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.

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.

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.

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.

Monday, April 20, 2009

Peace in Israel

Today, faithful readers, I turn my blog over to a friend from high school whom I haven't spoken to in more than 30 years.

His name is Dr. Sig Kharasch and he went to Israel to see how he could use his skills to help others. My friend (and high school English teacher) Mary Freund sent this missive and Sig has given me permission to share it with you. Enjoy! Please read it and let Sig know how you feel about his work!

There is peace in Israel

We rarely read or hear of good news from the Mideast and Israel. The second Lebanese war, Hezbollah, rockets raining down on Sderot, operation cast lead, Palestinian suffering, Syrian nuclear reactors, Gilad Shaleat. Iran. Even an optimist like me could see little hope for this region in turmoil.

Last year I visited a number of different pediatric emergency departments in Tel-Aviv and Jerusalem to observe and see if there were opportunities for me to contribute as a physician. (I have deep roots in Israel. My father moved to Israel in 1974 and was a physician near Tel-Aviv for 25 years before his passing 5 years ago. I have visited numerous times over the last 30 years).

I was particularly taken however with Professor Eitan Kerem, Chairman of the Department of Pediatrics at Hadassah-Mount Scopus Hospital in Jerusalem. Dr. Kerem, a renowned pediatric pulmonologist and chair of the European Society for pediatric pulmonology, guided me through his department, introduced me to some of the staff and made rounds on patients. He described to me some of the history of Hadassah Hospital, the diversity of patients and disease as well as the underserved population it serves.

The hospital “felt” very similar to where I work now at Boston Medical Center that likewise shares the mission to care for the underserved. I left thinking what an incredible place this would be to work at and by the time I landed home in Boston, my plan was in place.

After numerous emails back and forth, Dr. Kerem agreed to have me work as an attending physician in the pediatric emergency department for up to 3 months the following year and helped me obtain my temporary medical license from the Israeli Ministry of Health. I started to study Hebrew in a serious way at an Ulpan in Boston, worked out my leave of absence from work and family (I have an understanding wife!) and left for my first month last March. I was ready to care for “my people”. It would not take long for me to understand how unprepared I really was.

I landed in Israel on a Monday morning and began work in the emergency department on Wednesday. I put on my freshly pressed white coat containing my stethoscope and other paraphernalia and walked into the ER still a bit tired from the trip and a bit in a fog like state from jet lag. I blinked a few times as the scene in front of me came into focus. The ED was filled with patients and most of them were Arabs!

I was quickly introduced to the nurse manager Ashroff, a Druze Arab from northern Israel and Muhammad, a nurse from the West Bank who was working at Hadassah as an Arab translator. I met the pediatric residents working that morning with me. Amjad, an Israeli Arab from Nazareth, and Ibrahim, a Palestinian from East Jerusalem who recently finished medical school in Egypt. Having a terrible sense of direction I thought for a moment I was in the wrong place and hospital!

There was little time for reflection as within minutes the first ambulance arrived with a 4 year old Arab child whose parents were concerned he was not speaking for the last day and sleeping excessively. Although breathing, the child was comatose. Our group quickly descended upon him with IV’s, blood gasses, metabolic and toxicology studies, CT scans and spinal tap, all of which were normal. I told Michael the unit secretary (an orthodox Jew from a large settlement in the West Bank) to call the neurologists for consultation.

Muhaned, the pediatric neurology fellow quickly arrived. I would later learn that he was born in and received his medical degree in Amman Jordan and was financially supported part of a program to further advance medical care in East Jerusalem and the West Bank). We discussed (in perfect English fortunately!) the further possibilities and Muhaned rapidly arranged an EEG and assisted with transfer to the intensive care unit.

By noon that day, Oded (a Jewish Israeli pediatric intern from Jerusalem) and Leah (an American from Baltimore who completed her pediatric training there and was doing a 3 month observation period after recently immigrating to Israel with her family) arrived and would round out most of our group that worked very closely together that month.

I would come to understand the wisdom of Professor Kerem over the ensuing month. Geographically, Hadassah-Mount Scopus is located between predominantly Jewish West Jerusalem and East Jerusalem, a conglomeration of numerous Arab villages. The pediatric emergency department sees 20,000 patients per year. Fifty percent of patients in the emergency department and on the inpatient unit are Palestinian Arabs from East Jerusalem and the West Bank.

One need only to look out the window of the hospital to see how closely intertwined the populations are in the same geographical area. Because of the close proximity, the same heath care issues can impact everyone. Infectious diseases such as the measles epidemic that began in the Jewish neighborhoods of Jerusalem 2 years ago would spill into Palestinian suburbs of East Jerusalem. In such a multiethnic and multilingual population, isolationism is impractical and not beneficial to the health care needs of patients and families in this community.

To address this and other challenges, Dr. Kerem has recruited both Arab and Jewish physicians to appropriately represent the patient population. Many of the Arab residents in training remain at Hadassah after completion of their pediatric residencies as attending physicians or as attending physicians in East Jerusalem. Language barriers have been overcome with professional medical interpreters and by offering courses in medical Arabic to non-Arabic speaking staff. On the inpatient unit, there are 4 beds to each room and both Jewish and Arab families share this space together. As part of the child life program, medical clowns that speak the universal language of humor are appreciated by all families and children. To disseminate clinical information and continuing medical education, Dr. Kerem has developed forums between Israeli and Palestinian pediatricians to improve health care delivery.

During my month I would come to meet and interact with many other physicians, nurses and from diverse backgrounds and cultures. Arabs from Syria, Turkey, the Palestinian territories and Jews from Israel, Iran, South America, Sweden, Russia Australia and Canada. Together we treated hundreds of patients with diseases including pneumonia, rheumatic fever, meningitis, diabetes, bowel obstructions and a myriad of rare genetic and metabolic diseases that are prevalent in the Mideast. Children from the Gaza strip and West Bank with Cystic Fibrosis and other chronic diseases were seen regularly in the emergency department, inpatient units and outpatient centers whose health care was sponsored by and supported by non-governmental organizations.

For obvious reasons, politics were never discussed in the hospital and in fact, resolutely avoided. One's alliance didn’t seem to matter anyway. Jews took care of Arabs and Arabs took care of Jews. No one blinked an eye. It was clear to me that people here were not judged by where they came from but by their caring and respectful nature and ability to provide medical care of the highest quality for all children and families. Besides, we had more important issues to discuss.

Our emergency department team had lunch together almost every day. Ashroff’s impending wedding (I was invited), Leah's new job, Amjad’s upcoming fellowship in pulmonary medicine and everyone’s concerns about how I was managing alone here. I was invited to and attended numerous dinners after work at medical students, residents and attending physician’s homes. I think one of the most memorable however was my invitation to Amjad and his wonderful wife Lamis (a social worker in the hospital) home in East Jerusalem (an area I never imagined visiting in my many trips to Israel).

The political realities of life here took a back seat to important matters such as who was a better cook, Lamis or her mother, should their 9-month old son have a pony tail, how much television is too much and how life would be for them in Canada or America for Amjad’s further training. The dinner and conversation was unforgettable and I did not get home until 1am.

A few days before I left I asked Dr. Kerem how best he would best describe the environment, atmosphere and department he has created at Hadassah-Mount Scopus. He leaned back, folded his hands behind his head and smiled-“it is my happy ship”. It is.

I am not sure there will ever be peace in Israel but what I witnessed each day was a peaceful coexistence between Arab and Jewish families and medical staff. All shared the common belief and goal that the health and well being of children was of paramount importance. If there ever is to be peace, it seems to me that caring for each other and each others children is a good place to start.

Thursday, April 16, 2009

Bring on the Real Tax Tea Party

Something very odd was brewing across the country on tax day, the time that most people ignore when it comes to their federal income tax.

Spurred by the miscreants at Fox News and CNBC's Rick Santelli, whose inspid rant on the floor of the Chicago Board of Trade inspired the tea party talk, the rally was little more than a lot of people waving signs.

They just didn't seem to have any, well, focus.

Some held up signs protesting the income tax itself. If they were like some, who falsely claim that the tax is illegal, they should have been holding up "spring me from jail" placards. Nobody seemed to mind that the tax code is more than 10,000 pages long, seems to favor everyone and no one, and is the source of far too many migraines.

Others simply went for bigger fish like eliminating the Federal Reserve Bank or wanting to return to the gold standard. How do you issue money then and back a $14 trillion economy with the yellow metal? Is there that much gold in the universe? These arguments were about as well thought out as how the Starship Enterprise manages to travel faster than the speed of light. Hint: Einstein said you'd just turn into energy and maybe not back into matter again.

Then there were the folks who thought Obama was spending too much or wanted to fire Congress. According to the constitution, Congress okays all spending. And they have not been too good at reining in the pursestrings. I'll give them that much. The national debt is now more than $11 trillion. Here's another way of looking at it:

The estimated population of the United States is 306,014,725
so each citizen's share of this debt is $36,675.96.

The National Debt has continued to increase an average of
$3.91 billion per day since September 28, 2007!

That's a lot of poster board! But how do you get Congress to stop? We're in a deep recession, we've shoveled off hundreds of billions to banks, GM, Chrysler, AIG and thousands of other financial concerns, yet no one knows where it's going to end. What do we cut? Medicare? The Air Force? The Census? Aid to millionaire farmers? Citizens Against Government Waste ( has hundreds of ideas, but how do we make Congress listen? No suggestions were forthcoming at the tea party.

So these folks were all over the place. There wasn't any one particular theme, save for the fact they didn't like taxes, didn't know which government programs to cut and probably didn't want the program cut that impacted them personally. Most of them probably didn't vote for Obama, either. I was thinking of what I get mad about when I think about taxes.

* Not enough bad things are taxed. I know gambling, cigarettes, gasoline and booze are taxed. But maybe they need to be taxed more? At what point do high taxes begin to get drunk drivers off the road, help pay for lifestyle diseases and stop people from gambling their homes away? Whatever that tipping point is, I don't think we've reached it.

* Let's tax the stuff that comes out of exhaust pipes and smokestacks. Forget about a carbon tax or cap and trade. Let's make it simple: The more bad stuff (carbon dioxide, carbon monoxide, etc.) you belch into the air, the more it's going to cost you. The befouled air levy would create a whole industry of emissions testers, another one to fix the problem and a whole pool of money from folks who don't want to change their ways. We could pay for health care this way.

* Working is for suckers. I don't mean this literally, but this is what the tax code tells us. Let's say you're living off your investments or buy and sell real estate for a living. The federal rate on capital gains is no more than 15 percent. On stock dividends, it's the same. On a payroll? You'll pay up to 35 percent for federal tax alone. Add to that state income tax (Illinois is no more than 3%), AND Medicare/Social Security (or FICA) of 7.65% (double if you're self employed). Even if you retire and convert your 401(k) to a lump sum or annuity, the income is still taxable at up to 35 percent federal plus the state tax. The one exception is a ROTH IRA or 401(k). You pay taxes on contributions, but not on withdrawals.

* Property Taxes Never Go Away (if you own property). You can be retired for 40 years and you still have to pay them on property you own. Since taxes are averaged three years into the past, you will not likely see them go down, either.

* Sales Taxes. They never go away, either. State, county and local taxes add up at the cash register. You can pay up to 10.25% in California, which includes all taxes on retail purchases. Some of the tea party folks want to institute a national sales tax to replace the income tax. What would happen to state and local taxes? It's not clear, but keep in mind, these people don't like any sort of income tax!

For simplicity's sake, it sounds like intellectual cheesecake to roll all of these taxes into one national tax. It's certainly not fair to tax people on a payroll a lot more than those non-retired folks living off their investment portfolio or real estate. And it would be morally right to have some way of paying for health care for every American. That should be part of our constitution. And I still like the idea of federal air traffic control, a well-outfitted armed forces, medical research, education and a host of other things that we call real civilization.

But how much should that one big tax be? If we said 25% was a good round number, then those who were paying up to 35% get a real great deal and those who were paying 15% get screwed. The devil is in the details. We've already gone through the Bush-Reagan tax-cut years and it hasn't fixed the banks, lessened our proclivity for greed nor got us national health care or financed Social Security and Medicare for the next 50 years.

Are more taxes on the way? Probably. Unless somebody finds a way to cut government programs big time without prompting people to burn down parts of cities, this argument about excessive taxation won't go any further.

Maybe we should all sit down and have a cup of tea or two to discuss it.

Saturday, April 4, 2009

The Wasiks Go to Washington

I've been wanting to take this trip for years. I've always enjoyed museums and learning in general; Washington is an exhibition center on steroids. Each new museum must be bigger and better than the older relics lining the mall.

Air and Space was the spectacular tribute to the space race from to X-1 rocket plane to the space shuttle, complete with great hands-on exhibits on the physics of flight. It's always a must-see in DC. The V-2 and a map of all of the places in Britain that were devastated is part of it as was the first German cruise missile (the V-1 or buzz bomb) and the Tomahawk cruise missile. It's ironic how this wonderful sense of awe and wonder about entering outer space became such an unrelenting arms race.

The National Archives is also a staple, with its darkened hall containing the Constitution, Bill of Rights, Articles of Confederation and Declaration of Independence -- so faded that all you can make out is John Hancock's signature. Guards hound you not to take flash photographs and the wait was 45 minutes just to get in the door. Was it worth it? To see those original words and to understand the thinking behind it -- and how this living document undergirds our freedoms -- is still a monumental feat of civilization. Yet to be written: an amendment stating that health care is a fundamental human right and should be guaranteed for all citizens from cradle to grave (working on that one). Although the physical building is small, the archives hold some 8 billion records from films of the Normandy invasion to immigration documents from our family (somewhere).

We were most excited about seeing the Capitol, which is the seat of the legislative branch, and a majestic building in its own right. The rotunda fresco has George Washington ascending into heaven along with a half-dozen Greco-Roman Gods watching over. It's a combination of American mythology and paganism that is capped by the iconic paintings in the rotunda hall. It's triumphant and disturbing in a way that defies words. Just as were were entering our orientation film, which was surprisingly stirring, we ran into our neighors David and Peggy Husemoller and their two boys. We took the tour with them. Although it was too loud, crowded and short to be very satisfying, we were happy to run into our fellow Prairie Crossingites. We skipped going back to our Congresswoman's office (Rep. Melissa Bean) to get a gallery pass (a separate deal from the tour) because it involved leaving the building and going through security again. I was a little taken aback that I couldn't schedule a time to meet with Rep. Bean (she was too busy), although they were all too happy to do a photo op with her (I don't do photo ops).

You have to go to the American Indian Museum kiddie-corner to the Capitol to discover how this manifest destiny came at the expense of the original inhabitants -- more than 90 percent perished either from disease, war or resettlement. In a peaceful, curvilinear building oddly containing a dome of its own while evoking a wigwam, the Indian Museum pays homage to the many great Native American nations and traditions while telling you how mercilessly Europeans exploited, enslaved and pogromized them. It's a sad saga with a heavy dose of dignity and culture. I learned that the Lakota believe that everything is connected (a true spiritual ecology), why native whale hunting is still important in Alaska (they feed an entire village) and how Cortez formed a rag-tag army to defeat 200,000 Aztecs with a handful of Spanish and other tribes. Despite all of the historical violence behind this American story, I found the museum itself serene.

At the other end of the mall, the Lincoln Memorial, Viet Nam, World War II and Korean Memorials all trigger this sense that tremendous sacrifices were made to preserve the working spirit of the constitution. Some injustices were corrected while other still fester (Viet Nam). It is the most reflective part of the Mall and for me, another opportunity to re-read Lincoln's second inaugural and decide whether the "angels of our better nature" are prevailing today.

By comparison, the World War II monument seems plain and perfunctory. Far too many laurels and columns. It seems like an afterthought. Viet Nam is still the one that reaches in and pulls your heart out, especially with the hundreds of vets and families trying to connect with it.

Sidetracks included the International Spy Museum, which appears to be a storefront (that is, private) museum, but offered everything from a short history of the Cold War to Julius Caesar's special code. It was fascinating, though pricey compared to all of the free Smithsonian venues, which dominate the mall. I heard an author there who wrote about the British counter-intelligence effort during World War II. Instead of torturing captured German spies, they threatened to expose them and turned them into double agents. "Deceiving Hitler" by Terry Crowdy is a must-read if you like this subject.

We also spent a day at the zoo with the three adorable Pandas, who sat and ate special popsicles in front of the crowds. The elephants, who are living in crowded quarters, will get a new expanded habitat area, and put on a little show as well. As with all of my zoo experiences, I always feel sad for the animals. I know they live longer in zoos and get excellent care and food, but they're still behind bars with millions of humans gawking at them. What must they think? Are we really saving habitat this way?

Washington is remarkable, because unlike most newer cities, the public transportation is excellent. With the exception of two taxi rides two and from magnificent Union Station (Washington), we either walked or took the Metra. That meant we were able to save some money on the outrageously expensive DC lodgings and stay in a family suite in Arlington, Virginia, just a few stops from everything we wanted to see in DC.

The girls were disappointed that the outdoor pool wasn't open yet, although the first and last days of our week-long visit were certainly warm enough for swimming. We saved a lot on cab fares and were able to cook a few dinners and breakfasts in our room's full kitchen. We also saved a bit eating at the Smithsonian food courts. Since we're members we saved 10% on food there.

One drawback: The Rosslyn metro entrance was a little disturbing for me since it's a huge tunnel going down at a 45-degree angle (a little offputting for me). I got over it and was pleased to hear a fellow playing a flugel horn as we left on our next to last day. We talked with Reginald Conyers and told him Julia would be studying trumpet. He said he would be looking for her and would be waiting to play a duet with her when she was ready. Julia, as always, was game. Earlier in the week, she struck up a conversation with a gent on the subway and bluntly asked what his job was. "Homeland security," he replied. Fortunately that's when we had to get off.

This was our second trip to Washington via Amtrak's Capitol Limited, which goes right into Union Station. We didn't get in a car the whole trip save for a lift to the Metra Prairie Crossing station. We went by train for nearly the entire week, trimming a bit from our carbon footprint. Had we been able to walk to the station (the weather turned bad on the way out), we could've avoided cars altogether. Maybe next time.

While we love the humanity of train travel, neither Kathleen nor I slept on the train all that well. It wasn't much better when we were in a reserved family sleeper car the last time out (coach this time). During one breakfast, we were watching President Obama bemoan the fact that he was "jealous of Europe's high-speed rail." Stop the train envy, Congress! We can build a fabulous, fast train network, reduce greenhouse gas emissions, reduce traffic fatalities and put millions back to work. President Obama has provided seed money in his stimulus and budget packages. Let's make a 20-year commitment to build first-class interstate and intra-city systems. The investment would bring this country together in a profound way.

Julia did manage to provide a highlight, though. A moony-eyed pre-teenage boy was palpitating over Sarah and threw a note at her to call him (without saying much more than that). Incensed, Julia went over to the lad and asked him "why are you sending a note to MY sister?"

The urchin replied that he went to school with her, obviously humiliated since he was sitting with his grandparents and was being confronted by a 60-pound, 8-year-old girl.

"No you don't!" Julia barked at him, a which point the youth skulked away to sit with his mother.

We are happy to report that the nation's liberty (nor Sarah's) is not imperiled at the present and won't be as long as Julia is around.