Saturday, December 12, 2015

Why single-payer healthcare funding may not work in America

Of course Obamacare is failing.

Not quite as badly as No-Obamacare was failing, so I'm still glad it exists. It's a necessary stopgap until we find a system that actually works.

But you know what? Single-payer healthcare will fail just as badly.

In 2015, U.S. spending is projected to hit $10,000.
Yes, I know that single-payer healthcare systems succeed in other developed nations. I also know that competitive insurance-based healthcare systems succeed elsewhere. But neither system will succeed in the United States, because the U.S. is the only nation on earth that refuses to keep healthcare spending from spiraling out of control. If the cost remains the same, it doesn't matter who's paying. In the long run, we all are.

Many Americans believe that a free market would drive spending down, but the American healthcare mishmash (both before and after Obamacare) is definitely not a free market. Just try finding out what a procedure is going to cost so you can choose the least expensive provider. Even the providers have no idea until they've already signed you up and run your insurance numbers. If you're computer literate and have lots of time and patience, it's possible to get approximate prices for prescription drugs, but what can consumers do about profiteers like the infamous Martin Shrekli?

And anyway, when you're being rushed to Emergency is no time to comparative shop.

Many in the general public scream "Rationing!" whenever any limitation to healthcare is suggested, no matter how sensible it may be (refusing to fund drugs with no proven benefits, for example, or allowing futile, often painful, but expensive procedures for people in the last stages of dying). It's frustrating when we grow up and realize that we can't all have everything we want, but it's rational to make sure that, when something (like money for healthcare) is in short supply, it's apportioned wisely for the common good. Americans are not rational about rationing.

Congress, as the right arm of lobbyists, has no interest in keeping healthcare affordable. They would not pass either George W. Bush's Medicare prescription drug plan or Barack Obama's Affordable Care Act until all threat of price caps was removed. Medicare is not even allowed to negotiate drug prices.

Well, folks,
  • if consumers are unable to do comparative shopping;
  • if we all believe we have a divine right to any healthcare that's available, no matter how expensive or ineffective it may be;
  • if we will not allow our healthcare payers to set price ceilings or negotiate lower prices;
  • and if our lawmakers continue to favor the lobbies who fund them rather than the people who elect them;
of course our healthcare system will fail.

It will fail millions of people who cannot afford the treatment they need. It will fail millions who pay high prices for treatment they don't need. It is failing all of us, since we pay twice as much for healthcare as we would pay in other developed countries.

Until we find an effective way to limit healthcare spending, American healthcare will continue to fail--whether it is funded by private individuals, by competing insurance companies, or by a single payer.

Wednesday, September 23, 2015

A nonpartisan plea to American candidates, pundits, political marketers, and my Facebook friends

Please don't tell me what will work in 2016 and beyond unless you also show me what has worked in previous years, or what is working right now in other countries.

Take healthcare, for example. Don't tell me what will work in some theoretical universe. Show me what is already working in the universe we live in. It's not hard to find information about other countries' approaches, costs, successes, failures, and overall health results. If you want to change our current system of healthcare--and I think we all agree that changes are necessary--how about basing your recommendations on some system that is already more successful than our own? 

Or consider taxes. Forget ideology. Look at our own history. When the highest earners paid a lot more in taxes, did business prosper or lag? When the trickle-down theory became popular, did inequality increase or decrease? When taxes were lowered, did we find it easier or harder to pay for things we value like roads, bridges, and veterans' benefits? When was the average American most prosperous? What was the tax structure then?

Most of us want Social Security to thrive, though we have different proposals for how this should be achieved. To those who think the system should be privatized: how about showing us what happened to pensions when they were largely privatized a couple of decades ago? Who benefited? Who lost out? To those who think earned income over $118,500 should be taxed, how do other developed countries take care of their retirees? Are any of their systems more effective than ours?

Or how about the minimum wage? We all want people to be able to find work that will support themselves and their families. Did American businesses thrive or languish when our minimum wage was proportionately much higher than it is now? Was poverty more or less widespread? Many other developed countries have a minimum wage that is higher than ours. Has this helped or hurt their economies? Has it helped or hurt job-seekers?

Or gun control. Are we safer when citizens are armed, or when they are not? What has happened in countries that have restricted gun ownership? How do our homicide and suicide rates compare to those of countries who regulate firearms more strictly than we do? What proportion of our homicides and suicides are gun related? Do countries that restrict firearms have a large number of criminals who use them anyway? If not, how do they prevent this?

Or abortion, a contentious subject if ever there was one. Instead of positing a paradise (for either conservatives or liberals) where no unwanted child is ever conceived, how about looking at what actually reduces the abortion rate? Which countries have a lower abortion rate than ours? Which ones achieve this without increasing maternal death from unsafe abortions? What policies and practices enable women in the more successful countries to avoid unwanted pregnancies and to raise the children they have conceived?

Or foreign policy, or civil rights, or regulation of financial institutions, or immigration, or education, or the environment, or poverty, or ...

None of these issues are new to Americans. We have dealt with all of them before--sometimes with good results, sometimes not. Why aren't we paying more attention to what has worked, and what has not worked, in the past?

And none of these issues are unique to Americans. Other countries also deal with healthcare, taxes, pensions, wages, firearms, abortion, and a host of other concerns. We can see where they are succeeding and where they are failing. Why aren't we paying more attention to what works, and what does not work, elsewhere?

I'm tired of exhausted ideologies. I'm tired of tear-jerking anecdotes about individuals who illustrate your point of view, or mine (it is easy to find heartwarming or infuriating stories that bolster opposite viewpoints on every one of the issues listed here, but they prove nothing). I want real-life, broad-scale examples from history or from other countries, well supported by reliable data.

The information is readily available. If you want my vote, or my respect for your opinion, inform yourself--and then show me what works. In the real world. 

Thursday, September 3, 2015

Love stories for literati: romances my book-loving friends admit reading

[Forget stereotypical bodice-rippers.
This is the book that got the most
votes from my friends.]
If you wanted to read a romance novel, my friends might not be the first people you'd turn to for recommendations. I've been an English teacher and a book editor, and the people I know tend to have high brows (considerably higher than mine); many of them actually enjoy literary fiction.

Yet when I--inspired by romance novelist Kristan Higgins's eloquent defense of her chosen genre in Publishers Weekly--wanted to branch out and read a romance, I asked my Facebook friends anyway, even though I feared they would limit their suggestions to Jane Austen and the Brontë sisters.

They didn't.

Here is a list of romances, mostly series, recommended by an assortment of bibliophiles including several published writers, some editors, a publisher, a linguist, a bookstore assistant and other dedicated bookworms. "I read them with NO apology," wrote a multilingual physician.
Martin, Deirdre: New York Blades series (Hip Check)
Nicholls, David: One Day
Phillips, Susan Elizabeth: Chicago Star series
Roberts, Nora: Bride Quartet series

Harkness, Deborah: All Souls trilogy

Bourne, Joanna: Spymaster series (The Spymaster’s Lady or The Forbidden Rose)
Gabaldon, Diana: Outlander series, Lord John Grey series
Heyer, Georgette: Regency Romances series (Frederica or The Corinthian)
James, Eloisa: Desperate Duchesses series (Three Weeks with Lady X)
MacKenzie, Sally: The Naked … series (The Naked Earl)
Quinn, Julia: Bridgerton series

Heitzmann, Kristen: A Rush of Wings Series (The Still of Night)
Marshall, Catherine: Christy

Brockmann, Suzanne: Troubleshooters series (The Defiant Hero)
If you'd like a longer list that includes some of these books as well as Pride and Prejudice and Jane Eyre, a retired English teacher recommends that you check out NPR's "Happily Ever After: 100 Swoon-Worthy Romances."

Friday, August 28, 2015

THE BEST MAN by Kristan Higgins

Last week I read an article by romance novelist Kristan Higgins, who is understandably tired of people rejecting her chosen genre without having read a single example of it.

"The categorical dismissal of the most-read genre in the world reveals ignorance, not intellectual superiority," she wrote. "This is a billion-dollar industry, and it’s not built on vapidity and cliché. It exists and thrives because romance authors offer readers an emotional experience that mirrors an elemental desire in life: to find a constant and loving companion; to become our best selves; to forgive our mistakes of the past and learn from them."

I stood convicted: I had never read a romance novel, at least not of the Harlequin variety, and I had no interest in doing so. And yet romance novels, in her description, sounded a lot like the kind of books I'm always looking for. "Our books have happy endings, yes," she wrote. "Our books affirm faith in humanity and preach the goodness and courage of the ordinary heart. We make our readers laugh, we make them cry, and we affirm our belief in the enduring, uplifting power of love. I fail to see the problem here."

I decided to read a romance.

So of course I asked my hundreds of Facebook friends to help me find a good one, and they cheerfully provided an avalanche of recommendations (I've listed them here)--so many, in fact, that I had no idea where to start.

Until it occurred to me that the obvious place to start was with Kristan Higgins herself. Her books' covers looked less embarrassing than most, and she has a series about a winery. I picked The Best Man, book 1 of the Blue Heron winery series, a genuine Harlequin romance.

It wasn't bad.

Faith Holland, spectacularly jilted at the altar, flees upstate New York for San Francisco and makes a career for herself (in an improbably short time) as a landscape designer. But her sister, worried about their father's girlfriend, summons her home, and she suddenly comes face to face with the man who had a lot to do with spoiling her wedding.

OK, you already know how it's going to end, don't you. But if (like me) you are unfamiliar with contemporary romances, you may be surprised (as I was) by the narrator's kicky style, by the abundant laugh-out-loud scenes, and by the numerous chapters told from the guy's viewpoint. In addition, there are a number of mostly funny subplots involving squabbling octogenarians, a sexting middle-aged couple, feckless adolescents, neurotic inhabitants of Faith's home town, totally unsuitable romantic interests... Hey, this book is almost chick-lit, and I'm a big fan of Jennifer Weiner.

But it isn't quite chick-lit. 

Like Weiner's heroines, Faith is a bit overweight, or at least thinks she is. She's about 30 years old, and her romantic life is a mess. Her pajamas are festooned with tiny Dalmatians. Those touches of realism are a plus for Higgins's readers, who can no doubt identify with Faith more easily than with, say, Wonder Woman.

But Higgins also adheres to what I assume are romance conventions that most chick-lit authors mercifully avoid. Her hero, for example, emanates conventional masculinity--washboard abs, hard muscles, a career in both the military (Afghanistan!) and the police force--and Higgins has a hard time not mentioning this every time he walks into a room (this man has "tanned, smooth, muscular forearm[s]" with "little golden hairs" that catch the light!).

There's no graphic sex, but every encounter between hero and heroine ends in either bickering (think Katharine Hepburn movies) or in tingling body parts ("the hot golden feeling was stronger now, pulsing hard"). The hero is obsessed with Faith's gorgeous or mighty "rack," as he frequently refers to her abundant endowment (she, on the other hand, calls it her "boobage"). The attraction between these two is more sexual than romantic, and they are so busy avoiding or sleeping with each other that it's hard to tell if they have common interests.

Unfortunately, the ending isn't likely to be happy.

Oh yes, the girl gets the guy. But this marriage, I'm afraid, is not going to work out. Our hero suffers from various emotional traumas that he does not want to talk about. He opens up slightly, since that seems to be a requirement for keeping Faith; but once they're married, she can probably forget about further revelations. He's not the kind of guy who prizes vulnerability.

Her ex, however, is exactly that kind of guy, and our hero may get jealous if Faith starts spending her evenings with him.

On the other hand, will he even know? Faith has a rather magical career that seems not to require either her physical presence or a great deal of her time, though she's always getting high-level commissions. But as Gilbert & Sullivan pointed out, "When constabulary's duty's to be done, / A policeman's lot is not a happy one." Our hero will continue to work around the clock, which may have something to do with why his first marriage broke up (even if Higgins makes it appear to have been entirely the ex-wife's fault).

When it occurs to Faith that she's married to a guy who is rarely home and refuses to share his feelings, she may stop experiencing the "rush of molten gold [flowing] through her limbs, heavy and electric." And if, as it seems, they have little else in common, what happens to the marriage then?

I enjoyed this book more than I thought I would, though I'm in no hurry to read another romance: the passages intended to be erotic were often unintentionally funny, and the flowing molten gold tended to disrupt the story's flow. I'm glad Higgins spared us the details of the nightly lovefests, but I wish there had been some indication that the man who used to bonk the town slut donned a condom for subsequent couplings, and that the woman who hadn't had any sex for several years was nevertheless using an effective contraceptive.

I was just a little worried that a powerfully built man with four tours of duty in Afghanistan (that he didn't like to talk about), several years as a policeman, and a predilection for "doing" Faith against the wall just might snap someday and abuse his wife or kids.

And, being a retired editor, I really wished Higgins's human characters would stop barking.

Still, finding a life companion, becoming our best selves, learning from mistakes, believing in human goodness and courage and "the enduring, uplifting power of love"--these are indeed good things. Maybe some of Higgins's 13 other books feature characters who achieve these ends without risking their physical or emotional health. Whether or not I ever find out, I wish the fictional Faith Holland the best, and I hope her talented, award-winning, oft-translated, and very popular author will soon break out of the romance mold and write a first-rate, life-affirming novel.

Not because romances are bad, but because Higgins could do better.

Thursday, July 16, 2015

How to restore the glories of the Old South

I have an idea for people who value their region's heritage so much that they continue to wave what they think is the Confederate flag (though it is actually the battle flag of Northern Virginia).

I suggest that they volunteer to be slaves. For life.

Fact: The 19th-century Southern way of life would have been impossible without enslaved people.

Fact: Just waving a flag will not bring back the shady verandahs, the mint julep breakfasts, and the boundless cotton fields enjoyed by rich white people. Neither will it bring back the advantages enjoyed by poor white people thanks to the vast enslaved class that was much worse off than they were (and if you can't imagine what those advantages might have been, read this article written by a Jefferson Davis supporter in 1861).

Probability: The one thing that could bring back that romantic bygone era would be if, once again, some 39% of the population were enslaved (that's the average percentage of enslaved people in the Confederate states).

Proposal: Let's recognize that no one values personal liberty as much as Southerners do. And let's take their word that the Confederate flag has nothing to do with racism. Let's encourage true Confederate patriots, especially white folks who are not racists, to volunteer to work in the fields from sunrise to sunset. There will be no pay, of course, and no bothersome education; but food, lodging, and two sets of work clothes per year will be provided. And the South will rise again.

I realize that the above photo was taken in Oklahoma, which was not a state during the time of the Confederacy. In fact, Oklahoma had a lower percentage of slaves than did the actual Confederate states--perhaps only 14%. So, to be fair, only 14% of Oklahomans will need to volunteer for slavery in order to bring back the halcyon days of yore--546,000 of their 3.9 million inhabitants should do the trick. It won't be hard to find that many volunteers, will it?

Admittedly, it may be harder to persuade 57% of South Carolinians to sign up. To match their percentage of slaves in 1860, they would need 2.75 million volunteers today--but surely nostalgia for the good ole days will eventually move the hearts of the good ole boys, and they'll do the right thing, don't you think?

But wait: as elegant as my proposal appears, it might not work. South Carolina has removed the Confederate flag from its statehouse. Virginia, North Carolina, Tennessee, and Texas have outlawed Confederate flags on state-issued license plates. (So has my adopted state, Maryland, which--though a Union state because federal troops forced it to be--enslaved 13% of its people in 1860). Other states are talking seriously about removing Confederate symbols.

Maybe there aren't enough Confederate flag-wavers to make voluntary slavery work. Maybe the apparently omnipresent flag-wavers are really just a few noisy, annoying people who risk giving millions of really nice Southerners--some of whom I'm closely related to--a bad name. Still, I'm sure that any flag-wavers who do volunteer to become slaves will have no trouble finding masters. And I'm also sure that once their masters take measures to keep them off the streets, the South will be an even lovelier place.

Here's a chart showing the percentage of enslaved people in the 11 Confederate states one year before they joined the Confederacy (I adapted it from 1860 census figures). The first 6 states to join the Confederacy were the 6 with the highest percentage of slaves. The last state to join had the lowest percentage. Once a state's percentage of slaves dropped below 25%, it didn't join at all.

By the way, I'm not accepting any comments, pro or con, for this post. I do hope all my readers recognize satire when they see it.

Thursday, July 9, 2015


My review of A Spool of Blue Thread was published in the April 29, 2015, issue of The Christian Century. I especially enjoyed that novel because I read it just a few months after moving to a Baltimore house only a few minutes' drive from the house in the story. I also enjoyed it because it is about aging parents and their adult children; over the last 25 years I have mysteriously shifted from one category to the other. And, of course, I enjoyed it because it is by Anne Tyler.

The review is behind a paywall, so I'm reproducing it here. If you want to read more of my Christian Century reviews, some 15 or 20 are available (to subscribers only, alas) at their website. My most recent review, of The Anchoress by Robyn Cadwallader, appeared in the June 29 issue. Try the link--it may not be hidden behind the paywall yet.


Anne Tyler’s 20th novel is, like her previous 19, about a mildly dysfunctional Baltimore family of loyal yet infuriating people who love one another, but not always helpfully. It is about youth and age, parents and children, brothers and sisters, ambitions and disappointments. It is about four generations of the Whitshank family and the house they inhabit for some 70 years. Most of all it is about home.

 In the opening scene, Red Whitshank is on the phone with his third child and elder son, Denny, who has just announced that he is gay. A few weeks later Red and his wife, Abby, learn—not from Denny—that he has withdrawn from college.
Denny . . . had withdrawn from the family years ago. What other middle-class American teenager lived the way he did—flitting around the country like a vagrant, completely out of his parents’ control, getting in touch just sporadically and neglecting whenever possible to give them any means of getting in touch with him? How had things come to such a pass? They certainly hadn’t allowed the other children to behave this way. Red and Abby looked at each other for a long, despairing moment.
Fast forward a couple of decades. The other children still live close to home. Amanda is an attorney; Jeanne and Stem work in their father’s construction business. All three are married with children. Denny, on the other hand, has had a succession of short-lived jobs. Apparently not gay after all—his parents can’t bring themselves to inquire—he has a failed marriage and a daughter who only occasionally joins family get-togethers in Baltimore. Red and Abby are still fretting about him.

And then the family dynamics begin to shift. Red, now in his midseventies, has a heart attack. His hearing deteriorates. Abby sometimes blanks out. She starts calling the dog Clarence after a dog that died long ago. At one point she wanders outside in her nightgown and gets lost. The children aren’t sure how to respond: after all, “Abby’s ‘usual’ was fairly scatty. Who could say how much of this behavior was simply Abby being Abby?”

Yet clearly something is amiss, and something must be done. Should Abby and Red downsize? Should they hire help with their daily tasks? Should one of the children move in with them—and if so, which one? And is anybody paying attention to what Abby and Red themselves want?

The caregiving dilemma allows festering resentments to surface. The long-standing push-pull relationship between Abby, “so intrusive, so sure of her welcome, so utterly lacking in self-consciousness,” and Denny, her beloved but baffling prodigal son, has set the stage for intense sibling rivalry to erupt whenever major decisions must be made. Over and over, the two older sisters and the younger brother wonder: Why, when we have stayed nearby and minded the family business, does Denny get all the attention? Why does nobody kill a fatted calf for us? At the same time Denny feels unwanted and disrespected, not only by his siblings but also by his parents. And then tragedy strikes.

A Spool of Blue Thread could have been a novel about the trials of the sandwich generation or the loneliness of old age. Tyler, however, inserts lengthy backstories that distract from what appears to be the main story. “In the Whitshank family, two stories had traveled down through the generations. These stories were viewed as quintessential—as defining, in some way.”

The first story is about how Red’s sister, Merrick, contrived to marry her best friend’s very wealthy fiancé. The second is about how Red and Merrick’s father, Junior, bootstrapped his way out of a three-room cabin in West Virginia, eventually building a thriving business and the house of his dreams in one of Baltimore’s most prestigious neighborhoods. Patience, Tyler writes, “was what the Whitshanks imagined to be the theme of their two stories—patiently lying in wait for what they believed should come to them.” Envy, she suggests, might be a more accurate theme. Or disappointment, because neither Merrick nor Junior finds lasting happiness in what they have acquired.

Abby tells a third story, about the day she fell in love with Red. She tells the story often, always beginning with the same words: “It was a beautiful, breezy, yellow-and-green morning.” Her story is not about patience or envy, but rather about seeing the goodness in an ordinary young man she has known for years. Her story leads to many complications, but never to disappointment: Abby is fundamentally happy. For some reason the Whitshank family does not see her story, along with the two others, as defining.

In Tyler’s books, character is always more important than plot. That doesn’t mean that A Spool of Blue Thread has no plot. Each chapter could, with minor adaptation, be a well-plotted short story on its own, and by the end of the book the longest story—that of the aging parents and their children—is pretty well wrapped up, though book groups will still have plenty of opportunity to debate what’s likely to happen next.

Still, the sudden shift two-thirds of the way through the book from story to backstory, and then to even further backstory, is jarring. At first I thought the book would have been stronger without those interjections, interesting though they were. And then I realized that the book is not just about the Whitshank family; it is also about the house on Bouton Road. Lovingly built by Junior, loved by Abby, inherited by Red, lived in or visited by every Whitshank since 1942, the house becomes a metaphor for the family it shelters. It is a sacramental house, an outward and visible sign of the home within—a place that makes home real, even though each family member has a vision of home that differs from or even conflicts with the vision of other family members.

It is at the end of chapter 4 that Abby begins telling her familiar love story:
On the porch, everybody relaxed. Their faces grew smooth, and their hands loosened in their laps. It was so restful to be sitting here with family, with the birds talking in the trees and the crosscut-sawing of the crickets and the dog snoring at their feet and children calling, “Safe! I’m safe!”
In spite of misunderstandings, irritations, rivalries, and even grief, they are—for a time at least—safe at home.

Tuesday, July 7, 2015

To my SDA friends on the eve of the GC vote on women's ordination

[Norval F. Pease, 1972]
As you prepare for what may well be a watershed decision on women's ordination, I would like to tell you a story. I think it happened in 1972.

My husband was a seminary student at Andrews University. My father, Norval F. Pease,* was a religion professor at Loma Linda University.

My father had a short sabbatical, and my parents came back to Andrews to be near us and to enjoy their two baby grandchildren. One Sabbath afternoon we went to visit our dear friend Hedy Jemison.**

Now Mrs. J was a good and conscientious woman, but flexibility was not her strong point. And my father was a loyal and conservative SDA, but fundamentalism did not appeal to him. For some reason, that Sabbath afternoon the topic of conversation switched to women's ordination. Mrs. J, not surprisingly, was against it.

My father, with a twinkle in his eye, said, "I agree with you that women should not campaign to be ordained." He paused for that to sink in, then continued: "I think men should campaign in favor of women's ordination."

At that point Mrs. J excused herself to refresh our drinks.

I know without a shadow of a doubt that if my father were alive today, he would go to General Conference, and if he were a delegate, he would vote in favor of women's ordination.

*For those who don't remember my father: he had also been, among other things, a pastor, a religion teacher at the College of Medical Evangelists, president of La Sierra College, chairman of the department of applied theology at the Adventist seminary, chairman of the Loma Linda University religion department, and the widely read author of books such as By Faith Alone and And Worship Him.

**For those who don't remember Mrs. J: she was associate director of the White Estate at Andrews University in the 1970s and 80s.