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Tuesday, December 2, 2003

Our tarnished image

Some of our municipal "leaders" get all hot and bothered when the city's mentioned in The New York Times. They often seem to care more about looking all sexy and progressive and Euro in the Times than they do about the basics of good governance.

Well, Portland found its way into the front section of Monday's Times no less than twice, and neither writer was heaping the usual glowing praise. One story was neutral, and the other was fairly negative.

First, the neutral: On the op-ed page, Dartmouth med school professor Elliott Fisher lamented that some communities, such as New York City, have a culture of over-doctoring every little hangnail. He compared it to Portland, where annual medical care spending is much lower:

Earlier this year five colleagues and I published a study of regional variations in Medicare spending. In 2000, for example, per capita Medicare spending was $10,550 in Manhattan, but only $4,823 in Portland, Ore. Despite such a disparity, we found that neither the quality of care nor patients' satisfaction with it was related to costs.

The difference in spending is almost entirely due to the way medicine is practiced in high-cost regions. Compared with similar patients in Portland, Medicare enrollees in Manhattan spent more than twice as much time in the hospital and had twice as many doctor visits per year. The additional services provided in higher spending regions are largely discretionary, like more frequent visits to specialists, longer hospital stays and more frequent use of diagnostic tests and minor procedures. Remarkably, more spending does not lead to more people receiving expensive and proven treatments, like cardiac bypass surgery or hip replacement.

Dr. Fisher fails to note the periodic budget crises that cause Oregon to yank publc health care assistance abruptly every now and then, to the point where some folks even die on account of it. It's about to happen again this coming spring once the income tax increase is voted down. Guess the news hasn't reached Dartmouth yet.

The other piece, on the National page, checked in with Portland author Chuck Palahniuk, who wrote "Fight Club" and other works. Palahniuk has a new book out about the "grimy and offbeat" side of the city, including its network of ancient tunnels where whores and nogoodniks once plied their trades. He's not happy with the development that's cleaning up what used to be called Old Town -- and his lack of enthusiasm rubbed off on Times reporter Matthew Preusch, who tells it this way:

And in Portland the fringe may be unraveling rather quickly. The former mill town turned growth management problem has fallen on hard times. Since March 2001 the city has lost 50,000 jobs, giving it the highest unemployment rate among American cities, 8 percent, according to the federal Bureau of Labor Statistics. Last year, voters of Multnomah County, which includes Portland, had to agree to a new temporary income tax for schools.

The economic descent has caused something of an identity crisis. Increasingly, Portlanders are turning from their insular ways and embracing a more cosmopolitan vision.

"People are more and more describing Portland as the largest European city in America," said Mr. Palahniuk, now aboveground at a Chinatown bar.

"It depresses me a little bit, because it seems it will be so structured and regulated that what we love about Portland won't really be there," he said.

As for the Pearl District, "It is a neighborhood Mr. Palahniuk barely mentions in his book, as if to rob it of legitimacy."

There go your Times mentions for this month, Erik, Vera, and Earl. Can't we do better?


Listed below are links to weblogs that reference Our tarnished image:

» Requiem For Portland's Underbelly? from The One True b!X's PORTLAND COMMUNIQUE
Jack's referencing it, and Emma's buzzing about it -- the "it" being The New York Times and its article on Portland through the eyes of Chuck Palahniuk and his book about Portland's fringes: And in... [Read More]

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