Ancient Living Memories, Defining 'Wokeness,' A.I. Health Care Denials - Dinner Table Digest № 46
The Dinner Table Digest is an intermittent collection of interesting material from around the internet, curated by Peter Thurley at Dinner Table Don'ts. Subscribe today!
There’s an eclectic selection of pieces in today’s Digest, from a discussion of Indigenous Knowledges, to the usefulness of ambiguity in propaganda, and finally to the hellscape that is A.I.-led health care.
Sections: Ancient Living Memories / Defining ‘Wokeness’ / A.I. Health Care Denials
Ancient memories through our very own skin - Terre Chartrand
My friend Terre is an excellent educator and connector who has a way with words when it comes to making Indigenous Knowledge more understandable to white settlers like me. Once again she has written a piece that challenges me, especially as someone who has embraced the western scientific model in part as a response to shedding religious belief. As a result of my history with religion, I feel very sensitive to the importing of spiritual or esoteric ideas into the scientific world. One of the things that Terre’s writing often reminds me - this time is no different - is that there are many ways to think about spirituality and its interaction with the world around me that I may never understand - and this is okay, because maybe it’s just not for me to understand.
Do the trees remember my DNA because a fungus picked up on the bacteria that I transmit, and that which transmits to me from the soil itself? We are constantly shedding skin and hair… do micro artefacts of me digest into knowledge and the acknowledgement of kin and histories emerge through our very skin, through our fungal systems and microbiome?
Does a sense of place come not just from a psychological moment but also the spooky action (this time at a proximity, not a distance) of entities coming into acknowledgement of each other in the same place and moment?
I talk about Indigenous connection being something that person of the settler populations here cannot understand. There are things that can only be learned from birth/infancy/early childhood: culture, worldview, mother knowledges. There are things that can be taught: how to replicate. or respect culture, a sense of worldview. But so much of what it means to be Indigenous to a place comes from something that isn’t tangible to people who are not.
I am not saying that it isn’t possible to come into a way of knowing the land. There are many trappers and coureurs de bois in my family who could bury me with knowledge and ways of seeing and respected the bush and everything in it. But even they learned most of that through the very ancestors I feel at the portage and others like them.
Why the GOP is obsessed with "woke" but can't define it - Amanda Marcotte - Salon
I’ve often featured Ron DeSantis as a quickly-approaching-fascist who is intent on legislating against things that he considers to be part of the ‘woke mind virus.’ And yet for all the right-wing frothing at the mouth about the dangers of ‘wokeness,’ none of them seem to really know what it means. As Amanda Marcotte points out, though, that might be exactly the point:
The inability to define "woke" is a feature, not a bug. "Woke" is very much meant to be a word that cannot be pinned to a definition. Its emptiness is what gives it so much power as a propaganda term. "Woke" is both everything and nothing. It can mean whatever you need it to mean, and you can deny that it means what it obviously means. The ephemerality of "woke" is what makes it so valuable. "Woke" morphs into being when a right-winger needs to feel outrage and evaporates into thin air should anyone try to ask a rational question about it.
"Woke" is both everything and nothing.
Mind you, that wasn't always the case with "woke."
It wasn't so long ago that "woke" was a slang term from Black America, and it meant something substantive and easy to define. To be "woke" was to refuse to be complacent about social injustice. This definition offended Republicans, whose very existence depends on complacency in the face of social injustice. So as an act of very racist revenge, they appropriated the term "woke," turning it into a catch-all insult for anything that annoys them.
In right-wing mouths, the term "woke" is very slippery, which is necessary for people who both want to be bigots but don't want to be called out for it. Labeling someone or something "woke" allows Republicans to live in a liminal space, communicating a vile belief to their fellow travelers while maintaining that's not what they meant at all.
Its emptiness is what gives it so much power as a propaganda term.
My friend Bruce Janz, a professor at the University of Central Florida (and thus caught up in DeSantis’ fascist crusades) has this to add to Marcotte’s analysis:
This article gets at the problem with right-wing use of words, at least in part. The part that it misses, though, is that not only is the lack of definition of woke a feature, not a bug, and allows all sorts of things to be swept up in its wake (and, allows plausible deniability on the part of right-wing politicians when someone actually acts on the ill-defined term), but it also allows cover for the real problem: it's about people, not ideas. They want to vilify people. And, they all know which people they mean. The enemy. Their enemy. Not just people who disagree, but people who are bad and wrong in their very being. Black people. Gay people. Trans people. Women who won't get in line and know their place. Muslims. Jews. And, people like me - university professors.
That's the real cover here, and the thing that they need to be called on, over and over. It's about hating people, not ideas. This is reinforced over and over again, in the desire to ban the entire Democratic party, in the desire to make abortion a capital crime, in the desire to suppress and make illegal all dissent.
It's about people, not ideas. That's the bright line between these people and most Americans.
One of my favourite cover artists, Violent Orlandi, covers the Nine Inch Nails classic “Closer” with the kind of macabre sexual power that the song truly demands.
Denied by AI: How Medicare Advantage plans use algorithms to cut off care - Casey Ross - STAT News
None of this surprises me. It appalls me, yes, but it does not surprise me. When health is about profit-making, however minimally, when the system exists not to deliver care but to deny care, when health is a matter of relying unseen on proprietary Artificial Intelligence models owned and operated by the very same companies charged with delivering care, we know that we’ve lost the plot. The future dystopia we imagined for ourselves has already arrived.
The algorithms sit at the beginning of the process, promising to deliver personalized care and better outcomes. But patient advocates said in many cases they do the exact opposite — spitting out recommendations that fail to adjust for a patient’s individual circumstances and conflict with basic rules on what Medicare plans must cover.
“While the firms say [the algorithm] is suggestive, it ends up being a hard-and-fast rule that the plan or the care management firms really try to follow,” said David Lipschutz, associate director of the Center for Medicare Advocacy, a nonprofit group that has reviewed such denials for more than two years in its work with Medicare patients. “There’s no deviation from it, no accounting for changes in condition, no accounting for situations in which a person could use more care.”
Medicare Advantage has become highly profitable for insurers as more patients over 65 and people with disabilities flock to plans that offer lower premiums and prescription drug coverage, but give insurers more latitude to deny and restrict services.
Over the last decade, a new industry has formed around these plans to predict how many hours of therapy patients will need, which types of doctors they might see, and exactly when they will be able to leave a hospital or nursing home. The predictions have become so integral to Medicare Advantage that insurers themselves have started acquiring the makers of the most widely used tools. Elevance, Cigna, and CVS Health, which owns insurance giant Aetna, have all purchased these capabilities in recent years. One of the biggest and most controversial companies behind these models, NaviHealth, is now owned by UnitedHealth Group.
It was NaviHealth’s algorithm that suggested Walter could be discharged after a short stay. Its predictions about her recovery were referenced repeatedly in NaviHealth’s assessments of whether she met coverage requirements. Two days before her payment denial was issued, a medical director from NaviHealth again cited the algorithm’s estimated length of stay prediction — 16.6 days — in asserting that Walter no longer met Medicare’s coverage criteria because she had sufficiently recovered, according to records obtained by STAT.
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The notion that the AI model outputs are used "as-is" rather than being treated as suggestions is especially problematic -- future versions of the AI are going to be trained on the data generated by these decisions. So if people don't assess the AI outputs critically and reject them when they're wrong, the AI will never improve -- it will just end up reinforcing its own behaviour over time.