Do you believe you have a soul?

Dollhouse Starring Eliza Dushku

Forget for a moment whether that soul continues to exist after you die; I’m not asking what color your religion is. Instead, I’d like to know whether you believe there’s something more to being human than mere material subsistence: consciousness, the capacity for rational thought, the emotional, intellectual, and logical processes that in some important way set us apart from our animal friends.

Do you believe that part of your existence is prospectively separable from your physical existence, intellectually, mechanically, digitally, or spiritually? That’s what I mean when I ask whether you believe you have a soul – is your essence distinct from your substance?

From militantly devout atheists to eagerly martyred Islamic extremists, almost all of us believe in this kind of a soul, an intellectual consciousness somehow divisible from our skin and bones, our axons and dendrites, a soul which is the source of our notion of justice and our capacities for abstract reasoning. We are logical and emotional and not merely biological beings, or so we believe.

But what do these beliefs imply? What if we could literally separate our consciousness from our body while that body continued to live? Would we want to? What is the moral status of our body while we are separated from it? Are we still connected to it, or has it somehow taken on a moral existence of its own?

And what if we could watch a television series that engaged these questions, and each week explored further the questions generated by that scenario? Fox’s Dollhouse, created by Joss Whedon (Firefly, Angel, Buffy the Vampire Slayer) and starring Eliza Dushku (Bring it On, True Lies) and Tahmoh Penikett (Battlestar Galactica), does just this, and may be the most intellectually engaging television series in the history of American television.

Television rots your brain, or rather, it softens it for Alec Baldwin to slurp like a slushie drink, or so he said in an advertisement during the 2009 Super Bowl. This popular image of television and other forms of visual programming as stultifying rather than edifying is being proven incorrect by the increasingly intelligent content produced for these media. While popular series from Dancing with the Stars to Two and a Half Men may offer little to no intellectual engagement at the same time as these series are finding massive audiences, so too are smart shows from Dexter to Deadwood, from The Sopranos to The Wire finding audiences despite their darker subject matter. While many people will escape the despair of economic gloom in Survivor or some variety of mischievous Housewives, we in the know take solace in the broadcast of intelligent, intriguing long-form fiction which, when done properly, challenges us to think about the human condition in ways that we might not have considered previously. Art has come to the boob tube, if only more of us would pay attention, literati especially.

On a daily basis, intellectualism-lite hits broadcast and cable television in the form of a variety of procedural series: you might have heard of the most popular family of shows on television, CSI: Crime Scene Investigation and its spinoffs, or one of the longest-running, Law & Order and its spinoffs. Even medical series, from the recently departed ER to the ever-popular Grey’s Anatomy are procedurals as well, only focusing on a different sort of problem. Therein, the viewer is asked not to focus so much on a set of relationships or conflicts but rather on some sort of mystery, which changes from one episode to the next. Properly done, each episode in this kind of series lets the viewer both satiate her or his base desire for character-driven drama while also allowing for the activation of the problem-solving areas of the brain; we aren’t just led from point-to-point on the chase to solving the mystery of the week. The writers of the best of these shows make us think about the motivations of the potential villains, make us ponder the protagonists’ decision-making, and occasionally entangle the characters in important social, political, and philosophical questions that can be wrapped up in the sixty-minute time limit.

These procedurals are distinct from more common television series, which focus on comedy, relationships, and drama for drama’s sake; the distinction lies in the attempt to actively engage the viewer’s intellectual inclinations. That these shows have not removed the commonly held scorn of the èlite toward flickering photography has everything to do, however, with the fact that these programs do so only on the surface, their plots and characters provide only a shallow depth to what is still mere cotton candy entertainment. They rise above the most base dreck, but not enough to distinguish themselves as more than mere entertainment: a procedural, even one shot beautifully starring award-winning actors and actresses, can rarely engage its audience more than superficially.

Some series step beyond superficial entertainment into a new level of conceptual complexity that goes beyond what a sixty minute episode can conclude. These series have some sort of conflict built into their creative core. Perhaps the new paradigm for this kind of show is Battlestar Galactica. In that series, a race of sentient machines created by humanity wipes out all but a few thousand of its creators in a nuclear holocaust; across four seasons, the surviving humans race across the galaxy trying to flee the robots they’ve created who believe the humans wish extinction on them just as strongly. The central question of Battlestar Galactica is whether, if we have created our own executioners, if we fight amongst one another endlessly in the face of our extinction, is our species really worth saving?

Programs like Battlestar Galactica explore issues existential, metaphysical, political, and social in their very conception. They are also free to examine issues in individual episodes just as though they had a mystery to solve in the sixty-minute window of a mere procedural series. Therefore, Dexter, about a serial killer who through careful training has been molded to both avoid detection and murder only other serial killers, will in one episode invite the viewer to question the morality of such an arrangement, ponder whether sociopaths can really be trained like puppies, question the extent to which a literal or figurative parent has the right to mold someone so thoroughly, and be forced to wrangle the ethical dilemma of whether an attorney who maliciously manipulates the legal system is just as guilty as the man who stabs with a knife. These shows can bring intellectual richness to viewer’s lives that procedurals, pure comedies and dramas, and even nonfictional documentaries cannot alone achieve.

And yet there is one class of television program that exceeds even conceptually complex programs in contemporary production; a higher level, as it were. These programs take the thematic conflicts at the center of such programs, the weekly mystery of the procedural, add the witty, educated dialogue of an Aaron Sorkin script, and keep the strong relationships and characters of dramas and comedies. These shows are, if not exclusively, at least often the creation of Joss Whedon.

I am no slobbering fanboy who believes the man infallible; indeed, once in the execution stage, his series can sometimes lose focus, his writing and directing of individual episodes is often too focused on relationships and not enough on theme. His series start slow, like essays going through the drafting process. But the strength of each of his three series prior to Dollhouse is in their conception and what he allows himself and the other writers and producers to create with each act, episode, and season of those creations.

Begin with his most famous creation, Buffy the Vampire Slayer. Sadly, the name alone turned off millions of prospective fans, and yet the title itself signals the genius conflict at the center of its creation: a hitherto unassuming and popularity-obsessed Valley girl discovers she is a supernaturally endowed superhero who must fight demons bent on the extermination of humankind. Like Battlestar Galactica and other such series, Buffy had both that central conflict and a weekly problem of some sort to solve. Story arcs of varying complexity crossed from episodes ranging  in the single digits to multiple seasons, and thematically, like Dexter or LOST, Buffy’s central conflict lent itself to thematic variations, like a classical symphony: Whedon conducted his writers and producers down winding roads of death, friendship, maturity, forgiveness, sexuality, and feminism, to sometimes greater and sometimes lesser effect.

So, too, did Whedon’s other two series combine thematic complexity with witty dialogue, close relationships, and weekly situations to solve. The Buffy spinoff Angel, starring David Boreanaz of the Fox hit Bones, explored a similar conflict to that of its mother series: whether a creature of darkness, granted a reprieve for his sins, could find repentance through good works: he helped the helpless using the supernatural strength and speed of a vampire. In Firefly, a comedic space western, Whedon began to explore more political themes. In every society, there is an inherent tension between the good of the many and the good of the few, or the one. How much right does the government have to interfere in the lives of individuals? How much personal freedom can individuals demand of the government when our actions have consequences for others? We clearly depend on each other, but how much can we afford to? These questions were examined in the guise of the crew of an interplanetary sometimes-smuggler/sometimes-freighter, the Serenity, led by a former freedom fighter (Nathan Fillion of the recent ABC hit Castle) who took on two refugees from the star system’s totalitarian government.

Put simply, if you want an enjoyable, cerebral serial fiction experience nonpareil, seek no further than the Joss Whedon oeuvre.

And yet even this might seem a matter of mere degree; perhaps Whedon was lucky or  was just a little bit better at hitting the central conflict and finding the corresponding episodic and season-long complementary conflicts, or might merely have found those conflicts that inspired adoration in this author.

Dollhouse is another story. Regardless of its ability to connect emotionally or aesthetically (while I disagree with reviewers who had and have problems with both criteria, such reviews are beyond the scope of this essay), it is the most intellectually engaging show on American television today, and might be the most cerebrally significant series in history.

If our consciousness and memories are indeed discrete entities separable from our substance as discussed above, the titular Dollhouse actually pulls off the separation. When young people are desperate and have no other recourse, they contract with the Dollhouse for a five-year term in exchange for an exorbitant fee. The Dollhouse gets exclusive use of their bodies, which they then fill with whatever consciousness, whether singular or composite, best suits the Dollhouse’s fabulously wealthy clients. These clients use the Dollhouse’s “actives” for a variety of tasks, from mere sexual and relationship fantasies to hostage negotiation, forensic profiling, or even professional singing.

Because the Dollhouse has removed the active’s personality and memories and imprinted a new set of biochemical imperatives, the active provides the client a real human experience: as the Dollhouse’s director explains to a prospective client in the unaired episode (on the Season One DVD), “Epitaph One,” ”an active doesn’t judge, doesn’t pretend. This [engagement] will be the purest, most genuine human encounter of your life and hers.” The active’s personality can be perfectly crafted to fit the client’s exact needs, whether interpersonal, sexual, or intellectual. Over the course of the first season and the beginning of the second, the actives have been on dozens of engagements, and some of them, despite having their new personalities “wiped” after each, have begun to achieve something resembling a sustained self-awareness.

The beauty of Dollhouse, what makes it creatively consequential, perhaps unparalleled, is the variety of conflicts inherent to this premise, the questions raised not only by that premise, but by each episode of the series in succession. The introduction to this essay was merely an appetizer. While most of us believe we have a soul, is that soul inviolable; that is, do we have a right to give that soul over to a corporation to reside on a hard drive while that corporation does with our physical bodies as they see fit? But if our soul is on a hard drive and we have no say over the actions of our body from one moment to the next, then surely that is indentured servitude or even slavery, held morally reprehensible in Western societies for well over a century. Yet it looks a lot like capitalism, too; and in the spa-state of the Dollhouse’s quarters, it looks just as much like dystopian communism. Can we sell our souls into slavery?

What about our bodies? The souls are separated from the bodies when the Dollhouse uses the latter as actives. Why should we care what happens to our bodies when our souls are separated from them? Is it not our souls from which our moral reasoning, our moral choice and conscience originate? All that matters morally are the choices we make; if my leg spasms and kicks my neighbor, then I am not morally responsible for that action, but if I intentionally punch him in the face, then I am to blame for that action. Why is it of any matter what my body does when my soul is on a hard drive in a storage room? Is the body even really mine at that point?

And what of our humanity itself? Am I a human being because I am of the species homo sapiens, because of my soul/consciousness/rationality, cogito ergo sum, because someone else tells me I am, or for some other reason? If my soul is stored on a hard drive and then wiped from my body, does my body retain some part of that essence, or have we been completely separated? Am I in two places at once? More than once place if copied? None if on a hard drive and wiped from my body? If deleted?

These and other questions are at the core of Dollhouse, questions that concern the fundamentals of human existence. And the series deals not only with these questions, but more in each episode. In the episode “Man on the Street,” the active called Sierra, played by Dichen Lachman, is raped by one of the staff of the Dollhouse. The staff of the Dollhouse are trained to treat the actives as pets rather than as people; after all, they’ve lost their capacity for rational thought in their tabula rasa, or non-imprinted state. If the soul is gone, and the active is regularly hired out for sexual fantasies anyway, why is it any different when the staff does it? The body isn’t violated any differently. And in the episode “Haunted,” Echo, played by Ms. Dushku, is imprinted with the memories and personality of a woman recently deceased, a friend of the director of the Dollhouse who, upon discovering her death wishes to solve her presumed murder. If the technology is possible, why not resurrect the dead? Put the deserving in the bodies of the undeserving? Create ever more complex machines to house our souls á la Battlestar Galactica’s soon-to-be-released spinoff series Caprica?

Therefore, it is not just that Dollhouse is conceptually complex, that it uses its episodes to explore that complexity and standalone issues, but also that the issues in an episode, in a season, and across the whole series to date are fundamental questions about human existence, questions with which we all must wrestle to a greater or lesser extent. One of the things that made Battlestar Galactica one of the most important achievements in the history of entertainment was that its central question in the age of global warming and nuclear war – does our species deserve to exist – was both powerful and, in some episodes, deeply moving. Yet that question holds one still more fundamental at its core: who am I and what am I?

While still a form of popular entertainment, Dollhouse is, on a spectrum from the most mindless of pastimes on the left to the highest concept art on the right, clearly trying to take television into the right-hand side of that spectrum. It explores the existential question and a related host in every episode. It engages those questions well enough that it deserves to be seen by more people than it is, but regardless of its viewership, Dollhouse is intellectually incomparable on modern television. It raises the bar for current and future television shows as though Joss Whedon is issuing a challenge to networks and creative minds around the U.S.: there is a way to produce intellectually compelling television at an even higher level without condescending.

–Posted by Kevin S. Burke

Dollhouse will not be renewed for a third season by FOX as reported on November 11th by The Hollywood Reporter and confirmed by Joss Whedon at the fan site Whedonesque. However, the second season will be aired by FOX in its entirety according to this schedule, beginning on December 4th at 8 PM EST with a double episode extravaganza. It can also be viewed at Hulu or Netflix and Season One, including an unaired pilot episode and an unaired thirteenth episode called “Epitaph One,” is available on DVD (or Blu-Ray) through Amazon in the US and UK.

Neither this blogger nor the members of this group blog are in any way affiliated with FOX, Mutant Enemy, or any other producers of Dollhouse, nor have we been compensated in any way for this post.

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If you’re a female under the age of about thirty-five, you probably know about American Girl dolls; they each come with their own historical setting, a six-book series, multiple outfits and accessories, and the sound of about fifty million small and not-so-small girls pleading with their parents to buy them one. I was one of them, once; my mother, who was extremely pleased to see a doll with brown hair and eyes, had planned to surprise me with Samantha for Christmas, but I found the catalogue and, steeped to the brim with Laura Ingalls Wilder stories, begged for Kirsten because she was a pioneer and wore a sunbonnet. I got her that Christmas, twenty-one years ago, and still have her, along with quite a few accessory sets – bought one at a time, twice a year (birthday and Christmas). She was by far the longest-lasting and best toy I can remember having.

Mattel bought out the company about ten years ago and in addition to expanding their stable of dolls they now have modern dolls and “best friend” dolls, some of them being pushed harder than others (poor Kirsten – since her best friend Marta dies of cholera in Book 1, I don’t think she’ll be getting a shroud-wrapped companion doll any time soon). I hadn’t thought much about them for a while, but that all changed last February when, two months to the day after my daughter was born, one of their catalogues arrived in the mail. Coincidence? I like to think so. Anyway, a quick review brought me up to date – the “Girl of the Year” was named Chrissa (um … OK) and had two friend dolls named Gwen and Sonali. All of them, of course, retailing for $95 apiece. I got another catalogue a few weeks ago, which introduced their new WWI-era Jewish doll. So imagine my surprise, when noodling around on the Huffington Post instead of doing something more productive (like, say, bouncing a rubber ball off my living room for three hours) there was a piece describing the “controversial new homeless doll.” Another doll? What the hell?

Not so much, as it turned out. The “controversial new doll” was the Gwen friend doll, who has been on the market for about ten months and, contrary to the piece (and the New York Post column decrying the “political preaching” and “cult-like” atmosphere of the doll stores which seems to have prompted it) wasn’t marketed as a “homeless doll.” She turns up in the Chrissa series as a shy kid who gets picked on a lot (the series is about bullying) and who was briefly homeless with her mother (living in a car) after her father walked out on them. They moved to a shelter, then an apartment. The other kids find out, and make her life hell for a while until the requisite American Girl happy ending. (Not that factual accuracy seems to be Andrea Peyser’s strong suit – her reference to a “Roaring ’20s” doll interested me, since there’s never been one to my knowledge. She’d probably have great clothes, though! Ahem, back to the original subject).

The comments on Peyser’s NY Post article are largely critical, but the HuffPo comments are largely as outraged as the columnist’s; there’s anger at a “homeless doll” being sold for the “ridiculous” price of $95 – apparently only “rich, spoiled brats” have these dolls, which would have come as news to me – apparently sharing bedrooms and not having a car because your parents can’t afford it makes you as rich as Samantha Parkington (Oops! Another cult reference!) There’s anger because the doll costs as much as all the other dolls, because she’s “too white” (seriously) and thus not typical of the homeless population. (I guess using stereotypes would have been a much better approach). Anger because she isn’t less expensive, or because the profits aren’t going directly to homeless advocacy or shelters. Anger because people are spending $95 on -gasp – a toy and not giving that money to real homeless people! The “Homeless Doll” meme seems to have gone viral; it’s turned up on ParentDish – with most of the commenters as PO’d as HuffPo’s – and turned up on CBS. If you want more examples, Google is your friend. I’ll warn you, it gets repetitive after a while.

Aside from the depressing sight of thousands of people latching onto the “Cynical marketing of a homeless doll! Outrage!” meme without bothering to do five minutes of research, I have to ask: In what way is the Evil Giant Company Mattel obliged to behave? Whatever Andrea Peyser says, they didn’t market the doll as “homeless” – I didn’t know the backstory until I flipped through the books. If they had, obviously, people would have thought they were doing an exploitative story, as the comments make clear. Should they have earmarked some of the profits from the doll for shelters? It would have been nice, I guess, but since her temporary homelessness isn’t treated by them as her sole defining characteristic I really can’t see why it’s some sort of moral imperative that this doll’s profits be donated but say, Julie The Child Of Divorce Doll’s profits not be donated to promoting divorce reform law or Kit The Impoverished Depression-Era Doll’s profits not be donated to food drives. Should the “homeless doll” not be so expensive? Her price is exactly the same as that of all the other dolls. Do people really want to go down the path where the less “wealthy” dolls are cheaper? I mean, really? For all the talking about “sending messages”, that’s one that comes across as a tad … ambiguous. (And while the dolls are certainly pricy, a lot of people get Wiis for Christmas. Just saying. Also, if you think that that’s as expensive as dolls can get, you are in for the shock of your life one of these days).

As for donating money to a charity; it’s a good thing to do, and imperative on all of us to help in whatever way we reasonably can. But donating to a charity and buying a toy are two different things. Sure, take your kid down to the soup kitchen and have them help out; it’s good for them to learn to help. But to say that this should be done instead of buying them specific toys is missing the point. There’s a time to serve, and there’s also a time to play. Take your daughter to help with the church sandwich program. Then, for Christmas, if you can afford it and she really wants it, give her a toy or a doll. Years from now, she’ll thank you for both experiences.

This is the second of three posts on health care reform in the United States. The first post was about which type of experts to trust. The third post will be published on the so-called “public option” after the author has had a chance to review the legislation.

Tonight, Wednesday, September 9, 2009, President Obama addressed a joint session of Congress to argue for health care reform. But you might not realize why health care reform is so desperately needed in the United States, since your only experience of health care in the US might have been good visits with an excellent physician. The need for health care system reform isn’t about the quality of our doctors and other health care providers: for the most part, they’re highly qualified and good at their jobs. Instead, there are three basic symptoms of ill health in our health care system, and I will investigate the causes of those symptoms in this essay, partly from the view of an insider who worked in health care for six years, partly from the view of someone especially knowledgeable about the health care system from careful study. I argue that because the health of this system has been bad for so long, we must take action as soon as we can to reform it.

When we’re evaluating the health of the health care system, there are symptoms and there are causes, just like when we look at the health of a person. A cough could mean that you have a cold, or it might mean that you have emphysema. Therefore, let’s examine the symptoms thoroughly first, and then we can get to the causes.

According to a recent Gallup Poll, the United States ranked 18^th among the 30 nation-states comprising the Organization for Economic Co-operation and Development; 83% of Americans are satisfied with their health care and 16% are dissatisfied. This result comes despite the fact that the US had the second-highest GDP per capita among the OECD nations (and thus, the world). We’re also the wealthiest nation in the world in terms of nominal GDP. What this means: despite our wealth, we aren’t all that happy, relative to our economic situation, with the health care we’re receiving. And remember what I said above – we’ve got really good doctors; we all know that. If our doctors and other medical professionals are well-trained and we’re relatively unhappy, what’s going on here?

Moreover, Americans spend more per capita on healthcare than any other nation. How is this different than our mere wealth? We’re each spending a ton of money to get mediocre results, putting our money to little use: we’re being inefficient. From spending on our insurance premiums to doctor’s office copays to coinsurance on prescriptions and surgeries, we’re paying more than any other nation in the world. And I didn’t mention the subsidies that end up going toward the uninsured or the payroll taxes that we pay for Medicare; we pay a lot for health care in the United States.

About those uninsured – according to the US Census Bureau, there are 45.7 million Americans who live without health insurance. In a nation of around 300 million residents, we’re not providing health insurance to 15 percent of our population. Some of these people have well-paying jobs and don’t have trouble paying for this expensive health care. But many more of them don’t have income to cover the expenses that go along with the high costs of health care in the United States. Insurance, after all, is intended to make health care less expensive – you (and, in our system, your employer) pay a premium so that when you use health care, most of the expense is covered by your insurer, thus softening the blow of the treatment. When someone is uninsured, he is unable to get that blow softened; doctors are either forced to accept less payment, no payment, or damage the finances of the uninsured person even further in their time of medical need.

And these are just three notable symptoms of our health care system’s illness, the cough, the sneeze, and the runny nose, as it were. The total list of symptoms could be much more exhaustive, but it’s enough to get us started on trying to get to the bottom of some of the causes of these symptoms, which I’ve seen first-hand in my six years of medical billing experience.

We should recognize that many of these problems are rooted in the way we deal with the cost of health care in the US: health insurance. Part of the problem is the particular public and private insurance partnership we’ve ended up with, and part of the problem is with the way the insurance market has evolved.

Insurance, as I noted above, is a scheme in which we attempt to reduce the amount that we pay for something, in this case health care. It might seem that we pay a little bit at a time so that we “build up” equity in a kind of health care fund. That’s not how it works. Instead, it’s more like a subscription service: the consumer pays a fee every month so that when they do need a health care service, the total amount they have to pay is reduced, and the insurance company draws from the subscription fees of everyone else to pay the doctor. They make a profit by getting more fees than they pay for services. Because health care is expensive, though, the system evolved pretty quickly so that employers offered health insurance benefits to their employees in order to give them extra incentives to join that company. That way, each month the employer and the employee shared the subscription fee of the insurance. In some cases, employers covered the whole cost of monthly premiums. When the employee needs to see a doctor or goes to the emergency room or has surgery, he or she still has to pay a copay or a percentage of the total fee of the service, which will differ depending on the service, but the insurance company pays the rest of the bill.

Once this system evolved, though, it was obvious that we had a problem; specifically, what do we do with those people who don’t have jobs, or employers who can split the insurance bill, or the indigent, or the retired? Do they have to pay the mountainous medical fees themselves, or, in the case of the indigent especially, how do doctors deal with the costs of treatment?

To solve this problem, we developed Medicare and Medicaid. Medicare is a program for the retired: those who meet the basic conditions of the program get low-cost health insurance, and the program is funded by a special payroll tax that’s outside the regular federal budget. Medicaid, on the other hand, is a program for the indigent: those who are either unemployed or have such low incomes that they can’t afford to get insurance either through their employers or for themselves. This program is funded through a combination of the regular federal government budget and each state’s budget; it’s a kind of partnership between the national government and the state governments.

I called this way of doing business a problem for a reason. Part of that problem is with the nature of insurance: the insurance company is taking a risk that you won’t be so sick that they’ll spend more money on you than you’ll give to them over the life of your agreement with them. If you apply for insurance on the open market and you have some sort of chronic health condition like diabetes or migraine headaches or something even worse, they might reject you. In fact, it’s in the insurance company’s interest not just to reject potential risks: every time you make a claim, they want to find excuses to reject it. From the doctor’s office accidentally mis-coding the diagnosis to you not calling them in advance to get pre-certification for a service, they want to find reasons not to pay so that they can save every penny they can without losing out on premiums. If the doctor’s office doesn’t recognize they’ve made some minor typographical error within a certain “timely filing” window, the insurance company doesn’t have to ever pay the claim to the doctor. If they think there’s a reason you went to the doctor when you didn’t have to, they’ll deny it as not being medically necessary, and leave the balance to you the patient. Even worse, if you develop a serious medical condition, insurance companies can – and sometimes do – just drop you from their rolls altogether, so that you have to pay the full bill for your medical services yourself. And because they have so much more power than you do, there’s often little to nothing you can do about it.

Because the states have recognized the power differential between the insurance companies and the insured, they’ve all, to a greater or lesser extent (depending on the political culture of that state), put together regulations and medical advisory boards in order to protect consumers.

But there’s a problem here that the states can’t deal with. According to the US Constitution, Article 1, Section 8, the federal government is the only entity with the power to regulate commerce between or among states. When an insurance company does business that crosses state lines, then, there’s very little any one state can do to regulate its size or promote competition.

This problem has become huge in the United States. Because of factors too complicated to get into here, there are really two major health care insurers in the United States, with several also-rans who fight over the scraps. The big winners are the United Health Group and the Blue Cross Blue Shield Association, which is usually represented by Wellpoint in the statistics. UHC and BCBS, as we call them in the billing and health care field, tend to take up a large percentage of non-Medicare patients and receipts, across specialties and across states. Aetna, Humana, and Cigna, respectively, each have a decent piece of the pie, but those pieces of the pie aren’t especially large relative to the mammoths of the industry.

What does this mean for consumers? Nothing good. UHC and Wellpoint each have the power to set the terms for the insurance conversation in almost every state they do business, and they have tremendous power in the United States at large. They can provide bad service in each state; bad service to doctors, bad service to patients, and meet state and federal regulations at a bare-minimum level. They are, put simply, monopolistic enterprises. While we in the United States value capitalism almost as much as we value liberty, monopoly is capitalism gone bad: monopolies leverage their power to keep other companies from providing services, which gives consumers fewer choices and, usually, worse services.

The only payer that rivals these insurance companies in size is Medicare; because the aging members of society tend to run into illnesses and injuries more than the rest of us, they use health care services more than we do. Medicare has a lot of the same monopoly-style power that UHC and Wellpoint have, and for good reason; they have the broadest demographic of subscribers built in to their programs. Medicare’s payment and enrollment policies are mandated by law, though – they have no incentives for trying to provide fewer services, and Medicare does an excellent job of negotiating low prices with doctors. So while Medicare is part of the monopoly problem, it isn’t as bad as UHC or Wellpoint in some respects.

But among Medicare, Medicaid, and the private insurance companies, we still have that gap of 45 million Americans without health insurance, and that’s something that has needed fixing for a long time, something that needs fixing even more given the recession conditions we’re faced with now. Think about how all this works: we’ve covered retired people with Medicare, people who are employed with medium-to-large sized companies through private insurers like United Healthcare or Aetna, and the indigent through Medicaid. But what about people who make more money than the Medicaid threshold but whose company can’t afford to split the difference on health insurance? What about self-employed consultants and freelance writers? Low-wage and part-time workers who don’t qualify for benefits in the first place? Suddenly, our institutions have left a big gap, one that widens every day.

Furthermore, while people complain about how Medicare and Social Security are running out of money, these are relatively easy problems to fix. The solution is fairly simple: raise the payroll taxes on these programs, adjust the benefits, raise the retirement age (since Americans are living longer and more productive lives), and move on. The only holdup is that these changes are in the hands of politicians, who don’t have the will to do what’s necessary. The big problem is that we keep adding people to the list of the uninsured from Medicaid, because this program is a partnership between the state and national governments. The federal government funds it from the regular budget, and the state governments fund it from their regular budgets. State governments, unlike the national government, almost all have a viciously restrictive check on their ability to fund Medicaid on top of the fact that politicians have to fund it: their constitutions usually require that they balance their budgets from year to year. This requirement is bad because in an economic downturn like this one, as more people become unemployed, more people need services like Medicaid. But fewer people are employed and contributing to the tax base, thus requiring the state government to cut services. Either they force people out of Medicaid, or they lower payments to doctors. In many cases, when the latter happens, doctors refuse to take Medicaid patients, making Medicaid an even worse program. It’s a vicious cycle that no one seems to want to fix.

So now we find ourselves in a mess: insurance companies have incentives to minimize services offered and avoid paying for services at all. Then the people who need those services the most get rejected because they have “pre-existing conditions“. Then the system leaves 15% of us without health insurance, from those who can’t pay to those who would be severely set back financially if they paid. But if they didn’t pay their doctors, the doctors would just stop taking uninsured patients. What the heck?

Part of the blame, despite their professional competence, lies in the administration of medical care and the way doctors think about their profession. We hear a lot about administrative costs in the health care debate: I was one of those administrative costs, a reimbursement specialist who tried to get doctors paid when insurance companies denied claims. I was exceptionally good at it. But I was necessary because of the way doctors and insurance companies interact. Doctors want to fix the patient, get paid, and move on. Insurance companies want to get paid, and if they’re going to give money to a doctor, they want to know why. When you see a doctor, she checks off on a sheet or a tablet what services she provided to you. Then that record goes to a billing department which double-checks the record for accuracy and transmits it electronically to the insurance company. If everything is acceptable to the insurance company, they pay within one to four weeks. If not, they deny the claim and give a brief explanation why.

Doctors hate this system. They don’t like justifying what they do. Part of the problem is that they don’t take classes in health care policy or in medical coding; they simply don’t have the training to turn their medical exam, procedure, and/or findings into the codes the insurance company uses to simplify their end of the business. But this is also bizarre; doctors are scientists, after all. Why wouldn’t they want to thoroughly document what they do so that the work they do can be followed up on if necessary and the insurance company can see what they need to see to give the doctors the reimbursement they deserve?

But it’s not just because doctors hate the process that people like me get hired; medical billing has become an extremely complicated enterprise. Medical procedures are broken down into thousands of codes that describe each different procedure, which can be different depending on anatomical site or the method by which the procedure was performed, plus doctors must provide a diagnosis for each procedure: these are also broken down into the thousands, which are similarly precise. There are governing bodies which give medical coders their CPC or Certified Professional Coder certification, so that these individuals can determine from a doctor’s notes what codes the insurance company will recognize from the services the doctor provided. And then, if anything about the billing is incorrect, someone has to look back through all the information from the claim, the codes, the service addresses, the insurance information, and determine what, exactly, went wrong. And a billing department might consist of several different people performing different functions, depending on the size and revenue of the office – a person to code the charges, another to input them, another to transmit or mail them, another to call patients about their unpaid copays, another to follow up on unpaid claims, and so on.

And those aren’t counting the costs on the insurance side: the actuaries who determine risk, the adjusters who pay claims, the appeals adjusters who look at claims a second time, the managers and executives and asssistants and mail clerks and so on. Or the administrative costs in the doctor’s office that aren’t part of the insurance billing process, like front office staff and accountants and attorneys and IT staff. Medical administration is labyrinthine and massive, and hopefully you can see how we’re spending so much on our medical care.

But up at the top, I talked about something that should have brought up a contradiction in your mind. We have some of the best-trained, most professional doctors in the world, and yet we’re still dissatisfied with our health care. How can these two things go together? Can we blame that on the insurance industry?

It’s not so much the fault of the insurance industry as the fault of the insurance industry and the doctors put together. The problem is that doctors get paid on a fee-for-service basis rather than on a set salary. Of course doctors are highly trained and deserve to be well-paid for what they do. But they get paid more for each individual service they provide, rather than for the quality of service they provide or for simply providing the correct, purely adequate service. Every doctor in the United States who works in private practice (not in a hospital, where things work a little differently because of the slightly more urgent setting) has a financial incentive to see as many patients in a day as he or she can. Most doctors schedule four to six patients per hour (10-15 minutes per patient) though their financial incentive gives them reason to schedule even more than that, and to provide services even when they aren’t medically necessary. If a patient needs to take longer than the doctor wants to take with the patient, that doctor might feel rushed to get out of the room.

Not every doctor will rush out of the room, of course, but many will. Or if a patient is shy or doesn’t communicate well, the doctor might not take the time to ask the questions necessary to find out what’s wrong, or might simply order a test rather than taking an in-depth interview; an X-ray or an MRI might figure out what the problem is and the doctor can go get money for another patient; the doctor even gets more money for figuring out what was learned from the test! While a doctor gets a fee increase for conducting a more in-depth interview, the fee for seeing more patients more often is usually higher than the fee for dealing with a more complex problem.

And still, this doesn’t mean that the doctor is bad, it just means that the doctor is facing pressure that she shouldn’t be. She has staff and rent and equipment to pay for, on top of a house and a car and a family and her own lifestyle, whatever that might be, and all that combines to force her to treat medicine not as an analytical process by which she uses her faculties to determine a problem and find a creative solution; instead, she’s trying to find a quick template for something she’s seen before and apply it quickly so she can get paid and move on.

While I can’t stress enough that not every doctor does this, that I’ve seen doctors who are fantastic and took the time to treat me or another patient like both a person and a complicated medical problem that needed treating, the financial incentive is against the patient on several levels. The financial incentive is to move on as quickly as possible and get paid as quickly as possible and find as many patients as you can who require extra services like surgeries and injections to boost the fee.

We need reform, and we need it now. These skewed incentives and gaps and monopolies have been here for at least a decade, which is the time span in which I worked in medical billing, and they’ve most likely been there at least three times that long if I understand the history of this issue correctly. So why reform now?

A combination of factors: first, we might be able to overcome the collective action problem, or the collective act of will, for the first time in decades, because the party in power thinks health care reform is important, and because the President has a gift for speaking and gathering support; second, because the unemployment rate is higher than it has been in almost twenty years, which means the gaps are widening, and we have to figure out how to help those people; third, because we are in an historic recession, and we can’t afford for health care costs to keep rising, and fourth, because we are in an historic recession and those are the best times economically to build long-term institutional reform.

But perhaps most importantly, people are suffering on a daily basis because we don’t take action on this subject. Someone you know, maybe someone you love, might be putting off going to a psychiatrist because she doesn’t have health insurance. What if she commits suicide? You might know someone else whose chronic condition is so badly treated by a doctor in a hurry that he suddenly dies of a cancer that wasn’t found until it was far too late to be treated. Or how do we manage the case of the doctor who does everything right? He keeps up-to-date on all the best journals, takes all the time necessary for each patient, but doesn’t make enough money to make ends meet, loses patience witht he profession, and switches to another profession? Then the whole system suffers. We have to help these people, and, because there are so many, all of whose lives could go wrong so quickly, we have to do it fast.

There’s an important counter-argument here; we don’t want to get this wrong by going too quickly, because we could cause more suffering in the long term. But we can still deliberate on these matters with all due urgency. We have to try to help those with whom we have the ties of mutual nationality, don’t we? We may not be able to fix every problem that they have, but when we see that other nation-states are doing a better job of this, surely we can at least recognize that we can do better and try harder. Don’t we owe that both to those suffering, and to ourselves?

As I mentioned in my previous post, and will bring up in my third, I prefer a public, or government-sponsored option as part of this institutional reform, and I strongly believe that this is the best, most likely way to effect both short-term and long-term change that will eliminate, or at least alleviate, both the symptoms of ill health in the US health care system and the underlying causes. However, whether a public option is included or not, reform must come, as increased cost per capita with lower satisfaction and higher rolls of uninsured simply cannot be allowed to continue. In my next post, I will examine the public option alongside other options and explain why I favor it.

Note: while in my previous post I argued that the only appropriate expert witness in the health care debate was that of the economist and then noted that I was not one, this was a different kind of testimony: eyewitness testimony. As I mentioned, I spent six years in the medical billing industry stretching back nearly a decade. I’ve seen the insurance industry and the health care industry up close, and I no longer have a personal stake in them, so I don’t have the same conflict of interest that doctors have. Furthermore, while I’m not an economist, I took several courses in economics as an undergraduate and am well-informed in institutions and the American political system. So while I don’t qualify as an expert, I do qualify as a someone who has more to contribute than just what he’s seen. I hope it’s helped you understand all that’s going on.

This is part one of a three part series on health care reform in the United States. The second part is a primer on how the health care system works and why it’s broken; the third will be about why I think we need a public option as part of any health care reform package. The third part will be published after I’ve had a chance to review legislation relevant to the speech and some of the broader reform efforts.

With President Obama addressing a joint session of Congress this Wednesday, September 9^th, 2009, on the subject, health care reform is again a focus of national attention. We’re being asked again to evaluate the president’s claims on the subject in light of the testimony of a great many expert witnesses. Since health care reform became a subject of serious discussion in the 2008 election cycle, we’ve had the occasional opinion from some doctor, for instance, on what he or she thinks should be the way we do health care in the future. Even the American Medical Association, allegedly the body the represents all the doctors in the United States, has made its opinion known on the matter, supporting reform but not a public option. But I don’t think we should treat doctors as our expert witnesses on the subject of large-scale institutional reform in the health care system. Instead, economists are the most suitable expert witnesses when it comes to the health of our health care system and the institutional reform that we should be implementing. After the jump, I’ll try to explain why I think economists* are suitable and medical doctors are not suitable as our experts on the subject of health care reform.

We’ve all seen the expert witness on our favorite crime procedural on TV – the psychiatrist, the medical examiner, the crime scene investigator. These expert witnesses try to explain in terms we can understand who committed the crime, or how exactly the crime happened, or how the person who committed the crime didn’t have the mens rea, or necessary intent to commit the crime, to be held legally responsible.

When it comes to health care reform, we obviously bring our own political beliefs to the table. Whether you’re a Democrat, a Republican, a Libertarian, or an independent, you probably think there’s something wrong with the way we do health care in the United States and have a vague idea of what we might do to fix it – polling leads us to believe that we’re satisfied with the quality of our care but we’re getting it inefficiently. But, like me, you probably need some help determining the specifics.

If you’ve been reading newspaper editorials or watching cable news, you might have come across a doctor talking about the national health care system – that doctor might have even been a senator or a celebrity. You might also have heard opinions from a doctor in your community on the subject. How much weight should you give to the opinions of these doctors on the subject of health care reform?

In general, not much. While an individual doctor’s opinion on the subject might be worthy of your attention, I think there are three important reasons why opinions on institutional reform should be left to others, with one group in particular taking precedence as our preferred experts – I’ll get to them in a minute.

First of all, as a class of people, the doctors we all see on a daily basis aren’t necessarily all that smart. I don’t mean to offend the medical doctors in the audience who are brilliant examples of their profession, but consider the incentives. If you’re a smart person, you have a few career options toward which you get steered – attorney, scientist, engineer, and doctor (among other things). If you pick medical doctor from those, you get a few more options – internist, specialist in a variety of fields, surgeon, or researcher. The incentives structures are set so that the smartest people go toward the specializations that pay higher – things like researching pharmaceuticals or prosthetics, complicated kinds of surgery, and so on. The more you’re interested in a particular topic, or driven by profit, the less likely you are to be the kind of doctor who runs a quiet practice and sees lots of patients. Occasionally the smartest doctors will choose to stay in low-paying medical professions like internal medicine, but all the altruistic reasons to be an internist apply at the higher-paying specialties, too. Why not get paid better?

And that’s without considering the fact that there are hundreds of medical schools in the US and the world that accept, almost of necessity, hundreds of mediocre students every year. There’s a pretty good chance your doctor, the one who’s telling you their opinion on health care reform, just isn’t that bright, especially if they’re not in an advanced specialty. Put simply, if you’re talking to a doctor in y0ur community, there’s just no reason to believe she or he has the intellectual chops to criticize the health care system unless you have specific evidence that says otherwise.

Furthermore, for decades now, you might have noticed an important trend on American television: the hospital series. From St. Elsewhere to ER, from Grey’s Anatomy to Scrubs, from Hawthorne to Nurse Jackie, we’ve been inundated for as long as I can remember with the daily lives of the members of the medical profession.

Why would I bring that up? The key thrust of most of these shows, if there is one, is that these doctors, who, for whatever reason, we’re trained to treat almost as gods, live their lives as we do. They are fallible people who make ridiculous mistakes in both their personal and professional lives. Of course, that’s not to say that they’re bad at their jobs, or any less good than anyone else. But doctors are human just like we are. We shouldn’t hold them up as people whose opinions on every subject should be respected. On the subjects on which they are experts – medicine – they are indeed worthy of our respect, if they are in fact occasionally mistaken.

But these fallible people aren’t experts on institutions, how they work, or how best to change them when they need changing. Why would we want their opinions on that subject? They are neither trained in the study of social institutions nor in the comparative benefits of different changes to those institutions when they become unhealthy.

And, of course, we must also be concerned with the fact that the opinion of a doctor on the subject of health care is a fundamentally self-interested opinion. Almost every medical doctor has a vested financial interest in keeping the health care system exactly as it is. After all, we all know that the average medical doctor makes more than the average American. If we go to a new system that threatens that status even slightly, of course the average doctor is going to feel personally threatened by the shift and will attempt to preserve the status quo however possible. And that might include giving advice that suggests we do something that’s not actually in the best interest of the country.

So if doctors aren’t necessarily the brightest, are fallible, and have a pretty blatant conflict of interest, who should we trust as our expert witnesses in the court of public opinion on the subject of health care reform?

I think the answer is obvious: economists.

While they’re no more or less fallible than doctors are, economists have three key edges on doctors when it comes to the subject of health care reform.

First of all, economists are specifically trained to diagnose the health of our political institutions. There are a wide variety of specialties in economics, too, but every economist gets basic training in assessing things like whether patients are satisfied with their health care, whether the care itself is being provided efficiently, and what kinds of remedies governments can and have taken to improve deficiencies on these kinds of scales. Additional specialization will prove even more beneficial – an economist who specializes in understanding our health care institutions and studying models of institutional change will be an even more beneficial expert witness in our reform project.

Secondly, while, like me, you’ve probably heard anecdote after anecdote about how health care in the United States is awesome and it’s terrible in Canada or the UK or somewhere else in the world, economists know better than to take these anecdotes at face value. They know to look at studies on efficiency here, and patient satisfaction there, and to do so not just based on what your cousin in Leeds told you, but based on the data. Very few doctors have training in understanding these sorts of studies, let alone using them in the context of political institutions.

Finally, to some extent, almost every economist has to communicate with the public to some extent, and so has experience explaining institutional concepts to the court of public opinion. Your doctor might be experienced talking about medicine to the layperson, but most don’t really understand all the intricacies of the health insurance industry – something I’ll be taking a stab at in my next post. Doctors don’t have to take classes in health insurance or even medical coding to get their Medical Doctor degree. An economist who takes the stand explaining the health of the health care industry will both have experience explaining institutions to the lay public, either in classrooms or in papers or elsewhere, but will have had to do so repeatedly to be able to be called an economist in the first place. While we might want to do a test screening before we put a particular economist on TV, we can still expect a better performance than we’ll get from a medical doctor.

You might be protesting at this point – WAIT! what about politics! All these economists are going to have political leanings, and so we can’t trust any of them. After all, the Democrats have their economists, the Republicans have their economists, and they all come up with their own different numbers, right?

That, my friends, is something you’re going to have to risk. If you listen to an economist explain the institutional health of the health care industry and suggest some institutional changes, then you’re going to have to pay close attention and then carefully weigh what they say against your own political beliefs before you come to your own conclusions. Just like in a court of law, you have to carefully weigh the evidence. You can’t depend solely on your own preconceptions. If you’re a conscientious voter, you shouldn’t be depending on them at all. Also, if you’re lucky and a bit industrious, you’ll spend some time tracking down reports from independent firms on what kinds of solutions they think are best.

In conclusion, I don’t think we want to completely ignore the viewpoints of doctors on the subject of health care reform, but we can’t treat them as anything more than well-informed citizens. They can’t be the experts we call to the stand to explain the problem or our options going forward. Their anecdotes, either on the success or failure of the practices of which they have taken part, will only be anecdotes just like any others. We cannot trust the fate of so important an issue where the lives of so many citizens are at stake on the misapplied training of a group of people. Instead, let’s look to the experts: economists.

* – While I am not an economist, I do have a substantial amount of undergraduate economic training and am friends with a couple of economists. However, I have no financial or other substantive interest in the long-term plight of the economist. Or The Economist, for that matter.

–Posted by Kevin S. Burke

The news on the radio this morning told me that today is the final day for Reading Rainbow. This makes me incredibly sad. It is the 3rd longest running show on PBS, after only Sesame Street and Mister Rogers. I am only 3 years older than this show, so it has effectively been around for my entire life. I found myself spontaneously singing the theme song just this past weekend when I spotted a butterfly in the yard. In elementary school, when we were waiting for our parents to come pick us up, tapes of Reading Rainbow episodes were among the few approved things we could watch once outside time was over. (Episodes of Square One were also approved. Man, now I miss Mathnet.)

I loved Reading Rainbow. I loved the illustrations from the books. I loved hearing the new stories and seeing them present ones I’d already read. I loved Levar Burton and the strangeness of seeing him in both that show and Star Trek, which was, of course, another childhood television mainstay. But the show has been on for 26 years now, so I think I could more happily let it go, if it weren’t for this explanation of why the show is ending:

The show’s run is ending, Grant explains, because no one — not the station, not PBS, not the Corporation for Public Broadcasting — will put up the several hundred thousand dollars needed to renew the show’s broadcast rights.

Grant says the funding crunch is partially to blame, but the decision to end Reading Rainbow can also be traced to a shift in the philosophy of educational television programming. The change started with the Department of Education under the Bush administration, he explains, which wanted to see a much heavier focus on the basic tools of reading — like phonics and spelling.

Grant says that PBS, CPB and the Department of Education put significant funding toward programming that would teach kids how to read — but that’s not what Reading Rainbow was trying to do.

“Reading Rainbow taught kids why to read,” Grant says. “You know, the love of reading — [the show] encouraged kids to pick up a book and to read.”

Linda Simensky, vice president for children’s programming at PBS, says that when Reading Rainbow was developed in the early 1980s, it was an era when the question was: “How do we get kids to read books?”

Since then, she explains, research has shown that teaching the mechanics of reading should be the network’s priority.

Honestly, this bothers me. I get that teaching the foundations of reading is an important first step, but isn’t inspiring kids to want to take that step also important? I had a very heavily phonics-based approach to reading taught to me in 1st grade, and I really have to say, Reading Rainbow was a lot more fun. I love, love, love reading, but how much would I have gotten into it if everyone involved in teaching me to read insisted that I had to learn all of my ABCs and phonics basics before I could actually explore the power of books? Of course, I don’t watch a lot of PBS kids programming anymore, so I may be overly pessimistic about the future of their reading-oriented programs. But I do feel that Reading Rainbow deserves some defense from those who are trying to make it sound like it was educationally behind the times and unfit in the face of new literacy research.

Thoughts? Opinions? Nostalgic stories? Comment away.

-posted by Dana

How hard of a problem could you solve in only three days? Who would you choose to help you do it?

The ICFP Programming Contest is an international programming competition organized in conjunction with the International Conference on Functional Programming, which is an annual academic conference about programming languages. Each year, teams from around the world compete in the ICFP contest to demonstrate the supremacy of their favorite programming language by solving a challenging problem over a 72-hour period.

The contest is organized by a different institution every time, typically a university, and the organizers work well in advance and sometimes take years to prepare the contest problem, which is kept secret until it’s time for the contest to begin. On the appointed day, which is usually a Friday in June or July, the organizers unveil an elaborate problem description on the Internet. When the problem is released — at a time that may be convenient or wildly inconvenient, depending on the difference between the organizers’ time zone and the time zone one’s team happens to be in — the teams go to work, using whatever tools they like to solve the task at hand. Past contests have challenged competitors to control a Mars rover that has to get to a home base while avoiding hostile aliens, design an ant colony capable of defending itself from invaders, and decode a string of letters resembling DNA (not coincidentally, the letters chosen for the bases were “I”, “C”, “F”, and “P”) and “resequence” it to draw a picture. The problems often include strange and hilarious twists, and the problem descriptions may be filled with in-jokes and cute asides.

The ICFP contest has been going on for twelve years, but the first time I heard of it was in 2007. I was living in Portland, Oregon at the time, and that summer, four of my Portland friends competed in the contest and were quite successful, coming in 28th out of 869 teams worldwide. (The contest scoring works differently each year and is determined by the organizers, but in 2007 the scoring procedure happened to be instantaneous and automatic. Teams could see how they were doing as the contest progressed by uploading their solutions to a website where they were automatically scored.)

It was great to see Jesse, Josh, Kim, and Paul do well in the contest, but it was also a painful wake-up call for me. They had invited me to work with them in the early hours of the contest (literally, the early hours — the difference in time zones was such that it started at 3 a.m. for us that year), and I had tried, I really had. Before long, though, it was clear that they were going to leave me in the dust. Part of it was that they’d worked as a group before and knew each other’s styles well, and I knew that I was a smart person, but as a programmer, I couldn’t keep up with them.

I was tired of being a mediocre programmer. It was time to get to work. That Christmas, my boyfriend, Alex, gave me the book Structure and Interpretation of Computer Programs, a classic computer science textbook, and we started reading the book together and doing all the exercises. My goal was to finish all 46 of the exercises from the first chapter of the book before I attempted the ICFP contest again. All through March, April, May, and June of 2008, I worked on the exercises, and on the day before the contest started in early July, I finally finished the last SICP exercise that had been giving me trouble. Alex and I were ready to compete. We dubbed ourselves Team K&R, a name which alluded to the first letters of our last names as well as to another well-known programming book, and for 72 hours, we furiously wrote code (with breaks for eating, sleeping, and occasional bouts of smooching).

That year, there was no automatic scoring; instead, there were a series of heats held after the 72-hour submission period ended. After each heat, the competitors were ranked by their scores, and some fraction advanced to the next heat, until a single winner remained. How did we do? Well, there ended up having to be eleven heats in all, and our team was eliminated in the fourth heat; another way of looking at it is that we came in 174th out of a total of 282 teams, or that 108 teams were eliminated before we were. Not terrible, but not exactly anything to write home about, either. Nevertheless, I was ecstatic. In just one year, I had gone from feeling incapable of participating at all to actually submitting a contest entry that had been moderately competitive! At the time, I was just about to move across the country and start graduate school for computer science, and the ICFP contest gave me the jolt of self-assurance that I needed to feel confident returning to school after four years of rather middle-of-the-road code-monkey jobs. I got to give a talk at Code n’ Splode, a monthly social event attended by many of my programmer friends in Portland, about how much fun I’d had doing the contest, and when I arrived at school, I was able to hit the ground running in my classes, because some of the things I needed to know were already fresh in my mind from having been in the contest. It was awesome.

Since then, for better or for worse, the ICFP contest has become a small but significant part of my identity. So, when it came time for this year’s contest, I had high expectations for myself. I wanted to make as big of a leap from 2008 to 2009 as I had from 2007 to 2008. I knew that a year of grad school had made me a better programmer. I already felt embarrassed by the code I’d written in the contest in 2008, and of how much time and effort it had taken to do things that now seemed easy — an excellent sign! And I was excited about the chance to try an ICFP-scale problem on for size again and see how I did now that I had a year of school under my belt. So I took a long weekend off from my summer research project to fly to Atlanta, where Alex was living, and spend the weekend working on the contest with him.

As usual, the contest spanned 72 hours, from a Friday afternoon (June 26th, in this case) to the following Monday afternoon. Alex took Friday afternoon off work, and we sat around his kitchen table drinking coffee, waiting for the problem specification to be released online at the appointed hour, and getting extremely fidgety. When the moment arrived, we downloaded the problem spec — and, of course, failed, because thousands of other would-be competitors were, of course, simultaneously trying to do precisely the same thing and overwhelming the poor web server with requests. Undaunted, Team K&R mashed the “reload” buttons on our browsers — exacerbating the problem for everyone else, I’m sure — and finally had the problem spec a few minutes later.

The spec told us that for this year’s contest, we would be writing programs to control (simulated) satellites moving through (simulated) outer space. Our satellites would have to perform a series of four increasingly difficult tasks: move from lower to higher orbit around a planet, meet up with another orbiting satellite, and so on, all of which were intended as “training missions” to prepare us for the eventual “Operation Clear Skies”, in which we would program a satellite to clean up space debris in orbit around Earth. So far, this was all sounding like an appropriately nerdy ICFP contest problem. We read on.

For each of the four tasks we had to complete, we had been provided with a rather enigmatic binary file. We couldn’t read the data in these files, but from reading the spec, we came to understand that they contained little computer programs — series of instructions that could simulate the physics of the satellites and celestial bodies for each task, accept input from us to control the satellites, and eventually produce a score according to how well or poorly we had accomplished the task. These little simulator programs were going to be indispensable — but we weren’t going to be able to run them directly on our computers. Instead, we would have to write our own program that would know how to run the programs that were encoded in the four binary files. Before we could start using the simulators to help us work out how to move things around in space, we would have to implement a virtual machine, or VM, and then run the simulators on that. Now things were getting interesting.

Alex spent the first few hours of the contest digging into the four binary files and figuring out how to decompile them into a format that we humans might be able to understand (and also, he hoped, that our as-yet-nonexistent VM would be able to run). Thankfully, we’d been provided a specification for the virtual machine we were supposed to build, and it was quite straightforward and complete. While Alex worked, I was busy absorbing the fifteen-page spec. Before long, I was having one of those incredibly trite revelations that I suspect I’m doomed to keep having for the rest of my programming career. Let me explain.

Everyone who uses computers deals with binary files all the time, but few of us open them up to peer at their insides. Many programmers have had the experience of accidentally opening up a binary file in a program designed to edit text. Typically, we see garbage, feel momentarily disoriented, realize our mistake, and quickly close the file again. Afterward, we may not think twice about it. If we do, we may have a sense of having seen something we shouldn’t have, of having blundered behind a curtain.

In such situations, the file we actually intended to open was, in all likelihood, a “plain text” file. Wikipedia speaks of plain text as being “unformatted”, but the scare quotes are there for a reason; in fact, the data in a plain text file is highly organized. We may think of plain text files as being fundamentally different from binary files, but as Wikipedia says, the distinction is arbitrary. A plain text file is made of data encoded in binary numerals, just like any other file on your computer. (We could go into how “file” is an abstraction, too, but I don’t really want to touch that one right now.) The only thing special about a “text” file is that it happens to be in a format that programs called text editors can process easily and turn into something that’s convenient for (some) humans to read.

So, when you open up that binary file in your text editor and see a bunch of garbage, it’s not that your text editor is doing something wrong. To the contrary, it’s faithfully doing its job, displaying the data it’s been told to display in the only way it knows how! It doesn’t know, can’t know, that what you’re seeing is garbage.

Some readers, I’m sure, are rolling their eyes and thinking “Obviously!” right now, and in retrospect, I am, too. But this realization hit me like a sledgehammer during ICFP. It took me an embarrassingly long time to understand what the hell Alex was doing, simply because it hadn’t occurred to me that we could write a program to process binary data just as well as we could write a program to process text, and, moreover, that there was absolutely no reason why we shouldn’t do such a thing. In fact, my misunderstanding had been not so much technical as psychological. I couldn’t follow what Alex was doing because I didn’t really believe that binary files were hackable, despite the fact that I had been attempting to preach the all-things-are-hackable gospel for years. When I saw that processing binary data was not only possible, but in fact utterly natural and unexceptional and reasonable, I caught a glimpse of enlightenment for a second.

Once I had made that leap, it followed that as long as we were processing binary data, we would do well to turn it into text, because while the computer didn’t care about the difference, it would certainly help us understand the data and therefore be able to write the rest of the VM more easily. By the time I had wrapped my head around all of this and started reading about how to deal with binary input and output in Scheme, which is my programming language of choice and the one that we had been planning to use for the whole contest, Alex was already under way with his implementation of the decompiler in C — a language which, notwithstanding our team name, I was pretty terrible at.

This part of Friday evening was the worst part of the whole contest for me. It had taken me a lot of effort to understand something that had been immediately apparent to Alex, which was a blow to my confidence, and to top it off, he’d written a bunch of code that I couldn’t really help with at all. This was not exactly my idea of a good time. But Alex, anticipating my frustration, started a much-friendlier-to-me Python version that we could work on together, and between us, we finished the decompiler. (The “obf” in its name stands for “Orbit binary format”, “Orbit” being the name of the still-nonexistent-at-this-point VM on which the simulators would eventually need to run.) Then, at Alex’s urging, we went outside for a quick three-mile run around nearby Piedmont Park. If he hadn’t suggested going out for a run, I think I would have sat there and tried to keep coding, and I probably would’ve gotten frustrated all over again. But running cleared my head and dissolved my remaining disgruntlement, and by the time we got back, I was pretty sure of how I was going to write the VM.

What followed was one of the best parts of the contest. Alex had gotten the decompiler to turn the binary files into something that looked remarkably similar to parenthesized assembly language. From there, I realized, all I had to do was write a little interpreter — something I’d had a lot of practice with. Interpreters were the bread and butter of what I had been studying in school for the past year, and I was delighted to have a chance to apply something I had learned. In short order, I had the VM up and running, and we were successfully crashing simulated satellites into the simulated earth! We were elated.

(Next time: the thrilling conclusion! To be continued in a future post.)

A fanciful new RPG from the people who brought us Spirit of the Century

Opening Salvo

“Air pirates? AIR PIRATES!” I shouted with glee as I seized the Swashbucklers of the 7 Skies from the “Indie Press Role-Playing Games” section of my local comics/gaming store. Completely un-phased by the $30 I was about ready to fork over for a softcover, I ran to the cashier and exclaimed with elation: “You know you’ve finally got a tabletop RPG about air pirates?” He shot me a look back.
“Well, there was always Skyrealms of Jorune, Castle Falkenstein,” he said, tallying them on his fingers. “And we just got a new steampunk book in: Victoriana.” The wind still billowing my sails, I laid it down on the counter and said in my most gallant voice: “Avast! my good sir, for this one appears to be good.” And he took my money.

Preface

A few words of explanation are warranted before I dive into a thorough review of said book purchase.  First of all, why the heck was I looking for a book in the “Indie Press Role-Playing Games” section of the store anyway?  Well, it just so happens that I A) live in western Massachusetts, a kind of mini-Mecca for the budding independent role-playing game designer (give the proximity of New York and Boston and number of nerdly college grads in the area), and B) regularly run these people’s RPGs at local and national gaming conventions.  Having been a convention gamemaster (GM) for 16 years and counting, I’ve discovered that this is where all the action is happening these days. These games (by which I mean my Top 11: Primetime Adventures, InSpectres, Mist-Robed Gate, 1,001 Nights, Dread, Dogs in the Vineyard, Shock, Annalise, Misspent Youth, Tales of the Fisherman’s Wife, Shooting the Moon) are the best in system design, the most conscious of social exigencies involved in the role-playing hobby, and the most academically cross-referenced and critiqued.  Many are designed by women, and most by graduates of small liberal arts colleges.  All I have to say is: check them out.  They are the future.

Furthermore, I’d like to say for the record that I’m not really a pirates fan per se (otherwise I’d be reviewing 7th Sea here), but for some reason I really dig the idea of air pirates.  I attribute it to an unhealthy amount of Skies of Arcadia played and Last Exile viewed while I was in college, as well as a desperate urge to see a kind of Star Wars-style epic played out in skyships – as opposed to space in a galaxy far, far away controlled by an indifferent, bearded Lucas-man.

A Brief Summary

Swashbucklers of the 7 Skies (S7S), written by Chad Underkoffler (whom I think I met at Dreamation 2008, and who wrote some great Unknown Armies supplements), is a game of fast-paced, swashbuckling action set in a world where islands float in a vast sky over a mysterious substance called the Blue.  Players create characters intended to accomplish great feats of derring-do and, without much ado, dive headlong into dangerous situations for a chance at eternal glory.  The system is designed on the Prose Descriptive Qualities (PDQ) model, which is synonymous with quick task resolution and immediate character empowerment (as opposed to waiting sessions and sessions to become effective against the big, bad mega-villain, characters in S7S tend to be ready to take him on right out the gate).

It’s a Big Sky Out There

A full four chapters of this book are devoted to the dense setting of the 7 Skies, which ironically serves the primary purpose of catapulting characters into the action without bogging them down with too much back-story.  A kind of fantastical pseudo-18th Century world order is established among 6 primary sky islands and a plethora of secondary islands.  There are the intrigue-obsessed Barathi (more like 16th Century Italy under the Borges — noble houses and poison, etc.), the resolute Viridese (Nordic/Scandinavian-type folks), the passionate Colronan Royalty (France), their neighbors the aloof Colronan Zultanistas (Ottoman Turks), the cosmopolitan Crailese (think 19th Century New York with some religious nutjobs outside the city limits), the ascetic Sha Ka Ruq (a cross between the Congo and Japan — Orientalism meets Token Fetishism, but I digress), the rebellious Ilwuzi (a pirate isle in the Caribbean) and the lost island of Kroy (Atlantis… or Laputa).  Each nationality is basically an excuse to have a different flavor of sword-wielding badass, from a weapon-snapping, fur-wearing Viridese to a tough-talking, cutlass-bearing Ilwuzi and so forth.  Magic and skyships are smoothly integrated into a world system that is believable as a fantasy setting – Underkoffler did a great job of creating a world that’s basically one giant opportunity for adventure where one nevertheless knows what to expect in each port, so to speak.  Read enough of his Bibliography – with entries from Wu Ch’eng-en to Alexandre Dumas, from Neil Gaiman (Stardust, of course!) to Rafael Sabatini – and you will understand that the world exists to put crazily passionate people with swords at odds with each other in dangerous, exotic, and breathtakingly beautiful locales.

System, Shmystem

The PDQ system is also particularly well-executed in this book.  I played Spirit of the Century – another Evil Hat production and an RPG-geneaological predecessor to S7S that has you generate pulp characters who are starring in a number of cross-overs – and found it to be surprisingly difficult to master at first.  S7S, however, seems to have struck an enviably perfect balance between – using the terms of Ron Edwards’ Big Model theory – Setting Simulationism, Style Simulationism, and Narrativism.  “Whoa!” you say, reaching for your musket.  “Where’d all these landlubber ‘-isms’ blow into port from?”  In simpler terms, the game does a good job of A) giving players a deep and enriching established world to explore, B) allowing stylistic tropes from swashbuckling books/movies to become game mechanics (i.e., you can have your cape flapping in the wind give you game benefits), and C) encouraging creativity in the storytelling realm, as opposed to that of maximizing personal player power.  In S7S, if you succeed with your dice roll, you may narrate how you succeed.  If you fail, you get points toward giving your character an extra oomph in the future and can choose to narrate how they botched this job.  It allows for and encourages Princess Bride-style antics in the way that games like 7th Sea only vaguely dreamed about.

One of the nicer bits of the system is a comprehensive ship combat system that revolves around teamwork – a captain giving orders to a crew in the heat of battle – while preserving a dueling system that emphasizes the primacy of individual coolness.  Another is the Style Dice mechanic:  players get handed dice to use in their favor if the GM decides to screw them over rather nastily.  There is an economy established that notably resembles the narrative economy one witnesses in swashbuckling fiction.  All suffering becomes more pleasurable when the hero can take the sweeter reward in the end.

Why You Should Get This Game in Great Haste

Actually, you should be checking out all the RPGs I mentioned in my Preface:  they’re the games so many of us were waiting for as we hunkered down in our mediocre games of D&D and Shadowrun, waiting for some narrative control to be handed back to us.  Why you should go pick up a copy of S7S is simple:  few games are as accessible, intuitive and richly devoted to players’ creative well-being as this one.  Now I’m off to liberate a Crailese freighter of its most burdensome cargo!

In this Gilded Age of the motion-controlled Wii, the Internet-friendly X-Box 360, the mega-military hardware of the Playstation 3, the guitar and drum controllers, the upcoming Project Natal motion-capture controllers and all the rest, I find it somehow refreshing to delve into the “classics” on emulation (without needing to pay a cent by the way!)  See anything you haven’t played?  Now’s the time to become more gamer-literate!

1. Rampage (1986)

Play George (a.k.a. King-Kong), Lizzie (a.k.a. Godzilla), or Ralph (um… Fenris or Amarok?) as they destroy major metropolitan areas and eat human beings while being shot at by military forces.  I distinctly recall first learning of the existence of cities such as Duluth and Toledo through this game, as well as the lesson that most U.S. cities look pretty much the same when they’re being kicked to the ground by giant monsters.  Requiring almost no brainpower, yet fulfilling a deep-seated wish to be in control over the destruction of one’s own civilization, Rampage will remain a pick-up game for all ages for years to come.

2. X-Men – The Arcade Game (1992)

Back when I was growing up, the malls still had thriving video-game arcades with an assortment of quarter-eaters to waste my disposable income.  The best of these was a 6-player, 2-screen beat-em-up extravaganza starring none other than Cyclops, Wolverine, Colossus, Storm, Nightcrawler and Dazzler.  Few people might understand the joy of being one of 6 pre-pubescent boys crowding around a set of sweaty joysticks and beating the living tar out of a giant pile of mooks that come at you on-screen.  I’ll be this one would still make money in any surviving arcades today.  Not too many 6-player games came after this one, after all…

3. Full Throttle (1995)

“You know what would look good on your nose?”

“What?”  *nose ring grabbed and slammed down on the bar*

“The bar. Now don’t mess around with me.”

Probably one of the best animated adventure games released for the PC, Full Throttle showcases the best of LucasArts’ SCUMM engine while offering a meaty array of bad jokes and crazy biker action (including a climax involving a chase between a bike, a semi and a wing-less cargo plane).  I find I can just sit someone down at the computer and play through it in about 2.5 hours… the length of a solid, well-made animated movie.

4. Maelstrom (1993)

Ambrosia Software certainly didn’t invent Asteroids – the 1979 Golden Age game that served as part of Atari’s main stable of games – but they certainly brought it into the 90s for the Macintosh user.  Chock full of Simpsons, Beatles and other pop cultural references in its soundtrack and brightly colored, 3-D-looking sprites, this game plays like a hyperactive stepchild who found the meth supply… in space.  Now if only they were to option this for a movie!

5. Maniac Mansion (1987)

Not to spend this whole blog singing LucasArts’ praises, but they did produce some damn fine adventure games.  A group of hapless teenagers are off to save their cheeleader friend Sandy from a sentient evil meteor and the weird family it has corrupted in a mansion filled with surprises.  Maniac Mansion adopts much of the crazy object-based logic puzzles inherent to the genre (“So I need to grab the faucet handle in the garage to turn on the shower to move the corpse to find the number I can call Nurse Edna with so I can get her out of the room so another kid can get up to the telescope and steal her money while they’re at it.”) but it self-referentially mocks its own silly set of errands often enough.  You can stick the hamster in the microwave in some versions!

6. Super Bomberman (1993)

Many nights I slept not a wink because of this Super Nintendo game’s excellence.  In Battle Mode, 4 players have two minutes to be the last one alive in a grid filled with bombs laid by you and your fellow players going off every which way.  A 30-second looping soundtrack amplifies the tension in ways you wouldn’t believe.  Most of its sequels are actually not as good as this original, a fact for which I cannot account.

7. Cyborg Justice (1993)

1993 must’ve been a good year for video games in my mind… This Sega Genesis beat-em-up features a combination of excellent sprite graphics and over-the-top ultra-violence (i.e., you can rip off an opponent’s arm and use it as your own).  You’re a cyborg and you’re seeking, well, justice!  It’s too bad that Sega was never able to keep up with the other franchises – their game design was always above-par.

8. Return to Zork (1993)

‘93 also saw Activision’s great adventure game release Return to Zork, which pre-dated Myst by several months and involved a much more interactive environment than said game.  In any given room, you can do like 50 things involving various objects you’ve picked up, etc.  What I really enjoy about this is the Neil Gaiman-esque dark fairy tale plot and the video-captured actors whom you can all kill if you get frustrated (and then you’re told by a guy in a funny coat that you can’t complete the game!)

9. XCom (1993)

Speaking of 1993, there was a turn-based strategy game for the PC produced by MicroProse that knocked our socks off.  In XCom, aliens have invaded Earth and you’re part of a worldwide task force sent to kick their ass.  The game features a sophisticated tactical engine copied by games like Fallout and later games like Freedom Force.  I watched fellow college students piss away whole semesters on this thing…

10. Marathon (1994)

So you’ve played Halo, right?  Let’s call it “Marathon 4″ and be done with it.  Marathon brought all kinds of innovation to the first-person shooter table:  network multi-player, a flexible map and sprite editor, and an intricate plotline of an almost literary quality.  You play a marine dispatched to a multi-generational colony ship that is under alien attack and has multiple AIs also vying for control of your activities.  We used to haul computers over to each other’s houses just for the opportunity to kill each other on maps we had created.

11. Hunt the Wumpus (1973)

The scariest game ever. You’re hunting a goddamn wumpus with these crooked arrows, and if you miss, it’ll come and eat you.  It fills your screen with its awful face.  I played this on my Commodore back when I was like 6, only to discover that the labyrinth is a cruel place.  The psychological environment of this deceptively simple game still gets me every time.

In summary, 1993 may have been a pivotal year in game development history – self-conscious, impressively addictive games made their appearance around that time.  But at least in 2009, we can still revisit all of these classics! After all, all our culture is nostalgia.

I just started reading River Town, by Peter Hessler, and thought this passage right at the beginning was interesting.

I often heard remarks like this, [that all the women of Fuling had a reputation for being beautiful due to being from an area with both water and mountains, or that people there had bad tempers because it was hot and there were mountains,] and they suggested that the Chinese saw their landscapes differently than outsiders did. I looked at the terraced hills and noticed how the people had changed the earth, taming it into dizzying staircases of rice paddies; but the Chinese looked at the people and saw how they had been shaped by the land.

-Hessler, 6

This reminded me of conversations I’ve had at various points with people from the Midwest. I am from the East Coast (or the Southeast, if you are one of those people who strangely thinks the East Coast only extends as far south as DC, or possibly Virginia,) specifically the piedmont area of North Carolina, and I am very used to being surrounded by hills and trees. In the days when I was frequently having to drive home from Iowa or Michigan during school breaks, I had a definite sense that “home” did not start until I entered the Appalachians and was surrounded by forests again. By contrast, several friends who grew up in the plains stated that they would find it a little scary not to be able to see for miles around. Hills and too many trees would give them claustrophobia. Whereas I found the first description of the plains in the Little House on the Prairie books terrifying and never really understood why they moved out of the Big Woods.

I also suspect that where we grow up or strongly identify as home can have a lot of impact on the color palettes we like the best. People who love the desert may have a much greater appreciation for shades of red and orange than a people from a greener environment.

Any other ways you’ve noticed your environment shaping you?

The only other example that comes to my mind right now is that when I lived in Chile, I was told that the women of Viña del Mar all had great legs, due to the many steep hills and steps in that city. That one is a bit more obvious than perhaps Hessler meant, though.

-posted by Dana

What the world needs now is a unified field theory of post-irony in the work of Wes Anderson, Dave Eggers and John Darnielle.

It’s the only thing that there’s just too little of.

- posted by Mike