Saturday, August 24, 2013

Problem #15: Post-Traumatic Stress Disorder

Problem #15: Post-Traumatic Stress Disorder

No, this essay won’t be about the near-epidemic of PTSD among returning veterans of the Iraq and Afghanistan wars. It’s a rather more personal story.

In 1994, after leaving a night class in genetics at the University of Pennsylvania, I was hit by two cars and killed. Well, not killed- at least, well, not permanently. As a friend of mine put it, I may have been dead, but it didn’t take. The two cars ran a red light at 33rd + Walnut Sts. in West Philadelphia- one was apparently trying to pass the other at the intersection- and hit me as I crossed the street to catch a bus to 30th St. Station. I suffered significant traumatic brain injury, was in a coma for about two weeks, and was hospitalised at the Hospital of the University of Pennsylvania and Bryn Mawr Rehab for about two months, all told.

The medical professionals involved in my care weren’t certain if, after recovery, I’d be myself, or a near-vegetable. It took ten years of hard work, but I’m myself again. Almost twenty years later, I’m a married father of two, a recently-minted Master of Science in Information Systems, a successful information technologies professional, and a member of Mensa. I have also come to accept that, whether I like it or not, I also suffer from post-traumatic stress disorder (PTSD). This is hardly a shock, given what happened. But I’d resisted accepting the diagnosis until very recently. I’ve been seeing a counsellor about my PTSD, and one of the things she suggested was that I write a letter- that I won’t send- to the people who hit me. I know who they are- I could easily find them. But I won’t, largely because I can see very little good coming out of said meeting. I am, however, writing this letter as if it were addressed to them.

Dear XX + XY (one driver was a man, and one a woman),

You may not recognise my name, but I hope you remember how we met. On December 7th, 1994, you both hit me with your cars at 33rd & Walnut Sts. in West Philadelphia and killed me. Fortunately- for me, at least- I didn’t stay dead. When you hit me, I was a post-baccalaureate pre-medical student at Penn- that means that I had a bachelor’s degree in something non-scientific, but wanted to attend medical school, so I was taking a concentrated year of science coursework to prepare me for the Medical College Acceptance Test. And I was doing exceedingly well- in A in all three courses, plus the two labs. Your mutual decision to run a red light and kill yourselves a Penn kid pretty much cut off the possibility of medical school for me.

It took me about ten years of hard work to get back to a point where I felt intellectually ready to go back into a pre-med course again and, by that point, it was too late. I was married, and wanted to start a family. I couldn’t, in good conscience, tell my wife that I wasn’t going to make any money for 10 more years, and that once I did make any, she’d never see me again. But, then again, I’m not sure if either of you are acquainted with your consciences.

Did it really help you to run the light? It seems from the evidence- admittedly sketchy, since I don’t recall anything from between noon on December 7th 1994 until somewhere between January 8th and 15th of 1995- that one of you- probably Mr. XY, since he was driving a Porsche- was passing the other in the intersection when you both hit me (something which is illegal under the Pennsylvania motor code, not that that’s ever enforced unless you’re drunk). Did that help? Were you late! late! for a very important date? Did you really want to kill someone- if so, congrats, but you didn’t finish the blasted job, did you?

I could go on into a revenge rant now, but I won’t. That wouldn’t solve anything, except to perhaps motivate one or both of you to put a restraining order on me (which would be fairly ironic, come to think of it). They say that the best revenge is living well, and I think I’ve done as much as I can do live well. I wasn’t able to get back into the pre-medical route and finish that, but I channeled my longtime interest in computers into a rewarding and lucrative career working with them. I also received my Master’s degree in information systems. Most importantly, I’ve been married for eleven years, and have two beautiful children. So, I’ve done fairly well for myself, all things considered.

But don’t think for a second that “no harm, no foul.” You killed me- and I do not forgive you for that. Maybe, just maybe, if you apologised to me and asked for my forgiveness, I’d grant it. But neither of you even did me the courtesy of calling the hospital after hitting me and asking how I was. Were you afraid of what you’d hear? Were you afraid that I was dead? Were you afraid that I wasn’t dead?

I hope- really hope- that neither of you ever suffers like you made me suffer. I hope that you feel some kind of remorse for what you did to me. But, somehow, I suspect that reading this letter will be the first time you’ve thought about that night since then. I’ve thought about it virtually every hour of every day since then. Nice job. But remember this: there is a G-d, and G-d is Just.

Friday, August 23, 2013

Problem #14: Our Broken Politics

Problem #14: Our Broken Politics

It hardly takes a close observation of US politics today to see that things are badly, badly broken. I’m not even talking about the corrupting influence of money on things- although that surely plays a part. The more pervasive, insidious part is deeper still. First, some background.

The US Constitutional system, with its checks and balances, and small state-big state arrangement, was explicitly designed to require all sides to work together. The Founding Fathers, especially, hated political parties, as best expressed by Madison’s warnings about “faction” in his Federalist #10. The goal should be for all parties to work together for the benefit of the republic. The minority- especially in the Senate, with its very anti-majoritarian design- almost always has a say on legislation. This is in marked contrast with parliamentary systems, where the majority party- except in a coalition government- can effectively tell the minority party to get bent, and frequently does. In the US, effective government requires the majority to work with the minority, and also for the minority to accept defeat and work with the majority.

There’s the idea of the “loyal opposition.” This means that, while you may not agree with the other side, they’re not evil. Democrat or Republican, we all love our country, and want to work for its betterment. So, we work together towards this common goal. The second you determine that the other side doesn’t consist of people who also love our country, but who are actually evil, then you can’t possibly work with then- you don’t compromise with evil, you destroy it. Anyone who questions that this is the current way of things in US politics should pay better attention.

We need a new birth of, if not love, at least respect and common decency in our politics. Or else, we can’t help but fail to fix them and move forward.

Falling behind, I know...

Yes, I know, it's the 17th of Elul, & I haven't even posted a 14th problem yet. Life continues to be very busy - I was at work until after midnight this past Tuesday, and will put in quite a few more hours than usual this week. But I am bound and determined to make 1 post per day for the month, even if they don't appear on a quite daily basis. As I told a friend, I will do this, even if it means that some of the essays are rather shorter than others.

Coming later today: a post on our broken politics, and what the a Founding Fathers might have to see about it.

Wednesday, August 21, 2013

Problem #13: Popular Music

Problem #13: Popular Music

OK, I’m not trying to say that pop music is a problem. Or, really, that I even have a problem with today’s pop music. I get it: I’m not a kid, and pop music has always been made by adults performing for teenagers. And, unlike Baby Boomers, I don’t consider myself to be an postdated teenager. Speaking of the Boomers, note that even their favourite musicians were typically not, themselves, Boomers- most were actually War Babies (born between roughly 1939 and 1945). That number includes all 4 Beatles, Bob Dylan, every Rolling Stone save Ronnie Wood, Jimi Hendrix, Janis Joplin… the ends are listless, so to say.

But the mention of the Rolling Stones leads me to a good point: they’re on their 50th anniversary tour. That means that, 50 years after they debuted as 20-something kids in England, they’re still acquiring new fans. Yes, lots of the fans shelling out mega dollars to see them are as old as they are- but not all of them. And that raises a simple point: almost 60 years after blues and jazz mutated into rhythm & blues and then rock and roll, rock’s still around, and popular. From a perspective of popular music, that’s a ridiculously long run. To put it in context, the idea that, today, rock music is popular among teenagers is comparable to people in the 1950s queueing up to buy the latest Scott Joplin rag. Or, in the context of classical music, 50 years takes you from the symphonies of Haydn to Berlioz’ Symphonie Fantastique, or from Brahms’ 1st Symphony to Schoenberg’s Transfigured Night.

I attribute rock’s popularity, not so much to the music itself, as to the fact that, unlike the musical forms I mention above, rock came of age when sound recording and broadcasting was already established, and being improved. Again, for context, compare a recording from the early 20th century to one from the 1950s, then compare one from the 1950s to one from today. The difference between the early 20th century and the 1950s will be shocking, but you’ll no doubt find the one from the 1950s to be perfectly acceptable. And, if you seek out a remastered classical recording from the 1950s, you may find its sound comparable to a recording made this year. Look, especially, for a digital remastering of a Mercury “Living Presence” CD- they are astoundingly good.

Owing to the presence of recording, and rebroadcasting, peoples’ musical tastes have stabilised in a way that they clearly never did before. You can go to a bar in Europe, and hear much the same kind of music you hear in the US- the language will be different, but the music will strike you as being very similar. Had music not been broadcast internationally, there’s little chance of such consistency across space and time.

What could be done to restore musical diversity? It’s simple, really: get an instrument, and start playing. If enough people do that, eventually, someone will come up with something different from 4:4 time, 3 chords, and a cloud of dust. Of course, I write this as a guitarist whose skill level doesn’t really allow me to play much more than that...

Tuesday, August 20, 2013

Madness takes its toll, please have exact change

Yes, ladies and gentlemen, my life continues to be insanely busy. No chance to post any problems today: as a matter of fact, it's almost 9 PM, and I'm still at work. I'll try to post an essay or two tomorrow, provided it's not as bonkers as today.

Monday, August 19, 2013

Problem #12: US Health Insurance Reform

Problem #12: US Health Insurance Reform

Lest anyone think that the Patient Protection and Affordable Care Act- aka ObamaCare- is the final answer to health care reform in the US, I would strongly beg to differ. There's a central problem to the US health care system: it's a for-profit system.

This should not be interpreted as meaning that all for-profit systems are wrong; far from it. To paraphrase Winston Churchill, capitalism is the worst economic system... except for all the other ones. From a very, very cynical perspective, here's how capitalism works for society:

  • Mr. X decides that he wants to make money (and, yes, this could be Mrs. X or Ms. X, etc.).
  • Mr. X decides that a good way to make money is by making and selling widgets. Popular things, widgets, even if nobody actually knows that they are.
  • While Mr. X can make a little money by making and selling his own widgets, he decides that he could make still more money by getting other people to make them for him. Therefore, he hires employees to make more widgets. He also invests in a factory in which to make the widgets.
  • In order to attract good widget makers, Mr. X has to pay them decently. He also decides to give his widget makers fringe benefits, such as health insurance coverage.
  • In the end, society as a whole benefits from high-quality widgets, whatever they are, plus you have people who are paid to make them. 

All good, right? Unfortunately, this whole system boils down to one motivation: Mr. X wants to make money. If he decided that it would be more profitable to burn down the factory and collect insurance money, well, he'd have a strong financial motive to do so. That's the main problem with the profit motive: profit drives out all other motivations. In this case- and in most cases- the side effects of the creation of profit are good for society. Unfortunately, when you apply this to health care, you wind up with a health care system in which healthy people are a side effect. You may be braver than I, but the idea of a health care system where health people aren't the intended goal scares me. To take it to an extreme, if a for-profit health insurance company were to decide that it could make more money by simply allowing all of its customers to die- or even to kill them- then it would have a fiduciary duty to do so. Not good.

Leaving all this aside, there's a more practical problem with a for-profit health care system: it doesn't work. Ever since the mid 1960s, the US has actually had 3 parallel health care systems running at once: single-payer (Medicare), socialised (the Veterans' Administration, where all providers are paid by the VA), and for-profit. And the results are in: the for-profit system is far and away the worst of the three. It's the most expensive, and provides the worst results (15.7% of Americans uninsured1, despite spending 17.6% of our GDP on health care).

The PPACA chooses to bend the cost curve by forcing all Americans to either receive coverage through their employer or on their own (the Individual Mandate). Despite the round condemnation of this plan coming from the Republican Party, the PPACA strongly resembles one promoted by the arch-conservative Heritage Foundation as an alternative to the Clinton health plan in the early 1990s3, as well as the MassCare plan passed by former Massachusetts Governor Mitt Romney4.

Unfortunately, this was the result of President Obama, whatever his personal motivations, being a miserable negotiator. The second he proposed as his opening bid RomneyCare + a public option- effectively Medicare into which you could buy5- that guaranteed that it wouldn’t be the end result of negotiations. As anyone who’s ever bought a house, or car, will agree, your opening offer isn’t what you expect to pay- it’s what you’d dream of paying. You offer 75% of what the seller wants- then you negotiate, and meet in the middle.

In this case, President Obama should have opened bidding with Medicare for All. This would have had 3 main effects: it would have thrilled his liberal supporters, it would have been the most economically defensible solution (Medicare’s overhead is as low as 5%, compared to private insurers, who often have 25%+ administrative costs- due in part to profit-taking6), and it would have guaranteed that the final result of negotiations would be a lot more progressive than RomneyCare without a public option.

Fortunately, the current state of the PPACA is no more the final state of health care reform than Social Security was a finished product in 19357. Just as Social Security was expanded to include cost of living increases, with changes in retirement age, it can be expected that changes to the US health insurance system haven’t finished either.

Endnotes:

1. "Income, Poverty, and Health Insurance Coverage in the United States: 2009." U.S. Census Bureau. p. 22. Issued September 2010.

Sunday, August 18, 2013

Coming soon: Problem #12!

It's the 12th of Elul, and that means that I need to post a 12th solution to a problem. Fear not- said post will come soon! I invite people to suggest problems for me to solve, though... c'mon, challenge me. :)

-Z