Understanding and Reducing Poverty

In Vermont’s early years, poverty was managed by an elected “Overseer of the Poor” until we passed the Social Welfare Act of 1967, which formally relieved communities of responsibility for care of their poor and ended the office of “Overseer.” The last “poor farm” closed in 1968.

Growing up in a middle-class family in Lamoille County, I knew people who were poor – though they’d have hardly described themselves that way. Many were grateful for the little they had and took both pleasure and pride in work, family, food, and neighbors.

My father ran the small Union Carbide office in Morrisville and was twice offered a whopping raise to move to Manhattan, but declined each time. His life was defined by his community, not his assets.

In 1958, Tom Watson opened the IBM plant in Essex and began hiring Vermonters at unprecedented salaries. Many folks sold their struggling hill farms and moved or commuted to the new plant but others declined to leave neighbors, land, and animals.

Our cousin, Sister Ste. Alphonse took vows of poverty, chastity, and silence. But even so, we kids knew her as a joyous presence in our lives when she came to visit.

Poverty is remarkably nuanced. For some, it may be a chosen lifestyle, but for most it’s destitution – an unwanted economic oppression with no exits.

If we wish to alleviate its impacts, and change the social and economic conditions that impose it, we must first listen to those whom we perceive as poor.

The essence of giving is asking someone what they need, not imagining or prescribing it. Our understanding of poverty may well be distorted by our own lack of any experience with exigency or need. And those we see as poor may be offended by that characterization and resent being “rescued”.

And while we’re defined by our differences as human beings, our communities are still collapsing under the weight of our gross financial inequities. Noblesse oblige prompts us to alleviate the effects of poverty but morality obliges us to change the causes of it. To accomplish either of these goals, we must first understand its variability.

And in one historical footnote of uncommon good sense, it’s interesting to note that in an effort to ensure fairness and appropriate empathy, the town of Richmond used to maintain the tradition of electing Overseers who at some point had themselves needed help.

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Getting Closer in Vermont…Affordable Health Care for All.

When I was young, Morrisville had three doctors, two dentists and the wood-framed, four-story, Copley Hospital, which had the town’s first elevator. Theoretically, there was competition, but price wasn’t the criteria by which we chose our providers, it was familiarity and trust. All docs pretty much charged the same for an office visit. Our doctor was our trusted friend and on his advice, we went to Burlington for major surgeries or life-threatening illnesses.

In the ‘70s, when cities became employment and retail hubs connected by new highways, community hospitals began to compete for patients. Medical technology became a marketing edge but also a major cost-escalator. If Newport got the newest M.R.I., then St Albans wanted it as well. New medical technology ballooned costs and spurred more utilization. Relations between community hospitals and tertiary care hospitals grew toxic in this new competitive environment.

Acknowledging the failure of competition and for-profit services, Vermont set out to design a regulated network of distributed medical services based on cost, access, and need. Regulators made two strategic decisions: first, Certificates of Need would not be issued to for-profit hospitals; second, Vermont would abandon the competitive model in favor of an integrated, collaborative network with regulated investments in technology, appropriate to cost, utilization, and need. And despite detractors’ claims, this system is working.

When we retire “fee-for-service” billing in favor of paying providers to maintain healthy communities, we move away from costly medical interventions and toward prevention – which history has always shown to be less expensive and traumatic than remediation.

But with our absurdly short political cycles, it’s easy to lose our institutional memory and forget where we’ve come from and where we’re going. Many Vermonters would like to see a national health care system like the rest of the civilized world. But short of that, we’ve tried to optimize what we have, to ensure affordable and accessible health care for all. Recent efforts to second-guess and demonize the network we’re building only distract us from our goals.

Many are too young to remember how America was wired for phone and electricity by regulated for-profit monopolies which could earn a fair return on their investment while being required to service everyone equally. The Rural Electrification Act and Universal Service Fund brought light, power, and communications to all Americans. We can do the same in health care.

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Children should never be allowed to name pets

I’m not obsessive about pet names. I usually leave them to the kids, perhaps with a little parental guidance, like avoiding undistinguished names likeFluffy or Spot, or ambiguous names like Pussy, or aggressive names likeGenghis or Trojan.

So, when we drove up to Frank Bryan’s hill farm in Starksboro to choose a tiger kitten from the dwindling array of barn cats left after an onslaught of fishers had depleted his neighborhood of most domestic pets under forty pounds, we decided on a double-toed tiger male and brought him home in the arms of my then 5-year-old daughter, Anna.

Looking small and confused on the floor of our kitchen, the still nameless kitten relieved himself mightily. I muttered under my breath, “Oughtta name him sphincter.”

Anna chirped, “What’s that?”

Now with children, parental duty demands honest and forthright answers, which I delicately provided.

Anna and her slightly older brother Steve were delighted with their vocabulary addition, which neither could pronounce, so our new kitty was henceforth known as “Phinxter.”

Luckily, I remembered from the legion of domestic house cats we’d had since I was Anna’s age that Phinxter would need shots. I made an appointment with the local vet and, to imbue my children with a sense of responsibility for their new pet, told them they were to accompany Phinxter to the vet. I’d drive and answer any difficult questions.

The avuncular vet knew the drill. He bent down over his computer keyboard to meet Anna’s smile as she held Phinxter in her arms and asked, “What’s your kitty’s name?”

To my embarrassment and his astonishment, in her 5-year-old voice, Anna pronounced “Sphincter.”

The vet blinked, but knew not to repeat the offending word in front of children. He just looked at me quizzically as if wondering whether to call the authorities.
I, too, avoided the offending word and simply nodded.

He shook his head and carefully hunt-and-pecked the word it into his computer.

After a terse lecture on the prevalence of feral ticks and a futile effort to sell us overpriced cat food endorsed by his trade association, I drove home with the children in the back seat, taking turns comforting their wounded pet.

The following year to my confusion, we received a blue, computer-generated. merge-purge, postcard from the vet that said:

Dear Mr. and Mrs. Schubart, it is time to bring your Sphincter in for a rabies shot.

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“We have met the enemy and… “

Like many, I wake up each morning and check online news sources for the latest read on the health of our nation. Like the addictive eater I am, I gobble up the latest ethical transgression, human rights abuse, crony favor, or governmental misbehavior. This menu of public service abuses sets the baseline for my thoughts, mood, and conversations for the day and I take satisfaction in thinking how right I am and how wrong so many of my fellow citizens are. It’s like scanning the country’s electronic medical record so I can keep up-to-date on its wellbeing.

But then I remember that it’s rarely the acute medical event that ends our lives. The heart attack, accident trauma, or stroke may bring us to the emergency room, but our lives end usually as the result of chronic deteriorations deep within us. It’s a medical metaphor just as applicable to the slow and invisible deterioration of our body politic.

The American hegemony will end not with a bang but with a whimper, and it won’t be due to any single administration. As Pogo said, “We have met the enemy and he is us.” While we focus on the acute symptoms, we seem to be missing the chronic decay of the values that made us a great nation.

The metastatic creep of corruption in the halls of our legislatures and Congress as business interests overwhelm those of ordinary citizens, the rising chorus of xenophobic voices, the imposition of closed-door secrecy – often all-male – these are the invisible cancer cells taking root deep in our body politic. Unlike the warnings of acute symptoms, they can remain largely unnoticed until they kill us.

Beyond fighting the latest abuses of executive, legislative, and judicial power, we must also be vigilant and call out the subcutaneous deterioration of values that once made us a beacon to the world: the welcome we extend to the oppressed, the difference between public and self-service, our shared belief that fairly-regulated free-market capitalism offers everyone a chance to thrive, and our commitment to caring for those not equipped to make it on their own.

We’ll survive most of the acute health alerts we experience during our lives but it’s harder to see how we’ll survive the slow chronic deterioration of values and ethics that are eating away at the cellular structure of our democracy.

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What Lies Beneath?

I’m losing my war against field mice. This time they chewed through the power cord to the freezer. So, with the freezer thawing, it’s time for a family cookout.

I’m pulling chunks of hoarfrost-covered packages out and sorting them on the garage floor. The 3, 4, 5-year old labels are illegible. Let’s see, this looks like liver – but lamb, venison, beef, or pork? These round things must be organs. That’s a chicken, or is it the wild turkey our lawn-mower guy gave us?

My worldly wife spent some of her youth in France where people eat much more of an animal than we finicky Americans do, like tripe, trotters, head cheese, veal kidneys, pork cheeks, sweetbreads, and the like. So, when we buy whole animals from neighboring farms she does the butcher’s cut chart. Most people get some 120 pounds of pork from the average Vermont pig. Not us. We get closer to 150 lbs. The unmentionables all add up.

I’m trying to sort the freezer-burned meats into edible piles and setting the nondescript offal aside for disposal deep in the woods where, our bobcats, coyotes, fishers, and turkey buzzards can have at them in prandial peace without being distracted by the chickens gobbling ticks in our yard.

I’m remembering the time I awoke to shrieks coming from the garage one night when my daughter and her buzzed friends were clearly rummaging through the freezer looking for Ben and Jerry pints and came upon a pig’s head staring at them from inside a clear plastic bag, waiting for Kate to simmer it slowly into a head cheese – unmentionable chewy-bits suspended in a gelatinous lump. Another time, I was asked by my son about the four little pig’s feet in a plastic tray in the freezer. Was I planning on making them into bookends? … but I digress.

I now have a large pile of meat that, doused with sugary barbecue sauce and adequately charred over a wood fire, might prove edible to bibulous friends and relatives. The rest I’ve stashed into a barrel to haul off to the critters that usually prefer fresh chicken to thawing carrion. The female bobcat, has become especially brazen, thinking nothing of trotting across our lawn with a spent hen in her mouth as we eye one another.

At the bottom of the freezer was the raccoon my son bagged up and kept to make into a coonskin hat when he was ten. He’s now thirty. The poor animal, surrounded by tufts of loose hair, seems to have developed alopecia. Should my son pursue his project, he’ll have a nice, loose-fitting shower cap.

Finally, at the bottom, indistinguishable from a pork tenderloin, lay a frost-covered bottle of Stolichnaya, which my wife and I enjoyed to celebrate having finally emptied the freezer.

The family barbecue was a resounding success. The heavily-sauced non-descripts were well-charred and tasted more like Dunkin’ Donuts than meat. I’d forgotten, however, the six-year-old mutton, on which I’d gotten such a good deal from our neighbor and assumed it was lamb.

My New York son-in-law asked if I hadn’t grilled a discarded deck shoe by mistake. “Tasty, but unchewable,” was his considerate comment, as he picked the gnarly bits from his incisors. Later than night I got a text from him, “Death by Mutton!”

 

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Burlington College: Politics or Governance?

I’ve been watching the national effort to politicize Burlington College’s demise and am saddened by the venality of our politics and our dangerous ignorance of non-profit governance. It’s endemic in Vermont. Where too many of our major non-profits have limped through a decade or two of un-reviewed leadership performance, mission decay, and disconnection from constituents because their boards have no idea what the obligations and liabilities of board members are or even what board service means.

I won’t dwell on the details of Burlington College except to say that the entire fault lies with the Board. It can be said that Jane Sanders has a checkered history leading colleges, but all presidents serve at the will of their boards. It’s also been alleged that she tried to deceive the Board. But this doesn’t happen with a properly functioning board that verifies the bases for all major financial and academic decisions.

A president or executive director’s performance is meant to be reviewed annually by the board with input from constituents, administration, trustees, and community. Boards that don’t commit fully to this basic process own the errors of their chief executives.

Delivery on mission, ethical integrity, financial integrity, and leadership performance are the key responsibilities of a board. If a president threatens any of those objectives substantively, they must be adequately warned, then terminated.

Legally, excuses don’t cut it. Boards are responsible. Any board members taken by surprise at the sudden financial collapse of their institution have no one to blame but themselves. A board financial committee monitors financial viability ratios in real time, challenges significant changes in financial position, and must verify and approve every financial decision by the president that significantly alters the balance sheet.

​The oversight college-accrediting organization that does financial and academic monitoring, NEASC, would have known and warned the board well in advance of the college’s trajectory. Then it was up to the Board to either choose new leadership or arrange for an orderly shutdown. Either would have been preferable to sitting by and watching it collapse.

Sadly, politicians are trying to make this a political issue rather than what it is – a complete failure of governance. Our vigorous non-profits harness the commitment and energy of Vermonters to improve our lives. Their boards must rise to the challenge of good governance and preserve and protect this vital community energy.

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Stay the Course in Vermont Healthcare

How quickly we forget. Just short of four decades ago, Vermont policymakers decided that a competitive healthcare system had not lowered healthcare costs, but was, in fact, driving costs up, as hospitals vied for more expensive technology and market share. The relationship between our thirteen community hospitals and our tertiary-care hospitals – then Fletcher Allen and Dartmouth – were tortured and riddled with expense.

We decided that a citizen-regulated monopoly would better constrain costs, regulating towards a more cost – efficient and accessible network of integrated healthcare facilities, spanning sole practitioners, community clinics, community and tertiary care hospitals. And it worked. Looking at measures of access, prevention and treatment, avoidable hospital use, costs, healthy lives and equity, the Commonwealth Fund recently ranked Vermont’s health system as the highest-performing in the country.

Governor Scott understands and supports this vision for Vermonters’ healthcare, while we now hear our progressive democratic legislative leaders railing against monopoly and championing competition as the factor that will control costs. But we already crossed that bridge many years ago, so I find it especially ironic that this rhetoric reflects current attitudes in Washington, as Republicans work to dismantle the Affordable Care Act and eliminate important protections, like those Vermont enacted thirty years ago. Vermont’s direction has been one of collaboration, not competition, and has prioritized policies that benefit all those over ones that might benefit only some.

We’re one of the last “civilized” countries in the world not to regard healthcare as a basic human right, even as Vermont has worked within its scarce means and small scale to create a healthcare system that could “act as if.” We’ve made great strides, including having among the fewest uninsured residents while being among the highest-quality, lowest-cost states in the nation.

We must stay the course – while admitting that having said that, affordability is as much an issue here as it is elsewhere in the country, and we need strong regulatory oversight to ensure continued progress on constraining costs.

But if we believe that healthcare-for-all should be a right, then we must also acknowledge that “free-market”competition in health care conflicts with the collaborative, integrated system we’re developing to provide access to quality healthcare for all Vermonters.

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On suicide, and what it tells us about our social and economic policies

Society is ill-served by our narrow definition of suicide. Suicide is more widespread than our definition would like to admit – “the act of an instance of taking one’s own life voluntarily and intentionally.” This definition is confined to self-inflicted, real-time incidents, counting only those who summarily end their own lives and understates reality, allowing us to overlook the human toll the world we’ve created socially, economically, medically, educationally, and environmentally takes on many of our citizens. It also understates the recently reported escalation in suicides, notably among middle-age women. From 2000 to today, the reported suicide rate has risen 25%. If we understood and defined suicide for what it is, the escalation would be significantly higher.

Those contemplating suicide face daunting questions. Will I have the courage? How do I do it? How can it be painless and instantaneous? How do I protect my loved ones from the aftermath or my death or from guilt? Suicides generally want to spare their family the sight of suicide’s aftermath.

The decision that life is no longer worth living can be the result of clinical depression or it can be understood as a direct reflection and harsh judgment on the communities we create as human beings… the sexually abused child who turns to drugs or gorges herself on food to make herself less sexually attractive to predators, one suffering from mental health issues with no access to healthcare, the laid-off worker left behind by automation or job-migration with no understanding of how to begin again, the impulsive teenager who succumbs to peer pressure or over-prescription by his dentist or doctor and becomes addicted to opiates until he can no longer afford them and moves to heroin or fentanyl.

These slow-moving suicides-by-lifestyle are equally decisive suicides but are not counted, as they often reframe the would-be suicide as a victim rather than a self-aggressor. Suicide-by-addiction is a powerful example. At what point does someone addicted to any substance – drugs, food, alcohol, tobacco, danger / adrenaline – abandon hope of recovery and embrace the fatal outcome?

Nor do suicides-by-consignment such as death-by-cop, death-by-car, death-by-suicide-bomb make the statistics, as these events consign the execution to others. These suicides decide to end their lives but leave it to another to complete the job with the same result… the driver who swerves in front of a semi, the person who draws a gun on a policeman, the kid with no vision for any future who dons an explosive vest in the hope of being remembered as a martyr.

Much has been written about suicide-by-lifestyle without naming it as such. Our shift to outcomes-based compensation in health care will need to account for those who have given up on self-care and decided to tacitly commit suicide with drugs, food, or liquor until their lifestyle achieves their goal. These are the suicides we are reluctant to count.

We are ill-served by our limited understanding and definition of suicide, as it is a critical metric of community well-being. Religions and governments have long condemned suicide. Catholicism considers it a mortal sin and until recently it has been a crime in the U.S. In modern times, the Church has softened its stance on consignment to hell, denial of last rites and burial in consecrated ground, acknowledging humankind’s inability to fairly judge the psychic pain or mental illness that leads one to suicide.

Nor is suicide a federal crime any more, parsed legally now into self-inflicted suicide, medically assisted suicide, and euthanasia, the last of which is illegal in all states. Medically assisted suicide or “death with dignity” is provisionally legal in California, Vermont, Washington and Oregon. Suicide, as we have understood it, is no longer prosecuted…irony abounds.

But in general, our culture still disapproves of suicide, regardless of what life would be like for the individual. Experts agree that medical heroics at the beginning and end of life account for half of all healthcare costs. The advent of advance directives is changing this culture for the better and offering people more end-of-life choices.

While our moralistic view of suicide has changed over the years, if not our tracking of it, suicide is the daily choice of many including the famous, such as Graham Greene, Jack London, Edgar Allan Poe, Sylvia Plath, Virginia Woolf and Hemingway. Modern philosophical and artistic works have tried to remove the stigma of suicide, if not justify it as a personal choice. The writer Arthur Koestler and his wife who committed suicide together come to mind.

We understand suicide as a personal decision made for private reasons. What we are less understanding about reluctant to admit is that it is also a reflection of the communities we create.

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Puccini in Middlebury

From as early as I can remember, I’ve been an opera buff. I remember sitting in the orchestra section at the Old Metropolitan Opera House on 39th and Broadway and hearing the great mid-century singers. My great-grandmother Selma was having a platonic affair with Caruso. My Aunt Rose hung out with the greats of the time: Gueden, Schwarzkopf, Kunz, and Jerome Hines. My fervid childish imagination lit up at the live passion, violence, and madness on stage that made the comics littering Al Melendy’s barbershop in Morrisville seem pale by comparison.

One afternoon after seeing an Aida with my grandmother, the head of the Opera Guild, the fan club for the well-heeled, ushered us backstage to meet the diva, Galina Vishnevskaya. But she was besieged by voluble, bearded men from the Russian embassy bearing flowers and champagne. On the way back across the stage, a crew was erecting a cottage set for that night’s opening of Lucia di Lammermoor, featuring the debut of an unknown Australian named Joan Sutherland. Our host asked if we might like to come, as she had two extra house seats. My grandmother, allowing that one opera a day was adequate, declined for me. The following week, Sutherland as Lucia made the cover of Life magazine.

We still see occasional performances at the new Met but airfare, a hotel, a few meals, and opera tickets are now about the price of a raised-ranch in Hanksville.

So when friends urged us to see the Middlebury Opera Company, lauding their productions, orchestra, and voices, I was resistant – doubting that Middlebury could mount a world-class opera. But my wise wife bought tickets and we recently saw Puccini’s Il Trittico, a trio of short operas. We’re still discussing the high caliber of the singers, production, and orchestra.

Their production of the comic opera Gianni Schicchi is a riotous send-up for our times. And while I won’t attempt a review, I can say I thought the performance – drawing on both local and national professionals – was about as good as live opera can get.

So, it’s provincial to imagine that only big cities can produce great opera. Vermont’s small towns used to be rife with opera houses and companies. Now, thanks to Middlebury and other regional companies like Opera North, live opera has returned to the green mountains.

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When reverence for our past blinds us to our future….

I love Vermont. I’ve lived here seventy years, and like my father, I’ve turned down opportunities to move away and earn more money. But I don’t trust the Vermont myth of ‘exceptionalism.’

We’re a microcosm of the world around us. Our communities and our natural, working, and built environments make us a wonderful place to live, but I worry that our tendency toward self-adulation calcifies belief systems that often impede our progress. Change happens whether we like it or not and it’s critical to understand and accommodate it without compromising our values. To ignore change puts our future at risk.

I love a well-framed barn, in fact, my first home was one. I love and use hand-made tools. But I try not to let my reverence for the past obscure my vision of the future.

Personally, I prefer small communities and local democracy, but driving through rural Vermont and seeing the hollowed-out towns and villages I knew as thriving centers of social and economic vitality when I was young challenges the ideal of local control. Small is beautiful, except when its windows are boarded up with plywood.

E-commerce, urbanization, and the industrialization of our food supply have exported wealth, gutting too many of our communities. Many of the old “tools” in our economic development toolbox are rusty relics.

So, to understand and confront change, we must re-imagine our communities and the institutions and commerce that feed them. When employment in the non-profit government, healthcare, and educational sectors outstrips employment in local businesses, we must rethink unregulated, free-market capitalism as a pathway to personal and community financial independence. Global economic, environmental, transportation, and communications systems ignore state lines. The boundaries on our maps now mean little beyond the law, politics, and taxation.

Finally, we may all be good people, but we each have the potential to do bad things. That’s the human condition. And the good-ol’-boy network that prefers back-room governance, winks, nods, and deals is a destructive anachronism. We must adhere to transparent and representative governance, and evolve and enforce ethical guidelines that oversee our decisions and policy-making.

We can love and preserve those aspects of our past that retain their beauty and utility, but not to re-examine frankly and honestly what has worked and what may now be failing puts us at risk. The Times They Are a Changin’ and so must we.

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