A History of Iran: Empire of the Mind by Michael Axworthy (2008)
I read a book like this sort of like I read a novel; what hooks me into the book is the sense of being pulled along on the ups and downs of tumultuous fortune. But a novel is structured so that the plot is simplified. The author makes sure that you have relative ease catching the name of the leading characters, that you understand the setting and can vividly picture a lot of the action. I can honestly say that of all the hundreds of historical personages I was introduced to reading this book, I can only remember one, and that’s Nader Shah, a pretty fascinating “great man” of history whose rise to power was more meteoric than that of Sarah Palin’s.
It’s no surprise that I remember clearly the main thesis of the book, which is that the nation of Iran is defined more by its intellectual character than by any set of boundaries or affiliation with a particular political doctrine. Axworthy spells this out very clearly at the beginning of the book, and refers back to the idea enough times that you really see where he’s coming from.
But there are a number of incidental observations that also stuck with me. For instance, the idea that a government’s primary role really has to be defense in order to serve any useful purpose. It’s memorable because Axworthy does not come across as a particularly hawkish thinker. He never hesitates to criticize the many Iranian leaders who brought ruin on their land by pursuing overly ambitious military campaigns. It’s an interesting principle, the primacy of defense, because it begs the question of what legitimate defense is, and of what happens when aggression is carried out in the name of defense. There are lots of examples of this.
Another observation that stuck with me was that part of the reason Iran seemed to lag behind in terms of technology and modernization is that the terrain of Iran and the organization of its communities really wasn’t suited for the sort of railroad infrastructure that was springing up around Europe and America. Although later on, Iran suffered from the discrepancies in technology, the short-term prospect of investing in these technologies just didn’t exist.
And the observation that was most memorable to me, and also the most incidental of the three I list here, was that the history of empires tends to focus almost exclusively on the causes of their decline. Having studied a lot of German and Austrian history, I immediately said to myself, “Hey, that’s true, isn’t it. Why is that?” My guess is that a lot of the modern study of history in the western world is modeled after the study of the Greek and Roman Empires as seen from the far side of the chasm of the dark ages. Perhaps there’s a crime scene investigation aspect to the study of history, where the first and best question to ask is, “Why did this death happen. Why did this empire decline and fall?” From this vantage points, you get the best access to the eyewitnesses who watched the collapse and reported on it, and these witnesses are better sources than those who were present during the victorious rise of the empire, because during the rise of an empire there’s too much distortion and propaganda, too many people with skin in the game, too much state secrecy and too many people infatuated by political slogans and aspirations. There are too many variables, too many proposals.
Over the past few months, as the debate over national health care reform has occasionally struggled its way in front of Michael Jackson and Sarah Palin to take into the tabloid tinged spotlight of the collective American consciousness, I’ve wondered a lot about what’s really being debated is the health of this nation. Just yesterday I went to an Organizing for America rally held in a local junior high school. It was impressive to see about 150 people gathered and cheering every time the concept of a public option was raised. This is a big crowd for Alaska, and it may be a sign that there’s more political will behind the reform movement than the headlines have led us to believe.
I think that a serious reform of our nation’s health care system, one that provides coverage to the uninsured and includes a public option, is going to be a much more meaningful contribution to our national defense than any invasion of Iraq or Afghanistan. And yet there seems to be an unspoken rule that says we debate the lead up to military campaigns very differently than we debate the lead up to health care reform. In our national consciousness, a war in Iraq is not very different from buying a ticket to see a movie like Transformers or Batman. There’s a sense that, whoever you are, you just gotta see it. You just gotta shell out the money. Even if you have doubts, you don’t want to miss out on this. The money’s already been spent in advance. The troops are already moving in. The demographic tests were performed years ago. Smarter people than you have decided in advance: this is the movie you want to see. How will we pay for it? That doesn’t matter. It’s just a movie. It’ll be over quickly, and after it’s over, you’re supposed to forget about it. So what if the new Transformers movie sucked. Get over it. Only geeks care about old movies.
In the meantime, there’s a different mechanism built up around health-care reform. We’re supposed to think about this sort of issue, and make a mature decision. But what’s our model for thinking? To carry on the movie model, the difference between the Iraq war debate and the health care debate is the difference between a Transformers movie and a movie like The Da Vinci Code or Angels and Demons. Yes, there’s a little more time to take in information, but not much more time.
The most salient idea to come out of the health care debate has been: Barack Obama is the Antichrist. His followers are mindless fanatics and they’re determined to take away America’s edge by euthanizing our grandparents.
Is this nonsense? Yes. But there are a lot of reasons why Barack Obama’s supporters haven’t been quicker to rally behind health care reform. Because in the months since his election, Obama has spent a lot more time meeting with the heads of big insurance companies than he’s spent meeting with the uninsured.
Over the past few months I’ve spent a lot of time working as a nurse in the operating room with surgeons and anesthesiologists. I’m privileged to spend so much of my time with these people, some of the best-educated people in the state of Alaska. None of them are really shy about speaking their minds when it comes to political issues, but it’s surprising that there really hasn’t been a lot of intelligent comment on the health care debate. When the issue get’s mentioned at all, it tends to be derisive. “Under ObamaCare, we’re not going to be able to do anything but tonsillectomies,” or “Did you heart them rip Dr Obama a new asshole on tv today?” At the same time that a lot of these docs were making jokes about the new dawn of American socialism, I saw a lot of these exact clustering in the hallways and talking excitedly about how they were taking advantage of the Cash for Clunkers program.
One thing that’s become clear to me over the past few years is that physicians are very smart, but they’re no more likely to form mature political views than anyone else. Just as anywhere else, there’s a lot of diversity of political opinion, and it’s an open secret that in the operating rooms where I work you get a harder time shooting your mouth off in support of a liberal point of view than you do of a conservative point of view.
Here’s a joke I heard recently from a surgeon who will remain nameless: “Did you hear that Obama’s going to tax aspirin now? It’s white and it works.”
Okay. That’s really low. Not only is that joke racist, it’s just not funny.
Physicians often don’t see nurses as their peers. That’s built into the structure of the health care system, and there’s reason for it. I can’t perform surgery, I’m not qualified, at least not at this point, to perform anesthesia. But I’m not stupid, and I do know that racist jokes are a far cry from rational debate.
One of our surgeons, Dr Mark Kimmins, has actually spent a lot of time seriously thinking and speaking in public on the issue of how the health care system works. One day I stopped him after an operation and asked him what he thought of the whole health care debate. While he didn’t exactly state that he was going on record, I don’t think that he’d hold it against me if I quote him when he told me that he thinks a nation ends up with a health care system that reflects its national character. He told me that he would give me a thousand dollars sight unseen if I could go into the doctor’s lounge right now and get any sort of consensus at all among whatever chance assemblage of physicians happened to be in there in the moment. Dr Kimmins spoke a little bit further about his own experience working with both the Canadian and the US health systems. Is the Canadian system perfect? He doesn’t think so, but he also doesn’t think that it’s a travesty. According to him, the nightmare situation where you have a government bureaucrat saying, “No, this surgery simply is not approved” just does not exist in Canada. But as with any system, including the current one we have in America, there is the system between infinite demand and finite resource.
I recently talked to a friend of mine who got a job loosely associated with the insurance industry after he lost a job in the restaurant industry after breaking up a brawl (My friend said, as an aside, that if his unemployment claims didn’t go through, he planned to sue the restaurant). I asked him what he thought of health care reform. He told me that he just doesn't think health care is a right that the government should be supporting. He’s happy with his own health insurance; he hasn’t been to the doctor in a few years and resents the thought of paying money for people who aren’t as smart about their own health care. He then digressed into talking about the fact that what he’s really upset about is the fact that his financial situation is a mess, and that he does fault the government for this because in all he years of education he’s had, he never got a firm grounding of personal finance.
I didn’t put my friend on the spot during that conversation, but I’m putting his thinking on the spot right now. It seems like what he’s doing is cherry picking his rights and responsibilities. At the moment, he feels like the government has a right not only to educate him, but also rather to make choices about his education, and if he comes away from the education making poor personal choices about money, well that’s the government’s fault. At the same time, he’s pretty sure that he’s in a situation now where he doesn’t have to worry about health care. If something bad happens to him, he’s covered, and nothing bad is likely to happen.
Well, I hope for his sake that he’s right. But I know a lot of people who think they’re covered until they get into a catastrophe, after which point they get a rude surprise.
I’m not perfectly happy with the presidency of Barack Obama so far, but I think that he’s right in calling for health care reform, and that we still do have a great opportunity for pushing such reform through in the next couple of months. I was heartened to see that the Organizing for America event I attended last night included some strong rallying cries in favor of the public option.
Health care reform is a complicated issue and I don’t pretend to be a great authority on it, but I do think that I’ve taken steps toward real understanding of the issue. I made a choice last night to throw my own weight heavily behind the Organizing for America initiative to push health care reform through. Do I have doubts? A few. Of course I do. I’m throwing my support behind the passage of legislation that hasn’t been written yet and that’s certain to come in a form that’s needlessly complex and inaccessible to the public understanding. But I’m also convinced that if this legislation does not pass, the situation will get much worse for ordinary Americans; many of us are not covered, and those of us who are find ourselves totally at the whim of whoever provides our coverage. Moreover, I agree with the assessment of Dr Kimmins: America will get a healthcare system that reflects its natural character, and I still do have hope that America’s national character is evolving and maturing toward something more civilized, more humane, and more likely to result in prosperity than the nightmare of the Bush administration.
