The $2.3 Trillion Magical Misery Tour

This coming semester (Spring 2011) I am again going to teach Medical Sociology. This is both an exciting opportunity to orient students to a fascinating field and a sobering occasion indeed. During the next five months I will have to live and breathe the grim statistics and sobering tales of the American health care (non)system. I have written about this subject on a number of occasions before and do not want to repeat myself; however, repeating oneself is surely one of the greatest pleasures life can afford.

This time I want to get personal with a number of tales that would surely provide enough fright for any number of juveniles arrayed before the campfire during dead of night. It all started a number of weeks ago when my endocrinologist (yes, I have one - he monitors my levels) suggested that I call my regular physician and set up a schedule of appointments in such a way that either one or the other saw me every six months. That sounded like a plan and last week I called my regular physician at St. John’s Clinic here in Springfield to complete the arrangements. Seems like a fairly simple transaction, no? Well, no.

The phone rang a couple of times and the cyborg on the other end quickly asked if I could be put on hold. No sooner had my internal assent been translated by my vocal cords, before I was enjoying music composed by the same folks who are subcontracted to build penitentiaries. My sentence, however, was not commuted as the few minutes turned into an eternity of anguished anticipation. In such circumstances, I never hold for more than a minute or two. I redialed immediately and cyborg gave me the identical greeting, asked the same question, and I foolishly gave the same assent, but with the proviso that, “I will not stay on hold forever.” Forever was definitely the key word. In fact, forever in some religious dispensations promises salvation, albeit at some indefinite time, but in this case salvation never came. I hung up and redialed and this time said in a rather stern and demanding tone that I would give cyborg my name and number and when the gracious moment arrived, I would be sitting anxiously by the phone awaiting undeserved condescension. Cyborg, however, would hear of no such arrangement, and again came the dreaded request: hold! At this point, I was enraged beyond description, filled with such emotion that my health was certainly not a beneficiary of the circumstance. But the health care system does not function to preserve YOUR health. It is the health of the system that is the subject of its prime directive. I was about to call St. John’s administration when I gave cyborg one more chance. This time through gritted teeth I said, “If you don’t take my name and number, the next call I make will be to St. John’s administration.” Wonder of wonders. Cyborg said, “How can we help you?” I was nonplussed. A few seconds ago cyborg was so busy that there was no time to jot down my name. Now we are all ears. The appointment made, I hung up thinking that with such genius in charge of the system what could possibly give us a second thought about the quality of our health care.

Coincidentally, a few days later something happened to create that second thought. The billing office of St. John’s Clinic called and wanted to discuss an outstanding bill in the amount of $115.14. I immediately opened my checkbook and found that I had written a check for that amount at the beginning of November. Billing office cyborg stated that, yes, the payment was received but that other amounts due had claimed it. I asked what amounts those were. In fact, they were the amounts created by the lab tests and my routine check by my endocrinologist. Those had happened a number of weeks after the payment had been mailed so I asked how the payment could have been misapplied. Cyborg became silent and had an “Er. . .” moment when it then became clear that the later amounts had not even been billed to me yet. So, when I asked what amount was outstanding, it turned out that nothing was outstanding. All of this was from a call placed to my home after 7:30 P.M. from a hospital billing office which had informed me during the course of this Kafkaesque dialogue that St. John’s gives patients only 20 days to pay all accounts in full unless other arrangements are made. Ah yes, nothing can beat the charity of a Catholic hospital system.

In this country we spend $2.3 trillion (and more given that figure is from 2008) for a really first crass health system. A little anesthesia never hurt when you are picking someone’s pocket.

LESS GOVERNMENT?

Less Government!!!! This is an idiot’s mantra shouted from housetops and on the lips of many a hysteric. In fact, in a recent editorial in the local Springfield paper, a comment was made about a politician that for whatever other flaws he might have, at least he advocated less government. This betrays an appalling lack of understanding of history and/or politics. Embedded within this complaint are elements that are partly true but mostly false.

First, a bit of humor. Those who have seen the movie Amadeus which showcases the life of Mozart might remember a scene when a small minded minister convinces the Austrian emperor that Mozart’s music is wonderful but contains “too many notes.” The theory proposed was that there are only so many notes the human ear can assimilate. So the emperor orders Mozart to reduce the number of notes in his music. Mozart replies something to the effect that there are just as many notes as he requires and asks in frustration which notes should be sacrificed.

Similarly, with the argument about the size of government, less government as a political slogan is mindless. There should be just as much government as needed to conduct public business. You might then ask: what is its business? Well, for starters we all assume that the government will ensure a safe supply of drinking water, a police force, schools, firemen, libraries, roads, bridges and sidewalks, courts and legislatures, elaborate systems of record keeping, enforcement of regulations to ensure the safety of food, consumer products, and the conditions in restaurants, etc. In a modern, fast-paced and complex society, the list is quite long. The services provided and the rights safeguarded are many. So which of these are you willing to forego? None you say. That isn’t the issue you say. We want all these things and more but we want them delivered more efficiently with less waste of our precious tax dollars. Now that is certainly an intelligent complaint. Why not “Honest Government” or “Efficient Government” as a demand? Most of us could get behind that.

Calls for “less government” are as sensible as children calling for “less parenting” or felons calling for “less justice.” Remember, the author of that 18th century riddle “Government governs best that governs least” was Thomas Paine, probably the most radical of American revolutionaries. Paine denounced religion as a human invention and supported the French revolution. How about “less cherrypicking” the quotes of 18th century radicals.

It is not too hard to find the motive behind these calls for less government.  Cui Bono - to whom the good? - is still the best question to ask when wanting to get to the bottom of something.  Those who do not wish to be regulated, those not wishing to pay their fair share, those who think that in the delirium caused by starving government of power their fondest wishes will come to pass.  They are playing a fool's game.  All that will be achieved will be the creation of a momentary vacuum which will be filled by an increased power and sovereign entity even more difficult to control.  But it is obvious that were we to judge the efficiency of government by the general level of public education and sophistication, those presently in charge of providing that basic service have much to answer for. 

Nuts on a Velvet Cushion

OK. There is something creative and kinky about wearing hardware as a fashion statement. The Today Show this morning (September 9, 2010) had a short segment about women creating jewelry from some of your favorite items in the hardware aisle. My favorite accessory in the “DIY Haute Couture” line was a belt made of out of a pulley and rope. Of course, there is nothing intrinsically wrong with giving Home Depot a seat at the fashion runway, but is simple youthful exuberance all that is going on here?

The American Middle Class, bless its plaque filled heart, is being further softened up for what MadTV brilliantly satirized as “Lowered Expectations.” Over the past 20 years, the productivity of the American worker has increased but real wages have declined. Now that the biggest bubble of those last 20 years has burst (in real estate), the economy has hit the skids, at least for those in the bottom 80%. Those at the top have never had it so good. The levees of our economy have collapsed and, except for those who live in the most exclusive neighborhoods, we are all trying to keep our heads above water.

Thus, our friends at NBC are there making life a little more pleasant by demonstrating that as every penny of savings and equity are eaten up, women do not have to go about unadorned. They can galvanize their admirers with items that are themselves galvanized. The hardware store is replete with all kinds of rings, chains, spokes and spools in many sizes and shapes. Minnie Pearl step aside. Your dowdy image is in for some stiff and steely competition.

Doesn’t anyone else find this depressing? I thought diamonds were a girl’s best friend. Turns out that all along those blokes who worked themselves into a lather mortgaging their sweat for that matrimonial rock, could have saved a great deal of trouble. All they needed to do for their true love was trot down to True Value and buy their baubles by the pound.

However, the big surprise comes much later. Get ready all you little tykes. When your grandma loses her last little bit of private health insurance and slips off to those faux pearly gates, your inheritance is going to be one large screw.

The 14th Amendment – Racial and Political from the Start

14th Amendment to the U.S. Constitution. Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Ah, you gotta love the Republicans. The 14th Amendment was passed by the required 2/3 vote by an overwhelmingly Republican Congress in 1866. The Civil War having concluded with the defeat of the South, that defeat put the slavery question to rest and should have also put to rest the relative constitutional position of the states vis-à-vis the federal government. Alas, some bad ideas never die even when they are buried under the bodies of 600,000 slain soldiers.

So, the present Republican leadership in our Congress, playing on racial and ethnic prejudices, wants to reverse the impact of the citizenship clause of the 14th Amendment as that has been understood for 150 years, this, ostensibly, as a remedy for “furriners” coming to this country and having children who immediately qualify as American citizens. Illegal immigration is certainly a problem with which the federal government needs to deal; however, for the past 30 years administrations both Democrat and Republican have feared the electoral repercussions of offending one or another voting bloc and left the situation to deteriorate. Reagan did attempt some reform and in the process gave amnesty to 6 million people who had entered the country illegally at that time. Amnesty is no longer a viable option because Republicans have recognized that their racist postures over these 30 years have so alienated many groups that the future does not bode well for their electoral prospects as the racial and ethnic composition of the U.S. will shift over the next 40 years.

Of course, when the amendment first passed the freed slaves were grateful to Lincoln and his party and that gratitude was expressed in voting patterns well into the 20th century, until the Great Depression and the emergence of the New Deal. Those polarities have reversed. African-Americans have been abandoned by the party of Lincoln, which has bleached itself of every progressive element that it may have ever contained to become the spokesparty for plutocrats, the avaricious and the retrograde. The 14th Amendment was passed to guarantee the civil rights of slaves who had been freed and were subject to imposition of disabilities that would have reduced them once again to a kind of functional slavery. It should not be forgotten that generations of slaves born in the United States were not considered citizens, their lives and labor forfeit to generations of people who believed owning other people was perfectly consistent with the idea that “all men are created equal endowed by their Creator with certain inalienable rights.”

Why is this attempt to undo the spirit of the American ethos such vile hypocrisy? For two basic reasons. First, the vast majority of Americans living today are citizens by virtue of the fact that their immigrant forebears, both legal and illegal, gave birth to children on this soil automatically making those children and their progeny American citizens. That was their dream and apparently the dream is still alive. The argument that terrorists are exploiting one of this country’s virtues is laughable. 10,000 people are killed by guns in this country every year. All Osama needs to do is make large contributions to the NRA, sit back, and watch the fireworks. Second, this attempt on the part of Republicans to rewrite the Constitution for their electoral convenience smells to high heaven because it is consistent with their attempt to disenfranchise certain groups in general. So many African-American men are in prison (11% of all African-American men between the ages of 30-34) that disqualifying felons from voting can be the difference between victory and defeat in many political races in this country. It is not that felons ought to vote. Elections can just as easily be stolen by trolling voter registration lists for felons and then disqualifying many eligible voters in the process. (That exactly this tactic was used in the Presidential elections of 2000 and 2004 is easily documented.) What Republicans are doing in this recent maneuver is an attempt to disqualify voters at a more strategic juncture – the very point of citizenship itself.

See Also: http://www.truth-out.org/connie-schultz-blame-babies62011

Sweden - Socialist Paradise?

I have been in Sweden for a week and a half and am about to depart in the morning. The purpose of this trip was attendance at the International Sociological Association meetings where I gave two papers and otherwise hobnobbed with my fellow wizards. But the experience of Sweden and, in particular, Göteburg, is what I wish to discuss.

Sweden has a bad rap in the United States for being too heavily taxed and the prime suspect in that crime known as “social democracy.” It is true that taxes here are high. Not only taxes, but prices for a middle-class sociology professor like myself are just about astronomical. A Caesar salad at any decent restaurant is going to cost the equivalent of about $20.00 and bottled beer goes for about $7.00. One ride on the tram is almost $3.00, at least 30% more than comparable cities in Germany, for example. One supposes that the high prices are a result of the tax structure. The lovely proprietor of a shop selling Indian goods told me that she had to pay 25% off the top from every transaction she made as tax.

On the other hand, the streets are clean and street crime is a non-issue. What is more the people enjoy a very healthy lifestyle and few are as extremely obese as Americans. Coming in by train from Copenhagen, I faced across from a Swedish professional woman who was quick to praise the many social services that were available to people in the country, especially child care. She had children who were in kindergarten which had a very active program and which could keep children until she got off work. In addition, the children were fed two nutritious meals. A woman came in every day and cooked for the class and prepared homemade bread and rolls. Her child does not eat prepackaged meals filled with preservatives and additives, but homecooking and that in a public facility. She beamed when she told me this and that childcare was a worry with which she did not have to contend. Children in the country receive the equivalent of $200 per month from the state paid to the parents and when they reach age 16, the money is paid to them directly. University education is basically free if a student can qualify.

Politically, Sweden is a neutral country so its politics are unusual. The defense budget of the country would not be nearly as burdensome as is that of the United States. Since crime is so low, there are few people in prison taking that burden off the budget as well. In fact, Sweden incarcerates 75 out of every 100,000 people, while the United States incarcerates approximately 750 out of every 100,000 people, ten times as many proportionately. There is an increasing amount of racial and ethnic diversity since Sweden welcomes immigrants from Africa and many foreign nations making its mix something fairly interesting.

Göteburg is a medium sized city (350,000) on the western coast of Sweden and is the second largest city after Stockholm, the capital. People are friendly and the extensive public transportation system makes getting around very easy. I heartily encourage a visit to this interesting place, but save your pennies because it is not inexpensive, especially for Americans who will find that as time goes on their money may not go as far overseas as it has in the past (nor will it at home). Sweden is an example of a working social democracy which is feeling the same pressures that all nations are contending with during the world-wide economic crisis. Forces in this world are attempting to dismantle every bit of human connectedness and feeling, but if people are aware that this happening, possibly they can take steps to prevent it.

Spilled Ink

It is a metaphor for so much of what is wrong with our society: a deeply embedded structural flaw is hemorrhaging national treasure, but, instead of providing any benefit, it is fouling the landscape. The ongoing calamity, the oil leak in the Gulf of Mexico resulting from the explosion and sinking of the rig Deepwater Horizon, demonstrates every day that the Obama administration is not in control of events and that the American people are not in control of their government. As of this writing, British Petroleum has “slowed the leak” but work continues. Up to this point, the term “leak” does not do justice to the colossal scale of the environmental catastrophe that already has taken place and which may be further exacerbated. Estimates run as high as 70,000 barrels of oil a day gushing out of that mechanical wound. At the higher end of the estimate, it would be an Exxon Valdez sized oil spill every four days. Even moderate figures mean millions of barrels of oil fouling the Gulf.

The response of the government provides an opportunity to evaluate its priorities and the credulity of the American people. We live with a legitimating legal dispensation that finds it entirely proper to invade foreign nations, bomb villages with mechanical drones sometimes killing dozens of innocent civilians, waterboard foreign nationals without any legal process, incarcerate its own citizens to the point where even a small quantity of illegal drugs can result in twenty year sentences creating the largest prison system in the world, foreclose on hundreds of thousands of homeowners pushing them into the street, deny veterans the medical care they have earned and so desperately need – all this and yet –

Our government is incapable of reflecting the outrage of the populace when a foreign oil company plays fast and loose with American lives and America’s landscape. Now we know what it feels like to live in a banana republic, helpless before the dictates of foreign corporations. Where is a Congress that sweeps into action denouncing these smug, self-satisfied CEOS who care nothing about life, limb or property? Here is a little action plan for Congress. Pass legislation sequestering every bit of profit made by British Petroleum as a fund against which to pay for any clean-up and continue withholding that profit until every penny in damages is recovered. If that had been done in the first week, the hole in that dyke would have been plugged then and there even if the fat-faced Board of Directors had to go deep sea diving to do it themselves. Instead of outrage we get tears. Congressman Melancon of Louisiana got emotional when thinking about the catastrophic damage done to the natural beauty of his home state. Our sympathy is with him but it is not tears of sympathy that are needed now. Nothing will wash that black stain out of the Gulf for quite some time to come. Unfortunately, it is small compared to the stain on America’s honor and intelligence which this episode has so sadly revealed.

Medical Soviet - Part II

A story recently turned up in the Orlando Sentinel that describes a urologist in that area who has posted a sign on his door that attempts to turn away from medical care in that practice anyone who voted for Obama or supports his health care reform. The story goes on to describe the ethical dereliction that this piece of professional arrogance represents. I suggest that if there are any firefighters in that area who disagree with the good doctor they should refrain from putting out any fires at his home. The pathologically anti-social nature of the sign on his door should deter anyone with any sense from putting themselves in the hands of such an ethical monster.

Unfortunately, the medical establishment in this country has been heavily colonized by this kind of sensibility. There is an interesting work by E. Richard Brown entitled Rockefeller Medicine Men: Medicine and Capitalism in America which provides an excellent introduction to the impact that both medicine has had on capitalism and vice-versa. (It should be noted that the entire work can be downloaded on the Internet at the site which has been hot-buttoned). There is little doubt that medicine as practiced in this country has been an auxiliary to the Fordist and Taylorist practices that have until recently organized the time, minds, bodies of the great masses of American humanity. In return for their faithful service, physicians have received an almost sacred status and the highest medical salaries in the world, although the impact of medical care on gross measures of health do not bear out any great return from all this expense.

It is high time that Americans freed themselves from mystifications of all kinds, but a good start would be the professional mystifications that abound in almost every area of life. Medical mystifications are some of the most durable, most resistant to being dispelled. This is not difficult to understand because we are all wary of criticizing the very people upon whom we rely for the maintenance of our health and the health of our loved ones. Thus, it becomes doubly important that the individuals who operate within that arena of activity, the medical/health care arena, do so on the most disinterested basis that can be arranged. Those who aspire to practice medicine must bring with them a strong sense of social responsibility as well as a basic humanity that transcends politics or economics. Physicians whose lives are taken up with entirely venal considerations are no better than priests who abuse the worshippers in their charge.

But our civilization has given itself over to the idea that we should recognize self-interest as the only worthy motive of action and competition as the engine providing the organizing principle of human relations. The result of this has been the perversion of human values and the transformation of American society into a version of ultimate cage fighting. Winning is everything and your opponent is an object to be eliminated in the pursuit of your goals. Religion, morality, education and even medicine, all these institutions are insidiously transformed to support this shift in values. In fact, there are some who would replace the book held by the Statue of Liberty that has carved into it “July 4, 1776” with something similar to the sign on the doctor’s door: Stay Out – Survival of the Fittest Rules!

The Medical Soviet - Part 1

Today’s comments do not have so much to do with medicine as they have to do with the various twisted ideas that come out of those witches Sabbaths of stupidity and hypocrisy known as “tea parties.” That tea parties are anything more than a collection of disaffected white racists who bemoan their perceived loss of privilege is a difficult position to defend. However, through the vulgar taunts and the vicious looks comes a number of complaints that have a pedigree pre-dating the Obama presidency and which have held together the right wing consensus through a number of presidential administrations. Some of those complaints emerge from a theory of society and economics. That theory maintains that government action, or any collective action for that matter, which stymies the free working of “the market” is illegitimate and guaranteed not only to fail as economics but also to undermine the sacred values of a democratic state.

Unfortunately, there is no easy way to distinguish between one set of regulations and another. To bring medicine back into the conversation, if the principle of open competition were to operate freely in the medical sphere, as I, for one, believe it should at least to a greater degree than it does, state regulation of physicians would be an unacceptable encroachment on freedom of choice. If I want to consult a physician who treats on the basis of the latest nutritional and herbal knowledge, why should I be denied the freedom of doing so? Considering the vast uncertainties upon which medicine is based, it is curious that there are not more disagreements among medical professionals. But medicine as conducted in this country is a series of closely monitored practices based on what is considered to be the best science. Even so, science, if it is science and not dogma, must be an open-ended practice ever laboring toward new paradigms. However, the track record of American medicine has not been one of toleration for alternative views or practices. All one needs to do is consult the history of chiropractic or the oppression suffered by lay midwives. The only way that medicine is able to exert any power is through the monopoly granted it by the state. But if competition effectively sorts between those who succeed and those who fail, why not allow the market to decide who stays in business practicing medicine and who does not?

Of course, to a degree I am playing the devil’s advocate. I suppose even hounds of the tea party breed would bark loudly and lustily if it was suggested that the state cease licensing and regulating the practice of medicine. But why? Well, I suppose it might be argued that some things are so well settled that it only stands to reason that the state has an obvious basis for intervening. The fact that this last insight should be applied to medicine and should not be applied to the provision of medicine would seem to me to be a failure of imagination. Reasonable people can come together and through their consensus determine that some things will not be subject to the whim of fate. “The market” in reality is only another way of saying “fate” or “chance.” At the risk of offending some religious believers, an analogy could be made between this fear of regulation and the refusal of some individuals to accept medical treatment on the basis that it upsets “God’s plan.” Medical treatment may not work and some social regulation may be misconceived and fail to produce its purpose. Neither of those two possibilities should mean that we avoid taking the most advantageous action when the opportunity arises. If the tea parties were operating out of a sense of wisdom and not vitriol, their medicine would be a lot easier to swallow.

Good to the Last Drop!

Hooray! As per a new study out in the last few days, not only has coffee been rehabilitated heart-wise, it is now touted as being heart protective. The new study (funded by the Robert Wood Johnson Foundation and Kaiser Permanente) suggests that dangerous heart arrhythmias are found to occur less often in people who are the heavier coffee drinkers. Of course, media reports of the study do not tell you which kind of coffee to drink, what time of the day to drink it or whether or not it operates the same way if you are taking it with Beta Blockers or whipped cream. Long ago my cynicism reached its now epic proportions concerning medical pronouncements when it became obvious from the conflicting studies that appeared on a regular basis in the media that all one needed to do was wait. You like to indulge in fried pig’s livers but were told that this is a death sentence for your circulatory system? Wait a few days and a new study may appear that will not only clear those livers of all harm but will exalt them to such a height they will be given their own float in the Rose Parade.

Don’t get me wrong. I love coffee, especially the kind that comes mit schlag in the wonderful cafes scattered so conveniently about the city of Vienna. When it was partially vilified by earlier studies, I continued to drink it. Now that coffee has been fussed over yet again by the medical establishment, my love for it has not increased. I drank it before, drink it now and will continue to drink it. Why? Because it tastes good (to me), has not caused any fatal complications as of yet and has a sophisticated complex of flavors and sensations that are appealing. That appeal is ancient and when coffee finally made its way into European salons it took off like a shot. There seems to be little or no evidence that its allure is fading anytime soon. Of course, everything needs to be approached sensibly, but that seems beyond the ken of our modern sawbones. Now that this study has given a green light to coffee drinking, I expect that Americans will put the pedal to the metal and start guzzling coffee like Ponce de Leon at the Fountain of Youth.

But isn’t this exactly the problem with the way that medicine is practiced? Physicians prescribe literally billions of drugs per year to Americans (see Greg Critser) but can only tell in the most general fashion who will suffer serious or even fatal side effects. Everything is a matter of percentage risk. Of course, herbs, teas, natural foods are off limits for most physicians to discuss with their patients because they cannot find “studies” which provide the probabilities of risk. Now that coffee has been the subject of a study and the numbers are in, their confidence swells like Tarzan’s pecs. What about the old studies? What all this is about is a professional narrative that medicine, especially American medicine, would like to have believed. That narrative is simple – we knew nothing before modern medicine came on the scene and we all owe our lives (and most of our fortunes) to the good doctors for the great benefits they have brought us. They have brought us great benefits indeed, but those need to be kept in perspective. Drugs which are enthusiastically marketed at one moment, become a deadly menace the next. Medical errors cost tens of thousands of lives a year. One cannot fault the medical profession entirely. It is really the American public that needs a good hiding for forgetting the simple lessons of their great-grandparents. With medicine, less is more.

Old Duffer responds to News-Leader Blog

The editorial I wrote in response to Dr. Lilly’s article in the Springfield News-Leader has generated a host of comments on the News-Leader site, many of them quite diverting, both in the sense they are funny and that they avoid the issue. In one I am called an “old duffer” to which I take some exception. Please, allow me to be a middle-aged duffer. My duffer-hood has only recently begun. Also, there was reference to my inflated salary, supposedly one of six figures. It is obvious that these posters do not know how to use the Internet because the State of Missouri makes public the salary of all its employees. This is a cruel exaggeration. When I came to Missouri State they hired me in at $29,000 a year, hardly six figures. But people who make such charges do so because they are resentful not only that the state employs people who do mind-work but also because such work may be beyond their understanding. Finally, a suggestion was made that professors be paid $20.00 per student per week, that figure chosen, one supposes, as a disparagement of the education process. In my case, that would mean a salary of more than $160,000. Please, write your representatives and actively work to make this scheme a reality.

As for the health care issues, it was interesting for me to see that there were actually comments made that attempted to downplay the well-known statistical evidence that health care in this country is not what it might be. Life expectancy and infant mortality rates are not the whole picture and present more than a few difficulties when being used to judge the adequacy of a health care system. However, coupled with the amount of money being spent and the lack of access to health care by millions in the population, the picture becomes rather bleak indeed. Dr. Lilly’s powerpoint is not persuasive. The problem lies not in the narrative itself, although there are issues that could be taken with certain points he makes, but the interpretation of the picture that he paints. Yes, third party insurance was abused just like illegal drugs are abused. But without pushers the problem of drug abuse would change considerably. Similarly, where were the AMA and the medical profession in general while all this was going on? They were doing what the hospitals, the insurance companies, the medical device companies and the pharmaceutical companies were doing – coining money. Let him produce the great campaigns that doctors undertook to convince the public that medicine was being oversold. If there were any, they were few and far between. If today, you should suggest that cost is a factor in the health care debate, the very same individuals who complain about the costs start shouting “death panels.”

One of the snide comments on the News-Leader blog concerned the fact that doctors pay so much for their education. In many nations around the world, medical school like university education in general, is either much less expensive than in the U.S. or is funded by the state. Imagine, physicians graduating without having to pay back enormous debts right out of the gate. Physicians today are the highest paid profession in the United States, earning considerably more than physicians in most other industrialized nations. Even so, physician salaries are only about 20-25% of total health care expenditures. None of this truly matters, unless we get the debate under control. This apparently is not within the capacity of a certain segment of our population. Some physicians are going to work hard to keep the present system intact or even to eliminate the government health care programs that now exist in the name of some free-market hokum (although there are more than a few physicians working for positive change). This will continue to allow them to reap enormous profits off the backs of frightened Americans who imagine that they need to throw a sacrifice of their virgin dollars into the health care volcano in order to protect themselves and their loved ones. This strategy does not seem to be working and a fiscal reckoning is approaching when some hard decisions will have to be made. The medicine may not taste very good but ultimately we may have to take it. Either we will realize that human decency requires that we extend health care coverage to everyone, or that we allow people to sicken and die because they are too poor to afford care, which, in fact, is happening already.

The Doctor Is Out

[The following is a facsmilie of an editorial submitted to the Springfield News-Leader on February 17, 2010 in answer to a column written by Dr. John Lilly.]

At the present moment, there are over 40 million people in this country with no health insurance, a good portion of them children. I am a university professor and receive e-mails from students who are too sick to come to class and who try to tough out dangerous conditions with the idea that if the pain becomes too great they will go to an emergency room. The country is drowning in debt, a good portion of which is generated by a health care non-system which drains almost 20% of the lifeblood of this country. And in the face of all those trillions of dollars poured down the health care sinkhole, our nation has one of the worst levels of infant mortality in the industrialized world and our life expectancy lags as well.

So I was again amused to see Dr. John Lilly, the former President of the Greene County Medical Society and a Young Conservative to boot, recommend in the Springfield News-Leader (February 17, 2010) that we institute a truly competitive system so that doctors would not be affected by the cuts that Medicare needs to make in order to maintain its fiscal stability. We now spend over $7,000 per capita on healthcare – that is $7,000 for every man, woman and child in this country and even in the face of that he fears that doctors will be shortchanged and thus will withhold their services. If he would consult his history, he would find that when medicine was “competitive” on the old frontier, doctors were paid in bushels of corn or with anything that people could pay and the doctors accepted it because medicine was their calling and when the community suffered they suffered as well.

What he really wants is something quite different than a return to the good old days. Medicine has never been nor can it ever be a competitive enterprise. When you purchase a commodity in a marketplace, you take account of the price and decide whether you can afford what you want and/or whether the commodity is priced fairly. The seller will make similar calculations in deciding at what price to sell or whether to sell at all. Both sides in a truly competitive market can try to find others from whom to buy or sell or decide in the end not to buy or sell. Immediately it is plain that medicine cannot be placed in this model. Those in need of healthcare services are often in no position to forego them. Life is at stake and the physician who does not hearken to the humanistic values of the now all but defunct Hippocratic Oath descends to the level of the extortionist. No one should work for “free,” but the physician who does not understand the difference between healing and haberdashery needs some therapy of his own.

Cute as a Reset Button

Well, if giving a real barnburner of a speech is any measure, we sure got our money’s worth with President Obama’s first State of the Union message. The buzz leading up to it was that he was going to hit the reset button on his administration as a response to some of the reverses it has experienced in the last year. He did speak of “setbacks” for his administration, but is it simply enough to endearingly characterize the problems of the country? Obama did this very effectively during his campaign and yet managed to create an Everest of doubt in his sincerity even among his most fervid admirers. He has been the President for a year and for those who supported him his accomplishments appear few and far between.

Nonetheless, it is my impression that he renewed his lease on hope with this speech and gave some momentum to his administration leading up to the elections in November. That he is a consummate politician and wordsmith was further ratified by this performance. He called attention to the strength and the decency of the American people and accurately described the desperate plight of working America. A line such as “No one should go broke because they chose to go to college” was later followed by recognition that American business will be the ultimate engine of our recovery. There was meat thrown to tigers of all political stripes. Rousing applause and standing ovation came most often from the Democratic side of the audience and a stolid and studied indifference from the Republicans. As with all such presidential speeches, remarks were made of such a general and patriotic nature that ratifying applause was evident from all segments of the audience.

However, it was interesting to note that the Republicans could not be moved from their seats by President Obama’s acknowledgment that American people are strong and decent, maybe because that was placed in the context of their gallant response to the economic downturn. Everything is perspective and from mine, the Republican side of the chamber looked like a collection of 250 suits each with a sneer in its lapel. The sneerer-in-chief Eric Cantor, the House Republican Whip, was turned out in his best supercilious expression, with which, in fact, he may have been born. Thus, no special notice need be taken of it. In any case, Obama’s desire to continue to work bi-partisan magic or the Democrats’ general tendency to defer to their opposition may not succeed, especially with all the serious financial and social difficulties facing this nation.

We are a pragmatic people and want problems solved and business done. The structural problems built into our political system seem to work against finding solutions, particularly the need for super-majorities before legislation can be passed. I know of no other real democracy that hobbles itself in this way. A democratic republic should truly represent its people. Rural states have much more power than their numbers warrant and lobbyists have much more influence than honest government can abide. Of course, many parliamentary governments with numerous parties are equally hobbled; small parties often wield power much greater than their size because of their strategic situation.

It will be interesting to observe whether Obama is able to turn the current tide in his direction. He has not really departed from the standard narrative nor has his political behavior been startlingly new. Yet, he is characterized in outrageous terms bearing no relationship to any reality. The ambitions of the American global empire remain unamended. The Republicans did not even applaud when Obama called for companies to keep jobs in this country. The fortunes of their patrons ride on a much freer expression of capital, one in which the government in all the moves that it makes works to their financial benefit. People – didn’t you attend the corporate orientation meeting where it was all laid out? The business of America is business and the sooner you learn that the happier you’ll be, and if not there’s always Prozac.

The Age of Stupefaction

After Hurricane Katrina had created its toll of human misery, I was moved to write a short editorial comparing that devastation with the earthquake in Lisbon in 1755. What interested me was the reaction to that catastrophe of various Enlightenment intellectuals. Voltaire, in particular, like so many at the time, found it difficult to reconcile the existence of a benevolent deity with the suffering and death imposed on so many tens of thousands, the good and the wicked together. By contrast, the British newspaper, the Daily Mail, February 2, 2009, reported that Gerhard Wagner, later appointed Bishop of Linz by Pope Benedict XVI, had said that the hurricane was divine punishment for the permissive sexuality in New Orleans (he also characterized the Harry Potter books as “satanic”). So much for God’s dialogue with Abraham where He would have foregone the destruction of a city (Sodom in that case) if it had contained ten good men. Similar sentiments were expressed in this country. In fact, the widely followed Pastor John Hagee said, “All hurricanes are acts of God because God controls the heavens. I believe that New Orleans had a level of sin that was offensive to God and they were recipients of the judgment of God for that” [NPR Fresh Air, 9/18/06], reported in the Huffington Post, February 29, 2008.

Well, the incomprehensible level of suffering occasioned by the earthquake in Haiti has also caused a seismic increase in the level of schadenfreude that can be found around the world. Sadly again, some of it appears in this country. Pat Robertson, not wanting to leave any doubt that his comments about the world scene are inane and should be dismissed by any right thinking person, made remarks suggesting the Haitians, during their long and tragic history, had made a pact with the devil to rid the island of the French and thus were now paying the price. There is a short YouTube video wherein he says the same and actually paraphrases the response that the devil apparently gave the Haitians. There are times when it is hard to believe that there ever was an Age of Enlightenment which provided the inspiration for the American revolution.

This has always been a religious nation but at the same time it has always been a pragmatic nation. We are going through one of our periodic upheavals of religiously based superstition and ignorance which is causing and, in the short term, will continue to cause much mischief. It is my belief that the American people will not allow themselves to be drawn into a vortex of know-nothingism from which they cannot escape. It would be a great pity if we entered history on the wings of Enlightenment and left it on gusts of stupefaction.

Pontius Pilate Applies for Blue Cross

Luke 10: 30 In answer Jesus said, 'A man was once on his way down from Jerusalem to Jericho and fell into the hands of bandits; they stripped him, beat him and then made off, leaving him half dead. 31 Now a priest happened to be travelling down the same road, but when he saw the man, he passed by on the other side. 32 In the same way a Levite who came to the place saw him, and passed by on the other side. 33 But a Samaritan traveller who came on him was moved with compassion when he saw him. 34 He went up to him and bandaged his wounds, pouring oil and wine on them. He then lifted him onto his own mount and took him to an inn and looked after him. 35 Next day, he took out two denarii and handed them to the innkeeper and said, "Look after him, and on my way back I will make good any extra expense you have." 36 Which of these three, do you think, proved himself a neighbour to the man who fell into the bandits' hands?'

The current disaster movie now being filmed in the halls of Congress is called “American Health Care Reform.” The ink on the various bills was not even dry when they were dragged into dark corridors and beaten into insensibility. The issues involved in reforming the provision of health care in this country are so complex and intersect with so many other areas that it is daunting to know where to begin. However, one of the most basic issues that must be settled before health care has any chance of being reformed is agreement on whether or not human beings owe each other a duty of care. If we say from the outset it’s every person for him or herself, then the health care debate becomes somewhat simplified. We ignore the needs of the poor, the weak, the old, the sick, the uneducated, the wounded and allow the logic of the present system to work itself out, letting the chips fall where they may.

Somehow that does not feel like the lesson of the good Samaritan. It is interesting that in this parable Jesus specifically uses the care of wounds as a measure of neighborliness. Some might reply that it does not mean that the government should have the responsibility for providing that care. As a sociologist, I would normally refrain from engaging in the use of religious argument, but let us suppose that Jesus is confronted with precisely this case. Is it to be imagined that his reply would be that government ought to stay out of the business of health care? Are we to suppose that the Samaritan would be any less praiseworthy if instead of providing assistance of himself he was instead a representative of the community at large? If Pontius Pilate decreed that henceforth all the medical needs of the community would be met, would that be cause for denunciation and alarm? Such a decree surely would be welcomed even if it did not exhaust the entire meaning of the parable. Compassionate human beings would still be responsible for those needs which escaped the notice of the authorities or for harms occurring in plain sight. Alternatively, one could easily imagine the complaints of the passersby who refused to give aid in the first place saying that they resented having to give their hard earned tax money for such a purpose.

Thousands of years have passed but the needs are still as great and their disregard is just as bitter. In the right hand column of this blog I have posted two parts of an interview with Slavoj Žižek, a controversial Slovenian sociologist and psychoanalyst. In the first part of the interview, he makes an interesting case that provision of health care should be treated like water or other public utilities. He willingly gives up the choices involved in treating health care like a business so he can devote himself to a truer freedom. If we are burdened with concern over how we can afford health care for ourselves, our children, our parents, then what is our freedom at the end of the day? There are powerful interests in this country and the world who benefit enormously by treating health care as if it were a giant haberdashery and not a matter of life and death. They have the resources to create the public relations necessary to stampede a credulous public into believing that its interests are best served by giving up the power to organize and control. It seems to me that the banks have been operating on the same set of principles that these health care interests are trying to keep in place. As Chico Marx once famously said, “Who you gonna believe? Me or your own eyes?”

Howdy

And they said that irony was dead. For the past few years I have been playing with the handle "a simple country sociologist" because it expresses in a mildly sardonic fashion a self commentary and a judgment. I am about as “simple” and “country” as a Schwarzwälder Kirschtorte (a Black Forest cherry cake). But it might get a chuckle and a bit of attention. I am, however, a sociologist, and one that has taken upon himself the task of making the world more aware of what sociology has to offer. It is one of the more neglected social sciences, taking a rather cramped back seat to Anthropology or Economics. In fact, Economics, the “dismal science,” has become the celebrity du jour of the social sciences, sucking up almost all the face time in the media no matter how repetitive and worthless the message. Thus, I have begun a commercial venture (Within-USA, Inc.) with the purpose of spreading the sociological gospel among other good works.

However, it appears that in the United States, a valuable tradition has been allowed to wither and almost vanish from the socio-cultural scene. Those of us who had the good fortune to attend public high schools when actual content was taught can remember exposure to the great American intellectual tradition of good writing and pragmatic inquiry. Today, what passes for writing shames the hunter-gatherers who took the trouble to invent language. And inquiry! People no longer inquire; they start by concluding, and then inquire how they can work their way back to their conclusions. But as a devotee of the work of Jean Baudrillard, it is not seemly to become too much of a curmudgeon. This blog will allow me ample opportunity for that and there are more pressing matters which need discussion, health care reform, in particular, which will be the subject of my next post.

Before going any further, I should introduce myself. I was born in Brooklyn when the Dodgers still played in Ebbets Field and trolley cars rolled on Church Avenue. My family moved around a bit but most of my childhood was spent on Long Island. After obtaining a Bachelor’s degree from Stanford University, I went to law school for a year but decided that was a dark alley best avoided. My Ph.D. in sociology is from the University of California, San Francisco. For the past twenty years I have taught in the sociology department of Missouri State University in Springfield, Missouri. New York to California to Missouri.

Springfield is not a place I would have imagined myself spending time, but it has its charms. Its geographic centrality makes it a kind of microcosm of the country as a whole, or you would think so. However, there are elements in its composition that make it distinctly unlike the rest of the country. It is a small city of 160,000 which does not reflect the racial or ethnic diversity of the rest of America. It is a decidedly conservative place but nonetheless a lively progressive element manages to thrive as well. Right now it is bitterly cold, dangerously so, and we had an ice storm three years ago that required the presence of the National Guard in its aftermath. I have included some recent photos of Springfield. These are not typical scenes but they convey a sense of civilization as it has been planted on the great American prairie. I began as a highly urbanized individual who took for granted all the amenities of places like New York and San Francisco, but after all this time I have developed a respect and even an affection for this “Queen City of the Ozarks.”