Many gay and lesbian bookstores followed, all over the country, as the movement grew in the following years. Many of those bookstores have closed recently, however, including the Oscar Wilde. Many see the disappearance of the stores as a sign of success growing out of the wider acceptance of gays and lesbians throughout society. They don’t need their own special bookstores any more because so many general bookstores carry gay and lesbian books.

The doors at Oscar Wilde closed in the spring of 2009, only weeks before Amazon.com accidentally pushed all books deemed gay and lesbian to the pornography section, a sad reminder of the days when a gay and lesbian bookstore was necessary due to discrimination. It’s worth taking a look back on those days.

Forty years ago, Christopher Street was the center of the Stonewall Inn riots. Today, the street still has problems with theives and vandals, but it still lies in one of the pricest areas of real estate, even for New York. Those riots of the 1960s and ‘70s, when Greenwich Village was the heart of a revolution seem like a long time ago in an age when gay marriage has been passed in Iowa, and when the Oscar winner for Best Picture played gay politician Harvey Milk, who was frequent visitor to the store and, for a time, a boyfriend of Craig Rodwell, the founder.

“You could say it’s really good because it means we don’t need segregated facilities but at the same time there’s something about going to a queer space that gets lost,” said Sarah Chinn, the executive director of the Center for Gay and Lesbian Studies at CUNY Graduate Center.

In 42 years, however, Rodwell’s tiny shop became packed with not only books and DVDs, but also people. Located on Christopher Street in Greenwich Village—just one block from the infamous Stonewall Inn—the bookstore became an information center, intellectual hothouse gather place and a home for the gay and lesbian movement.

When the Oscar Wilde Bookshop first opened its doors, the nearby Christopher Street park was home to homeless gay youths, now a statue stands in memory of the Stonewall Inn riots. The Christopher Street Liberation Parade, organized at the Oscar Wilde, is now known as the Gay Pride Parade.

While there was a once a network of gay and lesbian bookstores in New York, the Oscar Wilde was the first and now the last to fall. Other famous institutions such as Creative Visions on Hudson Street and A Different Light in Chelsea all closed their doors in the last decade. The website for Oscar Wilde suggests only three stores for patrons looking for gay titles: Lambda Rising in Washington D.C., Giovanni’s Room in Philadelphia and Common Language Bookstore in Ann Arbor, Michigan.

Martin Duberman, the author of the book “Stonewall” and a professor emeritus at Lehman College and the City University of New York Graduate Center, suggested this is part of a trend of gay bookstores closing.

“I’m always sad when a bookstore closes, especially a gay bookstore,” Duberman said.

Rodwell died in 1993, and the neighborhood surrounding his store is no longer the revolutionary one it once was. While up and down Christopher Street, from its western edges near the Hudson to the eastern end at Sixth Avenue, gay pride flags still wave proudly outside many of the stores and the Stonewall Inn still stands, instead of having a notorious reputation, the old articles about the Stonewall riots are framed in the window in order to attract tourists. A Starbucks is now at the corner of Sheridan Square, where young homeless gay youths used to sleep because they had nowhere to go. Christopher Street has become one of the priciest areas of real estate, with tree-lined streets and old buildings that were once dilapidated have been fixed up and for sale for high prices.

In the last few weeks before the store closed, the shop filled with regulars, tourists and reporters.

Cecilia Martin, 39, working the register, called the store a “safe place” for the gay community. She herself remembered her first time visiting the store, which she loved so much she later applied for a job.

“I didn’t even know what being gay was—when I was 16, I thought I was the only one that was,” said Gary Merston, 46, of East Orange. “Since I was 16, I’ve been coming to this store. I love this place.”

Merston stopped by with one his 14-year-old son, one of two children he adopted with his partner. Merston and his son said were saving souvenirs from the bookstore, right down to the shopping.

“When I saw Channel 7 broadcast, I couldn’t believe it,” Merston said. “I said, this is not really happening. We must have watched it 10 times, and repeated the news over and over again.”

Both Martin and the last owner of the bookstore, Kim Brinster, a former manager who bought the place after one of the store’s near-death experiences in 2003, said they felt the store is a victim of the current hard economic times, and the increasing presence of on-line retailers.

“Unfortunately, we do not have the resources to weather the current economic crisis and find it’s time to call it a day,” Brinster said.  “So thanks to all those who have been a part of the Oscar Wilde family over the years, you have truly been a part of the global community.”

Rodwell had been one of the more militant members of the homophile movement in the early 1960s, but by 1966, he was fed up with the Mattachine organization, the leading group fighting for gay rights across the country. Rodwell wanted to open a bookstore that would be an intellectual gathering place for gay people, and in fact, he banned the sale of any pornography in the early years. In order to save up the money for the bookstore, he worked summers at a motel at the Fire Island Pines, the popular vacation spot for gays on Long Island.

After two summers, Rodwell had saved enough money to rent space at 291 Mercer Street, the first location of the store. It moved two years later to its famed home on Christopher Street. The Mercer Street location, according to Duberman, was the cheapest place Rodwell could find.

Duberman profiles Rodwell in his book and wrote Rodwell struggled in those early days—and even had to ask his own mother to help set up the store the night before it opened due to a lack of resources. Rodwell later relented on the pornography ban in order to make some money, Duberman said.

When the bookstore first opened, the mainstream press either ignored it or attacked its existence. According to Duberman, a columnist for the New York Post compared it with see-through dresses and topless flicks, despite Rodwell’s hatred of pornography. Some gay activists were not happy with the store because it did not stack pornography, and other claimed it was stinted more toward men. Still, Rodwell put in 70-hour weeks and ran the store by himself for the first 18 months.

In addition to the bookstore, Rodwell also began his own gay and lesbian organization, called the Homophile Youth Movement—later amended to Homophile Youth Movement in Neighborhoods, so the acronym would be HYMN and less gender-specific—and used the store as the headquarters. He published a newsletter called The New York Hymnal, where he called for homosexual law reform in New York State. Rodwell even hung a banner in the front window proclaiming “Bookshop of the Homophile Movement.” He would later replace it with a bumper sticker proclaiming “Gay is Good.”

During the early morning hours of June 28, 1969, the police attempted to raid the Stonewall Inn, located at 51 Christopher Street, only a few doors down from the new location of the bookstore. But the raid did not go as planned and turned into a full-scale riot. Rodwell, who personally hated the Stonewall Inn because he thought it was unsanitary, could see the riot going on from Oscar Wilde and called the newspapers and three New York papers—The New York Times, the New York Post, and the New York Daily News—all covered the siege. For the next few nights, people gathered on Christopher Street to protest—and Rodwell printed leaflets from the bookstore to help organize. From the back room of the bookstore, Rodwell encouraged a boycott of the Stonewall Inn, which closed only a few weeks after the riot.

One year later, Rodwell organized “Christopher Street Liberation Day” from Oscar Wilde, now celebrated each year as “Gay Pride Day.” The gay rights revolution had been born.

Rodwell died of stomach cancer in 1993, and one of the store’s managers, Bill Offenbaker, bought the store. After Offenbaker struggled to keep it afloat, Larry Lingle took over in 1996.

But Lingle could not save it either, and he announced he would have to close its doors in 2003. At the last minute, Deacon Maccubbin, the owner of gay bookstore Lambda Rising in Washington D.C., bought the store and rescued it at the last minute. Three years later, Brinster, then one of the store’s managers, took over.

While rents in Greenwich Village have increased over the years, Brinster said the Oscar Wilde Memorial Bookshop paid only $3,000 a month, well below market value. But that was still too much.

Sarah Chinn, the gay and lesbian center director at CUNY, said she thought the world around Oscar Wilde had changed too much for it to survive.

“Now you don’t have to schlep all the way to the Village to buy a gay book—you can just go on-line and order it,” Chinn said. “I think someone could see it as a good sign. That we’re not totally marginalized, but at the same time, community-run institutions have a place and they have a value beyond what’s available. It’s essentially a shame that it’s the oldest gay bookshop in the United States and it’s closing.”

Martin said the full force of the bookstore’s closing hadn’t hit her yet.

“I think it’s definitely a loss,” Martin said. “It’s like, you may realize someone is dying, but you don’t understand the real impact…and they won’t until they don’t have us as a resource—the regulars who come in every week.”

One month before the scheduled closing date, the last meeting of the Lesbian Book Club still met. Instead of Rodwell’s famous “Gay is Good” sticker in the front windows, they were covered in “Final Sale” stickers. The club was meeting to discuss “Aimee and Jaguar” by Erica Fisher.

On the last day, the store officially closed at 7 p.m. The doors were locked, but the club members lingered in the trailblazing store for just a little while longer.

You are going to die. Of the more than 8 million people now alive in New York City, all will be dead, eventually. That’s a lot of bodies:  44 million feet of cadaver when laid end to end, assuming average height. And in New York City, where space is always at a premium, there’s not enough earth to grant them all eternal rest.

Green-Wood Cemetery in Brooklyn has interred almost 600,000 bodies in its 171 years of operation.  As its graves have filled, it has followed one of the tenets of good planning, build up, and developed large community mausoleums, which it markets on its website as “a choice once reserved for the wealthy, is now available to our families at prices comparable to that for in-ground burial.”

The price for in-ground burial has gone up, too.  A single, non-premium grave at Green-Wood now lists at $11,000.  The miscellaneous charges for burial, the foundation for the stone, having the funeral after 4 p.m. or on a Saturday will add an extra $2500 or so.  Gravestones, which the cemetery does not supply, cost anywhere from a few hundred to several thousand dollars, depending on the size and intricacy of the marker.

Richard Fishman, the director of the New York State Department of Cemeteries, said that the prices reflected more than supply and demand.  The cemeteries are heavily regulated non-profits and have to charge more as their capacity shrinks in order to keep themselves financially solvent in perpetuity.

“It costs $5 million a year to keep Green-Wood going as it does,” Fishman said.  “And it’s not as though those being served with that money can be charged.”

No, indeed.  So those now dying have to pay more for the upkeep of those who died before, just as those to die in the future will pay a premium for the upkeep of those now paying.  The similarities to a pyramid scheme are stark, though necessity rather than criminality is the source of the creativity.

While the department only has jurisdiction over non-denominational graveyards, those run by religious organizations have many of the same concerns.  St. Patrick’s Cathedral runs Mount Calvary Cemetery in Queens, the most populous cemetery in the city with over 3 million permanent residents.  They’re almost done, said Lyndon Roche, a spokesman for the diocese.  He said that St. Raymond’s, another Catholic cemetery in the Bronx, would have room for at least another 20 years.

“You look on either side of the Cross-Bronx, because St. Raymond’s is all around you, and there’s still plenty of space,” Roche said.

The nightmare scenario can be found in Ozone Park, at Bayside Acacia, a small Jewish necropolis.  The Upper West Side congregation, Shaare Zedek, doesn’t have enough money to pay for proper maintenance, and the cemetery has gone to seed.

Vines grow over tombs, headstones are toppled and broken, crypts and even coffins have been opened.  Calls to the Rabbi were not returned.

At Mount Olivet Cemetery, which has been pressed for space for a number of years, there haven’t been any issues of abandonment, nor have they dramatically increased their rates, nor are they completely full.  It’s just more of the same at Mount Olivet, said David Gigler, the superintendent.  They have been tearing up roads to make room for more graves and, like Green-Wood, has developed a large community mausoleum, which includes more and more niches for cremation urns.  Gigler said that there weren’t other reform options available.

“Maybe in 25 years, they’ll come up with something,” he said.  “But by then, I’ll be retired.”

In some crowded places around the world, they have come up with a broad array of somethings.  In Great Britain, where burial grounds are most often small, ancient churchyards, the government has permitted the reuse of graves that have been untended for more than 75 years.  The tiny nation-state of Singapore allows interment for 15 years, followed by mandatory exhumation and cremation.

Cremation is not allowed under Islamic law, which is why burials are still in demand, despite their impermanence.  The Italian Catholic Church, which had long opposed cremation as heretical, recently began allowing Mass for people whose remains were to be burned.  But cremation can be dangerous to the environment, as mercury from fillings is borne on the smoke.  So Sweden has permitted the use of a new method, promession, wherein the body is frozen in liquid nitrogen, shattered and then thawed, allowing the body’s water weight to evaporate and leaving a small amount of residue that can be safely recycled into the earth.

Will New York City allow these, or other new developments in the disposal of dead bodies like burying coffins upright?  Absolutely not, said Fishman, from the Department of Cemeteries.  He said there were plenty of cemeteries in Westchester County, Connecticut, New Jersey and Long Island that had room and land to expand.
As in life, so in death: when the city gets too crowded, move to the suburbs.

In the past, adults called from employment centers looking to place high school kids in Betancourt’s store. Now, they’re calling for themselves – and they’re desperate for income. “They were like, ‘Do you have anything?’” said Betancourt, who manages a Carvel’s in Forest Hills, a neighborhood in Queens in New York City. “They just wanted to work.”

Betancourt is not the only manager getting such calls. Across the country, other businesses with positions that don’t require qualifications or degrees – mainly food service, retail, and customer service – say they are being flooded with applicants who are too qualified for them. As joblessness continues to rise, people who need to pay their bills may be willing to take anything to carry them over.

Working a job that is beneath your skills is part of a broader phenomenon called underemployment. According to the Bureau of Labor Statistics, nearly one in six workers is unemployed or underemployed. That’s almost double what it was a year ago, when about one out of eleven workers was in that situation.

That captures the magnitude of the jobs crisis, said Kevin Jack, principal economist and statewide labor market analyst at the New York State Department of Labor. Historically, those rates were highest among those with low education levels. But now, even white-collar workers are vulnerable, so there is more competition for lower end jobs, Jack said.

Economists say there is no way to determine how many people are in jobs that are beneath their skill level. Other types of underemployment – working for fewer hours than you’d like and working for lower wages than your skills deserve – are quantifiable. A skills mismatch, however, is hard to measure, said David Howell, a professor and economic researcher at Milano The New School for Management and Urban Policy. “Who’s to say who is over- and under-qualified for a job?” Howell explained.

But some economists are troubled just by the concept of rising underemployment rates.

“Underemployment is a very, very corrosive thing on our economy,” said Mark Zandi, chief economist at Moody’s Economy.com, in a phone interview with students at the City University of New York’s Graduate School of Journalism.

Because people who are underemployed earn less than they used to, not only do their spending habits decrease, but their general mindset is also affected. “You’re panicked, you’re worried, you’re nervous, and that causes you to pull back even more,” said Zandi.

This anxiety can lead to a lack of confidence in both your financial future and in the country’s. “In fact, the difference between a typical recession and a depression is a loss of faith in our economy,” said Zandi. “And people who are underemployed certainly are losing faith.”

But underemployment is not necessarily a product of the recession, said John Robst, an associate professor of economics at the University of South Florida who specializes in labor economics and who recently published a paper about overeducation and underemployment.

For example, narrowing a job hunt to a specific metropolitan area – even one as large and as job-laden as New York – can make the search more difficult. In such a case, the cause of underemployment is personal, and not wholly symbolic of the job market.

Many workers consider themselves underemployed – and in a sense they are, said Robst, if they have skills that are more advanced than their job requires. But when is that significant from a macroeconomic perspective? If someone is unsuccessful in a nationwide search, that is more likely to reflect the broader economy than if someone is unsuccessful in a search that is geographically limited, which reflects personal choices, Robst said.

“Is it really there?” asked Robst about a recession-related rise in underemployment. “It’s tough to say.” In a weak economy, he explained, there’s probably a slight increase in underemployment, but it gets a lot more attention because the press picks up on it.

Unemployment has taken its severest toll on the young labor force, said Joseph McLaughlin, a senior research associate at the Center for Labor Market Studies in Northeastern University in Boston. Workers between the ages of 16 and 29 make up more than 52 percent of this recession’s laid off work force, said McLaughlin. And some of those newly unemployed young workers are turning to all sorts of jobs, at least to support themselves temporarily.

Twenty-six-year-old Eric Rubin of Linden, N.J. may soon join the ranks of the underemployed. Rubin is an environmental engineer who was laid off in October. He has a bachelor’s degree in geography from George Washington University, a master’s in environmental management from Montclair State and a 3.92 GPA, but he’s having a hard time landing a new job.
Rubin said if he doesn’t find something within the next few months, when his unemployment runs out, he may need to resort to working at a local fast food joint. “It’s weird,” said Rubin. “If you asked me five years ago where I would be, it wouldn’t be here. I wouldn’t be unemployed. I said I’m going to school, I’m getting my master’s degree, I’m going to have a job. And here I am with a master’s degree, but with no job.”

Because so many young workers are the victims of layoffs and hiring freezes, underemployment and its effect on morale is a big concern for that age group. “It’s not ideal to come out of Harvard and work out of McDonalds, not Goldman Sachs,” said Lindsey Pollak, a career development guide writer whose focus is young professionals.

People in these situations sometimes believe that if they start at a low salary, they might never recover, but Pollak discourages that notion. “I refuse to be one of those people who says that you’re destroyed because the economy is bad,” said Pollak.

Zandi, on the other hand, said he was worried because acquired skills can degrade if people aren’t working in their fields. “You get thrown out of a job that utilized your education and background and you get pushed into something that doesn’t, you lose the skills and talents pretty fast,” he said. This can also have a significant impact on the economy at large, because it can slow down the country’s economic recovery and subsequent growth.

Not everyone is as worried about skill loss. Ann Baehr, a certified professional resume writer and president of Best Resumes of New York, said, “No one is going to think that you lost your edge and your skills if you’re in a temporary position for six months or a year.” In fact, workers in these positions may even expand their skill set, possibly in another industry.

Some workers are willing to do whatever is necessary to stay afloat, but they worry about listing menial jobs on a resume. Pollak said it shouldn’t be a concern. “I think that no one will fault you for what you do during the great recession of 2009 just to get by,” she said.

But for many, it’s not just a matter of making a living – it’s also a matter of pride. “It’s more of a concern on my ego,” said Rubin. “I went to school for eight years for a reason. And here I am and I might be working at McDonald’s or Barnes and Noble.”

Here are some tips for the underemployed from Lindsey Pollack, who writes career development guides for young professionals:

•    Pride shouldn’t get in the way. “Don’t crawl under a rock because you’re embarrassed.”
•    “You’ve got to stay in the game”
o    Keep up on industry news – “If you want to work on Wall Street but you’re now working in retail, read the Wall Street Journal.”
o    Network, network, network.
•    Volunteer – you can get experience and it looks great on your resume.

Cleveland is not the only city struggling with providing access to the uninsured. Many hospitals around the country are making it more difficult for the uninsured to receive health care. Hospitals in several U.S cities have been consolidating and expanding their facilities outside of the city center where many uninsured live. In Cincinnati and Denver, new outpatient centers are springing up in wealthy suburbs. These hospitals are designed to look like high-end health spas. Hospitals in the city, where most uninsured receive care, remain overcrowded and run-down.

“What’s happened more and more— I guess you can call it uninsured and Medicaid patients are marginalized—but I like to say they’re abandoned,” said Gary Benjamin, a spokesperson from the Universal Health Care Action Network of Ohio.
One-third of U.S hospitals are operating in the red. In order to stay afloat, many of these hospitals have decided to relocate to areas where there is a better payer mix. “It’s just like retail, they are going where the well off live—out of the city into better paying neighborhoods,” said Alan Zuckerman, president of Health Strategies and Solutions. Zuckerman said it’s tough to operate a hospital in the city these days. Not only are urban hospitals caring for the uninsured, they also have larger amounts of debt, density issues, more competition, and higher labor costs because of a unionized work force.

The Cleveland Clinic and University Hospital are the two big hospitals operating in greater Cleveland. Although the main facilities for both the Cleveland Clinic and University Hospital have remained in the city, both hospitals built outpatient facilities in the suburbs to boost revenue and attract insured patients. “And they wonder why poor people are using the ER in the city? It’s all that’s left,” said Benjamin.

As cities expand, hospitals are taking advantage of an opportunity to open up new outpatient facilities out in the suburbs so that they can make money.

Cincinnati is steadily growing. By 2020, the area between Dayton and Cincinnati is expected to fuse together. Tom McCormally, a spokesperson for Children’s Hospital in Cincinnati, said there is a demand for more space at Children’s Hospital, the big nonprofit hospital in the city center. “It’s not like we’re cannibalizing. Our growth has been phenomenal in the last 10 years, and I’m not seeing the numbers drop when we open up new facilities.” Children’s has set up 10 outpatient centers in the suburbs of Cincinnati in the past several years.

In Denver, the population has already grown out toward Aurora and Boulder. The Denver-Aurora-Boulder combined statistical area had an estimated population of 2,998,878 in 2007, and ranked 17th most populous U.S. metropolitan area. Mike Romano, a spokesperson for the Catholic Health Initiatives, thinks that if hospitals want to make money, expanding into suburbs is certainly one way to do it. Denver’s expanding metropolitan area has made it one of the nation’s hottest markets for healthcare construction.

As hospitals follow the money out to the suburbs, they’re also able to embark on a new image that’s designed to attract patients with money.

While care is compromised for the uninsured in Cleveland, it’s top notch for those who can pay. In September, the Cleveland Clinic opened up two new buildings. The first was the state-of-the-art Sydell and Arnold Miller Family Pavilion, home to the Clinic’s cardiovascular program. The center is recognized as being the best in the world, according to U.S News and World Report, which is why the Cleveland Clinic is able to transport non-local patients in one of their two private jets.

University Hospital, the Cleveland Clinic’s main competitor, is trying to catch up. Their new projects include a $232 million cancer hospital, a seven-story garage, and a $45 million emergency center, scheduled for completion in 2010.

In Cincinnati, hospitals are not reaching out to uninsured patients as they expand. Instead, new hospitals are marketing their facilities to the insured, taking advantage of population growth just north of the city.

The Westchester Medical Center is currently being built from the ground up and will be operational next year. A new hospital hasn’t been built in Cincinnati for the last 25 years. But this hospital is being built in the suburbs, not on “Pill Hill”—the area in the city where the most hospitals had been located for decades. “Pill Hill” is also known as Clifton Heights, near the University of Cincinnati and walking distance from downtown Cincinnati where most poor, African-Americans live.

Most recently, Children’s Hospital opened up an outpatient facility in Liberty Township, a suburb north of Cincinnati, in the center of the fast-growing Cincinnati-Dayton metroplex. Although the two big nonprofit hospitals have been able to stay in the city center, they have also been able to expand elsewhere.

The suburban areas of Denver are being populated at a rapid rate. Douglass County—where two state of the art hospitals have been constructed—has been one of the nation’s fastest-growing areas for the past decade. From 1990 to 2001, the population increased by 224%. People in this part of town are also considered high-end patients. In Douglas County the median income in 1999 was $82,929—more than double the figure in the city of Denver. In the Sky Ridge area, about 73% of the population is covered by private insurance. Both hospitals in Douglass County—Sky Ridge Hospital and Parker Adventist Hospital—were designed with marble floors and healing gardens to appeal to this wealthy demographic.

The same is true in Denver’s northern suburbs where the Exempla Health Care System is trying to control the market. The median income there is almost 40% higher than Denver’s urban center.

Dr. David Sbarbaro, medical director of University Physicians, a doctor and patient resource at the University of Denver School of Medicine, said that Denver’s construction boom is designed to meet demand. “The city has grown, so the question is how to redistribute services,” he said. “It’s become increasingly difficult to maneuver around Denver because it has gotten so crowded. We’re seeing a redistribution of services that will be better balanced.”

Rick Wade, vice president of the American Hospital Association, said hospitals usually follow population growth. He said hospitals are the economic engines of an area. They create jobs within, and commerce is built up around them. “They [hospitals] have a dual and conflicting role as a hospital and an economic engine. They have to deliver care but also be economically strong because the city depends on it,” he said.

The Center for Studying Health Care Change, a nonpartisan policy research organization, published a study this summer that said safety net hospitals are suffering because of the liberties private hospitals are taking in expanding to affluent suburbs. Newer suburban facilities are taking away paying patients from these safety net hospitals and further straining them with a disproportionate number of uninsured. In addition to the nice rooms, patients now can stay in the suburbs for their hospital care instead of traveling longer distances to downtown areas. These new suburban facilities are also equipped with the latest technology and amenities. This creates the impression that the suburban facilities have higher quality of care than some of the older looking safety-net hospitals. Disparities in health care are only getting worse as a result.

Cleveland’s shrinking hospital system has certainly hurt the uninsured. Ashwini Sehgal, co-medical director at the Cleveland’s Department of Public Health and a kidney specialist a MetroHealth Medical Center, moved to the city 15 years ago. There were 22 hospitals then, now there are only four. The Cleveland Clinic controls half of the market and University Hospital controls one-third. The other small hospitals—MetroHealth, Parma Community Hospital, St. Vincent Charity Hospital and the VA Medical Center— take on the remaining patients. Most of them are uninsured. With so few hospitals and so many uninsured people in Cleveland, it’s an unfair burden.

Both the Cleveland Clinic and University Hospital have primarily been sending their uninsured patients to MetroHealth. Sehgal said that most recently, MetroHealth had to lay off staff and in turn, they have had to send some of these uninsured patients to the Free Clinic or the Neighborhood Family Practice. Peggi Chella, a spokesperson from the Neighborhood Family Practice, said her clinic has been overwhelmed in recent months because of an influx of so many uninsured patients.

In Cincinnati, Children’s Hospital and University Hospital take in most of the uninsured. As a result, their emergency rooms are overwhelmed. McCormally said Children’s Hospital has had to turn away patients from the main campus hospital in the city for the first time this year. Similarly, University Hospital has had to send their ambulances to other hospital emergency rooms, usually further away, because their emergency rooms are full to capacity.

But care at an outpatient center away from the city is even harder to come by for an uninsured patient in Cincinnati. Trey Daly, a senior lawyer from the Legal Aid Society in Cincinnati, said the typical scenario follows along these lines if a patient from Children’s Hospital or University Hospital is sent to an outpatient facility: “someone needs surgery at an outpatient center, and the surgeon requires payment upfront but the client can’t afford to pay so they are turned away.”

If the city’s nonprofit hospitals are turning away the uninsured because their emergency rooms are full, and the outpatient facilities are not accepting them because they can’t pay, uninsured patients only have clinics to turn to. Cincinnati has a total of eight free clinics set up to treat the poor. But, these clinics are only opened during business hours and are going to be more overwhelmed as the uninsured population grows. In October, the Greater Cincinnati Health Council released a report that said the number of uninsured people in Cincinnati has increased. Approximately 250,000 persons are estimated to be uninsured in Greater Cincinnati.

In Denver, four new hospitals have been built in the suburbs, and the three existing downtown facilities are uprooting. Presbyterian St. Luke’s Medical Center and St. Joseph’s are both building facilities on the University of Denver’s campus nine miles from downtown, while still maintaining services at the city hospitals. St. Anthony’s Hospital is leaving the city altogether and moving south to Lakewood where there is a better payer mix. Sbarbaro said this leaves the predominately Hispanic northwest Denver uncovered. There will be 39% fewer hospital beds in downtown Denver in the next couple of years because of these moves. This means less access to care for poor, uninsured patients.

Jim Hertel, manager of Managed Care Review, a monthly newsletter that covers Denver’s insurance and healthcare industry, said Denver Health has had to take on all the city’s poor since they are the remaining public hospital for uninsured. Rose and Swedish Medical Centers downtown are also feeling the impact of poor, he said.

Certain policies have fostered these health disparities between the insured and uninsured.
The certificate of need laws, originally designed to limit health care facility costs and allow coordinated planning of new services and construction, were repealed many years ago in several cities. Cleveland, Cincinnati and Denver are just a few examples where this has happened.

Benjamin said that doing away with the certificate of need laws has allowed hospitals to get away with a lot. “That they set it up that way is debatable, but the design of it was to abandon folks in the city,” he said. And unlike some other countries, the United States has no federal agency charged with hospital oversight. As is the American way, hospitals have turned into big conglomerates that compete with each other for business.

Although these big hospitals that are abandoning the poor could be easily mistaken for-profit hospitals, most are nonprofits. By law, nonprofit hospitals receive a tax exemption for providing charity care since they were originally set up to serve the poor. But after Medicare and Medicaid were created in 1965, the hospital industry argued that there would no longer be enough demand for charity care to satisfy the IRS’s tax-exemption standards. Most Americans, they said, would be covered either by the new government programs for the poor and elderly or by private health insurance.

Some of these hospitals have come under fire recently from patient advocates and members of Congress for slacking on charity care—especially as they build these new facilities away from the city center. Instead of defining charity work as caring for the poor, some hospitals think it’s acceptable to count health fairs as charity care. Still, they receive millions of dollars in tax exemptions and are able to compete as big businesses.

Colleen O’Toole, president of the Greater Cincinnati Health Council, attributes the
growth and expansion of the city’s hospitals to better reimbursement levels after federal budget cutbacks during the 1990s. By combing with other hospitals to form large health systems, individual hospitals have gained leverage and are able to negotiate better prices with health insurance companies.

One of the main reasons hospitals have done so well in the competitive health-care market today is because they have merged with a number of regional hospitals and family health centers in order to offer a single, stronger source for health insurance negotiations.

With this new capital, hospitals have been able to take on major construction projects, advance sophisticated technology and market it to paying patients. It makes sense that many of these new facilities are most accessible to affluent, well-insured consumers.

Hertel thinks the smarter hospitals saw an opportunity with the Bush administration and went on construction sprees. “The financial market was willing to finance hospital expansion… tied with the best level of Medicare payments in decades and the laissez-faire attitude of the government,” he said.

But as the number of uninsured keep growing, cities and states realize something has to be done. Twenty percent of adults in Colorado are uninsured. To make matter worse, Colorado has one of the most limited Medicaid programs in the country. The Blue Ribbon Commission on Health Care Reform was created by the Colorado legislature in 2006 to come up with ways to cover the uninsured and control health care costs. The commission realized hospitals played a significant role in the well-being of the uninsured. In its recommendation, the commission stated that “safety net providers such as community clinics and hospitals play an essential role in caring for those on public programs and those without any health coverage. If we expand public programs to include more people, and as we recognize that noncitizens will continue to need care even if they do not have coverage, we must preserve and enhance safety net providers’ ability to serve these populations.” This past March, however, health policy analysts in Colorado criticized the recommendations, saying they would damage the market and decrease consumer choice.

In Cincinnati, the situation is a little brighter. For the past 40 years, Cincinnati taxpayers have voted on a levy that gives money to Children’s Hospital and University Hospital. The indigent care levy is a measure that uses city revenue dollars to pay for the poor’s health care. University Hospital receives 80 percent of the local levy funds and Children’s Hospital gets the rest. On top of the money generated by local taxpayers, a federal program called the Hospital Care Assurance Program, or HCAP, has sent more than $147 million to the hospitals since 1996. Even with the extra money, hospitals said they lost a combined $12 million last year in providing health care to poor people.

Policies for hospital charity care have also improved in Cincinnati. Policies have  expanded income eligibility levels at a higher percentage above federal poverty levels recently. The Greater Cincinnati Health Council said in a report this year that while policies from hospital to hospital vary, a family of four with a household income of $80,000 would in some instances meet the requirements to receive discounted care.

Back at the uninsured forum in Cleveland, organizers believed they were doing something revolutionary when they got hospital representatives and uninsured people in the same room together that Saturday in November. “It’s a totally local level and it remains to be seen how much momentum this will get,” said Chella.

“My focus used to be 90 per cent love and relationships and 10 per cent economical,” Rivera said. “Now it’s about 20 per cent love and relationships and 80 per cent economical.”

Rivera’s fortuneteller Karin Marcello, 29, also from Long Island, says that this switch in interest from love to money is a growing trend among her eclectic clientele, which includes top managers, cashiers and lap dancers.

“People are paranoid,” she said. “They ask: Am I going to keep my job? Will I be able to afford to live in New York? Should I still invest? Will I be able to pay my mortgage? Will I have any luck selling my house?”

Traditionally, a fortuneteller only had to divine the future, but a survey of 12 New York fortunetellers and psychics suggests that as the economic crisis has deepened, clients are treating them more like cheap psychologists and sympathetic university counselors, who have to reassure more than predict.

“Before the crisis people felt they were in control of their lives,” said psychic Stacey Worlf. “Now we feel unsafe. I find that my clients want to know whether they will be OK, and when you tell them so, they feel a lot better.”
Angela Lucy, a Manhattan fortuneteller, shares her colleague Worlf’s point of view and describes what usually happens in her office once she spreads the tarot cards out on the table.

“You get knee-jerk reactions, they are panicking,” she said. “I tell them they are going to be fine and advise them to stop listening to the news.”

According to Dr. Bonnie Maslin, a psychologist who has worked as a psychotherapist in private practice for over twenty years, when life is out of control, as in the case of the economic crisis, some people, rather than dealing with their anxiety through traditional therapy, resort to magical thinking.

But people now want more than magical thinking and whimsical advice from their psychic readings. Entrepreneurs ask whether the bailout is going to work. Small business owners ask whether investing in real estate is still worthwhile. And even artists, usually concerned with inspiration, are now more worried about making their artwork profitable. In order to respond to their clients’ more specific and personal-finance-oriented questions, fortune tellers say they can’t just rely on tarot cards and crystal balls. These days, they’re consulting economic papers and Paul Krugman’s columns.

“I’ve always picked up on the news,” said astrologer Zoltana, “but now I buy Fortune and Forbes and look at financial articles more closely.”

Psychics say they are integrating their strong astrological backgrounds with newly acquired economic savvy to help their cards provide creative, slightly more practical solutions.

“This year Aquarius is in Jupiter, which means that money can be made in the Aquarius way: thinking outside of the box and believing in your genius,” says a fortuneteller who goes by the name Joshua the Psychic. “So, for instance, I advice clients that were in finance to try to get from that arena into more creative jobs like marketing.