I've just published a book that millions will love to hate: The Cul-de-Sac Syndrome: Turning Around the Unsustainable American Dream (Bloomberg Press, 2009).
Here's an essay that summarizes the book. The conclusions are not pretty, but half the book talks about how to heal the country after the worst housing and credit crisis since the Great Depression. It's now in bookstores and at amazon.com and bn.com.
The Cul-de-Sac Syndrome and the Future of Housing
By John F. Wasik
Author, The Cul-de-Sac Syndrome: Turning Around the Unsustainable American Dream (Bloomberg Press, 2009), www.culdesacsyndrome.com
How did the U.S. succumb to one of the most devastating housing recessions since the 1930s? Was it as simple as saying that everyone from mortgage brokers to Wall Street just got greedy? Or did it have to do with Americans’ obsessions with ever-bigger homes?
Weren’t homes supposed to be the safest investments on the planet?
Much of what happened in this flood of exuberant optimism did not just happen overnight. The underlying causes of the debacle have been ingrained in Western culture for almost half a millennium, myths that came to full blossom precisely at a time when Americans’ view of themselves, their post 9/11 security and their shaky financial future was being tested like never before.
As it stands now, the housing bust may shake out as one of the biggest financial blow-ups in history, rivaling the Great Depression as more than $4 trillion in wealth evaporated. A bubble where demand exceeded realistic economic fundamentals was triggered by a number of uniquely American cultural values, desires and economic shortcomings.
Millions entered a financial cul-de-sac during this period of irrational exuberance. It may take years for them to escape from this dead end.
The stereotypical villains in this story have been Wall Street bankers, the government and greedy participants from speculating “flippers” to the Federal Reserve.
Although there’s plenty of blame to spread around when it comes to who was motivated by pure avarice or criminal exploitation, much of that picture has been illuminated. Those who thought they would profit handsomely have already been exposed, have taken their losses and are well known to anyone following this debacle. It’s far too easy, though, to point fingers at the purveyors of the usual human excesses. Something deeper and more profound triggered this crisis, something that lurks at the core of the American experience.
The nature of the American Dream – and what it has cost us – is what this book explores. How did we come to think that each home should be a worthy investment that propelled millions to leverage beyond their ability to pay? In an age of burgeoning info-technology, why are we still building homes with the latest 19th-century techniques?
What was the market behavior that drove homeowners into subprime loans and moving ever further out from jobs and cities? How did we come up with this idea that we should “buy as much house as we could afford?”
We’ve gotten stuck in an unsustainable cul-de-sac. After following the bubble and its aftermath for the past seven years as a personal finance columnist for Bloomberg News, I’ve gained some insights into urban planning, resource depletion, homebuilding techniques and economics that are disturbingly critical of the American dream of homeownership.
I am more intrigued at how America created what I call spurbs. These are car-dependent sprawling urban areas, unconnected to core cities by public transportation and beset by unsustainable costs for infrastructure, services and resources. As highly leveraged places now ravaged by foreclosures and falling property values, they will suffer the most in coming years.
How do we heal this syndrome? Even if the home market superficially recovers with higher prices, home starts and sales, there are some deep-seated problems that will haunt future generations if we don’t correct them.
Doubtless, it had been a great run. From 2000 to 2006, U.S. median home prices rose about 50 percent to an average $221,900. Whatever Americans were losing to inflation and stagnant wages during those boom years for housing, they were more than making up in their home values.
Family income only inched up 14 percent during that period. Yet home prices can only outpace family income for so long. After a while, the aberration had to disappear by what economists call ``regressing to the mean,’’ or returning to a historical average return, which is less than the rate of inflation when you subtract the myriad expenses of homeownership.
Was there something about the role of the home in American culture that convinced millions in a relatively short period of time that they could win the lottery just by taking out a mortgage? Could they suddenly re-invent themselves as passive investors and successful speculators who could ride the treacherous waves of the bond market, Wall Street’s propensity for bundling securities like frayed pieces of fabric and the property markets?
I submit that we need to do nothing less than reinvent the American Dream. Homes were unaffordable to begin with for nearly half the population. We can build them cheaper in factories within environmentally sound technologies. In the process, we can create millions of jobs and export technologies.
What about the communities that embraced the ever-expanding American home? What will enable a metropolitan area to grow in an age of expensive energy, rising taxes, constrained resources and an aging population? There are a host of approaches that I’ve culled from leading thinkers, research organizations and environmental groups.
• De-Link Property Taxes from School Funding and Local Development. In a handful of areas, this has been done. The key is to provide a diversified source of school and infrastructure funding from local, regional, state and federal sources. This will help address the reason why families move ever further out from central cities to find better schools and housing values. Educational quality simply needs to improve in every school district if America is to stay in the global economic game.
“The problem with U.S. education is a problem of inequality,” says Fareed Zakaria, a skilled observer of geo-politics. “This will, over time, translate into a competitiveness problem, because if the United States can’t educate and train a third of the working population to compete in a knowledge economy, this will drag down the country.”
• Prioritize Transportation Funding. Channel the majority of federal transportation subsidies into public transportation and road and infrastructure repairs. Rebuild the bridges, overpasses, grade crossings and roads we have now. Direct a greater proportion of federal dollars into urban light rail, zero-emission buses, trails, public transit, bike paths and inter-city high-speed trains. Provide funding to new communities that emphasize grid layouts to minimize street traffic. Minimize the building of high-speed, multi-lane highways. Provide tax incentives and financing for transit-oriented developments that are within walking distance of public transportation.
• Create Model Zoning Codes. This can be done on the local, county and state level. Allow for mixed-use zoning that encourages pedestrian and bike traffic and discourages sprawl while promoting green buffer zones. There should be model ordinances on the books for areas that want to create livable, walkable and bikeable communities.
• Update Building Codes for the 21st Century. Require that all new construction and communities be required to meet the standards set forth in the LEED, Energy Star or other local programs. Montgomery County, Maryland, for example, is mandating that new homes meet Energy Star guidelines. Mandate water conservation measures in homes and subdivision design. A national energy building code needs to mandate conservation for every new or remodeled building. On a local level, building permit fees can be reduced for green improvements. The city of Chicago, for example, will waive up to $25,000 in fees, depending upon the level of improvements.
• Create Green Jobs, Particularly in Blighted Areas. Millions of jobs can be created to refurbish sub-standard housing, installing energy appliances, building public transportation and retrofitting buildings. According to the Apollo Alliance, for every $1 billion invested in public transportation, 47,500 jobs are supported. Wind power creates 2.77 jobs for every megawatt produced; solar photovoltaic manufacturers generate 7.254 jobs. A comprehensive energy program should mandate all new buildings follow national efficiency guidelines and provide as much funding that was invested in the Space Race of the 1960s to carbon-neutral energy technologies. A tax on carbon emissions on every level – industrial, commercial and residential – will finance this research and development. In addition, take away the $47 billion in subsidies to the oil and coal industries and invest it in clean energy and building research and tax credits.
• Trim Real Estate Tax Breaks. Write-offs for mortgage interest, property taxes and capital gains distort and artificially inflate home prices. It effectively provides subsidies for those in the most expensive areas, ranging from $26,285 per owner-occupied unit in the San Francisco Bay area to $12,759 in Hawaii, according to a University of Pennsylvania-Wharton School study. Start with repealing the mortgage-interest deduction. Desirable areas would still be in demand if these tax breaks go away and prices may fall in others. That will enhance affordability.
• Fund a Smart Grid. Provide the necessary funding to update the electrical grid for this century. Ideally, the grid should be able to respond automatically to power surges without breakdowns. Supplement the grid with substantial investments in clean energy and modern electrical storage. Mandate that utilities provide services to tell customers when off-peak power is available and provide tax incentives for homeowners who want to create their own clean power supplies. Require net metering and buy-back of home-generated electricity. Enhance the tax credit package to a 20-year horizon for those who want to invest in clean energy production. De-couple utility industry profits from sales through tax credits. Reverse the paradigm: the less power they sell through energy-conservation measures, the more money they can make.
• Create Private Incentives for More Affordable Housing. Mandate that new developments offer a variety of housing by size and price, including rentals and high-density townhomes. When home prices rise by $1,000, another 217,000 are priced out of purchase. Offer builders tax breaks for keeping homes under 3,000 square feet and increasing density.
• Personalized, National Health Care. American mobility is largely based on employment. Millions not only want a better job with higher wages, they want freedom from catastrophic health expenses. The only way to achieve this is to de-link health coverage from employment (and the tax breaks provided to employers for offering health care). In a personalized, national program, the government can contract with private companies who bid for the business to underwrite policies that cover the entire country. This will enable people to be more productive, take any kind of employment and move wherever they want. It will indirectly help housing because Americans won’t be locked into communities. They may be able to move to less-populous areas and pursue telecommuting. A guaranteed universal savings plan for all Americans is also essential.
That brings us to the American project itself, which dictated that ordinary homeowners could indeed start over as housing investors. Investment homes would become not only their retirement fund but their college savings vehicle. Castles could be profitable as long as land became scarcer. After all, they weren’t making any more of it.
Friday, May 29, 2009
Saturday, May 16, 2009
Star Trek Rocks
I just saw the new Star Trek. The characters are well written and ably fleshed out by the actors and director JJ Abrams.
Spock is my favorite, always wrestling with his human side to great effect. Spock is a living study in the split-brain theory -- or at least the old version of it.
On one side, logic and reasoning prevails. This is the enlightenment in action, the rational course of events. The other side is less structured and more seat of the pants.
Although neuroscientists now know that both sides work together and emotions permeate nearly everything we do, it's not easy to make that split down the middle of the corpus callosum, the wiring that connects both hemispheres. The brain is more like a network of networks. Sort of like an organic internet that tells the body what to do.
Nevertheless, Spock represents the duality of human nature. We want to do the right thing, but we always get tripped up by gut instincts, hate, envy, revenge, lust, greed and a host of other emotions that make us totally anti-Vulcan.
James Tiberius Kirk is all instinct. He seems to have very little time to contemplate his actions; he knows what he's going to do before he can access the thought. He's a hair-trigger, jump into bed, ride'em high cowboy. He doesn't seem to worry about consequences and has the confidence of a gunfighter.
Spock cannot complete his self or resolve his conflicts without Kirk, who is the man Spock could be but can't be. Together, well, they boldly go where no one has gone before.
Filling out this symphony of personalities is Bones McCoy, the ever-cranky doctor; Chekov, the bright kid with a syrupy accent; Sulu the warrior; Uhuru the linguist and Scotty the eccentric engineer. I'm not sure if every vessel has these kinds of folks on board, but they better if they want to go anywhere.
Anyway, the movie is great. I've seen them all plus the TV shows. The theme still sounds hokey, but it will put a smile on your face. The franchise is alive and well and freshened up a bit for a new century, although I'm not sure which one.
Spock is my favorite, always wrestling with his human side to great effect. Spock is a living study in the split-brain theory -- or at least the old version of it.
On one side, logic and reasoning prevails. This is the enlightenment in action, the rational course of events. The other side is less structured and more seat of the pants.
Although neuroscientists now know that both sides work together and emotions permeate nearly everything we do, it's not easy to make that split down the middle of the corpus callosum, the wiring that connects both hemispheres. The brain is more like a network of networks. Sort of like an organic internet that tells the body what to do.
Nevertheless, Spock represents the duality of human nature. We want to do the right thing, but we always get tripped up by gut instincts, hate, envy, revenge, lust, greed and a host of other emotions that make us totally anti-Vulcan.
James Tiberius Kirk is all instinct. He seems to have very little time to contemplate his actions; he knows what he's going to do before he can access the thought. He's a hair-trigger, jump into bed, ride'em high cowboy. He doesn't seem to worry about consequences and has the confidence of a gunfighter.
Spock cannot complete his self or resolve his conflicts without Kirk, who is the man Spock could be but can't be. Together, well, they boldly go where no one has gone before.
Filling out this symphony of personalities is Bones McCoy, the ever-cranky doctor; Chekov, the bright kid with a syrupy accent; Sulu the warrior; Uhuru the linguist and Scotty the eccentric engineer. I'm not sure if every vessel has these kinds of folks on board, but they better if they want to go anywhere.
Anyway, the movie is great. I've seen them all plus the TV shows. The theme still sounds hokey, but it will put a smile on your face. The franchise is alive and well and freshened up a bit for a new century, although I'm not sure which one.
Tuesday, May 5, 2009
Yes, I was on Glenn Beck
This should be subtitled "What you can't get into a four-minute Fox News show and we're afraid to ask."
Yes, I was on the Glenn Beck show this evening. That was me, answering questions about the US real estate market, hoping I would not be one of Mr. Beck's shredded targets. It's nice not being a target.
The interview featured your humble scribe talking about why it's too soon to be optimistic about the US real estate market. I had to qualify my comments, since in reality there is no ONE US real estate market. There are metro areas, neighborhoods, regions, states and whole corridors where people are walking away from homes and ghost town developments. They have been devastated for different reasons.
* In South Florida, where I was a few months ago, developers overbuilt and speculators used the cheap Fed bubble money like it was buttered popcorn.
* In Southern California, prices were -- and still -- obnoxiously high relative to the rest of the country, so homebuyers did everything they could to get into a house. Bankers and real estate agents bent over backwards (play limbo song here) to get them into these homes, some of which were located in the sprawling Mojave Desert and blistering Central Valley.
* In Michigan and Northern Ohio, you know what happened to the US auto industry.
* Elsewhere, price declines weren't as severe as the West Coast. Still, folks are hurting.
I believe that a combination of unemployment, supply and demand (too many homes, too few buyers), the complexities of mortgage guarantees (not enough of them), the failure to stem foreclosures (they continue) and the aging of the Baby Boomers (were downsizing the love shack, baby) all contribute to this housing malaise, which could last for decades.
Since that's a lot to squeeze into four minutes, I'm afraid I failed on that account and must have sounded like someone who's just a pessimist.
I'm a realist and believe that the mainstream media not only largely ignored the bubble but is failing to grasp the long-term consequences of the housing bust. Here's a few observations, all of which I expound on in my upcoming book "The Cul-de-Sac Syndrome," now available for pre-orders on amazon.com.
* Aging boomers will not be buying McMansions or moving to sprawling burbs, which I call "spurbs" in my book. They will want to be near amenities like museums, music venues, universities and cultural treasures. That means condos and townhomes in cities and inner suburbs.
* Large-scale superstores and malls are going to shrink big time. Boomers are scared to death of their diminished nest eggs. First they got clobbered by the dot-com scam, then the credit bubble, then the housing meltdown. They know they will have to work and SAVE much longer than they anticipated. They won't have their parent's retirement.
* Those places that were overbuilt (there are several lists in my book) will be crippled for perhaps a decade, maybe more.
* Congress and the Obama Administration haven't even begun to address the housing meltdown. They're going to have to do a LOT more than offer first-time homebuyers an $8,000 credit and a $1,000 check to loan servicers to modify the interest rate on mortgages that may be foreclosed upon. Mortgage guarantees need to cover most of the market for at least 10 years, either through Fannie Mae and Freddie Mac (which need to be restructured) or the FHA. The secondary market for mortgages either needs to be reinvented or government sponsored. Either way, you need to be able to sell a mortgage to an investor again.
* Congress needs to get realistic about lost equity. Some $6 trillion is gone and not coming back. I know the Senate killed a bill that would have allowed home owners to write down mortgage principal in bankruptcy, but that needs to be reconsidered. Write down the evaporated equity and move on. That's what the banks are doing.
So, dear readers, I can't possibly cover this ground (and more) in four minutes on national television, so I hope that you'll forgive me and give The Cul-de-Sac Syndrome a try. It will take more than four minutes of your time, but it might give you some novel ideas. For too long, "home was where the heart is." Let's start using our brains again when it comes to our domiciles.
Yes, I was on the Glenn Beck show this evening. That was me, answering questions about the US real estate market, hoping I would not be one of Mr. Beck's shredded targets. It's nice not being a target.
The interview featured your humble scribe talking about why it's too soon to be optimistic about the US real estate market. I had to qualify my comments, since in reality there is no ONE US real estate market. There are metro areas, neighborhoods, regions, states and whole corridors where people are walking away from homes and ghost town developments. They have been devastated for different reasons.
* In South Florida, where I was a few months ago, developers overbuilt and speculators used the cheap Fed bubble money like it was buttered popcorn.
* In Southern California, prices were -- and still -- obnoxiously high relative to the rest of the country, so homebuyers did everything they could to get into a house. Bankers and real estate agents bent over backwards (play limbo song here) to get them into these homes, some of which were located in the sprawling Mojave Desert and blistering Central Valley.
* In Michigan and Northern Ohio, you know what happened to the US auto industry.
* Elsewhere, price declines weren't as severe as the West Coast. Still, folks are hurting.
I believe that a combination of unemployment, supply and demand (too many homes, too few buyers), the complexities of mortgage guarantees (not enough of them), the failure to stem foreclosures (they continue) and the aging of the Baby Boomers (were downsizing the love shack, baby) all contribute to this housing malaise, which could last for decades.
Since that's a lot to squeeze into four minutes, I'm afraid I failed on that account and must have sounded like someone who's just a pessimist.
I'm a realist and believe that the mainstream media not only largely ignored the bubble but is failing to grasp the long-term consequences of the housing bust. Here's a few observations, all of which I expound on in my upcoming book "The Cul-de-Sac Syndrome," now available for pre-orders on amazon.com.
* Aging boomers will not be buying McMansions or moving to sprawling burbs, which I call "spurbs" in my book. They will want to be near amenities like museums, music venues, universities and cultural treasures. That means condos and townhomes in cities and inner suburbs.
* Large-scale superstores and malls are going to shrink big time. Boomers are scared to death of their diminished nest eggs. First they got clobbered by the dot-com scam, then the credit bubble, then the housing meltdown. They know they will have to work and SAVE much longer than they anticipated. They won't have their parent's retirement.
* Those places that were overbuilt (there are several lists in my book) will be crippled for perhaps a decade, maybe more.
* Congress and the Obama Administration haven't even begun to address the housing meltdown. They're going to have to do a LOT more than offer first-time homebuyers an $8,000 credit and a $1,000 check to loan servicers to modify the interest rate on mortgages that may be foreclosed upon. Mortgage guarantees need to cover most of the market for at least 10 years, either through Fannie Mae and Freddie Mac (which need to be restructured) or the FHA. The secondary market for mortgages either needs to be reinvented or government sponsored. Either way, you need to be able to sell a mortgage to an investor again.
* Congress needs to get realistic about lost equity. Some $6 trillion is gone and not coming back. I know the Senate killed a bill that would have allowed home owners to write down mortgage principal in bankruptcy, but that needs to be reconsidered. Write down the evaporated equity and move on. That's what the banks are doing.
So, dear readers, I can't possibly cover this ground (and more) in four minutes on national television, so I hope that you'll forgive me and give The Cul-de-Sac Syndrome a try. It will take more than four minutes of your time, but it might give you some novel ideas. For too long, "home was where the heart is." Let's start using our brains again when it comes to our domiciles.
Sunday, April 26, 2009
48-hour culture blast
Welcome to my life, at least the last 48 hours. This is a mash-up of cultural activities over the past 48 hours, a pastiche of the wonderful, elegaic and pop-cult samplings of what's new, old and dynamic.
I started my odyssey Friday night in Chicago's Archicenter. The birthplace of the skyscraper doesn't have a real architecture museum (hello Mayor Daley), but this storefront shop on Michigan and Jackson is the closest thing to it. It's crammed full of touristy knick-knacks and lots of books on architecture. You can also book one of the famous architectural tours there. I usually put a bug in somebody's ear to push along the idea of a gorgeous dedicated space to showcase all of Chicago's glorious heritage. I think they're working on it.
While I have architecture on the brain, I saunter past the Art Institute, which has a pathetic display of Burnham drawings of the 1909 plan. Although it's the centennial of one of the most famous urban planning visions in history, the great museum has consigned a few dozen drawings to what amounts to a basement hallway.
Meanwhile, the Institute is showcasing its development prowess through its new modern wing, which will house everybody from Picasso and Matisse to many lesser-known, newer artists. The addition, designed by Renzo Piano, is a soaring testament to all of Chicago's more elegant structures with a cantilevered roof canopy that is nicknamed "the flying carpet."
A walkway connects the new building (still under construction) to Millenium Park across Monroe street. It's like a giant concrete blade of grass, tapered at both ends and appears to float much the way the roofline does. I follow the lithe line of the walkway into Millennium Park, which teaming with children playing in the Plensa fountain and observing the three new sculpture of a red, steel dinosaur, a golden fat man holding onto a pig that is suspended by a 20-foot red tongue and another metal sculpture that looks like 30 feet of dental fillings melted together.
The sculpture is as playful as the atmosphere in the park. Kids and teenagers are screaming as they get wet. It's a place of joy.
Reluctantly I head over to the stentorian Union League Club for the annual Lisagor awards sponsored by the Chicago Headline Club chapter of the Society of Professional Journalists. It's a night in which we honor all of us newshounds, whether we're in broadcast, print, online, or all three. I am honored to receive my seventh Lisagor, yet feel a certain sadness about the layoffs and the dissapation of the great papers. Chicago was always a great news town, yet it's undergoing some sort of metamorphosis. None of us know how we're going to fare on the other end of this change of life. There will always be news in Chicago; it's now a matter of seeing how best to serve those who want to consume and digest it. We still need diligent reporting. Blogging alone won't tell us what we need to know.
After a tasty dinner and chats with my colleagues, I head back home on the train, where I meet my friends Jackie and Jerry Kendall, two true-believing progressive activists. We cogitate and groan over the fate of health care and try to unearth some new issues in Washington. I scratch my ear a little too hard and it starts to bleed.
The next morning I'm back on the train with my girls, this time to Orchestra Hall, where the world's greatest symphony -- or at least a kid's size version of it -- is playing the last of the Kraft family concerts. The series is aimed squarely at introducing kids to all kinds of great music from jazz (Wynton Marsalis) to orchestrated folk (Danny Boy). The Trinity Irish dancers, two singers and a bagpiper all parade across the space where Georg Solti, Bernard Haitnik and Fritz Reiner have held their batons. An hour's worth of Britten, Williams and Grainger and we're off to have lunch.
We return to the Plensa fountain where the girls proceed to soak themselves, dodging some real rain as we dance in the middle of the third-largest city. We walk over to check out "Cloudgate," otherwise known as "The Bean," then head back to the train.
To unwind, I put on the director's cut of "Apocalypse Now (Redux)," which includes nearly an hour of additional scenes that Coppola cut out of the original. The girls are in bed, of course, as Martin Sheen once again enters the heart of darkness that was Viet Nam. There's a compelling scene of a French family that his Captain Willard character discovers somewhere near the Cambodian border. They are clinging to the frail hope that they can stay. Like most of the other characters in the film, they are doomed like Marlon Brando's Colonel Kurtz, who reads aloud TS Eliot while sending his native army out to behead any number of unfortunate souls.
"Are you an assassin?" Kurtz asks Willard.
"You're just an errand boy sent by grocery clerks," Kurtz mumbles.
Few films about war have captured the pagan madness of conflict as well as this film. It's still a phantasmagorical nightmare that gave Sheen a heart attack and nearly ruined Coppola's career. The film has aged well, even as Laurence Fishburne, Harrison Ford, Sheen and Coopola have gone on to other projects.
The next morning the grimmest of scenes from "Now" is still on my mind as I shuffle off to thecheery Marriott Theatre to see "Disney's High School Musical." It's a group show for about 1,000 girl scouts; I'm one of about 8 males. The music is pre-recorded and the cast is hyperkinetic. This is Andrew Lloyd Webber for ADHD kids. It's not that the music is bad; it isn't. It's just bland and contrived. It's like eating a box of caramel turtles. The real treat is seeing energetic live theatre with the girls.
Back home I settle in with the New York Times Sunday edition. Friedman is still plugging for a carbon tax to improve fuel efficiency (I don't see it coming in a recession) and the business section has failed once again to tell me where all the TALF and TARP money went. It certainly did end up in my pocket. Maureen Dowd seems to have lost her spark and is wandering around California.
When I'm done with the Times, Kathleen and I go for a walk and talk about what American culture is all about. I claim that most Americans don't expose themselves to it -- that is, the authentic art and architecture that was created here (jazz, several folk forms, etc.) Most inject themselves with downloaded drivel that is as manufactured as macaroni and cheese.
What is authentic American culture? Is it the cusinarted mush that Disney produces? Is it an original Chicago skyscraper? Is it Woody Guthrie, The Talking Heads or Andrew Bird (or maybe just Bird/Charlie Parker)?
There's so much more to discover and it's a journey that will take me on some crazy backroads. Stay tuned.
I started my odyssey Friday night in Chicago's Archicenter. The birthplace of the skyscraper doesn't have a real architecture museum (hello Mayor Daley), but this storefront shop on Michigan and Jackson is the closest thing to it. It's crammed full of touristy knick-knacks and lots of books on architecture. You can also book one of the famous architectural tours there. I usually put a bug in somebody's ear to push along the idea of a gorgeous dedicated space to showcase all of Chicago's glorious heritage. I think they're working on it.
While I have architecture on the brain, I saunter past the Art Institute, which has a pathetic display of Burnham drawings of the 1909 plan. Although it's the centennial of one of the most famous urban planning visions in history, the great museum has consigned a few dozen drawings to what amounts to a basement hallway.
Meanwhile, the Institute is showcasing its development prowess through its new modern wing, which will house everybody from Picasso and Matisse to many lesser-known, newer artists. The addition, designed by Renzo Piano, is a soaring testament to all of Chicago's more elegant structures with a cantilevered roof canopy that is nicknamed "the flying carpet."
A walkway connects the new building (still under construction) to Millenium Park across Monroe street. It's like a giant concrete blade of grass, tapered at both ends and appears to float much the way the roofline does. I follow the lithe line of the walkway into Millennium Park, which teaming with children playing in the Plensa fountain and observing the three new sculpture of a red, steel dinosaur, a golden fat man holding onto a pig that is suspended by a 20-foot red tongue and another metal sculpture that looks like 30 feet of dental fillings melted together.
The sculpture is as playful as the atmosphere in the park. Kids and teenagers are screaming as they get wet. It's a place of joy.
Reluctantly I head over to the stentorian Union League Club for the annual Lisagor awards sponsored by the Chicago Headline Club chapter of the Society of Professional Journalists. It's a night in which we honor all of us newshounds, whether we're in broadcast, print, online, or all three. I am honored to receive my seventh Lisagor, yet feel a certain sadness about the layoffs and the dissapation of the great papers. Chicago was always a great news town, yet it's undergoing some sort of metamorphosis. None of us know how we're going to fare on the other end of this change of life. There will always be news in Chicago; it's now a matter of seeing how best to serve those who want to consume and digest it. We still need diligent reporting. Blogging alone won't tell us what we need to know.
After a tasty dinner and chats with my colleagues, I head back home on the train, where I meet my friends Jackie and Jerry Kendall, two true-believing progressive activists. We cogitate and groan over the fate of health care and try to unearth some new issues in Washington. I scratch my ear a little too hard and it starts to bleed.
The next morning I'm back on the train with my girls, this time to Orchestra Hall, where the world's greatest symphony -- or at least a kid's size version of it -- is playing the last of the Kraft family concerts. The series is aimed squarely at introducing kids to all kinds of great music from jazz (Wynton Marsalis) to orchestrated folk (Danny Boy). The Trinity Irish dancers, two singers and a bagpiper all parade across the space where Georg Solti, Bernard Haitnik and Fritz Reiner have held their batons. An hour's worth of Britten, Williams and Grainger and we're off to have lunch.
We return to the Plensa fountain where the girls proceed to soak themselves, dodging some real rain as we dance in the middle of the third-largest city. We walk over to check out "Cloudgate," otherwise known as "The Bean," then head back to the train.
To unwind, I put on the director's cut of "Apocalypse Now (Redux)," which includes nearly an hour of additional scenes that Coppola cut out of the original. The girls are in bed, of course, as Martin Sheen once again enters the heart of darkness that was Viet Nam. There's a compelling scene of a French family that his Captain Willard character discovers somewhere near the Cambodian border. They are clinging to the frail hope that they can stay. Like most of the other characters in the film, they are doomed like Marlon Brando's Colonel Kurtz, who reads aloud TS Eliot while sending his native army out to behead any number of unfortunate souls.
"Are you an assassin?" Kurtz asks Willard.
"You're just an errand boy sent by grocery clerks," Kurtz mumbles.
Few films about war have captured the pagan madness of conflict as well as this film. It's still a phantasmagorical nightmare that gave Sheen a heart attack and nearly ruined Coppola's career. The film has aged well, even as Laurence Fishburne, Harrison Ford, Sheen and Coopola have gone on to other projects.
The next morning the grimmest of scenes from "Now" is still on my mind as I shuffle off to thecheery Marriott Theatre to see "Disney's High School Musical." It's a group show for about 1,000 girl scouts; I'm one of about 8 males. The music is pre-recorded and the cast is hyperkinetic. This is Andrew Lloyd Webber for ADHD kids. It's not that the music is bad; it isn't. It's just bland and contrived. It's like eating a box of caramel turtles. The real treat is seeing energetic live theatre with the girls.
Back home I settle in with the New York Times Sunday edition. Friedman is still plugging for a carbon tax to improve fuel efficiency (I don't see it coming in a recession) and the business section has failed once again to tell me where all the TALF and TARP money went. It certainly did end up in my pocket. Maureen Dowd seems to have lost her spark and is wandering around California.
When I'm done with the Times, Kathleen and I go for a walk and talk about what American culture is all about. I claim that most Americans don't expose themselves to it -- that is, the authentic art and architecture that was created here (jazz, several folk forms, etc.) Most inject themselves with downloaded drivel that is as manufactured as macaroni and cheese.
What is authentic American culture? Is it the cusinarted mush that Disney produces? Is it an original Chicago skyscraper? Is it Woody Guthrie, The Talking Heads or Andrew Bird (or maybe just Bird/Charlie Parker)?
There's so much more to discover and it's a journey that will take me on some crazy backroads. Stay tuned.
Thursday, April 23, 2009
Doctors Want Single-Payer Health
Why is Congress so reluctant to see the logic of single-payer health care? It's because the K Street lobbyists are doing full court presses on lawmakers to accept a scheme that will let them charge whatever they want, pass along their high marketing, executive compensation and administration costs to premium payers and shut out the very sick, chronically ill and unemployed from full, affordable coverage.
Don't take my word for it. This is the testimony of Dr. David Himmelstein, who came before the House Subcommittee on Health today. He wants to eliminate the wasteful spending that providers spend on the tracking the expense of every aspirin and fighting with insurers. In nutshell, here's why the present system is broken and unsustainable:
1) Insurers are the adversaries of patients and health care providers. They regard a claim as a "loss," so their entire business model is predicated on paying as little as possible.
2) They will pay for only what they approve. Sure, this limits their cost exposure, but it's patently inhumane. What if the treatment that's going to save your life isn't covered? What if it's not "reasonable and customary?" You're out of luck.
3) If you don't pay, they will hound you for every penny. This drives millions into bankruptcy and foreclosure. This shouldn't be if we can spend billions on fighter jets, armies across the world, agricultural subsidies for farmers who don't farm and propping up avaricious bankers.
4) If you've had any pre-existing condition, you will either be excluded from the malady that made you ill, not be able to get insurance or face onerously high premiums. This is underwriting for known risks. Insurers don't want sick people. That costs them money.
5) We should be examining the best possible care for the lowest possible cost, not the most expensive care at any cost.
Here's Dr. Himmelstein:
Testimony of David U. Himmelstein, M.D. Before the HELP Subcommittee
April 23, 2009
Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts, and associate professor of medicine at Harvard. I also serve as national spokesperson for Physicians for a National Health Program. Our 16,000 physician members support nonprofit, single-payer national health insurance because of overwhelming evidence that lesser reforms will fail.
Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills contributed to about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three-quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.
A single-payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31 percent of health spending in the United States, nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans.
By simplifying its payment system, Canada has cut insurance overhead to 1 percent of premiums — one-twentieth of Aetna’s overhead — and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.
A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each Band-Aid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.
And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.
Significantly, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a “public plan option” might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9 percent of the savings under single payer.
While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3,000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.
My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23 percent between 2005 and 2007, and the insurance exchange adds 4 percent for its own administrative costs on top of the already high overhead charged by private insurers. As a result, 1 in 5 Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety-net hospitals and clinics to keep the reform afloat.
In sum, a single-payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may seem politically expedient, they are economically and medically nonsensical.
Don't take my word for it. This is the testimony of Dr. David Himmelstein, who came before the House Subcommittee on Health today. He wants to eliminate the wasteful spending that providers spend on the tracking the expense of every aspirin and fighting with insurers. In nutshell, here's why the present system is broken and unsustainable:
1) Insurers are the adversaries of patients and health care providers. They regard a claim as a "loss," so their entire business model is predicated on paying as little as possible.
2) They will pay for only what they approve. Sure, this limits their cost exposure, but it's patently inhumane. What if the treatment that's going to save your life isn't covered? What if it's not "reasonable and customary?" You're out of luck.
3) If you don't pay, they will hound you for every penny. This drives millions into bankruptcy and foreclosure. This shouldn't be if we can spend billions on fighter jets, armies across the world, agricultural subsidies for farmers who don't farm and propping up avaricious bankers.
4) If you've had any pre-existing condition, you will either be excluded from the malady that made you ill, not be able to get insurance or face onerously high premiums. This is underwriting for known risks. Insurers don't want sick people. That costs them money.
5) We should be examining the best possible care for the lowest possible cost, not the most expensive care at any cost.
Here's Dr. Himmelstein:
Testimony of David U. Himmelstein, M.D. Before the HELP Subcommittee
April 23, 2009
Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts, and associate professor of medicine at Harvard. I also serve as national spokesperson for Physicians for a National Health Program. Our 16,000 physician members support nonprofit, single-payer national health insurance because of overwhelming evidence that lesser reforms will fail.
Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills contributed to about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three-quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.
A single-payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31 percent of health spending in the United States, nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans.
By simplifying its payment system, Canada has cut insurance overhead to 1 percent of premiums — one-twentieth of Aetna’s overhead — and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.
A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each Band-Aid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.
And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.
Significantly, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a “public plan option” might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9 percent of the savings under single payer.
While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3,000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.
My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23 percent between 2005 and 2007, and the insurance exchange adds 4 percent for its own administrative costs on top of the already high overhead charged by private insurers. As a result, 1 in 5 Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety-net hospitals and clinics to keep the reform afloat.
In sum, a single-payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may seem politically expedient, they are economically and medically nonsensical.
Wednesday, April 22, 2009
How US Healthcare Humiliates the Best of Us
Today I feature a guest blog from my friend Donna Smith. Like myself, Donna grew up in the Chicago area and is a former newspaperperson.
Several years ago both her and her husband got seriously ill (cancer and heart disease) and were driven to bankruptcy by medical bills. And they HAD health insurance! Like millions, they were hounded by insurers and providers until they lost their house. Their story was featured in Michael Moore's film "Sicko."
Today Donna lives in Washington and is fighting with every breath to usher in health care reform as an organizer for the California Nurses Association. I had dinner with her a few weeks ago when we were in Washington, when she was working with other like-minded folks to push for a single-payer plan.
Before you start getting worked up about "socialism," "the government telling me who my doctor should be," or "waiting in line for care," keep in mind that a single-payer plan means personal choice. YOU choose your providers. The government only pays the bills to privately employed doctors, nurses, hospitals, etc.
One of the current proposals is to allow Americans to choose which plan they would like: private insurance or a public plan, perhaps offered through the federal employees program or Medicare. Both would compete side by side. Since private insurers spend heavily on marketing and administration -- costs they pass along to their customers in the form of higher premiums -- it's doubtful if they would be able to compete effectively without reining in their expenses. In either case, there would be true national competition for the best insurance at the lowest cost. If I was to choose a name (actually my wife came up with this) for the best kind of plan I would call it "iChoice."
Congress is vetting many proposals right now, will have a template for discussion soon and may even vote on a plan before the end of summer. Let your congressional representatives know how you feel. Do you have an insurance nightmare you want to tell them? Now's the time. Whatever emerges, it will need to end the widespread discrimination and humiliation of anyone who has the misfortune to get really sick.
Here's Donna's recent piece.
My Harry Winston Diamond and My Healthcare
by Donna Smith
Maybe I am getting old as I look to the past for some better times, but maybe I have grown a bit wiser about recognizing what quality is and what it is not. When it comes to my health, I pay much more than I ever did for care and I get far less -- and what I am able to afford is often of far worse quality than it used to be. I do think about how healthcare has changed in my lifetime and all that my children will never know is possible. And I remember one little engagement ring and how its story foretold my healthcare journey as a once middle class, American wife and mother.
It's not that I long for the good old days - but I do think many Americans still just want simple quality and value in healthcare, and in our current system we certainly have complicated and convoluted many issues at the expense of not only our human compassion but also our American common sense.
When I was a young bride, my husband and I walked by the jewelry counter at our favorite JC Penney store and saw a small but elegant engagement ring. At $199, it seemed expensive to us, but the salesperson told us it was a ring with a tiny Harry Winston diamond - with beautiful facets - and it sparkled on my finger like nothing I had ever worn before. And we stood at the beginnings of our now-33 year marriage with great hope and all the deep passion and love that our young relationship could hold.
Soon, I would give birth to our first child. In the months leading up to our baby's birth, even as my little Harry Winston ring grew a bit more snug on my finger, I saw my doctor for regular pre-natal care and routinely spent 15 or 20 minutes with him as we discussed my pregnancy and my health. His charges for the full seven months of care and the delivery of my child were set in advance, along with the routine lab work. And, because my labor was so fast and my good doctor did not make it to the hospital in time to actually attend the delivery, a nurse delivered my beautiful son and my doctor adjusted his set fee to reflect missing the delivery. Hmm...
When I left the hospital after three days of terrific nursing care for me and for my baby, including lots of wonderful advice from maternity ward nurses, my husband checked me out through the hospital administrative office, but I never worried once about being slammed with financial issues either while in the hospital or upon discharge. As a patient, I was able to focus on my care and my baby's start in life. What a marvelous time for me as a wife and mom. I recall small bills but nothing onerous or crushing - and certainly nothing that robbed me of my own well-being or threatened my child's health in any way.
Fast forward 33 years. I avoid the doctor whenever possible. I hate going to the doctor as it is unpleasant and humiliating to be checked out financially and made to pay my portion of the bill before anyone even provides one moment of service or any healthcare at all. My healthcare insurance costs - for myself and my husband - have escalated far faster than my income. And I never plan to seek care before I gauge if I feel sick enough to warrant the expenditure from the family budget. As my story was already told in SiCKO, everyone knows I lost my house, went bankrupt and gave up nearly everything I owned even though I had insurance - and lots of insurance.
I have a lot of skin in the game, as the popular saying goes. And I never see a doctor for more than a few moments at a time any more. Cancer check-ups be damned, it's a whole day off to get one test done.
I let chronic pain linger. I let symptoms wait. I take huge amounts of over-the-counter medications in the attempt to avoid any interaction with the healthcare system. I don't want to ever take time off work for being sick or worse yet for a family member's illness, and I cannot remember the last time a doctor called me in response to a simple question or test result - I always have to be assertive to even get a response. And many times, healthcare providers seem truly annoyed when having to deal with any patient follow-up at all.
Let it not be said that Americans don't wait for care. We wait for weeks before we go to seek care. We wait in waiting rooms and business offices for forms and insurance benefits to be scrutinized and co-pays and deductibles to be collected brashly and crudely as our financial transactions are open for everyone in the waiting room to hear. We wait inside the doctor's office or exam room - often in some state of undress with no word on approximate time for a doctor to come in. And then we wait for scripts and follow-up appointments. Question any of those waits, and we are often subject to verbal scolding or fear that our daring to speak up might slow the process even more. Healthcare in America? For an average, insured woman like me in 2009? It is to be survived when absolutely necessary only.
If I could avoid being in this mess of a system until I just die in my sleep some day, I'd be happy.
But that's not likely. The healthcare system is a monster of profit-making potential and force now - for not only our healthcare providers but also many of our political leaders. I am incidental to their feeding frenzy. I am only needed as a payer of premiums, co-pays, deductibles, prescriptions and all the other high costs for my husband and myself. I get expensive tests and procedures not always because I need them (though I may not know that) - I get the tests that my insurance says I am allowed to have and that have been deemed profitable by some business folks wheeling and dealing behind the scenes. If I am deemed worthy financially, I get care.
Listen to those who testified yesterday for the Senate Finance Committee as they talk about us as metrics and how to mold and shape our healthcare system - listen for any hint of humanity in these talks.
Don't be fooled by the double-speak you hear. Having a national health care system is not the same as allowing the government to control your healthcare. In fact, giving over your power as a patient to an insurance company because the insurance industry bought and paid for health reform that forces us all to buy their for-profit, financial product is not healthcare but is the highest form of control you can give away - control over your own body.
It doesn't have to be this way. It could be a just and responsible system. It could be a sound, caring and competitive system in which we all pay fairly into one public pool, we all get care when we need it and we all are allowed to choose those private or public doctors, hospitals, clinics and other providers that deliver the kind of care we want to receive.
I want a publicly funded, privately delivered system in which I choose my care and my provider. And so do more than 60 percent of my fellow Americans. My choice. My care. My life. My nation's system.
So, what happened to my little Harry Winston diamond? It went the way of our healthcare system. One cloudy afternoon about 15 years ago when my husband was in the hospital and needing more medication, I sat in a pawn shop office and bargained for $120 in cash for my engagement ring. I left the pawn shop shaking and beaten-down but drove to the pharmacy where I picked up my man's meds.
Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.
Several years ago both her and her husband got seriously ill (cancer and heart disease) and were driven to bankruptcy by medical bills. And they HAD health insurance! Like millions, they were hounded by insurers and providers until they lost their house. Their story was featured in Michael Moore's film "Sicko."
Today Donna lives in Washington and is fighting with every breath to usher in health care reform as an organizer for the California Nurses Association. I had dinner with her a few weeks ago when we were in Washington, when she was working with other like-minded folks to push for a single-payer plan.
Before you start getting worked up about "socialism," "the government telling me who my doctor should be," or "waiting in line for care," keep in mind that a single-payer plan means personal choice. YOU choose your providers. The government only pays the bills to privately employed doctors, nurses, hospitals, etc.
One of the current proposals is to allow Americans to choose which plan they would like: private insurance or a public plan, perhaps offered through the federal employees program or Medicare. Both would compete side by side. Since private insurers spend heavily on marketing and administration -- costs they pass along to their customers in the form of higher premiums -- it's doubtful if they would be able to compete effectively without reining in their expenses. In either case, there would be true national competition for the best insurance at the lowest cost. If I was to choose a name (actually my wife came up with this) for the best kind of plan I would call it "iChoice."
Congress is vetting many proposals right now, will have a template for discussion soon and may even vote on a plan before the end of summer. Let your congressional representatives know how you feel. Do you have an insurance nightmare you want to tell them? Now's the time. Whatever emerges, it will need to end the widespread discrimination and humiliation of anyone who has the misfortune to get really sick.
Here's Donna's recent piece.
My Harry Winston Diamond and My Healthcare
by Donna Smith
Maybe I am getting old as I look to the past for some better times, but maybe I have grown a bit wiser about recognizing what quality is and what it is not. When it comes to my health, I pay much more than I ever did for care and I get far less -- and what I am able to afford is often of far worse quality than it used to be. I do think about how healthcare has changed in my lifetime and all that my children will never know is possible. And I remember one little engagement ring and how its story foretold my healthcare journey as a once middle class, American wife and mother.
It's not that I long for the good old days - but I do think many Americans still just want simple quality and value in healthcare, and in our current system we certainly have complicated and convoluted many issues at the expense of not only our human compassion but also our American common sense.
When I was a young bride, my husband and I walked by the jewelry counter at our favorite JC Penney store and saw a small but elegant engagement ring. At $199, it seemed expensive to us, but the salesperson told us it was a ring with a tiny Harry Winston diamond - with beautiful facets - and it sparkled on my finger like nothing I had ever worn before. And we stood at the beginnings of our now-33 year marriage with great hope and all the deep passion and love that our young relationship could hold.
Soon, I would give birth to our first child. In the months leading up to our baby's birth, even as my little Harry Winston ring grew a bit more snug on my finger, I saw my doctor for regular pre-natal care and routinely spent 15 or 20 minutes with him as we discussed my pregnancy and my health. His charges for the full seven months of care and the delivery of my child were set in advance, along with the routine lab work. And, because my labor was so fast and my good doctor did not make it to the hospital in time to actually attend the delivery, a nurse delivered my beautiful son and my doctor adjusted his set fee to reflect missing the delivery. Hmm...
When I left the hospital after three days of terrific nursing care for me and for my baby, including lots of wonderful advice from maternity ward nurses, my husband checked me out through the hospital administrative office, but I never worried once about being slammed with financial issues either while in the hospital or upon discharge. As a patient, I was able to focus on my care and my baby's start in life. What a marvelous time for me as a wife and mom. I recall small bills but nothing onerous or crushing - and certainly nothing that robbed me of my own well-being or threatened my child's health in any way.
Fast forward 33 years. I avoid the doctor whenever possible. I hate going to the doctor as it is unpleasant and humiliating to be checked out financially and made to pay my portion of the bill before anyone even provides one moment of service or any healthcare at all. My healthcare insurance costs - for myself and my husband - have escalated far faster than my income. And I never plan to seek care before I gauge if I feel sick enough to warrant the expenditure from the family budget. As my story was already told in SiCKO, everyone knows I lost my house, went bankrupt and gave up nearly everything I owned even though I had insurance - and lots of insurance.
I have a lot of skin in the game, as the popular saying goes. And I never see a doctor for more than a few moments at a time any more. Cancer check-ups be damned, it's a whole day off to get one test done.
I let chronic pain linger. I let symptoms wait. I take huge amounts of over-the-counter medications in the attempt to avoid any interaction with the healthcare system. I don't want to ever take time off work for being sick or worse yet for a family member's illness, and I cannot remember the last time a doctor called me in response to a simple question or test result - I always have to be assertive to even get a response. And many times, healthcare providers seem truly annoyed when having to deal with any patient follow-up at all.
Let it not be said that Americans don't wait for care. We wait for weeks before we go to seek care. We wait in waiting rooms and business offices for forms and insurance benefits to be scrutinized and co-pays and deductibles to be collected brashly and crudely as our financial transactions are open for everyone in the waiting room to hear. We wait inside the doctor's office or exam room - often in some state of undress with no word on approximate time for a doctor to come in. And then we wait for scripts and follow-up appointments. Question any of those waits, and we are often subject to verbal scolding or fear that our daring to speak up might slow the process even more. Healthcare in America? For an average, insured woman like me in 2009? It is to be survived when absolutely necessary only.
If I could avoid being in this mess of a system until I just die in my sleep some day, I'd be happy.
But that's not likely. The healthcare system is a monster of profit-making potential and force now - for not only our healthcare providers but also many of our political leaders. I am incidental to their feeding frenzy. I am only needed as a payer of premiums, co-pays, deductibles, prescriptions and all the other high costs for my husband and myself. I get expensive tests and procedures not always because I need them (though I may not know that) - I get the tests that my insurance says I am allowed to have and that have been deemed profitable by some business folks wheeling and dealing behind the scenes. If I am deemed worthy financially, I get care.
Listen to those who testified yesterday for the Senate Finance Committee as they talk about us as metrics and how to mold and shape our healthcare system - listen for any hint of humanity in these talks.
Don't be fooled by the double-speak you hear. Having a national health care system is not the same as allowing the government to control your healthcare. In fact, giving over your power as a patient to an insurance company because the insurance industry bought and paid for health reform that forces us all to buy their for-profit, financial product is not healthcare but is the highest form of control you can give away - control over your own body.
It doesn't have to be this way. It could be a just and responsible system. It could be a sound, caring and competitive system in which we all pay fairly into one public pool, we all get care when we need it and we all are allowed to choose those private or public doctors, hospitals, clinics and other providers that deliver the kind of care we want to receive.
I want a publicly funded, privately delivered system in which I choose my care and my provider. And so do more than 60 percent of my fellow Americans. My choice. My care. My life. My nation's system.
So, what happened to my little Harry Winston diamond? It went the way of our healthcare system. One cloudy afternoon about 15 years ago when my husband was in the hospital and needing more medication, I sat in a pawn shop office and bargained for $120 in cash for my engagement ring. I left the pawn shop shaking and beaten-down but drove to the pharmacy where I picked up my man's meds.
Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.
Tuesday, April 21, 2009
Earth Day Angst
Yes, it's that time of the year again when we forget about Easter Bunny, Santa Claus, the US banking boondoggle and Britney Spears and wonder what we should be doing to preserve our precious planet. We're not in Oz anymore. Time to get real.
Some folks collect garbage by the roadside and that's an aesthetic aid,
while others cower in front of the TV, far too afraid
to handle the truth
that even their idiot box is contributing to global warming.
Many fancy themselves ecoconsumers,
buying hemp clothes and green cleaners
and forget that more stuff won't stave off the doom and gloomers.
Others like me want to enjoy a mauve sunset
or counting sandhill cranes
instead of preaching the end of the world
like we're all insane.
Yet there is something everyone can do
and it's not too tough
unplug yourself for a day
It's about disconnecting from stuff --
to be without a car, cellphone, computer or satellite TV
and watch the dust dance in the air
or the coyotes prowl through your yard with nary a care.
I burned the prairies around my house
as form of renewal
(forget about the CO2)
and watched the forbs sprout up again --
nature's sweet accrual.
To date, I've replaced nearly all my lightbulbs
with compact fluorescents,
attached electronic gizmos
to power strips and turned them off during my somnolence.
We set up a clothes line
for drying in the summer
a rain barrel for the garden
and a solar pump for a fountain.
When I can afford it
I'll go with solar heating panels
and if the PV cells ever get cheaper
I'll tune in electrons from the sun's radiant channels.
The best thing I can do
and it's nearly carbon neutral
is to grown my own food
and make something useful.
We try to avoid plastic
and Disney World trips
we took the train on vacations
across this country's broad midriff.
I write my Congresswoman
about building high-speed rail,
more clean energy and tax breaks
of this ilk. Obama's stimulus plan
will start us down this track -- we must prevail.
Somewhere out there
is a girl or guy
who will find a way
to get energy from the sky
store it in a thimble
and not worry about recharging
because it's renewable, carbon-free
and simple.
Cheap, portable energy,
clean water, food and air --
it's all about peace.
If you've got it,
there's no need to be the global police.
So remember this Earth Day --
we've reached a tipping point,
the best thing you can do
is to let go of that old, conventional goo.
Some folks collect garbage by the roadside and that's an aesthetic aid,
while others cower in front of the TV, far too afraid
to handle the truth
that even their idiot box is contributing to global warming.
Many fancy themselves ecoconsumers,
buying hemp clothes and green cleaners
and forget that more stuff won't stave off the doom and gloomers.
Others like me want to enjoy a mauve sunset
or counting sandhill cranes
instead of preaching the end of the world
like we're all insane.
Yet there is something everyone can do
and it's not too tough
unplug yourself for a day
It's about disconnecting from stuff --
to be without a car, cellphone, computer or satellite TV
and watch the dust dance in the air
or the coyotes prowl through your yard with nary a care.
I burned the prairies around my house
as form of renewal
(forget about the CO2)
and watched the forbs sprout up again --
nature's sweet accrual.
To date, I've replaced nearly all my lightbulbs
with compact fluorescents,
attached electronic gizmos
to power strips and turned them off during my somnolence.
We set up a clothes line
for drying in the summer
a rain barrel for the garden
and a solar pump for a fountain.
When I can afford it
I'll go with solar heating panels
and if the PV cells ever get cheaper
I'll tune in electrons from the sun's radiant channels.
The best thing I can do
and it's nearly carbon neutral
is to grown my own food
and make something useful.
We try to avoid plastic
and Disney World trips
we took the train on vacations
across this country's broad midriff.
I write my Congresswoman
about building high-speed rail,
more clean energy and tax breaks
of this ilk. Obama's stimulus plan
will start us down this track -- we must prevail.
Somewhere out there
is a girl or guy
who will find a way
to get energy from the sky
store it in a thimble
and not worry about recharging
because it's renewable, carbon-free
and simple.
Cheap, portable energy,
clean water, food and air --
it's all about peace.
If you've got it,
there's no need to be the global police.
So remember this Earth Day --
we've reached a tipping point,
the best thing you can do
is to let go of that old, conventional goo.
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