Health care reform shorts: a day observing waste in a medical center

I spent 12 long hours yesterday accompanying a friend who was trying to get urgently needed treatment from a major academic medical facility. It was interesting.

This is not a story about health care denied. My friend has a huge array of medical problems that leave her severely disabled. In consequence she is indigent, dependent on MediCal (Medicaid) and an array of public social service programs for her survival. Stubborn and determined, she works at enlisting and coordinating them all, as much a full time job as any other. She successfully corrals much of the help she needs. At every turn yesterday, she presented her MediCal card and her eligibility for the expensive procedures that a major med center has on offer was never questioned.

Nor is this a story about medical mistreatment or neglect. With rare exceptions, the many people who transported, poked, prodded and diagnosed my friend were polite and professional, though harried. Lying helpless on a gurney while hurting is brutally awful; aides, orderlies, nurses and doctors tried to offer calm and respect. Only one of nearly a dozen examining doctors insulted her dismissively when she questioned what he wanted to do to her body and even he backed off. This was a "good" urban hospital experience.

But what a morass of inefficiencies this day revealed. There must savings that could be squeezed out of the way people get necessary treatment under reform! Some observations:

• My friend tried to approach getting care "right." She somehow wangled an emergency urgent care appointment with a medical resident in the department where her primary care doctor works. She showed up on time. That doctor examined her, consulted with the attending primary care doc -- and they concluded my friend should be sent to the Emergency Room because "she can get tests quickly there." So much for keeping people out of over-burdened ERs. I was deputized to push my friend in a wheel chair across the street to the ER, carrying a sheaf of papers on which the examining doc had recorded her observations.

• When I presented the papers to the ER triage nurse, we had a revealing conversation. She looked at the internal med doctor's notes, commented "that's pretty good handwriting but I still can't read it" and then took my friend through the same narrative of her needs the previous doctor had written up.

• My friend has gotten her care in this system for 15 years. She has a history with them which, when printed out, would probably be the size of a couple of urban phone books (remember those?) Yet every nurse and doc had to ask her the same historical questions and write them down, by hand, on a new form. I can understand repeatedly asking about drug allergies -- that might be life saving. But this woman's "chart" is so unwieldy and the medical people so rushed, as far as I could tell they simply didn't try to read it. From the patient's standpoint, the inquiries start out helpful, but when asked over and over, come to feel abusive.

• This is not a crumbling public charity hospital (see pic above). But nurses and orderlies seemed to spend much of their working lives running from place to place looking for what must be fairly common supplies: for example more plastic tape or a portable commode.

• Each phase of the diagnostic process would run into a moment when the resident doctor who'd just seen my friend would retreat to a hallway to try to find out who the appropriate specialist to call in might be. Because this is a teaching hospital, any sort of specialist needed seemed be available somewhere in the complex -- but the ER docs spent a lot of their day trying to figure out who might be on duty and where they should call.

• When the ER finally decided to admit my friend to the hospital proper, then the search for an available bed began. Several of her hours taking up an ER cubicle with all its associated high tech facilities passed while doctors and clerks tried to coordinate with the main hospital. Meanwhile, more patients were crowding the ER waiting room, hoping to get into the cubicles.

These medical people were obviously working diligently to provide the best care they could in difficult circumstances (though by no means the most difficult). And people were getting cared for.

But I do hope the reform we seem to be getting can lead to universal adoption of electronic health records. And there must be some way to achieve better coordination among the parts of the medical non-system.

City of Belief: a novel

On November 9 1965, a young man named Roger La Porte set himself on fire in front of the United Nations in New York. La Porte was one the "volunteer" members of the Catholic Worker community on the Lower East Side; in the few hours he lived after his self-immolation, La Porte explained he was opposed to all wars. His act took place in the context of escalation of the U.S. war in Vietnam, long before most of the public had much awareness of that murderous conflict that would drag on another seven years.

Nicole d'Entremont, who was part of that Catholic Worker community in that time, has published a haunting little novel, City of Belief, that takes off from these events. She's adopted what seems to me a strange and daring means of shaping her story: she uses named historical characters for whom she has invented dialogue and inner thoughts; gives some actual community members their real names while covering the identities of others, equally recognizable, with aliases; and, I think, invents others entirely. (I too was there, about five years later. This book is full of old irritants and old friends.)

But after a slow start, d'Entremont's novel "works" for me.

We have forgotten how war objectors were met with popular violence in those years -- if you weren't around then, think how this country responded to anyone who dared to oppose the U.S.'s initial assault on Afghanistan in 2001. This was a flag waving country in 1965, fearful of enemies and largely trusting of government authority; the Vietnam war broke that trust and it will never come back.

But the politics are secondary to a story of young people trying to find themselves amidst the violence of city life and urban poverty as well as the looming war. As I experienced in the Catholic Worker communities where I lived for a time, the line between the poor who were served and the volunteers who thought we were making a choice to serve was blurry, not that either group much acknowledged that. We were all there because, often for reasons we couldn't articulate, we were where we needed to be. City of Belief is about good people caught up in events and conflicts beyond their comprehension. It doesn't solve anything, but it gently drops you among them. That's a good thing. Very much recommended.

Sweeney Ridge trail maintenance:Getting sore for the pure pleasure of it

I use local hiking trails every chance I get, so I figure I ought to do a little work on them once in a while. When the Golden Gate National Recreation Area teamed up with REI to organize a Saturday's maintenance project, I signed up. Sweeney Ridge runs along the spine of the hills that separate the ocean from San Francisco Bay a few miles south of the city. The trail includes the "Discovery Site," the reputed location where Spanish explorers saw there was a huge body of water -- the bay -- over the mountains.


The group I joined was working to improve the condition of some of the hundreds of wood-demarcated steps on the trail. See that shadow at the right lower corner of the picture? It's presence means the earth behind the step has sunk, creating a tripping hazard.


Our small crew of volunteers spent a morning shoveling earth into plastic buckets and hauling it --mostly downhill -- to fill in those steps.


That is, we acted as inefficient, under-muscled mules.


Dumping the buckets was satisfying.


After we'd filled in a step, we stomped the new earth flat.


After about eight trips up and down the hill with the weighty buckets, it was time for some water and a laugh.

I'm lucky. This kind of work hurts since I don't do it often, but I find it profoundly relaxing. The steps are marginally improved. They'll last a winter, perhaps. It's not a huge accomplishment to have shored them up, but it was a pleasant way to spend a November morning.

UPDATE: This project was also sponsored by the Bay Area Ridge Trail Council.

Health care reform shorts: Forward movement?

Damn -- I took a day off yesterday to be outside and the House passed some kind of health care reform.

They appear to have had to sacrifice the lives of some poor adolescents to do it, but hey -- who cares about girls who let themselves get knocked up? The bill would ban private insurance companies from covering abortions sought by private customers who pay for that insurance themselves if the same companies also want to cover anyone for anything in the new insurance exchanges.

In light of the foregoing -- and recent elections in Maine and California -- I have to wonder whether cutting away the tax exemptions of churches that try to make their peculiar repressive prejudices a matter of law ought not to be a major progressive goal? (That's you -- Catholic bishops and Mormon elders). I say that as a member of a good "liberal" church that makes oh-so-correct liberal pronouncements public issues, but effectively wields no clout.

More later about sandhill cranes and trail maintenance ... my mini-vacation.

What U.S. Muslims are up against after Fort Hood

In the saturation coverage right after the events, the "expert" talking heads are compelled to offer theories about the causes and consequences. In the following days and weeks, newspapers and magazine will have their theories too. Looking back, we can see that all such efforts are futile. The shootings never mean anything. Forty years later, what did the Charles Whitman massacre [at UT Austin] "mean"? A decade later, do we "know" anything about Columbine? There is chaos and evil in life...

James Fallows

I grieve for the people at Fort Hood, for all soldiers sent to be broken in wars, for Iraqis and Afghans caught in our madness, and for U.S. Muslims who once again have to trot out to reassure ignorant majorities that they aren't all responsible for the actions of a crazy person.

After the condolences and the condemnations of the shootings, this is what the Council on American-Islamic Relations knows it must say to its community:

Unfortunately, based on past experience, we also urge American Muslims, and those who may be perceived to be Muslim, to take appropriate precautions to protect themselves, their families and their religious institutions from possible backlash.

The rest of us should be ashamed that our neighbors have to endure these fears. As Fallows says, these shootings mean nothing, except that some of us lose it sometimes.

(Photo from New York Times.)

Seen in the 'hood

What was the Department of Public Works thinking when it installed these?

Off-year election afterthoughts

Before we've all forgotten there was a wacky contest on Tuesday somewhere in the far northern reaches of New York State, I want to get in a few more thoughts. Until I read the following, I didn't have any very authentic picture of what might be going on in New York's 23rd Congressional District. But thanks to Booman who pointed to this from a local newspaper, I think I now have more notion of what may have given Democrat Bill Owens an unexpected victory over wingnut Conservative candidate Doug Hoffman.

Owens won in Hoffman's home Essex County, where Republicans have a substantial voter registration advantage, with 3,718 votes compared to 3,175 for Hoffman and 432 for Scozzafava. Keene town Councilman Paul Martin couldn't vote in the Hoffman-Owens race because, like Hoffman, he lives in the neighboring 20th District, but he found Owens' taking of Hoffman's home county interesting.

"This used to be a tremendous conservative center, this whole North Country area," Martin said. "You couldn't find a Democrat in this whole area. ... And of course, all that's changed. ... It's kind of like what Vermont went through.

"I think there are a lot of thinking people up here, and maybe they figured it was time for a change somewhere along the line."

Adirondack Daily Enterprise

That had echoes for me. You see, I worked politically in Vermont in 1970 before Vermont "went through" a political sea change. The state had lost its woolen mills (and their jobs) to the South; agriculture had always been marginal on granite hillsides; all the state seemed to have were gritty people, beautiful hills, and fall foliage. Politically, the state was "conservative" in a way that really meant depressed and anxious. Back then, Democrats were rare creatures in Vermont.

Since then, Vermont has changed enormously. It's still struggling economically, but, somehow combining out of state immigrants attracted by its beauty, a vigorous year-round tourist industry, and some knowledge work, it has pulled itself together. Now it is the most libertarian/liberal of the New England states, fielding a Socialist Senator (Bernie Sanders) and giving President Obama the highest percentage of his vote from white males of any state in the country (map here).

I have to wonder -- are parts of far northern New York going the way of nearby Vermont? Like Vermont, the area doesn't have an agricultural future; there's a limit to living on sugar maple tapping. And much of it (the bits by Lake Champlain and the St. Laurence river) is beautiful, attracting tourists and newcomers fleeing cities. It wouldn't be entirely shocking if the kind of transition that happened in Vermont is happening here -- and this unexpected election with all its noisy outsider interlopers just both covered and revealed a local process that was well underway.

In any case, if, as expected, New York State loses a Congressional district after the 2010 census, this particular district shape is not likely to endure much longer.

***The mainstream media explanation of what happened Tuesday (in New Jersey and Virginia) seems to be that independents voted for Republicans. Nate Silver at 538 punctures this meme as an explanation. Since Democrats and Republicans almost always vote as Democrats and Republicans, independents always deliver the margin of victory to one side or the other. So this "explanation" is not very meaningful. Moreover, the label "independent" covers voters who do not have a party affiliation for very different, sometimes conflicting reasons. I like Silver's list of the kinds of independents and pass it on here:

1) People who are mainline Democrats or Republicans for all intents and purposes, but who reject the formality of being labeled as such;
2) People who have a mix of conservative and liberal views that don’t fit neatly onto the one-dimensional political spectrum, such as libertarians;
3) People to the extreme left or the extreme right of the political spectrum, who consider the Democratic and Republican parties to be equally contemptible;
4) People who are extremely disengaged from politics and who may not have fully-formed political views;
5) True-blue moderates;
6) Members of organized third parties.

The number of divergent sorts of "independents" always makes campaign outreach to the margin-makers a difficult task.

Health care reform shorts: Why the House bill is better for elders

Elderbloggers, listen up:
Here's Harold Meyerson at the Washington Post explaining how the proposed reform that Nancy Pelosi is working through her chamber is good for older people.

The House bill ... offers a lot more assistance to Medicare recipients by reducing the cost of their prescriptions. While the bill that emerged from the Senate Finance Committee renews the Bush administration's mega-bucks gift to the drug companies by continuing to prohibit Medicare from negotiating drug prices with them, the House bill authorizes those negotiations. The Senate bill reduces by half the payments that Medicare recipients must make for prescription drugs that fall into the "doughnut hole" (annual drug expenses are covered up to $2,700, and coverage kicks in again at $6,100, but for all purchases in between, Medicarians are on their own). The House bill would cover all prescription purchases by 2019.

He goes on to explain why this is good politics for the Democrats: we elders vote, especially in non-Presidential years like the upcoming midterm elections. If Democrats are running a little scared after defeats in New Jersey and Virginia yesterday, they'll pay attention. ***The photo of Obama speaking to the AARP in July comes from the Whitehouse online photostream. Apparently AARP is poised to endorse health care reform.

Maine, messaging and marriage for us all

Robert Cruikshank, a smart and very hard-working guy who works with California's Courage Campaign, writes about the Maine marriage defeat:

...the Maine experience suggests we still haven't figured out how to message this in a way that neutralizes the other side's lies.

That's not to critique the No on 1 campaign in any way. It's more a broader point that none of us have, for example, figured out how to overcome the Schubert/Flint bullshit about schools. ...

Much as I respect Robert, I think he's wrong. I think he's repeating a piece of conventional wisdom here that we need to move beyond. And yes, I know it is impolitic to admit this.

The reason that the anti-gay messages about LGBT marriage being taught in schools "work" is twofold:

• Being worried about the "innocent" kids is a more acceptable form of bigotry than outright recoil from gay ickiness. Gayness is rapidly being normalized in 1000s of venues, most notably consumer culture. It would be unacceptably uncool for many adults to admit that gay people simply make them queasy. But they can be proud of themselves for being queasy on behalf of someone else -- kids serve well for projection of very adult anxieties.

• When we win the right to marry, what opponents fear will come true. Kids will learn in school that gay people/gay families are simply a normal variation in their world. In most circumstances, teachers aren't going to teach that Johnny's parents are dirty and immoral while Suzy's are good and pure. This sort of thing creates discipline and administration problems; better to teach the kids that we're all human and we can all get along.

Most gay people who work for marriage equality are seeking exactly the recognition that anti-gay marriage forces hope to prevent us from getting. We can't message away our desire to be included as normal members of a complex and various human family. Fortunately, with enough hard work, our opponents will become more and more irrelevant until even they wonder what all the fuss was about.

Elections junkie round-up

I guess I'm hopeless. Even in this dead year for a Californian, I had to follow election results last night. It wasn't much fun.

It had been obvious for some time that the Democrat Creigh Deeds was going to go down to Republican Bob McDonnell in Virginia. And he did, big time. A friend who had worked for Deeds in the past says he is not an inspiring campaigner. By far the most interesting observation I've read on that campaign was by James Collins in the New York Times.

It appears then, that to be elected to statewide office in Virginia as a Democrat, it helps to not be particularly Virginian, but rather an expatriate educated professional.

It's a snarky piece of writing, strictly anecdotal -- but Collins may be on to something about that state-in-flux.

Republican Chris Christie has knocked off Democrat Jon Corzine in New Jersey. Guess that proves the guy from Goldman Sachs found something he couldn't buy. I have zero idea how New Jersey politics works -- they seem to elect 'em and then reject 'em with unusual frequency. I have no idea what Corzine was like as governor.

Meanwhile the circus freak show in the New York's 23rd Congressional Districts seems likely to spit out a Democratic winner, the first such in a 100 years. Guess having the likes of Glenn Beck and Sarah Palin muddling in their backyard was too much for those upstaters. Coming from a long line of upstate Republicans, I can just imagine the revulsion ...

But mostly, I just ache for the folks who worked on the Maine marriage equality campaign. Once again, the polling suggested we'd make it. Yet as I write this, supporters are saying "too close to call." This may very well be another narrow loss for gay marriage.

From afar, No on 1 looked like a well run campaign. I hope folks can avoid falling into recriminations. Gay marriage is coming, but both we and the naysayers have to live through the painful hiccups along the way.

The culprit in Maine seems to have been the Roman Catholic Church. No surprise there. Nationally the Conference of Catholic Bishops is out to kill any health care reform that allows private insurers to offer the choice of policies that include abortion services in the new market exchanges. Get it -- their beef is about what private insurers would be allowed to sell when competing with a public plan that doesn't cover abortion? The RC Church is willing to kill health care reform for everyone because some people have different moral ideas than they do. Not edifying.

Meanwhile all around the edges of the more visible elections, LGBT people are making good progress. Anti-gay forces put Kalamazoo Michigan's gay civil rights ordinance up for referendum -- it survived handily. A gay man was elected mayor of Chapel Hill, North Carolina -- a very "New South" sort of place, but progress nonetheless. And a lesbian Democrat became the leading candidate in a run-off for Mayor of Houston. That's the fourth largest city in the country! In Washington State, voters appear to be approving an expanded domestic partnership law that gives couples all the rights and responsibilities the state offers, except the label "marriage."

Here in San Francisco (the home of the multi-lingual polling place sign above) we had an election so boring almost nobody came -- 12.5 percent according to the Department of Elections. I was among this sliver of the population, but even this elections junkie can't remember what any of it was about.

Health care reform shorts: Republican abuse of the filibuster

Because we are constantly told it takes 60 votes to pass anything (like health care reform) in the U.S. Senate, it would be easy to assume that the filibuster has always worked as this kind of obstacle, allowing 40 percent plus one members to stop any law.

But that is just bullbleep! The following chart shows the frequency of cloture votes (formal votes to end debate -- end the filibuster) that minorities (of whichever party) have forced on the Senate since 1959.



Though the use of the filibuster to block majority-approved legislation has been rising throughout the period, it only really took off in the last 2 years of Bill Clinton's presidency -- and then again when Democrats took over the Senate in 2006. The last Congress (the one represented by the huge spike on the right) set a record for filibusters, even though the minority Republicans had George W. in the White House to backstop them with a veto. This Senate, the 111th, will set a further new record.

According to Steve Benen from whom I got this item,

There's nothing routine about this distortion of institutional constraints. It's an abuse unseen in American history.

Part of restoring democracy in this country will have to be curbing the Senatorial privilege to gum up the works for majorities. This was accomplished once in my lifetime, in the late 1950s and early 1960s in order to pass civil rights legislation over the opposition of Southern segregationists.

Lyndon Johnson cut the cloture vote requirement down from 66 to the current 60 and broke the power of Senate committee chairmen in that era. The current Republican Party is not really so different from those old fossils. As usual, progress in this country amounts to a struggle to extend democratic (small-d) rule.

Chart from Norman Ornstein.

One of the good mysteries

Remembering BA Fanning, 1934-2006
On the Feast of All Souls/Dia de los Muertos

I still find it hard to believe she's gone, felled by a stroke. In truth, I didn't know her very well, but she had a major role in enabling me to live the life I have lived.

BA (Elizabeth "Betty Ann") Fanning, along with husband Tom and their young children, Trip and Liz, moved in next to my parents not long after I took the 3000 mile solution in 1965, fleeing Buffalo (NY) for college in Berkeley (CA). I was busy finding a a larger world and a more grounded self over the next couple of decades and dropped into my old home as infrequently as familial propriety would allow.

By the mid-1980s, even so oblivious an only-child as I was had to notice that my parents were getting older and I became more diligent about regular visits from California, often over conventional holidays. It was then that I really became aware of BA.

At the time she was teaching ethics (or maybe it was called religion) part time at a Catholic high school. Previously she'd worked as a nurse. At home, she was constantly remodeling and improving the family's 3-story early 20th century house. She seemed always busy about some good deed or some creative project. And over holidays, she gathered her whole extended family around her for magnificent dinners. There was her mother; and her mother's retired railroad worker boyfriend; the boyfriend's dim son; her brother, the priest; her sister, the nun; always other strays; and my elderly parents. A complete fish out of water in a Buffalo I no longer knew, when I started turning up regularly, I slipped right into the menagerie. BA had made family of us all.

Yet she kept some careful distance alongside her welcome. There was a private person inside the warmth. And she could be prickly. She didn't think much of most authorities of church or state and was inclined to burst out with her prescriptions for improvements. "When I have my world ...," she'd begin. I found discussions of "her world" congenial.

In 1991, my father's tired lungs and heart gave out. Young Trip Fanning helped Mother lay his body out on his bed. BA Fanning called me with the news of his passing. Mother lived on alone in the big empty house for another eight years. BA watched the lights go on and off every day and looked in on her frequently, while carefully respecting her privacy. I visited more and more often -- and at the same time lived a rich professional life that sometimes involved travel out of the country.

Throughout that last decade of my parents' lives, I kept wondering whether I would have to move to Buffalo to help them. I'd ask BA what she thought whenever I visited. She didn't advise, but she reassured me that my folks felt cared for by me. Mother especially never "wanted to be a burden." Knowing that BA was there meant I didn't make the move.

In 1999, BA noticed that the lights next door weren't following their usual pattern. She found Mother paralyzed by a stroke at age 90; I flew in from California and Mother died rapidly. Over the next few months, the Fannings offered moral support as I cleared up the detritus of my parents' fifty years in the house. I never saw BA again after I left Buffalo that year, though we talked on the phone a few times.

As I said, I'd be exaggerating if I said I "knew" BA Fanning. Rather, I was privileged to be among the hundreds of people she befriended and assisted simply because that was how she lived. I have the sense that I was made better by having received the gift of her attention. Some people are like that. It's one of the good mysteries.

A snippet of the hidden is revealed

Last week when the President signed the Defense bill, he also was enacting the Matthew Shepard Hate Crimes Law, a truly epic progressive victory for LGBT people. The measure had been attached to the big war spending bonanza.

Also hidden among the weeds in the "Defense" law was another juicy item: an exemption from the Freedom of Information Act covering photos of prisoner mistreatment dating from 2001-2009. The Secretary of Defense (War) now can hide pictures from that era even if a court has ordered them released.

The torture regime thrives on such secrecy. To break down its lies, the ACLU has provided this set of interviews with former Guantanamo detainees now resident in the United Kingdom in a video titled "Justice Denied." They are remarkably articulate and well spoken young men.

"...it's like asking a woman who has been raped when her life got back to normal. Never."

"...I want humans themselves, the good people of in America which I've met many of, to realize how in their names those ugly people have done all of it..."

[9:30] Utterly worth watching ...

All Saints Day thoughts from Muir Woods

While walking in John Muir's wood, we came upon the plaque pictured above. And therein lies a tale:

Last summer at the General Convention of the Episcopal Church, where I was working for full inclusion of LGBT folks, a distracting issue arose that might have tied an important committee in knots. The folks delegated to consider "Prayer Book, Liturgy and Music" were trying to add a list of people to the roster of men and women remembered in the calendar. This is not like the Roman Catholics announcing that someone is a saint -- Episcopalians think all the baptized are "saints" but some people's lives were especially good examples to be contemplated and commemorated. The PBLM committee was working on updating the list.

Among the potential additions was John Muir, the early 20th century naturalist for whom the redwoods monument is named -- and who properly gets credit for the founding of the U.S. National Park system. Many of the same people who would have preferred to avoid full inclusion of gay people in the church objected to including Muir among a long list of new commemorations. Muir's relationship to the divine was a little unconventional for his time and perhaps for any institutional church. Muir explained that he had found a

"primary source for understanding God: the Book of Nature." ...

[Muir also wrote:] "Every particle of rock or water or air has God by its side leading it the way it should go; The clearest way into the Universe is through a forest wilderness; In God's wildness is the hope of the world."

This sort of thing smacked of heterodoxy to some conservatives at General Convention. So they proposed that if TEC wanted to list a naturalist, how about Gifford Pinchot?

Who was Gifford Pinchot?

If we owe the National Parks to Muir, we owe the National Forests to Pinchot. A turn of the 20th century Progressive, he believed U.S. government should not simply turn public lands over to private exploitation, but should employ scientific management to make the country's natural resources both profitable and sustainable for posterity. Under President Teddy Roosevelt, he served as the first head of the U.S. Forest Service. Driven from office by more conservative Republicans and then Democrats, he entered politics and eventually became governor of Pennsylvania. According to his supporters at General Convention, Pinchot was also an Episcopalian.

The contrast between Muir and Pinchot is well captured in these two quotes:

Let everyone ... travel, and see [the redwoods] for himself, and while fire and the axe still threaten destruction, make haste to come to the help of these trees, our country's pride and glory.

John Muir, 1903

It is almost impossible to bring home to the average man the economic importance of this great national resource. But without cheap lumber our industrial development would have been seriously retarded.

Gifford Pinchot, 1901

In 1913 the two men battled over the creation of the Hetch Hetchy Reservoir which dammed a valley within Yosemite National Park to provide water to the city of San Francisco.

A group known as Preservationists, led by John Muir, was staunchly opposed to the building of this dam. They felt that building a dam would destroy the natural beauty that the area was known for. Another group led by Gifford Pinchot, the Conservationists, felt that a dam would benefit the people greatly, and pushed for its construction. Almost every major newspaper in the country followed the story, and it captured the nation’s attention.

Though Muir lost that environmental battle (and we drink Hetch Hetchy water today), his preservationist vision has largely prevailed in the public imagination.

As we live into a time when humans will be forced to respond to the changes our species is making to the planet, the Muir-Pinchot arguments are sure to arise again. However much we are drawn to wildness, how much pure preservation can we achieve? Do we contribute to our own destruction when we seek to bend nature to our needs -- or is the notion we have any choice just an illusion?

Maybe we need to ponder both these guys. Their issues are still with us. If I remember rightly, I think General Convention took the oh-so-human route of referring the Muir-Pinchot matter to a committee.

A visit to Muir Woods

What to do with a Nicaraguan guest who works on rural sanitation, water systems and reforestation projects? Take her to Muir Woods National Monument to walk among the redwoods, naturally.

A few photos from that corridor of light and shadow:





It's fun to look straight up in such a tall forest.


Or at reflections in the stream.


As well as toward the light.


The moss likes it the dark and damp (I needed a flash).


The trees grow burls at their bases that enable them to throw out green shoots.


The light seems unnaturally bright on the way out.

Health care reform shorts: Happy Halloween!

I don't know if I'm sure we "win" if Congress manages to pass the emerging "plan" -- but for sure if they don't pass something that provides health care to most everyone, we all lose.

Looks like me

A friend sent me this cartoon. Aside from the gender, it's an accurate portrayal of your blogger. Minus the camera and a protest sign, of course. I haul around lots of interests.

Since I'm busy with an international guest today, that's it for now. If you really want a fix from me and haven't seen these, here are a couple pf "Gay & Gray" posts from Time Goes By that I haven't mentioned here before: Caster and Me: Musings on Gender and Dick Gephardt's Second Career.

Noted while walking on Bernal Heights

What leads a person a create this kind of tableau on the rear window of their SUV? I cannot and need not interpret. Admirably done.

Health care reform shorts: What the fight is really about now

So Senator Harry Reid has given Senators a health reform bill to chew on.

Forget noxious Joe Lieberman's egocentric grandstanding. We'll either batter him (and the rest of the dithering Dems) into doing the right thing (breaking a Republican filibuster) -- or not. If not, there's no point in bothering to elect any of them. But since pure self-interest will probably lead to something getting passed, there are other aspects to this fight.



As Senator Ron Wyden (D-OR) explains in this clip [4:33] the real focus of reform now should be to make it possible for most people to have the choice of an affordable public option, not just 10 percent of us.

On punctuation

While we're on questions of written usage, let me suggest a book which has had me laughing out loud of late: Eats, Shoots and Leaves: The Zero Tolerance Approach to Punctuation by Lynne Truss.

Truss, a London journalist, wishes we were more literate -- and defends proper punctuation as a prerequisite.

The reason it's worth standing up for punctuation is not that it's an arbitrary system of notation known only to an over-sensitive elite who have attacks of the vapours [sic, British spelling] when they see it misapplied. The reason to stand up for punctuation is that without it there is no reliable way of communicating meaning. Punctuation herds words together, keeps others apart. ...

I'm with Truss on this -- I try to use punctuation to convey sense, even on a blog.

This book may be a cultural stretch for a writer of U.S. English. I'm not sure it would have been quite so enjoyable to me if I hadn't spent an odd couple of months in South Africa acting as an occasional "sub-editor" (British usage for "copy editor") on a Cape Town newspaper. My ideas about proper punctuation collided shockingly with the local norms -- acquiring some fluency in a novel variant usage made me much more aware of my own punctuation assumptions.

But anyone could appreciate Truss' good humor about a subject more likely to elicit yawns than howls of laughter. To convey the flavor, here's the anecdote that provided the book's title:

A panda walks into a cafe. He orders a sandwich, eats it, then draws a gun and fires two shots in the air.

"Why?" asks the confused waiter, as the panda makes toward the exit. The panda produces a badly punctuated wildlife manual and tosses it over his shoulder.

"I'm a panda," he says, at the door. "Look it up."

The waiters turns to the relevant entry and, sure enough, finds an explanation.

"Panda. Large black-and-white bear-like mammal, native to China. Eats, shoots and leaves."

Enjoy if the opportunity presents itself.