Happiness For Blessing

Representative Williams, The government shutdown is costing us $300 million per day, according to the IHS. It is time for the House of Representatives to stop the political grandstanding and vote for a clean funding bill to end the government shutdown. I happen to be a supporter of the Affordable Care Act. I have friends and family that have pre-existing conditions and can now purchase insurance just as you and I have been able to do in the past. I understand that you and most of your constituents disagree with me. However, it's time to stop fighting this law, which was passed by a democratically elected Congress, signed by a democratically elected President, and upheld by the Supreme Court. The House has now voted 41 times to repeal this law. How many more times will be enough? The 113th Congress is on track to be the least productive Congress in modern history based on measures passed, according to the Pew Research Center. You ran on a platform of ending political gridlock, but it appears that you are intent on continuing your party's obstructionist agenda. Twenty-one House Republicans have now said publicly that they would vote for a clean funding bill, which is enough to get one passed. As one of your constituents, I would appreciate it very much if you joined that number. Thank you for your time. Robert L. Bishop Burleson, TX

So it's 2012 - almost 2013.  Surely racism is dead now, right?

Nope.

Supporters of Russian football (soccer) team Zenit St. Petersburg recently published an open letter of sorts where they demanded that the team not add or select players that make up racial or sexual minorities. 

Pay attention to the language and arguments used in the letter.  For starters, when you have to begin your argument with "I'm not racist, but..." you might want to back up and rethink your position.  The more important point is that the group argues that their identity is in jeopardy.  Many other teams in other nations do this, albeit with more stealth and acceptable language.  In England, for example, the FA requires that teams carry a certain amount of "homegrown" players on their active roster.  Without going into too much detail, a homegrown player is basically defined as a player who has spent a certain amount of years in the club's academy (think minor leagues, but for even younger players) before their 21st birthday.  There's no language in the rule that players have to be a certain nationality, but because of the way the system already works, the rule basically ensures that English clubs will have a certain quota of English players.  Racist?  Eh.  Xenophobic?  Oh yes.  Such is the nature of international sport. 

In both cases (that of Zenit and of England), the fear is that "others" will come along and ruin the identity of the organization.  As members of a melting pot (or is it salad bowl?) society, we Americans have certainly seen this attitude.  Perhaps we have even espoused it.  The problem with this kind of thinking is that it is inherently exclusionary.  The Zenit supporters have defined their identity using external factors, and therefore the best way to preserve it is through exclusion of people who are externally different.  Let's go back to the original point: they think they're not racist, even though it's apparent to all on the outside that that's clearly not the case.  It's very easy to convince yourself that you're not prejudiced or biased against a certain person or type of person, but that doesn't make it true.  Rather than simply shaking our heads about the state of the world in 2012 and looking down at our noses at those silly Russians, let's examine ourselves.  What excuses are we making in order to exclude others?

Over the last several days, I've seen the following pattern repeated several times on Facebook: Person complains about politicization of tragedy, then immediately offers their own political views.  The message seems to be that offering views we disagree with in the wake of terrible news is unwelcome, but as long as we are Right, we can say whatever we want. 

Have we always shown such blatant disregard for the views of others that we immediately dismiss "their" opinions as exploitative, while our own poignant words of wisdom are so essential that they must be shared with the world immediately?  Or have social networking sites like Facebook simply revealed how narcissistic we can be?

It saddens me, because people I know and respect and would love to dialogue with are more and more staying away from Facebook and the like because it can be divisive and ugly.  More than that, I'm saddened because I see this trait (blatant disrespect for others and their thoughts) in myself. 

Is social networking redeemable?

Tomorrow, Americans will go to the polls.  In nearly every race, there will be one winner and one or more losers.  In many of these cases, a little more than half of the people will be happy, and almost as many will be disappointed (or worse).

It's a byproduct of democracy.  The most lopsided victory (in terms of the popular vote) in U.S. history happened in 1920, when Warren G. Harding defeated James M. Cox, 60.3-34.1.  Thirty-four percent is not a small number - over 9 million people voted for Cox!  There were certain counties in South Carolina where every single person that voted cast their ballot for him.  I imagine that if Facebook existed in 1920, November 2 would have been a busy night, what with 9 million people threatening to move to Canada while 16 million others yelled at them to get in line and support the President.


Take a look at the concession speeches given by John McCain (2008) and John Kerry (2004).  Here's what jumps out to me: both candidates are gracious to the point of being almost unrecognizable.  I can't help but think that both men would have done better if they had displayed this side of themselves before the votes were tallied, but when you're behind in the polls, the political playbook says you must go on the offensive to motivate your base.  These men failed, so they each gave speeches about the need for unity and cooperation.  These speeches were promptly ignored by the respective parties, with one audience even booing the speaker. 

Either Barack Obama or Mitt Romney will be probably declared a loser tomorrow night.  Roughly half of the country will be upset about this news.  The same goes for the many Senate, School Board, Railroad Commissioner, and Justice of the Peace races going on everywhere.  I'm personally most worried about the Senate race in Texas, where it looks like my preferred candidate will lose, but there are other races where I'm happy about where the polls currently stand.  There's a chance that I will be disappointed and perhaps even depressed about the results tomorrow night.  If I don't set standards for myself on how I'll behave when that happens, I may say or do something I regret.  So I'm making the following campaign promises.  You can consider this my preemptive concession speech, in bullet form.

• I will not suggest that people in my country or state or polling district are mentally or morally deficient because my candidate lost.
• I will not direct anger, no matter how righteous I believe it to be, at politicians or voters.
• I will not launch a scorched earth campaign against the winning politician simply because I disagree with him.
• I will continue to strive to think critically about issues, and place my reasoning above party loyalty.

"Have nothing to do with foolish, ignorant controversies; you know that they breed quarrels." - II Timothy 2:23

"You're criticizing me for not living up to your tagline. And you dismiss any criticism as further evidence of how the rest of the media persecute you. You like to pretend, Bernie Goldberg and Fox News, that the relentless conservative activism of Fox News is the equivalent of the disorganized liberal influence you find on ABC, NBC, and CBS. You may be able to detect a liberal pathogen in their bloodstream, however faint, but Fox News is such a crazy overreaction to that perceived threat. You're like an autoimmune disorder. I'm not saying the virus doesn't exist in some small quantity, but you're producing way too many antibodies. Fox News, you are the lupus of news." - Jon Stewart

Note: I did not write this. It was written by Dr. Jeremy Spinks, who used to work in the Emergency Room at Parkland Hospital (where Jodi currently works) here in Dallas, and I have reposted it with permission. I find it to be a very articulate argument for universal health care. I don't consider this to be the final word, but a start to healthy and reasonable discussion. Let me know what you think.

A striking phenomenon occurred in the emergency department at Parkland Hospital every morning around 6AM: about twenty to thirty patients with kidney failure would show up at the emergency department, would have their blood drawn and EKG checked, and each person would hope that he was sicker than the other, because only a lucky few would be selected to receive emergent dialysis that day. Patients with insurance who have kidney failure normally receive dialysis three times a week; without it, fluid builds up in their lungs, making them feel like they are drowning; nitrogen levels build up in their bloodstream, causing severe abdominal cramps and muscle aches; their blood pressure becomes drastically elevated, causing intractable headaches and putting them at risk for a brain hemorrhage; and their potassium levels grow unchecked putting them at risk for sudden death. The swarms of uninsured kidney failure patients that would come to the emergency department every morning were lucky if they were chosen to receive dialysis once every few weeks. The “lucky” ones in this scenario were the people whose potassium levels were the most elevated, the ones who might die from a heart rhythm abnormality at any moment. I once had one of these patients go into cardiac arrest while waiting to be seen in the ER. We rushed her into a resuscitation room, performed CPR and defibrillated her, and we were fortunately able to get her back, after which she quickly received the life-saving dialysis treatment that she needed. I later found out from her that she had consumed numerous bananas and soft drinks that morning in a deliberate attempt to elevate her potassium level so that she would be chosen to receive dialysis. That’s why her heart stopped. This is how desperate she was to get the treatment she needed, and the only way she knew how to do it.

This is the situation that millions of Americans face today – access to health care only when their situation has become so grave that they are knocking on death’s door. And what I came to discover very quickly in my training as an Emergency Medicine physician is this: the vast majority of people who do not have health insurance are hard-working, good people who simply cannot afford it. And because they cannot afford health insurance, they receive no preventative or maintenance health care, which leads to worsening of their illnesses. They are then forced to visit the emergency department where thousands of dollars are spent to deal with the complications and consequences of their untreated illnesses that could have been prevented if only these people had received access to regular, basic, and much cheaper health care from a primary care physician. The system, as it stands today, refuses to provide basic services to persons who need those services the most, but then is forced to provide far more expensive services to these same people when it is already too late.

When I finished my residency and started working at a private community hospital in the suburbs of Washington, D.C., I was eager to see what it would be like to work in a system in which the majority of patients have health insurance and good access to health care. I’ve been here for two years, and I am still eager to see what that would be like. In talking to numerous colleagues that practice emergency medicine in a variety of settings, the consensus I get is that the situation is the same at all emergency departments across this country – a very large percentage of the patients seen have no health insurance and no decent access to health care once they leave the emergency department. I’ve seen far too many patients come to the ER in very difficult situations that shouldn’t be allowed to occur, like the gentleman who comes in with an arm splint that he has been wearing for months, originally placed for a broken bone. This splint should have been taken off and replaced with a cast a few days after his injury, and now his broken bone will never be able to heal properly, and he can no longer function in his job. But no orthopedist is willing to see this patient and provide this very basic service because the patient doesn’t have health insurance. And more and more, specialists are refusing to take call for emergency departments because they know that they will wind up having to care for numerous patients without health insurance. This results in a dangerous situation for emergency department patients because the expert help required for certain emergencies is no longer available. I often have to transfer patients who have a very treatable problem to other facilities because I have no specialist on-call to treat the patient. These transfers result in dangerous delays to patient care and are extremely expensive, putting a drain on the health care system’s valuable resources, and so the cycle of inefficiency continues.

I’ve been fortunate to experience health care in our country from many angles – as a resident training in a county hospital that serves the poor, as an attending physician working in a private, community based hospital, and as a patient who must fend for himself in the private health insurance system. The issue has become very dear to me – every day I see numerous patients that deserve so much more than what we as a country give to them. It is wrong to have to prescribe a man an inferior antibiotic for his pneumonia because he can’t afford the more expensive antibiotic that he really needs. (By the way, he will later come back to the Emergency Department and require admission for his pneumonia.) It is wrong to tell a patient to follow up with an endocrinologist to manage her thyroid condition when I know the endocrinologist will refuse to see her because she can’t afford his fees without health insurance. (She’ll be back, too.) It is wrong to have to intubate a patient who has a brain hemorrhage caused by uncontrolled high blood pressure that existed simply because the patient couldn’t afford to see a primary care physician. It is wrong to have to send that same patient by helicopter to another facility, dangerously delaying the patient’s care, because my hospital can’t convince a neurosurgeon to take call for the emergency department because he doesn’t want to have to deal with uninsured patients. Day in and day out, the inadequacies of our current system force me to do things as a physician that are not in the best interest of my patients.

I used to believe that healthcare was a privilege, but what I have come to discover is that when healthcare is treated as a privilege, only the privileged receive it. I now fervently believe that health care is a fundamental human right. It is morally wrong for a society to have the basic resources that are necessary to save lives and prevent suffering and to distribute those resources in a fashion that favors the lucky few and ignores the millions of people who need those resources the most. Furthermore, denying millions of uninsured and under-insured persons access to basic healthcare results in a system that is appallingly inefficient, costly, and impotent; it costs us more as a country to persist in restricting access to healthcare than it would cost us to provide that care. And health care, much like education, a police force, and a military, is something that is so crucial to the welfare of our society that it cannot and should not be relegated solely to a for-profit system whose goal is not the welfare of the public but the financial profit that can be made at the expense of the public. Every day that I work in my emergency department and see patients coming in whose needs I cannot meet because of the inadequacies of our system, I become more steadfast in my belief that it is our duty as citizens of this country and as members of the human race to work quickly towards finding a system in which we all have access to basic health care, a fundamental human right.

(If you agree, please contact your district's representative and more importantly both of your state's senators and let them know! Specifically, let them know that you support a public health insurance option as an alternative to compete with private health insurance. Here's a website where you can get your senators' and representative's contact information - just click on "contact elected officials": http://www.usa.gov/index.shtml )