Q & A: For Sake of Service?

Ed. Note: Do you have a political question?  Go ahead and ask me: bkirby816 at Yahoo dot com.  I'll do my best to give you a good answer -- no promises on whether or not you'll like the answer, though...

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Dear Spencerian Editors:

The public/society, through grants, taxes, charitable donations, etc. pays from half to two thirds (see Note) of a doctor’s  education.  Should not then an essential criteria for entrance to medical school be a desire to serve others, that is the public/society?

Note: copied from the internet Aug. 6, 2009; 
“ ... tuition revenues will be substantially less than one-third of our revenues to support the college.”

by Anonymous, CA

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Thanks for the question, Anonymous.

Well, here's the short answer: yes.  

I have a great doctor.  He is a nice guy, he seems to know his stuff, he wants me to be healthy, and he's honest with me.

If someone were to ask me if my doctor had a desire to serve others, I'd say without hesitation, "sure."  We need more doctors like my doctor.

I worked in the health care advocacy non-profit world for a few years.  I was exposed to several doctors -- all specialists -- and found each of them to be dedicated to serving a higher cause.  It was a genuine highlight of my professional career to meet and learn from these physicians. 

Anonymous, I'm going to take this in a little different direction than kind of a medical school admission thing.  Of course, our country is in the midst of a "debate" on health care right now.  I say "debate," because the word "debate" implies that there are two reasonable sides working to come to an agreement on a big issue.

Well.

One side is reasonable.

One side is... I guess "out there" is the most polite way to describe them.

Look, here's my dirty little secret, Anonymous: just a few weeks ago, I had major issues with health care reform.  I had some real questions before the issue of President Obama's version of health care reform -- mostly around this idea of a public option, but in larger part around the cost itself.  Now, I think A.) we just ought to do something, anything because the current way we're doing it is not sustainable, and B.) I just don't want to be aligned with the people screaming about killing grandma and death panels and other racist, violent diatribe. 

Which is a shame, because I think we, as a nation, would have gotten farther if we'd had an open, honest, civilized debate about it.  Instead, we had to break out the swastikas, didn't we?  What a shame. 

From my perspective, it starts with branding.  And this is a rare Obama failure.  We should have never approached this as health care reform.  What we are really talking about here, Anonymous, is cost reform. 

Health care costs a lot of money.  But why? 

Well, in part, for the reason you cite: it costs a hell of a lot of money to send doctors to school.  Sending nurses and physician assistants to school isn't exactly cheap, either.  It costs a lot to make drugs and medical devices.  It costs a lot of money to administer hospitals.  In other words, it's an industry that brings in -- and distributes -- a lot of money.  It's a huge part of the American economy.

And its very structure keeps the classes within our society out of balance -- and actually works to keep them out of balance.

Here's the bottom line, Anonymous: we want our doctor's to cost a lot of money.  We want our doctors to spend a ton of money going to school.  If we're honest with ourselves -- and we so rarely are -- we want our drugs to cost a fortune. 

Think about it.  When you're at a party or an event and you say, "I have health insurance from my work," and someone else says, "I don't have insurance," don't you feel just a little bit better?  It's terrible, I know, but we've all been there.  Such is the constant struggle of class division. 

And if we continue this honest conversation, what we have to recognize is that we're going to have to break down some of these walls of class division -- and it starts with health care.

It's not an easy job.  If you don't think this is about class division, then I encourage you to read Anne Hull's frustrating piece in the Washington Post, Squeaking by on $300,000.

Laura Steins doesn't mind saying that she is barely squeaking by on $300,000 a year.

Can you imagine that?  In America?  If I were this woman, I'd have been ashamed.  But apparently while money can buy you a $500 a month gardener and a $40,000 a year nanny -- "non negotiable facts of life and not discretionary" -- it cannot buy you any sense of shame.  

As a vice president at MasterCard's corporate office in Purchase, N.Y., she earns a base pay of $150,000 plus a bonus. This year she'll take home 10 percent less because of a smaller bonus. She receives $75,000 a year in child support from her ex-husband. She figures she will pull an additional $50,000 from a personal investment account to "pick up the slack."

You know, it's almost worse that she works for a credit card company.

I don't want to digress too much, Anonymous, but the "class" part of this discussion is important.  Most Americans are worried about going bankrupt if they fall ill because of poor insurance coverage or no insurance coverage. 

Do you suppose these people are worried about the quality of their health care coverage?  No, that -- along with the nanny and the gardener -- are "non negotiable," I'm sure.  They can afford to pay exorbitant prices for coverage.  Not that they do. 

In fact, it would seem that not much bothers the rich.  They still find time to have a good old fashioned condescension party!

The Steeds are big community volunteers. They're also known for their zany parties. They come up with an idea to get people talking, and soon the invitations are in the mail:

You are invited to a recession party.

Serving: Cheap Wine and Beer with Simple Fare (Costco Deluxe)

Wear: Old Clothes (hand-me down particularly welcome)

Entertainment: Any recession story, joke, poem, item, etc. guests might provide.

Warning: Anyone bringing a hostess gift other than canned goods (to be delivered to a food pantry) will be denied admission.

On the night of the party, Bob greets guests in a T-shirt that says, "Eat Dessert First, Life is Uncertain," and he jokes that that's why we're in this mess in the first place.

One guest who arrives in khakis and a blue blazer says he wanted to wear jeans but his wife wouldn't let him.

"They were so vintage, I couldn't bear it," she says.

Yes, "vintage."  Unbearable.

The party turns out to be spectacular. Champagne and oysters and shrimp followed by a seated luncheon for 70. Steins joins a small group back at the birthday girl's house for a casual supper of lobster bisque. No names, please, the host requests, as if codes for nuclear warheads were discussed and not youth hockey and green grocers. But everyone is being sensitive these days. In the next morning's New York Times is a recession story on how dollar stores are stocking more food items in hard times.

The bold is mine, because wow!  You wouldn't think these people would be so careless.  Please, don't use our names -- we wouldn't want to be identified in any way by... the common folk. 

Not to worry.  We can tell who you are by your khakis.

My point with relaying timely stories like this is not to beat up on the rich, but to demonstrate that they'll do anything -- include shamelessly whore themselves to national publications about how "terrible" their lives are -- to keep the status quo.

Look at some of those protesters against reform, Anonymous.  What are these protesters -- who are really just the front lines of the Hampton's set -- really saying when they call Obama a "socialist" or a "nazi" or worse?  What people fear is not giving those who need it -- some 47 million of our fellow countrymen -- a hand up.  The fear lies in believe that leveling the playing field somehow forces those with care to take a step down.   Will my Medicare benefits be less because of reform?  Will my heart medication cost more because of reform?  Will it cost me more to take care of my grandmother because of reform?  My health plan is expensive and the system is broken, but it's mine...

Those questions aren't about 47 million Americans.  They're about me.  They're about you.  They're about whomever.  It's an individual thing, and it's frightening. 

But that doesn't mean we don't do it.

And if part of our reform discussion -- if we ever really get to it -- centers around the value we place on a physician's education, then we'll be better for it, too. 

Thanks for the question, Anonymous.

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Have a political question?  Email me: bkirby816 AT yahoo DOT com.

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Comments

[Kevin]

Socialist.

[Benjamin]

You're wrong, Kevin.

I'm not a socialist.

I'm a Nazi. A *Muslim* Nazi.

A Muslim Nazi baby killer. Also.

[Kevin]

A high school Facebook acquaintance was flaunting that infamous Obama-Joker pic at me the other day. I was like "You do realize that, being a madcap anarchist, the Joker is the furthest possible thing from a "socialist" going, right? In other words, that poster makes zero sense."

Sigh. So much stupid going around these days.