I'm home again. I have waited eight years for this chance to come back to the States
and live in my house. If somebody told me now the sabbatical was off and I had to return to work in Tokyo, I'd ride into the sunset and never be heard from again. I've anticipated this period of uninterrupted time to read and write so long, it's as if I've done it two or three times already.
I love getting up in the morning and grabbing a book, or sitting down at the computer knowing I don't have to look at a clock. Or starting the day with a walk. Or sleeping in. It's exhilarating, this freedom. It's working, in other words, if you think a sabbatical is supposed to be a time for refreshing the lagging spirits and opening the possibilities for creative work. Just as I planned. Just as I hoped.
But something's not right.
Of course. It's just too good. Too much freedom. Where am I going to get my creative juices? For years now, I've enjoyed the time to read and write because it comes with a sense of guilt. I'm stealing the time from something else, something I should be doing instead, something I'm going to have to pay for later. I need something to fight against. I can't handle the gift of a luxury like this; I have to wrench it out of somebody's hands, pull it out by the roots and make it feel like victory.
I know there are people who get a sabbatical and go straight to work, write the novel, plan the lecture series, polish the argument, revise the draft, catch up on the reading. People who know what to do with the gift of time without distractions. I can't. Never could. I require justification when the muses fail. How can I work? All these people bugging me. How can I get my reading done? I'm exhausted from the commute. So I've begun my six-month sabbatical with a quest for distractions.
The house. Now that should be like shooting fish in a barrel. The clogged drains, the need to put in a doorbell, change a shower head, remove the jungle of weeds from the garden, that sort of thing. Where do I buy a good carving knife? What do I do about window coverings? Is it time to tune the piano again? The dishwasher hose is blocked, the refrigerator has a bad rattle. You get the idea.
Somehow, though, at the end of the day, these questions find their answers. A distraction worth its name has to say “dwell on me; fixate, stew, grow anxious.” The house concerns require time and effort, but the answers come. Write a check for $300 and the plumbing gets fixed. Momentary alarm, but no lasting anxiety. The concerns, actually, even come to represent the fact that I have a house to call my own after all these years. No. I need a distraction that makes no sense. One that will drive me up a tree and give me a sense that life has meaning. Bona fide kvetch material.
I've got it. I'll go into culture shock. I've spent many years counseling others in dealing with culture shock. It's time the guru freshened up his skills by getting down and dirty. First hand experience to keep me in tune. Front line knowledge. “Why don't they..., how can they..., how do you explain this absurdity?
God Bless You, America. America the Beautiful. Land of the Free, Home of the Brave. America, you are in serious disrepair. (I think I've got it.)
America's home appliances, for example. (Yes, I sense I'm on the right track.) When I bought the house nearly two years ago now, the former owner performed a wonderful act of generosity and bought me a bunch of housewarming gifts. Among these were a microwave, a rice cooker, and a toaster. They were all bought at once at the same place. And they were all state-of-the-art stuff. Names like Cuisinart and Black & Decker, good stuff with lots of bells and whistles.
The toaster, for example. You push a button and it expands and contracts to toast bagels or tiny slivers of French bread. It has a motor that raises and lowers the bread slowly – no rude pop-up, this – and holds it snug until it reaches the right degree of toastiness.
The first time I plugged in the rice cooker, smoke curled out of the front of it and there was a distinct odor of an electrical burn. I tried it again. More smoke. More stink. I put it away, too busy raiding the video and book stores for my next three or four month stint in Tokyo. A year later I tried again. More smoke, more stink and the heat turns off in less than a minute, before the water is even warm.
Two dramatic changes here since I left eight years ago are the proliferation of 800 numbers – I reveal my Japanese roots by calling them “free dial numbers,” – and the now apparently nationwide acceptance of the California belief that people have only one name.
Rochelle answers the phone. I tell Rochelle my rice cooker smokes. “It's supposed to smoke, sir. That's how it cooks the rice.” Now there's an amusing conceit. I am tempted suddenly to transform myself into Rita Moreno. “Listen, ass kholl. It's steam what make dee rice kook, not smok. Dees pietz of chit what you sell me dommake no rice.” I maintain a dull businesslike persona and get the point across in a more ordinary fashion. This enables Rochelle to come up with a wonderful little plan. Why don't I wrap up the rice cooker in its original box and mail it back to San Diego where they will try to repair the damage I did to it. Oh yes. I need to send them a sixteen dollar check for their trouble. I start to lose it again over the sixteen dollars, but catch myself, save my energy for the hour long wait I know is coming at the post office.
The post office! The thought makes my heart sink. I've got to take this clunker to the U.S. Post Office! I've just come from the post office. I wanted to send postcards to Japan and went to the post office for stamps.
“How much to send a postcard to Japan?”
“You'll have to stand in line, sir.”
“But I just want some stamps. I'll buy them in the machine.”
“You'll have to stand in line, sir.”
I stand in line for twenty minutes. Not before looking all over the place in vain for a list of postage rates around the world. “They used to have one here somewhere, but I guess they took it down,” one of my neighbors-in-line offers. I do manage to find a machine that will weigh your letters, but it only works for domestic postage. A machine which cost the U.S. taxpayer maybe a thousand bucks, and all it can tell you is you need to slap on thirty-two, fifty-five, or seventy-eight cents worth of stamps for this first class piece of mail you are now weighing.
“Fifty cents,” the clerk tells me, looking it up.
“Give me ten fifty cent stamps.”
“We don't have fifty cent stamps. Try the machine over there.”
The machine doesn't sell fifty-cent stamps. Only thirty-two cent stamps.
A week later I notice my toaster isn't working. I jiggle the cord and it burns the toast on the edges, jiggle it again and it burns it in the center. My friend Bill is visiting and he mutters something I don't want to hear about fire insurance. I begin looking nervously out of the corner of my eye to see what the microwave is up to. I can see the dialogue about to ensue.
Et tu microwave?”
The coincidence is apparently leveling off at two out of three. So I call the Cuisanart people in Arizona. I'm an old hand now at calling appliance manufacturers, I think, and am ready for the worst. But it turns out Cuisanart, compared to Aroma, is a class act. Or maybe it's that they do things a whole lot better in Glendale, AZ than they do in San Diego, CA. And, best of all, they actually say, “Oh, dear!” when I tell them my story.
I am taken aback by this. I am about to gush at them for caring. I'm to wrap up the toaster (no need for the original box this time) and include not a check but the receipt for the postage in a separate letter so they can reimburse me. The toaster will be fixed for no charge. They are so nice about it that I begin to wonder if they will fly in and do the stint at the post office, but evidently I'm at the limits of good service here.
Meanwhile, while I'm struggling with appliances, my housemate Taku, who arrived a week after me from Japan (and is also carrying the burden of Japanese expectations) is out getting himself a checking account. A “very nice lady” methodically copies his name (he always comments on kindness) from his passport and promises him his checks and his ATM card will reach him within ten working days. The ATM card comes first. Misspelled.
“How could this happen?” he wonders. “She seemed like such a nice lady!” He calls the bank and is told to come in with the ATM card. I think he should simply cut it in half, but they insist since it's a new account he needs to bring it in before they will issue another one. A few days later when the checks arrive, he calls to tell them they too are misspelled. “You'll have to bring them in.” No please. No sorry. No sign of distress at all. How could this be?
We could mail the checks, actually, but last year I waited seven days for an important piece of mail to travel from San Francisco 94103 to 94104, so we decide the walk to the bank will do us good. They repeat the same procedure and promise him new checks within ten working days. Again, no apology. No thanks for coming in. Just a weak smile and a helpful assurance that he will not have to pay the fees for the second set of new checks.
I can't recall whether this was the point where Taku's culture shock kicked in or whether it was the trip to the grocery store for ginger. “We're out.”
“When will you have ginger?”
All that afternoon he mumbled to himself, “How does a produce market run out of ginger? And why are they so rude?”
Rudeness, I know, is very relative. They don't think they're being rude. They're Americans doing their job. They don't like their jobs much, apparently, and they don't hesitate to show you how they feel. I used to notice that when you tried to get a cashier at Macy's to wait on you, she or he was usually fighting with another cashier over whose turn it was to take a break. Now that pattern seems to have extended to the banks and grocery stores. Relative, I say, because there is a reason to think of store and bank clerks as relatively gracious people. The reason is called public transit in the Bay Area.
A friend in Palo Alto sold me his old Toyota Camry, so I went to Palo Alto to pick it up. I took BART to Fremont, where I asked a driver (there were no signs posted) where I might find the bus that crossed the Dumbarton Bridge to Palo Alto. Turns out the information I got from one of the BART employees in Berkeley was wrong and the bus, in fact, went from Union City and I would have to get back on BART and go back a stop. I arrived back at Union City at 1:00 to learn the next bus would be at 1:45. Forty-five minutes! How often do they run? “About every two hours or so.” I'm actually lucky to hit it so close.
My grumbling starts the man next to me grumbling. “I've been here since 11,” he tells me. “ I missed the bus at 11:15 because I was trying to help a woman in a wheelchair down the stairs. The elevator here isn't working.”
On the bus was a blind man looking for the bus to the Veteran's Hospital. Does this bus go there?
“Where do I transfer?”
“I don't know,” was the answer. “Ask at the Palo Alto Caltrans Station,” says the bus driver.
“But I'd have to get off the bus to do that!”
At least BART got me there. Now it's on strike. The union workers are the highest paid in the country, but they're on strike for more. This in a system that regularly runs late, sometimes runs not at all, and has been known to change destinations on you. They tell you when they do this, of course, but on loudspeakers that don't work. The most frustrating aspect of Bay Area Rapid Transit is that while the trains are rapid, absolutely nothing else about the system is. Long waits. Frequent transfers. Frequent breakdowns. Lack of coordination with other transportation systems.
These features of the system, arguably, all have good explanations. But not everything can be explained away. If you're going somewhere in San Francisco where you have to transfer to a bus, for example, you need one dollar to buy a transfer ticket, available only at your transfer point. The machine takes only quarters. You wait in line while each person unfamiliar with the system fumbles for four quarters and drops them in the slot one at a time. The machine takes no other change and it doesn't take dollar bills.
To compensate, they provide you with a dollar changer, which wraps up the madness of public transit in the San Francisco Bay Area in one easy illustration: You put in one crisp new dollar bill (it, too, rejects most dollar bills), and it gives you three quarters, two dimes, and a nickel.
At the moment, there is a strike on, and you can't take BART at all. So you take AC transit to get to San Francisco. From my house, that means a short walk over to Shattuck Avenue to catch the bus which takes you across the Bay Bridge. Typical for American city bus systems, there is no apparent schedule. Certainly none posted. They run when they run, something on the order of every half hour. But they only stop if they have seats available. The other day it took Taku three hours to get to San Francisco State. After that, I started driving him. It takes me twenty minutes by car. At dinner the other night, as people exchanged horror stories about getting into San Francisco, somebody suggested maybe a sign with the words, “I'm small. I promise I won't take up much room. I've been waiting here for an hour. Please let me board.”
The strike is major news. Everybody turns on the local channels now morning and night to find out how to get to work. The ferries are running again from Oakland, but there you can stand in line a half hour to get on, and wait in the bay another half hour to dock. Apparently the ferry companies put on extra crews to handle the overflow crowds, but it turns out San Francisco has only two docks, so you have people lined up on the shore for hours, crews waiting on empty ferry boats with nothing to do, and more people than ever vowing never to leave their cars again for public transportation.
For all the talk about public transit, about finding ways to save the environment, one overriding rule still governs the lives of people with cars (i.e. all but the very poor and the residents of Manhattan.) If it's too far to walk and too close to fly to, take your car. The rule is as American as apple pie, true today as it was when General Motors savaged the trains and John Middle America first lost the ability to distinguish between his car and his genitals.
The post office. The public transportation systems. The clerks in stores. What's with this place! Is it just the Japanese lenses I'm wearing over my eyes? Is it that I'm now over 55 and officially an old fogy whose DNA tells him things aren't as good as they used to be? I read somewhere that only one Americans in ten is satisfied with his or her job, only three in ten feel any loyalty to their company. After a month back in the USA, that strikes me as the high end of the guess.
But wait. You ain't seen nothing yet. Kvetch material? I'll give you kvetch material. I've always known America was an easier place to live for most whites than for most people of color. But that's because the struggle to rid the culture of racism has yet to reach cruising speed. That it was a better place for the rich than for the poor. But then most places are. That is was a better place for the thin than for the fat, the swift than for the sluggish, the crafty than for the dull. But that doesn't seem to be a fault of the United States so much as a flaw in human nature. Recently, however, I've discovered how much better America is for the healthy than for those in need of a doctor. And that is not because of human nature, but because America has fallen down badly as a democratic society.
The story of this discovery on a personal level begins with the belated recognition on my part of what most of my compatriots have known for a long time. That those boys regularly on trial for ethical breaches, the ones called to represent the people in gummint (as Molly Ivins calls them), have determined in their Republican greed and their Democratic cowardice that they should leave the health of the nation in the hands of private industry, gummint being so bad at everything they do. Now private industry means the insurance industry in this case, and let me illustrate what this can mean if you are a fifty-seven year old remarkably healthy man who happens to have a cluster of cholesterol polyps in his gall bladder.
It means no insurance. No insurance means if you get hit by a car and break your leg you pay whatever the market decides it can get from you. It means if you have a heart attack and end up in a hospital charging two thousand dollars a day just for the bed, you pay. It means if you need to see a doctor, you pay $85 out of your own pocket. That's what it means not to be covered. You pay or they take your house.
Because of the horrendous costs of medical care in the United States (and why did my fingers decide just now to reverse the i and the t in “united”) I have always taken out Japanese traveler's insurance when I come here for a short stay. This time, though, since I plan to stay here for eight months, I decided I ought to get on an American health plan. I turned first to Kaiser Permanente, the originator of the healthcare management idea and a biggie in the Bay Area. They are everywhere and they are reasonable – about what I pay in Japan.
Well Kaiser said no. No insurance for you, my man. You have cholesterol in your gall bladder. Now how do they know this? Because I told them. A fact which still has several of my friends doubled over in laughter. Never seen a man my age so naïve. But I believed the fine print when they said, “Any information you fail to report on this form which suggests a pre-existing condition could cause us to revoke coverage, and you would be responsible for all payments ever made to you for medical services from Kaiser.”
I hate rejection.
“Thank you for your interest in Kaiser.”
“I'll shop elsewhere,” I think. I know how capitalism works. It's a shopper's paradise, right? And I start the long long search for the health care provider who will provide. In fact, I list them, line them all up, and then set aside a day, pencils sharpened and coffee maker fired up, and prepare to be put on hold for hours at a time as I run down all the 800 numbers.
I start with Blue Cross. They will send materials. Pacific Plan. I join the Writer's Union. Mars and Venus Hospital Systems. Pizza 4 U and Comedy 2 Health Promotion, Inc. I do them all. Get on the mailing list for San Francisco State and Stanford alumni organizations. I'm going to find the best deal. American Association of Retired Persons. I'm going to do my homework here. This is too important to do casually. “No Body too Decrepit of Omaha.” Got to do this just right.
I wait for the forms to come in. It doesn't take long. These guys are hustlers. They want them premiums. I fill out the applications and send off my checks. And the answers come back no. Why no? “Because you have been turned down by another health care provider.” No. No health insurance for you. No again. No from us, too. No. Nope. Sorry. No can do.
How the hell do they know I've been turned down? I've obviously got to stop telling these used car types the truth. Well, turns out it's “in the computer,” filed under my social security number. This stinks to heaven, has got to be illegal, but that's little consolation. I'm in the computer under my social security number as a person with cholesterol polyps. No health coverage. The great collusion of providers - you will not be surprised to hear that “provider” is a word which is beginning to rub now like an extremely bad case of crotch itch – this great collusion means there is indeed organization in health care. Organization for the stockholders, not organization of any use to anybody who needs a doctor.
Second round. I have some choices. (You always have choices in capitalism, remember.) I can get a provider to write a policy which will exclude my alleged gall bladder condition, but there is a chance they will run it at a higher rate, I'm told. I can pay $500 a month to some shark who will gamble on my condition. I can take my chances, tack my plane ticket to Tokyo on the front door and keep the car pointed toward the airport and the engine running in case the ticker should fail. I can get a friend to hire me, pay me for a month, put me on his group plan. Then I can quit, pay the money back, pay taxes on the money, lose my income tax exclusion as a resident of Japan, etc., etc. Or, I can contest the rejection.
I start the process of contesting the rejection. I pay a doctor $85 to give me a phone number of a hospital where they will do an ultrascan of my gut to see just how bad these polyps are. Now my private doctor in Japan has told me that this “condition” is not a condition; it is something to watch and would become dangerous only if the polyps became cancerous, and this kind of polyps normally does not. Keio Hospital, where my routine health exam is done, has been absolutely uncooperative in the past, but who knows, maybe things have changed, I dream, as this state of affairs invades my sleep. Maybe if I ask real nice and tell them this is an emergency, they will let me borrow the pictures. I know their view is the pictures belong to them because they own the equipment that took them, but I'll wash my hands before and after.
The doctor gives me the phone number, and I pay him $85. I call the hospital and wait two weeks for an appointment. How much will this all cost? “Probably around $300, says the young doctor.” That plus another $85 visit to read the echograms once he gets them in his hands.
I know the routine. No solids. No liquids. No nothing after midnight. Up in the rush hour freeway traffic to the hospital at the crack of dawn, where I sit and wait for an hour, despite the fact I have an appointment. The problem? I don't have health insurance and the person who knows the actual fees isn't in until ten. I wait.
They take me in a little office, ask me how I intend to pay. I pull out my check book. They say, “That will be $577.00 please.”
“In your left ear,” I say, and walk out. But I have second thoughts, walk back in and ask them why it costs so much.
“Those are our rates.”
“Where do you suppose my doctor got the figure of $300?”
They seem to understand what I'm up against, so I wait while they call him to ask. He's waterskiing, so they can only guess. “Must be he's thinking of some other hospital. Try @#)$%. Or Mount $#(&*. Or maybe Saint &*(*#&$'s. They (the low rent hospitals in “that” part of town) might be able to help you.
So I go home and phone first @#)$%. Then Mount $#(&*, then Saint &*(*#&$'s, all actually closer to home than Wechargemore Medical Center in Richmond. Problem is they don't have people to talk to, only answering machines. I leave messages; they don't call back. I call again; they don't call back. I start leaving stronger messages, then more mournful messages; they don't call back. They never, not one goddam one of them, call me back.
I've had days now to reflect on what I'm trying to do. I'm trying to pay more than $700 to get somebody to smear some baby oil on my gut and run a little cord with what looks like a doll house vacuum cleaner around for about three to five minutes, to get an echogram of a cluster of cholesterol polyps in my gall bladder, which I can then compare with the echograms of same taken two years ago, which are currently in the hands of a hospital which up till now has steadfastly refused to turn them over to me because they own them and I don't. Now if I leap each of these hurdles without falling off my horse, and, if there has been no change in my sub-belly, I can ask my doctor to put a gold star on my medical history, certifying that I am indeed not a risk to an insurance company. If he will do that, I have half a chance of talking an insurance company into accepting a monthly check which will allow me to sleep peacefully again.
I can begin the surgical procedure of separating the Siamese twins of illness and poverty. I will have met the prime requirement for health care in America: clear indication that I will not need medical attention.
A well-meaning friend points out to me, midway through what is beginning to look like a charge at windmills, that I have overlooked another option. I can go back to Japan and live. Stay there till I'm 65 and hope Medicare will not have been eaten alive by the Gingriches who ate Christmas and the likes of Jesse Helms, who only today said yes to tobacco companies, no to emergency aid to children not covered by any health and welfare programs. I am overdoing it, perhaps, with the poverty bit. I am not an American without resources. I have a good job. I have medical coverage, in fact. Just not in my homeland.
I'm not sitting entirely still while I wait. I also decide at some point to write a letter to Kaiser telling them what shits I think they are for doing this to me. I decide to start first with a letter of explanation and keep the invective in my back pocket for the eventuality of a protracted battle. I tell them how much I love Kaiser, how many people I know who have put their lives in Kaiser's doctors' care, how many hands of loved ones I've held in their tastefully decorated waiting rooms.
A week passes and there is a letter in the mail from Kaiser. No word about the rejection. No word about my letter. Their letter says - I intend to have it framed – “Please present this form to our medical staff when you visit our Kaiser Permanente facility.” After that is so much stuff about blood pressure and things too naughty to mention, and the very welcome words, “There will be no charge for these services.” I am in my car within three minutes of the time I open the letter. Pedal to the metal, ten bucks worth of rubber on the road. If I drive fast enough, I can get to Macarthur and Broadway and up to the 11th floor before they change their mind. Blood pressure 123 over 69. Praise. Praise. Such good health for an old man.
Another week passes and another letter from Kaiser appears in the mailbox.
“Welcome to Kaiser Permanente! (sic on the !)” I am now a member in good standing, 'twould appear, of the Kaiser Permanente family. “You now have a full health care team on your side with complete services to get the care you need when you need it.” What, do they actually think I need more selling?
Kaiser, I understand, is in shaky financial condition. Rumors abound they could fold anytime. But that's another tale for another day. “Sufficient unto the day is the evil thereof,” my father used to love to quote. Don't let another day's misery affect this day's joys. This day I am marking on my calendar. This day I am loved by a provider. I am in my provider's care. I belong. I am an American with rights. I am back in America once again. I live in an American home, drive my car on American streets, gaze from my window at American sunsets. An American chez soi. Nothing can happen to me now.
September 25, 1997