Smart Government

Keith Humphreys acknowledges that substance abuse treatment programs are often designed poorly.  Further, we shouldn't have outsized expectations.  Yet this isn't an argument against there being a treatment solution, nor is it an argument for less spending.  He outlines some very sensible solutions.

It's hard to sell people on government spending towards social problems when there is a lot of money out there being spent poorly.  This tends to get held up as evidence that *no government spending works*, or at least that the benefits aren't worth the cost.  But there are many things out there being tried, and many of them with success.  Instead of debating *whether* money should be spent at all, we need to be debating *how* the money gets spent, with the knowledge that there are answers and that we have a responsibility to find them.

The sooner we can come together as a society and decide to hold ourselves accountable for the problem, the sooner we will be able to have a truly "smart" government,.

What It's Always Been About

Given all the hem and haw recently over the question of the Affordable Care Act's constitutionality, it pays to remember that for conservatives this is merely a technicality.  Jonathan Zasloff reminds us what the real concern is when, following Chait:

all success is earned success. They do not believe that luck or life circumstance play an important part in economic success. They believe that wealth and poverty are essentially moral categories, interchangeable with “hard work” and “sloth.” They decry government, but they don’t really oppose government per se. They oppose those government functions that transfer resources from the rich to the non-rich.

he writes:

What Chait could have said but didn’t is that this is essentially Social Darwinism 101, or Scrooge, or Rand.  Ironically enough, this is the only Darwinism in which Republicans believe.  So instead of the man himself, I would suggest replacing the elephant as the GOP’s symbol with William Graham Sumner, the late 19th social Darwinist.  Although Sumner’s academic bona fides would no doubt offend most in the party, his insistence on the futility and downright immorality of doing anything to assist workers and the poor would be quite congenial.

Liberals need to remember this: the fight for the disadvantaged and oppressed is not about the individuals who exploit them.  It is about the persistent mythologies that drive men to stand behind policies that enable wretchedness.  To pin the intransigency of the right on mere moral failings or character flaws is demeaning to the rich history of callousness that almost defines conservative thought.

Conservatives generally oppose the ACA because it seems a reward for people who don’t deserve it.  A “redistribution”. This is stated over and over. Yet oddly, when repeated back to them, they often respond as if this is somehow an insult, that they could be accused of such a thing! The oddest version of which was Glenn Beck's CPAC speech in which he sung the glories of “allowing people to fail”, because that is the only way they’ll really learn. As if his own AA sob-story has much to do with people who are uninsurable, or are too broke to afford insurance.

Or maybe it does: maybe the poor are really to blame for their poverty. Maybe they are too lazy. This too is a stated claim of many conservatives, even if usually spoken of in a round-about way by all but the most brave. The logic is sound. The wealthy created their own wealth, so the poor must *not* have created it, right? Further, wealth is a prime motivator. If we “give it away”, people won’t have anything to work for. Just look at communism.

Have conservatives not been listening to their own rhetoric these last few decades? Is there something about liberals saying the words that bothers them?

I think one last note to hang on this: the question of contra-causal free will plays a role here. Conservatives generally believe people are responsible for their own choices, and thus social privilege doesn’t really compute. They worship stories of men who succeeded “despite the odds”, as if to prove that privilege means nothing. And yet this magical fortitude, this mystical agency is neither a socially learned function, nor a genetic advantage. Because either (or both – as most liberals believe), would imply *causality*.

Yet if you have causality, you suddenly lose responsibility. Better genes or learning places agency’s origin in events beyond human control (we don’t pick our genes, we can only learn how to learn, how to learn (etc.). This of course is all the logic behind liberal social programs – we call this “social responsibility”. And without it, you have conservatism. Or at least to the degree you have less of it, you have more conservatism.

I personally have never heard a conservative argue around the vast data that supports this basic liberal equation. You generally get the question changed from “should we?”, to “how can we?”, with the answer usually being “it’s too expensive”, or “it’s hopeless”, or “you’ll do more harm than good”. But conservatives never have any helpful solutions aside from vague and hopelessly inadequate gestures towards charity. So then the issue is dropped. Until once again you hear conservatives complaining, “we shouldn’t… we shouldn’t”. And you then explain why, and the liberal policy is criticized (even though, like with the ACA, it has been so weakened by conservative compromises that most liberals in many ways will agree).


Yet, like Sisyphus, we keep trying, fighting for our little old “social justice”, calling for “social responsibility”, pushing that ball a little up the hill. A little more health care for the needy. A little more money for poor kids. A little more regulations on businesses destroying the environment. This will all sound like creeping serfdom to some. But to those of us just looking to give every one a fair shot at success (or just dialysis, for crying out loud), it is a better, slightly more just and ultimately moral world.

You Get What You Pay For

The New York Times reports today that despite all the efforts towards "accountability", many schools are struggling to replace "failing" principals.  Of low performing schools in states that agreed to enforce strict sanctions for a chance at some of Race to the Top's $4 Billion in grants, nearly half have found ways to keep their principals on board.  Apparently finding talented individuals willing to work in troubled schools is harder than was expected.

From the article:

Because leading schools out of chronic failure is harder than managing a successful school — often requiring more creative problem-solving abilities and stronger leadership, among other skills — the supply of principals capable of doing the work is tiny.

You think?  And we're only talking about principals.  What about all the so-called failing "teachers"?  Given the average poor school might have more than 20 teachers,  finding replacements would be that much more difficult.

Of course, the assumption is completely flawed.  As the article rightfully notes, working at a poor school is more difficult.  Add to this the enormous expectations being placed on an already over-burdened and under-appreciated staff, and ask yourself who in their right mind would feel attracted to such a position?  The list of those of us willing to accept that offer is surely shortening fast.

Maybe the real question is why we should expect to be able to ask so much more of these workers in the first place?  We either need to pay them much, much more, or provide the proper support to begin with, so the job will be actually possible with an average employee. 

The Delicacy of Nuance

A favorite education blog of mine is Bridging Differences, penned by Deborah Meier and Diane Ravitch.  A recent post by Deborah however, interested me less for its actual subject than for the issues it raised in how we all communicate to each other.  The thesis of her post was that in many ways the modern school is like a prison.  The students are forced to attend.  They are not allowed to leave.  They must generally listen when spoken to and register any protest in strictly muted form.  In the post she used words like "abuse", "torture" "coercion" and "justice".  These terms all have a rather large spectrum of contextual meanings, and Deborah's use mainly resided in the less-severe form.

One of her commenters took offense at her choice of words, pointing out that what she was describing seemed not to warrant such hyperbolic language.  Could one not get the wrong impression from such heated words?

I think that might be true, but I can completely relate to Deborah's style of thinking - even though it constantly gets me in hot water!  It's all in the nuance.  Because from another mouth, those words might indeed sound really terrible.  But if you "get" what she is trying to say, there is a very powerfully spoken emotion in her language that might be sacrificed in a "tidier" version.  The danger, of course, is in this type of language being misread, especially as it can sometimes sound like the sort of cynical rhetorical device used by propagandists, in that the intent (consciously or not) to deceive or manipulate.

To elaborate, this is how I at least defend my own style, which I think is similar.  There is a certain faith that is placed in the listener that assumes they are interested in taking a kind of walk with me, that they too are operating in good faith and are willing to possibly forgive the inaccuracies implicit in what I am saying in order to, with me, understand a deeper meaning that may not otherwise be understood.

The reader is in this way thought of as a serious and capable participant.  In the same way a poet might choose beauty over specificity, or a musician might choose dynamism before harmony, a leap is being taken with the hope that the listener will follow.

Obviously, this technique requires delicacy, and could easily slip into laziness.  Yet for those to whom this type of writing - thinking, really - appeals, it is in their DNA to carry on this way.  In the same way a more literal or linear thinker's lack of nuance, or "art", must be overlooked in order to appreciate their special focus and well-chosen delivery, the abstract, impassioned speaker must be indulged to reap the charm of whatever new and delightful dalliance they might take.

So, are schools really like "prisons" for children.  Often torturous, or abusive?  Well, yeah.  I know exactly what she means!

Singing Songs

Andrew Sable, looking for inspiration in the glory of the unsung laborer, recommends this speech by Patton:

An Army is a team. It lives, sleeps, eats, and fights as a team. This individual heroic stuff is pure horse shit. The bilious bastards who write that kind of stuff for the Saturday Evening Post don’t know any more about real fighting under fire than they know about fucking! We have the finest food, the finest equipment, the best spirit, and the best men in the world. Why, by God, I actually pity those poor sons-of-bitches we’re going up against. By God, I do.
…
All of the real heroes are not storybook combat fighters, either. Every single man in this Army plays a vital role. Don’t ever let up. Don’t ever think that your job is unimportant. Every man has a job to do and he must do it. Every man is a vital link in the great chain. What if every truck driver suddenly decided that he didn’t like the whine of those shells overhead, turned yellow, and jumped headlong into a ditch? The cowardly bastard could say, ‘Hell, they won’t miss me, just one man in thousands.’ But, what if every man thought that way? Where in the hell would we be now? What would our country, our loved ones, our homes, even the world, be like? No, Goddamnit, Americans don’t think like that. Every man does his job. Every man serves the whole. Every department, every unit, is important in the vast scheme of this war. The ordnance men are needed to supply the guns and machinery of war to keep us rolling. The Quartermaster is needed to bring up food and clothes because where we are going there isn’t a hell of a lot to steal. Every last man on K.P. has a job to do, even the one who heats our water to keep us from getting the ‘G.I. Shits’.

…One of the bravest men that I ever saw was a fellow on top of a telegraph pole in the midst of a furious fire fight in Tunisia. I stopped and asked what the hell he was doing up there at a time like that. He answered, ‘Fixing the wire, Sir.’ I asked, ‘Isn’t that a little unhealthy right about now?’ He answered, ‘Yes Sir, but the Goddamned wire has to be fixed.’ I asked, ‘Don’t those planes strafing the road bother you?’ And he answered, ‘No, Sir, but you sure as hell do!’ Now, there was a real man. A real soldier. There was a man who devoted all he had to his duty, no matter how seemingly insignificant his duty might appear at the time, no matter how great the odds. And you should have seen those trucks on the road to Tunisia. Those drivers were magnificent. All day and all night they rolled over those son-of-a-bitching roads, never stopping, never faltering from their course, with shells bursting all around them all of the time. We got through on good old American guts.

It's a great speech. 

Sable then puts out a call for similarly inspiring odes to the working man.  Beyond the physical rewards for labor, he writes, the work cannot be honored enough - especially by the left.

But one wonders – is any of this more than blather without the actual existence of rubber-meets-the-road improvements in lives? Like decent pay, benefits, pensions, etc? Ooooh… I said pensions!  Because now more than ever, it seems we need less speeches and more actual, real-world "trickling down".


Because I recall the time I proposed to a conservative, in a conversation about trade schools vs. college, that we don’t respect the working class in this country. She assumed to remind me that I would sure respect a plumber when he came to fix my broken pipe. Well, that was my point. Not only do we not respect their work, but in terms of pay, physically demanding labor is often valued less – certainly the less skill it requires. Anyway, many of the traditional tools we have had for guaranteeing some measure of wage equality (unions, minimum wage, health care, regulations, etc.) are hated by the very same people who would champion such oratory.

I realize there are nuanced arguments for how unions, minimum wage, health care mandates, etc. all end up hurting the lowly worker. But those aside, there is a substantial degree of meritocratic pablum out there, in which each man is measured not by his work, but by his wage. And that there is no real inequality in making less, because that is simply what one deserves, according to the wisdom of the market. So if you can barely pay your rent, can’t afford health care, work in unsafe conditions with no job security and no retirement benefit – well it’s your own miserable fault. (You just need to work harder and you too can be like Rush Limbaugh with your fat suits and thick cigars.)

All of this ends up doing two things: it avoids offering any prescriptive measures for change, and reminds us that there need be no real change anyway. Things are fine just the way they are. Except they aren’t, really. So the class anger – which is real – is magisterially woven into a narrative about Cadillac union memberships, wine and cheese college elites, public pension cartels and anyone else getting “payed off” by a Democratic party less interested in social justice than funneling taxpayer money to liberal interest groups and rubbing their pagan social mores in the faces of mustachiod Nascar mechanics.

What’s interesting to me about this set-up is that it offers a tragic salve: it recognizes that there is an injustice out there, but buries the blame in a phantasmagorical, Freudian blend of class resentment and cultural fundamentalism, none of which actually gets at the real truth. Public pensions are not to blame for the fact that pensions don’t exist anymore. Unions are not to blame for the fact that so many people are without health care. The minimum wage, child labor laws and regulations are not the reason that all of our jobs have gone overseas. Well, actually they are. But that’s just sad.

Getting the Light Just Right

 Keith Humphreys presents the following dillema in pain management:

"Every public health official I talk to at the city, county, state and federal levels knows how serious prescription drug misuse and overdose are, yet is also struggling to find ways to limit the damage without causing harm to people in pain. If you can thread that needle perfectly, the world will beat a path to your door."

It's a really sketchy call.  Let me share some of my personal experience.

I've had moderate chronic neck pain since I was in a near-fatal surfboard accident in 1989.  As the onset of the pain was slow - taking maybe 6-8 years to fully present, I watched my quality of life slowly deteriorate.  Depression thus became a growing concern; suicide gradually came into focus as a sort of emergency escape hatch.  The pain was essentially non-stop, worst at night, when sleep was difficult.  Formerly a very athletic skateboarder, my life activities ground to a near halt; more than light/moderate activity risked intense spasms that could last days.

I attempted suicide a couple of months after the birth of my first daughter.  Hard to fathom such a cruel act in retrospect, at the time it seemed perfectly logical.  I was the primary caregiver (my wife taught classes during the day) and the baby was colicky.  I was able to imagine my wife remarrying and finding a better life for her and my daughter with someone who was able to give them what I felt I could not.

I had been taking anti-depressants and over-the-counter tylenol/advil for years.  I had a few sleeping pills I'd stashed from my time spent in a medical environment earlier in my career.  Yet none prescribed.  Anyway, what I took was some combination of those.  I remember regretting it almost instantly.  As the baby cried downstairs, I went to the toilet and tried to induce vomiting.  But it was too late.  I lost consciousness in a matter of minutes.

I found out later that my wife came home from work to find me blue on the couch.  She called the ambulance and had to wait for it to arrive, with me dying by her side.  They pumped my stomach and in two days I regained consciousness.  I spent the next week in the psych ward.  But it was largely unnecessary.  I knew as soon as I woke up what I had done.  It was as if something terrible had rushed out of me, and something beautiful had rushed in.  The pain was still there, it has never left.  But so was my wife, my daughter, my family, my friends, my art, my dreams.  Keeping my mood up is often a daily battle.  But it's never been so hard since.  The suicide, like some taunting devil in the closet, has been banished far, far away.

I now take a doubled dose of anti-depressants and a sleeping pill.  On really bad days I'll take a Xanax.  The doctors I've seen over the years have all been very nervous about treating my pain with opioids.  And for the most part I agree - I try to live without as many "crutches" as possible.  It is partly just a matter of psychology.  The less I worry about my pain, the less I, well, worry about my pain.

But sometimes you can't escape, and it can overwhelm you like a ton of bricks.  A formerly beautiful day full of golden promise can become a wretched bog of shit to slog through.  What a difference a "mood" makes.

I wonder if my pain could have been managed better, I might never have reached the depths of depression that nearly robbed my family of me.  But that's a counter factual too impossible to know.  And yet, there is a correlation between suffering and depression, between pain and suicide.  There is a logic to the thought that the only way to stop the pain is to end your life.  But it is a logic that misses a couple of key things.  One of them is medical treatment.  And the other is the extraordinary power of the mind to transcend physical suffering.

However, that power is not inexhaustible, and all it takes is a few life events to pile up and you have a powder keg of stressors that can break even the most strong-willed patient.  It occurs to me that in this time I was without medical insurance.  Ironically, this was because I had a pre-existing, chronic condition, and could not find coverage.  It may have been no use.  But a better system of pain management, possibly a routine series of visits with a physician every few months, might have helped.  Ultimately, in many ways I got lucky.  These cases can be tricky for the health care system to deal with.  But I find it hard to come to the conclusion that less care would ever be better.  Especially for those who need it most.

For the Good Times

For all the tragedy and complaints I might have about the ways in which the continuation high school isn't meeting the needs of my students, it does do a lot of good.  At least for troubled kids, it's certainly much better in many ways then mainstreamed classrooms. Many drop-out, and many do little work, and most are mainly interested only in sex, drugs and violence. But they're out of the teacher's hair, and with the individualized attention we can meet more of their needs. It isn't perfect. And some days they seem to do no work at all. But for many of them they are simply in a safe environment in which they can let their guard down.

I had an interesting talk with the counselor yesterday about meeting the emotional portion of their needs, which for at least 50% of the students is the main barrier to academics. They've tried providing one-on-one counseling sessions, but the population has trouble making appointments. Then the bigger problem is being able to build rapport. Many students are so emotionally closed off that it takes weeks or even months to get comfortable with any adult.

I'm reminded of this story in the NY Times, in which a psychiatrist argues that one of the most crucial aspects of any kind of therapy is simple human connection - something that surely won't happen in a class of 40 kids. Then again there was the study which seemed to find that the real therapeutic effects of placebos were in the doctor's relationship with the patient - that they were being paid attention to, as patients who were informed of the placebos did as well as those who were blinded!

Anyway - a bit tangential. But goes to the concept of making meaningful interventions in students lives, meeting not just their "academic" needs but looking at their whole story. There are a lot of cumulative effects of poverty that wear a kid down over the years - whether it's the wrong crowd, stress at home, drugs, violence, etc. By high school many have simply reached the breaking point. And I honestly don't blame them for wanting to punch someone in the face.

Tidbit from the trenches: yesterday I was talking with a group of young mothers/mothers-to-be who I'm trying to design a sort of parenting elective for. One of them is rolling her eyes as she describes a girlfriend of hers who has 3 kids by 3 different guys, while her boyfriend has 4 kids by 3 different girls.

I turn to one girl - heavy eyeliner, sort of chola-style - who has previously discussed her deeply dysfunctional relationship with her boyfriend ("I hate him but he says he'll hurt himself if I leave"). I ask her, "You don't have a baby do you?" She shakes her head non-nonchalantly and replies, "Nah, but we're trying."

"What?!!", I reply, shocked. "Is this the same boyfriend you're always talking about hating?"

"Yeah," she says, "I know we're prolly gonna break up... but this way I have something to remember the good times by, you know?"