Tag: Responsibility

Downward Spirals of Drug Addiction

The Downward Spirals of Drug Prohibition

Posted on by jabittan
In his book Chasing the Scream, Johann Hari describes the ways in which drug prohibition leads to downward spirals for those dealing with drug addiction. From what he has seen first hand, the drug war doesn’t stop people from using drugs and doesn’t help the planet get closer to a point where no one uses or abuses drugs, but instead creates more drug users. It forces drug addicts to the lowest possible rung on our social ladder and ensures they can never improve their lives.

 

Hari writes, “Prohibition—this policy I have traced across continents and across a century—consists of endlessly spreading downward spirals. People get addicted so we humiliate and shame them until they become more addicted. They then have to feed their habit by persuading more people to buy the drugs from them and become addicted in turn. Then those people need to be humiliated and shamed. And so it goes, on and on.”

 

People who abuse drugs and develop drug addictions are pushed out of our homes, out of public spaces, and out of the work force. We force them into dangerous situations where they can be taken advantage of, abused, and harmed by tainted drugs and needles. When people become so isolated and have no connections to help improve their lives, the only thing they can turn to is more drugs. To finance their habit they begin dealing drugs, often mixing the drug with other substances to have more to sell. They pressure the few people they have connections with to become drug users, so they can have some income to then further their habit.

 

The drug war doesn’t help rehabilitate these people, doesn’t show them that we care about them and want them to get better. It tells them they are worthless, and discourages and degrades them. The entire system creates negative downward spirals in peoples lives, in communities, and in our economy. It propels itself, creating the evil that it lives to fight against.
Shifting Away From The Drug War

Shifting Away from the Drug War

Posted on by jabittan
In the context of supporting the war on drugs, Johann Hari, in his book Chasing the Scream, describes most people as, “admirable people who have a series of understandable worries about the alternative. They support the drug war out of compassion for all the people they fear might become victims if we relaxed the laws. They are good people. They are acting out of decency.”

 

However, Hari believes that support for the drug war is actually more costly in the long run, and damages the lives of those who use drugs to an unreasonable extent. In the book, Hari looks at recreational drug users who don’t develop addictions and don’t generally cause a lot of harms through drug use. He compares these individuals to those who do develop addictions, and who contribute to crime and public health problems as a result of their drug dependencies. A key difference between the groups is that many of the people who develop addictions also have severe trauma in their lives. They are often isolated, have had adverse childhood experiences, and are suffering from physical or psychological pain without a supportive community to aid them. Not all harmless recreational drug users are free from pain and trauma, and not all addicts have a traumatic past, but the frequency of past trauma and ongoing psychological pain is a substantial difference between the two groups. Punishment and making life harder for drug addicts who have experienced pain hurts them and makes it more likely they will feel stuck and isolated, with no alternatives to alleviate their suffering besides the temporary relief of continued drug use.

 

The idea of punishment for drug use makes sense when we think about recreational drug users who we want to prevent from causing problems as a result of drug use. But those individuals, aside from contributing to an illicit economy, are not  contributing to the major drug use problems that we see. We can see this in our alcohol policy. Responsible recreational drinkers are not problems, but people who either have trouble consuming alcohol responsibly or simply chose not to consumer responsibly (perhaps college binge drinkers fit in both categories) do create problems for the rest of us. Helping an alcoholic is often understood as helping them develop a safe social setting where they can avoid alcohol or use it responsibly with people who understand their addiction and/or other alcohol challenges.

 

At another point, Hari writes, “We all want to protect children from drugs. We all want to keep people from dying as a result of drug use. We all want to reduce addiction. And now the evidence strongly suggests that when we move beyond the drug war, we will be able to achieve those shared goals with much greater success.” Moving beyond the drug war means that we will develop real, meaningful treatments and supports for drug addicts. It means we can have safe, legal drugs that people can use in supervised settings. It means that people with a history of drug use won’t be barred from ever finding even the most menial of jobs, and will be able to reintegrate back into society, rather than being forced out into situations where continued drug use is almost inevitable. Our approach to drug policy via the drug war has had disastrous consequences, and Hari encourages us to reconsider the path we are on.
Fiduciary Healthcare Responsibility

Fiduciary Healthcare Responsibility

Posted on by jabittan
For many Americans, their job provides them with some type of retirement savings account. Historic legal action, laws, and regulations require that companies who offer retirement savings vehicles responsibly manage the money they invest on behalf of their employees. The investment options that employers chose must perform at a reasonable level. A company can’t push all of its employees to invest back in the company (as Enron did in the 1990’s) and a company can’t just take employees retirement savings accounts and put them in a low return savings account at a bank – the return to the employee in interest would be so small that it would be meaningless. Employers fiduciary duty requires that they offer legitimate retirement savings options that are in the best interests of their employees and will likely achieve a reasonable level of return on the investment. We understand this fiduciary responsibility for employers when it comes to our retirement savings, and now, some leaders are starting to look closely at the fiduciary healthcare responsibility of employers in the same way.

 

In his book The Opioid Crisis Wake-Up Call, Dave Chase explains his concerns regarding wage stagnation in the United States. He shows that real hourly wages in the United States, across all education groups, has fallen since 2007 (the book was published in 2019 making the time period of falling wages 12 years). At the same time that wages have fallen or stagnated, healthcare costs and expenditures have soared. With out of pocket spending rising, employer contributions to health plans going up, and patient premiums also getting more costly, Chase argues that the lost wage increases for American’s have been channeled into an under-performing healthcare system.

 

This is where the fiduciary healthcare responsibility of our employers becomes an important issue. Our employers are offering us (for about 50-65% of Americans) health insurance at the expense of higher wages. The money used for purchasing the plans offered to us and helping us access care, can be thought of like a retirement savings account. It is our money, and the company has a responsibility to ensure it is used in our best interest and that the products and services purchased with our money are safe, effective, and likely to provide us with a reasonable return on our investment. The healthcare dollars spent by our employers for health insurance today does not measure up.

 

Chase predicts a series of lawsuits targeting the fiduciary healthcare responsibility of employers in the near future. Lawsuits could target ever rising expenditures for diminishing or stagnant healthcare quality. They could address limits in services that hinder health outcomes for individuals. Companies could be on the hook for failing to do background checks on brokers or failing to shop for the best insurance plan for their employers. All of these issues are addressed by Chase in his book, and he believes that if employers took their fiduciary healthcare responsibility seriously, they could be a major asset in changing the future direction and costs of healthcare in the United States.

Markets & Civil Society Organization

Posted on by jabittan
I tend to be a bit hard on the idea of free markets. I grew up learning about the invisible hand and in a family that started a business and did well. I (mostly because of my family’s business) appreciated the idea that setting up a market and running a business was a good thing from the standpoint of finding an efficient point at which to price a product or service. Today however, perhaps as a result of my healthcare interests, I see numerous examples of markets falling short of the goal we establish in our minds based on the idea of the invisible hand.

 

Rather than seeing markets find an efficient point where competition drives efficiency and provides everyone with better products at better prices, I see too many externalities from free markets and unfettered competition. We are producing a lot of greenhouse gasses that harm life on the planet. CEOs are getting better (maybe deservedly so) at capturing greater salaries from their companies, driving economic inequality, and straining social stability. Private health insurance markets seem to drive overall healthcare costs up at every turn, and no one seems to be able to understand how health insurance actually works. The free market, and open competition, does not appear to function as clearly and organize as succinctly as my simple understanding from high school would have suggested.

 

What is missing is something that ties markets and capitalism back into civil society. Bruce Katz and Jeremy Nowak, in their book The New Localism, suggest that shifting political power and decision making back to local contexts within cities and metropolitan regions can help correct these problems. They write, “New Localism is a mechanism for converting the self-organizing power of markets and civil society into structured fiscal and financial resources, and ultimately, political power.”

 

National and multinational sized corporations often have a responsibility to maximize profits for shareholders or top executives. Their huge scale means that any local or regional place is less important for them, since there are always markets in other countries and other states. However, when local governments exert more control over such companies, the local contexts begin to matter more. When CEOs and executives from these companies are invited in to help shape policy beginning at the local level, and are held accountable to the local individuals in the places where their markets are strong or where their employees actually live, the business motives that encourage negative externalities are shifted. The dynamic becomes one where civil responsibility is elevated, and ultimately political power is shifted in a way to help organize business in a more responsible manner in relation to the local context.

 

The lesson that Katz and Nowak share is that businesses on their own are encouraged to organize themselves in a way that maximizes profit at the expense of the local communities in which they operate. By giving localities more power and better networked governance structures, big businesses can instead be a cooperative part of the political and social structure, re-organizing themselves within society in a way that helps make Adam Smith’s invisible hand dream a little more plausible. The Invisible hand in this model is not so invisible, but more of a structured handshake creating a commitment to more than just profits.

Personal Medical Decisions?

Posted on by jabittan
A couple weeks back my grandma sent me a message on Facebook that was a picture of two very obese individuals eating a giant pizza and drinking soda. A caption on the photo read, “This is why I don’t want to pay for your healthcare.” As a person who is interested in and taken classes about public health and health policy, I actually think about these things all the time. I recognize the importance of making smart health choices, but I also understand that health outcomes can be a result of a complex web of social determinants of health. There are factors that are beyond our control in regard to living healthy, and there are some factors that seem like easy decisions to some people, that are monumental challenges to others. Despite the amount of time I spend thinking about these things, I don’t have a clear answer in my head for when people need a tough love kick in the pants versus compassion, and when a given outcome is generally more the result of poor individual decisions and habits or more the result of uncontrollable social determinants of health. There likely is no clear answer to this question, and I think it is reasonable to say, “I have thought about this a lot and I don’t know.”

 

This leads me to another factor that compounds the complexity of healthcare decisions: What choices, decisions, and behaviors are personal, and which ones should be considered public? If I chose to smoke, is that a personal decision even though there may be public consequences if I die early, have poor health overall, and require more emergency medical care which ultimately drives everyone’s healthcare premiums up? Do I have to exercise every day to stay healthy as a public good and not just as a private good? If I go get an x-ray on the ankle I sprained to make sure it isn’t broken, is that going to take time away from medical professionals who could help someone that really needs it when all I likely need to do is ice it a little bit?

 

In the book The Elephant in the Brain, Kevin Simler and Robin Hanson write about Steve Jobs and his decision to forgo cancer treatment as recommended by the American Medical Association’s best practices. Jobs is an interesting case because the fortunes of a company that many people love rested on his medical decisions. Beyond just his own health and the considerations of his family, people felt that they had their own money on the line if they owned apple stocks. If Jobs lived and survived his illness, it would be good for Apple, but if he denied standard treatment and died, what did that mean for the public?

 

“The point here,” write Simler and Hanson, “is that whenever we fail to uphold the (perceived) highest standards for medical treatment, we risk becoming the subject of unwanted gossip and even open condemnation. Our seemingly personal medical decisions are, in fact, quite public and even political.”

 

The kind of medicine we pursue and the lifestyle we live are never going to be restricted to just ourselves. We will at the very least be judged by others for our health and medical decisions. Our choices may or may not have major financial implications for other people, but that doesn’t mean that we can make our choices in a vacuum.

 

What is important to remember here is how complex the line is between personal and societal responsibility. Our individual decisions can have bigger impacts than we realize, and it is hard to keep something just within our own bubble. Added to that are questions about liberty and the authority of the state. It is not an easy question to ask if your diet should be controlled by anyone other than yourself, or if you should be forced to exercise and sleep a certain amount. Approach questions about healthcare understanding that these questions don’t have clear answers, and whichever choice we make is going to have strange consequences as a result of these complex inter-dependencies.

Pointing Out What is Wrong

Posted on by jabittan
America has laws to protect whistleblowers within corporations and within government because we understand how important it is to shine a light on the negativity and unfair practices of those with impure motives. When we turn this idea toward society, however, we suddenly become quite disdainful of those who acknowledge and speak out against the lack of racial progress, equality, and fairness within our nation. In a system of capitalism there are winners and losers, and the American system of capitalism has a history of creating winners at the absolute expense of other people. This is what happened with slavery and was maintained through legally sanctioned segregation and discrimination with Jim Crow laws. The protections we offer corporate and government whistleblowers disappear completely when the light is pointed toward market failures that advantage one group over another or when that light is pointed toward things that we associate with positive parts of our individual identities. My belief is that this relates back to our tribal nature as human beings. Pointing out the flaws of corporations and government is an attack against the other team and against someone else with more power, but observing the inequities in social systems that benefit us is a direct attack against our tribe and against who we are. Criticizing the system that has helped us be successful individually is criticizing us and taking away from what we did to become successful.

 

Ta-Nehisi Coats in his book, Between the World and Me, observes this phenomenon from the side of an African American living in a society that is in some ways divorced from reality in terms of opportunity, justice, and equity. He writes, “But part of what I know is that there is the burden of living among Dreamers, and there is the extra burden of your country telling you the Dream is just, noble, and real, and you are crazy for seeing the corruption and smelling the sulfur. For their innocence, they nullify your anger, your fear, until you are coming and going and you find yourself inveighing against yourself.” The idea that Coats shares in this quote is that any observation of racial injustice is frowned upon in our society, and that the only approach to racial observation that is allowed is a criticism of black culture.

 

Arguments suggesting that society is not established or operating in a way that extends equity and justice toward minorities are forbidden by a pervasive sense that they are wrong or that they are simply an excuse for failure. Many of the arguments and tensions in society today are related to this idea. Most people are not outwardly racist but instead unintentionally discriminate against minorities by failing to see where inequities exist, and then by challenging observations of inequities and labeling them as excuses meant to protect lazy people who fail to overcome obstacles and make smart decisions. Moreover, if we accept that black and brown people have faced greater obstacles than we have, we admit that we have had advantages that were not extended to others. This puts our idea of personal responsibility at risk because it becomes clear that our success is not completely dependent on our own greatness, hard work, and smart decision-making, but was helped along by simply having the right skin color and benefitting from a society that discretely favors white people at the expense of minorities. Not only does this take away from our success, but it questions the level of success we have achieved, forcing us to ask if we should have become even more than we are given the advantages we have experienced. The threat that white people face when asking whether society has truly been just and equal for minorities is a threat against them, against their responsibility for their own success, and against their achievements.

 

Our country fails to give any legitimacy to those who call out our injustices or to the claims they make, and punishes individuals who make such claims. We offer protections for those who shine the light on corruption in business (if it is a business we dislike or are afraid of) and government, but those who call out the injustices of society are scorned. They are pushed back and told the problem is not with society, but with the individuals who are being discriminated against or who have failed to become successful in the eyes of society because this response is easier and preserves the image that white people want to have about themselves. If we want to move forward and reach a place where we are more equitable, white people need to be able to drop their ideas of personal responsibility and success. White people must drop  their ego and accept that their success, or image of success, is not truly connected with who they are as a person or individual. Only if we change our relationship with personal responsibility and success can we begin to see the importance and value of extending equity to minority groups and the value of honesty in our reflections on racial equality within our country.

Failure in School

Posted on by jabittan
Everyone knows it is important for children to be successful in school and to grow to be more thoughtful and successful later in life. One of the challenges with the current school model that Ta-Nehisi Coats points out in his book Between the World and Me is the way in which our education system is designed for a specific culture with specific expectations for specific students. Those who match the culture and who have the right support from parents and teachers find success, but those who don’t fit with the culture of the schools, who don’t have support from parents, and who don’t have safe environments are left behind. Our individualized culture, focused on self-reliance and self-responsibility often looks at schools as though they are an equalizing force, giving each student an equal opportunity to grow and succeed, but Coats views schools differently.

“The society could say, ‘He should have stayed in school,’ and then wash its hands of him,” Coats wrote about the system he found him self in as a child. The great equalizing power of school, was an equalizing of blame, moving the responsibility for success or failure from society on to the individual. This meant that the child whose parents worked two or three jobs, the child whose parents dealt with substance abuse, and the child who had to walk home along dangerous streets was now on equal footing with the children in gated communities with parents who could afford to stay at home and pay for private tutors. In this model it is not the parents, not the society, and not the culture of the school that are responsible for whether kids learn and grow, but rather the children themselves who bear the responsibility of success in school.

When we criticize those who do not complete school and resign them to low paying jobs, poor housing, and exclude them from society, we are reducing their future based on factors they could not control growing up. For me it seems unreasonable to ask so much of a person at such a young age, to demand that they not make mistakes and demand that they become more than human before they are 18. For Coats, it was unreasonable to demand academic success from young children who lacked the support and guidance of parents, who had to learn in schools that  did not accept the culture of the child, and who have to navigate the tough social realities of concentrated poverty. The most challenging part of the system, as revealed by Coats, is the idea that school was a great equalizer, and that after someone failed in school, they could be forgotten by society.

Interdependence

Posted on by jabittan
Senator Cory Booker starts the epilogue to his book United with a quote from Mahatma Gandhi, “Interdependence is and ought to be as much the ideal of man as self-sufficiency.” Throughout his book he focuses on the connections that everyone in the United States shares simply by being an American. We are connected to those generations that came before us and the decisions they made, and we are connected to the generations that will come after us and those who will live with the world we create. Our lives are dependent on one another in ways that we cannot always imagine or understand, but when we focus on our connections we can begin to see how important it is to live intentionally and recognize how our choices impact others.

 

In the United States self reliance and personal responsibility are emphasized far more than interdependence or social reliance. When we talk about success we are quick to look at the ways that we have achieved greatness on our own and we are quick to provide examples of  individuals producing great value and reaping great reward. It is our individual spirit and our industriousness that we look at when we think about how we succeed. The situation and the environment are often left out of the equation in favor of the obstacles we had to overcome and the smart decisions we had to make. When we look at what a successful person is, we focus completely on the person, assuming that the person is great entirely due to their own actions and hard work. This translates back into the world in which we live, and we look at successful and famous people and assume there is something special about them or that they are worthy of praise because they achieved wealth, status, and fame through hard work and an innovative spirit. In some way, we elevate their moral standing, their intelligence, and their character simply because we see them as successful.

 

When thinking about failure on the other hand, we find many excuses that push responsibility away from us, onto the situation, onto other people, and onto random events. Our personal responsibility seems to diminish as soon as things are not going our way. We hold self-sufficiency as our goal, and push toward it, and any failure seems to indicate that we are somehow less than an ideal version of ourselves, so we find ways in which our failure or lack of success is not an indication of our self-sufficiency. Yet at the same time, when we see people who ask for money, or are out of shape and are not as financially well of as we are, we blame the individual and begin assuming that they have deficiencies in character and work habit that have led to their less than ideal situation.

 

A more healthy world view would be one similar to Gandhi’s. We would recognize that our success is not simply a matter of our own great decisions and actions, but rather the consequence of our choices within an environment that in many ways shaped the actions and options available to us. Our success or our failure would be dependent on the lives of those who came before us and the systems, norms, and culture they left behind. Shifting how we think about where self-responsibility fits with success can change the way we think of others, helping us see value in all people, and not just those who have achieved notoriety and wealth.

 

When we step outside the personal responsibility bubble we can begin to see that our actions and decisions matter a lot, not just for our own success but for the well being of everyone. We can begin to see that we had assistance from people and factors that we could not control or predict, and it helps us to become more connected with those around us.

The Role of Individual Responsibility

Posted on by jabittan
A question that we all answer when we vote and  think about politics is a question about the role of individual responsibility in our lives, communities, and country. How much individual responsibility should we accept in achieving financial success, in taking care of our elderly, and in providing aid to those who need it the most? How much of our current situation is a result of our individual responsibilities and decisions?

We never truly ask these questions out loud, and when we do discuss them, we don’t pull out a piece of paper or a calculator to weigh all the possible decisions and factors that have combined to shape our life. Surely our actions, attitudes, and decisions play a big role in determining our own success, but how much assistance did we receive from family? Did we have a natural disaster destroy our home? Were we the victim of random violence, and did we have a healthy support system around us as we recovered from that violence? There is certainly a role for individual responsibility in our lives, but there are so many variables between along our path to success that measuring the role of personal responsibility is complex and ever shifting, especially since there are different measures of success like financial success, health, and happiness.

In his book United, Senator Cory Booker looks at the question of personal responsibility and asks the difficult questions that I laid out above. As someone who played college football and graduated from Stanford and Yale, Booker certainly understands the importance of personal responsibility, but at the same time he is acutely aware of the support and assistance he received from family members and people in his community along the way. In regards to how we answer the question about personal responsibility as a community he writes,

“Our rightful, long-cherished veneration of individual freedom and self-reliance and our faith in the free market must not be accepted as excuses to fail in our individual responsibilities to preserve our communal treasures. These American ideals, despite a history that too often exhibits evidence to the contrary, can and must coexist. The idea that each of us has an absolute right to get all we can get has led to the devastation of our commons. It has violated the Justinian ideal as well as the American dream; it has diminished us all and impoverished our children.”

The first two lines from Booker’s quote really strike me. We often hold our own success as our own personal triumph and acceptance of responsibility, and from that vantage point it is easy to say that those who have not found the same level of success have simply failed to accept responsibility in their own lives. When we are succeeding it is easy to favor the free market and act as though government assistance or community involvement is not a necessary ingredient in growth and success. However, as soon as we perceive that someone is cheating us, that the system is somehow not working properly, we demand government intervention and we question why those with more are not doing their part to help those with less. When we look at our reactions to government through this lens we see that there is no inherent ideology favoring more or less government action, there are just differences in where we sit in terms of success, and what we perceive in terms of fairness or whether we are being cheated.
Booker’s quote continues to talk about personal responsibility in terms of how we help or hurt the environment and community in which we live. If our personal responsibility is to simply amass as much as we can and become as financially well off as possible, then those around us and our community will suffer as we put our own needs above others. If however, we decide that a major part of our personal responsibility is to use our advantages, our wealth, and our success to aid those around us, then we can do and be more for ourselves and for our community. Seeing the health of our cities, counties, and country as a reflection of our actions is important, but we often only see the health of ourselves and our families as our responsibility. It is important to see not just personal success and failure as our responsibility, but communal success and failure as our responsibility. In the world today we close ourselves from our community by escaping reality with television and suburban life, and we justify our decision to do so by adopting a narrow view of personal responsibility where our responsibility is primarily on ensuring our own financial success, and not ensuring the health of our community.

Our Environment, Incarceration, and Societal Responsibility

Posted on by jabittan
In my last post, I wrote about Cory Booker’s reactions to meeting inmates at a prison when he was in law school. Having a chance to speak with inmates and ask them about their lives, the environments they grew up and lived in, and how they approached life in jail was very impactful for Booker. He began to look at people in prison as real people, and began to look at them beyond just the negative things they had done. In short, he began to see a more full picture of who the people he met were. Reflecting on the experience Booker wrote, “I could walk out of that place instead of remaining not just because of my own choices but also because of the abundantly privileged environments in which I had lived.” It was where Booker grew up, the support his family provided, and the schools Booker was able to attend that shaped his life and the choices he could make. Throughout his life he has certainly had to make smart decisions and has certainly had to work hard, but because he grew up in a more affluent part of New Jersey and because his family was able to provide for him (both financially and in terms of being role models) Booker saw a true avenue and opportunity to make the right decisions.

 

Many of those who end up in jail do not start out with the same advantages as Booker. It is not to say that we can excuse the crimes and mistakes they have made, but if we truly want to correct behavior, and if we truly want to put an end to crime throughout society, we must think about what we provide for others and what the environment is like where these individuals grow up, work, and live.

 

As Booker left the prison he thought about the people society has left behind and the decisions society has made to lock problems away in prisons. “I walked out of the prison free, and yet I was shackled to what I now knew,” Booker writes, “I was implicated. I couldn’t take my full measure of pride in our greatness as a society if  I was not willing to take responsibility for our failures.” In America we place a lot of responsibility on the individual and we celebrate individual achievement and success to a high degree. We are also quick to point out the moral shortcomings and negative traits in others that lead to failure. Our society is quick to celebrate individual accomplishments and we are able to view ourselves in the success stories of others, taking pride in one person’s accomplishments as a reflection of the potential within our society. When one fails however, we are not quick to latch on to their negative outcome and identify ways that their failure could be attributed to society.

 

Great  wealth is a result of a superior capitalistic society and freedom, when local sports teams win it is a result of community support and fandom, and when a new business opens up it is because our community is so vibrant and wonderful that we attract the interests of those who want to give us more. Failure on the other hand, is a result of an individual being unable to accurately read the economy. Crime stems from personal moral failures. And poverty exists because other people are lazy and don’t want to take jobs. This split in how we all share success but view failure as individual shortcomings is an inaccurate and shortsighted view of society.

 

Booker’s time visiting the prison helped him to see that how society is organized impacts the opportunities that people face. How society supports or abandons people makes it easy for some to make good decisions and generate wealth, and it places others in positions where crime and poverty are hard to avoid. It is hard to take pride in society when we leave behind so many people and focus all our attention instead on a relative few that achieve great success.