Month: April 2009

A reader writes:

Your reader's response to Megan got a lot closer to the core of the problem with healthcare costs.  I am a physician in an emergency room in New York City, and every day I see tons of cash needlessly flying out the door due to "the Burger King factor."  American patients often come to the ER with very minor complaints – back pain for which they have not even tried tylenol, nasal congestion for two days, itchy mosquito bites, and so forth.  All of them expect something from you, quickly, for their trouble – and it must meet their preconceptions or they will accuse you of ripping them off.

Many of them become virtually incandescent with anger if they aren't given some kind of medical test that they (or one of their friends) thinks is a good idea, but they don't really need.  They insult you, they threaten you, they loudly announce that they're going to call their lawyer or the hospital administrator, etc.  Sometimes we stand up to them, and sometimes we're too exhausted to fight.  Sometimes it's just easier to get the x-ray on the patient with back pain rather than take the abuse and argue with them for 40 minutes and then have them send an angry letter to the review board. Others are simply beyond the pale and can't put anyone else ahead of themselves.  Some are incensed that I have to see a critically ill patient before I see them, because "I got here first."  People will literally interrupt cpr to scream that they want a sandwich or something to eat NOW.  People want a blood test, a cat scan, an EKG, anything in exchange for their time.  People will quote TV shows as medical authorities.   All of us have our favorite 'placebo' methods to try and gratify these patients, from ultrasounding their skulls (safe, dramatic, shows nothing but costs nothing) to pointing an ultraviolet flashlight into their maalox before they drink it.    It's our version of wearing a wooden mask and shaking a rattle – we hate it, and patients love it.

The amazing thing is that when needless tests come back negative, the patient is completely satisfied. There is never a sense of regret, or how much money they just wasted, but rather one of accomplishment, even if they still have the same problem they walked in with.

Ultimately, the American sense of entitlement, so long appeased and encouraged by our commercial culture, is what is poisoning the healthcare system.  Doctors have played into it and are just as guilty for caving in when they know better, or billing for procedures a patient doesn't really need.  We have played along and made medical glitz into the standard of care, feeding and feeding off of a narcissism that cannot be satisfied.  It is a uniquely American problem, which is why the solutions that other nations have reached will not work as well for us.

The other one here.

Well, saner than Hannity. But kudos to Bernie Goldberg.

A metaphor:

By the way, Failblog rocks.

An update. The bureaucracy works slowly, but there is movement, and many of us are grateful for it.

I've been waiting for this piece of news:

Known Gentleman Randy Sarafan decided to make this office chair to help "accurately document and share [his] life as it happens," which is as admirable a cause as there ever has been to open a Twitter account. The setup is surprisingly complex: A natural gas sensor does the sniffing; an Arduino does the thinking; an Squidbee wireless module does the communicating; Twitter does the sharing. It's a feat, to be sure.

The tooting tweet itself:

Pfffffffffft about 24 hours ago from web

Or my favorite:

Someone please disassemble me

Let me know the first tweeted queef, will you?

Massie opines:

I tend to take the view that a panicked reaction in the immediate aftermath of 9/11 is one thing (and in fact entirely reasonable) but actions taken months and years after it quite another and it is distressing how many people and pundits on the American right fail to understand that Guantanamo is, for many people, a more grievous stain than anything else done in the Bush years.

There is, I think, a great difficulty for some in accepting that the torture program was ramped up long after the initial scare happened, that it became Cheney's central front in the war, that the entire Gitmo/Bagram paradigm was devised to enable torture as a critical font of intelligence, and that all of it was plainly illegal – and made possible only by a truly radical understanding of a dictatorial presidency in foreign affairs. What staggers me, of course, is that this is also true after Abu Ghraib, after any claim to ignorance or self-deception was possible. And yet Abu Ghraib showed lesser forms of abuse and torture than that directly authorized by Bush and Cheney. Think about that: they had seen Abu Ghraib, determined it ws shocking, and then secretly authorized much worse.

This cannot be viewed as denial. They knew exactly what they were doing and had no compunction in doing it. Even now, they champion it, and if there is another major attack, will insist that torture be returned to the center of the American system. This is why we have to get all the facts on the table – what was done and what it revealed; and this is why, in the end, these people must be prosecuted.

Then there is a natural resistance, especially on the neocon right, to question the benevolence of America's actions. It is as if neoconservatism came to believe that American exceptionalism also means that America, by virtue of its unique virtue, is uniquely empowered to commit evil and somehow thereby render it good. This is how religious fundamentalism in Bush's mind came to demand the use and routinization of an absolute evil. But for the others, it is just evil. Consciously pursued.

Ken Starr breaks from the partisan pack. First Charles Johnson tries to be fair, now Kenneth Starr. Maybe there's hope on the right after all.

Thoreau vents about the torture debate:

On another forum I’ve tried to argue with people who want to split some legal hairs and it just doesn’t work for me. There’s a place where “Well, I respectfully dissent from your view, while appreciating the spirited and intelligent manner in which you offer it” ends and “Fuck you, this sh!t is just plain wrong” begins. We can argue over where that exact point is, but once you’re beating somebody according to a KGB manual, it’s safe to say that that bad point has been reached.

I feel the same way.