Wednesday, July 29, 2009

Cindy Goes To The Doctor

One day last March Cindy woke up with a red and swollen eye. Her predicament offers a case study on American’s dysfunctional health care system.

For years Cindy had a comfortable income earned from a small business she operated in the shadow of Noblesville’s clock town. At an ever-increasing price, she bought health insurance. As the price got higher, she accepted an increasingly higher deductible, to the point that her coverage, though it cost $700 a month, was for all practice purposes, catastrophic insurance. She was paying for most expenses out of pocket. But at least she was covered for a major illness.

But last fall as the national economy tanked, so did her business. To make ends meet, she dropped her insurance and joined the other 50 million Americans who have no health insurance.

And then she woke with that eye problem. A pretty small issue, really. She didn’t have cancer, wasn’t maimed in an accident. But her relatively simple problem became an maddening ordeal.

She tried to find inexpensive treatment and went to a local Med-Check center. They said they would charge $150 for a consultation. Sounded high to Cindy. They kindly suggested she try the clinic at Wall Mart. So she did. The Wal-Mart clinic suggested she go to the emergency room.

Her attempt at bargain shopping failed.

Lots of people say competition in health care would bring prices down. But when people have a stroke or heart attack or cut their arm open, or for that matter, get some mysterious inflammation in their eye, they don’t typically go looking for bargains. They look for relief. It’s why competition hasn’t worked very well in health care. You rarely have a couple days to read Consumer Reports or compare quotes from competing doctors.

So Cindy went to the emergency room.

Once at Riverview Hospital a nurse put some numbing drops in her eye.
A doctor came in, examined her for 5 minutes and said he couldn’t help her, but referred her to a specialist. When she left, she asked a checkout clerk what she owed and was told, “We’ll catch up with you next time you come in.”

She drove to the specialist’s office at 146th and Cumberland and after another 5-minute consultation she was given some eye drops. The drops made her eye hurt more. She quit taking them and decided to let nature heal it for her. Which eventually worked.

Then the bills started rolling in. There was a bill from Riverview Hospital for $350 with no itemization or explanation. The ER doctor also billed her $196 for their fruitless 5-minute consultation. That’s a rate of $2,353 per hour (Who does he think he is, a Wall Street banker?). The specialist charged her $100 for his 5-minute conversation that resulted in the eye drops that didn’t help.

So the total bill came to $646 for a lot of driving around, fleeting encounters with doctors, and a treatment that didn’t work. Cindy still doesn’t know why her eye was red and swollen.

Why did Riverview and the ER doctor charge so much? A Riverview representative told me the hospital bills $22 million worth of care a year that goes uncollected. You see, as people complain about “socialized” healthcare plans being considered in Washington, few acknowledge that it’s already socialized. The hospitals, insurance companies, and doctors have done it themselves. They’ve been forced by market realities to charge those who can pay to cover losses caused by those who can’t pay.

The expenses are compounded because those without health insurance tend not to see the doctor when they have a cough or the flu – because they have no coverage, then show up at the emergency room a week later with pneumonia, which is far more expensive to treat than the original illness.

Was the doctor bill high because of malpractice insurance? Research tells us that malpractice insurance, lawsuits, payouts and extra tests run on patients by doctors to protect from lawsuits accounts for only 1% of health care costs. Eliminate that and Cindy’s bill falls by just $6.46.

Cindy called the hospital and the doctors and asked for an explanation of the bill. She was told they’d give her a 20% discount if she didn’t have insurance. Sounds like more socialized, “spreadin’ it around,” to use the parlance of last year’s election.

While Cindy was struggling to understand the bills, Cigna, owner of her former insurer, Sagamore, announced that their 1st quarter profits had tripled to $208 million, which disappointed Wall Street insiders who had hoped for more. According to Forbes, Cigna’s CEO, E. Edward Hanway, earns on average, $15.6 million per year. Which helps us understand another problem for people like Cindy. The goal of most insurers and providers isn’t simply to provide a service, but also and perhaps more importantly, their goal is to earn a profit.

To this day, Cindy still owes the $646, is being threatened that her bills will be turned over the a collection agency, and still, nobody’s asked her if her eye got better.

Facts about American healthcare:
*The Institute of Medicine estimates that 18 thousand people die each year in America because they have no health insurance.
* The United States is the only industrialized country in the world without a universal
health insurance system. -American Journal of Public Health
* Half of all bankruptcies are caused by medical bills. Three-quarters of those filings are
people with health insurance. –Health Affairs, 2006
* There are four times as many health care lobbyists in Washington as there are members
of Congress. -
* According to the UN Human Development Report, while the United States leads the
world in spending on health care, “countries spending substantially less than the US have
healthier populations.… The infant mortality rate for the U.S. is now higher than for
many other industrial countries.”
* A baby born in El Salvador has a better chance of surviving than a baby in Detroit.
The infant mortality rate in Detroit is 15.5, compared to El Salvador's rate of 9.7. -
• Canadians live three years longer on average than Americans do.
* Cubans have a lower infant mortality rate than the United States and according to the
U.N. Human Development Report, a longer average lifespan.
*Americans rank 29th in the world for life expectancy. We tie with Jordan. –CIA World Factbook

Wednesday, July 22, 2009

Where Have All The Young People Gone?

When I first got involved in civic activities in Noblesville in the late ‘80s there were a lot of people my age, fellow 20-somethings participating. Though I served on city committees, Main Street, Benchmarking, the Housing Authorities and other groups, I was most active in the Noblesville Preservation Alliance (NPA).

By the mid ‘90s NPA’s energy was waning. But a new group of young people got involved and reinvigorated the organization, buoying it with fresh energy and ideas.

But since that time I’ve often wondered where all the young people have gone. Yes, NPA has had new people join and become active, but they are disproportionately middle aged or older.

I stopped Noblesville’s volunteer extraordinaire, Nancy Chance one day at Riverview Rehab last year and asked if she noticed a similar lack of young adults helping out at the community projects she’s working on. “This young generation,” she said, “well, they’re not joiners.”

In his book, Bowling Alone, Robert Putnam documented in excruciating detail the many ways volunteerism and community participation is in decline in America.

I wonder if we’re getting a glimpse of the first generation of latchkey kids to become adults. The 20-somethings and 30-somethings of today are the first generation raised, for the most part in families led by two breadwinners or by a single parent. The media dubbed this age group, “Generation X” (GenXers).

When the Baby-Boomer generation came home from school, they’d often run out to make their own fun – organize their own neighborhood baseball, basketball, football teams. Might as well, there were only 2 or 3 TV channels for most folks. And there was an adult home in most of their houses, so watchful parents kept track of what was going on in the neighborhood, which gave parents the comfort needed to let kids roam. Boomers, like their parents were joiners. They went to all the school activities, joined the school clubs, and sat in pep-club blocks so big they filled entire sides of gymnasiums.

But the world Boomers made for their kids, the Generation GenXers would be very different.

Because both of their Boomer parents were working, GenXers were told to come inside and lock the door when they got home from school, a home that might have 30-100 cable TV channels, VCRs, DVDs, computers and video gaming systems. When they went out and were physically active, most often it was in adult-directed sports and enrichment activities – dance lessons, piano lessons, soccer, T-ball, and on and on. In other words, if the adults didn’t have them sequestered in the house, they were driving them to a seemingly endless array of adult-controlled activities.

In the years I taught GenXers in the ‘90s and early 2000s, a relatively small group of kids joined extra-curricular activities compared with my age group in the 1970s. Few of my students saw football or basketball games as the place everyone would be on the weekend. Their fun was fragmented into often-isolated clicks that didn’t just go to ball games, but rented movies, played video games or hung out at the mall.

Could it be that the waning numbers of young adults active in civic groups is just a reflection of the way they were raised?

I used to be encouraged when young couples moved into my neighborhood, figuring they’d get involved and reenergize things. In the past decade I’ve gotten over that foolishness. GenXers lives out their lives behind closed doors.

And as we Americans always do when there’s a deficit of some sort, we create a program or a class to address it. At the school where I once taught, in the early 2000s they began requiring seniors to do community service before graduation. Noblesville did this recently to a class of seniors to make up snow days.

But it’s doubtful we can change young people this way. Some things, like social norms actually do come to us by osmosis. Whatever takes place routinely around us during our formative years imprints us somehow, forming our expectations, motivations, and notions of what’s reasonable. If you’ve been raised with the feeling that your home is an island apart from the community, rather than a part of the community, if you’ve spent most of your time within the confines of that place rather than free to roam around and interact with your community, and if the adults around you guided all organized activities instead of you having the opportunity to form and referee your own teams in the school yard after school and over weekends, well, you’re probably going to interact with the world differently.

It is perhaps unfair to lay this all on young adults. Main Street director and fellow Realtor, Joe Arrowood has been leading local not-for-profit groups for decades. He told me recently, “It’s harder and harder to find anyone to volunteer.”

I do see the current economic downturn igniting some soul searching in young families. A few of my recent GenXer real estate clients tell me they want to live more simply and pursue less consumption, to live a life less dedicated to chasing a bigger car, a bigger house, and more expensive gear for their kids. But whether the resulting free time can spurs a more community-focused lifestyle, remains to be seen.

Wednesday, July 15, 2009

Indiana's Own(?) Michael Jackson

Michael Jackson was a Hoosier. But Indiana didn’t always know what to make of him.

I remember loving the Jackson 5 as a kid. My sisters and me had 45s of “ABC,” and “I’ll Be There.” But when I saved my lawn mowing money to buy a Jackson 5 album, I was disappointed to discover that there were only a couple good songs on it. Having carefully slit the album cover’s plastic wrap, I put the record back in and taped up the slit, then wrapped it and gave it to my sister, Jama for Christmas.

Though disappointed in that album, I recall a tinge of pride when the Jackson 5 put out a song called, “Going Back to Indiana.” In those days, seemed like nobody and nothing famous came from Indiana.

As my musical taste evolved toward folk-rock through my teens and college years, I grew disdainful of soul music and its groups of singers in matching suits dancing in unison. When Michael Jackson went solo and released “Off The Wall,” I was intrigued by the production quality of, “Rock With You,” but my bias prevented me from listening closely. When “Thriller” came out in 1982, again I dismissed Jackson.

But that summer, driving in the car, I heard the song, “Human Nature,” and was dumbstruck. “Damn,” I thought to myself, “this guy is brilliant.” I went back and opened my mind to “Billie Jean,” and it’s relentless, surging bass-line. It is pure pop perfection.

Before that summer, Michael Jackson was just famous, but after that summer, he gained Elvis-like/Beatle-like fame. The kind of fame that destroys people.

Even for all his stage bravado in those heady days, Jackson had a very Hoosier kind of reaction to fame. Think Larry Bird. Think James Dean. Regardless of how he performed on stage, Jackson couldn’t overcome that Hoosier quality of self-deprecation when the performance was over.

Sure, Larry Bird posed for the posters and did the TV commercials, but watch his personal behavior in interviews. He all but apologizes for his success. In the off-screen shots of James Dean, you could see the demurring body language that said, “Awe shucks, don’t make such a big fuss over me.” Never mind he was pursuing and winning rolls with Natalie Wood, Elizabeth Taylor, and Rock Hudson. And my son, Cal just saw Seymour native, John Mellencamp last weekend in Dayton, doing a show with legends Willie Nelson and Bob Dylan. Mellencamp makes his home to Indiana. Why doesn’t he live on the beach in Malibu? Why not a house in London? It’s the Hoosier in him.

Watch shots of Jackson in interviews or just walking down the street, away from his manufactured, near comic roll of pop royalty, you get the sense that just like those other Hoosier men, with hard work and startling talent he’d found fame, but still didn’t quite know what to do with it.

Compare this to Madonna from Michigan or Muhammad Ali from Kentucky. Even when Madonna was off the stage, even when Ali was out of the ring, they both grabbed fame by the throat and knew exactly what to do with a camera in their face and the microphone at their mouths. Though Jackson was full of grand flourishes and public stunts, turn off the music and pull him off the stage, and he inerviewed like, well, a soft-spoken Hoosier.

But as his fame grew and his behavior grew ever more strange, his home state didn’t quite know what to make of him.

When newspapers and local TV newscasts do stories about Ernie Pyle, James Whitcomb Riley, well-known Indiana songwriter John Hiatt, or any other famous Hoosiers, they say, “Indiana’s own [insert name here].” But they rarely described Jackson that way.

World-renowned Hoosier author Kurt Vonnegut got similar treatment. While big city intellectuals applauded Vonnegut’s often-absurd characters, flourishes of science fiction combined with magical realism, and blistering social commentary, many in his home state were left scratching their heads. People were proud of the notoriety, but would keep the hometown-boy-made-good at arms length just the same; “Somethin’s just not right about that boy.”

And there was something not quite right about Jackson. Though he claimed not to have had plastic surgery, he clearly had way too much, and it all seemed aimed at transforming him from a handsome black man into some Hollywood/Madison Avenue notion of the handsome white man. Cleft chin, pointed nose, lightened skin. It didn’t work. From a distance, it read like self-hatred.

Combine that with multiple accusations of child molestation, and well, many here simply avoided calling Michael Jackson, “Indiana’s own,” even though his album “Thriller” sold better than any Elvis or Beatles album.

And so with his death come all the absurd biases accumulated during his remarkable journey from a gritty industrial town in the northwest of Indiana to our radios, TVs, movie screens and supermarket tabloids. Those who deified him ignore his apparent and troubling flaws. And those who demonize him ignore his remarkable talent, rolling their eyes at the fawning and extended TV dramatization of the aftermath of his death.

As is so often the case with the death of cultural icons, how we react to Jackson’s passing perhaps says as much about us it does about him.

How will Indiana remember it’s Hoosier-boy-made-good? My guess is many Hoosiers will gladly re-gift him to Los Angeles with the same conflicted disappointment that led me to re-gift that Jackson 5 album to my sister.

Wednesday, July 1, 2009

Denzel Hufford, 1910-2009

When you saw her working in her yard or strolling down Logan Street, you sometimes had to remind yourself that in her century of living, Denzel had witnessed unimaginable change.

When she was born in a farmhouse on 216th Street, north of Noblesville the automobile was a new and unreliable invention sharing the road with horses, rural telephone and electrical service was sporadic or nonexistent, the recently invented airplane was a rare site and the typical American home still relied on an outhouse. During her lifetime there were two world wars, a great depression and 18 presidents. And during her life she witnessed the creation of radio, television, computers, nuclear weapons, men on the moon, Jazz, and Rock ‘n Roll.

Once you got to know her a little you realized that none of that time was spent sitting in a rocking chair. Her life was marked by a passion for activity.

And I never met a woman with blue eyes more beautiful than Denzel’s.

When Greta and I moved to Noblesville in the mid-‘80s, we became part of a group of young families restoring old houses. Problem was, while people like us were removing the aluminum siding and stripping the woodwork on our homes, we were often living next door to older people who had gladly put aluminum siding on their homes and painted the woodwork.

A lot of the people who made up Old Noblesville, didn’t know what to make of us.

But there were a handful of well-established older folks who gladly joined our group and Denzel was one of them. She didn’t care what her peers thought. She loved things that were beautiful, be it flowers, or music, or old houses.

I recall her telling me once how she went to the Wild Opera house with a hammer and crow bar the evening before it was demolished and tore out one of the fireplace mantels and brought it home to her house.

In 1928 as a senior at Noblesville High School, she was engaged to a West Point Cadet. But when she met big band leader, Red Hufford at the Indiana Roof Ballroom, the West Point man went by the wayside. She married Red and had a daughter named Adele.

Through the 1960s she worked at the Sears catalogue store on the courthouse square. She spent her two weeks vacation each year at the State Fair teaching crafts to schoolgirls.

When my wife, Greta left work to stay home with our children, Denzel taught her to cane the seats of antique chairs. Our daughter, Sally spent many hours playing at Denzel’s house during chair-caning sessions. Sally has a doll that Denzel gave her that was always known in our house as, “Denzel Dolly.”

Denzel’s life story speaks of an openhearted, hardworking soul with a lust for life. When she was over the age of ‘90 she jumped in a carnival bounce house, climbed on top of her refrigerator to wallpaper the kitchen ceiling, and gardened in high heels. Three years ago at Shakespeare in The Park she drank a beer with me. She played in 3 bridge clubs and walked downtown several times a day. She was active in Tri Kappa and Master Gardeners. She’s networked with so many gardeners over so many years; starts from plants in her garden are blooming in yards all over Old Town.

If Denzel wanted to do something, you had to just give up telling her she couldn’t. She wouldn’t listen anyway.

Four years ago, when she was a mere 95, on a very hot summer morning like those we had in the past week, I left my house for the office at 7:00 and saw Denzel tending her flowerbeds. At noon when I came home for lunch I passed her house and saw she was still at work. I parked in front of her house and reminded her to have a rest and some water. She shrugged, “I’m fine.”

Mid afternoon I passed again. She was still working. I parked again and told her it worried me to see her working so long in the heat. Well now she was just plane irritated with me stopping and babying her. “Don’t you have anything else to do?” she asked me. She waved me away and said, “I’m fine, now leave me alone.”

Her daughter, Adele once told me a story that speaks volumes about Denzel’s independent, even feminist spirit. One day Adele came home from school to find Denzel had used an ax to demolish the front porch of their house. Denzel told Adele she did it was because, “When I grew up on the farm, too often men sat on the porch and watched the women work.”

Longevity runs in her family. Her older sister, Gladys died just before her 100th birthday. Denzel told me her long life was due to a steady diet of peanuts and lots of catnaps.

One afternoon a few years ago I found Denzel sitting alone in Noble Coffee & Tea. She was staring out the window at 9th Street with a lost expression. We talked for an hour. She told me at one point, “I’m lonely. All my friends are gone.”

Reaching 99 is a rare gift, but also, sometimes, perhaps a burden few of us can imagine. You gotta be tough. Denzel was.

Having Denzel among us was an extraordinary luxury. She lived long, lived well, saw so much, and did it all with a gritty determination and grace.