Thoughts

The best of times

Isn’t it interesting how timeless and true good writing proves itself, even in our modern age, and even though it was originally intended for a different literary context?

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way…

“A Tale of Two Cities” by Charles Dickens, 1859

We are indeed living in the best times of current recorded history and because every coin has a flip side, there are surely plenty of things to complain about. Yet I thought I’d point out some of the good things in this post.

Out of all our known and written history, I don’t believe we’ve ever had a time like this, when most of the world is enjoying a period of “not war” and when the options available to us in areas such as healthcare, living conditions, hygiene, infrastructure, learning, jobs, possessions, transport, personal freedoms and just about everything else you can think about are so many and so readily available. Yes, some of these options can get expensive, but they are there and they are available, whereas most of them simply did not exist in the past.

We get so caught up in our daily, mundane routines and our various disappointments that we allow to blacken our lives, that we forget we have it so good. I’d like to invite you to find and watch documentaries and TV series that portray our various periods of history with accuracy; there are quite a few these days. I’d like you to become acquainted with how people lived and how hard it was to simply get through a day and have some food to put on the table, much less be able to afford a few knick-knacks here and there.

Most people have never been able to afford what we call a proper home and have lived in sheds, hovels and small cottages for most of history. Most houses were a one-room affair in the past. The toilet was a pot under the bed or a communal outdoor hole in the ground. Chamber pots would be thrown into the street every morning. Think about taking a walk in those cities! Even in civilized cities, right up to the 1960s-70s, people would have to share a common bathroom or bathrooms in apartment buildings or subdivided houses. And now we’ve gotten to the point where we mind sharing a bathroom with our guests and we complain if our house has less than 3-4 rooms.

The capability to take a daily shower under hot running water, with a pleasant soap and shampoo, has been unheard of in all our recorded history, until recent times. And yet people still find excuses when it comes to maintaining proper daily hygiene and complain about water hardness and water pressure and soap quality, etc.

Dental care is so important. Without it, most of us would be toothless by our 40s and those who’d still have teeth would have some rather nasty decoloration and build-up on them. Should we be part of the majority of the population without teeth, we’d have to wear dentures made of wood or animal teeth, or of metals such as lead, dentures that wouldn’t fit properly and cause us daily pain. We now have access to orthodontics, fillings that match the color and hardness of our teeth and are almost invisible, crowns, implants and now stem cell implants, which can regenerate our own teeth! This was never available in the past. We’ve had to struggle with primitive tooth care for so long.

Of all healthcare options available, I would single out trauma surgery as the most important development. Nowadays we have the option of receiving triage and trauma care that allows us to fully heal without infection, including proper bone and joint surgery and for most of known history, we simply didn’t have this. Broken arms stayed broken. Torn joints stayed torn. Cuts and flesh wounds often got infected and led to death. Yes, healthcare is terribly expensive. Yes, good basic healthcare should be a right, not a privilege. But look at the bright side: it exists! How governments choose to make it available to their citizens is an open and ongoing discussion instead of a “No, we’ve never heard of that, it doesn’t even exist” kind of discussion.

How easy is it to learn things nowadays? Access to information is virtually free, and more resources (historical and modern) have become available online than we’ll ever have time to read, and yet I’m hard pressed to come across than a few learned, thoughtful individuals during the course of a day and sometimes even a week; (perhaps that’s also due to the way our educational systems are structured.) Various apps on our mobile devices compete to make learning as fun as possible for us. Universities and colleges post videos from their courses for free online access. For most of history, people didn’t know how to read or write. They were thirsty for learning but it was out of their reach. It was simply too expensive or just not an option for them. Trade secrets, for example, were closely guarded and only revealed to tradespeople in secrecy, after long apprenticeships. Now everyone can watch how-to videos and learn how to do something, but how many follow through and actually do those things or even more, persist at them until they get good? Most of us tend to confuse reading or watching the news with learning. Opening up our minds and pouring in the news isn’t learning, it’s just a deluge of unhelpful and depressing bits of information.

For most of our history, people couldn’t pick their jobs. There was little social mobility. If you were born into a peasant family, you were a peasant, end of story. Only the aristocracy could pick and choose what they wanted to do, but even if they were passionate about something, it could only be a hobby, because they were expected by all to be aristocrats, not do things (I know, boo-hoo for them…) Now anyone can be just about anything, and training for that job is within reach if they want it enough. One way or another you can make ends meet and get to do what you like in life. I know, I know, student loans are huge… that’s why it’s doubly important to figure out what you want to do before you start going to school for it, else you’ll be spending money you don’t have so you can get to do what you don’t want to do. While I’m talking about this, allow me to pitch you on choosing a career in the trades; good craftsmen are in severe demand these days.

The subject of possessions is huge, both figuratively and literally. We could talk all day about rampant consumerism and fake economies and fast fashion. The point is, it’s incredibly affordable to buy things today, and it simply wasn’t the case for most of our history. Even something that we often take for granted and is typically rusting in our garden sheds, such as a simple hand saw, was incredibly hard to make and buy during medieval times. Even an axe or a pick was hard to make. They cost lots of money, the equivalent of small cars nowadays, so people saved up for years to buy tools, then cared for them and handed them down to their sons and daughters. Clothes were made by hand, and that included the materials. You cared for them and mended them as long as you could. Someone would typically only have one change of clothing. Nowadays clothing is literally clogging up our homes and people are desperate to get help in order to clean them up and organize them.

In the last 100 years, means of transport have progressed tremendously. Whereas travel was slow and expensive, it’s now fast and inexpensive. We can travel by car, train, ship and airplane. We can even skip physical travel and visit locations virtually by looking at photos from those places, or street views in mapping applications. We can even immerse ourselves in 360 degree videos and virtual realities.

We find time to bitch about every little bump and pothole in our public roads, yet we’ve never had it so good. It’s true that Roman roads are legendary, but you have to remember they were cobblestone in a time where suspension hadn’t yet been invented. Every single bone and sinew in your body would have been shaken out of sorts by the time a day’s ride would be over. After Roman civilization degraded, we were back to mud ruts and dust for over 1500 years, plus frequent attacks from highway robbers. Now all but the most rural roads are paved and can be safely traveled.

How about personal freedoms? Have societies ever tolerated so much free speech, even when it’s hateful and offensive, and offered so much personal freedom for various lifestyle choices, even for something that we now consider so commonplace as divorce or adultery? Do you know how shunned people were for adultery in the past, or how impossible it was to get a divorce, even when situation was terrible and abusive? How about the open criticism and ridicule of politicians, business leaders and other figures of authority or fame that we now tolerate? When was that sort of thing well-tolerated in the past? And yet we still find ways to take these things to the extreme, and we keep pushing the boundaries till things get truly and downright brazen and defamatory, instead of celebrating the freedom of speaking out against someone and doing it with some sense of decency.

I do wish more people would realize how good we have it and would be more grateful for all of the opportunities, amenities and conveniences that modern times offer us. We certainly don’t want to put ourselves in a position where we lose what we’ve worked so hard for as a human race and civilization, because then we’ll have really failed ourselves. I think the way to become more grateful is to pay attention to the past, because it offers up enough contrast to the present to make us have those little epiphanies of conscience that raise our collective morale.

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Thoughts

A case study of Romania’s healthcare system

Question: what do you do if your child gets sick on a weekend in Romania?
Answer: nothing; not an effing thing, not unless you want to deal with Romania’s state health system.

Sophie got sick over the weekend. We initially thought it was a mild case of heat stroke. Now we think it’s enterocolitis.

We don’t frequent state-run hospitals in Romania, because the doctors and nurses are more often than not undertrained and uncaring unless you bribe them, and the facilities are incredibly dirty and overrun with filthy, smelly “citizens” — you know, the kind of “citizens” who don’t contribute a cent toward the very services they overrun.

When she started to complain of a headache and tummy ache and started to go limp in Ligia’s arms, we panicked. We thought, okay, let’s hop in the car and drive to the private Polisano hospital in Sibiu, which is where we typically go on the rare occasions when we need medical care.

An aside: we don’t go to the state-run hospital in Medias, which is where we live, because it’s packed full of the same medical staff I mentioned above and is also full of the same “citizens” in its waiting rooms. The last and only time we tried using the emergency room at the hospital in Medias, Sophie could have literally died for lack of care and concern on the part of the staff, who were more concerned with the “citizens” than with tax-paying, hard-working people like us. But hey, the SMURD helicopters can fly low right over our houses to ferry the dirty dipshits to the emergency rooms, waking us up and scaring our children at night, because why not, dirty dipshits are more important than tax-paying, law-abiding, decent people.

Back to Polisano. Turned out they were closed on weekends. What kind of a hospital is closed on weekends?! So there were no private, paying alternatives for people like us on a weekend. We were pointed in the direction of the state-run emergency room.

We walked in. It was chock full of dirty, smelly “citizens”, some of them yelling at the nurses. Some dipshit was yelling about suing the hospital, so everyone could hear him. The door to the treatment room got slammed into his face by one of the nurses (good on her). There was grime everywhere in the public areas, even on the walls. There weren’t enough chairs. “People” were standing up, emanating the unmistakable stenches of unwashed sweat, layers of it, that had been alternately drying up and getting wet again on them for days on end. NO way we were staying there. We walked out with nowhere to go.

Thankfully, Sophie started feeling better. We took a walk through Sibiu’s historic district with her. We held her in our arms. When we got back to the car, she started complaining again about aches. We were at a loss, with nowhere to go.

Sophie’s usual pediatrician doesn’t answer her phone on weekends. Most of the doctors in Romania don’t answer their phone on weekends, as if diseases and accidents take a break on the weekends as well. A pediatrician in Medias even yelled at me when I called her on a Saturday, told me not to bother her and go to the emergency room.

I got in touch with my dad, who is a doctor — albeit not a pediatrician, but a psychiatrist and a damn good one if I might add. He lives in another part of the country, so he couldn’t see Sophie personally, but judging from her symptoms, he eliminated heat stroke and pointed us toward the likely possibility of enterocolitis, probably contracted at the kindergarten. We picked up some furazolidone for her from the only pharmacy in town open 24 hours and drove home.

As a last reminder of how shitty the healthcare system is in Romania, the hallway leading up to the pharmacy stank to high heaven of a filthy mix of old perspiration and urine. I complained to the pharmacist, who apologized and said about half an hour before me, a gypsy woman had come in for something and left the pungent odour behind her. The pharmacist had opened all of the windows to air out the stench, but it was stubbornly clinging to the space.

Conclusion: For f***sake, don’t get sick on weekends in Romania. Better yet, just don’t get sick in Romania, period, end of story.

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Events

Romanian doctors play hooky at Buenos Aires conference

My parents just got back from a big, worldwide conference in Buenos Aires, Argentina — the 15th World Congress of Psychiatry. My dad, who is a devoted psychiatrist, went there to learn new things, like most doctors who go to conferences.

Unfortunately, all but five of the entire group of Romanian doctors (150 in total) who registered for the conference decided to play hooky. This was after their travel, hotel stay and meals were paid for by European pharmaceutical companies, who flew them out there so they could stay up to date on the latest research.

One of the event staff confided to my father that the Romanian doctors couldn’t be bothered to even pick up their badges, which is something that only takes a few minutes. Instead, they all went on a sightseeing trip through Patagonia and were absent for the entire duration of the conference.

In case you’re not sure why this matters, you may want to read through my review of the Romanian healthcare system.

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Thoughts

Healthcare in Romania

 

There are two options for the person requiring care: the public healthcare system, financed by the government, where one is supposed to be cared for without cost if they hold medical insurance, and the private healthcare system, which is not really a system but is made up of different, unrelated private clinics or hospitals, where one must pay all expenses out of pocket. Let’s look at each system in more detail.

Public healthcare

I believe there are three main problems plaguing public healthcare in Romania:

  1. Widespread corruption at all levels of care. Bribes must be paid to hospital directors, managers, doctors and nurses, and sometimes even to hospital guards, if you are to get any competent care other than a daily temperature and blood pressure check until you check out or expire, whichever comes first.
  2. Incompetent personnel, due to:
    1. An inefficient medical education system, staffed with teachers and professors who care more about furthering their own careers, brown-nosing and getting bribes than teaching students how to be proper nurses and doctors.
    2. An unwillingness on the part of most students and medical personnel to put in the effort to acquire the knowledge they need to do their jobs right.
  3. Old facilities and equipment. Hospitals and clinics lack the funds to maintain the infrastructure properly, so all of them are run-down, cold in winter, hot in the summers, with drafty rooms and hallways where you’re likely to catch pneumonia, with bathrooms that have leaky faucets and leaky toilets, mostly left uncleaned, smelly, wet and old, with metal beds that date way back from the 1st or 2nd world war (I’m not kidding about this), and with mattresses that have seen more than their fair share of human bodies and bodily fluids. When it comes to equipment, it’s mostly non-existent, other than basic X-ray machines.

Sure, there are exceptions. There are some doctors and nurses who don’t ask for bribes. And there are some medical personnel who are competent at their jobs — they know how to do them and take the time and effort to put their knowledge to good use. But if you think the two groups contain the same people, you are probably mistaken. It’s usually the doctors who are the most competent that demand the bigger bribes, though it could be that a really good doctor or nurse may also be the one who doesn’t ask for or accept bribes. There’s no way to tell, really. It’s like taking a potshot in the dark. You’ll go to get some care and may end up with a butcher or a blundering fool who only makes things worse, and you may also end up paying him or her plenty of money for the shoddy treatment.

On some level, I understand why the corruption exists. Salaries for government-paid doctors and nurses are very low — janitors at profitable private businesses usually make more money than doctors in government hospitals — but that’s still no excuse for the endemic corruption. While salaries are low, medical personnel have also gotten used to asking for money from each and every patient, to the point where they expect it for the littlest thing and won’t help you if you don’t pay. There’s a ridiculous, infuriating sense of entitlement among most, if not all of them. Somehow they’ve gotten to think you owe them money simply for looking at you. That’s not right.

If only they’d take the time to study more, to get better at their craft, I, along with the millions of Romanians who visit hospitals, would feel better about paying extra to get care, but most are ignorant of any new developments in their fields. They only know enough to get by on routine matters. As soon as there are complications, they’ll take your money for a consultation, then tell you to go see this other doctor, who’ll ask for his share, then send you along to another, and so on and so forth until you’ve seen seven, eight, nine, ten doctors, have spent a month’s or two months’ salary on bribes, and you’re still no closer to getting treated right or cured. They’ll all nod their head, promise to help, take your money, run their tests, then scratch their heads and say they’re not sure what’s going on, that you’ll need to come see them again in a little while, etc., while happily fleecing you.

When it comes to government nurses, they won’t administer the injections or infusions or obey the doctors’ orders if you don’t slip them a bill, or some coffee, or chocolate, or whatever. It has to be something a little more expensive than just some candy or a trinket, and let me tell, when you’re being seen by four or five nurses and you need to make sure each of them gets something, it gets expensive. It’s so sad to visit hospitals and see all the old people on small pensions walk about with sad looks on their faces, mostly ignored by the nurses who are supposed to care for them, simply because they can’t afford to bribe them.

Private healthcare

There is hope when it comes to Romanian healthcare, and as is usual in a free enterprise system, it’s found in the private arena, where there are financial incentives for those willing to take some risks and make some investments in buildings, medical equipment and qualified personnel.

There are private clinics and hospitals, completely separate and unrelated to the government, where you can get competent care if you have the money to pay for it. Truth be told, it may end up costing you less than government healthcare if you add up all the extra costs involved with bribing government personnel.

Only the best doctors and nurses get hired in the private clinics and hospitals, are paid good salaries, are forbidden from taking bribes, and these facilities are equipped with the latest devices needed for proper patient care. There are entire hospitals and sanatoriums placed in beautiful locations in the mountains, where you can go to spend a few weeks to relax and get allopathic or natural, holistic treatments. There’s an entire gamut of options available to those willing to pay out of pocket.

For example, let’s say you need to run a whole battery of tests to see how your body is doing. You can go to the local government hospital, see and bribe a doctor to get some tests, then go to five or six different labs inside the hospital to run those tests, bribe your way through each place, then come back to the doctor in a few days to give him or her more money to look at the test results and tell you what’s going on. Or you can check into a private clinic, where for a fixed cost, you will spend a few days in a clean, private room with proper heating and cooling, pick your food from a menu, have your meals served to you, be able to take showers in a clean bathroom, be seen by caring, competent doctors and nurses, and get accurate test results interpreted properly. That’s the difference.

I should mention that private doctors’ offices aren’t the same thing as privately-run clinics and hospitals. Many government doctors also keep private offices, and will actually force people who come to see them in hospitals to go to their private offices and pay out of pocket to get the same care they could get for free in hospitals, but the care patients get there is just as bad as inside hospitals, and the facilities are usually just as unhygienic and inefficient. No, you must seek out professional private clinics and hospitals if you want to get the serious care I mentioned above.

Possible solutions

I think you know by now which option I would pick if I were to get sick in Romania, and for good reason. That’s not to say public healthcare can’t be fixed. In recent years, there’s been a serious push against corruption in Romania, at all levels of government, not just in healthcare, driven by the EU, but they haven’t made much headway other than talking about it and putting up posters in government agencies. Much more needs to be done, and it needs to start first with better salaries for medical personnel, probably double or triple what they are now.

Corruption in Romania is a very serious problem, one that requires an organization with teeth, one that can and does take immediate action against infractors, and where the identity of the person reporting incidents of corruption is kept top secret. Sadly, the system is still stacked against those willing to report it. Think for a moment what happens to someone who wishes to report a doctor who asks for money. First, they won’t get the treatment they need, and they may have an urgent medical problem, and then, if their identity is leaked, word about them spreads like wildfire, and no medical personnel at that hospital will want to treat them — and it may be the only government hospital or clinic in town. So people usually shut up and pay up, because they want to get on with their lives, not cause problems for themselves and for others.

Until the problems of corruption and salaries and public healthcare infrastructure get resolved, I would encourage people to use private healthcare options, if they can afford it. The more people use private healthcare, the more affordable and accessible it will get over time, and the more incentive there will be for the government to fix public healthcare.

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Thoughts

Cigna increases premiums while CEO gets more pay

Our medical insurance policy is with Cigna. We’re on the Open Access Plus plan. After I renewed my Cigna policy recently, I got our new insurance cards, and noticed that the premiums and copays increased as follows:

  • PCP Visit ($20 vs $15)
  • Specialist ($40 vs $30)
  • Hospital ER ($100 vs $50)
  • Urgent Care ($50 vs $25)
  • Rx ($10/25/50 vs $10/20/45)

Those are some pretty hefty increases, particular for items 2-4 above, so I thought I’d have a look at Cigna’s executive compensation packages, to see if they’re tightening the belt there as well.

Their CEO is H. Edward Hanway. Here’s what he makes [source]:

  • Current annual compensation: $30.16 million
  • 5-year compensation: $120.51 million
  • His performance vs. pay rank is 162/175, which means he’s the equivalent of a D/F student

In 2006, two years ago, here’s what he was making [source]:

  • Annual compensation: $28.82 million
  • 5-year compensation: $78.31 million
  • Performance vs. pay rank: 166/189, which was slightly better than what he’s averaging now

So what we’ve got here is an overpaid CEO that isn’t pulling his weight, but still paying himself gobs of money off our backs. God knows how much the other executive officers are making, all while we, the customers, get charged more for our premiums and copays. Talk about a rotten deal.

I don’t think that’s fair at all.

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