After coffee, I'll put on my winter boots and take a stroll.
Autumn Leaves
Fall in Seoul can be enjoyed not only in the surrounding mountains, but in the parking lot of our apartment complex.'
Shaman
A short five minute walk from our dense apartment complex, is the steep flank of Surak Mountain. Myriad trails wind within the forested nature preserve and provide adequate satisfaction to the vagaries of my mood. I can strain in high intensity efforts as I accelerate the rate of climb, practice mindfulness as I stop and listen to the gurgle of a tiny creek, and on some occasions train my cognitive abilities as I challenge myself to retrace, on my decent, the exact route I took on the way up. This last activity is not easy, as the forest obscures forward visibility, and there are dozens if not hundreds of occasions to choose between similar-looking foot paths. But I diverge. Traversing the mountain, at about a third of its height is a segment of the Seoul Trail, a popular, well maintained route. This Saturday, we chose it as an active long-cut between our apartment, and a restaurant located one subway stop away (A subway stop is a common unit of distance in Seoul). After satisfying our palate and our bellies, and soon after our ascent into the mountain, we heard clanging and drum beats, which Adi recognized as a Shaman ceremony. We followed a small path leading down (Those are many, remember?), and approached the walled villa bordering the forest. Adi hesitated, but curiosity won. We entered the courtyard in the midst of the ceremony. The organizers asked us not to get too close, but otherwise, we were welcome.
Shamanism in Korea is becoming rare. Most Koreans frown on the practice. However, when tragedy strikes, they may seek the service of a shaman. The shaman is a conduit between our and the spirit world. He can channel a loved relative, who will provide consolation and advice. Instead of describing the ceremony, I took the easy route, a short video clip. Click below:
Milim Yafot Ka'ele
La Poem won. Rabidance came at second place.
Enjoy Milim Yafot performances:
The Korean version: http://naver.me/F55Bgdpj (I hope the link works. Fiddle with it in a new window if it doesn't)The original version: https://www.youtube.com/watch?v=95anpoEb4fM
The Flu
"Mr. Tee? Please get up"
T is in a darkened room, there are several people around him.
"Mr. Tee. Please get up."
'Where am I? His mind rapidly reconstructs his reality, 'Burgundy light outside, late afternoon, it was noon before, hotel room, after a long flight, must have taken a nap.' He is back with himself now. 'Who the fuck are these people?'
"Mr. Tee. Please get up" She looks tough. In her thirties, dark pants, dark jacket. Some logo on the jacket, which T can't read. She flashes a badge, which he does not inspect. "You need to come with us." Two of the men, "help" him sit, and he puts his shoes on. They are all wearing a similar jacket. "We will explain later." she says. They go out of the room. The corridor is deserted. They walk in a tight formation, the woman in the lead. Another agent is guarding the waiting elevator. No one speaks. He wants to get to the lobby, he hopes that someone there will be able to explain what is going on. The front desk is unattended. A few hotel guests in a side corridor, look on with curiosity, but an agent is blocking them from entering the lobby. It is eerily quiet as they pass through, and go out of a service door. T is ushered into a black van, and strapped into the single chair in the cabin. "For your safety" she explains, and closes the sliding door. Through a glass partition, he can see her sit by the driver, and pick up a microphone.
"Mr Tee, we have been informed that you are gravely ill. We are taking you for treatment. We have a long drive ahead, so sit back, and relax" She puts down the mike and turns away from him. He senses a musky odor, which he knows is familiar, yet he can't recall from where. He feels drowsy, and perhaps sleeps. When the van stops, it is dark outside. Several figures dressed in white spacesuits, are waiting. They help him out. He feels weak and unstable. 'Am I ill? Drugged?' One of the space-suited figures points at a gurney. 'I do want to rest', he thinks. A white outline of a human body is painted on the gurney's pad. T aligns himself with the markings. Soft straps emerge from the gurney, and secure his limbs and chest. Above, he can see stars. To the sides, he sees only a large structure. It is several stories high, grey colored, and vaguely circular. The van drives away. A transparent half-cylinder is placed above him, and clamped to the base of the gurney. A whisper of a sound, and air moves softly over his face. 'That smell again. What is it?' Through the enclosure, he can hear the figures talking in a language he cannot recognize. One of them maneuvers the gurney towards the structure. An opening appears, and he is inside.
They move through a long corridor. Doors on both sides. There are no light fixtures. Instead, the whole ceiling is glowing a warm white. The attendant beside him, does not seem to be exerting any effort in pushing or guiding the gurney. It moves smoothly, without any vibration or noise. In front of them, a door slides open. Inside, another group of spacesuits. In the center of the room, a large machine with a circular opening. The gurney, or more correctly, his cylinder, slides precisely into that opening, feet first. He is startled by the whirring sounds of the machine. The scent becomes stronger. A tingling sensation at his feet, then slowly moves up his body. It is not unpleasant. He closes his eyes, and drifts to sleep. He wakes up in another room. He is wearing pants and shirt, both pink colored, and made of a thin and stretchy material. The material is smooth, and feels cool on his skin. He may be running a fever.
"Hello, Mr. Tee"
A spacesuit in the room is talking to him. T can hear sounds from inside the spacesuit's helmet, but the voice he hears is different. It is clearly computer-generated, and a bit awkward.
"The scan says, you are ill. Maybe we make you healthy"
T asks some questions, but does not learn much.
"Now we do tests. Please lie on bed"
He lies down on a narrow bed, which, adjusts itself to his body contours. It holds him firmly in place. The spacesuit, guides several mechanical arms and attaches them to various parts of his body. Near his left arm, T can see his blood entering a small capsule. 'Strange, didn't feel a needle.'
"Thank you"
The probes detach themselves from his body, the bed relaxes, and he is free to sit up. The spacesuit shows T the location of the en-suite bathroom, and demonstrates the operation of the room's lighting and video screen, both are controlled by hand gestures. The spacesuit turns and walks away. A sliding door opens with a 'swoosh', and he leaves. Another spacesuit, enters through the sliding door, and places a tray on a table attached to his bed. The food on the tray is arranged in several compartments, each dish has a distinct color and shape. He carefully tastes a sample from each compartment. Some are spicy, some are delicately sweet, He enjoys the variety. He is hungry and proceeds to eat most of the tray's contents. After a while, he climbs into bed, gestures the room to darken, and falls asleep. He wakes up to a dim light which gradually becomes brighter. The hydraulic door opens and the first spacesuit enters. "Good morning. Time for tests" As before, the bed conforms to his body, holding him in place, the spacesuit, which T decides must be a doctor, attaches the various probes, and blood is painlessly drawn. T still feels weak and knows he is running a fever. Someone else brings a tray into the room. T makes an attempt at a conversation, without success. 'Nurses,' as he decides to call them, 'have no translation devices.' Just like the previous meal, breakfast is colorful, with unfamiliar texture and taste. Feeling stronger, he gets out of bed and inspects his room. There are no windows. The light comes from the glowing ceiling. The bed and an armchair are the only furnishing. A spacious bathroom includes a toilet and a shower. The sliding door does not open automatically as he approaches it, nor can he discern any buttons or handles. On the other side of the door, he can see a small room, with its own door on the opposite side. He presumes it is some sort of an air lock. He operates the video screen, flips through the channels, but none catch his interest. The tour exhausts him, and he goes back to bed for a nap. The rest of his day is uneventful. At night, he dims the light and watches TV until he falls asleep.
The next few days are a repeat of the same routine. He gradually feels better. 'Time to get out of here.'
"Today, you will take another scan "
The floating gurney is wheeled into the room and he climbs into it, the transparent cylinder is placed around him, and he is out of the room, through the air lock, and into the corridor. T observes the route carefully. He will needs the information if he attempts an escape. He is now familiar with the scanner, its harmonic mechanical sounds, the tingling sensations, and that scent. The next day, he questions the doctor about leaving
"Scan is good, tests are bad. You stay."
More days. He adds exercise and meditation to his routine. He can now place the probes on his own, and the doctor's visits less often. He discovers that he can move the video display to any spot on the wall, which makes it convenient for reading. He brings up a Pynchon novel, which he started a long time ago, and quit in frustration. 'This time,' he hopes, 'I will finish.' He pays more attention to the nurses. Their loose fitting spacesuit covers them from head to toe. In addition to the helmet, they also wear googles and mask. Yet he can now distinguish among them, and note the differences in reaction to his attempts at communication. With one in particular, he makes a connection. She lingers after delivering the food, and talks to him kindly. He learns her name, though he can't pronounce it. She brings with her the translation device, and they talk in short sentences. One night, she comes into the room, and hands him a pill.
"What is it?"
"Take it". He does. He is outside. A slight breeze, the sun heats his skin, and the warm water laps at his feet. He needs to cool down, and he walks into the gentle waves. The water feels good on his skin. He is chest deep, and she is beside him. Her long black hair runs wet and shiny over her breasts, barely covering her nipples. She smiles, and takes his hand. He touches her face and they embrace. Her body fits perfectly into his. His whole being is concentrated on the contact of their skins. His hands caress her smooth back as she presses her breast and pelvis towards him. They kiss, and don't break their kiss even as a wave passes over them. She lies beside him as they hold tight, cherishing every surface of contact. She twists and moans as she wraps her thighs around his leg. His muscles are tense, the whole body aching, he wants her. Now! Then he is inside her, and he can breathe again. They look at each other, and gently start moving. Their bodies, their breath, their thoughts are synchronized. He knows that her emotions and sensations are exactly as his. Their movements increase in speed and intensity. His whole being is focused on their points of contact, the surroundings fade. She gasps then shudders as she reaches climax, his energy rises to an unbearable level, and he explodes. She is standing by his bed, her hand oh his chest. Her eyes are smiling.
"You too?" he guesses.
"Yes"
She visits him almost daily, and often with the pill. Their encounters grow in complexity and intensity. He talks to her about leaving together.
"I want also, but talk to doctor"
On the next visit he does.
"You cannot!"
"Why? I feel healthy"
"Tests still bad"
"After tests are good?"
"Impossible"
A bit of linguistic struggle, and he learns that they cannot breathe the same air. For them, the high oxygen content in his atmosphere is poisonous. He stops talking abut the future, and lives one day at a time. Until one day, "You are healthy. You can leave"
The departure is as swift and unemotional as his arrival. A nurse comes in and brings his old clothes. Another, brings the floating gurney and he is inside the hermetic cylinder and guided out. She is not anywhere in sight. The familiar odor and drowsiness. He is in the hotel room. The date on the clock indicated his flight's arrival date. The front desk confirms. This is not an error.
'What happened to me? Was it a dream?' Yet, he knows he read all of Gravity's Rainbow.
Rational Healthcare Spending
The Corona epidemic threw a spotlight on our willingness to spend large amounts of money on saving lives. It prompted Gini, my brother, to ask whether we are spending it wisely. Perhaps, he added, if we divert some of that money to other areas, it could save more lives. I was intrigued by the premise, and decided to explore it. I thought I should start from first principles, and see if it leads me to the same conclusion. Adi, my editor, read the initial draft and was horrified. After calling me by several names, she forbade me from publishing. I realized that putting question-marks in front of accepted moral standards, is not a good idea. I abandoned that path, and embarked on a less dangerous one.
I started by analyzing Gini's assumptions (I counted five assumptions)
1. We should try to save more lives - I will treat this assumption as an axiom.
2. Causes of death are medical - True.
Over 90% of the deaths are caused by disease. Of the non-medical causes, road accidents are the most frequent (6.5% of the total deaths.)
3. Money spent on healthcare extends life - Partially true.
Two examples validate the assumption.
3.1. The graph below shows (if you can ignore the curve-fitting line) that up to about $3000, higher healthcare spending is associated with increased life expectancy. Above that amount, the curve flattens.
3.2. Higher income level is associated with higher life expectancy. The top income quartile, lives eight years longer than the bottom quartile.
4. Health Care spending is not allocated rationally - Probably true.
When faced with a choice between spending to prevent the death of a loved one, and indirect efforts such as preventive medicine, I have no doubts of the outcome. Another anecdote, reinforces the assumption. Among the developed countries, the US, has the highest mortality rate for children under five. Conversely, it has the highest survival rate of people over 75. It seems that too much is allocated to saving old geezers like me.
5. There are areas that are more cost-efficient in savings life - Needs to be calculated.
Among the cost efficient areas that Gini mentioned are the following:
- Universal health insurance
- Preventive medicine
- Orphan drug research
- Road safety
- Water and air quality
- Aid to poor countries
Perhaps economists can prioritize these areas based on measures such as 'Lives saved, per dollar of investment.' and compare them to new life-saving efforts.
I concluded that the premise is plausible.
At this point, the path leads to high hurdle, How do we implement this vision? Who can make the hard decisions of shifting resources based on rational thinking? The path branched into three directions: Individual choice, the democratic process, or a benevolent dictatorship.
A. Individual choice (in a free market)
My libertarian tendencies tell me to let individual choice find the rational solution. (See I pencil)
The US is an approximation of such a market. Yet, despite healthcare expenditures of $10,000 per capita, the results are dismal. Life expectancy (79 years), is three years shorter than the average in the developed countries, and on par with countries that spend only $2,000 per capita. Within the population, there are large disparities based on race, income, and education level. These results can perhaps be explained by the fact that 20% of the population spends 50% of the healthcare money.
The free market may work for the top 20%, but the process is not efficient. I would hate to describe what could happen to society, if the trend continues.
B. Democratic process.
The Democratic process allows the majority to impose limits on the wishes of the affluent minority. For example, some democratic countries implemented universal health insurance. Can it also work to shift resources from emotionally charged areas, to more cost efficient endeavors?
Ç. Benevolent dictatorship
There are many examples of dictatorships in the world, but few can be considered benevolent. Two that might fit the term are China and Iran. I compared those to an unscientific sampling of five countries (*) whose healthcare spending is in the same range. I defined efficiency as the years of life expectancy divided by the health care expenses per capita.
Country Healthcare Spending[$/PC] Life expectancy[Yrs] Efficiency [Yrs per $100]
China 426 77.5 18
Iran 366 77.3 21
5-country average 350-450 77 19.4
It seems that authoritarian regimes do not have a clear efficiency advantage.
Conclusions
The Democratic process may be the preferable implementation approach. However, to achieve a rational resource allocation, we will need to become much more active politically.
* Armenia,Bosnia,Columbia,Malaysia,Romania.
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