More Political

As noted in the last post, the problem with gas getting this high is that the US is not, and most likely will not be for a very long time, equipped to handle a huge increase in price due to city structure.

We have focused on autonomy, little on public transportation, and many people live at least 30 minutes out from their jobs. It's quite rare to have a city that can actually move a tremendous amount of people efficiently during the rush hour and all day. I believe a couple cities on the coasts are the best examples, but not much else.

So then, what are we going to do? Mass influx into the crime-ridden and impoverished inner cities? Nope.

Demand our city planners make transportation miraculously affordable, available throughout the day, and easy to use? Not likely in many areas.

Buy motorcycles and scooters? Dangerous and honestly not a good option.

Hybrids? This should have been done years ago, but was constantly being put off by "Big Oil" influence amongst both parties. The cost of purchasing one currently offsets any savings in gas they might provide as many are pricey. For me, having paid off my car, it's completely ridiculous to even consider for many years.

As was pointed out, some Eurpopean countries are paying almost $8-$10 a gallon. Yet, even though they're paying a lot more we should understand that Europeans have paid more for years (I remember my brother telling me that gas was as high as $6 or $7 a gallon in Switzerland when he was there for a year - 9 years ago), are far more accustomed to other methods of transport (like bikes, trains, etc.), and are much smaller than the US. We're huge - some countries across the pond are the size of Maryland or even Rhode Island.

I listened in yesterday to a debate about "the pain at the pump" as two senators from the Dems and Repubs argued how to help out 'our consituents'. Both raised interesting ideas, that are all doomed to fail. Our leadership in this country has no real good idea to help us - they've been sucking up to the oil companies for too long and little has been done to plan for this inevitability.

In my 30 years, I don't recall a worse time. Thankfully, for all the bitching and whining I do about medical training, I have a rather secure job ahead of me. My wife, however, is seeing the impact on her job as hours are cut, people lose jobs, and more is expected to compensate for declining cash flows.

Whomever the next president is, I hope they understand how important these next 4 years will be for our country. It's make or break time and I'm scared that all involved won't have what it takes to turn us around.

Where Will It Go?

While driving my daughter to preschool today I passed a gas station that, just yesterday, was selling gas for $3.55 a gallon. Today? $3.70. Where did the 15 cents come from?

I'm actually in an area that's not been hit as bad as others - we've yet to reach over $4 for 87 octane, but I'm not holding my breath that it won't happen in the next couple weeks. I wonder, when's it going to end and why is this happening in the first place?

I mean, as I'm sure all Americans are wondering right now, what the fuck is going on here? Are there no more controls? Are we at the mercy of every CEO who controls energy in this country since the Bush-era arrived to pillage the country into extremis?

Before gas would rise based on "situations" that would invarably be used as excuses. Now I don't even hear anything - just expect it to keep going up. Bend over and take it, America, you're fucked and we're getting rich as hell doing it.

A sign I read the other day stated that gas was about $1.50 a gallon in 2000. While looking over some of my daughter's baby book I noted that we had placed gas at $1.75 a gallon. She is 4 years old. More than a 100% increase in over 4 years.

I wonder where it's going to eventually end. If we had better public transportation here (meaning it would leave early enough so that I wouldn't be late getting to the hospital for rounds) I would have ditched driving a long time ago. As it stands I have to budget a certain amount, fill up to that, and hope I don't have to get gas again for another 7 days. Anymore than $4 a gallon and I don't know what's going to happen to a lot of people commuting. Unemployment will surely rise, the economy will continue to falter and fail, investors will be ruined while the companies they invested in will be "saved" by the gob'mint, and the Bushies will thump their chests, smoke their cigars, watch their children get married in lavish ceremonies, and laugh all the way to the bank.

News From the Front

Medical students are useless. We just are - adding extra work to resident's daily to do lists, getting in the way during procedures and rounds, and having to be accounted for on a regular basis all leads to a rather mundane and useless person.

Yet for all the tomfoolery that goes on with training med students the majority of residents/ attendings/ nurses are nice and considerate to make you not feel completely ridiculous. Most. A nurse from the L&D ward was down in the ICU yesterday and she brought with her the mentality that I hated on that floor: get out of my way you useless piece of shit!

Twice I was attacked by her for just looking in a patient's chart (which I had to defend by stating it was my patient, so back off), I witnessed her badger the radiology tech for HIPPA violations since she was walking around with patient labels on her sleeves (which most people do when they're actually, you know, up and moving to get their work done and not sitting behind a PC all day), and several times this behemoth of a woman got after the residents. Once she even went so far as to tell my senior "You need to get off my computer and get back onto yours!" The resident yielded, laughing outwardly at the farce this woman was making of her position, and I smiled as the nurse pulled up her important work - shoe shopping online.

Campaign 2008

The reason that Hillary is struggling? Perhaps this hits the nail on the head.

Personally I hate the Clinton machine and her attempt to run on her husband's coat tails (running on 35 years of change my ass). Plus Hillarycare is scary to think about working under. I imagine it would be kinda like Stalinistic - but worse. And yes, I hate her that much.

I would like Obama to take her under, but he also worries me as well. The more he gets going the more I see someone who could potentially be dangerous. Little leadership experience running the country? Hmmm. Plus, anyone who believes that universal care is going to "fix" our healthcare system has their head up their ass. Period.

Republicans? God, another lose-lose situation there. Maybe I won't vote this time - then I won't feel bad when one of the godawful choices fucks everything up and messes with medicine even more.

Oh, and today is the deadline to submit the rank order list to the NRMP. I changed a program's location yesterday up one, but other than that I haven't touched my list. 3 weeks to go.

Single Payer Naysayer

Want a single-payer system? Sure, we all do – right? Free healthcare for everyone and we all live happily ever after.

Wrong.

One of the most basic reasons that single-payer will not work is that it’s controlled by government. I don’t need to point out the troubles that are staring the NHS and Canadian systems in the face to make this point (and therefore did not provide links – you can get them yourself if so inclined).

Instead, imagine why patients are scared of the VA. Put yourself in their place – having to be seen by government paid healthcare providers who do “only what’s in their job description” and nothing more. A friend of mine has yet to receive adequate care for his illnesses and has begun to utilize homeotherapy - he's sick and tired of being "treated like shit by dumbass docs". I’ve seen some awful events, terrible care, and a complete lack of responsibility for patients at the VA during my few rotations. All perpetrated because the government employee mentality sinks in and once caring people become clock-punchers.

Beyond that, think of the military heroes whose medical care is being taken care of by places such as Walter Reed and other embarrassments of governmental medical care. Having spent 2 months in an army base I can tell you that more often than not the patients, doctors, nurses, and techs were more than frustrated by the ridiculous administration set in place to hinder movement through the system. What’s even more outlandish are the wait times in order to even see a doctor – months. Would you want to wait months for care? Months to receive surgery?

You can already see the impact imparted upon the medical field by beaurocracy crazy pencil pushers (regardless of association). If you haven't read or seen the images of nurses waiting to clock in and out in order to avoid infringements I can tell you it's completely absurd - patient care suffers. JCAHO is another entity who seems hell bent on making ridiculous mandates in the name of "patient safety". Do you really think that a single-payer system wouldn't be frought with these forms of "suit abuse"?

Then consider that your choice of doctor will be limited. Your care, paid for by your hard work and budgeting, will be reduced to “equalize” the care between poor and “rich” alike. Now consider whether you still really want a single-payer system. What's more, have you ever had or knew someone who had an HMO medical plan? Right.

That's government healthcare, clearly not "the answer" as preached by idealists all over the US.

Personally I feel that I and my family should be able to get the care that we work for, pay for, and earn through responsible actions. I do not want to receive mediocrity in order to help those who are less fortunate, immature, drug-addicted, slothful, and polybabydadics be spoon-fed more than they already receive.

Primary Fever - Catch It!

"...That's what you said about yellow fever and that was no fun at all"

In touch with very little since medical school began, I find that I have been able to keep up with a great deal more during these last few weeks. Perhaps a month’s vacation has been good for more than just interviewing.

Since we’re in the primary season and Iowa showed us that the ‘Clintons’ are not about to run away with everything (though NH sure wasn't making me happy) I thought I’d discuss my personal political opinions (I wonder what this will do?).

I consider myself an Independent. Despite originating from a Republican dominated family in a red state I found that the impulse to vote for anyone running with an elephant backing was absurd. So I try to figure out who has the best ideas, who appeals to me more, and overall has the best chance to do something worthwhile – regardless of their party affiliations.

Enter the presidential candidates. There are a few here and there that I have some tendencies to admire and others that scare the bejesus out of me.

Democratically I only favor one, that being Barack Obama. He is by far the best of what they’re offering. He understands that the healthcare system needs help, but has stated that a single payer system would not be beneficial at this time. He wants tort reform, but unfortunately doesn’t support federal mandated caps. He's new enough to politics that I don't hear lies with every flick of the tongue. Plus he'll offer something that this nation has never had - a minority president. Cool.

Hillary is far too polarizing – we’d end up with every nation hating us or loving us (like we already do, but worse) and healthcare reformations a complete disaster. Part of my dislike for her, apart from the above, is the entire ‘feminist pride’ that I see and hear constantly when women talk about her. We don't need to vote in someone who, at every turn, cannot be taken seriously. She is so bereft of genuine goodwill that it's scary. She scares me - a lot. Also, why does she keep saying that she’s running on 30+ years of change? Am I mistaken in saying that her husband was elected into every office until her NY senate win? Why am I supposed to believe that he did everything with her by his side (and we clearly know he did a lot away from you)? I’d vote for a woman for president without a problem, but not one who clearly is so malevolent, so condescending, untruthful, and unappealing as her.

Edwards is a joke to think about. Consider the fact that he made his fortune by suing doctors over birthing injuries without real proof of when the injury took place and worked ardently to cloud the issue related to cerebral palsy (blaming the incident entirely during the time during birth) and then look at whose blog your reading. His malpractice lawyer roots are more than I can stomach – it’s no wonder he doesn’t support any real tort reform (nor does he believe that there’s a real crisis). The only thing this man wants to do is make himself wealthier while destroying the rest of the nation.

Mitt Romney is my favorite out of the Republicans. I think he has a firmer footing in the nation’s problems and is handling the ridiculous concerns regarding his religion with a great deal of tact. Republicans, being as they are, support tort reform more fully and are less likely to approve a single payer system (afterall, why should people be forced to provide to everyone?).

Guiliani has some good about him as well, but I’m really kinda over hearing about 9/11 with each speech.

Huckabee? I mean, do we really want someone whose name sounds like Huckleberry running our country? Another Arkansas governor? I didn’t think Bill Clinton was the best president either, so why would I put another Arkansas man in the office? I agree with some of what he stands for, but I tend to lean more conservative.

What of McCain? I like him well enough, but being in the political spotlight for decades always makes me less sure of what you're selling. You're more likely to get someone who lies through their teeth, is in deep with lobbyists, and just has no real idea of what being an American is about anymore.

Whatever your political ideals are, regardless, we should take some interest in these people. Our nation is at one of its lowest points and we need someone who will actually do more than play simple party politics. Bush has been bad, but what we don't need is someone coming in and fucking around with the country more.

Avarice and Health

Many bloggers are discussing the nature of people going into extreme debt at this time of year – procuring expensive electronic items with little to no argument about the cost. It is, of course, only natural to make the connection between the money spent on frivolous expenditures while we wring our hands over what to do about the poor and healthcare. What must be seen, if you haven’t already seen the absurd juxtaposition is this: these same people, who spend several hundreds to thousands of dollars for one day’s avarice are the exact same who bemoan the cost of healthcare and villify the physician.

Personally I have changing views on the subject. I used to believe that universal coverage was the best option – in effect, socialized medicine. Then I began reading about the Canadian and the NHS, their troubles, and realized that, even though their citizens are covered, they had harder times getting people to use the system correctly, providers throughout all spectrums were incredibly taxed to work "within" the system, and the outcomes were not much improved. Now I find myself less inclined towards universal healthcare, but struggling to find a plan that makes the most sense.

I do know that some of the political ideas of taxing physicians in order to help cover healthcare for the poor are just monstrously ignorant. Why should those who have to suffer direct losses from this patient population be forced to incur further decompensation simply because of their profession? Do we honestly expect doctors, the one profession that has little to no say in what they receive in reimbursement, to keep allowing insurance companies to decrease their payments precipitously while, at the same time begin taxing them for indigent populations for whom they've never received compensation? Would lawyers be so willing, I wonder, to take hits in the same respect as that offered by some of their colleagues? We all know the answer to that.

The idea of requisite health insurance seems more on the right track. We require people to have car insurance based on the degree of risk inherent with owning an automobile, so why not coverage for their health needs? Certainly people realize that at one time or another they’ll need the healthcare industry – either for minor ailments or severe conditions – and should be more capable of contributing towards their care. We are, as humans, inherently at risk each and every day.

Making people comprehend that they are responsible for covering their asses won’t be easy though. Massachussets has had significant backlash regarding their plan, some due to the significant cost of covering oneself, but a great deal from the parasitic nature of lower income and young populations. The idea of having to pay for something that one might never use has been routinely touted as a justifiable reason to avoid insurance mandates by those refusing to buy into the idea.

Despite the problems encountered by Massachussets, I feel its ideals are on the right track – shifting the responsibility onto those who are actually culpable for their actions and less on those who just have to deal with them. People are so eager to get the newest cell phone accessory, iPod, or fanciest TV regardless of their income level, but refuse to spend a few bucks each week towards their healthcare. Cigarettes continue to increase in price, yet the 1+ pack per day smoker doesn’t cut down on their habit, just their luxuries – like bills and responsible spending. I cannot count the numerous times I’ve seen someone with little to no insurance, complaining about the cost of their care, with a fancy cell phone, cigarettes, and a tricked out car who inevitably heads to the nearest fast food chain for lunch. It’s actually quite ironic to consider that the money spent on these gadgets and behaviors actually decreases one’s health (cancer, hearing loss, obesity, HTN, heart disease, etc.).

While I certainly don’t have the answer, I do feel socialized medicine is not the option that’s best for this country. As a 4th year medical student, it’s hard for me to even begin to understand the complexities of payments, billing, and the business of medical care, but I have been able to gather enough information to understand socialized medicine will only fail patients and providers together.

H.U.A

HUA = head up ass.

Mr. Bush has certainly qualified for this distinction in the past, but he's never deserved it more than he does now. Despite intelligence reports stating that the state of nuclear affairs in Iran is not as bad as previously believed, the "president" continues to make threats:

Bush said the new intel "contradicting earlier US assessments...would not prompt him to take off the table the possibility of pre-emptive military action against Iran."

Um, excuse me, Mr. President...just when are you going to learn from your mistakes? Is this not the same bullshit you tried to spin about Iraq? Do you really think you have enough trust with the American public and congress to actually try and start a 3rd front? No, sir, you do not.

You're acting like a child - refusing to hear the truth with your fingers in your ears chanting "nyah, nyah, nyah, I can't hear you". Why don't you sit down and take a time out? Please, for the love of God, just stop!

More Money

How much do I want to party? Is it worth $100 or more for a bash?

Our class dues this year were elevated to help pay for some items that the senior class has traditionally done. This includes a class gift, planning an event the day of match as a celebration for 4 years of hard work, etc. However, I have recently seen that the dues are to be increased by over 200% for the year to pay for these “responsibilities”.

I was planning on paying for the initial class dues this year, but more than $100 is way too much for this guy. I mean, God, I’ve had to increase my debt further in order to even interview this year since the school’s tuition hike killed any travel money I was set to receive. I have a couple private loans that will be due upon graduation and cannot be deferred through my residency. The fact that the “elected” class officials (ran unopposed) are now increasing the amount they want from us in order to throw some fucking party irritates me.

I guess I just won’t plan on going to our match celebration if this is how they’re going to try and fund it. Citing low class participation in fundraisers as a reason to increase the amount needed as an entry fee isn’t reason enough. There are people who are on aways, are too busy with life, and just don’t care anymore about helping “the class” out anymore. Personally, I’ve been trounced one too many times in the past to give a shit now.

It’s sad to think I won’t be able to hang with some of my friends and celebrate our accomplishments, but I thought the amount last year was ridiculous and we’re doing the exact same thing here.

Here We Go Again

AOA nominations were sent out about 2 weeks ago. For the 2nd year in a row I was nominated and have to turn in the last of my information today since Friday no one was in their office due to a “mandatory” reception (which I ditched out on, of course). I asked 2 different faculty members for their letter of support and altered my essay from last year in hopes to make me look more appealing. I was feeling good about my election until I read an e-mail.

Yesterday the class of 2008 was asked to “vote” and comment on whom they feel should be elected into AOA. Goddammit.

Unfortunately I no longer have the events of my first nomination, but if you can remember, back in March I was freaking out about my class voicing their opinions on our AOA candidacy. This is based on several factors, but the fact that I ran for an executive office in our class 2 years in a row and was soundly defeated each year did not lend itself to a feeling that my class was enamoured with me. Since I had contact with limited people last year I hope some of those feelings have lessened - maybe.

Personally I find it stupid that the class gets to vote at all for an honors society. There are people who hold grudges, don’t like people for various reasons, and are vindictive assholes who can make you look bad with their comments.

From what I’ve heard there are 8 slots open this year with 16 nominees, some from last year, but many new. I’m glad to see that one of my friends who wasn’t nominated last year was on the list, but saddened to see another nominated last time absent this year. I don’t know why he was dropped, but I think he is a helluva lot better than a couple students nominated.

Anyways, hoping for a better outcome and my class to be kinder to me this year.