Thursday, November 20, 2014

Each of us has many lives to live … one life at a time


 
Alfred North Whitehead
 
Each of us has many lives to live … one life at a time.
Believers in reincarnation will interpret the previous paragraph in a way contrary to what I mean.
In process philosophy and thought (process philosophy began with the ideas of Alfred North Whitehead; prominent among process theologians are John Cobb, Marjorie Suchocki, and David Griffin) individuals (whether a person, another animal, an inanimate object, or a sub-atomic particle) are events that rather than things. Events have a duration measured in inconceivably small fractions of a second.
Interpreting the cosmos in terms of events rather than things has some important consequences. First, no thing is constant. Every sequence of events incorporates ongoing change. On a sub-atomic level, no particle's location and energy are both fixed. Inanimate objects (think of a rock, for example) constant change, e.g., because of erosion, pressure (if buried underground), etc. Living things change in more obvious ways, though it is worth noting that humans constantly change as both the brain morphs in response to new sensory input and thoughts and most of a human's billions of cells have a seven-year lifecycle. In other words, we are never the same person for more than the smallest fraction of a second.
Second, what we normally regard as things (sub-atomic particles, inanimate objects, all forms of life) is more accurately regarded as a continuing stream of events, the present emerging from the previous and leading to the next. Each of us has many lives to live … one life at a time.
Third, life is sequential rather than repetitive, i.e., unlike what happens in the movie "Groundhog Day," we live each moment only once. Once a moment – a unique set of events has occurred – it will never reoccur. Therefore, it behooves each of us to make every moment count.
Fourth, the cosmos exhibits an increasing complexity indicative of the presence of emergent properties. I, in this millisecond, am an event. But each of my organs and internal systems are also events as are each of my cells, each component of each cell, etc. Properties associated with one level of complexity (e.g., cells that self-propagate) are not necessarily found at other levels (e.g., an atom does not self-replicate). Humans have a level of awareness, because of our relatively high degree of complexity, not found in less complex events.
Fifth, we have the ability to exercise some degree of influence on the formation of some of the events in which we participate. This is an emergent property associated with greater levels of complexity that allow more opportunity to exert that influence. Concomitantly, greater complexity usually diminishes the options that other events and forces, including God, have to exert change.
In sum, process thought offers many people a way to make sense out of life while both incorporating the knowledge gained from science and avoiding the dead end of scientific reductionism that fails to account for life's multiple levels, creativity, and indeterminacy. Concurrently, theologians, biblical scholars, and clergy who utilize process thought provide a positive, constructive alternative to the foolish bibliolatry that sadly dominates so much contemporary thought, e.g., cf. my Ethical Musings' post on Noah's Ark.


Monday, November 17, 2014

Jesus and healthcare - Part 2


 
This is the second of a two-part post on Jesus and healthcare (to read the first part, follow this link). As always, I invite reader questions and comments.

Thus, from the perspective of economics, my reader posed the wrong question. The question is not whether one chooses a healthcare system characterized by capitalism and free markets but what constitutes the preferred form of socialism:

  • What resources (hospital beds, emergency rooms, ambulances, etc.) and how many of them does a community need?
  • How can society minimize administrative overhead?
  • What parts, if any, of a healthcare system lend themselves to free markets, i.e., is a hybrid system possible?
    • One possibility might be the choice of a primary care provider, especially if structural barriers to entry were reduced (cut the cost of medical school, encourage unlimited competition between medical schools, etc.) and non-physician providers (physician assistants, nurse practitioners, midwives, etc.) could easily and legally provide routine care.
    • Another possibility is to nationalize all healthcare research (including on drugs), eliminate patents on all healthcare devices and drugs, and then promote competition between manufacturers. Taxpayers would fund the research, eliminating the outsize profits that private industry demands for engaging in admittedly high-risk research that often has an uncertain payoff.
    • Another possibility might be to segment healthcare, socializing most of it but creating free markets for optional procedures such as most cosmetic procedures.

Of course, funding represents a major obstacle to moving from the cherished illusion of free markets to an openly socialized healthcare system. However, the change should cut the total cost of healthcare in the US, which is now the highest in the world and generally produces mediocre results, even though it occasionally produces exceptional results. The people who would reap financial gains from the change would include most taxpayers; among persons and companies who might lose are shareholders and employees in the nations for profit healthcare companies (hospitals, insurers, physician groups, etc.).

All of which brings me back to Jesus. The most important reason to change the US healthcare industry is Jesus' concern for the most vulnerable and least among us, i.e., the uninsured and underinsured, people who postpone seeking care because they cannot afford it and don't like charity. The second reason to change is that Jesus worked for health and healing, outcomes on which the US approach currently receives very mediocre marks. The third most important reason to change is that Jesus expects us to be good stewards of the resources entrusted to our care. Our healthcare industry is costly and needlessly wasteful. Finally, Jesus sought to create genuine community and honest relationships. Our healthcare industry is divisive and built on a web of misinformation and half-truths that mask the problems I've sketched above as well as others.

Thursday, November 13, 2014

Jesus and healthcare - Part 1


 
An Ethical Musings' reader asked for my opinion on the following question: Of which healthcare system might Jesus approve, the US for profit or Canada's socialized?

My answer to that question has two parts. In this, the first, I answer the reader's question, concluding that it is the wrong question to ask. In my next post, I'll ask the right question, offer an answer, and conclude with some thoughts on Jesus' priorities.

First, Jesus' concern would be that everybody – regardless of a person's wealth, social position, race, religion, or other demographic factors – have equal access to quality healthcare. Scripture consistently portrays Jesus as a healer who cared equally for all people.

Second, no healthcare system is – or ever will be – perfect. Healthcare systems are devised and operated by humans. Choosing a healthcare system inevitably requires choosing between sets of tradeoffs. In other words, healthcare debates will generally involve differences of opinion that result from assigning different weights to various values and from different projections about the probability of future outcomes.

Third, the choice between a free market (what my reader termed capitalist and I rephrased as for profit) and socialist approach to healthcare is in many respects an economic decision. As I have previously argued at Ethical Musings, capitalism often has significant advantages compared to other economic systems. However, healthcare poses seemingly insurmountable obstacles on both the demand and supply sides of the market to devising a satisfactory free market healthcare system:

  • On the demand side, sometimes when a person wants (the more accurate verb is needs) healthcare, timing is critical, e.g., in the aftermath of a life-threatening injury or acute medical crisis such as a heart attack. In such a moment, the person requires immediate care and does not have the time, and often not the ability, to choose a supplier. Yet informed consumers are a prerequisite for free markets to function properly. In sum, a free market healthcare system is incompatible with the provision of emergency care. Many communities have recognized this fact, establishing a monopolistic first-responder system and limiting the number of emergency rooms.
  • Also on the demand side, for free markets to function effectively and efficiently consumers must make informed choices about treatment options and suppliers (also known as vendors and healthcare providers). The more complicated a medical issue is, the more costly treatment is likely to be. However, the more complicated a medical issue is, the less likely a consumer will have the time, education, and perhaps intellectual ability to make a rational choice between her/his options. Furthermore, consumers generally have little incentive to acquire the knowledge and skill to make good healthcare choices about complex medical issues because most consumers will not need to make any of these choices for themselves until they near the end of life, when thinking abilities are often degraded. Acquiring such knowledge early is usually pointless: the range of possible medical issues is too huge (which is why physicians specialize) and knowledge about those issues and preferred treatment protocols often change (which is why continuing education is important for physicians). Meanwhile, complicated insurance policies, uncertainty about the future, and consumer optimism about the future (I won't get sick, I'll somehow get by, etc.) discourage individuals from researching insurance options before they buy.
  • Also on the demand side, consumers and their families understandably and generally want the best available care, regardless of price. Healthcare markets, in other words, tend to be inefficient because they are highly inelastic (insensitive to price), which allows suppliers to maximize profits.
  • On the supply side, free markets require multiple suppliers to compete with one another. Yet much of the US healthcare system is currently an oligopoly (few suppliers) or monopoly (one supplier) and not a free market system with many suppliers. Competition does exist between physicians in many places. However, in most markets only a few (three or less, usually) hospitals compete with one another. Population density will often support only one hospital; proximity, as much as anything, will often appropriately dictate which hospital treats a person, meaning that competition is more illusory than real. Similarly, healthcare insurers have succeeded in minimizing competition in many places, sometimes through legislative intervention and sometimes by ruthless competition in a badly regulated market. Regardless, the consumer loses.
  • Also on the supply side, healthcare providers have worked to establish high barriers to entry that effectively limit competition. If the US had twice or three times as many physicians as it does today, those doctors would start to compete on price. Drug patents promote research in the hope that sales of a blockbuster drug will generate massive profits, but do so at the cost of discouraging head-to-head competition between drug companies. This dynamic is especially evident in the resistance of drug companies to consumers buying generic drugs, medicinally the same as the original but manufactured and sold at a far lower price. The pharmaceutical industry has often succeeded in colluding with physicians and pharmacists to minimize use of generics.
  • Also on the supply side, healthcare providers adamantly refuse to provide consumers with price information. When I moved to Raleigh, I wanted to choose a primary care physician based on which doctor would bill my healthcare insurance the least (my copay in all cases would be the same). None of the physicians who accepted my healthcare insurance would tell me the amount that they would bill my insurance. In other words, price competition was impossible. I found the same refusal to provide pricing information when I contacted the three area hospitals about their services. In fact, the people with whom I spoke were first surprised that anybody would ask about price (after all, insurance would pay) and then were offended that I would choose a provider based on price (none of the physicians had had any complaints filed publicly and the hospitals all have great national reputations).
  • Also on the supply side, very profitable private healthcare insurers (think large insurance companies) and the administrative burden associated with funding US healthcare this way represents a de facto surcharge of about 25% to consumers and taxpayers. This extra cost adds little if any value to actual healthcare.
  • Also on the supply side, extensive government regulation (e.g., controls on the number of hospital beds, emergency rooms, costly equipment such as MRI machines, etc.) already recognize that parts of our healthcare are really a monopoly or oligopoly, not a free market.

In other words, significant structural barriers on both the demand and supply sides mean that a free market approach to healthcare will never really exist. The existing US approach is more accurately described as dysfunctional oligopoly than as free market capitalism.

Monday, November 10, 2014

Veterans Day 2014


 
Today is the 239th anniversary of the United States Marine Corps, founded in 1775. Tomorrow is Veterans Day, when the United States honors those who have served in its armed forces. From a Christian perspective, these annual commemorations prompted two musings.

First, Jesus loved all of God's children; we are the branches and he is the vine. The Marine Corps emphasizes from boot camp forward, Once a Marine, always a Marine. In other words, being a Marine (they always capitalize the word) means being a Somebody who belongs to a group larger than self. More broadly, Veterans Day calls us to honor those who have defended our freedoms; we honor them best not with words (Thanks for your service) but with genuine caring through adequate healthcare, pensions, etc. The high rates of homelessness and alcoholism among veterans reflect the large number with invisible wounds whom we too often forget are branches just as we are. Honoring veterans should not be an annual responsibility but a daily privilege. Similarly, being a human means being a Somebody who belongs to a group larger than self.

Second, Jesus said, Blessed are the peacemakers. The image included with this post is of the Iwo Jima Monument, a WWII victory against the Japanese in which triumphant Marines (one Caucasian, one Native American, and one Afro-American) plant the symbol of freedom atop Mt. Suribachi. Thirty years ago, I saw Iwo Jima. I could see no signs of life, only the rusting hulks of tanks and landing craft. The island was a stark reminder that while war may occasionally be necessary, war never solves our problems. At best, a necessary war creates an opportunity to build peace. Since WWII, the US has sadly become increasingly militaristic, looking to warfighting rather than peacemaking to solve problems. The most recent US misadventure has slowly begun to expand, from airstrikes against the Islamist State of Iraq and Syria (ISIS) to inserting ground personnel to advise and to train Iraqi and Kurdish forces fighting against ISIS. The US cannot end this conflict militarily; no matter the extent of any military defeat inflicted on ISIS, it will do little to resolve the underlying problems or to end the violence in that area permanently. Be of good courage; pray for peace; and work to end violence that God will bless you as a peacemaker.

Thursday, November 6, 2014

Noah and the ark


 
Well-intentioned but foolishly misguided persons are building what they claim is a replica of Noah's Ark as part of a Christian theme park in Kentucky (this link is for their website).

This effort insults Christianity.

First, the biblical story of Noah and the ark is just that, a story. This story, whatever its origins, is not historical. Neither God, nor any other power, ever flooded the entire world. Life did not continue because two of every species lived amicably together aboard an ark. No archaeological evidence of such a flood exists. The idea of prey and predator peaceably co-existing on an ark is absurd. How would species unique to a limited geographic area (e.g., Australia) get to the ark? How would Noah collect and then co-exist with all viruses, bacteria, and other microscopic organisms unable to live in water and then extant? Why would a wise God establish principles/laws for the functioning of creation and then choose to abrogate them? Accepting the story of Noah and the ark as literal history requires a thinking person to set aside most of what is known about biology, physics, chemistry, etc.

Second, Christianity is not a religion exclusively for the ignorant, whether those ignorant from choice or from a regrettable lack of education. God's creation led to the emergence of thinking persons. We insult God when we refuse to utilize our minds (which are an integral element of who we are) to learn about creation and to advance human understanding.

Third, theology and spirituality are dynamic not static. We can regress. Centuries after Christians stopped reading the Bible literally, we can pretend to do the same. We are pretending and not emulating their example, because Christians in prior centuries read and interpreted the Bible using the best scientific information and theories they had available. Alternatively, we can progress. We can read the Bible in light of the new information and latest theories that the sciences and social sciences have developed. Future generations will inevitably think our views limited and incorrect. But they need not think us foolish or needlessly ignorant. To postulate that people in the twenty-first century can know no more about God or life than did the people of the tenth century BC, or the first century AD, is to reject the insights and wisdom accumulated by intervening generations, often at considerable effort and cost.

The story of Noah and the ark is a great story. Sadly, it is rapidly becoming a bad joke eroding Christianity's diminishing credibility.

Monday, November 3, 2014

VOTE!


Nov. 4 is Election Day in the United States. Voting is projected to be light, as is typical for non-Presidential elections.

I recently read an economic analysis of voting, in which the author suggested that the value of any individual voting in any election was very close to nil. One vote will almost never decide an election, so why bother voting if one's vote will not make a critical difference?

In part, that question points to a flaw in utilitarian ethics and traditional economic analysis that presumes a person always acts out of self-interest. If everybody acted entirely out of self-interest and no one person's vote is likely to be decisive, nobody would vote.

Rule utilitarianism is an alternative to traditional utilitarianism. In rule utilitarianism an individual should follow rules that when applied universally maximize benefits to individuals. Rule utilitarianism would, for example, require everyone to vote because democracy is a superior form of government compared to anarchy and to tyranny, the most probable outcome if nobody voted in any election.

Rule utilitarianism aligns perfectly with deontological ethics with respect to the importance of individuals voting. For people with a theological perspective, voting is an individual's opportunity to exert divine influence on an election's outcome. That is, voting is a religious duty. If a religious voter is upset with the identity of winning candidates or decisions made on referendum questions, then one of three things happened. Perhaps the person misunderstood God's will. Perhaps the person failed to engage the political process with sufficient commitment and ardor to allow God's voice to be heard. Alternatively, perhaps evil triumphed (an outcome that I personally deem unlikely—God depends upon God's people to help move the world in a positive direction.)

For people without a theological perspective, the most common deontological ethic is Kant's categorical perspective, i.e., that one should do that which every person should do in a similar situation. In other words, every citizen should vote.

The cost of voting is VERY low. Voting wisely takes a few moments to review the ballot, to learn something about the candidates and any referendum issues, and then to go to one's local polling place and vote. Incidentally, if I have failed to persuade you to vote, in an election in which few people vote, each vote is proportionately more significant.

VOTE!

Thursday, October 30, 2014

Hope, the power of positive thinking, science, and All Saints Day


Two conflicting – almost diametrically opposed – news reports recently caught my attention. The first, published in The Atlantic (Maggie Puniewska, "Optimism is the Enemy of Action," October 17, 2014) reviewed scientific research that supposedly demonstrates that positive thinking impedes achievement. The second, published in the New York Times (Bruce Grierson, "What if Age Is Nothing but a Mind-Set?" October 22, 2014) argues the opposite, citing research that suggests a person can retard, perhaps even prevent aging, by thinking her or himself young. Both studies are worth a read.

Then I came across an article in Science (Tom Siegfried, "In science, popularity breeds unreliability," October 17, 2014). Siegfried cites research to show that the popular news media tends to feature reports of controversial studies and studies with practical implications, regardless of the quality of the research undergirding the study. That conclusion made sense to me, especially in view of the two news items I had read in the previous hour.

Let me advocate two theses.

First, one cannot use good science to prove anything (unlike the Bible, in which one can find a justification for almost anything!). Unlike biblical interpretation, quality science functions by using standardized principles: articulate a thesis; develop testable predictions based upon that thesis; then test the accuracy of those predictions adhering to recognized scientific methods and protocols.

Incidentally, a scientific approach to biblical study can occasionally be helpful. For example, predictions of the end of the world, based on whatever biblical texts one wishes to consult, represent a thesis (one can predict the end of the world) that is testable (i.e., a prediction of when the world will end). To date, the dozens if not hundreds of specific dates proposed have all proven false. Biblical prophets described God at work in their world; they did not predict the future.

Good science reports that Ebola is transmitted only through body fluids (spit, blood, urine, etc.). Ebola is not transmitted through the air. This is not a matter of opinion or choosing one study over another. There is simply no evidence of airborne transmission of the virus that causes Ebola. Religious leaders of all traditions support people in living abundantly by fighting unfounded fears and promoting courageous living.

Second, positive thinking can enhance one's quality of life but is no substitute for hard work, perseverance, skill, or knowledge. Hope is one expression of positive thinking. If a person has no hope of a better future (or better performance, or positive change – depending upon the specific hope), then the person is unlikely to change, improve, grow, etc. Hope is essential. I have repeatedly witnessed the power of hope to transform life. Among the transformations I have observed are a sick person who believed that they were dying recover hope for healing and return to health, persons in relationships they thought were dead revitalize self and the relationship, and persons who had given up on self experience renewal.

The Bible is an anthology of stories about the power of hope – positive thinking – transforming life, an anthology of windows through which the light of God shines and illuminates our lives. This is not a matter of science, but like science, I have seen the evidence of my thesis (positive thoughts as one walks in God's light) in the lives of changed people.

All Saints Day, celebrated annually on November 1 (many churches may celebrate this year on Sunday, November 2), is set aside, in part, to recall the lives of the countless people in whose lives we can observe God's transformative love and power at work. Who is your hero in the faith? In whom do you see, or have you seen, the light of God shining?