Who deserves to die?
It's much easier to demonize criminals than to examine inequality.
Last week, the Washington Post reported a bombshell story: David Bennett, the man who recently received a groundbreaking transplant of a pig’s heart, was convicted years earlier of repeatedly stabbing a man. He was sentenced to 10 years in prison and served six. The victim, Edward Shumaker, was paralyzed by the attack, causing much difficulty and anguish for his family until his death 21 years later. The Post story pits the outrage of the victim’s family against medical ethicists and doctors, who say that healthcare is not an arm of the justice system to mete out punishments. “Withholding medical services is not a part of that punishment,” the paper wrote, literally anything you could read about prison healthcare notwithstanding.
In the race for scarce organs, the piece implies, hospitals could consider the criminal history of patients, in addition to whether they have a history of substance abuse or can access follow-up care. (The University of Nebraska Medical Center site, for example, warns prospective transplant patients that “you and your family must be able to accept the responsibilities, including financial, that are part of the long-term care you will need after transplantation.”) Wouldn’t that be good, if they could do that? If they could ensure that only good people got organs, and bad people didn’t and died, because they were bad? The fact that experimental procedures like the one Bennett underwent could pave the way for those organs to become less scarce wasn’t really examined. Nor were the deeper implications of deciding who gets medical treatment based on their personal character; if we did that, Henry Kissinger would probably not have made it to 98.
This story proved apparently irresistible to the press. Practically every news outlet followed suit with their own stories, including other titans like the AP (thankfully not the Alex Pareene) and the New York Times.
All the brow-furrowing, finger-tenting interrogation of the fascinating ethics of this case seems like a flimsy pretense for a much seedier impulse in American media, which is the reflexive disparagement of anyone convicted of a crime. Our ‘liberal’ media has only just begun to realize that it might not be cool to post mugshots of criminals; they’ll use them to illustrate stories about a poor person ‘stealing’ medical care. The “no angel” stories that often surface after a Black person has been shot by police are part of the same instinct: Sure, you may have a right not to be shot for no reason by police, but have you considered that this guy was not perfect, so maybe it’s kind of a wash?
The real question at the heart of this story is not whether criminals deserve healthcare, but: Are organs, in short supply, allocated fairly? If the media pays less attention when the patient is not so interesting, then it becomes clear that this story is more about sensationalizing crime and criminals, and finding another way to argue for their rights to be eroded, than some high-minded question of medical ethics.
In 2020, ProPublica’s Lizzie Presser reported the story of JaMarcus Crews, who died of Covid-19 while waiting for a kidney transplant—just a couple weeks after he had finally been referred for one, after years of mistakes and oversight. He was 37. In devastating and painstaking detail, Presser shows how Crews was forgotten or ignored at every stage of his illness. His doctors didn’t tell him his creatinine levels were too high; Crews didn’t know until he reviewed his medical records himself. A “race-adjusted equation” for determining eligibility, which “assigns healthier scores to those who are listed as Black” because of their supposedly higher muscle mass, pushed Crews further out of contention. His only option for dialysis was a for-profit clinic, where patients are 17 percent less likely to get a kidney. Those charged with his care at the clinic kept failing to recommend him for transplant. No one told him that the University of Alabama’s weight requirements had changed, either. (After all, would a for-profit clinic take on the job of losing its patients to transplants?) He died of Covid-19, a disease that has disproportionately affected Black people, his body made much weaker to the virus by kidney failure.
Where is the wildfire of outrage for JaMarcus Crews, and the wife and child he left behind? Diabetes is far more common among Black people and the poor; his short life was marked by gaps in insurance coverage, medical treatment, and income. In the wide world of stories that can be written about access to transplants, here is one glaring example of injustice, with nothing to make up for it but the careful attention of one dogged reporter. At least Bennett went to prison for his crimes; no one’s gone to jail for letting JaMarcus Crews down.
Dr. Michael Hanaway, a kidney transplant specialist at the University of Alabama, where Crews would have been eligible for transplant had he not died, told ProPublica: “Not all good candidates get to the transplant center.” Contrast this with a quote given by a medical ethicist to the New York Times, in their story on Bennett: “There’s a longstanding standard in medical ethics that physicians don’t pick and choose who they treat.”
This is flatly untrue, of course. Doctors in emergency rooms have to treat whoever walks in, but emergency care is not the only kind of medical care. Almost every other doctor in America screens patients to some extent on the basis of their ability to pay, whether that means having insurance at all or having the right kind of insurance; around one in three primary care doctors won’t take new Medicaid patients. If you have cancer, you can’t walk into an emergency room for an appointment with an oncologist, a round of chemotherapy, or emotional support. You must have insurance, and money on top of that for deductibles and time off work, to be treated in the manner you need. You will be turned away if you don’t, although more likely you’ll just know not to even try.
And poor, Black patients can be routinely ignored and forgotten, like Jamarcus Crews was, no matter how ‘deserving’ they are, no matter how carefully they follow medical guidance or attend their appointments. No one goes to jail. None of the people involved in letting him down received blaring headline condemnation across the entire media. We can’t say how many more like him there are out there, being lost in the shuffle of a for-profit healthcare system—not just for kidney transplants, but for all kinds of medical care. I’ll save my outrage for them.
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Wars of Future Past
Kelsey D. Atherton
There are many reasons to promise an army that it will “all be over by Christmas,” not least of which is that the holiday promises soldiers a kind of normal worth surviving to reach. When nations ask (and, always, compel) people to sacrifice on behalf of some greater good, it’s an easier sell if that sacrifice comes with clear, concrete actions, and a fixed duration of hardship.
This winter, I’ve been thinking a lot about what it means to ask people to endure. And, as is typical for me at all times, I’ve been thinking about nuclear war. This week’s upcoming edition of Wars of Future Past is about the sharp delineations nuclear war makes between before and after. It is also about how Civil Defense messaged that moment, from pamphlets for morticians to songs for school children. It was not a cheery vision, but it was one at times exceptionally straightforward, while still promising some kind of new normal on the other side of cataclysm.
As we endured the second pandemic Christmas, reports surfaced that the Biden administration floated and then abandoned plans to proactively offer people tests and masks before the Omicron wave. Given the mismanagement of the present crisis, I have to wonder: would we be better served by the same civic faith that produced Bert the Turtle?
Welcome to Hell World
Luke O’Neil
This weekend I sent out to paid subscribers a great excerpt from Jonathan M. Katz’s new book Gangsters of Capitalism: Smedley Butler, the Marines, and the Making and Breaking of America's Empire. “For colonizers, zombie stories are powered by fears of revenge or contagion by the people they conquered,” Katz writes. “For the colonized, the zombie retains its older connotations: fear of abduction, assimilation, and losing one’s soul.”
Here’s a coupon for 33% off for Discontents subscribers only. Subscribe to a year of Hell World you’ll also get a free six months paid subscription to Foreign Exchanges by Derek Davison and Forever Wars by Spencer Ackerman as well as access to the Discontents Discord channel. Also if you buy a year at the full price today I’ll send you a copy of one of my books of your choosing. Let me know if you want to take advantage of that.
In that post I also took a look at some of the more evil shit of the week including a sick fuck pig of a Michigan judge named Alexis G. Krot harassing an elderly cancer patient for not keeping his yard immaculate.
Read it here.
Earlier I wrote about the case of a man in upstate New York who was tased and set on fire inside of a police station by cops who ran out of the room instead of helping him. It’s all horrible and extremely hard to watch like I said but there are two parts of it that really broke me one of which was after Jones had put the flames out himself one of the cops goes toward him and you think he’s maybe going to help but the first thing he thinks to do instead is to try to put his arm behind his back as if to handcuff him before apparently thinking better of it. The second is when a civilian bystander who seems to have watched what transpired from another room comes in and simply hugs Jones at which point he calms down. He seems so relieved by the simple gesture of human kindness even after what he’s just endured.
Read it here.
You might also appreciate this one from a while back about one of Orson Welles’ most stirring radio addresses about violence against Black people in this country.
“I come with a call for action,” he said. “This is a time for it. I call for action against the cause of riot. I know that to some ears, even the word “action” has a revolutionary twang, and it won’t surprise me if I’m accused in some quarters of inciting to riot. Well, I’m very interested in riots. I’m very interested in avoiding them. And so I call for action against the cause of riots.”
Read it here.
The Flashpoint
Eoin Higgins
At The Flashpoint, I talked to teachers about the inability for school districts to come up with coherent plans to combat Covid in classrooms.
District administrators have had two years to put together a plan for how to handle the pandemic, but are still coming up short. Jane, a teacher in the Hudson Valley in Upstate New York, told me that her district isn’t even able—or willing—to provide basic protective gear.
“My kids are young and have small faces,” Jane said. “The district does not provide appropriately sized masks for young children, so if we want masks that fit our students we buy them out of our own pocket.”
I also chatted with people about what pushed them to the left.
In school, Hannah Etengoff was a “liberal with radical tendencies,” but fundamentally someone who still believed in the system. Watching in real time as climate change ravaged the landscape, she realized those politics were no longer sufficient.
“I could see the land changing, I could see the climate changing, I saw the mega fires, the effects of the decreasing snowpack in the cascades that was leading to mass salmon die off,” she told me. “I realized how incredible fucked we were and how much more fucked we were going to get if there wasn’t a radical change.”
Plus—Karen Geier on psychedelics, Osita Nwanevu on democracy, Q. Anthony Omene on the ASPI, and a particularly cringeworthy video from Tulsi Gabbard.
And check out the podcast on the Callin app.
BORDER/LINES
Gaby Del Valle & Felipe De La Hoz
States attempting to take immigration enforcement functions into their own hands never turns out well. Perhaps most infamously, Arizona’s SB 1070, which was signed into law over ten years ago now, shattered any remaining trust between immigrant communities and the state government, triggered an avalanche of of boycotts against the state, and set up a never-ending civil rights quagmire as local law enforcement was incentivized to essentially racially profile people, even after portions of the law were gutted by the Supreme Court. Now, continuing on that sordid tradition is Texas, where Gov. Greg Abbott last year instituted Operation Lone Star, an effort to deploy local law enforcement and National Guard soldiers to the U.S.-Mexico border in an effort to compensate for President Joe Biden’s supposed open-border policies (which is, for the record, a laughable concept given that the administration has retained the bulk of the Trump border approach).
It was never more than a political show, and it has unsurprisingly been a disaster on nearly every front: moral, obviously, but also legal, operational, and even PR. As we wrote in last week’s BORDER/LINES, the mission has been marred by a string of apparent suicides by troops frustrated by a pointless, open-ended deployment, procedural mess-ups, troops trespassing on private land (which is the exact reasoning Texas is using to arrest migrants, since the state does not have the authority to conduct immigration enforcement directly), and legal challenges. Abbott has never been coy about the fact that this is an effort to have the state do the enforcement that the federal government ostensibly wasn’t doing, which set up an eminently predictable legal defeat: a state judge ruled last week that that the mission violated the Constitution’s Supremacy Clause by having usurping a federal function.
It’s not clear what happens now, but Abbott is standing by the mission even as it blows up in his face, likely because he wants to use it as a plank in his reelection campaign as he faces stiff competition from right-wing lunatic Allen West. At this rate, it might be a political anchor, but it does push the envelope even further in terms of what authorities some GOP governors are willing to do to show down with the federal government. Immigration is low-hanging fruit, but next it might be deploying troops to “protect” voting booths from “fraud.”
Sick Note
Libby Watson
Last week, I was a sour crone about the new surprise billing law, which went into effect at the beginning of this year, and pointed out all the problems with it—like the fact that it doesn’t apply to the single largest source of surprise bills, ground ambulance rides. I also listed some, but not all, of the things that are still legal, like turning away patients because they can’t pay (see above!) and garnishing patients’ wages to pay back medical debt.
Also, hi again! I took some time off but I’m back now. Please hit me up with healthcare stories if you have them: sicknote@substack.com.
Discourse Blog
Hi everyone, welcome to another week online. Here’s what Discourse Blog was up to last week. I wrote about Mitt Romney’s limp, disingenuous defense of the filibuster, which conveniently gave us a perfect microcosm of the two prevailing theories in politics right now.
Meanwhile, Sam wrote about not letting CDC director off the hook for essentially failing to provide any sort of leadership during the ongoing crisis. For what it’s worth, Dr. Fauci, perhaps the most recognizable face of the U.S. medical community’s response to the pandemic, has becoming nothing more than a reality TV talking head, sitting around and yelling at Rand Paul in lieu of doing anything particularly useful.
Paul also covered an aspect of this late-COVID shutdown: the crushing labor shortage in healthcare. Paul’s idea to fix this is simple, and has been on the table for Biden for years now: cancel student loans, and maybe do one better and create an incentive or signing bonus program for new healthcare workers when they find jobs.
That’s our highlights this week! Just kidding – you don’t think we would have skipped Kyrsten Sinema’s filibuster speech right? Oh yeah. We blogged that too.
The Insurgents
Jordan Uhl & Rob Rousseau
Hey folks. This week we’ve got fellow Discontent Derek Davison of Foreign Exchanges to help us break down and make sense of a number of the geopolitical flashpoints making headlines over the last few weeks. From the burgeoning Russia/Ukraine conflict, to Iran, Nicaragua, or Kazakhstan, to the question on everyone’s minds, “What should the left do about China,” there’s plenty to get into. Especially the overall theme of all these conversations, which is why the US and its junior partners in imperialism like Canada, the UK, Australia and the rest of the “international community” have the eternal, perpetual right to sanction, invade and destabilize any official enemy country in the name of national security, but any time one of these countries mildly pushes back on this constant belligerent behavior, its framed as some kind of hostile move by an out of control dictatorship? This one is for subscribers only, but it’s a great conversation and absolutely worth it.