Ammunition for the US Health Care Debate: JAMA Compares Systems and Canada Wins

Last month's Journal of the American Medical Association had an interesting comparison of health care in the US and Canada. It shows that choice--that American bugaboo--is not limited in Canada. It's worth passing on to those who are wavering on whether to support health care reform in the US.

Note: I've copied this from the on-line edition of JAMA which is not readily available to the lay reader.

Health Care Choices and Decisions in the United States and Canada
By Joseph S. Ross, MD, MHS; Allan S. Detsky, MD, PhD
JAMA. 2009;302(16):1803-1804.

Media speculation about the scope of proposals for health care reform in the United
States has led many Americans to be "very concerned" that changes will limit their
choices in the future. Health care choices are made on 3 levels: insurance plans,
sources of care (physicians and hospitals), and clinical decisions (diagnostic tests and
treatments). In this Commentary, the extent to which Americans currently are able to
exercise choices is discussed. For context, the US environment is compared with that in Canada, partly because the Canadian health system, with much greater government
involvement, is often publicly portrayed in the United States as limiting choice.

Insurance Coverage
United States
All US citizens, other than those aged 65 years or older and the very poor, make the choice to purchase private health insurance (or not). It is estimated that nearly 47 million individuals have no coverage. It is unknown how many choose not to purchase coverage, cannot afford coverage, or cannot obtain coverage. Uninsured persons are severely limited in all other health care choices. They must either receive charity care or pay for care out of pocket, possibly incurring substantial debt or bankruptcy. The choice of insurance plan is also often limited; 96% of US
Metropolitan Statistical Areas have insurance markets that are highly concentrated, consolidated among only a few companies. Employers who offer health insurance also frequently limit choices. One plan is often established as preferred and made less expensive through lower premiums and co-payments. Few working adults can afford to purchase plans outside of their employer because other plans' costs and risks are neither subsidized nor pooled. In addition, loss or change of jobs often results in loss of insurance coverage or substantially higher payments to retain existing coverage.
In contrast, insurers have the choice to accept or deny individuals coverage for innumerable reasons, often related to prior or current medical conditions. They may even deny coverage among those they insure for specific care related to preexisting conditions.
Canada
All Canadian citizens and landed immigrants are eligible to receive health insurance through the government-sponsored plan administered by their province or territory. Because the application process is simple, without screening for current or preexisting health conditions or means testing, unenrolled individuals who seek care are routinely enrolled by clinical practices and hospitals, removing the need for charity care. Insurance coverage is not tied to employment and so does not change with loss or change of jobs. The Canadian government mandates that all provincial plans cover "necessary care," including most physician and hospital services. However, there are private insurance plans to obtain coverage for services that are not covered by some provincial plans, such as pharmaceuticals, private rooms in hospitals, dental care, home care, physiotherapy, and chiropractic care.

Hospitals and Physicians
United States
The choice of hospital or physician is often made by an individual's insurance plan. Whether structured as a health maintenance organization, preferred provider organization, or otherwise, most plans attempt to limit costs by designating hospitals and physicians, offering either discounted coinsurance or additional benefits to promote their use. Receiving care "out of network" requires that individuals pay substantially larger co-payments.

Health insurance plans often require individuals to choose a primary care physician on enrollment who arranges referrals to specialist physicians. Forty percent of sicker adult Americans report difficulties seeing a specialist, 40% because of long waiting times, 31% because of a denied referral or waiting for a referral, and 17% because they cannot afford private insurance.

Choice is also influenced by availability of care. The United States ranks last in international comparisons for patients finding it somewhat or very difficult to obtain care on nights or weekends without going to an emergency department.5
Canada
Canadians may choose to receive care from any physician or hospital anywhere in Canada. Typically, a family physician provides primary care and makes referrals to specialists. There is no limit to the number of different physicians a patient can see. If patients are not satisfied with the care of one physician or hospital, they may change to another. Specialists generally require a referral from another physician (not necessarily the family physician) to be reimbursed for a "consultation" but can evaluate any patient and be reimbursed for an "assessment." Individuals may present to any hospital emergency department and request specialty care,which is scheduled as long as the emergency physician, who has no incentive not to, agrees.

Diagnostic Testing and Treatments
United States
The common presumption is that there is access to every new diagnostic test, procedure, medication, and intervention in the United States. However, insurance plans make use of formularies that restrict medications. Generally, at least 1 medication in any pharmacologic class is offered among "first-tier" medications, for which co-payments are the least expensive. Choosing less expensive or generic medications is also facilitated by requiring prior authorization for brand-name medications when a generic alternative exists or by offering 1 medication in a class at a lower co-payment after contracting with the manufacturer to obtain a discounted price.Similarly, although many routine, less expensive services are not restricted, prior authorization is often used to limit the use of expensive health care services such as magnetic resonance imaging or experimental interventions.

In international comparisons, US waiting times are consistently shorter for elective surgeries and procedures. However, even though physicians and hospitals generally are able and willing to provide care quickly and efficiently, insurance plans are not necessarily similarly willing to fully reimburse charges. Often, it is not until after the procedure and utilization review that patients become aware of the substantial portion of the payment they must incur.
Canada
Virtually all health care services available in the United States are also available in Canada. There isregionalization of specialized services, such as surgical, oncology, or imaging procedures. For services unavailable in all parts of Canada, such as gamma knife surgery, governments will reimburse care received in the United States, but patients are required to apply in advance. In contrast with common perception, Canadians' use of elective health care services in the United States is not common.For care in Canada, there is no utilization review and all services are covered in full without co-payment. Physicians and hospitals are paid promptly by the government. Patients receive no bill and fill out no forms. However, as opposed to prior authorization, the use of expensive health care services is limited by supply; there are fewer facilities per capita that provide this care. Provincial and private drug plans use formularies similar to those in the United States.

Waiting time is less a health care issue than a political one. Both federal and provincial governments haveresponded to media-facilitated public pressure to reduce wait times for specific services, such as hip and knee replacement, cataract surgery, cancer surgery, and emergency care through strategies that resemble pay for performance.Moreover, there is provincial variation in reliance on private facilities that charge individuals directly for common diagnostic services (eg, blood drawing, imaging); some provinces have allowed (or tacitly encouraged) these facilities, allowing patients to choose to pay for some routine care to receive it sooner.

The Bottom Line
Government-sponsored plans like Canada's are frequently publicly portrayed as limiting choice. However, there is clear evidence that for Canada's health care system, less choice in insurance coverage (although guaranteed) has not resulted in less choice of hospitals, physicians, and diagnostic testing

Saturday Photo: Hortênsias, Azulejos and Memories

Today this photo, taken in June when the hydrangeas (hortênsias, in Portuguese) were in bloom, is a bit of celebration. As I've said. before I've been struggling to learn to speak and understand oral Portuguese. For the last several years I've been able to read it with some facility, but the oral language, particularly as spoken in the Mother Country itself, has been a mystery.

But thanks to a great class at the Université de Montréal taught by Luís Aguilar and Vitália Rodrigues I've made great progress this fall. It helps that the other students are motivated and great fun--four of us fogies over 55, a half dozen Hispanophones, several people who are itching to return to Brazil because they had such a great time on holiday there, and one young guy whose parents came from Angola at least 25 years ago.

Thursday Luís and Vitália showed us the website they've been developing about Portuguese language and culture, which includes links to Radio-Televisão Portugal. They showed us part of the previous night's news, and I found that I could understand almost all. What a change from last winter when I watched clips from RTP news regularly, but was completely lost.

Hence the photo. Hydrangeas grow as hedges on São Miguel which is where most of the 40,000 Montrealers of Portuguese descent have their roots. You find them planted in tiny front yeard gardens all over the center city neighborhood where the first wave of immigrants settled. You'll also find tiles--azulejos--decorating entrances just as you do in Portugal. This summer I set out to take a series of photos to document them--as the original owners age, they are selling their places to people who may or may not appeciate the tiles--and this is one of the nicest.

Would Nudity Work Better Than Buy Nothing Day to Stop Consumerism: Some Thoughts of a Wild Cat General Strike

Today is Buy Nothing Day, an international protest again consumerism. It was launched to be a counter-weight to Black Friday, which is when American merchants finally go into the black in the run up to the Christmas holiday. In Europe and other places, tomorrow, November 28, will be the day.

The organizers are calling for "a Wildcat General Strike. We’re asking tens of millions of people around the world to bring the capitalist consumption machine to a grinding – if only momentary – halt.

"We want you to not only stop buying for 24 hours, but to shut off your lights, televisions and other nonessential appliances. We want you to park your car, turn off your phones and log off of your computer for the day.

"We’re calling for a Ramadan-like fast. From sunrise to sunset we’ll abstain en masse, not only from holiday shopping, but from all the temptations of our five-planet lifestyles."

I'm not sure what effect this kind of campaign will have. Those who are concerned already have begun to cut their foot prints on the earth: if you never bought a clothes dryer, it's not going to be a sacrifice to dry your clothes in the air after all.

Just as importantly, those whose lives are empty of meaning except for what they consume will not be reached by such Puritan-like appeals. Making frugality sexy is going to take some doing--although going without clothes might help.

Well, Lee bought The Globe and Mail today, but I think that's all we'll buy. Now this gray panther (who paid her dues as a wild cat) will go down to the basement to hang up the clothes on the line to dry. But no nudity here: it's too cold even if we're not too old.

This Just in: Harper to Go to Copenhagen

The CBC news just reported that Prime Minister Stephen Harper's office has announced that he'll go to Copenhagen after all.

Now it remains to be seen if he'll say anything interesting,.

Quebec on the Right Path When It Comes to Green House Gases, Schwarsnegger Says While Harper Hides

What’s wrong (or right) with this picture?

Jean Charest is getting praise from Arnold Scharzenegger, but it looks like Harper will be a no-show in Copenhagen. The Republican governor of California has just praised Quebec’s announcement about amibitious plans for green house gas reductions.

“Like California, Quebec is not waiting for national and international commitments; they are taking action now to reduce emissions and dependence on fossil fuels,” he’s quoted as saying.

“This is another example of a subnational government leading the way and I look forward to more commitments and partnerships from all levels of government in the fight against global warning as we head into the 2009 climate conference in Copenhagen next month.”

I’m no fan of Jean Charest—or of Republicans either—but moves in this direction are not to be sneezed at. That Quebec plans on focussing on transportation is all to the good too. Despite its great distances, the province’s cities have not-bad records when it comes to encouraging public transportation. But real, permanent green house gas reductions, to say nothing about solutions to problems of continued dependence of petroleum, will only come when our cities become more compact.

Will that happen in Quebec? Maybe.

Will it happen in California? Who knows. This former California girl has her doubts. But at least Scharzenegger is going in the right direction, which Stephen Harper, stuck in Ottawa and beholden to Alberta petroleum interests, is not. More than 50 heads of government have confirmed for Copenhagen, but Steve may be occupied elsewhere, opening another doughtnut plant or something.

Photo: Daylife, taken October 2, 2009 at Governors' Global Climate Summit 2

Little Cat Feet or Temperature Inversion: Quiet in the Middle of the City

Lots of background noise this morning when I woke up—it’s an effect I’ve noticed frequently lately as temperature inversion layers settle over Montreal. Then when I walked into a cloud/fog as I climbed Mount Royal in the cemetery, I noticed how progressively quieter things became, until at the top the roar of traffic appeared very distant.

There are climatological reasons for this, it seems. To make a long story short, sound is deflected downwards by the inversion which acts sort of like a lid on the bustle of the city in the morning. Up the mountain, one is above the inversion and hence above, literally, the madding crowd.

The phenomenon can be explained in equations, but I prefer Carl Sandburg’s poem Fog, from his Chicago Poems.

The fog comes on little cat feet.

It sits looking over harbor and city on silent haunches and then moves on.

Photo: Fog in the summer cemetery

Quebec to Cut Green House Gases by 20 Per Cent Compared to 1990, But the Problems Isn't Solved

Montreal has a smog alert today as it has several times in the last two weeks, which is a little ironic, considering that yesterday Quebec Premier Jean Charest pledged to cut the emissions by 20 per cent compared to 1990 by 2020.

On a per capita basis, the province's emissions would drop to eight tonnes, considerably less than Quebec’s previous target of 11 tonnes per capita. In comparison, the European Union targets are nine tonnes per capita, while the Harper government aims to reduce them to something around 22 tonnes.

Charest said that the biggest effort will go to reducing emissions linked to transportation, currently making up 40 per cent of the total. Most of Quebec’s electricity is generated by hydroelectric plants, so coal-fired power is not an issue.

But still on days with temperature inversion layers we get smog. Local officials have begun to attack the winter problem, which is exacerbated by use of wood for heating. But the kind of hydrocarbon smog we have today would seem to be mostly transport-created. Certainly for the last few days it has smelled the way it did when I was a kid in Southern California when smog was an unrecognized problem.

We need to move quickly on providing better public transportation, and to expand programs to encourage walking and bike riding as ways to get around.

Photo: Good traffic day on Montreal's Métropolitain boulevard/Highway 40.

Quality and Media: Maybe the Key to Having Many Voices Survive Is Making a Voice Distinctive

This morning I dropped by a corner store I hadn't been in recently, and couldn't find where they're keeping their newspapers these days. I had to ask, and while I was looking around for The Globe and Mail, a man jokingly said it was on the side with the "pagan" papers--those in English.

I laughed and said we get Le Devoir at home, but because it's cheaper in my neighborhood to buy The Globe in a store, we don't get it delivered.

Ah yes, he said. He and his wife get La Presse daily, but he picks up the Journal de Montreal on Mondays for the sports.

Small matters: sports, the vagaries of newspaper delivery routes. But as I started home, I reflected on what a good thing it is to have several newspapers to choose from. Even if much of the news is the same, there are differences in coverage and emphasis. Strong, differing editorial voices should be heard too.

Only two of the four newspapers we spoke of this morning are in reasonable health, however: La Presse has just exacted major concessions from its unions in order, management says, to stay afloat financially. The Journal de Montréal locked out its employees nearly a year ago over similar issues of salaries, hours and convergence of tasks. (Check out the locked-out employees online newspaper Rue Frontenac .)

Le Devoir, however, is counting down to its 100th anniversary with brio. Its circulation--never very large but concentrated among Quebec's educated leaders which gives it influence far beyond that Le Devoir's stats might indicate--is actually growing. And the Globe appears to be doing quite well, thank you very much, continuing to have correspondents in Washington, New York, China, India and Africa, as well as bureaux in several Canadian cities.

Moral: quality of content matters in getting and keeping readers. Publications aiming at the lowest common denominator are frequently doing worse in this time of media trouble than are those whose standards are higher

Saturday Photo: Bixi Getting Ready for the Winter

Montreal's bike rental program is winding down for the season, after providing more than 1 million trips around the city. Since the first of November, the numbers of Bixis available has been cut, and November 30, the system will shut down for the winter.

A great success, most observers say. Certainly people who might never have ridden a bike to run an errand have begun to do so. Even I, who hate to ride bikes, have begun to think that maybe next year I ought to try it.

Last week I ended up taking a taxi to the Université de Montréal--a trip I make on foot in 35 minutes--that got stuck in traffic. I ended up paying $15 and arrived in only 10 minutes less time than I would have, had I walked. But as I watched the bixis peddling past the taxi on the bicycle path, I realized that grabbing one of them would have been much faster and certainly cheaper: the sign up fee for a day is $5, with the first half hour of a trip free (subsequent first half hours are also free: the idea is not to provide bikes for long trips, but for short ones.)

Well, we'll see if I get up the courage next year.

Carpe Diem and Rain Boots : Notes on the Mois des morts

"Henry Pharris, ring bearer, wore L.L. Bean rain boots with his navy blue blazer and khakis." The Daily Star, November 5, 2007

This is a rainy day when we will attend the funeral of a good friend and neighbor Michel Freitag. November, they say here, is the mois des morts, partly because it begins with All Souls' Day, and partly because the weather is usually gray and the days are growing very short. This year we have had record sunshine, but death is closer than usual. Besides Michel, this week has seen funerals for our brother-in-law's mother as well as that of the best friend of another neighbor.

Against this somber background, it was a delight this morning to find the account of the wedding two years ago of Christian Monberg and Michelle Lafrance. I stumbled on it following a track back from this blog: it's amazing where lateral thinking on the net can lead you. At any rate, here is the link to the account of their wedding, which sounds as if it were lovely. And Henry Pharris must have looked marvelous! (I remember when Lukas, aged three or so, insisted on wearing his red rain boots everywhere too.)

Best wishes to the whole Monberg-Lafrance-Pharris family. To the Freitag-du Pasquier family also. Carpe diem!

More Proof That PPPs Are Bad for Health--and Many Other Things

Public private partnerships (PPPs) to build mega hospitals were foisted on Quebec by politicians and bureaucrats who made biased calculations, the province's auditor general says.

In his report, released yesterday, Renaud Lachance reports that planning and building the two super hospitals (one based on the Université de Montréal medical school and the other, on McGill's) would have been cheaper using methods used to construct major projects in the past. The arguments for PPPs were deeply flawed and PPPs have cost far more than conventional project management, planning and financing would have.

Lachance also revealed several instances of collusion and lack of oversight in the awarding of contracts for highway construction and repairs. His careful study adds ammunition to growing criticism of how the current Liberal government has run things in recent years. And the way he demolishes the arguments for PPPs should lay to rest any idea that using the partnerships profits anybody but the people hired to consult, design and build the projects.

His report comes too late to do much about the hospital projects, but it should be read with care by anybody who wonders about how to manage a society. Never forget that private companies are ALWAYS in business to make a profit, and far too often profit comes not from efficiency but from getting all that be gotten from the public purse.

Tremblay Acts Like a Good Christian in Appointing Bégeron to Montreal's Exec Committee?

A bit of drollery from Radio Can this morning:

Apparently newly re-elected Montreal Mayor Gérald Tremblay’s spiritual advisors are very happy with his decision to include Richard Bérgeron, leader of one of two opposition parties, on the city’s executive committee.

After all the Sermon on the Mount says: "If someone strikes you on the right cheek, turn to him the other also,"(Matthew 38) and Tremblay's made that a lot easier by putting his leftist adversary there.

Going to be some fights, do you think?

Recycling Household Waste Is Going to Be Tough, and It's Not Clear Whether They've Got That Leaf Thing Right

The Quebec government says it wants to ban "green" and recyclable waste from landfills within a decade, starting with paper and cardboard with the aim of lowering average household waste from 810 to 700 kilograms per year. It announced Monday that it will be earmarking $650 million over the next ten years for projects, including new recycling sites.

That’s good news in the main, altough as always the devil will be in the details. If we’re talking mostly about things like garden waste and grass clippings, there should be few problems. But when it comes to kitchen scraps, I can see major difficulties.

Let me say that I’ve been composting ever since we move in this house, more than 30 years ago, so I know just how scraps can stink if you don’t handle them right, and also what a mess you can have if you spill a container full of stuff ready to go on the compost heap. By now I’ve got the hang of it, so except in years when we have so many pears that they ferment in the compost, we don’t have smell. That's the result of trial and error, though, and I don't think it would be wise to leave much to chance if you want to get everyone recycling kitchen waste.

What will be needed is a concerted campaign to educate people on what they can compost—egg shells maybe, but no meat scraps, for example. And the pickups have to be absolutely reliable, otherwise people are just going to bundle things up and put it all out for the regular trash collection. We have run into that this fall, when pick up dates for leaves have been unclear: it seems that most folks have either just raked everything into the street, or put leaves in garbage bags. That's no way to solve a problem.

The Power of Song II: Scenes from Portugal and Brazil

More Portuguese music today: The first is "Fado Tropical," by Chico Buarque de Holanda. It's sung and played against the background of newsreels from the Portuguese Carnation Revolution in 1974 where that country peacefully overthrew a dictatorship nearly 60 years old. At the time, Brazil was also under a military control, and the song caused great waves there, since it was seen as a protest against what was going on there.

The second clip is from a multi-part BBC documentary on Brazilian music. Its history is far more than "The Girl from Ipanema", and, like Pete Seeger, it demonstrates the Power of Song.

Saturday Photo: Fall in Kamloops, an Old Railroad Town That's Now a Regional Centre

Last weekend I was in Kamloops, British Columbia, a town on the confluence of two branches of the Thompson Rivers. Its history as a settlement goes back to fur trader days (although the First Nations were there long before then) and at the end of the 19th century it became a major railway center.

Those days are past: the major employers now are a pulp mill, regional health facilities and Thompson Rivers University. The scenery is spectacular in that pared-down arid, Western way, and while I was there the weather was wonderfully sunny.

Véhicule Cleans Up--Or Vicki Marcok's Most Excellent Advice

Going to see your publisher can be most rewarding, sometimes in unexpected ways.

Wednesday I dropped by the Véhicule Press offices with the proceeds from the books sold at the Fields of Walking last weekend in Kamloops. I filled in Simon Dardick, Véhicule’s co-publisher, and Vicki Marcok, the general manager on the conference. Then I said, rather sadly, that the next thing on my agenda—having exhausted all the interesting tasks--was digging the house out since I’d been so busy lately that grime was everywhere. That is when Vicki gave me the best household hint I’ve had in years.

“One part dish soap to two parts vinegar,” she said. “A friend told me about it a couple of years ago. Put it in a spray bottle, spray it on, wait five minutes and wipe it off. Terrific.”

She’s right! Got rid of almost all the burned-on crud in the oven, took grease off the walls behind the stove and shined the bathtub to a brilliance not equaled in years.

The last is particularly rewarding as the tub is a big old one with iron feet that we had refinished several years ago with acrylic. At the time, the contractor warned us not to use abrasives or harsh cleaners on the surface. Since then it slowly has gotten dingier and dingier, despite frequent and energetic applications of elbow grease, fancy-dan green-style cleaners, baking soda, and vinegar on its own.

But Vicki’s miracle solution really was one: the collected whatever rolled off the surface without much effort and what was left rinsed off with clean water. The last step, I suspect, is important, because if you don’t you’re likely to have leave residual soap film that will collect more grime.

Hey, Simon: got a sure-fire bestseller for you. Have Vicki do a “Secrets of Successful People” book, featuring their household hints, and beginning with hers!

Charles and Camilla: A Real Love Story, and Encouragement for Constant Lovers Everywhere

Prince Charles and Camilla, the Duchess of Cornwall, have been in Canada this last week, making the hearts of monarchists palpitate and tongues of fashionistas spew venom about the second Mrs. Prince's dowdiness. Ordinarily I don’t pay much attention to either, but before they go back to the UK, I think it’s important to note that theirs is a real love story, one that is much more uplifting than that fairytale involved Diana Spencer.

Camilla and Charles met when they were 23 and 21 respectively, but even though sparks apparently flew, their romance was stifled because Royal Family advisors thought Charles too inexperienced to marry. Officially they went their separate ways, Camilla marrying a military man 8 years older than she, and Charles marrying a beauty who shared few of his interests. But both marriages broke up in the 1990s, in part because of their continuing affair, although it wasn’t until 2005 that they finally married each other.

So a romance begun nearly 40 years ago continues today. That’s not bad at all. What a shame they weren’t allowed to follow their hearts at the beginning. As for Camilla’s fashion sense: well, she looks to me like a woman who dresses for her age and who is happy in a relationship that took far too long to come about. Good on her...and him too for recognizing the value of a love and a lover who have grown over time along with you.

Let Sorrow Be a Lesson on This Rembrance Day

On this Remembrance Day, a study in contrasts: The statue on the left is one in Parc Saint-Viateur in Outremont, while the others are from the Cenotaph in Westmount. The latter is of a clean, confident soldier protected by an angel. The former, despite its "Glorious Victory" cry, shows the sorrow of war.

It is no accident that one Montreal suburb--an Anglophone one--chose to celebrate a triumphant army while the other --considered to be Francophone--mourns. Anglophones in the two World Wars were far more ready to fight than Francophones, even though it is clear from the list of the dead in Parc Saint-Viateur than many Francophones fought and died too.

Never forget that: "War is Not Healthy for Children and Other Living Things." In the long run it is saner to mourn than celebrate.

Photo of Cenotaph from westmount.org

And What If Plato Had Been Written Down Digitally? The Dangers of Relying Too Much on High Tech Records of Our Culture

Three things this week have started me thinking about the dangers involved in consecrating all our thoughts to electronic media. The first is the latest chapter in a philosophy text that Lukas has been translating for the last several months from French to English. He’s just about done, and I’ve agreed to give it quick look to see if I can suggest any changes to make the English more readable. So far what he’s given me chapters on the presocratics, Plato and Aristotle, which reminded me how much of the thought of the Ancients has been lost, and how much we owe to Arab scholars who kept the texts alive during the long centuries when the West had forgotten them.

Then last weekend when I was at Kamloops, I discovered to my surprise that one of the prime movers (to indulge in a little philosophic joke) was philosopher Bruce Baugh, whose students quoted me Plato and Socrates as we were walking around town Saturday morning. I was impressed once again at how long lasting is the influence of those thinkers of ancient Greece.

Thirdly the Writers’ Union of Canada’s list serve has been buzzing about the demise of the book as we know it: the latest link was a link to an Inside Higher Ed story of a debate among librarians about whether libraries should just forget about print. The story starts off: “Let’s face it: the library, as a place, is dead,” said Suzanne E. Thorin, dean of libraries at Syracuse University. “Kaput. Finito. And we need to move on to a new concept of what the academic library is.”

But what happens when the electronic media on which we are storing journals and scanned books deteriorates? Who is going to keep up with changes in storage technique? Is anyone anywhere printing all that stuff out so that someone can access it in a low tech way?

I fear not. Twenty years ago there was a great hue and cry about switching to acid free paper in order to safeguard books since so many printed between 1850 and 1950 were beginning to fall apart. We seemed to have solved that problem only to begin conserving our collective wisdom on even more delicate media—on and off circuits which we need specialized equipment to read.

The Fall of the Berlin Wall, and the Search for a New Enemy

Twenty years ago I was in San Diego, preparing to move my parents to an assisted living residence in Bellingham, Washington. My dad was not at all well, and during the summer it had become clear that they had to move 1) out of the place they were and 2) closer to me in Montreal or to my sister Laurie in Vancouver, BC. They vetoed any move east because of the cold and flatly refused to allow us to start the process of bringing them into Canada as sponsored immigrants. That was a mistake, but at that point Laurie and I were still learning how to be adults in relation to our parents, and we didn't argue too much.

Laurie did the footwork and found The Leopold, an 1920ish hotel converted to a retirement residence in downtown Bellingham. Our parents loved it--you can get an idea of the place from the fact that it had a Cheers-style bar downstairs and a ballroom with chandeliers where ballroom dancing still is a feature--and our mother stayed on for a couple years after Dad died in January 1991.

But it's that window in time--November 1989 to January 1991--that I remember today. As we sorted through their belongings and packed boxes in San Diego, we watched the fall of the Berlin Wall and the flood of people from East to West all over Eastern Europe. It was exhilarating, and my parents, who had lived most of their lives under the threat of war, Cold and Hot, were as pleased as everyone else at this promise of a more peaceful planet.

By the time Dad's lung cancer (because that was what was beginning to eat through his body 20 years ago) struck him down 14 months later, that great hope had evaporated. He died the day that George Bush père announced the beginning of the West's first 20th century war in the Persian Gulf, and his funeral was held the day that troops of the US and its friends attacked Iraq.

My mother always said she was glad that he was not aware of what had happened, that the nightly news programs were full of promise for a better world up until the last weeks before his disease removed him from combat.

What opportunities have been squandered in the last 20 years! What happened to the Peace Bonus? Are we as a species constitutionally unable to live without enemies?

Saturday Photo (a Little Late): Asters, the Last Flowers of the Year

First, an apology. I had this post ready to roll before I left on Thursday, but something happened and I erased the photos accidently so I couldn't post it until this morning. Now, back in Montreal (and more about the trip later) I can put up the picture on the right, taken earlier this fall when the asters were at their height, and the one on the left, taken last week when the leaves were off the trees, but the asters were still hanging in there.

When I came in last night I saw that the flowers are all gone, as are the leaves. Fall is technically here--but it also seems that we're in for a few days of Indian summer before it really gets cold.

Miles Davis Is Coming to Montreal

Yes, yes, I know he's been dead for years, but the greatest trumpeter ever will be featured next summer at the Musée des beaux arts, it has just been announced. I don't know what to think of these exhibitions which cater to popular culture--some of them are great fun--but they certainly seem to bring in the crowds who may also take advantage of the Musée's permanent collection to widen their horizons. Is this dumbing down the museum experience, or simply building an audience?

Whatever, I'm looking forward to the Miles Davis show. To while away the time, here's the YouTube clip of him playing while a lovely Jeanne Moreau wanders around Paris thinking that her lover has betrayed her. The film is Louis Malle's 1957 debut, Acenseur pour l'échafaud, or Elevator to the Scaffold. A great film noir :

Family Reunion Coming Up Thursday Night

Off to British Columbia. The official reason is to give a talk at a conference at Thompson Rivers University in Kamloops. But, since getting there requires flying to Vancouver and then flying back to Kamloops, I'm going a little early to see my niece Kristin, her husband and dogs. And, as luck would have it, Elin is also going out to give a concert with Les voix humaines for Vancouver Early Music, so we'll be able to travel together and then have a little family reunion. My brother in law--Kris's dad--will be coming up from Seattle to have dinner with us too. Should be great fun!

The Song I Can't Get Out of My Head: Blame It on the Portuguese

Learning Portuguese is taking a lot more effort than I had originally thought. No, that's not true, because I've been struggling with the language for several years, ever since I got interested in seriously looking at the Portuguese and their heritage. Learning how to read it was pretty easy, and since before my trip to São Paulo in 2004 I've been reading newspapers, magazines and history books.

Oral comprehension and expression weren't advancing at all, though, so this fall I started taking classes at the Université de Montréal. Luis Aguilar and Vitália Rodrigues teach the class twice a week for three hours, and I come back wrung out but exhilarated. What's more I'm beginning to understand!

One of the exercises on Monday was to listen to this video of Manuel Freire singing The Philosopher's Stone, a poem by António Gedeão. It's really lovely--reminds me of Jacques Brel--and I've been humming it ever since the class.

Good News on the Greenhouse Gas Front: US Emissions Are Down. Now the Question Becomes, How to Keep Them That Way

Straight Goods editor Penney Kome passes on a bit of good news via a recent analysis of where we are in the greenhouse gas emissions fight. Lester R. Brown, of the Earth Policy Institute and who has been on the case for years, says that things are actually much better than they were two years ago. US. carbon emissions have dropped 9 percent since 2007, in part due to the recession, but also from efficiency gains and fuel substitions.

Brown writes” As motorists turn to public transit, and also to bicycles, the U.S. car fleet is shrinking. The estimated scrappage of 14 million cars in 2009 will exceed new sales of 10 million by 4 million, shrinking the fleet 2 percent in one year. This shrinkage will likely continue for a few years” as fuel enconomy standards come into effect and the increased use of hybrid and all-electric cars.

To those who point out that the electricty for these vehicles has to be generated somehow, he answers thatt: “not only are electric motors three times more efficient than gasoline engines, but they also enable cars to run on wind power at a gasoline-equivalent cost of 75¢ a gallon.”

He adds: “We are headed in the right direction. We do not yet know how much we can cut carbon emissions because we are just beginning to make a serious effort. Whether we can move fast enough to avoid catastrophic climate change remains to be seen.”

One caveat should be considered here, though: when fuel efficiency standards were introduced after the 1970s petroleum crunch the gains were very shortly frittered away in making more powerful vehicules, not capitalizing on the economies. We must not fall into the trap this time. Denser living patterns will have a longer lasting effect than short term dips mandated by standards that some people may try to get around.

Did Montrealers Just Take a Walk on Sunday, or Were the Last Polls Faulty?

The Montreal municipal elections are over, with a majority of voters turning their backs on incumbent mayor Gérald Tremblay. He’ll still be mayor though because of the way the vote split between three main candidates. He received 37 per cent of the votes against 32.3 per cent for challenger Louise Harel and 25 per cent for Richard Bergeron.

The latter’s showing amounted to a moral victory since in August, he was polling less than 10 per cent. Harel’s score was a disappointment to her partisans, given that polls made last week showed Harel ahead in a much closer, three-way race.

What happened will be scrutinized by political junkies for months. One thing is clear: either the electorate was extremely volatile in the last few days, or the polls were faulty.

Angus Reid, one of Canada’s biggest polling firms, had been tracking the race for a couple of months and announced on Friday that Harel should receive 34 per cent to 30 per cent for Tremblay and 32 per cent for Bergeron. The poll was done by internet among members of Angus Reid’s carefully selected panel of respondents. The firm argues that internet polls are probably more accurate and certainly easier to do than conventional telephone polling, since increasingly people with land line telephones won’t respond to polling firms while pollsters can’t access cell phone users.

In a marketing document prepared last December, Angus Reid boasts that its internet polls were more accurate than those of other polling firms during recent elections—even calling the 2008 provincial election within less than a percentage point. But if you look at its stats, it seems that smaller, left-leaning parties always poll better than they do on election day. That may be because Angus Reid’s universe of possible respondents may over represent them.

Cold feet on election day may also be a factor: how many people switched from Bergeron to Tremblay at the last minute because they were overcome with doubts about whatever when they entered the polling place?

And it was a gorgeous day: maybe people who were having trouble making up their minds just took a walk: turn out was less than 40 percent of registered voters.