I’m tired of hearing know-nothings talk about medicine. But who is responsible for carrying the discussion?

A Samuel Beckett play is somewhat like a confession without hope of absolution. A sense of sin that lies too deep to be expiated. Past societal guilt (just fill in the blank with your favorite guilt) about present actions continue and such remorse is denied relief. Beckett’s characters reach out to one another for affection, and frustratingly embrace only the perturbed and tormented feelings of themselves.

You would think by now that I have just gotten back from the theater. Wrong! I am just currently watching the Sunday morning “talking heads” which nicely fill out the time slot between 9am and noon as the bagels and coffee are consumed.

A discussion is going on about healthcare which is being conducted by four people who have no idea of what healthcare really is. They somehow believe there is a direct correlation between the amount of money we spend as a nation and how long and how well we live. This flies in the face of the fact that as the country with the largest healthcare budget per person on the planet (2.4 times our nearest competitor), we have just fallen from 37th to 42nd in the world in infant mortality, 21st in male longevity and 19th in female longevity.

While the United States approaches 20% of the gross domestic product being spent on healthcare, the country which is number one in infant mortality will spend about 5.8% of the gross domestic product on healthcare – Singapore. To hear two U.S. Senators, both of whom are lawyers, drone on endlessly about the need “for more or less” government spending enrages me. The pandering to the public is disgusting. To say that the Roman age of “bread and circuses” is back is an understatement. No nation ever sued or spent its way to greatness.

While we are on the subject please tell me why American physicians have abrogated their responsibility to the public. Every time I write a check for AMA dues I wonder why. Why have they abandoned us believing the only real interest of members is their own income and not the better healthcare of the citizens of the United States. This is an organization which has provided essentially no leadership through this morass of healthcare. They were so busy defending income that they forgot that there were larger questions on the table. So now, those least informed, least understanding diminishing return on healthcare money and those least educated in science and its’ limitations are to be viewed as spectacle carrying on such debates. There are precious few people with MD degrees who are waging these fights and it is a comment on both physicians, their organizations and the public in general that we have degenerated into non fact based and uninformed diatribes on how healthcare needs to change. Shame on all of us.

Don’t you ever wonder why people who have done something real in life aren’t running the country? Why isn’t someone who has a concept of end-of-life expenditure dilemmas – or even a knowledge of the meaning of the term sensitivity and specificity – ever found in these debates? The talking heads all think there is a crisis, but none of them are willing to do any primary process thinking to define what we want this life to be. “Dust thou art, to dust returneth” was not written of the soul. Nowhere in The Constitution are we guaranteed a daily bowel movement, let alone everlasting life. I propose a real discussion about both the rights of citizens and their concomitant responsibilities for their own healthcare. I propose a forum on a formula for healthcare surcharge using the formula BMI times packs-of-cigarettes-consumed-that-week and the number-of-times-you’ve-gotten-drunk-and-threatened-to-sue-an-emergency-physician-who-is-only-trying-to-help-you. I am still working through the modifications of dietary intake. But as a fellow sinner, I need to be careful here lest I become a major contributor to the fund. 

Last weekend I did, however, see the ultimate in what can only be considered a death-by-food concoction while attending the classic car auctions in Auburn, Indiana. Right there in the middle of the food midway was a vendor selling the penultimate ER disaster – a donut bacon cheeseburger with eggs and chili optional. Does it get any better than that? Cynicism is not my general cup of decaffeinated latte, but it is a convenient location from which to observe the decline and fall of a once great society.

Why don’t we get back to deciding that the individual is responsible for themselves? When do we as medical community participate in calling a halt to the insanity of ICU beds for demented patients? When are we as physicians going to demand that American expectations are brought in line with American resources? Our problem is we have – no pun intended – lived off the fat of the land for too long. Our problem is there are more people getting rich from America’s illnesses then dying from them. We only steer the great ship of a human’s life within a few degrees. And we constantly pat ourselves on the back for successes that were truly the vicissitudes of nature. News flash, the talking heads just suggested the Obama plan would give young adults complete access to yearly physical exams that would “save more lives.” These people really don’t understand 20-year-old males do they? God help us. I’m going to change the channel now. I can’t take it anymore. Again I ask the question, why are we led by functional idiots who believe that science is magic and that people, if only treated right, will live forever. There is no rational basis for the current suggestions on health plan modifications and it is frightening to think that the black hole of healthcare gets deeper and wider without the care becoming better.

Oh no, it’s worse. I’ve gone from watching Godot to O’Neill’s A Moon for the Misbegotten. The “misbegotten” this time are three lawyers/congressmen (80% of congress are lawyers) are talking about energy issues. Great, just what I need are people who never took physics – and wouldn’t know Maxwell’s equations from their butt – talking about energy creation and distribution. I bet none of them can state Ohm’s law or cares that they don’t understand what they’re talking about. My next channel brings up a special on Al Gore inventing the internet. Now you’re talking.