The American Idea

In June of 2007 The Atlantic Monthly ran a feature, “The Future of the American Idea” in celebration of 150 years of the The Atlantic Monthly publication. The introduction was lofty citing famous intellectual and literary names of the past. The writers of this intro hail the Atlantic’s deep understanding of change as a prime reason for its longevity and endurance!
John Updike kicks off the ego trip with a salute to the rise of the individual. That only in this vast open, untainted land mass could the human bring forth and develop those traits, talents and creative attributes and allow for a the tolerance of a critical mass to create a culture free from “terrorism from above rather than consent by of the governed”. He extols the creation of this new entity as populated by people who “know their own minds and act in their own enlighten self interest, with necessary respect for others”. Now let’s stop right there!!!
First of all I find it very hard to go on and on about the virtues Mr. Updike lauds when really, it was out of extreme disrespect for the indigenous people of the North and South American continents that allowed the white foreign (European) invaders to exploit and run over these native people out of a well defined sense of superiority and greed, traits which we hold true to this very moment. So the truth is that no, there was no intellectual prowess at play among the early invaders or those born thereafter. Self interest? Oh yeah, in spades and more. Enlightenment? Hardly!!!
In conclusion, Mr.U cautions against the world’s poor, saying they have nothing to loose (does that mean they will invade us?), a ruinous depletion of of the worlds’ natural assets, global warming with world geopolitical change as a result. (Never mind that we’ll all be toasting!)
So here are my comments to Mr. U: you act as if these are problems of the “other” when in fact we (Americans)have depleted more of the world’s natural resources/assets than the rest of the world ( all countries combined). And global warming! Oh, Mr. U don’t get me started!!!!! If ever there was an effort to stoke the fires of hell then Americans have surely led the charge with un-wanton expulsion of greenhouse gasses. Its all junk science anyway. And what’s this scat “promulgated in a land of plenty”??? The American idea is grounded in the unscripted notion that we can do what ever we like, good or bad, as long as we do it off the backs of others!!! Such rubbish!!!! More later!

A New Spin on an Old Theme..Health Insurance

The Sept 15 issue of Businessweek has a feature on healthcare. It’s called “Hospitals and Insurers Try Flat Fee – Again”. What is presented first is a maligning comment on managed care of the ’80s and ’90s. The unexplained complaints simply assume insurers are greedy, I suppose by denying subscribers their contracted benefits and in turn lousy healthcare as a result. I am assuming their explanation here. The idea proposed in the “new” plan, is very unclear as presented in this article. Example: in Massachusetts BXBS of Mass and Caritas Christi Health Care, the former an insurance company and the latter a healthcare facility/hospital, want to switch from insurance carriers paying hospitals for each service performed on a patient to flat fee per patient yearly, adjusted for age and illness. Now how would that actually work? Does the insurance pay this annual flat fee to a subscribing hospital at the beginning of each year for each pt who choses that hospital..meaning that the patient would have to go to that hospital if ill? Or if you break a leg does the insurance company pay a flat fee for a broken leg set? No matter if the cost of care should exceed this fee say if clot develops or some other complication occurs? The CEO of Caritas says by accepting a flat fee it will allow Cariras to offer cost-efficient care with an emphasis on preventing illness. Now just how would this work??? BXBS chimes in saying they can cut what they pay by 1/2 with flat fees.
Okay, so I see how if you tie the providing facility and the hands of providers down with a tested and found wanting contract, how the insurers would make more money. But does this even adequately support the healthcare facility and its many expenses in providing care??? Caritas claims it can be fair to patients and doctors with builtin safeguards to assure flat fees will please both. ….but the article does not explain how??? What kind of safeguards? None of this is explained. You cannot manipulate the true value of numbers… but I suppose you can hide their existance. One nonprofit executive says managed care is the only way to control costs. He states that the providers will have to work within the amount of money provided from flat rates each year. The resisters are stated to be the providers… that may be true but only specialists are singled out as the ones loathed to make the change because primary care would, I think, reduce the need for their services?? Is that true??? It is a question that needs answering, with proof, that is.
So then the article jumps off on the rise in the total cost of services blaming the rise on unnessary procedures just to pump profits.. What are these much maligned procedures and where is the evidence.? Seems to me that in this article there is no substance to back any of the accusations up… they may in fact be true but I certainly don’t see it. The article goes on to state that 1/3 of procedures are unnessary care. Oh really!!! And how is that??? And then they claim this produces quanity over quality citing incentives for docs and hospitals to produce more. This is a legitimate argument. But show how quality is compromised.
It seems that the safeguards set up in the new plan may be that the insurer pays a flat fee per patient and then walks away from the case. The docs and the hospitals can then order as many tests as they want (or as few), do as many procedures as they want or not..implying the quality of care will improve and waste will be reduced. This also elimnates the insurer bean-counters docs complain about so much in the current system. So, if the docs want more pay they will have to tighten their belt by eliminating services they may feel are necessary and of course those they are doing just to pump profits..and which services are those????. And here is the clinker: the undocumented assumption that quality will improve. It may indeed improve but there is no evidence in this article to truly support this, and the connections are not there. . Then bonuses will be given to those docs who come in under fees paid. Will care quality automatcially improve? Really? As for quality of care an example is given (a rather sideways one at best). It has to do w/ coronary bypass surgeries where the quality is measured by readmission rates. What?? That’s what they said!!! I find that connection bogus at best and mostly desperate.. In the example cited readmissions fell 44% under a capitation system where the insurer paid a flat rate for each operation. Well my question is does that number include those who didn’t make it (died) so were not around for readmission, and/or those who fell ill and were simply not readmitted and either got worse or better on thier own. If a hospital administator comes to a surgeon and says “You are readmitting too many of your cases, please stop or I may not be able to renew your contract in the future.”, what is likely to happen???? A no brainer!!!! Right? My hunch is the surgeon will think twice before readmitting. Do we really want this? And what about lab tests? Are unneeded test frequently ordered??? I don’t know. Surely in a teaching facility this is likely to happen. But this can probably be solved with centrally located electronic records, a much needed requirement in the healthcare industry. And did it occur to anyone that sometimes, I would guess often, tests are ordered to protect the doc against liability if a case doesn’t turn out well. I can just hear the mediocre attorney making a case out of “If only you had ordered a such and such test Mrs. Whoever would be with us today!!!” I doubt it would have much sway with a jury for the doc to defend himself/herself with a “The insurance wouldn’t pay for it” statement.
And finally the idea that fee for service fails to contain cost because it focuses on fixing problems instead of preventing them. And why do we continue to focus on illness and not prevention? This is a no brainer!!!! It is because illness is what comes the way of healthcare providers. The average person, and I include myself, simply don’t think about illness and prevention of much of anything when we/I are feeling well. Not smart I admit but healthcare only bubbles up to the surface when there is a problem. As I recall some managed care plans of the past, HMO’s, allowed for very low cost (to the subscriber) health exams and certain routine tests. It failed basically because of over utilization. Many more subscribers utilized this benefit than predicted. The providers were not being paid by the insurer nor the subscriber, combined with treatment that was severely discounted by the insurance carriers to the providers. So the providers began an internal triage of sorts rationing care to staunch the bleeding of resources they didn’t have. So how will flat fee plans enhance preventive care? It is beyond me!!! I think this poorly made argument is without merit when the untouched 800 lb gorilla in the room is the subscriber/patient. There is no place where the subscriber is held accountable for his or her health or lack of. How many studies have been done that measure patient noncompliance with recommended treatment, especially as it relates to containing costs? Take for example the man who refuses to take his HBP meds because it often reduces his libido…he claims he doesn’t feel bad and when he takes the meds he cannot get it up. And he doesn’t believe in the concept of HBP as the silent killer. And what about the proud, long term smokers??? And drinkers??? What about the young, upstart males who engage in high risk behavior…causing broken bones, lacerations, contusions, organ injury and on and on, who continue time and time again to continue the injury-risk behavior. And what about the guys who fight, with fists, knives and guns..all their injuries are preventable. Then there are the mentally ill who go off their meds because, again, their libido is affected. So here you have it as stated by me… 1. an industry of payers(insurers) who exist for profit to their executives and shareholders, profits and nonprofits alike, 2. healthcare providers who exist for their own means of providing for themselves and their families with some left over for the stress and risks (they take all the risks, by the way) and 3. the subscriber/patient who expects cadillac care and a freeride with no responsiblility beyond their insurance premiums. The only entity not required to take any responsiblity for reducing costs is the subscriber/patient.
So now the cycle has come full circle.
It never ceases to amaze me that when considering our current financial crisis no one holds the quality of services given by the providers of these services, yet when it come to healthcare, the most deeply personal of all human services, the public wants it all and holds the providers not only to the strictest of standards, but by God, resents every penny they earn albeit a fraction of the manager of their failed retirement fund. So as a final word I’d much rather pay my physician more and the hospital that maintains me more than to go “duh, okay” to the financial managers who bilked a large segment of our populice and are now residing on the beaches of the Bahamas counting the cash assets in their Caymen bank accounts. The financial mangers do far more to ruin lives, break families for far more money than a herd of physicians could do or ever have done. So do you want cash or do you want care?

Sarah Palin –

Sarah Palin – John!!! What were you thinking??? Or better, were you thinking at all? Certainly Sarah Palin is a very impressive woman, quite a looker, has the resources to welcome a Down’s child without hesitation to her family. But as for possibly becoming second in command of our country..well she clearly is not qualified!! I suppose if your only interests are abortion and gay marriage well then she can do the Republican party’s bidding on that. But gee! in the larger scheme of things these issues are not even on the radar of those of us who are even minimally capable of critical thinking! Lets take the family values issue. She actively, as governor of Alaska, opposed sex education in the public schools of Alaska. She espoused abstinence as a practice or as an answer for the out of control teen sex/VD epidemic our country is experiencing. And how I hate to rail about her daughter’s out of wedlock
teen pregnancy, but gee Sarah you got your tit caught in a wringer on that one!! This entire issue is so-o-o-o disturbing to freedom loving Americans because Ms. Palin probably will not stop her authoritarian agenda of expanding this belief into laws that affects all Americans!! So where are the hallmarks of freedom in that? Where is the dimunition of big government/big brother the Republican/ social conservative/evangelicals preach on and on about?? Sounds as controling and misoginist as the Talibans drive to dehumanize muslim women. I know I have been shipped to another planet. And abortion. Again it is fortunate Ms. Palin has the resources to support a Downs child. Good for her..but she is clearly the exception and not the rule. Many women find , indeed many families find they are incapable for reasons ranging from poverty to mental and physical illness to support at any level a Down’s syndrome child … the immediately after birth care is manageable … for a while..but in time the burdon becomes far too great. Many times the child looses through benign neglect and the family looses through dispropotionate allocation of resources or parental abandonment.. at least one parent, usually the dad.
Not to be ignored.. when this offspring is an adult and if an unfortunate reversal of fortune occurs what then happens to this person?? A nursing home? An institution for the retarded, where risk is high he will be abused, mistreated, neglected..harmed in a way no person should be? So this leads to the so called “life” issue. It is a freakish twist of logic to oppose abortion for all, find sport in slaughtering moose and bears (all active killing), cheering her son off to war when he will be paid a wage to kill other humans, a form of sanctioned murder and in the same breath call yourself a pro life political candidate. Wha-a-a-a? AND this does not address the issue of the biblical conflict of Christian values stated in the commandment from God of “Thou shalt not kill!!”.. Period! God states no exceptions. (This 800 pound gorilla has been sitting on my shoulders for a life time!!!).
Ms. Palin is also the babe who rejects the clear science of global warming. Does she have a thought disorder??? Anyway she strongly supports drilling for oil in Alaskan wildlife preserves along w/ off shore drilling well within the currently enviornmentally restricted shorelines of the US. She sued the Bush administration for declaring the polar bear and endangered species caused by the loss of the animals habitat, the rapidly melting polar icecaps. She felt this act was an endorsement that the polar caps were actually melting which may just back into the reality of global warming which may then back into excessive carbon emmissions being belched from oil burning industrial plants and the millions of cars on the roads today.
And speaking of science, she rejects evolution and wants creationism ( her Christian type) to be taught in the public schools of Alaska and as governor she has strongly pushed that agenda.
This moves us to her stand on gay marriage. She opposes it of course. And why??? Well she must assume it is unchristian. Clearly she chooses to ignore the constitutional issue of equal protection..as do many of her ilk.
Now there is the issue of her using her office as governor to force the firing of a state officials for his mishandling of her sisters soon to be ex-husband. From facts garnered from a lengthy article in the Washington Post I am very aligned with her rage over her sister’s ex-husband behavior, the frustration she experienced with the commssioner who grossly mishandled the case (the one she later fired) and in my heart I am sorry this stroy is being showcased against her. BUT she should have been less bullish about it…. but I can relate on this one. Also the pregnant daughter… wow!! too bad!!! Such a nice appearing kid….but what about sex education here…… Sarah, not Bristol need to be hammered on this one. The Dems should not let this one go!!! Sex education is far reaching interms of prevention of 1. pregnancy 2. teen sexual exploitation 3. veneral diseases such as chlamydia, syphillus, gonnorhae, HIV, herpes, Hep B and C, all dreadful diseases. 4. Also not to be forgotton are the links between sex (prostitution) and drug addiction. This list can certainly be added to.
It is worth stating again Sarah Palin is no slouch. I do admire her guts. BUT the 800 lb gorilla remains firmly ensconced in the room. On the national political scene she is a scant featherweight. More later after I hear her speech tonight.!!!

Barack for President and Hillary for Chief Justice

In light of the Obama nomination I reflect on the political career of Hillary Rodham Clinton. Some think this is the end of the line for her, others predict she will try again in four years especially if Obama’s administration falters. I believe there is a silver lining in this small cloud. Another venue to serve seems obvious to me if she wishes to accept the assignment, and that is a seat on the US Supreme court with the idea that when the current chief leaves she will move forward as Chief Justice. In my opinion this is the absolute best and brightest venue for a person of her talent, range, depth and intellect. She has surely been more than adequately vetted, and is a lawyer and with unprecidented political savy as well as vast legislative experience, a substative prerequisite for such a position. And the icing on the cake is twofold…. she will 1. offset the groteque imbalance of the Thomas and Scalia justices and more than heal the hearts and minds of the millions of disappointed supporters who continue to recover from the effects of disenfranchisement of the Obama nomination. And I like Obama..he has my vote!!!
So, hail to the chief (Obama) and hail to the chief justice(Clinton)!!!!

Leadership

Q. What is the most critical asset for a leader of today to have?
A. The ability to deal with different cultures. In business, for example, with so many companies going global, with company teams being being scattered all over the planet, a firm understanding of the client culture, no matter which one, China, India, you must understand how to negotiate, operate, construct, whatever is demanded, from and within their cultural context. It is necessary for success to understand and motivate people who look at the world and function in it (successfully), very differently from you. No easy task!! But essential for success. So, a leader must be prepared to deal with teams who are multicultural and who do not think nor see the world through your eyes. A true leader must be able to see the world through the clients eyes!

Q. If you are assigned as a team leader in a foreign culture in lets say an emergency situation AND you or your company is viewed skeptically, what is the best advice going in?

A. When going in an enviornment you don’t know at all the first step is to listen, listen, listen!!!!
Listen and interact with many people and many different levels. Then analyze your impressions and findings from hard data. Make tentative diagnosis the listen, interact and analyze a second if possible. Establish a diagnosis and from that develop a tentative plan of action.

Q. Can anybody do this?

A. Yes and no. It demands someone of strong and pure character who is willing to break away from the past at all levels to motivate change. It could be a connected (one inside the organization)person or most likely someone from outside the organization…one w/ fresh eyes, untainted by the culture but also one who understands it and if understanding is lacking, one who can listen openly.

Q. Does one who is raised in a multicultural enviornment have an edge/advantage over one who has not had that experience?

A. Most definitely! In many ways it is fundamental. It’s similar to learning a language when you are a child…you develop a mastery of that language that you cannot achieve when you learn a language as an adult. Like learnign to play and instrument as a child. Mr. Suzuki used this knowledge to develope the legendary Suzuki violin teaching method for kids. Being in a multicultural enviornment as a child intuition, reflexes and instincts. You may acquire basic responsiveness later on, but it is never going to be as spontaneous as when one has existed and functioned inan enviornment during childhood.

This report was inspired and in many instances paraphrased from a print news media publication. It is from an interview with CEO of Nissan Carlos Ghosn.

June 12, 2008

For nearly a year I have been trying  open my account and access this blog to post as usual..my password failed everytime.  At last wordrpess sent me a new one and I am back in. Thanks WordPress!!!! There are some screed-like messages waiting..I think!!!! More later!!!

 

Religion in America

 I’m an atheist, BUT . . .

by Richard Dawkins

Written for this website, 18th November 2006.

Of all the questions I fielded during the course of my recent book tour, the only ones that really depressed me were those that began “I’m an atheist, BUT . . .” What follows such an opening is nearly always unhelpful, nihilistic or – worse – suffused with a sort of exultant negativity. Notice, by the way, the distinction from another favourite genre: “I used to be an atheist, but . . .” That is one of the oldest tricks in the book, practised by, among many others, C S Lewis, Alister McGrath and Francis Collins. It is designed to gain street cred before the writer starts on about Jesus, and it is amazing how often it works. Look out for it, and be forewarned.

I’ve noticed five variants of I’m-an-atheist-buttery, and I’ll list them in turn, in the hope that others will recognize them, be armed against them, and perhaps extend the list by contributing examples from their own experience.

1. I’m an atheist, but religion is here to stay. You think you can get rid of religion? Good luck to you! You want to get rid of religion? What planet are you living on? Religion is a fixture. Get over it!

I could bear any of these downers, if they were uttered in something approaching a tone of regret or concern. On the contrary. The tone of voice is almost always gleeful, and accompanied by a self-satisfied smirk. Anybody who opens with “I’m an atheist, BUT . . .” can be more or less guaranteed to be one of those religious fellow-travellers who, in Dan Dennett’s wickedly perceptive phrase, believes in belief. They may not be religious themselves, but they love the idea that other people are religious. This brings me to my second category of naysayers.

2. I’m an atheist, but people need religion. What are you going to put in its place? How are you going to comfort the bereaved? How are you going to fill the need?

I dealt with this in the last chapter of The God Delusion, ‘A Much Needed Gap’ and also, at more length, in Unweaving the Rainbow. Here I’ll make one additional point. Did you notice the patronizing condescension in the quotations I just listed? You and I, of course, are much too intelligent and well educated to need religion. But ordinary people, hoi polloi, the Orwellian proles, the Huxleian Deltas and Epsilon semi-morons, need religion. Well, I want to cultivate more respect for people than that. I suspect that the only reason many cling to religion is that they have been let down by our educational system and don’t understand the options on offer. This is certainly true of most people who think they are creationists. They have simply not been taught the alternative. Probably the same is true of the belittling myth that people ‘need’ religion. On the contrary, I am tempted to say “I believe in people . . .” And this leads me to the next example.

3. I’m an atheist, but religion is one of the glories of human culture.

At a conference in San Diego which I attended at the end of my book tour, Sam Harris and I were attacked by two “I’m an atheist, but . . .” merchants. One of these quoted Golda Meir when she was asked whether she believed in God: “I believe in the Jewish people, and the Jewish people believe in God.” Our smirking critic substituted his own version: “I believe in people, and people believe in God.”

Religion, he presumably thought, is like a great work of art. Many works of art, rather, because different religions are so varied. I was reminded of Nicholas Humphrey’s devastating indictment of an extreme version of this kind of thing, quoted in Chapter 9 of The God Delusion. Humphrey was discussing the discovery in the mountains of Peru of the frozen remains of a young Inca girl who was, according to the archaeologist who found her, the victim of a religious sacrifice. Humphrey described a television documentary in which viewers were invited . . .

” . . . to marvel at the spiritual commitment of the Inca priests and to share with the girl on her last journey her pride and excitement at having been selected for the signal honour of being sacrificed. The message of the television programme was in effect that the practice of human sacrifice was in its own way a glorious cultural invention – another jewel in the crown of multiculturalism . . .”

I share the outrage that Humphrey eloquently expressed: -

“Yet, how dare anyone even suggest this? How dare they invite us – in our sitting rooms, watching television – to feel uplifted by contemplating an act of ritual murder: the murder of a dependent child by a group of stupid, puffed up, superstitious, ignorant old men? How dare they invite us to find good for ourselves in contemplating an immoral action against someone else?”

It would be unfair to accuse our critic in San Diego of complicity in such an odious attitude towards the Inca ‘ice maiden’. But I hope at least he will think twice before repeating that bon mot (as he obviously thought of it): “I believe in people, and people believe in God.” I could have overlooked the patronizing condescension of his remark, if only he hadn’t sounded so smugly satisfied by this lamentable state of affairs.

4. I’m an atheist, but you are only preaching to the choir. What’s the point?

There are various points. One is that the choir is a lot bigger than many people think it is, especially in America. But, again especially in America, it is largely a closet choir, and it desperately needs encouragement to come out. Judging by the thanks I received all over North America, the encouragement that people like Sam Harris, Dan Dennett and I are able to give is greatly appreciated. So is this website, as I heard again and again. My thanks, yet again, to Josh.

A more subtle reason for preaching to the choir is the need to raise consciousness. When the feminists raised our consciousness about sexist pronouns, they would have been preaching to the choir where the more substantive issues of the rights of women and the evils of discrimination against them were concerned. But that decent, liberal choir still needed its consciousness raising with respect to everyday language. However right-on we may have been on the political issues of rights and discrimination, we nevertheless still unconsciously bought into linguistic conventions that made half the human race feel excluded.

There are other linguistic conventions that still need to go the same way as sexist pronouns, and the atheist choir is not exempt. We all need our consciousness raised. Atheists as well as theists unconsciously buy into our society’s convention that religion has uniquely privileged status. I’ve already mentioned the convention that we must be especially polite and respectful to a person’s faith. And I never tire of drawing attention to society’s tacit acceptance that it is right to label small children with the religious opinions of their parents.

That’s consciousness-raising, and atheists need it just as much as anybody else because atheists, too, have been lulled into overlooking the anomaly: religious opinion is the one kind of parental opinion that – by almost universal consent – can be battened upon children who are, in truth, too young to know what their opinion really is.

5. I’m an atheist, but I wish to dissociate myself from your intemperately strong language.

Sam Harris and I have both received criticism of this kind, and Nick Humphrey probably has too, for the quotation given above. Yet if you look at the language we employ, it is no more strong or intemperate than anybody would use if criticizing a political or economic point of view: no stronger or more intemperate than any theatre critic, art critic or book critic when writing a negative review. Our language sounds strong and intemperate only because of the same weird convention I have already mentioned, that religious faith is uniquely privileged: above and beyond criticism. On pages 20-21 of The God Delusion I gave a wonderful quote from Douglas Adams on the subject.

Book critics or theatre critics can be derisively negative and earn delighted praise for the trenchant wit of their review. A politician may attack an opponent scathingly across the floor of the House and earn plaudits for his robust pugnacity. But let a critic of religion employ a fraction of the same direct forthrightness, and polite society will purse its lips and shake its head: even secular polite society, and especially that part of secular society that loves to announce, “I’m an atheist, BUT . . .”

Unknown

Bob Woodward. His 14th book due on Oct 3, 2006..Title is still unknown… it focuses on the war in Iraq and is a devastating look at America’s current Mideast politics.