The trip is going really well so far, and there are too many incredible experiences going on to try to squeeze them into blog posts through this soda straw of an internet connection. I do wish to report, however, on the local hooch: “Chaang.” This is a barley beer made locally, and it’s mentioned in most of the travel guides next to yak butter tea as man, you gotta try this, if only for the experience.

Last night I was finally feeling up to an alcoholic drink (altitude change is no joke!), so I ordered a mug of chaang. When it arrived, I recognized it immediately. This is primary fermentation beer. This is what I’ve produced dozens of times in my kitchen. If you just skipped that whole process of settling, clarification, secondary fermentation, racking, bottling, and aging – you would have chaang. If you’ve been to my house with a batch in process, this is the bubbly, foamy, opaque, yeasty smelling proto-beer.

Put another way: It’s alive.

I’ve sampled live beer, before the yeast settles. I knew what I was getting into. Still, I was somewhat stunned by the speed and power with which the yeast went to work in my belly. Without too much unnecessary detail, I’ll just say that it was tasty, but I won’t be doing that again. Woo-hoo. Buy the ticket, take the ride.

In other news, the altitude sickness has almost entirely let up – we’re down to a vague idea of a headache and “taking it easy” on the walking pace and stairs. The sites and tours are absolutely incredible. We’ve got time to take time and really get into monasteries and temples and talk to people and try to understand. The fact that we’re out here for three weeks means that I’m actually able to relax a bit.

I’m writing from the comfort of the Kyichu Hotel about a block from the Potala Palace, in the core of Lhasa.

For those who were hoping for up to the minute facebook or twitter, those are stone cold blocked by the Great Firewall of China. Wikipedia’s list of similarly blocked sites is an eye opener. I mean, who has a really good reason for blocking Amnesty International?

The trip is going quite well. In both Chengdu and here, we met our guides with no problem. The hotels are nice, and the arrangements all appear pretty straightforward.

Last night, we found Ma Po Tofu in its native environment. Apparently one of my favorite Chinese dishes was invented in Chengdu. Ordering was a bit of a trip. When I’m higher bandwidth, I’ll upload a bunch of pictures (flikr is blocked too). For those not in the know, Ma Po Tofu is a fiendishly spicy, peppery concoction. This was (according to Jen), “face numbing,” and even I had to admit that it was pretty intense. Fortunately, we had lots of hot tea to cut the burn.

The altitude change, coupled with jet lag, is no joke. Jen and I were both rendered a little woozy after breaking into a quick jog to get across a street. I had to pause, pulse thumping, after having the nerve to walk up to the 2nd floor rather than taking the elevator. Seriously, the nerve of me. For a cleaner metric, my usual resting pulse is around 55 beats per minute. Here, after a good half hour of sitting calmly in a chair, I’m running around 65 or 70.

Plan for the evening is to chill in the room, and perhaps to nap. Later on (it stays light very late here, all of China runs on Beijing time) we may go and check out the Potala. Tomorrow, we’ll hit a bank to change money, and then begin sightseeing in ernest.

In a bit of nerd-chest-thumping, I will mention that this blog post was written from a netbook in Tibet, and is being served to you from a virtual machine hosted in my basement. Booyah!

I write from the upscale “pay-in shower lounge” at the Hong Kong international airport.

At first we were confused about the setup, but it all became simple very quickly. The key is to accept that we’re from the backwater sticks of the world, and that Hong Kong is actually in the future, after Earth joins modern civilization. It may well be Earth’s first spaceport. We’ve got a five hour layover here before departing for the mainland on our third flight of the “day.”

Anyway, $40 buys three hours of access to an extensive breakfast bar (both asian and western fresh-cooked food), a comfy lounge, good coffee, wi-fi, one drink at the bar, and a shower.

Let me be clear, this was not some seedy grimy airport shower. This was basically just the bathroom from some of the nicer hotels I’ve stayed in. The cleaning staff emerge, you go in, and 20 minutes later you feel human again.

The other mechanics of travel are going fine. Flew to New York, chilled for five hours, then 16 hours on a Boeing 777. There was some hilarity along the way – but nothing too out of the ordinary.

All’s well. Updates as they happen!

Jen and I are taking a trip to Tibet, and I’ve been asked more than a few times: “Why Tibet?” It’s one of those difficult questions because it’s absolutely simple and clear to me why we’re going – but for a dozen different reasons. Teasing those reasons apart turns out to be harder than I would have thought. Each one is a long and somewhat personal story.

One path through the story starts about 15 years ago:

In 1995 or 1996, my mother came to Ann Arbor to visit me at college. I sang with the Men’s Glee Club, and we were doing a concert. She stayed in the Bell Tower hotel, which is right in the middle of campus.

One morning, as my mother was coming down for breakfast, she stumbled into a kerfuffle of security in the lobby. She asked the staff what was going on and discovered that the Dalai Lama was also a guest at the hotel. He was about to leave for his day’s activities. She didn’t know much about this fellow, but it seemed like the beginning of a good story, so she grabbed a newspaper and settled on one of the comfy chairs in the lobby. In short order, a signal went around, security was organized, the elevator descended, and a monk in orange and yellow robes emerged. Not knowing what else to do, she stood up. He made eye contact with her, put his palms together in front of him, and gave a little bow. Instinctively, she smiled and returned the gesture. At that, he broke into a broad grin and hustled out to start his day.

In the ensuing weeks, she began to read his writings. The Art of Happiness served as an accessible introduction. After that, she plunged deeper into readings about and by the man, into the history of Tibet, and into the Tibetan Buddhism that he practices. She sent me copies of some of the books that she read. At the time, I was a clueless undergraduate, then a self important and busy grad student, and then a self involved young professional. I stuffed the books on shelves and rarely took time to read them. Now, those books are still on my shelves, but well thumbed and forming an odd chronology. I sort these books by the dates of the inscriptions she wrote in the front covers.

Tibetan Buddhism had a significant positive impact on her life. I think that the practices and ideas that she learned from the Dalai Lama helped her to live a happier, calmer, and more satisfying life than she otherwise might have. Those same teachings are helping me as well, in similar ways.

Today, I’m plowing through John Avedon’s In Exile From The Land of Snows. It’s one of the definitive histories of the Chinese invasion and occupation of Tibet, and it’s a hell of a read. However, I have to hurry through the last 200 pages before we depart: Chinese authorities might seize it if I were to take it with me to Tibet. It contains pictures of the Dalai Lama, you see, which are strictly forbidden. As a foreigner, I would probably only get hassled a bit. However, were I to share those pictures with a monk, a nun, or with a TIbetan family – they could face imprisonment or worse.

The Dalai Lama is the temporal and spiritual leader of the Tibetan people. He was forced to flee his country in 1959 in front of the advancing forces of the People’s Liberation Army of China. Even his image is forbidden there. The man has lived and will almost certainly die in exile, a guest of India and of the world. If his image is forbidden, you can only imagine the reception he might receive were he to try to travel to his home even one more time in this life.

Me and my tourist dollars are welcome, provided that I don’t cause any trouble while I’m there. I have been warned against telling stories like these to the Tibetans who I meet. Much as the image is forbidden, so is “divisive and rebellious talk.” My story about the smiling monk who bowed to my mother, whose books changed her life, these are forbidden in the land of his birth.

I think that my mother would have liked to see Tibet, but she didn’t get the chance. I think that the Dalai Lama would like to see his country again, but that chance may be gone as well. I’m going out of respect for people who won’t get to see those lands. I’m going to see for myself, to take pictures, to meet the people, and to feel my weight on the same earth that brought forth the ideas of Tibetan Buddhism.

I’m going, even if I have to fall silent for a little while, while I’m there. A little silence every now and again is good for the mind.

My brother in law, Doug, teaches at a middle school west of Philadelphia. For years, he’s been suggesting that I would have fun presenting at their career day. This year I had a tiny bit of space in my schedule, so I snuck down and back on the Acela. I spent the morning talking to five different groups of 6th through 8th graders. Each group had me for about half an hour.

Here are my slides

The kids were great, they asked all sorts of fun questions. Arguably the best question was “what is your IQ?” (Um, I don’t know?). Every session had at least one precocious one with the persistent and detailed questions. The staff were totally accommodating, and I had a great time. Of course, I was on the schedule as “Dr.”, and apparently I’m a Geneticist and an Author now. I did my best to straighten that out – and to convey a couple of simple messages to the kids:

* All human beings are related to each other. This was met with cries of “EEEW!”
* Computer programming is a decent job skill, but you still have to decide what to build.
* Science changes rapidly, so it’s a good idea to focus your education on the basics: Math, science, critical thinking, and to continually study and read up on what’s new.
* All life on earth is related, in exactly the same way that all humans are related to each other (no “eew,” but there were some very thoughtful looks).
* It’s possible (and a good idea) to aim for happiness in your job as well as a stable income.
* Personal genomics is to the point where you can fill a plastic tube with spit, (“EEEW!”), drop it in the mail, and look on a website a few weeks later to see the where your father and mother’s families were probably from.

What fun!

Found this gem via Matt Taibbi: “With an absolutely straight face, Rand Paul compares public health care to slavery. He says that if everyone has a right to health care, that means that people can come to his office – Rand is a doctor, after all – and “conscript” him to provide service.”

Keep in mind that this is not a fringe lunatic on late night radio. That is a United States Senator, in his full formal capacity. As usual, Bernie Sanders is brilliant and salvages a bit of our national dignity.

Paul’s statement is a great example of the sort of self serving whining that has taken hold of large swathes of the conservative party in the US. It takes a very special combination of ignorance, selfishness, and belligerence for an upper class white doctor, a member of the majority race and avowedly part of the majority religion, one with a family legacy of national political office, to claim that he is afraid of being ‘enslaved.’ That’s a serious allegation – that the government might go back on more than a hundred years of a fairly strict ‘no-slavery’ policy.

Of course, Paul knows better. He knows full well that this debate is not about slavery. The hearing where he was sitting was, in fact, about is a set of government programs that provide health care to people who can’t afford it. Paul is deeply opposed to many such programs. Taken as a whole, he doesn’t seem to want us to have much of a country at all.

It’s disingenuous and insulting for him to express his supposed fears of the manacles and the whip in the context of the health care debate. It’s a cheap trick of misdirection and emotional manipulation.

For what it’s worth, I agree with him on the terminology: “Right” is a poor choice of word. I would prefer to state most of these things as “obligations” placed on those of us who fortunate enough to have our heads above water. An ‘obligation’ puts the onus of action where it should be. People may have ‘rights’ to life and liberty, but the rest of us can remain idle until those rights are cast into active requirements that we help the starving, clothe the naked, and so on. There is no ‘right’ to health care, but there damn well ought to be a social obligation to help the less fortunate – and that is what the health care debate is all about.

At best, Dr. Paul should be ashamed of himself for splitting rhetorical hairs during an argument about basic social services in his area of professional expertise. He brought up both Hippocrates and Jesus in his little speech – and I think that either would be ashamed to be associated with him.

Morning. A crew of painters is walking around outside the house. Two humans (Chris and Jen) and two cats (Maia and Minnow) are watching from inside and preparing for work.

Chris: Who wants breakfast? Breakfast for cats!
Minnow: (excited circling)
Maia: (stony silence)
Chris: Maia, do you want breakfast?
Maia: (stony silence)
Minnow: MEW!
Chris: C’mon Maia, it’s breakfast time!
Maia: The men are here to kill us. On this, my last day, I shall fast.
Minnow: MEW! (gentle pawing at Chris’s knees)
Chris: (sets down two bowls of food)
Minnow: (eats a little from each bowl, and then shovels a bit of dry food and dirt into each of them)
Minnow: New friends! (begins following the painters around the house from inside the windows)

Later in the day, Maia is seen grudgingly eating.

I saw a good talk by Jane McGonigal at PAX East. She spoke based on her book Reality is Broken, which is about how many of the traits developed in playing games (particularly video games) are terrifically useful to succeeding at life.

One of her slides was (and I’m paraphrasing here): “The opposite of play isn’t work. The opposite of play is depression.”

I spend an increasing amount of time thinking about what it means to have a “job.” About what it means to work – especially about what it means to work “for” someone. I think a lot about the difference between doing what you’re told, adding value to an organization no matter what you’re told, and putting your own ass on the line by owning what you do. I’ve thought a lot about “compensation,” and whether time, product as requested, or results are the best metric on which to be rewarded. I also think a lot about the power dynamics of witholding money until someone does what you want them to do.

These feel like very grown-up thoughts.

It’s pretty horrifying to me that work falls so squarely on depression for most Americans. Play and work are perceived as opposites, which isn’t fair to either. Broadly, we seem to see “play” as the useless crap that you would rather be doing, and “work” and the useful crap that you don’t want to be doing. Sure, yes, I get it. The rent must be paid – but it seems like a damn shame of a way to spend a human life.

Of course, I’m insanely lucky. I work with a team that has somehow managed to stay out of that world, for the most part. Sure, we have to pay our dues – pick lucrative gigs and so on. However, I’ve seen us turn down genuinely profitable opportunities for reasons that range from ethics all the way down to “that sounds like a crappy way to spend 3 months.” It’s odd to me that the latter reason looks weird to me on the page. What sensible business would turn down a profitable gig because it wasn’t fun? I’ll tell you: It’s a business run for the benefit of the people who make up the team – not for the benefit of some imaginary “corporate good.” Still less are we run for the benefit of investors.

That’s the core of my recent thinking: Businesses should run for the benefit of the team doing the work. Sure, it’s still competitive. No namby-pamby un-american socialism here. Just – when we compete – let’s be sure that the people getting their hands dirty have some skin in the game. I’m not opposed to anything as big and vague as “capitalism.” Being opposed to “capitalism” is like being opposed to “rain.” You have to get a hell of a lot more specific before it’s a useful statement.

Actually, you don’t have to get more specific – but it helps. Otherwise you’re just whining.

What I am opposed to is what we’re doing now: Millions of people spending the majority of their lives unhappy. Longing for the chance to do some useless crap that – they think – will be better than the useful but hateful crap where they spend their days.

I think we can do better.

I rely you people to correct me when I screw up – and I made something of a howler in that last post. Fortunately, Krugman’s actual column today caught it.

I claimed that the current debate is about how best to reduce the size of the medical industry. That’s wrong. What we’re really arguing about is how to reduce the amount of government spending (taxes) going into that industry.

As Krugman puts it:

Before you start yelling about “rationing” and “death panels,” bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money. And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.

And the point is that choices must be made; one way or another, government spending on health care must be limited.

Unfortunately, we’re going about it wrong. Both parties are trying, somewhat ham-fistedly, to “starve the beast,” which screws up health care for everyone. Republicans appear to want to return some small fraction of our taxes to some subset of the people as tokens that can only be used for private insurance. That sounds idiotic. It also sounds like their old bugaboo “forced redistribution of wealth.” I would rather keep the money and buy insurance, or not, as I see fit. Of course, because most of us are really bad at life – we probably need to provide some baseline social services for the idiots who don’t (or can’t) buy insurance under those circumstances. Otherwise we’ll have poor people dying of easily preventable diseases. Whether or not you perceive a moral requirement to help the less fortunate – it’s embarrassing and bad for the appetite to have to watch them die.

Democrats have a different problem. In the current system, there are lots of incentives leading to “everyone gets the absolute top of the line.” Litigation (less tests = vulnerability to lawsuits), fee for service (more tests = more money), and lack of cost transparency (my $3k MRI doesn’t cost $3k to anyone involved. That’s just a magic number that allows the insurance company to set profits) are the big three. Democrats appear to want to add another layer of bureaucracy to compensate for that moral hazard / profit seeking. I think that the panel that Obama has proposed would do something like deciding what services are “appropriate” for medicare – but then they would use ham fisted financial methods to pay doctors less for providing these services and hope that the market worked its magic. So we layer a flawed system on top of another flawed system.

Of the two, I prefer the latter. It’s an inelegant solution, but at least it acknowledges the really interesting question: what services are we going to provide for people who cannot pay for them. We can’t buy everything for everyone, and at some point we need to have the real debate about when we let grandma die and move on to caring for the newborn in the next room over.

Neither of them can pay. Who’s it gonna be?

I’ll cut to the chase here. The correct answer – assuming that we want to provide some level of health care to people who cannot afford it – comes in two steps:

1) Decide what’s included and what’s not.
2) Hire care providers to implement those services.

I.e: If we want to provide health care – let’s provide health care rather than insurance or vouchers or whatever. You want to cut out the middleman? Cut out the damn middleman! Hire a doctor!

As above, nobody is talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. Seriously. There’s no death panels here unless you’re too dumb (or unlucky) to save some money or buy insurance. You’re expected to look after your own health. You’re expected to be sensible enough to eat healthy and save some money for end of life care. Social services are what we stand up when we acknowledge that most people are neither sensible nor terribly lucky – and when we also acknowledge that we don’t want those people dying preventably on our front porches.

The question of health care costs for those who can pay is a substantially different rant. There’s a simple solution there as well – but it’ll have to wait.

I got some good traction from a recent blog post by Krugman about the dangers of treating medical care as a commodity, sold by doctors to consumer/ patients. The thoughts this inspired just don’t seem to fit in Facebook’s ever shrinking comment window. Here’s the crux:

The idea that all this can be reduced to money — that doctors are just people selling services to consumers of health care — is, well, sickening.

Most of us are able to build the necessary font of knowledge to buy the correct netbook computer or pickup truck. We look at our bank account options and balance risks and rewards. We pick housing based on a rent / own ratio, and we might even be able to decide whether to invest a day in figuring out how to replace a lift gate piston, pay $250 to have it done, or cope with the danger to our head during grocery and mulch time.

The above is crap. Most of us are ill-suited to even these straightforward market choices. I know exactly one couple who did the rent / own financial math before they moved. If we were good at this stuff, the average US citizen would not be swimming in credit card debt, underwater on her mortgage, and terrified of the trivial injury that might bankrupt her. Most of us would have sensible retirement accounts. We would use credit to buy durable goods that accrue value, and we would pay cash for consumer goods that lose value the moment we take them out of the bubble wrap*. The reality of our lives is almost exactly upside down from “sensible.” We are terrible at even the basics of financial life.

Add in the emotional and personal aspect of medical care and we’re 100%, stone cold screwed.

Let’s dig in, just a bit, to that “emotional and personal” aspect. On Wednesday night my “little” sister counseled a family through the decision of when to allow their aged and dying father to die. What I mean is that she explained that until they gave the nod, physicians would default to breaking his ribs and forcing tubes down his throat. The family was unable to nod their heads to allow dad to die in peace. They had planned to have that conversation “tomorrow,” you see. They were unable to get their heads around the idea that dad might die before they had their meeting. Finally, after two ‘codes’ a senior physician made the call to stop what was an eminently pointless and brutal exercise. My spouse advises people who have to balance HIV, pregnancy, poverty, homelessness, sexual violence, and other less straightforward issues like immigration status and sexual identity. My father spent more than 30 years catching and stabilizing whatever disaster walked through the door in whichever emergency room he happened to be working that night.**

Couple all that in your mind – just for a moment. Try to hold in your head – simultaneously – the general financial incompetence of the populace and our general (and reasonable) terror of the great medical unknowns. For bonus credit – try to hold in your mind at the same time the knowledge that someone fucked up your retirement account in 2008. Imagine that your “fixed” income turned out to not be “fixed,” in the sense that you thought. If you succeed in this effort then you understand why medicare is the third rail of American politics.

There are great examples of consumer culture in medicine. Lasik and eyeglasses in the mall are great. Those are commodities. Primary care is where the rubber meets the road – and that will never – should never – be commodified. There is a balance to be struck here – and it is absolutely not the raw commodification of primary care.

Back in the bad old days, there were four “honorable” professions: Law, education, medicine, and (snort) the clergy. These four were supposedly distinguished from the merchant class by a high level of trust and privacy between the practitioner and the client. Instead of a (supposedly) informed consumer wandering between a variety of market stalls and selecting products, the client would establish a trusting relationship with their provider. Within that context, whether it’s law, medicine, education, or spirituality – the practitioner is expected to fill dual roles where they both advise on what should be done, and then perform the service itself. They are expected to balance the needs of the client, society, and their own professional community.

Of course, physicians need to make a living – so they charge for their time. I don’t begrudge that. It’s worth noting that the top physicians in the world make, on average, less than the lower-tier of wall street financiers. Maybe that’s as it should be. After all, physicians rarely impoverish their clients. That has to be stressful.

Hey wait, I haven’t talked about money yet. It’s worth noting that all of the above is invariant with cost. On that topic, I’ll share more Krugman another post on a different topic:

Look, this is an important debate. If you can’t be bothered to look at the numbers, you shouldn’t weigh in.

Go all the way back to economic basics. Instead of “reducing health care costs,” imagine that we’re talking about reducing the economic footprint of an industry***. They’re the same. You want to shrink health care in the US – but you can’t just close Detroit because everyone needs to die someplace. That means that you turn your MBA learning upside down. Just turn your usual methods upside down. Decrease value, increase prices, and wait for the customer to go away.

Hey check it out – that’s what we’re doing. Wahoo!

More loosely, wait for the poor (who don’t deserve it anyway) to die.

That’s not the civilization I want to live in. It doesn’t describe the medical “industry” I hope to have there for me. Sadly, I have no idea how to vote to prevent it.

*: Pop pop, hope no one sees me, gettin’ freaky.
**: At family gatherings, the three of them get going and I go have a soothing cup of tea with whoever else is around.
***: They’re the same thing