“From each according to his ability, to each according to his need.”

In a perfect world I’d support that statement from Marx. But it’s just not viable. The moment you implement socialist systems, they start to not work. Everyone ends up with less or nothing. I think there’s ample historical evidence to show that.

I think everyone deserves a nice car, a nice house, a nice computer, internet access, a decent amount of money. Why is healthcare different? Also, material things can contribute to psychological well-being, so we must provide EVERYONE with what they want or they’re not getting good healthcare.

I, for one, want a mid 90’s blue, white racing striped Dodge Viper with low miles. It’s essential for my psychological health. I want my healthcare.

First of all, no one has claimed that freedom is a privilege. A Marine fighting for freedom is not securing a privilege.

I know that just saying that freedom is a basic human right is meaningless because we all have wildly divergent views on what, exactly, freedom is. Personally I take a very broad view of freedom and believe it means that we should all be allowed to try and improve our lives, live where we can afford to live, pursue the things that make us happy so long as they don’t directly harm others, and so on. (Obviously, it would take a 100 page essay to fully describe what I mean by “freedom” - I’ll spare you.)

The point: freedom (in some sense) is a basic human right. Health care is NOT.

Why?

Health care costs hundreds of billions of dollars a year, requires brutal doctor training programs, necessitates vast man-hours from techs, nurses, and admin staff, requires numerous industries to produce drugs, R & D medical devices, and so on.

NO ONE HAS A RIGHT TO DEMAND THAT SUCH A SYSTEM BE BUILT.

It is sinfully arrogant to claim that because you were born, millions of people must be involved in a multi-billion (trillion?) dollar industry because you have the RIGHT - and thus the authority to DEMAND - free or cheap access to health care.

That is outrageous.

No one has a right to health care.

But even more fundamentally, no one has a right to consume more than they produce, with exceptions for the mentally or physically handicapped, children, and (this is a stretch) the elderly (who ought to have already produced enough by retirement to meet their needs). People who claim that they have a RIGHT to consume MY product (my profits translated into taxes translated into their free health care) are simply looters and mooches.

As for denying that the American Dream is real, I challenge you with this: go find some poor inner city youth, say about 10 or so, and mentor him or her. Work with this child over the next 12 years. I guarantee you that you (or I) could get this kid into medical school. Do you deny that with the proper motivation and mentors that this is not possible?

As for attributing the fact that most people will NOT live the American Dream to “underfunded public schools”, I recommend:

1. Do some research into how much of our GDP is spent on public education and supporting institutions. You may be surprised by how much we spend at both the federal and state levels. Also, be SURE to look at how much is spent at your average private schools versus how much is spent at failing inner city schools.

2. Consult some teachers who have taught inner city youth (the students least likely to achieve the “American Dream”).

I have, and the results are in: All of the teachers I have spoken with (some old friends, some new acquaintances, some teaching in Chicago, some teaching in Baltimore) were (a) Liberal (often far leftist), (b) well educated at nationally recognized universities, and (c) shocked at how messed up inner city culture turned out to be. These anti-conservative teachers all wanted to level that playing field, and walked away completely hopeless.

Why?

* None of the children had stable families - they were shuffled between mom’s apartment and grandma’s house.

* None of the children had any positive role models - many of their fathers were MIA

* None of the children made any effort in school in part because of the above two reasons and in part because any such efforts would make the child an outcast for playing the Man’s game

* None of the children did homework - the teachers new not to even assign it because it would literally never get done

* Teachers had no carrot and no stick to control the children - for instance, the bureaucracy (staffed almost exclusively with liberals) prevented teachers from breaking up fights (even between 7 year olds!) because the school district didn’t want to get sued. The teachers had literally no recourse if students misbehaved, other than sending them to another room with other children where they could all misbehave together.

* Most children’s parents took no interest in the children’s progress, and were more likely to accuse the teacher of discrimination than believe that their child was disruptive in class

* 99% of the teachers’ energy was spent trying to control the children - very little teaching was done

How could a child POSSIBLY learn in this environment?

The liberal answer: SPEND MORE MONEY. I’ll tell you - new libraries and Macs are not the answer to any of the above familial and socioeconomic forces undermining these young minds.

Of course, this doesn’t stop the leftists from wanting to raise taxes and give more money to (startlingly inefficient) public school districts.

Yet I ask you:

1. IF it’s a problem of underfunding (as Yan has claimed), then how in God’s name did children learn in the past when all a school needed was a building and some books? 100 years ago the education system received very little funding yet it produced the great minds that ushered in the incredible achievements of the first 50 years of the 20th century - and they did it on the cheap!

2. IF it’s true that the problem is underfundiung (as Yan has claimed), then how do the Chinese and Indians manage to train students so well that I.T. jobs are moving from the US to those countries? You can’t POSSIBLY say it’s because China and India are spending so much more money on education than we are.

The fact is it’s an issue of culture. Where I grew up, young people had positive role models and were encouraged by family, friends, and teachers to do well in school, go to college, and get a good job.

Where I lived after high school, young people were encouraged to attend high school just often enough to not be harassed by the police, and then to get a job at a factory in town, or not work at all and live on welfare.

It’s a problem of mindset and culture, which are in part due to the de-industrialization of our cities, the inability of many people/groups to adapt to the changes (if it was even possible, which is contentious), followed by the rise of welfare that broke up the family structure in many poor communities (black, white, and others).

And you have the gall to attribute this awful mess to a lack of funding. That is such a cop out - it requires no real thought, just a reflexive “hey, they’re poor… the problem MUST be money”.

I wish it were: then we’d have a tenable solution. Sadly, it’s not, and millions of children grow up in areas without hope, as “socially conscious” liberals conspire to fix a FALSE root cause. I *almost* look forward to the day when liberals get their way and dump tons more money into public education, all to see it flushed down the drain because children without familial and communal support WILL NOT READ BOOKS, USE MACS, OR BENEFIT FROM INCREASED SPENDING.

::Back to Business::

Guju doc said: “But since that time I’ve grown up a lot and realized what it really entails: less time per patient reducing the quality of care, less
reimbursement for physicians, less people going into medicine if money reduces very quickly and at that less quality applicants going into medicine which could very much lead to an ehangeven greater shortage of physicians then there already exists, more potential for abuse of the system, etc. That’s just a few of my gripes with such a system.”

It sounds as if you have subsituted the ideas behind nationalized health insurance for HMO and continue to critique all the effects of HMO’s on American medicine i.e. lower reimbursements, less patient time.

However I understand that you see some of these as applying to a nationalized health care system. So lets say they do and now lets thing through this dilemma:

Currently 15 % of the US population is uninsured. Considering a large number of Americans suffer from chronic diseases (Diabetes, Heart Disease) which can be easily treated by medications along with a strong and highly funded public health infrastructure that focuses people on disease prevention.

So lets say Patient Bob comes in with a High BP and Bob like many other Americans is uninsured and cant afford to pay for meds. Bob just has yet another risk factor that will increase his likelihood of an untimely death.

Now Guju, the ultimate question is: does it matter that you have more patient time with Bob if Bob cant afford to buy the medication he needs to lower his blood pressure? Now I love chit chat as much as the next guy but last time I checked chit chit didnt prevent stroke or MI.

Does it matter if physicians get paid well if what they get paid for isnt producing the same high quality health outcomes as in other Western nations?

It seems like all the Bobs in America arent responding well to doctors orders on how to stay healthy, and perhaps such a task should not rest solely on the physician, but should also be a part of a larger societal shift in which the whole population is educated about their health in a well funded way as part of a national health system.

I learned in Preventive Medicine that 85% of cancers are PREVENTABLE. Go look that up! 35% are caused by smoking 30 % are caused by poor nutrition. The doctors arent getting the message across to the American Public on how to change their behavior.

Perhaps there needs to be a greater system wide change so that health care providers will be effective health care providers who are able to provide health care to the population and prevent people from suffering from many dreadful/painful yet preventable diseases.
Since when did physicians begin to think that the service they were providing was such a “priveledge” that even if they werent effective as their neighbors that could still scream bloody murder against any suggestion of improving the health system for the nation.

The priveledge argument is funny.Can you imagine a Marine complaining that the freedom he fights to secure is a “priveledge” and that any system which increases national security but is not appealing to marines is not worthy?

The data is in!

Fact:
National Health Care improves health outcomes on multiple measures of health in virtually all the Western Nations that have adopted it.

Fact:
The US health care system is inefficient and is bleeding dollars left and right when it comes to how much $$ we spend and the health outcomes we get.

Fact:
If you went into medicine to make sweet $$$, wake up. This is HMO land now and Oxford/Aetna… have got us by the nuts.

Fact:
National health care reform is on the tongue of every single presidential candidate for the 2008 election. Im no Miss Cleo but i think somethings on the horizon for us mon.

# of people insulted in this blog 135

Now, I’m trying to focus more on content that I think will actually help other students see things that I was never able to see prior to beginning medical school. Let students see what it’s like from my viewpoint, and if they’re still willing to go through it (like you are yourself), they’re more informed and have an idea of what to expect. I want to give that back to you guys.

My experiences are based on where I trained. I can’t offer any more than that, but I wish I could. Your experiences could be better or worse than mine, but based on some of the feedback I’ve gotten on this blog it seems that my experiences are somewhat typical.

Thanks again for the compliments, they are much appreciated.