As the world stands by and watches the flames of conflict I am saddened. I am saddened because humanity continues to destroy ourselves. We continue to sow the seeds of distrust and anger among our children. We seem not to be able to remember the pain that we have endured. We call on others to pursue peace as we beat the drums of war. How can peace be attained while retribution is supported? How can we support the process of peace while developing the means of war?
Some will say that war will always be with us. The truth is more complex and challenging than that simple statement. War will be with us as long as our leaders are cowards. As long as our leaders behave like street thugs, but are not held to the same rules. The problem is, there is no one to hold the powerful to the same rules as the weak are held. Fundamentally the thugs that rule world politics are rich in resources both monetary and civic. They are primarily rich in civic resources. Powerful people support the slaughter and protect the barbaric.
We wonder why young educated and economically stable people join in the barbarism of conflicts all over the world. That questions is only asked by the morally deprived. I was brought up with a deep moral compass, in a country that has a longstanding history of supporting the “little” guy. The sun and fun of Jamaica was always equally matched by our deep mistrust of world powers, because we have suffer at the hands of the powerful. The powerful will always abuse the weak as long as the weak allow it. The arc of history is long and today’s victory for the morally deprave will turn into tomorrows sadness.
Many of us, and I include myself have long ago stopped being attentive to the many slaughters on the world stage. We have stopped paying attention because our anger has no outlet. We have joined the ranks of those that have chosen to deliberately not follow the happens in the world. We have stopped watching because the answers are obvious but will never be acted on. The powerful are amoral and the killing of non-combatants has become acceptable. We have stopped watching because there is no one willing to call out the complicity of those that pretend to represent us.
I have stopped watching because it makes me angry. I will not allow my anger to push me into the world of the depraved. I will not become a statistic.
Have you ever wondered why your antibiotic is so expensive? The answer is not as simple as it would seem. The answer is much more simple. The drug company is doing the imperative of every company in the capitalist paradigm. Making the maximum return on investment is the paramount objective. If the company is privately or publicly owned there is no difference.
A key component of profitability is the company’s ability to have “pricing power” in the marketplace. In lay terms, can the company price its products to maximize profits per item? A key component of pricing power is the presence of or not of competition. Competition reduces pricing power; without which pricing power can be maximized. Consequently, the ability to decrease competitive risk is vital. A not often examined part of the profitability paradigm is the patent system.
Most of us know enough about patents to continue to support their continued presence and influence over our economy. Unfortunately, what we know is inadequate to make good decisions. The patent system was designed to give inventors the ability to protect their work for a finite period from theft while allowing others to see the details of a novel work. At the birth of the system it was argued that it would encourage inventors to develop on the works of others while allowing the original developer to have protection from loss of economic benefit. It can be argued that the system has worked very well. However, the current incarnation of the American patent system has drifted significantly away from the original intent.
With the only goal of modern corporations being to maximize profitability the patent system as been adjusted significantly to make it work for big business. The protected period as lengthened over the years. Various legal and technical methods have been used to extend the protected period. This time is used to maximize pricing and profits from the protected product. This is not a bad thing for the company that is benefiting. It is following the primary objective of capitalism, maximize return on investment.
For the individual that is not a shareholder the system is not as beneficial. There are two things that disadvantages the individual, she is deprived of the potential of a better product from the work of another developers improvement on the original and she is deprived of making a better return on her resources secondary to the excessive cost of the product she is buying. The lack of competition is further detrimental to the community as a whole for the same reasons. Even the company that is doing all to maintain its competitive edge by excluding others from the marketplace is losing. The company loses by the loss of the competition that would push it to bring a much improved product to the marketplace.
If the system is objectively examined there is only one conclusion, the patent system as significantly deviated from the original design and should be abolished. I would completely abolish the patent system and unleash real competition into the marketplace. What say you?
Every July 4th I remind myself of the courage of the founders of my country. The beauty of the declaration of independence is in the broad inclusiveness of the sentiments expressed. The global equality of mankind as expressed is at the root of the American dream. However, the history of our country is littered with the carcasses of failed policies and leaders who have not lived up to the lofty expectations of that celebrated document. The 4th should be used as a time to refocus on the sentiments expressed. This land of immigrants is not about where you were born, but about what you believe in. It is about fairness, equity and the continuous match toward a more perfect union.
The dream of America is alive and prospering despite all the attempts to distract. Some have lost hope in the self-evident greatest of the American experiment. I am not one. For people of color the American experience is that of continued heart-break, but there runs a determined strain of hope that as continued to improve our lot in this union. I read the declaration of independence on the 4th to be reminded of the promise and the progress. This is a marathon not a sprint, and we dream of true equality as we march toward that goal. This is my American dream.
I have hope because I have to be hopeful. I have young children and I know that the world has changed for the better and that change will continue. Most importantly I know that the growth in American society is irreversible because my generation and the following have made it so. As the country ages those who express the old prejudices have been out numbered and embarrassed into submission. There will always be a few stubborn ones. There will always be some expressions of darkness, but the light of equity is here to say. Progress has been slow and inconsistent but it is here to stay.
The continuous expression of hope and growth is why I continue to love my America. American greatness is derived from the philosophy of her people. If you were born in this land or emigrated the dream is the same. We are a people buoyed by hope and the understanding that we can be the best and always expect to be.
What is your American dream?
Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care. As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.
Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.
As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.
No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.