Archive for December, 2013

Film Review: Nebraska

December 25, 2013

Alexander Payne’s new film demonstrates the artistic virtues of modesty.  His last two films, as well made as they were, disappointed: with About Schmidt, a loose meandering narrative winds up woefully pretentious; but with his next film, The Descendents, a tighter focus didn’t help because the dramatic payoff was so weak. Finally, Payne discovers his strengths again. Nebraska benefits from its control of tone and structure, guiding us through a simple story of a son’s newfound connection to his elderly father. The modesty pays off because we become absorbed by believable characters who are presented in the simplest dramatic terms.  Bob Nelson’s script never hits a false note. The resolution of the story satisfies because nothing is falsely intensified for a cheap emotional payoff. We see that only one of its characters, the son, changes at all during the course of the film, which must have been a hard sell to producers because audiences have become so used to being spoon-fed the uplift of phony reconciliations.

The story concerns Woody, a feeble, elderly drunk (Bruce Dern) barely surviving with his scolding wife, Kate (June Squibb), on their farm. His son, David (Will Forte), a neer-do-well himself, is at least not self-destructive like his dad, but is only able to hold down a sales job he hates, and has no real relationships. When Woody mistakenly thinks he won a million dollars, he browbeats David into driving him to Omaha to collect his “winnings”. David does it to humor him, even though he dreads the moment when Woody learns the truth.  Along the way, they encounter the people that Woody knew from his past, a collection of aimless, mean-spirited losers who stayed in the town he had left years before. Dim bulbs all, with two exceptions: Ed (Stacy Keach), the dominant force in the town, who is even more mean-spirited, but cunning and dishonest enough to rule the roost, and Peg (Angela McEwan), Woody’s first girlfriend, who has stayed to run the town paper.

Filmed in black and white, with minimal camera movement, Nebraska shows the extent that people can become attached to the land, and how it diminishes them. The sky in the American plains is vast and oppressive; the land is barren, without promise. Why do they stay?   We get no clear answer to that, and a good thing too.  Any person of average intelligence could give a theory of about it – say, the need to be near family, the comfort of the familiar – but to have a character actually say those things would be fatal. Payne lets the story bring the audience to that conclusion, through the skills of his cast. There are a number of “Leo McCarey” moments. My favorite is when Kate visits the town graveyard and repeats, with absolute delight, every salacious bit of gossip she can recall about those buried there.

Whatever Bruce Dern’s Oscar chances, we already know it’s the role of his career. He is especially fine near the end, when he tells his son  what he wanted the money for. This speech forges a steel resolve in his son, leading to the film’s climax. Part of the film’s success is in seeing just how pathetic Woody’s “triumph” really is, but why it is so important to him anyway. But the most important character is David, who actually discovers new strengths in himself; nobody else discovers much of anything. Will Forte is certainly appealing, but only adequate in the role. He’s not “there” yet. He doesn’t yet convey the sense of someone being tested from within, so that David’s final gesture is fully prepared for, even as it surprises.


Obamacare: The Second War

December 5, 2013

We hardly expect to see obscenities in the Gray Lady, much less on the front page, but there it was, almost shimmering in its power: “redistribution”. Esteemed commentator John Harwood took up the challenge by describing how the Obama administration sidled around the dreaded word when selling the ACA to the public in 2010, and ever since, and by exposing just how dishonest this was, since redistribution is such an essential part of the law (NYTimes, 11/24/13, p.1). Of course, a brief essay could only do so much in terms of analysis, and Harwood should be given half a bravo for his frank terminology in pointing out that the cost of health insurance will increase for many of us because we are subsidizing those who are not paying their full cost. The subsidy is mainly channeled to two groups: those who cannot afford coverage, and those shunned by insurers as too risky because of a prior condition. So this is the cost part of the “redistribution”.

But this is only half the story. Once the ACA starts to operate as intended – and, yes, I think it will eventually – we’re going to see the other kind of “redistribution”, one that I haven’t heard much about even from its opponents. I am referring to the redistribution of the care itself, viz. what we are actually paying for with our premiums. 

To put it bluntly, the consequences of redesigning the entire marketplace for a commercial service will cause the kind of discomfort that this blog is named for. And, yes, medical care, whatever else it may be, is a commercial service. It remains ruled by the marketplace, and I am confident we will see major changes in how quality medical care is “re”-distributed, probably within two years. Unlike Social Security, which is a universal pension program, health care cannot be standardized into one government-approved delivery system. Social Security exists alongside employer pension plans and private ones, but the end product for all is still delivered in only one form: money. While the amounts may differ, each dollar unit is spent in exactly the same way. For that, one dollar is as good as another.

Not so with health care. What you are paying for is the full “experience” of medical treatment. This is only measured by how you feel when the treatment is over, once you get back to living your life. Which usually means not thinking about your health at all until the body – that pesky thing! – forces you back to the doctor’s office. At that point, the measure of “quality” health care is not only how much you pay for it but also whether the problem is fixed and, of at least equal importance, what the total experience feels like from the patient’s point of view.

There are a lot of components to that experience, among them: the location of the treatment facility; the comfort level at the facility; the amount of wait time; the amount of time with the treating professional; the reputation and level of experience of that professional; the confidence you feel, both during and after treatment, that you are receiving the best care available for you at that time, for that problem. And there’s another part, the one nobody likes to talk about: who else is waiting with you to get treated by those same people.

My feeling is that, once Obamacare gets going, there will be lots of attention paid in the media to finding out the “number ranking” of the providers, and the results will be this: the people who are receiving the most care by the HIGHEST-rated professionals are OVERWHELMINGLY those who are paying more for it. Conversely, the ones getting the most care from the LOWEST-rated professionals are the underclass, who are being subsidized by the taxpayers. This divergence will come about because the market forces that are left untouched, or relatively untouched, under the plan will converge to activate a kind of “counter-redistribution” within the health care marketplace. Of course, this will be totally unacceptable to the progressives, who will raise bloody hell at the continuing inequality in the distribution of a “basic right” in our society.

Thus, the second war of Obamacare. But the combatants will be different this time. The progressives were always waiting for the data to show the divergence because they never believed Obamacare would be able to prevent it. They were always looking to impose the full Cuba-style egalitarianism, namely the single payer system. Rather than “adjusting” the law, they will use the data to try to kill it and replace it with single-payer. The moderate Democrats and (admittedly few) Republicans who want to preserve the law will be the main target of their rage, while the right-wing minority who always hated it will just snipe at both armies sporadically.

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