I questioned my patient's plan to move from northern Idaho to Colorado in the middle of winter, and near the ninth month of her first pregnancy.
"Joe found work down there, and we need to stay together," she explained. She seemed satisfied with her answer.
"What will happen if you go into labor in the middle of a Wyoming blizzard?" I asked gently. "Cars do break down sometimes, you know. If you must go, at least take the bus."
"Can't afford it until we get a paycheck. Anyway," she smiled at the rusty clunker parked outside my office window, "Joe just finished rebuilding the engine. And we'll carry a blanket. God'll get us there!"
The odds were strong against Jesus being born safely that night long ago, after a two-day journey from Nazareth. Mary must have had misgivings about the whole thing. Would a midwife be available? Or would the only one around be her husband? He was a good carpenter, but he didn't have much experience in assisting childbirth.
I think that perhaps we never have the right to demand miracles of God. But when there are no alternatives to taking risks, the knowledge that God is with us can sustain us in our endeavor. And God-directed endeavors can change the world.
(First written for "The Workplaces of Christmas" 1994, American Baptist National Ministries
Tuesday, December 20, 2011
Monday, October 24, 2011
Almost-a-doctor
I walked through the autumn leaves in the fall of 1950, toward my first day as a real medical student with a feeling of exultant expectation. Up till then, I had found that being a “pre-med” didn’t make as much impression as I would have liked. With girls, especially, the attitude seemed to be “Forget this one; he’ll be buried in the books for four more years.” But now my embryo medical career was finally on track. I had at least made it in through the door.
Classes for first year medical students were all held in one building, across campus from my home. I joined seventy would-be doctors in the lecture auditorium that first day, all of us waiting with apprehension for the professor of anatomy to appear, who would rule our lives for the next five months. First semester in medical school covered only two subjects: Human Anatomy and Histology, which is anatomy viewed through a microscope.
Dr. Phillip Armstrong was a deceptively bland man in his fifties, who made no effort to put us at ease. His aphorisms were memorable:
“We will address you here as ‘Doctor’. For some of you, this will be the only time you will ever hear it applied to you.”
“Up until now, you have worked to achieve a well-rounded education. Here, we intend to flatten you out.”
We spent that first day getting organized into working groups of four, and learning detailed instructions for the care and study of our cadavers. We took notes on everything; one nervous student even jotted down the professor’s “Good morning.” We entered the dissecting room that first afternoon, wondering what our reaction would be to studying the dead. We four, Onas Morgan, Tony Rivera, Tony Slivinski, and I, grouped ourselves around our dissecting table, and surveyed the motionless shape swathed in pungent, formaldehyde-soaked layers of sheeting beneath the yellow oil-cloth.
Following the instructor’s directions, working one pair on each side, we laid bare the groin area and made a first incision along the inguinal ligament, surprised at the toughness of human skin, careful to go slowly and meticulously, exposing and identifying each nerve branch and blood vessel. We would spend most of the first week on the abdominal wall, laying open each muscle layer under the critical eyes of the instructors and Dr. Armstrong himself.
Dissecting a dead person brought a feeling of awe, different from working with dead animals in my pre-med courses. All of us had a healthy fear of making a mistake in the work and earning Dr. Armstrong’s displeasure. Perhaps he kept us off-balance on purpose during these first uneasy encounters with death.
“The name of the muscle is not pronounced ‘ili-op-soas’ as it is spelled,” he said. “Say ‘ilio-soas.’ The ‘p’ is silent. As in swimming.”
Three students dropped out that first week. One fainted dead away. Another threw down his scalpel, cursing, and stalked out. We never saw him again. Rumor had it that the third decided to take his girl-friend’s advice to study pharmacy instead.
We compensated for our insecurity with a certain amount of dark humor. Medical students learn a large number of limericks and memory devices, ranging from the fate of nymphomaniacal Alice or the efficient young man from Bel-Air, to the names of the eight bones in the wrist or the sequence of the twelve cranial nerves.
We four lab partners learned that our cadaver’s name had been Peter B_____, who had died in a state hospital of “old age.” Weeks later, deep in the abdomen, we found that undiagnosed urinary obstruction had destroyed his kidneys.
A month after entering medical school, I had acute appendicitis. The operation went well, but spinal headaches from the anesthetic kept me on my back for a week. I still recall trying to study, holding the six-pound Gray’s Anatomy textbook on my sore abdomen. I also remember, when I was exhausted by the four-hour work sessions in the anatomy lab the following week, that even Dr. Armstrong had a compassionate streak. He stopped at my table to ask quietly how was I, and to tell me it was all right to take a rest break occasionally.
We four, and most of the rest, survived that five months and the examination at the end. One of my tense friends panicked when the examiner thrust a skull at him, jabbed a finger at the large opening at the base and barked, “What goes through there!”
“Food!” the student blurted, then winced as he realized the answer should have been spinal cord. Our universal wish, we all agreed, was that we could repeat the whole course, now that we knew what we were supposed to be learning.
We celebrated the end of anatomy the last weekend in January, a double milestone for me. That night I first met the girl I would marry.
Classes for first year medical students were all held in one building, across campus from my home. I joined seventy would-be doctors in the lecture auditorium that first day, all of us waiting with apprehension for the professor of anatomy to appear, who would rule our lives for the next five months. First semester in medical school covered only two subjects: Human Anatomy and Histology, which is anatomy viewed through a microscope.
Dr. Phillip Armstrong was a deceptively bland man in his fifties, who made no effort to put us at ease. His aphorisms were memorable:
“We will address you here as ‘Doctor’. For some of you, this will be the only time you will ever hear it applied to you.”
“Up until now, you have worked to achieve a well-rounded education. Here, we intend to flatten you out.”
We spent that first day getting organized into working groups of four, and learning detailed instructions for the care and study of our cadavers. We took notes on everything; one nervous student even jotted down the professor’s “Good morning.” We entered the dissecting room that first afternoon, wondering what our reaction would be to studying the dead. We four, Onas Morgan, Tony Rivera, Tony Slivinski, and I, grouped ourselves around our dissecting table, and surveyed the motionless shape swathed in pungent, formaldehyde-soaked layers of sheeting beneath the yellow oil-cloth.
Following the instructor’s directions, working one pair on each side, we laid bare the groin area and made a first incision along the inguinal ligament, surprised at the toughness of human skin, careful to go slowly and meticulously, exposing and identifying each nerve branch and blood vessel. We would spend most of the first week on the abdominal wall, laying open each muscle layer under the critical eyes of the instructors and Dr. Armstrong himself.
Dissecting a dead person brought a feeling of awe, different from working with dead animals in my pre-med courses. All of us had a healthy fear of making a mistake in the work and earning Dr. Armstrong’s displeasure. Perhaps he kept us off-balance on purpose during these first uneasy encounters with death.
“The name of the muscle is not pronounced ‘ili-op-soas’ as it is spelled,” he said. “Say ‘ilio-soas.’ The ‘p’ is silent. As in swimming.”
Three students dropped out that first week. One fainted dead away. Another threw down his scalpel, cursing, and stalked out. We never saw him again. Rumor had it that the third decided to take his girl-friend’s advice to study pharmacy instead.
We compensated for our insecurity with a certain amount of dark humor. Medical students learn a large number of limericks and memory devices, ranging from the fate of nymphomaniacal Alice or the efficient young man from Bel-Air, to the names of the eight bones in the wrist or the sequence of the twelve cranial nerves.
We four lab partners learned that our cadaver’s name had been Peter B_____, who had died in a state hospital of “old age.” Weeks later, deep in the abdomen, we found that undiagnosed urinary obstruction had destroyed his kidneys.
A month after entering medical school, I had acute appendicitis. The operation went well, but spinal headaches from the anesthetic kept me on my back for a week. I still recall trying to study, holding the six-pound Gray’s Anatomy textbook on my sore abdomen. I also remember, when I was exhausted by the four-hour work sessions in the anatomy lab the following week, that even Dr. Armstrong had a compassionate streak. He stopped at my table to ask quietly how was I, and to tell me it was all right to take a rest break occasionally.
We four, and most of the rest, survived that five months and the examination at the end. One of my tense friends panicked when the examiner thrust a skull at him, jabbed a finger at the large opening at the base and barked, “What goes through there!”
“Food!” the student blurted, then winced as he realized the answer should have been spinal cord. Our universal wish, we all agreed, was that we could repeat the whole course, now that we knew what we were supposed to be learning.
We celebrated the end of anatomy the last weekend in January, a double milestone for me. That night I first met the girl I would marry.
Saturday, October 22, 2011
Nottingham High
from "Bridge Ahead, A Medical Memoir" copyright 2008 Keith Dahlberg
High school is a time of many changes for any teenager. Still more so, if the teenager is a dissident. And I was a pacifist, in the middle of World War II.
I felt strongly about this. I took my cues from my Dad, whose sermons from the pulpit were pro-people, but against all war. To him, peace did not mean merely absence of war. He believed war went against the word of God and solved very few issues. It did not mean that a Christian should be a weakling or a doormat. On the contrary, Christians are expected to be strong in order to help the oppressed, enslaved, or lost to find a personal relationship with God, and so far as possible help them find a way out of suffering and injustice.
As a young man at the time of the first World War, Dad at first had refused even to register for the draft. He finally registered as a conscientious objector, although the draft board would have allowed him a clergy exemption. He continued to preach against war during World War II, even while he ministered to the needs of two hundred service men and women among his congregation in Syracuse. The FBI had him on their list for a while; they listened to him preach, and questioned the church members, but never found anything to even suggest that he was seditious or unpatriotic. (Years later, I read their conclusion in the FBI's dossier on Dad, released under the Freedom of Information Act.) His congregation, in fact, highly respected him, even though many members had questions about his message.
During World War II, a pacifist teenager was hard for most of my classmates and teachers to figure out. Following Pearl Harbor, the whole nation had mobilized to the war effort. Buy war bonds. If you can't afford a bond, buy war stamps each week until you have enough for a bond. Turn in your aluminum cooking pots to build airplanes. Plant victory gardens. Save gas. Knit sweaters. Write the boys overseas. The time I spent at Boy Scout farm camp, in 1942, weeding cabbage fields and picking beans, was to help the national effort to raise more food, and I had no problem with that.
But I had a decision to make on my own in wood-shop class in junior high school. The whole class was assigned the project of making scale-model wooden airplanes, about five inches long, used for training aircraft spotters and gunners in instant recognition. To me, that was supporting war and I told the shop teacher, Mr. Pepper, that I couldn't do it. "I understand,was his gruff reply, but I don't think he ever really did.
It got worse in high school, during home-room period each day. Students were expected to buy at least one war savings stamp (twenty-five cents) each Friday. If even one student in the whole school did not do so, the school could not display the 100% banner on the flag pole that week. Nottingham High never got to fly the banner when I was a student. Some of my classmates resented this, although most adopted a neutral attitude. Things improved after about a year when the school held a Red Cross fund drive one day. I figured up what I had not invested in war stamps over the past months, and gave it to the Red Cross, possibly more than the rest of my home room combined. A hostile classmate accosted me one morning, "How come you can give to the Red Cross but not to the war effort?"
I told him the Red Cross healed people. I added that I wouldn’t get any savings
investment returned after the war, like he would from his war bonds. He didn't like that at all; I thought he might hit me, but I stood my ground. The class president and his girlfriend were standing nearby; both took my side and told the guy to back off. After their endorsement, things got better.
During 1945, the Baptist Youth Fellowship at church became active in drama. I had a bit-part in Elmer and the Love-Bug, found that I liked acting, and when a drama club at school presented Why I Am a Bachelor, I got the lead role, playing a misanthropic lecturer. It was a corny play, but the student body liked it. In looking back, perhaps part of its popularity was their opinion that the role fit me exactly.
In my senior year, I happened to have Miss Frederica Smith as my English teacher. "Sister Smith was a middle-aged, self-possessed soul in horn-rimmed glasses who believed in getting the whole class involved. After we had studied poetry and verse-making for two weeks, Miss Smith announced that, tomorrow being Valentine’s Day, each student would choose some character from literature and write an appropriate valentine to him or her. After making sure that the Bible was considered literature, I submitted my valentine, from Samson to Delilah, with a straight face:
All the while I’ve been making your people feel blue,
Though I’m fighting with thousands, yet think I of you.
I’ve torn city gates from their place in the wall,
But your icy cold heart I cannot move at all.
In times of distress I’ve relied on my brawn,
But that’s no help at all when to you I am drawn.
Of all the Philistines I think you’re most fair
But Baby, I can’t keep you out of my hair.
The class, Miss Smith included, burst into laughter. To my surprise, I was later elected senior-class poet based on this offering, and was invited to join the staff of the school newspaper, but I never wrote any more poems worth remembering.
The year went by quickly after that, and on June 24, 1946 graduation night came for 256 of us. Our principal, Harold Coon, was graduating too, moving up to a post in the school district headquarters downtown. There was the usual procession to Pomp and Circumstance, speeches, awards etc. My mind was chiefly on summer vacation; I would go directly from school to the railroad station and catch the night train west for my second summer of work at Green Lake, Wisconsin, along with one of my classmates.
I was startled out of my reverie by hearing my name called at the tail end of the athletic and citizenship award presentations. Mr. Coon announced that the class had voted me the one they would most like to represent them in life. I hadn’t known there was such an award, but it’s the one I would most like to have.
High school is a time of many changes for any teenager. Still more so, if the teenager is a dissident. And I was a pacifist, in the middle of World War II.
I felt strongly about this. I took my cues from my Dad, whose sermons from the pulpit were pro-people, but against all war. To him, peace did not mean merely absence of war. He believed war went against the word of God and solved very few issues. It did not mean that a Christian should be a weakling or a doormat. On the contrary, Christians are expected to be strong in order to help the oppressed, enslaved, or lost to find a personal relationship with God, and so far as possible help them find a way out of suffering and injustice.
As a young man at the time of the first World War, Dad at first had refused even to register for the draft. He finally registered as a conscientious objector, although the draft board would have allowed him a clergy exemption. He continued to preach against war during World War II, even while he ministered to the needs of two hundred service men and women among his congregation in Syracuse. The FBI had him on their list for a while; they listened to him preach, and questioned the church members, but never found anything to even suggest that he was seditious or unpatriotic. (Years later, I read their conclusion in the FBI's dossier on Dad, released under the Freedom of Information Act.) His congregation, in fact, highly respected him, even though many members had questions about his message.
During World War II, a pacifist teenager was hard for most of my classmates and teachers to figure out. Following Pearl Harbor, the whole nation had mobilized to the war effort. Buy war bonds. If you can't afford a bond, buy war stamps each week until you have enough for a bond. Turn in your aluminum cooking pots to build airplanes. Plant victory gardens. Save gas. Knit sweaters. Write the boys overseas. The time I spent at Boy Scout farm camp, in 1942, weeding cabbage fields and picking beans, was to help the national effort to raise more food, and I had no problem with that.
But I had a decision to make on my own in wood-shop class in junior high school. The whole class was assigned the project of making scale-model wooden airplanes, about five inches long, used for training aircraft spotters and gunners in instant recognition. To me, that was supporting war and I told the shop teacher, Mr. Pepper, that I couldn't do it. "I understand,was his gruff reply, but I don't think he ever really did.
It got worse in high school, during home-room period each day. Students were expected to buy at least one war savings stamp (twenty-five cents) each Friday. If even one student in the whole school did not do so, the school could not display the 100% banner on the flag pole that week. Nottingham High never got to fly the banner when I was a student. Some of my classmates resented this, although most adopted a neutral attitude. Things improved after about a year when the school held a Red Cross fund drive one day. I figured up what I had not invested in war stamps over the past months, and gave it to the Red Cross, possibly more than the rest of my home room combined. A hostile classmate accosted me one morning, "How come you can give to the Red Cross but not to the war effort?"
I told him the Red Cross healed people. I added that I wouldn’t get any savings
investment returned after the war, like he would from his war bonds. He didn't like that at all; I thought he might hit me, but I stood my ground. The class president and his girlfriend were standing nearby; both took my side and told the guy to back off. After their endorsement, things got better.
During 1945, the Baptist Youth Fellowship at church became active in drama. I had a bit-part in Elmer and the Love-Bug, found that I liked acting, and when a drama club at school presented Why I Am a Bachelor, I got the lead role, playing a misanthropic lecturer. It was a corny play, but the student body liked it. In looking back, perhaps part of its popularity was their opinion that the role fit me exactly.
In my senior year, I happened to have Miss Frederica Smith as my English teacher. "Sister Smith was a middle-aged, self-possessed soul in horn-rimmed glasses who believed in getting the whole class involved. After we had studied poetry and verse-making for two weeks, Miss Smith announced that, tomorrow being Valentine’s Day, each student would choose some character from literature and write an appropriate valentine to him or her. After making sure that the Bible was considered literature, I submitted my valentine, from Samson to Delilah, with a straight face:
All the while I’ve been making your people feel blue,
Though I’m fighting with thousands, yet think I of you.
I’ve torn city gates from their place in the wall,
But your icy cold heart I cannot move at all.
In times of distress I’ve relied on my brawn,
But that’s no help at all when to you I am drawn.
Of all the Philistines I think you’re most fair
But Baby, I can’t keep you out of my hair.
The class, Miss Smith included, burst into laughter. To my surprise, I was later elected senior-class poet based on this offering, and was invited to join the staff of the school newspaper, but I never wrote any more poems worth remembering.
The year went by quickly after that, and on June 24, 1946 graduation night came for 256 of us. Our principal, Harold Coon, was graduating too, moving up to a post in the school district headquarters downtown. There was the usual procession to Pomp and Circumstance, speeches, awards etc. My mind was chiefly on summer vacation; I would go directly from school to the railroad station and catch the night train west for my second summer of work at Green Lake, Wisconsin, along with one of my classmates.
I was startled out of my reverie by hearing my name called at the tail end of the athletic and citizenship award presentations. Mr. Coon announced that the class had voted me the one they would most like to represent them in life. I hadn’t known there was such an award, but it’s the one I would most like to have.
Wednesday, October 12, 2011
Front Halves of Horses Sent to Washington DC for Assembly
That was one of the guesses about what was being manufactured at the super-secret city of Oak Ridge, Tennessee back in the 1940s. The closely guarded production turned out to be purified Uranium-235 for the first atomic bombs, but in a back-handed way the earlier guess has been quoted as a paradigm for thought processes in the nation's capital.
This was reinforced in my hometown of Kellogg, Idaho back around 1984, when the Cold War and atomic bomb threats were often in the news. Someone in the national bureaucracy, pondering how to save citizens' lives in case of atomic attack thought "Mine tunnels!" The Silver Valley in northern Idaho has more than 200 miles of tunnels underground, thought to be enough to accommodate most of the population of the city of Spokane (seventy miles away, it's true, but they had a super-highway.) Accordingly, 200 cots and a few initial supplies of food and medicine arrived for storage in our local hospital against the day of holocaust.
The bureaucrat's thinking was not entirely off the wall. An atomic bomb hitting Fairchild Air Force Base (ten miles the other side of Spokane) might conceivably give citizens an hour or two to take shelter from the radioactive dust that would be borne on our usual westerly winds. And after three weeks underground, people might (we were told) be able to survive in the diminishing radioactivity. When Mount St. Helens had blown up, four years earlier, the volcanic dust did indeed reach Kellogg and beyond. The local miners noticed that it only penetrated the mine tunnels about 300 feet before adhering to the moist tunnel walls, and it was reasonable to suppose that radioactive dust from a bomb might behave in the same way. Anyway, some of us had enough interest in the topic to spend some of our days off evaluating the suitability of mines as fall-out shelters.
After getting permission from the mine companies, four of us - a fireman, a public health worker, an instructor from the mine rescue training school, and myself (a doctor) - formed the core of a crew to map the mines, We pre-supposed that in any atomic attack electric power would be gone, and the mine hoists and ventilation fans would not be operating. So only entry level, horizontal tunnels would be accessible. (Try climbing twenty flights of stairs, the distance between one mine level and the next, and see how your legs feel.) There would be no light or food except for what could be brought in or stored ahead of time.
There is natural air circulation in many mines, and a warm enough temperature. Our public health man tested various underground water sources and found some of them drinkable. Some had drainage ditches that would provide sanitation. The tunnel floors are rocky and wet, and many of the mines had nothing but a vertical shaft access. We checked out ten or fifteen mines. It wasn't until we saw our mine rescue expert casting worried glances at some of the rotting mine timbers in a long-abandoned tunnel that we decided we had explored enough.
The mines of Shoshone County, Idaho, those with horizontal access, drinkable water and breathable air, had enough room to accommodate perhaps 1,200 people, if food, medicines, and electric batteries were stored ahead of time and people did not mind the dark, damp, sometimes dangerous surroundings.
But as is often the case, bureaucrats in the nation's far-away capital city had no clue about conditions in mines. Nor did they realize how much preplanning, and checking the facts of the local situation, was needed to provide genuine safety for the people on site. Our bureaucrats took no further action.
When I told some of my patients about our study, showing room in the mine tunnels for only about one-tenth the local population, let let alone 250,000 Spokanites, they were philosophic. One told me:
"Well, that's okay, Doc. If the bomb ever drops and we can't dynamite the river bridge in time to keep the city folks out, I'll just sit on my front steps with a six-pack of beer, and watch the fireworks."
This was reinforced in my hometown of Kellogg, Idaho back around 1984, when the Cold War and atomic bomb threats were often in the news. Someone in the national bureaucracy, pondering how to save citizens' lives in case of atomic attack thought "Mine tunnels!" The Silver Valley in northern Idaho has more than 200 miles of tunnels underground, thought to be enough to accommodate most of the population of the city of Spokane (seventy miles away, it's true, but they had a super-highway.) Accordingly, 200 cots and a few initial supplies of food and medicine arrived for storage in our local hospital against the day of holocaust.
The bureaucrat's thinking was not entirely off the wall. An atomic bomb hitting Fairchild Air Force Base (ten miles the other side of Spokane) might conceivably give citizens an hour or two to take shelter from the radioactive dust that would be borne on our usual westerly winds. And after three weeks underground, people might (we were told) be able to survive in the diminishing radioactivity. When Mount St. Helens had blown up, four years earlier, the volcanic dust did indeed reach Kellogg and beyond. The local miners noticed that it only penetrated the mine tunnels about 300 feet before adhering to the moist tunnel walls, and it was reasonable to suppose that radioactive dust from a bomb might behave in the same way. Anyway, some of us had enough interest in the topic to spend some of our days off evaluating the suitability of mines as fall-out shelters.
After getting permission from the mine companies, four of us - a fireman, a public health worker, an instructor from the mine rescue training school, and myself (a doctor) - formed the core of a crew to map the mines, We pre-supposed that in any atomic attack electric power would be gone, and the mine hoists and ventilation fans would not be operating. So only entry level, horizontal tunnels would be accessible. (Try climbing twenty flights of stairs, the distance between one mine level and the next, and see how your legs feel.) There would be no light or food except for what could be brought in or stored ahead of time.
There is natural air circulation in many mines, and a warm enough temperature. Our public health man tested various underground water sources and found some of them drinkable. Some had drainage ditches that would provide sanitation. The tunnel floors are rocky and wet, and many of the mines had nothing but a vertical shaft access. We checked out ten or fifteen mines. It wasn't until we saw our mine rescue expert casting worried glances at some of the rotting mine timbers in a long-abandoned tunnel that we decided we had explored enough.
The mines of Shoshone County, Idaho, those with horizontal access, drinkable water and breathable air, had enough room to accommodate perhaps 1,200 people, if food, medicines, and electric batteries were stored ahead of time and people did not mind the dark, damp, sometimes dangerous surroundings.
But as is often the case, bureaucrats in the nation's far-away capital city had no clue about conditions in mines. Nor did they realize how much preplanning, and checking the facts of the local situation, was needed to provide genuine safety for the people on site. Our bureaucrats took no further action.
When I told some of my patients about our study, showing room in the mine tunnels for only about one-tenth the local population, let let alone 250,000 Spokanites, they were philosophic. One told me:
"Well, that's okay, Doc. If the bomb ever drops and we can't dynamite the river bridge in time to keep the city folks out, I'll just sit on my front steps with a six-pack of beer, and watch the fireworks."
Thursday, July 28, 2011
Watchdogs versus "Government Interference"
Think about this a minute. You maybe have a burglar alarm at your business site, or a watchdog at your home. Military installations routinely post sentries. And most of us are familiar with airport security inspections. None of these guardians are violating Constitutional rights. You may not like the inconvenience, but few would dispute the need. That's because there are occasional people out there, whether citizens or aliens is irrelevant, who do not respect your property or your life.
So why is a watchdog agency such as the Federal Aviation Authority, or the Federal Drug Administration, or the Securities and Exchange Commission, or any of dozens of other government groups considered "interfering" when they blow a whistle on the shenanigans of Wall Street, or lax safety inspection, or executive greed?
Someone does need to blow a whistle when a smelter lets clouds of unfiltered lead dust billow out of the smokestack. Or when a drunk takes the wheel of a car. Or when a bank or insurance company risks its customers' investments by loaning billions of dollars to high risk enterprises.
When an industry persuades Congress that deregulation of pharmaceuticals, or neglecting building codes, or cutting taxes are in the public interest, there is often a thin line between good business practice and corruption.
When a physician, called about a patient, doesn't see the patient but orders some medicine over the phone, and then charges the patient's insurance a fee for doing an exam, "because he is taking the responsibility," he's getting pretty close to fraud. That's a nasty word, but sometimes it has to be said, and it is another large factor in the rising cost of medical care.
There are trade-offs. If the government is to repair highways, it must find funds to pay for the workers, the material, and the equipment. If there is obvious waste in a program, it doesn't make sense to let the money continue to bleed away while the work stands idle. Nor does it make sense to continue to borrow endlessly and let hundreds of billions of dollars go to pay interest on the debt. And it doesn't make sense for a First World nation to leave 15% of its citizens medically uninsured. This makes the taxpayer or those with insurance pay the cost for the visits of the uninsured.
What Government Could Do Better: One of the tasks of Congress is to create laws for public benefit. To leave no doubt of what the law means, Congress adds regulatory clauses, often to the extent of a thousand pages or more. That length creates a lot of doubts of its own. For one thing, I doubt that many lawmakers or their aides have read the whole thousand pages carefully enough to grasp their full meaning.
How about a two or three-page summary stating concisely the purpose and actions required by the act, to which the other 997 pages must conform? And if any don't conform, they must be revised until they do.
The public wants action to produce a medical care act that reduces waste, increases efficiency, and addresses the problems of 45 million uninsured citizens. Instead, both houses of Congress, and many agencies besides, jockey for a political agenda rather than addressing the merits and flaws of the act they are trying to put together. Such delays cost money. Endless catch phrases and frank misstatements of meaning, on TV ads and talk shows, don't get the job done.
Congress can't expect to mandate new standards of care without funding them. It is hypocrisy to say "no new taxes," while cutting federal funding, leaving the states to finance new federal laws through state taxes. And cutting funding for watchdog agencies would be reckless negligence.
This blog post is adapted from my book, "Access to Medical Care, Common Sense for Doctors, Patients, and the Public," © 2009 by Keith Dahlberg, MD; iUniverse, publisher.
So why is a watchdog agency such as the Federal Aviation Authority, or the Federal Drug Administration, or the Securities and Exchange Commission, or any of dozens of other government groups considered "interfering" when they blow a whistle on the shenanigans of Wall Street, or lax safety inspection, or executive greed?
Someone does need to blow a whistle when a smelter lets clouds of unfiltered lead dust billow out of the smokestack. Or when a drunk takes the wheel of a car. Or when a bank or insurance company risks its customers' investments by loaning billions of dollars to high risk enterprises.
When an industry persuades Congress that deregulation of pharmaceuticals, or neglecting building codes, or cutting taxes are in the public interest, there is often a thin line between good business practice and corruption.
When a physician, called about a patient, doesn't see the patient but orders some medicine over the phone, and then charges the patient's insurance a fee for doing an exam, "because he is taking the responsibility," he's getting pretty close to fraud. That's a nasty word, but sometimes it has to be said, and it is another large factor in the rising cost of medical care.
There are trade-offs. If the government is to repair highways, it must find funds to pay for the workers, the material, and the equipment. If there is obvious waste in a program, it doesn't make sense to let the money continue to bleed away while the work stands idle. Nor does it make sense to continue to borrow endlessly and let hundreds of billions of dollars go to pay interest on the debt. And it doesn't make sense for a First World nation to leave 15% of its citizens medically uninsured. This makes the taxpayer or those with insurance pay the cost for the visits of the uninsured.
What Government Could Do Better: One of the tasks of Congress is to create laws for public benefit. To leave no doubt of what the law means, Congress adds regulatory clauses, often to the extent of a thousand pages or more. That length creates a lot of doubts of its own. For one thing, I doubt that many lawmakers or their aides have read the whole thousand pages carefully enough to grasp their full meaning.
How about a two or three-page summary stating concisely the purpose and actions required by the act, to which the other 997 pages must conform? And if any don't conform, they must be revised until they do.
The public wants action to produce a medical care act that reduces waste, increases efficiency, and addresses the problems of 45 million uninsured citizens. Instead, both houses of Congress, and many agencies besides, jockey for a political agenda rather than addressing the merits and flaws of the act they are trying to put together. Such delays cost money. Endless catch phrases and frank misstatements of meaning, on TV ads and talk shows, don't get the job done.
Congress can't expect to mandate new standards of care without funding them. It is hypocrisy to say "no new taxes," while cutting federal funding, leaving the states to finance new federal laws through state taxes. And cutting funding for watchdog agencies would be reckless negligence.
This blog post is adapted from my book, "Access to Medical Care, Common Sense for Doctors, Patients, and the Public," © 2009 by Keith Dahlberg, MD; iUniverse, publisher.
Tuesday, July 26, 2011
Road Block Deadlock
All right, it's time to stop fixating on each party blocking the other party and work together to move the nation off the railroad tracks before the train comes along.
Okay, there have to be budget cuts, and yes, they must include parts of the major entitlement programs; I say that as a Democrat and beneficiary of Social Security and Medicare myself. Those who have no other income should not bear the burden, but those of us who do have other resources should not expect full benefits to go on increasing forever. Incremental reductions over several years need not be a disaster.
Republican spokespeople are fond of saying that new taxes destroy jobs. What do they think budget cuts do? I am told (today's Spokane Spokesman-Review editorial) that failure to renew the operating authority of the Federal Aviation Administration last week laid off 4,000 clerical workers, and that in turn halted construction work on the nation's airports and runways, suspending the jobs of the construction workers.
Hospital emergency rooms have been the last resort of the uninsured ill and injured. Now there is a movement afoot, already enacted into law in some states, to limit Medicaid patients to only three paid ER visits per year, with shared computer data bases to detect hospital-hopping. With unpaid ER visits increasing each year, hospitals have no other choice when their funding is cut, but what is the child with chronic severe asthma or any number of other maladies to do?
Yes, small businesses need reassurance that they can plan ahead on tax rates, etc., but the mega-corporations' profits are doing quite well, thank you, and they may have to struggle along, even without the tax loopholes and exclusions and subsidies to which they have been accustomed.
One big difference between President Obama's four trillion dollar debt reduction and the one trillion proposed by Mr. Boehner is the saving in annual interest costs. At six per cent, that extra three trillion cut saves l80 billion dollars per year. So, enough with the smokescreens already. Even the Congressional rookies will have to learn to sacrifice. It comes with the job.
Okay, there have to be budget cuts, and yes, they must include parts of the major entitlement programs; I say that as a Democrat and beneficiary of Social Security and Medicare myself. Those who have no other income should not bear the burden, but those of us who do have other resources should not expect full benefits to go on increasing forever. Incremental reductions over several years need not be a disaster.
Republican spokespeople are fond of saying that new taxes destroy jobs. What do they think budget cuts do? I am told (today's Spokane Spokesman-Review editorial) that failure to renew the operating authority of the Federal Aviation Administration last week laid off 4,000 clerical workers, and that in turn halted construction work on the nation's airports and runways, suspending the jobs of the construction workers.
Hospital emergency rooms have been the last resort of the uninsured ill and injured. Now there is a movement afoot, already enacted into law in some states, to limit Medicaid patients to only three paid ER visits per year, with shared computer data bases to detect hospital-hopping. With unpaid ER visits increasing each year, hospitals have no other choice when their funding is cut, but what is the child with chronic severe asthma or any number of other maladies to do?
Yes, small businesses need reassurance that they can plan ahead on tax rates, etc., but the mega-corporations' profits are doing quite well, thank you, and they may have to struggle along, even without the tax loopholes and exclusions and subsidies to which they have been accustomed.
One big difference between President Obama's four trillion dollar debt reduction and the one trillion proposed by Mr. Boehner is the saving in annual interest costs. At six per cent, that extra three trillion cut saves l80 billion dollars per year. So, enough with the smokescreens already. Even the Congressional rookies will have to learn to sacrifice. It comes with the job.
Friday, July 15, 2011
National Debt Reduction
"No new taxes" and "No cuts in entitlements" have both become paralyzing cliches in the past week, arresting any tangible Congressional work output, and stifling productive thought.
Let's take perception a step further. If you don't pay off your personal credit card debt, you eventually lose your credit. Credit card payments require cash. So does the government credit card.
And a large portion of any cut funds were used to pay people's paychecks, (or indirectly to pay those who produce materials.) And if, on the average, people make $ 50,000 per year, every billion you cut from the budget means twenty thousand more jobs lost, plus the income tax revenue those people could have paid.
But there is no doubt that we must cut spending. My previous blog (scroll down) addresses relatively painless ways to reduce Medicare and Social Security costs. Lest any one accuse me of lacking details, allow me to advertise a small book I published two years ago, "Access to Medical Care: Common Sense for Doctors, Patients and the Public" It's fifty-six pages long, can be read in a single evening, and is available on Amazon for $ 8.95, (soon to also be a six dollar e-book.) I just read the whole book again this morning, and believe it to still be as relevant today as in 2008. Except the last chapter, "Working Together". Congress is still undecided on that.
Let's take perception a step further. If you don't pay off your personal credit card debt, you eventually lose your credit. Credit card payments require cash. So does the government credit card.
And a large portion of any cut funds were used to pay people's paychecks, (or indirectly to pay those who produce materials.) And if, on the average, people make $ 50,000 per year, every billion you cut from the budget means twenty thousand more jobs lost, plus the income tax revenue those people could have paid.
But there is no doubt that we must cut spending. My previous blog (scroll down) addresses relatively painless ways to reduce Medicare and Social Security costs. Lest any one accuse me of lacking details, allow me to advertise a small book I published two years ago, "Access to Medical Care: Common Sense for Doctors, Patients and the Public" It's fifty-six pages long, can be read in a single evening, and is available on Amazon for $ 8.95, (soon to also be a six dollar e-book.) I just read the whole book again this morning, and believe it to still be as relevant today as in 2008. Except the last chapter, "Working Together". Congress is still undecided on that.
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