Move over, Marty McFly. The Flux Capacitor is here and now. #TrashIntoGas


Backto the Future
This article, from the
New York Times, shows that as of today, we can be self-producing of clean fuels just by converting our garbage. This should be the most important US works project of the new millenneum. 

ALL states should be doing this, don't you think? Maybe a writing campaign is in order.

We're Back to the Future–and just in time to save Miami. 

But do we want to,

— Josie

Trash Into Gas, Efficiently? An Army Test May Tell

By PAUL TULLIS / New York Times

THERE is an indisputable elegance to the idea of transforming garbage into fuel, of turning icky, smelly detritus into something valuable.

But big drawbacks have prevented the wholesale adoption of trash-to-gas technology in the United States: incineration is polluting, and the capital costs of new plants are enormous. Gasification systems can expend a tremendous amount of energy to produce a tiny amount of electricity. Up to this point, it hasn’t seemed worth the trouble.

Mike Hart thinks that he has solved those problems. In a former Air Force hangar outside Sacramento, his company, Sierra Energy, has spent the last several years testing a waste-to-energy system called the FastOx Pathfinder. The centerpiece, a waste gasifier that’s about the size of a shower stall, is essentially a modified blast furnace. A chemical reaction inside the gasifier heats any kind of trash — whether banana peels, used syringes, old iPods, even raw sewage — to extreme temperatures without combustion. The output includes hydrogen and carbon monoxide, which together are known as syngas, for synthetic gas, and  can be burned to generate electricity or made into ethanol or diesel fuel. The FastOx is now being prepared for delivery to Sierra Energy’s first customer: the United States Army.

Ethanol has long been promoted as an alternative fuel that increases energy independence, and federal law requires the use of greater amounts of it. But most ethanol in this country is produced from corn or soybeans, and many people worry that the mandate is pushing upfood prices. Ethanol produced from trash — or agricultural waste, as others are trying — would allay such concerns.

Ineos Bio, a Florida company, announced last month that it had produced ethanol from gasified wood waste, using a method that it expects to be commercially viable, and KiOR Inc. will make one million to two million gallons of diesel and gasoline this year from wood waste at its plant in Columbus, Miss., according to Michael McAdams, president of the Advanced Biofuels Association. Mr. Hart said Sierra Energy’s technology should be complementary with the Florida company’s; the FastOx turns all municipal waste, not just wood scraps, into a gas that Ineos Bio could then transform into ethanol.

The FastOx gasifier is the brainchild of two former engineers at Kaiser Steel, patented by the grandson of one of them and commercialized by Mr. Hart. “It’s a modular system that can be dropped into any area,” Mr. Hart said, “using waste where it’s produced to make electricity where it’s used.” Once it’s off the ground, he said, “garbage will be a commodity.”  

From concept to construction, the story of the FastOx is of one fortuitous accident after another. And while Sierra Energy has not yet proved to be a successful company — it will be a long while before your garbage is shoveled into a FastOx — its system has become the first waste-to-energy technology acquired by the Defense Department, which paid $3 million for it through an environmental technology program. (The California Energy Commission, which supports renewable energy development in the state, also gave Sierra $5 million, to cover the portion of Sierra’s costs that the Pentagon couldn’t.)

The military is looking for ways to reduce its oil consumption, and to make it easier to supply the front lines with the fuel it uses in all its vehicles and generators. “These days, the supply lines are in the battlefield,” said Sharon E. Burke, the assistant secretary of defense for operational efficiency plans and programs. “And we consume a lot of fuel, which makes us a big target.”

MIKE HART got into the energy business by way of a train. In 1993, he bought the Sierra Railroad, a small freight and tourism line in Northern California. During the California blackouts of 2001, he had an idea: “As the lights were going out, I realized every one of my locomotives creates 2.1 megawatts of electricity,” he said — enough to power many hundred homes. “It’s a rolling generator, and inexpensive.”

The train-as-power-generator idea never really left the station, but it got Mr. Hart thinking about alternative energy. Then, as part of a settlement after a fuel spill from one of his trains, he promised to convert his trains to nonpolluting biodiesel.

Biodiesel, however, proved hard to find, and Mr. Hart started looking for new ways to source it. In 2002, he was asked to judge an annual business plan competition called the Big Bang, at the University of California, Davis. That’s where he met Chris Kasten.

Mr. Kasten came to the competition with an idea to use a modified blast furnace to turn waste into fuel. His grandfather, Bruce Claflin, a retired chief industrial engineer at Kaiser Steel in Fontana, Calif., had given him the idea.

Kaiser used blast furnaces to make steel, and Mr. Claflin and a colleague, John Jasbinsek, were tasked with finding “a way to make the blast furnace more efficient and less polluting,” said Mr. Jasbinsek, who is now 86.

Like all blast furnaces, Kaiser’s emitted a flue gas out of the top. It occurred to Mr. Clafin and Mr. Jasbinsek that this gas might have value. The two came up with the idea of injecting oxygen, instead of the atmospheric air that steel makers had always used, to create the chemical reaction that heats the inside of the furnace. This would cut pollution while raising the energy content of the flue gas — in essence, giving the steel maker a second product. But pure oxygen made the system too hot, so they added steam. This gave the furnace a third product: hydrogen, which can be used to produce electricity in fuel cells.

After Kaiser decided to close the Fontana plant in 1983, workers were told to toss all demolition debris into the blast furnace. It was then that Mr. Jasbinsek and Mr. Claflin realized that the furnace could take garbage, too. “No matter what they put in, the furnace melted and gasified it,” Mr. Kasten said. This meant a potential fourth revenue stream — from taking municipal waste that would otherwise go to landfills.

When Kaiser wasn’t interested, Mr. Jasbinsek recalled, “we took the idea to other steel companies, too.” But “nobody gave a damn!” he said. “Now there are hardly any steel companies left in the U.S.”

Kaiser Steel went bankrupt in 1987, so the idea belonged to Mr. Jasbinsek and Mr. Claflin. They were nearing retirement, though, so Mr. Claflin told his grandson about it. (Mr. Claflin died before the idea could be commercialized.)

Mr. Kasten’s first fruitful step in developing his grandfather’s idea was meeting with Chris Soderquist, founder of Venture Lab. “When you run a technology incubator, you see a lot of crazy and half-baked ideas,” Mr. Soderquist said. But Mr. Kasten’s was different; Mr. Soderquist could see right away the value of multiple revenue streams.

Gasification is more efficient than incineration and eliminates toxic byproducts that come from burning trash. But it was especially appealing from a business point of view because it relied on a proven technology and used materials in wide abundance: blast furnaces being abandoned as the American steel industry was collapsing.

“What was compelling from the start,” Mr. Soderquist said, “was repurposing existing infrastructure into a generator of clean energy, with a second revenue stream from people paying you to take their waste.”

Mr. Soderquist helped Mr. Kasten prepare for the Big Bang competition. “For a grad school business plan competition, it was quite a plan he presented,” Mr. Soderquist said, and the judges agreed: Mr. Kasten, now 43, won a $2,000 prize.

Mr. Hart, 51, as a competition judge and a serial entrepreneur, was intrigued. He had started his first business at 12, operating a string of candy machines in high schools throughout what would become known as Silicon Valley. Next, while still living at home, he opened a sort of temp agency for teenagers doing odd jobs. There were a lot of other businesses from the late 1970s to 1993, and stints as a developer for Steve Jobs’s company Next, and for Apple. Mr. Hart also did some consulting until he realized that he would make more money buying whatever devalued company he had been hired to help, and turning it around himself. That was when he bought the Sierra Railroad.

Mr. Hart checked out Mr. Kasten’s gasifier and decided to buy the patents. Then he applied to a Pentagon program established to shepherd proven concepts to the production stage. Results at the Defense Department’s testing facility near Sacramento have been promising; after about four hours, one ton of waste creates enough gas to produce 1,580 kilowatt-hours of electricity, which would power an average home in the United States for about a month and a half — at one-third the emissions of coal — and 42 gallons of renewably sourced fuel. And that’s with a 12-ton-a-day gasifier; existing blast furnaces can handle as much as 2,000 tons a day.

Now that the Pentagon is convinced that the FastOx will work as advertised, the system should be providing electricity later this year at Fort Hunter Liggett, a  training base in Monterey County, Calif., and fuel for vehicles and generators in early 2014.

“California produces 30 million tons of garbage a year,” Mr. Hart said. “If it decided to turn its waste into clean fuels, at that rate it could meet all its oil consumption needs and still export more fuel than some OPEC members.” That is, if the FastOx can do what no other waste-to-energy gasification technology has done before: take any kind of trash, in any succession, without additional separation or preparation.

Sierra plans to license its technology and to sell systems to make electricity or ethanol from the syngas produced by the FastOx. The first will be small and cost about $3 million. But Mr. Hart said he expects to sell larger systems to municipalities and biofuel makers that will go for much more.

Any waste-to-energy plan, however, must overcome a major hurdle: the wild inconsistency of the waste stream. “Until you’ve demonstrated that you can handle it all, nobody’s interested,” Mr. Hart said. “I can understand it; they’ve heard similar promises before. We’ve got 150 cities, communities and businesses lined up to be Serial No. 2. Nobody wants to be No. 1.”

NOBODY, that is, except the Pentagon. The Defense Department is the country’s largest single consumer of energy, spending $15 billion a year just on fuel.

“The mission drives this,” said Ms. Burke, the assistant defense secretary, “and the mission is inherently energy-intensive.”

The FastOx could reduce the military’s reliance on oil overseas and the grid at home. “I have a $24 million-a-year electric bill at Camp Pendleton” in Southern California, said that Marine base’s commander, Brig. Gen. Vincent A. Coglianese. “If I can reduce that cost, that’s more money I can put into training Marines and sailors.”

Ms. Burke added, “Something for military operations has to be really rugged, deployable, simple to use — all of those things.”

Consultants and municipal sanitation officials who’ve looked at the FastOx say it meets those criteria. John Conger, the acting deputy under secretary of defense for installations and the environment, who oversees management of military bases in the United States, says Sierra Energy’s technology should provide energy security for the military in the event of a blackout and provide budget savings as well.

The military’s cost of petroleum, when the costs of transporting and guarding it are factored in, can run as high as $50 a gallon. Moreover, about half of United States casualties in Iraq and Afghanistan between 2003 and 2007 were of servicemen and servicewomen moving and protecting fuel convoys, according to an Army report.

The appeal of Mr. Hart’s Pathfinder system is that it would produce fuel on site, eliminating the need to truck in fuel to dangerous military outposts. It would also reduce the need for trash-burning on bases, which creates pollution and noxious odors that have contributed to locals’ distaste for the American presence in Iraq and Afghanistan.  As a result, United States forces in Afghanistan are working to close burn pits.

“Waste is a problem,” Ms. Burke said. “So if we could dispose of waste and create energy at the same time, that would be a silver bullet.”

This article has been revised to reflect the following correction:

Correction: August 20, 2013

 

An earlier version of this article referred incorrectly to a product of Sierra Energy’s gasifier system. It  produces hydrogen and carbon monoxide, which together are known as “syngas,” for synthetic gas;  it does not produce “synthetic natural gas.”

 

This article has been revised to reflect the following correction:

Correction: August 20, 2013

 An earlier version of this article referred imprecisely to Fort Hunter Liggett, a training base in Monterey County, Calif. At more than 165,000 acres, it is not a “small” base.

(c) 2013 New York Times

 


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New York Times gives us another reason to be disgusted with the high cost of US healthcare

Having just been biled $260 for a six-minute earwax removal procedure (oh yeah, minus a whoopdeedoo $180 "credit for being a Blue Shield member), I can tell you I'm truly fed up with the egregious cost of American healthcare. How about you?  This New York Times article certainly puts things in perspective — Josie

For Medical Tourists, Simple Math

By  | Published: August 3, 2013 / New York Times

Josh Haner/The New York Times

 

Michael Shopenn, who has an artificial hip, on Copper Mountain in Colorado. Joint replacements have grown sharply.

WARSAW, Ind. — Michael Shopenn’s artificial hip was made by a company based in this remote town, a global center of joint manufacturing. But he had to fly to Europe to have it installed.

Mr. Shopenn, 67, an architectural photographer and avid snowboarder, had been in such pain from arthritis that he could not stand long enough to make coffee, let alone work. He had health insurance, but it would not cover a joint replacement because his degenerative disease was related to an old sports injury, thus considered a pre-existing condition.

Desperate to find an affordable solution, he reached out to a sailing buddy with friends at a medical device manufacturer, which arranged to provide his local hospital with an implant at what was described as the “list price” of $13,000, with no markup. But when the hospital’s finance office estimated that the hospital charges would run another $65,000, not including the surgeon’s fee, he knew he had to think outside the box, and outside the country.

“That was a third of my savings at the time,” Mr. Shopenn said recently from the living room of his condo in Boulder, Colo. “It wasn’t happening.”

“Very leery” of going to a developing country like India or Thailand, which both draw so-called medical tourists, he ultimately chose to have his hip replaced in 2007 at a private hospital outside Brussels for $13,660. That price included not only a hip joint, made by Warsaw-based Zimmer Holdings, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, a week in rehab and a round-trip ticket from America.

“We have the most expensive health care in the world, but it doesn’t necessarily mean it’s the best,” Mr. Shopenn said. “I’m kind of the poster child for that.”

As the United States struggles to rein in its growing $2.7 trillion health care bill, the cost of medical devices like joint implants, pacemakers and artificial urinary valves offers a cautionary tale. Like many medical products or procedures, they cost far more in the United States than in many other developed countries.

Makers of artificial implants — the biggest single cost of most joint replacement surgeries — have proved particularly adept at commanding inflated prices, according to health economists. Multiple intermediaries then mark up the charges. While Mr. Shopenn was offered an implant in the United States for $13,000, many privately insured patients are billed two to nearly three times that amount.

An artificial hip, however, costs only about $350 to manufacture in the United States, according to Dr. Blair Rhode, an orthopedist and entrepreneur whose company is developing generic implants. In Asia, it costs about $150, though some quality control issues could arise there, he said.

So why are implant list prices so high, and rising by more than 5 percent a year? In the United States, nearly all hip and knee implants — sterilized pieces of tooled metal, plastic or ceramics — are made by five companies, which some economists describe as a cartel. Manufacturers tweak old models and patent the changes as new products, with ever-bigger price tags.

Generic or foreign-made joint implants have been kept out of the United States by trade policy, patents and an expensive Food and Drug Administration approval process that deters start-ups from entering the market. The “companies defend this turf ferociously,” said Dr. Peter M. Cram, a physician at the University of Iowa medical school who studies the costs of health care.

Though the five companies make similar models, each cultivates intense brand loyalty through financial ties to surgeons and the use of a different tool kit and operating system for the installation of its products; orthopedists typically stay with the system they learned on. The thousands of hospitals and clinics that purchase implants try to bargain for deep discounts from manufacturers, but they have limited leverage since each buys a relatively small quantity from any one company.

In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know what their competitors are paying. This secrecy erodes bargaining power and has allowed a small industry of profit-taking middlemen to flourish: joint implant purchasing consultants, implant billing companies, joint brokers. There are as many as 13 layers of vendors between the physician and the patient for a hip replacement, according to Kate Willhite, a former executive director of the Manitowoc Surgery Center in Wisconsin.

 

Hospitals and orthopedic clinics typically pay $4,500 to $7,500 for an artificial hip, according to MD Buyline andOrthopedic Network News, which track device pricing. But those numbers balloon with the cost of installation equipment and all the intermediaries’ fees, including an often hefty hospital markup.

That is why the hip implant for Joe Catugno, a patient at the Hospital for Joint Diseases in New York, accounted for nearly $37,000 of his approximately $100,000 hospital bill; Cigna, his insurer, paid close to $70,000 of the charges. At Mills-Peninsula Health Services in San Mateo, Calif., Susan Foley’s artificial knee, which costs about the same as a hip joint, was billed at $26,000 in a total hospital tally of $112,317. The components of Sonja Nelson’s hip at Sacred Heart Hospital in Pensacola, Fla., accounted for $30,581 of her $50,935 hospital bill. Insurers negotiate discounts on those charges, and patients have limited responsibility for the differences.

The basic design of artificial joints has not changed for decades. But increased volume — about one million knee and hip replacements are performed in the United States annually — and competition have not lowered prices, as would typically happen with products like clothes or cars. “There are a bunch of implants that are reasonably similar,” said James C. Robinson, a health economist at the University of California, Berkeley. “That should be great for the consumer, but it isn’t.”

COMPARING TWO OPERATIONS

 

‘Sticky Pricing’

The American health care market is plagued by such “sticky pricing,” in which prices of products remain high or even increase over time instead of dropping. The list price of a total hip implant increased nearly 300 percent from 1998 to 2011, according to Orthopedic Network News, a newsletter about the industry. That is a result, economists say, of how American medicine generally sets charges: without government regulation or genuine marketplace competition.

“Manufacturers will tell you it’s R&D and liability that makes implants so expensive and that they have the only one like it,” said Dr. Rory Wright, an orthopedist at the Orthopedic Hospital of Wisconsin, a top specialty clinic. “They price this way because they can.”

Zimmer Holdings declined to comment on pricing. But Sheryl Conley, a longtime Zimmer manager who is now the chief executive of OrthoWorx, a local trade group in Warsaw, said that high prices reflected the increasing complexity of the joint implant business, including more advanced materials, new regulatory requirements and the logistics of providing a now huge array of devices. “When I started, there weren’t even left and right knee components,” she said. “It was one size fits all.”

Mr. Shopenn’s Zimmer hip has transformed his life, as did the replacement joint for Mr. Catugno, a TV director; Ms. Foley, a lawyer; and Ms. Nelson, a software development executive. Mr. Shopenn, an exuberant man who maintains a busy work schedule, recently hosted his son’s wedding and spent 26 days last winter teaching snowboarding to disabled people.

His joint implant and surgery in Belgium were priced according to a different logic. Like many other countries, Belgium oversees major medical purchases, approving dozens of different types of implants from a selection of manufacturers, and determining the allowed wholesale price for each of them, for example. That price, which is published, currently averages about $3,000, depending on the model, and can be marked up by about $180 per implant. (The Belgian hospital paid about $4,000 for Mr. Shopenn’s high-end Zimmer implant at a time when American hospitals were paying an average of over $8,000 for the same model.)

“The manufacturers do not have the right to sell an implant at a higher rate,” said Philip Boussauw, director of human resources and administration at St. Rembert’s, the hospital where Mr. Shopenn had his surgery. Nonetheless, he said, there was “a lot of competition” among American joint manufacturers to work with Belgian hospitals. “I’m sure they are making money,” he added.

Dr. Cram, the Iowa health cost expert, points out that joint manufacturers are businesses, operating within the constraints of varying laws and markets.

“Imagine you’re the C.E.O. of Zimmer,” he said. “Why charge $1,000 for the implant in the U.S. when you can charge $14,000? How would you answer to your shareholders?” Expecting device makers “to do otherwise is like asking, ‘Couldn’t Apple just charge $50 for an iPhone?’ because that’s what it costs to make them.”

But do Americans want medical devices priced like smartphones? “That,” Dr. Cram said, “is a different question.”

A Miracle for Many

When joint replacement surgery first became widely used in the 1970s, it was reserved for older patients with crippling pain from arthritis, to offer relief and restore some mobility. But as technology and techniques improved, its use broadened to include younger, less debilitated patients who wanted to maintain an active lifestyle, including vigorous sports or exercise.

Narayan Mahon for The New York Times

Dr. Rory Wright at the Orthopedic Hospital of Wisconsin with two modern hip joint options.

 

In the first few decades, implants were typically cemented into place. But since the 1980s, many surgeons have used implants made of more sophisticated materials that allow the patient’s own bone to grow in to hold the device in place. For most patients, implants have proved miraculous in improving quality of life, which is why socialized medical systems tend to cover them. Per capita, more hip replacements are done in Britain, Sweden and the Netherlands, for example, than in the United States.

Motivated in part by science and in part by the need to create new markets, joint makers churn out new designs that are patented, priced higher and introduced with free training courses for surgeons. Some use more durable materials so that a patient requiring a hip implant at age 40 or 50 might rely on it longer than the standard 20 years, while other models are streamlined and require smaller incisions.

Zimmer got a big sales bump a few years ago when it began promoting its new “female knee,” a slightly slimmer version of its standard design, in an advertising campaign directed at patients. Hospitals on average pay about $800 more to buy the gender-specific knee implants, according to MD Buyline.

Many doctors say that for most patients, older, standard implants with a successful track record are appropriate. Expensive modifications make no difference for the typical patient, but they drive up prices for all models and have sometimes proved to be deeply flawed, they say.

In the last few years, joint manufacturers have faced lawsuits and have settled claims with patients after new, all-metal implants, which were meant to be more durable than the standard version, had unusually high failure rates. As for those “female knees,” a studyfeatured at the meeting of the American College of Orthopedic Surgeons this year concluded, “While we certainly use the female components frequently in surgery, we don’t detect any objective improvement in clinical outcomes.”

That is why Dr. Scott S. Kelley, an orthopedist affiliated with Duke University Medical Center, generally tries to dissuade patients who request “new, improved” joints. “I tell them: ‘That’s taking a big risk for the potential of a few percentage points of improvement. You wouldn’t invest your retirement account this way.’ ”

YOUR PERSPECTIVE

Can you relate an experience that has led you to feel that the price of American medicine does — or does not — correlate with the quality of care you received?

A Town’s Lifeblood

The power and profits of the medical device industry are on display here in Warsaw, which has trademarked itself the Orthopedic Capital of the World. Four of the big five joint manufacturers in the world are based in the United States; the other is in Britain. Three of these giants — Zimmer, Biomet and DePuy, a division of Johnson & Johnson — have their headquarters here, a town of 14,000.

An industry that began as a splint-making shop in 1895 has made Warsaw the center of a global multibillion-dollar business. The companies based here produce about 60 percent of the hip and knee devices used in the United States and one-third of the world’s orthopedic sales volume, local officials said. Nearly half the jobs in Kosciusko County, where Warsaw is, are tied to the industry. Residents joke that a mixed marriage is when one spouse works for Zimmer and the other for DePuy.

The industry’s benefits are evident. The county has the lowest unemployment rate in Northern Indiana, and the median family income of $50,000 puts it significantly above the state average. The town boasts lush golf courses and streets lined with spacious homes. The lobby of the elegant City Hall, which is in a restored 1912 bank, features plaques about device manufacturers.

“We eat, sleep and breathe orthopedics,” said Ms. Conley of OrthoWorx, which she said was set up to “plan for the future of the orthopedic industry here.” OrthoWorx’s board of directors includes executives from Biomet and DePuy.

With a high-tech industry as its lifeblood, Ms. Conley said, Warsaw needed to attract engineers and doctors from afar and train local youths for “the business.” It has upgraded the public schools and helped create programs at local colleges in orthopedic regulation and advanced machinist techniques.

Officials at OrthoWorx say the device makers do not discuss “competitive issues” among themselves, including the prices of implants, even as employees stand together watching their children play baseball. Still, it is in everyone’s interest not to undercut the competition. In 2011, all three manufacturers had joint implant sales exceeding $1 billion and spent about only 5 percent of revenues on research and development, compared with 20 percent in the pharmaceutical industry, said Stan Mendenhall, the editor of Orthopedic Network News. They each paid their chief executives over $8 million.

“It’s amazing to think there is $5 billion to $6 billion going through this little place in Northern Indiana,” said Mr. Mendenhall, adding that the recession has meant only single-digit annual revenue growth rather than the double-digit growth of the past.

Device makers have used some of their profits to lobby Congress and to buy brand loyalty. In 2007, joint makers paid $311 million to settle Justice Department accusations that they were paying kickbacks to surgeons who used their devices; Zimmer paid the biggest fine, $169.5 million. That year, nearly 1,000 orthopedists in the United States received a total of about $200 million in payments from joint manufacturers for consulting, royalties and other activities, according to data released as part of the settlement.

Despite that penalty, payments continued, according to a paper published in The Archives of Internal Medicine in 2011. While some of the orthopedists are doing research for the companies, the roles of others is unclear, said Dr. Cram, one of the study’s authors.

Although only a tiny percentage of orthopedists receive payments directly from manufacturers, the web of connections is nonetheless tangled.

Companies “build a personal relationship with the doctor,” said Professor Robinson, the Berkeley economist. “The companies hire sales reps who are good at engineering and good at golf. They bring suitcases into the operating room,” advising which tools might work best among the hundreds they carry, he said. And some studies have shown that operations attended by a company representative are more likely to use more and costlier medical equipment. While some hospitals have banned manufacturers’ representatives from the operating room, or have at least blocked salesmanship there, most have not.

No Gift Shop

There are, of course, a number of factors that explain why Mr. Shopenn’s surgery in Belgium would cost many times more in the United States. In America, fees for hospitals, scans, physical therapy and surgeons are generally far higher. And in Belgium, even private hospitals are more spartan.

When Mr. Shopenn arrived at the hospital, he was taken aback by the contrast with NewYork-Presbyterian Hospital, where his father had been a patient a year before. The New York facility had “comfortable waiting rooms, an elegant lobby and newsstands,” Mr. Shopenn remembered.

But in Belgium, he said, “I was immediately scared because at first I thought, this is really old. The chairs in the waiting rooms were metal, the walls were painted a pale green, there was no gift shop. But then I realized everything was new. It was just functional. There wasn’t much of a nod to comfort because they were there to provide health care.”

St. Rembert's, the private hospital in Belgium where Mr. Shopenn had his hip replaced for $13,660. Thomas Vanden Driessche for The New York Times

 

The pricing system in Belgium does not encourage amenities, though the country has among the lowest surgical infection rates in the world — lower than in the United States — and is known for good doctors. While most Belgian physicians and hospitals are in business for themselves, the government sets pricing and limits profits. Hospitals get a fixed daily rate and surgeons receive a fee for each surgery, which are negotiated each year between national medical groups and the state.

While doctors may charge more than the rate, few do so because most patients would refuse to pay it, said Mr. Boussauw, the hospital administrator. Doctors and hospitals must provide estimates. European orthopedists tend to make about half the income of their American counterparts, whose annual income averaged $442,450 in 2011, according to a survey by the Commonwealth Fund, a foundation that studies health policy.

Belgium pays for health care through a mandatory national insurance plan, which requires contributions from employers and workers and pays for 80 percent of each treatment. Except for the poor, patients are generally responsible for the remaining 20 percent of charges, and many get private insurance to cover that portion.

Mr. Shopenn’s surgery, which was uneventful, took place on a Tuesday.On Friday he was transferred for a week to the hospital’s rehabilitation unit, where he was taught exercises to perform once he got home.

Twelve days after his arrival, he paid the hospital’s standard price for hip replacements for foreign patients. Six weeks later he saw an orthopedist in Seattle, where he was living at the time, to remove stitches and take a postoperative X-ray. “He said there was no need for further visits, that the hip looked great, to go out and enjoy myself,” Mr. Shopenn said.

Staying Active

The number of hip replacements has risen sharply in recent years, with much of the growth coming from people younger than 65.

With baby boomers determined to continue skiing, biking and running into their 60s and beyond, economists predict a surge in joint replacement surgeries, and more procedures for younger patients. The number of hip and knee replacements is expected to roughly double between 2010 and 2020, according to Exponent, a scientific consulting firm, and perhaps quadruple by 2030. If insurers paid $36,000 for each surgery, a fairly typical price in the commercial sector, the total cost would be $144 billion, about a sixth of the nation’s military budget last year.

So far, attempts to bring down the price of medical devices have been undercut by the industry.

When Dr. Daniel S. Elliott of the Mayo Clinic decided to continue using an older, cheaper valve to cure incontinence because studies showed that it was just as good as a newer, more expensive model, the manufacturer raised its price.

“If there was a generic, I’d be there tomorrow,” he said.

With artificial joints, cost-trimming efforts have been similarly ineffective. Medicare does not negotiate directly with manufacturers, but offers all-inclusive payments for surgery to hospitals to prompt them to bargain harder for better implant prices. Instead, hospitals complain that acquiring the implant consumes 50 percent to 70 percent of Medicare’s reimbursement, which now averages $12,099, up 25 percent from $9,645 in 1993. Meanwhile, surgeons’ fees have dropped by nearly half.

With the federal government unwilling to intervene directly, some doctors and insurance plans are themselves trying to reduce the costs by mandating preset prices or forcing more competition and transparency.

After concluding that hip replacements billed at $100,000 yielded no better results than less expensive ones, the California Public Employees’ Retirement System, or Calpers, told members that it would pay hospitals $30,000 for a hip or knee replacement, and dozens of hospitals have met that number.

Dr. Wright’s orthopedic hospital near Milwaukee has driven down payments for joints by more than 30 percent by resolving to use only two types of hip implants and requiring blind bids directly from the manufacturers; part of the savings is passed on to patients.

The Affordable Care Act tries to recoup some of the medical device manufacturers’ profits by imposing a 2.3 percent tax on their revenues, effective this year. But Brad Bishop, the executive director of OrthoWorx and a former Zimmer executive, said that the approach would harm an innovative American industry, and that the cost would ultimately be borne by joint replacement patients “whose average age is 67.” He argued that the best way to reduce the cost of joint replacement surgery was to rescind the tax and decrease government interference.

The medical device industry spent nearly $30 million last year on lobbying, according to the Center for Responsive Politics. The Senate moved to repeal the tax, and the House is expected to take it up this fall. The bill’s supporters included both senators from Indiana.

Mr. Shopenn’s new hip worked so well that a few months after returning from Belgium he needed a hernia operation — a result of too much working out at the gym. He was home by 4 p.m. the day of the outpatient surgery, but the bill came to $16,500. Though his insurance company covered the procedure, he called the hospital’s finance department for an explanation.

He remembers in particular a “surreal” discussion with a “very nice” administrator about a $750 bill for a surgical drain, which he called “a piece of plastic in a sealed bag.”

“It was mind-boggling to me that the surgery could possibly cost this much,” he said, “after what I’d just done in Belgium.”

(c) 2013 New York Times

For the Love of Sisters

Darien at 18My sister, Darien, was on the homecoming court, and president of our high school's chapter of the National Honor Society. Geeks, freaks, and football quarterbacks all fell in love with her because she made every guy feel as if he had her full attention and undying admiration. She also had a cadre of BFFs, some whom, to this day, still are close with her.

I was the rebellious little sister, the one who felt as if she were an outcast. And yet, I was never jealous, just proud to call her my big sis. Maybe because, despite all she had going for her, she made me feel as if I were the most special person in her life.

Although we now live some 2,855 miles apart, we try to talk frequently, and to see each other at least once a year. Our chats are what you'd expect. We discuss the latest glories of our children, our current worries, a triumph or two, and every now and then a shared memory.

Would I say that we're close? I'd say close enough to love and appreciate each other, and know our boundaries. She lives the life she wants, and I do, too. We respect that about each other, and don't try to meddle in each other's lives.

So, yeah, this article from the always insightfull Deborah Tannen, which ran recently in the New York Times, resonated with me.

Read it and enjoy. Then scroll below to watch Rosemary Clooney and Vera Ellen sing the song, "Sisters," from the movie "White Chritsmas".

Then call your sister,

–Josie


(ISBN: 9781439173176)

In bookstores June 1, 2010. Order it TODAY!

"Hollywood's got nothing on the cast of characters living in the bedroom community of Paradise Heights, who have the secrets, sex, money and scandal of an OK! Magazine cover story. Josie Brown is a skilled observer whose clever dialogue and feisty style make for truly entertaining reading." –Jackie Collins, Hollywood Wives

October 25, 2010

Why Sisterly Chats Make People Happier

By DEBORAH TANNEN

“Having a Sister Makes You Happier”: that was the headline on a recent article about a study finding that adolescents who have a sister are less likely to report such feelings as “I am unhappy, sad or depressed” and “I feel like no one loves me.”

These findings are no fluke; other studies have come to similar conclusions. But why would having a sister make you happier?

The usual answer — that girls and women are more likely than boys and men to talk about emotions — is somehow unsatisfying, especially to a researcher like me. Much of my work over the years has developed the premise that women’s styles of friendship and conversation aren’t inherently better than men’s, simply different.

A man once told me that he had spent a day with a friend who was going through a divorce. When he returned home, his wife asked how his friend was coping. He replied: “I don’t know. We didn’t talk about it.”

His wife chastised him. Obviously, she said, the friend needed to talk about what he was going through.

This made the man feel bad. So he was relieved to read in my book “You Just Don’t Understand” (Ballantine, 1990) that doing things together can be a comfort in itself, another way to show caring. Asking about the divorce might have made his friend feel worse by reminding him of it, and expressing concern could have come across as condescending.

The man who told me this was himself comforted to be reassured that his instincts hadn’t been wrong and he hadn’t let his friend down.

But if talking about problems isn’t necessary for comfort, then having sisters shouldn’t make men happier than having brothers. Yet the recent study — by Laura Padilla-Walker and her colleagues at Brigham Young University — is supported by others.

Last year, for example, the British psychologists Liz Wright and Tony Cassidy found that young people who had grown up with at least one sister tended to be happier and more optimistic, especially if their parents had divorced. Another British researcher, Judy Dunn, found a similar pattern among older adults.

So what is going on?

My own recent research about sisters suggests a more subtle dynamic. I interviewed more than 100 women about their sisters, but if they also had brothers, I asked them to compare. Most said they talked to their sisters more often, at greater length and, yes, about more personal topics. This often meant that they felt closer to their sisters, but not always.

One woman, for example, says she talks for hours by phone to her two brothers as well as her two sisters. But the topics differ. She talks to her sisters about their personal lives; with her brothers she discusses history, geography and books. And, she added, one brother calls her at 5 a.m. as a prank.

A prank? Is this communication? Well, yes — it reminds her that he’s thinking of her. And talking for hours creates and reinforces connections with both brothers and sisters, regardless of what they talk about.

A student in my class recounted a situation that shows how this can work. When their family dog died, the siblings (a brother and three sisters) all called one another. The sisters told one another how much they missed the dog and how terrible they felt. The brother expressed concern for everyone in the family but said nothing about what he himself was feeling.

My student didn’t doubt that her brother felt the same as his sisters; he just didn’t say it directly. And I’ll bet that having the phone conversations served exactly the same purpose for him as the sisters’ calls did for them: providing comfort in the face of their shared loss.

So the key to why having sisters makes people happier — men as well as women — may lie not in the kind of talk they exchange but in the fact of talk. If men, like women, talk more often to their sisters than to their brothers, that could explain why sisters make them happier. The interviews I conducted with women reinforced this insight. Many told me that they don’t talk to their sisters about personal problems, either.

An example is Colleen, a widow in her 80s who told me that she’d been very close to her unmarried sister throughout their lives, though they never discussed their personal problems. An image of these sisters has remained indelible in my mind.

Late in life, the sister came to live with Colleen and her husband. Colleen recalled that each morning after her husband got up to make coffee, her sister would stop by Colleen’s bedroom to say good morning. Colleen would urge her sister to join her in bed. As they sat up in bed side by side, holding hands, Colleen and her sister would “just talk.”

That’s another kind of conversation that many women engage in which baffles many men: talk about details of their daily lives, like the sweater they found on sale — details, you might say, as insignificant as those about last night’s ballgame which can baffle women when they overhear men talking. These seemingly pointless conversations are as comforting to some women as “troubles talk” conversations are to others.

So maybe it’s true that talk is the reason having a sister makes you happier, but it needn’t be talk about emotions. When women told me they talk to their sisters more often, at greater length and about more personal topics, I suspect it’s that first element — more often — that is crucial rather than the last.

This makes sense to me as a linguist who truly believes that women’s ways of talking are not inherently better than men’s. It also feels right to me as a woman with two sisters — one who likes to have long conversations about feelings and one who doesn’t, but who both make me happier.

Deborah Tannen is a professor of linguistics at Georgetown University and the author, most recently, of “You Were Always Mom’s Favorite! Sisters in Conversation Throughout Their Lives.”

 

The Pulitzer Prize and the Novel TINKERS: What Dreams May Come in Publishing

Tinkers One of the hardest things to do is write a novel. I guess that's why everyone attempts to do so.

Even when you spin prose into gold, like Paul Harding has done with his book, Tinkers, you still have to overcome the reticence of those publishing industry decision makers (agents, then editors) that your book will somehow catch the zeitgeist and find an audience.

Even when word of mouth is enthusiastic, a book has to compete with those tried-and-true commercial (operative word here) bestsellers who come out the same month and also have three very big things working in their favor: "co-op" (the marketing push that gets a book on the front table beside the door, where 70 percent of most books are sold); vast distribution (not just independent bookstores, but large purchases from the chains, Barnes & Noble and Borders Books, as well as, perhaps some big box store sales, from Wal-Mart, Costco or Target; and most important of all author name recognition (James Patterson: I'm lookin' at YOU...)

Needless to say, I'm always happy to read a success story about a book that might have been mired in oblivion if it didn't get that extra push from somewhere. In the case of Mr. Harding, he had an angel of an editor (yes, they do exist: I am proof of that — thank you Ms. M, of S&S!). He also had a sales person on his publishers team who became his advocate in the wilderness; and those at the front line of defense–the independent bookstores–recognized his genius, too. That is to be expected: they love books with a passion, and and always the first to recognize a great one and put the wind beneath its sales (pun intended, thank you).

The New York Times has done a marvelous job of telling Mr. Harding's journey from first book oblivion to Pulitzer prize winner. It is also quick to give a mea culpa for missing out in reviewing the book for its readers.

It's not in 3-D, and there is no three-act arc, but that's okay. I can't wait to read it.

(And maybe that's why),

—Josie

http://twitter.com/JosieBrownCA




SecretLives400 Josie's
Next Book: Secret Lives of Husbands and Wives

Simon & Schuster/Downtown Press

(ISBN: 9781439173176)

In bookstores June 1, 2010. Order it
TODAY
!

"Hollywood's got nothing on the cast of characters living in
the
bedroom community of Paradise Heights, who have the secrets, sex, money
and scandal of an OK! Magazine cover story. Josie Brown is a skilled
observer whose clever dialogue and feisty style make for truly
entertaining reading."

Jackie
Collins
, bestselling author of Hollywood Wives and Poor Little Bitch Girl

April 19, 2010



IOWA CITY — Six years ago Paul Harding
was just another graduate of the Iowa Writers’ Workshop with a quiet
little novel he hoped to publish. He sent copies of the manuscript, in
which he had intertwined the deathbed memories of a New England clock
repairer with episodes about the dying man’s father, to a handful of
agents and editors in New York. Soon after, the rejection letters
started to roll in.

“They would lecture me about the pace of life today,” Mr. Harding
said last week over lunch at a diner in this college town, where he is
now teaching at the workshop. “It was, ‘Where are the car chases?’ ” he
said, recalling the gist of the letters. “ ‘Nobody wants to read a
slow, contemplative, meditative, quiet book.’ ”

His manuscript languished in a desk drawer for nearly three years.
But in perhaps the most dramatic literary Cinderella story of recent
memory, Mr. Harding, 42, not only eventually found a publisher — the
tiny Bellevue Literary Press — for the novel, “Tinkers,” he also went
on to win the Pulitzer Prize for fiction last week. Within an hour of the Pulitzer announcement, Random House
sent out a news release boasting of the two-book deal it had signed
with Mr. Harding late in 2009. A few days later the Guggenheim
Foundation announced he had received one of its prestigious fellowships.

The early rejection “was funny at the time,” Mr. Harding said. “And
even funnier now.” Mr. Harding, a onetime drummer for a rock band, is
far too discreet to name any of the agents or editors who wouldn’t
touch his work a few years ago.

But he is quick to praise those who helped “Tinkers” become a
darling of the independent bookstore circuit, including Erika Goldman,
the editorial director of Bellevue, whom Mr. Harding described as a
“deeply empathetic reader”; Lise Solomon, a sales representative in
Northern California for Consortium, the book’s distributor, who
passionately advocated for the novel with booksellers; and the
booksellers and critics who embraced the book early on.

Although “Tinkers” sunk under the radar in some quarters (including
The New York Times, which did not review it), it made several year-end
best lists, including NPR’s best debut fiction and The New Yorker
magazine’s list of reviewers’ favorites. According to Nielsen Bookscan,
which tracks about 70 percent of retail sales, “Tinkers” sold 7,000
copies before the Pulitzer announcement.

Now many independent booksellers are claiming Mr. Harding’s victory
as their own. “This shows how indie bookstores truly are the ones that
can be movers and shakers when it comes to a book,” said Michele
Filgate, the events manager at RiverRun Bookstore in Portsmouth, N.H.,
who raved about the book on Bookslut, a literary blog. As it turns out,
it was Ms. Filgate who first told Rebecca Pepper Sinkler, a former
editor of The New York Times Book Review and chairwoman of this year’s
Pulitzer fiction jury, about “Tinkers” at a book-reviewing workshop Ms.
Sinkler led in Manchester, N.H., last April.

In classes at Iowa Mr. Harding has become an instant celebrity, of
course, but also, a reassurance. Marilynne Robinson, the Pulitzer
Prize-winning author of “Gilead,” Mr. Harding’s former teacher and now
a friend, said last week in her workshop office that she had already
repeated Mr. Harding’s story several times.

“One of the problems I have is making my students believe that they
can write something that satisfies their definition of good, and they
don’t have to calculate the market,” Ms. Robinson said. “Now that I
have the Paul anecdote, they will believe me more.”

Mr. Harding is an avid reader of 19th-century novels, theological
works (Karl Barth is his current favorite) and physics, making it hard
to believe his claims that he was a poor student at the University of Massachusetts, Amherst, where he majored in English. The university does confirm that he took six years to complete his degree.

Wearing wire-framed glasses and a white button-down shirt tucked
into Levi’s, he talked effusively, the antithesis of the taciturn
father and son portrayed in “Tinkers,” a novel with sparse dialogue and
large portions set inside the characters’ heads.

Framed partly as a deathbed vigil for George Washington Crosby, a
clock repairer, the book wanders through time and consciousness,
describing in fine-grain detail its rural Maine setting and the
epileptic fits of George’s father, Howard, an old-time tinker who
traveled the countryside by wagon.

The story’s genesis came from Mr. Harding’s own grandfather, who
grew up in rural Maine and whose epileptic father abandoned the family
when he learned that his wife, Mr. Harding’s great-grandmother, planned
to send him to an asylum.

Mr. Harding spent his childhood in Wenham, Mass., a town not far
from where he lives with his wife and two sons, and he went fly-fishing
in northern Maine during the summers. He apprenticed with his
grandfather in clock repair, and after graduating from college he
recorded two albums and toured Europe with Cold Water Flat, the band he
helped form at UMass.

The band fell apart (the usual: creative differences), and Mr.
Harding decided to scratch another itch. He enrolled in a summer
writing course at Skidmore College, where he took classes with Ms.
Robinson.

With his application for the Iowa Writers’ Workshop, he submitted two stories, one of which was his first stab at “Tinkers.”

But for most of his time in Iowa Mr. Harding worked on a novel about
a 12-year-old girl who disguised herself as a boy in order to work in a
Mexican silver mine during the 16th century. As he graduated, he
realized the novel didn’t work.

Once again the story of his grandfather beckoned. Turning back to
it, he said, “was just such a sense of relief to not have to go looking
in history books.”

After his first son was born and he was teaching expository writing to undergraduates at Harvard
and creative writing to night-school students, the novel became an
extracurricular project. “It got so it was guerilla writing,” Mr.
Harding said. “I could flip open the laptop and start writing
anywhere.” He wrote on bookmarks and the backs of receipts,
transcribing the scraps into the computer later.

Finally, one Saturday night, he printed out his mishmashed computer
file and laid it out on the living-room floor. Nursing a few fingers of
whiskey, he cut up the document, stapling and taping sections into the
structure that ultimately made it to publication.

Shortly after Ms. Goldman finally agreed to buy the book — paying a
$1,000 advance — things began to go right. Ms. Robinson, who rarely
gives blurbs, gave “Tinkers” a stellar one, calling it “truly
remarkable.” Independent booksellers started to push it.

Meanwhile Ms. Sinkler began to champion “Tinkers” among her fellow Pulitzer jury members, Charles Johnson, the author of the National Book Award-winning “Middle Passage,” and Laura Miller, a senior writer at Salon.com.
“I think that sentence for sentence, it was the most beautifully
written and most gorgeous use of language of any of the books we looked
at,” Ms. Sinkler said in a telephone interview.

Mr. Harding is working on his next novel, set in Enon, the fictional
town where George dies, focusing on one of George’s grandsons, Charlie,
and Charlie’s daughter, Kate.

The Pulitzer may change some worldly things, he said, but not how he works.

“I sort of feel like I know how I got here, every step of the way,”
Mr. Harding said. “Something like this can befall me, and it won’t be
catastrophic success.”



Copyright 2010
The New York Times Company

Art from the Heart: Suburban Kitsch, Immortalized in an ’80s Art Review

Eric_Fischl_Dining_Room_Scene_2_2003 While researching my next novel, EXTRACURRICULAR, I came across a fabulous review that ran in the New York Times about the same time my protagonist in that book would have been growing up and reveling in the kind of life that, she hopes,  moves beyond suburbia and its aspiring classes.

The book warps speeds into the present. Have we really changed that much? If you want my opinion, you'll have to read the book to find out.

Of course, I'll want you to read Secret Lives of Husbands and Wives first.

In the meantime, enjoy this blast from the past: 1989, to be exact. Or, as those of us who lived through it, we remember that it was more than just Madonna, mullets and John Hughes movies that idealized the essence of teendom.

There was Seinfeld too.

—Josie




SecretLivesCoverFinalWeb   Josie's
Next Book: Secret Lives of Husbands and Wives

Simon & Schuster/Downtown Press

(ISBN: 9781439173176)

In bookstores June 1, 2010. Order it
TODAY
!

"Hollywood's got nothing on the cast of characters living in
the
bedroom community of Paradise Heights, who have the secrets, sex, money
and scandal of an OK! Magazine cover story. Josie Brown is a skilled
observer whose clever dialogue and feisty style make for truly
entertaining reading."

Jackie
Collins
, bestselling author of Hollywood Wives and Poor Little Bitch Girl

July 23, 1989
ART

IDEALLY, suburbia is a place that has the benefits of both rural
and city living but none of their drawbacks. Books taking issue with
that run from the socially scientific to the comic, and there are many
of them. But even more abundant is art about the subject, which
invariably takes the form of caricature, be it an affectionately witty
cartoon in The New Yorker or a cruel photograph by Diane Arbus.

But an entire exhibition about suburbia – this is almost unheard
of. Yet, at the Whitney Museum in Stamford, is ''Suburban Home Life:
Tracking the American Dream,'' a show that made its debut in Manhattan
at another Whitney branch.

Assembled by five Helena Rubinstein Fellows in the Independent
Study Program of the Whitney, this selection of roughly 70 paintings,
sculpture, architectural visualizations and video commemorates well
enough the surge to the suburbs after World War II. But the catalogue is
a problem: the discourse is glib and a bit smart-alecky.

Apparently, suburbia is an exclusively American manifestation for
the curator, Miwon Kwon. She writes as if it had nothing to do with the
European Romantic movement, itself a byproduct of and a reaction to the
Industrial Revolution. Nevertheless, she itemizes the familiar pros and
cons: peace and quiet versus the monotony of look-alike housing (as
opposed to the infinite variety of, say, high-rise living in Manhattan);
serenity on the surface versus abnormality below (see Eric Fischl's
painting of hanky-panky by the swimming pool), and so on.

At the same time, Ms. Kwon makes it clear that for all the
criticism leveled at it – mostly by intellectuals and artists – suburbia
continues to flourish. The curator takes the conventional view of the
development as the realization of the American Dream (as if the desire
to own a house and the land it stands on were peculiar to this country)
but does not touch on the almost cicadian regularity with which it is
enacted. After all, countless couples settle in the suburbs in order to
rear children, only to have them bolt for the city at their earliest
opportunity. Those children go back, of course, when the time comes to
rear children of their own who, in turn . . .

In her essay, Sarah Bayliss, a Rubinstein Fellow, probes suburban
domestic life for materialism, hypocrisy and the oppression of women,
citing as evidence advertising from the 1950's on, the photo-realist
Robert Bechtle's painting of an average American family posing with its
Pontiac, and more recent ironies by the photographers Judy Dater and
Sandy Skoglund. All highlight, Ms. Bayliss says, ''the need for an
alternative way to perceive women and home life; one that exists
independently of material domestic conventions.''

Counting the psychological cost of the good life, Christopher
Robert Hoover's essay attributes to suburbia a failing that is endemic
in egalitarian societies: to revere the theory of individualism while
recoiling from its practice. In any case, Mr. Hoover sees proof of the
suburban pudding in movies like ''A Nightmare on Elm Street,''
''Poltergeist'' and ''Dawn of the Dead.'' Five hours of horror
transferred to tape, the films go with the show and, taken with the
tapes by contemporary videoists and a few documentaries, the total
viewing time is close to nine hours. (The museum is open from 11 A.M. to
5 P.M.) Equally obvious is the collective bias of the curators, but
though they are against capitalism, they subscribe to its class system.
For example, there is a model of Frank O. Gehry's house in California, a
large, rambling lean-to where the walls are as likely to be made of
corrugated metal and chain-link fence as of wood. The architect is
quoted expressing disingenuous surprise at the smugness of neighbors who
do not like his structure. He notes that when he points out to them
that he uses the same industrial materials that they keep lying around
their backyards in the form of boats, campers and the like, they reply,
''Oh, no, that's normal.''

Then there is Diane Arbus's famous black and white photograph, ''A
Family on Their Lawn One Sunday in Westchester, N.Y.'' – a litter-strewn
lawn that looks more like a picnic ground. Suburbanites or not, the
movie-star type blonde and her distracted man would doubtless seem as
bored and estranged if they were at Coney Island for the day.

With their poker-faced renderings of houses in color, the
photographers William Eggleston, Tom Bernard, Steven Izenour and Stephen
Shore hold suburbia at arm's length for a more clinical investigation.
The architectural firm of Venturi, Rauch and Scott Brown offers color
pictures of Levittown housing with a caption that, in effect, advises
the cognoscenti to grin and bear it. The residents, they say, are happy
with their homes and the improvements they make are consonant with the
designs. Incidentally, when compared with the chip board structures seen
recently by the reviewer in New Jersey, the show's houses look pretty
good.

Outside of Mr. Gehry, the show ignores the suburban upper crust;
splendid villas are nowhere to be seen. Aside from the aerial view of
Levittown taken by an anonymous photographer, beauty tends to be in the
eye of the artist – Ed Ruscha's nocturnal view of a shadowy black
mansion with a large red ''F'' plastered to its facade; the terrace of
toy houses made by James Casebere and photographed by him in black and
white, along with a similarly staged scene of mock toys filling a room.

James Wines, who heads Site, the architectural collective
responsible for the Best Products Company showrooms, is represented by a
mysterious charcoal drawing of skyscrapers standing beside water. The
facade of one has been removed to reveal landscapes within studded
mansions. An architectural whimsy? A proposal for saving nature from
developers by keeping it indoors? Never mind, the image is the ''after''
to Frank Lloyd Wright's ''before'' – two views of an urban fantasy
where the automobiles look like miniature paddlewheelers and the
helicopters like U.F.O.'s.

Doubts as to the show's mission should be resolved by Jeff Koons's
ghastly ''Winter Bears.'' A boy bear and a girl bear carved by another
hand, the two evidently stand for the kitsch preferred by suburbanites.
This highlights the production's greatest weakness, which is to imply
that suburbia is a lower-middle class enterprise when in fact it has all
the usual social gradations.

There is, however, a problem and Mr. Hoover comes the closest to
identifying it when he observes that the planned communities formerly
regarded as an ''attractive alternative'' to rural and urban living are
now seen as a ''homogenizing growth over the entire social sphere.''

''Suburban Home Life: Tracking the American Dream'' will remain at
the Whitney Museum, 1 Champion Plaza, Stamford, through Sept. 6.

Photo of work by Eve Arnold; work by Stephen Shore

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