Healthcare for the lucky ones among us.

I am definitely one of the lucky ones: senior citizen with no chronic ailments and with access to Medicare and private insurance. I can choose my doctors (sort of) and usually do not have to wait a long time for appointments.

Thinking about fellow citizens who are uninsured or under-insured, I took time to add up what I spend annually on health coverage. Counting mandatory deductions for my Medicare coverage, premiums paid to private insurance companies, and the fee my internist charges for “concierge medicine,” in 2019 I spent about $9,000.00 on health care. Again, I do not suffer from chronic ailments and nothing happened in 2019 that required more than routine maintenance.

Could I cut back on my annual expenditure for health care? Yes, I could forego “concierge medicine” and sign up with an internist who does not charge a fee. That is, I could do so in theory. Finding another competent internist in my community who accepts new patients is another matter.

In my case, the best option is to do nothing. I can afford to spend about $9,000.00 annually on health care. But what about the large majority of my fellow citizens who cannot? We are generally aware of the number of people who seek medical help only when they are desperate; we know why many people show up in emergency rooms all across this country. What about the much larger number who forego preventative care from the day they are born? What about the seniors who have health coverage in theory, but are told “sorry, Dr. X does not accept Medicare patients.”?

What is truly alarming is that millions of my fellow citizens experience this reality and accept it, having been told over and over again that in this country we enjoy the best healthcare system in the world. An enormous and enormously profitable industry feeds this myth with help from the medical establishment and many elected officials. Nobody, it seems, is willing to explain to the American public the difference between cutting-edge medical research and treatment, in which we excel, and plain old public health, in which we fail day after day.

Coronavirus: an opportunity to change course.

Daily news reports highlight areas of our society on which we should have focused well before disaster struck:

HEALTH CARE: the heroic efforts of thousands of healthcare workers cannot fill the gaps we have accepted for decades: uninsured and under-insured families; the high costs of hospitalization and prescription drugs; the evident imbalance between ever more specialized physicians and primary care/family practice physicians.

EDUCATION: the dedication of thousands of teachers and professors cannot fill the gaps between technology haves and have-not; traditional models for financing education at all levels, especially tertiary education, widen those gaps and discourage innovation in developing and delivering instructional programs.

JUSTICE: we have known for sometime that too many Americans, especially males from minority communities, are incarcerated; the privatization of prisons is a significant factor in our reluctance to do what criminal justice experts and many law enforcement officers recommend we do.

ECONOMICS: the practice of gauging economic success by employment rates and stock market numbers blinds us to underlying factors. The number of filled jobs does not tell us how many employed people are actually making a living wage. The stock market does not tell us which companies that report strong earnings are heavily leveraged or poorly managed.

ENVIRONMENT: the current trend, including the rescue passage passed by Congress, suggests a commitment to subsidize environmentally harmful activities (coal-mining, fracking, drilling in fragile ecosystems, packing thousands of passengers on cruise ships) rather than supporting the industries of the future.

If we stay the course, we will miss the great opportunity of the 21st century to prepare this country to thrive in the future and to lead globally.

Reflections on missed opportunities.

From coast to coast, colleagues at different types of institutions report struggles as they adapt pedagogies, supporting materials, and communication with students to distance teaching. These reports bring back memories of the mid-1990s.

In 19944-1995, a bipartisan group of governors in the Mountain West came togethet to envision the future of their respective states. They agreed on the need to improve the quality while also expanding the capacity of their educational systems. They also agreed that new operational and financial models would have to be developed for higher education.

The universities of the future would have to be affordable for students of modest means, accessible to working adults, parents of young children, and others unable to commute long distances to the existing campuses. The governors also shared a belief that emerging technologies might offer solutions to the key issues of lower cost and greater access.

I have been reflecting on this experience as I hear from higher education colleagues struggling to “convert” courses, master new tools, and evaluate student performance. I feel sad, even a tad guilty.

Twenty-five years ago, some elected officials and some corporate leaders who supported their experiments led the way in envisioning the future of higher education. They focused on academic quality, largely as defined by accreditors and professional societies, but also on access and affordability. Most of their counterparts in higher education (my contemporaries) resisted the experiments, doing little or nothing to prepare their institutions for the future.

The list of missed opportunities is long. Fortunately, most of the higher education leaders who were in charge in the 1990s have already retired. Today’s students cannot imagine a world without information and communication technologies literally at their fingertips. They also understand issues of access and affordability. The current crisis makes it possible for today’s campus leaders to catch up, to engage the radical transformation of the higher education enterprise that my generation mostly failed to engage. As others have said, we should not let a major crisis go to waste.

America and the Gun Culture.

With many friends, colleagues, and neighbors in the past couple of years I have participated in forums, marches, and vigils to honor victims of gun violence and to protest against the influence of the arms industry, and its principal lobbyist, the NRA, on our elected officials.

I will probably continue to participate in such activities. But there is one thing I have stopped doing. I will no longer pray to ask God to relieve American society from the plague of gun violence.

My God, the God of Moses, Jesus, and Mohammed, gave us the capacity to reason, to make choices, to distinguish between policies and actions that benefit our communities and those that do us harm. Instead of praying for miracles, we need to use our God-given capacity to understand how we got where we are.

The origins of America’s gun culture are clear. In colonial times, our ancestors used weapons, including guns, to tame an enormous wilderness, killing indigenous humans and animals that stood in their way. 

At the end of the 18th century, our ancestors took up weapons against the British monarchy. The insurgents were successful not only in gaining independence from Britain but also in crafting a new political order.  The new American government, however, was broke, in debt to European allies, and unable to organize and finance a standing army.

The Second Amendment of the new Constitution addressed this issue. A “well regulated militia” of citizens bearing arms (and hopefully trained to use them) would protect the fragile new republic from foreign powers and from insurgencies within. In the absence of a standing army accountable to “the commander in chief” and the Congress, this was a practical way  to protect the new republic.

Today, the American Republic is protected from external enemies by a gigantic arsenal, placed strategically across the globe. Each of the states has its own “well regulated militia,” the National Guard, and numerous intelligence and law-enforcement agencies that identify potential threats to the common welfare from crime syndicates and terrorist networks.

The Second Amendment has outlived its raison d’etre. Worse, it has become a shield for an industry that invokes its original intent, the protection of the common welfare, to attract  consumers eager to own its most advanced, glamorous and lethal products.

Instead of asking for divine intervention against our national scourge, we should focus on understanding why the Founding Fathers felt the need for “a well regulated militia” and for citizens bearing arms. Historians who know why and how the American Constitution reads the way it does, and why it can be amended to fit changing times, must take the lead. I wish them Godspeed!

Re-reading Julien Benda’s La trahison des clercs

What do student debt, originalist interpretations of the American Constitution, TV drug advertisements, and wars of choice have in common? Separately and in various combinations they are doing serious damage to contemporary American society.

Citizens who feel the impact of these trends try to understand them, and often they ask for relief. But who will take the lead to help them? Not the political parties, internally gridlocked or beholden to special interests. Not faith-based organizations that are either losing followers or focusing inwardly on narrow issues. Not charitable foundations that assist people in need but cannot engage in effective advocacy.

Yet, we do have alternative voices that potentially could speak out on the most urgent issues of the day and lead us to a better place. These are the large non-profit organizations that recruit, educate and nurture “the best and brightest” in American society: the American Medical Association, the American Bar Association, the American Association for the Advancement of Science, the American Association of Engineering Societies, and hundreds of others.

Members of these association practice and teach; they lead agencies and write legislation at all levels of government. They have their own communication channels but also plenty of access to popular media. They matter!

Thinking about these associations, their stature, human capital, and access to power, I asked myself: can they lead? Will they lead? These questions about today’s professionals and intellectuals and their organizations motivated me to read Julien Benda, an author who had similar concerns in his own time. Hs classic 1927 book, La trahison des clercs, ineptly translated into English as The betrayal of the intellectuals, was widely read in the United States. If Julien Benda came back from the great beyond, what might he say about the position and roles of les clercs in contemporary America?

If he dialoged with legal scholars and judges he might ask: how can you discern the Founders’ “original intent” when you rule on issues, conditions, and organizations that did not exist in the 18th century? If he saw drug advertisements on TV or heard about the massive numbers of opiod pills delivered to pharmacies in sparsely populated, impoverished counties, he might inquire: what were the venerable American Medical Association and the American Pharmacists Association doing while Big Pharma prospered and communities were torn apart?

Benda might be impressed with the first-rate research that members of the American Psychological Association and the American Psychiatric Association are doing on the treatment of war zone traumas. He might wonder, however, why this work focuses on improving the ability of military personnel to withstand those traumas rather than on avoiding military intervention, especially wars of choice, in the first place.

What is Benda attended a large academic conference, for example, the Annual Meeting of the Modern Language Association?  He would surely hear discussions about the plight of contingent faculty and about threats to academic freedom. He might ask why American universities protect academic freedom for some, but not all, teaching and research faculty. In fact, he might ask why this much valued form of protection is denied to the most vulnerable members of the academy.

In the disparity between the associations’ potential for influence and leadership and their current performance Benda might recognize the same moral failure that he decried in the 1920s, the same tendency of les clercs to protect individual or tribal interests at the expense of the common good. Of the professionals and intellectuals of his own time Benda wrote: “[The have forgotten that] the morality of an act is its disinterestedness …[they have accepted instead] that the morality of an act is measured by its adaptation to its end.”

Example of such “adaptations” are all around us. Many individuals and institutions have adapted their research interests and projects to a vaguely defined but all-encompassing end goal of national security. Others have adapted to the ideological or personal preferences of wealthy donors, without asking questions about those donors’ desired end goals.

What can we do today? Like Julien Benda, we can identify and acknowledge corruption among our clercs, whether they work within or outside of the academy. But we can and should do more, mobilizing resources and membership organizations on a scale that would have been unthinkable in the early 1900s.

Depending on their mission and the expertise of their members, groups of professional and scholarly associations are already quite adept at identifying critical issues and providing data and recommendations to policy makers. As the next step, they can and should lead their members in the rediscovery of the morality of disinterestedness.  

On stepping out of the bubble

My husband Ben was insatiably curious about the world we live in. Before he died in 2011 he had traveled to 150 countries. I lagged far behind. At his urging, I traveled to Egypt, returning home just a few days before the revolution in Tahrir Square shut down Cairo airport.

When I finally decided to book a trip to Iran, the international situation was more volatile and dangerous than in the previous decade. My visa application was being processed through the Embassy of Pakistan when the Trump administration issued the first travel ban. Iranian citizens were included in the ban, although none of them played a role in the 9/11 attack, engaged in terrorist acts against the U.S., or practiced suicide bombing.

The visa came through, the agency I traveled with proceeded with plans, and none of its clients opted to stay behind. Determined to see Iran, we were somewhat apprehensive. After decades of anti-Iranian policies,  we had experienced two years of frenzied rhetoric by opponents of the multinational agreement concerning Iran’s nuclear program. We had witnessed the unprecedented intervention of a foreign leader who voiced his opposition to the agreement in the halls of the U.S. Congress, without even a courtesy call to our President. Our media depicted Iran as they did in the days after the 1979 Revolution and the occupation of the U.S. Embassy: a country ruled by religious fanatics, intent on domination of the Middle East, the foremost danger to American interests in the region.

I was grateful for the opportunity to step out of my bubble, to be able to compare the dominant narrative offered by our media with at least a glimpse of a different reality.  First, nothing in Iran reminded me of underdeveloped countries I have visited in the past.  Iran has the highest literacy rate and per capita income in the region, with the exception of Israel. Second, while significant pro-Western and  ultra-religious opposition groups undoubtedly matter, the government is stable and functioning, in contrast to everyone of the adjacent countries.

Iran has impressive natural resources, in addition to oil, and plenty of potential brain power. The sanctions imposed after the 1979  Revolution, and strengthened for various reasons over decades, are holding Iran back from developing those natural and human resources. As happened in Cuba, for the Iranian government the sanctions are the gift that keeps giving.  Quite credibly, the government can claim that U.S. control of the international financial system stifles economic growth and thus impacts everyone’s standard of living.

Iran trades with many countries and hosts millions of tourists from Europe, Asia, Australia and New Zealand. However, the convoluted maneuvers required to connect indirectly with the international financial system come at very high cost to Iranian businessmen and consumers.

Are the sanctions and the fragile nuclear agreement topics of daily newscasts and conversations? Not really. Two crucial issues are on the minds of the Iranian elites, whether supporters or opponents of the current government. These are the dramatically visible impact of global warming on Iran’s vast, arid plateaus, and the future of its huge cohorts of children and teenagers, more than 40% of the population.

As Iran’s leaders try to address these existential threats, they also face the most perilous international situation since the days of the Great Game between Russia and Britain in the 19th century. To say that Iran is in a very bad neighborhood in which it has vital interests and very few tools to protect those interests would be an understatement.

Whatever they think of their own government, Iranians ask: why does the financial chokehold continue? Why don’t the U.S. and the international community pursue nuclear disarmament in the region, bringing all parties to the table, including Israel? Why are  the U.S. and Israel strengthening ties with Saudi Arabia, cradle of Wahabi Islam and of Osama Bin Laden? The lifting of financial sanctions and the pursuit of nuclear disarmament would enable Iran to focus resources on dealing with the crucial issues of desertification and youth unemployment.

The country is still recovering from the effects of the war it fought in the 1980s against a Shia-majority neighbor. Portraits of the young men who died in that war hang in every Iranian city. They are not martyrs who died for a religious cause. They died protecting the Iranian homeland against an Iraqi government that received arms and support from the U.S.

The people of Iran and their government are scared, and they have reason to be.  In the 1980s they had one enemy, on their southwestern border. Today, Iraq, Afghanistan and Pakistan are unstable neighbors bristling with American military bases. The U.S. Navy dominates the Persian Gulf, to the advantage of Saudi Arabia and the Emirates.  And corrupt regimes with ties to the U.S. or Russia rule Azerbaijan and Uzbekistan.

This large country of 80 million people proud of their history and culture is not backward, it is not isolated from most of the world, it does not practice or promote radical Islam. It is a country under siege.

The Village

I live in an unusual community, the Village of Friendship Heights, which is part of Chevy Chase MD. If the name suggests an idyllic place with cute cottages, a church, a pub, and maybe a green space with grazing sheep, think again. My Village is a densely populated community of high-rise buildings within a dynamic  and growing metropolitan area very close to the nation’s capital, Washington DC.

The Village is home to about 4,800 residents, most of them highly educated and relatively affluent. It is a “Special Taxing District” that enjoys considerable autonomy within the State of Maryland and Montgomery County. Because it receives tax revenues, the Village is governed by a local Council of seven members, elected by residents every other year.

I joined the Council in 2014.  As a professional historian I have enjoyed working on the Village’s archives. There are days, however, when I wish I had specialized in the fields of organizational behavior and psychology.

The Village is an urban and diverse community with many human and physical assets.  At its founding four decades ago, it was the prototype of a successful “urban village,” an innovative and attractive alternative to suburban lifestyles.  Initially, most buyers and renters were adults near retirement or retirees who wanted to be near Washington’s cultural resources and venues, yet feared the social and political turmoil that accompanied the struggle for Home Rule in the capital city

Today, the Village is home to a significantly younger  and more diverse population.  And it is one of many “urban villages” that have been built throughout the Washington metro area since the 1990s. The Village faces a major challenge: how to transition from a successful founders’ organization to one that understands how much the internal demographics and the external environment have changed since the 1970s and 1980s.

A greater number of residents from various age groups and backgrounds are paying attention to what’s going on. A good thing. Some are commenting on the fact that the governing Council of the Village is not holding itself accountable for timely and effective execution of projects — even projects that are neither controversial nor particularly difficult to execute. Others note that self-appointed spokesmen “for the community” pursue personal agendas, spend time on trivial issues, and sometimes disseminate bad information while Council remains silent.

Any organization that wants to make a successful transition from the legacy of its founders to plans for its future must begin with substantive and structured conversations based on facts. At the most basic level, Village residents should have a grasp of the following factors:

1) who lives in the Village in 2017? Statistical data as well as qualitative data from Village staff, condo boards, and building managers tell a story of continuity and change over the past 25 years or so;

2) in terms of infrastructure, services, and amenities, how does the Village compare with more recent versions of itself? Although the Village lacks in-house expertise on this topic, help is readily available from practitioners and scholars of urban planning;

3) what kinds of investments in infrastructure and programs will ensure a high quality of life in the decades ahead, and thus keep the Village competitive among similar communities? Again, insights and data from experts are available for the asking — from residents, county planners, and private firms;

4) what is happening on the periphery of the Village?  The competitive advantages the Village enjoyed in the 1980s and 1990s — a major transportation hub and an array of retail businesses — are eroding.

The deterioration of the Metro system, with no end in sight, is an existential threat to the Village, as it is not to other parts of Chevy Chase. The Chevy Chase Land Company is struggling to replace exiting tenants at the high-end shopping center known as The Collection. County approval of planned site amendments to this property means little if new retailers are not signing leases. The situation is even worse at Mazza Galleria, where many stores lie empty. These developments somehow never make it onto the Council’s agendas.

4) is the governance structure of the Village, developed in a different era and heavily influenced by the failed political ambitions of a high-profile leader, still viable and effective?

For example, does it make sense for the Mayor to control the agenda, yet not chair Council meetings? Does it make sense to list standing committees that, for the most part, do not meet and do not facilitate and expand residents’ participation in discussion of issues and formulation of projects?

None of these issues are being addressed and discussed among the elected members of the Village Council; they are certainly not discussed with residents.  Far from filling the void,  in its most recent incarnation the Community Advisory Committee gets bogged down in discussions of mundane issues that the paid staff of the Village is quite able to address and  (mostly) resolve.

The result? While the D.C. metro area and southern Montgomery County continue to grow, evolve, and plan for the future, our Village remains frozen in a time warp.

In a  few weeks registered voters who live in the Village again will have an opportunity to elect their governing Council. All or most incumbents plan to run again, untroubled and perhaps unaware of the work left undone. Unless several challengers come forward, engaged residents will have to find other ways to generate the ideas, discussions, and specific plans that will enable the community to remain viable and competitive.

 

 

Accreditation Blues

It took a long time to redefine the purposes of college and university accreditation, but we are doing it. The “we” are not the accreditation agencies or the major professional associations that speak for higher education. The change agents are a loose coalition of state and federal government agencies, some members of Congress, and the media that report on higher education, especially the issue of student debt.

Members of the coalition are not always on the same page and they don’t always get the issues quite right. But overall, they have raised critical questions about the impact of a college education on individual lives and on society. They have asked for metrics to understand value added. They have questioned  Congressional legislation that decades ago enabled regional accrediting agencies to be the gate-keeper for billions of federal dollars invested in higher education.

I hope that we have finally reached a turning point in the history of American higher education. If we try at all, we should be able to figure out how to walk and chew gum at the same time. Classic, historical accreditation based on peer review of academic programs is as valuable now as it has ever been. Done judiciously and without bureaucratic trappings, it enables campus leaders to benefit from the insight of qualified and unbiased peers; it builds collegial networks of people who share expertise and passion for specific segments of the academic enterprise. And it need not be expensive.

Accountability for the expenditure of federal dollars and consumer protection measures are not only valuable,  they are appropriate to the times, and politically necessary.

Oversight for purposes of fiscal accountability and consumer protection can be done in a sensible manner that avoids excessive regulation; they might be done by random spot-checking of a group of institutions in any given fiscal year. Oversight cannot be a collegial, peer-review process, but it can be a civilized and transparent process. The ideal conduit? Probably NACIQI, which is already a politically appointed board advisory to the U.S. Secretary of Education.

 

Fighting ISIS

More than twenty years after the disintegration of the Soviet Union, the universities, military academies, and specialized institutes of which we are so proud seem incapable of educating graduates well equipped to understand the world of the 21st century.

There are striking parallels between the language our “experts” used during the Cold War and the policies they recommended or enacted and what they say or their disciples say and do in our time. They fought  “communism” in the 1950s and beyond; now they are “fighting terrorism” or “fighting ISIS.”

Focusing on an alien and threatening ideology, one or two generations ago our experts understood the ideology’s power and appeal but did not take the time to understand the specific reasons why the ideology took root in some societies and not in others.

For this reason, the experts largely missed the significance of communist movements embedded in century-old struggles for cultural and political identity.  In Vietnam and other places such movements would have stood up to the communist colossi of the 20th century, the Soviet Union and China.  European colonialism and subsequent U.S. interventions drove the leaders of those movements in exactly the opposite direction. In Cuba, the global war on communism continued for decades after the Soviet Union had packed up its military installations.

And so it is today. The global war on terror launched after the 9/11 attack was never a war against a major power like Communist Russia. It is a very expensive and wrong-headed endeavor to defeat an ideology, or more precisely a movement  — political Islam — that takes many different forms and whose leaders have widely different objectives, beyond, perhaps, a shared  resentment of economic and cultural domination by Western countries.

The tragic and continuing failure of our experts to understand a complex movement in its many local manifestations, their determination to “fight ISIS” as if it were a new incarnation of Soviet Russia or Mao’s China have had horrendous consequences, with no end in sight. States have been destroyed, social bonds and conventions shattered, fragile eco-systems damaged perhaps beyond repair.

The experts don’t seem to know what they have wrought; indeed, they are intent on cloning themselves. As it was said of the Bourbon rulers of France after the Revolution, they have forgotten nothing and learned nothing.

On being a founding trustee

Last week I spoke with a professional writer and editor charged with ghost writing a history of Western Governors University. I became  involved with this project in 1995, at the invitation of Fife Symington III, then Governor of Arizona.  As a founding trustee of the new university from 1996 to 2006. I enjoyed an extraordinary learning opportunity.

I learned to question the traditional ways in which public colleges and universities served students and communities in the 1990s. I learned what could be done for students and communities by harnessing the power of emerging technologies. I learned that it was possible to develop new business models for higher education, models that generally lowered the cost of earning a degree. And I learned that assessments of what students know and can do in a given realm tell us a great deal more about academic progress than a tally of courses taken and credit hours earned.

More importantly, the WGU experience got me out of the higher education bubble in which by the 1990s I had very comfortably settled. The governors and business leaders with whom my colleagues and I interacted were friends of higher education, but friends who asked many tough questions. I learned to be proud of my contributions, yet also humble because I recognized how much of WGU’s energy and identity came from smart people outside of higher education.