Author: Frank Yacenda

Elie Wiesel
Remembering Elie Wiesel

Remembering Elie Wiesel

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The news of Elie Wiesel’s death reached me on the car radio last July 2 as I was driving through Banff and Jasper national parks in Alberta. The sun had come out after a very rainy Canada Day the previous day, but the news of Wiesel’s passing arrived as a shock that darkened even that bright Saturday. I had a most personal and moving encounter with the Holocaust survivor, Nobel laureate, author, teacher, and renowned advocate for the oppressed 17 years prior, and I knew I needed to write something of my memories of him. Unfortunately, circumstances were not conducive that day or in subsequent days as I made my way back to the U.S. and to Florida, and the months that followed proved far more tumultuous and challenging than I had imagined. But now, on the anniversary of his death, I feel it’s finally time I share my thoughts on this man who touched my life so profoundly.

In June of 1999 I was again posted to the U.S. Embassy in Tirana, Albania, returning there on TDY at my request from my then-permanent station in Brasilia. I couldn’t bear to read any more accounts of what the Serbs were doing to the Kosovar Albanians during their onslaught on the province of Kosovo – perhaps in part due to my own partially Albanian ancestry – and I asked to be sent on temporary duty back to Tirana, where I arrived in mid-May and was to remain through most of July.

It was during the first week of June 1999 that Elie Wiesel was sent as a personal representative of President Bill Clinton to visit the refugee camps housing the displaced Kosovar Albanians in Macedonia and Albania. The President wanted to get a first-hand read on what was going on, and what the state of the refugees was, and so he turned to the man who had spent so much of his adult life speaking out for the oppressed of the world. The man who himself had survived internship, at the age of 15, at two of Nazi Germany’s most notorious death camps, Auschwitz and Buchenwald.

Perhaps because I constituted a significant part of the embassy’s collective memory, having been posted to Tirana from 1995 to 1997, including during Albania’s own internal descent into temporary madness following collapse of the country’s massive pyramid schemes, I was assigned as control officer to Mr. Wiesel. What that meant was that I was to accompany the visitor wherever he went, look after his safety and well being, oversee the translators, drivers, and other personnel assisting in the mission, serve as liaison to the embassy and whatever relevant agencies to assure that his requests were met, answer his questions about the country and the situation to supplement what knowledge he was garnering on his own, and to generally provide whatever support the President’s envoy might need or want. It struck me then as a great honor to be selected to fill this role, and it still strikes me that way.

Interestingly, in his report to the President, Mr. Wiesel said he was “accompanied by three able US government officials” during his visits to the two countries, and in acknowledging the role played by the embassies and the U.S. government agencies that assisted with the visit, he said, “They went out of their way to be helpful. They bring honor to our country.”

In truth, I felt that it was he who brought honor to us through his visit and, more than anything, the serious, sensitive, and intense manner in which he approached his role and the kindness he showed to everyone he came in contact with.

June brings heat to Albania, and the tents housing the thousands of refugees who had fled their homes in Kosovo were hot in the June sun. Elie Wiesel never faltered for a moment as we went from camp to camp, interviewing dozens of people in each camp, conducting the interviews in the tents, working through a translator, and listening intently to the unrelenting accounts of personal horror and loss that poured out. I sat in on most of these interviews, and hour by hour and day by day the strain and the sadness grew.

We got out into the areas where the camps had been set up, and this provided me with the occasion of my first-ever helicopter ride, aboard a U.S. Navy Sea Stallion that carried our entourage west out of the capital to our first stop. The schedule we kept up would have been grueling all by itself, but Wiesel was unstopping in his quest to speak with as many of the refugees as he could, seemingly disregarding any jet lag he might have picked up coming from New York, even at the age of 70 at the time.

We set up individual interviews as well as, as I recall, one or two group sessions, always in the big white refugee tents. For hours upon hours we heard women tell of watching their husbands and sons taken away and gunned down by the Serbs. We heard of parents separated from their children, of children watching their parents killed before theirs eyes, of the difficult and dangerous trek over the mountains and out of Kosovo to relative safety in Albania.

As Wiesel wrote in his report to President Clinton, “I listened to their tales of senseless cruelty and inhumanity which characterized Milosevic’s army and police; they have been reported in the international media. Still, it is different to hear it first-hand. One feels frustrated and powerless in their presence. And embarrassed. Pristina and Pec, Djakovica and Cecelija, Mitrovica and Glogovac, Kuraz and Izbica: eyewitnesses brought back harrowing detailed graphic reports from Kosovo’s killing fields. They go on and on. Forced expulsions, houses looted, villages burned, insults, threats, imprisonment, repeated rapes of young women, beatings of young men, separation of men and women, summary executions: everywhere, the process is the same. And the tormentors – who are they? Most of them are former neighbors.”

He heard again and again how it was former neighbors who were inflicting these cruelties, and I remember the interview Wiesel cites in his report: “ ‘A policeman came with his 5-year-old son,’ a man with an extraordinarily kind face told me. ‘He pointed at us and asked the boy to choose the prisoner to be beaten that morning.’ ”

When we took breaks, or when it was time to head back to Tirana at day’s end, we would watch the refugee children playing their games between the tents, as children will do.

“In this haunted world of Kosovo refugees, adults wept,” Wiesel writes in his report to the President. “Children did not. They sang. They played games. They laughed. And I no longer know what hurt us more: the children’s laughter or their parents’ tears.”

But what is not contained in those words is what we saw, again and again, which was children not just laughing and singing, but also pretending in their play to capture and execute one another, having picked up perhaps all too well what they had witnessed back home. I remember being at dinner in an open-air restaurant with embassy colleagues the evening of our camp visits and trying to describe what I had witnessed. But I was unable to get past the image of children forming guns with their fingers and using them to play-shoot their playmates in the back of the head, and breaking down at the table, not able to go on. The memory still haunts me and brings tears to my eyes even as I write these words.

It’s relevant to recall the details of Elie Wiesel’s life, being born into a town in Transylvania, a part of Romania that was transferred to Hungarian control for several years during World War II. And from there being hauled off with his family to the Nazi concentration camps as part of the Holocaust. Only Elie and two older sisters survived, their parents and younger sister killed in the camps, and the only reason Elie survived was by lying about his age, saying he was 18 and so able to work and prove useful to his captors. His life since then was marked with concern for the oppressed, and working to see that something like the Holocaust could never be repeated.

I think hearing the Kosovar refugees tell of the horrors that they were subjected to and witnessed brought back too many bad memories to Elie Wiesel. I could see it in his face, a look I can still see today, the effect all this was having on him. And in a low voice what he conveyed to me was his fear that this terror the refugees experienced was just going to carry on, was going to engender hatred and a desire for revenge, and the adults and the children playing their games were going to return to Kosovo with a desire to inflict on the Serbs what the Serbs had inflicted on them. It was this fear for the future that concerned him the most.

He writes in his report, “What I saw and heard there was often unbearable to the survivor that still lives in my memory. In fact, I never thought that I would hear such tales of cruelty again.”

His fear was that the victims would become the victimizers, seeking to wreak back onto the Serbs what their Serb neighbors had done to them. Toward the end of his report Wiesel expresses his concern for the future: “Their bitterness, indeed their hatred for [Serbian President Slobodan Milosevic] and his subordinates, will not fade away.”

When Wiesel was awarded the Nobel Peace Prize in 1986, the Norwegian Nobel Committee called him “a messenger to mankind.” But at the entrance to the U.S. Holocaust Museum in Washington, it is Wiesel’s words that are carved in stone: “For the dead and the living, we must bear witness.”

Other words spoken by Wiesel must give us pause for thought, though. Lamenting that his father had no grave at which he might grieve, he said, “”What can I tell him? That the world has learned? I am not so sure.”

In June 1999 and afterward, Elie Wiesel bore witness to the suffering and cruelty brought down on the Kosovar Albanians, and I think it added to his uncertainty that the world had changed since the Holocaust. But for me, a lowly embassy control officer, I will never forget his presence or his concern. In those couple of days, my life was truly touched by him.

Read Elie Wiesel’s full report to President Clinton here.

Photo by Remy Steinegger, World Economic Forum. Used with permission.

This piece also appears on Medium. Follow me there, and here.

Shell Game
The Biggest Shell Game in the World

The Biggest Shell Game in the World

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Healthcare has been all in the news these days with the U.S. Senate considering its version of whatever is to replace Obamacare. So it seems fitting to take a look at the intractable morass that is the American healthcare system. Which, as I see it, is better seen as the biggest shell game in the world, and as long as it is, resolving the issues surrounding it are likely to remain intractable.

You probably know what a shell game is. That’s the scam that sometimes crops up on city streets where the scammer, also known as a tosser, places a small ball or pea under one of three shells or cups, and then moves the shells or cups around on the table. The marks – people betting they can beat the tosser – have to guess which shell or cup contains the ball or pea. But of course the game is rigged, often with the ball or pea surreptitiously removed from the table altogether, so the marks lose their money. And that, of course, is the scammer’s objective. They’re not in the game for their health.

Now I don’t claim to be an expert on our healthcare system, but I’ve engaged with it enough and watched some of its inner machinations over the years to see how it resembles a classic shell game. You’ve probably seen it, too. How about those band aids that show up on the hospital bill for $8 (or whatever the current going rate is – a hospital in New Jersey charged a patient $8,200 for a band aid on a cut finger, plus $800 for a tetanus shot and a few other basic things). Or those $15 Tylenols, which can add into the hundreds of dollars during a typical hospital stay? And what about those nameless “specialists” who rush up to patients as they’re heading into the operating room so they touch the patient’s arm, crack a joke or two, and then send a sizable bill for hundreds or thousands of dollars for their “services.” And then there are those “itemized” hospital bills that can run pages long. Ever try checking one of those for “errors”?

I’ve done some research, too. For instance, the average cost of an MRI in the U.S. is $2,611. But price around to various hospitals and health centers, and you’ll find costs ranging from about $1,000 up to twice the national average (that’s what I found). Doing some number crunching, I determined the actual cost, depending on the rate of utilization and maintenance costs for any given installation, should be in the $250 – $500 range, which is close to what an MRI costs in Canada when paid for privately or with private insurance. The national average cost of a CT scan is $1,200, but the actual cost can range from $250 to $4,600. And during the discussion going on in the past week, I heard one person say they actually paid $9,000 for a CT scan. And that was after pricing around and driving something like 60 or 80 miles to get to it. What a deal!

The shell game doesn’t end there. A three-day hospital stay costs, on average, $30,000, and the average emergency-room visit runs $1,233. But I personally know of a case where someone was billed $6,300 for a four-hour visit where she spent most of that time sitting in a room by herself with a monitor draped around her neck. And that was 10 years ago. Yet, there are community health centers where one can be seen and treated for $20, or less. I’ve even had minor surgery at one of these centers, performed by a doctor, for $20. I can’t imagine what the same procedure would have cost had I gone to a hospital or private clinic.

Costs can also vary enormously, depending on whether one has insurance, the kind and terms of the insurance, is on Medicaid, pays cash, pays on time, or doesn’t pay at all. All these factors, which go to the heart of how our healthcare system is run and costs are assigned, guarantee these results. And the problems go beyond healthcare, reaching down into our educational system, where the outrageous costs of medical school cause medical students to run up enormous student-loan debt, often of a quarter of a million dollars and more. While eventually many of these medical graduates will earn significant salaries, the salaries for recent graduates and residents are a far cry from generous, falling in the range of $51,000 to $66,000 per year, before taxes, for an 80-hour work week. Taking that $51,000 figure, a new doctor working 48 weeks a year is averaging $13.28 an hour, less than many retail employees.

While the House, the Senate, the Administration, the Congressional Budget Office, and commentators on all sides of the current healthcare debate parse the finer points of the various bills and proposals on the table, the bigger issues seem to be lost in the cacophony. I can’t help but think that the special interests, the insurance companies and industry lobbyists, are given more consideration than the lowly patient. And whenever one hears the word “comprehensive,” it’s time to run for the exits since the fix is almost certainly in.

Perhaps the biggest issue of all concerns the near-complete divorce of healthcare costs from market forces. Healthcare providers, whether hospitals, private doctors, diagnostic labs, or clinics, are essentially businesses and, in aggregate, they form an enormous industry. In what other business or industry are costs not known, not set out in formal tariffs or schedules, and not subject to public scrutiny? Even airlines, for all their multitudinous fares and conditions, are forced to lay out their tariffs, and before customers buy tickets they know exactly how much they will cost.

While government regulates – to various degrees of effectiveness – the nature and quality of healthcare and medical practice, it does little to promote market forces. It is my contention that any healthcare provider should be required to post the rates or costs for any given procedure, action, or item. Even if there are different tariffs for different methods of payment, the consumer will at least have something to go on in deciding how and where to spend his or her healthcare dollar. And this will inevitably lead to price competition between providers and a brake on upwardly spiraling costs.

This divorce of healthcare costs from market forces also stems from how many Americans obtain their insurance, which is paid for or subsidized by their employers. There is no incentive for many Americans to price around (even if they could, given the price morass) and obtain the best bang for their buck. “Oh, the insurance will cover it,” is often the refrain. Now some insurance policies and plans do enforce certain limits on what providers within the plan can charge or be reimbursed for, and that helps control costs to some degree, but there is often a downside to the insured.

One downside is a limitation of choice, but the other side is the cost of administering these various insurance plans, approvals, billing, and so forth. In the U.S., 25% of healthcare spending goes to administrative costs. A full quarter of what we spend on healthcare. In our neighbor to the north, Canada, the administrative burden is half that – 12% – and most other countries have far lower administrative burdens than ours. Perhaps the only country that comes close to our burden is The Netherlands, with a 20% administrative burden.

While the U.S. often is criticized for lack of public support for healthcare, in fact our governments, federal, state, and local, spend more on healthcare than that spent by the governments of most other OECD countries. Overall per capita spending on healthcare puts the U.S. at the top of a list of 13 high-income countries – more than $9,000 per year, nearly three times the OECD average and more than double the next biggest spender, France – it is also near the top of the list of countries in public per capita spending on healthcare. Only Norway and The Netherlands spend more public funds on healthcare than the U.S., while Switzerland and Sweden rank just below the U.S. In fact, per capita public spending on healthcare in the U.S. is a third higher than in Canada.

What this indicates is that the U.S. does – and doesn’t – have a spending problem when it comes to healthcare. We’re certainly spending much more than what other countries are spending on healthcare overall, and even our public spending on healthcare exceeds what most other countries spend. But we’re not getting the results of some other countries in terms of total coverage of the population. And while it’s true that U.S. health results, measured in terms of life expectancy, infant mortality, and some other indicators, are below those of other countries even with our high outlays, there are mitigating factors influencing those results that are not as present in other countries.

By most standards, the quality of care in the U.S. is good, even excellent. And compared with other countries – including, again, our neighbor to the north – waiting times to see doctors, referrals to specialists, and to receive diagnostics and operations are significantly lower overall, though these can vary significantly from one area or region to another. While gaining access to the healthcare system can pose a challenge to many Americans, once that access is gained things tend to work pretty well, and better than in some countries with so-called universal coverage.

So where do we go from here? Okay, I have some ideas. These are my proposals, and while I can’t cite empirical data supporting their efficacy, I think they merit serious consideration and may allow us to gain control over this nationwide shell game:

● Introducing market forces by requiring all healthcare providers to develop, publicly post, and operate under specific costs and tariffs;

● Instituting public oversight of costs and charges of healthcare providers, including hospitals, clinics, private practitioners, and diagnostic labs, and allowing private suits and administrative processes challenging unreasonable or unsupportable costs;

● Encouraging individual initiative by expanding health savings plans where people can set aside a portion of their income to be applied to healthcare costs, and allowing them to roll over funds not expended from year-to-year;

● Encouraging employers to offer their employees allowances which employees can use to shop around and acquire their own insurance plans (often at lower cost than group policies), and further allowing tax deductions to cover insurance premiums and other healthcare costs;

● Allowing insurers to offer a variety of plans covering a range of services, and not requiring services that a given insured determines he or she is unlikely to need, such as mental health services or pregnancy coverage;

● Not restricting insurers to certain states but allowing them to operate across state lines;

● Taking steps to reduce the administrative burden and associated costs;

● Directing greater public funding toward community health centers and using these centers to provide health care, on sliding cost scales, especially to lower income and uninsured parties;

● Encouraging formation of healthcare cooperatives, both private and public, and allowing both insured and uninsured people to join them;

● Developing public policies and pressure to reduce the cost of medical education;

● Allowing write-offs of most or all debt or costs incurred by medical students in return for a certain period of service, at reduced salary levels, in rural and other under-served areas (as is done in some countries);

● Developing policies increasing the numbers of medical, nursing, and allied health students to address national shortages in these fields, applying the law of supply and demand to reduce costs and improve access;

● Applying both public and private initiatives to controlling the cost of pharmaceuticals;

● Instituting reasonable limits on medical malpractice claims to help contain the cost of malpractice insurance.

Again, I don’t claim to be an expert on healthcare, and I don’t claim to have all the answers. But I think these steps could go far toward expanding access to healthcare, controlling costs, and getting the runaway train of American healthcare back under control, without further straining public budgets. And it’s time we put a stop to the shell game inherent to the American healthcare system.

I welcome comments, criticisms, and other suggestions to what is said and proposed here. And please share this posting with your social networks and others who might have interest in the topic.

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Summer Solstice
Thoughts on “the Longest Day in the World”

Thoughts on “the Longest Day in the World”

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It’s June 21, the day of the summer solstice in the Northern Hemisphere, the winter solstice in the Southern Hemisphere. It’s a day that holds various meanings for different peoples, and its significance goes back millennia. The solstice, whether summer or winter, officially took place at 12:24 a.m. U.S. Eastern Daylight Time this morning, or 04:24 UTC.

Just to set the record straight and dispel any questions about my scientific knowledge, I know it’s not the longest day in the world. It’s the longest day of the year in the Northern Hemisphere, the shortest day in the Southern Hemisphere. But we’ll get to this a bit later.

It’s been a mixed bag today here on the West Coast of Florida. We’ve been having a lot of rain, something we didn’t have much of over the winter, and the rainy times are interspersed with sunny breaks. Right now, as I look out the window of my boat, the sun is mostly out but I’m looking at the light through rain-drop spattered glass. At least we’re not getting the effects of Tropical Storm Cindy, which is much further west and at this moment dumping lots of water on the upper Gulf Coast.

In this country, the summer solstice marks the official beginning of summer, though in other places and other cultures it marks the middle of summer, as indicated by the name Midsummer Night, which can occur anywhere from the 20th to the 24th of June. And really it is midsummer, since the days, which have been lengthening since the equinox three months ago, now will start to grow shorter, the nights longer.

The sun has reached its apogee in this hemisphere, as it stands today directly over the Tropic of Cancer. I feel summer ending, we already are on the downhill side, the side that will take us through the hot coming months but already on the slide back into winter, the cold time of year. Just as in the Southern Hemisphere the days will begin to grow longer as the seasons move back to summer.

A year ago on this day I was in Alaska, where there never really was a night. Where I was, well below the Arctic Circle, the sun went down sometime around midnight, but there was a kind of twilight that lasted until the sun rose again a few hours later. Above the Arctic Circle on this day, the sun never sets, and it truly is the Land of the Midnight Sun.

My thoughts turn to other things on this day. Someone asked me the other day, which was Father’s Day in the U.S., what thoughts I had of my father on that Sunday. But really, I think of Father’s Day as a commercial holiday. I also remember the last Father’s Day I had with my father, and how my mother did her unwitting best to create conflict between me and my father. While I may wish a happy day to the fathers I know on Father’s Day, it is today, the day of the solstice, that I think of my father. June 21 was his birthday, which in most years coincides with the solstice. I was told as a child that it was the longest day of the year, which I translated in my own way into it being the longest day in the world, and I would go around telling everyone who would listen that it was.

“It’s the longest day in the world!” I’d exclaim each year on his birthday, from morning until night.

I think today of my father on this day, the 21st of June. Gone now, for nearly 48 years. And I think back to the day of his birth, June 21, 1913. One hundred and four years ago. Even had he not died young as he did, just 56 years old, it is hard to imagine that he would still be alive today had he not died when he did. A prolongation of the inevitable.

A factoid I learned earlier is that today is not the longest day in the history of the world, as one might imagine it to be given that the earth’s rotation on its axis generally was slowing. Rather, the longest day in the history of the world is believed to be June 21, 1912, and things like the earth’s tides and recession of the glaciers have caused a slight increase in the rate of the planet’s rotation since then. My father was born a year later, which arguably could have been the second or third longest day in the history of the world, if not the actual longest day in the world.

I wonder what it was like on that June day, the day of the solstice, the longest day of the year, the day my father was born, in Jersey City, New Jersey. Did his father and mother, his Italian parents, my grandparents that I never knew, know it was the solstice? Did they even know of the solstice? Regardless, I’m inclined to think they did not think of it, if for no other reason than that they had something else on their mind that day. And then I think of the things people from then knew and were taught and how many of those things have been lost today, in these encroaching new Dark Ages in which we find ourselves, and I have to wonder. Perhaps they knew, better than most people today know. Or care to know. And they did note the auspicious day on which their son was born.

I’ll think of my father again on July 27, the anniversary of his death, and by then even our summer, the summer as we define it, will be half over.

The solstices, like the equinoxes, serve as a kind of punctuation for me. I watch the ebb and the flow of the days, the seasons, the years, and they mark the passage of time, time that increasingly slips by way too quickly. All of life is punctuation, I think. Slowing. Stopping. Breaking things, even waves on the water, into different parts, different pieces, different rhythms and fugues and movements and phrases and sentences. It is through such punctuation that we mark our lives, mark our transit through summer and back into winter, from day into night, from life into death. Watching, as a reader of a story does, while the time of our lives flows past. When we lose that punctuation, everything blends into one big mass, and we feel lost in the current, flailing and drowning as we’re pulled inexorably along. At least I do.

Enjoy this song, which I found today amid my files, and with which I end this post, and enjoy the time that nature and life give us.

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