Thursday, November 5, 2009

Health Care Morass

An issue recently brought before a city-sponsored diversity task force in Fort Worth, Texas was whether health care insurance provided by the city to its employees should include coverage for sex-change operations. The city of Fort Worth is currently under siege by gay rights advocates and others for a controversial raid made by police on a gay bar. That raid was later deemed improper. An internal investigation of the raid is currently underway. According to the article printed in this morning's Dallas Morning News, the issue of extending insurance provided to city employees to cover sex changes put forward by a diversity task force was "greeted warmly" by the city.

The issue at hand is one that bodes ominous for national health care. The line between necessary health care and procedures, and desired health care and procedures, is one that should be crossed with great apprehension, if at all. There are a wide vary of procedures available to those unhappy with their appearance and condition. Breast lifts, tummy tucks, face lifts, hair implants, nose jobs, and numerous other procedures are available to those dissatisfied with themselves and their appearance. Increasingly, such procedures are not viewed as motivated by vanity, but rather necessary to self esteem, and, by extension, psychological well being. Yet, despite the angst and psychological discomfort such conditions may cause, they are very rarely medical conditions that pose a threat to health or require medical treatment. As far as I know, no one has ever died, or needed to be hospitalized, because they were unable to afford getting a sex change operation, let alone a face lift.

For some time, medicine has striven to keep up with the demands made by those with low self-esteem, anomie, and out sized egos. The demand for the psychological comfort and ease that medical and cosmetic alterations and improvements can provide is unlikely to wane in the future. Apart from the costs to any public health care plan that such procedures pose, there is also the matter of using taxpayer money to assuage and accommodate the egos and insecurities of the vain and self conscious through funding those procedures. I suspect many taxpayers would be uncomfortable with the idea that their money was being used to fund sex change operations. But then again, few seem very interested in what taxpayers think anymore.

Feeling that one is somehow living in the wrong body and that they have the wrong genitalia is not a medical condition. It is a psychological condition.

Wednesday, November 4, 2009

Tipping Teachers

In this morning's Dallas Morning News, it was reported that the $300 million spent to encourage teachers here in Texas, and thereby improve student achievement, hasn't worked out. Despite the money, student academic performance has not improved. Some attribute this to the fact that the bonuses offered were not enough. Others asserted the poor results were due to the fact the money was spread to thin and resulted in incentives too small to motivate teachers. In essence, teachers were not offered enough money to motivate them to do what they are already being paid to do.

In some professions it is customary to offer bonuses to improve service. One tips a waiter, a doorman, or a parking valet to encourage them to do their job with more enthusiasm. One does not offer bonuses to policemen or fireman for doing thier job well because they are expected to do the job they are paid to do to the best of their ability. One does one expect a policemen, a fireman to do their job poorly because they feel they are not being paid enough. If one is robbed, or one's house burns down, for the police or the fire department to claim that it was the result of poor pay and lack of motivation would not be accepted as an excuse.

To blame the unfortunate state of public education in the United States on poor teacher pay is also unacceptable. Teachers choose their profession. They know what they can expect to be paid. To take the job and then blame their lack of enthusiasm and effectiveness on a lack of financial incentive is a cynical attempt by the teachers unions to shift attention from the sad state of education in the U.S. today. It also creates a mercenary aspect to a profession that has traditionally prided itself as a calling.

The mechanical pedagogy and standardized curriculum increasingly prevalent in public schools today is a practice almost guaranteed to produce little enthusiasm on the part of students and teachers and so produce poor results. To treat education as simply a body of facts and set skills to be transmitted by people whose credentials are based more on methodology than knowledge, is to stultify education. Education is an activity that should be participated in by both the teacher and the student. It is not an object to be given and received.

Treating education as a body of facts to be learned according to a standardized method has the appeal of objectifying education and making it more amenable to measure and manipulation; both of which in turn have an appeal to a nation preoccupied with statistics and standards. They also have an appeal to a profession increasingly sensitive to criticism, for it allows blame to be shifted from how well they perform their jobs, to the standards and conditions they are "forced" to practice under.

Many private schools operate with teachers paid far less than public school teachers and a fraction of the resources available to public schools. That private schools are able to select their students is little excuse. Many public schools perform well. Not all public schools are struggling with low achievement. For those schools that are struggling with low achievement, to blame low pay and lack of incentive is more a reflection on the teachers in those schools than the teacher's unions might care to admit.

There are many reasons behind the poor performance of students in schools these days. Teacher motivation is but one. Even if the desired effect of motivating teachers through paying incentives is achieved, it is unlikely it will do anything to motivate students or parents. Very few of the problems faced by schools can be redressed by simply paying teachers more.

Monday, November 2, 2009

Of Guilt and Execution

There has been no small amount of controversy here in Texas regarding our system of justice. The recent execution of Cameron Todd Willingham, whose guilt has come into question, has added to this controversy. Over the years, the release of prisoners, some of whom where on death row, whose verdicts were overturned or found not guilty after review, has become disturbingly common. Many are rightfully upset and demand changes in the legal system to ensure that only the guilty be convicted and punished. This is a special concern in states like Texas that have the death penalty. As bad as it is to convict and imprison an innocent man, it is many times worse to execute an innocent man.

The matter of determining guilt has a long, sometimes amusing, but more often disturbing history. Very few in history have been indifferent to the prospect of punishing or condemning an innocent man. Virtually every society has had some system for determining innocence and guilt. Here in the West, Trial by Ordeal was once popular. If someone was suspected of committing a grievous crime, they were threatened with a terrible peril, such as being burned alive or crushed with a stone. The theory behind this was that God would never allow the innocent to suffer and so would intervene if the accused was innocent. Indeed, the more gruesome the ordeal, the greater the opportunity for God to demonstrate His mercy and judgement. The often horrible death of the accused was taken as proof of their guilt. One of my favorites was a method adopted to sort out cases of suspected witchcraft. In these cases, a method was adopted where the accused woman would have a stone attached to her whereupon she would be dropped into a lake. The theory in this case was that, since witches were believed to float, those who somehow floated back to the top would be condemned of being witches. Those who drowned, or nearly drowned, were absolved. The confidence of the people in the efficacy of these methods allowed them to sleep peacefully, even after the most terrible of ordeals.

One system in particular that grew in favor was trial by combat. Here, the questions of right and wrong, truth and lie were to be settled in a feat of arms. Under this approach it was believed that right (good), would always triumph in a contest with wrong (evil). In cases where the combatants were manifestly unequal, such as if a woman or an elderly man was party to the dispute, a champion would be allowed to fight in their stead. In time, the use of champions grew in popularity to the point where few, if any, would fight in their own behalf. A lucrative trade developed for skilled men of arms to hire themselves out to settle disputes. These champions had little interest in the dispute they were hired to settle. There job was to win. It goes without saying that such a system was not a very reliable way of determining guilt and innocence. Nevertheless, it is this fine tradition that led in part to our modern adversary system. The men at arms who championed the claims of those seeking justice would eventually be replaced by lawyers. Swords and maces would be replaced by writs and motions. Nevertheless, the adversarial nature of the system, and the confidence that in a contest, right will prevail over wrong, and that truth will triumph over error, would endure.

The problem (and benefit) at the core of our legal system is its adversarial nature. The lawyer's job, like the champion of old, is to win. It is the prosecutor's job to convict and it the defense attorney's job to acquit. This system encourages zealousness on behalf of the prosecution and the defense, the result of which is that truth becomes only one factor to be considered among several. As Judge Jerome Frank once wrote,"the lawyer aims at victory, at winning the fight, not aiding the court to discover the facts." Like in the contests between champions of old, it is believed that amidst the struggle, the invisible hand of justice will prevail.

In regard to the state, prosecutors receive evidence from police and investigators, and when they believe that evidence has merits, they prosecute. It is part of their job assess the evidence they receive to determine its truthfulness and significance, but it is not the only part. Their primary job is that the suspect, once accused, is found guilty. It is the instances where prosecutors become so focused on proving the person they are prosecuting is guilty, rather than objectively assessing and weighing the evidence, that the most egregious errors occur.

A prosecutor's zeal for a conviction, and, or the ineptitude or indifference of a defence council, has on occasion lead to the conviction of an innocent man. The fact that the measure of good prosecutors is their conviction rate does little to temper their zeal. Defense attorneys, in their turn, are measured by their acquittal rate. No one is measured according to how many actually guilty people are convicted and how many actually innocent people are acquitted. There may be no way to know. The jury is there to decide whether the prosecution has made its case beyond a reasonable doubt and so decide whether the accused has been proved "guilty" or "not guilty." Innocence is a subject beyond their purview.

Perhaps in the future technology and forensics may advance to the point where guilt or innocence will be a simple matter of lab results. Yet, even in that case, trials would still be necessary to verify that the methods were used properly and applied appropriately. We have come a long way since sword fights, crushing people, and throwing them into lakes, but we are still well short of certainty. Until technology is able to advance to the point where its results are irrefutable, and, more importantly, its use, application, and interpretation are indisputable, doubt will, and should remain. And where there is doubt, there should be no death penalty.

In cases where evidence and procedure are questioned, or new facts brought to light, we should not hesitate to review them when a man's life is at stake. Legal systems have always been flawed and always will be flawed. This is why we should stop executing people, especially where there is any controversy whatsoever, legal or otherwise, surrounding the conviction. The execution of Cameron Todd Willingham may be a case where a guilty man was executed for his horrible crimes. But, due to the inherent flaws in our legal system, we cannot be assured that an innocent man might not be executed in the future. It is because of this possibility that we should cease executing people. If it has not already happened, it will happen that, someday, an innocent man will be executed. And because he will be executed in our name, that blood will be on all of our hands. We should not sleep peacefully, as our forbears did, so long as this is a possibility.