'Familiar as an old mistake'

The Worship of Mammon, by Evelyn De Morgan.

Time was when his half million drew

The breath of six per cent;

But soon the worm of what-was-not

Fed hard on his content;

And something crumbled in his brain

When his half million went.

Time passed, and filled along with his

The place of many more;

Time came, and hardly one of us

Had credence to restore,

From what appeared one day, the man

Whom we had known before.

The broken voice, the withered neck,

The coat worn out with care,

The cleanliness of indigence,

The brilliance of despair,

The fond imponderable dreams

Of affluence,—all were there.

Poor Finzer, with his dreams and schemes,

Fares hard now in the race,

With heart and eye that have a task

When he looks in the face

Of one who might so easily

Have been in Finzer's place.

He comes unfailing for the loan

We give and then forget;

He comes, and probably for years

Will he be coming yet,—

Familiar as an old mistake,

And futile as regret.

— “Bewick Finzer,’’ by Edward Arlington Robinson (1869-1935), a native of the Maine Coast

Relationship studies

“Small Blue Thing’’ (oil on canvas), by Christopher Sullivan, in his show “Between the Lines,’’ at the Bromfield Gallery, Boston, Jan.2-27. He paints to probe relationships.

Another New England college going under

Newbury College’s motto, translated from Latin, is, ironically, “Let It Flourish’’.

From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

‘So another in the surplus of small private New England colleges will die. Newbury College, in Brookline, will shut down at the end of the spring semester because it can’t rope in enough tuition money to keep going. There will be more. I wonder how many of these usually attractive, bucolic campuses can be reused as corporate campuses, retirement communities, affordable housing or even outpatient health centers.

Chris Powell: Connecticut should put casino rights out to bid

The Mohegan Sun casino, in Uncasville, Conn.

No government pursuing the public interest sells something without first putting it to bid. But for almost three decades Connecticut has given casino exclusivity to a couple of reconstituted Indian tribes out in the woods in the eastern part of the state and has never ascertained what anyone else might pay to operate a casino here.

The tribal casinos have been paying state government for this exclusivity -- a quarter of their slot-machine revenue, which over the years has amounted to hundreds of millions of dollars. But these royalties have been declining steadily as casinos open in neighboring states.

Meanwhile MGM, having recently opened one of those casinos just over the Massachusetts line, in Springfield, is arguing that Connecticut might do better by authorizing it to open a casino in Bridgeport. This would draw gamblers from heavily populated New York and Fairfield County, many of whom now journey to the tribal casinos two hours deeper into the countryside. These gamblers might be glad to lose their money closer to home.

Under federal law the two tribes have the right to run casinos on their reservations, and Connecticut can't change that. But the tribes do not have the right to exclusivity in the casino business in the state. Nor is the 25-percent tribute from their slot-machine revenue fixed permanently; it could be renegotiated. So now that state government is permanently broke and unable to economize, it should ask whether the tribes might be induced to pay more for their casino exclusivity or whether a different entity operating another casino or two might pay more tribute than the tribes pay.

It's telling that the supporters of the tribal casinos don't want to find out. Their argument for preserving the exclusivity of the tribes is only that the tribes have been "good partners" for state government and employ thousands of people in eastern Connecticut. But another casino operator might be just as good a partner, employ just as many people, if elsewhere in the state, and might pay more tribute.

As industrial-strength gambling, casinos are a nasty business. They pander to the worst instincts, exploit the worst weaknesses, and create terrible social problems as the price of the tribute they pay state government. They redistribute wealth from the many to the few and shift commerce from small businesses to big business. They create nothing of value. They are profitable to state government only insofar as they draw gamblers from other states, and as casinos proliferate, states increasingly will prey on their own people.

But Connecticut already has made its big policy decision by opting for casinos. This is bad enough and it should not be allowed to cancel ordinary good practice, competitive bidding for government-issued privilege.

The tribal casinos are warning state government against pursuing competition but the slot-machine tribute they pay actually gives them little leverage. For state government could cut off their traffic any time by surrounding them with casinos in, say, Bridgeport, Hartford, Torrington, Putnam and New London. A casino in Bridgeport alone might devastate them. Faced with that prospect, the tribal casinos might be willing to pay a lot more for their exclusivity, just as the state might profit more by ending their exclusivity. It's time to find out.

Chris Powell is a columnist for the Journal Inquirer, in Manchester, Conn.

'Among those dark trees'

The Robert Frost Farm in Derry, N.H., where he wrote many of his poems, including "Tree at My Window" and "Mending Wall."

“Once, walking in Vermont, In the snow,

I followed a set of footprints

That aimed for the woods. At the verge

I could make out, ‘far in the pillared dark,’

An old creature in a huge clumsy overcoat,

Lifting his great boots through the drifts,

Going as if to die among ‘those dark trees’

Of his own country….’’

-- From “For Robert Frost,’’ by Galway Kinnell

Holiday traditions around the world

Uri Shulevitz, “Lights..., ‘‘ 2013, illustration for Dusk by Uri Shulevitz, (Margaret Ferguson Books, Farrar Straus Giroux 2013], ink and watercolor on paper, ©2013 by Uri Shulevitz. All rights reserved. ) This is in the show “Cultural Traditions: A Holiday Celebration,’’ at the Norman Rockwell Museum, Stockbridge, Mass., through Feb. 10

The museum says:

“This exhibition uses the art and stories in children's picture books to explore the similarities and differences of holiday traditions throughout the world. Cultural Traditions features over 40 original illustration works of art by six award-winning children's book illustrators. The colorful images brilliantly show the customs and traditions celebrated during Hanukkah, Christmas, Kwanzaa and the Chinese New Year.’’

Llewellyn King: The 4IR and glittery Davos

Davos conference logo.

On Jan. 22-25, 2019 in Davos-Klosters, a Swiss resort, the World Economic Forum meets. It is the glitteriest of conferences. The great and the good, the rich industrialists and the glamorous public intellectuals get together to sort out where humanity is headed.

Just to be invited is a kind of credential, a sort of honorary degree, a statement that you are world-class important.

There are politicians, CEOs, so-called thought leaders and the top non-governmental organizations, environmentalists and academics.

The world’s most important international conference it is, but does it work? At some level, yes. At others, no.

It stimulates thinking, but does it change anything? Reading the news coverage year after year you are inclined to think that a lot of the participants come to rehash things they have said before or ideas that have been with them for a long time. Others are stuck in ideological dogma and try to bend the facts to fit the dogma. Think socialist; think Republican.

Yet it has no competition. It is the place to float an idea. Probably no one floats more ideas than the man who founded the forum in 1971 and serves as its executive chairman, Klaus Schwab. He is a visionary German, who holds doctorates in economics and engineering from universities in Germany and Switzerland and a Master of Public Administration from the John F. Kennedy School of Government at Harvard.

It was Schwab who, in 2016, launched the idea of the Fourth Industrial Revolution (4IR) by making it the subject of the forum that year and writing a book on it.

The 4IR is the concept that all of science and technology -- from biology to nanotechnology, from quantum computing to artificial intelligence -- are coming together with stunning and, at times, frightening visions of the future. A 3D printer may be making a body part while a robot is helping treat Ebola in Africa. New metals are being formulated for specific needs without human input and farms are operating with few farmers.

In that way, with all science melding and communicating, 4IR may have consequences far beyond the previous three: first, mechanical power from water and steam; then electrical power for manufacturing; and followed by computing power and communications. Now, in the age of the Internet of Things, unity of things from artificial intelligence (AI) to advanced medicine.

Enter governments. Schwab sounds a note of warning: Will they grasp and facilitate, or will they frustrate what is happening? Will they regulate when regulation is needed? In short, will the global political class comprehend that it is in the throes of something big -- bigger than it can imagine? Will it allow it to flourish while checking its Frankenstein tendencies (as with the social media companies), or will it try and subdue it or let it run to excess?

If the Davos forum has a structural weakness, it seems to me, it is that executives who are mostly middle-aged and older are dealing with ideas that have been generated by young scientists, researchers and thinkers. The average age of the people in the control room for the first manned moon launch, Apollo 11, was 28. By the time NASA had become more grown-up, the average age of the control-room operators for the first space shuttle launch was 47.

Call it the sclerosis problem. I have often wondered, as civilian, large airframe design is dominated by two companies, Boeing and Airbus, whether a young engineer with a better idea would get a hearing.

It takes new companies to pursue new ideas. Those that do not grasp the speed of change fall by the way, or are just reduced in size. Half the companies of the Dow in 2000 are not there now.

The 4IR is underway here and now -- it is not something in the out-years. A microcosm of 4IR is in the emergence of smart cities where telephones, computers, electricity and social welfare are fusing.

All of this raises the two great questions of our time: What is the future of work and can we save the environment in time? You will hear on these from Davos, no doubt.

A contradicting footnote to the idea that the young are the only big idea merchants: Klaus Schwab is 8o.

Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com.

At The Breakers, more revenue, no more porta potties

The Great Hall of The Breakers.

Adapted from Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

The Preservation Society of Newport County has told me that for the six months July to December (month-to-date) this year the new Welcome Center at The Breakers mansion has brought the society $350,000 more than it got in the year-earlier period at The Breakers. Back then, the center hadn’t yet opened and only memberships and tickets were for sale. The Welcome Center sells beverages and light meals. The society said that was a 10 percent increase in revenue for the society at The Breakers.

Of course, the Welcome Center aroused much neighborhood opposition, which delayed it for years. Foes were divided between those who didn’t want the new facility at all and those who wanted it, if it had to be built, across the street from The Breakers, the most famous Newport mansion.

In any case, good riddance to the port-a-potties that had served as the rest rooms for the public at The Breakers!

Refund for Vt. woman shows how 'really arbitrary' medical insurance is

From Kaiser Health News

Sarah Witter had to pay for a second surgery to repair her broken leg after a metal plate installed during the first surgery broke. On Friday, she got a more welcome break — a $6,358.26 refund from the hospital and her insurer.

Witter’s experience was the subject of December’s KHN-NPR “Bill of the Month” feature. She and her insurer, Aetna, had racked up $99,159 in bills from a Rutland, Vt., hospital and various medical providers after she fractured her leg in a skiing accident last February.

A surgeon at Rutland Regional Medical Center implanted two metal plates, attached to her leg bones to help them heal. Less than four months later, one of these plates broke, requiring her to have a second surgery to replace the plate. Witter, who is 63, ended up paying $18,442, mostly to the hospital, for her portion of the total cost for all her care from the hospital, doctors, emergency services and physical therapists.

After KHN contacted Aetna about these costs, the insurer noticed that Rutland Regional had billed Witter for the difference between what it charged for its services and what Aetna considered an appropriate price for the first surgery. Those additional charges are known as “balance bills” and occur when a medical provider is not in the insurer’s network and has no contract with the insurer. Rutland Regional is not in Aetna’s network. In our original story, KHN had calculated $7,410 in balance bills.

Aetna said it contacted the hospital and negotiated a compromise in which the insurer paid the hospital nearly $3,800 and the hospital waived the remainder of the charges to Witter that Aetna considered unreasonably high.

“As part of her benefits plan, Sarah’s claims in question went through a patient advocacy process that allows us to negotiate with the provider on the member’s behalf to resolve any balance billing issues,” a spokesman wrote.

Aetna said it will negotiate disputed bills for any of its customers who request assistance, and also help schedule appointments, get services authorized and deal with other non-medical complications. However, an Aetna spokesman wrote, “we weren’t fully aware of all of the bills that Sarah had received before we received them from you/her.”

Last week, Rutland Regional again declined to discuss Witter’s account. Witter said she learned of the refund during a meeting, at Rutland Regional’s invitation, with a hospital financial administrator.

“They went through all the costs and I guess treated it [the first surgery] more like it was a hospital service that was within my contract,” she said. The administrator told her they had “reprocessed” the charges from her second surgery, but that her portion of the bill did not change, she said.

“It’s good news — who doesn’t like getting money back? But I don’t quite understand,” she said. “If it’s that easy for them to reprocess this billing to get me this, then it’s obvious that everything is really arbitrary.”

One difference between the two surgeries was the first one was conducted during a crisis after Witter was admitted to the hospital through the emergency room. Balance bills in those circumstances are the most difficult to justify because patients with injuries that require immediate care, such as a heart attack or car accident, are usually taken to the closest medical facility. Patients are not in a position to figure out where the closest in-network alternative is.

Neither Witter’s hospital nor her insurer budged on her underlying complaint: that she shouldn’t have had to pay for second surgery, which cost $43,208, because one of the plates — known as a bone fixation device and manufactured by Johnson & Johnson’s DePuy Synthes — broke.

Device manufacturers generally do not offer warranties for hardware devices once they have been implanted, saying that device failure can be due to a variety of factors beyond the company’s control. Those include poor implantation by the surgeon; bones that fail to heal and subject the device to unremitting strain, causing metal fatigue; or patients who apply too much weight or movement on the bone despite instructions not to.

DePuy, which declined to comment for this story, earlier said that device failures occur in “rare circumstances.” In its instructions for surgeons, DePuy noted: “It is important to note that these implants may break at any time if they are subjected to sufficient stresses.”

Witter said her surgeon was present at her meeting at Rutland Regional and told her that “the fact the bone hadn’t completely healed yet was part of the problem.” She said she has not been able to find a contact for the device manufacturer so she can complain about it breaking.

Even after she receives her refund, Witter still will have paid $12,084 for her broken limb. Asked her advice for other patients dealing with bills they consider excessive, she said: “Don’t break your leg!’’

Chris Powell: Malloy leaves feeling the ingratitude of the great unwashed

Gov. Dannel Malloy in 2016,

From the many valedictory interviews he gave to journalists last week, Connecticut Gov. Dannel Malloy seems to be departing as bitter as Connecticut is about his eight years in office.

Malloy says he meant all along to be unpopular by always doing the right thing, apparently presuming that the public always perceives the right thing as the wrong thing. While civic engagement and literacy indeed have continued their collapse during Malloy's administration, people remain entitled to their opinion, and the governor isn't leaving them persuaded. But even as he retires as Connecticut's most disliked governor in modern times, he should be enjoying the last laugh, since he did persuade enough people when it counted, twice getting the most votes for governor.

Malloy can't acknowledge it, but there are reasons for being unhappy with him quite apart from his supposedly always doing the right thing for the ungrateful great unwashed.

During his re-election campaign he said he wouldn't raise taxes, but, returned to office, he raised them hugely. (Was lying doing the right thing?) While portraying himself as a hands-on administrator, he was brazenly indifferent to misconduct and incompetence in state government and sometimes sought to conceal it. He pandered to political correctness and proclaimed it as sound policy. A Democrat, he candidly told the government employee unions, his party's base, "I am your servant," and in this he kept his word, making his highest priority the preservation of government employee compensation.

In one interview last week the governor even attributed the defeat of some Republican state senators to their supposed bigotry against homosexuals. The senators, Malloy charged again, had voted against his nominee for chief justice of the state Supreme Court because he is gay, not for his having been part of the court's majority that presumed to erase capital punishment from the state constitution. Yet the nomination was hardly mentioned in the recent state legislative campaigns. Mostly the Democrats hung President Trump around the Republicans' necks. Malloy's charge is still hard to believe, but thank God if something in the election had nothing to do with Trump.

As with any administration, Malloy's did some good things, and his office last week issued a lovely report enumerating what he thinks they are. For example, he hastened Connecticut's move away from drug criminalization; increased medical insurance for the poor and resisted the Trump administration's malicious sabotaging of universal coverage; nearly eliminated homelessness among military veterans, and improved Bradley International Airport.

But state government remains grossly insolvent and overextended and all that good stuff was peanuts against the failures Malloy never confronted: the failure of social promotion to educate, the failure of unconditional welfare to lift people to self-sufficiency, the failure of the contentment of the government class to trickle down to taxpayers, and the failure of ever-increasing taxes and regulation to grow the private sector, which finances everything.

The better high school graduation rate Malloy often touted is deceitful when most graduates learn little and need remediation. No matter how much is spent in their name, Connecticut's cities grow poorer and more demoralized and depraved. And, perhaps the key measures, under Malloy the state's population declined relative to the rest of the country and its economy shrank.

Malloy was left a disgraceful mess and is bequeathing one to his successor. But then of course everything always could be worse.

Chris Powell is a columnist for the Journal Inquirer, in Manchester, Conn.

Study says oyster aquaculture is good for wild oysters too

From ecoRI News (ecori.org)

KINGSTON, R.I.

A fisheries researcher at the University of Rhode Island has found that oyster aquaculture operations can limit the spread of disease among wild populations. The findings are contrary to long-held beliefs that diseases are often spread from farmed populations to wild populations.

“The very act of aquaculture has positive effects on wild populations of oysters,” said Tal Ben-Horin, a postdoctoral fellow at the URI Department of Fisheries, Animal and Veterinary Sciences. “The established way of thinking is that disease spreads from aquaculture, but in fact aquaculture may limit disease in nearby wild populations.”

Working with colleagues at the University of Maryland Baltimore County, Rutgers University, the U.S. Department of Agriculture, and the Virginia Institute of Marine Science, Ben-Horin integrated data from previous studies into mathematical models to examine the interactions between farmed oysters, wild oysters, and the common oyster disease Dermo.

Their research, part of a synthesis project at the National Center for Ecological Analysis and Synthesis, was recently published in the journal Aquaculture Environment Interactions.

According to Ben-Horin, diseases are among the primary limiting factors in wild oyster populations. There are few wild populations of oysters in New England because of Dermo and other diseases, and in the Chesapeake Bay and Delaware Bay, wild oysters are managed with the understanding that most will die from disease.

Dermo is caused by a single-celled parasite that occurs naturally in the environment and proliferates in the tissue of host oysters, which spread the parasite to other oysters when they die and their parasite-infected tissues decay in the water column. But it takes two to three years for the parasite to kill the oysters. As long as the oysters are held on farms long enough to filter disease-causing parasites from the water, but not so long that parasites develop and proliferate and spread to wild oysters nearby, aquaculture operations can reduce disease in wild populations.

The disease doesn’t cause illness in humans.

“As long as aquaculture farmers harvest their product before the disease peaks, then they have a positive effect on wild populations,” Ben-Horin said. “But if they’re left in the water too long, the positive effect turns negative.”

He said that several factors can confound the positive effect of oyster aquaculture. Oyster farms that grow their product on the bottom instead of in raised cages or bags, for instance, are unlikely to recover all of their oysters, resulting in some oysters remaining on the bottom longer. This would increase rather than reduce the spread of the disease.

“But when it’s done right, aquaculture can be a good thing for wild oyster populations,” Ben-Horin said. “Intensive oyster aquaculture, where oysters are grown in cages and growers can account for their product and remove it on schedule, is not a bad thing for wild populations.”

The study’s findings have several implications for the management of wild and farmed oysters. Ben-Horin recommends establishing best management practices for the amount of time oysters remain on farms before harvest. He also suggests that aquaculture managers consider the type of gear — whether farmers hold oysters in cages and bags or directly on the seabed — when siting new oyster aquaculture operations near wild oyster populations.

The next step in Ben-Horin’s research is to gain a better understanding of how far the Dermo parasite can spread by linking disease models with ocean circulation models.

“Everything that happens in the water is connected,” he said. “There’s a close relationship between the wild and farmed oyster populations and their shared parasites. Sometimes ecosystem level effects are overlooked, but in this case they’re front and center.”

Study co-author Ryan Carnegie, of the Virginia Institute of Marine Science, said this research is an important contribution to the dialogue about the interactions between shellfish aquaculture and the environment.

“It’s critical that we fully appreciate how aquaculture fits in the ecology of marine systems, and this study provides new perspective on this,” he said. “It highlights an important ecological benefit that intensive shellfish aquaculture may provide. This should help bolster the well-justified public perception of shellfish aquaculture as a green industry worthy of their support, which this industry must have if it is to grow.”

On 'False Flags' in Stamford

Still from Theodore Darst’s “This Machine Makes Fascists,’’ in the show “False Flag: The Space Between Paranoia and Reason,’’ at Franklin Street Works, Stamford, Conn., through Jan. 6.

 
The gallery explains:

“‘False Flag: The Space Between Paranoia and Reason,’ refers to false flags,’ or situations where a segment of the population accuses the government of staging a traumatic event in order to push an agenda. With videos, sculptures, paintings and photographs the exhibiting artists allow the viewer to formulate their own view of the contemporary and vast subject matter of paranoia, philosophical position and psychological state.’’

Northeast fights air pollution regionally

From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com

Louis Brandeis, the late Supreme Court justice, famously called states "laboratories of democracy," describing how a "state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country."

We now have a new and happy example of this in an agreement by Massachusetts, Rhode Island, Connecticut, Vermont, Delaware, Maryland, Pennsylvania, New Jersey, Virginia and the District of Columbia to impose regionwide limits on transportation emissions, which are America’s largest source of carbon pollution. New York and Maine are expected to soon join the compact. It’s unclear if New Hampshire will.

Under the plan, the states would have a year in which to create a system to cap total emissions, a system that would include requiring gasoline and diesel distributors to buy pollution permits for some of the carbon they’re partly responsible for putting into the air. The money would be used for such “greener’’ transportation projects as public transit, subsidies to speed the use of electric vehicles, carpooling and new bike lanes. Besides the environmental elements, the program would make the participating states more economically competitive over the long run: Rapidly growing tech companies and their employees want nearby public transit and other ways of avoiding dependence on cars. That’s one reason that Amazon and Google are expanding so much in very expensive and crowded New York City.

That much of the region to be covered by the pact is heavily urbanized makes such projects seem particularly apt. Also, New England would probably benefit the most environmentally from this plan since the prevailing wind is southwest

xxx

With the Trump regime, dominated by such fossil-fuel interests as the Koch Brothers, the states have to step in to address pollution and global warming, as California, under outgoing Gov. Jerry Brown, has been doing for some years. Given the Golden State’s size and economic clout, this tends to force the rest of America to eventually take similar actions

xxx

Watch for collapsing ice sheets

For all the turmoil in Washington, the single most interesting recent item I read was a News and Comment story in Science about something that happened 125,000 years ago. During a 13,000-year interlude of warming between two ice ages, temperatures were only slightly higher than they are today. Nevertheless an Antarctic ice shelf fell into the sea.

By the end of the period, sea levels around the world were 6 to 9 meters higher than today. Why? According to new evidence reported last week at the American Geophysical Union, in Washington, D.C., the West Antarctic Ice Sheet collapsed. Something of the sort is feared possible today.

If you believe the science (and I certainly do), then further evidence of the peril posed by carbon pollution will be forthcoming. A welter of expert testimony and a few hot summers haven’t been enough. A cataclysmic event may be required to galvanize nations, the U.S. in particular, to action. Yes, important discoveries will be made in the decades ahead. But if we don’t act on what we already know, a world of trouble lies ahead.

David Warsh is proprietor of economicprincipals.com, based in Somerville, Mass.

No wonder he grins

How doth Professor Superstar
Pursue his shining quest.
His glory awes us from afar.
He dwells atop the crest.

How cheerfully he seems to grin,
How neatly wields his clout,
To welcome all his cronies in
And keep outsiders out.

— Felicia Nimue Ackerman

Charles Pinning: An exciting Christmas miracle.

It was rock-splitting cold. For two weeks, the furnace ran continuously and cars groaned and didn’t want to start. The bottoms of your sneakers got hard as soon as you stepped out the door and all the ponds were frozen two feet thick.

We were members of the Sachuest Skating Club, which used the outdoor rink on the hilltop at St. George’s School, in Middletown, R.I., and as we got off the ice we rushed into the “hot house” to take off our skates and snuggle into our shoes. Pulling out of the dirt parking lot, my mother said, “Do you want to go look at Christmas lights?”

Of course I did. Back at home there wouldn’t be much to do. TVs only got three channels back then, plus we could cruise around in our new Pontiac station wagon. Well, not completely new, but new to us. It had originally been custom-made for Count Reventlow, who lived on the Ocean Drive, in Newport, and when it appeared on the used-car lot at Bove Chevrolet, my father, a car aficionado, snapped it up immediately.

It was a gorgeous two-tone navy blue and cream, the roof and hood and lower half of the sides cream, the upper half of the doors and the full tailgate, navy. It had whitewall tires and an impressive amount of chrome. The inside upholstery was also cream and blue and the radio was tops.

We took the usual route around Washington Square Park, in downtown Newport, then we rumbled down the cobblestones of Thames Street, magical beneath swags of colored lights and displays in the store windows. We turned up Mill Street and climbed the hill to the stately houses around Touro Park, where the Old Stone Mill sat in the center.

From there it was down Bellevue Avenue past the Art Association, The Redwood Library, The bright white Muenchinger-King Hotel and the big brick Hotel Viking, then a right down Kay Street.

We were having fun. The heater was blasting and WBRU out of Brown University in Providence was playing the Beatles. Instead of turning onto our street, we continued along to Kay Boulevard and up the hill to Bliss Mine Road.

“Drive My Car,” came on and my mother said, “That’s appropriate,” and I took that as a sign I could crank up the volume.

Bouncing up and down on the sumptuous bench seat, unfettered by seatbelts which had yet to become standard equipment, we turned on Green End Avenue and barreled down the hill singing “Baby you can drive my car….”

“But whose car is it? His or hers?” asked my mother in a raised voice.

“What do you mean?” I’d never thought of that before.

“It’s not clear whose car it is,” she said.

And it was just at that moment taking a curve that we fishtailed and flew right into the driveway of my mother’s former piano teacher, Pearl Stevens, who had to be at least 90, who was reading in front of her Christmas tree, oblivious as we spun by the side of her house missing it by inches. My mother cut the wheels and hit the brakes which only increased our speed and we propellered down Pearl Stevens’s sloping backyard toward Green End Pond.

“Whoooaaa….” cried out my mother, sounding like a teenager. I held my breath as we slid over the embankment onto the pond, whizzing across it like a hockey puck, finally coming to rest in the middle.

My mother lowered the radio and looked at me. The moon glistened off the ice. It was so pretty.

“Are you OK?” she gasped.

“Yeah,” I said. “That was cool!”

Slowly she drove across the pond to the low embankment just below my grandparents’ lane, then gunned it to make the grade and the tires caught some of the rocks and we were up.

“Wait’ll Dad hears about this!”

“No, sweetheart. Dad doesn’t need to hear about it. He might think I hurt the car. Do you think I hurt the car?”

“Nah. It’s fine. Where to now?”

“Straight home, sweetie. We’ve had our Christmas miracle.”

Charles Pinning is a Providence-based writer.

Kentridge at Exeter

From the show “William Kentridge: Universal Archive,’’ at the Lamont Gallery, at Phillips Exeter Academy, Exeter, N.H., Jan. 11-March 9. The gallery says:

Renowned South African artist William Kentridge shares new work inspired during the writing of his Norton Lectures at Harvard in 2012. In this expanding series, a familiar personal iconography is revisited - coffee pots, typewriters, cats, trees, nudes and other imagery; an intimate thematic repertoire appearing in art and stage productions throughout the artist’s career. Meticulously based on ink sketches, over 75 linocut prints shift from identifiable subject matter to deconstructed images of abstract marks.’’

Phillips Exeter is one of the two most famous American prep schools, the other being its great rival, Phillips Academy, in Andover, Mass. The first is usually just called “Exeter,’’ the second “Andover’’.

The two schools were founded by the Phillips family, Andover by Samuel Phillips, Jr., in 1778, and Exeter by his uncle John Phillips, in 1781. The two schools are 37 miles apart and share similar seals and mottoes as well. The novel A Separate Peace was inspired by writer John Knowles’s days as a student at Exeter in the 1940s.

‘A chant sublime’

“I heard the bells on Christmas Day
Their old, familiar carols play,
    And wild and sweet
    The words repeat
Of peace on earth, good-will to men!

And thought how, as the day had come,
The belfries of all Christendom
    Had rolled along
    The unbroken song
Of peace on earth, good-will to men!

Till, ringing, singing on its way,
The world revolved from night to day
    A voice, a chime,
    A chant sublime
Of peace on earth, good-will to men!

Then from each black, accursed mouth,
The cannon thundered in the South,
    And with the sound
    The carols drowned
Of peace on earth, good-will to men!

It was as if an earthquake rent
The hearth-stones of a continent,
    And made forlorn
    The households born
Of peace on earth, good-will to men!

And in despair I bowed my head; 
'There is no peace on earth,’ I said ; 
    ‘For hate is strong
    And mocks the song
Of peace on earth, good-will to men!’

Then pealed the bells more loud and deep: 
’God is not dead; nor doth he sleep!
    The Wrong shall fail,
    The Right prevail,
With peace on earth, good-will to men!"‘

— “Christmas Bells,’’ by the New England poet Henry Wadsworth Longfellow. It was written in 1863, during the Civil War, and first published in 1865.

Martha Bebinger: An outrageous air ambulance bill for a Mass. patient

Via Kaiser Health News

BOSTON

Kristina Cunningham was in stable condition on an evening in June, when EMTs lifted her gurney into a medical flight, bound for Boston.

The 34-year-old couldn’t use her right arm or speak clearly after a stroke six days earlier, and still had two blood clots at the base of her brain. Cunningham’s dad, Jim Royer, remembers doctors at the small hospital in Wichita, Kan., where Cunningham had attended a family wedding, saying she needed to see a neurosurgeon.

“There was discussion of flying her to St. Louis, there was discussion of flying her to Chicago, there was discussion of flying her to Dallas,” Royer recalled, but “we don’t have family in any of those locations.”

So the doctors arranged to transfer Cunningham, via an Angel MedFlight Learjet, to Massachusetts General Hospital, where she would be diagnosed with a rare blood vessel disease of the brain. MGH is about an hour from Cunningham’s home in Berlin, Mass. — and her 7-year-old son. Cunningham’s doctors and her insurer, CareFirst BlueCross BlueShield, based in Maryland, agreed the transfer was medically necessary.

“We assumed it would be [covered],” Royer said, “because it was supposedly pre-approved by the insurer before any flight took place.”

Royer said he and Cunningham didn’t think about the Angel MedFlight piece of her health scare again until a letter arrived in August. It was a one-page “explanation of benefits” with a jaw-dropping total in a column labeled “other amounts not covered.”

“When I got the bill for $474,725, I’m thinking six or seven flights, and you can buy a whole new jet,” Royer said with a wry laugh.

That nearly half-million dollars is the total of four items, the largest of which is a per-mile charge. That figure, $389,125, breaks down to $275 a mile.

“It’s larger than any surprise medical bill I’ve personally seen,” said Chuck Bell, program director for the advocacy division at Consumer Reports. “It’s really outrageous.”

In a study last year, Consumer Reports detailed some of the reasons excessively high air ambulance bills have become more common. Use of air ambulances is rising as more rural hospitals close, Baby Boomers age and the use of telemedicine increases.

“The industry has really grown by leaps and bounds over the last 15 years and prices have doubled or tripled,” Bell said. “Most of the operators of air ambulances now are for-profit, Wall Street-type corporations reporting very large profits to investors.”

The Association of Air Medical Services (AAMS), a trade group, counters that it is not unique, that many hospitals and health insurers across the country are also for-profit and that some are owned by private equity firms.

AAMS said a key reason bills for patients with private insurance plans are often high is this: Companies have to make up for the money they lose transporting other patients.

“Medicare pays about 60 percent of the cost of the flight. Medicaid pays 35 percent or less. Self-paid patients pay a few cents on the dollar. And that has led to a crisis of being able to sustain the service,” Christopher Eastlee, AAMS vice president for government relations, said in a statement, stressing that he has cost data only for emergency helicopter transports, not jets like the one in which Cunningham traveled.

In 2018, Medicare paid $8.65 per mile for a fixed-wing aircraft like the Learjet that transported Cunningham. That’s a stark contrast to Angel MedFlight’s $275 charge per mile. There are no guidelines for determining reasonable charges in this case.

Cunningham’s insurer, CareFirst, initially paid $14,304.55, leaving about $460,420 unpaid. In Massachusetts, a ground-based ambulance could not demand that Cunningham pay the balance, as state law doesn’t allow so-called balance billing. But air ambulances are governed by federal aviation laws. There are numerous cases of companies demanding payments from patients. A few states have tried to intervene but been unsuccessful, with courts saying that federal law prevails.

Cunningham has been focused on recovering her speech and preparing for surgery. In January, she will meet with her doctors to decide which type of surgery they recommend for removing or bypassing the blood clots at the base of her brain.

But Cunningham and her father have another worry: what the mail may bring.
“I don’t know, we’ll see,” Cunningham said, with a shrug.

“It’s a big bill to be sitting out there wondering what’s going on,” said Royer, who contacted KHN-NPR’s Bill of the Month on his daughter’s behalf. “It would force her into bankruptcy.”

Angel MedFlight COO Andrew Bess told WBUR the company is negotiating with CareFirst and will not demand payment from Cunningham.

“We’re quite confident we’ll come to a clear resolution despite the insurer placing the patient in the middle of the dispute,” said Bess.

Royer said it was a letter from Angel MedFlight that sounded threatening. As he read it, the company told Cunningham she must sign over the rights for Angel MedFlight to negotiate with CareFirst or risk being held liable if the insurer did not pay. Cunningham signed the request.

Bell, with Consumer Reports, said agreeing to such terms can be risky. Some air ambulance companies ask for detailed information about the patient’s personal finances, information they then use to determine how much the patient can pay if the insurance reimbursement is deemed inadequate.

During inquiries for this story, CareFirst told WBUR it would increase the proposed payment to Angel MedFlight. The insurer said it had discovered an error in its initial reimbursement to Angel MedFlight. CareFirst is now proposing to pay $70,864.90, or about one-seventh of the original charge.

“Unfortunately, exorbitant charges like these by air ambulance providers are not uncommon,” said Scott Graham, a spokesman for CareFirst, in an email. “This is an issue because companies like Angel MedFlight typically do not contract with health insurers on negotiated rates.”

WBUR forwarded this update to Bess, who called it a “meaningful offer” in his emailed response.

“We provide a valuable service, and for that providers should be fairly compensated and reimbursed,” Bess said. “We strive to work with our patients and advocate on behalf of them to get coverage rightfully owed to them under their insurance plans.”

Royer, a retired Air Force air traffic control systems manager, knows something about the cost of operating jets. To him, it looks like Angel MedFlight inflated the bill, hoping the insurer would agree to a generous settlement.

“I guess that the way things work nowadays. You ask for the moon and if you only get a large island, that’s what you get,” Royer said.

Bess responded to Royer’s claim in a statement.

“Staffing what is essentially an Intensive Care Unit at 30,000 feet presents unique medical and aviation challenges that may not be apparent to those outside of the medical aviation industry,” Bess wrote. “The amount we receive per flight is a fraction of the billed charge.”

Patients caught up in an air ambulance billing dispute can file a complaint with the U.S. Department of Transportation.

A recent push for stricter federal billing regulations was stripped out of the Federal Aviation Reauthorization Act, passed in October. The legislation did establish a council of industry representatives, including air ambulance providers and insurance company representatives, among others, to write and re-evaluate consumer protections, including balance-billing practices. It did not add a requirement for more price and other data transparency called for in a Government Accountability Office report on the air ambulance industry.

The National Association of Insurance Commissioners says federal legislation is needed so that states can intervene to oppose unreasonable air ambulance charges. Lawmakers from rural states, including Sen. Jon Tester, a Montana Democrat, said they’ll reintroduce such legislation.

The air ambulance trade group says any such change would create “borders in the sky” that would interfere with lifesaving air rescues across state borders.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Martha Bebinger, WBUR: marthab@wbur.org, @mbebinger

'Roused to Christmas mirth'

The Examination and Trial of Father Christmas, (1686), published after Christmas was reinstated as a holy day in England.

’’When gloomy gray Decembers are roused to Christmas mirth,
The dullest life remembers there once was joy on earth,
And draws from youth’s recesses
Some memory it possesses,
And, gazing through the lens of time, exaggerates its worth,
When gloomy gray December is roused to Christmas mirth.’’

—- From “Christmas Fancies,’’ by Ella Wheeler Wilcox (1850-1919), a Connecticut poet.