Special Deal

On the last week of April earlier this year, a small committee of doctors met quietly in a midsized ballroom at the Renaissance Hotel in Chicago. There was an anesthesiologist, an ophthalmologist, a radiologist, and so on—thirty-one in all, each representing their own medical specialty society, each a heavy hitter in his or her own field.

The meeting was convened, as always, by the American Medical Association. Since 1992, the AMA has summoned this same committee three times a year. It’s called the Specialty Society Relative Value Scale Update Committee (or RUC, pronounced “ruck”), and it’s probably one of the most powerful committees in America that you’ve never heard of.

The purpose of each of these triannual RUC meetings is always the same: it’s the committee members’ job to decide what Medicare should pay them and their colleagues for the medical procedures they perform. How much should radiologists get for administering an MRI? How much should cardiologists be paid for inserting a heart stent?

While these doctors always discuss the “value” of each procedure in terms of the amount of time, work, and overhead required of them to perform it, the implication of that “value” is not lost on anyone in the room: they are, essentially, haggling over what their own salaries should be. “No one ever says the word ‘price,’ ” a doctor on the committee told me after the April meeting. “But yeah, everyone knows we’re talking about money.”

That doctor spoke to me on condition of anonymity in part because all the committee members, as well as more than a hundred or so of their advisers and consultants, are required before each meeting to sign what was described to me as a “draconian” nondisclosure agreement. They are not allowed to talk about the specifics of what is discussed, and they are not allowed to remove any of the literature handed out behind those double doors. Neither the minutes nor the surveys they use to arrive at their decisions are ever published, and the meetings, which last about five days each time, are always closed to both the public and the press. After that meeting in April, there was not so much as a single headline, not in any major newspaper, not even on the wonkiest of the TV shows, announcing that it had taken place at all.

In a free market society, there’s a name for this kind of thing—for when a roomful of professionals from the same trade meet behind closed doors to agree on how much their services should be worth. It’s called price-fixing. And in any other industry, it’s illegal—grounds for a federal investigation into antitrust abuse, at the least.

But this, dear readers, is not any other industry. This is the health care industry, and here, this kind of “price-fixing” is not only perfectly legal, it’s sanctioned by the U.S. government. At the end of each of these meetings, RUC members vote anonymously on a list of “recommended values,” which are then sent to the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs those programs. For the last twenty-two years, the CMS has accepted about 90 percent of the RUC’s recommended values—essentially transferring the committee’s decisions directly into law.

The RUC, in other words, enjoys basically de facto control over how roughly $85 billion in U.S. taxpayer money is divvied up every year. And that’s just the start of it. Because of the way the system is set up, the values the RUC comes up with wind up shaping the very structure of the U.S. health care sector, creating the perverse financial incentives that dictate how our doctors behave, and affecting the annual expenditure of nearly one-fifth of our GDP.

by Haley Sweetland Edwards, Washington Monthly | Read more:
Image: uncredited

Kintsugi (to patch with gold) or Kintsukuroi (to repair with gold) is the Japanese art of fixing broken pottery and ceramics using a lacquer resin sprinkled with powdered gold (or silver). Rather than being concealed, the damage is celebrated and becomes a defining feature of the object. As a general rule, the repaired artifact acquires far higher value and enjoys greater appreciation than it had in its previously undamaged state.
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Daniel Gordon ‘The Green Line’
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Joseph Lorusso (1966)
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The Decline and Fall of the Book Cover

Getting to design your own book cover is the sort of ultimately maddening power that probably shouldn’t be entrusted to vain mortals. It’s a little like getting to choose your own face. What kind of face would best express your inner self? Maybe more important, what kind of face will make other people like or respect or want to sleep with you? Do these two hypothetical faces bear any resemblance to each other? Can you imagine a face that would combine their best features?

There’s often an embarrassing disconnect between how people try to present themselves and how they’re actually perceived, which is why they ask their friends to tell them honestly how they look in something—and why publishing houses hire professional designers for books’ covers and allow their authors very little say over them. Most writers are given what’s called “consultation” on their covers, which means that when they’re shown their cover designs they try not to cry right in front of their editors. But, because I’m a cartoonist as well as an essayist, and also have a savvy and implacable agent whose will is not to be opposed, I had “approval” over the cover of my book, which meant that I got to make a tiresome and nit-picky pest of myself.

I had what we’ll call a constructive dialogue with my publisher’s editorial, design, and marketing teams, finding a balance between my personal vision and something people might possibly want to buy. For months we went back and forth: I’d send them several illustration options and they’d pick whichever one I liked least; they’d send me some design options, I’d pick the one that made me least unhappy, and they’d veto it. Book covers are an important sales tool, and the marketing department felt, quite reasonably, that the cover was very much their business. I also had a paranoid sense of shadowy, Olympian forces weighing in from farther above; I’ve been told that the most powerful figures in the current literary world, the buyers for the major national bookstore chains, have been known to offer to increase their orders for a book if its cover is changed.

Perhaps to get rid of me for a while, my editor dispatched me on a research mission: to go to a bookstore, survey the covers of other literary nonfiction books, and report back to her about which ones I liked, and why.

The main principles of design—in books, appliances, cars, clothing, everything—are:

1. Your product must be bold and eye-catching and conspicuously different from everyone else’s, but

2. Not too much!

Which is why the covers of most contemporary books all look disturbingly the same, as if inbred. It seems as if sixty-five per cent of all novels’ jackets feature an item of female apparel and/or part of the female anatomy and the name of some foodstuff in the title—the book-cover equivalent of the generic tough-guy-with-gun movie poster with title like “2 HARD & 2 FAST.” There’s clearly some brutally efficient Darwinian process at work here, because certain images—half-faces, napes, piers stretching into the water—spread like successful evolutionary adaptations and quickly become ubiquitous.

by Tim Kreider, New Yorker |  Read more:

Illustration by Laurent Cilluffo

Cuauhtémoc Suárez
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Ashore I, Nanna Hänninen

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Unity with the Universe

Manhattan, Mont. -- Something strange is happening at the house glowing in the distance. Or rather, a web of strange things, magic almost, if you'll permit what might seem on the front end to be hyperbole. A man named Tom Morgan lives here, making some of the most expensive and sought-after fly fishing rods in the world, which he does despite having been paralyzed from the neck down for the past 17 years. He's revered for what he calls "thought rods," where the instrument functions as an extension of the mind, delivering the fly where you imagine it will go, not where a series of clumsy physical muscle movements try to direct it.

In all of his rods -- both in the way he builds them and in the way people seek them out -- there lives a sense of the mystic. One old model is nicknamed "The Unity with the Universe." Tom once offended a conservative fisherman by joking that their accuracy was the result of prayers and incantations. He has that kind of faith in his rods. He believes in how they can connect an angler, if only briefly, to the soul of nature, and how they can connect him to the person he used to be. The rods are what matter, to Tom and to his customers, which seems like such an inadequate word to describe the relationship.

Most of the people who buy them are spiritual pilgrims, and some are literal pilgrims, flying to Montana to visit or pick up their rods in person. They come from as far away as Japan. They drive out of Bozeman, headed west, finally seeing the glow on a ridge to the right. A white bus named Moby -- yes, the people inside love Melville -- lets them know they've found the place. The house is surrounded by snowy peaks and a herd of buffalo, which move like ghosts across the high plains. The strangers arrive at the front door, the wind coming down from the Tobacco Root Mountains, blowing hard and cold. Tom's staff often joke when they hear tires on the long gravel road: "Get out the prayer rug." Some visitors don't even know he's paralyzed. A young rod maker once arrived for an apprenticeship and stuck out his hand when he met Tom. Nobody had told him. The rods are more important than the obstacles overcome to create them, and the anglers who travel such great distances don't want to unlock the secret of his life; they are grasping for understanding of their own. "It's like they're walking in to see the Dalai Lama," says that apprentice.

It's a lot to expect from a fishing pole.

A small epiphany waits at the end of their time with Tom, if they pay attention to the signs. There is no his life and their life, just life. The rods don't provide answers, only questions, about how you lived it before you arrived, and how you might live it after. The questions apply to Tom, too. There are secrets to be unlocked at the house glowing on the hill, about dreams and perfection and, yes, even love, but first you have to go inside.

by Wright Thompson, ESPN |  Read more:

Image: Ross Detman

“Superbowl” by Laurie Bartley, 2007
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The Breakup

I am home in the Midwestern city where I was born, and I am not entirely certain how I got here. I know that I have taken a lot of trips in the last year, to two continents and three countries, over and across the United States a handful of times by air and once by car. I know that my pockets are filled with bar coded baggage tags, and that I never have the clothes I need for the right seasons. I am rarely dressed for the occasion at the best of times, but lately I have been looking stranger than usual, hoping a smile and a pair of earrings can compensate for living out of a suitcase. 

I am not exactly sure why I am here, but like a lot of things I have done this year, I suspect it has something to do with a boy. Twelve months ago, the idea of uprooting myself for that reason seemed unfeminist and absurd to me. Back then I was working long hours and eating Goya beans every night for dinner with produce retrieved from dumpsters by a fregan acquaintance who was spending some months on my couch. Cutting the mold off a block of cheese, he would ask incredulously, "How can you eat something straight out of the can?" The Squatter, as I affectionately called him, also advocated following your heart. I had never before considered my heart to be a particularly reliable compass, and following it is not the marketable experiment that a year spent following Oprah or the Bible is, but nothing else was working for me so I decided to give it a try.

I had lost my bearings and two consecutive Metrocards during a period when a lot of things in my life were turning over. I'd moved from a two-story house I shared with my boyfriend to a basement apartment with three roommates and a number of mice. I thought of the former house as the place where I had learned to cook soups and invest in quality tights. It was easier to eulogize it that way, rather than as the first place where I made someone important to me cry, and then learned to look away, in a way that seemed like self-preservation but was in lieu of having to change, a callous made thick from gardening instead of just buying gloves or learning to hold the spade right.

Once settled in my new apartment, I began the process of something many people I know have done in reverse: New York was breaking for me and so I decided that I was in love with someone far away. The super of our building was ejected from his nearby home over marital issues, so he began converting the laundry room off our kitchen into an apartment for himself. Bugs crawled through the new incisions he made in the walls. It seemed like the city sanitation department never recovered from holiday weekends, the trash mounting in lolling piles around lampposts. I had developed a difficult relationship with the man at the laundromat, and when I walked to the bodega at night, a guy on the corner had started saying things like, "I would do anything to touch your legs." I loved my neighborhood anyway, the sudden jolt from the smell of dried fish in cardboard boxes at Nostrand Avenue produce stores, or Saturdays sprawled in Prospect Park's islands of shade. But sometime last summer I thought I might be able, for a while at least, to love this boy more than I loved the city. For a while I did.

by Lucy Morris, This Recording |  Read more:

Image: uncredited

McDonalds’ Suggested Budget for Employees

McDonald’s has partnered with Visa to make a website dedicated to showing its employees how to properly budget their meager peasant salaries. However, what it actually does is illustrate the fact that it is nearly impossible to get by on minimum wage, as shown in this “example” budget chart:

Yeah– now, when I first saw that, I assumed that the top line was for a part-time McDonald’s employee. Then I got out my calculator– that is actually what you would make if you were working full-time at McDonald’s. 1,105 dollars a month.

Now let’s say that the “second” job that they budget in here (feels like cheating, but OK) is also minimum wage. That would mean you were working about 62 hours a week, on average. Oh, wait. That’s if they live in Illinois where the minimum wage is $8.25. The national minimum wage is $7.25. That translates to 74 hours a week. That’s almost a whole other full time job.

And what do you get for working 74 hours a week? Well, you don’t get heat, clearly. There’s a big ol’ zero next to the heat in that chart. In my building– we have separate checks for gas and electric– that would mean that not only do you not get to heat and cool your home, but also that you do not get to heat your water, or cook on your stove, if you have a gas stove (I do).

Also noticeably absent in this budget? Food. And gas. There’s a line for a car payment, but not for gas. Which is suspect, because if you’re working two jobs it’s possible you will pay more for your gas than you’d be paying for your car.

Also… health insurance for $20 a month? There is really no such thing as health insurance for $20 a month if you’re buying your health insurance on your own. I think the least amount is going to be about $215 a month– and that only covers hospital emergencies.

The minimum wage in this country is reprehensible. If the minimum wage had kept up with inflation it would be over $10 an hour. If it had kept up with productivity? It would be $21.72.

by Robyn Pennacchia, Death and Taxes | Read more:
Image: uncredited

Ross Dickinson: Valley Farms (1934)
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Figura Afligida, Eduardo Kingman. Ecuadorian (1913 - 1998)
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"Dune" Endures

As the temperature in California’s Death Valley climbed toward a hundred and thirty degrees recently, I had a vision of giant sandworms erupting from the desert floor and swallowing up the tourists and news media gathered around the thermometer at the National Park Service ranger station. The worms I had in mind sprang first from the imagination of Frank Herbert, and they have, over the past half century, burrowed their way into the heads of anyone who has read his science-fiction classic, “Dune.” Set on a desert planet named Arrakis that is the sole source of the universe’s most valued substance, “Dune” is an epic of political betrayal, ecological brinkmanship, and messianic deliverance. It won science fiction’s highest awards—the Hugo and the Nebula—and went on to sell more than twelve million copies during Herbert’s lifetime. As recently as last year, it was named the top science-fiction novel of all time in a Wired reader’s poll.

As David Itzkoff noted in 2006, what’s curious about “Dune” ’s stature is that it has not penetrated popular culture in the way that “The Lord of the Rings” and “Star Wars” have. There are no “Dune” conventions. Catchphrases from the book have not entered the language. Nevertheless, the novel has produced a cottage industry of sequels, prequels, and spin-offs, the production of which only accelerated after Herbert’s death in 1986. There are now eighteen novels in the “Dune” chronicles, not to mention screen adaptations, comic books, and countless board, video, and role-play games. The conversion of “Dune” into a franchise, while pleasing readers and earning royalties for the Herbert estate, has gone a long way toward obscuring the power of the original novel. (I gave up after the fourth installment, “God Emperor of Dune.”) With daily reminders of the intensifying effects of global warming, the spectre of a worldwide water shortage, and continued political upheaval in the oil-rich Middle East, it is possible that “Dune” is even more relevant now than when it was first published. If you haven’t read it lately, it’s worth a return visit. If you’ve never read it, you should find time to. (...)

Perhaps one explanation for “Dune” ’s lack of true fandom among science-fiction fans is the absence from its pages of two staples of the genre: robots and computers. This is not an oversight on Herbert’s part but, rather, a clever authorial decision. Centuries before the events described in the novel, humans revolted and destroyed all thinking machines. “The god of machine-logic was overthrown,” Herbert writes in an appendix, “and a new concept was raised: ‘Man may not be replaced.’ ” This watershed moment, known as the Butlerian Jihad, resulted in a spiritual awakening, which put into place the religious structures that ultimately produce the messiah, Paul Atreides. There is no Internet in Herbert’s universe, no WikiLeaks, no cyber war. This de-emphasis on technology throws the focus back on people. It also allows for the presence of a religious mysticism uncommon in science fiction. It’s a future that some readers may find preferable to our own gadget-obsessed present.

by Jon Michaud, New Yorker |  Read more:

Image: uncredited

Daigo Daikoku, a designer with Nippon Design Center, has won a Yellow Pencil at the 2012 D&AD Awards for “100 Graphics of Anatomy Chart” (人体百図), the catalogue for a series of works made for a solo exhibition at Leta Gallery. Each work consisting of the word for a part of the body and visuals inspired by that word.

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Gary A. Bib
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Haul Videos: Postcards from the End of the World?

So, haul videos are a thing. If you’re interested in secondhand clothing and/or you spend much time on YouTube, you may already know this. I didn’t know about haul videos for a long time, though, despite the fact that I qualify in both categories. I first saw one last year when I had a research job that required me to transcribe an incredible number of media posted to the internet. We were allowed to work with user-uploaded videos on any topic, so since clothing is kind of my thing I looked for videos about that. My searches turned up many thousands of Outfit ofthe Day videos (save yourself some trouble and just type OOTD), which was another neat discovery. So many young women—and the occasional older woman, and the occasional man—standing in their bedrooms, modeling, maybe, the new jeans they matched with a tunic top and describing how they planned to wear the outfit to school, or work, or on a picnic that is also a first date. I’ve also seen a surprising number of instructional videos in which a woman shows the different ways to fold a scarf: into turbans that collect loose hair on the top of the head, hijab to cover the hair and sometimes face, shawls for the shoulders, or that jaunty, fluffy sort of cravate that I’ve never been able to pull off without looking like my own grandmom.

I can’t truthfully say that there was a single one of these videos that I didn’t enjoy looking at. Besides the fact that I find other people’s outfit choices to be a good source of ideas for my own ever-shifting “look,” there’s something really beautiful about the existence of these videos. Actually I find all of YouTube touching that way. Something about the simple, I don’t know, faith that goes into believing that the nice little things you do are not only worth doing, but are also worth talking about or even helping other people learn to do. It’s amazing the things we can come together over: skateboarding down railings, blowing up bottles of soda with Mentos, performing that rude Cee Lo Green song in American Sign Language. There’s just so much to do.

But there is this other category of videos about clothing, and it’s called “hauls.” In a haul video, a person sits in front of her camera and holds up every piece of clothing she bought that day and describes where she got each item and how much she paid. Some of the hauls are collected on a day of shopping at regular stores—places where the stuff is new—and I tend to find those less interesting and actually a little distressing, considering how much new clothing can cost. It’s the hauls from a day of thrift store shopping (nope, still not using the word thrift as a verb) that get me excited. (...)

I’ll grant you, it is a weird, late-capitalist phenomenon. We don’t get to see the purchased thing being used, even, we just learn about the purchasing itself. If shopping—spending—has become a hobby, then haul videos are ... what? Digital fanzines? Skill-sharing workshops? Postcards from the end of the world? Nah, I don’t know. I think it’s just human. Telling someone what you did today is important, and if you don’t have enough people in your life then tumblr and Twitter and YouTube are there for you, and while it might be easy to denigrate that kind of internet behavior as socially stunted I think it’s pretty lucky that we have those ways of reaching out. My high school best friend was an eccentric girl named Sara, and she’s the one who taught me how to dress cool for cheap. One day after a few hours at the nearby Salvation Army stores (and Hole in her tape deck, and some awkward attempts at smoking cigarettes in her car) we went back to my house. I sort of blasted through the front door like the jerk that I was but coming in behind me, Sara said quietly, “Do you want to show your mom the stuff we got?” Sara’s mom died young, when she and I were still teenagers. I wasn’t in the habit of showing my mother the clothing I’d found—she doesn’t care about that stuff, not the way Sara’s mom did—and I remember not especially wanting to, at first, but after a moment thinking it was a really good idea.

by Katie Haegele, Utne Reader | Read more:
Image by Freaktography, licensed under Creative Commons

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Sleeping cat netsuke by Kai Gyokusai, Japan. Mid to late 19th century.

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