Thursday, February 12, 2009

Just Tell Me Where My Obligation Ends

Nothing has lit up the blogosphere quite like the infamous human litter. I would feel like I'm slighting my duties as a semi-intermittent blogger if I did not chime in.

As a Med/Peds physician, I have no problem with saying that our society does have certain obligations (entitlements) to certain populations. Children and the elderly. Everyone else in between is another discussion for another day.

The problem I have with the way our healthcare system is structured is not that we have decided as a society to provide assistance to these groups (I think that we should, which is vastly different from saying that we have to) but that the public at large has translated this initially-voluntary offering of assistance into the mantra of "healthcare as a right".

Should an elderly couple, having worked their entire lives, be entitled to some help with prescriptions at the age of 65? I do not think this is unreasonable.

If we decided, as a society, that we can no longer afford to do so, are we somehow denying that couple civil liberties? Absolutely not.

As a disclaimer, I am not really sure how to categorize myself politically. I think it would be a tragedy to live in a world where we subsidize some of the most outrageous BS ever and let infants waste away because we aren't offering assistance for formula. But I do start to take deep offense to those who see such assistance as a means to an end, rather than a safety net. Like our new friend Nadya Suleman.

As most physicians who have spent any time in outpatient primary care, the patients who seek disability for back pain are suspicious at best. (Have you really given physical therapy a decent shot? Really?) Given Ms. Suleman's observed pattern of behavior, I would guess she had to browbeat her physician (or change PCPs a few times) to get that disability paperwork filled out.

And how does a woman who is "disabled" able to "work double shifts" to "save up" money for more in vitro? If you could save up for that much in vitro, maybe we need to assess how much gets paid out for SSI.

Rumor has it one of her pre-octuplet kids is autistic. If that's true, I truly take an exception to my rant. Autism is a horrifically underfunded chronic condition that only lots of expensive speech therapy, etc. has been shown to significantly affect. (This is where No Child Left a Dime fails.) If I had an autistic child, it would be a 2nd full-time job to give that kid the attention he/she needed to ensure peak potential. The kind of care an autistic child needs is truly out of the price-range of most Americans to pay for out of pocket. I have no problem subsidizing that.

But all sympathy for her struggle with an autistic child evaporates when you see what decisions she made next. It reveals her to be pathologically selfish. If she gave a rat's ass about her autistic child, she wouldn't take the little time she had for him/her and divide it amongst 8 more. Oh yeah... AND go back to college.

Her deftness at filling out disability paperwork must have made it quite easy to get 2 of her other kids on the federal/state subsidy payroll. Let me guess.... "bipolar disease" and "ADHD". What normal child growing up in this environment wouldn't start showing some signs of these conditions?

Now that we hear (shockingly) that this hospital wants the state to reimburse them for this care, I am waiting on bated breath for SOMEONE in power (ahem.... Obama) to comment on where the Era of Responsibility begins, and where the Era of "Oh, don't worry about that horrifically boneheaded decision you made.... let us take care of that for you" ends.

I'm actually hoping she gets piles of cash from a bunch of moronic sympathetic viewers. But I want to hear when my obligation ends. If I lived in California, I'd be even more pissed. How many book deals does one need to sign before you can't get food stamps anymore?

I think my rage over this selfish woman has peaked. But if I find out that she has ever put a cigarette to her lips in the last 10 years, I will probably have a stroke myself. Then all of you, dear readers, will be paying for my tube feeds.

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