Coronavirus Reveals Dysfunctional Culture in Arizona

In mid-October, 2020, when the coronavirus was again peaking in E.U. states such as France and Germany and U.S. states such as Wisconsin and New Mexico, public health experts were worried about how the upcoming flu season would interact with the new virus, especially as people gather more indoors when outside temperatures turn colder. On October 15, 2020, for instance, seven U.S. states saw record numbers of hospitalizations, according to the Covid Tracking Project, and fourteen states set records for their seven-day averages of new daily cases, according to Johns Hopkins University.[1] France and Germany had already instituted nightly curfews. On October 16, Tier 2 Restrictions went into effect in London, which include urging people to avoid public transportation. Because physical distancing is not always possible on buses, subways, and light rail, universal mask wearing was crucial. According to IHME projections at the time, universal mask wearing in general “could save the lives of more than 70,000 Americans in the next three and a half months.”[2] With New Mexico’s chief executive referring to the coronavirus situation as “the most serious emergency that New Mexico has ever faced” on October 14, it was very troubling that Arizona, which borders New Mexico, had failed to enforce laws requiring masks on public transportation. This failure is extraordinary because of the mentality behind it.
On June 19, 2020, Maricopa County, which includes the Phoenix metropolitan area, had announced mask regulations approved by the Board of Supervisors. One of the regulations reads, “All riders and operators on public transportation must wear a mask.”[3] This bore directly on the light rail and buses, which Metro Valley, the transportation authority, either ran directly or through subcontracted operating companies and Allied Security. With enforcement of the new regulation being “the responsibility of law enforcement,”[4] Metro Valley announced that it would not use its employees and subcontracted security guards to enforce the regulation. In allowing passengers to board the buses and light rail without wearing masks, Metro Valley was actually breaking the law even during the “second wave” of the virus in June, 2020. In fact, it was not uncommon to see bus drivers and security guards either not wearing masks or wearing them around their chins rather than on their mouths and noses. It was especially common to see the riders wear masks covering only the chin.
Metro Valley’s excuse for not enforcing the “requirement,” which meant allowing passengers (and employees) to be on mass transit without wearing masks even though the regulation forbid it, was that some passengers (and employees) could not wear masks due to medical conditions like asthma. Allowing this exception to break the rule overall bespoke ignorance, stinginess, and laziness. Because at risk riders could have been accommodated with the modest requirement of having their respective physicians fill out a medical form that in turn would be necessary to obtain a special medical transit ID. Medical IDs were already issued to the disabled who had a medical provider fill out Metro Valley’s medical form. The transit authority did not have to emasculate the regulation and thus the public health on account of an exception. Talking to Metro Valley supervisors, I was struck by the near obsession on the exception to the extent that I could detect no awareness of making a requirement anything but, and in so doing, violating the regulation. Small minds should not rule large companies, for the consequent harm to the public can be large.
I was thrice flabbergasted when I listened on my phone to Metro Valley customer-service employees insist that masks were required on buses and light rail and that passengers could ride without masks was not incompatible with the requirement! Declarations by ignorance that cannot be wrong have a bad odor. Such ignorance has no legitimate basis in standing on stilts above customers (or anyone). When I pointed out the obvious point that allowing maskless riders on buses and trains means that masks are not required, the standard reply was actually corrective. “Masks are required. Riders will not be turned away for not wearing masks.” How can a mind possibly hold those two thoughts together as if they were consistent? Perhaps willful ignorance enjoys being corrective because of the little bit of power that can be enjoyed—so starved for the pleasure from power is the weak bird of prey, according to Friedrich Nietzsche.
Unfortunately, neither the county sheriff’s office nor the Phoenix police (nor that of at least one suburb) felt the need to enforce the county and various city laws on masks. “You need to call Metro Valley on that,” I was told as I sought comment. Even if Metro Valley had a policy of enforcing rather than breaking the regulation (and city laws) mandating masks on public transit, it was still the responsibility of law enforcement (i.e., not a transit company) to see that the regulation (and laws) are enforced. For law-enforcement agencies of municipal governments to rely on company policies conflates governmental law with organizational policies. The lack of accountability was staggering even as the coronavirus remained as a viable threat to the public health.
The political and educational cultures in Arizona were such that efforts to enforce the regulation and correct Metro Valley’s pathetic policy were especially important. On October 17, 2020 in a conference room at a resort at Scottsdale, a suburb of Phoenix, two presenters with QAnon “went on a long diatribe against people who wear masks to prevent the spread [of coronavirus]. It’s a way to control people, and a symbol of submission, they argued.”[5] It bears stating that in 2019, Arizona had ranked 49^th out of the 50 American states on education prior to college. Unfortunately, a culture of ignorance can easily support and spread the message of QAnon in Arizona—“inventing an imaginary threat and ignoring the very real virus” in spite of all those people who had already died from the pathogen. Such a culture can also enable a vacuous “requirement” to be perpetuated as if it were really a requirement rather than an instance of reason turned against itself with impunity. In such a culture, a significant number of riders and employees, including bus drivers, can be expected to skirt their company’s policy on mask-wearing because it is a fraud anyway. Such employees need only have told their respective supervisors that a medical condition prevents the wearing of a surgical mask without any written documentation to support the validity of the claim. In such a culture, bus drivers would rather bar riders from sitting in the front half of the buses, meaning that the riders might not be able to keep apart spatially as per governmental and even Metro Valley’s own guidelines, than bother to wear masks while driving. Why could such drivers be required to wear plastic face guards if a legitimate medical reason exists for not wearing a surgical mask? Besides the culture of ignorance, one of a lack of regard for the public health (i.e., other people) is also part of the sordid culture that has been so ensconced in Arizona.

A Metro Valley employee and a rider covering their respective chins. 

Security employees exposing their noses and mouths contrary to company policy. It is no wonder that riders did so as well, or went without masks, even though they were "required."

At times, the bus rider on the right held his green towel by his teeth, as if this were equivalent to wearing a mask. Such minimalists were common on public transportation during the pandemic.

A bus driver wearing his mask to cover his chin. I called Metro Valley to report the unsafe practice, and yet two months later, the driver was still leaving his mouth and nose exposed (see photo immediately below). Moreover, the continued prevalence of drivers without masks or not wearing them correctly is an indication that Metro Valley and its subcontracted operator companies have been managerially incompetent in holding drivers accountable. The continued bad driving (e.g., stopping abruptly rather than coasting to a light already red) also points to managerial negligence. 

Two (of several) other bus drivers not wearing masks, hence violating company policy. Were they medically exempt, presumably they would be wearing face coverings instead. 

Seats being held/blocked contrary to Metro Valley's policy by drivers. A plastic divider between the drivers and the seats is supposed to be sufficient protection for the drivers. Their efforts at over-protection, incredibly even by maskless drivers, can be at the expense of passengers being able to maintain physical distance between each other. Even though restricting the seating violates company policy and the company is aware of the practice, accountability has been a problem. 

A security guard starring at me taking a picture (which is legal) perhaps to intimidate me while literally overlooking the maskless rider stretched out on three seats. Starring at innocent riders to intimidate them while ignoring infractions of train policies (e.g., lying over three seats) epitomizes the local police/security culture. 

Four security guards in one-half of a train car, and four in a train car on a routine basis. Such excessiveness intimidates paying customers and leaves other trains without any protection. This epitomizes the local police/security culture in which as many of three backup police cars are used for police giving a traffic ticket. Meanwhile, the police departments refuse to enforce the laws on mask-wearing in retail stores and on public transportation. Hence, "bipolar" aptly characterizes the culture, wherein minor matters deprioritize more important ones. 

A security employee prohibited by Metro Valley even to instruct riders how to wear masks correctly. 

Perhaps the overriding question is how such a badly managed mass transit company (including its subcontractors that operate the buses) could continue in such a condition of ineptitude. In 2019, I had shot lots of videos of aggressive bus drivers, bad driving (e.g., stomping on the brake pedal at the last minute), and excess security on some trains (hence with none in others). The city of Tempe’s Transportation director invited me to attend a meeting with Tempe’s transit director, representatives from Metro Valley and the director of one of the bus-operating subcontractor companies (First Trans) in the room. Reflecting the local culture, the director dismissed all of my videos because one of them shows speeding of only six miles-per-hour above the speed-limit. To my utter astonishment, the other people in the room let him get away with the illogical effort to invalidate all of the videos—even those showing aggressive bus drivers shouting at passengers (the drivers generally viewed their ridership as lower class than themselves, which would have to be pretty low). Tempe’s representative lied to the director, “The city of Tempe has no problem with the driving,” after only months earlier having told me that speeding is a real problem (to which I added hard braking). Perhaps bribes helped reinforce the pathetic inter-organizational culture there.
Also up for grabs is why the local law enforcement would decide not to enforce a law so relevant to the public’s safety/health, and let the mass transit company (and its contractors) violate the law by allowing passengers to ride without wearing masks. It seems that in Arizona, the local law enforcement agencies have too much discretion over which laws they will enforce. Anyone calling in a noise complaint there knows this to be true. 
Ironically, and reflective of the bipolar culture, residents in poor and middle-class areas have had to endure police departments' excess reliance on low-flying police helicopters, which have routinely interloped beyond their respective jurisdictions (such as a city helicopter flying over county land), flown outside of designated air corridors for fly-through traffic, and flown around more expensive neighborhoods.  
On the evening when I published this essay at a coffee shop, a police car passed by as I was about to go to the shopping center's parking lot, and a few minutes a police helicopter flew over diagonally. Both seemed to be on a routine basis and duplicative rather than on a coordinated search. Then a mile away, just after I had stopped at a grocery store, another police helicopter was making at least ten wide circles over a nice looking residential neighborhood before flying away. Then just before I reached my apartment, several miles away, I saw yet another police helicopter (with yet another in the distance). The next morning on my way to the coffee shop to edit this essay, I again saw a police helicopter. The local residents may be used to living in a police state, but we others are not and it doesn't take long for us to notice it on account of its excessiveness, just as we new-comers notice the proclivity of the local police departments to refuse to enforce certain laws. To be sure, surveillance and so many back-up police cars for traffic tickets do take up resources, including personnel. If half the effort were applied instead to enforcing masks on public transit when the E.U. and many U.S. Midwestern and Northeastern states were coronavirus hotspots, Arizona would have been in a better position going into the winter.  

[1] Christina Maxouris and Jason Hanna, “The US Has Reached 8 Million Covid-19 Cases, and the Pace of New Infections Signals a Tough Winter,” CNN.com, October 16, 2020.
[2] Ibid.
[3] “Board Approves Mask Regulations Due to Community Spread of COVID-19,” Maricopa County Communications Office, June 19, 2020.
[4] Ibid.
[5] Donie O’Sullivan, “Analysis: A CNN Reporter Went to Two Different QAnon Events. Here’s What He Found,” CNN.com, October 19, 2020 (accessed same day).

Corona Crisis: Unethical and Criminal Businesses and Municipal Agencies Pervade in Phoenix, Arizona

On July 7, 2020, NBC News reported that Arizona had a record number of cases (105,094) and of deaths (1,927), with a four percent daily increase in reported cases. Also, coronavirus hospitalizations and related ventilators being used were also at record highs. A reporter with MSNBC stated, “Arizona is in crisis.” On the previous day, on MSNBC television, that same reporter had said, “Arizona is in free fall,” in that the number of cases was rising so fast. It had taken three months for the first 50,000 cases and only 23 days for the next 50,000. Observing that people were not wearing masks in downtown Scottsdale, he reported that “Arizona is out of control.” People there were not taking precautions, and the local and state authorities were not on top of the crisis. On June 22, 2020, a physician with the University of Arizona-Phoenix interviewed on The 11^th Hour show on MSNBC asserted that the Arizonans who were saying, “No one is going to order me to wear a mask,” were being selfish because refusing to wear a mask, say on a bus or in a store or restaurant/bar puts other lives at risk. Also a salient ingredient of the crisis in Arizona was the anti-science contingent of the population. In an interview at the time, Alan Alda (of the TV show, MASH) pointed to “pockets of people who still think science is just another opinion” as having a mindset that “puts us all in danger.”[1] The rigors of scientific experiment, such as the use of control groups and random selection, render science closer to knowledge than are mere opinions based on ideology and a person’s own experience. Privileging one’s own ideology and experiences counts as self-embellishing, and perhaps even self-idolatry. Such people are not likely to accept knowledge that contradicts their respective opinions and experience. Living in Phoenix at the time, I had encountered a lot of anti-intellectualism and incompetence along with refusals to enforce virus-deterring policies and even laws. Just one year earlier, Arizona’s education system through High School (K-12) had been rated as 49 out of the 50 States. Combined with an ideology in which companies and individual residents should (which implies can) self-police themselves on physical-distancing and wearing face masks indoors in public and on public transportation,  the recipe is for a greater need for respirators. 

To be sure, Arizona got to the place of crisis in part because the governor had lifted the stay-at-home order and opened businesses on May 14, 2020. His choice was in line with the wishes of U.S. President Trump, who wanted a more productive U.S. economy that would facilitate the president’s re-election in the coming November. The spike in new cases began in Arizona after the governor allowed non-essential businesses, including bars, restaurants, and gyms, to reopen. Pressure from President Trump and a shared pro-business political ideology were likely factors in the Republican governor’s decision. Meanwhile, Arizona had more than its share of political ideologues who believed that business policy or a public law mandating physical distancing and mask-wearing were tyrannical overreaches even though government has a duty to keep its people safe. 

Does mandating the use of masks indoors in public constitute tyranny? Is God against public health? Are certain political ideologies blind to the health and safety of a people? Can what is generally viewed as outlandish in most democratic societies be mainstream, and thus virtually unchecked, in one particular society?

However, other salient factors leading to the crisis in Arizona as of early July are worthy of being mentioned. Such factors include the refusal of Arizonans overwhelmingly to maintain a physical distance from other people while in public—especially indoors, such as at retailers including grocery stores, department stores, and bars. Even before mid-May, when Arizona had been on lock-down, grocery store employees got away with regularly ignoring the store policies and state law on physical-distancing because neither the store managers nor public authorities (e.g., the local police, county Environmental Services dept, city government) would see that the policy or law was enforced. Store managers of two grocery chains blatantly told me that they were not enforcing their own physical-distancing policies and thus the state law. Even on July 9, 2020, when the state’s hospitals were nearing capacity from the virus, I was stunned at a Sprouts store to see neither customers nor employees paying any attention to the store’s own regularly-announced physical-distancing policy. From a business standpoint, refusing to follow or enforce a store policy goes beyond incompetence and sheer foolishness; fecklessness, I submit, was also in the mix.

Wearing masks indoors when in public became a local law in Phoenix in late June, 2020. A few days before July 4, 2020, I went to Target, a retail department-store chain, to return an item. As I entered the store, I saw a sign indicating that masks must be wore as per the local law. 

Inside the store, I asked the assistant manager helping me with the return what is done to customers who ignore the policy and law. “Oh, we can’t enforce that,” she said matter-of-factly. 

On the evening of July 4, I (stupidly) went to a bar/restaurant called Half-Moon Sports Grill for a burger. As I approached the establishment, I heard a group of customers leaving the “restaurant” wonder aloud, “No one in there is wearing a mask.” Yet I went inside anyway, though to an isolated table from which I could see the horse-shoe bar where neither masks were being worn nor physical distancing was being enforced (e.g. by spacing out the seating). The store’s policy violated the law on both counts. 

The seats had not been spaced out along the bar. Perhaps the manager was spaced out? Many people sitting at the bar and at the tables near me were not eating anything. Even actual drinking was sparse. The customers "nursing" their drinks could have removed masks to take periodic gulps or sips, as the case may be. 

Indeed, the governor had recently closed bars (and gyms) because they had been hotspots for transmission of the contagion. A waitress told me that masks were not required when people were sitting. The law, however, stated at the time that masks need not be worn while mouths are being used to eat or drink.  The manager of Half Moon must have assumed that anytime a customer is seated, he or she must be eating or drinking. This is not what I saw, and during a crisis wouldn’t it just make sense to err on the side of caution in interpreting the local law? I was especially shocked when the waitress came up to my table twice without wearing a mask; she had been walking without wearing a mask and she had apparently decided that physical distancing does not apply to herself.

So the next day, I gave the local police a tip. On a Sunday afternoon, the cops would go to the bar/restaurant to see if any violations were occurring. I offered to send the videotape I had shot inside the establishment, but the Phoenix police refused. So the matter being corrected depended on whether the bar was busy enough on a Sunday afternoon to show a violation. No one would ever guess that the matter was urgent and important; it was as if the police were oblivious to the unfolding health crisis. The police had obviously not been paying attention when the governor had only weeks early stated in a news conference that businesses refusing to enforce local and state measures would be dealt with. Instead, the police followed their typical minimalist enforcement routine. A minimalist mentality has no place during a crisis, except, it seems, in Arizona.

The local transit authority, Metro Valley Transit, already had a sordid reputation for enabling bus drivers who were hostile to paying customers and drove badly. In early July, the company showed just how incompetent it was by having signs and a company voice (phone) message indicating that masks were required on the buses and yet Oliver, a supervisor of the customer-service department, told me that because some passengers cannot wear masks for medical purposes (i.e., there were exceptions), the company was only recommending that masks be worn. That a requirement would be treated as optional because exceptions exist demonstrates gross managerial incompetence. Such incompetence (and narrow-minded rigidity) is apparently inert even to a societal crisis (e.g., sky-rocketing numbers of coronavirus cases). That is to say, more was involved than ignorance.

Masks being worn improperly, or "minimalist," quickly became popular in the Phoenix metro on the buses, with drivers looking the other way. In the photo just above, the driver had even contorted his mirror so as to see the passengers, and yet he did not even ask the passenger pictured to wear a mask in spite of there being a "Mask Are Required" ungrammatical sign facing the entry door. This is ironic, given the driver's intent to be able to watch as many passengers as possible. The pleasure of power seized at in weakness issues out in control, yet interestingly here without holding passengers accountable. 

On July 10, 2020, I was fortunate on my morning commute to be on a bus in which not only was the driver not wearing a mask, but three passengers were not too. One of them was biting down on a small towel, demonstrating that the lack of accountability on the non-enforcing drivers was particularly risky, given the willfulness and ignorance of many riders. By the same reasoning, the lax enforcement of the public-health state, county, and local (Phoenix metropolitan area) laws by police and the respective governments on not only the bus company, but also grocery and department stores and restaurants/bars bore a high health cost given the condition of the local population. 

It was bad enough that the vast majority of bus drivers were not enforcing the mask policy in spite of the local law even though signs notifying passengers (and drivers) of the requirement were on the buses. On July 10, I discovered that at least one driver didn't think his company's policy and the law pertained to him. After he let on three passengers who were not wearing masks, I called Metro Valley's customer service number. Not surprisingly, no one from the company (e.g., the driver's supervisor) bothered to call the driver during the route. That too is typical, even though the customer service employees could see to it that someone from the company immediately calls the driver, whether he or she is not wearing a mask, enforcing the policy/law, or being verbally abusive toward paying customers. In May, I had tried calling the local police on a driver who was refusing to comply with the bus company's policy on 10 riders maximum on a standard-sized bus. "You have to call the bus company," the police dispatcher told me. "But the driver is breaking the physical distancing state law," I exclaimed, utterly astonished that a private company rather than a police department would be the only enforcer of the law. "You would have to contact the bus company," I heard again. The local police also tried to avoid enforcing the local laws on nighttime noise, so I was not surprised at the push-back itself. 
During my conversation with Oliver of the bus company in early July, I mentioned the company’s voice-message and the signs specifying that masks were required. “They are wrong,” he informed me. He even said he would change the voice-message; I was not surprised at all a week later to hear the same phone-recording that masks were required. Oliver believed that he could not be wrong even though people could die as a result. So I wrote to the city of Phoenix and the local press on the conversation. Although Oliver had no reason to fear being held accountable, given the company’s squalid management cadre, I suspect that the city may have come down on the bus company for telling customers that wearing masks is merely recommended due to there being exceptions. For a week or more later, the bus company's customer service employees were no longer telling riders that drivers do not enforce what is a recommendation. Even so, drivers were still not complying, even though the company was finally taking its own signs and voice-recording seriously. 

Despite complaints from paying customers for some time on driver hostility and bad driving (e.g., abrupt stops), the management had failed to solve those two problems. In part, the drivers’ union was too strong, but the city of Phoenix and the suburbs were not good at holding the regional transit authority accountable. So I was not surprised in early July, 2020 when a bus driver became enraged when I called customer service to report that masks were not being worn by about half of the riders, and the driver was ignoring the company’s policy on the ten-passengers maximum on a regular-sized bus. With 17 riders on the bus, physical distancing was not possible, which made the non-compliance on masks particularly risky. Fortunately, the customer service representative also heard the driver’s shouts. In going after me rather than having enforced the policies (and laws) in the first place, that driver demonstrated to me why things were out of control in Arizona with regard to the pandemic. The driver was certainly out of control mentally, and his refusal not to enforce bus-company policies with impunity means that his company was out of control managerially. By implication, the city governments in the metropolitan area were falling short in holding the regional transit authority accountable.

By early July, 2020, I noticed that the riff-raff (i.e., rules don't apply to me) on the buses were developing a sub-culture wherein masks were to either not be worn at all or just cover the chin. Because the buses are so unreliable there, the riff-raff make up the vast majority of the ridership. Even so, drivers were not enforcing the mask requirement on that ridership, which one driver confided to me is generally viewed as pathetic by the drivers. Is not a refusal to enforce a requirement also pathetic? Does this not liken the drivers to their typical ridership? Signs on the buses continued to declare that the masks are mandatory, and the drivers continued to dismiss their duty to enforce that company policy. As evidence for this investigation, I took a photo of a rider as he was dozing off; he was wearing his mask to cover his chin only. 

When this passenger got off the bus, he put his bandana on even though no one else was on the sidewalk. 

As I turned back around, I saw the driver shaking one of her fingers at me as if she were scolding a child. It is legal to take pictures on the buses and light rail in Arizona, and yet the driver felt sufficiently emboldened in her refusal to enforce the policy that she called her supervisor and took a picture of me!  Rather than realize that she had failed to enforce a requirement, she directed her hostility to me. Generalizing, given all the reports of driver hostility toward passengers, the drivers who refused to enforce company policy not only felt entitled to do so, but also aggressively went after the paying customers who felt that the drivers should be held accountable because they were putting the health of those customers at risk. Sadly, given the continued bad driving and driver-hostility generally, I could conclude that the company’s management was lax (i.e., incompetent) on holding its drivers (and bus operating subcontractors) accountable.

It is interesting that at least some retail companies, bar/restaurants, and bus companies in Arizona gave up on enforcing their own respective policies (and any underpinning laws), while Airlines, libraries, medical clinics, and hospitals had no such problem. It is not surprising that NBC News would find that things are out of control in Arizona regarding the pandemic. It is ironic that such a heavily-policed state, where intimidation from a huge police show of force/presence is presumed to be the best deterrent to crime, would be so deficient on enforcement even during a crisis. Perhaps views of the national news could finally see just how pathetic the situation in Arizona really was, and likely will be for some time.

Theists, ecologists, and ethicists could agree that a pandemic taking a particularly dire toll on such a people would make sense. Theists could point to God’s disfavor on the selfishness, lack of consideration for others’ health, refusal to do one’s duty in enforcing public-health business policies and governmental laws, and hostility. The same rationale would support a variant on the Biblical story of Noah—this time with God extinguishing our species for having refused to sufficiently stave off carbon-induced climate change. Naturalists could paint a picture of a selfish, inconsiderate people being especially prone to a pandemic. Nature abhors weakness, and thus a weak people. Ethicists might say that it is just that people who refuse to enforce policies or laws protecting the public health during a crisis catch the virus themselves. Similarly, bus passengers and retail customers whose risky behavior puts others at risk could be said to deserve to suffer the plight themselves. They would doubtless disagree, and they would insist that they could not be wrong about it, as if they were gods on stilts during a flood.

1. David Hochman, “Alan Alda Is Obsessed with the Power of Science,” AARP: The Magazine, June/July, 2020.

A Bit of Federalism in ObamaCare

Senator Ron Wyden has written to government officials of Oregon to encourage them to “come up with innovative solutions that the Federal government has never had the flexibility or will to implement.” This is significant because he is a democrat. As long as a state covers the same number of uninsured and keeps coverage as comprehensive, the following can be waived:

1. the individual mandate to purchase insurance (i.e., what Virginia and Florida are suing over)

2. regulations about business taxes

3. federal standards for minimum benefits

4. allocation of subsidies in the insurance “exchanges.”

These are called section 1332 waivors. There is also some flexibility on medicaid--but how much flexibility do these waivors proffer? The states might be able to determine how the uninsured are to be insured. For instance, they could go single-payer. Or could they?The federal allocation of subsidies in the insurance “exchanges” can be waived, but can the “exchanges”?

There is a trade-off involved in federal standards and state waivors. If the federal standard is too high (e.g., the number of uninsured covered and the amount of minimum coverage), then not much freedom is involved in the waivors because the standards must be met regardless. Given the diversity within the Union and our system of federalism, the US Government should have been oriented to coming up with minimum standards for health-care rather than trying to make it a federal responsibility. By minimum, I mean that below which is unacceptable for a state in this union. For instance, it could be that universal health-care is a minimum if health care is to be considered an American right. The states, rather than the general government, would then be required to pass laws to implement the minimum standard in any way they preferred. They could determine the means, whether single-payer or exchanges. I’m not sure that the existing waivors, which do not begin until 2017, allow for such flexibility as would accommodate the various political ideologies of our states. Once power is grasped, it is very difficult indeed to let go of some of it.

Source: Wyden Defects on ObamaCare, WSJ, September 3, 2010, p. A16.

Happiness: A Matter of Prosperity or Economic Security?

A macro-economist would probably assume that the percentage of people rating their lives positively enough to be considered thriving is positively correlated with real GDP per capita. Yet evidence suggests that this is not the case. The key to happiness, I submit, is having the sense of foundational economic security—that come what may, even in the case of rich people, you won’t fall through the cracks. It is difficult to thrive over a continuous, subterranean (i.e., subtle) anxiety, whereas a sense of security, such as most children feel while still living in their childhood homes, is a sturdy foundation on which a sense of thriving can grow and survive. I think most people, particularly Americans, take this point for granted, and thus are all too willing to make staples like housing, food, and health care conditional on having money.

In Britain during the two years leading up to the referendum to secede from the E.U., Gallup found that the percentage of people who were happy in the sense of having the sense of thriving fell 15 percent.[1] Meanwhile, GDP per capita (PPP) in current international dollars increased from $38,873 to $41,499.[2] Egypt, likewise, went from 29 percent “happiness” in 2005 to 8 percent in 2012, while GDP per capita increased from $8,123 to $11,210. Clearly, something other than the level of prosperity is behind changes in happiness as a sense of thriving.

That Norway (7.537), Denmark (7.522) and Iceland (7.504) led the pack among countries in terms of happiness as thriving in 2017, with the Netherlands coming in sixth and Sweden tenth may suggest that having an economic safety-net may be important. The United States stood at only 6.993, and the safety nets in those states are partial. To be sure, the state of France in the E.U. came in even lower, at 6.442, and Italy at 5.964, so we cannot conclude that the stronger safety nets in the E.U. necessarily translate into more happiness. However, even within the E.U. Denmark and the Netherlands were known for their well-fortified socio-economic infrastructures, whereas in the U.S. only Massachusetts and California were known to have relatively encompassing social policies in comparison with the other American states. Unfortunately, Gallup lumped all of the American states together while distinguishing the European states, so we cannot tease out differences within the U.S. 

Even so, the high marks of Denmark, Norway, and the Netherlands suggest that having a solid social-welfare safety net for the most vulnerable in matters of food, housing, and medical care is at the very least consistent with a broad sense of happiness in the sense of not merely surviving, but thriving in life. With less of the existential, conditional angst, people rich or poor can feel more stability upon which they can step out onto striving, venturing, into the unknown, with paradoxically a higher chance of sustainable self-sufficiency.

---

1. Jon Clifton, “The Happiest and Unhappiest Countries in the World,” The World Post, March 20, 2017.

2. Source: The IMF

Big Soda Campaigning against a Proposed Tax in San Francisco: A Vested Interest Thwarting Democracy?

With a proposed 1-cent per ounce tax on sweetened beverages such as soda-pop on the 2016 ballot in Oakland and San Francisco, the effected industry reserved about $9.5 million in television-ad time.[1] As of August 10^th, the American Beverage Association had already spent $747,267 on campaign consultants and advertisements against the proposed tax in Oakland, whereas supporters of the proposal had spent only $23,297.[2] The imbalance itself could mean that business was subverting democracy by overwhelming voters. If big-soda’s ads were unethical as the pro-tax camp contended, the subversion would be especially harmful.

We’re “up against a campaign that’s willing to lie,” Campbell Washington, an Oakland Councilmember said.[3] As if the industry’s massive ad blitz were not enough of a problem for people like her, the industry was claiming that the tax would increase the prices of eggs, bread, and milk. “It’s an incredibly painful and unethical lie,” said Oakland Councilwoman Rebecca Kaplan. “People worry about having to pay for their groceries. To threaten that their groceries are going to be taxed when it’s not true is a totally despicable tactic from the soda industry.”[4] Hoe Arellano, a spokesman for groups opposing taxes, retorted that grocers “have shown repeatedly that they will pass on those costs to their consumers.”[5] He was assuming that the grocers would not up the price of sugary drinks, but would do so on other foodstuffs.

With the proposed tax being only 1-cent per ounce, Arellano’s assumption that consumers would see a significant increase in the prices of other foods and drinks seems a stretch. The industry’s strategy does seem to include scare tactics, which are unethical. The question of whether grocers would up the prices of soda to fully capture the tax increase is more difficult to answer. The evidence from Berkeley’s tax from 2014 shows that consumption of soda, energy drinks, and other taxed items fell by 21 percent in some neighborhoods after the tax took effect.[6] So People would likely cut down on their purchases of soda. It is possible, therefore, that grocers would not try to capture all of the tax with price increases on the drinks. Even so, the grocers’ profits could take a hit instead of prices of other foods and drinks being affected. I must conclude, therefore, that the industry’s advertising campaign contained untruthful fear-mongering and hence was unethical.

The broader question is whether the huge imbalance in advertising spending was getting in the way of the will of the people being found by democratic means. That is, aside from the fear-mongering, does a large imbalance of campaign spending cause voters to lean too far in one direction when they would otherwise weigh both sides as each having a point. Put another way, such an imbalance can keep a side from getting its message out. To be sure, the pro-tax camp was relying on a grass-roots approach, but that has its limitations in reaching the mass-electorate which has been saturated with ads from the opposing side.

It may be that business has a social responsibility, being within a democratic system, not to overwhelm it with spending on political ads. When an industry has a vested interest in the vote, it may be best for the industry to limit itself to providing facts to the public discourse. To be sure, election results do not always favor the party that spent most; money isn’t everything. Even so, it seems unethical for business to dominate society simply because the bottom line is affected. Free speech is of course a right, but the U.S. Supreme Court’s ruling that spending is speech can be regarded as problematic. If so, the use of public policy to reinforce good social responsibility would be possible and perhaps even advised in the interest of protecting the democratic process from being overwhelmed.

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[1] Michael McLaughlin, “Big Soda Spends Millions on ‘Unethical’ San Francisco Area Ads Fighting Drink Taxes,” The Huffington Post, August 24, 2016.

[2] Darwin Graham, “Big Soda Is Spending Big Money Against Oakland Surary Beverage Tax Proposal,” East Bay Express, August 10, 2016.

[3] Ibid.

[4] McLaughlin, “Big Soda.”

[5] Ibid.

[6] Ibid. See the following: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362

A Subtle Conflict of Interest in Obama’s Nominee for FDA Commissioner

Robert Califf, U.S. President Barak Obama’s nominee in 2015 to head the federal Food and Drug Administration (FDA), had received consulting fees of roughly $205,000 between 2009 and early 2015 from drug companies and a medical-device maker.[1] He donated the money he had made since around 2005 to nonprofit groups, and he had ceased all such work before he became the FDA deputy commissioner for medical products and tobacco. The question is whether he would have a conflict of interest in taking the helm at the regulatory agency that puts the public’s interest above those of the regulated companies. I contend that such a conflict is indeed entailed, though not on account of the money he received or any relationships he had developed with people at the companies.

As a clinical-trial researcher at Duke before joining the FDA, Robert Califf was a founder of the Duke Clinical Research Center Institute, which helped pharmaceutical companies run clinical studies. Such facilitation is oriented to helping companies, and, if ethically done, ultimately to helping the public too. In other words, he was not oriented to an area in which the respective interests of a drug company and the public are apt to be at odds. He could thus safely assume a mentality favorable to the companies. Such a mentality is at odds with that of a regulator of companies. Government regulation itself presupposes a tension between the interests of the regulated and the wider public. The mentality fitting the regulator’s role puts the public interest above the interests of the companies possibly to be regulated or already being regulated. A regulator, or an entire agency, captured by one or more of the companies being regulated, regulates sub-optimally because the public interest is valued less than a private interest (including the regulator’s own personal interests).

Public Citizen, a nonpartisan public-health group, urged the U.S. Senate to reject the nomination because “it would accelerate a trend of FDA decision-making that is more aligned with industry than with patients.”[2] Interestingly, the group did not highlight the fact that Robert Califf had received money from drug companies for consulting work, such as participating at an AstraZeneca employee-education session about cardiovascular disease. Rather, the complaint is oriented to the impact of a mentality aligned with the drug companies.

In the language of conflicts of interest, a regulator acting in line with his or her mentality assumes one role. Acting in line with the public interest above that of company interests to the contrary, can be considered another role. Both roles pertain to the regulator’s exercise of his office—for our purposes, the FDA Commissioner. The roles conflict. Robert Califf could reasonably be expected to be tempted to make decisions in line with his mentality (i.e., a private benefit to himself, and a broader private benefit to the companies involved) at the expense of his office’s duty to put the public interest above the two private interests (which include that of his mentality, or orientation). Herein lies the personal conflict of interest—personal in that he could be expected to be tempted on an ongoing basis to put his personal mentality (i.e., a personal benefit, psychologically) above the duty of his office to put the public’s welfare first.

To be sure, we cannot assume that Robert Califf would give into the temptation as Commissioner of the regulatory agency. Sanjay Kaul, a cardiologist, asserted that Califf had demonstrated his ability to act with independence. “Even though I have not always agreed with him on many issues, I respect him for his intellect and integrity. There is no doubt in my mind that he will leverage his inside knowledge of how the industry works to promote innovation without compromising public safety.”[3] Although I suspect that Kaul overstates the congruence of the respective interests of the industry and the public, we cannot assume that a predisposition to help drug companies necessarily wins out.

Even so, I contend that to have a person with a mentality or at least habit of helping companies in the regulated industry as a regulator necessarily involves an ongoing tension for the person, and furthermore that submitting said person to such a tension (or temptation) is itself unethical because of the subtle harm done on him or her. More simplistically, a regulator ought to have a mentality or bias that is aligned with putting the public interest above the interests of the regulated.

Even a subtle bias gained from substantial work-experience, which itself points to an underlying orientation and may even extenuate it, can be reckoned as a personal role. That role can be in tension with another role to be performed—a role oriented to a wider-held benefit (e.g., that going to the public). A personal conflict of interest can therefore exist even without any hint of personal financial benefits (e.g., bribery, extortion, etc.) being likely in a person’s position/office. Even as we tend to limit our recognition of personal conflicts of interest to the superficial level of money—such conflicts being much more extensive—the good news is that more of those conflicts are avoidable than we surmise. Merely in matching a mentality or predilection of a potential office-holder to the role having a wider rather than narrow distribution of benefits (i.e., acting for the public welfare), we can reduce the incidences of such conflicts.

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[1] Drug companies spent an additional $21,000 reimbursing the cardiologist for travel, meals, and other expenses. Joseph Walker, “FDA Nominee Received Industry Fees,” The Wall Street Journal, September 19-20, 2015.

[2] Ibid.

[3] Ibid.

Does the Affordable Care Act: Healthcare as a Human Right?

Did the Americans who were in favor of passage of the Affordable Care Act in 2010 believe that access to healthcare is a human right? Did the Americans who opposed “Obamacare” reject that assumption and thus favor treating health insurance as a commodity? We can look at political and economic indications to reach an answer.

According to a report by the U.S. Department of Health and Human Services, based in turn on Gallup survey data from early March 2015, 16.4 million people had gained health-insurance coverage since the Affordable Care Act went into effect. The figure includes people who signed up for Medicaid under the law. “When it comes to the key metrics of affordability, access and quality, the evidence shows that the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said Sylvia Mathews, the Health and Human Services Secretary at the time of the report.[1]  That the uninsured rate had fallen to 13% from 20% at the beginning of open-enrollment in October 2013 supports the secretary’s conclusion. 

The strongest gains were from the states whose governments expanded Medicaid. “Those states had an average baseline uninsured rate of 18% in early March, compared with 23% for those that didn’t.”[2] This suggests that an upturn in the economy did not account for all of the change. The overall increase is large enough that the upswing in the economy is not likely to be the sole cause, according to Rachel Garfield, a researcher at the Kaiser Family Foundation.[3]

Furthermore, the difference between the two zones of states (to borrow a catchy term from Europe) points to an ideological condition wherein Americans as a whole were not convinced that access to medical care is a human right, and thus a responsibility of government. Modern federalism, wherein the member-states and federal institutions both have a share of governmental sovereignty, accommodates “being on the fence” concerning whether a benefit is properly a commodity or human right.  To the extent that the benefit is available regardless of state, that extent of being insured from the federal government can be treated as a human right, whereas the amount of benefit left up to the states indicates the extent to which Americans do not consider health-care to be a human right.

Admittedly, a federal base-level combined with various amounts of contribution from member-states does not necessarily mean that “We the People” are on the fence on whether a benefit is a human right. A person could be in favor of more state authority because of an excess at the federal level, for instance, while firmly believing that the benefit at hand is a human right. Clearly, other measures are needed in the assessment.

Another indication of the extent to which Americans as a whole consider health-care to be a human right is how close the percentage of uninsured is to zero. The uninsured rate of 13% for adult Americans and illegal immigrants in March 2015 tells us that health-care was not viewed as a full or established human right. Were access to medical care definitively regarded by “We the People” as a human right and the elected representatives representative of their constituents as a whole, the Federal Government would see to it that every American or even every resident of the U.S. has access to healthcare. This does not necessarily imply a single-payer system, though reliance on private insurance companies without subsidies for every poor person would be insufficient.

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[1] Stephanie Armour, “Rate of Uninsured Falls Sharply Under Health Law, Report Says,” The Wall Street Journal, March 17, 2015.

[2] Ibid.

[3] Ibid.