A quick solution for the national debt

I was just idly reading through the Wall Street Journal‘s Weekend Journal, a fine way to start a leisurely weekend morning and one of those niceties of life one cannot enjoy in front of a computer. Come on, folks, buy a newspaper for crying out loud.

In case you missed it, there are a few pages of Distinctive Properties & Estates for sale, and one of them might be just the thing for you. Skipping over the second home suggestions in the Turks and Caicos Islands ($9m and change) or New Zealand (Bay of Islands hotel, price on request) we find a comfy waterfront estate in Boca Raton, majestic views, $17,900,000, or a skier’s dream in Whitefish, MT for a mere $20m… or you might prefer urban living in the Big Apple in any of several condos with views for way under $25m.

I was particularly drawn to a shady Virginia estate overlooking the James River, where I learned to sail and to bum drinks from friendly millionaires (those were the days when a million was real money) sunning on their docks. It has garaging for 5 cars and a children’s stage on the lower level, and you can pick it up for a mere $4.8m, after which your children will no longer have to suffer with makeshift cardboard boxes for their theatricals.

Included in the 30-acre digs of a little piece of Garfield, MN heaven are a caretaker’s bungalow so you won’t have to worry about those professionally landscaped grounds going to pot, plus a couple of guesthouses for your friends who come to play midnight tennis on the lighted courts. That one’s a steal at $14.9m. Or maybe you’d be more interested in a fixer-upper in Los Angeles: Frank Lloyd Wright’s Ennis House, with separate staff quarters, can be yours for $15m and it is already “stabilized and awaiting future preservation.” Frank, whose designs were prone to have leaky roofs so caveat emptor, will surely bless you from the wherever-after of architectural geniuses.

Finally, mid-page, we learn that country superstar Alan Jackson’s pad (am I the only person who isn’t familiar with Alan’s oevre?) in Franklin, TN, is available for the first person to come up with $38m, and it has a bunch of rolling acres and a lot of two-story porches all of which “allude to the grand Southern plantations of years past.”

So here’s the deal. At the risk of being labeled a commie pinko redistribution of wealth fink, I am suggesting that we start a campaign of charitable giving to the national debt. It strikes me none of these prospective buyers and sellers (the above are only the tip of the golden iceberg) could possibly miss a couple million.  They would be honored at a grand ball, no crashers allowed, at the White House, possibly receiving a copy of Going Rogue, unless some Obama fan snuck in and wanted to choose Dreams From My Father. The point is, they would get a whole lot of honor and acclaim, and if a few thousand of these folks — even if it took two grand balls — each enlisted a hundred or so of their closest billionaire friends we could pay off the national debt and throw the leftovers into funding universal health care.

Since I am NOT a commie pinko anti-capitalist scum, I am only recommending this as a one-time event. You don’t pony up, you don’t get another chance at fame and feel-good glory. Then we all go back to our CA Prop-13-protected homes or our suburban underwater mortgages and life goes on.

Could anyone possibly argue with that?

Gay Rights, Abortion Lose – – Meanness Wins. Is this the 50s?

The New York State Senate‘s rejection of a bill that would have allowed marriage between two people who love each other — but happen to be gay — is just the most recent in a string of set-backs in the area of gay rights. Other set-backs have been occurring, or are currently looming, in women’s rights, specifically reproductive rights. One wonders about the mood of this country.

This particular one wonders if anyone else is harking back, with more than a little sadness, to the 1950s. If you weren’t around then, I can tell you it was a strange decade. Great optimism for the future — well, there’s not much of that today — while simultaneously there was terrible meanness behind the McCarthy witch hunts and the denial of women’s rights, plus a certain amount of smugness embedded into a bland, national complacency.

At ladies’ bridge parties there were small china ashtrays on each corner of the table and the conversation usually drifted toward those lovely wonder drugs emerging to give instant relief for any problem. The conversation never drifted toward back-alley abortions, unless someone had recently died and the others knew how it had happened. Those of us who had jobs — running a house, entertaining for the husband’s business, raising children; those were not considered jobs — usually had male counterparts doing the exact same thing for twice the salary. One did not complain. If one were middle class white, and involved in any sort of civil rights work, one never brought that up at the bridge table.  It was a strange decade.

Today’s New York Times story quotes senators who voted against the same-sex marriage bill as saying “the public is gripped by economic anxiety and remain(s) uneasy about changing the state’s definition of marriage.” The San Francisco Chronicle article includes a comment from sponsoring Senator Thomas Duane, “I wasn’t expecting betrayal.” I’m sure those are both accurate reports. Whatever its underlying economic, political or social fears, the public seems also to harbor a degree of meanness in discounting the rights of others.

If you substitute a measure of cynicism or hopelessness about the future for the complacency of a half-century ago, and throw in the self-righteousness of those who for religious or political reasons justify the denial of rights to their fellow citizens, it’s easy to draw parallels between this decade and that one long ago.

In the fifties the groundwork was being laid for civil rights, for women’s liberation, for Roe v Wade and the upheavals that eventually led to progress, by courageous and energetic people of all sorts. I wish I could list myself in that number; I was at the bridge table trying to pretend normalcy in a life gone amok.  Today there are others working just as hard for the rights of their fellow men and women.

I hope they can keep the faith.

Menopausal Militia Mobilize for Choice

Bart Stupak is probably a nice, regular guy. It’s just that he belongs to a sub-species which cannot fully understand the need for a woman’s right to choose to have an abortion. As it turns out, a growing number of the other sub-species don’t fully understand it either. This is because that right has existed since before they were born. One person who does understand is Representative Louise Slaughter, for whom the right to choose is not just an abstract. The battle now being fought by Slaughter and others is detailed in a New York Times article by Sheryl Gay Stolberg:

In the early 1950s, a coal miner’s daughter from rural Kentucky named Louise McIntosh encountered the shadowy world of illegal abortion. A friend was pregnant, with no prospects for marriage, and Ms. McIntosh was keeper of a secret that, if spilled, could have led to family disgrace. The turmoil ended quietly in a doctor’s office, and the friend went on to marry and have four children.

Today, Louise McIntosh is Representative Louise M. Slaughter, Democrat of New York. At 80, she is co-chairwoman of the Congressional Pro-Choice Caucus — a member of what Nancy Keenan, president of Naral Pro-Choice America, calls “the menopausal militia.”

The militia was working overtime in Washington last week, plotting strategy for the coming debate over President Obama’s proposed health care overhaul. With the Senate set to take up its measure on Monday, a fight over federal funding for abortion is threatening to thwart the bill — a development that has both galvanized the abortion rights movement and forced its leaders to turn inward, raising questions about how to carry their agenda forward in a complex, 21st-century world.

Not all stories such as that of Louise McIntosh’s friend had happy endings. More of them ended in doctors offices only after botched abortions left women permanently scarred and frequently barren, although last-minute treatment led to survival. Still more of them ended in terrible pain, isolation and death. But because those stories slowly faded into abstractions, even the women who will write new ones when legal abortion is denied them have a hard time understanding how critical this fight for health and sanity is.

It has been nearly 37 years since Roe v. Wade, the landmark Supreme Court decision that established a right to abortion, and in that time, an entire generation — including Mr. Obama, who was 11 when Roe was decided — has grown up without memories like those Ms. Slaughter says are “seared into my mind.” The result is a generational divide — not because younger women are any less supportive of abortion rights than their elders, but because their frame of reference is different.

“Here is a generation that has never known a time when abortion has been illegal,” said Anna Greenberg, a Democratic pollster who studies attitudes toward abortion. “For many of them, the daily experience is: It’s legal and if you really need one you can probably figure out how to get one. So when we send out e-mail alerts saying, ‘Oh my God, write to your senator,’ it’s hard for young people to have that same sense of urgency.”

Polls over the last two decades have shown that a clear majority of Americans support the right to abortion, and there’s little evidence of a difference between those over 30 and under 30, but the vocabulary of the debate has shifted with the political culture. Ms. Keenan, who is 57, says women like her, who came of age when abortion was illegal, tend to view it in stark political terms — as a right to be defended, like freedom of speech or freedom of religion. But younger people tend to view abortion as a personal issue, and their interests are different.

The 30- to 40-somethings — “middle-school moms and dads,” Ms. Keenan calls them — are more concerned with educating their children about sex, and generally too busy to be bothered with political causes. The 25-and-under crowd, animated by activism, sees a deeper threat in climate change or banning gay marriage or the Darfur genocide than in any rollback of reproductive rights. Naral is running focus groups with these “millennials” to better learn how they think.

“The language and values, if you are older, is around the right to control your own body, reproductive freedom, sexual liberation as empowerment,” said Ms. Greenberg, the pollster. “That is a baby-boom generation way of thinking. If you look at people under 30, that is not their touchstone, it is not wrapped up around feminism and women’s rights.”

Abortion opponents are reveling in the shift and hope to capitalize. “Not only is this the post-Roe generation, I’d also call it the post-sonogram generation,” said Charmaine Yoest, president of Americans United for Life, who notes that baby’s first video now occurs in the womb, often accompanied by music. “They can take the video and do the music and send it to the grandmother. We don’t even talk anymore about the hypothesis that having an abortion is like having an appendectomy. All of this informs the political pressures on Capitol Hill.”

Well, I am the grandmother. Those videos are not the baby. They are images of an embryo in the body of a sentient human being whose life does not belong to Bart Stupak.

The women who will suffer and die if the right to choose a legal abortion is denied, though, are not women who get pretty little sonogram videos made for their grandmothers and their scrapbooks. They are the very young, the desperate, the poor. They deserve respect. They have rights.

The pressures relating to abortion had seemed, for a time, to go dormant. Mr. Obama, who campaigned on a vow to transcend “the culture wars,” even managed to win confirmation of a new Supreme Court justice, Sonia Sotomayor, without the usual Washington abortion uproar. Most of his political energy around abortion has been spent trying to forge consensus on ways to reduce unintended pregnancies.

The quiet was shattered this month, when the House — with surprising support from 64 Democrats — amended its health care bill to include language by Representative Bart Stupak, Democrat of Michigan, barring the use of federal subsidies for insurance plans that cover abortion. Lawmakers like Ms. Slaughter, who advocate for abortion rights, found themselves in the uncomfortable position of voting for the larger health bill even though the Stupak language was in it.

Proponents of the Stupak language say they are simply following existing federal law, which already bars taxpayer financing for abortions. Democratic leaders want a less restrictive provision that would require insurance companies to segregate federal money from private premiums, which could be used to purchase plans that cover abortion.

Representative Debbie Wasserman Schultz, Democrat of Florida and chief deputy whip of the House, blames what she calls the complacency of her own generation for the political climate that allowed Mr. Stupak to prevail. At 43, the mother of three children, she has taken up the abortion rights cause in Congress, as she did as a state legislator.

But if she had to round up her own friends “to go down to the courthouse steps and rally for choice,” she said, she is not certain she could. When older women have warned that reproductive rights are being eroded, she said, “basically my generation and younger have looked at them as crying wolf.”

Unfortunately, reproductive rights have already been eroded, and it’s about to get worse.

The question now is whether the Stop Stupak coalition can succeed. Ms. Wasserman Schultz sees the debate as a chance to rouse women of all generations, and Ms. Slaughter warns that if Mr. Obama signs a bill including the amendment, it will be challenged in court. She says she has worried for years about what would happen “when my generation was gone.”

At the moment, her concern has diminished. “Right now, I’ve never seen women so angry,” Ms. Slaughter said. “And the people that were angriest with me were my three daughters.”

Being a member of Ms. Slaughter’s generation myself, my concern is still pretty high. My concern is for those women who don’t have the education, access and opportunities of our own daughters and granddaughters, those women who will suffer and die if their rights are taken away. If we have to cave to the likes of Bart Stupak — and the ultra-conservatives, and the U.S. Conference of Catholic Bishops — in order to get a health bill, then so be it. But once we get a bill, the Menopausal Militia will continue to fight for those women threatened with suffering and death. Because we remember the stories, and they are terrible stories.

In Support of Abortion, It’s Personal vs. Political – NYTimes.com.

Recovery Act funds boost Alzheimer's research

Spotting brain changes before symptoms appear… identifying risk-factor genes… finding drugs that improve memory… these are a few goals of newly-funded Alzheimer’s research. And for millions of us, tomorrow won’t be too soon. The National Institute on Aging (NIA), part of the National Institutes of Health, is boosting these and other research areas in grants made with American Recovery and Reinvestment Funds.

Dementia is the looming fear of most of us over 50, an age group that recently inducted my son. My own mother died at 70, after a decade of strokes and the gradual fuzzing-out of a once sharp mind. My father-in-law, and his father, both suffered from “Alzheimer’s-related” illness. We are now light years beyond what we knew then, but probably another few light years away from prevention or cure. When you have witnessed close-on the devastation that dementia wreaks, any step toward those goals is very good news.

A few of the new or ongoing projects getting a boost from Recovery Act dollars were summarized several days ago by Medical News Today:

“We are delighted to announce the award of Recovery Act funds to many dedicated, hardworking scientists committed to advancing scientific discovery into Alzheimer’s disease and cognitive impairment,” said NIA Director Richard J. Hodes, M.D. “Over the next two years, the recipients will use this unprecedented boost in research funds to help reach our ultimate goal of understanding age-related cognitive decline and reducing the individual and societal burden of this devastating disease.”

More than 100 Alzheimer’s or Alzheimer’s-related research grants were awarded under the Recovery Act.

The complete list, a daunting read for the scientifically challenged, is available online at the ARRA (Recovery Act) site. Snippets of the list, paraphrased from the Medical News Today, summary, include:

$24 million to the Alzheimer’s Disease Neuroimaging Initiative to track changes in the living brain as older people transition from normal cognitive aging to amnestic mild cognitive impairment (MCI), in which individuals have a memory deficit but generally retain other cognitive abilities, and from MCI to Alzheimer’s disease.

A grant of more than $5.4 million to add 3,800 Alzheimer’s patients and an equal number of people free of the disease to a previously funded study by the Alzheimer’ Disease Genetics Consortium (ADGC), which aims to identify the additional risk factor genes for late-onset Alzheimer’s disease. These huge datasets will allow scientists also to search for genes associated with a number of traits associated with Alzheimer’s, as well as for genes related to cognitive decline.

Another study, examining cognitive decline in older African-Americans will collect and analyze the DNA of 4,140 elderly African-Americans enrolled in NIA-funded aging studies already taking place in Chicago and Indianapolis. The study will assess the associations of over 900,000 genetic markers for such issues as stroke and high blood pressure.

Another $820,000 in Recovery Act funds will advance Alzheimer’s genetics research by developing methods for identifying combinations of genes that might influence age-related risk of AD.

There are more — some looking at drugs and exercise, some studying specific populations, many (including the above) examining a multiplicity of factors in the search for answers to the puzzles of the brain.

This space will be following the progress of them all — if I don’t forget.

Recovery Funds Advance Alzheimer’s Disease Research.

Diet, exercise and Alzheimers

These paragraphs are a segue from talk of holiday festivities, over the past several days,  into the very un-festive subject of Alzheimer’s disease.

Part of the conversation at the very festive Thanksgiving dinner I was lucky to enjoy (without having cooked a single dish!) centered around food for the brain. One argument was that the good stuff for one’s neurotransmitters — egg yolks, broccoli, soy, starches — should be meticulously watched. I heard my mother’s voice in my head in response. “If you have three meals a day that look pretty on the plate,” she liked to advise, “you’re getting the proper diet.” When pressed she would explain that “pretty” equates to “color-coordinated,” i.e.: toast/bacon/scrambled eggs with parsley; or broccoli/carrots/potatoes/hamburger. I can’t remember whether our plates were 9-inch or otherwise.

Then there is the larger issue of exercise. Fitness, and occasionally brain exercise, have been contemplated several times in this space over the past few months (10/5: How’s your brain fitness today?; 9/7: The new best thing.) These theories hold that it is possible to strengthen, possibly even build anew, those neurotransmitters.

The definitive word on all this has not been written, and answers surely won’t originate with someone who barely passed Science I-II for the math/science requirement of her BA in Art. But some fascinating studies are being done, and new American Recovery and Reinvestment Funds will be going to projects that will be the focus of this space tomorrow.

Meanwhile, Alzheimer’s and various forms of dementia remain the ultimate tragedy in millions of lives, diet and brain exercise and clean living in general notwithstanding.

One of the most poignant insights into this disease you’ll be likely ever to see is currently offered by the PBS series Life (Part 2.) It follows a beautiful, articulate woman named Mary Ann Becklenberg as she confronts her own decline with incredible courage. What science may find answers for in the next few years, Mary Ann Becklenberg is exploring in real time. Schedules and clips are on the Life (Part 2) website.

Chances are, whether you’re over 50 or not, your life will be impacted by dementia. I, for one, am grateful for science and for Mary Ann Becklenberg.

Pilgrims? Turkeys? None of the above. Today was just Honest Abe's good idea

Perhaps the pilgrims and the Indians did indeed sit down to a great feast and a peace pipe; there were probably plenty of wild turkeys around in the early days of the pre-U.S. But all of those things had nothing to do with the beginnings of Thanksgiving Day — you knew that, of course.

Nope. It was Abraham Lincoln’s effort to bring a little peace into the fractured country he found himself trying to lead, at a time about as fractured here as the world is, today, everywhere. Abe thought a little reverence and repentance would be a good thing. Here, in part, is what he had to say:

“But we have forgotten the gracious hand which preserved us in peace and multiplied and enriched and strengthened us, and we have vainly imagined, in the deceitfulness of our hearts, that all these blessings were produced by some superior wisdom and virtue of our own. Intoxicated with unbroken success, we have become too self sufficient to feel the necessity of redeeming and preserving grace…”

Poor Abe. If he thought he knew deceitfulness and intoxication, he should have seen what’s going on in health reform. And if he looked beyond our shores he might have sensed wider “punishment and chastisements in this world” and called for a global pause.

Whatever its origin — Lincoln’s formal establishment of the day was in 1863, but what would preschool be without pilgrims and cornucopias? — Thanksgiving Day still offers a nice time to pause.

Here in San Francisco a few hundred or so of us will be doing that at the 5th Annual Interfaith Thanksgiving Service, where we’ll have a group Ommmm, a Muslim call to prayer, a bunch of other prayers to Whomever has not given up on us all,  “with one heart and one voice” as Mr. Lincoln suggested we do. Then we’ll go home and eat stuffed turkey and watch ball games.

And a Happy Thanksgiving to all.

God, Thanksgiving & Mother Theresa

Former San Francisco Mayor Art Agnos spoke briefly, and with holiday hilarity, this morning to several hundred Christians, Muslims, Jews, Buddhists and assorted other believers at the annual San Francisco Interfaith Thanksgiving Breakfast — “the biggest crowd I ever addressed at seven in the morning.” The event highlighted some of the work the SFIC does in the city: an annual winter shelter for homeless men, a citywide disaster preparedness program, a variety of ongoing efforts to promote understanding, cooperation and general interfaith goodwill. Agnos told a tale of encountering Mother Theresa which is condensed and paraphrased below as a Thanksgiving present from this space.

Coming home one Sunday night during his tenure, the mayor got a message (this was in the late 1980s, pre-cellphones) from his wife saying Mother Theresa was at their door. (“What should I do?” “Let her in.”)  When he walked into the living room, sure enough, there was the diminutive nun in her blue and white habit, seated on the Agnos’ sofa with another nun on each side. She wanted the mayor, she explained, to secure a particular piece of property for her good works. It was after 9 PM.

“I’ll get right on it, first thing in the morning,” Mayor Agnos said.

“No,” said the tiny nun in her quiet voice. “God’s work does not wait until morning.”

The property in question was in an area of town into which few ventured after dark. When that factor was mentioned as cause for caution, however, Mother Theresa would have none of it. “God,” she said in her still-quiet voice, “will protect us.”

So the mayor, the three nuns, the mayor’s wife (who wasn’t about to miss this experience) and a police bodyguard Mayor Agnos invited along just in case God wasn’t paying attention, climbed into a police car and drove to the building in question. Working their way through a fence which had long before been erected around the property, they walked around the back to find a small group of homeless men gathered around a fire. It was not only getting later all the time, it was mid-winter.

“Oh,” the men said in unison, “it’s Mother Theresa.” She blessed them. Then the mayor asked if the building did indeed belong to the city. “Well, yes,” they said, “but we’ve been living here for several years and nobody’s bothered us.” So the mayor assured the nun that he would get to work on her request first thing in the morning.

She was not finished. Next, she wanted to see about another piece of property, this one necessitating a trip to San Francisco General, the City/County hospital of last resort for citizens in need. By now it was getting on towards midnight.

At that hour at San Francisco General, Mayor Agnos explained, most of the people on site are the cleaning crews and base-level helpers — all of whom immediately recognized Mother Theresa. “When we got ready to leave,” said Agnos, “it was like a football huddle. Everybody in the area gathered around this tiny nun you couldn’t even see in the middle of the crowd.”

“When you die and go to heaven,” said Mother Theresa to her fellow laborers, “you will meet God. And God will bless you for your good work.”

“So,” concluded the Mayor as he opened his arms to indicate those around the room, “when you die and go to heaven, you will meet God. And he or she, whomever, will bless you for your good work.”

Makes you thankful to be in the presence of so many people doing good work.

Doctors making house calls? An old idea whose new time has come

Could house calls make a comeback? It’s already happening. The University of California at San Francisco, for one success-story example, started the UCSF-Mt. Zion Housecalls Program in 1999 with a philanthropic gift. Its original goal was to teach medical students about home care, but with the exploding need for primary care for homebound elders it has evolved into filling that need throughout San Francisco — while still teaching the new generation about house calls.

In an article in the San Francisco Chronicle, staff writer Victoria Colliver details some of the many advantages that such programs have.

June Hagosian’s brain tumor has made it difficult for the 77-year-old San Francisco woman to leave her house in recent years, keeping her mostly confined to her bed.

For someone like Hagosian whose medical needs require frequent doctor visits, that would usually pose a problem. But because of a program run by UCSF, the doctor comes to her. She has had to leave her bright yellow home in the Richmond District to go to the hospital just three times in the past seven years.

“This program has been so wonderful,” Hagosian said during a recent home visit with her physician, Rebecca Conant, director of UCSF’s Housecalls Program. “I wish everyone could have it.”

Conant, who had just 15 patients when she took over the program in 2001, is one of five part-time UCSF physicians who spend all their clinical time outside the office, traveling from home to home visiting frail and elderly patients. Housecalls currently serves nearly 100 San Francisco residents and has an eight-month waiting list.The Housecalls physicians visit patients whose conditions make it so hard for them to go to the doctor’s office that they might otherwise put off seeking medical care. By then, they would be so sick they would need an ambulance and end up in a hospital emergency room. The program takes patients regardless of whether they have insurance or an ability to pay, which separates it from private practices that offer home visits as a convenience but at an added cost.

UCSF’s 10-year-old Housecalls Program is an old idea that has gained new traction. Both the House and Senate versions of the health reform bills contain proposals to examine whether home-based care improves the health of chronically ill patients and saves the government money by reducing hospitalizations and ER visits.”There’s no question there is both a medical need and substantial cost savings to the Medicare program,” said Constance Row, executive director of the American Academy of Home Care Physicians.

The Department of Veterans Affairs’ Home-Based Primary Care program, which has been operating for more than two decades, has showed a 24 percent reduction in costs for those patients, and some studies suggest savings as high as 40 percent, Row said.

UCSF’s Housecalls Programs operates on an annual budget of $300,000, almost all of which is devoted to physician salaries. That’s an average cost of $3,000 per patient, which does not include the cost of hospital care when needed. Medicare spends a national average of $46,412 per patient over the last two years of life, when patients typically have several chronic illnesses, according to researchers from the Dartmouth Institute for Health Policy and Clinical Practice.

But new technology – the ability to X-ray patients using portable machines, conduct blood tests and provide other services using mobile devices – allows doctors to offer a much higher level of care in the comfort of the patient’s home.

Conant, an associate clinical professor at UCSF, said she uses mobile devices to aid in her patient care, but she finds home visits offer other advantages like allowing her to see patients’ physical environments, meet their caregivers and better understand what kind of care they need.

“Not only does that improve medical care, but it’s based in reality,” she said.

The UCSF program is not the only home-based primary care program in the Bay Area. Kaiser Permanente, for example, serves some 370 members in San Francisco as part of its 13-year-old Community Care Program, which is handled by physicians, nurse practitioners and social workers.

Reinstituting and reinforcing in-home care, considering the significantly improved care for patients and the reduced cost to the taxpayer, would seem a no-brainer. But brains are losing out to politics a lot these days.

via UCSF program shows house calls’ time returning.