To my young friends who find my columns uselessly esoteric, I order you to stop reading right now. Last month we were able to provide you with practical insights from three brilliant and accomplished legends in emergency medicine. You have no such luck this month, as it’s just me, greased and ready to kick you in the teeth, at least intellectually.
In the dying stages of my column (Oh Henry will conclude at the close of 2016), there are a few issues I need to express. So the unlikely combination of Justice Louis Brandeis, the current Presidential race and the Obama college scoreboard will all get a modicum of comment. Merle Haggard, the Dixie Chicks, Homo Sovieticus and John Paul will all have cameo roles in this piece, depending on how long the cognac holds out.
In May, thousands of young people streamed into stadiums and lumbered out with diplomas as college graduates. The young today live in a virtual world of guardedness, seeing both possibility and peril. My generation was more optimistic. We assumed a respected university diploma was what you need to catapult you into both maturity and prosperity. The system worked in those days. Not so now.
The Obama Administration for reasons that make no sense to me has given us the “college scoreboard.” It is a government project that provides a large number of young college graduates the job of culling data from every four-year institution in the country; except for a few private holdouts who told the government to shove it. This is a caveat emptor on steroids: 4,247 schools sent in data about what it costs to attend their prestigious institutions and what you can expect to be making at the end of ten years out. That’s right. What did all that money and time and a piece of paper buy you when you’re looked at in 10 years? Incidentally, they skewed the data by exempting med schools and business schools. MIT topped the list at $91,600 a year salary when you’re out of the institution for 10 years, soundly beating CalTech at $74,000. Harvard at $84,000 soundly defeats the Whiffenpoofs of Yale and the Tigers of Princeton by $12,000. As expected, schools that put out social workers and education graduates frequently showed that the graduates make less than it cost to go there for one year.
There is a reason I tell this story. Two days before the University of Michigan graduated, I was at the BMW dealership having my Three Series differentially diagnosed and treated. I asked the service manager how business was going. His response: “If I could only hire more techs, it would be great. But you can’t find them. No one wants to do a real job.” He went on to inform me that of his 12 techs, seven had made $100,000 or more last year.
Now look back at the numbers above in the last paragraph. If the administration wanted to give high school students real information, why wasn’t this data collected and pushed at them like the “four-year college” numbers were? Obviously, no one wants you to know that a technical education has some advantages.
What does this have to do with emergency medicine? Everything. We need to reassess our training requirements and make real decisions about what is needed. The Germans view the technician as a respected [and remunerated] class. Job requirements need to reflect the work actually being done. This type of thinking in all forms of medicine tend to bankrupt the federal system without any true intellectual discussion. College debt is real. And we’re going to have to ask more questions if we want real answers.
Let us now praise unforgettable men. 2016 marks the centennial of the confirmation for the first Jewish member of the Supreme Court of the United States. Louis Brandeis served this country as almost no one else has, from 1916 to 1939. I love Louis Brandeis. He is the father of the philosophy that the nation benefits when the states can do their own thing and serve as the “laboratories of democracy.” He understood that the American experiment of creation and governing of a continent-size country was best accomplished when regions solved some of their own problems.
In 1927 Brandeis wrote a defense of free speech that is the stuff of legends after a California woman was jailed for expressing communist philosophy. I am a constitution-caring citizen with a fervent interest in the First Amendment. Brandeis’s defense of these principles has never been equaled. He believed in reasoned discussion and that useless, hateful speech unless it poses imminent danger is acceptable and that the remedy to hate speech is more speech, not enforced silence. Today the most vitriolic and least tolerant space on American soil isn’t found in religious communities but in our rigidly secular academic centers brimming with political correctness and dogmatism.
We suffer an increasingly alienated and vulnerable existence because we inhibit free speech. We lack a true respect for the rights of others to express themselves honestly. Thank God the administration can’t get at our thoughts as easily as our tax returns.
Demosthenes, who flourished in Greece long before Socrates, was told by the god Justice: “cling to that which is and cannot be.” In other words: Unite yourself with permanence. Brandeis went on to undo most of what FDR tried to do with centralizing control and homogenizing the country. Brandeis personally stopped the packing of the Supreme Court. His hope was government at a level that the people could understand would flourish. Go ahead. Pull some Tenth Grader aside ask them to write 18 trillion, which is the current national debt. I bet they can’t do it.
We need more Brandeises today. The Canadians can do healthcare at the provincial level. We can do it at the state level and find out what works. Developing power to an accountable level is paramount in both government and healthcare. Getting back to democracy in a distracted, cynical age will be difficult but there really is no clear alternative.
Which brings me to my last powder keg topic. The current presidential race is the strangest thing I’ve ever seen. I can remember Huntley & Brinkley going gavel to gavel in 1952 when a university-acclaimed war hero, Eisenhower, steamrolled over an actually very kind and interesting intellectual, Adlai Stevenson. In my memory, there has never been this much of a free-for-all in politics. Thomas Jefferson’s vision of an America as a country of self-governing yeomen farmers is passé.
Hillary Clinton’s platform is built on tottering stacks of federal regulations, questionable tax credits and legions of paper-pushers who would make Brandeis weep. To the Democrats, big is better and one-size-fits-all. They never saw the fed program they didn’t like and always feel is an answer to corporate power and civil rights.
The Republicans on the other hand are the freak show of the year. The Dems have outdated ideas and have bankrupted the country. The Republicans seem to have no ideas. As I sit here, I know more about their sexual organs than their policy ideas. Who could imagine a discussion on penis size at a nationally televised debate? Oh, yeah, I’m talking about you, Donald.
In any incoming administration, the real discussions on federal control and excess [insert electronic medical record here] and distribution of healthcare will never go in any orderly manner. The return of medicine to its rightful role will come from some other source and some other people, not this set of clowns. God help us. I wish the ballot had a “no” option. I’d check it in a second.
Lastly, I want to comment on Russell Moore’s piece in the June/July issue of First Things on the death of Merle Haggard. If there’s anyone I like better than Louis Brandeis, it’s Merle. Russell captures his essence when he says: “He stood with, not for.” He was a puzzle, at the very least, to both parties. The then Governor of California, Ronald Reagan, freed him from a life sentence in prison. He was a lovable outlaw and was real, not like those “Duke Boys.” He wasn’t on anyone’s side. His song Okie From Muskogee took a direct shot at the hippie generation. He had “hung out” for some time with both Joan Baez and Richard Nixon.
No one lived such a schizophrenic, detached life; except perhaps Hunter Thompson, who happened to be one of his best friends. He knew right from wrong and knew he was mostly wrong. His songs were closer to the meditations of Marcus Aurelius than the Sermon on the Mount. Never politically correct, but he never turned his back on his friends [because that would be dangerous] and he sang about the miseries he knew. Goodbye old friend, I’ll drink one for you tonight, amigo.
Amicus usque ad aras
When Breath Becomes Air
by Paul Kalanithi
When Kalanithi, a neurosurgery resident, died of lung cancer at age 37, he left behind a wife and an eight-month-old child. He also left each one of us this book – a gift that reflects both his voice as a neuroscientist and his voice as a dying man. Trust me, it will shape you for years in both your practice and your view of your mortality. His scientific basis reconciles with his Christian faith. If you don’t think you have the time to read the whole thing, take it off the shelf in the bookstore and read the last paragraph in which he writes to his eight-month-old daughter. I dare you not to cry.