Thursday, November 17, 2011

The Hearse Horse Snickers Now for Doctors Too

Carl Sandburg wrote a poem expressing the public’s negative attitude towards lawyers that has the arresting line, “Why does the hearse horse snicker hauling a lawyer away?”  The poem was presented to us as first-year law school students to encourage us to be compassionate in our law practice, to help those who cannot afford to pay, to deal with our clients as people rather than just a source of billing hours, and to contribute our talents for the wellbeing of our community.  Back in 1965, we were in an indirect way told that lawyers should be more like doctors.

How times have changed.  While of course there continue to be compassionate doctors of the old school, the average contemporary doctor is a very different animal.  They are concerned mostly with how much money they make, which translates into seeing as many patients as possible in a given amount of time and finding ways to bill patients (and their insurance companies) for as many procedures, tests, and consultations as possible.

Doctors like to blame the federal government and insurance companies for this transformation.  They say they have so much paper work to do that they have little time left for doctoring, and that the fees they are paid are so inadequate that they have to charge as many billing items as possible just to get a decent financial return.

Nonsense.  While there is no question that there is lots of paper work today, the main culprit is that doctors have become capitalists.  Both in their practice groups and in most hospitals, the healing profession has become a for-profit corporate entity whose main concern is the bottom line.  As such, they find every conceivable way to milk money from their patients, just like one would expect from a corporation.  And the relationship between doctor and patient has been transformed accordingly.  Small wonder that some now refer to the Hippocratic Oath that all doctors take as the “hypocritic” oath.

Let me illustrate with a case in point.  Recently a friend of mine had to go to an eye-ear-nose-throat specialist to have the remains of a silicone earplug removed from his ear.  He has no insurance and so was informed by the receptionist that his bill could be “up to” $200.  The extraction of the plug took a minute or two.  The doctor spent a further couple of minutes “examining” his nose and throat, much to my friend’s bewilderment as there was no reason for the further exam.

When he went to pay his bill, he was told by the same receptionist that it was $254 … no apology, no explanation.  He was dumbfounded but paid it.  When he got home, he looked at the bill and found he had been charged $107 for the extraction and $147 for a “minor consult.”  He then wrote a letter to the doctor explaining his consternation. The letter the doctor wrote in response boldly displayed the mindset of the contemporary doctor.

The whole situation was blamed on the inadequate fees paid by the government for Medicare and Medicaid patients.  For that reason, he said, insured and self-pay patients had to be charged more. He neglected to mention that, as everyone knows, doctors only get paid a percentage, perhaps 50%, of what they bill insurance companies, which means that it is only the uninsured person who pays the full amount. 

He did not address the ethical issue that uninsured persons should be given a break, and especially not charged for sham services rendered, such as in this case the exam or “minor consult,” which are only conducted so as to be able to bill insurance for another service and thus get a reasonable payment, even at 50%.

Bottom line ... doctors and hospitals should not be profit centers.  That orientation is inimical to the ideals of medical practice and caring for patients.  By all means, doctors and others involved in the profession should make good livings because they provide a valuable service to people and society. But beyond that, to profit from ones patients should raise ethical questions.

Why does the hearse horse snicker when hauling a doctor away? Isn’t it obvious!

Tuesday, November 15, 2011

What the Catholic bishops seek is religious tyranny, not religious liberty

In perhaps one of their most deceitful efforts, the Conference of Roman Catholic Bishops yesterday sought to recast their opposition to abortion and same-sex marriage as a struggle for “religious liberty” against a government that is impinging on the church’s rights.  As reported in The New York Times today, they cited that Catholic agencies that receive state funding in Illinois and a few other states had been “forced” to stop providing adoption and foster care services because the state required them to provide the same services to same-sex couples as heterosexual couples.

Let’s talk about religious liberty.  The right protected by the Constitution is that the government can make no law prohibiting the free exercise ones religion or “respecting an establishment of religion.”

In their vocal opposition to abortion rights and same-sex marriage, not just as a moral issue but to get the government to prohibit women from getting abortions and prohibit same-sex civil marriage, the bishops are in fact seeking to impose their religious views on the rest of the nation through government action. That would violate both the rights of the members of other religions who do not believe that abortions should be prohibited to practice their religion, and it would thus in fact if not in language be a law respecting the establishment of religion by preferring one religious viewpoint over others. 

This is an example of religious tyranny, not religious liberty.  If Catholics were forced to have abortions or if the Catholic church were forced to perform same-sex marriages, that would be a violation of religious liberty.  But that is not what is involved here.  Even on the same-sex marriage issue, no one is suggesting that churches be forced to perform or recognize such marriages.  It is solely a civil government matter.

What about their argument that they are being “forced” to abandon adoption and foster care services? Again, this is simply not the case.  The church’s agencies are perfectly free to provide such services solely to heterosexuals and discriminate against same-sex couples. All laws regarding sexual orientation rights provide for exempting religious institutions who oppose homosexuality.

However, if they choose to apply for state aid for these services, then they must comply with state rules, both legislated and constitutional, regarding the use of state funds.  That in no way prohibits their religious liberty.  If they want to continue discriminating, they are free to do so … just without state aid.

It is shameful that the bishops have cloaked their attempt at religious tyranny and their desire to use state funds to discriminate under the banner of religious liberty.

Monday, November 14, 2011

Democrats Better Pay Attention To The Needs of The Middle Class

Why are Tea Party people so angry and fearful? Yes, right-wing demagogues aided by right-wing funders like the Koch brothers have stoked their fears and anger to a fever pitch, but why were they angry to begin with?  Why are they and many in the broader population so receptive to the lies and fear-mongering?

President Jimmy Carter posited that their fear is of a changed social order evidenced by the election of a black president. While I’m sure that is part of the answer, is it really so simple as the color of Obama’s skin and his progressive policies? No, the answer lies elsewhere.

Feeding this fear of a changed social order, racism, and the Tea Party’s resonance has been a sea change in the wellbeing of America’s middle class. The middle class is made up mostly of nonprofessionals … people with only a high school degree. As manufacturing and other middle class jobs have disappeared over the past 30 years, their standard of living and the quality of their lives has been drifting downward.

The recent recession only exacerbated the trend. In March 2011, 12 percent of those with only a high-school diploma were unemployed compared to 4.5 percept of those with college degrees and 2 percent for those with professional degrees. The greatest impact has been on men … in 1967, 97 percent of men 30-50 years old in this cohort were employed; in 2010, just 76 percent were.

Not only has this resulted in economic problems for these men and their families, these pressures have brought about greater interpersonal stress, with a resulting increase in divorce rates and other examples of social dysfunction. The greater income inequality that developed during this period has also resulted in heightened actual and felt lifestyle differences between the middle class and those with more income and education.  (All data from, Don Peck, “Can the Middle Class Be Saved,” The Atlantic, September 2011)

The world as the middle class knew it since WWII has been turned upside down.  Small wonder they are scared, angry, and alienated. Yet this important shift in the American social fabric is never discussed. Politicians talk vaguely about the need to protect the middle class, but the evisceration that has already occurred is not mentioned.

If the Democratic Party wants to win in 2012, it must clearly let the middle class know that it is aware of their pain, that it feels their pain, and that it proposes a series of interrelated policies to restore the lot of the middle class. It's a complex economic and social engineering question that will require the attention of our best and brightest. Obama and the other candidates must share their vision for where they want the country to go and how they propose getting there.

Friday, November 4, 2011

Strengthening America by Changing from a Consumer Economy to a Nation-Building Economy

While our culture of consumerism has been a boon to corporate America, it has been bad for our citizens, bad for our economy and bad for our nation. 

Psychologically, mass marketing images have led to a nation of individuals who are constantly dissatisfied with their lives ... whether it’s how they look, the job they have, the amount of money they make, the home they live in, etc.  There is not a single aspect of our lives that escapes this need of ours … not to be better individuals in some meaningful way but to project success or power/popularity, mostly through the acquisition of material things.  And we always want more; it’s never enough.

You won’t find evidence of this in polls because our culture places a premium on having fun, being happy.  Since people feel that they’re supposed to be having fun and be happy, that that state is valued by our culture, people put on that fa├žade … not knowingly but in an act of self-deception. 

While I know of no studies that document what I am about to posit, I believe that the huge increase in the extent of depression in this country stems not from more awareness of the problem as has often been thought but results from this constant dissatisfaction that people feel about themselves.  Indeed, it is not uncommon when people are feeling down to get a “fix” by going out and buying something.

Our economy has also become addicted to consumerism.  70% of our GDP is derived from consumer spending. But consumerism is a very unproductive use of the nation’s wealth.   It does not move our country forward.   And since much of what we consume is no longer produced here but overseas, it doesn’t even help employment like it used to, just the revenues of American global corporations.

Meanwhile, the United States is falling behind other countries and entering a dangerous period because we cannot afford to do what needs to be done to keep this country strong … and I don’t mean military spending.   I mean spending on infrastructure … both maintenance and new.  I mean spending on education.  I mean spending on cutting edge research and development, investment in new industries that will drive our economy in the future. When measurement is taken of national and individual wellbeing, the United States typically finds itself towards the back of the pack of developed countries.  Not in front as we like to believe.

In order to find the money to invest in our country’s wellbeing, we must switch our economy from one that is primarily based on consumerism, to one that is based primarily on building our country.  This involves changing the components of our GDP but not lessening it or our growth.  Actually, because it mostly would involve projects that must by their very nature be accomplished in the geographic United States, it means a greater bang for the buck when it comes to job creation.

To get from the consumer economy to the nation-building economy, we will need to wean ourselves from the need to constantly buy things to be happy.  And instead of using discretionary income for self-gratification, we will need to learn to be comfortable with that money going to the government in the form of taxes to be used for projects that will benefit the nation, and thus ultimately ourselves.

Many will howl at this suggestion, but we must remember that the United States has by far the lowest tax rate of any developed country.  Yet, and this bears repeating, the people of these other countries nevertheless prosper and have a higher level of wellbeing … whether it’s their health, education, or other measures … than we do.

Making such a change in our culture will take principled leadership and preferably a united political front.  This must be approached like a war used to be … all hands on deck and united.  And everyone must be prepared to sacrifice. At this point in our history, that concept … a united political front … seems impossible to imagine.  And yet we must strive toward that end if America is once again to regain its global strength and provide its citizens with a secure and high standard of living.