Against Having it All

(Originally, this flowed out of healthcare: I thought that it deserved its own post) 

It is extremely challenging in this world that chants 'you can be anything' and 'you can do anything' to make decisions and have discussions about trade-offs, opportunity costs, and the fact that you can't have it all.

I think the 'have it all' outlook has been, and continues to be, incredibly damaging to individuals and the health of society. Paradox of Choice, by Barry Schwartz, articulates the problem incredibly well (and then beats it into you after the first 20 pages with interminable examples). You cannot, in fact, have it all. You have to make choices, and this includes eliminating options, i.e. not having it all. You can't be a doctor, a lawyer, an astronaut, a Hollywood superstar, a mom, an author, a politician, an artist, a teacher, a businessman, a friend, sister, cousin, daughter, reader, and long walk taker. Or at least not all at once. Which means you have to make a decision, eliminating some choices, at least for now, and committing to others. Yet with the 'have it all' outlook, we have deprived ourselves of systems for making decisions, by claiming them unnecessary, and the supports for following through with decisions, once made. 

Where does this leave free will? A question for tomorrow, once well rested. 

Health Care: Brits v. Americans

I was quite impressed and inspired by an interesting NY Times article on drug costs and the British healthcare system, and the follow-up letters. The British healthcare system is almost alone in considering effectiveness data and costs in deciding which drugs and treatments to provide. 

These are conversations the US seems unwilling to have, taking an attitude that all drugs, no matter how costly, should be marshaled at the patient's request, never mind the costs to the health care system, that health care costs may now be out of reach for a low income family with a sick child. Can you imagine our government consulting a citizens group to decide whether a 75-year old should receive the same care costs as a 5 year-old? To say nothing of conversations truly denying the 'right' to million dollar medical care.  

No matter how hard it is to determine the value of a life--seeing a grandchild, or a child graduate--I very much agree with the reader who wrote in to say: 

In a world of limited resources, every choice has an opportunity cost -- we forgo the value of that on which the resource would otherwise have been spent. Extending a life by a year, for instance, might reduce other people's life spans, or educational opportunities. 

So, either implicitly or explicitly, we unavoidably place a value on a year of human life. Most of us prefer implicitly, so we don't have to face the fact that we're doing it. But this avoidance is inefficient; society pays for it in many ways, including life years. 

I applaud the British people for facing up to reality. 

I do also sympathize with the reader who points out how unappealing this is to Americans who have battled managed care, spending so much on preventing care and battling claims, to again set up a system that denies them some care. However, a system that involves citizen dialogue for setting limits and boundaries, and articulates opportunity costs, bring the problem and question into the public consciousness, rather than leaving such decisions up to purely profit-seeking business minds seems far more promising. 

Codicil to the Criminal Justice System

I generally take significant umbrage at those who would blame the media for creating problems. I think much of the quality of media we receive is what we want and deserve: easy. Life is stressful enough most of the time, thank you, I do not need further problems presented to me when I look to leave my life, when I seek entertainment and escape.

One escape is the media's treatment of criminal justice. And here I do think they are creating a problem through incredibly irresponsible journalism. It is the same problem of perception that surrounds Islam, the creation of monsters rather than men. To pillory someone, they must be painted in the darkest of terms. Thus, 'news' shows that set men up to be monstrous pedophiles, and create the perception that terror lurks on the internet, rather than amongst your real, flesh and blood, fellows. You know the person who hurts your child, 90% of the time. And they do not report the (admittedly, remarkably hard to find) facts that might actually prevent crime. What they do report incredibly distorts perceptions of issues that are incredibly important to Americans (that is, after all, why they watch).

Not that the average American viewer will be terribly likely to write into a TV station to say that he wished the murderer's portrayal had been a little more nuanced and sypmathetic. It is so nice when they are monsters, and could never be us. We can just lock our doors, pull up our blankets, and not worry our pretty little heads. And the media these days certainly appears unlikely to challenge our cozy assumptions. Even if they do not reinforce them, I have yet to see a strong strain of denouncing them, and all the public benefit that might bring. It is only if we understand a problem, and its causes, that we attempt to solve it. And our understanding of crime and the criminal justice system is seriously warped by how the media and press covers it; this skews the answers we seek, and the plans of the officials we elect, to our certain detriment.

The Criminal Justice System

So I have a tendency to get excitable about the injustices in our criminal justice system. However, I wanted to find some good, reliable facts about the problems currently facing the criminal justice system. I could not, however, find a quality informational source. There were many sources essentially compiling news articles about recent sensations in the criminal justice system. Actual information, however, is a lot harder to find.

Here is the one that got my attention rolling in the first place, though. The average operational cost for keeping a prisoner is $24,000 per annum (this number from Amicus). One out of every hundred Americans is currently incarcerated. This is a huge social cost, both in what we have to pay in taxes and in the lost contributions from these individuals. And yes, I do believe that criminals can contribute. If we let them become anything other than criminals (This is not so as to say that they did nothing wrong; only by making them personally responsible for their actions can we also allow them the possibility of and responsibility for personal redemption).

Perhaps we could cut all prison sentences in half, and for what was originally a two year drug sentence, imprison someone for a year, and then get her clean, with a GED, job skills, and improved mental health. Or use that money, and invest it ahead of time, to give her an education and future before things go terribly awry.

One major predictor for reoffense is whether or not an offender successfully reintegrates into the community. This is a joint effort on the part of criminals AND society. If someone who molested a child cannot find a church that will welcome him, it will in fact make him more likely to reoffend.

Not that this is easy for either offender or community to be open to. However, my personal perspective was significantly readjusted when I learned that the greatest predictor for sexually abusing children was having, one's self been abused as a child. So we can sit on our high horses, and say "he should have known better," lock him up for life, and never teach him better... or we could get down off our fear and pride and make things truly better.

It is quite frightening to address issues like child sexual abuse as public health issues. It's a huge move to make to say that this a problem that the, well, public has, as opposed to those scary monsters over there, who we shall lock up the minute we find them out (I shan't even begin to expound on the notion that perhaps it would be better to not have this problem happen in the first place, and that prevention is more than paranoia and extreme reactions). And it is a problem truly belonging to us; 90% of children are abused by a family member or other known and trusted adult.

It is so much nicer to think that you can lock monsters away, you can slay them, vanquish them, speak in grand terms that appeal to people who would like someone else to police the problems out there, thank you, instead of having to realize there are problems here, and everywhere. It is so much easier to sensationalize, to make men into monsters we can punish and keep at bay, than to try to address the intergenerational roots of problems such as drugs, alcoholism, child sexual abuse, racial inequalities, violence, and despair.

Prisons in no way solve the problems that sent men and women there. They just allow us to dust our hands of them. A 'serious' and 'tough' approach to crime would deal with crime prevention, including recidivism, rather than the monsters we weave around the real human suffering and misery represented by offenders.

To treat criminals as the people they are, to look into their eyes and say -- you might, but for the grace of God, have been me -- is by far more true, helpful, and humane. Our urge to punish and shun just condemns us, and our children to more of the crimes we claim to abhor, and to more lives lost into the swirl of the criminal justice system.

Rare Events

For an excellent article on the relationship between statistical literacy and human liberty, see http://www.guardian.co.uk/technology/2008/may/20/rare.events

I especially appreciate the point about how rare it is for strangers to sexually abuse children. If we actually cared about kids, we would address the problems created by authority figures and family members. However, it is much easier to create phantom faceless monsters to blame for all our problems and program and rail against, rather than addressing the complexities of real problems, which might involve admitting painful realities. 

It is incredibly important to be informed on the actual problem if you want to solve it. 

The Role of Government

It seems to me that a great deal of the political flack that is flying has been orbiting a center of assumptions regarding the nature of government, assumptions that are not themselves articulated or debated.

Specifically, there seems to be split amongst those running for government office as to whether or not government is, in fact, a good thing. It is, in a certain light, darkly humorous to contemplate those running for government office who are against, well, government. Although perhaps those against government who are running for office are attempting to undermine the system from within.

Sarcasm aside, there does seem to be an underlying philosophical difference between conservatives and liberals as to when and whether government should be involved in individuals lives. Some of these beliefs, even within a political perspective, are quite contradictory (get your hands off my gun, but put your hands right into a woman's uterus, and vice versa). Overall, the contradictions within and between perspectives illustrate, to me, a serious confusion in our country on what the role of government is, and ought to be. 

There are those who argue largely for an absent government, one that protects our national borders, defines our rights, polices the enforcement of those, and then goes back to the plow. 

This is not how we live today. Americans take the government to task for failures of the road system, of providing schooling, drug safety information, prescription coverage, and naming the French Fries. We demand a great deal of the government without being willing to articulate clearly our expectations of the government's rights towards us, or our responsibilities towards them.

Nor do we articulate clearly our priorities. Let's say Anna gets raped. The DNA sequencing of her rape kit costs $1,500. Paying the D.A., the judge, and the stenographer for their time to prosecute her case, and the public defender is another $5,000. The cost of locking up her attacker for the next fifteen years is $150,000. I do not, under any circumstances, think Anna should have to pay for being a victim. However, someone has to pay for these expense. It is generally socially shared, by the government's taxation. 

Let's say Thomas, turned 18, just graduated from high school, and looking for a job as a house painter gets hit by a drunk driver. He does not have insurance. We cannot, in good conscience, leave him to die rather than treat him. His medical bills are $27,563. He cannot pay this.  The government picks up the tab, and spreads it around through taxation. 

Yet, at a certain point, if these individuals cannot afford these expenses, Thomas and Anna cannot pay their own way, there is a huge problem when the balance tips and we are all Thomas and Anna. And we cannot pay for what we expect. There is no clear guidance on where to cut back. 

This is especially problematic with death. A heart attack, cancer treatment; these cost hundreds of thousands of dollars. Yet we cannot say 'No, die.' But we cannot pay the bills, either, and the payment is coming due. What are we to do? What can we expect of our lives and governments? It is clear, now, that house prices do not always go up. The stock market does not always rise. These are not things you can expect. What, though, is our social contract in this day and age? What can we expect, and expect to give in return? Does the social contract need rewriting? For I started this: The Role of Government. But Government is made up of citizens, Americans. And we need to speak much more of: The Role of Citizens.