As readers of this blog will recall, on Superbowl Sunday we added another member to our family, one Lola Elizabeth Buckelew. My step-daughter Sara found herself getting to the end of her fertile age and was without a partner, as so often has happened with high achieving professional women, alas. Sara is a double-boarded pediatrician and preventive medicine specialist, with a subspecialty in adolescent medicine, and is director of the UCSF eating disorders program. We’re very proud of her, but it does seem she has paid a price.
So Sara bravely decided to have a baby on her own, and the happy result was Lola. For the first six weeks Sara and Lola have been staying with us, which is just fine with us. It’s been a long time since a baby has been in the house, our youngest, Pete, now being 26. And thankfully Lola is a very good baby, no excessive crying, regular habits. She does grunt a lot in a very unladylike fashion, and is a regular fart and poop machine, but as grandparents, we figure that’s mostly Sara’s problem, and we just chuckle at little Lola.
Both my wife Ann and I have regained our newborn skills. We do well with soothing. Lola likes to be held, and we hold her. Lola looks askance and we jump. We each take her and walk her and keep going, terrified if we stop she will wail, but she never really does. When Lola poops we hand her to Sara. We are, after all, grandparents.
So as Lola has matured in these six weeks, she has demanded songs. Babies without songs are bereft indeed. Ann and I have had to go back into our memories and come up with songs. It has been a long, long time since we sang to babies. Not sure we did such a good job of it with our own. But now with all our years of experience, and the luxury of having just one baby and three adults, we can search for the proper songs.
It was hard at first. I came up with “Ten Thousand Men of Harvard Want Victory Today.” Dunno, just trying to come up with a song. Sara objected and tried Roar Lion Roar, her Columbia fight song, but could remember only that line. We looked it up on Google and got some other lines, but she couldn’t quite get the tune. Sara isn’t that musical.
Ann came up with the California fight song. It was more like a response to my Ten Thousand Men of Harvard than a real solution. A counter-non-solution, I guess you could call it.
Farmer in the Dell was OK, and seemed to capture some attention, but that’s pretty dull. When the Bough Breaks did it for a while, but it’s hard to continue that one.
So, I made up a song. I kind of like it. It goes like this: “Lola is a good girl, a good girl, a good girl, Lola is a good girl,” and then you add any final line that you want. Like, for instance, “She has very cute nose.” Or, “She poops all of the time.” Or, “She loves me better than you.” It’s a good song for improvising. Its downside is that it’s one of those songs that sticks in your head, so you have to be careful with it.
Anyway, that’s a pretty good solution for right now. But it didn’t quite fit Ann. She had to come up with her own, which she did.
Now, you have to know Ann a bit to understand that she is not in the least saccharine. She always looks at life a little aslant. You’re never quite sure what she will come up with. But I have to say, her solution to the song for the grandchild took even me by surprise. I think it took even her by surprise.
Picture Ann with Lola lovingly in her arms, as she purrs to Lola, The Theme From “Cops.” “Whatcha gonna do when they come for you – bad boys, bad boys!” “Whatcha gonna do???” “When they come for you????”
We just had to laugh with the power of the unconscious. It’s just pretty funny. Her version of Rockabye Baby isn’t everyone’s. Could it be coincidence that we have two sons in law enforcement, do you think?
Just had to laugh.
Budd Shenkin
Sunday, March 21, 2010
Friday, March 19, 2010
What's Up With Kucinich?
Dennis Kucinich was dead set against the health care reform legislation because it didn’t meet his criteria. Then he met with President Obama. Afterwards, Kucinich says he’ll vote for it. He says that he was offered nothing by Obama that would account for his vote change. Then, completely uncharacteristically for Kucinich, he started recruiting colleagues to follow his lead and vote for the bill.
What gives?
I have absolutely no inside information, and haven’t even followed the commentary very closely lately. But here’s what I think.
I think Obama told him that he needs to pass health care reform or his presidency is effectively dead. The bill is not completely repellent; it’s good enough not to be ashamed of. It will be very significant domestic legislation. It can be improved later on. And as Axelrod says, at this point they are all in. It’s now success or failure.
And then, here is what I think Obama said next. I think he said, after we pass health reform, I’m not stopping. I’m going to use this as a springboard for the next thing- financial reform. I’m going to double down – I’m going to be more aggressive, not less. And I’m really going after the banks. We gave enough money to them to stabilize the system – now we’re going after them.
It makes perfect sense for policy. Pivot away from Summers/Gaithner, over to Paul Volcker. Resurrect separation of deposit and investment banks, Glass-Steagall. Institute controls and transparency. Start a consumer financial protection agency. Dodd’s bill isn’t strong enough, but maybe they can get the House to be stronger, the way it was before Barney Frank went soft on us.
Then push the hell out of it and gain popular, populist support. Go for a 1934 – the only time beside 2002 that the incumbent party picked up seats in the off year election. Be very aggressive, which is what Roosevelt did. Take a chance. Say, we tried to be bi-partisan and what did we get? We tried to get some support by incorporating some of their ideas, and what did we get? We tried to include them, and what did we get?
I might have been a little naïve, but I’m not dumb. If we’re going to do something, we going to have to be aggressive. And we do have to do something. This country hasn’t been in this kind of a mess for a long time, so these are things we have to do. We won’t exclude them, and if they want to be part of this, they’re welcome to join us and weigh in. But we’re not going to wait around the way we did for health care. I’m not that dumb.
Then, see if the Republicans can be goaded into defending Wall Street. They will support “free markets” and decry “socialism,” but if they do, we can say – why are you defending the banks? And we’ve got them.
In other words, they went all in for health care – now double down.
How could Kucinich resist this?
It could be a hot summer and into the fall. Here’s hoping.
Budd Shenkin
What gives?
I have absolutely no inside information, and haven’t even followed the commentary very closely lately. But here’s what I think.
I think Obama told him that he needs to pass health care reform or his presidency is effectively dead. The bill is not completely repellent; it’s good enough not to be ashamed of. It will be very significant domestic legislation. It can be improved later on. And as Axelrod says, at this point they are all in. It’s now success or failure.
And then, here is what I think Obama said next. I think he said, after we pass health reform, I’m not stopping. I’m going to use this as a springboard for the next thing- financial reform. I’m going to double down – I’m going to be more aggressive, not less. And I’m really going after the banks. We gave enough money to them to stabilize the system – now we’re going after them.
It makes perfect sense for policy. Pivot away from Summers/Gaithner, over to Paul Volcker. Resurrect separation of deposit and investment banks, Glass-Steagall. Institute controls and transparency. Start a consumer financial protection agency. Dodd’s bill isn’t strong enough, but maybe they can get the House to be stronger, the way it was before Barney Frank went soft on us.
Then push the hell out of it and gain popular, populist support. Go for a 1934 – the only time beside 2002 that the incumbent party picked up seats in the off year election. Be very aggressive, which is what Roosevelt did. Take a chance. Say, we tried to be bi-partisan and what did we get? We tried to get some support by incorporating some of their ideas, and what did we get? We tried to include them, and what did we get?
I might have been a little naïve, but I’m not dumb. If we’re going to do something, we going to have to be aggressive. And we do have to do something. This country hasn’t been in this kind of a mess for a long time, so these are things we have to do. We won’t exclude them, and if they want to be part of this, they’re welcome to join us and weigh in. But we’re not going to wait around the way we did for health care. I’m not that dumb.
Then, see if the Republicans can be goaded into defending Wall Street. They will support “free markets” and decry “socialism,” but if they do, we can say – why are you defending the banks? And we’ve got them.
In other words, they went all in for health care – now double down.
How could Kucinich resist this?
It could be a hot summer and into the fall. Here’s hoping.
Budd Shenkin
Tuesday, February 23, 2010
Dreams and Déjà Vu
I thought I had a dream last night, I’m sure I did. I kind of remember it was about Nick, son number two. What was he doing? Hard to remember. But it was something that mystified me at the time, and even more now, since I can’t remember it.
And then there is déjà vu. Others thing that this is a malfunction of the mind, but in my case, I’m not so sure. I think if I could only get one extra piece of memory to function, it would actually work, and I could see what was going to happen, because it happened before. Really, I do.
Wonder of wonders, amazingly and incredibly, so satisfyingly, we are going to see more of exactly why these things happen in the near future (if we haven’t already and I’m unaware of it.) Functional MRI – we see what areas of the brain are working when the person can tell us, or we can just see as someone calculates, for example, what the brain is doing. Shades of Wilder Penfield, who opened up the brain and stimulated it and asked the person what they were thinking! It’s just a miracle. The computer companies put chips in with the intention of performing tasks; the brain scientist looks at the bio-chips already in there and figures out what they do. What a world of wonder. That plus the universe opening up to the Hubble. That plus anthropology unraveling the evolution of great apes and people, how there were other humanoid species that died out, and some of them recently on an Indonesian island, and great ape anthropology showing us that chimps have culture, that they use tools one way in West Africa and another in South Africa, and that it’s culture, not genes. What a world!
OK, that was a diversion.
But there is also another way of thinking about brain functions besides functional MRI – evolutionary, teleologic thought. If it works this way: there must be a reason however our brain works, it must give us an advantage, because we’re here and we had to survive competition. So, why does it work that way?
Here’s what I think. Dreams have lots of functions. They have symbolic thought that somewhere in our brain, where exactly I don’t know, they picture meanings to us and work out our problematic areas. OK, that’s pretty general, but let’s leave it there. What I really want to say is this – why are these dreams hard to remember, in our conscious minds? (Except for Ingmar Bergman, who claimed to remember them all in detail.) I think I know. We have to keep our conscious minds very clear. If we are to work our way through the world and eat – always my primary preoccupation – we have to be pretty clear about what is and what is not factually and objectively true. So, we can’t have the airy fairy dreams cluttering our minds while we are about our work. Someone who remembers his or her dreams and – here’s the important point – can’t distinguish them from objective reality, will wind up not eating. They will be too confused. So the best way to make sure that there is no confusion is to make dreams unrememberable in the conscious world. So, not remembering your dreams is functional.
Of course, that doesn’t mean they are forgotten. They are just not recoverable by the part of your brain that is conscious. There’s a whole lot more of your brain, and lots of the processing is “subconscious” and “unconscious.” These areas of metaphor will no doubt be further subdivided as the functional MRI gets more capacity and other technologies come on line.
So what about déjà vu? Well, I think déjà vu is a lot of fun. I really treasure those moments. But what is the function of déjà vu, what is the evolutionary advantage? I don’t think there is one. I think it’s a malfunction. I don’t know where it comes from, and it sure is like a dream. I think it’s an overflow from somewhere that is dream related. It’s to our benefit that these malfunctions are transitory. I always want them to last longer, but if they did, I would think I could find something to eat just the way I did before, but then I would become befuddled. I wonder if there is a mental disorder that features prolonged and repeated episodes of déjà vu? Haven’t heard of it, but you would think it could happen. I wonder.
You heard it here first.
Or maybe not.
Budd Shenkin
And then there is déjà vu. Others thing that this is a malfunction of the mind, but in my case, I’m not so sure. I think if I could only get one extra piece of memory to function, it would actually work, and I could see what was going to happen, because it happened before. Really, I do.
Wonder of wonders, amazingly and incredibly, so satisfyingly, we are going to see more of exactly why these things happen in the near future (if we haven’t already and I’m unaware of it.) Functional MRI – we see what areas of the brain are working when the person can tell us, or we can just see as someone calculates, for example, what the brain is doing. Shades of Wilder Penfield, who opened up the brain and stimulated it and asked the person what they were thinking! It’s just a miracle. The computer companies put chips in with the intention of performing tasks; the brain scientist looks at the bio-chips already in there and figures out what they do. What a world of wonder. That plus the universe opening up to the Hubble. That plus anthropology unraveling the evolution of great apes and people, how there were other humanoid species that died out, and some of them recently on an Indonesian island, and great ape anthropology showing us that chimps have culture, that they use tools one way in West Africa and another in South Africa, and that it’s culture, not genes. What a world!
OK, that was a diversion.
But there is also another way of thinking about brain functions besides functional MRI – evolutionary, teleologic thought. If it works this way: there must be a reason however our brain works, it must give us an advantage, because we’re here and we had to survive competition. So, why does it work that way?
Here’s what I think. Dreams have lots of functions. They have symbolic thought that somewhere in our brain, where exactly I don’t know, they picture meanings to us and work out our problematic areas. OK, that’s pretty general, but let’s leave it there. What I really want to say is this – why are these dreams hard to remember, in our conscious minds? (Except for Ingmar Bergman, who claimed to remember them all in detail.) I think I know. We have to keep our conscious minds very clear. If we are to work our way through the world and eat – always my primary preoccupation – we have to be pretty clear about what is and what is not factually and objectively true. So, we can’t have the airy fairy dreams cluttering our minds while we are about our work. Someone who remembers his or her dreams and – here’s the important point – can’t distinguish them from objective reality, will wind up not eating. They will be too confused. So the best way to make sure that there is no confusion is to make dreams unrememberable in the conscious world. So, not remembering your dreams is functional.
Of course, that doesn’t mean they are forgotten. They are just not recoverable by the part of your brain that is conscious. There’s a whole lot more of your brain, and lots of the processing is “subconscious” and “unconscious.” These areas of metaphor will no doubt be further subdivided as the functional MRI gets more capacity and other technologies come on line.
So what about déjà vu? Well, I think déjà vu is a lot of fun. I really treasure those moments. But what is the function of déjà vu, what is the evolutionary advantage? I don’t think there is one. I think it’s a malfunction. I don’t know where it comes from, and it sure is like a dream. I think it’s an overflow from somewhere that is dream related. It’s to our benefit that these malfunctions are transitory. I always want them to last longer, but if they did, I would think I could find something to eat just the way I did before, but then I would become befuddled. I wonder if there is a mental disorder that features prolonged and repeated episodes of déjà vu? Haven’t heard of it, but you would think it could happen. I wonder.
You heard it here first.
Or maybe not.
Budd Shenkin
Monday, February 22, 2010
The President's Health Reform and CHC's
Since the President’s health care reform proposal has just appeared two hours ago, there may be some items that have not come to light. But it appears that the new proposal remains a huge windfall for the Community Health Centers:
“Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.”
At the same time, while Medicaid eligibility is extended, the House’s proposal that Medicaid payments rise to the level of Medicare over three years simply goes unmentioned. In other words, the uneven playing field between private practitioners seeking to give care to the poor on the one hand, and the CHC’s on the other, will become a mountainside, not a playing field at all.
In addition, the CHC’s say that they see many patients now who are uninsured. What will happen now, as many uninsured become insured, and the CHC’s can now collect from them, but they retain their giant funding? It will be a double win.
As a side note, I saw Chris Van Holland, Congressman from Maryland and the Chairman of the Democratic Congressional Campaign Committee, last week. I explained to him the inequity of funding, and how CHC’s got so much more per visit than practitioners. “I did not know that,” he said. “But the House Bill has a rise of Medicaid payments to the Medicare level,” he said. “It will never pass,” said I. Boom goes the dynamite!
Well, why are CHC’s so popular? They have their claque, to be sure. But also, think of this. The Democrats like them because they are for the poor, and they are governmental entities, essentially. Organized, bureaucratic, just like the doctor ordered.
And why do Republicans like them? Even Mike Enzi came out for them last week. I can only think, they like them because the Republicans like the idea of not infringing on the paying population. It’s two class care, very separate, and you can say that you’re doing a lot for the poor, but the waiting rooms of private practitioners won’t be cluttered with them.
But who knows? Maybe CHC’s will turn out better than I think they will. Maybe they will be so successful that they will spread to middle class medical care. But I don’t think so, tell you the truth. I’ll relate my field trip to Kaiser in a post in the next day or two – Kaiser, the great success story that health policy analysts point to – and tell you why I think they are not our future.
At least, that’s what I think today. Who knows, as I always say, I make mistakes every day, and all I can hope for is that they are not big ones.
Budd Shenkin
“Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.”
At the same time, while Medicaid eligibility is extended, the House’s proposal that Medicaid payments rise to the level of Medicare over three years simply goes unmentioned. In other words, the uneven playing field between private practitioners seeking to give care to the poor on the one hand, and the CHC’s on the other, will become a mountainside, not a playing field at all.
In addition, the CHC’s say that they see many patients now who are uninsured. What will happen now, as many uninsured become insured, and the CHC’s can now collect from them, but they retain their giant funding? It will be a double win.
As a side note, I saw Chris Van Holland, Congressman from Maryland and the Chairman of the Democratic Congressional Campaign Committee, last week. I explained to him the inequity of funding, and how CHC’s got so much more per visit than practitioners. “I did not know that,” he said. “But the House Bill has a rise of Medicaid payments to the Medicare level,” he said. “It will never pass,” said I. Boom goes the dynamite!
Well, why are CHC’s so popular? They have their claque, to be sure. But also, think of this. The Democrats like them because they are for the poor, and they are governmental entities, essentially. Organized, bureaucratic, just like the doctor ordered.
And why do Republicans like them? Even Mike Enzi came out for them last week. I can only think, they like them because the Republicans like the idea of not infringing on the paying population. It’s two class care, very separate, and you can say that you’re doing a lot for the poor, but the waiting rooms of private practitioners won’t be cluttered with them.
But who knows? Maybe CHC’s will turn out better than I think they will. Maybe they will be so successful that they will spread to middle class medical care. But I don’t think so, tell you the truth. I’ll relate my field trip to Kaiser in a post in the next day or two – Kaiser, the great success story that health policy analysts point to – and tell you why I think they are not our future.
At least, that’s what I think today. Who knows, as I always say, I make mistakes every day, and all I can hope for is that they are not big ones.
Budd Shenkin
Tuesday, February 16, 2010
Clinics vs. Private Practice
From a friend who has experience in several different venues, commenting on post citing the uneven playing field:
"I couldn't agree more.
The FQHC vs private practice debate has occupied my mind ever since Hurricane Katrina, when the FQHCs received all kinds of federal assistance and bonus payments, while private practitioners received nothing. Not "next to nothing"--I mean absolutely nothing. The Gulf Coast now has what is basically a two-tier system for primary care--community clinics for the poor, and private practices for the insured. It wasn't the most egalitarian system before the storm, but it's certainly far more stratified now (which, as we know, also utterly violates the equal-access provision which was part of Medicaid's original intent)."
Budd Shenkin
"I couldn't agree more.
The FQHC vs private practice debate has occupied my mind ever since Hurricane Katrina, when the FQHCs received all kinds of federal assistance and bonus payments, while private practitioners received nothing. Not "next to nothing"--I mean absolutely nothing. The Gulf Coast now has what is basically a two-tier system for primary care--community clinics for the poor, and private practices for the insured. It wasn't the most egalitarian system before the storm, but it's certainly far more stratified now (which, as we know, also utterly violates the equal-access provision which was part of Medicaid's original intent)."
Budd Shenkin
Friday, February 12, 2010
My Superbowl Weekend
My last weekend. Start with home internet (DSL) going out Friday - major disruption for both wife and me. Finish day, call tech support (ATT), figure out it's the modem. Go to Best Buy, get new modem. Connect. Not plug and play. Call tech support. Spend hours on phone with several techs who it seems were competence challenged. Give up. Our in-office IT guy will help, but has gaming tournament on Saturday - so I say, go, relax, see you Sunday. Go to office on Saturday for 3 hours just to do email work. Call Comcast and arrange for Tuesday visit by cable guy to change from ATT internet to cable internet. Take wife to lunch by waterfront and forget about internet. Next day is not only Superbowl Sunday, but stepdaughter's (prospective single Mom, with out full support, by choice) due date. Stepdaughter to stay at our house tonight. She has back ache. 12 midnight water breaks. Call OB, friend. Get set to go to hospital. OB calls, he is outside our front door, house call, just to be friendly. Go to hospital, wife up all night with laboring step-daughter. Anesthesia screws up, epidural becomes spinal, anesthesia to level of jaw. Baby comes well, 8# 2 oz., at 7:30 AM, in time for Superbowl. Stepdaughter with lots of bleeding, pain. Take sleepless wife to breakfast. IT guy comes to house, fixes internet. Go with wife back to hospital. Power steering on car goes out in parking lot. Baby still fine, step-daughter in good spirits, although bled a lot and on high pain meds for very tough labor. Tow truck comes. Go in tow truck to dealer. Saints narrowly behind, haven't seen game yet. Wife walks home from hospital to get car to pick me up at car dealer. Wife calls me, you wouldn't believe this. Her car blocked by step-daughter's car, but step-daughter's battery dead - probably left a light on. Car salesmen supervisor hears me on phone, no customers in showroom on Superbowl Sunday, asks salesman to drive me home and then go home himself. Salesman is thrilled, I get home. Triple A comes to charge step-daughter's battery. Everyone so thrilled by baby none of above matters. Baby very cute. Get to see second half of game, wonderful game. Call brother in Philadelphia to ask about snow, and how many storms of the century you can have in two months time. Brother amused, keeps asking if baby can be named after him. Wife sleeps for 12 hours. I go back to hospital to help step-daughter and hold baby for 2 hours. All still thrilled. Suggest football name for little girl, DeBrickashaw. Suggestion refused but laughed at. Next day name chosen, Lola. All still thrilled. Driving step-daughter's car while power steering fixed, Mini too small for me, but it's a car. Hear from dealer late on Monday, power steering module was recalled, so whole fix will be free. Baby still fine, hardly cries, step-daughter's spinal headache bad, but blood patch works, she can now sit up. Anesthesiologist makes two bedside visits in one day. OB pissed at him. Comcast guy comes at 6 PM, takes 2.5 hours to install new internet. Works slightly better than ATT DSL, hope for reliability, not have to talk to ATT tech support again. Package of cable, internet, and phone will be less than what we were paying for just internet, no more DSL charge, unlimited long distance. Pick up car at dealer Wednesday morning, they throw in car wash and full tank of gas, which was near empty. Feel that life is good. Step-daughter and Lola home from hospital, got own car back, wife resuscitated, wife so thrilled she can't stand it, step-daughter thrilled and amazed. Me, too. Turn back to AAP SOAPM listserve and find 140 items received.
From saga above, have omitted days in office, clinician meetings, meeting with new Administrator to counsel and direct, four perfect circumcisions, interview peds candidate. Who says we can't multi-task?
Budd Shenkin
From saga above, have omitted days in office, clinician meetings, meeting with new Administrator to counsel and direct, four perfect circumcisions, interview peds candidate. Who says we can't multi-task?
Budd Shenkin
Wednesday, February 3, 2010
Health Reform and Medicaid: Clinics vs. Private Practice (2)
I left a point out of yesterday's post on the consequences of granting $10 billion (that's ten thousand million dollars!!?) to the Community Health Centers, while leaving private practices that treat Medicaid patients severely underfunded and headed out of the business of treating the poor.
Some might argue that granting this money to the CHC's will improve care for the poor. But in the end, that is an unlikely event. By pushing private practice out of the Medicaid picture, Health Reform will in effect be creating a very separate system for the poor, and we know enough now to understand that separate is inherently unequal, with the advantage to the overclass, not the underclass.
It is clarifying to look at the looming situation from the viewpoint of graduating primary care residents. They will have to choose - will I serve middle class patients, or will I serve the poor? There will be no middle ground, no practices like Bayside (our practice), that serve both. Medical schools and training programs do a surprisingly good job of indoctrinating their charges with the mantra of equal care for all, and the precepts of the Hippocratic Oath. Graduating residents tell me in job interviews that they really very much like that they will get to serve everyone. After Health Reform? Not so much.
Obama is right in saying that getting health care for all is a moral issue. It is. This under-appreciated part of the the Health Reform legislation, however, cuts exactly the opposite way. Alas.
Budd Shenkin
Some might argue that granting this money to the CHC's will improve care for the poor. But in the end, that is an unlikely event. By pushing private practice out of the Medicaid picture, Health Reform will in effect be creating a very separate system for the poor, and we know enough now to understand that separate is inherently unequal, with the advantage to the overclass, not the underclass.
It is clarifying to look at the looming situation from the viewpoint of graduating primary care residents. They will have to choose - will I serve middle class patients, or will I serve the poor? There will be no middle ground, no practices like Bayside (our practice), that serve both. Medical schools and training programs do a surprisingly good job of indoctrinating their charges with the mantra of equal care for all, and the precepts of the Hippocratic Oath. Graduating residents tell me in job interviews that they really very much like that they will get to serve everyone. After Health Reform? Not so much.
Obama is right in saying that getting health care for all is a moral issue. It is. This under-appreciated part of the the Health Reform legislation, however, cuts exactly the opposite way. Alas.
Budd Shenkin
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