Month: February 2013

Julie Bindel rails against legalized prostitution:

A third of Amsterdam’s bordellos have been closed due to the involvement of organised criminals and drug dealers and the increase in trafficking of women. Police now acknowledge that the red-light district has mutated into a global hub for human trafficking and money laundering. The streets have been infiltrated by grooming gangs seeking out young, vulnerable girls and marketing them to men as virgins who will do whatever they are told. Many of those involved in Amsterdam’s regular tourist trade — the museums and canals — fear that their visitors are vanishing along with the city’s reputation.

Like me, Daniel Nexon has mixed feelings:

This is one of those issues that I can’t sort out of my views on. My inner libertarian tells me that the state does not have the right to prohibit the exchange of money for sex. My inner pragmatists looks at the experience of some European countries and says, more or less, “that’s nice in theory, but in practice legalization just makes things worse.” My inner lefty responds, “but that’s because of inadequate regulation — if the regulators, parliamentarians, and police did their jobs than selling sex would be little different than offering personal training or non-sexual massage services.” My inner old-school feminist chimes in by pointing out that prostitution is the ultimate in objectification. My inner new-school feminist champions sexual autonomy and de-stigmatizing sex work. And on it goes. Of course, the internet isn’t much help in sorting out fact from propaganda.

I can’t help but note that a third of the brothels, as it were, have been closed. So some regulation is clearly going on. And Amsterdam’s problem may be its uniqueness – attracting far more scumbags than would be the case if sex work were more broadly available and legal. But that’s from where I’m sitting. This is a pragmatic decision, it seems to me. The Dutch will figure it out. They are among the sanest people on the planet.

Dreher expects the La Repubblica report—describing a group of gay prelates blackmailed from outside criminal elements—is onto something. Charles P. Pierce derides Dreher’s term, “Lavender Mafia,” and is skeptical of the rumors:

What gives me a little pause is that the “secret gay cabal” theory is an old favorite among those curial powerbrokers for whom Machiavelli was something of a wimp. It also has been a regular trope of conservative Catholics seeking to defend the institutional Church’s inexcusable behavior in the face of the sexual abuse scandal, largely through the rancid technique of implying that being gay and being a pedophile are so closely allied that the former have a reason for covering up for the latter. (The linked piece from the Telegraph makes it clear that “the other side” that so exercised Dreher was not a “Lavender Mafia,” but the usual cast of institutional authoritarians up to and including John Paul II) It also is an old-line reactionary conspiracy theory beloved of, among other people, the late crackpot Malachi Martin.

And it can also be true. Pierce’s detection of the hoary old “lavender mafia” trope is dead-on. Rod’s gay conspiracy-mongering has more than a tinge of sexual panic to it (as does a large amount of Rod’s prose). But nonetheless, this conjecture of Rod’s is of a piece with everything I have heard and seen about the dysfunctional gay men who help run a church dedicated to the marginalization and stigmatization of their fellow homosexuals. Here’s where Rod and I agree:

True, this story is very thinly sourced, which is why I don’t say that I know it’s true. But I expect that it is true because of what I know all too well about the lavender mafia in the US Catholic Church, from things priests in a position to know about the situation in Rome have told me personally, and from situations like the Cardinal Groer debacle.

Where Rod errs, I think, is in believing that covering up child-rape has a direct link to homosexuality.

In some cases, truly fucked-up gay priests may indeed have been involved in the cover-up of child-rape or indeed committed the rapes. But many non-fucked-up gay ones had nothing to do with it and were part of the solution, not the problem. Many straight ones were among the worst conspirators and rapists. (One of the more chilling passages in the psychiatric evaluation of Father Lawrence Murphy, who raped 200 deaf boys in Milwaukee with impunity was about his choice for boys over girls. He said it was because there was no chance of conception if he raped boys.) We’re talking about categories and psyches and pathologies that go far beyond our ideas of gay and straight.

But the high camp sub-culture of the Vatican and large swathes of the Catholic priesthood definitely exists. I’ve seen and heard it with my own eyes and ears. It’s one reason I find the hierarchy so nauseating on this subject. It’s not so much the tortured psyches of these moral leaders, it’s the cynicism that necessarily follows that grieves me. Given the kind of worldly intrigue and politics that practically defines the Vatican, I wouldn’t be in any way surprised that there is a gay faction among the Cardinals; and a gay faction in the Vatican bureaucracy. And it truly saddens me.

The question is whether this faction is for or against reform. I don’t know. But I’ll pause to note that many gay leaders of the church in the past have been among the most conservative. They know their ermined, frilly closets depend upon total secrecy and separation from normal life. So take the latest example – Britain’s Cardinal O’Brien, derailed on his way to Rome because of credible reports of male sexual harassment of his inferiors. He’s no reformer:

O’Brien has been an outspoken critic of gay rights, denouncing plans for the legalisation of same-sex marriage as “harmful to the physical, mental and spiritual wellbeing of those involved”. He was named bigot of the year in 2012 by the gay rights group Stonewall because of his central role in opposing gay marriage laws in Scotland.

I used to think that the gay question was important to me but not that important in the context of the whole church. But as the years have gone by, I wonder if it isn’t actually central to the crisis in Catholicism today. We need honesty – honesty about gay priests who need to come out as a way to buttress their celibacy; honesty about how priests are human beings and can benefit from a stable relationship in ways that enhance rather than detract from their ministry; honesty about the absurdly high proportion of the priesthood that is gay; honesty about the desperate need for wives and daughters to be part of a priest’s life in order to help him understand the flock he is supposed to tend to; honesty about the total arbitrary nature of the ban on women priests; and a recognition that gay priests have been among the greatest leaders of the church and still could be if allowed an option for a loving relationship with another human being – as Cardinal Newman had his whole life.

“Be not afraid!” John Paul II once wrote. “Of what should we not be afraid? We should not be afraid of the truth about ourselves.” This conclave – created by one of the gravest crises in the history of the church – needs to lose fear. It needs to face the truth about itself. And it needs to grasp the opportunity Benedict XVI has given it: the chance for a new birth, a new era, a new broom.

(Photo: Cardinal Keith O’Brien poses for pictures following a conference at Gillis Centre on May 8, 2012 in Edinburgh, Scotland. By Jeff J Mitchell/Getty Images)

[youtube http://youtu.be/I4yIlbh0CwE ]

Steve Brill’s Time cover story is, to my mind, what journalism should now be doing. There is surely going to be a backlash soon against listicles, GIF-swaps and corrupting “sponsor content” in favor of deep, thoughtful reported journalism. Steve Brill is pioneering the next wave in journalism – the long, deep-dive, debate-shifting essay that addresses our reality in an accessible, clear but compelling way. It pains me that The New Republic didn’t run this as its first cover-piece in its new incarnation. It would have been such a fantastic statement about where they want to go (the return of serious reported journalism) rather than a suck-up interview with the president (a media “get” that is so very last decade).

I have only skimmed it and intend to read the whole thing today, and will write soon about it. But the real beauty of the piece is that all it does is go through various healthcare bills line by line and point out the massive mark-ups hospitals put on routine procedures and various drugs. We all knew this already. But what great journalism does is force us to know it better and definitively. Money quote:

When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Yglesias wants more radical reforms than Brill proposes:

He wants to alter medical malpractice law, tax hospital operating profits, and try to mandate extra price transparency. That’s all fine, but it’s odd. His article could not be more clear about this—health care prices are high in America because, by law, we typically allow them to be high. When foreigners force prices to be lower, they get lower prices. When Americans force prices to be lower (via Medicare), we get lower prices. If we want lower prices through new legislation, the way to get them is to write laws mandating that the prices be lowered.

Sarah Kliff’s related thoughts:

What sets our really expensive health-care system apart from most others isn’t necessarily the fact it’s not single-payer or universal. It’s that the federal government does not regulate the prices that health-care providers can charge. You can see this in Luxembourg, which had the lowest health-care cost growth — 0.7 percent — of any OECD country in the 2000s. Its system allows patients free choice of what doctor to see or what hospital to visit but has the government set all rates for what doctors get paid for those visits.

Martin Gaynor is unsure about the effects of price controls:

[W]e don’t know what the impact of rate setting (price controls) would be on health care spending in the US. It’s possible that rate setting could prevent some of the most egregious practices recorded in the Brill article, but that depends on what’s enacted and how it’s enforced. Whether rate setting would substantially slow the rate of growth of health care spending isn’t clear. Further, the question that must be asked is what is the alternative? There’s evidence to suggest that robust price competition, such as we had with managed care during the 1990s, can perform very well in controlling costs. Unfortunately there has been a tremendous amount of consolidation in health care markets since the 1990s, raising serious challenges to competition. Whether the US decides to go with competition or with regulation, we have some serious work to do to make the system we choose work effectively.

Felix Salmon’s proposal:

Americans should have access to Medicare’s discounted rates — either by being eligible for Medicare, or else by signing up for health insurance with an insurer who allows Medicare to negotiate on its behalf. All of this would be voluntary, of course. If you want your insurance to cover the kind of things that Medicare won’t pay for, then you can do that. But if you think that Medicare-quality coverage is good enough, then you should be able to get it, at only a modest premium to what Medicare itself pays.

The Bloomberg View editors want more price transparency:

If health-care payers — Medicare, Medicaid, insurance companies, public-employee health-care plans — were to make public the prices that they pay, then maybe fees for services, equipment, facilities and medicines would fall. They could also reveal how much their beneficiaries pay out of pocket. Aetna and the state of New Hampshire have started doing this. It is exactly this kind of transparency that will improve the health-care system. Unfortunately, many contracts between hospitals and insurers contain gag clauses prohibiting the public release of pricing information. These gag clauses should be prohibited.

And, after reviewing the data, Drum wonders why Brill considers doctors underpaid:

The bottom line is that compared to other rich countries—all of which pay Medicare rates or less for medical services—American doctors are pretty well paid. The report also shows compensation as a ratio of the average wage in each country, and the story is similar (though GPs look a little closer to the OECD average when you compare their pay to average wages).

So is this more or less than U.S. doctors “deserve”? On that score, it’s worth pointing out that most American doctors have to pay their own medical school bills, a cost that’s picked up by the government in most other countries. Despite that, it’s a little hard to argue that American doctors, especially specialists, have been squeezed to the breaking point.

My specific thoughts ASAP.