President reaches out to boors

The President’s health care address and the GOP reaction

Last Wednesday, President Obama, that well-known Socialist-Fascist-Kenyan-tool of Marxists everywhere, in between meeting with revolutionaries who are tasked with subjecting our kids’ tender ears with un-American thoughts of killing Granny, addressed a joint session of Congress to plead for an overhaul of our health care delivery system. The opposing GOP acknowledges that the system is flawed and needs reform but urges restraint and warns against rushing into things. Universal health care and reform have been discussed in Congress since the days of Theodore Roosevelt, 100 years ago, and seriously addressed in 1935, when social security was adopted, in 1965 when it was enacted for the elderly and a few others, in 1993 when the Clintons’ efforts were shot down; it is curious as to what further and novel reflection would be appropriate.

There are real and legitimate questions that must be answered and issues that must be resolved, issues that are being ignored by the GOP by calling the whole thing “socialistic”. The “S” word is being bandied around to refer to government programs with which we disagree; it is meant to refer to a system whereby the government takes from some people to give benefits to another group. We don’t disapprove of all such schemes, of course. Howard Troxler, writing in the St. Petersburg Times, gives one such example:
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Is there anything more “socialist” than a fire truck? After all, having a fire truck means these things:
“(1) the government has decided that it, not the private sector, will be in charge of putting out fires;
“(2) the government will tax the citizens for the fire truck regardless of their wishes; and;
“(3) the citizens will have no choice in calling upon the government to put out their fires.
“And yet, not many people are opposed to having a Fire Department, are they? We generally accept it as a legitimate government function.”

Republicans strangely picked Representative Charles Boustany of Louisiana to give its response to the President. One reason, of course, that he is a physician and therefore lent the GOP position some gravitas. As opposed to that, however, is that Representative Boustany is one House member who is a “Birther”, that is one who has managed to ignore all evidence that the President was born in the United States! The Birthers the most extreme product of the right-wing fringe, so much so that virtually all respectable conservatives ignore this idiocy as a matter of course. The other remarkable thing about Representative Boustany’s choice is that he was clearly not up to the task. He seemed to agree with the President on many aspects of the administrations’ positions but, essentially, said that Congress should scrap everything and start over! We should, he urged, strive for a truly bi-partisan Bill even though GOP leaders had already announced that they would not vote for any negotiated proposal, no matter what!

What about the fear of “socialized medicine”? Now, in 2009, the American Medical Association and most physicians acknowledge that cost containment and waste prevention are needed. Most physicians rail against unneeded duplication of tests and redundant procedures; it wasn’t always so. Back when Medicare was enacted, the medical establishment worried and threatened that a government-run and single payer system would prevent a patient from choosing his or her own doctor, would limit access to tests and procedures, would result in rationing of health care and people would die in droves.

They were not all wrong! We have non-medical people restricting unlimited choice of physician. We have non-medical people, in effect, choosing which medications we take, regardless of what the doctor may prescribe. We have non-medical people deciding which tests are to be given and, even, which hospital should be used and which treatment modality can be employed. This is what is happening right now. Rationing and choices are being made by private insurance companies and health maintenance organizations that correctly, from their viewpoint, protect their stockholders from loss and their financial balance sheets from lessened profit. I ask: is it better to have these decisions made by the patient’s physician aided by a panel of experts who can make recommendations (but not mandates)?

We can and should discuss these basic issues as well as those related to fiscal obligations, the costs and how we can meet them. If we are distracted by the “S” word or suggestions that our elected officials are subversive evil unprincipled people, we will never get to the real stuff.

Another concern of many physicians is the burden of malpractice insurance premiums. I have a conflict here, which I freely acknowledge. Moreover, my daughter and son-in-law are both physicians who work much too hard and, in so doing, make sacrifices. I, on the other hand, am a retired attorney, although not one who practiced in the fields of personal injury or malpractice. Years ago, I wrote an essay on the conflict between members of our respective professions.

Let us suppose a few incidents. First, a pharmacist parties late into the night and arrives at work suffering from blinding headaches, shaky hands and a generally sour attitude. He fills a prescription calling for 40 mg tablets with ones having strength of 400 mg. The patient/customer takes the incorrect medication and becomes gravely ill and, eventually, dies.

Second, an attorney is retained by a group of homeowners to pursue a claim against a chemical company that has, intentionally or without any real concern, dumped toxic materials over the landscape. A large number of children have developed cancer and will surely die. The attorney does nothing with the file because of simple inadvertence or because he simply doesn’t know what to do, and, when he finally files suit, the statute of limitations has expired and all claims for damages are for naught.

Third, a builder adds an extra room to an existing home. Either to save money or simply because he was distracted, the roof to the addition is not securely installed. At the first storm, the roof flies off the extra room and all furniture in the room is severely damaged by water. Moreover, the roof lands in the yard next door, striking a child who suffers permanent injury.

Finally, because he rushed into the operating room, relying on the preparation work performed by normally careful staff, or because he had been on duty at the hospital for twenty hours without a rest or break, a doctor amputates the wrong leg or fails to examine a patient carefully and misses skin cancer or, exhausted from days and evenings “on call”, makes another gross error that causes substantial injury.

In the first three examples, there is nearly universal acceptance that the pharmacist, attorney or builder should be compelled to indemnify the losses caused through negligence, carelessness, inadvertence or ignorance. In the case of a physician, however, the rules have been modified! Part of this is due to the reverence we pay physicians and part is the direct result of advertisements and lobbying by the insurance industry.

Republicans and, to a lesser degree, Democrats have latched on the idea that, if only trial attorneys were restrained, then doctors would not have to practice “defensive medicine”, order redundant tests and all would be right in the world. I disagree for several reasons, while suggesting that this is an area for reasoned debate. For example, a number of states have enacted draconian laws limiting attorneys’ fees in personal injury cases; more have imposed restrictions on bringing malpractice suits against physicians, often requiring doctor-peer review, mediation panels and the like. In those states, for example Florida and Texas, malpractice insurance premiums have not been reduced. All that has happened is that the insurance companies’ profits have gotten fatter.

But, the issue deserves study and debate. And this is not what the Republicans offered at Wednesday’s speech. Rather the President was met with boorish and revolting behavior. Forget, for an instant, the outburst of South Carolina’s Joe Wilson, one for which he has issued an apology to the President. Other Republicans took to booing and hissing and making rude noises. Many Republicans kept raising their hands and waving sheaves of paper.

One final observation: When I was in grammar school, students raised their hands for one of two reasons. First, they had something to say at that moment or, second, there was a need to go to the bathroom. Since it was the occasion of a presidential address, the former reason doesn’t apply. So the assembled GOP members had a sudden urge to urinate, which indicates possible prostate problems which, in turn, gets us back to health care. It would be nice if every American had the same access as members of Congress.

We don’t.

Tags: Address to Congress, attorneys, Charles Boustany, far right, GOP policies, healthcare, healthcare industry, insurance industry, Joe Wilson, liberals, malpractice, national health care program, obama, pharmaceutical, physicians, talk radio, “Healthcare Reform in the United States."