Recently in Politics Category
The unfortunate politicians who have braved town hall meetings in recent days to talk about health reform seem to have been taken by surprise by the vitriol and volume of the push back. Yes, I know the audiences were marshaled and recruited to shout down the speakers but still the passion on display was genuine and not in the least surprising to me. What the President and our politicians should have known is that our personal health is the one arena of our lives (the other being our love lives) where reason and logic get thrown out of the window. Talk about our health and suddenly our education and civility vanish and we are a mob waiting to be ignited. The incredible thing is you can just as easily incite us to march for reform as you can against reform. All that matters is what button you push. Read More
I had the pleasure of being in the East Wing of the White House on Wednesday, one of about 160 people in the audience as President Obama appeared on national television, fielding questions about health care.
It was my first look at the President at close quarters. I came away with the impression that the President was possibly the most knowledgeable person in the room when it came to the current health care crisis. That's no small thing given the people who were there. We have had Presidents whose understanding of issues seemed confined to the precise talking points prepared by aides in briefings. This President knew his material well and was improvising as smartly as a jazz pianist, in response to questions.
The other thing I sensed was the President's tremendous passion for this cause. If there is something more important on his agenda, I don't know what it is. What also came across is that compared to everyone else who was there (physicians like me, the CEO of Aetna, the head of the AMA), the President was probably the only one whose interests in the health care debate were not self serving. His sole motivation seems to be to head off disaster, which seems inevitable if reform does not take place.
An important moment for me personally came when a young woman asked the President the very question that I had been prepared to ask. She wanted to know why we could not emulate the example of other advanced democracies that manage to cover all their citizens for about half what it seems to cost us. The President's answer was revealing; he pointed out that most of those countries had a one-payer system whereas we in America, "...have an employer based system that has grown up over decades. For us to completely change our system, root and branch, would be hugely disruptive and I think would end up resulting in people having to completely change their doctors, their health care providers in a way that I'm not prepared to go. This is one-sixth of our economy. I think that we can build on what works, fix what's broken, and still have some substantial money."
The obstacles in the President's way are considerable: 1) people and businesses who are profiting hugely from the status quo; 2) a general fear of government interference; 3) fear in Congress about the amount of money to be spent on health care reform and finally, 4) the fact that legislators who have to make change happen often serve the interests of the people who gave them the most campaign money--pharma, insurers, organized medicine. These contributions are what taint our political process--call it first world corruption.
I got back to my hotel room at 10pm, just as the session (which had been recorded "live to tape") was finally being aired. I was surprised to see that one commercial shown during the health care debate was on behalf of "Patients United Now"--a group I know little about. The ad was sowing seeds of fear by having a Canadian patient talk about the difficulties of that system. They couldn't wait to hear what the President had to say it seems.
Oh yes, and the other thing on television competing on the other channels was the news of Governor Sanford's whereabouts. As to that . . . less is more.
Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.
The President's speech even quoted Newt Gingrich:
As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient's health records.
The speech reminded me of a conversation a few days ago with a close friend who said casually, "Face it, Abraham, medicine is corrupt." I paused. I sputtered. I was about to say something. But I shut up. I shut up because (as the President explains) whether I like it or not, I am a beneficiary of a system of :
. . incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary. It is a model that has taken the pursuit of medicine from a profession - a calling - to a business.
We can quibble on the ways the President proposes to fund the changes he proposes, but I don't think we can quibble on the moral imperative to change the way we do business. As the President says,
"You entered this profession to be healers - and that's what our health care system should let you be."
(For another take on the speech from a thoughtful physician who also happens to be in New Hampshire, see KevinMD.com)
The word "empathy" is getting interesting play these days. At times it even sounds like a pejorative. President Obama used the word frequently while campaigning and since being in office. In the context of choosing a Supreme Court nominee, he said that ideally such a person should understand Americans' problems and have empathy for their fellow beings. But he's also talked about empathy (in Atlanta in Jan 09) in the context of its absence: "We have an empathy deficit when we're still sending our children down corridors of shame--schools in forgotten corners of America where the color of your skin still affects the content of your education . . . when there is Scooter Libby justice for some and Jena justice for others . . . when homeless veterans sleep on the streets . . ."
Most dictionaries will define empathy as "the intellectual identification with or the vicarious experiencing of the feelings, thoughts, or attitudes of another." Yet, for some, like Senator Orrin Hatch, President Obama's saying "empathy" when talking about judicial appointments is seen as a "code" for appointing a left leaning liberal. Instead of being seen as an admirable quality that describes someone with a visceral understanding of the human condition and especially of human suffering, it is seen as a bias.
To be fair, it could be that Republicans reflexively and correctly see the President's use of "empathy" as being empathy not for all people, but for some people, or even (in their view) the wrong people: for mothers instead of the unborn, for unions instead of big business, for the homeless and unemployed rather than for the well-off or even for the middle-class tax payer.
It did not help that Judge Sotomayor once said in a speech, "I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than the white male who hasn't lived that life." This would seem reasonable, but only if the issue at hand involved Latina women. What if the issue had to do with white men with un-rich experiences? One sees the slippery slope she is on.
As someone not in the legal field, it seems to me that if the law were absolutely cut and dry, and if the process of being a judge meant simply following algorithms, being impartial, ensuring that justice was done and procedure followed, then empathy would be irrelevant. But since judges always seem to be writing 'opinions' and disagreeing with each other, clearly, there is a human factor at work. In that case, broad empathy, a Shakespearean breadth of interest in all people, in the wise and the foolish, in the misanthrope and the saint, in politicians and the public who suffer them would surely be a good thing.
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John Sotos is a physician well known in medical circles for his book, ZEBRA CARDS: AN AID TO OBSCURE DIAGNOSIS. We tell our medical students, "When you hear hoofbeats think horses, not zebras," or, common things occur commonly. But John has had a lifelong interest in rare diseases--zebras. (He is also a medical consultant for the TV show HOUSE.)
Recently, I heard John make the case in a lecture that Abraham Lincoln suffered from a rare endocrine disorder called MEN2b (Multiple Endocrine Neoplasia Type 2b) in which most patients will die of cancer of the thyroid if the thyroid is not removed. John argues that at the time of his death, Lincoln was dying. Indeed, if one looks at Lincolns pictures
from January 1864
and then a few months later in February 1865,
it does appear that he has lost weight and reports from that time suggest he was greatly fatigued. One characteristic of this syndrome is the presence of mucosal neuromas--little bumps on the lips. Close examination of photographs such as the one below suggests that he did have these.
John's talk provoked some heated debate. For more details see John's book THE PHYSICAL LINCOLN. Photographs are courtesy of John Sotos. The Grand Army of the Republic museum in Philadelphia has a pillowcase with Lincoln's blood on it, and DNA from that could conceivably prove or disprove this hypothesis. (It could also prove or disprove another hypothesis that states Lincoln had another condition, namely Marfan's syndrome.) For now, the museum has decided to wait on DNA testing.
There have been hundreds of books about Lincoln. In fact, the Library of Congress catalog suggests that a new book about Lincoln comes out every 5 days or so. If indeed Lincoln had a disease whose manifestations had much to do with his behavior, and which might explain the early deaths of his mother and of his son--seminal events in any life--then in a sense, all previous biographies are inaccurate.
But is this a slippery slope? Are historians to become forensic anthropologists?
Would Abe have wanted the DNA testing done?
One day there might be a test that could tell us what he would have decided.
Abraham Verghese
