Saint Bernadette

Saint Bernadette is no saint. And just this morning, I suffered the consequences of one of my less saintly actions by spending the morning in an appallingly long line at Superior Court.

I went there in a naive attempt to decrease my fine for the ticket I received a month or so ago for running the red light at the intersection of Fairfield and State St. (you know the one, near the McDonald’s). In my estimation, one can make a “right” on red, even though, according to the cop, it’s technically not a “right”.

In any case, regardless of the time it took, I am now thankful that I decided to dispute this ticket if only for the opportunity it provided to observe our criminal justice system.

The long wait on the line outside the courtroom was the criminal justice version of the legendary TV series “Playboy After Dark” – a smattering of overheard conversation and impromptu performances in an open space lorded over by provocative personalities. In this case, instead of Hugh Hefner in a smoking jacket, it’s lawyers in bad suits.

Most of the overheard conversations went something like this:

Lawyer: Ok, do you understand what you need to do? I don’t want you to get in trouble again.

Citizen: Yeah, hey you’re the lawyer. I don’t want to get in trouble again.

Lawyer: Ok, do you understand what a protective order means?

Citizen: Yeah, it means I can’t see my wife and my daughter.

Lawyer: Ok, so you don’t want to violate that protective order.

Citizen: But why can’t I see my wife and daughter?

The citizen in question was a 50 + man of limited intellectual capacity and uncertain sanity. Following this conversation, he launched into the performance component of the day’s entertainment which consisted of what I believe to be an excerpt of Jerome Robbin’s legendary choreography from the garage scene in West Side Story and what the Haitian girls next to me believed to be worthy of a punch in the face, which for a moment there seemed extremely likely to be delivered courtesy of a confused citizen waiting in the line for Courtroom B.

When I finally reached the courtroom, I gave my name and saw its corresponding yellow file pulled from the box and put into a pile. I was instructed to take a seat. As I waited in the bitter cold (probably 10 degrees colder than the hall), I witnessed a litany of tongue lashings doled out by the prosecutors to the perpetrators of such charges as driving with a suspended license, illegally parking, and my personal favorite: loitering.

In one such tongue lashing, I felt a surge of empathy for the prosecutor (a good looking guy in a pretty decent suit). He seemed to genuinely care for the citizens coming before him, trying to give them a break and extra credit for being well spoken, looking him in the eye, being enrolled in school or working. However, as I sat there, a little Bill O’Reilly -shaped troll deep within my brain started to rise up from under the bridge, rubbing the crust off his eyes and demanding to be heard.

“Why is he cutting deals for these people?”

The deals would be presented like this “Okay, so, take this as a life lesson. The police are watching that corner and they are watching you. They don’t want people hanging out on that corner and they use this loitering charge as a way to permit them to search you and if they find something on you, you’re going to jail. Okay? Do you understand? Don’t hang out on that corner. I don’t want to see you here again.”

The young man on the receiving end of this speech nodded obediently throughout and seemed genuinely thankful for the leniency. Until he turned around to face those of us waiting in our seats at which time, a bounce came back into his step, a smile broke out across his face, and he rubbed his hands together like a hip hop supervillain, so clearly pleased he pulled yet another one over on the system.

Of course, I know the answer to this. They have to cut deals because there’s no possible way to process all of these people, committing all of these petty crimes. And there’s no possible way to collect money from people who have no money. In the end, the cutting of deals and collecting at least half of the owed money in conjunction with the doling out of tongue lashings is really the best these prosecutors can do.

But the real question is this – when we discuss the “people” who need help or education or healthcare or outreach or whatever it is that underprivileged or disadvantaged or wrongly imprisoned or improperly served people need, we always come up against a wall of how to reach these people. And it’s very simple – they are all in Superior Court with plenty of time on their hands.

Perhaps we could hand out pamphlets about public programming there? Info on the assistance program at the organic market? Info on the resources available at the Small and Minority Owned Business Office? Info on community college courses and incentives in green business? If there was ever a motivation for reading – it’s standing in a line with nothing to do for several hours.

I, on the other hand, did not receive a tongue lashing. The prosecutor I encountered seemed to know the intersection I described and thought to herself that it was kind of up for grabs whether or not I actually violated any traffic laws, so she offered me a deal.

Pay $35 and if I already have some tickets on my record, maybe I would get some points, OR donate $50 to a charity having something to do with criminal injuries and she would throw it out.

So, what do you think I did?

Drive safe!

Saint B

At my regular check-up yesterday, I carried on my usual “how are things” conversation with my doctor of over 15 years. He asks about my mom, I ask about his kids. Over the years, we have developed a decent rapport for two people who see each other for about 15 minutes a year.

On the whole, my doctor is a jovial guy. He’s smart, personable, wears a bow tie. Yup, he’s that guy. Gray hair, distinguished, smiley bow tie guy.

But this year, our usual five minute catch up took a turn. After my examination, he told me, as always, to meet me in his office to go over any issues I might be having. I waited in the chair across from his desk. But, when he entered the room, instead of sitting at his own chair, he plopped down in the second visitor’s chair next to me, slumped down in it, turned his distinguished gray head and said “I’m gonna get a job driving a cab.” Perhaps responding to my shocked expression, he continued “It would just be easier.”

This is the state of our health care system. It’s so screwed up that even happy bow tie guy cannot find the bright side.

I probed him, asking what did he feel the big problems were. He said he was sick of hearing that the US health care system is second rate. He is completely certain we still have the best care in the world. The problem is that the system does not allow doctors to do their job. The issue he was focused on is generic prescription drugs. According to him, generic drugs can vary up to 20% from the name brand in terms of dosage of the active ingredient. This makes it nearly impossible for a doctor to know how a patient is responding to a drug and how to adjust their dosage accordingly. He said, “I don’t care what Obama says – generic drugs are not the same!”

There are so many sides to this issue – the consumers, the pharmaceutical companies, the insurance companies and, of course, the health care providers. We all think we know where the evil is coming from – the profit-driven players: insurance and pharmaceutical companies. And yes, they are evil, BUT, the profit motive is what keeps these companies in business. The profit motive fuels jobs, research and development, advertising and marketing and the billions of dollars they contribute to the economy as a whole. This is not something that can be converted to a not-for-profit, government-run model completely. The profit motive is what makes American health care among the best in the world. Any plan with a chance of being successful must keep this profit motive in tact.

The challenge will be to find the balance – how do we allow these companies to stay profitable AND provide fair and appropriate care to American citizens?

A very good friend of mine is a doctor at Columbia Presbyterian Hospital in New York City. She graduated from Harvard and got her medical degree at Columbia. She is probably the smartest person I know. A few years ago, she called me to see if I could introduce her to a journalist friend of mine because she was thinking of switching careers. I couldn’t believe it because she had wanted to be a doctor since high school. I asked her what was behind her decision and she said, “I’m a fellow at Columbia Presbyterian and I make the same money as my husband’s executive assistant”.

Now, that’s a wake up call. Of course, this was a few years ago. You know, those years where the financial services industry was rewarding itself (and its executive assistants) to the tune of all the money in the world, which is now lost, due to the fact that it never actually existed. So, yes, this executive assistant was paid a much larger sum than your average executive assistant, but still, it seems a stretch that there would be any economy where this would be the same as a surgical fellow at a major hospital.

My friend decided to stay a doctor because she’s a good doctor and it’s what she wants to do. But to ignore that compensation factors into all of our decisions, is naive and unnecessary. There are other countries who do not have as robust a commitment to the free market economy as America claims to have. I think the reason Obama is coming under so much fire from his own constituency is because he is representing what is essentially a conservative-style commitment to this ideal. What I like about his spin on it, is that he is saying “Listen, profit motive is good, evil people who cheat and take advantage of it (like our friends at Pfizer) are evil.” This is exactly the same issue with the financial services industry – there’s nothing inherently wrong with the development of new financial products, but there is something wrong with corrupting, polluting, cheating, and over-leveraging them for short term gain at the expense of the long term financial health of the entire world!

The fact remains that we need the free market (FREE market, the real kind of free, not the kind of free that’s sort of free except for when it favors people who happen to have influence in Washington) to be involved in our health system. When the best and brightest in a given profession are not appropriately rewarded, they will not stay. Why should my friend, after years of busting her butt to graduate from the top universities to be a doctor at one of the top hospitals, make the same amount as someone who provides admin support? Why should my doctor, after years of providing health care, in one of the wealthiest areas of the country, feel that he would be happier driving a cab?

This health care issue is deep and complex. It affects you personally no matter what. Tune in – listen to Obama’s speech and develop your own opinion. Think about your own situation and what health care system would work best for you. Think about the free market economy and how it should intersect with insurance and health care. The time is now and we all need to be engaged in an actual, substantive debate.

And though I’m sure my doctor would make a great cab driver, I think he’s pretty useful right where he is.

The passing of Ted Kennedy has me thinking about a lot of things – bloodlines of greatness, tragic flaws, the modern meaning of liberalism and, of course, the issue of the day: healthcare.

Fixing a broken system at this scale has appropriately triggered a fierce national debate. And while I find myself tempted to tune it out altogether (full disclosure: I have amazing healthcare coverage provided by one of my jobs), I am still drawn to the part of the debate surrounding President Obama and what some believe to be his failure to adhere to the methodologies central to his party’s platform.

This perceived failure is where I am ever more glad that I cast my vote for President Obama and where I tell him to soldier on and make as many people as angry or confused as possible. What he promised to do (at least what I perceived he promised to do) was to finally extricate real American values and goals from the clutches of both parties to form a platform of good-for-all initiatives that can no longer afford to languish in limbo, held hostage by meaningless battles over fringe issues.

To use healthcare as an example – the “real” American value is a commitment to developing the best healthcare possible, with a reasonable and rational system in place to provide it and administrate it to our citizens, that can exist within our capitalist identity and market-based economy.

In my opinion, President Obama is ultimately playing a game of chicken with the GOP and the far left elements of his own party (whatever “far left” means, I’m finding this very hard to define these days). By being willing to withdraw the controversial “public option”, he is effectively pulling out of the debate the Republicans’ favored accusation toward any governmental solution to a large scale problem – “socialism”.

For years, the democrats, have trapped themselves into a weak argument on healthcare by using moral arguments and wonky explanations of complicated efficiencies of scale and multi-tiered program structures. By refusing to posture for his own party’s terminology, he is asking the Republicans to step forward and tell him, then, how exactly we are going to provide quality healthcare to all Americans.

President Obama is now essentially saying “Okay, fine, ’socialized’ medicine’ is off the table. Now, if you could, please tell me how the kids dying of cancer will be able to afford their treatment. Tell me how the people being rejected by insurance companies for pre-existing conditions can afford their treatment. If it’s not the government, then who?”

And if he can hold out, he can finally expose that 1) they do not have an answer to this question and 2) their policy is based on what it is always based on: what is best for themselves and their lobbyists as individuals and entities and not what is best for the country as a whole.

It’s already starting to happen. According to this article in Slate, Republican senator, Tom Coburn (also a medical doctor), answered a constituent’s question about her husband’s brain injury and their struggle with affording his treatment with the following: “The idea that the government is a solution to our problems is an inaccurate, a very inaccurate statement.”

The article goes on to explain that the plan that Senator Coburn is supporting is virtually the same as President Obama’s and that his comments have been met with embarrassment and disbelief by doctors around the country.

President Obama is exposing both parties here. By appearing willing to ditch to the public option, he can’t be as easily defeated by Republicans with accusations that he is a “socialist” and a lover of “big government”. He can also expose his party’s own tendency to get lost in a debate on ideology instead of real details. Of course we have a moral responsibility to provide health care to the sick, but beyond that we still have to create a viable and sustainable system to provide care that doesn’t bankrupt our country or the insurance industry, which despite its proliferation of evils, is still the source of thousands of jobs and billions (zillions?) in corporate tax revenue. We all have to work together, like it or not.

I am not a health care expert. I have nothing but empathy for anyone who even attempts to wrap their brain around this incredibly complex problem. Perhaps one positive development to come from this heated debate will hopefully be for more people to engage themselves in a little bit of the wonky, boring stuff. Once you look at the facts, it gets a lot harder for the Republicans and the insurance companies to hide that there has been some really rotten stuff going on.

We, as a country, are definitely smart enough to develop a better system as long as we can move past our own buzzwords and blind party affiliations to get there.

Eat your veggies,

Saint B