The Dish

A reader writes:

As a general proposition, I’m against the adoption of a two-tiered medical system. The best doctors will gravitate toward the concierge system, leaving the worst doctors to treat the masses. This is just another example of the widening split in this country between the haves and have-nots.

Another sighs:

It always makes my brain break when I read people who obviously don’t know much about the medical industry suggest things like “AMA guidelines” to deal with specialists who require cash payments. First, the AMA is not an oversight body. It’s a voluntary lobbying association representing solely the most conservative physicians, with a heavy focus on pure internal medicine – unspecialized physicians who only see adults.

The only regulatory body for medicine in the United States is the US government, and the only entities with any reliable power are Medicare and Medicaid, because they control the purse strings. (If you break their rules, you don’t get paid). The AMA has no authority, and these days a rapidly declining membership of cantankerous old men. By definition all AMA guidelines are vague, because nobody gives a hoot.

If you want good professional guidelines that are actually followed, look at the individual society for that field. In my case, as a pediatrician, it’s the American Academy of Pediatrics (AAP).

Finally, concierge practice is just the newest iteration of a very old form of practice, that of the “society” physician. Every city has its pediatrician and internists that the best people go to, with wait lists and other shenanigans. These doctors always went the extra mile, gave antibiotics when they weren’t indicated, and did all sorts of medically dubious things to keep their entitled patient population happy (and they still do). The concierge version of this just reflects the newer iteration, where doctors are not as attached to their titular independence, and are getting paid more to sacrifice their time and common sense.

Michael Robbins, whose review essay on the intellectual shallowness of the New Atheists sparked a number of reader dissents, writes in responding to his would-be critics:

It’s a good idea to at least try to get an argument straight before you attack it, but I’ve found that the people most likely to leave a comment or shoot off a huffy email are the least likely to do so. This is unsurprising – thoughtful people take time to consider different views and to consider how they challenge what they think. The huffy responders already know it all – they’ve got their preconceptions and assumptions armed for bear. For example, one of your readers writes:

If Michael Robbins wants us to worry that the decline of organized religion implies some loss of certainty about the foundations of our ethics, we will need some data showing that religiosity correlates with ethical behavior.

Well, I guess it’s a good thing I don’t want anyone to worry about that. I didn’t say a word about “organized religion.” I specifically denied that I was arguing that a coherent morality requires theism. And does this reader really suppose that Nietzsche believed that religiosity correlates with ethical behavior – or, I should say, does he not understand Nietzsche’s argument in On the Genealogy of Morality about what “ethical behavior” really is and where it comes from?

The point is simply that a morality predicated on Enlightenment rationalism retains its Christian foundations, at the expense of coherence. Therefore the moral codes we retain after the death of God are grounded in nothing, a point the Neo-Darwinians underscore every time they trumpet that article of faith, the “morality gene.” It is not enough to argue that we can simply ground our morals in ourselves, in our conceptions of the good (for one thing, it is self-evident that we don’t agree about what these conceptions should consist in).

That religious people of the past were often quite as murderous and duplicitous as we is beside the point, properly understood. We are talking about the loss of a coherent worldview, about grounds, not about practices. Anyone interested in the history of the shaping power of mental conceptions should understand why such a loss is a problem.

Alasdair MacIntyre’s After Virtue is still the best book to address this.

MacIntyre shows that Kant, Hume, Smith, and Diderot failed to provide justifications for their moral philosophy, because of their historical backgrounds, grounded in Christian morality. Morals unfold in time – their social and historical contexts matter. You can give a Rortyan shrug and say that it doesn’t make any difference whether we retain Christian conceptions of the good without Christian metaphysics – that we can simply consider them abstracted from their contexts -but you’re left in the shaky position of defending a concept of virtue without a first principle to prop it up. There is a real question of why anyone should agree with you.

Again, this has nothing to do with arguing for the retrievement of Christian metaphysics. MacIntyre himself, though a Catholic, calls for a revival of Aristotelian moral philosophy. These are the sorts of confusions that could be avoided by doing what I suggested – reading.

Which brings me to the readers who write in to inform me of the most obvious fact in the world, that some religious people believe crazy shit. (Although I have to laugh at the trend of quoting the extraordinarily metaphor-rich Jonathan Edwards to prove this.) One of your readers comments:

When Robbins writes: “Of course the dead in Christ don’t intervene with God to help you find your car keys, and of course the Bible is inconsistent and muddled (no matter what the Southern Baptists claim to believe), and of course I find it extremely unlikely that Mohammed flew to heaven on a winged horse”, that’s when he gets to criticize atheist focus.

I guess I get to criticize atheist focus, then, since I’ve explicitly written that such beliefs are superstitious nonsense, often, in Slate, the Chicago Tribune, and Commonweal. (The same reader has failed to note that “austere abdication of metaphysical premises” is a quote from David Bentley Hart in which he is praising science for its abdication.) I had assumed it was obvious that Origen and Augustine would hardly have taken the trouble to deny literalist readings of the Bible if such readings did not exist. And some of the more idiotic beliefs held by American Christians (such as young-earth creationism), are, of course, based on no readings of the Bible at all.

But as I have written elsewhere, religious fundamentalism is a soft target. You’ve figured out that Mohammed did not fly to heaven on a winged horse and that Rama’s bridge was not built by monkeys and that Noah did not build a giant ark to survive a heaven-sent deluge? Good for you.

But the New Atheists did not write books that simply attacked creationism. They wrote books that purport to challenge theistic belief as such. They therefore have a responsibility to address the best cases for God, not the dullest. When Dennett asks if super-God created God, and if super-duper-God created super-God, he is simply revealing a lack of acquaintance with the intellectual traditions of the major religions. If you want to argue against something, you have to understand what you’re arguing against. That’s axiomatic.

One of your commenters kindly informs me that Nietzsche was anti-democratic. Somehow I had already managed to pick that up even before I earned my PhD from the University of Chicago. This same reader believes that I want to claim for Christianity a monopoly on morality. Again, there are the words that I actually wrote, and the words that some people decided, on the basis of no evidence, I really meant.

What “American Christians” believe is diverse. Do most Catholics really reject “human rights, social justice, and egalitarianism”? Do most Episcopalians? Has this person met many American Christians? Has he or she decided that groups such as Sojourners are simply lying about their values?

Yes, many people believe things that are plainly untrue. Some atheists believe that their faith in scientific naturalism suffices to disprove the existence of God, for instance. Some Christians are mistaken about the age of the earth. Some religious believers don’t understand their own traditions. Some believers are better at explaining particle physics than some atheists.

So what? None of this has any bearing on what I wrote. But again, it’s no surprise that some folks decided to invent a caricature of my argument out of thin air. As Epictetus said, “If you say to somebody … ‘your opinions are ill-considered and mistaken,’ he immediately walks out, exclaiming, ‘You’ve insulted me!'”