The Case Against Everyone: The America you don’t see

7 Jun

As the primary season winds down today with the last gasp from the Left Coast, we can look forward to a general election featuring the two most-detested major party nominees in polling history.  The media worked strenuously to avoid doing its job filtering, interviewing, and probing the views and histories of the two soon-to-be nominees.  This year’s series The Case Against Everyone will indeed include a case against the presidential candidates (Mr. Trump was covered last year) and will also include highlighting the issues and forgotten corners of the American and international landscape that are rarely asked or intelligibly discussed.  Answers may or may not exist, but dear readers, you will soon know the questions to hold your elected officials to account.

Mr. Donald Trump and Sen. Bernard Sanders (I-VT) have drawn large crowds throughout the nation.  TV news finds this puzzling; rarely are audiences asked why they came to see these candidates.  If the answers are not coherent, perhaps the longing for a different nation could be translated by the media into recent statistics, surveys, and polls.  These surveys should shame the media who unabashedly proclaim the American political and economic system open, democratic, and fair.

The Associated Press-NORC poll revealed shocking numbers about the trust of Americans in the two major parties and the three branches of government.  The only major paper to cover it was the Denver Post.

  • 8% of Americans think the Republican Party is extremely or very responsive to ordinary people.  62% do not.
  • 12% of Americans think the Democratic Party is extremely or very responsive to ordinary people.  46% do not.
  • 12% of Republicans think their party is responsive and only 25% of Democrats think their party is responsive to ordinary people.
  • Confidence in Congress is 4%, confidence in the executive branch is 15%, and 24% in the Supreme Court
  • 55% of people feel helpless about the election and 2/3 of young people do too.

Not exactly views promoted every day by the talking heads on TV.  Their flag waving about the American political system is not reflected by actual Americans.  In the mean time, Puerto Rico voted in the presidential primary and while everyone was complaining about the decrease in polling locations, there was no substantial discussion about the economic crisis of Puerto Rico.

  • 2% of Puerto Ricans have left the island in a year.  Florida may soon have as many Puerto Ricans as New York.  More Puerto Ricans lives on the mainland than on the island for the first time in history.
  • Tax breaks that propelled the island’s pharmaceutical industry have ended, killing the manufacturing base and jobs.  The U.S. territory is effectively bankrupt.

The fact that the only substantial discussion of Puerto Rico has been by a comedian on HBO puts to shame the election “coverage.”  Meanwhile health indicators point to a sickness in body politic.

  • Nobel Prize winning researchers have shown that death rates for non-college educated whites have risen dramatically since 1990, likely linked to decline in the manufacturing economy.  Suicides, overdoses, and alcohol abuse are all likely culprits.  No other nation or ethnic group has shown such a reversal.  Half a million people are dead who should not be dead.
  • Suicide rates are rising to recent highs.
  • Opiate (and its related cousin, heroin) abuse deaths are at record highs which are at least partially related to commercialization of health care and “patient satisfaction scores” imposed by hospitals and Medicare.  This McDonald’s “customer service” approach is killing medicine and the morale of health care providers.

These are glimpses of the desperate situation of real America not discussed in “election coverage” and vapid celebrations of the American “political process.”  What little is mentioned is insubstantially probed or run past “political” experts not content experts.  These are some of the many issues to be discussed with friends, colleagues, co-workers, and elected officials to play our collective roles as good citizens.

 

Book Review : A Brief History of Seven Killings

21 Dec

This was posted last week on the website of the Cleveland Book Award from the Anisfield-Wolf Foundation.  The author, Marlon James, won their award this year and the Man Booker Prize.  Here I review and compare the book to Sacred Games.

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In 2007, when I asked my driver in Caracas if evangelical Christianity had been making its way into the oil-rich jungles of Venezuela, he nodded, smiled, and said, “Yes, they say officially they are here for the Church of Pentecost, but I think they are here for the Church of the CIA.”  In every developing nation, that nod and that smile and that second story represent the beginning of almost every great storytelling session I have had about recent history and current events.

Listen to me now.  Me warn him… Long time I drop warnings that other people close, friend and enemy, was going get him in a whole heap o’trouble.  Every one of we know at least one, don’t it?  Always have a notion but never come up with a single idea.  Always working plenty of scheme but never have a plan… Me not going name who but I warn the Singer…. Me love that man to the max.  Me would take a bullet for the Singer.  But gentlemens, me can only take one.

Writer Marlon James has won this year’s Anisfield-Wolf and Man Booker prizes by driving us past recent Jamaican history.  In a cacophony of voices, versions, and views, James writes a fictional exploration into the 1976 assassination attempt on reggae superstar Bob Marley.  In A Brief History of Seven Killings, quoted above, readers embark on a violent and entertaining ride through Kingston slum fights (sponsored by warring political parties) that become a Cold War flashpoint in Michael Manley’s Jamaica.  Marley, perceived to be supporting the socialist People’s National Party, falls victim to that fateful winter election and the CIA. The book then shifts to the United States where Jamaican political gangs morph into nonpartisan drug smugglers, tolerated by intelligence communities willing to overlook drug money if it goes towards fighting socialism and communism.  Until it gets out of hand.

The book, whose rights have been sold to HBO for a TV series, should do well as a long form television drama.  A populous that once stood at the docks to snatch up the latest installment from Charles Dickens now awaits the latest weekly HBO serial, one of contemporary America’s strongest art forms. James novel fits the format with its motley mix of characters and politics (“Game of Thrones”) and urban and police violence (“The Wire”).  As East becomes West, the West too has become East by picking up a taste for epic legends with endless sub-stories, ambiguous facts and no definitive, singular truth.  All thrive on a range of viewpoints, versions and classes.

From the deceased MP to the barely intelligible ramblings of a crack-fueled shooter, readers absorb from top to bottom a long overdue cultural multiplicity in A Brief History of Seven Killings. No one knows who served Mr. Darcy tea, but we all know who serves Lord Grantham tea.  All of this points to progress.  It points to the widening of the literary establishment’s mind but not perhaps as wide as it celebrates.

sacred gamesJames’s novel most reminds me of Vikram Chandra’s magnum opus, Sacred Games, about a Mumbai police investigation into an Indian mafia don.  Thick with pages and characters, Sacred Games exposes the connections between the underworld, police, politicians, and the film industry.  Chandra also leaps into the future and the past with intercalary chapters that covered Naxalite rebels, Indian secret intelligence and the Partition of British India.  Few novels set in the developing world can parallel A Brief History in quite the same way.

Published to positive reviews, Chandra’s novel did not have the sales or impact other South Asian books did.  Even compared to other literary and popular books about South Asia (Bookseller of Kabul, All the Beautiful Forevers, Three Cups of Tea, Shantaram), it never received critical or popular mass appeal.  It is rare to find on bookshelves today.

Why A Brief History of Seven Killings and other South Asian novels would have similar trajectories while Sacred Games did not is clear to me.  The former have appeals to Western sensibilities that the third does not.  Three Cups of Tea (for example) has a strong element of Orientalism with the classic story of a Westerner coming to Asia and educating rural women.  A Brief History of Seven Killings tells a story about music and a musician famous throughout the West that cannot help but arouse interest in the United States.  American characters from Rolling Stone and the CIA help ease the transition into the unfamiliar worlds of Jamaican politics and Kingston slums.  If the book was about an assassination attempt on Prime Minister Manley and not Marley, we may not be having this award or book review.

Meanwhile film and music references in Sacred Games were unabashedly Bollywood; secretive government agencies were the CBI not the CIA, and the bogeyman feared is Pakistan not Russia or Cuba.  No one smuggles drugs to the United States or London.  No white people, no Christianity, no Clint Eastwood references, and no colonialism at all!

A Brief History of Seven Killings is a fantastic book, and it will make a fantastic HBO series given the novel’s natural similarity to the channel’s specialty—epic dramas.  But Sacred Games moved me more deeply as it was a book deeply rooted in its culture and unapologetically Indian.  Perhaps when we award books we should examine why some get attention and some do not and question the cultural biases we have against looking deeply into a truly “foreign” book.  A truly open mind can wade into another world mentally without needing the props of the world it just left behind.

The Case Against Everyone: America’s Mogul

30 Aug

If Sarah Palin in 2008 brought Republican politics into the era of reality TV and the constant up and down in the polls in 2012 made the Republican primary look like a reality show then perhaps 2016 will be the year that Republicans perhaps settle on the real deal: Donald Trump, host of his own reality TV show: The Apprentice.

The media loves Trump; left, right or center, they cannot stop taking a hit from that Trump pipe that is increased eyeballs and increased ratings no matter how minor his news announcements may be.

Donald Trump scares establishment Republicans.  Why he does so is not so clear to me dear reader.  After years of trumpeting the wisdom of the mega-rich, a distaste for career politicians, hate for immigrants and the emerging minority-majority America, and habitually living in a separate universe of facts (Jon Stewart nicknamed it Bullshit Mountain), why wouldn’t Republican voters develop a taste for “the Donald.”  Why have a career politician meekly spew these inanities while collecting unlimited corporate money from their billionaire corporate overlords like Sheldon Adelson when you can just vote for the billionaire directly?  And no one can say what Republicans want to say (and hear) more directly and crudely than the Donald.

In a once-proud nation of entrepreneurs, independent lawyers and doctors, unionized factory workers, and self-made men, years of corporate consolidation and online shopping have reduced the few of left still working into a cowardly, sniveling, sniffling, salaried underclass.  The nation of Clint Eastwoods and John Waynes is now the nation of The Office.

Donald Trump, in the psychogeography of the new America, makes America great!  Not because he is one of us but because he is one of the few people left who is allowed to say what he wants when he wants no matter how illiterate, stupid, contradictory, or racist it may be.  He reminds America of what Americans used to be: free.  Free from the Man (government or corporate).  Now this nation of Dwight Schrutes loves and admires a man who will say what a free people would want to say.  We’ve had millionaires and billionaires ranting before in the last Gilded Age, but at least the masses still had Mark Twain, William Jennings Bryan, Eugene V Debs, and a Roosevelt or two to kick them around.

Can he win a general election?  Given that Mitt Romney won 27% of the Hispanic vote in 2012 which was down from John McCain’s 31%  which was much lower than George W. Bush’s 44% in 2004, I find it hard to imagine the Republicans getting anywhere close to 25% with Trump or whoever emerges from the GOP primary bleeding to death.  Ejecting Jorge Ramos (the “Walter Cronkite” of Univision) from his press conference only made him and the party look that much more bigoted.  When Gov. Pete Wilson (R-CA), went on an anti-immigration spree in the 1990s, he activated the latent power of the Mexican vote in California which has transformed California into a Democratic bastion.  Donald Trump may do that nationally.

What is he worth anyways?  No one really knows what he is worth (anywhere from less than a billion to $10 billion) because much of it is secret or related to the PR value of his brand (aka his name).  And no one mentions that Donald Drumpf inherited his construction business and millions of dollars from his father.  So much for 100% self-made.

But like many things in America, it is the myth and the legend that win over the truth.  Rudy Giuliani, another New Yorker, was falsely called America’s mayor after September 11, 2001 despite the fact that he didn’t do anything for firemen, bought defective radios that killed many of them, and based the emergency control center in the World Trade Center despite warnings not to by EMS.  And that is why I anoint Donald J. Trump the title of America’ Mogul.

Michael Ventura, an appreciation

10 Jan

Last year, Michael Ventura retired his column from the weekly newspaper, the Austin Chronicle.  I consider Michael Ventura the finest columnist in the English language alive today.

Michael Ventura is a Sicilian-American New Yorker who moved to California and wrote for LA Weekly for years before moving to Lubbock, Texas and writing a bimonthly column for the Austin Chronicle.  He has lived and driven across this nation several times over, and he can write from a unique perspective.  His range and deep understanding of humanity, the United States, and art allowed him to publish some of the greatest columns about what it means to be American and live in the United States at the dawn of the 21st century.

In one series of columns, “Dispatches from the Former United States“, he took the perspective of the year 2107 reflecting on the successes and failures of the United States of America.  In “Red State Blues,” “Broke Down in Bossier City,” and “Lubbockian Identity” he examined the people and places ignored by the American intelligentsia.  He also writes about the breakdown in culture and common understanding that leads to the mental unrest grappling this country.

Who else can write a column accurately describing the globalization and diversification of middle of nowhere Lubbock, Texas and reflect, “Lubbock, Texas, 1973 would never have agreed to become Lubbock, Texas, 2008.”

He challenges us to take that step and mentally engage with those different than us.  And to see the changes we did not even notice happening under our very own eyes.  In his next to last column, he writes about the “World that Calls itself the World” and how our media ignores and disempowers us from the world that is our world.  You know, the one we live and see every day in our lives.

The greatest writers can write about topics so distant from their readers’ experiences yet still reach out and touch and move the reader by reaching for their shared humanity.  Michael Ventura was able to do that every week in the Austin Chronicle to me.

 

Austin Chronicle – “Letters at 3AM”

Michael Ventura – “If I was a Highway” – book  collection of his columns

Issue LVII: Austin and the Cost of Cool

9 Jun

Leslie Cochran, the most famous homeless man in Austin, died last year.  For a city whose unofficial slogan was “Keep Austin Weird,” the town became just a little bit more square.  As the icon of weird in Austin, he ran for mayor every election and crashed on the street in front of my apartment near the old Tower Records.  His obituary ran in the New York Times.   

And that perhaps is the problem.  When the New York-Hollywood media set starts to notice a fun place, they’ll suck all the coolness out; at a minimum, they’ll wrap a velvet rope around it and start charging for entry.  For a place that is no longer and town and not quite a city, Austin looked to guidance for its future as one of the fastest growing metropolitan areas in Texas and the nation.  And the coolest.  

Richard Florida, an urban studies professor, preached a vision for growing urban areas like Austin.  His theory was that cities needed to recruit what he called “the Creative Class” who will bring the new economy to blighted cities like Pittsburgh, Pennsylvania where he used to teach at Carnegie Mellon University.  The Creative Class works in industries that require thinking and creativity and high levels of formal education.

It is important for your city to be “cool” for young people.  Because without all those gays and rock bands, your town will not attract workers with the high social capital and job skills your region needs to grow in the future.   

Austin was a chosen city that was intrinsically cool (#2 in Florida’s list).  Austin has been “cool” since at least the 1970s when cheap pot, rent, and beer brought the music scene it is known for today.   

 What makes a city cool?  A combination of “diversity”, tolerance, outdoor activities, arts, nightlife, and walkability sets the stage for most creative cities or towns.  Richard Florida’s book made a huge splash amongst policymakers and the media.  He turned his book into a consulting company and then abandoned Pittsburgh for the University of Toronto.       

 Ten years later after Richard Florida’s book came out, what has the Creative Class done for America’s cities?  Our first warning in 2005 was when Joel Kotkin first pointed out that San Francisco (#1 in cool) had become an ephemeral city with no middle class, children, or jobs that transformed itself into an entertainment and eating center.  The City of St. Francis has become an adult Disneyland that drives the rent up and pushes minorities and the middle class out.      

 

Now Florida admits that the benefits of focusing on the Creative Class actually benefit that class and not anyone else in the city.  It gentrifies cities and makes them monochromatic and increases the gap between the rich and power when the middle class moves out.  Austin is the only city in Texas that became less diverse and more white.  East Austin (historically a Mexican-American neighborhood) is one of the most rapidly gentrifying neighborhoods in the United States. 

And not every city can be cool like Austin, Boston, Boulder, or San Francisco.  There are not enough yuppies and hipsters in the world to save every city in the nation.  But it does help real estate companies pocket big tax subsidies for projects in these neighborhoods and help Richard Florida collect $35,000 per speech from Rust Belt towns.

 

I am not saying that tolerance, arts, walkability, and creativity suck.  All cities need them, even the boring ones.  The New Urbanism movement of re-creating lost spaces and emphasizing the environment when planning development has improved nearly every American city.  But focusing on a narrow sliver of the population to save very different cities will not improve most cities or even states in the nation.  And the side effects of attracting wealthy outsiders may just make life more unpleasant from the poorest people actually living there and the rent much higher.        

 Cool costs too much.  It costs personality and pushes out locals for out of towners obsessed with “the local thing to do” all while the actual markers of local flavor pass away to make room for placeless markers of upscale “cosmopolitan” urbanity that an honestly be find anywhere. 

 True Austinites swore to never let their town turn into Dallas, but that never stopped the city from subsidizing a mall with a Neiman Marcus.  Focusing on the city’s fundamentals and authentic flavor and independent businesses is the key to true personality and (hopefully) revival.        

 

Austin was always the place that was way cooler before you go there.  The end of Austin was hailed (before my time) when Liberty Lunch closed, when Las Manitas Avenue Café closed (during my time), and when Leslie Cochran died (after my time).  This time the old timers may be right. 

  Links

Washington Monthly – “The Rise of the Creative Class” 

Houston Press – “Finding Austin

San Francisco Chronicle – “The Ephemeral City

The best articles on gun control

23 Dec

Since the shootings in Connecticut earlier this month, I am sure that every one is interesting in learning more about the history of guns and gun control in the United States.  A friend of mine passed along a very interesting article last year about how the Black Panthers started gun control hysteria by marching on Sacramento armed to protest a gun control bill written by a Republican and eventually signed by Governor Ronald Reagan.  The modern NRA began with a coup in 1977 led by Harlon Carter which moved the organization’s focus from hunting and marksmanship to a zero tolerance policy for sensible gun laws.

And for those concerned that the world will end (or at least get more violent), I recommend listening to this interview with Steven Pinker about the decline of violence worldwide about how murder and violence and war are at historic lows.  Crime is at historic lows in the United States, and war is becoming (surprisingly) much less rare.  To paraphrase John Lennon, “War is ending, if we notice.”

Links

Atlantic Monthly – “The Secret History of Guns

WNYC – “Steven Pinker on why violence has declined

Dear Dr. Gawande

26 Aug

Dear Dr. Gawande,

        As the nation (or media’s) most foremost health policy expert, I must object to your recent article comparing hospital chains to restaurant chains.  Since I am pretty sure the New Yorker will not publish my letter to the editor, I will share this letter publicly with my dear readers. 

       Comparing health care to the Cheesecake Factory is ludicrous. Anyone in health policy knows that health care is meal ordered by one person, eaten by another person, and paid for by a third. Competition does not bring down prices in health care because patients do not know what they want and do not know how much it costs and there are no standard national prices. This is not like choosing between Olive Garden and Carabba’s.

       There are narrow niches which could be competitive like the cited example of the author’s mother’s knee replacement. But these are elective procedures in which the patient has time and knowledge about exactly what he/she needs. That is not most of health care or most patients. Low spending regions in the United States are generally dominated by local monopolies. The CMO at Scott & White Hospital in Temple, Texas (a low spending region) openly told me competition increases prices in America.

       What motivation do hospital chains have to bring down actual prices? Consumers don’t pay hospital bills directly, and CMS rules forbidding charging anyone lower than the Medicare rate effectively rule out any downward pressure on prices. Instead hospital chains focus on increasing volume and usually fraudulently as Hospital Corporation of America has done with cardiac catherization labs. Most of these chains will be like HCA and not like semi-noble physician-run enterprises like the Cleveland Clinic or Mayo Clinic.

       Quality of care contracts will not lower costs much either. A recent study (New England Journal of Medicine, September 8, 2011) comparing spending in Massachusetts Blue Cross/Blue Shield’s quality contract with non-quality contracts showed that quality contracts merely slowed the increase in health care spending by 1.9% or a princely $15 per quarter per enrollee. Meanwhile Partners Healthcare’s anti-competitive contract with Blue Cross/Blue Shield contributed $1 billion in excess profits.

         You are the eloquent defender of changes already in progress, pretending that those in charge of healthcare will be like the ICU quality improvers and not like hedge fund managers only interested in bilking the public. A for profit health care systems means that medical clinics and facilities want to make more money, every quarter, every time.

        The proletariazation of American physicians from Jeffersonian small businessmen into wage labor for “Hamiltonian” hospital systems will not make health care better or more affordable or even higher quality. It will concentrate wealth and power further to distant elites. Health care quality improves for the uninsured and insured (NEJM, July 5, 2012) when more people get insurance. A nonprofit, universal health care system will lower overhead and standardize payments and care. Fairness is cost-effective.

        Hamilton may have brought America money, but Jefferson brought us justice. Beware of technocrats who think that tweaking a corrupt and unjust system will fix its ills and not their salaries.   

 

Sincerely,

A working physician