Race and the Confederate Flag

Sometimes when you screw up, it’s hard to know what to do to make things right.  (I am well versed). The ultimate solution – undoing what was done – is generally not an option.  Unless you happen to have a DeLorean, a working flux capacitor, and some plutonium.  There are different levels of screw-ups, too.  It can be accidental, it can be deliberate.  The damage may be to stuff, or it may be to people.  It may be transient, it may be permanent.  It may affect just one person, it may affect a whole bunch of people.

If you do something horrible, and you are sorry, then – at minimum – you say so.  You apologize.  And you mean it.

Slavery was (and still is) a horrible thing.  It’s a bit like genocide in that I can’t even wrap my head around how someone can be so distorted and deranged to even get near to the consideration that this might be something acceptable for any reason whatsoever.  To keep another person as a thing.  It’s unconscionable.

We Americans have this history that we are all struggling to deal with, a swirling stew of past injustice, and the pot has boiled for decades – sometimes over – distilling down to a simmering residual that is racism.

The discussion of what to do now is not new; it has been going on for the life of our nation, well before the legal end to slavery.  And during that time, it is fair to say that the social environment has slowly evolved.  But even as we have made inexorable progress, no one can say that we have reached a state in which we are truly equal, where all traces of the past divisions between whites and blacks in our nation have faded beyond recognition.  Far from it.  We can still see those effects, and we can even measure them.  They are the basis for unequal distributions in education, in employment, in income, even in healthcare.  (All of these metrics are proxies for the true disparity: poverty.  But that’s for another time).

On one side of the discussion are those who call for reparations.  There are many reasons why I don’t believe this is a valid solution, but even if I don’t support the concept, I can at least empathize with someone who feels that slavery was so egregious that compensation on a similar scale is the only fair response.

Moving along a continuum, we get to various forms of affirmative action.  My resistance to this concept is very similar to that of reparations: at this stage in the game, these responses only serve to perpetuate racial divide, and I would like to see it continue to tail off into non-existence.  But again, that’s my position, and I can fully understand the opposing view.

I hold to a different philosophy, but it is certainly not mine alone: if we are to truly eradicate racism – which means going beyond the tangible acts and measurable divides and eliminating the mentality itself – we must have laws that treat us as equals, and we must have a society that does not tolerate racial bias.  And we must have time.  Unfortunately, we cannot legislate racism out of the heads of the idiots who harbor it.  We just have to be intolerant of their tendencies, and wait for them and their arcane ideology to fade into insignificance.

But no matter where you fall on this spectrum, a horrible thing happened.  To a lot of people.  For a long time. So if we are sorry, we say soAnd we mean it.

If you are incapable of recognizing that something might be a reminder of past atrocities, then it’s hard to say you are sorry and have your apology accepted at face value.

Look, I just said I am not for reparations or even affirmative action.  But let’s be realistic here: when people living in a country which still has measurable racial disparities ask to remove symbols and monuments that are reminders of a century-long systematic atrocity, it’s not a big ask. It’s a very reasonable ask.  In fact, it’s really something that shouldn’t have to be asked.  And the response, “But it’s part of our history!”  That’s lost on me.  Seriously?

First, you can’t do this one favor?  It’s that bad, giving up public display of the confederate flag, taking down some statues?  Doesn’t it bother you that these things may deeply offend someone else?  That it reminds them of that very same history, the part of our nation’s past that I hope you find reprehensible?  Does it not worry you that someone else would interpret your support of these displays as evidence of your own persistent racism?

Being called a racist is so offensive to me that I voted for Donald Trump.  (It was the last straw).

But if these things don’t bother you, if you are unconcerned for the feelings of others who still struggle with the aftereffects more than 150 years later, if it doesn’t make you uncomfortable that you might – I mean that there is even a shred of a possibility – that someone views you as a racist, then you are part of the problem.

Because it’s not all about you.  We can’t ignore the past.  People were enslaved.  Now people are in poverty.  And we are past due moving forward.  We are way past due putting this to rest and extending our hands collectively to our fellow Americans, treating them with the respect they deserve.  And sometimes that means going out of your way or giving something up, because it’s the right thing to do.

I have been told that I can’t do anything about racism because I am white.  Bullshit.  Black people can’t do anything about racism.  In the past, absolutely.  But today, the more the black community fights for equality, the more it perpetuates the residual divide. The only people who can eliminate racism are white people who refuse to allow this to be a persistent stigma in our society.  It is up to us to stand up en masse and say, “This happened in our past.  It was unconscionable.  We were not there; we cannot make up for the harm that was done.  But we refuse to allow the mindset to persist, and we will not tolerate those who would treat people differently because of the color of their skin.”

At the very least, we have to say we are sorry.  And we damn well have to mean it.

The Motionless Ghosts that Haunt the South

Politicians: dodging reality, one dollar at a time. 

Here is another example of how much of what is batted about by government is just smoke and mirrors, primarily because reality is hard to sell. I have said it before, but in case you missed it (I forgive you), Obamacare/Americare or whatever rework of it we are wasting time on, is never going to fix our healthcare system, because it is insurance-based legislation. Say it with me people: insurance is a way to pay the bills, but it doesn’t do anything about how big the bills are. Why is government messing about then? Because they can make it look like it will help. Which gets you all excited and agitated. And then when whatever they did fails, they blame the other side. And that gets you excited and agitated too. And an excited, agitated voter is easy to manipulate and motivate. Especially with memes. Perfect!The only way to make healthcare less expensive is to… yep, you got it…spend less money on healthcare.

That doesn’t sound quite as magical does it.  Sometimes, reality bites.

But wait! Obamacare insured millions of people that were previously uninsured! Yup. And did nothing for the size of the bills, it just shifted who was paying, some of the money coming from people who were previously uninsured, some coming from the government (which, by the way, doesn’t have enough money to pay its current bills, but let’s not go there today).

People keep pointing to other countries and how they have great results but spend less money. How do they do it? By being smarter with their money. And we can do that too, but we are not going to like it.

I walked into my office this morning to this 33 page document on the highlights of prescribing Ketruda, a relatively new immunotherapy used on several different cancers, but lung cancer has been in the spotlight. You may have seen ads on TV like this one, which is for a similar drug called Opdivo.

These are a big deal right now, and in some cases these drugs are improving results significantly. That’s all good, right? Yes, but there are some catches.

First, you need to understand that chemotherapy for lung cancer really sucks, because it has bad side effects and doesn’t work very well. So doing better than the current standard is not too difficult. Second, the results of these new therapies are extremely variable and hard to predict: some patients will do well, some won’t, some will have side effects, some won’t. And often when we talk about “significant” improvements, people don’t understand what that really means: we are talking about progression free survival differences of a few months. Now, I am not suggesting that is not significant, but some people associate “significant” with cure. And we unfortunately far from that.

What does this have to do with the price of tea in China?

I don’t know about the price of tea, but we are talking about the price of healthcare, and how to bring it down, and how politicians don’t really want to do anything about it, because working on real-world issues effectively is not so good for elections. These drugs are really expensive, like $150,000 a year. There is a reason that drug companies are marketing them direct to consumer. There is a reason that the stock prices of Merck and Bristol Myer Squib are fluctuating based on clinical trial results.

And there is a reason that countries like Canada and Switzerland are not using these drugs.

Because they do things like cost-benefit-analysis and decide if it is worth it to spend the money. And I don’t think we the people are open to that yet. Yes, we like to point at other country’s system’s and how effective they are and how happy and healthy everyone is, but if a politician in our current, screwed-up I-don’t-really-do-anything-but-campaign system were to introduce legislation that functioned in this way, their opponents would have a field day. They would accuse them of doing things like organizing death panels, just to save a few bucks at the end of life.

So instead, our fearless leaders work on stuff that you will like, ignoring the realities of life, putting out feel-good legislation that lets them look busy and gives them reason for you to get excited about them and get agitated by anyone who opposes their progressive, life-changing ideals. And an excited, agitated voter is easy to manipulate and motivate. Especially with memes. Always with the memes.

 

Belief: The Power of the (Misguided) Mind

I watched a video blog by ZDogg that centered on the difference between “homeopathy” and the placebo effect.  It’s worth watching, but I will quickly dilute it down as best I can: Dr. Damania (“Z” from now on) states that homeopathy has power because it is administered by a “practitioner” who espouses the benefits of some therapy (which typically has absolutely no actual physiologic effects) by describing some magical mechanism (or “bullshittery”).  An example would be acupuncture, which in its traditional thought, is based on manipulation of flowing life force within meridians in the body; or a homeopathic remedy such as using lavender oil to treat anxiety.  As Z says, the effects are real, but they based in the mind-body connection (which is also real); they are essentially forms of the placebo effect.

In case you aren’t up on the lingo, “placebo” refers to the administration of an inert medication or other non-functional therapy, typically as a control in a clinical trial to better demonstrate the effectiveness (or lack thereof) of a treatment being studied.  We know this placebo effect is real, but it is not magic, it is just poorly understood.  And for millennia we have attributed things we don’t understand to the realms of the mystic.  But instead of perpetuating the myth, why not study it, understand it better, and potentially use that knowledge for even greater benefit?

I believe there may be a monkey in the works:  Belief.

Embedded, and potentially inseparable from the placebo effect, is belief.  The patient-clinician relationship is imperative, as the patient has to fully accept that the therapy is real.  So in essence, there is an underlying element of deception that I worry may be essential to the effect.  Not everyone requires this disinformation, some can simply run with it (my father, a dentist, had a patent that could hypnotize herself such that she needed no anesthesia, even through painful procedures like a root canal).  But I suspect few are actually that gifted.

There is power in belief.  Great power.  It is fundamental to religious conviction, and as history has demonstrated, capable of motivating a willing follower to unimaginable acts.  But it can also give strength where it may otherwise be found lacking, allowing people to endure, to motivate them to overcome incredible obstacles.  The mind-body connection can take many forms, but in the appropriate host and use in a positive manner, it can have life-altering effects.

I believe the recognition of this power is fundamental to Dr. Z’s insistence that it not be used in a disingenuous way.  In other words, don’t bullshit someone and say you are going to realign their chakra with a Red-Bull and a jade egg.  Instead, tell them that you are going to play some music or burn some incense, and though we don’t know why, it may provide them some benefit.  I agree that this is the most ethical path, but unfortunately, I also believe it will leave money on the table.  I think there will patients that just won’t get any benefit from a true placebo.  And those same patients may receive tangible results from magic, simply because they believe; in the right circumstances, we should not deny them that benefit.  The question is, how can this be done ethically?

For sure, it has the potential to allow exploitation – with significant financial gain of the practitioner – of gullible patients.  Which is a problem.  A big problem.

This is why it is absolutely imperative that we all recognize the incredible power of belief.  Each of us must be careful in how we create and shape our own beliefs, because we are in a very real sense crafting our own hidden superpower.  So if we build beliefs that are rooted in some egregious fallacy – such as skin color dictates the worth of a human, or another person’s refusal to accept your vision of God means that they must die – then those beliefs may result in catastrophe.

These days, we continuously hear that we all need to be more accepting of other people’s beliefs, to let them live how they see fit.  I agree wholeheartedly, but at the same time, I find this horribly ironic, as many of these same people are often the least likely to truly accept those who have completely different philosophies about things like the nature of the universe.  Even more interesting to me is the fact that we seem to have more trouble accepting belief systems that are near to us; we are much better at dealing with religions or cultures that are truly foreign.  For example, in the US, non-Christians seem more offended and threatened by their Christian neighbors than they do Buddhists or Hindus.

I have certainly struggled with true acceptance of other belief systems.  For one, I have been a doubter since childhood.  I attended  church virtually every Sunday with my family growing up (Methodist).  I would listen to sermons and think, “Jesus said we are supposed to give everything away.  I don’t think we are listening.”  And then I would pester my parents at Roy Rogers (our weekly treat) as to the true nature of the universe.

Since becoming a doctor, I have found myself feeling geuinely threatened by those who would attempt to dismantle the triumphs of science.  On the one hand, I don’t really think someone’s beliefs about the origin of the universe has significant impact.  Yet when the arguments begin to erode the fundamental process of scientific discovery and therefor question its validity, then we begin to allow our society’s collective knowledge to be eroded.  We no longer accept sound arguments of our brightest minds, but instead are susceptible to being misguided by those who would exploit our ignorance (like Andrew Wakefield has done for decades).

How then do we reconcile this cognitive dissonance, and allow others to go through life believing things that are in complete contradiction to our own convictions?  Particularly when we know that these beliefs have the ability to imbue a person with significant – and real – power?  How does someone with deep religious convictions accept another who disputes the very concepts that they hold most dear?  This is a topic for several other blogs, but it is a topic worth spending time on.  I hope to spark your interest in pondering this quandary, because I think it may be at the very heart of what prevents us from truly accepting others.  It represents a source or power that has been used to manipulate populations en masse to commit all manner of societal atrocities.  And yet, if we were to overcome this shortfall, we have the potential to truly advance as a society, as humanity.

The mind-body connection is no more magical than any other awesome element of our reality.  But we have yet to truly understand – and unlock – the potential.  Perhaps in the study of this phenomenon we can also come to a better understanding of how to simply live with each other.

 

Competition in Medicine

For my city, this is a big deal, but it is also a good example of why competition has no place in medicine.   I know in America we are bred to believe that competition is the ultimate method of bringing out the best, but think about what that means in healthcare: if one doctor or facility is the best, then everyone else is getting substandard care.  That’s not the way it should be.  We should cooperate, working together in an effort to provide the absolute best care for everyone.

The government is pushing us – in a good way – towards cooperation.  But like everything, it gets complicated.  And then, we get unexpected results of legislation, and they can be incredibly profound.  Enter the Accountable Care Organization, or ACO.  This is essentially a cohesive medical system intended to provide better care for less cost.  The manner in which Medicare is beginning to pay doctors – and every other payer will follow – strongly favors these legal entities.

It works like this: if I am a solo doctor, I am going to be measured against other doctors.  The better I do (based on some defined metrics) the more I get paid. OK, so far so good.  Now, if I am kinda crappy, I get paid less.  So it is in my interest to do my job well, and this will weed out the bad doctors, yes?  Well sorta.

Good is defined as above the 50% line, and bad is defined as below it.  There are gradients of good and bad, but there is no middle ground.  Which means every year, half of the doctors get a bonus, and the other half take a pay cut…ignoring the fact that few solo private practitioners can handle a pay cut.  And what if all the doctors around are actually good doctors?  That doesn’t really matter, it’s you against the world.  To me, it seems a good method to pick Navy SEALs, but maybe not so much family docs.

But, doctors have the option of joining an ACO.  If you do that, you don’t get measured individually, you get measured as a group.  And these groups have more resources, more ways to save, more ways to cross cover, more ways to perform well.  That’s good, and that’s one of the reasons we are being asked to join up: the results are better.

What’s not to like?

Well, there are some subtle issues.  With ACO’s, individual doctors aren’t measured against each other, they are considered part of a group.  But that group, the ACO as a whole is, it goes up against other ACOs.  To do that, we have to have a way to measure that entire group’s performance.  Which is not as easy as it sounds.  How do we know a group is doing well taking care of patients?  There are all kinds of variables.  For instance, who is actually the patient’s doctor?  You may have a family doc you consider your own, but here we have to define that.  What if you see a specialist, too?  Now who is your doctor?  Is it the cardiologist who does an expensive procedure on you?  Is the person you see the most?  That has to be defined.  What do we look at to tell if they are keeping you healthy?  What if you have a chronic disease?  Does that mean the doctor is not good?  What if you get cancer?  All of these things have to be considered.  It is extremely complicated.

Here is the kicker: because the government needs to measure the performance of these groups, doctors can’t move from one group to the other.  If they did that, how would we be able to figure out who did what?  So what we are left with is: (1) all doctors kinda need to belong to an ACO, and (2) a doctor can only belong to one ACO.

And that, my friends, has huge implications, here and elsewhere.

Because if we end up with 2 different ACOs covering the same area, then we draw a line down the healthcare system and everyone and everything has to get on one side or the other.  Competition.  And that is exactly what we are going to have, right here in little Lynchburg.

For years, we have tried to align all of the doctors into a single entity.  This wasn’t for control, it was to increase collaboration.  But not everyone saw it that way, and for a variety of reasons, the primary care groups slowly morphed into those associated with the hospital, and those that remained independent.   Not too long ago, those independent primary care offices, in an effort to maintain autonomy, formed their own group, with the intention of becoming an ACO.

But it is not so easy.  There are numerous requirements, and jumping through those hoops means all sorts of red tape, and not a small amount of money.  Money for things like an electronic medical record system that can provide the government all the data it needs to judge how well you are doing.  It’s so complicated that the network I am involved in, Archetype Health, is only now considering applying for ACO status, despite being sponsored by the hospital system and thus having far better resources.

So what did the private group do? They joined an outside ACO: Privia Health.

What is that?  Well, Privia is a group of primary care doctors that have formed an ACO aimed at best practices in healthcare.  They have great data to show how effective they are at taking care of their patients.  That’s good, right?  Won’t that bring better medicine to our area?  Well, yes. Sorta.  And sorta not.

One enormous downside is that part about doctors only being allowed in one ACO.  If Archtype Health becomes an ACO – and we pretty much have to with the way the reimbursement formulas work – any doctor in Privia will be prohibited from joining with us, and vice versa.  Which means patients will have to choose.  It means we will not be able to share resources like labs and radiology equipment and electronic medical records.  The very laws that are designed to increase collaboration will actually become the largest impediment to cooperation that our area has seen in a long, long time.

Yes, we can try to work together.  But, intentional or not, the financial incentives will encourage competition.  Let’s say I come up with a clever method of improving outcomes or reducing costs. In an ideal world, I would share that across the region, hoping to help anyone who could benefit.  But now, it will be to my advantage to hoard it at our system, and deny it to those other guys.  And their patients.  And that idea makes me kinda ill.  That’s not what we are supposed to be doing.

And there are other issues too, even more subtle.  I am planning to go through some locally-generated, heart-stopping data about the health of our region (yet another rant), but let me give you a preview: affluent people are healthier than poor people.

No!

Yes, it’s true.  People in poverty do worse in virtually every aspect of healthcare.  What’s that got to do with the price of tea in China?  Let it sink in a bit.

If the government is going to measure my performance on outcomes, how can I make myself look better?  Simple: I just choose to look after healthier patients.  The last thing I want to do is look after sick people, right?  But wait!  That’s not allowed.  I can’t deny service to sick people!  That’s true.

But I can refuse to see poor people. 

There is nothing that says I have to accept patients with no insurance, patients with Medicaid, or even patients with Medicare.  By selecting which insurance I accept, I not only maximize my reimbursement, I automatically improve my outcomes data.  Compared to the other guy, the one that takes responsibility for the uninsured, the under-resourced, the difficult patients?  I kick his ass.  For my own benefit, I skim off the easy, high-paying patients, and I come out looking better, and with much higher margins.  All at the expense of whomever in our society makes an effort to help the ones that need it most.

And that inevitably leads to a little bit of vomit in my mouth.  Bleck. And though I admit I am proud to be on the side that is doing the right thing, that’s honestly not fair.  I know many doctors on the other side of the wall.  And I can tell you that now that most of them are well removed from the decisions and forces that push these changes and write these agendas.  As often as not, physicians are just along for the ride.

This is what happens when business is woven into medicine.  It’s what happens when we try to use competition to improve healthcare.  Because competition favors the one that studies the rule book and finds the angle and exploits it for maximum effect.  That’s simply the way business people are trained.  And there is nothing wrong with that, if you are making smart phones or TVs or some other widget.  But not doctors, not hospitals.  There is no place for that when it comes to people’s health.  And that is precisely why that part of our culture, that competitive mindset, it has no place in medicine.

Taxes and Culture and Creative Solutions

I have this tendency to claim I have all the answers (ask my wife).  No one has all the answers.  Why?  Because, as I love to say, it’s complicated.  (See what I did there, I gave you an answer.  And there is more where that came from).  It’s much easier to criticize and point out the mistakes people make or the flaws in some system than it is to actually get things done.  Probably 99% of the crap being batted about (including much of this right here) falls into that category.  So let’s take a break from swamp and have a little siesta in the land of What-If.

Before this park opens, you need to understand: everything I am going to show you is hypothetical, but all of it is completely possible.  Yes, we would have to make changes in our current system of government to get there, but nothing I am going to talk about is pure fantasy.  Think of this as a teaser of what we might be able to be accomplished if we got fed up enough that we decided to pull together (sigh…world peace…).

We have this big machine that is our American society.  Taken as a whole, it remains the best comprehensive system to date, warts and all.  But could we make it better?  At present, we continue to try to make small adjustments to different aspects – taxes, education, social programs, commerce, etc. – in hopes that these changes will have some sort of butterfly effect on the rest and we will all wake up in a new, perfect world.  And that’s just not going to happen.  Because everything is interconnected, and those connections tend to dampen the results of those changes, both positive and negative.  A tax change here, a new social program there, revision of a particular law; the frenzied arguments in the media tend to outweigh the actual impact.  And when the hubbub dies down, we realize not much has changed.

But what if we started from scratch and looked at the things we have that are working and the things that are necessary and the things that aren’t doing jack sprat, and tried to build a better mousetrap?  The trick here is to try to re-weave the system where each thread can leverage the strengths of other threads.  Like a piece of cloth, instead of a ball of yarn.

Taxes.  The government has to have money to function.  Yes, we have heated debates about who should pay for what and how much and blah blah blah, at the end of the day the government needs some damn money.  But where should it come from?  Can we structure that system better?  Changes always seem to result in one side that is happy and one side that is pissed.  But there are a few things in our tax system that we should maximize because they benefit everyone:  1.  Efficiency.  The less money that is wasted collecting and policing the tax system, the more money that is there to get shit done.  2.  Simplicity.  This ties in a bit with efficiency, because time is money.  And both individuals and businesses should spend as little time as possible dealing with taxes.  3.  Flexibility. Taxes need to be adjustable for changes in our culture and society and businesses and economy.  But we need to be able to do these things without increasing efficiency and simplicity.

Poverty.  Listen up, people: poverty is going to be our downfall if we don’t figure it out.  It’s killing our healthcare, our education, our crime rates, our culture.  Like everything else, it’s complicated.  We need a way to provide assistance in a more efficient, more flexible, and more focused manner.  But more than that, our approach needs to promote community integration.  If we maintain an “us vs. them” attitude, we will continue to build barriers that only sustain the problem.  Our Achilles heel is actually the fact that we care (well, most of us do).  There are societies that don’t seem too bothered by it, and that makes life a lot easier (unless you are poor).  India has one of the fastest growing economies on the planet.  It also has just about as many people living in poverty as our entire population.  And I have a feeling being poor in America looks a wee bit different than being poor in India.  We have to be sure we are extending a hand to everyone here that wants an opportunity for a better life, but we also want to be sure we aren’t flushing our hard-earned money down the drain.  And we have to recognize that all of this is interwoven into our culture.  Our society is based upon our collective views of our values, our education system, our work, our play.  If we want to collectively improve, we have to stimulate growth in the areas that are meaningful to us, as Americans.  Do we value education?  Do we value work ethic?  Do we value recreation and community?  And yes, it’s perfectly OK to see value in goofing off; life is a gift to enjoy!

If we started from scratch and said, “We need us some taxes, yo!” we would probably arrive at a much different system than the one we have now.  Efficiency, simplicity, and flexibility.  We need money, but even as we get started let’s remember that poverty thing.  It makes no sense to take money from people that don’t have enough money and then turn around and give it back.  That’s neither efficient nor simple.  We want to be sure that all of the basics of life – water, food, shelter – they come first.  We also have a huge problem related to poverty and work: the transition from being unemployed and getting benefits, to being employed and losing those benefits.  We have a significant disincentive in place that has to be fixed.  A system that provides a better life to someone sitting on their butt is idiotic.

Whatever we do, it does need to be progressive: no matter where you are, there is a basic “cost of living.”  Taxes should only apply above that line.  And it absolutely makes sense that the further above that line, the more you pay (and that’s as far as I am going to go with that particularly prickly porcupine).

Income tax allows us to tax people at progressive levels, but implementation is a royal pain in the ass.  It is neither efficient nor simple. And though it gives us the opportunity to be flexible, any creative changes designed to provide incentives or disincentives are exponentially more complicated.  Look at the Obamacare tax penalty for not having health insurance: the purpose was to try to change a component of our culture, to create a disincentive for not having healthcare.  But the effects were completely muted by other issues in the system (like ridiculously high insurance costs), and now only serve to penalize and complicate the lives of the very people the program was designed to help.

Just for a moment think on a completely different approach: a national sales or consumption tax.  Now before you spit your drink on your screen and start screaming about VAT taxes and whatnot, let me be absolutely clear: having two primary methods of taxation – income tax and sales tax – is just stupid.  It automatically jettisons our ideas of efficiency and simplicity.  Pick one and size it where it needs to be to get the revenue you need.

As a citizen, which do you find easier to deal with?  I already pay sales tax, and it’s just not a big mental burden.  Yes, it would be a shock if I went into a store and the sales tax on the latest gadget was something like 25%.  But it sure would be nice to get a paystub that just had one number on it, eh?  You know, the bigger one, before all of those damn withholds?  And anyone that has run any business can tell you that sales tax is crap tons easier to deal with than employee payroll/income tax.

But wait, it would by completely non-progressive, and crush the poor!  Not so fast… here is where we get to be flexible.

Basic needs, they are pretty easy to identify.  Housing.  Power.  Water.  No taxes here.  What about clothing?  What about food?  Well, there’s food and then there’s food.

America is all about freedom, but we are increasingly seeing problems where our cultural choices are starting to hit us hard in our bank accounts, and food is a perfect example.  Let’s be honest with ourselves, we are not setting the global example of healthy eating.  On the contrary: as other nations adapt our fast-food lifestyle, they are acquiring all of the health problems that go along with it.  How do we incentivize people to eat better, and in particular, make those choices more available to the ones that are for a variety of reasons most affected: under-resourced?  Simple: don’t tax unprocessed food.  Meats, vegetables, breads, baking needs, sauces… no tax.  Oreos?  Have at them, but you pay tax.  You want to eat out?  Again, no problem, but you have to pay tax on that too.  Fast food has its place, because it’s fast, and we should be free to eat all the Big Macs we want (or should we…), but they are a luxury, not a necessity.  Not only do we have a method of incentivizing good choices, we can create disincentives for bad choices.

But wait! We can get even more creative.  We have lots of gadgets, almost all of which are “luxuries.”  But these days, things like computers and cell phones are becoming less and less frivolous, and more and more important.  With a consumption tax, we can be much more flexible than with an income tax.  A cell phone is necessary, but the latest smart phone 11.0 is not.  “Basic” models of any sort of good could be considered for exemptions, including things like appliances, even hot water heaters or AC units.  And that benefit is seen at the counter of the store, not after filling out forms and applying for an exemption.

There are other benefits to a consumption tax besides simplicity and efficiency and flexibility: it’s unavoidable.  We continue to have discussions about income inequality and who pays their fair share and the rich dodging taxes and on and on.  Moving to a national sales tax means that we can stop arguing about inheritance taxes and trust funds and capital gains taxes.  Because you get taxed on what you spend.  Lamborghini?  $100,000 party?  10 million dollar boat?  Have at it!  The family that lives simply will pay very little taxes, those that wish to be extravagant will be taxed appropriately.  Not a citizen?  Sorry, looks like you don’t have to have a social security number for us to collect.

Is this perfect?  Oh hell no.  But how perfect is our current system?  Not very.  And this would be much more efficient (we would still need an IRS, but no tax returns or audits of individuals).  And way more simple: April 15th becomes just another day of the year.

So what are the real downsides?  Well, for one, politicians use tax laws as currency.  You know, give a break here, get some campaign money there (it’s bribery, but we don’t like to call it that).  That ability would go away, and so it would be met with all sorts of illogical arguments because they never like losing power.

Anything else?  Bueller?  Bueller?

So how might swapping our tax system to a consumption tax address cultural issues dovetail into poverty and social programs like welfare?

I recently heard a story where a local guy pulled up to the light next to a gut with a sign that said “hungry, will work for food.”  The man rolled down his window and said, “meet me across the street at McDonalds.”  And the down-on-his luck sign-holder did just that.  After very brief introductions, our good Samaritan asked what the gentleman wanted from the menu, but was a bit irritated at the reply: “how about you just give me the money?”

“I thought you were hungry?”

“I’d rather have the money.”

One of the biggest criticisms of programs like welfare is that they aren’t effective, that we are just teaching the dolphins to come to the boat.  Or to buy drugs.  If we hand out a check, we have little say in what someone does with whatever money they get from whatever program.  So why do we continue this way?

Why not issue a card?  Instead of mailing checks or direct depositing into accounts, we should provide cards that work essentially as credit cards as far as merchants are concerned.  With today’s technology, this would provide significantly better oversight of where the money goes.  Categorizing goods in order to stratify them for a national consumption tax would pave the way to allow the purchase of certain items vs. just providing unregulated funding.  Look, I don’t want people, especially children, going hungry.  Or being without power or water.  But I also don’t want someone taking the money intended for basic necessities and blowing it on the next fix.  I’d also like to encourage them to shop at a grocery store, and I am willing to cover a basic stove and transportation costs to avoid having kids grow up under the reign of Burger King.  A completely electronic system would allow us to provide continued and graduated benefits, from full coverage of certain goods to partial coverage, allowance for items necessary for a particular job, even short term loans for establishing credit.  A graduated step-down helps to eliminate the disincentive that our current system has in regards to benefits, such that people would actually see the positive effects of working vs. dealing with the hassles of a job and losing income at the same time.

The same ideas could be applied to transportation and healthcare.  And of paramount importance: connected to education.

I don’t care who you are or what you think about our public school system, we as a nation must strive to increase the value we place on education.  There is tremendous discussion about opportunities in school, but little is said about personal responsibility.  Mostly because it’s political suicide to even hint at what we all know to be true: involvement in school is the key to success, and is essential to escaping the cycle of poverty.  We as Americans have an obligation to try work towards at least a basic education.   And that extends to parents, who should be held accountable for their efforts (or lack thereof) in motivating their kids.  If Jack (or Jill) doesn’t show up to school, that should result in some manner of feedback in regards to the parents benefits.

With careful regulation of the way benefits are utilized combined with integration of real-time information from institutions like the workplace, schools, and law enforcement, the potential for positive (or negative) reinforcement of behaviors is tremendously increased.  And that means better results for the same investment.

We never get things right the first time out of the blocks.  These types of systems are virtually instantly modifiable.  Want to changes tax rates with today’s system?  You’ll be waiting until next year.  Want to change benefits for parents with kids in school that are having some specific social issue?  Uh, say that again?

But here, changes are just a click away.  And we need that flexibility to try new ideas and plans and see how they shake out, to measure the results, to evaluate for unintended consequences.  If we move towards this type of global approach, as opposed to working in silos and  talking just about taxes or just about education or just about food or just about transportation, we can unwind the ball of yarn and build a cohesive, more effective system designed to maximize the results of whatever we put into life.

Wouldn’t that be better than picking some line item and fighting about it?

ZDoggMD

I would describe my recent discovery of Zubin Damania as stimulating and empowering.  My daughter described it as a “man-crush.”  Whatever.  It takes about a half a minute (which admittedly is 2x standard internet attention span) to pop the top on the genius contained in the satirical videos relating to the various issues in healthcare (my current fave being this Hamilton / Pharma sketch).  Here is an internist – you know, a generic doctor – that can put together a video which not only gets my wife rapping along (she never asks me to play guitar for her, WTF?) but also nails laboratory issues like a closet pathologist (there is a part of me that worries he would be better at my job than I am).  And if you take the time to actually listen to what he has to say (which I did last night with such enthusiasm I completely neglected to even ask my daughter how the first run of the school play went…I am sure it was fine) you get an appreciation of the depth of the intelligence and wisdom combined with a level of empathy that seems almost non-existent today.  Give me a hell yeah!

In comparing our philosophies on the current healthcare debacle, it is like hearing someone describe my interpretation of a movie, but using completely different adjectives and phrases. I just want to blurt out, “Exactly!  That’s what I have been trying to say!” His “Healthcare 1.0” is the old style, family doc centered model that has been replaced by our current fee-for-service, push-the-buttons-for-reward “Healthcare 2.0” system.  And now we are trying desperately to shape a new and better process, one that reorganizes the implementation of our assets with a common goal of helping people stay healthy, “Healthcare 3.0.”  Somebody gets it!

What is even better is that we are working in completely different, arguably polar opposite spheres: he is in Las Vegas, a city that is essentially ten times the size of my little town, with many variables and challenges completely foreign to central Virginia.  Why is that better?  Because to affect real change, the plan has to be applicable anywhere. As idyllic as Lynchburg is as a potential model (we have much greater opportunities for cooperation and unity here), there are many other significant factors that must be considered in the development of “universal” healthcare.  This let’s us compare the growth in two different petri dishes.

Beyond the medical arena, he serves to demonstrate the fundamental problem with our political system.  Because here is another example of a phenomenal person on par with the Tom Colby’s and Kevin Leslie’s and Dora Lam-Himlin’s of the world, all physicians with whom I had the honor to learn from at the Mayo clinic, each of which has an inherent brightness that throws a shadow across the offices of our leaders, if for no other reason than people of this quality will never participate in the current system.  And these are the very folks we actually want in those jobs.  But you will not see Dr. Damania quitting what he is doing to run for office.  And why would he?  His intellect and wisdom and empathy are neither requirements for any political position, nor are they helpful in negotiating a campaign that demands villainizing an opponent and creation of a platform of promises based only on their ability to be fed to an eager public, as opposed to affecting meaningful change.  And yet all the creative ideas and potential solutions won’t remedy the fact that we rely on the lawmakers to actually implement the plan.  We gotta fix healthcare, but we will have to fix the system before we can.

Luckily, he is appears poised to fight for that change, and unlike me with my wordy rants, he may be genuinely effective.  And that is what has lit my enthusiasm up like a plasma torch.  OK, so it’s a man-crush.  Whatever.  Tune in, listen up, share the love!  (Follow him on Facebook, or whatever your preferred social media)

Oh, and that play is tonight too!

 

 

Planned Parenthood

The ruckus about Planned Parenthood is a great example of using a contentious, binary argument (abortion) to shroud a societal issue that is much more stubborn and pervasive (poverty). If you are a politician, taking a firm stance either for or against abortion at least assures you will have a large group of people standing with you, regardless of the side you chose. But introducing legislation genuinely aimed at trying to reduce the scope of a multifactorial, racially-tinged, societal blight that has been plaguing us since the dawn of civilization is not exactly a “safe” road to travel. It’s more like going for the win in the Indy 500 wearing just your undies and skipping the seat belts: even if you’re not the one that causes the crash, you are still going down in flames.  The abortion issue will never be resolved, simply because there is no answer. In an idealistic world, we would never ask the question, but our world is far from ideal. It is reasonable for an individual to take the stance that they will never personally support abortion in any form. But, unfortunately, our society as a whole – and that includes our government – doesn’t get off that easy. Look at international relations: should we go to war with China? After all, they continue to have state-mandated abortions. Think on that: here, we argue about whether or not a teenage girl in poverty with no support is able to terminate an unwanted pregnancy; but in other countries, authorities force pregnancy screening and will kill a wanted child in the womb of a loving mother. Funny that we don’t see many folks protesting…

Probably the biggest difficulty that Planned Parenthood faces is rooted in statistics: we can count abortions, but there is no way to count the number of prevented pregnancies. I will ask you this: isn’t it better to provide services that allow a teenage girl in an under-resourced environment where everything – parental guidance, education, healthcare, even basic needs like food and shelter – is a struggle, to not get pregnant; as opposed to preventing that abortion, resulting in a child born into those same conditions, and all but assuring that the mother will never climb out of her situation, continuing the cycle of poverty and adding to its participants? I will answer for you: it’s not only better, it’s tremendously better. But the scoreboard never reflects the results. It’s much easier to simply say “abortions: no” than it is to delve into the dirty complexities.

But that’s reality.    

I have two teenage daughters. As a physician, I have seen enough “it-will-never-happen-to-me” parents to know that my family is not immune to any situation. But I know that the funding or defunding of Planned Parenthood is not going to directly affect us. Because we are not poor. We have the resources to deal with whatever comes our way. We have the luxury of idealism. Not everyone has that luxury. Planned Parenthood by definition is serving the under-resourced, and we cannot ignore the spectrum of differences in our situations throughout society. And don’t pretend that because it doesn’t affect you directly, that it doesn’t affect you at all. We all have to deal with the burdens of poverty.    

If you are idealistic and you struggle with these issues, consider this: poverty is essentially fertilizer for evil. Crime, drugs, terrorism, abortions, you name it, it’s rooted in poverty, whether here or abroad. Ghengis Khan, Hitler, ISIS, Osama Bin Laden, the downtrodden are ripe to be steered towards a goal, with nothing to lose. Realistically, it will never be eliminated. But it is essential that we do everything possible to mitigate its effects. And that means we throw all of our collective resources at it, whether those are social, educational, or medical.

No, I am not a fan of abortions, and I would also vote for a reality where the question was purely hypothetical. But it’s not. As always, it’s complicated. It can’t be reduced to a binary decision based on one facet. It has to be put into context with contingencies in place to balance the effects of our decisions, not just on an individual, but on society as a whole. Planned Parenthood is not a binary institution, it is a complex organization addressing a complex problem. So don’t try to reduce it to a “yes or no” question.                      

Science!

As a scientist, I implore all of you other science-minded activists to recognize that this current round of protests is yet another byproduct of a system that thrives on controversy without regard logical discussion of rational solutions.  It’s a really just a bunch of noise and clever memes.

As a car guy, I am going to use the transportation sector as a quick (I know that’s unlikely, but I will try…) example.

We in America love our cars.  We like making them, we like driving them.  Our country is big, and we have a lot of people, and we churn out a lot of exhaust.  Regardless of whatever data is out there on climate change and carbon emissions, no one can argue that we burn up a lot of gas.  Burning gas puts out two kinds of stuff: really nasty stuff and carbon dioxide.  OK, that’s oversimplifying, but still: there is the poisonous smog stuff and then there is the CO2.

Back in the days of hair metal and cassette tapes, the nasty stuff was really nasty.  People killed themselves with cars – literally – as the carbon monoxide alone was enough to snuff you out.  With modern cars and the incredible, scientifically-designed systems, that’s not going to work.  So if the political turmoil puts you over the edge, you are going to have to resort to another method.  (As expected, firearms are numero uno here in the states, where hanging is the most prevalent worldwide.  But neither fact has anything to do with the underlying cause of suicide, or climate change).

OK, so through science we have come an incredible distance dealing with the nasties of exhaust, but we are still left with that pesky CO2.  How to reduce that.

I know, legislate it!  We will simply make a law that says cars will have to get incredible gas mileage!  Like 54 miles to the gallon!  Done.

Oops.  Maybe not.

See, the reality is that cars are tools that do work for us.  We don’t like to do things like move ourselves and our stuff around on our own power (which some countries call walking).  That work requires energy, our favorite source of energy for transportation is gas.  The more work, the more gas you burn.  Yes, you can make things more efficient, and we have.  But there is a limit, and we are really close to that physical limit.  In other words, science has run out of options.  Or at least real-world options.  We can make laws about gas mileage, but those laws won’t change the laws of physics that say things like if you want to move big vehicles with air-conditioning and heated seats and crumple  zones and iPod adapters around town, it is going to take energy.

So let’s apply some advanced math: 4 people in a car that gets 25 miles per gallon is equivalent to 1 person in a car that gets 100 mpg.  Except the first scenario is not only realistic, it can be done today.  However, the second scenario is completely unattainable; it would require sacrificing safety and comfort standards that we are not going to do.  It would be almost as uncomfortable as riding a bicycle.

By the way, I tried to calculate the effective miles per gallon of a person on a bike, but there are so many variables, like how many burritos the rider ate, and how much gas was burned growing the corn for the tortillas, it’s just too much.

But what all of this advanced math should show you is that we have very real options, right now, right in front of us.  But there is a big problem with those options: we won’t really like implementing them.  We don’t actually want to do things like walk and ride bikes and carpool and take public transportation.  What we want is for science to make it so we don’t have to do these things.  I mean, a clean environment is one thing, but it shouldn’t impact our lifestyle.

And if a legislator suggested mandating any of these things, it would be political suicide.   

Which brings us back to those politics, and all of the debate about science and the environment.  One side takes the “pro-environment” stance, and who can argue with that?  You want a clean world to live in, yes?  So, they put out unrealistic regulations that have the appearance of being logical and supportive of our environment, that don’t require citizens to actually contribute.  Sweet.  And the biggest complainers are the auto makers, who clearly are just bitching because this is going to cut into their bottom line, and that’s the only thing those evil bastards care about anyway.  It’s us vs. them!  Perfect!

And then there is backlash from the other side, who in a fit of world-burning insanity want to repeal those same regulations.  And a bunch of other stuff that is actually very important but happens to be tied up in this mess but is lost in the minutia because we aren’t actually looking for solutions, we are just trying to appear to be doing so.

And in the end, nothing genuinely productive happens, we just get all riled up and active, ready to do all kinds of work to oppose the other side.  Which is only going to serve to increase the illogical divide between us – yes, illogical, because no one wants to actually burn the earth, we simply aren’t communicating.

If you really want change, then change the people making the decisions and the way they operate.

Or both sides can keeping protesting.  I am sure that’ll work.

Gun Control: the Compromise

Thus far in this discussion, we have yet to genuinely consider a compromise.  I am not even sure if we remember what a compromise looks like.  Because in this case, it isn’t the elimination of private firearms, and it isn’t a continuation of essentially no regulation.  Nor does it look like Donald Trump’s description of a trade deal, where we “win” by sticking it to the other guy.  The idea is not to beat the opposition, particularly when that opposition represents your own countrymen.  The idea is to arrive at a solution that satisfies both sides, and then we all win.  The one arena this doesn’t apply to is the current election process, where this type of work does little to strengthen a campaign.  Which is why our leaders are disinterested.  They don’t have time to waste on work that will not keep them in office.

It starts by considering the essential pieces of the opposition’s viewpoint. You have to understand that viewpoint, you have to validate it as a logical ideology, even if you don’t share it.  Not easy.

On the one hand, we have literally millions of firearms in circulation that were designed with one purpose: to kill things.  We need to control these.  This is not an unrealistic position, and even if we say that we have a right to bear arms, the manner in which we interpret our constitution’s protection of other inalienable rights – like speech and press – allows for that control.

On the other hand, we have a need to maintain our ability to protect ourselves, both from others in society, but perhaps more so from the potential actions of our government itself.  This is also a very valid stance, built upon the fundamental ideology of our nation.  And it means that we cannot allow the government to regulate that right if we are to guarantee our ability to resist that very entity.

OK, so we need regulation, and it can’t be the government that does it.  Why is this so difficult to resolve?  Have a private regulatory agency.  It is so obvious, the fact that it has not been done should make you ask the questions I want you to ask: WTF have these people been doing?  How long do we intend to go like this?  How many decades more will we perpetuate a system that puts leaders in place who are gifted only at campaigns, and are dissuaded from actual compromise?

A private regulation for firearms is actually preferred.  For one, it doesn’t cost you the taxpayer any money, where government regulation does.  The financial burden should be borne by those who chose to participate; you have a right to have a gun, but if I am not interested, I shouldn’t have to pay for it.

Second, it is far easier to include assessment of mental health, an absolute essential component of effective regulation, which would be extraordinarily complex for the government to implement with today’s healthcare privacy regulations.

Most importantly, you already have the infrastructure, the technical knowledge, and the motivation to do it effectively.  And you have all of that wrapped up in an organization that has fought so hard against the government intervention that they simply cannot refuse being asked to take on the task themselves: the NRA.

I for one understand that I am walking into a barroom brawl.  This topic – like many of our most contentious – is not being calmly, rationally discussed anywhere.  Both sides have been marginalized through our climate of political inflammation.  No one stands in the middle.  We only have two types of people: those that believe we should all hold hands, sing songs of love and peace, and commit to a diet of wild-grown nuts and lettuce.  And then we have those that feel we should rally our efforts to provide fully loaded assault weapons to everyone as they are released from local mental hospitals and prisons, with maps to the nearest churches and schools.

The NRA (aka the “gun lobby”) is currently pushing for national concealed carry reciprocity, and that legislation is being fought by the “anti-gun lobby.”  If you look at the arguments on both sides, you will see that neither is really considering the position of the other.  Everytownresearch.org begins with a dramatic story of a nut-job who goes on a shooting rampage.  I have to ask, does anyone really believe that this guy was careful in considering the legalities of his actions?  Maybe this legislation is peripheral to the real discussion, and by simply shouting insults instead of listening, we are in effect shooting ourselves in the foot.

A better overview of the issue is (somewhat ironically) posted on Aljazeera.com.  If we calm down and consider things just a bit, we might see that reciprocity primarily affects law-abiding citizens (sorta by definition), and primarily if they happen to be travelling.  But I am not here to even work on this issue, I am simply pointing out how peripheral it is to the real issue: a complete lack of ongoing assessment of a gun owner’s competence.  Because both sides are simply hurling insults, we are stuck in a stalemate, and politicians churn over laws that in reality have virtually no effect on anything but our psyche.  The passing or suppression of this legislation, like the assault weapons bill of the 1994, will have exactly zero impact on gun violence, and will instead have its greatest effect at voting booths.

We have to rationally evaluate what we are trying to do and come together in a productive manner.  And that means leaving the playground behind.

The National Rifle Association is largely misunderstood by those on the left side of this discussion.  But that misconception is brought on by the same political environment in which it operates.  For those who believe the world would be a better place had the gun never been invented, the NRA is a bastion of insanity, seemingly staffed by lunatics who thrive on senseless violence.  For supporters of the second amendment, the NRA represents the primary force in preventing brainwashed sheeple from allowing the corrupt government to systematically disarm its subjects prior to bending them to a sinister, self-gratifying plan.  Perhaps the real truth lies somewhere in the middle.

If you are going to stereotype the typical NRA member, at least get it right: they are patriotic, knowledgeable, organized, fervent supporters of our constitution.  If you don’t know any members, if you haven’t been to a class such as a course for concealed carry, if you aren’t truly educated about that which you oppose, then you need to listen prior to passing judgement.  Likewise, those on the other side of the aisle need to recognize that yearning for peace, regardless of the implausibility, does not make you a lesser American.

An artful compromise satisfies the needs of each side.  On the one hand, we want regulation of firearms.  On the other, we want the freedom to defend ourselves independent of intervention from the government.

There is delightful irony in privatizing firearms regulation: those arguing against that very regulation have no more argument.  Furthermore, the process would build that same organizations membership base and involvement. Think about the implications of that fact: if the NRA set in place the licensing system for ownership of firearms and purchasing of ammunition, its membership would grow dramatically.  And no, that’s not a bad thing.  At present, anti-gun folks dread this, but remember that the increased participation would be commiserate with increased scrutiny, and isn’t that what we are really after?  Personally, my primary criticism of the NRA is the fact that they have not been leading the way down this road.

We cannot pretend that the gun lobby does not exist.  What?  Did you think we stepped into some utopia where these things are not genuine factors in the forces that shape our society?  (I am encouraging us to work towards that goal, but until then, let’s be realistic, shall we? And that’s for another blog).  Requiring regular training to maintain licensure would only serve to increase the sale of guns and ammunition.  And gun manufacturers, despite the meme’s to the contrary, don’t actually want to sell guns and ammo to bad guys, they just want to sell guns and ammo.  And this would let them do that, again, in parallel with ongoing evaluation of said owner’s fitness.

What would the requirements for licensing look like?  My suggestions would include regular demonstration of competence (every two years?) to maintain a license for purchasing any firearm or ammunition, which would include some form of a mental health exam.  The more dangerous the weapon, the more stringent the requirements, not unlike a driver’s license.  If you want to drive an 18-wheeler, you need a bit more training.  The details would need to be hashed out, but keep in mind: at present we have nothing.  Anything is better than nothing.

Compromise is easily achievable.  We just have to make an attempt to come together, to work together, to validate the opposing point of view, to find a solution that satisfies both of those views.  Unfortunately, this wouldn’t be good for anyone’s campaign.  Because genuine solutions aren’t good for campaigns, winning is good for campaigns.  And when it comes to our government, anytime one side wins, we all lose.  Even the victorious.

Gun Control, Stage Right

It’s a bit of a toss-up as to which side to analyze first (If you are coming to this late enough, which is highly likely, then I may have the other view done, and you can chose which order you want to read).  Remember, it’s not helpful to sit about with people who have the same view as you and commiserate on the stupidity of the other side.  Instead, read both, and try to put yourself in the shoes of the other person to see where they are coming from.  That’s the only way to find middle ground.

The Constitution.  It wasn’t easy getting that thing passed, the fear of an oppressive government looming large.

“A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.”

The fundamental premise of our country is freedom to do what you want to do, so long as you don’t interfere with the rights of others.  For the bulk of us who actually care a bit about those others, it is irritating that we have to have so many rules.  But such is life; there are bad people in the world.

As much as possible, I would like to prevent said bad people from doing anything unseemly to those close to me – the wife, children – oh, and myself included.  I feel strongly that it is my right to take steps to achieve that goal, so long as I don’t interfere with the rights of others.  I am not alone in this belief, and my interpretation of the wording of the second amendment is supportive.

Some say that’s crazy.  Or more specifically, unrealistic.  They may site statistics that show I am more likely to shoot myself in the ass than use a gun to protect my family.  Fair point.  But here is where you get into the concept of freedom.  Our constitution does not state the things that I must do because they are the most logical choices.  I get to do whatever I want.  Even if it’s stupid.

For example, I can spend all my spare money racing a car around in a circle.

Because in many ways, freedom is a mindset.  Think on the revolution itself.  We could have easily continued to accept British rule, paid the taxes, and gone on with our lives.  But we wanted independence, we wanted freedom.  We wanted to make our own choices, for better or worse.  Sometimes it’s not the end result so much as: can I live with myself if I do otherwise?  Do I have an obligation to take steps to potentially deal with someone who might break into my house in the night?  It is a personal choice, so how you feel about the scenario has no bearing on my decision.

This is usually the point in the discussion where some start saying, “you don’t need an assault rifle to protect your home.”  Depends on the home, and what you are protecting it from.  Recently, a man in Oklahoma shot and killed three intruders with an AR-15 (a semi-automatic assault rifle).

We could have a long discussion about this case, about the type of weapon, about whether or not deadly force was necessary, should charges be filed, with whom does the blame reside.  We can even compare this to the countless others where the bad guy wins.  But at the end of the day it comes back to freedom.  Who are you to tell me what is necessary?  If I am not interfering with your life, I have the right to do as I set fit.

But we do put limits on those rights.  All of them.  We have freedom of speech, but there are limits (slander, perjury, yelling “fire” in a movie theater…).  We have freedom of the press, but you can’t just print anything you like.  And we have the right to keep and bear arms, but there are limits.  The discussion really should be centered on those limits.  But we haven’t quite gotten there yet…

The major argument from those who are the most dedicated supporters of the second amendment is the ability of the people to defend themselves against a tyrannical government, but there are many who seem unable to get their heads around this entire concept.  That sort of thing could never happen here, and we are above the atrocities committed by others around the globe.  Besides, what good is a little rifle against the might of the government?  If it all goes south, resistance will be futile.

I have a great deal of statements for people of this mindset.  But the most important ideal embedded in all of the rhetoric is that, if our country goes in a direction that I find unconscionable, I don’t have to be a party to the injustice.  I might even be a small impediment.  Would such action be a useless endeavor? Perhaps, but that’s not the point.  Many people lost their lives in similar acts during World War II, but few look down on such defiance today.  There are scenarios where I would find it difficult to live with myself if I simply sat back and did nothing.

This is the foundation for the demand that government be left out of any regulation of firearms.  If the establishment has a list of the third of the population that could prove the most ornery in resisting some grand scheme, they will be the first to be silenced.  If there is to be any hope for the people, we cannot allow this, as it would swing the balance of power so far in favor of the government that resistance truly would be futile.

For anyone that feels a shred of emotion, there are few things that can dull the horror of an event like Sandyhook.  But the atrocities of the Holocaust are so immense that it is hard to put the numbers into meaningful perspective.  It would be like systematically murdering the entire population of Switzerland, every man, woman and child.  We cannot for any reason be complacent in such a plan, and if the price is a society that makes random acts of violence more common, then we have no choice but to bear that cost.

I will admit that this has not been high on my personal list of fears (though recent events do raise my eyebrows).  The scenario that I feel is of greatest concern is not the oppression of a tyrannical leadership, but actually the complete lack thereof.  It is a situation like the aftermath of hurricane Katrina that scares me.  It doesn’t take many days without power to start to recognize the veneer of security our present day society provides.  If by some natural or man-made disaster we lost all of our precious utilities, what then?  My family will quickly tell you how long I will last without a shower.  My ability to provide for them with traps and snares is going to result in an unavoidable weight-loss program as I get up to speed.

In such a situation, the defense of one’s home takes on a whole new meaning.  It is one thing to consider that the police may be several long minutes away.  It is another thing entirely when they won’t be coming at all.  Mix that with the animosity that inevitably follows a regional lack of resources, and I will be having that assault rifle, thank you very much.

Are there other happy countries that feel differently?  Yes.  But embedded in my psyche as an American is the right to protect myself and my family, to have a means to provide for them when the promises of our society fail, and to choose to resist any plans of unconscionable injustice.  No matter the utopia you wish were so, no matter if others in other lands smirk or even scoff at this ideal, it is without question one of the inalienable rights.  And the document that was signed in the formation of our still great nation agrees.