Friday, August 21, 2009

Who deserves to suffer?

An American woman reacting to the release on compassionate grounds of Abdel Basset al-Megrahi, the Libyan convicted and sentenced to life imprisonment for playing a role in the bombing of Pan Am Flight 103 on Dec. 21, 1988, said “He already got his compassionate release when he was sentenced to life imprisonment instead of getting the death penalty.”

The implication of the woman's comment—I should perhaps add that she made a point of saying that she was speaking as a Christian—was that being allowed to remain alive was as much compassion as the man deserved. The fact that he is believed to be dying of prostate cancer was not worth taking into consideration. Apparently also irrelevant to this woman is the fact that al-Megrahi was tried and convicted of murder in the United Kingdom, where capital punishment for the crime of murder was formally abolished in 1969 and abolished for all crimes in 1998. There was no possibility of al-Megrahi's being sentenced to die for any crime in the UK, so his being “allowed” to remain alive was not a question of compassionately releasing him from a punishment that under law he deserved. Rather, it was a question of applying the law of the land.

Megyn Kelly co-host of America's Newsroom on Fox News, may have been unaware of the law of the land in the United Kingdom when she said words to the effect that while the Scottish courts seem to favor compassion, Americans are more interested in the rule of law. In fact, the Scottish court demonstrated that it was quite interested in the rule of law, for the custom in Scotland has been to release terminally ill prisoners so that they can spend their last days with their families. It turns out that in the United Kingdom, the rule of law is not incompatible with compassion. The law itself has provision for the judicious exercise of compassion.

American law, of course, is not entirely devoid of compassion. In contrast to all other industrialized nations, however, there is more a culture of punishment than of rehabilitation. Not only is the duration of imprisonment in the United States longer than in Canada or Europe, but it has increased. It rose by 83% in the 1990s. That trend may be reversed as a result of fiscal difficulties in many states. Already there has been a serious cutback in California in allocations for programs to educate prisoners and teach them trades. These programs, which could reduce the likelihood of recidivism (now more than 70%), are proving too expensive to maintain in the short run. The long-term costs of cutting those programs, along with the pressure to release prisoners from severely overcrowded prisons without their having the benefit of being in facilities that could rehabilitate them, could be very high indeed.

Why are sentences in the United States so long? Why is the prevailing philosophy to throw people in prison and throw the key away? A web site dedicated to the so-called Three Strikes Law explains that the 1994 California law that mandates giving a minimum prison term of 25 years to a person convicted of a third felonious offense grew out of a conviction that some people are simply not responsive to being imprisoned. While it might seem strange to increase the time in prison of people do not benefit from imprisonment, the principal rationale for doing so was that society is made safer by keeping dangerous people in a place where they cannot commit more crimes. Experience has shown that such people often do continue to commit more crimes; it's just that their victims are other prisoners rather than people on the outside. The reasoning seems to be that people already in prison may somehow deserve to be victims of crime more than other people.

That people allow themselves to ask the question of who “deserves” to be a victim of violence or unpleasant treatment is alarming. Once the question is even asked, people can be drawn into thinking that it somehow makes sense to allow other sentient beings to suffer. Animals can be allowed to suffer, some might argue, because they are allegedly not intelligent, and besides they are useful for food and clothing. Poor people can be allowed to suffer, some might argue, because they do not work hard enough to get out of poverty. Jews and gypsies and homosexuals can be allowed to suffer, many Europeans did argue not so long ago, because they make no useful contributions to society. Immigrants can be allowed to suffer, many now argue, because they have not taken the right steps to become citizens, and even if they have, they may not understand our culture.

I do not understand our culture, especially that aspect of our culture that tolerates the suffering of prisoners, illegal immigrants, newly arrived legal immigrants, people living in countries against which we wage declared and undeclared wars. This aspect of American culture–human culture–is repugnant to me.

There is an alternative to the culture of punishment and allowing the suffering of those who allegedly deserve it. For the past several days I have been recalling a speech in Shakespeare's The Merchant of Venice that my ninth-grade English teacher made the class memorize some fifty years ago. That teacher died about forty years ago, but I hope there are many of her former students who still remember at least the opening lines of the lines we were made to memorize. We need those words.

The quality of mercy is not strained.
It droppeth as the gentle rain from heaven
Upon the place beneath. It is twice blest:
It blesseth him that gives and him that takes.
Tis mightiest in the mightiest; it becomes
The throned monarch better than his crown.
His scepter shows the force of temporal power,
The attribute to awe and majesty,
Wherein doth sit the dread and fear of kings.
But mercy is above this sceptered sway;
It is enthroned in the hearts of kings;
It is an attribute of God himself;
And earthly power doth then show like God's
When mercy seasons justice.

In closing I express my heartfelt condolences to all those who lost loved ones on Pan Am flight 103. I also wish the best for the man convicted of their murder. May all the tormented souls connected with that tragic incident find peace of mind before they go the way of all flesh.

Sunday, August 16, 2009

Why do Americans fear government?

Last night I saw a news segment about one of the town-hall meetings around the United States in which citizens are voicing their concerns about health-care reform. One woman, her voice trembling with emotion, asked “Can you name one thing—one thing—that government has become involved in that has not grown wildly out of control and hopelessly inefficient?” I gather that her rhetorical question was meant to be an argument against government being involved in the health-care industry.

Within a couple of seconds of hearing the question, I was thinking of all the government agencies that have done excellent jobs of overseeing and performing tasks that private enterprise would have done much less efficiently and that have not grown wildly out of control. The first few that came to mind were government agencies that I know about because members of my family have worked for them: The United States Geological Survey, the National Park Service, the U.S. Department of Housing and Urban Development, the Department of Health and Human Services. Then I thought of government agencies that have provided funds to scholarly, scientific and artistic endeavors that would not likely be funded by private enterprise: the National Endowment for the Humanities, the National Science Foundation.

Within less than a minute I was able to think of about a dozen or so more national government agencies that routinely do excellent jobs without growing wildly out of control. And of course when I began to think of governmental agencies at the state, county and municipal level the number of exemplary government agencies began to fill me with a deep sense of gratitude for all the things that governments provide the citizens of the United States. So where, I began to wonder, does this fear of so-called “big government” come from?

When I begin to think of government ventures that really have grown wildly out of control and have swollen budgets for inefficiently doing services that we hardly need done at all, I also notice that it is these government enterprises that we hear about most often and that we encounter more often than we would like. The most wasteful big-government operation of all, of course, is the military, which gobbles up 43% of all monies gained through taxes. When people look back on American military ventures that have taken place since the end of the second world war, the only thing they can see are counterproductive operations that have wasted lives, destroyed property and depleted the treasury. If the military is the most visible arm of the American government, no wonder Americans are so distrustful of government.

Another branch of government that everyone who travels by air experiences is the Transportation Security Administration, which makes sure that no grandmother boards an airplane with more than three ounces of skin lotion and that no child has a bomb concealed in his shoe. At enormous expense and irritation to the traveling public, this highly visible organization asks us to believe it is their work that has prevented further hijackings and bombings of aircraft. When Americans see how many obviously pointless measures are taken by government agencies in the name of airport security, no wonder they are wary of more big government.

Is there any reason to believe that a government-regulated medical insurance program or a government-regulated pharmaceutical industry would be as inefficient and wasteful as the military or the Department of Homeland Security, or as invasive as the FBI? No. It has not proven to be so in other industrialized nations. Why assume that a national health service would be more like the US military than like the US Park Service or the Department of Housing and Urban Development?

Is there any reason to believe that a government-regulated medical insurance program or a government-regulated pharmaceutical industry would be as inefficient and wasteful as for-profit health insurance companies and for-profit health maintenance organizations (HMO)? Again, the answer is suggested by the experience of people living in countries that have government-managed health-care systems. They provide much better care at a fraction of the cost of what is available in the United States in our market-driven system.

The American fear of big government is not entirely irrational. There are very expensive government agencies that return very little of value to society; the military is the most obvious of these. But it is irrational to fear all government. There are also scores of governmental agencies that none of us would want to live without: the National Guard, various police forces, fire-fighting agencies, departments that build and maintain roads and highways and bridges and airports. Who would prefer having to travel on privately owned turnpikes and tollways instead of on the federally maintained system of interstate highways and all the state highways? Who would prefer to live in a society in which every merchant had his own definition of what a pound of weight or a yard of length or a minute of time is, as opposed to a society with a federally financed Bureau of Standards? Who would like to live in a country without a national postal service?

Who would like to live in a country that has a health system in which the people most in need of care cannot afford to pay for it, and in which insurance agencies have no incentive at all to provide coverage to anyone who might make claims that could reduce the dividends or shareholders or diminish the bonuses paid to already highly paid executives? I guess that question has an answer. Sarah Palin seems to be one such person. But why? And why are so many Americans so ready to be persuaded by her careless rhetoric than by a careful study of what would actually be of benefit to them?

Care to study the situation a little more carefully? One place to begin is at the CNN site on health care.

Friday, August 14, 2009

America's love affair with ignorance

There has been a lot of blogging recently about an editorial in Investors Business Daily. A summary of some of the best-known blogs can be found on the BBC website. In addition to what one finds there, a reflective piece occurs as part of a recent post on Bodhipaksa's blog site, Bodhi Tree Swaying

The BBC site notes that a theme in the debates among bloggers is whether the author of the Investors Business Daily was deliberately lying about the British national health care system or simply misinformed. As I have heard some of the questions coming from the audience at town-hall meetings on the proposed health care reforms in the United States, I have been astonished at the level of ignorance being manifested in the questions. As I have written before, it is astonishing to me to hear comments about “the” Canadian health care system. (As I pointed out in that blog posting, Canada does not have a health-care system; each province has one, and the details are different from one province to another.) I have heard almost everything from Americans but accuracy in descriptions of Canadian health care; even Americans who are relatively well-informed about the world in general seem to know very little about their neighbors to the north. In this post I plan to draw attention to a few features of the systems that I personally experienced while living in Manitoba, Alberta, British Columbia, Ontario and Qu├ębec, Canada and to say why I would love to see similar features in the United States.

  • Universal coverage. There may be people living in Canada who are not covered by any health insurance, but it is not because they cannot afford insurance or because they have been rejected as a bad risk by an insurance company. There are various ways to make sure that low-income people are covered. One method is to subsidize people below a given level of income as reported in their annual income tax filings. Another is to pay for health care out of taxes, which automatically means that those who make (and spend) a lot of money pay more into the health care system, and those who earn or spend little pay less into the system.
  • Excellent medical care. Twice when I was in hospital in Canada for surgical interventions that I never would have been able to afford in the United States, I met patients from the United States who had come to Canada for medical procedures more advanced than any they could find in the United States. They were not there only because the price was lower for procedures than the price would be in their own country; they were there because they could get in Canada medical attention that was not available at all in the United States. Canadian medical research is among the best in the world, and it becomes available to the public much more quickly than it would do in a profit-oriented systems.
  • Cost-efficient medical care. Because most medical insurance is provided through government-run plans, billing is simple and can be carried out by far fewer clerks and bureaucrats than is the case in a system in which there are numerous insurance companies, each with its own forms and regulations. Medical procedures are routinely approved in Canada, unlike the case in the United States where insurance companies, motivated by the need to make profits to pass on to their shareholders, spend time and money finding reasons to deny claims. (In my own experience, I never had to appeal a single medical expense during my thirty-six years in Canada. Since moving back to the United States, I have had to appeal several decisions made by my insurance company.
  • Employers do not pay for employee's health care. One of the greatest advantages of a single-payer system is that health care costs are borne by a combination of the person insured and the government, not by the insured person's employer. This means small businesses in Canada are not burdened by having to pay the same high costs as their American counterparts. When the North American Free Trade Agreement first came into effect, this became one of the first major issues of dispute. American small businesses complained that Canadian competitors had an unfair advantage, because they had no health-care premiums to provide for their employees. Strangely, rather than demanding a single-payer system in their own country, American companies insisted that it was only just for them to impose tariffs on Canadian goods and services.
  • Canadian pharmaceutical providers are limited in the amount of profits they can make on a product. If you have an e-mail account, it is likely you (or your spam filter) receive several e-mails a week advertising pharmaceutical products at Canadian prices. Canadian prices are lower than American prices for exactly the same products, because the Canadian government places a cap on the amount of profit a pharmaceutical company can make on a given product. The profit margin is still reasonable, but it is not allowed to become exorbitant as American profit margins are allowed to get.

The Canadian health-care systems provided by the provinces I have lived in are far superior to anything I have experienced in the United States. (Having said that, I have heard enough about the Kaiser plan in California to think it would make an excellent model for health-care in the United States.) What has amazed me most about the debates in the United States is that from the very start the most sensible plan of all—a single-payer system—has been “off the table.” None of the various proposals being considered in the United States would make the US health-care system even close to either the British or the Canadian systems or anything that is available in Europe or Japan. Almost as astonishing to me has been the sheer ignorance that prevails in the United States about why health care is so substandard in the United States. In place of accurate information and careful argumentation, one finds in this debate very little but misinformation and inflammatory rhetoric. If Americans do not wake up and take an interest in matters that are to their own advantage, they will end up with the inferior kind of health care that willfully ignorant people probably deserve.