Browsing the blog archives for February, 2006.


Staggering Ineptitude

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Bush Administration, Iraq War

Via Josh MarshallWarren Strobel and Jonathan Landay write for Knight Ridder,

U.S. intelligence agencies repeatedly warned the White House beginning more than two years ago that the insurgency in Iraq had deep local roots, was likely to worsen and could lead to civil war, according to former senior intelligence officials who helped craft the reports.

Among the warnings, Knight Ridder has learned, was a major study, called a National Intelligence Estimate, completed in October 2003 that concluded that the insurgency was fueled by local conditions – not foreign terrorists- and drew strength from deep grievances, including the presence of U.S. troops.

On the “Bush Policy Decision Process” flow chart, this is the familiar step of “Policy Decisions Made” inside a bubble. And no one with expertise or a diverse point of view is allowed inside the bubble.

The reports received a cool reception from Bush administration policymakers at the White House and the office of Defense Secretary Donald H. Rumsfeld, according to the former officials, who discussed them publicly for the first time.

President Bush, Vice President Dick Cheney, Rumsfeld and others continued to describe the insurgency as a containable threat, posed mainly by former supporters of Saddam Hussein, criminals and non-Iraqi terrorists – even as the U.S. intelligence community was warning otherwise.

Most … incompetent … administration … in … U.S. … history …

Robert Hutchings, the chairman of the National Intelligence Council from 2003 to 2005, said the October 2003 study was part of a “steady stream” of dozens of intelligence reports warning Bush and his top lieutenants that the insurgency was intensifying and expanding.

“Frankly, senior officials simply weren’t ready to pay attention to analysis that didn’t conform to their own optimistic scenarios,” Hutchings said in a telephone interview.

Keep in mind Bush’s only response to any questions about his decisions: Trust me.

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Old News

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Bush Administration, Iraq War

The situation in Iraq is so volatile that conflicting spin and news cycles are bumping into each other. By way of illustration, here’s a screen capture taken from Memeorandum this afternoon.

Old News: The violence in Iraq is subsiding.

New News: Um, maybe not.

Old News (yesterday):

The US ambassador said the risk of civil war from last week’s crisis was over. …

… “That crisis is over,” US Ambassador Zalmay Khalilzad declared.

“I think the country came to the brink of a civil war, but the Iraqis decided that they didn’t want to go down that path, and came together,” the ambassador told CNN. “Clearly the terrorists who plotted that attack wanted to provoke a civil war. It looked quite dangerous in the initial 48 hours, but I believe that the Iraqis decided to come together.”

New News (today):

Attacks in Baghdad, including a car bomb near a Shi’ite mosque, killed at least 60 people on Tuesday and U.S. President George W. Bush told Iraqis who fear civil war that they faced a choice between “chaos or unity”.

As deposed leader Saddam Hussein returned to court after the worst week of sectarian violence since the U.S. invasion, three bombs in quick succession killed 32 people. After dark, a car bomb killed at least 23 near the Shi’ite mosque and a market.

New polls reveal that both the American public and the troops in Iraq are heartily sick of the mess Bush made and want out. This suggests to me that people outside the winger base are not listening to what Bush says any more.

As I mentioned in the last post, a whopping majority are skeptical of the UAE ports deal. Today on television I saw a clip of Bush, with his most condescending smirk, saying “If there was any doubt in my mind or people in my administration’s minds that our ports would be less secure or the American people in danger, this deal wouldn’t go forward.”

In other words … trust me.

Tonight on ABC’s World News Tonight Bush will speak to Elizabeth Vargas in an exclusive interview. Viewers will get to hear Bush flat-out deny there will be a civil war in Iraq. They’ll hear him deny that his low poll numbers concern him — “I’ve got ample capital and I’m using it to spread freedom and to protect the American people.” They’ll hear him say that the UAE port deal will be confirmed after review; the only reason Congress and the American people are concerned is that they don’t know the stuff that he knows.

Personally, I think the boy has completely slipped his tether. He could get away with that “trust me” stuff after 9/11. He’s not getting away with it now. Yet he doesn’t know any other way to relate to the American people.

Seems to me the American people ain’t relatin’ back.

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The Bush Policy Flow Chart

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Bush Administration

Da Big Nooz, from CBS

The latest CBS News poll finds President Bush’s approval rating has fallen to an all-time low of 34 percent, while pessimism about the Iraq war has risen to a new high.

Excuse me while I dance about and pump my fist a few times.

The article goes on to say that Bush took a hit on the UAE port deal (7 in 10 Americans are opposed), and he’s still hurting from Katrina (2 out of 3 Americans say he hasn’t respond adequately). Regarding the port deal, whether the deal compromises national security or not, the way the Bushies handled the deal reveals a lot about what’s wrong with the Bush Administration. Thinking about the port deal inspired me to spend at least three minutes painstakingly and meticulously doodling the following flow chart:

The “Bush Policy Decision Process” works as follows: First, the President and a small group of long-time advisers carefully chosen to agree with each other get together inside the bubble and decide on a policy. This is the easy part, especially since no one with expertise or a diverse point of view is allowed inside the bubble.

Next comes a critical decision: Should the White House make this policy known to Congress and the public, or should they keep it secret?

If they choose to make it public, the next step is packaging the policy. The packaging may or may not (probably not, truth be told) be representative of what the policy actually is; the point of the packaging is purely to maximize sales appeal. For example, the Bushies might decide on a policy of maxmimizing timber production in national forests because it would be good for the logging industry. The policy will be packaged as good for the forests. They’ll call it something like the “Healthy Forests Initiative.”

You’ll remember that Andy Card let it slip that the 2002 saber rattling over Iraq was a “marketing campaign.” Later we heard (from where? Maybe someone can remind me.) that the weapons of mass destruction argument was used to build support for invading Iraq because it was the most saleable argument, not because it was the actual reason. In any event, the Bushies have had to repackage the Iraq War at least two or three times, haven’t they?

Now, as part of the marketing campaign, all dissenting opinion must be suppressed. Therefore, anyone who argues against the policy is smeared and ridiculed by the VRWC. The more expertise and logical arguments dissenters might have against the policy, the harder they are smeared. Thanks to a compliant media, this has meant (until recently) most of the public never hears the opposing arguments, just that so-and-so who opposes the policy is an unhinged ultra-liberal Bush-hating Saddam lover who wants to destroy America.

So the policy goes into effect. What if it becomes obvious that the policy is failing? The Bushies go back to the “marketing/smearing” phase, repackage the policy, and issue fresh smears. At the same time, people who had been shut out of the policy-making process except to be allowed to rubber-stamp it (such as “Democrats”) will be blamed for the failure of the policy.

What happens if the policy becomes a resounding success? We haven’t reached that stage with any Bush policy, so anything we say would be speculative. Just thinking about what they might do gives me the willies, though.

If the Bushies choose the “keep it secret” option, and the policy is made public in spite of their best efforts to keep it secret, they switch over to the “marketing/smearing” plan, and the rest of the chart flows along as with the “make it public” option.

In the case of the UAE port deal, they seem to have gotten sloppy. They defaulted to the “keep it secret” procedure even though it wasn’t really secret. When the deal became public and the shit hit the fan, the Bushies hastily switched over to marketing/smearing, but by then they were behind the public opinion curve. And a lot of the people who got caught up in the smear campaign were long-time Bush administration supporters who were astonished at being called unhinged ultra-liberal Bush-hating Saddam lover who wants to destroy America, in so many words.

The Katrina disaster doesn’t fit into the flow chart anywhere, which is why the Bushies don’t know what to do about it. I’ve written before about the many times the Bushies are utterly confounded by problems they hadn’t foreseen, like power blackouts and hurricanes. But responding to an unexpected disaster that cannot be blamed on scarey swarthy foreigners it haaaard. It’s hard to get a good propaganda campaign going before people have already made up their minds the administration is screwing up. And if the disaster is domestic, people will notice fairly quickly that the administration’s efforts aren’t working. Mind-boggling ineptitude is easier to hide if it’s happening in another part of the world; like, say, Iraq.

Unrelated: A gold medal for Wales! Wales beats France in cooking contest! Llongyfarchiadau!

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The Mississippi Correlation

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abortion

Speaking of South Dakota, I was just wondering if it complied with the Mississippi Correlation. The MC states that where a state’s legislature is obsessed with banning abortions, that state will have a higher than average infant mortality rate.

Yep. It does.

“The good news is that deaths from Sudden Infant Death Syndrome continued to drop. There were eight deaths in 2004, down from 21 in 1995,” said Doneen Hollingsworth, Secretary of Health. “But unfortunately, the infant mortality rate did increase to its highest level since 1999.” …

.. There were 93 infant deaths in South Dakota in 2004, or a rate of 8.2 per 1,000 live births. That’s well above the United States rate of 6.6 infant deaths per 1,000 live births for the same year (provisional data).

If you are interested in looking at comparative data on infant mortality rate in the U.S., here’s a report (PDF) from the Center for Disease Control you might like. If anyone can find a similar report more recent than 2002, please add a link in the comments.

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Rights, Facts, Comments and Kibble

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abortion

Every now and then I get a comment that requires so much time and research to respond to that I decide, what the hell, I might as well write a post. Well, folks, the “Chao-Chou’s Dog Has Puppies” post attracted such comments, beginning with #72:

I could only read the post and about 1/3rd of the comments before getting depressed at the lack of liberal understanding in regards to the pro-life position. Yes, the exact point that a fertilized egg becomes “Fred” is ambiguous, and the morality of destroying that fertilized egg is hazy, and that’s why we had a large myriad of nuanced laws dealing with different aspects of abortion in different parts of the country before Roe v. Wade came along and wiped all of them out and said, in effect, that as long as the baby’s head hasn’t been exposed to air, then vacuuming his or her brains out is fair game. This shouldn’t be an either/or situation, where you either have complete restriction on abortion or no real restrictions at all. Let the states decide.

I answered this comment (#73) but I want to add a bit to the answer. In particular, I want to address the “let the states decide” nonsense.

In the United States, we have these things called “rights” that all levels of government (since the 14th Amendment, anyway) must respect. For example, the 13th Amendment abolished slavery. This means Alabama can’t reinstate slavery even if 100 percent of the state legislature votes for it. And the 4th Amendment protects a “right of the people to be secure in their persons,” meaning state governments cannot dictate to a citizen (say, a pregnant woman) what medical procedures she may or may not have (for example, abortion or childbirth) without some kind of court order. The legislature cannot circumvent the 4th by writing a law that says the state can search and seize personal property whenever it wants to, for example. Such matters are off limits no matter how big a majority of the voters might want such laws passed.

I have already posted arguments (here, for example) why I think the Constitution does protect a right of privacy that includes the right of a woman to choose to have an abortion. I am not going to repeat those arguments now. If you want more arguments, head on over to Lawyers, Guns & Money. Scott Lemieux of L, G & M (whom I have met; in person he’s so intensely bright he makes me feel dim) has accumulated a substantial opus of Roe v. Wade posts. See, for example, “Roe Was Right (Part I)” and “Roe Was Right (Part II)“. If you enjoy those, you might also like “Roe Was Right (Part III).”

Now, as for the “myriad of [sic] nuanced laws” about abortion that allegedly graced the states before Roe, I refer you to this Alan Guttmacher report, “Lessons from Before Roe: Will Past be Prologue?” In a nutshell, the “nuance” was as follows: In 33 states, abortion was illegal in all circumstances. In 13 states, various provisions had been made for medical necessity. It had been legalized in 4 states.

As I wrote in my comments, “nuanced, my ass.”

As for “This shouldn’t be an either/or situation, where you either have complete restriction on abortion or no real restrictions at all,” in fact Roe v. Wade provides for a number of restrictions, including a complete ban on elective post-viability abortions.

Now, also in my response to the post above, I provided a link to this post, which refers to the Alan Guttmacher report linked above, which says,

Estimates of the number of illegal abortions in the 1950s and 1960s ranged from 200,000 to 1.2 million per year. One analysis, extrapolating from data from North Carolina, concluded that an estimated 829,000 illegal or self-induced abortions occurred in 1967.

(Now, the Guttmacher Institute is affiliated with Planned Parenthood, which I realize to some people is a partisan organization. However, both the American Medical Association and the Center for Disease Control use Guttmacher data in their reports and consider it to be as reliable as anybody else’s data.)

The commenter responded,

I did some googling, and it seems like your stats in the other post are way off. “1.2 million illegal abortions” a year before Roe v. Wade is at the extreme high-end of the possible estimates, and it includes miscarriages. I found an abstract for a paper called “An objective model for estimating criminal abortions and its implications for public policy” here:

http://www.popline.org/docs/0472/007923.html

. . . and, from what I can gather, it seems like a scholarly work that estimates that there were between “a low of 39,000 [illegal abortions] in 1950 to a high of 210,000 in 1961, or an average of 98,000 a year” and that, after Roe v. Wade, the total number of abortions increased six to eleven times, and that, strangely enough, the number of illegal abortions only dipped a little bit.

The “scholarly work” is an abstract of a paper written in 1981 by people I’ve never heard of. Without seeing the entire work I have no idea where they got their numbers, but I suspect they counted only illegal abortions that were actually documented as such at the time they were performed. Meaning, they were only counting a tiny part of the actual abortions going on at the time.

[Update: Alert reader Jeffrey Rowland discovered the “scholarly work” was sponsored by “Americans United for Life.” So much for that.]

Any number anyone comes up with is an estimate. But when you consider that that in 1962 alone, nearly 1,600 women were admitted to Harlem Hospital Center in New York City for incomplete abortions — just one hospital, and no doubt those were only a fraction of the women who aborted in the area served by the hospital — then a “high” of 210,000 abortions nationwide seems a tad low. (Women in more affluent neighborhoods got safer abortions and were less likely to turn up in hospital emergency rooms.)

As for, “strangely enough, the number of illegal abortions only dipped a little bit” — strangely enough, after Roe, the number of women who turned up in emergency rooms with complications from back-alley abortions just about stopped. And which abortions were “illegal” after Roe, pray tell? I think someone is confused.

The total number of abortions per year did go up after Roe v. Wade (although not “six to eleven times”). This is a phenomenon that seems to nearly always happen when abortions are legalized; the rate goes up for a time, and then settles back down again in a few years. (See “Sharing Responsibility: Women, Society and Abortion Worldwide [PDF] Report on unplanned pregnancy and abortion around the world” [Alan Guttmacher, June 1999] pp.28-29.) This happened in the U.S.; rates began to come down around 1990 and declined steadily through the 1990s.

The fact remains that making abortion illegal doesn’t stop abortion. We see this in nations throughout the world; there is no correlation between abortion law and abortion rate. I wrote about this at length here. And the fact remains that where abortion is illegal women will, in desperation, abort themselves or submit to back-alley abortions that are enormously dangerous. And some of them will suffer permanent injury. And some of them will die.

Finally, we get this brilliant argument:

Honestly, I have more animosity towards Roe v. Wade than I do towards abortion. And my animosity stems from the fact that it was an authoritarian, anti-democratic decision that has polarized this country in a terrible way.

Look at it this way — Christians probably think abortion and prostitution are about equally bad. I mean, one of the ten commandments is about adultery. However, do you see hundreds of thousands of people marching to Nevada every year to protest legalized prostitution? No. I posit that the reason why is that prostitution hasn’t been forced on the entire country, and that the only areas that have legalized it are those communities that are okay with it.

That’s exactly what people said about Brown v. Board of Education, you know. Are you old enough to remember the years in which school desegregation had the whole nation up in arms? I am. I believe it was a worse conflagration than what was caused by Roe. (See also “The Long Tentacles of Conservative Revisionism” by Scott Lemieux.) By your logic, we should have maintained Jim Crow laws because declaring them unconstitutional got so many people riled up (and hollering about “states’ rights”).

Sometimes liberty and justice get messy. Deal with it.

Update: See also August J. Pollak.

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Must Read

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American History, big picture stuff, Bush Administration, Iraq War

Today’s Bob Herbert column, courtesy of True Blue Liberal —

Eisenhower delivered his farewell address to a national television and radio audience in January 1961. “This conjunction of an immense military establishment and a large arms industry is new in the American experience,” he said. He recognized that this development was essential to the defense of the nation. But he warned that “we must not fail to comprehend its grave implications.”

“The potential for the disastrous rise of misplaced power exists and will persist,” he said. “We must never let the weight of this combination endanger our liberties or democratic processes.” It was as if this president, who understood war as well or better than any American who ever lived, were somehow able to peer into the future and see the tail of the military-industrial complex wagging the dog of American life, with inevitably disastrous consequences. …

… The way you keep the wars coming is to keep the populace in a state of perpetual fear. That allows you to continue the insane feeding of the military-industrial complex at the expense of the rest of the nation’s needs. “Before long,” said Mr. Jarecki in an interview, “the military ends up so overempowered that the rest of your national life has been allowed to atrophy.”

Be sure to read the whole thing.

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Obliviousness

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Canada, conservatism, Health Care

This is a follow up to “Touching Innocence,” below. A blogger named Russell Roberts writes,

Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.

The New York Times reports that the Canadian system is imploding. …

You already know where this is going … the Times report discusses problems with the Canadian system, and says some private health care is rushing in to pick up the slack. Whereupon blogger Russell gloats a bit about how superior the U.S. health care system is, and how fortunate Canadians will be when their public system breaks down entirely and they can have a health care system just like ours.

Russell goes off track with the first sentence — “Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.” Although I’ve met such people, in fact the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?” Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad” example of a system with problems.)

And, I’m sorry to say, I also run into uninformed lefties who seem to think our only choices are a Canadian-style single-payer or the overblown mess that is the U.S. “system.”

As I wrote earlier today, just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system, with the exception of the United States. And every nation has worked out its own system; it is not true, as the uninformed would have it, that there is only the Canadian Model or ours. People who have looked at the myriad systems on the planet say that Canada’s is not necessarily the model we should be emulating. Other countries (notably France, whose system is ranked #1 in overall performance by the World Health Organization) have mixed public and private systems, with public “universal coverage” supplemented by private insurers and hospitals for those who want to pay for them. This may be where Canada is heading now.

Ezra Klein wrote a series of posts on the health care systems of various other countries. France’s system, he says, is not only more cost-effective than ours, it also provides better care for most people.

France’s health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.

So France spends less, gets more, and does so through a public-private hybrid that’s heavily, heavily public.

Also,

The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals — which operate on a fee-for-service basis — make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How’s that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there’s patient-client confidentiality.

Everyone I’ve ever met who’s lived in France even a short time sings the praises of the French health-care system. This is not to say that Americans with lots of money or top-notch insurance don’t get as good, or better, care. But, I’m told, if you don’t have lots of money or insurance, try to arrange to have your health problems in France.

The Canadian health care system is slowly breaking down, The New York Times says. The U.S. system, by contrast, is not slowly breaking down. Parts of it are already broken, and what’s left of it is hurtling toward disaster at breakneck speed.

Once again, Jane Bryant Quinn:

America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.


Here
Sebastian Mallaby explains why Bush’s health savings accounts will make our system even worse. In another column, Mallaby concludes,

Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?

See also “Single-Payer Health Would Increase US Competitiveness” by Hale Stewart at BOP News.

This is a huge topic, and this evening I don’t have the time to go into the detail the topic requires. But whenever I see a rightie snicker about the problems of other health care systems, I wonder what it’s going to take to get them to see that our system is a disaster in progress. Corpses in the streets? Oh, wait, we’ve been there already. I’m afraid it’s what Quinn says — the shock of being dumped out of the “winners” rank. Until then, it’ll take major surgery to get their heads out of their butts.

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Screen Capture o’ the Month!

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big picture stuff, entertainment and popular culture, News Media, science

Anna Nicole Smith illustrates the “ecological role of mammals” on a web site called South Coast Today.

(To be fair, there is some news about Ms. Smith further down the page. But this, um, made me laugh.)

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Touching Innocence

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abortion, big picture stuff, conservatism, Health Care, Social Issues

This is a sorta kinda followup to the last post, which discussed matters of life and death, space and time, religion, law, morality, and what it is to be human. Which was a tad ambitious now that I think about it. But I request that people not add comments disagreeing with this post until you’ve read that one. This will save us both a lot of time.

Anyway, I see that some righties are upset about a British court ruling that will allow physicians to impose a “do not resuscitate” order for Baby Charlotte, a desperately ill two-year-old, against the wishes of her parents.

The rightie blogger of Stop the ACLU asks,

Is this the direction America is headed? Is this where the ACLU, and the “right to die” folks will take us?

Kim Priestap of Wizbang blames socialized medicine:

Baby Charlotte’s health is fragile normally, so she will go through health scares like this again. This will cost Britain a lot of money. Since Britain has a nationalized healthcare system, funded by taxpayer money, it’s in the state’s best interest to let her die.

What’s going on here? As a mother myself I’m very uncomfortable when government interferes with family decisions like this. I tend to think that when the family is agreed the patient should be resuscitated, the doctors should respect the decision and not involve courts. I don’t know enough about Baby Charlotte to be able to judge whether there is a compelling reason to make an exception in her case. I infer from news stories that the doctors consider her case to be hopeless and that keeping her alive is just making her suffer. And her parents see things very differently.

I argued in the last post that humans need to struggle with hard choices. When governments or other institutions swoop into our lives and make our choices for us, it makes us less human. And this is true even when we make “bad” choices (within the law, of course). Our decisions may be less important than the process we go through to make them. So in that respect I’m sympathetic to the rightie point of view.

However … the title of this post doesn’t refer to Baby Charlotte. It refers to the righties who are oh, so innocent of the facts of life and death these days.

Nearly a year ago us “culture of death” liberals took up the cause of Sun Hudson, a Texas baby whose life support was terminated against family wishes. Although their diagnoses may differ, the legal situations of Baby Sun and Baby Charlotte seem to me to be nearly identical. If anything, Sun’s case was more extreme than Charlotte’s. His mother (father unknown) wanted aggressive medical care to continue, but the law sided with physicians who decided enough had been enough. Baby Sun’s breathing tube was removed on March 15, 2005, and he died of asphyxiation within minutes.

My understanding is that Sun Hudson’s prognosis really was hopeless. But then, so was Terri Schiavo’s.

Sun Hudson died three days before Terri Schiavo’s feeding tube was removed for the last time. Some of you might recall that righties got a tad excited about the Schiavo case. However, they were mostly silent about Sun Hudson — slipped their attention, I guess. Were it not for liberal blogs I wouldn’t have heard about Sun Hudson either.

Why were righties so oblivious to the Sun Hudson case? One explanation is that the law that allowed his life to be terminated had been signed by then-Governor George W. Bush.

The federal law that President Bush signed early yesterday in an effort to prolong Terri Schiavo’s life appears to contradict a right-to-die law that he signed as Texas governor, prompting cries of hypocrisy from congressional Democrats and some bioethicists.

In 1999, then-Gov. Bush signed the Advance Directives Act, which lets a patient’s surrogate make life-ending decisions on his or her behalf. The measure also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient’s condition is hopeless.

Bioethicists familiar with the Texas law said yesterday that if the Schiavo case had occurred in Texas, her husband would be the legal decision-maker and, because he and her doctors agreed that she had no hope of recovery, her feeding tube would be disconnected. [Knight Ridder]

The Sun Hudson story came out just as the VRWC media echo chamber was working overtime to promote George W. Bush as a champion of life. Faux News’s Bill O’Reilly first commented on the Sun Hudson story before he discovered the Bush angle, forcing him to flip-flop harder than a trout on a hot pier. While Terri Schiavo’s parents were depicted as noble and pure of heart, Sun Hudson’s mother became a deranged black woman who couldn’t face reality. Never fear; O’Reilly had flip-flopped back by April when he attacked the ACLU for (perhaps) being behind “infanticide for impaired babies.”

Let’s go back to the Texas Advance Directives Act of 1999, which is the law under which Sun Hudson’s life was terminated. Put very simply, the law allows a health care facility to discontinue life support against the wishes of the patient’s family. The law requires the facility to jump through a number of hoops before it can do this, which ensures there is an overwhelming medical consensus that the patient’s condition is hopeless before the plug is pulled. The family has the option of finding another medical facility willing to continue life support. But other medical facilities are unlikely to take such a patient, especially if the patient will be a drain on the budget.

In other words, if the family is wealthy enough to pay the costs of Grandma’s care and make a generous contribution to the hospital building fund, Grandma lives. If the family’s insurance is capped and they’ve already spent the second mortgage to pay her medical bills, she dies. To paraphrase (well, OK, mock) Kim Priestap of Wizbang (see above), Grandma’s care will cost hospitals a lot of money, so it’s in their best interest to let her die.

There are two issues to be addressed here, both involving rightie inability to face reality. The first is regarding health care and how it is paid for. Just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system. The exception is the United States. In a recent Newsweek column, Jane Bryant Quinn (hardly a socialist) said that America’s health-care system is turning into a lottery.

The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

Years ago there was a joke in circulation that said a conservative is a liberal who got mugged. The new joke is that a liberal is a conservative who’s lost his health insurance.

The point is that all the evil, inhumane things going on in Other Countries That Have Socialized Medicine are happening here, too. Righties just refuse to acknowledge them. Among those Other Countries, Britain is a good “bad example” because they’ve underfunded their system for years. Meanwhile, we in the U.S. spend far more per capita than other nations (see this report in PDF format; note especially Figure 1 on page 3) but we’re getting worse results (see Table 1, page 4). By some measures we’re getting even worse results than those cheapskate Brits.

And the moral is, people whose health care system is a broken down mess shouldn’t be pointing fingers at other peoples’ health care systems.

The other issue I see here is the touching innocence of righties regarding hopelessly terminal patients. Physicians have made decisions not to aggressively treat hopeless patients, especially suffering hopeless patients, since Hippocrates. Generally they’ve done it quietly and without drawing attention to themselves, but they’ve done it. For example, since the 19th century physicians have prescribed larger and larger doses of opiates to ease the pain of dying patients, knowing that eventually the dosage will be fatal. And as far as the family ever knew, it was the cancer that killed Grandpa, not that last dose of morphine.

Just about any health care professional will confirm this. I’m sure such decisions are being made all over America even as you read this.

The reason we’re hearing about such cases these days is, IMO, multifold. First, in the past medicine wasn’t all that effective. It was easy for doctors to make a show of “doing all we can” because in truth there wasn’t a whole hell of a lot they could do. But now we can do so much more. We have medical technology that will retain life in a body even when the person that body once sustained has long since dissipated, as in Terri Schiavo’s case. The line between life and death itself has blurred.

Second, because of the technology, more and more families refuse to accept a hopeless prognosis. I understand even anencephalic babies are sometimes put on life support these days, even though those babies have no hope of survival. In earlier times, the only choice offered parents would have been whether they wanted to hold the baby while it died, or not.

And third, mass media and our “reality TV” culture make sure the more controversial decisions get global publicity. In earlier times, these matters wouldn’t have been been discussed outside the family. Today, people with less than a half-assed idea of the facts can plaster their uninformed opinions all over the Web.

As individuals, as a nation, as a society, as a species, we’ve got hard choices to make. These choices involve ourselves and our loved ones. We need to make some mature, non-politicized judgments about how to pay for health care. We must think rationally about how much of our health-care resources should be spent on futile care. We need non-hysterical discussion about if, or when, governments should intervene in family decisions. These are all complex issues. Reasonable people will disagree on many points. But we’re going to get nowhere until we’re able to face some hard realities.

Which means we’re going to get nowhere as long as righties dominate the discussion.

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Chao-chou’s Dog Has Puppies

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abortion, big picture stuff, Religion

I see that Lance Mannion has taken up the question of when “life” begins. I see that Shakespeare’s Sister mostly agrees with Lance; Jedmunds of Pandagon mostly doesn’t.

Now I want to confuse everyone by arguing that “when life begins” is the wrong question. It’s the wrong question because life doesn’t begin. Or, at least, it hasn’t begun on this planet in a very long time. However life got to Earth — between 3 and 4 billion years ago, I believe — once it established it hasn’t been observed to “begin” again. It just continues, expressing itself in countless forms. The forms come and go — in a sense — but not life itself.

It will be argued that fertilization marks the beginning of a unique individual and is, therefore, a significant moment in the life process — the point when a life begins. But let’s say a couple of weeks later the egg divides into twins or triplets. Did those individuals’ lives begin with the conception? Or, since they didn’t exist as individuals at conception, is the cell division something like an existential reboot?

Further, in the grand scheme of things, is any one moment really separable from all the other moments, the couplings, the countless episodes of cell mitosis going back to the first stromatolites and microbes and macromolecules to the beginning, which is beginningless as far as I know, considering that a stray enzyme at any point over billions of years would have resulted in you being a lungfish?

I don’t have an answer to that. I’m just sayin’ “beginnings” are way overrated.

The real question, seems to me, is when does an individual begin? Is there a clear, bright moment at which we can all agree, “yep, that’s Fred,” and be done with it?

Some argue that the product of pregnancy is a unique individual from conception because its DNA is different from its mother’s. But if unique DNA combinations are what make a unique individual, you’d have to conclude that the twins from the third paragraph are the same person, divided. And if we give you a transplanted heart, lung, and kidney, each with unique DNA combinations from their respective donors, does that make you four different people?

I don’t think science can help us with this one, people. Indeed, if you step back and look at human civilization throughout space and time, you might notice that “person” is a social construct that has been constructed in very different ways by different societies. At various times only men, or only people of a certain skin color, or only people from our tribe, or only people of a particular caste or class, were considered “persons.” We may think we have reached maximum enlightenment by considering all human beings “persons” (assuming we all do, which I question), but it’s possible our distant descendants will expand “person” to include, say, other primates, whales, dolphins, and border collies. You never know.

The argument made by many opponents to legal abortion is that the product of pregnancy is human life, and human life is sacred; therefore, it must be protected. There’s no question that a living human embryo is both alive and human, but when you call it “sacred” you’re throwing a religious concept into the mix. And the great religions of the world do not at all agree on the question of when (or even whether) “human life” becomes “sacred.” Some say at conception, some say at “quickening,” some say at viability, some say at birth. And some will tell you that everything and nothing are equally sacred, so stop asking stupid questions.

The reason we’re even having this discussion is to settle the question of abortion as a matter of law. But as a legal matter, the question of when humans are allowed to take the lives of other humans rarely has absolutist answers. Some kind of regulation about who can kill whom is necessary for civilization, since we can’t very comfortably live together in communities without some assurance our neighbors won’t throttle us in our sleep. But there are always loopholes. Through history, in many societies (even Christian ones), a noble could kill a peasant or slave without penalty. Today governments can order wars or impose a death penalty, and legally that’s not murder.

I tend to get impatient with people who argue that laws are based on morality, and abortion is immoral, therefore it ought to be illegal. As I said in the last paragraph, there are some laws essential to human civilization. These laws regulate who can kill whom and who can own what. They make commerce possible by imposing penalties for fraud. They make complex human enterprises possible by enforcing contracts. Exactly how law has regulated these matters has changed considerably over time; the important point is that, within a given society, there are basic rules everyone is supposed to agree to so that society can function.

The realm of morality, however, is separate from the realm of legality. There are all manner of things that we might consider immoral that are not, in fact, illegal; adultery is a good example. Such acts may have harmful personal consequences, but regulating them isn’t necessary to civilization. And I don’t see what’s immoral about, say, misjudging how many coins you should put in the parking meter. That’s why I tend to see the legal versus moral question on a Venn diagram. The diagram here isn’t entirely accurate since the blue area should be bigger — law and morality intersect more often than they don’t. I’m just saying that answering the moral question of abortion (assuming we ever will) does not tell us whether an act should be legal or not. In fact, since abortion is legal (with varying restrictions) in most democratic nations today with no discernible damage to civilization itself, I’d say the abortion question falls outside the blue area of the diagram.

On the question of morality I disagree a lot with Ezra Klein when he says “confused polling on abortion is evidence that Americans have confused views on abortion.” I think people are not so much confused as limited. Our conceptions of life or humanity or individuality or the self are to a large extent conditioned into us by our culture. It’s very hard to step outside of our conditioning and take a broader view. We’re all blind men feeling an elephant — our ideas about what an elephant is depend on what particular part we happen to be feeling (an elephant is like a a tree trunk? a wall? a fan?). Following this metaphor, there are all manner of people in America today who do not feel confused at all about that elephant. They’ve got hold of its trunk, and they are certain it’s just like a snake. End of argument.

If anything, most people aren’t confused enough.

Our notions of where a fetus fits on the morality scale depend very much on the angle from which we view the question. A fetus is human. But humans are sentient, and a fetus is (so science tells us) insentient. A fetus is like a parasite, or a lower life form. A fetus is God. A fetus is a baby. A fetus is not a baby. A fetus is a potential baby. A fetus is sacred. Nothing is sacred. Everything is sacred.

How about, All of the above?

In case you’re wondering, from a Buddhist perspective it might be argued that since a “person” is an aggregate of the five skandhas (form, sensation, perception, discrimination, consciousness) and an embryo or fetus has only form, it’s not a person. On the other hand, Buddhism teaches that each of us is all of us, throughout space and time. The cells of whatever is conceived contain all life forms, from the beginningless beginning to the endless end, perfect and complete. Interfering with life’s attempts to express itself is a serious matter.

So where does that leave us? It leaves us with individuals who have to make hard choices. Struggling with hard choices is a distinctively human activity. I think it’s something we need to do to be fully human. It helps us wake up. The decisions we make may be less important than the fact that we can make decisions.

I have written in the past (such as here) why I think abortion should be legal, at least until the fetus is viable. My opinion is based mostly on the effects of abortion law in the lives of women. You might notice I don’t spin my wheels much over the question of morality, since I’ve come to see that morality depends on the state of mind in which one acts as much as the act itself. People do “good” things for selfish reasons, and “bad” things for altruistic reasons. Judge not, lest ye be judged.

So, I say, ambiguity is good for you; don’t be afraid of it. Go forth and be human and work it out for yourselves.

[Note: The title of the post refers to the first koan of The Mumonkon. If it doesn’t make any sense to you, that’s OK.]

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