This is a revised and expanded version of a post I wrote two years ago about my father.
Many of you, I suspect, have had a tough time over the holidays. Perhaps lonely, perhaps worried about what the future will bring. Many all over the world are yet unemployed or underemployed. Things have been difficult.
I offer you, therefore, an audio excerpt linked below, from a late 1941 speech given by Winston Churchill, the British Prime Minister during most of World War II.
I hope that it will provide some solice and some reason to believe that a better future is possible.
Things were particularly dark for England in 1940. All of continental Europe had been conquered by the Nazis and night after night, the great cities of that island nation were bombed by the Luftwaffe, Hitler’s air force. The British Empire stood alone against the Third Reich and expected a land invasion. The United States had not yet entered the War and there was no certainty that it would.
Virtually no one thought England would survive.
But Churchill did and the Nazis were defeated.
In October of 1941, still prior to the USA’s entry into the war, Churchill was asked to speak to the students of Harrow School, an independent boarding school that was his alma mater.
What he had to say applies quite well to those, even today, who might fear that worse is to come in their lives, as well as those who despair over their current condition.
Listen to the first three minutes and ten seconds and take heart.
The entire excerpt is just over four minutes long.
Once you click on the blue link just below this paragraph, look at the upper right corner of the page. Then scroll down and click on the Speech #33 (incorrectly identified as having been given in November 1941):
The image above is Winston Churchill on Downing Street Giving His Famous ‘V’ (For Victory) Sign, June 5, 1943. Sourced from Wikimedia Commons.
Perhaps it shouldn’t surprise us, but one can do the most violence to another when one is close to that person. Physically close. Pinching, punching, pushing, plucking, picking, pulverizing — actions that can only be done at close quarters, the victim is pilloried and punished. Perhaps then, it is no wonder that human kind can be uncomfortable with and afraid of intimacy.
When physical vulnerability is compounded with the psychological, we tend to be even more careful. Those who are close to us know just where to strike, where the soft and breakable parts are; and they are just in reach.
I watched a History Channel feature the other night on The St. Valentine’s Day Massacre. The point was made that while the Thompson submachine gun was a useful weapon for killing at a distance, many of the most important gangland assassinations were done with a pistol, while holding or grabbing the victim, or pulling him close to make certain that he couldn’t reach for his own weapon. Intimacy again — the closeness that made injury possible, more certain, more lethal.
Remember Delilah of the famous bible story that featured Samson? Again, intimacy, this time of a sexual nature, allowed her to rob Samson of his strength by having his enemies cut his long hair while he slept.
When you were a kid, do you remember an aunt or uncle or grandparent who would hold you close and then pinch (and shake) your cheek between thumb and forefinger? It was alleged to be an act of affection, but whenever it was done to me, I couldn’t quite understand how something that hurt that much was supposed to show love.
I’m sure you know the origin of the handshake — an ancient custom designed to display the fact that you do not have a weapon in your hand with which to do injury at close range.
And, in the “you always hurt the one you love” department, we should not forget that “crimes of passion” account for many of the violent deaths in this country. That is, we are harming those we know, not strangers, in fits of intense emotion and impulsivity.
How does this relate to therapy? In part, because the therapeutic relationship is a somewhat one-sided intimacy. The patient makes himself vulnerable to the doctor, displays his wounds and expresses his emotions, trusting that his secrets and feelings will be safeguarded, treated with kindness and respect, and definitely not used against him. Therapists need to keep this in mind, lest they re-traumatize the person, injuring him in a way that is similar to the very torment that he came to therapy to heal.
Although a counselor’s power can hardly be considered “great,” it is considerable when it comes to his patients. Psychologists would do well to remember the quote from the movie Spider-man: “With great power comes great responsibility.”
The moral of the story? Allowing one self to become close and vulnerable to another person opens the door to the best and worst that life can offer. It is therefore of great import to choose a friend, a lover, or a therapist with care.
As the Knight Templar told Indiana Jones in Indiana Jones and the Last Crusade when the explorer had to pick out the Holy Grail from an assortment of old cups, “choose wisely.”
The above image is William-Adolphe Bouguereau’s 1850 painting Dante and Virgil in Hell sourced from Wikimedia Commons.
Would you like to know who you are? Then it is essential to know what is of real value to you. One way of finding that out is by asking the question, “What would I be willing to give up for something that I claim is important to me? What would I be willing to sacrifice for love, or great wealth, or power, or honor, or for my child’s well-being?”
What we are willing to sacrifice defines us, both as individuals and as a society. But first, let’s look at what the word sacrifice means:
The on-line Merriam-Webster’s dictionary gives the following definition of the noun sacrifice:
1 : an act of offering to a deity something precious; especially : the killing of a victim on an altar
2 : something offered in sacrifice
3 a : destruction or surrender of something for the sake of something else b : something given up or lost <the sacrifices made by parents>
4 : loss <goods sold at a sacrifice>
Thus sacrifice involves loss and giving something up.
In primitive societies, it often included murder.
Human sacrifice was intended most often to appease a God, win the God’s favor, or avoid the God’s wrath. Igor Stravinsky wrote a famous ballet about this, The Rite of Spring.
More recent depictions of this sort of behavior have included Friedrich Dürrenmatt’s 1956 novel, The Visit. In this story a wealthy woman (Claire Zachanassian) returns for a visit to her home town, a place that has fallen on hard times. She departed in disgrace many years before when she was impregnated by her young lover. This person denied the charge of paternity and bribed two people to support his case by claiming that they had been intimate with her. Shamed by the townsfolk, Claire eventually turned to prostitution.
Her return home is noteworthy for a “proposition” she has for the town where her former lover continues to live as a respected businessman. She will bequeath an enormous sum to the hamlet if it will do one simple thing: put to death the man who caused her disgrace. In effect, the book asks the question of what this woman is willing to sacrifice for revenge (her money, her morality) and what the town’s people are willing to give up for money. The movie of the same name starred Ingrid Bergman and Anthony Quinn.
More recently, a very different sort of sacrifice is depicted in a 1967 episode of the original Star Trek TV series, The City on the Edge of Forever. While in an irrational state, the ship’s physician enters a time portal on an alien planet, one that takes him back to 20th century USA in the midst of the Great Depression.
At the instant that this happens, the Enterprise starship disappears from its orbit of the world on which the time portal exists. Captain Kirk and Mr. Spock, already on the planet in pursuit of Dr. McCoy, recognize that he must have altered history in such a way as to result in a universe in which their space vehicle never existed. Kirk and Spock therefore enter the time portal themselves at a moment in history slightly before they believe that McCoy reached 20th century earth, in order to prevent whatever action he took that changed subsequent events.
While back in time, Kirk and Spock meet a social worker named Edith Keeler, who runs a soup kitchen for the down-and-out victims of the Depression. Soon, Mr. Spock uses his technological prowess to discover that Dr. McCoy will eventually have something to do with Edith Keeler herself.
In one possible historical thread, Spock finds a newspaper obituary for her. In another, however, he discovers that she will lead a pacifist movement that delays the USA’s entry into World War II, resulting in Hitler’s victory and the very alteration of events that prevented creation of the star fleet of which the Enterprise starship is a part. Thus, in order to create the more benign future known to the three officers, Edith Keeler must die.
There is only one complication. Captain Kirk and Edith Keeler (played by Joan Collins) have fallen in love.
The climatic moment comes when Dr. McCoy and Captain Kirk see each other across the street for the first time on 20th century earth. As they rush to reunite, Edith Keeler (on a date with Kirk), attempts to cross the street to join them, heedless of the fact that a fast-moving truck is headed toward her. The doctor attempts to rescue Kirk’s love, but is restrained by Kirk from doing so. Edith Keeler is killed.
The heartbreak is heightened by the incredulous McCoy’s indictment of his captain and friend: “I could have saved her…do you know what you just did?.” Unable to speak, Kirk turns away while Mr. Spock says quietly, “He knows, Doctor. He knows.” Thus, Kirk has sacrificed Edith Keeler’s life and his own happiness, to prevent her from actions that would have led to world enslavement by the Third Reich.
I have always been troubled that two of the most important biblical stories involve human sacrifice. The tale of Abraham and Isaac finds the former, the founder of the Jewish faith and monotheism, asked to sacrifice his son Isaac in order to prove his devotion to God. As he prepares to do this, an angel appears and stays his hand. A lamb is slaughtered instead. Rembrandt depicted this beautifully in the painting reproduced above.
Remember now, that I’m a psychologist. I cannot look at this painting without wondering what the child Isaac might be thinking and feeling in the aftermath of this moment. How will his relationship with his father be changed? Might there have been other possible ways of testing Abraham without permanently scarring his son?
The foundation story of Christianity poses a virtually identical dilemma, with the sacrifice of Jesus to pay for the sins of humanity. I fear that we are so used to abstracted representations of these events, that we have become inoculated against the trauma depicted by them and the human, societal, and theological implications of such horrors, reportedly authorized by God.
Of course, most of our sacrifices are much less dramatic. Do we give up eating what we might want in order to be fit and live a longer and healthier life? Do we brush off the attractive member of the opposite sex who “comes on” to us, in order to maintain our marital fidelity, avoid injuring our spouse and children, and keep whole our integrity? Do we sacrifice time having fun or attempting to climb the career ladder in order to go to our child’s boring orchestral recital and enduring hours of “Twinkle, Twinkle, Little Star” played by tiny violinists, all of whom are out of tune?
I’m sure you can imagine many more such choices and sacrifices of your own.
We make decisions, all of us, about the question of national sacrifices too. Jobs vs. clean air, tax cuts vs. social services, giving to charity vs. keeping the money for ourselves, liberty vs. the promise of security, and most poignant of all, the decision of when war is necessary despite the sacrifice of the unlived lives of our young adult children.
Just as an exercise, you might want to make a list of all those things you spend time on that are inessential, all the things that you could live without if it came to something really important.
Or, still another exercise: if you could only take 10 things or 10 people with you to a desert island, who or what would they be and who or what would you leave behind? And what cause would be great enough for you to agree to go to a desert island in the first place?
Who are we as a nation? Who are you as a person?
We might know more about our country and ourselves if we first ask what we are willing (and unwilling) to sacrifice.
The top image is the Sacrifice of Isaac by Rembrandt. The second picture, taken by Michael Gäbler, is of Adi Holzer’s hand colored etching Abrahams Opfer from 1997. Finally, Caravaggio’s version of the same scene Die Opferung Isaaks from 1594-96, sourced via the Yorck Project. All of the above come from Wikimedia Commons.
Part of the problem with figuring out whether your life is satisfying is what exactly you expect from life. If you expect close to constant happiness, you haven’t been paying attention to what is going on around you — to what the nature of life is. No one is that happy — life doesn’t permit it with all its routine ups and downs. And, if you compare yourself to people in the media — beautiful or handsome, smiling, rich, famous, and seemingly in control — you will be hard pressed to think that you are doing as well as you should be. Moreover, if you believe that struggle and work frustration are somehow indicative of a life that isn’t satisfying, you just might be misunderstanding what “satisfaction” is.
Take Beethoven, the famous German composer who lived from 1770 to 1827. What is it like to be a genius? Well, for Beethoven it involved lots of struggle and enormous amounts of dedication and hard work. You can learn a bit about this by watching a recently issued DVD set that includes Leonard Bernstein’s Omnibus television programs. One in particular focuses on Beethoven’s process of composing his Symphony #5, the one that begins with the most famous four notes in music history: three Gs and an E-Flat; three eighth-notes and a half-note.
According to Bernstein, Beethoven tried out 14 different versions of the opening of the second movement over a period of eight years. The DVD features Bernstein talking about and conducting the Symphony of the Air in several different passages that were rejected for the first movement, which Beethoven sketched out over a period of three years. Indeed, the composer altered some passages in that movement as many as 20 times. The agony and struggle involved in the composing process can be seen even on the orchestral score of this piece, with numerous write-overs, scratch-outs, and cross-outs.
One might then ask, did Beethoven obtain satisfaction from the process of composing with all its frustration, reworking, effort, reconsideration, revision, contemplation, and strain? The answer apparently is “yes,” he was deeply engaged and committed to the creative process and proud of the results he achieved, however dear the cost. Put another way, “no pain, no gain.”
Happiness isn’t a day at the beach, at least not on a regular basis. Rather, it usually requires that you work for and achieve something — something that isn’t simply given to you. It is not great wealth or a big house in the right neighborhood; it is not power for power’s sake or lofty status simply because you’d like others to look up to you. Rather, it demands that we take on a task that is challenging and engaging — perhaps even creative — master the challenges, and produce a result of value. Having attained that level of accomplishment (not necessarily a material thing or something to which you can assign a dollar value), you can look back with satisfaction on what you have achieved (be it the healthy young life of your child or a great symphony). It is not about work alone, but work is a part of it.
Beethoven wasn’t what we would call a happy man. He was lonely, in part due to his growing deafness, and often frustrated and frustrating in his relationships (and satisfying relationships are normally needed for happiness). But he knew he was a great composer and lived for and through his enormous gifts and an unflagging dedication to producing the greatest music that was in him to create, no matter the length of time and the strain required.
Indeed, it is the strain and struggle within Beethoven’s music itself, and his ultimate triumph over the difficult technical and emotional act of composing, that draws us to him. Beethoven’s “process” is felt in Beethoven’s “product.” The trajectory from travail to triumph mimics the task of composing in such works as the 5th and 9th Symphonies or the Leonore Overture #3. And, in his mastery of the challenge of composing (not to mention the overcoming of his deafness to make great music), he also gives us a model for living.
Should Beethoven have quit his day job and found something easier?
I think you know a rhetorical question when you read one.
(The image above is a life mask of Beethoven done by Franz Klein in 1812 when Beethoven was 41).
By the way, the Chicago Symphony plays all of Beethoven’s Symphonies conducted by Bernard Haitink in June of 2010.
Maybe, maybe not.
The weight of regret as we look back on mistakes can be great, robbing us of the possibility of happiness now or in the future.
On the other hand, if we are to learn anything about life, some amount of reflection on the past is required.
There is also a biblical take on this to be found in the Book of Daniel. It is rendered above in a reproduction of Rembrandt’s painting Belshazzar’s Feast.
God has numbered the days of your kingdom and brought it to an end.You have been weighed on the scales and found wanting.Your kingdom is divided and given to the Medes and Persians.
So it comes to pass that very evening that King Belshazzar is murdered and replaced as king by Darius the Mede.
The handwriting on the wall comes late, too late for Belshazzar to undo his misdeed and profit from the learning. Most of us have a bit better chance of putting things right and reforming ourselves and our behavior.
Unfortunately, not everyone does so, that is, takes the time to learn. Satchell Paige was right: “…something might be gaining on you.” But it just might be something important, knowledge or self-awareness that must catch up to you despite the forward rush of life.
One of Paige’s contemporaries, Adlai Stevenson II, put it very well.
“Most people can’t read the handwriting on the wall until their back is up against it.”
Look over your shoulder now and then. A little self-reflection is a good thing.
The above image is Belshazzar’s Feast by Rembrandt, source from the Web Gallery of Art via Wikimedia Commons.
I have eaten lunch in the CPS—Chicago Public Schools—in each of the last 10 years. Granted, I only ate one meal at the same school in every one of the years between 2000 and 2009. But still, I must be due some sort of military award for courage (or foolishness).
The good news is that I’m still alive.
The even better news is that CPS promises to improve the menu starting in the next school year. Reportedly, healthier choices will be offered and some of the worst options reduced or eliminated. This comes as a consequence of complaints from the students themselves.
But again, the change doesn’t start for several months.
This all means that my friends and I, supporters of the Zeolite Scholarship Fund, will once more go into “the valley of death” of gastronomy that is the Mather High School cafeteria on May 7th. On that date, we will also award a scholarship to a member of this year’s graduating class.
Remember Alfred, Lord Tennyson’s famous poem The Charge of the Light Brigade? Here is a slightly altered version of one stanza, just to give you a “flavor” of what our gustatory experience has been like:
Pizza to the right of them,
Nachos to the left of them,
Pop-Tarts in front of them
Lined-up and waiting;
Assaulted by stench and smell,
Troubled we walked, unwell,
Into the jaws of Death,
Into the mouth of Hell
Reeled the still-starving.
Please understand. My friends and I, all Mather grads from the 1960s, love our old school. We admire the dedicated teachers and administrative personnel and the hardest working of the students. The lunch room is clean, the cafeteria workers are courteous and efficient, and they do the best that can be done with the materials at hand.
The school has been described as a “multi-ethnic stew” by Charles Storch of the Chicago Tribune. Lots of languages, colors, religions, nationalities, accents, and styles of dress. And, somehow, the kids get along well and seem to respect their differences. Some even aspire to great things. We try to figure out whom among those students to place our bets on, giving them money to support a college education that they might not otherwise be able to afford.
But the food supplied to the school—I’m not exaggerating when I say that if you have a pet you love, you’d be hesitant to feed it to him.
It has every quality a good meal should have except for nutrition, taste, color, and texture.
I’m glad to hear that things will improve and look forward to the return of my classmates and I in 2011, when we will get a chance to evaluate the new cuisine.
In the meantime, if you have a child who eats at school anywhere in this country, I have a suggestion.
Go to the school cafeteria. Eat a meal there. And if it isn’t any good, complain. Organize.
Pack him a lunch.
These are our children. This is our posterity.
Our kids deserve better.
Do you ever find yourself thinking of an old childhood friend? Someone you haven’t seen in an age?
My friend Jerry lived across the alley from me in Chicago’s West Rogers Park neighborhood.
If you grew up in the suburbs, you probably don’t know much about alleys. I met some of my best friends there, playing lots of softball in the narrow confines of cement bordered by an endless row of garages on each side. I learned to climb roofs to retrieve softballs that landed there and (like my friends) occasionally beat a hasty retreat when a line-drive shattered a garage door window.
Jerry wasn’t much of a softball player. He had dark brown hair combed straight back, handsome features, and a smile of devastating charm. His eyes could be impish and alive as he stood there in the shadow of one of the garages on a summer evening taking a drag on his cigarette, especially when he talked about something slightly naughty for a 12-year-old, like sex.
Or they could be sad and mournful, as if he knew something that none of the rest of us knew about.
His parents were Holocaust survivors.
He lived with them on the first floor of a two-flat building. He had a sister, I seem to recall. His aunt and her husband owned the upstairs flat. Jerry’s mom, a sweet woman who had likely once been very pretty, was always kind to me; but worn out, faded in appearance, weary, looking older than my mom, although they were probably about the same age.
Jerry’s father was short, with a bristly, full head of salt-and-pepper, almost angry hair. He was never mean, but there was a grim severity about him, a desperate seriousness. I never once saw him smile.
Jerry told me that his dad disapproved of him. Jerry’s relatively poor school work was the reason. I could never understand why Jerry didn’t do better at his studies. He could be witty and clever — he was certainly bright enough. But, he didn’t have much interest or heart for it, seemed not to try very hard, even was held back by a half-year, winding up in my eighth grade class despite the fact that he should already have been in high school.
I remember one conversation. Something about money. Jerry told me that his parents were pretty careful with their money and didn’t want him to spend it unwisely. But, he said, there was one exception. “They say that for food I can have as much money as I want — so I can buy it anytime I want.” Peculiar, I thought. Nice of them, I guessed. But, it stuck there in my mind, not fitting somehow, an inconsistency that I couldn’t fully understand.
My friendship with Jerry dropped away in high school. He continued to struggle in school and we both gravitated toward other people. I don’t think he graduated, but I heard that he eventually got his GED (high school equivalency degree).
When I was in college or graduate school I ran into him on the bus. We had one of those semi-awkward reunions, catching up on our lives, not having much more than that to say. Jerry was then a hair dresser. And, I suspect, a good one, since he always had an artistic flair.
I met Raya in college. She was tall and very pretty, with wavy, long brown hair. Her form was willowy, and she moved with the grace of a dancer, as if trying, in her fluid motion, not to disturb the air. Raya spoke with an accented English, having come to this country with her parents from Israel only a few years before.
It was hard not to find Raya attractive, but she was very quiet and conversations were always a struggle. I find that curious in looking back, because you’d think that I would have asked her tons of questions about her life in Israel and how it was different than Chicago.
Maybe I did.
Nonetheless, Raya and I went on two or three dates. I remember the first one, driving to her home to pick her up and meeting her father there. He reminded me of Jerry’s dad: a very strong and dark presence, grave, serious, not to be trifled with.
At the time, I probably wrote that off to the protective relationship between a father and a daughter. As I said at my youngest’s wedding, the job of being a father to a beautiful daughter is not an easy one. You spend a lot of time thinking unkind thoughts about little boys, wondering what plots they might be hatching to ensnare your female child!
In any case, Raya and I went to a movie that evening, the highly rated The Pawn Broker starring Rod Steiger. I didn’t know anything about it, just that it was the movie on everyone’s lips. I don’t think Raya knew much about it either.
It turned out to concern a man, played by Steiger, who lost his family in the Holocaust, later becoming a pawn broker in Spanish Harlem; and especially about his relationship with a young Hispanic man who works for him, and a social worker who attempts to draw him back into the world from the dark, shadowy place into which he retreated after his wartime experience.
It was not long into the film before I noticed that Raya was quietly weeping. I asked her if she was OK, but she tried to minimize her upset. And when the movie was over, she told me that her parents were concentration camp survivors.
Now, you’d think I would have been more careful about this, about what exactly the movie was about and who exactly was this pretty girl underneath her surface beauty and grace.
But, to my discredit, I hadn’t been.
Apparently, Raya didn’t hold this against me particularly, because we went out one or two other times. But, as I said, it was difficult to generate conversation and we parted in a not-unfriendly way. Perhaps there were things too deep for words, things that one simply couldn’t talk about on a “date” with someone you hardly knew.
It might be of interest to you to know that the word “Holocaust” was not immediately applied to the genocidal murder of six million Jews by the Nazis during World War II. In fact, if you watch the old 1959 Alfred Hitchcock movie North by Northwest, you will see in the scene just following Cary Grant’s narrow escape in a corn field, a prominent newspaper headline using the word “holocaust” to describe the explosion of an oil truck when it collided with a low flying airplane.
These days, that word is rarely applied to anything except the European Jewish experience of the 1930s and 1940s.
Today, April 12, 2010, is Holocaust Remembrance Day.
Back in the time that I was in high school, the 1960s, virtually no reference was made to these events. One simply did not talk about them in any great depth and it was not the subject of special study or attention in class. In fact, this failure to mention it was particularly true of the homes of most of the survivors. But, the children of these unfortunate people, mostly about my age, came to know enough about what happened to their parents to give them special consideration, and to try to protect them and compensate them for what they lost in the European tragedy.
It was a heavy burden for the generation just behind the survivors, one written about for the first time by Helen Epstein in the classic book, Children of the Holocaust. For everyone else among Jewish children of the time, the shadow of the event was there, even without a name. Simply the idea that but for the accident of time and place — had you been born just a few years earlier in Europe — you would have almost certainly been a human target in a deadly game, along with everyone else you loved.
Long after my relationships with Jerry and Raya ended, I was reading a book by a French Holocaust survivor in which he described his return to Paris. It was within a few months of his homecoming. The man was on the subway, close to two teenage girls who were talking together. He heard one say how hungry she was; “I’m starving,” she said.
The survivor knew the words, understood the meaning, and thought to himself, “I have no idea what she is talking about.” Put another way, this man knew “starvation” to mean the severe malnourishment that he experienced in a concentration camp, not the colloquial, everyday meaning that the girl was giving it, an expression he might have used himself in the time before the war.
When I read that passage, I flashed back to my conversation with Jerry, the one when he told me a bit about his parents’ exception to their usual cautiousness with money: “They say that for food I can have as much money as I want — so I can buy it anytime I want.”
And then, I understood just a little bit, what they must have meant.
I wonder where they are now, Jerry and Raya.
I wonder who they are now.
It would be nice to know.
The image above is Russian Stamp No. 583 created by Russian Post, Beylin V., painter. It is sourced from Wikimedia Commons.
Health care reform has been necessary for a long time. But having said that, I’d like to give you an example of how the expected changes might lead to some unfortunate results, as well as some that are helpful.
My example will focus on Medicare. Everyone knows that Medicare is expensive for the government and that it will ultimately suck the life out of the national economy if costs are not restrained. One way to restrain costs is to require physicians to accept lower fees for their services, something that Medicare has struggled to do for a while, even before passage of the recent health care legislation. Providers are already getting paid less than they were a few years ago, but even more extensive mandated annual changes have been regularly rescinded by the Congress. If they are actually accomplished in the future, Medicare would pay out still less to those same MDs, Ph.Ds, and other health care professionals.
What will happen when reduced fees become more significant? Some healers will decide that it is financially unwise to see patients who are covered by Medicare. They will drop out of the Medicare panel of providers. The greater the fee reductions, the smaller the number of physicians available to see Medicare patients, while at the same time the number of individuals covered by insurance is increasing, led by the large expected additions to the rolls of the insured because of recently passed health care reform legislation.
Let’s say you are the following person: someone covered by Medicare who doesn’t have the cash to pay for treatment out of your own pocket, who also has a medical problem or concern that cannot wait very long. The good news in this hypothetical example is that your MD still accepts Medicare. But when you call your doctor’s office, you are told that you can’t have an appointment for four months—again, hypothetically speaking. The problem and the pain aren’t getting any better in this period of time, maybe they are even getting worse. So what should you do?
First, you will probably try to find another medic who accepts your insurance and has a nearer-term appointment for you. But given the anticipated shortage of people who do take Medicare patients, it will be unlikely.
Eventually, however, you will do what any sensible person would do once the problem becomes really acute—and what your doctor’s office will probably advise you to do under the circumstances—go to the emergency room of your local hospital.
Since emergency room care is notoriously expensive and since the condition might be harder to treat because you waited, this will only serve to drive up the amount of money spent on health care, something that the intended reduction in doctor fees was expected to reverse. Whether the decrease at one end will outweigh the increase at the other, I do not know.
And, instead of the growing number of people who had no health insurance being the impetus for the increased use of the ER, it will now be people with health insurance who are using it more because they have no other readily available alternatives.
I don’t have a handy solution to this problem. My hunch is that there is some amount by which doctor’s fees can still be cut before they start dropping out of the Medicare system in large numbers. It may be that only trial and error will determine exactly how much cutting is possible before producing the unintended consequences I’ve described. The good news, however, is that where there is a high demand for services, eventually supply does catch up, although in the case of producing more docs it will takes years to do so.
Surely, there will be many more unintended consequences of health reform just around the corner. Some might actually be beneficial, but certainly not all. The system we have is not working well for many of our fellow-citizens, so the status quo is not a good answer. Doubtless, once legislators hear enough complaints about problems such as the one I’ve described, they will attempt to alter the system further. How long it takes before we get something that works well is unknown. It is likely that we will eventually have a two-tiered system: a universal, government-run insurance plan on one side, and some number of pretty rich people simply paying for health services out of their own pockets on the other.
In the short run, all of this reminds me of an old joke Woody Allen told at the end of one of his nightclub routines.
It went something like this:
I’d like to leave you with a positive message.
But I can’t think of one.
Would you take two negative messages?
Much ink and electronically generated language have been expended commenting on the oppressive and stressful nature of everyday life. We are expected to move too fast, produce instant answers to complex problems, and respond with a fax or an e-mail or a text on the spot.
Many of us travel long distances just to get to work. We hardly know our neighbors and, even if we do, don’t have the time to talk to them. Each of us has his own individualized shipping container (called a car), further separating us from each other. We relate to gadgets more than to people — voice mail and snail mail need answering, internet sites demand surfing, our phones are always on and in our pockets — even vacations don’t place us out of reach of urgent demands and obligations.
Teacher conferences require our attendance, our children plead for our time and homework help. The house needs minding, the lawn needs mowing — there is never any rest.
Witness this commentary:
I cannot help but regret that I did not live fifty or a hundred years sooner. Life is too full in these times to be comprehensible. We know too many cities to be able to grow into any of them, and our arrivals and departures are no longer matters for emotional debauches — they are too common. Similarly, we have too many friends to have any friendships, too many books to know any of them well; and the quality of our impressions gives way to the quantity, so that life begins to seem like a movie, with hundreds of kaleidoscopic scenes flashing on and off our field of perception — gone before we have time to consider them.
I should like to have lived in the days when a visit was a matter of months, when political and social problems were regarded from simple standpoints called “liberal” and “conservative,” when foreign countries were still foreign, when a vast part of the world always bore the glamour of the great unknown, when there were still wars worth fighting and gods worth worshipping.
These words were written by George Kennan, a Pulitzer Prize winning author, diplomat, and scholar.
Yesterday, you ask?
They were written 83 years ago in his journal, on December 20, 1927 when he was 23.
They can be found in his book, Sketches From a Life, published by Pantheon.
The above image is Tension Belt by LeonWeber, sourced from Wikimedia Commons.