Pro Lowell Bennion

It is good to praise and give thanks for those we have looked up to and admired. Lowell Bennion was one of those for me. I spent 8 weeks in each of the summers of 1972, 1973, 1974 and 1978 at the Teton Valley Boys’ Ranch that Lowell Bennion established, first as one of the boys and in 1978 as a counselor. The Teton Valley Boys’ Ranch did a lot to help me grow up. Though Dr. Bennion, we called him, was quite cerebral and led thoughtful discussions in the evenings, the ranch helped me balance out bookishness with a wide variety of manual labor in the weekday mornings (for which the boys were paid $2.50 for 4 hours out of the camp fees their parents had paid in the first place) with physical activities such as hiking, horseback riding, trampoline and competitive sports, and time with many new friends in the afternoons and on the weekends. (The Teton Valley Boys’ Ranch had a big enough impact on those who attended that alumni of the ranch have made sure that even a quarter century after Lowell Bennion’s death in 1996, a successor to the Teton Valley Boys’ Ranch exists.)

During the first few weeks I was at the ranch in 1972, I got sick and missed some workdays and asked Dr. Bennion what I should do. He suggested I work with him in the garden on some of the afternoons. So I got to know him well early on. He told me about his dissertation on Max Weber (the first book on Max Weber in English) and communicated wordlessly his love of gardening. He taught the principle of continuing to try to improve throughout life by apologizing for very mild profanity (“golly,” “by Jove”) and saying he was trying stop.

To the boys more generally, he said other memorable things. When we were building a barn, he talked about his hope that it would be beautiful. Combining a humanitarian lesson with an invocation of God, he said that painting widows’ fences as a way to get the favor of God was a substitute for the fire insurance he couldn’t buy for the ranch. With a largely Mormon context of trying to steer us toward avoiding premarital sex, he recommended not “going steady” with one woman until one was ready to marry.

Dr. Bennion communicated one key value by having the ranch quite literally take on at least one juvenile delinquent each summer to try to help them reform. This was costly in many ways, but he didn’t want to give up on people.

But beyond any of these specifics, it was Dr. Bennion’s presence that was most impressive. His soft-spoken, articulate wisdom was backed up by a calm centeredness. That example has provided me with a clear picture of what it looks like to be a good man. My Dad has some of that, but it was even more striking in Lowell Bennion.

I wish everyone were as lucky as I have been to have clear examples of deeply good men and deeply good women in their lives. Those of us who have been that lucky should tell stories about our heroes to bolster everyone’s faith in human potential.

Postscript: I’d love to connect with old friends from the Teton Valley Boys’ Ranch I have lost track of. Contact me on Facebook! I wish it had existed back then so we wouldn’t have fallen out of touch.

Gratitude for Challenges

Link to the Amazon page for Maps of Meaning by Jordan Peterson

I am currently listening to the audiobook for Jordan Peterson’s Maps of Meaning. This is a book interpreting religious archetypes, written before Jordan became famous for championing freedom of speech in areas where being for freedom of speech is a controversial position (a controversy that gains him notoriety and fame respectively from the two sides of the political spectrum).

In Maps of Meaning, Jordan emphasizes the importance of having a positive attitude toward the unknown. Comfortable things don’t get called the unknown. So the unknown isn’t comfortable. Engaging voluntarily with the unknown to bring back knowledge and other treasures is the hero’s journey. In the Christian tradition, Jesus himself is the primary hero.

The hero’s journey often begins when something we weren’t looking for and didn’t want comes knocking at our door. Then we have a choice: bemoan our fate, or take them on as if voluntarily that challenge that we have no choice about. Somewhat paradoxically, approaching our challenges with gratitude is a great way to maximize our chances of coming out of those challenges not only intact, but with greater power and wisdom than he had before those challenges came knocking at the door.

So today, on Thanksgiving, give thanks not only for the obviously wonderful things in your life, but also for the things that are forcing you to grow, whether you like it or not, on pain of being diminished if you try to hide your eyes from the reality of those challenges.


Posts on Positive Mental Health and Maintaining One’s Moral Compass:

Less Institutional than a Regular Nursing Home

As they get older and some help becomes important, many people dread the idea of going to a nursing home or to “assisted living.” A big part of the reason is fear of a loss of control and loss of privacy, since safety and health often get put first over all the things people want that give them a reason to live. And there are other intangibles about what makes a place seem like home. There have been many good innovations in nursing homes and assisted living to make them more appealing. One that is important because it has been scaled up is the Green House Project. Here is what Atul Gawande says about the Green House Project in his wonderful book Being Mortal: Medicine and What Matters in the End:

Around 2000, [Bill] Thomas got a new itch. He wanted to build a home for the elderly from the ground up instead of, as he’d done in New Berlin, from the inside out. He called what he wanted to build a Green House. The plan was for it to be, as he put it, “a sheep in wolf’s clothing.” It needed to look to the government like a nursing home, in order to qualify for public nursing home payments, and also to cost no more than other nursing homes. It needed to have the technologies and capabilities to help people regardless of how severely disabled or impaired they might become. Yet it needed to feel to families, residents, and the people who worked there like a home, not an institution. With funding from the not-for-profit Robert Wood Johnson Foundation, he built the first Green House in Tupelo, Mississippi, in partnership with an Eden Alternative nursing home that had decided to build new units. Not long afterward, the foundation launched the National Green House Replication Initiative, which supported the construction of more than 150 Green Houses in twenty-five states—among them the Leonard Florence Center for Living that Lou had toured.

Whether it was that first home for a dozen people in a Tupelo neighborhood or the ten homes that were built in the Florence Center’s six-story building, the principles have remained unchanged and echo those of other pioneers. All Green Houses are small and communal. None has more than twelve residents. At the Florence Center, the floors have two wings, each called a Green House, where about ten people live together. The residences are designed to be warm and homey—with ordinary furniture, a living room with a hearth, family-style meals around one big table, a front door with a doorbell. And they are designed to pursue the idea that a life worth living can be created, in this case, by focusing on food, homemaking, and befriending others.

… He took the control away from the managers and gave it to the frontline caregivers. They were each encouraged to focus on just a few residents and to become more like generalists. They did the cooking, the cleaning, and the helping with whatever need arose, whenever it arose (except for medical tasks, like giving medication, which required grabbing a nurse). As a result, they had more time and contact with each resident—time to talk, eat, play cards, whatever. Each caregiver became for people like Lou what Gerasim was for Ivan Ilyich—someone closer to a companion than a clinician.

This sounds attractive to me. You can see the map at the top of this post of which states have Green House homes. There are three in Colorado, two near where I live now. The Green House Project website says “Don’t See a Green House home in Your Area? Build one!” I hope many people do this.

I’d be interested in other initiatives like this to given people more autonomy, privacy and sense of home in a nursing home/assisted living that have been scaled up.

In Being Mortal, Atul Gawande’s main theme is that we must face our mortality and the limitations of old age, but then choose freely within those limitation the things we care most about in our final years—and that people should be supported in doing so. Our final years are an important part of life. Without thinking about them, it will be hard to make them as good as possible.


For organized links to other posts on diet and health, see:

The Federalist Papers #43: The United States Constitution as a Commitment to Democracy at the State Level—James Madison

In the The Federalist Papers #43, James Madison defends a continuity-of-debt-obligations principle and gives a justification for miscellaneous powers of the federal government in the proposed constitution, such as establishing a federal district (which became Washington D.C.), owning property within states, patent law, establishing new states (but only with the permission of states whose territory is involved, if any) and establishing treason law within limits. And he addresses four very interesting provisions of the proposed constitution:

  1. It is ratified by the people, not by state legislatures. James Madison writes that that is important because otherwise:

    • It has been heretofore noted among the defects of the Confederation, that in many of the States it had received no higher sanction than a mere legislative ratification.

    • A compact between independent sovereigns, founded on ordinary acts of legislative authority, can pretend to no higher validity than a league or treaty between the parties.

    • … a breach of any one article is a breach of the whole treaty ..

  2. The constitution can be amended. Here James Madison may underestimate how difficult it will be to amend the constitution:

    • It guards equally against that extreme facility, which would render the Constitution too mutable; and that extreme difficulty, which might perpetuate its discovered faults. It, moreover, equally enables the general and the State governments to originate the amendment of errors, as they may be pointed out by the experience on one side, or on the other.

  3. The amendment process cannot touch the non-population-based, two senators per state rule. This untouchable rule has been criticized lately as counter to democracy.

  4. States would be committing through the proposed constitution to democratic government at the state level, with the federal government empowered to intervene if democratic state government should ever be in peril in a state. James Madison argues:

    • In a confederacy founded on republican principles, and composed of republican members, the superintending government ought clearly to possess authority to defend the system against aristocratic or monarchial innovations. The more intimate the nature of such a union may be, the greater interest have the members in the political institutions of each other; and the greater right to insist that the forms of government under which the compact was entered into should be SUBSTANTIALLY maintained.

    • In cases where it may be doubtful on which side justice lies, what better umpires could be desired by two violent factions, flying to arms, and tearing a State to pieces, than the representatives of confederate States, not heated by the local flame?

    • Among the advantages of a confederate republic enumerated by Montesquieu, an important one is, "that should a popular insurrection happen in one of the States, the others are able to quell it. Should abuses creep into one part, they are reformed by those that remain sound."

    • Insurrections in a State will rarely induce a federal interposition, unless the number concerned in them bear some proportion to the friends of government. It will be much better that the violence in such cases should be repressed by the superintending power, than that the majority should be left to maintain their cause by a bloody and obstinate contest. The existence of a right to interpose, will generally prevent the necessity of exerting it.

    • Is it true that force and right are necessarily on the same side in republican governments? May not the minor party possess such a superiority of pecuniary resources, of military talents and experience, or of secret succors from foreign powers, as will render it superior also in an appeal to the sword?

Awkwardly or worse from a modern point of view, James Madison also argues that the federal government might need to defend a minority with voting rights against a disenfranchised majority:

  • May it not happen, in fine, that the minority of CITIZENS may become a majority of PERSONS, by the accession of alien residents, of a casual concourse of adventurers, or of those whom the constitution of the State has not admitted to the rights of suffrage? I take no notice of an unhappy species of population abounding in some of the States, who, during the calm of regular government, are sunk below the level of men; but who, in the tempestuous scenes of civil violence, may emerge into the human character, and give a superiority of strength to any party with which they may associate themselves.

Thus, in James Madison’s interpretation, the preservation of a “republican form of government” can include the preservation of an aristocracy of a minority who have voting rights.

James Madison underestimated the likelihood of a civil war pervading a large chunk of the United States:

  • … it is fortunately not within the compass of human probability …

But he had it right that, as John Locke would say, such things must be given over to the determination of military arms and to heaven:

  • Should it be asked, what is to be the redress for an insurrection pervading all the States, and comprising a superiority of the entire force, though not a constitutional right? the answer must be, that such a case, as it would be without the compass of human remedies … it is a sufficient recommendation of the federal Constitution, that it diminishes the risk of a calamity for which no possible constitution can provide a cure.

In some sense, the US Civil War—and more fundamentally its internal contradiction of slavery—broke the Constitution; then it was put back together in a new form. The key 13th, 14th and 15th amendments would never have been ratified without the formerly Confederate states being conquered and required to ratify as a condition of coming back into good standing. Even then, the internal contradiction between a belief in equality and racism continued to infect the body politic—for a long time in the very obvious blot of Jim Crow.

Nevertheless, it was quite an accomplishment to get the original, quite flawed, Constitution adopted at all. It isn’t good to let the perfect be the enemy of the better. The Constitution was better than the Articles of Confederation. And it set the stage for the yet better Constitution we have today. The Constitution only became minimally consistent with justice after the 13th, 14th and 15th amendments. Even then, that basic level of justice was only on paper; it required most of a century for those amendments to take on anything approaching the full force they should have.

Below is the full text of the Federalist Papers #43.


FEDERALIST NO. 43

The Same Subject Continued: The Powers Conferred by the Constitution Further Considered

For the Independent Journal.

Author: James Madison

To the People of the State of New York:

THE FOURTH class comprises the following miscellaneous powers:1. A power "to promote the progress of science and useful arts, by securing, for a limited time, to authors and inventors, the exclusive right to their respective writings and discoveries. "The utility of this power will scarcely be questioned. The copyright of authors has been solemnly adjudged, in Great Britain, to be a right of common law. The right to useful inventions seems with equal reason to belong to the inventors.

The public good fully coincides in both cases with the claims of individuals. The States cannot separately make effectual provisions for either of the cases, and most of them have anticipated the decision of this point, by laws passed at the instance of Congress. 2. "To exercise exclusive legislation, in all cases whatsoever, over such district (not exceeding ten miles square) as may, by cession of particular States and the acceptance of Congress, become the seat of the government of the United States; and to exercise like authority over all places purchased by the consent of the legislatures of the States in which the same shall be, for the erection of forts, magazines, arsenals, dockyards, and other needful buildings. "The indispensable necessity of complete authority at the seat of government, carries its own evidence with it. It is a power exercised by every legislature of the Union, I might say of the world, by virtue of its general supremacy. Without it, not only the public authority might be insulted and its proceedings interrupted with impunity; but a dependence of the members of the general government on the State comprehending the seat of the government, for protection in the exercise of their duty, might bring on the national councils an imputation of awe or influence, equally dishonorable to the government and dissatisfactory to the other members of the Confederacy. This consideration has the more weight, as the gradual accumulation of public improvements at the stationary residence of the government would be both too great a public pledge to be left in the hands of a single State, and would create so many obstacles to a removal of the government, as still further to abridge its necessary independence. The extent of this federal district is sufficiently circumscribed to satisfy every jealousy of an opposite nature. And as it is to be appropriated to this use with the consent of the State ceding it; as the State will no doubt provide in the compact for the rights and the consent of the citizens inhabiting it; as the inhabitants will find sufficient inducements of interest to become willing parties to the cession; as they will have had their voice in the election of the government which is to exercise authority over them; as a municipal legislature for local purposes, derived from their own suffrages, will of course be allowed them; and as the authority of the legislature of the State, and of the inhabitants of the ceded part of it, to concur in the cession, will be derived from the whole people of the State in their adoption of the Constitution, every imaginable objection seems to be obviated. The necessity of a like authority over forts, magazines, etc. , established by the general government, is not less evident. The public money expended on such places, and the public property deposited in them, requires that they should be exempt from the authority of the particular State. Nor would it be proper for the places on which the security of the entire Union may depend, to be in any degree dependent on a particular member of it. All objections and scruples are here also obviated, by requiring the concurrence of the States concerned, in every such establishment. 3. "To declare the punishment of treason, but no attainder of treason shall work corruption of blood, or forfeiture, except during the life of the person attained. "As treason may be committed against the United States, the authority of the United States ought to be enabled to punish it. But as new-fangled and artificial treasons have been the great engines by which violent factions, the natural offspring of free government, have usually wreaked their alternate malignity on each other, the convention have, with great judgment, opposed a barrier to this peculiar danger, by inserting a constitutional definition of the crime, fixing the proof necessary for conviction of it, and restraining the Congress, even in punishing it, from extending the consequences of guilt beyond the person of its author. 4. "To admit new States into the Union; but no new State shall be formed or erected within the jurisdiction of any other State; nor any State be formed by the junction of two or more States, or parts of States, without the consent of the legislatures of the States concerned, as well as of the Congress. "In the articles of Confederation, no provision is found on this important subject. Canada was to be admitted of right, on her joining in the measures of the United States; and the other COLONIES, by which were evidently meant the other British colonies, at the discretion of nine States. The eventual establishment of NEW STATES seems to have been overlooked by the compilers of that instrument. We have seen the inconvenience of this omission, and the assumption of power into which Congress have been led by it. With great propriety, therefore, has the new system supplied the defect. The general precaution, that no new States shall be formed, without the concurrence of the federal authority, and that of the States concerned, is consonant to the principles which ought to govern such transactions. The particular precaution against the erection of new States, by the partition of a State without its consent, quiets the jealousy of the larger States; as that of the smaller is quieted by a like precaution, against a junction of States without their consent. 5. "To dispose of and make all needful rules and regulations respecting the territory or other property belonging to the United States, with a proviso, that nothing in the Constitution shall be so construed as to prejudice any claims of the United States, or of any particular State. "This is a power of very great importance, and required by considerations similar to those which show the propriety of the former. The proviso annexed is proper in itself, and was probably rendered absolutely necessary by jealousies and questions concerning the Western territory sufficiently known to the public. 6. "To guarantee to every State in the Union a republican form of government; to protect each of them against invasion; and on application of the legislature, or of the executive (when the legislature cannot be convened), against domestic violence. "In a confederacy founded on republican principles, and composed of republican members, the superintending government ought clearly to possess authority to defend the system against aristocratic or monarchial innovations. The more intimate the nature of such a union may be, the greater interest have the members in the political institutions of each other; and the greater right to insist that the forms of government under which the compact was entered into should be SUBSTANTIALLY maintained. But a right implies a remedy; and where else could the remedy be deposited, than where it is deposited by the Constitution? Governments of dissimilar principles and forms have been found less adapted to a federal coalition of any sort, than those of a kindred nature. "As the confederate republic of Germany," says Montesquieu, "consists of free cities and petty states, subject to different princes, experience shows us that it is more imperfect than that of Holland and Switzerland. " "Greece was undone," he adds, "as soon as the king of Macedon obtained a seat among the Amphictyons. " In the latter case, no doubt, the disproportionate force, as well as the monarchical form, of the new confederate, had its share of influence on the events. It may possibly be asked, what need there could be of such a precaution, and whether it may not become a pretext for alterations in the State governments, without the concurrence of the States themselves. These questions admit of ready answers. If the interposition of the general government should not be needed, the provision for such an event will be a harmless superfluity only in the Constitution. But who can say what experiments may be produced by the caprice of particular States, by the ambition of enterprising leaders, or by the intrigues and influence of foreign powers? To the second question it may be answered, that if the general government should interpose by virtue of this constitutional authority, it will be, of course, bound to pursue the authority. But the authority extends no further than to a GUARANTY of a republican form of government, which supposes a pre-existing government of the form which is to be guaranteed. As long, therefore, as the existing republican forms are continued by the States, they are guaranteed by the federal Constitution. Whenever the States may choose to substitute other republican forms, they have a right to do so, and to claim the federal guaranty for the latter. The only restriction imposed on them is, that they shall not exchange republican for antirepublican Constitutions; a restriction which, it is presumed, will hardly be considered as a grievance.

A protection against invasion is due from every society to the parts composing it. The latitude of the expression here used seems to secure each State, not only against foreign hostility, but against ambitious or vindictive enterprises of its more powerful neighbors. The history, both of ancient and modern confederacies, proves that the weaker members of the union ought not to be insensible to the policy of this article. Protection against domestic violence is added with equal propriety. It has been remarked, that even among the Swiss cantons, which, properly speaking, are not under one government, provision is made for this object; and the history of that league informs us that mutual aid is frequently claimed and afforded; and as well by the most democratic, as the other cantons. A recent and well-known event among ourselves has warned us to be prepared for emergencies of a like nature. At first view, it might seem not to square with the republican theory, to suppose, either that a majority have not the right, or that a minority will have the force, to subvert a government; and consequently, that the federal interposition can never be required, but when it would be improper. But theoretic reasoning, in this as in most other cases, must be qualified by the lessons of practice. Why may not illicit combinations, for purposes of violence, be formed as well by a majority of a State, especially a small State as by a majority of a county, or a district of the same State; and if the authority of the State ought, in the latter case, to protect the local magistracy, ought not the federal authority, in the former, to support the State authority? Besides, there are certain parts of the State constitutions which are so interwoven with the federal Constitution, that a violent blow cannot be given to the one without communicating the wound to the other.

Insurrections in a State will rarely induce a federal interposition, unless the number concerned in them bear some proportion to the friends of government. It will be much better that the violence in such cases should be repressed by the superintending power, than that the majority should be left to maintain their cause by a bloody and obstinate contest. The existence of a right to interpose, will generally prevent the necessity of exerting it. Is it true that force and right are necessarily on the same side in republican governments? May not the minor party possess such a superiority of pecuniary resources, of military talents and experience, or of secret succors from foreign powers, as will render it superior also in an appeal to the sword? May not a more compact and advantageous position turn the scale on the same side, against a superior number so situated as to be less capable of a prompt and collected exertion of its strength? Nothing can be more chimerical than to imagine that in a trial of actual force, victory may be calculated by the rules which prevail in a census of the inhabitants, or which determine the event of an election!

May it not happen, in fine, that the minority of CITIZENS may become a majority of PERSONS, by the accession of alien residents, of a casual concourse of adventurers, or of those whom the constitution of the State has not admitted to the rights of suffrage? I take no notice of an unhappy species of population abounding in some of the States, who, during the calm of regular government, are sunk below the level of men; but who, in the tempestuous scenes of civil violence, may emerge into the human character, and give a superiority of strength to any party with which they may associate themselves. In cases where it may be doubtful on which side justice lies, what better umpires could be desired by two violent factions, flying to arms, and tearing a State to pieces, than the representatives of confederate States, not heated by the local flame? To the impartiality of judges, they would unite the affection of friends. Happy would it be if such a remedy for its infirmities could be enjoyed by all free governments; if a project equally effectual could be established for the universal peace of mankind! Should it be asked, what is to be the redress for an insurrection pervading all the States, and comprising a superiority of the entire force, though not a constitutional right? the answer must be, that such a case, as it would be without the compass of human remedies, so it is fortunately not within the compass of human probability; and that it is a sufficient recommendation of the federal Constitution, that it diminishes the risk of a calamity for which no possible constitution can provide a cure. Among the advantages of a confederate republic enumerated by Montesquieu, an important one is, "that should a popular insurrection happen in one of the States, the others are able to quell it. Should abuses creep into one part, they are reformed by those that remain sound. "7. "To consider all debts contracted, and engagements entered into, before the adoption of this Constitution, as being no less valid against the United States, under this Constitution, than under the Confederation. "This can only be considered as a declaratory proposition; and may have been inserted, among other reasons, for the satisfaction of the foreign creditors of the United States, who cannot be strangers to the pretended doctrine, that a change in the political form of civil society has the magical effect of dissolving its moral obligations. Among the lesser criticisms which have been exercised on the Constitution, it has been remarked that the validity of engagements ought to have been asserted in favor of the United States, as well as against them; and in the spirit which usually characterizes little critics, the omission has been transformed and magnified into a plot against the national rights. The authors of this discovery may be told, what few others need to be informed of, that as engagements are in their nature reciprocal, an assertion of their validity on one side, necessarily involves a validity on the other side; and that as the article is merely declaratory, the establishment of the principle in one case is sufficient for every case. They may be further told, that every constitution must limit its precautions to dangers that are not altogether imaginary; and that no real danger can exist that the government would DARE, with, or even without, this constitutional declaration before it, to remit the debts justly due to the public, on the pretext here condemned. 8. "To provide for amendments to be ratified by three fourths of the States under two exceptions only. "That useful alterations will be suggested by experience, could not but be foreseen. It was requisite, therefore, that a mode for introducing them should be provided. The mode preferred by the convention seems to be stamped with every mark of propriety. It guards equally against that extreme facility, which would render the Constitution too mutable; and that extreme difficulty, which might perpetuate its discovered faults. It, moreover, equally enables the general and the State governments to originate the amendment of errors, as they may be pointed out by the experience on one side, or on the other. The exception in favor of the equality of suffrage in the Senate, was probably meant as a palladium to the residuary sovereignty of the States, implied and secured by that principle of representation in one branch of the legislature; and was probably insisted on by the States particularly attached to that equality. The other exception must have been admitted on the same considerations which produced the privilege defended by it. 9. "The ratification of the conventions of nine States shall be sufficient for the establishment of this Constitution between the States, ratifying the same. "This article speaks for itself.

The express authority of the people alone could give due validity to the Constitution. To have required the unanimous ratification of the thirteen States, would have subjected the essential interests of the whole to the caprice or corruption of a single member. It would have marked a want of foresight in the convention, which our own experience would have rendered inexcusable. Two questions of a very delicate nature present themselves on this occasion: 1. On what principle the Confederation, which stands in the solemn form of a compact among the States, can be superseded without the unanimous consent of the parties to it? 2. What relation is to subsist between the nine or more States ratifying the Constitution, and the remaining few who do not become parties to it? The first question is answered at once by recurring to the absolute necessity of the case; to the great principle of self-preservation; to the transcendent law of nature and of nature's God, which declares that the safety and happiness of society are the objects at which all political institutions aim, and to which all such institutions must be sacrificed. PERHAPS, also, an answer may be found without searching beyond the principles of the compact itself. It has been heretofore noted among the defects of the Confederation, that in many of the States it had received no higher sanction than a mere legislative ratification. The principle of reciprocality seems to require that its obligation on the other States should be reduced to the same standard. A compact between independent sovereigns, founded on ordinary acts of legislative authority, can pretend to no higher validity than a league or treaty between the parties. It is an established doctrine on the subject of treaties, that all the articles are mutually conditions of each other; that a breach of any one article is a breach of the whole treaty; and that a breach, committed by either of the parties, absolves the others, and authorizes them, if they please, to pronounce the compact violated and void. Should it unhappily be necessary to appeal to these delicate truths for a justification for dispensing with the consent of particular States to a dissolution of the federal pact, will not the complaining parties find it a difficult task to answer the MULTIPLIED and IMPORTANT infractions with which they may be confronted? The time has been when it was incumbent on us all to veil the ideas which this paragraph exhibits. The scene is now changed, and with it the part which the same motives dictate. The second question is not less delicate; and the flattering prospect of its being merely hypothetical forbids an overcurious discussion of it. It is one of those cases which must be left to provide for itself. In general, it may be observed, that although no political relation can subsist between the assenting and dissenting States, yet the moral relations will remain uncancelled. The claims of justice, both on one side and on the other, will be in force, and must be fulfilled; the rights of humanity must in all cases be duly and mutually respected; whilst considerations of a common interest, and, above all, the remembrance of the endearing scenes which are past, and the anticipation of a speedy triumph over the obstacles to reunion, will, it is hoped, not urge in vain MODERATION on one side, and PRUDENCE on the other.

PUBLIUS.


Links to my other posts on The Federalist Papers so far:

Encouraging Cost-Saving Innovations in Health Care by Redistributive Health Savings Accounts

Link to the article shown above

The progress of medical understanding means that more and more diagnoses and treatments are routine. With supportive government policy, everything that is routine in health care can be hived off from hospitals and regular doctors offices to specialized health care providers who only do those routine things. And that specialization allows productivity improvements that bring down costs. This is already happening: the number of health treatments you can get at your local pharmacy has been increasing. For example, many people have gotten some of their Covid vaccinations at the drug store rather than in a doctor’s office. These pharmacy-based health treatments are generally quite inexpensive.

This is path of hope for lower health care costs mapped out by Clay Christensen and his coauthors in an excellent books The Innovator’s Prescription. I wrote a series of posts a while back inspired by that book. See:

As it is, pharmacies have to negotiate with insurance companies. One way to encourage even more hiving off of routine health diagnoses and treatments to pharmacies (beyond regulations that allow it) is give people money for health care that is otherwise unrestricted.

Currently, there is a lot of activism in favor of a bit of basic income. For example, child allowances may become standard policy in the US. If some of that reasonable urge toward redistribution could give people money in health savings accounts, it could encourage the development of more low-cost medical care because people would do some comparison shopping across different pharmacies to conserve their health-savings account dollars.

As things stand, health-savings accounts mainly benefit those who are quite savvy about getting legal tax breaks. Health savings accounts could become something that benefitted the poor greatly if they had government transfers directly into those accounts. Inexpensive treatments could be dropped from Medicaid and the poor would still be better off because of the better choices they would have.

Some of the extra choices people would get from having health savings account funds from the government would come from a political dynamic of lobbying for more types of health treatments to be payable from those health savings accounts. The argument that it is people’s own money would likely lead by this political gravitation to more choices for use of the health savings accounts than the choices available through Medicaid. For example, Medicaid doesn’t always cover nutritional counseling (it depends on the state and on the particular health maintenance organization), despite how many chronic diseases are caused by bad eating habits. I would be surprised if people weren’t ultimately allowed to use funds from health savings accounts to pay for nutritional counseling. And Medicaid does not cover chiropractic care as freely as I think is optimal as a policy matter. With government transfers into health savings accounts of a fixed size, people could be given that freedom with the government having to worry about out-of-control explosion of extra spending from people getting valuable chiropractic care.

Many people have an almost inborn urge to want to control other people. We should always be on the lookout for this urge in the public policy arena. Freedom is good. We policy wonks should act like it. The blessings of freedom don’t always override other concerns, but they should weigh a lot in the balance.

Geriatrics: The Grim Good Magic of Setting Priorities in Old Age

Economics is about tradeoffs. People want many things and care about many things. Indeed, we want so many things and care about so many things that it is extremely unlikely we will ever get them all. We have to choose.

Professionals in any area become enamored of the particular outcomes they focus on improving. This is as true of medicine as any other professional area. Because death, despite its inevitable, seems like the ultimate defeat to doctors, they face the temptation of pushing people toward prolonging life at the expense of other things people value. This can steer doctors wrong toward the end of patients lives, when patients often value the freedom to do some things they want to do in their remaining time more than a few extra months.

Atul Gawande’s wonderful book Being Mortal is on this theme: people rightly rebel at being told they must always play it safe and always put medical concerns first in their final years. (All the quotations in this post are from that book.)

There are other issues with medical judgment for older patients. Even within strictly medical outcomes, doctors not trained in geriatrics (old-age medicine) often have trouble setting clear priorities. For example, avoiding falls is crucial. Atul Gawande writes:

Each year, about 350,000 Americans fall and break a hip. Of those, 40 percent end up in a nursing home, and 20 percent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. Elderly people without these risk factors have a 12 percent chance of falling in a year. Those with all three risk factors have almost a 100 percent chance.

I think often about the danger of falls in my future; I regularly do balance exercises. (See “Learning to Do Deep Knee Bends Balanced on One Foot.”)

Specialized training in geriatrics helps doctors do a much better job in making the lives of older patients better:

Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services.

These were stunning results. If scientists came up with a device—call it an automatic defrailer—that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink-ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailulation specialists, and Wall Street would be bidding up company stock prices.

Instead, it was just geriatrics. The geriatric teams weren’t doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe.

Unfortunately, geriatrics gets low reimbursement, low pay and little respect. The government has mismanaged its price. This puts us in a crisis as the population continues to age. Here is the situation and remaining hope:

I asked Chad Boult, the geriatrics professor, what could be done to ensure that there are enough geriatricians for the surging elderly population. “Nothing,” he said. “It’s too late.” Creating geriatric specialists takes time, and we already have far too few. In a year, fewer than three hundred doctors will complete geriatrics training in the United States, not nearly enough to replace the geriatricians going into retirement, let alone meet the needs of the next decade. Geriatric psychiatrists, nurses, and social workers are equally needed, and in no better supply. The situation in countries outside the United States appears to be little different. In many, it is worse.

Yet Boult believes that we still have time for another strategy: he would direct geriatricians toward training all primary care doctors and nurses in caring for the very old, instead of providing the care themselves.

In dealing with older folks, what doctors with no geriatrics sensibility is to try to fix everything. But every fix has potential side effects. Tradeoffs mean that patient preferences have to be consulted. But, interestingly, experience Atul recounts in Being Mortal by those who are especially good at working through decisions with patients makes it clear it is better to ask people about their preferences in general terms (“What is important to you?”) before talking in detail about the particular decision a patient faces. Indeed, the recommended type of interaction with patients sounds for all the world like what I do (totally non-medical contexts) as a part-time Co-Active Coach. (See “Co-Active Coaching as a Tool for Maximizing Utility—Getting Where You Want in Life” and the other links at the bottom of “Zen Koan Practice with Miles Kimball: 'I Don't Know What All This Is')

Optimizing-subject-to-constraint needs the right objective function, which for most people is much more complex than simply maximizing lifespan. Optimizing-subject-to-constraint also needs a clear recognition and understanding of the constraints. Admitting to ourselves the doom of mortality that hangs over our flesh-and-blood bodies—and the bodily breakdown likely to presage that end—is an important part of seeing the constraints clearly.


For organized links to other posts on diet and health, see:

Zen Koan Practice with Miles Kimball: 'I Don't Know What All This Is'

I have heard that instruction in Zen is often hardcore. Some Zen instructors may well be like drill sergeants, but Henry Shukman’s course within Sam Harris’s “Waking Up” app is wonderful. I highly recommend it. Henry Shukman does give some instruction on proper Zen posture, but I simply ignore that, and pay attention to everything else.

A Zen koan is a word, a phrase, a sentence or a little story designed to have a revelatory effect on the mind, without necessarily making any literal sense. Paradox is a way to knock the mind out of its accustomed ruts without ever needing to find a solution to the paradox.

Henry Shukman is great at explaining some of the principles of Zen that are reasonably easy to explain. For example, Zen encourages you to identify with your entire sensorium—everything they see, hear, taste, smell or feel at any given moment—rather than the human-shaped object within your sensorium. (“Who Am I?” is a koan that gets at that fairly directly.) That is only a fraction of what Zen reveals; that much all by it self is a great liberation. What seems to be “out there” is really inside your mind—not because there are no “things-in-themselves,” but because what you actually perceive are highly processed in-your-mind representations of those things. “Mind is nothing but the rivers, the mountains, and the whole wide earth; the sun, the moon and the stars.” Rather than being isolated Cartesian minds, our minds naturally connect us to all of the things around us that matter to us, where what matters to us (both animate and inaminate) has a long evolutionary history going back through millions of years of interaction.

Another key principle of Zen is “ordinary mind” and its emphasis on the transcendent beauty of ordinary objects. As such, Zen can easily fit within one’s regular life: whatever your days are like already, in any outward sense, there is transcendent beauty to be seen within that day.

Closely related to the principle of “ordinary mind” is the principle of “beginner’s mind.” I used to think “beginner’s mind” referred to the kind of openness I discuss in “Open Skepticism and Closed Skepticism.” It is something else. It is experiencing each moment as if it were the first time you had ever experienced anything like it. Instead of anticipating what is coming a second ahead of it’s happening and overlaying that expectation on what is happening, just see what is there. It may be much different, much more intricate and hence much more beautiful than anything you had imagined. (This might be hard to do without listening to some instruction in Zen from someone like Henry Shukman.)

“Beginner’s mind” reminds me of a principle I learned in a Landmark Education Communication Course of listening to someone like you don’t know what they are going to say. That simple practice can be surprisingly powerful.

In addition to listening to Henry Shukman’s course in the “Waking Up” app for the 3d time now, and buying one of the many collections of koans out there (I bought Entangling Vines), Henry is so clear in explaining how koans work that I feel I can invent koans of my own. Fortunately, as far as I know, Colorado has no occupational licensing laws for an upstart internet Zen master :)

The koan I have in mind today is one that works great when you are out and about doing whatever you normally do in your life. I have been using it on my daily walks, but you could use it during many other activities as well. It is an encouragement to beginner’s mind. I say to myself repeatedly:

I don’t know what all this is.

A variation on the theme of trying to see everything new that I also say to myself is:

I know what my feet should do, but I don’t know where I am.

With Zen koans, you don’t have to try to think or feel any particular way, just say the koan to yourself repeatedly and see what happens. These particular koans are intended to go along with other activities rather than to be used in any kind of sitting meditation. They are working for me, but I don’t know whether or not they will work as entry-level koans, without other koan practice first. Try them and see!


Posts on Positive Mental Health and Maintaining One’s Moral Compass:

An Altruism Paradox in Our Attitudes toward Foreigners

As I discuss in “What is a Supply-Side Liberal?” and “Inequality Aversion Utility Functions: Would $1000 Mean More to a Poorer Family than $4000 to One Twice as Rich?” Most Americans have an inequality aversion above two. That means that they assess a dollar to a family twice as rich as making only a quarter the difference to the lives of those in the richer family. Conversely, to a family living on a tenth the income, a dollar would make one hundred times the difference to their lives that it would mean to a family ten times richer than they are. Even if we decided that foreigners should have a welfare weight only one hundredth as big as an American citizen (something I call “The Aluminum Rule” because it is a far cry from the Golden Rule of loving one’s neighbor as oneself), there are many foreigners so poor that they would matter a lot in welfare calculations. As far as I can tell, our policies don’t follow the Aluminum Rule. They seem to follow something more like the “Dirt Rule” of treating poor foreigners like dirt when they show up at our borders, with a welfare weight far below .01 times the welfare weight of an American citizen.

So it comes as a surprise that as a nation we slow-walked booster shots for Americans in order to free up more vaccination shots for folks abroad. (I talk about this more in “Lying is Bad.”) Unlike dollars, that are worth more to people who have fewer of them, life versus death counts about the same for a rich person as a poor person. So if we had that attitude for citizens and then followed the intermediate Aluminum Rule of a .01 welfare weight on non-citizens, we wouldn’t be shipping vaccine doses abroad when there are supply shortages. However, it seems that rather than following this logic, people have much more sympathy for folks abroad who might die from Covid-19 than folks abroad who face an elevated risk of dying from abject poverty and a lot of poverty misery along the way who just want a chance to work in a decent country like ours. We are getting closer to the Golden Rule than to the Aluminum rule for getting vaccines to poor folks in other countries, but follow the Dirt Rule when poor folks in other countries want to immigrate to the US. What is going on?

For more on the moral dimensions of immigration policy, see:

Processed Food is Our Evil Overlord

Most of what we as a nation eat is processed food—or technically “ultra-processed food”—to use the nutritionists’ term that allows for the fact that, for example, even triple-washed spinach is technically “processed.” This is pretty much anything that is in a package or can and has a nutritional label on it. Matthew Rees’s November 3, 2021 review of The End of Craving by Mark Schatzker summarizes it this way:

58% of calories in the American adult diet come from ultra-processed foods, 67% among children and adolescents. Such foods—prepared meats, potato chips and other snacks, really almost anything in a package—are high in sugar, salt or fat. Many also contain a witch’s brew of ingredients that make nutrition labels unintelligible: sucralose, methylcelluloses, saccharin, microparticulated protein, Solka-Floc, maltodextrins, carrageenan.

Other than transfats which are very unhealthy, I tend to think dietary fat isn’t as bad as all that, and that even salt has been overly demonized. But sugar is a slow poison. I have often pointed out that, as things stand, it isn’t easy to distinguish between going off of sugar and going off of processed foods because such a high fraction of processed food has sugar as a major ingredient. (And the most common nonsugar sweeteners in processed foods are pretty bad, too. See “Which Nonsugar Sweeteners are OK? An Insulin-Index Perspective.”) And many of the other ingredients in processed food are suspect, if only because they haven’t had a chance to be tested by time in the way things humans have eaten for centuries have been tested by time. The objective function of trying to hook people on the particular processed foods a given company is making is also likely to push processed food toward extremes one should worry about.

The End of Craving has an additional hypothesis about how processed food could mess us up. As Matthew Rees summarizes it:

Consuming foods and beverages that have been designed to fool the brain into believing that it has received nutrition when it hasn’t, says Mr. Schatzker, stimulates a desire to consume more of them. Cravings follow, and they’re satisfied with the supersize concoctions that have become a defining—and depressing—feature of America’s food landscape…. The portion size of entrées at U.S. fast-food outlets, in roughly the past three decades, has grown 24%.

Could it be that fake food—a.k.a. processed food—often isn’t very satisfying? Mark Schatzker goes there:

For inspiration, he travels to Italy to determine why people there have a healthier relation to food—and a lower obesity rate (under 8% in the north). There’s no simple explanation, but he approvingly quotes a chef in Bologna who says: “It comes down to the difference between feeding and eating. . . . Italians don’t want just to feed themselves, they want to eat. . . . They want an experience.”

Mark Schatzker also has a more out-there theory:

In Mr. Schatzker’s telling, dietary deceptions are not the only reason for Americans’ girth. In the 1940s, he notes, the U.S. government began mandating that enriched flour be fortified with B vitamins. The policy continues today, resulting in Americans ingesting niacin and thiamin at levels that are well beyond what’s needed. Mr. Schatzker describes these vitamins as essential to calories being transformed into fuel, but he cautions that their excessive consumption results in the body metabolizing a higher share of calories. “With great obesity,” writes Mr. Schatzker, “comes great B vitamin intake.”

This sounds as if it assumes a simple calories-in/calories-out model. If more B vitamin intake means more calories are absorbed, that might be more satiating and then people would adjust the amount they ate. On the other hand, enriched flour is high in easily-digested starches that are quickly broken down by the body into sugar, and many baked products have sugar added to boot. Sugar causes an insulin spike that can mess up the appetite. So enriched flour could easily mess us up, but I’m doubtful that it is the vitamin enrichment that is messing us up.

I have inveighed against processed food before. See:

I attack sugar in these posts among many others:

For organized links to other posts on diet and health, see: