Medicare Part D Delenda Est!

During the time of the ancient Roman Republic, the Roman senator Cato the Elder worked a slogan into virtually every speech or conversation -- Carthago delenda est! -- Carthage must be destroyed! The city-state of Carthage was a economic competitor to Rome and was considered to be a constant threat (though the reality of how much a threat has always been debatable). Ultimately, the ire of Rome was raised, and Carthage was defeated, its citizenry enslaved, and the city razed to the ground. (Alas, the story that the ground there was sown with salt to prevent anything even growing there again was just a legend.) The medical world faces a similar threat today, one which I feel is non-debatable. Its name is Medicare Part D, and, paraphrasing Cato, I now say, "Medicare Part D delenda est! -- Medicare Part D must be destroyed!

Do not think me deluded or misguided. For years we in this country have been spoonfed a continuing mistruth about the "need" for a prescription drug plan under Medicare. The rationale for this has been described variously, but it usually boils down to some variation of "our senior citizens should not have to choose between buying their medicines and buying food" and other similar malarkey. However, the real reason a "Medicare Part D" was "needed" has nothing to do with altruism. It has to do with power. Political power.

For years (a couple of decades actually) the Democratic Party lorded it over the Republicans with their support of a Medicare drug plan (as opposed to the Republicans' supposed opposition to such a plan) as part of the Democratic strategy of fear-mongering to gain the votes of the AARP and other senior citizen groups. But despite being in absolute control of the House and the Senate from 1965 (when Medicare was first passed) until 1994, when the Republicans gained control of the Senate, they made virtually no effort to actually implement such a plan. When the Republicans finally gained control of both houses of government, they passed a program (the current Part D) mainly to take away the sledgehammer the Democrats had been beating them over the head with for over 30 years. It had little to do with "helping" our senior citizens, and more to do with helping the Republican party. Only they really just shot themselves in the foot (actually in a somewhat higher place of their anatomy), but they haven't fully realized it yet.

No one, not even the news media, seems to remember this, but believe it or not, the current Medicare Part D is not the first prescription drug plan passed for Medicare recipients. Back in 1988, Congress passed a bill called Medicare Catastrophic Health Insurance, designed to make sure that Medicare would never run out for extremely sick elderly persons (something which was then and is now theoretically possible). I remember this because one of this bill's main sponsors was then Texas Senator and ultimately failed Democratic Vice-Presidential candidate Lloyd Bentsen. This bill also contained a prescription drug coverage program for senior citizens, at the relatively modest cost for the entire program of an increase in the Medicare premium (deducted from Social Security checks) of $3/month. This raised the ire of the communists at AARP, who wanted the coverage but at no additional cost to their members. The political opposition was severe, and the entire bill was rescinded about three months after it was passed, and before it could actually go into operation. The AARP seems to have learned their lesson; they do not like the current Part D and want it changed into a government-controlled entitlement, but they realize now that it is much easier to get a program changed than it is to get one passed (since it took almost twenty years to get the second plan passed after they had assassinated the first one).

The problem I have with Medicare Part D (and I mean any kind of Part D, not just the one we have threatening us now) is that it is the wrong solution to the wrong problem, and it comes at a tremendous price. There has been no real public discussion on the costs of Part D, but recent estimates (in the medical press) of the costs of the second ten years of the program are around two trillion dollars. The Democrats' version would cost even more. And government cost estimates are always woefully too low. Additionally, any kind of a Part D (as I will discuss in more detail in subsequent postings) shifts at least part of the costs onto the backs of other segments of our population, which is inherently unfair.

The sad truth within the mistruth is that there are elderly people in this country who do have to make the choice, with their limited incomes, between food and medicine. But the problem is not, as we are constantly being told, that our senior citizens cannot afford their prescription drugs (which is what Medicare Part D is the solution for). The problem is that the drugs cost too much, and Medicare Part D is not the solution for this; it will in short order actually make this problem worse, at least for some Americans (the ones least able to afford it).

The real reasons that drugs cost too much in this country are not what you think or what you are being told. But they can be easily uncovered. A Congressional investigation could get to the bottom of it in a couple of years. Time, Newsweek, or U.S. News and World Report could do an investigation and have a cover story in about six weeks. But all it really takes is to open one's eyes and look at the obvious truths in plain sight. Which unfortunately, no one at any point along the political spectrum, from the farthest left to the farthest right, seems willing to do. But I will, and my observations will be forthcoming in my next several posts.

Until then:
Medicare Part D delenda est!
Medicare Part D delenda est!
Medicare Part D delenda est!

The non-"Right" to Life and Abortion

As I re-read my last post, I thought, "Oops! I've stepped in a big pile of it now!" Because in my last post I stated that I did not think that you had a "right" to life (but you do have a right to live; they don't mean the same thing), and I'm sure that some readers are now thinking that I am in favor of abortion. Sorry to disappoint you, but just because I don't believe there is a "right" to life doesn't mean I am pro-abortion. The bigger question that is often argued in this regard is when does life begin. But even that is the wrong question, especially for those opposed to abortion, because the answer is not at the moment of conception.

Life does not begin at the moment of conception, because to accept this argument implies that the ovum and the spermatocyte that actually commit the act of conception are not previously alive. And they most certainly are alive. And the cells that made those cells were also previously alive, as were the cells that made those cells, and the cells before them, and the cells before them, and so on and so on and so on.......

From a scientific point of view, life began on this planet Earth about 3 1/2 to 4 billion years ago, and every living cell on this planet can trace its ancestry back to that original act of life-generation in an unbroken chain of living cells. So when conception occurs, no new life is created. But what does happen?

At the moment of conception, a new combination of human genes occurs, one that has never existed before in the history of Earthly life and will probably never exist again. That one cell contains all the information necessary to build another unique human being. So what happens is not the creation of new life, but the creation of a unique genetic combination -- a new individual human being.

When it grows, it will become recognizably a person. When it is an adult, it will contain no more genetic information than it did in that unicellular state -- it will simply have more copies of that information. When he was a child, he was smaller, but he was a person; when he was smaller still he was a fetus and before that a single fertilized conceptus -- but he was still a person, with all the rights and privileges our laws and customs accord to each individual person.

When you kill an adult human, you destroy every copy of his or her unique combination of genes. We also call this murder. So basically, murder scientifically is the destruction of all of the copies of the unique genetic combination that spells out a unique individual. When an abortion is performed, all the copies of the unique genetic combination of that fetal person are destroyed. From a scientific point of view, only one conclusion can be reached:

Abortion is murder.

Please note that although I credited (appropriately) God in giving us life in my last post, I did not mention God once in this argument. My personal views are that abortion is reprehensible on religious grounds, but also on secular grounds as well. The pro-life/anti-abortion crowd (pick your label) is never going to win their argument as long as they argue religion and the pro-abortion/anti-life crowd keep arguing rights and "choice". One side or the other needs to take on the other on the opponent's playing field. A scientific definition of abortion as murder does just that, and is difficult to counter. Though it would be interesting to see someone try to come up with a religious argument that supports abortion.

Healthcare is not a Right

The next time I hear or see someone talking about their (or your) right to healthcare, I think I shall explode. I don't know where this idea that a right to healthcare exists, but it does not. The Declaration of Independence claims a right to "life, liberty, and the pursuit of happiness", but it doesn't mention doctors' visits; the Constitution says the government should "promote the general welfare" but it doesn't say anything about guaranteeing affordable or free medical care. It simply isn't there. The only real "right" that you or anyone else has regarding their health is the right to air, and that's only because it's a violation of your personal space and physical being for me to close off your airway to prevent you having access to air. And note that I didn't say that the air had to be clean. There's no right to that either.

Believe it or not, I don't think you even have a "right" to life. You do have a right to live, but that's not the same thing. Life is a gift from our Creator. And it is our privilege to respect that life. Health is the same thing -- it is a gift, and we are obligated to respect that gift and take care of it. In fact, I feel it is our responsibility to do so.

You do not have a right to expect that someone else will take care of your health. It is your responsibility to take care of it. It is your responsibility to eat right. It is your responsibility to exercise. It is your responsibility to not smoke. It is your responsibility to not drink to excess, and to not drive if you do. It is your responsibility to not put illegal and mind altering substances into your healthy body. And it is your responsibility to seek medical care, and to make some provision for how you will afford it, when you need professional assistance with keeping yourself healthy. You do not have a right to expect that any of this will be done for you.

About this time someone always interjects, "But what about people who can't do those things for themselves?" Certainly I recognize that there are some people, through no fault of their own, due to genetics or the cruel hand of fate, who simply cannot physically or mentally take care of their responsibilities on their own. Society has to provide for these individuals. But not because they have the right to expect this. It is because we are a just and kind and compassionate society, and we reject the Spartan option of putting the old, the sick, and the infirm out for the weather and the wolves to get rid of.

Will I take care of you if you come into my office having not kept up with your responsibilities? Sure. You probably have insurance, and if you don't, I have taken an oath to provide to those in need. But don't expect or demand that that care must always be there because you have a right to healthcare. Because, you see, you really don't.

Rantings of a Medical Mind

I've been meaning to do this for some time now. I mean, there are some things that I have to say, some things that someone needs to be saying, that I have not heard or read anywhere else. So here is where I will say them.

I have called this blog "Rantings of a Medical Mind" for a number of reasons. To begin with, it's rather catchy, and I do want people to read this. Secondly, I am a medical mind, or at least I have one; I am a practicing internist in Texas. Thirdly, I chose "rantings" to state from the outset that these posts will be mainly opinion pieces, within which I intend to discuss issues of medical, medicolegal, medical business, and occasionally just general scientific nature. And yes, I do intend to occasionally rant. Hopefully I will not get too technical very often, but technical is quite often necessary in my line of work.

The first real rant will be posted within the next few days, after I've had a chance to get to know my new blog a little better -- kick the tires, take it around the track a few times, see what I can get it to do.

At the outset, however, I feel compelled to include one very huge, very important caveat, which my attorney and my malpractice carrier would strangle me if I didn't. Although I may from time to time discuss various medical topics such as specific illnesses and specific therapies, nothing here should be taken by any reader as specific medical advice. I cannot see you, take your history, examine you, or order medical studies on you through a blog, nor would I want to. Furthermore, I cannot accept any requests for specific advice through this medium; any such requests received via comments will be summarily deleted and forgotten. IF YOU ARE HAVING ANY TYPE OF MEDICAL PROBLEMS OR COMPLAINTS, SEE YOUR PERSONAL PHYSICIAN ABOUT THEM! (First mini-rant -- note I did not say "provider".)

I will welcome your comments and critiques of my thoughts. I enjoy a spirited debate on the issues. Until next time, I'll be ranting in real-space.