The Enervated Man of the West

There are truths that must be stated. Mark Steyn starts down that road with the speech from which I quoted some hours ago, which has earned him a great deal of hatred; yet while he identifies the problem — that there is little in the multicultural identity, or lack of same, that can offer a compelling alternative to a determined, militant Islam for the individual Muslim — Steyn stops halfway in his search for a solution. We must regain calm self-confidence in our Western culture and heritage, Steyn says. Very good; yet what about our heritage are we to have confidence in? What specifically does the classical tradition hold that the modern multicultural society lacks, which is the essential point that will grant us victory in the long war ahead?

Steyn does not say straight out, aside from correctly stating that we will only fight to defend our society if we see it worth defending, as being superior to the opposing culture. But why does he not say clearly what in the Western tradition he thinks is superior and worth defending?

I hesitate to put words in Steyn's mouth; but he returns again and again in his writings to the example of the Thuggee cult in India, which would immolate young widows at their husbands' funerals. The response of the British General Sir Charles Napier to this charming custom (known as Sati) was not to ignore it as an expression of a different culture, but to eradicate the Thuggee cult from India. It seems, then, that one of our great virtues according to Steyn is that we consider human life sacred.

This by itself is easy; how difficult is it for an individual to abstain from killing people? The difference with the West is that we value life so much that we are willing to kill people to protect it. This requires a sterner mind than does simple nonviolence; it is not trivial to develop a philosophy in which you can willingly kill others at the same time as you hold life sacred, indeed, in service to that sanctity.

A word on sanctity. It necessarily implies that human life is sacred everywhere, at all times, regardless of prevailing social mores or laws. This carries with it the obligation to protect human life everywhere, to the best of our practical ability, and regardless of opposing social mores. Which is why Steyn is horrified that:

In London last summer, the Metropolitan police announced they were reopening investigations into 120 deaths among British Muslim girls that they'd hitherto declined to look at too closely on grounds of cultural sensitivity. Now think about that. Think about that. One hundred and twenty women are murdered and their murders go uninvestigated because the cops thought it was just some multicultural thing.

Steyn realizes that such murders are common in the Muslim world, of course, which is a large part of his implacable opposition to the spread of Islamic law. But what makes this truly horrifying to him (and to me, frankly) is that these murders went uninvestigated on British soil. That is to say, Britain had consciously abdicated its duty to defend human life even within its own sovereign borders, to say nothing of elsewhere.

Why? "Cultural sensitivity." Britain was unwilling to enforce the sanctity of human life among a community that thinks otherwise. Doing so might lead to a violent reaction, after all; better to let sleeping dogs lie and avoid trouble, no matter how many young girls are murdered in the meantime.

How could such a travesty occur? As I said above, it is difficult to reconcile the sanctity of life with the need to kill people in its defense. It is even more difficult for a decent person to kill another, himself (as opposed to supporting a champion who kills in his stead). And, most of all, it is most difficult to do so when it places yourself and your loved ones at risk. In short, we are dealing with an intertwining of philosohpical dissonance, misplaced mercy, and above all else a deep, pervasive fear.

All of these are symptoms of enervation. Intellectual enervation, in which elites who fear the abyss more than anything else have chosen to turn their backs on it, so that the abyss will not stare back at them. Moral enervation, in which individuals can reject necessary duties because they are distasteful. And enervation of the instincts, in which fear is allowed to dominate our minds above all else. We lack the fortitude, the iron determination, to do what must be done.

Why?

To approach our answer, let us return to the question of the hour: why will Islamic communities not assimilate into the West?

Set aside the various ways in which the West does not conform to Islam's ideal. I am not concerned with whether practicing Muslims feel at home in the West; I as an Orthodox Jew am not truly at home here even though I am a proud American from birth. What concerns me is why many Muslims are actively repelled by Western culture. Why do so many seemingly Westernized Muslims seem driven into the arms of the anti-Western exclusionism of the Jihad?

One finds this revealing sentence in a review of Osama bin Laden's writings by Printculture: "Democracy is at best a materialist doctrine for [bin Laden], a sinful worship of human desires of happiness." Similarly, a term that comes up over and over again is "decadence." The West puts the pursuit of pleasure above all else, so says the contemptuous Jihadi.

Materialism. Worship of human desire. Worship of happiness. All this set against the ultimate self-nullification of the suicide bomber.

But why should our decadence be so repulsive, and the alternative so attractive, to these Jihadis? After all, decadence is fun. It is pleasurable. It is so very easy! But (and here we tread on dangerous ground indeed) it is our decadence that is enervating us as a society. In the midst of our tremendous material wealth and power, we have grown so weak and stunted that much of the West cannot bear to use that power. Whereas, while the warriors of the Jihad are materially weak, they are indeed the mightiest of men. For they have offered up their very lives for their beliefs, and the halls of the powerful tremble with fear.

Steyn cannot say this out loud (assuming he even thinks in these terms, which he may not) because if he does, he must identify those decadent ideas and practices that are to blame for our enervation. It is hard enough for him to argue that Western culture is superior to others because it holds life sacred; if he tried to explain why some no longer defend that sanctity, he would have to challenge not only ideas of the multicultural Left, but of classical liberalism itself — the founding political doctrine of the United States.

The tradition of classical liberalism is built around the social contract, in which citizens cede power to a government in exchange for the guarantee that their rights will be protected. The main rights, of course, are "life, liberty, and the pursuit of happiness," or alternatively "property." In essence, the government has a limited mandate: to ensure the security of material goods, and the negative good of freedom from oppression.

But what of our civic obligations? They are narrow indeed: obey the law. Beyond that, you are free to act however you wish. You may feel certain behaviors as an obligation, but the obligation does not come from government. The government will not force you to be a good person.

More than that, this freedom to act however we choose is extolled as a virtue. Matthew Arnold, in his work Culture and Anarchy, speaks of the British love for "doing as one likes," a love which largely carried over to America. Politicians, who need the support of the people to gain power, naturally celebrated this tendency and called "doing as one likes" a glorious expression of political liberty. In essence, they confirmed and celebrated the existing prejudice of the people.

What they did not do, and what few politicians do today, was use their stature to ecourage the people to become a better people. Indeed, there is no civic obligation in democracies for an individual to improve himself morally or physically, beyond a certain bare minimum. On the other hand, there is great civic value attached to gaining material possessions. This is not difficult to explain, and I have some related thoughts in a previous post. Put briefly, society agrees that material goods are better than their absence, and even has a standard for keeping score, i.e. money. This, incidentally, allows free markets to function well, since each individual can measure the effectiveness of his commerical transactions in absolute terms, setting up a constant feedback loop.

However, there is no single agreed-upon standard for morality. The standard against which you measure your moral choices is itself the product of a choice. The classical liberal government does not impose a uniform moral standard, thanks to Europe's long bloody history of religious war. Morality is essentially separate from civic obligation.

This was less of a problem in former years, when communal organizations and religious goups still commanded great authority, and public standards of behavior were agreed upon through collective consent, and not through government decree. However, as Socrates warned, the natural trajectory of democracies is to become dissolute; how can it be otherwise, when democracy is about rule by the majority, and not rule according to a set standard? Extragovernmental moral authorities held the line for a very long time, but have been effectively routed by the forces of eros and the everpresent love of "doing as one likes." Now, we live in a moral anarchy, where anything that is legal (and a few things that aren't) is considered acceptable behavior by large numbers of people.

All right; but why is this a problem? After all, why should an atheist care if the three monotheisms officially outlaw homosexuality, or premarital sex? It doesn't hurt anyone, does it? Why should someone avoid using profanity if it is considered acceptable in his social circle? If a person wants to eat a deep-dish pizza every day and play video games until his thumbs drop off, what business is that of anyone else?

The fundamental problem is that Western society is fast abandoning the concept of personal discipline, of measuring oneself against a standard which he must struggle to attain. In particular, we learn to immediately gratify our emotional impulses (especially sexual impulses), rather than controlling them and channeling them towards a higher use. There is no more place for the sublime. There is no example of the exceptional moral paragon which we are encouraged to emulate. Whereas before we could imitate Washington's honesty, Lincoln's steely resolve in the cause of anti-slavery, Franklin's homespun wisdom, now we are constantly reminded that these dead white guys are all flawed men and not worth paying attention to.

It is very hard work to seek moral and ethical improvement; not for nothing does the Bible speak of "refinement," being passed through the fires of the crucible to emerge purer on the other side. Now there is less and less reason for the average citizen to go through the effort. And this sloth is extending past the moral realm and into the material. Each generation has a poorer work ethic than the last; each has a larger obesity problem; each accumulates more debt. The mere presence of our abundance is excuse enough for citizens to gorge; that they could train themselves to hold back from immediate gratification seems laughable. Our society no longer teaches the young to accept hardship. Our wills are weak and flabby, unused to hard strain.

Not for nothing is the bulk of the U.S. military made up of the deeply religious. They are increasingly the only communities willing to shoulder the burden. They are the only communities who not only dedicate themselves to a higher purpose and to civic virtue, but actually accept significant limits on their behavior in the process.

The specific problem of our unbunded sexual impulses is, I think, a primary contributor to our societal enervation. Sex is not simply a method of cooperative amusement; it is an incredibly powerful innate drive. It is the source of much of our emotional vitality. And how the sex drive is cultivated will have dramatic effects on a personality. If you are used to gratifying every urge, not willing to let even the slightest sexual tension accumulate, then you will lose a great source of emotional power and discipline. Not for nothing did the Victorians refer to orgasm as a "little death." Almost every program of spiritualism calls for periods of abstinence, because of the dramatic power that will accumulate during these periods: power which can then be applied in your daily life. Recall the movie Raging Bull, in which the protagonist avoids orgasm in the days leading up to a big fight. Recall, too, that in Orwell's 1984 the Party sought to suppress sexual activity to keep its members at a constant fever pitch of frenetic energy.

And yet in the West, every institution for channeling and controlling the sex drive has been devalued. Premarital sex is commonplace; adultery is shrugged off. Masturbation was even encouraged by Surgeon General Elders, under the most apropos of presidents. This is one part of the reason why the young seek ever-more-extreme diversions: when the pinnacle of primal experiences has become commonplace, life loses some of its color.

Compare the preceding with Islam. Much like traditional Judaism, Islam sees no distinction between government and religion; indeed, it is the duty of government to enforce the dictates of religion. Muslims must discipline their dietary habits according to the laws of halal, must pray five times daily, and — perhaps most importantly — must severely control their sexual behavior (at least in theory, though this is more rigorously enforced on women than men). Across entire societies, material goods are seen not as the prime societal good, but as a means for attaining the true good: submission to Allah. There is very little "doing what one likes" in Islam in the sense which it is found in the West; all Muslims have a duty to continually perfect themselves (as they understand the term), and activities that detract from that goal are condemned. Here, we have a society founded on discipline, submission to a greater good, and continual focus on serving Allah. Is it any surprise that the most fanatical should look at the West with contempt, even as the outputs of Western culture are eagerly consumed?

I fear that so long as Western culture permits the soft nihilism of "doing what one likes" instead of restoring the concepts of discipline and self-perfection as civic virtues, that the secular Western world will fall. In its place will rise the deeply religious communities of all stripes, those with the fortitude and will to fight for their beliefs. Religious commitment is already associated with high birthrates, compared to more secular populations; if only religious communities are prepared to fight in their own defense — or, more ominously, as an aggressor — then it is only a matter of time before secularism passes from the earth.

(Is this all a gross generalization? Absolutely. There are many secular stalawarts, just as there are many religious sluggards. But demographics are all about generalizations; and demography is destiny.)

Will the secular world meet the challenge? Or has it already become too enervated to escape its own nihilistic implosion?

Quote of the Day

Now I have a great sympathy for Muslims that face demands that they assimilate; it's on the front pages of all the newspapers in London this weekend. Even if you wanted to, even if you wanted to, how would you assimilate with say, Canadian national identity? You can't assimilate with a nullity, which is what the modern multicultural state boils down to. It's much easier to dismantle a society than put anything new and lasting in it place. And across much of the developed world, that's what's going on right now.

--Mark Steyn, keynote address of his recent Australia tour.

Hat tip: New Sisyphus

A New Paradigm for Medical Insurance

Our medical system is heading towards a meltdown. The symptoms are easily apparent; we have devolved into two loosely connected systems, each of which performs poorly. In one, people pay a large amount of money every month so that if things go wrong, they can take advantage of free or heavily subsidized medical care. In the other, people incur no costs until something goes wrong, in which case they must navigate a system that largely caters to the first set of people, racking up huge bills in the meanwhile.

A large part of the problem is with our insurance structure. Medical insurance, in its ideal form, guarantees any amount of treatment. This means that patients are encouraged to consume all the resources they can, and medical companies are encouraged to overcharge. Insurance carriers, in turn, are encouraged to sharply circumscribe the coverage they actually give in response to the foregoing; the end result is our present situation, in which medical premiums are exploding more that 10% or even 20% per year, even as the insurance actually covers less and less.

Attempts have been made to inject some market economics into the system. The most serious such attempt, the Health Savings Account, amounts to a weird hybrid between being insured and not insured: you must foot the bill up to a given deductible, usually $2400 and up (though you can do so with tax-free money), but larger bills are covered as with a typical insurance plan.

Meanwhile, the present system is heavily weighted in favor of conventional medicine and treatments; experimental treatments are rarely covered, as are most physical therapies such as Hellerwork, chiropractic care, or even exercising at a gym (a crucial step for most rehabilitation programs), which can sometimes be more effective than conventional medicine at a fraction of the cost. Worse, psychological care is almost never covered. If you are mentally ill, good luck to you, because chances are you will never get insurance coverage.

Furthermore, more and more doctors are refusing to accept medical insurance of any kind. The excessive paperwork, sharply decreasing payouts, and circumscribed treatment options are making insurance not worth the trouble for doctors to deal with.

Why are things this way?

If you get into a car accident, does your insurance company guarantee your repairs or give you a new vehicle? No; a dollar figure is arrived at for the damage, money is paid out, and you use that money as you see fit.

If you have disability insurance, does the insurance company guarantee that you will never miss work? No; a dollar figure is arrived at for the value of the missed work, money is paid out, and you use that money as you see fit.

Similar examples can be found all over the insurance industry.

Why not with medical care?

What if there were a new class of medical insurance that instead of guaranteeing treatment, placed a dollar value on each type of injury or illness? Patients would receive cash payments based on the value of their condition, once it has been confirmed by a medical diagnosis; they would then spend that money however they wanted, with the expectation that they will seek as much medical care as they see the need for.

There will be no need for doctors to worry about dealing with the insurance companies (except to verify the medical condition); moreover, by coming up with standard retail prices, they will be better able to serve those without insurance. And of course, this will introduce price competition between doctors and drug companies, since no one will be held captive to a preapproved list of doctors and treatments as those with insurance are today. Price competition will benefit everyone: those with insurance, those without it, government, and the insurance companies. (The exceptions, of course, are those marginal medical care providers who cannot compete. But, such is commerce.)

Moreover, patients who can find cheaper treatments will benefit, since they will be able to pocket the difference. This will be a boon to the "alternative" medicines that actually have beneficial effects, since they are ususlly much cheaper than the conventional alternatives. (That this will also lead to an explosion of snake-oil salesmen is unavoidable.) And it will provide a strong incentive for patients to take a clear look at how much a given medical treatment actually benefits them, compared to other goods they could spend the money on.

What about the time lag between when a condition occurs and when money is disbursed by the insurance company? One of the services that an insurance company should provide is a line of credit, usable only at medical facilities, which would be drawn upon with the expectation that the eventual payout will cover it. For example, if I broke my arm, I would go to the hospital, whip out my Medical Credit Card, and charge the cost of treatment at prime interest rate or thereabouts. Then, two or three weeks later, the insurance company will approve the payout, apply it to my credit balance, and send me the rest. Medical offices need never worry about insurance accounts-payable again.

Conventional medical care does a poor job of compensating for lost work. Disability insurance is an imperfect substitute, since it does not account for decreases in productivity caused by "manageable" medical conditions. But in a system of cash payouts, one could choose to increase the insurance premiums in exchange for a correspondingly higher payout when a medical condition arises. In effect, individuals can ensure some compensation for lost work due to injury or illness.

In the ideal scenario, such a system would rapidly drive down medical costs, force more scrutiny on the effectiveness of medical procedures, and improve the lot of those without medical insurance. It would also help to plug our government deficits, since medical care is a vast portion of government's expenses. And a few adventurous individuals could find cheaper cures, and then use their payouts to buy homes or start businesses. Insurance companies themselves would benefit as well, since managing client accounts will become much simpler.

In the dystopian scenario, however, this could lead to people chasing dubious medicine so that they could pocket the cash. Medical fraud would also be possible for a vaster segment of the population, beyond the few medical companies that practice it today.

More seriously, people will run the risk of having the payout money run out before they get better. But this danger is mitigated because conventional insurance will still be available, and one could conceivably purchase such insurance with the payout money, or simply purchase an annuity.

Cash-payout medical insurance has the potential to completely reform our medical system. It is time someone tried it.

Peace in Our Time

He who is kind when he should be cruel, will be cruel when he should be kind. If you could point to a single ironclad rule in history, this Talmudic dictum would be it. The specific context for the quote was the Biblical reign of King Saul. Ordered to annihilate the kingdom of Amalek, Saul instead spared the Amalekite king, Agag, and allowed his troops to take back plunder which had been specifically forbidden to them by the prophet Samuel. This misplaced act of kindness, motivated in large part by Saul's chronic inability to resist the whims of his subjects, ended up destroying the legitimacy of his rule. David was anointed as king in Saul's place; and as Saul became increasingly paranoid of a rebellion by his young captain, he massacred the priestly city of Nov, who were innocent of any crime.

Again and again throughout history, leaders have confused moral cowardice and political fecklessness with mercy, or as the present odious parlance would have it, "restraint." Again and again, it is the innocent who pay the price. Munich 1938 comes to mind, of course; but more immediately, we have two seemingly unconnected cases who are drawing ever more intertwined.

The Iranian stooge Muqtada as-Sadr, let us remember, first became news when he ordered the murder of elder Ayatollah Abdul Majid al-Khoei. At the time, the Coalition Provisional Authority (an embarassingly feckless body if there ever was one) shied from arresting him; Sadr controlled a militia of some few hundred men, after all, and there was no point in stirring up trouble. Never mind that an Iraqi judge had issued a warrant for his arrest.

In retrospect, the insanity of this decision is easily apparent, given the tremendous power that Sadr has now amassed, and the rivers of blood his men have shed, Iraqi and American. But even without the benefit of hindsight, this should have been an easy call. By refusing to enforce justice immediately, the CPA taught Iraq that all that you needed in order to murder people with impunity was a gang of thugs at your back. Was it really so difficult to imagine what would happen next?

Now, Sadr is flexing his power by lending his movement to the cause of Hizbullah in Lebanon, the other case of misplaced "restraint" I have in mind.

After the pullout from Lebanon, Israel committed the cardinal blunder of allowing Hizbullah to periodically shell her cities, across an international border, with near-impunity. Oh, there would be periodic artillery duels, and the occasional airstrike. But these are all of minor tactical significance.

With the exception of the abortive Operation Grapes of Wrath (terminated after the accidental strike on the Qana civilian shelter, which happened to be just where Hizbullah decided to set up its weapons... as in the present war), there was no attempt made to change the fundamental strategic problem. Hizbullah fired rockets for years running, in twos and threes, all the while building fortifications and amassing more powerful weaponry. And Israel did nothing, mostly in deference to the everpresent, unidirectional delicacy of world leaders.

Worse, when Hizbullah kidnapped and murdered three IDF soldiers in 2000, Ariel Sharon did not retaliate. Indeed, he freed 400 Hizbullah members in exchange for three corpses, along with the now-disgraced Col. Tannenbaum who had also been kidnapped. This capitulation, as we now know, persuaded Nasrallah that he could kidnap Israelis at will, without consequenses. The bloodshed that is now ravaging Lebanon and the north of Israel is a direct consequence.

Because the CPA did not uphold the law when it was inconvenient to do so, America's position in the Middle East is uncertain where it could have been much firmer. Even barring an arrest, we have had many chances to put a bullet in Sadr's brain. That we did not, and do not, is inexcusable. That man should be dead, and every day he draws breath he draws more blood, most of it innocent civilians. Because Israel refused to uphold its sovereignty in the face of the first Hizbullah pinpricks, it invited the far heavier toll we see today, and was forced in turn to take much innocent life along with the guilty.

As Machiavelli said, wars can almost never be avoided. They are instead deferred, to the benefit of the aggressor.

Why do we continue to make the same mistakes, year after year? Has it become so easy to take the cowardly way, huddle up under the covers and hope that the bad men vanish like bad dreams?

Some seeming cruelty can be the greatest kindness of all. Justice and the right of self-defense are rarely set aside without great woe in the end.

Ezekiel 13:3-11

Thus said the Lord Hashem/Elokim: "Woe unto the foolish prophets, who follow their own spirit, and things they have not seen. Like foxes among the ruins, so are your prophets, O Israel. You did not ascend into the breaches nor build a fence for the House of Israel, that could stand up in battle on the day of Hashem. They saw a worthless vision and false divination; they say, 'The word of Hashem!' but Hashem did not send them, yet they expect their word to be confirmed. Have you not envisioned a worthless divinationa and uttered a false divination? You say, 'The word of Hashem,' when I have not spoken!"

Therefore, thus said the Lord Hashem/Elokim: "Because you have spoken worthless words and have seen a false vision, therefore, behold, I am against you" — the word of the Lord Hashem/Elokim — "and My hand will be against the prophets who see worthless visions and divine falsehood; they will not be among the counsel of My people, nor will they be inscribed in the record of the House of Israel, nor will they enter into the soil of Israel; and you will know that I am the Lord Hashem/Elokim. Because — and again because — they led My people astray, saying, 'Peace,' but there is no peace. They erect a curtain and even smear it with plaster!

"Say to those who smear with plaster, 'It will fall! There will be pouring rain.' And as for you, O huge hailstones, you shall descend and a stormy wind shall break forth.

This passage was referenced in the prayers for the Ninth of Av, the Jewish fast which just drew to a close this evening. The words speak to us, even now. [Hashem= God, the Eternal One, the Lord]

Bitter Medicine

This morning, I listened to an NPR news report that surveyed the non-approved use of the cancer drug Avastin to treat a common cause of blindness, wet macular degeneration. A researcher realized that Avastin was chemically similar to another drug being specifically approved by the FDA for this disorder (whose name I forget, but it is made by Genentech), and tried it on his patients with great success.

The FDA-approved drug retails for $2000 a dose. Avastin, when used as an eye treatment, costs about $50 a dose. (A course of treatment is typically two doses several months apart.)

It gets more interesting. Avastin is comparably cheap because in its normal use, as a cancer drug, it requires much more volume than as an eye drug. But as a cancer drug, Avastin is also about $2000 a dose.

Why are the drugs priced this way? A spokesman from Genentech said that they determined that their typical patient would have insurance, and would only have a $50-a-month copay out-of-pocket for the blindness drug. The rest of the cost would be eaten by the insurance companies.

In short, the calculation is made based on what cost the individual user will see. But because the true cost is shielded by the insurance comapny, Genentech and other companies like it are free to put the hurt on the insurance providers for everything they can get.

It isn't that simple in practice, unfortunately. Many people lack insurance, of course. Moreover, many people with insurance must pay for the entire cost upfront, and only later will they be reimbursed by their provider. This presents a massive cash-flow problem, as one can imagine.

Most of all, this contributes to an inflationary spiral in which insurance companies must continually raise their premiums to recoup the exploding costs on innumerable individual treatments, whose pricing is being determined by the calculation noted above.

Given that the drug prices are set based on the felt cost to the patient, which translates to a massive premium to the manufacturer, it seems obvious that insurance companies can rapidly drive down prices by covering a smaller fraction of the drugs' cost. This would force the manufacturers to adjust accordingly, reducing the burden on insurance companies, policyholders who must pay crushing premiums, and those without insurance altogether.

Some might protest that lessening drug coverage will hurt patients. But this ignores the truth that everyone is already paying indirectly for the full cost of the drugs, through high premiums; and anything that can bring down the absolute price will help everyone, especially the uninsured.

Drug companies will charge what the market will bear. That being the case, it is foolish to distort the market in the way we have done. Consumers should feel more of the cost for their specific treatments, or else overall costs will continue to grow.