6 April 2018

Dear Interested Readers,


Examining The Dream: Perspective on the Very Short Journey Forward From 1968

It amazes me that almost every article that I have read recently about the fiftieth anniversary of the assassination of Dr. Martin Luther King, Jr. at least touches on the question of whether things have really changed much in the fifty years since the tragedy. No matter how you answer the question there seems to be universal agreement that we are still a long way from “the dream” King described in his most famous speech of many famous speeches. On a hot August afternoon in I963 he described the “is” of that moment and ventured to shared a most personal view of what “ought” to be.

He described the “is” of 1963 in the context of the reality that Black Americans had been waiting for equality for one hundred years. President Lincoln had signed the Emancipation Proclamation on January 1,1863. He led with the disappointment bred of that reality:

But one hundred years later, the Negro still is not free. One hundred years later, the life of the Negro is still sadly crippled by the manacles of segregation and the chains of discrimination. One hundred years later, the Negro lives on a lonely island of poverty in the midst of a vast ocean of material prosperity. One hundred years later, the Negro is still languishing in the corners of American society and finds himself an exile in his own land. So we have come here today to dramatize a shameful condition.

I have been reading Toxic Inequality: How America’s Wealth Gap Destroys Mobility, Deepens the Racial Divide and Threatens Our Future, published in 2017 by Thomas M. Shapiro, the Pokross Professor of Law and Social Policy at the Heller School of Brandeis University. Professor Shapiro’s data and narrative documents that in economic terms the picture today of what “is” reveals that the gap between the “average” African American and the “average” white American is now really greater than it was fifty five years ago when Dr. King gave his speech. It is easy to find a small “numerator” of African Americans who have made progress on the ladder of personal wealth and social opportunity, but those increases are unbalanced against the larger growth of the denominator of the entire population and further diminished in comparison to the growth in advantages that have accrued to many white Americans. Those are disappointing facts when balanced against the “ought” that Dr King presented as his dream. As Dr. King moved through his speech he rejected the excuses for why one hundred years had passed without the emergence of equity. He had been advised that equality would be “expensive” and that patience and “gradualism” were necessary. He did not accept the analysis:

...we refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. So we have come to cash this check — a check that will give us upon demand the riches of freedom and the security of justice. We have also come to this hallowed spot to remind America of the fierce urgency of now. This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism.

He knew the danger inherent in the frustration and the anger of being put off, but he advised those who followed him to continue to take a higher road that is reminiscent of the counterintuitive advice of “turning the other cheek” given in the Sermon on The Mount:

But there is something that I must say to my people who stand on the warm threshold which leads into the palace of justice. In the process of gaining our rightful place we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred.

We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into physical violence.

Dr. King did not advocate for violence, but he also did not advise a passive acceptance of injustice. He used his words and nonviolent protest as tools for change. In the next part of his speech he was explicit about the existence of police brutality. He called out the realities of the ghettos and the lack of physical and social mobility that exist for America’s poor, especially poor minority Americans. He identified the voting irregularities that disenfranchised African Americans and enabled the existence of the injustices that robbed and disadvantaged people through “Jim Crow” legislation designed to perpetuate our American version of apartheid. He was unflinching and brutally descriptive about the injustices that created the “is” of his day.

On the anniversary of the tragedy Congressman John Lewis describes how he believes Dr. King would be proud of what has been accomplished but simultaneously disappointed with where we are today. In an excellent conversation with a Canadian Broadcast journalist Rev. Jesse Jackson relives that awful moment on the balcony of the Lorraine Motel but he hits some of the high points of the intervening years as he admits the distress of this moment in history and applies the lessons of Dr. King to a strategy for our time. It will take you ten minutes to listen to both conversations. Whether 1968 predates you, or if you can still remember the moment when you heard Dr. King was gone, I would recommend that you listen to these to testimonies from history.

The climax of the speech on the Mall on that hot August afternoon was “the dream.” I have read that it was a spontaneous addition to Dr. King’s prepared remarks that was a response to Mahalia Jackson’s call to him as he approached the end of the speech. She had heard him talk about “the dream” before so she shouted from the side of the platform, “Tell them about the dream, Martin!” Everyone was there protesting for what “ought” to be. Dr King gave them a visual image of the “ought” which we still struggle to reach fifty years later.

I say to you today, my friends, so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream.

This is our hope.

It was spontaneous poetry. It is the expression of the true American Dream. It is the appropriate successor to expand the resolve at the end of Abraham Lincoln’s Gettysburg Address:

It is rather for us to be here dedicated to the great task remaining before us-that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion-that we here highly resolve that these dead shall not have died in vain-that this nation, under God, shall have a new birth of freedom-and that government of the people, by the people, for the people shall not perish from the earth.

It is hard to think about Dr. King as a visionary leader without commenting on his last speech delivered less than 24 hours before he was shot. It is called the “Mountaintop Speech” and it is eerily prescient. It is a long speech of over 5,000 words. He was a preacher. He begins with a tour of history to set up the point that if he could live in any time, he would live in the last half of the twentieth century even though it was easy to see that at that moment what “is” was a mess. I have bolded my favorite line.

Strangely enough, I would turn to the Almighty and say, "If you allow me to live just a few years in the second half of the twentieth century, I will be happy." [Applause]

Now that's a strange statement to make because the world is all messed up. The nation is sick, trouble is in the land, confusion all around. That's a strange statement. But I know, somehow, that only when it is dark enough can you see the stars. (All right, Yes) And I see God working in this period of the twentieth century in a way that men in some strange way are responding. Something is happening in our world. (Yeah) The masses of people are rising up. ..."We want to be free." [Applause]...And another reason I'm happy to live in this period is that we have been forced to a point where we are going to have to grapple with the problems that men have been trying to grapple with through history, but the demands didn't force them to do it. Survival demands that we grapple with them. (Yes) Men for years now have been talking about war and peace. But now no longer can they just talk about it. It is no longer a choice between violence and nonviolence in this world; it's nonviolence or nonexistence. That is where we are today. [Applause]...

Dr. King digressed to describe when he had been stabbed. He talked about concerns that the plane he that had carried him from Atlanta to Memphis might be sabotaged. He was clearly aware of the fact that many people wanted him dead. That is when he said:

Well, I don't know what will happen now; we've got some difficult days ahead. (Amen) But it really doesn't matter with me now, because I've been to the mountaintop. (Yeah) [Applause] And I don't mind. [Applause continues] Like anybody, I would like to live a long life—longevity has its place. But I'm not concerned about that now. I just want to do God's will. (Yeah) And He's allowed me to go up to the mountain. (Go ahead) And I've looked over (Yes sir), and I've seen the Promised Land. (Go ahead) I may not get there with you. (Go ahead) But I want you to know tonight (Yes), that we, as a people, will get to the Promised Land. [Applause] (Go ahead, Go ahead) And so I'm happy tonight; I'm not worried about anything; I'm not fearing any man. Mine eyes have seen the glory of the coming of the Lord. [Applause]

I am certain that as a theology student in the early 50’s earning a PhD at Boston University Dr. King would have been aware of Paul Tillich’s 1952 classic, The Courage to Be which rocked the world of many people caught in the despair of mid century existentialist philosophy. Dr. King’s affirmation of his hope in the face of danger that was real and had already been manifested as attempts to kill him is perhaps the best example I know of in history of “The Courage to Be.” The introduction to the most recent edition of Tillich’s classic was written by Peter Gomes, a man of mixed Cape Verdean and African American heritage who was also the Plummer Professor of Christian Morals at Harvard Divinity School and the Pusey Minister at Harvard's Memorial Church. In the introduction Gomes connects the “courage to be” with hope and expands the idea with a poetic reference which I am also sure would have been familiar to Dr. King. Gomes is writing about the America that “is” and had not changed much between 1968 and 2010. His description of us now is a reinforcement of why we need to remember Dr. King and what he tried to show us with his words, deeds, and courage.

We work hard and play hard not because we are more industrious or more playful than our ancestors but because we dare not stop lest in the stillness we are overwhelmed by the sound of our own anxieties and fears...our only hope is the hope that appears when the situation is beyond hope itself, or hopeless. This complex concept was anticipated in early 1900 by the African American poet James Weldon Johnson, who in his poem/song “Lift Ev’ry Voice and Sing” spoke of the African American’s persistent hope “when hope unborn had died.”

The poem which was created about halfway through the century between Gettysburg and the Emancipation Proclamation and Dr. King’s Dream underlines hope as essential to achieving the better world that Dr. King dreamed of and that we all know in our hearts should be our goal. I bolded the key line that Gomes referenced.

Lift Every Voice and Sing

James Weldon Johnson, 1871 - 1938

Lift every voice and sing,
Till earth and heaven ring,
Ring with the harmonies of Liberty;
Let our rejoicing rise
High as the list’ning skies,
Let it resound loud as the rolling sea.
Sing a song full of the faith that the dark past has taught us,
Sing a song full of the hope that the present has brought us;
Facing the rising sun of our new day begun,
Let us march on till victory is won.

Stony the road we trod,
Bitter the chast’ning rod,
Felt in the days when hope unborn had died;
Yet with a steady beat,
Have not our weary feet
Come to the place for which our fathers sighed?
We have come over a way that with tears has been watered.
We have come, treading our path through the blood of the slaughtered,
Out from the gloomy past,
Till now we stand at last
Where the white gleam of our bright star is cast.

God of our weary years,
God of our silent tears,
Thou who hast brought us thus far on the way;
Thou who hast by Thy might,
Led us into the light,
Keep us forever in the path, we pray.
Lest our feet stray from the places, our God, where we met Thee,
Lest our hearts, drunk with the wine of the world, we forget Thee;
Shadowed beneath Thy hand,
May we forever stand,
True to our God,
True to our native land.

Perhaps you think the words of Johnson’s poem are unnecessarily “syrupy” or describe a struggle that does not concern you, but the urgency in Dr. King’s message and mission was not misplaced and I pray that you realize that his dream is something that should be as inspiring and motivational for all humankind as it is for African Americans. Dr. King’s words, works, and life should hold great meaning for us all. His dream of justice was universal. The fearful alternatives to justice for all that he warned us of have never been closer than they are in this moment. We should not waste either his wisdom or his sacrifice by failing to notice that his message and concerns were timeless and universal and are applicable to this moment. He began with the injustice that was closest to him. By the time of his death he knew that injustice and inhumane disregard for human rights were infectious diseases that threaten us all. The courage and hope that defined him are really our only hope if what “ought” to be is our collective dream. The “is” of the moment is not permanent. It will move toward what “ought” to be only if we will it. We are foolish to think that “is” is stable. We learn from history that if “is” does not move toward “ought,” it can become a nightmare of “ought not” rather than the realization of a dream.

Applying Dr. King’s 1968 Wisdom to Healthcare in 2018

Congressman John Lewis and others, like some of the experts at the Brookings Institute, have spent some time this week speculating on what Dr. King would be saying or doing if he was still with us today. I did not disagree with any of the ten opinions of the Brookings experts but I was sorry that they had not included an opinion from one of their healthcare experts. I thought that I would need to do the job alone until I found a blog post on the Internet from “healthpowerforminorities.com” written by Norma J. Goodwin, MD, the founder and an authority on the issues of the social determinants of care and healthcare in minority populations.

Dr. Goodwin begins her piece where I would with Dr. King’s famous quote about healthcare:

She continues by stating the obvious.

She documents the social determinants of health as central to this failure:

Reasons for well-documented racial and ethnic health disparities include, for many but not all of those who are affected:

• Decreased health knowledge;
  
• Lower priority given to preventive health through risk reduction, often because of competing demands and related stress production;
  
• Decreased socio-economic status (often poverty), and
  
• Decreased access to health care, especially high quality health care.
  

I was delighted with her next statement because it is excellent strategy for any population and is probably the most effective strategy for all of us:

While I consider this to be a universally applicable strategy that if adopted and followed by all of us would definitely move us much closer to the Triple Aim, I believe that Dr. King would expect more.

Over the last year of Dr. King’s life he was clearly embracing the issues of inequality across all races at home and around the world. There are several famous quotes beyond the quote about inequality in healthcare being “shockingly inhumane” that support my contention. Here are a few that we should consider as we ask ourselves what would Dr. King think about healthcare and poverty in America in 2018.

• “As long as there is poverty in this world, no man can be totally rich even if he has a billion dollars.”
  

• “Injustice anywhere is a threat to justice everywhere.”
  

• “God never intended for one group of people to live in superfluous inordinate wealth, while others live in abject deadening poverty.”
  

• “A second evil which plagues the modern world is that of poverty. Like a monstrous octopus, it projects its nagging, prehensile tentacles in lands and villages all over the world. Almost two-thirds of the peoples of the world go to bed hungry at night. They are undernourished, ill-housed, and shabbily clad. Many of them have no houses or beds to sleep in. Their only beds are the sidewalks of the cities and the dusty roads of the villages. Most of these poverty-stricken children of God have never seen a physician or a dentist.”
  

• “There is nothing new about poverty. What is new, however, is that we have the resources to get rid of it.”
  

• “The rich nations must use their vast resources of wealth to develop the underdeveloped, school the unschooled, and feed the unfed. Ultimately a great nation is a compassionate nation. No individual or nation can be great if it does not have a concern for ‘the least of these.’”
  

• “The time is always right to do what is right.”
  

• “While millions enjoy an unexampled opulence in developed nations, ten thousand people die of hunger each and every day of the year in the undeveloped world.”
  

• “The time has come for us to civilize ourselves by the total, direct and immediate abolition of poverty”
  

If I couple these statements with the reality that at the time of his assassination he was planning the Poor People’s March on Washington, I would have to conclude that if he were alive today Dr. King would be a leader in the fight to eradicate the inequities in education, jobs, housing, food availability, and criminal justice that we loosely group as social determinants of health. He would be appalled by our failure to responsibly address the epidemics of gun violence and opioid misuse which threaten all of us and are best conceptualized as epidemic public health problems.

If Dr. King were alive I must believe:

• That he would consider the ACA an important but insufficient small first step toward equity in access. 
  

• That he would be disturbed by our inability to come to consensus about how to humanely resolve our controversies over immigration policy. 
  

• That he would be concerned with the suffering and lack of access to care of many of the undocumented people in our society. 
  

• That he would be active in trying to expand the social safety net as a small step toward the elimination of poverty as a threat to health. 
  

• That he would be an enthusiastic supporter of the objectives of the Triple Aim. 
  

• That he would understand the importance of eliminating overuse and misuse of medical resources.
  

• That he would applaud Don Berwick’s articulation of the Moral Era of Healthcare, “Era 3.”
  

I think that he would be disturbed by the reality that in America in 2018 life expectancy is a function of zip code rather than genetic code and that he would advise electing legislators who would be concerned enough to develop a workable strategy to eliminate the injustices that create the reality of what “is” and usher in a reality that is closer to the equity that “ought” to be.

Dr. King stands in history as the strongest and most compelling voice for the expansion to all people of the high minded principles that the founding fathers conceptualized for themselves and those whom they considered to be their peers. We have always been a work in progress. We will always need someone that reminds us of where we should be going.


I Was Not Dreaming of a “White” April: Random Thoughts While Shivering at Opening Day

I attach a sense of color to the seasons and the months. December through March are various shades of white swirled with the intermittent shades black, brown, and grey of road slush and overcast skies. July is a verdant green that deepens to a darker, tireder green in August and early September before we see the bright reds, yellows, and oranges of late September and October that fade fast into the rusty brown of November. I know. I left out April, May and June. Those months are the set up for the verdant green of July. I like a progression of light greens and the shocking pastels of yellow and pink against a “robin egg blue sky” that are all consistent with the new growth during the Spring months leading into the transition to Summer in late June. April is the pivot from the dead end of a worn out winter to the energy of an awakening Spring. Snow in early April is always possible, but seems to me to be as inappropriate as wearing Bermuda shorts to a formal dinner.

I want to be in shirt sleeves or at least a light jacket when I settle into my seat at Fenway and look across at the Green Monster with the Citgo sign looking over its shoulder. Parkas, double gloves, long johns and my warmest headgear are not what I want to be wearing while I watch the hometown team take the field for the first of the 81 home games. As I was saying “This is not right!” to the weather gods yesterday, I was thankful again that I was not a Yankees fan like my daughter in law. The Yankees were “snowed out” on their opening day in the Bronx. We were just cold as we watched the Sox win in twelve exciting innings.

With the help of my son who lives in Brooklyn but is not a Yankees fan like his wife, I have tried to let today’s header be emblematic of the fickle weather of early April. Snow on Tuesday that falls on a still frozen lake is contrasted with baseball on a freezing windy Thursday. Hope and the Courage to Be were themes in this week’s letter, and they are all we have as we wait for more definitive evidence of Spring. I am still looking for the first crocus in my garden, but I have seen robins.

The great thing about walking is that it does not really discriminate between seasons. You can get in a good walk even in New Hampshire on more than 95% of days. It is just a matter of will. Wherever you are this weekend, I hope that you will find the will to walk or draft on the will of a friend and get out for a good walk in whatever weather comes your way.