Health Care in America

It is not just that time of year to begin thinking about sugar plum fairies.  It is also the dreaded time of benefits open enrollment for most people who have employer-sponsored health care.  Unsealing the open enrollment package each year is always a bit scary; there is that anxious moment when I have to face how much the expense of my premiums will increase for the upcoming year (this year, it was about 5%, less than the past few years).  But I am lucky.  There are lots of people with no health insurance, or, as in our household, a person (Tim) with no employer-sponsored plan, who has to go out into the marketplace solo and negotiate for the best plan he can afford (usually one with an extremely high deductible and costly prescription coverage).  For someone like Tim, who often has to visit the doctor for his chronic condition, health care is no fun.  

So, what is to be done?  I read two articles in the New York Times that discussed the high cost of health care.  In The High Cost of Health Care, there is a discussion about why health care in America costs so much, and a delineation of possible solutions to help keep prices down.  The health care problem affects all sides of our economy - consumers, businesses, and governments:

Workers complain that they cannot afford high premiums for health insurance. Patients forgo recommended care rather than pay the out-of-pocket costs. Employers are cutting back or eliminating health benefits, forcing millions more people into the ranks of the uninsured. And state and federal governments strain to meet the expanding costs of public programs like Medicaid and Medicare.

Health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis. And health costs here have been rising significantly faster than the overall economy or personal incomes for more than 40 years, a trend that cannot continue forever.

It is the worst long-term fiscal crisis facing the nation, and it demands a solution, but finding one will not be easy or palatable.

As the cost of health care increases and eats up more of the government’s budget, as well as personal disposable income and corporations’ profits, there will be less money for other important issues and projects (for example, curbing greenhouse gases, inspecting meat-packing plants, schools, levees in New Orleans, etc.).  So what to do?  In the above article, the author discusses practical solutions within the existing framweork of the American insurance industry (things like managed care, preventive medecine, and technology upgrades).  I, for one, think we need to dispose of the entire existing system, and I feel that now is the time to have the discussion.  We have a presidential election going on where health care coverage is being debated.  We also have a state, Massachusetts, that is experimenting with requiring health care for all of its residents.  Will the Massachusetts plan work?  Could its parameters be expanded to the nation?  The second article I read, Massachusetts Faces a Test on Health Care, describes how the mandatory Masachusetts health plan works and how successful it looks to be.  Basically, residents are required to sign-up for health insurance or face penalties.  In the first year, the punishment is not much – those who do not enroll will not receive a personal tax exemption on their state taxes.  However, in subsequent years, the penalties will increase.  There is also a state-sponsored plan for low income residents to enroll in, if they choose.  Has the Massachusetts plan worked?  Have all people enrolled?  Will it save money?

More than 200,000 previously uninsured residents have enrolled, but state officials estimate that at least that number, and perhaps twice as many, have not.

Those managing the enrollment effort say it has exceeded expectations. In particular, state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.

But the reluctance of so many to enroll, along with the possible exemption of 60,000 residents who cannot afford premiums, has raised questions about whether even a mandate can guarantee truly universal coverage.

Additional concerns have been generated by projections that the state’s insurers plan to raise rates 10 percent to 12 percent next year, twice this year’s national average. That would undercut the plan’s secondary goal of slowing the increase in health costs.

Perhaps not.  I think it is too early to tell - I do think there will be additional savings over time as people who were once uninsured take advantage of their coverage and preventive medicine helps curb costs of preventable illnesses.

Frankly, I feel that we should have a two-tiered system in America.  One tier which caters to all Americans and provides basic health care – a regular check-up once a year, and care for those with chronic illnesses.  Doctors on this level will mostly be primary care physicians and provide basic care for anyone.  On a second level would be specialists.  Anyone could buy into this second tier which would be run by health insurance companies and provide specialized coverage.  This way, those who complain that universal health care stymies innovation and leads to worse health coverage, can opt for the higher level.

But, as Massachusetts is discovering, can we require people to be covered?  Even if we do require it, can we force all people to visit the doctor?  If someone doesn’t want to have insurance and does not visit the doctor regularly, for whatever reason, then that person could create additional expenses (when he/she becomes chronically ill, shows up in an emergency room, and becomes a problem of the state).  The system sucks; it needs to change; but I don’t really know how.  As much as I want revolutionary change in the system, I think the current batch of candidates is being naive if they think it will be possible to change to a universal health care system, or to get the health insurance industry out of the picture.  The industry, and the myriad of politicians they support, will not leave without a long and expensive fight.  What are your ideas for the American health care system?  Should it change dramatically?  Should we expel the insurance industry? 

Melito’s

Tim and I visited Melito’s last Saturday evening.  He asked me if I would review the restaurant and I answered that I must have already, as we visit Melito’s fairly frequently.  I was surprised to discover that in fact, I had not yet reviewed this West End establishment, even though I always enjoy it.

I used to live with friends of mine in a house in a neighborhood off of Three Chopt to the east of Melito’s.  That is when I first discovered this neighborhood bar/restaurant.  Melito’s is a smoke-free environment and has recently had an external face-lift (Melito’s is located in a strip mall near Westbury Pharmacy and Regency Mall).  We have never had a long wait at Melito’s and, on this visit, were able to score a booth seat quickly.  One negative aspect of Melito’s is that many of the seats are four-top tables with free-standing chairs.  These tables are crammed into small spaces and we have felt squeezed into our seats when we have been seated there (for example, on this recent visit, we watched as a heavyset, but not obese, man was escorted to one of these tables and was unable to sit down as the people at the table behind him were already squeezed in – he could not move his chair back far enough to sit down).

Melito’s has a regular menu that includes a diverse array of sandwiches and a few entrees.  The also offer nightly specials that primarily include entrees.  I usually order an appetizer of soft pretzels and a house salad for my meal, basically because I am a soft pretzel whore and because Melito’s concocts fabulous salads – simple yet fresh – and serves them with homemade dressings.  However, on this visit, I opted for a meatball sandwich with a side of french fries.  The meatballs were small, but juicy and flavorful.  The marinara sauce was a little sweeter than I like, but still good.  The sandwich bread was fresh and hot, just the way I like it.  Overall, the sandwich was pretty darn good.  The french fries were battered and were also very tasty (because I love Melito’s salad dressings so much, I asked for a side of ranch to dip my fries in – very good).

Tim ordered the hotdog plate, which was a hotdog served with chili, mustard, and onions.  He also had a side of fries and was served a side salad as part of the plate.  He enjoyed his dinner but did state that the hotdog he had at Table 9 was better (alas he also received no side dishes with his Table 9 dog).

Our server was fantastic during this visit, being very attentive – she filled up our waters and coffees repeatedly without prompting.  In the past, the service has always been fine, although not exceptional – a bit brusque as the place gets busy.  I love the atmosphere at Melito’s, as the lighting is dim, the music does not get too loud, and the furniture and bar are outlaid in soothing dark woods.  I also like how Melito’s always seems to be filled with neighborhood regulars.  No, not those skeevy regulars who sit at the bar all day, drunk and smelly, but families and older folks who come in for drinks and meals often.  I will definitely return and encourage others to visit if they have not been there before.  Also, if you are a fan of American Idol, Elliot Yamin used to work there.

Rating:

The Mexican Restaurant in Carytown that is not Nacho Mama’s and is located where the old Mom’s Siam was

We visited the new Mexican restaurant in Carytown last week, after meeting our football team and some other friends for drinks at New York Deli.  We should have remained at the Deli and eaten there, because, as succinctly stated by the West of the Boulevard blog, this new Mexican restaurant was “bad.”  Also, I cannot remember the name of this restaurant and cannot seem to find it on-line, after an extensive search (by extensive, I mean a 10-minute Google search and a search of RVA blogs).

Tim and I visited the new establishment on Friday night with our friends Leigh and David.  We were quickly seated and served the customary salsa and chips.  We, like all the other tables, received a horrible white dipping sauce in addition to our salsa.  I don’t believe it was a queso sauce, but I am at a loss as to how to describe it, except to say it was wretched – very, very sweet and sugary tasting.

I ordered a margarita, on the rocks, with salt and received a margarita on the rocks, with no salt.  It was fine, but like most cheap Mexican restaurants, was made using an awful margarita mix rather than tequila, triple sec, and lime juice.  I ordered a chicken burrito with mole sauce for my dinner, and it was almost inedible.  I ate approximately 5 bites before giving up in disgust.  The chicken was overcooked, the burrito shell was mushy, and, most disappointingly, the mole sauce was thick, too sweet, and not spicy.  It was “bad.”

Tim and David thought their entrees were fine, but not noteworthy.  Leigh enjoyed her chicken and rice entree, but, how can you screw up chicken and rice?  If you know me, you know my constant lament on the closing of El Rio Grande in the Fan near VCU.  Their burrito with mole sauce was extraordinary, and I cannot seem to replicate its magnificence anywhere. 

I did not like the atmosphere of the new Mexican restaurant either – a bit rundown and very glaring lighting.  I thought most items were over-priced, although I suppose that is to be expected for a restaurant in Carytown.  My recommendation is to stay far, far away.

Rating:   

Penny Lane Pub

Tim, Leigh, and I headed to Penny Lane Pub last week prior to heading to the ballet.  Penny Lane is located on the corners Franklin and 6th Streets, and sells itself as a traditional English pub.  I have visited Penny Lane a few times, both at its old location and its current location.  The pub is spacious; the bar is set off in a room with tables on the side.  If you pass through a foyer, there are additional tables out of sight of the bar.  There is also a semi-outside section, a former open air space that is now enclosed, although plenty of natural light still pours into that area.  Apparently, there is a spacious upstairs area that I have never visited.

Usually, the British owner is on-hand to give a hearty welcome to all guests, chat with them, and flirt with the ladies.  When our group visited recently, he was not present.  We were seated quickly and drink orders were taken promptly by our waitress whose curt friendliness was adequate.  Penny Lane has a nice selection of British beers on tap, although nothing truly rare or remarkable.  The menu has the typical British fare – shepherd’s pie, fish and chips, bangers and mash, etc.  None of this food appeals to me (actually, none of the entrees appealed to me).  Our waitress brought over the pub menu, which had about 5 sandwiches featured.  I opted for a burger with fries.  The burger came cooked as ordered, with tomatoes, onions, and lettuce.  It was fine, but not remarkable.  The fries were those big, thick fries that I don’t like because they are too mealy (I always douse them with vinegar and salt to make them more edible).  Both Tim and Leigh ordered shepherd’s pie, which came prettily presented with mashed potatoes atop the meat and pea stew.  Both Leigh and Tim enjoyed their meals.

As mentioned above, I have visited Penny Lane several times before, primarily for drinks.  I do like the bar and the atmosphere for drinking is nice.  I don’t think the food is very good, but mostly because none of the options appeal to me.  I give Penny Lane Pub 2 out of 5 stars – great for a drink, not so great for entrees.

Port Isobel and Tangier Islands

I was away from civilization for several days last week, on a work retreat.  Every year, we congregate on a remote island in the Chesapeake Bay to learn some stuff and to socialize (and by socialize, I mean drink a lot and act silly (best example this year was our administrative assistant climbing and subsequently falling out of a tree)).  We own a small island, called Port Isobel, which is customarily used for education trips – we take groups of students to the island to learn about water quality, the Bay, and the lives of watermen.  Port Isobel is very close to Tangier Island:

The population was 604 at the 2000 census. The tiny island community has attracted the attention of linguists because its people speak a unique dialect of American English, hypothesized to be nearly unchanged since the days of its first occupation by English colonists. Each of the original surnames and several of the present surnames on the island originated in the British Isles, particularly in Scotland, and the accent has a distinctly Celtic flavor, similar to those in Scotland, Wales, Ireland, and Cornwall, four of the seven Celtic nations [source].

I was able to go over to Tangier during one of our free afternoons.  I had heard the distinct Tangier accent before, as there are a few Tangier residents who work for our Foundation.  However, it was remarkable to go over there and hear so many folks speaking that way.  Tangier was beautiful; lots of old houses and pretty marshland.  Everyone drove around (fast) using golf carts – I think we saw one automobile while there.  Like New Orleans, because the ground is so low and marshy, many people are buried above ground in tombs (many of the dead were buried in the front lawns of people’s houses).  There were also a large number of stray cats darting around.

                              

Port Isobel itself was quite beautiful.  I took a very early morning walk with some co-workers and some some beautiful marshland and beachfront.  We also tried frag-diving, which is basically running and throwing your body in a big grove of fragmites.  The weather was cool and brisk, perfect for an autumn getaway.

     

We had an interesting speaker, Peter Forbes, at our retreat, from the Center for Whole Communities.  I could ramble on about several of his interesting points, but the essential message for me was the need to include all aspects of the community to make our message (environmental stewardship and water quality) more effective.  For example, how can we stress the importance of water quality when some one has no house in which to live?  However, perhaps if our organization joins forces with different non-profit groups, our messages and work can be combined to be more effective for both organizations.  I have some ideas that I might present after I mull them around some more (and find some time to develop them).

Godless and proud!

Earlier in October I read an interesting article about the Freedom from Religion Foundation, describing how the group was holding their 30th annual convention.  Apparently, the numbers of atheists and agnostics who are joining the group are growing, as is the discontent and dislike against the group among mainstream religious America.

Atheists are viewed far more negatively than any religious group, according to a recent survey by The Pew Forum on Religion and Public Life.

Religious Americans are not comfortable with atheists’ refusal to believe in God and think they must lack morality, said John Green, a senior fellow with the nonpartisan forum.

Green said the number of people who do not worship is slowly growing but the exact number of atheists in America is unknown because many people are reluctant to identify themselves that way. About 4 percent of people in Pew’s latest survey said they were atheist or agnostic and an additional 10 percent said they followed no religion.

I was a bit surprised when I read that some non-believers were reluctant to admit their atheism, but then I reconsidered.  I am an agnostic myself, and have felt uncomfortable at times admitting as such, especially at work.  I have been at meetings where there have been blessings and even though these blessings are supposed to be “non-denominational” they are clearly Christian-based and definitely not non-religious.  When I taught in the public schools (briefly) we had to say the Pledge of Allegiance daily.  I was always uncomfortable about saying, “one nation, under god,” but I felt it inappropriate to not say the pledge.

I am not surprised that most religious people feel that atheists and agnostics are immoral, and I’m not sure how I can argue that viewpoint.  I think everyone should know that there are plenty of moral folks who are believers and plenty who are non-believers (just as there are plenty of immoral folks on both sides).

I accept the fact that I live in a Christian-based nation, and I am not suggesting that we remove all references to god from every public document and venue, but I do feel that there needs to be further understanding and sensitivity to folks who are not religious.  Even Tim, when I expressed an interest in joining the Freedom from Religion Foundation, kind of sniffed and did not understand what the organization does.  I explained that it is a community (like a church) for those who believe in similar ideas about religion.  He still thought it was slightly ridiculous.

I also think things have become less tolerant in our community and nation over the past few years.  I’m not certain if it is because of the rise of “compassionate conservatism” and George Bush or if it is because Christians feel threatened by the rise of secularism (although I just don’t see this rise in secularism – I feel like every kid I meet is very dogmatic in his/her faith in a Christian god at the exclusion of others).  I feel the need to join the Freedom from Religious Foundation now more than ever to combat what I feel is an unreasonable blending of church and state, the foundation on which our nation was built.  We should not let this idea fade away, not even a little bit.

The Nautical Chart

I finished reading The Nautical Chart some time ago and have basically been trying to forget the time and brain cells I wasted to read this paltry excuse for a swashbuckling tale of sunken treasure and romance.  I wanted to read a light yet engrossing novel, so decided to pick up a Arturo Perez-Reverte book we had lying around the house – all of his other books have been exciting and intelligent tales (usually a hybrid of Eco’s The Name of the Rose and Dumas’ The Three Musketeers – fun yet not dumb).  The Nautical Chart is the exception to his body of work.

Here is the plot in a nutshell: the protagonist, Coy, is a seamen who has had his nautical license suspended.  He circuitously meets Tanger, a beautiful woman who Coy inexplicably falls in love with and who he constantly tries to “protect” by beating to a pulp anyone who he suspects is trying to cause her harm.  Tanger has an old nautical chart and she is trying to locate a sunken treasure.  They spend some time diving off the coast of Spain searching for the treasure while Tanger’s competitor watches them and tries to steal it.  Tanger and her competitor get killed at the end after Tanger betrays Coy. 

The story is very boring.  The characters are caricatures and silly.  Coy waxes poetically about the sea and how beautiful and sexy Tanger is – endlessly.  There is really bad writing in here about how women are mysterious and their only functions are to destroy men and how Coy will never understand females but nevertheless he is under the spell of Tanger.  I strongly dislike how Coy, who is presented as a reasonably sensible character, consistently beats to a pulp anyone who looks at him wrong.  The only good thing I can say about this novel was that it is a very easy and quick read.  I give The Nautical Chart1.5 out of 5 stars.  Please do not take this as a condemnation of Perez-Reverte’s work as a whole.  I truly enjoyed The Club Dumas and The Seville Communion.  Please read those instead if you are searching for an intellectual thriller.

I did attempt to find one redeeming quality about the book, but all I could produce was one short passage that struck a chord with me:

And Coy asked himself, envying him, what the first man felt the first time he went out to hunt a whale, a treasure, or a woman, without ever having read about it in a book.

Poorly written, but an interesting idea that I have contemplated at other times.  How are our experiences shaped by what we have read or heard or viewed on television?  Would we like and enjoy the same things if we did not have this constant media barrage telling us what others like and have experienced?  I have always wondered what type of person I would be if I had been born in another time, pre-media saturation.  Would I have the same moral compass, likes, and dislikes? 

Bar Louie

We met our friends Jenn, Ray, Chris, and John at Bar Louie in downtown Short Pump, our first visit to this relatively new space.  Apparently, it used to house a more formal seafood restaurant that failed miserably.  The owners then decided to convert it into a spacious bar.  The layout of Bar Louie was pleasing – lots of open space with two large square bars (you could sit around all sides of each bar).  There were tables scattered around the floor, separate from the bar.  Bar Louie has some good happy hour specials: $2 draft beers (with a decent selection of beers on tap) and half-price appetizers from 7:00 until 9:00.

Tim and I arrived first and were shocked about how loud the place was - overbearingly blaring music drowned out the din of conversations.  Since we were meeting some old friends traveling from out-of-town, we really desired a setting that would be conducive to conversation.  We debated as to whether or not to leave and find quieter digs.  Unfortunately, neither of us were very familiar with Short Pump and could only think of some chain restaurants that did not seem very appealing.  So we decided to wait it out and see what the others thought.  

Our hostess let us know it would take a few moments to get a table for six ready, so Tim and I went to get a drink at the bar.  I received my drink quickly, but then it took approximately 20 minutes to get my change.  My bartender kept coming over to me and asking, “Have you gotten your change yet?”  “Well,” I wanted to reply, “Do you remember giving it to me?” or “Do you think I am waiting here expectantly for pigs to fly?”  Finally, I received my change.  By that time, our table was ready, so we sat down.

Tim and I could barely hear each other, as the music clamoring from the stereo was inordinately loud.  I understand that the place is primarily a bar, but does it have to be so loud?  It was extraordinarily so, and cast a pallor on the evening.

Eventually our friends arrived.  We started our dinner with some half-priced appetizers: hot, doughy pretzels and spinach and artichoke dip.  The pretzels were not pretzel-shaped but rather long logs of pretzel-y goodness.  They came served with three dipping sauces, cheese, mustard, and hot mustard.  I thought these were excellent, but, then again, I love hot pretzels and it is very difficult to serve low-quality ones.  The spinach and artichoke dip was fine – typical bar fare.

After the appetizers I was not particularly hungry so just ordered a grilled cheese sandwich.  It came with bacon and tomato and was a gooey combination of different cheeses.  It was fairly good, but unremarkable.  The french fries that came on the side were very tasty – they were battered and seasoned, just the way I like them.  Everyone else was pleased with their food.  Items ordered varied from burgers to wraps to an entree of baked macaroni and cheese with chicken that Chris ordered (he liked the mac and cheese but thought the chicken ruined the dish).

Our waiter was courteous and accommodating, and usually, food and drinks arrived promptly.  However, there were a few times when we seemed to wait an inordinately long time for drink orders to be filled.  Overall, I think Bar Louie fills a niche out in Short Pump: primarily a bar at which the 20- to 30-something crowds can mingle.  I give it 3 stars out of 5.  Incidentally, if you are a sports bar fan, there seemed to be quite a number of TVs placed throughout the restaurant, all tuned to sports.

After dinner, we went bowling.  I broke 100 both times, and got a turkey in my second game.  I was on fire!