A Modest Set of Reflections on the 2016 Election and the Impending Trump Administration

As an introductory note, I am writing this post from Quebec, not because I've become an ex-pat for the Trump Presidency but because I'm on one of my short pre-holiday vacations, recharging my intellectual batteries before I invariably get stuck selling hundreds of turkeys and pounding innumerable pounds of fat wrap to encircle Christmas roasts.  I haven't made an extensive effort to engage folks up here in Montreal on the US election.  My inclination is that, in a place where liberalism has not yet been eclipsed by the present rise of nationalist chauvinism, the reaction is probably one colored both by a degree of embarrassment for us in our election of an arrogant, bigoted con-man as the leader of the free world and by a sense of apprehension at what the election result will mean for the future of Canada/Quebec, especially with regard to Trump's promises to engage in renegotiation of trade agreements.  The point of this post is not, however, to extensively assess the effects of the election on US-Canada/Quebec relations.  Rather, my purpose is to evaluate the consequences of the election for certain liberal agendas and offer some suggestions on weathering the storm for the next four to eight years, in lieu of emigrating.

1.  The New Deal is dead and the neoliberal Hillary Clinton was never going to resurrect it.  Erstwhile American supporters of the welfare state need to get over its demise and start working for alternatives that realize basic social justice goals through a mix of policy experimentation at lower echelons of government and non-governmental community organizing.  With Trump's victory and the election of two Republican houses of Congress, the American political right has an unprecedented opportunity to remake domestic policy in order to pull America back to the policy landscape that existed before the New Deal, with only Senate rules on floor debate (i.e. the filibuster) in place to spare us from the repeal of the Affordable Care Act (ACA) and from significant policy experimentations with Social Security, Medicare, Medicaid, and federal housing policy (i.e. supporting the stability of secondary mortgage markets and promoting home ownership among economically marginalized populations).  The best that can be hoped for, in this circumstance, is that very little in Washington will change that Trump cannot effect by executive order, a field that still confers significant power in the hands of an individual with questionable competence as an executive and with questionable comprehension of his own limitations under the Constitution.  I don't want to argue that there is nothing to worry about here with regard to the retraction of the welfare state in areas that may adversely affect most Americans, but things may not necessarily be as grim as they seem - Trump cannot remake the federal government by himself, even if that is what he and the people who elected him ultimately believe.
           Furthermore, had she won, the neoliberal Hillary Clinton was never going to pursue an agenda oriented toward resurrecting broader social welfare institutions (e.g. shoring up the long term finances of the Social Security retirement trust fund, introducing a public option to the ACA structure, etc.).  If these ideas were written into the Democratic Party platform, then it was just a residual effect of the left-populism of the Sanders campaign during the Democratic primaries and a carrot to get the Sanders people to show up at the polls in November (which apparently worked out just great, proving that all those excited millennials who supported Sanders in the spring were not stupid enough to believe that Hillary was going to endorse all of Sanders' best policy recommendations).  Moreover, there wasn't adequate support in Washington to pursue anything close to a liberal social welfare agenda and there would not have been even if the Democrats took control of the Senate.  Fundamentally, the country as a whole just doesn't buy into the idea of going back to the New Deal and the Great Society right now.  If it was, then we would not only have strong Democratic majorities in both houses of Congress but a new Democratic administration, committed to pursuing a not-so-incrementalist agenda of economic democracy.  If Clinton had been elected, we would have been headed toward at least two more years of gridlock over domestic policy and, perhaps, an acrimonious continuation of investigations and a potential impeachment (though not removal by the Senate) over Clinton's mishandling of classified information as Secretary of State.  
          On the other hand, maybe the electoral outcome is one more chance for supporters of social justice to disengage from a statist agenda for change, or at least from a statist agenda that relies on broad legislative and administrative enactments by the federal government.  If a Trump Presidency means that the federal government is going to back away from the responsibilities that it took onto itself since the 1930s to prevent poverty among the aged, to counter malnutrition of children in low income households, and to address health care deficiencies in low income households, among other things, then it will indisputably open up a space for states and non-governmental community organizations to assume these roles.  The missing piece in this regard might be federal tax relief - if the federal government is going to divest of certain domestic policy responsibilities, then other echelons of government will only be able to make up the difference if they can command larger fiscal resources and that would mean shifting some of the tax burden exacted from American households from the federal government to states and local governments.  The ensuing policy regimes might be manifestly inferior to existing federal administration in certain domestic policy areas, but, in my view, it's better for state governments and non-governmental organizations to undertake modest relief for, say, penniless retirees, deprived of the existing federal Social Security safety net, than to let such individuals starve, freeze to death in the winter, or go entirely homeless.  If a majority of the US population (i.e. the "99 percent") gets to learn, more viscerally than today, the meaning of fiscal austerity at the behest of an extreme minority of winners, then maybe the moral and ideological impacts of austerity will have, over time, justified the sacrifice.

2.  If and when the Trump administration finally is enabled to reconfigure the federal judiciary, all of the liberal agendas promoting racial justice, reproductive rights, and marriage equality in the face of racial bigotry, patriarchal oppression, and sectarian prejudice will be eroded away, demonstrating, fundamentally, how short-sighted the idea of expanding individual rights through the federal judiciary, rather than through statutory enactment by democratically elected legislature, actually was.  At the outset, I want to enunciate the fact that Roe v. Wade (1973) was a bad judicial precedent.  As a matter of Constitutional law, substantive due process has always been and will always be a two-edged sword.  At the end of the Nineteenth century and the beginning of the Twentieth, the political left had a long history of being bludgeoned by jurists, fabricating unwritten Constitutional doctrines to suffocate legislative social justice projects (e.g. the elimination of child labor) that enjoyed popular support and democratic mandates at the state level.  That all ended suddenly in 1937, but, then, as the left began to savor the right of state legislatures to enact policies for the economic benefit of their citizens,
 substantive due process became a mechanism for approaching the desired social projects of the left in the name of racial equality, reproductive freedom, and the struggle against other entrenched manifestations of prejudice against insular minorities (e.g. LGBT populations).  In this manner, by a seven to two majority, the US Supreme Court spawned an unwritten right to privacy in reproductive decisions by women through the Fourteenth Amendment, determining off-handedly that state legislatures lack a compelling governmental interest to protect life in the womb before the end of the first trimester of fetal development on the principle that the life of the fetus would be non-viable outside of the womb.  When nine jurists with no background in medical science determine when, as a matter of Constitutional law, human life can be considered to begin, against the wishes of numerous state legislatures, their respective electorates, and diverse sectarian religious traditions, it should stand to reason that the argument is not settled and that the right of reproductive liberty, enshrined through a dubious interpretation of due process, may not be viable in the long term.
              When the Trump administration fills Justice Scalia's open seat on the Supreme Court with another avowed conservative, the only thing that will conceivably stand in the way of the overthrow of Roe v. Wade is the continuation of the Court in its current form, with its current array of liberal justices and Justice Kennedy, who can be counted on as a libertarian friend of individual rights against governmental interference.  When Kennedy or one of the liberals goes (probably passing away), so, invariably, will the institution of reproductive freedom as a matter of federal Constitutional protection.  For that matter, so may the institution of marriage equality/gay marriage and a slew of other judicial precedents anchored on liberal institutions of Constitutional interpretation going back to the Warren court.  In my opinion, it was utterly short-sighted of the liberal supporters of these institutions to wager the solidity of legal protection on the continuity of a federal judiciary that would hold the same willingness to expand the concept of due process to encompass their ideals.  In the effort to enshrine new individual rights under the US Constitution, moreover, they have nurtured peculiar alliances of enemies, determined to turn back the clock on a society where they feel alienated by the rise of godless secularists devoid of any respect for the sanctity of human life or the preservation of traditional morality.  Succinctly, I would contend that the durability of reproductive freedom and marriage equality would have benefited more from an incrementalist approach through state legislatures, acknowledging that such an approach would have produced patchworks of reproductive rights and marital institutions enduring for decades or entire generations.  On the other hand, once the federal judiciary steps out of the way, that is precisely the best thing that liberals can hope for!

 3.  If Black lives don't matter now, then it stands to reason that they will be worth even less over the course of a Trump administration.  There is nothing to suggest that the Trump administration is going to make any tangible effort to redress racial inequalities that are driving the current course of race relations in urban America and, especially, relations between African-American communities and local law enforcement.  And then there is race.  My point in this post is not to heave all of Trump's supporters into Hillary Clinton's "basket of deplorables," but we have to acknowledge that there are a lot of abject racists who voted for Trump, perhaps out of some expectation that somehow a Trump victory would restore the "natural" order of American race relations (Whites on top, Negroes down below, other assorted brown or otherwise colored populations somewhere in between).  Furthermore, enhanced racial subordination does not require transparent, de jure mechanisms to segregate and enforce racial hierarchies, a fact that citizens of Massachusetts should be manifestly aware of in regard to the reaction to forced desegregation of public schools in the 1970s.  It cannot be overemphasized that the racial compositions of most urban communities in the Commonwealth have been, to a significant degree, shaped by White flight to suburban communities, arising, in part, from desegregation of urban schools.  The continuity of disparities in the educational performance of urban and suburban school districts in Massachusetts, highlighted on election day with the failure to pass an expansion of public charter schools in municipalities with underperforming district public schools (a measure largely supported by voters in urban communities), constitutes a significant vector in the persistence of racial inequality in the Commonwealth, particularly with respect to employment, income, and entrepreneurial opportunities for non-White populations.
            With regard to race relations writ large, it is not that the Trump administration is going to advance an explicit federal policy agenda in order to actively promote further degradation of race relations or actively create de facto conditions for racial subordination.  Rather, Trump was elected by a demographic within the US population that is overwhelmingly sick and tired of hearing about racial inequality from the media, of being called racist (when they can point out that one or two of their friends are Black), and of flipping the bill for government programs intended, in part, to redress the prolonged impact of racial inequality in access to education, employment, housing, and a range of other public policy areas.  Most Trump voters, especially outside of the South, would likely view the Ku Klux Klan with utter contempt, but, conversely, the Trump electorate by and large simply wants the Civil Rights era to finally be over and for America to move along as if there was nothing more to be done.  On the contrary, the creation of the Black Lives Matter (BLM) movement and the current struggle of relations between African-American communities and law enforcement is indicative of the fact that the Civil Rights era is far from over and that, emphatically, every effort to prematurely move beyond the struggle for racial equality and justice constitutes a step backward.
           If the Trump administration is going to effectively serve the wishes of those who put it in power, then racial relations in the US are going to fester for the next four years with, at best, no appreciably efforts made by the federal government to address important issues facing African-American and other racial and ethnic minorities.  That conceivably implies that the Civil Rights Division of the Justice Department is going to be placed on an extremely short leash fiscally and operationally.  There will be no more exhaustive investigations into police brutality against African-Americans or other minority groups.  In turn, without the specter of federal investigation into police practices, a spiraling of violence between local law enforcement and African-American communities is a possibility, as both sides conclude, rightly, that Washington will not intervene to reduce incendiary pressures.  At worst, being a "law and order" administration, Trump will actively intervene in local flash points of racial violence to bolster law enforcement without any effort to acknowledge possibly valid grievances from aggrieved populations.  Such a situation implies an expressly autocratic turn to repress movements for racial justice and perpetuate discriminatory practices by law enforcement.  Effectively, if Black lives don't matter now, then they certainly will matter even less in four years as the federal government does everything in its power to make believe that racism doesn't exist.

4.  Policy agendas aside, people on the American left need to come to some conclusions on what it is that we are dealing with in a Trump administration.  Can Trump be treated as if he was just a garden variety conservative Republican who will undertake a strongly conservative agenda in conjunction with Congressional Republicans?  On the contrary, is Trump something completely different - an autocrat and potential fascist, backed by a narrow majority of the American electorate, intent on a radical transformation of the federal government and willing to contravene the US Constitution in the process?  The answer to these questions is not going to become apparent immediately, but we need to be vigilant that we do not mistake the latter circumstance with the former.  There has been an impulse apparent among leadership within the Democratic Party and among educated liberals, generally, to conclude that Trump's victory needs to be treated in approximately the same manner as the Republican electoral victory in 2000 (beyond the initial struggle over ballots in Florida).  That is to say, if we assume that Trump is no different from any other Republican political leader, then Democratic leaders should pursue efforts to forge compromise with the administration on domestic policy agendas where possible and adopt conventional legislative tactics to minimize the negative effects of shifts in federal policy.  Effectively, with Republican leadership in control of the executive and legislative branches of government, we can assume that domestic policy agendas will shift to the right but that the Constitutional institutions of government will not dramatically change.  This conclusion might be overly presumptive.  Emphatically, I think that it is too early to axiomatically label Trump a fascist.  It is apparent that some corners of the American left are already proceeding from such a determination.  Protests that are already taking place in numerous American cities reflect fears that the Trump administration will follow through on numerous campaign promises, including mass deportations of undocumented individuals and restrictions on Muslim Americans, possibly including registration with local authorities.  The latter of these policy proposals, in particular, would represent a pernicious contravening of American Constitutional institutions respecting freedom of religion.  If such a policy was enacted, then we can only guess which other Constitutional protections might be actively violated by the Trump administration, with the consent of those who elected him.
            Succinctly, I would argue that the US, as a whole, has something much more ominous to worry about than the impending Trump administration per se.  The election of Trump is the clearest sign that the American public has become dangerously polarized on a range of policy issues and, more fundamentally, on the role and purpose of the federal government, as outlined within the US Constitution.  The limitations of federal power, as outlined in the Constitution, are plastic but not non-existent.  We forever find ourselves debating what the proper role of the federal government is.  In these terms, the civil war was one extremely traumatic episode of sorting out the authority of the federal government in relation to the states.  Something tells me that we are approaching once again one of those violent efforts to sort out what limitations exist on Constitutional federal power.  At this moment, the focus of that violent struggle might not be opposing field armies, but opposing mobs, in the same sense that the 1960s race riots were struggles between mobs, mediated through the forces of law and order.  Can the latter be counted on when they are shaped by the impulse of white nationalism?  That is to say, I believe we are heading toward a moment in US history when decent people, with respect for our Constitutional traditions are going to have to put their bodies on the line against the federal government and its supporters.  This doesn't paint a pretty picture on the number of freedom loving Americans who may die fighting their government in this period of American history.  The left might be wise to fundamentally reconsider pacifism and join the "Second Amendment people" at their own game.

Catholicism, Christology, and Marxism I: A Reckonning

A couple of weeks ago, my brother Norm informed me that the last time he had taken our father to mass our dad had gotten up out their pew during the offertory and proceeded to the tabernacle where he began putting items away while the mass was still going on.  Apparently this sort of behavior is to be expected from people suffering from cognitive impairment/mild dementia, but it was upsetting to Norm, who had to fetch him and bring him back to their pew, and it is upsetting enough to me that I am now going to have to attend mass with him on a weekly basis to keep an eye on him on weeks where Norm is otherwise occupied, which will likely amount to at least three Saturdays a month.  This would not be a significant problem for me relative to my work routine.  On Saturday nights, when my dad goes to mass, the store where I work is normally closed for cleaning, and my coworkers are more than capable of finishing up our weekly clean up without me.  They have been very gracious to me in allowing me to slip out for a few minutes every week to give my dad a ride to the church (he no longer drives himself), and I'm sure that it isn't going to be that much more of an inconvenience to lose me for the rest of clean up.  Departing from work twenty minutes early really isn't the heart of the problem. 
       Emphatically, I've reached a point in my relationship with my family where I just don't talk about politics or religion for largely the same reasons.  A real dissonance exists relative to my views and those of my father, my siblings, and most of our relatives to the point that I've just accepted the fact that will wear the moniker of the black sheep, even if I do my best to be inconspicuous.  My family is extremely Catholic and, for all intents and purposes, mildly conservative, politically speaking.  When I say "extremely Catholic," I mean that, up until about a year ago, my father attended mass daily and, I suspect, sought reconciliation at least once a month.  I have at least one brother who is a member of the Knights of Columbus, who partakes of volunteer opportunities to conduct ministerial duties to groups otherwise unable to partake of weekly mass or other liturgical services for Catholics (I specifically remember him telling me about helping out Catholic veterans with weekly mass at the Holyoke Soldiers Home).  Moreover, to my knowledge, I have a sister-in-law and at least a few nieces who have taken part in pilgrimages and Catholic youth festivals.  Among our wider family, to the exclusion of one aunt, who I remember openly questioning the virtues of the sacrament of reconciliation, and perhaps a handful of cousins, I truthfully do not think that anyone diverges from the level of strict adherence to the Catholic faith demonstrated among my immediate family.  In this regard, the only impression that I can offer is one of appreciation to the rigorous degree of adherence to the worldly practice of a particular faith tradition, whatever anyone has to say about the relative asceticism of Catholicism in relation to other Christian and non-Christian faith traditions (i.e. I will hand it to observant Muslims for their practices of fast during the month of Ramadan, but that is an entirely different subject!).     

        Having said this, I would argue that, like Paul the Apostle, I fought the good fight with Roman Catholicism, in particular, and with Christianity, in general.  I tried very hard to be as observant as my fellow family members.  When I attended UMASS as an undergrad, I even went through a prolonged stretch of attending mass daily at the Newman Center on campus and trying to be more frequent in seeking absolution for my sinful behavior.  I joined a parish community in Northampton after I moved away from my parents in 1999.  I sought to be helpful as a lay Catholic parishioner in liturgical duties, even taking on a role in my parish within a ministry to lapsed Catholics who wanted to return to the faith ("Catholics Returning Home").  All things considered, I may not have been the ideal practitioner of Roman Catholicism (at least a few times before the end, I would show up with a few beers on my breath to Lord's Day mass on Sunday afternoon, especially during football season when the Patriots had an early game), but I reflected at least some of the disciplined spiritual vision embodied by the remainder of my family.  Around age thirty, in 2004 or 2005, however, I stopped.  Moreover, while I held for some time to the notion that my stopping was a "phase" and that I had effectively taken on the trappings of a run-of-the-mill lapsed Catholic, it has eventually become evident that the manner in which I stopped really does not afford me a way back in that reconciles my beliefs and my grasp of spirituality with those of Roman Catholicism.

       Being the sort of Althusserian Marxist that I am, it would be easiest and most truthful to argue that my reasons for leaving Catholicism were overdetermined (that is, complexly determined by the conjunction of an infinitely large set of different determinants).  I had a lot of reasons for leaving when I did, not all of them entirely good or, succinctly, meaningful to the articulation of some alternative reflection on spirituality.  I could start by acknowledging that I had a lot of acquaintances in my life who were either ambivalent or entirely hostile to organized religion.  This might have been a major source of my changing attitude toward Catholicism but for the fact that I have a tendency to keep some level of precautionary distance between myself and others.  I just don't have any relationships where I fully invest myself without holding a lot of autonomous space back.  Inside of my space, I'm too cerebral to allow any unvarnished influences reshape my life without some deeper self reflection.  Any reflections on the nature of the universe, transcendence, eternity, and the presence of God, by any definition, must demand some more profound consideration than that afforded from someone who is spending his Saturday night getting drunk and trying to hookup with some atheist hippy chick for whom Catholicism just isn't cool in any way, shape, or form.  Invariably, my departure from Catholicism was the product of deep self reflection on my part, not of whimsical inspiration from the atheistic or agnostic acquaintances in my life.
         While we are at it, I can strike down a few other potential exogenous influences.  Notably, I definitely did not leave the Catholic Church, at the beginning of the Twenty-first century, because, at the close of the Twentieth, there was a problem with priests sexually molesting children entrusted in their care.  The Catholic clergy abuse scandal in North America and Europe certainly deserves some attention by the Church, inclusive of its organizational hierarchy and the laity, if only because it presents a very strong argument for more inclusive oversight by lay parish communities over the activities of the clergy and commends the laity to a more expansive vocation in redefining their roles within the Church as a whole.  That is to say, as I have argued previously on this blog, I think the Catholic lay community is long overdue in its duty to institute a reformation from within, to transform their own responsibilities for defining the Church's purpose in their lives.  Such a radical and democratic reconsideration of the Church, of the ordained hierarchy, and of the role of the latter in the everyday lives of the laity, presently stands beyond my own sphere of responsibility, but, as a point of compassionate, humanistic advice, the laity needs to recognize that, to the extent that the institution of sacramental Holy Orders attracts at least some individuals with serious psychological problems in negotiating the development and sublimation of their sexual instincts, something needs to be done to reconfigure the liturgical duties of ordained clergy and lay ministerial assistants (e.g. the permanent diaconate) in order to effectively marginalize the offices of professional theological thinkers/higher-level policy makers and executioners (i.e. of the Holy See) and lifelong reclusive ascetics/monastics from the broader community of lay parishioners and their everyday liturgical/spiritual advisers and supporters at the parish and/or the diocesan levels.  It won't do to browbeat thousands of priests who might have known better not to sexually abuse children if their own lives had assumed a more realistic and humane approach to sexuality than that afforded by existing Church doctrine on the ascetic responsibilities of the cloth.  To the extent that penalties from criminal prosecution can apply, the Church needs to leave abusive priests to the discretion of the criminal justice system and, as a matter of Christian virtue, accept their guilt and remorse and offer forgiveness for their sinful actions, if for no other reason than because human beings are innately imperfect.  On the other hand, the laity needs to demand organizational changes to ensure that this never happens again.
           Furthermore, I did not leave the Church because, at some point in the course of my undergraduate studies, I happened to grab onto a particular strain of Marxian thinking.  The Marxian dictum that "religion is the opium of the people" might be wholly true as a matter of casual observation on the role of religious practices in relation to the class processes (e.g. extraction of surplus labor from one group within a population by another group) of capitalism, but it truncates the larger relevance of religious community and of individual faith and spirituality, per se, as social processes supporting a range of human needs beyond the legitimation of exploitative economic processes.  To the extent that Marxism, as an approach to theoretic analysis of social processes emanating from an entry point of class, seeks to present meaningful and persuasive arguments about society in order to pursue a more expansive vision of practical humanism, grounded in collective, non-exploitative class processes (i.e. communism), it is unclear to me that Marxism can sensibly avoid questions of spirituality, if only by approaching them as social arguments on the everyday practices of real human communities, without conceiving theories that are starkly ignorant of large practical dimensions of lived human experience.  To do otherwise is to court the same sort of self-confident faith in the singularity of truth embodied in one's own theory of the universe evident in every manifestation of the Western Judeo-Christian-Islamic theological tradition.  Again, it won't do for atheistic Marxists, as militant revolutionaries and social activists, doctrinaire state bureaucrats, or reclusive philosophical academics, to lecture audiences of the spiritually inclined on the rigorously functionalist nature of their theological fantasies on God, Virgin-birth, the Resurrection, and the impending Apocalypse.  Rather, as rigorous materialists, we always have to ask where a particular set of religious ideas and practices fits socially in relation to class and in relation to myriad other social processes, without either validating or diminishing the unapproachable truth or falsehood of such ideas (because, in any case, as materialists, we can never validate transcendental truths).  What ends do they serve?  How can they be accommodated in order to achieve the broader goals of Marxian politics/activism (i.e. the creation of realizable and sustainable forms of communism)?  It may be open to question, for many erstwhile Marxists, whether my way of thinking about Marxism is, in fact, authentically Marxian, but this is a subordinate concern for my current argument and, in any case, I'm not willing to concede that any run-of-the-mill party Stalinist or campus-bound Trotskyist commands enough ideological authority to redraw the boundaries of one of history's broadest and most successful intellectual traditions to tell me that, despite all of my efforts to examine the theoretic works of Marx, Engels, Kautsky, Lenin, Lukacs, Althusser, and others to find meaningful arguments about the present world, I'm locked out because I'm not militantly atheistic enough for someone else's liking!  Marxism is not a religion, and the adherents of Marxian theory are not duty-bound to adhere strictly to the letter of holy scripture defined by its an erstwhile clergy of party bureaucrats and community activists.  In these terms, Marxism was never a stumbling block in my effort to remain a faithful Catholic, and it wasn't a principal motivation for my leaving the Church.
                Having stricken the above reasons for abandoning Catholicism, I want to emphasize that I didn't initially stop being Catholic with the intention of never returning.  The fact that I am at such a point now is indicative of the fact that I went through a kind of theological transformation, one that was, in part, shaped by my experience with Catholicism and, similarly, by my experience with Marxism, as it was shaped by many other dimensions and experiences in my life.  That is to say, being an intellectual, I did a lot of thinking about why it was that I stopped going to mass every weekend and every holy day.  The primary axis of this thinking involved a particular field of theological inquiry concerning the relationship between God and humanity, labeled Christology by Christian theologians in reference to the centrality of the figure of Christ (i.e. the mediation of the relationship between God and humanity through the person of Jesus the Nazarene) within their resolution to the fundamental problem of this relationship.  In my thinking, I didn't want to contest this label, but, on the contrary, I sought to generalize it, and, in doing so, the figure of Christ as Jesus the Nazarene, in some degree, had to lose its centrality.  Accordingly, as an intellectual, I found myself veering theologically from a tradition that accepted a singular, simplistic mediation of the Christological relationship to a place where the relationship became thoroughly blurred by myriad spiritualities and multiple mediations of the transcendent.  In good conscience, whether I labeled such thinking Christological, I could not meaningfully identify with Christianity, in general, or Catholicism, in particular.  The subsequent posts of this document seek to elaborate some of the ideas I developed about Christology and, in particular, the comprehension I developed between my own generalized perspective on Christology and my approach to Marxism, emphasizing my take on the relationship between (materialist) ontological, epistemological, and theological (i.e. immaterial/non-materialist) reflection.       

On Voting One's Conscience: Clinton v. Stein(v. Johnson)

This post seeks to sort out a set of arguments regarding the choice in the general presidential election in November.  Standing among the "anyone but Trump" crowd, there is some obvious room for strategic considerations in deciding for whom to cast my vote and why.  Most significantly, it is worth asking how Trump's nomination by the GOP and his continued inability to spend an entire week without opening his mouth to insert his foot are going to play out before traditional Republican voters, especially when he expresses condescending opinions regarding veterans, service members, and their families.  Notwithstanding my roommate's fears to the contrary, the general electorate is apt to be much less forgiving toward an incident like Trump's war of words with Khizr and Ghazala Khan over the sacrifice made by their son as a military service member in Iraq than the Republican primary electorate had been when Trump attacked Senator John McCain's service in Vietnam.  All of this said, Trump is still going to line up at least thirty-five percent of the popular vote and win electorate votes throughout much of the deep South, the Plain states, and the Rockies, however he performs in the "swing" states.  At this point, however, the role to be played by the Libertarian ticket of Governors Gary Johnson and William Weld in pilfering Republican votes, especially in the swing states, is open to question.  The conventional logic should be that if Trump can't help himself in offending large sections of the general electorate between here and November, then it is at least possible that substantial numbers of principled economic conservatives and defenders of small government, especially well educated ones, will flee to the Libertarians.  If, in this regard, Johnson and Weld can command even seven or eight percent of the electorate in states like Pennsylvania, Ohio, and Indiana drawing largely from traditional Republican voters, that might be enough to turn these states in Clinton's direction.  On the other hand, such an outcome would additionally depend on how much campaign financing finds its way toward the Libertarians, acknowledging that no third party is going to win no matter how well they campaign.
              I offer the strategic considerations above as a suggestion that the fracturing of the American political landscape on both sides of the liberal-conservative divide is adequate to afford voters on the left, like myself, the chance to actually consider whether it is worth casting a vote for a mediocre, Wall Street-friendly centrist professional politician on the Democratic ticket or to "vote my conscience" and go with the Greens.  In the interest of offering an honest and compelling case, in this regard, I would advance the fact that I live in the Commonwealth of Massachusetts, a safely Democratic state.  Secretary Clinton is going to safely take Massachusetts, whatever Donald Trump and Gary Johnson do and however well Massachusetts native and Green Party candidate Jill Stein performs.  Realistically, given the exuberance of Sanders voters in the Democratic primaries this year, if large numbers of young progressives in the five college area of Western Massachusetts and in metropolitan Boston were to come out and cast their votes for Jill Stein, then the Greens might take as much as five or six percent across the Commonwealth, accounting for many millennial voters who would have otherwise sat out the election entirely if their only choice was Hillary Clinton!  This isn't going to be nearly enough to swing Massachusetts into the Republican column, where Clinton would win by double digits in the absence of a Green Party alternative.  Further, in the interest of full disclosure, I have, in the past, registered as a member of the Green Party and I have voted for the Green ticket in three of the last four general presidential elections - I don't need to be told to vote my conscience, that's all I ever do!  For progressives in states like Florida, Ohio, or North Carolina, however, going Green might be a little bit more problematic.  Assuming every erstwhile progressive voter who was going to be showing up at the polls anyway (i.e. not single-mindedly driven by any personal appeal for a particular candidate, like, say, Bernie Sanders) cast their lot with the Greens, then, in a state like Ohio, this might account for two or three percent of the electorate, in a state where the final vote might be decided by one or two percentage points, whether or not Gary Johnson steals some economic conservatives away from Trump.  As such, it might become really expensive to be Green in Ohio, if, as a consequence, the world has to endure President Donald Trump.
             My point here is not to repeat to anyone the Democratic argument that a Green vote is a vote for the Republican candidate, especially when I enjoy the luxury of voting for whoever I want.  On the other hand, it is worth advancing several realistic considerations, based on policy and the trajectory of American politics, writ large, that might convincingly prompt progressive voters to select one candidate over the other, acknowledging, further, that I have not yet decided who I am going to vote for between Secretary Clinton, Dr. Stein, and Governor Johnson (hell is going to freeze over before I cast a vote for Donald Trump).  To begin:
1.  Party platforms are NOT iron clad promises that an elected president will pursue a particular legislative agenda. Whether or not a fifteen dollar per hour federal minimum wage is, economically speaking, a good idea, it is written into the Democratic Party's platform (and if you don't believe me, take a look:  https://www.demconvention.com/wp-content/uploads/2016/07/Democratic-Party-Platform-7.21.16-no-lines.pdf).  That said, the loose contours of the document, as a statement of general principles governing the formation of the legislative agenda for the next four years, ensures that President Hillary Clinton would have a lot of wiggle room to forestall any struggle to enact a fifteen dollar per hour federal minimum wage.  The same can certainly be said with regard to the idea of reenacting the Glass-Steagall firewall between commercial and investment banks, because such an accomplishment would mean breaking up several large American financial corporations, combining commercial and investment/brokerage banking operations.  This isn't going to happen under President Hillary Clinton's watch, both because it would imply a substantial struggle against a strong and politically influential component in the American and global business community and because it would compel President Clinton to invest political capital behind a struggle that she and a wide range of liberal economic minds (e.g. Paul Krugman) consider ultimately unnecessary to defend the health of the American and global financial sector - after all, Glass-Steagall is an antiquated and unnecessarily blunt regulatory instrument, targeting a lot of legitimate financial activity by upstanding corporations, when what we really need is to microscopically regulate the creation of suspect financial securities by "shadow banks" (By way of analogy, I should add that the number of guns in the US has nothing to do with the prevalence of gun violence because guns don't kill people, people...). It suffices to say that, whatever the Democratic Party platform says, President Clinton's legislative agenda in office would reflect her preexisting political prerogatives and commitments, the influences of diverse advisers from both relatively conservative and relatively liberal standpoints, and the political environment in Washington over the next two Congressional terms, in particular whether she can come to Washington with a majority in one or both houses.  Jill Stein might be a little more committed to her party's platform, but, at the end of the day, we would have to ask whether an idea like guaranteed minimum incomes, implied in the Green's 2014 platform and likely to be included in the 2016 platform, would enjoy any traction in Washington assuming, by some bizarre fluke, the Greens won the White House.  Simply stated, when Bernie Sanders stands up at the DNC to praise the extremely progressive nature of the Democratic platform, it amounts to a meaningless consolation prize for the Bernie or Bust people that won't carry any weight after the general election in a Clinton administration.

2.  Notwithstanding Down Ballot Effects, the 2016 general election is not going to extract the federal government from its current state of dysfunction - minimally, the first two years of a Hillary Clinton administration will accomplish only as much domestically as the last two years of the Obama administration have accomplished, subject to deference by the federal judiciary on the President's use of executive powers.  I will hold to the premise that a big reason why the federal government exists in such an all-encompassing state of dysfunction relates quite specifically to the skin color of the man in the Oval Office and the abject state of displeasure held by wide swaths of Republican voters, especially in the deep South but in other places as well, that their elected representatives might ever consider compromising with such an individual and with his party to pass the most minuscule piece of legislation in the best interests of the country.  The implementation of federal budgetary sequestration in 2013, as a structure of across the board cuts in non-entitlement spending, is evidence of how far Republican legislators were willing to go to ensure that they would never have to engage in substantive budgetary discussions with the Obama administration over spending priorities.  Better just to level a blunt instrument to the entire budget and then complain about how the Defense Department budget was inadequate for the nation's needs and that the blame rests squarely with the administration!  I see no reason why this is going to turn around with a Clinton administration - Hillary may not be Black, but she's a Clinton and that's almost worse.  The capacity of a new Clinton administration to pass any legislative agenda, however meaningful and salutary for the functioning of the US government, the nation's economy, or foreign relations, will depend on the makeup of the One-hundred fifteenth Congress, and, given the way in which existing Congressional districts have been drawn since the last Census, there is not likely to be any significant change to the makeup of the US House.  If Democrats are capable of taking the Senate, then they will not take it by a margin to prevent filibusters by a Republican minority.  In this manner, a vote for Clinton and for down ballot Democrats probably isn't going to make the federal government any more coherent in its legislative processes or less dysfunctional in its efforts to address major issues of national concern!  Again, on the question of a progressive agenda, this isn't an argument against voting for Clinton or in favor of Stein and the Greens.  It is simply an attempt at clear headed reflection on the utter incapacity of the federal government to meaningfully address a wide range of social problems for which many progressives might otherwise, in some knee-jerk reflex, urge the federal government to just pass a law (e.g. gun control).  In the end, it might just say more about why the knee-jerk reactions of many people on the American left reflect a strong degree of myopia.  

3.  In the present election, Hillary Clinton will, indisputably, be Wall Street's candidate.  Before we consider this a problem, we need to ask ourselves why it would be.  Just a thought, in this regard: Donald Trump has, over the course of this campaign, floated the idea that reinstating Glass-Steagall would be a reasonable idea!  When Bernie Sanders and Donald Trump can agree on something in a subject as complex as financial regulation, it is time to watch out and think the issue through a little more pensively.  Again, I am not willing to accept the line of argument by certain liberal economists that the elimination of the Glass-Steagall firewall in 1999 had nothing to do with the financial crisis of 2008, but there might be something to the notion that reinstating Glass-Steagall is less a panacea than a mere campaign slogan.  It is by no means clear that the reinsertion of a firewall between investment and commercial banking would prevent a recurrence of the sort of contagion by means of incorrectly rated, complexly tranched mortgage-backed securities that produced the 2008 crisis, or that pricing bubbles in other markets might be allowed to spread by similar financial innovations.

       With this in mind, would it be a significant problem if Hillary Clinton was "in Wall Street's pocket?"  Breaking this down somewhat, what would it mean for Wall Street to have influence in a Clinton White House and who would exercise it?  In the first Clinton administrations, Robert Rubin of Goldman Sachs and, later, Citigroup served as Treasury Secretary and lent considerable support to the sort of financial deregulation that was enacted by the Gramm-Leach-Bliley Act, which removed the Glass-Steagall firewall between commercial and investment banking.  In fact, it turns out that lots and lots of people at Treasury, Commerce, the Securities and Exchange Commission, the Commodity Futures Trading Commission, the Office of the US Trade Representative (i.e. the folks that brought us NAFTA, TPP, and numerous other acronyms denoting multilateral trade deals), and the Federal Reserve system find their way there by way of Wall Street.  Where else would you expect to find people capable of regulating bankers and securities dealers/underwriters?  In the current administration, Penny Pritzker, a member of the family that founded the Hyatt hotel chain and the founder of her own private capital fund (PSP Capital Partners), serves as Secretary of Commerce.  Eight years ago, Ms. Pritzker's younger brother and managing partner of the private capital/venture capital firm the Pritzker Group, J.B. Pritzker, served as national co-chair in Hillary Clinton's presidential primary campaign of 2008.  To date within the 2016 presidential campaign, Hillary Clinton has enjoyed substantial financial support from the owners and employees of the Pritzker Group ($7.8 million), as well as from Saban Capital ($10.6 million), a Los Angeles-based fund focusing on communications and entertainment media, and from Soros Fund Management ($7.8 million), the investment fund founded by liberal billionaire Georege Soros (see John Carney and Anupreeta Das, "Hedge Fund Money Has Vastly Favored Clinton Over Trump," The Wall Street Journal (July 29, 2016), at: http://www.wsj.com/articles/hedge-fund-money-48-5-million-for-hillary-clinton-19-000-for-donald-trump-1469784601).    

            What kind of influence do these people have and how might that be a problem?  I would suggest that most of these individuals do their best to be conscientious public servants, but we have to bear in mind that their world views reflect their experiences serving the private interests of speculative investors, some of whom have not adhered to conservative perspectives on portfolio management.  In regard to finance and banking, the jettisoning of Glass-Steagall was a real problem, caused at least partially by people like Bob Rubin who sincerely believed that securities markets would police themselves if given the chance to engage more openly in certain areas otherwise reserved to commercial banking.  If you don't have the kind of fluidity between mortgage originators, investment banks, and other financial sector agents where myriad agents carry suspect securities in their portfolios, then you don't get the degree of crisis that erupted in 2008.  The problem is that the financial sector wants and, to some degree, needs this kind of freedom from regulation to innovate and create new investment products that will satisfy the needs of different investors.  Bearing this in mind, it would be really hard to break up large financial institutions in order to ensure that the US government would not be left on the hook to save banks too big to fail!  Commercial and investment banks have become so well integrated that trying to separate these sectors at this point would be really messy.  Having so much connection to Wall Street is not going to make that job any easier for Hillary Clinton.
          In regard to trade liberalization, the capacity of financial sector agents to leverage capital against shifts in the geo-spatial organization of commodity production makes them the most logical supporters of reductions in trade barriers, even to the extent that such reductions create an incentive for certain firms and industries, particularly in manufacturing, to abandon the US economy altogether.  If Wall Street veterans are, thus, likely to possess the skills and acumen to negotiate trade agreements for the US government, then such agreements are also likely to reflect the particular interests of the financial sector at least as much as they reflect patterns of "comparative advantage" in relative production costs between the US and trade partners.  Granted sufficient freedom to inject capital and repatriate profits, it doesn't matter to investors whether a car is manufactured in Indiana or Inchon, South Korea so long as they can get an adequate rate of return on their investments when the car is sold.  As such, the negotiation of such standards as the rules of origin of materials in higher stage manufacturing may not solicit the attention from financial sector veterans negotiating trade deals like the Trans-Pacific Partnership (TPP) that might otherwise be conferred by representatives from manufacturing industries or organized labor.  With this in mind, it is worth asking whether Secretary Clinton's present opposition to the TPP will long survive the November election and how she might be able to massage a transition to support some amended arrangement with the associated member states of the existing TPP deal.    
          Again, this is not an argument to go out and vote for Jill Stein, who would be walking around in the dark when it comes to financial regulation and the negotiation of trade agreements.  It is, on the contrary, an invitation to be aware that if and when America has to deal with a new Clinton administration, we will have to aggressively hold its feet to the fire, both through Congress and by means of direct appeal through diverse media, to make certain that the public interest is being safeguarded in relation to the interests and agendas of the financial sector.

4.  Jill Stein has even less foreign policy expertise than Bernie Sanders.  It is one thing to want a fresh approach to major problems, like the Islamic State, Russian incursions into neighboring sovereign states, the South China Sea, North Korea, and Iran; it is another thing to vote for an abject novice and hand her the keys to the nuclear arsenal.  As a point of argument, we might regard any third party vote cast in a general presidential election as a protest vote, implying that, because there is no way that such a candidate will win, any vote cast in their name must only be cast to send a message to the major parties that voters are dissatisfied with the policies advocated by both major parties.
            To the extent that this conclusion is true,  Green Party voters in this election can consign themselves to the reality that they need not pay attention to all of Jill Stein's policy positions, particularly on foreign policy, because she stands no chance of enacting any of her policies.  There is something disingenuous about such a vote.  It diminishes the power and potential of democracy at least as much as the electoral institutions that constitute it as a strategy.  Voters should be obliged to develop a full understanding of the candidates before them and develop a conscientious rationale for selection based on their policy positions.  Acknowledging that this is a tall order and that I have seldom lived up to it, we should at least have some minimal thresholds of competence against which we can evaluate each candidate for an office like that of president, and the supervisory management, oversight, and contingent authorization for use of the nation's strategic nuclear arsenal is one area where I would hold a candidate to a higher standard, even if I was only casting a protest vote.  By this criterion, is it fair to say that someone with Jill Stein's credentials as a social activist remains unqualified for an office in which she might be called upon to give the order to use nuclear weapons?  The 2014 Green Party platform commits the US to pursue the elimination of nuclear weapons by a set of steps intended to ensure that an environment exists for mutual disarmament by all nuclear powers.  If I can agree in principle that such a policy is a good idea, then I have to simultaneously point out that mutual disarmament has to be mutual.  What is the alternative in a world where nuclear weapons continue to exist in multiple arsenals, ready for use with no immediate prospect for disarmament?  At present, the US faces a number of difficult choices in the management of our nuclear arsenal.  The Minuteman ICBM system is substantially antiquated, as is the Trident SLBM.  Questions may further exist on the survivability of ground based nuclear missile installations and the need for retrofitting and hardening.  The navy's Ohio class SSBMs need to be replaced with newer vessels, incorporating newer technologies to make the submarine nuclear threat less detectable and, hence, increase its survivability.  I am confident that Dr. Stein would stand as a tireless advocate for nonviolent resolution of international disputes and as a defender of nuclear disarmament, but I am less confident that, in the current environment, she would be able to leverage diplomacy to achieve these ends.  Leftists may often be quite sincere as committed defenders of idealistic principles, but diplomacy of this kind demands a stronger degree of pragmatism.  Moving beyond the subject of nuclear weapons, the same may be said in regard to Russian involvement in Ukraine, Chinese efforts to militarize dredged shoals in the South China Sea, promoting political stability and maintenance of free speech and democratic processes in post-coup Turkey, and facilitating a return to negotiations on a two-state solution in Israel/Palestine, assuming we haven't reached a point where a single state solution is inevitable (a conclusion that I would hold).
         In these respects, I lack confidence in Dr. Stein's ability to achieve diplomatic breakthroughs in these areas.  I would, on the contrary, possess a stronger degree of confidence in the capacities of either Secretary Clinton or Governor Johnson to approach diplomatic goals in a more pragmatic manner.  Again, this is not to suggest that anyone else should or should not cast a protest vote for Dr. Stein, but any such vote should reflect the priorities of the voter with regard to both foreign and domestic policy, minding the reality that Dr. Stein lacks significant policy experience in the former arena.

5.  For all the people Hillary Clinton will be indebted to in January, she won't owe any strong allegiance to the oil and natural gas industry.  In this regard, I don't expect that she will stand in the way of a long term reconsideration of federal energy policy, prioritizing clean energy.  If I feel reasonably certain that large quantities of campaign financing will find its way into the Clinton campaign from Wall Street and from Silicon Valley, as well as from Hollywood, then I am nonetheless sure that the oil, natural gas, and coal industries will treat Clinton like the plague.  There is no evidence that fossil fuel industries have anything to gain from funding a Democratic Party that is largely committed to addressing carbon emissions from hydrocarbon use.  Nevertheless, I want to acknowledge that some effort has been made, to date, by the Koch brothers to support Secretary Clinton's campaign against Trump.  Emphatically, this appears to reflect a broader conviction on the part of the Kochs that, in view of Trump's suggestion that the US should disavow and renegotiate existing multilateral trade agreements, Clinton constitutes the lesser of two evils in the presidential contest.  On the other hand, following from existing commitments of the Democratic Party to pursue clean energy development, the Clinton campaign has given no indication that it intends to accept funds from the Kochs or endorse independent advocacy by Koch-associated groups on the behalf of the Clinton campaign.
            Dispensing with the notion that fossil fuel industries might be a source of support for the Clinton campaign, we need to consider in what way a new Clinton administration might privilege renewable energy sources in place of fossil fuels.  Here, I think the portrait is apt to be murkier.  The Democratic Party platform sets as a goal that the US should obtain at least fifty percent of electricity production from clean sources within a decade.  However, it is not precisely clear what clean energy means in this context.  In particular, despite positing the idea of installing "half a billion solar panels within four years," it seems unlikely that the term "clean energy" precisely implies "renewable energy sources."  If clean energy, in this context, constitutes a relative term, including increased use of natural gas in place of oil or coal, then the threshold for realization of the platform's stated goal might not be such a stretch for the Clinton administration to achieve, and it might mean a lot less than it actually suggests on its face.  Beyond ambiguities in the terminologies used, however, the Democratic platform's position on energy policy closely parallels the language on energy policy utilized in the 2014 Green platform, with some minor differences, like a categorical moratorium on hydraulic fracturing in the Green platform until the potential negative ecological effects of the fracking, especially on watersheds, can be definitely determined.  Both the Democrats and the Greens propose to regulate the use of chemicals involved in hydraulic fracturing through the Safe Drinking Water Act and both seek means to place a positive economic value on carbon emissions, although the Greens explicitly posit their support for carbon taxes.  With these issues in mind, it might be hard for a Clinton administration to diverge substantially from the Democratic platform on energy policy.  In fact, the administration could identify tangible gains from prioritization of green economies through investment in energy infrastructure improvements that, minimally, will generate savings on the waste of fossil fuels in antiquated, leaky pipeline structures.  Moreover, if the administration can successfully generate some consensus, especially among Congressional leaders from coal producing states, on alternative economic developmental planning for regions affected by the loss of jobs in coal production, then the administration might successfully contribute to meaningful diversification in states like Kentucky, West Virginia, and Wyoming, addressing simultaneously ecological concerns with fossil fuel extraction and the need to propel extractive regions toward a durable entrepreneurial transition.

            I do not want to argue, in this regard, that a vote for Clinton would realize broader goals in the development of clean and, specifically, renewable energy as effectively or consistently as a Green Party administration acting in conformity with the party's 2014 platform.  Rather, the point is that, at least in its statements, the Democratic Party is at least as decisively committed to addressing climate change, as an effect of hydrocarbon use, as the Green Party is.  As such, it would be hard for a Clinton administration to abruptly change directions to approve, say, vast expansions of off shore oil development on the Atlantic and Pacific continental shelves and in the Arctic, a fact that, at least for the immediate future, will be supported by market forces (i.e. current commodity pricing patterns for crude oil and natural gas).  In the longer term, however, a commitment to make energy infrastructure more efficient and transportation networks more seamless would be likely to yield rewards both in reduced energy costs across distinct regional markets, reduced physical waste of energy sources, and, perhaps, safer transmissions of fuel sources from extraction/production sites to points of consumption.   All of this, of course, relies on a political environment in Washington where compromise between the Clinton administration and Congressional leadership from both parties is at least conceivable on ecological issues, and such an environment cannot be taken as a given.

6. In the aftermath of the 2016 general election, the lingering dysfunctional character of the federal government will reinforce the reality that the states are the true and logical sites for domestic policy experimentation and enactment.  As such, it should matter very little who wins the general election provided that Trump loses and/or he confronts legislative and judicial branches and a broader American public determined to confound his capacity to assert absolute control over the country's future.  This point is critical.  Dysfunction in the operations of the federal government constitutes both a problem and an opportunity for state governments.  On the one hand, the federal government has numerous fiscal obligations to support state level programs, especially with regard to health care and assistance for lower income households but also in education and transportation infrastructure maintenance.  When the federal executive and legislative branches cannot come to compromises on fiscal/budgetary matters, in many areas, the states may be left holding the bag even for programs where enabling legislation for certain programs stipulates some level of federal budgetary commitment.  In recent years, federal grants in support of state and local governmental programs have amounted to over $600 billion per fiscal year.  As such, the importance to state and local governments of budgetary compromise at the federal level is substantial.
             Having made the argument that a fiscal role by the federal government in the operations of state and local governments is critically important to the fiscal solvency of lower governments, the presence of an active commitment by the federal government in state and local governmental processes shapes the operations of the latter in both positive and negative ways.  Most notably in recent years, the Patient Protection and Affordable Care Act (i.e. "Obamacare," henceforth "ACA") gave state governments the choice of setting up individual state-level online exchange sites to enable citizens to purchase individual health insurance policies in compliance with individual mandates for health insurance coverage or allowing the federal government to directly offer residents the use of a federal online exchange site.  The record of technical performance for online exchanges at the federal and state levels was decidedly mixed, but significant technical difficulties involving the federal site took on a magnified significance insofar as those states with leaderships opposed to the implementation of the ACA writ large could point to the failures of the federal government to properly implement the law, and, hence, that their citizens were made worse off as result of the law.  Conversely, states that had made a palpable effort to implement their own exchanges encountered some technical problems in integration with federal infrastructures, most notably IRS to determine eligibility for subsidies.  In Massachusetts, where our exchange predated the federal intervention by several years, integration with the federal government proved to be a significant problem.  Technological structures that functioned effectively prior to the ACA's enactment failed because the required connective infrastructure to IRS and other entities was not adequately provided on the federal side.

      To a significant extent, the problems arising from ACA implementation could be traced to the larger inability of the Obama administration to achieve cooperation with the One-hundred thirteenth and fourteenth Congresses on funding of the ACA's provisions, particularly those associated with the enforcement of individual mandates.  Again, part of this can be traced to a larger animosity between the president and the base of the Republican party, reducible substantially to racialist concerns.  Notwithstanding, the rollout of the ACA has reflected a pattern in which conflict at the federal level has demonstrated adverse effects for individual states, where in many cases there was at least some palpable commitment to make universal health insurance coverage a legitimate and realizable goal in the public interest.  

       Part of the problem here is that efforts by the federal government to resolve issues as complicated as health care implicate partisan divides made steeper by virtue of regional differences in philosophy regarding fiscal matters.  If we can, as a rule, generalize regarding the willingness of individual states in particular regions to impose heavier per capita tax burdens in support of a social safety net and broader social expenditures on health and education, then such differences might be indicative of the degree to which Congressional delegations from higher tax/higher expenditure states and regions approach the role of the federal government with regard to domestic spending initiatives, like those contemplated under the ACA, differently from Congressional delegations in lower tax/lower expenditure states and regions.  Such differences must, to some degree, transcend party lines to reflect basic differences in the political cultures characterizing individual states and broader regions.  My state is always going to be regarded by many, both here and elsewhere, as "Taxachusetts," even if per capita tax levels in Massachusetts are far from the highest in the US at the present time.  On the other hand, a strong consensus continues to exist, manifest if nowhere else than in the liberal character of the state legislature, favoring relatively high expenditures on education, including public higher education, and on public health.  Such prioritizations are not typically characteristic of state legislatures in the South, the Plain states, or the Rockies.
          Health insurance coverage is a major problem social concern for the entire US.  In the absence of universal coverage, services to uninsured individuals pose a financial burden both on the individual patients and the servicing healthcare providers, for whom the inability to receive timely payment for services necessitates a prolonged shift of expenses onto other payers, contributing to inflation in the cost of healthcare provision and the cost of obtaining health insurance.  As such, a universal minimum threshold for individual health insurance coverage stands to benefit the entire US economy if only by partially arresting the inflation of health care costs.  This conclusion does not imply that the solution to the problem of less than universal health insurance coverage had to be a national solution, conceived at the level of the federal government.
          The ACA solution of mandates for the purchase of individual health insurance coverage through publicly sponsored exchanges of partially subsidized health insurance plans was loosely based on the experience of Massachusetts in developing such a structure.  The health insurance reform in this state was less than perfect, but it substantially contributed to a reduction of uninsured individuals before the ACA was ever contemplated.  With this in mind, it seems clear that, had there never been an ACA, other states could have undertaken their own statutory reforms to health insurance availability.  Maybe some would have looked starkly different from the reform in Massachusetts that eventually inspired the ACA.  Four years ago, for example, the administration of Governor Peter Shumlin in Vermont was contemplating the possibilities for establishing a Canadian-style single payer system in the state, plans for which came to nothing as the administration concluded that such a reform would have created insurmountable administrative incompatibilities with the federal reform.  Other states might have built on the idea of setting up individual, tax exempt health care accounts, through which pre-tax income could be diverted to an account strictly reserved for direct household healthcare expenses, including preventative care,or for the purchase of health insurance.  Any such ideas would have had potential benefits and costs to individual households and to the larger economy of states enacting the reforms, but the experience of having such a diverse array of reform initiatives across the US might have benefited the entire country by demonstrating the conditions under which particular reform initiatives operated well or floundered.  In place of such a radical context of policy experimentation, we got an acrimonious debate about a one-size-fits-all reform initiative in which numerous state governments sought to actively pursue the initiative's failure through inaction, non-compliance with statutory requirements/recommendations, and litigation against the federal implementation authorities.  Moreover, we had to endure six years in which Republican-controlled houses of Congress pursued the non-funding of statutory provisions and repeatedly sought unsuccessfully to repeal the ACA, without any clear conception of what was to replace it or how such a replacement could be conceived in a thoroughly toxic environment of legislative and executive struggle to steer the trajectory of federal fiscal policy, as a whole.
             As argued above, I am confident that, whatever happens in the presidential election, Secretary Clinton's influence will not be able to achieve such a decisive down ballot coup that a new Clinton administration will be able to impose the will of the Democratic Party onto a unified and coherent federal government.  The federal government is going to remain dysfunctional for some time to come, and this would not necessarily be a bad thing if state governments could learn to take the initiative to develop their own solutions to relevant issues in public policy, perhaps, additionally, collaborating horizontally with other state government to harmonize public policy initiatives across broader networks incorporating multiple state jurisdictions.            

7. In the end, Bernie Sanders' assertion at the DNC that we are responsible for the future of our own progressive democratic revolution is absolutely true and this revolution will not rest on an electoral ballot cast for either Hillary Clinton or Jill Stein.  It will demand a steady and inclusive exercise of a much broader conception of democracy than any heretofore advanced in American history.  Not to spin any cliche, but governments don't wage political revolutions; they squash them.  For all that American liberalism, as a broadly partisan institution, has its contemporary foundations in the New Deal, it is worth remembering that the policies enacted by the Roosevelt administration domestically reflected a broader commitment to supplant more radical (democratic) revolutionary alternatives with (liberal) statist solutions in areas like labor relations and retirement income security.  In these respects, when we contemplate amelioratives to deal with the impending exhaustion of the Social Security retirement trust fund, we are traversing discursive ground in which we have a more or less firm consensus that the federal government has a role to play in ensuring that retirees have some basic income to cover living expenses.  When someone like Bernie Sanders comes along and starts calling for a political revolution to bolster Social Security and expand Medicare coverage, we would be right to ask where the revolutionary part is supposed to arise - these reforms are the stuff of bureaucracies.  As such, I am not going to downplay the importance of developing new funding sources for Social Security, but we need to differentiate between reforms to state institutions and broader transformations to a political culture that has become too reliant on state action to ameliorate social problems that might otherwise be addressed through the private entrepreneurial actions of inclusive communities.
         In what way would a reform of state bureaucratic institutions, like Social Security, represent a moment of genuine democratic revolution?  Beyond the rudimentary observation that such a reform might be preceded by the democratic electoral victory of a candidate and an administration committed in principle to the long run solvency of public retirement insurance, it isn't clear to me that a reform of fiscal allocations or of bureaucratic procedures and the disbursement of funds would truly represent a moment in which the maintenance of living standards for a broad spectrum of the US population would have changed substantially to reflect the assumption of a collective burden, transforming and democratizing the functions of Social Security.  To me, a real democratic revolution must imply the commitment of a majority of the population to assume a collective investment and burden in the resolution of a given social problem, transcending the bureaucratic actions and the limited fiscal investment of government.  In regard to the maintenance of living standards for retirees, this might involve more widespread and inclusive sets of volunteer-based in-kind service provision at the local level, maybe orchestrated through senior centers, in order to offset certain expenses that retirees on fixed incomes would otherwise incur.  Effectively, it would amount to removing from the market sets of goods and services that retirees would have to pay for with their Social Security income in order to supplement this income, whether or not a fiscal reform of Social Security ever happens.  This kind of democratic revolution would, necessarily, amount to a reformation of the concept of community at a local level, making the local community into an active, inclusive concept, rather than an accident of geography/collocation, in which all members of the community become engaged and entrepreneurial/risk-taking stakeholders in the resolution of common social problems.
         This conception of a progressive democratic revolution is almost certainly not what Bernie Sanders had in mind at the Democratic National Convention when he argued that progressives need to press home the democratic revolution that his candidacy for the presidency heralded.  On the other hand, I would be amiss not to acknowledge that there is a long slate of policy issues that government at multiple jurisdictional levels needs to address for which progressives need to remain strong advocates, among them reform of law enforcement and criminal justice, particularly, in relation to the persistence of racial inequities, realignment of public educational processes to define and develop the means for realization of broader educational goals not limited to economic rationales for education, and addressing the expansion of wealth and income inequalities to the extent that such inequalities produce real and quantifiable costs to the US economy relative to economic growth and social mobility through paid employment.  Unfortunately, the 2016 general presidential election is simply not going to provide the last word on these issues.  A candidate like Jill Stein would certainly be a strong advocate for many issues of concern held be progressives, but she is not likely to win the general election.  Secretary Clinton might be a clear favorite to win election to the presidency, but, the Democratic Party platform notwithstanding, she may not be the most zealous advocate for a wide range of progressive policy solutions and she will be limited in her actions by the persistence of incoherence and dysfunction in the relationship between legislative and executive branches at the federal level.  In the end, progressives are going to have a lot of work to perform in order to achieve broader changes to federal policies to reflect commitments to racial justice, gender equality, equitable distributions of the gains to economic growth from free trade, principled foreign policy engagement, and promotion of global ecological sustainability.  Much of this work might be for naught, but, in a larger sense, the left really needs to become more aggressive in developing hybrid strategies that can address multiple jurisdictional levels of government while simultaneously nurturing private, entrepreneurial DIY solutions at a community level where such solutions can be meaningfully enacted and make tangible, if small, changes to particular areas of social concern.
          As such, whoever actually wins the presidential election should matter very little to the progress of a democratic revolution in America.  I cannot, in this manner, suggest either that progressives should adopt a strategic standpoint in holding their noses to cast a ballot for Secretary Clinton or that we should adhere to our consciences in casting a ballot for Dr. Stein and the Greens.  Neither of these choices will confer on the US a ready-made set of transformations to domestic and foreign policy in ways sought after by progressives.  If the best that can be hoped for is to keep Donald Trump out of the White House, then individual voters should decide for themselves the best way to ensure that they will be contributing to these ends.    
                     

The Genomic "Bomb"

I mean to offer this post, in part, as a statement of frustration with humanity, in the name of peace, liberty, inclusive community, free individual development, and love, sentiments that seem to be utterly at war with various governments, including my own, and non-state/quasi-state entities (I am thinking in particular of the Islamic State).  I watched a particular TED talk on contemporary research with genomes involving a technology called CRISPR (Clustered Regular Interspaced Short Palindromic Repeats) (see Jennifer Kahn, " Gene editing can now change an entire species - forever ").  CRISPR apparently uses bacterial species to unravel particular segments of DNA in sexually reproducing species to amend such segments, introducing mutations to alter relevant genetically hard wired material in individuals.  The speaker, Jennifer Kahn, further explained how technology now exists to make such mutations repetitive over successive generations.  She, finally, offered a relevant example, concerning management of invasive species (her example, the Asian carp in the Great Lakes), suggesting that it might be possible to engineer a genetic mutation that would cause a sexually reproducing species to only produce male offspring by rendering the XX combination in male gametes to malfunction or otherwise be incapable of fertilizing a female egg, ultimately leading to the population's extinction.  Given ready transmission of individuals over vastly expansive geographic spaces, it is possible, given the pattern of dominance exhibited by CRISPR mutations across generations, that such would lead to the total global extinction of the species. 
        A thought: what if some really intelligent people at a Silicon Valley start up, without any government involvement, were to engineer the very genetic mutation that Ms. Kahn offered in the case of the Asian carp on the human genome, "weaponized" it for rapid and consistent transmission within the gene pool, AND INTENTIONALLY RELEASED IT, to as broad an international spectrum as possible, transcending all manner of class, ethnic, and geospatial lines (say, through fertility clinics, where reproductive materials can be readily assembled and manipulated to generate the appropriate mutation)?  It would take a highly concerted (and entirely clandestine) effort to research the appropriate steps to identify a genomic pathway, to produce the mutation, to disseminate it, and to prevent any disclosure of the mutation to any government or media entity.  The mutation might go undetected for decades, maybe even a century, until, in certain regions, the all too evident sexual disproportionality within the population would reveal, maybe too late, the potential for whole regional populations to crash within generations.  In the process, in particular societies where the mutation begins to reduce numbers of females of reproductive age, males carrying the mutation would be apt to migrate to places with larger numbers of reproductive age females, promoting the explosive diffusion of the mutation across international borders, reducing the proportion of reproductive age females everywhere.  Within maybe 150 years, the global female population might reach a breaking point where entire societies might be on the verge of disappearing and global population falls well below a steady replacement rate.  Assuming enough sophistication went into the mutation's development, moreover, perhaps involving multiple manipulations of different sections of the human genome, it might be really difficult for genetic scientists in the future to pin the mutation down in order to reverse it.  Given the apparent robustness of CRISPR mutations and their capacity to dominate a gene pool, maybe such a mutation could successfully euthanize the entire human species within, say, 350 to 450 years.
        I offer this possibility with a question.  Assuming that what I have just described might be theoretically possible, should individuals capable of producing such a mutation do it?  On its face, the obvious answer would, of course, be no.  After an entire week of media coverage of events like the IS inspired mass murder by truck in Nice, the seeming drift toward something approaching fascism in post-coup Turkey, and the amazing robustness of fascism across many countries right now, I am intrigued with the thought of placing a time bomb within the human genome, if only for fear that the world we are living in may be descending into barbarism.  That is to say, if, one hundred years from now, humanity was mired in a new dark age of religious extremism, xenophobic nationalism, and nuclear-backed imperialism, the thought that science today might have demonstrated the foresight to place our species on a hard deadline might at least be the Enlightenment's last laugh before the horror show and the planet's last hope to be spared any additional pilferage by its most successful invasive species!

On the FBI's Determination that Clinton Should Not Be Indicted

Briefly, FBI Director James Comey's statement that the bureau will not recommend to Justice Department officials that former Secretary of State Hillary Clinton should be indicted for mishandling of classified material in association with the use of a private email server for official State Department business leaves me a little confused.  Strictly with regard to the law, my understanding is that Clinton's actions fall within the terms of the US Code, Title 18, Chapter 1924, on the "Unauthorized removal and retention of classified documents and materials." In this regard, the failure of the FBI to recommend prosecution in this case hinges on a particular interpretation of this provision, inferring that violations of the law require strict intent on the behalf of the transgressor.  As such, Secretary Clinton will not be prosecuted under the law because she was oblivious either to the fact that she was handling classified materials in her email traffic or that handling such materials on an unauthorized server constituted a violation of the law.  In other words, mere careless handling of classified materials does not constitute a criminal violation.  The particular legal provision in question does, in fact, contain language supporting such an interpretation on the part of law enforcement officials and prosecutors, explicitly stating that classified materials must be "knowingly" removed "with the intent to retain such documents or materials at an unauthorized location." If this is the accepted interpretation of USC Title 18, Chapter 1924, then I can understand the sense of disgust that seemed to accompany Director Comey's announcement, implying that there apparently was much more that the Bureau wished that it could do to deter this sort of behavior in the handling of classified materials, but the law simply afforded no meaningful remedies.  To the extent that this is true, it suggests that, especially in our current environment of informational warfare, hacking, and aggressive activity by violent non-state organizations aided significantly by online information gathering, Congress really needs to reexamine statutory standards on electronic storage and transmission of classified materials and add unambiguous criminal penalties for negligent handling of classified material, especially within electronic information transmission networks.  

            Apparently, the Office of the Inspector General for the State Department had explicit, written procedures in place to prevent employees of the department from doing precisely what Secretary Clinton had done, and, upon her appointment as department head, Secretary Clinton had cavalierly taken it upon herself to establish a nonconventional communications protocol without even asking the Inspector General's office whether use of private, non-governmental server was compliant with departmental procedures, much less with the United States Code(!).  As a result, the department head and her staff set an example that sloppy, unprofessional skirting of security procedures in the handling of classified materials generated and circulating within the department was entirely understandable and permissible - precisely the sort of example that you would want to see from a head of state and chief diplomat of the United States.  To the extent that conscientious compliance with the sound and reasonably enacted security procedures of a department responsible for maintenance of globally expansive communications networks incorporating thousands of diplomatic and foreign analytic personnel should be expected from the head of the department, at least as an example for subordinates, Director Comey quite reasonably voiced his frustration with the careless mishandling of classified materials by Secretary Clinton and her staff, and the American public deserved such a frank appraisal of Clinton's actions in order to better develop an informed judgment on Clinton's suitability for the office of President.  

             Having said this, we need to simultaneously keep in mind what is at stake in November for the American general electorate.  Following the present course, the choice between prospective Democratic and Republican candidates, respectively, pits an arrogant, overly ambitious, out of touch, technocratic-minded career politician, who is apparently too concerned with appearances of professionalism to follow through on important details like information security, against an equivalently arrogant, self-centered billionaire real estate magnet and quasi-populist, who likes to play footsy with racist, xenophobic fascists and contemplates ripping up negotiated treaties and international agreements in order to remake the world in his own desired image.  It should go without saying that, in a contest between Hillary Clinton and Donald Trump, Clinton should be the only reasonable choice.  As low an opinion as I have of Secretary Clinton, I do not want to even contemplate the alternative!  

               As for the conclusion that I am bound to hear, especially from the avowed Clinton-haters I work with, that someone had to have gotten to Comey and, further, to the Attorney General Lynch to convince them not to move forward on a prosecution of Secretary Clinton, the legal interpretation of Title 18, Chapter 1924 speaks for itself.  Knowledge regarding the potential for violation of safe handling and intentionality to violate safe handling procedures is unambiguous as a threshold for criminal prosecution under current law.  The prosecution of Hillary Clinton for criminal mishandling of classified material would have required a contortion of existing patterns of enforcement of federal law.  On the other hand, many, many individuals will conclude, notwithstanding, that something stinks in the U.S. Justice Department.  That is alright.  Such individuals were never going to vote for Hillary Clinton in the November general presidential election anyway and were simply looking for some justification to vote for Donald Trump, even if he is utterly unqualified to serve as President of the United States.  Any conspiracy theory concerning Secretary Clinton's use of her private email server expressly contradicts existing patterns of criminal law concerning the handling of classified materials by U.S. government employees.  Insofar as this is the case, I still hope, sincerely, that Hillary Clinton will have learned from this episode, seeing through her own self-important, know-it-all arrogance to realize that she is embarking on a destiny that transcends, in its importance, the limited imagery that she envisions with the title of President and, as such, that she understand that the relevance of her achievement in November far transcends her own ambitions!                                

Reflecting Again on American Health Care

A familiar story I like to tell about the fundamental character of health care in the U.S. concerns orthodontics.  Braces are a life experience for millions of American adolescents every year, and yet most dental insurance plans fail to cover orthodontic care on the principle that it is effectively cosmetic.  With this in mind, I was born without one of my lower permanent incisors, causing all of my teeth on this side of my mouth to shift.  Numerous dental professionals have advised me to consider braces, but I have resisted the move both for cost considerations and for the larger inconvenience.  As a result, I have a somewhat unsightly gap between some of my teeth where the gums are somewhat more vulnerable to gingivitis, but, on the whole, I haven't suffered any significant health issues from my decision not to correct my teeth. 
         My brother Norm's children, by contrast, have each gone through orthodontic work.  I cannot blame my brother and sister-in-law for choosing to invest in the straightening of their kids' teeth, especially when dental professionals, no doubt, advised them to do so.  Just the same, I can remember several years back that my mom and dad would take their grandchildren along for the ride up to the Mondiale des cultures festival in Drummondville in Québec, my mom's hometown.  It seemed like every time they would go, they would invariably meet up with the grandchildren of one of my mom's friends about the same age, and not one of these Québécois youngsters had braces, however straight or crooked their teeth were.  The interpretation seemed pretty clear to me.  Orthodontics is an investment that the single-payer health care system in Québec has largely chosen not to invest in, and, given the income levels of these youngsters' family, there simply was not going to be a private investment made in this direction.  Perhaps they would have wanted to, but the cost precluded the possibility.  More over, it seemed like this was a regular outcome in Québec with regard to orthodontics, which did not appear, on its face, to be as prevalent a subset of the medical establishment, at least in Drummondville.
           This conclusion is pertinent to a larger evaluation of medical expenditures in the U.S., and, in particular, of our propensities to accept the diagnoses of medical professionals advising expensive treatments for conditions that are neither life threatening nor particularly debilitating to the everyday lifestyle of the patient.  Emphatically, our health care system is so expensive, in large part, because patients undergo a variety of procedures that may be unnecessary to the general maintenance of their health on the advice of medical professionals who prescribe treatments and/or diagnostic tests for diverse reasons but, pointedly, in the hopes of skirting medical liability from the experience of an unhappy patient who might conclude that their physician was negligent in identifying treatment options and thoroughly diagnosing their condition.  We can, in this manner, conclude that this is another side effect of our relatively litigious culture, but it also tells us something important about our conceptions regarding the integrity of our bodies in relation to medical science's capacity to repair every malady and physical shortcoming, conferring on medicine a more profound stature of objectivity as a science and a more expansive capacity to achieve improvements on the human condition than it might otherwise deserve. 
          That is not say that medical science does not deserve credit for its vast accumulation of knowledge on the human body (and, for that matter, the human mind if we include mental health) and for its striving to research the causes and cures for numerous deadly maladies.  On the other hand, all of the research conducted by medical professionals carries a substantial bill for services rendered that invariably filters down to every patient receiving medical care, partly reimbursed from patients themselves and partly covered by the financial sector through health insurance.   Every penny of capital sunk into medical research or specialized facilities for cutting edge diagnostic technologies or treatment regimens demands a rate of return, frequently recovered by cross subsidization, charging higher rates for more conventional procedures to patients and/or third party payers.  Again, this is not to say that we should not make such investments, but we need to recognize how the normative practices of finance pervert the aims of erstwhile humanists, researching cures to cancers, Parkinson's disease, Alzheimer's, and other chronic maladies impacting humanity (at least among those quarters most able to cough up the cash required to start a research agenda). 
       Beyond the pure economics of health care, the rigorous ethos of professionalism exuded by physicians and other highly trained front line care givers conveys an impression of infallibility that, to some degree, shapes the expectations of patients in ways that may be unrealistic.  This sense of total expertise is the thing that most concerns me in this post.  Again, this is not to say that patients should not listen to the advice of their physicians or entrust them with an expectation that their accumulated training and experience will lend credibility to their diagnoses.  However, no science can ever claim absolute objectivity.  The best that medicine can claim is to possess extremely reliable experiential and research-driven points of reference in regard to particular physical conditions and the infliction of such conditions on individual bodies.  Conceding as much, every human body is different and constituted as much by micro-level interactions with microbial species as with macro-level social/ecological effects on the body.
         Particular strains of the influenza virus, for example, may have a relatively predictable infection pattern on the human body, in the abstract, but when the same strain of influenza infects a particular individual, its progression must, necessarily, depend on the mix of microbial species already coexistent with the individual, with the individual's broader health habits (e.g. diet, sleep, work routines, etc.), and with weather, ecological factors (e.g. exposure to higher levels of air pollution), and social interaction with other infected individuals.  No matter how educated a medical professional might be, it is extremely difficult to isolate and control all of the determinants of an individual's health in order to effectively, precisely diagnose such an infection and prescribe the precise recovery plan, including use of antibiotic and/or anti-viral medications, best suited to that individual without generalizing across unrelated patients in ways that may be unhelpful to the patient's treatment.  In the end, medical diagnostics may reduce itself to a practice of trial-and-error, where multiple diagnoses accompanied by multiple unsuccessful treatment regimens precede a successful resolution of a particular malady, not because the medical professionals treating the malady are incompetent but because the physical constitution of an individual is a complex interrelation between myriad factors that are difficult to analyze.
         Part of the problem here is that the inherent complexities of medicine are difficult to disentangle from claims of incompetence and/or negligence as a matter of civil liability, especially when, as an especially litigious culture, we place so much faith in the capabilities of medical professionals to cure every ill and fix every physical and/or mental impairment.  For medical practices, testing our faith that the powers of medicine are effectively limitless can get expensive and, collectively, drive up rates for malpractice liability insurance.  So, if you cannot achieve an iron clad diagnoses of some patient's condition, it makes sense that you would exhaust every avenue in diagnostic testing, however expensive for the patient and his/her insurer, to make sure that the diagnoses was correct.
         This brings me to another example in medical care involving myself and multiple coworkers.  I noted on this blog that, about a year and a half ago, I broke my wrist (a distal fracture of the radius at the wrist joint).  Coincidentally, no sooner did I return to work than one of my coworkers take a tumble over the handle bars of her bike while trying to avoid a dog along a bike path, in turn, achieving a small radial fracture for which she did not require a cast.  Finally, again by strange coincidence, this coworker's son (with whom I also work) had had an accident while snowboarding that, apparently, resulted in a fracture of some sort to his radius for which he went untreated for almost an entire year, until, after a prolonged history of soreness in that wrist, his physician determined that the radial bone had been fractured, had healed incorrectly, and would require surgery to repair the damage to his wrist joint.  The three wrist fractures in question are pertinent to my larger argument here if only because they show different approaches to the resolution of a common medical problem and different negotiations of health care costs, all under a shared, employer sponsored health insurance plan.

        When I broke my wrist, I required a cast and my treatment precluded me from working at my job for six weeks.  Moreover, I encountered substantial out of pocket expenses in addition to my copays, especially for diagnostic tests (x-rays to determine the progress of healing).  After my cast was removed, I experienced some soreness in the wrist joint attributable to immobilization of my tendons.  The orthopedic surgeon who treated me had prescribed occupational therapy to ensure that I would regain my full range of motion, but, after the expenses I had already incurred, I concluded that it was simply cost prohibitive to undergo such treatment.  I downloaded a video off YouTube showing therapeutic exercises for recovery from radial fractures, committed to doing such exercises for a couple of weeks, and went straight back to work.  I have not encountered any wrist pain since, even when doing push ups.

          By contrast, Cathy, who broke her wrist just after I returned, apparently had such a minor break that she returned to work immediately wearing a brace.  In hindsight, it might have been the case that her treatment was inadequate to the injury, but, again, she got the full account from me on how expensive my treatment had been, and, maybe as a result, she was trying to avoid significant expenses for an injury that just was not very severe to begin with.  On the other hand (figurative, not literally), she apparently still has some discomfort in her wrist, especially when she exercises.

          Finally, Cathy's son, David, apparently had such a minor break that it went completely undetected for almost an entire year, during which time he worked for a moving company!  After he had left the aforementioned job, he apparently had a stretch of real discomfort in his wrist, which prompted his mother to suggest that he should have that checked out.  There was apparent evidence of a fracture that had healed improperly, suggesting that David would experience lifelong problems with his range of motion if it was not surgically reset.  So, he underwent surgery, has been in a cast/brace for the last four months, and has been undergoing repeated (expensive) diagnostic testing to ensure that the joint is indeed healing properly this time.

         A principal motivation for writing this post has been the repeated conversations that I've had with Cathy about the medical expenses from David's surgery and from all of the follow on therapy and examination, including the orthopedic surgeon's decision to send David a bone stimulator machine, apparently all on our insurance company's tab(!).  Noting that they had no idea what the device was for or how it was supposed to assist in David's therapy, Cathy further offered, in exasperation, the question of who is supposed to pay for all of this.  Honestly, that tends to be a question that repeatedly gets aired when Cathy and I talk about David's wrist!
           To be fair, Cathy has bent over backwards to ensure that her son could get the treatment that he needed for his wrist and to follow through, making sure that David goes to all of his orthopedic appointments, only to hear all over again that the joint is healing just fine.  Moreover, as she has pointed out, given that David remains on his parents' health insurance policy and they have invested their money into David's treatment to cover out of pocket expenses, the proper healing of David's wrist has become a real investment for her and David's father.  At the end of all our conversations, however, I always seem to end up coming to the same conclusion, and it is one that ultimately sums up the point that I have been trying to make about American health care over the entire course of this post.  First, every penny of capital that is invested in medical research or the provision of medical services to patients in the U.S. demands a rate of return, and, collectively, as an incompletely but substantially integrated market structure, every patient and every third party payer is on the hook to reimburse every penny of capital invested when patients utilize the health care system, if only by virtue of the accumulation of claims to reimbursement along the long course of a medical industrial supply chain.  As long as medicine continues to attract such heady quantities of capital looking for a decent rate of return, American health care consumers will continue to pay higher and higher health insurance premiums, higher and higher copays, and higher and higher deductibles on annual health insurance benefits, as well as restrictions on certain categories of care.
             The point here is that, at some point, someone on the demand side of the health care market place has to put their foot down and say "no."  "No, I am not going to pay for a bone stimulator when I have no idea what it's supposed to do or how it is supposed to help."  "No, I am not going to pay for braces or clinical teeth whitening."  "No, I am not going for another CT scan, after I have already had two negative scans."  "No, I am not going to pay for the most high tech, new circulatory anti-coagulant medication when older medications work just fine and are available as lower cost generics."  In other health care systems, like the Canadian and Québécois single-payer systems, the problem of saying "no" is easily resolved.  A government bureaucracy is always available to be an ever present gatekeeper to health care services in order to control the expansion of costs.  Likewise, in other health care systems with third party payment by private insurers like, say, Germany, the health insurance industry seems to be readily able to exercise its capacity to say "no" when medical professionals prescribe treatments regimens of questionable merit that will extraneously tax the ability of the health insurance establishment to cover the full range of its expenditures.
            To a certain degree, health insurers in the U.S. are also willing to exercise their authority as the gatekeepers to medical treatment.  The health maintenance organization (HMO), pioneered by Kaiser Permanente in California, for example, was predicated on the principle of controlling expansion of health care expenditures by controlling the terms of health care provision within organizations of salaried medical professional employees.  However, the HMO lost favor quickly because it did not conform to the preferences of American consumers for more choice in selecting medical professionals across the larger span of the market place.  Greater market freedom in American health care means that opportunities always potentially exist to profit from investments of fresh capital.  When health insurers cannot control this process because they cannot control the provision options demanded by policy holders, the only choice they have is pass on an ever increasing share of costs to patients.  In this manner, the ultimate gatekeeper in the American health care is the patient, and the problem is that American health care consumers are inadequately invested, as a whole, with knowledge on medical conditions and treatment options to make informed decisions that will mutually respect their own needs and the imperatives of the larger system to maintain good cost control.  This is a tall order when the American health care consumer/patient demands both the objective truth with regard to any particular physical condition that ails them, expects that their medical professionals can provide that truth, and then uses the recourse of civil litigation when they fail to meet their promises!
             Concluding, it is the peculiar structure of incentives in American health care that is really dooming us to a system where costs rise out of anyone's control because, at the end of the day, too few people are willing or adequately informed enough to say "no."  With this in mind, there is something to be said for reform of medical torts if only because tort reform would place much greater responsibility in the hands of patients to account for the treatment options they've selected.  On the other hand, it would also have to be accompanied by a much greater effort by medical professionals to educate their patients, in particular, on why they are prescribing certain options in treatment of medical conditions, both when such conditions are life threatening and when they are merely cosmetic resolutions to common physical deficiencies.