The Doctor Is In

A recent post on the worldview of contemporary postmodern liberalism was kindly linked by Gerard Vanderleun over at American Digest. In his link post, a commenter left the following missive:

The essay would have value if there were absolutes. Never have been, never shall be. Our standards of behavior are devised by us, and used or misused by us. We decide which is good and which is evil, and in every case we are right and wrong at one and the same time.

Each of our rules and regulations is enforced through agreement, and through coercion. The wise among us agree to follow the laws because it makes for a calmer, safer life. The fools among us must be made to follow those same laws because they haven’t the wisdom to see the necessity. And this speaks of those ordinances that do make sense.

Those that do not have to be enforced through coercion more often than not because they really don’t make any sense. And there are times when our rules make more or less sense than other times because circumstances differ.

We are responsible for our laws, and for our adherence to them. Our legislation being wise is to our credit. Our legislation being cruel is to our shame. Nobody else can remove that charge from our shoulders.

Now, I take no issue with this gentleman personally; he is doubtless a bright fellow, well-educated in our institutions of higher learning, where professors emeritus emote their postmodern erudition in the lofty ephemeral ethers, far removed from the dross of desperately-ignorant humanity. He is more to be pitied than censured; he has, after all, been taught not to think. But he serves herein a useful purpose, insofar as his comment exemplifies the mindset of those who eschew the idea of absolutes — which assertion is the very metaphysical mortar of secular postmodernism.

I find it interesting that most every argument rejecting absolutes contains within its very language and structure, not to mention its premises, a framework of absolute assertions. And our subject does not disappoint: tossing around terms like “wise” and “fools” and “shame” and “credit”, qualitative words without meaning when there is no transcendent standard against which to measure them. What is shame if not the humiliation of rejecting an absolute good? Who is wise, and who a fool, if there is no standard of enduring and unchangeable wisdom by which to categorize one thusly? The lines of their straightedge are random and irregularly spaced — if there are measuring lines at all — yet they carefully measure and mark off “progress”, confident they have measured accurately. There is, of course, the inevitable rejoinder to all such foolishness which asks, “Are you absolutely sure there are no absolutes?” But beyond this childish rebuttal — childish, not in the sense of silliness or immaturity, but rather of unvarnished simplicity — there lies an even more evident and profound incoherence which can be discerned — from which a not-so-evident proposition emerges from the heart of anti-absolutism.

It is impossible to function as a human being in society without the concept of transcendent absolutes, even if this foundational principle is unrecognized or denied. We as humans do not simply move as pack animals, driven by instinct and primal drives, but are by our very nature creatures of judgment. We are constantly comparing, evaluating, appreciating or depreciating everyone and everything around us. The food is either tasty or awful; the woman is attractive or homely; the music is beautiful or grating; the weather is warm and pleasant or cold, wet, and miserable. Of course, some of these judgments are self-referential: the food tastes good to us, or bad to us; we prefer rock music to Rachmaninoff, while others may differ. Thus to some degree, we individually determine the standard against which we measure objects apart from ourselves. Yet even there it is possible to compare our preferences to a fixed standard: is slasher rock not discernibly different in quality from a Bach fugue?

But within the realm of human interactions, writ large as communities, societies, nations, and cultures, judgments about the outside world become collective, embodied in law and cultural and social strictures. Behavior which is objectionable to some is desirable to others; that which some find beneficial others find harmful. It is at this level of community and human interactions where some overarching determination or standard against which interpersonal behavior is measured becomes utterly necessary if we are to avoid a society capricious in its justice or cruel in its enforcement.

The anti-absolutist posits this standard in the consensus of the group, be it tribal, community, or society. The society at large, whatever its dimensions, determines that certain behavior is acceptable or unacceptable, and enforces the standard through collective coercion or force. While this seems plausible at first glance, it almost immediately runs into problems with the de facto use of absolutes. What standard will the collective mind of a society choose? Is it simply the standard of survival? Is it a collective self-gratification? Self-interest alone? And how can it be a standard at all without becoming, to greater or lesser degree, a transcendent absolute?

If, as our commenter suggests, we decide for ourselves what is good and what is evil, what is right and what is wrong, are these standards not infinitely malleable by their very nature? Such a philosophy of law is nothing more than the tyranny of the masses, the rule of the mob. For a society may agree by consensus that certain members of the society are inferior by nature, or should be exterminated, or have their possessions confiscated, their daughters raped, their members sold into slavery. Such societies are not mere abstract entities, but stark historical realities, evident in gulags, ethnic cleansings, and rape rooms to which even our most recent decades testify. Such a philosophy in its purest form is the will to power; those who gain dominance, either in number or by force, determine the standard against which all will be judged.

The notion that such a standard is invariably beneficial to a society or culture is ludicrous in the light of history. One need look no further than the 20th century, where the social consensus arising out of pathologies such as Nazism, Marxism, and the emperor worship and militarism of Japan, wrought horrors upon not only the world, but especially on the societies which themselves embraced these pathologic standards. That German militarism and anti-Semitism was profoundly destructive to the very society which engendered these ideas and standards is self-evident; ask the citizens of Hiroshima how Japan’s imperialistic and fanatical militarism panned out.

Yet the world of the anti-absolutist one cannot form a judgment about any such self-evident evils. It cannot say that Nazism and the Holocaust were evil — they can only say that by their own standards, self-engendered and not universal, that such abominations are different. The inevitable moral indifference arising from such a philosophy runs counter to every fiber of the human spirit. We cannot say such things are evil if we cannot reference them against an absolute standard arising above, and transcending, any consensus formed only by a society.

Our very language is steeped in the vocabulary of absolutes — it is impossible to communicate without them. Good and evil, right and wrong, justice and injustice, wisdom and foolishness: these concepts are universal, ubiquitous, and unresectable from language and thought, across all cultures and civilizations.

The consequences of the rejection of absolutes, fully embraced, are nothing short of anarchy — or in its stead, tyranny. There can be no true justice, for justice appeals to a standard above the law, and thus judges not only behavior contrary to law, but the law itself. Absent a transcendent moral absolute, there is no limit to the granularity at which arbitrary determinations of good and evil, right and wrong, may occur. it is a recipe for tribalism at best, as competing groups determine their own rules, rejecting those of other groups, large or small, which run contrary to their perceived needs or desires. The inevitable conflict between tribal standards can bring nothing but perpetual conflict or isolation.

Those who claim to reject absolutes do not in reality reject all absolutes. There is never a quibble about the law of gravity, or the laws of nature, or those of nuclear physics or astronomy. Were they consistent in their philosophy, they would reject the term “law” (which implies an underlying transcendent; there is, after all, no laws without law-givers), and instead describe what their metaphysics mandates: that seemingly predictable behavior is no more than random coincidence; the electron may fall into the nucleus at any time, ending this existence as dramatically and as randomly as it came into being. As Chesterton said, “They feel that because one incomprehensible thing constantly follows another incomprehensible thing the two together somehow make up a comprehensible thing.”

At the very heart of a philosophy of deterministic, self-engendered moral standards stands the individual. The rejection of moral absolutes is nothing more than radical individualism broadcast across society — the notion that we are the sole arbiters of our behavior and morality, the we alone determine what is right and what is wrong. As a corollary, there is another assumption underlying this one: that others should bear the consequences, especially adverse consequences of our actions. Those who reject moral absolutes gravitate to a nihilistic narcissism, where there are rights but no responsibilities, demanding freedom to act as they please without thought for anyone else, all the while demanding that others rescue them from wreckage their behavior has wrought.

This battle of worldviews lies at the very heart of our culture wars, of the endless societal conflicts engendered over abortion, or religion in the public square, or the status of heterosexual marriage, or unrestricted sexual license, or any one a host of other seemingly irreconcilable culture clashes which saturate and sour our daily lives. It is a take-no-prisoners battle, for there is no middle ground, no comfortable compromise which will bring peace and harmony. It is a battle to the death, a battle not only of the mind but of the heart.

It is, above all, about bending the knee, a battle for the soul: we will submit to the absolute, or destroy ourselves in dark delusion denying it.

It’s long past time we choose which it will be.

The talk of the past week or so in political circles has been Barack Obama’s tour of Europe — in particular his non-political political speech in Berlin. Two of the better commentaries you will find on the event are the devastating critique by John Bolton, and the more humorous, but equally effective demolition by
James Lileks. I recommend you take a few minutes to digest these gems.

Now, I cannot hope to match the insight and wit of such as these — but nevertheless I hope to toss a few ideas and impressions into the arena of discussion on this subject. I rarely touch on politics on this blog, as others far more passionate and adept at such commentary abound. But there were some undercurrents in the speech which I found very emblematic of our current age, and very troubling, and perhaps I may offer a few insights of value.

First, the purely political: isn’t this man running for President of the United States? So, why on earth is he giving political speeches to the Europeans? I suppose it is a feeble attempt to burnish his anemic foreign-policy credentials — although I strain to understand why shaking a few foreign hands and giving a too-slick speech to our Germanic übermeisters somehow augments one’s foreign policy portfolio. Having your picture taken with a cow does not a dairy farmer make.

Then there was the heady libation of contemporary liberalism: the obligatory apologies to the rest of the world for America’s great failures. Shortcomings we have an abundance — but, apologizing to the Germans? To the Germans? The same Germans, who spent the first half of the 20th century — and no small part of the previous century — conquering Europe, slaughtering millions and wreaking untold havoc on an entire continent? The same Germans, who killed millions of our soldiers, 6 million Jews, and countless other political and social outcasts in their concentration camps and euthanasia centers? The same Germans for whom we, having crushed them at enormous cost of life and treasure, then rebuilt their country and defended them from another 40 years of horror under totalitarian communism?

Could someone please explain to me why, in any just and rational world, an American politician should apologize for our behavior, to the Germans?

I just had to get that off my chest. There, I feel better now.

But on to larger things: large swaths of the speech spoke in vaunted and eloquent terms of the hope and desire for world united, a world without walls. We heard repeatedly about how such walls — both actual and metaphorical — must be torn down, removing all divisions which confront and challenge us:

That is why the greatest danger of all is to allow new walls to divide us from one another.

The walls between old allies on either side of the Atlantic cannot stand. The walls between the countries with the most and those with the least cannot stand. The walls between races and tribes; natives and immigrants; Christian and Muslim and Jew cannot stand. These now are the walls we must tear down.

Now color me a contrarian, but I am not entirely convinced of the wisdom of this wall-breaching braggadocio. As Robert Frost once wisely said, “Good fences make good neighbors.” Should we really be about tearing down every barrier which divides us? Aren’t some of these fences, some divisions, critically important to our safety and integrity? After all, prison walls divide us from the criminals — should we not, if we want to live in peace, harmony, and new age oneness, tear these walls down as well? Is every division, whether existing between nations, or races, or tribes, or religions, by its very nature a candidate for dismantling?

Some divisions, it seems, exist for our protection: the division between freedom and tyranny; the division between nations which oppress and those who liberate; the division between good and evil itself. But to uphold and defend these necessary walls, there needs to be a conviction of the absolutes which form their ramparts. You cannot defend good from evil if “good” and “evil” are but fungible and flexible preferences, made near-meaningless with endless shades of gray obscuring their sharp contrasts and muting their colored brilliance. If right and wrong are detached from their transcendent mooring in absolute truth, and made mere preference or personal piety, then there is nothing left to defend. The walls which have kept the barbarians at bay now become broad promenades welcoming in regal splendor the very forces which will enslave us.

Our modern secular utopians, like their brethren throughout the ages, ignore the differences which matter while elevating the differences which do not. Hence the Christian who stands against the slaughter of the unborn innocents and the Muslim who slaughters the innocent through self-immolation become indistinguishable — both “extremists”, both “divisive” — and we must tear down these walls to live at peace. Such distinctions between religions and philosophies run to the core of their very nature: to dismantle the division is to destroy their unique character, to render meaningless any judgment about which worldview is better for the well-being of man and society. Be hot or be cold, as someone once said — but the lukewarm will be expectorated, with extreme prejudice.

And what of destroying the “division” between rich and poor, the West and East? Is not one more wealthy, more free, more successful, more propitious to its citizens exactly because of the differences which divide us — specifically, respect for human life and property, for rule of law, for individuality, for a spirit of generosity and sacrifice arising out of Judeo-Christian principles instilled at its founding? Shall we instead denigrate a nation which, for all its flaws, has sacrificed countless lives and expended endless lucre throughout its history to free the enslaved and crush the tyrant; shall we become the object of self-loathing and shame which must grovel for its sins before the sinister, the enslaver, and the slothful? Is this the price of such world unity? We have seemingly arrived at a place where we are unable to proclaim the good without the ridicule of the glib; we cannot call an act evil but to the catcalls of the cynics.

In our utopian zealotry, we attack the divisions of substance while elevating the divisions of appearance. The unity which is our strength — a common culture, and language, and shared set of moral values — must now give way to the triumph of the superficial: we categorize by color rather than by character; we talk of freedom while enforcing speech codes and pursuing thought crimes. Religion is our enemy while conformity becomes our religion. Science becomes truth and truth becomes myth; We are overcome by evil because we refuse to call it by name.

The gnostic hubris which is our modern foolishness boasts in what it knows, while knowing not what it does not know. Our ignorance of human nature cripples us; we believe that if we reason with evil, evil will change, charmed by the magic of our words and soothed by the sincerity of our childish desires. Like some love-maddened missionary, we sleep with the strumpet to save her soul, then find ourselves amazed when we become as lost as she.

There is, in truth, but two ways to unity: the way of inner submission, and the way of outer coercion. Within the limits of the frailty of our fallen nature, we achieve a measure of unity by common compliance to inner morals, arising from the recognition of a transcending set of absolutes which dictates such standards for both the individual and the common good. We acknowledge a standard of behavior and restraint which arises from the divine — though we often fall short of this standard, and may differ in some measure on its particulars. We become one — imperfectly to be sure — because we submit to and follow One, whose perfect moral standards and ethical precepts are held as the highest ideal and a noble pursuit.

When such an overarching absolute standard is rejected — as it has been by aggressive secularism, atheistic, reductionist, and materialistic to the core — we can only enforce a form of unity through coercion and power. Inner moral dictates must be subjugated to coerced conformity. It is “acceptable” to hold “values” which are at odds with the secular societal standard — as long as these “values” are never acted upon in speech or behavior. We may believe abortion to be morally abhorrent — but must never act to restrain it; we may hold homosexuality to be morally wrong and believe gay marriage to be a threat to a core foundational institution of society — but to verbalize thus is “hate speech”, and “intolerance”, and “ignorance.” Our unity is the unity of the gag, a multicultural muzzle which celebrates the superficial, elevates the insignificant, tolerates the intolerable — and punishes the moral. Our unity is the unity of relativism, a superficial solidarity where everything is acceptable but absolutes, where anything is tolerated but truth. Such unity strives for the lowest common denominator, maintaining its forced cohesion by the will to power, destroying in its enslaving solidarity the very soul of freedom and the heart of true human harmony.

It is no small irony that Obama proclaimed his utopian tome to the Hun — they of the fertile ground which brought forth Nietzsche and Hegel, and a National Socialism which crushed the dividing walls of Old Europe with an iron fist and a broken cross. Our modern nihilism is far more appealing, wrapped in soothing bromides of hope and change — but no less corrupt and empty at its core.

Beware the man who brings unity at the cost of individuality. Beneath the sheep’s clothing lies something far more ominous than smooth words and glib promises betray.

Donald Sensing has a good post about the all-too-common accusation against Christians, that they are hypocrites:

The hypocrisy excuse for staying away from church has got to be the oldest there is. Which only proves what Mark Twain observed, “When you don’t want to do something, any excuse will do.” And to borrow one of Yogi Berra’s malapropisms, If people don’t want to come to church, nobody’s going to stop them.
 
But I say, “Hooray for hypocrites!” If you’re a hypocrite, you’re just my guy or gal.

Yes, the accusation of hypocrisy is freely administered by those who, in their righteous indignation, would never darken the door of their nearest church. To be sure, there is no shortage of hypocrisy in Christianity; in fact, there seems to be a rather large supply well-distributed across the human race, religious or not. I’ve had a few thoughts of my own on the subject, contained in a long-winded riff on refrigerator magnets, here.

Sensing nails the issue beautifully:

Because hypocrisy requires the hypocrite to believe in something or someone outside himself. Hypocrisy requires an aspiration to something higher or better than oneself. That is the meaning of the folk saying, “Hypocrisy is the tribute vice pays to virtue.” Hypocrisy is an imperfect, deficient attempt to be better…

It is deceit that makes hypocrisy what it is. The true hypocrite wants others to think better of him/her than is actually justified. Absent this deceit, there is no hypocrisy, just error or human frailty. That’s what the hypocrisy-excuse people don’t understand - or pretend not to understand - about church people. What may appear to be church people’s hypocrisy is almost always just simple failure to meet the standards of our faith rather than deceit. Why? Because the standard is so high:

But I say to you that everyone who looks at a woman with lust has already committed adultery with her in his heart (Mt. 5:28).

But I say to you that anyone who divorces his wife, except on the ground of sexual transgression, causes her to commit adultery; and whoever marries a divorced woman commits adultery (Mt. 5:32).

There are many such examples. So I say that if our churches are filled with such “hypocrites,” then let’s have many more. Vice is easy, virtue is hard. It’s no hypocrisy to fall short of a very high standard and such an excellent goal. And I would suggest that the hypocrisy-excuse people have largely chosen the easy way over the hard way, and choose to call that virtue. So who are the hypocrites? Well, we always have room for one more.

The irony in this situation is that the accusation of hypocrisy often comes from someone incapable of hypocrisy — for the simple reason that you cannot fall short of a standard which you do not have:

Thankfully I have known very few non-hypocritical people. They were insufferable. They were entirely self centered, self directed, self oriented, self focused and just plain purely selfish. They recognized no cause, entity or belief higher than themselves, their own desires, wants or needs. You can see, I’m sure, that it is impossible for such people to act hypocritically because they are always looking out for No. 1 in every situation. They never pretend they are acting in someone else’s interests. They don’t seek others’ approval because they don’t fundamentally care about others or what they think.

So don’t be a hypocrite — Check it out.

Today is Tony Snow’s funeral, and this meditation he wrote in his last days just came across the transom:

Blessings arrive in unexpected packages, - in my case, cancer. Those of us with potentially fatal diseases - and there are millions in America today - find ourselves in the odd position of coping with our mortality while trying to fathom God’s will. Although it would be the height of presumption to declare with confidence ‘What It All Means,’ Scripture provides powerful hints and consolations.

The first is that we shouldn’t spend too much time trying to answer the ‘why’ questions: Why me? Why must people suffer? Why can’t someone else get sick? We can’t answer such things, and the questions themselves often are designed more to express our anguish than to solicit an answer.

I don’t know why I have cancer, and I don’t much care. It is what it is, a plain and indisputable fact. Yet even while staring into a mirror darkly, great and stunning truths begin to take shape. Our maladies define a central feature of our existence: We are fallen. We are imperfect. Our bodies give out.

But despite this, - or because of it, - God offers the possibility of salvation and grace. We don’t know how the narrative of our lives will end, but we get to choose how to use the interval between now and the moment we meet our Creator face-to-face.

Second, we need to get past the anxiety. The mere thought of dying can send adrenaline flooding through your system. A dizzy, unfocused panic seizes you. Your heart thumps; your head swims. You think of nothingness and swoon. You fear partings; you worry about the impact on family and friends. You fidget and get nowhere.

To regain footing, remember that we were born not into death, but into life,- and that the journey continues after we have finished our days on this earth. We accept this on faith, but that faith is nourished by a conviction that stirs even within many non-believing hearts… an intuition that the gift of life, once given, cannot be taken away. Those who have been stricken enjoy the special privilege of being able to fight with their might, main, and faith to live fully, richly, exuberantly - no matter how their days may be numbered.

Third, we can open our eyes and hearts. God relishes surprise. We want lives of simple, predictable ease,- smooth, even trails as far as the eye can see…. but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance; and comprehension - and yet don’t. By His love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.

‘You Have Been Called’. Picture yourself in a hospital bed. The fog of anesthesia has begun to wear away. A doctor stands at your feet, a loved one holds your hand at the side. ‘It’s cancer,’ the healer announces.

The natural reaction is to turn to God and ask him to serve as a cosmic Santa. ‘Dear God, make it all go away. Make everything simpler.’ But another voice whispers: ‘You have been called.’ Your quandary has drawn you closer to God, closer to those you love, closer to the issues that matter… and has dragged into insignificance the banal concerns that occupy our ‘normal time.’

There’s another kind of response, although usually short-lived an inexplicable shudder of excitement, as if a clarifying moment of calamity has swept away everything trivial and tiny, and placed before us the challenge of important questions.

The moment you enter the Valley of the Shadow of Death, things change. You discover that Christianity is not something doughy, passive, pious, and soft. Faith may be the substance of things hoped for, the evidence of things not seen. But it also draws you into a world shorn of fearful caution. The life of belief teems with thrills, boldness, danger, shocks, reversals, triumphs, and epiphanies. Think of Paul, traipsing through the known world and contemplating trips to what must have seemed the antipodes ( Spain ), shaking the dust from his sandals, worrying not about the morrow, but only about the moment.

There’s nothing wilder than a life of humble virtue, - for it is through selflessness and service that God wrings from our bodies and spirits the most we ever could give, the most we ever could offer, and the most we ever could do.

Finally, we can let love change everything. When Jesus was faced with the prospect of crucifixion, he grieved not for himself, but for us. He cried for Jerusalem before entering the holy city. From the Cross, he took on the cumulative burden of human sin and weakness, and begged for forgiveness on our behalf.

We get repeated chances to learn that life is not about us, that we acquire purpose and satisfaction by sharing in God’s love for others. Sickness gets us part way there. It reminds us of our limitations and dependence. But it also gives us a chance to serve the healthy. A minister friend of mine observes that people suffering grave afflictions often acquire the faith of two people, while loved ones accept the burden of two peoples’ worries and fears.

‘Learning How to Live’. Most of us have watched friends as they drifted toward God’s arms, not with resignation, but with peace and hope. In so doing, they have taught us not how to die, but how to live. They have emulated Christ by transmitting the power and authority of love.

I sat by my best friend’s bedside a few years ago as a wasting cancer took him away. He kept at his table a worn Bible and a 1928 edition of the Book of Common Prayer. A shattering grief disabled his family, many of his old friends, and at least one priest. Here was an humble and very good guy, someone who apologized when he winced with pain because he thought it made his guest uncomfortable. He retained his equanimity and good humor literally until his last conscious moment. ‘I’m going to try to beat [this cancer],’ he told me several months before he died ‘But if I don’t, I’ll see you on the other side.’

His gift was to remind everyone around him that even though God doesn’t promise us tomorrow, he does promise us eternity, - filled with life and love we cannot comprehend, - and that one can in the throes of sickness point the rest of us toward timeless truths that will help us weather future storms.

Through such trials, God bids us to choose: Do we believe, or do we not? Will we be bold enough to love, daring enough to serve, humble enough to submit, and strong enough to acknowledge our limitations? Can we surrender our concern in things that don’t matter so that we might devote our remaining days to things that do?

When our faith flags, he throws reminders in our way. Think of the prayer warriors in our midst. They change things, and those of us who have been on the receiving end of their petitions and intercessions know it. It is hard to describe, but there are times when suddenly the hairs on the back of your neck stand up, and you feel a surge of the Spirit. Somehow you just know: Others have chosen, when talking to the Author of all creation, to lift us up, - to speak of us!

This is love of a very special order. But so is the ability to sit back and appreciate the wonder of every created thing. The mere thought of death somehow makes every blessing vivid, every happiness more luminous and intense. We may not know how our contest with sickness will end, but we have felt the ineluctable touch of God.

What is man that Thou art mindful of him? We don’t know much, but we know this: No matter where we are, no matter what we do, no matter how bleak or frightening our prospects, each and every one of us who believe, each and every day, lies in the same safe and impregnable place, in the hollow of God’s hand.’

Tony Snow

Contrast this with the chatter of our age: the hollow arrogance of the neo-atheist; the mindless and irrational contradictions of the postmodern professor; the decadence devoid of dignity and grace in Hollywood’s finest; the flapping frivolity of the fawning and feckless media.

It is no small irony that the things of life grow clearest in the looming shadow of death; that for those who grasp these deeper things — glimpsed only in part, hoped for in faith rather than seen with the flesh — that the darkness of death casts sharp relief on the very essence and meaning of life.

Rest in peace, Tony. We will meet some day in the light, and our joy will be shared.

I’ve been feeling a bit remiss (but only a bit) about my light posting of late — but hey, it’s summertime, and if Vanderleun can take a vacation, well, why not me?

But of course there’s always something which comes up, which demands some comment — such as this little blurb in the Wall Street Journal today:

Medicare Auditors Recover $700 Million in Overpayments

 
Auditors have recovered nearly $700 million in Medicare overpayments to hospitals and other medical providers in a half-dozen states under a controversial program that pays the auditing firms a portion of amounts they identify.

The program has drawn fire from health-care providers, and hospitals in particular, who call it overly aggressive and too confrontational. But the federal Centers for Medicare and Medicaid Services has supported the move and is in the process of expanding it nationally.

In all, the agency’s recovery audit contractor program caught $1.03 billion of improper payments over about three years, primarily in New York, California and Florida, about $992.7 million of which was overpayments by Medicare. The audits also identified about $38 million that providers should have received but didn’t. (Three states were added toward the end of the trial program, but accounted for only a small part of the recoveries, Medicare officials said.)

The program’s expenses amounted to about 20 cents on the dollar, including $187.2 million paid to the audit firms, and medical providers successfully challenged about $60 million of overpayments identified by the auditors. In the end, about $694 million has been returned to the Medicare trust funds, the Medicare agency said. The auditors reviewed a total of $317 billion in claims.

“All in all, we’re very happy with the results,” said Tim Hill, the agency’s chief financial officer and director of its office of financial management. “It returned a lot of money to the trust fund, particularly when you think that we’re talking about three states.”

I’ll bet you’re very happy, Mr. Hill.

Now, at first glance, this would appear to one of Medicare’s already notorious fraud and abuse investigations, carried out by OIG, but no — there’s no accusation of fraud involved here, although the government is more than happy to let this implication stand.

What this involves is demanding refunds based on different interpretations of Medicare’s mind-boggling regulations. So you provide a health care service, and bill Medicare based on your best understanding of its Byzantine regulations, and get paid. Then, at some future date, a third-party auditor, hired by the Feds, reviews the claim and decides — with no input from clinicians or other health care experts — that you were paid in error. Out goes the notice, pay up or else. Of course, this is always a highly objective, impartial review — the fact that the auditor gets a hefty cut of the refund has absolutely no influence on their judgment, none whatsoever.

Of course, you have a right to appeal — on your own dime and time, hiring your lawyers and taking time off from your practice to prove to the bounty hunter that your interpretation of the regulations is the correct one, and his is wrong. If you win, you get to keep the cash you already earned — minus a small stipend for lost time and lawyers fees. So, on that disputed $35 you got for an office call, you might come out, oh, $20,000 short, give or take a few thousand. But hey: You won!! Ain’t it grand?

Of course the low rate of appeals, entirely predictable based on the above freakonomics, is seen as proof that the audits are finding real problems:

Mr. Hill pointed to the low appeal rate — about 14% of overcharges were appealed, and 4.6% of the total were overturned — as evidence that the audits succeeded. “We know that we got the right answer,” he said.

If an 800-pound gorilla wants to make love to you, it’s always best to fake an orgasm. And the luvin’ ain’t over ’till the gorilla says it’s over…

Of course, these auditors also expend large amounts of time and energy looking for cases where you were underpaid:

RACs [Recovery Audit Contracts] are authorized to review payments for the previous 4 years. The software they use is more capable of picking up overpayments than it is underpayments. This discrepancy is borne out by a CMS report showing that 97% of improper payments in fiscal year 2006 were overpayments, and only 3% were underpayments. No money has been reported as having been returned to physicians because of underpayment.

At this point, the program has been primarily focused on hospitals in a few states, but is being rolled out nationwide, and will quickly be auditing physicians and other health care providers.

I have spoken a considerable length about the maze which is our current reimbursement system. It makes perfect sense, in a way, for the Feds to do exactly this: use bounty hunters to exploit the system’s complexity and inscrutability. They will no doubt recover a bundle of money, keeping the band playing on the Titanic for a few more years.

But sooner or later there’ll be a price to be paid — and that price is access. Repeated pay cuts such as the currently stalled 10.4% Medicare fee reduction being bantered around Congress, combined with heavy-handed recovery audits such as these, will drive physicians to the exits in droves. It is already nearly impossible in our area to find a primary care physician who accepts Medicare patients; a few more years of this B.S. and you’ll likely get a pretty clean sweep: best of luck finding anyone who will see you if you have Medicare or any other Federal health insurance.

Happy hunting on your audits, Mr. Hill.

 
A few links for your weekend browsing pleasure:

• Cloud warfare: Army Adds Its Own Aviation Unit. Bottom-up changes in the military for asymmetrical warfare using Pin-Point Liquidations and Network Collapse
• Dean Esmay sobers up: and writes a very enlightening piece on the progression of alcoholism: Alcoholism Progression
• Protecting your credit and identity: Been dinged a few times with fraudulent credit card charges, so it’s tempting to hire one of those credit & ID theft protection companies. Turns out you can easily do everything they do, for a lot less money: Never Pay Someone to Protect Your Identity. A credit lock is also cheap, easy, and reversible — not to mention a good safeguard against impulsive credit by you: Credit Security Freezes
• Dr. Discontented: Man, can I relate — my profession is being exsanguinated by a thousand cuts, and its a full-time effort to keep focused on the goal of caring for patients. Lots of docs are retiring early, lots more restricting their practices or doing more boutique services. Look for a significant access problem in the near future. Eyes Bloodshot, Doctors Vent Their Discontent
• Open-source health care: Interesting take from a Linux guy on shifting the control center to the patient. Mixed bag, from where I see it, with huge issues of privacy, data security, access control (who gets to see/edit your medical data?), etc. The Patient as the Platform (HT: John Ballard)
• Straight Talk Express?: “Brothel bus” makes last stop in Miami Beach
• Lets do the Canadian health care system, shall we?: Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits

That’s all for now, God bless, take care.

Often in the sturm und drang of a world gone mad, there comes, through the chaos and insanity, some brief moment of clarity. Such times pass by quickly, and are quickly forgotten — as this brief instance might have been, courtesy of my neighboring bellweather state of Oregon: (HT: Hot Air)

Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, [Barbara] Wagner was notified that the Oregon Health Plan wouldn’t cover it.
 
It would cover comfort and care, including, if she chose, doctor-assisted suicide.
 
… Treatment of advanced cancer meant to prolong life, or change the course of this disease, is not covered by the Oregon Health Plan, said the unsigned letter Wagner received from LIPA, the Eugene company that administers the plan in Lane County.

Officials of LIPA and the state policy-making Health Services Commission say they’ve not changed how they cover treatment of recurrent cancer.

But local oncologists say they’ve seen a change and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

It doesn’t adhere to the standards of care set out in the oncology community, said Dr. John Caton, an oncologist at Willamette Valley Cancer Center.

Studies have found that chemotherapy can decrease pain and time spent in the hospital and increases quality of life, Caton said.

The Oregon Health Plan started out rationing health care in 1994.

We have, at last, arrived. The destination was never much in doubt — once the threshold of medical manslaughter had been breached, wrapped as always in comforting words of compassion and dignity, it was only a matter of time before our pragmatism trumped our principles. Once the absolute that physicians should be healers not hangmen was heaved overboard, it was inevitable that the relentless march of relativism would reach its logical port of call.

Death, after all, is expensive — the most expensive thing in life. It was not always so. In remote pasts, it was the very currency of life, short and brutal, with man’s primitive intellect sufficient solely to deal out death, not to defer it. There followed upon this time some glimmer of light and hope, wherein death’s timetable remained unfettered, but its stranglehold and certainty were tempered by a new hope and vision of humanity. We became in that time something more than mortal creatures, something extraordinary, an unspeakable treasure entombed within a fragile and decomposing frame. We became, something more than our mortal bodies; we became, something greater than our pain; we became, something whose beauty shown through even the ghastly horrors of the hour of our demise. Our prophets — then heeded — triumphantly thrust their swords through the dark heart of death: “Death, where is your victory? Death, where is your sting?” We became, in that moment, something more than the physical, something greater than our short and brutish mortality. We became, indeed, truly human, for the very first time.

That humanity transcended and transformed all that we were and were to become, making us unique among creation not only in the foreknowledge of our death, but our transcendence of death itself. Life had meaning beyond the grave — and therefore had far more weight at the threshold of the tomb. Suffering became more than mere fate, but rather sacrifice and purification, preparation and salvation. The wholeness of the soul trumped the health of the body; death was transformed from hopeless certainty to triumphant transition.

But we knew better. We pursued the good, only to destroy the best. We set our minds to conquer death, to destroy disease, to end all pain, to become pure and perfect and permanent. We succeeded beyond our wildest dreams. The diseases which slaughtered us were themselves slayed; the illnesses which tortured and tormented us fell before us. Our lives grew long, and healthier, more comfortable, and more productive. Our newfound longevity and greater health gave rise to ever more miracles, allowing us to pour out our intemperate and precipitous riches with drunken abandon upon dreams of death defeated.

Yet on the flanks of our salient there lay waiting the forces which would strangle and surround our triumphant advance. Our supply lines grew thin; the very lifeblood of our armies of science and medicine, that which made our soldiers not machines but men, grew emaciated and hoary, flaccid and frail. We neglected the soul which sustained our science; the spirit which brought healing to medicine grew cachectic and cold.

So here we stand. We have squandered great wealth to defeat death — only to find ourselves impoverished, and turning to death itself for our answers. The succubus we sought to defeat now dominates us, for she is a lusty and insatiable whore. We have sacrificed our humanity, our compassion, our empathy, our humility in the face of a force far greater than ourselves, while forgetting the power and grace and the vision which first led us and empowered us on this grand crusade. Our weapons are now turned upon us; let the slaughter begin.

We will, no doubt, congratulate ourselves on the wealth we save. We will no doubt develop ever more ingenious and efficient means to facilitate our self-immolation while comforting ourselves with our vast knowledge and perceived compassion. Those who treasure life at its end, who find in and through its suffering and debilitation the joy of relationships, and meaning, and mercy, and grace, will become our enemies, for they will siphon off mammon much needed to mitigate the consequences of our madness.

It has been said, once, that where our treasure is, there will our heart be also. We have poured our treasure in untold measure into conquering death — finding succor in our victories, while forgetting how to die. The boatman now awaits us to carry us across that dark river — and we have insufficient moral currency to ignore his call.

• For the ultimate Marguerita: The Gas-Powered Blender with Handlebars. Are you man enough to get one?
• Donald Sensing on D-Day: The awful stakes of D-Day. It could have turned out very, very differently.
• Airline travel in the golden years: Back in the Air. Yeah, they were slow and noisy, but check it out: large, comfortable seats, beds(!), smiling passengers, no overhead storage compartments. Where can I book my next flight?
• No need to call the Incredible Hulk: if you want to witness a good thrashing and smashing, read VDH take down Pat Buchanan. Not pretty, but very, very satisfying: Patrick J. Buchanan—Pseudo-Historian, Very Real Dissimulator
• Planned Parenthood & ACLU are screwing kids: The War on Abstinence
• Good laughs over at Maggie’s: To wit: “Why does Sea World have a seafood restaurant?? I’m halfway through my fish burger and I realize, Oh my God…I could be eating a slow learner.”
• Gay marriage is not about gays getting married: Redefinition Revolution
• Gagdad Bob hits his stride (again): how atheistic scientism leads not to freedom, but to brutality: Religious Humanism vs. Darwinist Animalism

Back soon, God bless.

Photo: Cass River Shay No. 5, an old geared logging locomotive.