Tuesday, August 15, 2017

Hiroshima and Nagasaki 2017

The Weekly Bystander is still on its August break so here is a post from 2015 about the bombing of Hiroshima and Nagasaki that brought an end to World War II. It is sadly relevant given the current heightened threat of a nuclear disaster.

This August marks the seventieth anniversary of the end of World War II after the dropping of the Atomic Bomb on the Japanese cities of Hiroshima and Nagasaki. Commentators are still debating the legitimacy of the decision to drop the bombs but no one questions the horrible devastation that was visited on the population of the two cities.

Thankfully over the last seventy years , despite the Cold War, Korea, Vietnam and the apparently unending conflicts in the Middle East, the world has avoided another nuclear catastrophe. Nevertheless, despite a shrinkage of the large nuclear arsenals of the USA and Russia, other nations have joined the list of those possessing nuclear weapons.

I do not want to comment on the Hiroshima/Nagasaki decision. Others, more informed than I, have long debated the pros and cons. Nor do I want to discuss the pending deal with Iran since no one as yet has anywhere near the information that the President and his advisors have.

PBS recently ran a documentary on the bombing of Hiroshima. In the re-creation a lone B-29 bomber is seen flying over Hiroshima, and in the next minute almost 100000 people are killed, maimed, or disfigured for life. They were people like us. Oddly enough, it made me think of Beethoven’s great symphony #9 with its magnificent choral ending, the Ode to Joy, based on the poem by Schiller.

The notes on my album claimed that Beethoven had considered putting the ode to Joy and Brotherhood to music for over twenty years.
We are all familiar with the opening strains in German.
Freude, schoner Gotterfunken.Tochter aus Elysium.Wir betreten, feuertrunken,Himmlische, dein Heiligthum.

Here is a full English translation of the text from this greatest of symphonies. It culminates in an affirmation of the brotherhood of man under one Creator.

Joy, thou gleaming spark divine,
Daughter of Elysium.
Drunk with ardor, we draw near,
Goddess, to your shrine.
Thy magic unites again
What custom sternly drew apart.
All mankind become brothers
Beneath thy gentle hovering wing.

He whose happy fortune grants him
Friend to have and friend to be.
Who has won a noble woman,
Let him join in our rejoicing!
Yes—even if it were one heart only
Beating for him in the world!
But if he has never known this,
Let him weeping steal from out our ranks.

Joy is drawn by every creature
From the breast of Nature.
All men good and all men evil
Walk upon her rose strewn path.
Kisses gave she and the ripe grape,
A good friend, trusty to the last.
Even the worm can feel pleasure,
And the Seraph stands before God.

Glad as suns that He hurtles
Through the vast spaces of heaven.
Pursue your pathway, brothers.
Be joyful as a hero in victory.
Millions, be you embraced!
For the universe, this kiss!
Brothers—above the canopy of stars
A loving Father surely dwells.
Millions, do you fall upon your knees?
Do you sense the Creator, world?
Seek him above the canopy of stars!
Surely He dwells above the stars.
Click here for a five minute flashmob doing the end of the chorale or just go to the video below.

Tuesday, August 8, 2017

Health Care Mortality Rates

The  Weekly Bystander is taking a break for the rest of August. For the rest of the month I will repeat some of the most popular posts since the blog began back in December, 2011.  Below here is one from 2013 that compared the U.S. Health Care system with that of the rest of the world by examining mortality rates, a standard measuring tool. The figures and the WHO chart might be a little dated but even after four more years of Obamacare, I think the conclusions in the post are still valid. Even before Obamacare, the U.S. Health Care system was working remarkably well. Click on the chart to enlarge.

Despite the fact that the United States spends more money per capita on health care than any other country in the world, many critics argue that health care in this country is inferior to what can be found in many other developed countries, especially those with National health systems. These critics are also proponents of a sweeping conversion of health care in this country to a single-payer or national system. 

Critics of the U.S. health care system point to statistics compiled by the World Health Organization (WHO) that rank the United States thirtieth in the world in life expectancy. The accompanying chart shows that in 2007 the average life expectancy in the United States was 78.06 years. Actually, that was not too far behind #1 France with an average life expectancy of 80.59. (click on the chart to enlarge)

I recently came across an excellent article* that attempted to put this statistic in perspective. The article was based on a book by Scott W. Atlas, entitled “In Excellent Health, Setting the Record Straight on America’s Health Care”, that argued that the U.S. health care system before Obamacare was “ the best system in the world.”

How could this be given the mortality statistics? Atlas argued that the WHO statistics were skewed by a number of factors, and that they should be taken with the proverbial grain of salt. The most important element in the low ranking of the U.S. mortality rate would appear to have no connection with health care at all. It is the extraordinarily high rate of murder and automobile accidents in the U. S.
“Murder and accidents account for the majority of deaths among young adults in the United States, and deaths at young ages substantially impact life expectancies.”
If murders and auto fatalities alone were factored out of the statistics, the U.S. would have the highest life expectancy in the world. Murders and automobile fatalities are serious but they are not a health care problem.

Other factors are almost as important in lowering life expectancy. The United States has a much higher rate of obesity than other developed countries and obesity reduces life spans by up to eight or ten years. Also, while smoking has dramatically decreased in the U. S., the residual effects of a long history of smoking in this country will continue to impact mortality statistics for years to come.

Finally, differences in record keeping also impact mortality statistics. Scott Atlas noted the more stringent reporting requirements in the U.S. compared to Europe in the matter of infant mortality figures.
“considering that roughly half of all U.S. infant mortality occurs in the first twenty four hours, the single criterion of omitting deaths within the first twenty four hours by many European nations generates their falsely superior infant mortality rates.”
Rather than blaming the U.S. for higher infant mortality rates, Atlas argued that, 
“The United States health care system should be applauded for its efforts to save premature babies rather than write them off as stillborn, as many other countries do.”

A proper evaluation of the health care system in the U.S. should be based not on flawed mortality statistics but on actual medical care, especially the diagnosis and treatment of important diseases. Here are some facts that Atlas unearthed.

1. Prolonged wait times are commonly found in health systems with government controlled nationalized health insurance. Numerous countries with single payer systems had to create policies to address prolonged wait times, including Canada, England, Italy, Sweden, and Spain.

[I saw this myself  when I visited my cousins in Italy a few years ago. They had purchased individual insurance policies to pay for things or procedures not covered by the national system. For example, government doctors would routinely say that you could wait four months for a procedure, or visit them in their private office for the procedure in the next day or two if they would pay on their own, The above chart indicates that over 90% of people in Italy have purchased private insurance policies.]

2. In the United States, referring doctors book CT and MRI appointments within days. In other countries people wait. In 2010, the average wait time for a CT scan was 4 weeks and for an MRI 10 weeks. A 2011 study in the United Kingdom indicated thousands of people waited over six weeks for an MRI scan. With respect to breast cancer biopsies, another survey indicated that only 1% of U.S. patients waited three weeks or more while 44% of Canadian and 20% of U.K. patients waited that long.

3. No elective cardiac bypass patients in the United States were known to have waited more than three months, while 47% in Canada and 89% in the United Kingdom waited that long.

4. The United States tends to have the highest percentage of screenings for breast, cervical, prostate and colon cancer.

In conclusion, the availability of state of the art medical technology, timely access to specialists, the most effective screening, the shortest wait times for life changing surgeries, the newest, most effective drugs for more accurate, safer diagnosis and for the most advanced treatment are all superior in the United States.

In 2008 one study showed that up to 85000 patients sought in-patient treatment outside their home country, and 87% of them traveled to the United States. 


*The article was written by Charles P. McQuaid, President and Chief Executive Officer of Columbia Wanger Asset Management. and appeared in the 2013 semiannual report of the Wanger International Fund. It was based on the book by Scott Adams mentioned above, as well as a book by Robert Ohsfeldt and John Schneider, "The Business of Health."

Wednesday, August 2, 2017

Connecticut: Democracy or Aristocracy

This week the Connecticut State Senate narrowly approved a package of labor concessions that had been negotiated by Governor Dannell Malloy in a last ditch effort to close the State’s enormous budget deficit. The whole process should be examined as a lesson in how democracy really works in Connecticut, the State that used to brag that it was the first colony to govern under a written constitution.

Connecticut is one of the bluest states in the country and the legislature has been dominated by Democrats for years. This year, however, while the House of Representatives is still largely Democrat, the State Senate is split equally between Democrats and Republicans 19 to 19. For almost a year the Governor and the Legislature have been struggling to close an enormous budget deficit but although the State constitution requires that the budget be balanced, they were not able to come up with a solution. Somehow, it was possible to ignore the State’s constitution and let the Governor govern by executive order.  

As a result, the Governor called the Legislature back into session and presented them with the public service union “concession” package that had been negotiated behind closed doors by his staff. Details of the package were not shared with the people of the state or with their representatives until the various unions involved approved them. In other words, the union members got a chance to review and vote on the package while the people of the state were kept in the dark.

Apparently the various bargaining units approved the “concessions” by a margin of over 80%, a sure sign that their leaders realized that it was a very good deal despite the so-called concessions. Although Governor Malloy is not running for re-election in 2018, he has effectively tied the hands of his successor with a five year, no layoff agreement. Moreover, the deal extends the union contracts for a full ten years. Control of the public service unions has been effectively taken out of the hands of the legislature for the next ten years.

In return, the unions agreed on temporary wage freezes, some furlough or no-pay days, and slightly higher pension contributions. The union members were not required to accept any fundamental changes to their very generous pension plan. They did, however, agree to throw new union members or public service employees under the bus by creating a defined contribution plan for them. After years of railing about the horrors of defined contribution plans, the current union membership overwhelmingly accepted them for new state employees, as long as they could keep their own privileged defined benefit plan.

This defined benefit pension plan is the elephant in the room that no Democrat politician wants to see or touch. The vast majority of Connecticut’s citizens who must pay for the pensions of their so-called public servants do not have retirement benefits even close to those enjoyed by the State’s union employees. The Social Security benefit of ordinary citizens is based on their average pay over 30 years, not on the average of their highest three years pay. Moreover, an ordinary citizen cannot get the full Social Security benefit until age 67. State employees get a fill pension at age 60 or after 35 years of service.

Union leaders often argue that pensions need to be generous since their members do not participate in Social Security. However, the mere mention that they switch from the Connecticut system to Social Security is enough to send them into shock. Does anyone ever realize that ordinary citizens pay for the pensions of State employees but that these same employees do not pay a dime into the Social Security system?

So, if the Governor can negotiate behind closed doors and keep the legislature in the dark, can this really be called a democracy? If the Governor must go hat in hand to the unions and beg for concessions, who is really in charge? Does the Governor ever submit his proposals to the people for their approval? When he threatens to cut services does he seek anyone’s approval? When he threatened to force the towns to pay for State employee pensions, did he ask the towns to approve the plan?

Actually, Connecticut is more an aristocracy than a democracy. The aristocracy are those members of the public service unions who enjoy benefits that are out of reach of most ordinary citizens.  These aristocrats do not have titles of nobility but they have become the ruling class. The newly approved concessions package guarantees that they cannot lose their jobs or their benefits for the foreseeable future. In retirement many of them will even be able to move to Florida to escape paying State income tax on their pensions.

The Social Studies curriculum in Connecticut’s schools should be changed to indicate that the government of Connecticut is an aristocracy; a government by the privileged few and for the privileged few. The unit could include a comparison with France on the eve of its Revolution. Governor Malloy is planning to leave office before the full impact of his concessions will hit his successor. He could easily be likened to the French King who supposedly said, “Après moi, le deluge!”***


***Click on this link for a witty portrayal of pension aristocrats or just view  the video below.

Monday, July 24, 2017

Marriage Vows

I know it is common for couples today to compose their own wedding vows. When my wife and I married 54 years ago, we never thought of writing our own vows. In our innocence we accepted the traditional words. In turn we said:

I take you for my lawful wife, to have and to hold, from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, until death do us part.

I take you for my lawful husband, to have and to hold, from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, until death do us part.

That was all we said. I then placed a ring on my bride’s finger “as a sign of our marriage vows.” Although it was followed by a Mass, the actual wedding was a brief ceremony taking no more than five minutes. I still have the little wedding pamphlet from that day, and I notice that the priest did not even say, “I now pronounce you man and wife.” It was our brief vows that made us man and wife.

The pamphlet included an introduction that provided the basis for the simple vows. Reading it today I can honestly say that I was not aware at the time of the awesome significance of the words.  I realize now that the words represented an ideal that would not be easy to attain.

This union then is most serious, because it will bind you together for life in a relationship so close and so intimate, that it will profoundly influence your whole future. That future, with its hopes and disappointments, its successes, and its failures, its pleasures and its pains, its joys and its sorrows, is hidden from your eyes. You know that these elements are mingled in every life, and are to be expected in your own. And so, not knowing what is before you, you take each other for better or for worse, for richer or for poorer, in sickness and in health, until death.

Truly, then, these words are most serious. It is a beautiful tribute to your undoubted faith in each other, that, recognizing their full import, you are nevertheless so willing and ready to pronounce them. And because these words involve such solemn obligations, it is most fitting that you rest the security of your wedded life upon the great principle of self-sacrifice. And so you begin your married life by the voluntary and complete surrender of your individual lives in the interest of that deeper and wider life which you are to have in common. Henceforth you belong entirely to each other; you will be one in mind, one in heart, and one in affections. And whatever sacrifices you may be required to make to preserve this common life, always make them generously. Sacrifice is usually difficult and irksome. Only love can make it easy; and perfect love can make it a joy. We are willing to give in proportion as we love.

No greater blessing can come to your married life than pure conjugal love, loyal and true to the end. May, then, this love with which you join your hands and hearts today, never fail, but grow deeper and stronger as the years go on.

I doubt that I read those words back then, or even that I would have understood their full significance if I had read them. It would take a lifetime.

Best wishes to my grandson Michael and his fiancée Christine who will be exchanging vows this coming weekend. 

Maybe the best depiction of the exchange of vows can be found in the final scene of the award winning 1946 film, The Best Years of Our Lives. It ends with the simple wedding ceremony of a sailor who after losing both his hands in the war, returned home to find that his childhood sweetheart was still in love with him. Click on this link for the brief video.