Map of life expectancy at birth from Global Education Project.

Sunday, March 31, 2024

Sunday Sermonette: Sadly, no

Psalm 89 is quite lengthy so it will be our only text for the day. I'm afraid I can't do anything special for Easter because we haven't gotten to the messianic prophecies yet. It isn't clear when Psalm 89 was written, but Ethan the Ezrahite was an associate of King Solomon, mentioned in Kings 4:31. One problem is that the (probably fictional) reign of Solomon as described in Kings does not include any of the hard times evoked here. It was a time of prosperity, military strength, and conquest. It could refer to the invasion by Pharaoh Shisak during the reign of Rehoboam, after the civil war that saw the northern kingdom secede, but it is implausible that Ethan could have still been alive at that time. 


A bigger problem is that the psalm repeatedly invokes God's promise to David 2 Samuel 7 that his line would endure forever:

12 When your days are fulfilled and you lie down with your fathers, I will raise up your offspring after you, who shall come forth from your body, and I will establish his kingdom. 13 He shall build a house for my name, and I will establish the throne of his kingdom for ever. 14 I will be his father, and he shall be my son. When he commits iniquity, I will chasten him with the rod of men, with the stripes of the sons of men; 15 but I will not take[b] my steadfast love from him, as I took it from Saul, whom I put away from before you. 16 And your house and your kingdom shall be made sure for ever before me; your throne shall be established for ever.’” 17 In accordance with all these words, and in accordance with all this vision, Nathan spoke to David.

 

In fact, when the Book of Psalms was compiled during the Babylonian captivity, the line of David had ended. The last king of Judah was Zedekiah, who Nebuchadnezzar installed as a puppet monarch in 597 BC. When Zedekiah attempted a revolt in alliance with Pharaoh Hophra, Neb responded by besieging Jerusalem, which he finally captured in 586 BC. He captured Zedekiah, blinded him, and took him to Babylon where he died, ending the line of David and the Judean monarchy.  So God lied to David. Of course the editors of the Book of Psalms knew this, but evidently it didn't bother them enough to leave this out.


A Maskil of Ethan the Ezrahite.

89 I will sing of thy steadfast love, O Lord,[a] for ever;
    with my mouth I will proclaim thy faithfulness to all generations.
For thy steadfast love was established for ever,
    thy faithfulness is firm as the heavens.
Thou hast said, “I have made a covenant with my chosen one,
    I have sworn to David my servant:
‘I will establish your descendants for ever,
    and build your throne for all generations.’”Selah

Let the heavens praise thy wonders, O Lord,
    thy faithfulness in the assembly of the holy ones!
For who in the skies can be compared to the Lord?
    Who among the heavenly beings[b] is like the Lord,
a God feared in the council of the holy ones,
    great and terrible[c] above all that are round about him?
O Lord God of hosts,
    who is mighty as thou art, O Lord,
    with thy faithfulness round about thee?
Thou dost rule the raging of the sea;
    when its waves rise, thou stillest them.
10 Thou didst crush Rahab like a carcass,
    thou didst scatter thy enemies with thy mighty arm.
11 The heavens are thine, the earth also is thine;
    the world and all that is in it, thou hast founded them.
12 The north and the south, thou hast created them;
    Tabor and Hermon joyously praise thy name.
13 Thou hast a mighty arm;
    strong is thy hand, high thy right hand.
14 Righteousness and justice are the foundation of thy throne;
    steadfast love and faithfulness go before thee.
15 Blessed are the people who know the festal shout,
    who walk, O Lord, in the light of thy countenance,
16 who exult in thy name all the day,
    and extol[d] thy righteousness.
17 For thou art the glory of their strength;
    by thy favor our horn is exalted.
18 For our shield belongs to the Lord,
    our king to the Holy One of Israel.

19 Of old thou didst speak in a vision
    to thy faithful one, and say:
“I have set the crown[e] upon one who is mighty,
    I have exalted one chosen from the people.
20 I have found David, my servant;
    with my holy oil I have anointed him;
21 so that my hand shall ever abide with him,
    my arm also shall strengthen him.
22 The enemy shall not outwit him,
    the wicked shall not humble him.
23 I will crush his foes before him
    and strike down those who hate him.
24 My faithfulness and my steadfast love shall be with him,
    and in my name shall his horn be exalted.
25 I will set his hand on the sea
    and his right hand on the rivers.
26 He shall cry to me, ‘Thou art my Father,
    my God, and the Rock of my salvation.’
27 And I will make him the first-born,
    the highest of the kings of the earth.
28 My steadfast love I will keep for him for ever,
    and my covenant will stand firm for him.
29 I will establish his line for ever
    and his throne as the days of the heavens.
30 If his children forsake my law
    and do not walk according to my ordinances,
31 if they violate my statutes
    and do not keep my commandments,
32 then I will punish their transgression with the rod
    and their iniquity with scourges;
33 but I will not remove from him my steadfast love,
    or be false to my faithfulness.
34 I will not violate my covenant,
    or alter the word that went forth from my lips.
35 Once for all I have sworn by my holiness;
    I will not lie to David.
36 His line shall endure for ever,
    his throne as long as the sun before me.
37 Like the moon it shall be established for ever;
    it shall stand firm while the skies endure.”[f]Selah

38 But now thou hast cast off and rejected,
    thou art full of wrath against thy anointed.
39 Thou hast renounced the covenant with thy servant;
    thou hast defiled his crown in the dust.
40 Thou hast breached all his walls;
    thou hast laid his strongholds in ruins.
41 All that pass by despoil him;
    he has become the scorn of his neighbors.
42 Thou hast exalted the right hand of his foes;
    thou hast made all his enemies rejoice.
43 Yea, thou hast turned back the edge of his sword,
    and thou hast not made him stand in battle.
44 Thou hast removed the scepter from his hand,[g]
    and cast his throne to the ground.
45 Thou hast cut short the days of his youth;
    thou hast covered him with shame.Selah

46 How long, O Lord? Wilt thou hide thyself for ever?
    How long will thy wrath burn like fire?
47 Remember, O Lord,[h] what the measure of life is,
    for what vanity thou hast created all the sons of men!
48 What man can live and never see death?
    Who can deliver his soul from the power of Sheol?Selah

49 Lord, where is thy steadfast love of old,
    which by thy faithfulness thou didst swear to David?
50 Remember, O Lord, how thy servant is scorned;
    how I bear in my bosom the insults[i] of the peoples,
51 with which thy enemies taunt, O Lord,
    with which they mock the footsteps of thy anointed.

52 Blessed be the Lord for ever!
Amen and Amen.

Footnotes

  1. Psalm 89:1 Gk: Heb the steadfast love of the Lord
  2. Psalm 89:6 Or sons of gods
  3. Psalm 89:7 Gk Syr: Heb greatly terrible
  4. Psalm 89:16 Cn: Heb are exalted in
  5. Psalm 89:19 Cn: Heb help
  6. Psalm 89:37 Cn: Heb the witness in the skies is sure
  7. Psalm 89:44 Cn: Heb removed his cleanness
  8. Psalm 89:47 Cn: Heb I
  9. Psalm 89:50 Cn: Heb all of many

Saturday, March 30, 2024

Country life

As I may have mentioned from time to time, I live in a small town, a farming community. Like a lot of people here, I heat my house with wood. We do it because we can, basically. There are only three retail businesses in town: a liquor store, a seamstress (yes) and a chainsaw shop.

 

In my case, between my own wooded property, and my neighbor who owns extensive forest land and is constantly having trees fall down across his roads, I get all the firewood I need by dint of my own efforts.  I pretty much exclusively rely on deadfall, unless for some reason we're removing a tree anyway, so I'm not angering the ents. It does cost money, between patronizing the chainshaw shop, fueling and maintaining my tractor and log splitter, and having the chimney cleaned every year. It's somewhat cheaper than fossil fueled alternatives, but the main benefit is that I don't have to pay gym fees. Harvesting and processing firewood is my main form of exercise.


That's all well and good for us country folk, but it doesn't work in the cities, and therefore it doesn't work for 90% of the population. In addition to the problem of wood supply, the concentration of smoke would be a major public health problem. Out here, the chimneys are far enough apart that the smoke dissipates before it can bother anyone, and our air is actually a lot cleaner than city air that's full of automobile exhaust and smoke from oil burners. We also can buy most of our produce from the local farmers markets during the season, and some products -- eggs, salad greens, and meat if you're into it -- are available year round. Many people who aren't in the farming business do have big gardens (that includes me) and they preserve much of what they grow for the winter. It's peaceful and all the green space is good for the psyche.


However, like it or not, for the current human population to survive and our civilization to work, most people have to live in cities, and the kind of self-sufficiency that's possible in the country is just not happening in the city. We are totally dependent on a worldwide network of trade of such complexity that nobody really understands it. Somewhere there may be a thread to pull that unravels the whole thing. Closing the port of Baltimore for a few months won't bring it all down -- there's a lot of resiliency built in. But the Covid pandemic, the invasion of Ukraine -- which is actually a very small country -- put a lot of strain on the global network and people are still feeling stress from the higher prices they have to pay for basic needs. (That's why, obviously, not because of anything Joe Biden did.)

 

I'm not a doomsday prepper but I do think we need to reconfigure the economy to limit interdependence. There has to be more local and regional self-sufficiency, and alternatives to the web of interdependency in case things go wrong. One consequence of globalization was that it put a lot of people in Ohio out of work, and now they're alienated and angry. We need to do it differently.

Thursday, March 28, 2024

Medical Costs

People have complained that I haven't said why Medicine is costing so much in the U S of A. Give me a break -- I can't talk about everything at once. I've been intending to get to this all along. This is just the first installment, it's a long story.



So, thanks to all the mind boggling complexities of employer-provided insurance, Medicare, Medicaid, the Affordable Care Act, and a few other programs, something like 90% of Americans have some form of health insurance. Great news! That means we can all afford the medical services we need and nobody has to go broke because they get sick or are injured in a car crash or by somebody exercising their Second Amendment rights! Err, no. Sadly it does not mean that. In the first place, for the 50% of people who get their insurance through employment, it’s costing them more and more for the premiums – by three times the rate of inflation, since 1999, as shown below.


 

 

 



With that, plus deductibles, copays/coinsurance, denial of services, coverage limits, and uncovered services, overall, spending by middle income families on health care increased by 25% from 2007 to 2014, while spending on other necessities declined.







What is more, four out of ten insured adults surveyed in 2023 said they had skipped or delayed some type of care in the past year, and one in six said they had problems paying medical bills. According to an investigation by KFF, more than 100 million Americans – 41% of adults – have debts for medical services. A quarter of those owe more than $5,000 and 1/5 of them never expect to pay it off.

The KFF investigation uncovered many depressing stories. A couple who were sued for $10,000 by a hospital where the husband’s leg was amputated; another who were left with $80,000 in debt after the premature birth of twins; innumerable people who have been denied services altogether because of outstanding debt. The New York Times reported recently on a large, not-for-profit hospital chain that had an explicit policy of refusing services to people with more than $4,500 in debt. The corporation’s CEO, according to the Times story, was paid $3.5 million in 2021.

Medicaid generally has low to no deductibles or copays, but a given state may not cover specific services someone needs. We’ve already discussed the coverage gaps and limitations in Medicare. These are functions of what congress and the state legislatures have decided is best for us. But most people have private insurance – including people with Medicare Advantage plans – which requires more extensive consideration. 

The reason insurers impose deductibles and copays is to discourage utilization. They believe, no doubt correctly, that if people have to spend their own money they may choose not to get as many medical services or buy as many medications. The problem with this reasoning is that people aren’t wise shoppers for medicine. Now, I’ll be the first to shout it from the rooftops that as a nation, we spend far too much on medical services that are low value or worthless. In fact, I will do so (metaphorically) later in this book. But it’s not because consumers of medicine aren’t wise shoppers, and making them pay out of pocket isn’t going to change that. 

Next, I'll discuss more specifics of how insurance companies and other corporations screw us.