The news is everywhere that Iran wants to build a nuclear weapon and is deceiving the West (meaning the USA mainly) about this. But why shouldn't Iran have nuclear weapons and why should Iran be accountable to the USA or anyone else on this matter?
I mean -- and I say this in the first entry of a new blog topic: antipode* -- isn't Iran a sovereign nation? Don't all sovereign nations enjoy ... um ... sovereignty over their government and what their government decides to do within its borders?
Sovereignty is, after all, a nation-state's supreme power within its borders. The United Nations charter explicitly states that "The Organization is based on the principle of the sovereign equality of all its Members" (article 2, para 1).
So where does President Obama get off telling Iranian President Ahmadinejad what to do with his country's nuclear facilities. Isn't that a matter for the Iranians to decide? You might say the Iranians decided when Iran ratified the Non Proliferation Treaty in 1970.
But wait a minute ... who was in power in Iran in 1970? Wasn't it none other than the Shah Mohammad Rezā Pahlavi, installed by a CIA-run coup in 1954, the one whom Amnesty International identified as holding and torturing 2,200 political prisoners, the one whose secularization and modernization plan gave rise to the Shi'ite rebel movement of one Ayatollah Khomeini in 1979?
To say that Iran should be held accountable to treaties signed by a dictatorial monarch, who was opposed to everything mainstream Iranian society today stands for, is tantamount to saying that the United States should respect slave tenure in Virginia, since it was once sanctioned by the Confederacy.
Why shouldn't a contemporary Iran, which repudiates everything the Shah stood for, not be able to repudiate a treaty ratification by that long-deposed monarch?
Besides, who says the United States government has the moral authority to tell any other governments whether they should build nuclear weapons? What makes the USA special? Not its restraint.
Not only did the United States bomb two Japanese cities, killing millions in a flash, with nuclear weapons. At least one presidential candidate -- Barry Goldwater -- advocated doing the same in Vietnam.
What makes the nuclear club -- Britain, France, Russia and China -- so virtuous? They haven't had empires and enslaved millions and been brutal and arbitrary? What reason do we have to believe that if they had had a nuclear monopoly, as the United States had for three years, they would not have bombed their own Hiroshima and Nagasakis?
OK, so Ahmadinejad rigged the elections. Didn't George W. Bush get "elected" in 200 and 2004 by fraud? Wasn't it alleged that Mayor Daley's deceased voters had put John F. Kennedy over the top in 1960?
Let the politician who has never made an unsavory deal, never taken money from companies opposed to every item of his public agenda, never arrived to power thoroughly sullied and compromised stand up and throw the first stone.
The Iranians are wild and crazy? Look at the other nuclear nations that might be at one time or another deemed "crazy" and "wild": India, Pakistan, Israel, North Korea. Why pick on Iran?
Why not ask all of them to stop?
Indeed, why not follow the South African example -- it disassembled its nuclear arsenal -- and have the United States government provide an example of peaceful behavior in the hope Iran might rise to the occasion?
* Antipode is a new topic on this blog in which I will attempt to pay attention to the opposite of the prevailing conventional wisdom.
Saturday, September 26, 2009
Tuesday, September 22, 2009
Missing in Health Care: Common Sense
When I was a boy of roughly 10 or 11, I came across a phrase spoken by teachers and other similar role-modeling adults that baffled me: common sense. It's only now, decades later, that the undefinable, ineffable "common sense" rears up its head again, this time to cover everything that's missing in U.S. health care -- not to mention the debate about its reform.
Let me paint a picture that is a composite of several experiences, my own and those of others.
You go to a doctor because you feel pain -- or a growth, or something that makes you feel uncomfortable about the state of your health, all of which, in the end, is pain. Yet the first thing that happens when you present yourself at a place designated to dispense healing is you get barraged with questions which you are usually in no mood to answer, or if you are, often cannot quite come up with one. Why? Because you are in pain.
I once tried yelling out "I am in pain." No one moved, everything proceeded as usual. So, you're in pain but they're there first and foremost to CYA and M-I-C-K-E-Y M-O-U-S-E you to death.
You're not important. The doctors are important; if not the doctors, then the stockholders, the managers or their aunts in Timbuctu -- anyone but you. Their time is money and their employees know better than to waste it. In this economy finding a new job is tough.
Assume you get treatment before your great grandchildren go to college -- a big assumption in most emergency rooms. Seriously ... the only time I ever got immediate assistance was when I literally collapsed on the desk of the receiving nurse.
Then they ask you what is wrong with you, yet saying "X hurts" -- where X is the part you are clutching like you'll fall into the Grand Canyon if you let go -- is never good enough. They want "I have an episomataspermoanthrodosis that has just trifulcated endomatically." What is wrong with these people? Do you look like you went to Harvard Medical School?
Then come forms of torture that the Inquisition abandoned sometime in the 1840s -- called "tests" -- to determine why that severed foot is bleeding. "Aha, your foot is disconnected from your leg hence the blood vessels have nowhere to go and the blood ... "
They can't say that. So they invent something that sounds good. Shrinks diagnose anything they don't really know what it is as "borderline." Physicians call anything to do with skin "dermatitis" (essentially skin+itis). Borderline dermatitis should just about cover anything.
There's a whole slew of scientific sounding terms for "Hmm ... I don't know what the hell is wrong with you, but since I'm going to charge you at least a few hundred dollars, I might as well make up something." If you don't know what the term means and they can't explain it in simple terms, you've got that Don'tknowwhatitis Syndrome.
Then you don't quite trust what they say, in part because no doctors look like Marcus Welby any more. Did they ever? I mean, Welby was a TV character. Old doctors can't afford the litigation insurance, young Welby-like people are making money on Wall Street securitizing insurance against unknown diseases, or starring in TV shows.
The doctors can never be bothered to explain anything from a normal person's perspective. Nurses dig into your duodenum while they chirp happily, "how are we feeling today?"
Everybody robotically follows some list of tasks written up by the MBA who runs everything from an office tower in Chicago. Even nurse cheer, probably quantified under Baldridge Criteria for Performance Excellence, is prescribed precisely.
U.S. health care, after all, is designed to imitate the assembly line of a Ford Model T automobile. Put an insured patient with the proper documentation at one end and spew out a much poorer, somewhat healed, not healed at all or even dead person, at the other end. All very efficiently, you understand.
If you're tempted to say it's the profit motive -- which in part it is -- you're missing the entire point. Profit is part of the problem, but it's not the essential problem.
The basic problem is a deficit of common sense.
That's a social problem. As we develop into an ever more individualistic society, we are losing our sense of commonality and the ability to trust in our own judgment as adults. That's what common sense was.
"Common sense," growled by exasperated teachers and adults, was what we children lacked when we did something dangerous or foolish or simply without thought. We failed to rely on the accumulated social wisdom concerning some basic basics.
Patients must be ask what they are allergic to, because that way, if we goof, it's their fault. Medical people can't trust their senses because they will be sued. Besides, they make more money testing.
It's a bother to apprentice and train people to use some horse sense about the degree of cheeriness a patient can take while you are rearranging the duodenum; so just give them a clipboard and a checklist: "Item 7: rearrange duodenum while proffering a toothy smile and Baldridge level 4.7 cheer."
The common sense of what is really needed to apply a modest amount of healing -- pain, after all is what keeps us alive -- has gone out the window.
Let me paint a picture that is a composite of several experiences, my own and those of others.
You go to a doctor because you feel pain -- or a growth, or something that makes you feel uncomfortable about the state of your health, all of which, in the end, is pain. Yet the first thing that happens when you present yourself at a place designated to dispense healing is you get barraged with questions which you are usually in no mood to answer, or if you are, often cannot quite come up with one. Why? Because you are in pain.
I once tried yelling out "I am in pain." No one moved, everything proceeded as usual. So, you're in pain but they're there first and foremost to CYA and M-I-C-K-E-Y M-O-U-S-E you to death.
You're not important. The doctors are important; if not the doctors, then the stockholders, the managers or their aunts in Timbuctu -- anyone but you. Their time is money and their employees know better than to waste it. In this economy finding a new job is tough.
Assume you get treatment before your great grandchildren go to college -- a big assumption in most emergency rooms. Seriously ... the only time I ever got immediate assistance was when I literally collapsed on the desk of the receiving nurse.
Then they ask you what is wrong with you, yet saying "X hurts" -- where X is the part you are clutching like you'll fall into the Grand Canyon if you let go -- is never good enough. They want "I have an episomataspermoanthrodosis that has just trifulcated endomatically." What is wrong with these people? Do you look like you went to Harvard Medical School?
Then come forms of torture that the Inquisition abandoned sometime in the 1840s -- called "tests" -- to determine why that severed foot is bleeding. "Aha, your foot is disconnected from your leg hence the blood vessels have nowhere to go and the blood ... "
They can't say that. So they invent something that sounds good. Shrinks diagnose anything they don't really know what it is as "borderline." Physicians call anything to do with skin "dermatitis" (essentially skin+itis). Borderline dermatitis should just about cover anything.
There's a whole slew of scientific sounding terms for "Hmm ... I don't know what the hell is wrong with you, but since I'm going to charge you at least a few hundred dollars, I might as well make up something." If you don't know what the term means and they can't explain it in simple terms, you've got that Don'tknowwhatitis Syndrome.
Then you don't quite trust what they say, in part because no doctors look like Marcus Welby any more. Did they ever? I mean, Welby was a TV character. Old doctors can't afford the litigation insurance, young Welby-like people are making money on Wall Street securitizing insurance against unknown diseases, or starring in TV shows.
The doctors can never be bothered to explain anything from a normal person's perspective. Nurses dig into your duodenum while they chirp happily, "how are we feeling today?"
Everybody robotically follows some list of tasks written up by the MBA who runs everything from an office tower in Chicago. Even nurse cheer, probably quantified under Baldridge Criteria for Performance Excellence, is prescribed precisely.
U.S. health care, after all, is designed to imitate the assembly line of a Ford Model T automobile. Put an insured patient with the proper documentation at one end and spew out a much poorer, somewhat healed, not healed at all or even dead person, at the other end. All very efficiently, you understand.
If you're tempted to say it's the profit motive -- which in part it is -- you're missing the entire point. Profit is part of the problem, but it's not the essential problem.
The basic problem is a deficit of common sense.
That's a social problem. As we develop into an ever more individualistic society, we are losing our sense of commonality and the ability to trust in our own judgment as adults. That's what common sense was.
"Common sense," growled by exasperated teachers and adults, was what we children lacked when we did something dangerous or foolish or simply without thought. We failed to rely on the accumulated social wisdom concerning some basic basics.
Patients must be ask what they are allergic to, because that way, if we goof, it's their fault. Medical people can't trust their senses because they will be sued. Besides, they make more money testing.
It's a bother to apprentice and train people to use some horse sense about the degree of cheeriness a patient can take while you are rearranging the duodenum; so just give them a clipboard and a checklist: "Item 7: rearrange duodenum while proffering a toothy smile and Baldridge level 4.7 cheer."
The common sense of what is really needed to apply a modest amount of healing -- pain, after all is what keeps us alive -- has gone out the window.
Monday, September 21, 2009
Delusions and Consequences
Is it your fault if a relative you drove to a hospital doesn't like your choice of venue or somehow gets sicker, even though you didn't choose the equivalent of a refugee camp clinic in Chad over a peer of the Mayo Clinic? You had two apples, a red delicious and a granny smith and with the best intentions you chose one over the other.
Is it your moral, philosophical or psychological fault if the person you gave the apple to gets an indigestion or just plain doesn't like the taste? There are people -- often enough they are women taught to apologize for their mere existence -- who would beat themselves up, who would engage for hours in exploration of the chain events that any small and largely apparent choice brings on.
You decided to major in English literature and not accounting, so you failed as a novelist and live in a garret in East St. Louis, but your accounting-major classmates have already retired to mansions in Provence. You turned left rather than right at a certain intersection and a truck laden with hundreds of pounds of bananas backed into your car three blocks later.
Remember, we're not talking legal here. Lawyers could argue that a matricidal maniac should not be punished harshly because he is an orphan, but that's not the kind of issue on which I want to dwell.
Responsibility, to my mind, turns on whether we actually have choices. I would argue that most of us have extremely few meaningful choices and it's a delusion of grandeur -- or Calvinism, depending on your mileage -- to think otherwise.
If I were given the choice of being 15 again to relive it all, given what I know now, I would like to think I would make choices that would make me either rich as Donald Trump or famous as Albert Schweitzer or, at a minimum, irresistibly handsome to women ranging from Heidi Klum to Janet Reno. But it's just not so.
Let's take Heidi Kulm and Janet Reno. Attractiveness to the opposite sex is based on a wide range of biological factors that pair certain groups of men and women with each other and the results ... are happenstance. An actress once told George Bernard Shaw that if they had a child it would be beautiful and brilliant, only to hear from Shaw that the reverse would be true if the child inherited her brains and his beauty.
Social norms have tended to accentuate some aspects over another. Indeed, in its pursuit of study, the Jewish tradition has historically pushed its most intelligent people to marry. A rabbi's son was once the dream husband. Conversely, the rule of priestly celibacy in Catholicism assured that, at least during the long medieval night, the era's most educated and talented men of western Europe either did not reproduce or spawned children born into social disadvantage.
I belabor birth, because one's birthplace and parentage remain the most meaningful and decisive factors in lifetime social and economic outcomes -- democracy and everyting else notwithstanding. Unlike many Americans, I did not get to choose mine, which is why I am not particularly proud of being American -- or of occupying a given quintile in U.S. income distribution or hailing anciently from a particular corner of the world.
It's simply not true that being superior makes you white or being smart makes you rich or being chosen by Uncle Sam makes you number one. Even if it were, what did you have to do with any of those?
So what makes you think that you had a real choice in the hospital for your relative? You didn't have a choice between the Chad and Mayo clinics. At worst you had a choice between equally mediocre hospitals operating in the midst of a collapsing system.
We all do our best -- and, yes, we can choose not to -- and consequences spring whether we like them or not. I'm not even sure that doing one's best makes a difference, except to ourselves.
Is it your moral, philosophical or psychological fault if the person you gave the apple to gets an indigestion or just plain doesn't like the taste? There are people -- often enough they are women taught to apologize for their mere existence -- who would beat themselves up, who would engage for hours in exploration of the chain events that any small and largely apparent choice brings on.
You decided to major in English literature and not accounting, so you failed as a novelist and live in a garret in East St. Louis, but your accounting-major classmates have already retired to mansions in Provence. You turned left rather than right at a certain intersection and a truck laden with hundreds of pounds of bananas backed into your car three blocks later.
Remember, we're not talking legal here. Lawyers could argue that a matricidal maniac should not be punished harshly because he is an orphan, but that's not the kind of issue on which I want to dwell.
Responsibility, to my mind, turns on whether we actually have choices. I would argue that most of us have extremely few meaningful choices and it's a delusion of grandeur -- or Calvinism, depending on your mileage -- to think otherwise.
If I were given the choice of being 15 again to relive it all, given what I know now, I would like to think I would make choices that would make me either rich as Donald Trump or famous as Albert Schweitzer or, at a minimum, irresistibly handsome to women ranging from Heidi Klum to Janet Reno. But it's just not so.
Let's take Heidi Kulm and Janet Reno. Attractiveness to the opposite sex is based on a wide range of biological factors that pair certain groups of men and women with each other and the results ... are happenstance. An actress once told George Bernard Shaw that if they had a child it would be beautiful and brilliant, only to hear from Shaw that the reverse would be true if the child inherited her brains and his beauty.
Social norms have tended to accentuate some aspects over another. Indeed, in its pursuit of study, the Jewish tradition has historically pushed its most intelligent people to marry. A rabbi's son was once the dream husband. Conversely, the rule of priestly celibacy in Catholicism assured that, at least during the long medieval night, the era's most educated and talented men of western Europe either did not reproduce or spawned children born into social disadvantage.
I belabor birth, because one's birthplace and parentage remain the most meaningful and decisive factors in lifetime social and economic outcomes -- democracy and everyting else notwithstanding. Unlike many Americans, I did not get to choose mine, which is why I am not particularly proud of being American -- or of occupying a given quintile in U.S. income distribution or hailing anciently from a particular corner of the world.
It's simply not true that being superior makes you white or being smart makes you rich or being chosen by Uncle Sam makes you number one. Even if it were, what did you have to do with any of those?
So what makes you think that you had a real choice in the hospital for your relative? You didn't have a choice between the Chad and Mayo clinics. At worst you had a choice between equally mediocre hospitals operating in the midst of a collapsing system.
We all do our best -- and, yes, we can choose not to -- and consequences spring whether we like them or not. I'm not even sure that doing one's best makes a difference, except to ourselves.
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