On the economic geography of health care

"Health care in America is in crisis" is a serious understatement. It will only get worse!

Consider, for instance, employment.  We tend to assume that health care is a growing industry and, therefore, that is where the income stream is, right?  Yes, jobs are there, but ...

Yet for every higher-paying job held by workers like nurses and doctors, more than six workers such as orderlies, phlebotomists and cooks make less than $15 an hour. Nationwide, 70 percent of hospital service workers make less than $15 an hour, NELP found. In the Midwest, it's 71 percent.

Now, the $15/hr might sound like quite a compensation to a person in Bihar.  But, ahem, a cup of coffee is not 15 rupees either; there is the cost of living:

Most counties in the U.S. have a cost of living across industries that isn't covered by minimum wage incomes, according to a recent blog post from Amy Glasmeier, a professor and co-chair at the Massachusetts Institute of Technology's economic geography and regional planning Ph. D program.
For instance, in Chicago, a single parent of one child needs to earn $24.67 an hour to meet a definition of living wage, while a person living alone there needs at least $12.33, based on a living-wage calculator  developed by Glasmeier in conjunction with MIT.

At least the cities are better, when one looks at health care in rural America; "half of the country's rural counties now don't have hospitals with obstetric services":

Maternity care is disappearing from America's rural counties, and for the 28 million women of reproductive age living in those areas, pregnancy and childbirth are becoming more complicated—and more dangerous.

One important factor is nothing but dollars and cents:

If hospitals want to offer obstetric services, they need to be ready for a baby to be born at any time—they need to have a bed available, the equipment available for mom and for baby, clinicians and staff available that have the necessary skills. That's a substantial expense. If a hospital's revenues are limited because it has a low volume of births—as many rural hospitals do—or if revenues are unpredictable, that creates a really difficult administrative problem.

It is exactly in such situations that we expect the government to step in where the market fails, right?  Especially when you consider this: "Medicaid funds about half of all births in the United States, and an even greater percentage of births in rural hospitals."  So, if these health care services for pregnant women are gone ...?

State and federal programs to support the rural maternity workforce are crucial. There ought to be programs to support training in emergency births in rural communities that lose obstetric care, and to support the costs of providing maternity care in communities where there are willing providers.

trump and his 63 million voters can fix this all with a complete repeal of Obamacare, right?

Were Adam and Eve the first ever to fuck?

I doubt that I knew anything about homosexuality when I was a kid.  I was drawn to girls from a very early age, though the feelings were forcefully repressed and buried deep down thanks to the screwed up social mores of those days.

As I got older, I have always wondered whether the love for the other sex does not preclude satisfying physical relations with the same gender.  Not having tested this out myself, I can only rely on what scientists and commentators have written about, and it seems like sexual fluidity is for real.

Whether or not straight people have sex--or fall in love--with others of the same sex, the more I have walked away from the old traditions of the old country, the more I have wondered what place law has in who people love, or who they have sex with.  I can even understand the religious orthodoxy issuing decrees on what makes something a sin.  If people do not like those religious decrees, then they can always shed that religious cloak.  But, the law?  One cannot simply walk away from one country to another, right?

In the old country, homosexuality as a crime was leftover from the years of the bastard empire's rules. A free India merely replaced the white masters with home-grown brown masters.

The criminalisation of homosexuality or what is popularly referred to as Section 377 of the Indian Penal Code (IPC) dates back to 1860 when the British introduced it as sexual activities against the “order of nature.” ... The roots of the legality, however, can be found in European culture which for a long time had influenced Indian ways and thoughts.

We then have to ask ourselves where the white colonizers got the idea that homosexuality is not the “order of nature.”

Britain was Christian, though Catholics and Protestants killed each other in the name of Christ!  In the narratives that developed a couple of centuries after the death of Jesus, Saint Augustine invented the story of sex:

He needed to understand the peculiar intensity of arousal, compulsive urgency, pleasure, and pain that characterizes the human fulfillment of desire. He was not looking back on these feelings from the safe perch of a diminished libido, or deluding himself that they were abnormal. As a young man who had already fathered a child, he knew that, for the entire human species, reproduction entailed precisely the sexual intercourse that he was bent on renouncing. How could the highest Christian religious vocation reject something so obviously natural? In the course of answering this question, Augustine came to articulate a profoundly influential and still controversial vision of sexuality, one that he reached not only by plumbing his deepest experiences but also by projecting himself back into the remotest human past.

Or, to put it in simple words, Augustine had a penis problem!

How weird it is, Augustine thought, that we cannot simply command this crucial part of the body. We become aroused, and the arousal is within us—it is in this sense fully ours—and yet it is not within the executive power of our will. Obviously, the model here is the male body, but he was certain that women must have some equivalent experience, not visible but essentially identical.

So, what did Augustine do?

Augustine’s tortured recognition that involuntary arousal was an inescapable presence—not only in conjugal lovemaking but also in what he calls the “very movements which it causes, to our sorrow, even in sleep, and even in the bodies of chaste men”—shaped his most influential idea, one that transformed the story of Adam and Eve and weighed down the centuries that followed: originale peccatum, original sin.
This idea became one of the cornerstones of Christian orthodoxy

Augustine blamed his own penis problem on Adam and Eve's sexual relations!

That whopper of an explanation from 1,700 years ago bled into Catholic, and later Protestant, doctrines, which the white settlers brought to the United States too.

In his deeply researched new book, Sex and the Constitution: Sex, Religion, and Law from America’s Origins to the Twenty-First Century, Geoffrey R. Stone gives his answer to these and other questions about our country’s regulation of sex, with a special emphasis on same-sex activity. According to Stone, a scholar of constitutional law at the University of Chicago, Christianity has exerted the biggest influence on how we have addressed the issue from colonial times to today. The “central theme” of Sex and the Constitution “is that American attitudes about sex have been shaped over the centuries by religious beliefs—more particularly, by early Christian beliefs—about sex, sin, and shame.”

Stone reminds us that life was different in the pre-Christian, pre-Augustine Europe:

In a brief survey of sexual attitudes in the ancient world, he blames the early Christians for having taken all the fun out of sex. In pre-Christian times sex was considered “a natural and positive part of human experience” and not “predominantly bound up with questions of sin, shame, or religion.” He echoes previous scholars in finding that “classical Greek morality and law focused not on sexual sin, but on whether an individual’s conduct was harmful to others.”

The missing link between Augustine and the British sodomy laws?

If Stone holds Augustine responsible for promoting the idea of sex as an evil force, he presents Saint Thomas Aquinas as “the man most responsible for the hardening of the Church’s attitude toward same-sex sex.” Aquinas “systematized and expanded upon Augustine’s thinking.” His Summa Theologica (1265–1275) “rewrote the whole of Christian moral theology” and pronounced same-sex activity, which could not be for procreation, “especially contemptible in the sight of God.” Aquinas distinguished sinful acts carried out by opposite-sex couples from the sexual activity of same-sex couples. The latter activity was per se the “more grievous sin.” The church conferred formal authority on Aquinas’s views on these and other matters at the Council of Trent in 1563.

At some point in time, the sooner the better, we better develop for ourselves an understanding of what it means to be human, which will then provide clear answers to questions such as who the fuck cares what Adam and Eve did!

Many shades of grey

During the couple of years before the faculty union blacklisted me, I used to engage in conversations with colleagues.  In one of those in-the-hallway chats, an adjunct faculty and I got to talking about imperfections in humans, especially the political leaders who transformed societies for the better.

We talked, in particular, about Gandhi and MLK.  And we both agreed that it does not help anybody by making them saint-like.  Instead, we ought to understand and appreciate them warts-and-all.  Such an unvarnished image then will help us understand that ordinary mortals like you and me were able to do so much, which will be way more encouraging to the youth than if they thought that one had to be super-human of sorts.

The adjunct's contract was not renewed, and I lost touch with him.  I tell ya, anybody who thinks like me doesn't last long.

During the road trip a few weeks ago, we were far, far away from anything and anybody familiar, when I heard a voice.

"Sriram?"

I turned around.  It was a former colleague, who was my lunch-mate during the couple of years he worked at my university.  I warned him in one of our early meetings that if he and I agreed so much, well, he might not last long on his job.  At our final lunch, I reminded him about my warning.  We both laughed.  And now after a decade a random encounter!

Anyway, back to Gandhi and MLK.  It is not that they had moral clarity from day one of their adult lives, and it is not as if they did not err in their daily lives.  Mistakes were in plenty.

Take Gandhi, for instance.  Most of us are familiar with his years in South Africa, which is when we began to understand white supremacy and, therefore, his own brown-skin standing in the bastard empire.  However, Gandhi in South Africa was not very much different from the white supremacists there, when it came to their views on the "native" Africans.  Gandhi thought less of black Africans, and his struggle was only to elevate the status of Indians like him who were there in the bastard empire, which he was not really fighting against.  As his biographer, grandson, wrote:

After all, Gandhi too was an imperfect human being. ... The imperfect Gandhi was more radical and progressive than most contemporary compatriots.

And by the time he became the Gandhi that we usually think about, he had become way less imperfect.

There is no need to create a false Gandhi here that ignores the real Gandhi since the real Gandhi is himself such a historical exception. And, of course, the fact that the real Gandhi was only remarkable – but not perfect, as per today’s moral standards – is also nothing to be ashamed of.

Gandhi was imperfect like the "deeply racist" Thomas Jefferson, about whom I have blogged here. Over the years, the more I understand the imperfect Gandhi, the more I have walked away from referring to him as a "mahatma."  But, while recognizing their imperfections, we ought to know better than to equate Gandhi with Churchill, or Jefferson with Hitler.  I am thankful that, Gandhi and Jefferson, despite their imperfections, worked towards constructing a positive, healthy vision for humanity.