Wednesday, December 30, 2009

Elements of Style, Strunk & White: A Review

Some of us had The Elements of Style forced upon us. Others of us sought it out for it's fabled wisdom and exacting measures of good and effective writing. This small book by William Strunk and his student E.B White is as concise as it counsels, but has an austerity about it that leaves you feeling uncomfortably constrained, even unsatisfied. And despite it's generally sound advice, you can't help feeling that strict adherence to its Procrustean set of rules might produce writing that is lacking, bereft of the richness, depth, complexity or whimsy that might make it more enjoyable, even more effective. Yet, it still sits on my desk, and I still consult it from time to time.

Peter Wood offers a thoughtful review of a new book on the subject, Stylized: A Slightly Obsessive History of Strunk & White's The Elements of Style, By Mark Garvey (Touchstone 2009). Wood offers clear, balanced, insightful observations in his treatment of Garvey's 240 page work. For openers:

Strunk's is the voice of stern minimalism, a reaction against overstuffed Victorian furniture and a culture blurred into rhetorical complacency. Strunk (1869-1946) was a near contemporary of the famously laconic Calvin Coolidge (1872-1933)—one of the few observations about Strunk's Great Rule that Mark Garvey does not make in Stylized: A Slightly Obsessive History of Strunk & White's The Elements of Style...

"Omit needless words"—the gnomic Rule Thirteen in William Strunk's original 1918 self-published edition of The Elements of Style—is the kind of advice that means less and less the more you think about it. Which words are needless? What need are we talking about? Just conveying information or mood, too? Sublunary matters or glimpses of God?

Strunk's exposition of Rule Thirteen seems sensible, at least initially:

'Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences, for the same reason that a drawing should have no unnecessary lines and a machine no unnecessary parts. This requires not that the writer make all his sentences short, or that he avoid all detail and treat his subjects only in outline, but that every word tell.'

But these sentences soften under steady gaze. Vigorous writing is not always concise. Gibbon is not concise. Dickens can be, but isn't always. Unnecessary sentences abound in good writing, or some kinds of good writing—the kind that is companionable, humane, allusive, and willing to treat the reader as a friend, not a customer.

--"What Are Words Worth?" a review by Peter Wood, The American Conservative (1.01.10)

But Wood sympathizes with Garvey's efforts to get past Elements "fundamentalism" and to the heart of what Elements at its best is, to see how it can best be understood and used as a guide to better writing. Wood continues:

Garvey, however, is at his best in those passages where he attempts to take the heft of Strunk's preference for the spare. The Elements of Style, he says, "embodies a worldview." He explains:

'It is a book of promises—a promise that creative freedom is enabled, not hindered, by putting your faith in a few helpful rules; the promise that careful, clear thinking and writing can occasionally touch truth; the promise of depth in simplicity and beauty in plainness; and the promise that by turning away from artifice and ornamentation you will find your true voice.'

Garvey is surely right to locate the enduring appeal of The Elements of Style in these largely unspoken promises. He is also right to pick out "Omit needless words" as the pivot of the Strunkian universe. That three-word command, he says, "continues to ring like a Lao Tzu aphorism at the book's center." I have known academic colleagues in whom this Zen-like rule, in its exacting, Bauhaus-on-the-page austerity, has taken full possession. They comb and re-comb every paragraph seeking perfect nudity. They do not rest until every vestment is torn away and every noun and verb stands blushing naked. And what remains is indeed clear and readable, like tracks in the desert sands.

Garvey never quite comes to terms with the desertification of English prose wrought by Strunk & White cultists. Perhaps it is because he is himself a devotee—though not the hard-core sort whose adoration of the purging of needless words leads their prose ever closer to that epitome of concision, the white pages of the telephone book. Instead, Garvey pleads the case that, rightly understood, Strunk's edict is capacious. It allows for good writing of many types and in many voices. Rule Thirteen is about clearing away clutter, uprooting obstacles, and bringing blessed order to the roiling chaos of our unfinished thoughts.

When Garvey urges this winsome Strunk—Strunk-the-judicious—my heart melts. But then I wonder: why have so many earnest people studied The Elements of Style and come away convinced that good writing involves squeezing every last drop from the grapefruit and then eating the rind? Do Strunk and his famous student E.B. White bear no responsibility for this heresy? After all, they preached a creed of clarity. Shouldn't their book be clear about its purpose? But if Garvey is right, a lot of readers have gone astray in The Elements of Style. They have imagined it a fundamentalist sect, when it is truly just an older brother's counsel.

With the sort of balance and freedom that Mr. Wood champions, I would recommend The Elements of Style to anyone who has not read it, young and old alike. You could do much worse than to give due consideration to Rule Thirteen, among the many others, but recognize that it is really best viewed as general guidance on how to strengthen writing, not denude it.

http://www.amconmag.com/article/2010/jan/01/00047/

Wednesday, December 23, 2009

Gag Reflex

Associate Press

WASHINGTON - The little town of Libby, Mont., isn't mentioned by name in the Senate's mammoth health care bill, but it's one of the big winners in the legislation, thanks to the influence of Finance Committee Chairman Max Baucus, D-Mont. After pushing for years for help for residents of the area, thousands of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation, Baucus inserted language in a package of last-minute amendments that grants them access to Medicare benefits.

He didn't advertise the change, and it takes a close read of the bill to find it...Here's a look at some other winners in the latest version of the legislation, which was expected to survive an initial test vote in the Senate around 1 a.m. Monday.

WINNERS
  • Nebraska, Louisiana, Vermont and Massachusetts. These states are getting more federal help paying for a proposed Medicaid expansion than other states are. In the case of Nebraskarepresented by Sen. Ben Nelson, who's providing the critical 60th vote for the legislation to pass the federal government is picking up 100 percent of the tab for the expansion, in perpetuity.
  • Beneficiaries of Medicare Advantage plans — the private managed-care plans within Medicare — in Florida. Hundreds of thousands of them will have their benefits grandfathered in thanks to a provision tailored by Sen. Bill Nelson, D-Fla., that also affects a much smaller number of seniors in a few other states.
  • Longshoremen. They were added to the list of workers in high-risk professions who are shielded from the full impact of a proposed new tax on high-value insurance plans.
  • A handful of physician-owned hospitals being built around the country — including one in Bellevue, Neb. — which would be permitted to get referrals from the doctors who own them, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Chalk up another win for Nelson.
--"Who wins, who loses in Senate health bill," Associated Press, as reported on msnbc.com (12.20.09)

I am a supporter of healthcare reform legislation. More, I support universal health care. Most of you know that. And I have been understanding and patient with our federal sausage-making legislative process. I understand that healthcare reform will be an iterative process, probably taking several legislative steps to achieve something inclusive enough, fair enough, and cost accountable. And for the first step we have to be satisfied with some basic healthcare coverage reforms and a significant increase in inclusiveness. Cost containment and reduction will necessarily be addressed in a later step. You've heard this before.

But with such a critical, weighty social policy issue as this, I expected the political maneuvering and negotiating tactics to be based on principled policy differences reflecting the ideological spectrum, and honest differences about the most pragmatic approaches to implementing needed change. I didn't expect open, unabashed pork-barrel exploitation and abuse of position and process from Democrats for whom this legislation is so important as a policy matter and measure of the administration's success--especially with the vote count teetering on the crumbling edge of success or failure. And it was mostly the "pragmatic," moderate Democrats, the swing votes, that most "pragmatically" exploited their position and the situation. I'm just sick.

By 2003, the Iraq War, and considering everything else a polarized and polarizing Bush administration and Republican Party had wrought, I was fully disabused of any lingering sense of identity as a moderate Republican. But yes, I had also undergone some changes in social views and policy orientation on my own. I would thereafter be a registered independent--and I have been. But over recent years, it's been clear that my policy advocacy relates mostly to universal education and health care, and well-regulated commercial (including financial) markets, the financial system, and the warming global environment. Shouldn't I just admit that I am a perfect fit with the Democratic Party, and likely the liberal Democrats at that?

Perhaps. But as I look back over this ugly healthcare legislative process--the progress achieved, and all that remains to be done--please do not allow me to forget for a moment what a bunch of self-interested, power-mongering scumbags our federal legislators are, regardless of political party affiliation. Statesmanship and stewardship of the national interest is now fully captive to the narrow political interest of those who live and work only to be re-elected again. But it has always been so, you say. Yes, but not to this extreme degree, not in matters this important to society.

So please do me a favor. Don't allow me to ever think thoughts about being a registered Democrat or Republican, or anything else. I'm counting on you, really. For now, I necessarily function without clear identity at the margin of organized politics, much as I necessarily function without clear identity at the margin of organized religion. It's how my gag reflex works.

http://www.msnbc.msn.com/id/34502819/ns/politics-health_care_reform/

Friday, December 18, 2009

Residents of Sunshine States Happiest

They never stop reminding you, do they? Those friends and family that live in the South, Southwest and West, they just want to make sure the rest of you bear in mind how much nicer it is living in year-round sunshine. Of course, the rest of you have your reasons for not being there--some would say your rationalizations--for why life is just as good wherever else you are. You're quick to point out that life in those places of wintry snow and cold can be fuller, richer for the distinct seasonal changes and their experiential diversity. You can even be a little smug about it, if not entirely convinced or convincing.

But now I too have to make my confession. We have been spending more of each year in Florida, and less in Rhode Island--and liking Florida more and more. Oh, You still can't beat RI in the summer and early fall. But the rest of the time? I have to be honest, it's Florida the other 7-8 months a year. I'm just saying...

And now comes new research that throws more light onto the whole issue of regions, climate and personal happiness. And guess what? It appears that those sunnier states and regions really are the places where people are happiest. Sorry to carry this news to all my old friends living in the Northeast, but "Sunshine states are the happiest, study shows," An Associated Press article reported on msnbc.com (12.17.09) provides a review of the research and implications:

Associated Press:

WASHINGTON - People in sunny, outdoorsy states — Louisiana, Hawaii, Florida — say they're the happiest Americans, and researchers think they know why.

A new study comparing self-described pleasant feelings with objective measures of good living found these folks generally have reason to feel fine. The places where people are most likely to report happiness also tend to rate high on studies comparing things like climate, crime rates, air quality and schools.

The happiness ratings were based on a survey of 1.3 million people across the country by the Centers for Disease Control and Prevention. It used data collected over four years that included a question asking people how satisfied they are with their lives. Economists Andrew J. Oswald of the University of Warwick in England and Stephen Wu of Hamilton College in Clinton, N.Y., compared the happiness ranking with studies that rated states on a variety of criteria ranging from availability of public land to commuting time to local taxes.

Rounding out the happy five were Tennessee and Arizona. At the other end of the scale, last in happiness — is New York state.

Probably not surprisingly, their report in Friday's edition of the journal Science found the happiest people tend to live in the states that do well in quality-of-life studies. Yet Oswald says "this is the first objective validation of 'happiness' data," which is something he says economists have been reluctant to use in the past.

He said he has been asked if the researchers expected that states like New York and California, which ranked 46th, would do so badly in the happiness ranking. "I am only a little surprised," he said. "Many people think these states would be marvelous places to live in. The problem is that if too many individuals think that way, they move into those states, and the resulting congestion and house prices make it a non-fulfilling prophecy."

Besides being interesting, the state-by-state pattern has scientific value, Oswald explained. "We wanted to study whether people's feelings of satisfaction with their own lives are reliable, that is, whether they match up to reality — of sunshine hours, congestion, air quality, etceteras — in their own state. And they do match."


http://www.msnbc.msn.com/id/34469042/ns/health-behavior/

Thursday, December 17, 2009

How, Why December 25th?

There is no clear understanding or provable basis for how or why the Christian Church came to celebrate the birth of Jesus on December 25th. And it appears no more likely that Jesus was born on December 25th than any other date of the year. Most of us probably know that or have heard it. Still, many Christians and Christian traditions have their preferred understandings and explanations, of course. And that's just fine with me.

A thorough and informative review of the issue and the possible explanations is provided in "How December 25th Became Christmas," by Andrew McGowan in Biblical Archaeology Review (January/February 2010). And he offers an intriguing alternative explanation as well. Some excerpts:

How did December 25 come to be associated with Jesus' birthday? The Bible offers few clues: Celebrations of Jesus' Nativity are not mentioned in the Gospels or Acts; the date is not given, not even the time of year. The biblical reference to shepherds tending their flocks at night when they hear the news of Jesus' birth (Luke 2:8) might suggest the spring lambing season; in the cold month of December, on the other hand, sheep might well have been corralled. Yet most scholars would urge caution about extracting such a precise but incidental detail from a narrative whose focus is theological rather than calendrical....

The extrabiblical evidence from the first and second century is equally spare: There is no mention of birth celebrations in the writings of early Christian writers such as Irenaeus (c. 130–200) or Tertullian (c. 160–225). Origen of Alexandria (c. 165–264) goes so far as to mock Roman celebrations of birth anniversaries, dismissing them as "pagan" practices—a strong indication that Jesus' birth was not marked with similar festivities at that place and time. As far as we can tell, Christmas was not celebrated at all at this point...

In about 400 C.E., Augustine of Hippo mentions a local dissident Christian group, the Donatists, who apparently kept Christmas festivals on December 25, but refused to celebrate the Epiphany on January 6, regarding it as an innovation. Since the Donatist group only emerged during the persecution under Diocletian in 312 C.E. and then remained stubbornly attached to the practices of that moment in time, they seem to represent an older North African Christian tradition.

In the East, January 6 was at first not associated with the magi alone, but with the Christmas story as a whole. So, almost 300 years after Jesus was born, we finally find people observing his birth in midwinter. But how had they settled on the dates December 25 and January 6?

There are two theories today: one extremely popular, the other less often heard outside scholarly circles (though far more ancient).

The most loudly touted theory about the origins of the Christmas date(s) is that it was borrowed from pagan celebrations. The Romans had their mid-winter Saturnalia festival in late December; barbarian peoples of northern and western Europe kept holidays at similar times. To top it off, in 274 C.E., the Roman emperor Aurelian established a feast of the birth of Sol Invictus (the Unconquered Sun), on December 25. Christmas, the argument goes, is really a spin-off from these pagan solar festivals. According to this theory, early Christians deliberately chose these dates to encourage the spread of Christmas and Christianity throughout the Roman world: If Christmas looked like a pagan holiday, more pagans would be open to both the holiday and the God whose birth it celebrated.

Despite its popularity today, this theory of Christmas's origins has its problems. It is not found in any ancient Christian writings, for one thing...

There is another way to account for the origins of Christmas on December 25: Strange as it may seem, the key to dating Jesus' birth may lie in the dating of Jesus' death at Passover. This view was first suggested to the modern world by French scholar Louis Duchesne in the early 20th century and fully developed by American Thomas Talley in more recent years. But they were certainly not the first to note a connection between the traditional date of Jesus' death and his birth.

Around 200 C.E. Tertullian of Carthage reported the calculation that the 14th of Nisan (the day of the crucifixion according to the Gospel of John) in the year Jesus died was equivalent to March 25 in the Roman (solar) calendar. March 25 is, of course, nine months before December 25; it was later recognized as the Feast of the Annunciation—the commemoration of Jesus' conception. Thus, Jesus was believed to have been conceived and crucified on the same day of the year. Exactly nine months later, Jesus was born, on December 25.

This idea appears in an anonymous Christian treatise titled On Solstices and Equinoxes, which appears to come from fourth-century North Africa...Augustine, too, was familiar with this association. In On the Trinity (c. 399–419) he writes: "For he [Jesus] is believed to have been conceived on the 25th of March, upon which day also he suffered; so the womb of the Virgin, in which he was conceived, where no one of mortals was begotten, corresponds to the new grave in which he was buried, wherein was never man laid, neither before him nor since. But he was born, according to tradition, upon December the 25th."...

Connecting Jesus' conception and death in this way will certainly seem odd to modern readers, but it reflects ancient and medieval understandings of the whole of salvation being bound up together...The notion that creation and redemption should occur at the same time of year is also reflected in ancient Jewish tradition, recorded in the Talmud...Thus, the dates of Christmas and Epiphany may well have resulted from Christian theological reflection on such chronologies: Jesus would have been conceived on the same date he died, and born nine months later...

How did December 25 become Christmas? We cannot be entirely sure. Elements of the festival that developed from the fourth century until modern times may well derive from pagan traditions. Yet the actual date might really derive more from Judaism—from Jesus' death at Passover, and from the rabbinic notion that great things might be expected, again and again, at the same time of the year—than from paganism...

But in the end, it matters not at all to my faith, my worship, my indwelt relationship, whether Jesus was born on December 25th or any other date. It matters only that I have a time, that I take the time, to honor that faith and relationship, to offer my special worship to Him in recognition of that special time and special gift. So December 25th serves me perfectly well for every personal and spiritual purpose. And why shouldn't it?

http://www.bib-arch.org/e-features/christmas.asp

Tuesday, December 8, 2009

Facebook: Faux Friendship?

From The Chronicle of Higher Education:

We live at a time when friendship has become both all and nothing at all...As the anthropologist Robert Brain has put it, we're friends with everyone now.

Yet what, in our brave new mediated world, is friendship becoming? The Facebook phenomenon, so sudden and forceful a distortion of social space, needs little elaboration. Having been relegated to our screens, are our friendships now anything more than a form of distraction? When they've shrunk to the size of a wall post, do they retain any content? If we have 768 "friends," in what sense do we have any? Facebook isn't the whole of contemporary friendship, but it sure looks a lot like its future. Yet Facebook—and MySpace, and Twitter, and whatever we're stampeding for next—are just the latest stages of a long attenuation. They've accelerated the fragmentation of consciousness, but they didn't initiate it. They have reified the idea of universal friendship, but they didn't invent it. In retrospect, it seems inevitable that once we decided to become friends with everyone, we would forget how to be friends with anyone. We may pride ourselves today on our aptitude for friendship—friends, after all, are the only people we have left—but it's not clear that we still even know what it means.

---"Faux Friendship," by William Deresiewicz, The Chronicle Review (12.7.09)

And that's just the way it sometimes seems, doesn't it? Of course, there would be many who would take exception and umbrage to the quote above--and more to the opinions, the provocations, in the remainder of the article. Among them would be my daughter and many of her friends, and many of the 50- to 60-somethings who find Facebook a social, emotional Godsend. It's all about connecting and reconnecting for them, which in itself is not such a bad thing.

But for me, the jury is still out, but not by much. I've been on the FB site for about three months, but remain there primarily because of contact or access to only a few old friends who otherwise were not so accessible. I have 13 "friends" on Facebook; those are the only ones I have found there, anyway. And most of them are also on my group e-mail lists and have access to my blog site. Yes, and too often my Facebook page is just a place to post an abbreviated version of my lengthier blog posts to be read by people who have likely already seen them. And for those few others, the Facebook post is often so abbreviated that it loses most of its content and impact. But yes, I also get to passively stay current on some aspects of some people's lives. Some of it can be of interest, sometimes. And, there are also the pictures, the little photo albums that represent them and their lives. I often like the pictures.

Oh, and yes, I am too aware that my open Facebook profile page is also a place for any time-traveling voyeurs out of my past to find that my appearance is still holding up fairly well for a 60-something, thank you very much, and that I have managed enough success in life to avoid landing on public assistance. Vanity. Worse, vanity toward people I hardly know and likely won't have any contact with now or ever. They just want to look through the window, and I am happy to let them do it. I think I could do without that, don't you?

So, for the most part, I am sympathetic to the position and arguments of the author, Mr. Deresiewicz. I think that in large part, for many people, he is right. Most of my friends are not on Facebook--for all the reasons the article cites, I suspect. Those people that are there so often appear just passive observers of the banality of other people's everyday lives, people they are often not really close to and don't really care that much about. Don't read that as an insensitive or misanthropic sentiment. It's just that there are people who really are friends, people we share or have shared our lives with to a meaningful extent, and most others who are not. The rest are passing acquaintances, at best. Let's be real about it.

And more, at my wife's urging, I have more than once buckled up to my computer to chase down some once-close friend I shared life with in the long-ago past--a classmate, a Marine buddy, a mentor, or colleague--only to find that what we once shared was very much in the past, and could not be meaningfully carried forward to today. As I wrote in an essay a few years ago about such experiences, "I still love you and miss you—but in that time, place or cause we once shared together. And I'm still grateful for that time together, what it meant to me then and what it means to me now." But in too many cases, that was then, and this is now.

And then there is the PR aspect of Facebook, the all-but-blatant commercial or professional functions it serves for so many who operate under the guise of just staying in touch with their vast network of "friends." Please. Anyway, the article covers all that and much more.

But don't misunderstand. I am not against Facebook. I'm on it, after all. I recognize that for many people it is a meaningful, important part of their social lives--for some, it may even be indispensible and irreplaceable. For many others, it may provide a healthy complement to active, vital face-to-face friendships. Then, for those real friends separated increasingly by time and distance, it is likely a reasonable and welcome option.

Let's just be clear about what it is and what it isn't. As for me, I live with a palpable sense of unease about phenomena such as Facebook, the aspects of them that promise more than they are, and more, that actually deter you from realizing that promise: real friendship. And so, every couple weeks, it seems, I'm considering anew whether it isn't mostly a waste of my time--and whether I wouldn't be better off just working a little harder to stay in touch with those few other friends through e-mail, my blog, an old-fashioned phone conversation or, better yet--if possible--over a cup of coffee, lunch or dinner. Mr. Deresiewicz makes the point in his own way.

So information replaces experience, as it has throughout our culture. But when I think about my friends, what makes them who they are, and why I love them, it is not the names of their siblings that come to mind, or their fear of spiders. It is their qualities of character. This one's emotional generosity, that one's moral seriousness, the dark humor of a third. Yet even those are just descriptions, and no more specify the individuals uniquely than to say that one has red hair, another is tall. To understand what they really look like, you would have to see a picture. And to understand who they really are, you would have to hear about the things they've done. Character, revealed through action: the two eternal elements of narrative. In order to know people, you have to listen to their stories.

Give the article a fair reading, if you would. If you are on Facebook, you might reconsider from time to time whether it plays a balanced, meaningful role in your relationships with real friends. Obviously, I do. (But, as of today, I'm still there.)

http://chronicle.com/article/Faux-Friendship/49308/?sid=cr&utm_source=cr&utm_medium=en

Sunday, December 6, 2009

Love Is No Game

I first read this on a poster on a friend's wall in Okinawa 41 years ago. It was written by the 20th-century Indian spiritual master Meher Baba, quoting, in part, the 14th-century Sufi poet Hafiz:

True love is no game for the faint-hearted and weak,
It is born of strength and understanding.
[And quoting Hafiz,]
Only a person with his life up his sleeve
Dares kiss the threshold of love.

I was so taken by it--mesmerized, really--that I spent quite some time trying to learn more of both men and their writings. And I have carried those verses with me all these years, unfailingly conscious of them. And as my faith journey carried me home, as I was given over to Christ anew, these words carried no less truth or meaning for me. For whether we are wrestling with the challenges--the joys, frustrations or pain--of love in interpersonal relationships, or the identity-challenging or changing deeper waters of spiritual love--agape love, unitive Love--this wisdom serves us well. And somehow, it seems to offer more as we experience more, as we understand more, as we grow more intimate with Him.

[Posted to Hyde Park's Corner and, in part, to facebook]



Saturday, December 5, 2009

A Right Prayer

Somehow, on a soft, rainy Saturday morning overlooking the lagoon at Vanderbilt Beach, when all is peace and right in this place, this is the right prayer thought for my day; this provides a doorway and a silent medium that nonetheless speaks.

Praying*
by Mary Oliver

It doesn't have to be
the blue iris, it could be
weeds in a vacant lot, or a few
small stones; just
pay attention, then patch

a few words together and don't try
to make them elaborate, this isn't
a contest but the doorway

into thanks, and a silence in which
another voice may speak.

[* from Thirst, Poems by Mary Oliver (2006)]

Saturday, November 28, 2009

Special People, Special Experiences

They are unanticipated. You can't know they're coming. But they are welcome, and often exciting, too. And they always make a difference, sometimes a big difference. They are sometimes events or experiences, but most often people. And you're fortunate if one or two grace your life, blessed if more.

They may offer new things, or make old things new. They can even be bearers of ambiguous or bittersweet experiences, but nonetheless change what was into so much more. They can heal you, grow you, strengthen you, even embolden you; they can make you more whole. They can move you toward who you could be, should be, and assure you in that identity and calling. They can move you to accept new and better invitiation to life. Joy and renewal, grace and peace, are more often yours.

These are the special people that, however unexpected, appear fated to come your way. Not often meant to remain or remain long, they play their special role, and move on to other life invitiations. In this time between the seasons of thanksgiving and advent, I am finding time for warm reflection and gratitude for the gifts of these special people and experiences that have passed my way, gifts only God and life could give. Perhaps you have some too.

Greg


Sunday, November 22, 2009

A Season of Thanksgiving

It's a season of thanksgiving. And I have a lot to be thankful for. Ginny is feeling her best in 15 months, full of energy and back at her classes and pastimes, thanks to her heart procedure. There's Adam and Nilofer in Spokane, Laura in Portland, all engaging life, their personal and professional joys and challenges.There's Naples and RI, and peace of place. There's existential and spiritual identity, and peace in both. There's quiet time, and seeing and hearing God in more ways, more places, more people. There's direction and peace there, too. There's reading, reflecting and writing. There are old friends, new friends, and friendships renewed. God and life are good when we are grateful.

Blessings to all, Greg

Wednesday, November 18, 2009

Reducing $Billions in Healthcare Waste: Sounds Easy. Not.


A Thompson Reuters Study:

Proposed reforms could be paid for by fixing inefficiencies, report claims

WASHINGTON - The U.S. health care system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday. The U.S. health care system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of health care analytics at Thomson Reuters, found.

"America's health care system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads. "The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's health care bill," Kelley said in a statement....

One example — a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending. "It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.

Some other findings in the report from Thomson Reuters, the parent company of Reuters:

  • Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of health care waste or $200 to $300 billion a year.
  • Fraud makes up 22 percent of health care waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
  • Administrative inefficiency and redundant paperwork account for 18 percent of health care waste.
  • Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.
  • Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers...

--Reuters, msnbc.com (10.26.09)

They may appear as low-hanging opportunities ready for the picking. But they are not. If they were that easy to address, they'd have been remedied a long time ago. There are entrenched financial interests and structural barriers that protect them. Each will be as much a political battle as any other healthcare policy or significant administrative change. And so, while these opportunities are well known and an adjunct part of the healthcare reform dialogue, initiatives to address them are not part of any healthcare legislation. First things first is the reality. It is proving difficult enough to pass any kind of healthcare reform, however desperately needed and however short of meeting the actual need. Further wrangling and wrestling over necessary, related healthcare cost reduction measures will have to wait for another day--or else nothing at all will be passed. For all have finally learned: this is an incremental process, and if it is to achieve anything, it must proceed one digestible, workable step at a time.

Some friends and others concerned about the stand-alone financial integrity of healthcare reform legislation argue that any cost reduction possibilities to be later addressed should not be counted as savings related to the reform legislation--now or then. I understand the arguments, the logic. Whatever healthcare plan that is passed cannot now deal directly with solving these problems, and so any benefit from separate efforts to solve them should not be counted to reduce the net cost of a new healthcare plan. After all, if we had only taken the initiative, we could have addressed some of those problems and achieved the cost savings earlier. But, then, might not the cost of today's healthcare bill be considerably less in some areas? Many of the issues are directly or indirectly related.

Regardless, the adjunct discussion of these opportunities, the evolving understandings of the absolute need to reduce these costs, will provide the impetus and incentive to next address these problems and opportunities in a way that did not exist before. Surely that much is true, isn't it? And I don't personally care how they format the benefits of the sum total of expenses and savings associated with healthcare or healthcare reform--that associated directly with the legislation, or that which follows indirectly but necessarily from it. The bottom line effectiveness and efficiency for the whole healthcare system is all that really matters, isn't it?

When new healthcare reform legislation is passed--whatever is passed--cost containment and reduction efforts will surely move to the front burner, won't it? Won't it be on the minds of healthcare providers, and federal and state governments alike--and the likely subject of future regulatory or legislative initiatives? Budget-conscious Republicans, Blue Dog Democrats, even progressive Democrats, will have to find common cause in the effort to rationalize the newly reformed health care system so that it is socially and financially accountable, and operationally efficient by standards of international best practices. It will happen. It will have to. But as already conceded, it will take time and will not be easy.

Walk through each of the identified problems or opportunities in the article excerpt, above. Take out a piece of paper, and next to each item list parties with important financial, ideological or political interest, and how critical it is to their continuing financial viability or power to maintain the status quo. List the structural, organizational and political barriers (including those representing the financial interests), legal and regulatory barriers, capital cost barriers, management and resistance-to-change barriers (regardless of the benefit to be achieved). Then, list the steps that would have to be taken to overcome them. It's all very daunting and tiring, and without a strong popular mandate, legislative will and initiative, and the leadership of the executive branch--the President--it's all a twisted, rocky road over a steep hill.

But it can be done, and it likely will be--at least to some extent. All responsible observers agree that it must be. And examples of many such successes already exist on a smaller scale at one hospital or another, in one medical system or another, somewhere. Take the challenge of a common computer system with all healthcare records. Many hospital systems already have that. The blueprint is there, and the savings are large. It should be a "no-brainer."

But then there is the indefensible, ethically inexplicable genuflecting of the Democrats before the American Trial Lawyers Association. The failure of tort reform in this country constitutes unwarranted support and subsidization of a shameless level of plaintiff's counsel compensation through unlimited contingent fees in medical malpractice suits. It raises to daunting levels the cost of medical malpractice insurance, and is a proven incentive for doctors, hospitals and other healthcare providers to maximize testing and procedures--often unnecessarily--to avoid any possible argument of negligence. The cost to the practice of medicine, as noted in the article above, has been far too great to justify. Reasonable, legal limitations on jury awards, and legally protected standards of medical practice have to be legislated and regulated. Why won't the Democrats--even at a time when cost containment is so critical to their legislative agenda--fail to do what is right and necessary? And what of President Obama? He, most of all, was supposed to be above such things. I'm an Obama fan, as most of you know, but he's been a disappointment on this issue.

So many of these cost-saving initiatives are financially necessary and ethically important to an effective, efficient healthcare system. Regrettably, as easy as they are to articulate and agree with, they nevertheless remain difficult to hold for long in the cleansing sunlight of social, financial and political accountability. But while a season of accountability and reform is still upon us, our public support must remain high and demanding. The government's political will must be buttressed, held firm, and energized by the strong, determination of healthcare consumers--we, the American people, all of us.

http://www.msnbc.msn.com/id/33480141/ns/health-health_care/

Monday, November 16, 2009

Uninsured ER Patients Twice as Likely to Die

Associate Press
CHICAGO - Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study. The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.

"This is another drop in a sea of evidence that the uninsured fare much worse in their health in the United States," said senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist....

The findings are based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals. "We have to take the findings very seriously," said lead author Dr. Heather Rosen, a surgery resident at Los Angeles County Hospital, who found similar results when she analyzed children's trauma data for an earlier study. "This affects every person, of every age, of every race."

--© 2009 The Associated Press, on msnbc.com (11.16.09)

Why should we be surprised? When healthcare and healthcare insurance are treated as a commodities mediated by commercial markets, you get what you pay for. And if you can't afford to pay, and your life rests in the balance, then you cannot be surprised if your life is forfeit when someone else with healthcare insurance will likely survive. Isn't it well past the time to join most civilized societies in defining healthcare as a civil right, a human right? But the answer's still no, isn't it?

http://www.msnbc.msn.com/id/33971846/ns/health-health_care/

Tuesday, November 10, 2009

November 10th. Semper Fi.

November 10th. Marine Corps Birthday. Oogh-ragh! Happy Birthday to all the Marines who have served through the years, the wars and conflicts of times past. And especially to all our younger brothers serving today in impossibly ambiguous and disheartening situations--but serving so well. Semper Fi.

Greg Hudson

Friday, October 23, 2009

Two Views, Two Realities: Rebirth or Failure of Small Town USA?

Thriving neighborhood restaurants are one small data point in a larger trend I call the new localism. The basic premise: the longer people stay in their homes and communities, the more they identify with those places, and the greater their commitment to helping local businesses and institutions thrive, even in a downturn. Several factors are driving this process, including an aging population, suburbanization, the Internet, and an increased focus on family life. And even as the recession has begun to yield to recovery, our commitment to our local roots is only going to grow more profound. Evident before the recession, the new localism will shape how we live and work in the coming decades, and may even influence the course of our future politics.

Perhaps nothing will be as surprising about 21st-century America as its settledness. For more than a generation Americans have believed that "spatial mobility" would increase, and, as it did, feed an inexorable trend toward rootlessness and anomie. This vision of social disintegration was perhaps best epitomized in Vance Packard's 1972 bestseller A Nation of Strangers, with its vision of America becoming "a society coming apart at the seams." In 2000, Harvard's Robert Putnam made a similar point, albeit less hyperbolically, in Bowling Alone, in which he wrote about the "civic malaise" he saw gripping the country. In Putnam's view, society was being undermined, largely due to suburbanization and what he called "the growth of mobility."

Yet in reality Americans actually are becoming less nomadic. As recently as the 1970s as many as one in five people moved annually; by 2006, long before the current recession took hold, that number was 14 percent, the lowest rate since the census starting following movement in 1940. Since then tougher times have accelerated these trends, in large part because opportunities to sell houses and find new employment have dried up. In 2008, the total number of people changing residences was less than those who did so in 1962, when the country had 120 million fewer people. The stay-at-home trend appears particularly strong among aging boomers, who are largely eschewing Sunbelt retirement condos to stay tethered to their suburban homes—close to family, friends, clubs, churches, and familiar surroundings...

---"There's No Place Like Home," by Joel Kotkin, Newsweek (10.19.09)

I guess it all depends on the scope or limits of the topic addressed, through whose eyes the viewing is done, through whose experience what is seen is assessed, and on what supporting data the assessment finds affirmation. Joel Kotkin has captured an attractive, evolving piece of reality for the more economically vital and vibrant suburbs and nearby small towns. For many, it is a welcome observation, a preferred picture of extended and expanded family and social life, and a more stable professional experience. A better, fuller, more socially holistic life can be yours.

The only problem is that it fails to address the very different, more desperate and deteriorating reality in the many small towns in more rural settings. Sociologists Patrick J. Carr (Rutgers University at New Brunswick) and Maria J. Kefalas (Saint Joseph's University, Philadelphia) take us there. They are associate members of the MacArthur Foundation's Network on Transitions to Adulthood and authors of Hollowing Out the Middle: The Rural Brain Drain and What It Means for America, to be published in Norvember by Beacon Press.

The most dramatic evidence of the rural meltdown has been the hollowing out—that is, losing the most talented young people at precisely the same time that changes in farming and industry have transformed the landscape for those who stay. This so-called rural "brain drain" isn't a new phenomenon, but by the 21st century the shortage of young people has reached a tipping point, and its consequences are more severe now than ever before. Simply put, many small towns are mere years away from extinction, while others limp along in a weakened and disabled state.

In just over two decades, more than 700 rural counties, from the Plains to the Texas Panhandle through to Appalachia, lost 10 percent or more of their population. Nationally, there are more deaths than births in one of two rural counties. Though the hollowing-out process feeds off the recession, the problem predates, and indeed, presaged many of the nation's current economic woes. But despite the seriousness of the hollowing-out process, we believe that, with a plan and a vision, many small towns can play a key role in the nation's recovery.

Civic and business leaders in the places most affected by hollowing out will tell anyone willing to listen how it is their young people, not hogs, steel, beef, corn, or soybeans, that have become their most valuable export commodity. Richard Russo, the Pulitzer Prize-winning observer of small town life, believes that any story of small-town America is, at its core, the story of the people who stay and the ones who go. Yet, what is different at this moment is how, in a postindustrial economy that places such a high premium on education and credentials, the flight of so many young people is transforming rural communities throughout the nation into impoverished ghost towns. A new birth simply cannot replace the loss that results every time a college-educated twentysomething on the verge of becoming a worker, taxpayer, homeowner, or parent leaves. And as more manufacturing jobs disappear every day, the rural crisis that was a slow-acting wasting disease over the past two decades has evolved into a metastasized cancer.

--"The Rural Brain Drain," by Patrick Carr & Maria Kefalas, The Chronicle of Higher Education (10.22.09)

This is a different small town America, a different experience and a different view, and it is supported by a different set of data. Carr and Kefalas have captured a much less attractive, evolving piece of reality for more economically challenged and deteriorating rural small towns. For many, it is an unwelcome and dispiriting observation, a troubling, helpless picture of the flight of the most talented young people, and for those who stay, a more unstable employment experience tied closely to the slow failure of the agricultural economy. And the stability and breadth of family and social life has predictably weakened. Not an attractive picture, whatever the definitions you work with. And the solutions offered by the authors to address the issues appear almost pollyannaish in their suggestion that they can be effected timely enough, expansively enough, and successfully enough to stem this tide of change, this evolution of larger economic and demographic realities.

Thursday, October 1, 2009

America's Flagging National Pride

[From Economist.com:]

JUST as some people have a better self-image than others, so it seems do countries. In a poll of 33 nations by the Reputation Institute, a branding consultancy, people were asked to rate their trust, admiration, respect and pride in their country. The results are presented as an index. By this measure, Australians are almost as exuberant about their country as they are about sport, and lead the list. They are followed closely by Canadians. Americans, normally a patriotic and positive bunch, are perhaps being affected by the recession. The limited self-regard of Brazilians belies their reputation as a sunny, carefree people, but the Japanese are gloomiest of all.

--"Who admires their country the most?" the Economist.com (9.29.09)


Yes, if you click on the link above or below, you'll see the sobering news that America's self image is flagging, lost in the middle of those many countries with a tepid, tentative assessment of their national identity. But, perhaps it's more than the recession. It is possible this is a clear sign of the conflicted, sometimes polarized cultural and political condition of the American public. Almost everyone I know is concerned--or deeply concerned--about some quality of what American is, is becoming, or no longer is. We, as a nation, as a cultural and political collective, are handling national and global cultural, economic and political change poorly, at best.

Of course, to one extent or another, that is the way it has always been with human nature and changes in culture, economics, and the global order--yes, in America, too. The only difference is that we are now the closest thing there is to the leader of the world's market-driven democracies. And even if that global order is unavoidably, necessarily changing toward a broader, shared leadership role for the US, it will make the transition better, healthier for all if our polarized and polarizing political leaders can manage to be more honest with each other and us, and just more constructive about it all--that is, if they will wisely lead. Then the American public can make the necessary adjustments, find our common identity and interest again--and again see ourselves as the great country we all know we should be.

http://www.economist.com/daily/news/displaystory.cfm?story_id=14536817&fsrc=nwl

Saturday, September 26, 2009

Is The Internet Melting Our Brains?

[From an interview on salon.com]

Sept. 19, 2009 By now the arguments are familiar: Facebook is ruining our social relationships; Google is making us dumber; texting is destroying the English language as we know it. We're facing a crisis, one that could very well corrode the way humans have communicated since we first evolved from apes. What we need, so say these proud Luddites, is to turn our backs on technology and embrace not the keyboard, but the pencil.

Such sentiments, in the opinion of Dennis Baron, are nostalgic, uninformed hogwash. A professor of English and linguistics at the University of Illinois at Urbana-Champaign, Baron seeks to provide the historical context that is often missing from debates about the way technology is transforming our lives in his new book, "A Better Pencil." His thesis is clear: Every communication advancement throughout human history, from the pencil to the typewriter to writing itself, has been met with fear, skepticism and a longing for the medium that's been displaced. Far from heralding in a "2001: Space Odyssey" dystopia, Baron believes that social networking sites, blogs and the Internet are actually making us better writers and improving our ability to reach out to our fellow man. "A Better Pencil" is both a defense of the digital revolution and a keen examination of how technology both improves and complicates our lives.

Recently, Salon spoke with Baron by phone about emoticons, the way Facebook and MySpace make us better friends and a not-too-distant future when everyone is a writer.

---"Is the Internet melting our brains?" a review and Q&A with Dennis Baron, English professor and author of A Better Pencil, on Salon.com.


That's right, relax those sphincters and embrace the ever-accelerating pace of change in concepts of communications and community. But, you might well ask, why should I feel good about these continual, persistent disruptions and changes in information flows and relationships in my life? Others did not in earlier generations of change, right? They often objected to it and rejected it, too. Some even lived without it just fine, thank you very much.

Well, one reason might be that it continues to evolve so fast, changing everything--communications, relationships, community--with such exacting technological dictates. You're either on-board or excluded. And no, says the author, it's not going to be the downfall of the English language and all that is good. As is always the case, it's just going to be different--and likely better. How could that be? Click on the link below and enjoy the interesting Q&A with Mr. Baron.

http://www.salon.com/books/int/2009/09/19/better_pencil/index.html

Wednesday, September 23, 2009

Where Are We Headed? Conway Morris Reviews Wrights "Nonzero"

Cambridge Prof. Simon Conway Morris (Life's Solution: Inevitable Humans in a Lonely Universe) reviews Robert Wright's Nonzero in the New York Times in 2000. A most interesting, challenging review, not least because I am a fan of both authors and both books--and notwithstanding their differing comfort levels with extending their shared views on the inevitabilities of biological and cultural evolution beyond temporal questions of "direction" and "purpose" to the metaphysical. For those of you who are reading or have read these authors' books, this book review should be particularly interesting. (Click on the link below.)

http://www.nytimes.com/books/00/01/30/reviews/000130.30conwayt.html

Tuesday, September 22, 2009

Green Metropolis: New York City?

[From the Christian Science Monitor:]

David Owen, a staff writer for The New Yorker whose interests include global ecology, has examined numerous communities across America and discovered one that strikes him as a model of environmental efficiency. That community is New York City, and in Green Metropolis, his latest book, Owen tells readers what green-conscious citizens can learn from Gotham's example.

Owen realizes, of course, that the Big Apple isn't the first place that comes to mind when most people think of reducing their carbon footprint. Noisy, crowded, and covered largely by concrete, New York seems instead to be the very antithesis of environmental stewardship.


Anticipating his critics, Owen concedes that when calculated by the square foot, "New York City generates more greenhouse gases, uses more energy, and produces more solid waste than any other American region of comparable size."

But plot those same negative effects by resident or household, says Owen, and Manhattan gets the blue ribbon from Mother Nature.

"New Yorkers, individually, drive, pollute, consume, and throw away much less than do the average residents of the surrounding suburbs, exurbs, small towns, and farms, because the tightly circumscribed space in which they live creates efficiencies and reduces the possibilities for reckless consumption," Owen writes.

Because car ownership in Manhattan is so inconvenient, New Yorkers often use public transit or walk, which conserves gasoline and promotes good health. "The average Manhattanite consumes gasoline at a rate that the country as a whole hasn't matched since the mid-1920s, when the most widely owned car in the United States was the Ford Model T," Owen tells readers.

New York has achieved its efficiencies because people live closely together – the principle of urban density so loudly touted by champions of the modern "smart growth" movement. If New York City's 8 million residents lived in the same density as the quaint Connecticut community that Owen calls home, they'd "require a space equivalent to the land area of the six New England states plus Delaware and New Jersey," he notes as a caution against the dangers of suburban sprawl.

New York's low per-capita energy use and its embrace of public transit and walking are practices that "the rest of us, no matter where we live, are going to have to find ways to emulate, as the world's various ongoing energy and environmental crises deepen and spread in the years ahead," Owen adds...

--A book review of Green Metropolis by Danny Heitman in the Christian Science Monitor.

So, who'd have thought NYC, by any reasonable definition, could be considered the greenest metropolis and a model for more responsible, greener living even by those living outside cities. Of course, the densely populated, constrained lifestyle he describes may paint less than a utopian image for many of us, something far less than the idylllic lifestyles we enjoy or aspire to. It may nonetheless paint a reasonably fair picture of the lifestyle that awaits us if we don't address more effectively the environmental challenges growing worse day by day. I haven't read the book, but the review provides a provocative outline and can be read in its entirety by clicking on the link above or below.

http://features.csmonitor.com/books/2009/09/16/green-metropolis/

Tuesday, September 1, 2009

The Late, Great Post Office? Implications for Health Care Reform?

The Late, Great Post Office

I'm paying more attention to what we find in our mailbox. And also what we mail out. I'm thinking about it a lot, too. I have good friend, Denny, to thank for that.

What's coming in? Junk-mail advertising, lots of it--and magazines, too, lots of them. We also get a lot of packages, mostly stuff we order on-line (although they are delivered by UPS or FedEx as often as the US Postal Service). Letters? Only rarely. In fact, I can't remember the last time we received a real letter, unless you consider letter-size bills to be letters. We get lots of bills. But if you're confusing the messages of billing notices with personal letters, you've got bigger problems than the postal service.

We also receive the occasional wedding or graduation announcement--and seasonal cards sent in recognition of religious or other holidays, especially Christmas cards. We get lots of Christmas cards, too.

What do we mail out? Not much, other than payment of a few bills and occasional, seasonal packages or returns. Oh, and Christmas cards. We send a lot of them, too. No letters. We use e-mail for that kind of thing. And the few bill payments mailed are for one-off or infrequent vendors. The rest are all paid through e-banking on the computer. Quick, easy, reliable.

But that's it. Mail isn't what it used to be when I was young, or even 15-20 years ago--before e-mail and competitive overnight package delivery, before inundating commercial junk mail and political advertising.

And the US Postal service isn't what it used to be either. Or, from what I've just shared, it's evident that they don't really do what they used to do, or at least as much of it. The mix of services is different. But what they do, it appears to me, they do pretty well. You know, in terms of friendly service, efficiency of work flow, on-time delivery, and mail delivered undamaged, that kind of thing. Pretty good, I'd say. Oh, and self-service mailing stations. Great idea. But if that's so, why are they losing so much money?

All this started in a conversation with Denny over dinner--my mailbox research and thinking about it, that is. We were talking about universal access to health care and the so-called "public option" for those who don't now have health insurance provided or can't afford it. I suggested the unthinkable. I suggested that we might derive some assurance and confidence about the government's potential for competent management in the effectiveness and efficiency of the USPS. (What was I thinking? Doesn't everyone use the postal service as a whipping boy for government inefficiency, even if I really can't figure out why?)

But Denny tried hard not to overreact, to treat the proposition--or at least the spokesman--with patience and respect. There was some loss of color in his face and a slight twitch to his widened eyes, but it passed instantaneously. He listened patiently, then said rather matter-of-factly, "They're losing millions." I said, "Really? Well that's not all that much for such a large enterprise in bad economic times." Nonplussed, he then added, "No, no, Greg. They're losing a lot of money. Maybe hundreds of millions. A lot. Really." "Oh," I said, "I guess I somehow missed that." "Yeah," he said, "so many people now use e-mail rather than write letters, and the recession is really hurting them, too." (But as patient and kind as he was with my blindness to the obvious structural changes in the postal service market, it seemed likely from the tilt of his head, the movement of his eyes in the side-long glance, that he hadn't fully bought onto my views of a competent post office and delivery service, either.)

How could I have missed this? For someone who tries to read everything credible about public issues, social, economic, and government issues, how could I have been so blind and deaf to this one? I'd just been looking past it, I guess.

Denny was right about the basic financial situation and the facts, but even he underestimated the size of the financial losses. And I think he and most everyone else may have underestimated the implications of these structural changes. I now think it is the beginning of the end of the US Postal Service as we have known it. It might even be the end of the US Postal Service, period, except as a regulatory oversight function. How's that for provocative?

First of all, this year revenues have tanked by 10%, and losses have moved into the $ billions, $1.9 billion in the 2nd quarter of 2009 alone. A US Postal Service news release (5.06.09):

WASHINGTON The U.S. Postal Service ended its second quarter (Jan 1 – March 31) with a net loss of $1.9 billion, as the economic recession and longer-term financial pressures, such as the diversion of letter mail to electronic alternatives, continued to reduce mail volume and revenue. Despite aggressive actions to reduce costs and grow revenue, the Postal Service will likely face a cash shortfall of over $1.5 billion at the end of the fiscal year.

The Postal Service has incurred net losses from operations in 10 of the last 11 fiscal quarters. The year-to-date net loss is $2.3 billion, compared to a loss in the same period last year of $35 million. A significant portion of the losses over this period can be attributed to an unprecedented decline in mail volume. In the second quarter, mail volume totaled 43.8 billion pieces, down 7.5 billion pieces, or 14.7 percent, compared to a year ago.

The second-quarter results include operating revenue of $16.9 billion, a decrease of nearly $2 billion, or 10.5 percent, from the same period last year, and operating expenses of $18.8 billion, a reduction of $782 million, or 4.0 percent, from the second quarter of last year. Complete second-quarter results are contained in the Postal Service Form 10-Q report, available later today at usps.com/financials (click Form 10-Q under Quarter Reports) and also attached at the end of this release.

"The economic recession has been tough on the mailing industry, and we have seen an unprecedented decline in mail volumes and revenue that continued to accelerate during the second quarter," said Postmaster General John Potter during today's Board of Governors meeting. "We are aggressively realigning our costs to match the lower mail volumes, while also maintaining the high level of service and reliability our customers expect. We are also taking a number of steps to grow revenue."

So, how could I assume that market size or share was not an issue? Just not paying attention. The market for handling letters is drying up. More vendors are now also sending more bills on-line and having them automatically paid through e-banking. That market is shrinking. And they have very effective competitors in the package delivery market, even if the Postal Service performs well as a competitor in that market themselves. Market share is also a big issue there, even if their pricing is competitive.

The result? The US Postal Service has a huge over-capacity problem. It now has far more infrastructure--property, buildings, vehicles and, yes, employees--than is economically justified. The fixed-cost structure is way out of line with the demand for service and anything like reasonable, competitive pricing possibilities. Earlier this year, the USPS announced it was considering closing hundreds of offices. And only in the last month, it announced a program offering $15,000 to any post office employees willing to quit their jobs or retire early. It has begun--but it is just the beginning. For it appears evident to me that this structural change in the postal service market is also just beginning. Here's what it looks like to me:

Almost everything they do--all their services--will necessarily go on-line for just about everyone and every business. The only exception, of course, is the package delivery market, and that will be very well serviced by private competitors. The USPS can see the handwriting on the wall as they watch the hand-wringing, painful experience of newspapers and magazines as they wrestle with the flight to the internet of most all print media in pursuit of today's and tomorrow's interested readers. The Postal Service could be out of business in a decade, two at most. Let's talk more details and process.

First of all, more advertising will continue to move on-line. That's where more and more of their customers are seeking product and service information, and doing their shopping. And not just younger folks. Excepting the very old, all age groups have moved in that direction. Soon magazines will move toward sales of their on-line product. They'll have to. That's where the younger generations of readers go for news, newspapers and magazines now. Yes, in part that's because it's now free, but also because that is the most convenient, efficient way for them to access all information. It's their comfort zone. It's what they know. (And yes, both magazines and newspapers will move toward charging appropriately for their product; they'll have to do that, too.) I'm already there; that's what I do now, and I'm in my 60's. More of us "late middle aged" folks are also finding comfort and efficiency in getting our news and articles that way. That trend will only increase.

As those markets dry up for the Postal Service, as economies of scale for postal services continue to shrink, the cost and pricing of their service will necessarily increase on a unit pricing basis. And with the cost of letter mail, bills, and bulk mail advertising increasing, and the cost of internet alternatives becoming cheaper and more effective, it will just hasten the final decline and submission of the remaining customers of the Postal Service. Even those who may prefer to remain with the Postal Service will be forced to move by the relative cost to value received.

But what of the poor and technologically illiterate? They may be unavoidably deterred from participating in this move to the internet. And do remember that the US Postal Service is provided for in the US Constitution. Although it has been independent for some time, it is really more quasi-independent in that it is constitutionally under the oversight of the federal government--and under ambiguous constitutional language has always been treated as a monopoly, at least with respect to first-class mail. So what does that mean in this changing context? Does the federal government have to provide letter carrying for whomever may continue to want it, regardless of the number of people or businesses, or how much an uneconomic operation like that would cost?

I don't know the answer to that question, but at some point it becomes a ridiculously untenable approach to the problem. And I think it becomes a moot question if the government could, at that point, just drive a stake into the heart of the suffering beast. Wouldn't the better answer be for the government to allocate money to provide a simple, user-friendly computer with big keys to all who can't afford one or fear them--a computer with a simple e-mail program, an e-banking set-up, and internet access? How long could it be before they could be provided at a cost not more than $100-200? There could be simple instruction provided on how to use the three functions, augmented by a user-friendly program on the computer that takes you through each program one big-print-and-picture step at a time. There could even be a free technical call-in number. And for the indigent, free, cheap dial-up ISP service. All that would still be a lot cheaper that keeping open a USPS letter carrying function for a small percentage of people.

The only other function that the government would have to assume--and I think it is a necessity and their responsibility, regardless--is regulation and oversight of internet communications: e-mail, commercial or financial transactions, web and blog sites, everything. Who knows, the Supreme Court may even find an implied or constructive Constitutional requirement for the government to oversee the "mail," whether it's the pony express, post office letter carriers, or e-mail on the internet.

Alright, okay. I know all this is not going to happen tomorrow--or next year. And who needs yet another sea change in government service and cultural expectations right now? But it is coming. Sometime in the foreseeable future, some process like this is going to be coming at us. It's not a matter of choice. It's just the irreversible unfolding of internet technology and the unavoidable movement of all communications to it. So we may as well be thinking about it, right?

Implications for Health Care Reform?

Yes, I think there are implications of our Postal Service experience for health care reform--but there are also implications of our experience with public education, the military (and medical services for the military and veterans), health insurance for federal government workers, Medicare and Medicaid. A broader look at these various government services can help us make sense of and guide our thinking on this complicated public issue.

But my conclusions may not be what you think. As always, it's about larger questions of public needs and values, how to distinguish one public need from another, and how to most effectively deal with it in the context of our social, government, and market structures. It's all about the reasons why. So please, bear with me as we take a walk from here to there.

The founding fathers saw such critical public importance in the availability and reliability of the post--mail delivery service at a reasonable price, and universal access to it--that they provided for it in the U.S. Constitution. They were so concerned about this service that they provided for a government monopoly of letter carrying, at least that's how the US Supreme has interpreted the language. Some things are that important to the proper functioning of society, commerce and government. But times change, as we've discussed, and so does what's most important to the public and national interest.

At the founding of the Republic, public education wasn't yet broadly viewed as basic and critical to the good functioning of the country. Or more practically, there were higher priorities. Their attention was focused on the essential matters of government, political process, national defense--standing armed forces--and commerce. All those things required unfettered, unobstructed public communications--a public postal function--but not necessarily public education, not yet. Public education--such as it was--was the province of local townships. Some did it betterthan others; some did it poorly, or not at all. Anything resembling serious elementary or higher education was the province of religious schools and private schools serving the wealthy. Serious education was mediated by the marketplace. And it was dispensed very unevenly based on availability, price and the requisite wealth.

It would be some years before it became broadly evident to American government and political leaders that universal education was in everyone's best interest. It was a need, and should be a right. And over the next 100 or so years, it would become increasingly clear that an educated person was a better prepared and contributing citizen, worker, artisan, or professional of higher potential and accomplishment, a better taxpayer. At least a basic education was essential to the better functioning of the country, to society, commerce and government. And the more educated the population, the more benefit and value that accrued to the country.

Today most everyone takes universal education and its essential value for granted. No reasonably person doubts that--not in the US, not today. In fact, we wring our hands in genuine concern over the challenges of providing better education in many inner city and rural areas. Why? Again, better citizenship, stronger families, better jobs, more productivity, fewer criminals, and more taxes paid. These are the well-researched and understood consequences of delivering better education to those who now lack it most. It is viewed by most as a right of citizenship, but it is more than that. It is a responsibility, an obligation, of responsible, accountable government to a nation that aspires to continually reach higher and be more, individually and collectively. And as a society, we've come to understand that universal education, constantly improving education, and more of it for each and every person is essential to reaching that national ideal.

There is still a private market for higher education, and access is based largely on wealth and merit. People who prefer independent K-12 schools or private colleges are free to pursue the most expensive education that the market offers--and it is very expensive. But America's experience with public education remains the foundation of America's success, and its support and value of an educated public. And state-subsidized colleges and universities remain the sine qua non, the pumping heart of America's social, technological, and commercial advancement over the last century.

But America hasn't yet found a consensus about health care as a public necessity--or rather, as an essential public responsibility and service--even if the rest of the advanced world has. For the most part, we have been satisfied to allow it to be mediated by the private market place--excepting, of course, medical care for the military and veterans, government employee medical insurance, Medicare and Medicaid. (And these are important and successful "exceptions" we so willingly ignore or refuse to acknowledge in our public discussions.)

So, I'd like to take a longer look at the issues of the private health care market, and the case for universal access to public health care--or more accurately, to public health insurance or a "public option." But first, a few very important questions: What does the market do best? What products and services are best left to mediation by market mechanisms, producers, providers and pricing? And more important, what kinds of products and services, and demand for them, are poorly served by the functioning and characteristics of markets? Then, what might we have learned from our experience with letter carrying, the US Post Service, and public education?

First, in general, we know that free enterprise and free markets, wisely regulated, are the most creative and productive forces advancing the endeavors of man. By definition, through natural incentives, they seek to understand what people need and want, produce it and provide it to them. They do it to make a profit, to make money--and as much of it as possible. Money is the universal reinforcer; power and privilege, as well as ownership, inhere in it. They can provide products and services at the best level of quality and the lowest price--but only if they must, only if the markets are regulated to keep competition open and free, and to protect the public consumers' interests, welfare and health.

Under those conditions, producers and providers will continually compete to produce better products cheaper. And they understand market differentiation; they know there are many different sub-markets or quality levels and "price points" for the same products and services. There are many levels of income ranging from poverty to wealth, and many standards of taste ranging from the most utilitarian and mundane to the most sophisticated and attractive. It's all about what you can afford. When the market mediates, those of wealth get the best of everything; those with more middle incomes get the basics, for sure, and some of what they want and a few luxuries, too; the poor and those with marginal incomes struggle to provide for basic needs, sometimes failing.

Markets are very poor mediators of products or services that, as a matter of public policy, every citizen needs equal access to. They can't do it. Markets do not provide equal access to anything. They do not provide equal price, quality or service. You only get what you can pay for--no matter how much you need it and regardless of the reason.

Generally, there are only two ways for a government to provide equal access to public goods and services: either (1) the government provides them directly, e.g., the US Postal Service, military defense and related medical services, and public education, or (2) the government provides the poor and low income families with public assistance payments that allow them to buy products and services in the private market place, e.g., "welfare" payments to the poor. A third alternative could be government payments or subsidies to private market providers on sales to the poor or low-income, but that is just a variation on a public insurance program, isn't it?

An example. Equal access to effective k-12 education at an affordable price for all is not something the private marketplace will or can provide. It doesn't work that way. It takes a dominating public education system to provide reasonably high quality service of that type to all citizens. It is just the nature and needs of a universal public service, and the very different nature and functioning of markets.

Another. Military defense forces and related health care services provide an important example of necessary and effective government-provided services. They are effective, but also expensive. But no one is suggesting there should be a competitive market for our national defense services (other than the production of military weapons, equipment and supplies). Moreover, no one is suggesting that the military medical services organization does not provide full and competent service. The government is also capable of doing that quite well. Yes, they already provide a direct health care service program and do it well.

In the case of the US Postal Service, we see a very different type of service that is transitioning to a new medium. It is morphing right in front of our eyes. It is now more a utilitarian service that new and advancing technology will allow most all people to access in the private market place at a very modest price--requiring only modest government cost to supply and help the poor and technologically challenged. That is, there is no longer a public need to treat it as a government provided service, except for "welfare-like" support for low-income people.

So, where do the considerations and challenges of universal access to health care fall in all of this? Well, lets ask the questions. Does it arise to that level of public necessity and priority that it should be treated as a public service? For many, if not most people, the answer is clearly, yes. Most all the things said about public education can be said about health care. People need it to advance to meet their potential for education, valuable service and productivity, to be contributing citizens and taxpayers. Abraham Maslow's "hierarchy of needs" would suggest we cannot get to that place unless basic health care is as much a right of all as it is a need of all. Only then might poor children also be healthy children, and in their best state of readiness to learn. Only then might poor children be likely to grow up to be healthy, well-educated and productive citizens. And last I heard, there are now nearly 50 million Americans without access to basic health care. And the number is growing.

Of course, I have been avoiding the humanitarian issue, the moral issue. But that's because, distressingly, it carries so little weight and commands so little attention in the discussion. The Scriptures of my Christian faith place a very high priority on serving and healing the poor. Second only to love of God and then humanity. Other Abrahamic faiths, and most other faiths and philosophies also embrace that value or imperative. Non-religious people who count themselves humanists or humanitarians do, too. And yet, too often, we do not live those values; they do not seem to inform the personal and public decisions of our lives--or at least not enough to make a substantial difference. And so it plays out with regard to basic health care for poor and low-income people, too. I'll just leave you with that.

Every other advanced industrialized country concluded some time ago that some combination of considerations--including the demands of their citizens--dictated the need for universal public health care. And notwithstanding all the misinformation spread about them, they provide good medical service at half the cost in the US. Further, according to recent studies, the measures of longevity and general health of people in these country are at least as good as those in the US.

Most Americans want universal access to reasonable health care, too. They do. They also want cost control and cost reduction, the elimination of inefficiencies, waste, misappropriation, and fraud. Everyone wants that, too--individuals, businesses and, yes, the government. And we've already proven we can provide it effectively in our military medical services program. But not enough of us are ready for change to a broad-based public health care system. I do not find the reasons and reasoning strong or convincing--obviously--but that's just the way it is.

And that's okay, even if my analysis would seem to lead us to the conclusion that a direct-provider public health care system is the only way to achieve all our public health care goals. The reason that's okay is because we have an existing health care delivery system that is very different and more complicated than the postal service, the military, or the education system. And a major part of that difference and complexity is the existing system of health insurance providers.

Yes, we already have a big, complicated, and dysfunctional--yes, dysfunctional--patchwork quilt of a healthcare system. It serves many very well, but many poorly, and many not at all. And that complex, ad hoc system of health care products producers and health care providers are mediated by an equally complex and dysfunctional system of health care insurers, mostly private, but also including Medicaid and Medicare. Unfortunately, it has turned out to be in the profit interest of private health care insurers to deny service wherever possible, terminate insurance for high claims patients, and deny insurance to patients with pre-existing conditions. That is to say, they are not providing a reliable insurance product--which certainly works against their declared purpose and mandate and the public interest.

Still, it is the collective bargaining power of competitive insurance companies that makes the providers of health care services price competitive at all. (Although, the benefit of those lower, negotiated contract amounts is not extended to the poor and those without health insurance. Unconscionable). So even if they have been scumbags toward their customers, failed out of self interest in that customer service role, private insurers have played a role in keeping medical cost from being even higher. And though, most likely, that could more accurately be viewed as just negotiating an increase to their profit margins, it has been an ameliorating factor in the direct cost of medical services.

One could understandably conclude, then, that without a public health care system, US health care costs are controlled in part, at least, through the mediating role of health insurance. That leaves providers of health care services to compete with each other to some extent for the contracted business of private insurers. At least that seems a fair conclusion to me.

But most providers of health care services do not appear to meaningfully compete with one another for patients—at least not on price and personal service. Many don’t appear to compete on medical practices, either. Hospitals and doctors do not openly reveal the cost of their services. It is painfully difficult to learn the cost of hospital care or medical procedures in advance, even if just a rough estimate. And while personal service at some hospitals has improved as a matter of professional responsibility, most still view such personal service as defined clinically by narrow medical practice standards.

Worst of all, however, there doesn’t appear widespread ardor for embracing and implementing medical “best practices” or the most reasonable health care policies, from a clinical, personal service, social policy, or cost perspective. Cost management is discussed by the medical community, but seldom pursued meaningfully or successfully. Of course, the intertwined issues of tort reform (reasonable limits or alternatives to law suits and excessive jury awards against doctors), inflated professional liability insurance costs, and excessive medical testing and procedures, must also be addressed. None of this will likely improve with better regulation of private health insurers alone.

Regardless, it seems to me that whatever improvement to our health care system might be imagined, whatever public role is to be played, for now it must work through the mediating role of health insurance providers rather than a direct-provider system of health care services. And that is just what is happening. And more, it now appears it must work largely through existing private health insurers. That's just the way it is unfolding, politically.

No one is still seriously suggesting a "single payer" system at this point--that is, having the government provide universal public health care insurance for everyone. Oh, there are many progressives--I like that term better than "liberals"--who believe that, if we can't have a national, direct-providerhealth care system, then a single-payer health insurance system is the only way to really provide universal access, effectively mediate provision of health care services, and assure cost reduction. And I'd be lying--and you'd know it--if I suggested that my analysis didn't take me to the same place. But there are other practical realities and considerations. And we need to recognize them.

The private health insurance industry is big and it's on the field--even if it needs better rules and stronger referees to make it shape-up and play nice. By nature and circumstance those companies are self-protective and politically influential. So, we can only hope that clear, enforceable regulation and oversight will do the job. Regardless, it appears we have no choice but to give it a chance. And might it not be wise to just take one step at a time toward what could be a too-big-to-succeed, one-step change to a government single-payer system? It does makes sense, as far as it goes, even if I do accept it grudgingly. It's probably got to be the first step, it seems. And, the government would have to subsidize the poor and low-income folks through direct “welfare-type” payments to them, or “insurance-type” payments to the private health insurers. But this approach still does not go far enough to assure health insurance access and effectiveness for all. We still need a “public option.” And here’s why.

You don't have to spend a career in fortune 100 and 200 companies to know that you can't insulate profit-making companies from competitive market forces, and you can't take them out of their mission and operating approach to maximizing profits in those markets--regulations and oversight notwithstanding. The day after those regulations are passed and the oversight assignments are made, significant resources of those companies and their outside consultants and advisors will likely be devoted to pushing those regulations to their legal stretching point in order maximize their revenues (premiums) and minimize their costs (payments for healthcare). And on the second day, they will dispatch their in-house and outside lobbyists to try to influence legislators and regulators to provide helpful changes in those rules, or accommodating interpretations. This is not a complaint. It's the way the system works. There is even wisdom in it, except for the dominance of business interests at the expense of those of the public.

No, there can be little confidence or comfort in an answer that does not give the government a greater role in influencing private health insurers to provide excellent service to the public and complete compliance with the spirit and letter of laws and regulations. And that role could be effectively advanced as a competitor of private insurers, at least with respect to citizens whose employment does not provide it to them, or to those who cannot afford it--the so-called "public option."

The insurance companies and the anti-government folks are kicking up a lot of dust about the "public option," saying they cannot compete against the government--even though the government has indicated it would be a financially "independent" enterprise of government. Much like the US Postal Service, I guess--except with a narrower mandate, a more limited market. If the private insurers could not compete with it in that narrow market, it would more likely be because of the quality of the service and the product than the price.

Yes, the private insurers do have to make a profit for shareholders. But are they fearful that they cannot compete with a limited-market, financially independent government agency on price, efficiency and customer service, and still make a profit? If that is the case, if they cannot better exploit their advantages on economies of scale and operating leverage--not to mention their expertise--then the sooner we move to a single-payer government system for the whole market, the better. But insisting on a limited-competition "public option" is one good way to model and better assure the performance results we need in general--and, yes, take a limited, but useful step in better evaluating the wisdom of a single-payer system.

(Of course, for the medical service providers—hospitals, doctors, et. al.—the issue of cost management will remain a challenge. Adoption of the best medical practices and most reasonable health care policies will require those providers, private and public insurers, legal and regulatory reformers to all do their parts. What will be required are conditions that produce more effective market competition, more professional accountability, and more exacting legal and regulatory requirement.)

An Afterword:

You'll notice that I have not used the words "socialist" or "socialism" anywhere, in any way, in this lengthy discussion. The reason is because it represents such a dysfunctional and obsolete approach to understanding and solving government and public issues. The only legitimate questions are the ones we have posed here. What are the public issues to be addressed, the problems to be solved? What are "public" products and services, and which are best mediated by markets, which by government programs, and which by some combination of the two?

It's simply a matter of understanding what works, what doesn't, and why--and the implications for serving the needs of citizens and the best interests of the nation. A functional analysis. Period. This anachronistic term was long ago broadened to demonize any government programs needed to solve pressing social problems or efforts to wisely regulate business really needs to be relegated to that chapter in the history books culminating with the reprehensible, shaming influence of Senator Joseph McCarthy--and left there.