They stand together in our wildest dreams

We invoke the Fomori

Strangers with the eyes of men

And they fall from grace

And they fall from light

Two hundred angels

Black rain from the clouds

And they fall from grace

And they fall from light

Blackened forsaken tears

Snake down my face

The high order of the Fomori

The sons of god, they never dream

Strangers with the eyes of men

  • Lament of the Watchers

[Faustus’ note: We have played 3 or so sessions of Undriel, of which only the last two sessions I have joined, and for reasons unrelated to the game I haven’t been in the mood to do write ups. I’m catching up now with this brief summary of the two sessions I joined].

Background

The party consists of five members:

  • Ichimusai, a Milesian warrior who does not speak. Milesians are a type of giant cat-people, much larger than humans and hailing from a strictly heirarchical and warlike society
  • Leantoir, a human druid, a great bear of a man from a nomadic and empoverished background, who combines magic and a very big stick
  • Idril, a Sidhe Draoi priest. Sidhe Draoi are a type of forest dwelling ancient that resembles a humanoid grown from a tree. Imagine an elf that mated with an Ent.
  • Fellan Braeduth, an Aes Sidhe assassin with a very short fuse. Aes Sidhe are a more classic type of elf, though they’re of dubious morality and probably more Drow-like than one should be comfortable with
  • Xenobia, a human noblewoman, unwilling necromancer, who uses her powers to investigate murders, deaths and other unsavoury deeds

The land of Undriel has just recovered from a shattering war with a race of evil outsider-like creatures called the Fomori, who come in many forms ranging from the beautiful to the monstrous. The party are veterans of that war, who have teamed up to travel across the war-ravaged lands to a regional city. They have stopped at the town of Crois Arald, which sits at a crossroads south of the city they are traveling towards, and is beset by many troubles. Seeing the chance for fame and fortune, the PCs have decided to help the citizens of the town to deal with some of their problems.

In the first session (which I did not attend) they stumbled on a gang of Fomori and slew them without negotiating, in an orgy of spectacular bloodshed (or so I am told). They kept one survivor, who they handed over to the town guard. The next two sessions begin here.

Interrogating the Fomori

The Fomori proved to be a most accomodating prisoner, willing to answer all our questions without trouble, although the interrogation still took half of the session because we were so stupid and indecisive. She revealed that the Fomori gang they had murdered was part of a splinter faction of Fomori who had opposed the war and were fleeing east to the Kingdom of Reynes, which is offering sanctuary to Fomori who opposed the war. They were heading to a rendezvous point with the rest of the tribe, which would then take some secret faerie route to cross the oceans to Reynes. Unfortunately the PCs had murdered her gang and she was unwilling to reveal the location of the rendezvous point. After much debate they agreed that she was being honest, and let her go.

Bandit and bear

Having “solved” the “problem” of the pacifist Fomori the group decided to take on a clearer problem, a gang of bandits preying on caravans on the western road into town. They set up a simple trap consisting of a wagon decorated as a noblewoman’s wagon, with Xenobia riding the front of the wagon as bait and the rest of them hiding in the back, while Fellan stalked ahead. This trap worked beautifully and the bandits, unable to resist such ripe and easy fruit, attacked without plan or sense. The resulting battle was a vicious bloodbath, with half the bandits falling in moments and the other half cut down in the forested slope as they fled, one having his soul ripped from his body to power Xenobia’s dark magic and the other being gutted and left to die slowly. (Apparently a slow death from disembowelment is more civilized than being rapidly drained of your life essence by a necromancer!) They then followed the path to the bandit’s camp and killed the rest of them in short order. While they were searching the camp they were disturbed by an enraged bear because of reasons; Leantoir tried to calm it but this failed, so then Ichimusai cut the bear in half with one stroke of his katana.

Ichimusai is large, and deadly, and very very quiet. Xenobia likes him.

Dark magic in secret places

The PCs rested a little before setting out on their next adventure, a quest to investigate a group of caves near the town that had recently been declared off limits on account of their being the source of a plague or curse of some kind. They traveled to the area and found the caves, which lay inside a narrow culvert cut into some hills. Stone outcrops just inside this culvert bore marks in Fomori script indicating it was death to enter; intrigued and unworried, they entered. Near the cave entrance they found the bodies of two Fomori, who bore the same markings on their clothes as the pacifist Fomori the group had previously mercilessly slaughtered. Xenobia investigated the bodies and found that they were occupied by a strange dark magic that would animate them as zombies, and was able to disable the magic just before they rose. They appeared to have been killed by black magic, the same kind of soul-stealing weapon that Xenobia uses and marker of necromancy.

Concerned that reanimated corpses might be immune to normal weapons, Xenobia enchanted some of the group’s weapons with coruscating aurorae of shadows, which would disrupt the animating magic of any corpses they encountered. Ichimusai and Leantoir initially resisted this magic but finally consented, but expressed extreme distaste at the slippery, slightly greasy cold feeling it imparted to their weapons and the strange whispering of dying children that they heard whenever they swung their weapons.

Xenobia shrugged, and they ventured further in. Here they found more Fomori from the same tribe, some of whom animated and attacked them. They cut them down and proceeded until they found an inner cave where a necromancer was engaged in a horrific ritual, stitching together the body parts of dead Fomori to make new monstrosities that he perhaps intended to turn into an army. They killed the necromancer and his minions, though this battle was tough and his powers frightening. Behind the ritual cave they found a smaller cave where the necromancer slept and studied, in which they found a strange orb hanging in space, which was obviously some kind of communication device.

Obviously something big was going on here. It appeared that the pacifist Fomori tribe had been meeting here, and the necromancer had killed them as they gathered, though they could not identify his purpose. Some dark plot was being executed here, and it was obviously being coordinated from somewhere far away by someone powerful.

Tensions with the Morrigan

When the party emerged, covered in blood, from the caves they found themselves facing a large squad of Knights of the Order of the Morrigan. This order are a kind of elite military force among the Fomori, and this band had been wandering the local area looking for remnants from the war. They were led by a big soldier called Rumiel, but in their midst was a sinister black-robed woman called Aredhel. When they encountered the PCs a strange, tense encounter unfolded, in which they seemed somehow altogether too interested in the manner of the Fomori’s deaths, and altogether too aware of what might have happened here. At the same time the PCs immediately distrusted this group of soldiers, and tried to angle the encounter so that no one from the group managed to get inside the caves and see the clues of necromancy. No one could quite say why but we all had a suspicion that this band was connected to the deaths of the Fomori. Aredhel also expressed an intense interest in any survivors of the group, and the PCs immediately suspected she was looking for any pacifist Fomori who might be drifting through the area. During this encounter they managed to organize a formal cremation of the dead Fomori, and also managed to escape with their lives. Unfortunately the Morrigan somehow found out about their past prisoner, and sent scouts to town to investigate further. So after they had parted company with this band of ne’er do wells, the PCs also decided to rush back to town to see what they could do to protect their erstwhile prisoner.

And on this strange and confused note the session ended.

Red sky at night … nostalgia’s delight

I have long held a special fondness for China, for two reasons. The first is that it has overcome enormous obstacles to get where it is today. The last two hundred years of Chinese history are a catalogue of horrors sufficient to sink any nation: From the depradations of the Emperors in the 19th century, to the Taiping rebellion, then British meddling and the opium wars, then the civil war, the destruction of the Japanese invasion, then the cultural revolution and the great leap forward – China has had barely any time to come to terms with itself in the last 200 years, and it is only in the last 30 years that China has been free of major conflict, famine or disaster and able to focus on development and peace. Against that backdrop, China really is the Little Country that Could, and despite the various repressions and problems of the recent communist era, lifting half a billion people out of poverty in just 20 years is a huge achievement for any country, let alone a country emerging from the ravages of 150 years of war and chaos. As someone who works in public health, China’s achievements in this field are something that any country should be proud of, and for this reason I have a soft spot for the country.

The other reason I look fondly on China is that it was the first developing country I visited for an extended period of time, and my first real holiday destination as an adult. In 2002 I spent a month traveling in China with my friend Sergeant M, starting in Beijing and traipsing through Xi’An, Xiahe, Langmuir, Songpan, Chengdu, Yangshuo and Guangzhou before finishing in Hong Kong. I studied a little mandarin before I traveled and went on a small group trek with a company called Intrepid Travel, and it was an amazing trip. Back then China was definitely still a developing country, and I visited places that still had not achieved adequate sanitation or regular electricity supplies, and I met people whose life experience was a world away from mine. It was eye opening for many reasons, and I still carry many powerful memories of that trip. It also was my first real opportunity to see that the way the west reports on East Asia is extremely shallow and superficial, and that almost everything we think we know about “distant” countries (like China, Japan, Iran) from the outside is wrong or distorted. I don’t believe that traveling makes anyone a better person and I’m not a big fan of travel – I usually only travel for work and don’t make a big effort to go on holidays – but this was a really important and I guess life changing trip for me, so for that reason I view China very fondly indeed, and I am always supporting the efforts of the Chinese people (as opposed to their government) to make their situation better, against occasionally incredible odds.

So it was with some pleasure that I had the chance last week to visit Guangzhou for work, to spend five days in a city that 15 years ago I just passed through on my way to Hong Kong, and to see how much China has changed over the past 15 years. This blog post describes some of the ways in which China has changed in the past 15 years while I was away, and also some of the many ways in which it has not.

Everyone obeys the traffic rules: Driving in China 15 years ago was a terrifying prospect, involving bouncing along decrepit roads in a barely-functioning rattling vehicle with no seatbelts or suspension, driven by a barely sane man who had a reckless disregard for lanes, speed limits or common sense, in a world where everybody shared his signature traits. The car horn was used as a means of communication – most commonly, warning – and things like lanes, traffic lights and traffic police were treated primarily as loose guidelines rather than strict rules. I spent 8 hours hurtling down a two lane road in Sichuan on the edge of a cliff, first watching in horror as our driver overtook slower cars exclusively on blind curves or hill crests, and then finally not watching at all – but looking out of the side window was not an option either, since every couple of hundred yards we would pass a section of barrier that had been torn away, and stare down into the looming abyss as our driver took another screaming turn, horn blaring, playing chicken with a massively overloaded truck. This time I hopped into a taxi at Guangzhou airport to find the familiar lack of seatbelts, but was shocked to find that my driver strictly obeyed the speed limits, drove within lanes, followed rules, and did not use his horn even once. Indeed, even when we hit the traffic crush of the city itself almost no one was blaring their horn, and the main time I saw someone use their horn was to admonish someone else for not following the road rules. I even realized that if you sit in the front seat of the taxi you get to wear a seatbelt. This is a huge change, that made me feel safer on the roads and as a pedestrian even though the traffic in Guangzhou was much more aggressive now than 15 years ago.

No one needs pachinko here

Old men still play chess on the street: In the Hutongs of Beijing 15 years ago I saw groups of middle aged men everywhere, huddled over game boards on the side of the road, playing cards or Chinese chess while other men gathered to watch, yelling advice and opinion. If I spent time watching I would even see the players arguing with the spectators over the right move. I was taught Chinese chess by a cheerful man from Xinjiang on the sleeper train to Xi’An, and after that Sergeant M and I would break out our chess set on long journeys, only to have everyone else on the train gather round to move the pieces for us and advise us. This doesn’t seem to have changed at all, and you can still see groups of men doing this now, as in the group pictured above who were enjoying a Sunday afternoon in Shamian by the water front, arguing over cards.

The portable tea jar is still a thing: Only now the jar is a hipster design. Back in 2002 everyone was carrying a jar of tea, in which the leaves or flowers just floated loose at the bottom of the jar. Often this was literally just a jar, repurposed from some other use, or a battered glass bottle that might have once held alcohol or juice. Everyone still carries that jar, but now everyone’s jar is a well-made, fancy construction, with a design emblazoned on it and a specially-made carry strap or handle. Somethings never change, even though they stay the same.

Smoking is worse: Everyone (male) smokes, and I guess now no one is so poor that they can’t afford to. China needs tobacco control badly. But it does appear that China has introduced indoor smoking laws, or at least lots of restaurants and shops have decided that is the best thing to do, and so in that regard it’s doing at least as well as Japan. Also compared to Japan women still don’t smoke much at all, which means that the tobacco companies haven’t made progress on half the population, and now that tobacco control efforts are beginning to happen, they probably never will. It’s good to see that half the world’s population still remains relatively safe from Big Tobacco’s evil schemes.

China has digitized incredibly: 15 years ago when I entered a restaurant my only concern was “did I bring cash”? But now when I enter a restaurant I have to worry “did I only bring cash?” Not because the restaurant only accepts cards, but because the entire process – from viewing the menu to ordering to paying – happens on your phone. I went to a restaurant with my collaborator where this whole process happened by scanning a QR code with your phone. This brought up the menu, from which we placed our order, and then we paid using a bank account linked to my colleague’s WeChat account (which is like the Chinese social network equivalent of Facebook). This also happened with the cafe next to the university, with a food order from my hotel, and with paying for small things everywhere. Somehow China has become a country that hasn’t yet got clean drinking water, but has skipped credit cards straight to a cashless society. Imagine if every daily transaction was handled by a QR code and a bank account attached to Facebook – including the bottled water you had to buy because the tap water is not potable. Weird!

Everyone rides a bike but no one owns one: 15 years ago the roads in Beijing had separate multi-lane bike sections, and all of life happened on bicycles. This is still the case, but no one rides their own bike anymore. Instead there is a network of QR code-operated disposable bikes, such as Mobike, which are just dumped anywhere around the city and which you access with your phone. Scanning the QR code unlocks the bike, which you can ride anywhere you want. You dump it at the destination and scan again, and the money is deducted from your account. There is no pick-up or drop-off point, like in many European bike share schemes, and no rules at all about how to use it. The bikes are simply there, everywhere, waiting to be used. This means that if you go somewhere far from public transport you can just pick up a bike at the nearest station and ride to your destination – as everyone did at the university I was visiting, which is equidistant from three railway stations. (You can see an example of one of these bikes in the picture above). This is a brilliant scheme that is really useful in a big urban conglomerate like Guangzhou, and makes perfect sense. I doubt it will ever be properly implemented in Tokyo, because the digital payment system won’t be and Tokyo is (comparatively) really strict about bike parking. It’s great to see China finding a way to make such a simple and liberating invention as the bicycle even more useful and liberating, using another uniquely liberating device (the mobile phone).

The security state is more intrusive: 15 years ago my only encounter with the security state was the (super stern) guards at Tiananmen Square, and the almost comically inept security official in Tibet who tried to interfere with our guide. This time around they were much more visible, with guards standing around every railway station scanning your bag when you entered or left, and public security police even stationed near roadway toll booths and other basic public infrastructure. It’s my understanding that there has been a lot of spontaneous local uprising in the past 10 years, not directed at central government but at local corruption and poor local decisions, and I imagine that the security state is quite scared that these spontaneous local expressions of discontent might link up and become national, so I guess this might explain it – along perhaps with fear of (or cynical use of the fear of) terrorism from Xinjiang, where there is a bit of an insurrection going on. There is also a lot more internet interference than 15 years ago, though this is probably a function of the internet being more integral to ordinary life (15 years ago press censorship in China was omnipresent, and it would have been impossible for a foreigner in the country to get access to foreign news sources that had not been approved). Interestingly no newspapers were blocked to me – the Australian ABC, the Guardian, the Washington Post, even the Daily Mail were freely available without using a VPN. It’s telling that China’s Great Firewall is directed at social media networks, not news. What does that say about the relative importance of those two forms of media?

Collect the set!

Socialist values have diversified!: 15 years ago there were big signs on public buildings announcing socialist slogans like “Postal workers united to build a revolutionary China” and stuff like that. These were huge banners in red with the slogans written in Chinese and English, presumably intended to inculcate the proper spirit of socialist fervour in this (intensely free market oriented!) society. This hasn’t changed, but it appears that the set of core values has diversified to 12, which include democracy, freedom, justice and the rule of law (see the helpful guide above). Who knew! Strangely I couldn’t find anyone who had recently voted … I’m a little sketchy about the equality value, since it’s pretty obvious that inequality has grown over the past 15 years, but I can certainly believe prosperity and patriotism, and Chinese people remain as civil as they ever were. There are a lot of building sites in Guangzhou, and their outer walls are all covered in this propaganda. I have to say the font is pretty cool, and the propaganda is quite swish (further along the wall I photographed they have a detailed exposition of each value, with pictures – patriotism has a picture of a bunch of children doing kung fu, with (of course) a QR Code in case you need more information.

On this point it’s worth noting that British newspapers often talk about “British values”, the British government is planning to (or has?) included “British values” in its citizenship test (do potential citizens of Mao-Mao descent have to answer questions on the British value of “Colonialism”?) Australian politicians also ramble on about “Aussie values”, including the reprehensible focus of a past conservative government on “mateship”, so I guess it’s worth noting that identifying core values and blasting them into the minds of your citizens is not a uniquely Chinese trait. But I will contend that it comes in a better font.

Under stranger skies

The sky bleeds: And it is cool. I follow a woman called Marilyn Mugot on Instagram whose shtick is pictures of China’s vivid purple-red urban night skies, and in Guangzhou I really understood the fascination that led her to run that account. The sky really is red at night, I guess through the pollution and also the Chinese fondness for vivid red and yellow light. Guangzhou is constantly misty and rainy too, which I guess helps to give the evenings a real Bladerunner feeling. Fifteen years ago it didn’t feel like that all, partly because the cities I visited were not yet megalopolises, and partly because the air was cleaner. It’s a pretty striking phenomenon and I have never seen it in Tokyo. Bright lights and strange skies – that’s modern China.

Chinese service is still ditzy, chaotic and effective: In my experience of getting any service in China it happens, it happens reasonably quickly, but it doesn’t happen always in the way that you expected, and often during every stage of the process everyone is confused about what they’re doing, and happily expresses their confusion while they find a workaround or a new way to do what they should, one assumes, have been doing forever. It’s also very cheerful, if not always very friendly, which makes it an almost perfect contrast with Japanese service, which is often cold or not friendly but always formal, polite, efficient, and organized. This aspect of China doesn’t seem to have changed at all – and neither does the inordinately large number of people required to provide service anywhere. The cafe near the university had 10 seats and five staff, so at any time three staff were standing around doing nothing. In Europe that would be one person, in Japan two. In terms of social cohesion and engagement I can’t say I think the European or Japanese way is better, but I guess I should kick up a stink because my coffee cost 240 yen, and if they employed half as many people maybe it would only cost 200 yen? That’s surely worth sacking three humans, right? In any case, it seems like this is a social contract – companies hire extra people, and there’s no unemployment, and everyone’s happy. I guess … I’ll be interested to see whether the productivity gains implicit in reducing those staff loads happen in anything like the time frame in which China has digitized, since it seems like the excess staff thing hasn’t changed at all in 15 years, while in every other way China has changed radically. Interesting, that … but I hope in any case that the ditzy chaotic service style doesn’t change, because I like it.

So that is my China after 15 years. My work fate is now entangled with China’s, as I am involved in an ongoing project here and hope to become further involved in working on public health in this amazing, growing, booming and innovative country, and some of my best students have come from there and now returned there to pursue their own futures. So I’ll be continuing to cheer China as its people negotiate the complexities of development and growth under communism, in an increasingly uncertain world. I hope they can do as well in the next 15 years as they have in the last 15!

Flying in a blue dream …

Last week in Tokyo was Golden Week, the long week of public holidays that people traditionally use to travel. I stayed in Tokyo and chose to use one of the days to visit what I thought of as “the Mucha exhibition” at the National Art Center, Tokyo. This exhibition was timed to coincide with the 10th anniversary of the opening of the museum, the 60th anniversary of the reestablishment of diplomatic relations with Czechoslovakia, and the Year of Czech Culture, 2017, so I guess it was intended to be something special. I had previously seen a Mucha exhibition at the Kitakyushu Art Museum in Fukuoka, where I saw primarily a collection of his illustrations and advertising work, and I was expecting the same in Tokyo but perhaps expanded, so I was completely stunned when I walked into the first room and found myself facing an 8m x 6m canvas of luminous beauty, The Slavs in their original homeland, pictured above. In fact this exhibition was displaying almost all of Mucha’s Slav Epic, a collection of huge oil paintings describing key events in the history of the Slavic peoples, which he painted over an 18 year period (1910 – 1928). These pictures showcase incredible art nouveau technique, while displaying striking mythical figures and key historical events in splendid beauty, and their impact cannot be appreciated by viewing them on any screen. Take the picture above, for example: The god on the right of the picture must be 4 or 5 metres high, and the two human figures at the bottom centre are almost human sized. The god doesn’t just loom over the viewer, but seems to actually float out of the picture, and really dominates the space around the picture in a way that even the best onscreen rendering cannot picture. The glowing fires at the centre left also spring to life with an almost feral radiance when you view the picture in person, the stars actually seem to sparkle, and those semi-corporeal distant figures on horseback are vague and indistinct in just the way you would expect if you were standing before that god, looking into the real distance to see oncoming soldiers.

The other pictures in the series are similarly dramatic, and to stand near them is to feel as if you are part of the unfolding drama rather than a witness in an art gallery – and this despite the fact that, because it was golden week in Tokyo, this gallery was packed. The photo below, which I took in the area where photos are allowed, gives a sense of the scale of the pictures and the crowd at the gallery, and the way the pictures stand imposingly above even this many people. In some ways the crowd was a boon, since it forced one to move back from the pictures and view them from their proper distance, as well as helping to keep the scale of the images in perspective.

Let’s enjoy Red Square together!

I’m quite a fan of art nouveau – I visited the Tiffany Museum in Matsue when I lived there, and I’ve visited Mucha and other similar exhibitions before where I can. I know a lot of people probably view it as not real art – kind of effete and shallow, the way perhaps some people view the romantic poets or perhaps like the pop music of art, but I think it has an evocative beauty that also speaks of a rare period of time in history when our developed nations were not yet modern but were full of hope and idealism and looking forward and upward. I also think it reflects non-European influences and I appreciate its intricate connections with advertising and popular theatre, which gives it a kind of populism that I appreciate in art. It’s not as “experimental” as some of the other movements that came at the same time, and for that I think it gets frowned on, and I think some modern art critics probably don’t respect its simple enjoyment of classical or saccharine beauty (especially feminine beauty). But I think at its best it is able to capture something of the human soul or the desire humans have always had to find transcendent beauty in their surroundings, and I think it must have been really stretching the available techniques of the time to achieve that sense of liminal and supernatural beauty that it aspires to. If I ever had any doubt about just how well art nouveau was able to achieve these goals, Mucha’s Slav epic dispelled them. This series of works is a masterpiece, and a perfect showcase of all the best aspects of this style. Walking through the halls of the epic is like drifting through an art nouveau dream, full of diffuse lights and ghostly figures, radiant spaces, beautiful ethereal women and striking, tragic moments. After viewing these massive pieces there was a large collection of his other work but some of his famous pieces – like the four flowers – which would have been masterpieces if they had been shown on their own were anti-climactic after the gigantic dreamscapes of the main display.

This is probably the third really great exhibition I have visited in Tokyo. In 2007 I saw Ashes and Snow at a temporary space in Tokyo Bay, having no idea really of the scale of its content; then quite recently I saw The Universe and Art at the Mori art museum,  and now within a year I get to see this unique apotheosis of art nouveau. This is one of the really good things about living in Tokyo – it may happen only once a year and they may be very crowded, but the quality and global nature of the content is really high. This exhibition lasts until the 5th June, so if you are in Tokyo I strongly recommend getting along to see it. Even if you aren’t especially into this particular artistic form, I think it will capture you with its scale and ambition, and if you do appreciate art nouveau I doubt you’ll ever get the chance to see as good an exposition of its best qualities as you will when you visit this exhibition. So, go, and get lost in dreams of Slavic history.

Who doesn’t want to be this guy?!

Trigger warning: Long rant; gender and racial theory; I may use the qualifier “cis-” in a non-ironic way[1]; Since saying “male genitalia” or “female genitalia” is apparently bad, I may use the words “cunt” and “cock” to refer to the things they refer to; Aussie pride; excessive footnotes[2]; dead naming of dead dudes[3]; anti-Americanism; as always, sex positivity, along with a healthy dose of trans positivity (I hope, though maybe 800 people will judge me a bastard) and my usual disdain for radical feminism; insufficient or excessive trigger warnings

TLDR: WTF is going on with feminist philosophy?! Also, if you think that transgender people are serious and real and should be given full rights and respect, you probably also need to accept that transracialism is cool; but unless you’re American you probably already did, without even thinking that it was A Thing.

I just discovered a horrific conflagration overtaking the world of feminist philosophy, which has got me thinking about a concept that I didn’t even really know existed, but which is apparently A Thing: Transracialism. Transracialism is the practice of people of one race adopting the identity of another and living that identity even if they hadn’t been born into or raised with that identity, so superficially it has this transition process in common with being transgender. I’ve obviously been out of touch with left wing radical social ideals for a while, because I didn’t know that transracialism was A Thing, and that it is Bad while being transgender[4] is Good. In this post I want to talk about transracialism and the stultifying consequence of Americans hogging the debate about sex and race, and also about the disastrous state of modern leftist discourse[5] about so many things.

The controversy concerns an interesting paper in the philosophy journal Hypatia, discussing some of the logical consequences of accepting transgender as a real and serious issue[6]. The article, In Defense of Transracialism, examined the similarities between transitioning to a new gender and transitioning to a new race, and argued that logically if you accept one you really run onto rocky ground if you don’t accept the other. For case studies (and not, apparently, as the fundamental logical basis of the argument) the paper presented the case of Caitlyn Jenner as a transgender, and Rachel Dolezal as a transracial person (“transracer”?) As we know, Jenner got widespread public acceptance for her decision, while Dolezal received widespread public scorn. The article argues in what, to me at least, appears to be a quite tightly reasoned and accessible style, that it’s hard logically to accept one and reject the other, and maybe that means transracialism is actually okay.

The paper was published in March but recently a bunch of Associate Editors connected to the journal published an open letter demanding that the paper be retracted because its publication caused many “harms” to transgender people, and because it was academically poor. The outline of the case, and a solid takedown of the public letter, can be read at this New York Magazine post. It should be noted that the author of the paper is a non-tenured Assistant Professor, a woman, who is therefore quite vulnerable in a highly competitive field dominated by men, and that some of the signatories to the open letter were on the author’s dissertation assessment committee, which makes their signing the letter an extremely vicious act of treachery, from an academic standpoint. For more background on the viciousness of the letter and its implications for the author’s career and for the concept of academic freedom, see Leiter Reports, a well known philosophy blog (e.g. here) or the Daily Nous (e.g. here). It appears that the author has a strong case for defamation, and that many of the leading lights of feminist philosophy have really made themselves look very bad in this affair. (In case you haven’t gathered, I am fully supportive of the author’s right to publish this article and I think the open letter, demand for retraction, and pile-on by senior academics to an Assistant Professor near the beginning of her career is a vicious over-reaction of which they should all be deeply ashamed).

Beyond the obvious bullying and the ridiculous grandstanding and academic dishonesty involved in this attack on the author[7], I am disappointed in this whole issue because it is such a clear example of how Americans can dominate feminist (and broader social justice) debate in a really toxic way. I’ve discussed this before in regards to the issue of sex work and radical feminism, and I think it needs to be said again and again: American influence on left wing social debates is toxic, and needs to be contained. Just look at the list of signatories to this attack on this junior academic – they’re almost all American, and this is yet another example of how America’s conservatism, it’s religious puritanism, its lust for power, and its distorted republican politics, combined with its huge cultural output, is a negative influence on left wing politics globally.

I’m also really interested in this paper because I think it shows not just that transracialism may actually be an okay idea, but when I thought about the implications, I realized that I think most people on the planet already accept transracialism, and if Rachel Dolezal had occurred in any other country we would probably just have shrugged and got on with our lives. So in this post I’d like to discuss what Americans can learn from other countries’ approach to race.

Transracialism in Australia

Just to clarify, I was born in New Zealand to British parents and moved to Australia aged 13, taking Australian citizenship when I was 21. My grandfather was a Spanish war hero, a proud soldier in the losing side of the civil war and a man who spent nine years fighting fascism, and I was raised by him and my (deeply racist, white) British grandmother for two years as a child. So actually I’m a quarter Spanish, and so in theory I could have been raised Spanish but wasn’t, and don’t know anything about my birth race, which at various times in history has been defined as a separate race or just a culture. This makes me probably really normal in Australia, because Australia is a nation of immigrants making a new life in a land swept clean by genocide. It’s my guess that if you grew up in Australia you know a lot of mixed-race people, and if you paid any attention to the discussion of the Stolen Generations in the 2000s you’re aware that race is a very contested and contestable concept, and that Australian government policy has always assumed that race is a mutable concept subsidiary to culture. I think it’s likely that if you grew up in Australia you will know at least one of the following stereotypes:

  • An Aboriginal person who doesn’t “look” Aboriginal, and who maybe has no connection to their Aboriginal culture; you may even not be sure if they are Aboriginal, suspect they are but don’t know how to ask
  • A young Asian Australian who looks completely Asian, acts in ways that are stereotypically associated with Asian Australians (e.g. the guy holds his girlfriends bag for her, the girl is a complete flake in a very Asian Australian way) but is in every other way completely and utterly unconnected from their Asian heritage and is thoroughly through-and-through “whitebread” Australian
  • A completely Australian guy who speaks fluent Greek and goes back to Greece to “be with his family” every year
  • A person who has discovered that they have an ethnic heritage of some kind and is trying to recover that heritage in some way that might inform them about their own past, even though they are effectively completely disconnected from it, but they are clearly serious about rediscovering their heritage and all their friends and family support this apparent madness
  • A black or dark-skinned Australian who literally knows nothing about the culture of whatever race gave them their skin colour

If you’re a little older, like me, or know a wide range of older Australians, you may also have encountered an Aboriginal Australian who was stolen from their family at an early age and raised white but is on a bittersweet quest to recover the heritage they never had – and may have found that that heritage was extinguished before they could be led back to it. When I was 20 I was paid to provide maths tutoring to a bunch of 50-something women who were training to be Aboriginal Teaching Assistants – a kind of auxiliary teacher who will assist fully qualified teachers in remote Aboriginal communities – and some of them couldn’t even do fractions. When I asked how they missed such an early stage of education they told me they were taken to “the mission” when they were young, and didn’t get a proper education. I was young and this kind of issue wasn’t discussed then but now I understand that they were from the Stolen Generation, and were at various stages of understanding of their own racial heritage. They were going back to help their community, and recovering their own heritage, not just to settle the question of their own background but also to right wrongs done and change society[8]. These kinds of people are a normal thing in Australian cultural life. But can you look at that list of archetypes and say they aren’t all in their own way transracial? Indeed the underlying philosophy of the Stolen Generations was that you can eliminate racial traits of Aboriginality in half-Aboriginal people simply by raising them white; and the underlying principle of Multiculturalism is that culture transcends race, and we can all get along. Also in Australia there is a lot of tacit recognition of the problems second and third generation migrant children go through as they “transition” from the cultural heritage of their parents to that of their born country, where although racially they’re distinct from the majority they are clearly culturally more similar to the majority than to their parents. In the 1990s this was happening with Greek and Italian kids, in the 2000s with Vietnamese kids, and in the 2010s with Lebanese kids. Everyone in Australia knows that this happens, which surely means that everyone in Australia sees transracialism as a common pattern of multiculturalism.

Since I’ve moved to Japan I’ve seen this confirmed in many ways, but the best I can think of is a child I knew in a rural country town. His parents were both white New Zealanders but he had been brought to Japan at the age of 3 and raised in rural Japan, and when I met him at 17 he was thoroughly and completely Japanese. He didn’t speak English, communicating with his parents in a mixture of Japanese, really really bad English, and typical adolescent boy grunts. He hadn’t experienced much racism in Japan and had been sheltered in a very nice and welcoming rural environment, had a good group of close Japanese friends, communicated in the (ridiculously incomprehensible) local dialect, and was a typical cloistered Japanese boy. But he was also a big, white lump in his Japanese world, standing out like dogs balls. His race was irrelevant to his cultural background, except that he knew he was “white” and that therefore every Japanese person who ever meets him will engage in a boring conversation about why he is so. Fucking. Japanese. How is this not transracialism? Sure, a lot of transracial experience is not a choice per se, but whether it is a choice is surely irrelevant to the fact that it is completely possible and that for some of us – probably only a small proportion – changing “race” is a choice we feel compelled to make. I.e. not a choice. Rachel Dolezal might be a bad example, but whatever her motives might be, is her ability to do it under question? I would suggest that from an average Australian perspective, it is a completely ordinary concept. The only thing at issue is “why?” But since most well-meaning people don’t impugn the motives of strangers, who gives a fuck?

Race is a social construct

The possibility of transracialism becomes even clearer when you recognize that race is a social construct. This doesn’t mean race doesn’t exist – it clearly does – but that it is an invention of humanity structured around clear physical lines, not a real thing. While there is a clear difference between black and white people, there is no boundary at which this difference can be defined, and no genetic markers that clearly distinguish between one and the other. This isn’t some weird fringe idea popular only amongst Black Panthers, but a fundamental plank of modern science, reasonably well accepted at least in the biological sciences and anthropology. When we talk about races what we really are referring to is distinct cultural identities that can be mostly distinguished by noticeable visual cues (e.g. Nigerians are black, and stress the first syllable of every word in a cool way). This also means that race has very little influence on the culture you can actually adopt, which is why although I’m a quarter Spanish I’m completely white, while there are Aboriginal or Maori people who are one quarter Aboriginal but completely wedded to the culture of that quarter.

In comparison, sex is an absolute category that is definable and distinct. It has a chromosomal origin, and multiple definable, distinct characteristics. It is also clear across cultures that men and women tend to be different in many physical and personality characteristics, though these aren’t always the same in every culture and there can be lots of differences between people of a single sex between and within cultures. But sex is a clear, binary concept that, for all its massive cultural baggage, is not independent of its biological underpinnings. This, by the way, is not an idea anathematic to feminism – lots of feminists accept that the sexes are fundamentally different, and although there may be argument about to what extent these differences are biological vs. cultural, there is a large body of feminist work that assumes these differences are real and important.

And yet still people can want to change sex. Really want to change sex! And this phenomenon is common across almost every culture, though it receives higher levels of acceptance in some cultures (e.g. some Asian and Indigenous cultures) than others (e.g. modern USA). It’s also clear that you can’t force someone to change sex the way you can race. You might be able to “breed out the colour” of “half-caste” Aboriginal people by stealing them from their parents and raising them in a white family, but you can’t breed out the pink by forcing a girl to grow up as a boy – she’ll still know that she’s a girl. The same is true of sexuality of course – most people can define their sexuality clearly by the gender of the people they fuck, but we have no evidence that you can change that, no matter how hard you try. We know in fact that down that road lies tragedy. And so most of us take people’s sexuality – and the right to express it freely – very seriously. Yet most of us also accept that the right to change sex, to express a desire to be the opposite sex to our birth sex or even to be a third sex, very seriously as well.

So why not race? It’s way more fluid than gender, it has no biological basis, and we have huge amounts of evidence that people do it by accident all the time. Yet when Rachel Dolezal was outed as white she attracted general derision across the political spectrum; and Trump trades on the Pocahontas slur for Elizabeth Warren, whose sole crime apparently is to have been raised thinking she might have Native American heritage. There’s clearly something wrong with this picture, especially if like me you grew up in a race-fluid environment. Why is it so wrong to be transracial?

The toxic American influence on sex and race debates

Of course in America race is not a simple issue, because of slavery. America has a complex, toxic and quite unique racial environment which makes it very hard for Americans to react reasonably to these debates. Just consider the “politically correct” term for black Americans – African American. How is this not a transracial identity? Africa is neither a country, nor a culture, nor a race. Being “African American” is a completely concocted identity, a race that didn’t exist until the 1970s and the advent of pan-Africanism. Nothing wrong with that per se, obviously, but it leads to strange contortions in which, for example, the previous president[9] was dismissed as not “African American” enough by some of his critics even though his dad was Kenyan. We also see unedifying moments like this, where we discover that one of Dolezal’s trenchant critics was raised in a white household from the age of 2, and has clearly made a conscious choice to be black – but rejects Dolezal’s choice on clearly spurious racial grounds.

I think the problem here is simply that Americans need to come to terms with their own racist history, and simultaneously with their role as centre of empire and cultural hegemon. It’s not just that white Americans are beneficiaries of a long history of slavery, or that a sizable portion of white Americans can’t even yet accept that slavery was really wrong, or that treason in defense of slavery was really bad. It’s also the case that black Americans are simultaneously deprived in their own country but hyper-privileged globally, benefiting from many of the profits of empire just as their white compatriots do. This is why, for example, in response to the water poisoning crisis in Flint, Michigan we heard so much about how this was happening “even in a developed country” – black Americans are used to certain basic things that many of the people in America’s tributary nations don’t get. Similarly, black Americans can talk about pan-Africanism while black Americans are bombing Libyans. This is a complex, messed up problem that Americans have to come to terms with before they preach to the rest of us about transracialism. Combine this with America’s well-established puritanism and religious extremism, and you have a perfect storm of stupid. It makes you wonder why they even bother doing philosophy.

It also makes me think that they don’t really have a proper grip on some of these issues. Instead of talking about their own race issues, I think a lot of American feminists could stand to look around the world and learn from others. Australia has a unique culture of multiculturalism and acceptance that, while far from perfect, offers important lessons on how to negotiate racial conflict. We also have a history of genocide and responding to genocide that is deeply entangled with old fashioned racial theories that still seem to have some influence on both the left and right of American politics. But as an Australian I think we have learnt a lot and grown a lot, both about sex and race, in ways that Americans need to learn from. Instead, however, these American philosophers seem to think that their experience of race is unique and universal. I even recently stumbled across a tweet by a “key” philosopher of transgender issues (American) who claimed that transracialism had never been practiced anywhere except by one person (Rachel Dolezal). What a joke! This shows deep ignorance of broader issues of race and culture and a kind of infantile understanding of what the rest of the world is doing. I bet right now there are huge debates going on in China in Chinese about people faking ethnic minority identity (or vice versa) that no American philosopher of race even knows about, let alone can turn into a lesson for American philosophical dialogue.

I think it’s time Americans learnt some humility. America is a nation of religious extremists with a history of slavery that just elected an orange shitgibbon for president. Some humility would be in order.

And a little less bullying too! So if, like me, you think that this article might have pointed you to a phenomenon that is more common than you think, that you didn’t even know existed, maybe you should read it. And then reconsider whatever passing judgement you might have made of Rachel Dolezal, and ask yourself how easily the media are fooled by ugly narratives, and what that says about their quality.

And then, I guess, be whatever race you want to be!


fn1: Google it!

fn2: Including but not limited to references to Aussie pride

fn3: Until today I didn’t know that this term existed, though I think that I probably tried to avoid doing what it refers to. Google it!

fn4: You’ll note that I am writing “transracialism” but not writing “transgenderism”. This is because apparently the latter term is offensive while the former is not; and this has nothing to say! Nothing at all! About how one of these processes is accepted by those who police our language in the name of social justice, while another is not.

fn5: Add “will non-ironically say ‘discourse'” to the trigger warnings! Too late!? Too bad!

fn6: Because for arbitrary and stupid reasons I can’t say “transgenderism”, every sentence where I want to refer to the process or state of being a person who is transgender is going to involve these slight awkwardnesses of English language. I’m going to stick to the politically correct phrasing here, but I hope that everyone sees how awkward this is, and how telling the acceptability of one -ism but not another -ism is.

fn7: I’m making a decision not to name the author because I suspect that if things go badly for her and the paper is retracted she is going to want her name not to be associated with the paper that she struggled over; I know that my actions won’t make a difference to the google search results, but I choose not to add to them. Nonetheless I think this is work she should be proud of and I hope she doesn’t have to retract or disavow it. Also what kind of budding philosopher wants their name turning up on a disreputable blog like this, associated with fantasy gaming and sex positivity?!

fn8: And they were being taught fractions by an ignorant white dude half their age. Can you imagine the indignity!? But they were very nice to me, and I think I did a good job of the teaching. But teaching fractions is HARD.

fn9: Please come back!

In the wake of the Republicans’ catastrophic inability to repeal Obamacare, many people have begun to accept that the Patient Protection and Affordable Care Act is the new basis on which the US health system will be built. This means that for the foreseeable future, assuming the Republicans are not able to suddenly develop a competent and coherent health financing agenda, progress towards universal health coverage (UHC) in the USA will depend upon improvements of and reform to the free market system as it is regulated by Obamacare. Obamacare is unusual among developing nation health financing systems for its heavy reliance on private insurers as the fundamental providers of risk pooling, as opposed to most other health financing systems where some form of government insurer provides the overwhelming majority of national health financing. For a lot of critics of Obama and Clinton from the left this is seen as a failure, and a sign that they are neoliberal sellouts: under this view of health financing reform, no market-based system will work and Obama sold out his own supporters when he put forward a plan that did not include single payer or a public option. For conservative policy makers in non-crazy countries – for example the UK[1] or Canada – and also in developing countries moving towards UHC, this offers an opportunity to see whether a free market approach to health financing can deliver the key goals of universal coverage and financial risk protection. The problem for conservative thinkers on health care is that there seems to be very little evidence that free market systems work, and the problem for left wing critics of Obamacare is that there is no evidence single payer could have been delivered in the modern US political environment. So for both far left critics and moderate right wing admirers of Obamacare the obvious question is: can UHC be achieved without a single payer system?

This week’s issue of the Journal of the American Medical Association has published an opinion piece addressing this issue. Entitled Achieving universal health coverage without a single payer: Lessons from 3 countries, it gives a brief overview of how Singapore, Germany and Switzerland have achieved UHC with at least nominally non single-payer systems. It attempts to address some of the key differences between these systems and the USA, and some ways in which the health market in those countries is different. Since JAMA is behind a pay wall, I thought I would give a brief summary of a few of these points.

First the article opens with a clanger, asserting that “Universal coverage is a top priority not only for Democrats but also for President Trump,” which does lead one to wonder how critical the authors are. It then goes on to dismiss summarily one of the key ideas raised by Republicans for making private health coverage more affordable in the US: high risk pools. The intention of a high risk pool is that patients with high cost or pre-existing conditions be offered insurance from a special fund financed by the government, thus removing them from the main private insurance risk pool and enabling insurance companies to reduce the cost of mainstream health insurance products. The problem with this model is that it is enormously expensive and there is no evidence that it works. The article points out that no US government will be able to justify the amount of money required to properly finance high risk pools, and that it probably costs upwards of 8 billion US$ a year to do this. It also notes that – contra Paul Ryan’s assertion that pre-ACA high risk pools worked great – most of the state-based high risk pools in the pre-ACA era were hideously expensive and did not work. The article also points out that a preferred strategy of some left-wing critics of Obamacare – shifting high risk patients onto Medicare – may also not work, since Medicare is already a high risk pool and expanding it by dumping in the highest cost patients will be impossible without increased funding (the article uses the language of sustainability, about which I’m suspicious because of its origins, but it cites well-respected sources on the challenges of continuing to finance Medicare if it is treated as a high risk pool).

So given this, the only way that a private system will be able to achieve universal coverage is if everyone is enrolled in insurance, and insurance is properly financed. The article describes the systems in Singapore, Germany and Switzerland, and how each of them force all their citizens into insurance coverage. For example, about Singapore it says:

Singapore institutes compulsory contributions from employers on behalf of their employees to create medical savings accounts. Employees maintain these accounts for health care expenses such as health and disability insurance premiums, hospitalization, surgery, rehabilitation, end-of-life care, and outpatient services. Those failing to pay their premiums are subject to garnished wages and other legal actions that can force payment of back premiums, penalties, and interest. Unemployed or low-income individuals are eligible for government subsidies that enable them to pay for the premiums.

and it points out that Germans are enrolled automatically in “private” funds that take a guaranteed 7.3% of their income. It’s hard to imagine any such plan being popular in the modern US, where the individual mandate has been subjected to years of withering don’t-tread-on-me type criticism and the idea of paying an income-based premium is terrifying to the GOP’s donors. In Switzerland and Singapore, where the systems do not use tax-based payments, they have government subsidies for (according to the article) up to a quarter of their population. So these systems – which by all accounts are functioning, affordable and tolerated by their citizens – share Obamacare’s key tactics of means-tested subsidies and individual mandates.

The article also makes the point that these systems have a very healthy free market structure, with much more vibrant private markets than the USA:

Germany in 2015, for example, had 124 sickness funds and 42 private health insurance companies, and the average resident of Switzerland in 2011 could choose from 59 health insurers offering coverage, with the 5 largest insurers covering 43% of the population. By comparison, in California, a state with approximately half Germany’s population, only 7 firms covered more than 95% of privately insured individuals in 2011, with the 3 largest firms covering 75%. In Massachusetts, with a population slightly smaller than Switzerland’s, 3 insurance companies enrolled 79% of individuals with private insurance.

I think this might be pushing the comparison a little bit, because many of the “sickness funds” in Germany are likely union-run or industry-based mutual associations with very strict management criteria, non-profit structures and guaranteed membership, and they may be regionally based so not actually directly competing with each other[2]. Also, I’m very confident that all three countries studied have rigorous price regulation and strict government oversight of providers (hospitals and clinics), so that they cannot for example price gouge the insurance provider for an infamous $500 band aid as they can in the USA. It’s much easier for private insurers to compete with each other for market share when they know what the cost of the insurance payout is likely to be, and can be confident that the provider won’t charge them arbitrary amounts, and I suspect that this certainty also removes a whole layer of administrative staff at both provider and insurer, for which the US system is infamous.

Having given an overview of these systems the article draws a simple conclusion and gives a firm recommendation: Obamacare needs tougher enforcement of a more punishing individual mandate. I think this conclusion is only partially correct, missing the role of price regulation and cross-subsidization from general taxation that protects these private markets.  So I think that the article is a little strong in concluding that the USA can definitely achieve universal health coverage without at least, for example, introducing a public option to every market place (or at least the rural areas). But it does make the point that a better regulated insurance market with better subsidies and a much tougher mandate would likely encourage competition, and achieve universal health coverage (or close to it) without driving up costs. It certainly seems that the architects of Obamacare knew this and had a long term plan for its expansion and improvement, and assuming the world survives Kim Jong Il’s birthday this weekend, hopefully the Democrats will be back in power in the USA soon enough to begin taking the next steps along that road. I’m not convinced yet, but it is still possible that Obamacare could show the way to a genuinely private, free market alternative to achieving UHC without single payer. In my view, however, if Obamacare (and human civilization!) does survive the Trump presidency, it is likely to become an increasingly state-regulated and state run system, rather than a robust private market place, because introducing a public option, slowly squeezing out private provides, and then making health insurance premiums fully means-tested and tax-based, is a much more reliable way to make everyone happy.

Still, for genuinely interested conservative policy-makers outside of America (whose “conservatives” have no interest in anything resembling policy), the next few years of Obamacare offers an exciting opportunity to develop new pathways to UHC. Given the complexity of movement towards UHC in some low income countries, and the very limited government finances in many of them, it would be interesting to see whether Obamacare’s roll out, expansion and improvement offers a new and more viable pathway to UHC than those currently on offer. I’m not holding my breath, but it will be interesting to see what lessons we can learn from this new and quite unique approach to one of America’s (and the developing world’s) big remaining problems.

First we have to survive the Trump presidency, though.


fn1: Caveats on the use of “non-crazy” should be inserted here, especially after Brexit

fn2: Interestingly, these sickness funds sound a lot like the non-profit mutuals that Obamacare was supposed to encourage, and which US “conservative” critics of Obamacare constantly sneer at and declare completely unviable.

By now everyone has learned the news that after 17 days of massive effort to try and force it through the legislature in the dead of night the Republicans have given up on their godawful attempt to repeal and replace Obamacare, and have accepted that Obamacare is now the “law of the land.” Having made no effort at all to reach out to Democrats, and after trying to push it through the Senate using a reconciliation process that was explicitly designed (and admitted) to negate Democrat votes, Trump’s first act of contrition for his and Paul Ryan’s failure was to blame the Democrats for not working with him. He went on to repeat the lie that Obamacare is “exploding” (it’s probably not) and openly admitted that he is going to try and hasten its collapse through executive action, following the logic that a program initiated by Democrats that is screwed into the ground by a Republican government will somehow be seen to be the Democrats’ fault.

Trump initiated this process of screwing Obamacare on his first day in office, when he passed a notoriously vague executive order that instructed all responsible departments to not comply with the details of the law to the extent they could legally get away with. A lot of people were duly concerned about this, because there are a lot of aspects of Obamacare that rely on administrative guidance that can be modified by the government in power. So this week’s New England Journal of Medicine has a short editorial by Jost and Lazarus about whether Trump can actually successfully undermine the workings of the act through administrative action alone. The two authors appear to be lawyers, one with a connection to the Constitutional Accountability Center, which supports the cause of “progressive constitutionalism” (which appears to be the idea that the Constitution is a living document whose interpretation can change over time), so presumably their understanding of constitutional law is fairly good.

The authors point out that reaction to Trump’s executive order ranged from fear to snorts of derision, and proceed to show at least one way in which it has failed bigly. One of the big fears expressed in initial response to the order was that the Inland Revenue Service (IRS) would stop collecting taxes it is required to under the “mandate”, the unpopular part of the law which punishes through the tax system anyone who does not purchase insurance. This was probably Trump’s intention in passing the executive order, but it turns out the IRS ignored him: it admitted on February 15th (a month after the order was signed) that it was still collecting mandate taxes, and that it’s sole response to the order has been to shelve a planned crackdown on tax evasion related to the mandate.

The authors point out why this should be unsurprising: government agencies are required to enforce the laws of the land, and there is a long-standing history of jurisprudence forcing them to. They point out that in fact

it is one thing to delay temporarily a legal requirement or to phase in a new law to facilitate adjustments by affected people or entities; it is quite another to refuse outright to enforce a law already in force, with the aim and effect of undermining that law. The Supreme Court has said that courts may step in to correct any such “abdication” of the executive branch’s duty to faithfully execute the law.

Apparently the highest court in the land has built up a body of precedent which requires government agencies to enforce government law, and the authors seem quite confident that if agencies don’t do this, court action would likely force them to. They go further than this, though, considering the hypothetical case in which the IRS bends the definition of “financial hardship” sufficiently to enable anyone affected by the mandate to be exempted from it on the basis of “financial hardship” (apparently some devious Republicans had considered this oily move). They write:

In a critical 2015 Supreme Court case upholding nationwide availability of ACA “premium assistance” tax credits for eligible low-income insurance purchasers, Chief Justice John Roberts held that courts and agencies must interpret and apply individual provisions of a law — indeed, of the ACA in particular — so as to further its overall “legislative plan.” Roberts concluded: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. . . . [W]e must interpret the Act in a way that is consistent with the former, and avoids the latter.”

This might seem quite reasonable to outsiders, but apparently in America the idea that government agencies must act according to the legislative intention of the law of the land is novel and requires clarification from the Supreme Court.

(Also note that this statement was made by justice John Roberts, a conservative judge appointment by Bush Senior, not one of those quisling liberals who think all toilets should be unisex because they’re radical feminists!)

In conclusion the authors are unconvinced that Obamacare can be undone by administrative action alone, though they concede it could become less generous and function less smoothly as a result of meddling. But the Republicans need to be careful here, since administrative overreach in this regard is likely to be punished by the courts, stacking further humiliations on Trump’s already woeful record of mistakes and inactions. Worse still, there is a big and growing split in the Republican movement over Obamacare, and signs that some of the 19 states that resisted the Medicaid expansion are going to cave, further entrenching Obamacare’s role. In particular Kansas, whose economy has been completely wrecked by Republican Crazy Caucus economic ideals, is desperate for money and is very close to taking the Medicaid expansion because balancing the budget will require the extra money. Virginia’s governor is also trying to get that state covered, and activists are using failure to take the expansion and its associated funds as a stick to beat Republicans locally. With Trump’s popularity nosediving, the collapse of the American Health Care Act showing the impossibility of reform through Congress, and many of the areas that voted for Trump most vulnerable to executive action, it is unlikely that vulnerable Republicans are going to want to push this issue at a local level. So the conclusion of this opinion piece in the NEJM is that while Obamacare won’t work as well under Trump, it is unlikely to be seriously damaged. And the longer it continues to function, the harder it will be for Republicans to repeal it or to continue to even talk about it. My guess is that over the next two years – and especially as the mid-term elections approach and it begins to look like a wave election is going to swamp a lot of Republican congress people – we will see more states take the Medicaid expansion, and moderate Republicans begin to talk strong talk about repairing the existing law rather than destroying it. Whether any of them survive the mid-terms will be another question entirely – but if they don’t, they will be replaced by angry Democrats, raising the possibility that after a wave election in 2019 the Dems might be able to force a veto-proof bill across Trump’s desk, requiring him to sign a public option into law.

Regardless of what happens at the next election, though, it appears that there is no easy way for the Republicans to undermine Obamacare enough to destroy it, and it would be increasingly reckless of them to try. Obama’s legacy looks to on increasingly solid ground, and I think it’s now safe to say that he was one of the greatest of the modern presidents. Who would have thought a Kenyan Muslim could go so far!?

I guess Speaker of the US House of Representatives Paul Ryan (aka the Zombie-Eyed Granny Starver) must be an avid reader of this humble blog[1], for within days of me posting a heart-felt plea for someone in the Republican camp to reveal their health policy principles, the GOP’s Granny-Starver-in-Chief gave a presentation on national TV to explain them. This presentation, intended to explain the Republicans’ Obamacare repeal-and-replace strategy (the American Health Care Act, or as Townhall.com call it, “Swampcare”), involves Ryan with his jacket off, a sure sign that he’s very serious, and it even has powerpoint! A fragment of it can be viewed here, and it’s clear from this monstrosity that Paul Ryan, the great and serious policy wonk of the Republican majority, doesn’t understand how health insurance works. Or worse still, he does understand, and he thinks that insurance is A Very Bad Thing.

From this presentation we can see two health policy principles that the Republicans appear to cleave to: That health insurance is bad and health savings accounts (HSAs) are good; and that the government should be the insurance provider of last resort for society’s sickest. Let’s look at these two principles and their implications.

Do Republicans really think health insurance is bad?

It appears from this keynote presentation of Ryan’s that they do. He makes clear that the healthy are subsidizing the sick and that this is a bad thing, and suggests that this is a bad thing and is the reason that Obamacare prices are rising. The tone of Ryan’s voice, the expression of exasperation, and the follow-up comment that “this is not working” and that the Republican plan will “fix this” are all keys to his belief that health insurance is a bad thing. The healthy, under his formulation, should not subsidize the sick. This is backed up by comments by Rep. Shimkus in the house energy and commerce committee, who when asked about requirements on insurance plans asked “What about men paying for prenatal care”, following up with the rhetorical “Should they?” (That Washington Post article also mentions similar comments from a 2013 committee, where a Republican asked why men should have to pay for maternity care). This isn’t just a glib and nasty comment, it’s a policy position. Note that Shimkus didn’t say anything along the lines of “Pregnancy is a lifestyle choice and our plan will not require insurance companies to cover lifestyle choices.” Rather, he gave an example of someone having to pay for coverage of a problem they will never themselves suffer.

But this is the entire point of insurance: Generally you buy insurance on the assumption that you will never have to use it, knowing that your insurance company will use your premiums to pay for someone who does have to use it. In the case of health insurance, since we all get sick everyone knows that their insurance is contributing to coverage for people who will suffer conditions that most of us will never suffer. Men pay for breast cancer treatment, women pay for prostate cancer treatment, people who are fated to die in a bus crash at 43 pay for alzheimers care that they themselves are doomed never to receive. That’s how insurance works. Once you start saying that people shouldn’t have to pay for things they won’t themselves experience then you are changing the entire nature of insurance. Or, you don’t understand how insurance works.

It’s clear to me from these comments that the Republicans are actually seeing insurance as a Health Savings Account. An HSA is designed so that no one can take out of it more than they have put in, and they use the money in the HSA only on care for the conditions they themselves face. With a well-run HSA the healthy don’t subsidize the sick – rather your current self subsidizes your future self. In this formulation, no one ever has to worry that their money will be used to pay for a treatment they themselves would not face, and no one can get angry about the healthy subsidizing the sick, since it’s only their own future sickness they’re subsidizing. HSAs never suffer from justice issues either – you won’t find a healthy supposed marathon-running non-smoker like Ryan being forced to use their premium payments to cover lung cancer for a sedentary smoker, because they won’t be subsidizing anyone.

So here we have Republican principle number one: Health insurance bad, Health Savings Accounts good.

Government as insurer of last resort

Paul Ryan also touted an alternative method for handling people who are rejected from health insurance plans due to pre-existing conditions, which he described as state-based insurance plans that would cover high risk people. Under this scheme the states get about $10 billion a year to run high risk insurance pools for those very sick individuals. This would enable the health insurers to reject these people, and/or would make a special form of insurance that was better able to handle these high cost cases, enabling health insurance funds to offer lower premiums to everyone else and thus to widen their risk pool. This insurer of last resort model is consistent with the idea of health insurers as a type of health savings account management company: They set a premium for people with pre-existing conditions that is prohibitively high, and then those people “choose” not to pay for the premium and instead run to the government’s high risk pool for coverage. Ryan touted the Wisconsin Health Insurance Risk Sharing Plan (HISRP) as an example of a “good high risk pool” that was shut down by Obamacare, presumably suggesting this as a model for the AHCA.

This is unfortunate for several reasons. The first is that HISRP was cross-subsidized by a tax on all insurance premiums charged in the state, meaning that in fact the healthy were subsidizing this program for the sick; the second is that doctors and hospitals charged lower prices to HSIRP recipients, i.e. they allowed the state to regulate what they were able to charge, which is anathema to Republicans. This is also not an idea that is absent in Obamacare, which offers states funds to set up high risk pools[2], so it’s not clear how this policy is an innovation compared to the current policy.

The other big problem with this high risk insurance pool idea is that it doesn’t work precisely because the people in the pool are too sick. Recent assessments of Obamacare’s state-based pools found that they were running out of money far faster than expected, and many state pools have had to go back to the government for more money. Elsewhere I have read estimates that the AHCA’s proposed funds will only cover about 400,000 high risk individuals, when America has about 2 million people who need them.

Still, this is a policy principle, and it’s not necessarily bad in and of itself – but it does require that the government be willing to offer a potentially open-ended assurance to states that these risk pools will be funded. This might be a good policy idea, but it doesn’t seem like it’s going to be compatible with either a) the Republicans’ historical antipathy for welfare programs and b) the reconciliation process’s restrictions on what funds are available for the plan. It’s the sort of thing that is easily sold as a sop to people concerned about the impact of reform on high-risk individuals, and then easily defunded in practice. If you doubt that, remember this: Paul Ryan’s nickname among his critics is “Zombie-eyed Granny Starver.” Also remember that Ryan is a confirmed liar, who lied about his marathon times to make himself sound like a champion when in fact his marathon times are really average, and you can’t trust liars when they promise to pay you back in future.

What’s wrong with confusing health insurance and health savings accounts?

Now it’s true that in and of itself favoring HSAs over health insurance as a policy tool isn’t necessarily bad. Singapore uses them as part of its health financing system, and China tried them (though I think they moved away from them to a more standard social insurance system), and they could probably theoretically be made to work. They come with obvious equity issues for people born without money, and also they have their own free-rider issues when dealing with people who don’t pay into them but then become sick, but they can probably be made to work. But to make an HSA system work will almost certainly require that they be mandatory (as I think they are in Singapore) and government-subsidized for the young poor. They suffer from many the same problems as private superannuation plans, in that the people who should be paying the most into them – young people – are simultaneously the people with least need of them and the least money to do so, so typically the best way to implement them is mandatorily and by stealth. Of course the Republicans hate mandating anything (except unwanted pregnancies), so they won’t be fond of forcing people onto HSAs; but it is true that HSAs are consistent with general Republican ideas about personal responsibility, no free lunches, etc.

The problem though is that to make HSAs a centerpiece of American health policy requires a root-and-branch reform of how the private markets work. The new Republican bill doesn’t do this, and continues to leave the private markets in the hands of traditional health insurance companies. But it’s clear that the Republican policy-makers are thinking of health insurers as administrators of a kind of HSA program, while the health insurers think of themselves as (and actually are) traditional health insurance companies. This is a big problem, because the policy requirements of HSAs and health insurers are completely different, and confusing one for the other is a disaster. This means that health insurance companies are setting premiums on the basis of an assumption that the government will work to expand the risk pool, or at least not to impede its expansion, while republican policy makers are thinking that insurance companies are setting premiums on the basis of the future underwriting risk each enrollee’s individual future health risk profile presents. So the Republicans have no interest in setting policies that will encourage the healthy (i.e., poor young people) into the market, and may even be trying to find ways to encourage sick people to enrol and pay more (such as through the first-year penalty on insurance for people who let coverage lapse). For example, if they could set policy legislatively rather than through reconciliation, Republicans might pass a law that allows health insurers to set premiums based on each person’s individual future risk profile (so e.g. young women pay more than young men because they will get pregnant), but the insurance companies would prefer to set premiums on the basis of actuarial risk and the size of the risk pool, which is a more instantaneous calculation. This could create policy conflicts that prevent insurers from properly setting prices while simultaneously discouraging young people from entering the risk pool.

Health policy in America for the past 100 years has been built around health insurance markets, not HSA markets. The republicans, by thinking of health insurance as a type of HSA, risk making policies to encourage a market that doesn’t really exist, while the health insurance market struggles to function without proper government subsidies. A good example of this is the way the subsidy design in the Republican plan does not vary by state. Republicans seem to be completely ignorant of the fact that premium prices vary by state, since they depend on the size of the risk pool in each state and the relative balance of healthy and unhealthy, old and young, and also the cost of health services in each state. So Alaska is much more expensive than California. Lawmakers who understood health insurance as a risk pool mechanism would get this, but policy makers who think that health insurance premiums are set as if they were HSA fees will not – HSA fees depend on the future health risks faced by an individual, so may not vary much by state, while health insurance premiums depend on the instantaneous balance of healthy and high-risk individuals in a geographic area, so vary a lot by state.

This confusion is a recipe for trouble, and a sign that despite having six years to sharpen their understanding of these issues, supposedly intelligent and committed Republicans haven’t bothered.

What does this say about the media’s love of Paul Ryan?

The media love to treat Paul Ryan as a serious Republican policy thinker, when in fact he is nothing better than a fraud and a shonkster, a hired salesperson for the policy preferences of his rich patrons. He doesn’t have any deep policy ideas, and he doesn’t care to or need to – his only legislative goal is to dismantle welfare programs and spend the money saved on tax cuts for the rich. He is also a confirmed liar and a fantasist, with no personal integrity – hardly surprising since he comes from a party that has long suffered from “family values” politicians who cheat on their wives and anti-gay politicians who solicit in bathrooms. But the media is labouring under the impression that America has two serious parties, rather than one serious party and one gang of frauds and criminals who occasionally get hold of the machinery of the state long enough to loot it for the benefit of their rich patrons. We now know that these pirates in the GOP aren’t even patriotic – they’re tools of the Russians and the Turks, and have moved from selling their domestic policy to the highest bidder, to selling their foreign policy to whatever foreign agent will help them win power. But so long as the media needs to keep pretending that the Republicans are a serious party and not a gang of wreckers and criminals, they also need to find people within that party they can treat as serious even when they’re not. Paul Ryan, with his fake sincerity and his ability to act like an idiot’s idea of a smart person, and his sleazy aura of seriousness, offers them someone to elevate to the level of “thinker”, even though he has repeatedly shown himself to be incapable of the task. Charles Pierce, who invented the term Zombie-eyed Granny Starver, summarizes Ryan:

Every time he produces a “budget,” actual economists collapse in helpless laughter and other Republicans hide behind the drapes. As a vice-presidential candidate, Joe Biden made him look like a child, and Ryan was unable even to carry his own precinct for the Republican ticket.

Since Obamacare reared its ugly head Ryan has consistently and repeatedly squibbed on the basic responsibility to produce an alternative policy, and now he has unveiled this one – and claimed it’s the best chance Republicans will get to repeal Obamacare – he has confirmed what anyone with any sense already knew: he hasn’t got a clue, and doesn’t care to make the basic effort required to have a clue. So will the media finally recognize this and give up on him – and hopefully by extension all the frauds and liars on his side of the chamber – or will they continue their love affair with him, and continue to sell the American people short? My money’s on the latter, because even though the past three months have made clearer than ever before that the Republican party is just a gang of crooks, the media will never admit their role in enabling these frauds and scoundrels over the past 30 years. They have to hit rock bottom before they can admit their problem and make amends, and I’ve no doubt that discovering their favourite policy wonk knows nothing about anything is nowhere near rock bottom for the US media.

We have a long way to go yet before the Republican party and its enablers are properly shamed for the damage they have done. Let’s hope that Obamacare repeal fails before we get there.

 


fn1: Maybe that’s why his health policy knowledge is so bad! But at least he won’t use OLS regression on count data like good ‘ole Barry

fn2: Funnily enough Ryan, a confirmed liar, didn’t mention that Obamacare set up a state-based high risk pool in Wisconsin when it closed the existing high risk pool. The new one has about 1100 enrollees – because most of the 21,000 enrollees in the previous one became eligible for Medicaid or individual insurance plans under Obamacare. This is an interesting bait-and-switch that Republican shonksters like Ryan use: at the same time as they are proposing to do away with a government entitlement and kick the poor over to the mercies of the free market, they attempt to gee up some outrage about how the Democrats unwound a government entitlement that people really liked. I guess I shouldn’t be surprised that a shameless liar like Ryan has no shame, but it still disappoints me every time I see it.