April 15, 2022
Dear Interested Readers,
Easter In Ukraine and Loosely Connected Musings About “Disorder” and “Reorder” in Healthcare
As is true for many others, the continuing war in Ukraine has stimulated my fascination with the bravery and willingness of the Ukrainian people as they make huge individual and collective sacrifices to maintain their freedom. I have become ultra-sensitive to any new facts or information about their country and their culture. I began my Tuesday walk listening to the last three innings of the Red Sox/ Detroit game. The Red Sox came back from being behind 3-0 to gain a 5-3 win. I am not going to connect that fact to Ukraine, but when the game ended I continued my walk listening to New Hampshire Public Radio where I was informed about the history of “Easter eggs” in Ukraine. The Ukrainian word for Easter egg is “pysanky or pysanka ” and the tradition of making ornately decorated eggs using beeswax to allow complex figures to be created using dyes is a spring ritual that goes back to pagan times. If you would like to see some of these beautiful eggs, click on the link above.
Like “heaven and hell,” Easter eggs were coopted by Christians from pagan traditions when Christianity became the dominant religion of the West. In Ukraine, the conversion happened around the year 1000. The story reported on NPR was corroborated by Wikipedia, but I favor the description given by the woman interviewed on NPR. It seems that the eggs initially evolved as a way of gaining favor with the sun god, Dazhboh.
“During the winter months, the days grew shorter and it was dark longer. People just assumed that the sun god was angry with them and was leaving them. So to bring him back,” she continues, “they decided to give him a gift. And each year, around springtime, they had this special spring ritual.”
Zielyk says that they believed that the egg had magical qualities.
“Number one, birds fly in the air,” she says. “They’re much closer to the sun than people are. People couldn’t catch the birds, but they could get their eggs, and people thought when they held the egg in their hands, they could harness a little bit of the power of the sun. Number two, the yolk reminded the people of the sun, and it was a way of paying tribute to him. And the third most important reason of all the rooster was the sun god’s chosen creature. He was the only creature that the sun god listened to, because when the rooster crows, the sun comes out — and very often a rooster can come out of a chicken egg.”
The people would decorate eggs with symbols — a pine branch for fertility or a deer for strength, for example — in hopes that the sun god would grant them their wishes. And when the area we now call Ukraine became Christianized in the 9th and 10th centuries, people started assigning Christian ideas to this pagan springtime tradition.
“So the ritual egg, which asked for the sun god to come back, now became the symbol of Easter and Christ’s defeat over death, rising from death,” Zielyk says.
Sarah Bachinger notes that as Ukrainians immigrated all over the world in the late 19th and early 20th century, they carried this tradition with them — which may have saved the artform.
“During the Soviet era, under Stalin, he was trying to stop and eradicate any type of religious practices,” Bachinger explains. “So pysanky were also banned because they were so deeply connected with Easter. The diaspora kept the tradition alive.”
I find myself being cynical about Vladamir Putin’s attempts to connect his Ukrainian adventures to his defense of religion. Being a “defender of the faith” has been an explanation for his oppression of minorities and has been part of his previous appeal to religious fundamentalists in America like Franklin Graham. It is remarkable to me that wannabe autocrats like Donald Trump and “for sure” autocrats like Putin seem to find support from religious leaders who would like their orthodoxy enforced by the state. The union of church and state should be antithetical to mainline conservative thought and the conservative think tank, The Heritage Foundation, published an article in 2019 entitled “How Putin Uses Russian Orthodoxy to Grow His Empire.” The article pointed out the problem with Putin and religion:
…recent conflicts with Ukraine suggest that Putin’s public affinity for Christianity may have more to do with geopolitics than religious sincerity. After Russia annexed Crimea in 2014, Putin sought to justify his action by pointing to a shared religious and cultural history.
Everything in Crimea speaks of our shared history and pride. This is the location of ancient Khersones, where Prince Vladimir was baptized. His spiritual feat of adopting Orthodoxy predetermined the overall basis of the culture, civilization, and human values that unite the peoples of Russia, Ukraine, and Belarus.
The Russian Orthodox Church has been in lockstep with Putin, and has in fact served to advance his ends. A case in point is its position on the Ukrainian Orthodox Church.
Since the year 1686, the Ukrainian Orthodox Church had been under the jurisdiction of the Patriarchate of Moscow. But last October, the Ukrainian church announced that after 332 years, it was splitting with the Patriarchate of Moscow in an attempt to gain independence from Russia. This split was facilitated by Ukrainian President Petro Poroshenko and approved by the head of the Orthodox Church, the Ecumenical Patriarch Bartholomew, based in Turkey.
Whether you are interested in any of the world’s religions or prefer to view the world through the lens of benevolent secular humanism, we all see hope in the end of winter and the coming of spring. The progressive Franciscan priest and founder of the Center For Contemplation and Action, Robert Rohr, has written a book entitled The Wisdom Pattern: Order, Disorder, Reorder. In the introduction to the recently rewritten version of this book from the nineties, Rohr argues that this three-part progression is a pattern that is universally seen in systems that range from the seasons to business. I would add that I have also seen the pattern in healthcare.
The pagan ancestors of the Ukrainians saw “the wisdom pattern” in the seasons. Summer and fall are ordered times when the sun brings us comfort and food. Winter is dark, dangerous, and the epitome of disorder. In winter everything appears cold and dead. Spring is an example of reordering and beginning again. Their pysanky, their beautifully decorated eggs, symbolized their vision of hope in the pattern.
This cycle can give the world some hope as we contemplate in retrospect the relative sense of order that we believed existed before Mr. Putin shattered that fantasy with his own remarkably destructive and disordering attack on the people of Ukraine that he imagined he could pull off while intimidating the rest of the world into looking the other way. In Ukraine, the cycle of order, disorder, and reorder is still in progress, but as we anticipate spring, Easter, and all of the renewal metaphors in our multicultural world, it is possible to have some hope that in time the world will experience “reorder.” The bravery and commitment to the values of a liberal democracy demonstrated by the Ukrainian people have been an explicit reminder of foundational values that we have allowed to fall into a state of disorder. Thousands of Ukrainians have died for their values, and it is likely that even more will die before the “reorder” they desire is achieved. We owe the Ukrainians our support no matter what the outcome, but the symbolism of their “pysankies” is that there is certainty in the hope for eventual reorder.
One of the most infectious and malicious vectors of “disorder” in our times is the pandemic of misinformation that has been multiplied by the misuse of the Internet and has destroyed our once hopeful dreams of what that technology might do to promote knowledge, justice, and equality. Recently, former President Barack Obama appeared at a conference on disinformation at the University of Chicago that was sponsored by The Atlantic. The highlight of the conference was a conversation between Jeffery Goldberg, the editor-in-chief of the magazine, and President Obama. You can click here to hear the interview or read the transcript of their conversation. I enjoyed it so much that I have listened to it three times.
The introduction to the transcript of their conversation sets the stage:
When they last sat down for an interview, in November 2020, Barack Obama told Atlantic editor-in-chief, Jeffrey Goldberg, that disinformation is “the single biggest threat to our democracy.” The threat was not a new one, he said, but it was accelerating. It has continued to accelerate since. A month and a half after that conversation, a violent mob stormed the Capitol, driven by the false belief that the election had been stolen from Donald Trump and could be taken back by force. Over the past year, COVID conspiracism has likely cost thousands of lives. Russia has mounted a massive disinformation campaign to justify its invasion of Ukraine. Yesterday, at Disinformation and the Erosion of Democracy, a conference hosted by The Atlantic and the University of Chicago’s Institute of Politics, Obama and Goldberg spoke once again about the threat of disinformation and what we can do to stop it.
The conversation began with a review of the war in Ukraine, the decline of values, and the necessity to defend the essentials of democracy. Obama summed up the challenge in a few words:
It’s something that we have to continually nurture and respond to new circumstances, whether that’s changes in technology, changes in globalization, climate change—all those things require us to say, All right, what does that mean for our capacity to maintain human dignity and freedom and self-governance?
It occurred to me that effectively answering Obama’s question may be essential to any effort to move from “disorder” to “reorder.” The question applies to the war in Ukraine, the dysfunction of our deep partisan divisions, the improvement of the social determinants of health, and all the problems in healthcare that create a sense of “disorder” and leave us wondering when, if ever, we will achieve “reorder,” the Triple Aim.
An important moment in the conversation is Obama’s response to Goldberg’s question about the various forms of misinformation:
But go to definitions. Let’s just start there. What is the difference between disinformation—I’m asking you this as a retired politician who uses facts or used facts to your advantage, your electoral advantage—what’s the difference between disinformation and information that’s narratively inconvenient, let’s say. How do you define disinformation, misinformation?
During his answer to the question, Obama returned to an issue about the ACA that has troubled me ever since 2010 when he was “explaining” the ACA to the public. You might remember the flack that occurred at the time when he was accused of lying because he said, “If you like your health plan (or doctor) you can keep it (him/her).” At the time and ever since I have felt that what he meant to say or should have better explained was “If your current health plan meets the standards established by the ACA, you can keep it.” Here is how former President Obama explains that moment now:
I was identified as having engaged in a political falsehood when I said and repeated several times that if you want to keep your doctor, you can. And the point we were trying to make is 85 percent of people had health care, and one of the big problems in trying to get health care for the uninsured is making sure that folks who already had it weren’t vulnerable to scare tactics that they were all going to be rationed, and socialized medicine, and they’d lose their plan and doctor. And we said, “Look, we’re keeping the system for folks who have employer-based health care intact.” Once we passed it and we were starting to implement, one of the things that we had done is to raise standards for what insurance could or could not provide, because there was a bunch of phony insurance on the marketplace that people thought they were purchasing insurance, but it turned out that when they actually got sick, there were so many restrictions to it that it didn’t do them any good. And there was constant churn in this market. So when people were up for renewal for these ultracheap insurance plans that didn’t actually provide coverage to the standard we had set, it turned out they couldn’t renew, because those plans were no longer being offered. Well, many mainstream reporters, not just Fox News, said, “Look, he lied. You lost your insurance that you had and you were perfectly satisfied with.” I thought, Well, I guess technically it’s true that you no longer had the plan you had, because the bogus plans that you used to pay for that offered you no protection when you actually, finally got sick, we regulated out of existence. That was deemed as I hadn’t been accurate. Four Pinocchios on Obama!
That is exactly what I remembered from the episode now more than a decade in the rearview mirror. It was painful then and painful now in memory and is a perfect example of how easy it is to make an “unforced error” in politics. It is also a great example of how quickly we jump on the errors of our competition. It is not an example of disinformation. It is an example of misinformation. What is Obama’s definition of disinformation?
…The way I define disinformation is if you have a systematic effort to either promote false information, to suppress true information, for the purpose of political gain, financial gain, enhancing power, suppressing others, targeting those you don’t like and that, I think it’s entirely different from information that is inconvenient.
I agree, and that definition describes what Putin, Trump, those that deny Biden won the election, many fossil fuel advocates, or global warming deniers practice. Tragically, disinformation has cost us several hundred thousand lives during the pandemic. Disinformation is a major factor in the evolution of “disorder” and “truth,” its opposite, is a necessary precondition for “reorder.”
Quite by accident, I read an opinion piece by Karen Tumulty in the Washington Post this week. It is really a story that corroborates President Obama’s analysis about the garbage health plans that were disallowed by the ACA and resulted in many of his opponents calling him a purveyor of disinformation. The title of the piece is “Opinion: Disease took my brother. Our health-care system added to his ordeal.” What the story underlines is the continuing lack of health equity in a “red state” like Texas. Our system of care is still a system in “disorder” and would be even worse if it weren’t for the ACA.
Tumulty, who has had a long career in journalism at Time Magazine and the Washinton Post, tells the story of her brother’s struggle against care denial from low-value healthcare policies and the barriers to Medicaid that underline many of the points the ACA sought to overcome. Ultimately, her brother who died at age sixty-seven after a long battle with neuroblastoma finally got some of the care he needed after the ACA was passed. Before the ACA was passed he had difficulty paying for his care because of a combination of Asperger’s syndrome and “pre-existing conditions,” like glomerulonephritis. The jobs that he could do with his disabilities had a low hourly pay and no benefits. The insurance he could afford was essentially worthless. He suffered many indignities and substantial expenses for care that was not covered by these ripoff policies that failed when needs arose. In his home state of Texas, it is still true that almost twenty percent of people, about twice the national experience, still don’t have any health care coverage.
The pandemic has underlined the reality that we fool ourselves when we think we have the best healthcare system in the world. We may have the best science, the most vigorous pharmaceutical capabilities, and some of the best medical schools, but when it comes to the assessment of the “best care” we come in as a second-tier nation that ranks 18th in the world. That is not disinformation. It is an inconvenient and uncomfortable truth. To say that in America we have great health care is an exercise in disinformation per President Obama’s definition,
…disinformation is…a systematic effort to either promote false information, to suppress true information, for the purpose of political gain, financial gain, enhancing power, suppressing others, targeting those you don’t like…
The shoe fits and there are those among us who continue to wear it “for the purpose of political gain, financial gain, enhancing power, suppressing others, targeting those you don’t like…” You may think that your care is great, and I hope it is, but we conveniently forget that collectively we pay over three trillion dollars a year for a low-quality product that excludes tens of millions of Americans. To say otherwise is disinformation. We are in a state of “disorder” and currently, any hope of “reorder” lies far into the future.
When it comes to “reorder” in Ukraine and healthcare, it feels like we will be waiting for a while. This week Ezra Klein interviewed Ukrainian philosopher and author, Volodymyr Yermolenko. Near the end of this very interesting interview, they discussed what “reorder” in Ukraine should look like. Klein had asked the question:
I want to be careful in this question not to assume an end to a war that is very much not over and that we don’t know how it will play out. But in more hopeful scenarios where there is a whole Ukraine on the other end of this conflict, how do you think about some of the rebuilding that will have to happen?
Yermolenko gave a very thoughtful answer that resonated with me because it included the hope that there would be a military victory. He hoped that the Russian army would be expelled from all of Ukraine, including the Donbas region and Crimea, that reparations would be paid for the destruction that the war has caused, and that Putin would be held accountable for his crimes. Ending the war by negotiation would necessarily require concessions to Putin and make it very unlikely that he would ever be held accountable. Yermolenko surprised me with the statement:
One of the light motifs of Russian culture, by the way, is the motif of “Crime and Punishment,” as we all know. The novel of Dostoyevsky. But actually, what we have in Russian political culture, in Stalinism, for example, is crime without punishment and punishment without crime. All those people who were sent to gulags without any trials or were exterminated, killed, they were punished without a crime.
I added the bolding because I think the statement is so true of many examples of “disorder.” The perpetrators of pain and suffering often profit and the innocent suffer and pay a price. Applying that principle to healthcare is not easy but I think that it is true that we won’t have a state of “reorder” in healthcare until those who need care are no longer punished with costs that are hard to bear, access problems that prolong suffering and reduce the likelihood of recovery, and processes of care that often feel like some kind of punishment while many of the institutions that profit mightily are never held accountable for their inability to produce care that is at a minimum still excessively expensive but equitable in its availability.
April 15th!
Can you believe it! Today is quite significant in many domains. It is “Good Friday,” the first day of Passover, almost halfway through Ramadan, the first day of the trout fishing season in New Hampshire, and Opening Day at Fenway Park for the Red Sox. April 15th is not tax day this year. When we pay our taxes, like many things in America, varies a little bit depending on the state you live in for some complicated reasons connected to Emancipation Day, Patriot’s Day, and other curiosities. I guess those extra days to get your taxes in order are a reason for celebration for some.
In our little town, the local Episcopal church has a noontime ecumenical “Good Friday” service where there is a reading of “The Passion of the Lord according to John” In the past, I have had the brief part of St. Peter, but this year I have a larger but more ignominious role. I am Pilate. The service hasn’t occurred for the past two years because of COVID. By the time you read this, the service will be over and I will probably be watching the Red Sox and thinking about fishing later in the evening after the Red Sox win.
I must admit I am a little nervous about being in a crowded church. I am “doubly boosted” but COVID is definitely on the rise again in the Northeast with a couple of more variants arising as a concern. My youngest son and his wife who live in Brooklyn were not on the “N train” when the shooting started, but it is a train they frequently ride. They did attend an event last weekend and one of the guests who gave them a big hug and a kiss has tested positive for COVID and now they too are quite ill. Their PCR tests are positive, and they are on Paxlovid. “Pilate” will be wearing a KN-95 mask and looking to duck out quickly after the service without any hugs or handshakes.
If the header for this note looks familiar, it means that you read to the end of last week’s “Musings”! I liked my wife’s picture that she took of “our” loon this week so much that I decided to use it again. It’s interesting that Mr. and Mrs. Loon do not travel back from their winter home on the Maine coast together. We have seen only one loon and its mournful call sounds lonely. Perhaps, the mate will show up his weekend and all will be well.
We have had one other wildlife event this week. One of our local bears came by on Tuesday night and snacked on my bird feeders. I was pushing my luck and should have taken in the bird feeders sooner. I know one man nearby who has a twelve-foot iron pipe with a four-inch diameter set in concrete with a branching device on top that allows him to raise about six bird feeders out of reach of the bears. I like seeing the birds, but his feeder is so high in the air that I would need binoculars to see the birds if I copied his device in my yard.
I hope that your weekend will be rewarding. It is nice to know that whether you participate in a religious service, enjoy baseball, like fishing, or enjoy being in nature, we all can look forward to the beauty of a spring weekend.
Be well,
Gene
