Night Light

Is Sarah Palin the First Post-Modern Politician?

Let's start with a multiple-choice question: Which answer is correct?

1. Sarah Palin's resignation less than two/thirds of the way through her term as governor is a violation of her compact with the voters, a flaky act that destroys her credibility as a serious politician.
2. Her resignation was a brilliant tactical move that makes her the de facto frontrunner for the GOP nomination.
3. Who gives a @#%$ @#$ about your traditional political conventions?

If you answered #1 or #2 you missed the point. Sarah Palin is not part of your frame of reference. She isn't participating in the worldview you share with your allies and opponents alike. If Obama is the Superego of American politics, the externalization of our idealized sense of who we are, Palin is its Id. She's the repository and expression of a deep-seated psychic urge to blow up the political world as we've come to understand it. She's the dark secret behind Door #3, the conjured vision of a deep-seated lurking anger that is greater than her own.

The "goshes" and "gollies" of the outgoing Alaska governor are a thin veneer for deep-seated rage, a spiderweb of resentment that captures every perceived insult and slight. That's a powerful motivator for a political career. It could resonate with a lot of voters, too, if their possibilities seem to shrink and the future remains shrouded in fear.

"We're not retreating," Sarah Palin quoted Gen. MacArthur as saying, "we're advancing in another direction." Anyone who doesn't recognize the essential truth behind that statement runs the risk of not only misunderstanding Palin, but of failing to foresee the threat she could represent. And those who judge her performance on traditional lines will overlook her genuine talent.

Palin may be as erratic as many people say. I wasn't the only observer who noted a hopped up, free-associating, almost amphetamine-like quality to the cadence of her resignation speech. But another way to view her speech is as the latest example of a style that could, in the end, prove revolutionary. Call it "post-modern" politics.

Look up postmodernism (or "PoMo," as some call it) and you'll get a broad range of definitions. It's almost like the Supreme Court definition of obscenity: You can't define it, but you know it when you see it. It was born of the sense that there are no underlying principles or conventions we can trust. It involves identifying, naming, and ultimately shattering the rules under which we've all been operating. It's related to the theater concept of "breaking the proscenium" or "knocking down the fourth wall," acknowledging that some of us are actors and some are spectators in what is, after all, only a performance.

Coherence? That's so yesterday.

It was very postmodern of Palin to characterize her resignation - an outrageous act by any reasonable standard - as a principled refusal to "go with the flow." Her vision of politics is so profoundly radical that even performing the duties of office becomes unimportant. The job you sought is no longer the point. It's all about the performance. It's politics as Conceptual Art.

Of all the Postmodernist movements, Palin most closely resembles the punk-rockers of the 1970's, especially the ones who insisted that having musical skill reflected an outmoded attachment to obsolete forms. Emotion was enough, and the dominant emotion was fury. A quick glance through Media Matters will illustrate the many forms of fury that are now bubbling on the Right.

Some say that there are more Palin scandals coming, although there's no evidence for that. In any case, scandals don't matter that much to a Postmodernist Politician. "Oh, sure," the PoMo Pol can say, "they care about those things, because that's how they've always operated. It's what they do." When they attack her she can kick through the Fourth Wall and claim it's all part of the show.

Politicians have always done that, to a certain extent. They've always claimed that they're not part of the system, and handled bad publicity by implicating their critics and the press. But Palin takes it to a new level, to the level of art form. It could be argued that the bipartisan outrage now being expressed toward her in Washington is directly proportional to the revolutionary nature of her words.

Sure, she's a long shot for President, but there are scenarios where she could win. Picture this: It's 2011 and unemployment is still high. The Democrats have been too cautious with their economic remedies, so lenders have pocketed bailout money without loosening credit for the average consumer. People are confused and frightened. Along comes Sarah with her Postmodernist neo-punk message: "The system is broken! Democrats, Republicans, all those guys in Washington have let you down. Let's really change things!" One or two moderate gestures to placate swing voters, and she could be the 45th President.

Odds are she'll fade away the way most pundits are predicting. But there's a chance - call it one in five - that she could seize the moment. She seems ridiculous to most Washington insiders right now, but truly transformative figures often seem ridiculous ... until they change the world. Democrats who dismiss Palin do so at their own peril, particularly considering the risks involved.

It probably won't work - but it could. Think about it: She'd be the most revolutionary force to hit her profession since Huey Long. Or Johnny Rotten. And the country would never, ever be the same.

You betcha.

On Health Reform, George F. Will Just Threw a Spitball

One could say of George Will what James Russell Lowell wrote of Emerson: "His eye for a fine, telling phrase that will carry true is like that of a backwoodsman for a rifle." Which is to say, the guy can write. But anyone who reads Will's latest screed on health reform with a critical eye might also be inclined to quote Lowell's observation about an Emerson lecture:

"It was as if, after vainly trying to get his paragraphs into sequence and order, he had at last tried the desperate expedient of shuffling them."

Indeed. Will's column is a mashup of disparate declamations. As is often his style, he offers quotes that are very enjoyable but only loosely related to the topic at hand. We also see the selective use of survey information and some standard-issue conservative lamentation that we have yet to unleash the power of the free market to fix health reform. (Will someone please provide some working examples of a "health care free market"?)

And baseball references, of course. If it's a George Will piece there has to be a baseball reference.

To the extent that the piece has a structure, it is built around a statement from Elizabeth (Betsy) McCaughey saying that the percentage of family income Americans spend on healthcare is essentially no greater now that it was in 1960. No supporting information or source material is offered for Ms. McCaughey's statement. Given her well-documented history of making false statements about health-related issues, it is sadly impossible to take this statement at face value. (See here for more information. Mickey Kaus, himself no liberal, wrote that "she completely distorted the debate on the biggest public policy issue of 1994.")

What's more, the point isn't all that relevant even if it's true. Medical conditions account for two-thirds of American bankruptcies today. Perhaps people died from lack of medical care at a greater rate in 1960, which limited their out-of-pocket expenditure. Or maybe people suffered just as much health-related bankruptcy back then as they do now.

Will goes on to say: "... (A)s societies become richer, they spend more on health care -- and symphonies, universities, museums, etc." This statement would be hard to substantiate, especially in the prosperous nations of Western Europe that spend far less on health care than we do. And Americans struggling to stay solvent while paying for needed care might rightfully take offense at the Marie Antoinette-ish undertone of the sentence. It's as if medical treatment were a whimsical indulgence of the prosperous, like attending the gala premiere of a new opera season.

"It is also because health care is increasingly competent," Will adds. But competent for whom? Isn't the ability to spend money on what works an essential aspect of competence? Yet conservatives continue to oppose studies that demonstrate what works and what doesn't. We spend far more on health care than other industrialized nations have poorer results, as measured by public health statistics. That does not meet any commonly-held definition of "competence."

And why compare us to the US circa 1960, anyway? In those pre-Medicare days older Americans and their families often went broke trying to meet basic medical needs. That could certainly account for the relative lack of change in those cost percentages over the past 50 years. It would make more sense to compare us to those countries that have a rational health system today - but that's not a comparison Mr. Will appears ready to make.

Ms. McCaughey, for her part, is now hard at work trying to undermine health reform by playing what can be described as a "six degrees of policy separation" game. In this piece, for example, she takes the Kennedy bill's "medical home" provision and suggests that it vaguely resembles "the unpopular controls HMOs imposed two decades ago" penalizing doctors for providing or authorizing care that was not approved by the plan. That provision is not present in the Kennedy bill nor, upon careful reading, does she claim that it is. But it looks like something that looks like something that looks like that provision ... or so she says, leading to guilt-by-inferential-association.

I don't mind a good healthy challenge in the marketplace of ideas. It would be valuable and even enjoyable to engage in a pickup game with our conservative colleagues over the merits of health reform. But George Will is throwing spitballs, layering extraneous matter - effluvia, you might say - onto his anti-reform pitch. Betsy McCaughey spits on the beanbag and George Will throws it.

Will and McCaughey have been guilty of this unsportsmanlike conduct before. As James Fallows documented so thoroughly, this is a routine they perfected in 1994 (see excerpt below).

To his credit, Will acknowledges that conservatives should stop arguing that reform will lead to health care "rationing," since - as he correctly observes - all goods and services (he uses the word "product," but I don't think that's applicable to healthcare) are already rationed "by price or by politics." Well said. As always, when Will stops throwing spitballs and gets to his real point he's well worth reading. He prefers rationing that is based on price because, he says, "prices produce a rational allocation of scarce resources."

Will should stick with that point and elaborate on it, since it's the crux of his (and other conservatives') argument against health reform. I think that's precisely the wrong way to allocate health care resources, but that's a debate worth having. In fact, it's the debate we should be having.

Instead, Will is too easily tempted to adopt a conservative strategy that appears to come from an old playbook: Toss out false statements or distracting statistics and hope that, as in 1994, the press starts repeating them as if they were either true or relevant.

The astute reader will observe that I've adopted some of Will's literary mannerisms in the writing of this piece. Consider it an homage to a master essayist who, should he so choose, could be a much better advocate for his own political philosophy. Instead he offers us, to use Russell's words, "a chaos full of shooting stars."

The problem with spitballs, as any baseball lover knows, is that the pitcher has a hard time controlling them. Will does neither his readers nor himself a service by continuing to throw them.

_______________________

(From Fallows)

The article's working premise was that McCaughey, with no ax to grind and no preconceptions about health care, sat down for a careful reading of the whole Clinton bill. Appalled at the hidden provisions she found, she felt it her duty to warn people about what the bill might mean. The title of her article was "No Exit," and the message was that Bill and Hillary Clinton had proposed a system that would lock people in to government-run care. "The law will prevent you from going outside the system to buy basic health coverage you think is better," McCaughey wrote in the first paragraph. "The doctor can be paid only by the plan, not by you."

George Will immediately picked up this warning, writing in Newsweek that "it would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem 'necessary.'" The "doctors in jail" concept soon turned up on talk shows and was echoed for the rest of the year.

These claims, McCaughey's and Will's, were simply false. McCaughey's pose of impartiality was undermined by her campaign as the Republican nominee for lieutenant governor of New York soon after her article was published. I was less impressed with her scholarly precision after I compared her article with the text of the Clinton bill ... In claiming that the bill would make it impossible to go outside the health plan or pay doctors on one's own, she had apparently skipped past practically the first provision of the bill (Sec. 1003), which said,

"Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services."

(cross-posted at The Huffington Post)

global reach

"Forever the King," from the newspaper "Hoy (Today)," Dominican Republic (via Huffington Post)

Global Pop: Finding Michael Jackson in Albania

Here's a small Michael Jackson story to place upon on the pile, one that illustrates the global reach and power of pop music.

Albania existed in totalitarian isolation from the rest of Europe for four decades. It broke with the Soviet Union during Kruschev's de-Stalinization reforms because its dictator, Enver Hoxha, liked Stalinism. Its only ally from that point forward was Maoist China, but even that relationship was severed after the fall of the Gang of Four and the death of Mao. It was illegal to even own a car there.

Like North Korea today, Albani was a closed country that allowed almost no foreigners in and let even fewer citizens out. Even listening to foreign media broadcasts was a crime. I arrived there in 1991 as one of the first wave of outside consultants sent there to help with reforms. People had already made improvised "cars" by welding windows onto the fronts of tractors. Saudi Arabian Wahhabi evangelists had already installed a loudspeaker and a muezzin at the local mosque, which had been unused for forty years. Although the government sent me to help with health care financing, it quickly became clear that they needed food and medical supplies far more urgently than they needed economic restructuring.

My host and translator was a warm and gracious physician who had learned his English by covertly listening to the BBC. He had been turned in once by a neighbor who heard the sound of English-language radio, and had spent a terrified day at secret police headquarters before being set free with a warning. The day I left for home I asked him what I could send him as a gift.

"Connie Francis records," he said. (Connie Francis, for those of you who don't remember, was a star from the pre-Beatles era whose big hits were "Lipstick On Your Collar" and "Where the Boys Are." )

Pop music's traces were faintly discernable elsewhere in the garrison country, too. When we walked into Tirana's only 'restaurant' - a barely-converted garage filled with card tables, folding chairs, and aid workers from everywhere in the world - Garth Brooks' voice was coming out of a boom box. And at a high-level diplomatic meeting some Albanians spoke of their country's best-known folk singer, saying that public use of English was so heavily forbidden that he had been given two years in prison for singing "Let It Be" at a folk festival.

"The last guy I heard singing it back home," I told them, "should have gotten five." They laughed - fortunately.

And when we went to see some remote medical clinics in the Sar Mountains, our car was stopped in remote villages by crowds curious to see a Westerner face-to-face. On one rock-filled road we were waved down by a gang of slightly-scary teenagers with dirty faces and rocks in their hands. When they saw me, the tallest boy - evidently the leader - reached into his pocket, pulled out a single glove, and put it on.   He tossed back the lock of hair that fell across his forehead, in a gesture common to tough kids everywhere.  There was a moment of silence.  Then ...

"Michael Jackson!" they screamed. "Michael Jackson!" The doctor translated for me as they kept talking. "They want to know if you know Michael," he said. I didn't. They let us pass.

I won't claim that Michael Jackson overthrew Albanian Communism. He never met Enver Hoxha in epic battle, although that picture on the cover of the History album made it look as if he had. I was in Prague when Vaclav Havel tried to make Frank Zappa a minister in his government, but I wouldn't say pop music overthrew Communism there, either. I'll say this, though: it didn't hurt.

Was Michael Jackson the first global pop star? Crowds in India mourned the death of country crooner Jim Reeves in 1964. And it took me a while to realize that the singer on an old African record called "Chimiraja," accompanied only by a loosely tuned guitar and someone banging on a Coke bottle, was actually singing about "Jimmie Rodgers," the "Singing Brakeman" of country music.

Jimmie Rodgers died in 1933.

Popular music has always been global. But Michael Jackson became a worldwide star in the first era to have satellite communications. People didn't just hear his music. They saw him. They experienced him - or at least an aspect of him. Michael Jackson broke barriers of race, language, and nationality. His private behavior had a strong impact on some people. But his music reached billions, and it did some good in the world.

In whatever court he may yet face, even if it's only the court of public opinion, surely that counts for something.

Iran: It's Not About You, People

Some Westerners have been driving themselves into a narcissistic frenzy over events in Iran, blind to the contradictions in their own behavior.  John McCain's outrage over the tragic death of "Neda,"  a young woman who might have died under  American bombs in his alternate reality, is merely one case in point.  Suddenly the "clash of civilizations" crowd is finding new enthusiasm for an Islamist political party.

The President's remarks today went as far as they could wisely go, but the opportunists and fantasists will both say it wasn't enough.

Why are the people who've been insisting there's a monolithic evil called "Islamofascism" suddenly backing one Iranian faction over another? As Prime Minister in the early days of the Islamic Republic , Mir-Hossein Mousavi helped orchestrate anti-American acts in Lebanon. Yet the crowd that's been demonizing the entire Muslim world is suddenly wearing green, which was adopted by Mousavi's party because it is the color of Islam. What's behind this seeming change of heart?

The behavior of pols like Lindsay Graham comes off as political expediency of the most cynical kind. They exploit American support for the brave demonstrators of Teheran by insisting the President isn't doing enough, knowing full well that to express more support than he has done would be counterproductive. It's the unattractive face of politics as usual.

For others, like McCain, it seems more genuine but no less misguided. He perceives no inconsistency as he careens from "bomb Iran" 'jokes' to eulogies for those he might have bombed. He, like many Americans, is caught up in the emotions of the moment. And who can fail to be moved by the courage of the Iranian resistance? But let's not pretend that this moment is about us.

For some of us, people only become human and real when they give us an opportunity to play out our own ambitions or fantasies. That covers public figures like McCain. But it also includes bloggers who think they're commando superheroes because they're coloring their websites green and cut-and-pasting Tweets from Teheran.

To the virtual barricades, comrades!

That's exactly the kind of fantasy projection that allowed people to enthusiastically support an invasion of Iraq, against all reason. At last! A war of our own! A cause we can support, a flag we can wave, a battle that will make us the "greatest generation"!

But we're dealing with human beings, not figurines to be moved here and there on the maps of our own egos. Overzealous talk from narcissistic foreigners can get people killed. And Americans aren't the only offenders. Bernard-Henri Lévy's unsubstantiated assertion that this uprising is the "end of the Islamic republic" is equally irresponsible, playing directly into Ahmadinejad's hands by equating dissent with subversion. He may or may not be right about the outcome. Neither he nor anyone else can know right now. But either way, the Iranian people aren't helped by these sorts of grandiose pronouncements from the West.

There are several possible outcomes. Ahmadinejad and Khamenei could prevail. Or Moussavi and Rafsanjani could win out, thereby saving the Islamic Republic. Or this could be the beginning of a newly democratized Iran, with Mossavi as its Gorbachev figure.

Want to help the people of Iran reach that third outcome? Then why not start by seeing them as they are? They're people who adopted a very centrist candidate as the symbol, rather than the reality, of change. (Did I just hear some progressives mutter "that sounds familiar"? Now, now ...) In supporting a more moderate candidate they've been given a chance, but just a chance, to transform their country. Let's hope that history is with them.

Whatever the outcome, however, this is their battle. We can support the Iranian people and the principles of democracy without becoming partisans in an internal political struggle. That's a less melodramatic stance, and perhaps a less emotionally satisfying one. But it's wiser.

As much as we might like to wear green and dream that we and not they are on the front lines of history, that doesn't help anybody. Their movement is brave and important and real. But it's their movement, not ours. This is not our feel-good moment. Our play-acting is, in the end, a selfish act.

We all need to look in the mirror and remind ourselves: This isn't about you.

"Human Events": The Right's Superstars and the Great Gun Giveaway

Human Events is one of the oldest and most establishing conservative journals in the country. Newt Gingrich is a regular contributor. So are Pat Buchanan, Chuck Norris, and a number of the Right's other luminaries. In today's violence-laden atmosphere, why are they letting their work be used to promote gun giveaways and implied calls to vigilante acts?

As the incidents of right-wing gun violence mount up - murdered Unitarians in Knoxville, cops shot dead in Pittsburgh, a doctor gunned down in Kansas - the magazine continues to distribute email ads for "free guns" offered by a "millionaire patriot" who "wants YOU armed and trained ... for what's coming."

"3,000 Handguns Almost Gone!" the latest ad reads. We're told that "Dr. Ignatius Piazza" - the reputed millionaire - "Pays His Own Money So YOU Get a Free Handgun Plus 5 Days of Training and a 30 State Concealed Weapons Permit for Pennies-on-the-Dollar!"

Email ads from Human Events are usually of the less lurid variety, like "The Ultimate Man Knows the Three Basic Baseball Pitches. Do You?" (I pitched a pretty mean slider back in the day myself.) There are quite a few quack medicine cures: "If your joints still hurt, read this now." "The 7 Great Diabetes Lies." "The Ultimate Man Knows Ben Franklin's 13 Rules of Improvement."

Then there's my personal favorite: "The Ultimate Man Knows How to Fight Off an Alligator: Do You?"

But the spiritual stepsisters of Dr. Piazza's ads are the editorial emails from Human Events or its political bedfellows and advertisers, messages that distort Democratic positions, suggest the presence of a religious war in our country, and question the legitimacy of the U.S. government itself:

- "Obama Do Not Need No Stinking Birth Certificate"
- "Is Obama Right? 'We're No Longer a Christian Nation'"
- "Judiciary Promotes Obama's Anti-Jesus, Pro-Allah Judge"
- "Chuck Norris: 'Got Your Permit to Study the Bible?'"
- "Why Aren't Scientists Allowed to Believe in God?"
- "Sen. Harry Reid: 'Punish Pastors, Protect Pedophiles'"

That latest piece, by Navy Pastor George Klingenschmitt, says "quoting the Bible in church will be punished" and "pastors will not be protected by the First Amendment." It calls the Matthew Shepard Hate Crimes Act the "Protect Pedophiles Act" and says that it would require U.S. Marshals to "protect 547 acts of sexual deviance," including pedophilia, necrophilia, zoophilia, coprophilia, and "fronteurism" (defined as "a man rubbing against a unknown woman's buttocks"). Besides being flatly dishonest (and from a pastor, no less!), it's a highly inflammatory work designed to convince readers that the full force of the U.S. Government will soon be put to use enforcing unwanted sexual invasions of children, strangers, and animals.

Is that much of a stretch to suggest that, having stated the extreme emergencies we now face, Human Events is also inviting Dr. Ignatius Piazza to help us fight back ... by any means necessary? We "want YOU armed and trained ... for what's coming ..."

It's possible that the entire Piazza ad campaign is a come-on, of course. Links direct you to "The Frontsight Institute," where I suspect that a slick cash-extrication scheme is soon presented to gullible gun seekers. But either way, this is a dangerous and highly violent pitch.

Human Events does include its usual advertising disclaimer with the gun ads. This standard language reads in part: "From time to time, we receive opportunities we believe you as a valued customer may want to know about. Please note that the following message does not necessarily reflect the editorial positions of Human Events." But what would have happened if, say, The Nation had started running "gun giveaway" ads immediately after George W. Bush became President?

I subscribed to the Human Events mailing list to understand what the mainstream Right is thinking, not to write an exposé . I've engaged in friendly email exchanges with its contributors in the past. I respect Newt Gingrich's work on healthcare, even though I disagree with most of his conclusions. (I also met Chuck Norris many years ago, when I was working at Francis Coppola's post-production studio. He was the only celebrity who ever came by the kitchen and thanked the workers for their help. Nice guy ...)

I miss the days when we could engage with civilized conservatism. These ads from Human Events seem to reflect in microcosm the descent of the entire conservative movement into lurid extremism tinged with incipient violence. Forgive the cussin', but what the hell is happening over there on the Right? Why aren't Gingrich, Norris, and Buchanan saying this is not the movement we want, that they refuse to be associated with smears, lies, and implicit violence? Here's a question for those three individuals, and for the editors of Human Events:

"The Ultimate American knows how to lead a high-minded opposition. Do you?"

Could Doctors Go the Way of Record Companies?

Those of us who follow health care may be overlooking the big picture. Most of the profound (and sometimes disruptive) changes of the last half century -- computers, the Internet, social networks -- weren't initiated by the political process. They arose at the intersection of technology, economics, and mass social change. So here's something to think about:

Could the medical profession go the way of the record industry?

Consider the path that led to the current crisis in the music business:

1. An industry with a near-total monopoly experiences a minor disruption (in music's case, with the invention of cassette tape recording).

2. It 'relaxes' and assumes the crisis has past.

3. An even better technology comes along (the Internet) that includes lateral as well as vertical connections. (Individuals could only make tapes for themselves; sharing was possible but cumbersome, until the Net and mp3s made it instantaneous and worldwide.)

4. The industry fails to recognize the long-term significance and risks of this new tech.

5. Enterprising individuals use this new technology to distribute "information" of mutual interest - songs - through "P2P" (peer-to-peer) file sharing.

The result? A massive and ongoing implosion of the music biz. (David Byrne provided an excellent overview in Wired, with some corrections on his blog.)

Could the same thing happen to the medical profession? Many people's immediate reaction will be to say 'no.' They'll list the many barriers to what we might call a 'P2PMed' disruption of our medical economy (with 'P2P' here meaning either 'peer-to-peer' or 'patient to patient'.) Doctors are too respected. Regulations won't permit it. Doctors control access to medications. Medical information is walled off behind expensive, subscription-only medical journals. It's unthinkable.

That's pretty much how the record industry reacted in the 1990s. Let's look at those objections:

160 million people looked up medical information on the Internet circa 2007, according to Harris polling data. Yet they still go to doctors. That's true -- just as millions of people made tape copies of music for decades without seriously undermining musical economics.

Each of these searches was a solitary activity. The difference will come when a new technology allows lateral information-sharing in a way that people trust. It hasn't happened yet, but smart people are banking on the idea that it will soon. I agree with that assessment, although none of the many projects I've looked at so far struck me as a breakthrough. But a lot of folks are working on it.

Doctors monopolize access to medications through the power of the prescription pad. That monopoly's already eroding as online pharmacies provide low-cost 'doctor consults,' a legal work-around that allows -- to an sometimes disturbing extent -- easy access to meds. Where there is demand, there will be suppliers.

People won't spend money based on self-referral. The multi-billion dollar complementary medicine industry demonstrates this is untrue. Most "CAM" (complementary and alternative medicine) transactions are based on self-referral out of the traditional MD/patient relationship.

Medical information is walled off. True, but a backlash against the sequestering of research data is already underway. Case in point: A new publication called The Journal of Participatory Medicine hopes to provide peer-reviewed articles on self care for patients, as board member Kevin Kelly writes.

The Journal's Advisory Board reads like a Who's Who of Internet and medical business pioneers (and it's an open-source publication, meaning its content will be free to all). The Journal goal of helping patients take "responsibility for their own health and healing" (in Kevin Kelly's words) aligns with decades of movement toward a more patient-centric model championed by both the Left (as "patient's rights") and the Right (as with high-deductible "consumer-directed health plans").

Once again, the left/right paradigm is ill-suited for new developments... and don't blame initiatives like the Journal if medicine goes the way of record labels. They're symptoms of broader socio-informational change, not its cause.

Not all doctors would go out of business after such a transition, of course. They're still selling some CDs, too. So who would be most likely to thrive after the transformation?

High-touch practitioners: Empathetic, comforting, and warm doctors.

"Mechanics": The most gifted and accomplished surgeons sometimes use this word to describe themselves. We will need talented neurosurgeons, cardiac surgeons, and other "fixers" for the foreseeable future (at least until the self-programmable nanobots take over).

Innovators: Doctors who are always exploring, changing, and trying new things, staying one step ahead of the curve.

Integrators: Doctors who can bring together seemingly unrelated ideas and solutions, whether in diagnosis or in treatment. Integration is the foundation of creativity, and creative doctors will always be valued.

Who'll fail? Doctors who function by rote, who make routine diagnoses, and who connect patients to other resources based on past relationships and not need. Anyone whose expertise and connections are easily replicated on the Internet (think "travel agents") will struggle to survive.

Watching the AMA defends its turf on issues like doctor reimbursement is like watching the RIAA file copyright lawsuits against teenagers, even as its business model collapses around it. You can't fight your own market and win, and you can't fight yesterday's battles. Doctor groups should look more like think tanks and less like a lobbying groups. (Come to think of it, so should the RIAA.)

Predicting this kind of change is not the same thing as endorsing it. But, like it or not, we should be talking about it now.

Because -- like it or not -- it's coming.

Antisemitism vs. Reasonable Opposition to Israeli Policy

Posts like this one from Lincoln Mitchell tend to be ineffective at best, in my opinion, when they suggest there's a problem with progressive anti-Semitism and don't provide specifics. 

His post suggests that there is a "constant drumbeat" of bigoted remarks "in the comment section of ... 'progressive' websites."  The implication is that lefty blogs are overrun with commenters who are saying there's " a Jewish cabal driving American foreign policy" (to use his words.)

He adds:  "The notion that one can be critical of Israeli policy without being anti-Semitic is, of course, true. Many, if not most, American Jews are critical of various aspects of Israeli policy while being far from anti-Semitic."

Fair enough.  The problem is that he doesn't provide any examples of fair or bigoted speech.  Which comments are reasonable criticisms of Israeli policy, and which does he feel cross the line?  He doesn't say.  The end result is another post whose overall point is unclear.  Does he think progressive anti-Semitism is a real concern, or is he just offended by a few ugly comments?

It's hard for the reader to know.  I've certainly read an occasional anti-Semitic-sounding comment that set my teeth on edge.  I've found them to be pretty rare - more like a stray rim shot here and there than a "constant drumbeat."  But I don't read everything and of course I could be wrong.

There are those who hope to suppress open debate with charges of anti-Semitism.  If Lincoln Mitchell does not want to be counted among them  - and I don't think that's his intent - then he needs to 1) link to posts that he feels contain such comments, and 2) identify those that he feels are anti-Semitic.  That permits the reader to judge for her- or himself, and avoids the risk of tainting an entire online community (progressive, in this case) with unfair suggestions of bigotry.  It might even help some commenters learn that their speech can be hurtful.

Specifics, please.  Let's not tar everyone with the behavior of a few.

Health Reform: Ideas At Work vs. Self-Negating Arguments

The opposition to a public health plan option seems to be imploding, victimized by logic which looks something like this:

1. A public health plan will be a nightmare. You won't get the doctor you want. Waiting times will be horrendous. Government pencil-pushers will stand between you and your physician while political hacks decide what treatment you'll get. Everybody will hate it.

2. Public health care will have an "unfair advantage" on price. It will then drive private insurers out of business because it will be so popular that everybody will join it.

What's wrong with this picture?

These self-negating arguments¹ aren't displaying much faith - either in free markets, or in the imagination of people working within the current system. Speaking of which ...

There's a very interesting new proposal from "Health CEOs For Health Reform," a project of the Health Policy Program at the New America Foundation. The "Health CEOs" come from a diverse set of healthcare companies, and their proposal focuses heavily on - in their press release's words - " quality, efficiency, care coordination, and patient-centeredness." The proposal itself emphasizes a radical shift away from today's fee-for-service model, favoring total case care, accountability for outcomes, and new payment models for chronic care. Many of these ideas have been around for a long time, but the proposal seems to go further in some of its global recommendations.²

Yesterday Sen. Kent Conrad announced a new alternative to the public plan option: non-profit health cooperatives. I would argue with Sen. Conrad's timing. We don't need a milder alternative to the public option, since momentum for it seems to be building . And independent cooperatives would not have the research, development, or innovation capabilities that a public plan could muster. This is not the moment to undercut the public plan idea with another fragmented program. That said, Sen. Conrad's "chartered cooperative" alternative could enrich the set of choices reform can offer, even if it's not a substitute for the public plan.

We already have operational health plan cooperatives and other nonprofit groups throughout the country. Some of them incorporate elements that relate to the "Health CEO" proposal, and surveys usually show that their members are very satisfied with the care they provide. The presence of a public plan option doesn't preclude all sorts of imaginative initiatives from the private and nonprofit sectors. It should encourage them, in fact, germinating new financial and medical models that help them thrive.

It's particularly disappointing to see someone like Sen. Charles Grassley echo the opposition's self-contradicting arguments. Grassley's a Republican who's often been willing to reach across the aisle on health care. His hearings on corruption in medical research have been both courageous and profoundly important. It's time for Sen. Grassley and others to either frame a more defensible and coherent opposition to the public plan option, or step down and let it be enacted.

Why not create a health system that taps into all of our country's resources - government's tools, the private sector's energy, and the capabilities of our growing nonprofit/"social entrepreneurship" sector? After all, choice and competition are basic American principles.

Let's redesign our health system so that it encourages ideas that work. And how will we know what works? In our country's tried-and-true way: by letting the people decide.
_______________________

¹ I may be oversimplifying, but not by much. Opponents may say, for example, that their real concerns involve a long-term scenario where a public plan forces its opponents out of business and then turns dictatorial. But we don't make policy based on hypotheticals, especially extreme ones. Congress can always pass new laws if circumstances change. And private capital will always move in if there's a new marketing opportunity.

.²I should note that I need to study this just-released plan in greater detail, especially its recommendations for an overhaul of Medicare's reimbursement structure. And to be clear, the "CEO" plan is silent on the issue of a public plan option. I don't want to leave the impression that it took a position either way on that subject.

A Health Care Bailout For the Middle Class

It's on. The President's assuming direct ownership of the health debate. Draft bills are beginning to circulate on the Hill. Dozens of policy details are being debated. Universal coverage is one way to describe the objective, but here's one that might be better: We need a healthcare bailout for the middle class.

High-income Americans will make out fine, and public programs will be strengthened for lower-income groups. But medical illness caused nearly two-thirds of all bankruptcies, and most of these bankrupt debtors had medical insurance. That raises two questions:

1. What's the value of "universal coverage" if "coverage" isn't providing the financial security people need?

2. If we can rescue troubled banks, what are we doing to rescue families whose "toxic assets" consist of unpaid medical bills for urgently needed care?

It's a mistake to assume that health reform will inevitably ease the financial burden for financially imperiled households. Medical problems caused 62.1% of all bankruptcies in 2007. Three quarters of these bankrupt debtors had health insurance. And 92% of them had medical bills of at least $5000, or 10% of pretax family income.

"10% of pretax family income" is also the figure many health policy analysts say families should be prepared to spend for health care under a mandate. But for many people that was a burdensome figure even before the financial crisis. We can't assume that a policy forcing them to spend that much will be either effective or politically popular. Nevertheless, AP reports House Dems are floating the idea of "slapping an unspecified financial penalty on anyone who refuses to purchase affordable health insurance." That's what is known as an "individual mandate."

Insurance was originally designed to eliminate financial ruin for individuals by distributing costs among many people. Does it make sense to insist that people buy coverage that won't necessarily protect them from disaster?

Feelings run high about this issue among us health policy wonks. Most Democratic/liberal analysts insist that reform can't succeed unless all individuals are first mandated to obtain coverage. The idea's based on sound economics: If some people can opt out, the healthiest are most likely to do so. Then the system will be burdened with sicker enrollees, driving up costs and making it harder to achieve universal coverage.

That's why smart and knowledgeable people like Jonathan Cohn can imply, as he does here, that individual mandates are indistiguishable from "good public policy."

I understand the economics, but here's the concern: The underlying concept of "shared responsibility" is sound, but in other countries - and in Medicare - that responsibility is mainly shared through the progressive mechanism of taxation. Unless carefully designed, individual mandates run the risk of being overly punitive and politically explosive among middle-income Americans.

Consider Sen. Kennedy's new draft proposal. It offers more generous subsidies than other proposals, with a sliding scale of assistance that goes up to $110,000 in income for a family of four. But a lot can happen beneath and near that $110,000 mark, especially in these perilous times. Yearly premiums for family coverage reached $12,680 in 2008 and continue to climb. That's one reason why families struggling to make ends meet sometimes 'bet' that they won't have catastrophic medical costs. That may be a bad bet, but using the levers of government to force them to pay $8,000 to $13,000 in premiums alone might not be the best solution.

And the assumption that mandates are more politically liberal is just that: an assumption. Mandates could, in fact, be economically regressive. They could also give the GOP a hot-button issue for 2010 and 2012. Proposals like Jacob Hacker's, which limit out-of-pocket premium costs to $2,500, go a long way toward addressing those concerns. But they're also costlier from the government side, so they don't seem to be on the table right now (even if those costs could ultimately be offset by improved compliance).

What's the solution? At least one proposal that has been anathema to Democrats might help. The Democrats campaigned against McCain's plan to tax health benefits. But a health tax, like any other, can be either progressive or regressive. (There's a good discussion of the topic here.)

It's true that a tax on all workers receiving health benefits could be disastrous. And nobody's receiving overly luxurious benefits, despite what some partisans claim. As Merrill Goozner observes, there are no "Cadillac health plans" for employees, though that phrase is has become a buzzword. (And Cadillacs are made by GM, where a little help was also needed.)

Here's one possibility: a health benefits tax that kicks in at high income levels. That could conceivably pay for some Hacker-like caps on premiums. It would also have the added benefit of sensitizing corporate decision-makers to the true cost of medical care in this country. It might even motivate more of them to take a proactive stand on health issues.

There are a number of other possible ways to "bail out" the American middle class in health care, too:

1. Phase mandates in slowly, as overall health costs are reduced through other measures. (This one's unpopular with a number of analysts, but I think unfairly so. It's do-able.)
2. Emphasize the public plan option. (If you're going to lay a heavy cost burden on the middle class, it's a good idea to give them every choice you can.)
3. Develop innovative ways of helping consumers pay their health debts through easy-to-use financing tools at favorable interest rates.
4. Ensure than health benefits include appropriate caps on out-of-pocket costs.

Universal coverage without universal financial security would be a Pyrrhic victory. The President and Congress can ensure successful health reform by making sure that American families can receive the care they need at a price they can afford.

Free Speech and Responsibility: The Conversation With Ron Kuby

Note that I didn't use the words 'debate,' 'fight,' or 'argument.'  I enjoyed the conversation and think it's an important topic that deserves more scrutiny and discussion.  Here it is (it runs about 11 minutes in total):

Free Speech and Responsibility: The Mitch Albom Show

Here's a clip of my appearance with Mitch Albom discussing Bill O'Reilly and the murder of Dr. George Tiller:

Albom Eskow-0

The broadcast was yesterday (Wednesday).

A couple of radio appearances (today and tomorrow)

This is last minute, but I’m making a couple of radio appearances (both booked in the last couple hours) to talk about the media and the killing of Dr. Tiller in Kansas. One is today at 5:20 Eastern, on the Mitch Albom show (he’s the guy who wrote “Tuesdays with Morrie” and “The Five People You Meet in Heaven”).  It’s here:

http://mitchalbom.com/radio

The other is with Ron Kuby, the lawyer I argued with Sean Hannity about a while back.  I’ll get you a link for that when I can.  That’ll be at 1:30 Eastern tomorrow.

Freedom, Speech, and Consequences: O'Reilly and Accountability

Let's start with a thought experiment: Let's say you denounced someone in your neighborhood as a a corrupt and terrible person - a killer, even. Let's give you the benefit of the doubt and assume you believe your words to be true. Then let's say that somebody who might have heard your words shot that person down in cold blood.

Wouldn't it give you pause? Wouldn't you want to know if that person heard your harsh words before firing those shots? Wouldn't you spend a sleepless night wondering if you might - just might - bear some portion of the blame for the death of another human being?

Assuming the answer is "yes," you have now learned the difference between you and Bill O'Reilly. Or Sean Hannity. Or Bernard Goldberg. Or any of a number of other commentators who use violent and hateful speech to characterize those with whom they disagree. I've used thought experiments like this one before, and the result is always the same: I and those around me would express regret, then attempt to turn down the rhetorical heat. These guys just keep cranking it up.

I criticized Dick Cheney quite a bit back in the day. But if someone had shot him (instead of vice versa) and my writings were on the shooter's shelf, I would express a great deal of remorse. Then I'd search my writings (and my soul) to see whether I might have crossed a moral line.

It's possible that Dr. Tiller's murderer never heard anything Bill O'Reilly said about the Kansas obstetrician/gynecologist. It's possible that he was completely unaffected by O'Reilly's description of Dr. Tiller as a "baby killer," as someone guilty of "Nazi stuff" who ""destroys fetuses for just about any reason right up until the birth date for $5,000." It's possible that he has never even heard of Bill O'Reilly.

It's not likely. But it's possible.

James Lee Adkisson had heard of O'Reilly, however. He's the man who shot down a roomful of peaceful Unitarians in Knoxville. He had an O'Reilly book on his bookshelf. This is the same Bill O'Reilly who encouraged Al Qaeda to attack San Francisco because of its liberal views, the same Bill O'Reilly who routinely characterizes those with whom he disagrees as "Nazis" and "traitors."

What do movie heroes do to Nazis and traitors? They kill them. So what do you do if you're mentally unbalanced and want to be a hero and all you read is Hannity and O'Reilly and Goldberg?

Adkisson was specific about his goals after his capture. "Who I wanted to kill was every Democrat in the Senate & House, the 100 people in Bernard Goldberg's book. I'd like to kill everyone in the mainstream media." Those sentences openly cite one of Goldberg's misleading and overheated books, The 100 People Who Are Screwing Up America (And Al Franken's #37)." But they could also have been inspired by two others: "Bias" and "Arrogance," which refer to the mainstream media. "But those people were inaccessible to me," Adkisson added, "... so I went after the foot soldiers." He also said:

"Know this if nothing else: This was a hate crime. I hate the damn left-wing liberals. There is a vast left-wing conspiracy in this country & these liberals are working together to attack every decent & honorable institution in the nation, trying to turn this country into a communist state. Shame on them.... "

The rhetoric about a vast left-wing conspiracy is straight out of Fox News, or Ann Coulter's book that says "the only way to talk to a liberal is with a baseball bat" or Dick Morris' books about liberals entitled "Traitor" and "Off With Their Heads."

(Wait -- cutting people's heads off ... isn't that what we condemn Middle Eastern terrorists for doing?)

Adkisson's manifesto fits right in with this crowd: "Liberals are a pest like termites. Millions of them Each little bite contributes to the downfall of this great nation." He only parts company with his highly-paid leadership when he addresses the solution: "The only way we can rid ourselves of this evil is to kill them in the streets. Kill them where they gather. I'd like to encourage other like minded people to do what I've done. If life aint worth living anymore don't just kill yourself. do something for your Country before you go. Go Kill Liberals."

How explicit a link do we need before it becomes reasonable to at least suspect that there might be a connection between violent rhetoric (traitors, Nazis, baseball bats, decapitation) and violent deeds? Why are media critics like Howard Kurtz so ready to exonerate O'Reilly and his cohort from even the possibility that their angry words might be a contributing factor?

********************

Which is not to say that I, or anyone I know, would consider abridging or limiting Bill O'Reilly's freedom of speech. The way to fight the hateful aspects of their speech, and the ugly atmosphere it creates, is with our speech. That form of engagement isn't just a right. It's a duty.

That's a point that seemed lost on Air America radio host Ron Kuby when I appeared on his show after the Knoxville shooting. He insisted that I was arguing for suppression of speech, even though I hadn't said or implied any such thing. It seems reasonable to hold the following set of positions simultaneously:

1) that freedom of speech is an inviolable right;
2) that some speech can encourage harmful actions;
3) that we should point that out and criticize such speech where appropriate.

Some people are concerned that certain types of speech will be suppressed if we suggest that they foster or encourage acts of violence. But if a causal link seems apparent, why should we be reluctant to point that out? Remember, the Left appeared to be growing its own violent wing in the late 1960s and early 1970s. But mainstream liberals were quick to condemn acts by groups like the Weather Underground. Those movements died out. Yet Rachel Maddow provided a litany of right-wing violence last night, with no corresponding violence from the left. Is that a coincidence? Or does part of the difference stem from the lack of violent and angry imagery from mainstream liberals?

I would never suppress the anti-abortion magazine that suggested killing doctors like Dr. Tiller was "justifiable homicide." But I won't hesitate to say that talk like that could get somebody killed. Scott Roeder subscribed to that magazine. Who can say that couldn't have inspired him to kill? The same is true of other violent rhetoric - rhetoric beamed night after night from every cable-ready television in the country.

Once - just once - I'd like to see Bill O'Reilly or Bernard Goldberg express regret for the possibility, however remote, that they contributed to an act of violence. But apparently O'Reilly would rather blame his critics than search his soul.

an excellent development

Michael Bérubé, he of the free-flowing style and the accents aigu, is blogging again.   He may have been doing so for quite some time, but if so it has been without my knowledge.  These things happen.

Michael is highly music-literate.  He has knowledge of the hidden coordinates of the soul/rock/funkosphere, for which I grant him a quiet nod of respect. 

He also plays drums, which is why I once anointed him "the Al Jackson Jr. of the blogosphere."   Plus he's some kind of professor or whatnot.  If you want the details on that ask David Horowitz.

Check him out.

World Brain Teasers: Handicapping H. G. Wells

H. G. Wells lobbied widely in the 1920's and 30's for something he called a "World Brain," a continuously updated Global Encyclopedia containing the sum total of human knowledge. He described it with terms we might call "cybernetic" now, although Norbert Wiener wouldn't write a book with that name for more than a decade.  Did Wells really predict the Internet?  Not really.  The enabling technology would have been unimaginable for him.  But he was on the right track.

Wells was already a pretty damned good forecaster by that point.  It's easy enough to check out his predictions for the 20th Century in an uncopyrighted (at least in the 1902 book called Anticipations of the Reaction of Mechanical and Scientific Progress Upon Human Life and Thought For road travel, for example, he predicted use of the "motor truck," the "motor carriage," and the "motor omnibus."

That's "tractor trailer," "car," and "bus" to you.  From that he extrapolated a new kind of road that "will be very different from macadamized roads; they will be used only by soft-tired conveyances; the battering horseshoes, the perpetual filth of horse traffic, and the clumsy wheels of laden carts will never wear them."  And from that he was able to predict that the United States would become the home of suburban sprawl.

He even saw Amazon.com coming ... well, almost ... together with a continued need for shopping centers.  He wrote:  "(F)or all such "shopping" as one cannot do by telephone or postcard (okay, okay - I said almost!), it will still be natural for the shops to be gathered together in some central place." He went on:

"And so, though the centre will probably still remain the centre … it will be essentially a bazaar, a great gallery of shops and places of concourse and rendezvous, a pedestrian place, its pathways reinforced by lifts and moving platforms, and shielded from the weather, and altogether a very spacious, brilliant, and entertaining agglomeration."

Did you catch that?  The guy predicted shopping malls, for crying out loud.  In 1902!  It wouldn't have been surprising if he had foreseen the Yogurt Hut and Urban Outfitters while he was at it.  He didn't do as well at global issues.  He predicted a disastrous conflict that would eliminate the ruling oligarchies of the 20th Century, replacing them with the more enlightened intellectual meritocracy of a "New Republic." 

So he got a Big Question wrong.  But how about those shopping malls?  And he predicted dishwashing liquids, too.  (I'm not making that up.)

His big-picture vision improved with 1914's The World Set Free, when Wells predicted the invention and use of atomic weaponry.  As the War to End All Wars flared into existence he wrote that "nothing could have been more obvious to the people of the early twentieth century than the rapidity with which war was becoming impossible. And as certainly they did not see it. They did not see it until the atomic bombs burst in their fumbling hands."

What else did Wells predict?  Commercial television ... VCRs ... gas warfare (like the mustard gas which injured my grandfather in World War I) ... automatic doors ... Twitter ... (well, maybe not Twitter.)

About that World Brain …  He described his work as "research in a field to which scientific standing is not generally accorded ... constructive sociology, the science of social organization.  This is a special sub-section of human ecology ... (which) surveys the species Homo sapiens as a whole in space and time."  Gregory Bateson fans, take note.

Wells wrote of "the terrifying sense of insufficient mental equipment (which dawned) upon some of us who watched the birth of the League of Nations," complaining that "the Peace Conference at Versailles did not use anything but a small fraction of the political and economic wisdom that already existed in human brains ..."

The World Brain was his answer.  But how could humanity's knowledge be assembled in one place, then spread across the world?  Through the wonders of a new technology:  microfilm.  Wells wrote that "the American microfilm experts, even now, are making facsimiles of the rarest, books, manuscripts, pictures and specimens, which can then be made easily accessible upon the library screen.  By means of the microfilm, the rarest and most intricate documents and articles can be studied now at first hand simultaneously in a score of projection rooms."

There you have it:  The world brain as seen through flyspecked lenses, illuminated by hot bulbs in projection rooms all over the world.  That was Wells' vision of a World Brain, and from it he grew lyrical and cybernetic in his interpretations:  "(The microfilm project) foreshadows a real intellectual unification of our race.  The whole human memory can be ... made accessible to every individual ... Photography affords now every facility for multiplying duplicates of this - which we may call? - the new all-human cerebrum."

There's more soaring rhetoric, including the notion of a "complete planetary memory," leading to this vision:  "You can see how such an Encyclopaedic organization could spread like a nervous network, a system of mental control about the globe, knitting all the intellectual workers of the world ... into a more and more conscious co-operating unity ..."

But this is H. G. Wells speaking, not Jimmy Wales, so he didn't envision an egalitarian Wikipedia model.  Instead he called for "a general editorial board and of departmental boards," "permanent bodies" with buildings, staff, and nothing like what we now call "user-defined content." Wells’ World Brain was to today’s Internet what the Supreme Court is to American Idol.  Yet the user-defined model is more efficient, especially if self-policing continues to improve. And if you combine Wells' vision with E. M. Forster's in The Machine Stops you'll have something very much like today's Web.  Of course, a lot will be missing, like LOLCats and Perez Hilton. 

Not to mention sex.  GOOD Magazine says (in a pseudo-erotic video, of course) that 12 percent of all Web sites are porn, 25 percent of all search engine requests are for porn, 35 percent of all Internet downloads are pornographic, and $2.84 billion in revenue was generated from U.S. porn sites in 2006.

Ol’ H. G. didn’t see that coming.  But then, not everybody buys those statistics anyway.  This ACLU study says that only 1% of the Net is pornographic. But even 1% of the Internet represents a massive computational engine working day and night to generate an orgiastic miasma of text, sound, and images.

So, our rating of Wells' forecasting is:  Not perfect, but uncanny. To be fair, the World Brain was more a proposal than a prediction.  But in all his work, Wells seemed to sway dangerously between Utopia and Apocalypse, embracing the future while at the same time dreading what it might provide.

"Humanity is like a leper woman who has given birth in the dark," said Chuang Tzu, "and now looks for a candle while screaming in terror lest the child look like herself."  Not a politically correct image these days, but a fair description of Wells' gift for anticipating both the best and the worst of the future.  Now, if he could only have predicted LOLCats ...

PS:  Wells cannot be faulted for failing to predict that the Internet would also result in sites like Celebrity Death Haiku. 

(written for 3QuarksDaily)

The Meaning of Swine Flu, the Universe, and Everything

Wait a second. First we couldn’t get away from that swine flu story, although we were told that it had affected less than 100 people in Mexico and only a handful here in the US. It was getting round-the-clock high decibel coverage on all channels. Twitter, our new electronic central nervous system, was going ballistic. Andy Borowitz seemed to be on to something when he wrote, “CNN Warns Swine Flu Could Continue Through Sweeps.”

By May 7 the Associated Press and others were writing stories about the overhyped flu. It seemed resolved in a lot of people’s minds: Just another overplayed media story.

But wait. Now the World Health Organization is reporting nearly ten thousand cases of the virus worldwide, with more than half of those occurring in the United States. “We are not out of the woods,” a CDC director said (on CNN.) 16 schools have been shut down in New York after an assistant principal died of H1N1. Cases are “ballooning fast” in Japan and elsewhere, says Forbes. UN Secretary General Ban Ki Moon alled for international solidarity, which includes ensuring that “all have access to drugs and vaccines.”

We went from apocalypse to afterthought in about two weeks, and now we’re swinging back. It’s hard to know what to think. Here’s a way to reconcile some of the different and seemingly contradictory perspectives we’ve been hearing, which include:

It’s no big deal. The CDC estimates that 36,000 people die each year as the result of regular flu. Very few people have died from swine flu, but it’s all people can talk about. It’s an overhyped phenomenon, a distorted perspective caused by media sensationalism.

It’s an emergency. An assistant principal dies in New York. 103 students at nearby schools develop flu-like symptoms. Then a toddler dies in Queens. Forget the statistics: Death is a singular tragedy for the deceased and everyone who loved them. Why take chances?

It’s unlikely I’ll get it. 5,000 people have it in the US. Even if that number increases a hundredfold my chances of getting it are still only one in six hundred. And it probably won’t be worse than any other flu.

I should take serious precautions. I should carry disinfectant and wash my hands regularly. I should stay home if I’m not feeling well, and should look for instructions from my local health authorities.

Let’s take the last two statements first. Which is correct? The answer, based on what we know now, is: Both. It’s unlikely you’ll get it, but you should take precautions anyway. You should be taking some precautions already to avoiding getting routine illnesses. But you should be even more careful with swine flu.

Why? To use Homeland Security symbolism, our individual threat level is “yellow” but our collective risk is “orange.” Your chance of getting it is low, and you don’t need to be too concerned about your own health right now unless you have other complicating conditions. But you should be concerned about all of us. As more people get it, the chance of pandemic increases. And a pandemic is a catastrophe. So even though your individual risk is low, our collective risk level is high enough that you should take precautions – for humanity’s sake, if not your own.

Concepts from risk management should help. Your risk of contracting it is low, and the outcome if you got it probably wouldn’t be severe. The chance this could become a pandemic is also low – but the outcome would be catastrophic. So we need to treat the possibility of pandemic very seriously.

Tyler Cowen does a good job of summarizing the way this kind of risk analysis should be conducted:

A one percent chance of one hundred million deaths is, in expected value terms, one million deaths and that is a big deal. Probably the United States is less vulnerable than it was in 1918, but how many people would die in China, India and many other locales? How much disruption to trade, travel, and the world economy would take place? Even in the United States, our public health systems would break down quickly and render many modern medical advances useless (e.g., when would the Tamiflu run out?)”

Expected value calculations are a good way to look at problems of this kind. The fact that the United States is less vulnerable than it was one hundred years ago does not mean it isn’t vulnerable at all. What’s more, the deaths of millions abroad should concern us for both selfish (e.g. economic) and altruistic reasons.

This kind of risk analysis should be standard operating procedure in the business community. That’s why it’s still surprising when business-friendly politicians strip money from the budget because they think bad events aren’t likely to happen (e.g. Bobby Jindal’s mockery of volcano monitoring, or Susan Collins’ removal of flu pandemic money from the stimulus budget). Remember: A low-probability event plus a high-loss outcome = cause for concern.

To sum up, based on what we know today: Swine flu is not that grave a threat to us as individuals, but it’s a serious danger for all of us – collectively. Think of it as an exercise in interconnectedness, a real-world and scientific example of that “one world” talk we’re always getting from pop stars and movie actors.

Because we are interconnected: A farmer coughs while tending livestock in Mexico. At lunch he shakes hands with his cousin the policeman, who writes a ticket for a visiting tourist later that day. The tourist goes home to Belgium, where his colleague leaves the next day to visit his cousin the day-care worker in New York. A week later a 16-month-old child dies in Queens.

It could have happened that way. We don’t know. And washing your hands today might save thousands of lives in Bangladesh or West Africa next month. We don’t know. But we do know that, in a a very literal sense, that “one world” business is real. It’s a good reason to take health precautions. It’s a good reason to support flu management and other risk management funds in the Federal budget. And it’s a good reason to care what happens anywhere and everywhere in this interconnected world.

(originally written for The Huffington Post; also cross-posted at The Sentinel Effect, my health blog)

public service announcement

When I tell any Truth it is not for the sake of Convincing those who do not know it but for the sake of defending those who Do.

- William Blake

consider this

The Foundation of Empire is Art and Science
Remove them and the Empire is No More

- William Blake

a little mother's day music

"A Real Mutha For Ya," Johnny "Guitar" Watson

For all those hard-working mothers out there trying to make ends meet ... groove on that electric piano riff while you're buying that powdered milk he talks about.

Health Noir: $10 Million Ransom Demand for Data - and Stranger Crimes Are Coming

(originally written for The Huffington Post)

“Attention, Virginia!” the ransom note begins. “I have your shit! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh “

“For $10 million, I will gladly send along the password. You have 7 days to decide.”

Someone says they’ve stolen 8.3 million patient records, and now the FBI is on the case. However strange this crime may sound, it was a predictable event. Stranger and more severe crimes are coming, if they’re not here already. I’ve been tracking health data breaches for a while, and it’s one of six scenarios I sketched out (but chose not to publish). It’s important now to ensure that these concerns are given a high enough priority – and proper funding – in future health IT initiatives.

Whatever your position on health reform, nobody wants health data to be the topic of the next private eye novel or film noir. Philip Marlowe wouldn’t be happy working at HHS.

Since they’re now playing out in public, I’ll briefly mention those other five scenarios. They are:

1. Individuals are blackmailed using information obtained from stolen medical records.
2. “Medical identity theft” – using stolen information to fraudulently obtain medical care
3. Stolen information is used to submit fraudulent bills to Medicare, Medicaid, and insurance
4. Electronic funds transfers are intercepted using stolen data
5. Medical data is used to obtain controlled substances and sell pharmaceuticals online

There are no doubt other ideas out there, and inventive minds will find them. Authorities say the Virginia hackers breached the system’s security, but it’s less clear whether they can do what they’ve threatened. Either way, the language in their ransom threat seems to fit the hacker profile of young American kids with time on their hands. We don’t know whether that’s real or a ruse, but it raises a couple of disturbing questions:

- What happens when organized crime gets into the stolen health data business?
- Who says they haven’t already?

Crime syndicates could become brokerages for acquiring and selling health information, which can be traded online.

It would be a mistake to use the threat of these crimes to oppose health IT initiatives, however. These crimes will continue, no matter what, because the exchange of data is embedded in every aspect of our insurance-based health system. Doing nothing will not protect us. It makes more sense to use this historical moment to take bold preventive steps.

If stolen health data fits the pattern of other cybercrimes, publicly reported breaches don’t reflect the full scope of the problem. So what should the Administration and private industry do next?

1. Acknowledge the problem. Don’t lose control of the debate by letting health reform opponents raise the topic first.
2. Provide funding for security software and solutions.
3. Clarify the security levels and procedures expected of all health IT users. (You’d be surprised how many of these breaches occurred because someone left a laptop in an airport or a computer disk on their front seat.)

What should private industry do? Those industries that will benefit from reform and IT initiatives could establish a reward – something like the “X Prize” – for innovative security solutions in healthcare.

Organized crime – or even disorganized crime – has no place in the world of healthcare.

Dylan's New Album: It's a Passport Photo

Guess what? Bob Dylan's moved on. His albums aren't transformational events anymore. Nowadays they're celebrations and echoes of the everyday working lives of a dying generation of American roadhouse musicians -- bluesmen and Tex-Mex balladeers, country singers, rockabilly madmen and crooning would-be paramours.

But if you've been listening to his last few albums you already know that. Together Through Life just confirms it.

Nothing on this album is going to burden Dylan with that troublesome "genius" tag. But then, nobody ever called any one of the Five Royales a genius either. Or Freddy Fender. Or Billy the Kid Emerson. But they were greats, and that's the company Dylan's keeping now. In fact, it seems as if Dylan would've been happy being part of the musical generation that came immediately before him -- the ones who had no hope for any but the cheapest, tawdriest, and most fleeting kind of fame. They weren't celebrities, except in their own ghettos or barrios or streetcorners. They were conmen and convicts, idealists and killers, Italian drunks, Jewish pimps, and mestizo gamblers. They were dreamers and addicts and hustlers who did a little performing on the side and turned out to be brilliant at it.

They weren't people Charlie Rose wanted to interview, if you catch my drift.

Like Nashville Skyline, this album feels like another attempted jailbreak from celebrity. It makes you want to wish him good luck with it, too. I wonder what it says under "occupation" on Dylan's passport. Probably not "poet" or "legend" or "voice of a generation." I get the feeling that it says what he wants it to say: "Musician." Or better yet, "working musician." The man tours all the time.

The album's on track to be Number One (if that matters anymore.) And he's on the cover of Rolling Stone (ibid). But mostly, the album's just there. Putting out albums is what working musicians do, and Dylan seems to be most in his element when he's fulfilling those job duties. Dylan's albums haven't changed people since Nashville Skyline made people "go country." What a relief that must be for a musician.

Nowadays Dylan's music doesn't do - it just is. Take it or leave it. The songs can't be laden with unintended meanings. They're not paintings, they're photographs -- like those great black and white pictures by Milt Hinton or Marty Stuart, where one great musician artfully captures another. In fact, "My Wife's Home Town" is so Willie Dixon ("I Just Want to Make Love to You") that the late Willie gets a cowrite credit.

There's no "Ballad of a Thin Man" on this record, so if you're still looking for that after all these years you'll be disappointed. But then, if you go looking for Jackson Pollack and find Robert Frank you'll end up disappointed too. And you'll miss some brilliance.

If you're a Dylan fan you've probably already heard that David Hidalgo's accordion runs through the record. That makes people think "Tex Mex." Some of the record is Tex Mex, too, although there's a lot more blues than anything else (and the accordion on those tunes is more reminiscent of Clifton Chenier accompanying Lightnin' Hopkins than it is of Flaco Jimenez.)

The blues numbers have a Chess Records feel, except for that accordion, even down to the same mambo-style rhythm on "Beyond Here Lies Nothin'" that Chess used when they wanted a catchier and more danceable track. Here, producer Jack Frost (Dylan) goes for a brighter, clearer, punchier aural quality than those old Chess sides.

Dylan's still an archivist, and still a gentleman bandit too. "If You Ever Go To Houston" starts off as a light rewrite of "Midnight Special." That's okay: Working musicians are measured by the quality of the material they steal. But then again, can you steal an public-domain song? Dylan's simply continuing the folk evolutionary process. You can't sue for that. It would be like filing a copyright infringement case against the limbic brain. "Midnight Special"? What's more American than a prisoner's song that finds God's redemption on the headlight of a railroad train?

Speaking of Freddy Fender, it's too bad he's not around to cover "This Dream of You." There would be a sweet circularity in the Mexican Elvis singing this border-style ballad. And the words "nowhere café" echo a fairly obscure (and beautiful) Doc Pomus/Willy De Ville collaboration called "Just to Walk That Little Girl Home." That tune has a little Tex Mex in it, too. Maybe Willy will cut this song in Freddy's place.

"Life Is Hard" is an exception to the overall sound. It's a lovelorn ballad that might've been sung by Mabel Mercer in some long-gone cabaret. But then, "lovelorn" is a redundant adjective for these Dylan tunes. He's so perpetually out of love in this collection that it feels like Purgatory. He's looking at romance through a window, like a kid watching working musicians rehearse in a bar where he can't come in. He holds a woman now and then, but the way a lapsed Catholic holds a rosary.

The catchiest tune, "I Feel a Change Comin' On," kicks off with some swooping Rick Danko-style bass, one of the few echoes of The Band on this record. This one would be the "single," if singles still mattered. It's as close to a car radio song as we're going to get. And people who say Dylan's close-mouthed should take this kind of lyric more literally: "I'm listening to Billy Joe Shaver and reading James Joyce." My guess is that's exactly what he was doing. (Hope it inspires more people to check out Billy Joe; he and I had a great talk a year or two ago.)

But what does it mean to say that this music just "is"? That's what all that original roadhouse music did: It just existed -- at least until all those college students started listening to it and writing dissertations about it. It was there to dance to, to get drunk to, to cry to... or to listen to if you really want. It's the kind of music that was once ubiquitous and unremarked upon -- in little record shops playing their hi-fi's on the city street, on transistor radios in the back seat, in the torn-up posters in the mouths of alleyways you don't dare enter, at the end of a barroom sweating under a few hot lights.

Okay -- but "is" it any good? Well, that all depends on what your definition of "is" is. The lyrics are brilliant, but in a sneaky kind of way. And nobody buys albums for the lyrics. There are no striking melodies, either, although Dylan's written far more of those than a lot of people recognize. It's not that kind of groove. It's everyday music, the poetry of the prosaic. If you want that other Dylan you're gonna need a time machine.

But it's a great album if you dig the Dylan of the last few decades, and if you love the music working musicians of his kind love. And else is going to sing "the door has closed forevermore/if indeed there ever was a door"? He's always been an underappreciated vocal genius, too, and now he's got the deconstructionist instrument to go with the stylings. The sound's not for everybody -- but then, neither was Furry Lewis.

The album won't change your life. But personally, my life doesn't need much changing. I didn't have to rush home to learn to play any of the tunes, either. But I know a lot of tunes already. It's like we were saying: These tunes are more like photographs than compositions. But maybe in the end they make up one big picture. And maybe it's not a work of art, but something more functional, like a passport photo of someone who's always on the road to the next gig. Somebody like Willie Dixon. Or Mabel Mercer. Or Bob Dylan.

A working musician.

Emotional Cartography: Christian Nold and William Blake

From the indispensable psychology and neuroscience blog Mind Hacks, some information on Christian Nold and his "emotional cartography."  Writes Nold:

Bio Mapping is a community mapping project ... In the context of regular, local workshops and consulltations (s9c), participants are wired up with an innovative device which records the wearer's Galvanic Skin Response (GSR), which is a simple indicator of the emotional arousal in conjunction with their geographical location. People re-explore their local area by walking the neighbourhood with the device and on their return a map is created which visualises points of high and low arousal. By interpreting and annotating this data, communal emotion maps are constructed that are packed full of personal observations which show the areas that people feel strongly about and truly visualise the social space of a community.

Nold goes on to ask, "How will our perceptions of our community and environment change when we become aware of our own and each others intimate body states?"  That's more of a forecast than a description of his current work.  He's predicting a technology that allows people to read the emotions of others in real-time.  His current maps essentially measure only stress, and the results are published retrospectively and not in real time.

But it raises a number of interesting questions and possibilities.  Before we go there, however, it's worth mention that, while Nold may be science's first "emotional cartographer," literature's been there already.  Take William Blake's London: 

I wander through each chartered street,
Near where the chartered Thames does flow,
And mark in every face I meet,
Marks of weakness, marks of woe.

In every cry of every man,
In every infant's cry of fear,
In every voice, in every ban,
The mind-forged manacles I hear:

How the chimney-sweeper's cry
Every blackening church appals,
And the hapless soldier's sigh
Runs in blood down palace-walls.

But most, through midnight streets I hear
How the youthful harlot's curse
Blasts the new-born infant's tear,
And blights with plagues the marriage-hearse.

Blake's cartography isn't only emotional, although it's intensely emotional.  It's also economic, political, and psychological (the "mind-forged manacles" evoking everything from learned helplessness to crushing social convention.)  The cagey old printer even manages to inject a little epidemiology into his mapmaking.  The youthful harlot's curse sounds a lot like a venereal disease, one that condemns the unfaithful husband and his family to death.  And the "marks" of "weakness and woe" that Blake inventories form the contours of his map.  The wounded soldier's bloody sigh on the palace wall reduces to zero the geographical distance between the suffering of the battlefront and the comforts of the wealthy.

And all in sixteen lines. 

So maybe Christian Nold hasn't caught up with the poet yet.  But he's done something interesting, and there's more to come.  The "emotional maps" aren't his only work, either.  He's also created the Newham "Sensory Deprivation" Map, which is where the illustration above comes from.  By switching up the senses people use to perceive the environment, he's helping map our geography in a new way.  A very nice idea.

So what would happen if we could read the emotions of those around us in real-time?  What if we could tell that the crowd around us at rush hour was overstressed, that the people at our bar band gig really liked the crazy rockabilly number we threw in, that our academic audience was becoming skeptical of our Blake-As-Cartographer thesis?  Would people on the street feel more personal responsibility for the well-being of the throng around them?  Would presenters and performers lose the willingness to challenge their audience?  Would anybody even care?

Would politicians be even more eager to say anything the public wanted than ever before?

Nold's work can veer in any number of future directions.  It could lead to new forms of psychological epidemiology, or to conceptual art works.  Or to new ways of seeing the world around us, a breaker of mind-forged manacles.  But he needs to be vigilant, to prevent his work from descending into an entertainment, a crowdsourced "mood ring" for the 21st Century, played with and then forgotten.

He can do it, if he gets the right support.  And draws the right inspiration from cartographers like William Blake.

(written for, and cross-posted at, 3 Quarks Daily)

anonymity and xeroxing

Ben Smith prints in full a memo attacking several potential SCOTUS nominees - all women.  Not only does he give the memo considerable space, but he  grants the memo's author anonymity without even acknowledging that he's doing so.  (He describe the source as a "conservative politico.")

Why the anonymity, especially since Smith acknowledges that the memo is "tendentious"?  And why try to slide it in under the radar, instead of owning up to it?  He doesn't say.

Here's what the Society of Professional Journalists has to say about anonymity in their Code of Ethics:

• Identify sources whenever feasible. The public is entitled to as much information as possible on sources' reliability.
• Always question sources’ motives before promising anonymity. Clarify conditions attached to any promise made in exchange for information ...

For its part, the New York Times' policy on anonymity (violated regularly) says that "articles should tersely explain what kind of understanding was actually reached by reporter and source, and should shed light on the reasons and the source's motives."

The Ethics Code also says that journalists should " (d)iligently seek out subjects of news stories to give them the opportunity to respond to allegations of wrongdoing."  We'll give Smith a pass on that one, since this is a blog post and not an article. 

But why doesn't Smith name the memo's source?  True, the writing is ungrammatical in spots, but he can't just be protecting the author from embarrassment.  And why are people who point out these lapses treated like unreasonable complainers?

As Atrios would say:  Time for a blogger ethics panel.

Hoot, Meet Smalley (with Fun Quiz!)

I'm getting a little fed up with bloggers who jump on every little mistake a person makes.  Take Rep. Michelle Bachmann's error in referring to the "Smoot-Hawley Act" as the "Hoot Smalley Act."  She's only human.  And the fact that she blamed the Act for our financial troubles and said it was passed by FDR - the first statement's absurd and the second wrong (it was enacted under Republican President Hoover) - well, she's only human. 

And comparisons between the Representative and Rowan Atkinson's character in Four Weddings and a Funeral are just plain unkind:

So dial down the snark, you rotten kids.  Turns out she was referring to a different act, one that involved cowboy actor Hoot Gibson -

and the comedic character invented by Minnesota's future Senator:

What act would that be? We're not saying -- but whoever's whistling "Back In the Saddle" should clean it up. Lay off Rep. Bachmann: She's good enough, she's smart enough ... wait! What's that? Our Announcer says it's time for a ... Bonus Quiz! The challenge? Match the Bachmannized pair with their real-life equivalent. Have fun - and no peeking!

1. Sass Gleagall
2. Pewlett-Hackard
3. Ram Gruntman
4. Horrible and Lardy
5. Soldman Gash
6. Melon and Lucartney
7. Blam-Bleach-Blimey
8. Honey and Scare
9. Ragged Jiggered
10. Marbury vs. Madison

Real-life pairs:

1. Gramm-Rudman (Act)
2. Sonny and Cher
3. Jagger/Richards
4. Hewlett-Packard
5. Lennon and McCartney
6. Goldman Sachs
7. Glass-Steagall (Act)
8. Gramm-Leach-Bliley (Act)
9. Laurel and Hardy
10. Marbury vs. Madison

Mix 'em, match 'em ... or make up a few of your own.