A Brief History of the Promenade

A typical gathering, with boys in tuxedos, and...
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Telling a teenager the facts of life is like giving a fish a bath.  ~Arnold H. Glasow

It is a night unlike any other in America.  It is twelve hours of paradox with one generation holding a candlelight vigil terrified by the combustible fusion of immaturity and immortality.   Off in the distance another generation dives headlong into a mosh pit of tuxedoed kings and gowned queens eager to erase eighteen years of privation.  It is prom night. 

Prom is a seminal life event for most American teens.  For some, the memory of a prom is a private scar or missed opportunity.  For others, it is a wistful breeze of emotion that floats in on the scent of a gardenia.

Most academics contend the origin of the prom is British and relates simply to the concept of the promenade – a long parade of guests who would parallel into a ballroom or gathering area at the beginning of a social event.  Escorts and debutantes would arrive in six horse carriages, the 19th century equivalent of a stretch limo, to socialize and dance.  It was a patrician affair where one would exhibit their breeding, etiquette and possibly end the evening donning a Victorian lampshade for a few cheap laughs.   

Anthropologists dismiss Anglo claims of the United Kingdom as the epicenter of the prom.  Researchers have traced the actual first prom back to a period dating to the Pleistocene and the lower Paleolithic periods when the first members of the family of man walked the planet. The term “prom” was actually a collective noun used to describe a gathering of mixed gendered adolescent Homo erectus.  

Reconstructing these gatherings has proven difficult, as the teens seemed to gather in one place and then move unpredictably – usually to the leeward side of a granite outcrop or thicket of trees.  “We surmise” muses Timothy Pimthwaite of the London Anthropological Society, “that these proms of juvenile hominoids would gather, secrete some sort of pheromone which would in turn, arouse the group and attract more hominoids causing a frenzied series of interactions and mating behaviors.  Within minutes, the groups would move out of sight of the adult Cro-Magnons – as if hiding or experimenting with brief independence.  The youth would seek protective cover from prominent landmarks such as caves and thickets. A few industrious ones even climbed trees.  What they were doing has never been documented. 

It was in these thickets that one anthropologist encountered discarded hollowed out gourds which male researchers assumed were primitive cups that held some sort of nectar.  One female researcher, who also happened to be a mother of five teenagers, quickly surmised that these were in fact, the first Stone Age beer cans.

Researchers theorize that the formal pairing of adolescents to celebrate prom as “dates” was a relatively recent phenomena dating back to the 1890s when British men got tired of attending dances with other British men  — as no self respecting Victorian woman would actually be seen “ dancing”.  This was also the golden age of British pantomimes where male actors would dress up as women to entertain audiences with silly skits and stories.  Given that the Queen Victoria resembled a man made all of this same gender activity remarkably good form. 

However, it took a nudge from the continent to move the Brits off of same sex proms. The first co-ed prom took place in the Austro-Hungarian Alsace in 1914.  The teenage graduation party was a smashing success.  Unfortunately, many of the youths got drunk at a local Hofbrau house and in a fit of patriotic fervor, the boys and girls carried their party into neighboring France and occupied a French village for a week, escalating tensions between the Hungarian Empire and France.  A week later a Serbian shopkeeper whose windows had been broken in the post party melee, shot arch Duke Ferdinand, whose son was one of the lead-offending vandals, sparking WWI.  It seems even then, kids did not understand the consequences of their actions and adults ended up footing the bill.

The prom disappeared for a few years as most kids graduated and were immediately sent off to Flanders to fight.  For a few years, only girls and flat-footed, deaf men were attending proms.  In 1919, the prom entered its golden age as returning soldiers and high school sweethearts were reunited in church halls to give thanks for the end of the global conflict.  The prom became a dignified and respectful affair with ballroom dancing, fruit punch and prayer.  Other than the occasional Catholic sneaking into an Anglican church to spike the punch or bribe the bandleader to play “The Vatican Rag”, things moved rather smoothly into the early 20th century.

In the 20’s, the prom became immensely popular among elite colleges and finishing schools.  In industrial America, most teens bypassed higher education to work and as a result, the prom went private.  In the era of F Scott Fitzgerald and Jay Gatsby, tuxedos and fashionable gowns gained a foothold – transforming the tame Puritanical dance into a patrician orgy of celebration. It was during this decade that teens started to wear increasingly outrageous ensembles as a form of misguided self-expression.   This unfortunate period is now classified as the “ dark age of fashion “ and at its nadir, the purple tuxedo was born. 

Proms carried on.  There were triumphs and tragedies as generations gathered for a fraction of a lifetime – one night – and then went off to college, work, wars and distant hard lives that would carve deep lines in the faces of these young adults so full of life.  There were auto accidents and drug overdoses compelling parents to leave their homes and anxiety-ridden vigils and engage to help shape the evening’s festivities so that the teens might enjoy their rite of passage but make it safely home the next day. 

Fifty years later in the 70’s, there would be nostalgic revival of late 20’s fashion fiascos. In one instance, critics described a black polyester and chiffon gown as only fit for someone “dressing like a centerfold for Farmer’s Almanac Magazine” and abused another rhinestone ensemble as a “ truck stop fashion tragedy. “  Combining these sartorial train wrecks with mullet and feathered hairstyles hijacked the prom into a new territory.  It was no longer a tradition to be meticulously honored but a generational annual rite of self-expression.  

Certain accoutrements have resiliently survived the years of metamorphosis.  The fragrant corsage and the boutonniere known as the “man flower” remain important accessories even into the 21st century.  The prom is now a well-oiled machine where communities and parents organize to build safe environments where teens can roam and forge a personal album of memories.  Text messaging, cell phones, helicopter parenting and electronics have supplanted word of mouth, massive amplifiers, speakers and telephone trees of overly paranoid parents.

Yet time waits for no man.  Each prom, like Dickens’ Ghost of Christmas Present has a life span of 12 hours. The early morning light enters somewhere off in the distance like a theatre cleaning crew reminding the actors and actresses that their passion play is concluding.  A young man sits exhausted as his date lays her head on his shoulder and falls asleep.  The smell of her perfumed hair and warmth of her breath on his neck stir a restless flutter that grows and seeks to express itself – – out of his body, out of his town and beyond his adolescence. 

There is a swirl of lights – a merry-go-round of time and motion.  The chrysalis breaks with the dawn and the butterflies are released into the wild. They float off into the morning mist – graceful and invincible.  Some may not return to this place.  Others will faithfully return like swallows every five years to remember.

Yes, it was the prom and it was their time.

To The Class of 2009

To The Class of 2009 

Education is an admirable thing, but it is well to remember from time to time that nothing worth knowing can be taught.” ~Oscar Wilde

Graduation is nearly upon us and another litter of free-range kids will be released into the wild to hopefully live and prosper.  Graduation ceremonies are critical passages for students, parents, family and friends.  It is a time to feel incredibly proud and terribly old as another milestone is kicked over like a garden gnome in the backyard of life. 

We are christening human vessels as they leave the safety of our ports on a sacred mission to become adults and societal change agents.  Class of ’09, I’d like to add my two cents.  After all, this is the generation that will likely be running the country when I am calling for my assisted living caregiver because I am concerned that the Three Stooges are hiding under my bed.

These young, sturdy ships are going to sea in a force ten gale – a time of global, domestic, economic and social upheaval – it’s the 1930’s minus the 1920’s plus the 1960’s minus the 1970’s.  Let’s see, that would calculate to, just a second, let me pull out the old HP — hmm, the answer is zero with only American Idol and Desperate Housewives left over.  Actually, the calculus of predicting the path of this perfect storm is too much for my tiny brain.  But, as this armada of young men and women slides into the water to sail to new ports of higher education or employment, I offer this advice from a seasoned sailor.  Don’t mind my scars, eye patch and peg leg.  They are badges of honor – earned in life’s battles or incurred at one of several Grateful Dead concerts. I offer as my graduation gift, a tapestry of quotes and ideas that have influenced my life.  These nuggets were mined through hard labor in the quarries of life or handed down to me as by 19th, 20th and 21st century writers, leaders, philosophers, gadflys, comedians and state troopers.

“Class of 2009, you stand before us today as explorers ready to navigate the vast, unfathomable world of mankind. Just remember that the “no one can make you feel inferior without your consent” [1] and years from now, you will return to your high school reunion and say to yourself, “I can’t believe I let that jerk make me feel bad about myself”

Understand you know less about people than you think. “The only normal people you know are the people you do not know very well.” [2] As you go out into the world, remember everyone lives in a house filled with bright drawing rooms for their public face and dark closets where they hide their private dysfunction. Your task in life is to be the same person always – for the more you attempt to project a different person than you see yourself to be, the harder it will be to one day find your true self or pants that will fit you. Your goal in life is not to get ahead of the other guy, but get ahead of yourself – unless you are running in flip-flops. Great people understand they only can control how they react to life, not control it.  Always ask about the benefits plan and if a first year bonus is guaranteed.

“If you want to make God laugh, tell him about your plans.”[3] My advice is install a screen saver on your computer that says “ Dear (your name), I won’t be needing you today, Love, God. “  For you atheists, agnostics and armchair cynics, there is a God, and she does not need your help.  There are no burning bushes, only people who decide to make a difference and of course, Redsox fans.

When you decide to take on a task and later when you go into the workforce, understand that “if you aren’t fired with enthusiasm, you will be fired with enthusiasm.”[4] You have to become knowledge workers as you are competing with a flat, hot crowded world of two billion peers who want your job and believe it is time that you wait on their table and rake their leaves.  Most of those competing with you did not spend last night watching old re-runs of Jackass, texting friends, twittering, ichatting or Facebooking.  They were doing math and science and actually liking it. They are intellectually hungry, well trained and eat fewer calories in a day than many of you eat in a meal.

Everyone you meet in life is significant and is a merely a different model manufactured on the same spiritual assembly line.  Everyone deserves your attention and respect – especially your art teacher. Smile and say hello to everyone. People matter and their lives matter.  Don’t allow yourself to dehumanize anyone.  Every man, woman or child’s death diminishes you whether it is in Danbury or Darfur. Look everyone in the eye and have a firm handshake. Learn the names of the people that pick up your trash, serve you food, drive your bus, clean your living areas, collect your tolls and serve your community.  “What is a city but its people”[5]

Do not borrow class notes from anyone who watches the View or has suffered at least four concussions. Don’t sell yourself short.  A person who doubts herself/himself is “like a man who would enlist in the ranks of his enemies and bear arms against himself. He makes his failure certain by himself being the first person to be convinced of it.”[6]

Learn about life and cultures outside America.  “To first understand the world, you must understand a place like Mississippi.”[7]We are 300M Americans on a planet of 6B people.  Be proud to be American and don’t feel the need to apologize for who we are when you travel abroad.  Don’t think less of America, just think of it less of the time. Seek to understand before being understood. Do not be one of the 92% of Americans who does not possess a passport and has not been abroad.  Visit a Muslim country.  Go to China.  Study the teachings of all the great prophets.  Visit Arlington Cemetery and never lose respect for our military.  Go to John Lennon’s grave and never lose respect for peacemakers. Never kiss a cannibal. Use Purell – often.

Remember that we are not driving the celestial car and that our best intentions and self-will often unintentionally take us into bad neighborhoods.  Be careful what you wish for.  Pray for courage and wisdom to effectively play the cards you are dealt and don’t whine about getting a poor hand – you can always bluff.  Don’t catastrophize your circumstances.  The worst-case scenario is that you become Paula Abdul and that is highly unlikely.

Have fun and remember these are the best years of your lives.  “It is indeed ironic that we spend our school days yearning to graduate and our remaining days waxing nostalgic about our school days.”[8]“At some point, your broad mind and narrow waist will begin changing places”[9]and the dreaded day will arrive where you will become your parents and they will become your children. Do not drink alcohol before 6pm and never order any drink called a “ Snake Bite”.

The very worst sin of all is self-centered fear.  Self-centered fear opens the Pandora’s box of all of our character defects causing one to compromise their true character by lying, cheating, stealing or voting Republican purely out of self interest. Be kind.  Say “I am sorry” and mean it.  Never gamble your sophomore year semester’s spending money in a Lake Tahoe casino. Look for ways to serve others and in losing yourself in service, you will become a person who is more beautiful and capable than your wildest imagination could have dreamed.  You are a super hero whose only kryptonite is self-doubt and a poor eating habits.  Do not sign up for any college class before 11am.

Read a translated book written by an author from a foreign country.  Study history – it is a distant mirror reflecting ourselves.  Loathe war but support our troops.  Vote with your heart, not your pocket book.  Sleep under the stars but use a mosquito net.  Never try to outrun the police in a Ford Granada. 

And finally, “never, ever hire an accountant named Frenchie”[10]or an investment advisor named Bernie.

Good luck and Godspeed


[1]  Eleanor Roosevelt

 

[2]  Oscar Wilde

[3]  Woody Allen

[4]  Vince Lombardi

[5]  William Shakespeare

[6]  Ambrose Bierce

[7]  William Faulkner

[8]  Isabel Wilson

[9]  Winston Churchill

[10] Woody Allen

Music and Lyrics

Music and Lyrics

I am a child, I’ll last a while. You can’t conceive of the pleasure in my smile.

You hold my hand, rough up my hair, it’s lots of fun to have you there.

God gave to you, now, you give to me, I’d like to know what you learned.

The sky is blue and so is the sea. What is the color, when black is burned?

What is the color?

I am a Child, Neil Young

The band was Buffalo Springfield – Bruce Palmer, Neil Young, Stephen Stills, Richie Furay and Jim Messina.  It was 1968 and they had released what would be their final album – The Last Time Around.  A teenaged hippy baby sitter named David was watching us for the evening.  I am certain when my father saw him in his psychedelic shirt and Birkenstocks, he mourned for the future of America.  The teenager was holding a number of record albums under his arm. “ Hey, little dudes”, he cooed as he flipped back his hair, surveying the four boys under 13.  My dad gave my mother that one last “ are you sure about this look”.  She smiled.  He was the oldest son of one of her dearest friends and was a great kid.  “ let’s go, Miles” she said.

Within seconds of my parents reversing onto the street and driving off toward some exotic liaison with other adults in a land of tinkling martini glasses and swirling perfume, the loading mechanism was dropping an LP on to the rotating turntable.  Richie Furay, Stephen Stills and Neil Young initiated the first track called On The Way.  As David grinned and fell into my father’s favorite lounge chair, I gathered on the floor and listened.  Eight songs later, a gentle harmonica led Neil Young into a soft ballad about being a kid.  “ I Am A Child” was the first melody where I can recall hearing the lyrics that were about me and how I felt.  The question of “what is the color, when black is burned?” came to symbolize for me a unfiltered world filled with innocent wonder.

Someone once reflected that “music is what feelings sound like.”  When you become a teenager, music, lyrics, books and perhaps your best friend are the only things in life that can be trusted.  As a writer filled with teenaged angst, I fashioned myself a lyricist and wrote bad songs – I mean, really bad songs, inspired by a counter cultural generation of poet songwriters who used words and music as a wedge to liberate feelings that lay trapped behind a generational door.  Whether it was Jackson Brown warning me that the “ the (earth’s) fuse was burning” or Stephen Stills reminding me to savor “ those top down nights when the air was red wine”, these sages of song seemed to know what lay ahead on the highway of life.

My first exposure to the mystical power of the lyrics was in 1977 on a silky Southern California summer night as we sat in my friend Phil’s bedroom screwing up our courage to play the White Album by the Beatles backwards.  It was rumored that the Charles Manson and his blood thirsty “family” had slaughtered Leno and Rosemary LaBianca along with actress Sharon Tate after hearing hidden messages on the White Album’s Revolution Number Nine.  “ If you play it backwards, the song says, ‘turn me on dead man’.” Sean warned.  Our other friend Brian nodded, knowingly. He was clearly disturbed by our experiment.  It was if we were playing with a Ouiji board on his grandmother’s grave.  He and Sean were devout Catholics and this all seemed like some great cosmic felony to be gathering like devil worshippers to play an LP that divined satanic messages to druggies and psychopaths.

We turned the record in reverse and slowly increased the volume.  It was scratchy at first- perhaps sounding the way Thomas Edison’s voice groaned as he invented his talking gramophone.  But, I could hear it, amidst the swirling mayhem of anarchic music in reverse – a ghostly moan repeating: “ Man-yon-min–man.  Man-yon-min-man”.  In retrospect, it was complete gibberish.  But at that moment, as I looked Brian, who sat like a stupefied granite statue, I felt a cold chill.  Had we sent some demonic homing signal into the night that could only be heard by murderers and long haired Satanists.

“ Did you hear it? He whispered.” I heard it!”  Not wanting to be left out, I agreed that the cryptic modulation could have been from beyond instructing us to go out and wreak mayhem on capitalists – whatever those were.  Just then Phil’s Mom stuck her head in the door and we all jumped ten feet into the air, looking guilty as if we had been caught using bloody chicken feet to outline pentagrams in some secret Satanist ceremony.  “Boys, it’s time to ride your bikes home.  It’s getting late and Mrs. O’Brien just called.” We looked outside and realized that the lingering afternoon had descended into sinister night.  “ You guys gotta go.” Phil confirmed. It sounded like a death sentence.

Brian and Sean disappeared together under weak, intermittent streetlamp light that barely fought off the shadows that sought to take over the empty road.  A van passed slowly and seemed to hesitate as it rolled by.  I was suddenly convinced that the entire Manson gang was following me home ready to plunge forks into my body and carve Helter Skelter in my rear end.  On that fateful night, I broke a land speed record covering three miles on a ten- speed while making countless deals with God that in exchange for my safe passage I would never tamper with the occult or malevolent lyrics again.

Yet, while others devoured music, I savoured the lyrics.  While people fawned over Dylan, I drank in the truth of Simon and Garfunkel and became a closet acolyte of Paul Simon, the songwriter– an oracle who lived in a province governed by emotions and physical forces.  In my lifetime, his lyrics have led me through the ghettos of Soweto and into the lives of the inspired, lost, indigent and misunderstood. “Kodachrome” reminded us how we gild the colors of our past and “ Me and Julio” introduced us to Mama Pajama in a Puerto Rican neighborhood. He urged us to go look for “America”.

Lesser known artists created singular works of art – testimonials to the marginalized of their generation.  Janis Ian summed up the broken glass and dark corridors of adolescence in “Seventeen”: “I learned the truth at seventeen. That love was meant for beauty queens, and high school girls with clear skinned smiles who married young and then retired. The valentines I never knew. The Friday night charades of youth were spent on one more beautiful. At seventeen I learned the truth. And those of us with ravaged faces lacking in the social graces, desperately remained at home, inventing lovers on the phone who called to say ‘come dance with me’ and murmured vague obscenities. It isn’t all it seems, at seventeen. “

John Lennon’s “Imagine” challenged us to think about a world devoid of war and hate. Don McClean’s American Pie became an anthem to America and rock and roll. Jim Morrison’s tortured literary genius was posthumously set to music and released by former band mates Robbie Krieger, Ray Manzerek and John Dunsmore in An American Prayer.  I feasted on every offering of free verse, attempting to conjure up my anthems to the sacred and the profane – dead Indians, women in ginger nylons, angels and sailors.  This turned out to be more difficult to accomplish in a sedate suburb cocoon where ballads about men with leaf blowers, postmen gone bad and car pool moms who choose to turn left and never look back did not seem to capture the imagination of anyone except perhaps, a child psychiatrist. I would have to wait until life led me into darker, rugged places where the raw minerals of insight and truth could be mined and forged into lyrics that could change the world.

I continued to listen between the lines of the music.  I became a boorish anthology of stories and useless anecdotes about the genesis of songs and the truth behind the music.  My world was shattered one evening when watching a special on the 60’s band Iron Butterfly.  The song, Indagaddadavida, soared up the charts in 1968 and was heralded as the convergence of psychedelic rock and heavy metal – a fulcrum moment in the evolution of the school of rock.  The seventeen minute song was analyzed, memorialized and canonized by legions of bobble headed burn-outs in search of truth and a party.

Years later, band members drummer Ron Bushy and Doug Ingle purportedly admitted that the title song was really intended to be called “ In The Garden of Eden” but that Ingle was so drunk during the recording session that he slurred the words to the track and the alternative version stuck.  All the years wasted trying to define the origins of the word

“Indagaddadavida”.  Sometimes, I learned, the lyrics were just in fact, words and the music was in fact, just music.  Things can be exactly what they appear to be, like the world seen through the unfiltered eyes of a child:

You are a man.  You understand. You pick me up and you lay me down again.

You make the rules, You say what’s fair. It’s lots of fun to have you there.

God gave to you, now, you give to me, I’d like to know what you learned.

The sky is blue and so is the sea. What is the color, when black is burned?

What is the color?

Harry and Louise Go To Washington

Harry & Louise Go To Washington

By Michael Turpin

 

As academics, reformers and political action committees swarm to Washington like springtime midges eager to help contour imminent health care reform legislation, change is clearly in the wind.  The mood inside the Beltway is infinitely different than in 1993 when a Republican controlled Congress, partisan stakeholders, employers and two iconic middle class consumers named Harry and Louise coalesced to defeat Hillary Clinton’s complex prescription for reforming runaway costs and inefficient delivery.  Unfortunately, once the threat was ameliorated, stakeholders fell back into old patterns and failed to offer more enlightened solutions to moderate the rising costs of healthcare in the US.

In May, 2009 the private sector is unusually silent.  Harry & Louise, have just lost 40% of their net worth in the recent financial markets meltdown.  Harry lost his job in January and is worried about being able to afford healthcare coverage.  Being 55, he would love to not go back into sales but take that teaching job. He and Louise are waiting to see what the government might propose to help relieve their financial burdens and growing concerns over healthcare once Harry’s subsidized COBRA coverage runs out.

Harry has read the statistics.  He knows that employers who purchase care on the behalf of some 177M workers appear to be at their wits end and seem to be pondering whether now is the time to transfer the risk of a generation of overweight, soon to be chronically ill Americans to the government.  Louise has a friend who is a pediatrician and has heard that doctors are torn between two evils – insurers that have serially reduced their reimbursement and smothered them with bureaucracy and a government run system of reimbursement that serially underpays for services. Harry and Louise voted for the new administration and they are hoping these proposed changes will be good for them. However, they get fatigued with all the discussion and don’t seem to have the stamina to question too deeply the long range cost impact for tax payers to extend universal coverage to an additional 45.7M Americans. It seems this time around, everyone is ready for change. 

The statistics on the uninsured tell a diverse story of healthcare in America.  Of the 45.7M uninsured, 12.1M are eligible for government sponsored children’s health insurance ( SCHIP) or Medicaid but are not enrolled. 17.6M earn $ 50k or more in earnings.  9.7M are non citizens and 7.9M are college aged adults. Each group represents a different pool of risk for a new and broadened US universal access plan.  Health reform is not just about achieving 100% access for Americans, it is also about achieving affordability so we can support the cost of high quality care for all citizens.  This means driving out an estimated $900M in waste caused by preventable illness due to lifestyles, clinical variability in healthcare delivery due to defensive medicine and inconsistent adherence to evidence based best practices for treatment, and inefficiency/lack of coordination across a predominately manually administered delivery system.

Having worked as a healthcare consultant in the US and in Europe and having laid with pneumonia on a gurney in the hallway of a socialized healthcare system, I felt the need to reach out to Harry and Louise and offer some perspective on a US healthcare platform that we all agree needs to be reformed: 

1) This is a Global Issue – Every nationalized system is straining under rising healthcare costs and is achieving affordability primarily through rationing services.  In each market, there is a rapidly growing consumer financed, alternative private care market that features concierge medicine and medical tourism (E.g. Canadians coming to US, French going to India, Arabs coming to France.)  As we move toward universal coverage and the possibility of backing into a single payer system in the process, we need to understand that many systems we are seeking to emulate are experiencing rapidly expanding privatization paid for by those who can afford to go outside of struggling government run healthcare programs.   We are in a sense, passing one another in the hospital hallway. 

2) Can Government Handle Being The Bad Guy?  -Where there is national health, the government is now the payer.  Instead of a for profit or nonprofit insurer denying coverage due to lack of clear medical necessity or the absence of clinical justification, the government now gets to wear the black hat.  During my most recent trip to the UK, a 30-year-old cancer patient was suing the NHS for denying a cancer therapy that was very expensive and not likely to change his prognosis.  His oncologist was obviously throwing everything he could at the disease but the poor cost/benefit of the specialty drug forced the government to deny the estimated $35,000-a-year treatment.  

3) I’ll have the Reformed Torte, please! – There are major differences in medical liability law in Europe.  Defensive medicine – that serves both as a shield to avoid allegations of malpractice and as a curtain to obscure overtreatment – is non-existent abroad. There are fewer MRIs, CT Scans, and multiple office visits delivered each year because physicians do not over treat as a means to avoid litigation or to enhance income due to reduced reimbursement.  Medical malpractice tort costs exceeded $ 30B in 2007 – a cost that eclipsed the profits of the ten largest commercial insurers by over 2 ½ times. 

4) Talent Drain – The per capita multiple of salary for physicians in the US is 8.5 times the average worker’s pay. This is down from over 10 times which attributes to the heartburn expressed by doctors as they watch their overall wages declining. In Europe, that per capita salary delta is less than 2.5 times.  Simply put, doctors make a lot less in nationalized systems.

A good example is the UK where the government has reduced pay for local family practice practitioners and nurses creating shortages that have been filled by foreign trained physicians immigrating to the UK seeking higher levels of reimbursement than their home countries.  As doctors leave home countries seeking better salaries, the talent drain is creating medical and public health crises in more vulnerable countries often exacerbating difficult public health problems at home.

Physician migration is beginning to happen in the US.  For example, in states like Rhode Island, family practice MDs see lower levels of reimbursement than in Massachusetts and as a result, move across state lines to practice the same medicine for higher reimbursement. The drain of physicians is even more acute in New York where rural counties with larger populations of Medicare and Medicaid beneficiaries are losing doctors to Metropolitan New York because there are more privately insured patients to treat.  It does not pay much to be a primary care doctor anymore.  It does not pay at all to be a primary care doctor paid by the government. 

5) Innovation Erosion – The US finances much of the medical device and biotech innovation that drives improvement in medical quality and treatment.  Insurers, despite their public relations problems and opaque business practices, do contribute to improving consumer information systems and provide needed sentinel controls to limit fraud and abuse.  The US health system also attracts capital – – investment that drives innovation, process improvements, competition and new therapies that are plagiarized around the world – often at much lower costs.  New drugs that are financed and sold at expensive retail prices in the US are offered wholesale in other countries where nationalized purchasing depress the profit making power of the bio tech or pharmaceutical company that developed the drug. 

If the US is slowly transformed through government purchasing into a single national purchaser, the velocity in which capital will flee the healthcare sector to seek better returns will be unprecedented. Overall medical spend as a percentage of GDP will surely subside but innovation will slow and investment will be redirected like the proverbial baby with the bath water into new areas where capital will get an adequate return. 

6) Public Plan Crowd Out – Expanding government run public health plan options will accelerate the transformation of the US to a single payer system.  As the Federal government adds 45.7 million plus uninsureds to some type of expanded Medicaid or Medicare (CMS) program, privately financed healthcare through employers will bear more cost shifting from doctors and hospitals.  CMS does not negotiate provider reimbursement, it promulgates it.  If a hospital knows its costs are increasing 8% and it has received a 2% cut from the government – which represents 60% of the hospital’s reimbursement – the hospital must get in excess of a 25% increase from its private payers to make its 8% budget.  If the private payers balk at such a rich price increase, the hospital threatens to drop out of the insurer’s network.  

Enter the employer who purchases the private coverage from the insurer.  The employer immediately gets skittish at the idea of losing a hospital from their broad PPO network and admonishes the insurer to resolve their dispute with the hospital.  Unwittingly, the employer is perpetuating the problem of cost shifting and will end up inflating their own cost of care. The insurer pays the hefty 25% increase and voila, you have medical trends in excess of 10% for private payer care. Meanwhile the government is applauding its 2% across the board cost reductions and urging more employers to join their public plan because of its affordability.  Eventually, the government controls the entire system and there is no one left to shift cost of rising care to except taxpayers and providers by limiting reimbursement.

7) Are We Avoiding the Tougher Conversation?- The third rail of health reform is affordability – you touch it as a politician and you die.  Access is a safe and popular term right now in the health reform debate.  Who does not want to see every American given access to healthcare?  However, the challenge is the failure of policymakers to understand that affordability is a zero sum game.  With the net present value of our current Medicare obligations already estimated to be underfunded by some $ 8 Trillion dollars, the additional cost of expanding this coverage to 45.7 million additional Americans seems untenable without corresponding cuts to offset the current and future costs of care.  To save $ 900B in documented overtreatment and waste, someone will have to get paid less money.

There is tremendous rhetoric around the cost of administration in healthcare.  The combined profits of the ten largest commercial insurers added up to $ 12.9B in 2007.  On the other end of the spectrum, the estimated cost of obesity, according to the Forum for Health Economics and Policy, over the last 25 years has been $ 1.1 Trillion.  The cost of smoking was estimated by Health and Human services to be $ 157B each year. The cost of fraud is estimated at $ 100B by the Center for Medicare and Medicaid Services. 

While reform must absolutely change stakeholder practices and insist on total transparency of all administrative expenses not attributable to actual claims, ( PWC estimates this number to be 13% of every dollar while anecdotally, we often hear numbers as high as 30% ), the real opportunity for changing the system is changing people.

Regulation should focus less on price controls and more on population risk management – medical management, personal health improvement, rationalizing redundant and inefficient delivery systems and returning patients to a primary care based model where physicians are incented to keep patients healthy. In Japan, government officials have gotten serious about the public’s obligation to contribute to lower costs of care. Ideas have included considerations that would be viewed as outrageous in the US such as a surcharge tax for overweight individuals – as these consumers are more likely to develop costly and avoidable chronic illnesses that will consume more services from the national system.

8)  Achieving Zero Trend – Zero medical trend can be achieved, according to Dr Dee Eddington of the University of Michigan, through risk management not through cost shifting or rationing. The current debate on healthcare reform is unfortunately happening among too few of the stakeholders and as we speak, compromises are being forged that seem to be less about lowering medical trend and more about limiting or eliminating the role of those who add administrative expense to the system.  

Pundits point to the Massachusetts “Connector” as a shining example of how a state government has created efficient purchasing of individual and small group coverage for the uninsured of Massachusetts.  A closer look reveals a different story – looming deficits, forced expansion of the  program to mandate the participation of small employers in with individuals creating a greater spread of risk, and disproportionate cost shift to small employers.  Perhaps the most troubling is a menu of benefits so rich ( much richer than most private plans ) that it will surely drive medical trends in double digits for the foreseeable future.  It is less than two years old and is already being seriously examined as a ” solution” for individual and small group insurance purchasing.  

True affordability creates winners and losers and that’s not always good for politics. You could convert the top ten insurers to non-profit status and save a mere $ 12B a year compared to attacking obesity, one of the root causes of medical inflation that has inflated our costs of care by hundreds of billions of dollars in the last decade.  

There are certainly egregious examples of 30% administrative costs for every insurance dollar spent.  However, these statistics are often isolated and misleading as these expenses are often incurred by individual and small group plans that have higher distribution, pooling and risk charges. Individual and small group insurance is in need of reform – reforms that require guarantee issue coverage, mandates for insurance and aggregated purchasing to achieve the same administrative savings that larger employers enjoy. Insurers do make a disproportionate amount of profit on small groups and individuals. Insurers will make less money on their commercial products when they no longer can shift risk to smaller employers and individuals.  Most large employers pay less than 10% for administrative services.  The average margin on all commercial insurance is less than 6%. They, like many others, will have to clearly justify the value they bring to managing the consumer through a complex healthcare system. 

 

9) Rationalize or Ration? – Affordability is an unpopular discussion.  To achieve affordable care, one must be prepared to make some tough decisions.  You must either begin to rationalize the excessive and uneven care provided in the US or ration it.   Rationalizing means taking on difficult decisions around which hospitals stay open and which hospitals close.  It means enduring withering attacks from hospital worker unions in underperforming or redundant facilities.  It means demanding accountability from consumers to take responsibility for their health and encouraging plan designs that shift cost to those who refuse to be complaint.  It means questioning profit taking by players in the system that are not clearly adding value to the distribution chain but merely living off it.  It is demanding total transparency in any opaque area of healthcare delivery.  Where there is less visibility, there is more room for abuse.

 

Rationalizing care means making tough decisions about redundancy of services – reducing the number of MRI and CT scanning machines within a geographic area, balancing the excess supply in markets where too many hospitals compete to cover too small a population. And, it means having a difficult ethical debate around end of life care.

True reform and long-range medical trend management is painful for a generation of Americans who believe the unencumbered healthcare is an entitlement.  Countries with aging and declining populations are bracing for surging medical and pension obligations.  As the US seeks to offer expanded access, other countries are seeking to control it and to forge a more reciprocal public covenant with its citizens. Everybody wants something for nothing and no one wants to change.  True political courage is leading the discussion first around affordability.  So far, the policymakers seem reticent to hold accountable those most likely to be impacted – consumers, hospitals, doctors, unions, medical device manufacturers, biotech, and pharmaceutical companies.   It is almost easier to first expand care, and then knowingly descend into the inevitable crisis of underfunding where Congress can then legislate draconian measures.

 

10. Stopping the Conveyor Belt – A nationalized system does nothing to slow the conveyor belt that moves “at risk” patients toward becoming tomorrow’s chronic, acute and catastrophically ill. Medical trends will continue unchecked and will only be marginally impacted by bulk government purchasing and price controls.  Over time, our best and brightest will no longer seek medicine as a career and with that shift, quality will erode along with capital investment.  As costs inevitably go up, rationing increases, and a two-tier system emerges like a toadstool on the heap of government bureaucracy and regulation.

 

There is no doubt that we need change to our system.  However, the question is whether reform will be driven by a Trojan Horse – universal access supported by an expanded public plan to compete with private employer sponsored care or a tougher discussion with all stakeholders – including unhealthy consumers – about the cost drivers and the need for everyone to change.

Will Harry and Louise wake up and smell the coffee?  Will Harry lose that 20 lbs he put on while sitting around the house watching the Food Channel when he was supposed to be looking for a new job? Will Louise end up on a hallway gurney in a two tiered American health system? Stay tuned.

Cat’s Cradle – Untangling the US Healthcare system

cats_cradle_article_by_mike_turpin_march_20081

Waiting For Dr Godot


If you think healthcare is expensive now, wait until it is for free.” – PJ O’Rourke

On the eve of sweeping health reform legislation, it is hard not to notice the glowing skyline in Washington as policymakers ignite their torches, grab their pitch forks and race as a mob toward for-profit stakeholders who many feel have created, perpetuated and benefited from our highly uneven, inflationary and inconsistent system of healthcare in America.

Over a quarter century, I have consulted with and led employers, consumers, hospitals, physician groups, attorneys, pharmacuetical manufacturers and insurers.  My personal epiphany prompting me to become more vocal about America’s need for systemic change did not spark in the middle of an inflammatory contract negotiation with a major hospital or flash during a heated employee meeting as we announced yet another deductible, co-pay and contribution increase.  My burning bush occurred on a gurney in the hallway of British National Health Service (NHS) hospital where I lay for 20 hours deathly ill with pneumococcal pneumonia.

After moving to London with my young family, we decided to opt for public care.  After all, I was curious to experience  the NHS and with three kids under eight, we were constantly under siege with myriad colds, earaches and symptomless fevers.  Best of all, it was free. Our neighborhood NHS family practice clinic was always crowded but convenient.  Other than the occasional drug co-pay, we never received a bill.  Yet, something was not quite right.  My doctor always looked as if wild dogs or the Inland Revenue Service was pursuing him.  I broke down during one examination and asked him how much he received from the National Trust for each patient to provide basic care.  ” Not nearly enough, Mr.  Turpin. Not nearly enough” He said absently while peering into my ear with a pen light.

In the bleak midwinter of our first English February, one of my kids came home with a nasty flu that raged through the house, flattening even my indefatigable wife who I considered indestructible.  I was travelling on the Continent and needed to return early to play Florence Nightingale to the family influenza ward.  As everyone slowly recovered, rising like Lazarus from the dead, I took ill and within one day, was coughing up blood and bedridden with a raging fever.  After a brief visit with my GP, he called an ambulance and I was taken to casualty (Emergency) in a local NHS hospital. I was admitted and deposited on a gurney in a hallway alcove as I waited to be transferred to a hospital room.  There was one problem.  There were no beds available.

The ER was utter chaos with sick elderly and acute care victims in every conceivable location.  The doctors were tireless and clearly dedicated but overwhelmed.  Through the haze of illness, I watched the trauma triage go on for hours.  My wife briefly appeared with the kids to visit.  

As she surveyed the floors strewn with bloody gauze and the frenetic ballet of emergency medicine, she mouthed to me with her little finger near her chin and thumb next to her head,” I will call you later ” and fled the hospital as if it was a haunted house. In my delirium, I could have sworn a giant staph germ escorted her to the door.  “Sorry you could not stay, love.  I am staphoccocolus bacterius.  Don’t worry he’s in good hands. Let’s do lunch.”

Doctors came and went in four-hour shifts.  My principal worry was the harried Casualty staff’s inability to remember that I had a Penicillin allergy.  I repeatedly mentioned my allergy to anyone who would make eye contact with me and twice awoke to catch a well-intentioned new doctor putting me on an amoxicillin drip.

In the early hours of the following morning, I was taken to a room that I shared with seven other of my new closest friends.  There was a poor woman dying of stomach cancer and an attempted suicide.   The bathroom smelled like Grand Central at 6pm and to my horror, there was no TV.  My pulmonologist appeared followed by graduates that shuttled behind him like ducklings crossing a Kent country road.  ” How is the pnuemo” he asked my Filipino nurse ” He is getting better, sir. Aren’t you?” she remarked looking at me. I wasn’t sure if this was a rhetorical question or a new affordability technique in stiff upper lip  British medicine called “self fulfilled prognosis”. 

I was suffering from pleurisy – the equivalent to a burning knife inserted in between your ribs each time you inhale.  I was also very unhappy.  I was in what felt like an overcrowded youth hostel and I wanted some bedside manner.  After all, damn it, I was American.  I wanted the head of pulmonology from the best London hospital to consult with me and give me his mobile and home phone number.  I raised my hand to ask the doctor a question and he flashed a perfunctory smile and said, “right”.  He turned and left the room.

I lay with an oxygen mask for a day drifting.  I awoke and saw the face of a colleague from the office.  It was as if he was a Red Cross worker checking on prisoner conditions per the Geneva Convention. He had lived in London as an ex-pat for five years and was appalled with my circumstances.  ” What are you doing down here? ” He whispered.  I gave him a pathetic look of incredulity and started blinking to him in Hanoi Hilton Morse code “ g-e-t  m-e  o-u-t  o-f  h-e-r-e”. 

He returned and was talking fast, “we have gotten you into private care and we have to transfer you.” He disappeared so quickly that I was uncertain if he had been a hallucination. I awoke again and was being moved.  I expected to be shuttled into an ambulance taken across London to Great Portland Street to a private hospital where most ex-pats delivered babies and accessed private care for routine and elective procedures. 

I was pushed on to an elevator by a Jamaican orderly who said in heavy Brixton accent, ” dis is yah lucky day mate.” The only luck I could fathom at this point was getting a room that did not smell.  The elevator rose up just one floor and opened to a well-lit, beautifully decorated foyer where two eager nurses smiled and gathered around my gurney.  “Mr. Turpin, we are so sorry about your illness and time down there“. Down there?  Even the staff seemed to consider my two-day tour of duty in Casualty as tantamount to one of Dante’s levels of hell.

But it got better. The same aloof pulmonologist who a day early had treated me like a flank steak referring to me as the ‘pnuemo’, grinned and shook my hand.  Mr. Turpin, I am Dr. G. Let me help you to your room.” The Jekyll and Hyde switcheroo was not lost on me.  Apparently, Dr G hit from both sides of the plate – public and private.  Personality and bedside manner came with private care.  My private room had a clean bath, cable television and a phone where I could call and order food.  It was like the Ritz Carlton. 

The doctor sat on my bed and shared my X-rays and described in pedantic detail my serious brush with death.  It was as if he had all the time in the world.  “You are over the worst of it but the inflammation and scarring will last quite a while. Once you are released, you can see me Tuesday next privately or in three weeks through the NHS.”

I was released the next day and chose to see Dr G privately for all my follow up care.  I was in constant pain from the pleurisy and the reassuring ability to access my doctor when I needed to see him was worth the significant out of pocket expense.  I was paying for the fast pass privilege of his time and attention.  My bill for the entire episode of private care delivery was well over $2000. I saw no bill for my 48 hours in Casualty.

It was interesting to reflect later on my experience. On one hand, the NHS triaged my condition, treated meet and summarily moved me out quickly to convalesce at home. If value is outcomes divided by cost, the NHS produced the most value. 

Yet, when I introduced my own subjective expectations as a consumer – hospital conditions, bedside manner, access to specialists and information, all subjective intangibles that Americans insist are essential elements to the numerator of outcomes, one might give the NHS barely a passing grade. 

As we watch Congress debate in the weeks and months ahead the future of our healthcare system, I worry that not enough of the 180 million privately insured Americans understand the difference between outcomes and access. We cannot possibly understand the downstream effects of some of the changes that are being proposed to our system.  US healthcare is in need of a major overhaul but we need to attack the factors that are driving the cost of care higher. Malpractice, overtreatment, poor lifestyles, reimbursement policies of insurers, major differences in clinical quality of hospitals and doctors and an insatiable consumer demand for immediate and unimpeded access are bloating our system. If one were to judge our identity by our budget, the US is essentially the world’s largest insurer with its own army. 

Swinging the pendulum too far in the opposite direction with national oversight, artificial price controls,  the erosion of private insurance by expanding government sponsored plans to over 44 million uninsured without tackling the underlying causes for rising costs may be more than most Amercians can bear. 
We will in effect be trading a public/private cat’s cradle bureaucracy for a single payer with little effect on true cost drivers.  Anecdotally, we already have a glimpse into what government healthcare might look like with Medicare. Ironically, if you ask most seniors, they would tell you they love Medicare but fear socialized medicine. Go figure! 

Change is in the wind and we will all be required to modify our behavior.  However, we should join the discussion and engage our Congressional representatives in the debate.  If we are not vocal or vigilant, we may wake up one day on that gurney in a hospital wondering what the hell happened to our health care system.

Jack Bauer Must Die

 

Jack Bauer Must Die

 

It’s midnight on a Tuesday.  The laundry is a massive multi-colored heap lying unattended on the mudroom floor.  The computer flashes, “you have 312 new emails”.  The dishes ferment slowly in the sink of what looks like a neglected soup kitchen.  The dog gnaws on a Ferragamo shoe while the cat temporarily passes out in a fetid litter box reeking of ammonia.

 

Upstairs there is thumping indicating the resident adolescents have yet to fall asleep.  The absence of authority permeates the house like the smell of a recent fish dinner. The television beeps like digital clock and a monotone voice announces, “The following takes place between 2am and 3am.”

 

My wife looks at me and asks rhetorically, ” You think the kids are asleep?” With my best codependent face, I reassure her. “Oh – – yeah. I’ll check them in a minute.”

We  hit the “play episode” button – pathetic addicts in a deep cocoon of denial.  We are in the middle of a debilitating video blackout watching the television show “24”. I cannot sleep until I find out whether the president will call back the bombers or he will permanently excommunicate his annoying, conniving Lady Macbeth ex-wife.  My wife is praying a new character – an urbane, handsome middle-eastern Oxford graduate will not be killed.  ” Oh, I hope Raiza lives,” she squeals anxiously clutching a pillow.  I am not jealous.   He has that “ I am a dead man “ look written all over him. I give him two episodes tops. I have become conditioned to not get attached to anyone on this show.

We are together but alone – each trapped in our own inescapable web of emotional knots tied to this soap opera serial drama starring Kiefer Sutherland as Jack Bauer, a seemingly indestructible instrument of US counter terrorism in a world that demands morally ambiguous actions to defeat the forces of evil that threaten our American way of life. 

Wherever Jack Bauer goes people die – usually bad guys.  However, if you get too close to Jack Bauer – not unlike a career as a stunt man, living among New Guinea cannibals or raising a 200lb chimpanzee as your own child, your life expectancy is reduced by about fifteen years.  And for goodness sake, don’t hire Jack’s daughter Kim Bauer as your baby sitter or au pair.  This kid is a tornado of bad karma.

Kim’s misadventures make teenagers that have ended up in their hometown police blotters look like cherubim.  In just 24 hours, innocent Kim rescues a young girl from her abusive father, discovers the girl’s dead mother, gets in multiple car accidents – one that results in her boyfriend losing his leg, pulls a gun on four different people- killing one at her Dad’s urging, endures a siege as a hostage, escapes from police custody, witnesses a nuclear explosion, and is trapped inside a bomb shelter with a reclusive survivalist.  Tough day at school, hon? Throughout this entire period, Kim keeps interrupting her father on his cell phone as he is trying to save Los Angeles and/or the President of the US, David Palmer, whining “Dad, just come get me.” Kids just don’t change – they still see themselves as more important than the future of the free world.

Jack does not eat.  He does not go to the bathroom. Jack does not sleep.  He is the ultimate warrior.  He makes the tough decisions and employs brutal methods that waffling bureaucrats cannot make in the face of danger. While interrogating a smug bad guy who displays indignant bravado given the government’s weak knee decision to grant him immunity, Bauer simply shoots the creep and asks his colleagues for a hacksaw so he can cut off the snitch’s head off and use the prize to insinuate his way in with some domestic terrorists.  As we watched “the head in a bowling bag” scene, we heard a noise behind us and to our dismay, realized our ten-year-old son had been spying on the episode from the doorway.  As my wife ushered him out of the room to bed, I could hear her talking to him as they went up stairs.  “ Honey, you know that cutting people’s heads off is not very nice, right?

Each hour is a heart pounding shot of epinephrine with soap opera lack of resolution that leaves a viewer aching and feverish for more.  My wife calls the library at 1am to extend our rental.  “Hi, we rented DVDs for “24” for Season 2. Can we recheck them for another two days? I assume you are not there right now but I wanted to call anyway.” ‘I assume you are not there?’, I say mocking her.   Most librarians are not fiddling with their Dewey decimals at 1am; And yes, sweetheart, please get “24 -Season Three” tomorrow.  If I am lucky, I may get sick from no sleep.  We can stay home and put a blanket over the windows like trailer park crack addicts and do “24 in 24.”  We can parcel the kids out to neighbors and send out for pizza.  We can be Sid and Nancy.

The problem with our “24” addiction is not only the need for constant injections of Jack and his Counter Terrorist Unit (CTU); it is the fact that we are only on Season 3.  As we race to catch the “24” train, it keeps moving.  “24” is now on season 7 and in our sprint to present day, we are subordinating health, hygiene and domestic responsibilities watching consecutive episodes which leave us completely over stimulated and vulnerable to odd dreams.

After a disturbingly symbolic dream where I cut my boss’ head off and present it to our private equity owners in exchange for some restricted shares of stock, I awake in a cold sweat realizing my obsession with “24” is threatening my sanity.  When my son would not confess to using his brother’s computer, I found myself wondering how quickly he would crack if I water-boarded him.  I routinely now refer to my children as ” hostiles” and ” friendlies” and suggest to my wife that when we have teens over we establish a soft perimeter around the basement.  When my daughter claimed she was in town but was in fact, at a friend’s party, I briefly considered using Google Earth to triangulate her location, “neutralize” the entire group and then drop them off at the local police station courtesy of “A Friend of 24.”

I realized that we are now in the grip of a mania and that for the bad dreams to end, Jack Bauer must die.  The problem is the guy won’t expire. He has been injected with more drugs than a Jersey milk cow, stabbed, shot, clubbed, injured in a plane crash, suffered numerous brain damaging head blows – and like Jason from Halloween, keeps getting up.

There is a side of me that understands that art sometimes imitates life.  Does the US employ spooks and shadow agencies like CTU who fight clandestine battles right under our noses on US soil? Do I approve of Jack Bauer’s tactics? Will democracy prevail over authoritarianism? Will Kim Bauer get through a day without breaking the law or maiming her latest boyfriend? Will Jack Bauer ever shave, eat or have a bowel movement? Perhaps some fiber might loosen him up literally and figuratively.

It’s late and we have just secured the first episodes of Season Three.  As I read my column to my wife, we chuckle at our obsessive behavior and get the kids off to bed. 

We have a civilized evening – cleaning up the house, walking to retrieve the DVDs and watching just three episodes – trying to convince ourselves that we can get

the “24” monkey off our backs any time we like.  As we turn out the lights, she is still.  I can tell she is thinking.  This is our last private moment before sleep where we discuss kids, the future and any other important unattended issue.

“You know, if you tell everyone in town that they can rent those DVDs from the library for free, we will never make it to Season 7.  The secret will be out.”

That’s my girl. 

We’re Still Together

We’re Still Together

 There’s a tree out in the backyard

That never has been broken by the wind

And the reason its still standing

It was strong enough to bend

 

When you say something that you can’t take back

Big wind blows and you hear a little crack

When you say “Hey well I might be wrong”

You can sway with the wind till the storm is gone

Sway with the wind till the storm is gone

 

Like a tree out in the backyard

That never has been broken by the wind

Our love will last forever

If we’re strong enough to bend 

 

Strong Enough To Bend, Tanya Tucker

 In a career that may never be equaled as a basketball coach, John Wooden won a remarkable 664 games and lost a mere 162.  His UCLA teams won 10 national championships in 12 years including seven in a row from 1966-1973.  During this period his teams won 88 straight games.  In his career, he led four different teams to perfect 30-0 seasons.

 If you were to ask John Wooden about his greatest decision in his remarkable career, he would unquestionably point to his decision to marry Nellie Riley, his high school sweetheart in 1932.  Nellie was the center of John’s universe and the person he claimed knew him better than he knew himself.   He once remarked that marriage like sports did not build character but revealed it.  

 Nellie and John were married for 53 years before she died of cancer in 1985.  For the last 24 years since her passing, John Wooden sits down on the 21st of each month and pens a love letter to Nell, his best friend.  According to sports journalist Rick Reilly, there are over 260 letters stacked neatly on her pillow, tied with a yellow ribbon.  Her side of the bed they shared remains undisturbed. When asked by Reilly if he was afraid to die, a then 90 year-old Wooden remarked, “ of course not, Death is my only chance to be with her again.”

 With over a 50% divorce rate in America, it’s even odds at best for couples to make it to the mountaintop together.  The cynics delight in reminding us of just how perilous the path is to the peak of life partnership.  British author Len Deighton once wrote, “the tragedy of marriage is that while all women marry thinking that their man will change, all men marry believing their wife will never change.”

 In any relationship and in life, you are really three people – the person you project to the world, the person you secretly see yourself to be, and the person your partner knows. It’s that last person who is probably the most accurate version of who you really are.  Most relationships get into trouble when the chasm between our face to the world and the person our partner knows becomes too great.  It seems the more we seek to be the same person all the time, the more capacity we have to focus on others which is the essential ingredient to love and the antithesis of self worship.

 It is a paradox of the human condition that we seem to gravitate toward our opposites.  I have a theory that in every relationship, there is an agitator and a fixer. The agitator is an expressive, aggressive and more mercurial partner while the fixer is the moderating influence, the rock, and a steady hand. When two agitators marry, it can be a combustible combination.  When two fixers exchange vows, the relationship may seem the equivalent to watching a test pattern at three am. And, yet while our personal preferences and aggressive or moderate styles bring a rich trousseau to our relationships, the foundations that remain the strongest are built on shared values.  When we see one another for who we are and who we are not – forgiving our limitations and reveling in our possibilities, a relationship breaks out of its chrysalis and takes wing.

 In the land of the blind, the one eyed man is king and in love the ability to reflect even momentarily, sometimes prevents us from falling prey to the false positives -the cotton candy rush of self-esteem borne out of immediate physical attraction.  We all learn the hard way that the currents of a relationship change with the trade winds of time – the arrival of children, life events that challenge our faith in one another, illness, success, disappointment and death.  Woody Allen, mused that a relationship “ is like a shark, it has to keep moving forward or it dies.”

 Those who have been married for decades do not gild the lily of love.  They talk of constant compromise, trying to avoid taking one another for granted, expressing appreciation, forgiveness, making time, playing the mood music, seeking to understand before seeking to be understood, recognizing perfect moments, never forgetting that anything you put ahead of each other eventually comes between you, you and remembering that resentment is liking drinking poison and waiting for the other person to die.  As these couples hurtle through life and fall prey to life’s ruts and distractions, they always circle back to find one another. “A marriage”, Honore de Balzac mused, “must constantly fight the monster which devours everything: routine.”

Commitment is not 50/50 but in fact two people giving 100%.  When the rate of change outside the relationship exceeds the rate of change within it, the end is near.  Many endure dark passages where they are overwhelmed by excessive responsibility or self-pity and must fight the instinct to abandon ship.  Some idealize relationships and love, wondering why their best-laid plans are constantly sabotaged.  Many make the mistake of comparing their private “insides” to other people’s public veneers.   We cannot resist the invitation when Cosmopolitan asks us to “rate our mate.” We forget what Oscar Wilde assured us when he said “the only normal people you know are the people you do not know very well.”

 And we are still together.  A gentle sigh in the dark of midnight.  A smile across a crowded room.  An extemporaneous moment at a piano recital – rare moments that are only complete when it can be shared together.  There are flash points, disagreements, and tired, lazy shortcuts that lead to hurt feelings.  But most of us find our way back to one another like emotional strays that once fed, keep returning for sustenance.  For all their periodic insanity, we need our relationships.  Perhaps some of our stories are not as romantic as John and Nellie Wooden or New man and Woodward but we all have chapters remaining to be written and common music to left to be made.  Our experiences together are the fine threads in our common tapestry of commitment.  Each couple is its own unique work of art.  And the beauty of that art is always in the eyes of the beholder.

 Woody Allen sums it up best in Annie Hall, “this guy goes to a psychiatrist and says, “Doc, uh, my brother’s crazy; he thinks he’s a chicken.” And, uh, the doctor says, “Well, why don’t you turn him in?” The guy says, “I would, but I need the eggs.” Well, I guess that’s pretty much now how I feel about relationships; y’know, they’re totally irrational, and crazy, and absurd, and… but, uh, I guess we keep goin’ through it because, uh, most of us… need the eggs.”

 

 

How To Make An Italian Chef Smile

How To Make An Italian Chef Smile

 

It had been a rough first six months since our move to England. Each child was showing the strain of change and unfamiliar circumstances.  I arrived home one evening from a business trip to find my wife striking the washing machine in complete frustration. 

“This stupid thing is so small I can only wash one sheet at a time.”  It seemed as though it would never stop raining. The fickle sun would appear at odd and inconvenient times like an unreliable friend.  While intellectually invigorated by our European move, we underestimated the emotional trauma of being cast adrift from friends, family and the familiar rhythm of our Northern California lifestyle.

 

My parents had joined us in London for the children’s October break and like most Brits, we immediately fled the damp emerald isle for the warmer embrace of Southern Italy.   We landed in Rome and were immediately serenaded by the whimsical strings of a city wired on life and caffeine.  Rome was a marching band with no conductor.  Every Italian seemed to move without regard for traffic lanes, lights or legal parking.  The classically laissez faire Italian police were more intent on staking out single women than suspicious characters. Vespas buzzed like mosquitoes while autumn starlings banked and rose in an aerial ballet. With each hour, we regained our warm weather equilibrium and sense of adventure.  After three days of fountains, forums and fusilli, we escaped north to explore Florence and the surrounding ancient hill towns of Tuscany resting like unsteady siena crowns on the crests of hills forested with beech, oak and chestnut trees. 

 

We arrived at our hotel, Villa La Massa, on October 31st. The chrome morning mist rose slowly, taking its time to shake off low gray clouds.  A wet chill loitered in the ravines and hollows and in between the villa’s main house and the guesthouses that peered over the southern banks above the Arno. There were no black cats, pumpkins or dark effigies of witches and goblins.  The long, pebbled driveway guarded by columned cypress trees and an ancient wrought iron gate, showed no signs of imminent pagan celebrations.  Our children, ages 7, 4 and 2, were only mildly interested that it was All Hallows Eve.  Back in America, giggling adrenaline-fueled goblins would be racing in and out of the shadows and light cast by houses a thousand grinning jack-o-lanterns.  It would be a night of sugar, ghouls and mayhem.  I sighed.  At our old home, we would be wandering our neighborhood – – faceless flashlights inching along dark streets and cul de sacs greeting the silhouettes and voices of our friends. Halloween was America and an essential milestone in the life of a young family and we were missing it.   

 

On this warm, windy day, I volunteered to take the children to the Etruscan hill town of Fiesole while my parents and wife wandered the back alleys of Florence. We spent a glorious morning chasing and playing among the ancient amphitheatres, roman baths and ruins.  A local restaurant owner adopted us, treating us to lunch at his local café where we were overwhelmed with freshly baked foccacia, homemade pastas and pizza. As the sun’s arc dropped toward the West, we descended into the valley of the Arno, navigating a patchwork quilt of vineyards and farms.  As we followed the narrow road back to our hotel, I could see the Duomo and the medieval skyline of the city that was once the cradle of the Italian city-states.  For all the enthusiasm I felt for being in this special place, I was suffering from a parochial melancholy wondering whether my decision to work overseas had been a mistake.  Was I denying my children a quintessentially American childhood?  Would they one day ask me, “Dad, what’s Halloween?”

 

European interest in the celebration of Halloween was mixed.  Given the more reverent traditions surrounding festivals like The Day of The Dead, Italians resisted the secular commercialism of monsters and Milky Ways.  Yet, there were signs of Catholic unrest.  In Milan, Halloween festivities were held by American schools and often spilled over into local communities.  In Bologna, the Miss Strega” (Miss Witch) beauty contest was held to identify the most enchanting sorceress.  A few Roman novelty shops had displayed masks, monster memorabilia and treats.  Yet, the Villa La Massa showed no signs of western infestation. It was just another sleepy Tuesday.

 

Unbeknownst to me, my clever spouse had packed a Donald Duck mask, a spider man outfit and all the accessories that a Hawaiian dancer would ever require.  Prior to departing that day for Florence, she had approached the charming concierge, Sylvia, explaining that the children were far from home and missing an important holiday; would she allow them to come down to the foyer that evening to trick or treat – knocking on the office and storage room doors of the sparsely occupied hotel where we might give them candy?  She left uncertain if our polished patron understood her request.

 

Once home, my wife whipped the kids into a happy lather explaining the significance of Halloween, their apparel and trick or treating.  Dusk brought frenetic preparation and squealing enthusiasm as the children donned their costumes.  I walked down the narrow hallway where a sinister suit of armor looked disapprovingly on my waddling two year old Donald Duck who would not stop making sounds like a dying Merganser.  A serious super hero and a seven-year-old hula girl bolted past the wobbly toddler.   We fell down the elegant staircase like a spilled bucket of tennis balls, crashing across the cobblestone breezeway toward the main house.  There were signs of movement inside the lobby as shadows darted across the row of equal-sized, closely placed windows. Soft light spilled out into the courtyard from the prominent portico.

 

Sylvia gasped with sheer delight as my youngest child quacked, announcing his arrival.  To my surprise, the entire hotel staff lined the foyer like an honor guard.  Each employee – waiters, maids, porters, groundskeepers and drivers – was holding a basket filled with homemade Italian treats.  Throughout the day, the Italians had baked and wrapped homemade cookies and chocolates.  The children were instructed to close their eyes as their hosts darted off to the first floor rooms. As each child approached a guest room door, it would swing open with an Italian feigning surprise and raising their hands in disbelief.  Sylvia suddenly had an idea and motioned us to follow her toward the restaurant kitchen.  She was explaining in broken English that she wanted to have the children trick or treat the head chef.  This spontaneous suggestion elicited disapproving looks from several of her male colleagues.  As a gourmet hotel, the chef was the mercurial lord of the manor.  Yet, Sylvia seemed determined to enter Hell’s kitchen.  My older children sensed the reticence of the staff and held back while our youngest recklessly burst through the cucina’s swinging doors clucking like a hen heavy with eggs.  There was silence, followed by a sudden burst of baritone laughter. The doorway suddenly filled with a large, handle bar mustached Italian chef holding my son and pinching his cheeks. The staff applauded.  Sylvia leaned in victorious and whispered, “they are terrified of him.  They have never seen him smile.”  We lingered in the hotel for some time forging a primitive bridge out of ragged Italian and English words as the children unwrapped candies and explored the living room.

 

We later walked slowly across the empty grounds and into the guesthouse, climbing past a not so malevolent suit of armor to our rooms. My anxiety had melted away.  It was clear that I had been wrong.  We were not missing anything back in America.  Our best Halloween will forever be remembered as a magical blend of cypress trees, ancient ruins, laughing chefs and doting Italians.

 

Meraviglioso! 

 

 

From Russia With Love

Cover of "From Russia with Love (James Bo...
Cover via Amazon

From Russia With Love

 

In the summer of 1971, I saw the movie, “Dr Strangelove – Or How I Learned to Stop Worrying and Love the Bomb.”   At 10 years old, I did not totally appreciate the bizarre characters like Brigadier General Jack D Ripper or Dr. Strangelove.  I could not entirely understand why Slim Pickens aka Major TJ  “ King” Kong rode the atomic bomb out of the B52 bomber like a bucking bronco.  However, I clearly understood that the US and Russia were fighting a Cold War.  My fiery imagination was stoked by a father who was constantly criticizing the US for letting down its guard against “commies” and “spies”.  Hollywood was full of “Reds” and while Senator Joseph McCarthy did his best in the 50’s to root out these ideological weeds, communist dogma was invasive and required relentless vigilance to detect and remove political parasites.  The entertainment industry, Congress, all of Europe and even our church had been infiltrated by the vodka swilling, plate breaking, Gulag operating, godless collectivists who were just biding their time waiting for the last capitalist to sell them the rope that they would hang us with.

I had to do my patriotic duty and keep our neighborhood safe for democracy.  This required me to develop a clandestine intelligence organization to inform on any person who might be providing secrets to the enemy.  I was not sure what secrets the Reds could gather from a neighborhood that was more boring than watching paint dry. However, one never knew where a sleeper cell might be cocooned.  Authors like Robert Ludlum described how sleeper agents could lay dormant for a generation.  A Manchurian candidate could be activated with a simple phone call. 

 

“ Is this Mrs. Ruth Turpin of 1828 Windsor Road?”

 

“ Yes, who is this?”

 

” Sasha sells sea shells by the sea shore.”

With this heavily accented, tongue twisting alliteration, my mother, the sleeper agent, would go into a brainwashed trance, drive her station wagon up the winding mountain roads of Mt. Wilson and blow up the radio tower disabling all radio and TV transmissions across the San Gabriel valley, isolating us from the outside world. Just up the street in Pasadena was Cal Tech, a bastion of high IQ engineers, rocket scientists and astrophysicists.  We were indeed a tempting target.  The 64,000 ruble question was which of my neighbors might be actually conspiring to sabotage our town.  Could the confederate turn out to be someone we never suspected like green thumbed Mr. Seidell who upon being “ activated” would fly across the country to Washington DC and attempt to assassinate President Nixon with his trowel?  Spies were clever and not easy to catch.  They were ruthless and not above posing as retirees, gardeners and even parents. 

I recruited my friends to assist me in patrolling our neighborhood.  Of particular interest was Mr. Harmon who lived across the street with his parents and kept odd hours.  We also had some concerns about Mr. Meister who routinely screamed at us to get off his lawn.  Vodka and socialism made people angry and loud.  Perhaps, Mr. Meister missed the snow of Moscow and was annoyed at the constant sun and temperate climate of Southern California.  On a warm summer afternoon, armed with binoculars, a Polaroid camera and walkie-talkies, we embarked on a series of information gathering patrols. 

The next morning, my mother received several angry calls from neighbors who were concerned over a disturbed child peering into windows, crawling through juniper bushes and in one case, taking a photograph.   Although I was not identified in person, the default accusation on our block was to always blame the Turpin boys.  Annoyed, and lacking actionable information, my mother could not deduce the identity of the young peeping Tom.  As all good spies do, I convincingly lied when interrogated. I even provided an alibi. While she could not prove anything, she lectured me about people’s personal privacy.  If she only knew that we had already uncovered some seamy information about some of our “upstanding “neighbors, including the disgusting fact that ultra tan Mr. Brown sunbathed in the nude and mowed his backyard in a Speedo while Mrs. Franke watched him from her adjacent upstairs window.  It seemed moral decline was everywhere.

 

My parents were naïve and did not understand the town was teeming with traitors.I even suspected my brother of selling information to foreign agents.  He was a weak individual with liberal ideas.  I searched his room and discovered a magazine stuffed between his mattresses.   It was called amazingly “ From Russia With Love” and had a beautiful woman in a provocative pose on the cover. It was obviously intended for fans of the 1963 James Bond thriller starring Sean Connery. The magazine was weathered and torn.  I opened it and to my delight and shame, I saw photographs of naked “Russian” women.  None of these women looked sinister like Spectre agent Rosa Klebb, the spy who attempted to kill James Bond with a poison tipped knife that jutted out from the end of her boot.  No, these women seemed, well – – more open to détente.  

 As any dedicated spy would, I immediately disappeared behind the garage for to “study” the magazine to be certain that if I ever saw any of these women in public, I could identify them, even with their clothes on.

 

After committing each page to memory, I carefully tucked the magazine under my pillow and went off to school ready to share what I had learned with my friends in homeroom.  I knew my brother would not report the magazine as missing.  Yet, as I was sitting through Social Studies class, my mother was fatefully making my bed. I rode home in record time, as I was eager to examine the magazine models for other distinguishing features – beauty marks etc.  As I walked in the back door, I immediately knew that something was not right.  I was escorted into the dining room, which was the center for all corrective action.  My mother looked overly concerned and for a moment I thought there had been a death in the family.  “ Honey, is there anything you want to talk to me or your dad about?”  I was stumped and then I saw the magazine on the chair next to her.  “ That’s not mine.” I protested.  “ It’s Tom’s!”  I protested to no avail. She remained convinced of my guilt.  “The neighbors have been complaining about someone peeking in their windows and now I have found this adult magazine in your room. I think you and dad need to have a talk. “

Suddenly, it hit me.  It was all so clever – I had been framed.  I was obviously getting too close to someone or something and “they” wanted me out of the way. Like my Dad always said, those Reds are pretty determined and would go to great lengths to remove any threat.  Later that evening I endured my father’s unimaginative lecture on the birds and the bees.  I had already heard a more graphic and entertaining version from Dennis Higgins in gym class.  It would do me no good to attempt an explanation to my Dad.  I would have to endure this punishment and bide my time. 

One thing was certain.  When I got older, I wanted to join the CIA – especially if it meant interrogating one of those Russian women.  After all, I was probably the only guy who could pick them out of a police line up.

 

Should H.R. Stand for Health Reform?

Should H.R. Stand for Health Reform?

By Michael Turpin

There is a story of Winston Churchill addressing an exhausted and beleaguered group of young RAF pilots during the height of the Battle of Britain.  As he surveyed the demoralized men who had logged so many combat hours and had witnessed friends die in battle against a superior Luftwaffe, he stood silent and allowed a heavy pregnant pause to fill the air.  Churchill turned to the pilots and posed just two questions:

“If not you, than who?  If not now, then when? “

The primary purchasers of healthcare for over 180 million Americans are human resource and benefits professionals. The job description for most HR and Benefit professionals is managing human capital.  These increasingly difficult jobs strive to achieve a harmonic convergence of employee attraction, retention and development that leads to growth in revenues and profit.  Yet, when faced with increasingly inflationary healthcare costs and fewer choices to mitigate them, employers are increasingly taking the path of least resistance – passing on rising costs to plan participants rather than confronting more deeply embedded drivers such as poor lifestyles, lack of consumerism and a reluctance of stakeholders to be held accountable.  It’s time we grab our national health crisis by the folds of its own fat and force fundamental change. It is going to ultimately fall to human resource, benefit and other business leaders to deliver some tough messages to stakeholders who have failed to solve this crisis.

As we follow the healthcare reform debate in Congress, the silence from many employers has been deafening. The genesis of true market-based reform can only occur at the level of the employer. HR and benefits leaders must exert a level of influence over the debate. As we enter this era of tough love and economic survival, it’s time for those who are most experienced to speak up.  HR and benefits managers should consider the following eight steps as a means of seizing the high ground in driving market reforms in healthcare.

1)    Advocate “loss control for healthcare” – Most smaller and mid-sized employers feel they have little leverage or control over their healthcare costs.  Ironically, these same individuals are active and aggressive in managing the costs of occupational health through workers compensation loss control programs.  If clinical industry benchmarking data indicates that 6% of a workforce is normally diabetic and your claim data suggests less than a 2% incidence of diabetes within your claims, you may want to focus on determining whether you have a higher rate of undiagnosed illness using health risk assessments and predictive modeling instead of blindly assuming that your loss experience is tracking more favorably than industry norms.  You must design value based plans that remove barriers to care and encourage prevention. It is time we develop strategies to drive non-occupational health management as a course of business.  Call it “wellness”, “productivity improvement” or “presenteeism” – it is all about improving the health of our employees and their families.  The days of fencing with finance over the return on investment of a healthy workforce must be replaced by a corporate commitment to improve workplace health.

2)    Have an opinion – Too many HR and benefit industry professionals do not express their opinions about what needs to change.  Get involved in industry associations.  A friend who runs a major employer coalition in a large US city confided to me how difficult it was to get HR and benefit professionals to participate in roundtable discussions with insurers, hospitals and other key stakeholders.  Call it apathy or a lack of bandwidth. The absence of employers (particularly hard hit mid-sized and smaller employers) voicing strong opinions about how the next iteration of healthcare should evolve in each market creates a void that may soon be filled by politicians and academics who have a less pragmatic understanding of the irreversible downstream consequences of radical reform.

3)    Insist that double digit trend increases are unacceptable – For insurers to continue to deliver core trends in excess of 8% and fully loaded trends well into double digits indicates that payers have not delivered on promises to offer lifestyle changing medical, disease management and claims management impacts. Insurance company underwriting and trend setting practices are an opaque alchemy.  Any vendor who purports to offer health plan management services should have their remuneration tied to managing your medical trend.  In the final analysis, trend drives cost.   If the best that the for profit and not for profit healthcare industry can offer is double digit increases, it deserves to be replaced by an alternative system.

4)    Force the C Suite to get help amplify your message– Senior management, finance and HR must work in partnership to assess risks, seek to eliminate and/or mitigate them, determine which risks should be retained through self insurance and which should be defrayed through risk transfer.  The days of treating insurance renewals like the purchase of a car – “If they get to 10%, tell them we will renew.  Otherwise, put it out to bid” – must be replaced with a more thoughtful year long discussion on claim cost drivers and ideas to mitigate near term and longer range claim costs.  Benefits are an investment, not a commodity.

5)    Understand cost shifting is not cost containment – Managing healthcare expenditures does not mean merely cost shifting increases to employees.  It means engaging and communicating with employees around cost drivers, lifestyle obligations and plan changes that are designed to improve health. Many employers opt for open access networks allowing employees the ability to bypass primary care in favor of more expensive specialty care self-referrals.  These paternalistic designs limit disruption but drive higher medical inflation which in turn, requires more cost shifting to employees. With new claims and episode of care data helping to designate providers who deliver higher quality and lower cost outcomes, we can design a new healthcare system around superior providers and higher quality outcomes.  We can focus on rewarding primary care providers for keeping people healthy instead of bankrupting our system around a legion of medical specialties that are exponentially growing to serve the needs of tomorrow’s chronically and catastrophically ill.

6)    Develop a plan – When was the last time your broker or consultant sat down with you during your budget cycle and helped develop your cost assumptions for the coming fiscal year?  Every 100bps of medical trend saved translates into dollars contributed to earnings, shareholder value or private equity owner returns.  HR and Benefits can been seen in a much more strategic light when a plan is developed and followed – particularly one that drives so much annual cost and increases disproportionately to all other corporate costs each year.

7)    Participate in provider negotiations – Insurers are often maligned for their business practices.  While health plans are clearly focused on shareholders and profits, they are critical partners to managing medical trend.  Most insurers privately confide their lack of confidence that employers will support them if they get into a major fee dispute with a large hospital system or medical group. Larger hospital systems are banking on the fact that employers will not tolerate the noise from employees resulting from the loss of a major healthcare system from their network.  This lack of solidarity forces the insurer to agree to pay larger fee increases in contract negotiations – leading to higher medical trends for the employer.

8)    Calculate broker value as outcomes divided by cost -.  There are 28,000 consultants, brokers, financial advisers and agents delivering advice on healthcare to employers across the US.  Like any industry, there is wide variability among intermediaries.  Many of these middlemen are reactive, focusing on annual plan marketing, issue resolution and administrative support services for HR. In the end, the calculus of determining service value should be outcomes divided by cost.  If you cannot measure outcomes (e.g. year over year trend mitigation, claims and vendor performance management) and you do not know what your broker or consultant charges, it is impossible to determine the value of services.

The greatest single asset we possess in American business is our workforce.  HR and benefits are the ombudsmen and advocates for these human resources and must use benefit plans as levers to drive productivity and process improvement.  Sounds like a big responsibility?  It is.  While HR and benefit leadership may seem thankless in these dark days of recession, rising medical costs, declining profits and layoffs, it can be a highly rewarding platform for those capable of elevating themselves to the role of business leader – helping ensure the personal health of employees, their families and ultimately their company.

Taming The Dancing Bear

0911_Cotillion_352
Image by Dawn Camp via Flickr

Taming The Dancing Bear

“We’re fools whether we dance or not, so we might as well dance.”– Japanese proverb

It was the uniform of the condemned: the hand me down blue blazer, striped tie knotted with a baseball sized double Windsor, a starched white pin point, and itchy, gray wool slacks with razor edged military creases. It was not even Sunday.  It was Saturday evening and I was going to the first of what promised to be several humiliating classes called “Cotillion”. I did not know what a cotillion was but judging from the wry, sardonic smile on my older brother’s face, I was not going to like it.  Cotillion was supposed to transform us into young gentleman and ladies – gentrified aesthetes whose table manners were only exceeded by their ability to do the cha-cha.  Each parent secretly held hopes that this rigorous social sandpapering would prepare their child to some day become the US cultural attaché to some exotic European country.

The dance macabre was held at the town community center and was hosted by the imperious Commander and Mrs. U. The Commander was a rigid cardboard cut out who feared no man except his spouse and dance partner, a Joan Crawford stunt double replete with hyperthyroid eyes and a fearsome tire skid unibrow. Her toxic perfume could have emptied an entire trench line in WWI. We suspected that life with Mrs. U was the equivalent of going to war – long periods of tedious boredom punctuated by episodes of sheer terror. We hugged the walls, a knot of restless and irritable fifth graders, pushing and shoving one another toward the demilitarized zone of ballroom floor that separated us from the mysterious tangle of Cinderella gowns, bowed hair and polished glass slippers.

“Heel, toe, heel, toe, slide, slide, slide” shrilled with mind numbing repetition through an ancient loudspeaker.  For the young attendees, the experience was reminiscent of a political reeducation camp in Cambodia.  For Mrs. U, each Saturday evening brought the chance to transform into a dreamy Blanche Dubois reliving a time when Tommy Dorsey music was floating on the cool autumn air and young men were lining up to fill her dance card. When the first few notes of Blue Danube fell like a soft silk veil, the U’s roamed the floor in a nostalgic blackout looking for partners.  A silent rosary could be heard from the mouths of every child, ” Please do not pick me, please do not pick me.” An alabaster claw clutched my arm.  “ Come with me, young man.  Let’s show this ballroom how to waltz!”  Nervous snickers and total humiliation swirled around me as Mrs. Unander proceeded to break me like a green colt. After enduring the Box Step with the skeleton lady, the music mercifully stopped. I returned to the fray of cowlicks and tight collars, emasculated and reeking of cheap perfume.

Our liberation from Cotillion and dancing was short lived.  The early trauma was followed by an even greater confusion of middle school and high school dances.  As boys, we understood that girls liked to dance and that asking the opposite sex to trip the light fantastic could lead to “going out” – – one of the many jasmine scented rites of passages compulsory to a young man’s journey. The gymnasium social scene was a tight onion of posturing and hormones.  An outer layer of boys and girls adorned the gym walls and risers watching the vortex of motion with envy and contempt.  The core of this anxious adolescent scallion was an evolving social order of post pubescent royalty – – princes, ladies in waiting, dukes, jesters and the first cut of prom kings and drama queens.  The dancing was free form expression with boys confined to safe, unimaginative jerking from side to side with the occasional overbite and riff of an air guitar.  The girls were infinitely more expressive with arms above their heads swaying like Moroccan belly dancers in a swirling hot wind.  And then there were the mavericks – individualistic kids who dared to dance outside the safety zone – using moves borrowed from American bandstand or Soul Train to distinguish them and perhaps leap frog the established social hierarchy by dancing with the most popular girls.  We would mock and badger these counter cultural souls from the safety of our shadows.  Yet, we were the ones who were not dancing.

I tried to break ranks with my larger, inept brethren practicing moves in front of the mirror days before dances.  There was simply no sequence of steps or motions that did not make me look as if I was on the cusp of an epileptic seizure.  My father was no help.  The man, who had grown up in a time with great dance steps like the Jitterbug and the Lindy Hop, had one series of moves that my brothers and I simply referred to as “the hydroplane”.  He would sway side to side like a Rodeo Drive palm tree while moving his hands parallel to the ground.  It appeared as though he was a tragic Prometheus forever condemned to administer Pledge wax to an imaginary tabletop.  My brothers were no help as they were equally challenged.  My last hope, my mother, could not stop laughing each time we privately attempted to hustle.  I was the dancing bear in the circus.

I married and was immediately diagnosed by my coordinated partner as suffering from severe rhythmic deficit syndrome (SRDS).  SRDS can effect anyone but I was sadly the poster child for the disorder.  My spouse patiently pushed therapy – – dancing at parties, weddings and informal gatherings.  Each step was painful and I created excuses to avoid the rectangular parquets of humiliation.  She signed us up for a couples dancing class but I flunked out.  I observed other men also challenged with SRDS who loathed parties with bands and DJs.  The music would start and this band of left footed brothers would flee to the toilets, bars and patios as if a fire had been declared, leaving their dates, partners and spouses to dance with one another and that same loathsome maverick that would see this opportunity to once again become the center of the galaxy of dancing queens.

It took twenty years but I finally stopped fleeing the party at the first machine gun burst of music. To my surprise, no one noticed ursus clumsius lumber on to the dance floor, as all were preoccupied with their own self- expression.  They had obviously observed dancing bears before. As the bass thumped and the music pitched, I noticed the ghost of an awkward adolescent hesitating at the party door, looking back at me – a thick, teetering jenga stack of overbites and invisible guitar riffs – smiling and then melting away. I glanced around the floor and watched as other bears entered the fray.  The maverick was still roaming the floor, ever the opportunist, feasting on partnerless women, urging all to join him in some Latin Salsa line step that he had learned while on a recent business trip to Sao Paolo.  I smiled and moved predictably, balancing on my invisible circus ball – arms confined within the proverbial safety zone. Somewhere off in the cosmos, the Unanders would be smiling.

The girls were still beautiful.  The music was still intoxicating.  The best part of all was no one cared.  Not even me.

The Dude Abides

Left to right: The Dude (Jeff Bridges), Donny ...
Image via Wikipedia

The Dude Abides

 

Your revolution is over, Mr. Lebowski. Condolences. The bums lost. My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?  David Huddlestone, The Big Lebowski

 

On its ten year anniversary, Andy Greene of Rolling Stone magazine attempted to explain why an offbeat comedy, The Big Lebowski, became “the most worshipped comedy of its generation”.  I count myself among the denizens who regularly quote, watch and discuss the 1998 Coen Brothers movie about an LA slacker named Jeffery “the Dude” Lebowski, a peacenik anti-hero who becomes mistaken for another Jeffery Lebowski, an LA millionaire with financial and personal problems. As a Dude connoisseur, I savored Greene’s entrée along with Walter Kirn’s side dish analysis of Dude, the ultimate underachiever.  Greene makes a persuasive argument as to why a decade of Generation X’s and Y’s related so clearly to a man who was and is, the antithesis of our hard charging society.

At its most basic level, any motion picture is created to entertain. However, film is art and an important lens through which we interpret, depict and assess society and ultimately, ourselves.  The Big Lebowski follows an unemployed forty something pot head who refers to himself simply as “ the Dude”, as he is haplessly drawn into a bizarre plot of kidnapping, extortion, pornography and deception. As Greene describes, “ the narrator ( a man simply known as the Stranger )…intones, ‘sometimes there’s a man who well, he’s the man for his time and place’. The odd truth is this man may have been a decade ahead of his time.  Today, as technology increasingly handcuffs us to schedules and appointments – in the time it takes you to read this you have missed three emails – there’s something comforting about a fortyish character who will blow an evening lying in the bath tub, getting high and listening to an audiotape of whale songs.  He is not the 21st century man.  Nor is he Iron man – and he’s certainly not Batman.  The Dude doesn’t even care about a job, a salary, a 401k and definitely not an iPhone.  The Dude just is, and he’s happy.”

The Dude still appeals to a multi-generational audience.  He has fans like myself – – the salt and pepper, latter stage Baby Boomers, known as the Generation Joneses, who were programmed by their Silent Generation parents to become economic grunions, genetically returning each day, month and year to beaches of hard labor in hopes of exceeding our parents’ standard of living and in doing so, writing the next great chapter for America.  The Jones generation exists as a fragile bridge and no man’s land between the rules and conventions of the Silent and Boomer crowd and the self obsessed cynicism of the Gen X’s and Y’s.  Generation Joneses were raised by the firm hands of self-reliant sergeants who believed in a strong military, free market, and the possibility that anything could be overcome with hard work. This ethos could vanquish any threat – a need, a want, a rival or even a foreign power with dark intentions.

The Silent and Boomer generations react viscerally to characters like the Dude.  He is a ne’er-do-well and a slacker.  Slackers are societal ticks and chronic underachievers who rationalize their inability to compete in our meritocracy by criticizing, pontificating, using mind altering substances and garnering unemployment checks from the very establishment they target with so much languid contempt.  To the older generation, the Dude is like Europe – – impractically egalitarian, unmotivated and content to constantly regress to the mean. Socialism is Dudeism .  Dude would rather see America lay medicated in a warm mineral bath listening to NPR than enforce its individual and collective imminent domain.  The Dude’s indolent lifestyle is a threat and virus that must be halted.  The fact that the emasculated Dude is content just to be and accepts life as it comes – “ strikes and gutters, ups and downs…you know, the Dude abides” – is lost on those whose lives are a frenetic merry go round of materialism and indentured obligation.

The Big Lebowski: Are you employed, sir?

The Dude: Employed?

The Big Lebowski: You don’t go out looking for a job dressed like that? On a weekday?

The Dude: Is this a… what day is this?

The Big Lebowski: Well, I do work sir, so if you don’t mind…

The Dude: I do mind, the Dude minds. This will not stand, ya know, this aggression will not stand, man.

Dude is an anti-hero.  He is a pacifist. Jeff Dowd writes, “He’s a character who’s very loyal to his friends, but in some ways, he’s a real intellectual drifter, a person who doesn’t really care what people think about him. I mean obviously, if it’s the middle of night, and you’re in Ralph’s in your robe and jellies, then obviously you don’t care all that much about what people think of you. He’s a character that sees the truth.” He is, by society’s definition a bum.  However, through the eyes of generations who have come to the depressing realization that they may not exceed their parent’s standard of living but instead inherit record deficits, a global environmental crisis, foreign wars and back breaking energy dependence, none of which was their doing,  Dude’s minimalistic lifestyle in a Venice Beach apartment looks downright noble. To many, Dude was and is, a metaphor for all who have been dragged against their will into conflicts and circumstances beyond their control – Vietnam, Iraq and a world that no longer seems full of possibilities but fraught with sharp edges.  He is the ultimate conscientious objector to a subtle social war.  It is a battle being waged against the weeds in our society – – the bums, ne’er do wells, bleeding hearts and those who cannot or will not help themselves.  The Big Lebowski and his ilk want to clear the fields of these useless dandelions who refuse to get with the program.  His “program” is a life of unilateralism whose offspring are fear and consumption.  Millionaire Jeffery Lebowski, The Big Lebowski, is the embodiment of this ideology – crippled, manipulative, angry and rich. He is a living picture of Dorian Gray, a canvas that reveals every twisted wrinkle of a man who has everything but has lost his soul.

 

The Dude: You thought that Bunny had been kidnapped and you were @$^*ing glad, man. You could use it as an excuse to make some money disappear. You’d just met me… You human paraquat! You figured ‘Oh, here’s a loser. A deadbeat, someone the square community won’t give a @$#% about.

The Big Lebowski: Well, aren’t you?

The Dude: Well… yeah.

Dude is surrounded by a supporting cast of misfits – – life’s tragic figures and confederates including a gang of malevolent German nihilists who nip and tear at his mellow cocoon.  He is ill equipped to deal with the bizarre circumstances that engulf him or the arrogant elitists who continuously put him in harm’s way.  While most of us cannot condone how Dude chooses to express his “rejection of absoluteism”, we have a soft spot for him.  We see him as a green branch bending in a strong wind but not yet breaking.  He is inept but loyal.  He is an ash from an old cigarette lit in the 60’s that never quite extinguished.  He is a relic and a reminder that it is ok to march to the beat of a different drum and not be persecuted or labeled for choosing the path of less resistance.

In the end, Walter Kirn describes “His Dudeness” in simple terms: “ The Dude is one of those saintly underachievers, those holy screw ups who make it ( life ) somewhat bearable. His greatest powers are not to use his power and to acknowledge, serenely, without resentment – that in the end, he doesn’t have much power.  Forever may he stagger.  Long may he weave.”

 

 

Back To School

Back to The School

Students at Washington High School at class, t...
Students at Washington High School at class, training for specific contributions to the war effort, Los Angeles, Calif. (LOC) (Photo credit: The Library of Congress)

It’s the week after school has started and I am already having those yips like a war veteran as I watch my soldiers leave each morning at 6:45am with field backpacks, educational essentials and new clothes to be sent into the ” bush ” of high school.  It is a time of great anticipation and angst.  We are on a slow conveyor belt to an empty nest with one in college and two in high school.  I confess to being one of those parents who live each kid’s experience vicariously and constantly relive my own roller coaster ride of hormones and missteps on the pot holed path to adulthood.

The term “Homeroom”…still sends chills down my spine.  I was wedged for twelve years between Tammy T and Brad W.  Tammy was gorgeous and to my alphabetical delight, was seated in front of me.   Judging from her Facebook photo, she is still inspiring men’s imaginations.  Brad was my periodic wingman in mischief and malfeasance.  He fell off my radar for a while and is now either a successful creative artist or possibly making license plates somewhere in a minimum security facility in the high deserts of California.  We will have to wait for our 35th reunion to find out.

The first few days of school were always an exhilarating rush of change – – new and old faces, strange text books the size of War and Peace, anxiety that an upper classman like a horse, might sense your angst and ride you off into a corner.  Schools have gotten better about bullying and overt acts of harassment that were viewed as critical rites of passage in the 60s and 70s. However, a stare can still be withering and a turned back can be considered the worst of omens portending a horrible year.  A lifetime is a day.

I think of my own teachers and the odd chemistry they created that helped move me through adolescence.  Miss S was my firestarter and inspiration to read, write and give a voice to the my own seemingly inconsequential existance.  To Miss S, each of us was a Forrest Gump innocently flying through life’s seminal events and playing a supporting but vital role in the mythology of our generation.

There was the Vietnam Medic turned history and PE teacher whose unconventional courses, extreme behavior and daily boxes of Uncle Joe’s donuts had him repeatedly voted teacher of the year.  He later married one of his students which seemed for some, to change his reputation from creative to creepy overnight.  Secretly,  he still garners my write in votes as the best teacher to follow through the history of the United States.  There was Mr R, the charasmatic, first generation Irish, high energy math and track coach whose bad knees were only eclipsed by heavy Irish brogue.  For the hip and unconventional kids, there was always Mr I – the biology teacher who wore flip flops and coached the High School Ultimate Frisbee team (this is California in the 70s, folks).  And one of my favs, Coach K, a sensitive and inspirational guy who produced championship swim teams and taught pre-Calculus and Algebra.  He was in tune to the ravages of exclusion and once remanded our class with a punitive pop quiz  for behavior he saw within the student body that disappointed him.  I always had this theory that when he was young, he was on the wrong side of some bully and the experience transformed him into a sort of uber musketeer – – a D’Artagnon of the disenfranchised.

School was hard because you were constantly encountering things for the first time and learning how to react to the vagaries of community living.  Think of it as being deposited daily in the middle of the expressway of life while being injected with a cocktail of hormones.  This explains the Chernobyl meltdowns that often occur in our houses every night as tired soldiers trudge in from the bush and literally fall apart.  Everything is tinged with melodrama and hyperbole…” Everyone has this except me”.  “No one will be there, except me”.  “No one wears those anymore” Oh, that’s right, I forgot, everyone now dresses like Jody Foster in Taxi Driver. “The teacher said we did not have to do that section”.  “I forgot my backpack at Teddy’s house”. On and on it goes like a great metaphysical wheel in a hamster cage – the only thing missing is the sawdust, rodent kibble and salt lick.  I often feel trapped like a rodent when I come home to the “House of Pain” on a weeknight.  Activities and sports are key as they seem to generate critical self esteem that keeps kids from drifting into those dark alleyways.

Despite the best efforts of an engaged parent and our educational institutions, some kids stub their toes.  Some do it quite spectacularly.   Many are now entering that electrifyingly exciting and dangerous era of being “young and invincible “. It means cars are driven at break neck speeds, new things are tried, popping off to your elders is a form of boundary testing and the advice of a chronically lying, pre-pubescent, acne ridden teen is of infinitely greater value than your insights – – you, with that big “ L” on your forehead.

In my old high school, we had the East Parking lot where the non conformists, disenfranchised and loadies would congregate.  The lot was situated behind the woodshop and metal shop which ironically became the future vocations for some of these maligned kids.  I played sports with many of them and while there was always an open invitation to exit the shadows and join the sea of polo shirts and deck shoes of the main stream social circles, the East Lot had its own lugubrious allure and a tight knit community borne out of being and feeling different.  Some felt most comfortable hanging out only with these kids who seemed to know their pain.  Invariably, they were always labeled as “bad kids”.  However, my Mom used to say, “There are no bad kids, only bad choices with bad consequences.” Given she was raising four potential felons, this made sense to me and I vowed I would adhere to this theology of parenting later in life. There were drugs, accidents, deaths and the occasional scandalous revelation.  Yet, the kids seemed to cope sometimes better than their parents and understood that school was an important training ground for finding passion, community and a sense of self worth.  We sometimes forget how emotionally charged the decade of age 8 to 18 can be. While elementary school is generally a time of wonderful learning and innocent exploration, middle school has become the demilitarized zone between childhood and full blown adolescence, a sort of no man’s land where kids are growing up faster than their brains can keep pace and they are experimenting to find their place in an evolving society of peers.  High school starts to lay the foundation. The pressure to fit in and the agony of being banished will never be forgotten or in some cases, forgiven.

Years later at my high school reunions I would learn of dysfunctional homes, alcoholism, abuse and mental illness that were hidden from everyone like an ugly scar and whose burden drove many of these kids to seek solace from others who were in their own way, struggling to fit in and cope.  I felt guilty that many of these kids that I harshly judged where in fact, just coping and at the same time, desperately trying to send flares into the night sky hoping that help might arrive and ease their pain.

I was amazed how many people came to these reunions, not just for the sheer nostalgia of the gathering but to mend some ancient wound.  Beautiful women that no one recognized at first – ugly ducklings turned to magnificent swans paraded defiantly across the floor.  Others that had been marginalized came to just make sure everyone knew their net worth, zip code or resume.  There were those who were hoping to regain even for a brief evening, the alpha status lost the day they graduated and entered the real world.  Everyone was once again, for a brief moment, seventeen — vulnerable, excited, secretly wanting to see what their old flame looked like, falling back into old cliques, feelings and friendships.

Everyone remembered that feeling when life was raw and unfiltered, witnessed through an innocent lens of a kid living and learning.  It was all the experience with much less responsibility than one will ever have again.  To feel again, just for a moment, the excited ache of a crush, the thrill of a new experience or revel in the triumph of peer approval.  Now imagine it all that again for the first time.  Imagine being barely mature enough to cope with the tsunami of emotions that come with those experiences.  It’s a wild whitewater ride that each kid responds to differently.  It’s about learning to fly and bumping your butt.  It’s back to school time parents, buckle up.