Tag Archives: Well-Being

Co-Housing

Not to be confused with co-working, co-ops, or condos, co-housing is its own cultural phenomenon.

This is a major article in the NYT describing a decades-old phenomenon of co-housing, and updating the phenomenon with present day facts:

Co-housing

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CREDIT: 

The most recent manifestation of the communalist impulse is the postvaccine nostalgia for the pandemic pod. People are now telling reporters that they miss the camaraderie of those pared-down social networks, as well as the frequent physical company of the same group of friends, the “transformative power of proximity,” as the psychologist Susan Pinker calls it.

I was late to find out about co-housing, a species of intentional community that dates back 30 years, in the United States, anyway. (It emerged in Denmark in the 1970s.) Forced to characterize co-housing in a phrase, you might say “living together, separately.” Those living together have built a community based on, well, belief in community. But they live separately, in that they own their homes, condo-style.

Co-housing sounds confusingly similar to co-living but has a whole different vibe. Co-housers aren’t transient. They have a much stickier idea of social affiliation, and they’re not about to rent a bedroom in some random complex. To draw even finer distinctions: Co-housing communities are not communes. Residents do not give up financial privacy any more than they give up domestic privacy. They have their own bank accounts and commute to ordinary jobs. If you were lucky enough to grow up on a friendly cul-de-sac, you’re in range of the idea, except that you don’t have to worry about your child being hit by a car as she plays in the street. A core principle of co-housing is that cars should be parked on a community’s periphery.

This, I thought, was an idea with promise. Co-living accommodates precarity; co-housing seeks stability. Podding is a byproduct of the collapse of society; co-housing builds society.

The most recent manifestation of the communalist impulse is the postvaccine nostalgia for the pandemic pod. People are now telling reporters that they miss the camaraderie of those pared-down social networks, as well as the frequent physical company of the same group of friends, the “transformative power of proximity,” as the psychologist Susan Pinker calls it.

I was late to find out about co-housing, a species of intentional community that dates back 30 years, in the United States, anyway. (It emerged in Denmark in the 1970s.) Forced to characterize co-housing in a phrase, you might say “living together, separately.” Those living together have built a community based on, well, belief in community. But they live separately, in that they own their homes, condo-style.

Co-housing sounds confusingly similar to co-living but has a whole different vibe. Co-housers aren’t transient. They have a much stickier idea of social affiliation, and they’re not about to rent a bedroom in some random complex. To draw even finer distinctions: Co-housing communities are not communes. Residents do not give up financial privacy any more than they give up domestic privacy. They have their own bank accounts and commute to ordinary jobs. If you were lucky enough to grow up on a friendly cul-de-sac, you’re in range of the idea, except that you don’t have to worry about your child being hit by a car as she plays in the street. A core principle of co-housing is that cars should be parked on a community’s periphery.

This, I thought, was an idea with promise. Co-living accommodates precarity; co-housing seeks stability. Podding is a byproduct of the collapse of society; co-housing builds society

Out of the 165 co-housing communities around the country, Eastern Village interested me because it’s urban and vertical, while the majority are suburban or at least suburbanish. I wondered whether co-housing could survive the claustrophobia of city living and the resulting need for personal space. My cheeks still get hot with embarrassment when I remember a remark in an elevator: It was a few years after my son was born, and I’d moved back to Manhattan, hoping to find the something I missed in the suburbs. “You’re not from around here, are you?” a man said, after I tried to start a conversation. Oh, right, I thought. People crammed into a box don’t want to talk to a chirpy lady they might have to edge away from. I never did get to know the other families in the building.

There are other, better-known urban co-housing communities around the country, but Eastern Village has the virtue of not being exemplary. For one thing, it was built from the top down rather than the bottom up. Model co-housing tends to be grass-roots: First the group meets to explore its wants and needs, then it finds an architect who designs a community just right for them, and finally it builds. From the time a group of would-be co-housers forms to the time it moves in, two to five years can pass. The idea for Eastern Village, on the other hand, came from a developer. He undertook the daunting task of retrofitting the building, then asked someone better versed in co-housing to go out, put together a group and teach participants how to live together.

The process still took two and a half years, but it struck me as a more replicable model. If co-housing didn’t have to be handcrafted, I thought, maybe it could be scaled up. And this seems the moment to think about how.

Americans may be about to experience three once-in-a-lifetime opportunities to reconsider how they house themselves. The first is the two big spending bills working their way through Congress. If they pass, they could provide billions of dollars to alleviate homelessness and increase affordable housing. The second opportunity proceeds from the shift to working from home: Record numbers of office buildings stand empty and ready for the refurbishing, and they won’t all be refilled

The third force that could push us to change our way of life is a heightened awareness of isolation. In a 2020 survey by the Harvard Graduate School of Education, one-third of Americans described themselves as seriously lonely — up from one-fifth before the Covid pandemic. Loneliness is now understood as a public health crisis, ranking as high among risk factors for mortality as heavy smoking, drinking and obesity.

Contrary to what one might think, the loneliest people in America aren’t the elderly. They’re young adults (close to two-thirds of them, according to the Harvard survey) and mothers of small children (about half). This makes sense: Young people tend to lead migratory lives, leading to weak social ties. Mothers have their children, although almost a quarter of them are raising those children without a partner; the United States has the highest rate in the world of children living with only one parent. With or without a partner, a mother may still have a hard time finding a fulfilling social life, since paid work and unpaid maternal labor take up so much of her time.

The pandemic lockdown exposed women’s solitude, in particular, as a function not just of time but also of space. Afraid to go out into the public domain, all caregivers — the newly full-time ones as well as those who had already put care at the center of their lives — became painfully aware that the private domain can be a very lonely and demanding place.

Under the circumstances, co-housing has the potential, if nothing else, to furnish ideas of how to build for community. After all, you’d never get away with snubbing people in the elevator at Eastern Village

If there is an adage that informs life in co-housing, it’s treat thy neighbor as thy family. Thy extended family, that is, assuming it’s a happy one. And what do happy families do? For one thing, they share stuff. As Rabbi Kimelman-Block led me through what felt like a labyrinth, he opened several overstuffed “sharing closets.” One was full of expensive, space-hogging items like travel cribs and skis. Another was for things being given away.

What else do families do? Well, chores, preferably cheerfully and collaboratively. And indeed, co-housers are expected to sign up for maintenance and cleanup days. Families also look out for one another. In co-housing that means, among other things, helping keep an eye on all the children. Many communities pay for formal day care. Most important, co-housers eat together. Breaking bread is probably the most effective bonding ritual society has ever come up with, and co-housers take turns cooking for and serving meals to other members. Some communities offer meals as often as six times a week. (Attendance is never mandatory.)

Most co-housing communities are anchored by a large, shared kitchen. It forms the heart of the common house, which may also offer pools, carpentry workshops, dance studios or meeting rooms — you name it, some community has it. In Eastern Village, common spaces have been cleverly tucked around the complex. Wending our way from basement to roof, Rabbi Kimelman-Block and I went through a dining room, a room for table tennis and foosball, a living room with a fireplace and fat leather chairs, a children’s playroom, a lamp-lit quiet room, a game room, a laundry room, an exercise room, a small lending library. The kitchen, though, is a problem. It’s not set up to cook communitywide dinners, in part because the fire marshal insisted that it install a crushingly expensive commercial range, and it went instead with a “warm-up kitchen,” as architect and developer Don Tucker calls it. So Eastern Village is more or less stuck with potluck.

But then again, as my mother liked to say, the perfect is the enemy of the good. We have to make do if we want to make change.

Today, the detached single-family house — the lonesome cowboy model of domestic architecture — dominates the American landscape so thoroughly that it feels as if it were inevitable. As of 2019, there were about 100 million single-family homes in the United States (including mobile and prefab homes), compared to about 40 million multifamily ones. But it didn’t have to turn out this way. Although the home on the farm had been the American ideal since Thomas Jefferson popularized pastoralism, as the country urbanized after the Civil War, many visionaries saw opportunities for a less atomized, more female-friendly lifestyle.

The landscape designer Frederick Law Olmsted, for one, imagined Emerald City-like metropolises with public laundries, bakeries and kitchens, taking some of the burden off housewives. Amenities like sewers, gutters and sidewalks would make streets more appealing for women. Women’s rights activists such as Charlotte Perkins Gilmanand a now-forgotten feminist named Melusina Fay Peirce envisioned Eastern Village-like cooperatives in apartment complexes, complete with communal laundries, sewing rooms, kitchens and dining rooms. Peirce called it “cooperative housekeeping” and thought women should make money at it.

During the early part of the 20th century, however, those reveries retreated into science fiction novels. Many forces converged to rob them of reality, not least the Red Scare, when politicians developed an allergy to anything that seemed to have a flavor of socialism or feminism. Along with builders, they began to promote the single-family dream house, with its Harry Homeowner and his happy housewife.

Today, roughly three-quarters of the residential land in metro areas is set aside for such houses and yards. Hub-and-spoke roads and commuter railways have grown up around them. Elaborate exclusionary zoning codes were written to protect them from the taint of commerce and industry — as well as to keep white, wealthy neighborhoods away from Black and poorer ones. The distance between home and everything else imposed by these laws is the reason most Americans need to drive to shop or work.

Back when the majority of breadwinners were male and made the journey downtown unburdened by domestic concerns, a long commute wasn’t a big logistical challenge. Today, mothers are also making those commutes, but they still have domestic burdens. Working from home improves the situation only if child care is available.

Co-housing arose, in part, as a solution to the work-life problem. In 1969, Hildur Jackson — just one among many co-housing pioneers, but an eloquent one — was living in a house in Copenhagen, a law school graduate unsure whether she should stay home with her two little boys or embark on a law career. “There was no apparent third option,” she wrote in a remembrance. Then she read an article titled “Children Need 100 Parents.”

Ms. Jackson decided to start a six-family community on an old farm in a Copenhagen suburb. The families built homes around two giant lawns, which were used largely for games, particularly soccer. The barn was turned into a common house, and three Icelandic horses were bought for the stables. “We chose to have no borders between our gardens,” she wrote. “We raised chickens, tended a large common vegetable garden and had fruit trees and berry bushes.” Days were set aside for community maintenance. When her husband traveled on business, which he did often, “I never felt isolated,” she wrote. When she had her third child, she had 11 other parents to help.

Co-housing (called “living communities” in Denmark) soon spread throughout Scandinavia and to the Netherlands and Germany; communities are now found all over Europe, as well as in Canada, Australia and New Zealand. In the 1980s, the architects Charles Durrett and Kathryn McCamant, who were married and business partners at the time, began importing co-housing to the United States. (Between the two of them, they have built or been consultants on many of the co-housing communities in the country.) The two got involved in the movement because they wanted children but their lives seemed too hectic: “We would come home from work exhausted and hungry, only to find the refrigerator empty,” Mr. Durrett has written. So they went to Denmark to study another way to build for parenting.

Co-housing is the nonthreatening heir of America’s far more radical communitarian past. And during my many years of self-education, I discovered that communitarianism has often had a feminist face.

Early socialists avowed an egalitarianism so radical that it included housewives. Nineteenth-century progressives, male as well as female, understood wives’ solitary and unremunerated duties as central to their oppression. Socialists set up model villages and touted them as a way to inspire workers to abandon cities, factories and industrial bosses. But they also promised to enfranchise women and free them from the shackles of domestic drudgery.

Robert Owen, the most famous British socialist of his day, and his French counterpart, Charles Fourier, envisioned the collectivization of women’s work in communal kitchens, dining rooms and nurseries, although they seemed to think this would require the construction of vast, ornate (and unrealistic) palaces. Owen’s and Fourier’s followers, known as Cooperators, established close to 50 socialist communities in rural areas in the Northeastern and Midwestern United States in the 1820s to 1840s. The leaders, who were almost always men, rarely put theory into practice when it came to women. As Carol A. Kolmerten, a historian and the author of “Women in Utopia,” a study of American Owenite communities, wrote, it fell to female Cooperators to prepare the food, wash the clothes and teach the little ones. Or, if the women toiled in fields and workshops, they would still cook and clean in the evenings. Wives who had arrived full of hope left, taking their husbands with them.

Male obtuseness was not the main reason these settlements failed. Other realities proved more damaging. Some settlements couldn’t generate enough cash to pay off the loans that paid for the land. Life in the wilderness wasn’t palatial; it involved log cabins and mosquitoes. Refugees from cities didn’t know how to farm. Class differences among members reasserted themselves, leading to factionalism. But the alienation of one-half of the population (the “woman problem,” Owen came to call it) didn’t help.

On the other hand, secular socialists accounted for only a small fraction of America’s intentional communities. Millenarian Christians — Shakers, Mormons, the Oneida Community and Anabaptist offshoots like the Amish and the Hutterites — built many more, and theirs tended to last longer, as Lawrence Foster writes in “Women, Family and Utopia.” Perhaps that’s because when their leaders broke down the walls of nuclear families to create communal ones, they did so to strengthen their members’ attachment to God and commitment to building his kingdom on earth.

What is remarkable about some of these religious communes is the degree to which they defied the gender norms of their day, in some cases going further than the socialists. The Shakers weren’t feminist in a way contemporary Americans would recognize. They didn’t question the gendered division of labor: Women worked in the kitchens and did the weaving, while men did the farm labor. But women’s work wasn’t seen as inferior to men’s. Both helped sustain the community; therefore both were equal in God’s eyes. More important, Shaker leaders were as likely to be female as male.

In the Oneida Community, a sect that eschewed what its leader called the gloominess of “the little man-and-wife circle” and replaced it with nonmonogamy, women were able to participate without restriction in every aspect of life — religious, economic and social.

Collectivizing domestic labor gave groups incentives to come up with labor-saving household devices. The Shakers patented a water-powered washing machine that cleaned clothes by churning them, an improvement on previous devices. Oneidans may or may not have invented the lazy susan (the point is debated); in any case, they used it to reduce the labor required to serve food in a communal dining hall. With the same goal in mind, they came up with, among other things, an industrial potato peeler and a mop wringer.

These old-time religious communes hold lessons for us moderns. “From a feminist viewpoint the major achievement of most communitarian experiments was ending the isolation of the housewife,” wrote Dolores Hayden in her classic study of feminist communalism, “The Grand Domestic Revolution.” “A second achievement was the division and specialization of household labor.”

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fter the tour, Rabbi Kimelman-Block roped in whoever was around to talk to me. We gathered on Eastern Village’s xeriscaped roof, its communal green space. Most people brought drinks. I ate Ethiopian takeout. Professions ranged from Realtor to social-justice activist. Eastern Village has 110 residents, 30 of them college age or younger. The ones I met were mostly middle-aged, though one couple bought in when they were in their 70s.

Parenting was the leading answer to my question about why they’d chosen co-housing: Kids aren’t stuck in their apartments; they can run downstairs. Neighbors’ kids or older members were almost always around to babysit, and for a while, there was a somewhat more formal day care arrangement. Adults benefit from the ad hoc interaction, too. Instead of planning dinner or drinks weeks in advance, on any Wednesday or Saturday, a sociable soul can find a neighbor to share a snack or a beer with.

One unexpected comment came from Adrienne Torrey, a curly-haired middle-aged woman with a relaxed manner. “Co-housing attracts a lot of introverts,” she said. That hadn’t occurred to me, but inclined to introversion myself, I immediately saw the logic. Who needs a community more than those who have a hard time spontaneously cobbling one together? Or — my next thought — than new parents stranded by their change of circumstance? By contrast, as soon as you show up in co-housing, you are swept into a round robin of meals and festivities and cleanup days.

The most controversial topic that evening was meetings. Almost all co-housing communities make big decisions by consensus. One member complained that arriving at unanimity is cumbersome and unnecessary. The rest disagreed. However long consensus takes, everyone feels heard and learns the art of compromise. That, I’m told, may be the most important key to successful group living.

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f co-housing offers solutions for so many of the problems from which America’s mothers suffer, if we are now uniquely positioned to put at least some of its lessons into effect — thanks to the pandemic’s unintentional consciousness-raising and the possibility that Congress will pass the Biden administration’s plans to rebuild the economy — what’s stopping us?

During one of my several conversations with Charles Durrett, I asked what he would identify as the biggest obstacle to building co-housing in the United States. “Our culture,” he said promptly. “We tend to think of ourselves as independent pioneers. We’re not a cooperative kind of culture.” But he grew up in a tight-knit neighborhood, he said, and his neighbors “played a huge role in my well-being.”

But planning departments, regional as well as municipal, don’t help. Typical American zoning laws frown on multifamily complexes unless they’ve been exiled to poorer parts of town. Even accessory dwelling units, such as mother-in-law apartments, are unpopular, lest they be rented to “undesirables.” Those are the most notorious restrictions; they’re not the only ones Mr. Durrett has had to fight as he tried to build co-housing.

City planning laws simply don’t envision communities focused on residents’ helping one other and keeping children safe. One city demanded two-car driveways for each unit, a waste of space and money in a community that keeps cars far from houses. When a town insisted that to accommodate the number of people in a proposed community, it would have to pay for a $1 million fire truck, Mr. Durrett asked the officials what the fire department’s most common call was. “Pick up and put back,” they told him, meaning putting seniors who have fallen out of their beds back into them. “We can do that for ourselves,” he said. Finding people who can put other people back in bed is precisely what co-housing is good at.

The other challenge, of course, is that not all people want to share their lives. People have to be willing to sacrifice time (all those meetings, the grounds maintenance) and the luxury of self-absorption (the small talk expected from those on their way to the mailroom). Co-housing may consume emotional energy that would otherwise go to keeping other social circles — work colleagues, college buddies, fellow parents at our children’s schools — spinning in the air. “Living in co-housing is not easy,” said Ann Zabaldo, the person hired by Eastern Village’s developer to recruit and educate its future occupants about the art of co-housing. But, she added, “it is so much richer, like drinking deeply from the well.”

Communal living by itself will never solve any one major social problem, be it loneliness or sexism or anything else. Although much more communal architecture can (and should) be built, you can’t mass-produce community. People have to be able to see the benefits before they’ll make the necessary commitments.

But life is changing in ways that may make collaborative coexistence more attractive. Rents are on the rise. People are getting used to the sharing economy. And then there’s that bottom-line truth exposed by the pandemic: Take away child care, and women stop working for pay and don’t start again, like the nearly two million of them who have dropped out of the labor force since February 2020. Something must be done.

In the past few years, states and cities around the country have started reconsidering single-family zoning or dared to vote to put an end to it. Last month, Gov. Gavin Newsom of California signed into lawbills to limit single-family zoning and permit construction of buildings with up to 10 units near public transit.

A wholesale revision of zoning codes could lead to a new built environment, one that would nudge us toward a new mind-set. We should build co-housing on a large scale. But even if we don’t, we could start reshaping the contours of our hyperindividualist and antimaternalist landscapes so as to encourage solidarity and fellow feeling rather than aloofness: Co-housing communities are centered on their greenswards; we need more parks. Co-housing puts people before cars; towns and cities should do the same. Co-housers live together, meaning they are around in case of need; the least inspiration we can take from that is to make our housing stock more varied, less focused on the nuclear family, so that members of extended families and groups of friends can be there for one another, too.

If this sounds not unlike the best-designed urban neighborhoods in America, well, maybe it’s not. But the pandemic has sparked a flight from cities and a demand for more suburban housing, and the boom in the market right now is in exurbia — low-density, lower-cost suburbs on the outer edges of metropolitan areas. As these neighborhoods are built, in all likelihood old design habits will prevail. But there’s no harm in imagining, and fighting for, a land-use philosophy focused on making life more pleasant for parents and children — and for the introvert in all of us.

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n the 19 years since I had my first child, I have spent a lot of time thinking about how my life might have been different if I’d known about Hildur Jackson’s “third option.” What if there had been tens of thousands of co-housing communities in America instead of a couple hundred? Maybe I would have moved into one rather than back to unfriendly Manhattan.

If I had to single out one feature of cooperative living I find particularly attractive, it would be regular, spontaneous contact with people of all ages. I had my children later in life, and my parents weren’t healthy enough to spend as much time with their grandchildren as all of us wanted, and then, as happens, they died. I’m nostalgic for an intergenerational experience I never had.

A few weeks ago, I watched my teenage daughter spend an entire meal talking conspiratorially to two of my best friends. How often do American teenagers open up to their parents’ friends? What would it have been like for her to be able to do that throughout her childhood with surrogate aunts and uncles and grandparents? The three of them sat just out of earshot, making it hard for me to eavesdrop, which I’m sure was the point. But the sight of them gossiping made me think that maybe, despite the blank suburban streets and the chilly city elevators and my never quite figuring out where we should live, I’d done something right.

Judith Shulevitz (@JudithShulevitz) is a cultural critic and the author of “The Sabbath World: Glimpses of a Different Order of Time.” She still lives in New York City.

Gratitude

I love asking my grandchildren: “what’s the proper attitude? “When I’m lucky, they yell back “GRATITUDE! “

As cheesy as it sounds, gratitude is a bigger factor in one’s personal well-being than most people realize.

The article below spells out a way to think about gratitude – about your past, about your present, and about your future – that can literally change the way you view your life.

https://www.inc.com/benjamin-p-hardy/gratitude-is-different-and-more-powerful-than-you-think.html

Arivale busts: a scientific wellness darling

Arivale – the end of a promising “scientific wellness” company

Anyone who cares about well-being, particularly that subset of well-being that many labeled as the “scientific wellness” movement, should note a decade-ender: the failure of Arivale. 

They burned through $50 million. They sold 5,000 customers over their lifetime. The customers were paying $99 per month on LABS tracking and health coaching that was tailored to the person’s genomes and other critical lab work. 

Their conclusion: customers would not pay for what it cost to serve them. In the future? Maybe. But not now. 

=======ARTICLE ON ARIVALE FOLLOWS=======

CREDIT: https://www.geekwire.com/2019/scientific-wellness-startup-arivale-closes-abruptly-tragic-end-vision-transform-personal-health/

Scientific wellness startup Arivale closes abruptly in ‘tragic’ end to vision to transform personal health

BY TODD BISHOP & TAYLOR SOPER on April 24, 2019

Arivale, the genetic testing and personal health coaching startup co-founded by genomics pioneer Leroy “Lee” Hood, shut down unexpectedly Wednesday — bringing an abrupt end to its ambitions to transform the lives of Americans through a new field that Hood dubbed “scientific wellness.”

All of the Seattle-based company’s approximately 120 employees were let go as of noon today, Arivale CEO Clayton Lewis confirmed in an interview. Arivale raised more than $50 million over its lifetime. The company offered ongoing wellness and nutritional coaching tailored to the results of each person’s genetic, blood and microbiome tests.

FOLLOW-UP: Why Arivale failed: Inside the surprise closure of an ambitious ‘scientific wellness’ startup

The decision was a surprise to many Arivale employees and customers. In a message to Arivale customers this afternoon, the company attributed the decision to “the simple fact that the cost of providing the service exceeds what our customers can pay for it.”

The message added, “We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. However, we are unable to continue to operate at a loss until that time arrives.”

Lewis told GeekWire that the high cost of acquiring customers also played a role in the decision.

“What is tragic on so many levels is that we were not successful in going out and convincing consumers that you could optimize your wellness and avoid disease with a little bit data and some changes in your lifestyle — that there’s not a market for that product that I believe in passionately,” Lewis said. “And that’s what we were trying to do.”

About 5,000 people took part in the Arivale program over the lifetime of the company, and Lewis said he is “incredibly proud” of the results. The program launched at a cost of $3,500 per year, but the price had dropped to the point where most customers were paying $99 per month for the flagship Arivale program, Lewis said.

The larger personal wellness industry includes heavyweights such as 23andMe, a genetic testing startup valued at more than $1 billion, and smaller players including EverlyWell, which raised a $50 million round last week, and Viome, the Seattle-area microbiome company led by Naveen Jain that just announced a new $25 million funding round from investors including Salesforce CEO Marc Benioff.

Global Wellness Institute estimates that the preventative and personalized medicine and public health industry is worth $575 billion.

Some of Arivale’s underlying work will continue at the Institute for Systems Biology (ISB), the not-for-profit biomedical research organization co-founded by Hood, where the ideas that led to Arivale were originally developed. ISB is now part of Providence St. Joseph Health, where Hood is chief science officer. Clayton said ISB is expected to hire some of the employees let go by Arivale as part of its closure. He declined to disclose details of the severance offered to employees, but said the same package was provided to all executives and employees.

Investors in Arivale included Arch Venture Partners, Polaris, and Maveron, where Lewis worked full-time before joining Arivale as co-founder and CEO.

Its scientific advisory board included George Church, a professor at Harvard and MIT; James Heath, president of Institute of Systems Biology; and Ed Lazowska, computer science professor at the University of Washington.

“Lee Hood sees the future with unmatched clarity,” said Lazowska, an early participant in the Arivale program. “A clear view, however, does not always imply a short path. Scientific wellness, as pioneered by Arivale, will be a foundation of 21st century medicine. But not right now. Right now, the cost of providing the service (the tests, the coaching) exceeds what people are willing to pay. Those costs will fall in time, and Arivale’s model and Arivale’s discoveries will see another day.”

Lewis said he has come to believe that Arivale was about a decade too early.

Arivale’s executive team included Sean Bell, chief operating officer; Jennifer Lovejoy, chief translational science officer; Mia Nease, head of healthcare and life sciences partnerships; Andrew Magis, director of research; Ashley Wells, chief product officer; and others.

Hood, who led the Caltech team that pioneered the automated DNA sequencer, said in a 2015 interview with GeekWire that Arivale was “the opening shot in a whole new industry called scientific wellness, and it really stands a chance of being the Google or Microsoft of this whole arena.”

GeekWire chief business officer Daniel Rossi was a longtime paying customer of the program, and we chronicled his early experience with Arivale in series of articles in 2017. “Arivale was crucial to my health journey,” Rossi said. “From them I learned not only the genetic hand I was dealt but also the best ways to maximize my health and well-being. I am most thankful for the weekly calls with my coaches who encouraged me every step of the way. I’ll miss this program. It was terrific.”

Here’s the text of the message sent to Arivale customers earlier today, a version of which was also posted to the Arivale website.

To Our Customers,

We are very sorry to inform you that, effective immediately, Arivale can no longer provide our program to you and our other customers. This letter explains why we are ending the consumer program and answers the questions you are likely to have about the process.

Our decision to terminate the program today comes despite the fact that customer engagement and satisfaction with the program is high and the clinical health markers of many customers have improved significantly. Our decision to cease operations is attributable to the simple fact that the cost of providing the program exceeds what our customers can pay for it. We believe the costs of collecting the genetic, blood and microbiome assays that form the foundation of the program will eventually decline to a point where the program can be delivered to consumers cost-effectively. Regrettably, we are unable to continue to operate at a loss until that time arrives; in other words, we have concluded that it is simply too early for a direct-to-consumer scientific wellness offering to be viable.

We founded Arivale with the vision of making personalized, data-driven, preventive coaching a new wellness paradigm in the United States. Since its launch in 2015, the results of the Arivale program have been remarkable. To cite but one example, our scientific paper describing the improvements seen in multiple health markers in ~2500 participants was recently accepted for publication in the journal Scientific Reports.

While our direct-to-consumer model isn’t yet sustainable, we know that the Arivale program improved the lives of our customers and showed great scientific merit. We are proud of everyone at Arivale for their dedication and devotion to our mission and grateful to you and all of our other customers for joining us on this journey. Together, our efforts have launched a new paradigm—scientific or quantitative wellness—which, we are confident will become a major component of 21st century medicine.

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Written by: Todd Bishop is GeekWire’s co-founder and editor, a longtime technology journalist who covers subjects including cloud tech, e-commerce, virtual reality, devices, apps and tech giants such as Amazon.com, Apple, Microsoft and Google. Follow him @toddbishop, email todd@geekwire.com, or call (206) 294-6255.

Microbiome Science Advances

On January 28, the New York Times published a major article on recent advances in microbiome research.

The article says that breakthroughs began in 2014, when scientists began finding evidence that the micro biome is linked to Alzheimer’s, Parkinson’s, depression, schizophrenia, autism, and other conditions.

The article also describes the early 2000’s, when major advances came from figuring out how to sequenced DNA from microbes in the micro biome. Apparently, a gene called SHANK3 Is particularly central to autism research.

Also apparently, Researchers have isolated one particular bacteria, lactobacillus reuteri. They seem to have identified compounds that are released. These compounds send a signal to nerve endings in the intestines. The Vegas nerve send these signals from we got to the brain, where they alter production of a hormone called Oxsee Tosun. This hormone apparently promote social bonds.

The article is below:

Climate Change Language

We Need A Better Language for Climate Change – that Acts as a Call to Action

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Below is as essay that makes the case for a new six-box classification system for global climate change – two columns and three rows. The core idea here is to move climate change out of a subject for the editorial page and into a subject for daily new – much like how storms, earthquakes and epidemics are covered. We want a language that serves as a “call-to-action”.

The news would inform the world about climate-change related occurrences that have impacts that are “major”, “disaster”, or “global disaster”, and that are either “incidents” (one-time) or “recurring”.

I worked this out with Karen . I am the scribe. Obviously, this is DRAFT 1.

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Climate Change Language

CREDIT: Karen Flanders-Reid
CREDIT: https://www.nytimes.com/2018/08/08/opinion/environment/california-wildfires-trump-zinke-climate-change.html

Karen and I read today’s NYT article about California wildfires, and found ourselves musing – is the language of climate change right? Why is a “wildfire” just an isolated incident? Why isn’t it part of a larger wildfire classification system (“BREAKING NEWS: THE CALIFORNIA WILDFIRE HAS JUST BEEN RECLASSIFIED AS CATEGORY V.”?

We went on to ask: if climate change is the critical issue of our day, why Why isn’t the wildfire in California an climate change incident – part of a larger climate change classification system?

Why do the NYT editorial writers have to scream – everything is related to climate change!!!! After all, news breaks when a Hurricane is re-classified: “BREAKING NEWS: THE TROPICAL STORM OVER CUBA HAS JUST BEEN RE-CLASSIFIED BY THE WEATHER SERVICE AS A HURRICANE.”

Why doesn’t climate change have its own global classification system? How do we move from the editorial opinion desk to the news desk? How do we move from “The science is being ignored.” To “BREAKING NEWS: THE WILDFIRES IN CALIFORNIA HAVE JUST BEEN RECLASSIFIED BY THE WEATHER SERVICE FROM A CLIMATE-RELATED INCIDENT (CRI) TO A CLIMATE-RELATED DISASTER (CRD).”

EXAMPLES OF POWERFUL GLOBAL CLASSIFICATION SYSTEMS

To identify a powerful classification system, and the new language it implies, it first would be useful to identify the other global classification systems that exist – especially those with imply a call to action.

There are at least four:

Storms; Classified by the World Meteorological Organization (WMO), using the Saffir–Simpson scale:

Tropical Depression
Tropical Storm
Hurricane/Cyclone Categories 1-5

Source: https://en.wikipedia.org/wiki/Maximum_sustained_wind

Earthquakes: Classified by the US Geological Service, using the Richter Scale:
Moderate (above 8)
Strong (7-7.9)
Major (6-6.9)
Great (5-5.9)

Infectious Disease; Classified by the global centers for disease control, the classes are:

Outbreak (more incident than expected)
Epidemic (spreads rapidly to many people)
Pandemic (spreads rapidly to many people globally)

Source: https://www.webmd.com/cold-and-flu/what-are-epidemics-pandemics-outbreaks#1

A NEW GLOBAL CLASSIFICATION SYSTEM FOR CLIMATE CHANGE

To Begin

We recommend s simple structure, with easily understood terms, that evolves over time:

Starts with a few terms, and adds terms over time.
Begins classifying major occurrences only, and evolves to classify most occurrences.
Begins classifying evidence-based occurrences only (where science is conclusive that the occurrence is climate-change-related) and evolves as science becomes increasingly conclusive.

Initial Terms

“Occurrence” – a natural phenomena that occurs somewhere

“Climate-Change-Related” (CR) – a shorthand for saying that the preponderance of science indicates that a given occurrence is a contributor to or the result of climate change.

“Incident” (I) – an episodic occurrence (with a beginning, middle, and end)
“Recurring” (R) – an on-going occurrence (no end in sight)

“Major” (M) – an occurrence with sufficient size to merit being classified.
“Disaster” (D) – an occurrence, with major impacts
“Global Disaster” (G) – an occurrence with major global impacts

Initial Classification System:

Climate-related Occurrences shall be identified.

Once identified, they shall be classified in one of six classes:

Either “incidents” or “recurring”.
Either “major”, “disaster”, or “global disaster”

“Climate-Change-Related Event” (CRE) – any occurrence that is deemed to be a contributor to climate-change.

“Climate-Change-Related Outcome” (CRO) – any occurrence that is deemed to be the result of to climate-change.

All major climate-change-related occurrences would be classified as follows:

CR Incident (CRE-I): An episodic event, with a beginning, a middle, and an end.
CR Disaster (CRE-D): An episodic event, with global impacts

The Weather Service would be tasked with implementation, and aligning with the World Meteorological Organization (WMO) and other agencies around the world.

Well-Being – Real Time Revisited

NOTE: This post revisits a post titled “Well-Being Real Time”. The original post was May, 2014, and can be found at: http://johncreid.com/2014/05/well-being-real-time/.

Well-Being – Real Time Revisited

Well-being is arguably the central mega-trend of the 21st century. As we look to the future, we have an obligation to “unpack” this dense concept, and find its essential component parts.

We describe these components here as “ACE” – ACT, CARE, and EAT. The wish we have for ourselves and for others is to be well. “Be Well” is our salutation and our call to actions.

How far out are we looking?

The future is now. ACE is here – together with real time measuring and monitoring. ACE is our pathway to greater and greater levels of personal well-being.

ACE measuring and monitoring will be supported by all elements of the quantified self movement. FitBit, Apple Watch, and so many other new monitoring devices will allow us to to bring personal well-being into a real-time modality.

ACE represents three pillars, each deceptively simple:

A – ACT: ACT is short for activity. The call to action is “stay active”. Well-being activity has physical activity at its center, but the pillar also embraces social activity, and activities of the mind. Staying active is a critical element of being well.
C – CARE: CARE is short for well-being care. The call to action is “care for yourself” and “care for others.”Well-being care of course has health care at its center, but there is so much more. e.g. genomics, massage, essential oils, acupuncture, etc. “Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care” regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.
E – EAT: EAT is short for eating and drinking. The call to action is “Eat well.” Well-being eating is the exploration of how what we eat and drink contributes to our well-being.

As simple as these pillars appear, each is complex: deep enough for a life-time of focus. Each represents bodies of research, skills, capabilities, and areas of professional endeavor. All together, these pillars represent pathway that each of us will follow as we attain greater and greater levels of personal well-being.

Discussion:

ACT

A – ACT (walking, running, calories burned etc)

Staying active is a critical element of being well. Well-being activity has physical activity at its center: sports, walking, lifting, climbing, yoga, and all of the other activities that light up a FitBit. The pillar also embraces activity of other kinds, e.g. social activity, and activities of the mind.

CARE

Well-being care is all about promoting health. Of course, it has health care at its center, but there is so much more. e.g. mental health, addictive behaviors, massage, genomics, essential oils, acupuncture, etc.

“Caring for myself” and “Caring for others” are elements of this pillar. “Preventive care”, eldercare and aging, palliative care are included, but so are regular check-ups, colonoscopies after age 50, mammograms, pre-natal care for expecting mothers, etc.

The ability to routinely monitor vital signs at home or at the office will be a part of this pillar. Lab work – including saliva, blood, and stool samples, will be more real time, more regular and less expensive. These trends will be one of the keys to progress in the care pillar. On the innovation side of this pillar will be many technologies, but breakthroughs in genomics will certainly be high on the list. Telemedicine is another innovation that will alter access to well-being care.

Predictive modeling will be more relevant than never. Am I headed for pre-diabetes? If so, what evidence shows me a path to avoid that condition?

CARE-MMEDS (what MEDS I take, what compliance I have, etc)

CARE-RResting Metabolic Rate (calories burned at rest)

CARE-VVITALS (pulse, BP, etc)

CARE-LLABS (blood testing, etc)

CARE-SSleep (duration, deep sleep, etc)

EAT

EAT is short for eating and drinking. The call to action is “Eat well.”

Well-being eating is the exploration of how what we eat and drink contributes to our well-being. Naturally, there is a social element, where eating and drinking together makes the experience more fulfilling. There is a physiological element, having to do with ingestion, osmosis, calories, glucose and glycogen, enzymes, etc. There is a psychological element, related to the feelings of satiety, or hunger, or thirst, and their related cravings. There is a sensory element, where sweet and sour contrasts, aromas, and their related metaphorical associations, play a part.

Eating delicious food and drink with friends is certainly a component. But achieving a balanced diet, with moderation as a central tenant,

On the one hand, this pillar is ancient. For thousands of years, elders have taught daughters and sons how to cook well. and cooking techniques have evolved

On the other hand, this pillar is ripe for innovation. The new breakthrough science related to the micro-biome is a part.

EATS (what I eat and drink, especially calories)

Implications

Monitoring all components of ACE (MEDS, Activity, Resting Metabolism,VITALS, EATS, LABS, Sleep) is now going to accelerate at an exponential rate.

There will be three settings where ACE monitoring will accelerate:

Employees in Workplaces: Employers will offer employees routine monitoring as part of employee benefits and/or health insurance.
Residents in Communities: Communities will offer residents routine monitoring as one of their amenities. Wellbeing facilities and programs will become as important as golf courses and swimming pools. Look for HOA’s,Condo and Coop associations, and subdivision developers to increasingly view MARVELS as critical to “place-making”.
Clients of service-providers: Hotels, spas, assisted-living centers, nursing homes, and many others will increasingly offer MARVELS monitoring as one of their base services.

The Privacy Imperative will be the critical success factor for all of these pushes into the future. It is foundational.

Without it, there will be no progress.

With it, personalized, real-time care will flourish. Each individual will be able to opt-in to his care-coaching community (and to opt-out whenever they choose), and get the extraordinary benefits that such a community can provide.

Want to talk to your well-being coach? FaceTime them, and they – with your permission – will help you sort out what’s going on with you.

Feel like you might need a check-in with a doctor? Send them an email – with your ACE history embedded in it, or get them on the phone or FaceTime, and see if they need you to come in.

The future is now.

BEWELL Centers will be everywhere. Look for:

DWELL CENTERS (part of BEWELL Centers) – for community ACE measuring and monitoring support. Target population is neighbors in the community.

Employee BEWELL CENTERS (part of BEWELL Centers) – for employees in workplaces ACE measuring and monitoring support. Target population is employees in the workplace.

CLIENT BEWELL CENTERS (Part of BEWELL Centers – for service-providers ACE measuring and monitoring support.Target population is clients of the service provider.
(Walgreens and CVS are already moving aggressively in this direction>

References:
The Privacy Imperative
LABS revolution
LABS By Disease
Quantified Self Movement

Neo.Life

This beta site NeoLife link beyond the splash pagee is tracking the “neobiological revolution”. I wholeheartedly agree that some of our best and brightest are on the case. Here they are:

ABOUT
NEO.LIFE
Making Sense of the Neobiological Revolution
NOTE FROM THE EDITOR
Mapping the brain, sequencing the genome, decoding the microbiome, extending life, curing diseases, editing mutations. We live in a time of awe and possibility — and also enormous responsibility. Are you prepared?

EDITORS

FOUNDER

Jane Metcalfe
Founder of Neo.life. Entrepreneur in media (Wired) and food (TCHO). Lover of mountains, horses, roses, and kimchee, though not necessarily in that order.
Follow

EDITOR
Brian Bergstein
Story seeker and story teller. Editor at NEO.LIFE. Former executive editor of MIT Technology Review; former technology & media editor at The Associated Press
Follow

ART DIRECTOR
Nicholas Vokey
Los Angeles-based graphic designer and animator.
Follow

CONSULTANT
Saul Carlin
founder @subcasthq. used to work here.

EDITOR
Rachel Lehmann-Haupt
Editor, www.theartandscienceoffamily.com & NEO.LIFE, author of In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family

Laura Cochrane
“To oppose something is to maintain it.” — Ursula K. Le Guin

WRITERS

Amanda Schaffer
writes for the New Yorker and Neo.life, and is a former medical columnist for Slate. @abschaffer

Mallory Pickett
freelance journalist in Los Angeles

Karen Weintraub
Health/Science journalist passionate about human health, cool researcher and telling stories.

Anna Nowogrodzki
Science and tech journalist. Writing in Nature, National Geographic, Smithsonian, mental_floss, & others.
Follow

Juan Enriquez
Best-selling author, Managing Director of Excel Venture Management.

Christina Farr
Tech and features writer. @Stanford grad.

NEO.LIFE
Making sense of the Neobiological Revolution. Get the email at www.neo.life.

Maria Finn
I’m an author and tell stories across multiple mediums including prose, food, gardens, technology & narrative mapping. www.mariafinn.com Instagram maria_finn1.

Stephanie Pappas
I write about science, technology and the things people do with them.

David Eagleman
Neuroscientist at Stanford, internationally bestselling author of fiction and non-fiction, creator and presenter of PBS’ The Brain.

Kristen V. Brown
Reporter @Gizmodo covering biotech.

Thomas Goetz

David Ewing Duncan
Life science journalist; bestselling author, 9 books; NY Times, Atlantic, Wired, Daily Beast, NPR, ABC News, more; Curator, Arc Fusion www.davidewingduncan.com

Dorothy Santos
writer, editor, curator, and educator based in the San Francisco Bay Area about.me/dorothysantos.com

Dr. Sophie Zaaijer
CEO of PlayDNA, Postdoctoral fellow at the New York Genome Center, Runway postdoc at Cornell Tech.

Andrew Rosenblum
I’m a freelance tech writer based in Oakland, CA. You can find my work at Neo.Life, the MIT Technology Review, Popular Science, and many other places.

Zoe Cormier

Diana Crow
Fledgling science journalist here, hoping to foster discussion about the ways science acts as a catalyst for social change #biology

Ashton Applewhite
Calling for a radical aging movement. Anti-ageism blog+talk+book

Grace Rubenstein
Journalist, editor, media producer. Social/bio science geek. Tweets on health science, journalism, immigration. Spanish speaker & dancing fool.

Science and other sundries.

Esther Dyson
Internet court jEsther — I occupy Esther Dyson. Founder @HICCup_co https://t.co/5dWfUSratQ http://t.co/a1Gmo3FTQv

Jessica Leber
Freelance science and technology journalist and editor, formerly on staff at Fast Company, Vocativ, MIT Technology Review, and ClimateWire.

Jessica Carew Kraft
An anthropologist, artist, and naturalist writing about health, education, and rewilding. Mother to two girls in San Francisco.

Corby Kummer
Senior editor, The Atlantic, five-time James Beard Journalism Award winner, restaurant reviewer for New York, Boston, and Atlanta magazines

K McGowan
Journalist. Reporting on health, medicine, science, other excellent things. T: @mcgowankat

Rob Waters
I’m a journalist living in Berkeley. I write about health, science, social justice and policy. Father of 1. From Detroit.
Follow

Yiting Sun
writes for MIT Technology Review and Neo.life from Beijing, and was based in Accra, Ghana, in 2014 and 2015.
Follow

Michael Hawley
Follow

Richard Sprague
Curious amateur. Years of near-daily microbiome experiments. US CEO of AI healthcare startup http://airdoc.com
Follow

Bob Parks ✂
Connoisseur of the slap dash . . . maker . . . runner . . . writer of Outside magazine’s Gear Guy blog . . . freelance writer and reporter.

CREDIT: https://medium.com/neodotlife/review-of-daytwo-microbiome-test-deacd5464cd5

20th Century History on Health Care and Insurance

A historian’s take on health care and insurance in the US:

Key points:

Health care in the US is primarily driven by an “insurance company model”.’
There actually was a “medical marketplace” in early 20th century.
One of the best in that marketplace was a “prepaid physician group” with profit sharing for docs.
Truman proposed universal health care.
A.M.A. fought government intervention.
A.M.A. decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model.
In the insurance company model, insurance companies would pay physicians using fee-for-service compensation.
Thus, physicians became allied with insurance companies – both striving to keep government out of health care. Fee for service was their chosen model.
The model worked to expand coverage: from 25% of the population in 1945 to about 80 percent in 1965.
Elderly did not get covered as well. Congress stepped in with Medicare in 1965.
Because of rising prices, insurers gradually took over. “To constrain rising prices, insurers gradually introduced cost containment procedures and incrementally claimed supervisory authority over doctors. Soon they were reviewing their medical work, standardizing treatment blueprints tied to reimbursements and shaping the practice of medicine.”
Innovation in lacking. Concierge medicine experiments show some promise, like Atlas is Wichita.

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JCR comments:
It’s always easier looking backward. If only 25% of the population have health insurance, it seems eminently sensible that driving that number up to, say, 80% would be a high priority goal.

That’s what America did: it adopted a high priority goal to increase health insurance coverage from 25% to 80%. It’s chosen method was a fee-for-service reimbursement model – the “insurance model”. We put insurance companies in the driver’s seat, and we encouraged them to work with employers and physicians groups.

They were the middle man:

Insurers made sure that their employer clients had the benefits they needed to attract employees, at a cost that was practical.
Insurers also made sure that their physician partners supplied the services that they needed, at prices that were practical.

So, with the insurer-as-middle-man-model, we achieved our goal of enrolling 80%, up from 25%. 80% of the American population had health insurance in 1965.

So – what’s wrong with that?

It’s mostly very good. But…

Looking backward, it is obvious now that what is wrong: it is the remaining 20%. These are the unemployed – or the seniors – or the ones who have such ugly health attributes that their health costs are truly exorbitant.

While America was getting the 80% “squared away”, the 20% were left to fend for themselves. They overran emergency rooms; they took beds in charity hospitals; they died.

In 1965, we adopted Medicare and Medicaid. Medicare addressed the 20% who were seniors.
Medicaid addressed the 20% who were poor, such as:

Low-income families
Pregnant women
People of all ages with disabilities
People who need long-term care

Most of this happened over time, not in 1965. State offerings vary.

In 1997, we adopted CHIP for children. This addressed the 20% who were kids. 11 million kids got coverage. They were from families with too much income to qualify for Medicaid.

in 2003, we adopted MMA “The Medicare Prescription Drug Improvement and Modernization Act of 2003”. Under the MMA, private health plans were offered, approved by Medicare “Medicare Advantage Plans’. An optional prescription drug benefit was offered (“Part D”)

In 2011, the Affordable Care Act was adopted.

So, the key question for today is: why is our health care system such a mess. Read on:

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CREDIT: NYT https://www.nytimes.com/2017/06/19/opinion/health-insurance-american-medical-association.html?emc=edit_th_20170619&nl=todaysheadlines&nlid=44049881&_r=0

The Opinion Pages | OP-ED CONTRIBUTOR
How Did Health Care Get to Be Such a Mess?
By CHRISTY FORD CHAPINJUNE 19, 2017
The problem with American health care is not the care. It’s the insurance.
Both parties have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model. The insurance company model drives up prices and fragments care. Rather than rejecting this jerry-built structure, the Democrats’ Obamacare legislation simply added a cracked support beam or two. The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.

An alternative structure can be found in the early decades of the 20th century, when the medical marketplace offered a variety of models. Unions, businesses, consumer cooperatives and ethnic and African-American mutual aid societies had diverse ways of organizing and paying for medical care.

Physicians established a particularly elegant model: the prepaid doctor group. Unlike today’s physician practices, these groups usually staffed a variety of specialists, including general practitioners, surgeons and obstetricians. Patients received integrated care in one location, with group physicians from across specialties meeting regularly to review treatment options for their chronically ill or hard-to-treat patients.

Individuals and families paid a monthly fee, not to an insurance company but directly to the physician group. This system held down costs. Physicians typically earned a base salary plus a percentage of the group’s quarterly profits, so they lacked incentive to either ration care, which would lose them paying patients, or provide unnecessary care.

This contrasts with current examples of such financing arrangements. Where physicians earn a preset salary — for example, in Kaiser Permanente plans or in the British National Health Service — patients frequently complain about rationed or delayed care. When physicians are paid on a fee-for-service basis, for every service or procedure they provide — as they are under the insurance company model — then care is oversupplied. In these systems, costs escalate quickly.

Unfortunately, the leaders of the American Medical Association saw early health care models — union welfare funds, prepaid physician groups — as a threat. A.M.A. members sat on state licensing boards, so they could revoke the licenses of physicians who joined these “alternative” plans. A.M.A. officials likewise saw to it that recalcitrant physicians had their hospital admitting privileges rescinded.

The A.M.A. was also busy working to prevent government intervention in the medical field. Persistent federal efforts to reform health care began during the 1930s. After World War II, President Harry Truman proposed a universal health care system, and archival evidence suggests that policy makers hoped to build the program around prepaid physician groups.

A.M.A. officials decided that the best way to keep the government out of their industry was to design a private sector model: the insurance company model.

In this system, insurance companies would pay physicians using fee-for-service compensation. Insurers would pay for services even though they lacked the ability to control their supply. Moreover, the A.M.A. forbade insurers from supervising physician work and from financing multispecialty practices, which they feared might develop into medical corporations.

With the insurance company model, the A.M.A. could fight off Truman’s plan for universal care and, over the next decade, oppose more moderate reforms offered during the Eisenhower years.

Through each legislative battle, physicians and their new allies, insurers, argued that federal health care funding was unnecessary because they were expanding insurance coverage. Indeed, because of the perceived threat of reform, insurers weathered rapidly rising medical costs and unfavorable financial conditions to expand coverage from about a quarter of the population in 1945 to about 80 percent in 1965.

But private interests failed to cover a sufficient number of the elderly. Consequently, Congress stepped in to create Medicare in 1965. The private health care sector had far more capacity to manage a large, complex program than did the government, so Medicare was designed around the insurance company model. Insurers, moreover, were tasked with helping administer the program, acting as intermediaries between the government and service providers.

With Medicare, the demand for health services increased and medical costs became a national crisis. To constrain rising prices, insurers gradually introduced cost containment procedures and incrementally claimed supervisory authority over doctors. Soon they were reviewing their medical work, standardizing treatment blueprints tied to reimbursements and shaping the practice of medicine.

It’s easy to see the challenge of real reform: To actually bring down costs, legislators must roll back regulations to allow market innovation outside the insurance company model.

In some places, doctors are already trying their hand at practices similar to prepaid physician groups, as in concierge medicine experiments like the Atlas MD plan, a physician cooperative in Wichita, Kan. These plans must be able to skirt state insurance regulations and other laws, such as those prohibiting physicians from owning their own diagnostic facilities.

Both Democrats and Republicans could learn from this lost history of health care innovation.

Christy Ford Chapin is an associate professor of history at the University of Maryland, Baltimore County, a visiting scholar at Johns Hopkins University and the author of “Ensuring America’s Health: The Public Creation of the Corporate Health Care System.”
Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

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Brian Hudes Comment:

I saw this one, as well.  The author lost credibility for me.   Ironically, what the author clearly doesn’t realize is that she is making an argument for the Kaiser Permenante model.  However, she unfairly and without any data makes the following claim: 

“Where physicians earn a preset salary — for example, in Kaiser Permanente plans or in the British National Health Service — patients frequently complain about rationed or delayed care”

Here’s a more balanced and comprehensive assessment supported by third party research:

Health Care Members Speak

==========

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Gallup reports on 2016 Well-being

Gallup/Healthways 2016 Report

This report, part of the Gallup-Healthways State of American Well-Being series, examines well-being across the nation, including how well-being varies by state and which states lead and lag across the five elements of well-being. The five elements include:
• Purpose: liking what you do each day and being motivated to achieve your goals
• Social: having supportive relationships and love in your life
• Financial: managing your economic life to reduce stress and increase security
• Community: liking where you live, feeling safe and having pride in your community • Physical: having good health and enough energy to get things done daily

In 2016, the national Well-Being Index score reached 62.1, showing statistically signif- icant gains from 2014 and 2015. Also in 2016, Americans’ life evaluation reached its highest point since 2008, when Gallup and Healthways began measurement. Now 55.4% of American adults are “thriving”, compared to 48.9% in 2008. Other positive trends include historically low smoking rates (now at 18.0%, down from 21.1% in 2008); historically high exercise rates as measured by those who report they exercised for 30 minutes or more, three or more days in the last week; and the highest scores recorded on healthcare access measures, with the greatest number of Americans covered by health insurance and visiting the dentist. Americans are also reporting the lowest rates of healthcare insecurity since 2008, as measured by not being able to afford health- care once in the last 12 months.

All national well-being trends are not positive, however; chronic diseases such as obesity (28.4%), diabetes (11.6%), and depression (17.8%) are now at their highest points since 2008. The percentage of Americans who report eating healthy all day during the previous day is also at a nine-year low.

Georgia ranked 29th – middle of the pack. Georgia improved – up from 35th.

Georgia showed a wide variation in sub-components. Georgia scored in the highest quintile on Social Rank (“having supportive relationships”), second quintile on Purpose Rank (“liking what you do each day”), third quintile on Physical (“having good health”), fourth quintile on Community ((“like where you live”), and fifth quintile on Financial (“managing your economic life”).