Who's to blame for health care highway robbery?

H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is on to something. Writing in The New York Times on July 4, 2013, Welch says the cost of medical care in the United States is, or nearly is, criminal.  And he says care providers (hospitals, MDs, universities, and drug and device companies) "are the ones benefiting."

Right, but they're not alone.

Payers are part of the crew.
As a former employer, I know first hand what it costs for a small business to insure its employees. As a former employee of several large organizations, I know the deep discounts that big employers and government agencies qualify for—easily 50%—and pass along to their employees. 

Also, having worked for several insurance companies, or payers as they are becoming known, I've seen the other side. Maybe you have, too. If you get statements from your health insurance company, you can get a feel for how payors negotiate reimbursements with the some of the providers that Welch fingers. And if you read business journals or job postings, you know how health insurance is dominated by huge companies and can get an idea of the salaries they pay.

Small fry? You're screwed.
Add Welch's provider set to the payor set and WOW. Let's just say there's plenty of money being made on the backs of employers of all sizes, but mostly on the backs of the rest of us.

Small-fries pay through the nose: employers, people who buy their own insurance and, God help them, people without insurance who need medical care but don't qualify for free care.

What's wrong with this picture?

I do...I don't...

Ding-dong DOMA is dead! I'm still celebrating the Supreme Court's ruling that the Defense of Marriage Act is unconstitutional. I agree: the state can't marry some but not others based on gender. And I'm over the moon for the men and women I know,  as well as those I don't know, who are now free to tie the knot. 

For those who choose to marry, best wishes! 

For those who don't, welcome to the emerging majority!

More U.S. adults opt out of marriage
As reported by The Economist, the marriage rate is way down in the United States. Since 1960 to December 2011, the ranks of the married have slid from 72% to 51% of U.S. adults, while the never-married portion of the population has nearly doubled, from 15% to 28% of U.S. adults. Racially, today's paper-thin married majority of 51% breaks down to 55% of whites, 48% of HIspanics and 31% of blacks. If current population growth for people of color holds, the marriage majority will evaporate very soon.

Makes perfect sense to me.

La meme damn chose

Sorry! I didn't mean to disappear. Took me longer than expected to decide on, and navigate a job change. In the meantime, we have returned President Obama to the White House, managed to break the gridlock in Congress (on immigration reform of all things), and been buffeted and buoyed Supreme Court rulings. More on all of that later.

While plenty has changed since my last posting, we're still stuck in the Eisenhower era when it comes to gender coding of toys.

Deja vu all over again
As French critic-journalist Jean-Baptiste Alphonse Karr said, the more things change, the more they stay they same. Writing in The New York Times, Elizabeth Sweet reports the comeback of gender stereotyping of toys, ironically, as the presence of women in the workforce soars to more than 70 percent.

How do we get toy marketers to return to the enlightened 1970s, when Sweet says "very few toys were explicitly marketed according to gender." Maybe it's time we told toy marketers to stop dictating what constitutes "appropriate" play behavior for girls and boys.

Barbaric rituals 3: "gender reveal" parties...don't you wish

Are you a boy, or are you a girl?*

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My May 9 post covered the basics of "gender reveal" parties, a ghastly new form of narcissism. Scroll down if you want the blow-by-blow. Otherwise, here's the gist:

Set aside two or three hours to graze on frilly cookies and carrots cut in the shapes of cars and dolls while playing ridiculous games designed to make a fuss over what's in her belly and how it got there because—we're pregnant! Your reward? Barrels of fun, plus we'll let you in on our precious secret: the baby's "gender." 

No thanks. If I want to be tortured, I'll stay home and watch Glee.

"The best things in life are free, but you can keep 'em...Give me money."**

I'm all for celebrating the rewards of sexual relations. But everyone knows gender reveal rituals are reserved for those who play by the rules, specifically, procreative sex. I can hear countless retailers cheering as they tally their profits from the sale of fussy little footprint cutouts to strew along shower buffet tables and all the other precious paraphernalia associated with the birthing of babies.

In Pink and Blue: Telling the Girls From the Boys in America University of Maryland Associate Professor of American Studies Jo B. Paoletti documents the push by U.S. clothing manufacturers around the time of World War I to agree on sex-signifying colors for infants' and children's clothing. So that they could satisfy shoppers demands they said. 

It seems immigrants to the United States brought with them contradictory customs for what constituted proper attire for boys, for girls. In the mid-1800s, any number of colors in pastel shades were considered appropriate for children to wear. But by the 1880s, when it was still customary for boys to wear dresses until their first haircut (about age 6 or 7), the convention shifted to dressing all babies and young children in white.

An elegant compromise, but not for those with capitalist appetites.

According to Paoletti, just before World War I the U.S. clothing industry began to push for agreement on separate colors for each sex. Paoletti cites a 1918 fashion trade journal article in which pink was named the right color for boys ("stronger"), blue ("more delicate and dainty") for girls. She says that formula held at least until 1927, as attested to by Time magazine and flogged by major retailers of the day, including Filenes, Best & Co. and Marshall Field.

By the 1940s it was the opposite: blue for boys and pink for girls became the rule. (Very provocative.) Then, in the mid-60s as feminists emerged and argued for gender equality, gender-neutral colors took hold and remained popular for 20 years until the hammer went down again.

Who's hammer?

"Who's Zooming Who?"***

Prenatal testing appears in the mid-80s and soon we're oohing and aahing over blurry sonagram printouts documenting budding sex organs. Manufacturers and retailers climb on board with an explosion of merchandise in pretty pink and burly blue, some of the most popular items embellished with other coded motifs like footballs and firetrucks (because one layer of sex coding is never enough).

Disney makes its return to children's films with" The Little Mermaid" and begins planning their now ubiquitous stores, the first of which opened in 1987, epicenters of must-haves designed (and color-coded) for little princes and princesses.

I'm no more than an armchair sociologist, but you can't tell me the reclamation of pink and blue sex markers in the mid-80s was all about retailers trying make more money. These were the Regan-Thatcher years, when Madonna and Queen and Prince (genius naming) were bending gender in novel ways on a new kids' channel called MTV. AIDS was decimating the gay community and straight America was running scared.

Coincidence? I think not.

Honey, let's get all our friends
together so we can reveal
the baby's gender.
Y I K E S.

Today, blue and pink sex markers are everywhere babies are: the sheets on their cribs, the diapers on their wee little bums, the teething rings in their mouths—because parents need to KNOW everything and SHARE everything about their child, even host a "gender reveal" party before the baby is born.

"You don't own me. I'm not just one of your many toys..."****

As much as some parents might like to celebrate (or even determine) it, a child's gender is one gift that only the child can know the contours of—and in time. But that doesn't stop moms and dads from trying...and denying.

Check out Jenny's post at Talk About Gender in which she quotes a 34-year-old mother, a self-described traditionalist, on her concern that if she were to dress her now 2-year-old son in "girly" colors, people—including her son—could get confused. Not that she cares about her son's sexuality, she adds. 

*     Doug Morris and Ron Morris/The Barbarians, 1965

**    Berry Gory and Janie Bradford/Barrett Strong, 1959

***   Aretha Franklin, Preston Glass, Narada Michael Walden/Aretha Franklin, 1985 
****  John Madara and David White/Leslie Gore, 1963

IT'S THEIR WORLD: DW brides & grooms

What's worse than a command-performance cruise with your family?  A destination wedding where the guests are conscripted by the bride and groom, forced to join the troupe for a fortnight (or more) of choreographed happiness.

Destination weddings: the height of arrogance

How do you define hospitality?

How is it that "guests" are asked to invest 4 or 5 days of vacation and thousands of dollars frolicking with people you may not care that much about, at a proscribed destination in accommodations that may not suit you, all to be part of some couple's fantasy moment when their life as couple begins. And save them a bundle.

At the salon this morning for a new do, I heard a bride-to-be gushing about her upcoming nuptials in Mexico.

"Everything is so cheap there. We can't believe how much money we're saving!" Plus, she announced, they will score even greater savings having chosen Thursday for their big event, rather than a traditional Saturday.

"So, everyone will arrive Wednesday and stay through the weekend. It's going to be just perfect--everything we want."  

Remembering all who serve

In honor of all who have served, I am devoting the day to a deep dive into Rachel Maddow's Drift: The Unmooring of American Military Power. I've poked around the book enough to know it will be a disturbing and important read, consistent with Maddow's premise that the decision to go to war should be difficult, painful and require sacrifice by all, right from the get-go. 

We can do better.

We should, collectively, anguish over a decision to go to war, Maddow suggests. As it is, we've drifted into systemic acquiescence--to appointed bureaucrats, military careerists and multinational service providers who profit (powerwise or moneywise) on the backs of the precious few who volunteer their service, their lives. We can do better.

Barbaric rituals 2: the "gender-reveal" party

Kids? Okay, but cut us a break.

Just when you thought the cult of parenthood might have peaked, what with the drop in birthrate and all, here comes the newest tsunami of overindulgence: the so-called "gender-reveal" party.

This emerging (mal)practice invents yet another platform for breeders to put the fruit of their loins on display--and coerce family, friends, colleagues and neighbors into lavishing more attention on the happy couple. Gifts, anyone? 

If you've yet to be introduced to the delights of "gender revelation," get acquainted by reading "A Boy or a Girl? Cut the Cake" as reported by Alex Williams and Kate Murphy for The New York Times--the photo alone, well...see for yourself.

I first heard about these ordeals from a Facebook friend who had been hired to bake for such an event. The mother-to-be ordered 3 dozen creme-filled lemon cupcakes capped with yellow fondant and topped with bits of green gummy worms formed into a  question mark. The baker was sworn to secrecy as to the color of the creme filling--pink or blue. 

"When the guests bite into the cupcakes..." the baker began. "The sex of the baby oozes into their mouths," I finished the thought for her. "Well, the filling oozes into their mouths," she clarified. "But yeah. That's pretty much it."

Gag me.

At least in the circles that Williams and Murphy describe in their article, typically the parents-to-be go into these parties on an even footing the guests, clueless as to the sex of the baby in her womb until the big moment when the news is revealed for all in a squirt of creme filling, or when a sealed envelope that has traveled from ultrasound technician to baker to party is ceremoniously opened and a blurry image of the wee one's sex is held aloft.

Yum, it's...a boy!

Sometimes, the envelope is dispensed with and the cutting of the cake is the main attraction. Here, the couple cuts the cake (they've practiced, they're ready) to reveal a sex-coded object (the article cites a pink shoe, as one example) or a lucky guest discovers the a small sex token in a telltale forkful. 

Greg Allen, who blogs at daddytypes.com, is quoted in the Times article and says it all. "The whole connection of cutting into the cake to find out, like it's a stand-in for the utuerus, is sort of sickening."

I'll say.  Stay tuned for part 3.

*half what it was 60 years ago according to the CDC's Recent Decline in Births in the United States 2007-2009