The Jameson Problem

I know a boy named Jameson and he is a problem. He’s not just a problem for me; I think he is a problem for all of us. I introduced you to this boy last November in an essay called “The Boy with No Arms”. I told you how young Jameson was born with no arms-just above the elbow. I told you how this birth defect was impacting him and his family. I went on to discuss the issue of medical care for this boy to provide him with prosthetic arms, and how expensive that was going to be over the course of his childhood years. Jameson will be one year old in April. Kids grow pretty fast and his need for new prosthetics will grow with him.

Back in November I had just attended a Pancake Breakfast fund-raiser to help his parents secure the money to get Jameson his first set of prosthetic arms. I noted back then that his parents are hardworking people who are dedicated to making their son’s life normal and productive, just as other parents are. They have some health care insurance but they had to battle the insurance company just to get them to acknowledge Jameson’s condition as one they would minimally cover. Even with their insurance, they will still face monumental costs for many years to come. The last time I wrote about this boy I expanded my view to discuss the costs associated with my friend Molly’s cancer treatment, and how my son-in-law literally lost everything because he had cancer some years before he came into our family. The story hasn’t changed. Medical care is unbelievably expensive if you have a serious illness or condition. The insurance companies still try every maneuver possible to avoid paying for care while relentlessly raising the price of premiums for everyone else. Sick people or the parents of afflicted children still stay up nights terrified about their health and equally terrified about how to pay the bills or how to face the real prospect of losing everything they’ve worked for. 

I'm  reminding you of the story I wrote last November because I had another Jameson experience about a week ago. Once again, very kind-hearted people had taken it upon themselves to sponsor a lovely event to raise money for Jameson and his family. This was a public event where the folks who attended bought tickets to attend, then purchased raffle tickets to win donated goods and services, or buy drinks, all to help raise money for Jameson’s care. There were 80- 100 in attendance. I’m sure it was a successful event, though I never heard how much money was raised. The money raised can be no more than a drop in the bucket of the actual costs. Throughout the night I kept having two conflicting thoughts. The first thought was how great it is that these people will come together to help fund some of this child’s needs. The second thought was how tragic it is that the richest country in the world is reduced to having fund-raisers to provide care for this child. I thought about the tremendous insecurity a family in this circumstance must feel knowing their fate lies in the random giving of others, however kind that giving is.

A woman was at the event to speak and share her experience as part of the event for Jameson. She too wears a prosthetic arm because she was born with an arm missing, just like Jameson- only Jameson was born with both arms missing. The woman now works for a company that researches, develops, and manufactures prosthetics. Her company has agreed to donate a set of arms for Jameson when he’s ready. The family will have to make some rather complicated decisions about the offer, but it was nonetheless a kind offer. The newest innovation in somewhat functional electronically controlled prosthetic arms will cost about $25,000.00 for one set which he will outgrow relatively quickly. The (one adult) arm our speaker was wearing cost approximately $40,000.00, she told us.

When we're confronted with a real life situation the policy decisions we make as a nation seem very different than the impersonal debate of bloodless politicians who bluster, and cajole us when the TV camera is pointed their way. Yet on some level we have to know and understand that policies and real life intersect all the time. Laws, policies, Court rulings, arguments about the role of government, or our obligations to our fellow citizens (young and old) don’t exist in the abstract. In fact they are played out in real life before our own eyes every day. The Jameson problem is that many of us have managed to compartmentalize these two facets of our lives and beliefs so successfully that it’s become too easy to feel compassion for a little boy’s needs on one hand, and feel disdain for our collective responsibility to him on the other hand. And just to be clear, when I say “collective responsibility” I mean government. Government exists for a number of reasons, and one of the reasons stated in the Constitution is to “promote the common welfare”.  This is certainly open to interpretation as are most parts of the Constitution, but I believe this portion of the preamble (at the very least) suggests there actually is a “common welfare”- that promoting the common good of the people is a role of government, which implies a collective responsibility. Even though it may not seem like it most of the time, we are the government in this democratic society of ours.

The Jameson problem, just like the problem for others I know and countless others I don’t know, is the same. We have created a health care system whose purpose is to not provide health care. Our private insurance system operates on the capitalistic, private enterprise model that most conservatives believe is the answer to everything. Private enterprise works well in most areas of commerce where there is choice and competition leads to legitimate market solutions- but not for health care that everyone needs without regard to choice in the marketplace. The marketplace  should not be in charge of our health care. The basic business model for health insurance is to charge maximum premiums, then resist paying them out for our health care. That’s how they create capital and corporate wealth.

I wonder if we really want a country that sees a boy like Jameson and says, “Tough luck- sorry you were born that way and I hope you can come up with the money you need on your own- good luck with those pancake breakfast fund-raisers”? Or do we want a country that sees so many of its citizens lose everything to medical bills and says, “gee that’s a shame, awfully sorry that cancer is so expensive and you had to choose between dying or getting treatment- sorry about that bankruptcy- But you know, government isn’t here to take care of you”?  If that sounds harsh, just remember that is exactly what we’re saying now.

As the debate goes on over the role of government, the deficit, and Obama Care, it’s important to remember the faces of those who live in the shadow of these monumental policy decisions. I’ve never been one who believes this country is broke. That is not to say we don’t have huge fiscal problems- we do. Our fiscal problems aren’t from a lack of wealth, they’re from policies that don’t properly prioritize the way wealth is created, collected, spent and distributed. If we look around it’s easy to see enormous wealth, along with powerful political forces so ready to protect the wealthy while telling the Jameson’s of the world “we just can’t afford to care for you”. Those forces are very eager to foster a “disconnect” between real cases and abstract policy decisions because it’s much easier on the conscience. Its child’s-play to make a sweeping case against the “takers”, until you look in the face of a real child and call a one-year old boy with no arms a “taker”.

We’ve had the answer to the Jameson problem right in front of us the whole time, but we’ve never had the political will to seize it.  The obvious answer is universal single-payer health care. Every other advanced country does it, and they all provide better and cheaper health care. But our politicians can’t seem to break away from anything that isn’t based on the profit motive. So the disconnect continues in our discourse and decision making. It is the same kind of disconnect that explains our Congress having a dismal 13% approval rating (lower than a root canal) but 92% of incumbent Congressmen get reelected. Everybody hates “them” but they love “mine”- even when “mine” is part of “them”.

So, we ask the question again: Is that the kind of country we want to live in; where misfortune, illness, or disability is simply viewed as “your problem”? If it is, then we are being very short-sighted and ignoring the other long-term costs of allowing our policies to ruin and bankrupt families and leave citizens without needed health care. The long-term cost of those preventable maladies is too great and ethically wrong. Young Jameson is proof of that problem.

Thanks for looking in.

A Look at Change

 As I was thinking about the nature of change, I realized that change has been the central theme of my entire professional career. The practice of social work is all about change. No matter what area of social work we’re talking about, the primary product of the work is change. In my early days just out of college I worked in a Juvenile Court with youthful offenders. The object there was to provide the tools and consequences to stop these boys and girls from committing more crimes. I moved on to child welfare, dealing with adults who were abusing and/or neglecting their children. Change in those cases is obvious. Those folks had to make big changes in their parenting practices or risk losing their children, sometimes permanently. The stakes are pretty high in that arena. After some years of that, I supervised social workers in a public assistance office. The stakes weren’t quite as high, but the need for change was still significant. Our task there was to assist people to transition (or change) from dependence to a life of self-sufficiency. I understood many of those who needed our help did not cause their own situation- but the need to change was ever-present no matter how you got there.

Then I changed too. After twenty years of social work with the State of Washington, I changed to working in a private agency and back again to child welfare. It was here that I finally began to understand how change really happens. Imagine that, after twenty years of being relatively successful in a profession that deals with change, I finally started to get it.

The first twenty years of practicing social work in a state bureaucracy was more about trying to get people to comply rather than change. In the state bureaucracy, behavior was rule-driven and always accompanied by adverse consequences for breaking the rules. “Go to drug treatment or you lose your kids”-“take that parenting class or see a therapist or I will take this to Court”- “Go to WorkSource, cooperate, or we’ll cut your assistance”-“turn in your papers on time or you’ll lose your food stamps and medical”.  In my next job I learned that real change can only occur when the person: 1. recognizes the need for change internally; 2. is invested in the change; and 3. is part of the process of change. We simply employed a different (and much better) way of dealing with change in human behavior than at my old job. It’s hardly a revolutionary idea- it’s been known forever. The problem is that it is hard to do in a fast paced bureaucracy or with those who have never valued the process of genuine change. This lesson was brought home to me even more by being around people who were going through treatment for addition. Attempting to change addictive behavior is a real study in the difference between compliance and genuine change. It’s so easy to see, because addicts who don’t engage in genuine change can’t hide it very well. The facade of compliance breaks down pretty fast in the drug world.

Perhaps  much more of the human experience deals with change than we realize. Even as most of us constantly strive for consistency in our daily lives, change is the only constant. As humans, our physical and intellectual development progresses at a (relatively) much faster pace than many other species. This is most true for our intellectual development. Our human intellect is the superior intellect on the planet. That is, we have more intellectual capacity than any other species- so our increase in that capacity out paces all other species. But we are social animals too, and social concerns and situations are a cause for constant change. And with all that intellectual capacity, along with emotional and social responses we sometimes make bad choices or get on the wrong course. I think all of us make course corrections, adjustments and changes because we come to understand that the result will improve our condition. There are a lot of variables in our lives; jobs, relationships, economies, politics, environment, etc. that all inform us about the need to change. Sometimes we realize that where we stand, and what we believe is just wrong. We discover new information, or the world around us changes -and we find our old ways of thinking and acting don’t work anymore. So we’re faced with that age-old dilemma of instituting real change, or just going through the motions and appearing to change. It’s a real dilemma for some because real change can be uncomfortable. It requires us to do an honest evaluation of ourselves- and it sometimes requires us to alter our belief systems in order to internalize new behaviors and new ideas.

Today’s Republican Party is a great example of how difficult change can be. They were beaten pretty soundly in the last election because their positions did not resonate with a majority of Americans on very basic issues. They failed the policy test in relating to minorities. They failed the policy test on economic justice and fairness issues. They failed the policy test on women’s issues. They failed the policy test on social issues. They failed the policy test on basic governance by being obstructionists. In other words, most Republican positions were roundly rejected by a majority of the people. They have been out-voted in the popular vote for President in 5 of the last 6 elections. Even in the House of Representatives a million more people voted for Democrats than Republicans this year (only gerrymandered districts allowed a GOP majority in the House). This is a good case for change because the world around them is changing and the old ideas don’t work anymore. Republican Gov. Jindal called his own party “The Stupid Party”. There is ample reason for change if the party wants to survive, but they demonstrate how hard change can be. It seems they only want the appearance of change- not real change. They realize they got creamed at the ballot box- but instead of honestly reassessing their relevance, they decided the best thing to do is try to fool us. It’s the same thing  desperate drug addicts do to maintain their lives without being committed to real sobriety. It never works. Consider these actions since the election: Still haven’t passed the Violence Against Women Act in the House; still haven’t solved the long-term fiscal cliff issues; threatening to let the sequestered cuts happen (against every economic warning for this) instead of considering tax reform; Republican State Houses in four states moving on personhood bills and trans-vaginal probes being forced on women; immigration proposals that claim a path to citizenship, but are impossible to achieve; filibuster on a Cabinet nominee for DOD (never before done in the history of the nation!); and continuous protection of the wealthy while proposing budget cuts that hurt the middle class and the poor. 

Instead of real introspection and change that is internally motivated and genuine, the Republicans say they aren’t wrong- they just didn’t do a good enough job of telling their story. Instead of re-thinking a failed immigration policy, they just repackage the old ideas and send a Tea Party Republican with a Spanish sir-name out to sell it. Instead of denouncing the failed sexual politics of redefining rape, making contraception harder to get, using unnecessary medical procedures against women, and failing to pass a Violence Against Women Act- they just double-down on the same policies while telling us the Party is different now. It shows that institutional change is sometimes the hardest change to achieve, and why institutions tend to flounder so long before they eventually fail. Another prime example of institutional change being so difficult is the case of the Catholic Church. The Church has endured scandal after scandal in its long history with great schisms that had world-wide implications- but they have always successfully resisted change. Today the Church is in a long period of floundering. Church attendance is at record lows in Europe, Catholicism’s home court, because too many closest to the Church simply view it as irrelevant, corrupt, and unwilling to consider real and meaningful change. The same is true in North America. But, change that is not internally motivated will likely never happen- so it will be with the church. As long as the same people (or same kind of people) can hang on to the vestiges of power in the structure of the Church there is no real motive to change. But when institutions finally find themselves with no followers they either cease to exist, or reinvent themselves out of desperate necessity.

Change is always occurring and, I think those people and those institutions that are open to change are the ones that have the greatest long-term success. But openness to change is more than a stated position- the evidence of genuine change can only be measured in actions. A political party that claims change, but does the same things and has the same policies, has not changed. A church that claims to have learned from past mistakes but continues the same practices has not changed. And a person who professes to change but behaves the same has not changed.

I wanted to write about this topic because I truly believe we are in a period of great social and political change. I believe better times are ahead after we get past the tensions, conflicts, and dynamics of change that are gripping us now. I believe that those who are open to our constant evolution and inevitable changes will emerge in a better world.

Thanks for looking in.

"All War Is A Crime"

One of my all-time favorite television shows was the very smartly written and expertly performed program, The West Wing. It depicted the fictional White House of President Jed Bartlett and his closest White House staff. I always admired the intelligent and fast paced dialogue between the characters as they grappled with nearly every dilemma that could befall a sitting President and those around him. It was compelling to me on every level.

As I see the flood of news about our methods of warfare that have risen to our national view over the last week or two, I’m reminded of a scene in that program that always stuck with me. I think it has application for the national debate that’s roiling just under the surface of our national conscience now. It goes like this: Leo McGarry is President Bartlett’s principled, but pragmatic Chief of Staff. Leo is in his office with General Adamle who is on the Joint Chiefs of Staff and was formally one of Leo’s superior officers when Leo was a combat pilot in the Viet Nam war. Leo is discussing advising the President to launch a unilateral military attack against some foreign dictator who used deadly weapons against a civilian target. Leo is angry and believes that American principles require the U.S. to retaliate against this dictator to show that America will not tolerate “war crimes” perpetrated against innocent civilians. The General stops Leo from ranting on with his indignation over war crimes and asks Leo if he remembers a particular mission he flew during his time in Viet Nam. Leo tells his old friend that he did remember the mission to bomb a strategic target in North Viet Nam. Leo remembered that it was a high altitude bombing of a bridge. Adamle takes a long pause, then he tells Leo that the mission was classified (even from the pilots that flew it) and that the target was not a bridge at all- in fact it was a civilian target the CIA has selected to send a very specific message to the enemy. Leo was shocked- then sickened to know the truth about his mission. He now knew that he too had committed a “war crime” by his own definition, even though he didn’t know it at the time. Then Leo turns to his old friend and asks, “Why are you telling me this now- why do I need to know this now?” Again General Adamle takes long pause and says, “because I wanted you to know that all war is a crime”.

The lesson that Leo learned from his conversation with this life-long, professional warrior and friend is that war itself is a crime, and that even those who believe that what they do in the cause of nobility-are guilty, because the very act of war itself is a crime against humanity. Yet my understanding of human history points to the fact that the unifying behavior of humans for many thousands of years is the waging of war.

Even though war is a constant occurrence in recorded history, the methods of war have changed and evolved through the centuries. As man’s quest for more of everything has increased, so has our penchant to take it from others- to conquer in the name of expansion and growth. As resources grow more rare and finite the need to control the world’s resources gives us the rationale to go to war. And as our ideologies, both political and religious, become more hardened into our national or regional characters we feel the need to go to war to impose that which we know is “right”, and vanquish the ‘evil” of those who believe differently. I think these are the same reasons that war has always happened. It’s just that means of doing it have changed.

 Before the advance of technology war was waged by throwing large hoards of people against each other, colliding in close combat, until attrition determined the outcome. It wasn’t until the time of the American Civil War that big technological advances in weaponry began to change the nature of war around the world. By WWI nations were now waging war in the air and developing chemical weapons. By WWII we were still using the hoard method, but added massive artillery, bombs, and advanced air and sea war technology to the arsenal. By the end of the war atomic weapons were developed and the overall result was 50 million dead world-wide-the most deadly war in man’s existence.

The other aspect of war that is evolving is the idea of warring nation-states battling each other, versus the current configuration of militant terrorist factions who commit random acts of war wherever they believe they can cause the most havoc, then disappearing into the population. Americans came to believe after WWII that our military power was irresistible and American military might always guaranteed victory. Viet Nam showed us that isn’t true. The Soviet invasion of Afghanistan and our war there showed us that ancient peoples in harsh territories can outlast even the greatest armies, thus changing the way we even think about war.  

I mention all these things about war because I have been thinking quite a lot about our behavior of using un-manned aircraft (drones) with incredible technology to strike with pin-point accuracy, for targeted kills. The implication is that we now have (and use) these weapons for a very different kind of warfare than we’ve even engaged in before- and it begs the question of whether that constitutes warfare that is morally acceptable.  The question was brought into sharp focus by two pieces of news that surfaced this week. The first was that Justice Department legal opinions justified the Obama Administration killing an American citizen living in the Middle-East who was now an enemy plotting against us. The second news item told us of nearly fifty (50) countries that cooperated with the Bush/ Cheney Administration to render prisoners to other countries for illegal confinement and torture. In both cases, our Presidents had the full cooperation of The Justice Department who provided legal opinions justifying their behavior.  The killing of US citizens (or anybody for that matter) without due process of law (even if they are very bad guys) and the use of torture by us or our surrogates should be cause for extreme concern and examination. They are not the same thing- but the common thread in these two issues is that they are a departure from traditional policy about our behavior in war. I’m very troubled by these behaviors.

This new behavior by American governments (both Bush and Obama lately) does not seem to be political. I believe this is not an issue for the individual Presidents as much as it is an issue for the Presidency itself. Every President since Hoover has used the American military in another sovereign country to wage war (except Carter). But no President since Roosevelt has done it with a declaration of war. The trend over the last seventy years in America is to cede the power of war to the executive, while Congress washes its hands of responsibility- only to snipe about it later. It is only natural then that when the power of war is given to one person, the potential for abuse is increased- even with good intentions. Both parties, it seems, have engaged in traditionally immoral practices, or war crimes. Is it the times, or the nature of the enemy that has driven us to this path? Is it pain we felt on 9-11-01 that compelled us to veer from our ethics? Is it vengeance, or desperate frustration with an elusive enemy who doesn’t fight fair?

These questions are complicated and multi-faceted. But I have noticed that since the attacks on our soil on 9-11-01 when three-thousand of us were killed by terrorists, we have adopted a very different way of thinking about our national war ethics. Perhaps we found these attacks so vile that we simply allowed ourselves to say “the ends justify the means”. Perhaps we were so shocked, hurt, and in need of vengeance we almost immediately gave up many of our own liberties by way of the Patriot Act, then told our leaders through our silence “go ahead and torture- imprison without trial- use drones to bomb and kill in any country you want- kill Americans if you think they hate the rest of us” So our government did just that, and got their lawyers to say it was all legal. But if we really examine our basic beliefs about ethics, and the values we were founded on, we know it is not legal or ethical. How can we lecture the world on liberty, lawfulness and human rights while we have given in to the temptation to abandon these sacred principles ourselves. If we truly are the beacon of freedom which, by definition, includes human rights, then we are always bound by the founding principles those notions are based on. The ends never justify the means if the means are in direct conflict with our values. As much as I support President Obama, his use of these new weapons and his tactics of killing without the due process of law is wrong- just as wrong as the last President was wrong to lie us into war, and practice rendition and torture of prisoners.

If, “all war is a crime” as fictional General Adamle said, then at least we must endeavor to set limits on ourselves for the way we wage it. If we recognize war as (a sometimes) necessary evil, it is incumbent on us to establish rules of conduct to reduce the evil. If we are true to our values, then I believe it is a duty to seek the path of lesser evil - and only the voice of the people demanding it can make it happen.

Thanks for looking in.