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My encounter with Danish medicine

On 27 August, my best friend Lars and I set out to cycle a 300 km brevet, a route in central and northern Jutland starting and ending in Aarhus. A brevet is a type of bicycle event where you do not race against others but simply have to complete a given route within the time limit, checking in at various control points along the route (which can take the form of buying something in a shop or withdrawing money from an ATM, so as to have a receipt to prove that you were there at the specific time). The time limit for a 300 km brevet is 20 hours, but from previous experience, Lars and I expected to make it in about 15 hours, so that, having started at 8 a.m., we would be home around 11 p.m. to enjoy a well-deserved cold beer. The weather was cool but dry as we set out on our ride. I was a bit unsure whether I would make it; I have done a 300 km brevet before, but this time I had been battling with a nagging knee inflammation for a couple of weeks, and I was wondering whether my knee would hold up during so many hours of riding. But once I got going, my confidence increased. There was pain but it was manageable.

The landscapes of central Jutland were pretty:

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We completed the first 100 km with a hot dog at Himmelbjerget, the second-tallest point in Jutland (not saying much). This was also a control point, so I made sure to keep the receipt from the kiosk. And then we turned north. After 132 km, we stopped for coffee at a supermarket in a village called Ans. While there, I noticed that my lower lip had swollen for some reason–I had not felt any insect bites but something must have caused it. It did not look pretty (and actually, it looked a lot worse outside the supermarket, this photo was taken after I had already received drugs to make the swelling go down).

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Lars did not like the look of my lip, so he called the doctor on duty (vagtlægen, reachable on the same number anywhere in Denmark) to ask about possible over-the-counter remedies we could buy in the supermarket. However, once he explained my symptoms, the doctor told him that given that I was apparently suffering an allergic reaction to something, and given that the swelling was near my mouth, he was concerned that it may spread to my throat, and not being able to breathe is not healthy–so he was going to send an ambulance for me right away. They sure take allergic reactions seriously in Denmark!

This was a real bummer; the leg I had been worried about was OK but my brevet was being cut short by some unknown Danish insect. But there was nothing I could do. So while Lars was phoning his brother to arrange the logistics of returning our bicycles to our home base in Aarhus (about 50 km to the south), we waited for the ambulance. Here I am removing the handlebar bag from my bicycle to take it with me to the hospital:

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The ambulance arrived after about 10-15 minutes, with a doctor in a separate car to have a look at me:

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In the ambulance, they inserted the IV, gave me some drugs per the doctor’s instructions, did an electrocardiogram, and took me to the nearest hospital, in the town of Viborg, about 20 km away. During the ambulance ride, I was chatting with the nurse who was taking down some basic information, including my CPR number (a Danish identity number that is the key to accessing all public services). I said that I lived in Spain and although I am a Danish citizen, I am not in the Danish public health insurance system, but that was irrelevant–they told me that they were worried about the medical aspects of our transaction, not the administrative ones.

In the hospital, additional tests were done, I was given some more medications and kept for observation for about 2-3 hours. I was not happy about not being able to complete the ride, but I was grateful for the medical attention I was receiving.

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It all ended well. The allergic reaction was controlled, and after checking a few more things and giving me some more drugs (including some to take over the next 3 days), they discharged me. By 9 p.m., Lars and I were back in Aarhus (as were our bicycles), eating pizza and drinking beer.

I have only good things to say about Danish medicine–this was my first interaction with it since my father died in 2004–both the ambulance crew and the people at the hospital were superb on this Sunday evening, and the issue of payment or insurance was not even mentioned by them. I did mention, as I had in the ambulance, that I did not live in Denmark and had an EU employee medical cover rather than the normal Danish sygesikring, but they were completely uninterested in the financial aspects–all they cared about was the patient. To this day, two months later, I have not received any kind of invoice, and I doubt that I ever will.

On the other hand, within a couple of days, all the details of my ambulance ride and hospital visit were accessible to me on the Danish health service portal, so that if I need to share any of the tests or information about the treatment I received with my doctor here in Spain, I can just print it out.

This is what medicine looks like when it is regarded as a basic human right and not something that exists primarily to make a profit for someone. My heartfelt thanks to the people at Regionshospitalet Viborg and the ambulance service of Region Midtjylland for the superb care they gave me on that Sunday in August. Tusind tak!

 

 

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When bad people do good things

Recently, I posted some photos from Copenhagen’s Churchill Park on my weekly photo blog. For me, Churchill is the greatest figure of the 20th century, the man who stood up to Hitler at the darkest hour in 1940, when Britain was all alone, with the Continent occupied, America neutral, and Hitler conquering all before him. But then I got an e-mail from a friend in India. For him, Churchill was not a great man. He viewed him as a butcher in the same league as Hitler and Stalin, because of his role in colonial India and in particular the Bengal famine. This is a side of Churchill of which I knew little or nothing until my friend from Chennai made me aware of it. What it does show me is that history is complex. Churchill still is a great man in my eyes but I recognise that not everyone will share my perspective.

In a similar vein, the world of art, entertainment and sports is full of good people and bad people, just like the rest of society. This raises the question (for me, anyway): how to deal with a great performer/creater who is also a bigot, a racist, an extreme right-winger, or similar scum.

Of course, if the artist in question is no good, there is no problem. For example, Mel Gibson is an utterly disgusting character, but since his films are by and large forgettable garbage, it is no sacrifice for me to ignore him.

No, the problematic cases are those people whose work I admire but who have despicable traits or views that are anathema to me. Take the great Norwegian writer Knut Hamsun, for example. His novel Sult (“Hunger”) is one of the great pieces of world literature, and his Nobel Prize in 1920 was thoroughly deserved. But alas, Hamsun was also a Nazi. Not just a Nazi sympathiser but someone who met with senior figures, up to and including Hitler, and who was unrepentent even after the war (he died in 1952). His mastery of the language is such that even his last work, Paa Gjengrodde Stier (“On Overgrown Paths”) from 1949 makes for great literature despite its defense of his repugnant views during the war.

Or take Ernest Hemingway, probably my favourite writer of all. In this excellent article in the Jewish Forward, Mary Dearborn discusses the very dilemma that is the subject of this post. Hemingway was clearly an anti-Semite, as were many Americans in the 1920s or 1930s. As Dearborn notes, however, later Hemingway showed his strong anti-Fascist stance, beginning with the Spanish Civil War (1936-39), which for many serves as a mitigating circumstance and is certainly in contrast to Hamsun. I conclude as Dearborn does: we should continue reading Hemingway, but we should also not close our eyes to the nasty aspects.

Things become even more complex when I consider Wagner, Hitler’s favourite composer. Obviously, given that Wagner died in 1883, I cannot blame him for the rise of Nazism 50 years later. But the connection is still there because of Wagner’s anti-Semitic writings and the nature of his music. And so, despite the undeniable merits of his operas and other compositions, I shun Wagner. It is wholly irrational, I know.

So what is the point of this post? Not much except to say that the world is complex and things are rarely black & white. Most of the time, they are a shade of grey.

 

My team

While the focus of my blogging is mostly on beer, photography and current affairs, this post is about my day job which is what pays the bills. I am the Chief Economist of the EU Intellectual Property Office. Thus, I manage a small team of economists who carry out studies on topics such as the importance of IP rights to the economy, the damage caused by counterfeiting and so on. The quality of their output is very high, and I am fortunate to be the manager of such a skilled group of people. One of the best rules of management is this: “hire people who are smarter than you and get out of their way”. I don’t know if the people who work for me are smarter than me in the everyday sense of the word, but certainly their expertise in the technical disciplines that we rely on to do our work far surpasses mine. And that is how it should be. I am good at the communications and political aspects of our work, they are good at the economics. Together, we are having a real impact of how IP is viewed by the policy makers in Europe and beyond.

Memorable quotes from US presidents during my lifetime

“Ask not what the country can do for you-ask what you can do for your country” – John F. Kennedy, inaugural address, 20th January 1961.

“In a land of great wealth, families must not live in hopeless poverty. In a land rich in harvest, children just must not go hungry. In a land of healing miracles, neighbors must not suffer and die unattended. In a great land of learning and scholars, young people must be taught to read and write.” – Lyndon Johnson, inaugural address, 20th January 1965.

“Mr. Gorbachov, tear down this wall!” – Ronald Reagan, West Berlin, 12th June 1987.

“Yes We Can” – Barack Obama, various occasions.

“Grab ’em by the pussy, you can do anything” – donald trump, 2005.

 

Sadly, I was right

Back in June, I predicted that Trump might end up winning because, among other factors, of the damage done to Clinton’s campaign by Bernie Sanders. I was right, even though I will admit that Sanders’s quixotic quest for the nomination was not the only factor. Hillary was clearly a flawed candidate, and the Democratic party should have done a better job of choosing its nominee. And most importantly, once again we see, as with Brexit, a collective failure of the commentariat and the pollsters to predict the outcome. As I write this, I listen to a Danish politician admitting that “we (meaning the established political class) communicate on a completely different frequency” that simply does not reach the people who voted for Trump. A lot of people–the Democratic and Republican establishments, the leading commentators, the pollsters and analysts–all of them have a very rotten egg on their faces.

But this slight sense of Schadenfreude cannot hide the deep depression I feel as I write this. The election of Trump is an even greater disaster than Brexit. It will affect the most powerful country in the world deeply and steer it in the wrong direction, even if Trump only delivers on a fraction of his election promises. He may only be President for four years, but even then the damage will be lasting. The damage to international relations; the misery at home; the reactionary Supreme Court justices he will appoint–those will endure.

The irony is of course that the people who elected Trump will be among those who will suffer the most from policies like the upcoming abolition of the Affordable Care Act. That they voted for him is an expression of the same nihilism that led to Brexit: a feeling among wide segments of the population that the established political system has let them down, that they have been left behind by globalisation, and that they have nothing to lose by “shaking things up.” This is related to my previous post. Unless the issues identified there are addressed, there will be many more Trump-like results in 2017. I wonder how President Le Pen will get along with President Trump…

The failure of my profession

I have been meaning to write a post about the state of economics for some time. For many years, I have been unhappy about the increasingly abstract articles in the most prestigious journals (e.g. the American Economic Review, Journal of Political Economy etc.). My PhD is from 1991; yet, today, I do not understand most papers published in those journals. The level of mathematics required to read them is simply beyond me. So we have a group of people publishing for a narrow circle of like-minded academics with absolutely no impact on public policy.

This general malaise is not new, and others have complained about it as well. And of course there are exceptions, people like Paul Krugman or Thomas Piketty or Joseph Stiglitz who write about real world problems in an understandable manner, but still based on rigorous analysis of empirical data and on sound theoretical foundations and methods.

No, what prompts me to write this particular post at this particular time is the increasing influence of populist parties and movements in the Western world. Whether you look at countries where the crisis hit hard, like Spain or Greece, or those where it had much less impact, like the UK or Scandinavia or the USA, you see different expressions of the same phenomenon: an almost nihilistic rejection of the established order, as expressed by Podemos in Spain, Syriza in Greece, the Freedom Party in Austria, the Front National in France, the Brexit vote in the UK and the rise of Donald Trump in the US…I could go on, but the picture is clear: increasingly, large groups of voters in Western democracies are voting for parties (whether on the left or on the right) that promise easy solutions to complex problems and that feed on the general sense of betrayal felt by those voters.

So, who are those voters and why do they feel betrayed? A big part of the answer lies in the globalisation that we have experienced in the past few decades and the failure of the political system to deal with its consequences. The Economist had an interesting article about this in early July, summarising the work of economists such as Dani Rodrick of Harvard, who question the consensus about the inevitability of globalisation and free trade.

Let us take a step back, to the birth of the economics profession in the late 18th century and early 19th century. The two significant names are of course Adam Smith who explained how society gets richer if everyone focuses on work that s/he is particularly good at and on the importance of the profit motive (“It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own self-interest.”); and David Ricardo, who took Smith’s analysis further and extended it to international trade.

Adam Smith is often regarded as an ultra-liberalist who advocated a minimalist state, letting Darwinian capitalism rule otherwise. This is a complete misunderstanding of his ideas. In The Wealth of Nations he recognises that business owners will team up to take advantage of the consumer if the government does not prevent them from doing so, and more generally, there are many quotes in his writings to which progressives can sign up to without reservations. For example, the following two quotes clearly show that Smith was concerned about inequality and was in favour of a progressive tax system:

“No society can surely be flourishing and happy of which by far the greater part of the numbers are poor and miserable.”

“It is not very unreasonable that the rich should contribute to the public expense, not only in proportion to their revenue, but something more than in that proportion.”

In his 1817 book, On the Principles of Political Economy and Taxation, Ricardo formalised many of Smith’s concepts and formulated the main principle of international trade theory. Using a simple example of two countries and two goods, he showed that even if one country is better at producing everything than another country, both countries are still better off if they trade, with each country specialising in the products where its superiority is relatively greatest (this is what we call “comparative advantage”). By doing that, consumers in both countries get at least as much of each of the two goods than they do in a situation without trade. This fundamental insight is behind all subsequent trade theory. Later researchers have developed the theory further to take into account various complicating factors from the real world, but the  principle of comparative advantage remains the basis of the economics of international trade.

So, if trade (and the associated globalisation of supply chains, finance, etc.) benefits everyone, how come large portions of the electorate are turning against it? The latest WTO-sponsored round of international trade talks, the Doha Round, which began in 2001, is basically dead, and the future of other major trade deals, such as the Trans-Pacific Partnership, the Trans-Atlantic Trade and Investment Partnership (TTIP) and even the EU-Canada free trade agreement is in doubt. I will argue that at least part of the answer is the intellectual failure of the economics profession to deal with the real world consequences of globalisation.

When we economists say that trade and globalisation benefits society, what we really mean is that in aggregate, society benefits. As consumers, we all benefit from the lower prices we pay for our electronics, for instance, now that manufacturing of such things takes place mainly in low-cost countries, first and foremost China. But it does not mean that everyone benefits. Clearly, there are losers–namely the workers who lose their jobs because making stuff in rich countries is too expensive when competing against the likes of China. This is not new. We have known it all along. The implicit assumption behind the near unanimous support for trade liberalisation among economists is that the winners compensate the losers. In other words: since the aggregate gain from trade is positive, there is room for the winners to compensate the losers and still be better off. This is undeniably true on the level of calculation. Unfortunately, in the real world, the losers have not been compensated. Instead, the winners simply keep the gains to themselves and smugly tell the unemployed steel worker that he must acquire new skills so that he can perform the higher value-added tasks that are needed in the new economy.

With a few exceptions, we have ignored the rise in inequality since the 1970s. Until recently, the only people who worried about it were inconsequential left wingers. Today, the situation is changing. Even the quentessential establishment organisation OECD, often referred to as “the club of rich countries”, is increasingly concerned about inequality and its social consequences. Hopefully, during the coming years this concern will lead to some policy changes. But meanwhile, out there in the real world, those people who have not gained from the economic changes of the past decade have concluded that they have nothing to lose and are rejecting the established order. They are doing it in diffuse ways. This is not an organised revolutionary movement of the sort Marx would have imagined. Sometimes the anger is expressed on the left, as in Spain or Greece; sometimes on the right, as in France; and sometimes in ways that are completely nihilistic and impossible to fit into the left-right catorisation, such as the rise of Donald Trump in the US or the vote to leave the EU in the UK. What these political forces have in common, however, is a desire to turn inwards and even to reverse globalisation, exemplified by Trump’s promise to cancel the North American Free Trade Agreement with Canada and Mexico, to deport 11 million illegal immigrants and to build the wall on the US-Mexico border. Whether or not he will be able to carry out these promises if elected is irrelevant; what is important is that the people who vote for him, or a large proportion of them, anyway, either believe in these promises or at least are looking to Trump to “shake things up”, whatever that might mean.

So I finish with a plea to my fellow economists: worry less about equations and more about describing and analysing the real world, including the political consequences of economic developments. I, for one, am no longer convinced that globalisation, given the political context, has been a good thing.

Voting with the heart

This is a year of three important elections (possibly more, but these are the three that I truly care about): the Brexit vote in the UK on June 23rd; the Spanish general election on June 26th; and the US presidential election in November. All three votes have something in common: a large proportion of the voters will decide their vote based on emotions, and in all three cases the results will be disastrous.

In the UK referendum, it seems this morning, with just over a week to go, that the LEAVE side might win. The people who vote this way do so for a variety of reasons, of course: some genuinely dislike the EU, rail against the “Brussels bureaucracy” and really think that the UK would be better off on its own. This is a fantasy. Still others (and I believe this is the majority among the LEAVE camp) are voting based on a vague fear of globalisation, of foreigners, of immigration–even if those things have little or nothing to do with the EU. The end result might well be that the UK votes to leave the EU, with grave economic and geopolitical consequences for itself (including a likely breakup of the UK as Scotland will surely hold another referendum on independence) and for the rest of Europe. Because regardless of this vote, geography will not change, and however much the Little Englanders dislike it, the UK is part of Europe.

Then the Spanish election three days later. Again, large numbers of people will vote for the new left-wing Podemos party, probably pushing the social democrats PSOE into third place. The people voting for Podemos have the idea that the two big parties on the left will then come together to form a governing coalition. This is another fantasy. In this scenario, the PSOE should accept that the larger partner, Podemos, gets the prime minister post. They will never accept it; nor can PSOE ever accept the Podemos line on Catalan independence. So the most likely result of the many Podemos votes will be that PSOE will abstain in the vote on government formation, allowing Rajoy and his reactionary and corrupt Partido Popular to continue governing. Surely this is not the outcome the Podemos voters want, but this is what they will get.

And finally, the US presidential election. Here, once again, we have millions of people who support Bernie Sanders in his hopeless quest to become the Democratic nominee. In the past I have had a lot of sympathy for Sanders. I certainly agree with many of his policies, much more so than with those of the other candidates. But sadly, Sanders is unelectable–he is simply too far to the left for most Americans (as opposed to Democratic primary voters). By continuing his campaign as long as he has, Sanders has accomplished only one thing: he has damaged his party’s nominee, Hillary Clinton, to such an extent that what used to be a comfortable lead for her over Donald Trump has now become a dead heat. So once again, by voting with their hearts rather than their heads, the Sanders supporters have probably accomplished only this: Donald Trump is the next president of the US. Surely this is not what you intended, my friends??