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.

On learning at 30… or 40… or…

True/Slant contributor Gina Welch, on turning 30 just now, posted a fine list of 20 things she learned in her twenties, at the precise moment when I’d been musing about the passage of time myself. A somewhat more elderly muse, that is, since mine was prompted by the realization that day before yesterday marked the 85th anniversary of my parents’ marriage. In case that doesn’t sound elderly enough, my parents were both born in 1897, whew.

So in response to Gina’s wisdom here are six things I learned in my sixties (which are way past, at that.) It was terribly hard not to plagiarize, especially Gina’s Listen to your mother, even if it’s only to her long-departed voice in your head, or Wallow not, advice that improves exponentially with age.

1 – Get up early in the morning. It’s way more fun when you aren’t doing it because the baby’s crying, the school bus is waiting or the boss is calling… but just because the To-Do list actually contains stuff you want to do. Plus, days have fewer hours in them.

2 – Go back to school. Classmates a generation or two younger can be wise beyond your years. After a lifetime of writing for newspapers and magazines (you remember print journalism?) I joined the Class of ’00 at the University of San Francisco to pick up an MFA in short fiction. Who knew? If you run into anyone ready to publish my short story collection, let me know. A few of them have actually seen the light of publication, but I’m going to publish The Marshallville Stories in full if I live long enough… or perhaps if I learn enough in my 70s.

3 – Medicare is good. Imagine not having to freak out at every bodily suggestion that fatal expenses could be right around the corner. Imagine everybody having that unfreakable experience. How about we pass health reform?

4 – Listen to your daughter. She can probably teach you a LOT about changing mores, gender identities, adventure travel and how to see the world. Not to mention low fashion, hair styling, organic food and living well.

5 – Listen to your granddaughter. She can definitely teach you about computer programs, digital photography, what 18-year-old college art students are doing, and teenage music. You can close your ears when the teenage music part comes.

6 – Count your blessings. Seriously. If you’re still able to get up in the morning and remember how to count, this is good exercise. And if you count forwards and then repeat the same numbers backward you have exercised your brain, which is increasingly important. At a certain point in life it is tempting to reflect on the world when nobody locked their doors and you dashed onto airplanes just as they were pulling up the steps. And people apologized if they inadvertently used the D-word in front of your mother (there’s her voice again in my head…) So it’s okay to count nostalgic blessings, too; just don’t forget about par courses or contemporary chamber music or sunsets over the Pacific or that grandson who speaks Mandarin and Spanish at 17…

Thanks, Gina. Happy Birthday.

Finances after 50: Have we learned anything from the Great Recession?

Too soon poor, too late smart? A story by WSJ staff reporter Glenn Ruffenach in the November 14/15 Wall Street Journal “Encore” section  asks if we’ve learned any lessons from the financial crisis. And just in case you’re feeling smug about having done so, a quiz inside may shine a sober light of reality. It also contains a lot of data you will find useful, interesting and possibly surprising.

Amid the tumult of the past year, financial advisers are telling us that the Great Recession has produced one invaluable benefit: an education.

We now know, for instance, that our nest eggs can lose almost half their value in a matter of months; that “diversifying” our holdings doesn’t necessarily safeguard those holdings; and that our homes—our one investment for later life that was supposed to be foolproof—can make us look like, well, fools.

How much have you taken away from the events of the past year? Try our quiz and find out.

OK, so it isn’t much of a silver lining. But even worse is that we’ve supposedly learned these lessons before—after each recession, sell-off and market bubble since the 1960s. And yet, we continue to make the same mistakes.

How much have you learned about retirement finances in the past year? And has it sunk in this time? Our quiz will offer you a chance to see if you know where you stand—and provide some guidance for the future.

You’ll have to pick up the Weekend Journal for the quiz, but here’s one freebie in advance:

Q – In retirement, Social Security will likely replace what percentage of your pre-retirement income: (a) 23%; (b) 33%; (c) 43%; (d) 53%.

A – Well, don’t guess high.

Or:

Q – The single best cure for a battered nest egg is: (a) invest more aggressively; (b) save more money; (c) Work longer; (d) Plan to withdraw less money from retirement savings

A – And just when that pile of books to read is so inviting… sorry. (c)

The quiz is full of useful data and interesting insight (fully 40% of men and 41% of women ages 40-50 are considered obese by the Centers for Disease Control & Prevention, for instance; you knew?) One overall message seems to be, in fact: If you have one, don’t quit your day job.

Doctors oppose abortion cuts in health bill

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

Housing, homelessness & other inequities

Today’s Sonoma County (CA) Press Democrat features a front page story about Joe Montana’s digs near Calistoga, available for $49 er–million. It is right above a photo of homeless vet Jack Saltzman reading in his hatchback, the juxtaposition of photos hard not to notice.

Others vets don’t have hatchbacks. Press Democrat feature writer Jeremy Hay reports that according to the Department of Veterans Affairs, approximately 400, or 12%, of Sonoma’s 35,000 vets are homeless, which fellow homeless vet Don Bridges says is “just the tip of it.” Some 131,000 of the nation’s 24 million veterans are homeless on any given day.

Hay details some of the measures being undertaken to alleviate the problem, including $3.2 billion recently pledged by the V.A. to be spent over the next five years toward getting veterans off the street and keeping them from falling into homelessness. But returning vets have been part of another world most of us only see in the extreme abstract and can’t possibly comprehend; fitting right back into mainstream America can be harder than anywhere they have served, where at least, another vet explains, “you’ve been part of your tribe.” More vets will return, and more will wind up on the streets.

None of this is the Montanas fault.

Another Press Democrat front page story, a New York Times article by Andrew Martin and Lowell Bergman, mentions a 91-year-old Florida woman who got a letter from Citibank last month advising her that her new credit card interest rate was 29.99 percent, up 10 points from the previous rate. Haven’t we been reading about Citibank lately?

These bits of information are being digested by those of us who elected Mr. Obama and now feel sad and frustrated because our expectations were, perhaps, too high. Some of us are wondering why he ever wanted the job in the first place.

We don’t have an answer to homelessness. We may not make an offer on the Montana estate — even though, with a Tuscan-style mansion, equestrian center, full-sized basketball court, gym, pool, etc, etc it is probably worth that matching 49er price — because with 20% down and a 30-year 6% fixed rate mortgage the monthly payments of $235,023 would be a stretch. And we are not planning any credit revolt, despite the fact that it is the responsible credit users who are being penalized by the likes of Citibank. What we are doing is just trying to comprehend the surreal nature of today’s news as covered on one front page.

And keep the faith.

Abortion, health reform and me: who is making our choices?

Am I the only person around who is squirming — make that fuming a little — over the concessions made to the anti-choice guys before the House passed its health reform bill? Does no one else find it offensive to turn from reading on page one of today’s New York Times about this sad state of events to page 14 for a large photo of President Obama shaking hands with Cardinal Sean O’Malley? They were meeting at the funeral for Senator Ted Kennedy in August, where reportedly the good clergyman told the president that the Congress of Catholic Bishops really wanted to support health reform ——– oh, but only if everybody caved to their wishes that abortion remain unavailable.

It is not as if we weren’t forewarned. I posted a brief note in this space a few days ago (see Abortion Foes Winning Health Concessions, 11/4, below) and tried to resume a position of calm.

It is hard to remain calm. Somewhere the lines about separation of church and state have to fuzz themselves back into reality. I believe in the right of the U.S. Congress of Catholic Bishops to tell Catholics how to behave (despite the fact that of my many Catholic friends I know almost none who pay any attention in matters of personal choice.) I even believe in the right of the Pope to tell the Bishops to tell their parishioners how to behave. I even believe in the responsibility of all individuals, including my Presbyterian self, to behave according to their conscience and their faith. I just hate being governed by someone else’s faith.

This is not a small distinction. My own church, admittedly starting with a small group here in woo-woo San Francisco, passed a fairly strong national resolution denouncing our country’s torturing folks and seeking justice. As far as I know, no one threatened the president about withholding support for these occasionally immoral wars we keep fighting unless the instigators of torture-in-our-name were sent to jail. However strongly I would like to see the latter happen, I believe there are limits to what faith communities should do.

I had personal experience with back-alley abortion, in the dark days pre-Roe v Wade. It was not pleasant. Is there any way a celibate Catholic bishop could even remotely understand the horrors to which he is condemning poor, desperate pregnant women with the relentless push to make abortion totally unavailable? No. I wish there were.

We still have got to have health reform. But what prices we are paying.