YDS: The Clare Spark Blog

March 6, 2014

Crises: real and manufactured

MAD“What, me worry?” Someone looked up this blog, written last year on the D-Day anniversary. https://clarespark.com/2013/06/06/morale-in-the-time-of-crisis-overload/. D-Day, 6 June, 1944, was a true crisis, not a mass media manufactured one. This blog is about both real crises and those emergencies that are ideological in origin.

Giving too much weight to crises that are not “real” can affect physical and mental health, not to speak of where we should put our primary efforts in coping with problems, both personal and social. I got the idea for this blog after reading all of “U” a periodical put out by the David Geffen School of Medicine at UCLA. Although positive in outlook, this important public health magazine is worried about the size of the Baby Boomer generation and the shortage of trained physicians who understand the needs of geriatric patients that is likely to result. It should be mentioned that this is a generally liberal magazine, optimistically progressive, reformist in tone, and certainly not alarmist, as they support ACA without reservation, including a warning about the pointless excessive cost of end of life critical care (i.e., death panels are not mentioned). As good multicultural liberals, they write to everyone (including veterans with PTSD and brain injuries), celebrating both recent discoveries in medicine (e.g. the Genome project, genetic sources of schizophrenia), and the healing power of “faith” and “happiness.”

And as good liberals, they published a letter from a doctor irate with the notion that faith heals, as opposed to science. But that letter is immediately followed by another celebrating faith and spirituality. There is no problem with the marketplace of ideas at UCLA, not here at least.

The rest of this blog lists some emergencies that I, from the distance of my years, can identify as real crises. Some are personal, some are social in origin. All affect personal and public health. As one example of a manufactured crisis, think of “anxiety and depression.” What sane person is not anxious and depressed given the real intertwined crises listed below in capital letters.

REAL CRISES.

True of false? According to Marxist-Leninist theory, capitalism is in a permanent state of crisis, being a “weak and unstable system” [Hyman Minsky’s diagnosis]. For lefties I have known, such an emphasis on the past and future crises (that either should have led to socialism/communism, or are guides for future action, sans errors), can lead to a carelessness or minimizing of personal crises: the ageing and death of parents, divorces, troubled attachments to lovers, families and children. Such persons, it has been widely observed, are living in hopes of a future utopia, not a past Golden Age, as reactionaries do. Their Leninist critiques of the present tend to be framed as “will it advance the working-class revolution?”, or will this or that movement advance such disasters as “false consciousness” allegedly caused by mass media and consumerism. Or, they may infiltrate reformist groups such as environmentalism, in order to turn “Greens” into Reds. Such tactics can lead to alarm over irreversible climate change, an alarm that is intended to delegitimize current types of energy usage. Or, and this is the worst: leftists have bonded with Islamic jihadists on the theory that they are correct to destroy “imperialist” Israel.

Here are some crises that should receive more attention from those of us who give at least lip service to capitalism as either social democrats, neocons, libertarians, or conservatives. Each of these has preoccupied me for the last four or five years on the website. I will not attempt to specify the causes of the intertwined crises that I have emphasized, but I have no love for the progressive activist reading of the “living” Constitution.

DUMBING DOWN.  THE CONFUSION OF PAIN WITH PLEASURE (systemic masochism).  LOSS OF FOCUS (CHANGING THE SUBJECT). THE LEFTIST TAKEOVER OF THE HUMANITIES AND MASS MEDIA. USE OF THE INTERNET TO FIND PARANOID CONSPIRACY THEORIES OR TO VENT RAGE. COUNTER-ENLIGHTENMENT/ANTI-SCIENCE. POSTMODERNISM. NEEDLESS POLARIZATION. NONCHALANCE and DROPPING OUT. THE ADMINISTERED STATE.* MULTICULTURALISM/IDENTITY POLITICS. INDIFFERENCE TO TERRORIST THREAT FROM ISLAMIC JIHADISM.

*By including “the administered state” I do not imply that concern with progressive statism is not a crisis, but that it is the source of  most of the other crises as listed. In this I am following Richard Epstein’s new book The Classical Liberal Constitution: The Uncertain Quest for Limited Government (Harvard UP, 2014). By including “postmodernism” I am agreeing with Epstein’s claim that all text are not inherently ambiguous, hence unresponsive to interpretation. This postulate of his is more significant than many would imagine.
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November 21, 2010

Dr. James Pagano on ObamaCare (2)

Filed under: Uncategorized — clarelspark @ 3:24 am
Tags: , , , , ,

Rembrandt: The Anatomy Lesson of Doctor Tulp, 1632

Two weeks have passed since the midterm elections.  The anxiety, anticipation, and exhilaration they inspired have had time to dissipate and now a clearer picture of where we stand, and what we have to do to move forward, is beginning to emerge.  While there are many fronts on which battles should, and will, be fought I will confine my comments to the one issue I am most qualified to critique—ObamaCare.

 It was crafted in secret with no bipartisan support.  It is monstrous in its scope.  It is being touted by those who created it as being about ‘healthcare for all’, and yet to get it passed, with supermajorities in both the House and Senate, votes had to be bought outright.  It has to go.

 While everyone agrees that there are problems with the cost and delivery of healthcare in this country I can guarantee you this law will not solve them.  It will make them worse and the cost for this ‘de-provement’ will be an American public indentured to the Federal government for the foreseeable future.

 This country was founded on the principle that individuals have value and rights.  Nowhere is this more apparent than in our system of healthcare.  Doctors are trained to treat patients as individuals, each with his own problems and circumstances, and patients have come to expect their doctors to make decisions regarding their care based on what is best for them.  Period.

 The architects of ObamaCare see things differently.  Our president, a self-proclaimed ‘progressive’, believes what all progressives believe.  Namely, that the welfare of society is more important than the welfare of any individual.  Individuals don’t matter in general, and when they cease to be ‘productive’ members of that society, they matter even less.  The fact that a society is nothing more than a collection of individuals working to achieve some common goals is somehow lost on these people.

 This belief in the primacy of ‘society’ underlies the key element of ObamaCare—stripping half a trillion dollars from MediCare to pay for thirty-some million people soon to be enrolled in various forms of Medicaid.  This is a disaster on a few different levels.

First, patients on MediCare are by definition older, sicker, and more in need of medical services, services that by and large they have earned during their ‘productive’ years by paying large amounts of money into the system via MediCare taxes. 

 Second, Medicaid is not what people think it is.  Specifically, it is not ‘insurance’ but merely a free pass for those who have it who will then never face a premium payment, a deductible, or a co-payment.  This creates a class of healthcare consumer with no skin in the game.  This is exactly what we don’t need if we want to control overuse of services and spiraling costs.

When I say it isn’t insurance I’m referring to the fact that very few physicians accept Medicaid patients.  They can’t afford to.  This is true for most primary care physicians and even more so for the great majority of specialists and subspecialists.  So when the Medicaid patient comes to the ER with a broken arm, we see him, do the exam, take the x-rays, make the diagnosis, and apply the splint.  But if that broken arm needs to be reduced, or operated on, we can’t get the orthopedist to take the case. 

 Some have suggested that a physician’s license to practice be dependent on his willingness to care for these patients.  I hope we’re not considering bringing back slavery. 

 The true goal of ObamaCare is to squeeze out private insurance companies and force everyone into a single-payer, government-run healthcare system.  Why seemingly intelligent people think this is a good idea baffles me.  In countries where this is being practiced, notably Canada and England, there is widespread acknowledgement that it doesn’t work very well.  Private clinics are popping up in Canada and doctors in border cities are doing a brisk business caring for Canadians who feel they can’t wait six months to a year for their joint replacement or their MRI.  My British friends are equally unenthusiastic about their system.

If we want to reform healthcare in this country then that’s what we should do.  Identify the specific problems that need to be addressed, the recisions, the denials for pre-existing conditions, the lifetime caps on benefits, and the availability of coverage for the great majority of people in this country, and then do the work of finding specific solutions in concert with physicians and insurers.

 We do not need the Federal government using healthcare as an excuse to commandeer a sixth of our economy.  We do not want bureaucrats deciding who gets what care and when.  We don’t need rationed care, we need rational care.  There’s a difference.

Hygeia

 If Obama succeeds in destroying the current private healthcare system his appointees, like Dr. Berwick, will be instituting a large number of ‘practice guidelines’ as a means of making healthcare delivery more homogeneous across geographic and social lines, and more affordable.  There are already such guidelines in place for certain diagnoses and they are referred to as ‘Core Measures’.  These guidelines are supposed to be the result of rigorous scientific study and are supposed to represent ‘best practices’ for the diagnoses they cover.

 In some instances they make sense, in others they seem arbitrary.  But even the most egregious of these guidelines—the one requiring us to obtain blood cultures on patients suspected of having pneumonia, which most physicians realize is a waste of time and money, remains in force.  Such is the inertia of government.

 The guidelines to come are not going to be anywhere near as pleasant as our current ‘Core Measures’.  My guess is that they will be closer to Draconian.  They will be designed to shift care, and the money it costs, away from the ‘non-productive’ members of society.  And yes, if this sounds like the ‘death panel’ stuff people were ranting about a year ago, well, it is.

 It is true that something like eighty percent or so of healthcare dollars are spent on the last 2-3 years of life.  We don’t need the government to fix this.  We need to promote rational care, where physicians feel free to discuss end-of-life issues with patients and families and where they do not have to live under the threat of being sued every time one of their patients has a bad outcome.  If you believe that death is a bad outcome, then we are all bound to have one.  It is not necessarily your doctor’s fault.

Educating the public about what we can and cannot do for the terminally ill, and having the courage to make decisions on that knowledge, will eventually save the dollars we are looking to save.  All without the government taking over, without Dr Berwick, without Obama.

 James Pagano, MD

Dr. Pagano’s first blog can be found here: https://clarespark.com/2010/03/19/dr-james-pagano-on-obamacare/. Dr. Pagano has just published a novel, The Bleed, “about ER doctors, sleazy trial lawyers, ne’er-do-well patients, gangs and girls–and what happens when their worlds collide.”  I have just read the novel, and its detailed account of a medical malpractice case and the current administrative difficulties that discourage doctors from a one-to-one relationship with patients should alert us to the dangers to individual and public health being advanced by left-liberals today. In Pagano’s own words to me, it is a good airplane read.

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