Carter, the Improbable Man

We must not lose memory of his decency, honesty, toil, service and faith.
White Dove, by Jimmy Carter in the Zaban Room of The Carter Center

Jimmy Carter’s life is now complete, a race run full out to the last day. The moravian bells of old Salem chime in his honor as I type. Many others will follow in the days, months and decades to come. We must not lose memory of his decency, honesty, toil, service and faith. And not dishonor him by elevating those virtues out of reach of all of us.

Counting him out was almost never a good idea whether he was running for an improbable office (every one he ever held) or an improbable health goal (guinea worm, polio, smoking or handgun violence). Or embracing improbable relationships—the Allman Brothers Band so key to the first steps of his race for President, Charles Taylor, the Liberian Pariah President or North Korean Pariah President, Kim Jong-un. Carter was able to live across improbable boundaries because he was comfortable with his own complexities and complicities; he knew he was human like all of the 8,018,082,868 of us. And he was clear-eyed about his own death, which most of us ignore until the last final shock.

Carter was always misread as being somewhat simplistic and moralistic. In fact, he worked through his own complexities to still choose to act, speak and do what he thought right. He was not surprised that his relationships sometimes made that harder; he was a loyal to people who made his life more complicated than a more ruthless man would have (thinking of a few bankers and entrepreneurs who clung to him like barnacles). A religious man with eclectic curiosity, he often confounded Baptist Christians who feared the grey areas (most of life). And he confounded secular friends who loved the grey so much they found it odd that a man could choose commitment and follow through. Not satisfied with a simplistic stab at polio, he did the hard work decade after decade after decade. Never satisfied with pontificating in a hotel ball room, he took African presidents to left-behind places in their own countries they had never seen. And then he went back again and again. He knew the complicated reasons for homelessness, but he never failed to pick up his own hammer and build one more home. He loved one woman his whole life, even though he was honest enough to almost lose an election by admitting “lust in his heart” for others. He gave the word “human” a good name.

Like many thousands, my life would be unrecognizably different had it not met his. Not long after he was involuntarily returned to civilian life from the White House, he started The Carter Center as a launching pad, more than a museum. He and Dr. Bill Foege, who had run the CDC under him, held the first global conference called Closing the Gap, even before he had a building. An engineer’s kind of conference, it asked how much of the burden of premature morality could be prevented based on what was already known. What could we actually do with what we already know? About two thirds was preventable back in the 80’s, as your grandmother would have guessed. And who needs to act? Among others, the ubiquitous faith networks who he knew tended to sit around and wait for something terrible to happen and then act surprised at the most predictable things (cancer, war, diabetes, river blindness). Could religious people grasp the vast moral chasm causes by not acting on the patterns we know cause needless suffering? He and Dr. Foege got the attention of the Robert Wood Johnson Foundation and started the Interfaith Health Program, which I ended up leading. Why me, and not some famous academic bishop? Frankly, I’m not sure, but both men had a preference for bold action over formal qualifications.

The first thing we did was blow up the perfectly respectable grant plan of work, which began with a big formal conference at the new Carter Center. We replaced it with two years of scrappy meetings in dumpy basements and raggedy centers all over the nation (not unlike his run for president, now that I think of it). We asked the leaders actually doing things what they would commend to him as worth replicating. And we asked where they were stumped for lack of a clear vision of what might work. The two lists were identical, of course, which meant that the big innovation was having enough humility enough to realize that somebody down the road had probably already figured out the answer we thought we had to invent. It is actually harder to adapt something as it demands even more intelligence than simply plopping down another idea from somewhere. He called this a “mundane revolution.”

Carter is known for protecting the Arctic reaches of the Alaskan wilderness. I rafted the Canning River which borders that vastness and I was grateful; what other President even knew it was there, or would spend scarce political capital to protect it? It wasn’t just big nature he loved; he never missed participating in the Audubon bird count in Plains. He personally called the American Chestnut Society to get some hybrid seedlings to plant at The Carter Center, where they are improbably growing strong. He accepted some gift of Koi from the Japanese government but refused to purify the pond so people could see them. (A Georgia pond is brown.) Life, even the mundane, is spectacular when you have eyes like his.

My very best ideas are tiny footnotes in the extraordinary legacy left by this special man. These include the  “Memphis Model,” emulated by dozens of major healthcare systems all over the nation, the “religious health assets” which paved the way for the WHO into activating faith networks all over the world and, of course, Leading Causes of Life, which I spoke about the first time at a Conference in Milwaukee to which the former President sent me to in his place (imagine their disappointment!). Carter created a physical and a mental space where it seems reasonable to imagine things that had never happened and then try to do them. And then keep trying, maybe even for 98 years.

After decades of one unbearably oafish Christian after another desecrating the very idea of faith, he quietly gave his life as a long gift to his church and all people of faith: an example of sacred dignity and integrity.  Not that the oafs understood. When he was gracious enough to invite evangelical leaders to the White House, more than one publicly prayed that he would become a better Christian. However, when my secular friends think that anyone who tries to believe is foolish, I could always say, “No, I mean people like Jimmy Carter.” They had to nod.

He had little patience with superficial piety. Once he had all of us Directors reflect on whether Newt Gingrich had any good ideas in his “Contract with America.” I choked and noted this was not likely to go down well with the faith people who actually do the work on the streets. He snapped that the churches rarely break a sweat, while the government at least knows where all the poor live.

In the very first article for the Interfaith Health Program he wrote, “We must make the choices that lead toward life.” And who is accountable for those choices? Not just improbable Presidents, but hundreds of thousands of improbable grown-ups doing the right thing when people notice and when they don’t.

This is true, even unto the very end of their days, when the right thing means releasing into the love of one’s family, instead of the normal vain and fruitless medicalized struggle against death. James Carter was proud, but never vain, often overlooked, but few lives bore so much fruit. I hope his last thought was satisfaction of a life well lived.

Pitchfork 1

A pitchfork is perfect for moving hay, compost, and the messy ensemble of cow poo that accumulates in barns. And the five sharp tines get attention by someone angry when the banker and landlord are insufferably arrogant. The wealthy are usually surprised. I know I was surprised last month as my party and candidates were so rudely put aside in favor of….well, you know.

“Reasons You Need a Pitchfork” from the Minnesota Horticultural Society (not the book Frankenstein)

Once anger flames, rationality has nothing to do with what happens next. Righteous anger can open the way for cynics with very ugly intentions to do things nobody voted for. Who voted for polio, measles, coat-hanger abortions and run-amok preachers? This is why Project 2025 was buried during the election and whipped out immediately after. This is why North Carolina losers used anger’s shadow to change the job descriptions of those that won. Ugly. And predictable.

Even when it is obvious that anger is being used by opportunistic frauds; it does not mean the anger will subside. Or that it will suddently become smart and be redirected toward the billionaire blowhards that actually do deserve a pitchfork.

What to do? Don’t argue with angry people, especially by telling them they are foolish to trust such obvious frauds. They don’t want instruction, especially from people like me they see as part of the “elite” that reminds them of their stolen dignity every time they go to the grocery store, bank, school or hospital.

Let’s talk about the hospital part of the conflagration. That’s the one I know best, having been inside the beast for nearly twenty years until recently. Why would anyone be angry at a hospital since everyone is going to need one? Normal people (the angry ones) understand that the shiny medical castles are only partly there for them. Hospitals are one visible knot in a complicated web of privileged guilds and professions including, executives, bankers, doctors, nurses, suppliers, technology companies, insurance companies, pharma, ambulance drivers, all seamlessly integrated into the government and universities. All that feels quite personal one is  vulnerable and in pain with no possibility of negotiating anything.

All parts of the system—cruelly called “health”—seem to be more and more obviously about money—theirs—and less and less about those who need their “care” (the services people cannot not buy).  This system costs roughly a trillion dollars a year and yet wants more. It drives every in the economy cost higher while whining all the time that it isn’t enough. Ironically, many of these hospitals (including my own) are not supposed to be “for profit,” so they do not pay taxes. All of this is painful at the family level only beginning with insurance and the huge indecipherable bills that result when you actually need the services. It makes the economy sick as every business thinks constantly about how to offload these costs onto vulnerable gig-workers or by shifting everything possible across the border or replacing humans with robots.

This interwoven system is the leading cause of bankruptcy in most states (for medical debt under $5,000). So who needs democracy when I can’t take my kid to the doctor without risking eviction or having my car towed away?

Pitchfork.

It is ironic that this web of privilege thinks it (we) are protected by our non-profit status and science. Who could quarrel with charitable scientists?  Well, we don’t look charitable and we don’t look scientific. Offensive executive and physician pay levels pulls one fig leaf away. The other fig leaf—science—disappears as it is always used to justify another shinier and more expensive building. What about the low-cost and low-tech science of prevention that makes at least some of those buildings unnecessary? Silence. What about the science supporting investment in education, faith and good stable jobs? Maybe later. What about the science linking democracy and neighborhood stability to health? Sounds woke. Everybody in healthcare knows that science, but we build bigger buildings instead of following it. So the angry people give us a Secretary of Health who doesn’t believe in science either.

The whirlwind is partly our fault. Those of us who do believe in that science and do believe in the non-profit mission should have been far more aggressive in pushing the medical industrial complex to act appropriately. Instead, we prodded gently and waited for a better time.

It’s not too late. Dr. King said it is always the right time to do right. It is crucial that we not be pulled into defending the indefensible. Not everything is worth defending from president Musk who will be losing support pretty quickly on his own. And as you pull apart the data we should notice that some of those most angry are people friends.  This might be a good time to lend some intelligence by helping aim the energy where it can do some good, instead of bad.

For instance. I offer two minor tweaks to non-profit health policy everyone should agree with:

First, hospitals’ non-profit tax status now rests on superficial “community benefit” rules. It should never have been allowed to be superficial. Those rules have little to do with the science of prevention and social determinants because implementation plans have no accountability to local public health (except in Ohio which is a story for another blog).

  • Give the local public health department authority to approve the hospital’s community benefit implementation plan so that it aligns with actual public health science and local government. This has been discussed quietly at the National Academies of Science for years. But religious hospital lobbyists fought it (!?!?!?!) It  would have been better to make the hospitals uncomfortable, Than having the voters angry. Do it now.

Second, hospitals are huge financial enterprises which often make as much money from their investments as from selling expensive medical procedures. It is likely they have about a trillion in their basement, which nobody ever thought possible. But there it is; they are banks that also offer medical services. Legally, their investments are invisible to their non-profit status; they aren’t required to report how much investments they have. They are usually required by their bankers to have between 100-300 “days of cash on hand”. Take your local hospital’s annual revenue and do the arithmetic. Unlike hospitals, your local banks are required by the Federal Reserve to invest some of their corpus in places impacted by their historical racism. Why not hospitals, which have done the same in the past (usually to the identical neighborhoods)?

  • Add transparency to the legal “community benefit” form. And give the Federal Reserve responsibility to oversee non-profit investments instead of the IRS.

Dumb is going to happen. But the chaos breaks open some room to do some good things, too. This is a great time to speak very specifically about how our public goods can be available to everyone no matter how they voted, prayed, worked, worried or shouted. If we use the pitchfork to shovel out the barn, nobody needs it as a weapon.

Good idea

Good ideas help us adapt to reality. The Statue of Liberty is one.

We bottled 8 gallons of mead last night, which seems more relevant to our times than honey for tea. The bees must wonder if it was all worth their trouble. One bee gathers enough nectar for 1/12th of a teaspoon of honey over their whole life, flying 500 miles, visiting tens of thousands of flowers. This is about the output (and the itinerary!) of the average writer, professor or pastor. They contribute to the strength of the human hive in tiny increments that are even less predictable than the bee which probably didn’t intend the mead. The human system lives on ideas that prove to be good and bad over time as they help or hurt our need to adapt to reality It is hard to tell with ideas.

“When a complex system is far from equilibrium, small islands of coherence in a sea of chaos have the capacity to shift the entire system to a higher order.” The internet attributes this to Ilya Prigogine, but it is hard to tell where even the best ideas originate. Of course, every writer thinks their 1/12th teaspoon of typing is that crucial small island of coherence as soon as it is typed. It actually takes a couple decades for a thought to stick and then another dozen for the speck of coherence to join many others to make even a small island.

Not sure the bees envisioned the need for 8 gallons of mead. I think they would be okay, if we share.

One of my own idea-specks was the about strengths of congregations in Deeply Woven Roots written at The Carter Center in 1997. It was useful enough to be used in many seminaries. Twenty one years later they found their way into the National Academies of Sciences workshop on how those strengths contribute to community health. We’ll see if that small island of coherence survives the cultural storm tides now raging.

A slight plurality of citizens turned the ideas in their gut to elect someone certain to knock our systems even further from equilibrium than they ever. Some of them like Bannon think they are the new island but I think not. We’ll see. The week after the voting I happened to be on an actual island built on granite and ideas now called New York. TC and I were tending to the grandsons as their mom gave birth to yet another play this one about the ultimate New Yorker, Billie Jean King. Lauren rarely passes an unscripted morning, so we trundled through the streets of the Lower East Side to the Tenement Museum—a living archive of the many waves of immigrants that became us.

I picked up a copy of The Island at the Center of the World, by Russell Shorto, which flipped my history-major mind upside down. He dives deeply into the revolutionary scholarship of Charles Gehring who translated thousands of pages of 17th century Dutch records of the New Netherlands to find us—the Americans.  His main point buried under two centuries of self-serving English mythology is that New York is New Amsterdam and our core culture and politics Dutch, not English. The English colonial built their “city on a hill” filled with the spit and venom of Christian nationalism. The Dutch had a different idea: us.

The Dutch didn’t mean to plant us; but they put a trading depot on the tip of Manathans (Manhattan) in 1608. The company director launched a stupid war against the Native Americans in spite of the counsel of the settlers which set off a battle of ideas still underway. One of the settlers, Adriaen Van der Donk, was the the sole lawyer who wrote their petition to the West Indian Company and eventually carried the battle right to Amsterdam. He was deeply influenced by the new Dutch idea of “natural law”—which overruled royalty and the rich. They also adopted the odd Dutch idea of religious and ethnic tolerance—which was the absolute opposite of the English and pretty much everyone else in the world, at the time. “Something was happening that was quite unlike the unfolding of society at the two English colonies to their north, where rigid Puritans…and even more rigid Pilgrims maintained, in their wide-brimmed piety, monocultures in the wild.” (p61). Bannon and his tribe know the narrow-minded city they mean to build on our hill—Plymouth, not Amsterdam. It was bad history and worse two centuries later.

Brooklyn has always thrived because of its welcome sign (over the right in red).

This Dutch embrace of human complexity is the foundation of what became the United States. That idea has always seemed vulnerable to fear baiting. It is the taproot that feeds our radically adaptive capacity to find the next new way which we need urgently. The test of our adaptive ideas is not on TV but in the real reality of our ecosystem, the slowing of the Gulf Stream and a 3 foot rise of New York Harbor. We need the best of intelligence, spirit, gut and grit, not just the fragile brittle ideas of Christian nationalism. It’s really Puritan nationalism which failed, as all brittle ideas do. The Dutch one thrived and we will, too.

A good idea doesn’t stay on an island. The revolutionary Dutch ended up infecting the English, Welsh, Scots and South Africans just as they did New Amsterdam. There are a few pretend kings around today tolerated for amusement like poodles. The rich who admire their pomp have missed the tale of time confusing work and show.

When TC and I are in Glasgow or Cape Town people wonder what happened to the Americans. They ask “when did you become mean and narrow?” I didn’t know what to say, as I barely recognized my people.

Adriaen Van der Donk  knew that there is no such thing as an American, Dutch, Scot, or African. We live on the same tiny blue island of coherence built on ideas that proved worthy of their times and may yet again.