Tag Archives: Elizabeth Bishop

Super-Saturated Southeastern Texas

Weather maps are among the most widely consulted visualizations in our over-mediated world.  They provide not only sources of fascination, however, but are among the most confounding media to orient viewers to the world’s changing climate.  Even as we are still trying to calculate the intensity of damages in Puerto Rico and of the fires in California, or the snows that suddenly blanketed the northeast, driven by a collision of hot water and cold air in the Atlantic, hoping to piece together the increased evidence of extensive collateral damage of global warming, we still need to come to terms with the intensity of rainstorms that hit southeastern Texas–the hurricane deluged the city with rainfall surpassing the standard meteorological chromatic scale, and at a pace which challenged the groundcover of the overbuilt and overpaved region to absorb:   for the mapping of “natural” levels of rainfall blurs the pressing problem of how shifting landcover has created an impermeability to heightened rains.

Real estate demand intersected with extreme weather in southeastern Texas in ways which dat visualizations have had trouble exposing, but which raise a curtain on the coming crises of a failure of ability to accommodate increased levels of rainfall  If the lack of precedent for the intense rainfall in Galveston Bay generated debate about introducing a new color that went beyond the rainbow scale employed in weather charts, what seemed a problem of the cartographic color-spectrum suggested a problem of governability and indeed government response to extreme weather conditions.  How to register the dangers of rainfall that goes of the scale or standards of measurement?   What is the best way to orient viewers to the intensity of consequent flooding, and to considering its consequences and better prepare ourselves for the arrival of deluging rains without falling back on the over-freighted metaphor of rains of biblical scope?

For many of the maps that chart the arrival and impact of hurricanes seem a form of climate denial, as much as they account for climate change.  Long after the hurricane season ended, the damage for hurricanes caused have hardly been assessed in what has been one of the most costly and greatest storm damage since 1980 in the United States,–including the year of Hurricane Katrina–we have only begun to sense the damage of extreme weather stands to bring to the national infrastructure.  The comparison to the costs of storm damage in previous years were not even close.  But distracted by the immediacy of data visualizations, and impressed by the urgency of the immediate, we risk being increasingly unable to synthesize the broader patterns of increased sea surface temperatures and hurricane generations, or the relations between extremely destructive weather events, overwhelmed by the excessive destruction of each, and distracted from raising questions about the extremely poor preparation of most overbuilt regions for their arrival, and indeed the extent to which regional over-building that did not take the possibility of extreme weather into account–paving large areas without adequate drainage structures or any areas of arable land–left inhabitants more vulnerable to intense rains.  For in expanding the image of the city without bounds, elasticity, or margins for sea-level rise, the increasingly brittle cityscapes of Galveston and much of the southeastern Texas shoreline were left incredibly unprepared for the arrival of hurricanes or intense rains.

To characterize or bracket these phenomena as “natural” is to overlook complex interaction between extreme weather patterns and our increasingly overbuilt environments.  To be sure, any discussion of the Gulf of Mexico must begin from the increasingly unclear nature of much of our infrastructure across land and sea, evident in the range of pipelines of gas and oil that snake along a once more clearly defined shore charted by ProPublica in 2012–

 

pipeline_line_mapProPublica, Pipeline Safety Tracker/Hazardous liquid pipelines are noted in red; gas in blue

 

-and whose tangle of oil pipelines that extend from the very site of Galveston to the Louisiana coast is almost unable to be defined as “offshore,” so much as an extension of the land, and a redefinition of the shore.

 

gulfofmexicopipelines

 

Despite the dangers that such an extensive network of hazardous liquid lines along the Gulf of Mexico, the confusion between mapping a defined line between land and water, and visualizing relations of extreme weather disturbances as hurricanes in the Gulf of Mexico and local infrastructure haunts the extremely thin nature of the sort of data visualizations that are generated about the dangers of hurricanes and their landfall in the region.  For all too often, they presume a stable land/sea divide, removed from the experience of inhabitants of the region and how we have remade the shore.

 

1. How can we do better by going beneath the data visualizations of record-breaking rainfall, to map the human impact of such storms?  How could we do better to chart the infrastructural stresses and the extent to which we are ill-prepared for such extreme weather systems whose impact multiplies because of the increased impermeability of the land, unable to absorb excessive rainfall, and beds of lakes and reservoirs that cannot accommodate increased accumulation of rainfall that  stand to become the new normal?  The current spate of news maps that provoke panic by visualizing the extremes of individual cases may only inspire a sort of data vis-induced ADD, distracting from infrastructural inadequacies to the effects of global warming–and leaving us at a loss to guarantee the best structures of governability and environmental readiness.

Indeed, the absence of accurately mapping the impact and relation between landcover, storm intensity, rainfall, flooding, and drainage abilities increases the dangers of lack of good governance.  There need not be any need for a reminder of how quickly inadequate mapping of coastal disasters turns into an emblem of bad governance.  There is the danger that, overwhelmed by the existential relation to each storm, we fail to put them together with one another; compelled to follow patterns of extreme weather, we risk being distracted from not only the costs but the human-generated nature of such shifts in seasons between extremes of hot and cold.  For as we focus on each event, we fail to integrate a more persuasive image of how rising temperatures stand to create an ever-shifting relation between water and land.  Provoked by the rhetoric of emergency, we may need to learn to distance ourselves better from the aerial views that synthesize intense precipitation, tally hurricane impacts, or snowfall levels, and view them less as individual “strikes” or events and better orient ourselves to a broader picture which put us in a less existential relation to extreme weather.

 

2017-four-us-hur-landfalls_3

 

We surely need to establish distance to process syntheses of data in staggering aerial views on cloud swirl, intense precipitation, and snowfall, and work to peel back their striking colors and bright shades of rainbow spectra, to force ourselves to focus not only on their human costs, or their costs of human life, but their relation to a warming planet, and the role of extreme of weather in a rapidly changing global climate, as much as track the “direct strikes” of hurricanes of individual names, as if they were marauders of our shores:  their creation is as much tied to the changing nature of our shores and warming sea-surface temperatures, and in trying to create a striking visualization, we deprive ourselves from detecting broader patterns offering better purchase on weather changes.

 

direct-strikes

 

If the patterns of weather maps from Accuweather forecast and projections suggest an exhilaratingly Apollonian view on global and regional weather patterns, they threaten to shift attention form a broader human perspective in quite deeply pernicious ways.  Such maps provided the only format for grasping the impact of what happened as the hurricane made landfall, but provided little sense of the scale of inundations that shifted, blurred and threatened the coast of the Gulf of Mexico.  They provide a format for viewing floods that are disjoined from victims, and seem to naturalize the quite unnatural occurrence of extreme weather systems.  Given the huge interest in grasping the transformation of Hurricane Harvey from a tropical storm to a Category Four hurricane, and the huge impact a spate of Category Four hurricanes have created in the Gulf of Mexico, it’s no surprise that the adequacy of the maps of Hurricane Harvey have been interrogated as hieroglyphs or runes of a huge weather change:  we sift through them for a human story which often left opaque behind bright neon overlays, whose intensity offer only an inkling of a personal perspective of the space or scale of their destruction on the ground:  while data maps provide a snapshot of the intensity of rain-levels or wind strength at specific sites, it is difficult if important to remember that their concentration on sites provide a limited picture of causation or complexity.

All too often, such maps fail to offer an adequately coherent image of disasters and their consequences, and indeed to parse the human contributions to their occurrence.  This post might be defined into multiple subsections.  The first actions suggest the problems of mapping hurricanes in the Gulf of Mexico in relation to flooding in data visualizations of the weather and the overbuilt region; the middle of the post turns to an earlier poetic model for considering the relation between land and sea that visualizations all too easily obscure, and the meaning that the poet Elizabeth Bishop found in viewing relations between land and sea in a printed map of the Atlantic; after returning to the question of the overbuilt shore compounds problems of visualizing the Texas coast, the final section, perhaps its most provocative, returns to Bishop’s reading of a map of the Atlantic coast.

What such new weather maps would look like is a huge concern.  Indeed, as we depend on weather maps to orient us to place ourselves in the inter-relations of climate change, sea-level, surface temperatures, and rain, whether maps cease to orient us to place, but when best constructed help to describe the changing texture of weather patterns in ways that can help familiarize us not only to weather conditions, but needed responses to climate change.  For  three months after the hurricanes of the Gulf of Mexico caused such destruction and panic on the ground, it is striking not only that few funds have arrived to cover costs of rebuilding or insurance claims, but the judgement or understanding of the chances for future flooding have almost left our radar–perhaps pushed rightly aside by the firestorms of northern and southern California, but in ways that troublingly seem to forget to assess or fail to assess the extent of floods and groundwater impermeability  along the Texas and Louisiana coast.  The problems that preparation for future coastal hurricanes off the Gulf of Mexico raise problems of hurricane control and disaster response that seem linked to problems of mapping their arrival–amd framing the response to the increasing rains that are dumped along the entire Gulf Coast.

 

 

Indeed, the chromatic foregrounding of place in such rainbow color ramps based on GPS obscure other maps.   Satellite data of rainfall are removed from local conditions, and serve to help erase complex relations between land and water or the experience of flooding on the ground–by suggesting a clear border between land and sea, and indeed mapping the Gulf of Mexico as a surface as if it were unrelated to the increased flooding around Houston, in maps prepared from satellite imagery, despite the uneasy echoes of anthropogenic causes for the arrival of ten hurricanes in ten weeks, in ways that suggest how warming waters contributed to the extreme inundation of the Gulf Coast.  Despite NOAA  predictions of a 45% likelihood of ‘above-normal’ activity for the 2017 Atlantic hurricane season, with, a 70% likelihood of storms that could transform into hurricanes, the images of inundated lands seem both apocalyptic and carefully removed from the anthropogenic changes either to the ocean or land that intensified their occurrence so dramatically on the ground.

 

Dartmouth Flood Observatory Flooding Harvey Dartmouth Flood Observatory

 

Harvey flooding_0.jpgwiDartmouth Flood Observatory/August 29, 2017

 

Is it possible to recuperate the loss of individual experience in such data maps, or at least acknowledge their limitations as records of the complexity of a changing climate and the consequences of more frequent storm surges and such inundations of rainfall?  As we seek better to understand the disaster relief efforts through real-time maps of effects of Hurricane Harvey as it moved inland from the Gulf of Mexico, shifting from Category 4 Hurricane from a tropical storm, we tried to grasp levels of rainfall that spun out of 115-mile-an-hour winds across southeastern Texas that damaged crops, flooded fields, ruined houses, and submerged cars, we scan stories in hope of clues to assess our position in relation to increasingly dangerous weather systems whose occurrence they may well forebode.  At a time of increased attention to extreme weather has long developed, the gross negligence of climate change denial is increasingly evident:  it recalls the earlier denial of any relation between hurricanes and climate change, when increased hurricanes were cast as “the cycle of nature,” rather than as consequences whose effects have in fact been broadly intensified by human activity.

Current attempts to map the toll of record-smashing hurricanes focused almost exclusively on point-based data view rainstorms largely as land-based records; even as they intend to monitor the effects of Harvey’s landfall by microwave censors, they risk seeming to isolate real-time rainfall levels from the mechanics warmer air and sea-surface temperatures which result from human-caused global warming, not relating increased storm surges or inundations to achanges in coastal environments or climate change.  To render such changes as natural–or only land-based–is irresponsible in an age of reckless levels of climate denial.

 

2.  Indeed, faced by the proliferation of data visualizations, part of the journalistic difficulty or quandary is to integrate humanistic or individual perspectives on the arrival of storms, rendered in stark colors in the increasingly curtailed ecosystems of newsrooms which seek simplified visualizations of satellite data on the disaster, which fail to note the human contributions to the travails that are often reserved for photographs, which increasingly afford opportunities of disaster tourism in the news, emphasizing the spectator’s position before disasters, by images that underscore the difficulties in processing or interpreting the proliferation of data from MODIS satellite feeds:  we can show the ability to measure the arrival of torrential rains, but in offering few legends, save the date and scale, but offering few keys o interpret the scale of the disaster.

The looming portent of human-made climate change, however, underlies the poor predictions that NOAA offered of perhaps 2-4 major hurricanes this Spring, and the lack of a new director for NOAA–on which local and state agencies depend to monitor the nations shores and fisheries–suggested the, from June to September, which left states on their own to make decisions and plan for disaster mitigation programs and better flood maps.  (The danger of appointing a newly nominated director, Barry Myers, who is a strong supporter of the privitization of weather maps and an executive at the private Accuweather mapping service, suggests the difficulty of determining the public-private divide in an era of neoliberalism, and a free market of weather maps that were once seen as central to national security and standards of safety.)   There are two hidden scales on which we read these opaque maps of global warming and globalization and local inundation are triply frustrating.   For all the precision and data richness of such point-maps of largely land-based rainfall, local temperature, or flooding, the biases of such instantaneous measurements seem to fit our current governing atmosphere of climate change denial, and dangerous in erasing how such storms are informed by long-term consequences of man-made climate change.  (As the mapping tools of coastal weather seem destined to change, what sort of change in direction for NOAA coastal maps do we want:  the appointment suggests the terrifying possibility of a return to the Bush-era proposal nominee Myers supported that prohibiting the agency from producing any maps already available in the private sector then threatened federal weather lines to go dark–lest they literally compete with ad-supported websites private providers–and shift federal information offline?)

For making moves toward the future readability of weather maps may well be at stake in critically important ways.  The 2005 proposal that Myers backed would have eliminated the National Weather Service, even while exempting those forecasts needed to preserve “life and property,” would in essence have returned the weather services to a pre-internet era, even as the most active hurricane season including a record breaking fifteen hurricanes and twenty-eight storms began in the gulf coast, including the infamous hurricane Katrina.  The proposed bill would have prevented NOAA from posting open data, and not only readily available to researchers and policymakers, in ad-free formats, free of popup screens, but allow them to make their own maps on the fly–ending good practices of posting climate data would work quite dangersously to prevent development of tools of data visualization outside commercial models of rendering storms and hurricanes as if environmentally isolated.

 

2005-tracks-update.jpg

direct-strikes

 

A deeper problem of providing such limited weather maps of tropical storms may be the subtexts about the relation of human causes to weather they convey, and the absence of a greater narrative of the transformation of a global ecology or of the ecology of the Gulf Coast.  The curtailed images of “nature” they present by symbolizing rains, winds, floods, or submerged regions in appealing hues as natural–raise questions of the odd simplicity of the absent storylines:  cheery colors erase or bracket complex questions of climate change, the human contribution to extreme weather events, or the human experience of suffering on the ground:  Rita, Cindy, Katrina, Dennis, and Wilma seem not part of the environment, epiphenomenal interlopers moving across a static deep blue sea, in an apparent dumbing down of the mechanics of hurricane or storm formation in a rainbow spectrum removed from a human-made environment.

Visualizations of the rainfall of Hurricane Harvey similarly compress a massive amount of data into elegant chromatic images, but focus attention on the levels of inundation that overwhelmed the gulf coast in ways that the land could not absorb, drain, or adequately process, they ignore critical pieces of the picture of Harvey’s landfall, from the unprecedented ocean heat just days before Harvey made landfall near Galveston–

 

Ocean Heat Harvey Gulf of Mexico 8-24-17Weather Underground/RAMMB @ CSU/CIRA

 

–to the surprisingly warm patches of the Gulf of Mexico across which Harvey crossed as it rapidly grew in size–

 

Harvey Course over Very Warm Water--UW 24 Aug 2017University of Wisconsin-Madison-CIMSS Satellite Blog

 

–as we treat the ferocity of southeastern Texas’ inundation by rainfall as an isolated question of the extreme amount of rain that arrived on land and sea by mapping the amount of rainfall we can register at a place in isolation from a broader picture, rather than contextualizing the intensity of rainfall within the causation of the Category Four hurricane, or mapping the failure to accommodate such extraordinary levels of rainfall, which have been argued to justify to create a need for seawalls or dikes to preserve the cartographical division between land and sea, to prevent the danger of surge flooding, rather than the new weather patterns that this hurricane season has inaugurated.

 

Gulf of Mexico Heat content Oct 2017.pngOcean heat content in western Caribbean and Gulf of Mexico on October 6 (U Miami)/WaPo

 

We are perhaps conditioned to be mesmerized by readily generated weather maps that convert satellite observations of rainfall to reveal unprecedented weather patterns–but are slow to take stock of the mechanics of the dramatically changing nature of a hurricane season in which Category Four hurricanes are making landfall in the United States that in any other, even as their occurrence challenges scales of measurement and putting new stresses on disaster preparedness.  The busiest recored season of hurricanes and the simplicity of the ways that we map their transformation and landfall raises compelling questions of how to best map weather maps and coastal surges in an era of climate change–and how to represent the increasingly destructive potential of tropical storms, cyclones, or hurricanes without succumbing to climate denial.  Whereas point-based visualizations suggest the ability to track rainfall, wind velocity, or the path of hurricanes over time, their limits must be acknowledged as presenting a sufficiently dynamic or situated picture of the increased sensitivity of populated coasts to extreme weather, to better grasp the intensified acceleration, or accumulated cyclone energy, which for 2017 is already, in mid-October, twice the average of previous seasons, as warming waters generate more intense storms–but are omitted from their landfall, as if we desire to curtail the abilities we have to better map.  While the current NOAA nominee insisted quite adamantly that “we don’t have enough data [yet]” to attribute these changes to climate change, noting the potential influence of other cyclical changes in water temperature, and a northward retreat of Atlantic high pressure systems, yet the probability for hurricane increase across the board with higher water temperature and an expansion of warm waters–increasing the humidity of the storms–that it is the ethical responsibility of the cartographer to capture, even if it is blanched from MODIS data or most visualizations that render the “sites” of hurricane landfall in isolation.

It may be that the time-sensitive nature of the rich data in weather maps focus attention on the present moment with such immediacy to makes it increasingly difficult to move from such real-time records to devote attention to evaluating deeper long-term changes in weather systems–or indeed consider weather patterns as natural, and removed from man-made changes in coastal environments or carbon emissions.

 

2017-four-us-hur-landfalls_3

 

The question of how we are best able to read and process the proliferating maps of hurricanes and rainfall extends beyond tracking any single weather system, to the stories maps tell about hurricanes and their landfall, and the new age of weather that they may both announce and exemplify.  Do the color saturated data visualizations that have burned Harvey in our collective retinas and memories herald a new age of weather maps, as much as the actual record-setting levels of rainfall Harvey brought?  The complex cognitive relation to the these maps may be part of the problem, as is the levels of meaning that we try to read into them, not only in the rainbow-spectrum images of rainfall levels, but the difficulty of assembling a coherent picture of them.  We need to more clearly relate that picture to a landscape mark by human intervention and to man-made climate change–moving from datasets mediating select points in space, to an ability to assemble their coherence or better appreciate their specific context and the scope of the natural disaster.  Despite clear limitations inherent in point-based data visualizations, we need to peel away the constraints of overlays to better discern the hidden mechanics of storm surges and their consequences.

For where their sense of continuity lies is as opaque of the sort of causality we might be able to be attached to them:  they place us in an existential relation to datasets, and erase human subjects.  Although rich with information, the proliferation of weather maps of literally off-the-charts rainfall levels raised eyebrows far outside the communities of limnologists, hurricane experts, and meteorologists, as the constant production of datamaps for the micro-economy of newsrooms seemed particularly disjunctive with a coherent narrative, and hinted at more apocalyptic visions by not clearly mapping onto experience and all but erased humans by creating a narrative about extreme weather, if not of nature out of whack.  Even as Hurricane Harvey was three miles south of Corpus Christi, it was feared to be a Category Three hurricane–bringing three feet of rainfall!–as it shifted from a tropical storm to a Hurricane long before it reached Houston.

 

Harvey Arival Transformation.png

 

But to read such instantaneous maps as a model for coastal stewardship or disaster response, we need to attend to how the city’s man-made landscape has changed, sinking due to long-term soil subsidence with increased water withdrawal created sinkholes increasingly deformed the surface of the low-lying city that would themselves soon flood, their extreme subsidence acting as a multiplier a multiplier of the intensity of flooding around the greater Houston area that was not recorded in rainfall charts, but that was in large part determined by the impermeability of the landcover, from the concrete banks of bayou to the absence of wetlands by the bay.

 

deformation2LIDAR Hillshade map of Houston/Dr. Shuhab Khan, 2012

 

Houston Subsidence. pngSubsidence since 1920.USGS

–at the same time as much local and regional landcover alike dramatically lost absorptive qualities, especially in proximity to the shore, as well as map the consequences of changes in ocean and air temperature to the acceleration of hurricanes.

 

SMAP Saturating Houston 8:25-26

 

3.  The cognitive disconnect of these maps that impressed viewers by their intense colors, but seemed The maps elicit fears that they eerily prefigure a landscape marked and shaped by the regular escalation of hurricanes growing rapidly before landfall that go on to drop unprecedented rains–and raise questions of whether new weather systems can be meaningfully measured against gauge-readings of rainfall or stream flow from earlier times.  Indeed, the potential of a tipping point in the extent of coastal hurricanes is suggested by the multiplier effects of global warming on the peaking of the intensity of Gulf Coast weather.  To be accurate, instead of continuing to map the separateness of the land from the sea–and anxieties of the relation of land to the sea in an era of climate change–we may be better off mapping the impermeability of local surfaces, the erosion of coastal offshore islands that buffered storms, the presence of clouds of ozone, and the consequences of the rising surface water temperature of the Gulf of Mexico.

The information relayed in these images overwhelmingly privilege point data–rather than communicate a continuous landscape of assistance in environmental governance or a policy of monitoring coastal protection over the long-term.  They pose questions for the management of the shoreline, as a result, not even taking into account the many chemical plants and refiners that are crowded along the Trinity Bay, Galveston Bay, and Port Arthur, whose spillage poses increased risk during flood that governments would not be able to manage or coordinate with the intensity they deserve:  the problem of not mapping such contextual information lies in the deeply superficial information contained in the rainfall maps calculated by government services and relayed to news rooms where they pass as news, replacing ruined crops, flooded residences, and toxic waste flows by a rainbow.

 

 

emissions near to Galveston TX

 

 

 

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Galveston to Apalchicola Bay

risk ranking legend gcoosCOOS/Jeffrey Paine (2007)

 

For whatever reasons, the failure to be able to forecast the arrival of Hurricane Harvey, until the day before it made landfall–with the storm being a  “tropical depression” as late as the evening of Thursday, August 24.  The lack of predictability or of an accurate forecast–although the site of landfall near and the wind velocity of Harvey were forecast immediately before it reached Rockport TX, on August 27, and the rise of its velocity and classification from a Category 1 to Category 5.  The speed of the transformation mirrors how Hurricane Maria quickly intensified from a Category 1 storm to a Category 5 over fifteen hours, its winds reaching speeds of 160 mph, has already led to six Category Five hurricanes making landfall in 2017, Irma and Harvey both making landfall in the US as Category Four Hurricanes.  And even as one is shocked by the sudden impact and uneven predictive powers of maps of hurricanes to drench much of the coastal United States–

 

wpc-5day-0Z-8.28.17Five Day Precipitation Forecast (NOAA/NWS/WPC)

 

–one is stuck by a need for mapping the growing proximity or intimacy between land and sea, and the dangers of the settled regions of the shore in an era of increased fluidity of land-sea divides, and the difficulty of developing a more humanistic perspective on the data map.

Data is designed by men–if it is meant to distill nature, as a rainbow spectrum implies.  The poetics of mapping that can be more sensitive to this human perspective must try to record the relation of the human to the monolithic mechanisms of the anthropocene, by locating the human creation of place within the layers of intense precipitation of such striking weather maps.  Before the opaque layers that blur land and water, one thinks of the engaged way Elizabeth Bishop interrogated the same formal divide between land and sea of a framed map of the northern Atlantic in 1934;  the need to map “land under water” and the ways “mapped waters” adequately rests on the ways that water, whose waves “lend the land their conformation”–shaping its structure and organization–and will continue to do so with the arrival of future storms:  Bishop described an engraved map, but her reflection on the poetics of the coastal map occasioned this post.  For the sorts of claims of providing an exact and accurate record of the landscape of the ocean contrast to a cartographical epistemology that is not rooted in seeing space, and erases any subjective relation to their cartographical space.

 

4.  The deeply personal history that Elizabeth Bishop brought to reading that map–not explicit, to be sure, but evident in the impact of the coast of Nova Scotia and New Brunswick she knew so well, and felt so far removed from in New York on that Christmas of 1934, as she used its limited tools of world-making to place herself in relation to its making of a palpable space, contrast to the resolute objectivity of the rainbow color ramps of hurricane maps that register measurements in ways that are so oddly alienated from on-the-ground experience.  While Bishop remade the map’s world, stripping it of measure, direction, and national divides, to reshape its signifying power, by using it as a basis for her own sense of literary form and to describe the world it creates, investigating its surface as a sharp-eyed observer, considering its contents without interest in its legend, but looking beneath the constructed nature of its form in an experience of map-reading that questions accepted conventions.

If Bishop is said to read the map before which she stood or sat as a poem, focussing on imagistic elements of its shorelines, tidal basins, or the outlines of peninsulas and landmasses, it could be argued that her engagement of the cartographical details in the engraved map–the crowded eastern bathymetry on the ledges, green layers of land underneath the sea that seem to lift it, or the sand bars on its shore:  was the active role of the elegance of the map’s design and cartographer’s colors as important as Bishop’s own sense of place in triggering her reaction to it’s surface, and the close proximity she implied–intimacy, for some readers–the land had to the sea?  Lastly, the deep meaning that Bishop responded to the map’s surface and conventions as a record of world-making to which she so successfully relates to her own life and sense of time that leave the present-focussed measurements of hurricane maps particularly impoverished.

 

NOrth Atlantic.png

 

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Is Health Care a Democratic Right?

The bulbous, bloated cartogram meant to render the prospective withdrawal of insurers from individual health-care exchanges under the Affordable Care Act in its deepest colors foregrounded the concentration of a reduced insurance market in rural areas.  The image of a nation seething over, and the ground boiling over as if with discontent, cartogram, distorted “red” and “blue” states alike, but seemed evidence of the ways that the Affordable Care Act warped the even playing field in the United States–as if that ever existed, and could be expected to exist today.  But it might be taken as an emblem of the deep anger and resentment that many areas of the United States felt toward what was labeled “Obamacare,” and the regional markets left with but one insurer–and an inevitable feared rise in their insurance premiums–in the health insurance markets that the Affordable Care Act would create.

The designers of the cartogram warped to counties’ population almost aptly if inevitably rendered the country as boiling over with anger:  it seemed to render a powerful emblem to justify if not inspire broad indignancy about the apparently uneven consequences of mandated insurance exchanges which it argued the less populated–and poorer–areas of the country would be stuck with, as a distillation of social injustice.  For the cartogram captured what its designers argued was the distorted market for health insurance which people on the coasts had designed as destined to shut out large areas of the country shaded in lighter colors–and prevalently light pink.  But the prediction of a contraction of providers that undergirds this ominous scenario, as we now know, didn’t come about at all,–even if the strong passions provoked by the fight over health care did leave the country boiling over with anger and indignancy widely felt to be objectively justified.

 

map2_20170725Warped Map on Insurers Red v Blue Goves

It can be quite forcefully argued that health care deserves to be regarded as a  democratic right–democratic with a “small ‘d,'” in the sense of an egalitarian right, even though debates about access to health insurance are increasingly cast in politically partisan terms.  Although access to insurance exchanges are increasingly treated as a question less of a right than the reflection of a political position, the proposition of guaranteeing health coverage is rejected by champions of the marketplace and its benefits, who argue that its falsity undermines a free market.  As a result, in part, health-care exchanges are increasingly mapped in terms that might well be mistaken for political partisan divisions within the fabric of the nation.  Indeed, the sharp, flat blues, reds, and deep carmine of different regions suggest the hopes and difficulties of providing a uniform insurance plan for a nation of radically different numbers of insured, facing the hope to provide more with coverage in a way that may seem to tilt against the open nature of the marketplace.

 

Us Marketplaces.png

 

But democratic rights include not only political participation but due rights to certain benefits that accord undeniable liberties.  And although liberties which were not defined as including health care in the eighteenth century, leading many strict constructionists to view health insurance as an excessive presence of the state in individual lives, the range of liberties have expanded to-liberties to education, or to health, or protect against race-based, ethnic, or sex-based discrimination–revealing the broadening scope of understanding liberties, and might be  mapped into the fabric of the nation as an individual rights, and a basis for ensuring greater egalitarianism–and social equality–as a right.

 

Obama-healthcareBlack Enterprise

 

Back in 2013, of course, the institution of health-care exchanges set up a new landscape of the Patient Protection and Affordable Care Act–the Affordable Care Act or simply ACA–allowing most Americans to buy insurance on  government-run exchanges (or marketplaces) to have access to health care that they were often lacking in all fifty states, creating the reign of designing data vis of Obamacare exchanges often subsidized by the government for those eligible, to make it available to all, in ways that created some thirty-six exchanges run with the federal government, as states ran the others alone–creating the odd scenario that more enrollees came from red states, where they were run largely by the federal government.

 

state-health-insurance-exchange-landscape

 

But this was not widely accepted, and the rejection of the promise of what is now widely labeled Obamacare reflect the deep divides that its opponents argue the government mandate for buying insurance policies will impose on the nation.  The online popularity of recent projections of a constriction of health insurance options for most counties of the nation that were proposed as recently as the spring of 2017 seemed to reveal the deep dishonesty in the proposals of the Affordable Care Act to level the playing field.  And although the capital of health care as a good to the nation demands to be mapped, the difficulty of parsing the ACA independently of the name of Barack Obama reflect the unfortunate polemic level of debate about seeing adequate health insurance as a right of all–even as fear of losing health insurance dramatically rose across the nation, and the fears of rising premiums posed by its mandates were widely stoked by data visualizations suggesting widespread abandonment of insurance exchanges.

 

Changes in Providers.pngUS Health Policy Gateway

 

The data visualization–which almost amounts to a tool of outright propaganda–uses flat carmine to blanket the real improvements in numbers of the uninsured.  The presentation of an apparent distortion of the market is confirmed by declining insurance policies available on Obamacare exchanges, as its accompanying text assures readers that the real people to benefit from “marketplace enrollment” was the “private health insurance industry” who gained $90 billion in premiums, greatly profiting “publicly traded insurance companies”–distorting meanings of “public” and “private” as if to imply the dystopian nature of health exchanges that benefit coastal states alone.  The map of possible changes in rates of premiums were even more striking, and was presented as evidence of poor policy planning, as well as signs of a grim “slow motion death spiral”–a strategic choice of term suggesting the poor level of health-care it provided, and organically faulty nature of its establishment, but alienating the numbers of premium growth from individuals covered.

 

obamacare-premium-map.png

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The familiar series of sequential images forecasting the mass exit of insurers from exchanges over a period of four years of the adoption of Obamacare stand at odds with the fears of losing health care and the defense of health care as a right, as well as a national system of insurance.  And despite an onslaught of maps  ostensibly demonstrating the ever-narrowing options for individuals as available insurers in state-based exchanges  dry up; they convey an imaginary future in which few counties with “active markets” of four or more alternatives–apparently compromising the rights of many Americans.

 

nssustaniable decline

Bloomberg Graphics/2017 Health Insurer Exits (projected)

 

Indeed, the image of rapidly dwindling options faced by Americans that such data visualizations claim to be based on data from HealthCare.gov. seem to suggest a focus on individuals.  But the broad brush strokes leave little to the imagination and present an ominous emptying of choice that seems designed to induce panic.  The images are executed with great dramatic effect, but little sense of cartographic skill–they presented a dire picture in which four options would be only available to residents of eight to ten states by 2017, calling into question the ability of much of rural America to remain insured.  The images of rural abandonment by health care exchanges were particularly powerful,  so absolute in their predictions as if to afford little room for interpretation

Yet the projections, for all their power, stand at variance with reality.  There will be, we now know, in fact no Obamacare marketplaces that remain at risk of being without insurers in 2018, as of August 24, 2017–

 

w:o insurers in echange

–and but a smattering of counties that were at risk for being without any insurers:

 

at risk of no insurer

Kaiser Family Foundation Interactive Version/Open Street Maps:  Counties at Risk of Having No Insurer on the Marketplace in 2018 as of August 24, 2017

 

In short, the disruption of the narrative of a dwindling of insurance options has been, after the failure to repeal the ACA, dramatically disrupted.  Even while acknowledging that there was a record low of uninsured in America after the American Care Act was adopted in “Obamacare marketplaces”–a coded term if there ever was one, loaded with disparagement–data visualization were crafted to predict deteriorating coverage options deteriorated in the months ahead in many rural states of apparent objectivity; hastily created maps, at an odd angle to reality, suggested that as much as over a fifth of all federally run marketplaces–predominantly in rural areas–were with only one insurer.

The alleged “bolting” of insurers from such marketplaces were predicted to leave areas like eastern Tennessee without any insurers, like, perhaps, southern Georgia, much of Colorado, almost all of Iowa, many counties in Ohio,  and large numbers of Virginians, as Aetna, Wellmark, and Anthem were predicted to “bolt” from the exchanges, leaving those Obamacare “customers” high and dry.  The argument of the abandonment of rural America was particularly grim.  But as the projections of the “bolting” of insurers fail to acknowledge the sparsely populated nature of many rural areas, the story that they tell of magnifies the poorly managed nature of the marketplace, obscuring the benefits or rights to health care–and the reduction of the number of uninsured across America– that the ACA has managed to create.  By privileging the size of largely unihabited regions of the midwest, maps of uninsured counties presented a decidedly skewed picture of enrollment, where the square miles covered by insurers projected to participate in health exchanges  seemed to outweigh those where insurers participated, irrespective of the sizes of inhabitants.  It is perhaps no surprise that support for Trump’s candidacy did not correlate with support for the ACA–

 

ACA-support-HaystaqDNA-score-by-county

 

 

We focus on individuals to measure popularity for the support for health care reforms across the country.  Although many have recently entertained sustained interactive levels of introspection about where Americans supported  the Affordable Care Act in the months that preceded the election, pouring over the support for the ACA through county-by-county lenses that made sense pretty much only in how they might translate into votes.

While moving toward the acknowledgement of health care as a right is independent from such measurement of support for the ACA, the  low support for the act in sparsely populated areas intensifies as one moved to less populated areas, by and large, to suggest poor penetration of exchanges into much of the nation–and the distance of health care from what seemed in square miles a quite considerable geographic area.  Resistance to the ACA however reflects a rejection of the broad classification of health care as a right–or to even start to affirm it as one nation.   The division of the country, while reflecting the red state/blue state map in many ways, suggest pockets of counties with strong support for the ACA in a surprising range of the south, southwest, and other regions–across the divide between red states and blue.  Haystack’s micro targeting models estimated just under 98,943,000 ACA supporters nationwide–wondering how the electorate would parse on such a push-button issue.  And, indeed, the Senate Republicans were quick to issue a somber grey data visualization that affirmed a clearcut divide suggestive of the status of yellow- or red-alert in areas “abandoned” by Obamacare– in an openly partisan moment, undoubtedly funded by tax dollars.

Senate Republican Party flawed policies 2018U.S. Senate Republican Policy Committee

 

If over a third of the nation, colored an arresting yellow, seem to flounder in facing monopolies of insurance in the image that the Republican Policy Committee in the United States Senate designed for public consumption, who seem to have sought to raise a yellow- or red-alert for subscribers of Obamacare being abandoned, the map foreground  a divide in deeply partisan ways, failing to note persistently steep inequalities among  uninsured across the states, and the difficulties to attract insurers to markets in equal numbers, particularly in regions where up to a fifth remained uninsured in 2001-3.

 

% Uninsured 2002-3.png

 

 

Despite some questions of whether Republicans would be “alienating their own voters” didn’t affect the results of 2016 congressional elections.  But the power of the continued threat of a coming “implosion” of exchanges that upset the level playing field as an inevitable occurrence was successfully manufactured in projections of insurance markets that peddled groundless prognostications as if they were objective fact:  they successfully mobilized fears of the ability to avoid or precipitate a coming crisis by making it concretely manifest for viewers, pushing many to question the benefits that the extension of the ACA would actually bring–and to see it as a promise that would not be able to guarantee continued coverage or familiar premiums, and indeed to be engineered by the coastal elites and insurance companies that so much of the country has already come to distrust.   For the data visualizations that projected the uneven playing field that exchanges would create cast a divided commonwealth as a result of the limited choices restrictive options of health insurance many Americans would face.  These visualizations raised significant alarms bout the fate of Obamacare–and the specter of its undemocratic nature raised questions of what it provided to the country, or what future it might bright–that were deployed in particularly effective ways.

Flat colors of a data visualization communicate as many falsehoods about its actual relation to people as Trump’s favored declamation of Obamacare “very, very bad insurance.”  They obscure satisfaction ratse of over 75% among those enrolled in plans, and of almost 90% in public Medicaid programs for the poor.  Rather, the picture of an implosion of insurance markets garnered ungrounded trust, and became demonized as but “a first step” toward what he presented as the apocalyptic scenario in which the “government basically rules everything”–a fear of the implosion of a free market–ignoring that the American Care Act is premised on encouraging competition among medical insurers.  Yet the image of such an implosion or collapse perpetuated in data visualizations of crude colors was something that was manufactured in projections that masqueraded as objectively designed maps.  In charting decreasing insurer participation in exchanges as actualities, data visualizations seem designed to stoke uncertainty about the future viability of health insurance markets in America.  Yet the uninhabited nature of this landscape of counties–a metric that makes sense only really as a convention of electoral politics, rather than health care or even of individuals residing in different parts of the country, is starkly removed from health care save in terms of how it might translate into a political choice.

The rhetoric of these “maps” uses projections cover the individuals who benefit from medical care.  They encourage voters to feel slighted in new medical marketplaces, and ask them to chose a future–without considering metrics of coverage or the relative quality of medical care.  They serve to map a landscape of fear, encouraging fears of growing premiums and less choice among voters in what is painted as a compromised medical marketplace.

 

1.  Construing health-care as part of a democratic system has been understood in surprisingly partisan terms.  Some would restrict liberties to participation a marketplace, by adopting and privileging the market as a primary metaphor if not end of civil society:  the success of such a distinction has lead to a broad and striking demonization of its mandate, rather than the policies of the health care law signed in 2010–the Affordable Care Act–which as a law has consistently received far less opposition than the change in health insurance provision that mentions President Obama’s name.  The divide in perceptions seems to have been broadened considerably by recent visualizations that project the future market for health care, or project the numbers of insurance carriers available in exchanges, the colors of the availability of carriers overwhelms the presence of individuals, and reveal the new markets that the Affordable Care Act (or ACA) created as if it were an uneven playing field for all Americans.

Indeed, as recently as June 2017 and during the Trump-Clinton campaign, media outlets and websites trumpeted “maps” or “a map” as evidence of the uneven playing fields that the ACA would bring in the country and the restrictive options that were increasingly identified with “Obamacare,” as if it were something different from the health policies that increasing numbers of Americans had enrolled in, but rather a specter of higher premiums, fewer rights, and new restrictions on providers if not health policies that could not be trusted, in ways that continued a drumbeat of visualizations predicting coming imbalances for those enrolled in Obamacare to insurance carriers or to a competitive marketplace–if not rob them of access to insurers–concretizing what Donald Trump cannily called “the broken promise” of Obamacare, as some 2.4 million “customers of Obamacare” would be with but one insurer to select in the coming year.   Health officials in the Trump administration issued a “new map showing in full color how many counties in the United States could have zero or just one insurer selling Obamacare health plans in 2018” as if to provide confirmation of the poor deal that was offered the nation; the data vis produced by the folks at the Heritage Foundation was accompanied by an announcement that, in case any one missed the point, insurance exchanges in 2017 would feature ” a major decrease in competition and choice” (italics added) that exposed the deep failure of the ACA to promote competition as promised:

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IB-exchange-competition-2017-map-1-825.gifHeritage Foundation (January 30, 2017)

 

The absence of competition left some state, the not unsubtle point was made, that were neglected by the insurance companies that had promoted the ACA:

 

ACA Header?.png

 

The stark contrasts of the data visualization were a rallying cry for a public campaign for the repeal of the Affordable Care Act, designed to activate the red states that were shown to be the largest losers of the insurance exchanges Obamacare created.  The map released shortly after the inauguration in a push to confirm the repeal of Obamacare, showed almost all counties in the southern United States with but one insurer–as almost a third of the counties in the nation–but not the population by any means.  In the rhetoric of an earlier map that described how “large of swaths of yellow cover a number of Southern and Midwestern states, all of Alaska, and elsewhere indicating counties . . .  are projected as of now to have just one insurer selling individual plans next year,” the images of a restriction of opportunities to buy health insurance was alerted, with areas with but one insurer appropriately colored red, as if to convey danger.

The slightly different visualization from June that accompanied this projected danger suggested that some counties–colored red again–would strip residents enrolled in Obamacare from any insurer for those enrolled in Obamacare–this time in “a new map showing in full color how many counties in the United States could have zero or just one insurer selling Obamacare health plans in 2018“:

 

Conties Analysis ObamacareMSNBC (June 13, 2017)

 

The fear that such maps stoked of an imbalance that cut into the insurance options of many as far as health goes suggested a lack of care and a lack of coverage that suggested a deep disinterest of almost a third of the nation, but did so with little actual grounds.  Those sparsely populated regions loose out in the new marketplace that Obamacare seemed to threaten to impose–even if the Affordable Care Act was created to extend health insurance across the nation:

 

Obamacare 2016_0

McKinsey Center for U.S. Health System Reform (August 26, 2017)

 

Such deep divides within the United States that cut against equal access to health insurance was of course what Obamacare was introduced to prevent, but the exchanges in the less populated states were indeed slow to attract insurers.  However, the terrifying fear of a subtraction of any guarantees of well-being and a level playing field that these projections promote–they are hardly really data visualizations, if they resemble maps–seem as good a definition and a metaphor of undemocratic policies, and a metaphor for the restricted roles people are given a crucial say in the policies and decisions that most affect their lives.  Although the sentiments for including health care as a right has become to a deep divide in the nation, the disadvantages that the initial introduction of the exchanges were cautioned to bring to peoples’ lives and policies were immediately striking.

And the recent success of mapping the actual resurgence of insurers’ involvement in many exchanges in counties nationwide reminds us of–and asks us to reconsider–the deceptive nature of their claims.  Indeed, as recently as June, 2017, media sources presented “a map” or a set of maps as evidence of the imbalances that the previous administration had failed to foresee, or willfully imposed on the nation.

 

1.  The negative benefits to all of health-care being a restrictive good are pretty clearly evident:  healthcare should not be seen as a commodity alone, existing on an open marketplace.  Given the clear negative pressures of lowering access to health care to society, the gleeful prediction by President Trump that Obamacare–as Trump calls the Affordable Care Act (ACA)-, as if it were just not American to promise health care to all–would be implode because of e lack of plans available on exchanges in much of the country thankfully seems untrue.  Indeed, the failure to repeal the ACA by the United States Senate–a failure that seems to have sent a shudder of initial convulsions within the Trump administration, and within Donald J. Trump’s sense of his hold on the Presidency, has led insurers to return to the many counties where they had in previous months left, provided all but one of the counties that seemed to have no clear options in the Obamacare exchanges–and that now-President Trump’s declarations of Obamacare’s demise were quite premature.  Although the graphics of health insurance providers that were available to residents in local exchanges under the Affordable Care Act seemed truly badly served in much of the nation by early 2017–when many of the counties not on the coasts or in coastal states seemed to suffer from a gap in options, as was true even shortly before the 2016 Presidential election in surprisingly effective ways.

As soon as the future markets for insurance were mapped and the maps were released, the revelation of apparent gaps and “dwindling in surname choices” and egregious absences in covering the nation’s populations seemed to show up the falsity of past promises.  The maps gained a polemic authority of their own, confirming lingering suspicions about the poor fit of “Obamacare” to the nation, and providing fodder for raising alarms about the inequitable nature of the exchanges that emerged in different states and counties.  For they seemed to reveal an apparent abandonment of the majority of the country by the coastal elites of California Massachusetts, New York, Chicago and Washington D.C.:  indeed, it triggered a sense of the abandonment of the nation by coastal elites.  The very story that was told about Hillary Clinton and the Democrats in many circles were being repeated in the Presidential campaign were used to lace increasing suspicion about the emergence of fair marketplaces in future years.

 

Graphic-of-Insurance-Providers-number.jpg

County-Level Data on Insurance Providers under ACA/AP  (October, 2016)

 

The deep brown nature of the map didn’t reveal the restrictive choices of insurers, but muddied the picture of the nation, as if throwing into relief a plurality of counties that existed on a higher plateaux of health care, and left behind the rest.  The visualization suggests that a sombre picture of health-care had emerged before the Senate failed to dismantle Obamacare, light tans suggesting the greatest gaps in low-lying lands of few insurance options, and markets where sufficient variability would not bring lower costs.  In those regions, the widespread “lack of choice” appeared so evident in dismaying gaps across the nation, where the departure of insurers from a market seemed that had been seen to rise in 2015 and 2016 had started to fall precipitously, raising the fears of rising premiums.  Several entire states–deep red states, as it happens, like Alabama, South Carolina, Oklahoma, and Wyoming–had only one participating insurer across the entire state, suggesting gaps in the health plan that claimed to be engineered to offer choice.

The mapping of these projections seemed to make manifest the deepest fears of inequality and an unloved playing field, which data visualizations like the above seemed to expose–while dying the projected nature of its claim that insurers’ “departure” had already occurred.  Yet the residents of all counties in the United States but one will be able to purchase an Obamacare plan in the coming year in actuality–the fifth year and enrollment cycle of Obamacare insurance markets, has brought successful expansion, with increasing coverage is provided by insurers across the United States may be even effect a new acceptance of health care as a right.  For despite widely stoked fears of drying out health insurance markets projected in deceptive data visualizations with such particularly alarming effects.

Just a mere two months ago, it was predicted that forty-seven counties would have absolutely no insurers by 2018, and that residents of greater than a thousand counties–and up to 1,200– would be left “bare”–hight and dry–with access to but one insurer in their exchanges.  The alleged analysis of the impending “collapse” of insurer participation nationwide showed an image of “projected insurer participation” as if they described an actuality of declining participation that had effectively fractured the nation–lending currency to pronouncements that struck fear into many voters.

 

County by County analysis.pngExchnage Carrier.pngCNBC, June 13, 2017

 

Despite the manipulative nature of these data visualizations, the recent resilience of markets after election, and specifically the failure to repeal Obamacare, has responded in ways that stand to change.

 

2.  But the picture was indelible when it was framed, forged in the sharp colors of data visualizations which arrived with regularity at the same time as maps of projections of the Presidential election dominated social media and the press.  They created a terrifying image of a divided nation, destroyed by the all but inevitable impending “collapse of Obamacare ‘coverage’ in 2017” as revealed in “stunning maps” released in the late summer during the Presidential election, as if they were the hidden understory of national divisions that some candidates just didn’t get.  These visualizations allegedly revealed divisions of the nation in ways that must have spooked many, weren’t being addressed by the White House or health care officials, and seemed to signal an era’s end–touting “Higher Costs and Fewer Choices for Obamacare Customers in 2017.”  The below-the-radar war of data visualization for national attention suggested nothing less than the erosion of the union that was tied to the encouragement of insurance exchanges.

Such data visualization worked their magic, triggering narratives of abandonment and appearing to reveal an isolation of several of the poorer parts of the nation that set of alarms about the increased division of a nation and an uneven playing field that the Affordable Care Act–now demonized by the name “Obamacare” to distance itself from the actual legislation–that revealed the apparent absence of competition in “stunning” ways.  For by depicting the “epic collapse” of a system that in fact seemed to be give greater stability to a projection and make it manifest as reality.  The magic of the data visualization was that they purported to reveal an actuality the Obama administration seemed to deny as if it were an actuality that denied options to many Americans.   And although the spread of the one-carrier-ounties across much of the “heartland” seemed confirmation, for many Republicans, of an abandonment of the mythic heartland of Trump voters, which pulled from Iowa to New Mexico to West Virginia for Appalachia for Trump–the complexion of where insurance is available.

The alleged objectivity of the visualization left many with breath held, as “stunning maps” released during the heat of the Presidential election in late summer prophesied an impending “collapse of Obamacare ‘coverage’ in 2017” as an all but inevitable reality.

 

Obamacare 2016_0McKinsey Center for U.S. Health System Reform

 

Data visualizations of jarring color selections suggest the discontinuity in a system of health care, using the not necessarily clear metric of the existence of a range of carriers.  The notion of the medical marketplace that such competition was supposed to create however realized clear gaps with the counties in violet, whose disarming continuities suggested pockets of the nation that were unfairly left behind, and others in pink that seemed to be similarly compromised in the notion of options or choice their inhabitants were offered.  But the alarmist cartographies were extremely effective in tellign of a story of those regions that were left out–not only Kansas, but Wyoming, West Virginia, and stretches of North Carolina, South Dakota  and Michigan. The maps spoke to many.

The deeper debate about health care as a right demand to be examined in far greater detail than the polemic nature of such visualizations allowed.  And the recent resurgence of insurers in almost all counties of the nation provides a good occasion to do so.   It’s not a secret that the difficulty of construing health-care as a democratic right has also been rejected by many,–who would  restrict liberties to participation a marketplace.  In doing so, they adopt the market as a primary metaphor if not end of civil society–and view any tampering with the health care market as undue governmental meddling.  Yet the guarantees of well-being and a level playing field seem as good a definition of what is democratic as any, as it affords a needed means to allow people to have greater say in policies and decisions that most affect their lives.  And sentiments for including health care as a right has however come to be one of the deeper divides in the nation.  And the recent success of mapping the real resurgence of insurers’ involvement in many exchanges in counties nationwide reminds us of–and asks us to reconsider–the deceptive nature of their claims about the narrative of the impending collapse of Obamacare that many data visualizations of the nation relentlessly advanced, with minimal questioning or interrogation, and the how the image of the nation they suggest may explain public understandings of health care as a democratic right.

But since the negative benefits to all of health-care being a restrictive good are pretty clearly evident, healthcare should not be seen as a commodity alone, existing on an open marketplace alone.  Given the clear negative pressures of lowering access to health care to society, the gleeful prediction by President Trump that Obamacare–as Trump calls the Affordable Care Act (ACA), as if it were just not American to promise health care to all–would be implode because of e lack of plans available on exchanges in much of the country thankfully seems untrue.  Indeed, the failure to repeal the ACA by the United States Senate–a failure that seems to have sent a shudder of poor guidance and convulsions within the Trump administration, and within Donald J. Trump’s sense of his hold on the Presidency, has led insurers to <em>return</em> to the many counties where they had in previous months left, provided all but one of the counties that seemed to have no clear options in the Obamacare exchanges have gained them.

 

3.  Trump’s declarations of Obamacare’s demise were indeed quite premature.  Although the graphics of health insurance providers that were available to residents in local exchanges under the Affordable Care Act seemed truly badly served in much of the nation by early 2017–when many of the counties not on the coasts or in coastal states seemed to suffer from a gap in available options, as was true even shortly before the 2016 Presidential election in surprisingly effective ways.  The sentiment of a curtailing of options–and of choice, that elusive and so malleable term–became something of a battle-cry against the ACA, which redefined how it was portrayed and cast as an imposition that failed to meet health needs, but whose premiums were substantially more.

If one might say, with poet Elizabeth Bishop, that “more delicate than the historians’ are the mapmaker’s colors,” unlike the color-choices by which cartographers define land and sea as areas viewers can inhabit and read, the stark colors of the data visualization suggest clearcut differences and decisive results–too often just to stark to be lent the credibility that they seek.  Bishop linked the art and science of the cartographer and the art of poetry, in her first published poem, written when staring at a framed map of the North Atlantic that lay under glass as she was ill.  In tracing the mapped waters, and the land that lies beneath the water in maps, shadowed in green, she admired the transformative nature of the cartographer’s art and the expressive license of defining land and sea, and the edges of sandy shelves, as allowing the cartographer to create an aesthetic object able to engage the viewer’s fantasy, through the delicacy of color choices:  the stark, flat tones of the above data visualization–whose colors are all too strict and edges overly severe–work best to create oppositions and manufacture absolutes that offer little distance on the world, or clear purchase on it.

The colors chosen by the cartographer, if at odds with the actuality of the ordering of the land, cannot compare to how the translation of the edges of insured and uninsured are erased in the clear contrasts that compress the actual contours of health care.  If Bishop contrasted the reality claims of the historian to the artifice of the map-maker, whose creations appear arbitrary, but reveal actual complexities, as allowing possibilities for the contemplation of the world.  But rather than presenting an authoritative version of the world, the human measure of a carefully made map, and the invention it offered as an angle at which to examine the world absent from many visualizations, which privilege a single actuality as sufficiently authoritative to orient viewers to the world along a single narrative–and not preserving a human scale to do so.  The deceptive nature with which data visualizations foretold collapsing insurance choices in the Affordable Care Act presented a false reality. about health insurance exchanges, in short, by creating alarming contrasts between sharp colors in maps that offered no opening for interpretation. In contrast, maps of the actual numbers of those without health insurance reveals a landscape of much more complex edges and shadows, as well as deep divides, demanding to be moused over in detail for their interactive experience, if only to come to terms with the changed life experiences of those in many states, as from 2013-16, as the constantly shrinking number of uninsured grew nation wide in ways that attest to the increasing health of the nation–if with considerable numbers of uninsured remaining in may exchanges:

 

shrinkin uninsured.png

 

percentage uninsured.png

New York Times

 

In contrast, the almost uninhabited landscapes bereft of insurers that data visualizations depict to suggest a narrowing marketplaces and dwindling options of Americans offers an image less about “health”–our about our health as a nation–than the problems of creating continuity among the insurance exchanges that underwrite the insurance marketplace.  The lack of perspective that they offer on the residents of each county and of our country–and the forced viewing of “health” in terms of insurance companies which participate in exchanges, suggest what more contemporary poet, Claudia Rankine, called the particularly contentious meaning of “health” today in the United States:  at a time when “Affordable Care Act” is seen as something different from “Obamacare” by most Americans, who want the affordability of health care but suspect the inequality of “Obamacare”–whose repeal Trump declared his first order of business as President.  “We heard health care and we thought public option/we thought reaching across the street across the lines,/ across the aisle was the manifestation of not a red state/ not a blue state but these united states we thought,” Rankine wrote with assurance of a new landscape of health insurance, “we could be sure of ourselves in this one way sure/of our human element our basic decency.”

But the increased decency of providing more Americans with adequate health care, “a kind of human kind of union we were ready to check-up,” as Rankine wrote, in the belief that “in this one way we were ready/to care for each other we were ready to see/our range of possibilities as a precious commodity,” was distorted in a map that focussed on the marketplaces of insurance options that Obamacare–the Affordable Care Act–sought to create.  If in this nation “despite being founded on genocide and sustained by slavery/in God’s country we thought we were ready/to see sanity inside the humanity,” the humanity of health care seems sadly obscured in the exclusive focus of data visualizations that focus on providers absent from the marketplace.

 

4.  It is rather terrifying that the alleged objectivity and authority of such data visualizations were arrogated to make a point that disguised their nature as projections and roles as arguments.  While doing so is tantamount to disinformation, claiming predictive value as declarative statements which has since proved to be without any merit.  For not only did they distort the question of coverage by ignoring that the areas where three or more carriers would be options were most populated–where the best job had been done informing patients of their options to enroll in policies, and also where far better medical coverage existed for Americans in previous years–but the alarms that they sounded were ungrounded, although the image of two coasts and a well-off midwest that suddenly left large parts of the nation in the lurch effectively tapped into deep suspicions and uncertainty.

Rankine persuasively hypothesized–and elsewhere actively protested–the deeply ingrained racism that motivated a nation ready to distinguish between “Obamacare” and the “Affordable Care Act”–valuing the affordability of health insurance, but suspicious of the insurance labeled by the name of Trump’s predecessor.  The motivations for suspicions about “Obamacare” as a tampering with the free market of health providers is unclear, but it undermines the interest in our understanding of the preciousness of health care as a right.  Yet the humanity of health care seems sadly forgotten by the shift from a topography of individuals insured to a topography of the marketplace.  Although Trump seemed to think he had fired Obamacare from the country by declaring it “dead,” and just destined to implode, the markets revealed themselves to have been set up with considerable resilience, despite deeply troubling glitches in its roll out; if more than eighty counties earlier risked offering no options to enrollees, insurers returned overwhelmingly, where they were able, especially when already strongly present in the marketplaces, despite the threat from President Trump to pull federal subsidies.

The presence of mapping future markets for insurance were released with claims to show of apparent gaps, “dwindling insurance choices,” and egregious absences in covering the nation’s populations.  They seemed to show up the past promises of the President to preserve choices for Americans to adopt a health plan that suit them best, and portray them as undue impositions on the marketplace.  The projections acquired a polemic authority, as if confirming lingering suspicions about the poor fit of “Obamacare” to the nation, by providing fodder for raising alarms about the inequitable nature of exchanges in different counties and even in different states.  They seemed to confirm a feared narrative of the abandonment of the much of the country:  indeed, many popular data visualizations triggered a sense of the abandonment of the nation by coastal elites in New York, California, and Washington DC, in particular in Arizona, Oklahoma, Texas, Colorado, Missouri and the Deep South, as well as parts of Michigan.  They confirmed the very story told about Hillary Clinton and the Democrats repeated in the Presidential campaign as if to lace suspicion about the emergence of fair marketplaces in future years.

 

Graphic-of-Insurance-Providers-number

County-Level Data on Insurance Providers under ACA/AP  (October, 2016)

The particularly grim picture that they offered came in for little criticism or rebuttal.  But the data visualizations describe landscapes that are curiously depopulated, even as they present a sobering picture to suggest the withdrawal of insurers from medical exchanges.   The map implies an absence of interest in much of America by the very insurers who claimed to have sponsored the new marketplaces–but had only concentrated on the most profitable regions.  Its implications one of the abandonment of many of the rural areas of the country–the less densely populated–although the greatest success of such exchanges in densely populated urban areas that were liberal-leaning is no secret, they imply an absence of interest in less populated areas of the nation.  The implicit message that little attention was paid to the rural areas was underlined through the strategic colors of the data visualization, which seems to suggest a relief map of areas that would suffer higher premiums:   audiences in much of the country were convinced that they just had it worse in the projections all too often portrayed as eventualities that the nation would stand to suffer.  The tan colors that suggest diminished choices of medical insurance muddied the picture of the nation, throwing into relief a plurality of counties that existed on a higher plateaux of health care, and left behind the rest.

The visualization suggests that a sombre picture of health-care had emerged before the Senate failed to dismantle Obamacare, light tans suggesting the greatest gaps in low-lying lands of few insurance options, and markets where sufficient variability would not bring lower costs.  In those regions, the widespread “lack of choice” that appeared evident in dismaying gaps across the nation, where the departure of insurers from a market seemed that had been seen to rise in 2015 and 2016 had started to fall precipitously, raising the fears of rising premiums.  Several entire states–deep red states, as it happens, like Alabama, South Carolina, Oklahoma, and Wyoming–had only one participating insurer across the entire state, suggesting gaps in the health plan that claimed to be engineered to offer choice.

Such premature projections seemed to make manifest the deepest fears of inequality and an unloved playing field, and invested themselves with an objective authority of exposing an uneven system that was indeed rigged–denying the projected nature of its claim that insurers’ “departure” had already occurred.  Yet residents of all counties in the United States but one will in fact be able to purchase an Obamacare plan in the coming year in actuality–the fifth year and enrollment cycle of Obamacare insurance markets, has brought successful expansion, with increasing coverage is provided by insurers across the United States may be even effect acceptance of health care as a right.  For despite widely stoked fears of drying out health insurance markets projected in deceptive data visualizations with such particularly alarming effects.

 

2.  To better grapple with the readiness of insurers to fill the health-care marketplace, the stunning maps of the presence of insurers who have made health-care policies available demands to be examined through a red state-blue state optic.  For eve if the aversion of Republican-leaning regions in the United States to providing alternatives to health care insurers creates a deep divide concentrated in much of the south, prairie, and southwest, where only 1-2 insurers exist, and despite uneven nature of conditions conducive to access to health services that guarantee well-being–and presumably happiness–the markets have grown.

 

HEalth Care Insureres:Red v Blue Govs.png

 

 

If the divide looks harsh anyway for many rural areas, the red/blue divides cannot reflect the actual availability of health providers to Americans.  Since the notion of the division of the distribution of insurance markets by counties seemed suspect anyway, given the sparser population of many of these states, a more accurate picture of national coverage is offered by a simple proportional warping of the odd division of the electorate by the “county”–an outdated geographical unit if there ever was one.  The mapped that warped counties by their relative populations reveals  an even sharper picture of the actually improving state of availability of insurers–the fewer residents of many of the just-one-insurer regions of the south and indeed midwest shrink, to confirm the growing success of the selection of insurance providers by the ACA, despite some obviously problematic and important to address gaps in coverage.

 

Warped Map on Insurers Red v Blue Goves.png

 

It is striking that these very gaps mirror with a terrifyingly clear correlation both dial-up speeds and broadband technology, as well as intractable bottom-line problems like gaps in the availability of health-care services in rural areas.

 

FQHCs.png

 

federally-qualified-health-centers

Rural Health Information Hub, December 2016

 

 

5.  Abandoning the red/blue divisions, which are taken by the elected governor, we see an even healthier division of the nation, at least in terms of the regions that provide their residents with something like a reasonable variety of possible health care insurers, with large areas of the most populated areas having three potential insurers, rather than insurance markets imploding at all, despite the clear gaps that it reveals in what seem more underpopulated areas–and, quite strikingly, the absence of broadband that would make it easier to enroll for insurance online.

 

5995cec01400001f002c3494Harold Pollack and Todd Stubble

 

Broadband 2014.pngNational Broadband Map, June 2014 (not updated since)

 

These gaps reveal a division of much of America into two regions–no doubt conducive between two expectations of health care or medical provision.  Most southern states indeed had far fewer insurers–left “bare” with but one provider, despite the low populations of such rural regions being just less conducive to insurance markets, and revealing an uneven playing field long preceding the passage of the Affordable Care Act–

 

SOUTHERN states health care insurers 2017-18Harold Pollack/HealthInsurance.org

 

One Provider South Rural.pngHarold Pollack and Todd Schuble

 

The area is not only medically underserved, but suggests a “Southern Problem” having far less to do with Obamacare than with the disproportionate topography of medicine and indeed of those without health-care, but creating many counties including large stretches of chronic undeserved populations.

 

RAC 2014

 

 

Such maps and data visualizations only suggest a need to appreciate and fathom the deeply compromised liberties in areas with few health insurance providers, where insurers haven’t reached clear markets, that not only overlap with many of the more chronically uninsured areas and populations, but with areas of the a terrifying number of uninsured–folks who have decided or been forced to do without health insurance, and where going without health insurance becomes an accepted acceptable alternative, unlike in many regions of the country,

 

 

us-health-insurance-coverage-map

 

which often echoed the very regions of greatest vulnerability in the nation–counties that to be sure often reached out to Trump as a savior for their deep discontent.

 

Rural Assistance Center Underserved.png

 

RAC 2014.png

 

 

2.  The increasing variety of insurance options for much of the nation raises questions about the persistence of a deep inequality–undemocratic for many–in those pockets coinciding with denser votes for Trump, in a normalized choropleth, and more hospitable to an argument of revising current options of health care–and viewing the Affordable Care Act as an imposition of the federal government.

 

Trump votes normalized choropleth

 

There are interesting overlaps on those areas where Trump out-performed previous Republican candidates, notably in Florida’s panhandle and less densely populous counties in the deep south; southern Texas; and Appalachia.

 

trump-increases-republican-votes

 

 

The odd reluctance of these areas to attract anything like a range of possible insurers in lower income areas of low-density where Republicans have recently performed well.

 

counties-1

New York Times

 

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They reflect the difficult problem of distinct notions of liberty and rights in the country, corresponding to areas where the civilian population was long underinsured, often by upwards of 15%, and where shortages of health-providers–even if not as readily available in county-level data–are strikingly revealed in a state-by-state survey:  states like Georgia, Mississippi, Arkansas, New Mexico, Nevada and Texas remained significantly below the national average for primary care physicians in 2012, suggesting regions where there were less developed expectations for attaining health care coverage.

 

maptitude-healthcare-providers-by-state-map.jpg

 

 

Increased numbers of uninsured exist in many of the same states are, to recap, unsurprisingly located in some of the same regions–which are less likely to vote for representatives who advocate the belief in health care as a right, and perhaps seeing it as able to be outweighed in importance by an argument of states’ “rights,” even if this discourse is designed to deny health insurance.

 

us-health-insurance-coverage-map.jpg

 

It seems a cruel irony in an era of globalization that the majority of those doctors or members of the healthcare force serving areas of the United States that were most in need, and who see some 14 millions patients every year, were from Iran, Libya, Somalia, Sudan, Syria, or Yemen–citizens of countries included in Trump’s Muslim Ban.  (In other words, these immigrant doctors are filling the increasingly pronounced gap that exists among medical providers in the United States–and getting the job done.)  If medically underserved areas occur in almost every state in the country, the preponderance of medically underserved populations concentrated in less populated areas–as the southwest, southern states, and parts of the Midwest seems to have attracted foreign doctors–and had already led bills to be sponsored to allow Medicare to reimburse pharmacists directly in those communities, to acknowledge the absence of medical services needed by Medicare beneficiaries, to allow clinical pharmacists to work in medical care settings as a health provider.

 

Doctors from coutnries in Muslim Ban.pngSee interactive version of this map here, at the Immigrant Doctors Project

 

The map has some striking overlaps with those regions of rural America that are losing population, although it should be kept tin mind that the above map, which used data from Doximity to suggest the commenting zones for the number of doctors in the United States may distort by expanding the zones of providing services beyond that which physicians actually serve most actively:

:

map-loss.pngRural Communities Losing Populations, United States of America

 

The elevation of the pharmacist to a medical provider may raise ethical questions.  But the existence of hight concentrations of medical physicians from the very countries that were targeted by the so-called “Muslim Ban” that Trump championed had the effect of allowing a crucial degree of medical assistance to reach Americans–although the apparent intent of Trump’s legislation would have been to restrict their abilities to return home freely to visit their families, and compromise the proportion of doctors on call in the cities where they are most concentrated–in Toledo, Cleveland, and Dayton, Ohio as well as Detroit MI.

 

Medical Assistance.pngImmigrant Doctors Project

 

Such pronounced concentrations of physicians which were mapped online in readily seaarchable formats by the Immigrant Doctors Project provide powerful tools to view how the markets for physicians’ skills meets the needs of a marketplace, to be sure, if one recalls the huge numbers of medically underserved counties.  But this is not a marketplace that would be easily filled by our current medical system, or the health-care industries that service more rural or poorer areas.

 

RAC 2014.png

 

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Filed under Affordable Care Act, data visualization, health care, health insurance, Obamacare