Saturday, April 17, 2010

Health Care Must Be All Heart


What's It to Be: the Commonweal or Me?

APART from comments that the health-care bill is Marxist, which are sheer nutball, can we please tone down the rhetoric? This is a complicated issue, and a complicated bill. Let's try to contain the confusion.


Details
Individual health care taxes, despite charges to the contrary, will be raised only for people earning more than 95 percent of Americans and have "Cadillac" (think "Mercedes") policies, and this does not go into effect until 2013. Then for those making $200,000 and up their medical taxes, deducted or prepaid, will increase from $2,900 to $4,700 (tax rate 1.45% to 2.35%) -- a rise of $1,800 a year or $34.61 per week. (The self-employed are taxed at 2.9% but the rise to 3.8% amounts to the same increase -- $1,800 a year.) That's seven bucks a day -- a cocktail at a motel bar, lunch at a fast-food drive-in. I'm sorry, not outrageous.


Bigger picture
Opponents of this bill, please confront several facts: First, the current system is a mess, giving far too much money and power to middlemen such as HMOs and insurance companies, as well as to certain suppliers such as drug companies and device makers, meanwhile under-serving or outright disenfranchising those with pre-existing or chronic conditions, the unemployed, and the poor.


Second, limiting medical coverage is far more expensive in the long run. Why? The uninsured  don't get checkups or do preventive care, which means small, cheap, fixable problems grow big and expensive before they are addressed; then they use emergency rooms, which is very costly; and pregnant poor women don't get good prenatal care, increasing the risk that their babies will be born with problems society will have to pay for the child's whole life.


Third, since somebody has to pay to cover the uncovered, that  should be those who can best afford it. People making more than $200,000, for example – or $4 billion as in “b,” which the top hedge fund manager copped last year. Corporations. The very profitable drug and device companies. Insurance companies and the HMOs.


Health Care and capitalism
It's become a common refrain that capitalism is efficient, that private enterprise is better at solving problems than public institutions. Why, then, are administrative costs for Medicare and Medicaid much lower than those for privately run health care? Yet some insist that patients be given full choice and become consumers, informed (presumably) buyers in the free market of health-care insurance. The way to such choice, they say, is vouchers, which patients will be free to spend on the health-care provider they select. Beyond the certainty that government vouchers will almost by definition fall short of need, how can a sick person possibly choose intelligently and carefully? The array insurance companies is bewildering. And the medical field is an expert system guided by a powerful code of honor, not an open market ruled by caveat emptor. Such an environment will benefit only owners, bankers, entrepreneurs and possibly shareholders.


That outcome used to be unthinkable in this generous, just country. What happened to fairness? To compassion? Indeed to the medical imperative, Primum non nocere (first do no harm)? Widespread commitment to the common good seems to have succumbed to greed and self-interest. If all we care about is money and stuff and our neighbors be damned, American democracy is over and the American dream is dead.
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Update 4-24-11: A proposed insurance "interchange" passed by the Oregon senate seems a step in the right direction. It puts all insurance providers on a largely federally funded exchange for Oregonians to visit and chose among. But it still does not address those without and probably unable to afford health insurance, some 600,000 residents according to Portland's leading daily, the Oregonian.

Thursday, April 1, 2010

NYU Is Purple Village Eater

Gargantuan Expansion Planned Over Objections

It is most encouraging that New York Univeristy has realized the expansion of its Greenwich Village campus so far has been “marked by piecemeal planning and undistinguished design,” as Times reporter Robin Pogrebin put it (3/24/10) -- to which I and many other Village residents would add, “to say the least.”  And it is gratifying to read that NYU’s president, John E. Sexton, understands his institution has had “a history of moving forward without listening,” and that it now senses “there’s a lot of wisdom in the community.”

But NYU’s dawning awareness that it lives within a vibrant, historically rich, unusually well-educated and accomplished community is less than reassuring in view of its voracious appetite for Greenwich Village real estate, property and housing stock, which will apparently continue unabated, part of the school’s plans to grow by “40 percent over the next 20 years.” 

What still seems lost on the University, and on the city’s development officials, is that NYU  is not merely changing the face of Greenwich Village. It is engulfing large parts of it and in the process transforming one of the country’s – indeed the world’s – great urban treasures into a monolithic university campus. The one-eyed, one-horned, flyin' purple people eater (NYU’s ubiquitous color is purple) is almost certain to destroy the very thing that drew good students and top faculty to what was until recently a middling institution. Lost will be not just “the wisdom of the community” but the community itself. 

Examples, you ask? NYU's new student center, a fatuous decorated box looming over Washington Square Park and blocking part of the once-stunning view down Fifth Avenue through White’s elegant arch. The school’s destruction of the historic Provincetown Playhouse to build a research center for its law school. The school’s fraudulent rescue of the Poe House: after demolishing it and absorbing the space into its new law school edifice, it built a remote resemblance of the house’s façade into the bulding’s own façade, but half a block away. That’s how NYU bends to community, cultural and historical concerns. 

And the future? One example: The Forbes building on Fifth Avenue and Twelfth Street, which will become NYU property in five years. Local restaurants, bars and businesses that benefited from the patronage of Forbes people will have to look to students, faculty and administrators for cultural and economic sustenance. They'll lose affluent adults and gain students and modestly paid academics.

Of course, New York must continually reinvent itself or become a museum, a Colonial Williamsburg on the Hudson, As urban planners and scholars from Jane Jacobs to Paul Goldberger have pointed out. Healthy reinvention, however, demands not destruction but a kind of assimilation: The new kid on the block doesn’t evict everybody and replace them with his friends but works to fit in. Greenwich Village, after all, has quite successfully reinvented itself a few times already on its own -- another reason why it is so loved. 

“For New York to be a great city,” President Sexton intoned, “we need NYU to be a great university.” That statement is precisely backward. New York is already is a great city -- by many accounts, the planet’s greatest. It already has Columbia, Fordham, and the world’s richest array of first-rate specialty and secondary schools.

NYU needs New York a lot more than New York needs NYU.