Thanks Giving Thanks

I've always told my girls that we're rich. We have money enough to eat what we want to eat and to help a few of those who don't. That's my definition of wealth. To have too much is, in the words of a Fairground Attraction song, too absurd.

This Thursday is Thanksgiving in the US. The day after Thanksgiving is called Black Friday. I love Thanksgiving. There is something great about a country whose main national holiday is about gathering together with friends and family to eat and talk and give thanks. Call me naive, but I think Thanksgiving brings out the best in people. Conversely, Black Friday provides example after example of the things which aren't so great about the US: a rampant consumerism, a blatant disregard for people other than oneself, a bloodthirsty hunger for a bargain. If you think I'm exaggerating, have a look at Black Friday Death Count, which monitors how many people are killed each year. Killed shopping.

I've recently been elected onto the board of a regional food shelf charity. We supply food to local people who've fallen on hard times, people who haven't got enough money in their pockets to buy the food they need, people who are described, in policy speak, as living in 'food insecure' households.  'Food insecure' means lacking reliable access to affordable, nutritious food. The cheapest way to eat in the US is to buy junk food - high calorie foods which have little nutritious content - so, ironically, symptoms of being 'food insecure' often include obesity. There are also strong correlations between being 'food insecure' and having chronic kidney disease, diabetes, behavioral problems, mental health issues, and hypertension. The problem is growing: 14.5% of the US population live in poverty, 49.1 million people live in 'food insecure' households across the US, and 1 in 5 Vermont children experience food hardship.

At the last food shelf meeting, John asked us for more money. His  name isn't really John, but he doesn't like to publicize the work he does so I would feel uncomfortable using his name on this blog. He's a Mason. I've always been wary about Masons - based purely on crass stereotypes of misogyny and funny handshakes. For the past six years, John has been on a mission to make sure that people can have a hot Christmas dinner. John is a man of high standards: the meals are delivered hot within an hour of being cooked, recipients choose what they would like to eat from a menu, the service is completely confidential, and this year John and his team estimate they will deliver 250 hot dinners to local families who would not otherwise have a Christmas dinner. They are informed about people in need through social services, confidential referrals from schools, and word of mouth.
 
'In a way that's just the start,' he said, leaning forward onto the table. 'We encourage our drivers to be sensitive. Last year, we delivered to a woman who asked for a small portion because she had nowhere to store leftovers. Within three days, we'd had a whip-round and delivered a fridge to her house. Another man told us he hadn't had a hot meal for several weeks because his stove had broken, so we arranged for a handyman to mend the stove and check the safety of the other gas appliances while he was there. There's lots more examples I could tell you, but the one which stays with me...' He paused, pushed his glasses down his nose and rubbed at his eyes. 'The one which always makes me want to keep doing this year after year was a little girl who ran out to the driver wearing flip-flops. There were a few inches of the snow on the ground. The driver made a joke about how brave she was running around nearly barefoot, and she just smiled and said she didn't have any proper shoes because they'd got too small for her. Within 24 hours, we were back at her door with $150 cash.'

John explained he was embarrassed to have to ask for a larger donation from us this year. When he started his charitable scheme in 2008, he could provide a full Christmas meal for $3.05. That included a starter, main and dessert with generous portion sizes (and, given that John was a generously sized man himself, I can only imagine what must be a 'generous portion' in his mind!). He works directly with suppliers to try and keep down costs. Everyone involved is a volunteer, drivers pay for their own gas, and the local school funds the kitchen expenses. Even so, this year he can't manage to provide the meal at less than $5.43 per head. Unemployment statistics might be going down as the US appears to recover from the recession and gas prices might be the lowest for 4 years, but the real cost of food is higher than it has ever been.

As part of their charitable activities, our local supermarket has a Helping Hands food box scheme. For a $10 donation, customers purchase a box filled with basic food stuffs - oatmeal, cereal, pasta, rice, peanut butters etc. - which is then donated to the local food shelf charity. On Sunday, the girls and I needed to collect that weekend's Helping Hands boxes and take them to the food shelf offices. People had donated three shopping carts' worth of boxes. It took a while to fit them all into the car. It's probably the closest I'll ever get to the Black Friday madness - filling my car with special deals and forcing my children to squash into the back seat among all the bargains. And it felt great.

Yoga greed

The yoga studio is stylish: stripped wood floors, exposed brick walls, ambient music playing in the background. Among the comfy sofas in the waiting area, a wide selection of expensive yoga clothing is displayed for sale. Burlington has a lot of yoga studios, but I can’t name this one in case they sue me. I know that wouldn't be very yogic behavior on their behalf, but underneath all the window dressing they’re not a very yogic place. 

The receptionist was sipping something beige and gloopy out of a see-through plastic cup. We’d met before. She wants to be a yoga teacher but hasn’t completed her training yet. If she hadn’t already told me how passionate she is about holistic health and how much she believes in maintaining the purity of the human body, I would have sworn she had a hangover.

Ideally, I wanted to see the finance manager, but the finance manager doesn't have a fixed schedule and hasn't been returning my calls. The studio prides itself on upholding a laid-back approach to the work place which, the receptionist had explained in one of our earlier conversations, counters the relentless, insidious corporate ethos of so many other businesses. It's possible this makes the staff happy, but it doesn't contribute towards excellent customer service. 

I smiled, said good morning, and explained I’d like to talk about the bills I'd been sent; and the receptionist winced slightly - which could have been hangover related, or might have been her reaction to me speaking about nasty materialistic money-type stuff.  

‘What exactly don't you understand?' she asked, flicking back a strand of her unbrushed brown hair and fiddling with the edge of one of her big silver earrings. 

'I don't understand why I owe you several hundred dollars when I paid for all my sessions up-front,'  

'I'm sorry if I gave you the impression that you'd paid,' she said.

'But I did pay,' I interrupted. ‘You swiped my credit card, I signed, and you took money from my account.'

'Actually, that doesn't mean you paid.' She scowled at me. 'We don’t know how much to charge for a session until we've contacted your insurance company.'

Medical insurance in the US is complicated:

1. The majority of people pay into some kind of medical insurance arranged by their employer. 
2. If you can’t pay for medical insurance, you’re screwed. (Iola’s school in Cambridge hosted a fund-raiser last year for a family whose 8-month old baby fell ill and died within 2 months. The family were about to have their home reclaimed and to declare themselves bankrupt because they couldn’t pay their dead child’s medical expenses. When I mention this to American friends, they can all think of similar scenarios with people they know). 
3. Some insurance providers operate 'co-pays', where the individual pays a flat rate up-front for each medical visit; other insurance providers have a 'deductible' which means the medical provider bills the insurance company who then bill the individual. The amount of the 'deductible' varies from insurance provider to insurance provider, from employer to employer, and from individual to individual. 
4. Once the 'deductible' amount has been met, a greater portion of medical costs are then covered by the insurance provider. (It has taken us several years to pay the deductible and other bills related to Maya breaking her leg nearly three years ago; it will likely take us several more years before we have paid all the costs associated with breaking my neck. Illness and injury in the US are comparable to taking on an additional mortgage.)
5. Different medical providers charge different amounts for the same services. So, for example, a mammogram might cost several hundred dollars with one hospital but several thousand dollars with another. 
6. And the same medical provider might charge different amounts for the same service depending upon the client's medical insurance provider. 

It is all very incestuous and almost impossible to untangle, and nobody likes talking about it very much. In the yoga studio in Burlington, the receptionist stared at her computer screen, as though hoping I might go away. 

'If I hadn't shown you my insurance card, would I owe you money? ' I asked. 

‘No,’ she answered. ‘If I hadn’t contacted your insurance company, the amount you'd paid would have covered the service.’

‘So it’s like going to the general store, and buying a gallon of milk.’ I began. ‘I pay $4 for the gallon of milk, but mention that Fred has given me the money to pay for the milk, at which point you decide to charge me $6.’

There is a particular facial expression some people use when they think they're talking to the village idiot; it tends to combine a tight plastic-y smile, clenched teeth and narrowed eyes. The receptionist put on her 'talking to the village idiot' face and spoke very slowly, 'You paid the amount it would have cost if you didn't have medical insurance. But you do have medical insurance. So you now owe this much money,’ she pointed at the bills I had put on her desk.

When I tried to explain I didn't think it was fair, the receptionist lost interest in our conversation. It's possible that, before trying to become a yoga teacher, she aced an assertiveness training course.'I'm not sure what you want right now,' she said. 'Some people like to vent because they feel bad about something, and if that is what you would like to do right now I am willing to listen. Other people want to understand a problem and, if that's what you want, then I have explained it to you and I am willing to repeat my explanation.'

I tried to take a slightly different tack. 'For my first session, I booked a yoga therapy evaluation. I was told it would cost $140. I paid $140. The session took slightly less than the hour I was told it would take. You have now sent me a bill which states I also received 'Therapeutic Exercise' for $110 and 'Neuromuscular Re-education' for $40. I did not ask for those services and, until I received this bill, I did not know I had received them.'

'How would you know?' she asked. 'You are not a medical expert.'

I still like yoga. I used to be able chattarunga with the best for them and my corpse pose is an absolute killer, but most yoga poses are more difficult for me now that I’m metal-necked and nerve-damaged. I'm pleased the receptionist and the finance manager benefit from working in an anti-corporate environment, even if it is funded by their extortion of additional funds from unsuspecting insurance providers. And I hope the finance manager returns my telephone calls one of these days. I haven't paid the bill yet because I still don't understand what I am paying for, so I'm sure she'll soon track me down with a reminder. While I’m waiting, I’m going to download a few yoga lessons from Amazon and set up my yoga mat in the corner of my bedroom. It's not a particularly stylish room, it lacks some of the atmosphere of the studio in Burlington and I'm sure there are ethical issues associated with using a large corporation like Amazon, but at least I'll know exactly what I'm paying for.