Tuesday, August 28, 2007

This Week in Mississippi

It’s the two year anniversary of Katrina. Two years ago today we were in our minivan, headed away from the terrible unknown, to the safety of family in Maryland. I’m trying not to dwell on it (too much), on the phenomenal failures of initiative and post-disaster planning, on the politicized quagmire, on the losses and missed opportunities. Instead, I present two news items from Mississippi. One is Katrina-related, one is not. I wonder if this will be all you hear about Mississippi this week; have we officially been written out of the Katrina story, as reported in the national press? Prove me wrong, people; prove me wrong.

(1) Mississippi is the fattest state.

Big surprise. Mississippi is also one of the poorest states. The cynics might scoff, “how can you be fat if you’re poor?” But there’s a difference between too poor to eat healthy, and too poor to eat. Fruits and vegetables are not cheap. Taco Bell, 2-liters of Coke, bags of Cheetos, and TV dinners are very cheap. Fried chicken, pork products, and bacon grease come from the cultural and historical roots of Southern cooking, using the cast-off parts and ingredients—again, directly related to poverty and lack of better resources.

Last week I was in the grocery looking for a post-lunch snack. Big ripe Georgia peach: $1.00. 5-ounce bag of Fried Somethings: $1.00. The Fried Somethings would have filled me up more, lasted longer. I did the healthy thing and had that scrumptious, juicy peach. But on a strictly cost basis, the Fried Somethings would have been a better buy. Unless Frito-Lay decides to raise its prices and sell fewer chips, taking a profit cut for the good of society—or if farmers decide to cut their prices and take a profit cut for the good of society (and in the process, go out of business, unless for government subsidies)—then I guess that’s that. Pity.

(2)How many licks does it take to get to the center of a Tootsie Roll Pop?

Reprinted from Waveland Ward 1 Newsletter, from Alderman Lili Stahler:
“An update on the ongoing projects are as follows:
Phase 1 Sewer & Water South of the tracks : completion October ‘08
Phase 2 Sewer & Water South of the tracks : completion January ‘09
Street Replacement South of the tracks : completion February ‘09
Water North of the tracks : completion May ‘08
Sewer North of the tracks : completion June ‘09
Gas : completion October ‘07
Garfield Ladner Pier : completion October ‘08
Library : completion October ‘08"

Four years. It apparently takes three to four years to get to the center of a Tootsie Roll Pop…er, I mean, rebuild the basic infrastructure of a town in these United States of America. Alderman Stahler writes, “Think back to last year at this time. How far we have come!!”

Yes, indeed. Oh, the Thinks you can Think.

Incidentally, a friend of mine is being featured on Oprah’s “Ask Dr. Oz” segment tomorrow (8/29), as well as on the Weather Channel, discussing Katrina experiences. I haven’t seen the interview, but I know the story, and it’s worth seeing if you can.

Tuesday, August 21, 2007

The End of the Ignorance: A Plea

As we approach two years out, a quick perusal of the blogosphere turns up more than a little Katrina backlash going on.

Much of it comes, sadly, from outright ignorance. Let's spend a few minutes, shall we?, responding to just a few of my favorite misconceptions:

"Isn't the Gulf Coast rebuilt yet? The government pumped in $100 billion already!"
Get on a plane to the Coast and you'll see for yourself the status of rebuilding. GulfCoastNews.com has a great article summing up where the Coast is and why it is so far from what any sane person would consider normalcy. They also correctly point out that $100 billion has been allocated; the actual amount being used is far, far less. A major reason I left the Coast was a belief that this recovery is going to take many, many years--I'll now say more than a decade--and I wasn't prepared to sacrifice my sons' childhood(s) to that.

"Those people living in trailers must be plain lazy if they haven't rebuilt their homes yet."
Ah, this one never gets old. For those who insist that there's been more than enough opportunity to rebuild, let's do the math, using some very rough estimates:
* Assume 5000 homes needing repair or rebuilding in Waveland and Bay St Louis (this, of course, leaves out Pass Christian, Long Beach, Gulfport, Biloxi, and New Orleans; I'm confining this example to the area I know best)
* Assume your average contractor has repaired and/or rebuilt 5 homes in the past 2 years (this might be generous, since my experience says a new home takes over six months to build, and almost nothing was started in Bay-Waveland until at least late winter-early spring 2006; then again, not every home needed to be rebuilt from scratch; maybe only a third? Which is actually a staggering number, so we'll keep that estimate where it is.)
* For all the homes to have been repaired within 2 years, that would mean 1000 contractors in the area. Now all of you out there who think there are 1000 contractors in Hancock County, please raise your hands. And that doesn't include the subcontractors and workers. By the time you add it all up, for all the homes to be rebuilt, the area population would have to be comprised entirely and exclusively of construction workers. And then you're left with wondering where they'd be living, since they're busy fixing other people's homes.

This little scenario also assumes that everyone received a fair settlement on their home and can afford to rebuild. Which leads to...

"If I was in that situation, I'd just pick up and leave."
Set aside emotional, historical, and family ties to the area. Financially, many residents are between the rock and hard place and Hell. They still owe a mortgage on a property which in many cases may be a slab. They can't afford to rebuild, since--oh, who knows why, maybe the insurance companies didn't give them a fair shake, maybe they didn't have flood insurance, maybe they didn't qualify for the Mississippi grant program, maybe they already lost a few thousand to a crooked contractor. And they can't sell the property since the real estate market has tanked. There are a record number of properties for sale--and a record low number of buyers. News flash, no one wants to buy a home in Bay-Waveland right now. Did I mention the astronomical price of wind insurance?
Your options? Keep trying to get by, sell the property at a major loss, or foreclose. That's about it. Which would you choose? Oh, by the way, it might be hard moving to a new place with no money and/or no credit...

And, finally,
"You people get what you deserve for living below sea level."
Um, Bay St Louis is 20 feet above sea level. It's actually the highest point on the entire frickin' Gulf Coast. That didn't mean much against a 30-foot storm surge. Which is pretty hard to imagine, but hey, it happened.

Why blame the victims? Why wallow in, and almost gleefully celebrate, the ignorance? Has anyone said those Minnesotans should have known not to trust an old bridge? Were New Yorkers at fault for living in the most prominent American city on 9/11/01? Why haven't we started yelling at the populations of Key West, Miami, coastal North Carolina, Galveston to pick up and leave, MORONS, before the next hurricane strikes and we have to clean up your mess, you crybabies? Why stop there--why should we feel sympathy or even responsibility for a post-earthquake San Francisco, a snow-bound Rochester, a flooded-from-broken-levee Fresno, a water-parched Las Vegas, a terrorist-hit Washington DC?

Is it simply Katrina fatigue? After the emotional drains of 9/11 and school shootings and war in Iraq, do we just have nothing left?

Is the dismal recovery simply too unbelievable to comprehend? Perhaps many Americans have a hard time accepting that the government of their great country could have been so callous and incompetent, and therefore they rationalize and project that the Coast's residents simply must have had a larger role in the current failures.

Or is it about southern rednecks of Mississippi hick-towns and dangerous inner-city blacks in New Orleans ghettos? Who must have been in their pre-Katrina situations due to their own slothfulness and moral failure? Are we in the throes of a neo-Puritanism revival that insists people's destiny is entirely self-determined and not subject to the earthly influences of the material world around them? Or even better, perhaps we'll just go all-out-Calvinistic (and no, don't go all Calvin-and-Hobbes on me, that's not what I'm talking about): these people are poor and uneducated because God has deemed they should be that way! We should no more feel pity on them or help them than we should try to improve the lot of a common dog!

Whatever the motivation behind the ignorance, perhaps the most concerning aspect is the fact that its adherents feel so free to profess it, with vehemence and self-righteousness. Perhaps we can thank Rush Limbaugh, and his protege, Bill O'Reilly, for the decline in courteous civil discourse in America today. Then again, the anonymity of the blogosphere certainly tempts many to more extreme emotions, outright provocation, and a lack of responsibility.

I enter a plea for tolerance, or at least, respect. In other words, stop the hatin'. Don't go spouting off on topics you know very little about; take the time to listen to the stories from the Coast. As anyone who has visited the region--let alone lived there--can tell you, it's all far worse and more overwhelming than you have been led to believe, or can even imagine.

But enough preaching, let alone to the choir. Good night, peace, and God bless.

Wednesday, August 8, 2007

Maybe they should call it SICK insurance...

Much in the same way that life insurance isn't really life insurance--it's death insurance (but who wants to buy something called that?)--what we call health insurance is really sick insurance.

Case in point:
This morning I was reading an article in the AAP (American Academy of Pediatrics) News describing new obesity guidelines to be published later this year. Truthfully, there was little groundbreaking in this article: treat obesity as a chronic disease condition, assess if the family perceives a problem, encourage a sensible diet and one hour of exercise daily (that last one is a little surprising, and potentially problematic: yes, it's recommended, but how many obese kids will do that much? I fear many will hear of such a lofty goal and fuggedabudit. I know I don't have time to exercise an hour a day...though I admit I should...)

The guidelines will also recommend checking up on obese kids every few months. Ah-hah, I thought, another ivory-tower academic recommendation, out of touch with the real world. Who will pay for these visits? Many insurers specifically do not cover office visits that have a diagnosis of "obesity." That's a lot of free care they're expecting us to write off.

Well, just a few paragraphs later, my concerns about ivory-tower recommendations were (partially) rebuked. The article went on to say that insurers need to start paying for visits related to obesity. It added that many insurers do not pay for obesity because they feel it does not directly cause health problems.

To put it mildly, pshaw. That's no different from saying that high cholesterol does not directly cause illness. The association between cholesterol and heart disease is pretty well established--granted, not in the course of days, but certainly over years. (I guess I missed that episode of E.R. where the man came in with a hypercholesterolemic crisis..."get me niacin, NOW, and some statins, STAT!") Let's see an insurer just try to deny coverage for our modern cholesterol-lowering pharmaceuticals.

Of course, paying for doctor's visits to treat obesity ultimately benefits the insurer in the end. Unless they actually don't mind paying for later treatment for metabolic syndrome and diabetes, heart disease, hypertension, bone and joint problems, not to mention the "incidentals" such as arranging for a specialized or open MRI machine that can handle our extra-large patients, extra-sturdy wheelchairs and beds and similar...

The administrators of these companies can't be that stupid. But they're also not that patient. They can't afford to wait 20 or 30 years to reap the dividends of investment now. Because their shareholders want to reap dividends next quarter. Wall Street needs to know what next year's projected revenue will be, and doesn't give much of a hoot about 30-year projections.

Then there's also the fact that there isn't a powerful obesity lobby waging a public relations war on the insurers. It's pretty much just the primary care doctors. Whereas, if the insurers decided to cancel coverage for cholesterol, you'd have the rich cardiologists and the mighty AARP yelling at CEOs within six hours, and the decision reversed in another twelve.

The insurers will cut costs, and coverage, where they can. And preventive care is one of the easiest things to cut. But then, since "health" is most effectively (including cost-effectively) guaranteed through preventive care, don't try to call it "health insurance." At least be honest and call it "sick insurance." And certainly don't try to claim you're in the business of "health care." As was said before, insurers are in business to make money, and it just so happens that they do it in the health care sector. Any health benefits to you, the consumer-slash-patient, are purely incidental.