" /> Glorfindel of Gondolin: March 2006 Archives

« February 2006 | Main | April 2006 »

March 20, 2006

Al Gore, resurrected?

Ezra Klein's article asks the question.

Al Gore's Martin Luther King Day speech on executive power, Jan. 16, 2006:

Moreover, if the pattern of practice begun by this Administration is not challenged, it may well become a permanent part of the American system. Many conservatives have pointed out that granting unchecked power to this President means that the next President will have unchecked power as well. And the next President may be someone whose values and belief you do not trust. And this is why Republicans as well as Democrats should be concerned with what this President has done. If this President's attempt to dramatically expand executive power goes unquestioned, our constitutional design of checks and balances will be lost. And the next President or some future President will be able, in the name of national security, to restrict our liberties in a way the framers never would have thought possible.

Al Gore's keynote speech at the We Media conference, Oct. 5, 2005:

I came here today because I believe that American democracy is in grave danger. It is no longer possible to ignore the strangeness of our public discourse. I know that I am not the only one who feels that something has gone basically and badly wrong in the way America's fabled "marketplace of ideas" now functions. How many of you, I wonder, have heard a friend or a family member in the last few years remark that it's almost as if America has entered "an alternate universe"?

Hillary Clinton, please note, isn't saying anything like this.

March 16, 2006

University of Chicago!!!

The exclamation points say it all!

More later after I get back from class. Oh, and Kayvon, you're getting a call from me soon.

UPDATE (1.5 days later): Ok, so now everyone knows what match I was hoping for. Chicago is such a great city, and I can't wait to get back to good old Hyde Park. I've been trying to get back, in one way or another, for about twelve years now. . . . My peeps from Sidley and many of my friends from Michigan Law will be there too -- starting their legal careers while I'm starting my career in emergency medicine. We'll definitely have to have some beers.

Apart from the city of Chicago, I'm thrilled to be a resident at the University of Chicago. My rotation there as a fourth-year medical student (November of 2001!) was probably the best single month of medical school for me. It felt like I learned more substantive medicine in that month than in any other. The attendings, the residents, the staff, the patients -- all great. When "they" say that some programs just click for you, that's U of C for me. I felt the same way when I went back for my residency interview last December. Four years had passed, but if anything I came away even more impressed with the faculty. The residents I met all seemed curious and sharp. Most importantly, they seemed like people I'd enjoy working with.

Plus, Chicago has the coolest helicopter in the business. As an undergrad I always loved to watch it flying low over the campus, and now I'm going to be flying on it! *big shit-eating grin*

Ok, off to celebrate some more. . . .

March 13, 2006

I'm going to be an emergency medicine resident!

Today, I learned that I've matched. Somewhere. I don't really know where yet, other than it's at one of the nine programs I listed on my rank order list.

I've avoided the scramble, and that makes me extremely happy. It would have been tough to try to get one of the very few unfilled positions in emergency medicine. Fortunately, I've already got one.

I'm enormously grateful to everyone who's helped me get to this point. Ever since I went to the ED of the old St. Francis Hospital in Colorado Springs as an EMT student and watched the victims of a mass shooting in a biker bar brought in and cared for, I've wanted to be an emergency physician. I've always thought I could be a pretty good one, if only because I think it's so fun, and challenging, and worthwhile. Now it'll be up to me to make the most of my three (or four) years of residency. I'm extremely fortunate to be here, and I'm going to make the most of it.

Wherever I end up.

Trip to Emergency Department: $1870.56

The best way to learn about health care costs is to incur some yourself.

Two weeks ago I got sick from eating bad refried beans, so I went to the ER because I was dehydrated and couldn't stop vomiting. Today I got the bill. It's really amazing.

The folks there took good care of me. They gave me IV rehydration, three liters. They gave me some IV antiemetic meds so I would stop vomiting. They ran a few basic labs. They didn't overtreat me, by any stretch. No abdominal X-rays, no CT scans. No ultrasounds. No crazy labs looking for zebras like porphyria.

Today I got the bill: $1870.56. Ridiculous. Outrageous! But that isn't really the amazing thing.

Why is it ridiculous, apart from its sheer size? First of all, the itemization is insufficient. Take drugs, for example. There's a line for "pharmacy" (298.95), "drugs/detail code" ($91.98), and finally, "other rx services" ($117.00). I was looking forward to finding out how much the ondansetron would cost, but how can I tell from this? I remember how many doses of each drug I got, but how can I tell whether they made a mistake? Are they charging me for five doses instead of three?

I'd like to pay this bill, but not until I'm confident that it's correct. This skimpy information gives me no way to know if it's right or not.

The biggest single charge on the bill is "emergency room." $697.00. Did I incur that cost by just showing up and getting in line? Perhaps there's something to this argument about reducing costs by making them more transparent to patients. If patients know they'll be hit up for seven hundred dollars just by showing up at an ED, a lot of them might choose not to go at all. If people are deciding between going to a movie or going into the ED for some unnecessary medical care, this might be a good thing. But, contrary to the evident beliefs of some of the most reactionary opponents of universal coverage, I don't think many people are like this. I was reluctant to go to the ED, and I want to spend my career in one. Most people, I think, try to avoid the ED until they see no other alternative (which sometimes happens at 3 a.m., I admit). This bill is really huge (but that's still not the most amazing thing).

For the curious among you, here's the entire bill for a simple ED visit for nausea and vomiting:

Pharmacy $298.95
IV Solutions $215.31
Med-Sur Supplies $20.37
Sterile Supply $67.95
Laboratory $23.10
Lab/Chemistry $449.20
Lab/Hematology $140.30
Lab/Urology $49.40
Emerg Room $697.00
Drugs/Detail Code $91.98
Other Rx Svs $117.00

When I was treated, I put a deposit on my credit card. Thus, the last line:

Patient Payment - Thank You! $300.00

Thus, the total bill is $2170.56. Outrageous (but not the most amazing thing). The next step, of course, is to call the hospital to see if I can get a more itemized bill. I'll keep you posted.

But hey -- what's the most amazing thing about this bill? It's not that it's so big, although that's part of it.

The most amazing thing about this bill is that, even if I find no errors in my favor, and I can't get the hospital to come down at all, I'm still coming out at least even with where I would have been had I signed up for the school's insurance plan! Yep, that plan had an annual premium of about 2000 bucks. When you throw in the copay of about 50 bucks, I'd have still been up shit creek -- even with this trip to the ED -- had I signed up for the insurance. I made the judgment that I probably wouldn't incur medical bills this year beyond that, and even with this huge bill, I was right!

Lesson? For someone like me (who's lucky enough to be reasonably healthy) the only thing more outrageously expensive than medical care is medical insurance.

March 12, 2006

Censuring George W. Bush

What does it say about our country when we'll impeach a President for lying about getting blowjobs from an intern, but we won't even censure a President who illegally wiretaps Americans without a warrant? I think it says: the American people are acting like fools and idiots.

Sen. Russ Feingold's call for Congress to censure George W. Bush can't substitute for the investigation we're never going to get, but it is entirely appropriate. Too bad it'll never happen. Here's Feingold's press release.

Even if you agree that FISA ought to be amended to allow the President to do what he's been doing illegally -- if you agree with Bill Frist that we should "[support] the president of the United States as commander in chief who is out there fighting Al Qaeda and the Taliban and Osama bin Laden and the people who have sworn — have sworn — to destroy Western civilization and all the families listening to us" -- George W. Bush still deserves to be censured.

People like Bill Frist who argue against censure aren't arguing just that warrantless wiretapping is appropriate. They're also arguing that the war against AlQaeda demands that we support George W. Bush's lawless behavior. That's absurd. In Frist's words, it's a "crazy political move." No President can be allowed to break the law with impunity. If Bush thought wireless wiretapping was essential after 9-11, he could have asked Congress for that authority. Given the restrictions of FISA, he need to ask Congress to change the law. Bush refused, and now we're going to let him get away with it without even a scolding.

Ambivalent Imbroglio's quick survey showing the highest percentage of respondents saying that we need Bush's spy program to make us safer, and Dan Froomkin's collection of reader comments about why so many Americans seem not to worry about the unchecked power Bush is claiming, suggest that Feingold's censure motion won't fly. It's depressing. Have we always been a nation so afraid? So enamored of the strongman at the top?

What if Tom Wolfe is wrong? What if we could go around saying that "the majority of the American people are fools, idiots, bumblers, hicks"? In a healthy democracy, where the citizens weren't fools and idiots, I would think that the people might actually appreciate being upbraided once in a while if they started bumbling. That's part of holding yourself to high standards, isn't it?

Even the best of us are fools every now and then. If our friends respect us, we hope they'll let us know when we are. The American people themselves surely aren't fools and hicks. But that doesn't mean they can't act foolishly, occasionally. Setting George W. Bush above the law is foolish, and we should say so. Feingold's censure motion deserves support from all of us, whether we think warrantless wiretapping is necessary or not.

Bad refried beans

That's about the only reason I can think of for why I got sick for two days in Sedona over spring break. Heidi and I ate the same food everywhere but at evil Casa Rincon. That's where Heidi laid off the frijoles refritos and I made sure they disappeared down my gullet -- for about 8 hours, at least. Then it was my time to pray to the porcelain God.

(Or should I say, "order Buicks over the big white phone?)

That first day I had to go to the ED for some IV rehydration and antiemetic therapy. Phenergan and ondansetron, baby. I'm curious to see how much it's all going to cost.

Interestingly, the malpractice negotiation exercise that we're doing in my Law, Medicine, and Society class involves a case of missed appendicitis that led to a $25,000 hospital bill after the patient required multiple abdominal surgeries and time on a vent. Even more interestingly, his initial presentation to the ED was exactly the same as mine in Sedona: abdominal pain and vomiting with no abdominal tenderness. The big difference, of course, is that 48 hours later I was better. The patient in our exercise returned with the same symptoms. Still no abdominal tenderness. Of course, he didn't have the benefit of a prescription for antiemetic suppositories, either....