Maternity Delivery: US is the COSTLIEST country in the world–by far.

This article, from the New York Times, should give pause to anyone who is having a baby–or has had a baby–in the United States. If this doesn't make the strongest case for health care reform in our country, then I don't know what does.

— Josie

 

American Way of Birth, Costliest in the World

Photo: Josh Haner/The New York Times

"I feel like I'm in a used-car lot." Renée Martin, who, with her husband, is paying for her maternity care out of pocket.

By  | Published: June 30, 2013

As you read this article, please share your experiences by responding to the questions that will appear. Your responses will inspire future articles in this series.

Elisabeth Rosenthal, reporter

YOUR PERSPECTIVE

What do you think the total cost of a woman’s pregnancy should be, from prenatal checkups through delivery and newborn care?

$

COMPARE

 

LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epiduralanesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

 

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”

Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care.

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold,according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey byChildbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

YOUR PERSPECTIVE

What aspects of maternity care or its costs were unexpected for you?

Only in America

In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.

Ireland, for example, guarantees free maternity care at public hospitals, though women can opt for private deliveries for a fee. The average price spent on a normal vaginal delivery tops out at about $4,000 in Switzerland, France and the Netherlands, where charges are limited through a combination of regulation and price setting; mothers pay little of that cost.

The chasm in price is true even though new mothers in France and elsewhere often remain in the hospital for nearly a week to heal and learn to breast-feed, while American women tend to be discharged a day or two after birth, since insurers do not pay costs for anything that is not considered medically necessary.

 

YOUR PERSPECTIVE

If you gave birth outside the United States, what was your experience with medical testing, procedures and costs?

 

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59). Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

In almost all other developed countries, hospitals and doctors receive a flat fee for the care of an expectant mother, and while there are guidelines, women have a broad array of choices. “There are no bills, and a hospital doesn’t get paid for doing specific things,” said Charlotte Overgaard, an assistant professor of public health at Aalborg University in Denmark. “If a woman wants acupuncture, an epidural or birth in water, that’s what she’ll get.”

Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data.

Rather it is the piecemeal way Americans pay for this life event that encourages overtreatment and overspending, said Dr. Kozhimannil, the Minnesota professor. Recent studies have found that more than 30 percent of American women have Caesarean sections or have labor induced with drugs — far higher numbers than those of other developed countries and far above rates that the American College of Obstetricians and Gynecologists considers necessary.

During the course of her relatively uneventful pregnancy, Ms. Martin was charged one by one for lab tests, scans and emergency room visits that were not included in the doctor’s or the hospital’s fee. During her seventh month, she described one week’s experience: “I have high glucose, and I tried to take a three-hour test yesterday and threw up all over the lab. So I’m probably going to get charged for that. And my platelets are low, so I’m going to have to see a hematologist. So I’m going to get charged for that.”

She sighed and put her head in her hands. “Welcome to my world,” she said.

Extras Add Up

Though Ms. Martin has yet to receive her final bills, other couples describe being blindsided by enormous expenses. After discovering that their insurance did not cover pregnancy when the first ultrasound bill was denied last year, Chris Sullivan and his wife, both freelance translators in Pennsylvania, bought a $4,000 pregnancy package from Delaware County Memorial Hospital; a few hospitals around the country are starting to offer such packages to those patients paying themselves.

The couple knew that price did not cover extras like amniocentesis, a test for genetic defects, or an epidural during labor. So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

“All of a sudden I have a bill that’s as much as I make in a month, and is more than 10 times what I’d been quoted,” Mr. Sullivan said. “I don’t know how I could have been a better consumer, I asked for a quote. Then I get this six-part bill.” After months of disputing the large discrepancy between the estimate and the bill, the hospital honored the estimate.

Christopher Gregory/The New York Times

"Most insurance companies wouldn't blink at my bill, but it was absurd." Dr. Marguerite Duane, who questioned line items on her hospital bill.

 

Mr. Sullivan noted that the couple ended up paying $750 for an epidural, a procedure that has a list price of about $100 in his wife’s native Germany.

Even women with the best insurance can still encounter high prices. After her daughter was born five years ago, Dr. Marguerite Duane, 42, was flabbergasted by the line items on the bills, many for blood tests she said were unnecessary and medicines she never received. She and her husband, Dr. Kenneth Lin, both associate professors of family medicine at Georgetown Medical School, had delivered babies in their early years of practice.

So when she became pregnant again in 2011, she decided to be more assertive about holding down costs. After a routine ultrasound scan at 20 weeks showed a healthy baby, she refused to go back for weekly follow-up scans that the radiologist suggested during the last months of her pregnancy even though medical guidelines do not recommend them. When in the hospital for the delivery of her son Ellis in February, she kept a list of every medicine and every item she received.

Though she delivered Ellis with a midwife 12 minutes after arriving at the hospital and was home the next day, the hospital bill alone was more than $6,000, and her insurance co-payment was about $1,500. Her first two pregnancies, both more than five years ago, were fully covered by federal government insurance because her husband worked for the Agency for Health Care Research and Quality.

“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”

Ms. Martin is similarly well positioned to be an expert consumer of health care. She administered the health plan for a large art gallery she managed in Los Angeles before marrying and moving to Vermont in 2011 to enroll in a year of pre-med classes at the University of Vermont. She has a scholarship this fall for a master’s degree program at Vanderbilt University’s Center for Medicine, Health and Society, and then she plans to go on to medical school. Her father-in-law is a pediatrician.

RENÉE MARTIN’S PREGNANCY COSTS

Video by Dave Horn; Photography by Cheryl Senter for the New York Times

Statement after delivery without any discounts; not an official bill:
Hospital charges
$20,257
Obstetrician
4,020
Anesthesiologist
3,278
Drugs
1,125
Bills for prenatal care:
Emergency visit
1,600
Genetic testing
1,500
Ultrasound
1,191
Radiology
520
Hematologist
346

 

She and her husband, who works for a small music licensing company that does not provide insurance, hoped to start their family during the year they were covered by university insurance in Vermont, she said, but “nature didn’t cooperate.”

Then they moved to the New Hampshire summer resort of Laconia, her husband’s hometown, for a year before she started the grind of medical training. But in New Hampshire, they discovered, health insurance they could buy on the individual market did not cover maternity care without the purchase of an additional “pregnancy rider” for $800 a month. With their limited finances and unsuccessful efforts at conceiving, it seemed an unwise, if not impossible, investment.

Soon after buying insurance coverage without the rider for $450 a month, Ms. Martin discovered she was pregnant. Her elation was quickly undercut by worry.

“We’re not poor. We pay our bills. We have medical insurance. We’re not looking for a handout,” Ms. Martin said, noting that her husband makes too much money for her to qualify for Medicaid or other subsidized programs for low-income women. “The hospital is doing what it can. Our doctors are taking wonderful care of us. But the economics of this system are a mess.”

Not knowing whether the pregnancy would fall at the $4,000 or $45,000 end of the range the hospital cited, the couple had a hard time budgeting their finances or imagining their future. The hospital promised a 30 percent discount on its final bill. “I’m trying not to be stressed, but it’s really stressful,” Ms. Martin said as her due date approached.

YOUR PERSPECTIVE

How would you describe the ideal scenario for insurance coverage during pregnancy?

Package Deals

With costs spiraling, some hospitals are starting to offer all-inclusive rates for pregnancy. Maricopa Medical Center, a public hospital in Phoenix, began offering uninsured patients a comprehensive package two years ago. “Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right,” said Dr. Dean Coonrod, the hospital’s chief of obstetrics and gynecology.

The hospital charges $3,850 for a vaginal delivery, with or without an epidural, and $5,600 for a planned C-section — prices that include standard hospital, doctors’ and testing fees. To set the price, the hospital — which breaks even on maternity care and whose doctors are on salaries — calculated the average payment it gets from all insurers. While Dr. Coonrod said the hospital might lose a bit of money, he saw other benefits in a market where everyone will have insurance in just a few years: mothers tend to feel allegiance to the place they give birth to their babies and might seek other care at Maricopa in the future.

Laura Segall for The New York Times

"Making women choose during labor whether you want to pay $1,000 for an epidural, that didn't seem right." Dr. Dean Coonrod, chief of obstetrics and gynecology at Maricopa Medical Center in Phoenix

 

The Catalyst for Payment Reform, a California policy group, has proposed that all hospitals should offer such bundled prices and that rates should be the same, no matter the type of delivery. It suggests that $8,000 might be a reasonable starting point. But that may be hard to imagine in markets like New York City, where $8,000 is less than many private doctors charge for their fees alone.

One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States. In Germany, midwives were paid less than $325 for an 11-hour delivery and about $30 for an office visit in 2011.

Dr. Palmer of the American College of Obstetricians and Gynecologists acknowledged the preference for what he called “medicalized” deliveries in the United States, with IVs, anesthesia and a proliferation of costly ultrasounds. He said the organization was working to define standards for the scans.

 

To control costs in the United States, patients may also have to alter their expectations, including the presence of an obstetrician at every prenatal visit and delivery. “It’s amazing how much patients buy into our tendency to do a lot of tests,” said Eugene Declercq, a professor at Boston University who studies international variations in pregnancy. “We’ve met the problem, and it’s us.”

Starting next year, insurance policies will be required under the Affordable Care Act to include maternity coverage, so no woman should be left paying entirely on her own, like Ms. Martin. But the law is not explicit about what services must be included in that coverage. “Exactly what that means is the crux of the issue,” Dr. Kozhimannil said.

If the high costs of maternity care are not reined in, it could break the bank for many states, which bear the brunt of Medicaid payouts. Medicaid, the federal-state government health insurance program for the poor, pays for more than 40 percent of all births nationally, including more than half of those in Louisiana and Texas. But even Medicaid, whose payments are regarded as so low that many doctors refuse to take patients covered under the program, paid an average of $9,131 for vaginal births and $13,590 for Caesarean deliveries in 2011.

Insured women are still getting the recommended prenatal care, despite rising out-of-pocket costs, according to a recent study. But that does not mean they are not feeling the strain, said Dr. Kozhimannil, the study’s lead author. The average amount of savings among pregnant women in the study was $3,000 to $5,000. “People will find ways to scrape by for medical care for their new baby, but are young mothers taking care of themselves? And what happens when they need to start buying diapers?” she asked. “Something’s got to give.”

Ms. Martin, who busied herself making toys as her due date neared, could not stop fretting about the potential cost of a complicated delivery. “I know that a C-section could ruin us financially,” she said.

On May 25, she had a healthy daughter, Isla Daisy, born by vaginal delivery. Mother and daughter went home two days later.

She and her husband are both overjoyed and tired. And, she said, they are “dreading” the bills, which she estimates will be over $32,000 before negotiations begin. Her labor was induced, which required intense monitoring, and she also had an epidural.

“We’re bracing for it,” she said.

(c) 2013 The New York Times.

 

HAH-2-Book-Set (3)

 

 The Housewife Assassin's
Killer 2-Book Set / Only $3.99!

 Book 1 – The Housewife Assassin's Handbook

Book 2 – The Housewife Assassin's Guide to Gracious Killing

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Love this version of Andree Belle singing “Go Go Gadget Heart”…

 

Soft Glow of Electric Sex
Here's one of my fave songtresses and her band, Andree Belle,  doing their thing!  

The song is "Go Go Gadget Heart, which you'll find on her digital album, "The Soft Glow of Electric Sex." Obviously the little techie had his effect on her! Only $7? Such a steal!

In fact, I featured this song in my novel,The Housewife Assassin's Guide to Gracious Killing. 

You can read the excerpt, below.

Josie


 

 

Book 2: The Housewife Assassin's Guide To Gracious Killing – Excerpt


Guide-to-Gracious-Killing-Final
Only $3.99

 Signal Press / In bookstores now!

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 978-0-9740214-4-7  / Digital eBook 

Donna and Jack are in the kind of hot mess that can cause an  international incident:

A nuclear arms summit, hosted by a politically-connected American billionaire industrialist, provides the perfect opportunity for a rogue operative to assassinate of the newly-elected Russian president on US soil. Acme operative Donna Stone's mission:

Seek and exterminate the shooter, before all hell–and World War III–break loose.

Not to mention what happens when Donna files for divorce.

Throw in a couple killer play dates and a few naughty neighbors, you've got a whole lot of fun.

 

Chapter 1: Breaking Bad Hostessing Habits

Every woman wants to be the perfect hostess, and frets over her inadequacies when it comes to the gracious art of entertaining.  Pshaw! A little forethought and a few hours of  planning makes it easy as cherry pie!

There is, however, one ironclad rule that every hostess must follow: make all your guests wish they’d never have to leave.

Especially in a coffin. With a bullet lodged in their heads.

 

Harry Happy Hour“You’re quite a saucy minx!” Prince Harry’s  ale-slurred come-on can barely be heard over the techno-vibe emanating from a starship-worthy console of  the Ivy Lounge rooftop’s head-bobbing deejay.  “What say you give me a peek as to where that tattoo ends?”

His head is cocked downward, as if it might give him the ex-ray vision he’ll need in order to see the rattle on the faux-tatt’ed snake drawn from my belly, which ends somewhere  in the nether regions that lay under my thong bikini.

“You’re a cheeky sod. I do have a face, you know.” I snap my fingers in front of his nose in order to draw his eyes northward.

I’ve succeeded, sort of.  But come on, already: the diplomacy born and bred into the Prince of Wales can’t beat two millennia of innate urges and four pints of Guinness.

His eyes linger below my neck, albeit above my abdomen.

When, finally, our eyes meet, I lean in and whisper, “You show me yours, and I’ll show you mine.”

I’m lying, even if he doesn’t know it—yet.

His outright laugh is accompanied with a shake of his head, and a tug at the waistline of his briefs. “Nothing under these trollies, I’m afraid. Sorry to disappoint.”

I finger his briefs longingly, then sigh. “I’m sure you’ll make it up to me somehow.”

His smile is his vow not to disappoint.

God save the queen…

It’s no secret the prince has been stateside with his Royal Air Force unit, learning the latest tricks and treats of the AH-64D Apache helicopter: his vehicle of choice for his upcoming tour of duty in Afghanistan. Tomorrow the soldiers complete their training and head home. To celebrate, the soldiers are here, in San Diego, which is just a couple of hours west of their training base, the Naval Air Facility at El Centro.

Seems some chatter, intercepted by MI-6, has led the Cousins to deduce that the prince is the latest target of “the Leprechaun,” a notorious assassin affiliated with the Irish terrorist cell known as 32CSM. If the Leprechaun succeeds in picking off the spare to the throne, then once again the always thin strand of peace between Ireland and Great Britain will be ripped to shreds.

If it happens on our side of the pond, the U.S. will have mud on its face, not to mention the bluest of blood on its hands.

So yep, I have to stop the Leprechaun before he gets lucky.

My employer, the freelance black ops agency known in the field as Acme Corporation, paid big bucks to the club owners so that I could be up close and personal with the prince. My goal is not to shag, let alone snag, Harry the Hottie. It’s to save his adorable hide from a possible assassination attempt.

The prince leans in, close enough to ask in a seductive albeit ale-sodden growl, “Want me to sign your bikini?”

I look down between my breasts. “Oops, forgot my pen. But you seem to be carrying one, in your pants pocket. Or maybe you’re just happy to see me.”

He’s laughing so hard his last gulp of Guinness goes down the wrong way.

“Prince Charming has a one-track mind.” Jack Craig’s snarl comes in loud and clear through the tiny microphone in my ear. As the team leader for this Acme Industries mission, he is close by, but far enough away that no potential assassin can spot him.

Trust me, there is an assassin lurking nearby.

Jack is also my main squeeze, which is why he’s growling about my having to play the coquette while under deep cover (in this bikini, I’m talking figuratively if not literally) as one of the nightclub’s VIP bottle girls, and more specifically, the world’s most eligible prince ’s pick-up du jour.

Needless to say, the club’s real bottle girls are pea green with envy. They can’t figure out how this newbie became Cinderella of this Century.

If I told them that my aim and my 1st degree black belt status had something to do with it, would they believe me? Probably not. All they see is that I’m just this side of Cougarville, which means Harry is less discriminating than they had hoped.

For once I’m glad Jack is not here with us, in the cordoned-off VIP section. One involuntary muscle flex and prince’s all too obvious brawny goon squad—three of his Royal Air Force mates—would be on top of him, like suds on ale. 

At MI-6’s behest, we’ve kept that a secret from Harry, for now anyway. Which, I’m sure, is why he feels so cocksure. This mission wouldn’t have been so hard if the prince weren’t so insistent about partying “like an ordinary surfer bloke,” is how he so preciously puts it. 

Thus far the natives have been awed as much by his title as his regular dude  personality.

Just as the deejay ratchets up the hip hop club mix, six drunken sorority sisters stroll our way. One of the girls, a Kate Middleton lookalike, pierces me with a jealous glare.

I stare back and smile, as if to say Take the hint. Get lost.

Her eyes shift from me to one of Harry’s RAF buds. She waves coyly at him, and he’s smitten. Smirking back, he nods her over. She squeals and grabs the hand of one of her girlfriends.

Harry's haremIn no time at all, she and her besties have jumped the red velvet rope. They toss themselves onto the prince’s entourage, who don’t seem to be fighting them off too hard.

In fact, they’re snapping their fingers at me with drink orders for their new arm charms.

“Not good.” Jack’s warning in my ear is just loud enough for me to here.

“Tell me something I don’t know,” I mutter back.

“How about this?” Jack is now shouting into my earpiece. “You’ve lost Prince Harry.”

He’s right.

The prince seems captivated by a petite, busty blond beauty. Even in heels, she barely reaches his chest. She had pulled him out onto the dance floor for a throbbing sex-drenched hip grinder, Andree Belle’s Go Go Gadget Heart.

The strobe lights and smoke machine make it hard to follow them in the crowd. Then I see them, against one wall. The buxom little tart has draped her arms around his shoulders and hugs him close, as if she’ll never let him go.

Apparently too close. I shove my way through the crowd until I’m close enough to I hear Harry’s woozy cry: “Blimey, you’re no bird! You’ve got a wanker!”

Before I can pull him away, the prince is pricked on the neck with something  his partner has pulled from her cleavage. Harry’s groan is loud—

Then the smell of smoke, and the lights go out—

But not before the last strobe catches the triumphant look on his partner’s face.

 “Oh my God, Jack! The woman with Harry—she’s—not a she! She’s—”

“I know, I saw it, too! The Leprechaun!”

Proof it pays to hit the M.A.C. counter before a night on the town.

 And to hang out where the lights are always low.

Everyone is screaming and shoving their way to the exits, leaving me room to follow the Leprechaun, who was shoving Harry in the opposite direction, up against a wall.

“It’s too dark to see where they went. Does anything show up on the club’s security cams?”

“I’m looking now. In the meantime, check the wall for a hidden pocket door. The schematic of this club shows a few of them on every level. I’m sure the Leprechaun had his exit scoped out in advance.”

While he scans the feeds from the security cameras, I skim the walls with my hands. Finally I find it: a tiny catch, waist high.

I pull it open it just in time to see the Leprechaun heaving Harry down a long corridor.

He may not be used to running in heels, but I am. If only I wasn’t running in a bikini, too.

“Too many wobbly bits,” I mutter under my breath.

It is inappropriate for Jack to be laughing now, but he can’t help it. “Just two. And they’re a sight to behold. Prince Charming will be upset he slept through it.”

The thought of Harry in the French-manicured hands of an assassin who can start the United Kingdom and Ireland down another bloody path of un-neighborly relations has me picking up my pace. Unlike the Leprechaun, I’m smart enough to ditch my high heels—

But I’m still not fast enough to reach them before the Leprechaun rolls him into the backseat of a dark BMW and screeches off.

I can hear Jack slapping the wall with his fist. “Aw, damn! We lost them!”

“Nope, I slipped a GPS tracker in the prince’s trollies.”

“You did what?…In his—what?”

“Oh, don’t worry, I didn’t peek. I’ll meet you around the corner.”

What’s a little white lie between fake husband and wife?

Before he can say another word, I snap off my earpiece and run down the block.

(c) 2012 Josie Brown. All rights reserved. This excerpt may not be resold or redistributed without prior written permission from Josie Brown or Signal Press Books (info@signaleditorial.com).

_______________________

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We have a homeless guy in our apartment building’s boiler room.

Homeless-teen

Turns out the guy has picked the lock, and made it his home: bedroll, pictures, personal items.

This breaks my heart. I can only imagine what it's like to have to sleep on a cold concrete floor every night, let alone  park bench or a sidewalk. At the same time, should something happen in that boiler room. it affects the whole building, and the tennants in it.

We will change the lock on the boiler room door to a deadbolt, perhaps put a gate in the passageway leading to it as well.

But first we will also box up his belongings.  I will put a few bucks in an envelope, along with a note explaining why he needs to move on. 

Like most homeless, he's not on the street (or in the boiler room) by choice. He's there because, somewhere along the line, he's had a fall from grace. Maybe mental health issues are involved. If so, I truly feel for him, because the governmental safety net for the mentally ill is broken in too many ways.

He is someone's son. Perhaps, someone's brother, father, or uncle or nephew.

He cannot deal with his problems. And his family is probably brokenhearted about it andworried about him, but also weary of the burden of carrying him.

Out of sight, but truly out of mind? We all know that's not the case.

He is the ghost of failure: not his own, but ours, as a society.

He is one of us.

We need to fix it. Whether we want to believe so or not, it is a reflection on each of us

— Josie

Today is a play day (sort of). Which means a trek through Golden Gate Park.

Goldengatepark

In many ways, San Francisco is a wonderland. One locale in the city that is always on parade is Golden Gate Park, which runs three miles east to west, and half a mile north to south. Its 1,017 acres make it 20 percent larger than New York's Central Park. 

Our park ends at the Ocean, so I'd say that's another wonderful advantage. It's far side ends in the Haight, which is why it was once a hippy haven ("Once"? Frankly, it still is. Everything changes, and stays the same).

GGParkNorthWindmill2We'll park at one end, and meander through it, down to the other. In the meantime, we'll pass the archery field, the Frisbee Golf grove, merry-go-rounds, drumming circles,  roller blade dancers, both The DeYoung Fine Arts Museum and the California Academy of Sciences, the first home of the San Francisco 49ers (Kezar Stadium) and several lakes (Stowe, for rowers; Spreckels, for those who are running their minature yachts, or sailing their miniature sail boats), not to mention a herd of buffalos. groves of picnickers, and a windmill or two.

Our own favorite passtime is discovering the wooded nooks and crannies; serene groves where one can lose oneself  in a good book, while lolling on a blanket, or sprawling on one of the many benches that you'll come across.

The park was concieved in the 1870s, and hosted several public expositions, of which some of its historic buildings remain (the flower conservatory,and its renowned Japanese Tea Garden are but two).

Strybing_Arboretum_trailAnd to think the park might have never happened, had San Francisco's silver barons gotten their way: they lobbied hard for a race track!

 

Now, go out and discover something new,

— Josie

 

 

Below, the architecturally renowned California Academy of Sciences


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Last weekend, San Francisco’s Chinese New Year Parade was PERFECT.

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 The synchronized dragons.

The stiltwalkers.

The elaborate masks and costumes.

And of course, the looks on the children's faces:
both those in the parade, and those wishing they'll be in the next one,
taking part in all the fun.

The parade gods blessed us with clear skies and a full moon on a balmy night.

Bliss,

— Josie

 

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My 17th NaNoWriMo Tip: Why your characters need emotional depth.

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It's NaNoWriMo Month!
(National Novel Writing Month, for the uninitiated…)

For those of you who have begun writing your first book, every day I'll repost my fave creative writing tips here, just for you.


Here's Tip #17, for Saturday, the 17th

The previous day's post can be accessed on this page, too.

The previous day's post can be accessed on this page, too.

Here's to your success as an author,

— Josie Brown

Don’t forget to enter my HOUSEWIFE ASSASSIN’S GUIDE TO GRACIOUS KILLING contest, for a chance to win a $100 gift card to the bookstore of your choice!

 

 

HAH Hanging Man V2Buy THE HOUSEWIFE ASSASSIN'S HANDBOOK! No #90 on Kindle Top 100/Mystery Women Sleuths. And it's only 99 cents on

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Squeeeee! Free books, two days only, just in time for Thanksgiving!




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Thanksgiving Free
ParTay!
 For Two Days Only, Nov. 14th – 15th,
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Housewife Assassin’s Handbook
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Notorious,”
Gripping, compelling crime drama—grabs hold and doesn’t let go!   By Ray
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Stop the Wedding!

A man and woman conspire to stop their parents' wedding, and fall in love. By Stephanie Bond. 

Deathscape,”
After a near-death experience, a tortured artist begins to paint the dead. By Dana Marton.        

To enter to
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Squeeeee! TOTLANDIA is up on Amazon!

Totlandia5_2TOTLANDIA
Book 1: The Onesies

 Coliloquy Books / 978-0-9740214-0-9 / eBook

Buy it NOW, on Amazon.com

Buy it NOW, on BN.com

Buy the Book App NOW, on BN.com

Friendship. Lies. Seduction. Betrayal. 
Welcome to Totlandia.

The salacious secrets of Desperate Housewives meet the aspirational lifestyles of Sex and the City in San Francisco’s most elite mommies group

In this sometimes bittersweet (and always humorous) novel, the friendships among four women who meet in a moms-and-tots playgroup are tested as they address their presumptions, family traumas, love, passion, and the hard realities of parenting their children.

Read an excerpt here…

Author's Q&A here…

Join the TOTLANDIA Facebook Page (Lots of contests and prizes…)

Pregnant Moms at the Oscars: That Winning Glow

Is-Natalie-Portman-Pregnant-Golden-Globe-Awards This year, when Natalie Portman gets her shot at Oscar gold, her very visible baby bump will be there, front and center–

And swathed in some sumptious designer couture.

That ain't no OshKosh B'Gosh.

As it should be.

Portman won the Golden Globe for her terrifying performance in THE BLACK SWAN, and she's considered the frontrunner for the Best Performace by an Actress Academy Award as well. 

Even if she doesn't win, what a memorable experience she'll have, sharing this wonderful accomplishment with your soon-to-be-born child! The paparrazi will capture her pregnancy glow. The gown she chooses will have been perfectly cut to enhance her beauty (if not her bounty). She'll be able to show her child the pictures from that magical night and say, "See, honey? You were there with me, too!"

Pregnancy is no stranger to the Bald Golden Boy. Click here to trod down Oscar history's red carpeted memory lane…

 

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Don't forget to enter the contest for my novel, THE BABY PLANNER  for a chance to win a $100 gift card from you favorite bookstore! 

__________________________________

 

Tucson Tragedy: It’s Time for Comprehensive Universal Mental Health

Jared-Lee-Loughner The despair felt by the parents of the mentally ill — especially those whose illnesses, such as schizophrenia, manifest into anger and has caused them to do physical harm to others — is unfathomable by the rest of us.

These are not bad parents. They are people who love their children, and have done their best to get medical attention for their offspring, despite the expense (psychopharmaceutical drugs can be as much as $100 a pill, even if needed daily), and the stress of all the red tape traps devised by our American health insurance system–not to mention the lack of comprehensive medical care for the mentally ill, once the financial hurdles have been jumped. 

Below is an excerpt for the Mother Lode column in the New York Times, in which several parents with mentally ill children who have done similar acts give their perspectives on the Tucson, Arizona killing rampage that injured fourteen, including U.S. Congresswoman Gabrielle Giffords, and killed six others.

We can't take healthcare off the table now. In so many ways, our lives depend on our society — and elected officials — addressing this topic, and moving forward on workable answers.

 

I've also included a video, from PBS's NewsHour, on the Tucson and the missed opportunities to prevent it by assessing Laughner's mental health situation. Sadly, Laughner was putting his intentions out there with YouTube videos.

The irony: Arizona had cut $65 million from its mental health social services budget since 2008.

Knowledge is power,

–Josie

 

 

MOTHERLODE / Adventures in Parenting / New York Times

January 11, 2011, 3:31 pm

A Killer’s Parents

By LISA BELKIN
A photograph of Jared L. Loughner released by the Pima County Sheriff’s Office.Pima County Sheriff’s OfficeA photograph of Jared L. Loughner released by the Pima County Sheriff’s Office.

With Jared Lee Loughner’s unhinged grin staring out from so many Web sites and newspapers today, parents of troubled young adults are stepping forward, giving glimpses into the pain and impotence that comes when your child has mental illness.

In Chicago, the longtime local CBS news anchor Bill Kurtis shared all that and more with viewers last night, talking publicly for the first time about his son Scott, who was diagnosed with paranoid schizophrenia and who died in 2009 when he was 38.

In unscripted comments coming after a report on the reasons authorities don’t take action against bizarre behavior before it turns threatening, Kurtis talked of how his son heard voices and suffered from hallucinations, but was not violent. The turn toward violence in the mentally ill, however, can be unpredictable, Kurtis said. “I was told my son went nonviolent, and he was no danger,” he said. “But 10 percent of the crimes are committed by mentally ill people who do turn violent.”

After the newscast Kurtis told the blogger Robert Federer that he decided to speak out because Loughner’s story seemed so familiar. “I never wanted to exploit Scott and the illness, and always thought that if he wanted it to go public, he should be able to make the decision and talk about it,” Kurtis said. “We’d been living with this for so long that when I heard some of the witnesses and observers who came forward Saturday [to describe Loughner], I felt this was the perfect time. In schizophrenia, they say people seem to come in and out. So they can look normal and function normally and go in and buy a gun.”

One can only imagine that Kurtis is putting himself in the shoes of Loughner’s parents and wondering “what if?” That is definitely what Jeannette Halton-Tiggs is doing, and she wrote about it today over on The Daily Beast.

In a column titled “Mother of a Monster,” she describes to columnist Mansfield Frazier how her son, Timothy Halton Jr. was sentenced to life in prison for shooting a police officer.

As she says:

…in truth my Timmy is not, and never was, a monster… what he was cursed to be is one of the literally millions of hopelessly and irrevocably mentally ill individuals in the world today. He suffers from a severe form of paranoid schizophrenia that renders him incapable of controlling his thoughts, emotions or actions when, for a variety of reasons — some beyond his control — he is off his medications. And I did everything humanly possible within my power to keep him on a treatment regimen, but, alas, to no avail.

The reality is, no one can be as deranged as my son, or as Jared Loughner apparently is, without many people being aware of his deteriorating mental condition — yet seemingly no one moved to force him into treatment. The burning question following a mind-boggling incident of this kind should be: “Why do we, as a society, allow known dangerously mentally ill individuals to make their own decisions in regard to receiving treatment?”

There is a powerful contingent of folks in the mental-health care delivery field in this country who posit that no one should be compelled to be treated for their illness unless, and until, they harm someone. This, in itself, is insane … and dangerous to boot. I screamed at the top of my lungs that my son was one day going to hurt someone, or himself, but no one in a position of authority to avert the tragedy would listen or do anything.

That is mostly because Timmy turned 18 and his mother lost legal authority to control whether he took his medicines or was hospitalized or even monitored. Halton-Tiggs cites data which show that “more than 40,000 dangerously mentally ill individuals are roaming America’s streets on any given day, untreated.”

All those individuals are someone’s child.

As Halton-Tiggs concludes: “I’m pretty sure I know what Loughner’s family is going though. The guilt, the shame, the sense of despair.”

Statistics mean that tens of thousands of other parents out there fear one day knowing those feelings as well.

(c) 2010 New York Times.