Will Bill White be the Perot of 2016?

By DAVID WARSH BOSTON

What might a successful Democratic presidential candidate in 2016 look like who is not Hillary Rodham Clinton?  The Republican Party can’t be expected to field a successful mainstream candidate until some of its serious kinks have been worked out – at least another cycle or two.  This time the Democratic Party nominee is more than likely to win. What happens after that depends on who that candidate is.

The former secretary ofsState has had a splendid career since striking out on her own as a senator from New York in 2001. It would be good to have a woman president.  But, to my mind, Clinton is too tied to battles going back to 1992 and before to hope that, once elected, she could win over her many critics and steer the nation back towards consensus.

A non-polarizing rival for the nomination might look like Bill White. He’s a personable fellow, 59 years old, a former litigator, oil and gas entrepreneur, deputy secretary of energy (1995-97), real-estate developer, and successful three-term mayor of Houston, the nation’s fourth-largest city. His candidacy might  have seemed a logical possibility, except that he was defeated by incumbent Rick Perry in the Texas gubernatorial election in 2010, the year of the Tea Party.  End of story, at least on the surface.

Mainly, I think of White because he has written a book, America's Fiscal Constitution: Its Triumph and Collapse, which seems to me like a very promising platform for a Democratic candidate. White has zeroed in on the long-term federal borrowing crisis that affects every aspect of America’s future role in the world. He has placed it, credibly, in historical perspective. That in turn demonstrates a deep political intelligence.

“To understand what recently has gone wrong,” he writes, “it helps to know what had once gone right.” Five  times in the past the United States has found itself deeply in debt:  after the American Revolution, the War of 1812, the Civil War, World War I, and the  16hard years of the Great Depression and World War II.

In each case the U.S. borrowed for a clear and generally agreed-upon purpose: to preserve the union, to expand and connect its borders (the Louisiana Purchase, in particular), to wage war, and to compensate in severe economic downturns, beginning with the Panic of 1819. In each instance, relying on a political tradition that White traces to budgetary procedures instituted by the Founding Fathers, Congress found the political will to pay it down afterwards – until 2001.

Then, says White, the 220-year-old fiscal tradition collapsed.  The federal government cut taxes and borrowed to pay for two wars, and a rising proportion of its domestic operating expenses as well. George W. Bush took office pledging to reduce the national debt by $2 trillion and create a $1 trillion rainy-day fund.  Instead he increased the debt by 50 percent, from $5.7 trillion to $9 trillion – before the Panic of 2008!

In the long and deep recession that followed,  federal debt exploded, to $16.7 trillion last year, or something like $120,000 for every working American.  Debt coverage, the measure banks commonly use to judge credit-worthiness of businesses and individuals, rose to nine times the revenue available to pay the debt.

America’s Fiscal Constitution is gracefully written, but it is not an easy read: 410 pages of narrative, with another 150 pages of notes, bibliography and tables, and only three charts in the entire book to illustrate the argument. White describes in some detail each prior episode of borrowing and, with a politician’s eye, the hard legislative compromises and monetary policy accommodations that were subsequently required to restore the tradition of more-or-less balanced budgets.

None of these chapters is better than the set-piece with which the book begins – the 1950 battle between President Harry Truman and Republican Sen. Robert Taft, of Ohio, over tax cuts on the eve of the Korean War, contrasted with the collapse of the tradition of fiscal responsibility in 2003, as the U.S. prepared to invade Iraq.

So what happened in 2001?  White sees the loss of discipline as having happened in two stages.  The first he traces to the run-up to Ronald Reagan’s election in 1980.  Traditionally the GOP had campaigned on promises to maintain balanced budgets. He describes the role of then-Congressmen David Stockman, of Michigan, and Jack Kemp, of New York, and Wall Street Journal editorial writer Jude Wanniski in fomenting a competition between two Santa Clauses – Democrats who delivered more services, and Republicans who delivered lower taxes. That lowering of taxes, it was promised, would pay for itself by stimulating growth.

Candidate George H.W. Bush, soon to be vice president, saw “voodoo economics” Gradually, Ronald Reagan perceived envisioned a “supply-side revolution.” White writes, “Never in the nation’s history had a president proposed large, simultaneous spending increases and tax cuts when the federal budget already had a deficit.”

But Reagan was more nearly a fiscal conservative than a heedless spender, White notes.  He expected higher inflation to make up for lost revenues by carrying taxpayers into higher brackets. And he gave his blessing to an historic rebalancing of the Social Security Trust Fund.  Not until George W. Bush arrived in 2001 was traditional discipline truly lost.

Presented by the Clinton administration with a budget surplus accumulated through a combination of savvy policies (tax increases combined with monetary easing) and good luck (the Internet boom), Bush immediately sought tax cuts, explaining that the resulting deficits were “incredibly good news” because of the “straitjacket” they imposed on Congress. The straitjacket notwithstanding, Bush went to war first in Afghanistan and then in Iraq, too. Congress cut taxes again. “Nothing is more important in the face of war than cutting taxes,” explained House Majority Leader Tom DeLay, of Texas.

What accounts for this sixth great spike in borrowing, unaccompanied by any of the traditional rationale?  The great advantage of White’s argument from history is that it underscores how weighty must be any satisfying explanation for the current mess. Oedipal rivalry in the Bush family is a non-starter.

My own preferred suspect is the entry into civic discourse of claims to authority derived from scientific economics in the years after World War II  This occurred gradually, first in the guise of a “Keynesian Revolution”  that put “demand management” through deficit spending at the center of the conduct economic affairs; then in the form of carelessly conjured “supply management” of the economy through tax cuts.  Plain old political pandering played an even larger role.

White, a Democrat, carefully delineates the counter-revolution, but he has little to say about the rise of the “New Economics,” except to note that when John F. Kennedy, in a memorable commencement speech at Yale University in 1962, urged young Americans to develop fiscal policies based on “technical answers, not political answers,” a Gallup Poll a few weeks later found that 72 percent of Americans opposed tax cuts financed by debt. Nevertheless, “guns and butter” policies of the Vietnam War followed.

I have nothing against technical economics; indeed, writing about it is how I make my living. Its findings, large and small, have greatly improved the lot of billions of persons around the world over the last eighty years. But I do think that its claims to authority, especially in public finance, have enjoyed a somewhat overblown in recent decades, in contrast to the common-sense strictures of the American fiscal tradition whose two-hundred-year arc White describes so clearly.

White identifies four time-honored conventions whose return would begin to solve the problem of today’s massive debt: clear accounting; “pay as you go” budget planning; separate budgeting for government trust funds; and explicit congressional authorization for each new debt.  Is such an extensive simplification politically possible?  Certainly not at the moment.

Might Bill White play a Perot-like role in the 2016 election?  I have no idea, though I hope so.  I do know that the search for alternatives to Hillary Clinton will continue. People will say that the hope for a new and transformative figure is what brought Barack Obama to office in 2008. In my opinion, the strategy has worked pretty well, for all the acrimony.  It is simply taking longer than had been hoped.

 David Warsh, a long-time financial journalist and economic historian, is proprietor of economicprincipals.com

Paul F.M. Zahl: Movie offers guide to Harvard Black Mass

"Order and chaos'' (mixed media), by LYNDA CUTRELL, at Galatea Fine Art, Boston, June 1-29.

By PAUL F.M. ZAHL

As a Harvard grad and an Episcopal minister, I am dismayed by the prospect of the university's sanctioning a Black Mass for tonight (May 12), within Memorial Hall.

But what I really want to megaphone to all concerned is this: Wake up, Harvard (not to mention the Satanic Temple of New York City), and watch more horror movies!

You could all spare yourselves a lot of trouble if you watched more horror movies. Specifically, you need to see that unregarded but rich Hammer horror film from the early 1970s, entitled Dracula A.D. 1972. For those who care, and this writer cares very much, Hammer Studios in England produced dozens of luridly wonderful horror movies from the late '50s through the early '70s. These immortalized such U.K. character actors as Peter Cushing and Christopher Lee.

Fans of these movies tend to regard the instantly dated Dracula A.D. 1972 as the nadir of Hammer's output. But in light of what's slated to happen today in Cambridge, Mass., it's risen to the top of my list.

This is because Dracula A.D. 1972 anticipates in detail a scenario that has already unfolded. To wit, the villain in the movie, whose made-up name in the story is 'Johnny Alucard' (the surname, of course, is ''Dracula'' backwards), looks, dresses and talks like the spokesman for the Satanic Temple of New York City. Secondly, he keeps telling his gullible young friends in the movie to ''Keep cool, birds'' -- the script is deliriously filled with faux-Flower Child and Swinging London colloquialisms. "This happening I'm asking you to jive to is just a stunt. Just a bit of fun, mates."

To their acute misfortune, members of "Johnny Alucard's''' circle believe him when he says: "This is just a re-enactment."

The movie's staging of the Black Mass itself is extremely well done. The director, Alan Gibson, is sure-footed in the blocking and the angles; and during the Mass, which takes place in a ruined Memorial-Hall-type building, a deconsecrated church damaged during the Blitz, in World War II, the movie gets serious. The elements of a real Black Mass are all there, just as they will be, presumably, this evening in Cambridge within the once hallowed walls of the university's memorial to its Civil War dead. The parallels between now and this absurd but tight English movie are breathtaking.

Finally, the church comes into it. But not priest, not bishops, not archbishop.. Rather, old-fashioned religion comes in to Dracula A.D. 1972 through the person of an aging physician named ''Lorrimer Van Helsing". (Who ever thought of that first name? The writer should have been knighted on the spot!)

Anyway, ''Lorrimer Van Helsing'' strides into the movie, an old man poignantly concerned about the well-being of his impressionable niece. (His niece has come under the spell of ''Johnny Alucard".) Fortunately for her, her uncle intervenes, with cross and stake, and Jessica van Helsing is saved.

This is a classic instance, which occurs often in English horror and sci-fi movies, in which wise members of the older generation are the only ones who know enough to save clueless members of the younger one. (Usually, the character actor Andre Morell played these roles, though John Mills did once, too.)

I wish that Harvard University officials would go straight to Barnes and Noble, and buy their very reasonably priced copy of Dracula A.D. 1972. It's in all the stores as I write. (Target, too.)

A personal note in conclusion: Three times during my ministry in the Episcopal Church, I was forced to get up close and personal with Satanists. Somehow they succeeded in inveigling members of our parish youth group in Westchester County, N.Y., to take part in a Black Mass.

They "staged" this on the grounds of a country club up on the Hudson. Two of the young participants -- and I had to clean up the bones of living animals that had been sacrificed during the service (and had to change the locks on the parish sacristy because Communion wafers were being stolen) -- were scarred indelibly by what they were lured into doing. I never of them smile again.

I also got to know a languid old trust fund Satanist, who lived in London and had the most beautiful personalized Satanic stationery.

Harvard, wake up! Buy this movie and watch it. And it may not be quite as campy as it first appears.

The Rev. Paul F.M. Zahl is an Episcopal minister and a theologian.

Addendum by Robert Whitcomb: So will we see the Prophet Mohammed in drag in the next Hasty Pudding Show at Harvard, or indeed portrayed in any public way on Harvard's campus as less than perfect? Or course not -- and not because of any particular respect by a mostly secularized Harvard community but because of the physical fear of offending followers of a religion a few of whose adherents are famously violent.

Fear is a key ingredient of hypocrisy.

Too much caffeine

"Splash Bowls,'' by EILEEN BRAUN, at the Lexington (Mass.) Arts and Crafts Society.

From Siberia to Suriname

"Maynard Spring'' (oil on canvas), by GEORGE NICK, at the Art Complex Museum, Duxbury.

It's always a bit of a shocker: A few weeks ago all was brown, gray, black and white, and now, after a couple of warm, wet days, southern New England turns into jungle-like lushness.

Chris Powell: Letting Tenet buy 4 Conn. hospitals would hit public hard

By CHRIS POWELL

Plans to sell four nonprofit community hospitals in Connecticut -- in Waterbury, Bristol, Manchester and Vernon -- to a national hospital chain, Tenet Healthcare Corp., raise two big issues of public policy.

The first issue is the political economy of medicine. It is proceeding as follows.

Gov. Dannell Malloy and the General Assembly already have reduced substantially state government's financial support for hospitals. This has pushed weaker hospitals toward insolvency and induced them to look for buyers, including for-profit companies. While state officials say the insolvent hospitals have no choice but to sell out, state government itself is largely responsible for that insolvency.

The nonprofit hospitals acquired by for-profits will lose their tax exemption and start paying state corporation and municipal property taxes. The acquired hospitals will recover their new tax expenses by increasing charges to patients and insurance companies.

The insurers will recover their increased costs by raising premiums to policyholders, thereby getting blamed by the public for price increases that are actually state tax increases.

State officials then will congratulate themselves on their new revenue and spend it to increase compensation for the government and welfare classes that support them at election time.

All this will be the product of a supposedly liberal Democratic regime and more of what passes for liberalism — pious plunder.

The second policy issue here is control of the hospital business, a change from local control to distant control by the Wall Street funds that own Tenet. State government could appropriate for local control simply by adequately covering the uninsured. If, as hospitals say, they can't find investment capital with which to modernize operations and improve efficiency, state government could create a capital fund for them as it has created other capital funds.

Instead state government lately has appropriated for:

* A bus highway from Hartford to New Britain even as the busiest commuter railroad in the country, the one serving Fairfield County, repeatedly broke down.

* All sorts of corporate welfare in the name of economic development less plausible than the economic development that might come from modernized hospitals. (Who can forget the burrito shops in Colchester and East Lyme that took state money and ran?)

* And, of course, incessant raises and benefit increases for government employees, often euphemized as “aid to education” when it is only aid to educators.

Public forums held last week by Tenet and Eastern Connecticut Health Network, whose hospitals in Manchester and Vernon would be acquired, illuminated the dubious nature of the undertaking.

The companies refused to answer critical questions put to them by the (Manchester, Conn.) Journal Inquirer, including whether “golden parachutes” have been promised to ECHN's already extravagantly paid executives; whether there would be any guarantees of hospital staff levels after an acquisition; and about exactly how Tenet would make the hospitals profitable. ECHN's president did reveal that the hospital in Vernon would be guaranteed three more years of operation, which meant that its closing is contemplated if not already planned.

While ECHN's executives maintain that the hospital company can't regain solvency on its own, Tenet obviously sees plenty of money ahead in the hospital business, if only through fraud. Over the last 10 years the corporation has paid a billion dollars in fines for misconduct and has appropriated another $27 million for possible new fines.

The fate of the two ECHN hospitals now is in the hands of their 257 community corporators, whose service seems to have been a mere formality in light of what they have slept through -- not only the extravagant executive salaries but also the lucrative contracts given by ECHN to members of its self-dealing Board of Trustees.

Chris Powell is managing editor of the Journal Inquirer, in Manchester, Conn.

Respond via rwhitcomb51@gmail.com

Blame Russia for Russian aggression

By ROBERT WHITCOMB (rwhitcomb51@gmail.com)

Some denounce the United States for Russia’s reversion to brutal expansionism into its “Near Abroad” because we encouraged certain Central and Eastern European countries to join the North Atlantic Treaty Organization. The argument is that NATO’s expansion led “Holy Russia” to fear that it was being “encircled.” (A brief look at a map of Eurasia would suggest the imprecision of that word.)

In other words, it’s all our fault. If we had just kept the aforementioned victims of past Russian and Soviet expansionism out of the Western Alliance, Russia wouldn’t have, for example, attacked Georgia and Ukraine. If only everyone had looked into Vladimir Putin’s eyes and decided to trust him.

Really? Russia has had authoritarian or totalitarian expansionist regimes for hundreds of years, with only a few years’ break. How could we have necessarily done anything to end this tradition for all time after the collapse of the Soviet iteration of Russian imperialism? And should we blame Russia’s closest European neighbors for trying to protect themselves from being menaced again by their gigantic and traditionally aggressive neighbor to the east? Russia, an oriental despotism, is the author of current Russian imperialism.

Some of the Blame America rhetoric in the U.S. in the Ukraine crisis can be attributed to U.S. narcissism: the idea that everything that happens in the world is because of us. But Earth is a big, messy place with nations and cultures whose actions stem from deep history and habits that have little or nothing to do with big, self-absorbed, inward-looking America and its 5 percent of the world population. Americans' ignorance about the rest of the planet -- even about Canada! -- is staggering, especially for a "developed nation''.

And we tend to think that “personal diplomacy” and American enthusiasm and friendliness can persuade foreign leaders to be nice. Thus Franklin Roosevelt thought that he could handle “Joe Stalin” and George W. Bush could be pals with another dictator (albeit much milder) Vladimir Putin. They would, our leaders thought, be brought around by our goodwill (real or feigned).

But as a friend used to say when friends told him to “have a nice day”: “I have other plans.”

With the fall of the Soviet Empire, there was wishful thinking that the Russian Empire (of which the Soviet Empire was a version with more globalist aims) would not reappear. But Russian xenophobia, autocracy, anger and aggressiveness never went away.

Other than occupying Russia, as we did Japan and Western Germany after World War II, there wasn’t much we could do to make Russia overcome its worst impulses. (And Germany, and even Japan, had far more experience with parliamentary democracy than Russia had.) The empire ruled from the Kremlin is too big, too old, too culturally reactionary and too insular to be changed quickly into a peaceable and permanent democracy. (Yes, America is insular, too, but in different ways.)

There’s also that old American “can-do” impatience — the idea that every problem is amenable to a quick solution. For some reason, I well remember that two days after Hurricane Andrew blew through Dade County, Fla., in 1992, complaints rose to a chorus that President George H.W. Bush had not yet cleaned up most of the mess. How American!

And of course, we’re all in the centers of our own universes. Consider public speaking, which terrifies many people. We can bring to it extreme self-consciousness. But as a TV colleague once reminded me, most of the people in the audience are not fixated on you the speaker but on their own thoughts, such as on what to have for dinner that night. “And the only thing they might remember about you is the color of the tie you’re wearing.”

We Americans could use a little more fatalism about other countries.

***

James V. Wyman, a retired executive editor of The Providence Journal, was, except for his relentless devotion to getting good stories into the newspaper, the opposite of the hard-bitten newspaper editor portrayed in movies, usually barking out orders to terrified young reporters. Rather he was a kindly, thoughtful and soft-spoken (except for a booming laugh) gentleman with a capacious work ethic and powerful memory.

He died Friday at 90, another loss for the "legacy news media.''

***

My friend and former colleague George Borts died last weekend. He was a model professor — intellectually rigorous, kindly and accessible. As an economist at Brown University for 63 years (!) and as managing editor of the American Economic Review, he brought memorable scholarship and an often entertaining skepticism to his work. And he was a droll expert on the law of unintended consequences.

George wasn’t a cosseted citizen of an ivory tower. He did a lot of consulting for businesses, especially using his huge knowledge of, among other things, transportation and regulatory economics, and wrote widely for a general audience through frequent op-ed pieces. He was the sort of (unpretentious) “public intellectual” that we could use a lot more of.

***

I just read Philip K. Howard’s “The Rule of Nobody: Saving America From Dead Laws and Broken Government.” I urge all citizens to read this mortifying, entertaining and prescriptive book about how our extreme legalism and bureaucracy imperil our future. I’ll write more about the book in this space.

Robert Whitcomb (rwhitcomb51@gmail.com), a former editor of The Providence Journal's editorial pages, is a Providence-based writer and editor, former finance editor of the International Herald Tribune and a partner and senior adviser at Cambridge Management Group (cmg625.com), a consultancy for health systems, and a fellow of the Pell Center for International Relations and Public Policy.

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'Beacons of hope'

"Lori X, Lancaster, California,'' by B.J. & Richeille Formento, in the "Circumstance: American Beauty on Bruised Knees'' show at the Robert Klein Gallery at Ars Libri, in Boston.

Mr. Formento is the photographer and Ms. Formento, his wife, is the stylist in this show, meant to show the changing face of the American Dream through pictures of "women who became beacons of hope against the dark and slated backdrops of their lives.''

Black Mass at Harvard

Some students from Harvard's Extension School plan to hold a Satanic “Black Mass” in a pub at Harvard's Memorial Hall (named in honor of Harvard's Civil War dead) on May 12. Needless to say, the Roman Catholic Diocese of Boston is livid, especially because a consecrated host reportedly might be used.

Harvard's administration says in effect that it can't do anything about the plan.

Jumping into summer

"No Strings Attached'' (oil on canvas), by CAROL O'MALIA, at the Art Complex Museum, in Duxbury, Mass.

George Borts, 1927-2014

George H. Borts, 86, a distinguished economist, writer and editor, died May 2 in Providence.

Professor Borts was born in New York City on Aug. 29, 1927, and educated at Columbia University, where he earned an undergraduate degree at 19 and worked on the student newspaper, The Spectator. He received both his master’s degree (1949) and Ph.D. (1953) from the University of Chicago, where he studied under Milton Friedman, the famed libertarian economist – an experience that profoundly influenced his thinking about economics and other aspects of society for the rest of his life.

Professor Borts spent 63 years at Brown University, where he joined the Department of Economics in 1950 at 23. During his long and distinguished career, he served as chairman of the Department of Economics at Brown and led its rise to prominence as one of the leading departments of economic teaching and research. He was also the managing editor of one of the economics profession’s pre-eminent journals, the American Economic Review, for more than 10 years.

His career gave him the opportunity for travel, research and other learning as a visiting professor/research fellow at Hokkaido University, the London School of Economics and the National Bureau of Economic Research. He retired last year as the George S. and Nancy B. Parker Professor Emeritus of Economics.

Professor Borts was an expert in international finance, industrial organization, regulation and transportation. His legacy as an economist includes not only his books and dozens of scholarly papers, but the many lives he touched as a colleague, teacher, friend and adviser. Over more than six decades at Brown, George Borts had instructed and mentored thousands of undergraduate and graduate students. He supervised dozens of senior theses and doctoral dissertations and until last year, he was teaching undergraduate courses on international finance and on the welfare state in America, as well as leading several independent studies on a variety of topics.

His intellectual curiosity and professional interests allowed him to analyze complicated issues without pre-judgment. He led discussions about political, economic and social issues in ways that were clear and engaging for undergraduate seminars and senior colleagues alike. Generations of Brown students, economics majors and non-majors alike, discovered the intellectual creativity of economics through his classes.

His interest in promoting excellence in education was also demonstrated by his leadership of Brown’s Phi Beta Kappa chapter for many years.

He gave frequent testimony before U.S. and Canadian regulatory agencies and commissions and served on many boards, including those of the Rhode Island School of Design, Dartmouth’s Amos Tuck School of Business, Rhode Island Blue Shield, Junior Achievement of Rhode Island and Temple Beth-El in Providence. And he advised political candidates of both parties on economic and tax policy and provided commentaries for The Providence Journal. In 1990-91 he was the editor of the Brown World Business Advisory.

The managing editor of that publication, who became The Providence Journal’s editorial-page editor, Robert Whitcomb, called Professor Borts a “joy to work with’’ over the two decades of their occasional projects together. “He combined intellectual rigor with great humor and congeniality, including when we didn’t agree on a specific issue. I particularly enjoyed his often amusing application of the law of unintended consequences to many societal situations at our numerous pleasant meals together.’’

Although he was a tireless advocate of the free market, he viewed political issues through an economic lens that was fair and open-minded. He valued greatly his relationships with both Keynesian and Monetarist economists. His closest personal relationships were with such prominent advocates of alternative points of view as Hyman Minsky, Phillip Taft, and Jerome Stein. Further evidence of this non-ideological approach was his pronounced belief in the need for immigration reform.

He is survived by Dolly, his wife of 65 years, three sons, three grandchildren and many friends and admirers around America and beyond.

More private seizures of public roads

rwhitcomb51@gmail.com

Much of Providence was paralyzed today by one of those promotions for a rich company that cities and towns get suckered into. Today's collection of races, called "Cox Providence Rhode Races'' after the media company, closes streets, hurts many local businesses and gets in the way of rescue vehicles so that a lot of people (presumably a lot of Cox "volunteers'') can run, or, more commonly, barely walk (because they're so out of shape) along many Providence streets.

Much of the city grinds to a halt in the process, with big macro-economic losses.

Like the giving away of public streets to rich private universities, which Providence has famously done, it's more erosion of the idea that public space is for the public, not for private interests, including corporate promotion.

A peak of realism and terror

A painting of Mt. Katahdin, Maine's greatest mountain, from photo-realist Richard Estes's "Realism'' show, opening May 22 at the Portland Museum of Art.

Looking at that gorgeous peak, I think of black flies and beer on a fishing trip to Baxter State Park 45 years ago. And, some years later, hiking Katahdin's scary "Knife Edge,'' with near-sheer cliffs on each side.

On a climbing trip to Katahdin about a decade ago, I noticed how variably physical fear can manifest itself. While I found walking along the "Knife Edge'' nearly terrifying (although every few minutes mitigated by clouds scudding in below us, thus helpfully making it impossible to see just how big the drop was) one of my companions, who had done extensive climbing in the Alps and other high mountains, seemed to display no anxiety.

And yet when the next day we rented a small plane (and its wisecracking Mainiac bush pilot) and flew over the gorgeous peak, our companion seemed terrified.

Coronary and traffic congestion

Photo copyright BOBBY BAKER, who travels New England in search of memorable shots.

This one, of a joint in gritty downtown Worcester, is very evocative to me. Friends and I used to stop there on road trips to Vermont and fill up on food that the American Heart Association would urge us all to avoid whenever possible. It is utter junk, but delicious. The confused and congested traffic circulation of downtown Worcester, "New England's Pittsburgh,'' was a frustration that was difficult to avoid but Coney Island made it considerably more tolerable.

From Worcester, we'd proceed northwest through assorted villages and mill towns, some of which looked little changed (except for the cars) from photos taken 100 years ago. If a year or more had elapsed since our last trip through the areas, we'd notice that some big wooden store or old stagecoach hotel on a common had burned down in the interval.

For those in peril on the sea

"Chapel on the Hill'' (oil on panel), by NAN HASS FELDMAN, at Fountain Street Fine Art, Framinghanm, Mass.

Dr. Pierson's 'Triple A' for health-care reform

  One of my gigs is to help out at a consultancy called Cambridge Management Group, which advises hospitals and other health-care institutions as well as physician groups. I learn the thoughts of some very interesting people. One is nationally known health-care reformer Marc Pierson. Here's the chat/interview I put together the other day and that ran on Cambridge Management 's Web site, cmg625.com.

We chatted the other day with James Marcus (Marc) Pierson, M.D., a Cambridge Management Group senior adviser. Dr. Pierson -- an internist, emergency physician and past vice president of clinical information and quality for PeaceHealth St. Joseph Medical Center, in Bellingham, Wash. -- is a major health-care reformer. His leadership in helping to create an integrated and patient-centered health-care system for Whatcom County, Wash., has received national attention.

As a leader of the Pursuing Perfection program in the county, he helped develop the community-based, patient-centric Shared Care health-record system and participated at the board level in the Whatcom Alliance for Healthcare Advancement (WAHA). <a href="http://whatcomalliance.org/ ">WAHA</a> helped lead to the recently approved Washington State Health Care Innovation Plan, which has put the power of the state government behind the many ideas arising from Whatcom County’s whole-community and patient-informed perspectives.

He told us that “the county level is the smallest appropriate geographic base for creating a coordinated-care system.’’ Whatcom County was particularly attractive for such efforts because it has attracted a lot of civic-minded and collaboration-minded physicians who “didn’t move here for the money but, among other things, for the natural beauty.’’

Dr. Pierson said that creating an integrated-care model requires first observing how the chaotic traditional “system’’ was or was not working, then trying to understand it and then writing down observations and designing changes. It was crucial to understand the inter-actions of all of the parts of the health-care system, and, crucially, to use patients’  knowledge and opinions – those too-often-neglected elements of health-care reform – in changing the individuals and institutions that serve them.

He cited the  “Triple A’’ approach:  1.)  research and analyze the needs and desires of the patient population; 2.) understand (clinically and financially) the other parts of the system (doctors, nurses, hospitals, insurers, etc.; 3.) design together one integrated health-care community in which patients’ decisions play the most important part.

With that, he said, we can build a health-care system whose treatment and payment system addresses the ever-changing needs of the whole community. “The quality of the entire system suffers,’’ he said, “when the focus is more on the individual parts and loses sight of the whole community health system. Perfect parts do not make perfect or even good systems. It is the interactions between the parts that must be designed….’’  In any event, the improve-the-parts approach is unsustainable.

Further, Dr. Pierson said, we need to move away from the “extractive financing model’’ of American health care, in which much of the savings from improving a community’s health care leaves the community, making it unavailable for reinvestment. And he touted the idea of setting targets for spending on health within a whole community, citing the success of Jonkoping, Sweden, which set a target of 8.3 percent of the local economy for health care and has had very good outcomes.

He said that his experience in the mid-'80’s as an ER doctor trying to pull together in an ad hoc fashion a variety of specialists to treat a young man badly injured in a motorcycle accident helped get Dr. Pierson thinking about systems and coordination.

This line of focused community building would ultimately lead to his campaign for integrated, community-wide care.  Along the way, he made it a point “not to ask anyone to do anything that was against their economic self-interest.’’ And he sought out the “most respected players’’ in the Whatcom health-care community to help him carry out this vision for the county. A very practical and behind-the-scenes reformer.

Given the widening income gap in the U.S., we wondered about whether only the rich would have the finest sort of individualized “concierge care’’. Somewhat to our surprise, Dr. Pierson was optimistic that the use of genomic information, personal medical devices and other advances would make “concierge care’’ available to everyone in the fullness of time, aided by the doctors, nurses, social workers and other health-care ‘’navigators’’ who will increasingly see a major part of their jobs as helping to  guide patients to the information they need as well as through the system.

It’s all part of his vision to have all of us see “medicine as a part of health and well-being.’’ The whole community, he says, owns its health and well-being and we must design our futures in that context.

Relatively springlike

 

"Everything Is Relative,'' by MIMO GORDON RILEY, in her current show at the Providence Art Club.

For growers of flowers and vegetables this is a edgy time of year. On the one hand, you want to get the tomatoes, etc., in the ground, on the other, your fear a late frost. Even the more tropical parts of  southern New England are vulnerable well into May. This gives a great excuse to put  off the work and sleep late on weekends. Growing things is very satisfying  but also very tiring, especially when the weeds get going and you can't afford yard crews of undocumented aliens.

By August, a lot of us are longing for the first frost, though that feeling doesn't last long.

You think of summer as a relaxing time but if you're growing things, there's always that pressure to get back to work, albeit outside and not in front of a computer screen. And it's politically correct to grow vegetables because that is seen as harkening back to principles of self-sufficiency, however  basically bogus your ambitions in this mission may be since it's much more efficient and usually much cheaper just to buy the products of agribusiness at the supermarket. You can even  get "organic'' produce there, if you believe that  it actually is. (How can you really find out?)

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Gulf Stream feeling

 

"Storm Lifting'' (oil on panel), by MARTHA STONE, in her show "Atmospheric Landscapes,'' at Galatea Fine Art, Boston, May 1-29.

April 29, 2o14

This morning had that pleasant wet feel that comes before a southeast rainstorm -- almost a breath of the tropics that reminds us of how close the Gulf Stream is.

A very agreeable effect until I realized that the basement might  flood  in the next couple of days.

And the wind  and the rain might soon strip off the blossoms from the flowering trees,  whose show is so brief.

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Architectural ruminations

"Atlas View'' (mixed media on wood). by MAGGIE CARBERRY in  her show "Urban Escape,'' May 1-29 at Galatea Fine Art, Boston.

She says that that images in her show ''represent a portion of my 'Daydream Dwellings project,' in which she is working to "re-imagine urban landscapes, one architectural detail at a time.''

Yankee magazine: More than B&B ads

  The current issue of Yankee magazine is pretty damn good. particularly "The Throwbacks,'' about James and Sara Ackermann, a young couple working (about 18 hours a day) a Vermont dairy and maple-syrup farm. Yankee still manages in most issues to combine touristy, ad--revenue-gathering stuff  and how-to material with rigorous reportage and very thoughtful ruminations about the region.

The article  about the Ackermanns is about  an old-fashioned work ethic  (involving mind and body) squared, in a beautiful if demanding countryside.

The issue also has a silly but entertaining quote from the writer  John Cheever, who grew up on the South Shore of Boston but spent most of his life in the New York City area:

"All literary men are Red Sox fans -- to be a Yankee fan in a literate society is to endanger your life.''

'I'd like to introduce her co-host'

 

"Co-Host'' (ceramic, metal, plastic and paper clay), by LINDA LESLIE BROWN, in her show at the Kingston Gallery, Boston.