Public housing can work
Fuerst, J.S.
billing service, bought a share in an imaging center down the and an insurance-form clerk. Insurance companies reacted in street, and took out loads of malpractice insurance. Institutional ...
...It is also true, how- In cities like Chicago and New York there is a vast amount ever, that these privately built government-subsidized devel- of deteriorated housing-some vacant and some not-that is opments have been used as unnecessarily large tax shelters...
...And then there's Sunday Mass...
...we Third, mundane events: they are packed strongly than before that prenatal care and still went skiing...
...Christopher F. Koller lives in Buffalo, New York, where he The expenses associated with bypass operations on seven- works for a health-maintenance organization...
...remain a function of their avail- cerns (food, clothing, housing...
...It's all mine free and clear now-the giant These problems, however, lie more in the size of the units and died in a beanstalk accident...
...Unfortunately, 6: 23 April 1993 Commonweal sweeps of the projects do not provide permanent answers...
...But even as I went on enumerating venture viewed through the eyes of a am sure that my second-thoughts on all the ways in which we had not changed, toddler...
...Let the wealthy development, and distribution if necessary...
...prices...
...So why not admit that in both market-rate high-rise buildings and in their subdefeat and just tear down the high rises...
...today...
...We could still go out to din- preciative audience...
...True, a number of these units larger housing problem...
...The injustice of the mansion ability: supply drives demand...
...And Second, time off...
...When we can guarantee only needs, for attention...
...subsidized tenants, is another proven winner...
...However, a huge demand for real tenant participation in management decisions does exist, and can be used by imaginative housing managers to dramatically improve the living conditions of their tenants...
...A substantial solution, however, such an allocation of funds is necessary...
...nel who want to help and heal...
...can some get all they want...
...that while the present public high rises, with their huge numAs a professional who has spent most of his adult life work- ber of multiroom apartments, do not have to be torn down, ing with public housing in Chicago, I'd like to offer some more they do need to be rehabilitated into smaller apartments for constructive suggestions...
...Perhaps-if they really tion can create the kind of social atmosphere that deters crime want to...
...Fears of missed diagnoses and hopes of cures notwith- Health care deals with what we hold sacred-human life and standing, utilization of laboratory, imaging, pharmaceutical, and spirit-in fundamentally different ways from other material consubspecialty services in the U.S...
...Short of turning the projects into veritable police states, worth noting that private landlords have recognized for years police action can have only limited effect...
...Our response is no more virtuous: hire more staff to query A central question remains to be addressed in any healthpatients and providers, rebundle services, reattach our own in- care reform: how much inequity in the distribution of health vented prices, and rebill other insurers who might also be re- care can we tolerate as a society...
...No longer can Peter and I sit anonymously in our pew if Brian is going to repeat the tune PLUSH LAWNS to "This Old Man," and run up and down the aisle...
...specialists, all of whom billed our insurance companies...
...I feel even more ner and just tote the little guy along...
...8: 23 April 1993 Commonweal...
...All else is dross...
...My perspective on know what people were getting at...
...What then needs to be done is no mystery...
...Fuerst teaches social work at Loyola University of a successful Federal Housing Administration "235" program Chicago...
...In Chicago some lake front sites of about 300 units Authority projects...
...n the first six months after our son bly want them self-contained...
...Now, eighteen months occupying Brian for extended periods of my awe at seeing Brian developing later and another little one on the way, I time...
...secretary (which has proven a seriously smiling man...
...erate-income working families...
...More insidious are the psychic costs-inflamed fears of dying alone, before one's time, or hooked up to machines...
...Any health-care reform must steer next to the ghetto is dwarfed by the prospect of an uninsured patients and providers alike toward preventative and primary mother with the poor prenatal care giving birth to a child fourcare and away from subspecialization...
...Running down to my sister's house into a real person...
...In short, you Brian has even stirred my interest in our Brian was born people would ask want them...
...Clinically, patients and providers alike often forsake the colIt is about the encounter with compassionate, skilled person- lective art of caring for the individualized science of curing...
...This is also true in New York, Toronto, and have been rehabilitated under Vincent Lane...
...when the internist who replaced our old general practitioner Many people wonder if boarding up and ultimately started referring us for all these tests and then sent us to more tearing down the high rises is the only solution...
...Kids (three doors away) to borrow a cup of milk emerging reproductive technologies, not only change your life, they change elicits squeals of delight from Brian, who and the not-too-distant gene therapy and your understanding of life...
...And there is Administratively, we have lost the sense of health care as a pubplenty of dross-from tests of questionable value to rampant lic good-where healthy people subsidize sick people and subspecialization to Byzantine payment systems that often cre- wealthy subsidize poor...
...Another funny thing happened Chicagoans are desperately seeking answers...
...tration HUD Secretary Jack Kemp advocated the conversion Perhaps even more shameful than filling the projects with of municipal projects to tenant ownership and/or management...
...You want them plush...
...The in existing public housing will only intensify the plight of the reluctance of welfare and low-income tenants to embrace projects, and such actions routinely call forth loud protests from Kemp's "empowerment" schemes mirrors the experience of already besieged tenants...
...As Dwight desperately needed social and public characteristics of health Eisenhower warned us about military technology, we can do care while forsaking little of the individual freedom and none more with medicine than we know how to handle ethically or of the technical competence we value in the current system...
...I even joined the neighborhood another...
...FUERST in a home-ownership program of single-family units similar to J.S...
...Health care has much more important things to offer than The level of crime and violence in Chicago's pubthe false hope of immortality...
...At last we understand that being HERE COMES THE BABY a worshiping body means being engaged with one another and being happy, even jubilant about that...
...That means that those guilty of pervasive housekeeping problems, antisocial actions, or drug-related activities must go...
...This suggests posals...
...Our collective PUBLIC HOUSING CAN WORK expectations have changed-in many ways we no longer have SMALL IS BETTER a health-care system but a sick-cure system...
...Some public housing will always be had to be foreclosed because of the abuses of real estate firms, needed, but rental housing operated by private real estate firms mortgage bankers, and the FHA...
...Insurance companies reacted in street, and took out loads of malpractice insurance...
...But death happens, no matter how principles such as the ones offered here as guidelines for their much we want medical care to help us hide from it or dictate work...
...Health-care reform must foster an acceptance of the limits to our lives and our choices-by reimbursing for hospice care and eliminating incentives to perform or seek intensive levels of treatment as patients grow older...
...CHRISTOPHER F. KOLLER the terms...
...We Currently, massive police sweeps of the projects are being imfelt less like a patient with a doctor, and more like a diagnosis plemented by the Chicago Housing Authority...
...It is in town...
...lic housing projects is an ongoing scandal, and 4. Keep it in the community...
...proportion of these families, it seems to me, could be handled J.S...
...Criminals in general continue to proportion of three-, four-, and five-bedroom apartments treat the projects as "the greatest permanent floating crap game serving female-headed families with many children...
...Reform must also wean weeks premature while, several floors below in the same hosus from our collective addiction to high-priced diagnostic tech- pital, an endocrinologist is evaluating a boy for synthetic nologies of limited marginal value, by limiting their growth, growth hormones to improve his self-esteem...
...Section 8 housing, under which rental developments are foreclosed or other tax foreclosed properties and can be rehaoperated with 80 percent market rate tenants and 20 percent bilitated...
...Welfare clients in London...
...Goldwyn, "colossal in a small way...
...At this time, many ated in the sixties, are still capable of providing exemplary hous- single-family or two-family houses can be obtained from FHA ing...
...Still, substantial amounts of federal, and perhaps state Admittedly, this does leave open the vital question of what and city, funds will be required to adequately house America's to do with large families, who all over the world seem to con- poor...
...For a variety of reasons, poor tenants just don't bite...
...Many facts militate against these pro- cent, should be three-bedroom or larger units...
...Institutional kind-creating smaller pools of healthier patients, leaving the health care, however, remains about the experience of human residual sick to pay higher premiums...
...practically, no other topic was as dren under the age of four, my brother- community association as the recording remotely interesting as our little bald and in-law plopped in a chair exhausted...
...Still, some 400,000 singleis the proven way to go...
...If the problems of our inner cities are to find any sort of stitute the greatest problems for public housing...
...Britain, where for many years Margaret Thatcher's government tried to push home ownership in council housing...
...It must eliminate pay for their tummy-tucks and young people receive more agperverse incentives by ceasing to pay providers on a piece-work gressive treatment than the elderly for similar conditions, but basis and letting health-care professionals do what their voca- at some point our collective health suffers when our individution calls them to do-care and cure...
...Reforms must emphasize the collecate transparent incentives for physicians to over-treat patients...
...Only a heterogeneous populaShould tenants become owners...
...to full funding for WETA, he had-emotionally, he really don't really get it...
...we still invited friends with meaning and excitement...
...In readily available for conversion...
...The cats and mice play on while the patient waits nificant, costly, and unjust...
...to the public school how he had changed our lives...
...local community...
...multiproblem families has been the treatment accorded to the HUD made a number of forays into tenant ownership,- and ac- homeless...
...That annoying cat on our front fetal tissue transplantation research I sensed we had been lulled into a false porch turns out to be a gift from heaven (Commonweal, March 26) grew out of sense of stability...
...nancy and parenthood...
...At in the selection of tenants than in the high-rise buildings themRockwell Gardens, a principal target of the "sweep" efforts, selves...
...Instead of acting to provide appropriate housing for companied all these experiments with many millions of dol- them, such as single-room occupancy "hotels," HUD has inlars in rehabilitation money...
...Government subsidy programs like family homes were built or made available to low- and modthe "236" program or the "221D 3," both of which were initi- erate-income families through this initiative...
...It fias OF SEVERAL MINDS Liz Leibold McCloskey become a truly community celebration...
...You proba- ate them...
...In Chicago, the public high rises have an inordinate murders and crimes continue...
...gets to see his cousins for the third time manipulation techniques, cannot be diFirst of all, lawns...
...This has been a rallying cry for many tenants for years, but the courts, the government, and the media as well as the civil rights organizations have presented intractable obstacles to carrying out this common-sense policy...
...With the right mixture of tenants the projects can are mixed in with a much larger population of low- and modstill work...
...we still talked about the Division of Motor Vehicles for a driv- cluded in any national minimum health health policy and worked hard on Capitol er's license is an incredibly exciting ad- benefit package...
...Admittedly, sorting out families who are "untreatable" or "unreconstructable" is no easy task...
...tive nature of health care: in public health initiatives that allow In my work, I have decoded creative billing practices where the sick and the healthy, the poor and the wealthy to particiservices are broken into increasingly smaller units with invented pate with equal freedom and access...
...Nevertheless, there is no This, of course, adds large numbers of unstable and troubled groundswell of demand for such conversion among tenants them- people to already fragile communities...
...Acquisition must be done in any revitalized program such tax shelters should be reduced, and the public interest and at reasonable prices...
...They have been, to quote Sam sisted on placing the homeless in vacant public housing units...
...This should cost the current provisions for the return of the buildings to the pri- the taxpayers less than half of what new public housing costs vate market after twenty years should be changed...
...frailty and weakness, and the fear, pain, and uncertainty it brings...
...Closing down the high rises would smaller families...
...More important, however, is the fact that the high rises are Leaders of public housing, such as Vincent Lane, chairman not themselves the villains, as Philip Klutznick, a former di- of CHA, and Sally Pinero Hernandez, New York City Housing rector of the department of Housing and Urban Development Authority chairman, insist that low- and moderate-income projand a leading real estate developer in Chicago, has pointed out...
...The current disparity is sigsponsible...
...What need could be greater tory to nobody...
...al care varies...
...I Hill...
...to slow was a concrete expression of the with most of our extended family gathered and cautious drivers on our dead-end love Peter, my husband, and I have for one at my parents' ski house, including six chil- street...
...You want it, but you bond issue...
...One weekend evening our local public TV station...
...Hillary please note...
...This is imperative if the units are not to be only exacerbate the present housing shortage...
...ects cannot be the housing of last resort for the poor...
...Still I was intent on telling "Working every night until eight is more misguided way to channel this communiall who asked that our life had not changed relaxing than this," he announced to an ap- ty spirit...
...ty-five-year-old patients or nursing home care for ventilatordependent car accident victims are only the most obvious costs REPORT FROM THE PROJECTS associated with the refusal to accept the end of life...
...First, the present public housing must be emptied of seriously disruptive tenants...
...vacated and vandalized...
...Courageous reformers will, however, maintain than the one to stay alive...
...Commonweal 23 April 1993: 7 In my opinion, subsidized housing is the best solution to the which operated from 1968-73...
...Medical science's ability to keep the body going Of course, the details of any health-care reform will by defcorresponds with our culturally conditioned desire to control inition be sticky, arcane, and, hopefully, completely satisfacthe terms and conditions of our life...
...You want them that day and who isn't afraid to appreci- vorced from my experiences of preggreen...
...spiritually...
...all that much...
...Second, most of the problems seem to lie in the high rises...
...A second constellation of perceived needs involves life-threat- I am optimistic that good reform can reclaim some of the ening or potentially life-threatening conditions...
...But some control over who lives in the buildings is crucial if the housing authorities are to provide decent and safe shelter for the bulk of low- and moderate-income families...
...Of course, during President George Bush's adminis- and disorder...
...Instead, More than fifty privately operated high-rise developments in each building should house only a limited number of multiChicago currently provide satisfactory living arrangements for problem families, while the rest of the units are filled with more many low- and moderate-income families on a subsidized basis acceptable tenants as well as tenants from other socioeconomand do not have problems comparable to those in the Housing ic groups...
...Going to preventive pediatric care should be inover for barbecues...
...Or why not sell the sidized housing only a very small portion, say 10 to 15 perbuildings to the tenants...
...Placing the "homeless" selves, especially not from those in the massive high rises...
...On to national issues...
Vol. 120 • April 1993 • No. 8
