On my July Diary. Many thanks to all readers who have commented. I’m having a serious problem right now with this business of there being only 24 hours in a day. I can’t possibly respond to all e-mails, but every non-abusive one is read and pondered.
• Doctoring: Several readers thought my doctor should have added smoking to the Big Three (diabetes, hypertension, cholesterol). That he didn’t, may be something to do with the fact that he is himself a cigarette smoker. That aside, smoking-related diseases see you off fairly quickly as a rule, and mostly before you need that couple of decades of institutional care at the end of a long life. The case has been made many times, in fact, that from a civilizational and fiscal point of view, cigarette smoking is a jolly good thing. Stimulated by their drug, young smokers do great creative work in their twenties through forties. Then, as they are entering their uncreative years, they die! What’s not to like? I’m not making the case, and people who’ve suffered bereavement as a result of smoking-related diseases need not e-mail in to yell at me; but it’s been made.
On tort reform, several readers questioned the constitutionality, or just wisdom, of federal action.
Mr. D — It’s ultimately a state problem. The overwhelming majority of medical malpractice suits are in the state courts. Reform of the federal torts system would be a good thing, but it’s ultimately a drop in the bucket.
Could Congress pass a bill that changed state torts? I dunno. Probably, since it’s not like they limit their grasp, but it’d be un-Constitutional and a bad idea. The best thing to do would be to voice concerns about tort reform to state reps. Plus, they’re closer, and less likely to call you a mob just b/c you disagree with them.
[Me] Not much help to us New Yorkers, whose state legislature is a wholly-owned subsidiary of the tort bar . . . but it seems to have worked pretty well in Texas. In regard to which, a doctor tells me that:
Mr. Derbyshire: I notice that your doctor is in New York, which explains why he’s obsessed with tort reform. I’m actually from New York and Connecticut myself — and I think that physicians who stay in that kind of environment are insane. They do know that they’re allowed to leave, right? I looked at every Northeastern state when I was deciding where to practice, and what with the cost of living, the malpractice environment, and the reimbursement, I have no idea why docs decide to stay.
Actually, I do know — the ties of friends and family are strong. An interesting issue, though, is that at least in my age group (30-50) a huge number of the physicians I know in New York are part of a two-income couple, and often the spouse works in the financial services industry and earns three times what they do. I truly wonder what’s happened to the medical commmunity in NYC over the last year as many of their spouses may suddenly not have a job.
On pro bono doctoring:
Derb, Regarding physicians providing pro bono medical care. It is illegal if the physician accepts either Medicare or Medicaid patients.
This lunacy is a result of the federal government requiring that it must receive the lowest price in the medical market place. If a doc is a Medicare/Medicaid provider and is reimbursed ten dollars for treatment X, he is guilty of defrauding the government if he charges an uninsured cash patient an amount less than that. Because then, as you see, the feds would no longer be getting the lowest price. The good physician, upon being audited, is discovered to have overcharged the government time after time. The good physician is fined at treble damages, and is grateful to have avoided the slammer. This has done away with a huge amount of free medical care. It has also practically eliminated physicians treating each other, on the arm, as a “professional courtesy.”
Another consequence of federal intervention in the health care market place is the elimination of public clinics at teaching hospitals. In the not terribly distant past, when hospitals ran something of a profit, teaching hospitals maintained clinics for the uninsured public. These were de facto free clinics. In NY, NYU, Cornell and Columbia all ran fabulous clinics, as did Bellevue. The clinics were staffed by Attending Physicians and House Staff (resident physicians and interns). The quality of care was superb. It was, virtually, the same care as that dispensed in the private clinics.
The clinics are long gone. The results? Overwhelmed emergency rooms.
Yes, as the federal government gets further and further involved in our lives, things just get better and better, don’t they?
[Me] Indeed they do. If this reader is right that pro bono work by a doctor may be illegal, it is an exceptionally fine instance of the general principle that “compassionate” government is actually the enemy of true, private, compassion. Which is itself an instance of the meta-principle that qualities we admire in persons are generally to be deplored when practiced by governments. I like my friends to be generous, trusting, etc.; but a government that’s generous is being generous with our money, a government that’s trusting will be gamed by dictators and welfare cheats, . . . etc., etc.
• Black-armband history: A reader:
The ultimate in sniveling apologies will be when Italy apologizes to France for Julius Caesar’s Gallic Wars. Go Vercingetorix!
[Me] Wouldn’t really work since both the modern French and modern Italians are really Germans (Franks & Lombards, respectively).
In fact perhaps we could just contract out the apologizing business to the Germans & have done with it …
• Assisted suicide: I got my kings mixed up. It was George V, not George VI who was hastened on his way by a helpful physician — in order that the king’s death would make the morning editions of the newspapers, it was said. (“An early expression of the Spin Cycle,” observes one of my readers.) If the story is true, this was the last act of regicide in the British Isles, though of cource by no means the first.
Derb, “Why not?” on legalized suicide: because if you aren’t willing to break the law to do it, you simply haven’t thought the whole thing through. The full gravity of the decision is reinforced by requiring the citizen to defy the letter of the law, to commit suicide or to “assist.” If a mere matter of legality intimidates you, perhaps literal life-and-death matters ought to wait until you’ve tackled less weighty moral problems!
My great-great-grandfather, terminally (?) and painfully ill in the 1880’s, had his death headlined in a paper near Macon, Georgia: “Local farmer blows off the top of his head with a shotgun.” (“Mr. Xxxx,” the text solemnly noted within the first paragraph, “was not in debt.”) An act that deliberate and defiant has a certain dignity which cannot be attained by a death which we and (our “helpers”) can pretend is more of a senior day-care naptime.
[Me] I suppose it depends on how you assess the gravity of suicide. “We’re going to make it illegal for anyone to help you so that you will have to really, really want to do it,” seems to me like less than sound jurisprudence. And I’d like to hear a second opinion on the “dignity” point from the person who had to clean up the mess.
Other adverse commetns on my assisted suicide segment proposed arguments of the “slippery slope” type, which we covered, adequately I think, over on those Secular Right posts I linked to and the attached comment threads.
• Free won’t: A reader:
But isn’t that the essence of free will? In classical Hebrew, the term is bechira chofshi, free choice. Any animal can respond to a stimulus, humans seem to be unique in their ability to not react to a stimulus, to not eat when hungry, to restrain natural impulses about sex and violence …
[Me] Yes. I posted the Ramachandran quote as just a cute bon mot (and in hopes of helping Andy move his book), but the more I think about it, the more I think he’s actually got a grasp of something important there.
• Math corner: So far the only reader who’s got the second one is the pal who sent me the first one! Come on, it’s not that hard. If you really need help, see page 111 of Martin Gardner’s new book.