But last night, it really was the moon! It had a face! Unless the across-the-street neighbors put a face on their living room light, it was the actual moon! This is very exciting because there is only a small piece of the sky visible from my bedroom window, and the moon is usually not in that part of the sky when I am going to sleep.
And the sun. How could I, in New York, ever see the sun? And during working hours! Here's how: At certain times of year, the sun reflects of the shiny high-rise buildings across from my office, straight into my window. (Yes, I am lucky and grateful to have an office window, although all I see out of it are the windows on the building across the street.) Anyway, this week has been one of those times. It's not reflecting off the building directly opposite my office, so it's kind of, well, diluted sunlight, but it is sunlight nonetheless! I think it might reflect into my office more directly in the winter. I will let you know.
THE MORAL-HAZARD MYTH
The bad idea behind our failed health-care system.
by MALCOLM GLADWELL
- “Almost every time we asked interviewees [people without health insurance] what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”
- The leading cause of personal bankruptcy in the United States is unpaid medical bills....Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance.
- Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year....Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations....Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.
- At the center of the Bush Administration’s plan to address the health-insurance mess are Health Savings Accounts, and Health Savings Accounts are exactly what you would come up with if you were concerned, above all else, with minimizing moral hazard. The logic behind them was laid out in the 2004 Economic Report of the President....The report continues, “Researchers believe that as many as one-quarter of those without health insurance had coverage available through an employer but declined the coverage. . . . Still others may remain uninsured because they are young and healthy and do not see the need for insurance.” In other words, those with health insurance are overinsured and their behavior is distorted by moral hazard. Those without health insurance use their own money to make decisions about insurance based on an assessment of their needs. The insured are wasteful. The uninsured are prudent. So what’s the solution? Make the insured a little bit more like the uninsured.
- The country described in the President’s report is a very different place from the country described in “Uninsured in America.” Sered and Fernandopulle look at the billions we spend on medical care and wonder why Americans have so little insurance. The President’s report considers the same situation and worries that we have too much. Sered and Fernandopulle see the lack of insurance as a problem of poverty; a third of the uninsured, after all, have incomes below the federal poverty line. In the section on the uninsured in the President’s report, the word “poverty” is never used. In the Administration’s view, people are offered insurance but “decline the coverage” as “a matter of choice.”
- The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.
I went to Frontier Square when I was downtown, and then walked back to Pike Place Market along the waterfront. It wasn't as interesting down there as I had hoped--mostly a lot of fresh oystery meals for sale, or so it seemed--but it was nice to be near the water. It smelled good, at least! I bought a watermelon flavored Laffy Taffy that reminded me of seventh grade and didn't taste as good as I remember them tasting.
Pike Place Market was full of the usual tchotckes. The highlight was a fantastic street performer. He was playing a harmonica and guitar while hula-hooping! He was great. He also had these wooden clickety clackety things strapped to his sneakers for added pizzazz. I was quite happy watching him hula hoop and play, but then he got all show-offy and started playing the guitar behind his head, and balancing it on his chin, and I think he was either juggling two guitars or playing two at once. And that was just too much, so I moved on. I also saw what I believe is the original Starbucks. Very nice, but I did not partake.
The flight to Palo Alto tonight was uneventful. There were some really cute kids on the plane, including one girl who started laughing with glee as we took off. She also said, "Mama, the lights are so beautiful!" as we neared San Jose, and then after the wheels touched down, during that rumbly time, she shouted, "Faster, faster!" It was all quite endearing and not annoying in the least. There weren't too many crying kids on the flight. Whenever I fly and see families flying with little kids, or multiple kids, I am awed anew at my mother who used to annually fly cross-country, sometimes in both directions, alone, with four kids in tow. I don't know how she did it and came out sane on the other end. I hope we were well-behaved...
Aside from the fact that's kind of sad (I don't think people were meant to live alone, at least not long-term, nor do I think they were meant to live with a rotating series of multiple roommates in crowded apartments in urban areas with sky-high rent), how can they afford to live without roommates? Are they all doctors and lawyers? Or do they all live in the midwest?
2. The average age for marriage in the US today is 27 for men and 25 for women (not for Jews, for everyone).
And, here, a more generalized reaction to CAJE... The thing that CAJE always makes me realize is that, at least according to the teachers here, many American six year olds first hear about God, Shabbat, and tefillah/prayer in Hebrew school. Why don't they know about those things before they're six? (That's a rhetorical question, I know the answer.) I just don't get why people don't "do Jewish" at home if they want their kids to "be Jewish." And if I didn't value "doing Jewish" enough to do it myself (I could see how people wouldn't), I don't see why I would send my kids to school to hear about it secondhand. That just doesn't seem like a sustainable model for Jewish life at all. And it's part of why I want to live in Israel. There, at least if people aren't actively doing Jewish (although many more are, in some way, than are in the US, I would assume), at least children, mostly, are exposed to God, Shabbat, and tefillah before the age of six.
I got such a running feeling this morning. When I first got up, it was raining outside, so instead of running, I went back to bed. Later in the morning, though, I went for a very nice jog in the Union Bay Natural Area, which is on the University of Washington campus, which is where the 30th annual CAJE conference is, which is where I am. The "natural area" is fairly small, and some students and others from UW are working on restoring it by planting native trees and shrubs, and by mowing down the non-native blackberry plants that are suffocating the native plants. The area is, not surprisingly, on Union Bay, which I got a glimpse of a few times along the trail. It smelled like wet mulch, which is not an altogether bad smell. There was an area that looked like it had been burnt on purpose, and that wasn't a great smell, but overall, it was fantastic. On the way back, I picked some plump, juicy, shiny blackberries off of a bush and ate them. Yum!
Even less frequently than that running feeling, I decide that I want to be a runner--a person who can just pick up and run, anytime, anywhere. Although I had a flurry of running activity during college (sophomore year? junior?) I've never been a runner for very long, because it always ends up hurting my knees or my shins. I once asked a doctor about it, and she unhelpfully said, "Sometimes exercise hurts." So I stopped. Also, there is no pleasure in running when the weather is bad, which, in Boston, is more often than not. It would take a fair amount of hard work to get into good enough shape to be able to run regularly, and sometimes, I feel like it isn't worth it, because there are so many times when I don't have any desire to run at all. During times when I've been in shape, I've combined running with less-painful forms of exercise, like the eliptical machine, stairmaster, and bike. When I'm into exercise, I like doing it all, but running does have a certain special appeal. It can really be exhilarating. Part of me really wants to get in shape enough to be a runner. Someone who can run. For more than, like, seven minutes.
I don't know that I'll ever be a runner, though, because when I see runners pounding the pavement, I often think they're a bit crazy. Maybe that's part of what's appealing about it.
I'm trying to convince Adina that we should go to this famous market tomorrow morning, which may be called Pike's Market/Pike Market/Pike Street Market/Pike Place Market. People have been remarkably inconsistent on this point. Adina originally felt enthusiastic about this plan, but she's decided that she may go on a nature walk instead. My personal opinion is that there's nature everywhere, but there's only one Pikesomething Market!
Adina 's buddy Jason from shul (whom I am claiming as my friend, too) suggested that I go and visit the first-ever Starbucks while I'm in Seattle. I don't think it's going to happen. I have this love/hate relationship with coffee, wherein I always think I should cut back, but I never do because it's so delicious. I'm not sure a group of total strangers is so interested in my caffeine intake, so I'll cut this thought short.
Speaking of nature, the campus here is very green! Lots of foliage and trees and undeveloped space. As Adina pointed out to me yesterday, Washingtonians seem very fond of recycling. All the garbage cans here have separate compartments to put cans and bottles in. I am all for this.
Okay, the natives are getting restless, so this will conclude my first ever guest-blog post. Props to Adina for letting me write here after I requested a shout-out in her previous post. Come say hi to me in the comments!
The airport here is lovely. Really. I don't usually think that about airports, but when I landed at Sea-Tac, it was so nice. There was a little atrium area, with tables and chairs and big boulders indoors, with huge windows and more big boulders outside. It did a good job of joining the indoor and outdoor space. (The flight itself went smoothly, also. I slept for three hours of the six, which was good, because I hadn't slept the night before.)
On my first day here, which was a welcome day of vacation from work, I ran a few errands with my aunt. We went to get vegetables at McPherson's vegetable stand and I was shocked at the low price of veggies. $15 bought more than enough fruits and vegetables to last awhile. Including pluots. Yummmm...
The weather here is great, too. On Friday, I took my aunt's dog, Calvin, for a walk in Seward Park, on the 2.5 mile loop that is surrounded on three sides (if circular loops had sides) by Lake Washington. It was absolutely wonderful. Sunny (but with enough shade), warm but not hot, not humid--basically, gorgeous. Enough to make me wonder why anyone lives in New York...
Shabbat was also very nice. We went to friends of my aunt's for both meals, I got a nice nap, and davened at the Klein-Galland Home. I met a nice woman whose name now escapes me, and helped her find the place. She noted (accurately) that the baal koreh was both too quick and not very good. Kiddush was, of course, herring and crackers. (Also, some sugar cookies 'n stuff, but there's no of course about that.)
Tisha B'Av was, well, the usual. My aunt, a nurse, knew all the right pre-fast tricks (salmon, a baked potato, salt earlier in the day to retain water, lots of water throughout the day--no amount is too much!), and the day was, I think, better because of it. It was also good not to have to go to work, and to get a lot of sleep. We went to The Summit, an assisted living facility, and visisted with Mrs. Etkin, with whom we discussed Tisha B'Av, and who told us some stories of finding hope in Auschwitz. I also saw a special "Tisha B'Av video" at shul after mincha about which it is best to say nothing at all. Sinat chinam and all that. Lashon hara is bad. I think we can all agree on that point.Okay, I am handing the blog over to Sarah Autry, my co-worker, who promises to blog about !exciting things! which is much more than I can say for this sadly boring post... (This is my first guest-blogger ever. Let me know if you want to guest-blog... Don't know if that is hyphenated or not...)
This past Sunday's magazine had a serious, thought-provoking, sad, and very resonant article. It was about death and dying, and what constitutes a good death. It gave some background on the hospice movement, which I found interesting. It also interviewed some people during their last months of life. It highlighted the choices that many people are faced with, as they near their last days. This is all very...discombobulated. I'm sorry. You should really read it yourself.
One of the reasons that this article resonated with me is, I think, because I've been thinking a lot about choices lately. All manner of choices. How many options are apparently open to me, and how difficult that makes life seem. Some naive part of me waxes nostalgic for the days when people had fewer choices. This is how things are, and then you make the best of it. Now, to some extent, I think we all just kind of float around, vaguely dissatisfied, hoping that we latch onto something meaningful, or that something (or someone) meaningful latches onto us. Now, we have almost unlimited choices, all the time. (There is some theory of economics that shows that the more choices people have...something interesting. I forget what. It turns out that people do better with fewer choices, was the upshot, I think.) We even seem to have unlimited choices about our death. We have learned to live so well that we can almost, almost, control death. But not really. People sometimes feel that they can choose which disease kills them, but they are sometimes denied even that. Ultimately, there are only a few things we can choose about how we die.
This article was very grounding. It took the floating feelings from me and smacked me upside the head with, "And, someday, you will die." I'm not sure what to do with that, but it's something to think about. Sorry, I'm still kind of flailing here, but maybe I'm getting something across?
The other thing that the article reminded me of was of my days volunteering at the Coolidge House Nursing Home, which I did from around 1993 until 2000, give or take. There were times when I went weekly, and I used to send postcards to the residents with whom I was most friendly, when I went away for vacation. The women there--and they were mostly women--died with such dignity. It was hard to be there, but it was also a unique pleasure to sit with them and talk when things got hard. They had lived such lives! I don't know if this makes much sense, but in their inevitable deaths, they honored life. And, of course, even more so, they honored life in their living. People are so brave, it boggles the mind sometimes. If I had to pick one thing that I'm the most glad I've done in my life so far, it would probably be choosing to visit the nursing home.
In any case, it's a very sad article, with many important things to say. Or, if not many, at least a few. And very appropriate for these Three Weeks/Nine Days, which are traditional periods of Jewish mourning for the loss of the Temple...and everything else. Everything we've ever lost, really.
Another place where it's really hot? Crossing the street behind a bus or taxi, when the exhaust hits your legs or, worse, your face. Bus exhaust is hot! Even when it's already 95 degrees outside. Then, when the exhaust dissipates, you feel nice and cool. Aaaaaah...
On a related note, I stopped by the new Columbus Circle yesterday and was delighted! For those who can't make it, it looked like this:
(Thanks, New York Times!)
It was just lovely. It was very, very hot and disgusting outside, even at 6 pm. But once I was in the middle of Columbus Circle, all that melted away. It was cool and refreshing. It was shaded by the new Time Warner mall buildings (not sure what they're officially called), and the noxious sounds of traffic were drowned out by the water. Children were laughing and playing in the water (some official quoted in the NYT said that they didn't intend for people to go into the water--what were they thinking?), and some adults had rolled up the pants on their stuffy work clothes and had their feet in the water, too. So nice! I wouldn't mind if it was a little bit more green, but Central Park is only a hop, skip, and jump (and a careful street-crossing) away, so I guess that's okay.
The new Columbus Circle is almost enough to make you forget that the city smells like rotting garbage all summer!
Asking Directions in Paris
Où est le Boulevard Saint Michel?
You pronounce the question carefully.
And when the native stops,
shifting her small sack of groceries,
lifting her manicured hand,
you feel a flicker of accomplishment.
But beyond that, all clarity
dissolves, for the woman
in the expensive shoes and suit exactly the soft gray
of clouds above the cathedral, does not say
to the right, to the left, straight ahead,
phrases you memorized from tapes
as you drove around your home town
or mumbled into a pocket Berlitz on the plane,
but relays something wholly unintelligible,
some version of: On the corner
he is a shop of jewels in a fountain
and the hotel arrives on short feet.
You listen hard, nodding,
as though your pleasant
disposition, your willingness
to go wherever she tells you,
will make her next words pop up
from this ocean of sound, somewhat
the way a dog hears its name
and the coveted syllable walk.
If you're brave enough, or very nervous,
ou may even admit you don't understand.
And though evening's coming on
and her family's waiting, her husband lighting
another Gauloise, the children setting the table,
she repeats it all again, with another
gesture of her lovely hand, from which you glean
no more than you did the first time.
And as you thank her profusely
and set off full of doubt and groundless hope,
you think this must be how it is
with destiny: God explaining
and explaining what you must do,
even willing to hold up dinner for it,
and all you can make out is a few
unconnected phrases, a word or two, a wave
in what you pray is the right direction.
— Ellen Bass
I especially like the end of the poem. I do sometimes feel like God is explaining and explaining, and for the life of me, I can't understand. Sometimes I feel like that on a personal level, and sometimes I feel like all of humanity is more or less in that position.
God, what is this world coming to?! I am waiting for an answer.
Updated to add: Thanks to Chayyei Sarah for pointing out this article, and for her (as always) insightful commentary on it. I agree with her. In case you're wondering why this article is particularly depressing to me.