Comments on “Fluidity: a preview”

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Healthcare in a fluid world

Elayne's picture

Wow. I'm home with the flu and have binge-read your book today-- and it resonates deeply. Most of my life, I've felt somewhat a Stranger in a Strange Land, and you've articulated ideas I've tried to develop, in a much more coherent manner than I ever managed. I was raised atheist and by default, "blue" politically, in the Deep South (can you imagine?!), but somehow monism has always seemed not just incorrect but personally ghastly. I can't say exactly why other than it seems to invalidate the parts of life which mean the most for me-- engaging with others in relationships. If we aren't actually two, although certainly connected as well, how can we love each other? I have used the term "ineffabilities" to describe those particular but indescribable and transitory qualities of the "other"... whether person or poem. I really like your term nebulosity. And the combination with patterns. Beautiful.

I see now why I don't fit anywhere, in groups, unless they are poets or the like, unless I keep my mouth shut. It's because like you, I'm neither monist nor dualist. I have been baffled at how my progressive friends are utilitarian but my libertarian or objectivist friends are the ones who seem to see people as non-abstract-- and now that makes sense.

My atheist friends are almost to a person varieties of monists, and they think I'm arguing just to argue, lol, because they know I'm not a dualist. I am a "geek" in organizations-- and ouch, I guess clueless, but I get that. It's why I've left most of them, because the purpose wasn't what I thought it was.

I don't know how I wound up being anti-monist plus someone with mainly typical progressive political ideas. I can tell you it's a strange place to be.

I'm a pediatrician and poet, with a very gap-filled education outside of medicine. I'm not sure I have anything useful to contribute here, but I have a request for an example of fluidity applied to healthcare.

I've been in practice over 20 years. My desire for people to be able to get healthcare isn't based in utilitarianism, because I seem to be fundamentally incapable of abstracting individual humans into math. It is just because I see, in person, people who want medical care and can't get it. Parents of kids in my practice. It breaks my heart.

Years ago, I thought the solution was to tackle one area at a time, starting with the most ignored. So I helped get a homeless clinic set up in my town. But... then I started reading and learning about the convoluted financing and access problems, and I thought well, we need to address this nationally. I heard a single payer speaker and went all in--I wound up being elected to a national board (I'm using a pen-name here).

I figured they'd be interested in tweaking the plan to accomodate folks who didn't want to participate. I thought that could be my contribution-- explaining what southern conservatives want. Because no single solution works for every person. I came up with some ideas where opt-outs could work, and even tested these out with my conservative friends and got favorable responses, but there was no interest from the single payer org. None. I was startled at how rigid the thinking was-- I figured there had to be something more than just trying to bring about healthcare going on with them. Smart, kind people, and with this funny religiousness about their idea. It was sacred and couldn't be adjusted. Even though it was only a 20 year old piece of legislation, it was untouchable. This universalism you describe would explain that.

About that time, I got some education on my political party of birth, the Democrats, and became disillusioned-- I left my party. I was amazed that it had taken me so long to question the good guy/bad guy bit. I toyed with being a green but decided to see if I could get a better view of things by staying out of parties. I spent a lot of time trying to organize advocacy at the state level, which has been mostly a process of stuffing newspaper in the leaky roof. It doesn't last long, and the structure doesn't change.

Then I started wondering if the government was too full of sociopaths to trust with healthcare. I read about how they climb hierarchies, and I see that it happens. Not all are, but a good many. I wondered if we were at the point where neither corporations nor government could manage healthcare without making it worse. Or whether there were even minimal boundaries between corporations and government anymore. And I realize I can't take up an eternalist stance that's just anti-corporate either. I gave up full blown socialism. I gave up anarchy. I don't know what the answer is, now. I don't know what to do in light of the sociopaths. We have to account for them. I do think there need to be multiple possibilities, which are somehow flexible and fluid.

To some degree, I've felt at an impasse. And intermittently nihilist, minus this big quasi single payer plan I had which now seems crazy, lol. I hate that feeling. Your book was very helpful in reminding me of how I really see meaning, which is the same as your description. It's hard to hang on to sometimes. If I get with a bunch of utopians, it's contagious. It seems to be for me, at least. I get caught up in it, until the rigidness is too much to take. So when I can't sustain that fantasy anymore, I get dumped into meaninglessness and have to find one of those little meaningness boats again.

So... any ideas for little healthcare boats?

Thank you again for doing this book ❤

Elaine's Comment

Corey's picture

Wow Elaine. So this will be a cheerleader comment for sure, but just thanks for posting that. Reading someone else illustrate in their own context a profound reaction to David's was cathartic. I'm right there with you, just basically 36 hours coming off of a couple month addiction to Standard Issue Leftist that on reflection I fell into.

This. This resonates:

If I get with a bunch of utopians, it's contagious. It seems to be for me, at least. I get caught up in it, until the rigidness is too much to take. So when I can't sustain that fantasy anymore, I get dumped into meaninglessness and have to find one of those little meaningness boats again.

I've learned from Matthew O'Connell that spiritual practice (the primary subject of some of David's other sites) must lead to some sort of impact on the wider world or there is a sense of cloistering off, of failing to engage with the whole of reality. The challenge in trying to 'make a difference' so to speak is that so many movements are completely subsumed in the Kegan level 3&4 logics that lead to the situation that you ran into. I am trying to respond to the challenge of this moment by withdrawing from a tendency to 'B.S.' into a wide vareity, and instead to narrow my own focus and trust more knowledgeable on others, opinions as I find David's technocratic approach rings true with my own experience and intellectual journey. It would seem that working for change with both political sides in a way that does not 'compromise' but rather transcends both perspectives, in a field one is passionate and skilled about, is the path to take. This approach would appear to be exactly the one you have taken. As we perhaps now more readily understand under a backdrop of David's illustration of our political climate, we who would take this path are an isolated lot facing a great challenge. Both Matthew and David have described how there aren't really any post-religious, post-traditional institutions that have yet emerged that would promote this way of thinking about and attempting to resolve problems, perhaps with the partial exception of Silicon Valley(?). I've just found the straight up difficulty of holding the line on this understanding very difficult. Maybe I'm just a weak person, but every time I read David's writing along these lines it resonates BIGLY (thanks Trump), but now several times in the meaning-making and now political arena I've found {"my"} favored opinion of the moment floating back into the level 3 and 4 due to an introverted+agreeable personality and the sheer volume of opinion that dominates this discourse as the days and months go by until I happen upon something that jolts me back awake from a state of either dull reluctant agreement with the Left or confused hopelessness. I'm currently working with Matthew, who I mentioned earlier, on practices that might help reign in this tendency to ground and leave more confident. But damn would it be much easier if we had more thoroughly developed ways of meeting flesh and blood individuals of like mind (I'm one that still believes there's irreplaceable value in that). Emotional support is a thing, even if it cannot usually be foregrounded if we wish to move beyond tribalism. David is concerned about our ability to maintain essential institutions in an anti-institutional, '4.5' cultural moment, perhaps it's part of our task to make an effort to maintain them with new materials that are more aware of their own limitations, thus appealing more to those who grew up in the postmodern age, or to work on scaffolding that's already started. Or maybe that task is so far fetched that it's naive to even work on it, and we should just make the best of it, find our friends and support as we can get it, and hope for the best, idk.

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