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A simple post by a friend of mine upon the passage of the Healthcare Reform bill triggered a rather lengthy discussion. The original post noted the bill’s passage, and also expressed wonder as to why some of his friends in medical school were upset that it had passed.

To be clear, I had long considered applying to medical school, but ultimately decided against it for a number of reasons, among which was the fact that I didn’t think that my heart was in it, along with the fact I could not handle the financial burden. I still view it as an honorable profession, and as far as I am concerned, dedicated to the service of society and not only the maintenance, but also the improvement of the quality of life of every individual, regardless of financial resources. It is clear, however, that my view is not universally held. A couple of our mutual friends and acquaintances now in medical school commented on the post, writing, for example:

[Med Student A]

it’s because we actually understand what this bill means…

1.doctors on average have 10s/patient. increase the number of patients without increasing residency positions = doctors can’t give anyone adequate care 2. doctors/hospitals will no longer be able to give the level of care americans are used to because we won’t get reimbursed from the government for all the new medicare pts…that means no expensive procedures thus decreasing the level of care that americans are used to 3. doctors will earn less money, no we’re not greedy we goddamn deserve it, plus we have to pay off hundreds of thousand dollars of debt…this will worsen that whole doctor shortage thing 4. every universal healthcare system that is going now is leaking money, our national debt is too big for that…. i could go on but i feel that’s adequate

At the very least, these comments by “Med Student A” (MS-A) fail to identify systemic problems in the way in which medical care is delivered in the United States, related to the completely inadequate number of medical doctors and other support professionals trained annually in this country. Furthermore, these comments also expose MS-A’s complete disregard for the idea that one should become a doctor to help patients, and not for one’s self-serving and shallow interests.

And from another med student:

[Med Student B]

It also screws over doctors pretty well, so we’re not too happy about our future

[Med Student A] put it pretty well – the other points that are big negatives for us are increased taxes on our bracket as well as decreased Medicare reimbursement (and small business health insurance costs, though I’m still unsure of how that effects groups the size of private practices). What that does is not only will we have 32 million new patients flooding the system with no one to take them up, but physicians will not want to take on many more from that type of plan. As it is, Medicare reimbursement is so low compared to private insurance, that most PCPs can only take a certain percentage of Medicare/Medicaid patients or they start losing money.

Training surgical assistants and PAs is all well and good, but the problem isn’t in specialties (well, it is, but to a lesser extent) – it’s in the primary care field. While a PA might be qualified to perform some tasks, patients are still going to want to see a doctor, their doctor. Even with the help, we’ll still have decreased time with patients, for no real benefit to them, and we’d have to offset the cost of hiring that PA.

Oh, addendum: I’m also unconvinced that by insuring more people, we’ll significantly change the American mentality. What I mean is that currently, the people who are uninsured go to the ER for care, costing the hospitals and system tons of money. As I mentioned above, with so many patients and no room for them, I don’t believe that this practice is going to significantly change. People are too used to getting their care through the ER, and with finding a PCP so hard, many will just delay getting one, still going to the ER. While them actually being insured will help, it’s still a large loss of cash, and won’t fit in the “preventative care” model that’s supposed to save money in the long term.

However, with all this in mind, there are a few steps int he right direction, especially with regards to insurance company regulation. Personally though, I’d like to see all insurance companies turned into non-profits.

These comments by “Med Student B” (MS-B) are an improvement on those by MS-A. However, in failing to criticize the earlier comments and instead offering unqualified acceptance and implied approval and concurrence, are disappointing at best.

Doctors are widely considered and held to be not only leaders, but also among the most educated and intelligent members of any community and our society as a whole. They are expected to act in the best interest of their patients, to critically analyze the symptoms of disease and deliver relief and comfort in the form of care and knowledge in understanding the ailment. In exchange for these tall demands, our society supports the doctors who serve us by offering financial support for their education through public educational and healthcare institutions through which these individuals receive their training, protection from illegitimate competition, and most importantly, our complete and unconditional trust.

The American healthcare system is not perfect. We demand much from our medical professionals, but ultimately, provide them with an insufficient amount of support. It is unreasonable to ask anyone to take on over a quarter-million dollars’  worth of debt and invest at least six years of their lives to become fully trained, and then pretend that this is an acceptable arrangement in light of the expectations placed upon them. Many practitioners are inadequately compensated, and some are even unable to repay the loans they withdrew in order to become medical doctors in the first place. We don’t train enough doctors to provide quality care for every individual, and the system as a whole has been wholly inadequate for decades. This places an even greater burden on the few medical professionals we do manage to train each year. This is unfair to our medical providers. Consider, however, the injustice done to those members of our society who have done nothing but happen to fall ill without the financial means to carry themselves through treatment.

It is sickening to hear of aspiring medical professionals approach the healthcare debate with only their own interests at heart. It is disappointing to see them fail to step back from their own narrow points of view and consider the system as a whole, to identify any problems other than those which will directly affect their paychecks and their workloads. It is agonizing to know that there are more altruistic individuals who would love to become doctors, but are unable to do so. I have only the utmost respect for the medical profession, but if we as a society are training students who are only interested in medicine for the title, the salary, and their own self-preservation, then these two medical students are right: the system will decay and we will all fail. I am deeply disappointed in these two, my friends, no less, for failing to step back from their own self-interest, and recognize that while imperfect, the reforms signed into law today represent an improvement for every individual in this country, and that any healthcare is better than access to none at all.

I spent a lot of time walking around Washington, DC this weekend, and much of my wandering brought me close to the National Mall, and even around the US Capitol Building. Just in time for history, and also just in time for the protesters. This, in combination with a few other factors, really spurred some thoughts, which I will attempt to develop here. I will be dividing these thoughts into a few posts, just to keep everything neat and also manageable.

National politics are important, and I have only become politically aware within the past few years. Having grown up in Seattle, national politics has always seemed very distant and obtuse. Knowing this, I paid especially close attention in my high school US Government and American History classes. I consider myself fairly familiar with the general structure and function of the Federal Government, and I have both the grades and AP test scores to support that conclusion. However, objective knowledge garnered from textbooks and the basic source texts and documents which form the basis of government are not sufficient to understand the culture of politics that have developed in this country over the past 233, almost 234 years.

Living in and around Washington for the past year and a half or so, I think I’ve figured out the basic structure: people either believe in government and its ability to affect and promote change to solve societal problems for the greater good, or they don’t. Most everyone I know considers themselves to be either a Democrat or a Republican, liberal or conservative, pro-choice or pro-life, or whatever. Those labels involve arguments over the details of government, and not the fundamental question of whether or not government actually has the ability to work. The idea of productive and civil debate in government assumes that all of the parties involve believe in the power and rule of law at least as far as it is able to induce change and resolve conflicts.

I consider myself to be solidly among those who believe in government, and in this nation’s federal government in particular. It may not be perfect, but the tools are there in order to improve it, provided enough people have the courage and conviction to help.

None of the anti-Health Reform/Tea Party protesters I saw this weekend share that basic idea, or even have faith in the government, let alone any kind of fundamental understanding of its structure or history. Many among them claimed to be patriots, and yet proudly bore some of the most politically sickening and disheartening signs I have ever seen. Furthermore, the behavior I later heard that some of the protesters had engaged in was even worse.

This is perfectly acceptable, and it is expression that should be brought forth; however, it is necessary for this kind of rhetoric to be accompanied by a willingness to debate and discuss real and relevant facts pertaining to the issues at hand. This was and has been largely absent for at least the past year, and I am truly sad for its loss, because I only truly came to appreciate it two years ago.

Building off of this New York Times Editorial:

If stimulus funds are used for the extension of unemployment benefits, then they’ll be unavailable for additional stimulus programs down the line. So far, the fiscal stimulus from the bank bailout is being replenished over time by repayments from banks, and this will be repeated if the jobs bill passes and low-interest loans are made to small businesses. If we use this money to pay out unemployment benefits, they’re not coming back.

For all the crying being done by conservatives declaring the Obama Administration anything other than democratic, they’re engaging in some really un-democratic tactics.

No, it’s not.

I like Ikea.  It provides me with reasonably good-quality furniture and other home-related items at a reasonable price, and allows me to satisfy my inner builder impulse with small, instant-gratification projects.

The quote in the title of this post suggests understandable frustration with the Swedish furniture company for entering the American furniture market and seizing a large portion of the customer base from more traditional furniture stores and manufacturers.  However, quoted statement comes from someone who has an interest in a more traditional furniture store, and also believes in free-market economics.  For these reasons, the statement, “Ikea is evil,” is, at best, misguided, and most likely, uninformed.

I prefer to think of Ikea as entry-level furniture.  Not everyone needs, or even necessarily wants, craftsman-grade furniture made to exacting standards and of solid hardwoods and the like.  College graduates and low-income individuals also need furniture, and Ikea provides it at a price within reach for this demographic.  It’s also appropriate for people who are in a transitional period within their lives, whether that is college, a first limited-term position just out of school, or just switching careers.  The furniture is inexpensive enough to replace, durable enough to move frequently, and also of a high enough quality to be re-sold and readily reused.

Not everyone is in a place in their lives or careers where it is reasonable to invest thousands of dollars on extremely nice, heirloom-quality furniture.  Such an investment requires not only economic stability, but also maintaining a single residence for a an extended period of time.  Moving involves significant up-front costs, and moving expensive furniture carries its own premium.

Ikea satisfies a niche in the furniture market that is difficult for traditional furniture stores to court, mostly due to the cost of doing so.  I would argue that a majority of the people who buy furniture from Ikea would likely not have bought furniture from traditional furniture stores if it didn’t exist; instead, they would rely on classified ads, garage sales, and listings such as craigslist, or even go without.

Ikea isn’t evil; it is just a company that does a very good job of providing goods and services to a particular market.  It doesn’t sell name-brand furniture at discount prices; it sells its own designs and its own reproductions of more high-end designer pieces.  The reproductions may be an issue, but for the most part, it exists in a totally different market than traditional furniture stores.

This post was written after I read comments on a Seattle Times article on the failure of I-1033. http://bit.ly/2haRLs

As with many things I learned about growing up, there’s a significant difference between the idea of a democratic society, and reality.  In the ideal democratic state, or even the ideal republic, every voter is an informed voter, who casts their vote with full knowledge of the issue at hand, and in the best interest of the society as a whole.  This is not the case.

If such an ideal were to be reflected in reality, none of Tim Eyman’s ballot initiatives or any similar “tax liberation” measures would collect enough signatures to make it on the ballot.  For example, I-1033.  It may have been defeated in this year’s election, but many political analysts have said that that may be due in part to the attachment of Tim Eyman’s name to the measure, casting aside the fact that this kind of measure inhibits the ability of the state to provide adequate basic services.

I-1033 would have limited any increase in state and local government revenue to inflation and population growth, with any excess being returned to the taxpayers in the form of a property tax break.  Washington doesn’t have an income tax, so sales and property taxes are levied instead.

The problem with this is that it would commit all levels of local government to a path of perpetual decline.  Maybe that’s the point.  If the revenue raised by various levels of government cannot grow faster than inflation or population growth, but it shrinks in response to economic downturns, it can only become smaller.  Have a relative on state health insurance, in public school, or drive on any road built and/or maintained by the state including interstate highways? See the connection?

Too many people are selfish, narrow-minded, and short-sighted — and it happens to the detriment of our society.

I’ve been listening to/watching a couple political podcasts, Countdown and Rachel Maddow, on my way to and from work every day for a while now. It helps me keep up with everything in a fairly efficient and effective way.

Lately, the issue being discussed in the political world that has piqued my interest has been healthcare reform. What boggles my mind is how long healthcare reform has been an active issue in Congress. It’s not a few months or even a few years. Try a few decades.

Last night’s Maddow show had a segment with video clips of recorded political speeches made by Bill Clinton in 1993, Ted Kennedy in 1978, and President Truman in 1948. That’s at least 61 years that this has been an issue in this country, and currently, certain members of Congress are arguing that healthcare reform legislation is being rushed through Congress.

It’s absurd that healthcare is considered anything less than a right in this country, given the vast material and human resources available. It’s unconscionable that we would deny healthcare to people simply for being poor, unemployed, or just too sick. These are exactly the people we should be providing healthcare to, and in the same manner that the government became the employer of last resort during the Great Depression and then later a primary employer in the nation, the government should formally become the insurer of last resort now, with the aim of also becoming a competitor in the insurance industry.

It’s naive to think that the government isn’t already the insurer of last resort for a significant number of people — the government already supports millions of people through Medicare and Medicaid, as well as through payments to hospitals that treat people who are uninsured. It’s an incidental and informal insurance arrangement, and it is inefficient and expensive for a number of reasons. To believe that it is fine and does not need to change, or that it should only be changed more slowly than it already has is foolish at best.