The Archer of Rouen

As Tony Robinson puts it, history is fragile. Some of the things we think are set in stone are actually written in water.

I just watched a fascinating documentary by Tony Robinson, the actor whose most popular character was Baldric in the Blackadder series on British television. After that series he started hosting and writing programs on history and archeology, notably Time Team, which ran for more than a decade. He also made a series of television specials dealing with historical myths, including a revisionist take on Richard the Third.

Most people know, or “know” about King Richard from the Shakespeare play. His character is an amoral grasping schemer, killing his way to the throne. Among his victims in the play are the princes in the Tower, the sons of his brother, Edward the Fourth. He not only has them killed, but he has one of his people announce that Edward, their father, was illegitimate.

Richard III, Act 3, Scene 5

Tell them, when that my mother went with child

Of that unsatiate Edward, noble York

My princely father then had wars in France

And, by just computation of the time,

Found that the issue was not his begot,

Which well appeared in his lineaments,

Being nothing like the noble duke my father;

The accusation is that, calculating back from Edward’s birth date, The Duke of York was nowhere near his wife around the possible time of conception. The added piece of evidence is that Edward in no way resembled his father. A nasty piece of slander, to be expected from a character like Richard.

But was it more than slander?

Elizabethan plays aside, there were rumors in Edward’s time that he was illegitimate. Those rumors pointed to an archer in the English garrison in Rouen France, named Blaybourne. Edward’s mother, Cecily Neville, had been at Rouen while the Duke of York was on campaign elsewhere in France.

Robinson spoke with a British historian who had been researching the English/French wars of the 15^th century and came across something startling in the records of Rouen cathedral. The cathedral’s chapter book records daily prayers for the Duke in July and August of 1441 – prayers because he was away fighting. Edward was born April 28^th, 1442. Forty weeks gestation gives us an ideal date of conception of July 29^th, 1441. Edward would have to have been a month late – impossible – or a month early, which would have elicited much comment. Premature babies had little chance of surviving in the 15^th century. There are other pieces of evidence, including a statement by Cecily herself that Edward was illegitimate, but an impossible birthdate clinches it.

So what does this mean? Edward the Fourth being illegitimate, so were his offspring, including his daughter Elizabeth, who Henry Tudor married to legitimize his own illegitimate claim to the throne. The entire Tudor line becomes illegitimate, and so on down through the Georges and Queen Victoria to Elizabeth the Second, now on the throne.

It sounds ridiculous. It’s the British Royal Family, right? Elizabeth, Philip, Charles, Harry, and Andrew. Kind of troubled and out of touch, but royal. However, the two qualifications for royalty are 1) legitimate birth, and 2) a royal ancestor. You can be evil, barking mad, or thick as a roast beef sandwich, but with a direct line back to a royal, you’re in. If 17^th-Great Grandma jumped the fence you’re out.

With the present occupants of Windsor Castle being squatters, who actually has a claim? The answer lies in Edward’s brother George, Duke of Clarence, legendarily drowned in a barrel of Malmsey wine. His daughter Margaret had five children before being executed on trumped up charges by Henry the Eighth. Those charges were fabricated due to the fact that her family’s bona fides rivaled those of the Tudors. Margaret’s line winds down and around till it joins with that of the rich and powerful Hastings family. Their fortunes collapsed in the late 19^th century.

Robinson traced the Hastings line into the 20^th century and ended up in the outback of Australia. There he met one Michael Hastings, a middle aged agricultural researcher. King Michael the First, as Robinson calls him, was born in England and grew up in a small house in the shadow of the ruined castle that once housed the mighty Hastings of old. Actually the 14^th Earl of Loudon, Michael was happy living as an ordinary citizen of Australia. He died this last summer at the age of 71, but left a royal family behind, including Simon the First, the new pretender to the throne.

It’s a solid piece of genealogical detective work, brought about by a chance discovery in a church record book. But what does it really signify?

Even if Richard III had prevailed at Bosworth Field, someone would occupy the throne. The names would have changed, but the turmoil and geopolitical forces would have been much the same. The royal line has enough backstabbing, usurpation, upset victories, and infant mortality that the chances of any branch of the British royal family were probably as good as any other. In 1066 that fateful arrow could have missed Harald and hit the guy next to him. So Elizabeth II is descended from an archer and not a Plantagenet – so what? She’s not about to pack up the Corgis and shog off. A properly descended monarchy would be just as archaic and ridiculous.

Perhaps this is a joke of the fates, a victory for the ordinary schmo. The commoners have taken the throne.

It makes no difference to me who waves to the crowds in London. What makes this story interesting is the way that a deep dive into history can turn supposed truisms upside down. The more important a piece of history is to people in power, or to a people’s self-image, the more likely it is to be fiction. Our own popular history in the U.S. is a cob-job of essential truths and essential myths.

The words “history” and “story” were not differentiated until the late 15^th century, and perhaps the eventual distinction was naive. Fiction is designed to satisfy our need for entertainment, for narrative cohesion, and in many cases, for closure and comfort. History, written by the victors and edited by the zeitgeist, adds the needs of power and social cohesion to the mix. History, real history, based on hard evidence, tends to annoy people, even enrage them. Part of the annoyance is that when done properly it leaves uncomfortable gaps.

From this I’ll postulate Minor Heretic’s Rule of Historical Narrative: If a particular bit of history makes you feel comfortable and satisfied, it’s almost certainly a crock of shit.

Saratoga

Ok, so Obama got reelected. I’m truly happier than if Romney had gotten in, but I’m not leaping out of my chair. In fact, I barely give a damn.

Back to my coffee cup metaphor: Let’s say you have a machine that makes disposable cardboard coffee cups. You hit the button and out comes a cup. You pour in hot coffee and it leaks out a hole in the bottom, burning you. You curse the cup, pitch it aside, and hit the button again. Same result – pour, leak, burn, curse, discard. And again. And again. Sooner than later you should get the idea that the machine itself needs fixing. Simply cycling through defective products is going to get you burned.

Always remember that the same political machine produced both Romney and Obama. Our president may have more progressive views on social issues, and he may talk a good line on economic issues, but there are boundaries he won’t cross. The banks will have their way and the security-industrial-prison-surveillance juggernaut will roll on.

I’m interested in some of the non-presidential battles lost and won.

There is a bump in gender issues. Maine, Maryland, and Washington held referenda on legalizing same-sex marriage, and all three won. Minnesota held a referendum on an amendment to the state constitution that would have prohibited same-sex marriage. It lost. Meanwhile, in Wisconsin (home of Paul Ryan), Tammy Baldwin became the first openly gay member of the U.S. Senate, defeating Republican Tommy Thompson. Thompson’s campaign tried a couple of anti-gay shots but had to walk them back. As a bonus, her vacated House seat was won by openly gay assemblyman Mark Pocan. I am thinking that the descriptor “openly gay” is slowly on its way out in reporting on political campaigns. There are many places in red state America where sexual orientation is still a political issue, but fewer.

Similarly, we have seen a couple of right-wing Republicans gaffe themselves to defeat over women’s issues. Senate candidate Todd Akin’s comment on “legitimate rape” and his sad ignorance of middle school level reproductive biology contributed to his defeat. So too, Senate candidate Richard Mourdock sank his candidacy with his statement that pregnancy resulting from rape was “God’s will.” My theory is that many voters, even somewhat conservative voters, are having “holy shit” moments when they realize just what dinosaurs these guys are.

In other races, Allen West, single term Tea Party favorite and commie-under-the-bed hunter is out. Also in Florida, former single term progressive and fighter Alan Grayson is back in. Ultra-right-wing-nut Michelle Bachmann held on, but by a hair-thin margin, despite outspending her challenger 12:1.

Oh, and Elizabeth Warren. The Harvard professor and bankster-bashing consumer advocate edged out Republican Scott Brown. Sweetness. I am looking forward to her causing some serious trouble for the Masters of the Universe.

Closer to home, New Hampshire booted some single term Tea Party types and swung a bit to the left. Vermont had a Democratic near sweep in statewide races, the exception being Lieutenant Governor and low-key moderate nice guy Phil Scott. Our governor hung his hat on single payer health care and won in a landslide. The Republicans in Vermont headed hard right and generally got their buttocks handed to them in fine silver tureens. Republican financier Lenore Broughton spent around a million dollars on half a dozen Vermont races without success.

Lenore’s role model, billionaire casino owner Sheldon Adelson, dumped $53 million into conservative national super PACs with a similar lack of success. Mitt Romney, George Allen, Allen West, and Schmuley Boteach lost, despite Adelson’s millions. Karl Rove’s organizations spent $390 million of millionaire money on far-right candidates and got near zero return on investment.

Nationwide, people got a close look at ultra-conservatism and most didn’t like it. They also got a look at the billion dollar fallout from the Citizens United ruling and they didn’t like that either.

On the Drug War front, Washington and Colorado legalized the possession and recreational use of marijuana. Massachusetts, as an addendum, became the 18^th state to legalize medical marijuana. This is huge.

Remember when Vermont instituted civil unions for same sex couples? Remember what a big deal it was at the time? How progressive and brave Vermont was for doing something that in retrospect was a half measure and a no brainer at that? My prediction: marijuana legalization will evolve the same way. The sky hasn’t fallen in states with legalized medical marijuana, and it won’t fall in states with legalized recreational marijuana. Those states will see their tax revenues rise slightly and their law enforcement and prison costs drop.

None of these are comprehensive victories. A rational health care system will take time and multiple defeats. The federal government will push back on legalization. Bigots will push back against equality. We’ll need a constitutional amendment to really get the millionaires and corporations out of or electoral system.

And yet, a couple of years ago, who woulda thunk? I’m looking back to Occupy Wall Street, when it was first pointing a finger at the banker-criminals and bringing the 99% vs.1% divide into general consciousness. We’re talking about income and class now. We’re talking about political money in a critical way.

Those of you who have studied early American history have probably twigged my title by now. Perhaps I should have been more cautious and titled it Valcour Island.

Back in 1776, the British had a plan to win the war with their rebellious colonies. They would send an army down the Champlain Valley from Canada, down the Hudson River, and cut off New England from the rest of the colonies. This required control of Lake Champlain. Benedict Arnold (yes, him) organized the building of a fleet to match the British one being built in Quebec. An outgunned and outnumbered American fleet took on the world’s greatest navy at Valcour Island – and got its ass kicked. Utterly. The British took the lake.

Even so, this victory cost the British time. The colonists had another year to prepare. When the British came down in 1777 they were picked apart, harassed, and ultimately defeated at Saratoga. The war went on for years, with many setbacks for the Americans, but the seeds of the outcome were planted at Valcour and Saratoga.

I’m hoping we are past the getting-our-ass-kicked-by-the-British-navy stage and into the picking apart the British army stage, but I’m not counting on it. Whatever the setbacks to come, I think that this election was the battle where the balance started to shift.

An Ounce of Enthusiasm…

…is worth a pound of skill.

Dear readers, I have discovered a gem.

Back in 1970 a teacher at the Portsmouth School of Art, Gavin Bryars, decided to form a student orchestra. He used an odd selection technique. The players had to be non-musicians, or if musicians, utterly unfamiliar with their chosen instrument. The result was the Portsmouth Sinfonia.

And it was magic. Please enjoy Thus Spoke Zarathustra.

How it worked, and how it didn’t

This is going to be a personal one, and a long one. I don’t like to write about myself in this way, but the story is so illustrative that I can’t resist.

First, the epic saga of my left eye. (Close friends can now go get a sandwich – you’ve heard this one) About a year ago I was at my optometrist for my regular exam, with complaints of moving spots of light in my left eye. She saw an odd blotch of pigment on the retina of my left eye. She referred me to an ophthalmologist for another look.

He pronounced it a spot of pigment of little significance, but recommended that my optometrist keep it under annual surveillance.

By the middle of this last summer my left eye was getting fuzzy. We all get “floaters” in our vision now and then, but this was like a squadron of jellyfish. More swooping lights as well. I went back to my optometrist, who kicked me up the ladder to a partnership of retinal specialists. One of them examined me, identified the spot as a birthmark, and scheduled me back in three months for another look.

In mid-September the view in my left eye was like looking through a mass of frog’s eggs.  I accidentally noticed that I was losing my peripheral vision in the top of the eye, so I emailed the retinal specialists. The next day I got the call from the doctor’s office. “Come in today” was the command. They thought that my retina might be rolling down like old wallpaper. The doctor fit me in at the end of the day. My eyeball got a visual exam, and ultrasound, and an angiogram. Then the doctor came into the exam room and shut the door.

“I think you have a choroidal melanoma, “he said. “At least, I hope it’s a choroidal melanoma. Yes, I’m pretty sure it’s a melanoma.” That means a malignant tumor – cancer of the retina. Yes, I was terrified.

My doctor got me an appointment at the Wills Eye Institute in Philadelphia for ten days later. I would go in for tests on a Monday, and if it was actually a choroidal melanoma (I didn’t have the balls to ask him what he hoped it wasn’t, but I had an idea) I would go in on that Thursday to get a metal plate loaded with radioactive iodine sewn to the back of my eyeball. Then three days in isolation, plate removal, and probable loss of vision in my eye. My chances of remission were around 98%.

The Librarian and I took the train down and she accompanied me to the Wills. I went through the usual battery of tests and was examined by a doctor from India on a fellowship and then by Dr. Carol Shields. She and her husband Jerry Shields are, as I found out, the world leaders in the treatment of ocular cancers.

The punch line: It wasn’t cancer. It was (and is) a benign hemangioma, a kind of leaky birthmark on the retina. I still had to have it treated to save the eye. Otherwise I would end up with a rakish eye patch, and every day would be Talk Like a Pirate Day.

I returned to Vermont with the Librarian (after a certain amount of celebration) and scheduled an appointment for Photo Dynamic Therapy, or PDT. This is a process where the patient is injected with a light sensitive drug that seals up capillaries. The doctor beams a cold blue laser on the spot to be treated and the drug is activated there and only there.

And so it came to pass. A couple of friends drove me up to the clinic, I was injected with $1200 worth of Visudyne, and the doctor shot me in the eye with the laser for 81 long, bright seconds. Then I reached into my “burkha bag” for a balaclava, a scarf for my face, glacier sunglasses, and gloves. With the Visudyne in me any skin exposed to the sunlight would blister like leprosy. I spent the next two days indoors with the curtains closed.

My eye is improving. The funhouse mirror effect has gone away. The frog’s eggs have diminished. The light show has toned down.

One could say that the system worked. I brought my complaint to my regular doctor at my regular checkup. I got kicked up the ladder as my condition changed. The retinal specialist made a mistake, but made it in the right direction – caution – and I was sent to the specialists who could nail it for what it was. I received state of the art treatment, which seems to be working.

Then again, one could say that the system worked because I am a special case.

Unlike many people, I go to my optometrist regularly. She has a baseline understanding of the condition of my eyes. Having been myopic for most of my life (Lasik changed that) I have an optometric habit. I was talking about my false alarm with a friend at the farmer’s market and he related the story of a friend of his who actually had had a choroidal melanoma, successfully treated with radiation therapy. He noted that in most cases choroidal melanoma is fatal. How was this, I asked, when they have a 98% effective therapy? Most people don’t get to the doctor until it’s far too late. Oh, right. Most people go through their lives with their retinas unscanned. And not just their retinas.

When I got my first diagnosis the doctor asked me if I had insurance. I did, but with a $10,000 deductible. “That’s gone,” he said. I noted that I had a $23,500 annual out-of-pocket maximum. “That’s gone too,” he said. Luckily I do have insurance, and a retirement account I can raid for this kind of emergency. 40 million Americans lack insurance and most people don’t have that much backup money.

An acquaintance told me the story of one of his golfing buddies, a successful lawyer with a six figure income, gold plated insurance, the works. He had been diagnosed with pancreatic cancer. Three hellish years later he was in remission, but also bankrupt, minus insurance, and foreclosed. Moderate wealth is no guarantee.

I had an interesting discussion with my retinal doctor as I put on my cloaking after the laser treatment.

Not surprisingly the conversation turned to the financing of health care. He was not optimistic. He reported that a number of his colleagues were folding their private practices and running for the cover of medical centers. I asked him why.

“This really needs to get out there,” he said. What follows won’t be news to Vermont doctors or hospital administrators.

He pointed out that if he and an equivalent specialist at the Fletcher Allen Health Care (FAHC) in Burlington do the same procedure, Fletcher Allen gets twice to six times the money from Blue Cross Blue Shield (BCBS). Likewise, BCBS pays him less than a 5% margin on any drug he uses, while FAHC gets a double digit percentage. FAHC gets a “facilities fee” that independent doctors don’t get, as if the independents were operating under a tree somewhere.

Why is this? “FAHC is the 1200 pound gorilla in Vermont.” He pointed to a couple of incidents in the last decade where FAHC had publicly threatened to cut off the insurance company CIGNA due to a dispute over reimbursements. I looked it up and in fact FAHC and CIGNA had gone toe to toe on reimbursement rates in 2003 and 2008. Vermont is a relatively small health care market, but our money is as green and spendy as anyone else’s. FAHC has the biggest revenue stream in our market, by far. It takes in 47% of the net patient revenue in the state, around $925 million. An insurer that loses access to FAHC becomes irrelevant in the Vermont market. Apparently the insurance companies yield to FAHC on reimbursement and make up for that by squeezing the independent practitioners.

I just received a letter from this doctor stating that his practice was ditching Blue Cross because of insufficient reimbursement.

This makes me wonder how efficient it is to have a big medical center like FAHC. Are they still trying to pay for the Renaissance Project? (From the memory hole: The Renaissance Project was a $173 million expansion approved by regulators in 1999, which turned out to be a huge fraud. The FAHC executives were keeping two sets of books on what was actually a $364 million expansion. Five C-level execs eventually pleaded guilty to various felonies and misdemeanors.)

I suppose there is a certain critical mass necessary for having a Level 1 trauma center and a teaching hospital, but do they really need twice the money for a procedure? I wonder how that plays out across various specialties, and whether one is used to subsidize another, or if it is just administrative bloat. My doctor doesn’t have any highly paid executives managing him.

It’s just another little facet of the whole dysfunctional health care mess. It points up the problem of having a monopsony (near monopoly) in a business where the consumer is desperately interested in results rather than price. That monopsony is necessary in certain cases. We can’t afford to have half a dozen Level 1 trauma centers in Vermont all competing on price. We can’t imagine that they would compete on price if there were six. What terrified relative would shop around while their loved one was bleeding from an artery?

I certainly wasn’t shopping around on price when I thought I had eyeball cancer. My two questions were

1)      Where is the best place to get treated?

2)      How fast can I get there?

Any real world experience debunks the concept of informed health care consumers using a “free market” to drive down costs. Sick people tend not to negotiate well. The worse, and therefore more expensive the condition, the more likely there is to be a specialist monopoly and the less likely that the patient will shop around.

I was also lucky that I had access to a retinal specialist less than an hour’s drive away. I am sure that is not universal. In some places people can’t even find a dentist.

And then, of course, I work for myself, so the boss gives me flex time. He won’t fire me for taking days off to get treated.

So, yes, if you see your doctor regularly, and have insurance, and have money in the bank to cover your deductible, and have a flexible work schedule, and have reasonably local access to the right doctor, and, and, and… the system works. That is too many conditionals for most people.

So what do we do?

 (All these answers are post campaign finance reform. The business of health care just wants to churn money through the system in the most extravagant way possible. Investing in the political campaigns of Social Darwinists provides a good return on investment.)

Pick one of the health financing systems of the 36 countries ahead of us in the World Health Organization’s rankings. That includes all of Europe, Canada, and even tiny Costa Rica. (But we just barely beat Morocco) Let’s be picky and choose one from the top ten. Copy it. They all provide universal coverage and obtain better health outcomes for far less money per capita. We are spending 17% of GDP on health care, when the average among OECD nations is around 9%. If we could duplicate France’s system we would save almost as much money as we now pay in personal income taxes. Let me restate that: Adopting a European style health care system would save us almost as much money as the government now collects in personal income taxes. We are simply idiots about this.

Start paying for outcomes rather than procedures. This goes hand in hand with separating doctors from particular technologies. When a doctor owns a special million dollar hammer (a dialysis clinic, a (insert acronym) scanner, an arthroscopic surgery setup) everything looks like, well, you know.

Institute regionally adjusted reimbursements to encourage doctors to move to underserved areas. Adjust the reimbursement levels regularly as the talent moves around.

Institute specialty adjusted reimbursements to encourage under populated specialties. Primary care physicians come to mind. In a recent article in the NY Times, a professor of economics advocates lower tax rates for primary care physicians, and points to a student loan repayment program offered to physicians who work in underserved areas.

Flip the organizational pyramid of hospitals upside down. Doctors, nurses, and technicians should hire and fire administrators. A hospital is about providing health care, not shuffling paper. Administrators should be organizers, fundraisers, traffic controllers, and bookkeepers, assistants to the people who are doing the primary work. Among other things, this would reduce the probability of grandiose, money sucking building projects.

Change direct cash subsidies to corn growers back to price supports. Say what? Before the mid-1970s, the government supported corn farmers as a buyer of last resort. If there was a bumper crop and corn prices fell below the cost of production, the feds would buy the corn at a sustainable price and store it. When the inevitable bad harvest came and prices went up, the feds would sell the corn at a reasonable price to keep it affordable to consumers. No net cost to taxpayers and corn prices stayed steady. Then President Nixon’s Secretary of Agriculture, Earl Butz, promoted ultra-cheap corn and soybeans with direct cash subsidies instead of price supports. The result of this policy is ultra-cheap sugar and fat, in the form of high-fructose corn syrup, soybean oil, and grain fattened meat. While the inflation adjusted price of corn has stayed flat over the past40 years, the price of produce has gone up 40%. Call it subsidized illness.

I’m ok. I’m lucky. I’m not looking forward to paying the bills – probably the price of a used car. But I am lucky; lucky in where I live, in how I work, and in my modest prosperity. However, we’re running a civilized society here, not a jungle. Luck is not the proper basis for a health care policy.

I Didn’t Watch

I didn’t watch the presidential debate last night. There is only so much my psyche can take. I have read a few of the after action reports, and it sounds as if I didn’t miss much.

Apparently Mitt Romney “won” on style, which is mostly what these things are about. He wore out his teeth from behind by lying through them continuously. Obama was professorial and languid. Yawn.

One commentator pointed out that the debates are aimed at the undecided, which means the low-information, low motivation voters who haven’t been paying attention in class, ever. I guess this means the people who are more concerned with the latest celebrity breakup than the future of the nation. It sounds as if the proceeding delivered for them. The outcome of the election may hinge on their casual judgment.

The contest of personalities between Romney and Obama interests me not at all. Their political differences are akin to the differences between a medieval surgeon who wants to bleed you before cutting your leg off and a 19^th century surgeon who knows better than to bleed you but wipes his saw on his pants by way of sanitary practice. Obama is a few centuries more advanced than Romney, but neither offering us a sure path to survival. Neither is operating on the basis of state of the art medicine or offering to save the leg.

This makes sense. Both men were chosen through the accumulation of large campaign donations from multi-millionaires. These wealthy donors, in turn, are remoras sucked on to the inhuman corporate sharks that run our society. These corporate sharks have all the foresight and compassion of…sharks. It should not shock us that the candidates have no policies that truly address the realities we face.

In a recent interview, writer and political activist Noam Chomsky was asked how progressives should view the present electoral contest.

Chomsky said “I think they should spend five or ten minutes on it. Seeing if there’s a point in taking part in the carefully orchestrated electoral extravaganza.  And my own judgment, for what it’s worth, is, yes, there’s a point to taking a part.”  The long and short: Vote against Romney/Ryan (for Obama) in a swing state. Vote third party in a non-swing state. Then get on with more important things.

What are those more important things? Primarily, fixing the machine. We don’t like the products, but most people are caught up with hating the present malfunctioning unit. They hope, against all rationality, that the same machine will suddenly produce a perfect model after an endless string of defectives. It’s a factory, not a slot machine. It’s not designed to produce what we need. Quite deliberately the opposite.

The first step in fixing the machine is doing what I am doing right now: Pointing directly at the machine and noting that it is what needs fixing. Education is the starting point. Most of America is caught up in its tribal hatreds.

A suggestion: The next time someone starts talking to you about how much they like candidate A or dislike candidate B, don’t get caught up in that discussion. Talk about the machine. The money filter. The Saving American Democracy Amendment. Anything other than personality driven horse race politics. The first step towards an answer is getting people to start asking the right questions.