Sunday, March 31, 2013

Old-Fashioned Correspondence

Last week I inadvertently cc.ed my daughter on an email I sent to one of my women friends. She read the entire long thread of our conversation and then emailed me “Mom, this email reads like a novel.” It was a glimpse for her into the private world of conversation between me and one of my contemporaries who loves to write as much as I do.

Remember the “olden days” when the letters of literary figures, leaders, artists, and others of consequence were compiled and published? When collections of letters were a commonly utilized form of memoir? Back before email, Facebook, text messages, and Twitter, people put more effort into correspondence. When I read the letters of Groucho Marx, I laughed my head off and fell in love with this genius all over again. The letters of Abigail Adams are an essential document of the Women’s Movement. But the art of writing letters, once a unique and respectable literary art form, is dying out.

When I write emails to my children, I try to be as brief as possible. My youngest won’t even read emails if they have too many words in them. I have an adult friend who asked me to keep it brief because he gets lost in my emails if I put too much information in them. So I usually find myself going for brevity. Economy. When Memories from Cherry Harvest was published, my marketing director suggested that I start a Twitter account. That idea didn’t make it out of the gate. I need a bumper sticker that says “What would Tolstoy do?” Not Twitter, I assure you. It is even a struggle for me to keep my blog posts short enough to read in under five minutes.

I love social networking. I enjoy communicating on Facebook in short sound bytes. I appreciate the ability to reach my children with a quick cell phone text message. (Recently I texted Sudi, call me, and he texted back, why?—Oyvay!) It’s surprising how much can be communicated using few words via phone, email, Facebook. But there are some people with whom I still share longwinded meaningful written correspondence, although their number has dwindled. Many people no longer have the attention span for reading  a thoughtful rumination or a detailed story. (I highly recommend a book called “The Shallows” about how the internet has rewired our brains.)

I vow never to lose sight of the fundamental purpose of language, one of our greatest tools for communication and relationship. I have dedicated my life to using words to communicate as beautifully and perfectly as possible; and to using words for transformation, for bringing positive change. I love words, their power, the magnificent things people construct with them. I love working to find the just-right way to say something. And I cherish my correspondences with the few people who still take the time to write well, to spread out in a written conversation, who go fearlessly into description, metaphor, and complex sentences. What a relief for me to write to these hardy few without counting how many words I have used. I find it interesting that to my daughter, in her brief glimpse into the old-world correspondence between us aging women writers (me and my friend), our emails read like a novel. Poetic. Philosophical. Passionate. Unabbreviated. Like a real letter in the mailbox, written longhand, pen-to-paper, soul-to-soul.

Sunday, March 24, 2013

Exodus from Mizrayim

Tomorrow evening, at sundown, is the first night of Passover, my favorite holiday. Passover, as most everyone knows, commemorates the Exodus from Egypt. As the story goes in the bible, the Hebrews escaped enslavement in Egypt under Pharaoh, passed through the parted waters of the Red Sea, and proceeded to wander for 40 years in the desert before entering the Promised Land. Interestingly, no archaeological evidence has ever been found to confirm this story. In fact, there is no hard empirical evidence whatsoever to support the notion that the Exodus is anything more than a terrific narrative, rich with life lessons, a theological fiction. Honestly, what difference does it make if the story is true or fabricated? These days I subscribe to the belief that the lines between fiction and nonfiction blur and in the end all that matters it the story itself; how much of it is true and how much imagined is of little consequence.

One of my favorite topics of study prompted by the Exodus story is the notion of being trapped in Mizrayim, which is the Hebrew word for Egypt, the word used to refer to Egypt in the book of Exodus in the Old Testament. But the Hebrew word mizrayim has other meanings, other connotations, as all Hebrew words do (gotta love this). Mizrayim also means a narrow or constricted place. So Passover is a good time to reflect on what constricts us, what prevents us from fulfilling our potential, from accomplishing things we wish to accomplish, from doing or going or being what we hoped for. What maes our lives narrow? An example of escaping from mizrayim in my own life is the story about how I published The Call to Shakabaz. After years and years of sending that manuscript (and others) off to publishers and agents and receiving nothing but rejection slips, I finally asked myself what was preventing me from publishing a book. I was in a narrow place. I was waiting for affirmation and discovery from the “publishing biz.” I decided to self-publish Shakabaz. Sometimes I think of that choice in this way:  I was a bird that kept banging its head repeatedly against a closed door until I finally flew back away from the door to get some perspective and noticed that next to the closed door a window stood wide open. So I flew through the window instead. Publishing Shakabaz brought me such satisfaction and taught me so much of value about the publishing business that stood me in good stead when a publisher later did choose to publish Memories from Cherry Harvest. I was living in Mizrayim and I found my passage out.

In this Passover season, I resolve to reflect on what is constricting me these days, what is preventing me from accomplishing the things I yet want to accomplish. I resolve to reflect on my current mizrayim and to consider what I can do to step through the narrow places in my life so that I may pass through the Red Sea and move forward in my journey. Truly, does it matter if the Exodus story is real or fabricated when it brings this kind of insight, prompts these important questions, and offers this kind of meaningful nourishment for the spirit?

Sunday, March 17, 2013

How the War in Iraq Gave Me a Book Group

Ten years ago this weekend, my husband, my son, and I marched in San Francisco with nearly 100,000 protestors to send a message to then-President Bush not to invade Iraq. We marched in solidarity with people all over the world who staged mass demonstrations. It was an opportune moment in history when we as human beings could have evolved beyond war and developed new models for peaceful conflict resolution on a global scale. We did not believe the lies about “weapons of mass destruction” and we knew that the war was about controlling oil. Sadly, the opportunity to evolve to a higher level passed and, in spite of our outrage, Bush gave the order and the U.S. military invaded Iraq ten years ago this coming Tuesday.

I wish that I could say that nothing good comes of war, but in truth the War in Iraq gave me one of the most wonderful things in my life:  The Code Pink Book Group. CODEPINK, you may recall, was founded in November 2002 by approximately 100 politically active women. The name CODEPINK was chosen as a humorous twist on the Bush Administration’s color-coding of the level of terrorist threat “alert” that the country was on at any given time. The CODEPINK website (here is the link) describes the organization as follows:  CODEPINK is a women-initiated grassroots peace and social justice movement working to end U.S. funded wars and occupations, to challenge militarism globally, and to redirect our resources into health care, education, green jobs and other life-affirming activities.

The original CODEPINK founders include Nina Utne, Alice Walker, Maxine Hong Kingston, Starhawk, Susan Griffin, Jodie Evans, Diane Wilson, and Medea Benjamin. I know a funny story about their first arrest at the White House. These women, along with many others, established a four-month-long vigil (it ended when the U.S. invaded Iraq on March 19, 2003). I heard Maxine Hong Kingston speak at the Sonoma County Book Festival, where she related the story of the first time that she and her comrades engaged in nonviolent civil disobedience and got arrested. The police told them they couldn’t stand in a certain spot in front of the White House or they would be arrested for trespassing. So several of them deliberately went and stood in that spot. A young Black police officer took Alice Walker by the arm (she was the first to get arrested) and he apologized to her profusely before informing her that he was going to have to arrest her and then he turned to the officer standing next to him and said, “Please don’t tell my mother that I arrested Alice Walker.”

When CODEPINK started the CODEPINK Book Club campaign, my friend Liz was on top of it. CODEPINK encouraged women to form book groups to read books together that focus on ending war and to use the Book Club to open dialogue about peace and justice issues in the U.S. and around the world. Liz called several of her women friends and invited us to form the Code Pink Book Group with her. (Here is the link to the CODEPINK Book Club page.I would describe all of us who were in the original group as liberal and/or progressive in our political leanings (despite the fact that our opinions vary widely). Many of us have been arrested for engaging in nonviolent civil disobedience (myself included) and, of course, we all love to read. How I adore talking about books with avid readers! Over the years, the group has evolved and only three of us original members remain. Liz relocated to Hawaii last year so she no longer attends (although we Skyped her in for a book group a few months ago). We also moved beyond being a women’s group so we include a couple of spouses. By a pleasant coincidence (for me and Ron), quite a few of us in the group don’t eat gluten, so we enjoy an excellent gluten-free potluck meal together at book group.  

We meet once a month to discuss a book that we have agreed to read together as well as anything else we have read and want to share with the group (sometimes prompting the rest of the group to read it). We also talk about films, music, politics, and more. One of the things that I particularly value about the group is that it is a space where I feel safe and comfortable to express my characteristically liberal views without fear of being belittled, of angering others, or of getting into an ugly or fruitless exchange. I also appreciate the intelligence of the group members and their ability to stay on track in discussions and to inspire me to re-examine my own perceptions and ideas. Although we often have differing opinions, we share some fundamental beliefs about the necessary paths to meaningful change and we share a passionate commitment to justice, equity, and nonviolence. Having lost a couple of group members in the past year (one moved away and another has medical issues), we have recently invited new members to join us to enrich and diversify the group. Our core group has been meeting for about four years.

On the anniversary of the U.S. invasion of Iraq, I find myself reflecting on how much my book group means to me and remembering where we began and why. For the curious, here is a sampling of the many books that our group has read over the years and would recommend:
The Storyteller's Daughter  by Saira Shah
Reading Lolita in Tehran by Azar Nafisi
The Lemon Tree by Sandy Tolman
Mountains Beyond Mountains by Tracy Kidder
Meena by Melody Ermachild Chavis
An Unreasonable Woman by Diane Wilson
Persepolis by Marjane Satrapi
A Thousand Splendid Suns by Khaled Hossseini
Diet for a Hot Planet by Anna Lappe
Whatever it Takes by Paul Tough
Hope in the Dark by Rebecca Solnit
Freakonomics by Steven Levitt
1491 by Charles C. Mann
The Round House by Louise Erdrich
Occupy the Economy by Richard Wolff

Sunday, March 10, 2013

Surprise On Impact

This past week I saw the film Searching for Sugar Man about the musician Sixto Rodriquez. The film was excellent, but more than that the film’s subject, Rodriguez, was astonishing. Rodriguez was a Bob-Dylan-esqu folk musician living in Detroit who released two albums in the early 70s. According to many, he was better than Dylan. His poetic lyrics were sophisticated, beautiful, moving, on target, and they inspired political action. Although he was a brilliant musician according to all accounts by those in the music business who knew him, his albums mysteriously went nowhere and he dissolved into obscurity. In America, that is. Unbeknownst to Rodriguez, his music wandered over to South Africa where it went viral.

In the 70s, apartheid South Africa was the pariah of the world and its people were extremely isolated. A white supremacist government ruled the country with the iron fist of fear. Every internal effort to protest apartheid was swiftly met with violent suppression. Enter Rodriguez’s music. The film chronicles how Rodriguez’s music inspired a generation of forward-thinking white youth to courageously oppose Botha’s pro-apartheid regime. His music became key scaffolding for the internal resistance mounted by young whites from inside the country, resistance which was rarely seen by the outside world (then and now). Yes, not all white South Africans favored apartheid.

Musicians in South Africa followed in Rodriguez’s footsteps, writing and performing music of resistance and protest, music that spoke of social unrest, music demanding political change. While no one in America knew who Rodriguez was and it was impossible to find his records anywhere, in South Africa he was bigger than Elvis Presley or the Rolling Stones. Every young white person in South Africa had three central albums in their music collection:  Abbey Road by the Beatles, Bridge Over Troubled Waters by Simon and Garfunkel, and Cold Fact by Sixto Rodriguez. Yet Rodriguez had no clue about this. And South Africans, who knew nothing about Rodriguez, had heard and believed urban myths that claimed he was long dead.

Searching for Sugar Man tells the story of how a couple of persistent South African fans tracked him down and engineered the opportunity for him to perform live in South Africa for weeping admirers who had loved him and his music all their lives. Every white child in South Africa raised in a progressive household knows the words to at least half of Rodriguez’s songs.

During all those years (between 1971 and 1997) before South Africa found him, Rodriguez had continued to play his guitar and sing his songs in private while working extremely hard labor to support his family. A Mexican American, Rodriguez had a college degree in philosophy but he earned a living working in the construction trade. His daughter mentions in the film that she saw him carry a refrigerator down the stairs on his back on many occasions. This is hard to imagine since he seems so slight.

Rodriguez is magnificently humble and lives extremely modestly. He has made some money doing live concerts in South Africa in recent years since his fans found him, but he apparently has given most of that money away to friends, family, and charitable causes. He dedicated his life to political and social change, to justice issues, and to helping those less fortunate individuals among us. He volunteered at homeless shelters and soup kitchens. He ran for mayor of Detroit a few times and lost. He wanted nothing more than to improve the lives of the disadvantaged, oppressed, and disenfranchised. I imagine that he must have thought he was helping people in his own small way by the everyday actions he chose in his life and then, out of the blue, come to find out that he had actually played a key role on a grand scale in turning an entire country around so that millions of disenfranchised and oppressed people were freed and were able to regain control of their homeland. His impact on the abolition of apartheid in South Africa was monumental. How mind-blowing. But Rodriguez appears to have simply taken it in stride, happy that could make a difference, not expecting to be treated special because of it. The film about him won an academy award this year for best documentary. Rodriguez was not at the Oscars. When the film’s director Malik Bendjelloul accepted the award, he mentioned that Rodriguez chose not to attend the awards because, as Rodriguez put it, he was simply the subject of the film and not the one who had made the film. If the meek shall inherit, then the earth belongs to Rodriguez.

Translate this. Our words and actions go out into the world in ways we often cannot imagine; so who among us can ever know the potential ultimate impact of our actions, creative projects, and the work of our hands? Continue toiling my friends, stay inspired and do the work. It could throw a wider arc one day than you ever imagined.

Sunday, March 3, 2013

Beating the Chargemonster: Thoughts on Steven Brill’s Brilliant Assessment of the Health System

Have you read Steven Brill’s brilliant exposé “Why Medical Bills Are Killing Us?” that appeared in last week’s Time magazine? Brill shines a particularly harsh light on the modus operandi of hospitals (those con artists). The article is an eye-opener and I urge you to read the whole thing (link to the article is at the end of this blog). Brill’s article could save you a lot of money. It could save you your house. Or your life. I want to share a few crucial things from Brill’s article that made me shout.

One of the most important things that Brill discussed is the way that hospitals calculate patient fees. Hospitals use an enormous computer-operated system called the chargemaster, which sets the costs for everything from doctor services to gauze pads. Apparently no one in the health industry has a clue how the chargemaster actually works or even exactly what it is. I think of it as an extra-terrestrial beast that lives in a giant computer and absconds with the life’s savings of 70% of the American middle class. I have renamed it in my head the “chargemonster.” Hospitals feed like leeches off patients by over-ordering tests, such as X-rays, blood and urine work, CT Scans, MRIs, etc. Doctors order these like crazy all day every day for patients during their stay in the hospital and they also over-order them for patients receiving outpatient care and ER services. Brill mentions a person who was charged more than $4,000 per day for blood tests during his hospital stay. That $4,000 was calculated by the chargemaster. The chargemaster puts a price on everything a patient uses or accesses while in the hospital. For instance, the chargemaster at Seton Medical Center in Daly City, California charges diabetic patients $18 each for blood sugar test strips when a box of 50 test strips costs less than $30 at the pharmacy. Hospitals charge patients (at arbitrary overblown chargemaster rates) the purchase price for gowns worn by the operating room staff, even though these gowns are laundered and reused. Beware:  the chargemaster is likely to charge you $5 for one ibuprofen.

Brill explains that a hospital bill is simply a starting point for negotiation, and most people don’t realize this. The bill is based on the crazy chargemaster rates. Insurance companies negotiate with hospitals about what they will actually pay based on real costs for things; and hospitals compromise. Medicare negotiates best of all because (after researching the real price) they have the ability to state the real cost and then tell the hospital that’s what they will pay. Medicare pays much less than the chargemaster rates for everything, except for pharmaceuticals, because federal law prohibits Medicare from negotiating the cost of drugs (and that’s a problem that needs to be fixed, according to Brill). Ordinary people can also negotiate. I have always done this. I call a health care provider when I get the bill for my portion of the cost after the insurance has paid their portion. I say that I have to pay this out of pocket and I ask if they can reduce it. Usually they do. And if it’s for more than $100, I set up a payment plan because they don’t charge interest so it’s cheaper for me to make payments directly to the health care provider than to my credit card. Just last year I negotiated an emergency room bill down by $1,200 and negotiated the separate doctor bill down by $600. Brill reveals in his article that people with seriously outrageous hospital bills are now hiring “medical billing advocates” at $100/hour to bargain their bills down. Wow, I could probably start a new career as a medical billing advocate. This whole scenario reminds me of that Monty Python routine where the merchant has a fit because the buyer hands him money while the merchant wants to bargain. “No, no, no, you’re supposed to haggle,” the merchant tells the buyer, refusing the money.

Maybe the most important part of Brill’s article is when he talks about the fact that hospitals don’t lose money on Medicare patients. Jonathan Blum, deputy administrator of the Centers for Medicare and Medicaid Services, provides proof that hospitals make enough money to cover the cost of serving Medicare patients (in fact they make a profit) and he says that hospitals actively recruit Medicare patients. Blum says that if you doubt him, you should drive through central Florida and notice how many hospitals post ads on billboards in their effort to recruit more Medicare patients. So Brill suggests, if this is the case, why not extend Medicare to everyone and pay for it all by charging people under 65 equivalent premiums to what they would pay to private insurance companies? (Duh, ya think?) Brill lays out a compelling argument for the single-payer approach to health care, which is used by most developed countries. How long do I have to wait for people to stop watching Fox News long enough to read Brill’s article and evolve a basic ability to comprehend how the health system works (or doesn’t) so they quit freaking out over the perceived “socialism” of a single-payer system? Argh.

Get this:  there are nearly 3,000 nonprofit hospitals in the country and they don’t pay taxes. They are making money hand over fist while sending patients to financial ruin. What do they do with their profits? They pay their upper echelon executives and administrators obscene salaries, they buy more equipment, they build more buildings for their medical complex, they buy rival hospitals (to create a regional monopoly on services), and more. When the New York Times ran a story about how a federal deficit deal could reduce hospital payments, Steven Sayfer (chief executive of a nonprofit medical center) angrily told the media that reductions in hospital payments would result in reductions in services to patients. Sayfer earns $4,065,000 a year, his CFO earns $3,243,000, his executive VP earns $2,220,000, and the head of his dental services earns $1,798,000. I would say that they could make up the difference in any reductions in hospital payments by scaling back some of their administrative costs, wouldn’t you? For a nonprofit, Sayfer’s hospital is making an awful lot of profit.

It really pissed me off to read about nonprofit hospitals asking for charity. They hold fancy fundraisers and mount direct mail campaigns to solicit donations. But actually, the amount of income these nonprofit hospitals make from charitable donations is less than 1% of their income. They go begging because they can make money at it and because they like to maintain their image as charitable organizations. Furthermore, hospitals boast about how much charitable care they provide (and talk about how federal hand-outs to hospitals will impact this charitable work), but the actual dollar amounts they come up with for their charity work are far beyond what it really costs them to provide services for free to impoverished individuals because they use the inflated chargemaster prices to calculate how much charity they provide. While in truth, the actual cost to them of serving charity patients is a fraction of what they say it is. A hospital lobbyist in Washington recently declared that hospitals provided nearly $40 million in charitable care for the poor last year. But the actual cost of that care was more like $5 million when recalculated at real costs (by Medicare) as opposed to chargemaster-calculated costs.

I could go on, but this blog post is getting long. Brill offers his suggestions for beginning to fix the broken system, and they are very, very good suggestions. My favorite is extending Medicare to everyone in a single-payer system. But check out his article to see what he says. Here is the link to the full articleonline. It’s long. Take your time. I predict that this will be considered the most important piece of journalism this year. Brill should win a Pulitzer for it.

Heavy blog this week. Here's some bonus material. This will give you a laugh!
The Washington Post's Mensa Invitational once again invited readers to take any word from the dictionary, alter it by adding, subtracting, or changing one letter, and supply a new definition. 
Here are the winners: 
1. Cashtration (n.): The act of buying a house, which renders the subject financially impotent for an indefinite period of time.
2. Ignoranus: A person who's both stupid and an asshole.
3. Intaxication: Euphoria at getting a tax refund, which lasts until you realize it was your money to start with.
4. Reintarnation: Coming back to life as a hillbilly.
5. Bozone ( n.): The substance surrounding stupid people that stops bright ideas from penetrating. The bozone layer, unfortunately, shows little sign of breaking down in the near future.
6. Giraffiti: Vandalism spray-painted very, very high
7. Sarchasm: The gulf between the author of sarcastic wit and the person who doesn't get it.
8. Inoculatte: To take coffee intravenously when you are running late.
9. Osteopornosis: A degenerate disease. (This one got extra credit.)
10. Karmageddon: It's like, when everybody is sending off all these really bad vibes, right? And then, like, the Earth explodes and it's like, a serious bummer.
11. Decafalon (n.): The grueling event of getting through the day consuming only things that are good for you.
12. Glibido: All talk and no action.
13. Dopeler Effect: The tendency of stupid ideas to seem smarter when they come at you rapidly.
14. Arachnoleptic Fit (n.): The frantic dance performed just after you've accidentally walked through a spider web.
15. Beelzebug (n.): Satan in the form of a mosquito, that gets into your bedroom at three in the morning and cannot be cast out.
16. Caterpallor ( n.): The color you turn after finding half a worm in the fruit you're eating.