July 9, 2021
Dear Interested Readers,
What We’re All Losing
After this past year and a half, almost everyone in America can name something that they have lost. What is also true is that most of us can name something that we have learned. If you can’t name what you have learned then perhaps there is something that has grown in significance to you. I think I have several items under the headings of something lost, something learned, and something that is clearer now than ever before. My guess is that if you can’t fill in something under all or at least two out of three of those headings then you are not being very introspective.
I am fortunate that I have not lost a close relative or friend to COVID although several members of my extended family members in the South have had and recovered from a COVID infection. During the last year, I have lost several friends to cancer, a more traditional cause of death, and a reminder that all of our previous issues remain active despite the shift of focus to COVID. What I value most that I have lost to COVID is my time with my grandchildren. Little boys grow fast and change very quickly. If you are not around you loose an experience that can’t be recovered. Like many others, my wife and I lost a trip to Europe that we had planned for 2020 but that loss or delay is nothing in the broader perspective of what others have lost.
Under the listing of what I have learned, I would definitely list that I have learned that there are saints among us who have put their professional sense of commitment and sense of duty and responsibility to others before their own safety. Almost every little town in America has a bronze plaque in some public place that honors the names of the citizens from that town who were willing to sacrifice their own lives in our foreign wars for abstract ideas like freedom and opportunity for all, and the defense of all of our collective values The heroes of the fight against COVID were willing to risk their lives for something as concrete as an individual in front of them on a litter in an EW, a lonely and confused elderly person in a nursing home, or perhaps a patient on a ventilator in an ICU. In April, Kaiser Health News and The Guardian published a report that suggested that at least 3600 healthcare workers had died taking care of patients with COVID over the previous twelve months. Of those 3600 over two-thirds were people of color. I urge you to click on the link because it contains a six-minute recording from NPR discussing the findings of the study and the misconceptions that contributed to so many of the deaths. There is much more that I have learned, as I am sure that you have too. The sum of our learnings has been that we now know that collectively we are not quite who we once thought we were. We have a lot of work to do. I will leave you to ponder that assertion without more explanation from me.
The category that is most interesting to me and that I think really impacts the future of healthcare is the third category. There are many things that are clearer now. COVID has uncovered some issues that we had been reluctant to face, or should have been addressing but did not have the interest or concern to admit and resolve. For me, the issue that is most exemplary of this category is the impact that race has had on healthcare over the last one hundred and fifty years since the Civil War and the emancipation of the slaves. The second “aha” for me is equally hard to admit. Healthcare in America is unlikely ever to undergo a meaningful and effective transformation without a compelling external demand for meaningful change. Connected to both of those insights is the fact that many of us disdain science and fairness and will choose to pay homage to a lie rather and its originator rather than address an issue that requires a change in some personal or collective bias or fear. Facts don’t win the day and are trumped by cultural fear even when the reluctance to face facts will certainly lead to multiple catastrophic losses. The last “aha” is captured in the thought, “Why did I ever think facts and what was fair and humane would make a difference?” An associated question that may be easier to answer is, “Why would an individual or group be willing to sustain huge personal or collective losses rather than address reality and make appropriate changes?”
The disappointing lack of the power of truth and right to confront and change bias is on full display in the emerging “culture wars.” If you read or listen to the current political commentary you are confronted with the astounding fact that since January 6th the majority of Republicans have doubled down on their assertion that Biden did not fairly win the presidency and that Donald Trump is the rightful president. Coupled with the “big lie” that is publicly embraced by the vast majority of Republican members of Congress is the analysis that because of the popularity of Joe Biden and his programs and leadership in a complex world Republicans can not win in 2022 or 2024 if they run on their traditional positions that advocate for small government, low taxes with the promise of even more tax cuts, cancelation of regulations to protect the environment and consumers, strengthening national defense, emphasizing law and order, and their traditional focus on anything that might be considered beneficial to business. They are still stuck in Donald Trump’s world and will be running on the “culture issues” that advocate for continued White advantage, denial of the importance of race in American life, exclusion of many people who are “other” from full participation in society, and a continued attack on the reproductive rights of women.
Nowhere has the current impact of “culture wars” been more obvious in the life of an individual than in the disgraceful way that the trustees of the University of North Carolina dealt with the application for tenure by Nikole Hannah-Jones, the Pulitzer Prize-winning creator of the “1619” Project published by The New York Times. Across the country, Republican-controlled state legislatures have attempted to block the use of the information in the “1619 Project” and the discussion of critical race theory. The best discussion of the tawdry event of her interaction with the UNC trustees was written by Ms. Hannah-Jones herself and published by the NAACP Legal Defense and Educational Fund, Inc.
The reoccurrence of serendipity in my life is a constant source of surprise and wonder for me. In midweek while I was preparing to sneak in a bike ride between showers I was selecting what I was going to listen to on my ride. I decided to listen to an Ezra Klein podcast. I clicked on the appropriate icon expecting to be taken to his most recent offering. To my surprise, I discovered that I was listening to Klein introduce a conversation with Heather McGhee, the author of The Sum of Us: What Racism Costs Everyone And How We Can Prosper Together. I had heard Klein interview her back in February and my first reaction was that he was interviewing her again because of recent events like the disrespect that the UNC board had heaped on Hannah-Jones or the growing cacophony over critical race theory. In time I realized that I was listening to the same interview that I had heard in February. I decided to go with the advice of the invisible force in cyberspace that had presented the option to me. What I discovered was just how beneficial it is to relisten to important conversations.
I had remembered Ms. McGhee’s central thesis that much of public policy and political thought is built on the concept of winners and losers. Many Americans have been led to believe if an opportunity is extended to someone in need it will ultimately cost everyone else. That is zero-sum thinking. Her position is that lifting the disadvantaged benefits us all. We don’t seem to be able to extend the prized concept of “investing” for success to investing in people for our collective success. Republican politicians and policy gurus like Paul Ryan have talked about “makers and takers.”[Click on the link to hear/see a brief clip where Ryan says that he was wrong to talk about “makers and takers.”] It is prudent to talk about what something will cost, but it is short-sighted not to consider what the cost of that investment might yield. McGhee takes her challenge to the short-sided concept of our willingness to invest in possibility one step further. She delivers example after example of how we will harm ourselves, our own children, and our future rather than share a resource or provide equity for our Black fellow Americans. Her quintessential example is that in the sixties and seventies communities across the country either closed, destroyed or sold at a loss many parks and public swimming pools to avoid the necessity to integrate them. Not only did Black children not get to take a swim, neither did White children.
Almost two years ago in “The 1619 Project” created by Nikole Hannah-Jones, Jeneen Interlandi wrote a piece where the title asked and answered a question. The piece was entitled “Why doesn’t the United States have universal health care? The answer has everything to do with race.” In their conversation, Klein and McGhee reference the fact that as great as the ACA has been, and thank God it has survived another attack and will be the foundation of Biden’s attempts to introduce universal access to healthcare, it has never been favored by a majority of White Americans. I could say the same for education. White America has withdrawn from public education since the Civil Rights Act and Brown v. Board of Education of Topeka made “separate but equal” unconstitutional. The grants and support to higher education that Biden is recommending as part of his legislative program to support higher education are not nearly as beneficial as the ones I enjoyed in the sixties before the public schools and colleges were put on a “diet” by tax conscious right-wing politicians elected on dog-whistle promises to White constituents. McGhee’s observation holds. If we have to give it to everybody we will elect to give it to no one, including our own.
At the beginning of the review of McGhee’s book that you could enjoy by clicking on the link above that is attached to the title of the book, the reviewer Jennifer Szalai writes:
Hinton Rowan Helper was an unreserved bigot from North Carolina who wrote hateful, racist tracts during Reconstruction. He was also, in the years leading up to the Civil War, a determined abolitionist.
His 1857 book, “The Impending Crisis of the South,” argued that chattel slavery had deformed the Southern economy and impoverished the region. Members of the plantation class refused to invest in education, in enterprise, in the community at large, because they didn’t have to. Helper’s concern wasn’t the enslaved Black people brutalized by what he called the “lords of the lash”; he was worried about the white laborers in the South, relegated by the slave economy and its ruling oligarchs to a “cesspool of ignorance and degradation.”
Helper and his argument come up early on in Heather McGhee’s illuminating and hopeful new book, “The Sum of Us” — though McGhee, a descendant of enslaved people, is very much concerned with the situation of Black Americans, making clear that the primary victims of racism are the people of color who are subjected to it. But “The Sum of Us” is predicated on the idea that little will change until white people realize what racism has cost them too.
The material legacy of slavery can be felt to this day, McGhee says, in depressed wages and scarce access to health care in the former Confederacy. But it’s a blight that’s no longer relegated to the region. “To a large degree,” she writes, “the story of the hollowing out of the American working class is a story of the Southern economy, with its deep legacy of exploitative labor and divide-and-conquer tactics, going national.”
I began this piece by asking you to think about what has been lost, learned, and better appreciated as a result of the pandemic and the events of the last eighteen months. The title of this section is “What We Are All Losing.” I hope that it has become obvious to you that the pandemic, and I should add the tragedy of George Floyd’s murder, has revealed what we should have known all along. We have consistently chosen denial of opportunity and even premature death for some over the opportunity for universal health and broad-based opportunity for all. Much of the political confusion of this moment and the “culture wars” that are likely to continue through the next two national elections and longer are essentially a debate about race and its derivative inequity. Any attempt to improve the social determinants of health, establish universal access to healthcare, improve poverty by improving housing, education, and the opportunity for good jobs will always be hampered by our confusion and denial about the importance of race, and yes caste, in our society.
I am not calling for a cessation of our attempt to improve healthcare or achieve the Triple Aim, I am just saying that it is clear that based on history and the efforts we now are experiencing to resist the teaching of the history of race in our country to the students in our schools, the progress we want to see will continue to be extremely slow. That fact is my “aha” experience of the last eighteen months. I wish that it were not so, but it’s hard to fix a problem when you will not address its origin.
It Feels Like A Tragedy
I usually use a positive image for the header for these notes each week. It’s not a rule, but a habit. This week I considered using a negative image because I was so upset. Then the loons showed up for a long day of loling around at my end of the lake. My wife had gone to Boston for a dental appointment so it was up to me to take advantage of the opportunity to capture a picture that showed the baby loon’s growth over the first three weeks of life.
I am not much of a photographer. My iPhone is my usual camera of choice, but I decided to grab my wife’s Nikon. I used the automatic settings and captured a few good images. I particularly like the one in today’s header. Moma loon’s eyes are in sharp focus. The baby loon is slightly out of focus but it is easy to see the incredible growth of the last three weeks. Seeing the loons was a real “pick me up.” The image below is a small dose of what had made me feel so blue. It is the image that I was going to use as the header before the loons showed up.
Let me give you the story. One of my neighbors has provided me with much joy. He had cows. I would check them out on most of my walks or bicycle rides. The only downer was that about once a year one of the cows would visit the butcher. Not long after the departure of one cow, there was always a new calf to enjoy watching as it grew up.
About three months ago all the cows were gone. Two weeks ago loggers showed up. The first thing the loggers did was to clear-cut a large area near the lake. The land that was cleared was owned by the fellow who owned the cows. That was a surprise, but what could I do? Conversations with other neighbors did not yield much insight into why this was happening. We were all surprised. What was going on? Then the day after the land near the lake was cleared there was more cutting. This time the loggers turned several acres of beautiful woods that fronted one side of my road just after it turned off the highway into a huge stack of logs. The carnage was about two-tenths of a mile from my house which is on the lake at the end of the road. I realized that it was not my land, but I had enjoyed the drive down the heavily wooded lane to my house. I assumed that the devastation was over, but then the next day as I made the turn onto the road along the cow pasture I saw that the loggers were attacking the trees that lined the road along the side of the field, and they were pushing back the edge of the forest between the field and the Interstate highway on the other side of the pasture. The cutting of the trees along the road by the cow pasture was the end of it. I felt like crying as I remembered the joy my grandsons had experienced standing by the fence and marveling at the sight of a newborn calf. If you look closely at the picture which is a little fuzzy you can see a stack of logs beyond the chicken coop that has recently replaced the cows.
We live in a land where property owners have rights. My neighbor has exercised his rights, but he has also changed the environment in a way that surprised all of his neighbors. I will get over my sense of loss, but it was a reminder to me of how we are all connected in ways that we frequently don’t consider. Perhaps the events would have been easier to stomach if there had been some advanced explanation. There are stone walls all around us and I know in the 1800’s the land was all cleared for farming or grazing sheep and cows. Wool production was a big local industry. The land will recover as it has in the past, but I won’t see it. I can take my walks and my bike rides in a different direction that bypasses much of the recent harvest of trees, but the surprise alteration of the landscape is a stark reminder that we live in a world where there are many events and realities that are far beyond our control. Changes occur that perhaps we should expect, but the possibility that we should have recognized never negates the surprise or sense of loss that occurs when the unexpected happens.
During this last week, I finished my seventy-sixth year and began my seventy-seventh cycle of seasons. I was very fortunate for the first three quarter centuries of my time. The fourth quarter century has gotten off to a rocky start. I haven’t had COVID, but there have been other challenges. It is clear for me, and for all of us, that the future will always contain a mixture of joys and losses. That’s life. It is also clear that things will continue to change in ways we never expected even as we intellectually expect change. Life remains a learning experience. At times I marvel that I have gotten as far as I have without the knowledge that I have picked up in the last eighteen months. I practiced medicine in a very protective and supportive environment. I was educated at a time when society was still willing to invest in its youth. I grew up in a cocoon that protected me from the adversity that a Black American my age would have expected as reality. My errors were largely forgiven and chalked up to “learning experiences.” I was nurtured by wiser and more experienced colleagues. I really did not appreciate how good I had it. In the face of all that has happened, I feel like, despite my years and previous responsibility, I was very naive. Now it feels like that supportive world has been clear cut like my neighbor’s trees and I don’t really understand the forces that have made our society chose continued loss when greater opportunity and universal abundance seem to be within our reach. It feels like we live on the edge of tragedy that does not have to happen. We can assure an equal opportunity for health, dignified existence, and a life full of possibility for everyone. A better world is a choice that we have the power to make. Yet we seem to fall prey to those who see an opportunity to turn us against one another as a path to power for themselves. Go figure.
The question I face is whether or not I can alter my course, take advantage of what I have learned, adapt to what I can’t change, and log another twenty-plus years. It feels like we all have the same choice. Do we want to continue to live in a zero-sum world where there are temporary winners and permanent losers, or will we collectively choose to work toward a non-zero-sum world where we can all enjoy the abundance that is the legacy that those who came before us hoped we would have?
Give that question some thought. If you choose the non-zero world there is much that we need to do together.
Be well,
Gene
