A while ago I wrote of my small bit of civil disobedience – disobeying, for all of a minute and a half, the letter of the law governing the reporting of suspected child abuse. Here, in contrast, is a report of someone who obeyed the law perfectly. I will leave to the reader any judgement on whether this is a law sometimes best honored in breach and not the observation.
In addition to my own occassional outsider’s observations of the educational systems, I would like to recommend the blog of an old friend from Princeton, an educator whose stature within his field easily eclipses my own. Another old friend who humbly calls himself the “has-been” (well, he “has been” in the White House) will, more likely than not, be an important voice in future politics very shortly, and may (one hopes) have the opportunity to strip some of the collateral damage producing glitches in the laws currently on the books.
As a pediatrician, I hope to be judged on how I handle medical problems, both routine and bizarre. The government, however, assesses physician differently. For those who wish to wade through a lengthy .PDF document, the pattern that emerges is that what the government calls “improvement” in “quality of care” is actually an increase in efforts by physicians to reduce risk behaviors in patient populations. Again, I leave it up to the readers’ judgement whether they would like to wait with a sick child while their doctor lectures a bored teenager about safe sex, good food, wearing a helmet while biking, staying away from substance abuse, water safety, and not getting into cars with idiots — but attention paid to how well we handle acute disease is nowhere near the attention paid to enlisting pediatricians in mass indoctrination. This may be a health care service, but it sure ain’t medicine. In a 1969 Maigret mystery, Georges Simenon had a French doctor voice concerns that now, 40 years later, become ours — the US thus being 40 years behind France in enlisting medicine in the pursuit of social engineering.
Now, my own definition of freedom and liberty includes the freedom of stupidity and the liberty of taking risks, as well as a fairly broad interpretation of autonomy rights for individuals as both personal decision makers, and desision makers for their minor children. The first person to parachute was a brave fool, as well as the second person to try fugu, and our own liberties were purchased by the imprudent men at Lexington, Gettysburg, Belleau Wood, and Bastogne, and say what you will about Spartan (literally) upbringing, if not for them I could be writing this in Farsi now.
But… money talks, and a state that wants to pay for all health care expenses cannot afford to pay for diseases and injuries sustained in pursuit of thrills, highs, and gastronomic delights. Money talks, and it tells us to desist from living dangerously. When you support single-payor medicine, as you consider whether it will take a half a year to approve that MRI, or three months for cancer surgery, as is the case in many countries with socialized medicine, don’t forget to ask yourself which of your hobbies will next be banned as expensively hazardous.