The Cost of Healthcare in America

As the US presidential election race grinds onward, the issue of the nation’s healthcare system—or, rather, the lack of it—has been getting some airplay. I recently saw a video of people in the UK being asked what they think health care actually costs in the States. Everyone was deeply shocked and horrified that such a system could actually exist in the 21stcentury. I’m here to say: it’s all true. I’ve written elsewhere about America’s approach to healthcare. Today, let’s take a journey through the maze of private insurance in America. Be prepared to add up some significant costs.

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Copays and Coverage

First, the issue of private insurance and what it does and doesn’t cover. Three months ago, on a trip back to the UK, I was bemoaning the costs of medicines to a British friend, pointing out the high monthly cost of insulin. She was staggered. “What? A life-saving medicine and you have to pay for it? I thought you had insurance?!” We do; but just because something is insured doesn’t mean you get it for free.

Private insurance comes with a job—not every job, especially not if you work part-time work or for a small company. Larger companies and the private sector usually offer some kind of plan; unless you work for a low-paying service sector company like Walmart, many of whose employees are encouraged to get Medicaid. The scores of different insurance companies each offer many different plans, with different levels of coverage. It’s up to the company what they choose to offer; bearing in mind that the company will be paying a hefty chunk of change to offer any kind of plan to their employees. According to research by the Kaiser Family Foundation, the average cost to an employer for providing coverage for an employee’s family is now over $20,000 a year.

Now, to the first cost: almost all of the plans come with copays—meaning, the amount you have to fork over for prescriptions, doctor visits, procedures, etc. Our current insurance plan comes through Spouse’s work. There’s a $30 copay for every doctor or office visit. That doesn’t sound too bad, right? But then there’s prescription copays, which for us, under our current plan, vary widely from $1.25 for a one-month supply to (on one memorable occasion) north of $100.

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That’s assuming your meds are covered. I still find it surreal to be discussing a problem and treatment options with the doctor, then have her stop and say, “Wait, what insurance do you have? They don’t all cover X.” It’s also often the case that the insurance may insist the doctor provide documentation proving that options A, B, and C have been tried and rejected before they will approve treatment X. Doctor’s offices have to waste inordinate amounts of time dealing with demand for documentation from multiple insurance companies.

It gets better. Each insurance plan also has a ‘formulary,’ a list of what meds they cover, at what level, and what they don’t. Every year, in November, the plans send out their information for the coming year, including how much your monthly premium will be (it always goes up, always) and any changes to the covered/excluded meds. Yes, that’s right, a medicine that was covered this year may not be covered next year because of some reason (usually financial) that makes sense to the insurance company, but not to you or your doctor.

Premiums and Deductibles

About those premiums—that’s the monthly cost for your insurance. Almost all employers that offer health care require premium sharing. That means that the insured has to pay some portion of the premium before even using the plan. A relatively new “innovation” is for the employer to pay for the insurance of the employee only, with the employee picking up some to all of the premium costs of insuring a spouse and any progeny. A sister-in-law used to be employed as a social worker for the county; she told me she never had to pay a monthly premium, one of the few perks of an otherwise low-paying public sector job.

The premium will depend on the plan your company offers, the state you live in, and a whole host of other factors. The Big Corporation I used to work for was headquartered in Chicago, where we lived for a while, which is in the state of Illinois. As a pretty big local employer, the company was able to offer decent health insurance for a family of four for a premium of about $300 a month. The premium can come straight out of your pay, pre-tax.

When I first started work in the early 1990s, we had a choice of 4 different plans with different levels of coverage and costs. Gradually, the number of options dwindled as the costs for even a Big Corporation became more extreme. By the time we moved to Pennsylvania, there was only a choice of two plans for Illinois-based employees; and for those in Pennsylvania, a state with only a handful of employees, there was only one plan on offer, take it or leave it. When I last worked for them, our monthly premium for 4 was about $700.

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This is from the web–an example of the kind of statements you get from an insurance carrier, showing costs, coverage, copay, etc.

So, you’ve got copays and premiums to add up. But wait, there’s more! Meet, the annual deductible—that’s the amount you have to pay out of pocket every year BEFORE the insurance kicks in. Again, how much depends on the plan; it could be $500 for each family member and a total of $2,000 for the family as a whole, or even more. One little wrinkle is that if, for some reason, you change plans mid-year, the deductible for the new plan begins all over again, regardless of what you paid already under the old plan.

Employer Role

OK, so it’s a very expensive way to fund your healthcare costs; but at least private insurance gives you peace of mind, right? If only. Many of us, most of the time, don’t realize it but our healthcare options are dependent on the choices made by our employers. And sooner or later, that reality hits you, hard. Three years ago, the Big Corporation I’d worked at for 25 years told me, “We’ve reorganized the department and your role has been eliminated.” The family health insurance came with my job so, on top of everything else, we had to scramble to make sure we could switch to using Spouse’s firm’s health insurance, and also check to make sure it covered the various doctors and medicines we each used. Federal law says you can continue using your company health insurance for up to 18 months after leaving a job for whatever reason, but unless the employer provides a subsidy you have to pay the full premium yourself, i.e., both the employee cost and the company cost—which for us would have been well over $1,000 a month. Needless to say, we switched to Spouse’s coverage (and yes, had to meet a new annual deductible that year before the coverage kicked in).

Incidentally, you can only switch plans at the beginning of a new calendar year, making your choice in the November before the new year. The only exception that lets you change mid-year is if there’s been a “life-changing event,” like changing/losing a job, having a baby, or marrying.

A year ago, when Spouse’s firm merged with another one, the plan changed yet again, meaning we had to check whether our existing doctors, including a couple of specialists, would still be “in network.” Fortunately, they were, but if you have an unusual or particularly expensive condition, you may be stuck with some hefty costs. Paying “out of network” for a visit to a doctor can cost upwards of $150 as soon as you walk in the door. And, of course, we started again with a new annual deductible—in October.

Finally, the quality of insurance plans varies widely. I’ve mentioned the gradual reduction in choices at the Big Corporation over the 25 years I worked there. In the final couple of years, we were stuck with an 80:20 plan, i.e., after all the premiums, deductibles, etc. the plan only covered 80% of the costs of anything. For doctor visits that meant a co-pay of about $25 each time; but, had any of us needed any kind of procedure, especially something major like in-patient surgery, the cost would have reached well into four digits.

All Hail the Affordable Care Act

One of the many reasons I will always love former President Obama is the Affordable Care Act (ACA), the provisions of which were fully effective by 2014. Among other things, this stipulated that insurance companies could no longer deny coverage for existing conditions. Under this lovely little wrinkle, when you first attained new insurance the company would likely refuse to cover anything related to a pre-existing condition for the first year. This could be anything from high blood pressure and cholesterol meds and insulin, to pregnancy, and even cancer care. If not for the ACA, our two insurance company changes in the past three years could’ve cost us thousands of dollars.

And when I was laid off three years ago, what if we hadn’t had the option of switching to Spouse’s insurance? Neither of us is old enough to qualify for Medicare (federal senior health insurance which kicks in at age 65). So, I could have ‘bought’ my old insurance for a year; prayed I found a new job with benefits asap; spent our way into penury in order to qualify for Medicaid (health insurance for the poor); or, thanks to the ACA, we could have purchased a personal plan from one of the 20+ offered in the state of Pennsylvania. I looked into this briefly at the time, and quickly got overwhelmed at the number of options, with premiums that ran from $200 to $2,000 a month for a family of four, depending on family income, coverage, deductions, etc.

Meanwhile, Oldest Son is now 24. Thanks to the ACA, he has to be covered on our insurance until the day he turns 26. If, by then, he doesn’t have the kind of job that comes with health insurance (very possible given the field he works in), he’ll have to buy his own ACA plan.

Finally, everything I’ve talked about here has referenced basic private health insurance—none of which covers dental care and most of which do not cover vision care (unless it’s for something awful like an injury that is considered “medical”). So, in addition to the monthly premium for our family health insurance, which is about $450, we pay $116 a month in dental insurance (I have standard grew-up-in-Britain-in-the-1960s-and1970s teeth, they need a lot of help); and another $25 monthly for vision care (we all wear glasses and two of us use contact lenses, so everyone gets two vision checks a year).

A Surgery Story

Earlier this year I had surgery of the “do this now or eventually things will be much worse and potentially fatal” type. This necessitated multiple doctor visits ($30 each time), culminating in three hours in the surgical suite followed by two nights in the hospital. The process started with my regular doctor recommending a specialist who in turn recommended a surgeon—each time, I had to go home and check that these recommended doctors were in network. And each time, it took weeks to get an appointment as these specialists were in high demand. (So yes, there can be long wait times under Britain’s National Health Service, but the same is true here, too.)

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(No, I wasn’t actually operated on by staff from Grey’s Anatomy!)

Eventually, I met with the surgeon who would be working on me (who, for the record, was absolutely wonderful). After she explained everything, I met with her admin staff to book the procedure. That person handed me many pieces of paper along the lines of “what to do/not do and what to expect” and one laying out the expected cost under our insurance: about $1,500. Had we not been able to afford that, there would have been no surgery, and I would be in increasing pain and getting steadily sicker.

After I was back home and recovering, the bills started to trickle in, listing the cost, the insurance payout, and the amount that we owed— sometimes things like the surgeon, the operating staff, the anesthesiologist, and the post-surgery nursing care are all on one bill, sometimes they bill separately. I do remember seeing the paperwork after Oldest Son was born and realizing that without insurance, our 36-hour delivery and stay would’ve cost about $10,000. That was 24 years ago; today, it would be closer to $30,000.

Missing the NHS

Back in 1992, I got one of those dreaded phone calls: “Mum’s in the hospital, it’s bad, you’d better come over.” Cue an emergency plane trip, and three harrowing days of discussing options with the doctors while holding the hand of a dying woman. The care Mum received was exemplary, the nurses unfailingly kind, and her death as dignified as was possible under the circumstances. And in all that crisis, there was one burden that never had to cross anyone’s minds: who was paying for all this?

So, when someone goes on a rant about how expensive a publicly funded health insurance scheme would be, how much people’s taxes would have to go up, and how much such a system “rations” healthcare, I tell them to take a step back. Add up how much you actually pay, out of pocket, for your healthcare—the premiums, deductibles, and co-pays. I’m pretty sure the tax cost would be less. And remember, too, that healthcare decisions in this country are made as much by the insurance companies as by the doctors.

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About Florida

In the 34 years I’ve lived in the USA, I’ve visited (i.e., spent at least one overnight) in about 30 of the 50 states, and my least favorite by far is Florida. Admittedly, I’ve only been there twice, most recently last weekend; and only to the southeastern coastal area that stretches from Palm Beach, through Fort Lauderdale, and down to Miami. But, those two visits were enough to convince me that the Sunshine State is a place where humans are just not supposed to live.

Florida is now the third-most-populous state (after California and Texas). In 1950 there were just 2.7 million people living in Florida; by 1990, thanks to the widespread adoption of air conditioning, that number had jumped to about 13 million and by the 2015 census it had reached 20.3 million. This number of permanent residents does not include the numerous “snowbirds,” retired folk who spend the winter months (roughly October through the end of March) in Florida and in the summer head back to New York, Pennsylvania, New Jersey, etc.

So, what is it about Florida I so dislike? Let’s start with the weather. In March, it’s actually very pleasant. You can enjoy a cocktail outdoors at a beach-side restaurant at 10 o’clock at night (recommended). You can sit outside on a balmy morning, sipping coffee in the lovely little courtyard of a bed-and-breakfast (also recommended).

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But once “the season” is over and the real heat kicks in? In the steamy summer months, year-round residents scuttle from air-conditioned condo to air-conditioned car to air-conditioned mall (humans aren’t supposed to live there).

Yes, the various, lush tropical flora can be lovely—this was the view from our window at the aforementioned B&B recently.

 

But, all that tropical lushness comes with one of my personal pet peeves—mosquitoes. On our first visit to the area about ten years ago, we stopped in to see an aged relative living in a senior facility in Boca Raton. She warned us that, “We can’t go to the pool area today because they just sprayed for mosquitoes and the kids shouldn’t go around there.” So, you get to choose between noxious chemicals and noxious disease-carrying bugs. Hmm. (Again, humans are not supposed to live there).

The central part of Florida is, basically, one big swamp. If you look at a map, you can see the area is chock full of lakes, streams, and ditches, all of them breeding grounds for mosquitoes—also, alligators. Ten years ago, we took a memorable “swamp tour” around the Big Cypress Seminole Indian reservation in the southern Everglades. Even in December, the swamp was a bit steamy—we were warned to be generous with the bug spray before the tour started. And yes, we saw plenty of alligators, blessedly sluggish as the weather was cooler by Florida standards that day. But still: mosquitoes and alligators? (Did I mention, humans are not supposed to live there?)

I suppose mosquitoes and alligators are only doing their thing, live and let live, etc. Worse is what humans have done to the southeastern coast. In the words of Joni Mitchell, “They paved paradise, put up a parking lot.” More specifically, they put up endless condos, hotels, gated communities, and strip malls, all linked by wide roads and highways.

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This is I-95 heading south from the Palm Beach airport towards Boca, and the inside of one of those gated communities.

 

 

We recently spent a few days in Lake Worth and Boca Raton dealing with Family Stuff. One evening we saw street signs pointing to “Town Center Boca Raton” and figured we could find somewhere to eat there, maybe spend a pleasant evening strolling around? Nope. Turns out “Town Center” is just the name of a large shopping mall with 200+ stores. There is no ‘town center’ in Boca.

And the drivers on those endless highways? Unbelievable. Which is another way to say, downright crazy. I’m not just talking about the kind of aggressive driving you see in NY or Boston; nor am I talking about one or two idiots weaving around the lanes on a highway. No. I mean, at least half the drivers acted like other cars were just a personal inconvenience; so, cutting off other drivers, swerving across lanes, and making a right turn from the far-left lane on a four-lane road were all perfectly acceptable. It was actually a pleasant surprise if someone used their indicators/turn signals. We quickly figured out that whatever was the most bonkers and least safe thing to do, someone would do it.

One local told me it’s all those snowbirds and tourists who don’t know where they’re going that makes the roads so crazy. I’m not convinced. In fact, Floridians are just crazy in general—and it’s not just me who thinks so. Comedian/commentator John Oliver did a segment on his show a few months ago on the strange fauna that is “Florida Man.”

Here are a few headlines from a recent piece in Esquire  on ‘The 90 Wildest Florida Man Headlines of 2019 (So Far)’:

  • Florida Man Denies Syringes Found in Rectum Are His
  • Florida Man Chews Up Police Car Seat After Cocaine Arrest
  • Florida Driver Finds Boa Constrictor in His Car Engine
  • Florida Man Threatens to Kill Man With ‘Kindness,’ Uses Machete Named ‘Kindness’
  • Florida Man Causes Highway Crash, Steals Good Samaritan’s Truck Who Stopped To Help
  • Florida Man Who Drove Ferrari Into Water Said, ‘Jesus Told Him To’

You get the idea. On the recent trip, I was chatting with the young man working at the FedEx office near Boca. He was a Florida man himself, born and raised, and he groaned when I asked him about the crazy Florida man headlines: “It’s all true,” he said, “Florida guys are just awful.” Maybe it’s a form of cosmic revenge because people are not supposed to live in Florida?

Away from the God-awful strip-mall-and-condo nightmare of the southeast coast, Florida looks very different. Not just the whole swamp thing, but the neighborhoods and the people. Less white, less wealthy, and a whole lot more interesting. Ten years ago, we spent a day in Miami and around the South Beach area—vibrant, colorful, and full of energy and great food. Back in Lake Worth this time around, the only thing that was vibrant and colorful was the annual Gay Pride Parade that was held the weekend we were there. (Some of the other guests at the B&B asked if we were in town for the boat show, the derby, or the polo event—I really wished I’d said, “No, we’re here for the Gay Pride festival,” just to see their reaction.)

Towards the end of our recent trip, in desperate need of some cheering up, we looked for nearby movie theaters and to my delight, we found a drive-in.

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I’d never been to a drive-in movie before—they used to be ubiquitous across the States but are now few and far between. This one was about ten minutes due west from the Lake Worth coastal area, a huge gravel parking lot with one screen at the front and one in the back. We loaded up on take-out snacks and drinks; then, for the princely sum of $7 each, we parked our rental car in front of the screen for the movie we wanted to see (and we could have turned the car around later on and parked in front of the second screen, too, if we wanted to spend the whole evening there).

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You can just see the light of the projector in the little tower of the taqueria that sat in the corner of the lot.

We tuned the car radio to the frequency on the sign, sat back, and enjoyed Captain Marvel. The picture quality was way better than this fuzzy shot and we quickly forgot that the sound was just coming from the car radio.

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Sister-in-law moved to Fort Myers, on the west coast of Florida, a couple of years ago. She insists that it’s not like the Palm Beach area at all but has more of a college-town vibe, and she claims to have only seen one alligator in two years. I’ll give her the benefit of the doubt and may even pluck up the courage to go visit her soon.

In the meantime, if you’re ever unfortunate enough to have to spend a few nights around Palm Beach, we strongly recommend this place: Sabal Palm House. It’s a lovely little adults-only B&B with rooms full of antiques and artwork, delicious breakfasts, and a great welcome from the owners, Colleen and John.

 

 

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Laissez les bon temps rouler!

This is the second of two posts on our trip to New Orleans (you can find the first one here). This one is about food, Mardi Gras, and cemeteries.

After five days in New Orleans, I came to the conclusion that the city subsists on a diet of sugar, alcohol, and seafood. Which is not so great if you’re a vegetarian and trying not to pack on the pounds. For an omnivore like the Spouse, however, it was a food paradise. Our only problem was figuring out which of the many restaurants recommended by locals we would go to, and which of the foods on offer in the French Market we wanted to try.

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A ‘po boy’ is a type of sandwich served on French-baguette style bread, always with some form of meat and lots of toppings. The name comes from ‘poor boy’; this was portable food for working people. One local story says that it was created in the 1920s to feed striking streetcar workers; others say the sandwich has much older origins and was designed for dock workers, assembled in the morning so that the juices of the meats or seafood gradually soaked into the hard slab of bread making it a tasty meal by midday.

Oyster bars are everywhere in New Orleans, and barbequed oysters are apparently a local specialty. Spouse sampled these at Red River Grill and pronounced them delicious.

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For some reason, he was less enthusiastic about Gator on a Stick. Can’t image why.

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Pralines are everywhere in New Orleans, made from a mixture of pecans, butter, sugar, and cream. They’re actually pretty tasty and apparently are one of the oldest ‘street foods’ in America, adapted from the almond-based recipes of Europe. According to this post, they evolved thanks to the “culinary genius of African-American women … a means for emancipated black women to make a living during a time when civil rights weren’t even in the picture.” These days they’re sold by the ton in every store and tourist outlet in the city.

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My vegetarian options were limited, but the nicer restaurants we tried each had one vegetarian dish that turned out to be way tastier than “vegetable platter” or “vegetable curry” implied—very fresh veg, perfectly cooked and spiced. But the highlight for (non-sugar) food for me was a place called Dat Dog in the Garden District—not so much hot dogs as fabulous sausage concoctions, including three vegan choices. Mine was delicious. Spouse’s dog is somewhere under all these toppings.

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I also discovered the Hurricane, a cocktail made from a mixture of rum, fruit juice, and syrup. Delicious.

But no trip to New Orleans is complete without beignet (pronounced ben-yay by the locals). It’s basically a square of fried dough, smothered in powdered sugar. The ones at Café du Monde are an institution, served hot and crispy, with a cup of café au lait—coffee with chicory and hot milk.

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Which takes us to the next fun thing about New Orleans, Mardi Gras! I didn’t realize this before we went, but Mardi Gras is not just one or two days of parades and parties before lent starts—it’s an entire season of parades and parties starting in the new year and slowly building up to the major parades just before Fat Tuesday (or Shrove Tuesday as it’s called in the U.K.).

There are numerous krewes who hold parades and events throughout the season, and we were lucky enough to catch one while we were in town: The Intergalactic Krewe of Chewbacchus. Basically, it’s the parade for sci-fi nerds (my people!) with an emphasis on homemade costumes and low-tech geekery, with the motto, “Saving the Galaxy one drunken nerd at a time.” Here’s their website: https://chewbacchus.org

I must have taken a hundred pictures, most of which are pretty blurry (those costumes and lightsabers moved fast with all the dancing and music) but here’s a few to give you an idea of the fun energy of this parade.

 

There were lots of Star Wars-references, including a whole troop of dancing Princess Leias and some baby stormtroopers.

I cheered for the Browncoats; anyone else remember Firefly?

 

There was a spoof on Trumps’ Space Force idea, and some pole dancers (because even sci-fi nerds like to pole dance).

There were even space vikings and space bananas (no, I have no idea either).

 

And because this is New Orleans, one group of guys dressed in glorious drag costumes for “queer eye for the sci-fi.”

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But after the party comes … the cemeteries! Among the most iconic images of New Orleans are its above-ground tombs. This is a shot of Cemetery Number 3, dating from 1854.

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Some of the tombs are quite small; others are massive and elaborate; this one holds the remains of many generations of priests.

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This one in Lafayette cemetery was apparently used by Anne Rice as the model for Lestat’s tomb in her vampire novels.

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Everyone assumes the above-ground burials are because of the water table, making it impossible to dig down very far to bury a coffin. But apparently, it’s more a function of saving space along with influences from parts of the Mediterranean where above-ground tombs are common. You can see many names on the outside of these tombs, which hold multiple generations of one family; how do they all fit? Well, when someone dies the front slab on the tomb is unscrewed, revealing the brick interior, like this:

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See the shelf halfway up the tomb? The bricks are removed, the coffin is slid into the top half of the tomb, and then it’s re-bricked and the front put back on. After a year-and-a-day (or longer), the tomb is opened up again—and all that is left of the coffin and its occupant is a pile of ash. Researchers from Tulane University confirmed that the interior temperature of a New Orleans tomb runs between 164 and 217 degrees Fahrenheit year-round, basically acting as a slow cremation. The remains are either swept through a hole in the shelf into the lower half of the tomb; or are collected, put in a bag (used to be hessian, now something cheaper but still biodegradable) and placed into the bottom half of the tomb along with the ashes of the previous ‘burials.’

If more than one family member dies at the same time, or if the person had no big family tomb, the coffin can be put in one of the wall units that surround the cemetery (although most of these are no longer used).

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A tour guide told us that these days, any metal inserts (like replacement hip joints) are collected and sold for scrap when the tomb is reopened, but things like breast implants also break down: “So, Kim Kardashian is fully biodegradable!” When I described this process to Oldest Son he said, “Oh, so those tombs are all slow-cookers and the cemetery is a giant kitchen?!”

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Unless the tombs are well-maintained, cracks appear and seeds germinate (well, there is plenty of fertilizer in there). The tombs sit on a concrete slab, so they can be picked up and moved. And, finding a tomb for your family can be a major undertaking—people hire realtors to help them find a good location. You can’t buy an old tomb (because they contain human remains which cannot be bought and sold), but you can “adopt” one and take over its maintenance.

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The names on the various tombs reflect the history of the city—French, German, Irish, Italian—and we spotted inscriptions as old as the 1700s and as recent as 2017. All of the large family vaults included the names of some children, a reflection of the toll taken on the city’s youngest inhabitants by the waves of yellow fever that used to sweep through the city in the 18thand 19th centuries.

I usually don’t like cemeteries at all, but the ones of New Orleans are different—surprisingly peaceful and so full of beauty that it doesn’t feel ghoulish to stroll amongst the dead.

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The Big Easy

So last week I had the great good fortune to accompany Spouse on a business trip to New Orleans. While he spent time in conference meetings and ‘networking lunches’ I got to play tourist in a city that is like nowhere else in the U.S.

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I started my explorations in the French Quarter, the oldest part of the city with stunning architecture, countless bars and restaurants, and twice as many tourists as locals. This is the part of the city that people think of when you say New Orleans: beautiful old buildings with wrought iron balconies; shops selling everything from tourist tat to lovely antiques, voodoo dolls to vampire accessories; and music everywhere, sometimes coming from inside bars and sometimes playing on the street.

 

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I also saw more drunk people on the streets of the French Quarter than I’ve ever seen in an American city! It’s actually legal to walk down the street carrying your glass of booze (which it certainly isn’t anywhere else in the U.S.). There are even places where you can get a drive-up daiquiri. This sounds like a seriously bad idea—open alcohol in a car? But a local cheerfully told me, “It’s OK, the daiquiris are sold with lids, it’s not an open container until you stick the straw in.”

This picture is actually a person, not a statue–if you added some money to her coin box, she’d slowly ‘come alive.’

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There also seemed to be a lot of homeless/rough sleepers; maybe no more than in any other city, but they seemed to be concentrated around the French Quarter, which made for some jarring contrasts between the people out partying and those just trying to survive.

The other major tourist area in New Orleans is the Garden District. A separate town called Lafayette until it was incorporated into Nola in 1852, this is the area full of big, beautiful old homes. The architecture is gorgeous, with a lot of French, Victorian, Italianate, and even Spanish/Caribbean influences.

 

Tour buses aren’t allowed through much of the Garden District, so everywhere you see groups of people trudging along in walking tours, gawking at the buildings. Many of these houses are used in movies and TV shows, like this one from American Horror Story: Coven.

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To get to the Garden District we took a streetcar (trolley), just $3 for a 24-hour pass. Four streetcar lines operate in New Orleans and they are a fabulous throwback form of public transport—the Charles Street line that runs out to the Garden District and beyond is the oldest continually operated streetcar/trolley line in the world. (This pic is from the norta.org website.)

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But as any local will be quick to tell you, the French Quarter and the Garden District are only a small part of the story of Nola. So, one day I took a guided tour on a small bus, to see the “rest” of New Orleans: like Tremé, where “free colored” families of artisans and musicians settled as far back at the 18th century, making it the oldest black neighborhood in the U.S. Or, Marigny/Bywater, with its vibrant music scene and colorful shotgun-style homes. There are still a lot of shotgun homes in New Orleans—so called because the rooms are arranged all in a line, one behind the other (you could fire a shotgun through the front door and the bullet would go straight out the back). From the street, the house looks very narrow, but they can run back quite a long way. The houses are designed to maximize cross-breezes on a hot day, by opening the front and back doors.

 

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Our tour bus driver, a young local man, told us that growing up in a shotgun house came with its own challenges for a teenager: His room was at the back but the alarm system for the house was in the front room. So, if he wanted to sneak out at night after his parents had turned on the alarm, he had one minute to get out the back door, climb over the fence, hurry along the side of the house, back over the fence and in through the front door to deactivate the alarm before it started to sound off.fullsizeoutput_ef5

The locals are also keen to remind visitors about the physical and psychological destruction inflicted on their city by Hurricane Katrina. Some 80% of New Orleans flooded in August 2005 thanks to multiple floodwall failures. You don’t really see any evidence of this today until you go into neighborhoods like the Ninth Ward. The Upper part of the ward has mostly recovered, but there are still plenty of empty lots and abandoned properties alongside homes that clearly have been completely rebuilt. The Lower Ninth Ward has never recovered with almost 70% of its previous population now gone; either killed in the floods, moved away, or in many cases their fate unknown.

Every damaged house and vacant lot is a story of a family’s loss and grief.

 

The tour paused in front of this house in Tremé, which our guide called “the home of a true hero.” The man who lives here single-handedly saved many people during Katrina, finding people that the search crews missed—or just didn’t bother trying to find. Grateful locals left objects that he’s turned into the Spirit of New Orleans shrine. He also left the blue paint search team markings on the front of his house as a reminder of what happened—the searchers would mark the date a property was searched, whether anyone was alive, or whether they found bodies.

 

All American cities have a rich multiethnic history, but New Orleans seems to carry its diversity proudly. It wasn’t always so, of course; and it’s not a coincidence that the (wealthy, white) Garden District recovered from Katrina while the (poor, black) Lower Ninth is still decimated. But from the Tremé to the Marigny you cannot ignore the role of black Americans in shaping the city; as slaves, as “free colored,” and as civic and artistic leaders. The guide book I bought pointed out that, unlike in the rest of the south, slaves in New Orleans in the 18th and early 19th centuries were permitted to work (their ‘masters’ took most of their wages, of course, but some could save enough to buy their freedom). Many mixed-race “free colored” people who fled Saint-Domingue (now Haiti) during the anti-slavery revolution (1791-1804) ended up in New Orleans.

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This is also the city where plaçage was practiced in the 18th and 19th centuries—a legal contract of concubinage between a wealthy white (usually French-Creole) man and a mixed-race free-colored woman. At the quadroon balls, white men could meet mixed-race women (quadroon meaning a person who was one-quarter black, i.e., had one black grandparent; one black great-grandparent was called octoroon). Learning about all this I got the impression that the “free colored” women of early 19th century New Orleans were a formidable group of businesswomen and artists. (For a fictional account of what life may have been like for black people in New Orleans in the 19th century, I recommend the Benjamin January series of historical mysteries by Barbra Hambly, starting with A Free Man of Color; truly eye-opening.)

You can see the impact of waves of immigrants from across Europe, Africa, and the Caribbean in the street names, the architecture, and the names on tombstones in the public cemeteries: French, slaves, free colored, Irish, Italian and German communities have all left their mark on the city. People are still drawn to New Orleans today, albeit as tourists—I heard almost as many languages and accents in the shops and on the streets as you do in London. In five days of playing tourist, no-one (tourist guide, cab driver, waiter, shop person, hotel worker) asked me about my accent. They’re used to people coming from all backgrounds.

This Monument to the Immigrant stands on the bank of the Mississippi.

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Which brings me to a quick comment on the weather. In the five days we were in New Orleans, the daytime temperature varied between 50 degrees and 80 (that’s 10-26 degrees Celsius). Locals told us that was normal—if you don’t like the weather right now, wait a few hours, it will change (except in July-August when it is unrelentingly hot and humid).

I took this picture from the plane as we were approaching New Orleans. Yes, the city is built on a swamp.

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Finally, you can’t talk about New Orleans without mentioning the Mississippi; the whole reason the city was built. These three pictures were taken from our hotel window, showing the wide sweep of the river as it curves its way through the city. It’s still a working river, so huge barges and container ships pass to and fro all day long. One morning we woke up to find the city blanketed in a thick fog that rolled in off the river, the ships passing by sounding their fog horns as they approached the port downstream from the hotel.

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The one thing I didn’t get to do on this trip was take a ride on this beauty—the Natchez, the last remaining paddle steamboat in New Orleans.

 

The next blog post will be about the food of New Orleans, Mardi Gras—and cemeteries!

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Halloween in America: Candy, Costumes, and Crazy Decorations

I’m cheating a little here and posting an update of last year’s piece on Halloween in America, with a few new pictures from the neighborhood. As usual (almost) everyone is getting in on the preparations; every other house in the neighborhood has some kind of decorations, indoors and out. Skeletons seem to be a dominant theme for 2018.

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As I’ve noted before (Happy St. Patrick’s Day!) Americans love any excuse to get dressed up and party. So, the stores are full not just of costumes for kids who plan to go trick-or-treating (superheroes, princesses, and monsters etc.) but also for adults heading to a party (sexy cop/nurse, and even scarier monsters). You can buy everything from cheap blonde wigs to vampire makeup kits; plastic skeletons to hang by the front door to fancy animatronic displays that light up and move every time a hapless kid runs by looking for candy. I read online that Americans spend over $5 billion dollars annually on Halloween, making it the country’s second largest commercial holiday. In addition, a quarter of all annual candy sales occur during the Halloween season.

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In the streets around us, decorations vary from low-key plastic pumpkins and “ghosts” made from sheets and old soccer balls (guaranteed to spook my dog whenever we walk by and the wind blows), to truly epic masterpieces. There’s one house that is covered every year in massive spiders (I couldn’t even take a picture of that one; shudder).

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This is one of the best ones I’ve ever seen: a bunch of skeletons playing basketball!

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The Saturday before October 31 our little town’s business and community organizations put on events for the kids. There’s a “Scare in the Square” in the local town square, where kids get to wear their costumes, enjoy themed games and face painting, and collect treats; and local shops that display a “pumpkin paw print” will give out treats to kids and their pets.

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I said “almost” everyone joins in; those with strict religious views don’t approve of the spooky shenanigans. Our youngest attended a Jewish daycare center when he was a baby; we were told very firmly not to send him to school on October 31st in any kind of costume because “Halloween is a pagan observation.” I also know of a couple of Christian families whose kids take no part in anything to do with Halloween because it’s “satanic” and unholy. I’m not sure how they come to that conclusion, given that Halloween is literally short for “All Hallow’s Eve,” meaning the night before the decidedly-Christian All Saints Day, but to each his own.

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The weather forecast for October 31 this year is for a mild, dry evening, which should mean we get plenty of trick-or-treat kids showing up as the sun goes down. The record was close to 100 kids, but in recent years it’s been around 50. Some people give out bars of chocolate or pretty little gift bags filled with treats. The lazy among us (like me) buy big bags of Halloween candy — basically, mini-versions of popular treats, often in Halloween-themed wrappers — dump it all into a big plastic cauldron, and tell each kid to just grab a handful. The little ones carry plastic pumpkins or little treat bags to fill; teenagers are not ashamed to haul around pillowcases to gather their loot.

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The deluge usually starts at dusk, around 6:30pm, with the little toddlers, often carried by a parent. As the evening wears on, more and more show up at the front door, usually in groups of 2-10 kids, sometimes with a parent or older sibling in the background. By 9:00pm it’s pretty much over, with just the odd bored teenager showing up; their costumes no more than an attitude that says “costumes are lame but I still want candy.” If it’s been a busy evening they’ll be stuck with the leftovers that no-one else wanted (sticks of gum).

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By the end of the week, the shops will have replaced their Halloween candy and decorations with Thanksgiving-themed treats and turkey-shaped table decorations, and some will start putting out the Christmas stuff, too; including the little plastic Christmas trees that will be everywhere by early December. Maybe someone should tell the strict born-agains that the Christmas tree is a pagan symbol.

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Voting in America

Americans are very proud of being a democracy—”land of the free” and all that—and voting is the bedrock of the democratic system. So why, in this most vibrant of democracies, is the actual act of casting of a vote so difficult?

To start with, you have to get yourself registered. This might seem obvious to Americans but in countries like Chile, Israel, and Sweden (and many others) you are automatically registered when you hit 17 or get a national ID number (the equivalent to an American social security number). In America, you have to fill out a form and provide proof of residence and of citizenship.

If you move, you have to submit a change-of-address form (your polling place will likely have changed) and if you’ve moved to a different state you have to re-register all over again. This may not seem like a big deal but remember, America is a migratory place where a lot of people move across town/state/country. According to research at FiveThirtyEight, the poorer you are, the more likely you are to move—non-whites also tend to move home more often than whites. Which raises all sorts of questions about who is more likely to vote.

Back to registration. One of the questions asked on the registration form is political party affiliation—Democratic, Republican, Green, Libertarian, None, or Other are listed on the Pennsylvania form. This is so that you can vote in a primary. (If you pick None, you won’t be able to vote in any of the primaries, and I have no idea what “Other” might include). The specifics of how primaries work and when they are held varies by state but basically, it’s when the voters choose the candidate who will stand in a local, state, or federal election on the particular party ticket. Primary elections are held sometime in the spring and full elections in the fall.

I live in the state of Pennsylvania. Back in May, the state held its primary elections, to choose who the respective parties’ candidates would be for the five state and federal elections coming up next month. On November 6 I’ll vote in the general election (same date across the country). These are called “mid-term elections” because they fall mid-way through the four-year presidential term.

So, I live in Montgomery County, a mostly-suburban area just north of the city of Philadelphia. My polling place is a local church hall. Below is what I will see when I get to the voting booth in on November 6. The Pennsylvania governor and the (federal level) senator are chosen state-wide. In addition, I’m in the 4th congressional district (federal level representative), the 154th district for the state assembly, and the 4th district for the state senator. Yes, it’s a bit confusing, with all the different districts and levels of government, but this is actually a pretty straightforward ballot with just five offices to vote for.

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All voting in this part of Pennsylvania is done using an electronic machine. Across the state and the country as a whole some places use paper ballots; at my polling place the machines look like this:

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This is a screenshot from a recent article in the Intelligencer (a Montgomery County newspaper). Note the headline. Not all voting machines are created equal and some are more secure than others. It’s still up for debate whether there were vote manipulation and machine tampering in the 2016 elections but for sure the system is way less secure than it should be.

So, there are a lot of things to vote for and getting on the register can be a hassle but otherwise, the whole thing looks relatively straightforward, doesn’t it? Well, not so fast. The upcoming vote is for a general election; these are held every two years in even-numbered years. Aside from the presidential elections, which are held every four years, exactly what you are voting for will vary—congressional and state representative elections are every two years, but the state governor and state senator elections are every four years, and the state’s two federal senators are elected to six-year terms (and not at the same time). It gets really confusing trying to remember what you are supposed to be voting for each time. And this is just the even-numbered years.

The odd-numbered years are used for local and municipal elections. Back in May and November 2017 the Pennsylvania primary and then full elections were held for various judges—magistrates, court of common pleas, commonwealth court, and superior court—along with local school boards, councils, mayors, tax collectors (yes, really), and election judges. I pay close attention to local races like the school board and council, but how am I supposed to choose judges? I’m not even clear on what the various courts do.

It sounds great, getting to exercise your citizen’s right to vote at so many levels of government—but the reality is that, with so many things to vote for every six months, most people don’t bother. Voter turnout in the USA has been declining steadily since the 1960s. In a presidential election turnout usually hits around 60%. Standard turnout in a mid-term election like the one next month is 40% of eligible voters; in odd-year, primary and local elections turnout averages around 20%. For comparison, in the likes of Sweden turnout regularly comes in over 80%.

And, young people are the least likely of all to vote. Close to 50% of Americans aged 18-29 voted in the 2008 presidential election—the first year that Obama ran—but the usual number is around 30% or lower.

All of which helps to explain the massive efforts currently underway to “get out the vote” for next month. Younger Son’s university campus (in New Jersey) has sponsored a big “Vote100” effort to try to get all eligible voters registered and signed up for absentee ballots. Older Son reports “all” of his friends on campus (in Maryland) are comparing notes on how to get an absentee ballot for their respective states. Both have been incensed by what they see going on in American politics in the past two years, and I’m proud to report that both mailed in their requests for absentee ballots last week. Whether they get them in time remains to be seen—there were numerous reports of our county absentee ballot system not working in 2016, including Older Son who never did receive his.

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Theoretically, you stay on the registration list until you file for a change of address or to register in another state. But, in recent years there have been reports from across the country of people finding they’ve inexplicably been dropped from registration. There are plenty of ways to check that you’re still registered, but you’d only know to do that if you’re paying attention to e.g. social media.

And then there are the reports of outright voter suppression. As with many of the problems in America, this is mostly a function of racism. This article in Slate highlights some of the most egregious examples underway right now, attempts by Republican incumbents in Georgia, Kansas, and elsewhere to dis-enfranchise “minority” (i.e., non-white) voters.

When you look at what’s happening on the American political scene right now, it’s hard not to conclude that voting in America is a flawed process that can lead to deeply flawed outcomes. The only thing that might save us all is if those 18-29-year-olds do, indeed, channel their rage into the ballot box.

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Pumpkin spice season

It’s been a rough few days on the American political scene so, naturally, I feel like writing about something orange and kind-of-disgusting that deeply divides the country. No, not that one: I’m talking Pumpkin Spice.

The calendar says it’s fall, though you wouldn’t know it from the weather, which is still topping out well into the 70s Fahrenheit every day (21 to 26 Celsius); or from the trees, with most of the ones in our neighborhood still resolutely green. However, America’s retailers are never slow to cash in on something, and as soon as mid-September rolled around they once again turned the shops and malls resolutely orange.

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This is the display that greets you when you walk into our local Trader Joe’s supermarket. Pumpkin baking mix; pumpkin spice snack bars; and pumpkin spice cookies. There’s pumpkin butter, pumpkin breakfast cereal, something called pumpkin spiced almond beverage (I have no idea) and, god help us, pumpkin spice tea.

Yes, you can nibble on pumpkin biscotti with your cup of pumpkin spice coffee (shudder).

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There are pumpkins and squashes everywhere—most of the more colorful ones are more likely to end up as decorations than as ingredients (note the “shellacked gourds” sign). These are at the local Trader Joe’s and the Acme supermarket.

 

Side note: Our first fall in this house in the suburbs I cheerfully “decorated” the front porch with a collection of pumpkins of various sizes, like the ones below currently on offer at the local Acme. Within 24 hours all of the smaller ones had disappeared. I couldn’t fathom who would steal tiny pumpkins—until I heard a chattering overhead and saw a squirrel perched on a branch of the maple tree, clutching a half-eaten pumpkin. So, I bought a large plastic one and put that outside every year, instead.

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Back to the pumpkin spice obsession. Check out the Trader Joe’s dessert options. Apple spice jam and “rustic apple tarte” actually sound quite nice (even with that annoying “e” tacked onto the end), but pumpkin marble mousse? Pumpkin cheesecake?!

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I know people who are ecstatic about Pumpkin Spice Season. They compete to see who can be the first to score a pumpkin spice latte from Starbucks, with all the zeal of a bird-watcher looking for the first robin of the spring. Now, I do like the apple-cranberry scents they waft around in shops like Bed, Bath & Beyond and the lovely fall-color plants and decorations are a treat. And, I have no problem with a well-made pumpkin pie; personally, I prefer pecan, but each to their own. But coffee should taste like coffee, not some overly-sweet vegetable concoction.

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Pumpkin flavored ice cream sounds horrendous to me—but the worst pumpkin item ever was the bottle of pumpkin beer a sister-in-law gave the Spouse a few years ago. She thought it was funny. Always one to try something different, Spouse did eventually try a mouthful. The rest went down the sink.

Looking for an image of pumpkin beer I found this: a pumpkin spice latte stout courtesy of Breckenridge Brewery of Colorado. I’ll just leave it here with no comment.

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