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Yes, we are all Americans and for the first time in several months, I feel positive. Thanks to the appointment of Mr. Mueller, as Special Prosecutor, I now feel that someone, who is not controlled by Trump, can lead the investigation unhindered and take us to a safer place. It was beginning to appear that Trump could not tolerate and would not allow anyone that he could not control to have significant authority. No one should be above the law, but Nixon had stated that “if the President does it, it is not against the law”. I believe that Mr. Trump had begun to believe this way.
Obviously, I am opposed to Mr. Trump, but in my defense, I did not care for the man and his style years ago. He is just too arrogant for my taste and of course now everyone knows that he lies – a lot. In any event, I thought I would just have to “suck it up” for the next four years. Now it appears that he may well do himself in. Then we can have an administration that I disagree with, but at least it would be rational. Indeed, these are truly difficult times and we could use some thought, rationality and a lot less volatility. The world needs the idea of an “America”. A land governed by laws. Where people have a chance to work, follow the “rules”, and rise in life. Not another land where riches and rewards are given only to a few, very fortunate, and very connected individuals.
I would like to share a bit on income inequality. To paraphrase Warren Buffet – “there is class warfare, and my class won”. I don’t really believe in the concept of class warfare, but sometimes it feels that way. Income inequality is not really the issue, in my opinion. In a capitalist system there will always be some inequality. The problem, as I see it, is that currently there exists an excessive, obscene inequality that did not exist before. For many years now, it is obvious that the rich get richer and everyone else simply struggles to get by. For a long time, this reality was accepted by the masses because they hoped that one day, through hard work, they too could be wealthy. This is no longer the case. Senator Warren, and others, have observed that the system is truly stacked in favor of the wealthy. Class mobility is a thing of the past. The situation is now reminiscent of old medieval times, when a person remained in their life station permanently, regardless of personal responsibility and hard work. This is unacceptable and unsustainable. One only has to recall the lessons from the French Revolution and the Bolshevik Revolution to understand that the masses will only take so much and then they will demand some measure of equality. Hopefully, this can be achieved through less violent methods, but it will be achieved.
There are many examples of inequality to be seen without trying too hard. Personal wealth is often looked too as a glaring example, but there are too many variables present in this case for it to be a useful example. Hard work should be rewarded and there will always be some who do better than others. This is to be applauded. Education is a better example. Education, and its access, has always been a “stepping stone” for the middle class. This is no longer the case. Higher education, and the benefits it brings, has become too expensive and out-of-reach for many. It is rapidly becoming accessible only to those who have the assets to afford it. I, personally, have witnessed many of the “perks” that are given to the wealthy or to those who are thought to be wealthy.
Another example is simple wealth distribution. So much is owned by so few that it has truly become unsustainable. It is no longer enough to simply be rich, now some seek to be “filthy rich”. It is not wealth that is so upsetting, it is obscene wealth and the inability of the majority to find upward mobility.
In my 33 years in the Emergency Department, I have witnessed an enormous amount of changes in healthcare delivery. Some of these changes have resulted in better patient care and healthcare delivery. Many have not. As an example, consider the patient with an acute heart attack. In the early days of my practice, there was not much that could be done for this patient. Oxygen, bed rest and pain control were about the extent of medical therapeutics available. Now we have “clot-busting” drugs, better blood thinners, and acute invasive intervention if needed. Another example is the very common diagnosis of diabetes. In addition to insulin therapy, we have many oral agents to help as well as aggressive patient education, insulin pumps, dialysis and more. There are 2nd generation CT scans, MRI’s and many other wonderful advances in technology.
However, many of the changes are simply “me-to-drugs” and greatly increased documentation that allows for more charges and therefore, more profit. We have a few new drugs, but we need many more advances on this front. These changes have little to nothing to do with improved patient care and satisfaction. They simply allow the companies that control the medical industry to make more money. In addition, all the beeping noises and blinking lights attract the attention of the staff and they often forget to look at the patient to see how they are faring. In the rush to embrace new technology, often the “old” ideas of listening, touching and caring for patients is lost.
I understand that “medicine” is a business and profits are important to keep the “machine” running, but I cannot escape the feeling that patient care is being left behind in the race for the money.
I would like to share some additional information on the misuse of the existing VA hospital system. Most people, I suspect, are completely unaware of this behavior. There is a population of veterans who use the hospital system as a hotel for their travels. It is not a small number. While I was working at the VA and reviewing medical records for the purpose of providing health care, I became aware of the fact that a number of “VA patients” were traveling South in the winter and back North in the spring. They would use the VA hospitals, along the way, as “hotels” to assist them in their travels. They would simply go to a new hospital, complain of vague chest pain or abdominal pain, and gain an admission for several days of evaluation. When they were eventually discharged, they would simply continue their travels, either North or South, find another hospital and repeat the process. When I discovered this activity, I confronted some of the veterans and they readily admitted to their behavior. Obviously, this is not what the hospitals were intended for, but in the veterans’ defense-they were just making use of a “resource” that they had discovered. They would share this “travel information” with other veterans and, in so doing, they would spread the activity. Initially, this was a great source of frustration for me, because I had assumed that hospitals were meant for “sick” people and not simply a source of food and shelter. Eventually, I accepted the “reality” and just played the “game”. However, I am no longer willing to “just go along” and at least attempt to make people aware of how their “tax” dollars are being misused. These are not “war-wounded” veterans, but simply people exploiting a system that is easy to exploit.
I have suggested eliminating the current VA healthcare system and consolidating it with the public system. There will be some individuals who will strongly oppose the elimination of the existing VA healthcare system. This will probably consist mainly of those individuals whose livelihoods and retirements depend on the existing system. There will be some veterans who mistakenly believe that the current system exists to benefit them and they will resist any change. This idea is incorrect. I agree that veterans deserve the healthcare they were promised when they signed up or were recruited. Unfortunately, the current healthcare system does not live up to the promise that they were given in the beginning. As I have stated before, in previous blogs, the current VA healthcare system is grossly inept and inefficient. It fails to provide the veterans with the most basic needs in an efficient and timely manner. Most of the health problems experienced by veterans could easily be handled by the existing private healthcare system. The majority of the health problems are not combat related. The veterans could obtain prescriptions at their local pharmacy and see their local physician for routine health maintenance. As I have previously alluded to, this would be much more convenient and efficient for the veterans. They would no longer have to drive 2 to 3 hours and see a strange physician for routine health maintenance. They could be issued a special “health-card” from the government and it could be used, like all insurance cards, to pay for any health related expenses. This would then allow the veterans to get the healthcare that they were promised in the beginning. Sen. Bernie Sanders from Vermont has already begun the change by allowing individuals to obtain local healthcare under certain conditions. This is a time of great change is the world. This is an idea whose time has come. If the old system worked, this discussion would not be necessary, The old way of doing things has been proven to be a failure, and the veterans deserve better.
Here is a radical idea. What if we used financial compensation as a tool to shape our society into the kind of society that we wish to live in? Sure, we already do that, but in my opinion we have gone a bit astray. What if teachers were paid better salaries, and doctors were compensated less? I was talking with a man the other day, who had just returned from Germany, and apparently that is what they already do there. I am a doctor, but I think this idea is perhaps the start of something beautiful. As a physician, we do some very valuable service for our society, but so do teachers and for that matter, so do police. Perhaps it would behoove our society to make these fields of endeavor more desirable, so that we might attract some of the best and brightest. After all, don’t teachers and our schools mold and inform our children, who represent the future of our country. The police provide social stability, which is vitally important to the economic welfare of our country, but as it stands, both of these fields of work are at the bottom in terms of financial compensation. The top is occupied by sports, entertainers, doctors, lawyers and others. I love making “large money”, but perhaps society would be better served by rearranging our priorities. They work very hard, put in long hours, and deserve our respect. They often use their own money to provide the students with the necessary equipment. Perhaps, they also deserve better compensation. This is not communism or socialism, as some detractors might infer, since it continues to rely on the markets for any adjustments. Maybe it is time that we, as a society, adjusted our priorities to reflect our goals and invest in our children.