Text 4 a Little Holiday Magic

Christmas Eve has always been my favorite day of the year. December 24, 1969,I was on my own, living in my first apartment. With several hours to fill before joining my family at Mother's, I decided to do a little last minute shopping.

On the third floor of our city's oldest and finest department store, I bought a large basket of gourmet cheeses, smoked oysters, a bottle of wine and wineglasses to take to my family. On my way down, the elevator stopped at the second floor, where everyone but an older couple and me got off - and where a tall, handsome man in a navy suit got on. We started down again; then suddenly, there was a loud thud. The elevator jerked, then stalled. We were stuck - on Christmas Eve!

Luckily the elevator was equipped with a phone, and the older man called someone in maintenance, who assured us we would soon be moving again. Thirty minutes passed while we made small talk, then placed another call. We learned that the elevator needed a new part and we were in for a long wait.

At that point, one by one, we - the older couple, Mr. and Mrs. Phillips; John, the handsome man in navy; and I - sat down on the floor and began sharing Christmas memories. An hour passed, then two; we found ourselves so involved in the conversation that we forgot we were trapped. As we took turns revealing bits and pieces of our pasts, we shared my basket of cheese and wine. I didn't realize it at the time, but what we were doing was creating another special Christmas memory.

After five hours, the elevator finally moved. When the doors opened, the worried store manager, relieved to find us in such good spirits, handed out gift baskets of gourmet cheese. Saying our good-byes, the four of us exchanged addresses and promised to send holiday greetings to each other in the years to come.

I got to my mother's for our traditional family Christmas - a bit late, but I got there. As I closed my eyes that night, I saw not visions of sugarplums, but a handsome man in a navy suit.

Christmas evening I returned to my apartment loaded down with gifts. Waiting for me was a single red rose and an envelope slipped under the door. Inside the envelope was a message: I could really use some help with this cheese basket. John. At the bottom was his phone number...

John and I were married the following Christmas Eve in a sunset ceremony on a Hawaiian beach. That was many years ago, and we are still exchanging Christmas greetings with Mr. and Mrs. Phillips and enjoying a basket of gourmet cheese and wine for our midnight snack every Christmas Eve. And I still wake up every Christmas Eve morning filled with excitement at the magic of the day.

Text 5 My Sergei

Not long ago I heard someone ask a friend, "If you had to live your life over again, what would you do differently?" I've thought about this, and for me, I'd like to live my life over again backward. I'd like to live in a world where tomorrow would be yesterday, the day after tomorrow two days ago, and so on. Any day I'm living now, I would exchange for any day in the past because I know that for me to find the kind of happiness I had with Sergei isn't possible. It's like trying to find the comet that was in the night sky last spring, which passes Earth once in seventeen thousand years. No matter what lies ahead, the best years of my life will have been with my Seriozha, and those years are now laid rest.

With Sergei and me, everything was natural, almost inevitable. First we were skating partners. Then we were friends. Then we were close friends. Then we were lovers. Then husband and wife. Then parents. I lived in a world in which I always had my favorite thing to do, which was skate. Then, God took Sergei away from me at the age of twenty-eight. Sergei died without warning of a heart attack on November 20, 1995, during a routine training session in Lake Placid, New York. I lost my husband and best friend, the father of my daughter. I lost my favorite thing to do, because now I had no seating partner. It's like I was living in a fairy tale before, and now I've been abandoned in a wild forest.

That is what life with Sergei was like, a fairy tale. It began the year I turned eleven. The pairs coach at the Central Red Army Club in moscow where I had skated since I was four, told me to come early to practice one day. He had chosen a skating partner for me. I was very excited because I knew it was going to be Sergei.

I had never spoken to him. I remembered seeing him on the ice with the older boys, and he was slender and narrow and handsome. But Sergei was so much older than me—four years, which at that age seems like a lifetime — that I'd never thought it possible that we'd someday be paired together.

As a pairs skater, you have to learn everything you learned as a singles skater over again because you have to align your body with your partner’s. Sergei and I practiced the jumps endlessly. I was never scared of the lifts because I always felt very safe in Sergei's arms. I'm not sure why, but once we were paired, I always believed Sergei was the only one who could skate with me.

Several years passed, we both grew up some more, and we began preparing for the 1988 Olympics. As the games approached, everything became a little more stressful, a little more intense. In mid-November, during practice for an exhibition, Sergei caught his blade in a soft rut in the ice while holding me aloft and dropped me. The first part of my body to hit the ice was my forehead.

I didn't feel any pain at first, then my entire head felt like it was splitting apart. I blacked out and was driven to the hospital. I ended up staying for six days. I'd suffered quite a serious concussion. I lay there worrying about missing practice and the Olympics, and I was mad at Sergei because I thought this fall was his mistake. Then, there was a knock on the door, and it was Sergei.

He was carrying a dozen roses, and he was very, very upset. It was the first time he'd given me flowers. I was surprised, even happy to see how distressed he was. It was another week before I was allowed on the ice, and Sergei continued to visit me at home every day. When at last I could skate again, I immediately noticed a change in the way he was holding me. Something had happened in those two weeks, and I realized that his thoughts for me had changed. Before we had been like two skaters. After that, we were a pair.

On December 31, we were spending New Years with my family. Sergei and I sat at a table and talked. He said, "I want to tell you something." But whatever it was, he was having trouble saying it. Then, he said, "Why don't we kiss?" Something like that. It wasn't really a question. He could probably see I wanted it, too. He gave me a gentle kiss on the mouth and when he saw that I liked it he gave me one that was longer.

I remember walking afterward and listening to the cold crunching of the snow beneath our footsteps. The fields were all blanketed in white, and the moon gave us shadows. It was so beautiful, and I was so happy. I wondered, why me? Why am I so lucky? I was so young and small and shy, and Sergei could have had any nice long-legged. Why should he choose me? I believed he would love - just for a little while, and then it would be over.

We went on to win the gold medal at the 1988 Olympics in Calgary, Canada. And the following year Sergei and I were married, and our daughter, Daria, was born a year and a half later. Then in 1994 we won our second Olympic gold medal in Lillehammer, Norway. The first gold medal we had won for the Soviet Union. This one we won for each other.

Text 6

CURRENCY AND PRICE REFORM IN RUSSIA

The establishment of a free market economy depends on the estab­lishment of a stable currency with relatively stable money values (prices) as a medium of exchange. Without a stable currency and prices indi­viduals will be hesitant to convert goods and services into cash, resulting in falling trade leading to falling demands and less production.

As the market depends on stable currency and prices, stable cur­rency and prices can be established only when all the conditions for a free market economy are met. In the absence of free market conditions, the freeing of prices leads to inordinate increases in prices due to short­age of supply and monopolistic control by industries. If at some stage during a transition from a highly regulated to a free market system prices

are freed from bureaucratic control before all the essential conditions for free competition exist, prices rise dramatically and spiraling inflation en­sues. This has recently occurred in Russia.

From this perspective, the inflation is a symptom of a deeper prob­lem resulting from the continued existence of constraints on competition. These constraints may be in the form of legal barriers to entry and exit, control over raw materials or retail distribution networks, monopolistic domination of industries, or restrictions on purchase and sale of private property. But once it is let loose, the symptom, inflation, becomes an ad­ditional factor preventing the market from establishing itself, like the fever resulting from infection which caused it and must be treated first.

If free and stable prices can only be established under conditions of free competition, then it is impossible to demand them as a prerequisite to introduction of an unregulated market. On the other hand, if the with­drawal of introduction of controls on the free market can only be safely established under conditions of stable prices, then some means are needed of reconciling these two a priori conditions.

Conditions in Russia are not conducive for creating a free market economy. The free market is based on complete freedom of production, distribution and consumption. It cannot be introduced in a society in which government insists on controlling and interfering in the economy. The market is governed by free will, not by decree. Also, it cannot be introduced in a society in which the people expect and demand the ad­vantages of subsidized, command economy prices alongside the ad­vantages of ample supply, which the market economy generates.

Nowhere does the free market exist in a pure and full sense. In every country the government interferes with the functioning of the mar­ket in the light of the country's social goals. This tampering with the mar­ket, influences the relative value of various goods and services and overall value of the currency. The market can bear a certain degree of interference and still continue to function. Beyond a certain limit, it breaks down and the currency loses its value.

Russia started out with a command system in which the level of in­terference is so high that it prevented the market from functioning effec­tively. It has introduced many reforms to achieve greater freedom, in­cluding freeing of most prices. Yet the reforms have not yet reached the point at which there is sufficient freedom for the market to function effec­tively. As a result, prices have risen to unrealistic levels and interest rates are exorbitant.

Without rationalizing prices, life will become impossible both for pro­ducers and consumers. Yet a proper rationalizing of prices demands creating free market conditions that do not exist today. The question is weather there is a strategy that can be employed during this transition period that will foster a smooth and rapid transition? We propose a rem­edy.

In spite of monopoly conditions and government interference, the free market may already exist and function in some areas fairly well. These areas do not require assistance. In other industries the continued existence of monopoly or regulation results in prices that are artificially high. In these areas, the first step is to identify the factors that constrain free competition and to eliminate them as far as possible. Once done, there will still be a gap between current prices and what would exist un­der a truly free market. That gap can be measured to determine true market prices in the manner employed to determine the pricing by water, power, telephone and other utility companies in the USA. Approximate market prices can be introduced as administered prices during a transi­tion period in which competitive conditions are established. Once true prices have prevailed for some time, even if some constraints continue to exist, lifting of the administered prices is unlikely to result in a return to the higher monopolistic prices.

In its origin, money has no inherent value of its own. Its value is only as a medium of exchange. In addition, it has acquired value arising from its capacities for preservation, investment and lending. Under free market conditions, money has no other value. However, in a market subject to regulation and interference by government this value of cur­rency is distorted. Constraints on production and fixed prices create an artificial currency value.

The difference between the prices prevailing under regulated conditions and the prices that would prevail under free market conditions is one measure of the artificial currency value of the economy. The greater the difference, the higher the artificial value accorded to^-the cur­rency, the higher the prices and the lower the actual domestic purchas­ing power of the currency. This value is directly influenced by actions of the government to control production, limit distribution, print more money, determine interest rates, etc. Up to a limit, these actions have moderate impact on the currency value. Beyond a limit, they destabilize and destroy its value. It should be possible to measure the artificial value of any currency as the average of the price distortions to all major goods and services. Once this value is ascertained, it can be utilized to esti­mate the level of price distortion in the economy due to interference and to determine appropriate "market equivalent" prices for goods and serv­ices.

Assuming that prices in Russia during the transition period are ar­tificially high due to constraints on free competition and that the level of

constraints exceeds the tolerable limit for the functioning of a free market economy, the first step would be to reduce the constraints as far as pos­sible so that prices gravitate downward toward their free market level.

Once this is done, it should be possible for economists to esti­mate the difference between prevailing and free market prices and to arrive at a set of administered prices that approximate free market con­ditions. If these prices are introduced and maintained for a period of time, they become a standard for "real" prices. The operation of the economy with a set of real market prices will help rectify the imbalances and distortions that have crept in and enable the economy to stabilize.

During the interim period efforts should be made to remove re­maining constraints to competition. If prices are then set free at the ap­propriate point in the process, the removing of administered prices should not result in any major fluctuation in prices.

Russia is attempting at a rapid transition from a command econ­omy to a market economy and has taken significant steps in that direc­tion. However, the structural impediments to change are extremely great. Monopolistic conditions exist in most industries. Nearly all property re­mains in the hands of the state. There are considerable barriers to es­tablishing new enterprises, expanding production, transporting and dis­tributing products. It could take years to remove all the major obstacles to free competition.

Meanwhile, the government has moved vigorously to free prices for almost all commodities. Under the present non-competitive conditions, this has resulted in soaring prices and spiraling inflation. Inflation is an additional destabilizing factor that further confuses and impedes devel­opment of the free market. Sky-high prices are likely to persist until the structural impediments to competition are brought down to a tolerable level in which market forces can act to establish an equilibrium.

The first phase of market reforms has caused a major dislocation of the economy as well as extreme pains to the population, so great is the disturbance that the government is under considerable pressure to slow or backtrack on its present course. Since the barriers to competition cannot be eliminated in the short term, there is little hope for relief from the present predicament, unless an alternative strategy for the transition is adopted. The question is whether any alternative strategy can resolve the dilemma. Our conclusion is that it can.

If it is conceded that the basic cause of the inflationary spiral is the residue of the old command structures of industry and trade, then the highest priority must be given to replacing these structures with those of a market economy. Freeing of prices will only be successful when it is accompanied by proportionate introduction of other attributes of the free market - private property, free entry and exit from industry, free flow of goods, control of monopolistic concerns, etc. Since most prices have already been freed prematurely, the highest priority should be given to measures for political deregulation of the economy.

Political deregulation can only partially create conditions needed for the free market to operate. The implementation of appropriate measures and the response of the economy to them will take time. Even if fully im­plemented, these measures are unlikely to meet the minimum conditions required for the market to function effectively. In this case inflation and instability will continue, the economy will continue to collapse and the market may never get established.

Granted that market conditions cannot be fully introduced in the short term, during the interim period prices need to be stabilized in some way. Some control on prices will have to remain in force until the market establishes itself. After exhausting the available opportunities for political deregulation, economic deregulation of prices should be utilized to move the economy further in the right direction and establish a stable currency.

It should be possible to determine the minimum distance the economy still has to travel toward deregulation in order for the market to function and to calculate the price levels that would naturally be obtained at the point. Administered prices for essential factors could then be intro­duced to force prices down toward their free market level. This action, would help counter-inflation, stabilize prices and approximate market conditions, thereby helping the market come into existence.

A team of leading economists can evolve a package of appropri­ate prices. If the government is convinced that the policy is sound, it can be projected to the people. In view of the great havoc being caused by the price spiral, it is likely to be received sympathetically and eventually accepted.

This approach would only involve controlling key prices during an interim period. During that period all efforts would be taken to create all essential market conditions. Prices would be adjusted and eventually released at the point when the market is functional and controls are no longer needed.

Garry Jacobs, Robert McFarlane, Moscow News

Text 7

HEALTH CHALLENGE: GETTING BASIC CARE TO THE URBAN POOR

NEW YORK – Two weeks ago, Earn Lloyd staggered into the Mon­tefiore Medical Center emergency room nearly comatose, nearly blind and barely able to walk.

Doctors discovered he had severe diabetes, which kept him in the hospital for the next 10 days. But Mr. Lloyd’s more serious medical problem was the lack of a decent general doctor, which for him and hun­dreds of thousands of others in New York’s poorer neighborhoods turns treatable outpatient diseases like diabetes into life-threatening condi­tions.

In wide stretches of inner-city New York, there are only a handful of doctors, and virtually none who offer patients a reasonable standard of primary care.

The severe shortage will make President Bill Clinton’s health careplan, or any alternative, difficult to achieve in these areas that most need help.

The president proposes to guarantee coverage for all, and plans to enroll the poorest in health-maintenance organizations. But unless there is a dramatic improvement in the quantity and quality of inner-city doc­tors, policy experts say, many patients will still head to the emergency room for their care.

“I don’t care what kind of health care card you’re carrying, it won’t help you if the doctors and facilities aren’t there,” said Ronda Kotelchuck, executive director of Primary Care Development Corp. in New York, a new organization to finance the building of clinics in underserved areas.

The number of doctors willing and eager to practice in the poorest neighborhoods, always inadequate, has dwindled to practically nothing in recent years because of low Medicaid reimbursement rates, the threat of violence and the shifting focus of medical education away from general doctoring and toward specialty training.

A 1990 survey by the Community service society of New York found 701 doctors serving a population of 1.7 million people in parts of Harlem, Brooklyn and the south Bronx. But only 28 doctors – or 3.9 per­cent – met minimum federal standards for decent primary care.

Many did not accept Medicaid, were open less than 20 hours a week, did not provide after-hour coverage in case of emergencies, and did not have admitting privileges at a hospital.

“The snapshot was bleak, and there was a concentration of older physicians who were nearing retirement, so we have every expectation that the situation has gotten worse,” said David Jones, the society’s president. The society is a nonprofit organization that is concerned with issues like the health and housing of the city’s neediest.

For patients like Mr. Lloyd, the lack of reasonable primary care means that coughs are neglected until they become pneumonia, and chronic conditions like asthma, diabetes and hypertension – which are generally controlled under the supervision of an attentive doctor – go untreated until patients are so sick that they need an ambulance.

Mr. Lloyd said he dutifully kept his monthly appointments at a grimy storefront clinic – even though the doctor there never spent more than eight or nine minutes with him and never examined him before refilling prescriptions for pain and high blood pressure.

And when he fell desperately ill on a Saturday, he had no other choice but to use an emergency room. The clinic is closed on nights and weekends, and his doctor is not affiliated with any hospital.

“I heard the doctor there was O.K.,” Mr. Lloyd said. “He took my Medicaid card. So I went there”.

Still there are some signs of hope. The expectation of increased federal and state payments for taking care of the poor has prompted a spurt of clinic-building in areas where there were formerly none.

And state and proposed federal measures have initiated a huge in­flux of poor patients into health-maintenance organizations, where they are generally required to have a fixed primary care doctor; a 1991 New York state law requires that half of all Medicaid patients receive their health care through these organizations by 1996.

So hospitals, which have for years taken care of these patients in their clinics and emergency rooms are opening primary clinics in low-­income communities, at least in part, to protect their Medicaid revenues.

Elisabeth Rosenthal, International Herald Tribune

Text 8

HEART DISEASE: AN ALTERNATIVE TO TRANSPLANT

WASHINGTON – For the many people who wait futilely each year for heart transplants, researchers are looking at a new option: an ex­perimental operation that wraps the failing heart with a back muscle that contracts to help boost the heart’s ability to pump blood.

Known as cardiomyoplasty, the procedure is undergoing evaluation at five medical centers.

“It is a very interesting new technique that may have some use,” said Sidney Levitsky, chief of cardiothoracic surgery at the New England Deaconess Hospital in Boston and a member of the American Heart As­sociation’s Council of Cardiovascular Surgery. In certain patients with heart failure, “it may be the solution for the transplant problem,” he said.

Now, doctors report that death rates range from 0 to 20 percent within one month of surgery at the different hospitals involved.

Many of the deaths are attributed to a range of problems that reflect other underlying heart conditions not corrected by the surgery, including irregular heartbeats and ventricular problems. Some patients have also died from other illnesses, including pneumonia.

George McGovern, the surgeon who first performed the operation at Allegheny General, said about 50 percent of the patients there have sur­vived for five years after surgery.

In comparison, approximately 80 to 85 percent of heart-transplant patients survive one year after surgery.

The concept of cardiomyoplasty has been discussed by physicians for more than 50 years. But there were two major hurdles to overcome.

The first was how to condition a skeletal muscle not to tire during 24 hours of daily contraction. Wayne State University thoracic surgeon Larry Stephenson developed the technique using electrical current to over­come this obstacle.

The second was how to get a large enough contraction to boost the heart’s production. Standard pacemakers produced small contractions, not enough to help the failing heart. But a researcher, Ray C.-J. Chiu, at McGill University in Montreal developed what is called a burst pace­maker to stimulate the back muscle.

One of the patients to benefit from the surgery was 74-year-old Reaugh Bonn, a retired business executive who developed congestive heart failure suddenly in 1988.

Despite extensive treatment, Mr. Bonn continued to deteriorate. His age disqualified him for a heart transplant.

“It was terribly discouraging,” he said from his home in Vancouver, Washington. “The only story that I really got out of any doctor was that there was no cure and that I would progressively go downhill until it was all over.

Then Mr. Bonn read an item about cardiomyoplasty in a tabloid newspaper and sought out the operation.

On July 11, 1991, Mr. Bonn became the first patient to undergo car­diomyoplasty at St. Vincent Hospital and Medical Center in Portland, Oregon. He spent 11 days recovering in the hospital, two and a half of them in the intensive-care unit, before being discharged. “The day I got out of the hospital I went home, took a nap and then went out to dinner with my wife,” he said.

Sally Squires, International Herald Tribune

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