Ideas For Dozens: Upcoming

This is one that's been knocking around for awhile. So, people comment all the time on the travesty that out of the richest countries in the world, the United States is one of the few that lacks some kind of national healthcare or socialized medicine. Whether these programs are seen as highly effective (Canada) or highly problematic (UK), there is a sense amongst liberal Americans and most Europeans that offering universal healthcare is one of the basic responsibilities of the state.

After President's Clinton disastrous attempt to implement large scale nationalized healthcare failed in 1993, American patients seem permanently stuck with the mixed private/HMO/corporate/government system we've got.

On the other side of this equation are doctors. The spiraling costs of Medical Liability Insurance have made practicing certain kinds of medicine in certain states unprofitable for any doctor and was a major campaign issue for President Bush in this past
election. Right now, the President and Congressional Republicans are seeking legislation that would attempt to limit doctors costs by capping payouts to litigating patients. To some degree this Republican position -- even this oppositional formulation of the issue (patients vs. doctors) -- is a product of the Democratic party's relationship with trial lawyer unions and the Republicans attempt to weaken, or at least make political hay out of, that support.

Awhile ago, around the end of John Kitzhaber's term as Oregon's Governor, I heard him on OPB discussing his legacy. As a doctor and author of the groundbreaking Oregon Health Plan, Kitzhaber's legacy is largely in the field of healthcare and it is an excellent one. The OHP's main innovation was that it attempted to address the actual costs involved in health care. A board of experts created a hierarchical list of procedures in terms of their medical necessity, the cost of paying for each of these procedures was evaluated, and then the budget for the plan was spent by starting with most necessary procedure, fully funding it, and moving down the list until the money ran out. While some seemingly arbitrary, and controversial, lines were drawn between procedures that would be funded and ones that wouldn't -- and the plan's budget has slowly been whittled by local Republicans and the recent recession until it exists only for the poorest of Oregonians -- it served to kick-start the kind of honest examination of the public costs and benefits of medical procedures that is a necessary first step towards universal health care and it got me to thinking.

It seems to me that one of the largest unexamined cost of healthcare is malpractice insurance itself. That is, since the ability of patients to receive care is based on the ability of doctors to economically provide it, malpractice insurance costs seem not just a cost of being a doctor that should accrue to the individual practitioners, but also a cost of having doctors, which should be paid by the society as a whole which reaps the benefits. Also, insurance is already a kind of socialization of risk, so it seems that there ought to be a mechanism whereby the heath care-consuming public could participate in sharing and dispersing the risk whose concentration results in the prohibitively high costs of doing business for certain kinds of doctors in certain places (i.e. ObGyn in Nevada, etc.) the absence of whom causes a great public calamity.

The only counter-argument I can see to this is that of the Economic theory of the Moral Hazard wherein reduction in the negative effects of risk, via insurance for example, leads to an increased willingness to take risks. I think that this effect would be forcefully counterbalanced by doctors' rigorous training and professional code.

For the last couple of days, I've been thinking about the practice of research, the web, and that thing out there somewhere we call 'Reality'. I heard a story fragment on NPR about a scientist who discovered evidence of some fossil evidence in Africa supporting the birds-evolved-from-dinosaurs hypothesis and also a series of colorful local folk tales. I heard just enough -- fact fragments: names of species, locations, people -- that I realized if I was interested, I could look up the whole story on the web. I could concoct a Google search, the results of which would serve to embed this strange and fanciful story fragment into the network of things I know, concretely, to be true, i.e. Reality -- which, as Philip K. Dick defined it is "that which when you stop believing in it does not go away." It also occurred to me that, without the web, I would have virtually no way of determining the story's reality without using the kind of advanced -- and all too uncommon -- research skills provided me by my liberal arts education. I would have to trust in the authority of NPR; I would believe the story exactly to the extent that I had faith in NPR. So the first thing here is: the web has made at least some aspects of this process of embedding facts or, maybe more importantly claims, into the network of known-things. With Google, research becomes simply search; and the authority and specialization that surround the protection of the truth -- of Reality -- become a little more widely distributed.

Secondly, this train of thought got me to thinking about why reseach (or search) works, why it yields a believable result about the world. It seems to me that research's authority in this department depends entirely on the ability of available documents to represent the world. That is, research is limitted exactly by the extent, depth, and believability of the texts on which it depends.

Now with this idea I don't want to proceed in the direction of some kind of critique of the knowability of the world through rational means, but instead to take a wild left turn and talk about internet marketing: specifically immersive games, alternative reality games (ARGs), unfictions or whatever you want to call them -- the cultural form that has so far found its highest expression in the Beast, an ARG surrounding the release of Steven Spielberg's film A.I. and I Love Bees, an ARG which acted as viral marketing for the relase of Microsoft's Halo 2. Now, if you are not familiar with these games, follow those links and find out about them; they are very difficult to describe abstractyl. Suffice it to say that they are complex series of narratives/puzzles that are meant to be viewed/solved by emergent communities of networked players in which the clues that advance the story are embedded in normal-seeming content througout the internet. Now much has been said about the way these games immerse their participants in the realities they set up (the best analysis of this I've seen is here by Jane McGonigal of UCBerkeley who worked on I Love Bees). What I want to get at is the relationship borne by the documents -- websites, email addresses, images, recordings of real world conversations, etc. -- that constitute these games to the rest of the documents that constitue the (re)search-sphere. If they extend the reality effect of the (re)search-sphere into their mimetic universes -- as would account for the 'reality effect' encountered by their participants -- don't they also plant a seed of something strange in the wider world of information? The game documents' role in this wider world is two fold: the simultaneously constitue 'false' information about the topic they cover within the mimetic world of the game -- i.e. they may contain data about people and events that are not real. If you reached one of these pages by searching for terms unrelated to the game, you would be getting false data, you would be misled about reality. On the other hand, they are also documents of the game itself proof of its existence in reality. This dual existence is what poses the problem people have with these kinds of games, what generates their nerdy uncoolness -- since this is a constant trope: the nerd or sci-fi addict who can't tell the difference between the game and real life. It seems that ARGs, though, change certain things about this trope by bringing these documents out in the open, as it were, where anyone can mistake them for real. In the ARG community these documents, which one might simply stumble across without seeking a game, are called 'rabbit holes' -- places you come stumbling along following your normal clockwork rabit when suddenly a porthole onto a new world opens up in front of you.

The existence of these rabbit holes in the search-sphere seem to both call its reality claim into question entirely and to greatly enrich it as a place where new human experience can happen rather than simply as that parallel plane which covers Reality, never touching it, always decribing it, pushing it ever further away.

It seems to me that various new web-ways of keeping in touch operate differently from other communication channels that have become familiar. I'm thinking here of things like blogs, friendster pages, etc. -- broadcast-based systems which seem new to the world with the web -- not email and instant messaging, which are basically web-ifications of existing channels: physical mail and the telephone. I think the difference is one of type rather than degree. These are not extensions or efficiences of 'analog' modes, but a new type of communication. I don't actually know that they constitute communication at all. Or, at least, maybe viewing them doesn't.

Here's what I mean: even though blogs -- and friendster pages and the like -- provide ways for the viewer to communicate with the post-er (comments, eg.), visitors mainly experience the site voyeuristically. They get the quick thrill of an artificial closeness that comes from looking into people's lives without them looking back at you, even though the material is explicitly "presented" for others to look at. The best blogs make you feel like you're looking into someone else's life and private thoughts, maybe without their knowledge; this effect is increased when the post-er is someone you know well, when you can better infer them from the things they present. A few times, I 've gone to people's blogs or friendster pages with the idea of communictating with them -- maybe they're someone I no longer see a lot, someone I miss and I don't have a current email address for them. After looking around awhile, reading their posts, looking at pictures of them, reading lists of things they like, my need to see them is spent. I feel like I've spent some time with them. The thing is: I actually haven't communicated with them. They don't know I'm thinking about them. I haven't caused them to think about me. I haven't told them anything, or done anything we normally think of communication as accomplishing. No information has been transferred even though the desire to communicate has been sated.

Whoever said that in the blogosphere everyone will be famous for fifteeen people had it only part of the picture. What happens when we start to be 'famous" for our friends? When that uncanny voyeuristic co-existence of closeness and distance that so defines media celebrity imposes itself into our relationships with each other?

It seems to me that at some point in the twentieth century the dominant metaphor for the artist switched from Producer of Commercial Product to Consumer of Consumer Products.

Producers -- Nike, say, or Prada -- define a unique style (a set of differences between their products and others that are similar) and the meaning of that style (a la Nike Go and both companies various highly sophisticated print campaigns). This is how Modern artists did it: from Picasso through Pollock: signature approaches, methods, and subjects (style) associated with worldviews (meaning of the style).

Consumers -- on the other hand -- define themselves by choosing amongst products and combining them. An individual's style is a combination of their choices in clothing, furniture, food, music, etc. People seem to feel strongly that their choices in these areas reflect not only what they like but who they are. High Fidelity's "What you like is more important than what you are like" is, in reality, synthezised. To be clear: consumers' identities are not reduced to their purchasing choices, but (ideally) acted out through them, embodied, or embedded in them and in the way they use, combine and think about their purchases. This is how Postmodern artists do it: Cindy Sherman, Matthew Barney, Damien Hirst, et al. They define themselves by combining, altering and reversing the meanings of existing cultural objects and practices -- the high art equivalent of making iTunes playlists and Amazon wish lists.

My point is not so much the periodization -- as obviously these categories messily overlap with Duchamps and Gehrys frolicking about in inappropriate decades -- as the continuity of the critiques applied to both sides of this metaphor. Convervatives, of political or artistic stripe, tend to be highly mistrustful of the Consumer. They privelege the Producer side of the relationsip, allotting to it all of the positive values: active, not passive; critical, not gullible; enlightened, not narcotized; creative, not consumptive.

It is pleasant to think that the acceptance of Postmodern art -- which by any reckoning has been underway at least 25 years -- might herald the end of these biases in regard to the wider culture. After all, we are all Consumers, every last one of us.