Andrew Sullivan's Blog, page 134

Our Priorities At The End Of Life

In an excerpt from his new book, Atul Gawande shares what he has learned about death and dying:

As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did. Lacking a coherent view of how people might live successfully all the way to the very end, we have allowed our fates to be controlled by medicine, technology, and strangers.

But not all of us have.

That takes, however, at least two kinds of courage. The first is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped when one is seriously ill. Such courage is difficult enough, but even more daunting is the second kind of courage—the courage to act on the truth we find.

His conclusion:

[O]ur most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; and that we have the opportunity to refashion our institutions, culture, and conversations to transform the possibilities for the last chapters of all of our lives.

Recent Dish on Gawande’s book here.

Panetta’s Plaint

In his new book Worthy Fights: A Memoir of Leadership in War and Peace, the former defense secretary harshly criticizes Obama’s handling of Iraq and Syria:

Mr. Panetta, who was C.I.A. director before taking over the Pentagon, recounted decisions that he disagreed with, including the withdrawal of all troops from Iraq in 2011, the failure to intervene in Syria’s civil war by arming rebels and the abrupt reversal of Mr. Obama’s decision to strike Syria in retaliation for using chemical weapons on civilians. Mr. Obama “vacillated” over the Syria strike and “by failing to respond, it sent the wrong message to the world,” he wrote. Had the president followed different courses, Mr. Panetta said in the interview, the United States would be in a stronger position as it now tries to counter the rise of the extremist Islamic State in Iraq and Syria. He added that he believed the president has turned a corner and “is going a long way in terms of repairing some of the damage I think took place as a result of the credibility issue that was raised on Syria.”

Beinart finds the “credibility” argument about Syria silly:

Since he declared war on ISIS, the Obama administration has been recruiting other countries to join the United States. And whatever you think of the war itself, that diplomatic effort has been remarkably successful. Ten different Arab countries have agreed to participate in the anti-ISIS campaign. Even John McCain and Lindsey Graham have praised the administration’s coalition-building skills. All this illustrates the silliness of Panetta’s claim.

It was one thing to speculate a few months ago that Obama’s chemical-weapons about-face would make it harder for the U.S. to convince allies to join a military coalition the next time. But the next time is now here. Roughly a year after supposedly squandering America’s credibility by standing down on chemical weapons, Obama has mustered enough credibility to convince a bevy of Arab countries to help us bomb fellow Arab Muslims in the heart of the Middle East.

And Drum responds to Panetta’s assertion about working in the Obama admin, that “for the first four years, and the time I spent there, I thought he was a strong leader on security issues. … But these last two years I think he kind of lost his way”:

Think about this. Panetta isn’t even a super hawkish Democrat. Just moderately hawkish. But his basic worldview is simple: as long as Obama is launching lots of drone attacks and surging lots of troops and bombing plenty of Middle Eastern countries—then he’s a “strong leader on security issues.” But when Obama starts to think that maybe reflexive military action hasn’t acquitted itself too well over the past few years—in that case he’s “kind of lost his way.”

That’s the default view of practically everyone in Washington: Using military force shows strong leadership. Declining to use military force shows weakness. But most folks inside the Beltway don’t even seem to realize they feel this way. It’s just part of the air they breathe: never really noticed, always taken for granted, and invariably the difficult but sadly necessary answer for whichever new and supposedly unique problem we’re addressing right now. This is what Obama is up against.

Panetta also believes that the fight against ISIS could turn into a “30-year war” and will likely require the deployment of ground forces. That statement understandably upsets Greenwald:

Only in America are new 30-year wars spoken of so casually, the way other countries speak of weather changes. He added that the war “will have to extend beyond Islamic State to include emerging threats in Nigeria, Somalia, Yemen, Libya and elsewhere.” And elsewhere: not just a new decades-long war with no temporal limits, but no geographic ones either. … At this point, it is literally inconceivable to imagine the U.S. not at war. It would be shocking if that happened in our lifetime. U.S. officials are now all but openly saying this. “Endless War” is not dramatic rhetorical license but a precise description of America’s foreign policy.

Panetta is, of course, not the first former cabinet member to come out with a book critical of the president’s leadership. Dana Millbank wonders why this is:

The lack of message discipline is puzzling, because Obama rewards and promotes loyalists. But he’s a cerebral leader, and he may lack the personal attachments that make aides want to charge the hill for him. Also, as MSNBC reporter Alex Seitz-Wald tweeted in response to a question I posed, Panetta, Gates and Clinton didn’t owe their careers to Obama. Clinton was a rival, Gates was a Bush holdover, and Panetta is a Democratic eminence grise. Loyalty didn’t trump book sales — or Clinton’s need to distance herself from Obama before a presidential run.

(Photo: Leon Panetta delivers remarks at Gaston Hall of Georgetown University February 6, 2013 in Washington, DC. By Alex Wong/Getty Images)

To Make A Long Story Short

It’s an idea worth keeping in mind, according to Ben Yagoda:

It’s not that books should never be long. Who would demand cuts in War and Peace, Moby-Dick, Ulysses, or Shakespeare, even though Ben Jonson wrote that “whatsoever he penned, he never blotted out a line”? Beyond the great books, it’s clear that in some fiction genres, fans demand thickness. People seem to want to get immersed in a story, and length adds to the feeling.

In nonfiction, certain subjects are important enough to call for comprehensiveness. Part One of Mark Lewisohn’s history of the Beatles, Tune In, is 932 pages long, and when it’s over the lads haven’t yet set foot in America. (Lewisohn pared for the U.S. market; at Amazon’s U.K. site, you can buy the “Extended Special Edition,” which is 1,728 pages.) But it’s OK. It’s the Beatles. Robert Caro’s multivolume biography of Lyndon Johnson, which is actually nearing completion, gets a pass for the same reason.

But those are, or should be, exceptions. The Great Gatsby is 48,000 words, for criminy’s sake! So many door-stopping novels would find their best form as novellas, so many nonfiction extravaganzas … as long New Yorker articles. They do not, for two main reasons. The first is that authors generally like to hear themselves talk, and editors, with so much on their minds, especially these days, aren’t sufficiently ready and willing to pare the extraneous. Also, since the market, as it’s been defined for a pretty long time, doesn’t have a place for novellas and 25,000-word nonfiction works, ideas that would work best at such length get artificially bulked up, like an offensive lineman on steroids.

Why Lineups Don’t Line Up

Virginia Hughes flags “helpful guidance” from the National Academy of Sciences about the accuracy of eyewitness identification:

One thing all of these scientists agree on—and was underscored repeatedly in the NAS report—is the importance of recording the witness’s level of confidence immediately after making a photo identification. As many studies have shown, witnesses’ confidence in their memories tends to inflate over time, which is obviously problematic if they’re testifying in court long after the event took place. As [John Wixted, a memory researcher at the University of California, San Diego] points out, most of the people who were wrongly convicted and then exonerated with DNA were initially identified with low-confidence witness ratings. Making sure to record confidence immediately “is a fantastic recommendation that will do far more to protect innocent suspects” than switching from one lineup type to another, Wixted says.

The Small Print On Health Insurance

Many Americans have difficulty understanding it:

This year, many people appear to have signed up for narrow plans unwittingly. A survey from the health research group the Commonwealth Fund found that about 25 percent of people with new exchange plans didn’t even know whether they’d bought a narrow network plan. So far, overall satisfaction seems relatively high, though most people are still fairly new to their plans. There are consumers in some states who are suing over their inability to get the care they need.

Stories like those recently chronicled by my colleague Elizabeth Rosenthal, of patients surprised to learn after the fact that they had been treated by out-of-network doctors, seem likely to proliferate if poor transparency about networks prevails.

Jordan Weissmann covered unexpected medical bills last week:

Surprise medical bills are an old issue, yet the Affordable Care Act mostly ignored them. Just a fraction of states have passed laws to protect patients in these circumstances, according to the Kaiser Family Foundation, and some of those statutes are extremely narrow in scope.

The problem, according to [professor Jack] Hoadley, is that it’s incredibly difficult to make insurers and health providers reach a compromise on how much out-of-network doctors should be paid. Some patient advocates hope that a new law that will soon go into effect in New York state could serve as a national model for how to strike the right balance. But just like most obviously outrageous problems in the U.S. health care system that make you pine for a life in Canada, surprise medical bills don’t have a simple solution.

This problem is particularly nasty with regard to ER visits. Nicholas Bagley explains:

How can it possibly be legal for your doctor to charge you out-of-network rates when you show at up an in-network emergency room? And how can we change the law to get at the problem? … Briefly: when you show up at an ER, you’re given an incomprehensible contract to sign. Among the terms you don’t read, you agree to pay the on-call ER physician for her services, whether or not the physician happens to be in-network. Given this “agreement,” the out-of-network physician can name her price.

He proceeds to suggest a few potential solutions.

Mental Health Break

A dog who digs Chinese disco:

The Best Of The Dish Today

Readers keep asking me:

I would love your perspective on the debate Bill Maher, Ben Affleck and Sam Harris attempted to have on Friday’s Real Time. I’m sure many other Dishheads would too. Can you please weigh in? It really is a fascinating topic that is drawing a lot of attention.

There’s been so much going on I let this one pass. But since you ask, I think it’s pretty indisputable that any religion that can manifest itself in the form of something like ISIS in any period in history is in a very bad way. I know they’re outliers – even with respect to al Qaeda. But, leaving these mass murderers and sadists to one side, any religion that still cannot allow its own texts to be subject to scholarly and historical inquiry, any religion that denies in so many parts of the world any true opportunities for women, and any religion whose followers believe apostasy should be punished with death is in a terrible, terrible way. There is so much more to Islam than this – but this tendency is so widespread, and its fundamentalism so hard to budge, and the destruction wrought by its violent extremists so appalling that I find Affleck’s and Aslan’s defenses to be missing the forest for the trees.

Yes, there are Jewish extremists on the West Bank, pursuing unforgivable religious war. There are murderous Buddhist extremists in Burma. There are violent Christian extremists in Nigeria, and in Russia. All religions have a propensity to banish doubt, to suppress humility and to victimize outsiders. But today, in too many parts of the world, no other religion comes close to the menace and violence of Islam.

Christianity has a bloody past and a deeply flawed present. Islam has a glorious past in many respects, and manifests itself in many countries today, including the US, humbly, peacefully, beautifully. But far too much of contemporary Islam – from Pakistan through Iran and Iraq to Saudi Arabia – is more than usually fucked up. Some Muslims are threatening non-believers with mass murder, subjecting free societies to shameless terrorism, engaging in foul anti-Semitism, and beheading the sinful in Saudi Arabia just as much as in the Islamic State. And if liberals – in the broadest sense – cannot stand up for freedom of speech and assembly and religion, and for toleration as a core value, then what are liberals for?

Does this make me a bigot? Of course it doesn’t. Criticizing a current manifestation of a religion is a duty – not a sin. And it’s not as if I have spared my own church from brutal criticism. And it’s not as if I do not respect – because I do – those countless Muslims and Muslim-Americans whose faith is real and deep and admirable. But it’s precisely because of those true representatives of the best of their faith that we should not hesitate to point out the evil and intolerance and violence of too many others. Some things really are right in front of our nose – and contemporary Islam’s all-too-frequent extremism and fanaticism is one of them.

As for Sam Harris, we are never fully in agreement, but on this issue – the unique threat that Jihadism represents in our world and the disgrace it represents for Islam as a whole – we are as one. I do not believe that all religion is poisonous delusion – au contraire – but I do believe that this particular religion at this particular moment in time is specifically dangerous and violent, and to argue that this has nothing to do with the religion that these fanatics profess is simply denial. We’ll also very shortly be starting our discussion of Sam’s new book, Waking Up: A Guide To Spirituality Without Religion. So we can perhaps address this in that bigger discussion. Stay tuned.

Today, I tried to think through what “containment” can mean in terms of confronting Jihadist terror (I think it counsels minimalism and a defensive posture, rather than our current military gestures in Iraq and Syria). I screwed up in a post comparing Obama’s and Reagan’s record in private sector job growth – although it remains indisputable that the Obama recovery would be far stronger if it had not been strangled by willful GOP austerity in the public sector. We noticed that chickens have grown in size over the last few decades almost as much as football players; and we pondered the meaning of a sudden explosion at an Iranian nuclear research facility.

The most popular posts of the day were those on Obama’s and Reagan’s economic records, followed by my reflection on the amazing progress of marriage equality this weekend – just today saw Nevada, Arizona, Idaho, Alaska, and Montana joining the bandwagon!

The entries for today’s window contest were particularly impressive. But one reader is left pulling out her hair:

It finally happened to me today, as it has happened to so many others. I looked at the View From Your Window pic on Saturday and said “It looks like Lake Chelan” – I grew up on the lake so I should know. Then I asked myself, “Yeah, but what are the odds?” and closed the window without sending in a guess.

I love you guys, but I kind of hate myself right now.

Many of today’s posts were updated with your emails – read them all here. You can always leave your unfiltered comments at our Facebook page and @sullydish. 19 more readers became subscribers today. You can join them here – and get access to all the readons and Deep Dish – for a little as $1.99 month. Gift subscriptions are available here. Dish t-shirts here.

See you in the morning.

Footnote Of The Day

From the Ninth Circuit, referring to governor “Butch” Otter of Idaho:

He also states, in conclusory fashion, that allowing same-sex marriage will lead opposite-sex couples to abuse alcohol and drugs, engage in extramarital affairs, take on demanding work schedules, and participate in time-consuming hobbies. We seriously doubt that allowing committed same-sex couples to settle down in legally recognized marriages will drive opposite-sex couples to sex, drugs, and rock-and-roll.

It’s Footnote 12 on page 21, as several Dishheads have discovered.

“An Absolute Masterpiece Of Geological Horror”

That’s how Geoff Manaugh describes the opening chapters of Deep Down Dark, Héctor Tobar’s account of the 2010 Chilean mine disaster. Really riveting stuff:

Tobar builds and builds to the actual moment of collapse, like an orchestra tuning itself to some inevitable and apocalyptic note that only gets more terrifying as its implications becomes clear. There are dust clouds and claps of thunder; changes in air pressure and growing suspicions; then an event unlike anything I’d ever read about before—the complete internal cleaving of a so-called “mega-block” inside the mine. Here, Tobar explains that a single block of diorite two times heavier than the Empire State Building has suddenly broken free inside the mountain.

It immediately free-falls straight downward like a cork plunging into a bottle of wine, breaking through the spiraling ramp on hundreds of underground levels and completely—seemingly fatally—trapping the miners nearly at the very bottom of the entire complex.

After hours—days, weeks—of audible strain and the popping of unseen faults, “the essential structure of the mountain must have failed.” It’s as if the entire mountain is “pancaking” from within, Tobar writes: “the vast and haphazard architecture of the mine, improvised over the course of a century of entrepreneurial ambition is finally giving way.”

For the trapped miners, the inhuman scale of this “mega-block” makes it into an almost totemic object, an otherworldly and supernatural mass. It is impossible for the miners to comprehend, let alone to see, in its entirety, and crawling around or—given their now drastically limited tools and virtually non-existent food supply—digging through. As Tobar points out, “Only later will the men learn the awesome size of the obstacle before them, to be known in a Chilean government report as a ‘megabloque.’ …

And, terrifyingly, it is not done falling.

(Photo: A view on October 13, 2011 of the tunnel that collapsed trapping 33 miners at San Jose mine, in Copiapo, Chile, 850 km north of Santiago, during the first anniversary of the rescue. By Ariel Marinkovic/AFP/Getty Images)

He Did The Crime, But She’s Doing Time

Sometimes staying in an abusive relationship means enduring more than beatings. Alex Campbell reports on the horrifying case of Arlena Lindley, a domestic violence victim who was sentenced to 45 years in prison after her child, Titches, was killed by her abusive boyfriend, Alonzo Turner, for failing to prevent the child’s death:

Lindley’s case exposes what many battered women’s advocates say is a grotesque injustice. As is common in families terrorized by a violent man, there were two victims in the Lindley-Turner home: mother and child. Both Lindley and Titches had suffered beatings for months. But in all but a handful of states, laws allow for one of the victims — the battered mother — to be treated as a perpetrator, guilty not of committing abuse herself but of failing to protect her children from her violent partner. Said Stephanie Avalon, resource specialist for the federally funded Battered Women’s Justice Project, “It’s the ultimate blaming of the victim.”

Lindley’s not the only woman to suffer this injustice, either:

No one knows how many women have suffered a fate like Lindley’s, but looking back over the past decade, BuzzFeed News identified 28 mothers in 11 states sentenced to at least 10 years in prison for failing to prevent their partners from harming their children. In every one of these cases, there was evidence the mother herself had been battered by the man.

Almost half, 13 mothers, were given 20 years or more. In one case, the mother was given a life sentence for failing to protect her son, just like the man who murdered the infant boy. In another, the sentences were effectively the same: The killer got life, and the mother got 75 years, of which she must serve at least 63 years and nine months. In yet another, the mother got a longer sentence than the man who raped her son. In one more, a father fractured an infant girl’s toe, femur, and seven ribs and was sentenced to two years; for failing to intervene, the mother got 30.

Amanda Hess comments:

Campbell’s story demonstrates how the criminal justice system is scapegoating domestic violence victims in order to cover for its failures to properly investigate and prosecute instances of child and intimate partner abuse. Shortly before he began dating Lindley, Turner was charged on two separate occasions, first with burglary and later “unlawful restraint,” after he broke into an ex-girlfriend’s home, pushed her, and stole her belongings, then returned three weeks later, grabbed her by the neck, covered her mouth, and forced her outside. The woman escaped after a neighbor stabbed Turner in the leg; months later, Turner was out on probation from the burglary charge and was still awaiting trial on the restraint charge when he murdered the boy. On the day of Titches’ murder, another neighbor called police after she witnessed Turner kicking Titches on the floor, but when police arrived and couldn’t locate Turner or the toddler, they failed to pursue the report. It is outrageous that the justice system in this case only took a hard line against domestic violence after a child was killed.