January 21, 2022

Dear Interested Readers,

 

A Week That Generated Much Concern

 

Was it not ironic that just four days after Dr. Martin Luther King, Jr.’s actual birthday, and two days after this year’s celebration of his life, the Senate slammed the door on the latest attempt of Democrats to regain a little bit of what Dr. King cared most about and died thinking had been accomplished? Dr. King lived and died to improve voting rights, civil rights, and a fairer distribution of economic opportunity and access to healthcare. He had a dream, and on the day he died, he said that he had been to the “mountain top” where he could see into the future and confirm that someday the dream would be a reality.

 

The New Jim Crow: Mass Incarceration in the Age of Colorblindness was published in 2010. In 2022 the term, “the new Jim Crow” can now logically be extended beyond incarceration as a mechanism of control to an effective denial of the ballot to many Americans who are either poor, members of a minority, or both. In a growing number of states, Republican-controlled legislatures are passing new laws that make it harder for many to vote, and easier for a conservative minority to control government and the courts. A major objective of the Biden administration has been to pass federal laws that would protect and preserve access to the ballot for every American. Passing this legislation was felt to be a crucial necessity in the effort to prevent us from sliding even further toward the possibility of some new form of authoritarian control of the government. All that was needed to complete the task was for Joe Manchin and Kyrsten Sinema to vote with the other 48 Democratic senators to modify the Senate’s filibuster rule, and they didn’t. 

 

Much of the work that was accomplished in the sixties by the movement that Dr. King led has been undone. It did not happen overnight after the Senate failed to act. The undoing has been made possible by the opportunity created by the conservative majority on the Supreme Court which handed down the Citizens United decision in 2010 which has gutted the Voters Rights Act of 1965. That decision has allowed Republican-controlled state legislatures to pursue an aggressive revision of voting laws toward the objective of limiting access to the ballot so effectively that we will have the equivalent of a “new Jim Crow era” where millions will be effectively denied their franchise to vote. Voting and fair elections together are the foundation of a true democracy. Many authoritarian governments have elections, but they don’t have fair elections. This week we failed to step back from the brink of the slippery slope to some new creative form of authoritarianism as we leaned even closer toward something much less than a true democracy. Just to make matters worse it is also true that this week the faint hope that a greatly reduced Build Back Better bill might pass also died. It was a dismal week on Capitol Hill.

 

Toward the end of Dr. King’s life, after the Civil Rights Act of 1964 and the Voting Rights Act of 1965 had been passed Dr. King turned his efforts toward equity in economic opportunity. He made the mistake of imagining that this issue would bring the poor of all races into a common cause. During his short life, he also expressed his concerns about healthcare equity when he is often reported to have said:

 

Of all the forms of inequality, injustice in health care is the most shocking and the most inhumane.

 

Over the past couple of years, I have seen some debate about what the exact quote was. I have recently discovered an interesting article published by PNHP, Physicians for a National Health Program that was an excerpt from a longer article written by Charlene Galarneau, Ph.D., MAR, Associate Professor, Wellesley College and originally published by Johns Hopkins University Press, Journal of Health Care for the Poor and Underserved in February 2018. The sense of the article was that as illuminating as the usual quote is about the concern Dr. King had for health equity, it does not reveal the real depth of his concerns about health inequity. Dr. Gaarneau writes: [I added some bolding of thoughts that I would underline.]

 

These often-invoked words attributed to Rev. Dr. Martin Luther King Jr. offer moral sustenance to many persons working toward health equity today…Yet, these words are not the precise words that King spoke more than a half century ago.

On March 25, 1966 in Chicago at a press conference before his speech at the second convention of the Medical Committee for Human Rights (MCHR), King said (in part):

“We are concerned about the constant use of federal funds to support this most notorious expression of segregation. [He was talking about segregation and inequity that still existed in healthcare in 1966.] Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.

“I see no alternative to direct action and creative nonviolence to raise the conscience of the nation.”

This documented quote (second sentence) differs from the more common “quote” in three striking ways. First, King spoke of injustice in “health,” not in health care. While it is impossible to know whether there was a meaningful difference between health and health care for King, his unfailing attention to poverty, racism, education, and housing—what we now often call social determinants of health—makes clear his moral concern beyond health care alone. Second, King said that injustice in health is “inhuman,” not inhumane. The distinction here is likely significant as a matter of degree. Inhumane suggests a lack of compassion for human suffering or pain whereas “inhuman” is more extreme, suggesting a denial of humanity so egregiously cruel that it is, or should be, beyond human action. The final difference in King’s actual words compared with the more popular version is perhaps the most important as it reveals King’s belief about why health injustice is inhuman. Injustice in health is “the most inhuman” form of inequality, says King, “because it often results in physical death.” King could not be plainer: human lives end because of this injustice. Death, as one of the most brutal consequences of radicalized injustice, is erased from King’s words by the exclusion of this phrase.

 

As I pondered this sad week in Washington and how Dr. King might feel about the erosion of his dream, I had one of those things happen in my head that may mean I am knocking on the door of dementia, or that I am subconsciously searching for some relief from the sadness that a straight-on analysis of this moment and the ongoing dismantling of the work of King and other civil rights activists who made huge personal sacrifices with the hope for a better world creates. In my melancholy state, I started thinking about an old hero of mine, Garrison Keillor. Garrison has been a bit of a disappointment for me since I discovered a few years ago that like all people he has some flaws, but that revelation did not cause me to reject the entirety of more than thirty-five years of perspective generating humor that I gleaned from him. 

 

I discovered the humor and wisdom of Garrison Keillor in 1982 shortly after his “Prairie Home Companion” became a regular offering every Saturday evening on my local NPR station, WGBH in Boston. I have described my experience with Keillor before, but in case you missed it, I had a weekly ritual that was built around his broadcast. The show was two hours long and occurred at an inopportune time for a father with two small boys, six PM on Saturday. I tried recording the show for later enjoyment, but that meant that every thirty minutes I needed to be alert to “flipping the tape.” 

 

Halfway through the show, there would be a few minutes of interlude that made changing the tape a little less stressful, but I frequently missed much of the program. I had a “eureka moment” when I discovered that one could occasionally find two-hour cassette tapes for sale if you knew where to buy them. Somewhere I read that the two-hour tapes were not advised, and that one-hour tapes or shorter were preferred by the fastidious subculture of audiophiles because the two-hour tapes delivered a recording that was technically inferior for reasons that I did not quite understand. 

 

All I can say is that those two-hour tapes worked great for me. Many Saturday evenings my wife and I would be going out and a very intelligent teenage babysitter from our Wellesley neighborhood who would eventually be bound for an expensive college education at an elite school and a future life as a professional or corporate executive would be charging us some large multiple of the minimum wage for a few hours of freedom from our parental responsibilities. I had no problem with her charge as long as she understood that job one was attending to the boys and job two was to flip the PHC tape at seven PM. It was early in the era of the “Sony Walkman” (If you are too young to know what I am talking about, click on the link to see one.), and I was the first on my block to have a Sony Walkman. I would listen to last Saturday’s “Praire Home” tape over and over as I logged my training miles over the next week. Those few young women who failed to promptly flip the tape one hour into the show were not invited back! Now, I have thousands of hours of Praire Home Companion on tape that I never hear because all of the old shows are online!

 

It is important to remember that our heroes are human and they have clay feet. In time and in many ways they can fail and disappoint us, and so it was with Garrison. Keillor’s time on public radio came to an abrupt end in 2017 when an episode of previous bad behavior was reported by a woman early in the “Me too movement.”  Keillor is resilient. He has denied intent, if not the charges. He accepted the practicalities of the indictment. He endured the public humiliation which perhaps he deserved, and he now lives on the internet and publishes “The Writers Almanac” and a very funny newsletter, “Garrison Keillor and Friends.” He is now approaching eighty, but he still gives small performances in person. You can catch him tonight in Las Vegas at the Smith Center.

 

Over the past few days as I listed to President Biden’s extensive news conference, and waited for the Senate to take the votes that for the moment block any hope of near term voting rights improvements or the Build Back Better bill from passage any time soon, I kept thinking about one of Keillor’s recent newsletters entitled “Why Washington Needs More Snowstorms.” The article was written earlier this month in the run-up to Wednesday’s disappointments. Keillor uses the fact that Senator Tim Kane from Virginia, Hillary Clinton’s running mate in 2016, was stranded overnight because of the recent blizzard that created a huge snarl in traffic on Interstate 95 South of Washington to make a political statement:

 

It’s always satisfying to see our nation’s capital hit by a good hard snowstorm and imagine powerful men trying to shovel their way out of a snowbank. It’s a parable right out of Scripture, Let the powerful have a sense of humor for each in turn shall be made helpless.

It was front-page in the papers and the subhead said that a U.S. senator had been stranded overnight on the interstate. The blockage of an interstate is the true measure of a serious storm and the headline writer tossed in the senator as further evidence, but it only made me wish there had been numerous senators — say, those from Florida, South Carolina, Alabama, Mississippi, and Louisiana, the five states least accomplished at snow motorism, and if the Senate had come to session the next morning, our nation would get moving again, one blockage breaking a logjam. But it was only a Democrat from Virginia, giving Mitch McConnell a one-vote edge, and there is no vacancy on the Supreme Court, so he didn’t need it.

 

During Garrison’s heyday, he would frequently refer to what must be a common obsession in the upper Midwest, licking very cold pump handles. As one might imagine such activity can lead to a tongue that is frozen to the pump. Just the thought sends a shiver down your spine. Hang in there if I am losing you because in his most recent post I think he was using this strange affliction to speak tangentially about some of the crazy behaviors related to COVID that are perpetuating our national distress. Deep into this Wednesday’s newsletter he writes:

 

I stay indoors in January out of fear I’ll forget what my mother told me as a small child — Do not, under any circumstance, even if someone dares you, do not, do not, do not put your tongue on an iron pump handle or railing.

If you do, your tongue will freeze to the metal and you will be trapped and you may spend the night there, tongue frozen to iron, and they will find your body in the morning, and your grieving family will ask, “Why? Why us?” to which there is no answer.

 

 

And now I regret mentioning this. For having warned you of the danger, I’ve planted the idea of handle-tonguing in your mind and you may reject my advice and say (1) it’s my tongue and I’ll do what I want with it, or (2) it’s no worse than having a cold, or (3) if it’s God’s will that I lick a pump handle, then I will, or (4) I read on Twitter that some doctors say that handle-licking may be beneficial, and tomorrow when you go out and see a pump handle or iron railing you’ll be unable to stop yourself from walking up to it and — so forget what I said. Erase it from your mind. Stop reading. Find something else to do. Snort some methamphetamine, toss back a pint of bourbon, smoke reefer — there are treatment programs for those bad habits, but there is no AA program for Arctic Adherence. No. The answer is to stay indoors. But if you must leave the house, be sure to wear a mask over your nose and mouth, but not a paper or cloth mask, you need an iron mask, one with a lock. Your breath will warm it and keep you safe. Leave the key at home.

 

[If you want to sign up for more of Garrison’s current humor and insights click this line.]

 

It will take me a while to get over the events of Wednesday. I was praying for a miracle. Perhaps there is a miracle coming that I cannot see. Until some unforeseen future event occurs to restore voting rights and address the needs of the millions who should not face the heavy burden of social disadvantage that we santitize with the term “the social determinants of health” and that Dr. King called “inhuman,” I will try to believe that Dr. King did see a better day coming from the mountaintop. Until that time perhaps my best strategy to maintain a temporizing perspective is to keep reading Keillor’s current posts and listening to his old shows on the Internet. What will your strategy be?

 

It Just Keeps Getting Colder, and Often Dark to Fit My Mood

 

The low last night was minus eight. The high today will be ten. I did walk yesterday when it was a balmy eighteen. I am not so sure about outside exercise today. I am comforted by knowing that there are no iron rails or pump handles to tempt me on my usual route. There is over a foot of snow on the ground, but we are behind our usual snowfall by almost three feet. Winter is an adventure. There have been winters in the past when all of the snow came in February and March. It is amazing to me that we live in an era when what happened before doesn’t really tell us what to expect going forward. 

 

I am amazed by the ability that the various weather services have of predicting the weather to the minute many days in advance. Our most recent snowstorm was predicted to the minute almost a week in advance even before the storm had completely formed in the Pacific off the coasts of Oregon and Washington. The current forecast goes nine days into the future and in that period there will be only one day when the temp tops freezing! The low on six of those nine days will be zero or below! What I have come to realize is that it doesn’t snow as often when it is really cold. The one day that we do have snow predicted in the next nine days is Tuesday which is also the warmest day in the forecast when the temp will rise into the low thirties.

 

Many of the days this week were not only cold, they were also dark. Wednesday, the day that Senator Chuck Schumer forced every senator to declare where they stood on voting rights, the Build Back Better bill, and the filibuster, was a dark day metaphorically and meteorologically as you can see in the header for today’s post. The picture was taken from Colby Hill which lies a mile or so north of the east end of Little Lake Sunapee. You see a sliver of the snow-covered lake in the middle of the right side of the picture under “ngs…” Beyond the lake, you can see the rooftops in “downtown” New London. Mount Kearsarge which is eight to ten miles south fills up the rest of the background. I love this view in any season, but I would be very apprehensive about living in either of the two homes that are above and behind the spot from which I took the picture. If you lived in either house you would not need to go to nearby Mount Sunapee to do some expert skiing. 

 

I have not been hiding my emotions over the past few weeks in my letters to you. I see difficult times ahead as what divides us gets greater, and our inability to share a vision for the future has the potential to compromise the health and well-being of even the most affluent members of our society. In the fifty-five years since I graduated from medical school, I have known that our system of care fails many of the poorest among us who have been dealt the worst hand when it comes to the social determinants of health. On a very cold and dark winter day, I find that I can question the validity of the reassurances of access and adequate care that many of us who are more affluent have always felt was ours. An honest appraisal at this moment of the pandemic is that we don’t know when the “groundhog day” of this long winter will occur or how much time will lie between the groundhog’s appearance and an improvement in the division that makes this country feel so cold.

 

In the real world of meteorology, we do not have to do anything to make the spring come. The question that I keep asking myself is what do we need to do in the political and medical worlds that will allow us all to take advantage of all that we could improve and have together if only we could take the chill out of the air and come together with the shared objective of improving “the weather.” A place like Garrison Keillor’s Lake Wobegon doesn’t have to be a joke or a fantasy. It may not be possible to have a country “where all the women are strong, all the men are good-looking, and all the children are above average,” but it should be possible for America to be a place where everyone has access to very good healthcare and the opportunity to achieve their potential through a good education, a safe place to live, and the opportunity and ability to earn a living wage. It was Dr. King’s real dream. He told us that he had been to the mountain top and seen that one day it would be true. I want to believe that Dr. King did see something better from the mountain top with the same confidence that I have that one day in April, or even earlier in March, the ice on the lake will melt beneath a warmer sun. 

Be well,

Gene