Monday, August 31, 2009

Accountability

Four decades after My Lai, Lt. Calley has apologized for his responsibility in the wanton murder of My Lai residents, including women and children:
“There is not a day that goes by that I do not feel remorse for what happened that day in My Lai,” William Calley told members of the Kiwanis Club of Greater Columbus [GA] today. His voice started to break when he added, “I feel remorse for the Vietnamese who were killed, for their families, for the American soldiers involved and their families. I am very sorry.” (Robert Mackey, “An Apology for My Lai, Four Decades Later,” New York Times, August 24, 2009)

Lt. Calley explicitly acknowledged that orders from a senior do not excuse or justify immoral behavior:
I asked him for his reaction to the notion that a soldier does not have to obey an unlawful order. In fact, to obey an unlawful order is to be unlawful yourself. He said, “I believe that is true. If you are asking why I did not stand up to them when I was given the orders, I will have to say that I was a 2nd Lieutenant getting orders from my commander and I followed them — foolishly, I guess.” He said that was no excuse, just what happened. (Robert Mackey, “An Apology for My Lai, Four Decades Later,” New York Times, August 24, 2009)
Evidence presented at Lt. Calley’s trial, however, supported the claim by Calley’s commanding officer, Capt. Medina, that he never issued an order to massacre everyone in My Lai. In either case, massacring noncombatants constitutes unacceptable criminal behavior according to international and national law. Such behavior similarly violates moral norms established by Just War Theory.

U.S. citizens can justifiably be proud of a government and armed forces that hold military personnel accountable for their actions.

Similarly, holding intelligence personnel for their actions should make Americans proud, confident that their democratic system can withstand the challenges posed by radical Islamiscists and other adversaries. Without the rule of law – prohibiting private individuals and public officials alike from acting as the person deems best without a responsibility to uphold an established legal standard – civilization and freedom will not long endure.

The minor tempest that former Vice President Cheney has ignited with his unsupported allegations that the Justice Department’s investigation of CIA agents’ possible use of illegal interrogation techniques has made United States less safe ignores the essential importance that the rule of law plays in protecting both freedom and democracy.

Moral accountability, in contrast to legal accountability, is what Christianity has sought to establish through its understanding of divine justice. Not all behavior is acceptable to God. Behavior that diminishes or destroys life demands being set right. The goal of divine justice, so often misunderstood, is not punishing the wrongdoer. Instead, divine justice entails identifying unacceptable thoughts, words and deeds, then restoring creation to wholeness by setting wrongs right in a way that heals the damage inflicted as well as the culpable parties.

Saturday, August 29, 2009

Some thoughts on prayer

Psalm 20 is one of the psalms for the daily office today, a prayer that God will aid one in the hour of trouble and prosper one’s plans. Of course, the psalm was originally a prayer for the king. Generations of people, however, have understood this psalm as a personal prayer for God's help in difficulty and assistance in good times. Are they wrong?

Historically, answering the question of relevance is easy. The psalm clearly pertains to Israel’s king.

Theologically, determining the psalm’s relevance requires a far more nuanced answer. Scripture is scripture precisely because generations have heard the words as vehicles – metaphors – that help people to experience God's presence. Therefore, we, like our spiritual forebears, should pray the psalm believing that words speak to and about us.

Accepting the psalm as a metaphor requires not only recognizing its relevance to people who are not Israel’s king but also recognizing that this psalm expresses heartfelt hope and not a statement of fact. The person praying the psalm hopes for God's assistance in bad and good times but knows that our hopes do not always determine the future. Equating hope with control over the future, even when we articulate those hopes as prayer, reduces God to a servant at our beck and call, like a genie in a bottle from whom we receive not three but an infinite number of wishes.

We pray not because we believe we can manipulate or placate God into complying with our desires because when we express our hopes, dreams, fears, and hurts to God we open ourselves to the moving of the Spirit within us. That moving helps to shape the future by giving clarity to our aspirations, guiding us in more Godly directions, calming our anxiety, and easing our pain. This deeper, profounder understanding of prayer results in a very different type of religion than the one Marx parodied and that today’s prosperity gospel preachers promote.

Friday, August 28, 2009

Protecting Americans

The Justice Department has named a Special Prosecutor, John Durham, to investigate possible lawbreaking by CIA personnel and contractors during their interrogation of terrorist suspects. The CIA’s Inspector General referred the cases under investigation to the Justice Department for possible prosecution during the George W. Bush administration, but Justice declined to become involved at that time. This action follows what I previously recommended as an appropriate way to move forward with respect to holding people accountable for criminal behavior without prosecuting those who acted in good faith that their conduct did not violate the law.

Former Vice President Dick Cheney castigated the government for appointment the prosecutor, contending that the step would weaken protections for Americans.

Violating Constitutional safeguards of American freedoms to protect Americans from physical harms is a bad trade-off. I prefer to take my stand with Patrick Henry, who famously declared, “Give me liberty, or give me death,” rather than with Dick Cheney. I, for one, do not want to live a society that emulates Orwell’s vision of “Big Brother” in his book, 1984. That people would compete with one another to be participants in reality TV shows that broadcast their lives 24/7 is incomprehensible to me. Freedom, not being a celebrity, is my cherished value and the reason that I proudly served in the U.S. armed forces.

Similarly, I am concerned that the Obama administration has continued a Bush administration policy of allowing Border Patrol and Immigration personnel to seize and to search, without probably cause, electronic media (cameras, ipods, computers, etc.) that travelers bring into the U.S. This appears a prima facie violation of the Constitutional safeguard against warrant-less searches. Safety without freedom is worth nothing.

Jesus also chose freedom above safety, refusing to comply with Roman mandates and Jewish conventions, insisting on fidelity to his own values.

U.S. military leaders now report to Obama administration officials that the U.S. has insufficient troops in Afghanistan to accomplish the mission. That public announcement is surprising only in its timing. The U.S. has never had enough troops in Afghanistan to end the Taliban troop. Afghanistan has approximately the same population as Iraq, is geographically larger, and poses greater physical challenges because of its topography. As is obvious from the current surge in violence in Iraq, the U.S. did not actually pacify that country nor secure its long-term security. The much-touted troop surge in Iraq simply “bought” the temporary cooperation of some factions, an arrangement that has generally fallen apart with the diminished U.S. role and funding. According to the Army’s new counterinsurgency manual, efficacious counterinsurgency operations in either Iraq or Afghanistan would require approximately one-half million U.S. military personnel, a level of involvement politically unpalatable in the U.S.

Wednesday, August 26, 2009

Kidney dialysis

Kidney dialysis affords a good example of many of the problems I’ve highlighted in this blog: the U.S. wasting money on less effective treatment (for more details consult Ethical Musings: Healthcare).

The cost of home dialysis is less than the cost of treatment in a dialysis center and produces better results, perhaps reducing the death rate from kidney failure by half. (For full details, cf. Rita Rubin, “Dialysis treatment in USA: High costs, high death rates,” USA Today, August 24, 2009.)

Most consumers rely on healthcare professionals to identify the best treatment modality. Healthcare professionals, often pushed for time, generally recommend what insurance or Medicare covers. Scientific data, in turn, rarely determines the scope of healthcare coverage.

Monday, August 24, 2009

Nationalized healthcare

People in the United Kingdom during my two years residency there spent much time complaining about their National Health System (NHS). However, if anyone else criticized the NHS, the Brits almost invariably rushed to defend NHS as superior to other systems. In particular, they pointed to several advantages of NHS over the U.S. approach: people can change jobs without worrying whether their healthcare coverage is portable; pre-existing conditions are no barrier to care; everybody has coverage; NHS costs less than U.S. healthcare and delivers better outcomes.

Incredibly, one third of Medicare spending goes to patients with less than two years to live. People desperate to live want to exhaust every possible cure or treatment options that, falling short of a cure, will at least extend life.

Too often, people in end of life situations receive the wrong care. First, hospice care is not uniformly available, allowing some people (sometimes aided, other times emotionally coerced by their family) to avoid facing the reality of death. Spiritually and emotionally, affording people time to make peace with self and others is a precious element of life that hospice often facilitates.

Second, modern medicine still cannot cure every disease nor can medicine alleviate every symptom. Patients frequently want to ignore those truths, relentlessly pursuing an imaginary “fountain of youth” that will restore them to health. Humans, like all life forms, exemplify planned obsolescence, i.e., birth necessarily and inevitably leads to death. People should not actively seek death but should also not believe that death is escapable. Similarly, healthcare providers should honestly and consistently inform patients when no treatment has proven beneficial rather than caving into patient expectations and the false notion that a patient’s death represents a healthcare system failure. That’s simply bad science and bad theology.

Morally, the single-minded pursuit of any possible treatment or cure diverts scarce resources from people who could greatly benefit from additional care. The U.S. wrongly rations healthcare based on a person’s ability to pay for the care. In the case of Medicare, reducing money wasted on ineffectual care expends funds that could provide healthcare for those without coverage.

Thus, patients and families have an ethical obligation to weigh the cost of healthcare against potential benefits (extending life, improving the quality of life). The U.S. approach to healthcare does not give medical providers or recipients a motive to address that question. Providers are paid on a fee per service basis, i.e., each service provided generates income. Few recipients pay for their own care and determining the cost of a procedure in advance is almost impossible, having attempted to do so on several occasions. (Tangentially, without full cost data no free market can function effectively or efficiently.)

Third, the practice of modern medicine should incorporate a more scientific, less anecdotal approach. That is, providers should determine the appropriate treatment by assessing the probability of success based on a national database of past usages. Given the pertinent factors A, B, and C for a person of N years and G gender (plus any other relevant information), has treatment option X or Y produced the best results? No such complete database now exists. Furthermore, providers often prescribe treatments according to personal preference, personal knowledge, or vendor provided information. Most expensive is not always best.

Fourth, fear of malpractice suits should not drive delivery of healthcare. Currently, U.S. healthcare providers generally practice defensive medicine, ordering tests and treatments to minimize the potential of malpractice suits. Tests both waste scarce resources and occasionally cause further complications. Why, for example, should a doctor order a test to learn more about a condition for which no known efficacious treatment exists? Why should a doctor order a test to learn more about a condition for which the patient does not intend to undergo treatment?

Friday, August 21, 2009

Central Asian instability

Warning signs are appearing that Islamicist radicals have moved north from Pakistan and Afghanistan into central Asian nations that have Muslim majorities and generally fragile governments. Those governments are responding by attempting to nip that problem in the bud. (Clifford J. Levy, “Central Asia Sounds Alarm on Islamic Radicalism,” New York Times, August 18, 2009)

The United States, however, should recognize the dynamics of that situation as a window of opportunity and concurrently more foreboding than simply an extension of the problems that Islamicist radicals pose in both Pakistan and Afghanistan.

Historically, oppressed Muslims have used Islam as their vehicle of choice for demanding change. As I have previously commented in this blog, that choice confronts the oppressor with a no-win dilemma. If the rulers retaliate against the protesters, this adds credibility to protestors’ painting their oppressive rulers as anti-Islamic or, even worse, as apostate Muslims. Alternatively, if the rulers fail to act against the protesters, the protesters gain strength and new recruits from the continuing injustices that originally birthed the protest movement.

Finally, the ruling elite can engage in self-reform. This diminishes their power, perhaps even ending their status as the ruling elite, significantly reducing the likelihood of the elite adopting this option. However, this is the only option that does not result in the protesters eventually coming to power. The United States should encourage the central Asian governments to adopt this option.

If unsuccessful in that effort, then the United States should support the reformers, preferably working quietly through indigenous organizations not identified with a radical version of Islam. Adopting this latterpolicy is consistent with the values that under girded and inspired the American Revolution and represents the only viable option for helping to create stable and healthy governments in those countries. In other words, the best way to stop terrorism is to prevent it from initially gaining traction among the disenfranchised and victims of injustice.

Wednesday, August 19, 2009

Legalizing gay marriage

A friend ensured that I had saw the New York Times story about Theodore Olson, a former U.S. Solicitor General, who is now one of the lawyers for a gay couple challenging California’s ban on gay marriages. Olson served in both the Reagan and George W. Bush. Olson is hardly a liberal. He is something of a libertarian, believing in small government and individual rights. Consequently, he believes that gay marriage bans stigmatize gays and treat them as second-class citizens, denying them their civil rights without any justification. Olson hopes that the case will eventually reach the United States Supreme Court and believes that the case will become as game changing as was Roe v. Wade. (Jo Becker, “Theodore Olson's Road to Championing Same-Sex Marriage,” New York Times, August 19, 2009)

I fully agree with Olson’s views on gay marriage. Nevertheless, I have mixed feelings about settling the issue of gay marriage through a series of court battles. I think if the abortion issue had been decided legislatively rather than judicially, we would have far less polarizing debate about abortion today. Speedy is not always optimal. The harder, multiple slogs to legalize abortion through votes in fifty state legislatures and Congress would certainly have taken longer than did the adjudication of Roe v. Wade. However, I think that we would have firmly established the legality of abortion and developed more of a consensus in support of that view. That has certainly proved to be true in European nations that legislatively legalized abortion.

Similarly, a Supreme Court decision about gay marriage might bypass the state and national legislatures, but could have the unintended consequence of prolonging debate over the issue and hardening opposition. I have seen huge strides towards full inclusion for GLBT people over the last two decades; another two decades, and I believe that sexual orientation will no longer be an issue for the vast majority of Americans and that gay marriage will be universally accepted across the United States. I am far less sanguine about that outlook if the Supreme Court pre-empts our messy, slow, and multiple political processes.

This is not to pin the price of progress on the backs of those currently treated as second-class citizens. Instead, advocates of gay marriage from all walks of life need to stand tall and be counted in supported of equal rights for all of God's children.

Monday, August 17, 2009

Thinking about chaplaincy

According to the Geneva Conventions, military chaplains are noncombatants. Chaplains may wear military uniforms, often share the hardships of the troops to whom they minister, and experience the danger of battle. But the chaplain’s role is clear: minister to spiritual needs.

In the United States, a secular democracy, the chaplain performs her or his duties by directly providing ministry to personnel of the chaplain’s faith group and as many other as possible, facilitate ministry for those to whom the chaplain cannot minister directly, and care for all. Similarly, in the United Kingdom’s Royal Navy, the chaplain’s role is that of “friend and advisor” to all.

Episcopal priests can minister to a wide variety of Christian groups, for example. But an Episcopal priest cannot say a Roman Catholic mass or circumcise a newborn Jewish male. In those instances, and others like them, the Episcopal chaplain will find a military chaplain or civilian clergyperson from the appropriate faith group to provide the requested ministry. Many times, the service member does not care about the chaplain’s faith group. Instead, the person simply wants somebody to listen, to care, to help as possible, e.g., in the case of a loved one’s death back home or when a marriage falls apart.

In my experience, a majority of U.S. military chaplains attempt to honor those three roles and fill each when appropriate. Regrettably, some chaplains clearly overstep boundaries. A high profile example of boundary transgression occurred several years ago at the Air Force Academy. Conservative Christian groups, apparently with chaplain support and assistance, pressured cadets to join.

Boundary transgression also happen senior chaplains explicitly or implicitly try to coerce chaplain subordinates to minister according to the practices of the senior chaplain’s faith group. In the early days of my Naval service, these transgressions typically involved a mainline Protestant chaplain wanting an evangelical chaplain to conform to mainline traditions, e.g., no altar call, offering wine in Holy Communion, using a common chalice instead of individual cups. More recently, the dramatic increase in the proportion of evangelical chaplains has reversed those roles with mainline chaplains feeling pressured by evangelical seniors to conform to evangelical practices rather than faithfully adhere to the practices of the chaplain’s own faith group.

Official ceremonies that include an invocation and/or benediction are another common setting for boundary transgressions. Recognizing the religious diversity represented among military personnel, chaplains historically offered prayers as part of official ceremonies couched in general rather than faith group specific language. In particular, Christian chaplains did not overtly pay in Jesus’ name or invited those present to pray in their own way as the chaplain prayed in her or his own tradition. Today, more chaplains pray in ways specific to the chaplain’s own tradition, especially evangelical Christian chaplains praying in Jesus’ name. This rightly offends non-Christians present and calls into question the propriety of including public prayers at official events that command personnel must attend. The failure to frame prayers at mandatory events in inclusive ways certainly adds fuel to the arguments of those who would abolish military chaplaincy.

Finally, some chaplains cross the boundary noted in the opening paragraph, the Geneva Convention requirement that military chaplains be noncombatants. A former Marine who underwent chaplain basic training at the same time as I did itched to again “kill commies for Christ,” praying fervently that the Soviet Union would invade Israel, an act he believed would be the catalyst for the battle of Armageddon that would lead to Christ's return to earth. His terrible theology, narrow mindedness, arrogant conviction of infallibility, or some combination of those three blinded him from seeing his sworn duty as a chaplain to serve as a noncombatant. Thankfully, he and I were never stationed together. More recently, I have had chaplains tell me about carrying weapons in Afghanistan and Iraq to protect those with them and themselves in case of attack. They too, out of concern for the safety of others or concern for their own well-being, violated their duty as a chaplain.

Serving as a noncombatant in the midst of a battle zone vividly reminds combatants of the fundamental humanity of all people, in and out of uniform. Warfighting is sometimes a tragic necessity, but is never a moral good. For Christian clergy, serving as a noncombatant in a war zone symbolically enacts the gospel message of God's love incarnated in Jesus, that love will eventually conquer violence and peace will eventually end war.

Against that backdrop, I read a report about the warlike attitudes exhibited by the Israeli Defense Forces’ (IDF) rabbinate during the recent conflict in Gaza. These rabbis, all IDF chaplains, were appropriately present on the battlefield. They also assertively encouraged IDF personnel to wage the Gaza campaign, distributing materials that characterized the operation in religious terms and morally defended IDF strategy and tactics. (Matt Friedman, “Too gung-ho? Israel military rabbis draw criticism,” Washington Post, August 16, 2009)

Sadly, the same type of thing happens in the U.S. Commanders sometimes refer to chaplains as force multipliers who improve combat effectiveness by boosting morale and implicitly, if not explicitly, demonstrating that God supports the U.S. Chaplains are not in the business of being force multipliers but are priests, ministers, rabbis, and imams who minister, facilitate ministry, and care for God's people in combat. The Geneva Convention recognizes that identity by noting that chaplains should minister to all people, whether friend, foe, or otherwise.

The chaplaincy, rightly understood, neither sanctions nor condemns particular military operations. That task belongs to the larger Church. The chaplain’s task is more narrowly defining: ministering to those entrusted to his or her care. Chaplains who allow the institution to seduce or manipulate them into becoming something else have compromised their calling.

Saturday, August 15, 2009

Healthcare reform - moving beyond narrowly conceived self-interest

Game theory predicts that most people consistently act out of self-interest. That prediction coheres with sociobiology’s theory that human behavior, like that of all living organism, results from the inherent tendency of genes to self-replicate.

Christianity promotes a different lifestyle, encouraging people to live equally for self and others. Historically, “others” connoted only humans; in the twenty-first century, “others” needs to connote the earth and all of the life forms that inhabit it because of our growing recognition of the interdependency of all life.

Indeed, geneticists, some sociobiologists, and other scientists now believe that narrow conceptions of human self-interest are wrong. Humans, they contend, have a genetic predisposition toward reciprocal altruism, i.e., doing good for others in the expectation that this will eventually benefit the one who has done the good.

Participants in the current U.S. healthcare reform debate should reflect on the implications of reciprocal altruism with respect to healthcare. In what ways might guaranteed, affordable healthcare for all benefit the larger society? Reasonably certain benefits might include less polarization between affluent “haves” and “have nots,” healthcare providers more focused on delivering quality care, and improved medical outcomes for a majority of the population.

Conversely, why are some participants in healthcare reform debates so adamantly opposed to reform? For example, opponents to change have floated the idea that reform will entail a government panel deciding who will live and who will die, an idea that has no basis in fact. Reform proposals do include suggestions to expand hospice care, physicians counseling patients about living wills, and end of life choices. Medicare already provides limited funding for some of those programs. Contrary to widespread public outcry, no reform proposal suggests funding suicide or assisted suicide; some of the proposals would actually prohibit funding for both. (Jim Rutenberg and Jackie Calmes, “False ‘Death Panel’ Rumor Has Some Familiar Roots,” New York Times, August 15, 2009)

I think that reciprocal altruism is something into which humans, individually and collectively, have to develop. Politicians, large healthcare and pharmaceutical companies, and other special interest groups pander to people’s self-interest in an effort to derail reform that may not work to the advantage of the politicians, corporations, and other groups. Such efforts represent a step backwards, not a step forward.

Healthcare reform has no easy answers. Like many complex problems, real solutions often require an iterative, trial and error approach. The current system is indisputably broken. Americans pay more for healthcare than anybody else on the planet pays and obtain worse results than do many developed nations.

A Roman Catholic priest working with the families of some of those killed when a small plane recently collided with a helicopter over New York City wrote in the Wall Street Journal that the families resiliency in coping with the tragedy greatly impressed him. He attributed that resiliency to the families not placing themselves at the center of the cosmos. Making room for something larger than self – God – helps people live more satisfying lives even in the midst of tragedy. (Jonathan Morris, “The Hudson Crash and a Different Kind of Miracle,” Wall Street Journal, August 15, 2009)

Good health is vital for life and the quality of life. However, the path to good health ironically does not lie in the unmitigated pursuit of self-interest. Rather, the path to good health takes one in the direction of loving others and loving God, a truth long ago recognized by all of the world’s major religions and a truth to which science is perhaps slowing beginning to recognize, albeit very belatedly.

Friday, August 14, 2009

Slowing life down

How can one slow down the pace of life?

That question presumes that a person finds life moving at too fast a pace, too many things to do in too little time. Obviously, people lack the practical knowledge needed to slow time itself or to travel through time. Therefore, the solution to slowing the pace of life necessarily entails reducing the number of things that one has to do.

One approach to this problem is good time management that prioritizes things you want to do, reducing the stress that comes from feeling overloaded. Begin by listing everything you want to do. Next, sort the list into categories:
Things that you absolutely must do (e.g., take care of a dependent or pay taxes – the alternative to not doing these tasks is going to jail). Put these things at the top of your revised list.
Things that you absolutely cannot do because you lack the ability or the resources required (e.g., take a trip to the moon, paint like Picasso, etc.). Cross all of these things off your list.
Things that you absolutely should not do because of the terrible adverse consequences that you will suffer (e.g., inflicting bodily harm on the person who daily infuriates you or taking a vacation you cannot afford). Cross all of these things off your list.
Prioritize the remaining items using criteria such as the potential positive benefits this goal will produce (joy, financial gain, psychic satisfaction, etc. – include short and long term benefits) for you or your loved ones, the urgency of each item (i.e., deadlines, not the magnitude of benefits), the costs entailed (time, financial, etc.), etc.

Decide how much you can achieve today and each day that remains in this week. Those items, and those items alone, are your goals. Repeat this process every Monday. Adjust your goals each morning to ensure that they remain realistic. Then utilize your time accordingly.

However, a strictly time management approach offers no assurance you will have adequate time for the truly important things in life. Have you included the following on your list:
Meditation or prayer
Spiritual or inspirational reading and reflection
Enjoyment of your loved ones
Enjoyment of nature
Worship
Pursuit of an activity that makes you feel most alive but that is not part of your job, such as painting, a martial art, dog walking
Regular exercise
Sufficient sleep
Good nutrition
Good conversation

Time management techniques can help to better utilize time. However, the technique is no better than the list with which one begins of things one wants to do. The problem with our lives is that we have often allowed the seemingly urgent to push the truly urgent out of sight.

God created us. God created days with twenty-four hours. Either God made a mistake or twenty-four hours per day provides sufficient time for the good life. To live the good life, decide on your vision of the good life and then prioritize accordingly. Set boundaries, excluding activities that do not fit your vision of the good life.

What if you hate your job? Life requires some financial resources. Employment – any employment – can be preferable to inadequate funds. Then the question becomes, how much money do you really need? What constitutes adequate food, shelter, clothing, and other essentials? Perhaps the major cause of people feeling so stressed today is that our culture promotes a consumer-based lifestyle, perpetuating the myth that more of everything is always better. Ironically, the economists who for years worried that Americans saved too little money now worry that Americans save too much, slowing recovery from the recession in our consumer driven economy.

Simplifying and reducing one’s standard of life has multiple benefits. Taking those steps requires less income to pay for one’s expenses, reduces one’s environmental footprint, and, most importantly, frees time for the truly important activities that too many of us regularly push aside.

These reflections are intentionally vague. The good life requires balancing competing concerns and activities. Each person must identify, usually through trial and error, the right balance for him or herself at a particular time. Periodic rebalancing incorporates the effect of the inevitable changes, whether in employment, age and number of dependents, personal health, optimal stress level, etc.

What pace of life allows you to get the most of each day?

Thursday, August 13, 2009

Free markets and healthcare

Some pundits now predict that the fate of healthcare reform hinges upon finding a way to pay for reform. (Cf., for example, Lori Montgomery, “Fate of Obama's Health-Care Effort May Boil Down to Cost,” Washington Post, August 13, 2009)

Contrary to popular opinion, the U.S. does not have a healthcare system based on free market principles. Two important free market principles are consumers having access to sufficient information to permit meaningful price comparisons and open competition between suppliers. Neither holds true of the healthcare market in the U.S.

In a medical emergency, consumers do not shop for healthcare by price but by timely availability of needed care. More broadly, obtaining price information prior to a medical procedure is almost impossible. Consequently, fees for medical services vary widely, according to a newly released report sponsored by America’s Health Plans. For example, an Illinois patient received a bill for $12,712 for cataract surgery, an operation for which Medicare pays $675; a California patient’s knee replacement resulted in a bill for $20,120, for which Medicare pays only $584. (Gina Kolata, “Insurers’ Survey Points to Big Bills as Health Care Problem,” New York Times, August 12, 2009)

Open competition does not exist between drug companies. The Federal Trade Commission estimates that drug patent holders paying generic drug makers not to sell generics costs American consumers $3.5 billion per year. (“Generic drugs and competition: Something rotten,” The Economist, August 6, 2009)

Numerous other examples of where the U.S. healthcare system does not conform to the basic principles required for efficient market functioning are easily identifiable. One significant advantage of managed healthcare plans, whether through the government or a private HOM, is that the plan can often force price competition in situations where multiple vendors exist. Yet even that process is fraught with difficulties.

Health is vital to living the good life – vital to living without respect to one’s quality of life, for that matter. An individual pressing for the best possible care is readily understandable. Loved ones reinforce that pressure. However, Americans do not receive the best available healthcare, simply the most expensive healthcare.

Love for others and love for self align in demanding change. Only greed and ignorance stand in the way, greed on the part of those who benefit financially from the current system and ignorance on the part of those who mistakenly believe that they in fact receive the world’s best healthcare. Healthcare reform may entail additional cost, preferably shared proportionately among all taxpayers based on ability to pay. Perhaps more possible, yet less likely because of the many entrenched interest groups, is healthcare reform that would make quality healthcare affordable for all Americans.

Wednesday, August 12, 2009

Synchronicity

During World War II, my father served in the Sino-American Cooperative Organization (SACO). SACO was a relatively small (about 2500 personnel) joint operation between the U.S. Navy and the Nationalist Chinese. Under command of a Chinese general, with a U.S. admiral as second in command, SACO worked behind Japanese lines fighting a guerilla war against the Japanese occupation of China. For years, SACO has remained largely invisible, even as it was officially secret during the war. U.S. Navy personnel, for example, wore civilian clothes instead of uniforms while attached to SACO.

Three times my life has intersected with SACO veterans or their family. Once, a Marine Colonel with whom I served asked if my father had been part of his SACO; my father’s name appeared in some correspondence that Marine’s recently deceased father, who had been part of SACO, had received. To both the Marine and me, the correspondence from a man who purported to be a four-star admiral and covert CIA operative seemed written by a person suffering from mental health problems. Then I happened to meet a veteran who in passant mentioned that he had served in SACO. Most recently, I had lunch with a man who was both a SACO veteran and instrumental in founding the parish I serve.

None of my four brothers has knowingly met a SACO veteran or descendant. Although none of my brothers served in the Navy, my contacts with two SACO veterans and the son of a third seems more than mere happenstance. Without attempting to calculate the mathematical odds, the probability of the three encounters seems to exceed that of pure randomness. Of course, the odds may simply point to the fact that I represent one of the outliers on a bell shaped normal distribution curve.

Alternatively, the encounters may represent synchronicity rather than serendipity. Jung coined the phrase synchronicity to describe events that convey a meaning or connection consciously unintended by the participants. For example, my links to SACO veterans may point to a subconscious effort on my part to connect with a previously closed-off chapter in my father’s life. Or, the encounters may have a meaning which I have yet to discern.

Theologically, synchronicity may point to God at work in a person’s life, drawing connections and suggesting meanings not otherwise visible. Modern physics reinforces this possibility, theorizing that once a sub-atomic particle has bonded with another sub-atomic particle, the two particles maintain a permanent bond that transcends any distance instantaneously. If that theory is correct, then the creator has hard-wired some form of synchronicity into the cosmos. Synchronicity thus points to God’s presence in life.

The existence of synchronicity suggests that people should take time to reflect on events and relationships, consciously seeking to be aware of any synchronicities, a way to cultivate one’s spirituality.

Saturday, August 8, 2009

Afghan elections

Afghan President Hamid Karzai is reportedly forming alliances with various warlords in order to prevail in the upcoming election. Supporters contend that the alliances should insure continuity of governance. Opponents believe that the alliances will compromise the central government’s ability to govern the nation. (Richard A. Oppel, Jr., “Karzai Wins Afghan Warlords’ Support as Others Fear the Cost,” New York Times, August 8, 2009)

The problem with both arguments is that they ignore the reality of life in Afghanistan today. The central government effectually governs little of the country’s population and area. Large part of the population lives in areas that the warlords or Taliban now govern. If the central government really ruled Afghanistan, then the U.S. and NATO would not be sending in more troops in an attempt to retake substantial portions of the country.

Historically, Afghanistan has never had an efficacious central government. Instead, Afghans find common cause only in opposing foreign occupiers, like the U.S. and NATO. Otherwise, Afghans have consistently had a decentralized nation, with the central government exercising only nominal authority and real authority residing with tribal, ethnic, religious, and local military leaders. That pattern has not changed in over eight years of U.S. occupation. Whether or not Karzai forms alliances with warlords, whether or not Karzai wins the upcoming election, for that matter, will not change the refusal of Afghanis to submit to centralized authority, especially a centralized authority propped up by foreign powers.

July’s substantially increased death toll of U.S. military personnel and Afghan civilians and military personnel adds to the cost of an occupation that, sooner or lately, will end badly with Afghanistan, at best, returning to a loose confederation of tribal and ethnic areas ruled by traditional leaders or military strongmen. At worst, the U.S. and NATO will continue in their futile effort to create a Western style democracy in a nation in which people are both unprepared for and do not want.

Friday, August 7, 2009

Watching TV and interior experience

A friend of mine, who lives alone, does not own a TV set. He finds TV too distracting, almost addictive. I wish that I could choose which channels to receive, excluding those channels on which I find little or nothing of interest and keeping only channels on which I find informative or truly entertaining programming.

My friend does own a computer with Internet access. I did not have the heart to tell him that he could now access most of what was on commercial TV through the Internet. In part, I think he experiences a small measure of self-righteousness in his symbolically iconoclastic (or perhaps eccentric) stance against TV. In part, I envy the simplicity and clarity with which he approaches the issue.

Most commercial TV programming has little redeeming value. The programs are only rarely informative, entertaining, or even a little inspiring. Europeans with whom I chat and who have not traveled extensively in the U.S. consistently have the warped images of life in the U.S., images primarily shaped by the TV programming they have watches. One woman actually believed that traveling to Disney World would expose her to the twenty-first century equivalents of the hazards depicted in TV westerns and gangster movies. No amount of conversation on my part could convince her that she was more likely to see elderly matrons than terrorists in Florida.

Twenty-first century modern conveniences free most first-world people from much once essential, time-consuming drudgery. Yet the tendency is to fill our days with new drudgery, tasks that in truth do little to improve the quality of our life or that of others. Even when we do have leisure time, we engage in frantic activity or feed our mind-numbing addiction to TV.

An observer spent an afternoon watching visitors to the Louvre. Almost everybody scurried through, hurriedly glancing at guidebooks or the labels, pausing occasionally to snap a photo. (Michael Kimmelman, “Abroad - At the Louvre, Many Snap but Few Focus, and Mona Lisa Smiles On,” New York Times, August 4, 2009) Art has become something to do, no longer something to experience.

The spiritual life demands experience. A person must regularly slow down, even stop, to focus on her or his interiority. Worship, individually and corporately, should provide such pauses. Similarly, relationships with other people, an important element of healthy spirituality, require those slow, inactive moments to enable communication and build strong, interactive bonds. A married couple who routinely spends their weekly date night at the movies has substituted entertainment for interaction. If getting rid of TV helps a person to develop spiritually, that seems like a very small price to pay with a potentially huge payoff.

Tuesday, August 4, 2009

The price military families pay for war

The wife of the U.S. Army’s senior officer told Congress in June that Army families are “coming apart at the seams” because long and frequent deployments. (Greg Zoroya, “Troops' families feel weight of war,” USA Today, August 4, 2009)

In a separation of six months, like most Navy deployments, people change. Phone calls, email, and the postal system all help. But they collectively cannot substitute for couples being physically co-located, sharing life with one another. Children further complicate the situation. A parent who “disappears” for six months, especially in the life of a young child, misses important moments and becomes emotionally remote, even inaccessible to the child. Experienced military families recognize that when the service member returns home, he or she needs to gradually ease back into the family’s routines, structure, discipline, and decision-making.

Like all military chaplains, I spent a considerable portion of my ministry as a chaplain directly working with families trying to cope with deployment related stress and problems. Most Iraq and Afghanistan deployments are for twelve months, thirteen months if the service member returns home a month of leave part way through the deployment. Doubling the length of a deployment more than doubles the toll on a family. Similarly, frequent deployments that happen every other year also disproportionately increases the toll of families.

The substantially higher divorce rates for military personnel represent a heretofore unidentified health risk for military personnel and cost to the nation. As I discuss in my blog entry, Marriage promotes health, divorce permanently diminishes one’s health. A majority of military marriages would not fail under normal conditions. Repeated, long, and frequent, deployments to Iraq and Afghanistan are not normal conditions. Military personnel return with a high rate of visible and invisible wounds, such as Post-Traumatic Stress Disorder. Family breakdown exacerbates those problems in the short-run while diminishing the person’s long-term outlook for good health.

Furthermore, health issues related to family problems and failed marriages entail a hidden cost for the nation, part of the true cost of fighting in Iraq and Afghanistan, that, like much of the cost of both campaigns, has remained “off budget,” out of sight of the American public.

Marriage promotes health

Marriage promotes health, as documented by numerous studies: “Married people tend to be better off financially and can share in a spouse’s employer health benefits. And wives, in particular, act as gatekeepers for a husband’s health, scheduling appointments and noticing changes that may signal a health problem. Spouses can offer logistical support, like taking care of children while a partner exercises or shuttling a partner to and from the doctor’s office.”

A national study of over 8600 people age 50-70 has concluded that divorce is not good for one’s health. Health problems in divorced and widowed men were 20% greater than in married men who had never divorced. Remarriage diminishes the increase in health problems but does not level the playing field. In fact, men aged 50-70 who have never married are healthier than the divorced or widowed. The same is true for women, but with less dramatic differences between the married and the divorced/widowed.

Why? Researchers believe that the explanation may be that the stress of losing a partner alters basic cellular structures, causing diminished health to persist even when the stress of loss has ended. (Tara Parker-Pope, ”Well - Divorce, It Seems, Can Make You Ill,” New York Times, August 4, 2009)

Obviously, some marriages need to end in divorce, e.g., in the case of an abusive spouse. Other marriages end with the premature death of a spouse.

Nonetheless, too many marriages end in avoidable divorces. Sometimes the problem is that the couple rushed into marriage, not taking time to get to know one another, not allowing the infatuation time to dissipate or grow into a more mature love.

Other times, the problem is that the couple stopped working on their relationship. Good marriages require frequent, regular investment of time and energy in real communication, shared activities, and goal setting. Couples do not just happen to grow apart. Instead, they fail to grow together. Entropy not organization is the more basic condition. What the evidence on marriage and personal health suggests is that working on one’s existing marriage is generally preferable to looking for a new partner, simply from a selfish point of view, without considering the well-being of one’s spouse or any children involved.

Monday, August 3, 2009

Military healthcare

About 16% of Army personnel and their families cannot receive medical care at Army facilities but must seek treatment from civilian sources at government expense. The problem seems to stem from the Army having sufficient medical personnel to care for its people and their families. This shortage often affects personnel assigned to units that have been most heavily committed to operations in Iraq and Afghanistan. (Gregg Zoroya, “Routine GI health needs not met,” USA Today, July 31, 2009)

That headline misses an important point: Army personnel and their families still receive at government expense the care they need and deserve. Obtaining the care from civilian sources parallels a single-payer healthcare system in which patients have latitude in selecting their healthcare providers. Obtaining the care from military treatment facilities is socialized medicine. In other words, the article, probably unwittingly, endorses socialized medicine as preferable to a single-payer system.

Furthermore, the ready access to healthcare that military personnel and their families enjoy has no civilian equivalent. The United States rations healthcare to the unemployed, the uninsured, and the under-insured based on ability to pay. Tens of millions of U.S. citizens must choose whether to pay the rent, buy food, heat/cool their dwelling, or purchase prescribed medications. Other Americans must choose whether to pay the rent, buy food, heat/cool their dwelling, or get treatment for an injury or disease. No person should have to make such choices.

Saturday, August 1, 2009

As the Episcopal Church goes ...

Marion Hatchett, a professor of liturgics at Sewanee and a leader in developing the 1979 Book of Common Prayer and the 1982 Hymnal recently exhorted the Episcopal Church:

“The American Church jumped way out ahead of the Church of England and other sister churches in a number of respects. One was in giving voice to priests and deacons and to laity (as well as bishops and secular government officials) in the governance of the national church and of dioceses and of parishes. The early American Church revised the Prayer Book in a way that went far beyond revisions necessitated by the new independence of the states.

“At its beginning the American Church legalized the use of hymnody along with metrical psalmody more than a generation before use of 'hymns of human composure' became legal in the Church of England. At an early stage the American Church gave recognition to critical biblical scholarship.

“The American Church eventually gave a place to women in various aspects of the life of the church including its ordained ministry. The American Church began to speak out against discrimination against those of same-sex orientation, and the American Church began to make moves in establishing full communion with other branches of Christendom.

“Historically the American Church has been the flag-ship in the Anglican armada. It has been first among the provinces of the Anglican Communion to take forward steps on issue after issue, and on some of those issues other provinces of Anglicanism have eventually fallen in line behind the American Church. My prayer is that the American Church will be able to retain its self-esteem and to stand firm and resist some current movements which seem to me to be contrary to the principles of historic Anglicanism and to the teachings of the Holy Scriptures.” (Quotation from Susan Russell’s blog, excerpted by the Episcopal Café on July 31, 2009)

In particular, the Episcopal Church should with stand pressures for the Anglican Communion to become a hierarchical, creedal form of Christendom and pressures to compromise its integrity by not fully welcoming and including all of God's people.