| 22 July 2016
Dear Interested Readers,
An Introduction to This Week’s Letter
Perhaps against my better judgement this letter and next week’s letter will draw from the events and the content of the conventions of our two parties. I approached the writing of this week’s letter with “fear and trembling”. I was taught in college to avoid “plagiarism” as I would avoid the plague or any other communicable, uniformly fatal infection. Indeed as I wrote “fear and trembling” I wondered if the phrase was an acceptable cliche available in the public domain without attribution or whether some other writer needed to be acknowledged. I was greatly relieved to learn that its origin is in St. Paul’s letter to the Philippians as translated in the King James version of the Bible published in 1610. I assume that I can use the phrase without attribution. Just for your enlightenment, Paul wrote and “God’s Secretaries” translated:
Philippians 2:12 King James Version (KJV)
Wherefore, my beloved, as ye have always obeyed, not as in my presence only, but now much more in my absence, work out your own salvation with fear and trembling.
The King James translation of the Bible is probably the most quoted document in the English language (a personal observation that I was unable to confirm) and lifting a phrase from it without attribution for speeches, poems, book titles or to use whenever pompous language seems appropriate is rarely considered plagiarism. Perhaps the scripture does offer good advice to both political parties and all voters as we move toward the November election. As many have already said at the Republican Convention, this election is of heightened importance. Because of the likely vacancies on the Supreme Court over the next four years, the next President will have an opportunity to have an impact that will last for decades.
As we all know now, the question of plagiarism was resolved by an apology of the ghost writer of Melania Trump’s speech. Properly attributing the work of others takes a lot of energy and I suspect that what we identify as plagiarism is more often than not legitimate human error or just intellectual sloppiness, and I am quite willing to accept the final explanation. I am guilty of both and with that statement, I am willing to pass on any error that Melania Trump and Meredith McIver made and would prefer to focus my analysis on more substantive concerns. I hope that what you find in this week’s letter will rise above much of the slimy underbelly of politics that I have felt compelled to view this week and expect to see more of next week.
I finish the letter by describing to you how I am trying to get relief from the arguments and anxieties about the election. It is important to plan a strategy to protect yourself for the rest of the summer and through the fall from the cacophony of the campaign. The election will put the future of our nation in the hands of either someone the Republicans would have us believe is a pathological, self serving liar or that the Democrats warn is a narcissist who would introduce a right wing authoritarian regime. Perhaps the most useful aspect of this letter and the one that will follow next week will be advice about how to get through the next three months running up to the election. Since there was nothing significant said about healthcare one benefit is that this week’s letter is a little shorter than most weeks.
As always I am hoping that you will adopt the weekly habit of checking out strategyhealthcare.com. This week’s posting was lifted out of last week’s letter and is entitled “What Can I Do Today?” The picture coupled with the the presentation shows the late Dr. Roy Rubin advocating for an idea to Barry Small who was one of his practice administrators. For decades Dr. Rubin was an informal leader at the Kenmore practice of Atrius Health. Dr. Rubin was always looking for what he could do to make the practice better. I hope that you will enjoy the picture and the essay. In the next few weeks the “comments” option on the site will be better developed. Until then I hope that you will continue to comment directly to me by hitting “reply” on this letter. Your comments and your opinions are important to me.
The Presidential Sweepstakes and the Future of Healthcare
I have always been an eager viewer of the political conventions. I have watched every convention beginning in 1952! My father purchased our first television that spring. It was a seventeen inch RCA that was set in a magnificent mahogany cabinet. We could only receive one station, WKY-TV in Oklahoma City. All summer long I had watched ads that were building excitement for the event. The 1952 Republican Convention was the first televised convention. Both conventions that summer met in Chicago with the Republicans going first and nominating General Dwight David Eisenhower. The Democrats came to town a couple of weeks later and nominated Illinois Governor Adlai Stevenson.
As a seven year old I was fascinated by what I saw and did not understand. As a seventy one year old I have been fascinated by what I see and have had an even harder time understanding what I hear and see. This is the seventeenth time for me to watch the politicians as they run around the quadrennial political block. As I look back there have always been surprises and drama for the talking heads of the media to explore for me.
Who could have predicted that the first big surprise would be a controversy over what is plagiarism? That took over 48 hours to resolve. Beyond the initial distraction over plagiarism, I find it sad that much of the proceedings this week have revolved around various definitions of lying, deceit, false claims, and what may or may not be acceptable variations of truth. The issue of truthfulness has been explored on each of the nights even though the “theme” for each night has been different. Night One was “Make America Safe” and was remarkable for Rudy Giuliani's passionate call for changes that would protect the homeland from terrorists and Chris Christie’s mock prosecution of Hillary Clinton. Night Two was “Make America Work” and the election of the ticket. Night Three was “Make America First” and was remarkable for Ted Cruz’s lack of endorsement and the acceptance speech of VP nominee, Governor Mike Pence of Indiana. Last night the theme was “Make America Whole” and the candidate again reminded us of the importance of truthfulness and experienced leadership in a speech that lasted over 70 minutes and mentioned healthcare only twice: once to say the ACA will be repealed and replaced and once to say that the care of veterans will improve.
We have only heard half of the argument. The Democrats have their turn at bat next week. I am sure both cases will resonate with those who are already aligned with one or the other candidate and the whole conversation is for the benefit of the undecided who are still trying to follow the advice that they should: “work out your own salvation with fear and trembling”. It seems likely that in the end many will remain confused and bewildered about what assertions to believe and whom to trust.
On the first night when safety in America was the theme most speakers referred to the events in Benghazi as evidence that America was not safe or that Hillary Clinton could not be trusted to make it safe, I would have appreciated a much more in depth discussion of the question of safety. I have no doubt that many people do not feel safe and that the threat of ISIS, fear of immigrants and for some hard to explain reason the “Black Lives Matter” movement account for some of that feeling. I am also sure that our lack of safety is more complex and that an election is not a solution. Even if the election is the beginning of a solution process, as a voter I would like to know more of the plan than that it includes a wall. Shootings by terrorists and bombings are dramatic but many more Americans die of medical errors, drug overdoses and mental instability associated with firearms than from the subversive activities of immigrants. I will not feel safer behind a wall.
Our country went through many similar concerns in the early years of the twentieth century. Then the undesired immigrants were Italians and Eastern Europeans who were feared to be anarchists. There were concerns about the relationship of anarchy to the labor movement. There were many bombings in 1919-20. The possibly unjust execution of Sacco and Vanzetti was related to these events and fears.
Using the issues of safety as an example for discussion, I found the presentations to lack any depth of analysis. It is easy to look back through history and see a connection between issues of equity, social acceptance, economic opportunity, violence and fear for personal safety. If we ignore experience and history, or forget what has already happened how can we be certain that our impulsive responses will make us feel safer? In the speeches I heard there was little evidence that there had been an in depth search for the potential solutions that were based on the social origins of our vulnerability to violence. There was no reference to the lack of safety in poorly managed complex systems, deteriorating infrastructure, and neglected social services. If one believes that complex problems are not amenable to simple solutions, there were many unanswered questions that emerged following the rhetoric on all four nights.
In 1952 and at many of the previous conventions there was real focus and debate about the party’s platform. The candidate was chosen with a reference to the platform. That relationship has lost some alignment in the most recent conventions since the primaries have moved most of the process of candidate selection to the long winter months before the conventions. Still, platforms should be important to voters as they are choosing a president since the power of the executive to implement programs through appointments to agencies and the courts creates much of the “operating system” that drives the agenda that should flow from the platform.
The final platform that was approved going into this convention should be of interest to us all. What does it say about healthcare at a high level? What does it say about reproductive rights? I have been amazed by the lack of discussion about the substantive issues that face us in healthcare. You may say, “Well the Platform committee was quite willing to copy and paste Paul Ryan’s new proposal for legislation to replace the ACA”. I would have loved to hear someone, perhaps Ryan himself, explain his proposal since it is a major part of the platform’s healthcare plank. I have been to Ryan’s website. I have read his program and listened to his YouTube presentations. I have read what knowledgeable people say it does and does not do. I have real questions that need answers. If I am going to give my vote to someone who will sign the bill for the law that will replace the ACA, I need to know more.
There was plenty of time to tell me what I needed to know if the complaints about Benghazi and Hillary Clinton’s culpability had been made once and the remaining time invested in educating me, a willing listener, to a new idea that I should consider. I resent that there was no respectful attempt to appeal to my realistic desire to hear a substantive presentation for an alternative strategy for providing universal affordable coverage for all Americans which is what Paul Ryan’s proposal calls for. I have bolded important points in the conclusions section of Speaker Ryan’s proposal:
Over the past six years, the Affordable Care Act has failed to make health coverage more affordable for the majority of Americans and, in too many cases, has been harmful to individuals and families. Increasing health coverage is a worthwhile goal, but the law has increased health care costs, reduced access to providers, and restricted patients’ ability to choose the coverage that best suits themselves and their families. As this plan shows, there is another way – a better way – to provide all Americans with health care that is accessible, affordable, and sustainable. In this plan, innovative, market-based, patient-centered solutions replace Obamacare’s one-size fits-all, Washington-knows-best approach. This plan empowers patients with access to affordable, portable health care options. It provides every American with the freedom to pick a plan that best fits his or her unique health care needs – not coverage mandated by Washington. It protects those individuals with pre-existing conditions and promotes innovation to encourage health care competition, to lower costs, and to foster new cures for patients.
I would be a fool not to pay attention to a proposal that claims that it will:
...provide all Americans with health care that is accessible, affordable, and sustainable…
And that:
provides every American with the freedom to pick a plan that best fits his or her unique health care needs…
It is a combination of assertions that may not be the Triple Aim, but it is very interesting. It is at least as pertinent to my future and probably to my overall safety as whether or not Secretary Clinton compromised the security of classified documents. If there was a real desire to convince me that I should trust the problem solving ability of a Republican lead executive branch, a good start would have been to give me a new set of ideas to consider as an alternative to the most import social legislation of this young century. How will Speaker Ryan and President Trump work together to give my family and all Americans better healthcare? They missed a big opportunity by wasting their time trying to convince me that they were a more reliable source of truth than the Democrats. If we are talking about political prevarication, I doubt that there is a statistically significant difference between the incidence of its occurrence between the two parties over time.
It seems that in all political discussions opinions are presented as facts. The presentation of facts are nebulous or avoided when inconsistent with a desired position. Body language and posturing are often substituted for intellectual substance. We have seen plenty of those behaviors this week and I expect that the demonstration of these political tools will continue next week as we shift our attention to Philadelphia and the Democrats, replacing the Republicans on the podium as the focus on the evening news.
Voters may be like “buyers” in a market who are listening to sales pitches. I think the phrase caveat emptor definitely applies because both sides agree that collectively we will be stuck for a very long time with the ramifications of the outcome of our decision process in November. In a sweeping generalization laced with sarcastic hyperbole it is probably safe to assume that all politicians mostly offer rhetoric woven with half truths to support ideas and attitudes that are often devoid of concrete policy formulation or irrefutable facts . There are no enforceable warranties or guarantees in politics and the authors of this empty rhetoric are often able to avoid accountability through the complexity of our system of government.
So as the election season goes forward from the conventions, I expect to hear plenty of false claims of accomplishments, misrepresentation of facts, denials of responsibility, unfounded assertions about the possible “when I am elected”, and continuous character assassination of the opponent. I hope that I can hear or read more in depth analysis of proposed solutions, but I am not holding my breath. A person with a short memory or someone who is not a student of history may argue that the political climate has never been this dreadful before but if he were alive I am certain that Yogi Berra would say this is “deja vu all over again”. All of this is justified in the mind of one conservative writer by using another well worn cliche, politics is a full contact sport. I think it is a reality that we must all accept as being a manifestation of human nature that we will not grow beyond by November 8, 2016. As voters we will probably need to dig for the answers we need.
I do not know how non Christians feel about the frequent references by speakers at the political conventions to the importance of Christ like behavior in our social interactions. I fear that the dichotomy between the teachings of Christ and the words spoken and actions advocated in this impassioned denunciations of those with a different viewpoint breeds cynicism in those from other cultures. This last week Fr. Richard Rohr, a Franciscan priest in New Mexico whose daily email I frequently read, was discussing “The Spirituality of Imperfection”. He quoted scripture from the “Sermon on The Mount”:
You have heard that it was said, "You shall love your neighbor and hate your enemy." But I say to you, love your enemies, and pray for those who persecute you, that you may be children of your heavenly Father, for he makes his sun shine on the bad and the good, and causes rain to fall on the just and the unjust. For if you love those who love you, what recompense will you have? Do not the tax collectors do the same? And if you greet your brothers only, what is unusual about that? Do not the pagans do the same? So be perfect, just as your heavenly Father is perfect.
Matthew 5:43-48
His lesson gleaned from the scripture may be more challenging even than the scripture itself which most of us have been able to effectively ignore for two millennia:
The real moral goals of the Gospel--loving enemies, caring for the powerless, overlooking personal offenses, living simply, eschewing riches--can only be achieved through surrender and participation. These have often been ignored or minimized, even though they were clearly Jesus' major points.
I am going to interpret surrender as suggesting that we give up the idea that we (as members of one particular party) have sole possession of the truth and participation as the suggestion that by the process of respectful discourse (with those who are our “enemies”,i.e. members of another party, social class or ethnicity), we can achieve what we all say we really want which is a just society that offers everyone the opportunity for life liberty and the pursuit of happiness. That was our original collective goal.
I am not naive. I know that there is a disconnect between what we say we believe and what we are actually able to pull off in real life, but I do believe that respectful dialog about solutions to shared problems is sorely missing in our political process. I wish that the two parties could “love” one another. I could vote for a genuine effort to “Make America Whole Again” if I could hear rhetoric that was both respectful in regard to all the diverse populations that call America home. Global warming is a problem for both the just and the unjust. Next week the Democrats will have their chance to show that they are willing to use their opportunity to find a different voice.
The Week Away From Politics
The header for this week’s Musings is a shot taken at the Hay Reservation which is on the shore of Lake Sunapee a few miles from my home. John Hay was from the midwest. As a young man he was Lincoln’s personal secretary. He married a woman of great inherited wealth and enjoyed Washington society, but like so many of the wealthy of his era enjoyed having a summer home in New England. In the years after Lincoln’s death he had many positions and was eventually our Secretary of State for seven years under William McKinley and then Teddy Roosevelt. He died suddenly while in office in 1905. Roosevelt was his friend and would visit him at Lake Sunapee. These days his home is a center that is used for social events, arts celebrations, and a journey back to a different era. It is a great place to walk where there is a juxtaposition of old forest and formal gardens. My wife and I enjoy walking the trails on the grounds and the adjacent nature preserve. A walk at "the Hay" is a good way to get over tiresome political speech.
I was saddened this last week to learn of the passing of Stan Sacon. Stan was a pioneer of medical group leadership. Most people credit him for the development of South Shore Medical Center and he was one of the leaders who help found Atrius Health. Stan was a one of a kind type of guy who blended personal energy with a leadership style built on intense loyalty to colleagues and mission. If you did not know Stan, there is no way to fully understand what an important contributor to a collective effort he could be. Last week’s letter about what one individual can do to make a difference could have been been appropriately dedicated to Stan. The best way to describe Stan was that no matter whether you always agreed with him or not, whenever you heard his name or thought about him you could not keep from smiling. Stan was an “Interested Reader”. I will miss his frequent comments about these Musings. With his passing there is also one less fan in Red Sox Nation. Stan would be delighted to know that the Red Sox have smashed their way back into first place. Who needs pitching when your offense can frequently score ten runs?
This week’s weather has been “all summer”. I hope that it continues into the weekend. I need to be out in nature to clear my head from all of the political excitement in Cleveland and get ready for the Democrat’s time at bat in Philadelphia. I hope that you have plans to be out and around in the world. |
| Be well, stay in touch, and don’t let anything keep you from doing the good that you can do every day,
Gene
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