Will Danes Adopt Preventive Health Care?

After the American Century

My vacation is drawing to a close and you can expect more postings here at After the American Century. In Denmark at this time of year there is little news, as most of the country has gone on vacation, including most of the politicians. Life seems a bit more pleasant without them showing up on the evening news.

However, there was one worthy idea, hardly new, in the news today, namely that all citizens ought to receive twice a year health check-ups. This was standard in the United States by the 1970s, and when I arrived in Denmark in 1982 and was assigned to a doctor, I immediately went by his office to get acquainted. I assumed there would be a physical examination, to establish a baseline for my future care. The nurse and receptionist were cordial but bemused. Regular physical exams were not part of the procedure, and amazingly, they still are not. In other words, while Danes have a free (tax supported) health system, it does not focus on prevention, only cure.

By now the health system has a pretty full record on me, or anyone else who has been treated for various ailments. Yet this record is a bit haphazard. Measurements of weight, blood pressure, and the like are not taken in a systematic manner, and there is no baseline to measure progress or deterioration.

Unfortunately, this "new idea" has been launched at a time when no one is paying attention, because the country is vacationing. But regular examinations is essential to a preventive health program, the goal being to keep citizens healthy rather than wait for them to fall ill. And while it might look expensive, studies show that preventive health programs save money, because problems or worrying developments are caught sooner.

Readers outside Denmark will probably be amazed that the health system has not yet grasped this basic idea. But for those who know a bit about it, this is not surprising, as Danes generally are not quick to learn from outsiders. I know many foreign-born permanent residents who have said for years that preventive medicine ought to be the national policy. But it is hard for outsiders to get a hearing. This, however, is a story for another day.

Climate Changes Faster Than Lawmakers

After the American Century

The climate is changing more quickly than lawmakers are. We know that species of fish along the coastlines are moving out from tropical zones into new areas. For example, fish not seen before in the North Sea have arrived because its waters have become milder. We know that summers are getting longer, that hurricanes are becoming stronger and more frequent, that the glaciers covering Greenland and Antarctica are melting faster each year.

Researchers at MIT plug statistics from such developments into a computerized model of the world's weather system. They include projected economic growth rates, and run hundreds of simulations, to see what might happen given different combinations of factors. Their latest findings are dire. Global warming is occurring twice as fast as previously thought, and they project a global temperature rise of 5.4 C by 2100. Their worst case scenario is a change of more than 9 Celsius. Most of southern Europe would likely become desert. The only good and fair thing is that in the US the predominantly Southern politicians would see their constituencies dry up or sink under rising seas.

We have now had quite a few such studies, but they have not led to major efforts to change human behavior. Every year the world has more CO2, more coal-fired power plants, more cars, and more electricity use. And this is true for almost every country. The United States House of Representatives, with only a small majority, has passed a law (that still must be approved in the Senate) which recognizes the problem and begins to take some mild measures toward change. It is not enough, although it is good to see the United States begin to take responsibility for its pollution. Meanwhile, the nations that signed the Kyoto Accords, promising to lower their CO2 levels have little reason to be smug. Most of them have failed to live up to their promises.

It may be that human beings are just not capable of long term planning. Is it possible that the time horizon of the brain remains somewhere between one to five years? However, it will take decades to replace existing housing and transportation systems with energy saving alternatives. The problem of global warming must be confronted immediately, because it will take decades of concerted action just to slow it down. Permanent changes in energy use are needed, but most governments have done far less than they might.

A small case in point. The Danish government put together a stimulus package for the economy, focused on home repairs and improvements. I applied for money to insulate the last remaining part of our house that is not insulated. The application was turned down, emphasizing explicitly that insulation was not covered. Now my little job will get done anyway. But does it make any sense for the Danish state to pay for such things are painting and wallpapering, but not insulation? Such policy mistakes tell Danish citizens that climate change is not really on the government's agenda. (Not that this surprises me. The government created a little independent agency, as a special platform for a prominent denier of global warming who is a statistician, not a scientist.)

Many national economies are shrinking, yet global warming is speeding up. Politicians do not yet realize that the goal can no longer be just to keep economies expanding. The old, high-energy form of expansion is at the core of the global warming problem.

Global warming is not merely a technical matter awaiting some technological fix that will make it go away. It is a problem of changing human behavior, including prohibitions and incentives built into the laws of each nation.

Danish Ministry of Education Fails Again

After the American Century

An independent study that cost 312,000 kroner, has found out what any experienced teacher could have told us for nothing in less than a minute. News flash: Students will cut more classes if they can get away with it. What a revelation!

The 2005 "education reform," brought in against the advice of many teachers, has markedly increased the number of gymnasium students who skip classes. The Danish Ministry of Education should have been able to figure out what would happen if they weakened attendance requirements. It used to be that no student was allowed to miss more than 10% of the classes - which was already a liberal requirement compared to many nations. Now, thanks to the 2005 "reform" there are entire schools where all students on average skip classes more than 10% of the time. Another triumph of the bureaucrats over the teachers!

During the last quarter century the Ministry of Education has repeatedly demonstrated little understanding of students, teachers, teaching, or the academic calendar, much less morale building. Had a foreign foe set out to undermine the educational system, it might have pursued the same policies as the Danish Ministry of Education. If other nations want to know how to sabotage an educational system, here are the main points.

- Drown the teachers in bureaucratic paperwork, so they have less time in the classroom.

- Cut back on the money for short courses and seminars, so that teachers no longer will have as much chance to develop their competence.

- Reward schools not for quality but for quantity, and pay schools only for students who pass. This will encourage teachers to let more students slide through without learning much.

- Should a student be caught for plagiarism, pay the school nothing, but insist on elaborate procedures so that teachers will learn that catching students who cheat is unrewarding, unpaid work. Also, make the punishment for plagiarism mild.

- Eliminate the already relaxed attendance requirements, and let students graduate even if they have missed as much as 35% of all their classes.

- Redesign the grading system, making it less nuanced, and pressure teachers to give higher grades. (At the same time, make the new grading system unlike that in any other nation, so no one outside the country can understand it.)

- As much as possible, let students dictate what subjects the teachers will teach, and at the same time underfund school libraries so there is less likelihood that materials will be available. Cut back on funds to buy new textbooks.

- Let school facilities deteriorate, especially bathrooms, but also more generally, so that the school is not an attractive place to be.

- During years of national budget surpluses make sure teacher salaries increase more slowly than in the private sector, so that the profession becomes less and less attractive. (Indeed, tacitly support national PR campaigns launched to attack the humanities, urging all students to study "practical" subjects.)

- Demand that teachers use the latest computer technologies, but do not put money in the school budgets to buy, install, and maintain the equipment. Also, do not set aside time or sufficient funds to train teachers in how to use the equipment.

Historians will one day wonder why a wealthy nation like Denmark misused its resources and undermined its educational system and demoralized its teachers. They may wonder how the Minister, Bertel Haarder, could have made so many mistakes for so many years without being fired. But they will realize that the Ministry of Education as a whole was a vast, growing, incompetent parasite that ate up resources and may have been beyond the control of anyone. Furthermore, bad as he was, Haarder was by no means the worst minister in the government between 2001 and 2010. Indeed, it is hard to pick a "winner" among so many self-assured incompetents.

The REA and Obama's Health Care Plan

After the American Century


As debate rages in Washington about how to reform the health care system, it might be useful to look at another government program that stepped in to help people who were not being served by the private sector. The program I have in mind was created 75 years ago and has been a great success. Roosevelt called it the REA, or Rural Electrification Administration.

How is this like heath care? Back in c. 1935 roughly 90% of rural people lacked electricity. Private power companies said it cost too much to build lines out into sparsely settled areas, and farmers often did not use that much electricity even if they had it. As with health care, 25% or more of the population lacked an essential service.

Whenever a politician suggested that government step in to provide this service instead, however, he or she was immediately denounced as a socialist or a communist or an unrealistic dreamer. But the REA was created, providing power to rural people, which had important health implications. With electricity, dairy farms could become more hygienic, for example, and all farms could have refrigerators, washing machines, and hot running water. Farmers also had fewer accidents, because they did not have to manoeuvre in the dark with a lantern in one hand. But to keep the focus on the fiscal bottom line, the rural electrical cooperatives as a group proved to be a good investment. The loans need to start them up were paid back, and the rural coops have not become a permanent burden on the federal government, not least because farmers gradually used more electricity.

The analogy with health care admittedly is not perfect, but note that the Obama idea of creating a public health care option is not so different from the idea of creating a public electricity option. In each case the plan is that people will pay their own way, but without unnecessary costs. Indeed, one reason that President Franklin Roosevelt wanted the REA (and also the Tennessee Valley Authority) was to find out what electricity really ought to cost. The public programs became a yardstick, measuring real costs for service, disciplining the private companies.

One more important point. When the REA was created, the Republican Party denounced it as socialistic, and predicted the demise of private power companies. In fact, the private power companies continued to grow all through the Great Depression, and today they still control the vast majority of US power generation and transmission. The REA has also prospered, and there really is not much debate about this any more.

Similarly, if Obama convinces Congress to create a basic health plan that any American can choose to have, private health care will continue to flourish. There will always be people who want to buy more elaborate care in fancier waiting rooms with less waiting time. But the point is that, as with the REA, everyone will have access to an essential service.

Just as the REA made farmers healthier and more productive, universal health care in the United States will make the nation healthier and more productive. The Obama plan could also save a good deal of money. The US consumer pays far more per capita for health care than the Dane or or the Dutch or the Norwegian or the German consumer. Almost twice as much, actually.

The Iranian Crisis

After the American Century

Neda Agda-Soltan, the young woman in the photograph on the left was shot and killed while standing on a side street in Tehran. She was not a political activist and not involved in a demonstration at the time. She was studying philosophy at the university, and taking singing lessons. She died on the spot, as the bullet had hit her heart. She has become a symbol of the movement questioning the validity of the elections and condemning the vicious suppression of freedom of speech, the denial of freedom of assembly, and the oppression of women in Iran.

The Iranian election has been a failure, indeed a textbook example of failure. When the public perceives elections as fair and orderly, the result is not only accepted, but the government gains legitimacy, as it clearly receives a mandate from the people. The consent of the governed is essential. But when more than 100% of the voters in some areas are counted, clearly the election is a fraud. When some ballot boxes are mobile, mounted on the backs of trucks controlled by one party, clearly the election is a fraud. When thousands of extra ballots are printed, and yet there are shortages of ballots at many polling places, clearly the election is a fraud. When national candidates supposedly "lose" in their home districts, clearly the election is a fraud. When the count of more than 43 million hand marked ballots is announced shortly after the polls close, clearly the election is a fraud.

Iran is really a sham democracy, because power is ultimately lodged not in the hands of the people but in the fists of a theocracy that is ready to crush opposition. In the past week the clerics who really control the nation have used intimidation, censorship, arrests, violence, and threats of more violence to try to silence opposition. The naked use of force is itself a sign of lost legitimacy. A large percentage of the population clearly think the government is lying and that it stole the election.


The theocracy that rules the nation itself is now split between two groups, pragmatic forces and the hardliners who hold power. Both are strongly Muslim. Both defend the right of Iran to develop atomic power and missile systems. Both see themselves as the true heirs of the Iranian Revolution against the Shah.

As the crisis deepens, the Iranian government is trying to claim its problems are the result of foreign intervention. This is nonsense. The West is largely powerless to shape events, other than to bear witness. The last thing that Europe or the United States wants, however, is an unstable Iran at war with itself. The region is already unstable enough in neighboring Iraq and Afghanistan, not to mention Pakistan. Ironically, the crisis in Iran comes in good part because the US has ignored that nation of late. Without an external foe to distract attention from its internal problems, Iran has begun to unravel.

In short, there seem to be no good outcomes. Iran may emerge as a more totalitarian Muslim state, or it may endure a period of civil unrest and division. But it does not seem likely that the more moderate and pragmatic group will prevail easily or soon, if ever. To see where this crisis is going, watch the army. If it is unwavering in support for the current regime, then expect more repression. If the army wavers (i.e. stays in the barracks), then expect blood on the streets.

Meanwhile, the EU and the United States realistically have little control or influence over the outcome. Conceivably, the Russians might eventually play a role. Guess where the Iranian president went immediately after he was declared the winner? Moscow.

The Great Firewall of China

After the American Century

The Chinese government has ordered all computer makers to pre-install a censorship program on new computers. (See New York Times for details) This is to begin in less than two weeks, on July 1. Will the big computer firms stand up to the Chinese on this? Hewlett Packard and Dell have asked the government to reconsider, and clearly the world's computer makers are not comfortable with the plan. But will their belief in democratic principles of free speech be strong enough to withstand the fear of profit losses?

China already has a bad track record on censorship, and makes great efforts to prevent the flow of information or dissent on certain issues. James Fallows has written a penetrating article on this, based on his experiences of (trying to) use the Internet inside China during the Olympics last summer. But evidently the Chinese government feels that blocking many sites and trying to control the flow of information through monitoring is not enough. It wants to have direct control over every single PC in the country. It wants an impenetrable Great Firewall.

The importance of the Internet in promoting freedom of speech is obvious in the present crisis in Iran. There, too, the central government is trying hard to block all communications with the outside world. The Iranian government already controls and censors the newspapers, radio, and television. If it had a Chinese style program installed on every PC in the country, then control might be absolute.

At moments like this, one can only hope that programmers who believe in free speech will develop ways to disconnect or disable the censorship software. Fortunately, there are quite a few computer people who want cyberspace to be free of censorship, notably those who set up the Electronic Frontier Foundation.

The naked Chinese challenge to the computer industry should worry anyone who believes in freedom of speech and democracy. It is more than dismal to contemplate a major nuclear power that crushes Tibet and thwarts all criticism. The twenty-first century may well turn out to be "the Asian century." Will that mean a century of greater censorship, more dictatorship, and trumped up xenophobia? Iran may provide part of the answer in the coming weeks, but so too will China, if it succeeds in stifling the Internet.

In the next two weeks, will any governments speak out against the Chinese plan? Or are markets more important than principles? Centuries ago China spent vast resources building a Great Wall to keep out the barbarians. It ultimately failed to do this, and one can hope the same will be true of the Great Firewall.

If you want to find out if any site is censored out of existence in China, check out greatfirewallofchina.org

Who Should Be Paid for Danish Research?

After the American Century

The Danish universities are moving to what labor historians would call a "piece rate system." That is, money for research will be paid not on the basis of weeks or months devoted to research, but rather on the basis of how many items are produced.

A new form of exploitation may emerge in this system. Exploitation is a strong word, so let me be clear what I mean by it. Workers are exploited if another person or institution is paid for their work. If I build a wall, and someone else, not me, gets paid for my work, that is exploitation.

Is something akin to this happening in Danish universities? Quite possibly. Every university has a number of recent PhDs who have completed their studies and who teach part time. (In many cases they are paid only as teaching assistants, which I think should not be allowed. Once you have a PhD, the proper title and pay scale should be that of external lecturer.) My concern is that these recent PhDs do not have research appointments. They only are paid, and rather badly, for their teaching. Nevertheless, they do their best to publish articles and books, for that is the surest path to full-time employment.

Who gets financial credit for a recent PhD's publications? I have asked around, and it seems that these new PhDs are encouraged to register their work, i.e. put it into each university's database. The system's acronym is, ironically enough, PURE. But there is nothing "pure" about hiring people only for their teaching and then including their research in the university's productivity. Why should the university be paid for publications by people whom it does not employ to do research? How would you feel if, outside your regular job, you painted a picture or renovated a car, and then suddenly your employer was able to send a bill to the government for that work, while you got nothing?

Is this happening? I fear it is. I know for certain that when university departments undergo accreditation reviews, the publications of recent PhDs at times are included in the statistics. Admittedly, this is a gray area, because typically these publications are portions of a PhD thesis, rewritten into articles. And the PhD thesis was written while on a research appointment. Nevertheless, it does not feel entirely right or fair. And for how many years can a university claim the publications of its recent PhDs?

Note too that retired faculty also may continue to publish. Can or should the Danish universities be paid for this work, which again they do not support financially?

There is a simple solution to this problem. Pay the writer for a publication directly unless he or she has a university research contract. This would mean that if a person does not have university employment, they could still be rewarded. Why should the government pay the university for the completion of research it did not support? Why should a scholarly publication by a private individual be worth nothing, if a publication produced by a university employee automatically releases funding?

To see the absurdity, translate this into agricultural terms. Imagine that there are university farmers who are paid for the crops they grow. Imagine that there are private farmers who are paid nothing for their crops. And imagine that university farmers find ways to claim the production of the private farmers, in order to get a completely unearned additional subsidy. Who would think that a fair policy?

The Danish universities do not seem to have quite reached this form of exploitation, but they appear to be headed that way. No one consciously planned this situation, which rather seems to be an unintended outcome. But it has dire consequences. If such a system is allowed to flourish, then universities will profit if they can produce many PhDs, keep them around as poorly paid part-time teachers, and claim credit for the research they do on their own. This is presumably not what the government wanted to do by introducing a piece-rate system.

[For critique of the new bibliometric system itself, see March 21, 2009
The Bureaucratic Dream of Quantifying Research Results

Iran Delegitimizes Its Election

After the American Century

Elections are the central events in democracies, giving voters the chance to reject some candidates and embrace others. A fair and free election strengthens the rule of the people, as both winners and losers learn to accept the will of the voters. But the farcical election in Iran does none of these things. No one can seriously believe that only two hours after the polls closed that the 46 million votes had been counted. No one thinks that all the opinion polls taken before the election were wrong. They showed a close race, with no one likely to get a majority. Yet shortly after the polls closed the government could announce that what had appeared to be a close contest actually was a lop-sided landslide, in which the incumbent received almost two-thirds of the vote.

Democratic elections also include extensive public discussion about what happened and reconciliation between the winning and losing candidates. But in Iran the government has used tear gas to break up rallies, shut down internet sites, intimidated opposition politicians, and cut off the use of text messaging. In doing so, the Iranian government throws further doubt on the legality of the election, enrages the opposition, and disqualifies itself. It is an insult to world opinion to pretend that this has been a free or fair process.

Once again, the educated, middle-class Iranians have been robbed of the opportunity to build a modern state that is part of an international world of states. Instead, critics who claim that Islam and democracy are fundamentally incompatible have another dismaying example for their arguments. But I remain hopeful that one day Iran will peacefully join the larger world as a democratic state. I say this because of the passion for justice, fairness, and democracy demonstrated in the election campaign. Sadly, however, it appears Iran will inflict much suffering on itself before reaching that goal.

Democracy in Iran?

After the American Century

I have followed Iranian politics, casually to be sure, for almost half a century. This is for the simple reason that I had an aunt who married an Iranian lawyer and remained in the country after originally going there to teach. She had a Ph.D. in linguistics from the University of Michigan, a somewhat unusual achievement for a woman in c. 1940. There were few university jobs available then (i.e. probably none), and so she took a series of interesting positions working for the US government in agencies that were precursors for the Peace Corps. First she taught in Bolivia and Peru. where she perfected her Spanish. Later she taught English in India briefly, before ending up in Tehran.

My Aunt Gertrude was a powerful personality. Think of the strong women in American cinema from the same era, like Kathrine Hepburn. She was adventurous, eloquent, forceful, and a wonderful role model for a kid growing up. Th exotic aunt who not only had a professional job, but a series of positions in many parts of the world.

She gave most of her professional life to improving the teaching of English in Iran, putting in more than 25 years before the Shah's government fell. By then she was over sixty years old, and because she was perceived to be an old woman, she was left alone by the Revolution. This is not the place for more about her, but she remained in the country for several more years, until it became clear that she would never be allowed to teach or take an active part in the cultural life of the nation again. Then she returned to the US, with her Iranian daughter, who still lives there today. Aunt Gertrude herself lived to be over 90.

Now let me read this little story as a minature version of what has happened to Iran. Until 1979 the nation was modernizing rapidly, using its oil money to develop a middle-class. This middle class embraced foreigners like my Aunt, who had married one of their own, who spoke the language, and who had only the country's betterment at heart. But the growth of this middle-class also brought discontent with a monarchical form of government. The urban middle class wanted a democracy and more western form of government. But the rural people and the poor disliked the Shah for quite a different reason, because he was secularizing the society. Religious fundamentalism swept through the country, and the exiled Ayatollah Khomeini became the idealized leader who would return Iran to its religious roots.

The problem in late 1970s was that not enough people like my Aunt Gertrude had been there, nor had they been there long enough, to nurture the transition to a secular, democratic state. The forces against the Shaw were strong enough to topple him, but there was no unity amongst the university students, peasants, and religious leaders who together brought him down. In the ensuing power struggle, obviously won by the fundamentalists, many of the talented young (like my cousin, Aunt Gertrude's daughter) left the country for ever.

In the election yesterday, the struggle appears once again to be between city and country, between middle class and rural peasants, and between modern Muslims and fundamentalists. The basic inconsistency, the core problem that came to light in the late 1970s, has not yet been resolved. But the terms of struggle have changed someone. For no truly secular figure had a chance in this election. Rather, the two leading candidates were each to the right of where their counterparts might have been thirty years ago. The current President Ahmadinejad is a right-wing demagogue who revels in confrontation with the West. His strongest opponent , Mir Hossein Mousavi, is a former prime minister of the country, and generally defined as a "right-wing reformer." This I translate to mean that his policies are at least informed by economic theory and pragmatic evaluations of consequences. A liberal he is not.

Both men have claimed victory. The government began playing games with the telephone system during the election, controls the media which all too-quickly announced a decisive victory for the incumbent, and has already used police to break up peaceful demonstrations in favor of Mousavi. Ideally this crisis will end well, with a run-off election between the two main candidates, as prescribed by law if no one receives more than half the votes. But it may be too soon for such a disciplined and secular outcome, and Iran could be falling into an intractable crisis.