by Brooks Riley
The Day Pope Gregory Met Sidney Bechet and the Walls Came Tumbling Down
I must confess, my title is more of a figurative come-on than an accurate indication. I’m not really going to talk about the sixth century pope, Saint Gregory the Great, but rather about the liturgical music that has taken his name, Gregoring chant, aka plainsong. I am, however, going to talk about Sidney Bechet, or rather, I’m going to let Ernst Amsermet talk about him, but mostly as an exemplary practitioner of the music that colloided with the European plainsong legacy early in the 20th century. We’re living in the dust and debris kicked up by that trainwreck [1].
It’s called primitivism: the reexamination and assimilation of the primitive within modern cultural forms. This phenomenon is not confined to music, but is a general aspect of European culture through the 19th and 20th centuries. In the cognitive sphere it gives us the discipline of anthropology. In the expressive sphere it yields primitivism, which parallels the emergence of museums of primitive art. This assimilation employs a metaphor of conquest: just as “inferior” cultures were conquered (and thus needed to be preserved from eradication) by the “superior” European civilization, so emotion was conquered by its superior, reason.
![[Portrait of Sidney Bechet, New York, N.Y.(?), ca. Nov. 1946] (LOC)](https://farm5.staticflickr.com/4082/4888063147_585ff7c42d.jpg)
Sidney Bechet, Nov. 1946, Gottlieb Collection, Library of Congress
Europe Makes Itself Through Painsong
The musical version of this story starts with plainsong, the liturgical music of the medieval Christian church. During the medieval period most plainsong was used within religious communities as a daily aspect of their religious life, rather than being performed with a congregation on Sundays. While this body of music has its roots in pre-Christian music of the Jewish service, it is generally known as Gregorian chant, after Pope Gregory I, who played a major role in organizing and codifying the chants late in the 6th Century CE. These chants are generally regarded as the fountainhead of Western classical music, all of whose forms all have some link to their Gregorian lineage, though many other musics are eventually put to classical use. For this reason we can think of the classical music as developing under a Gregorian Contract.
Plainsong is pure melody, sung in unison, utterly without pulse and meter. It is horizontal melody without upheaval; it is, in effect, spirit without body. That is the core conception that over the course of centuries becomes stretched and modified, both by extending its own devices (e.g. the development of parallel vocal lines and then polyphony) and by assimilating other types of music, including various dance styles, whether the courtly minuet of the Baroque and Classical periods or the mazurkas beloved by Chopin.
Two Great Assets
"….Actually, throughout my life, my two greatest assets have been mental stability and being, like, really smart." -Donald Trump via Twitter (January 6, 2018)
Oh, that was good. But here's the thing. What exactly are his two greatest assets? Or yours? Or mine?
Trump's tweet is funny/horrifying not only because it's the exact opposite of correct, but because he has failed spectacularly at the most timeless and profound of human pursuits: to know oneself.
Socrates admonished us that the unexamined life is not worth living. But the world's most powerful man seems to live in open mockery of the ancient Greek. To gaze upon him is to be cast in the dark shimmer of a soul so thoroughly incapable of introspection that when Trump is on his deathbed, his "Rosebud" moment will be pronounced in tones of "Everyone says I'm the best," or "No one dies like I do," or "Bring me a diet Coke."
Thus, as if by sit-com writing formula, Trump's cavalier effort to engage the greatest of challenges was doomed to a banana peel slipup far more jaw dropping and painful than anything ever filmed by Buster Keaton or The Three Stooges. Give him the setup ("What are your two greatest assets?"), and he can't help but write the punch line.
For many of us, however, the grand quest for introspection is more tragedy than comedy, a tortured, unfinished novel rather than a furious tweet, the cruel taunting of unanswered questions as opposed to firm, imperial pronouncements from the White House bedroom as the Gorilla Channel booms in the background.
We are all quick to judge Donald Trump then, in part, because it seems so easy; his character is so achingly shallow, but also because it is always far safer to judge others.
To judge oneself is to play Russian Roulette with your spiritual essence. Because for every laudable attribute there is a bullet or two of dark secrets, disappointing shortcomings, and crippling fears.
Monday, January 1, 2018
A Tulip By Any Other Name
by Misha Lepetic
"To be in the world like tulips in a garden,
to make a fine show, and be good for nothing."
—Mary Astell
In a rush to make sense of it all, many people were happy to pronounce bitcoin (along with cryptocurrency in general, and blockchain as well, because sure why not) as just another episode of the madness of crowds. Knowing glances were cast back to past bubbles, epitomized by the pets.com sock puppet, JP Morgan's shoeshine boy, and of course tulipomania.
But such a rush to judgment can be its own form of madness. To be sure, in these binary times it's difficult to tread a subtler line. The suggestion that we should be pursuing far better questions isn't necessarily the same thing as claiming that ‘this time is different', even though the two stances are easily confused. Instead of dismissing cryptocurrency as the latest demonstration of humanity's inability to learn from its past mistakes, we may rather use it as an opportunity to inquire about the nature of value, and what difference the future may make in relation to the present.
Beginning with the ur-phenomenon of tulipomania, we can find both striking similarities and differences between it and the current situation. For one thing, tulips are a real thing – that is, a commodity. As Mary Astell implies above, flowers may not have much going for them, but they are pretty to look at, and in an affluent society, that counts for something (it ought to be noted that gold is similar, in that its practical value, as jewelry and an industrial metal, is far outstripped by its value as, well, gold). So it was for the Dutch, who saw in tulips a signaling mechanism that rapidly got out of hand.
Mind from matter: physicists on consciousness
by Daniel Ranard
"I am in the world and at the same time in myself: is there geometry more beautiful?"
—Abdelmajid Benjelloun
But I want to write on what physicists think about consciousness. Not because they deserve special authority, but because they provide an important point of reference. The physicist's worldview usually contains some aspect of physicalism (asserting the only "real" things are physical things, governed by physical laws), reductionism (asserting all observable phenomena are explicable in terms of their microscopic parts), and positivism or operationalism (asserting that the only meaningful concepts are empirically testable). And in recent generations more than any others, it seems, this web of attitudes permeates the zeitgeist. It is our inheritance from the success of 20th-century physics.
This inheritance alters the way we frame questions about the mind and consciousness. While Descartes asked how the physical realm interacts with the realm of the mind and soul (his answer: the pineal gland), today we immediately privilege the physical. If the world consists only of the physical, how does the conscious mind arise? If your brain is a soup of electrons and protons, how does this soup come to harbor an interior experience? What gives rise to thoughts, feelings, and sense of being?
Philosophers have devised an intricate taxonomy of responses to the question of how consciousness relates to the physical world. Where do modern physicists fall within this taxonomy, especially as a community whose attitudes have historically shaped the framing of the question?
perceptions
Sughra Raza. Celebrate Symbiosis – Spanish Moss/Live Oak. New Orleans, Feb 2015.
Digital photograph.
Gender Trouble 2017, Comedy Edition
by Katrin Trüstedt
"Next time Feminism will not be a tragedy, but a comedy"
—Carla Lonzi
The danger at this point, it seems to me, is that of reaffirming and hypostatizing the very gender categories that have been at the heart of the problem in the first place. The suggestion, for instance, that men, per se, are predators, that it is the very nature of male behavior to be sexually transgressive and aggressive; and that woman are, per se, victims, and dependent – such suggestions are in danger of reproducing the very problem they are addressing.
Acts of sexual harassment including many of those that have been outed in the past couple of months seem to show, on the contrary, that something like masculinity is not a given, but in need of constant performative reestablishment. To come back to something like a "primal scene" of the current developments – the Weinstein case, and in particular one piece of "evidence" that is out there, namely the audio from a wire tap – it seems like the masculinity in question here is in rather desperate need of violent performance with elaborate arrangements. Trying to bully Ambra Battilana Gutierrez into joining him in his hotel room by repeating what a powerful man he is, appears on tape as a pathetic attempt to performatively produce manliness as power. Not only does the repeated claim suggest the lack of what this performance is intent to prove ("I am a powerful man"). It also exposes the very need of this position to be performed, enacted, and reaffirmed by its other. Needing the woman to feed back to him what a powerful, powerful man he really is, he also needs to emphasize how powerless she is by contrast in this situation ("you don't want to ruin your friendship with me for five minutes").
Review of Sue Hubbard’s New Novel RAINSONGS
by Maniza Naqvi
Hubbard's expressive talent is in full display through her descriptions of the south western Irish landscape of Kerry, so that the reader feels a sense of belonging and a resonance with its emotional and social fabric. I read this book the week before the year changed, curled up in bed, tucked in against the winters bone-chilling cold outside, deeply aware that I was savoring a rarity, seeing through words a remote land. Seeing it through the eyes of the main character, Martha Cassidy who, herself not Irish, has returned after a period of decades of absence.
In the end of December 2007 Martha Cassidy is a woman in mourning who returns to her late husband's cottage in search of solace from grief. Rainsongs approaches the peril and remoteness of relief through the certitude of both storm and calm and its attendant pain on the journey towards consolation. Martha is a beautiful, mature-minded, self-assured woman in her fifties, focused on her own inner journey. Yet she is neither weak nor in need of comforting or saving. And perhaps because of her demeanor, is orbited by men who knew her husband and, as in the case of the young poet-musician, Colm Nolan, is the same age as her son.
Driving rain and wind are the song and silence of the inner drama where Rainsongs will take you. That place within yourself of sorrows, solitudes and solaces, the spaces you have been through, the ones you are passing through, the ones you surely will go through. That place is lit up momentarily like a revelation, then gone and, in the novel, searched out metaphorically through the beam of a lighthouse – beckoning, saving, warning – on Skellig island as it sweeps across the darkened sea and landscape on Bolus Head and shines into the room in the cottage where Martha sleeps. Periodically, as if a monitor for a heartbeat.
CATSPEAK
by Brooks Riley
Is Wine a Living Thing?
by Dwight Furrow
The claim that wine is a living organism is something I hear often from people in the wine world impressed with the capacity of wine to evolve. Writer and sommelier Courtney Cochran writes:
Wine, with its clear ties to the lifecycle of plants, its ability to evolve and change (to grow) and its delicate fragility in the face of danger (TCA, oxygen, light), fairly screams "alive." In today's overly sanitized, automated world, could our wine be more alive – perhaps even more ‘human' – than us?
Wine grapes react in a very sensitive way to the conditions under which they are grown. They are a product of an ecosystem as well as a reflection of that ecosystem with the characteristics of the vineyard, community, winemaker and weather living on in the wine—a storehouse of the past, a series of "memories" that are transmitted to the consumer in the flavors and textures of the wine.
Even after the grapes are harvested and fermented, wine as it ages responds to stimuli, adapts to its environment, and like a child, requires guidance and nurturing to reach its potential, expressing its aesthetic worth through its own "evolutionary" path, influenced but not wholly directed by the winemaker. People in the culture of wine think of it as "living" because wine not only persists but changes and in some cases improves with age. There is a trajectory of maturation that is in some respects similar to the development of living organisms.
The claim that wine is a living thing has also received philosophical endorsement. In philosopher Nichola Perullo's introduction to his edited, online anthology "WineWorld: Tasting, Making, Drinking, Being", he advocates treating wine as a living thing in order to reform tasting practices and gain a deeper understanding of the aesthetics of wine production, especially in light of the fact that wine is ultimately assimilated to our own living tissue. If we take this view on board, wine is best understood not as a commodity but as something with emotional resonance and authenticity, an object we can engage with as emotional beings, not just through analytical tasting.
But is wine really a living thing or is this discourse just making use of a particularly resonant and vibrant metaphor?
The Female Anatomy of Letters: A Five-part Essay
by Shadab Zeest Hashmi
This piece of writing, I promise you, is neither about the gut-brain axis, nor is it about writing. It is the first of a short series of essays on my views as a feminist. I have always believed and stated repeatedly in interviews that it is enough to deal with this subject in poetry, that so much of my poetry–nearly all of it—assembles the many facets of feminism important to me, that talking about womanhood requires a language that does not exist. The topic is like handling a slab of granite: a paradox of sheer heft and delicacy, better conveyed through poetry— reduced, ignored, exoticized and caricatured as it has been through the ages. We must mold the language first and create our own terms. I changed my mind, however, after mulling over a few significant discussions, the first of which began as a direct question about the women’s movement from a noted Pakistani poet, the feminist legend Kishwar Naheed at my poetry session at Lahore Literary Festival, the second at SOAS, London, with my activist-academic friend Dr. Maria Rashid, and the most recent one with Rafia Zakaria whose writings on the subject I find truly impressive; I have now begun to see the value of articulating, in prose, how I see gender dynamics and how I have fared as a woman of multiple identities.
Monday, December 25, 2017
The Songbird – A Short Story
by Yohan J. John
But the path to the great old tree was dangerous — there were slippery rocks and tangled roots. Wild animals prowled in the shadows. Still, the beauty of the bird's song had an irresistible pull. The village elders decided that the bird should be captured and brought to the village. Soon enough, the bird was caught, and placed in a cage. The Bird Girl told everyone that the song had somehow changed, and that something important had been lost. The elders did not pay her much attention. She went back to exploring the jungle, but rarely told the elders what, if anything, she found.
The villagers gathered every evening to behold the bird and its song. Word spread to neighboring villages, and soon curious pilgrims arrived. The villagers began selling food and trinkets to the visitors. The bird was a blessing!
One day the king was traveling through the region, on his way home from a victorious battle. He heard stories of the songbird, and decided to see it for himself. The bird proved even more impressive than he imagined. Nowhere in the kingdom was there a bird such as this!
The king decreed that such a bird could not be hidden away in an obscure village. He took it to the capital, where more people could be touched by the grace of its song. The villagers were sad to see the bird go, but they could hardly stand in the way of a king.
In the capital city, the king displayed the bird at his court. The courtiers told the king that such a bird could not possibly be placed in a crude wooden cage: it must have a royal cage, befitting its miraculous nature. And so a golden cage was built for the bird.
Over the years the king continued to embellish the cage: jewels and engravings were added to every bar. A temple was built especially for the bird. It was almost as marvelous as the king's palace. People arrived from every corner of the kingdom to behold the bird, hear its song, and marvel at its glorious cage. One day the Bird Girl came — though by this time she was called the Bird Woman. She muttered about how the bird's song had changed. As before, no one listened.
Evolution, the Iraqi Translation Project, and rebuilding science in the Arab World
by Paul Braterman
Translations change the course of civilisations. The translation project begun by Caliph al-Mansour in the 8th century CE, and accelerated under his grandson Harun al-Rashid, made available in Arabic scholarly writings from Greek, Aramaic (Syriac), Persian, and Indian sources, and laid the foundation for the flowering of science and philosophy in the Islamic world during Europe's Dark Ages. A second translation project, from the 10th century onwards, was in the other direction, from Arabic to Latin. Among its initiators was Gerbert d'Aurillac, the future Pope Sylvester II, and it reached its height in Toledo in Spain where for a while Christianity and Islam came into close contact and where Gerard of Cremona translated al Khwarismi and Avicenna (ibn Sina), as well as Arabic versions of works by Ptolemy and Aristotle. It refreshed Europe's contact with classical learning, while also conveying what was then current scholarship. It was the pathway through which Christian Europe rediscovered Aristotle, while Avicenna's clinical expertise is mentioned in the Canterbury Tales. His writings on geology, which I have discussed elsewhere, were among those translated at this time, but originally misattributed to Aristotle.
R: Avicenna expounding pharmacy to his pupils, from the 15th century "Great Cannon [sic] of Avicenna"; Wellcome Library via Wikimedia. Click to enlarge.
Happily, if belatedly, another translation project is now under way, from English to Arabic, focused largely on science-related topics of general interest, with special attention to evolution.
Why evolution? Not only because of its central role in modern life sciences, but because the response to evolution is a test of willingness to accept reality. Not just to accept that sacred texts require interpretation (we all know that anyway), but that human beings are part of nature. And because the teaching of evolution is under attack in the Arabic-speaking world (as it long has been next door, in Turkey, where last June it was dropped from the textbooks).
Acceptance of evolution is low throughout much of the Islamic world. In Saudi Arabia, school texts describe "Darwin's theory" as blasphemous and unscientific. In territory controlled by ISIS, the teaching of evolution was banned. In July, ISIS was finally driven from Mosul, its last major stronghold in Iraq. In August, Iraq itself dropped evolution from the school syllabus, on the grounds that the syllabus was overcrowded and that evolution was never really taught anyway. The Iraqi Education Minister, Omar Mahmoud Mohamed Iqbal Al-saydali, has religious party connections and while he has a degree in education (more that can be said for his opposite number in the US, or the UK or Scotland, for that matter) he has no special training in biology.
The road to scientific character: The proof is in the product
by Ashutosh Jogalekar
"The “human face” genre was an understandable response to hagiography, but more recently it has lapped over into a commitment to dirt-digging. Some modern scientific biographies mean to show great scientists as not just human but all-too-human, needing to be knocked off their pedestals. Galileo—we are now told—was a self-publicizing courtier, sucking up to his Medici patrons; Robert Hooke was a miser who molested his niece; Newton was a paranoid supervisor of torture who cheated in a priority dispute; Pasteur was a careerist power broker who cut ethical corners; even gentle Darwin was channeling laissez-faire capitalist ideology and using illness as an excuse to get colleagues to face down his scientific opponents on his behalf. Weary of stories about the virtues attached to transcendent genius, biographers have brought their scientific subjects down to Earth with a thunderous thump."
This view does not quite conform to the post-modernist ideal of treating every achievement as a subjective product of its times rather than as the unique work of an individual, but it does go a bit too far in discounting the nature of the few genuinely intellectually superior minds the human race has produced. The approach also tends to conflate people's scientific achievements with the social or personal aspects of their lives and somehow asks us to consider one only in the "context" of the other. But it seems odd to say the least to declare that Feynman is not a role model for science communication when millions of young people of all colors, nationalities, genders and political views have been deeply inspired by his teaching, books and science (more on this later). When it comes to being a successful model for science communication, shouldn't the product speak for itself rather than some preconceived ideology?
Thank you for the Christmas Present
by Carol A Westbrook
Did you give any Christmas presents this year? Or Hanukkah or birthday presents? Did the lucky recipients send you note by post, email, text, or at least a phone call? No? Well where, then, are their manners!
Yes, where, actually, are their manners?
It is true that our lifestyles have changed considerably since the days that the etiquette books were written. Many of the old rules are no longer relevant, while there are many new circumstances that Emily Post did not consider: cell phones, social media, gender equality, unconventional marriages, to name a few. This does not mean you have a license to ignore all of the etiquette rules that your parents taught you.
The rules of common courtesy make it possible for us to live together in harmony, without misunderstanding, insult, or hurt. These rules are there for a reason: to allow us be kind and polite to everyone without having to think about it–even if we can't stand them. As every etiquette book will tell you, if you are uncertain what is proper, then use common sense, treating everyone with kindness and respect.
Forgetting to say "thank you" is just one of example social rules that people break without thinking. There are many others that are especially important in getting along in today's society, and many which particularly vex me. I began to compile a list, which began to sound like Ko-Ko's song in the Gilbert and Sullivan operetta, The Mikado,
"I've got a little list
Of society offenders
Who might well be underground
And who never would be missed"
Rather then sending this list to the Lord High Executioner, I will share it with you.
Flood on the Tracks
by Christopher Bacas
There’s a sidewalk grate in Beverly Road station. Train sounds rise; squealed intervals evaporating as you pass. Underground, sun squeezes through the grid like skin pressed on a window screen. On the brightest day, its gutter brims gold, but never overflows. During heavy rains, the station’s walls sluice water that puddles next to the benches. When trains pass, delicate ripples ply their surface. On a grey April morning, feet bridging two platform lakes, I heard a heavy thud. The whoosh of air preceding it didn’t register. Three days of rain swelled my skull. Between the tracks, garbage sank in oily swamps. Over a dry stretch, a man lay face down; nylon backpack listing across his tan jacket. Instantly, a horizontal window opened and time upended.
Matter is quite un-material. Atoms are flickering emptiness. In that chasm, cosmic forces act on infinitesimal scale. Particles unravel and reconstitute; their paths, limitless sorcery. Mass doesn’t tally the apple’s downward push, but the warp of gluons lacing quarks into its nuclei. Ancient eyes tuned to vibrations of air and earth, not dancing voids, we see only objects, immobile and too, too solid.
I looked left for an oncoming train. The tracks ran straight to “The Junction”, terminus of the 2 and 5 lines. From the intervening stop, an approaching train’s headlamps tilt down, then steadily rise. In front, on the rails, parallel mercury streams advance. Now, two oncoming lights shimmered, guttering ahead, backlighting people near the turnstiles.
“Stop the train! Stop it!”
I jumped to the tracks. A man further down joined me. We rolled the body face up, then grabbed handfuls of clothing and ankles. He was heavy and the platform shoulder high. We couldn’t heave past the bumper at its edge. From above, hands pulled the jacket and dragged him across concrete.
Leaning into the bumper, I discovered it was soft underneath; a rubber Mille Feiulle. In its layers, street grit and countless bug carcasses, the sour delta of 21st century Flatbush delivered by gushers of spring rain. I pushed down and couldn’t clamber onto the platform. Hands grabbed mine, and I stumbled up. Behind us, the stopped train, unblinking.
What Alignment Are You?
by Max Sirak
(Rather listen? Go right on ahead…)
Ho, ho, ho!
Merry Christmas, Happy New Year, and Praise, Pelor!
Last year for my December column, I borrowed a Steve Martin bit from SNL about wishes and riffed on it. (Here) This year, in the spirit of giving, I'm going to offer up a useful lens and associated vocabulary you can use to analyze behavior and decisions. But before we get to the goods, I'm going to take a moment and explain how I got familiar with this system.
Back In The Day
Ah, the year was 1993. Radiohead's first album, Pablo Honey, debuted. Bill Clinton became President. The Unabomber was running amuck. David Koresh was holed up in Waco, TX. And, because I was twelve years old, none these events garnered much of my attention.
Computer camp did.
That's right. The summer between sixth and seventh grade, me and two buddies, Josh and Andy, went to a weeklong, overnight programing camp. C++. BASIC. Visual BASIC.
I wasn't a strong coder. I never made it past your basic BASIC, but the week I spent at Cleveland's own, Ursuline College, influenced me greatly. It was there, amongst the caffeine- fueled, acne-riddled adolescents, who spent all their time staring at screens (long before it was cool…), I was introduced to a lifelong hobby.
THE DARKENING AGE – the Christian Destruction of the Classical World
by Renuka Sornarajah
The author, Catherine Nixey, is a journalist at The Times and studied Classics at Cambridge describes the vandalism that took place between the mid AD 380s and AD 532 as Christianity grew to become the dominant religion. Christianity’s triumph is usually explained as ‘inevitable’, but as this book makes clear, it was not simply because the Roman empire was weakened by forces beyond its control. The book reveals the zeal of those espousing Christian teachings, their strategy and their willingness to harness their followers including monks, who were given a licence to destroy. Christians were told that they would reap the benefits in heaven if they became martyrs to the cause of destroying the existing beliefs. She writes with passion and tells a story which has thus far been suppressed, or at best ignored.
The book begins in AD 532 when Damascius and six members of the Academy, the most famous philosophical school in Athens, abandoned the school and the city and went into exile. The Academy had been in existence for over one thousand years, but draconian laws, destruction of temples and book burnings had crushed the followers of Greek and Roman religions. Damascius and his companions came to realise that there was no place for philosophers in the Roman Empire. The Christian Emperor Constantine and his successors had effectively destroyed a culture and a religion which had given strength to its followers, celebrated pluralism and led to the flowering of a civilization which incorporated gods, ideas and philosophies from the Mediterranean world and beyond.
Monday, December 18, 2017
Invisible Hand Ethics
by Thomas R. Wells
“[B]y directing that industry in such a manner as its produce may be of the greatest value, he intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention….By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good.” (Adam Smith, The Wealth of Nations, IV.2.9)
Invisible hand ethics has long since conquered economics. We no longer worry, as theologians did (they still do – but we don’t listen anymore), about whether it is ethical for businesspeople to make a profit beyond what they deserve for their work; whether prices should be proportionate to people’s ability to pay; whether a life of money making is a good one. The duty of the businessperson – as taught in every business degree, magazine, and TV gameshow – is to help her company win the game and take home the profit prize.
The idea of moral desert is still there. But now merit is decided by economic outcomes (price and demand), not by the moral inputs (the character or intentions of those concerned). Economic ethics has been outsourced to the markets. It is now a property of the system rather than of individuals.
Invisible hand ethics has spread. It can now be found far beyond the economic domain, especially in the professions organised around antagonistic competition, such as politics, science, sport, academia, law, and journalism. Lawyers strive to tell the story that best suits their client’s interest; scientists race to make discoveries first; politicians compete for votes so as to gain power; etc. The invisible hand is supposed to transmute this aggressive pursuit of self-interest by individual players into values like truth and justice and prosperity. For example, competition between politicians keeps them subservient to the people and encourages a vigorous public debate about where our society should go. Thus, democracy.
Who knew healthcare could be so complicated? Snapshots from an American dataset
by Hari Balasubramanian
Just as the distribution of wealth exhibits dramatic skews – a small percent owns a disproportionate share of the total wealth – so too does the distribution of healthcare expenditures. When individuals in the US population are ranked based on their healthcare expenditures in a particular year, then it turns out that:
1. The top 1% of individuals account for 22.8% of the total healthcare expenditures
2. The top 5% of individuals account for 50.4 % of the total healthcare expenditures
3. The bottom 50% account for only 2.8% of total healthcare expenditures
https://meps.ahrq.gov/data_files/publications/st497/stat497.pdf
(Healthcare expenditures refer to all payments made related to health events – either by insurer or out-of-pocket.)
The estimates are from 2014, but the trends remain quite consistent from year to year. It is true that older individuals are more likely to have higher expenditures. But even if we look only at those over 65, we will still find that a small percent has an outsize impact. There is a fractal-like consistency to the pattern: if we narrowed our search down to the top 1% in a population of 10,000, then among these 100, the top 1-5 individuals will still account for a large percent of the total.
A similar trend emerges when we look instead at the prevalence of health conditions. If we were to plot the percent of individuals in a population (y-axis) who had no health conditions (count=0 on the x axis), exactly 1 health condition (count=1), exactly 2 health conditions (count=2) and so on, we would get something like the graph to the right. About 45% of the population has no apparent health conditions; about 25% has exactly one health condition; 12% has exactly two health conditions. The percentages start to decline as the count of conditions increases, indicative of the few who have 6, 7, 8, 9 or more conditions. We are now at the tail of the distribution where healthcare costs are most likely to be concentrated.
Because most of us in any particular year are healthy, the challenges faced by this small segment of the population can remain somewhat distant. Yet at some point in our lives – hopefully later than earlier or even better not at all: who can say – there is always a chance that we might join their ranks.
In this column, I will present visualizations of healthcare use by individuals at the tails of the cost and health condition count distributions. I started creating these visualizations while researching a publicly available dataset called the Medical Expenditure Panel Survey – MEPS for short. This is the same dataset that was used to characterize the expenditure distribution above. Aggregate trends are valuable, but it is by looking closely at individual cases that one can begin to sense what is going on. Each year MEPS collects granular data on health events for members of thousands of households across the United States. Households are chosen in the survey to represent the national demographic; each household is compensated for the time spent filling out questionnaires. To protect the identities of those surveyed, the data is anonymized before it is released to the public.