Steve Luxenberg - Official Website

Monday, June 9, 2014

For readers: Making sense of Amazon's battle with Hachette

When two heavyweights brawl, it's probably best for bystanders to stand clear. Unfortunately, authors and readers aren't mere spectators to Amazon's current fight with Hachette, one of the world's largest publishers. By refusing to maintain a normal inventory of books published by Hachette, Amazon has drawn its customers into the fray. Understandably, readers are scratching their heads at the wisdom of Amazon's strategy, which amounts to sending its customers elsewhere (at least for now) to buy the print books they expect Amazon to have. (E-books aren't affected.)

When the dispute flared into the open a few weeks ago, I did not consider for a nanosecond weighing in. Authors with more books to their name, and more clout, were stirring the pot quite nicely. Since then, however, enough potential readers have expressed their frustration about the unavailability of Annie's Ghosts on Amazon (except through third-party sellers) that I thought it might to wise to post a note with alternatives. Here's a set of options for readers accustomed to buying their print books through the world's online king.

Option 1: Independent bookstores love their customers, and would like you to be one of them. Many sell books online, just as Amazon does, if not at Amazon's prices. (Some even offer discounted prices, just like Amazon.)

Option 2: If you can't bear to pay the shipping costs, order Annie's Ghosts (or other Hachette titles) to your local bookstore. On your way to somewhere else, stop by and pick it up. The bookstore will welcome you with open arms. (The indies have recognized the opportunity that Amazon has handed them, starting a campaign with a slogan, "I didn't buy it on Amazon.")

Option 3: Libraries don't charge at all. I love libraries. They give authors a permanent place for their books, and sometimes, a place to talk about our craft. I'd rather have the book in the hands of readers than to see them frustrated.

As an author with a book published by one of Hachette's divisions, my self-interest makes it's hard for me to endorse Amazon's hardball tactics. Even if Amazon has a point in demanding better terms from Hachette -- reportedly, Amazon wants to sell e-books at prices below what Hachette prefers -- the company is risking its trusted name. It is assuming that its customers will return with no hard feelings. A lot of businesses have made that mistake, and later regretted it. If Amazon brings Hachette to heel, some may award the retailer an A for acumen. But it also will earn an A for arrogance. That's a dangerous report card for the company's long-term health, whatever the shorter term benefits.

Amazon is entitled to employ whatever (legal) strategy it chooses to build a stable business. It's not entitled to sympathy or support from authors or readers who, like me, cling to the notion that such disputes can be worked out without escalating to the equivalent of retail warfare and the accompanying collateral damage.

Now, back to the sidelines.


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Saturday, November 2, 2013

On the road: A few photos from The Great Michigan Read tour

Yes, we really were having as much fun as these photos suggest.

Thanks to Mardi Jo Link, author of the 2013 memoir/chronicle Bootstrapper: From Broke to Badass on a Northern Michigan Farm, for her engaging questions, trenchant insights and impish sense of humor. She did more than act as interviewer. She created a conversation -- with me, and with the audience that filled the State Historical Center auditorium for the kickoff of the 2013-14 Great Michigan Read.

By the way, for those who recall songwriter Paul Simon's great line, there are no diamonds on the sole of that shoe...

Sept. 24, 2013, State Historical Center auditorium, Lansing, Mich. All photos by Dave Trumpie

It's hard to wield a camera and talk at the same time, so thanks to photographer Dave Trumpie (and the Michigan Humanities Council, the force behind the Great Michigan Read) for capturing the moment.

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Friday, November 1, 2013

An Author's Thank You to Readers (and more from the Great Michigan Read tour)

One reader stood up during the Q&A portion of a recent talk, part of the Great Michigan Read author tour for Annie's Ghosts, and asked a great question: Do writers mostly write to please themselves?

I hesitated only a moment before blurting out: No way, I said. We write to be read. What's the point of telling a story if no one reads it? If you were writing mostly for yourself, wouldn't you just leave the finished manuscript on the computer or put a print out in a drawer?

Writers are sly enough to know that a little mystique helps make us seem special, so some of us cultivate an air of mystery around what we do. It's certainly possible that there are writers who set down their stories, whether fiction or nonfiction, to satisfy some primal urge. But for me, a main motivation is connecting with readers -- first through the story itself, my words to their eyes. Then, if I'm lucky enough to have the opportunity, through first-hand interactions at public talks or conversations.

That's one of the great benefits of the 2013-14 Great Michigan Read tour that kicked off on September 23. I've had a chance to talk about Annie's Ghosts with a wide variety of readers, at a wide variety of venues -- a large high school in Pinckney, the State Historical Center auditorium in Lansing, the School of Social Work at Michigan State University, the annual fall conference of the Michigan Association of Community Mental Health Boards. The conversations have been amazing, with people sharing their own stories as well as asking the kind of tough questions that make a discussion not only lively, but thought provoking.

Many other books could have been the Great Michigan Read. There's no shortage of great writers whose stories have a tie to the state. So, a few thank yous:

To readers, for wanting to read the book and discuss it, in their book clubs and at events like the ones I just mentioned.

To Michigan's independent bookstores, for working hard to keep Annie's Ghosts in stock, and for helping the book make the Heartland (Midwest) Indie Bestsellers paperback nonfiction list for three weeks running.

To the Michigan Humanities Council, and its statewide and regional selection committees, for choosing the book as the Great Michigan Read -- and especially two student members, grads of Pinckney New Tech High School, who made the book their number one choice, and pushed for it in their committee's discussion. I met them on a visit to Pinckney, and had a chance to thank them in person.

They were readers, and they wanted others to read the book, too -- and that's one of the reasons I write.

To be read.

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Monday, July 8, 2013

A little beach reading? (And news about Annie's Ghosts)

Here's a new piece of mine that just appeared in The Washington Post. Added bonus:  In this digital version, no newsprint to recycle!

And here's the (unexpected) news about Annie's Ghosts: The Michigan Humanities Council has selected the book as the 2013-2014 Great Michigan Read, a state-wide "One Community, One Book" program. That means a year-long series of activities and discussions about the book and its themes, starting in September with several kickoff events in the state capital, Lansing. To read about the Great Michigan Read and see a tentative schedule (including the author tour that I'll be doing), click here. A full slate!

Carla Ingrando at the Michigan Humanities Council emailed me with word a few months ago that the nominating panels had chosen Annie Ghosts from among the many deserving titles, and the MHC board had approved. You can't apply for the Great Michigan Read -- which for me, made the honor feel a bit more special.

The MHC staff sees the Great Michigan Read as the opportunity for conversation, and there will be plenty of conversation over the next year:  I'll be making five trips between September and May. Most of the events, though, will go on without me -- at libraries, book clubs, schools, nonprofit organizations, among others.

To help promote discussion about the book's central themes (secrecy and its consequences, personal journeys and immigration, mental disability and poverty, the changing nature of memory and the search for identity), the MHC's energetic staff will create and distribute a reader's guide and teacher's guide to organizations that register as partners.

The Council also promotes the program through inserts in newspapers. Annie's Ghosts already had a big presence in Michigan, where so much of the book takes place, but this is the kind of boost that every author wishes for. The kickoff event on Sept. 24 at the Michigan Historical Center will feature a conversation with Mardi Jo Link, author of a new memoir that is getting great reviews.

I'm looking forward to it, and if you're in the neighborhood, I hope you'll join us.


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Tuesday, April 12, 2011

In today's Washington Post : My take on a health-care maze

We all have a stake in the health care system, and how it operates. In the article below, which ran today in The Washington Post, I recount a recent experience that my wife and I had. (Click here if you would like to read the story as it appeared on The Post website.) See what you think, and let me know your reaction.

Just tell us how much it cost: One couple's trip through a health-care maze

By Steve Luxenberg, Monday, April 11

My wife and I don’t want to add to the nation’s financial woes. We understand why it’s important for us to take responsibility for managing our use of the health-care system, why we should limit ourselves to necessary expenses. Not only is it in the country’s economic interest, it’s also in ours: Our health plan is structured so that any medical excesses come out of our own pockets.

Now here’s the $2.5 trillion-a-year question: How can we make wise choices about how much to spend on health care if we can’t easily find out the cost of a simple medical procedure? It shouldn’t require more than a dozen phone calls and hours of time — not to mention a hunting dog’s single-mindedness — to piece together an accurate estimate for a recommended treatment.

But that’s precisely what happened to us in January and February.

If you work in the White House, on Capitol Hill or anywhere in the health-care industry, which now consumes about 17 percent of the nation’s gross domestic product, perhaps our micro-example brings a little bit of the real world into the debate. Consider it one citizen’s attempt to make a difference.

Our story begins with a diagnosis (osteoporosis) and a choice of what to do about it. Several years ago, a bone scan revealed that my wife, Mary Jo, had lost enough density in her spine and hip areas to suggest that she had a slightly higher risk of fractures than other women of her age (early 60s). It’s a consequence of aging, so she has a lot of company: According to National Institutes of Health estimates, more than 8 million older women and 2 million men have bone-density measurements that qualify as osteoporosis, with millions more heading in that direction. The NIH attributes 1.5 million fractures annually to weakened bones.

For years, Mary Jo had been taking daily calcium supplements and Vitamin D, but our family doctor wanted to do more. She prescribed Fosamax, a once-a-week tablet that can help slow or halt bone loss. It has since become available in its generic form, alendronate sodium.

The current cost to us under our insurance plan’s pharmacy benefits for generic drugs: $80 annually. A bargain, if it worked.

Mary Jo wasn’t keen on signing up to take a medication for the rest of her life. In the end, though, she decided to give it a try.

Mixed results

The regimen for alendronate sodium is trickier than for many other drugs. You not only have to remember to take the pill on the same day each week, but it must be swallowed whole on an empty stomach, first thing in the morning, with at least six to eight ounces of water. For 30 minutes after consumption, no lying down or eating. The worry: damage to tissue in the esophagus on the way down. For the same reason, the pill cannot be chewed.

Not exactly a user-friendly routine for a weekday work morning. Mary Jo chose Sunday as swallowing day, a schedule she kept for the next four years.

Her subsequent bone scans yielded mixed results. At best, the treatment was slowing the decline. At worst, it wasn’t having much effect.

When her most recent scan came back with the same ambiguous results except for one of her hip numbers, she began questioning the medication’s value for her, in part because she had been wondering whether it was a contributing factor to several months of on-again, off-again gastric distress. But it was hard to know whether the drug was working without stopping it entirely, waiting a year and then comparing her next scan with previous ones.

Our family doctor wanted Mary Jo to consult a specialist before making a decision. The specialist agreed that her density numbers could be better and suggested a newer medication that she thought might be more effective: Reclast, approved by the Food and Drug Administration since Mary Jo’s original diagnosis.

Reclast also offered a major practical advantage: It is given just once a year, by intravenous infusion, typically at a hospital’s outpatient clinic. It takes 15 to 30 minutes and, as with any medication, there are risks. Before the injection, blood tests are required to make sure the patient’s kidneys are not vulnerable to damage, one of the nastier possible side effects.

Once a year vs. once a week? Worth exploring, certainly. One big question: How much more than $80 a year would this trade-off cost?

The quick answer: No one could tell us.

Financial incentives

Almost without exception, everyone we asked — at the doctor’s office, the hospital financial office, the infusion center, our insurance company and the “Reclast Patient Support Network” (at the drug’s maker, Novartis) — was unfailingly patient and willing to help. What they lacked was clarity. Either they didn’t know the answer and had to refer us to another office, or what they told us turned out to be incomplete and, occasionally, incorrect.

The infusion center informed us, twice, that the total cost would be $300. “That’s everything,” we were told.

No hospital charge? Nothing for overhead, administration?

“No, that’s it,” was the reply. “There’s no extra charge for a doctor. We do it all here.”

We didn’t want to be surprised by a big bill at the end, so Mary Jo kept making phone calls while we awaited our insurance company’s pre-certification to proceed. We’re insured through one of Aetna’s “consumer-directed health plans,” the Aetna HealthFund. In recent years, private employers have embraced these plans as a way to cut rising costs.

It works like this: At the beginning of each year, we receive a set amount ($750 each for 2011) in our account, and we’re responsible for paying our medical and pharmacy bills from that $1,500 until it is exhausted. (We also pay a hefty monthly premium.)

If we stay within Aetna’s network of providers, we pay less — because Aetna has negotiated deals with providers for each type of charge. In other words, the insurers and providers know precisely what every procedure costs. Only consumers remain in the dark.

Once the HealthFund is depleted, we’re responsible for 100 percent of most charges (excluding hospitalization) until we satisfy one of our deductibles, which is $3,500 each or $4,750 combined. After that, a co-pay arrangement kicks in, until we reach our $6,000 out-of-pocket maximum. At that point, the plan covers all expenses. As you can see, it’s very much in our economic interest to hold down what we spend.

In early February, Aetna approved the infusion. The next day, we got a surprise phone call.

“Hi, I’m from the Aetna Specialty Pharmacy,” the caller said. “We’re ready to ship your medication.” He wanted to confirm the address on his order form.

It was our home address.

“Whoa,” I said. “No one had told us that the medication would come here. Does it need to be refrigerated? Why would you send it to our house?” I had assumed the medication was included in the infusion center’s “that’s everything” package.

Now it was the Aetna caller’s turn to be confused. We agreed that his first move should be to check with the infusion center and the specialist.

“Just out of curiosity,” I said, “how much does the medication cost?”

Silence while he looked. “$1,113.20,” he replied.

I made a noise that might have sounded like a gasp.

“Don’t worry,” he said, cheerfully. “It’s covered 100 percent.”

I was dubious. I said, “We were told this isn’t covered as a pharmacy benefit, because the infusion is considered a medical procedure. If that’s right, then we will pay all the costs out of our HealthFund.” I went on to explain that the $1,113 plus the $300 infusion-center charge would wipe out our $1,500 for the year.

He said he didn’t know what would be covered. His job was to check on sending out the medication. Compartmentalization. He wasn’t the first person to tell us something incomplete, and he wouldn’t be the last.

The rest of the story

Our skepticism now justified, we intensified our efforts to pin down the exact cost. Another round of phone calls produced more conflicting information. One thing we learned for sure: The infusion center would order Reclast from the hospital pharmacy, and it would cost $200 more than the Aetna Pharmacy price.

Why didn’t our earlier phone calls elicit this information? Again, compartmentalization: The infusion center wouldn’t be billing us for the Reclast, therefore it wasn’t factored into the $300 price. We learned this from the hospital’s financial center.

That prompted another call to Aetna, to see if the hospital could submit the Reclast order as a pharmacy charge. My argument: When I typed “Reclast” into Aetna’s “Price-a-Drug” online cost calculator, the digital estimator treated it as a covered expense under our plan. Cost: $70.

No such luck. We would be on the hook for the entire $1,300, the Aetna representative said, because a Reclast infusion was considered a medical procedure.

That made the decision easy. Weighing the $1,600 cost vs. the likely benefits, Mary Jo opted not to go ahead. She also decided to go a year without any medication. She would keep to her routine of calcium and Vitamin D supplements, weight-bearing exercises and good diet, and then see what her next scan showed.

Making health-care choices isn’t easy, particularly when it comes to such intangible benefits as reducing a risk that’s already hard to quantify. Ambiguity comes with the terrain — which is why the health-care system shouldn’t add to the confusion.

Of course, it’s hard to predict every eventuality. A surgery estimated at two hours could turn out to be much longer if complications arise. But Mary Jo and I weren’t asking for a guaranteed price, just the basic one. Yes, insurance plans vary, but aren’t computers good at storing data, sorting it out and calculating bottom lines?

The medical world does not have the equivalent of a restaurant menu or an auto mechanic’s estimate. You might scoff at comparing health care to eating out or fixing a car, but think about it: If we consumers are expected to take charge of our health care, we need a one-stop place to find out the itemized cost of various choices. Otherwise, the idea of “consumer-directed health care” is little more than euphemistic pretense.

That’s hardly what the doctor ordered.

© The Washington Post

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Tuesday, February 8, 2011

The Writing Life

Several readers have asked what I'm working on these days. Writers love this question, the way Facebook likes being asked about its privacy policies.

I'm only kidding. For business and legal reasons, Facebook has to talk about its privacy policies. I can be less forthcoming.

Here's the short version: My next book project is under development. I'm researching several possibilities. Meanwhile, I've scratched the writing itch with several shorter pieces, all for The Washington Post. Here's the list:

* An op-ed on the Tucson shootings explored the mental health implications and whether the "system" really failed. About a dozen other newspapers picked it up.

* An essay on the Oscar-nominated movie, "The King's Speech," examined the limits of cinematic license in dealing with historical events. As the headline said, "Brilliant filmmaking, less-than-brilliant history."

* An article on my venture into Facebook advertising offered a first-hand look at its allure and it's effective for the D.I.Y. crowd. My ads appeared more than 755,000 times. Click here to find out the rest of the story in "Facebook ads are a bargain, but can you get the right crowd to click?"

I'm out on the road again in a few weeks, heading to Vero Beach in Florida, where the Indian River County Public Library has chosen Annie's Ghosts for its first annual "Community Read." On February 23, I'm speaking at the Richardson Conference Center on the Mueller Campus of Indian River State College. If you're within driving distance of Vero Beach, come on by. The event is free.


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Tuesday, December 14, 2010

Last Chance for 2010 Annie's Ghosts Gift Giveaway!

Time's running out.

Tomorrow, December 15, is the deadline for entering the raffle that could win you a signed autographed copy of Annie's Ghosts. I'm giving away two signed copies for the holidays. If you want to throw your name into the giveaway hat, please send a request to steve@steveluxenberg or click here to use the email form at my website.

Make sure you say "giveaway" in your email. Otherwise, I won't know for sure that you're entering.

As they say, no purchase is necessary. But please feel free to visit the Steve Luxenberg author page on Facebook, and join the ranks of those who "like" it. You can click here to get there.)

Have a warm holiday season, and here's hoping you find many books that will delight you in 2011.


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