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A champion of America’s great writers and timeless works, Library of America guides readers in finding and exploring the exceptional writing that reflects the nation’s history and culture.
Throughout the 1990s, the growth of the haiku movement continued to be reflected in the formation of new groups in major metropolitan centers. The Spring Street Haiku Group was organized by Dee Evetts and included, by invitation, some of the best of the New York City haiku poets. Especially noteworthy among the groups activities was the publication annually since 1993 of a series of members anthologies in chapbook format. In 1994 the group also organized Haiku on 42nd Street, a selection of haiku and senryu by twenty-six New York area poets, that was displayed for six months on the marquees of empty movie theaters on 42nd Street at Times Square and caught the attention of the national media. In early September 1995 a group of poets from the Washington, D.C., area decided to get together regularly to discuss haiku; they took for their club the name Towpath, from the scenic pathway of the historic C & O Canal along the Potomac River. The Richmond (Va.) Haiku Workshop was formed in September 1996 by Josh Hockensmith and Stephen Addiss; the group took over publishing the journal South by Southeast in 1999. Nine enthusiasts from the Chicago area met on January 21, 1996 to form Chi-ku, the Chicago-area haiku group.
As Yusef Komunyakaa, Pulitzer Prize-winning poet and Vietnam veteran, writes in the foreword: “Whatever one witnessed in battle became a silence carried within.
Such an arrangement can make physician investors rich. But it can’t be the whole explanation. The hospital gets barely a sixth of the patients in the region; its margins are no bigger than the other hospitals’—whether for profit or not for profit—and it didn’t have much of a presence until 2004 at the earliest, a full decade after the cost explosion in McAllen began.
Sections include: Jane Austen's World, In Praise of Jane, Minor Works and Juvenilia, Jane Austen's Books and Characters, Regency Fashion/Recipies/History, Biographies, and an E-newsletter with online articles.
Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.
 In early 1996 the function of newsletter editor was split from that of the HSA secretary. Dee Evetts became secretary and Charles Trumbull was named to edit and publish the HSA Newsletter, and its informational role was further expanded. Mark Brooks took over the editorship after the spring 2002 issue but managed only one issue before he was replaced by Pamela Miller Ness. Johnye Strickland became Newsletter editor in January 2005.
Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.
This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful—the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?—and disseminate what we learn. Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care—to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions. And we would do well to form a national institute for health-care delivery, bringing together clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.
Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.
In El Paso, the for-profit health-care executive told me, a few leading physicians recently followed McAllen’s lead and opened their own centers for surgery and imaging. When I was in Tulsa a few months ago, a fellow-surgeon explained how he had made up for lost revenue by shifting his operations for well-insured patients to a specialty hospital that he partially owned while keeping his poor and uninsured patients at a nonprofit hospital in town. Even in Grand Junction, Michael Pramenko told me, “some of the doctors are beginning to complain about ‘leaving money on the table.’ ”