The Health Policy Commission of Massachusetts was created by the legislature in 2012 when it passed a remarkable piece of healthcare law known as Chapter 224. The law requires an annual hearing to review the cost trends from the previous year. I am a member of the Advisory Council to the HPC. The annual hearings were held at Suffolk University Law School on Monday and Tuesday and the bulk of this letter is my attempt to report to you items of interest from those hearings.
In the second section I pass along an inspiring email from Peter Dreyfus, the site administrator at the Post Office Square office of Atrius Health. Peter’s email contains thoughts of a medical student on the first day of her clinical experience at PO Square. She concludes with a poem that got me thinking about the voice of the patient and the social determinants of health. I wonder where your thoughts will take you as you reflect on both the essay and the poem.
In the final section I reflect on the shared joy of being in Chicago as their team wins its wild card game as the first step toward shedding the mantle of a loser in its greater than 100 year quest for a world championship.
The traffic at strategyhealthcare.com continues to produce new readers. The site is now a year old and each week it brings new “interested readers” to these musings. I have enjoyed exchanging emails with many “interested readers”, old and new, over the last several months. I long for contact with you and want to get your take on the issues that face us all so this week I am modifying a line from Garrison Keillor and changing my typical sign off from “Be well” to “Be well, do good work, and drop me a line now and then”. I like words so why not replace two with thirteen? I also like change.
Reading Faces, Rationalizing with Averages and Good Intentions
For Christmas several years ago one of my sons and his wife gave us DVDs of the entire first season of the television drama “24” starring Kiefer Sullivan. Not long after receiving the gift, while spending a few days at the little house in the woods that was our first New Hampshire retreat, we found ourselves with not much to do on a snowy January evening. We made the mistake of putting the first episode into the DVD player early in the evening and finally staggered to bed at four in the morning.
We repeated the process with some moderation again the next day. Since that initial episode of “binge” viewing we have never quite repeated that behavior but we do enjoy getting into a series like “House of Cards” on Netflix and watching for three or four hours at one sitting. We have buzzed through dozens of episodes of several shows in our first year of retirement. Recently we have fallen under the power of “Lie To Me”.
The story line in “Lie To Me” involves a quirky psychologist, Dr. Lightman from England, played by Tom Roth who consults with the FBI and occasionally with the DC police, the military and other agencies to solve crimes. The core concept is that he has combined behavioral science and great powers of observation to know when a lie is being told. Lightman and some of the associates that he has trained can read volumes from faces and body language in real time and on video to identify liars, or if you you prefer, those trying to justify their bad behavior with some form of deception. He can also read other emotions like fear and anxiety that can mimic the appearance of prevarication. Some of the episodes require accepting unlikely events and questionable facts but if you can suspend disbelief and allow a little fantasy to creep in, it is good entertainment. I have been trying to see if the face reading technique can work for me since a review of my past reveals that more than once I have been deceived by people I trusted.
One part of the presentation that I really have enjoyed is the frequent use of the images of American politicians who are explaining their bad behavior at press conferences. Remember Bills Clinton’s defiance after the revelation of his Monica Lewinsky affair or the sad decline of Eliot Spitzer, Gary Hart or John Edwards? The facial expressions the pictures show as these bad boys try to talk their way out of the jams that their carnal instincts, narcissism, and raw ambition have created for them because of their poor impulse management, give a lot of credence to the concept behind the story line.
As the annual Cost Trends Hearings of the Health Policy Commission approached, I had plans to drive to Boston to attend. It would be a big investment of time and energy but I felt obliged to be there because I am a member of the Advisory Council to the HPC. My plans changed at the end of last week when I received an email from the HPC staff that informed me that the full two days of the hearings would be streamed on the Internet! That was too good a deal to pass up. As I saw it, my choice was between driving over two hundred miles, spending the night in a hotel, and sitting in a stiff chair in a room full of equally uncomfortable people for over more than twelve hours spread over two days listening to people as they were being grilled by the Commissioners versus sitting in my recliner and enjoying all of the comforts at home with access to my own bed and any beverage of my choosing at any time. It was like the choice of fighting the traffic to Gillette Stadium on a cold and raining night to watch the Patriots versus enjoying the game at home on TV. As they say, it was a "no brainer".
At the moment that I decided to choose the comforts of home over the unnecessary discomforts of duty, the thought that I might be able to practice my new interest in reading faces like Dr. Lightman does on “Lie To Me” had not occurred to me but it did the moment the broadcast began. The camera work was great. If I had been at the meeting in person I would have been looking at the back of those sitting at the witness table and speaking to the commissioners. The only thing that was lacking was play by play commentary. It would have been a good gig for Jerry Remy and Don Orsillo. What I immediately appreciated was that the cameras were set up to show the face of every speaker whether the speaker was a member of the HPC, an invited expert, a politician, a concerned citizen or one of the many healthcare leaders who was there to answer hard questions about what they and their institutions were doing to improve the cost of care in the Commonwealth.
The agenda and the pre conference materials were terrific and you may check them out at mass.gov/hpc. After the welcoming speeches by Stuart Altman, the chair of the HPC and David Seltz, HPC's enthusiastic and very competent Executive Director and a few others, the first person to address the commissioners was the Governor. He arrived with a wounded limb and revealed that he was following the instructions of his physicians at Harvard Vanguard.
The Governor spent much of his time talking about the state’s increasing challenges with opiates and the epidemic of associated deaths from overdoses. When he did begin to talk about the cost issues he introduced a thought that I had first heard from a Partners executive several years ago. Was there really a healthcare cost problem? He presented a "fact" that is at the core of the Partners argument that price is not really a problem. If you divide what Massachusetts spends on healthcare by its per capita income you get a factor for Massachusetts that is lower than all but three other states.
My heart sank. Would he really swallow this bogus statistic as a reason to question or create doubt about the efforts to make the hard choices to transform the finance and delivery of care in the state? Could he be blind to, or worse yet, not really care about the impact of the cost of care on individuals, on taxpayers, and on employers? Would this be his justification for “going slow” and mollifying the fixed interests of the status quo? He associated his comment with a litany of economic benefits that our expensive but world renowned academic medical centers bring to the state. They employ thousands, more than any other local industry. They attract the business of big pharma and high tech companies and other industries that gather here to be close to what is happening on the leading edge of science. These industries come to Massachusetts because they want to be close to the basic science and the opportunities that our institutions offer them to test the applications of the medical science that they produce. He seemed to be asking, "Do we want to mess with this picture?".
What I heard was really two speeches because after his interesting combination of truths and faux statistics that added up to an attempt to rationalize the consideration to go slowly into the future, he then did a reasonable review of our financial challenges, the chaos in the delivery system, and the operational challenges of moving healthcare finance and care delivery from the status quo to new approaches that might be risky but also might be the way that we should go. As the day wore on I could not help but think that his introduction of uncertainty and caution changed the tone of this year's hearings from the urgency that has characterized the hearings in the Patrick era to a considered "let's think twice" about what we are doing. With the Governor's current popularity this expression of caution and his small modicum of doubt was an alternative leadership style for the conversation.
With the tone set for a conservative review of the issues and potential actions, the day's discussions and testimony followed a pattern of superficial speculation with an easy disregard for evidence of serious shortcomings and real opportunities that for me were at times infuriating as pleasant people seemed to enjoy going through the motions of a process that they were required by law to perform but realized was unlikely to cause any real change.
I watched and listened for the remainder of the day to a process that seemed to be all about business. With only a few exceptions the conversation seemed devoid of real concern about how the lives of real people were affected by the issues under discussion. There were very few mentions of patients at all. It was a discussion of numbers. Facts and data would be presented but then someone would raise the question of statistical validity, of correct data interpretation, and of the practical problems of changing how care is delivered. Some heads would nod and everyone would move on with nothing concluded other than that there were confusing problems that needed to be studied more before they could be solved. The day was rife with the pain of ambiguity. If you remember my reference to The Phantom Tollbooth in the letter of September 25, it is easy to say the "the Terrible Trivium" won the day.
To be fair, I thought that the presentations of Aaron Borros, the director of CHIA (the Center for Healthcare information and Analysis) and Professor Amitabh Chandra, a healthcare economist from the Harvard Kennedy School, were terrific but their potential was muted by the lack of passion and the element of caution in the room. As the cameras looked into the faces of the commissioners and those who testified on the panels that followed Mr. Borros and Dr. Chandra, I think that Dr. Lightman might have been able to draw some real conclusions about displacement, frustration and anger. Had the camera been pointed at me, my guess is that my face would have spoken volumes.
I got the sense by the end of the day that success for the hearings would be measured more by conformity to the agenda and finishing on time than to creating a launching pad for real progress over the next year. As I pondered my disappointment with day one I was reminded that one great way to slow down or prevent change that I had learned from the work of John Kotter of "the burning platform" fame is for the leadership of the resistant powers of the status quo to embrace the need for change and then do little or nothing to lead the way.
Perhaps the highlight of day one for me was the 15 minutes allotted at the end of the day for people from the audience to comment. There were five who came forward on day one. Three of the speakers represented companies or special interests like labor but two were real patients who wanted to describe how desperately they needed real reform. The first “patient” had great difficulty getting to his point because he had a need to tell a long personal story of the intertwined nature of his economic woes and the deterioration of his health but an empathetic ear could easily discern that he and his family had fallen through many cracks and were financially devastated by the high cost of their care. The second testimony of interest came from a woman with an MPH who understood the system. Her knowledge of healthcare had not protected her family from the waste and dysfunction of the system when two of her children became ill. Her punchline was that after frustration with the ineptitude of the system she defaulted to an emergency room to get the care that her children needed. Cost was not her complaint. She was complaining about basic operational ineptitude. I think that it may be true that she was really the first person in a long day of hearings to clearly suggest that there was waste and ineptitude in the care delivered in Massachusetts.
The day was an example of how the context created by the need to be “polite” and nonconfrontational is antithetical to the creation of passion and commitment that is necessary to do what is difficult. It was clear early on that the hearings would not explain why the delivery system had failed to keep the cost of care under the goal of the increase in the state’s economic growth. It was hard for anyone to be held accountable for missing this statewide goal.
Explanations for missing the target were offered like the increased use of high cost drugs. That fact was quoted again and again through the whole two day stretch. Mental health issues and the cost that poor behavioral health adds got some consideration as a cause for failing to meet the target. A big contender for the “the reason” for the cost over runs was dysfunction within the state's enrollment of Medicaid recipients. That was a very popular supposition. My thought was if these people were not enrolled in Medicaid, we would still want them enrolled in some program that gave them access to care. It was not their enrollment in Medicaid that was the origin of cost, it was their need for care no matter who paid for it, and the methods by which that care was delivered, that were the core problems.
There were explanations that raised new concerns and some were questions that should have begun an intense dialog rather than a shrug of the shoulders and a nod of acceptance. Can we realistically build a new system of reimbursement on a “fee for service chassis”? Why do we have one of the highest levels of emergency room use of any state in the country? Do bundled payments represent progress toward a better system of finance or a self serving detour? How will we finance the behavioral health services that are fundamental to an era of improved health for individuals and the community? What are the important measures of quality and how do we focus our efforts on refining and measuring them? How can we agree on standard measures and processes across all payers both public and private? How can we better manage the growing impact of high deductible plans on access to needed care?
There was one question that was asked many times and to many people but remained unanswered although it was asked in many different ways. Why do we have such a wide variation in reimbursement for the same hospital and physician services? There were some historical answers and a corollary question. Since we know that there is payment variation unexplained by quality or case mix, why do we allow it to persist?
This question has been studied intensely since 2011. I was on a commission appointed by Governor Patrick to explore this question. I know that the only viable solutions will require tremendous political focus and will and there is little likelihood for that from a governor who is concerned about not undermining a status quo that many find quite comfortable and profitable. This is a tricky question for Partners and also a tough one for Atrius, the organization that I once led. The data shows that Atrius is one of the best paid practices in the state (by at least one major payer). I know the history of how that came to be true because I was a part of the discussions and negotiations that created that reality. There has been continuing benefit and reward for being the first organization to agree to be paid by the AQC.
Our explanation for our need to be treated differently by the fee for service payment systems has been that high reimbursement for individual acts of care is justified by our total cost of care which has been quite low, the lowest in the market for some populations, and our measured quality was which has been high across all populations. We pointed out that the extra money did not go into the pockets of individuals but rather we used the “enhanced rates” to support a managed care infrastructure that included services and processes that were not reimbursed by the FFS schedules. All that has been true in the past and every institution that receives a disproportionately high reimbursement can make an argument for why it should not change but how long into the future should that advantage persist? What damage does this variation do to our collective goals? That issue was never discussed.
The historical explanations for the variation do not answer the question of why we allow the variation to persist. That question of “why still” arose several times but was never answered. I think the answer to why the question has never been effectively addressed lies in the realities of the power of the status quo.
To do something about variation will take a combination of insight, leadership and power that does not exist now. As wonderful as the passage of chapter 58, chapter 305 and chapter 224 have been, none of these laws have created an entity that has the power to force the hard changes. Chapter 224 created the Center for Healthcare Information and Analysis and the HPC and charged them with reporting the state of things. It requires the HPC to study many things and render opinions but did not give it any real power other than the power of a pulpit. CHIA is charged with supplying in depth information about practice and finance and can be a tool for transparency but no individual or entity other than the combined will of the legislature and governor can require compliance or hold any institution accountable.
The Attorney General does not have much real power to push transformation. She can require organizations to reveal business facts and answer questions under penalty of perjury, as can the HPC, but neither the HPC nor the AG can create change without convincing the legislature and the governor to work together for new legislation. She does not have the power to move us past goals and process measurement to accountability and real change. Change is occurring very slowly, now driven more by the national process or changes within the control of CMS and the national insurance industry than by self prescribed and enacted change at our state level.
Well, day two was better.The expert presentations like the one given by Professor Leemore Dafny from Northwestern were enlightening. She described the options and limitations in an area of great importance, organizational and practice consolidation. Healthcare for All presented their continuing position that transparent, understandable and usable information will allow patients to play a more effective role in containing costs. On day two Commissioners were a little bit more challenging with their questions to those on the panels giving testimony. To my view their good questions frequently met a stone wall effectively erected by the executives who were giving testimonies. After five years of experience they have really developed their arts of deflection and redirection.
I salute Professor David Cutler for finally pushing the question about waste. He got a response similar to what Al Gore might expect if he talked to a group of libertarian oil producers about global warming but at least Professor Cutler brought up the subject. Dr. Paul Hattus and Dr. Carole Allen seemed to have gained resolve overnight and they too asked hard questions and their faces registered polite frustration with some of the "slick" and practiced answers that they received. At times those theoretically giving testimony went on the offensive by attacking the statistical methodology and expertise of CHIA and returning again and again to our fledgling and perhaps misdirected efforts to measure outcomes while we ask for value based reimbursement.
The most effective dodger and deflector was Dr. Torchiana, the CEO of Partners. I have discovered that his arguments have made it into an article in Becker’s. He even brought the conversation full circle by giving reference to the same faux statistic about income and healthcare cost with which the Governor had kicked off the meetings. CommonWealth Magazine is quoted in the Becker’s article and if you clicked on the CommonWealth link above you can see a great picture of the hearings with one of the testifying panels that included Dr. Torchiana from Partners. From left to right the panelist are Eric Schultz from Harvard Pilgrim, Dr. Steven Strongwater, the new CEO of Atrius, Dr. Kevin Tabb, the CEO of the BIDMC, Dr. Torchiana the CEO of Partners, and Ellen Zane former CEO of Tufts Medical Center and now chairwoman of the new system of which Tufts is the major teaching affiliate.
For me the high point of day two came early when the Attorney General and her staff made the sort of leadership statements that suggested to me that she was not in harmony with the Governor's rhetorical, doubt creating questions of the day before. Her first point was that averages hide a lot of dysfunction and individual pain. The victims are the disadvantaged whose need is obfuscated by the excess benefits and wealth of others. She talked like a physician who understood population health. For me her soft tones and unemotional restating of reality were a breath of fresh air after listening to a day of diverting conversation that was directed, it seemed to me, by a strategy designed to stall the conversation while whitewashing a less than acceptable status.
Her second point was that affordability affects access in a way that undermines our efforts to improve health. You know that and I know that. Everyone in the room knew that but she presented the principle as if we don't know it because to know it and to do nothing to make care affordable is worse than not knowing it. To know it and ignore it suggests that our focus is more likely to be self interest than a passion to provide the best care for everyone.
Using these ideas she attacked unwarranted price variation and carried the analysis further than anyone did before or after her. Her conclusion was that we can't achieve the objective of a competitive marketplace where innovation and attention to quality are rewarded, if some institutions get less than a fair share of the reimbursement pie.
She did not hold the floor for long. She delivered a strong statement without drama which left no room for the consideration of avoiding the hard decisions which had been the pattern of the previous day. After speaking for less than fifteen minutes she turned the presentation over to her able staff. Follow the link below to see the presentation that her staff gave.
On the last three slides you will find the recommendations of the AG’s team which I have copied below:
- Simplify and expand demand side efforts: – Require clear, easily compared information on the cost and quality of different insurance plans and provider systems for employers and consumers at the time of health insurance plan and PCP selection. Simplify and strengthen how tiered networks are designed. Promote consumer access to and understanding of health care cost and billing information.
- Consider Ways to implement supply side incentives and penalties more evenly: monitor variation in health status adjusted global budgets. Evaluate provider performance under statewide cost growth benchmark in ways that take into account existing differences in provider efficiency.
- Monitor and address disparities in the distribution of health care resources: – Consider forms of directly regulating the level of variation in provider prices and/or medical spending. Monitor income and health status adjusted medical spending by zip code on an annual basis. [Much more beneficial as a metric than the gross one lump state evaluation of income v. healthexpense suggested by Partners and the Governor] Promote the development of population health status metrics that better account for socioeconomic risk factors.
As was true on day one there was some drama in the period at the end of the day. Once again a real person from the middle class gave testimony to the pain of enormous healthcare costs. His story underlined a new reality predicted by the economist
Uwe Reinhardt. The new class of uninsured will surely be those families who work hard to earn at a level that precludes support by public funds but by status of self employment or other quirks are thrown into the exchanges and find the coverages that they can afford to exceed their means even if they select the lowest cost plans with the highest copays and deductibles. Despite the supports that are available through full implementation of the ACA, there will be many who will continue to find that the cost of care drives unacceptable choices for them.
The other comment of importance came from
Dr. Lachlan Forrow of the BIDMC who is one of the leaders of
the Conversation Project about end of life care. He pointed out that surveys show that over 25% of people in Massachusetts are concerned about the quality and cost of end of life care and that addressing end of life care would improve patient satisfaction, safety, quality and cost at measurable levels and not one word was said about the concerns of our management of the cost issues at the end of life in the whole two days of hearings. I think there were a few red faces.
Let me surprise you. I found the Cost Trends Hearings of 2015 to be a very positive experience and my hope was bolstered that Massachusetts will find the energy to resume its leadership role in the reform and transformation of healthcare. One must look into the abyss. The pushback against the reliance on statistics that hide the realities of individual suffering was aired by the Attorney General. The unfair nature of resource distribution was outed more effectively than at anytime before through a conversation that might be the beginning of the solution that did not occur. At least the AG gave notice that she cares. I think in time, through the work of Healthcare for All and others like the AG, the public will eventually come to understand that their best interests are served by a fair and competitive marketplace.
It is good to acknowledge that our statistical tools are still nascent and that if we collectively demand that they be better focused and more objective, in time they will be. Societal change is a slow process but the existence of the hearings is itself evidence that the change will come. Blue Cross used the hearings to announce that their alternative quality contract methodology will be extended to PPO products starting January 2016. I can hardly wait for 2016. It will be interesting to see how much progress is made over the year toward the Triple Aim Plus One or as Dr. Ebert said 50 years ago, how much progress we will make this year toward what he called a “conceptual framework and operating system that will provide optimally for the health needs of the population.” Ebert was right then, and it is still true now that: “The existing deficiencies in health care cannot be corrected simply by supplying more personnel, more facilities and more money.” I believe that if we can develop a collective will and find leaders and followers who have a passion to live in a better world, we will make progress.
New Hands and Hearts are on the Way
Peter Dreyfus is a long time friend, colleague and Interested Reader who frequently shares meaningful organizational experiences and insights with me. He also gives me literary tips from time to time. Our close collaboration goes back over twenty years to when we both were involved with the work of moving Harvard Vanguard out of Harvard Pilgrim Health Care to become an independent care delivery organization. For many years he has been the practice leader at the downtown Post Office Square practice. This week Peter sent me an interesting note.
Greetings --- As you know, several physicians at Post Office Square, including Marcelo Campos, teach Harvard Medical School students in the office. One of Marcelo's students, Claire Wagner, (in her first year of medical school), wrote the following reflection after her first day in the office. I thought you might enjoy reading it. I was struck by the simplicity and soulfulness of Claire's insights.
Peter
Her words:
“Ah, come on!” I heard a fellow pedestrian shout at a honking car while we each tried to dodge puddles as we dashed across an intersection downtown. (We had the right of way!) It was the last street to cross before arriving at 147 Milk Street, where he and I both found refuge under the awning, out of the biblical downpour that had descended on Boston that morning. He wore a bright raincoat and held a trash bag in his hand. I closed my umbrella and hurried inside- shoes sloshing with water; black pants soaked.
About 10 or 15 minutes later, after greeting and debriefing with you (Dr. Campos), Dennis (Diaz, Marcelo's medical assistant) opened the door to the patient waiting room and welcomed in the same individual with whom I had recently shared the experience of arriving safely at Harvard Vanguard Post Office Square. I introduced myself and added “I think I just saw you out there in the rain!” We three chatted while Dennis took his vitals and weight. Dennis left the exam room where the patient, Mr. C, allowed me to take a brief history: a self-described suboxone patient in his early fifties who had struggled for the past two decades with addiction.
The challenges he faces in his life were challenges I was (and am) pretty unfamiliar with; I had never before had an encounter with someone struggling with an illegal substance addiction, though I do hear about it nearly every morning on NPR. He is a professional baker, who – from the sound of it – lives paycheck to paycheck. I was humbled by his honesty, and by his willingness to let me ask him many questions about the history of his present illness, and his past medical history, that he may not have anticipated having to sit through during a routine weekly visit!
Speaking with Mr. C was a different experience than other patient encounters I have had, largely in Rwanda where the patients I spent time with were children with cancer and congenital heart defects in an inpatient setting. Although the specific issues dealt with by Mr. C and the Rwandan children may be quite dissimilar, at the core, both remind me of a poem by Bertolt Brecht (copied in part below). Spending time with Mr. C in the exam room and observing your approach to his adherence plan, and his health overall, was illuminating. In Rwanda, we always say that “the world is a little village” and that we all need to care for one another, and work to reduce structural barriers to care. I learned a lot from watching you care for him and establish rapport to engender long-term healthy practices. I saw figuratively and literally the ways we all can be out in the rain sometimes, and ultimately we all just want an awning.
Peter noted that she had only copied part of the poem. I think there is value in considering the whole poem so here it is. Her original note printed the part that I have bolded.
"A Worker's Speech to a Doctor" by Bertolt Brecht
We know what makes us ill.
When we’re ill word says
You’re the one to make us well
For ten years, so we hear
You learned how to heal in elegant schools
Built at the people’s expense
And to get your knowledge
Dispensed a fortune
That means you can make us well.
Can you make us well?
When we visit you
Our clothes are ripped and torn
And you listen all over our naked body.
As to the cause of our illness
A glance at our rags would be more
Revealing. One and the same cause wears out
Our bodies and our clothes.
The pain in our shoulder comes
You say, from the damp; and this is also the cause
Of the patch on the apartment wall.
So tell us then:
Where does the damp come from?
Too much work and too little food
Make us weak and scrawny.
Your prescription says:
Put on more weight.
You might as well tell a fish
Go climb a tree
How much time can you give us?
We see: one carpet in your flat costs
The fees you take from
Five thousand consultations
You’ll no doubt protest
Your innocence. The damp patch
On the wall of our apartments
Tells the same story.
Perhaps that poem should have been read and followed by a moment of secular reflection at the start of the Cost Trend Hearings. I am encouraged and inspired by Claire’s observations. I do believe that our greatest hope lies within the next generation of caregivers. They are entering the profession with their eyes wide open and I hope that their enthusiasm for service survives their training and that their mentors like Dr. Campos will arm them with tools and a professional philosophy that will enable them to thrive as they meet the challenges of the Triple Aim Plus One.
I love the lines:
One and the same cause wears out
Our bodies and our clothes.
Clare’s generation of caregivers will be more successful than mine which is now slowly leaving the stage, if they pay heed to those lines and make a full force effort to confront the social determinants of illness. We can prepare them to be successful where we have failed so far, if we arm them with tools to manage populations while helping them to remember that populations are composed by individuals.
Excitement in the Windy City
One reason that I was delighted to watch the Cost Trend Hearings from the comfort of my easy chair at home was that I knew that I was headed to Chicago on Wednesday to attend a Simpler meeting. I did not want to be away from home all week. Next week’s letter will largely be a report of the inspiring experience that I have had at the Simpler conference. I have loved Chicago ever since I saw my first major league baseball game there in 1956 while our family tagged along as my father attended a conference. We stayed at the Drake Hotel which is obscured behind the trees in the header picture for this week that I took during one of my perambulations along the lakefront these past two days. It is called the “Gold Coast”. The structures that crowd the shore going north from the heart of downtown do look expensive but I would prefer to think it is called the Gold Coast because the lakefront is a great place to get some air and exercise.
As my plane landed early Wednesday afternoon I was thrilled to realize that for a little while I could be a Cubs Fan (my apologies to John Gallagher who is loyal to the Pirates). My reasoning was that their GM was Theo Epstein, the one and only, who had brought World Series success to the Red Sox and that Jon Lester now pitched for them. I know that is thin but the mother of one of my daughter-in-laws is a die hard Cubs fan and she forces my grandson to wear cute little Cubs’ hats and T shirts so I feel connected.
Well, as you know that game was in Pittsburg but that did not matter to folks in Chicago who were pretty excited. Perhaps by the time you get around to reading this far Jon Lester will have already have beaten John Lackey (another former Red Sox pitcher), and his Cardinals as the Cubs take the next step toward the World Series. Some of my “Sox” pain was eased by the drubbing of the Yankees, even though I know that disappointed another daughter in law who is a Yankees fan. This really should be the year of the Cubs (I hope). The Yankees have had their glory.
Even though you probably will not have the pleasure of Chicago’s Lakeside Trail for your walks this weekend, I do hope that you get out in the refreshing fall air. Winter is coming and these fall days and a long weekend are too great to waste.
