Satyagraha

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The Moral Wrongs of Obamacare. Part 1. Entrenching the Medical-Industrial Compex

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I believe it is important to set down, in as methodical and systematic way as possible, the ways in which Obamacare is not only risky or potentially harmful, but actually something morally wrong.  Several times I’ve begun to write an article that does this, and each time had to quit as the task became simply overwhelming in scope.  It is a big issue, a huge one.  We’re talking about something that may constitute, both in what it is and what it may lead to, a fundamental restructuring of the system of American government and the nature of our society.  Yet, as many times as I give up and put the project aside, I feel dissatisfied for having done so and return to it again.

In part, what I face is what every person faces when, in a debate, they encounter the big lie.  The big lie is the tactic by which a party presents a falsehood so enormous, so outrageous, so utterly beyond the realm of plausibility, that it literally overwhelms the ability of the other party to refute it.  The opponent is simply flummoxed, bewildered by the sheer audacity.  The big lie changes the ground rules of a debate, transforming what should be an earnest attempt by two agents of good-will to find the truth, into something of bad-will.  The big lie is a power play, a trick, which seeks to win  by deceit and  subterfuge.

The big lie tactic therefore, is not used, or should not be, by decent people, either in debates between two people, or between groups of individuals in a social or political context.  However in the present case we are not debating an individual, nor groups of individuals.  We are ‘debating’ – in a broad sense of that term – a vast system, something intrinsically amoral.  It is a system like or analogous to the military-industrial complex, but something much greater; a system that includes our government, our political parties, Wall Street, multinational corporations, and our news and entertainment media.  Moreover, each of us is, to varying extents, consciously or unconsciously, part of this system.  Anyone who has a mutual fund or retirement plan with dividends linked to Wall Street profits, is, to some extent, part of this system.  This system is our opponent.  That it resorts to the big lie to sway public opinion is the least of our problems.

One reason the big lie tactic is so effective is that an opponent faced with the prospect of refuting it envisions how hard a task it will be, and simply gives up before trying.  Much as I might like to do that, I simply don’t see it at as an option.  The only alternative, therefore, is to try to make this daunting task more manageable by breaking into several smaller ones.  The present, then, will be the first of several installments dedicated to this.

Preliminary Remarks

Some preliminary remarks are in order.  First I wish the reader to know that I am most certainly committed to the principle of social justice – both in general, and in the particular matter of health care.  I *am* a health professional, and I chose that profession not to make money, but because helping people with health and psychological problems is in my nature.  It is my vocation (or, at least, one of my vocations).  In fact, it is precisely *because* I care about people’s health that I am opposed to Obamacare, which I see as ultimately harmful to public health. I have major political and economic concerns, also; but, frankly, I would be willing to overlook these were it not for the disastrous effects on public health.

Second, I should make clear that it is not Obamacare in particular that I am concerned about, but rather any attempt to place the healthcare system further under the management and direction of the federal government.  If a plan of universal health care administered at the level of local or county governments could be developed, I would have much less reason to object.  In any case, it is certainly not because the new plan is associated with President Obama that I object.  For me that is simply a term.

Third, I wish to clarify what I mean by “moral wrong.”  I mean this in the strictly technical sense of moral philosophy.  That is by “moral wrong” I mean (1) what is opposite or opposed to moral good; and (2) that which we therefore have a moral responsibility to prevent, change, or oppose.

Finally, it should be pointed out that I am not writing this out of any need or wish on my part to merely complain or criticize.  There is already too much emotionalism, antagonism, and partisan strife in society today.  I know better than to be part of that.  I am writing because I should.  I have many years’ experience in diverse facets of the health field, an insider’s perspective (including positions at
Duke University, Wake Forest University, and the RAND Corporation) and, it could honestly be said, a uniquely informed one.  Much as I might like to evade it, I have a civic responsibility to write about this.

These clarifications made, let’s proceed to the analysis.

Reason 1.  Industrial Medicine

The first and greatest reason why I see Obamacare as morally wrong is that it will consolidate and entrench the paradigm of modern industrial medicine in our society.

By consolidate I mean it will strengthen and make more prominent the model of industrial medicine, and those organizations and institutions that promote it, and it will drive out competing, non-industrial health paradigms.  By entrench I mean that, once consolidated, it will be extremely hard, almost impossible, at least for many years, to change that paradigm.  We will watch in anger and disgust as public health and healthcare deteriorate, and be powerless to change it.

By modern industrial medicine I mean the prevailing system by which medicine is practiced today, which emphasizes (1) domination of healthcare and policy by large corporations, (2) treatment rather than prevention; and (3) expensive rather than moderately or low-priced alternatives.

The modern paradigm of industrial medicine is inextricably linked with profit motivation.  The innovations in healthcare, the new products that emerge, are those which deliver the most profit to corporations.  The nature of the system is that there is every incentive to develop expensive, invasive interventions, and virtually none to produce less expensive and less invasive treatments.  The paradoxical nature of “health for profit” can be illustrated with a hypothetical example: if we had the technology to develop a pill that cured the common cold that cost .1 cent per dose, we wouldn’t do so.  There’d be no profit in it.  But if the same pill could be sold for $10, companies would be fighting tooth and nail to develop and market it.

Similarly, it is well within our technological ability to wipe out a global scourge like malaria; but this receives comparatively little attention, because it isn’t seen as profitable.  I don’t know the actual statistics, but wouldn’t surprise me if more money is spent in the US developing new versions of Viagra and Cialis than goes into anti-malaria research.

Malaria doesn’t affect public health in the US, but obesity does.  So do the effects of alcohol and tobacco use.  The effects of this deadly trio alone probably account for at least half of all hospital admissions in the US.  We have virtually an unlimited ability to prevent these problems.  Anybody can stop smoking.  Most obesity can be prevented by intervening in childhood.  But, again, it’s much more profitable to treat the outcomes of these problems than to concentrate on prevention.

This problem affects the very foundation of medicine, the culture of it.  It affects how physicians, nurses, and medical researchers are trained.  It affects undergraduate education.  By the time someone gets an MD or a research PhD, they are fully indoctrinated in this model.  It becomes difficult to think of health in any other terms.

As long as the federal government stays out of healthcare there is some hope for change.  We always have the potential for new ideas and innovators to arise at the grass-roots level, to demonstrate new paradigms, which catch on and influence others.  But the danger of Obamacare is that, in centralizing healthcare delivery, planning, and policy to an unprecedented degree, and laying the foundation for still further centralization, we make it much harder for the grass-roots kind of innovation to occur.  Instead, will have a massively top-down model of dissemination of technology and practice.  Centralized boards will review and approve only certain medical procedures, and will pressure all players to use these methods.  Further, it is the large corporations who will have the most influence in choosing these methods and designing policies.  Naturally these policies will lean towards  practices and a basic philosophy of medicine that produces the most profits.

It is not just the actual dangers outlined above that concern me.  Beyond these is the fact that we will be placing literally our lives under the control of a vast, amoral, non-human system.  We have already seen, over the last 50 or 60 years, what happens when we place national defense in the hands of such a system: instead of peace, which is the natural desire of every human being, we have perpetual war.  Our collective policy becomes utterly dehumanized, and inimical to each individual.  I do not see how we can expect anything different when we hand over control of our health to the federal government and profit-driven corporate system.

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In Praise of Imitation Meat

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We take a brief departure from deeper subjects to devote a post to food.

Many years ago, when I was an undergrad at the University of Southern California, I had the pleasure of taking classes with Prof. Robert S. Ellwood.  Ellwood is an expert on the religious and philosophical movements that sprang up in Southern California during the 60’s; in his classes we visited various groups and cults around Los Angeles.  Some of these were rather strange, but one of the more ordinary outings involved visiting a yoga ashram in Santa Monica.  After the tour, students (being always hungry) availed themselves of a natural foods deli run by the ashram.  I had a “vegetarian chicken sandwich”, which replaced chicken with a textured soybean product.  I was amazed at how good it tasted — *exactly* like chicken.  At the time it seemed likely that within a few years everyone would be eating textured soy instead of meat.  While so far that hasn’t exactly happened, a few products have become so popular now that you can find them at your local supermarket.

In case you’ve tried meatless bacon or veggie-burgers, you’re in for a surprise, because the products mentioned below are in a completely different class.

I have gone for years at a stretch basically eating these products every day instead of meat.  I found that they kept me healthy and energetic, supplied plenty of protein, and never lost their taste appeal.

Here are some of my favorites.

bprod_turkeyFor a long time the best products available were deli slices by Yves veggie cuisine.  They’re still an excellent choice, and come in a variety of flavors; the ‘Meatless Turkey’ and ‘Meatless Smoked Chicken’ are, in my opinion, the best.  If you place these in a sandwich with the usual pickles, lettuce, and mustard, you’d be unable to tell that these aren’t meat. The only drawback is that lately prices have gone up.

p_deli_Hickory
Not to worry.  Tofurkey Deli Slices by Turtle Island Foods taste even better and cost less than Yves deli slices.  The best flavors are “Hickory Smoked” and “Oven Roasted” (though fewer stores carry the latter).  For a while I could only get these at Trader Joes, but now I see Safeway is carrying them.


The same company makes several varieties of imitation meat sausages.  These are a better bargain, since they cost the same as the deli slices, but supply two meals whereas a package of deli slices is about right for a single dinner entree (for an adult male).  Another benefit is that you can cook or heat the sausage products.

Again, the sausages come in a variety of flavors, though the Italian Sausage is all I’ve been able to find locally.

Bon appetit!

Written by John Uebersax

July 5, 2013 at 10:07 pm

The Soul-State Homology

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Thomas Cole (1836) - The Course of Empire.  Part 3: The Consummation of Empire

The soul-state homology posits a close connection between the individual soul and political organizations like a city and state. The relationship is stronger than a mere analogy. Rather, soul and state are seen as two expressions of a common archetype ; or that the state’s affairs are outward expressions or materializations of the soul’s affairs.  The phrase, ‘as within, so without’ explains the notion succinctly. Whatever happens within your own soul is paralleled by events and processes at the societal level.

Expressions of this homology can be found in various spiritual and philosophical traditions. In the West, its most elaborate and articulate presentation is found in Plato’s Republic. The same general idea can be found in various Eastern religions, and elsewhere.

If true, the homology has important practical implications.

First, the it implies a distinct view of how one thinks of oneself in relation to society.  Today especially, idealistic people take a keen interest in the world.  The avidly read the news, identify problems, and remain in a state of irritation or outrage.  This easily becomes a preoccupation approaching an obsession with the world’s affairs and problems.

The soul-state homology, however, suggests a different, more appropriate response: if society has problems and is unjust, these same problems must exist within the personal soul.  The soul, not society,  is our first concern: because the soul is closer to us, because we are uniquely responsible for its cultivation and integrity, and because it is immortal.  If something should preoccupy us, then, it should be concern about the integrity and welfare of our soul. It is by tending to the soul that we find happiness.

Moreover, to the extent that disorders in a nation are manifestations of disorders of soul, then by concentrating our attention on self-knowledge and self-improvement, we are more likely to effect positive changes in society.

An extension of this principle is that the main purpose of the material world is to teach us about our souls.  Thus, if we look to politics and see strife and discord between ‘left’ and ‘right’, the purpose of that is to alert us and teach us about some corresponding internal conflict.

A second implication of the homology concerns charity.   At some level, all other people — at least insofar as we perceive and experience them — are manifestations of ourselves.  And since the ideal of a perfect soul is one where all elements are harmoniously ordered and united in concern for the welfare of the entire self, so this must also be true of society.

It therefore becomes impossible or even absurd to deny the entitlement of any other person to ones love,  or to seek a social system that is not perfectly just and fair.

This, in turn, suggests that one function of society and social institutions is to supply an arena for action:  a field laboratory, as it were, for the soul’s alchemy.  By working to help other people or to make society more just, we simultaneously engage in a kind of healthy transformative medicine or magic in our souls.

So much, then, for theoretical speculation; ultimately, the soul-state homology is the kind of idea that will either appeal to one or not.  Either way, not much can be said here to make it appear more or less plausible than it already is.

Rather, let’s consider what the homology would imply today:

  1. Your soul is in crisis, and has been for about 10 years.
  2. War is threatening to break out between your inner United States and your inner Iran.
  3. An old order, based on money, materialism and social disparity is decaying.  A new order is emerging.
  4. You have some kind of internal government (with Executive, Legislative and Judicial branches).
  5. Your internal government has been co-opted by selfish special interests.
  6. A resistance movement has developed, but is currently poorly organized and lacks a clear vision of the future.
  7. You have the inner equivalent of news sources, but these supply false opinions, rather than true facts.   You have an inner Fox News, CNN, etc.
  8. Your inner citizens are polarized into two diametrically opposed camps: ‘progressives’ and ‘conservatives.’ Each camp demonizes and blames the other for everything wrong.
  9. This conflict is promoted by special interests, who use the inner government and inner news sources for this purpose.

We could go on, but this is enough to convey the general idea and sufficient food for thought.

What, then, would be the practical implications?  Clearly, if our individual souls are as troubled and messy as the outside world today, then we need to focus a great deal of attention on cleaning house!  The homology suggests we should redouble efforts toward self-improvement.   It also means that, while we can learn much from the world, we should retain the ability to be detached from it.  If we let worry over injustice or war upset our thinking, and place our minds under the control of fear and anger, rather than clear reason, then we are unable to focus attention on self-improvement, which is where our attention should be.

One further feature of the soul-state homology might encourage us. A standard tenet of religion is that, while one has a personal moral responsibility to apply oneself to self-improvement, ultimately improvement comes by grace from a Supreme Being.

This makes sense.  To the extent that we are fallen, or perhaps simply immature, we are not wise enough to direct our own spiritual and moral growth.  Help must come from a higher source.

Our attitude, then, must be one of humility.  While we intensely want to change for the better — if, for no other reason, than because our life is filled with frustration and unfulfilled hopes — this must not manifest itself as an egoistic striving, which only makes matters worse.  Our personal responsibility is not to change ourselves, as much as to choose to cooperate with grace for our self-improvement.

A similar humility, then, should govern our approach to the outside world.  We should believe that a higher power already has a benevolent plan; and we should trust and cooperate with this plan, chiefly by removing whatever obstacles we ourselves are presenting to its attainment.

The Occupy Movement, Agrarianism, and Land Reform

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ALTHOUGH the Occupy Movement is voicing many important social and economic concerns, one has thus far escaped attention:  land reform. Here we outline arguments in favor of its inclusion.

The well-known monetary disparity, such that 10% of Americans have 90% of the wealth, is paralleled in land ownership.  Media baron Ted Turner, for example, alone owns more than 2.2 million acres — an area larger than Delaware!

Moreover, the federal government owns vast expanses of habitable land, including military bases, National Forests, and land administered by the Bureau of Land Management (BLM).  In administering public lands, federal agencies, especially the BLM, are frequently accused of being overly responsive to corporate special interests.

We should consider the reorganization of land to produce a more just, happy and harmonious social system.  This may seem an unconventional and unrealistic proposal, but the truth is that reallocation of land to improve social justice has been done throughout history.

Legislation to allocate small parcels of public land to private homesteaders is easily accomplished.  Though no longer in force, the Homestead Act nevertheless established a precedent we may follow

With respect to vast private lands, we must first forestall the obvious objection:  that private parties have an inalienable right to retain lands to which they currently hold title.  This is definitely not so. Ownership of real estate — save, perhaps, that on which ones house and garden sit — is not a  natural (and hence inalienable) right.  We can allow that people have a natural right to own the property on which their domicile sits; or perhaps a few acres with which they ‘mingle their hands with the soil’ for sustenance.  But private ownership of larger parcels of land is an arbitrary social convention — something created by legislation, and removable by legislation.   Society may change such conventions according to the will of the majority and for good of society.  To be clear: this does not dispute that private parties have, in our society, a right to own land  — only that this is a legislated right, not a natural one.  That is, we could envision a society in which all the people got together and decided to disallow the owning of large tracts of land.  Certainly we can find indigenous societies where such is the case.

The idea of legally limiting public land ownership is not utterly foreign to European and American political theory.  Thomas Jefferson, for example, advocated the usufruct principle.  This holds that private citizens have a right to use the land and enjoy it’s fruits — but not to own it.  If you plant an orchard, you might own the apples, not the land itself.

Agrarianism

What concerns us is not just land redistribution, but, more broadly, effecting a transition to a more sustainable, natural, agrarian society.  Agrarianism, in a historical sense, can be defined as:  “the doctrine of an equal division of landed property and the advancement of agricultural groups.”  Today we may extend the definition by envisioning a migration of a certain number of modern urban dwellers to the country, where they may live sustainably in individual homesteads and/or intentional communities.

Sustainability would imply emphasis on self-sufficiency, including cultivating gardens or crops for food, use of renewable energy, water conservation, and like things.

Advantages of a More Agrarian Society

It seems self-evident that much would be gained by redistributing land to give more people the ability to leave the large cities and start self-sustaining, rural homesteads.  Certainly this is appealing to the sensibilities of many.  Specific advantages include these:

  • Gets  people out of crowded urban areas
    • reduces pollution
    • reduces stress, anxiety, and confusion associated with modern urban life
    • reduces water and energy problems
  • Eliminates commuting lifestyle
  • Healthy country living and natural food would promote good health and reduce health-care costs for society.
  • People can live in harmony with nature: the earth is made for man, and man for the earth.
  • 5000 homesteads = 5000 experiments in sustainable living and crop innovation
  • With the option to leave and migrate to the country, urban workers gain better bargaining position; can demand better wages and working conditions
  • Agrarian happiness doesn’t require a $100k college education
  • Committed individuals living on land can help preserve it (stewardship)

The last point is important because it counters the objection that National Forests or large conservancy land tracts should be left free from human habitation.  Responsible people can live within such areas in ways that enhance, not interfere with forest and wildlife preservation.

Feasibility

Is redistribution of land possible, or merely a pipe-dream?

It’s important here to refer to American history, in which a strong current of agrarianism has always operated. Indeed, the history of American economic ideology can be seen as a dynamic tension-of-opposites between agrarianism and commercialism.

Nowhere is this tension more clearly illustrated than in the opposing visions of Thomas Jefferson and Alexander Hamilton.  Jefferson, the Virginian farmer, wanted the country to follow an agrarian path.  He hated cities, in fact, and considered them breeding grounds for vice and unhappiness.  He believed that a nation of independent, citizen-farmers was the best way to achieve just and stable democracy.

In a draft constitution for Virginia, Jefferson proposed: “Every person of full age neither owning nor having owned 50 acres of land, shall be entitled to an appropriation of 50 acres”.  This proposal did not eventuate, but Jefferson did succeed in abolishing primogeniture laws in Virginia. Primogeniture is the custom by which all land in a family is inherited by the oldest son; abolishing primogeniture had the effect of, over several generations, breaking down large land tracts and distributing land ownership more fairly.

Those who labour in the earth are the chosen people of God, if ever he had a chosen people, whose breasts he has made his peculiar deposit for substantial and genuine virtue. It is the focus in which he keeps alive that sacred fire, which otherwise might escape from the face of the earth. Corruption of morals in the mass of cultivators is a phaenomenon of which no age nor nation has furnished an example…. Dependance begets subservience and venality, suffocates the germ of virtue, and prepares fit tools for the designs of ambition…. While we have land to labour then, let us never wish to see our citizens occupied at a workbench, or twirling a distaff…. The mobs of great cities add just so much to the support of pure government, as sores do to the strenth of the human body.

Source:  Thomas Jefferson, Notes on the State of Virginia, Query 19, 1787.

Jefferson was not the only advocate of agrarianism.  John Taylor of Caroline, for example — the American foil to free marketer Adam Smith — supplied a philosophical and economic foundation for agrarian principles.

In contrast, Alexander Hamilton (who, incidentally, was one of Wall Street’s founders), believed America must follow the path of commerce and industrialization; for this, centralized banking and a financial infrastructure to promote corporate investment was needed.   Hamilton’s party won the day, setting in motion a series of reactions and counter-reactions that have continued since.

Acquisition of new territory (e.g., the Louisiana Purchase), along with growing unemployment and immigration in cities, produced a gradual campaign of political agitation for land access.  A wave of agrarian fervor swept the nation during the presidency of Andrew Jackson.  And a few years later, a new phase of agrarian populism began, associated with such names as Horace Greeley, George Henry Evans, Henry George, and George Julian.

The movement gained steady ground.  In 1848, Martin Van Buren ran for president as the nominee of a newly formed Free Soil party.  Pamphlets circulated, and the phrase “Vote Yourself a Farm!” became a popular slogan.  Extracts from one such pamphlet are revealing:

Are you tired of slavery — of drudging for others — of poverty and its attendant miseries? Then, Vote yourself a farm.

Are you endowed with reason? Then you must know that your right to life hereby includes the right to a place to live in — the right to a home. Assert this right, so long denied mankind by feudal robbers and their attorneys. Vote yourself a farm.

Are you a man? Then assert the sacred rights of man — especially your right to stand upon God’s earth, and to till it for your own profit. Vote yourself a farm.

Would you free your country, and the sons of toil everywhere, from the heartless, irresponsible mastery of the aristocracy of avarice? Would you disarm this aristocracy of its chief weapon, the fearful power of banishment from God’s earth? Then join with your neighbors to form a true American party, having for its guidance the principles of the American revolution, and whose chief measures shall be — 1. To limit the quantity of land that any one man may henceforth monopolize or inherit; and 2. To make the public lands free to actual settlers only, each having the right to sell his improvements to any man not possessed of other land. (Reference: 1846 handbill.)

This activity culminated with the Homestead Act of 1862. Under the Act, an applicant could receive up to 160 acres of undeveloped public land. Requirements were minimal:  applicants needed only (1) to be at least 21 years old, (2) to live on the land for five years, and (3) to show evidence of having ‘made improvements’ to the land.

Despite problems, including widespread fraud by middle-men brokers (and national theft of Native American lands), the Act was, to judge by the number of families who participated, a  spectacular success.  Another testimony to the program’s success was its longevity: the Act stayed in effect for over a century: until 1976 in the lower 48 states, and 1986 in Alaska.

Prospects

This brings us to the present.  Clearly the tradition of agrarian reform is long and deep in American history.  It is eminently practical, and reflects the simple truth that it makes no sense to crowd people in cities when there are millions of acres of habitable land available.  It is, arguably, simply unnatural.  In 1850, 85% of Americans lived outside of cities.  By 1900, 60% of the population lived rurally.  Today the rate is perhaps 20%.  Perhaps we should reverse this trend.

This doesn’t mean scrapping cities.  Logically, what seems best is a balance between commerce and agrarianism, urban and rural living.  It seems, though, that we are today at a crest of a radically commercial phase, with urban areas falling apart and becoming increasingly aversive. A convergence of social and environmental problems suggests it may be time to shift towards agrarianism to restore balance.

Reading

Clawson, Marion. Uncle Sam’s Acres. Dodd, Mead, 1951 (repr. Greenwood Press, 1970). ISBN: 0837133564.

Commons, John R. (ed.) A Documentary History of American Industrial Society: Volume 7 and Volume 8. Labor movement (1840 – 1860, Parts 1 and 2). Cleveland, Ohio: The Arthur H. Clark Co., 1910.

Dick, Everett. The Lure of the Land: A Social History of the Public Lands. University of Nebraska Press, 1970.

Gates, Paul W. The Jeffersonian Dream: Studies in the History of American Land Policy and Development. University of New Mexico Press, 1996. ISBN: 0826316999.

Landau, Elaine. The Homestead Act (children’s book). Children’s Press, 2006. ISBN: 0516258702.

Parrington, Vernon Louis. Main Currents in American Thought (3 Volumes). New York: Harcourt, Brace, 1927 (repr. 1987). ISBN: 0806120819. Volume 1, Volume 2, Volume 3

Porterfield, Jason. The Homestead Act of 1862: A Primary Source History. Rosen Publishing Group, 2004. ISBN: 1404201785.

Robbins, Roy M. Our Landed Heritage: The Public Domain, 1776-1936. Peter Smith, 1950. ISBN: 0803208669.

Smith, Henry Nash. Virgin Land: The American West As Symbol and Myth. Harvard, 1950.

Thompson, Paul B.  The Agrarian Vision: Sustainability and Environmental Ethics. University of Kentucky, 2010. ISBN: 0813125871.

Wiltse, Charles Maurice. The Jeffersonian Tradition in American Democracy. Hill & Wang, 1935 (repr. 1960). ISBN: 0809000288.

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