Tea Party in Troy, Michigan

I went to the Tea Party in Troy, MI today (suburb of Detroit, for those of you not from around here), and I took a little video. Please excuse the shakiness and amateurish quality (it was hard for me to see the LCD screen with the glare from the sun), but the purpose was to capture the essence of the demonstration. Many Liberals in the mainstream media and on blog sites have criticized what they call "teabagging" as being a wacko attempt by the right wing nuts to initiate a violent overthrow of the government. They say, "Today we have taxation with representation, nothing at all like the Boston Tea Party!" Yes, that is true. But, there is a sense among many, myself included, that we as voters are less and less represented in Washington. And while Obama is promising lower taxes for 95% of Americans, I wonder if anyone out there has seen any of this benefit. Furthermore, while the national debt is escalating faster than ever during his watch, I wonder how and when (and if) the Liberals believe this debt will ever be paid. As you can see in the video, the people protesting were very peaceful, and just gathering to express their discontent about the country's current direction. It's funny how Liberals like to paint Conservatives as crazy "teabaggers" (an insult on many levels) when they have the likes of Barney Frank, Nancy Pelosi and Cindy Sheehan leading their ranks. For those of you who don't remember who Cindy Sheehan is, check out this little video to remind you:

So, THAT is normal, and the "teabaggers" are wacko? Hmmmm....

Meanwhile, I felt the song "Shuttin' Detroit Down" by John Rich was appropriate background music. Here are the lyrics in case you can't hear them very well:

My daddy taught me
In this county everyone's the same
You work hard for your dollar
And you never pass the blame
When it don't go your way

Now I see all these big shots
Whining on my evening news
About how their losing billions
And it's up to me and you
To come running to the rescue

Well pardon me if I don't she'd a tear
Cuz they're selling make believe
And we don't buy that here

Because in the real world they're
Shutting Detroit down
While the boss man takes his
Bonus pay and jets on outta town

DC's paying out the banker
As the farmers auction ground
And while their living up on Wall Street
In that New York City town
Here in the real world they're
Shutting Detroit down
Here in the real world they're
Shutting Detroit down

Well that old mans been working
Hard in that plant most all his life
And now his pension plans
Been cut in half and
He can't afford to die
And it's a crying shame
Cuz he aint the one to blame
When I look down and see his
Callused hands Well let me tell you friend
It gets me fighting mad

Because in the real world they're
Shutting Detroit down
While the boss man takes his
Bonus pay and jets on outta town

DC's paying out the banker
As the farmers auction ground
And while their living up on Wall Street
In that New York City town
Here in the real world they're
Shutting Detroit down
Here in the real world they're
Shutting Detroit down

What to do About Education in the United States?

Education is one of those issues which is occasionally controversial, but basically should not be. I think I can safely assume that pretty much all Americans are in favor of an improved educational system. We've all seen the stories about statistics showing that more Americans recognize a photo of Paris Hilton over Joe Biden, or the alarming number of people who don't know that Washington DC is the nation's capital. But, more importantly, in a country which offers free public education for all of it's citizens, there is an alarming number of children who never graduate from high school. In fact, according the National Center for Higher Education Management Systems (http://www.higheredinfo.org/), only 68.6% of 9th graders ultimately finish high school. In Detroit (my hometown) that number is actually about 25%. So, if high school is free (which it is), then why do so many students drop out?

Well, of course, a certain percentage of them don't have a choice. Some kids actually have to work and help support the family. In farming communities, there are kids who are expected by their parents to start working full-time on the farm as soon as they're able. Of course, there are some kids who simply fail academically or have discipline problems which lead them to be expelled. And then, there are some who get pregnant and/or married and start families early in life. Finally, there are those who simply think that school is a waste of time, and their time can be better spent doing other things. While some will argue that this is a failure of the country's educational system, I argue that it's more a failure of parental and family role models. Of course, the teachers and schools need to emphasize the importance of school, but it's really the family that provides the role models and examples.

I have a daughter who is turning two next month. At this age, it's amazing to see how hard she tries to imitate my wife and myself. She mimics almost everything we say or do, whether she understands it or not. Obviously, we are the most visible adult role models she has. If we curse, then she will curse. If we fight, then she will fight. But if we try our hardest to be kind, caring, hard-working and respectful of others, then...well, you get the point. So, the question is, if the socioeconomic conditions, education and culture of the parents is a large contributor to what motivates the children, then how, as a society, do we make a positive change?

Some believe the answer is to give these people enough money to get them OUT of the socioeconomic state they're in. Obviously, that would reduce some of the stress on the children (assuming, and this is a big assumption, that the parents spend that money wisely). However, it doesn't correct the fact that the parents are still not educated and it doesn't change their background or culture. In a nightmarish, totalitarian state, the answer would be to take away the children at birth and raise them in state-controlled orphanages where they would all be provided the same upbringing and thereby equal opportunities. Obviously, that should NEVER be an answer. My question is very simple: in a society which offers freedom and liberty to its citizens, is there an answer at all? It seems to me that the best we can do as a society is to continue to offer free education to our citizens through high school, and hope that families and children make the right choices in life.

Furthermore, I believe the biggest favor we can do for children who are raised with the socioeconomic disadvantages is to give them the opportunity to get educated outside of that environment. The concept of giving families vouchers for education is one solution which would achieve this goal. Instead of imprisoning children to a failing public school district, why not at least allow them the opportunity to go to private school as an alternative? In the current system, if you're poor (or even middle class), you simply can't afford to go to private school. Only wealthy families who still have enough money after paying all of their taxes can afford private schools. This includes the likes of Caroline Kennedy, who is a strong proponent of the New York public schools, but would certainly never send one of her own children to such a school. Furthermore, she doesn't want you to be able to afford to send your child to a private school, hence her opposition to school vouchers. The hypocrisy of the Liberal, yet once again.

The people who would benefit MOST from a voucher system would be the people who could not afford to get out of the public school prison system. If Democrats and Liberals cared about opportunities for education as much as they claim, then why would they oppose school vouchers? I honestly don't understand this rationale at all. As a general internist, my family is a perfect example of one for whom such a system would be beneficial. If I could allocate a portion of my tax burden to pay for my daughter to attend private school, then I would. As it stands, I simply can't afford it...certainly not pre-school through 12th grade. Thank goodness I live in a district which still has a decent public school system. But what if I didn't? The likes of Ted Kennedy, John Kerry, John Edwards, Barbara Streisand, Keith Olbermann, etc. will never need a voucher to get their kid to a private school. But why do they insist on denying that opportunity to everyone else? Are they really so elitist that they don't want their kids to mix with the "riff raff" out there?

Our Broken Healthcare System

OK, I've already explained my view that healthcare is more of a privilege than a right, and should be treated as such. However, while I don't believe it's a right, I do believe it's important that it be affordable for all Americans. I do believe, as a nation, we're doing our citizens a disservice if we do not make healthcare available to everyone. At the same time, while it would be ideal to be able to provide some level of care to everyone, I also think that Americans should at least have the ability to purchase superior care if they have the means. Yes, I'm talking about a tiered healthcare system.

It's like housing, food, clothing, or any of the other basic necessities of American citizens. While we can all agree that everyone should have access to all of those things, not everyone has access to the same quality or quantity. Just because Oprah lives in a multi-million dollar mansion, it doesn't mean we all need one. Just because there are some people who eat at Morton's Steakhouse every week, we can't expect to provide that to everyone. Understand?

Healthcare, like every other commodity, is just that -- it's a commodity. It has a real value attached to it, and certain things are more expensive than others. For instance, I have some patients who have health insurance which pays for whichever medication or test I order. Others require prior authorization for almost everything. To those who don't understand exactly what that means: prior authorization means if I want Jane Doe to take Crestor for her cholesterol, I need to call her insurance company and explain to some nurse/clerk (i.e., a nurse unqualified to actually take care of patients, so she works as a telephone operator) why I want her on this drug. The nurse asks me a series of questions off a computer screen including, "Have you tried the patient on simvastatin or pravastatin yet?" If the answer is no, or if the patient hasn't been tried on BOTH of those cheaper generic alternatives yet, then the prior authorization is denied. If the patient HAS been tried on both drugs, then they better have had a very bad reaction to both of them for the insurance company to approve the more expensive Crestor. So, it's not just a matter of me calling and getting approval. The insurance company is literally deciding for me which drug is best for Jane Doe.

In a "National Healthcare System," we would all be reduced to this lowest common denominator. In other words, people who can afford more expensive drugs or services will still be denied. A "one size fits all" approach to medicine and healthcare. In contrast, a multi-tiered system would allow patients to sign up for the "free" national healthcare, a relatively inexpensive healthcare plan, a more expensive plan, or the supreme plan (for example). While some of you might argue how unfair this is, consider that this is essentially what we have today, though it just doesn't work efficiently. The poorest people are on state-run Medicaid. The problem with it is that many doctors don't accept it, it only pays for the cheapest generic drugs, and you often have to wait a long time before seeing a specialist (because so many doctors don't take it). The wealthiest people generally have fee-for-service insurance which basically either charges very high premiums, or charges patients a lot of money for each service or medication as they go. But, they can see anyone they want whenever they want, they can fill any prescription and they can get any test done -- while never having to ask permission from an insurance nurse/clerk.

To those who I know will tell me how unjust it is to have a tiered healthcare system, I ask you why is it unjust? Isn't this a free country? Shouldn't people have the freedom to buy whichever kind of healthcare they'd prefer for themselves? In Canada they deny people the freedom to seek out private healthcare. That would be equivalent to denying people in the US the right to send their children to private schools.

If the government wants to control healthcare costs, this is the solution. Let the government pay for a minimalist system which offers the ability to take care of anyone who wants it, but provides less bells and whistles. People who NEED it, will sign up for it. People who'd prefer to have higher quality, will pay for it out of their pockets. So, what I'm basically suggesting is a national Medicaid system for anyone who wants it (not just the poor), but provides only Medicaid-like service and care. Meanwhile, use this to replace the current Medicare system, and allow the citizens to choose between this and private insurance. Lower costs, healthcare for all Americans, and freedom for people to choose whatever healthcare they'd prefer. Once the Liberals get past the concept of a tiered system (which, in a free country, is a fact of life in every industry), then I think even they would have to admit it would work.

Why Are Conservaties Afraid to Admit It?

I have noticed a disturbing trend in the United States. People who believe in conservative principles, like myself, are often afraid to admit it in public. I have many friends on Facebook who have recently sent me private messages complimenting me on my blog posts, but very few are willing to publicly make such comments. On the other hand, Liberals have no problem stating their opinions in public and often accompanying their comments with some form of Bush-bashing, name calling, or generalizing by saying something like "all Conservatives are paranoid wingnuts."

Why is this the case? Why has it become "fashionable" to be a Liberal, but heresy to be a Conservative? This is not something that has existed just since the election. Nor is it something that started during George W. Bush's administration. I think it was a trend which began in the 1960s during the Vietnam War and has grown into the mainstream over the past 10-20 years. Obviously, the hippies from the 1960s becoming the leaders of the mass media in the 21st century is a large part of it. As the media (news, television, movies, music, magazines, literature, theater, etc.) have a tremendous impact on public opinion, it is not difficult to see the connection here. Also, Liberals are generally thought of as being "artistic", "sophisticated", "compassionate", and "tolerant" -- all admirable qualities. Conservatives are thought of as being "religious zealots", "greedy", "rednecks", or even "racists." Are these fair stereotypes? Furthermore, are Liberals being "tolerant" when they hold such views? Do they even bother to understand where Conservatives are coming from, or would they rather simply label them as stupid or crazy?

Well, I'm here to say that we are neither. We are merely Americans, like you, who have a very different point of view about how to make this country a better place. I think we both want the same results. Our difference lies in how we best achieve this result. I believe that the founders of this country wrote the Declaration of Independence and the Constitution with the intention of limiting the power of government over the people and guaranteeing freedom and liberty to the individual. Unfortunately, freedom and liberty come with a price: responsibility (see my blog post from 3/27). On the other hand, Liberals believe that it's not enough to be born in a country free of government persecution. Rather, they believe it's the government's job to ensure that we all at least start from equal footing. Just because you're born poor, it doesn't mean you should be condemned to less than adequate education, healthcare, shelter, nutrition, etc. You should have all the same advantages the rich kids have. Furthermore, if you make some mistakes in life, like abuse drugs or alcohol, you should be given the care you need to get yourself back on your feet. Furthermore, if you fall in with the wrong crowd and commit a few crimes, you should be rehabilitated and re-educated, and returned to society for a second, third or fourth chance to get your life back on track.

Again, what did the founders intend? Did Thomas Jefferson want a government which could take care of all of its citizens, risking the possible increase in size and power? Well, let's examine one of his quotes: "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them." Um, I don't think so.

The bottom line is that Conservatives have nothing to be ashamed of. You're beliefs are just as valid, if not moreso, than those of the Liberals, and the written documents upon which this nation is founded support all of the conservative principles much more strongly than liberal principles. Conservatives, by definition, hold to traditional attitudes and values and are cautious about change or innovation. Liberals are open to new behavior or opinions and are willing to discard traditional values. That may work with respect to office dress codes, but not with the founding principles of the United States. People who think we just need to "change with the times" are simply ignoring history and what has worked for over 200 years. Remember if you are a conservative, you are actually in pretty good company. I would argue that Conservatives want to stick to the principles of Thomas Jefferson, Benjamin Franklin, Thomas Paine and James Madison. Be proud of your beliefs and stand up to those who try to ostracize you! Remember, you are right...they are not!

But What About Abortion and Stem Cell Research?

Generally, I'm conservative (if you haven't gotten that yet). But most of my conservatism is fiscal in nature. I am opposed to higher taxes and higher government spending, and I'm in favor of capitalism and free markets. I believe the principles of limited government powers and freedom of the individual is what makes this country great. The more power we give government in terms of increased money, programs and regulations, the less freedom the individual will have, and the less chance capitalism will have to survive.

But how exactly do conservative principles apply to social policies, and specifically abortion and stem cell research. Traditionally, conservatives are strongly opposed to abortion and the use of embryonic stem cells for research. Their reasons for this opposition are rooted in their strong religious beliefs and their definitions of human life. Their first premise is that human life begins at the moment of conception. Secondly, they say that it is always morally wrong to take a human life, regardless of how old or young it is. That's it. That's really the bottom line. If we assume those two points to be true, then their argument is correct...abortion and stem cell research should both be illegal.

However, this is where I differ slightly from the traditional conservative. As a physician, I agree that human life begins at conception. No educated person in the medical sciences could possibly argue that this is NOT a true statement. However, I question whether it is always morally wrong to take a human life, regardless of age. From a moral point of view, when it is the rights of the mother vs. the rights of the embryo, there is an intelligent argument which states that since the embryo is completely dependent on the mother for continued growth and development, then her rights outweigh those of the embryo. The problem with this argument is where to draw the line. Can't you also argue that an infant is completely dependent on the mother as well? What about a toddler? What about a teenager? Well, obviously, as the child grows, they gradually become less and less dependent. But how do we decide where to draw the line? Brain development? Well, that is actually a continuous process. It is not something that occurs overnight.

The "pro-life" crowd sees the slippery slope problem with this. If we allow abortion, then what's next? Are they going to start allowing the killing of infants at the mother's discretion? After all, is that really any different? In fact, there are some liberal "intellectuals" out there who think this is a good idea, namely Peter Singer, a bioethics professor at Princeton University. And if that becomes okay, can't the government come in and then say it's okay to kill children up to age 4 or 5, when most experts believe that a child is actually able to reason.

Well, obviously, these questions are more serious than just "I'M PRO-CHOICE!" or "I'M PRO-LIFE!" People who are steadfast in their beliefs on this issue, without at least considering the other side of the argument, are stupid in my opinion. You need to at least see the reasoning behind the alternative argument. The problem is that it's a stale-mate. There's simply no answer we're all ever going to agree on, and that's because people have different codes of ethics based on their moral upbringing.

This is why, while I personally am pro-choice and in favor of stem cell research, I don't believe I can summarily say that what's right for me is right for the nation. I also believe that the foundations of Judeo-Christian laws are what this country's laws and morals are based on, so I don't really have a problem with religious zealots setting the rules here. After all, it's their morals that have prevented total anarchy for the past 233 years, and I don't have a good enough REASON to argue that I'm right and they're wrong...since they are right about the human life part of it. Besides, while this an interesting debate, and while I would like my daughter to be able to have an abortion at some point if she really needed it, I don't really care too much one way or the other.

The importance of free markets, capitalism and limited government are FAR more important to me than any of this. Government's role is to defend our borders and uphold the law. If the law is that abortion is illegal, well, so be it. It got us through the first 200 years of our history. But if government comes in and starts firing CEOs, pandering to unions, manipulating markets, and generally screwing up our entire economic system...well, that will have much more serious consequences for ALL OF US then if my daughter is forced to have a baby when she's a teenager.

Health Care: Right or Privilege?

This is one of those eternal questions in the world of medicine. Even among physicians and health care providers, the field is split fairly evenly, just like in the general population. Conservatives generally consider it a privilege, while Liberals consider it a right. But what do those terms mean in this context?

A "right" is a just claim, whether legal, prescriptive or moral. Obviously, there are no legal or prescriptive rights to health care. So the question here is whether there is a MORAL right to health care. Historically, the answer has clearly been no. In fact, in the history of mankind, it has not been until the 20th century when such a question even existed. Prior to that time, medical care has always been like any other service provided: if you wanted it, you had to pay for it. But if we guarantee our citizens the rights to "life, liberty and pursuit of happiness," should health care be implicitly included there? After all, don't you need health care to LIVE? Or do you? There are some people who live very full, long lives and never see a doctor. In fact, some sects of Christianity in the US actually FORBID medical care. Does that mean those people don't live? Of course not. Furthermore, if we consider health care a basic RIGHT, given to all citizens by the government, then shouldn't food be a basic right? And a home? And clothing? And cable TV? Yes, I just said that. After all, how can you "pursue happiness" without having at least 100 channels of entertainment going into the home 24 hours per day?

So, clearly, my question is, "Where do we draw the line?" Why are my services, or the services of other physicians, so worthless that the public should not have to pay a single dime for them? But it's okay to charge people $200 to see the Detroit Pistons play basketball? Or $10 to see a movie? Or $100 per month for cable TV? Why are the services of professional athletes or movie stars placed at a higher monetary value than medical care? Why can all other professions in the country charge "market value" for their services, but physicians should be subject to government price controls?

Frankly, I find it insulting that people now believe health care is a basic right. What does that really mean? It's so important, so valuable, that you shouldn't even have to pay for it? If the government takes over health care, in order the minimize costs, the government will determine the fair price for all services. The problem is, the "fair price" is not what the doctors consider fair, but rather the politicians. This is really no different than in the old Soviet Union how the government determined the "fair price" for bread. Of course, this led to lines around the block for people to buy it.

If the Obama administration wants to mess with basic supply and demand, they are going to get a lot more trouble than they're bargaining for. And if the American public is so stupid that they don't understand the connection here, then they frankly deserve what they get.

Why Am I So Conservative?

People often wonder why I'm so politically active. My wife and I have friends who ask, "What's the deal? Why does Dave always go off on these crazy right-wing rants against Obama?" Of course, that's what our more liberal friends ask. Our conservative friends make comments like: "Good for you Dave!" "You just said what I've been thinking!" "Sorry I can't post comments on your blog, but I'm more of a 'closet-Republican.'"

Well, of course, it is not popular these days to be a conservative. Obama was one of the most popular presidential candidates in history, he has achieved rock-star celebrity status, and he's black. So, if you don't like him, you must be a racist, right? WRONG. But more importantly, if you're conservative these days, then you must be a cold, heartless bastard. After all, the liberals want the government to take care of all of those helpless people who aren't able to care for themselves. Conservatives just want to steal as much money from the common people as possible and funnel it off to the Caymen Islands, right? WRONG AGAIN. I do agree that liberals think with their hearts. They really do have good intentions and they WANT to do the right thing. On the other hand, conservatives think with their brains. They UNDERSTAND human nature, and realize that giving people entitlements from the government only makes people DEPEND on those entitlements in the future, thus taking away incentives to take care of themselves. Furthermore, history has shown that free enterprise and the capitalist system is what has created the greatest nation in the world. If all people worked hard to better their own lot in life, then everyone's lives would be better. The problem, as I see it, is that people have lost sight of that American Dream. People at a young age start figuring out ways to 'scam the system' and get the government to take care of them.

As a physician, I can't even tell you how many people I've seen over the years who are looking for something for nothing. From people with no true disability asking for disability forms to be filled out, to teenage mothers on Medicaid who are addicted to all kinds of substances and not working, to people who retire from GM at 48 and rely on their pension. This has become what our American culture is all about. How to get something for nothing.

In the Obama Utopia, all of these individuals and others will be cared for by "the people" (i.e., the government). There will be no suffering in our world, because all of the less fortunate people will simply be GIVEN what they need to survive. In my Utopia, all of these people would have stayed in school, not have become pregnant before they're married (or at least not before they're self-sufficient), not addicted to chemical substances, and not retiring at 48 to let the younger generations take care of them.

I think we all agree that we'd live in a better place if there were no suffering. But the difference between the liberal and the conservative is that the liberal wants to take what little wealth there is and spread it around equally; the conservative wants to create more wealth for everyone by everyone taking an active role in that wealth creation. You are simply not going to motivate people to take care of themselves if they see that they can survive by letting someone else take care of them. In this "new era of responsibility," I think people need to start taking some responsibility for themselves, first and foremost. After all, if you can't be responsible for yourself, how can President Obama expect you to be responsible for the country?

And that brings us to health care. As a physician, I have often debated others on the question of whether health care is a right or a privilege. You can probably already imagine my opinion on the subject, but that will be the topic of my next blog entry.