What is the difference between broccoli and health insurance anyways?

Posted on March 28, 2012 by

Up until now, I hadn’t considered to write an article on healthcare reform simply because of the divisiveness and the complexity of the issue. But after listening to the supreme court session and the arguments made on both sides, I can’t help but comment on one popular argument that continuously resurfaces. Yes, it’s the infamous “broccoli argument”.

Not Healthcare

In short, the argument states that if government were given the power to force individuals to purchase health insurance, a precedent will be created that allows for the government to force individuals to purchase other material goods such as broccoli. This is a slippery slope and, as Justice Anthony Kennedy proclaimed during the hearing, “Here the government is saying that the federal government has a duty to tell the individual citizen that it must act, and that is different from what we have in previous cases, and that changes the relationship of the federal government to the individual in a very fundamental way.”

But does it really change the relationship between the government and the individual? It is already mandatory in many states to vaccinate one’s child. If the individual does not act, the child will not be allowed to attend public school. During certain periods in American history, it has also been mandatory for an individual to enroll in the military or face prison time.

And will the mandate lead to a slippery slope in which we all will be forced to buy broccoli? No, thanks to another precedent set by McCulloch v. Maryland that cites the “Necessary and Proper” clause of the constitution. In short, congress has the power to make laws that are not expressly provided by the constitution as long these laws are a necessary and proper means of achieving a major, legitimate public end. The major, legitimate public end in this case is universal healthcare and the mandate is a necessary and proper solution to guaranteeing and subsidizing the healthcare coverage of the sick while allowing for private insurance companies to still be profitable. Otherwise, universal healthcare is only viable through a vast expansion of Medicaid and Medicare. This “government takeover of healthcare” is the reason why the mandate, as ironic as it may seem now, actually originated as a conservative idea.

On the other hand, it is difficult to think of any public end that would deem mandatory broccoli purchases as “necessary and proper”. Simply purchasing broccoli is, for example, neither a necessary nor proper way of guaranteeing a healthy lifestyle or preventing illnesses. This “slippery slope” is not as slippery as some make it seem.

No, still not healthcare

What is really disturbing about the “broccoli argument” is the fact that it shows how out of touch some are with the current state of healthcare. One cannot treat health insurance as a routine material good because there are very few things in life that are as crucial, expensive, and unpredictable as one’s need for healthcare. At any time, not being insured has the potential of carrying with it a life-altering consequence. The broccoli argument dangerously simplifies the complexities of healthcare and masks the very real need for reform.

We should stop focusing on political issues such as the constitutionality of the mandate and start focusing on improving the real weaknesses of the bill such as its lack of malpractice reform and the absence of an effective solution to the primary care crisis. That would be the necessary and proper way to go about improving healthcare.

Posted in Healthcare | 1 Comment

The Conservative Nature of Medicine

Posted on March 21, 2012 by

Once I find an area of interest, I obsess about it to a point that is no longer healthy. The same is true with medicine. As I eagerly await my entry into medical school, I hunt for anything that can help me understand more about the field that will dominate the rest of my life.

Yes, I am that stereotypical premed who fell in love with House, M.D. in my freshman year of college, but I immediately (OK, maybe not “immediately”) realized that shows such as these, no matter how entertaining they may be, are ultimately and exceedingly fictional. That is why I have grown to love medical documentaries and, more specifically, documentaries about the hardships in medicine. It is relatively easy to find documentaries about larger-than-life doctors and complex medical conditions that are deciphered and cured. It is not so easy to find documentaries about the trials and tribulations of medical training and the medical profession, and the complex medical conditions that are neither deciphered nor cured. It is rare to find a show that successfully portrays doctors as human and fallible.

One of the shows that I have come to treasure is Hopkins. It follows attending doctors, nurses, residents, and medical students at (you guessed it) Johns Hopkins and manages to portray the darker moments in medicine that outsiders rarely get to glimpse. You meet a cardiothoracic surgery resident who is in his sixth year of training and struggling with the excruciatingly long working hours while trying to prevent a looming divorce between him and high school sweetheart. You also meet a first year plastic surgery intern who messes up a thoracentesis and causes a collapsed lung and no shortage of anger in the patient. For every scene where a live is saved and a family celebrates, there is also one of a live being lost and a family grieving.

Another documentary that has made an even bigger impression on me is Doctor’s Diaries. It follows seven first year medical students for 31 years. You see a young medical student warmly joke and reassure a patient before his heart bypass surgery only to witness this patient’s death on the operating table and break into tears. You see the students evolve from clumsily navigating their way through a routine physical exam with the help of an experienced doctor to becoming one of those experienced doctors themselves.

Dr. Tom Tarter. Picture courtesy of PBS

Arguably the most interesting story among these is that of Dr. Tom Tarter, an Olympic hopeful filled with charisma, intelligence, and wit who entered medical school in his early thirties. Thirty years on, he is flying across the country picking up work where he can find it and barely making ends meet. He complains that when interviewers look at him, they don’t see the medical school diploma from Harvard or the fact that he is a certified emergency room physician who has worked in a high-volume hospital. Instead, they just see his ponytail and his tattoos.

That grievance reveals a very interesting aspect of the medical field. Medicine is at its core a very conservative profession. While there may be room for original and creative thoughts and ideas, there is no room for expressing oneself aesthetically in a manner that deviates from the mean. Your haircut, your clothes, and even your figure will have a deceivingly large impact on your success in the medical field. This is not the fault of the current medical culture, but rather a product of intimately interacting with people on a day-to-day basis. As a doctor, you will need to earn the confidence and trust of the patient within the first seconds of meeting them. There is simply no room for tolerating large visible tattoos, messy haircuts, or raged clothing when every first impression you make has to be a positive one.

The same is true of medical school interviews, third and fourth year rotations, as well as residency interviews. It may be shallow to judge others by your first impression of them, but it is human nature to do so and your success in entering and excelling in the medical field will partially hinge on how others perceive you within the first few seconds of meeting you. Dr. Tom Tarter, who posesses a great resume but also a ponytail and a tattoo, is an unfortunate victim of this conservative environment. It is heartbreaking to watch as the talents of this brilliant doctor are ignored and his life slowly falls apart. You cannot help but admire him for his steadfastness as he flies around the country to make ends meet.

Changing this conservative environment in medicine will be exceedingly difficult, if not impossible. As long as we continue to treat and interact with fellow humans, we will forever be subject to human emotions and human prejudices. The best we can do is iron that dress shirt, wash that white coat, cut that messy hair, and set off into that consultation room with a warm, welcoming smile.

Posted in Education | Tagged , | Leave a comment

Why write?

Posted on March 17, 2012 by

For as long as I remember, I have never been a fan of writing. I would always look with dread towards those papers that I need to finish for my English class and sit in front of the computer for hours with immense writer’s block. Writing was always a task, not a hobby. This changed as I started to apply for medical school.

I have long been passionate in reading about topics that interest and pertain to me. The moment I bought a smart phone, I started subscribing to countless blogs about the latest technology and the coolest new tweaks. Needless to say, my phone and its accompanying software are now customized to oblivion. The same is true of my passion for wine, cars, soccer, and Formula 1. I can talk with you for hours on end about about mechanical grip, aerodynamic grip, oversteer, understeer, and weight distribution. Reading obsessively about my areas of interest has become second nature to me, but it has never occurred to me to contribute to the vast amount of blog entries that were feeding my obsession.

Then I started to search for medical news and stories. The first few articles that I encountered were fairly pedestrian. They debated current healthcare issues such as the Affordable Care Act the impending Medicare reimbursement cuts in a very journalistic manner. But then I stumbled upon blogs and books written by medical students, residents, and attendings. These pieces were some of the most captivating that I have ever read. They describe medical and ethical dilemmas, heartbreaking and humbling experiences, as well as personal triumphs with incredible depth and emotional maturity. Each piece possessed within itself amazing insights about the authors themselves and about human nature.

I have decided to start writing about my upcoming experiences in medical school not because I think that I will have amazing insights to contribute. On the contrary, I write because I don’t think I can recognize the meaningfulness of my experiences without verbalizing them. I write because I don’t want the extraordinary to start turning into the mundane. The more I thought about writing, the more it seemed to become a necessity. The moments I spend writing allow me a breath of fresh air and a bird’s-eye-view of my surroundings. Without this, it is all too easy to get lost in the vast field of medicine.

Whereas I have dreaded writing before, I have now come to rely upon it.

Posted in Writing | Tagged | 1 Comment