Freeloader Nirvana

No Cows Were Harmed

Your typical leftist, a person conditioned for shameless abasement to every social issue that can be blamed on his distant ancestor who allegedly once shot an indian, eats his bowl of Ben and Jerry’s ice cream with the same gusto he usually reserves for giving other people’s money away in the name of social justice. Ben and Jerry’s, as anyone who has taken the tour-cum-political-indoctrination-session of their environmentally friendly facility in Vermont knows, makes ice cream with a social conscience (sort of Cirque du Soleil meets Baskin-Robbins) and there is no hint of filthy lucre or consumerism allowed in this happy, shiny place, even the kind that paradoxically allows people who would otherwise deny to the very gender-neutral and non-denominational heavens their involvement with materialism to spend five bucks for a high quality confection that is the very essence of unfettered materialism. It’s like paying four dollars for a coffee at Starbucks while writing poetry about lynching Dick Cheney and other evil capitalistic tools. There’s kind of a disconnect. But you see, Ben and Jerry’s is materialism with an alibi. You can feel good eating it knowing that the cows making the milk not only were given no growth hormones but also had full access to all of their reproductive options.

In a similar manner, Social Justice is just welfare with an alibi and is a concept to which the left has cleaved because “welfare,” itself at one time a noble sounding word, has so many justifiably negative connotations that to but breathe your support of it will lose you an election faster than a fat kid can inhale a cupcake. The very word itself carries with it the image of a great mass of freeloaders, relieved from the responsibility of providing for themselves, deciding to trade the struggle for a possibly higher standard of living for a lower one but one which requires no productive effort on their part. An unfair generalization of the poor, but true enough in many particulars for anyone who understands human nature and the destructive effects of a large dependency class on both the the intangible moral fiber of the nation as well as the on the economic growth required to pay the tab for multiplying entitlements. The number one problem, after all, of all the Western Democracies is paying for the freebies that were rashly promised in the deceptive times before people discovered that being non-productive was a viable option.

Without belaboring the obvious (although maybe not so obvious as economics seems to be little taught nowadays in the propaganda mills that pass for universities) a government has three choices open to it to pay for its obligations; things like Medicare, for example, which is an obligation because it promises, by law, to pay for the medical care of the elderly even if and when expenditures outpace the tax revenue required to meet the obligation. Your elected representatives can either borrow money from the private sector and do nothing (always a popular choice) in the hopes that the system will only crash and burn after they are out of office; they can print or otherwise create funny money to throw at the problem resulting in inflation and a comensurate devaluation of the currency; or they can raise taxes, a strategy with tremendous appeal to the purveyors of class envy but which has disasterous consequences on the production of goods and services, stifling as it does the incentive for individuals to be productive and increase the wealth of the nation. This wealth is the sum total of all the goods and services produced and what is required to to serve as collateral for the mortgage we sign when give every American the right to have as many babies as they want on somebody else’s dime or take no responsibility at all for any aspect of their medical care.

And we’re going to justify this kind of thing by invoking Social Justice, a nebulous phrase that is so ghost-like nobody can really define what it means except that by God, somebody’s giving out free money! To some, social justice means equality although it’s a crazy kind of equality. If everybody is equal and medical care is a right, are people who pay for better medical care violating somebody else’s rights? This would make the entire ruling classes of Canada and Europe, people who can and do avail themselves of medical treatment not available to the proles, the biggest violators of human rights on the planet. They need to be arrested. But why stop at medical care? Housing is more important to most people. You’ll die in an hour or two here in the frozen part of Yankeeland without shelter. Your high blood pressure? Hell, that’ll kill you at a leisurely pace. Does the right to housing guarantee a yurt? A crappy apartment in some crime-infested project? A split-level ranch in the suburbs? A mansion? Why the disparity? It is a right after all. My freedom of speech is not better than anybody else’s, why is the right to housing any different?

Some leftists, driven by self-loathing for their privileged upbringing and their hatred for their nation, define Social Justice as payback, extortion to be paid to the poor because once upon a time, some African tribal king sold a distant ancestor of the underserved to a Muslim slave trader who ended up, after being processed in a Portugese baracoon, in the Virgina colonies. The only equitable thing thing to do then, if you go in for this kind of nonsense, is to give everybody who still feels the psychic pangs of the suffering of their distant ancestors a bunch of freebies, paid for by people whose ancestors may have had nothing to do with the distant crimes and in fact, as is the case of my own Greek ancestors, had their own problems at the time. In the name of equality and Social Justice, we’re going to assign collective guilt to people based on nothing but their ability to pay protection money to their leftist masters, a strange notion of justice more in keeping with some third-world kleptocracy than a country built on the principles of individual freedom and inalienable rights.

Throw then, oh you who long for social justice, a general blanket of oppression over everybody who is poor and insist that it is The Man keeping them down despite the fact that a constant stream of immigrants, arriving from countries were oppression truly exists, have somehow managed to pull themselves out of poverty and run circles around the children of the big, bad oppressors, those rough beasts, their hour gone, shuffling towards the trailer parks. It will have to be a general kind of blanket, a big, wet, suffocating blanket because unless you plan on convening a Council of Wizards to divine the complicated mileu of each life-perhaps deciding that a Greek who only suffered a little at the hands of his ancestral oppressors is only equivalent to three-fifths of a real, oppressed man in good standing-there is no way to equitably distribute anything at all. To even try is to exacerbate what isn’t even a problem except that we gotta’ have our alibi.

36 thoughts on “Freeloader Nirvana

  1. Dr. Bear, you are my blogosphere hero. I am a career-changing medical student, so I have so far been shielded from the grosser problems of the medical system, but I must agree with your basic philosophy of the importance of personal responsibility and the dangers of a hand-out-driven bureaucracy or system of entitlements. My prayer for our country is that it will return to model of personal liberty wherein one strives for personal achievement and securing the wherewithal to take care of oneself. Thanks for your thoughts.

  2. Not that you’re trying, but do you think that blog-skewering the concept of “social justice” has convinced a single member of your readership to shift a significant opinion or maybe even a vote? I appreciate the creative hyperbole used to mold your point, but it’s been my experience that no matter how measured the conversation, arguments about the role of government in anyone’s lives end up dying a harsh death after some name calling. People rarely budge, and it has convinced me that goading someone’s personal philosophy through rational discussion is about as easy as having them trade wives or switch religions. I’m sure you don’t need more people telling you that reading your blog makes them feel slightly less guilty for never reading all those great literary classics, so I’ll just say that for the most part, I agree with you. Call the lab & talk them out of some O neg. Hearts are gonna bleed on this one.


    (I have never, to my knowledge, changed one person’s opinion in any significant way on any significant issue.  However, there are a significant number of people who have no opinion or have never considered some of the topics we discuss here so I’m hoping to have first crack at ’em. -PB)

  3. Panda,

    I don’t know if you saw in the news today, but Grady Hospital in Atlanta might be shutting down. According to the New York Times, about one third of Grady’s patients are uninsured, forcing the hospital to lose millions upon millions of dollars each year in unpaid medical care. Emory University and Morehouse College of Medicine have both threatened to pull their physicians away from Grady because the hospital’s inability to pay for attending salaries. This truly magnificent hospital, which serves as a major teaching facility and treatment house for many people in Atlanta is being forced out because of the freeloader mentality. What’s worse, government groups from the federal, state, and local level have refused to participate in any bailout package. So here we see the government is forcing the hospital to take on uninsured patients at a loss, yet it does nothing to try to even pay for these health services. And to think that Obama is going to to save us from health care crunch…

  4. From your “about this blog” section:

    “I am interested in your political point of view as it relates to medicine but this is not a political blog and, as I am still post-ictal from the 2004 presidential election, I will delete any toxic spew of the type that passes for political debate on much of the web.”

    So… I’m waiting for you to delete this idiotic post. Your entire line of reasoning is weak. Not everyone that is disadvantaged is a “freeloader,” I doubt that anyone who believes in provider some sort of social safety net is doing it because of their ancestors (mine were Native Americans, so I guess I’m oppressed too). The idea that guilt has anything to do with it is silly. I look at it as the moral imperative of the strong to look after the weak. I realize that is not how it’s done in the jungle, but who in the hell thinks that society ought to resemble the wild?

    Despite my oppressed ancestors, I still make more than the median household income in America, so why shouldn’t I want a portion of the taxes that I pay to go towards helping people less fortunate? I don’t want to take your spittle laden diatribe in to more vitriolic territory, but between having my tax dollars fund teeth cleaning for the daughter of a single mother versus funding a useless war, I’d rather help the kid. You don’t even need to be entirely altruistic to support that kind of action. As a physician you ought to realize that there are public health reasons to, for example, vaccinate everyone regardless of their ability to pay. Subsidizing that is not only an act of charity, but a good self-centered action to keep yourself and your children safe from disease.

    Anway, that’s enough for now. I think there is a good argument to be made for scaling back the amount of care provided, opportunities to make it more efficient, and so on. Also if we could reduce the tax burden on more fortunate folks like you and I, maybe I could just choose to donate that extra income and you could choose to keep yours. There are plenty of good arguments for how to improve the system, I just felt that your post here didn’t cross the 60 IQ point mark.

    (Buddy, if the shoe fits, wear it.  As I have always said, the way to send a liberal into fits of shrieking is to accuse him of being a liberal.  You obviously didn’t really read my article but just sort of waded into it with your knee on a hair-trigger and didn’t get past the first couple of lines before it started jerking.  I want you to tell me, specifically, what I said that was not unvarnished and perhaps unpleasant truth.  I can, for example, with very little effort dedge up a thousand liberals on the internet and in real life who believe very strongly in the concept of “reparations,” that is, that whitey needs to pay real cash money to black people in atonement for sins that my ancestors, as they were being mightily oppressed by the Turks at that time, had nothing to do with.   Social Justice, you understand, which even you will admit is, just like I say, a fairly nebulous concept and thus not something upon which public policy should be based.  Hell, even Graham at Over!My!Med!Body!, a great blog but also stricltly adherent to all that is good and holy in the political left, admits that he can’t define social justice.

    I also don’t know where you are in the medical world but I assure you that almost every Emergency Medicine blogger out there with the exception of Shadwfax who has taken his ball and gone home will confirm that freeloaders are a huge problem in at least our specialty.  It’s not a secret.  Is it half of the uninsured?  A third? A fifth? Opinions will vary.

    The other thing is, I am very lenient of my critics on this blog provided they have a point (which you do).  On the other hand you display a marked tendency to be intolerant of other people’s opinions.  I didn’t insult you (aforementioned shoe excepted) so the need for you to get all snarky to me is fairly rude.   I imagine that if I had just said, “Dear Readers, many people are lazy freeloaders and will abuse the social safety net, therefore we should move towards a system which minimizes welfare benefits,” you’d be more polite and even agree with me a little.  The problem is that not only do I have to be informative to keep this blog a going concern but I also have to be funny, sarcastic, interesting, and entertaining.    This involves a certain amount of literary effort where I use metaphor, humerous examples, and funny things straight-from-life I have seen and heard.  The presentation is the thing, you understand.  If I was boring you’d be happier because as it stands now, I acutally have a chance of influencing opinion in my little corner of the internet because people do read, even if it hurts ’em. -PB)

  5. If you want a portion of your income to go to help the genuinely down-on-their-luck, be my damn guest. BUT DON’T MAKE ME DO IT!

    You’re totally missing the point, so I hope that paragraph got your attetion. Like Panda, I think it is ridiculous to think that anybody is honestly opposed to helping those in genuine need. However, it is silly to help those that AREN’T in genuine need… you are actually repressing them! (just like when you send all your “aid” to Africa).

    Subsidizing is never an act of charity. If you had ever taken an economics class you’d realize that you only subsidize behavior you want to encourage (think unemployment).

    If we spent a little more money selecting for those that ACTUALLY needed the help, the net gain in efficiency would be astronomical. You lost a leg in ‘Nam? Here’s your check. You smoked yourself into COPD and are too lazy to work? Sorry, buddy.

  6. Dude, I thoroughly enjoy many of your posts. As an ER tech, rising medical student and Democrat, my sympathy for the poor and battered is tested about 15x a shift, and it’s falling.

    However, you might want to lay off the straw-manning – speaking of some monolithic left in which everyone shares the most fervent 1968 ideals.


    (Once again, it is necessary to occasionally make generalizations.   Generally, it is people who generally hold views that we would generally say are generally to the left of, let’s say, people whose views are generally to the right who generally use social justice as a justification for things that we can generally say are leftist.  This is not the same as propping up a straw man to knock him down.  Are there people who believe in Social Justice (the alibi kind) who are not leftist in most of their ideals?  Sure there are.  But not generally and you know it as well as I do. -PB)

  7. The “straw-manning” comes from both sides here. Despite the fact that Panda has repeatedly asserted that he is NOT against providing healthcare for CHILDREN of those who can’t afford it (or who refuse to give up their satellite TV to afford it), those who comment frequently bring up examples which include tax dollars used to, well, provide healthcare for children.

  8. Wow, Dan: You are a liberal. You talk about giving to the disadvantaged – but you want to do it with OPM (other peoples money).

    Want to give to charity? Go for it, bro. Want to give away my money? Drop dead


    (“Disadvantaged,” “underserved.”  Talk abouty euphemisms. -PB)

  9. The real question is where do we draw the line? What coverage should be the minimum expected from the government, if any? Vaccines? What if you get into a car accident and can’t afford treatment (right now, the ER is obligated to treat them)? What about if you have cancer?

    How do you judge if someone can afford health insurance, but also what do you do for people whose coverage is denied? There are many people who insurance companies won’t cover. The insurance companies certainly have that right – they are a corporation and have to make a profit.

    So the question is if we as a country should say, ‘Too bad, you can die of cancer.’, or we can provide them with care. No healthcare system will be perfect, but you cannot deny something so essential on the basis of ‘freeloaders’.

    If everyone has the basic minimum care, those who can afford it will certainly get better care, but its not about providing the best possible (and most expensive care) for everyone. It’s about providing the minimum standard of care for everyone. If you can afford better, as with everything else, go for it. I don’t really buy that it would bankrupt the country, as we already spend equal or more than most countries on healthcare.

    In such a system, we will certainly have to ration care, and as you say, a lot of money will be saved because we wouldn’t spend $100,000 to prolong the life of a 95 year old for an extra day. That outcome, to me, is a much better one than a 30 year old being denied insurance for cancer and goes broke trying to pay for it himself.

  10. It’s a complicated issue and I think things are getting mixed up. Some people on here have talked about Welfare. I agree, paying people not to work is bad — I would not cry if that went away. As I mentioned in my post, part of the issue isn’t that people can’t get jobs, it’s that they can’t get jobs with healthcare benefits. Being able to put dinner on the table should be possible for anyone other than the truly disabled (who should be cared for, in my opinion).

    On the other hand, one person suggested that I lack education in economics. I would argue that you lack imagination. You cited unemployment, there is support system that requires you to pay in to take out in proportion. It’s not so much a hand-out as government sponsored insurance (in this case, insuring your income for short periods). That is a good thing, in my opinion.

    Let me take a small tangent. The housing bubble burst and people are losing their homes. Would it be fair to say that as conservatives your take on the issue is “They were irresponsible to take out loans they couldn’t pay back. Let them live on the street.” And, if that is your view, I agree with that — in principle. The problem is that allowing nature to run it’s course would have disastrous consequences, that’s why Paulson (a person who, I’m sure you realize has more economics experience than any of us will ever have) has worked to provide this “government bail-out.” It’s not just for the people losing their homes, it is in our self-interest (you remember Adam Smith right?) to stabilize the economy.

    Back to providing a minimal standard of living, I think it’s very similar. If you refuse to pay, will they stop showing up? No, that’s already the system today. If you could refuse to treat them do you think they would just go die in some alley? I’m genuinely curious in this case. What sort of change do you really want to see (Yes to unemployment, no to welfare, yes to insurance, for example). And what do you think would be the effect?

  11. So wait, all those idiots who signed up for ARM’s and are now waking up to reality were out on the street BEFORE this scam was cooked up?

    “Stabilizing the economy” now means that you have to buy idiotic peoples’ way out of their idiocy? Or what? They’ll riot? It’s called extortion. It’s called welfare. Now it’s called “Social Justice.”

  12. I think we have to accept that in this world when given the chance, everyone is a freeloader.


    If somebody offers you something for nothing, there isn’t anyone anywhere who can honestly say they won’t try and take advantage of the situation.

    So accepting that everyone is a freeloader and FREE=MORE applies to every living being in this nation/world goes along way to understanding why our financial house is in the mess it is in.

  13. Dan says:

    “On the other hand, one person suggested that I lack education in economics. I would argue that you lack imagination. You cited unemployment, there is support system that requires you to pay in to take out in proportion. It’s not so much a hand-out as government sponsored insurance (in this case, insuring your income for short periods). That is a good thing, in my opinion.”

    I’m not sure what you mean by “there is support system that requires you to pay in to take out in proportion”- I’ve paid plenty to state coffers and I’ve never taken unemployment. I personally know 2 people that have taken out but never paid in. Government-sponsored insurance IS a handout. Particularly when there is no scheme to separate the disabled from the cheaters.

    Imagination? okay….

    “that’s why Paulson (a person who, I’m sure you realize has more economics experience than any of us will ever have) has worked to provide this “government bail-out.”

    You do realize that plenty of people with the same level of economic experience DON’T want a bail-out, right? Anecdotes, anecdotes, anecdotes… so much easier than citing real evidence that I used them in my reply 2 paragraphs up.

  14. What about the people who do work full-time but who don’t have available health coverage? I am a hospitalist in a poor rural area of a poor rural state. I share your frustration with those who don’t seem to take responsibility for their own lives. But, I have taken care of too many really nice people who don’t have a lot of choices. For example type 1 diabetics in their 20s and 30s who can’t get hired at small businesses because they would run the health insurance premiums up, can’t find any private plans to touch them, and are married so don’t qualify for Medicaid, etc. due to their spouse’s income. Not everyone has the ability to get a job at a large company where they won’t be screened out of the insurance pool. I have several of these folks who have been hospitalized for ketoacidosis who don’t smoke, try to take care of themselves, etc. But they get some other trivial illness like a viral gastroenteritis and it throws them into DKA. I would not mind at all if there was a list of qualifying diagoses that would allow people to get covered by government (tax-payer) funded insurance. My “responsible” patients would gladly pay into such a plan. As physcians, we need to focus on specifics, not generalities. There are a lot of free-loaders out there, but there are also a lot of people doing their best who have the deck stacked against them.

  15. Exactly what I’m talking about. I have a heart, I want to help those that can’t help themselves. I REALLY want to find a way to tell the difference.

  16. Look, the problem — as PB has made clear — is the freeloaders for whom there’s no compelling reason why they should be, not the people who really have no alternative.

    Primary care is not expensive, so anyone talking about the inability to see a PCP has got matters sideways. There have been ample examples offered showing what people are willing to pay for which they don’t need (e.g. big screen TVs) vs. what they’re not willing to pay for which they do (e.g. health care). My wife likes to point out how every time you see a story about a recent immigrant (often illegal) who’s impoverished for one reason or another, they may not have a stick of furniture in their apartment — but they do have a TV, and it’s turned on. There are problems of expectations and proper priorities here, not a problem with a lack of insurance per se.

    I’m old enough to remember when seeing a GP in his office didn’t involve an insurance claim. People who had medical insurance were covered for “major medical”, but the inexpensive, routine stuff — requiring, in modern terms, no more than the price of a Starbuck’s latte for a month — was paid for out of pocket. Then my mother’s employer switched to an HMO, and we suddenly had to drive twice as far to see a doctor in a large clinic not of our choosing. (RCHP, which was something like Kaiser.) This was not an improvement. I no longer knew my doctor since I got a different one each time, and on an HMO’s schedule none of them had much time to spend with me. (This was the Old Dayes: until I was around 14 I had literally been seeing the same doctor since the day I was born. No one bothered with a specialist for routine births back then.)

    For type I diabetics, it was pointed out in comments to the previous post that insulin isn’t expensive. If you’re really so poor you can’t afford around $40/month, then you probably do need a hand up. There are not the people PB is talking about, as he has made amply clear.

    Now, I see a lot of specialists. I have a son with severe CP and many of the usual complications including epilepsy. His medications alone, if I had to pay for them myself, would be equivalent to the rent on a second house, and I live in a very expensive part of the country. I’m glad I have insurance, but this being California, California Children’s Services would pay for what was needed had I no insurance of my own. They do this for all disabled children. When he’s in an emergency room, it’s because we have a serious problem such as a seizure we can’t bring under control with Diastat, or he has aspirated some vomit and will die of pneumonia if untreated. But for parents who bring their perfectly healthy kids into an emergency room with a cold: why the hell are they not seeing a pediatrician? Are they really that poor, in which case MediCal is available even if they’re not legal immigrants? Or are they spending what money they have on things they don’t really need?

  17. I think you should consider a change in employment.

    This is giving you a very jaded view of mankind. Not everybody wants to freeload. You gotta get yourself into a better environment before you get permanently warped.

  18. “There can be no such thing as a “right” to products or services created by the
    effort of others, and this most definitely includes medical products and

    The quote above from Commentary by Yaron Brook – The Right Vision Of Health Care.
    The commentary not only relates to health care but relates to many other issues in our society.

    There is a huge difference between helping those without and enabling and keeping them dependent on “the system”.

    I find it alarming that many in our country no longer think Socialism is a bad thing. I’ve always advocated a free market approach to medical care. I think Brook makes a compelling case for how it “could” work. Sadly, I think we are much farther down the slippery slope than we care to admit.

    For comparison and thought.

    In Denmark, someone who makes the equivalent of $70,000 US will have a tax rate of around 63 %. Yup,63%. As a result younger Danes are leaving the country to work where the tax rate is not as “progressive”. There is a labor shortage and the country must continue to find ways to pay unemployment benefits, medical
    care and on and on.

    I would rather help that 30 something with cancer get treatment than be forced
    to have my money sucked out of my pay check. The more money I can bring home, the more I have to help those who need help.

    I think those who think free or subsidized healthcare will help “us” to be happier, more productive and most of all “fair” have not taken into account some of the issues with socialized healthcare. Funding , retaining physicians, and not to mention wait times for elective surgery.

    Case in point, in UK a friend of mine needed Carpal Tunnel Release surgery. He saw his Doc, who referred him to a Surgeon. Six months was the wait to SEE the Surgeon and THEN book a date for surgery. Canada’s wait times can be up to 3 months – including hip and knee replacements.

    While a CTS is not life threatening it can be very painful and debilitating. I speak from experience. -My hand is 100% post CTR, thanks for asking 😉 –

    Does the line in the sand to help the underserved move? If so how much?

    Will those underserved then be ‘unjustly’ treated because they have to wait on the average three months to have their bone on bone, grinding with each movement, popping, extremely painful, knee replaced?

  19. “but I assure you that almost every Emergency Medicine blogger out there with the exception of Shadwfax who has taken his ball and gone home will confirm that freeloaders are a huge problem in at least our specialty. It’s not a secret. Is it half of the uninsured? A third? A fifth?”

    whine….whine…whine. I find it hard to believe you where ever a marine with the way you sputter. Let’s see. In spite of all those “freeloaders” you will make significantly more than any primary doc and a good number of specialists. You never take call (as an ER doc), no 24-36 hour stretches. When done you will work 10-15, 8-12 hour shifts per month. You have little (if anything) to do with the day to day hassles of the business of medicine (ever had an insurance company refuse a CT you ordered?). Every area of medicine has it’s hassles. EMTALA is not going to go away. You surely must have known the negative aspects of ER medicine before you switched residencies. Very simply, if you don’t mellow you will become one of those a$$hole docs none of the rest of us want to talk to. Jesus, you sound burned-out and you are only half way through residency. If it really sucks that bad may I suggest pathology. No loser patients (at least breathing and talking), good pay, light call, and no EMTALA.


    (Whatever, Dude.  If we can’t discuss legitimate problems and unintended consequences of social programs because it it robs you of the sunshine and mother’s milk which you need to nurture yourself then please find any number of Smurf Homage sites on the internet. -PB)

  20. Panda opines brilliantly “…Social Justice is just welfare with an alibi…”.

    High sounding words. Excellent writing. I tip my hat to you, PB.

    (Wait a minute, in an earlier post you said you didn’t read my blog.  What gives? -PB)

    But lets look closer at what constitutes “social justice” among the medical community’s Republican far right wing nut universe.

    The following article is ostensibly about possible political favoritism the United States Attorney Christopher J. Christie of NJ used in awarding lucrative legal contracts to Republican Party insiders to perform ‘oversight’ in large corporate settlement cases and the Bush Administration’s possible abuse of “so-called deferred-prosecution or nonprosecution agreements between the department and large companies”.

    I fault the settlement b/c apparently not one M.D. who accepted a kickback in this criminal scheme lost his or her license to practice medicine.

    Still, this article reveals the ugly details underlying the crime of the legal settlement and thus is an example of today’s lack of ethical behavior by practicing M.D.’s.

    The M.D.’s here may dispute this and find it insulting. I say stop whining and clean up your profession.

    Ashcroft Deal Brings Scrutiny in Justice Dept.

    Published: January 10, 2008

    …skipping…”Mr. Ashcroft was awarded the contract last fall at the direction of Mr. Christie as part of his office’s settlement of criminal accusations against Zimmer Holdings and four smaller firms accused of paying kickbacks to doctors.”

    …skipping…”…Zimmer Holdings revealed in filings with the Securities and Exchange Commission in late October that it had hired Mr. Ashcroft’s consulting firm, based in Washington, to monitor its settlement of criminal charges based on accusations of kickbacks to doctors involving the company’s knee and hip implants.”

    (Aeiiii!  Head for the hills! There’s politics, lobbying, chicanery, and political pork in the gubmint’.  What a stunnning revelation!  We are indebted to you!  We had no idea.  Again, kudos for bringing this to our attention. (Oh, and repost the link , I deleted it because it screwed up my formatting) -PB)

  21. Elmo would be surprised to discover what some insurance companies refuse to pay for in emergency care.

  22. “The M.D.’s here may dispute this and find it insulting. I say stop whining and clean up your profession.”

    This is beyond ludicrous, a chiropractor telling physicians to clean up medicine.

    Of all health professionals (calling chiros that is being generous), chiros are…

    1. the dumbest, as measured by undergraduate GPA.
    2. the most likely to engage in quackery and unproven sham treatment (applied kinesiology, accupuncture, activation therapy, etc)
    3. the most likely to rip off the government via defaulting on student loans
    4. the only profession whose entire therapeutic basis is scientifically unsound (“subluxation theory”)

    Chiros are the ones bringing healthy, asymptomatic patients in on a weekly basis for “maintenance treatment” by scaring them with horror stories about what will happen if they stop. There isn’t even a defined scope of practice of what chiropractors can treat! Some say back pain, some say asthma, ear infections, allergies, some say almost everything.

    This is all within chiropractic mainstream. The “get your spine adjusted to prevent asthma, cancer, and bad feelings” types aren’t the fringe element, they’re typical. Physicians who engage in sham treatments/quackery are reviled by their colleagues, whereas chiros who do the same are congratulated for their practice management skills.
    Why doesn’t the body’s innate healing power (that chiros unleash via their snap, crackle, pop routine) extend to the vertebral column? How DID people ever survive before magnetic healer/messiah wannabe Palmer invented chiropractic in 1895?

  23. Could you be any more heartless and cynical?

    And why do I find myself nodding in agreement with almost everything you write? Damn, this is a sad state of affairs.

    Oh well, I have step 1 to worry about.


    (I am not heartless.  I’m just describing the problem. -PB)

  24. PB asks “Wait a minute, in an earlier post you said you didn’t read my blog. What gives? -PB”

    I agreed with you that it was unfair of me to judge you, your blog and those m.d.’s who comment here if I did not read more of what you posted and presumably stood for and against.

    In other words I broadened my scope of reading here.

    Do you find fault with that?

    The result of my added reading was to be shocked, disgusted and saddened by almost everything you stand for and against.

  25. “CC” you are correct that chiropractic has some shady characters practicing shady chiropractic.

    If allowed I would plead nolo contendere for the profession.

    Now ask yourself how that is any different than medicine?

    As for your comment, “This is beyond ludicrous, a chiropractor telling physicians to clean up medicine” I believe you are ignorant, uneducated or incredibly naive to think that MEDICINE does not have its share of charlatans, quacks and fast buck artist.

    Are you unaware of the recent study that nearly half of all M.D.’s admit to witnessing malpractice/questionable practice by another physician but FAILED TO REPORT IT?

    That’s called coverup.

    In fact, a conservative estimate of the number of said m.d.’s is more than 75K or 10% of the medical profession in the USA which is equal to the entire number of chiropractors in the USA.

    The upper end of the range of estimates of unethical, illegal and unfit retail medical practice and practitioners is >50%.

    The trouble with such estimates is the great variability in the definition of what constitutes unethical, unfit and illegal.

    Regardless, put into context it looks like the medical profession has a lot of work ahead of it.

    It is common sense for medicine to clean up its profession before attempting to clean up unrelated health professions.

    I recommend that you stop whining and start cleaning.

  26. “CC” I apologize for not reading your entire diatribe against chiropractic.

    My eye just now saw this: “This is all within chiropractic mainstream. The “get your spine adjusted to prevent asthma, cancer, and bad feelings” types aren’t the fringe element, they’re typical. Physicians who engage in sham treatments/quackery are reviled by their colleagues, whereas chiros who do the same are congratulated for their practice management skills.”

    “Why doesn’t the body’s innate healing power (that chiros unleash via their snap, crackle, pop routine) extend to the vertebral column? How DID people ever survive before magnetic healer/messiah wannabe Palmer invented chiropractic in 1895?”

    Your statement is an outright fabrication and distinctly untrue: “This is all within chiropractic mainstream. The “get your spine adjusted to prevent asthma, cancer, and bad feelings” types aren’t the fringe element, they’re typical”

    Ain’t happening “CC” except in extreme outliers.

    The assertion “Why doesn’t the body’s innate healing power (that chiros unleash via their snap, crackle, pop routine) extend to the vertebral column?” shows your ignorance and that you have no idea what you are talking about.

    The “innate healing power” is always there in every living cell and is not released by adjustments.

    The goal of natural healing via chiropractic is to remove interference so that the living cells can express their healing power, which btw (I hope this does not confuse you further) may mean cellular destruction by the body.

    Medicine of course relies upon the same innate healing force of living cells. It is not unique to chiropractic or medicine, it is unique to living organisms, i.e., their biological innate capacity to heal themselves.

    A practical example is a bone mending after breaking.

    Bones don’t need a doctors prescription to heal themselves, though they may require a skilled orthopedist to produce the best outcome, bones simply and immediately embark upon repair.


    Magnetic healing is an ancient healing phenomena and not related to chiropractic or to Dr. D.D. Palmer.

    See “The History of Magnetic Therapy – Attracting Claims and Controversy” on the web.

    Reconstruct this link to go to the article:






    h-t-m-l (remove dashes)

    And as for answering your query “How DID people ever survive before…” it is simple, the same way they survived without modern medicine, i.e., the bodies innate ability to heal itself.

    Even with the body’s capacity to heal itself people need help with illness, diseases and traumas in a legion of ways which is why the healing arts are the way they are, including medicine and CAM.

    Your education must be terribly deficient.

  27. “The trouble with such estimates is the great variability in the definition of what constitutes unethical, unfit and illegal.”

    You said it yourself. What does that report consider “questionable practice”? Is this an example of physicians (an arrogant bunch, on the balance) second guessing each other and stating that Dr. so and so did something “questionable”? Also, what is the timeframe? Did the physicians polled see questionable activity recently, or just at some point in the past?

    How do you define “questionable”? Of questionable benefit? That occurs frequently when it is unclear how a patient will respond to a particular treatment due to comorbidities or other complicating factors.

    “It is common sense for medicine to clean up its profession before attempting to clean up unrelated health professions.”

    Why don’t you try taking your own advice? Even if 10% of physicians practicing in this country did engage in shady business practice (which I find questionable), what is the comparable percentage of chiros engaging in outright quackery?

    Check this paper published by the National Board of Chiropractic Examiners for a list of the procedures performed by chiropractors. Half use homeopathy. Half use accupressure/meridian therapy. Do you really think homeopathy (medication with drugs lacking active ingredients) is ever appropriate?

  28. everytime i read your blog it’s like a tribute or excerpt from ayn rand.

    sometimes i question what is happening to our society. the us was founded on the principles of the right to the PURSUIT of happiness and the freedom from others – because as rand once said, who besides his brother can restrict the freedom of a man (not verbatim).

    no one has a RIGHT to my effort, my property, etc.

    i cannot recall who mentioned somethign about physician salary with such apparent bitterness, stating that panda should not complain because he’ll be making such a large sum of money.

    1. doctors have spent hundreds of thousands of dollars on their education to earn such a sum of money. (esp when compared to the salaries of ceo’s who i doubt spent that same amount of time in school)

    2. shift work, despite popular belief, doesn’t mean EASY. during an er shift, you are on your feet the entire time. i can bring up numerous other examples of how er isn’t everything it’s cracked up to be – educate yourself before you attack a profession.

    3. ragging on a speciality does not strengthen the validity of your argument (it probably makes it weaker) and it especially does not weaken panda’s. you have no concept of the demands of a speciality, just like panda doesn’t go around saying how easy it would be to do ____________ (fill in the blank).

  29. You know, I really do enjoy your blog, but every once in a while you go off the deep end. For someone as clearly intelligent as yourself, you have this propensity to set up some honestly ridiculous strawmen and post vitriol against some sort of entity that exists only in your mind and in Anne Coulter’s books.

    For the love of Christ, what exactly is this supposed self-loathing, country-hating, flag-burning, fag-enabling leftist? Is it a Democrat? Does that mean about half of Americans are secretly plotting to ruin the country due to some sort of shared collective guilt? Or is it merely the very fringe elements of the left. Yet, if this is the case, how does it wield this incredible power that you rant against so fervently?

    I just do not understand. You are a smart guy, but you take this partisan nonsense to levels unheard of before the advent of talk radio. The left does not hate this country, nor does it want to destroy it. Likewise, the right is not composed purely of gun-toting, Bible-thumping, hillbilly retards who lack their front teeth. You would label anyone a moron if they were to categorize Republicans as such, yet do it to the left without any second thought.

    Most people want to do what they feel is best for their country. Their methods may differ, but this is not a question of patriotism. Please, reconsider these meaningless blanket assertions. People are simply people. Some believe in policies that differ from your preferred ones (ie – wealth distribution), while others agree with you. Yet, disagreement should not make somebody The Enemy. The person you disagree with shouldn’t be reviled and hated because of said disagreement. This sort of partisanship is anathema to a functioning democracy. It dissuades any real discussion and debate, instead replacing it with vilification. Your beliefs are neither divinely inspired, nor always correct. Don’t succumb to this trash of false generalizations aimed at anyone who doesn’t immediately agree with you – it’s for a very stupid class of people.



    (Where, I ask you, have I ever used the word “Democrat” on this blog?  Think about it.   -PB)

  30. to elmo.

    The freeloaders ruin the system for everyone, including hard working insured and uninsured. They bog the system down and take for themselves what is not rightfully theirs to take.

    They suck the system dry without giving back.

    Free loaders include wealthy Medicare patients ,who by virtue of turning 65 get handed to them a silver platter for which to consume all care all the time for a fraction of any possible pay in.

  31. Panda:
    What’s clear to me is none of you guys actually practiced medicine before 1986. I did. While I totally disagree with what EMTALA has become I understand what happened that put it in place. Why? Because I was there. I trained in a large county/university hospital before EMTALA. It was far from uncommon that certain community suburban hospitals would dump patients they didn’t want (ie there were payment issues). Let me tell you these patients were NOT necessarily stabilized. Patient’s suffered and died. It is all documented in medical journals of the era if you are interested. I believe cook county specifically was one of the examples (no I did not work there). Personally, I think EMTALA was the wrong way of enforcement. There were rules and regs at that time, they were just ignored or patchwork. The right way of addressing the issue would have been to close down the dumping hospital. The feds should have pulled all access to government billing and special tax status on the dumping hospital. Instead you get EMTALA. Yes we all know the feds would screw-up a wet dream. However, all of that stated I am here to tell you I have never seen the egregious dumping activities I did in residency since EMTALA. That’s the fact Panda, since I was there (and you weren’t) I don’t really care what you think about the my opinion. You might want to ask some of your old attending’s about it.

    (If we both think that EMTALA, as it is implemented, is a bad law, why so confrontational?  I am perfectly aware of why the law was enacted, by the way. -PB)

    When I spark: good luck in med school. I know the ER medicine very well thank you. You see, the specialty of EM is relatively new. Back in the day, us lowly non-ER boarded docs ran in the ER (in fact it still happens in many smaller ER’s). Why, because there is not nearly enough boarded ER docs (though each year the numbers improve). Over the years I probably have spent significantly more time in the ER than panda has. I know first hand the positivies and negatives of being an ER doc. I am NOT bagging on the specialty (working in ER’s kept me alive until my own practice was running). What I am commenting on is panda’s incessent whining about everything wrong with the ER and it’s patients as if it is the only area of medicine that has these problems and as if he didn’t not have a choice of which specialty to go intop. Agains Panda, Path is still an option.

    (I will never understand why my little blog, alone among the numerous Emergency Medicine and other medical blogs, is criticized continuously for being negative (and you should see my private email, comments that would make your hair stand on end).  It’s as if everybody else can point out obvious faults with the way medical care is delivered and the perils to our society of irresponsible behavior but I have to be Little Mary Sunshine and do a little happy-happy dance to avoid making anybody grumpy.  I hazard to say that Emergency Medicine has changed considerably since the 1980s, something that my attendings are continuously talking about with amazement.  One of our most senior attendings said that they routinely used to have slow nights in our ED with an empty waiting room and empty beds in the hospital if you can believe it.  

    I also want to point out that while I am relatively new to medicine, I know a little about a lot of other things, especially how things of all kinds are produced and delivered, so this colors my opinion of the medical industry.  -PB)

    Chris C: The point is that Panda would still have gotten the CT done and I am sure he would have documented/justified it in such a way that to minimize any insurance company denial afterthe fact (though it could happen). Tthe simple fact is the PCP won’t even be able to get the CT. I am sure panda has seen patient’s sent to the ER essentially to get a CT/MRI that the insurance company was denying asan outpatient.

    (Yes. I have. Many times. -PB)

    HH: I never said freeloaders weren’t a problem. I just stated that inspite of the freeloaders Panda will make more and work less hours than any PCP or HOSPITALIST. Personally IMO day in day out Hosptialists are the hardest working “shift-working” docs out there. I agree the present “freeloader” mentality is a problem. But let me ask you a question inspite of all this panda whining about EMTALA, when have you ever ever seen the government pull back on a entitlement (funded or unfunded) program. Please give me one good example cause I can’t think of any. In fact as opposed to pulling back on these programs the feds just added a massive underfunded expense system called Medicare D. The long term expense on medicare D will make EMTALA look like a cheap date. Personally, I agree with Panda, people should pay for the majority of their primary care. All people should have a copay at the ER (ie medicaid). Insurance company’s/medicare/medicaid should step in for hospitalizations, expense procedures, expensive drugs, things that can bankrupt people. I have seen NO evidence that this is going to happen. All I see is the slow progression to a single payer system. I just don’t think most Americans have any clue what that really will mean for them. They will find out when the government starts refusing expensive items for the “good of society” and when they find out they will have no one to sue as the feds won’t let that happen.

    (you make many excellent points and I appreciate your taking the time to comment.  It’s comments like yours that add value to this blog and give people a better perspective than they can get from jsut reading the posts. -PB)



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