The Celebration Chronicles
Page 31
As with the Catholics, Celebration’s Jews had been jump-started by the Presbyterian initiative. According to Larry Pitt, a high-ranking Disney lawyer and legal secretary of TCC, they had also hewed to the spirit of the old Jewish joke: “How many synagogues are there on an island of shipwrecked Jews? Three.” A Hebrew school met twice a week, a Jewish Council was established for social and cultural representation in civic affairs, and a Jewish Congregation put on a service and Shabbat dinner in the Golf Club tavern on Friday evenings. The Council was a political compromise from the beginning. One or two Orthodox members, strongly vocal, were opposed to a synagogue that they knew would be Reform. Lacking any consensus as a result, the Council was mostly inactive. Pitt and Larry Haber, a business director with Disney’s TV department, had both helped to start a conservative temple in South Orange, just to the north. Trained in Boca Raton as a community Jewish leader (a “SuperJew,” he quipped) by the Wexler Heritage Foundation, Pitt pushed for a Reform congregation in Celebration so as not to conflict with the South Orange synagogue. He had chosen the first seder Haggadah carefully—a politic blend of traditional references spliced with modern commentary about the condition of the Jewish faith around the world.
Passover in April was swelled by the addition of the tornado-ravaged Osceola congregation, one of whose elders, seated opposite at the table, tried earnestly to recruit me to the Poinciana temple. “We need young blood,” he pleaded. I noticed that there were no gentiles from Celebration in attendance. Neither had the Orthodox members shown up, partly because gentiles had been present the year before. Several Jews in town told me they found the Orthodox presence to be off-putting. They preferred to attend the merely social gatherings and steer clear of the low-intensity religious friction. Haber and Richard Cowin, the presidents of the congregation, clearly favored a more inclusive profile, and eventually won the adoption of a Reconstructionist identity for the synagogue. Pitt was less enthusiastic about this development: “The message is being muddled and watered down to the point of being Jewish in name only.” This kind of sentiment was shared by the town’s fundamentalist Christians, like Donald Jones, the evangelist pastor who believed that “there’s too much here that goes under the name of Christianity that’s not at all Christian.” Jones was active in Carrin’s congregation, but he saw the religious scene around town as more of a “country club, or social occasion” than as a serious Christian environment.
Its identity aside, Pitt acknowledged that the founding of the Jewish congregation had been an important form of publicity, especially for attracting prospective residents: it was “like putting up a lighthouse to say ‘Jews are here’ in Celebration.” A high mark of visibility had been the erection of a large menorah by the lakefront next to the Christmas tree during the long holiday season. A Christian group had lobbied for a nativity scene, and there was some heated debate about whether the Christmas tree was a sufficiently Christian symbol. Ron Dickson, the merry prankster from Campus Street, made his own intervention in the name of religious pluralism when he showed up at Herrington’s Town Hall office in full Druid regalia—white shirt and pants and a broad-brimmed, white sailing hat—to request permission to position a Druid wreath between the menorah and the Christmas tree.
In late fall, other symbols, with a less direct religious origin, had begun to dot the landscape. Pink flamingos were appearing mysteriously in backyards and on porches and balconies. Given Celebration’s official canons of taste, and the unofficial surveillance of the semi-mythical Porch Police, this was a highly questionable item of decor. In November, Rev. Wrisley had declared that the birds would henceforth be an “anchor for prayer” around town to remind residents of those “throughout the world who are persecuted for the faith they hold.” They were “planted” overnight in residents’ yards and were supposed to be moved every few days, circulating around the congregation. Whatever were you thinking, I asked him? Wrisley explained that he had chosen the trophy bird—the tackiest object of outdoor Florida furniture—because it is supposed to “represent reality” in a town where the aesthetic regulations are often viewed as an artificial imposition, even by residents. His iconoclastic taste for the offbeat had embraced the postmodern appetite for kitsch. Town Hall tactfully turned a blind eye to this violation of the rules. “When we take ourselves too seriously, we’re in trouble,” Wrisley observed earnestly. He joked that his next scheme for the kitschification of Celebration might be to sponsor a “tacky Christmas parade.”
WELLVILLE
There was another church that exerted its influence in town, in quite another way. Out near the I-4 interstate (which bisects the Celebration site), Celebration Health, a massive 260,000-square-foot “wellness center” had been designed by Robert Stern in the red-tiled, Spanish style. It is owned and operated by Florida Hospital, health-care home of the Church of the Seventh-Day Adventists, and it boasts an octagonal tower that symbolizes the Adventists’ eight principles of health Creation. Bodily health and purity had been a staple of Adventist doctrine since the evangelizing of Ellen White in the 1860s and the founding of Battle Creek health-care center in Michigan, where W. K. Kellogg held sway with his strict, natural-fiber dietary regimes. The Creation-based, Adventist health credo has now been retread as a forerunner of today’s holistic approaches to disease prevention, emphasizing fresh air, exercise, and whole body maintenance as a fillip to spiritual upkeep. The Sabbath Rest Principle, a cornerstone of church doctrine, is part and parcel of a creed that sees Christ as a physician as much as anything else.
Florida Hospital itself has grown from a small, restorative haven for wintering northerners into the second busiest hospital system in the United States, and the recipient of the nation’s largest Medicare check. But it has never had the opportunity, which Celebration now offered, to integrate a planned town, founded on the principle of community health, with a health-care doctrine based on bodily and spiritual holism. More to the point, this concept had not promised a life of profits until recently. Now, with the escalation of self-care and nonallopathic medicine, and the gathering crisis of managed care, the conditions were ideal for a commercial venture of this sort. As Des Cummings, director of Celebration Health, put it to me, “society was not ready before to reward the holistic approach.” Cummings saw a lucrative opening for bridging the gulf between the New Age holists and the Machine Age surgeons, viewed by each other until recently as quacks and mechanics, respectively.
The Adventist credo of “creating health” fits seamlessly with postmodern concepts of promoting organic wellness, so opposed to the medical industry’s prevailing view of the body as a machine that needs a technical fix after every illness crash. But Florida Hospital had not exactly turned its back on machines; it still embraced the full spectrum of advanced medical technology. The challenge behind Celebration Health was to forge a mission in synch with TCC’s blend of tradition (community or family doctors doing the rounds) and futurism (hightech magic bullets). Consequently, the building was designed to resemble a grand Mediterranean hotel—a “hospit-el” where patients would feel like “guests”—and a huge portion of its facilities was given over to rehabilitation and fitness centers. Some of the medical industry’s top names—GE, Johnson & Johnson, GlaxoWellcome, Hewlett-Packard, Hoffmann-Laroche, Astra Merck—were recruited as corporate partners, contributing big bucks for the opportunity to showcase their products in the Disney corporate tradition and duly underwriting the construction of the building. All the latest toys, from state-of-the-art imaging to telesurgery, were lined up to be showcased. It being Celebration, the facility was loudly touted as a laboratory for the “health care delivery system of the future.”
The lavish grand opening in November 1997, replete with the release of a cloud of white doves, also featured a two-day symposium of podium voices offering hosannas of praise more befitting the coronation of a monarch than a new hospital. Leland Kaiser, a silver-tongued futurist, who is a consultant to Celebration Health, spoke breathlessly of Cele
bration as the “start of habitat redesign. If it works here, it will work in other places. This is the epicenter.” Mindful of the assembled corporate partners in his audience, he was more direct: “What we have created here is a possibility. Not since the Middle Ages have we had one language system that can bring together science, spirituality, and business and we have done that here. We have entered the Quantum Age.… For the first time, the businessperson, the clinician scientist, and the spiritual person sit at the same table, use the same words, and are engaged in the same business. What we see here is a new kind of capitalism, a capitalism with consciousness, with the resources and the vision to create a better world.” I was not so comforted by the prospect of these three groups sitting at the same table and speaking the same language, whether in the Middle Ages or in Osceola County. The table, for one thing, probably ought to be a lot bigger, with a much wider circle of conversants. This new rhetoric of body-mind-spirit was a training seminar for the corporate titans of the medical industry, whose junior reps filled the seats around me. They were studiously learning how to survive the ratcheting down of the welfare state and, in particular, how to poach some of the direct fee-for-service action from the huge boom in self-care and alternative medicine. The language made perfect sense for an industry bracing itself for a life of profit beyond managed care where premiums would lie outside the insurance orbit. Florida’s HMOs had started to hemorrhage money, and Florida Hospital’s own Medicare HMO, Premier Care, would go belly-up before the year was out.
Kaiser had offered a rather different angle in an article he wrote for the first issue of a promotional publication called the Celebration Journal. “The investment-owned health providers trying to dominate our current marketplace will fail,” he predicts, because the “for-profit industry is opportunistic, it comes and goes with the fortunes of Wall Street.” “Empowered communities” with their own health plans will come to the fore, collecting the premiums from the enrolled population and the profits will go back into the communities. “Dollars will not leave the community and gravitate to Wall Street while children in the community go without basic services.” Self-care and nonallopathic treatment will help this system keep costs down, but Kaiser also advocates tapping the “gift economy” whereby retirees will volunteer their time and talents, in addition to working people who will “tithe their time.” Pretty soon, the “gift economy will be larger than the money economy.”4
However stirring as an agenda—Cummings, the hospital’s director, described it to me as “universalistic and socialist,” and impractical in a “mobile, capitalist society”—Kaiser’s vision of an “empowered community” was not likely to be realized in Celebration. With poised understatement, Brian Haas, a physician who lived in town, observed, “It’s not exactly a community hospital.” Haas, a partner in one of the metro region’s top ophthalmology groups and a crack ex-Navy surgeon, had been passed over initially by the hospital in favor of a group headquartered in Tarpon Springs, eighty miles distant. When contracts with this group and others fell through, Haas was asked to direct the opthalmology unit, but declined. By then, several doctors within the community had left the staff, as had some units, including pediatrics, and the hospital’s business plan was in disarray. It had dropped the $25,000 fee required of all participating physicians but was still taking 50 percent of all revenues. Unusual for a medical center, Celebration Health was strictly in the subcontracting business, with no permanent physicians on staff and none at all who functioned within the community in the bedside manner. So far, what existed of the hospital’s holistic component seemed to be pretty upmarket. A center for holistic evaluation was gearing up to offer luxury package weekends to corporate executives in need of a life booster. In the meantime, Celebration Health had already become a regular on the conference circuit for organizations like the Christian Medical and Dental Society.
Haas, who still uses the facility on occasion to see his patients, offered a clearheaded analysis of the economics of the facility. Getting into the wellness business, he pointed out, was the future of industry profit because “preventive care is fee-for-service, and it is much more profitable to run a wellness center with healthy people who pay their own way than to run a hospital for the chronically sick.” Indeed, fitness centers within hospitals are the fastest growing trend in medical real estate in Florida, fast displacing the independent gym sector. Haas saw Florida Hospital “maximizing a marketing niche in a competitive milieu,” and predicted that the ultimate source of its business would lie in the international tourist facelift market. Affluent world travelers could linger under lasers while their families enjoyed the theme parks. Sure enough, Florida Hospital had already embarked on an extensive campaign of international marketing in countries that service the Orlando tourist market. The facility’s brochure for selling itself to physicians promised that “Celebration Health will develop major channels of international business targeted at the following regions: Central and South America, Caribbean countries, United Kingdom, Mexico, and Germany. Contracts will be developed with international governments, physicians and insurance carriers to provide medical services, educational conferences and clinical demonstrations through teleconferences.… Many other strategies are planned to capture international and tourist business.”
For a while, it looked as if Celebration Health would be a hospital with no beds. In a highly unusual sequence, the $150 million facility had been built before a certificate of need was issued by the state. Indeed, the application was turned down twice by the Florida Agency for Health Care Administration on the basis that the area, where occupancy rates averaged less than 36 percent, did not need more hospital beds, especially acute-care beds at a cost of almost $2 million each.5 The agency had concluded that Celebration Health would draw wealthy patients away from other area hospitals, leaving these hospitals with an underfunded responsibility for indigent patient care. Initially, Florida Hospital had submitted no plan for indigent or Medicaid care.6 But no one seriously doubted that the combined lobbying power of Disney and Florida Hospital would not prevail. Sixty beds were approved in January 1998—they would be moved from the group’s Kissimmee hospital—and, as part of the agreement, a Community Health Improvement Coalition was established to fund innovative health care for women, seniors, minorities, and children in the county. But the agreement was a costly one for Florida Hospital. Under its terms, the nearest rival hospital, Orlando Regional Healthcare System, would have an option, after five years, of buying half of the facility.7
Of all the town’s institutions, the wellness center seemed the most remote, and not simply because it was located out near the corporate campus. Few talked of it as an integrated community limb, although about half the residents had initially joined its fitness center. Perceptions of health among Celebrationites were focused more on the benefits offered by the town’s physical layout, its walkability, parks, and trails, and the highly positive psychological environment promoted within the community. The pastoral virtues of exurban places have long been considered a beneficial moral influence on the population. Far from the vices and vexations of urban life, and secure from the physical hazards of the central city, there would be no excuse for ill health, and indeed every incentive to avoid it. Celebration had been designed to cultivate healthy people, and its capacity in this department, as in every other, would be promoted and boosted before its performance was proven. For my own part, I had a mixed response. I exercised more than I had done in twenty years, but I also became a regular smoker for the period of time I lived in Celebration.
For practicing health professionals, the boosterism was not always easy to stomach. Haas’s wife, Diane, a critical-care specialist at a clinic in Lakeland, found an overly moralistic streak in the constant inducements to be healthy. Involved daily in keeping people alive, she was nonetheless dubious of the American obsession with living as long as possible, and had a robust skepticism about community expectations that “you must cut all of the bad practices ou
t of your life.” Professionally in a position to joke about the Health Police (even more mythical, but no less diligent around town than the Porch Police), she believes that a wellness regime may only defer for a little while the high cost of keeping people alive for the last few years of their lives. The real problem, she feels, is that “death is morally unacceptable in our society.” Until that taboo is broken, all talk of the economic prudence of cutting costs is a sham. Health care, she regrets, will continue to be seen as “a consumer commodity, and not as a community right.”
The Haas family in their estate home, on Longmeadow. (Photo: Jonathan Hayt)
These were candid, though unorthodox, thoughts in Celebration, but then Diane and Brian were exceptional residents. Ardent cosmopolitans, and Ivy League educated, their tastes ran somewhat against the cultural grain of the town. The walls of their Longmeadow home were lined with prints from Japan, Sri Lanka, and Greece, German Expressionist and Russian Futurist posters, and contemporary neorealist photography. Devotees of the opera, fine arts, and international cuisine, subscribers to magazines of opinion, and victorious survivors of many tennis matches with the author of this book, they started an informal film club toward the end of my stay. At these exclusive monthly gatherings, discussions of the films, shown on home video, took place over a leisurely dinner. The first few screenings were cerebral foreign fare: Nanni Moretti’s Dear Diary and Pedro Almodovar’s Labyrinth of Passion, followed by an arty Italian vampire film and Dusan Makavejev’s Sweet Movie.
Diane Haas was not the only medical professional in town to acknowledge the perils of health moralism. Cummings himself painfully recalled a Rotary Club meeting when an insensitive visiting speaker had wisecracked about a local member’s weight. “How can you be so fat in a such a healthy community?” The Celebration resident had slunk away, shamed and mortified. Cummings also conceded that the denial of death was a great obstacle, but assured me that the massive costs of dealing with the coming geriatric bubble could be sliced by attending to chronic diseases long before they occur. Through stressing “the individual as the primary care-giver,” he insisted, “we can reduce the number of disabled years, and increase the enabled years.”