Made in 1997, this film never played anywhere remotely close to where I live, and I can say with complete assurance it never will. I have to admit that I nearly turned it off, and I had to pause it several times to catch my breath.

Gummo is a nihilistic, non-linear cinema verite romp through Xenia, Ohio, a town that was nearly destroyed by a tornado in the early 1970’s; people fell from the sky and buildings imploded, crushing friends and family. Pets and people were dismembered, blown away, and impaled on television antennae, creating gristly sculptures.

Gummo documents the aftermath, the post-apocalyptic Xenia. And a word of warning … if you’re a cat lover, as I am, you may want to pass on this film, which contains scenes of graphic violence done to animals. According to Korine, prosthetic animals were used for the scenes. It will still make you squirm. It may even make you vomit

What you get out of all this is a direct experience, unlike most modern films, which are re-enactments of various kinds of film experiences you’ve already had.

The way this film was constructed is extremely interesting, too. Although it is set in Xenia, Ohio, it was actually shot in the poorest suburbs of Nashville, Tennesse, near where Korine grew up.

Korine brought in well-known cinematographer Jean-Yves Escoffier, who did Les Amants du Pont-Neuf , The Butcher Boy, and The English Patient, as well as the video for the Johnny Cash version of Trent Reznor’s Hurt.

Gummo is 35mm film combined with a variety of other media. Korine handed out 8mm, 16mm, VHS video, and polaroid cameras to friends and crew members, encouraging them to shoot at will, on and off the set. Korine then mixes documentary shots featuring real non-actors in real situations with vignettes shot with the five professional actors in a bunch of different media to produce a rich and perverse visual experience that is 75% scripted and 25% improvised, according to Korine.

Often, in the spontaneous scenes, violence is palpable, and just below the surface. One scene featured a drunken kitchen party, with an impromptu arm-wrestling tournament, that devolves into frantic chair-wrestling by one of Korine’s shirtless, drunken, found-actors, who had just gotten out of prison. The crew and monitors were hidden when this scene was filmed. Korine was out of the room. At one point, the improvised scene breaks down, and no one knows what to do. This moment is priceless. I’ve experienced moments like this after something shocking or inexplicable takes place at a party, or in a public place.

Some of the locations used were so cramped and pest-ridden that the film crew demanded hazmat suits. Korine and Escoffier, offended by this, wore speedos and flip-flops to the shoot, just to piss off the crew.

Korine himself makes a cameo appearance as a drunken young man who is trying to seduce a gay, encephalitic, black dwarf. The dwarf is a non-actor who Korine knew from high school.

Chloe Sevigny, Korine’s girlfriend at the time, is the only household name in the film. She both performed as an actress, and contributed costume design for the film. Costumes were largely drawn from what the found actors actually owned, combined with thrift-shop finds.

The soundtrack combines various elements of American pop culture, from a field recording of the children’s song ‘My Little Rooster’, to Madonna’s ‘Like A Prayer’, with whole bunches of black metal, from bands like Absu, Barzum, Bathory, Bethlehem, Brujeria, Eyehategod, and Spazz. The aural, visual, and dramatic all work well together.

There are a lot of weird vaudeville references too, with characters spontaneously breaking into vaudeville-like standup monologues. Tap dancing also makes an appearance.

Gummo has been variously described as a surrealist joke, a visual poem, and a worm’s-eye view of white-trash suffering. As with the films of Lynn Ramsey and Vincent Gallo, I feel like I know, or have met the characters. Parts of this film could easily have been filmed a few miles from where I live.

The film is a visual treat, simultaneously hyperrealistic, and surreal. Korine had so much footage left after the final cut that a companion work, a three screen installation called The Diary of Anne Frank, Part II was created out of the leftovers. I’d love to see it.

Although this film isn’t quite as challenging as Pasolini’s 120 Days of Sodom, it’s challenging enough, and may not be for you. I thought it was worth it. It’s available from Netflix.

Korine’s newest film, Trash Humpers, released last fall, will be coming to video soon.

Impossible Music is the first release on the hyperfunction label, a new label created by guitarist Michael Peters and touch-guitarist Marcus Reuter, specifically for algorithmic music.

If Impossible Music is any indication, hyperfunction is off to an auspicious start.

The compositions here were created in 1996 by Michael Peters, using his software implementation of an algorithm based on a strange attractor named after Igor Gumowski and Christian Mira, CERN physicists who discovered it during their research in nonlinear dynamic systems.

Starting out with an (x,y) value pair, the next value pair (xn,yn) is computed like this:
   xn = a * y + p * x + 2 * sqr(x) * (1 – p) / (1 + sqr(x))
   yn = -x + p * xn + 2 * sqr(xn) * (1 – p) / (1 + sqr(xn))
with “a” typically being = 1.0 and “p” being a constant between -1 and 1.

The visual output of this strange attractor is quite beautiful, and provides the cover art for the release.

While the math may look daunting, there is nothing heavy or ponderous about the music, which is light, cheerful, and full of wit and humor.

The compositions incorporate process improvisations that use the output of the algorithm as a starting point to generate a stream of musical information. Michael and collaborator Matthias Ebbinghaus then interacted with the stream in real-time by changing various parameters in response to the output, to produce the final result.

The result is a collection of sixteen tinkling, percussive pieces that will bring a smile to your face. Most of the pieces are under two minutes in length, and would work perfectly as the soundtrack to a classic Mack Sennett comedy.

The overall recording quality of the release reflects a lot of love, care, and a meticulous attention to detail. The sounds chosen to voice the pieces perfectly complement the musical structures produced. The final recording was mastered in 2007 by Walter Bruhn, who did a wonderful job. The sonic quality is superb overall.

I had my introduction to algorithmic music in 1997, at the hands of Gary Lee Nelson, a professor of composition at Oberlin Conservatory of Music, near Cleveland, Ohio.

I’d driven out there over several days on a slow, meandering route making field recordings and staying at truck stop motels, in anticipation of attending the two-week summer workshop in electronic and computer music that the conservatory makes available every summer for a modest fee to the general public.

I had expected to use the high-end digital editing tools that would be available there to create a collage of the field recordings that I’d made on the way out.

Instead, I was introduced to Opcode MAX, a visual programming language that was used then to create, process, and manipulate MIDI data. MAX was later expanded to include msp and Jitter. Today these tools can be used to manipulate sound and video too.

MIDI data works like a player piano roll. It contains information about sound that include primary characteristics pitch, duration, and velocity as well as some or all of 128 secondary characteristics that can include things like portamento, pitch bend, etc. MIDI data doesn’t contain sound, only information to be used in creating a sound. MIDI data must then be voiced by an electronic instrument that accepts MIDI data, in the same way that a player piano roll doesn’t make sound until it serves as input to a player piano.

An algorithm is a number factory that takes a stream of input, and produces one or more streams of output. In algorithmic music, the output stream of an algorithm is mapped to a musical system of one kind or another. The process is similar to cryptography in that a transformation is performed on a body of data.

In cryptography, clear text that is readable by anyone is turned into an encrypted message that only the intended recipient can read.

Creating algorithmic music is like cryptography in reverse. The composer finds a musical message in a stream of data, and then decodes it by mapping it to an appropriate musical system so that it can be enjoyed by everyone.

For instance, to map a single stream of output to a diatonic scale in one octave, you could use modular, or clock arithmetic (Mod 7), because a diatonic scale in one octave consists of 7 notes. A quick way to do clock arithmetic is to do integer division on the number by whatever the modulus is, in this case 7, throw away the result, and keep the remainder.

So, if your algorithm produced the following values: 1177, 2018, 66, 5, 3, 22, 1, 11, 299 4, they could be mapped to C major, as follows:

1177(Mod 7) = 1
2018(Mod 7) = 2
66(Mod 7) = 3
5(Mod 7) = 5
3(Mod 7) = 3
22(Mod 7) = 1
1(Mod 7) = 1
11(Mod 7) = 4
299(Mod 7) = 5
4(Mod 7) = 4

If 1 is middle C (C3), the resulting melody would be C – D – E – G – E – C – C – F – G – F.

Then, the same stream could be reused, this time to map a duration to each of the note values. To do this, you could use (Mod 5) to map one of 5 note duration values (whole, half, quarter, eighth, or sixteenth) to each of the pitches, as follows:

1177(Mod 5) = 2
2018(Mod 5) = 3
66(Mod 5) = 1
5(Mod 5) = 1
3(Mod 5) = 3
22(Mod 5) = 2
1(Mod 5) = 1
11(Mod 5) = 1
299(Mod 5) = 4
4(Mod 5) = 4

This is the result:

I selected 4/4 time here, filling in measures with rests when the note value occurring next is too large for the bar.

This is the result of a single very simple stream mapped to a simple musical system.

Impossible Music is the result of a much more complex algorithm producing two streams mapped to a carefully chosen musical system.

The composition in algorithmic composition is in the process of selecting the method of mapping, and what kind of musical system to apply this map to.

Michael Peters and collaborators Matthias Ebbinghaus and Walter Bruhn have revealed the wonderful music hidden in this strange attractor. I highly recommend this release. Impossible Music can be purchased now from Iapedus and Burning Shed.

Impossible Music
hyperfunction, 2009
Michael Peters: programming and realtime parameter manipulation
Matthias Ebbinhaus: live mix and controllers, editing
Walter Bruhn: Final Mix

My first exposure to Mr. Gallo was Downtown 81, the Edo Bertoglio film, originally titled New York Beat Movie, that was shot in 1981, but not released until 2000.

In 1981, when I bought a ROIR cassette release of a live set by James White and the Blacks, a.k.a. James Chance and the Contortions, I got the stink-eye from the record store clerk in the conservative college town where I bought it, and my small-town musician buddies, who were perpetually decked out in full Clash regalia at the time, considered me to be a triple loser in the trifecta of cool, with dodgy hair, dodgy clothes, and shit taste in music. Spending ten bucks on a cassette tape of a guy in a lounge-lizard tuxedo playing out-saxophone in front of a band of jazz musicians while singing like Pee Wee Herman channeling James Brown did nothing at all to enhance my reputation.

So when Downtown 81 came out I felt kinda thrilled and vindicated to find out that what I had liked in 1981 was actually pretty cool at that moment, despite what the Clash Police would have had me believe at the time.

On top of the superb performances in the film, the incidental music is pretty good, and some of this is by Mr. Gallo, who, as well as being an actor and filmmaker, is also a painter, composer, and musician. He is a contemporary of Jean-Michel Basquiat, James Chance, Liquid Liquid, Tuxedomoon, Kid Creole, and the others featured in Downtown 81.

As a result of Downtown 81, I discovered Gallo’s film music, in a collection released on Warp Records in 2002 called Recordings of Music for Film, featuring thirty instrumental tracks that range from lyrical to abrasive. Three of the tracks are from Downtown 81. The remaining tracks include his full contributions to the soundtracks for his films If You Feel Froggy, Jump, The Way It Is, and Buffalo 66. This, in turn, lead me to Gallo’s post-post-punk industrial project Bohack, that released It Took Several Wives on Family Friend Records in 1982. This album is roughly contemporary to the better known Homotopy To Marie by Nurse With Wound, and is in a somewhat similar vein.

Gallo’s most recent musical project is the band RRIICCEE, which includes a revolving cast of other musicians. I’ve read descriptions of RRIICCEE that characterize them as a noise band. They sound nothing like what I would consider to be a noise band. I’ve only heard a bootleg of a 2007 live set, but what I’ve heard sounds more like a continuation of Bohack and Gallo’s soundtrack work in a live, improvised context than, say, Harry Pussy or Merzbow.

So, in the spirit of full disclosure, I like the man’s music, which predisposes me to like his films, too.

The Brown Bunny is the more recent of the two films, but both have elements in common. It’s clear also that both are set in a world that Gallo knows well, and from first hand experience. It’s his evocation of this world that won my sympathy for the rest of what he does or doesn’t do.

The first cut of The Brown Bunny isn’t available, as far as I know. The DVD version is 92 minutes, down from the 118 minute version that premiered at Cannes, and provoked most of the controversy that surrounds the film.

The pace of the film is stately, but I wasn’t yawning. Bud Clay, a motorcycle racer, finishes a race somewhere on the east coast, packs up his bike, and heads to California. On the way, he meets several women, all named after flowers, that he seems to want to, but becomes unable to connect with.

In both films, Gallo shows the right stuff to establish the mood that he’s looking for. I screened these right after the Lynne Ramsey films Morvern Callar and Ratcatcher. And there are some similarities. Gallo’s films are set in working class America, in the same way that Ramsey’s films are set in working class Scotland. Gallo, whose parents were hairdressers, comes from Buffalo and is a part of the world he portrays. And his portrayals resonate with me, because I’m also a part of that world.

Buffalo 66 has more humor, and more familiar faces than The Brown Bunny. The bleak picture-in-picture beginning of Buffalo 66 morphs into a series of sight gags about having an impossibly full bladder, trying to find a place to take a piss, and having no success. Also, Buffalo 66 was, and continues to be much more highly regarded critically.

The Brown Bunny is much rawer from a production standpoint. The grain suggests it was shot on super 16 and blown up to 35mm. The only humor, at least from my perspective, is that all of the women are named after flowers, and all unambiguously want Bud Clay, but Bud wants none of them. Former supermodel and Sears spokesperson Cheryl Tiegs turns in a strong cameo performance as Lily. But there are some technical point-of-view issues that can be confusing, especially after Bud meets the first flower-girl in the convenience store, and invites her to California with him.

Buffalo 66 is shot almost exclusively in Buffalo. I’ve only been to Buffalo once, but the look of the place is the unmistakable strip mall and chain restaurant milieu that characterizes rotting post-industrial America, east coast version. So even though I haven’t been there often, I know it well. Supposedly, the house where protagonist Billy Brown takes his kidnapped tap-dancing ad hoc girlfriend Layla is Gallo’s own childhood home. The scene in the bowling alley is priceless. Christina Ricci’s character Layla tap-dances to King Crimson’s Moonchild right there on the lane. And Gallo obviously bowls just as well as his character Billy Brown.

The Brown Bunny is about the effect addiction can have on young women, and about loss. Buffalo 66 is about the overwhelming and unreasonable love children can feel for indifferent and abusive parents. In both films, what you expect to happen doesn’t.

Chloe Sevigny is an excellent actress. I spotted her first in Whit Stillman’s Last Days of Disco, and I love her character Nicolette Grant in Big Love. I’ve yet to screen Gummo, but look for a review of it here as soon as I do. The final scene of The Brown Bunny includes Sevigny performing unsimulated fellatio on Gallo. So put the kids to bed. That being said, the scene is absolutely necessary dramatically. The framing, angle, composition and dialog of the scene are far from being pornographic. And I recommend turning on the subtitles to capture all of the dialog.

Gallo has gotten a lot of bad press, and I can’t say that I like his politics, as the press perceives and reports them. Although when I’ve been confronted by liberals of the witless, reflexive and upper-middle-class variety, I’ve often adopted a larger than life caricature persona of the racist, reactionary and homophobic lout liberals of the witless, knee-jerk, and upper-middle-class variety often assume all working class people to be, just for the fun of watching them reveal their own prejudices by swallowing it all whole, without catching even a hint of the irony involved. Somehow, I think that Gallo may be doing something similar with his public persona. And he is, along with Jim Goad, a gamy, bona-fide working class hero in a world full of working class hero poseurs.

To paraphrase Gallo’s website, if you had to share your childhood bedroom with someone else, you couldn’t put anything of your own on the walls, you couldn’t lock the door, and it had to look, at all times, like nobody lived there, you’re probably working class.

Despite my admiration for Gallo, his music, and his films, he’s not someone I’d care to meet. And I’m definitely not buying any of the self-aggrandizing and over-priced stuff on his website.

But Buffalo 66 (1998) and The Brown Bunny (2004) are worth the effort. Get them from Netflix.

In both films, horrific things can happen suddenly, for no reason at all. In the opening sequence of Ratcatcher, the little boy who is wool-gathering and twisting himself up in gauze curtains by the window is stunned back to reality by a slap to the head from his mother, who is out-of-frame.

Once each of these films started, I couldn’t tear my eyes away, or my ears either.

Ratcatcher, which is set in the late 1970’s during the garbage strike that led to the election of Margaret Thatcher, and the transformation of the country, for better or for worse, features songs by Eddie Cochran, Tom Jones, Frank Sinatra, The Chordettes, Carl Orff, and is anchored at multiple points with sections of Nick Drake’s incomparable ‘Cello Song’, from ‘Five Leaves Left’

As the other film opens, it’s namesake and primary character Movern Callar snuggles up to what turns out to be a corpse, and we don’t know it’s a corpse at first, until we see the self-inflicted wounds on the wrists and neck. But we know it’s Christmas, because we see the tree with the winking lights, and the gifts nearby.

The typical gush of emotion and obligatory bad weather funeral scenes that would be forthcoming in any other film never happen here. Instead Morvern is in something that looks like denial, but is actually an instant and pragmatic acceptance of the situation as just one more shitty thing that happened, for no reason at all.

After she reads the suicide note left by the boyfriend, we find out that he’s written a novel, probably while Morvern has been off paying the bills working her gig at the supermarket, and that he wanted her to submit the novel for publication, and use the remaining bank balance for his funeral. He generously tells Morvern that she can keep all the music.

Instead, Movern decides to go off on an extended pub/party crawl with a good friend, claim the novel as her own, and give her selfish and self-absorbed boyfriend the very unique funeral he actually deserves, while wearing a walkman playing his mixtape duct-taped to her naked leg.

After a weekend of wicked partying, Movern glides into work at the supermarket to Lee Hazelwood and Nancy Sinatra’s ‘One Velvet Morning’, one of the strangest songs I’ve ever heard; an attempt at psychedelia that went horribly wrong somewhere, in a mesmerizingly terrifying way. Can, Ween, Aphex Twin, Boards of Canada, Holgar Czukay, John Cale, Sterolab, and Lee Perry round out the soundtrack, which is superb overall.

In Ratcatcher, it’s all about one family’s quest to get a better council flat, set in the ebb and flow of the banal and the terrible. All Morvern Callar wants is to step outside of the deadly and soul-crushing routine of her tiny, and miserable life.

The characters in both films succeed somewhat in getting what they’re after. But the most impressing thing about the characters in both of these films is how little real impact the awful events that come their way seem to make on them. It’s as if the character’s emotions have been cauterized, tied-off, stunted; amputated or shrunk somehow, along with their aspirations.

The films are hauntingly beautiful visually, despite the stark settings of the action. The actors and actresses have the look of the hardscrabble Scotch-Irish I grew up around, and who still surround me today. The rolling scenery and rotted post-industrial landscape look quite a bit like home, too.

The performances given are nearly flawless technically, and transparent dramatically.

My only complaint is that, while the Criterion edition of Ratcatcher had subtitles so the dialog remained available, even when the thick Scottish accents were undecipherable, the characters in Morvern Callar had equally thick accents, but no subtiltes were available in the DVD edition of this film.

Both of these films are highly recommended. Ratcatcher was released in 1999, Morvern Callar in 2002. If you haven’t had an opportunity to see them, I’d take the time. Netflix has both, and both are worth the effort.

Ethan Hawke and Julie Delpy are two extraordinarily beautiful young people who fall in love in Vienna, an extraordinarily beautiful city. Both are earnest bourgeois bohemians. And they meet in that most romantic of places, a train hurtling through continental Europe.

The film opens with Jesse, Ethan Hawke’s character, reading a book on a train. A middle-aged couple is arguing loudly in German, a language tailor-made for loud, ugly exchanges. So Jesse moves to a quieter part of the train, where he spies Julie Delpy’s character, the gorgeous but sensitive Celine, reading a book by Georges Bataille, indicating that as well as being gorgeous and sensitive, she’s smart, too.

They introduce themselves. She’s French, a student at the Sorbonne, returning from a visit with her grandmother in Budapest. He’s an American from Texas, bumming around on a Euro-rail pass after a breakup with his girlfriend in Spain.

Jesse tells a story about a theory that middle-aged couples stop hearing each other, because as they age, men lose hearing in the high frequencies, and women lose hearing in the low frequencies.

The story serves as an opener to some really earnest conversation, typical blind-date talk.

Then Jesse makes his pitch. He wants Celine to get off the train with him in Vienna and bum around the city for the night. Jesse doesn’t have money for a hotel room, and he has a cheap flight back to the states leaving from Vienna in the morning.

Jesse has some serious mack-daddy charm, because she buys it, and agrees to spend the night with him knocking around Vienna.

They float around Vienna, which is a friendly, mildly exotic place, full of mildly exotic, yet harmless and friendly people, and engage in a lot of friendly, earnest blind-date chatter all the while.

Oh, and by the way, it’s June 16 – Bloomsday — which adds a patina of undergraduate literary charm to the undertaking.

They don’t fall into each other’s arms immediately though. Their first kiss is reserved for an enclosed ferris wheel car that looks to be the twin of the one in which the incomparable Orson Welles coolly waxes misanthropic as the charming and villainous Harry Lyme. Is this ferris wheel, having been soiled by unspeakable evil, thus Redeemed By True Love?

They finally bump uglies in the park, after a bottle of wine cadged (improbably) from a bartender who, Blinded By The Power Of True Love, accepts an earnest promise from Jesse that, if the barkeep should be so kind as to provide a bottle of wine today, he will gladly pay on Tuesday.

Looking scarcely rumpled, and none the worse for wear, despite being up all night on the streets in a major city, they part when Celine gets back on the train for Paris that morning, both promising to meet there again in six months.

To paraphrase Celine, this is an archetypal college-boy guy-fantasy, albeit the genteel liberal-arts version …. meet a gorgeous French girl with good teeth on a European train, fuck her on a blanket in a Vienna park, and never see her again. And what shy, sensitive college girl wouldn’t want to be a hot French girl like Celine taking a flyer with a handsome, sweet-talking American, who she could fuck on a blanket in the park, and never see again?

I avoided this film for years because I had it pegged as a first-date flick for the middlebrow art cinema crowd. Then somehow Netflix put it in the mailbox. I didn’t even know that Linklater directed it until we sat down to watch it.

Well I was right. This was a boring bit of fluff, predictable post-college twenty-something fantasy pap in a gorgeous wrapper. What beats me is why this went over so well when it came out in 1994. Krysztof Kieslowski’s ‘White’ and Roger Avary’s ‘Killing Zoe’ were also from 1994, and both were far better films than this one. Julie Delpy looked just as good in these films, too. Yet I don’t recall these better films getting even half the press, if that. And I’ve probably sat through the ‘Before Sunrise’ and ‘Before Sunset’ trailers a hundred times or more at various theaters over the past 15 years.

While initial reviews of this film were overwhelmingly positive, more recent reviews, not so much. The film seems impossibly trite and innocent now. Of course, 1994 was a trite and innocent time, compared to now. If the film were made today, Jesse and Celine would meet on a Greyhound from Portland. He’s newly homeless and heading to Pittsburgh to spend a weekend with his brother before reporting to Army Basic Training. She is a pretty hispanic girl on the run from her homicidal Guatemalan gang-boss boyfriend and his posse of machete-wielding thugs. She’s on her way to Cleveland to catch another Greyhound south to New Orleans where she plans to make big bucks as a server in the new French Quarter Theme Park. The Greyhound breaks down in Detroit, where they’re forced to spend the night. They are beaten and robbed. A meth dealer sees them as a Light of True Love and fronts them a bag, which they do up. They fuck all night in a public restroom. They vow to meet in six months, in the same bus terminal bathroom.

In the sequel, they meet in the same bus station nine years later. He’s on his way to military prison, and she’s mopping the floors. They are thrown beneath the wheels of a bus by the meth dealer, who is still waiting to get paid for that bag.

During the late 1990’s and the early part of this decade, my parents were finally beaten down by long-term chronic conditions. They died. I was their intermediary with the health-care system. They had Medicare, a paid Medicare supplement they could barely afford, and at the end, Medicaid. It wasn’t enough, and their care was compromised as a result.

In 2006, my wife was diagnosed with a potentially life-threatening condition. She’s all better now, but the experience was instructive and expensive. And we were well-insured, or so we thought. It was the quest for more-better health insurance that drove me back to work after the bracing autonomy of retirement.

I’m now a pubic employee, a member of that great big union the conservatives love to hate, and because of the collective bargaining agreement negotiated by this union, I have premium health insurance, a guaranteed payout pension, and a measure of job security virtually unheard outside of the C-officer suites and boardrooms of today’s corporations. Yet even though my coworkers enjoy all of these same benefits, including the premium health insurance, many if not most of them are in alarmingly poor health.

Citizens of the United States aren’t at the top of the list of the world’s healthiest people anymore, and an inadequate and over-priced health care system is part of that problem, but not all of it.

If you find yourself without health insurance, do whatever you need to do to get some. Sell the pickup, tap the 401-k, get a second mortgage and a third job, whatever. Providing of course, that a policy is available for you at *any* price. Not having insurance can be fatal. Being poor can kill you.

When I was growing up, like most working-class families, we went to the doctor when we were sick. We went to the dentist when we had a toothache. If we couldn’t see the blackboard at school, we got glasses. My parents, in order to make these visits possible for my brother and me, did without themselves.

I was seriously ill a couple of times as a child, and I remember that the entire process was stage-managed by a general practitioner, who coordinated and explained everything.

When my parents started to get seriously sick, I had to run interference for them with the health care and social services bureaucracies, and the first thing I learned is that nobody coordinates anything. You are totally on your own. And if you’re not proactive, or God forbid, if you’re an elderly person without an advocate, your care is going to suffer and ultimately, so will you.

At the Medicare end of the spectrum, a lot of sick people are competing for relatively scarce healthcare resources. Not all doctors see Medicare or Medicaid patients, and the ones who do usually aren’t the best resources available.

My parents relied on the health care infrastructure of the decaying mill-town ten miles down the road. The mills closed up and moved out in the 1970’s, leaving their aging former employees with a legacy of chronic health problems. My parents didn’t work in these mills, but my paternal grandfather and many of my aunts and uncles did. And almost all of them died from the kinds of chronic lung conditions endemic to the textile industry.

The children of these mill workers, or the luckier ones not imprisoned in the service and retail ghettos, now work primarily in health care, the only growth industry that pays, left in the wake of industrial decay and abandonment. Except none of them are doctors. They fill the more menial roles, while the doctors are largely graduates of medical schools in Mexico, Central America, India, and The Philippines. Are these doctors competent? Who knows. They are the only game in town.

I remember taking my mother to one of these Medicare Mills for the first time, and walking into a dirty, crowded waiting room full of people with chronic respiratory problems. A security guard in a blue blazer and name tag stood in the hall. After 40 minutes, we saw the doctor, a south-asian, and the exam was cursory, at best. The whole office appeared harried and over-worked.

And this office was the rule, rather than the exception. The process of dealing with the various providers was fraught with error and miscommunication. Follow-up was necessary for each and every item. Conflicting appointments and appointments at impossible hours, missed tests, misplaced test results, a reluctance to do hospital admittance and attempts to discharge from hospital sick, elderly people too weak to care for themselves were common.

Threats and even yelling were sometimes necessary to eke out a bit more care, or a higher quality care for my parents. But the sad thing is I know that every advantage I was able to secure for my parents probably came at the expense of other poor elderly without advocates.

If I could have pulled my parents up out of that mess and possibly prolonged their lives, I would have. But by the time I became involved in their care, it was already too late. They’d been misdiagnosed, over-medicated and under-treated for too long. And there *was* nothing else. It was Medicare Mills filled with indifferent and marginally competent foreign-trained doctors. Or nothing.

My Father died from complications related to lung cancer in a Medicaid nursing home bed November 8, 2001. Patients with his diagnosis and better care often live five to ten years. He lived three. My Mother died from complications related to COPD and emergency room error March 25, 2002.

My wife is also a public employee, and at the time of her diagnosis, she was carrying the health insurance for the entire family, a policy that is generally perceived as one of the best you can get. As we started making the rounds of the doctors, it was immediately clear that we were at a different tier of the health care system than the one my parents were forced to occupy. The doctors were graduates of US medical schools. The waiting rooms were both less crowded and cleaner. And the doctors were more available to talk at length about prognosis and treatment.

Yet the whole process was still largely self-service. We gleaned the majority of our information about my wife’s condition and treatment options from the Internet, and leveraged this information with the health care providers we were using to improve care quality and options. And we still had to coordinate tests, follow up for results, and double-check for errors and omissions. Once again, if you just passively take the default in all the interactions without questioning and following up, your care will suffer.

And from the very beginning, there were ominous financial rumblings. It was made crystal clear immediately that any amounts not paid by insurance were due and payable immediately, up-front and prior to treatment. At this point, we found out that the first $5000 would be out-of-pocket. Luckily, we had a flexible spending account, and were able to distribute this out-of-pocket expense over an entire year, and pay it with tax-free dollars. And ultimately, it cost a lot more than $5000 to satisfy that requirement, as many of the things we had to pay for out-of-pocket didn’t count toward satisfying this out-of-pocket minimum.

But the major shock came when we realized that there was a chance my wife could be disabled by her condition, and unable to continue working. In which case, she’d have no health insurance, and she’d either have to continue her coverage via COBRA, which is extremely expensive and is only temporary, with an 18 month cap, or we’d have to buy private coverage, which was unlikely to be available at any price, given that my wife would have been disabled. A disability retirement with pension and Social Security Disability with Medicare would be an option in this situation, but this takes years to apply for and get. And of course, the rest of the family would still be without coverage.

Luckily, the doomsday scenario didn’t happen. My wife continued working, with health insurance, through her treatment. But it was a major wake-up call.

If only one member of your family is carrying insurance for all of you, what happens if this person gets sick? What happens if they are disabled? That’s the question that sent me back to work. Now my wife and I both carry full coverage on each other, so in the event one of us becomes too sick to work, or loses a job, there will still be uninterrupted coverage. And health insurances can be set up as primary and secondary, with charges not being paid by the primary policy falling through to the secondary coverage for payment.

Short-term disability coverage, which was a part of my compensation package with a private-sector employer (albeit a very good one)
twenty years ago is no longer available, even in a public-sector unionized environment. If you get seriously ill and need to be off work for three to six months, and you don’t have the sick-time saved up, you’re just shit-out-of-luck. So now I also carry a private short-term disability policy that will pay me 75% of my salary if I’m disabled for 30 days up to two years.

Granted, it’s expensive and redundant; a belt-and-suspenders approach. But the consequences of *not* having medical coverage and income when you need it, unlikely as this may be, are too dire to contemplate.

So, what’s the solution? Two words. Single Payer. Nationalized health insurance for everyone, with an enhanced social safety net to cover short and long-term disability, as well as long-term and systemic unemployment and underemployment. Universal health insurance will benefit the poor and working poor, obviously. But it would also act as an engine fueling innovation, as a major operating expense for small and medium-sized companies would be eliminated.

But great universal health insurance, disability, and catastrophic employment-change insurance is only part of what’s necessary to bring the United States back up to world-leadership in citizen health and well-being.

Let’s go back to my new coworkers in the public sector for a minute. These are folks that already have much of what I think all of us deserve. They have good job security, great health benefits, and a pension to buttress Social Security in their old age. Yet many of them are in startlingly poor health. Most are significantly overweight. Many still smoke in middle age, and eat an extremely poor diet.

The diet, the smoking, the overweight are in large part due to ignorance as a result of inertia and social and media conditioning. Fast food tastes good, and is advertised ad-infinitum. Cigarette advertising is now illegal, but 007 smokes. I also suspect busier schedules, an inability or unwillingness to cook, combined with an over-reliance on pre-packaged food. Trans-fats and high-fructose corn syrup are culprits too, I think. And there is a justified mistrust of the medical profession — if you’re unsophisticated enough to take things at face-value, and you’re too timid to bark back, anything can happen. Diagnostic screenings and early detection efforts often seem arcane, painful, and unnecessary, especially if you’re feeling OK.

But yet, it’s the diagnostic/preventative stuff that keeps you well and really pays off in terms of extended years of quality life. I had a colonoscopy myself last year. On an unpleasantness scale of 1-10, prepping for the colonoscopy is a 10. Yet the procedure is invaluable in heading off colon cancer. In my case, I had a benign polyp in my ascending colon. Maybe nothing would have come of it if it hadn’t been removed. On the other hand, if it had turned malignant, by the time I had sensed any symptoms or discomfort, it would have been way too late.

It takes education and awareness to convince people that the most productive visits to the doctor are the ones you make when you’re *not* sick. Many of my coworkers aren’t getting routine physicals. They’re doing what we did in my working-class childhood. They’re not going to the doctors unless/unitil they’re sick. And by then, it’s usually too late. A chronic condition has already taken hold and is irreversible.

Education about the importance of diet and exercise in long-term health needs to be stressed, and coupled with a new regulatory structure with teeth. Poisonous foods, sham diets, snake-oil health claims, and sales of products that damage people or make them sick need to be stopped.

The social interface to the current health care system sucks, sucks, sucks. Three people I work with are diabetic. Our medical coverage *pays* 100% for diabetic testing devices and consumables, yet all three until recently were either paying $200 out-of-pocket a month for these supplies, or doing without them, simply because no one was able to tell them that the Durable Medical Equipment benefit, which is administered separately from the health coverage proper paid for the meters and the test strips. What they needed was a meta-interface that straddled all the care available and could direct them quickly to the appropriate resource for their needs. I suspect in my organization, health issues go under-treated, and insurance resources go under-utilized simply because people don’t know *how* to intelligently apply the resources they have.

I get really pissed every time I see a billboard, advertisement, or slick PR magazine handout from a health care institution. I say *fire* the marketing vice presidents, drain the ad budget, and spend that money on making sick people well. Spend that money on project managers/caseworkers/coordinators for people who don’t have the resources to do this for themselves, because God only knows, you need it if you’re going to get decent care.

After nearly fifteen years of dealing with the health care and social service bureaucracies, I can say with 100% assurance that the system is definitely, irreparably broken beyond fixing. Greedy insurance companies and for-profit healthcare have got to go if the United States is to regain world leadership in terms of citizen health and well-being.

Where will the money come from? We’re already spending more per person than most of the world. We simply need to redirect more of the money to care that matters. Fire the CEO’s and marketing vice presidents. Let the Doctors run the show. And then there are taxes. I suggest we start with private equity firms, hedge funds, and their traders/managers. These people by and large profit from a zero-sum speculative game that drains public companies and pension funds of resources while creating absolutely nothing of productive value. If these ill-gotten gains can be confiscated, and better yet, if the whole thieving business category can be taxed into oblivion, so much the better.

The New York Public Library has installed one of these and will be giving away free public domain and open-license books to patrons. Read about it here.

read more about the machine | digg story

DRM costs millions, takes years, and is defeated in days, for pennies, by hobbyists.

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This is an interesting angle. I’ve worked in enough corporate environments to understand that, outside of technology companies, top managers are seldom conversant with technology and view any attempt to understand it in depth as a waste of time best left to the losers in the IT departments. So, when someone shows up who looks and talks like they do, and tells them what they want to hear — i.e. that their precious ‘content’ can be ‘protected’ from pirates and others who would ’steal’ it and impact their ‘revenue stream’, they are inclined to believe it, even if it’s bullshit. Perfect DRM could only have a chance in a tightly controlled environment where every advantage would accrue to those who wanted to do the protecting. Think a situation where technologies of production are both incredibly expensive and technologically opaque, distribution is a single-player closed shop, and marketing is achieved via exclusive access to a closed channel …. uh, wait … that sounds a whole lot like the world of media and popular entertainment, pre-internet.

I think the only way DRM will succeed is if the Internet can be turned into or replaced by a neo-broadcast technology, that is a technology that is bi-directional, but massively asymmetric in favor of the broadcaster … in other words, the channel down to the audience is broad and rich, and the channel back to the source is narrow and small to facilitate purchases, and little else, save maybe an old fashioned letter to the editor or two ….

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Hmmmm ….. Perhaps this means that the credit card processing denial-of-service attack perpetrated on the discount Russian sites at the behest of media cartels here in the US isn’t going to stand up in Russian court ….

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Yes, it’s finally gone. Former allofmp3.com customers will be forced to go here or here or here …… well, you get the idea …

It’s highly unlikely that the disappearance of one discount music download service that takes advantage of international differences in intellectual property law will change the overall landscape or the direction of an inevitable trend.

I still can’t understand why media companies can’t process the obvious lesson here. If I were them, I’d be running with the wind on this one, instead of against the wind, as my ship slowly sinks …