Planet Grelican

America Can Lead the World Out of This

2018-08-07T15:09:00.003-04:00

This is what a global existential crisis looks like. Migrants are fleeing war and environmental catastrophe, arriving at the borders of our relatively rich and stable democracies. At the same time, the average citizen finds the world more expensive, insecure, and unfulfilling than any time in living memory. We are all questioning the fundamentals of the existing order, and one way or another, our geopolitical reality urgently demands a moral response from all of us. We must find a positive alternative or else face large-scale unrest, even social collapse or annihilation.

The positive alternative must take a hard look at immigration. What happens when thousands a week float across the Mediterranean arriving half-drowned at your country’s coastline? What happens when another thin and hungry family is caught in the high beams of a border patrol’s Suburban somewhere in the Sonoran desert? Do we take them in and assure that they have the same rights and responsibilities as any other resident of our countries? Do we send them home? Do we hand them over to the hostile vagaries of the bureaucracy? These are questions that demand answers; as individuals and as nations we will answer them differently, but we must have an answer. Too much of the world seems to be ceding that response to our worst instincts.

There is a point at which every society perceives threats from outsiders. In Japan, it is next to impossible to become a full citizen if you are not Japanese by blood. Relatively few immigrants are admitted, much less refugees. In Hungary, a massively popular leader is deporting anyone who does not have official standing with the authorities. The issue of migrants has France and Germany at the precipice of reactionary rule, and here in America, our own government has forcefully separated families and used that and other threats to intimidate the helpless away from our shores. It is clear that many, perhaps most highly industrialized countries have shown strong and perhaps dangerous reactions to today’s circumstances.

War and famine over a broad stretch of Africa and the Middle East has sent millions in search of refuge. Drugs and violence in Central America have made life impossible for many there. Growing storms ravage islands and coastlines. In looking at these catastrophes on people’s lives, we must never absolve ourselves of responsibility, both historical and ethical. We must come to understand and admit that our societies have played enormous, sometimes central roles in these events. We must also accept that some portion of our nations’ wealth should help to ameliorate these concerns. But first, we must save our democracies from fascism, or else the whole world will go with us.

Immigration alone does not drive today's rage. There is a pervasive sense that our societies no longer offer many of us a good, just life. For all its problems, why does America offer a unique response to this dilemma of mass migration and civic insecurity?

First, a far greater share of the American public is more comfortable with immigration and immigrants than in many other liberal democracies. After all, we are a nation of immigrants.

Second, we are unique in our cultural and social energy. Our diversity has long demanded a strong legal and a cultural order, and our gains in civil rights have always been hard-won, at great loss. We have a deep appreciation for the power of communities. For all our failures, America has an unusual way of spontaneously organizing ourselves in responding both to threat and opportunity. This is precisely what we are doing in response the sorry state of our governance.

Last, while our current state of politics resonates strongly with the European far right, unlike Europe, we have a popular alternative lying in wait. Perhaps this is simply because we do not already have a robust social democracy that meets our people's needs, but look at France or Germany, where the incumbent leadership only ever offers more warmed-over tropes about the status quo. What vision does UK Labour offer anyone other than maintaining an unhappy order? For all our shortcomings, we do not take our nation's promise for granted.

The good news is that the American alternative is no longer fighting a rear guard against the reactionary hordes. Months before our first chance to weigh in on our government’s positions towards the world (and indeed its own people), a new vision is coming into focus. At the risk of future ridicule, I believe it will be this American vision that once again gives our cousins across the globe an answer to the insular, atavistic, and downright dangerous world view that has become endemic in all our nations.

For me, a first step is that it must offer a clear and final answer to our problems with managing immigration. Our nation will always be susceptible to demagogues, but much of their power can be diminished by simply addressing the fears they exploit head-on.

The demagogue's border wall does nothing to someone who just chooses to stay here after their visa expires. Forced deportation is never humane, but neither is our dependence on the expansive black market for undocumented labor. People deserve to be paid a just wage, and be offered all the protections of the law. All this means that we need to have a universal and mandatory system for verifying individuals’ eligibility to work in our country, and it needs vigorous enforcement. At the same time, we must accept that most of the people who are here now are here to stay, and we must come to terms with some just status for those people. In the end, we can and must balance the concerns of our vast immigrant communities and the public conscience with those who feel threatened by changes to their way of life. The American consensus position on immigration is far closer to these answers than anywhere else. We must be an example for how to manage and adapt to a globalizing world.

Second, if we are to take our role as a world leader seriously, America must devote real resources to foreign aid and investment. We should dedicate large sums to rebuilding the infrastructures, economies, and societies to our south, in both hemispheres. Imagine the good will and positive outcomes if we mandated that one percent of our present-day defense budget, or about $6 billion should be allocated towards aid, loans, technical assistance, and diplomacy.

Imagine what could happen at five percent, or $30 billion a year. We could truly address our ethical and historical responsibilities towards the world’s most helpless; an alternative to Islamist rhetoric or the cartels. A better truth than Russian propagandists can concoct, and a fairer deal than Chinese investors will offer.

Last, the American vision must look inwards. We need a full reckoning of why so many of us feel that our institutions are failing us, that opportunity is becoming ever-scarcer, and that modern life leaves so many of us severely wanting. Sacred cows will go to slaughter. Unions and shareholders alike will need to own their part in this.

It will take a wholesale rework of our education system to assure that someone emerging from its conclusions has the basic skills to succeed. It requires an overhaul of our health care and social services delivery systems to assure that everyone receives the care they need, and that we can most certainly afford. A new way of thinking about how labor and capital interact that assures reward for honest work. A renewed push towards service, both civic and military for our own cultural cohesion. A painful but compassionate look at our own society’s uglier tendencies met by a pride at our national strength and accomplishments.

I leave the specifics of this American vision intentionally vague. Visions are best interpreted and not simply revealed. They evolve to the liking of their interpreters, and different regions both here and abroad will have different priorities. A vision's true value is in motivating people, both in the streets and at the ballot box.

I also leave this largely free from partisan terminology because our present problems will not be resolved without some reasonable broad-based consensus. The greater point is that a new global paradigm is needed. I believe that the present American will is closer to identifying one than anyone else. I believe that our collective will can show the world a way out, if only as an uncertain ideal. Come November, and come 2020, I just hope that our democracy represents that will, if only for the sake of all of us.

Our National Pastime: Running Ideas Into the Ground

2016-09-22T12:08:00.000-04:00

George Carlin had it right when he said, "Where ideas are concerned, America can be counted on to do one of two things: take a good idea and run it completely into the ground, or take a bad idea and run it completely into the ground."

This is what we do. It's what's made us a great country. Running ideas into the ground gave us the Apollo program and rock and roll. It took computing, something that was once the sole province of statisticians and engineers, and made it a ubiquitous, and essential piece of daily life. This tendency to run ideas into the ground also gave us the Civil War, mass incarceration, and an unending rotation of saccharine, common-denominator-driven-packaged-for-export bubble gum culture.
America takes ideas, invented or appropriated, and exhausts all possible avenues of thought and action. The deep complexities of Mexican food becomes the Seven-Layer-Crunch Taco. The Star Wars trilogy, an original and successful idea, is expanded into spinoff movies, prequels, sequels, and billions in ancillary marketing opportunities, royalties, and other enterprises. We create great cacophanies of media, volumes of thought, and litanies of inventions, for better or worse. It's what we do.

Another big American idea is Freedom. American Freedom has been an essential source for the world's oft-exhausted reservoirs of hope and optimism. It's inspired nations to better themselves, and it's expanded global prosperity. In the century after the nation's founding, the idea of American Freedom helped to end the unquestioned rule of monarchies, and went on to spend much of the last century defeating several distinct forms of tyranny. But this is a new century now, and we're not done running the idea of American Freedom into the ground. We now believe in freedom to shop for both chemotherapy and assault weapons. We believe that bankers and oil companies should be free to dump their debts and detritus onto the public trust. We believe that individuals should be free from the social burdens of living in a complex society; free from universal public education, free from paying for someone else's health care, free from making any sacrifice to our short-term livelihoods for the greater good, or even to improve our own long-run chances. We also believe in other nations' freedoms to trade with us on our terms, and to run their governments according to our notions of Freedom. We apply our cultural proclivities, often noble and hard-fought, to all of human nature. It is in this way that American Freedom will one day run itself into the ground.

It bears repeating that our penchant for running ideas into the ground did the world a lot of good. The American idea of Freedom was more popular and successful than the competing ideas of Soviet Communism. The American idea of democratic rule inspired the defeat of sclerotic, kleptocratic governments the world over (even as we sponsored others). The good we did came with our own extreme ideas around the purity of markets, and ignoring the ancient hierarchies and power struggles that prevent poor, women, and minorities from exercising their own freedoms on equal footing. We fought the cold war on such absolutist terms that we sponsored Apartheid, right-wing death squads across Latin America and Africa, and the persecution of our own citizens for their beliefs at the hands of the FBI and congress itself. We intervened in the Middle East in order to foster democracies in places that were unprepared and uninterested in following our leads. At home, we grew to believe that any state intervention in the economy is a harbinger of total annihilation of our values.

It seems very likely that like all American ideas, good and bad, American Freedom will have to be run into the ground before we can evolve. After all, we couldn't end slavery here without a bloody conflict that nearly destroyed the country and leaves scars across our culture even today, long after the war itself departed the realm of living memory. Now it is this modern American idea, itself an exaggerated mirror image of prior bad ideas like communism and the divine right of kings, that is left standing. At some point in our future, possibly very soon, the moderating forces against a total political adoption of American Freedom will no longer be in place. Some day soon, we will run this idea of American Freedom into the ground. And the world will have to live with what comes next, for better or worse.

Winston Churchill famously said that, "You can always count on Americans to do the right thing - after they've tried everything else." And that's just what we're doing. It's what we do.

What I Know For Sure About Donald Trump and 2016

2016-05-27T15:30:00.004-04:00

Wow, almost a year with no blog. I've got to do better.

Donald Trump Will Screw You

…and I don’t care who you are. If there is one consistent aspect of this man’s behavior, it is that he will say or do anything to advance himself, with no regard for anyone else.

The first trait this behavior is a belief system that views nearly all of the human race with contempt. If you are his friend or ally, he sees you as a weak submissive. If you are his enemy or opponent, you are the subject of a pathological hatred. People move from one category to the other with every news cycle, and it doesn’t much matter where one is. The common denominator is his contempt for us all, friend or foe.

The second part of this belief system is a need for love, but not a mother’s love, or a lover’s. I think of it as akin to the love that the Japanese Emperor demanded of men who were willing to pilot a bomb-laden plane to their own death, all for the man who says he gives you everything, for a need to retain an imagined order, and the anonymous safety that a steep hierarchy grants the average person.

Psychoanalysis aside, can anyone name one principle that this man has held constant aside from his own grandiosity? Is there any business associate from his decades of alternating rapaciousness and bankruptcy who will step forward and honestly say that he actually made them money? What would his ex-wives and confidants say if not for fear of legal action?

Watching Trump’s rivals bend the knee and pay homage to this man, after the personal venom he spat at them without remorse, makes me think two things. First, politicians sense that they have to get behind power at all costs. Second, a lot of people, even smart, powerful people, can be made into lackeys by saying just the right thing, or offering just the right meager concession, however fleeting. He will say anything to get you on his side, and if you cannot be won, he will do anything to destroy you and salt the earth of your ambitions.

For me, watching the crowds view this man with such adulation isn’t about who is right or wrong. I see people who are being told exactly what they want to hear, regardless of the world’s hard truths, the known limits to power and economics that constrain us all. We will not reopen the coal mines. The oil fields of North Dakota were never going to last forever, and the immigrants will never go home. He only gave money to veterans once he was caught red-handed, months after he swore to do so. It’s not even an indifference to you, but a malevolent contempt.

I can’t speculate on where this election is headed. The one thing I am certain of is that, no matter who you are or what you believe, Donald Trump will screw you. If you are running for office and choose to side with the man, you will either go down with that ship, or be taken on a ride to places you do not want to go. If you are a voter and place your trust in this man, you will one day be sorely disappointed. Donald Trump will not help anyone’s campaign but his own. Donald Trump will not build a 2300 mile long wall at the Mexican border. Donald Trump will not get your good union job back. He will do none of these things not because they are impossible, but because there is no chance they will help him to acquire more power or fame in the long run, when words end and money must change hands.

I believe that the next 6 months will be the man’s undoing, and in the end, one way or another, he will slink into the reeking shadows of ignonymity, with only his inner circle there to tell him how great he is. What I do know is that no matter how ugly this election gets, he can only screw me if he becomes president. And I will do anything necessary to make sure that does not happen.

A Good Week

2015-06-29T10:39:00.000-04:00

Last week began with the vague feeling of dread and uncertainty that have become too common in this age of war, economic and social upheaval that is now well into its second decade. A young man decided to enter a historically monumental black church in Charleston and kill nine of its congregants in hopes of sparking a race war. The Supreme Court was due to announce a decision that would harm the health and well-being of millions were they to rule in favor if the plaintiffs, and another that would determine the scope of human rights as understood by modern jurisprudence.

By the end of the week, Southern state houses were removing confederate flags from their masts; symbols that have stood as a bulwark against racial progress for decades. The causes of the Civil War are being revisited without nostalgia, and we are in the midst of a national conversation about race relations that is more honest than we have had since the civil rights era saw an end to state-sanctioned racism and left us with the more insidious versions that any black person who has had encounters with the police knows all too well.

By the end of the week, the Supreme Court had declared that the federal subsidies that 6 million people in 37 states depend on to purchase health insurance were legal, and would continue in perpetuity. A day later, the court ruled that marriage is a right for all couples, regardless of their sexual orientation. All couples, from Massachusetts to Mississippi are now allowed to marry under the authorities of both their county and the states they call home.

It's important to step back and acknowledge that some weeks are good. They may not start out that way. Such a glibly simplistic idea might not look at the larger contexts of war and displacement, poverty and environmental degradation that continue unabated. But some weeks are good.

This week is good too. It's a 4-day work week, ending with our nation's celebration of its independence, and a time to revisit all the trials and missteps that have led us to what we are today, and provide some idea of where we are headed.

We are not perfect. We are not the beacon of justice and equality that we wish we were. We have an odd national habit of making many wrong decisions before settling on the right ones. We are too often ignorant of the rest of the world, and indifferent to the suffering of our own. But this country is good. This country is unrivaled in its people's optimism, and its ability to change the world, whether it be through innovation of products and processes, or through its influence in affairs across the globe.We have immense power for good or evil, and remarkably, is viewed by many, perhaps most, as largely a force for good. No other great power has ever achieved the scale of power, admiration, and genuine respect that the United States enjoys today. Deep pockets of insecurity that are unconscionable for such a rich nation remain among many of our citizens, and we continue to commit grave errors abroad. But on balance, we are good, and we are getting better.

Consider how things looked just a week ago. Things do change, and often for the better. For all our problems, we are a nation that is always getting better, and today the result is a place that is largely good. Next week we will be better. Next week, perhaps, we will be a nation that is great.

Progressives: Don't Get Hung Up on Single Payer

2014-12-24T11:49:00.002-05:00

As a health policy wonk, whenever my vocation comes up among people of a progressive stripe, the conversation inevitably leads to (and usually ends with) the refrain, "if only we had single payer." Having dealt with the American health care system both as a consumer and as someone who reads hundreds of pages of its rules and regulations on a weekly basis, I understand the allure. Health care in America is an unholy pain in the ass. I would love to be given a card that lets me go to any doctor I want any time I want for free. But that's not happening, even in the rosiest scenarios,

Yes, we can and must do better, but "single payer" isn't some holy grail. If we just handed out Medicare cards to everyone in the country tomorrow, we'd still have to choose between traditional Medicare and Medicare Advantage. We'd still have to choose a Medicare Part D plan if we want prescription drugs. We'd still face 20 percent coinsurance and a litany of copays, meaning that we'd probably also shop for supplemental coverage.

Even if we somehow swept the Canadian system of paying for care down from the North, we'd still have to deal with the endemic perverse incentives of hospitals who are paid by the procedure, medical malpractice, fraud and abuse, the profit motive, and a good number of other aspects of American health care that are untouched by who pays for it. If the politics of enacting single payer above insurance companies' objections is tough, it's nothing compared to all the pharmaceutical companies, device manufacturers, hospital and medical associations, all demanding that the tax payer float the costs of every new, expensive thing without prejudice.

Imagine all the ads on TVs for scooters and diabetic testing kits if everyone had insurance that was guaranteed to pay for anything and everything with only a doctor's note. That's America.

I don't like our health insurance system, but consider this: every year these captains of industry don't take a growing percentage of our health care dollar. It's steady. It may be 10 percent, it may be 25 percent, but it doesn't change. At the same time, hospitals and doctors are paid more and more and more annually. Put those two facts on a curve and the math it pretty clear that health care costs are going up, and it's the cost of health care (not health insurance) that drives it. We could save money with single payer, but the pressures to spend more and more on the newest gadget, or the guy with the fanciest medical degree will remain. Medicare deals with this in the same way that private insurance does, and faces real political and regulatory constraints. It's health care that's expensive, not health insurance.

That said, even people with really good coverage must sort through a morass of deductibles, copays, preferred providers, pharmaceutical tiers, and who knows what else before a claim is either paid out based on some hidden algorithm, or it's rejected by some mysterious technicality. Forget it if you're poor, have crappy coverage, or can't be bothered to learn the rules of a game whose rules are both arbitrary and capricious. In my work, I'm constantly exposed to a regulatory structure that's designed to both encourage a functioning, competitive market and reduce abuses of the consumer that are often a result of that competition. I have to be familiar with dozens of federal, state, and private rules, and am supposed to have some wisdom about how they all interact. I'm reminded again and again that one person's policy pet peeve is another's cash cow, and that even with the best intentions, the everyday consumer is powerless against this deluge of legal jargon. The market can help here, but not without some strong, sometimes complex, sometimes controversial protections for regular people. We can and must do better.

Single payer would be simpler to deal with. It'd probably be somewhat cheaper too. Had we gone for it in the 60s, when Canada and other nations did, before medicine got so expensive and profit-driven, it'd probably have been a much better decision than any alternative proposed since. But here we are today. Health care is far more complex and costly than it was in 1965. With the power and economic influence that health care has amassed, I doubt that even Canada would be able to pass today what it did back then.

It's possible that a few states will move ahead with legislation, despite the recent setback in Vermont. It's even possible that Single Payer will spread like wildfire until some day decades hence, the Alabama legislature approves CrackerCare to become the 56th state in the union with a fully public system. But progressives can't just sit around and hope.

Right now, all the energy in health reform is on the conservative side. All the model legislation bandied around statehouses calls for greater "consumer participation," where larger deductibles and copays, an ever growing stack of confusing insurance products each with its own shell game, and fewer regulations is somehow supposed to lead to a utopia of Joe Consumer shopping for his chemotherapy from a number of willing, transparent bidders, each vying for the shrinking balance in his Health Savings Account. That's reality, and it's happening now. The progressive answer to complex, though thoroughly bad legislation with a good chance of passing cannot be "yeah, but Single Payer." It has to be complex, good legislation.

So what are some progressive ideas that might work within the confines of today's health care system? A few general principles are a good place to start.

The consumer should be freed from having to think about whether they're better off going for the cheaper or the more expensive chemothreapy. That's a job for doctors and insurance companies. As a consumer, I can shop for those with the right tools. I can't be expected to decide how best to treat my cancer.
If it's cheaper health care you're after, deductibles and copays are a waste of time. A $5,000 deductible keeps consumers away from doctors who might prevent a problem early on, and then, once it's a $100,000 life-threatening problem, doesn't really affect the consumer's decisionmaking. It's the quintuple bypass surgeries that make health care expensive, not the visits to the cardiologist.
The government should set rules for negotiation between doctors and insurers. It should ensure that a neutral third party is available to appeal an insurance decision within 24 hours.
The consumer should be able to deep-six any insurance plan that gives them the run-around any time they want (within reason). That's consumer-driven health care.
The government should provide and publicize good evidence on what's good and what's a waste of money, regardless of who stands to make money off of it. Insurance companies can do with this what they will (within reason).
If we're going to have private insurance companies, they need the same bargaining power that the state would have. Much of Europe has private insurance. The difference is that everyone has it, and the companies bargain collectively. Let the insurance association sit down with the medical association and come up with a fair price for things.
Insurers should pull from the same risk pool. Right now, plans are carefully crafted to keep sick people out. They might not offer a particular drug, or have a higher copay for a given condition. If insurers' risks were adjusted across the whole population, they'd compete on who offers the best service, not who has the cheapest patients.

There must be a clear progressive alternative to the status quo in the post-ACA era. Progressives need to get better at talking a big game while playing small ball. Single Payer is a nice, simple idea, but it's not the only way to achieve better health care for more people for cheaper. We can't wait around for a perfect alignment of political forces to usher in some new, magical era of free health care for all. We can't expect its opponents to take it lying down. We need to work on the system as it is, today, before someone else does. We need to do this now.

Just because it itches...

2014-09-13T22:14:00.000-04:00

Back in Junior High and High School there was this sort of guy who could reliably be made to fight almost anyone, almost at any time. The Spaz. All anyone had to do was walk up to him and say something like, "yo mama better stop wearing that rainbow lipstick because when..." and he would spaz on command, running headfirst at the guy who says it, or as a bank-shot move, the guy that the spaz thinks said it. Looking back at it, he was probably deeply traumatized by events of his past or the realities of his present. It was probably the only way he knew how to react. He always came back for more.

The Spaz is a modern allegory for us-- America and many others aside. This isn't middle school. It's the Middle East this time, and all we do is spaz, spaz, spaz.

"...We are continuing this policy in bleeding America to the point of bankruptcy...All that we have to do is to send two mujahedeen to the furthest point east to raise a piece of cloth on which is written al Qaeda, in order to make generals race there to cause America to suffer human, economic and political losses without their achieving anything of note other than some benefits for their private corporations... Every dollar of al Qaeda defeated a million dollars, by the permission of Allah... As for the economic deficit, it has reached record astronomical numbers estimated to total more than a trillion dollars." --Osama bin Laden

When this started out, we charged into the Middle East headfirst in a righteous fury. A bunch of Arab guys had run several planes right into our nation's most enduring symbols. Thousands died, and the rest of were deeply shaken by what they did. So we went to Afghanistan, who only recently had finished with the French, British, and Soviets. The Arab guys who first came up with the whole idea were holed up in some caves in the middle of nowhere there. So we killed almost all of them, and many others aside. We spilled our lives and torched our money there.

Then we notice Iraq, who may never have cared for suicidal Quran-banging hillbillies, but was somehow supposed to have nuclear arsenals fit into overhead-bin-sized suitcases, thermoses full of VX gas, and tubes of toothpaste full of plague, all headed our way. So we went there too. And we killed almost all of those guys and many others aside. Lives and money were everywhere traumatic, ignoble wastes. And for nothing but a cabal of desert sadists, some old Russian tanks, some decent oil fields, and a hundred thousand dead, largely blameless, faceless people. We saw existential threats there and everywhere.

Eventually, most of us didn't like what we'd done over there. Here in America we were poor and shell-shocked. So a new president was voted in, and we mostly left Iraq and Afghanistan, somehow still hemorrhaging lives and money over there. Then other Arab guys, and many others from Central Asia and East Africa, who mostly learned from the earlier guys' run-ins with us, tried to smuggle bombs in Gatorade bottles, shoe soles, and underwear. They set off some nasty bombs on European public transit a couple times. They nearly got us in Times Square. And we mostly held back from all-out war.

Since then, several European countries, America and other allies have stopped many, many of these guys. A few have gotten through, and people in the West have died, but we were paying less and less attention to Iraq and Afghanistan, focusing here on ourselves as a nation than as vengeful occupiers of others. Then there were a few civil wars across North Africa and a few in the Near East, with all their associated atrocities and injustices didn't seem to raise our hackles like before. We mostly held back. So they took hostages and they start posting their grizzly deaths on Facebook, Twitter, YouTube and a thousand other sites, each with their own millions of viewers, watching agape. And we can no longer hold ourselves back.

Now we're going back into Iraq. We're talking about bombing Syria. We're making secret handshakes with Iran and greasing the palms of generals and sheiks. We're getting pressured to "leave everything on the table" in certain quarters here at home. But we know we're being taunted again. The overall threat of those behind ISIS might be vastly diminished from before, but they are taunting us with every last tool still available to them, scaring the world with viscous, horrific images, doing everything they can to drag us headfirst back onto the battlefield.

Let's be clear. Terrorists can hurt us. Even from afar, with only an IPhone, a kitchen knife, and a black mask, they can disturb us down to our soles. But nobody anywhere these days talks about these guys on the awful scale of nuclear annihilation. Let's not forget that just before we started getting involved in the Middle East, we had passed a generation under the real possibility of billions of lives gone in a final conflagration. Before that, a generation had gone to a war against total world domination, just after a massive economic collapse of their own. Before that there was only more of the same, and worse by many measures before that.

How can we compare the horrors of slightly more distant past with the events of the past thirteen years? It's been nearly an entire history of violence, and our traumas have left us punch-drunk, angry, and afraid. Terrible things may have happened to us in the past, but all it takes is a mama-joke now. These weak, almost childish enemies can get us playing their unending game. This time we have to see that the whole world is no longer at stake here-- there is no need to spaz.

Listening to Dictators

2014-06-20T15:16:00.004-04:00

One thing about dictators is that they're usually the most brutal in countries that were made up by others in the first place. Take the atrocities of Saddam Hussein, who was allowed to run roughshod over his straight-lined piece of desert because of other people's desires for oil and cold wars. We even encouraged him to gas people when we were fighting the Iranians.

Another thing about dictators is that when their authority is questioned, they usually say that the country will fall apart without them. If there's one thing we've learned in the 21st century, it's that they're usually right. We don't have to like them, but they're not stupid.

As a nation of immigrants ourselves, America has no natural ability to understand what sectarianism really means to people whose families have been killing one another for generations. Our collective boat ride over the proverbial ocean erased those instincts from our psyches, and replaced them with clear borders and a constitution that we hold sacrosanct. So we're left with pious theory. In come the neo-cons; people whose lack of instinct and skillful amnesia could only come from America. Denial is not just a river in Egypt. It flows right through our own country.

Watching events unfold in Iraq, Syria, and to a lesser extent in other parts of the middle-east, I sometimes imagine the raspy laughter of Saddam Hussein, followed by endless "I told you so's." I can easily picture just how absurd it must have seemed to him for our haughty generals to believe that we could replace what he controlled only through great bloodshed with peaceable, pluralistic, semi-secular democratic institutions.

For those who think that if we'd just stayed longer, dug in deeper instead of "cutting and running," it's worth considering now not whether nominal peace could have been assured in Iraq, but whether we could have achieved it without the level of tyranny that men like Saddam Hussein believed necessary. The tyrant has a natural constituency, speaks the local language, and has everything to lose by his defeat. These are inborn advantages to running a highly fractious, largely contrived nation that no amount of military hardware can surmount.

Others can relitigate the decision to go into Iraq. I'm actually grateful that the matter is up for discussion once again. It's the only way we have any hope of not repeating its mistakes. I'm more interested in what we should do now. While it was apparently news to some a decade ago, we know by now that in the Levant and Greater Mesopotamia there are several ethnic and religious groups that have never gotten along. Why should we force them to live in the same country?

Yugoslavia came into existence in the same era as Iraq and Syria, and for many of the same reasons. Once the dictators fell, it wasn't long before a nasty civil war broke out, followed by a plodding though eventually successful political resolution. Its progress strikes me as an excellent model for foreign involvement in a seemingly intractable ethno-religious conflict. Perhaps if the Kurds, Alawites, Christians, Sunnis, Shi'ites, and a handful of others had their own states, they'd relax a little.

Perhaps those who live in nations that aren't ethnically their own would be viewed less as separatist enemies, and more as minorities that deserve protection. Nations with large separatist factions might even consider giving the separatists what they want. The Kurds of Turkey might drop the freedom-fighter bit if there was an actual Kurdish homeland, instead of a theoretical one that must still be fought for. If I was Turkey, I'd even donate some acreage, perhaps in exchange for a sweetheart oil deal.

My belief is that people who have a long history of hating one another might be better served by having their own borders, and answering to their own leaders. It's not to say that nations can't be very diverse. Perhaps levels of economic development or cultural heritage play roles. Whatever the case, when people start hurting one another, these sorts of solutions ought to be high on the list of anyone interested in stopping it.

The World Doesn't Owe You a Thing

2014-05-28T11:45:00.000-04:00

Mass-Killings. Gun Rights. Mental Illness. These issues will be thoroughly argued over, forgotten, and rehashed when the next 20-year-old opens fire on innocents. What hit me about this most recent tragedy is the raw narcissism at its root. Here is a man who believed that his failure to attract the opposite sex is due to some systemic failure in the nature of all of humanity. It wasn’t he who was untalented, unattractive, or just plain unlucky. Despite his obvious superiority to anyone who ever had any actual success in getting laid, his failures all came down to unerringly shallow women who were universally attracted to brutish men. The cosmic order of things was simply skewed against men like him. The only solution was for them all to die. How can anyone think that way?

Despite the headlines, most troubled young men don’t end up as mass murders. Some become criminals or recluses. Some just kill themselves. Some get over it. The solutions are manifold. Experts have toiled over identifying some algorithm that predicts who is who among this most dangerous group, and how to stop them. Take all the guns away and surely there will be fewer deaths. Public vigilance might head something terrible off. Improve mental health care and surely someone will get the help they need. But none of those decisions alters the fact that any one mass shooter represents thousands of others who don’t quite have all the pieces in place to commit such a reprehensible act. Certain policy changes may alter the odds of one particular tragedy, but they will do little for the related but subtler forms of suffering present in all quarters of our society. What is it about these men? What does it mean for the rest of us?

Maybe someone who harbors these feelings of self-hate, or hatred of others will read this. If so, the one thing I want you to hear is that the world doesn’t owe you a thing. No amount of rage or retribution will bring you peace. Get all the help you can, but in the end, it’s up to you to heal.

The tragedies that bring about suffering are irrelevant. Suffering is suffering, whether it’s because the Khmer Rouge tortured and killed your whole family, or because some girl rejected you in the eighth grade. In both instances, people are left with the simple choice of how they react. Do we blame others or is it somehow our own fault? Ultimately, are we capable of overcoming suffering or will it destroy us? Will we find it just to take others with us?

In my limited experience, despite some chemical imbalance or series of genuine tragedies, the most resilient people are the ones who believe that the world doesn’t owe them anything; that injustice happens and that the only question is what we do with what we have. Given the same variables, different cultures lead people to different choices. We can and should help those in need, but for real healing there must be some sense that in the end, it’s up to us to improve our own lot. Maybe it’s with the help of family or friends. Maybe it’s religion or some other social order. Maybe our cultural shortcomings are due to the erosion of traditional institutions, or the growing mountain of self-referential role models present in our torrent of media, but it’s not just about the next 20-year-old mass shooter. Something is lacking in many, many of us.

Malaysia 370: All Right, Good Night

2014-03-18T11:26:00.001-04:00

Something about the disappearance of Malaysia Airlines Flight 370 is utterly captivating. Pings off of a geosynchronous satellite tell us that the plane was last on one point of a vast arc that covers a significant fraction of the globe, including both the wilds of central Asia, and one of the emptiest stretches of deep ocean in the world. That’s the last we know.

Before 1999 turned to 2000, people believed that even TV remotes wouldn’t work after a mysterious bug in its and all electronics’ programming took hold in the moments we rang in the new year. Many were confident that the whole world would fall into chaos as power plants shut, traffic lights went dark, and phones went dead. Whatever happened or didn't happen, none of those beliefs mattered once the event came and went. In the hours after 9/11, people believed it was right-wing crazies, left-wing nuts, radical vegetarians, or terrorists. We all wanted to know, “what are their demands?” though that seems beside the point in light of the continuous war that must have been the real demand of all sides concerned.

Sitting where I am in time, I know that Malaysia 370’s fate will probably be known someday soon, even if ten days seems like a long time for a jumbo jet to remain missing. It may return as some horrific vehicle of destruction at the center of a terrorist plot. It may be at the bottom of the Indian Ocean. But right now, nobody knows. It’s during times like these, before all the mysteries are revealed, that capturing thinking on what happened is of underappreciated importance. In our era of information collection few new mysteries are made. Too little is not captured in some database or closed-circuit camera. Once all is known, conjecture collapses into cold fact; the stories end, and the remaining carcass of truth is picked apart by analysts.

For this window of time before all is known about such a globally witnessed event, there is a space for public imagination, and that in itself is valuable to people in the future who want to understand the veins of thought at work in today’s collective unconscious. Some groups with high profiles, have raised the possibility of alien abduction. Many look at the potential flight paths to central Asia as a reason to suspect that the plane touched down safely in some mountain redoubt to be repurposed for something terrible. Maybe it’s the Uighur separatists-- the East Turkestan Liberation Front. The Chinese say no. Then there’s the Malaysian Al Qaeda informant who spoke of a 9/11-style plot back in 2012. Or maybe it’s pirates, intent on taking the 777-ER to a chop-shop in some non-aligned state, or selling it at a markup to someone who prefers not to order directly from Boeing.

For myself, I'm pretty confident that the plane crashed somewhere in the south Indian Ocean, after an electrical fire or some other cataclysm onboard led the pilots to make a sharp turn for a nearby runway, and take their communications offline to isolate an errant circuit. Autopilot could have been programmed and engaged before the pilots lost consciousness and the plane would then have continued on a southern heading for many hours until its tanks went dry and it fell into an unimaginably massive expanse of unpatrolled ocean, somewhere in the lonely landlessness west of Australia and north of Antarctica. I also want to believe anything but that simple, sad likelihood.

We want to believe that the 239 people onboard that plane are somehow still alive, held captive by terrorists or pirates, to be released when the time is right. Others want their beliefs confirmed that it’s Muslim terrorists as usual. A few want to ascribe the plane’s disappearance to aliens, benevolent or otherwise. These are the thoughts that are in today’s mass psyche; the thoughts that will be mothballed and forgotten in internet archives once the truth is almost inevitably known. There’s a value to those ideas, a sense of how people in a given moment respond to something that hasn't yet reached its conclusion, or perhaps never will.

As time compresses with our expanding capacity to capture and analyze everything everywhere, these mysteries will shorten in their duration or disappear altogether. Would Amelia Earhart still remain missing if she had set out today? Would people still be free to imagine her living out her days on some desert island these past 75 years?

Mystery, even when couched in tragedy, is a rare, precious thing. We should all try to remember what we used to think before we knew everything. It's the key to understanding belief.

ComplexityCare

2013-11-05T11:42:00.001-05:00

For most Americans, complexity in government is like apples in apple pie. Many of us accept that we must purchase a complex computer program to do our taxes, or verify our identities by way of state-issued drivers’ licenses that require extensive documentation and a long wait in line. When we retire, we cash in our 401-Ks cobbled together across our various jobs, and managed without much expert help. We make sure our long-term care plans are in order, and decide on whether to purchase a supplemental Medicare package, or go with an all-private Medicare Advantage plan. All of the complex rules and programs we navigate in our lives ensure that relative to our peers in other countries, we shoulder immense amounts of risk in hopes of fostering innovation, and we tolerate immense levels of complexity in the name of preserving some notion of personal choice.

How did we get here? From a global-historical perspective, when doctors couldn’t do much beyond prescribing chicken soup and leaches, we paid cash. As it became possible to routinely survive a surgical procedure, or recover from serious illness through medical intervention, health care got more expensive, so people came up with all sorts of clever ways of spreading the risk. Guilds of artisans, unions, and charities helped people to pool their money for the next time someone needed an amputation, or a case of tuberculosis required months in a sanitarium.

Then our fates diverged. Some nations began a slow process of nationalizing the finance and delivery of all health services, while others codified their existing complex arrangements into laws that ensured some level of help for the weakest. In America, in the name of non-interventionist choice preservation, we left health care up to employer, leaving the poor or elderly free to choose chicken or split-pea soup as they pleased. Eventually, feeling bad for the elderly and poor, we created Medicare and Medicaid. Eventually, for the poor people’s kids, we created CHIP, or the children’s health insurance program. Somewhere along the way we passed ERISA, or the employee retirement income security act, which, despite its name, also had a lot to say about the average working stiff’s insurance plan. There was also COBRA and HIPAA, which are important but tedious.

Over the years, mostly in the name of choice and innovation, we variously delegated some responsibilities to states or the private sector through a series of waivers and demonstration projects. In hopes of saving money, we placed a greater share of the costs on the individuals, so they’ll shop around for chemotherapy, or in any case, no longer be part of someone else’s budget. Every year, open enrollment allows us to pick from a smorgasbord of health insurance policies that are significantly more expensive than the year before, with higher fees, and smaller networks of providers. We’re thankful for what we have, and we count the days until we’re old enough for simple, cheap, national Medicare.

The Affordable Care Act did nothing to change anything I wrote above. It added some regulation to make health insurance available to (almost) all through existing mechanisms, and paying insurance companies to cover those for whom a plan would cost more than roughly 10 percent of their income. Its means testing guaranteed a rough interaction with our already byzantine tax rules, and its diffuse market approach ensured that there would be 52 sets of rules for 78,000 individual health plans, another 52 for Medicaid (poor people) plans, and all sorts of tax credits, market incentives, and options for employers to offer coverage (or not). The people who are trained to help others enroll are called Certified Application Counselors, Navigators, In-Person Assisters, and non-navigator personnel. And those are just the ones operating in the 36 federally-run health systems. The other 16 have their own set of terminology.

But we don’t have to start over. We can and should build on what we have. If I was the God of US Health Care, here would be my ten commandments for a new bill (in no particular order):

1. Start negotiating for prices. Mandate national negotiations for a medical fee schedule with any necessary geographic adjustments, similar to Medicare. Negotiations would be between medical societies and insurance providers, with a government-chartered but independent panel of public citizens and experts as final arbiter of any decision. Allow providers and insurers to create their own fully comprehensive regional networks of care using any payment structure they want, as long as it costs the same or less than the national one. Let them keep most of the difference. Inside a network, this puts the people who pay for care, and the people who provide the care on the same side. Outside a network, this frees insurers to charge a little more to those who want maximum choice, while ensuring that insurers compete on quality of customer service, and the ad hoc coordination of care.

2. Federalize Medicaid. Giving Medicaid to the states was a political compromise that has long outlived its usefulness. Today, state budgets are often upwards of one-third devoted to Medicaid. Its waivers and exceptions are unfair and incomprehensible, and it is massively expensive to run dozens of programs instead of one. Since states typically cover half the cost of Medicaid now, to pay for it, cash transfers would have to flow from the states to the federal government, or other transfers from the federal government could be reduced to offset the difference. In either case, the net change in funds the state would owe could be significantly reduced through administrative simplification and economies of scale. Medicaid plans can be distributed through the newly established health insurance exchanges.

3. Open the insurance exchanges to all, and make us all use them. Retaining several different types of markets and risk pools is an actuary’s nightmare, and only adds to costs. Also, if competition is really worth anything, then we should all have the maximum choice possible and the freedom during open enrollment to deep-six any insurance company that gives us the run-around. Employers would also be freed from the costs associated with benefits decisions, reducing an administrative burden while retaining a protection people depend on.

4. Roll Medicare into the exchanges too. On one hand, Medicare beneficiaries would have the option to purchase private plans under the same rules as everyone else (eliminating Medicare Advantage and other complexities). On the other, everyone else would be allowed to buy Medicare. For this to work in the context of the other ideas, Medicare rates would have to be negotiated under the same rules as the other plans, as described in point 1. The only difference would be whether a plan is publically or privately administered. It's concievable that private plans could offer lower premiums compared to Medicare through carefully negotiated networks or alternative payment strategies.

5. Opt out instead of opt in. If someone chooses not to purchase insurance, they should be automatically assigned to minimum coverage. If they choose to be uncovered, they must actively do so. This removes the actuarial need for the hated “insurance mandate.” Insurance premiums should be payable through a payroll withholding, similar to income taxes. That’s how most places do it (even Canada). Payroll withholding also simplifies employers' contributions to employees' premiums.

6. Develop a truly universal claim form, and a universal format for insurance cards. Doctor’s offices often employ several people just to chase insurance claims, and it’s often unclear whether a service will be covered and in what ways. Patients should be able to scan their card and get a coverage determination on the spot, and claims that follow the rules should be paid out without delay or confusion.

7. Reform medical malpractice. Caps on fees don’t really work, as evidenced in Texas and California. Courts or expert panels are necessary to address complex litigation and make fair judgments. Suits deemed frivolous should result in penalties for those who file them. Malpractice coverage should be nationalized, with some measure of risk rating in the premiums.

8. Get everyone primary care. It’s not enough to give everyone insurance. We need standards for primary care that ensure access and quality. People with access to good primary care are healthier and cheaper, regardless of insurance status. Payment priorities, grants, and provider licensure rules can make this a reality.

9. Allow policies to be sold across state lines, but federalize the rules. States should not be involved in regulating insurance plans. If we want real competition, then insurance plans should be better able to conform to the natural catchment areas they operate under. In other words, insurance plans could be regional or national, and offered across state lines, but without the concern that one state or another would be encouraged to lower its standards to the detriment of consumers.

10. End tax writeoffs for insurance. Right now, large employers are far better served giving people expensive insurance plans over paying them more in cash. Take away the tax write-off, and employees will see a gain in net pay, though there will also be a gain in net taxes owed. The added taxable income could go towards subsidies for insurance. A dedicated payroll or other tax might also be needed to finance the vast new group eligible for subsidized coverage and make up for the loss of tax-advantaged coverage employers offer today. A payroll tax could even replace premiums altogether if the rate is pegged to a combination of employee income and their plan selection. For example, an employee making $50,000 a year and buying a plan that costs $5,000 a year would have a 5 percent payroll deduction (resulting in a 50 percent subsidy, perhaps split by the employer and the government), while an employee making $100,000 a year and buying the same plan would pay a 10 percent payroll deduction.

This isn’t about public-versus-private, conservative or progressive policy. It’s about creating a system that is a little more understandable to most people, and easier to access, and with fewer interruptions to coverage. For me, universal coverage is an absolute priority. It trumps nearly all other considerations when it comes to health care, but we have to do better than what we managed to get passed in 2010. For all nations that have taken on this problem, it’s required a series of laws, each with their own setbacks and controversies.

America’s market orientation and culture of innovation is responsible for a disproportionate share of the world’s medical advances. We need to preserve the unique incentives present here to bring new drugs and equipment to market. At the same time we need to make sure that our own citizens can afford it. It’s not fair to say that the United States has done nothing until now to address people’s concerns about their health care. We’ve passed a number of laws to help make health care more widely available and affordable, but when it comes to a universal system, we’re only just beginning. Let it be the beginning of something great.

Paging Doctor America

2013-09-11T16:00:00.000-04:00

The concept of "duty to act" is one of the central tenets of medical ethics. If your medical skillset has a reasonable chance at improving a dire situation, you must use it. Someone who's trained in first aid is legally obligated to help if someone isn't breathing. With our nation's bolus of strengths and a seeming lack of alternatives, we face a similar obligation to the world. But even if the ethics are similar, a civil war is not a human body.

Again and again, Doctor America sees herelf as the only doctor in the house, or lifeguard on the shore. The good doctor has mighty military and massive diplomatic and economic clout, but unlike a person whose heart has stopped, the clinical signs that present themselves in geopolitical conflicts are often vague and conflicting. She gets some things right, messes other things up, and sometimes interferes where she isn't wanted. She also has her own self interests to consider. But for the better part of a century the world has turned to us for help.

With the power we have, we face stark moral choices. Here's one: 1,400 civilians were gassed by a tyrannical regime in the middle of an existential battle that has now killed over 100,000. In the tickertape of atrocities that continue to pile at our feet, this one is pretty bad, at least by recent standards. What do we do? There are people dying in an interminable civil war. There are international laws to consider, regional allies, rivals, and foes. The world and our own consciences scream, "we have to do something."

Another central tenet of medical ethics is "do no harm," but again, even if the ethics are similar, a civil war is not a human body. Assad is a nasty illness, but he's present in the essential organs of the nation, and he isn't the patient's only problem. Diplomacy was going nowhere. An airstrike against certain targets may or may not improve the situation for the Syrian people. We aren't willing to engage in a full-scale war, and even if we were, there are serious doubts if it would help. With the muddle surrounding major strategic decisions there is seldom a clear diagnosis or treatment plan. We look at a country at war and understand the history fairly well, and we measure our decisions based recent experiences. Even after all is said and done, we can't know the counterfactuals. We never can be sure if we made the right decisions.

This case is different than any one I can remember. For the first time in my memory Doctor America is coming to believe that the weight of the world doesn't rest on her shoulders alone. She isn't Doctor Quinn, practicing her basic medicine and shooting wolves to keep the patient safe. She is part of a team of trained physicians who must coordinate themselves between conflicting interests, massive egos, and differential diagnoses. She is part of a geopolitical health system; with institutions that are supposed to help smooth out the bumps between these powerful people and arrive at a consensus. For the first time ever, those systems appear to be doing their jobs. The United Nations has provided a valuable forum for decisionmaking between the US, Russia, Syria and its neighboring states. Allies like France have stepped up to offer their own solutions. Syria's neighbors and family are pitching in where they can. Suddenly we are saved from the terrible decisions we felt we had to make on our own.

The prognosis in Syria is a long, long way from improving, and our responsibility for its eventual recovery is far more limited than a doctor's to her patient, but something fundamental has changed in our approach. Maybe we're realizing the limits to our skills. Maybe we're trying some new approaches. And maybe, for the first time in a long time, we feel like we have help.

Whatever Happened to Peace?

2013-07-12T10:38:00.000-04:00

Our country's been at war for a long time now. The longest time in our history. At the time of writing 6,735 American troops have been killed in Iraq and Afghanistan. The official numbers say that over 50,000 American troops have been wounded in those conflicts. They won’t even tell us how many civilians have been killed.

There is an eerie acceptance of all this; a tacit understanding that no cost is too high, no burden too great, and that more fighting is a sad inevitability. There’s a missing reluctance to engage in warfare. This massive apparatus of destruction, once created, demands a purpose. We may try to hold back, but there never seems to be an end. Syria, Iran, Pakistan, and most of North Africa, including Egypt, are all smoldering candidates for US military intervention. There is no end game, just the next fire to put out, too often caused by the fanned embers of the last.

Whatever happened to peace? I don’t mean putting flowers into the barrels of guns, or frolicking morons in the sun. Those are too often the images that come to mind when the word is invoked, after the defeat of the non-interventionists in the Bush years, and the many years of war that followed. Whatever happened to there being some realistic image of what peace would look like, here or abroad? People raising kids in relative safety, going to work, building and prospering? Why is this not even mentioned as an objective to all this destruction?

Whatever happened to the “peace dividend,” the idea that out of conflict and suffering come new business opportunities, or that the skills and assets acquired in wartime can be retooled to benefit everyone? Instead of thinking about how all its energy can be put to use, we worry about the impact that demobilization of our military would have on the economy as if there were no substitute activity for all our restless young. Instead of thinking about all the other investments that could take place with the money spent on war, we think about the losses to defense contractors who have profited massively on something that used to be considered the world’s greatest evil. Only war pays a dividend now.

We can’t imagine peace today because we have built ourselves around war. Any sporting event coast-to-coast has at least one patriotic moment where we honor our troops. We stand and cheer their bravery, and that’s important. But these displays have a dual function. They not only honor people who have sacrificed tremendously for their country, they also leave us unable to question why they do so in the first place. How can we be uncomfortable with war and avoid insulting someone whose legs were blown off in its service? We may mutter to ourselves about how all this is no good, but surely we can’t take it out on him. For this and many reasons, we can’t even begin to think about peace and patriotism coexisting.

Even as the Iraq and Afghanistan conflicts wind down, related conflicts demand our ongoing vigilance. Sectarian violence, religious extremism, fallen dictatorships and emergent nationalists all beckon in different settings, all tied together as a larger trend, but each with its own potential for conflagration. War profiteers stand at the ready with tailor-made solutions to each of these possibilities, and sage advice on when to deploy them.

Nobody stops to consider what peace would look like across the entire region, or how it could be achieved. There are no multi-national solutions to our involvement. We’re tired of mass efforts. We don’t believe in diplomacy. It is now about small-bore policy with short-term goals, each with its convenient unit cost. Stop the fighting in Libya. Take out an Al Qaeda sect in Yemen. Send arms to Syrian rebels. Dance around the overthrow of the Muslim Brotherhood in Egypt. Ally with the Saudis and the Gulf States against the Iranians. Support some insurgents, but not others. One conflict inevitably leads to the next. How does this ever end?

We will be involved in Middle-Eastern conflict, but it’s time for a strategic re-evaluation of the why they are happening at all, who is responsible, and how to end them once and for all. We need to revisit our most basic assumptions on how we involve ourselves. What are the major divisions? Sunni-Shia, Secular-Islamist, Democratic-Dictatorial, proxy wars between oil-rich princes who dare not dirty their hands. There are other realistic approaches to consider. How can we approach these problem on as a whole, instead of our unending piecemeal approach? What must we demand of our allies? What are we willing to sacrifice in order to cripple our enemies? How can you neutralize or coopt extremists instead of endlessly incurring their wrath? What about putting the restless unemployed to work building their nation? Who can we call out for not doing their part? What can we control, and what are we best off avoiding?

We need to ask our enemies and ourselves alike, how can we once again make peace more valuable than war?

Can't Buy Me Omnipotence

2013-06-24T12:44:00.001-04:00

(Or He's Got a Ticket to Ride)

I’ve followed the Edward Snowden case without having much personally to say. It’s hardly revelatory to learn that the NSA is combing through the world’s communications. All you have to do is look at the $10-odd billion in shadow budgets and the hundreds of thousands of people who scrupulously maintain high security clearances to stay on that particular gravy train. If they’re not spying on us they’re wasting our money. Whatever the case, right or wrong, this cat-bites-mouse story is about as enlightening as an episode of Tom and Jerry.

What is interesting to me is the elemental weakness it reveals. In 2011 we spent over $1 billion on criminal and civil background checks, drug tests, polygraphs, interviews with thousands of people’s neighbors, colleagues, exes, and old roommates, along with mountains of paperwork. But no screening can uncover a quietly held opinion, a change of heart, or a random act of rebellion or revenge. In the end, no system can prevent Edward Snowden, Bradley Manning, Daniel Ellsberg, or Mark Felt from deciding to submit the damning things they know to the judgment of the public.

None of this is to say that I particularly like knowing that there’s a massively powerful organization with unknown authorities and abilities checking through everyone’s Facebook accounts for references to fertilizer and diesel fuel (think of the farmers). Something about Snowden really rubs me the wrong way too. We can argue on the merits or we can argue about the optics, but we're not covering any new territory. The potential for a crazy bastard or bastards to cause arbitrary harm on innocent bystanders probably merits some system of finding and arresting them. Even if Snowden is an arrogant self-interested jerk, he may have done some good. Even if there are serious breaches of the public’s trust, some of what the NSA does is probably a good thing. Some of what the KGB did was probably good in some sense too. The world's complicated and all sorts of people do all sorts of things for all sorts of reasons.

But power is limited by other factors aside from the odd disillusioned contractor. Snowden showed up in Hong Kong with information showing that Chinese systems had been compromised by American intelligence. Conveniently, the extradition paperwork was held up on technicalities, and Snowden flew off to Moscow before the Americans could get near him. When he arrived in Moscow he remained in the pre-customs holding area, complete with its own hotels and restaurants. Russia, still sore from both the cold war and our ongoing wars on their allies, told US officials that there was nothing they could do since he was never checked by their customs officials. Now Snowden is off to a small Latin American country with a left-wing government, a chip on its shoulder for past American transgressions involving intelligence personnel, and favorable extradition treaties for political dissidents. When you do things people don't like, they don't forget.

In the end, American power is constrained by forces far above or below what can be bought from a defense contractor or launched from an aircraft carrier. American power can’t buy omnipotence. Even with our colossal military, legal, and diplomatic force in play, what real choices remain for American authorities to place Snowden in their custody? What stops some anonymous intelligence analyst with information and an agenda from sharing what he knows?

To be certain, it would be a logistical flick of the wrist for Obama to order a special forces team and a couple of drones to track down, capture, and forcibly relocate Snowden from his Wikileaks-funded beachfront villa to a Supermax facility in Kansas. But political considerations like the sovereignty of our allies, or the ugly precedent set by such tactical escalation take that option away. To paraphrase someone with wisdom on the subject, the more we squeeze, the more things slip through our fingers.

No number of lawyers, diplomats, soldiers, spies, or assassins can bring Snowden to justice. No amount of computer programming, viruses, or hard drive erasures can take back the information that is out there for the public to see. If we have any level of moral standards or even practical considerations beyond the immediate, we can’t do anything. And the heroic dissident is sitting on the beach. Consider that precedent.

Day 7: Could it be...

2013-01-15T20:07:00.001-05:00

Seitan!?

Why yes, it is special

No, not that kind of protein, whatever it is you're thinking.

The Vegan Age is coming to an apocalyptic end.

And why not go out with a little flourish?

Tonight I invited Seitan into my life.

Seitan is known by many names,
including Wheat Meat.

Seitan is a weird asian industrial food product. For some reason, lots of people think this kind of thing is good for them. I don't know, but it cooks into something meat-like, and it got a nice char on the grill pan.

Since I've been talking about hell and paganism all week, it had to be seitan Greek-style. Those guys know their sin. Opa!

Hey, that's not lamb!

Pseudo Souvlaki

Grilled seitan

Caramelized onions and red peppers
Roasted garlic-dill aioli (vegannaise base)
Red romaine lettuce
On flatbread

with tabouli, assorted olives,
and pickled peppers

But I don't care!

Week's Recap:

Eating vegan for a little while really isn't a punishment. I didn't challenge myself by trying to eat out, but what I made at home was great. After a day or two, all these oddball proteins actually tasted meaty and satisfying. A little soy sauce and you're there.

Takeaway:

I had fun cooking and writing about rabbit food, and I lost a couple of pounds along the way. Right now, I could go for a little dairy, but I really don't miss meat. All I can say for sure is that it's possible to eat vegan and eat very well.
I'd even do it again.

S. Pacific Volcano Mt. Cilantro Erupts

2013-01-14T20:16:00.000-05:00

50 supertasters still missing.

Embassy Officials: "no comment."

The green guy upstairs is happy

Day 6: The Vegan Basin

"Boom!
"Nobody saw it coming. There was cilantro everywhere. Our chief leaves the island and 6 days later, Boom! Our Cilantro is furious!" said a local man.

"But then we offered our coconut-peanutbutter-noodles-with-tofu-and-veggies to the mountain spirits. They thought it was awesome." and the island was saved.

Locals are advised to take cover

Stir-fried Offerings

Ginger-garlic tofu

With bok choi, onion, red pepper, and rice noodles

In peanut-coconut milk broth

Cilantro

Day 5: Approaching Balance

2013-01-14T13:33:00.000-05:00

Asceticism has a way of becoming routine. At some point, any exercise in restriction becomes plain old life as we know it. All the discipline it took to hold back goes to waste. We slowly regress to the mean of our old way of living. We're all tied up to cycles of abundance and scarcity, our fat times and lean times. Finding a way to live through both fat and lean is a challenge for everyone. Finding some way to change where the balance lies between the two is even harder.

"Whosoever would undertake some atrocious enterprise should act as if it were already accomplished, should impose upon himself a future as irrevocable as the past."

---Jorge Luís Borges

Borges wasn't much of a rice-and-beans guy, but the yin-yang thing with the white rice and black beans was too much fun.

Arroz y Habas "Yin-Yang"

El Yin

Refried black beans

Green chile and sauteed onion

Spices

La Yang

White rice

Served with fake cheddar, corn tortillas and pico de gallo, alongside a dram of Red Breast Irish Whiskey. So much for asceticism.

Day 4: Is This Scurvy?

2013-01-13T18:10:00.001-05:00

One of the best ways to make yourself write is to start a series of something. When you count day 1, 2, 3, etc. you start feeling obliged to add more. Even if you don't really feel like cooking or showing it off. Even if nobody ever reads it.

Vegan Week would be as incomplete as the proteins I'm eating it didn't get a full run of 7 days.

Here's all I could come up with on Day 4.

Back to basics. A typical pasta-and-sauce, with a few added tricks. Fresh oregano, mushrooms deglazed in grappa. Then you pour in a bunch of Textured Vegetable Protein and presto, you have an ersatz bolognese. It did the job.

The dog didn't beg tonight

Rotini Bullshitnese
San Marzano Tomatoes
Soy flakes
Mushrooms
Herbs

Day 3: Our Future, the Triple MMM

2013-01-11T22:09:00.002-05:00

It tastes like just like a Manwich or Sloppy Joe, I swear. Manly, yes, but wearing drag and strutting with crabby Maryland flare. Here in the land of pleasant living, we call it a Sloppy Josephine (Jehws-ephine, as spoken here). Or a Maryland Marshy Mushwich. Or a "Triple M."

Counting down

We're entering the middle of Vegan Week. It's no longer feeling like a penance for December's sins. More like a taste of the future instead. A sampling of the kind of food they'll make you eat if you ever go to space. The Triple M is full of protein and vitamins, and easily reconstituted with water. It wouldn't go bad in storage, and would stick to the plate even in weightlessness.
Just sayin'.

The Triple M is spicy, tangy and hearty, with a strong Old Bay flavor warming up the background. The sweet potatoes have a good desert herb aroma, along with a nice sweet-salty balance.

No green here. No meat either.
It's delicious. The future is MMM.

It tasted much better than my webcam let on

Triple M
Soy flakes
Red pepper-vidalia onion puree
Fire-roasted tomatoes
In Gator Ron's Original Bloody Mary Mix

Sweet Potatoes
Rosemary and sage
In olive oil

with
Gotham
2010 Shiraz
Barossa Valley

Shout out to Steve and Debbie Paderofsky!

They're my cousins, and the people behind...

Gator Ron's Zesty Sauces and Mixes
Ron was their close friend. He cooked all sorts of amazing sauces for barbecues, wings, bloody marys, and lots of other things until ALS made it impossible. Ron's wife and Debbie got together and remade all Ron's recipes in his memory.

All money that they can squeeze from their operation goes to research to find a cure for Amyotrophic Lateral Sclerosis.

They're all awesome. That goes for the sauce too! And it's showing up in restaurants and grocery stores around the DC-Baltimore area. Check them out.

http://www.gatorrons.com/

Day 2: Mid-East Madness

2013-01-10T20:24:00.001-05:00

I love to make generic middle-eastern food. Stuff that could be passed off as Greek, Lebanese, or maybe Moroccan on a bad day. Doing it vegan makes me feel like I was cooking with the best stuff I could find outside my cave without getting spotted by a drone. But it was pretty good.

The hummus, tabouli, and baguette did the job nicely. The lentil burgers were more like a well-fried corned beef hash, and that's a good thing.

Maybe I'm just hungry, but this tasted good. I'd even make it again.

The Sheik's Lentil Burgers
Roasted garlic and shallots
Carrots and peas
Natural flavor and/or...

Tabouli
Parsley, tomatoes, and onions in bulgar wheat
With mint, lemon juice and olive oil

Traditional Hummus

Toasted Soft Baguette

Day 1: Post Holiday Repentance

2013-01-09T20:26:00.002-05:00

Get out your sack cloth and ashes everyone!

It's

Vegan Week!

He hates carrots but he's been a bad boy

For many of us January is a time to lay low, curl up by the fire, and sweat out the habits of gluttonous December. This year, part of my self-administered purgatory is a week of veganism.

Not bad.

Still hungry. A little gassy too.

But not bad.

Day One:

Massaman Kale
with carrot-celery-shallot mirepoix

Curry Tofu
fried with hoisin sauce

Long Grain Brown Rice
prepared with vegetable broth

Indefensible

2012-11-14T18:58:00.000-05:00

Speaking as a federal employee* the stories of largesse among the higher ranks of our armed forces really rub me the wrong way.

On one hand we have the cohort represented by General Petraeus marching to cocktail parties with an entourage of 50, decked out in epaulets, medals, and merit badges, screwing their fawning biographers, and biding their time before their fat 50s-era pension matures so they can sell their insider connections to the highest bidder among a sea of mostly unaccountable defense contractors. Or this guy.

On the other hand, there’s the typical experience of a federal employee, represented by me. If I have a meeting downtown I need to fill out a travel form for the five-dollar subway ride a month in advance. If there's a conference, only one person from my office can go, and it can’t be somewhere nice, like Vegas or Key West, or they probably won’t approve it. We have an office fund for the water cooler. Someone fronts the money and we all pitch in 8 dollars a month so we can enjoy our Cup ‘O Noodles with something other than bathroom tap water.

This is not to belittle military service. It’s to say that we are all public servants and should be held to the same ethical standards. Speaking with people I know in the defense community, it’s shocking to hear about the routine abuses of public office by the upper echelons of the military communities. It's even built in to the rules. Many defense contracts work under a cost-plus methodology, where instead of receiving a fixed sum for their work they are paid an open-ended rate for the hours they bill, plus a guaranteed profit, regardless of whether they are massively over budget or generate inferior work. We don't even know about large chunks of that spending (and others) because it's classified.

Members of Congress routinely inquire into the minutest details about my tiny agency’s half-million dollar grants, looking for any malfeasance they can tout as government waste. It is rare to hear about any elected official providing meaningful oversight to the multi-billion dollar defense contracts, even as defense spending has nearly doubled since 2001. They target us because we are part of the health care safety net. We provide services to poor, politically unimportant constituents.

Federal spending requires oversight. I get that. My agency doesn’t give a dime to anyone without half a dozen levels of program and grant review, independent audits, and continuous performance assessments. We're scared to death of Congress, but if Congress finds something wrong with my program, we’ll fix it. Meanwhile, twenty percent of federal spending goes to the defense department. Who’s watching them?

*Unofficially, not on Uncle Sam’s time or equipment

Five Things I Learned from the Election

2012-11-07T12:42:00.002-05:00

1. Money can’t buy you love.

Going into this election the pervasive view was that reduced restrictions on political advertising would mean billionaires buying elections. We can’t know what would have happened under the old rules, but after ridiculous billions spent almost nothing has changed. It is also clear that saturating the airwaves day-and-night with one side’s or another’s propaganda has steeply diminishing returns. Ads buy votes, but only to a very limited point. In the end you need a strong movement, a real passion for a candidate, and plans for the country that doesn’t freak most people out.

2. We may need a constitutional amendment based on national annoyance.

Our nation has reached a point of electoral mutual assured destruction. It is bad for the country to have a four year presidential term, and two-year terms in the House of Representatives dominated for 18 months by fundraising and campaigning. It’s bad for our democracy to turn a spirited civic discussion into the Second Cola Wars. It’s bad for our collective psyches to have to hear political messages day and night for months on end. It’s oppressive, polarizing, and guarantees that our politicians will be working for whoever pays for their campaigns, and not the people who ultimately vote them in. Something has to be done about the length of campaigns, and the spending arms race, whose net result is only beneficial to the influence of advertisers and interest groups.

3. Polling doesn’t lie.

I’ve been on both sides of this. In 2004 I remember being sure that the polls were undercounting the young and minority groups who used cell phones or were otherwise difficult to reach. I remember looking at polls and thinking they must be off by 3 to 5 points based on some gut feeling I had that kept me going when winning felt like a mortal struggle. I was wrong then, and the other side was wrong this time. Modern polling is very sophisticated. Taken on a macro level over time, polls predict election outcomes with remarkable accuracy. Last night’s results look almost exactly like the weighted polling averages of many experts, red and blue. In the end I was only surprised by how few surprises there were.

4. Even the deluded can concede that they were wrong.

Watching the internet and TV chatter since last night it’s striking how the other side has been so real about the policy and demographic corners they’ve painted themselves into. The same people who were so sanguine about their side’s mass appeal and were so absolutely certain about victory completely reversed themselves over the 15-or-so minutes around 11:00 last night. They could have called for revolution. Instead they became sober, contrite realists. It gives you a little faith in reality eventually winning out. It makes me a little less cynical about how the world works.

5. The other side can be gracious in defeat.

After a brutal campaign Romney gave a magnanimous concession speech, and by any standards his audience was admirably calm and collected. Republicans were shocked by the results, but accepted what they meant without hesitation, and with minimal acrimony. When you scrape away the punditry, propaganda, loud extremists, and bluster of campaigns, what’s left are people of all kinds who are truly decent and absolutely invested in the future of this country. For me, it’s a reminder that most Americans want solutions to our challenges above ideology, and want leaders to work out our differences, no matter who’s in charge. It’s often those with the greatest power and influence who stand to gain the most from an angry, divided nation. We all need to learn that lesson.

How to Follow a Campaign and Not Go Crazy

2012-10-17T12:26:00.001-04:00

2004 was a tense time for me. I spent most of that year following RealClearPolitics, Election Projection, and countless other sources in hopes of divining some prediction of who was going to win the presidential election. Words were parsed, and debate body language was scrutinized by experts. Positions were spun, and so was I. My guy had to win at all costs; I couldn't even imagine how anyone would vote for the other guy. As usual, the whole world was at stake. And my guy lost.

2008 was a little better. I was still a bit of a mess by October. The economy was in full astrophysical implosion, and, as usual, the whole world was at stake. Polls went up and down. Debates were had. I trawled my blogs obsessively, and read every experts' exegesis of the tea leaves. Every turn of phrase mattered, but my guy looked pretty good. And he won.

In 2012 I decided to do things differently. The past decade-and-change has been a learning process for everyone who ever had to rely on a newspaper or network TV for their information. Today's media practically comes out of the faucet. Nobody is culturally equipped to deal with it all. Anyone with an opinion can now be labeled an expert, and conventional wisdom can flip at a moment's notice.

There is no way I could be a close observer of this election without losing my mind. So I've established some general principles for survival now, and moving forward. They've really helped me. Maybe they'll help someone else who reads this.

1. Whatever the gaffe, it probably won't matter next week. Campaigns are about fundraising, door-to-door, ads, speeches, baby kissing, and fighting to win the news cycle on an hourly basis for months on end. Does anyone remember anything Newt Gingrich said back in March? One side or another may get some momentary traction out of a given incident, but it is rare that a single moment or turn of phrase will solidify public opinion.

2. Polls are samples. Every single poll brings its own convoluted approach to sampling a small number of people, and then goes on to profess some larger existential truth about our future as a nation. Ignore them. All that matters are the trends. If 20 polls say your guy is winning, that's good. Anything else is mostly meaningless.

3. Hey dog, who's wagging that tail of yours? The media decides the message, and even they disagree. We have no control over pubic perception as individuals. With thousands of media outlets, each variously customized for our biases, competing for our attention, and selling ad space, it's no wonder that it's not the viewer who decides who won a debate. You can't change that. It doesn't matter what I think, only who I donate time and money to, and ultimately how I vote.

4. No matter how expert the opinion, they're often wrong. This is really a corollary to Number 3. People who are actually paid for their opinions aren't paid if they're right. Nobody even remembers that. They're paid to have an interesting enough opinion to keep you watching through the commercial break. Even the people you trust the most are often wrong about what the public cares about. They're subject to the same noise and hive mentality we all are.

5. Life goes on. Don't expect politics to end just because your guy won or lost. Anyone who's paid attention and been passionate about politics has endured crushing defeats. Forget politics. The world is a tough place, but it used to be a lot worse. In the long run it's mostly gotten better. No matter who is president on November 8, the sun will still rise, the world's hardships will remain, and there will still be work to be done.

Viral Democracy

2012-08-27T17:56:00.001-04:00

There’s an outbreak of hatred and resentment that is bigger than is generally healthy for a superpower. There’s widespread hatred towards the decade-long war with no end in sight, even if we don’t agree on what comes next. Almost everybody lives with some resentment towards shadowy, malevolent corporations and sprawling, opaque government. Something Big and Powerful has been eating away at our paychecks and home equity and gorging itself on skyrocketing health insurance premiums and social security checks for someone else.

We we may be at each other's throats, but we're more connected to one another than at any time of history. Everything is viral. We share our beliefs like social diseases. So much human interaction primes us for an epidemic of belief systems.

We hope for panacea, some political party or ideology to finally break the logjam in government, end the war, pay our nation’s debts while give us the dignity of a good-paying job and a clear conscience. Most of us have only two parties to choose from in this process. It’s not enough choice and there’s widespread suspicion that that the Big and Powerful run it all anyway. Nobody but the daft really likes their polished, cloying options in political parties and a few doe-eyed suckers still hold out hope that their side isn’t quite as sold out as the other.

In times like these, it’s not that people haven’t tried something different. During a war and a recession, Ross Perot combined his own wealth with a certain brand of pragmatic-but-crazy ideas and managed a little under 20%. This time around, Americans Elect employed the best political minds in some vaguely centrist quest for Twitter followers, but they never even made it on the ballot. The lesson is that you can’t go it alone, nor can you crowdsource ideology. To truly go viral, you have to start from some set of ideas. But in this time of free-thinking, frustrated people, each with access to thousands of viewpoints, the possibilities for new majorities are endless, and the demand is greater than at any time in living memory.

The two parties resemble sick, sclerotic, overfed businesses who jealously guard their profit margins and send armies of lawyers after any young upstarts. A third party might assemble a team of personalities and ideals that would win over voters, but the rules of the game (and the players themselves) keep them off the field. Maybe the way is to avoid playing the game in the first place, and not form a party at all.

Call it a Political Interest Network (PIN®) instead of a political party. A few strangers could come together around 3 to 5 seemingly unrelated interests that transcend the political parties and happen to agree strongly with some segment public preferences-- Things like campaign finance reform, energy independence, and ending the Afghan war come to mind. Politicians, experts, and civic-minded individuals can meet in some public space, online or in person, and talk through ideas under the umbrella of an interest group. They can quietly raise money for individual network-affiliated candidates through the partys’ own fundraising channels, or at the grassroots, where nobody is looking. PINs could take great advantage of the political realities of Super PACs and Citizens United.

It could start small, winning a few statewide races and growing a small caucus in some minor legislature or city council that one party or the other needs to win. Like a virus, it can get larger and replicate by using the existing, vulnerable infrastructure, working the RNA of a concrete set of ideas into caucuses and committees in both major parties, slowly building a brand around your people and ideas, allowing for change and making compromises. Sell subscriptions to politicians who want access (or immunity).

To avoid dangerous virulence, my ideal PIN would adopt bylaws from the outset that restrict the influence of industries, government officials, associations, and powerful individuals. It will need to have experts in political organizing, money, communications, and other aspects of a movement, all while retaining connection to the core set of popular principles the network agrees on, and being responsive to people’s interests. At some point, PINs will become voting blocs independent of the parties, and possibly new parties themselves. They can't do that by killing the host.

There are some ground rules to consider. For me, I’d want it so that no individual or group will have control over where it goes. Its founders will have to accept the high probability that the network will go in directions they strongly disagree with. The PIN that is interested in campaign finance, energy independence, and ending the war might also develop a position on abortion or health care. A politician or an individual might subscribe to more than one PIN, depending on their rules.

Viruses mutate. No matter what rules are established at the beginning, the PIN might become a political party in its own right, end up co-opted by some special interest, or disappear entirely. The point is that with a third, or a fourth, or a fifth party, each with its own distinct set of issues. To actually get things done they’ll be forced to compromise on the job, instead of the zero-sum fight to the death of the modern two party election. Who knows? People might even stop thinking of themselves as Democrats or Republicans, and instead think of themselves as subscribers to beliefs.

At the beginning, at the local level and among a group of people who know one another to respect their views, we don’t have to agree on everything-- Just enough to create a network around a few easy ideas that straddle the party divide. Hurricanes can start with sneezes.

It Ain't Over

2012-06-29T09:40:00.000-04:00

I heard from someone down South today. They were crossing into South Carolina from Georgia. Over the South Carolina line, the American flags were flying at half-mast. Nobody important died. It was in mourning for yesterday's Supreme Court's decision on the health care bill.

After two years of inflammatory rhetoric promising the certain end of freedom should this bill be enacted, many, many people believe it. For a long time, this belief could be sustained on the hope that the court would find it unconstitutional, or that congress would devise some way to pull the plug. But the reality is setting in that the Affordable Care Act is the law of the land. With less than a year and a half from its main provisions taking effect, if you don't like it, it's time to get specific about what you don't like. It's not going away on its own.

As a nation we accept the general principle that our individual freedoms are circumscribed by our legal frameworks. We believe in the system. This law isn't perfect, but it now belongs to all of us. The bill was passed and it's no longer up for debate on constitutional grounds. Griping about the death of freedom is all well and good, but if you really want to do something about it, it's time to call your congressman and demand reforms.

Let's look at the individual mandate. It's a provision in the Affordable Care Act that compels people to retain health insurance coverage, or else pay a tax amounting to no more than 3.5% of personal income. It's also the least popular part of the law that people know about. The mandate is essentially a tax is managed by the IRS, but the money goes directly to a fund to help pay for other people's insurance premiums. Unlike other taxes, the IRS doesn't have the authority to impose criminal penalties for non-compliance. If you don't have insurance, all they can do is garnish your tax refund, and if you can demonstate financial hardship, the tax is waived altogether.

Is this the death of freedom? If so, then we need to talk about the tax benefits I enjoy from being married, or massive deductions in mortgage interest that forego from not owning a house. Even though I want to be a married homeowner, I don't want the government telling me I should be. I question the social value of those rules, but I'm not about to take up arms. It's just not that big a deal. The tax system is riddled with incentives and penalties. If you don't like them, call your congressman and demand reforms. Start a web site. Get a dozen people to call and they will listen. You are not powerless.

But consider this: Young people can now stay on their parents' plans until they are 26. Uninsured people with pre-existing conditions (like my mom) can now get good insurance for cheap. Insurance companies can no longer have lifetime limits on benefits, and cannot turn away sick kids. They have to spend 80% of your premiums on actual health care, or else give you a rebate check. In 2014, if you don't have coverage, you will be guaranteed a decent plan that costs no more than 11% of your annual income. The government will pick up some or most of the tab for families of 4 making less than $90,000 a year. And it's paid for.

If you don't like those provisions, by all means, call your congressman. If you didn't know them by now, and you didn't like the Affordable Care Act, then maybe you should rethink where you stand and who you trust.

This isn't the system I would have designed, but for me there is only one non-negotiable abstract principle: universal health coverage is a human right. If there is another way achieve that goal, I'm all ears. More specific to our realities, if there's another way to incentivize the healthy people we need to buy insurance, I'll listen. Seriously.

But I have no more patience for the partisan blowhards and their abstract claims to liberty. If people can't be bothered to inform themselves on what they like and don't like about the bill, they forfiet their right to complain. If they choose to ignore the good and overdramatize the bad, then they are not acting in our nation's interests. If they have real concerns about the bill, I'm listening. We all should.

If our leaders still can't come to the negotiating table after two years of near-existential political warfare, lost court battles, and unending bad faith, then they should be replaced. It's well past time.