Politics

Your health choked by the invisible hand of the market

R. Horton

Sometimes the invisible hand of the markets is all too apparent as it clutches us by the neck and strangles us slowly and painfully. If you are a typical adult American, you are likely to have at least one prescription for a drug indefinitely, either until you die or another drug is developed to replace it.

In the world of libertarian fantasy, pharmaceutical companies would compete to develop drugs we need to cure diseases that plague us. Hoping to sell us their products, they would race to develop effective and inexpensive drugs that consumers would rush to purchase. Unfortunately, those profits would be short-lived. People would buy the drugs, get well, and go about their business drug-free and non-contagious. Companies can make some money that way for sure, but it is much more lucrative to develop drugs that do not cure anyone but simply maintain their health.

This is why we have so many drugs for cholesterol, blood pressure, acid reflux, and other chronic conditions with fewer drugs aimed at eliminating disease, and even fewer aimed at curing (or even treating) diseases that affect those too poor to pay for expensive remedies. The fact that there is any treatment, even in early experimental drug trials, for Ebola is thanks to government funding of research. Left to markets alone, the diseases that kill the most people in the world would be completely ignored by drug companies.

Some diseases, such as Type II Diabetes, affect poor people, but drug companies spend quite a bit of time developing treatments for them. This, of course, is because enough people receive insurance payments from private insurance or Medicare and Medicaid to make treating them worthwhile. Almost 27 percent of Medicare beneficiaries 65 or older have diabetes, accounting for 32 percent of Medicare spending.  in 2002, Medicaid expenditures for people 20 and over with diabetes were estimated at more than $18 billion.

Of course, diabetes also affects people who are relatively affluent by global standards. In fact, it is considered a disease of babymotherdeathoverconsumption notwithstanding the fact that many who suffer from diabetes in the US are less affluent. Thus, it is extremely profitable for companies to develop products and services for diabetics in the US where their profits are underwritten by taxpayers. Diseases that primarily affect impoverished people in poor countries get much less attention.

It would seem likely that donations from individuals could fund research and development into alleviating disease. Indeed, the ALS ice bucket challenge raised more than $100 million as of this writing for research and treatment of ALS. But this again, leaves the allocation of resources to the mercy of marketing campaigns. ALS is a cruel disease, and it will only be a blessing if a cure can be found, but diseases that affect primarily impoverished individuals (e.g., malaria, antimicrobial resistance, trachoma) in the world are still waiting for a viral marketing campaign to draw attention to the millions that die from them. Market-based approaches drive money to those with the most influence.

In order to reduce the burden of diseases that affect the most people, we must provide research funds that are distributed where they will be most effective, rather than where the market funnels them. We need research centers funded by money offered with no conditions with the charge only to reduce mortality and relieve suffering. Such centers could be funded by government money or by individual contributions, but funding must come with no strings attached other than a demand for transparency from researchers as to how the money is used and what diseases are being treated. Some have offered solutions that would rely on industry to conduct research and develop products to alleviate suffering, but industry cannot be trusted with this task. Industry will always develop products to maximize profits, not minimize suffering.

The so-called “rugged individualists” in our society would argue that each person should have the healthcare he or she can afford, as income is a reliable measure of a person’s worth. Unfortunately, disease doesn’t attack people on the basis of merit. Honest and hard-working individuals can and do fall ill or become injured. Some are surprised by their turn of fortune. It is easier for a wealthy person to become poor than it is for a poor person to become wealthy, and disease and injury are great conveyors to the lower classes. Some, of course, are rich enough to be indifferent to the cost of healthcare or even long-term care. Even without working at all, these individuals will be housed, fed and treated.

People who work for their income, though, even in highly paid professions, are vulnerable to losing everything to healthcare costs. The “excellent” health insurance many people rely on is tied to employment and employment is tied to health. The unlucky ones who become ill lose both in a heartbeat. Bad luck isn’t a matter of bad choices or immorality; it is only a matter of chance. Libertarians argue, basically, that people should be responsible for the choices they’ve made in life, but libertarians also feel the government should protect people from events and circumstances out of their control. Thus, libertarians support the use of government funds to provide courts, police, and standing armies to protect the security of citizens.

The risk of disease and injury threatens us all. The question is whether we, as a society, should take responsibility for protecting all our citizens from this threat. If we don’t do this through government action, we must do it through collective action. Single-payer healthcare, such as all other developed nations have, is the most obvious solution to making citizens secure. Other solutions exist, and can be considered, but no one can prepare for catastrophe alone—collaboration is required.

We must provide funding for both medical research and healthcare. I am not asking you to provide healthcare for someone else. I am asking you to share the burden of providing healthcare for yourself. Sure, there is the chance you will never need it, but your chances are no better than anyone else’s. If we are not all secure, we are all insecure, we are at risk of being choked by the invisible hand. If we are insecure, we are not free.

 

 

 

 

 

On the 49th anniversary of Medicare, let’s work to expand it

R. Horton4 Comments

Medicare was born on July 30, 1965 primarily to help provide medical insurance for Americans over 65. As of 2012, Medicare covered more than 50 million people and it has succeeded in preventing many people from falling into extreme poverty in their old age. And of the 50 million covered, about 8.5 million are people with disabilities, who would not be insurable through private insurance plans.

Despite a few arguments, from the for-profit insurance industry, Medicare is financially more efficient that public plans (see a discussion here ). Even pro-industry arguments tend to highlight some of the advantages of Medicare. In this defense by Merrill Matthews for The Council for Affordable Health Insurance  of private sector insurance, for example, the author says, “Executives and boards of directors consider, debate and decide company policy; in Medicare that function is often handled by Congress and itmedicare for alls legislative staff. “ The authors point out that the time of Congress is also of some value, but the cost is borne by taxpayers. Of course, the time spent by private-sector administrator is also borne by those who enroll in their plans, but private-sector administrators are not accountable to taxpayers in the same way members of Congress are expected to be. The CAHI defense also points out that private insurance companies must raise money and include the cost of raising capital in their administrative costs estimates while Medicare does not include the cost of raising capital as that is done through Congress.

The real difference, according to Matthews’ argument, though, is in the amount of money spent on patients. Matthews points out that private insurance companies spend more money on administration because “they scrutinize individual provider claims much more closely, challenge questionable procedures and determine whether, in the company’s opinion, a claim is valid or needs to be reconsidered.” In other words, private insurers spend a lot more money denying claims. If you’ve ever experienced a major illness or injury, you have been bombarded with paperwork explaining why you will have to pay your own way with no reimbursement from your insurance company.

Matthews said that in 2003, Medicare spent $6,600 per patient paying claims, while private insurance paid only $2,700 per patient. This hits consumers in two ways. First, if you’ve already received treatment and the bill is denied, you are on the hook for payment. Second, the price of your premium includes the salaries of the administrators who are committed to denying your claims, so you are paying them to refuse payment for your treatment. If you think it is good that your claim was denied, leaving you with enormous medical bills after a serious illness, private insurance is the way to go. If you want to have some peace of mind that your bills will be covered, expansion of Medicare is certainly the best choice.

Nonetheless, it is true that Medicare payments need to be lowered. The costs of Medicare payments reflect the costs of for-profit healthcare. The costs can be lowered by enabling Medicare to negotiate the costs of medicine (drugs, hospital equipment, and other medical technology). The costs of common medical procedures vary wildly from city to city in the United States (to see a comparison of four services, look here). By bringing more transparency to healthcare costs, Medicare can pay providers what is reasonable, rather than what is currently possible. While many say that markets create competition that will lower prices, this is simply not the case. The reason it isn’t the case should be obvious to anyone: patients who need healthcare are in no position to shop around. After I had knee surgery in 2001, I had complications that some blamed on my choice of doctor. When asked why I chose this particular surgeon, I said, honestly, that I lay in bed with a shattered tibia, calling doctors for appointments. The doctor I “chose” was the seventeenth doctor I called. No, I did not carefully research his credentials, prices, or hospital admitting privileges. Even at that, I had to wait two days with a shattered tibia to get an appointment. This is the reality of for-profit healthcare and for-profit insurance. It is a nightmare. While Medicare may not be a blissful dream, it leaves fewer patients with healthcare induced night terrors.

Many people seem to have a false sense of security with their employer-sponsored health insurance. In the first place, they overestimate how much of their care will be paid for by the insurance. Then they seem to forget that any serious illness or accident that makes them unable to work will also make them unable to maintain their insurance coverage. The fact that your employer provides insurance today is no guarantee that it will be there when you need it. Further, under the Affordable Care Act (ACA), employers may reduce employees or hours to avoid providing healthcare, as discussed in this article in the Wall Street Journal. And finally, under the ACA may further restrict patient choices of providers, as noted in this piece in the New York Times.

Should anyone be at the mercy of employers for healthcare? Should small-business owners and the self-employed have to shoulder a disproportionate burden for healthcare? Medicare for All is an equitable solution that is fair to everyone and enables us all to pursue our vocations according to our dreams and talents rather than our fear of medical bankruptcy. The time to expand Medicare was 49 years ago, but let’s do it now. Support H.R. 676.

Additional Reading: For more resources on this topic, see the Public Health and Social Justice website.

Horton’s Taxonomy of Racial Prejudice

R. Horton1 Comment

It seems we keep having people make racist remarks and then proclaim, defensively, that they are not racists. Some people are so hostile that their claims of innocence are both laughable and infuriating, but others seem genuinely bemused by the accusation that they are racist. It doesn’t seem possible that anyone could be so clueless, their critics think, that their attitudes would not be obvious to them. In other cases, people strive with everything they have against being racist, only to find to their dismay and horror that they have unconscious racial biases.

In order to sort things out, I think we need to recognize a few categories of racism:

1. Overt racial hostility. In this category we have white supremacists (or other kinds of supremacists, even, depending on your location and circumstances). People in this category believe other races are inferior and will not apologize for saying so. We can renounce them, but we aren’t likely to shame them, as they are quite self-righteous in their belief in their own superiority (leaving their latent fears and anxieties aside for the moment).

2. Racial Prejudice. Some people say they don’t hate anyone or want anyone harmed, but they just happen to believe it is a brute fact that people from different races are different and have different abilities and preferences. People in this category can be the most confounding, as they might say things that are outlandish to the rest of us and then become extremely offended that anyone could possibly accuse them of racism. “I don’t hate such and such people, but they sure hate hard work. God love ‘em.”

3. Racial insensitivity. Sometimes people genuinely don’t mean any harm at all but have no idea how their comments may hurt others. Assuming a person of a particular race enjoys a certain kind of music, dance, food, or whatever may seem completely reasonable to you while it reduces that person to a broad stereotype. Even if the person does happen to like that music or food, he or she may resent you making any assumptions about their taste based merely on race or ethnicity.

4. Racial privilege. A member of my family once said he couldn’t understand why certain groups were always complaining about police harassment. He mentioned that he had many experiences with the police and he had always been treated with respect and courtesy. It didn’t occur to him that his skin color, sexual orientation, and socioeconomic class had anything to do with his treatment. That certain groups are targeted for mistreatment seemed inconceivable to him because he never had to experience what others endure regularly. This is the nature of racial privilege. (Yes, many kinds of privilege exist, but they aren’t relevant to this discussion.)

5. Unconscious and undesired racial bias. Finally, we all have biases without realizing it. When people take psychological tests (you can take one here) to see what biases they have, they may be chagrined to find they are biased against others without wanting to, but some of us are even surprised to find we hold implicit biases against our own social groups. Even those who are aware of no bias whatsoever find that some biases are so deeply entrenched that they are difficult to detect. Ironically, those with the least ill feelings toward other races are, in my experience, more aware of implicit bias. Confront an obvious racist about overt racial attitudes, and he or she will often declare, loudly, that he or she is completely indifferent to race. In my experience, those who are most committed to ending racial prejudice are the ones who are also most willing to examine their own implicit biases. Such is life.

Gender Disparity: Paycheck Fairness Act is not enough

R. Horton

Before I start, let me say that I support any effort to address wage inequality and I believe strongly in the right to equal pay for equal work. If the Paycheck Fairness Act helps to bring more equity to the workplace, I’m all for it, but it will not eliminate wage disparities between men and women on its own.

Republicans are wont to point out that women make less than men not because of discrimination but because of lifestyle choices. (Read a fuller discussion of this in The Guardian.) Their argument centers on the fact that it is possible to pay every woman in any given job the same wage as every man in a similar job and still end up with wage disparity because more women are in lower-paying jobs. To Republicans, this means sexual discrimination is not a problem (everyone should just choose to be a petroleum engineer or investment banker, right?), but for the rest of us it means that sexism is a pernicious problem that will not easily be solved with a piece of legislation.

First, we might ask why the jobs more women choose pay less than the jobs more men choose. One proposed answer is that men choose jobs that are riskier and require a more “masculine” personality. Women, it is assumed, will choose safer and less demanding jobs. Another answer is that women gravitate toward jobs that require fewer hours (they need to get home to the kids, you know?). And another is that women choose jobs that require less training.

According to the 2013 Physician Compensation Report, male doctors earn 30 percent more than female doctors. The report explains the disparity thus: “There are fewer women in some of the higher-paying specialties. For example, in orthopedics, only 9 percent of the survey respondents were women, whereas in pediatrics, 53 percent of survey respondents were women.”

Interestingly, the lowest paid specialty in medicine is now HIV/Infectious Diseases, which also happens to be the specialty with the second highest rate of overall satisfaction (just behind dermatology). The other low-paying specialties are family medicine, diabetes/endocrinology, and internal medicine. Other high-paying specialties, after orthopedics, are cardiology, radiology, gastroenterology, and urology.

While I can’t see that the risk of treating infectious diseases is lower than the risk of practicing urology, I do see that the lower-paid specialties focus more on care and concern and require human interaction. (It still may be true that women are more risk-averse, which may be why they are safer doctors.) It seems to me that we value technical expertise over human and care and concern in most fields. At least we are more willing to pay for technical expertise and less willing to pay for the care and concern that we will all need.

Teachers work hard and take many risks but will never earn as much as petroleum engineers. Ah, but petroleum engineers fatten the bottom line for their employers, you say. Let them try to survive without teachers to get them there. Let all the hard-working risk takers make it through life without the people who cared for them and helped them become successful. And men have always said this, haven’t they? We have clichés such as “Behind every successful man is a woman.” And women have done their work, largely, for free—because they had no other choice. So the work women have done is devalued (though prized in way) and undercompensated. If fewer people were willing to do “women’s work,” the price of such work may indeed rise, but I don’t see this happening any time soon.

And men sometimes choose work that may be seen as “feminized.” When they do, men also earn less because their work is undervalued, too. If the work were not undervalued, I aver that more men would choose different careers. After successful careers in industry, some men choose to leave their jobs for more “meaningful” work after middle age. The work people describe as “meaningful” or “rewarding” is almost always related to either caring relationships or creative enterprises; these are the activities that make life seem worthwhile.

Because these activities bring so much personal satisfaction, people are willing to do them for less pay. If petroleum engineering did not pay so well, I’m sure some people would still choose it as a profession, but many people choose it now only because it pays well and not because it enriches their lives in any other way. Many men are starting to reject the idea that they must choose careers based on how well they pay. Some men in the men’s movement reject being treated as “success objects.” Nonetheless, I think women are more likely than men to feel free to choose careers based on satisfaction rather than remuneration, and men are more likely than women to feel they must choose a career that pays well. There are many, many exceptions, of course, but not enough to close the pay gap between men and women.

So, what should we do to address the problem of wage disparity? First, stop devaluing “feminine” work. Recognize the true value of education and care. Second,  stop treating men as “success objects.” Remove the stigma from rejecting a high-powered career for a more rewarding and meaningful life. Finally, make it possible to find a balance between a career that pays well and a meaningful life. Some women may pass up high-paying professions because they do not want to neglect their family relationships or similar concerns. At the same time, some men neglect relationships and personally rewarding work because they feel obligated to earn as much as possible. Men and women would both behave differently if it were possible to enter any career without having to sacrifice family relationships, volunteer opportunities, and creative outlets. Another world truly is possible.

What Obamacare has done for me

R. Horton2 Comments

When I first met my wife in 2007, she told me she was about to quit her job of 27 years in the oil and gas industry to pursue a career in family therapy. Quitting her job meant giving up her employer-provided insurance, so she went on COBRA for 18 months. By that time, she was in graduate school and was able to get student insurance. When she graduated, however, she was unable to get insurance on her own as she had pre-existing conditions that precluded purchasing insurance on the open market.

I was following a similar path. When we first met, I was working on my PhD while also teaching full time. In 2011, I was beginning my dissertation and my college, facing budget cuts, was offering a payoff to anyone willing to resign. By this time, my wife was on my insurance, and I hesitated to give up my benefits, but we eventually decided I would resign and take student insurance for both of us.

From there, I was playing a delicate balancing act. I knew the healthcare exchanges mandated by the Affordable Care Act (Obamacare) were supposed to become available in January 2014. I pressed forward with my dissertation without wanting to graduate before the exchanges were available. I found that I could stay on the student insurance for six months past my graduation date. I defended my dissertation in March 2013, but did not turn in final paperwork in time for spring graduation, meaning that I would have to enroll in the summer. I graduated in August and was able to keep the student insurance for my wife and myself until February 2014.

Thankfully, the exchanges did go into effect by the beginning of 2014, and we were both able to purchase insurance for ourselves. The cost of the insurance was about the same as the price for the student insurance, but it is a much better insurance plan. I am extremely grateful for the Affordable Care Act (ACA), which made this possible.

But the ACA is even better than I realized. I now teach part time for two colleges. Under the ACA, I can join rejoin the Teacher Retirement System of Texas and purchase health insurance along with disability insurance, accidental death and dismemberment insurance, and life insurance for myself and my wife. Further, the teaching I am now doing applies to my years of service in the Teacher Retirement Service, which means my retirement account is growing and will become available to me sooner.

I am not happy with all of President Obama’s policies by any means, and ultimately I would like to see the US adopt a single-payer model for healthcare, but Obamacare is a step in the right direction. Without Obamacare, my wife and I would have joined the millions of working Americans who have no health insurance or access to affordable healthcare.

So, thanks, Obama.

Sunshine disinfects nothing

R. Horton5 Comments

I seem to remember Jon Stewart once playing a clip of a politician declaring that sunshine is the best disinfectant. After the clip, Stewart warned viewers that using sunshine as a disinfectant could lead to a nasty infection. In response to the Sunshine (Open Payments) Act, bioethicist Mark Wilson sounds a similar alarm in a recent paper.

For years, many people, including myself, have argued that industry payments to physicians should be disclosed to the public, so that we will all be aware of possible financial conflicts of interest (FCOI). My hope was that disclosing conflicts of interest might help actually reduce corruption or even simple bias in medical practice, but Wilson points to our experience of Wall Street before and after the 2008 financial collapse to show that knowledge of conflicts of interest does not prevent them. Rather, disclosure only shifts the burden for reducing FCOI to patients, who are least empowered to eliminate them. Rather than fixing the problem, Wilson claims the Sunshine Act only “mythologizes transparency.”

Wilson pointed me to a paper (“Tripartite Conflicts of Interest and High Stakes Patent Extensions in the DSM-5”) in Psychotherapy and Psychosomatics that illustrates the problem. If you want the details, you can read the paper yourself, but I will skip right to the conclusion, which I admit is how I read most papers anyway:

[I]t is critical that the APA recognize that transparency alone is an insufficient response for mitigating implicit bias in diagnostic and treatment decision-making. Specifically, and in keeping with the Institute of Medicine’s most recent standards, we recommend that DSM panel members be free of FCOI.

Telling people about FCOI does not reduce bias and corruption; it only offers an opportunity for people to be aware that bias and corruption exist. I think it is valuable that the Sunshine Act is making people aware of FCOI. In response, though, I hope we will take steps to reduce FCOI. Unfortunately, the burden is indeed shifted to voters and consumers. The most disturbing and obviously true statement Wilson makes in his paper is this: “Until politicians end their own commercial COIs, the Sunshine Act will likely remain the governance order of the day.”

We can’t hope the experts will solve this problem. We must demand that FCOI are eliminated.

What scientism means to me

R. Horton

I’ve been reading many posts on scientism lately. Some have been from well-known academics and some have been from less known equally astute members of my social-networking circle. Some seem to equate scientism with atheism, some equate it with a reasoned approach to the world, and some equate it with pure evil, apparently.

I don’t know what definition is correct, but I view scientism as the belief that science is not only the best way to gain information about the world but also the best way to make meaning in the world. As a humanist, I reject scientism because I believe we can and should turn to philosophy, literature, religion, art, music and other forms of human introspection and expression to make meaning in our lives. This does not mean I reject the idea that science is the best way to learn facts (disputable as they may be) about the world.

In other words, I think climate scientists are the best qualified individuals to give information about whether the climate is changing and what is causing it. I don’t think I should challenge scientists because I don’t “feel” like they are correct. Opinions are not all equal. Informed opinions are of greater value than uninformed opinions any day.

Similarly, believing that religions can help us find our make meaning in our lives does not mean that scientific information regarding evolution is invalid. Science as an endeavor does not encroach upon religion. It is only when religious dogma makes scientific claims that conflict arises between the two discrete domains of knowledge. Some people in science may occasionally make a religious claim, citing their authority as a scientist, that runs in to conflict with religion and creates controversy as well, but I really think that most scientists simply do their best to report the best information they can glean from available evidence with the hope of improving life for all of humanity.

I’m not sure, but I suspect this has all come to head because of recent controversies over evolution and climate change. Folks on the left have accused those on the right of being “anti-science” because they reject the findings of scientists in these two areas. Many on the right took this as an attack on religion for some reason that I don’t understand, but there you have it. What would we call the view that religion is the only way to find information about the world? Religionism?

Anyway, in response to the left’s accusations of an anti-science bias on the right, some on the right have accused the left of being anti-science because they don’t like genetically-modified foods or vaccinations or something. Never mind that many who oppose GMOs and vaccinations are either conservatives or libertarians, it is true that some people on the left do not approach the world with scientific rigor.

And somehow this has all resulted in people tossing the word “scientism” around like a new hacky-sack. If someone says you are anti-science, you can just say that they are guilty of “scientism.” And, once someone throws that label at you, it is hard to shake it off. So, you either accept the label, ignore the situation completely, or fire back a volley of counter-attacks.

In Steven Pinker‘s response to such an attack, he embraced scientism in a positive sense by simply recounting all the successes of scientific reasoning. Of course, in response to an accusation of scientism, he basically says humanists should embrace scientism and accept that only scientists can save the humanities from extinction. He said, “A consilience with science offers the humanities countless possibilities for innovation in understanding.” He then inadvertently points out the risk of doing so, saying, “In some disciplines, this consilience is a fait accompli. Archeology has grown from a branch of art history to a high-tech science.” In other words, we should all accept how the infusion of science can improve our disciplines by destroying them.

Pinker mentions that philosophy has benefited from collaborations with cognitive scientists, and interesting and productive work has certainly been done in philosophy around cognitive science, but western philosophers have been involved in scientific theory and method from the beginning. Early on, philosophers and scientists were essentially the same people, but even later philosophers sought both to influence scientific method and apply apply scientific method to philosophy. In the twentieth century, the drive to conduct philosophy with the rigor of science led it to a level of obscurity that almost destroyed any hope of philosophers reaching any kind of popular audience.

In the twenty-first century, this movement continues but without a somewhat different focus under the banner of “experimental philosophy.” In this scientific approach to philosophy, philosophers actually gather data to analyze and test their philosophical assumptions. Kwame Anthony Appiah summarizes the problem with this approach quite succinctly: “You can conduct more research to try to clarify matters, but you’re left having to interpret the findings; they don’t interpret themselves. There always comes a point where the clipboards and questionnaires and M.R.I. scans have to be put aside.” When all is said and done, data must be interpreted, and interpretation has always been the forte of philosophers, so, as Appiah suggests, we must return to the armchair for the hard work of hard thinking.

But how do philosophers reach beyond their small circle of professional philosophers to a more popular audience? Philosophers achieve this when they write on matters that intersect with the daily lives of non-philosophers. Appiah is an excellent example of someone who is able to engage the public on matters of moral concern to anyone who happens to be alive on this planet. As a public intellectual, he comments on how we think, how we converse, and how we interact with one another. This ability has taken him out of obscurity and into the public domain.

But the least obscure living philosopher in the world must be Peter Singer. Singer writes on issues that affect our daily lives (what we eat, what we do with our money, how we preserve life), and he creates great controversy in the process. Whether you think he is skilled as a philosopher or not, you cannot deny the scope of his reach. He is helping, as is Appiah, us to interpret and determine exactly what value we place on life and exactly what we consider a good life to be.

Neither Appiah nor Singer is anti-science, but both know that a philosopher’s skill lies in helping us examine what is meaningful and valuable to our personal lives. They seem also to realize that science is unable to interpret and analyze human values. No, it is the humanities that enable us to envision a meaningful and rewarding existence. Scientific advances make a constant re-examination and re-evaluation necessary, and the humanities help guide us down that path. The idea that the humanities have nothing to add to this journey toward meaning and value is what I call “scientism.” Scientists and humanists can both be guilty of scientism.

And scientists and humanists can both engage in a search for meaning that reaches beyond data.

You shouldn’t have to go to jail for mental health treatment

R. Horton

Last week I tweeted a link to a Texas Observer article by Emily DePrang about sexual assaults in Harris County jails. DePrang had written about two Bureau of Justice Statistics studies that showed the Harris County Jail on Baker Street had sexual assaults that are higher than national averages.

One survey reported rates of sexual victimization as reported by inmates, and found that inmates reported higher than average rates of victimization from other inmates. The other survey was based on official reports of sexual violence in jails and also reported higher than average rates for the Baker Street jail. DePrang did not discuss, in her short post, all the statistical and methodological limitations of the studies in question.

To my surprise, Alan Bernstein, the director for public affairs at the sheriff’s office tweeted me, saying he hoped someone would fact-check DePrang’s article as it had many mistakes, so I asked him what the mistakes were, and he sent me a list of items he felt were misleading. Later, the Texas Observer agreed to publish his response to the article (his published response was slightly different from what he sent me).

For the most part, his response pointed out the limitations of the study. Also, he noted that only one of four jails in Harris County had a higher incidence of sexual assault, and he also noted that jail had a high percentage of inmates who are under treatment for mental illness. In his note to me, Bernstein asked, “Is touching a clothed inmate’s thigh sexual violence? Maybe so. But this is one of the actions considered sexual victimization in the study.” I will just say that I consider any unwanted touching of my upper thigh over or under clothing to be sexual assault, even if the “violence” seems minor.

In trying to separate the signal from noise, though, what interested me most was not the definition of sexual violence or even the limitations of the study but the fact that the jail had so many inmates on medications. The Houston Chronicle quoted Sheriff Adrian Garcia saying, “The Harris County Jail has been referred to as the largest psychiatric facility in the state of Texas” and “More than 2,000 inmates … are on psychotropic medications on a daily basis.” And in Bernstein’s response, posted on the Texas Observer site, he said:

That building houses the jail system’s inmates with acute mental illness. In fact the statistician who worked on the 2011 study tells us that two-thirds of the surveyed inmates in the so-called “high” rate building had “psychological stress disorders.” We don’t know how that was determined, and we would never allege that people with mental illness fabricate allegations more often than anyone else.

I’m not sure what “acute” means in this context, but I suspect anyone on medication is assumed to have an acute mental illness. Given the number of prescriptions written for antidepressants and anti-anxiety medications these days, I suspect a fairly high percentage of the general population is acutely mentally ill, according to these assumptions. Even someone being treated for mild depression, though, will experience unpleasant side-effects if doses are missed, as they are likely to be missed inside a jail. We should be concerned both about lack of treatment for mental health and the over-prescription of  drugs for depression and anxiety. Withdrawal sometimes leads to aggressive behavior and could account for some problems. On the other hand, mental illness is also stigmatized, and those receiving treatment may become targets for abuse at the hands of other inmates.

Fortunately, I found more information on treatment of the mentally ill in Harris Country jails in excellent article by DePrang titled “Barred Care.” According to the article, the jail “treats more psychiatric patients than all 10 of Texas’ state-run public mental hospitals combined.” And why is that? Because no one else is treating those patients. Again from the article: “Harris County has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending.” Some people get so desperate for relief, that they break the law just so they can go to jail and get treatment.

The program in the jail is commendable. The funding priorities of our state government are not. In 2003, the Texas legislature slashed funding for mental health services in Texas. According to DePrang’s article, “In Harris County, the number of law enforcement calls about people in psychiatric crisis jumped from fewer than 11,000 in 2003 to more than 27,000 in 2012.” So, the Harris County jail has a high number of mentally ill as a result of deliberate action of our state’s lawmakers. This should make us all angry. Cutting funding for mental health services only to force the mentally ill into jails is cruel and expensive. No matter what sends people to jail, many will never really recover from the stigma and the trauma of the experience.

What should be done? We should lobby our lawmakers to restore funding for mental health services in Texas. We should stop blaming the mentally ill for their problems. We should resist the temptation to treat even minor difficulties with powerful and addicting drugs. We should insist that Texas expand Medicaid as part of the Affordable Care Act (this would cost the state nothing) so that people can receive basic medical care and avoid crisis.

In short, we should learn to heal each other. The person with a mental health crisis tomorrow could be you.

Tea Party and the “Mask of Anarchy”

R. Horton1 Comment
Percy Bysshe Shelley, by Alfred Clint (died 18...
Percy Bysshe Shelley, by Alfred Clint (died 1883). See source website for additional information. This set of images was gathered by User:Dcoetzee from the National Portrait Gallery, London website using a special tool. All images in this batch have been confirmed as author died before 1939 according to the official death date listed by the NPG. (Photo credit: Wikipedia)

I don’t think I’m the only one to notice that Percy Bysshe Shelley‘s “Mask of Anarchy” seems amazingly relevant to current efforts to suppress the voices and will of workers around the world. So, I’ve taken the poem almost verbatim, made a few textual changes, and changed the names of the politicians to the names of Tea Party members and others in the Republican party. For more info on the poem, see The Guardian‘s partial explication.

Here is my take:

As I lay asleep in Houston, Texas
I heard a voice declare war on us,
And with great power it led me
To walk in visions of Poetry.
I met Murder as the widows began crying—

He had a mask like Paul Ryan—
Very smooth he looked, yet grim;
Seven blood-hounds followed him:
All were fat in the savage crew,

For one by one, and two by two,
He tossed them human hearts to chew
Which from his wide cloak he drew.
Next came Fraud, and he had on,

Like John Boehner, an ermined gown;

Official portrait of United States House Speak...
Official portrait of United States House Speaker (R-Ohio). (Photo credit: Wikipedia)

His big tears, for he wept well,
Turned to mill-stones as they fell.
And the little children, who

Believed him to be true,
Thinking every tear a gem,
Had their brains knocked out by them.
Clothed with the Bible, as with light,
And the shadows of the night.

Like Perry, next, Hypocrisy
On a crocodile rode by.
And many more Destructions played
In this ghastly masquerade,
All disguised, even to the eyes,

Like Bishops, lawyers, peers, and spies.
Last came Anarchy : he rode
On a white horse, splashed with blood;
He was pale even to the lips,
Like Death in the Apocalypse.

And he wore a kingly crown;
And in his grasp a sceptre shone;
On his brow this mark I saw—
‘I AM CRUZ, GOD, KING, AND LAW!’

With a pace stately and fast,
Over Texas land he passed,
Trampling to a mire of blood
The adoring multitude.

And with a mighty troop around
With their trampling shook the ground,
Waving each a bloody sword,
For the service of their Lord.

And with glorious triumph they
Rode through Texas proud and gay,
Drunk as with intoxication
Of wine of wanton destruction.

And each dweller, panic-stricken,
Felt his heart with terror sicken
Hearing the tempestuous cry
Of the triumph of Anarchy.

For from pomp to meet him came,
Clothed in arms like blood and flame,
The hired murderers, who did sing
‘Thou art God, and Law, and King.

‘We have waited weak and lone
For thy coming, Mighty One!
Our purses are empty, our swords are cold,
Give us glory, and blood, and gold.’

And Anarchy, the Skeleton,
Bowed and grinned to every one,
As well as if his education
Had cost billions to the nation.

When one fled past, a maniac maid,
And her name was Hope, she said:
But she looked more like Despair,
And she cried out in the air:

‘My father Time is weak and gray
With waiting for a Change this day;
So long as Anarchy rages on still,
The world awaits a reborn will!

‘He has had child after child,
And the dust of death is piled
Over every one but me—
Misery, oh, Misery!’

Then she lay down in the street,
Right before the horses feet,
Expecting, with a patient eye,
Murder, Fraud, and Anarchy.

And the prostrate multitude
Looked—and ankle-deep in blood,
Hope, that maiden most serene,
Was walking with a quiet mien:

To an accent unwithstood,—
As if her heart cried out aloud:
‘People of conscience, heirs of Glory,
Heroes of unwritten story,

‘Rise like Lions after slumber
In unvanquishable number.
Shake your chains to earth like dew
Which in sleep had fallen on you—

You are many—they are few.
‘What is Freedom?—you can tell
That which slavery is, too well—
For its very name has grown
To an echo of your own.

But change rose as a two-headed monster
Each head struggling to devour the other
But Hope nourishes the stricken half
And leaves Gold with a dark epitaph

“Let not this monster rise again.
Squelch the greed that lies within.”
We are not, as impostors say,
A shadow soon to pass away.

We ‘Rise like Lions after slumber
In unvanquishable number—
Shake our chains to earth like dew
We are many—they are few.’

Related articles

Nussbaum and Rand on the Politics of Love

R. Horton1 Comment

I’m currently reading Martha Nussbaum’s Political Emotions: Why Love Matters for Justice. Love is an important focus of the book, but it is certainly not the only emotion that Nussbaum considers important to a minimally decent society. Still, love (and its relevant associate, compassion) is an integral part of a stable and humane democratic society.

English: Photograph of Martha C. Nussbaum take...

Nussbaum suggests that it is entirely appropriate for governments to encourage the development of political emotions that are absolutely necessary for a functioning society. Of course, totalitarian, repressive regimes often rise to power on waves of extreme patriotism coupled with xenophobia and violent anger. This is a risk of the state cultivating emotions, but it is also likely that inappropriate emotions arise because we shirk our duty to cultivate the correct emotions. Who decides which emotions are correct? Why, we political liberals, of course. Nussbaum is more optimistic than I about the ability to create a state that will encourage the appropriate arts and literature to cultivate emotions that will engender empathy and promote democratic feeling. Still, we are obligated to make every effort to counter those who would work to destroy both compassion and democracy.

Nussbaum recognizes the potential for paradox in her claim, but she defends her position with depth and detail. The fact that I agree with both her goals and method make it quite easy for me to follow along and hope, against all odds, that is possible to create a more decent society than what I currently see around me, even if I feel we must go it alone without the full support of government.

Ayn Rand

But all this talk of love got me thinking of Ayn Rand, of course, as many things these days get me thinking of Ayn Rand. She said that we should be selfish and never sacrifice ourselves to others. In contrast, many of us have foolishly believed that to love someone was, in fact, to be willing to sacrifice ourselves for his or her well-being. On this point, I think Ayn Rand was able to explain herself quite clearly. When asked whether we shouldn’t be selfless in our romantic relationships, she said,

“When you are in love, it means that the person you love is of great personal, selfish importance to you and to your life. If you were selfless, it would have to mean that you derive no personal pleasure or happiness from the company and the existence of the person you love, and that you are motivated only by self-sacrificial pity for that person’s need of you.”

She makes a good point. We sacrifice for those we love because we value them so much that their loss is a personal loss to us, and their suffering is a suffering we share. We do not love out of duty; we love for the pleasure it brings us.

For Rand, altruistic concern for strangers entails a denial of self-satisfaction and an indenture to others. By living for the needs of others, we deny our responsibility to determine and seek our own needs. It does not occur to Rand, as it does to Nussbaum, that is possible to value other humans with a love that extends beyond our realm of personal contact. It is possible that I want to preserve the lives of strangers thousands of miles away because I value them, even if abstractly, to the point that their suffering causes me suffering.

I don’t want to live in a world where millions of people starve to death each year, and I do not believe they are starving because of the poor choices they have made. I believe they are starving because of structural economic violence against them. In many cases, the world’s resources have been stolen by brute force (did farmers and fishers in Africa foolishly give their land to oil companies?). Poverty, addiction, and disease are largely a result of violence against people who are not recognized as being fully human, fully deserving of respect.

We don’t have to accept this reality. As Nussbaum says, “We should surely not assume that the form emotions take in the corporate culture of the United States reveals a universal and timeless truth about how things must be.” No, we can work to ensure that our moral imagination can perceive other human beings as beings worthy of respect, dignity, and, yes, love. If we seek to respect ourselves, we must demand respect for all.

Love is possible.