Time's Cover Article on Medical Bills

The cover of the latest issue of Time magazine (March 4, 2013) has a picture of a big “Bitter Pill” on it and the title of the lead article, “Why Medical Bills Are Killing Us.”

It's a long article, available here online, but you can catch the basic meaning of the whole from the little notation arrowed toward that pill on the cover: “One acetaminophen tablet cost 1.5 cents. Your hospital marks it up 10,000 %.”

I think it's safe to say that if something appears on the cover of Time magazine, it is something everyone has already known for some time. Time has always been a sort of report of the common view, often a view which is even just slightly behind what is current.

The article is loaded with examples of simply shocking criminality on the part of the medical industry but we know of it already. My neighbor fell and got a cut on his nose, and his wife felt he should go to the Emergency Room at the hospital across the street to have it looked at: they found nothing wrong and did nothing to it and then gave him a bill for over $8,000 and a bandaid.

I myself got a metal splinter stuck in the cornea of my right eye and went to the emergency room. An Intern took a pair of tweezers and a magnifying glass and pulled it out, taking less than four seconds to do it. The bill was $625. I talked with my optometrist about it later and he said that the standard charge for it was $125, set by the insurance companies, what he himself would have charged me. He also said, “If you had insurance they would have charged you $125 but since you don't have insurance, they can charge you anything they want.” The truth is that even $125 for what was done would be thievery.

The Time article, by Steven Brill, to be fair, brings out many more sources and ramifications of the “industry” than I was aware: for example, that so many of the incredibly profitable players are classified as “non-profits.”

Yes, but I still think it's true to say that everybody knows. In fact, probably a majority of the “Kansans” who are getting these extraordinary medical bills and reading about them are out there demonstrating for, campaigning for, voting for, lower taxes and less regulation on the very criminals who are playing them.

That's what moves me most about medical crime. The thought is that the situation is so bad, so horrifying, that it can't continue. People will eventually rise up in revolt. But that's part of the whole fantasy. It's one of the places Marx went wrong. The opposite could even be true: the more degraded people become, the less likely they are to be able to summon righteous, effective power to correct the situation.

The Time article does not even mention this.

My 'Cello vs. Football

The first piece I ever published was a letter to the University of Alabama newspaper in Tuscaloosa fifty years ago in the mid nineteen sixties. I was a bit shocked to see fragments of that letter on the Internet yesterday, written long before the Internet came into existence, written with great passion, but true after all.

The great questions of those days are still very much with us fifty years later despite, or maybe because of, the reaction, the “Reagan revolution,” the hiding, since then. I read a remark recently about “the care-free 'sixties of sex, drugs, and rock and roll.” But that's not what I saw during those years.

The Viet-Nam war had become transparent; there were racial demonstrations, riots and murders right before my eyes; assassinations of King and the Kennedys; and the corruption and collusion of the educational establishment had become explicit and undeniable – definitely not “the care-free 'sixties.”

I was studying and teaching sociology in graduate school at Alabama at the time, but in the middle of it all I was also taking one class each semester in the music department, studying the 'cello. The faculty and students there were just inspirational. I remember that's where I was when I first heard of John Kennedy's assassination – I came into a music room for a 'cello lesson and my teacher told me that the President had been shot and then she talked of the extraordinary music that the campus classical radio station had been playing in response.

Well, shortly after that, the University closed down the classical music station. It was the money, they said. I was deeply offended, as were my friends in the music department. So I sent a letter to the University newspaper in which I wrote that music was far more important than football, and that money currently being spent on football should be reallocated so as to keep the FM radio station going for the university and the community. Football was a very big thing then at the University of Alabama, just as it is today. My letter was published, but no one congratulated me for speaking the truth or to say what a fine fellow I was, no applause from 60,000 in a stadium (it now seats 102,000 people), no awards, no beautiful Alabama girls, no name on the Walk of Champions, no respect.

There were then no black people on the Alabama football team, if you can believe it. So there has been some progress as a result of the excruciating truth-telling and consequent bloodshed of those years. Maybe there is or will be social progress in other areas at some time of which I have no guess. Fifty years, or one hundred years, seem now like nothing to me.

I've been reading lately Thorstein Veblen's “The Higher Learning in America; A Memorandum on the Conduct of Universities by Business Men” which he wrote one hundred years ago. We are still working on the issue. Here is just a short sample before I go. Old Veblen.

The underlying business-like presumption accordingly appears to be that learning is a merchantable commodity, to be Produced on a piece-rate plan, rated, bought and sold by standard units, measured, counted and reduced to staple equivalence by impersonal, mechanical tests. In all its bearings the work is hereby reduced to a mechanistic, statistical consistency, with numerical standards and units; which conduces to perfunctory and mediocre work throughout, and acts to deter both students and teachers from a free pursuit of knowledge, as contrasted with the pursuit of academic credits. So far as this mechanistic system goes freely into effect it leads to a substitution of salesman-like proficiency -- a balancing of bargains in staple credits -- in the place of scientific capacity and addiction to study.

Mis-Used Metaphors

 

The subject of “metaphors” probably seems remote and not very interesting at first, but there are some aspects of it that I just find fascinating.

I happened to pick up recently a new book entitled “Don't Buy It: The Trouble with Talking Nonsense about the Economy,” by Anat Shenker-Osorio and there on p. 75 was this criticism of progressives who are ineffective in challenging regressive economic arguments because they use the same inappropriate metaphors of “the economy” as having agency and intentionality, or even as being a God:

...they imbue the economy with agency and intentionality, obscuring the roles people play and the harms done to them...these habits reinforce self-defeating notions about the market as an independent entity. This makes it harder to see the truth: the economy is a construction of human choices that requires our oversight and control. We are not here in its service, at its beck and call. It is neither our creator nor our crotchety uncle but rather the means by which we produce and distribute...

Here are some common economics phrases that come immediately to mind:

“Let the market choose the winners and losers.”

“The markets climbed higher today.”

“The market is rational.”

“The markets showed no confidence.”
 

“The economy allocates rewards.”

“Let the market correct itself.”

Now, I think why this fascinates me so much, and is not just quibbling about words, is because I have seen the mischief caused by using inappropriate metaphors implying agency in sociology and social psychology. A sociologist can vitiate his entire life's work by assuming that society or culture “dictates” or “requires” or “mandates” or “causes” people to act the way they do. Or, a psychologist can vitiate his entire work by assuming that some inner drive such as “survival instinct” “drives” us or “pushes” us like water in a pipe or move us like a gear in a machine. Inner or outer “forces” - environment or heredity - are mistakenly believed to act upon us. The forces do the acting and we are believed to be like beads on a string or vegetables in a garden.

The currently most popular misused metaphor is the computer. But the computer is an input-output device and does nothing, and has no intentions, on its own. If we know the wiring, and the input - which are analogous to the heredity and environment – then we can predict the output, minus a little indeterminacy to be found in all physical systems. Ronald Laing's pithy 1969 comment is every bit as pertinent now as ever:

So the person who says he is a machine is mad, while many of those who say men are machines are considered great scientists!

We use metaphors all the time. They are simply symbols after all: “meta-phor” is literally “with-carried” in Greek as “sym-bol” is “with-thrown.”

My mentioning Ronald Laing brings to my mind his magnificent little book entitled “Knots.” Here's just a lovely little sample from it which may bring you a smile:

They are playing a game. They are playing at not
playing a game. If I show them I see they are, I
shall break the rules and they will punish me.
I must play their game, of not seeing I see the game.

I look back now, forty years after having last read him, and I think; Lord, I'm going to have to read him all over again because now I can see so much more in what he was saying, great as it was even then.

The White Magnolia Tree

I happened to see a white Magnolia tree yesterday when I was passing though the little North Carolina town of Richfield. Spring hasn't quite come to that part of Carolina yet, so around it was mostly brown, but here was this outrageous white Magnolia tree in full bloom.

It reminded me of hearing, many years ago when I was a student in Montreal, the actress Helen Hayes' recitation of Helen Deutsch's poem, “The White Magnolia Tree.” It was planted inside me, as it were, and it's still there and I still can hear it now exactly as then.

It is surprizingly difficult to find Helen Hayes' recording, given how good it is. The only place I know is here at this link on YouTube, where it is not adequately labelled, and I am not absolutely certain that it is Helen speaking - But it sounds very much as if it were she!

There is a passage in the wiki for Helen Deutsch that goes:

Shortly after Helen's Barnard graduation, she was asked to write something to recite on a radio show to be aired just two days later in honor of the late actress Jane Cowl. Overnight, Helen wrote "The White Magnolia Tree." She then forgot about the poem. In 1957, she was commissioned by NBC-TV to provide a poem to be recited by Helen Hayes for the 50th anniversary celebration of General Motors. She got out her old poem, and Helen Hayes recited it with such tenderness that within a week thousands of people had requested a copy of the poem. General Motors provided it in booklet form. Helen Hayes herself made a 45 rpm of the poem and sent out hundreds of copies. Today it is still searched for on the internet, some having success in finding it and others still looking.

In Australia, the Helen Hayes version was superseded when Gay Kayler (Gay Kahler) recorded her version of The White Magnolia Tree with a lush 32-piece orchestral backing. This became Gay's signature tune and remained in EMI and Readers Digest catalogues for more than 33 years.

Gay Kahler and her husband, Johnny Ashcroft, did a version of it with a 32-piece orchestra, which reviewers say is "iconic," better than Helen's. I have never heard it but I can believe them after hearing some of their other songs. It's only available, again surprizingly, on old vinyl in Australia.

Thomas Ricks' Generals

This is a perfectly sunny morning in Ohio as I write, with all the harbingers of spring appearing, even a red robin on my lawn. I feel lucky to be alive.

And yet, on this lovely, warmest day of the year so far, with all its hope and glory, my mind is very much occupied with this new book that I was reading late into the night, Thomas Ricks' The Generals: American Military Command from World War II until Today.

The first paragraph on the jacket flyleaf pretty much describes the thesis:

History has been kind to the American generals of World War II – Marshall, Eisenhower, Patton, and Bradley – and less kind to the generals of the wars that followed. In The Generals, Thomas E. Ricks sets out to explains why that is.

The thought that keeps coming back to my mind as I read this book, for all its wealth of learning and insight, is that the most important fact is still missing.

For example, Ricks says on p. 309 that the My Lai crime “was the low point of the U. S. Army in the twentieth century,” not just because of the crime itself, or secondly because of “the chain of command's coverup” but thirdly,

“the failure of the Army leaders to react properly to all of it...Instead, it went into a defensive crouch, letting the general responsible for the affair off the hook and blaming others for its problems. In sum, the generals who were running the army acted less like stewards of their profession and more like keepers of a guild, accountable only in themselves. This posture would have long-lasting pernicious effects on American generalship.”

Now, Ricks is right, yes, yes, but it seems to me that his own perspective is still too local, still too small, despite his persistent criticism in the book of the modern generals' perspectives.

I think the problem ultimately goes back to the fact that you simply must think it through very carefully before you decide to kill someone, and before you support and participate in the killing of large numbers of people.

Senator James Webb, a Viet-Nam “war hero” and scion of a military family, recently said that he “may now be the only member of the Senate who thinks the Viet-Nam war was a good idea.” There are probably a couple others, like war hero John McCain who still think it was a good idea.

I notice that war heroes, former Senators Chuck Hagel and John Kerry, who recently have been appointed to Cabinet postions by President Obama, now believe not only that the Viet-Nam war was a bad idea but also the Iraq war was a bad idea. These heroes killed people, large numbers of people, without having first thought it through adequately. Neither of these Cabinet appointees, or any other of the war heroes, Colin Powell included, have adequately accounted for their killings, or even been seriously asked why they did not adequately pre-think through these killings which they now see to have been “a bad idea.”

Look, if I could see through these wars beforehand, surely these high-powered Generals and Senators and Presidents could have done so. There was plenty of reasonable doubt at their inceptions, plenty of people pointing out the falsehoods and pretensions of the explanations for those wars. A child could see what they were about: arrogance, ego, money, careers, the system, and all that. World War II's justifications were stronger, clearer, and probably still are. It's this larger issue of the purpose of a war itself that I think Ricks himself does not appreciate.

I go so far as to say that, if you kill large numbers of people without adequate justification, just as in the case of killing a single person, you will not ultimately get away with it. There will be a price to pay, even though it looks like you won, you “succeeded,” you prospered, you received hero's honors, you advanced in your career and reputation. It's the idea of “The mills of the gods grind slowly but they grind exceeding fine.”

And what of that child who sees it's wrong, refuses to go along with it, and who goes down to the dust unhonored and unsung, who is never able to get work in this town again because he or she spoke and lived the truth? There is a whole lot to be said on this, but for now I will end with Elias Canetti's observation:

“Whom the gods would destroy, they first make mad. Whom men would destroy, they first make sane.”

More Leonard Cohen

I finished reading Svlvie Simmons' new biography of Leonard Cohen, I'm Your Man: The Life of Leonard Cohen, late last night and even had a dream about it after I fell asleep. It is 500 pages, a bit uneven, but was worth it to me. There are other biographies of Cohen, two major, devoted websites, and a lot more, but life is short and there is so much else to read. 

The part that struck me the most was the account of his losing most of his money at the age of seventy due to theft by a close personal friend, Kelley Lynch, to whom he had entrusted it. She made threats against Cohen after her theft was discovered, and ultimately got over a year in jail for the threats. Cohen had to go back out on the road giving performances in order to recover financially, but found also that he increased. Simmons writes, p. 460:

Leonard was quoted as saying that 'old age' was the 'best thing that ever happened to me.' Despite the business with Kelley Lynch, he felt light and peaceful. 'The state of mind I find myself in is so very different than most of my life that I am deeply grateful.' 

I lost everything at age seventy and yet feel that old age is the best, too.

Old Mind

Petroglyphs in Vermont

The thought that keeps coming to my mind most often lately is about how old our minds must be.

It matters a lot because there are serious, complicated problems that we face individually and collectively which cannot be resolved mindlessly.

The U.S. Public Broadcasting System has a TV series entitled “Closer to the Truth” in which the host, Robert Kuhn, interviews leading scholars on the subject of mind and the results are, to me, beyond ridiculous. These “leading scholars” are so lost, so divergent, so encased, so limited, that it's simply annihilating. This is the best? It's just so shocking.

Petroglyphs in Northern Australia