The Hearse Horse Snickers Now for Doctors Too

Carl Sandburg wrote a poem expressing the public’s negative attitude towards lawyers that has the arresting line, “Why does the hearse horse snicker hauling a lawyer away?”  The poem was presented to us as first-year law school students at the University of Chicago to encourage us to be compassionate in our law practice, to help those who cannot afford to pay, to deal with our clients as people rather than just a source of billing hours, and to contribute our talents for the wellbeing of our community.  Back in 1965, we were in an indirect way told that lawyers should be more like doctors.

How times have changed.  While of course there continue to be compassionate doctors of the old school, the average contemporary doctor is a very different animal.  Doctor groups today (the sole practitioner of yore is almost extinct) seem concerned mostly with how much money they make, which translates into seeing as many patients as possible in a given amount of time and finding ways to bill patients (and their insurance companies) for as many procedures, tests, and consultations as possible.  They don't know their patients anymore.

Doctors like to blame the federal government and insurance companies for this transformation.  They say they have so much paper work to do that they have little time left for doctoring, and that the fees they are paid are so inadequate that they have to charge as many billing items as possible just to get a decent financial return.

Nonsense.  While there is no question that there is lots of paper work today, the main culprit is that doctors have become capitalists.  Both in their practice groups and in most hospitals, the healing profession has become a for-profit corporate entity whose main concern is the bottom line.  As such, they find every conceivable way to milk money from their patients, just like one would expect from a corporation.  And the relationship between doctor and patient has been transformed accordingly.  Small wonder that some now refer to the Hippocratic Oath that all doctors take as the “hypocritic” oath.

Many doctors don't seem to think anymore, to think about what their patient is experiencing - given their knowledge of the patient - and decide how best to address the problem presented.  Instead, if you're lucky, the doctor will apply "best practices" by rote.  I say "if you're lucky," because best practices are not the norm but the aspiration in the profession today.  As for an holistic approach, the doctor who takes such an approach today, because it requires both a philosophy and knowing his or her patient, is the exception.  It did not use to be so.  But today it's all just about science.

Bottom line ... doctors and hospitals should not be profit centers.  That orientation is inimical to the ideals of medical practice and caring for patients.  By all means, doctors and others involved in the profession should make good livings because they provide a valuable service to people and society. But beyond that, to profit from ones patients should raise ethical questions.

Why does the hearse horse snicker when hauling a doctor away? Isn’t it obvious!

What the Catholic bishops seek is religious tyranny, not religious liberty

In perhaps one of their most deceitful efforts, the Conference of Roman Catholic Bishops yesterday sought to recast their opposition to abortion and same-sex marriage as a struggle for “religious liberty” against a government that is impinging on the church’s rights.  As reported in The New York Times today, they cited that Catholic agencies that receive state funding in Illinois and a few other states had been “forced” to stop providing adoption and foster care services because the state required them to provide the same services to same-sex couples as heterosexual couples.

Let’s talk about religious liberty.  The right protected by the Constitution is that the government can make no law prohibiting the free exercise ones religion or “respecting an establishment of religion.”

In their vocal opposition to abortion rights and same-sex marriage, not just as a moral issue but to get the government to prohibit women from getting abortions and prohibit same-sex civil marriage, the bishops are in fact seeking to impose their religious views on the rest of the nation through government action. That would violate both the rights of the members of other religions who do not believe that abortions should be prohibited to practice their religion, and it would thus in fact if not in language be a law respecting the establishment of religion by preferring one religious viewpoint over others. 

This is an example of religious tyranny, not religious liberty.  If Catholics were forced to have abortions or if the Catholic church were forced to perform same-sex marriages, that would be a violation of religious liberty.  But that is not what is involved here.  Even on the same-sex marriage issue, no one is suggesting that churches be forced to perform or recognize such marriages.  It is solely a civil government matter.

What about their argument that they are being “forced” to abandon adoption and foster care services? Again, this is simply not the case.  The church’s agencies are perfectly free to provide such services solely to heterosexuals and discriminate against same-sex couples. All laws regarding sexual orientation rights provide for exempting religious institutions who oppose homosexuality.

However, if they choose to apply for state aid for these services, then they must comply with state rules, both legislated and constitutional, regarding the use of state funds.  That in no way prohibits their religious liberty.  If they want to continue discriminating, they are free to do so … just without state aid.

It is shameful that the bishops have cloaked their attempt at religious tyranny and their desire to use state funds to discriminate under the banner of religious liberty.

Democrats Better Pay Attention To The Needs of The Middle Class

Why are Tea Party people so angry and fearful? Yes, right-wing demagogues aided by right-wing funders like the Koch brothers have stoked their fears and anger to a fever pitch, but why were they angry to begin with?  Why are they and many in the broader population so receptive to the lies and fear-mongering?

President Jimmy Carter posited that their fear is of a changed social order evidenced by the election of a black president. While I’m sure that is part of the answer, is it really so simple as the color of Obama’s skin and his progressive policies? No, the answer lies elsewhere.

Feeding this fear of a changed social order, racism, and the Tea Party’s resonance has been a sea change in the wellbeing of America’s middle class. The middle class is made up mostly of nonprofessionals … people with only a high school degree. As manufacturing and other middle class jobs have disappeared over the past 30 years, their standard of living and the quality of their lives has been drifting downward.

The recent recession only exacerbated the trend. In March 2011, 12 percent of those with only a high-school diploma were unemployed compared to 4.5 percept of those with college degrees and 2 percent for those with professional degrees. The greatest impact has been on men … in 1967, 97 percent of men 30-50 years old in this cohort were employed; in 2010, just 76 percent were.

The issue is not just unemployment.  For those employed, their wages have stagnated since the 1970s as a result of numerous factors but primarily the impact of globalization, having to compete with low-cost overseas workers - corporations will shift production overseas without much concern if it increases their profit by saving costs of production.

Not only has the combination of unemployment and stagnating wages resulted in economic problems for these men and their families, these pressures have brought about greater interpersonal stress, with a resulting increase in divorce rates and other examples of social dysfunction. The greater income inequality that developed during this period has also resulted in heightened actual and felt lifestyle differences between the middle class and those with more income and education.  (All data from, Don Peck, “Can the Middle Class Be Saved,” The Atlantic, September 2011)

The world as the middle class knew it since WWII has been turned upside down.  Small wonder they are scared, angry, and alienated. Yet this important shift in the American social fabric is never discussed, even by Democrats. Politicians talk vaguely about the need to protect the middle class, but the evisceration that has already occurred is not mentioned.

If the Democratic Party wants to win in 2012, it must clearly let the middle class know that it is aware of their pain, that it feels their pain, and that it proposes a series of interrelated policies to restore the lot of the middle class. It's a complex economic and social engineering question that will require the attention of our best and brightest. Obama and the other candidates must share their vision for where they want the country to go and how they propose getting there.

Strengthening America by Changing from a Consumer Economy to a Nation-Building Economy

While our culture of consumerism has been a boon to corporate America, it has been bad for our citizens, bad for our economy and bad for our nation. 

Psychologically, mass marketing images have led to a nation of individuals who are constantly dissatisfied with their lives ... whether it’s how they look, the job they have, the amount of money they make, the home they live in, etc.  There is not a single aspect of our lives that escapes this need of ours … not to be better individuals in some meaningful way but to project success or power/popularity, mostly through the acquisition of material things.  And we always want more; it’s never enough.

You won’t find evidence of this in polls because our culture places a premium on having fun, being happy.  Since people feel that they’re supposed to be having fun and be happy, that that state is valued by our culture, people put on that façade … not knowingly but in an act of self-deception. 

While I know of no studies that document what I am about to posit, I believe that the huge increase in the extent of depression in this country stems not from more awareness of the problem as has often been stated but results from this constant dissatisfaction that people feel about themselves.  Indeed, it is not uncommon when people are feeling down to get a “fix” by going out and buying something.

Our economy has also become addicted to consumerism.  70% of our GDP is derived from consumer spending. But consumerism is a very unproductive use of the nation’s wealth.   It does not move our country forward.   And since much of what we consume is no longer produced here but overseas, it doesn’t even help employment like it used to, just the revenues of American global corporations.

Meanwhile, the United States is falling behind other countries and entering a dangerous period because we cannot afford to do what needs to be done to keep this country strong … and I don’t mean military spending.   I mean spending on infrastructure … both maintenance and new.  I mean spending on education.  I mean spending on cutting edge research and development, investment in new industries that will drive our economy in the future. When measurement is taken of national and individual wellbeing, the United States typically finds itself towards the back of the pack of developed countries.  Not in front as we like to believe.

In order to find the money to invest in our country’s wellbeing, we must switch our economy from one that is primarily based on consumerism, to one that is based primarily on building our country.  This involves changing the components of our GDP but not lessening it or our growth.  Actually, because it mostly would involve projects that must by their very nature be accomplished in the geographic United States, it means a greater bang for the buck when it comes to job creation.

To get from the consumer economy to the nation-building economy, we will need to wean ourselves from the need to constantly buy things to be happy.  And instead of using discretionary income for self-gratification, we will need to learn to be comfortable with that money going to the government in the form of taxes to be used for projects that will benefit the nation, and thus ultimately ourselves.

Many will howl at this suggestion, but we must remember that the United States has by far the lowest tax rate of any developed country.  Yet, and this bears repeating, the people of these other countries nevertheless prosper and have a higher level of wellbeing … whether it’s their health, education, or other measures … than we do.

Making such a change in our culture will take principled leadership and preferably a united political front.  This must be approached like a war used to be … all hands on deck and united.  And everyone must be prepared to sacrifice. At this point in our history, that concept … a united political front … seems impossible to imagine.  And yet we must strive toward that end if America is once again to regain its global strength and provide its citizens with a secure and high standard of living.

The Rights and Responsibilities of a Citizen

Man is by nature concerned solely with his and his family's wellbeing. That is his biological imperative.  Socially, however, man has evolved into being a member, a citizen, of a larger society. And so, from the most primitive communities to contemporary societies, that driving instinct has had to be reigned in for the greater good of the community. 

In primitive societies and in many Asian societies, a collective culture developed that enforced working for the good of the group largely through strong social pressure; the individual was of lesser importance. In the West, where the concept of individualism took root, societies have instead depended upon laws to control the relationship between man's individual liberties and rights and his part in the larger society.

There are thousands of laws that control the right of an individual to do what he might want to do.  Whether it's the criminal law, traffic laws, building codes and zoning laws, or product liability law, laws have been developed that balance the individual’s rights against the greater public good; they tell the individual what the limits are of his freedom to act.  Without such laws we would have anarchy.

As our society became more civilized and enlightened, the concept of man's pro-active responsibilities to the larger society developed.  Man not only has rights that are given by the laws of the community, he has concomitant shared responsibilities for the community that go beyond the responsibility not to harm others. This is the basis for the American social contract.

In the current political context, there is a huge uproar on the Right regarding three fundamental aspects of the relationship between government, individual rights, and the greater public good that came to define the American social contract in the 20th century.  The first is the regulation of business.  The second is progressive taxation.  The third is the government's responsibilities towards those less fortunate.

The primary interest of any business is self-interest ... that is its nature as much as it's man's nature.  As we saw during the industrial revolution and the early decades of the 20th century, if business is not regulated, it will show no concern for either its workers or the greater public good.  Indeed, it is because of man's unbridled greed that most of the laws and regulations we have on the books today exist.

It goes without saying that no man or business likes being regulated.  It hampers his freedom to do as he thinks is best and it often costs him money.   This is no different in concept from his desire to drive faster than the speed limit allows.  And so business tries to find a way around regulation, often with the collaboration of the very people hired to enforce regulations.

That is what happened with oil drilling in the Gulf, which resulted in the BP disaster.  That is what happened with the financial industry, which resulted in the 2008 recession and the current economic malaise of a large proportion of our citizens.

Most taxes, likes sales taxes, are regressive … the lower a person’s income, the larger the share of their income that goes to paying taxes.  (With regard to the sales tax, that’s because lower income people spend a larger share of their income on the purchase of necessities and other goods, accounting for the tax taking a larger share of their income.) 

As the United States developed into a more progressive society, it realized that regressive taxes posed an unfair burden on the poor.  A socially fair tax would work in the opposite way … the higher ones income, the greater the share of that income that would be paid in taxes because such people have much more discretionary income and therefore a higher tax would not pose any hardship.  And so when the income tax was instituted, that’s how it was designed … as a progressive tax.

In 1932, the income tax for the top bracket was 63% of income over $1,000,000.  In 1950, it was 91% of income over $400,000.  As recently as 1980, the rate was 70% of income over $212,000.  Today, the rate is 35% of income over $380,000. The rich are paying a smaller portion of their income as taxes to support the greater public good now than at any time since the income tax was instituted.

Over the course of the past 100 years, again as society has become more civilized and enlightened, government has taken a greater hand in both directly providing for those in need as well as ensuring in various ways that they have the opportunity to better their position in life. This was a fuller implementation of the role of government stated in the Declaration of Independence … “to secure” the right to life, liberty, and happiness. Programs that were once considered radical or socialist by Republicans, such as Social Security and Medicare, which they fought tooth and nail at the time, are now accepted by most as necessary programs ... not without their problems, but vital to the wellbeing of a large proportion of our citizens and thus the stability of our economy.

In all these areas, the current radical brand of Republican conservatives, egged on by the energy and anger of the Tea Party, have argued that the government’s role should be reduced or eliminated.  Business should not be regulated.  The wealthy should not pay more taxes.  Everyone should have to fend for themselves … if you don’t success, it’s your fault.

Each of these positions is against the balance that our nation has historically struck between private rights, the public good, and the role of government.  These positions violate an enlightened concept of the rights and responsibilities of a citizen.

The Tea Party wishes to take us back to an era where individualism ran rampant and success was limited to the few.  America’s strength in the 20th century evolved by broadening the base of prosperity among its citizens and creating a more vibrant, intelligent workforce through the intervention of government programs and regulation.

That is where we need to continue heading in the 21st century to ensure America’s continued strength.  The Tea Party and their Republican captives need to be recognized for what they are … a shill for big business and the rich.  They are not responsible citizens of this great republic.

Why Tax the Rich When You Can Tax the Poor?

As reported in USA Today, states across the country are increasing existing tolls on roads/bridges/

tunnels as well as charging tolls for the first time on roads that have always been free.  A toll is a tax and one that falls disproportionately on the middle class and poor.   It is a very regressive tax.

I understand that states and localities are strapped for money and that they need to raise revenues somehow in order not to have even deeper cuts in services.  But to raise revenues in a very regressive manner … hitting lower income people harder than upper income … is socially unfair and contrary to progressive principles.

This is especially egregious when the tax is on something that is a necessity for many.  For people commuting for work within large metropolitan areas, public transportation is not generally a very realistic alternative.  It either just doesn’t exist, or it doesn’t take you where you need to go. 

For many people in the lower-middle income categories, a raise in tolls could mean that commuting to work is no longer financially reasonable.  If they have to quit their jobs that means higher unemployment with greater strain on local government services.  Regardless how you look at it, it’s bad government policy.  Other examples of bad taxes to raise would be sales taxes and gasoline taxes, both of which are regressive and impact the ability to acquire necessities.

And there are alternatives that are not regressive.  The one is obviously to raise income taxes on the wealthy.   It’s anathema to the Republicans, but it’s the right thing to do.  The tax rate for the richest Americans is lower than it has been since before the Depression.  Another option would be to place or raise a sales tax surcharge on luxury items.

Then there are alternatives that, while regressive, do not impact necessities … although granted that’s all in the eye of the beholder.  I’m referring to sin taxes … taxes on alcohol and cigarettes. While these definitely hit lower income people disproportionately, cigarettes and alcohol are not necessities and in quantity are actually bad for people. So if a state has a clear social policy of discouraging the use of cigarettes and alcohol, I could support such a tax increase.  But only then,

We live in a culture where the rich and big business have access to the people who hold the levers of power in government.  The middle class and poor have no such access.  As a result, the rich and big business are catered to; the rest are mostly given lip service.  It is unjust.  It is against the American social contract.  It is un-American.

Is It Class Warfare or Is It a Cry for Justice?

Over the past three decades this country has experienced rapid growth in income inequality.  While the incomes of those in the top 5% have increased exponentially, especially during the past decade, the inflation-adjusted income of production and non-supervisory workers has actually decreased.  The 2010 census found the number of Americans living in poverty to be higher than at any time in the past 51 years that records have been kept; the poverty rate … 1 in 7 Americans … was higher than it’s been since 1994.  The rich have indeed gotten richer and the poor have gotten poorer.  The middle class has been eviscerated.

Yet in Congress the Republicans, who say they speak on behalf of the average American, instead fight any efforts to regulate the financial industry excesses that brought about the recent/current recession, resist any tax increases on wealthy Americans (although current tax rates are lower than at any time since before the Depression), and in general continue to support government subsidization of industry while seeking savage budget cuts in programs that support middle income Americans and the poor.  All in the name of reigning in the deficit.

This is the context in which Mitt Romney and other Republicans are crying “class warfare” at the protests taking place against the financial industry and at Obama’s call for the rich to pay a minimum tax at least equal to the taxes paid by middle income Americans.

Call it mendacity; call it hypocritical.  But beyond deceit, as Rick Perry so aptly stated when criticizing his fellow Republicans for their stand on immigration, these people have no heart.  Not only have they no heart, they have forgotten the American social contract which has benefited them greatly and under which they have an obligation to support the government’s efforts to help those less fortunate.

It is not class warfare to ask that the rich pay their fair share to support the government.  It is not class warfare to ask that industry be regulated so that the public good is protected.  These demands are a cry for social justice.  They are consistent with the balance that our nation has historically struck between private right, the public good, and government. 

The Republicans seek to fundamentally alter that balance.  They are making war on the American social contract and on the middle class, the poor, and the environment.