Community Health

Critical Politics

Do not worry about these brief essays for editing. None of them have been.

The analysis of public response to the Great Recession of 2008 reveals similar errors compounded in the Pandemic of 2020.  The failure to produce a system change from the private and public realms regarding these two instances is evident and a little frightening. Now is the time for writers to demand improvements in critical thinking from every mountaintop.  It was not until political interference was exposed in the POTUS45 DOJ investigations that the possibility of a similar financial manipulation occurred.

Financial service companies, insurance agencies, and families went underwater on bad loans and poor judgment. Thousands of people have become sick and face financial disaster. A high percentage of the most vulnerable to infections have died. Fire, flood, drought, and a rising sea is encircling cities all over the world. Ending what is beginning to look like the tragic cycle of change requires a summary of the public response to correcting the “money” problem. Money, faith in trade, and its use for the oblivious accumulation of goods are the root cause of this trouble. The use of it dominates the argument and the conversation. It is accurate but a distraction to the purpose of consequence. More plainly, my super wealthy grandparents just said, you cannot take it with you, and we (all of us) should only get a leg-up on confidence with a dose of tenacity.

In 2008, the American business community won the case – use federal funds and reestablish aggregate demand, sustain liquidity for global trade, and keep employment up, but income marginal in a high percentage of households. Attack tax rates, government interference, and expose public incompetence. Continue to reduce and weaken mechanisms for public oversight of private financial practices. These are highly persuasive claims and strategic practices from the business community. They draw values such as individual freedom and independence that took over two centuries to establish a Republic built on a foundation of slavery.

The struggle for the freedom of all people remains unexamined. Civil rights, social justice, equity, and a basic “leg-up” is falsely claimed as a strain and a distraction. Despite the depth of the 2008 and 2020 global economic tragedies, several questions go unaddressed disproportionality.  Why wasn’t it disproportionate when eight percent of the households in a Georgia county were slaves? That isn’t the issue today, but The Report has comparable questions.

Why does the world function as if the acquisition of equity is the only means of power? Where are their attempts to succeed with alternatives? The vote seems a possibility. Yet, the dividing lines tell us to separate the ability to meet human needs in the private marketplace from those found essential to the validity of a public realm.

Only one modern American hero has a national day of remembrance for the courage it took to lead his challenge in the public realm. His agony became ours, and his name was Martin Luther King. He was murdered in 1968 by something much bigger and more heinous than the racism of his era.

King’s anguish for justice held the U.S. Constitution to account first, but this did not extinguish his view on the economics of politics. He believed the solution was not in a “thesis of communism or an antithesis of capitalism.”  His demand was for synthesis based on two facts. An economic system built on slavery and imprisonment will not change the rules. Change must, therefore, come from changing something else.

“I am now convinced that the simplest approach will prove to be the most effective – the solution to poverty is to abolish it directly by a now widely discussed matter: the guaranteed income…” MLK

Where do We Go from Here? 1967

The economic crisis of 2008 and the health and financial crisis of 2020 has one word that tends to stop any discussion of change dead in its tracks.  That word is “debt.”  Less understood is the concept of equity as it is a thing larger than cash.  An accountant will tell you that “equity” combines your assets and liabilities. One of the first pre-eminent sources of it in the United States is homeownership. With the help of government mortgage guarantees, it is the prime asset held by most Americans. Still, confidence and trust in each household is the one thing that makes the liability expressed by a mortgage possible. Thus, the question. If it is confidence, where are the approaches to building it anmog those to which it is denied.

Recently the idea of retaining that trust and confidence was expressed by none other than the American Enterprise Institute in a map of the United States they tweeted to the world. The map illustrated the relative GDP of individual American States with other countries globally so that people would be more confident – to trust the system.  I would call your attention to Wisconsin before you read the next paragraph.

Source: here

In response to the pandemic, Europe understands the “system exchange” relationship between public and private equity.  I have one example of why Wisconsin should have no difficulty changing their health care system if they were like Denmark.  The Denmark government stepped forward to continue paying wages even when they were not working.  People kept their jobs with their employers.  Denmark retained some business and family income and stopped the COVID-19 virus from spreading efficiently. The policy maintained the cultural status quo of the nation’s steady anticipation of ending the crisis. Denmark’s business activity restarted with as little cost and disruption.    

System Change

I have a request in closing this bit of critical thinking about the need to produce a system change first with the idea that this would allow the rules to change. The first is to ask you to conduct a brief exercise, followed by taking the concept outlined above further in some way and sharing it with this blog – a link would do.

The habits of the mind that contribute to critical thinking involve the following types of thought.  The first one should be on the word critical. In health, the word describes a “short-term” condition. Here is a quick exercise.  Run through the following ten words in ten seconds, asking.  

What is?

  1. contextual perspective
  2. confidence
  3. imagination
  4. elasticity
  5. inquisitiveness
  1. intellectual integrity
  2. intuition
  3. open-mindedness
  4. perseverance
  5. reflection

If you had a rapid response to each one of them, know three things 1) you have some or all the skills listed below, and 2) if it took even a bit longer than ten seconds, more work on “critical” thinking is essential and 3) they are just words — you can pick your own ten if you choose.

  1. analyzing
    1. break the whole into parts to discover practical relationships
    2. list the parts piece by piece
    3. sort the things into things
  2. applying criteria
    1. judge using well-known rules
    2. apply personal, professional, and social standards
    3. compare and assess the means
  3. discriminating
    1. recognize differences and similarities
    2. rank things together or separate in groups
    3. differentiate categories or decern status
  4. information seeking
    1. evidence
    2. facts
    3. sources
  5. logical reasoning
    1. inference stated
    2. conclusions made
    3. basis of evidence
  6. predicting if that then this
    1. envision events
    2. plan futures
    3. determine possible consequences
  7. transforming knowledge
    1. changing conditions
    2. converting function
    3. alter concepts

Pick Your Own

Critical thinking can be brief, momentary, temporary, short-lived, impermanent, cursory, fleeting, passing, fugitive, flying, and like lightning.  It can also be transitory, transient, temporary, brief, fading, quick, and meteoric. Not being curious enough is a problem — inquisitiveness exercises human intuition. It helps a person run inference, seek integrity, and demand contextual change.  Therefore, differentiating the language as becoming more demanding, or obscure, improves hearing.

Just after the election of POTUS45, one message kept getting repeated about the need to produce change at the local level that moved to the city, county, and state governments.  Only then would a change have a chance for federal legislation or be recognized as a new cultural norm. The example given most often was the demand to make laws governing marriage far more inclusive.  The changes began locally but rapidly across the United States.  The rules change issues regarding women’s rights and voting rights. All are noted here because few of them go unchallenged, and all of them require leadership demanding a civil discourse and faith in the law. The following table or chart is one of the easy-to-read summaries of the process.

To solve problems adequately or ask more satisfying questions. The Report uses the following chart to create a change.

Contact

Earth’s Fifty!

No doubt that urbanization has been a messy business. The rapid pace of development over the last couple of centuries has led directly to life-threatening conditions in a rush to mechanize every aspect of life. People were packed into camps to harvest forests of wood, mountains of granite, and every available mineral with trade value. For thousands of years, absolute command over the environment has been the central organizing force, from tribes roaming the prairies for fruits, grains, and meat to the construction of massive urban towers to sustain these endeavors across the globe. I am therefore comforted with the knowledge that it has only been fifty years since we noticed the mess and began efforts to make improvements.

Whenever infection has taken a life, it did it wherever people gather. In strict epidemiological terms, the more significant the diversity of people in a natural gathering area, the more likely the subtle protections of the human immune system will protect all. Concerning human medical history, this is relatively new data. Today, more people know the biology of DNA finds all humans to be identical. They are learning that physical differences are unique, beautiful, even exciting but fundamentally meaningless.  In just the last few decades, this knowledge is filtering an entirely new value system into American culture and mostly in urban areas.

There is no stable connection between urban areas and coronavirus impacts. What is significant is how cities manage an infection with compact actions and resource preparedness. Dense cities such as Hong Kong, Seoul, Singapore, and Berlin have contained COVID-19 very well. Where greater preparedness is needed, suburban cities such as Detroit, Michigan, Macon, Georgia, and New Orleans, Louisiana, suffer right alongside dense areas like New York City with a similar impact. 

In past attempts to solve urban social problems, the focus has been on eliminating inhumane physical conditions, it also had a tendency to place blame on people trapped in them. The effort to uproot the causes of their plight and poverty was intellectually criminal because good people did little on the larger issue. The failure to criticize the social and economic order as a principle reason continues to this day. It was fully expressed by the inhumanity of two world wars. The enormous successes of the nonviolent anti-war revolution for civil rights through the end of the 20th century reveal the courage of ordinary people. It also exposed an increasingly reactionary American culture due to the mere tinkerings from the top down on the edges of greatly needed reform.

Only recently, has relief from the view of urban life as unhealthy begun to fade. Hundreds of new and exhilarating urban places found expression in cities like New York throughout the country. For decades the history of urban success builds on the city’s capacity to identify and resolve the causes of potential disorder. These causes can be intense or subtle actions, but all are well-studied and tightly defined by deeply funded social science institutions and economists. Leadership and the flow of information in urban areas through interagency communication efforts allow course corrections and rapid policy changes in response to community demand. While many of the city’s top leaders have been taught hard lessons over the years, they remain well served by the deep structure of nonprofit city-wide and community-based institutions throughout the city. Without this structure, the distribution of essential resources during a city-wide emergency of any kind would be impossible to deploy.

The deep structure of urban governance produces trust in its diagnostic capacity for defining problems and then acting to get solutions. The city has taken its lessons in neighborhood economic disinvestment to create new kinds of banking institutions. Other social innovations help purge deterioration in rental housing before it spreads or in the case of the city’s public housing stock expose the failure of city and federal commitments in exquisite detail. Most recently, the city has focused on the depth of its communications resources to slow the spread of a pandemic with efficiency. Holes in its safety net are recognized with laser-like first responder precision and with this exposure repaired with the substantial institutional depth the city can muster.

Public institutions produce solutions to attacks on the quality of life by helping us to understand in highly sophisticated ways how and why we attack one another. The lessons through decades of urban crisis at various levels of impact continue to reveal the need to prevent and respond dramatically to the “tragedy of the commons” problems. The shared commons of the city are easily recognized by residents as our public health, education, open space, and transportation systems.  On this point, there are futures all dense urban areas must carefully evaluate in the aftermath of every crisis.

Public Health and Education

There is no doubt, improvements in human health and education systems occur by fully defining the health concerns produced by commonly used environments. With this responsibility, a deepening in our common understanding of the issues depends enormously on the quality of public education. Today the practice of investment in health and education is grounded in policies to eliminate inequality and build better pathways to equity. We know as an undisputed fact this eliminates a long list of the health and economic disparities in life for all people. We have benefited from previous generations who also demanded reform with a noble cause. Nevertheless, we also know that many of the actions for transformation failed by forcing displacement and rehousing few. In the last fifty years of the 20th century, attempts to demolish homes, cultures, and the economies of entire neighborhoods produced a valuable urban institutional resistance defined by two words, “never again,” but as political leaders (as all of us) admitted to errors and vulnerability, the entire city learned to accept a new kind of strength.

Public Infrastructure

Parks, open spaces, and transportation networks of the urban public realm are assets of the reform movements and business interests of previous generations. The so-called ‘lungs of the city,’ expressed by an extensive park system, and tree-lined streets are also like the city transportation infrastructure. Neither is a static or unchanging system, and both desperately need to improve as a safe, seamless, and unfragmented component of urban life. The well-tended park reminds us of the self-cleaning capacity of nature, the same role for mass transit can occur with the same principles of self-protection.

The Way Forward

The COVID-19 crisis offers many opportunities for reflection on the importance of national moral leadership and responsiveness, but there are more pressing issues. First, this recent crisis brings to the world a second major challenge to the quality of life on earth. Second, the vast landscape of human knowledge is at our fingertips. Third, this should make us all reasonably pleased, and this is why.

The science of geology states with confidence that the earth is about halfway through its 18 to 20 billion-year life cycle. For all the analysis of all the other “x-ologies,” we value; this alone should give people good reasons to take a deep breath and reflect.

New pathways for the growth of humanity in cities we are building all over the earth for the next few thousand years are here today, waiting for continuous improvements. Long waterfront parks will expand urban resilience as each reaches to extend its pleasures in an unfragmented, linked urban park system from the hills of the wilderness into the valleys of every neighborhood. All the massive structures constructed by our forebearers for public education and health await reinvestment and re-invention as centers for learning. We can make them all cleaner, brighter, and more beautiful than ever before. We will move with confidence onto the swift, super-clean, and revitalized mass-transit system for access to these exciting new resources. Every crisis tells us just one thing. We have more work to do.

Know the following things:

It Is too late for sustainable development because the public discourse has difficulty with subtle, conditional messages so realize that.

  1. Growth advocates change the justification for their paradigm rather than changing the paradigm itself.
  2. The global system is now far above its carrying capacity.
  3. We act as if technological change can substitute for social change.
  4. The time horizon of our current system is too short.

This is why the term resilience is now used more often than not.  The main changes are upon us and Dennis Meadows who say the above is right.  It is time to invest in resilience.

The estimates for a stabilized and sustainable world called for about 3% of the world’s GDP.  Resilience will cost more than that, but now there is no choice.

Dancing with the Bear

The following introduces trends in professionalism. It is an excerpt from a more substantial project entitled: The Four Problems. The focus of that effort is on planning, architecture, and engineering. The challenge to all professionals today suggests that the dance with the bear has begun, and we can’t stop until the bear stops.

Three Steps of a Four-Step Dance

There are three steps in developing “professionals” in meeting human needs, interests, and concerns. Historically, professional services began in response to a widely accepted set of cultural functions such as healing, leading, and building. A millennium or so later, these functions become more specialized. For example, the healer becomes a surgeon, leaders become law officers, and builders become architects and engineers. Finally, as the culture matures, licensing and certification assure compliance with well-established standards of practice by governing bodies with enforcement power and policies that support internal and external niche functions.

These stages suggest a fourth – the rapid development of interprofessional education to support radically new and deeply needed practices. The implication is an increase in technology transfers between professions with advanced applications and the exchange of data sets for quantifying everything by gram per second in the erg economy. Examples are (political) (economic)

The ability to manage change from minute to minute and, in some cases – milliseconds or decades is a new professional capacity. It is possible to imagine a flawless transportation network, zero-waste systems in building practices, and net-zero energy use with this power. Substitutions and commutation of data between these activities lead to rapid improvements in every aspect of urbanization. We only need to solve the four problems mentioned above (here).

In just the last half of the 20th century, the service economy grew to nearly eighty percent of employment in the United States. In just a few generations, highly trained professionals have discovered an array of new specializations. For example, access to the technology of interprofessional education allows physicians to build a digital model of a patient’s beating heart and petition for the power to prescribe safe housing. Likewise, law officers can replace the prison and chain response to choose hundreds of new intervention tools for building a culture free of fear.

As 2020 began, communities worldwide became confronted with the task of redefining problems in a categorically different fashion. The contagion expressed as SARS-CoV-2 (the one that causes COVID-19), MERS, EBOLA, and others are real symbols in the broad context of climate. The climate of threat is known, but without direct experience, unease becomes the primary evidence of the senses.

The ill-feeling of separation or polarization by forces not fully understood can be relieved. An effort to understand the usefulness of that feeling grows because everyone has it. The central lesson of the first 21st c. pandemic will be to figure out what this sense means to help make it good and not bad. Given limited knowledge of the epidemiology of a viral contagion, it is logical to consider dense areas as to cause but, more importantly, as a source of cures.

Over half of the population of the world is urbanized very poorly. Here, a well-thought-out protocol for ending or expanding the threat of global contagion is effective on multiple fronts. First, the rapid deployment of a testing regime within a limited area with extended containment is possible yet considered unlikely. Second, the source of a good defense is in the bodies of those held for care or distributed lethality. The deployment of serological tests can be as quick as a McDonald’s drive-thru to identify an infected person. Third, serosurveys figure out how widespread a virus is among people who remain asymptomatic. Fourth, define the human antibody response and the possibility of an immune reaction or not becomes Combined. This “urban health data” can lead to stopping the potential of a pandemic. (see details in Contagion (here). It comes down to a question of readiness.

Dense urban areas such as New Jersey (the densest suburban State) and New York City may be hard. Still, they also offer the best capacity for intervention fueled by data and backed with the ability to initiate clinical trials as proof rapidly. The issue was summed up succinctly when State Governor Andrew Cuomo pointed out that we knew COVID-19 was identified in China as early as November 2019. Still, they did not confirm until early January, and so he made a demand.

“…the federal government should decentralize testing and give it to the states. I have 200 labs in this State. Let me use my 200 labs. Why am I waiting on the FDA and CDC?”

(News Conference 16 March 2020)

The State of New York acquired the authority to proceed. Most of those labs are in New York City. The element to remember is the concept of readiness and the effective use of unique human power – the ability to analyze, understand and act. Because events with a global impact can occur without significant warning, the lesson already learned regards the first-level response to energize analysis, define the problem, and determine urgency. All of us know this as a well-known national defense protocol – DefCon One to whatever. Unfortunately, the professionals in microbiology labs got nothing; action did not occur at the national level until a State Governor demanded it.

In the urban world, well before a large construction project begins, technology provides the architect and engineer with services to model highly complex systems in virtual environments envisioning entirely new frameworks for social and economic interaction. For example, these systems suggest the ability to document and envision the impact on a hospital system during a health care crisis; it can mark the flow of every ounce of water, watt of power, and a liter of air in every tube, wire, and opening serving urban life.

Systems with such data authority for day-to-day use or crisis are not a fantasy as their integration is already more fully imagined than a dream. Moreover, these practices have tangible demonstrations that allow any attentive person to conduct their Bayesian inference regarding forming the harmless city. Recognizing the three stages of professionalism as essential to creating new professions establishes the fourth level of enormous importance, but it must be aggressively defined.  Ending the isolation of specific professional skills will lead to the active implementation of anti-silo tasks capable of fully developing the city as a single, fully integrated, undamaging earth entity.

Too many technical proficiencies are organized vertically like silos; they symbolize data segregation because they give their occupants special impact abilities. Examples are seeking competitive opportunities, targeting specific clients or competitors, isolating geographies, and insulating technologies for business purposes. As such, the lack of encouragement or opportunity to negotiate new elements that function laterally within governments, businesses (or groups of them) can be damaging, possibly deadly. An often-used phrase by planners to describe problem-solving is a policy (mostly public) that must end. It is called “catastrophic resolution.”

In attacking the downside of these practices, the four problems I have begun to define call for the city’s recognition as a single construction and rehabilitation problem. It will engage the entire social and economic context of the urbanized earth. With this view of the city as the essence of human existence, I address the need to radically alter the traditional contract arrangement responsible for building cities and connective tissues. The urbanizing earth is singularly crucial to the quality of every aspect of all life. In this context, I attempt to define the professional realignment problem more thoroughly.

If you want to know when the first phase of this effort ends – let me know (here).

American Health Care Crisis

The “If Not Now, When?”

Since 2010, 100 rural hospitals have closed, and another 430 are at risk, yet 30 million Americans cannot get regular care, of which 63% are racial and ethnic minorities. These are the facts, the American health care crisis ends when everyone will routinely see a doctor regardless of their income.

Danger+Opportunity

A crisis is composed of two “hanzi”– danger and opportunity. Now more than ever in American history, everyone needs primary and mental health care, dental, and low-cost prescription drugs. To help make that happen, the Defense Production Act authorizes resources of the National Guard, the Army Corp of Engineers, and others to assist providers in opening shut down hospitals, support existing facilities and expand community health centers in every community. Activating the Medicare System to pay for all COVID-19 emergency and related medical bills is the way forward. Do it now. Don’t argue with zombies.

The Real Test: Solving the Economic Crisis

  1. No layoffs, a livable wage, equity to the government, and workers on corporate boards
  2. Use Federal Reserve under section 14(2)(b) will buy short-term municipal debt securities.
  3. Stock buybacks and bonuses for executives will be banned
  4. Ensure no corporation profits from the economic pain of COVID-19 people
  5. Ensure every employer in crisis gets emergency credit extensions and loans
  6. Suspend all Farm Service Agency loan payments  
  7. The government will price all prescription drugs developed with every known form of tax code/taxpayer dollar and take patents from pharmaceutical companies for emergencies and for cause due to violations, give license to generic companies.

All crises are opportunities, even COVID-19. Many small and medium-sized businesses will go out of business. The large corporations will seek and take new markets. We need resources to document our prevention failures in health and economics. We will need to know who, how and where these failures occur, region by region, state by state. The unintentional impacts of ‘for the good financial care’ need to be understood because it can suppress thoughtful interest and protest movements. It also provides time for “big-capital” to choose what it needs and take what it wants even as it adds public resources to continue downward pressure on American wages.

Consider how direct-cash-payment for small and medium-sized businesses payrolls extends the economic crisis if it includes $2,000 cash payments per person/employee every month as needed. That 40% of our people who could not afford a $400 emergency is moot as it is unlikely to occur all at once, and yet now seems possible. A moratorium on bills due (i.e., evictions, foreclosures, utilities, mortgages) could be one of those everything all at once $400 problems so again, to “who, how and where,” we must add when.

More capital and expanded capacity for existing safety net programs are desperately needed, but ineffectual for systemic change. Unemployment insurance to cover 100 percent of prior salary with a cap at $75K/year could also command some brain-power participation by advancing a job/GND/health corps challenge. Do not waive the payments on student debt held by 45 million Americans due to the COVID-19 crisis without paying down a sizeable chunk of the principal on the $1.6 trillion we now hold. On that point, set a precedent with that down payment in a way that will assure a future of tuition-free public colleges, universities, and trade schools.

My Hometown

The single greatest asset in my Congressional District (CD9) is a vast combination of health service and education institutions that are in part, a testimony to the chaos of the American Health System on the one hand, and a story of extraordinary health service heroism in the United States on the other.

The American Community Survey ACS estimates a total of 691,000 people have health insurance of which 430,000 have private insurance, and 318,000 have public coverage. About 65,000 people are without coverage. The Susan Smith McKinney Nursing and Rehabilitation Center, the Kings County Hospital Center and the Downstate Medical Center are the district’s largest employer and an excellent partner in seeking the means to provide effective service to low- and moderate-income households. Because of this economic fact, they struggle mightily to provide essential ounces of prevention too often highly distressed population, and for the lack of prevention, hemorrhage frightening levels of debt in the pounds of cure we call our hospitals.

The above was sent to plan@berniesanders.com. It was a great run, Senator Sanders. There is no reason to slow down now, just point yourself in a slightly different direction. You would have been a great President of the United States. You made a new path by walking for all of us. Thank you.