Tuesday, April 03, 2012

Primum non Nocere

I wrote the other day about how tiring it was looking around at the seemingly bottomless ocean of venal and stupid that is much of my country at the moment.

Here's exactly the sort of thing I was talking about, and why it's so frustrating, courtesy of Fred Clarke at slacktivist;
"Solicitor General Donald Verrilli, discussing the free-rider problem created by the millions of uninsured, spoke of “...the social norms that allow — that — to which we’ve obligated ourselves so that people get health care.”

Scalia responded, “Well, don’t obligate yourself to that. Why — you know?”

Justice Scalia’s remark there isn’t addressing the Affordable Care Act or its constitutionality. He is addressing an earlier law, the Emergency Medical Treatment and Active Labor Act, signed into law by Ronald Reagan in 1986. That’s the law encoding the “social norm” Verrilli mentions — the law that requires hospitals to provide emergency care to anyone in need regardless of their ability to pay.

Scalia’s suggestion was that this law be dismissed. Or perhaps just disregarded because, eh, it’s just a law, so whatever. He did not try to say that it was unconstitutional — it clearly is not. He was simply suggesting that he finds it inconvenient and thus that we, the people, ought not to have written into law a social norm that runs counter to the social Darwinism he seems to prefer."
Now I'm willing to accept that there's an argument to be made for and against the notion of how sick and injured people's care can and should be paid for.

What I can't accept is the argument for just NOT caring for these sick and injured people at all.

That's...beyond callous. Clarke calls it stupid, idiotic.

But I'd call it worse. I'd call it insane.

And suicidial.

Let me explain why, and use an analogy I know pretty well.You all probably know that I was a medic in the U.S. Army. I am proud of that, proud that the guys I served with called me "doc" and seemed happy to see me roll up with my bag of health care. I liked that I was their country doctor and was asked for medical advice on everything from head lice to erectile dysfunction (and I had a hell of a time with that one, I can tell you...)

But, here's the thing.

Why should an army bother with medics?

I mean, a wounded soldier is useless. He or she can't fight, they can't work. Even worse - they suck up valuable resources away from combat power. Another soldier has to stop fighting and care for them. Other soldiers have to carry them - often requiring an expensive vehicle or aircraft and all its logisitical tail - back to where another soldier - a highly paid surgeon - can treat them.

And there's worse!

Then a fully staffed hospital must be organized to care for this useless soldier. Nurses and medics for daily care, doctors, therapists. If the soldier is so badly injured that he or she cannot return to duty - and let's not be all swoony, the whole point of a hell of a lot of this medical care is to get that trooper back to work; the motto of the Army's Medical Corps is "To Conserve the Fighting Strength" and don't you forget it - the Army still doesn't stop wasting time, money, and people on them.They are shipped back to a CONUS medical center where they are taught to live as best they can. Often it's not great, but compared to the injured soldiers in earlier wars the U.S. trooper has a pretty damn good deal.

Starting with all those expensive medics.

Why? Why the hell would any sensible military organization waste all this stuff?

Okay, you know the answer and so do I; it's part of the contract.

One way armies get soldiers to fight - smart armies, armies that understand how people think - is to make sure those soldiers understand the Deal. You fight for me, I'll take care of you when you get hurt.

Which is why, by the way, that old soldiers like me tend to scream at the VA when it fucks up, or at other people or politicians when they fuck with the VA. Because they're trying to renege on the Deal. And that's why, for all that it probably drives them crazy, none of our deficit-"hawk" politicians is willing to go all budget-cutty on things like medical treatment for wounded soldiers. They know their ridiculous expeditionary wars in central Asia are not popular - imagine just how not-popular they'd become if messed-up GIs started falling all over the sidewalk?

But these jokers, both the professional funnymen like Tony Scales and the non-made guys like zombie-eyed granny-starver Paul Ryan (thanks, Charlie), don't seem to understand that societies have a very similar dynamic down underneath.

Once we moved along from the Hobbesean world of pure tribalism - and even most tribes works on the basis that you care for your helpless young, old, and sick - we developed a sort of Deal; the stinky common people worked their asses off, and in return the nobility went easy on them from time to time.

This has taken a hell of a lot of different forms throughout the centuries, from largesse, panem et circensus to Henry Ford paying his rivetheads three bucks an hour.

It isn't a giveaway. It isn't charity. It's part of The Deal, and when the people on top, the people like Scalia, forget that, things can go to hell in a hurry;
"We were hardly seated before a head at the end of a pike was presented at the window. Tison’s wife screamed loudly; the murderers thought it was the queen’s voice, and we heard the frantic laughs of those barbarians. Thinking that Her Majesty was still at table, they had raised the victim’s head so that it could not escape her sight; it was that of the Princesse de Lamballe. Though bloody, it was not disfigured; her blond hair, still curling, floated around the pike."
The U.S. Army isn't a perfect organization by any means, and it, like any other big corporation, can do some damn dumb things when it tries.

But it is also charged with doing one of the most damn deadly difficult things ever invented - fighting wars. And in doing so has learned that some things just don't make any sense at all, and screwing around with the privates, and leaving them to die when they get sick, or hurt, is the quickest way to break the damn Deal. And that when the little people are finally, throughly convinced that you are willing to let them fucking die before lifting a finger or spending a nickel to do something, well, they tend to figure they have nothing to lose, and from there the discussion usually deteriorates. Into something less pleasant.

Putting heads on pikes and such.

So I'm not sure if Scalia and his intellectual siderunners are, as Clarke believes, stupid, or just, like the Princesse de Lamballe, greedy and shortsighted. Or like I suspect, all the above and to the extent that it makes them functionally suicidal; if they got what they wanted they'd put us on a path that would make a real revolution, a genuine, bloody, civil explosion, not just inevitable but necessary.

But whatever there reason, their hearts or their shoes, the effect seems to be the same; a longing for a world where people don't act like people - who can be tossed out to croak and won't destroy their society if it shows it doesn't care about them.

I honestly have no idea how this nonsense will end. But if it ends, as at least one prominent conservative seems to think it should, with the poor bleeding out at the door to the emergency room, well, then...

...how fucking stupid and suicidal would that be?


Like I said; the damn ocean of stupid just seems to go on forever.


rangeragainstwar said...

The SC will rule on politics rather than law.
I'll bet money on it.Just like in 2000.
Being a Medic(pecker checker) is indeed a noble profession.
I salute you.
BTW-Archeology Mag did a thing on medical treatment in the Roman Legions.

FDChief said...

jim: Agreed on the Supremes. But the Scalia thing is just fucking insane. Here's a guy - not one of the GOPs licensed fools like Rushbo or Beck or Malkin - who's what in goomba talk we like to call a "made guy"; he's one of the big heads at the end of the table - saying "Hey, what's the problem? Those uninsured fuckers? Let'em croak..."

Can you imagine a threat briefing where the brigade surgeon gets up and tells the one-star that he can't get Class VIII resupply and the brigade commander just looks at him and laughs? Tells him "Oh fucking well, some guys were gonna die anyway?"

His division commander would have him commanding a supply depot in West Buttfuckistan before the briefing was over!

And yet here's one of the senior people in the GOP suggesting - yeah, I know, this is part of their schtick and he "probably" wasn't serious - that the real problem is that medics and docs worry about helping sick and injured people rather than who can pay or not?

Any commander who took that attitude would be considered flat-out, stomp-down fuckin' nuts.

But that either is, is is becoming, the default position of a third of our country.

And that IS fuckin' nuts.

What the hell is wrong with us?

FDChief said...

But that either is, OR is becoming...

rangeragainstwar said...

The SC has ruled v. Clinton v. Jones/Gore,00/and will rule v O,12.
The system of checks and balances has lost it's meaning.
We have an imperial presidency, but what do we call the equivalent SC?
A mafia Don is more honest than the 5 supremes.At least ,as Dylan says- to live outside the law you must be honest.This is beyond the SC.

FDChief said...

Agree. The frustrating part is that somewhere between a third and half of the citizens of our country look at this and see FREEDOM! They have taken the position that they want their desired outcome more than than they want a working republic; they'd rather be dead than Left...

And I have no freaking idea how you make a republic work with half the citizenry coming from there...