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I grew up in Baton Rouge, Louisiana. My parents moved there in 1959 so my father could go to graduate school at LSU. After a couple of non-academic jobs my father took a job at LSU in academia and we moved to an area near campus. So near, in fact, that on Saturday night I could see the glow from the lights at Tiger Stadium. The Baton Rouge I knew was mostly college professors and their kids and mostly “white” although my neighborhood had it’s share of brown and black college professors kids. The schools I attended were good schools. The Baton Rouge I knew was a good place to grow up.

I looked at Google Maps to try to get my bearings and determine if I knew the area where Alton Sterling was shot. I realized that though I didn’t know the area, I KNEW the area. Some auto repair stores, several convenience food stores, a dialysis center, and a couple of cell phone shops. The area is over 80% minority and has lost 10% of its population in the past 10 years. The median household income is less than 50% that of the Louisiana average and Louisiana is a poor state. I suspect you have driven through this area as well. Often by accident. Checking the door locks to make sure the doors are secured.

Race is a funny thing. The construct of race dates from the 1700s and, though there is some controversy, seems to be more tied to a desire to boost folks of certain color or ethnic make-up than to be a clarifying concept with any basis in science. Though life expectancy clearly does track with self identified race, many “whites” have African ancestors and many “african-americans” have more native American than African ancestry. Some point to sickle cell disease as evidence of a racial component of disease but the disorder clearly  tracks with factors other than black skin color.

A better construct is this study,  reported by Vox last year. Instead of being a dichotomous variable (black-white) or even a categorical variable (race is now often sorted into as many as eight categories, including “two or more”) the investigators suggested that how you self-identify your  “race” is actually a compilation of attributes that include skin color and genetics but also include such attributes as religion, social-status, power relationships, and dialect. Instead of being assigned at conception, race becomes a more dynamic construct. Other research identifies the act of ANTICIPATING being a victim of racism is clearly harmful to the health of the victim, regardless of any objective, “scientific” status of the victims “race.”

None of this brings back Alton Sterling. If, however, we could stop seeing things in the South as “black-white” maybe we could make some progress. Once we do that, here are some other things to work on:

  • Improve public transportation
  • Acknowledge that access to healthcare is a right
  • Hire public servants who are of the community and train them appropriately.
  • Demilitarize the police force.
  • Disarm the citizenry.
  • Stop being scared of “the other” because they live in poverty
  • Most importantly, stop making the poor and disenfranchised the victims of our fear.

 

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[In response to increased dependence on oil from unstable countries] EEN began to create the “What Would Jesus Drive?” (WWJDrive) educational campaign in February 2002 to help Christians and others understand the relationship between our transportation choices and these three major problems – human health impacts, the threat of global warming, and our increasing oil dependence.

Evangelical Environmental Network

Remember those WWJD bracelets. Folks wore them as a reminder to act “right” when no one was looking. The letters stood for “What Would Jesus Do?” and the presumption was that in every given situation there was a “Godly” answer. Of course, placing yourself into the mindset of a person who lived 2000 years ago to establish a course of actions in a given modern-day situation led to some strange speculation. What Would Jesus Do when confronted with pork? Is veganism the established Jesus-like diet? This person can site scripture to say it is. It also leads to some creative marketing. On ETSY are several pages of handmade items embossed with the official WWJD query. One “ladies T” substitutes the letter “D” for the “J” allowing one to substitute The Donald’s thought process for those of the Other Big Guy.

In 2002 a group of creative and and liberal soles asked themselves “What would Jesus drive?” This was a time immediately after the trade towers went down. The national narrative was being shaped and it was understood that our purchasing of oil from the Middle East was a proximate source of terrorist funding, bad for the environment, and bad for our health. Their solution?  Drive smaller and more efficient cars. Not SUVs. Unfortunately, the opportunity to invade an oil rich country seemed much more the Jesus-like answer to some:

God told me to strike at al-Qaeda and I struck them, and then he instructed me to strike at Saddam, which I did, and now I am determined to solve the problem in the Middle East. If you help me I will act, and if not, the elections will come and I will have to focus on them

George W. Bush. 2005

Why the walk through memory lane? I was sent a copy of the Alabama Department of Public Health’s transportation survey (found here). Groups from every county in Alabama who care for the poor and underserved were interviewed and to a group they coalesced around a single theme -Transportation for poor people is terrible in Alabama. Agency after agency identified between 25% and 50% of their clients have to rely on friends, strangers, or don’t keep health care appointments at all because of a lack of affordable transportation. Most counties in Alabama have no public transportation; for example in Marion County:

The hospital is not aware of any other transportation entities available to patients in this area, with the exception of one called “Tommy’s Taxi Service,” consisting of one elderly man and his personal vehicle, which they have known patients to use to get back and forth from their dialysis appointments. These dialysis appointments represent one of the largest challenges to patients without reliable transportation access, due to the necessity of attending multiple times per week.

Multiple agencies including this “for profit” entity suggested that churches are the answer:

Finding a way to involve the churches and other faith-based organizations in this area with the issue of non-emergency medical transport would help a lot of people in this area, and could be done by scheduling specific pick-up points and times at regular intervals. However, issues with reimbursement and assumption of liability are most likely the largest roadblocks to developing this type of solution.

So, Jesus might drive a passenger van and make scheduled stops to keep Alabamians from having to budget tax dollars for transportation. Perhaps He would work on His followers in the legislature to create and fund an effective bus service. I’m betting He would just heal the poor, sick people in Alabama. Alabamians who drive SUVs could take their turn being sick for a while.

I have a saying I use with my patients who are prone to fret as they grow, and feel, older.  “Every day on the green side,” I say to them, “is a good day.” Now that my wife, Danielle, is no longer here to share these days with me, I appreciate very much the effort she put in to making our “green side” as pleasant and inviting as possible.

We recently spent a long weekend mucking out the backyard pond and removing several dozen crawfish so the tadpoles and dragon flies would come back. They are back in force. The blueberry bushes, including the new ones we brought at the Botanical Gardens plant sale, are producing berries and the birds are, with the help of a netting reminder, leaving them on the bush long enough to stay ripe. The chickens continue to lay even after the flock has been reduced to a more manageable three birds. The citrus trees are loaded with fruit. Even the leak in the fountain has slowed, allowing me to keep the water feature flowing and providing the birds with a place to bathe. Here, in Danielle’s urban patch of green, the promise of renewal that spring brings to the gulf coast continues. Danielle is still with us, in her way, here on the green side.

Sudden cardiac death. That, in stark “doctor words,” is how she left those of us still on the green side. Although because of prompt paramedic response she still had a heart rhythm on and off after arriving at the hospital, it soon became clear that, clinically, she had left us on that Sunday, three weeks ago, while still in the house. I like to think that, once called, she decided to stick around. At the very least, she intends to make sure that the crawfish population stays down so she can continue to watch the dragon flies from the kitchen window. I choose to believe that is the case in part because draining that pond was very hard work.

Very few people study sudden cardiac death (SCD) in the general population, mostly because there is little clinical information to be had after the fact. If people make it to the hospital while having their heart attacks, we can mobilize millions of dollars of equipment and personnel to preserve their heart function. When we know that a person is at significant risk for sudden cardiac death, we implant defibrillators which stand at the ready to shock the heart back into compliance should it get out of kilter.

Most SCD happens to relatively healthy people, as it did with Danielle. As documented on the American Heart Association web site, every year about 300,000 people will succumb to SCD. This is about 15% of the deaths that occur in America annually. Of those, about half of the men and two-thirds of the women will have no reason at all to suspect a problem. The modifiable risk factors (hypertension, hypercholesterolemia, diabetes mellitus, kidney dysfunction, obesity, and smoking) have all been brought to the attention of the public. Improvements in management of hypertension and diabetes and reduction of smoking has lead to a reduction in all deaths from heart disease, including SCD.  A surprising number of these events occur during exercise (which tends to make the news and provides an excuse  for those who embrace the couch potato lifestyle). Jim Fixx perhaps is the most famous victim of sudden cardiac death while exercising. For the most part, habitual exercise is protective. That is, once it becomes a habit.

In Danielle’s case, genetics clearly played a role. However, saying “genetics plays a role” is not the same as saying “it runs in families” like red hair. There is a complex interaction between genes that makes us all unique. Family history doubles the risk of SCD. A rare event becomes half as rare. So far, researchers have identified 23 different gene areas that might play a part. Mathematics suggests that finding a pattern useful for screening or targeted treatment is still many years away.

So, what does this mean for SCD? In the words of the investigators, “Our ability to accurately identify individuals most at risk for SCD within the population remains poor.” Preventing SCD, as of now, is the same as preventing all heart disease. Eat right, exercise regularly, monitor blood pressure and get checked for diabetes if you are one of those at risk. Make exercise a habit and report unusual symptoms such as passing out, chest pain while exercising that improves with rest,  or unusual amounts of fatigue. Fund emergency services adequately but realize they are not the answer. Support policy efforts to make exercise more accessible.  Bike lanes are one such example. Support policies to reduce exposure to cigarette smoke and access to healthy food. Support research but realize the research will be difficult and expensive to perform.

How about for those of us still on the green side? Support dragon fly habitats. Eschew backyard crawfish breeding. Plant fruit trees. And remember, every day on the green side is a good day.

Two weeks ago today I lost my lovely wife.  Coronary atherosclerosis. That is what the death certificate says. My family and I have received an outpouring of love and heartfelt sympathy from our community of twenty-five years. We will never be able to repay their kindness.

Danielle was a craftsperson when it came to her writing. She would work for hours (or days) to express a thought or concept in just the right way. Medical writing was a mystery to her with its passive voice and weasel words. Early in my career I tried to enlist her help with one of my “scholarly” articles. We soon reached an agreement that I would write what I needed and she would pretend to read it once published and say “that’s nice dear.”

This blog was a collaboration and was different. Our attempt was to write it for a layperson with an interest in health care, a passion for doing the right thing, and a desire to connect the dots regarding the flaws in our care delivery system. If we succeeded it was because of her. If we failed, I take the blame. I only hope I can continue and not embarrass myself too much without her contributions.

Danielle was a healthy, fit, active women who unfortunately had a terrible predisposition to cardiac disease and no sensation of cardiac pain. In other words, no “warning signs.” She did not smoke, was not overweight, and ate mostly vegan. Her “coronary atherosclerosis” would have been as much of a surprise to her as it was to the rest of us. Here are my thoughts, at two weeks out:

  • Disease occurs randomly. Being adopted, she had limited knowledge of her family history.Had she known that that was a possibility, there are only a couple of things she could have done to change the outcome.This is true for many people who suffer from illness and disability. Victim blaming serves no purpose and is an incorrect response. This we all need to stop.
  • That being said, risk factor mitigation only makes good sense. Eat right (a diet low in fats and animal protein, high in fiber, and minimize processed components), exercise daily, avoid cigarette  smoke and alcohol in excess. While it didn’t save her life (nor any of us eventually) this type of living likely gave her 10-15 years she would not have had. And gave us that time as well. We all need to try and live in harmony with our bodies.  As a community we need to provide these opportunities.  Farmers’ markets, community gardens, and bike paths all contribute and should be supported.
  • Human connections are very important. What I learned of Danielle after her death was how important her friendship was to many people. I cannot count the number of people who have come up to me to say that at a vulnerable time she reached out and help him or her through the rough patches. As a primary care physician I am brought in at times of crisis. We need people like Danielle who will take an interest and have a serious discussion about concerns with folks who are vulnerable. Things like this prevent crisis. Please reach out to someone who seems distress and ask them what can be done to help them. While churches can serve that purpose, activities involving the arts, informal interactions within the community at open air markets and dog parks, for example, are where such interactions take place. As a community we need to build in these opportunities for casual interaction.
  • Illness, random or otherwise, in America is expensive with insurance and cost-prohibitive without it. We are very fortunate that we had health insurance through my employer and enough money to cover incidental costs.  Without insurance, the hospital would be able to put a lien on my house if I didn’t have the money. While the ACA is not perfect, it is what we have at this time. President Obama has made it so that, at least in those states that have expanded Medicaid, bankruptcy for medical bills is much less common. Please support the Medicaid expansion.

Enough rationality. For those who know us, I miss her every day in ways both big and small and I know you do as well. For those who did not have the opportunity, hug someone and go back to helping us continue the fight.

Aloha, Danielle.

 

 

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Resident: This is an 85 year old woman who presented in sepsis from a multilobar pneumonia. Her temperature was 103.2 and she had a blood pressure of 100/60. Her chest x-ray showed pneumonia. Two hours after the antibiotics, she is up and around and wants to go home.

Me: Wow

Resident: I know, based on the CURB-65 criteria her predicted mortality is about 50%

I give away a lot of advice, that people may or may not want.  People come to me not for information regarding their disease but for a cure. They want to feel better. This is in part an residual of the miracles of the antibiotic age that I was a part of this weekend. Pneumonia, the “old man’s friend” is now, if treated efficiently and effectively, almost always curable as attested to by my patient form this weekend. The proliferation of “urgent care”s and “immediate care”s is partly because people want to feel better immediately (it isn’t Dr. Perkins I need, it is a prescription and a steroid shot) and partly they don’t want to miss a pneumonia and die (it isn’t pneumonia, is it?).

The antibiotic model is that it works great for pneumonia in old people in part because the outcome is so dramatic. The older person is still old but the pneumonia is now gone. It is a lousy model for chronic illness. Take insulin for 4 days for your diabetes and you still have to take it the 5th day. And the 365th day for that matter. Unlike the pneumonia, which if untreated will kill you quickly, the high blood sugar of diabetes rarely kills. It is the aftereffects, the sequelae, of diabetes that kills with heart disease, stroke, infection, and blindness.

The New York Times covered a science story regarding the differences in premature mortality between the rich and the poor (found here). In it they point out that the differences can be explained by smoking (the poor are much more likely to smoke, now) and prescription narcotic abuse (just because it came with a prescription doesn’t mean it is safe). The third contributor is obesity. The rich are less likely to be obese than the poor, but not that much less (31% vs 37%), so why is obesity more of a problem for them? The investigators didn’t know why, exactly.

We had another patient this weekend who was admitted for her diabetes that explains why obesity isn’t so bad for the poor but the sequelae of obesity is. Her diabetes is well controlled when she has her insulin. Her job provides her insurance. Unfortunately her job doesn’t pay enough to cover the copay for the insulin, her grocery bill, and her housing expenses. So often, she has to make a choice between food and insulin, especially if her job doesn’t give her enough hours. So it isn’t the obesity per se. It really isn’t the diabetes, per se. It is the need to choose between a warm place to stay, food for her family, or her insulin that forces her to neglect herself. The sequelae of being poor in America.

 

 

david-sipress-but-we-re-not-homeless-we-re-on-a-camping-trip-new-yorker-cartoon

 

Donald Trump and Hillary Clinton were walking down the street when they came to a homeless person. Trump gave the homeless person his business card and told him to come to his office for a job. He then took $20 out of his pocket and gave it to the homeless person.

Hillary was very impressed, so when they came to another homeless person, she decided to help. She walked over to the homeless person and gave him directions to the welfare office. She then reached into Trump’s pocket and got out $20. She kept $15 for her administrative fees and gave the homeless person $5.00.

Joke” on the internets

Chronic homelessness is a complex problem. In 2006 Malcom Gladwell told the story of “Million Dollar Murray.” Murray was a gentleman who lived in Reno, Nevada, and had a major substance abuse problem. A veteran who learned to cook while in the service, Murray had two personalities. When drinking, he drank a lot. He was arrested a lot. He ended up in the emergency room a lot and, in fact, someone did the math and it was calculated that during one binge he cost over $1,000,000 in services. When supervised, sober and in housing supplied by an agency, he cooked well. He made money. He would be released on good behavior and go back to drinking. A lot.

Malcolm Gladwell points out that most people who are ever homeless are homeless for 1 day. The second most popular number for “days homeless” is 2 days. Murray’s case, though not typical for homelessness, was typical for expensive homelessness.

It’s a matter of a few hard cases, and that’s good news, because when a problem is that concentrated you can wrap your arms around it and think about solving it. The bad news is that those few hard cases are hard. They are falling-down drunks with liver disease and complex infections and mental illness. They need time and attention and lots of money. But enormous sums of money are already being spent on the chronically homeless, and Culhane saw that the kind of money it would take to solve the homeless problem could well be less than the kind of money it took to ignore it. Murray Barr used more health-care dollars, after all, than almost anyone in the state of Nevada. It would probably have been cheaper to give him a full-time nurse and his own apartment.

As told in this article, the George W. Bush administration looked into the chronic housing problem with the lens described by Malcom Gladwell. They found that $10,000 targeted towards these hard cases through housing subsidies could save the government several hundred thousand dollars. This money did not go to making them less dependent on substances. It did not go to giving them employment skills. It went to housing…and it worked:

In terms of impact, the number of chronically homeless people living in the nation’s streets and shelters had dropped by about 30% – to 123,833 from 175,914 – between 2005 and 2007, which policy makers attributed in part to the effectiveness of Housing First

Today that number is a little more than 100,000 with the number of homeless vets (not necessarily chronically homeless) being 40,000.

Why are we not celebrating this success?

From the right side of the aisle, it was seen as a “give away.” It reflected a paradigm shift in housing, the movement away from emphasizing “housing readiness” to offering low demand permanent housing solutions. Though it fixed the problem, it fixed it by giving housing to those who could not control themselves, thus exacerbating the feelings of unfairness amongst those who “play by the rules.”  From the left, Housing First has been criticized on its failure to address broader service outcomes, particularly substance abuse issues. It was seen as a market based solution (these folks cost us less money now) which didn’t address broader issues of equity and values.
John Maynard Keynes said “there is nothing a politician likes so little as to be well informed; it makes decision-making so complex and difficult.” The appeal of many of the current politicians is their willingness to ignore evidence as they pursue policies which have broad, superficial appeal. Homelessness rises to the level of public awareness when the tourists feel bullied or otherwise threatened (see comments following this article). One can only hope that our core values will come through as we work through this election cycle.
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What should be huge medical news is that the mortality rate (the rate at which people die) for white men and women aged 45 to 54 with less than a college education is rising in this country. This despite all the money that is spent on health care. This just does not happen. Why is this? Per the Washington Post:

“Drugs and alcohol, and suicide . . . are clearly the proximate cause,” said Angus Deaton, the 2015 Nobel laureate in economics, who co-authored the paper with his wife, Anne Case. Both are economics professors at Princeton University.

Whitedeath2

And we are talking about a lot of excess deaths

Based on the findings, Deaton and Case calculated that 488,500 Americans had died during that period who would have been alive if the trend hadn’t reversed.

There is a lot of speculation about the exact why and more studies are certain to follow, It is clear that the economic recovery has left these people behind and it is also clear that the safety net, including mental health but also including meaningful retraining, has not been effective for this group of people. For now, as a physician I need to do a better job of screening for pathological substance use and mental illness, As citizens we all need to advocate for more, not less, support services for this at risk population. As people, we can all say out neighbor “Is there anything I can do to help?”

How can Dr Carson be leading in a national poll for president and get a pass on a some, well, scientifically suspect beliefs such as “his statement in the wake of the Oregon mass shooting that it would be advisable to attack an armed gunman during a mass shooting ‘because he can’t get us all‘?” Or. how can folks want a president who is doing infomercials on neutraceuticals which misrepresent scientific fact and when called on it, deny having been paid for what was almost certainly a paid gig?

The New York Times gives a plausible answer to this question today. Ishani Ganguli, a Boston internist with an interest in health policy, points out that, pretty much, physicians get a bye:

  • He points out that we are trained to speak authoritatively regardless of the certainty of the situation or the strength of the evidence. In other words, as I tell my residents, “patients and attendings smell fear.”
  • He points out that surgeons are trained to believe that their skill is what stands between the patient and death and the loss of that faith leads to a crisis, one that a successful surgeon may never experience. He or she may not be good (and there is now a scorecard to look at) but will never admit defeat.
  • Doctors should never be politically correct, or so they are portrayed in the media (see House, MD),
  • There is a long line of physicians who are given a pass (see Dr Oz for the latest example)

Dr Ganguli points out that we as a society feel the need to ascribe trust to the MD. Our Hippocratic sales pitch has been an effective marketing strategy. He goes on to point out that self reflection and knowing our limits are keys to maintaining this trust. I am afraid that these are qualities Dr Carson does not have.

139263_600Ben Carson on setting up health savings accounts in a post Obamacare world:

“You also give people flexibility to transfer money within a family. So if you were $500 short, your wife could give it to you, your daughter could give it to you, your uncle, your cousin.”

Me in conversation with a fellow who is homeless and suffers from a terminal illness last week:

“Can you give me a ride? I sleep in a cot in the shelter down the way. I worked all my life until I got sick. Just got discharged a week ago from the hospital. Can walk about a half a block before I have to rest. I spend my morning walking to the this place for food.”

Me: “How long does it take you?”

“Oh, all morning. It’s about 3/4 of a mile. I spend the afternoon walking back. The give me a lot of medicines but when I run out I end up back in the hospital”

From a blog on population health

…..success (in lowering healthcare costs and increasing quality of healthcare/better outcomes for patients) …will require the ability to embrace the messiness of disease and the complexity of patients, rather than providing idealized solutions that impress in the boardroom but flop in the examination.

It is refreshing not to have a wonkish campaign for the Republican nomination. Both 8 years ago and 4 years ago terms like “bending the cost curve” and “medical loss ratio” were being used by the actual candidates. Voters don’t want to hear that. They want common sense solutions for common sense problems. For healthcare, the answers are simple—after all, we’ve all been to the doctor, right? Make the sick folks make choices. Get ’em out and working. Since Dr Carson is, well, a doctor, his common sense answers are just the prescription for our sore ears.

As found here, he feels that Health Savings Accounts for almost all are just what the doctor ordered:

ObamaCare, he opines, is way too restricting. Why should people need to have the details of what they purchase?

A major problem is that many people in our entitlement society see nothing wrong with forcing others to provide for their desires. In a free and open society, anyone should be able to purchase anything they want that is legal.

Given enough freedom, the invisible hand will sort things out:

Most people will want to get the biggest bang for the buck and will independently seek out both value and quality. That, in turn, will bring all aspects of medicine into the free-market economic model, thus automatically having an ameliorating effect on pricing transparency and quality of outcomes.

In addition, the miracle of compound interest will overcome the human predisposition to become sicker as we get older:

If accounts are established at the time of birth, they will be even more potent because the vast majority of people will not experience catastrophic or even major medical events until well into adulthood. By that time, a great deal of money will have accumulated.

Lastly, Americans are generous to a fault and will contribute to a fund if it goes to those who are deserving:

The 5 percent of patients with complex pre-existing or acquired maladies would need to be taken care of through a different system, similar to Medicare and Medicaid, but informed by the many mistakes in those programs from which we can learn. Even this kind of system should have elements of personal responsibility woven into it.

Problem is, facts really get in the way of an attractive market-based narrative:

  1. Healthcare in this country costs about $8,000 annually for each man, woman, and child, of which the government currently pays around $5,000.- President Carson would put $2,000 into everyone’s account. Already he’s saved us money!
  2. Five percent of the population accounts for almost half (49 percent) of total health care expenses with most of those people being on Medicare or Medicaid.- Um, does that mean we bonus everyone $2,000 and then have to pay the same amount for folks on Medicare anyway? Or does their account magically grow? 
  3. The lower 50 percent of spenders accounted for 3 percent of the total national health care dollar.- Uh, oh, here’s a problem. We have taken this money out of health care and moved it into a savings account for healthy people.
  4. High spending persists over multiple years for many patients, while others return to more normal spending levels after an expensive episode. There is also evidence that high spending occurs near the end of life for many patients, particularly within the Medicare population- Well, this is a problem…what happens when the savings account runs out? I guess they are walking to the homeless food site.

Interestingly, Dr Carson performed operations that cost the patient’s insurance $3,000,000 on a routine basis. He never published his results, but the operation he became famous for (separation of twins joined at the head) apparently has a mortality of 50%, and an unknown but high rate of severe disability. It is clear that informed consent remains a real problem regarding outcomes without surgery. Since these operations occur in the first year of life, the twins could kick in the first $4,000 from their HSA. Wonder if having to collect $2,996,000 from the health savings accounts of 1498 of the parent’s closest friends and family would make a difference?

Me, I’m now into the Donald’s plan:

Trump said that the Affordable Care Act has “gotta go” and that he would repeal the law and replace it with “something terrific.”

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Me (while in the military): Well, why can’t we do it this way. This person is malingering and really needs to be “not in the Marines.”

My superior: You really don’t want to. This person might be a screw-up but he is well connected and you really don’t want to start a “congressional.”

In Hawaii, where I was stationed, we lived in fear of “congressionals.” Some enlisted person or another would get what he or she perceived as bad care and before you new it, a letter from a congressperson’s staffer would appear on the commanding officer’s desk.

Dear Captain (blank),

This is to inform you that one of our constituents feels that the care they received  was substandard. Please provide in writing the circumstances surrounding this incident. 

Signed, 

Congressman Foghorn Leghorn

This letter would initiate a chain of events that resulted in all productive activity stopping until all of the minute details could be compiled into a mountain of paperwork and sent “up the chain.” The reality was that the Congresspeople probably could care less about what actually happened but, being the representative of the people, wanted to respond (or be seen as responding) to their constituent. The actual effect was to keep us from doing what we were being paid to do, provide quality care to the troops, and instead focus on the distraction.

This past week our Congressman, Bradley Byrne, responded to what he perceived his constituents wanted. He voted aye on a blank check for congress to “investigate” Planned Parenthood’s role in, I don’t know, having a disturbing lunch conversation regarding embryonic tissue donation. (If you want an in-depth discussion on the ethics of the use of cells in scientific discovery, a good source is this book.)

The investigation, though, seems not to be investigating the use of embryonic tissue in medical advances (think rubella and varicella vaccine) but, very specifically:

Requires the Panel to investigate and report on:

  • medical procedures and business practices used by entities involved in fetal tissue procurement;
  • any other relevant matters with respect to such procurement;
  • federal funding and support for abortion providers;
  • the practices of providers of second and third trimester abortions, including partial birth abortion and procedures that may lead to a child born alive as a result of an attempted abortion;
  • medical procedures for the care of a child born alive as a result of an attempted abortion; and
  • any changes in law or regulation necessary resulting from such findings

Congressman Byrne, please don’t let them turn this into an expensive distraction. Let’s investigate how to make it REALLY difficult for these entities to procure fetal tissue by making pregnancy termination rare. I would ask that Congress use the  “any other relevant matter” clause to investigate the real causes of our abortion crisis and these should include:

  1. In states that have not expanded Medicaid, working parents are only eligible for Medicaid if their incomes are below 61 percent of the poverty line (about $11,900 for a family of three), and jobless parents must have incomes below 37 percent of the poverty line (about $7,200 a year for a family of three). In most states, Medicaid coverage is not available at all to adults without children. This large group of people does not have easy access to long-term effective contraception and thus is more likely to have an unwanted pregnancy and seek out pregnancy termination. How are these states responding to the challenge?
  2. Health coverage during the period before pregnancy allows women to receive preventive care like regular doctor visits, birth control, information about making healthy food choices, tobacco cessation programs, and substance abuse services that decreases their own health risks and makes it more likely that their babies will be born healthy if and when they become pregnant. For example, research shows that prenatal care for high-risk pregnant women reduces the incidence of costly premature births. In states that have not expanded coverage. these people only seek care after they become aware of their pregnancy and make a conscious decision to go to the doctor’s office. They are more likely to have a fetus with a problem and seek out termination. What are we doing to provide access to women prior to conception in the states that have not accepted expansion?
  3. By accepting the Medicaid expansion and eliminating gaps in coverage, the state administrative costs are reduced because the states  no longer have to process enrollment and disenrollment for women who move on and off Medicaid coverage based on pregnancy, thus reducing the size of government and saving the state needed tax revenue that could be returned to the taxpayers. In those states not accepting the expansion, how are they justifying this needless expansion of bureaucracy?

I expect my response soon.

Signed, your constituent and a taxpayer.

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