Friday, May 22, 2015

The "Race Card" Card

Ever since our President became President, one segment of the American public has gone ballistic—the racist element. Practically before he took office, the right wing billionaire set decided to form a “Tea Party” to oppose him. And the GOP leadership decided that he was not to be treated seriously as a President, but instead, they would do everything within their power to oppose anything and everything he might say or propose.  Their goal—Make Obama a one term President.
In part, I guess, one might think that the far right rhetoric could be construed as simply the “other party” wishing to marginalize a Democrat, so that they could regain the power they had exercised under their right wing GOP leaders—you know, those paragons of American virtue—St. Ronald of Reagan, Bush I and Shrub. But the nearly hysterical quality to the opposition, especially from such as the “Tea Party”, seemed to go way beyond the normal right wing politics.  I finally decided that the only explanation that made sense was racism. And then the “Birther” movement began and it became very clear that racism was not only the preferred explanation, it was really the only plausible explanation, especially since he had not even proposed anything yet.
And then, Fox News (aka the Faux News Network), the PR wing of the far right GOP, began its campaign of hammering the President at every turn, amplifying every statement made by the most right wing of our GOP political establishment.
Finally, other real news commentators began saying the obvious—racism had taken over the GOP and its commentator wing.  And then came the response—“ahhh, they’re playing the “Race Card”.
And so, the “Race Card” card was born.  What, you ask, is the “Race Card” Card? Well, it is the standard reply to a charge of racism, averting the need to actually respond with facts. When someone calls out an obvious racist remark, the standard response now is, “oh, you’re playing the “Race Card.” And what that means is, “ I don’t have to explain myself, because you have adopted the standard ad hominem attack by calling me a racist. Whether I am a racist, or whether I am acting like a racist is irrelevant. If I say you are playing the “Race Card”, I no longer have to explain anything. And so, the “Race Card” Card became the standard rhetorical response by the right wing establishment, and the game continues today, six years later.
When I read articles in various papers and journals about some issue vaguely affecting our foreign policy, I often get distressed at the inevitable comments by the right wing folks in the land.  Think of the right wing  politicians writing to the leaders in Iran, telling them to ignore the President's efforts to rein in any possible Iranian nuclear arms efforts. Or think of the GOP's Ron Johnson, saying, "when it comes to a nuclear deal with Iran, he’s “not so sure” he trusts President Obama over the Iranian Supreme Leader Ayatollah Ali Khamenei." What might the right wing have said, had any Democrat said something similar about St. Ronald of Reagan?
The level of vitriol against anything the President or his Administration does, or says is amazing. I keep thinking, where were you all, and what were you saying when St. Ronald of Reagan was selling arms to the Iranian terrorist regime, so he could arm the Nicaraguan terrorist thugs? Were you as hysterical then as you seem to be now?  And how about, when Shrub declared victory in Iraq, standing on the deck of an aircraft carrier? Did you huff and puff and threaten to blow the house down? And have any of you begun screaming about Ted Cruz, born in Canada to a Cuban father and American mother? Is there a Ted Cruz “birther” movement? No??? How come? Oh, yeah, he isn’t black is he?
When I read some of the commentary, including especially from people I actually know well, and they yell (writing in caps) that “every action taken by this President had made this Nation less safe—yes, every action,” I have to ask whether they have taken leave of their senses, or is their commentary just a racist rant?  “Do you mean that when the President arranged to kill Osama Bin Laden, and, unlike Shrub,  followed through with an actual kill, he made us less safe?”  
“And were you thinking that, when he signed into law the Affordable Care Act, making health insurance available to millions formerly uninsured, he was making us less safe?”
“Or were you just finding a way to label him as awful without actually calling him a Nigger”?
Is that what we have come to in this nation? We have governors threatening to secede from the country (think Texas), and even considering calling out their National Guard because of some military exercises in their state? Would they do that had John McCain (born in Panama by the way) won the Presidency? Oh, I thought not.
The right wing in this country seems no longer to care about what ordinary Americans think of them. Reminds me a bit actually of Russia and their view of Emperor Vlad. The Russians no longer seem to care what he says, how outrageously and obviously he is lying, so long as he continues to sing the song of the Russia of old (i.e., the old Soviet Empire days).  So, perhaps, the right wing here feels the same way. They hate having a Black man as President, and long for the days of old (when St. Ronald of Reagan was ruling as emperor here). And they don’t care how much they have to lie about that Black man President. They want a return to the days of olde (although in some respects they seem to want to return to, say, 1850, rather than 1980).
I no longer think this schism within this country will heal during my lifetime (increasingly short). In fact, I believe it is getting worse, mainly because the right wing seems to believe that it is ok again to be a racist—after all, that was one of St. Ronald of Reagan’s great accomplishments during his term.

I continue to hope that my grandchildren will work to overcome this racist element within our nation. But I am not any longer certain. One of my worries is that the worst elements in this nation actually take over the government in 2016 (think the British elections), and they encounter that Emperor Vlad Soviet Empire place, and that really bad things happen. But that’s for the kids to sort out. 

Wednesday, April 29, 2015

Growing Up Poor

I grew up somewhere between poor and lower middle class. Raised in a largely single parent household, by a working mom who had a high school education (maybe).  Pops was there occasionally, mainly when he had finished his drinking spree and wanted the comfort of a home and good woman. Sometimes, my mom would let him in, sometimes not. Mainly, though, he was missing in action.
So, we had a tenuous grasp on an apartment in midtown Manhattan, once having to change apartment buildings quickly, to stay one step ahead of the collection agency.  There were three kids, me being the youngest.  My sister tired of the education game, dropped out of Julia Richman high school and went to work in the same company employing my mom—it was the War, and worker bees were much in demand, even undereducated ones.  
Note that education was not a large issue, at least not a spoken one.  My mom’s folks, Scottish immigrants to the US during the late 1890's, were not educated beyond the 8th grade, and that could be a stretch. Similarly, on my dad’s side, education did not figure prominently.
But, there were no pulls away from continuing our education either. My brother was extraordinarily bright and was granted access to Stuyvesant High School in New York. My sister, through luck, charm, and good looks, hooked up with a med student attending Columbia. They were married and began their life together, a life very different from my sister’s early days.  Because Bill was so bright, he propelled himself towards college, graduating fairly young.  With him as my male role model, I went off to college, with nary a thought about how to pay for it. Happily, with loans from my sister, and working a job or two, I also managed to make it through my days at my small college in what is now Silicon Valley.
Our lives growing up poor in Manhattan provided little trauma, aside from the occasional broken arm, or other assorted street accidents—we played on the streets, and wandered all over the city, did my bro’ and me.  Will even was mugged once in Central Park, but it never stopped us from walking there with great frequency to play.
During this growing up absurd phase of our lives, never once were we hassled by the police; there were no gangs harassing us, and nobody got shot on the streets, aside from our cops and robbers games.  It was not that we were never “armed”. We made "brass knuckles" out of garbage can handles. My brother and I used to play War, and we would sometimes duel with real steak knives—I have a V scar on my hand to prove it. And we learned to make a flame thrower—turns out, if you load a water pistol with a flammable fluid (lighter fluid??) and then shoot that liquid through a lit match, you get a magnificent flame thrower—of course, we almost burned down the bathroom door, but what the hell . . . we were armed and ready.
But throughout this period, when we were forming our personalities, no one harassed us, no one told us we were thugs, or stupid. Our apartment, though modest, was not rat-infested (lots of cockroaches, though) and our plumbing worked.  My mom earned enough as a bookkeeper to pay the rent and keep us fed. We attended school every day and then played in the streets after.

We knew nobody who got shot, or otherwise assaulted/killed.  We were just modestly poor, like a lot of people during the War in New York City.

And then we went off and got educated, married, had kids and the kids got an education, and then they married and educated their kids. That’s the way it is in Middle Class White America, at least for most of us. We didn't know any Blacks growing up in New York City, and later in Rockland County. Black residents mostly lived above 125th Street and largely stayed there. If police were hassling folks north of 125th Street, we didn't know about it.

But I’m fairly sure, had we been Black and living in Harlem, our lives would have been different.  I don’t know how different, but different they would have been.  And I’m pretty sure that the people of color growing up now in the segregated sections of Baltimore live very different lives than we did as poor White folks growing up in 1930-40's Manhattan.  And I’m equally sure that those people of color have a different view of American privilege than we do.  And that many of them do know someone who has been shot and killed. And they do know about police harassment—DWB, and even Walking While Black (WWB) are real things, even if not to me.

So, as I read about the riots in Baltimore, my mind goes in two directions simultaneously. One side says, “God, why burn down your own neighborhood? How will that solve anything?”  But then my other side says, “I no longer care what you think. I’m fed up with the whole shitload called America. My life is always going to be in the toilet, so if I feel like burning something down, I will.”  That’s what can happen to folks when they feel as though they have nothing left to lose. When you lose all hope, then anarchy reigns, and anything can happen.

So, as much as I want to see rational behavior, including even peaceful protests, I need to understand that many people are beyond that point. And I am reminded of another conflict, the one that has been raging in that benighted place called the Middle East. I ask the same questions there of that conflict raging now since, at least 1947.  Why do you keep shooting rockets at Israel, when you know they will return the compliment tenfold? And the answer is, “because we no longer care.”  And Israel, why do you keep up the Settlements, and why do you level apartment buildings with all those innocents inside?  And the answer is, “because we can.”

Maybe we’re dealing with basic human nature in these awful conflicts, whether here in Baltimore, or around the world. Maybe people will continue killing one another. But I keep wondering, isn't there anyway to call a halt? Can’t we find some way to treat other people as humans, capable of hurt and love? Can’t we for God’s sake just stop what we’re doing and quit pretending that we’re better than “those other folks” just because it makes us feel bigger?  Can’t we try people???


Monday, April 27, 2015

Shit Happens


The awful act of nature that comprises the Nepal earthquake—3700 dead and counting—causes many people to question their concept of God. As usual, Christians with no brains have linked the earthquake with “paganism” and God being angry.A former Los Angeles police officer and self-styled preacher, has sparked outcry by suggesting that Nepalis should not rebuild their “pagan shrines” and instead convert to Christianity. Tony Miano, an outspoken conservative who has previously been accused of homophobia, triggered angry responses when he posted a series of messages on social media, expressing sympathy for the people struck by devastation in Nepal, but suggesting God was angry.”

And lest the thinking Christians begin imagining that they possess the only emptyheads in the universe, it clearly is not so. In India, Vishwa Hindu Parishad (VHP) leader Sadhvi Prachi kicked up yet another controversy when she came up with her logic on the recent earthquake that devastated Nepal. Commenting the most unreasonable statement that could come at this tragic time, controversial BJP functionaries, Saksha Maharaj and Sadhvi Prachi have linked the earthquake in Nepal to Rahul Gandhi’s Kedarnath visit. Speaking to media persons in Haridwar, Sakshi Maharaj said, “Rahul Gandhi eats beef and goes to the holy shrine without purifying himself, the earthquake was bound to happen.” It may be mentioned here that the lady was in the news recently for calling the Father of the Nation, Mahatma Gandhi a British Agent.

See, every religion has its emptyheads.

Apparently, every tragedy, such as the Nepal quake, begets some idiot who has “the explanation” and it is never based on facts, reason, or science. Instead, the emptyheads of the universe almost always ascribe the event to some failing on the part of the folks affected. One could only hope that organized religion, if it won’t be helpful, then perhaps it could refrain from opening its mouth at all.  It all makes me wonder whether they would ascribe Jesus’ “problem” (that nailing to the cross thing) to some awful failing on his part—he must have committed some unspeakable act to so offend God/poppy that his nailing was ordered.

But back to Nepal. The tragedy continues to unfold, with the death count continuing to rise. Partly, the destruction is simply a result of a 7.9 quake, which is huge. By way of example, here is a quote from Wiki about that 1906 California quake: “Since the 1906 earthquake preceded by more than 30 years the development of the Richter magnitude scale, the most widely accepted estimate for the magnitude of the quake on the modern moment magnitude scale is 7.8, values from 7.7 to as high as 8.25 have been proposed The main shock epicenter occurred offshore about 2 miles (3.2 km) from the city, near Mussel Rock. Shaking was felt from Oregon to Los Angeles, and inland as far as central Nevada”.

So, we have a quake equaling the San Francisco quake, which really destroyed the city.  Is it any wonder that so much damage was done in Nepal? Kathmandu is an old city by any standard, with its history spanning some 2000 years. Many of its key buildings, especially its temples, are several hundred years old. As such, the building standards did not include any technology that might withstand such a powerful quake. So, it may even be surprising that the buildings survived at all. One assumes there are geologic explanations for why some buildings collapse, while others standing nearby remain unscathed.  But the ancient buildings are vulnerable, God’s wrath notwithstanding.  But for the newer buildings, we have less good explanations.  It seems clear, that building standards capable of withstanding powerful quakes exist, but have not been used throughout the country, including the capital, Kathmandu. For that we can blame, not God, but building contractors who wished to save money. These days, money is almost always a preferred explanation for disaster, and Nepal is no exception.  

So, we should think about the Nepali people who are currently sitting out in the open, or in tents, with little food or water, as disaster aid groups try desperately to reach them.  If you can, send some money to their aid—there are many private relief agencies now gearing up who can be contacted and would welcome your money. If not, then at least keep them in your prayers or your thoughts. And if you hear or see a religious emptyhead trying to blame these people, please tell them to shut up and go find a bank or a republican to blame.

Wednesday, April 15, 2015

Big Government


I was having a discussion the other day and a friend made some comment about ‘big government” when referring to some government action he didn't like. It occurs to me that we really need to think a bit more about this term, “big government”.

First, we have four levels of government in this country—town, county, state, and federal.  From having worked with all four levels (in addition to working with governments of others countries) I have concluded that there are significant variations in the relative competence displayed by each of those four levels, with the county and state being at the bottom.  But any of the four could be described as “big”, and certainly the four in combination qualify for that term.  We have a lot of government in this country. But, to be fair, we have a lot of people—pushing 320 million at this stage.  If we don’t want anarchy (Rand Paul notwithstanding) we need government at several levels.

We also need government to provide many of the services we require to exist as a civilized nation—education, roads, defense, home security (policing, et al), protecting us from commercial predators, and the many other issues that require intervention on our behalf. So, yes, we have and need a lot of government.

But the term is used often to describe some policy or rule we don’t like. And often, the folks who use the term do so by decrying the “bureaucrats” who carry out the policies of government.  In fact, most of the stuff we don’t like has been conceived by one segment of that “big government”—the elected officials at each of the four levels.  It’s even a bit mind-blowing, when I hear an elected official—generally someone at the state or federal levels, blowing off steam by yelling about “big government”.  This is a common cry now in republican circles. While trying desperately to get onto that federal titty-sucking, they yell about big government, by which they mean all the “other guys” sucking on the federal titty.

Mainly, I have come to understand that “big government” really is elected officialdom at whatever level.  It used to be that the feds—i.e., Congress—were really the target of that term. The more obnoxious the action, the more disgust accompanied the “big government” expletive.  In recent years, however, the Supreme Court—I now refer to them as “Tony and the Supremes” to denote that most corrupt justice of all time, Tony Scalia, and his “houseman” Clarence--has entered the realm of "big government". Their Citizens United ruling that gave our government over to big commerce (see the Koch brothers and Sheldon Adelson) has almost destroyed the concept of a true representative democracy in our country.  So, does that square with the term “big government”?  It does, in my view, but it now means something different. It means that our government is being directed by a very small group of super wealthy commercial beings, much as we might imagine the old systems of royalty. The various kings, dukes, et al were still “big government” entities, but the folks they ruled didn't have much say. It’s getting that way again and “big government” per se has very little to do with the ultimate decisions that are made.

So, we need to rethink this term and the underlying concept of “big government”.

First, “big government” has relatively little to do with the thousands of working stiffs who work every day in the various halls of government, and carry out the whims of their elected officialdom bosses.

Second, if we don’t like the results of some policy/law that has been written and voted upon by our elected officials, we need to tell them about our dislike. We do that in two ways. First, we vote and we tell them by voting the rascals out of office when we don’t like what they produce. Second, we write or call or e-mail them to tell them we don’t like what they are doing.  If we don’t speak up, or we don’t vote, we don’t get to complain.


So, maybe it’s time to retire the “big government” epithet. As I have noted in the past, our government is only as big as we agree to make it. Second, my view is that most things that grow very large become both inefficient, and often behave in stupid ways—see “big banks”, big oil companies, big airlines, big commerce in general. Remember, when banks become “too big to fail” they are also too big to exist and should be broken up. That’s when we need “big government” to intervene and break them up.  See, we often need “big government” to protect us from our own worst instincts, which include placing too much trust in “big commerce”.

Wednesday, April 8, 2015

Gods and Other Fantasies

I have begun thinking anew about the existence of God. When I penned my last thoughts on this subject, I admitted to not possessing any actual knowledge of the existence, or lack thereof, of a God, or Goddess. But of late, I believe we are gathering some substantial evidence for the absence of any godlike interventions, including especially with regard to the existence of humankind creatures.   I believe we can now safely assume that man was created more or less accidentally, perhaps as a result of an aberrant evolutionary mechanism.  I have been wondering for some time now, as I watch the dreadful events unfold throughout the Middle East. I mean, ISIS alone could be the key to understanding that either: a) there is no God; b) if there is a god, it is a cruel and horrid thing, certainly unworthy of any form of worshiping on the part of humankind; or, c) if there is a God, that entity surely never intervenes for good or evil in the affairs of humankind.  The constant slaughter on all sides of innocents and evildoers alike seems all the evidence we need (Bibi, please take note).
And then we have this “exceptional” land called the US of A. And as if the now routine shooting of folks whose main crime appears to be faulty taillights is not enough, this assault by state legislatures/gubernators to adopt “religious protectorates” that allow their faithful to discriminate to their hearts content against any and all folks who fail to measure up to their standards of good Christian behavior seems to seal the deal for me.
I felt badly for that pizza parlor that wanted to offend homosexuals everywhere by refusing to serve them, with the resulting furor causing them to go under.  I mean, if you can’t discriminate, what the hell good is organized religion?  But then the public furor caused the good Christian Taliban to come out of the woodwork to begin tossing money at the pizza parlor owners—nearly a cool million.  So all was well in the land again, unless that is, you’re Gay, or Lesbian, or transgender. I assume, one could postulate a religious belief that suggests one should discriminate against any class. Let’s see, can I claim a religious belief that allows me to refuse to serve Mormons, because of their (prior??) belief in multiple spouses?  Or perhaps, I can discriminate against all those folks who don’t eat meat on Fridays?? Remember that fun game?? Or, obviously, if I am a good Christian follower, I might well refuse to serve Muslims. Maybe, I can refuse to serve anyone who wears a beard, or wears a turban, or sports a tattoo. Or how about Scientologists? Surely it's ok to discriminate against the terminally stupid.
See, it’s always a religious belief that allows one to act like a dickhead.  Which means to me that perhaps organized religion is the problem.  And maybe that means that God is either not paying attention, or doesn't exist after all. Just a thought folks.

Let’s see if we can pass some legislation that outlaws organized religion of any kind. If you’re going to be kind, and act morally, just do it. You don’t need to cite a religious clause in some ancient novel penned by ignorant white guys seeking power over their fellow man. Just do it. Act like decent human beings. Help your fellow man, instead of bombing him.
Oh, and if there is a God, my money is on that creature(s) being a woman.  So act accordingly.

Wednesday, March 25, 2015

Pawns

Book Ends
I have written before about my life as bookends.  Before I was commenting about growing up in the 1930s and 1940s, and now seeing some similarities here in the US to those troubled times.  But now, my bookends relate to health care.

We are on Medicare, thankfully, and have been for 15 years. We have also lived in Concord for the same 15 years.  During that time, thanks to our daughter, Erika, who is one of the doctors in a leadership position at Cabarrus Family Medicine, we have gathered around us a supportive network of high quality physicians to care for us as we age into our final life stage.   And we feel very well cared for indeed.

Now, one of the things you discover as you age a bit (I have now entered my 42nd 39th year of life—you do the math) is that you require increasing amounts of medical care—both from the docs, and from Big Pharma, as well, occasionally, from the local hospitals. Yes, aging in place is a lot of fun, but as has been noted by others, aging is not for sissies.  And in discovering that one needs a lot of care, one also discovers that the trusty old Medicare doesn't quite pay all the bills. Congress has seen to it that Medicare hasn't quite kept pace with inflation and there are increasing gaps between what our Medicare pays and what the actual bills are. So, guess what, one needs what they call Medigap policies.  The gaps exist in regular Medicare payments for physician visits, tests, and the pharmaceuticals that keep one upright (most of the time).  So, in addition to the regular Medicare insurance, one now needs to purchase some added insurance.  So we do exactly that.

Now, for those folks currently whining about the complexities of Obamacare, or the bad old IRS, it is useful to note that those complexities do not begin to compare with the complexities introduced by the much beloved private insurance companies.  Yes, we understand that republicans do so love private insurance companies. They’re private after all.  They’re not big bad GOVERNMENT.

So, we have been dealing with these beloved private insurance companies for many years now. We have occasionally changed carriers, mainly because the companies keep changing how they cover, what they cover, and how much one has to pay for the various services one needs. They do keep you on your toes.
In a recent open season (what a charming name, huh?) we again switched from one carrier to United Health Care, mainly to gain some pricing advantage.  They were somewhat less expensive than our previous carrier.  We attended an open meeting sponsored by United, listened to their sales pitch. We checked their materials to be certain that our entire panel of both primary care and specialist care physicians were on their list of “in-network” physicians, and that our drug regimen was within their formulary.  All were included, so we decided to change.

That was last November.
What United Health Care neglected to tell us was that they were currently in process of negotiating a new agreement with the vast Carolina's Health System, which includes the hospital we use, and the entire panel of doctors we visit.  Had we known about their “negotiations”, we almost assuredly would have foregone the pleasure of changing to their coverage.  A bit risky.

But we didn’t know and they didn’t bother to tell us.

So, the changeover occurs, and now we are using United Health Care. Lots of changes, but the complexities are all manageable. But then . . . the “negotiations” drag on—December . . . January . . . February.  Then we start getting notices from United that we may have to obtain a different primary care provider, one who is “in-network”, since they seem not to be able to conclude their “negotiations” with CHS yet. The shocking piece of news from United is that Cabarrus Family Medicine—our PC provider network system, will soon be “out-of-network”.  But, ever helpful, United offers to sign us up with a new primary care doc. They suggest a doctor by name.  We check the doctor. Turns out he is a resident in training at, guess where . . . Cabarrus Family Medicine.  So, it seems they don’t have a clue what they are doing.

The “negotiations” drag on. It is now nearing the end of March. Still no progress. The rhetorical war heats up, with the equivalent of name calling.  I begin to think about the Arab-Israeli “negotiations”. The reason they always fail to reach an agreement is that both sides think they will/must “Win”, ergo they never really put anything worthwhile on the table. As a result, no settlement is ever reached. I imagine the same thing occurring with United and CHS.   Neither side wishes to give in, lest they “lose” something of value (money). And then, while checking something on-line, my wife notes something interesting. United has already ‘assigned” us to a new primary care physician.  Note, not only did they not ask our permission to assign us, they did not even have the courtesy to inform us.  Oh, and it turns out the doctor to whom we were assigned is a staff physician on a local indigent care clinic in our town. Wow, that really fills us with enthusiasm.

Well, it’s really all about the money. And, as I noted in my last blog posting, when money becomes the sole criterion, then nothing else matters, including especially the wishes/interests  of the people within the system-the customers/patients. No we really don’t matter at all. Money is all that matters. Oh and forget about that "continuity of care" thing.  Our insurance company either doesn't understand that concept, or it has been lost in the money chase.

So, one option is for us to have the equivalent of no insurance, i.e., we would be paying United, but be unable to access any of our regular physicians or hospital.  And that brings me back to the bookends concept. See, when I was little, growing up in New York City, we didn't have regular physician or dentist visits. We simply didn't go, except when an emergency occurred (like me breaking an arm, or requiring a dozen stitches. Dental care? Nope. Regular "well-child” visits?? Nope.  Dental care occurred once in a while, when I needed something done, and then I went to a dental school, where they practiced on me.
So, now, we understand that we—the insured—are the pawns in this chess game being played between United and CHS. They are quite willing to use us in any way they choose, as bargaining chips (remember that old saw about taking your football and going home?). Yep, that’s United Health Care.

So, instead, we are taking our business elsewhere. Turns out, we can switch back to our original plan, if we don’t like our new coverage, anytime within the first year.  So, yeah, that’s what we will do.  And our suggestion to United?? Perhaps they should go into some business they might better understand—like maybe auto insurance. Yeah, they could start a motor maintenance organization (MMO). That way, they might still screw things up, but, hey, it’s only your car, right???

Anyone for a single-payer system???? I'm in.

Sunday, March 22, 2015

Money as the Enemy

Dr. Danielle Ofri is a practicing physician, as well as a prolific author. She writes often about medicine and the practice thereof.  She recently penned a thoughtful (they always are thoughtful) article about the increasing role money plays in medicine and the delivery of health care. She begins below:

"In mid-January a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168—a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month.

This is such a familiar story by now that it hardly makes news. Yet it is tragic, every single time.  Beyond the fact that it is monstrously cost ineffective, there is something just plain wrong about it.

Money, of course, cannot be ignored in medicine. But just because money is a realistic consideration in medicine, doesn’t mean that we have to blindly accept all the consequences..."

Read her full article here:


I often respond to Dr. Ofri, because I find her articles both stimulating and thought-provoking. My response is as follows:

You are correct when you assert that earning money is not in itself an evil thing. But it is that same old saw, “guns don’t kill people, people kill people.” And I could add, “Alcohol doesn't kill people, people with too much alcohol kill people.”
Why do these three things all say the same thing? Because excess is itself a bad thing.  Is big bad? Well no, but too big is bad.  When an entity, a bank for example, becomes “too big to fail”, then it must be judged too big to exist and should be broken up.
Money in the medical system is not in and of itself bad, but in the pursuit of more and more money, the chase begins to crowd out the central purpose of the system.  As money begins to dominate any system, the other relevant criteria of “goodness” are moved aside. We understand that corporations exist to earn money, and that means drug companies, insurance companies, medical device manufacturers, hospitals, and, even medical practitioners.  They all wish to make money.  Yet, in this vast system, if the health and well-being of people—patients—in the system becomes lost, a casualty of the financial aspects, then the entire system becomes meaningless. That is when money becomes the central evil—when it drives out the main purpose of any system.  In health care, the central purpose of the system is to maintain a full population at its expected state of health and well-being.  When folks are trading off one element of the system –say drugs to control blood pressure—in order to obtain and use another element—say asthma medication, then that system is by definition operating suboptimally.
But I should add at this point that all of our systems in this country have moved in that direction. We are trading off optimal performance in order to either reduce cost, or increase income/profits. You can observe this phenomenon in system after system. In the broad range of consumer products, by shifting to a single criterion—cost—we have opted for a consumer product system in which we produce garbage in China for sale in America, regardless of the consequences in terms of performance. Quality in this system is no longer a relevant criterion.  Reliability is nearly irrelevant.
In perhaps the most egregious example of this phenomenon, Banking, the pursuit of ever greater profit margins and ever greater CEO salaries and bonuses, we have produced an almost completely useless system that operates at the “out-of-control” stage almost continually.
In Education, we have begun to dismantle a system that has worked reasonably well over a very long time period, and we are shifting to systems that, not only do not work as well, but almost by definition are seriously flawed systems, because they favor money over performance.  In that system, we have begun to rid ourselves of the task of educating our population. Why? Because it costs money, and, not coincidentally, it produces a population capable of thinking and potentially rejecting the politicians who favor money over performance.
And so it goes. Money has become not merely the most important criterion in our systems, but is closing in on becoming the sole criterion, with all other criteria being relegated to nominal performance criteria.
And the saddest part? This has been happening with relatively little outrage on the part of the affected population.  We are all sitting around, sucking our collective thumbs, while distracting ourselves with video games, Facebook, Twitter, and March Madness.   Meanwhile, the 0.1% continue to acquire all the available money in the world, while we sink into a morass of our own making.