I was quite gratified that in his recent sixteen hour panorama of Country Music, Ken Burns spent a disproportionate amount of time in episode six on Kris Kristofferson. Kristofferson has always been a favorite of mine. He was an exceptional athlete at Pomona College, a Rhodes Scholar, a captain and helicopter pilot in the army, and one of our most literate and poetic practitioners of songwriting in any genre. Kristofferson’s songs are full of lines that get you thinking. A good example of my point is the song, “The Pilgrim: Chapter 33.” It contains some of my favorite Kristofferson lines.
See him wasted on the sidewalk in his jacket and his jeans,
Wearin’ yesterday’s misfortunes like a smile
Once he had a future full of money, love, and dreams,
Which he spent like they was goin’ outta style
And he keeps right on a’changin’ for the better or the worse,
Searchin’ for a shrine he’s never found
Never knowin’ if believin’ is a blessin’ or a curse,
Or if the goin’ up was worth the comin’ down
Those are seventy seven words that are much better than a picture. It is a story that is not yet over about a person with great talent, who has wasted opportunities, is still on a quest that has been derailed by bad choices, and now is confused about whether persistence is worth the effort. The picture gets even darker:
…he’s traded in tomorrow for today
Runnin’ from his devils, lord, and reachin’ for the stars,
And losin’ all he’s loved along the way
But if this world keeps right on turnin’ for the better or the worse,
And all he ever gets is older and around
From the rockin’ of the cradle to the rollin’ of the hearse,
The goin’ up was worth the comin’ down
In the intro to the song Kristofferson gives us a list of entertainers that he had in mind as he wrote the song, but could the song be about all of us? Are we trading in tomorrow for today? Are our better days behind us? Are we coming down? It is good to remember that the song was written in 1970 during dark days of our national failure in Vietnam. The last verse contains my favorite line which I have no problem applying to us collectively whether or not Kristofferson was talking about himself, someone he knew, or all of us collectively:
…a walkin’ contradiction, partly truth and partly fiction,
Takin’ ev’ry wrong direction on his lonely way back home.
There’s a lotta wrong directions on that lonely way back home.
When I read These Truths: A History of the United States, Jill Lepore’s 2018 one volume history of America, last year, the phrase “…a walkin’ contradiction, partly truth and partly fiction,” kept popping into my mind. It seemed like a good way to describe our attempt to move toward the higher ideals that were described in our Declaration of Independence by Thomas Jefferson, an owner of many slaves and the father of several black children from his long term relationship with his slave, Sally Hemings. Jefferson wrote in 1776,
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
The theme of Lepore’s history is our ongoing struggle through more than 240 years to try to live up to those words. Lepore paints a picture that is similar to the Pilgrim in Kristofferson’s song. We’ve been searching:
Searchin’ for a shrine he’s never found
Lepore debunks with excellent documentation the idea that slavery was tolerated out of some lack of social awareness that it was wrong. Slavery was an economically important institution that enabled the nation’s growth, enriched many people, and drove expansion. It’s economic advantages were so beneficial to the wealthy advantaged minority that it took the loss of over 700,000 lives to get rid of it at a legal level, and yet the bloody consumption of one person’s unalienable Rights for the advantage of another has remained such an economic advantage that we still can’t scrub the blood stains from our collective teeth. Emmett Till was not the last black child to die because of our “walking contradiction” that remains partly truth and partly fiction.
Slavery has not been the only “walking contradiction” in our national struggle to be true to the promise of Jefferson’s 35 word declaration and justification of our reason for separation from Britain. Women have struggled, and continue to struggle for their full share of “These Truths,” migrants and immigrants have had, and continue to have, an ambiguous status in relationship to these truths. Indigenous people were not citizens in the land occupied by their ancestors for more than 10,000 years until 1924 when the Indian Citizenship Act was passed. We continue to debate inclusiveness. There are three cases now before the Supreme Court where we are still debating the civil rights of the LGBTQ+ community.
Martin Luther King, Jr. connected the violation of human rights and our national walking contradiction with access to medical care and with economic inequality on many occasions in his short life.
If that is not radical enough, have you ever read this quote from one of his later speeches as his concerns spread to all economically disadvantaged people who were having difficulty with “these truths”?:
“The contemporary tendency in our society is to base our distribution on scarcity, which has vanished, and to compress our abundance into the overfed mouths of the middle and upper classes until they gag with superfluity. If democracy is to have breadth of meaning, it is necessary to adjust this inequity. It is not only moral, but it is also intelligent. We are wasting and degrading human life by clinging to archaic thinking.”
—from “Where Do We Go From Here: Chaos or Community?” 1967
In his famous “I Have A Dream Speech” he used the metaphor of an uncashed check to focus his audience on our collective contradiction to “these truths.”
In a sense we’ve come to our nation’s capital to cash a check. When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence (Yeah), they were signing a promissory note to which every American was to fall heir. This note was a promise that all men, yes, black men as well as white men (My Lord), would be guaranteed the unalienable rights of life, liberty, and the pursuit of happiness. It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned. (My Lord) Instead of honoring this sacred obligation, America has given the Negro people a bad check, a check which has come back marked insufficient funds. [enthusiastic applause] (My Lord, Lead on, Speech, speech)
But we refuse to believe that the bank of justice is bankrupt. (My Lord) [laughter] (No, no) We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. (Sure enough) And so we’ve come to cash this check (Yes), a check that will give us upon demand the riches of freedom (Yes) and the security of justice. (Yes Lord) [enthusiastic applause]
A good companion read to Jill Lepore’s These Truths: A History of the United States is David Blight’s Frederick Douglass: Prophet of Freedom. I highly recommend an op ed written by Blight about the subject of his book. I knew nothing about Frederick Douglass when I was named the DAR Medal winner in the eighth grade as the best student in American history. I knew a lot about Abraham Lincoln, Robert E. Lee, Jefferson Davis, and even a little bit about Stephen Douglas. I knew what I had been taught. In fact, I was taught that the Civil War was a struggle over states’ rights and that slavery was not the real issue. States’ rights is also a theme that comes up from time to time in the discussion of healthcare, women’s rights, and LGBTQ+ issues. Bright’s biography is a celebration of a man, Fredrick Douglass, who did not accept the status quo and the inevitable continuation of our collective “walking contradiction” with all of our incomplete truths and continuing fictions.
While reading the Douglass biography and Lepore’s history, it occurred to me that the discussion of the next steps in the pursuit of the Triple Aim falls into the history of our continuing “walking contradictions” that are so prevalent in our collective history. It also occurred to me that the continuing theme through all of our “contradictions” is the perpetuation of economic inequality and the pursuit of the personal advantage of those who control the status quo. Even among Democrats, the debate continues about whether we can afford universal access with no cost barriers at the point of service, and how we will pay for it.
As Martin Luther King, Jr. pointed out, we have long had the ability to address economic inequality and fix the reality that many are excluded from adequate medical care. Our “contradiction” is that even as a majority of Americans say that healthcare should be an entitlement, our individual fears and self interest make us reluctant to make it a reality everyone for fear of what it will cost to us as individuals in taxes and in the potential risk of our own care of changing in some way we can’t control.
I was delighted to discover that David Brooks has also been reading the same book about Fredrick Douglass. His October 10th column was entitled “What Makes Us All Radically Equal: It’s not our brains and it’s not our bodies.” After a story about the struggles of a non profit in Detroit which is seeking to make a difference and the personal struggles of it leader full of “— moments of fury and harmony, despair and hope,” he writes:
The somewhat comforting truth is that it’s always been like this. [The “this” being that we have often failed to understand and accept one another as we struggle to live up to our founding principles.] When you read David Blight’s brilliant biography of Frederick Douglass, for example, you see that Douglass passed through exactly these many moods in dealing with his countrymen of another race — moments of fury and harmony, despair and hope.
Sometimes he was disgusted with America. “I have no love for America, as such,” he once said. Other times he was enraptured: “I am an American citizen. In birth, in sentiment, in ideas, in hopes, in aspirations and responsibilities.”
Douglass’s genius was his ability to balance his indignation at oppression with his underlying faith in the American project. In his speeches he would praise his white audiences in one movement and thunder condemnation in the next. In an 1876 speech about Abraham Lincoln, he both condemned and complimented the man who inspired and infuriated him: “Viewed from the genuine abolition ground, Mr. Lincoln seemed tardy, cold, dull and indifferent; but measuring him from the sentiment of his country … he was swift, zealous, radical and determined.”
Douglass could withstand all the ups and downs, all the ambivalences, because of an unchanging underlying belief: in the natural rights of all humankind.
He constantly returned to the core belief of America’s founding in 1776, that we are endowed by our creator with certain unalienable rights. Slavery and racism were not just wrong — they betrayed the divine natural order of the universe. Douglass had an underlying faith in the providence. Justice would eventually triumph. The “laws which govern the moral universe,” he said, would make it so.
At this point Brooks explains the attitude that enables us to move from being a walking contradiction confused by self interest and immobilized by fear:
And here we get to the nub of what sustained Douglass and what sustains people today as they do this work. It is the belief that all humans have souls. It is the belief that all people of all races have a piece of themselves that has no size, weight, color or shape, but which gives them infinite value and dignity.
It is the belief that our souls make us all radically equal. Our brains and bodies are not equal, but our souls are. It is the belief that the person who is infuriating you most right now still has a soul and so is still, deep down, beautiful and redeemable. It is the belief that when all is said and done all souls have a common home together, a final resting place as pieces of a larger unity.
When people hold fast to their awareness of souls, then they have a fixed center among the messiness of racial reconciliation and they give each other grace. If they lose the concept of the soul, they’ve lost everything.
I once had a resident who described his attitude toward the universal similarities that patients present to us in a simple way by saying, “In a hospital johnny we all look the same. We all feel pain. We all bleed red blood when we are cut.”
I don’t think it is a stretch to apply Brooks’ reasoning and his example of Frederick Douglass to the current challenges in healthcare. Economics in the form of the question, “Who is going to pay?,” has always been a barrier to “these truths.” Sometimes the barrier to “these truths” is not a straight up issue about money. Sometimes the contradiction arises from a concern arising from control, status, or personal belief. Let’s face it, just as it was true that reversing course and abolishing slavery had a huge cost in lives and billions of dollars of “property loss,” there will be both a cost to abolishing inequality in healthcare and delivering on the promises of “these truths.” Until now, and perhaps for sometime into the future, it will be easier to remain a collective contradiction, but at some moment the road we are traveling is likely to reverse direction. We may come to a moment soon when our collective ascent as the world’s leader in everything from human rights to wealth could be reversed by our own selfish concerns being magnified by self serving political leaders. At that time, we could realize that the ultimate cost of worrying about loses associated with delivering on “these truths” for fear of the cost will prove to have been our “coming down.” At that moment maybe we will realize that the short term benefit of ignoring “these truths” while we were “going up” was not really worth that “coming down.” It’s time to make good on the “check” for economic opportunity and health care, and deliver on what everyone deserves at a minimum, which is access to the care they need and the full meaning of “these truths” in every life. I would apply what Brooks’ writes in reference to racial equality to all forms of inequality, including the inequalities in healthcare:
It is the belief that our souls make us all radically equal. Our brains and bodies are not equal, but our souls are. It is the belief that the person who is infuriating you most right now still has a soul and so is still, deep down, beautiful and redeemable. It is the belief that when all is said and done all souls have a common home together, a final resting place as pieces of a larger unity.
