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Sunday, May 4, 2008

Even the Insured Feel Strain of Health Costs

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

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Karena Cawthon for The New York Times

When Marianne Falacienski’s husband started a new job, the family could not afford the health plan. Ms. Falacienski, 32, found individual coverage only for him and their daughter, Gabrielle.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.

“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.

Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills.

“That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”

Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents “are waiting longer to bring in their children,” said Dr. Richard Lander, a pediatrician in Livingston, N.J. “They say, ‘The kid isn’t that sick; her temperature is only 102.’ ”

The problem of affording health care is most acute for people with no insurance, a group expected to soon exceed 48 million, but those with insurance say they too are feeling the pain.

Since the recession of 2001, the employee’s average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average American household’s income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte, and is now approaching one-fifth of the average household’s spending.

In a recent survey by Deloitte’s health research center, only 7 percent of people said they felt financially prepared for their future health care needs.

Shirley Giarde of Walla Walla, Wash., was not prepared when her husband, Raymond, suddenly developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formal-wear store, the Purple Parasol.

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for Medicare for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.

Experts say that too often for the underinsured, coverage can seem like health insurance in name only — adequate only as long as they have no medical problems.

“There’s a real shift in the burden of health care to people who happen to be sick,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a research group in Washington.

Companies and policy makers have yet to focus on what the faltering economy means for employees’ medical care, said Helen Darling, president of the National Business Group on Health, a Washington association of about 200 large employers.

“It’s a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession,” she said. “Americans have been giving their pay raise to the health care system.”

Sage Holben, a 62-year-old library technician with diabetes who is active in her local union in St. Paul, says that in 2003 union members agreed to a two-year freeze on wages to protect their health care coverage. But for the union, which will begin talks on the next contract this fall, it may be difficult to continue that trade-off, Ms. Holben said. “It’s at the point where we’re losing, anyway,” she said.

“I live paycheck to paycheck,” said Ms. Holben, who makes close to $40,000 a year at Metropolitan State University.

When she took the job in 1999, she says, the health benefits required no co-payments for doctor visits. Now, her out-of-pocket cost per visit is $25, and she pays $38 a month for her diabetes medicine. She has not been to the eye doctor in two years, even though eye exams are crucial for people with diabetes and she knows she needs new glasses. Nor does she monitor her blood sugar as regularly as she should because of the cost of the supplies.

“It’s not an extravagant expense,” she said. “It just adds up.” And it comes atop the increasing cost of utilities, gasoline and food — and the few hundred dollars of repairs her 1994 Chevrolet Cavalier needs.

Many employers do recognize that their workers are struggling financially even as they are asking them to pick up more of their health-care bills.

“It makes the work we have to do even more challenging,” said Anne Silverman, the vice president in charge of benefits in North America for the publishing company Reed Elsevier. “Employees are being stretched in terms of their disposable income.”

Even so, more companies may see themselves as having little choice but to require employees to pay even more of their health expenses, said Ted Nussbaum, a benefits consultant at the firm Watson Wyatt Worldwide. And when a weak economy undermines job security, he said, workers may simply have to accept reduced benefits.

While Mr. Nussbaum and other consultants say it is unlikely that significant numbers of employers will simply drop coverage for their workers, the weak economy could prompt more of them to push for so-called consumer-driven plans. Such plans tend to offset lower premiums with higher annual deductibles.

And while these plans often allow employees to put pre-tax savings into special health care accounts, they typically end up forcing the worker to assume a bigger share of overall medical costs. About six million people are now enrolled in these medical plans.

Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are “burying small business,” said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by Ron Wyden, Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. “It’s a huge chunk of change,” he said, noting that he was forced to raise his employees’ yearly deductible by 50 percent, to $750.

Around the nation, some workers are simply priced out of their employee health plans.

After Brian Falacienski of Milton, Fla., was laid off last year from his job as a surveyor for a construction company, he found another position. But the cost of his new health plan — $800 a month for coverage with a $1,000 annual deductible — was beyond the means of Mr. Falacienski, 38, who is married and has a 2-year-old daughter.

His wife, Marianne, started researching individual insurance policies and was able to find policies for her husband and daughter offering basic, if minimal, coverage, costing $161 a month for father and daughter. But Ms. Falacienski, 32, who has arthritis and the severe digestive disorder Crohn’s disease, is now uninsured. Because of her conditions, she said, four major insurers rejected her.

“I even applied for Medicaid,” she said, “but I wasn’t low-income enough.”

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Millions of Americans in Chronic Pain

Nursing a migraine today? New research shows you're not alone. More than a quarter of Americans suffer daily pain, a condition that costs the U.S. about $60 billion a year in lost productivity. And how often you're in pain depends largely on the size of your paycheck.

Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000, according to a landmark study on how Americans experience in pain. The findings, published Thursday in the British journal the Lancet, also found that participants who hadn't finished high school reported feeling twice the amount of pain as college graduates. "To a significant extent, pain does separate the classes," says Princeton economist Alan Krueger, who authored the study along with Dr. Arthur Stone, a psychiatry professor at Stony Brook University.

Krueger notes that the type of pain people reported typically fell on either side of the rich-poor divide. "Those with higher incomes welcome pain almost by choice, usually through exercise," he says. "At lower incomes, pain comes as the result of work." Indeed, Krueger and Stone found that blue-collar workers felt more pain, from physical labor or repetitive motion, while on the job than off, which at least offers hope that the problem can be mitigated. This finding "emphasizes the need for pain preventing measures [in the workplace] such as better ergonomics," wrote Juha H.O. Turunen, a professor of social pharmacy at Finland's University of Kuopio, in an accompanying commentary to the report.

People with chronic pain also worked less, the new study found, costing U.S. businesses as much as $60 billion annually. These conclusions are in line with previous studies on productivity lost to common pain conditions, including a 2003 report finding that nearly 15% of the U.S. workforce's output was diminished by ailments such as headaches and arthritis. What's new in Kruger and Stone's study, however, is the level of detail with which the researchers were able to chronicle the lives of Americans in pain. With the help of the polling firm Gallup, they asked nearly 4,000 survey participants to diarize their daily activities over a 24-hour period. From these personal accounts, the researchers saw the impact pain had on people's emotional states. Though participants said interacting with a spouse or friend lowered their pain, those suffering chronic pain tended to socialize much less. They also spent a lot more time watching television�about 25% of their day compared with 16% for the average person.

Pain also appeared to be a major driver of healthcare costs. Krueger and Stone found that Americans spent about $2.6 billion in over-the-counter pain medications and another nearly $14 billion on outpatient analgesics in 2004, the most recent data available. But in these numbers, too, there may be a distinction between the haves and the have-nots. A 2005 study in Michigan showed that minorities and the poor have less access to such drugs than wealthier Americans because local pharmacies don't stock enough pain medications such as oxycodone or morphine. "Those [pharmacies] in white ZIP codes were more than 13 times more likely to have sufficient supplies," says lead researcher Dr. Carmen Green, an anesthesiology professor at the University of Michigan. "I have patients who have to drive 30 miles or more just to get their pain medications."

One characteristic that pain doesn't seem to distinguish is gender: according to Krueger and Stone's study, men and women were nearly equally likely to find themselves in pain. Another is age. People reported more aches and pains as they got older, though surprisingly that pain tended to plateau from ages 45 to 75. "Maybe people reach a point in their career where they move up the ladder into a desk job," Krueger says. "Or maybe they've just learned how to cope with the pain."

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Think twice before stuffing your suitcase with prosciutto

What should and shouldn't go into your suitcase for the trip back to the States is not always an easy decision to make. Visiting a few U.S. government websites is your best chance of not having to give up a coveted food item at customs upon returning.
By Larry Crowe, AP Photo
What should and shouldn't go into your suitcase for the trip back to the States is not always an easy decision to make. Visiting a few U.S. government websites is your best chance of not having to give up a coveted food item at customs upon returning.

Jamie Mitchell offered to eat the illicit ham on the spot, but the border official was having none of it.

"I said 'Can I just have a couple pieces of it now?' and she said, 'I really can't let you do that,'" said the Washington lawyer, recalling his tussle with customs regulations at Philadelphia International Airport last year.

"But she was very nice for someone who was taking $60 worth of ham from me," he said of the Spanish jamon Iberico he'd been so seduced by during his vacation he had to bring some back. Or at least try.

Hijacked hams, seized sausages, confiscated confits. On a typical day last year, U.S. Customs and Border Protection processed 1.13 million people entering the U.S., and seized nearly 4,300 prohibited plant or animal items.

And during the summer, when travel peaks and Americans stampede to Europe, you can expect your friendly Customs officers to be even more vigilant than usual. Peak tourism season spurs special vigilance, Customs officials say.

The rules for what you can — and can't — stuff into your suitcase are so complicated even conscientious travelers like Mitchell — who declared the ham and was initially waved though — might have trouble.

Created by the Department of Agriculture and enforced by Customs and Border Protection, the rules allow some things that seem dicey and flag others you might not even think about.

The result is a bit of a regulatory roller coaster.

Fungus routed from the ground by pigs in France? Load up. Basil plant from your grandmother's garden in Italy? Pack it up (just shake off the soil)! Kangaroo jerky from Australia? Bon appetit.

But don't even think about canned corned beef from Dublin or smoky, Spanish chorizo. And foie gras, even cooked and canned? At your peril.

In general, baked goods, candy and chocolate are all fine to bring into the U.S. Condiments — oil, vinegar, mustard, pickles, syrups, honey, jelly — also fine.

Cheese is trickier, with hard varieties such as Parmesan and cheddar allowed, but soft, fresh or runny varieties, such as Brie, burrata and ricotta — big no-nos.

Fruits and vegetables generally are prohibited or require special certificates, unless you can prove they were grown in and came directly from Canada. Except potatoes. No Canadian potatoes, which have suffered disease outbreaks.

Fresh meat generally is forbidden. No steaks, no chops, no sausage. Unless it comes from New Zealand. Or is a wild bison. From Canada. That you killed yourself (keep your hunting permit with your passport.)

Cured meats — that's your Serrano, Parma and Iberico hams, plus Hungarian salami and other delicacies — are almost always forbidden. Unless they come from particular, preapproved production facilities.

So how does a traveler navigate all this?

"As a rule of thumb it's best not to bring it in or to at least declare it at the port of entry," says USDA spokeswoman Melissa O'Dell. Fines start around $300 and can climb to $10,000.

If there's something specific you know you will want to bring back, you can research it in the various manuals or on government websites. But it may take several phone calls before you get a clear answer about how, or whether, you can bring the item back. In some cases you may need a permit or other certificate.

The authorities aren't just being dinner party poopers. And they're not actually worried about whether you get sick.

They're concerned with protecting the U.S. food supply. Contaminated meat can put U.S. livestock at risk of mad cow disease, foot and mouth disease, swine fever, avian flu and other illnesses that can enter the food supply through garbage feeding and other means. Plants may harbor pests that could decimate whole crops.

So the regulations are based on the disease conditions in the country the product is from. Beef in any form is not allowed from Europe, Oman or Israel, all classified as areas with bovine spongiform encephalopathy, or mad cow disease. Canned beef bulgogi from Korea, however, is fine. Korea is classified as free of mad cow.

Spain and Italy are recognized as countries with swine disease, so in general no ham because curing methods don't always kill the disease. Parts of France have been designated as bird flu zones, so no foie gras.

Border protection officials insist there is no personal discretion involved when it comes to fines or confiscation, yet sometimes things do get through.

Atlanta-based chef John Wilson, who spends several months a year in Europe, once stuffed his suitcase with pecorino and Parmesan cheeses, dried mushrooms, olive oil, vinegar and 12 bottles of wine.

"The inspector said 'Let's nail this guy,' and the agriculture guy said no, I was OK," Wilson says. Except for the wine. "I told him I would pay the taxes, but they said 'Put it back in your luggage. It's not worth the paperwork.'"

And if you do try to sneak something past, chances are it won't be the most shocking item officials have seen.

For Maurine Bell, port veterinarian at Chicago's O'Hare International Airport during the 1990s, that would be the whole goat she once found stuffed in a passenger's luggage.

"The gentleman was from Greece and he was bringing it in for his daughter's wedding," she says. "We took the goat. And the suitcase, too."

Tips for getting your food across the border

If you know you'd like to bring food items back from your foreign holiday, some advance research may improve your chances of getting it into the U.S. The following websites and offices may provide some guidance.

• U.S. Customs and Border Protection, help.cbp.gov

This list of FAQs begins with "What food can I bring into the U.S. (fruit, cheese, meat, etc)?" Be sure to check out the links at the bottom of each entry, which provide more specific information.

• U.S. Department of Agriculture's Q56 Fresh Fruits and Vegetables Reference Database, manuals.cphst.org/q56/Q56Main.cfm

This site breaks down permissible food items according to country, product and other criteria. The site is difficult to navigate, but agency hopes to launch a more user-friendly site sometime this year.

• U.S. Department of Agriculture's Complete Animal Product Manual, www.aphis.usda.gov/import_export/plants/manuals/ports/apm.shtml

This is the guide the government uses to determine whether your animal product is permitted.

• Duty-free is no guarantee. Items purchase in duty-free shops may still be confiscated.

• Remember that items purchased in Hawaii, Puerto Rico or the U.S. Virgin Islands may also be subject to restrictions.

• Keep items in their original containers. If you break the seal to nibble, you might lose it at the border, even if it's something that is otherwise allowed.

• Vacuum-sealed packages are less likely to get in than canned or shelf-stable, hermetically sealed items.

• Have your receipts handy. Duty on some items is levied according to their value.

• Current security regulations limit liquids in carryon luggage. With very few exceptions, all liquids must be in 3-ounce bottles or smaller and fit inside one 1-quart plastic bag.

So if you've just got to lug home some of the local wine or olive oil, carefully pack the bottles (wrapped in plastic wrap or clothing) at the center of your checked bags.

• Confused about what to declare? Declare it all. Question 11 on the declarations form asks: "Are you bringing with you: a. fruits, plants, food, or insects? b. meats, animals, or animal/wildlife products? c. disease agents, cell cultures, or snails? d. soil or have you visited a farm/ranch/pasture outside the United States?"

So if your ham/cheese/basil plant/croissant falls into any of those categories, put an "X" by "Yes." And avoid the hassle later.

Getting special permission

Animal products: Some items will require an import permit. The document costs $91 and can take up to three weeks to receive. And unless you have the foreign government's certification information the permit is not likely to be granted. Contact National Center for Import and Export: 301-734-3277. www.aphis.usda.gov/vs/ncie

Fruit, vegetable and plant products: May require something called a "phytosanitary certificate." Also a difficult process. www.aphis.usda.gov

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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9 forbidden foods

Government agencies have outlawed these forbidden foods, but epicures love them. Here's what restaurateurs and other business owners around the U.S. have to say about culinary contraband.

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An outlawed cooking fat
Trans fats
Banned in: New York City

In December, New York City became the first metropolis to regulate the presence of trans fats - such as vegetable shortening, margarine, and partially hydrogenated vegetable oil - in restaurants.

Commonly used for frying and in baked goods, trans fats raise LDL, or "bad" cholesterol, and lower HDL, or "good" cholesterol. Since the New York Department of Health passed the measure, restaurants and bakeries have been phasing out trans fats, replacing them with healthier fats such as olive oil and safflower oil; restaurants must be trans fat-free by July 1, 2008. Other cities, such as Boston, Philadelphia, and Seattle, have followed suit and also banned trans fats.

"I made a conscious decision early on to prepare our food as healthily as possible, a decision I made for the health of my guests," says Kenneth Wood, co-owner and chef at Sylvia's, a famed soul-food restaurant in Harlem. "So the ban didn't affect me like it did some other businesses who hadn't made that choice. But overall, I think the ban has been a positive thing: trans fat is unhealthy, and it doesn't affect the quality or the taste of the food."

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Life in Mars: reclusive dynasty behind one of world's most famous brands


Photograph: David Levene

You might think that a chocolate company with one of the world's most famous brands would have a flashy headquarters with a visitors' centre and a neon sign. Not Mars. A notoriously secretive Virginia-based firm, it is run out of an anonymous brown building near the CIA's headquarters.

Nicknamed "the Kremlin" for its opaque ways, the snacks manufacturer is wholly owned by a reclusive dynasty of billionaires who spend a good deal of time on a remote ranch in Wyoming.

This week's $22bn (£11.6bn) takeover of the chewing-gum maker Wrigley put Mars dead centre on Wall Street's radar screen — giving the firm the kind of visibility it had studiously avoided for 98 years.

"They're based in a dark, hidden building," says Jan Pottker, author of a tell-all book about the Mars family, Crisis in Candyland. "It's simply incredible — rather than being proud of their company, they don't want to be noticed."

With 129 factories and 223 offices in 66 countries, Mars employs 48,000 staff and commands annual sales of $22bn. As well as confectionery such as its eponymous bar, Twix, Snickers and Starburst, its lines include Uncle Ben's rice, Dolmio pasta sauces, Masterfoods ready meals and Whiskas catfood.

Its move for Wrigley came out of the blue — astonishingly audacious for such a relentlessly low-profile business.

"Mars is a very, very quiet company," says Mitchell Howard, a food analyst at the stockbroker Morningstar in Chicago.

He believes the deal's logic is largely driven by marketing muscle and by distribution power — the combined company will command shelf space at more corner-shop retailers, particularly in emerging markets.

"This gives them a huge distribution footprint all over the world," says Howard. "Wrigley has a lot of distribution in Asia and eastern Europe. The retail trade is a lot less consolidated in those markets, so distribution really matters."

The deal, agreed in just three weeks, was negotiated with Wrigley's bosses over sandwiches around the kitchen table of Mars's president, Paul Michaels. Mars tapped the world's richest man, Warren Buffett, for $6.5bn and secured a further $5.7bn from Goldman Sachs.

Food industry experts see it as a sign that Mars is finally opening up — possibly due to the influence of Michaels, a former Johnson & Johnson executive who is part of a first generation of non-family members to be responsible for the day-to-day business.

"They did have a leadership change about four years ago," says Howard. "They've got quite aggressive in terms of advertising and innovation — there have been more product extensions, more line extensions."

Michaels took the reins in 2004 after the retirement of Forrest Mars junior and his brother John who, with sister Jacqueline, still own the company. They are the grandchildren of Franklin Mars — a Minnesota-born entrepreneur who started the company by making butter cream sweets in his kitchen.

Forbes magazine estimates that each of the three siblings has a fortune of $14bn. But they don't grace the society pages of America's newspapers and grand gestures of philanthropy are not their style. However, there have been occasional donations to the Republican party.

Mars will only say that certain descendants of Frank Mars still occupy management positions and refuses to reveal how many of them sit on the board. When second-generation boss Forrest senior died aged 95 in 1999, Mars would not even confirm his death.

Strait-laced

Traditionally, Mars has been deeply conservative and highly competitive. It lobbied Congress to change the end date of daylight saving time to get an extra hour's evening light on Halloween — a crucial day for selling confectionery. Its strait-laced approach has sometimes tripped it up. Mars refused to allow its M&Ms to be featured in Stephen Spielberg's blockbuster ET. So the film's young hero, Elliot, used Hershey's Reese's Pieces to lure his alien friend to come out from a hiding place — prompting rocketing sales.

"You couldn't laugh at the products in any way," says Pottker. "At the time, they would never do a product placement — certainly not with an extra-terrestrial."

She says the "cult of secrecy" around the firm dates back to the second world war when Forrest Mars senior patented a method of parboiling rice to extend its shelf life — subsequently launched as Uncle Ben's rice. American military chiefs read about the patent and tried to overturn it in order to supply troops.

"Forrest was absolutely appalled at what even a positive article about rice could end up with," says Pottker. "The kids took it to heart."

This insistence on privacy has been a useful device in helping the Mars family to maintain its unanimity according Joseph Astrachan, an expert in family enterprises at Kennesaw State University in Georgia. He says it implies betrayal if any relative dissents or talks to outsiders. "It keeps the family aligned — you don't give the people the sense that they can go elsewhere," says Astrachan. "They've been unswayed, unbowed by the so-called experts who tell them to do things differently."

A booklet signed by 13 members of the family gives a glimpse into their thinking. The pamphlet, the Five Principles of Mars, explains what makes the company "different". It lists quality, responsibility, mutuality, efficiency and freedom — of which the last is described in a curious way.

Private ownership, says the pamphlet is crucial to Mars's "freedom" as it means the firm is not answerable to anybody.

"Many other companies began as Mars did, but as they grew larger and required new sources of funds, they sold stocks or incurred restrictive debt to fuel their business," wrote the Mars clan. "To extend their growth, they exchanged a portion of their freedom."

Mars has shown more flexibility in recent years. In response to concerns over obesity, it has launched a range of healthier snacks for school vending machines called Generation Max. And it has developed a chocolate ingredient called CocoaVia that can help lower cholesterol levels.

The fact that Wrigley, too, is a family company may have smoothed the path to this week's deal. The Wrigley family controls 60% of the gum maker's stock and is chaired by Bill Wrigley, great grandson of founder William Wrigley — a baking powder salesman who began giving away free packets of gum to merchants in the 1890s.

In the chewing gum firm's hometown of Chicago, the Cubs' baseball stadium is called Wrigley Field and the white terracotta-clad Wrigley building is an architectural landmark, floodlit at night on the Chicago river. The Wrigleys command a degree of public respect — a little like another legendary American business founder, Wal-Mart's Sam Walton. "People have an affection for people like Sam Walton," says Pottker. "I don't think anybody gives a damn about Frank Mars."

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One boy, one girl -- one dorm room

(AP) -- Erik Youngdahl and Michelle Garcia share a dorm room at Connecticut's Wesleyan University. But they say there's no funny business going on. Really. They mean it.

art.coed.dorm.room.ap.jpg

Erik Youngdahl and Michelle Garcia surf the internet in their room at Wesleyan University.

They have set up their beds side-by-side like Lucy and Ricky in "I Love Lucy" and avert their eyes when one of them is changing clothes.

"People are shocked to hear that it's happening and even that it's possible," said Youngdahl, a 20-year-old sophomore. But "once you actually live in it, it doesn't actually turn into a big deal."

In the prim 1950s, college dorms were off-limits to members of the opposite sex. Then came the 1970s, when male and female students started crossing paths in coed dormitories. Now, to the astonishment of some baby boomer parents, a growing number of colleges are going even further: coed rooms.

At least two dozen schools, including Brown University, the University of Pennsylvania, Oberlin College, Clark University and the California Institute of Technology, allow some or all students to share a room with anyone they choose, including someone of the opposite sex. This spring, as students sign up for next year's room, more schools are following suit, including Stanford University.

As shocking as it sounds to some parents, some students and schools say it's not about sex.

Instead, they say the demand is mostly from heterosexual students who want to live with close friends who happen to be of the opposite sex. Some gay students who feel more comfortable rooming with someone of the opposite sex are also taking advantage of the option.

"It ultimately comes down to finding someone that you feel is compatible with you," said Jeffrey Chang, a junior at Clark in Worcester, Massachusetts, who co-founded the National Student Genderblind Campaign, a group that is pushing for gender-neutral housing. "Students aren't doing this to make a point. They're not doing this to upset their parents. It's really for practical reasons."

Couples do sometimes room together, an arrangement known at some schools as "roomcest." Brown explicitly discourages couples from living together on campus, be they gay or straight. But the University of California, Riverside has never had a problem with a roommate couple breaking up midyear, said James C. Smith, assistant director for residence life.

Most schools introduced the couples option in the past three or four years. So far, relatively few students are taking part. At the University of Pennsylvania, which began offering coed rooms in 2005, about 120 out of 10,400 students took advantage of the option this year.

At UC Riverside, which has approximately 6,000 students in campus housing, about 50 have roommates of the opposite sex. The school has had the option since 2005.

Garcia and Youngdahl live in a house for students with an interest in Russian studies. They said they were already friendly and didn't think they would be compatible with some of the other people in the house.

"I had just roomed with a boy. I was under the impression at the time that girls were a little bit neater and more quiet," Youngdahl said. "As it turns out, I don't see much of a difference from one sex to the other."

Garcia, 19, admitted: "I'm incredibly messy."

Parents aren't necessarily thrilled with boy-girl housing.

Debbie Feldman's 20-year-old daughter, Samantha, is a sophomore at Oberlin in Ohio and plans to room with her platonic friend Grey Caspro, a straight guy, next year. Feldman said she was shocked when her daughter told her.

"When you have a male and female sharing such close quarters, I think it's somewhat delusional to think there won't be sexual tension," 52-year-old Feldman said. "Maybe this generation feels more comfortable walking around in their underwear. I'm not sure that's a good thing."

Still, Feldman said her daughter is partly in college to learn life lessons, and it's her decision. Samantha said she assured her mom that she thinks of Caspro as a brother.

"I'm really close to him, and I consider him one of my really good friends," she said. "I really trust him. That trust makes it work."
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The Camera That Wears a Badge

THESE days, the police are much less likely to be hiding behind a billboard waiting to nab someone going over the speed limit. Technology has gone far beyond that.

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Nell Redmond for The New York Times

In Charlotte, N.C., a traffic-light camera is positioned to catch any red-light runners in the act. Some drivers have objected.

In recent years, local governments have eagerly adopted photo-enforcement technology — surveillance cameras that take a picture of an offending vehicle and its license plate — to nab those who exceed the speed limit or cross an intersection when the light is red.

As with most technological advances, there have been some unanticipated consequences.

Increasingly, travelers are receiving unpleasant surprises in the mail upon returning home: tickets for reported violations that they may not remember, perhaps from weeks or months earlier.

A spokeswoman for Avis said that citations directly attributed to enforcement cameras increased 25 percent in the last year among its customers. Both Avis and Hertz, the two major car-rental companies, say that they often pay the fine and then bill the customer, adding a processing charge.

Casey W. Raskob III, a lawyer in New York who specializes in traffic violations, said that some states and municipalities “want to get enforcement cameras in so badly to raise revenue” that they have reclassified red-light and speeding summonses issued through camera enforcement as violations like parking tickets, and don’t assign points to a driver’s record as a result.

Although drivers’ rights advocates have argued that some states and municipalities have gone too far with photo enforcement, the Insurance Institute for Highway Safety is a strong advocate. It argues that standard law enforcement doesn’t have the resources to keep pace with violations.

“Between 1995 and 2005, the estimated number of vehicle miles traveled in the United States increased by 23 percent, but the number of municipal law-enforcement officers grew by 12 percent,” Stephen L. Oesch, senior vice president at the organization, told Maryland legislators in February.

“Because speeding is common and viewed as acceptable behavior by many drivers, it is a major factor in motor vehicle crashes,” the institute said in a recent report evaluating the efficacy of speed cameras. Red-light cameras are now in use in 300 jurisdictions and speed cameras in more than 30 jurisdictions in 26 states, the group says.

Critics point to federal statistics showing that 42,642 people died in motor vehicle crashes in 2006, or 4 percent fewer than in 1975, even though roads have become more crowded. What’s needed, the critics say, is better road engineering and law enforcement that concentrates on manifestly unsafe driving.

Drivers, meanwhile, are fighting back with their own technology, as they have since the automobile radar detector became widely popular in the early 1970s.

With tax revenues falling, incentives are growing for municipalities to use photo enforcement to raise cash, said Shannon Atkinson, president of www.Njection.com. With an enforcement camera, he said, “you can pick off 20 people an hour, easily.”

Mr. Atkinson, a network engineer, started his business as a Web site for car and driving enthusiasts, but added a popular feature that merges Google Maps technology with on-site information from motorists that pinpoints real-time speed traps — whether operated by police officers or by camera — at thousands of locations in the United States and abroad.

The feature has drawn many new users, including “drivers whose livelihoods depend on being on the road all the time — your truck drivers, your road warriors who go from city to city,” he said.

NJECTION recently began supplying its speed-trap technology to Garmin, the G.P.S. navigational systems company, and is planning to add others like TomTom, Mr. Atkinson said. Drivers can set their devices to map speed traps on any route, he added.

The identities of tipsters reporting the location of a speed trap are protected, he said.

“We actually hear from police officers about where they hang out on such and such days and times — because what they’re mostly interested in is getting people to drive safely,” he

said.

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