i want to start by reminding you of my prediction for the election result. there were doubters among you, but he has taken some big steps in recent weeks. even ann coulter agrees--and i would take her word over jon stewart's anyday. my newest caviat is that romney will beat clinton. he probably wouldn't beat several of the other democratic candidates that won't win the democratic primary.
so, todays exercise is one some of you may be uncomfortable with. pretend you are democrat. don't take this lightly; really delve in. if the democratic primary were held today and you feel the current president (a liar, unilateralist, polluter, bigot, oil stealing, gun wielding and stupid white man--among his finer points) has brought our nation to the brink of destruction (not a religious, armageddon destruction. religion is for weak, unintelligent people. it is a bigoted and hateful relic of the dark ages. this destruction will be a pragmatic response of reasonable muslims who have been bullied by a big texan).
DISCLAIMER: if you really are a democrat, please realize the paragraph above was just a joke and i don't believe you personally believe what i just wrote. and who's to say i'm not a democrat at heart?
anyway, whatever your reasons, you are democrat through and through and you get to pick from one of the candidates below. do you know any of them? whom do you know? for whom would you vote?
(i'll give you 50 green house gas credits if you can name them all right now without google--in order, by number)
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is it time for a new party in the white house? what are the issues that are most important to you? is there one issue that means so much that it would cause you not to vote for a candidate? are there reasons you would or wouldn't want a mormon in office? do you feel our country is headed in the right or wrong direction?
19 comments:
i will begin.
i knew three of the candidates by face yesterday when i sat down to write the post--clinton, edwards and obama.
i could name two or three others by name but not face--dodds and biden.
their policies? i only know what clinton tried while in the white house the last time.
single issues for me?
i worry about health care. the number of uninsured in the country bothers me. in the ER we turn away no one regardless of insurance.
however, the call for a single payer system (ie. the federal government) is very concerning to me. i want to propose that recent scandal at walter reed (a very crowded building at the medical center filled with soldiers, mold, dirt and grime) was a symptom of a salaried employees and a single payer system. competition drives quality. the VA system's employees get paid the same regardless of the number of patients they see in clinic or the number of surgeries that do in a day. there are no other hospital options for the cadets and therefore the hospital doesn't need to worry about 'losing business' because of unsanitary conditions.
innovation and quality in the US has been traditionally driven by the free markets. there are downsides to the free market in health care (doctors and hospitals doing unnecessary and expensive tests and procedures. hospitals trying to pass off those patients with no insurance elsewhere.)
those are some rambling thoughts on what i will be listening for as candidates talk about health care. i want coverage for more americans, but not at the expense of a healthy competitive free market model.
i'll keep talking to myself a bit longer. in the wake of the silly recent article about romney's polygamist great great great grandancestors, i started reading other sources talking about other candidates family backgrounds. i found some disturbing things about some of the candidates parents, spouses, etc. there were candidates that i was previously favorable towards whose family ties gave me pause. what effect does a candidates family ties have on them? how does it affect their moral stability, emotional abilities, underlying philosophies? giving an answer would be a generalization (and inherently biased right stephen?). i think this election cycle will be exciting as candidates from both sides of the aisle will be forced to be innovative and find new solutions as president bush sits in the white house plugging away with very low public opinion.
I'll admit, I'm not incredibly educated on each of the candidates, but I've seen a few of them interview, and I've heard much about others. I could name four of them by the pictures: hilary, obama, edwards and biden. Biden had an appearance on the Daily Show, and he was very charismatic--more likable than clinton. But based on his controversial comments on obama, I don't know if he's much of a contender. With the little education I have on each of these candidates, if there were an election today, I would vote for obama. My opinion would probably change if I knew more, but that's my answer for now.
I only knew 4 of the 8 wanting to run to the Dem. nom.
I was a little uncomfortable with your Ann Coulter comment. She has definately dug herself into a hole, I would avoid quoting her at all costs Paul.
I have said this before but I will say it one more time. Our overhead when we came here 21 years ago was 30%. The more the government gets involved the more our overhead is. Our overhead is now over 70%. Nationalized health care is very much of a concern. Maybe that would give daddy the excuse to do what he has always wanted to do.....teach.
Single-payer health system (government)? I know I am not an MD and I didn’t have to put in all of the time, work and expense of a medical eduction. But I felt blessed to perform in a profession I loved, even with lots of hours, lots of call, lots of weekends and holidays. Luckily, most of my patients were insured or had government assistance. I was able to afford some great disability and health insurance I didn’t imagine I ever would have really needed. What would our lives be like now if we weren’t able to afford all of that good insurance? We were able to keep our house and cars. We were able to support a missionary without requiring assistance, and our children are able to have a university education.
There are lots of good, hard-working people out there that cannot afford even decent health insurance. I understand that many employers go to amazing efforts to avoid providing insurance. That may be one of the reasons we get some really great deals at Cost-Co.
I may get the chance to see things from a different perspective now. Val had to stop working because she felt she needed to be with me more. Our COBRA-assisted health insurance runs out this fall. We will be able to insure the rest of the family, probably, but what company in their right minds would insure me? (think Stevens-Johnson again, not to mention daily medication costs I wouldn’t have imagined existed).
I hope you don’t see this as a request for sympathy, because that is not at all why I am writing this. But like I say, there are different perspectives. I understand that Oregon has a program to assist uninsurables, like me. Whoops! Sounds like government assistance. Do you think we should look into it?
Sorry about the rant. I promise, my next blog is going to be really pleasant.
i am in no way denigrating the need for government assistance. there must be a safety net for those who 'not insurable'. in massachusets romney made health care insurance a requirement (like car insurance). he then focused the assistance on programs that assist those without the means to afford the premiums. by making health insurance mandatory to all it puts the 'uninsurable' patients back into the 'risk pool'. therefore insurance companies are willing to share the risk and premiums go up some but they go up for all. that way you don't have insurance companies shopping around for only healthy patients.
there are definitely problems with a strictly free market in health care. government oversight and assistance is absolutely essential. i am advocating utilizing the free markets responsibly to insure all members of our society are insured. there is a difference between insuring everyone responsibly and putting bumbling bureacrats and politicians in the drivers seat.
dad risenmay: i hope the above explanation explains better some of my thoughts. i'm glad you brought up your feelings on the subject. do you think my thoughts on mix of free market and government oversight are plausible/sustainable? do you think the single party payer would fix the problem? i worry that a single party payer would just drive a two tier health system where physicians would leave their 'government offices' early eachday to work in their private offices for out of pocket payment patients. my understanding is that this is the norm in many of the national healthcare style countries...
mother dear: ann coulter is very witty and very good at riling up her opponents. i don't condone what she said the other day about edwards. my point was the left's lackeys (stewart, moore et al.) are not below making similarly offensive generalizations or specific pointed attacks about members of the political right.
dad risenmay: you said, "I felt blessed to perform in a profession I loved, even with lots of hours, lots of call, lots of weekends and holidays."
my other worry is that the quality care you provided on all those weekends and holidays would slowly go the way of the buffalo in america. do salaried government employees ever come in on the weekend or on a holiday? do they ever stay past 5 pm (or even 4:30 pm on friday)? it seems that you didn't mind being away from family some of those weekends and holidays because there was comfort in the fact that those same hours would go towards means for music lessons, prom dresses, college education and health insurance...
paul.
please i beg you never to put moore and stewart in the same category. ever.
moore is an extortionist, opportunist infection that should go away forever.
of course, stewart is also lefted and opportunistic, but nowhere near as dispicable as moore.
as for being a democrat. if i were to choose today, i would vote edwards. i like he strong focus on domestic issues and love of grass roots. i think we over emphasize international affairs (while very important) to define our identify and we the citizens are the victims. i think we need a stronger national focus. i think edward's agenda is the most suited for this.
peter: i'm sorry to have offended your sensibilities.
edwards bothered me more than kerry in the debates 4 years ago. there may be issues of his that work, but his history as a tort lawyer is distasteful to me. unfortunately my politics are tainted by my schooling...
Edwards bugs me too. We went to one of his/Kerry's campaign rallies in Iowa and he didn't say one thing about what he planned to do for the country. It was Bush bashing for 45 minutes. I was hoping to at least hear something that would be thought provoking, or worthy of bouncing on a wagon, but he disappointed. Maybe he has changed, but for now, I would not vote for Edwards. I would probably vote for Obama, but I'll admit, there is still much to be researched.
Health care is of big concern to me too. We don't have pre-existing health conditions like Amy's dad, but we have also run into insurance companies denying us because we did IVF. This is super frustrating because we are healthy, good tax paying, middle class citizens who would like to be reassured that their children will be covered in chance of an emergency, without having to worry about going bankrupt. There has got to be a better option for people who are willing to pay insurance premiums, but are denied because of circumstances they can't help. I will be interested in hearing proposed solutions to this dilemma.
Insurance companies = secret combinations. Sorry.
I can't think of any good "medical" issues an insurance company would have against insuring IVF families. Perhaps the cost of another IVF pregnancy? The "risk" of more multiples?
I mean, come on... isn't insurance all about "risk?" I mean, when I pay a premium, I "risk" never seeing that money ever again...
I recognized old Billy Richardson as well. He is currently our "Out Campaigning" state governor. Don't like him. He is campaigning on a gimmick of cooperation and halt of mudslinging. He didn't get involved in any mudslinging in his last campaign as governor, but then... he didn't have any competition.
I don't trust him. He may make his way to the forefront over time because of his experience as a congressman, Secratary of Energy, and other prominent positions.
That said, I don't know who I would vote for. I think I would vote for the person most likely to lose the presidential campaign, but then I wouldn't be voting like a true democrat, which is one of the requirements Paul placed on us all.
With respect to healthcare? We all know that all aspects of social issues will get worse as the morality of our society declines. In government: less=better, if the people are generally charitable and caring towards those less fortunate than themselves.
Voting on a candidate based on what they can do about heathcare and the war in Iraq is short sighted. As a society, we need a leader that will guide us in a direction of accountability for our own society. That is what will be guiding my vote.
matt: interesting thoughts. i like you thoughts about the president being a moral beacon. someone who gives exudes a sense of moral authority and who acts accordingly.
the economy and it's health often drive votes. defense spending has burgeoned under bush and has probably been good for sandia. what if your moral beacon cut nuclear research in half? or deemed it inhumane and lobbied to cut all funding? your thoughts on her moral identity would probably be tied up in her opinion of your profession so the answer gets muddled.
i may have overstated my stance on walter reed as the scapegoat for all things 'centralized healthcare'. however, my points in relation to walter reed were no altogether untrue.
i don't think that the president's political and policy beliefs are innocuous. bush's bungled foreign policy attempts have hurt our image abroad. his inability to push innovative solutions for retirement, social security, healthcare and other problems may leave us to suffer as the hands of an even less adept president/congress or party to solve these very important and pressing problems.
iraq=shortsighted may be a shortsighted sentiment if it leads to an armageddon...
Like a loved daughter, son and son-in-law, I love a good debate.
The recent revelations of poor care, mold and grime in VA hospitals, patients going without pain medication for 5 1/2 hours, and and other remarkable examples have been used by some as an argument that government-funded and supervised health care just doesn’t work. Physicians work their shift and go home. They just don’t care, because they are not compensated any differently if they are excellent and caring physicians, or if they are poor, unconcerned wage-earners. Almost all of the MDs in the private sector, meanwhile, are on call, work weekends and holidays, much, much more than the common wage-earner in our society, because they are appropriately compensated by their patients and insurance companies (you know, those secret combinations.)
I can’t believe my personal experience with the “other side” of hospital care was almost five years ago. I know, absolutely, I am here writing on this computer because an ER physician recognized that my symptoms were much more serious than were readily apparent. He, along with other, also well-educated and trained and experienced physicians, placed me immediately on exactly the correct and only medication that kept me alive. I was put in intensive care, and they worried about me and monitored my condition. Medications were prescribed, and changed when necessary. They fretted over me, often after 4:30 and even 5:00, even though they had never met be before.
They were compensated for their efforts in my behalf by my insurance-along with some generous co-payments. I am absolutely sure they were also motivated by the selfless concern that I know motivates most physicians
Paul, I have watched, and been amazed at the incredible hours of study and hours of training that have been required of you to enable you to receive the education and experience so you will be, I am certain, an extraordinary, caring physician. I have worked with MDs much of my life, and did not appreciate what they had to go through until I have watched your education, study, testing, and training. And then you to start your residency!
Back to my care. I was also kept alive and cared for around the clock by a team of RNs, LPNs, assistants, respiratory therapists, physical therapists, dietitians, and others. You know, those wage-earners. They made sure that medications were appropriately given, and IV pumps and ventilators were monitored. Symptoms and problems were identified and information was appropriately exchanged. I didn’t see a bit of mold in the hospitals, and the walls weren’t peeling. My bed linen was even changed.
Could it be that the poor care experienced by our deserving veterans is not because of wage-earning federal workers? Perhaps it is due to recent Republican presidents, who, in an effort to prove that only a supply-side economy works, have cut taxes to an extent that these hospitals are now under-funded. Perhaps some of those patients didn’t receive their pain medications because of an overworked, understaffed medical team that may have the desire to care for their patients, almost as much as those in the private sector. As a wise physician I know once said, compensation does drive quality. In our system, federal compensation requires taxes and in our case, an amazing federal defecit.
Also, I hope it is not unpatriotic to point out that America does NOT have the best medical care in the world. It is a myth that physicians from countries that have a single payer system (i.e.. the federal government), flee to the US when they personally require care.
dad risenmay: good to hear from you. i was worried we wouldn't get your thoughts back before our next post.
your thoughts on the nursing, lpn, respiratory care and other staff that earn 'wages' are interesting. amy and i were talking about icu care (i am on the CCU right now) and the big difference from a floor bed and an ICU bed is the qualifications of the nursing staff and the monitoring capabilities. these members of the health care team are in large part what makes our healthcare system great.
(we can have a debate about the quality of our health care system some other time. i had MD/MPH professors that would quote infant mortality statistics and vaccination statistics and gripe about how our health care system is worse than most developed countries despite more health spending than most countries' GNP. i don't buy into all the statistics. america deals with uniques immigration, population and poverty inequity problems. statistics do not tell the whole story. another topic, another day.)
the notion of money driving quality is crass. i don't see that with any of the staff or physicians that i work with on a day to day basis. HOWEVER, if you talk to hospital administration, competition, profits etc certainly drive their desire to attract patients and staff to their facilities. a single payer, federal system like the VA does not deal with the problem of patients going elsewhere because of poor conditions. therefore the administration is less likely to tie employee promotions and tenure to longer lists of quality assurance requirements. in a private hospital the underlying competition drives the administration's demands for excellence in as many arenas as possible (beauty of the facility, quality of the food, kindness of the employees, quality of the mattresses, number of cable channels and the list goes on).
a powerful example for me is my dad. early on in his career he said he would never practice medicine as a business for profit. his thought being that he would consciously not ever practice medicine with the monetary endpoint in mind. he consistently and consciously gives all options surrounding any lucarative procudure or test that he approaches with a patient. these type of ethics may have been lost in some health care arenas. it's hard to tell.
so, in response to bush cutting taxes and the VA system faltering, i don't buy it as the sole cause for walter reed's specific problem and the VA's more general problems. granted, if the VA is federally funded then taxes are the answer. What if the VA system is already leaps and bounds better than conditions immediately after the vietnam war. are the problems inherent in a government run agency rather than a republican or democratic president throwing more money in the pot? are politicians ever good at following inflation trends and keeping up with 'fair market trends'? good questions all.
i should add that you (dad risenmay) are another powerful exanmple of a very caring health professional.
going to work with you was a highlight for me. the staff loved your humor. they enjoyed working with you in OR cases. your patients were at ease around you appreciated your ability to relate to them. i don't believe money was the conscious driving force behind the care you gave.
we all know that your partner wasn't a better physician because of the money he earned or how he chose to spend it.
hopefully my statements here are not implying that money=quality. quality is driven by good, hard-working, motivated members of the health care profession. money is often a sub-conscious (hopefully), yet vital part of care. what drives quality in law? dentistry? the specific quality falls on the shoulders of each individual and their personal moral convictions and decision to perform to high standards.
Federally-run efficiency, and VA reports?
It reminds me of a WWII camp song Dad used to sing to us:
The biscuits they make here, they say are mighty fine.
One rolled off the table, and killed a bud of mine.
Oh, I don't want no more of army life.
Gee, Mom, I want to go, but they won't let me go, oh gee Mom, I want to come home!
There are other verses I can't remember.
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