Sunday, March 28, 2010

Bart Stupak

After Michael Moore claimed credit for changing the health care vote of his congressman, I was so confused I looked up the boundaries of Bart Stupak’s first Michigan district.

It does not include Flint, but does include the entire upper peninsula, as well as the northeast quadrant of the lower one. It has more land and more counties than any other and probably the lowest population density in the state.

Its boom times came with logging and mining, exploitive industries that moved on when the resources were gone, leaving environmental eyesores that time and the CCC reforested. The soil’s too thin to support farming, the summer’s too short. The region now lives on tourists, seasonal residents, retirees, the neighboring lakes and what natural resources are left.

As I looked at the map, I realized both health insurance and abortion are problems of areas with reasonable, if not now healthy, economies. In Stupak’s district, I imagine the major health crisis is simply finding a doctor.

A study done for the Michigan Medical Society in 2005 listed three counties Stupak represents as having the fewest number of physicians per 100,000 residents: Arenac, Keewenaw and Oscoda. The last two have only one physician. He also represents three counties with high ratios, but such small populations the numbers are probably misleading: Emmett had 32,741 people in 2003, Dickinson 27,186, and Marquette 64,616.

In contrast, Kalamazoo and Genesse counties, some of the hardest hit by the state’s deindustrailization, were still in the top ten best counties for physician availability. Both had grown on lumber, but Kalamazoo replaced the paper industry with a pharmaceutical company and Genesee includes Flint. The drug company was sold, and its operations slowly closed. Even the new research center in Washtenaw county’s Ann Arbor was shut as redundant. Moore has documented what happened to his home town.

The place where I grew up, bordering Kalamazoo and Ingham counties, home of Oldsmobile, was never as rich as Kalamazoo, Flint or Lansing, but had three factories making parts for automobiles, refrigerators and televisions, as well as a community hospital built in 1924. The hospital was sold to private investors in 1967, and closed in 2002, the same year the last large factory moved operations to Mexico.

The town is better off than Keewenaw and Oscoda counties. There are still hospitals in cities 30 miles away, and it still has physicians. The roads, including an interstate, are clear most of the year, unlike the far north, but most of the doctors have Indian sounding last names.

Stupak’s district does not include a single county with an abortion rate near the state’s 12.5 per 1,000 women of child bearing age. Some have numbers so low, they can’t be reported statistically.

With so few physicians, there may be areas with no abortion provider. Women have to go elsewhere, as the residents do for any kind of specialized medical service. Some abortions may be buried in the statistics for young people who leave the region every year, and others may use unlicensed practitioners or folk remedies.

Young, unmarried teenagers, however, aren’t the only ones who seek abortions. When you read oral histories of poor areas or descriptions of folk medicine, you realize that abortion has always existed, regardless of cultural values, among women who felt there was no way they could feed another person. In areas with no self-sustaining economies, perceptions of malnourishment and deprivation may differ, but the edge of subsistence is still there.

The areas with abortion rates above Michigan’s average are all ones that have seen their industrial economies threatened since I graduated from high school: Detroit with 29.2 per 1,000 women, the rest of Wayne County with 17.1, Genesse with 15.2, Kalamazoo with 15.0, Saginaw with 14.3, Ingham with 13.7, and my home county with 13.2.

The high abortion rates seem to reflect the sense of economic desperation of people who see their incomes falling or disappearing. The health reform bill doesn’t address that root problem, only the consequences.

People, like his primary challenger, Connie Saltonstall, ask how Stupak could be against health care reform when there are 44,000 uninsured people in his district. That’s more people than live in many of the constituent counties. The bill doesn’t address the problem of shortages of doctors and nurses, only creates more demand on the existing ones and keeps the Medicaid reimbursements lower than those paid in more affluent areas with lower doctor-patient ratios.

Stupak’s views on abortion probably not only arise from his Roman Catholic background, but from the fact one of his sons committed suicide in 2000. Anyone who’s lost a child that way is likely to have a more emotional view of the value of children.

Moore may like to take credit for helping convince Stupak that many more of his voters and contributors supported health care reform than he may have thought, but Moore’s self congratulations don’t recognize that for Stupak, more than political calculation was involved, and the benefits to his district are not as great as they are to Flint or Saginaw.

Notes:
Michigan Department of Community Health. “Abortion Rates by County of Residence, State of Michigan, Michigan Counties and Detroit City, 1998 - 2008.”

Moore, Michael. “How the People in My District Changed Stupak's Mind and Saved Health Care Reform,” Huffington Post 22 March 2010.

Public Policy Associates, Inc. “The Future Supply and Demand for Physicians in Michigan,” 2005.

Saltonstall, Connie. Campaign website.

Sunday, March 21, 2010

Waiting for Godot

Despite all evidence to the contrary, we’re still an achieving society.

Since each house of congress passed a health care bill and we’ve been waiting for our elected officials to find a way to create a joint bill, the media has been engaged in an increasing frenetic search for some distraction, a holiday, a scandal, a staged event, anything to avert our gaze from paralysis in the face of deliberate obstruction.

The events that have gotten the most exposure turn out to be those that celebrate achievement. The longest lasting was the winter Olympics. The media could find no celebrity to promote and looked for some way to prove we’re still the best. They settled on medal count, but at least some who watched the broadcasts were looking for stylized achievement, not instant bloopers.

The Academy Awards came next, which gave the media an abundance of glamour to inflate. While it’s hard to separate natural gifts from achievement with actors and easy to disparage peoples’ clothes, there’s never any question that honest effort is rewarded in technical areas like special effects.

We’re now left with amateur events, the basketball tournaments and American Idol, but we’re still looking for some alternative to our political impasse - some evidence that someone, somewhere can demand our attention through their ritualized demonstrations of skill.

As an alternative, we’ve been offered dramatic displays of self-destruction: a man who flies a plane into an IRS building, a man who opens fire on guards at the pentagon, young men who commit suicide. The media has kept them in the news as long as they could, but most viewers weren’t willing to romanticize such attacks on society as a substitute for positive political action.

Our longing for people to finally solve some problem may have lead many to expect too much from Obama. It will keep us watching and hoping, and increasingly nervous until something positive does happens. It the meantime, the distractions of circuses will continue to offer some reminder of what’s possible.

Sunday, March 14, 2010

Mark Sanford

Every now and them something happens that exposes cultural fractures we don’t even suspect exist.

In 1989, Marc Lépine opened fire on female engineering students at the École Polytechnique in Montréal. This was the first of the mass student shootings, years before Columbine and Virginia Tech. His suicide letter claimed his life had been ruined by feminists.

Men were able to distance themselves from his actions by suggesting Lépine, in fact, was not a typical man. Instead, psychologists reassured them Lépine was a disturbed Catholic, or the son of a foreigner who had left him to be raised by his mother, or an abused a child who had failed at previous attempts to learn engineering.

Women could not ignore the 28 dead or injured young women. No matter how rational the psychologists’ explanations, they were frightened for themselves and their daughters.

When couples, even those married for decades, responded differently they couldn’t ignore the fundamental differences that existed between themselves and in society. The shock of the assault could not be excised.

The recent travails of South Carolina’s Republican governor, Mark Sanford, threatened to develop into a similar rift. When he first appeared before the press to confess he had actually fallen in love with another woman, a number of male reporters, including Salon’s Gary Kamiya, were sympathetic. Women, like the Times’ Gail Collins and Maureen Dowd, were more cynical, but noted it was a nice change that he didn’t humiliate his wife by forcing her to be present and didn’t treat the other woman as an object.

We’ve all suffered enough watching the forbearance of Silda Spitzer and Hilary Clinton. We’re tired of Elizabeth Edward’s passive aggression, and may have been just a bit suspicious of Jenny Sanford’s bitter comments during the time her husband was incommunicado.

Then, Sanford spoke to the press again.

Women’s views didn’t change much, but men, especially conservatives, found the personal nature of his comments disturbing. The Republican party has become a pragmatic coalition of religious conservatives and men bent on holding wealth or power who tacitly agreed neither would reveal their abiding interests.

Mark Sanford seemed their perfect spokesman, an educated Episcopalian married to woman who left Lazard Frères for her husband and four sons. But then his refusal to accept stimulus money, invoking South Carolina’s nullification crises, led some to think his lust for power was blinding him to the necessary political compromises. Now his refusal to follow the accepted method for dealing with moral transgression suggested someone who failed to understand his world.

His fellow Republicans in South Carolina, who are primarily concerned with their own reelections and pursuing their agendas in the legislature, began suggesting he was temporarily insane. Larry Grooms said "he is coming unhinged." Larry Martin. believed he’d heard "the ramblings of a troubled man" and "that man needs help."

The deeper problem is a cultural expectation that one not become too serious about anything, that passion is the mark of the unstable. If genuine excitement should arise, it should be channeled into following a sports team. When that wasn’t sufficient in the past century, it could lead to anonymous mob violence. In this century, we’re supposed to have progressed beyond that. Respectable southerners especially do not want to be reminded that cultural outlets may fail.

Many Canadians marriages are not the same after Marc Lépine, and neither will Sanford’s political life. Genuine shocks always do isolate people, no matter how unruffled the surface remains, and only a few outsiders are willing to learn from them. Resorting to using psychologists as gatekeepers of the damned only limits the utility of our tools for coping with crisis.

Notes:
Wikipedia article on the École Polytechnique Massacre provides a good summary.

Barr, Andy and Jonathan Martin. "South Carolina GOP: Mark Sanford Must Go," Politico 1 July 2009, interviews Grooms and Martin.

Collins, Gail. "An Affair to Remember," The New York Times, 1 July 2009.

Dowd, Maureen. "Rules of the Wronged," The New York Times, 30 June 2009.

Kamiya, Gary. "The Strange Nakedness of Mark Sanford," Salon, 25 June 2009.

Sunday, March 07, 2010

South Carolina - Doubt

Historians are attracted to comparative history because it provides the more scientifically minded a way to look at their subject from an outsider’s point of view. The hope is that comparisons will reveal the universals of the human condition and show the points of uniqueness that our cultural blinders prevent us from seeing.

When one looks at the investigations in Charleston, South Carolina, in 1822 into a possible slave insurrection, the ones in Salem, Massachusetts, in 1692 into acts of witchcraft, and the ones described by Carlo Ginzburg in Friuli.between 1575 and 1644 one sees a similar pattern: progression from doubt to belief.

When churchmen in Friuli interviewed the first man with special powers, there was such a disjunct between the questions and answers that they dropped the case because "he told other tall tales which I did not believe, and so I did not question him further." It was only when another individual, one more knowledgeable about witchcraft, became probing that the Holy Inquisition believed it had uncovered witchcraft.

Similarly in Charleston, when James Hamilton, Jr., first interviewed Peter Poyas and Mingo Harth, their treatment of the questions with disbelief led him to think the possibility of a plot only lies. It was only when a second man, John Lyde Wilson, reported similar comments from a second slave that the Charleston city council acted.

In both cases, events moved from doubt to certainty, and once that change in attitude had occurred, there were never more questions about the existence of either the witches or the slave conspiracy.

In Salem, there appears to have been little initial doubt about the truthfulness of the early accusers: they weren’t peasants or slaves, but the daughter and niece of a respected churchman, Samuel Parris, and their accusations came after physical fits observed by several witnesses. The magistrates took protestations of innocence as proof of guilt, and meted milder sentences to those who confessed. It took the refusal of Giles Corey to go to trial to shake their confidence that they were dealing with real acts of witchcraft.

Historians have taken the final judgements to be the true ones, to question the events in Salem, but not in Charleston or Friuli. And so, we wonder what were the social, economic and psychological factors that precipitated Salem, but accept the reality of a slave mutiny and so don’t ask why Charleston in 1822, why not 1812 or 1832.

The acceptance of doubt took different forms in Charleston and Salem. The second was still a Puritan society, even if it had moderated its beliefs since 1620. People still believed in predestination, that God decided before individuals were born if they were saved, and nothing individuals could do would change their state of grace. At best, they could look for evidence of proof, as the magistrates had looked for evidence of witchcraft. However, they could never absolutely know if they were saved.

Jacobus Arminius disagreed with Puritan theology and argued God had granted man free will with which to accept or reject God. It was individuals’ decision that determined if they were saved, and if they made that decision there was no doubt about their state of grace. His beliefs informed the great Methodist revival that swept the country in the 1740's, and would influence the revivals that were to come in the next decade in the south.

Roman Catholics and Episcopalian Charlestonians, of course, would never have considered the question. They were saved by virtue of following the practices of the church. Doubt was not a concept, only certainty.

And so, the event that occurred in an environment where people lived with doubt, is treated with doubt today, and the ones that occurred where people saw doubt as proof of their failure to believe are the ones that are accepted as fact today. It may be no coincidence that the historian who felt the need to use comparative history to escape the bubble of culture, Frank Tannenbaum, was investigating the institution of slavery.

Notes:
Ginzburg, Carlo. I Bendandatti. 1966, translated as The Night Battles by John and Anne Tedeschi, 1983.

Tannenbaum, Frank. Slave and Citizen, 1947.