Ktismatics

2 March 2014

A Populist Yet Elitist Alt Model for the Book Biz

Filed under: Culture, Fiction, Reflections — ktismatics @ 3:12 pm

Reading what the literary agents say they’re looking for in a novel, I’m struck by how similar and bland these wish lists are. They want excellence, which generally comes down to a distinctive voice, sympathetic characters, and stories so compelling they make the agent miss her next subway stop (several used this same image of compellingness). In making your inquiry, you should be able to blurb your book in a single paragraph and synopsize it in a single page or at most two — straightforward linear narratives would seem best suited to this sort of punchy summary. Are these really the indicators of a good book, or are they features that make a book easy to sell?

There’s no good reason why individual readers should have to pay for books. A reader does not “consume” a book: after it’s been read, the book remains intact, available to be read again and again. Public libraries use tax revenues to buy communal copies of books that are made available without charge to all residents. Electronic books cost nothing to print, distribute, and warehouse, and so the marginal cost of downloading each individual copy is zero.

Suppose that, instead of selling books directly to individual readers, the publisher sold exclusively to libraries. Each library would pay the average retail price of a new hardback — $25 or so — to acquire an e-copy of the book. Then anyone who wants not just to borrow the book but to own a copy can download it onto their electronic reading device for no charge through the library.

Let’s say that 600 libraries buy a copy of a given book: that’s $25 x 600 = $15,000. Let’s say that it costs around $3,000 to edit and format a novel: $15K – $4K = $12K net. Allocate another $1000 for informing the libraries about the new book: that leaves $11,000. There are no investors or marketing people to take a cut of the proceeds, no printers or distributors or wholesalers or bookstores to reimburse. All $11K goes to the author. That’s just about what the average published novelist makes these days via royalties, but it’s earned  on 10,000 copies of a novel printed, distributed, and sold one at a time, the old-fashioned way.

The main problem with the library scheme is visibility. How would readers find out about these books, freely available for them to own through their local public library? There would be no hard copies to browse at the local bookstore, no promotional campaigns pushing the latest titles in the mass media. Not very many readers patronize their local libraries, so library-based educational campaigns would have limited impact. On the other hand, the publisher would make its $25 per library copy regardless of how many patrons actually download the book. And if librarians acquire new titles based at least in part on the enduring archival quality of the collection, then the publisher’s sales pitch would rely more on the excellence and distinctiveness of the book than on its appeal to fleeting pop-cultural tastes.

Still, it’s not like the traditional publishing industry is going to cease and desist in order to make way for this new, less expensive, more populist yet more elitist alternative. Despite perpetual lamentations about the end of literacy, book sales in the US generate around $30 billion annually. The library-based distribution system could make those same titles available to everyone for a tenth the aggregate price. Authors of best-sellers wouldn’t like it, but there aren’t very many of those. Nearly all other published novelists would make just as much money as they do in the current system, while making their books freely available to a potentially much wider readership.

27 February 2014

Exploitation Fiction

Filed under: Culture, Fiction, Reflections — ktismatics @ 11:59 am

Some believe in giving the people what they want. Some believe in getting the people to want what they’re given. It’s the job of the marketing department to bring these two forces together: getting producers to make what the consumers want, getting consumers to want what the producers make. The convergence happens at the checkout counter, where the commodity is exchanged for cash. When the gap is minimized between demand and supply, between desire and fulfillment, the transaction becomes all but inevitable — if the price is right. The up-front investment in design, production, warehousing, distribution, and marketing must be recouped in a sale price that the consumer is willing to pay.

What’s happened is that the investment function has come to dominate the marketplace. For the investors, the specific product isn’t particularly important. Investment decisions are driven by return on investment = revenue in excess of cost. In effect, ROI is the product that the company sells and the investor buys. If the ROI doesn’t satisfy the investors, then they take their money elsewhere and the company folds. And so top management focuses most of its attention not on satisfying the producers and consumers of the company’s product but on satisfying the company’s investors.

Of course I’m not just writing abstract economic musings here. Though I’ve been writing fiction for more than a decade, I’m a newcomer to the writing industry. Now, looking at the business side of things, I’m realizing that the publishing industry exemplifies many of the worst features of contemporary capitalism.

The designers of the product — the writers — are not employees of the manufacturer and distributor — the publishing company. The writers aren’t even paid short-term contractors. They are speculators, doing the work on their own time without compensation.

The writers’ speculative risks are not commensurately rewarded. As I wrote yesterday, the average published novel earns maybe $11K for the author — minimum wage at best. And most novels aren’t published, earning the author a zero ROI.

The literary agent, who sells the writer’s speculative work to the publisher, actually works not for the writer but for the publisher. In Hollywood, the agents work for the screenwriters, the directors, and the actors. Hollywood agents earn their commission as a percentage, typically 10% to 15%, of their clients’ earnings on the film or TV show. In New York, the writer’s agent works for the publisher. As I wrote yesterday, the agent collects a commission of 15% not on the author’s take but on the gross revenues generated by the book. I.e., the agent earns the same percentage that the author earns in royalties. So the literary agents’ primary financial incentive is to satisfy not the writers they represent but the publishers who sign their commission checks. It’s well recognized that, in the wake of corporate downsizing in the publishing industry, the literary agents’ main job is to screen and select commercially viable books on behalf of the publishers.

In Hollywood there is an actors’ guild, a directors’ guild, a screenwriters’ guild — labor unions that provide collective representation and bargaining power on behalf of the individual workers in negotiations with the corporate studios. There is no fiction writers’ guild — the literary writers are on their own as individuals, negotiating with corporate publishers and corporate agencies.

And that doesn’t even take into consideration the consumer/buyer/reader side of the transaction…

26 February 2014

Fifteen Percent of Not Much

Filed under: Culture, Fiction, Reflections — ktismatics @ 5:12 pm

So far I’ve sent out 6 agent inquiries concerning the first novel in the Salon Postisme Suite; I’ll probably send another half-dozen over the next week. While sifting through the online information about the agents in order to target those I deemed most likely to respond favorably to my writings, I couldn’t help but think about the business milieu in which these people — and me too, tangentially — are embedded.

My data are sketchy, so I’m making some educated guesses. Let’s say that it takes half a year to write and edit a novel. Maybe one novel out of 300 submitted to agents gets published. The average published novel sells 3 thousand copies. At a 15% royalty rate on a cover price of $25, the author of the average published novel makes about $11,000. The other 299 unpublished novelists make nothing; or, if they self-publish, they sell an average of 50 copies of their books, which is next to nothing.

The agent makes 15% commission — the same as the author’s royalty. So the agent, like the author, averages $11K earnings on each published novel. Let’s say that the typical agent represents 50 writers and that, between them, these writers put out 10 new published novels per year. The agent can devote maybe 3 weeks’ time on each client’s new novel — the same pay as the author for a tenth the work. For 10 published novels, the agent makes commissions totaling $110K per year from his or her stable of fiction writers — ten times the average royalties paid to each published author in that agent’s stable.

 

20 February 2014

Short Story Versus Novel?

Filed under: Culture, Fiction, Reflections — ktismatics @ 10:52 am

A couple of posts ago I wrote that I had decided not to carve off excerpts of my novels as short stories, submitting them to journals and mags in hopes of getting them published, hoping still further that by thus enhancing my résumé I might be more likely to snag a literary agent and ultimately a book deal. Relatedly, here’s an excerpt from “MFA vs. NYC,” a November 2010 article in Slate. The subtitle of the piece: “America now has two distinct literary cultures. Which one will last?”

*  *  *

The MFA system also nudges the writer toward the writing of short stories; of all the ambient commonplaces about MFA programs, perhaps the only accurate one is that the programs are organized around the story form. This begins in workshops, both MFA and undergraduate, where the minute, scrupulous attentions of one’s instructor and peers are best suited to the consideration of short pieces, which can be marked up, cut down, rewritten and reorganized, and brought back for further review. The short story, like the 10-page college term paper, or the 25-page graduate paper, has become a primary pedagogical genre form.

It’s not just that MFA students are encouraged to write stories in workshop, though this is true; it’s that the entire culture is steeped in the form. To learn how to write short stories, you also have to read them. MFA professors—many of them story writers themselves—recommend story collections to their students. MFA students recommend other collections to one another; they also, significantly, teach undergraduate creative writing courses, which are built almost exclusively around short works. In classes that need to divide their attention between the skill of reading and the craft of writing (and whose popularity rests partly on their lack of rigor), there’s no time for ploughing through novels. Also, scores of colleges now have associated literary journals, which tend overwhelmingly to focus on the short story; by publishing in as many of these as possible, a young writer begins building the reputation that will eventually secure her a job as a teacher-writer, and an older writer sustains her CV by the same means.

Thus the names that reverberate through the MFA system, from the freshman creative writing course up through the tenured faculty, tend to be those of story writers. At first glance, this may seem like a kind of collective suicide, because everyone knows that no one reads short stories. And it’s true that the story, once such a reliable source of income for writers, has fallen out of mass favor, perhaps for reasons opposite to that of the poem: If in the public imagination poetry reeks suspiciously of high academia—the dry, impacted arcana of specialists addressing specialists—then the short story may have become subtly and pejoratively associated with low academia—the workaday drudgery of classroom exercises and assignments. The poet sublimates into the thin air of the overeducated Ph.D.; the story writer melts down into the slush of the composition department. Neither hits the cultural mark. A writer’s early short stories (as any New York editor will tell you) lead to a novel, or they lead nowhere at all.

*  *  *

MFA versus NYC — surely that’s journalistic hyperbole. Cross-genre fiction is always hot: a cross between Harry Potter and Sherlock Holmes, that sort of thing. Almost certainly it’s become desirable for authors to present themselves as MFA meets NYC: I got the degree, I got the short story pubs, but really I’m a commercial fiction writer. Agents too: send me the blurb and the first ten pages of your novel, but in your pitch letter be sure to tell me about your MFA and your short story pubs. Back to the article…

*  *  *

To be an NYC writer means to submit to an unconscious yet powerful pressure toward readability. Such pressure has always existed, of course, but in recent years it has achieved a fearsome intensity. On one hand, a weakened market for literary fiction makes publishing houses less likely than ever to devote resources to work that doesn’t, like a pop song, “hook” the reader right away. On the other, the MFA-driven shift in the academic canon has altered the approach of writers outside the university as well as those within. Throughout the latter half of the last century, many of our most talented novelists—Nabokov, Gaddis, Bellow, Pynchon, DeLillo, Wallace—carved out for themselves a cultural position that depended precisely on a combination of public and academic acclaim. Such writers were readable enough to become famous yet large and knotty enough to require professional explanation—thus securing an afterlife, and an aftermarket, for their lives’ work. Syntactical intricacy, narrative ambiguity, formal innovation, and even length were aids to canonization, feeding the university’s need for books against which students and professors could test and prove their interpretive skills. Canonization, in turn, contributed to public renown. Thus the ambitious novelist, writing with one eye on the academy and the other on New York, could hope to secure a durable readership without succumbing (at least not fully) to the logic of the blockbuster. It was a strategy shaped by, and suited to, the era of the English department, which valued scholarly interpretation over writerly imitation, the long novel over the short story. (And when it came to white males imagining themselves into the canon, it helped that the canon was still composed mostly of white males.)

The death of David Foster Wallace could be said to mark the end of this quasi-popular tradition, at least temporarily. What one notices first about NYC-orbiting contemporary fiction is how much sense everyone makes. The best young NYC novelists go to great lengths to write comprehensible prose and tie their plots neat as a bow. How one longs, in a way, for endings like that of DeLillo’s first novel, Americana, where everyone just pees on everyone else for no reason! The trend toward neatness and accessibility is often posited to be the consequence of the workshop’s relentless paring. But for NYC writers—despite their degrees—it might be better understood as the result of fierce market pressure toward the middlebrow, combined with a deep authorial desire to communicate to the uninterested. The NYC writer knows that to speak obliquely is tantamount to not speaking at all; if anyone notices her words, it will only be to accuse her of irrelevance and elitism. She doesn’t worry about who might read her work in 20 years; she worries about who might read it now. She’s thrown her economic lot in with the publishers, and the publishers are very, very worried. Who has both the money to buy a hardcover book and the time to stick with something tricky? Who wants to reread Faulknerian sentences on a Kindle, or scroll back to pick up a missed plot point? Nobody, says the publisher. And the NYC novelist understands—she’d better understand, or else she’ll have to move to Cleveland.

*  *  *

So where does that put me? How about “neither MFA nor NYC”?

The article was written by somebody named Chad Harbach. I googled him: it turns out he wrote The Art of Fielding, a novel that I read and liked and even excerpted here on the blog. It was published in 2011 — a year after his Salon article — by a big NYC publisher. He also got an NYC-sized advance of $650K. And now I see that he’s got a new book out, published just this month: MFA vs NYC: The Two Cultures of American Fiction — a book-length edited compilation expanding on his Salon piece. How does Harbach do it? I gotta find out who his agent is…

ADDENDUM — I see that Harbach’s agent is Chris Parris-Lamb. It turns out that, on my first pass through the long list of literary agents, Parris-Lamb made the cut as someone whose tastes might coincide with mine, someone I might actually want to query.

14 February 2014

First Pass Through the Agent Lists

Filed under: Culture, Fiction, Reflections — ktismatics @ 1:02 pm

I’ve read, one by one, the bios and preferences of each agent on 30 of the 106 pages of the online Literary Agents Directory. That’s 310 agents. I’ve also looked at the home pages of many of the agencies for which these individuals work, so that by now I’m sure I’ve read about at least half of the working literary agents. Tallying up from my notes, I’ve identified 41 whose interests align at least remotely with my own writing. That’s around a 10 percent hit rate — better than I expected when I started going through the list. I think that’s enough for now.

My sense is that the agents’ self-descriptions are quite generic, quite broad. That’s meant to be encouraging, I suppose — they’re open to practically anything. These are professional salespeople after all — they don’t want to be inundated with submissions, but they don’t want to miss anything either. I’m sure they’d rather say no to 99% of the inquiring authors in hopes of striking gold. They want to demonstrate high standards while also flattering potential clients into believing that they’ve found just the right person to represent them in the literary marketplace. Here’s a composite of preferences compiled from three agents who work for the same agency:

“For Michelle, compelling writing consists of strong, carefully crafted characters with a unique voice. Most importantly, she’s looking for projects with emotional resonance and longevity. She’s specifically looking for high concept plots with literary underpinnings, psychological conflict, quirky protagonists, and fast-paced writing. Michelle is seeking literary works, women’s fiction, horror, thrillers, multicultural voices, and any well-written novels with quirky characters and/or unique plots and settings. She is drawn to an authentic voice, unforgettable characters and a well-crafted story that is emotional in unpredictable ways.”

I don’t believe that my own fiction pushes all of “Michelle”‘s hot buttons, nor do I necessarily wish that it did. Still, she would probably make my short list. I’d try to keyword my first paragraph with “high concept” and “unpredictable,” letting the content of the letter convey the careful craftsmanship of my prose, the uniqueness of my plots/settings, and the quirks of my characters.

Next, I’ll sift through my 41 agents looking for more information about them online in hopes of customizing my inquiry letters a bit more. I’ll also see what they want in the initial inquiry and in what form they want it. Hopefully next week I’ll start sending out the correspondence.

19 December 2013

An Obamacare Testimonial

Filed under: Culture, Reflections — ktismatics @ 10:23 am

We signed up for Obamacare yesterday, and I’m a satisfied customer.

I’m here to report that the process of applying for and obtaining health insurance on the much-maligned website is much easier than applying for private insurance the old-fashioned way. We encountered an initial glitch in logging in, but it turned out to be our own fault, not the site’s. No questions are posed about hospitalizations over the past 5 years, prior surgeries, prescribed medicines, most recent blood pressure readings, diagnosed health conditions, and all the other data that the companies insist on collecting from you every time you change insurers. As I recall, the only health-related information we provided were age, whether we currently smoke, and whether we have difficulties in performing activities of daily living (eating, dressing, toileting).

To determine the amount of your government subsidy for covering insurance premiums, the site asks you to estimate your income for 2014. It’s possible to enter varying estimates offline to see how much of a price break you might get for varying income levels. The discounts turn out to be quite steep, even for income levels that don’t fall below the officially recognized poverty line. Since this is a program administered by the federal government, it will be possible at the end of the year for the Obamacare administrators to identify, via your income tax returns, how much income you actually made. If it turns out you make more income than you estimated, you will have to repay unmerited subsidies. If you earn less than you estimated, then you get the additional subsidy refunded to you or applied to the subsequent year’s insurance premium.

When you’re ready to buy insurance, you’re presented with a list of insurance plans offered by private insurers that have agreed to participate in the Obamacare program. I thought that maybe there would be two choices, but there were maybe 40, clumped according to comprehensiveness of coverage (bronze, silver, gold, and platinum, of course). For each option the website displays the basic features: deductible, coinsurance, copay, maximum out-of-pocket expenses, prescription prices. The price of each option is displayed: the unsubsidized full amount as well as the amount you would have to pay after your calculated subsidy. Even if you don’t quality for a subsidy, the site’s method of displaying comparative costs and benefits of various options is extremely helpful.

We selected a plan from the list that best suited our preferences for coverage and price, then clicked the button. Congratulations! You’ve successfully signed up for Obamacare-administered health insurance. Presumably we’ll receive an email from the insurance carrier within the next couple of days instructing us on how to pay. Coverage goes into effect on 1 January 2014 — a mere 14 days after applying.

In conclusion, Obamacare is the easiest and best way of buying private health insurance that I’ve ever experienced. The website lets you shop for features and compare competing products head to head. And the program does make private coverage much more affordable to people with low incomes.

25 April 2013

Zizek’s Post-Traumatic Speculative Fiction

Filed under: Culture, Fiction, Psychology — ktismatics @ 11:08 am

The past two days I’ve participated in a lively thread about post-traumatic subjectivity at the Attempts at Living blog. In the course of the discussion I became aware of an essay by Slavoj Zizek entitled “Descartes and the Post-Traumatic Subject.” [The Abstract and a link to the PDF of the paper  can be found here.] Having read Zizek’s essay, I’m not sure what value there is in writing a post about it. I once did a lot of PTSD counseling and might do so again in the future. Does Zizek offer practical therapeutic advice? No. Does he reframe post-trauma in a way that has psychoanalytic value? That question might be worth considering, although I regard Zizek’s frame as a constraint to break rather than a context to step into. Does he reposition post-trauma politically? He does, and that’s what I find most objectionable about the essay. Is Zizek claiming that what he writes is true? If so, I don’t see any evidence supporting his truth claims. Alternatively, is Zizek telling a story, writing a kind of fiction, an alternative reality in which characters can act and events can be staged? Previously I’ve concluded that I get the most personal value out of metaphysical speculation if I regard it as a fictional genre. Do I find value in Zizek’s speculative “short story” about the post-traumatic subject? I do. In fact, I think I can adapt it for a chapter in my own fiction that I expect to write next week. So I’ll write this post about Zizek not as a critique but as a kind of summary description of a fictional world, an oppressive apocalyptic vision.

In some realities, what the subject fears is the inability to attain desires. In that sort of reality, trauma is the definitive obstacle to the fulfillment of desire. Trauma maims or kills you so that you cannot pursue your desire. Trauma removes that which you desire from the field of possibility, making further pursuit pointless — learned helplessness. The post-traumatic subject becomes passive, psychically numb, alienated, zombified, reduced to brain and body without a heart and soul. Trauma permanently severs the link between desire and fulfillment. Post-trauma, desire dies because it cannot possibly be fulfilled.

But that’s not how Zizek’s alternate reality works. Zizek begins his story by rehearsing (his version of) the Freudian-Lacanian fiction about trauma: that the victim actually wants to be traumatized.

For Freud (and Lacan), every external trauma is “sublated,” internalized, owing its impact to the way a pre-existing Real of the “psychic reality” is aroused through it. Even the most violent intrusions of the external real — say, the shocking effect on the victims of bomb-explosions of war — owe their traumatic effect to the resonance they find in perverse masochism, the death-drive, in unconscious guilt-feeling, etc.

In ZizekWorld, what one fears is what one desires. And what one desires is to be hurt, to be victimized by the sadist, to be punished, to be dead. I desire what I fear: some might regard this construction as a delusional phantasm, a subjective fiction. Trauma, when it comes, could be regarded as the irruption of the Real, destroying the fantasy, clearing the way for the individual who was previously immersed in a fictional delusion to get a little more real, to start becoming a real subject. But that’s not Zizek’s story. In ZizekWorld, not only does the subjectively Real incorporate the phantasm of imagined trauma: the image of the trauma is central to the subject’s reality.

Why? In Zizek’s fictional universe, as in many other parallel universes, the human subject is activated by desire. But here’s the twist in ZizekWorld: if the subject’s desire is ever fulfilled, then the subject loses the prime motivation to do anything. The object that someone desires is never really the cause of desire; if the object is attained, then desire must shift to some other object, some other potential source of fulfillment that must be pursued. At some unconscious level the person occupying Zizek’s fictional world understands this to be the case: if ever my desire is truly fulfilled, then I have nothing left to motivate me, no emotional engagement in the world.

In ZizekWorld, then, it’s not the permanent impossibility of fulfillment that kills desire. What kills desire is the fulfillment of desire. And so in effect the subject desires that which would kill desire, which would in effect kill the subject. The subjects in ZizekWorld are animated not by libido versus death drive, but by libido intertwined with death drive. And it is trauma that, catastrophically, fulfills the subject’s desire. In trauma, the phantasmatic image of desire held at a distance by the subject suddenly and uncontrollably closes the gap — between subject and object, between desire and fulfillment, between libido and death. Trauma destroys the object of desire because the object was always just a stand-in for death. And now death has come upon the subject, killing the object of desire. And trauma kills the subject of desire too, because the subject is intrinsically organized around desire.

But in ZizekWorld, killing the subject of desire doesn’t kill the subject altogether.

All different forms of traumatic encounters, independently of their specific nature (social, natural, biological, symbolic…), lead to the same result — a new subject emerges which survives its own death, the death (erasure) of its symbolic identity: after the shock, literally, a new subject emerges. Its features are well-known from numerous descriptions: lack of emotional engagement, profound indifference and detachment — it is a subject who is no longer “in-the-world” in the Heideggerian sense of engaged embodied existence. This subject lives death as a new form of life — his life is death-drive embodied, a life deprived of erotic engagement; and this holds for henchmen no less than for his victims.

The resurrected undead zombie subject is born again, its desire fulfilled. Should we feel sorry for the post-traumatic subject, and angry at the perpetrator of the trauma? Not in ZizekWorld.

What if we surmise that the cold indifferent disengaged subjects are NOT suffering at all, that, once their old persona is erased, they enter a blessed state of indifference, that they only appear to us caught in unbearable suffering?

The post-traumatic subject feels no pain because pain, like all feeling, is a product of a subjectivity fueled by desire, and the desiring-subject is dead. What then do trauma and its consequences mean in ZizekWorld? They mean nothing, since meaning is another product of the desiring-subject, a story that the subject tells itself about what it desires and why, how it goes about pursing its desires, why it is thwarted, etc.

In ZizekWorld the post-traumatic subject lives on, without desire, continually repeating the same meaningless sequences of actions again and again, the death drive decoupled from libidinal investment. And who are these “degree zero” subjects, these shells without substance, these “autistic monsters” that populate ZizekWorld? They are the “new proletariat”:

the exploited worker whose product is taken away from him, so that he is reduced to subjectivity without substance, to the void of pure subjective potentiality whose actualization in work process equals its de-realization.

Presumably in ZizekWorld the new proletarian masochistically wants to be exploited, feels he deserves it as punishment for his guilt, wants to be reduced to performing repetitive meaningless tasks. Who else are the post-traumatic subjects occupying ZizekWorld? Those cold-blooded killers, terrorists, and suicide bombers, those mindless followers of orders dictated by their authoritarian leaders, the Muslims:

When one looks an autistic subject (or a “Muslim”) into the eye, one also has the feeling that “there is nobody home.”

I could go on to discuss Zizek’s negate-the-negation shtick, whereby trauma ironically doubles the original primal trauma of symbolic castration from the Mother by the Father, a trauma that creates the subject in the first place. But this is enough I think: I’ve got my own fiction to write. We can certainly envision a Leader in ZizekWorld who organizes the zombified new proletariat in order to accomplish a violent revolution. Even if they’re killed or maimed in the battle it doesn’t mean anything, because they’re already dead, beyond meaning, beyond suffering. Or the ruling class can simply continue to exploit their undead workers, who don’t feel it anymore, who don’t care about anything anymore. Or the Muslims can be bombed into oblivion, since they’re already undead zombies. I can use these fantastic totalitarian speculations of Zizek’s for my own sinister fictional insurgencies…

17 April 2013

I’m Shocked, Shocked

Filed under: Culture, Reflections — ktismatics @ 7:16 pm

…to find that US hospitals make more money by fucking up than by doing it right. From this NYTimes article:

Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds. Changing the payment system, to stop rewarding poor care, may help to bring down surgical complication rates, the researchers say. If the system does not change, hospitals have little incentive to improve: in fact, some will wind up losing money if they take better care of patients…

The study is based on a detailed analysis of the records of 34,256 people who had surgery in 2010 at one of 12 hospitals run by Texas Health Resources. Of those patients, 1,820 had one or more complications that could have been prevented, like blood clots, pneumonia or infected incisions. The median length of stay for those patients quadrupled to 14 days, and hospital revenue averaged $30,500 more than for patients without complications ($49,400 versus $18,900). Private insurers paid far more for complications than did Medicare or Medicaid, or patients who paid out of pocket.

The authors said in an interview that they were not suggesting that hospitals were trying to make money by deliberately causing complications or refusing to address the problem. “Absolutely not,” said David Sadoff, a managing director of the Boston Consulting Group. “We don’t believe that is happening at all.” But, he said, the current payment system makes it difficult for hospitals to perform better because improvements can wind up costing them money.

Susan Pisano, a spokeswoman for American Health Insurance Plans, a trade group for insurance companies, said in an interview that the study illustrated that the entire health care system needed to move away from what she called “the perverse incentives of the old fee-for-service system that emphasized quantity over quality, and toward methods of payment that reward better care.”

…Dr. Barry Rosenberg, an author and a managing director of Boston Consulting, said the study came about because his firm was working with Texas Health Resources to find ways to reduce its hospitals’ surgical complication rates, which, at 5.3 percent, were in line with those reported by similar hospitals. Part of that work involved analyzing the costs, and he said the team was stunned to realize that lowering the complication rates would actually cost the hospital money. “We said, ‘Whoa, we’re working our tails off trying to lower complications, and the prize we’re going to get is a reduction in profits,’ ” Dr. Rosenberg said in an interview…

In an editorial, Uwe E. Reinhardt, an expert on medical economics from Princeton University, called the study’s findings “troublesome but not surprising.” He called the current payment system “untoward,” adding that it “can tempt otherwise admirable people into dubious conduct.”

16 April 2013

Springtime for the Homeless

Filed under: Culture, Reflections — ktismatics @ 9:30 am

UPDATE: The Shelter just announced that it’s going to stay open tonight and tomorrow night before closing for the season. Maybe my post helped in shaming management into it.

Winter Sheltering services are available from October 15 through April 15 for any adult in need.

That’s what it says on the website of the Boulder Shelter for the Homeless. It’s not true: any “adult in need” who has already spent 90 nights at the Shelter during the current “warming season” cannot spend another night there. And capacity isn’t nearly adequate: while the Shelter sleeps 160,  another 100 people spend their nights sleeping on the floors of churches and synagogues that have agreed to provide “overflow” shelter during bad weather.

But today is April 16 and according to the Shelter’s calendar the season is now over: the Shelter is closed tonight and every other night until October 15. Presumably in the warm weather homeless people are not “in need” of an indoor place to sleep, even though it is illegal to sleep outdoors in Boulder. Here’s what Boulder looks like today, April 16, out my back window:

april16boulder

Today’s local forecast: Moderating temperatures will change morning scattered snow showers to rain showers by late day. Patchy freezing drizzle possible. High around 45F, low of 31F. Winds SE at 15 to 25 mph. [Currently it’s 25F, so the meteorologists were being a bit optimistic about the low.]

Tomorrow: Cloudy with snow showers becoming a steady accumulating snow later on. Cold. High 36F, low 19F. Winds N at 15 to 25 mph. 1 to 3 inches of snow expected.

10 April 2013

Undead Text

Filed under: Culture, Fiction, First Lines, Ktismata, Psychology, Reflections — ktismatics @ 11:54 am

“I still remember the day my father took me to the Cemetery of Forgotten Books for the first time.”

That’s the first line of The Shadow of the Wind, a 2004 novel by Carlos Ruiz Zafón that I’ve been reading. Yesterday I was searching my document files — my private cemetery of forgotten texts — for a fragment I remember having written, thinking that I might be able to splice it into the fiction I’m presently writing. I never did find what I was looking for, but I did come across a document from 2004 that read like a Ktismatics blog post before Ktismatics even existed. Better late than never, I figured, so I reformatted the document as a post. I titled it “Wallace Stevens, Bond Man.” While proofing it I was remembering a couple of other posts I’d previously written about Wallace Stevens. So I googled myself: it turns out that I had already turned this same text into a Ktismatics post. It’s called On Keeping Your Day Job, posted in August 2007. So it was three years after having written the text that I turned it into a blog post, but that post is nearly six years old now and I’d forgotten all about it. Sometimes even the resurrected texts find their way back into the crypt.

31 January 2013

School Violence

Filed under: Culture — ktismatics @ 2:29 pm

Of course Sandy Hook was a tragedy. It was also an anomaly. According to the U.S. National Center for Education Statistics:

During the school year 2008–09 there were 1,579 homicides among school-age youth ages 5–18, of which 17 occurred at school. During the 2008 calendar year, there were 1,344 suicides of youth ages 5–18, of which 7 occurred at school. I.e., school is a lot safer than not-school for kids.

“Violent victimizations” include simple assault, rape, sexual assault, robbery, and aggravated assault. The rate of nonfatal violent victimizations of 12-18 year olds occurring at school declined from 55 per 1,000 in 1994 to 14 per thousand in 2010. I.e., schools are a lot safer now than they were 20 years ago.

Based on national data, homicide victims are disproportionately male, young, poor, and black. So are the perpetrators. So are prison inmates. I’m all for tough gun laws and tight school security, but the US incarceration rate has doubled over the past 20 years and quintupled over the past half-century. Drugs are regarded as a “gateway crime,” presumably leading to more serious infractions, and so a lot of poor kids get thrown in jail for possession as a preventive measure. No doubt the new tough-on-guns stance will result in more locker searches, more pat-downs, more busts for firearm possession even when no other crime is being committed. Almost certainly those arrested and sent to jail/detention in this new crackdown will, once again, be disproportionately male, poor, and black. But it’s certainly a cheaper solution than more and better schools, housing, jobs…

27 January 2013

Lola

Filed under: Culture, Reflections — ktismatics @ 5:59 pm

Lola de Valence

lola-de-valence-1862.jpg!Blog

–  Edouard Manet, 1862

Lola de Valence

Entre tant de beautés que partout on peut voir,
Je contemple bien, amis, que le désir balance;
Mais on voit scintiller en Lola de Valence
Le charme inattendu d’un bijou rose et noir.

Among such beauties as one can see everywhere
I understand, my friends, that desire hesitates;
But one sees sparkling in Lola of Valencia
The unexpected charm of a black and rose jewel.

— Charles Baudelaire, 1863, translated by William Aggeler

“The Triumph of Manet”

…Manet, with his fondness for the picturesquely exotic, still paying tribute to the toreador, the guitar, and the mantilla, though already half won over to everyday objects, to models found in the street, must have seemed to Baudelaire like a close reflection of his own problem: the crucial condition, for an artist, of being subject to several opposing temptations and actually capable of expressing himself in a variety of admirable styles.

We need only glance through the slender collection of Les Fleurs du mal, noting the significant and as it were concentrated variety of subjects in the poems, and compare it with the variety of subjects to be remarked in the list of Manet’s works, to decide on a reasonably obvious affinity between the preoccupations of the poet and the painter…

Both were born into the same environment of the old Paris bourgeoisie, and both display the same rare combination of a refined elegance in matters of taste with a singular strength of will in their work.

Furthermore: they were both equally contemptuous of any effects not arrived at by conscious clarity, and the full possession of the resources of their craft; it is this quality, which defines purity, in painting as in poetry. They have no mind to speculate on “sentiment” or introduce “ideas,” until the “sensation” has been skillfully and subtly organized. In fact, what they aimed at and reached was the supreme quality in art — charm, a term which I use here in all its force.

That is what I think of when I recall the delicious line — a line that seemed equivocal to the evil-minded, and a scandal to the Law — the famous bijou rose et noir which was Baudelaire’s tribute to Lola de Valence. A mysterious jewel, it seems to me less appropriate to the strong and stocky danseuse in her rich and heavy Spanish petticoat, standing superbly in wait behind the scenes, ready, with all her supple sureness of muscle, for the signal that will release the vigor, rhythm, and syncopated violence of her dance, than to the cold and naked Olympia, that monster of banal sensuality, ministered to by a negress…

– Paul Valéry, 1932

Lolita

She was Lola in slacks.

– Vladimir Nabokov, 1955

18 January 2013

Mali?

Filed under: Culture — ktismatics @ 11:01 am

Many years ago my traveler’s checks were stolen in Tangier by some English guy who later cashed them in Timbuktu, which happens to be in Mali. Other than that I had paid virtually no attention to the place until the French government’s recent military intervention. Here’s what I’ve pieced together:

Mali has undergone numerous political upheavals since France cut it loose in 1960. From 1992 a publicly elected government held office. Just before the scheduled 2012 elections the military seized power via a coup. The military say they took charge because the elected government was not maintaining a hard enough line against the Tuaregs of the north, who wanted to establish an Islamist state. I infer that the military was concerned about Islamist candidates doing well in the upcoming elections, as well as the possibility that the Tuaregs would be permitted to secede from Mali in order to form their own nation. Not surprisingly, a sizable proportion of the Malian populace is incensed that a stable, popularly-elected government has been deposed by military strongmen. Again not surprisingly, the resistance is being led by the Tuaregs.

So when France unleashes bombing sorties against the so-called Islamist extremist terrorists, it’s siding with the leaders of the military coup that only last year overthrew the democratically elected government. The Malian government has also called on neighboring Algeria to aid in suppressing the resistance. Algeria’s history is similar to Mali’s. In 1991 an Islamist coalition won the popular elections. In response a military coup ensued, deposing the elected government and triggering a civil war in which something like 200 thousand people were killed. A democratic republic has subsequently been installed, but it’s clear that the military still controls the Algerian government.

Again not surprisingly, not a few Algerians take exception to the Algerian military strongmen going to the aid of the Malian military strongmen. And so in protest an armed Islamist faction took control of a natural gas field, holding local and foreign energy workers as hostages. The Algerian military came charging in, guns blazing, mowing down captors and captives alike.

Is this largely an ethnic skirmish, limited to an uprising among the minority Tuaregs who also happen to be supporters of sharia law? Or are the Tuaregs standing on the front lines of a more widespread popular resistance against the military dictators that have seized power in the country? I don’t know. An estimated 90% of Malians are Islamic, but that doesn’t mean most of them support the establishment of an Islamic state. But I’d be surprised if most of them prefer a military dictatorship to the elected government which it overthrew just last year.

18 December 2012

The Perfect Christmas Gift?

Filed under: Culture, Reflections — ktismatics @ 9:11 am

From the Denver Post:

This weekend set a record for all single-day background check submittals in Colorado for potential gun purchases, according to Colorado Bureau of Investigation officials.

The first day after news of one of the worst mass shootings in America, when a gunman killed 20 children and six staff members at Sandy Hook Elementary School in Newtown, Conn., requests to buy guns in Colorado surged.

A total of 4,154 background checks were submitted on Saturday, said CBI spokeswoman Susan Medina. Those figures topped the previous greatest number of background checks on Black Friday this year, when 4,028 were processed.

The surge after the massacre surprised CBI officials, who said the office wasn’t adequately staffed to deal with demand. The situation soon created a backlog and increasingly long wait times for potential gun buyers waiting for check results.

So many background checks were submitted the process that normally usually takes minutes turned into wait times of more than 15 hours… By Sunday, the wait for a processed background check grew to 18 hours, Medina said. By Monday afternoon, it took longer than 21 hours for a check to be processed.

Richard Taylor, manager of Firing Line — which bills itself as Colorado’s largest gun shop and has been active since the mid-1980s — said the store had never been as busy as it was over the weekend, and times for a background check to be processed proved it.

“It’s just been crazy,” he said. “I’m surprised the system didn’t crash, it’s been so busy.”

The rush began Friday afternoon after news of the Sandy Hook shootings broke, Taylor said. Customers coming to the store speculated on how laws could change in the aftermath while browsing the store’s selections, he said.

Assault-style rifles were the most popular gun over the weekend, Taylor said.

 

15 December 2012

The Bisexual Allure of Objects

Filed under: Culture, Language, Psychology — ktismatics @ 2:14 pm

To test whether grammatical gender really does focus speakers of different languages on different aspects of objects, we created a list of 24 object names that had opposite grammatical genders in Spanish and German (half were masculine and half feminine in each language), and then asked a group of native Spanish speakers and another group of native German speakers to write down the first three adjectives that came to mind to describe each object on the list. The study was conducted entirely in English, and none of the participants were aware of the purpose of the study. The question was whether the grammatical genders of object names in Spanish and German would be reflected in the kinds of adjectives that Spanish and German speakers generated. All of the participants were native speakers of either Spanish or German, but both groups were highly proficient in English. Since the experiment was conducted in English (a language with no grammatical gender system), this is a particularly conservative test of whether grammatical gender influences the way people think about objects.

After all of the adjectives provided by Spanish and German speakers were collected, a group of English speakers (unaware of the purpose of the study) rated the adjectives as describing masculine or feminine properties of the objects. The adjectives were arranged in alphabetical order and were not identified as having been produced by a Spanish or a German speaker.

As predicted, Spanish and German speakers generated adjectives that were rated more masculine for items whose names were grammatically masculine in their native language than for items whose names were grammatically feminine. Because all object names used in this study had opposite genders in Spanish and German, Spanish and German speakers produced very different adjectives to describe the objects. For items that were grammatically masculine in Spanish but feminine in German, adjectives provided by Spanish speakers were rated more masculine than those provided by German speakers. For items that were grammatically masculine in German but feminine in Spanish, adjectives provided by German speakers were rated more masculine than those provided by Spanish speakers.

There were also observable qualitative differences between the kinds of adjectives Spanish and German speakers produced. For example, the word for “key” is masculine in German and feminine in Spanish. German speakers described keys as hard, heavy, jagged, metal, serrated, and useful, while Spanish speakers said they were golden, intricate, little, lovely, shiny, and tiny. The word for “bridge,” on the other hand, is feminine in German and masculine in Spanish. German speakers described bridges as beautiful, elegant, fragile, peaceful, pretty, and slender, while Spanish speakers said they were big, dangerous, long, strong, sturdy, and towering.

– Boroditsky, Schmidt, and Phillips (2003), “Sex, Syntax, and Semantics.”

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