24 September 2008

Politics (Meta)

I used to notice that when I put up a purely political piece, that the comment section was usually over-run with biting responses from conservatives. I attributed this to the fact that the med-blogosphere has an undeniable right-wing, reactionary slant. And I don't mind, truly. There is something satisfying about being a gadfly to those who see things differently. Sometimes it got a little depressing, though, when the comments section would devolve into a shouting match between the trolls and me.

Lately, I've noticed a shift. A lot more people are commenting on the political posts from a progressive point of view. Maybe it's the generally increasing traffic here, or maybe it's due to the increased energy and attention on the left, as the political cycle heats up. I don't know, but it's a welcome change. There are still plenty of dissenters, but I enjoy seeing that there are readers out there who share my viewpoint on politics and health policy.

So to all of you who venture into the sandbox in support: thanks. It's good to know you've got my back.


  1. There might be a tendency to comment on things you disagree with more often than on things you agree with, although I think you may be right that the med-blogosphere has a politically regressive slant...at least if you primarily consider MD's blogs.

  2. It's not just the docs, but nurses and EMT bloggers, too.

    From what I can see, there's a lot of anger out there, especially among your ED colleagues, at what they perceive as abuse of the system. Entitled Medicaid patients, convoluted and impossible Medicare requirements, low insurance reimbursement, non-emergencies presenting for treatment, and so on -- all frustrations I'm sure you've dealt with. They seem to have bought the party line and are wont to blame the healthcare crisis on those d*mned "tax and spend Democrats."

    They see progressives as socialists, and think a healthcare plan that's proactive for patients means higher taxes and worse reimbursement for them. In short, both the progressives, and medical patients in general, are the adversary.

    I'm amazed at having to argue with anyone that basic healthcare should be a fundamental human right.

    Conservatives need to take a good, hard look at which party is really responsible for dismantling funding of social programs, creating an obstructionist bureaucracy, and allowing insurance companies to dictate medical policy. It sure ain't the Dems.

    Unless certain doctors consider themselves members of the Investor Class, they are voting against their own best interests, and their patients' best interests, by endorsing McCain. I don't understand why they're reluctant to see that.

    *disclaimer: I'm not entirely sure this makes sense because I've mislaid my glasses and can't read my own typing.

  3. "I'm amazed at having to argue with anyone that basic healthcare should be a fundamental human right."

    But this is a serious question: if it's my fundamental right, then who will be ordered to provide it to me? I don't think any other rights require the action of another person. I have the right to speak, but no one is ordered to listen.

    If I have a fundamental right to an appendectomy, then is Shadowfax required to perform it? If not him, then who? I can't pay!


  4. we're paid lip service to the fact that we have a "right" to protection by the police (although I'd argue we more often need protection FROM the police) as well as the "right" to fire safety via the Fire Department (which used to be privatized, until too many people's houses burned down for having the wrong fire protection subscription badge hanging in front of their house). Over the years we've had the money to provide these basic services (with the exception of the police strike of 1919 in boston maybe), so why not preventative and curative health care services?

    The reason is because the government is interested in protecting the rights of PROPERTY, not the rights of people.

    Of course, with the money we spend on military adventurism, we could provide health care to the entire global population several times over, as well as feeding and educating them, and still have money left over for a self-defense force.

    Such is the fate of declining empires, I suppose.

  5. Oh, no, BC. If your appendix bursts and you have no money, you should be left to die on the streets.

    Is that the way you want it? Serious question.

  6. There's a wildly hyperbolized example of this in the excellent novel "Jennifer Government". The protagonist happens upon a young girl who's been critically injured in a shopping mall. When he calls 911, the emergency dispatcher won't send help until a credit card number is given and verified. I sympathize with the frustrations of emergency MDs, nurses and medics, hell, their blogs probably make up half of my blogroll. Still, I can't accept that reducing access to care is going to somehow cut down on abuse of the system. Sure, free care equals more care, but that's a good thing if there's a care deficit. The trick is making sure the resources are used appropriately, and in the healthcare-as-subsidized-business model, it doesn't seem to be working.

  7. I'm amazed at having to argue with anyone that basic healthcare should be a fundamental human right.

    Define "basic" health care. Good luck with that task.

    Should I be able to access specialized health care services for free for "really bad" acne? Should I be able to get cardiac stents for free when I'm 90 years old? Should I get a brain tumor removed if I am a death row inmate? How about a total knee replacement if I'm 450 lbs, unemployed, and refuse to exercise? Should I be able to get all the services that privately-insured people get for "free" and deprive the privately-insured of the same services for an extended length of time given that health care is finite?

  8. No, Nurse K, I'm not saying that. We all understand healthcare resources are finite, and at some point decisions will have to be made as to how to apportion care.

    That may mean hospice treatment rather than futile care for many people (often more humane, anyway); limiting invasive procedures for those over a certain age, and so on.

    Obviously, certain categories of treatment, such as purely elective procedures, can't be doled out like Halloween candy.

    We already make decisions about who qualifies for donor organs on the basis of lifestyle choices and ability to benefit. There may be a need to broaden the kind of services that warrant such scrutiny (like your knee replacement example).

    I'm not saying we'll ever be in a position to do everything for everyone, nor is that the goal as I understand it. But everyone should have timely and affordable access to primary care and preventative medicine, and no one should have to die in the street from a ruptured appendix, as BC seems to advocate. Nor should the insured or uninsured be bankrupted by serious illness.

    Imo we need to rethink our national priorities, and shift toward more humanitarian goals. Do we really need to spend trillions of dollars on the war in Iraq? Have we accomplished anything positive in that endeavor? The money spent could have bought a lot of medical care, increased primary physician salaries, staffed hospitals at a safer level, and so on.

    I would go on, but I'm being thrown out of my office/daughter's dorm room so she can sleep.

    What do you think is a fair solution to the healthcare crisis?

  9. We when talk about "rights" in America, we often end up talking about money and who pays who.

    As a society, we have declared that every child has a right to primary schooling, basic nutrition, and to be safe from abuse from their caretakers.

    I use this as an example. We as a society has agreed to these principles. And we as a community pay taxes to provide these services.

    Now, I know the counter arguement....but MY kids go to a private school. I have no idea what happens in YOUR state. But in most places, BOTH private and public schools receive a specific amount of money per child. Of course public schools are funded beyond that.

    So yes, in my community my taxes go to teach children in religious schools.

    Yes, because we have decided that education is a right.

    I believe that basic healthcare is a right. I am not going to define it, but I do think it is important for some regulatory body to define what that basic care may be.

    However, my taxes will go towards paying for that care, as it does (very inefficently now).
    Yes, that may be the bank of "medicare and medicaid."

    Nearly all large medical instituions have some relationship with medicare. Most of these facilities are receiving some funding somewhere that is not flowing through the billing office. Nonprofits and government run facilities receive lots of $$$$$$$$$ to offset charity care, capital purchases, etc...Most of this $$$ comes from state and federal sources.

    I know that doctors do not directly benefit from this funding as they are billed seperately from the facility charge. But, I imagine that many doctors benefit from being able to use facility materials and staff.

    If a private facility exists, they are making money somehow, or they would not be in existant. Funny how many skilled nursing facilities are private? That is because long term custodial care is not paid for by medicare.

    I am sorry, but my background is in finance, in , um, healthcare.

    So what I am saying as that we are ALREADY funding basic healthcare but in a horrible, unfair, and inefficent system.

  10. "Oh, no, BC. If your appendix bursts and you have no money, you should be left to die on the streets.

    Is that the way you want it? Serious question."

    No, so I have insurance. I wouldn't be without insurance, because I'd hate to have to spend my house on the operation.

    I'm suggesting that the terms "really good idea" and "fundamental right" are not interchangeable.

    I'll bet you Shadowfax would do the job if he was the one to find me. But if it's a "fundamental right", then it seems the first doc on the scene with the skills would be required to do it. By law.

    I think people have a "fundamental right" to listen to music; but I don't want to be forced to play for them.

    And if insurance is a "fundamental right", then that means insurance companies are required to insure people.

    Here's my serious question: can we not change the structure of health insurance slightly--so that any group of people, not just employees, can form a group for insurance? It's the insurance being tied to jobs that hurts a lot of people (like me, for instance).


  11. Is health care a right? Great discussion, and a timely one. I will expand on all these shortly in a real post.

    thanks again for playing...


  12. In my world, rights are limitations on government power. So, I don't think a person has a right to healthcare.

    That said, I think it is immoral for someone's access to healthcare, politics, or justice to be dependent on how good a capitalist he or she is. And therefore, I think we should use the government to ensure that people from all economic classes are treated equally in this sense.

  13. Article 25
    Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care ......

    Universal Declaration of Human Rights


  14. Ah, the UDHR...such a great idea..it's unfortunate that the US opted out of the whole "right to return" thing because of the middle-east situation.

    Anyway, back to health care, I think the reason things are so screwed up is because from the point of view of the patient, it's cheaper to let chronic problems become acute problems that MUST be treated, because it would cost them more money to go to get preventative "elective" health care due to the "market" in it's "infinite wisdom". In reality it would probably be cheaper for the state to provide preventative healthcare and still have insurance to cover the acute problems.

    "How will the doctors get paid?" is the rallying cry I see on the blogs. We can consider a 1.2 trillion dollar financial market bailout, but spending 30-something billion to insure uninsured neonates? Out of the question! It's clear what is of value to the powers that be, and it's not US. It's profit, in and of itself. It's a myopic position to take. Without people, the economy is just a balance sheet. "Education would be a great business if it weren't for the damn kids" is the old joke.

    1.3 trillion sounds like a lot, but a conservative estimate of the cost of the iraq war put forth by the washington post was 3 trillion. We're already up to 12 billion a month.

    The failure of our health care delivery system is merely another casualty of War. If we were governed by people who believed that the welfare of it's people was worth investing in, I'd imagine things would be strikingly different.

    It's been suggested that the market is the best vehicle to deliver health care services, but the market has long ago figured out it can make more money through government subsidized warfare.

    The system is sick, and all it takes is a simple application of the Nursing Process to diagnose this maladaptive response to disease process.

  15. I've got your back on all things Apple too!


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