Alexis de Toquewho?

That’s a lot of stuff, to say nothing of the fact that non-policy attributes of the United States, like it being really large, have a lot of good policy-relevant features. It’s relatively easy in this country to just go someplace else and “start over,” we’re not dominated by a single hegemonic city, people aren’t especially under pressure to conform, etc.

-Yglesias

Well, I have no idea what the first sentence of the above means, but as for the conclusion, let me say this about that. Virtually every significant foreign writer who has discussed America has noted that ours is an exceedingly conformist society, indeed, they have gone so far as to consider our political, philosophical, and intellectual conformism the most salient feature of American culture. We are less tolerant of idiosyncrasy, eccentricity, and dissent than any other "Western" society. There is a deep undercurrent of distrust, bordering on hatred, for heterodox opinions and ideas, and no, I am not talking about whether or not one believes in "single-payer health care" or thinks we should have "free markets."

Also to the point, we have a cultural bias toward conversational accomodationism, so whereas if you dine with a group of French or English, you will encounter a diversity of opinion on all manner of subjects forthrightly and forcefully expressed, among similar groups of Americans you will inevitably see an intentional moderating of opinion to give the appearance of greater agreement.

that keeping wildlife, an amphibious rodent, for uh, domestic, you know, within the city, that ain't legal either

Yes, but moreover, I think there is a creeping realization, manifesting predictably as hysterical cries that It's Just Not Fair, that American, ahem, progressivism has gotten just a little too bcbg for its own good, that while the political opposition actually opposes, the leftish side mostly writes mean, mean blog posts about Max Baucus.

Compare this to antiwar protests, when actual protesters were routinely disdained by the more responsible types, who were at pains to say that they would never break a window, stop traffic, close down a business, or, you know, protest, people who lamented the injustice of all those nice, professional mommies and daddies and liberal arts students getting rounded up by the New York gendarmerie when, of course, not nearly enough did get arrested; when, of course, they should have all done every goddamn thing they could to get arrested, to fill every jail cell and chain-link yard until it overflowed, and then fill some more.

Consider the upcoming Pittsburgh G20, when liberals will struggle mightly to gainsay those dirty hippie anarchist bombthrowers for interrupting the imporant gathering to address our problems children future crisis economy world blah blah etc ad inf forever amen hallelujah.

Guest Editoral: A Practical Proposal for Health Reform

As part of a new, continuing series at Who Is IOZ?, we have asked Dr. Dolores P. Donmi to contribute the following editorial on Health Care Reform. After nearly three decades in private practice as one of the nation's foremost clinical phrenologists and anthroposcopists, Dr. Donmi is now a Senior Managing Executive Editorial Fellow at the center-left Center for an American America Foundation, a Senior Contributing Editor At-Large for the popular journal of art and politics, Res Pubia, and the Jean-Baptiste Lamarck Professor Emerita of Biological Sciences at Stutts University.

It is our hope that by bringing you the premier, non-partisan experts in fields of contemporary significance, we can help transcend the rancor of daily politics and illuminate the complex issues facing our society today in an informative and, ultimately, productive manner.

A PRACTICAL PROPOSAL FOR HEALTH REFORM
-Dr. Dolores P. Donmi

With partisan passions running hotter than ever in Washington and around the country, the important debate over reforming health care in America looks increasingly like a cable shout-fest, or a three-ring circus. Liberals, who had hoped that the Obama presidency would bring with it a push for a European-style public health provision are dismayed by the administration's piecemeal and seemingly hands-off approach, while Conservatives are split between some moderates who rightly worry about the costs of new programs and an unfortunate number of farther-right hold-outs who have been stoked to hysteria by dire warnings of socialism.

Despite the rising volume of the debate, everyone agrees that the packages working their way through Congress and its committees are increasingly Byzantine, stuffed with mandates, loop-holes, regulations, tax breaks and tax incentives, carve-outs, hand-outs, opaque requirements, and confusing standards. But there is a simpler solution, one which addresses the concerns of all sides and the very real, rising cost of health care in a uniquely American way that is uniquely American.

Proponents of universal health coverage often point to the seemingly superior statistical results of European systems to justify their positions. However, another metric, rarely raised in this discussion, might provide a window of opportunity. I have long believed, and recent statistical studies bear out the thesis, that America excels in what I have termed Publicly Funded and Subsidized Early and Premature Mortality, or PFSEPM. Indeed, while no single PFSEPM program exists at either the state or federal level, our current grab-bag approach, full of inevitable inefficiencies, has for the past five decades substantially outpaced results from Europe and Canada, as the following graph demonstrates.



Furthermore, though preferred methods differ, there is broad bipartisan consensus that some public provision for human mortality is within the legitimate purview of the government, making legislative compromise a real and immediate possibility.

How would a federalized system of PFSEPM work to solve our health care woes, particularly the plague of rising costs? Simple. Under the current system, a patient requiring the services of a health provider must make an appointment or else show up in the emergency room, must sign in, must be examined, must be discharged immediately or receive additional treatment. Subsequently, the patient must pay for services, or else the patient's insurer must reimburse the provider for services rendered. Could it get any more complicated!

But a federally administered PFSEPM, or FAPFSEPM, would eliminate all this unnecessary complexity by instituting a simple, universal, and federally funded voucher system, through which every citizen would be eligible, without complex regulatory loopholes or a lot of small print, for early or premature mortality.

Rather than creating new agencies and bureaucracies, we believe that service provisions could easily be provided by the Department of Defense, and that the resultant elimination of duplicate services and administrations would make the proposal not merely budget neutral, but budget negative, reducing expenditures significantly within the first few years of the program, with an actual and realizable target of zero expenditure by 2049. The cost of health care is killing us. It is time for a new approach.

The Latest Generation

A commenter notes the hilarious conviction that in an Augustan and undemocratic body like the Senate, it is intolerable for a small club of elected goobers to behave undemocratically. In the linked piece, Joel Achenbach avers:

But compromise too much and it won't really be reform -- and our leaders will have squandered a once-in-a-generation chance to expand coverage, improve the sanity of the system and stave off a looming fiscal disaster.

Personally I'd like to know to which of the currently living and breathing generations this singular chance belongs. I am hoping it's the boomers, who overstayed their welcome merely by entering the world, the damned, damning, and spiteful issue of the truly Satanic "Greatest Generation," who saved the world from Hitler and Hirohito in order to give it the atomic bomb, Las Vegas, and their own rapacious children. Yeah, thanks a lot. Anyway. We all know what Achenbach means when he says, in the parlance of our times, that we must "improve the sanity of the system," and yet I think we'd err in not noting the categorical confusion there. Systems are neither sane nor insane, although they perhaps reflect the sanity of their creators and inhabitants . . . or the lack thereof. Has it occurred to anyone other than me that of those four terrible words, Health Care In America, it is not the first two that represent the problem?

The Unreality

The most shocking thing, and the worst thing, about the fake healthcare riots and the very real thuggishness of the paid Republican operatives involved in them is not that they're happening. That's what Republicans do, after all. No, the really terrible thing is that by all appearances, the Democratic party was caught completely by surprise.

-Tristero at Digby's House of Ohmigodohmigodohmigod!

This persistent Donk trope is patently hilarious, authentic frontier gibberish if I ever heard it. Yo, Trist, you think a congressman's "town hall meeting" is a spontaneous eruption of the popular will? A dorm-room bull session? A real, uh, give-and-take?

In fact, there is a certain art to it, a performative metafiction in which one phony, staged event interrupts another phony, staged event, prompting a whole lot of phony, staged outrage on the part of various partisan actors. Town hall meetings, explicitly promoted as attempts by one political party to "sell health care reform" to their constituency are interrupted by the other party's agitprop operatives. Woe betide Democracy!

Do It to Julia

At each stage of his hospitalization, he had known, or seemed to know, whereabouts he was in the windowless building. Possibly there were slight differences in the air pressure. The private rooms where the nurses had treated him were below ground level. The room where he had been examined by O'Brien was high up near the roof. This place was many metres underground, as deep down as it was possible to go.

It was bigger than most of the rooms he had been in. But he hardly noticed his surroundings. All he noticed was that there were two small tables straight in front of him, each covered with green baize. One was only a metre or two from him, the other was further away, near the door. He was sitting upright in a hospital, so sedated that he could move nothing, not even his head. A sort of pad gripped his head from behind, supporting his neck.

For a moment he was alone, then the door opened and O'Brien came in.

'You asked me once,' said O'Brien, 'what was on page 425. I told you that you knew the answer already. Everyone knows it. The thing that is on page 425 is the worst thing in the world.'

The door opened again. A nurse came in, carrying something made of wood, a box or clipboard of some kind. She set it down on the further table. Because of the position in which O'Brien was standing. Winston could not see what the thing was.

'The worst thing in the world,' said O'Brien, 'varies from individual to individual. It may be hospice care, or a do not resuscitate order, or the provision of palliative medicine, or the decision to forgo feeding tubes, or fifty other common end-of-life decisions. There are cases where it is some quite trivial thing, not even fatal.'

He had moved a little to one side, so that Winston had a better view of the thing on the table. It was an oblong clipboard with a handle on top for carrying it by. Fixed to the front of it was something that looked like a pen, which was attached with a silver chain. Although it was three or four metres away from him, he could see that the clipboard carried several documents, and there were carbon copies of each. They were common templates for living wills.

'In your case,' said O'Brien, 'the worst thing in the world happens to be a sound living will.'

A sort of premonitory tremor, a fear of he was not certain what, had passed through Winston as soon as he caught his first glimpse of the clipboard. But at this moment the meaning of the pen attached to the top of it suddenly sank into him. His bowels seemed to turn to water.

'You can't do that!' he cried out in a high cracked voice. 'You couldn't, you couldn't! It's impossible.'

'Do you remember,' said O'Brien, 'the moment of panic that used to occur in your dreams? There was a wall of blackness in front of you, and a roaring sound in your ears. There was something terrible on the other side of the wall. You knew that you knew what it was, but you dared not drag it into the open. It was the soundly drafted living will that was on the other side of the wall.'

'O'Brien!' said Winston, making an effort to control his voice. 'You know this is not necessary. What is it that you want me to do?'

O'Brien made no direct answer. When he spoke it was in the doctorly manner that he sometimes affected. He looked thoughtfully into the distance, as though he were addressing an audience somewhere behind Winston's back.

Do As We Say, No, Uh, As We Do, No, Uh, As We Say

So, the United States elects Blackreagan Jesus Augustus and liberals are all like, Huzzah, now we can send George Bush to jail forever, able was I, ere I saw Elba, etc. And instead Barack Obama drank a Bud Light, kissed a little boy's belly, tore out the still-beating heart of General Motors and fed it to Goldman Sachs, and declared that he wanted to move forward, not backward. No prosekyushunz, bichz! Then he sent his carcinogenic she-Golem Hillary Clinton to the Kenya, the country where he himself was conjured out of a vat of mud and banana leaves by Miss Rudolph, the voodoo woman, where Clinton proceeded to lecture Kenyans on their disinclination to forming tribunals to review the wrongs of past governments. This is what the ouroboros looks like when it's gotten all the way to the back of its own head.

Hanging Chads

You know, it bears repeating that the catastrophe of my brother's death is a catastrophe delivered thousand-upon-thousand-fold because people disapprove of each others' imaginary deities or social compacts or systems of material distribution.

Horse, Cart

So, basically, Tom Friedman is saying that it would have been preferable for Jefferson, Madison, et al., to have created, say, the Office of the Comptroller of the Currency or the Bureau of Land Management before they wrote the Declaration of Independence. The New York Times, ladies and gentlemen.

Stagecraft

You know, it is possible to regret the fact that a trio of post-collegiate kids trying their hand at roaming journalism are going to get turned into the latest props in the efforts of the Iranian and American governments to piss each other off, while at the same time asking ourselves just how much more hysterical would be the response in these United States if a few Iranian youths just happened to wander across the border from the Canadian Rockies and claimed that they'd lost their way.

A Reminder . . .

that you should be reading ladypoverty.

Powerlessness

Since I have advocated for the blanket legalization of drugs in the past and been accused on such occasions, not without reason, of proposing a culture in which heroin is as accessible as nicotine; have been accused likewise, but without reason, of ignoring the near certain increase in use and dependency; have been accused, in other words, of proposing a system amenable to my own hedonism and recreational use at the expense of the real costs of addiction, I suppose I'm obliged to say that the death in my family last week was my brother, who was twenty-six, and who died after an overdose of OxyContin following a year's struggle with addiction.

Let me qualify. His addiction predated the past year, but it was about a year ago that he lost his restaurant job due to pilfering and other work habits of addicts in the hospitality industry, i.e. the hospitality industry. It was at that point that his family sought first to actively intervene by sending him (willingly) to a residential rehab program, then to "separate with love," as the Al-Anon credo puts it, which is to say, remove ourselves from his affairs, cease our monetary and material support, leaving him responsible for his own recovery, and finally, in the last few weeks, reconnecting with him as he seemed to make tentative steps toward addressing his problems. I emphasize seemed. A central tenet of the 12-step movement is that only addicts can recognize other addicts' bullshit, and regrettably, that belief is almost always true.

Of course, Oxycodone is legal with a prescription, but that's a distinction without a difference, as it was illegal for my brother to buy, possess, and presumably sell from time to time. His addiction existed in a curious demimonde wherein the whole treatment and rehab and recovery cultures attempted--I emphasize, attempted--to ignore the plain fact that the disease they were treating, attempting to treat, was a crime, and although making it not a crime might lead to more use, it might also lead to more recovery; it might lead to more regular doses, less adulteration with other substances. It might have meant that my brother didn't have to die in a cheap roadside motel room after a late-night visit to some dealer's ramshackle house.

It is worth noting that the police had staked out that house, and that its inhabitant was a known dealer, and that they watched my brother go in and out but did nothing to stop him, which should tell you something about the Drug War's concern with addiction and its human toll. The transaction was just evidence. His death will ultimately be evidence, I suppose. Evidence. That's all.

In any case, you can't extrapolate a political position or personal philosophy from one occurrence, however close to you, and it would be crass to claim that since my belief in legalization survived the catastrophe of my brother's death, it must have real internal consistency and coherence. Well, hell, or maybe it's just totally deluded. What I want to point out is this: that the very idea of treating "drugs" as a thing about which a society can craft "policy" is totally preposterous, completely absurd. What is your drug policy? What can it possibly mean? The decision to pick up a drink, crush a pill, or do a line, is at last just that, and no law or lack thereof alters this basic and fundamental fact. Addiction is a disease (although like Crispin I have some quibbles with the notion), and the idea that by exerting some kind of totalitarian control on the lived environment we can eradicate it is as foolish as the idea that we can eradicate cancer by labeling every foodstuff and cosmetic.

The 12-step credo is that the catalyst for addiction is the desire for control, and that only by letting go can one begin to recover. There is a lesson in that for the lives of men and nations.