forever wild?

          On Sunday, July 6, 2012 the frontpage of the NYT's SundayReview featured an article on "Rethinking the Wild." In general it is a thoughtful article and the changes discussed in the management of the Wilderness Act 1974 are actually minor and commonsensical. Most are concerned with remedying and forestalling the effects of the northward movement of warmer temperatures. The central question is raised by one of the Act's promoters, viz. that "we should be guardians, not gardeners." The article's recommendations are summed up as "We need to be more nuanced in our hands-off approach."
          The danger lies that once the hands-off approached is open to modification the politicians will gradually introduce ecologically harmful "nuances" on the advice of graduates from forestry etc. departments of State Universities that are primarily funded by commercial corporations hungry for more resources. On the premise that one should not bite the hand that feeds these Departments they are not conducive to promote free thought. Some pretty disastrous remedies emerging from the Department of Agriculture include the recommendation of creating windbreaks and hedgerows of multiflora roses the hips of which provide food for many songbirds who caused the roses to become pests invading every untended plot including the "forever wild" ones. An other such invasive remedy was the use of the Japanese honeysuckle used to stabilize railroad banks against erosion. That too gets spread by birds and in my untended woods the multifloras provide support for the honeysuckle creating an area much loved by breeding songbirds and migrating or wintering guests.
           The problem of the Act lies in the fact that its aim to protect wilderness areas from destructive human exploitation was based on a pre-1970's concept of "hands-off" as direct physical action. Virtually all ecologist then were not fully - or at all - aware of the long term and distant - as well as cumulative - effect of human action that creates climate change as well as the acidification of the earth's surface. There were instances of man-made natural disasters in the past such as the dustbowl of the 1930s, which in the memory of most became a draught caused by capricious nature because the Plains became fertile and populated again and thus providing arguments for the eco-sceptics of today, arguments that are still more salient than the disappearance of the Ice Age when the Sahara had the climate of Europe and Canada an new England uninhabitable. Draughts are seen as tornadoes, hurricanes, earthquakes and floods which have been around ever since records were kept. And people continue to build homes in fragile coastal areas or in forests prone to wildfires, for most people remain unaware or disregard the warnings of the steady increase in such disasters and their violence. Our culture allows us to satisfy our desires and provides the  justification for it by providing a moral, political and economic system of protection one socially costly aspect of which are the insurance companies. I am reminded of the devastating hurricane of the early sixties when the then Secretary of the Interior suggested that the destroyed areas on New Jersey barrier islands be turned into a national park. Today these areas are more built up than before.
          Of course, the article's nuanced approach can not be a one time remedy for of climate change will be with us forever as the world population continues to increase and modernization of the poorer nations accelerates. Thus we see the 1950s smog of London replicated in today's Peking. A telling instance was described in a long article in the NYT of 7/27 concerning the adoption of frozen food as a staple in Chinese households and the deleterious consequences on the environment of the increased demand for refrigeration.
           But even if there was no man-made climate change, the wilderness areas that were created under the Act would inevitably change as suggested by the maxim that all wild areas revert to forest, a maxim well illustrated by the forests of New England in many of which one comes across the old stone walls of farms that were abandoned since the late 19th century. This is in a climate suitable for forests; in other places it may be deserts, a place where gardening is a challenge.
          Usually when we are in Maine in August we visit the Singing Meadow Preserve in Edgecomb, a truly favored spot. Although it is mowed once a year to keep the brush down and paths are mowed more than once, the landscape has been changing, subtly, but changing nevertheless. Alders are particularly resistant to the yearly mowing and I suspect that it's done by a landscaper "who has adopted" the Meadows that it is not done very well. And there certainly is no resemblance to the original working farm. But as an "abandoned meadows" preserve the "forever wild" doesn't apply as the meadows would no longer have the same singing birds and insects. And I wonder whether the "forever wild" concept didn't mean wild as it appeared when designated. If that includes saving the species that were there then at the time, the preservation becomes more like curating a museum.
          

         

politics (17) DC is getting nuttier

In  1925 Congress established The Federal Helium Program to stockpile helium in case of dirigible warfare. One would have thought that after the disaster of the Hindenburg in New Jersey in May of 1937, which effectively ended the "airship" program, while the regular aircraft industry was expanding, would also have reduced if not eliminated the US program. The Germans indeed redirected their effort and the airship materials to building up the Luftwaffe.  It is true that at the beginning of the German air campaign against London the English tried to protect the city with a ring of stationary balloons, the heavily laden German bombers being limited to low altitudes. But it did not work as the planes "jumped" over the balloons and within a short time higher altitude planes were developed to reduce losses to anti-aircraft artillery.

I am bringing this up because Congress voted, before going on recess on 4/27/13 to extend the program (which Repr. Barney Frank thought ended in 1996!), with only 1 vote against in the House. This when Republicans promote spending cuts and the idea that private enterprise can do a better job anyway, while the Democrats generally oppose the Republican spending cuts; but in this instance they all voted for a truly non-essential spending bill. In the total Federal budget the savings from letting the Helium program die would not save the Nation, but as a matter of principle it would have looked good if this near unanimity had produced ANY savings.

The helium bill came at the same time as the bipartisan vote to give the FAA the flexibility of deciding where to apply the sequester cuts instead of applying them across the board as required which had led to furloughing air controllers etc. thus creating delays at airports. As the politicians wanted to get home for their recess this vote would have been a no brainer if the members of Congress were in the habit of using their brains. Undoubtedly a similar vote will become expedient when it comes to the defense department. But why not to all government departments as a principle?

But some programs like Meals on Wheels, etc. probably have not much flexibility (but its recipients are among Romney's famous 47% and usually do not live in the gerrymandered districts of Rep. House members). It would be better to get rid of the sequester altogether, while maintaining the idea of savings. For example, all members of congress could reduce their staff by 1, committees could reduce their staff proportionally, etc. For one thing there is a lot of overlap between a congress member's staff and the staffs of the committees on which a member serves. And it would not just be a saving of salaries but also of the office expenses etc. the "work" of a staff member entails, much of which, I'm sure serves to show that the person is productive. But then, lest we forget, Congress exempted itself from the sequester. But would that not make the staff savings more symbolic of the congressional will to reduce public expenditures?

 Republicans used to say: Well, where is Obama's leadership? As if they would be led in Obama's direction. Media types blame him for failure to reach out and have turned this failure into a character defect. But Obama did reach out and mostly in vain in 2009 or, for example, playing golf with John Boehner. Someone suggested: "have a drink with Mitch McConnell." But why shouldn't the Senate Minority leader reach out? After all he is still the Minority leader after 4 years of trying to prevent Obama's re-election and of becoming the Majority leader. What happened to the famed southern graciouness and hospitality?  And why do columnists like Ms Dowd insist on blaming Obama for not reaching out. It's clear that O. can show the donkeys where the water is, but he can't maken them drink. Even when the Republican Senator Toomy proposes a compromise on "background checks he has to admit that it failed because some fellow Repuclicans woould not want it to look as if Obama had a victory, REGARDLESS OF THE 85% OF REPUBLICANS  NATIONWIDE ARE IN FAVOR
OF THESE CHECKS.

I hate to suggest it, but it maybe racism after all. In 2008, one could blame W. for the victory of a Democratic candidate, even if a black one (during the nationwide gun control debate someone said: Why should a Jewish big city major tell us wat to do). But no such excuse existed in 2012, unless the Reps must blame themselves for putting up the inept Romney. Would the antagonism to the president have been as strong it it had been Ms Clinton? After all there was a lot of antagonism to Mr. Clinton and even with all his "social" problems, the Republicans worked with him even while they were trying to impeach him. Nothing that Obama has put forward in the budget and debt ceiling debates is way off center, yet it nearly all gets rejected without real consideration. And that even in cases where  "private enterprise" has no ideological opposition.

politics(17) the NUTS in D.C.

Politicians' DOUBLESPEAK, even their use of hyperbole (that so easily become "facts" in sound bite quotations) was what used to raise my hackles. But recently it has been hard to come by as politicians no longer feel the need for restraint. Civil discourse in the exercise of their functions may be lost forever; in fact the news cast made a big deal out of the jovial exchange (about golf scores) between Vice President Biden and Speaker Boehner before Obama's speech to Congress on Sept. 8 as if it had been thought impossible.

Today, primarily because of the Tea Party, whose members have borrowed the vocabulary of lies and name calling by the likes of Glen Beck and Russ Limbaugh, with the avowed aim of being transparent and honest with the "American people that voted them into office," Republicans in the House of Representative bluntly tell lies on the floor as much as the Republican candidates on the Campaign trail. Transparent in a way, but honest? Never mind that they get on their high horse and get the choir on Fox TV to demand apologies and retractions when one of their critics adopts their own playbook. It used to be that violent speech, name calling and hyperbole were the preferred means of communication of extremists of the left, of which the radicals at World Trade Conferences have raised the strident tone. That was rejected by everyone in public office, including those who may have agreed with the objectives. This is no longer so as extremists on the right have adopted those tactics as became clear during the 2010 campaigns of Democrats who were verbally assaulted by opponents of Obama's Health care legislation and earlier by supporters of Senator McCain's bid for the presidency in 2008 who called Obama a Communist, a Muslim and a non-citizen. A Congressman remains uncensored (and receives millions in donations for his re-election) for having called the President a liar during the State of the Union Address, for he is entitled to "his" opinion although he may have broken the rules of decorum. Censuring is apparently reserved for financial and in particular for sexual improprieties, though for the latter voluntary or pressured resignation is preferred. My own reference to "nuts in D.C." may be justified by Rep. Cotter's (R-Mich.frequent Fox contributor) "Washington is nuts." And I include those who hope to go to Washington.

Sarah Palin may be the most egregious "misleader" but in her case I'm not reluctant to paraphrase one of Christ's Words from the Cross: "Forgive her for she doesn't know of what she speaks." I am far less forgiving of Michele Bachman, who, after all has a good education and especially because she once worked in President Carter's election campaign. Her fortunes seem to be slipping, but her rhetorical license has strengthened the conviction that the views of her Tea Party supporters are correct. Se is simply too quick in making unsupported statements as in the case of a girl that developed mental retardation after being injected against cervical cancer, which medical experts say must have been coincidental. But the Tea Party types do not read or hear the comments from humorists and moderate commentators that her candidacy provided them with numerous one-liners, though nothing as entertaining as Tina Fey's impersonations of Palin.

I want to single out Rick Perry, the newly announced Republican candidate for 2012, because he is the front runner in some polls and appears to have won over the obviously fickle Tea Party crowd. He is proud that large numbers of Texans have no health insurance and his first action as President will be to issue an executive order abolishing "Obama-care." He also prides himself on the jobs he created in Texas but these turn out to be mostly minimum pay jobs that do not get the workers out of the poverty class, nor do they get the normal social benefits. Really scary is the fact that he ran for Agriculture secretary denouncing a rule that farmers should remove their workers from the fields before they sprayed with insecticides. He insists on calling Social Security "unconstitutional," "a Ponzi scheme" (because it's paid for from worker's contributions and not from investment) and a "lie" (because it won't really be there when the workers retire).

I have not heard anyone explain what makes Social Security unconstitutional and Perry's argument appears to rely on the Federal Govt's assuming a "right" that belongs to each State. Considering the opposition to FDR's New Deal by some conservatives who brought suits against part of its programs, wouldn't they have brought a successful suit against Soc. Security? The one that was brought, Helvering vs Davis (1937) was argued on the basis of Congressional taxing powers and the Supreme Court upheld the law.

Ponzi schemes have deservedly gotten a bad reputation and they are set up as a scam, which is not true of Social Security. It relies exclusively on payroll deductions. In the 1970s its independent status was ended and its accumulated funds used to, temporarily, reduce the government's debt, the assumption being that the Govt would pay all its debts anyway; the Gov't, theoretically at least, ensured this by means of the Soc. Sec. Trust Fund that consists of bonds held by the Govt, in fact promissory notes. "Borrowing" the money from Social Security was one of Senator Moynihan's bright ideas and it was adopted by the Republican Administration to help pay for the unfunded Vietnam War. If Soc. Sec. is not going to be there, it is most likely because Republican presidential candidates and Representatives keep talking about "privatizing" it, a policy currently being advocated by Representative Ryan (whose proposed "budget" doesn't stop at privatizing Soc. Security).

One serious problem is caused by high unemployment which reduces Govt revenues. Another is the fact that soc. sec. taxes are levied on low salaries at the beginning of one's career and the retiree may not have paid in what is taken out, especially if retirement begins at 62. Because the Soc. Sec. Trust Fund is not invested in any growth portfolio but in government promissory notes it may seem that the contributions, if invested by the payee (i.e. "privatisation") might yield better returns. And with the increased lifespan of today's population it becomes evident that something has to be done to keep the system solvent, for example setting the age for drawing the first payment at 67 or 68 for the employed. In this context the statement "Younger workers pay for the retirement of the old, and that is not fair (Gov.Scott, R-Fl. on MSNBC, 9/29/11)," while accurate in fact is nevertheless misleading, for not only was the system set up that way from the beginning, but it ensures that those young workers will receive their social security when they retire, so that in reality their contributions will be returned to them.

"Privatizing" sounds appealing: 1) it removes the government from the life of its citizens and gives responsibility for one's decisions back to the citizen; 2)it avoids the necessity to raise taxes to pay for the increasingly inflationary cost of this program, and 3) there will be the, not publicly admitted, benefits that would accrue to the private sector (insurance companies, brokers, bankers, etc.) The assumption underlying the Republican privatization proposals is that citizens will be responsible savers of the deductions that are no longer taken out of their paycheck and wise investors. Wise investors have to rely on the same investment bankers that created the veritable Ponzi schemes of derivatives of mortgages that would have been retirement savings for the worker. But evidently the decision makers in Washington do not expect, and do not want, the worker to save any reduction of their taxes as they are enjoined to spent the country out of recession. And if workers no longer paid into social security, how would the Govt pay the current retirees?

"Wise investors" are probably only a virtual reality. Even the bright boys of Wallstreet didn't quite understand their own schemes, for at the time of the Bush Adm.'s bail out it was publicly admitted that Congress was not equipped to solve the problems on its own. Economists have coined the phrases "adverse selection" that results from "adverse information," which would not be needed in a honest world where the person with superior knowledge would not offer a choice to a less informed person by withholding his knowledge. One thinks immediately of the common warning "buyer beware" or phrases that cover what used to be called "horse trading" or quacksalvery. It has become abundantly clear in the aftermath of the financial debacle that the investor was merely not informed enough, but was fed incorrect information as a sales strategy. Any regular reader of the NYT Business section and in particular of Gretchen Morgenstern's Sunday column knows that whatever legislation was passed to rein in Wallstreet's abuses was imperfect, often failing to address the central problems and/or is poorly enforced.

During the Republican "Tea Party" debate on Sept. 12 (the day after the 10th commemoration of 9/11 with its calls for "unity") that anti-Obama rather than substantial policy proposals received the most applause from the selected Tea Party audience. A striking instance occurred when a hypothetical question was raised concerning a successful, healthy young man who had chosen not to have any health insurance who unexpectedly ends up in a coma. Ron Paul began to answer by approving the young man's decision as the American way's "freedom of choice" which caused him to be interrupted by enthusiastic and loud reactions and by the moderator who asked "would you let him die" which clearly shocked the audience, but some loudly yelled "yes."

Perhaps the most outstanding lie by Tea Party-wooing politicians and rightist commentators is the statement that millions of Americans pay no income tax at all. It is obvious that "income" hear excludes payroll taxes that all workers pay. And even the unemployed pay some taxes, e.g. each time they buy something the price of which includes not only the sales tax but also the taxes that are hidden in the product and paid for by its producers, transporters and other handlers. They also pay rent and that includes the property owner's taxes. The statement becomes still more of a lie when it is repeated in sound bites as "they pay no taxes at all." In elections the terms "adverse selection" and "adverse information" thus also play their role as the latter becomes the "coin of the [political] realm."

Tea Party members in the House and other Republicans have pledged not to raise taxes and Speaker Boehner thus continues to rule out any new taxes, including restoring some of the Bush tax cuts on the top income bracket. Obama's poposal to do so, is immediately rejected as "class warfare" though it is simply a demand for a fair contribution on incomes that had risen 23.5% since the late 70s (when they were still rising at nearly 9%). Instead, Republicans want all savings to come from "entitlement" programs. This stance makes all of them liars in fact, for if programs that are paid for in payroll withholding are reduced than the result is in effect a tax increase as the cost of the service is raised for each individual. The talk is about eliminating waste, which sounds good, but some politicians' idea of waste in health care may actually reduce the care.

Then there is the lie created by the victory of Republicans in 2010 who ran on the slogan "Where are the jobs?" They now have the majority in the House and could create jobs programs. Instead they are fixated on reductions in spending; they would make additional taxes ("You can't tax the job creators!) unnecessary and perhaps reduce taxes; this will put more money in the pockets of Americans which will allow them to buy more which will cause the economy to grow. So far, their reductions have not lowered taxes or created jobs. Instead they raise the cost of living of most individuals who relied on public programs and shifted the burden of such programs to the states and municipalities so that these have to raise taxes and/or decide on lay offs thereby adding to the jobless and thus reducing state, local and federal tax revenues. As these governments are large buyers of goods, their decling revenues reduces their buying, etc. etc.

healthcare (11) at last!!!

Like so many, I had become a sceptic and disgusted with the process of merchandising as well as with the manipulation of the legislative process in Congress, but at last there now is a law that establishes the principle of universal health care even if it does not yet achieve it in fact.

Unfortunately, this weekend was an ugly moment in US history as the venom of extremist right wingers was at work on the steps of the Capitol when thoroughly mislead "Tea-party" types behaved like illiterate, intolerant and intemperate hysterics. And these were not a few among mostly "'honest and upright, patriotic Americans,' driven to extremes by a bill the American people do not want," as one Republican Representative described them. What happened there was the fruit of incessant harassing by the likes of Glen Beck of a black President and the program that a majority had voted for. None of the Republican Members who were there with their placards made any attempt to stop them. Subsequently they even argued that the Dems had provoked the outrage as Nancy Pelosi walked arm in arm with John Lewis. And then they argue that there is no racism in this anti- aggression.

And then there was John McCain who announced in an interview "There will be no more cooperation this year." What cooperation? It's hard to believe that this handsome young man with whom I shared beers and cooked hamburgers a few times turned out such an embittered looser who seems totally oblivious to the fact that he is in the process of self-destruction. A son and grandson of admirals he could not surpass them as a result of his tragic imprisonment and not having become Commander in Chief, he's willing to become remembered as a failure, where at least he could have salvaged his reputation as a heroic prisoner of war. During the campaign he prided himself as the one with experience in "reaching across the aisle." But that was went he believed he would reach out to minority Democrats as the Republican President. Though at the end of the week he called for "civic discourse," which is nice, but doesn't civic discourse include being truthful?

healthcare (4)

Numerous have been the predictions that the "Obama" Health care Reform proposals are dead, but others, incl. the President keep saying that something will be achieved as there's 80% agreement on the bills currently debated. I am more pessimistic and have a strong impression that the current process in Congress and the "anti" lobbies and advertising campaigns engage in a whittling down strategy that will postpone the production of a meaningful reform until next year, an election year in which chances of Reform will diminish. THERE IS OF COURSE NO OBAMA-BILL, BUT ONLY AN OBAMA WISH LIST. There are 4 bills in the making in the House and 2 in the Senate; the 4 in the House have a "public option" provision, and one in the Senate does so. According to Senator Harkin, Chair of the Senate Health Committee it is therefore likely that the final bill to be sent to the President will include a "public option." Those who do not want that, but favor a mandatory individual insurance system, are talking about creating something like cooperatives that will lower premiums much like those for large employers. The indigent will be covered by Medicaid and low income groups would be subsidized. ANY STATEMENT OF ANY SPECIFICS OF WHAT IS ACTUALLY IN THE "OBAMA" BILL IS IN FACT NOTHING BUT A RED FLAG FLOATED BY SOME INTEREST GROUP OR IDEOLOGICAL PUNDIT TO GET PEOPLE UPSET ENOUGH TO DEMONSTRATE ETC., MUCH LIKE THE NONSENSE ABOUT "DEATH PANELS."

Meanwhile, since my last entry (Healthcare 3), a lot more water has gone over the dam and much useful information has become available. For example the English, including the Prime Minister and other officials. incl. the Leader of the Conservative Party, David Cameron, have spoken out against the distortion of their medical insurance and care by Republicans and other American opponents to Obama's Reform proposals. THUS THE ENGLISH DEPT OF HEALTH ISSUED AN E-MAIL TO NEWS MEDIAS WITH A 3 PAGE REBUTTAL OF AMERICAN "MISCONCEPTIONS," EACH FOLLOWED BY THE COMMENT "NOT TRUE." In the NYT's News in Review (8-19-09) Sarah Lyall, an American living in England describes her experiences and states that the National Health Service there is great at emergency and pediatric care. A cancer patient was assured of the same care and medicine as an American patient would receive and when she died at last, her family wasn't left with disastrous medical bills. And in spite of public criticism, American misrepresentations have created a Twitter reaction campaign called "We love the NHS." Among the defenders of NHS is Stephen Hawking, the very handicapped scientist, who has received its care since he was 6 years old. But many who can afford it have some supplemental private insurance which helps to speed up medical care or provide better facilities. In the NYT's Sunday Magazine of the same date Sara Paretsky, the mystery writer, relates her experiences in the French system. When on vacation her husband needed emergency care, the got to a small provincial hospital where she explained that the had no reciprocal insurance as is the case with European Union citizens. Her husband receive all the tests and was diagnosed with pneumonia, he receive antibiotics. When she offered to pay with her MasterCard the desk clerk said he would send a bill. This arrived 6 months later. For x-rays, EKG, 10 hours in emergency room, a doctor, a cardiologist, technicians, etc. that bill was for $ 220.

These personal testimonies are used by both sides in the debate and I just received a phone call from my daughter that adds another one showing problems with the current system. Her youngest son (7) broke his fore arm on the school playground. In the emergency room they put on a splint, told her to make an appointment with a doctor (one was recommended) to get a cast put on. She called the doctor's office, gave her insurance information and made an appointment. She had to take a day off from work. When she got to the office and had to give her insurance info, the secretary said this doctor did not accept her insurance (provided by the Am. Libr. Assoc.). She found another doctor who did accept the insurance but could not see him until 3 weeks later; another doctor could see her 3 days later and she made the appointment (for which she has to take off one more day). So much for the doctor of one's choice or the readily available care.

The NYT also has a "Prescriptions" blog with relevant news items. One of these, printed in the 9/13 paper gives a comparison with some statistics of the French and US health systems. It cites the fact that the World Health Organization ranked the French system as overall the best in the world in 2000. A more recent study affirms this, noting also that the French have the lowest rate of avoidable deaths, while the US was last, in 19th place. (One conservative pundit said the US would do better if you took out all the deaths caused by road accidents or while hunting). The US also has very high rates of "avoidable hospitalizations," i.e. for routinely controllable conditions like asthma, diabetes or bacterial pneumonia that do not require hospitalization. The French system enrolls the entire resident population and like Medicare or Social Security is paid for by compulsory payroll taxes. Doctors work predominantly in private office based and fee for service practices and there's a mix of public and private hospitals. The stats show that the French life expectancy is 3 years more, infant mortality is 4/1000 (US 7/1000), Health spending is 11% (US 15%) of GDP., the percentage of private costs is 20 (US 54) and there are 34 doctors per 1000 inhabitants as opposed to the 26/1000 in the US. The latter figure is revealing as a rebuttal of Obama's opponents who argue that his reforms will cause a decline in doctors.

John Tierney, one of the contributors to the NYT writes articles and maintains a blog at the Times (NYTimes.com/Tierneylab) which regularly summarizes work that questions scientific research supporting for example alarmist environmental developments. On 9-22 he wrote about the findings of 2 (medical) demographers, Samuel H. Preston and Jessica Y. Ho, at the Un. of Pennsylvania that Tierney read as a better than average report card for actual health care (including for the uninsured) in the US in comparison with other industrialized nations. For instance, once you reach the age of 80 you are likely to live longer in the US and life expectancy in general is greater here after one has survived middle age. Americans apparently get ill and die in greater numbers in the US than in the other countries. The fact that one lives longer than average once passed the dangerous age bracket has always seemed to me an axiom of historical demography: even in the dark middle ages there were lots of people who lived to be twice the age of average mortality and some still longer. This situation improved during the so-called "age of discovery" (which increased Europe's food supply as well as healthier foods, but - alas - also tobacco) and the emergence of societies in which wealth and power were no longer based on land ownership but on the production and distribution of manufactured goods which raised the standard of living of more and more people). What remains, after all statistical correlations, including the greater reduction in smoking in the US) have been taken into account, is the question of why middle age is more dangerous here than in other advanced countries. For, even with the better report card the US moves up from the bottom to only the upper half of comparable nations.

In a new book (T.R.Reid. The Healing of America. A Global Quest for Better, Cheaper and Fairer Health Care. Penguin, $25,95), a journalist for the Washington Post uses his chronic (and real) shoulder ailment to investigate the systems in the several countries, including Japan and India) to contrast them with that in the US. In addition to relating his experiences, he also focuses on a careful examination of the philosophic and political history of the different systems. REID THUS ADDRESSES AN ISSUE THAT IS MUCH OVERLOOKED IN THE AMERICAN DEBATE, NAMELY THE DIFFERENCE BETWEEN THE cost OF HEALTH CARE AND ITS quality (which if payment is not an issue, may indeed be - as is often claimed - among the best in the world). He found a variety of systems with the Japanese (and that of some European countries) being most like that of the US, EXCEPT that the private insurers are NON-PROFIT and paid for with payroll deductions, the pay private doctors and hospitals. The M.D. who reviewed the book in the NYT of 9-15-09 draws unfavorable comparisons that indite the US system. Reid's Colorado orthopedist recommended a replacement costing his insurer thousands with unknown co-payments. In India he ends up in a [Y]Ayurvedic hospital (i.e. based on ancient Hindu religious prescriptions) which is private and cost him $42.85 per night. The treatment consisted of meditation, massage, rice and lentils and, he writes, led to "obvious improvement in my frozen joint." In his discussion Reid also notes that one reason for Americans not wanting to adapt for example the Canadian or other model is their insistence on being independent [as if such adaptation shows a weakness]. Reid answers questions of his book's readers on nytimes.com/health.

Considering the recommendations of Reid's Oklahoma orthopedist and the oft cited costly practice of "defensive medicine," i.e. doctors prescribing tests not only for preventive care (e.g. blood tests as part of regular check ups or to confirm their diagnosis, but rather to avoid malpractice suits or just to make sure that their medical group's expensive diagnostic equipment gets its uses, I am reminded of the fact that when I still worked and had dental insurance, one dentist talked about implants and other expensive procedures. I never had those and now that I no longer have dental insurance, only necessary maintenance (3x/year) appears enough. Admittedly, after all those years with the same dentists I receive excellent care.

Meanwhile the Kaiser Family Foundation reported on 9/15/09 that the average cost of employer/employee insurance has doubled from 1999 to 2009 to $13,000 (op from 5,800), while employee expenses have also gone up to $3,515 on average in addition to higher co-pays and annual deductibles. Most of these increases occurred between 2000 and 2006 (though the smaller percentages for the last three years may be somewhat misleading as a smaller % on a higher premium may translate into more money than it seems). Of the 13,000 the average employer pays 9,800, an amount that is paid for by all consumers in the price of the services or products they buy from that employer/company; presumable an individual consumer has some choice of not buying (but not the consumer in aggregate and if the services or products were not bought, the employer goes out of business).

Some of the current opposition is based on the question of who will be paying for whom (illegal immigrants are the big bugaboo). All the emloyed people pay for the care of the poor though Medicaid and all employed people pay into the Medicare fund according to their income. (One problem is caused by the voluntarily underemployed: they do not contribute to Social Security or Medicare (or to the wellbeing of society), but they will eventually get the benefits. This is still a serious issue in the Netherlands with its generous social service laws). In any of the established insurance systems, be they Medicare or private, all of the members pay the cost of any member's care. Thus I paid into Medicare (and even now a contribution is withheld from my social security payments each month) and the College continues to pay for my supplemental private insurance (which is actually in lieu of salary). I do not anywhere near use the prescription costs that most 78-year olds use and my insurance, including my personal contributions, thus contributes to the cost of the medicine of others. One of these is a Harvard economics professor who wrote that he takes one statin pill a day at an estimated cost (including pharmaceutical research etc.) of $150.000 for an estimated additional year of life. Whatever Harvard provides in medical insurance and whatever the Professor pays for a supplemental clearly doesn't pay for his statin (and, a cynic might add - having taken note of the social usefulness of economics as a science for the common good - may be his additional year isn't a good exchange). The issue here is not whether he should get his medicine, but whether this expensive statin is necessary. What would the physician, if he were an old-fashioned caring type, prescribe instead if the Professor had no insurance or a less generous one?

Additionally several articles, for example the cover reportage in Time (8-31-09) on "The Real Cost of Food" or the N.Y.T.'s lengthy reportage on infractions and poor enforcement of the 1972 Clean Water Act (9-13-09, followed by a second one on 10-13-09 that reports on coal burning plants reducing their air pollution by dumping some chimney residues into local rivers!) make it clear that health care would be cheaper if the cause for many illnesses were eliminated. At least 2 factors may work against this solution. In the case of food, people may not heed the warnings because newspapers etc., have been crying wolf too often and where the fault lies with the production of foods, the consumer is likely to feel powerless against the "powerful." This last factor also plays a role in the lack of enforcement of the Clean Water Act, which although a Federal law is dependent on local enforcement and local courts in the sense that enforcers are under pressure by local interests, e.g. a federal prosecutor may be afraid to lose his job if a local Representative or Senator needs local votes. (One thinks of former Senator Pete Dominici from New Mexico who put pressure on the Federal prosecutor to bring voter fraud cases against Democrats just before the election of 2006 and then had him fired when he refused). The water pollution article is especially alarming as it shows a photo of the damage done to a child's dentures by certain chemicals in the ground water in West Virginia. These instances bring to mind the old saying about "an ounce of prevention", in particular if one thinks of the costs that will be borne by the taxpayer for enforcement and clean up of the pollution or the illnesses resulting from food related illnesses (E.coli, salmonella) or obesity (diabetes).

I have mentioned the problem of E.coli in an earlier blog on hygiene in the fields. But another of those horrifying tales, a front page article in the 10-4-09 NYT, about the suffering caused by greed must be mentioned here. It relates the suffering of a young woman who, in 2007, was infected with the severe strain of E.coli from eating a grilled hamburger that had been frozen; her nervous system was affected and she can no longer walk. The article goes on to discuss the origin of the products that go into a hamburger. It turns out that slaughter houses do some testing but "few grinders test ingredients, citing costs and and the fear of recalls."(italics provided) The woman was one of 940 people that were sickened and the company, Cargill, recalled 844,812 pounds of ground beef. The components (various types of scraps) of this beef came from 4 different processing plants in three different states and Uruguay. Two of these plants had earlier been found to have failed USDA or other inspections. After the recall, a spate of inspections showed that 55% of plants did not follow their own safety protocols. In a reaction to this article, the president of the American Meat Institute wrote a letter to the NYT (10/7/09) in which he stated that the incident of E.coli now occurs at a rate of less than one half of one percent, having declined 45% since 2000. This raises questions in my mind: 1) did the decline occur mostly after 2007; 2) does it mean that there's still 55% left; 3) one percent of what?

On the radio this morning a correspondent was interviewing the president of a fancy "longevity" resort on Turnberry Isle in Florida that aims at improving health by way of stringent dietary requirements, among which fruit and vegetables are dominant, in order to reduce high blood pressure and obesity related illnesses. Here I am reminded of the 1970s food revolution in France that introduced the nouvelle cuisine with one chef creating a cuisine minceur (a reducing diet of a 3-star cuisine) in a resort in Eugenie-les-Bains (SW France). For those who can afford it.
In my own daily living I have also adopted a regime of no smoking (without withdrawal problems), normally 5 meatless (and mostly organic) days (restricting red meat in particular) and when birding selecting usually a large salad for lunch with 2 glasses of wine rather than beer.
We use, almost always, only extra virgin (Italian) olive oil and very rarely (saltless) butter and cubed bacon (fat removed afterwards) only when making a stew.

At home I have on average less than 2 glasses of wine per day with the main meal and on days that I have no wine I may have a shot of Calvados. Instead of breakfast I have a large glass of orange juice (with pulp) and otherwise I drink a small can of tomato juice and San Pellegrino. I try to avoid having two meals a day. I must admit that vegetarian meals leave me with an unsatisfied feeling at the end of the day. My doctor finds my vital organs in good shape, probably because until my retirement and especially before coming to America in 1957 (at 27). As a kid my daily routine consisted of walking to school (4x 15 minutes in primary school and 2x45 to secondary school), bicycling to work (2x30+ minutes/day, depending on the always present Dutch winds). And at school there were twice weekly calisthenics as well as, voluntary, school sports; I was on the soccer and handball (a sort of soccer played with the hands). In addition there were long bicycling trips on the weekend or hikes in the dunes. As a teenager I had also a series of kayaks and spent days (incl schooldays!) exploring nature in the fields in our canal-rich region. As a merchant mariner (approx. for 1 1/2 year spread over 5 years) I played soccer whenever we were in a port with another ship that could produce a team and during a 7 month period in France I played soccer (all Dutch players are assumed to be good!) as a semi-professional in a small town. I was provided odd jobs (gardener, goatherd and what have you) by sponsors of the team and we got some pay whenever we did not loose. It was an often harrowing experience. In my early years, as a result of the Great Depression of 1930/31 and because of a long tradition of thrift our family had meat only 2x and fish 1x per week, while during the German occupation (1940-45) there might not be any meat and all food quantities were gradually severely limited (which gave the name "hungerwinter" to 1944/5). Underweight when I arrived in the US in November 1957, I rapidly gained too much weight, mostly as a result of ice cream and fast food. It could have been worse but for the fact that, living in the city of Philadelphia, I walked everywhere and hiked whenever out in nature. From 1983 to 1999, when I lived on campus I walked everywhere, climbed stairs to my classes (and toilet on the 2nd floor of my house). Though gradually adopting a less physical way of living, I have maintained the same weight ever since 1960, even when after my knee replacement in 2000 (at 70) and other muscle problems I have become more sedentary. Maintaining our hilly 2 acres and (organic) gardening helps.

heathcare (3)

The N.Y.T.s of 6/14, 6/21, 6/23, 6/28 and in between contained several articles on healthcare as well as on factors that affect our health, such as Kristof''s columns (6/21) on industrial agriculture (with nostalgic description of the 0rganic food grown by his farmer parents in Oregon) and (6/28) on endocrine disruptors that are a probable cause for malformation in frogs and fishes as well as in human sexual organs. The argument that modern diets are responsible for such health problems as obesity, diabetes and clogged arteries is an old one, as is the increased cost of these conditions in terms of medical care and lost productivity (not to speak of the suffering of affected individuals and the burden borne by their relatives).

Relevant to the dietary aspects of health is David Kessler's recent The End of Overeating: Taking Control of the Insatiable American Appetite (Rodale Press), which deals with an examination of the food industries successful attempts at creating a combination of fats, sugars and salt that tap into the brain's reward system creating a desire for more. While serving in the Clinton Administration, Dr. Kessler took on the tobacco industry in a drawn out battle during which it emerged that the tobacco companies actually created cigarettes with ingredients that made them addictive and in order to avoid the US' Food and Drug Administration the grew the experimental tobacco in Brazil.

The reluctance of the executives of the food and chemical industries to be active in changing their products as soon as evidence of their negative impact becomes available (or in disregarding/suppressing negative test results in reports to the FDA) is also well documented. The latest case in point is the subject of an article by Morgenstern (6/28) about the producers of Zicam whose first reaction, apart from their denials that have become the automatic commonplace of anybody questioned (no doubt the result of early childhood training by moralistic parents and teachers - in my childhood symbolised by the question "Let me see your forehead" in reference to Cain having been marked by God when he was caught in a lie about the whereabouts of his brother Abel), was to sue the whistleblower who went out of business because of the legal cost of his defense. The offending Zicam was taken of the market after the FDA took action.

Articles in the Business Section of June 14 discussed the overuse of medical care, including the prescribing of too many tests (to protect the physician against malpractice suits for negligence or to help defray the cost of the high tech equipment that every medical group feels it needs - rather than use that already available in the area) received but sparse reaction from healthcare givers. One of these pointed out that it is often the patient who, subject to the pervasive advertising by pharmaceutical and medical equipment industries (and hospitals), insist on the doctor's prescribing new medicines and tests. Doctors may give in because instead of having time to discuss the matter with the patient they know that there are patients waiting not only in the waiting room but in their other consulting rooms. Of course when the doctor is part of a for profit medical system (incl. hospital, labs, etc. referred to in the White House as the McAllen, Tex. syndrome) prescribing hospital stays and test increases the bottom line AND the prescribing physician's share; in case of the elderly the costs are reimbursed by Medicare (i.e. the taxpayer).

One M.D. wrote in a letter to the editor, that physicians see so many patients to pay their bills, afford "college for their children and enjoy the lifestyle rewards of decades of education." There is some remedy for these expenses and not simply by suggesting that teaching Ph.D.s (of which I was one) paid for my own education (by working part time - and full time during the last for years) as well as the private school education of my two children, etc. True, we didn't have (a) luxury car(s) and never lived in the equivalent of a McMansion or belonged to a private golf course etc., but we were not homeless, vacationed in a rental cottage in Maine, went to the theatre in NYC, bought books, drank good wine, i.e. not a life of poverty. There are also the examples of European nations where education is generally free so that the graduates do not have a burden of debt nor the cost of their kids tuition, etc. In addition in Europe there is less of a gap between highest income careers and those of educated professionals so that the "lifestyle rewards" are less subject to inflated expectations.

The B.B.C. World News America had three reports on the Healthcare debate on July 6-8. One of these was on the McAllen, Tx. extravagances and the last one on the system in the Netherlands where two years ago the government decided to institute a moderate free market approach to healthcare, giving a greater role to private insurers (with contributions from those who can afford them (the employed, etc.). One item that caught my attention was the fact that the Netherlands is among the nations that spend much on healthcare for each citizen but only half of what the USA spends and that while in the Netherlands everyone is covered. Another fact emerged from an interview with an M.D. in General Practice who said that she and her colleagues tried to treat their patients without immediate recourse to hospitals and high tech labs, what came across as an anti-McAllen approach. And it is not that Dutch MDs lack in "Lifestyle rewards" but rather, it appears to me, that they lack the prevailing American attitude of "let's get when the getting is good," that parallels pretty much the malpractice indemnities that jack up their own malpractice insurance. [Addendum: In an interview in the NYT (Nov. 11-10-09, p. D5) the Dutch Minister of Health describes the health care system that is being changed to give people yet more choice of improving care that uses transparent "quality indicators" based on electronic records without a "fee for services" system.] Of course, some Dutch doctors are not above committing frauds and I remember that as far back as the 1950s - when I was still there - several individual physicians in two small towns near us submitted false claims; it was a public scandal not in the least because of the high regard in which educated people were then held - they were among the "notables."

On Sunday June 21 '09, the Front Page of the NYT began two healthcare articles, one on an odd case of malpractice, the other on a poll showing widespread national popular support for a greater government role in providing health insurance.

The malpractice case concerned a pysician in the Philadelphia Verterans Hospital who implanted radiactive seeds to attack prostrate cancer. In too many instances these seeds landed not in the prostrate, in one case most of the seeds landed in the bladder of a patient and in a second implant quite a few ended up in the same patient's rectum. The surprising thing is that investigating regulators allowed the physicians to rewrite his surgical plan. It turned out that the entire cancer unit at the hospital was involved in botching 92 of 116 treatments. The entire report makes you wonder, for not only were treating physicians repeatedly at fault but the control system failed as well.

The New York Times/C.B.S. News poll showed that 85% of respondents said that the health care system needed to be fundamentally changed and that 72% backed public health care, including even 50% of Republican respondents. Of those making less than $ 50,000, 65% were willing to pay more taxes and of those with more income 52% percent did so. Fifty percent believed that the government would provide better coverage and 59% that it could do a better job at keeping costs down. All this while there was an awareness that the quality of an individual respondent's care might get worse or that they might have to change doctors.

Apparently those statistics did not change the opposition of conservative members of the House or Senate and one wonders why they would so blatantly disregard public opinion. One reason is possible cynicism about the value of public opinion polls which, they well know, is influenced by advertisements, Presidential speeches, etc. Among those adds are those that warn against the Obama health plan with scare tactics about loss of choice of doctor and decision making federal bureaucrats. But as the poll shows, these scare tactics have some effect, but not on the majority of respondents. A more important reason for continued opposition by conservatives is the American selection system that is based on well defined election units rather than, as in some European countries, on nationwide party lists. It is a given of the American system that incumbents are difficult to defeat in an election, especially in a midterm election (e.g. 2010) when the majority party is likely to loose some seats, which in this case would strengthen the opponents. After all, each member of Congress represents some of the American people all of the time and the American people as a whole only some of the time and that mostly during elelction campaigns.

irreconcilable loyalties (2): the Dutch national character

A Dutch friend lent me a collection of historical essays written by a grandfather, his son and his grandson (Jan Blokker, et al). The thesis of this collection is that the "national character traits, defined by historians from the 19th century on, are not supported by the events they describe in Nederland in twaalf moorden (The Netherlands in Twelve Murders). Amsterdam 2008.

Although each of the writers has some academic training in history, they write like journalists, or rather op-ed editorialists; they also have arranged the essays, each dealing with one or more murders in a non-chronological and, as I see it, random manner. The character traits they are particularly examining are those given by Johan Huizinga (d. 1945), the wellknown author of The Waning of the Middle Ages as well as several important essays, one of which seeks to define the origins of a "sense of belonging together" (an icipient nationalism) which he sees emerging during the Burgundian era (15th and 16th centuries) to be strengthened for the provinces that became the modern Netherlands in the so-called Eighty Years War of independence against Spain (1568-1648). Huizinga enumerated the salient Dutch character traits in the 1934 (when the country was a relatively closed society in a pre-electronic age) as a variation of those defined by his predecessors. The Blokkers single out the "relatively small inclination to national pride" and if one felt pride it was a private emotion. The Blokkers recall that at the beginning of the 21st century, as a result of the enlarged European Union, the replacement of the guilder with the Euro and the influx of Muslim immigrants, the Dutch are experiencing a sense of loss of identity. This led to a search of what was actually lost which came to a head after the murder of Theo van Gogh by a radical Islamist (a Moroccan with Dutch nationality) in 2004. Then the authors return to Huizinga who thought of the Dutch as "unheroic, bourgeois and modest, but with a high regard for the rights and opinions of others and individually they tended to resist social and political extremism and rejected illusions and rhetoric." (p.11).

As I read Huizinga's discussion, these characteristics apply primarily to the Dutch of the 19th and 20th centuries and as one of Huizinga's successors H.A. Enno van Gelder, made abundantly clear if one were to project them back into Dutch history beginning in the 16th century, they would appear as exceptions or tentative beginnings. In fact 19th century historians cite the bourgeois desire of a comfortable, self satisfied existence as a negative in contrast to the heroic and enterprising nature of our 17th century ancestors that created the "Age of Gold" and in my high school (conservative and Calvinist) the decline of Dutch heroic enterprise was the result of the wealthy regent class avoiding risks, beginning in the early 18th century after the grandiose foreign policies of William III of Orange (who had become King of England). A corollary of my education was that the Dutch were the linear heirs of God's chosen people. None of this appears important to the Blokkers whose "murders" demonstrate the absence of tolerance and the existence of extremism in the Dutch past.

The essays are well researched, easy to read and even the ones that went over familiar ground kept me interested; quite a few dealt with unfamiliar events so that I finished the collection in two days.

I have two major problems: 1) The authors' goal to disprove Huizinga slants their presentation; 2) they include "murders" that occurred before there was a Dutch nation.

1) Here I would question their use of the word murder to describe all the violent deaths they discuss. The standard Dutch dictionary defines murder a "killing with malice aforethought, to which Webster ads "unlawfully." A case in point is the death of Count William II which occurred in battle. It may be true that, having gone through the ice, harnessed and all, he was fairly defenseless and his enemies could have taken him prisoner and held him for ransom, but the undisciplined and non-aristocratic band of Frisians that did away with him, apparently not having recognized him (not even identified him by his armor) did not fight according to the rules of chivalry that in the 13th century might have been applied. A more historically appropriate term would be "he was slain."

Still more absurd is the authors' inclusion of the "Virgin of Yde," one of the so-called (pre-historic) "bog people," people whose bodies were well preserved by the airless and acid soils in which they were deposited. The Blokkers admit that she was killed long before there was a civilized Netherlands language and that we can hardly be certain of the "why" of her death. But they describe her people as " nearly non-human" and "as merciless as Jack the Ripper, brute as the Afghan executioner who strangles an unfaithful woman." Such comparisons may excite the empathy of the reader but, as I see it, are a-historical. They also write that scholars generally agree that these "bog people" were ritual offers. Thus, once more, the girl's death hardly qualifies as a murder in the modern sense.

The Blokkers are on more solid ground in their selection of the execution of a group Catholics from the town of Gorcum by Protestant privateers in 1572. It could be argued, as has been done by 19th century historians, that these privateers were led by a non-Dutch nobleman, etc. As pirates they generally acted unlawfully in any case. Certainly they were guilty of an extremism (religious if not political) that Huizinga excluded from the Dutch character. Obviously they acted
with malice and their execution of these Catholics can be seen as a parallel to the still more horrid battle in 1997 between the fans of two soccer teams that is the subject of another essay. Or can it? The 1572 pirates lived in an era in which the cruelties in war or the execution of heretics, witches (and criminals) were hard to justify in peoples brought up with the words of Christ (I sometimes got the impression that the Blokkers are more critical of Christians than of Huizinga). My teachers did not approve of the mores of those days in the history of what became our country. A similar lesson was drawn from Voltaire's Candide in which, it was pointed out, one of the few positive characters is a certain Dutchman, Martin the peace loving Mennonite. The soccer hooligans may not have been brought up by the same words any more, but they were certainly brought up in a law abiding modern democracy and their behavior is a conscious choice of deviance, but even they were appalled that a death resulted from their action. A better parallel with 1572 is the lynching by a mob of the brothers Jan and Cornelis de Witt, leading statesmen in the Dutch Republic, about a hunderd years later. (The composition and style of the 17th century painting of the martyrdom of the Catholics is obviously based on the Deposition of Christ by Rembrandt). I doubt that lynchmob can be called extremist but they certainly exhibited uncontrolled histeria in which one action led the next one. My high school history teacher used this lynching as an example of the dangers of ignorance fed by rabble rousers (or demagogues). Class consciousness was a by(?)product of our education and I always, automatically, assumed that Huizinga's essay referred to Dutch citizens with a thorough formal eduction in the humanities or to those who aspired to that and acquired it as autodidacts rather than to the Dutch people as a whole.

2) A propos the ritual death of the "Virgin of Yde, the authors ask whether we should be ashamed of this un-Netherlandish behavior which they answer in the negative citing as a justification a biblical text from Ezekiel 18 that sons do not have to pay for the sins of the father. I am tempted to use this citation as an instance of their cavalier use of sources, after all the Bible frequently says the opposite as when the sins of the father are visited upon the children of the seventh generation, etc. In any case, the choice of her sacrifice, which is one of many that also occurred in what are now Denmark, Germany, etc. has nothing to do with these later nations, even if the Blokkers suggest that such behavior must somehow have left traces in successive people and thus in us. It seems an odd argument, as if people are passive victims of a (not even their own) past.

Other questions also arise, such as "How Dutch were those Frisians who had successfully resisted the Counts of Holland in the attempts to annex their mostly island (the campaigns were in winter) region.?" Or even "How Dutch was William himself?" He was a descendant of the nobility of the western Low Countries, but two generations after him the Counts of Holland were no longer from Holland and soon they were Bavarian, then Burgundian and then Austrian. So un-Dutch were his successors that in 1477 one of them had to grant the "Dutch" the Great Privilege, which among other rights stipulated that the counties of Holland and Zealand had to be administered by native officials according to the regional laws.

If they not purposely picked a fight with Huizinga's 1934 essay, the Blokkers were led astray by their confusion of tolerance (incl. freedom of thought and speech) of "the other" with national identity, for as the historical works of Huizinga make abundantly clear, the Dutch nation emerged in opposition to the otherness of foreigners with different languages, legal systems and religion. And to cite Voltaire, one must always be intolerant of intolerance.

Healthcare (2)

The first week of June doesn't appear too propitious for HEALTHCARE (actually health INSURANCE) in spite of Obama's having leading Senators at the White House on Monday. In an interview with Andrea Mitchell, Sen Ch. Grassley who seems a nice enough Midwestern, expressed his strong opposition to a public option, for, a.o. arguments, "rural doctors would not be fully reimbursed" and thus rural people will not have access to care. He also said there is already a public option, namely Medicare. It reminds me of the argument made a decade ago by Pennsylvania doctors who wanted the State to limit the cost of Malpractice insurance, for otherwise doctors would be leaving the State. The failed, but none that I use (and were active in these attempts) have left. Rural areas would perhaps get more Asian etc. physicians, as was the case in Phoenixville and Norristown in the 1980s (I haven't seen any for at least a decade).

But already today, rural areas in the Midwest etc., have problems of access, even if one has private insurance. It's a question of distance. We had a very nice birding trip in East-Central Montana last year and found that several small towns had no doctor and none had a hospital or a clinic. And one had to drive for an hour or more on lonely roads between those small towns, roads that had turn outs designated for putting on or removing snow chains. When we were in Alaska, the owner of the cottages had to take his wife to nearest hospital (Anchorage) a 2 1/2 hr drive one-way under normal conditions. It helps explain why the R.V. camps in Texas, Arizona and Florida have a preponderance of winter guests from northern rural areas.

The other piece of bad news was the announcement by the FDA that they may be less secretive and even open some of their files. The Pharm. industry maintains that the secrecy is necessary to protect their formulae. This could be a valid argument but one that would not apply to medical devices, for, once on the market, devices can be easily imitated (of course drugs can be analysed by competitors as well).

A NYT editorial of June 3, refers to an article on the subject (June 2) that revealed a "widely prescribed" heartburn drug was toxic to babies, that a diabetes an painkiller increased the risks of heart attacks and that antidepressants increased suicidal thoughts (a fact admitted by drug companies in their inserts distributed with the drugs and referred to in my earlier blog). The Editorial suggests that the agency has been more cautious in hiding information than required by law or its own previous practices.

This brings me to a full page ad in the same June 3 NYT, for Toprol-XL. Replete with medial and pharmacological terminology (all of it unknown to me and some of which I could not find in my dictionaries), it begins with "For full Prescribing information see package insert." It's indicated for the treatment of hypertension and may be used alone or in combination with other hypertension drugs. Then there follows a list of "contraindications," "warnings," "precautions" in general and for specific conditions or side effects. The latter are based on animal studies and are followed by the statement (relating to pregnancies): "There are no adequate and well-controlled studies of pregnant women. Because animal reproduction studies are not always predictive of human response this drug should be used during pregnancy only if clearly needed." What troubles me is that this statement is included in the paragraph on Pregnancy Category C, but would apply equally to all pregnancies.

Apart from Contraindications and Precautions there are warnings listed under the rubric Dosage and Administration which is followed by an extensive description of Adverse reaction, which refers back to Contraindications, Warnings and Precautions while giving a bit more precise information. Here we get to the misleading use of percentages. Three side effects of the drug occurred in 1.8, 1.5 and 1.4% of patients each 2x or 3x than in those given a placebo (was this control group told what side-effects to expect or do they occur in patients with hypertension at the same diminished rate already?) At the end there's one more rubric "Dosage and Administration." All this is followed on the next page by another ad suggesting you talk to your doctor to see if you can take Toprol-XL, a once-daily drug rather than its twice-daily generic equivalent with the advice to see "adjacent page for a brief summary of the full Prescribing Information. . ." (A brief summary of the full . . .information?). Then there's Spiriva that may help you breathe easier, but one of its possible side-effects is a narrowing of the airways making breathing MORE difficult. A similar drug, Advair, has similar side-effects plus it can increase the risk of getting pneumonia, weaken the immune system, increase blood pressure, etc. and then there is, as always, the statement that there may be other side-effects about which you should ask your healthcare provider or pharmacist.

Addendum: June 7. Today's NYT has further news on the Admin's wishes and a Mag. article on the Congressional insiders who are going to decide to what extent they will go along. There's also an editorial on the various problems, yet is still opting for a sort of Medicare extension to cover the currently uninsured; McCain favored taxing employer contributions during the campaign, an idea that's generally nixed.

Addendum: 11-15. The NYT has a long editorial on the cost of the Reforms if the House Bill were combined with the Senate Fin. Comm. (Baucus) Bill; also suggesting ways to address these costs. Very thoughtful it appears to me. And there's a long article by the Representative who proposed the "death panels" (so called) and the falshoods spread for the sake of partisan advantage.

healthcare (1)

Since the collapse of GM and Chrysler an d, of course as a result of the Obama campaign, "healthcare for all" and especially its allegedly high cost has been much in the news. Now that the O. Admin. has made its budget public and a "down payment" on its cost is proposed to be funded by revoking the tax relief on the very rich, opposition voices (mostly Republican) are becoming louder than ever. The parts of the Obama plan are gradually revealed, and what is known is not very encouraging as it is an extension of the hodgepodge already practiced for those who have insurance, i.e. employers are still the ones to provide the insurance which is in the hands of private insurance companies. Govt subsidies will be available and for the poor a govt system will be created (an extension of Medicaid?).

From my Dutch perspective the problem with US healthcare was that there has not been a national system (except for the Medicaid and Medicare programs aimed at specific groups of the population). The prevailing view of healthcare is that it is a matter for individual citizens and where it is "collective" it has been achieved by the various Unions. A new start has been made with the Children's healthcare system.

Opponents to universal healthcare make use of several arguments, all of them either spurious or just plain false; they mainly center on 1) increases in taxation, 2) the inability to pick one's own physician as well as on 3) problems with the care provided in countries that do have a national system.

1) About 80% of US citizens have some form of health insurance, mostly through an arrangement with their employers. This is actually paid for by anyone who buys a product of that employer, for ex. an American-made car, or an education. Among this 80% are also govt employees of the many govt institutions, their insurance is paid for by their gov.t institution as in the case of Congress (with members paying a supplemental that annually amounts to 12-2400 dollars) or through their salaries that are financed from local, state and Federal taxes paid by all who have taxable income, incl. those who may themselves not have health insurance. Because govt employees form large pools (and insurers want to have the goodwill of the government), insurance premiums may be lower and benefits higher than that of smaller groups and certainly of individuals. The most popular Congressional plan is a Blue Cross/Shield Preferred Provider Org. at $152/ind. or $357/family per month. The providers are PREFERRED by Blue Cross/Shield, but coverage is near complete, for ex. for out- and in patient mental-health care (which appears not always effective or so I deduce when listening to C-Span or Fox).

It is clear that citizens with income may in fact pay for the healthcare of others several times over. My own insurance was paid for by my College; it covered all costs (for the last 10 years even up to $1,000/year for dental care). The College still covers my medical and prescription costs. The College also covers my (still working) partner's costs, but under a new program she has a co-pay arrangement and when she retires she'll have to find her own supplemental insurance (for which a small fund is being accumulated in her name by the College). For a long time the insurance was through a Blue Cross/Shield system (as mine still is) but hers is now through other companies that have been changed several times. I found an old statement detailing my salary and the cost of all benefits which then, on a salary of 68.000 came to an additional 18.000 for the College, all of which was paid for through tuition charges, annual giving, etc. I noticed that the State and the County are now taxing those benefits as salary and her W-2 shows a federal withholding salary and a higher one that includes the benefits for Local and State withholding purposes. Obviously some fiction is involved in this arrangement. The annual givers, etc. deduct the gifts from their taxes but much of these gifts is taxed in turn as faculty salaries etc. Also, when I began teaching, I paid 5% into a retirement program and so did the College. In competition for faculty the C. (like most others) began to pay the entire contribution as well as an ever better medical insurance. I pay a Medicare contribution that is withheld from my Soc. Sec. payments. Thus models for universal withholding programs exist.

In the recent debates surrounding the near collapse of the Detroit auto makers, the fact that the companies have to pay for all sort of benefits, incl. health care for the workers is always cited as one of the causes of GM and Chrysler's (near) collapse as these benefits raise the price of the cars. Cars made in other countries, where these benefits are provided by governments out of general revenue from several earmarked withholding programs, or Japanese cars made in the US that have no benefit costs built into their price, can thus be cheaper, etc. (Incidentally, when employers are facing financial problems they are apt to use their employee retirement and healthcare funds, which may therefore not be available for their purpose and employees may in fact become uninsured on retirement, etc. or, as seems likely, when the companies go into bankruptcy).

As to the argument that universal healthcare would require more taxes, these taxes may be offset to a great extent as employers no longer have to include the cost of health care for their employees in the price of their product and when the insurance is no longer provided by for profit private companies. One argument in favor of privatizing all sorts of things is that the govt will not be responsible for the cost of the retired employees. But employees of private companies will have to be paid enough so that they can retire with health benefits and thus the cost will remain and perhaps be higher as the private company raises the cost of doing business, etc.

The cost of health care could also be reduced by limits on reimbursement to care givers as is now already done by most insurers and is shown on the forms sent to the insured which includes the statement: your provider has agreed to accept this amount (or some such phrase). This is sort of like the outlawing of smoking, if it is forbidden in every bar, bar goers will not be able to go to a 'smoking permitted" competitor, etc.

But perhaps the best argument, selfish though it sounds, is the fact that the uninsured are very likely a risk to all who come in regular contact with them. Additionally the cost of lost production through illness that could have been prevented or shortened if all people were insured, is born by the entire citizenry. (There is a sort of disconnect between medical journalists and reality as in the case of differences in age when heart problems arise in blacks and white men. Treatment of high blood pressure in a twenty year old is advisable and "they should consult their doctor." This would be good advice if these young blacks were insured and therefore could afford to have regular check ups, rather than have to rely on emergency room situations.

BUT TO CALL WITHHOLDING FOR HEALTHCARE TAXATION IS A POLITICAL PLOY, FOR THE PAYMENT IS IN FACT THE PREMIUM THE CITIZEN WOULD OTHERWISE PAY TO AN INSURANCE COMPANY.

2) The choice of one's primary care physician in the USA isn't all that free, even in cities where there could be a choice. Most of the uninsured end up in emergency rooms (not always available as hospitals have abolished them to save costs) where the care is given by the first available physician (sometimes an intern). I ended up there several times and in spite of my excellent insurance, once had to wait 2 and 1/2 hours. My son who had an appendicitis had to wait until a surgeon could be located (one was found in a clubhouse on the golf course, the still very visible scar - after some 30 years - in the form of a "z" provoked the ire of several subsequent doctors. Even in non-emergency cases an insured patient may not be able to pick the physician, for supplementary insurers have lists ( a network) of approved doctors and in other cases pay only part of the charges. Moreover I found that some medical groups refuse to participate in an insurer's system because they consider the reimbursement fees too low. I found in discussion with my longstanding physician who charges the insurance about half of what my ear specialist does, that the fee-for-service, tends to inflate the fee if the insurer pays a percentage of the fee.

One morning when I had an appointment for an ear check up and later for a dental cleaning, I spent the time in the waiting room (I was early in both cases) going though the available mags. The Time of 3/16/09 had a lengthy Cover-story by its medical reporter entitled "So you think you're insured? (Think again.") about the misery experienced by her brother because of the insurance company's unwillingness to accept his medical expenses. And he had the benefit of his sister's expertise in finding the people who could go to bat for him. Actually that day (April 1) was a bad day for medical insurers as the NYT had a long exposee on insurers in New York State who employed retired doctors (ostensibly to root out fraudulent claims) to "examine" patients so that the insurer could routinely deny reimbursements.

While there, I also checked the fine print in drug adverts that Pharmaceutical Companies began to resort to "to fave an informed public" (and avoid legal action, just in case). Obviously, modern medicine has come a long way in helping patients since the thalomidide scandal, but it seems that (like "Wallstreet") they just don't get it. Drugs still have to be taken off the market and some of that fine print I read was very disturbing, not in the least as some of the side effects were introduced by phrases like "In a few cases. . ." or "3 in 100. . ." But 3 in 100 is the same as 3% of 1 million or 30,000, which is a staggering number. The possible side effect of an asthma remedy: "in rare cases the asthma may get worse." Anti-depressants may cause "suicidal thoughts."In each of these adverts the advice (as on the t.v. adds) is "tell your doctor" or "immediately alert your physician." Great advice if you can get hold of your doctor, most of them are protected from their patients by telephone systems that are confusing even to me and undoubtedly an obstacle course for any patient not speaking English (or Spanish). This reading reminded me of the fake sponsor of some of St. Colbert's segments: ". . . Prescott Pharmaceuticals. We have medicines for any illness caused by our previous medicines." (While I was there a second time I found the Consumer Reports of May 2009 which has an article on heath insurance policies for individuals, the fine print of which must be read, it is as disquieting as the fine print of pharmaceutical products).

Meanwhile pregnant women, or those that plan to get pregnant or who got pregnant or who are breastfeeding, are excluded from these (all of those I read about) pharmaceutical miracle cures.
One of the latter, used in studies of painkillers for post-delivery pain actually sounds like "oxymoron." Enough said.

3) Usually slick American politicians - like Mayor Giuliani who maintained he could not have had his prostrate operation in another country- cite English examples as their assistants probably know no other language. I don't know much about England, but my Dutch family, like me increasingly old and in need of frequent medical attention, have no complaints and all care is free (and the indigent cannot be refused). My late sister in law spent the last months of her life in a nursing home, and my brother followed her there about 2 years later. He was there, a paralytic, unable to speak etc. for three years and received excellent care. My sister, who lived in an assisted living apartment, was found one morning on the floor, unconscious. She was taken to a hospital and as nothing could be done she ended up in the same nursing home, where she died after 5 months. My remaining brother had a serious fall, received the required care and is still under supervision as an out-patient. My partner's French family also receives excellent care and also without cost or complaints about waiting periods. Her mother, in her eighties had several operations for different problems. She finally died of cancer. While she was at home a visiting nurse came to wash her, etc. and a household help, provided by the city government, came each morning (because of the family's income they paid 40% of her costs). It must be said that my partner's sister in law, herself a healthcare giver for the elderly (in a different district), tended to ride roughshot to smooth out bureaucratic problems which are endemic in France, regardless of which administrative department. During part of the treatment, the mother was in a private hospital or clinique (only part of the cost there was reimbursed by the universal health insurance, the rest was paid for by their private supplementary insurance), but the local hospital was better equipped and that's where she ended up (free of charge).

Each of these patients (Dutch or French) had their own doctor of long standing (who still do home calls!) and specialists were recommended on the basis of the physician's knowledge of his patients, their problems and his knowledge of the specialist. Like the private cliniques some specialists are in private practice and their charges are paid by the universal health system up to the amount approved, the remainder must be paid out of pocket unless the patient has an additional (private) health insurance. When I still worked in Holland everyone paid a health insurance contribution that was withheld from one's pay. In the 1930s my father paid into an insurance fund for the building trades and he did so for my brother who worked with him. In those days we had two M.D.'s in our village and each had consulting hours, where you might have to wait for an hour or so. The wife of our doctor was a pharmacist and dispensed most medicines after the consultation (there was less duplication in those simpler days). We never paid anything by way of co-pay. (I note that of the four sedans in the village, each of the physicians had one and their children, my contemporaries, went to university, which in those years was not free). Of my parents' generation every one lived into their eighties or longer, except an aunt who died of cancer and an uncle who drank. There was no distinction in quality as there were only 4 medical schools with very rigorous requirements (attendance at which - as at all institutions of higher education -is now virtually free). In her later years my own mother was in 3 different hospitals for her operations and post-operative care, according to available space, in Amsterdam, all easily reached by frequent public transportation (Holland is still a small country!)

Recently the Dutch government has come to favor "privatizing" using the "free market competition will lower prices" argument, but in fact as a way to reduce the civil-service payroll and pensions. At the moment, all citizens with income contribute 1,500 euro/year for health insurance; the insurers cannot refuse to provide insurance nor can hospitals refuse care. My youngest niece, a mid-level executive in one insurance company (that used to provide supplemental insurance for private care, etc.) thinks that this privatisation is a step in the wrong direction because in the health industry, competition means duplication and thus extra costs, i.e. rising prices. Already there is developing a certain - she calls it "soft directing" - by insurers of patients to specific physicians that she fears may lead to less freedom of choice. She's also convinced that the personal contribution will increase after the current "transition period" and the for profit insurance companies renegotiate prices with the government. This Dutch experiment is being studied by other Common Market countries.

Question: Didn't St. Paul say: "The love of money is the root of all evil"?

(my) money

In the aftermath of last Fall's banking bail-out (the TARP program) there's a good deal of frustration, not only because credit is still not made available or bailed out banks aren't out of the woods yet, but even more so because bankers apparently have not gotten the message that rewarding failure with bonuses etc. is bad public relations (and here read people/voters for "public"). Thus as there are calls to provide even more bail out $$$, e.g. by AIG, Citigroup as well as by G.M. and Chrysler, some people in high places, or with a lot of savvy, begin to suggest a take-over of the worst banks (which in fact is happening gradually with Citigroup and more overtly with Freddy and Fanny and AIG).

In a previous blog on Paulson's bail-out dreams, I wondered why the Secy of the Treasury should be a banker as bankers helped cause or aggravate the problems. Now we have T. Geithner; he is perhaps kept in line by P. Volcker and Larry Summer, but his insistence on a policy of restoring consumer spending is worrisome, for too much credit card debt was part of the problem (after all, subprime mortgages are consumer debt also). Let's hope he can be restrained, though the new billions for AIG make me still more sceptical. One aspect is especially bothersome, nl. that the govt is exchanging preferred stock that was to have a 10% return for stock that has hardly any. This may be to safeguard all the investments but it's backpedalling from all the grandstanding that the TARP moneys would be recouped from profits of the aided banks. And each time I read Gretchen Morgenstern, I find that there is that link to Goldman-Sachs.

Meanwhile little is done about the excesses of some banks who received TARP money and gave out huge amounts in bonuses in spite of the groundswell against that. One excuse apologists have made that such pay-outs are necessary to keep the "best and the brightest" from leaving the company. It's hard to believe that people that helped create a system of phony financial instruments, are the "best," however bright they may be. I would argue that they are not the "best" and their brightness makes their shortcomings in ethics (for ex.) even greater. But where would they go now that lay-offs are the order of the day. Are any financial institutions hiring? (Apparently some are: the NYT of 3-15-09 has reminiscences of former Bear-Stearn execs that are now in new exec. jobs elsewhere, but they were unemployed). I'm mindful of a colleague who went with a very good offer from another institution to the President of our College only to be told that he should take it. When I asked the President why, he said that having obtained the offer, my colleague either wanted to blackmail the College or he was willing to leave and thus he should follow his ambitions. But that was in the 70s when there were quite a few openings, even in the Humanities. In the case of financial wizards, the world is full with summa cum laude graduates from the most reputable universities, younger and probably more inventive and willing to start at a lower salary than any disgruntled un-bonused manager who'd leave.

In her latest NYT column (03-01-09), Morgenstern discusses the fact that in creating the phony (i.e. not backed by actual value, well, by a value of $ 1 for every 30 on paper) financial instruments, the best and the brightest also had a cavalier attitude to the rules of bookkeeping so that the docs of the original real estate loans were not always transferred as those instruments were traded and now a bank who wants to foreclose cannot show that it owns the mortgage or a sellers cannot sell a house because the bank the mortgage has been paid to is in a similar position. It's enough to make an old curmudgeon like myself disgusted enough to reread the French writer Proudhon who in the early 19th century defined "property" as "theft." This may be truer today than in his time, for if the best and the brightest make off with millions while my pension is reduced as a result of the financial collapse they helped create and then make off with part of my taxes thru TARP etc. they have in fact stole my money.

Jon Stewart, who's often funny and sometimes very intelligent, was much excerpted on various News Channels for his showing up the frailty of tv (CNBC) financial "analysts" who are in fact not much more than stooges for Wallstreet execs etc.

Also in the (bad) news is a new company formed by former executives of Countrywide, the experts in sub-prime mortgages, who our now buying up their own lousy creations for the proverbial "pennies on the dollar."

Question:

Would it help if students in business schools, etc. were required to read Louis Brandeis' (later Justice of the Supreme Court) Other Peoples' Money and analyze modern case studies that parallel his? And this in addition to a course with appropriate case studies in the ETHICS OF RISKING OTHER PEOPLE'S MONEY.

irreconcilable loyalties

In an old Law and Order a black attorney asks whether his is a black lawyer or a lawyer who happens to be black. In an other L&and O an Imam asks whether he is a Muslim first or an American First. Although they do not raise exactly the same question, both do question where their loyalties lie, the lawyer' to his minority community, the Imam to his possibly much larger community, although the case in question concerns only a small NYC part of that. The issue interests me, for the Imam's loyalties are to a religious community and religion transcends the social and political. Actually, I think both placed themselves in a false dilemma for although it often appears that there is one as the law is often applied differently for white Americans than for members of a minority. In the case involving the Imam, who is unwilling to testify about a member of his congregation, the same black attorney returns for the defense and in his peroration he actually argues that the accused is in the dock only because he is a Muslim.

If I were to extend that premise it seems that only if these minorities do not want to be integrated, they can argue that the laws of the US do not apply to them, in which case they have to create a legal system of their own (sharia law for example) AND not commit crimes, etc. against those who are not members of their minority, or a sort of new court would have to be created to deal with conflicts between the separate legal systems. That would be something like the office of praetor peregrinus in the Roman Republic, though the word peregrinus suggests these foreigners were not permanent citizens.

The perception that there is "one law for white Americans and another one for minorities" (which is perhaps an extension of "one for the rich and one for the poor") rests on the frequent real misuse of the law by prejudiced officials, beginning with the arresting officers. This misuse occurs at all levels of interaction and is not necessarily based on ethnic antagonisms, it is also present in the penal system where white collar crime results in so called "country club" prisons, though the crime may involve millions or, in the case of elected officials, the betrayal of the public trust.

However that may be, it seems to me that if one chooses to live in a country by choice as a born citizen who does not leave and especially as an immigrant, one must live according to the its laws. When I came to this country in 1957 from the Netherlands I was required to sign to a list of things, one of which a pledge not to overthrow the government by force. In England the question is being debated whether such Muslim laws as those concerning marriage can be recognized even if they are contrary to English law. Roman Catholics have similar issues, e.g. they can divorce under the secular law, but the Church does not accept such a divorce and neither of the couple can marry in a Catholic Church again until an annulment is obtained from the Church. These, I think, are not questions of loyalty but of obedience. In the Middle Ages when there was only one church it was held that obedience to God superseded obedience to any wordly authority (who were all expected to obey God's Word. This idea led during the Reformation of the 16th century to the question whether obedience to God justified a Protestants' disobedience to a Catholic ruler if this ruler forced them to go to mass which Protestants believed was contrary to their reading of God's Word and thus a sin. This eventually led to the (much expanded) political theory of legitimate resistance on which the Dutch fought their War of Independence, the English engaged in the Glorious Revolution, etc. In the process the useful theory of separation of Church and State became (gradually) accepted in the Western world, for in a nation with several religious organisations,  the prescriptions of which religion would govern the people? This question was debated during the presidential election in l960 because JFK was Roman Catholic.

This started me to think about the problem of loyalties in a wider context. When the sovereignty of nation states was established by the treaty of Westphalia in 1648, the Pope refused to recognize it; fortunately without much practical consequence (how many troops does the Pope have?) or the question would have arisen whether I could be Dutch and a Christian at the same time (neither is any longer of essential importance to me). Yet, the Imam's question on Law and Order raises the same issue by extension, namely if one has a state like Iran is there a dual loyalty, one to the President and his government and one to the council of clerics? To what extent do the clerics permit latitude of action to the secular government or to the people? There is no relationship between Osama bin Laden's anti-Western crusade (he's a Sunni) and the Taliban's political aims of a radical Islamic nation, other than their use of terrorism. It is the West that has joined them together from the shoulders down (e.g. Al Queda tried to use anti-American feelings apparently only in the Sunni areas of Iraq, but Bush et al. treated them and the Shia Sadr's followers alike as enemies in the war on terrorism) even though they apparently kill each other as well as Westerners.

May Questions suggests themselves:
If the law of the Koran with its many interpreters must have precedence over all other laws, rules and regulations can there be national states, some Sunni and others not, in the Muslim world?
or:
If the West "simply went away," would Sunni and Shia engage in a civil war like Protestants and Catholics did and some already seem to be engaged in?