The purpose of government

Simply put, the purpose of government is to provide for our needs so that we can provide for our own wants. And, the government should do this in a cost effective way that is open to inspection and review of the citizens.

First are the group needs. We need, as a nation, to be safe from foreign intrusion that might take away our lives, liberty or freedom to pursue happiness. To that end, we need diplomats, ambassadors, foreign intelligence, and a military to discourage aggression against us. We need to be self sufficient in these areas, including the R&D needed to keep ahead of potential enemies. It is the honor and duty of all citizens to fund this part of government.

Next are our individual needs. We need to be free from intrusion by our government and our neighbors on our lives, liberty, property, and freedom to pursue happiness. We need to have a strong infrastructure that provides for these internal needs. A fair and quick court system. Police, fire, and health services. Food, shelter and clothing for those who have none. A clean and healthy environment. We need to fund the R&D that keeps us ahead in each of these areas as well. It is the honor of those who earn money to fund this for themselves and even for those who earn little or nothing.

Basically, everything else can be classified as wants. How do we satisfy wants? We work for them. We pay for them as individuals and perhaps donate them to others who are less fortunate. In this way, we become closer as individuals and are able to do good. It is the honor of each of us to do this for ourselves, to be all that we can be.

Some things will be easier for those with money, such as acquiring things that money can buy. Some things will be easier for those without money, such as having a free spirit to explore the edges of artistic freedom and individuality. Like the game Shoots and Ladders, people rise and fall, sometimes in their lifetime, sometimes over several generations. Anyway, this is all about wants.

Whose mood?

Passions are great! Without them, we would all be like Mr. Spock in the early episodes. Cool to watch, but dull to be.

Time is a construct of the mind. In truth, we exist in the present, except when our mind takes us into the past or projects us into the future. While it is important to learn from the past and to try to bend the present to create a future we want to live in, the only way we can do that is to fully exist in the present.

Some mental illnesses, such as depression, may be seen as a failure to exist in the present. Most depressed people DocBrain runs across are anchored in the past. They ruminate about the past as if their thinking about it will change the facts or, more specifically, change how they feel about their contribution to the past. Like a criminal returning to the scene of a crime, the depressed person returns again and again to the past, but finds no solution, no resolution. In truth, the only resolution comes from living in the present.

Is it the mood that drives them to look for an explanation and to delve into the past, or is it the delving into the past and inability to enjoy and fully experience the present that depresses the mood?

DocBrain remembers visiting one elderly depressed woman living in a nursing home. She was crying, her husband was trying to console her, and I said, "You have to try to enjoy life. You never know what might happen." Suddenly, as if on cue, there was a knock at the door. A nurse entered with a large flower arrangement. The flowers were from a neighbor who had move away years before. The accompanying note said, "Just found out you were sick. We just wanted you to know we are thinking of you. Please get well soon."

The old woman look stunned, stopped crying, and slowly smiled. She began to reminisce about her neighbors and how they had such fun together. She talked about how nice it was to be remembered by such nice people.

I left the room around that time, but spoke to her husband a few days later. He said that the good spirits lasted about one hour, and then she returned to her crying. She died one year later, never, to my knowledge, experiencing such joy again.

Things are as they are, not as they were, nor as they might be. Don't bring the miseries of the past into the present unless you want to be miserable. Don't fear the future, for it will never be exactly as you project it to be.

Life life in the present and enjoy it. It is all that is real. And if it isn't all that great right now, it is OK to look back for fond memories and ahead for better times.

Patient Centered Health Care

Health care is no longer centered on the patient. It is centered on rules, bureaucracy, regulations, insurance companies, and government.

Here are some of the problems with the current system:

• Information cannot be shared about your health easily. Not a problem if you are a conscious liberal concerned about your privacy, but a big problem if you have cognitive problems and your health information is scattered. For example, a patient with a brain hemorrhage was transferred to our hospital for rehab. While there, he deteriorated and became comatose. A CT brain scan showed a large hemorrhage with brainstem compression, but was this new, progressive, or the same as before? We had a report from the referring hospital which was unclear about the mass effect. When we requested the films from the other hospital to compare studies, they wouldn't release them without a HIPPA release. We called in the wife who signed the release, but the other hospital wasn't satisfied. "Why didn't the patient sign?" they asked. Of course, under HIPPA, we cannot tell them why, as we would be disclosing health care information. Eventually, they agreed to send us...a report, not the films. Why? They said they didn't have any films! So, we decided to send the patient to them for re-evaluation. The doctor there initially refused to accept the patient, as he was convinced that there was nothing wrong. An attempt was made to send the patient to the emergency room, but this was a violation of EMTALA. So, eventually, the patient was sent to an ICU. All this because a film could not (or would not) be sent. No common sense. No patient-centered thinking.
• If you have a condition that is best treated by a medication that your health insurance doesn't have on it's formulary, good luck! This happens frequently. If you are lucky, you get it with a high co-pay. Or perhaps, you and your doctor agree on using something less optimal for your care. How good is that?
• If you have something unusual and there is a treatment for your problem that is well documented in the medical literature, but for some reason your doctor has not read about it, pharmaceutical representatives are forbidden to let your doctor know even if your doctor asks, unless that information is allowed by the FDA. How is that FDA regulation patient centered? It is more based upon the fear of sleazy marketing practices than upon your need for help as a patient.
• Truly, doctors, hospitals, nurses, and pharmaceutical companies try to provide for your health in an increasingly frictioned and hostile legal, bureaucratic, regulated, "managed", insurance based environment. Is the current system working? Patients still die in the hospital from medical errors, so you be the judge! The cause of the errors is the system, not the people. And the doctors, nurses, hospitals, and pharma companies are on the receiving end of the rules. We are not the problem. We are the solution.
• When pharma makes a profit, it plows the money back into research or into giving free or reduced price medications to those in financial need. When doctors and hospitals make a profit, they spend it on either bringing more services to the area, hiring more people, or buying goods and services, generally locally. When health insurance companies "make a profit" they spend and use it to further their image. They buy advertising in sports stadiums, TV ads, planes, buildings, donate it to symphonies, etc. Guess what? It isn't their money! It is the hard earned money of the subscribers to their plans. These subscribers get less care and don't even get the surplus back as a rebate against future premiums! The true enemies of good health are the government, the health insurance companies, and to a lesser extent malpractice attorneys. However, they have framed the issue of health care to make it look like they are the good guys in white hats. The AMA and PHARMA have sat back and accepted the framing of the issues, doing neither their constituents or the public a good service. It is time that doctors, nurses and hospitals take back health care from big government, big insurance, and big law. It is time to free the pharma companies to bring the excellent products in development to us, the patients. It is time to make the USA a great place to do pharma research, bringing jobs and talented people to our country. And, it is time to bring back charity in health care. Time to give back, to pay it forward. Time to give patients what they need in the way they want it. To paraphrase JFK, ich bin patient.

Feelings

A few Penn State students dressed up as victims of the Virginia Tech shootings at a private party. Some pictures were taken that eventually made it to the news media.

There are three issues in this situation:

1. Don't ever do anything in private that you would not want known in public.
2. It is wrong to act in any way that might offend another person's feelings.
3. Is this an issue of privacy or secrecy?

If interpreted strictly, few people would be completely comfortable with making every moment of their lives public. While the bar of public decency is to not offend, exceptions are allowed where there is a need to present another view that may not be "politically correct" but does express another viewpoint. That is the concept of freedom. People have the choice to have a cognitive and an emotional response to your message, or even to ignore it. This event of "performance art" is no different than the urine on Jesus picture or any other artistic expression that incites the emotions. The message that I got was that the Penn State students thought that the VT situation was being milked for secondary gain by many people who had nothing directly to do with the event.

The more complicated question is whether or not this was a private or secret situation. The students who staged it thought of it as a privacy issue, while the news media are playing it up as a secrecy issue. To me, it was a privacy violated rather than a secrecy exposed.

It is more telling how the news media milks all stories. Now, that would make a great parody!

Wants and Needs

DocBrain needs a new car. I really do! My old car works just fine, but there is a really nice AWD foreign sedan that I really like! It is only about $35,000. Just respond to this post with your email address and I will give you an address where you can send your check to help me with my purchase. If you are living on a limited fixed income or earn less than $10,000/yr, please do not send me anything. Otherwise, just let me know how to tell you where to send the money.

If you are sending me the money, thanks. If not, there are only three reasons why you wouldn't do it.

First, you don't have the money.

Second, you don't believe that I need a new car. You believe I want a new car. A person in need creates a desire to help. A person who wants but doesn't need something is usually on their own.

Third, you don't believe I have the ability to (legitimately) force you to give me your money. If I were king, I could command my troops to take the money from you if you did not comply willingly. Resistance would be futile. So filled with resentment, you would just fork it over.

Does any of this seem familiar?

Many wants are framed by lobbyists and politicians as needs in an attempt to pander to constituents. Similarly, many needs are ignored in an attempt to pander to constituents. Don't believe me? Think about it!

How do you decide if something is a want or a need?

DocBrain believes that needs are in a way inalienable. Without them, there is no life, liberty or pursuit of happiness.

For example, here are some things DocBrain considers needs: oxygen, clean water, nutritious foods and supplements, exercise or other physical activity to keep healthy, knowledge about what is unsafe and dangerous in the world, shelter, clothing for modesty and to protect against the environment, facilities to keep clean, personal space to be alone, companionship, purpose for living, someone to take care of you in your infancy and childhood until you are able to take care of yourself, and health care to keep you comfortable, well and alive.

Our government has no trouble taxing us for some of these, but refuses to provide for all the needs, ignoring some in order to curry favor by providing some wants instead.

Many children are born into situations where no one takes care of them. CYS is such a slow, blundering bureaucracy that these children are permanently damaged before they can act. Nowhere is there a federal law about exercise. Our laws about healthy and unhealthy food choices are more based on information rather than action. We give money to the poor but do not check and see if they use it to satisfy needs. If we really care about people, we will help them with their needs, and let them do what it takes to satisfy their own wants.

The problem with liberals is that they purport to care, but really just want to appease. Wants are placed above needs for votes and to accrue power. Needs are diminished when a strong posture would cost votes.

Conservatives tend to reduce the number of needs to a small subset, creating true need. At least conservatives leave the community to handle the unanswered needs.

What we need are people identifying, framing, and labelling a strong position where we, as a society, address the true needs of people and leave the wants to individuals to achieve through their own efforts. Empowering people such as Bill Cosby, Martin Luther King, Ronald Reagan, and JFK, among others, have raised the bar as to what we should strive to as individuals and as a society.

Just protect all our children from unfit parents, more strongly encourage healthy lifestyles, keep our streets and neighborhoods safe, and I will buy my own car.