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A Sinking Ship

The days are getting hotter and so are American politics. The President of the United States has chosen a rogue path to diplomacy with foreign countries. People who follow politics are becoming more and more stressed over the recent unfoldments. I see it every day in my office. To be expected, it is affecting the health of our country.

In the past, people shared their politically dissenting views with each other to expand their knowledge and learn from their opponents. Our American society frequently debated about taxes, tariffs, foreign aid, federally funded charity to its citizens, immigration, marijuana, and healthcare. In medical school thirty plus years ago, I was told that healthcare passed its golden years and our future as physicians would be uncertain. I did not realize the massive scope of change that was coming over the horizon.

People are intolerant of any viewpoint, other than their own. It appears that feelings are injured when someone remotely challenges their ideas about our country. Anger is filling our discussions instead of understanding. We are in a time when facts and statistics do not matter; data is replaced with personal bias and worldviews which at first blush appear logical but are ultimately irrational, hanging on the edge of pure absurdity.

I grew up in an inner-city environment. The community was everything. My neighbors were black, Mexican, and Philippino. There were very few whites in our community. My elementary and middle school classmates were primarily black, as well as members of my sports teams. We had one feature in common: we were all on the low end of the socio-economic scale. We shared wearing worn-out tennis shoes, patched-up pants, and darned socks. All of us ate at home since we could not afford to eat in restaurants, we seldom had large birthday celebrations and holidays were filled with simple pleasures. Our automobiles were patched up too. We dreamed of new cars, new clothes, and faraway places. None of us thought about getting free food from the government. We were dignified and poor. I painted a neighborhood woman’s home for a few dollars at eleven-years-old. I had a paper route and worked at A & P grocery as a bagger at age fourteen. My friends all tried to pull their weight too. We were poor, but we were determined to make something of ourselves. We had dreams.

I am not sure what has happened to our society in the past fifty years. I have seen a significant shift in societal compassion for the impoverished people who live in our community. Those who are socially empowered to champion the poor or socially disenfranchised are overtly Machiavellian in their approach to getting things done, but only for their people. In the past, when all boats rose because of social programs or health care funding, everyone benefited. Now, only the ships of special interest groups rise to the detriment of those who have no voice in the matter. The minorities of the past have become the majorities of the future. Those minorities still behave and publicly assert that no one has given them a leg up in any way. Phrases such as “white male privilege at birth” has become so entrenched in our conversations that any white person, male or female, regardless of their socioeconomic weaknesses are considered privileged in all ways. There are no quotas for accepting or hiring white men in any educational system or job category of which I am aware. Our population was a melting pot at one time; now it is a group of dissociated groups fighting for their separate share of the economic spoils of the largest economy in the world.

What does this have to do with healthcare? Everything. I am saddened that physicians have given up their power freely to guide health care and have allowed insurance companies’ and Medicare’s non-physician administrators and financial number crunchers to create and maintain standard practice guidelines which are no guidelines at all. These guidelines are iron clad mandates of standardized practice for any physician accepting insurance or Medicare. These doctors will not be reimbursed for the care they provide if they do not follow the guidelines correctly. An example of these practices: Medical insurance and Medicare will not compensate for Vitamin D levels anymore, even though vitamin D is known to help protect women against breast cancer. Physicians do not order vitamin D levels in patients who have these insurance companies or Medicare. Bone density is also affected by low vitamin D levels. I do not practice for an insurance or Medicare payment. If I order the test, it is an expense our patients must endure themselves if they wish to see if they are vitamin D deficient and at risk.

Why have physicians given away the store to non-physicians? Because the candidates for medical school in today’s world are far less committed to practicing medicine than those who enrolled when I went to school; financial gain has become the mantra of young residents and physicians as well as the lack of desire to assume responsibility for their patients in off hours, weekends and holidays. Patient care has been regulated to shift time by hospitalists and hospital-based physicians who check outpatient care when they leave the rooms of their patients. Family nurse practitioners and physician’s assistants have populated clinics to reduce the cost of care, but most times the quality of care decreases also. I believe nurse practitioners and physician assistants are helpful when they perform procedures such as pap smears and bimanual exams or routine follow-up care after surgery. They have limited experience in evaluating undiagnosed disease and may not have the expertise to prescribe medications to complex medical patients.

Instead of letting every healthcare boat rise for every patient, the government and insurance companies have reduced the quality of care for everyone across the board, so that no one can claim that their special interest group is being ignored or not receiving adequate healthcare. For insurance companies, it also serves to increase their double-digit profit margins and financially protect their shareholders.

The movement to lower expectations for everyone’s quality of healthcare bleeds across lines to education and jobs. There is so much money spent to mainstream children with disabilities that the coffers are empty for those gifted children who need more stimulation to remain active in school. Employers are hiring on quota systems instead of qualifications. Large corporations that have spent incredible amounts of money to find appropriate prospective job candidates by designing and administering sophisticated pre-interview tests which are intended to discriminate against people on critical thinking skills, logical reasoning, and intellect. Companies have had to resort to these testing techniques because colleges and universities are lowering their academic standards for graduation to assure higher graduation rates for everyone which captures the most compensation in State and Federal dollars for higher education. There is big money in the education system to produce mediocre talent which in turn creates average employees who falsely believe they are top notch.

I am not sure how we get out of this fix we are in. I am not a socialist and do not believe that Bernie Sanders and the extreme left-wing has the answer to our countries dilemmas. I am also far from the extreme right-wing conservative who thinks that privilege has its privilege. The socialists can move to Europe, and the Right Wingers can move to India. The caste system would work well for them there. 

We have already increased the Deficit with each party in control; we have people in White House cabinet positions who might have graduated from college but show an incredibly low level of intelligence witnessed by their decision making. We have a Congress that will not get along regardless of the rightness or fitness for our country. We have decision makers rolling back healthcare to times when pre-existing illness determined whether you were eligible for medical insurance, and we have no upper limits on premiums, deductibles or out-of-pocket expenses that we will be responsible for.  Hospital and pharmaceutical charges have grown exponentially in relationship to our wages and cost of living raises, and costs of medical goods. There is no ceiling for the price of healthcare in sight. 

As military generals argue that we need more spending so that our service men have more than one hundred thousand effective ways to kill an adversary; as black members of our society argue that white people have privilege and should be subdued and black people need quotas to further their agendas to subdue the white population’s racist agenda and increase educational opportunities for black Americans; as gays speak out and demand protection under the law for marriage and parenting; as the right wing evangelicals want abortion to be outlawed by the federal government with no regard for the unwanted child or compassion for the extremely distressed mother; as feminist women who demand to get equal pay for equal work and favoritism over white men for unfilled management and political jobs; as mothers of children with learning disabilities argue their children need more resources in school and individual compensation for job placements even though their child might not measure up to other children; as pastors who say that the criminals in their flock need rehabilitation and education to recognize right from wrong; as college and university presidents say that we need more educated young people in our country and everyone should go to college for free; as healthcare insurance companies demand more freedoms to charge more money for their products and initiatives to keep our citizens more healthy as Americans as a group become more unhealthy compared to other more frugal countries worldwide; and farmers argue that without government subsidies to keep crop prices high, we would drop food production and farming as we know it would disappear, the American ship as a whole is sinking like the ice caps are melting: subtly but most assuredly.

And when the ship begins to sink, it’s every man for himself. And remember, the rats are always last to abandon a sinking ship.  Let’s get this boat righted before we end up locking up the rats.

Doc

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