Sunday, March 21. 2010
Once again, my life has conspired to give me a real-world example of how consumer-driven healthcare saves money.
At five o'clock on a sunny spring Friday afternoon, my six-year-old begged me to go outside and ride Razor scooters. We went to the top of our enormous hill (wearing helmets and biking gloves, or course) and came speeding down again. Right at the end of the ride, as I was stepping on the brakes to come to a stop, I found the scooter wasn't slowing down. I pressed down harder, and suddenly the whole scooter kicked out from under me to the side. I flopped sidewise and landed smack on the pavement. I sat up, feeling a little stunned but not too bad. "Am I hurt?" I ask Malcolm. "You're bleeding!" he shouts. I looked down and saw quarter-size drops of blood on my jeans and gloves. I walked about twenty yards into the house and look in the bathroom mirror. My left cheek is covered with blood. After gently wiping it away, though, I find I have only one injury: a cut under my left eye, about an inch long. Later on I figured out that the cut had come from the edge of my rimless glasses.
I wrapped ice in a wet washcloth and held it on my face while I contemplated what to do. My wife Janet, juggling an infant and two other sons, called a neighbor to drive me into the emergency room. I briefly considered going to an urgent care clinic, but at that point I wasn't quite sure what I was going to need. I figured I'd be better off going to the emergency room, in case the cut called for a plastic surgeon.
I sat for three hours in various waiting rooms at UNC Hospital, ice clutched to my face. After the first two hours I decided that I wasn't concussed and hadn't broken anything, and I started to wonder if I'd made the right decision to come here. After a few text messages to my wife, I found out I didn't have any other option; all the urgent care clinics closed at 8 pm. I paged my regular physician, who advised me to stay put; "Since it's your face, you're probably in the best possible place." Ok. Fine.
After another hour in the examining room, the doctor finally arrived: a young, calm, conscientious resident. I had had lots of time to prepare my speech. "Hi!" I said. "I'm really, really glad to see you. Before we get started, though, I have one small request. I have a high-deductible insurance plan. That means everything you do for me tonight, I will be paying for entirely out-of-pocket. So, as you do your work, I would appreciate it if you tell me what services I can expect to be billed for, and what they might cost, if you know." The doctor was very sympathetic: "To be honest, I know absolutely nothing about what you will be charged. I just write down what I do, and someone else figures out the charges. But I will keep that in mind as we discuss your options for treatment."
I was very glad we started with that conversation, because here's what the doctor said next after examining me: "Because you have a laceration on your face, ordinarily we would call in the 'face team,' which would include a plastic surgeon as well as an experienced EMD. However, looking at that cut, I can tell it's really clean and would come together with just two or three sutures. I could do that for you right now."
"In your professional opinion," I asked, "How much difference would there be between you doing the stitching, and what the 'face team' would do?"
The doctor shrugged. "Not much . . . none, really."
"Ok, then! Stitch me up!" It only took about 20 minutes for him to do the job. There was no mirror in the examining room, but he led me to a bathroom around the corner so I could look at his work. As promised, the wound was closed completely, with three sutures. A nurse gave me a tentanus shot and I walked out, a satisfied customer.
What are the morals of this story?
Tuesday, March 2. 2010
Now that the health care reform debate has gone into overtime, I feel like I need to make one more last-ditch argument. Fortunately, at least one person has made all my arguments for me: David Goldhill's cover story in the September 2009 issue of The Atlantic ("How American Healthcare Killed My Father") says practically everything that needs to be said.
Goldhill is extremely forthright with his motivations, which I especially like – he lets you know right away that his study of healthcare is the result of seeing his father die of a preventable hospital-borne infection. But despite the personal tragedy, his article is remarkably free of emotional charge. He doesn't attack anyone, or blame anyone, but rather lets his critique rush unerringly to the glaring absurdities of the business structure of American medicine:
Goldhill's entire analysis would fit nicely into one of the Freakonomics books, since he is merely pointing out what Levitt and Dubner took as the central thesis of their pop-econ books: "People respond to incentives." Everything that has happened to American healthcare is clearly the consequence of distorted economic incentives. From this perspective, it should be clear that ObamaCare will only give us more of the same distorted incentives, cementing in place the illusion that "someone else" is paying for our healthcare, while letting the healthcare beast continue to devour our national economy.
Goldhill's article is refreshingly full of common sense, especially when you compare it to other popular studies of American healthcare, like Atul Gawande's high-profile article in the New Yorker ("The Cost Conundrum", June 1, 2009) which Obama publically praised. Gawande confronted overwhelming evidence that high costs of health care were driven by doctors' and hospitals' financial incentives to overtreat and overcharge . . . and still he is utterly dismissive of the power of competition. "Any plan that relies on the sheep to negotiate with the wolves is doomed to failure," he quotes one doctor. I see it as a sign of doctors' arrogance that they find it impossible to think of themselves as a commodity that can be shopped. Consumers might not "haggle over the price as if he were selling a rug in a souk," as Gawande puts it . . . but if a hospital down the road offers the same surgery for $20,000 less, don't you think that's going to influence the patient's choice? Especially if it's $20,000 of the patient's own money?
Gawande had another New Yorker article ("Testing, Testing", December 14, 2009) that compared the healthcare industry to agriculture, and suggested that healthcare might undergo a revolutionary change similar to the "green revolution" through government sponsored experimentation similar to what the USDA did for farms. The article was a lengthy apology for the Democratic health reform proposal, which did not have a clear plan for cutting costs but did have lots of pilot programs that would hopefully find new ways to cut costs. I find it utterly disingenuous to suggest ObamaCare is a set of experiments, when the core elements of the plan – guaranteed issue, mandated levels of coverage, wimpy personal mandates – have already been tried in several states, and were colossal failures in every instance, driving up costs and exhausting state budgets, while hardly making a dent in the number of uninsured. You can't position yourself as an experimenter when you ignore the results of the experiments.
Speaking of experiments, I have run the high-deductible insurance and Health Savings Account experiment for myself and my family . . . and it works. I protect myself from debilitating debt from medical emergencies, but I also function as a smart consumer. I spend half of what I used to on insurance, and lower overall medical costs by at least 20% by questioning bills, tests, and procedures. And all of it – insurance and medical costs – could be entirely covered by my FICA taxes, if the government only let me keep that money.
Friday, January 29. 2010
The final episode of Joss Whedon's sci-fi series Dollhouse aired tonight. I'm going to seize this last occasion to write about Dollhouse, since I will probably never feel motivated to do so again. The overall reaction to Dollhouse, from myself, the geek community and perhaps even Joss himself has been . . . meh. Whedon fans watched it, but they never really committed themselves to it.
So, a few final comments (warning, spoilers follow):
Best Character: Topher Brink. The egotistical, amoral technical genius went through a believable transformation into someone who cared, and therefore someone we care about. His style was so distinctive that you could never mistake his lines for anyone else's (the first law of memorable dialog).
Best Character (runner up): Adele DeWitt. The iron-fist-in-silk-glove leader of the L.A. Dollhouse had style, grace, and sophistication. She also went through a believable development, showing vulnerability as well as ruthless resolve. Somehow we always wound up cheering for DeWitt, even when she was being bad. In her final post-apocalyptic days, she was stripped of her title, power, and make-up, but she still had the bearing of authority. Her nursing of the deranged Topher was touching -- it was perhaps the first time her British stiff-upper-lip notion of moral duty was overshadowed by unadorned love. Amazing how restraint magnifies the impact of the smallest gestures.
Adele narrowly edged out Alpha for the runner-up position. Alpha really wouldn't be in the running at all, except that I enjoy Alan Tudyk so much and hope to see him again in future roles.
Worst Character: Echo. I loved Eliza Dushku in Buffy. She's a good actress . . . but only good. I don't know whether to blame the writers or to blame Dushku for the role of Echo falling flat. I had predicted from the very beginning that the conceit of beaming a new personality into her every week would prevent us from bonding with her, but it's more than that. All I know is that all the actors around her managed to make us care about their characters -- Topher, Adele, Boyd, Paul, Anthony/Victor -- and yet somehow I never really cared about Echo. This would be the second time that Joss managed to build a series around an actress who was consistently outshone by her ensemble cast. (I loved Buffy the Vampire Slayer, but never really bonded with Buffy herself.)
Best Acting: I'll go out on a limb and say Enver Gjokaj's portrayal of Victor/Anthony showed the best acting chops among the whole cast. Most of the Dolls could never quite make me believe in the premise of uploadable personalities, but Gjokaj could. When he was imprinted with Topher's mind, he was a perfect Topher. Now that I think about it, he got the most widely varying roles -- Russian mobster, English playboy, American soldier, psychopathic killer, corporate villain, etc. -- and he played them all with equal convincingness. Use him again, Joss -- he can handle whatever you cook up for him.
Best Plot Twist: Adele going from kinda-good-guy to washed-up good guy to bad guy to really-good-guy in the course of three episodes. Joss kept me guessing -- how will she wind up? And when the dust settled, it was all believable in the realm of Adele's character.
Best Plot Twist (runner up): Whiskey/Dr. Saunders shooting Bennett. Joss openly acknowledges that all romances must be cruelly frustrated in order to make for good TV, so the moment Topher kissed her I knew Bennett was toast. But I didn't know she would be toasted quite so fast. And for Joss this was a two-fer, since it simultaneously shattered the romance of Boyd and Saunders. Speaking of which . . .
Worst Plot Twist: Boyd revealed to be the super-villain. It just . . . didn't . . . work. It's the sort of revisionist twist that signaled that Angel had jumped the shark. The romantic arch between Boyd and Saunders was carefully developed and then . . . totally forgotten about. You will never convince me that the writers planned to do that from the beginning, and I can't support such twists unless they were planned.
Best and Worst Themes: Mind and identity. The good news was the show was alive to all the mysteries of consciousness: what makes a person a person? Is person a body? A mind? Memories? Relationships? But the show's grasp of the issues was so muddled that it took different perspectives without even realizing it. One moment they act like the mind is identity, and the body just a shell -- a "suit" to be worn and discarded. But then the characters feel moral compunction for the body -- say, Echo trying to save Whiskey, even after she's been imprinted with an evil villain. But then when Paul is suddenly killed, Echo is reunited with his mind when she uploads him into herself. The premise of programmable people turns out to be too big for a prime-time series to sustain smoothly. We have to believe in the impossible on a regular basis, but then believe in enough limitation to sustain dramatic tension. For instance, we have to believe that Topher can reprogram an entire world of people with a bomb made of spare parts, yet somehow he can't rig it with a timer and has to blow himself up with it. When everything is possible, all limitations become arbitrary, and we stop caring. We drop them like, um, dolls, and go play with something else.
Good luck, Joss, on whatever comes next. Please let it be a Dr. Horrible sequel.
Thursday, January 28. 2010
Kenny pointed out to me another example of people feeling a yearning for a simpler existence: "What Could You Live Without?" a New York Times op-ed about a family who, at their daughter's urging, downgraded to a smaller home and donated the proceeds to charity. The family experienced a double benefit: not only did they get the warm-and-fuzzies for making an enormous gift to the needy, they also discovered that a smaller house gave them more time together.
The benefits of cutting back are getting renewed attention these days. The recession certainly removed a lot of excess buying power, forcing people to look for happiness that couldn't be bought. The environmentalists, as we had discussed before, consider overconsumption to be a moral issue, since consumption of energy and other resources is what ultimately drives pollution, deforestation, and (is widely believed) global climate change. Kim John Payne, a therapist who recently spoke at our school, published a book called Simplicity Parenting that urged parents to jettison substantial amounts of both material possessions and scheduled activities as a means of making their kids happier and more well-adjusted.
I'm glad that people are rediscovering these truths. But I put the emphasis on re-disovering, since these are hardly new. While some forms of evangelical Christianity have occasionally gotten sidetracked down the doctrine of wealth, the mainstream Christian message has always advised people to "lay up their treasure in heaven" – moral action, not material accumulation, is the secret to happiness. It used to be that thrift – only buying what you needed – was a common-sense virtue, not a startling epiphany.
The Salwens, the family that sold their house, did so because their daughter observed, ""Dad, if that man [in the Mercedes next to us] had a less nice car, that man there [begging for food on the other side of us] could have a meal." While I admire the moral bravery of such a statement, I shudder at its economic naiveté. It's such a small step, intellectually, from wanting to help those in need, to believing that poverty can be "fixed" through a simple redistribution of wealth. It reinforces the massively mistaken notion that economics is a zero-sum game – that someone having more is somehow taking away from those who have less. My ethical heroes are not the sackcloth-and-ashes folks that make "sacrifices," but rather the mega-philanthropists like Bill Gates and Warren Buffett, who generate enormous value and wealth by doing what they love, and who then use that wealth for something better than mere conspicuous consumption. You never know – that guy in the Mercedes might have already fed more hungry people than you could even dream of helping with your modest means.
Wednesday, January 27. 2010
In some of our discussions on pantheism, Kenny pointed out that some of environmentalism is really a repressed desire to return to a simpler way of life. Lauren also sent on an article that described how some fans of Avatar were actually suffering from depression after seeing the movie, because they felt like their own lives could never have the beautiful richness and simplicity of the Na'vi in the film.
I have some mixed reactions to this sort of back-to-the-land nostalgia for a simple way of life. As with much nostalgia for the past, it is a longing for something that never existed in the first place. David McCullough made this clear in a recent lecture: "There never was a simpler time. The colonists in the 1700's needed to know a vast array of skills to survive." The perils that threatened their very lives – disease, weather, wild animals, Indian raids – made their lives chaotic, unpredictable, uncontrollable, and anything but simple. They had to work extremely hard to enjoy even the most meager of comforts. Technology, it turns out, removes complexity as much as it generates it.
What people are longing for is not simplicity per se, but connection to something that feels real and significant. A side effect of our recent technological advances is that it is vastly more possible to live without direct interaction with a community of people. Our economic transactions are automated and anonymous; we hardly ever know the person who sells us our food and clothing, much less the person who made them. We are often far removed from the people who benefit from our own work; lots of corporate worker-bees spend their entire careers without ever meeting a customer. Our entertainments used to be primarily social – singing, dancing, playing music, playing games were all done with other people. Now all those things can be done alone, and usually are. The net result is we feel supremely disconnected from everything in our world. Our actions have little visible purpose, our roles are interchangeable, our human interactions shallow and unremarkable.
So, what the homesteader achieves, and the rest of us often lack, is a tangible and immediate relationship to their environment. If you build your own house, make your own clothes, grow your own food, and even create your own entertainments, you can literally surround yourself in the fruits of your labor. You literally eat, sleep, and breathe your accomplishments. And if you trade the products of your labor with others, you have the satisfaction of knowing your customers, since they are usually your neighbors. Pride in craftsmanship takes on huge significance when your family, friends, and community are counting on the quality of your work.
Of course, even a modern American can experience all these things. Even a cube-dweller can take pride in his code. It's just that the "simpler" life makes it all so much more tangible, concrete, and inescapable. The homesteader lives in the knowledge that everything they do matters, both to themselves and the people they love. We don't need to be rescued from complexity -- just complacency.
Tuesday, January 26. 2010
I love all pop culture that dares to be smart. Still, I had not fully realized how much of an economics geek I had become until I watched "Fear the Boom and Bust", a rap video recently featured on NPR that contrasts the philosophies of John Maynard Keynes and F. A. Hayek. This beautiful work manages to be unapologetically thick with ideas and still convey the core of the debate to a layman's audience. I've been reading the Wall Street Journal for the past twenty years, so the on-going battle to retrieve our nation's fiscal policy from the Keynesians is familiar to me, but the video makes it much more dramatic.
On the outside, economics looks like the driest form of abstraction. It took writers like Dubner and Levitt (Freakonomics) and Ariely (Predictably Irrational) to remind us that economics is really the study of human decision-making, which makes the field both accessible and endlessly fascinating. Or, to put it another way: economics is the study of how people work together in a society. I'm not sure if you can have a really well-developed sense of fairness, freedom, or the meaning of life without some basic understanding of economics.
Monday, January 25. 2010
When I described the Axe and Dove ads, and how they demonstrate the need for media awareness, I was only relating the lesson as it was presented in the workshop. I had some other thoughts on the matter. As Kenny points out in the comments, feminist interpretations of things are fraught with contradictions.
Why (Kenny asks) is the Axe ad supposed to be offensive? Can anyone pretend to be surprised to find out that young men (and who are we kidding here – all men) like to look at scantily-clad women? Well, no. I think the most rational feminist explanation would go something like this:
"The ad shows women primarily as sexual objects and not as human beings. The young man on the beach does not know or care who these women are. He is gleefully happy to have any of them, all of them. In that sense, the ad is reaffirming and tacitly justifying a dehumanizing view of half the human race. The women are also portrayed as being sexually enslaved by the technology of a man, reduced to slavering animals by a mere scent, which is degrading and insulting."
All this is true, but it doesn't change the sad and obvious fact that the ad is more or less correctly portraying the real attitudes of men. It is a scientifically established fact that, barring the restrictions of moral codes or established relationships, nearly all men are willing to have sex with nearly any woman. (Consider, for a moment, if an advertisement featured hoards of slavering men clawing their way through a jungle to attack a woman. It wouldn't be funny, because, well, it's too close to the true state of affairs.) Our societal codes of modesty and chivalry are not intended to deny our animal natures – they are very explicit recognitions of our animal nature, and a rational attempt to transcend them by constraining when and how our animal instincts are engaged. So, I agree with Kenny that all men are transfixed by nudity – that's why we don't want to be let advertisers to take advantage of it.
If the Axe ads are offensive, you would think then that most feminists would be champions of modesty. Some are – some even renounce heterosexuality entirely – but they are a minority, I think. Far more feminists see the exposed thigh and breast as signs of a progressive and free culture: women liberated from their slavery to marriage and free to pursue their own pleasures. Feminists want to have their sexual cake and eat it, too: they want to be free to present themselves as sexual objects, and yet not be regarded as sexual objects. To the women who want the freedom to present themselves as sexually attractive beings, I say: great! But don't be offended when men stare at your chest.
My feminist straw-person would probably excoriate the Axe ad but praise the Dove ad as being a positive message for girls. But actually I think the Dove ad doesn't get off that easy. Even though the Dove ad attacks the media-enhanced images of beauty, and tries to praise "real beauty," it's still focused on beauty. In other words, it is still encouraging women to define themselves primarily by their ability to be attractive to men. If you really want to encourage young women, you would break that cycle entirely, and talk about women building businesses and curing cancer. But, of course, this is an ad intended to sell soap, and beauty turns out to be more compelling to young women than mere comfort or healthy hygiene.
Both the Dove and Axe ads are preying upon the sexual insecurities of young people in order to sell stuff. That is understandable; sex sells. I don't think sex is bad. I just want my life, and the life of my children, to be more than just sex. And to achieve that end, I think we would be better off with fewer ads like these.
Saturday, January 23. 2010
Emerson Waldorf School held their annual Waldorf Education Day this morning, and the theme was "True Connection in a Hyper-Connected World." Waldorf schools have a very cautious view of media and technology, and believe that TV and computers should be introduced to children in a thoughtful, age-appropriate, and conscious way, when they are ready for it. That generally means that they introduce media much later than others schools, but then have a much more conscious engagement with it later. So, for instance, you won't see a computer in most elementary and middle school Waldorf classes, but you might see an eighth grade class start learning about computers by building their own from scratch.
One workshop I attended this morning on teaching media awareness had an interesting demonstration, that I thought I would pass on. (Hat tip to Jerry Stifelman of The Change Creation and Lisa Braden of the Emerson Waldorf School.)
First look at this ad for Axe Body Spray. "This is 100% guaranteed to offend all feminists in the room," says Braden. Clearly, a callous appeal to young men, at the expense of the dignity of women.
Now, look at this interesting pitch, a part of Dove's Real Beauty campaign. "Seems like a nice, wholesome, love-yourself message for young women, right?" Braden asks. "The complete opposite of the Axe ad."
Now for the punchline: both the Axe and the Dove brands are owned by the same company, Unilever.
The moral of the story: advertising is not a reflection of values, or lifestyles, or ideals. Advertising's sole purpose is to sell things -- and companies will use whatever means necessary to make you buy their products. What our children -- and all of us -- need is a greater awareness of how the media manipulates our opinions.
Thursday, January 21. 2010
As a side-note to our earlier conversation about pantheism, I thought it was interesting to see how that religious philosophy was playing out in the global warming debate. I just finished SuperFreakonomics (really enjoyed it, more on that later) and I had heard on the news that the authors, Stephen Dubner and Steven Levitt, had gotten lambasted by various prominent environmentalists for daring to suggest that geoengineering was a promising strategy for averting global warming. Evidently, backing any solution that does not revolve around carbon reductions is considered "aiding and abetting the enemy," since it takes the wind out of the carbon-reduction cap-and-tax (oops, I mean, cap-and-trade) schemes currently being pushed. After finishing the book, I read the critiques from Elizabeth Kolbert and Raymond Pierrehumbert, as well as Dubner and Levitt's replies.
Let me start by saying: I have no idea who's right. I generally agree with Dubner and Levitt's basic assertion that it will be well-nigh impossible to get 6 billion people to all forego their self-interest for sake of averting a possible crisis hundreds of years from now. The outcome in Copenhagen only bears that out – the costs of the proposed solutions (slowed growth, lots of money changing hands) is still too high to get everyone on the same page, and you need everyone on the same page to avert a tragedy of the commons. So I think it's only sensible to look for some game-changing technological breakthroughs instead of relying on altruism and changes in human behavior. I also know that Malthusian doomsayers have been predicting the end of the world for centuries, and they routinely overestimate the hazards and underestimate the effects of new technology. On the other hand, I think geoengineering is so rife with the potential of unintended consequences that it also deserves some serious skepticism – even if we succeed in changing the earth's climate, it's impossible to predict the side-effects. So on the facts of the matter, I'm not taking any sides yet.
What interests me about this debate, though, is how absolutely nasty some of the environmentalists were in their reactions. Dubner and Levitt maintain a basically cheerful but factual tone in their writing, while Kolbert and Pierrehumbert drip with condescension, insult, and innuendo. Dubner and Levitt notice it, too, and they suggest the reason some environmentalists are so upset about geoengineering is because it offends a moral sensibility rather than an intellectual one. Dubner and Levitt just wanted to find the best strategy for cooling the earth, while environmentalists like Al Gore are trying to live in harmony with Mother Earth.
It does seem like a lot of environmentalists are carrying around certain pantheistic assumptions:
Someone with that kind of world view will perceive global warming very differently than those who don't. For the pantheist, global warming is a moral issue. We haven't merely created a difficult situation; we have sinned against the Goddess. The problem isn't that global warming will cause all kinds of problems for humanity; the problem is that a global economy, capitalism, consumerism and technology have offended the gods. Sometimes it seems like averting global warming is only the convenient pretext for a much larger agenda for reshaping society into a socialist, vegan, agrarian, earth-worshipping retro-utopia (with environmentalists as the high priests, of course). So of course geoengineering would be a heresy – that's only more "interfering" with Nature. That's why even safe, non-polluting thorium-based nuclear energy still ruffles their feathers. A purely technological fix only interferes with their plans to stick it to the capitalists.
Ok, maybe that's too much. I don't want to descend to Kolbert's level of snark. I think everyone in this debate is well-intentioned and even well-informed. I also think everyone in this debate has self-interested motivations and underlying philosophies that affect their positions (even me). We might as well root them out.
Wednesday, January 20. 2010
When I first heard the premise of "Ratatouille", Pixar's 2007 tale of a rat trying to become a chef in Paris, I thought I heard the most unlikely high concept imaginable. Think of what the pitch must have been like: "Let's take a garbage-eating rat and put him in with high cuisine." Neither cuddly nor appetizing.
But then came Up, and I heard an even more un-Hollywood premise for a family film: "Let's tell the story of an old man who loses his wife before he could ever fulfill their shared dreams." A typical studio exec would pick his jaw up off the floor and say, "Yeah, great, Oscar potential, but this is not going to sell plush dolls."
Yet for all the gravity of the subject, Up defies gravity, and maintains a life-affirming tone throughout. The silent montage that summarizes Carl and Ellie's life had me in tears, and yet even at the end of it my wife could say, "Oh, that's so sweet." Bittersweet, that is, and beautiful in an achy sort of way. I wonder if the kids in the audience can follow the full pathos. As Carl turns the page in the scrapbook past "Things I'm Going to Do" and finds blank pages, did the theater echo with: "Daddy, why are you crying?"
It was the profound realness of Carl's life, and Ellie's death, that provides sufficient counterweight to all the credulity-stretching premises that follow: the floating house, the talking dogs, the old man finding an even older hero, a protagonist who starts the story needing a chair-lift and ends in a leaping, climbing, rope-sliding, cane-dueling rescue attempt. It is all so perfectly unbelievable, and it doesn't matter, because what is happening inside Carl is so perfectly true.
Whenever a house features prominently in a story, you should brace yourself for Jungean archtypes: "Coraline" and "Howl's Moving Castle" are recent examples. Up is no exception. A house is a classic symbol of the self, and Carl's house follows the same transformation he does. It starts as his childhood playground, with the promise of adventure. It later becomes the center of his adult life, loaded up with the full pleasures, painful disappointments, and unfulfilled dreams that humans are prone to. In old age it is his refuge, the last vessel of everything he holds dear. He struggles to preserve the old dream, flying his house away, even dragging his house behind him over mountains (he is literally "tied to his past"). But in the end, he lets go of the past, empties his house of its old furniture, and sets off on a new mission. When Carl transcends his old life, sacrificing it for worthy cause, only then does it finally drift down to its proper place above Paradise Falls. The dream is fulfilled only when Carl no longer needs it.
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