Tuesday, June 1, 2004

Healthcare reform plan

Won an Honorable Mention in a healthcare reform contest run by CodeBlueNow

Executive summary

This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.

Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:
1. A continuation of Medical Savings Account laws, with some important clarifications.
2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities.
3. Reform prescription drug coverage.
4. Reforming government administration of Medicare and Medicaid.
5. Providing incentives to businesses to participate in this new system,
6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation.

Proposal: A reformed U.S. healthcare system

This proposal is based on the principles in the Health Care Magna Carta, at www.oconnorhealthanalyst.com/magnacarta.html and included in Appendix 1.
It is important that sweeping change in the U.S. healthcare system take place in a short period of time. This document lays out the changes and transition plans, as well as an ongoing plan for funding and support for a new style of healthcare system, which will result in high-quality affordable healthcare for all Americans.
The problems are legion and well-known: cost shifting from government onto the sick and the infirm; lack of choice for medical expense coverage, leaving either an all-or-nothing plan, or payment out-of-pocket for everything; money squandered providing insurance rather than care; and lack of individual choice of care, provider or payment method.
The opening moves in this renovation of healthcare can only be made by government, which is the sole group with the power to bind itself and others to a process of change.

Therefore, the Congress shall enact, and the president shall sign, a sweeping healthcare reform bill, based on the principles that the U.S. government is bound to protect the interests of all Americans; many Americans have no healthcare and many more have trouble affording it; and it is the duty of Congress to act to cause healthcare to be accessible and affordable to all Americans.
Contained within that legislation will be:

1. A continuation of Medical Savings Account laws, with some important clarifications. Contributions of after-tax dollars to MSAs will become tax-deductible. Distributions from MSAs will become non-taxable. In keeping with a recent IRS ruling, funds remaining in MSAs at the end of a calendar or fiscal year will be able to be rolled into the following year without tax penalty.
Two incentive programs will be created to encourage people to use MSAs, and to permit them to use their money intelligently.
First, the federal government will pay $1,000 to each American citizen and legal permanent resident each year, into the person’s MSA. If a person does not have an MSA, the money is not paid. This money is intended to provide funds for preventive care and treatment for small routine illnesses that occur throughout the year.
Second, MSAs will be able to be held jointly by, and for the benefit of, immediate family members, such as married people or parents and their dependent children. When joint holders of an MSA no longer wish to hold their funds jointly, they may divide them in any mutually agreeable way, but the money must remain in someone’s MSA. That is, funds cannot be withdrawn from one MSA without being put into another one immediately, much like an IRA rollover.
Rationale: (HCMC 1, 2, 3, 5, 6, 8, 9, 10) People and employers will be able to contribute amounts they can afford on a regular basis into their MSAs, making money available for later use to pay for medical expenses. The present system requires people and employers to contribute amounts they cannot afford toward the profits of private companies, pulling that money out of the pool available for people to pay for actual medical care. In effect, they pre-pay large sums for the privilege of paying even larger sums when they actually need services. If they do not use medical care in any given year, that money has been spent for no useful purpose.
Revamping this system will permit more money to be used to pay for actual medical services, without putting additional pressure on working people to pre-pay for medical care they may not use. Further, it will allow them to save that money to pay for medical care they actually use in the future.
Funding: Find out how much people and businesses pay in insurance premiums vs. how much they pay for actual healthcare
Impact on healthcare services: Services will remain as accessible as before, but people’s access to them will improve dramatically. Rather than paying expensive premiums for future discounts on services, all of the money spent will go directly to providing healthcare. A family that pays, say $300 a month for insurance today will be able, instead, to visit the physician for preventive checkups from time to time, using that same $300.
Impact on healthcare costs: Costs will not go down or up, but people’s ability to afford the costs will increase. Money for insurance premiums, now taken away from the pool for spending on actual healthcare, will become available again for buying actual care.

2. Malpractice liability will be capped, limiting liability for all medical professionals and facilities. Malpractice liability must remain in existence to protect patients from accidental wrongdoing by medical professionals. However, to protect the public from malicious professionals, malpractice claims resulting from wilful wrongdoing or wilful negligence will have no liability cap.
In cases, however, where the intent of the medical professionals and facilities was to help, and there was no intent to harm, the liability cap will be:
• For a procedure of which the damage can be repaired, the amount of the cap shall calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the costs of the procedure to repair the damage.
-Adding the patient’s actual lost income and wages while repairs are made.
-Doubling the sum total, to include actual damages plus a penalty.
• For a procedure of which the damage cannot be repaired, the amount of the cap shall be calculated by:
-Figuring the amount of any money paid by a patient, government or private company for a procedure or other action that is deemed to be malpractice. Fees for services provided by parties not judged guilty of malpractice shall not be included in the cap.
-Adding the amount required to perform the procedure properly (e.g., amputate the correct leg).
-Adding the amount required to cover appropriate, medically necessary amelioration of the situation (if the wrong leg has been amputated, for example, add in the cost of prosthetics).
-Doubling the sum total.
-Adding the compensation that would be available under the standard Accidental Death or Dismemberment insurance policy offered by airline carriers at the time of the miscarried procedure.
Rationale: (HCMC 1, 3, 6, 7, 8) This will permit patients who have suffered at the hands of medical professionals to recoup losses and cause the responsible parties to feel some punitive damages. And it will permit medical professionals and facilities to keep a better handle on their insurance premiums, which are one of the factors driving up the cost of healthcare.
Funding: In 2000, doctors paid $6.4 billion in insurance premiums. All of this cost was shifted to patients, insurance companies and government agencies paying for healthcare. Reducing this amount would reduce upward pressure on doctors’ prices. (According to the National Association of Insurance Commissioners, Statistical Compilation of Annual Statement Information for Property/Casualty Insurance Companies in 2000, (2001).)
Impact on healthcare services: Services would be no more or less available than they are today. Some medical professionals might actually begin offering services they had not before because of high insurance costs.
Impact on healthcare costs: A major factor in the high cost of some procedures is the malpractice coverage required for professionals who conduct those procedures. This would reduce some of the cost pressure, resulting in lower costs and increased access to services by all Americans.

3. Reform prescription drug coverage. Prescription drugs may be paid for by money from MSAs. Pharmaceutical companies who refuse to sell their drugs at Medicare-negotiated rates to all purchasers will have their drugs subjected to prior review by Medicare. That requires state or federal approval before a doctor can prescribe a medication. Drugs and companies subjected to this will effectively cut themselves out of the Medicare market.
Drug companies will be prohibited from advertising their products to the general public, whether on television, on radio or in newspapers, magazines or on-line advertisements.
Drug companies will be allowed to have their company web sites describe the drugs they sell, but those pages and descriptions must be approved by the FDA as including full disclosure of results of all clinical studies.
Drug companies will be allowed to advertise their products to doctors, under FDA rules that require full disclosure of the results of all clinical studies and only making FDA-approved claims for treatment or prevention of diseases or conditions.
Drug companies will be prohibited from sponsoring conferences for medical professionals.
Drug companies will be permitted to send marketing personnel to meet with doctors, but may only drop off FDA-approved literature, and may not purchase meals, gifts or other small items (including office supplies) for medical professionals.
Rationale: (HCMC 1, 4, 7, 8) Companies that make revolutionary drugs that they want to make large profits on will remain allowed to do so, but not at the expense of taxpayers and private citizens who want important medical services.
Drug companies today spend more money on marketing than they do on research and development, and take less in corporate profit than they spend on marketing. If marketing budgets were reduced, drug companies would have more money to do research and development of products, and would still be more profitable than they are today.
This ensures doctors would have access to complete information about drugs they might prescribe.
Further, members of the general public would not be subjected to advertisements for things they have no power to actually procure for themselves. Members of the public would also be able to learn more about important drugs, but would have access to the full range of information given to doctors about the drug, rather than just a phone number to call. This limitation on advertising is an extension of the existing FDA rules on drug advertising, but ensures that marketing spending by drug companies is limited, allowing them to focus on their core function to their shareholders and society: making drugs and finding new ones.
Funding: FDA approval costs are covered in application fees for licensing and regulation. FDA fees may increase for drug companies, but no more money will be needed from taxpayers or healthcare consumers.
Impact on healthcare services: Some drug companies may change operations or cease some operations. This could disrupt prescription drug development in the short term, but will provide better access and information in the middle and long terms.
Impact on healthcare costs: There will be decreased upwards pressure on costs of prescription drugs. While they may not drop, drug companies will see public pressure brought to bear on their profiteering. They will still be allowed to charge money for their drugs, and to make a profit, but their role as providers of important public services and needs will be recognized and held to account for the public’s well-being.

4. Reforming government administration of Medicare and Medicaid. Government will pay the full amounts of “accepted reasonable costs” for services provided to Medicare and Medicaid patients.
Rationale: (HCMC 2, 3, 4, 8, 9) The government is now hiding, from the public and from itself, the true cost of treating the elderly and the poor with proper medical care. Those costs are being shifted onto private insurance carriers and people who pay out of their own pocket for medical care, in effect taxing the sick and the injured.
This would require the entire society to pay the true cost of treating the people who need help. It would prevent government from hiding the costs, and would create a built-in incentive system to improve access to preventative care for the poor and the elderly, to cut costs overall while improving the public health.
Funding: According to the Centers for Medicare and Medicaid Services (CMS), in 2002 Medicare paid $256 billion. Medicaid paid $258 billion, to match on a 2-to-1 basis $129 billion from state funds for Medicaid. This represents 80 percent of the total cost of care to Medicare and Medicaid beneficiaries, leaving $161 billion in unpaid Medicare and Medicaid benefits to be covered by people with private insurance. Reducing this burden will lessen upward pressure on medical prices for private payers.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: This will appear to make Medicare and Medicaid costs go up. That appearance is false, however, and will merely reflect a readjustment of the cost structure now in place for medical care. Medicare and Medicaid will be charged the full cost of caring for beneficiaries, while private-payers and third-party insurance companies will see cost savings because they will pay only the full cost of caring for their beneficiaries, without also paying for services rendered to other patients.

5. Providing incentives to businesses to participate in this new system, by encouraging them to contribute to MSAs and assist with sponsoring major medical insurance coverage for catastrophic medical needs. Specifically, creating tax exemptions as follows:
-Business contributions to employee/family health insurance plans are only considered tax-deductible business expenditures if the insurance plans have a deductible over more than $4,999 for a single person or $9,999 for more than one person.
-Business contributions of any amount to employee MSAs are tax-deductible business expenses. Contributions may not be made based on discrimination of any kind, but need not be equal in amount for each employee. (That is, employees with families may be eligible for additional MSA funding. Also, employees are free to make arrangements for part of their salaries to be allocated directly to MSAs.)
Further, the law will put a 5 percent payroll tax on all businesses employing two or more people, to cover federal and state healthcare expenditures (This will be less than those businesses would pay in medical premiums under the present system.)
Rationale: (HCMC 2, 4, 5, 6, 9) Businesses are key to this, because of their historic role in providing or helping to provide medical insurance. They also are used to spending money to benefit employees, and are used to getting tax credits for it. Major medical insurance is much closer to a single-pool insurance system, despite the fact that different providers offer it. There is much less demographic variation in who could be hit by a bus or fall off a cliff than with other conditions or illnesses.
Funding: Based on the U.S. Department of Commerce’s Bureau of Economic Analysis, total payroll in 2002 was $8.276 trillion. A 5 percent payroll tax would raise $414 billion, more than twice as much as necessary to cover the Medicare/Medicaid shortfall detailed in section 4, leaving plenty left over to fund the remainder of the programs prescribed in this document, especially if future cost savings are incorporated into the healthcare cost system to further offset cost increases.
Impact on healthcare services: Services would be no more or less available than they are today.
Impact on healthcare costs: Healthcare costs would not necessarily change, but people’s ability to afford healthcare certainly would. Today many employers cite cost as the major reason they do not provide any health insurance, or only limited health insurance, to employees. They are locked into an impossible choice: provide a plan that neither company nor worker can afford, or provide nothing at all. With this system, employers would be free to allocate as much as they want to afford towards employee healthcare. Further, the money spent would go to providing actual healthcare, rather than paying in advance for discounts if and when healthcare is provided.

6. Creating national, regional and statewide health planning boards to allocate healthcare resources effectively across the nation. At present, for-profit companies determine where they will build new hospitals or other healthcare facilities. Profit is the motive for locating these important centers of public health and well-being.
Instead, the motive should be intelligent design of services, so that all people will have reasonable access to all levels of care, with quality practitioners providing top-level care in well-maintained facilities not subject to cost-cutting by corporations seeking shareholder revenue.
The boards would plan where new healthcare facilities will be constructed or moved, and what services will be provided at those facilities. They would take into account existing facilities, patient demand and utilization, cost-sharing opportunities of regionalization, and medical importance of immediate access.
Government representatives, medical professionals and community members will collaborate to determine where services shall be provided, such that everyone has access to quality medical care, with more basic and often-used services provided at more locations and specialized high-level services centralized regionally, all spread intelligently across an area of human and physical geography.
Each type of medical service requires a certain level of usage to keep medical professionals skilled and up-to-date. Specialized services, such as open-heart surgery, shall be provided at regional centers, rather than out at primary care centers.
These boards will also become venues for healthcare advocacy, urging people to take better care of themselves and each other.
Rationale: (HCMC 1, 3, 7, 8, 9, 10) Profit is the wrong driving factor for choosing locations of healthcare facilities. Instead, the goal should be to provide services equably to everyone.
Funding: This will pay for itself. Rather than just going out and constructing a hospital or other care facility in one place, a company will have to justify the location and services to regional planners. Competing companies will not be able to build two similar hospitals on the same city street and leave rural areas in the same region without services.
Impact on healthcare services: Specialized services will be somewhat less immediately accessible in some areas, but more accessible in many other areas. Further, the quality of care will be higher, because medical professionals at the centralized specialty facility will have better and more consistent practice to keep their skills fresh.
Impact on healthcare costs: Costs will see downward pressure, because services will be provided more effectively and more efficiently across a region. All people will have relatively easy access to all ranges of healthcare, and all medical professionals will have a workload that neither overwhelms them nor leaves them idle to forget specialized skills.




Appendix 1

Health Care Magna Carta
www.oconnorhealthanalyst.com/magnacarta.html
Copyright July 2002
Kathleen O’Connor

1. We believe we must all participate in health care decisions and that health care is too important to be left to someone else. Just as war is too important to be left to the generals, our health care is too important to be left to the industry and employers.

2. We believe everyone who participates in the health care system should pay for it—individuals, businesses and government. If we all benefit, we all must participate and support it. No one gets services without paying for them, at least in part.

3. We believe all people should have access to a common set of health care services that promote the health and well-being of our nation, including access to preventive services, full maternity and well-child care, childhood immunizations, and full dental and mental health services for children, as well as comprehensive health services for seniors. We believe that this includes culturally sensitive health care services that recognizes the diversity of our nation and that includes complementary and alternative therapies, as well.

4. We believe no person should face bankruptcy because of catastrophic health care costs and needs.

5. We believe in the freedom of employers to offer more than a common set of health care services; but in return, large employers should not oppose the needs of small businesses to offer at least a common set of benefits, so people don’t live in fear of insufficient insurance.

6. We believe we should all be in the same risk pool rather than separate our society into smaller and smaller segments.

7. We believe we all need clear and succinct information about health care services and benefits, and that information about services and benefits should be written for the average reader, not just for lawyers, physicians and government employees.

8. We believe we need central standards and management of health care financing and services, just as we have central standards and management for the banking industry. We need an independent national board, but we also need local flexibility to meet the specific health care needs of our communities. We also need to define care standards for ourselves, our providers and our communities.

9. We believe funds for health care services should not be dictated by the specific health care categories as we now have, so we can be more flexible in meeting the wide range of needs of clients vs. the compartmentalized requirements of each separate system as we now have.

10. We believe we must all assume personal responsibility for our health and help our friends and family members do the same. We encourage individuals, employers and community groups to put their efforts into health promotion and disease prevention and reduction.

Friday, May 28, 2004

Song of ages: Winter Harbor belts out Louie, Louie

Published in the Portland Phoenix

People who are older often describe themselves — or are described by others — as "set in their ways." How do we get that way, though? Playwright Lanford Wilson’s 1970 work Serenading Louie offers an answer with his tale of lost souls.

The title springs from "The Whiffenpoof Song," the song of the men’s a cappella group at Yale — where three of the play’s characters went to college. The song’s lyrics talk of friends gathering at a bar where a man named Louie is a fixture. The friends are "little black sheep who have gone astray," and "Gentleman songsters off on a spree/ Doomed from here to eternity."

These characters, the Whiffenpoofs sing, "will serenade our Louie while life and voice shall last/ Then we’ll pass and be forgotten with the rest."

That is what Alex and Gabby (Chris Holt and Phoenix contributor Caitlin Shetterly) and Carl and Mary (John Linscott and Paula Vincent) see in their own futures. They wrestle against it, remembering their younger years, filled with promise and adventure. "The smallest thing that ever happened was an event" back then, Carl remembers.

And big things that happened unified the country, like the tragedy of Kathy Fiscus, a 3-year-old girl who fell into an abandoned well in 1949. The story of the rescue effort was one of the first ever broadcast live on television, and had people around the globe glued to their radios for nearly 50 hours, Carl recalls. More than just a shared past, though, it is a sign to Carl of how immortality can be earned through tragedy.

Now their lives are stuck. In their early thirties, married, with decent jobs and clear — if conventional — futures ahead of them, they want to reclaim past potential before they enter into historical oblivion.

Gabby, the aptly named, insecure chatterbox (played cleverly by Shetterly, whose tortured facial expressions and simpering advances toward Alex are both deeply human and singularly superficial) drives Alex crazy. Shetterly’s performance is so strong, I wanted to strangle her, as did a man sitting just in front of me in the audience. "I’d kill myself" in Alex’s place, he said during the scene change.

Alex, her husband, is wrenchingly torn between wanting to follow his dreams and wanting to reclaim his past. In the meantime, though, he is forced to endure Gabby’s meandering monologues, which drive him to distraction. Holt conveys this tearing of his spirit very well, fuming visibly but silently, then exploding and contracting again, inside his shell.

Mary and Carl are similarly glued to their spots. Mary, an emotional recluse, lovingly bosses Carl around a lot, and he is deeply depressed. Linscott’s glowering aspect sheds light on his deeper inclinations, and gives the lie to his statement that he is unable to feel any emotions.

They are indeed set in their ways. As much as a result of this as an antidote to it, suspicions of infidelity arise, leading all four to question their positions in life. Carl believes most people can’t handle life in the late 20th century. He argues that self-sacrifice, seen by many as an ancient pagan ritual modern people have moved beyond, is not dead nor gone. Instead, it has changed form.

As the lights rise and fall and the four actors explore the simple, homey living-room set, their anguish also ebbs and flows. Carl first covers his pain at his wife’s infidelity by talking of sweet nothings and remembering the past. Linscott’s gentle dancing around the real subject lasts just long enough to let Vincent’s gentle, secretive Mary slip away.

It is the last time the two connect as friends. The next time will be after the confrontation is over, after Carl’s pain prevents him from even looking at his wife. Tessy Seward, here in her first directing effort — and having replaced original director Mel Howards over "artistic differences" — has a clear vision for where these characters are heading.

Mary views her love as a self-sacrifice. Not only has she gone willingly to the altar to begin the ritual, but she finds the blissful rapture of love only seconds before it is too late.

When Gabby learns of Alex’s indiscretion, Shetterly transforms from a weak, vacillating girl into a woman in full roar. She demands a response from Holt, who stays well within his character’s reserved façade, but worries more about others than himself.

These couples are indeed "on the eve of destruction," as suggested by the song playing before the show begins. And though destruction can also bring rebirth, that will not happen on this stage. Their passing remains inevitable. All that Carl changes with his gun is the length of time society will take to forget.

Serenading Louie
Written by Lanford Wilson. Directed by Tessy Seward. With Chris Holt, John Linscott, Caitlin Shetterly, and Paula Vincent. Produced by Winter Harbor Theatre Company at the St. Lawrence Arts Center, Portland, through June 5. Call (207) 775-3174.


Backstage

Mike Levine reports that a search for shared rehearsal, classroom, and performance space is moving along, and is likely to find a home in South Portland, where the city government is apparently willing to work with the group to promote the arts.

• Twenty-two high-school-aged actors at The Theater Project are inviting the public to see the world through their eyes. They have written and produced, and will perform, Voices in the Mirror, from Friday, June 4, through Sunday, June 6.

Friday, May 21, 2004

Laugh lines: Standing up for a thousand bucks

Published in the Portland Phoenix

It’s fitting, really, that a postal worker who mocked her own profession’s tendency to go ballistic was the one best able to get a rise out of the audience at the Comedy Connection last week.

But that’s getting ahead of ourselves. It was the final round of the Portland’s Funniest Professional competition, with six top laugh-getters vying for " fame, fortune, and one thousand dollars. " For a shot at one-fiftieth the dough you can get for eating cow innards on Fear Factor, these folks got up and did what strikes true fear into many people’s hearts: Talking in public, and trying to make people laugh.

The " host " for the evening was local funnyman Shane Kinney, whose warm-up banter involved personally insulting members of the audience. It made me wish he would take on the woman three to my left, who insisted on talking the whole night.

Amy — her friends told me her name — is a blond fortysomething surgical nurse who seemed to think she was on the stage. Not so, though her droning drunken monologue and four — count ’em — cell-phone conversations during the show made her the focus of attention for many in the back of the room. (And netted nearby paying customers apologies and gift certificates from the management.)

Amy, needless to say, did not win the competition.

Neither did Scott Davis, the first real competitor, who seemed to follow in the Kinney mold. Beyond laughing at his own corny jokes and sort-of-gross, but not-quite-dirty interjections, his best line was to describe rap music as " sneakers in the clothes dryer. " His audience — mostly white folks who appeared not to be rap fans — ate that one up. Amy, nonplussed, yammered on.

Next up was Tim Hofmann, who had a shot at winning, if only he weren’t so awkward on the stage. Clad in startlingly clashing clothes, he delivered funny laugh lines and showed deep, if offbeat, thought into the ways of the world. (An example: He told the crowd he tries to eat based on the FDA’s Food Guide Pyramid. He had a question: " How many mummies am I supposed to eat? " )

He also suggested a revolutionary diet that had the crowd in stitches and even momentarily drowned out Amy’s nonstop blather. It was the Tapeworm Diet. Simple in its application, and easy to adopt: Eat what you want. " With tapeworms, you’ll shit rivers. " No reaction from Amy.

Next up was Sheila Jackson, who went straight to work targeting her postal co-workers. Fortunately, it was with jokes about guns and not actual guns. Here is a woman who knows what she’s talking about and — forget poking fun — is not afraid to ram fun down people’s throats.

She had great presence and a wonderful " I’ll tell you the inside scoop " rapport with the audience, and everything she told us confirmed our worst fears about mail employees. A former postal worker walks into a post office with two pistols and 34 rounds of ammunition. The death toll? Two. " That’s what we call an underachiever, " she said, as the building nearly fell down around itself and Amy continued to discuss — something vital.

Jackson, who had a sizeable cheering section, far outshone last year’s champ, Mark Mathewson, a guy from New Hampshire whose " intermission " routine was slow and based on clichéd admissions of his shortcomings with women.

The first competitor in the second half of the show was either Ann Harvey or Ian Harvey — I’m still not sure. This strangely androgynous being played off the gender-swapping thing, making people laugh with discomfort when she said she was " the youngest of three brothers. " Amy was momentarily silenced, stunned or confused, it’s hard to say.

Next up was Tuck, a teacher who talked about chaperoning dances and violent games. " Remember Jarts? " he asked. " Now there’s a violent game. " He reached a wide group with his everyman humor, showing new twists on things we could all relate to, and won second place for his efforts.

He got big guffaws by taking on the old favorite, drug commercials. But he did his homework. Some legal prescription drugs have been found to cause renal failure as a " side effect, " he announced. Pot remains illegal. You choose, he said: " A taco and a nap, or renal failure? " Amy roared with laughter and clapping at this one. It made me wonder what those nurses are really smoking as they stand outside the hospital doors.

The last of the competitors was Karen Morgan, who had just a few days before graduated from the 11-week stand-up comedian class at the Comedy Connection. She’s a stay-at-home mom of three kids, aged 5, 3, and 2. A lot of her work was based on that, and while baby humor may seem bland, it was nothing of the sort.

Her biggest line came at the end of a story in which she related her role as arbiter of an incident in which her daughter, 3, played " doctor " and lightly bit the penis (which in their house, for reasons unexplained, they call a " tally " ) of the 2-year-old boy. Her final ruling, after a hilarious account of her own thought process on the subject: " We do not bite other people on the tally. " Her twist on potty humor was that it was inspired by people who actually still use potties. Amy, though, didn’t seem to notice. She had another phone call to make.

Friday, May 14, 2004

Swimming in ecstasy: Women and the Sea a trophy catch

Published in the Portland Phoenix

Free at last. This is how some women feel when they encounter the sea. And this is how audiences should feel when they encounter Women and the Sea. Anita Stewart and Portland Stage Company have done something important here.

Stewart, with playwright Shelley Berc, interviewed dozens of Maine women in their research for this show. These stories — of 17 women and two girls — are not just of women and girls, however, but of a community of fishermen (both male and female), their friends, and their families.

It is this play, filled with joy and heartbreak, wonder and worry, which Portland Stage should use as a model for its future endeavors. Why dilly dally around with the safe comedies and fan-favorites when it can produce something as truly special as Women and the Sea.

While many of PSC’s recent shows have lacked excitement and passion, Women and the Sea has that special something. It’s a new work, directed by one of its creators (Stewart), with all the color and energy newness can bring to a piece. There are no audience or actor preconceptions, no way "it’s always been done."

From its beginning, with silhouettes speaking from amid the waves, to the dockside tales and dual climaxes, this play has what PSC needs to find for all its shows.

In the creation of this work, figure not just Stewart, whose clear vision for the performance comes through powerfully, and Berc, whose writing skills keep what is essentially an action-less drama moving. The six actors on stage each night imbue their characters with real and palpable life. Each of the 19 characters — actors plays at least two, with three playing four people — is fascinating in her own way, and has her voice clearly heard.

Some of them — like aquaculture scientist Evelyn (Amy Staats) — are hilarious and well played, with nerdy dramatic pauses where the audience is meant to fill in the space with pithy remarks, but can find only laughter. Others, like Carol (Nicola Sheara) the Irish clam-digger, are hilarious but serve to remind us how many people find their calling in life only by accident. And still others, like Shirley (Moira Driscoll), are understated and reserved, but magical all the same.

The passions of life bubble from each of them, churning the emotional sea into a raging storm that calms into a placid lake before again getting rocky.

This is not a play about women, though it is through their eyes that we learn of the sea and the fishing life. Linda Greenlaw (Brigitte Viellieu-Davis) reminds us women who go out to sea in boats also prefer to be called "fishermen." The struggles of the seafaring life, and of their families back on land, are the same whether the captain is a man or a woman.

Fishing policy problems, government incompetence, bad luck, abusive relationships, and poor judgment are explored as fully and fairly as the triumphs and pleasures of working on or near the sea. Tears flow as freely as laughter, at the humanity of tragedy and of silly ignorance. It is as much a story of endurance as it is a requiem for times gone by. Fishing, these women confess angrily, is on its last legs in Maine, in part thanks to the governmental regulations that try to sustain it.

The closeness of the community is also made apparent, in the choice of several women who all know each other, and can therefore tell parts of each other’s stories. While the aftermath of the Julie N spill introduces this approach, it is taken full advantage of in the retelling of the loss of the Two Friends, which sank off Cape Neddick in January 2000.

This is where the threads begin to come together. In the first act, the line was reeled out, as the women told their own tales and began to relate to each other. (On the stage the group forms a mini-audience for each speaker.)

In the second act, especially as the Two Friends is caught at sea in a storm, Yuberquis (Viellieu-Davis) begins, but breaks down, still consumed by grief. Into the breach step her friends, Susan (Molly Powell) and Debbie (Sheara), to take up the story. With almost no props, no boat, and no visual image to go on but those in their heads, they paint a terrifying portrait of the last night two men ever spent on the water, and of the women on the shore.

Women and the Sea
Written by Shelley Berc and Anita Stewart. Directed by Anita Stewart. With Nora Daly, Moira Driscoll, Molly Powell, Amy Staats, Rebecca Stevens, Nicola Sheara, and Brigitte Viellieu-Davis. At Portland Stage Company, through May 23. Call (207) 774-0465.


Backstage

The Center Stage Players, a theater company for older adults, will give an informal "chamber theater" performance of Different Paths, a new one-act by Edith Hazard of Topsham. The performance, a follow-up to a staged reading of the play, will be on Saturday, May 22, at 1 p.m., at the 55 Plus Center, in Brunswick. Admission is by donation. For reservations and further information, call (207) 729-0757.

• Concord, New Hampshire, playwright Doug Dolcino’s play Monument was given a reading by Generic Theater regulars Betsy Kimball, Helen Brock, Nancy Pearson, Alan Huisman, Steve Erickson, and Bruce Allen on Tuesday. The play is a broad-ranging spectacle about the possible future, including a civil engineer who redesigns civilization, an Orwellian postal inspector, and a wide spectrum of possible influences.

Friday, May 7, 2004

Hearts and minds: It's also a fight for bodies, and homes, and memories

Published in the Portland Phoenix

Bosnia is a forgotten place now. With Afghanistan — remember that one? — and Iraq eating up the headlines, it’s easy to forget — or never find out — that they’re still finding mass graves in Bosnia, still prosecuting war criminals, still sending US troops to keep the peace.

Feminist playwright Eve Ensler (who wrote The Vagina Monologues) has not forgotten. In the early 1990s, she went to Bosnia, seeking out the stories of women who had been cruelly treated in the sectarian fighting among the Muslims, Serbs, and Croats there.

Necessary Targets is one of the results of the interviews she conducted. It is a riskier play than many established Maine theaters might put on, but the Theater Project isn’t asking people to pony up 30 bucks a seat, which forces theaters to play it safe to avoid a box-office disaster. No, the Theater Project’s artistic wings have been freed by its pay-what-you-can ticket policy for every seat at every show.

The theater suggests donating $15 for a ticket, but they’ll take a penny if that’s what you’ve got. Artistic director Al Miller says the dollar income at the box office is about the same as before the policy began in January, and audience numbers are up.

The crowds still pack in for big shows, but more people come to risky shows than would if prices were higher. Most people who are new to the theater pay about $5, says producer Frank Wicks. Long-time fans often pay $15 or more.

Those who make it to Necessary Targets will find one of the richest, best-acted shows to appear on Maine stages in a year. It’s a pity the play itself is so choppy, because the acting is inspired and the stories riveting.

The plot serves as a vehicle to get Ensler’s experience on the table. A psychiatrist (J.S., played by Kathleen Kimball) who has never left the US, and a war-zone-junkie trauma counselor (Melissa, played by Heather Perry Weafer) head to Bosnia together, to help women deal with their experiences, which included gang rape among other, more unspeakable abuses.

The five women whom they encounter in a Bosnian refugee camp are a broad spectrum of the women Ensler must have met. There is Azra (Tootie Van Reenen), an old woman angry about the wasteful slaughter of her cows and goats; Jelena (Wendy Poole), a tough-as-nails Rizzo-type; Nuna (Reba Short), a gleefully America-crazy young woman; Zlata (Michele Livermore Wigton), a pediatrician who is both war-weary and suspicious of foreigners coming to " help " ; and Seada (Elizabeth Chambers), a young mother from the country.

One by one, the women begin to tell their stories, from the heartbreaking simplicity of Azra’s ouster from her home, to Seada’s graphic tale of being chased from her home and suffering abuses whose details had me nearly ready to vomit in the aisle.

The thoughtful one turns out to be combative Zlata, who comes to a deeper understanding with J.S., while still keeping her contempt for Melissa’s " parachute " style.

These stories demand our attention, our suffering. As Seada says from the depth of her grief, " Hurt. " And hurt we do. It’s crushing to hear what humans are capable of, and simple to think of how we might become that way. As Zlata asks, " What would drive you to violence? "

More often than not, it’s little things, piled on top of each other, that send people over the edge. It could indeed happen here. We are not more superior, more tolerant, or otherwise better. We are, perhaps, just luckier.

The staging is deceptively complex. It looks like a basic refugee camp, but becomes a river, a tent, a bluff overlooking a view, a grave, and a dark forest of terror.

Yet the choppy structure speaks of too much to say with too little organization, and the heavy ending falls into the same trap as many activist plays: It states outright, over and over, the point of the play, without giving credit to the brains and hearts of the audience.

Necessary Targets
Written by Eve Ensler. Directed by Christopher Price. With Kathleen Kimball, Heather Perry Weafer, Tootie Van Reenen, Michele Livermore Wigton, Reba Short, Elizabeth Chambers, and Wendy Poole. At the Theater Project, Brunswick, through May 16. Call (207) 729-8584.

Backstage

• It’s festival time! First up is the Little Festival of the Unexpected, when Portland Stage Company showcases the top three New England plays from the annual Clauder competition. It can be a great way to see shows that would otherwise rarely make it to PSC. This year’s festival starts May 11 and runs through May 15, with staged readings of Clauder winner Yemaya’s Belly (a Caribbean coming-of-age tale) by Quiara Alegria Hudes, and runners-up Remuda (a dark comedy) by William Donnelly and Wonderland (a satire of celebrity) by David Valdes Greenwood, a contributor to the Boston Phoenix.

• Then the Maine Playwrights’ Lab (formerly Amma Studio) will have a pair of new-play readings at the Stillhouse Studio, above the Katahdin restaurant on High Street. Admission is $5. At 7 p.m. May 16, the piece will be John Manderino’s play Stools, Benches, Ladders & Chairs, a series of short pieces. At 7 p.m. May 23 will be I Remember You by Phoebe Reeves, a personal family drama.

• And between June 8 and June 12, Acorn Productions will put on The Cassandra Project, a festival of female performing artists including 14 shows. All will be held at Portland Stage Company, either on the main stage or in the studio theater.