OMG!! I have a clean office/library! It’s the first time in . . . well, forever.

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This is an update to my earlier post on Aboriginal Australians.

After a really great hike through the Valley of the Winds in Kata Tjuṯa on the 20th, Lisa and I stopped into the national park’s Cultural Centre. It was really interesting reading stories from the Aṉunga Dreaming about the formation and significance of Uluṟu.* Other displays in the Cultural Centre focused on how they thrived in this harsh desert environment. It was clear that a lot of consultation with the Aṉunga went into the creation of the Centre, which was commendable.

But none of the displays answered the main question that I wanted answered. So I went up to the (white) ranger staffing the information desk.

“If one wanted to learn about contemporary Aboriginal life, what’s available?”

He looked at me skeptically, as if sizing me up. “Are you asking about the daily lives of Aborigines?”

“Yes. There are a lot of exhibits about the traditional ways of life and knowledge of the Aṉunga, but it doesn’t say anything about whether that represents their daily lives.”

“The Aṉunga have lives very much like our own. They live just down the road, here.” He pointed to an area labeled “Restricted. No Entry.” on the map. “It’s very hard for them to live a traditional lifestyle because most of their lands have been taken over by pastoralists.”

We talked briefly about some of the similarities between the situation of Aborigines and Native Americans. The ranger got a little circumspect.

“It’s obviously going to be exceedingly difficult for any people whose land has been . . . overrun by another group. The best that we can do is to aim for reconciliation and to try to improve the situation of Aboriginal people in Australia. We’ve got a long, long way to go.”

It’s now a few days later. We’ve been back to Alice Springs, which has one of the largest Aboriginal populations in the Territory. I’ve talked to gallery staff about Aboriginal artists and their works; we even bought some art. We’ve seen people from all walks of life on the Todd Mall and in the shopping centers: old people, young people, parents with children, single people, packs of youths, native-born, foreign-born, tourists . . . everybody. Some Aboriginal women stayed at our hotel, and there were a couple on our flight to Cairns this evening. Clearly, there are many Indigenous Australians who have lives like white Australians and recent immigrants.

But at the same time, there’s clearly an enormous racial divide between Aborigines and everyone else. Everybody can occupy the same space, but that seems to be where it ends. The native-born and immigrants work in shops and service and construction and everything else; we didn’t see a single Indigenous Australian working in any of the restaurants, hotels, or shops that we visited, even the ones that dealt in Aboriginal goods. With a few exceptions that I saw in the public spaces, Aborigines stick together, not interacting with other groups; and vice versa. (This, in no small measure, is partly due to language issues.) Basically, there is no mixing between whites and Aboriginal people, and non-white immigrants seem better integrated into mainstream society.

I’m not going to pass any kind of judgment on this, except to say that it feels very odd. In fact, it reminded us of a trip that we took to Philadelphia, about six or seven years ago. I’ve never really spent any time in the south — not that Philly is in the South — and I’ve only ever lived in overwhelmingly white regions of the country; so this was my first trip as an adult to a place with large neighborhoods with “majority minority” populations. I wasn’t uncomfortable, just perplexed at how awkward everything felt. Alice Springs had that same feel.

And once again, I find myself looking in from the outside. Do Aboriginal people want more interaction with other Australians? I don’t know. Once upon a time, it was official policy that all Aborigines should become fully “assimilated” Australians, essentially just the same as whites (if they weren’t completely killed off beforehand).

All Aborigines and part-Aborigines are expected eventually to attain the same manner of living as other Australians and to live as members of a single Australian community, enjoying the samerights and privileges, accepting the same responsibilities, observing the same customs and influenced by the same beliefs, hopes and loyalties as other Australians.

In practice this was very cruel to Aboriginal people. And it never really took into account the wishes or agency of the Indigenous population. Those wishes and the results of exercsing that self-determination today is what I’ve been hoping to discover. It’s also what I haven’t been able to learn yet.

* — I don’t think I had realized just how much you can miss talking to people from your own country when away on a long vacation. They are living in Sydney now after moving from Seattle and have an interesting perspective on Australia. We couldn’t quite ferret out their exact feelings, except they think Australia’s a bit “behind on a few things.”

** — The Aṉunga are the Aboriginal groups most connected to the monolith of Uluṟu and the neighboring rocks of Kata Tjuṯa, and they hold the title to the land, which they have leased back to the government.

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I’m going to live a little dangerously now and write about race, specifically Aboriginal Australians. Hopefully reading about it doesn’t make you too nervous; although I have to admit that it makes me a little nervous that I’m going to accidentally write something that doesn’t convey my true feelings or (worse) that shows me to have biases that offend Australians. Try to bear with me, and feel free to call me out.

I still know next to nothing about Aboriginal people in Australia. (And I’m ashamed to say that’s almost as much as I know about present-day Native Americans, too.) I won’t feel bad about buying some of their very interesting art — if we do in fact buy any — but I would really love to know more about them: how they think about themselves, whether they feel or want to be “Australian,” what they do in their daily lives, what kind of lives they want to live.

I like the various “dreaming” stories that we’ve read during our travels; and I like the very idea of a Dreaming, of a set of beliefs that tie people and landscape and ancestry and law and custom and survival all together. It’s a powerful concept. The dreaming creation/preservation stories are excellent, multifaceted, multigenerational works of collective memory.

So I’m a bit sad that we’ve had few interactions with Aboriginal Australians. (I’m using the term advisedly, since I don’t know the names of the clans and tribes whose land we’ve been on.) It’s strange: All of the parks are tribal lands that have been leased back to the government, which runs and manages them almost exclusively with white people. And as we’ve come further into the middle of the country we’ve seen more and more Aborigines, yet we’ve had almost no direct interactions. (One man in Darwin — I think it was Darwin — said “G’day” to me, and the ranger Ubirr in Kakadu.)

When you consider that the white Australian holiday makers we’ve met will talk your ear off and are a jovial bunch, it seems odd. Of course, Aboriginal people aren’t here for my amusement; nor are they obliged to satisfy my bottomless well of curiosity about the world. It just seems like there’s a very distinct separateness between “white” and “black” Australians. One some occasions it seems almost actively enforced, especially at some of the road houses.* But, in general, it’s a feeling like people are expected to be in their own spheres. The supermarket in Tennant Creek was about the only place where everybody under the Australian sun was doing the same thing as equals (presumably).

I don’t want to feed into any stereotypes — after all, I’m not at work myself — but there seems to be a lot of “hanging around” by Aboriginal people.** Is that normal? Perhaps I don’t understand the rhythms of Australian life. Are they waiting for stuff to happen, just like those two white guys at Daly Waters who were sitting around playing the guitar until someone showed interest in their hand-carved wooden signs? And what should be the expected lifestyle anyway of a people who were happily doing their own thing until a couple hundred years ago when a colonizing superpower came through, seized all their lands, stole their children, depersonified them, and only recently came to feel the least bit bad about it? If (hypothetically) an Aborigine — or anyone for that matter — wants to live in a traditional way outside of the European “social compact,” should the state be allowed to say, “No?”

These are some questions that Lisa and I have discussed on this trip since we got to Darwin; and they’re questions that apply to our own country as well. Of couse, I have my inclinations and (probably incorrect) assumptions, but I have no answers. It’s certainly not my right as an American to answer or dictate to anyone else.

Maybe I can start to understand more over the next couple weeks. Maybe even starting tomorrow, when we plan to stop by the Cultural Centre in the Uluṟu-Kata Tjuṯa National Park.

Let me know what you think.

* — Incidentally, I met my first person in the flesh with a swastika tattoo in a visible place the other day when I was getting gas for the campervan.

** — I most emphatically do not want to traffic in the “lazy fill-in-the-blank” stereotype. I’m merely interested at a basic level in what everyone does and how they do it. I’m an anthropological/sociological busybody.

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Today is Memorial Day, the day that Americans commemorate lives lost in war and combat. As in previous years, someone from Holliston has placed markers and flags along the main roads in town. Each hand-lettered sign has the name and age of the soldiers, marines and sailors who were recently killed in action in Afghanistan and Iraq, as well as the state or country where they lived.

It’s quite an affecting thing to see the miles of signs, flags, names and ages as I drive home from work. The names don’t leave much of an impression usually. But the ages definitely do. So many of them are so young. And this year more than in many years past — because of the surge of violence in Afghanistan — the dead were from many different countries.

It seemed to me the only way to really convey the experience of seeing all of those signs was to walk along parts of Routes 16 and 126 in Holliston and photograph each of the signs that I saw along the way. Here are 100 or so, as well as a few random scenes along the way to give a sense of what Holliston is like the rest of the year. (You can click any photo for a larger version.)

If you’re in the military, thank you for your service. And please stay safe.

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It’s finally time to write that continent-sized post that I’ve been mulling for quite a while. After all, we leave for Australia in just 10 days.

I have a hypothesis — I’m full of them, by the way — that Australia and the United States are fraternal twins separated at birth. We (the U.S.) are the headstrong child who left home in a rage in our teenage years and forged a life of power and wealth. Australia is the marginally younger child who stayed close to the parents, even at a great distance — both physical and emotional.*

So how are our two countries similar?

We both speak English — or something like it — and have funny accents. (Well, Wisconsinites do, anyway.) Hugo Weaving and Nicole Kidman can pull off both of our accents very well. I’m fairly convinced, though, that no American can really do an Australian accent without sounding like an idiot.**

We’re approximately the same age in terms of European settlement, and we’ve each had our British colonial experience. Each nation had its own foundational myth that used the legal fiction of terra nullius to dispossess the native population.

We’re approximately the same size (if you leave out Alaska). And we’re both coastal nations, with the majority of our populations living within a few hundred miles of the ocean. And each country/continent has dry, sparsely populated regions full of ranches and deserts — the outback, if you will — where we like to engage in extractive industries and (occasionally) blow up nuclear weapons.

The U.S. and Australia are both “first world,” late capitalist, market-based, bourgeois democracies. We each have relatively low opinions of our governments. Each country has recently experienced troubles with its healthcare system. We even have our own versions of Medicare, too.

We love prisons and “football” and surfing. We both use dollars, which are currently moving away from parity in our favor as travelers. We each have an ABC television network. And we both like off-beat humor and alcohol.

Finally, we’re demographically similar. And each country has a sizable population that worries quite a bit about new immigrants and “boat people.”

Oh yeah, and the sun also rises in the east.

So let’s talk about differences.

Australia and the U.S. are mirror images. As antipodal pairs, we’re in different hemispheres, no matter how you look at it: east-west or north-south. The sun rises in the east and sets in the west; but at midday it will be in the northern sky when we’re in the southern hemisphere. I personally don’t care how water goes down a drain*** — that’s not going to help me navigate anywhere — but the sun being in the wrong place, that’s going to take some getting used to. Then throw in the whole driving on the opposite side of the road. . . .

I’m really, really looking forward to seeing a different set of stars, though.

We each have our own language quirks. Australia has wonky animals, all of which want to kill you. In America, it’s mostly the people who want to kill you. American football uses pads to dull the pain; Australian footballers use nothing more than toughness and alcohol, it would seem.

Now let’s get down to the big, big differences. Australia can go to the Commonwealth Games. We had this little revolution that got us permanently kicked out of the club. Australia stuck around; so HRH Elizabeth II is technically still the leader. I think she might be on some of their money, too.

Thinking of money, the GDP of the U.S. is roughly 15-20 times larger than our sibling’s. This — along with our youthful rebelliousness — has given us a particular swagger. The United States is an imperial superpower. We can do things that almost all other nations cannot do. (And probably would not do for that matter.)

It will be interesting to see how these differences and similarities appear from the opposite side of the globe. Stay tuned.

* — And then there’s Canada. I love Canada dearly, so I’ll just leave them be for now.

** — I’ve watched “Strictly Ballroom” and “The Adventures of Priscilla Queen of the Desert” probably a dozen times each and the only things I can say with any kind of convincing accent are “Hard?! You think this is hard?” and “bogo pogo.” I’ve decided that the best thing I can do in Australia is to talk like John Wayne.

*** — I’ve finally decided that the whole water down the drain thing isn’t (completely) an urban myth. Hey, precession happens. But the effect is so slight that you can say whatever you want.

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In case you wondered what that post from earlier today was all about, perhaps a picture will help:

Click for larger . . .

This envelope came in the mail yesterday. I don’t know who put me onto this mailing list, but I’m pretty sure it’s related to the work I’ve done over the last few years supporting the NITF file format, whose users are an interesting lot. They don’t really like to talk about what they do or what they keep in their files: secret stuff mostly.

I’m not one to judge. I’ll just say that I’m very glad that I was also responsible for adding support for the DICOM medical imaging format to MATLAB.

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It’s day #5 of Diabetes Blog Week. Today we’re talking exercise.

I have a bike. I like love to ride it all over.*

Is that exercise? I guess that depends on whether you think it’s “exercise” to do the thing that you love.

On one level, the answer is undeniable: Yes. I have to carve out time from my daily schedule to do it. Sometimes I have to convince myself to get going, especially when I’ve had a tough day and I want to veg out. And it burns a lot of calories, which was part of my initial motivation. According to the computerized bean-counters at MapMyRide.com, I’ve burned more than 130,000 Calories over the last 10 months by running, bicycling, and swimming,** which helps explain why I lost about 25 pounds over the same period.

I don’t think about it as exercise, though. In fact, what I do after work feels more like training. I “train” on weekdays so that I can ride longer distances with more ease on the weekends. I wear myself out repeatedly riding up long hills so that I can feel badass when it comes time to ride up an actual mountain. I go out in the winter and in the rain to put the miles in the bank, so that they’re there when I need to draw on them in the fourth or fifth hour of a ride. While I’m out training I have mental image of my idealized self. “I’m climbing like Andy Schleck. I’m grinding away on the flats like Fabian Cancellara. I’m spinning easily like all those other people in the peloton, waiting for the breakaway to wear itself out.”***

Whatever I call it, cycling is something that I love and that I think about way too much while I’m at work. I live for the long ride on the weekend. This Sunday, I hope to do the 90-mile ride that I was going to do last weekend before the jet stream shifted and changed my plans: Up and over Mt. Greylock in western Mass. before heading into the Taconic Range that divides New York from New England.

View Larger Map

As with all things diabetes, it’s not as easy as just putting in the miles and showing up. There’s day-to-day planning that has to happen, too. I find it easiest to ride in the morning before the day’s first bolus: Just lower the basal about 50% an hour or two before starting and eat frequently along the way, testing every hour or so. I put Clif bars, bananas and string cheese in my jersey pockets and fill up my bottles with Gatorade. And on the weekends that’s what I do.

But weekdays I ride after work, so it’s more challenging. I hate seeing the high numbers, but I build up a bit of a blood sugar cushion by snacking without bolusing along with lowering my basal. And I drink Gatorade throughout my hour-long workout. I’ll keep tweaking everything until I get it right — until my BG levels don’t drop 50-100 mg/dL in an hour — and then I’ll lock it in until diabetes decides to change how my rules work (again).

Thanks to diabetes, I always carry three things with me when I ride****. (1) A tube of glucose tablets, which I occasionally need to use. (2) My phone, which I fortunately have not had to use except to snap the occasional picture. And (3) about $15 dollars in small bills in case I need to stop for an emergency snack or to bribe someone.

But to paraphrase Lance Armstrong, it’s not about the diabetes. I love to ride, and diabetes can come along if it promises to keep up. When I actually get on the bike to ride, that’s the time when I feel like I’m beyond diabetes. I put my pump in the pocket of my Team Type 1 jersey to represent for my PWDs and because I’m so damn proud and inspired by what that professional team does; but cycling connects me to a time before I had diabetes, and it’s my way of being as free from it as possible.

* — I’ve also been known to run, walk, hike, and backpack. And, yes, I’ve even started to enjoy swimming — though, I still suck at it.

** — Seriously, I’m not thinking about competing in a triathlon. I’m not.

*** — I have no delusions about my abilities, though. I’m just a guy with diabetes on a bike, after all.

**** — That’s in addition to the Boy Scout stuff that always stays with the bike: fix-it tools, patch kit, tire levers, etc.

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Roz Savage talks about rowing solo across oceans:

First off, what she has done — rowing solo across the Atlantic as well as two out of three legs across the Pacific — is completely amazing. She’s currently rowing from Tarawa to Australia. You have to be a bit touched to depart from the herd like this, yet her story (and the earnestness with which she presents it) is so inspiring.

You really should watch the sixteen minute video, but here are some choice bits:

• “Getting outside your comfort zone is by definition uncomfortable.”
• You don’t have to look like an adventurer [or athlete or revolutionary or . . .] to be one.
• “The bigger the challenge, the greater the sense of achievement.”
• Things break and challenges occur; you have to improvise.
• We tell ourselves stories, and our interior dialogue makes us who we are.
• Tiny actions by individuals accumulate to make an enormous difference (both good and bad). What we do “spreads ripples” across the community.
• We have the responsibility to make ourselves happy.

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It’s Earth Day, so it’s time for a public service announcement. This is no “holier than thou,” tree-hugger BS — just a little something you can do to reduce waste. In particular, those plastic bags that end up tangled in tree branches or filling cow’s stomachs or littering the side of the highway or floating in the middle of the Pacific Ocean. You can do whatever you want, of course, but it’s quite likely that more place are going to eventually adopt something like Washington DC’s tax on plastic shopping bags. Consider getting out ahead of the curve.

Sometime in February I decided to try using as few plastic bags as I could. I don’t know why I decided then, it just seemed like it was time. In my mind it sounded easy enough — after all, we’ve been using them for grocery shopping for more than a year. It wasn’t quite as effortless as I had imagined, but it wasn’t very difficult either. And it has worked, too. We only have a couple disposable bags left in the house for our recycling and cleaning up after the kitty.

So what have I learned?

• The flat bottom nylon fabric bags are where it’s at. They cost about $1. They’re really sturdy. You can put 20 pounds of whatnot in them, they won’t tip over in the trunk or on the counter, and you don’t have to worry about pulling off the handles. And I think they’re easier to fill than other kinds of reusable sacks.
• If the bags aren’t with you, they won’t do you any good. Keep at least one in each car. Getting them back into the car from the house. . . . oy!
• A family of two needs 3-4 bags to shop at the supermarket for 1-2 weeks.
• When you’re sending your groceries down the belt, try to group the things you want in the same bag. (For example, send all of the cold things together.)
• Cashiers/baggers are all pretty accustomed to reusable bags; but I find that you have to give the bags to them first thing, otherwise they default to plastic.
• If you’re going to multiple stores (other than the grocery store), you don’t need one bag for each store. I’ve found that I can usually get by with two or so: one for the store I’m visiting and one (or more) that I keep in the car and transfer the stuff I just bought into. This leaves me with an empty bag for the next store, and fewer half-empty bags when I get home.

Well, that’s probably enough more-or-less obvious ramblings about how to use a shopping bag. Now just go and do it.

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Sometimes, things happen that almost immediately crystallize an aspect of one’s life, splitting it into a time before the event and after. Your parent takes a job in a sparsely populated Western state and moves the whole family. A plane crashes with a family member on board. You drive a U-Haul truck from Oregon to Massachusetts without a job to start post-college life with your new spouse. You buy a home. You take a trip to India.

Some other events are just as important but only in retrospect. These are subtle things, a turning of the tide. A high school student teaches you a bit of French in fourth grade and inspires a life-long interest in la belle langue and the nation of France. You go to camp a couple years later where you bicycle a couple hundred miles around Iowa and realize that cycling is the activity that you really love. You appropriate the family camera on a trip to Yellowstone and pick up the habit. You ride the 80 bus from Watertown to Cambridge and start to give up most of your conservative political views as you see that the working people (of which you are one) need more opportunity than they’re getting. The tragic, brutal death of a young gay man in your home state makes you rethink some of the other bullshit ideas you had.

Another thing that slowly changed me was the bombing of the Murrah Federal Building fifteen years ago yesterday.

I should note that I was in my second year at Grinnell in the spring of 1995. I loved Grinnell, but I felt like I lived in a cave. Very little news made it my way. That is, I consumed very little of it. I remember the Republican revolution of 1994 — I may have been one of the few students there who didn’t really mind it. I seem to recall there was (still) a war in the Balkans. And the farm bill was rewritten. It wasn’t that I didn’t want to know what was going in the world; I just wasn’t very connected to the media at the time.

McVeigh and Nichol’s act of terrorism really struck close to home — figuratively, of course. At the time, I still considered myself a Wyomingite. Like many people in Wyoming I felt that the federal government was a more-or-less foreign, colonial power. DC is almost 2000 miles from the Equality State, but unelected officials there ultimately control how most of the land in the mountains and plains can be used. With only three electoral votes, our Congressional delegation might have had disproportionate power relative to our population, but we felt marginalized on the national stage. It seemed like a lot of the issues that mattered to us didn’t matter to the rest of the country, and vice versa. People on the coasts and in the cities wanted to take away the guns we (truly believed) we relied on for our protection. We might not have had “Live Free or Die” on our license plates — we had a broncobuster — but we felt like we actually lived what New Hampshire was trying to claim.

I knew a guy — a sort of family friend/hanger-on — who taught me about the militia mindset. He spent a lot of time at the gun shop. (I should say one of the gun shops, for there were several.) And he would tell us what he heard and (thus) believed. He was a real life Dale Gribble. The government had designs on our guns and our liberty. For reasons I didn’t understand, the Clinton Justice Department was training a secret NATO army using black helicopters to impose the “one world government” under the auspices of the UN. The Federal Reserve was part of an ancient secret society that finally surfaced at the Bretton Woods summit in the 40s; they too were part of this enormous plot, and at the appointed time this unelected body would devalue the US dollar for their nefarious ends. Ruby Ridge and Waco and Vince Foster’s suicide were visible corroboration of the dozens of other insidious events for anyone who would just bother to connect the dots. He buried guns and ammunition in PVC pipe in the backyard so that once ATF agents came to take his “sacrificial” firearms away, he would be ready to carry on the fight. He stocked extra food and claimed to have survival skills. And he “knew people” who claimed to have shot down a helicopter that was scaring their cattle on BLM land. But the “real” militia action was always over the border in Montana, where the crazy people live.

(If it weren’t for the talk about aliens, it was almost conceivable as an alternate reality. After graduating college I watched “X-Files.” And I felt like I had heard all of the stories already. The guy I knew was a wannabe Western version Fox Mulder, uncovering the evil machinations of the Cigarette Smoking Man. After my first year working in tech support where I frequently helped people working in the defense industry on government contracts, it became crystal clear to me that the very idea of a “massive government conspiracy” crumbles because it’s just not possible to hold it all together secretly. Even people working on secret things need help completing their part of the secret.)

So when a couple of “lone wolves” put an actual plan into effect, I was stunned. I knew that some people believed the government wanted to make them slaves to its bureaucratic will. I knew that there were a lot of well-armed, slightly off-balance people out there. And I knew that there was a lot of angry — or, at the very least, agitated — rhetoric. (“Talking treason” the guy I knew liked to say.) But I didn’t think anyone would actually do this sort of thing. If I were old enough to remember the Weathermen, it wouldn’t have been so surprising.

After the bombing — which thankfully didn’t actually touch my life directly — just about anything associated with the militia point of view rapidly lost whatever bit of Revolutionary-era-throwback legitimacy I had carved out for it in my mind. These are modern times; there’s no need to “water the tree of liberty with the blood of tyrants,” because we are so far away from tyranny. Government wasn’t the problem; it was the bulwark against domestic terrorists. Gun legislation might not always be consistent; but it seems like a necessity. There should be no such thing as a “well-regulated militia” except as run by the states.

Above all, the tremendous amount of lost life, the needless deaths, and the premeditated brutality of the Oklahoma City bombing shows us the danger of unchecked bullshit. I don’t claim to know what was in McVeigh’s mind, though I hear he was upset about Waco and Ruby Ridge (which were unfortunate and needless in their own way). But the idea that these events herald despotism makes no more sense than the gun shop hearsay that the family friend shared with us.

Looking at American history, we see that our form of government is more durable than we let on. We have never had periods of despotism. The Republic has never fallen, although it did crack apart from within during the Civil War because of or own inconsistent ideas of “liberty.” Neither fascism nor communism — the two greatest external ideological threats to democracy — took hold. (The methods of prophylaxis — Palmer raids, strike-busting, Pinkertons, McCarthyism, widespread FBI surveillance — may even have been worse than what the forces of stability were trying to prevent.) We have survived wars and contested elections and depressions. The historical power behind the idea of America is the strongest argument against militia activity.

In fact, militias have only gotten us into trouble since they peeled us off from the British Empire. (And depending on your point of view, maybe even then too.) Shay’s Rebellion helped destroy the first post-Revolutionary confederation. Armed white civilians moving into the interior of the continent committed ethnic cleansing and spread race-based tyranny. John Brown’s raids and the Missouri troubles hastened the Civil War, while the South Carolina militia’s siege on Ft. Sumter actually started it. The Ku Klux Klan began as anti-Reconstruction civilian militia. The Gilded Age’s corporate militias killed working men and their families. The counterculture’s left-wing terrorist/nihilist militias in the 1960s and 70s helped usher in the current generation’s culture wars.

So it bothers me very much to see a contemporary resurgence in the kind of sentiment and speech that I heard in my late adolescence, the kind of words and ideas that led McVeigh and Nichols to kill 168 people fifteen years ago. I didn’t say anything about the notions I heard before Oklahoma City because I thought it was diverting, idle chatter — a jester’s story, if you will. Now that I’m starting to hear the same BS, I must say that it’s time to stop . . . before our nation’s adolescent obsession with civilian militias gets people killed again.

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“Mr. Speaker, I seek unanimous consent to revise and expand my comments in the record.”

Yes, I’m watching C-SPAN right now, waiting for the vote. But it’s making me nervous. (Presently, Minority Leader Boehner is getting roundly shouted down. But he’s also getting some “Amens!” from the chamber, too. So there’s at least a little bit of bipartisanship in the House. Ha!)

I will continue thinking about healthcare and writing about it here. Because tomorrow, however the votes are cast, I will still have diabetes; it will still be expensive; and there will still be a lot of work to do.

And it’s abundantly clear from what’s being said by both sides, there’s still a lot of need for more facts.

“I yield back the balance of my time.”

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I have a coworker who has been keeping us updated on the “whip counts.” He has been following it with the intensity that a devotee of the Tour de France might afford each stage of the 23-day race. And he’s been reporting the results in an almost cryptic shorthand that would make a cricket fan proud: “197-209 No, 205-212 with leaners, and 14 unknown.” (More results.)

Now, don’t get me wrong. I love the Tour de France, and I find cricket intriguing. I also really like bratwurst — almost all sausage, in fact — but I’m pretty sure that I wouldn’t want to eat it (quite as much) if I watched it being made. The same goes for Washington. I enjoy being in DC. I love the architecture and the museums and the people. Being inside the Capitol really is an amazing experience. But the act of getting legislation passed fills me with something between disgust and despair. And every time I have to fret over how a bill is made, I wish just a little bit more for a benevolent dictator. (Not really, but you probably get a sense of my frustration.)

This almost makes it look glamorous…

I prefer policy to politics. So I usually shrug and say, “This is what I would like to see, and I don’t really care very much how it gets passed.” Don’t get me wrong, I have my principles. There are things I think government should do when it can and actions that I absolutely think should never be taken. For the most part, though, I’m pretty flexible. I like bipartisanship, and I believe that compromise isn’t a bad thing. The perfect should not be the enemy of the good.

But this healthcare bill is so weak, so imperfect — not to mention so awfully crafted and politicked — that it took me a bit of mental back-and-forth before I could answer the question my vote-counting colleague asked. “How would you vote on the bill?”

First off, it’s absolutely clear to me and to the majority of Americans that we must do something with respect to healthcare. It’s too expensive; it’s getting more expensive; and we don’t get as much out of our healthcare dollars as people in the rest of the world do. There are about forty million uninsured Americans, and most of us have insurance at the whims of our employers and insurance providers. There’s an enormous amount of ineffective spending, and a lot of our spending doesn’t seem to make us that much healthier. We need to make some large, systemic changes to our healthcare system.

I’m not certain exactly what’s in the bill and its amendments — the various bills and amendments run to thousands of pages of text — but I am not impressed with what I’ve heard. Yes, it should bring down insurance premiums for those of us with private insurance already because it will bring more people who are relatively healthy into the pool of the insured. (Although that certainly hasn’t happened in Massachusetts despite the presence of Commonwealth Care, at least not for the average Bay Stater.) And the CBO claims that it will reduce the federal debt by $130 billion over the first 10 years and $2 trillion almost $1 trillion over the next 10. (I need to do more research to understand exactly how they arrived at these figures. I suspect that there are enough systemic changes in the bill to produce some real savings, but I don’t know if the actual costs will come down or if we’ll just see smaller increases.)

Mostly I’m disappointed because I would like to see the bill do more. My British coworkers like the National Health System — a single-payer, completely taxpayer-funded health system. My Canadian coworkers think all of the talk about national healthcare in Canada killing people is utter bullshit and fear-mongering. I look at France, which also has a single-payer system, and I see better results for patients at a lower cost per capita.

I understand that a single-payer, national healthcare system is scary to some. Even many people on Medicare or who use the VA and BIA hospitals — all of which are single-payer, tax-funded systems that are quite effective at delivering services and holding down prices while keeping their members happy — are worried that additional governmental involvement will ruin what they’ve got. While I understand that people are afraid, I don’t understand why they’re afraid. It seems to me after looking around the world that a single-payer system is the most effective option for insuring everyone, lowering costs, eliminating health-related bankruptcies, creating a “wellness” mindset, fostering efficiency, and bringing healthcare to traditionally underserved areas.

But even if you think a single-payer system is too scary or radical, there are things other nations do that we could adopt as well. For example, the government might…

• Allow importation of drugs from other nations with the same pharmaceutical standards as the United States. If a drug costs 50 cents per dose in Canada, there’s no reason it should cost many times more in the United States.
• End the absurd prohibition against states and Medicare bargaining for lower drug prices.
• Encourage competition between private insurance providers nationwide but make them nonprofit entities. (This is what Germany and Switzerland have done.) Insurance companies would compete to include people into their pool instead of excluding them, since the government would (almost certainly) provide subsidies for the chronically ill, the poor, and the elderly. Keeping customers healthy would lower costs; and by competing on service, the hope is that happier patients would also buy homeowners’ or life insurance from the same company.

These are things the current bill does not do. And I don’t understand how the bill is supposed to bring down healthcare costs overall. I do believe that it will reduce the amount that the federal government has to spend in “uncompensated care” provided by hospitals to people without insurance; but how does that translate to less total spending as measured in costs per capita or as a percentage of GDP? As far as I can tell neither the Senate nor the House bills actually constrain or reduce costs.

I am glad that the current bill tentatively slated for a vote in the house will cut the number of the uninsured by 2/3 — though it will still leave 10 million people without the ability to afford insurance. And I’m glad that it will eventually prevent insurance companies from dropping sick people or charging us more.

It’s unclear whether the reconciliation bill contains a nationwide public option with a reasonably large (though not necessarily all-inclusive) set of covered conditions and therapies — possibly a plan similar to the health insurance program that federal employees and Congress members can buy into. Such a program should prevent a race to the bottom between states (the way that interstate insurance competition probably would) at the same time that it provides a nationwide platform for insurance competition.

But I don’t understand why the many of the bill’s key provisions don’t start for four or eight years. And I’m certainly not happy with how the Senate and House leadership have been presenting the bill to the American people. Nor am I happy with how the Republicans have been staunchly opposed to the numerous good ideas that it contains.

But it’s a bill. And it’s here. And it needs to get a vote.

So back to the question of whether I would vote for it if I were a Congressman. Would I hold my nose and ignore all of its flaws? Or would I hold out for a better bill?

Ultimately, I would vote for it. There are two steps that we have to take to improve the health of Americans and the health-related competitiveness of the US economy. One is getting everybody covered so that everyone can get well or remain healthy. The other is lowering the costs of healthcare. A bill that does one without the other is incomplete, but it’s better than no bill at all.

I would vote for the bill but also be very honest with Americans. The speech might start a little something like this: “We passed a historic health insurance reform act that provides nearly universal coverage for all Americans. It was difficult to do, and it exposed many of the cultural fault lines in this country. Ultimately, it showed us that we are a nation which cares about our fellow citizens — all of them — as much as we care about ourselves. That was the easy part. Now we have to start the process of fixing the fundamental problems in the healthcare system that we hold so dear, so that we can afford the wonderful thing that we’ve just done. it’s going to involve some tough choices, but other countries with more limited resources than ours have made the necessary changes; and now they have better health than we do. It’s about time that we catch up.”

That sure sounds a lot better than the other speech members of Congress might have to give if they vote against it and it goes down to defeat: “As a nation we can’t afford our healthcare spending, but we’ve decided to wait until a later date and start over from scratch in the hopes of finding a better and/or more bipartisan bill. I hope you can hold on a little longer while your elected officials figure out what’s actually important to us as a nation.”

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I would have to say that I have a generally cheery, optimistic, “can do” disposition that is somewhat tempered by my belief that we have to persevere through adversity brought on by those who subscribe to a variety of reactionary attitudes. (My endearing, sarcastic cynicism stems — most likely — from the recognition that I have these same, conflicting attitudes within myself.) For the most part I am stoically undeterred. I go about my day gathering information, using that to formulate solutions, and acting on them as much as I can.

In short, I’m an engineer.

But I have to say that the uncertain future of healthcare change — I’m hesitant to call it “reform” or “improvement” these days — is really dragging me down. It challenges my fundamental belief that we can come up with good, equitable solutions to social and governmental problems, that we can form a more perfect union. It’s getting harder for me to push down the unwelcome, paranoid, elitist, (probably) untrue feelings that the demagogues are tricking the hoopleheads into ruining my life for inscrutable (but certainly nefarious) reasons.*

But that’s not really helpful. So today I’m going to muddle through in the only possible way I can: by writing unit tests, going to meetings, and listening to Tracy Chapman. (Oddly Tracy’s music — I’ve seen her twice, so we must be on a first-name basis by now — usually cheers me up by reminding me that it could be worse, that it was worse in the late 80s and early 90s, that there’s pain and heartbreak, that we’ve got to keep going.) Because if I can’t make things better right now, at least I can calmly carry on get excited and make things. I can keep doing what I do well and wait to get back into the right frame of mind to think about healthcare again.

* — I do recognize that there are legitimate reasons for disliking the current proposals and/or the way that the legislation might be passed. I’m limiting my resentment to those who object with questions like “Why now? Why here? Why so far-reaching? Why should I give up anything I’ve got? Why should I pay anything to help someone else?” despite all of the evidence of the need for change in order to improve the health, economic security, competitiveness, and essential fairness of the nation.

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Updated on 5 March 2010 at 8:30AM: I added a few more questions that were written down at the office.

It seems like I have a lot of answers about healthcare, but I really don’t. However, I do have some anecdotes and a few facts. And I have done some research when prompted or to fact-check other people’s claims. I even have a lot of opinions that I usually try to keep to myself.

But mostly I have a lot of questions and a rubric for evaluating options. I have a lot of questions. That’s what I do: I ask myself questions that I’d love to have answered before I come up with a firm opinion, if I come up with one at all.

I’ll tell you what I wonder, and I would love to know your questions about healthcare reform and costs.

Here are some of my questions, which I’ll number in case you want to provide your own answer:

1. How should we pay for insurance?
2. How much should individuals have to pay for their healthcare? Should everybody pay the same amount? Should we have tiers of service? Should it be tied to income? Is the important thing equality of coverage or equality of access?
3. How would allowing health insurance competition across state lines impact costs, benefits, and outcomes?
4. Would cross-border insurance competition lower insurance premiums? If so, what are the mechanisms? Would it cause a “race to the bottom” in covered services?
5. What are “health insurance compacts?” Are they run by states, nonprofit organizations, or for-profit companies? Would they promote competition, lower costs, lead to cuts or improvements in covered services, etc.?
6. What’s the proper amount of regulation of insurance companies and healthcare costs and services?
7. How would simplification — going from 51 or so different regulatory schemes and hundreds of insurance plans to a dozen or fewer — affect costs, coverage, and patients’ health?
8. What should be mandated? Why should this vary by state? What’s the right way to determine what’s covered?
9. If we continue to have a system with different mandates, aren’t we going to end up exactly where we are now, with some people covered for some illnesses and others not?
10. What’s the proper role for federalism in healthcare?
11. Does actively preventing chronic illness cost more than treatment?
12. How much of our healthcare spending is attributable to “unnecessary” incentive-based, fee-for-service activities? What are these “unnecessary” services?
13. Is radiology too expensive? Do hospitals buy the appropriate power of scanner? Is there a point where spending more doesn’t get us better results?
14. What impact would electronic health records have on costs and outcomes?
15. What is the cost to hospitals, governments, and the insured for “uncompensated care” provided to the under-insured?
16. Is it okay to bring currently healthy individuals into the insurance pool (thus lowering premiums per capita) without enacting a plan to reduce total healthcare costs at the same time? How will we sustain momentum for cost containment if we don’t?
17. What are the subsidies for insurance premiums and/or healthcare costs that are part of the (current) Democratic plan? How much are they? Who would get them? Where do the funds come from?
18. How do the plans proposed by the House and the Senate reform delivery to “ensure better outcomes” as Kent Conrad (D-ND) said they would on “Meet the Press?”
19. How does the Medicare pricing and reimbursement model impact providers, patients and costs?
20. What does the Congressional healthcare plan do to Medicare? Would the President’s plan move people to Medicaid, as the GOP says? How would it affect taxes, the costs to the states, insurance premiums?*
21. Why does everyone hate Medicaid?
22. Will the fees in the President’s plan increase the cost of healthcare, as John Kyl (R-AZ) suggests? What are these fees?
23. How much healthcare do we really need? Is there a target number?
24. What is the rationale for more government involvement? How do we know its influence won’t mess everything up or politicize coverage?
25. Why aren’t the administrative costs and overhead lower for private insurance companies?
26. With as many people paying so much for care, everybody must know someone who is having a hard time or paying a large part of their income. Why isn’t there something like a “pink ribbon campaign” to mobilize for lower healthcare costs?

Okay, now it’s your turn. Feel free to give voice to what you know in the comments, and please share your own questions. Opinions are fine, but data/evidence-based opinions are even better. Everything civil is welcome.

* — Senator Lamar Alexander (R-TN) said some rather unflattering things about the Democrats’ plan Sunday on ABC’s “This Week.” They’re all unsourced, so I’m going to leave the actual claims unstated. But it’s worth checking them out.

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There are three questions I ask whenever I look at potential healthcare changes:

1. How will it improve patient health outcomes?
2. How will it contain or reduce the cost of healthcare?
3. How will it increase access to healthcare for all Americans?

The first question focuses on the basic purpose of medicine: making or keeping us healthy. In general, it makes little sense to make a change that does not improve our wellbeing. I feel like this frequently gets lost in the conversation. Of course, treatments have costs along with benefits, so . . .

We should also ask, “What kind of value will we get for the money that we spend?” After all, it makes no sense to spend money on healthcare that doesn’t make us healthy or to pick an expensive option that is no better (medically) than a less costly one. Not every drug, procedure, or policy involves such a choice, but many do.

And finally, a variety of changes aim to move people onto insurance rolls or improve access to medication and services. These solutions ideally encourage wellness and move patients away from using the emergency room as a primary care option.

Personally, I think that we have been focusing almost exclusively on the second question: “How will this change reduce my insurance premiums and out-of-pocket costs?” And we rarely ever ask the last one: “How will this change improve the health of my relative, neighbor, coworker, or the guy I don’t know on the bus?” We seem to think that we’re not all in this together, that we’re autonomous healthcare consumers, that we can improve our own outcomes and costs without making changes at the societal level. (Ironically, if we improve everyone’s health, we should see lower overall costs. These questions/issues are all related.)

At least, that’s how I see it.

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