever role you might have had in this...


Since we have now consolidated the groups re: registering dc’d voters and have their guarantees of 11-13% inc turnout for HRC should we consider looking to another sure-fire bid for hard vote count? Remember POTUS take on fickle AA and Latinos that may not show esp if bad weather. Got this proposal from Priorities USA.



---------- Forwarded message ----------

> From: Jesse Ferguson <jferguson@hillaryclinton.com
> 
> Date: Wed, May 6, 2015 at 5:26 PM
> Subject: Priorities USA
> To: HRCRR <hrcrr@hillaryclinton.com>, Dennis Cheng <
> dcheng@hillaryclinton.com>, Marc Elias <melias@hillaryclinton.com>, Robby
> Mook <re47@hillaryclinton.com>, Charlie Baker <
> Charlie.Baker@deweysquare.com>, Jennifer Palmieri <
> jpalmieri@hillaryclinton.com>, Kristina Schake <kschake@hillaryclinton.com
> 
> 
>We have identified a previously untapped group
>that will help insure Democratic majorities for
>years to come. While we have long relied on the
>vote of dead citizens still on the election rolls,
>we now would like to propose a campaign to go after
>the 'near dead'. These include not only elderly
>people but also chronically sick patients, many of
>whom are currently not voting. Many of these
>citizens are too mentally impaired to have an
>informed vote, making them ideal candidates for
>Democratic recruitment.
> 
> 
>Our current proposal involves financial
>incentives to family members to provide us
>the names of the 'near dead', and then make
>sure that those people do not go to the polls.
>This will include additional financial
>incentives to keep these people out of the
>hospital, and not report their deaths to
>authorities. This will not only allow our
>representatives to vote in place of these
>citizens in perpetuity, but will also save
>considerable money for the health system.
>In this way the program will easily pay for
>itself in the long run, with the Medicare
>savings alone possibly running into the
>billions of dollars.
> 
>As far as mobilizing our volunteers to the
>polls to vote in place of the 'near dead',
>this can easily be done as an extension of
>our current system for voting for the already
>deceased. Our system of vans and union
>volunteers may need to be supplemented with
>buses, but we anticipate that the costs of
>this expansion will be low, and definitely
>can be offset by fewer outreach efforts for
>the living, whose votes will become less and
>less important over time.
> 
> 
> 
















 

The Psychology of Tyranny

During a recent discussion the old adage about a frog and boiling water arose. People know the story so well it has become stale. It has lost its effectiveness as a metaphor because as soon as you start talking boiling-frogabout the frog and the pot their eyes glaze over. The most interesting part is, like a lot of things in life, what we think we know to be a solid fact often isn’t true. Even heated slowly, at a certain point, if the frog can get out, it will. The problem is that our current science does not allow us to ask the frog how it feels about its environment, and given that we don’t even know what the hell human consciousness is all about, it is difficult to speculate on the level of self-awareness of our amphibian compatriots.

But people can tell us what they think and feel, and at a certain point in a deteriorating environment, hopefully before a critical maximum is reached, a revelation will occur, and people will try to escape.

redflatbarkbeetle

In zoology we can study the critical thermal minima and maxima of different species, and we find that some are more cold or heat resistant than others. Red flat bark beetles (Cucujus clavipes puniceus) essentially have antifreeze in their tissues and can survive in temperatures as low as -58°C with their larvae able to survive to around -100°C. In the oceans Pompeii image_1116-pompeii-wormworms (Alvinella pompejana) can survive in water over 80°C, and on land the Sahara desert ant (Cataglyphis bicolor) thrives to a critical thermal maximum of 53.6°C.

But the king of resistance is the tardigrade (Hypsibius dujardini), also called the water bear. This little sucker can survive to almost absolute zero and up to 150°C. Considering it is less than 1 mm in length, it takes electron microscopy to reveal the cuddliness of this bear.

tardigradeThere are critical minimum and maximum points of governance, as well, but they are different for different people. Some people could thrive alone, with little to no supervision after a sufficient childhood learning period. Others require leadership and structure just to be able to survive. There are examples of people who were raised in the wild, without parents to teach them and with minimal human contact.

structure
Some people need more structure than others.

At the other end of the spectrum, theoretically everyone has a maximum point of governance, the point beyond which even the most law-abiding and submissive types will crack and rebel, but these thresholds are vastly different based on upbringing, environment, and political leanings. Call this the critical governance maximum (CGM).

Actually, the psychology of obedience to authority has been examined in a number of fascinating studies, and as with most things in life, the story is complicated.art-milgram Probably the most famous research was done by Milgram in the 1960s and 1970s. In these classic experiments volunteer ‘Teachers’ were ordered to deliver electric shocks of increasing  voltage to ‘Learners’ to ostensively try to improve memory tasks. In reality the shocks were fake, and the experiment was to see how far the ‘Teachers’ could be pushed. The disturbing finding of the study was just how compelling the authority figures could be – all of the volunteers delivered what were thought to be very painful shocks and two thirds were willing to go all the way to a dangerous 450V shock when told to do so. These studies have broken through to the popular culture – so much so, in fact, that the “Law & Order: Criminal Intent” rerun on while I was writing this post highlighted Milgram’s experiments as a motivation for the killer. D’Onofrio made that show, but I have to say that I like Jeff Goldblum as well…

_law_and_order_criminal_intent_to_take_on_spider_man_musical_accident

The Stanford Prison Experiment (SPE) also delved into this territory, randomizing college student volunteers to be guards or prisoners in a mock prison in the basement of the Psychology Department. This experiment is often cited as an example of the abuse of power, but the reactions of the ‘prisoners’ are as interesting as the role-play of the ‘guards’. Despite being student volunteers paid for the study, the participants internalized their roles. The guards became brutal and on just the second day the prisoners revolted.

One of the main findings of these studies was an understanding of what led people in power to abuse that power. Arendt’s book about the trial of Adolph Eichmann, published in 1963, introduced the idea of the banality of evil. She had been struck by the fact that Eichmann did not come off as a monster during his trial, but as an almost disinterested bureaucrat. Later writings of Milgram from 1974, largely influenced by Arendt, attributed the actions of the ‘Teachers’ in his studies not to any prior sadistic tendencies or motivations, but to the subjects taking on the role assigned to them in the studies. He described this as an ‘agentic state‘, where

the essence of obedience consists in the fact that a person comes to view themselves as the instrument for carrying out another person’s wishes, and they therefore no longer see themselves as responsible for their actions

Zimbardo’s conclusions from the SPE also supported this idea. He thought that the guards’ brutality derived from the role that they were put in, not from personal characteristics of the volunteers. He argues that almost anyone, given the right situational influences, can be made to abandon moral scruples and cooperate in violence and oppression, a problem he termed the Lucifer effect.

The findings of Milgram and Zimbardo dominated social theory for decades, although they were not universally accepted. Some critics have felt that these theories excuse horrific war crimes by the Nazis, and also the abuses at Abu Ghraib, particularly by lower level officers and enlisted men because they could claim that they were “only following orders”.

In fact, detailed examination of both Milgram’s experiments and the SPE do not entirely support their own conclusions. Milgram found substantial resistance by some subjects in his studies to carrying out shocks, and he did not publish his results until he had gone through many revisions of the experiment. The events divulged showed that while some ‘teachers’ resisted strongly and refused to carry out more severe shocks, other participants seemed to enjoy subjecting the ‘learners’ to pain, carrying out the shocks with zeal and even joking about the process. Milgram himself admitted that his study was as “as much art as science.”

The SPE had similar aspects which seemed to contradict the ultimate conclusions. Some of the guards were much easier on the prisoners than others, while the most sadistic guard, nicknamed ‘John Wayne’, seemed to take great pleasure in coming up with creative ways to punish the prisoners.

These reexaminations as well as more recent works in social identity theory have begun to challenge the idea that people will passively conform to authority. Current theories identify an in-group, or “tribe”, that people associate with, and instead of passive obedience, what is observed is an engaged followership. The authors of the BBC Prison Study (BPS) say:

people’s willingness to accede to the requests of others is predicated upon social identification with them, and an associated sense that they are legitimate representatives (emphasis mine) of shared group goals, values, and aspirations.

A main idea that has emerged from the BPS is that individuals need to come to identify with their group and its leadership before acting in a tyrannical way. Haslam and Reicher say that in order to carry out evil acts, people need to be able to justify their actions as ‘good’ in some way, a process that is easy for some people – those who may have more antisocial or sadistic tendencies – but more difficult for others. Peoples’ own identities converge with their group identity.

This new theory also better explains the fact that while some Nazi concentration camp guards took to their tasks eagerly and energetically, others were hesitant and only acted under direct orders. They had actually convinced themselves that they were acting for ‘the greater good’. This has been noted not only in holocaust memoirs by prisoners such as Frankl, but also in the Nazi’s own notes, where they categorized guards as cooperative or difficult.

So now we have discussed social identity theory and what drives people in power to tyrannical acts as well as what drives those under them to obey or resist authority. Besides being of general interest, what does this have to do with anything – specifically, why are we talking about this here?

nomoc

The analogies to the Maintenance of Certification (MOC) system should be clear. First of all, this program has been put into place through long and convoluted arguments that MOC is ‘good’ for physicians. Despite the assertions of the American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM), for whom this program represents a major conflict of interest, there has been no general outcry by patients for this program, and despite some political posturing there has been no real proposal for Congress to put such a system in place. There is also no proof that this program serves any purpose for the benefit of patients, while the evidence of the harm of this time- consuming, expensive, and demoralizing system is clear. In fact, the only ‘benefit’ of the system seems to be the great financial benefit to the non-practicing physicians and bureaucrats who run the system – this is cronyism at it’s worst.

We can therefore say that this system is not ‘good’ for patients or physicians, but represents an ‘evil’. Only through self-serving justifications have our ‘leaders’ deluded themselves that this cronyism is for the ‘greater good’, and convinced us that it is a necessary evil.

So, if this system is so obviously bad and corrupt, why have doctors accepted this program and are only now starting to object to it?

Like the frog in the warming water we have only now realized that it is getting hot and we are trying to get out. Unfortunately, the bureaucrats have devised a pot so tall, steep, and slippery that we are finding it difficult to escape. For years we have obeyed authority, partially because this is the role that we have been placed in, partially because this is how we have been trained to act through years of having to follow authority without question, and partially because we have accepted our physician leaders as part of our in-group, acting in the group’s self-interest.

It is only recently that we are recognizing that our ‘leaders’ are no longer part of our in-group, but represent their own new group of non-practicing robber barons. Practicing physicians do not get high six figure salaries, reimbursement for spousal travel, and chauffeur driven limousines for little or no work. Practicing physicians do not get to commit tax fraud with impunity. Practicing physicians do not get to lose millions of dollars, and then demand money from their colleagues to cover up their incompetence.

So now we see that the ABMS and the ABIM are no longer our legitimate representatives. It is time for all physicians to refuse to participate in MOC. We must lobby our legislatures to pass bills such as in Oklahoma, giving us the right to work free from the MOC tyranny. For all of those who argue that we have no choice because the hospitals and insurance companies require it, we must stand collectively. We have more power than you might think – the medical system in this country cannot operate without us. There is no need to succumb to weakness and ignorance. Support the NBPAS, and do not send another cent to the ABIM, or any of the other ABMS bureaucracies.

For those of you close to recertification you may have to give in to keep your job, because the system has a lot of momentum, and many hospitals and insurance companies have not yet seen the light. But for all of you who are years away – please, please do not send any more money to these corrupt organizations. The only way to kill this monster is to starve it of its food – no more money.