As reported recently exclusively in NewsLanc, Mayor Rick Gray’s chief of staff, Pat Brogan, outlined the three questions that are driving the City’s consideration of streetcar feasibility:

While fairly comprehensive in assessing the possibility of this proposed system, the City overlooks what should be the most pressing consideration of all:  Will a streetcar system actually contribute to the quality of downtown?

Assume that the state and federal governments provided the city with a blank check to install and subsidize this proposed streetcar loop in Downtown Lancaster.  In such a scenario, according to the City’s current criteria for streetcar feasibility,  it would be a done deal.

However, the streetcars impact on the quality of the lives of city residents would not have been evaluated. After all, a trolley system using the same types of cars was eliminated from city streets over half a century ago, presumably because they were perceived to be more of a burden than a benefit.

Full government funding only tells the City that it “could” install the system—but not that it “should.”

For $150,000, the study ought to address the legitimate sentiment of downtown residents and merchants to trolleys that may well clog the streets, endanger pedestrians, and run virtually empty.

This is a case where it makes sense to look a gift horse in the mouth to make sure that it isn’t a Trojan Horse.

“The Wall Street Journal is reporting that the owner of the Orange County [CA] Register is expected to file for Chapter 11 bankruptcy protection this week.”

WATCHDOG: Given the national drop in advertisement and subscribers and the increased costs of production, another major newspaper falls. We are in the era of transition from print to Internet media, for good or for bad, like it or not.

“Motorcycle rider dies in crash” is a heading.

WATCHDOG: Missing from the article is whether or not the accident victim was wearing a helmet, a matter of both concern to other cyclists and, since this is often the case, a very constructive piece of information.   Even the follow up article on LancasterOnLine.com in the afternoon providing the name of the deceased and describing the accident failed to provide information concerning a helmet.

NewsLanc has subsequently learned from Sgt. Carolyn Gundell, the investigating office,  that the victim was wearing a full helmet with visor, not the small cap helmets that some riders wear.

An article “SDL boosts employees’ salaries” states that administrators average wages will increase will by 2.4% and teachers by 4.1% this year.

WATCHDOG: Without  commenting on the merits, we note that the rate of deflation over the past year has been 2.2% to date, thus bringing the real (as opposed to nominal) increases to 4.4% and 6.1% respectively. Not bad for a year of deep recession.

A local realtor mentioned that the penthouse unit at the proposed condos at Queen and East Chestnut Streets has been sold for a million dollars.

Taiwan born Ang Lee has directed a dozen films since 1992, an eclectic mix of different genres, all graced with the same knowing hand. He works in a classic style, like the great craftsmen of Hollywood’s golden era.  And though I think his best work has been set in Asia, mainly the Hong Kong Trilogy, and “Crouching Tiger, Hidden Dragon” he has made a huge imprint on world cinema with English speaking films like “Brokeback Mountain,” and “Sense and Sensibility.”

His American subject matter has ranged from the civil war, (“Ride with the Devil,”) to suburbia, (“The Ice Storm,”) to comic books, (“The Hulk.”)  In all cases Lee shows directorial authority, but too often, for me anyway, he seems to be illustrating stories instead of reinventing them for the screen.  There’s no arguing the meticulous attention to detail, at least from the standpoint of covering material. But they feel long, not because of their running time, rather a willfully studious pacing.

Not so with his Hong Kong films.  “Pushing Hands,” “The Wedding Banquet,” and “Eat, Drink, Man, Woman, are witty, light and completely absorbing.  With each new film Lee seemed to keep discovering the potential in both character and plot, with very little gimmickry.  He  kept growing, as a writer and director, but that was only part of it. There was an intimate relationship with the material that drove them. And finally, razor sharp focus on the elements that made each story important.

Lee’s American films are very different.  Mostly adaptations of books, they’re respectful of their source material to a fault, but also, and perhaps because of that, a bit torpid. At first you think it’s due to the running time, in most cases over two hours.  But it’s more than that; it’s craft trumping inspiration.

In spite of its supposed daring I found “Brokeback Mountain” long winded and humorless.  “Ice Storm,” a downer about sexual ennui in suburbia is better at illustrating Rick Moody’s book than turning it into drama.  “Ride With the Devil,” an expensive civil war epic, cries out for dramatic focus but delivers very little.  And yet there’s still that undeniable craft, almost painful to dismiss.  We admire these films because in style they recall so much of our filmmaking heritage.   But they lack the daring that would make us surrender to them.

Now Lee and his producing partner, James Schamus, have set their sights on Eliot Tiber’s  remembrance of the famed peace and love music festival in “Taking Woodstock.”  The result is an odd, listless film that never finds the high spirited energy it wants us to believe in.

Tiber’s parents ran a dilapidated motel on the verge of foreclosure when a permit to run a music festival in a nearby town was turned down by the local city council.  Sensing a way out of the town’s financial woes he helped the festivals’ producers rent Yasgurs farm. When a half million long hairs descended on the place his family and a few other land owners cashed in.

For those interested in the bare bones history of the festival the movie will have some appeal.  The production is well staged, with a wealth of amusing details.  A gallery of superior actors have put their all into vivid character parts; Liev Schrieber, Emile Hirsch, Paul Dano, Eugene Levy.  But the parts don’t add up to a satisfying whole.

The film has a bemused attitude toward the hippie culture, and the free love and drugs that horrified a lot of the locals.  There’s a lot of mud, pubic hair, and psychedelia, which now seem quaint.  But there’s no drama to move the project along, no real sweep or energy, because after all, it was a music festival, not a battle. And we know what happened.

There’s an attempt to suggest that for some, the festival was life altering. Our hero, played by the amiable Demetri Martin, with the help of a little acid and a number of eager partners, discovers his homosexuality.  But he didn’t need the several hundred thousand visitors to do that.  Too much time is lavished on his parents, Jewish immigrants, played by Henry Goodman and Imelda Staunton, who take their roles like refugees from the Yiddish theater.  They may represent real people, but as screen characters they’re shrill and grating.   Others wear their hippie credentials like badges, lacking irony or any form of self awareness.  It’s tiring.

“Taking Woodstock” runs less than two hours, but as it ground on I felt it dragging.  I wondered, what did the makers see in the material?  There are no musical performances; the focus is entirely on the festival as an “event.”  Yes it shows the organizers intentions, the local confusion, the logistical nightmare.  But to what end?

If you really want to get a sense of what happened, grab the DVD of Michael Wadleigh’s excellent documentary from 1970, “Woodstock.”  You can get it in the original 184 minute version or the later constructed, “director’s cut,” which runs 228.  Whether you opt for three hours or four, you’ll get a torrent of great performances, a feeling for the energy of the moment, and a grand view of the culture through the eyes of someone who was there. Turn up the volume, grab a mood altering substance of choice, kick back, and contemplate the significance of it all from the vantage point of 40 years on…Without the need for a pup tent or raincoat.

In his column “One for the Books”, Editor Marv Adams explains:

“If the ‘re-runs’ delivered to you on Saturdays, I hope you have already read the Perspective section and noticed the Books pages have moved. Saturday delivery is a choice made by the carriers, often to lighten their Sunday load.”

WATCHDOG: Business Lancaster Newspapers style: Keep the advertisers guessing as to the delivery date and whether ads will be seen with or without the news sections. Keep the readers guessing where to find the Perspective and other sections.

Dr. Thomas J. Gates’s “In my opinion article, the primary care solution” sets forth many ways to improve health care delivery and reduce expenses.  First he points out “With overall costs having doubled in the last 10 years, and projected to double again in the next 10, the current chaos is simply unsustainable.” His main argument is “There is a large body of scientific evidence that has conclusively shown that when it comes to health care, more is not better.  Comparisons between high-cost and low-cost regions within the U. S., or internationally between high- and low-cost countries, show that spending more money not only does not improve outcomes, it actually seems to make them worse.”

He goes on to state “Public option, health care cooperatives, single payer, marketplace competition:  The current contentious debate has narrowed into an argument about insurance.  But what we really need is not health insurance reform, but health care reform.”  He concludes “We can and must have universal coverage and reduced costs. The way to accomplish this is to make a robust primary care system central to health care reform.”

WATCHDOG: The good doctor is excellent in diagnosing the ailment but falls short in prescribing the cure!

Only a single payer system, which in one form or another exists in advanced nations throughout the world, will deliver “universal coverage and reduced costs.”

Failure to learn from other nations is an example of the ruinous conceit of Lancaster exceptionalism and “American exceptionalism”, a carry over from the days of old when we were far wealthier than other nations due to our abundance of natural resources, limitless frontier, and buffering from national defense obligations by distance.

And if we are going to single payer, it should include scholarships for medical education. This will level the playing field, attract a huge number of talented individuals, and justify a system that generously remunerates health care providers, but without burdening them with huge debt and causing maximizing earnings to be a high priority.

David Goldhill’s father, 83 but still working, walked into a non-profit Manhattan hospital with pneumonia. Five weeks later he was dead from hospital-borne infections. Appalled by the negligence and primitive record-keeping of a top-rated hospital, Goldhill spent two years researching the US health system. The September Atlantic features Goldhill’s report on how misdirected incentives seriously distort the system. Goldhill, a business executive, proposes an alternative system to give consumers more choice, and allow competition to improve quality and lower costs. (See http://www.theatlantic.com/doc/200909/health-care.)

Key to Goldhill’s reform is to split health care into two components: he would require us to contribute regularly to a health savings account to cover basic care and to purchase catastrophic insurance—with appropriate subsidies for lower income citizens. (Note that requiring subsidized purchase of health insurance, as Obama also proposes, is a political smokescreen to hide the reality that universal health insurance will reduce benefits and raise costs for those relatively well off Americans who have benefited most from the current system.)

I agree with Goldhill on splitting the system between basic and catastrophic, but I don’t think his health savings account will provide the best incentives. Here’s the problem:

As a society we want all citizens to receive basic health care. That means immunizations, treatment for minor illnesses or injuries, dental care, hearing aids, eyeglasses, pregnancy monitoring, routine counseling for chronic diseases like diabetes, or high blood pressure or heart disease—care that heads off serious conditions and keeps people productive and out of hospitals. Such care should be more than free: it should be accessible to those who can’t afford a taxi or much time off from work. (Great Britain not only provides free health care, but reimburses transportation.)

As a society, we also don’t want over-treatment, let alone the incompetent treatment that killed Goldhill’s father. But as long as doctors are paid by fee-for-service, there will be over-treatment and little incentive to make doctors wash their hands. That’s true whether or not a hospital is non-profit. Moreover, fee-for-service encourages doctors to become specialists, who are better paid, instead of primary care practitioners.

The problem with the health savings account part of Goldhill’s proposal is that it would not only discourage over-treatment but encourage people to skimp on basic health care. Moreover, people would still lack the information to make good healthcare decisions.

How do we promote basic health care while discouraging over-treatment?

Some thirty years ago, we thought HMOs like Kaiser had come up with the solution: capitation, that is, charging a fixed amount per client. Supposedly, the patients who stayed healthy would balance out those who got sick, and the HMOs would profit by cutting waste. It didn’t work that way. HMOs started denying care to sympathetic patients, provoking public outrage. The HMOs backed off–and raised premiums.

What went wrong with capitation? As someone wrote at the time, if you charge a fixed price for a buffet at a cafeteria, watch the quality of the food decline. In other words, capitation gave HMOs an incentive to cut service.

So are we stuck between over-treatment with-fee-for service and under-treatment with capitation? No. In the real world all-you-can-eat buffets thrive without cutting quality–because they face competition. Most HMO patients are there by choice of their employers, not their own. In some states, there is only one HMO. Capitation has failed in HMOs due to lack of competition.

Here’s my alternative to Goldhill’s health savings accounts. Provide every citizen with a fixed, age-adjusted federal voucher to cover the services of a primary care physician/ medical service advisor. This primary-advisor would provide all basic health care services. And the advisor would offer counseling on serious health problems, recommendations for specialists as needed, and guidance on choices of catastrophic insurance providers.

Why would this primary-advisor approach work where HMO capitation failed? The answer is competition and informed clients. First, the primary-advisors would compete with one another to offer the best service for the voucher. Second, they would enable clients to make well-informed health care choices–creating competition among service providers, such as MRI facilities or catastrophic insurers.

A primary-advisor and catastrophic insurance system would of course require regulatory constraints. For starters, neither primary advisors nor catastrophic insurers could refuse or drop clients. While the system would be de facto single payer with private provision, it could potentially provide better service and more effective cost control than our current full single-payer system: Medicare.

While we need to have reform with our health care system, I don’t believe we need this large price tag that will greatly increase our taxes again. I feel we need to have inter-state competition, we need to find a way for health care items—prescriptions, and medical supplies—to not cost so much.

The person I share office space with was talking about how people just accept the cost of things without questioning outrageous prices.

Her husband has a sleeping disorder and uses a breathing machine. Shortly after they purchased the breathing machine (their health care covered it) a little plastic piece that held the strap that goes around his head broke. The company said it would sell it to him what the insurance carrier would charge (a discounted rate). It cost him $300.00 (three hundred dollars). [The retail price] was $500.00.

She was furious at the cost and did her own research. She “Googled” the piece—same order #… everything. When it arrived at their house it was EXACTLY the same in every way. She purchased that piece for around $50.00. They took it back to the medical supply place and replaced the piece and got a refund.

I am sure this kind of thing is multiplied thousands of times across our nation. If we could get a handle on this I believe our insurance and health care costs come down.