Politics

[masterofmonkeys]

I was raised to believe that you don't talk about politics or religion unless you're ready for an argument.

Being a libertarian-conservationist agnostic-hindu-buddhist, I'm used to disagreeing with everyone in the room on these issues, including myself.

Politics of a left-leaning nature seem to be brought up with distressing frequency throughout the interview trail. Mostly by residents and interviewees but by attendings as well.

I think it's the almost dismissive way its brought up that most bothers me, as if there's no way anyone in the world would disagree with their viewpoint. As if championing universal health care or believing Obama is 'inspiring' is something that everyone can agree on, like the sky being blue.

Having gone to the ivy league and lived in London, I'm used to having different political views from the majority of people I'm surrounded by. Living in the bible belt, the same thing applies.

But one thing I've rarely seen before is the casual nature in which it seems to be assumed that everyone holds the same political views they do, and that there is no intellectual reason to believe in a different guiding principle.

Maybe it's because I'm used to being a minority in matters of politics. Maybe it's because if I just dismissed anyone of a different political bent than myself I wouldn't have my two best friends (both raving hippies). Maybe it's because I realize that bringing up matters that most people disagree with me on is hardly the way to build bridges with those same people. I dunno.

Am I missing something? Is a desire to go into psychiatry somehow wedded to 'progressivism'? Can I not be a psychiatrist if I believe that universal health rationing isn't the answer? Should I wait out a year and figure out what specialty I'm really meant for?

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[freaker]

Oh, I've noticed it, too. And incidentally only from those on the far left end of the spectrum. I consider it pretty tasteless and in very poor form. It's fine to talk about this sort of thing with friends, but when you start extending to something with the formality of an interview process, well, you're crossing boundaries.

I might expect of a bit of crowing after the recent election, but I wouldn't expect this to seap into interview questions, and it absolutely did. I've lived in many differnent political environments like yourself and have done just fine. Perhaps a few run-ins with an obnoxious politically-correct robot or two in Portland, but I think those guys even annoy most leftists.

That said, you're not alone in all of this. But I would say that psychiatry tends to lean more left than any medical field I've encountered. I've something I've noticed in faculty, in residents, and in applicants--the kind of flippant disregard for other belief systems. Just run with it.

I'm sure someone else will chime in about the far-right bozo in an interview, as well, and so it goes. If you're doing what you love, you'll be fine. And it sounds like you're quite used to walking to your own drummer, so I say keep walkin on.

 

[loser]

I was raised to believe that you don't talk about politics or religion unless you're ready for an argument.

Being a libertarian-conservationist agnostic-hindu-buddhist, I'm used to disagreeing with everyone in the room on these issues, including myself.

Politics of a left-leaning nature seem to be brought up with distressing frequency throughout the interview trail. Mostly by residents and interviewees but by attendings as well.

I think it's the almost dismissive way its brought up that most bothers me, as if there's no way anyone in the world would disagree with their viewpoint. As if championing universal health care or believing Obama is 'inspiring' is something that everyone can agree on, like the sky being blue.

Having gone to the ivy league and lived in London, I'm used to having different political views from the majority of people I'm surrounded by. Living in the bible belt, the same thing applies.

But one thing I've rarely seen before is the casual nature in which it seems to be assumed that everyone holds the same political views they do, and that there is no intellectual reason to believe in a different guiding principle.

Maybe it's because I'm used to being a minority in matters of politics. Maybe it's because if I just dismissed anyone of a different political bent than myself I wouldn't have my two best friends (both raving hippies). Maybe it's because I realize that bringing up matters that most people disagree with me on is hardly the way to build bridges with those same people. I dunno.

Am I missing something? Is a desire to go into psychiatry somehow wedded to 'progressivism'? Can I not be a psychiatrist if I believe that universal health rationing isn't the answer? Should I wait out a year and figure out what specialty I'm really meant for?

I work at a mental health agency and of course, the psychiatrist I work with happens to be a Republican, lol. However, I'm sure that most p-docs do lean to the left but they don't strike me as being that far to the left, at least not the raving hippie types. They're more like the Starbucks sipping sushi eating yuppie liberals instead of the raving lefty Caucasian hippies in dreads who never shower and smell funny. I've never seen a psychiatrist in dreads and they are usually pretty showered and fresh. The raving hippie lefties are actually kind of anti-psychiatry. They don't believe in using psychiatric medications and they go into all of these pseudo-intellecual theories like, "mental illness is a social construct created by the man to oppress people who are different". Yada yada yada. Although I am leery of Big Pharma and I am concerned about people being overmedicated, I definitely think medication is necessary for some people.

 

[OldPsychDoc]

...
That said, you're not alone in all of this. But I would say that psychiatry tends to lean more left than any medical field I've encountered. I've something I've noticed in faculty, in residents, and in applicants--the kind of flippant disregard for other belief systems. Just run with it.
....

I don't know. Having this come up on interviews is clearly not kosher, but I need to say, as someone openly left of center politically, that I do NOT see flippant disregard for others' belief systems in my colleagues, either to my left or my right.

Where I'm at , if there is a left-ward bias, it is because so many of our patients inhabit the margins of society, and we haven't seen much sympathy for those folks from conservative circles since the Reagan years... I think also that psych-docs, in self selecting this population, tend to be those with a tendency toward mushy bleeding-heart lineralness, but I only speak for myself...

 

[billypilgrim37]

Academic physicians in general are much more likely to swing left. Most good capitalists don't willingly choose to do more work for less money.

For example, most academic interventional cardiologists vote Republican. Private practice interventional cardiologists eat their weak young. See the difference?

 

[Doc Samson]

I don't know. Having this come up on interviews is clearly not kosher, but I need to say, as someone openly left of center politically, that I do NOT see flippant disregard for others' belief systems in my colleagues, either to my left or my right.

Where I'm at , if there is a left-ward bias, it is because so many of our patients inhabit the margins of society, and we haven't seen much sympathy for those folks from conservative circles since the Reagan years... I think also that psych-docs, in self selecting this population, tend to be those with a tendency toward mushy bleeding-heart lineralness, but I only speak for myself...

I agree - psychiatric practice in the trenches drives you further to the left as you grow increasingly frustrated with the lack of resources available for the mentally ill due to a misplaced "every man for himself" mentality. Looking at the state-by-state rankings for mental health care, it's no real surprise to see the top of the list shade blue, and the bottom shade red.

 

[notdeadyet]

And for those of us who are a bit long in the tooth, it's less of a scare.

2/3rd of my life has been under a Republican president. The fad of Democrat being the cool side of the street is a novelty and may not last. I wouldn't sweat it.

Medicine you'll find more folks on the liberal side of the aisle due to the work that gets done. In business, you'll find more folks on the conservative side due to the work that gets done. Such is life.

 

[strangeglove]

Is a desire to go into psychiatry somehow wedded to 'progressivism'?

Yes. Your whole career (unless you only treat the rich) will be spent providing very expensive services to people who cannot afford to pay for them because they are too sick to work, even when they are doing relatively well. All of this is made possible by entitlements that are funded by good-old tax dollars. It's hard to see how this is not a progressive system. And if you disagree with the need for such a system, then you will find yourself very frustrated throughout your training and beyond. You would also be wrong, but that's just my opinion.

 

[OldPsychDoc]

And for those of us who are a bit long in the tooth, it's less of a scare.

2/3rd of my life has been under a Republican president. The fad of Democrat being the cool side of the street is a novelty and may not last. I wouldn't sweat it.
.

Well I was born in Camelot and weaned on the Great Society, but that still only brings me up to 40% of my life under a Democrat. But calling it a "fad"???? Please!

(Oooo--had to run some more numbers--I won't hit 50% of my life under a Democratic president until 2018, 2 years into the Chelsea Clinton administration! Assuming we don't have a Palin administration....)

 

[masterofmonkeys]

Well, I am a huge bleeding heart, like a lot of libertarians. That's why I chose medicine instead of something else I'm just as passionate about but felt I'd be doing less to serve my fellow man in. I just don't think government is the way to get it done. I have never voted for a republican president (the occasional senator or rep, yes). And at the current rate, probably never will.

As for being a good capitalist, don't confuse being a supporter of free association and free markets with being a capitalist. Capitalism is a marxist term that denotes people who believe that wealth and power should go together. That might be caricature of Randian objectivism but it is not libertarianism. Most libertarians make far far less than I will as a an academic psychiatrist. Plutocrats are a different thing altogether.

That said, I'm not even sure what I'm saying anymore, except that I don't think government is the only way to serve the underprivileged, and it gets frustrating when people seem to assume that I must think that way.

 

[whopper]

Most of the psychiatrists I've talked to tend to lean left. However its not like I was gauging their views & and I've spent most of my time in this field in NJ which slightly leans to the left.

I think I leaned the most right out of all the psychiatrists I've met, and I consider myself a moderate, but with more extreme views on the left or right depending on the issue. I'm an environmentalist & social liberal, but I'm an economic, fiscal policy conservative that thinks several social conservative values are good (just that the government shouldn't be involved with it).

Anyways, most people in the treatment team seem to have leaned left, most though IMHO are moderates, they lean left now because they're upset with Bush's performance. There are 2 die hard liberals, and 1 die hard conservative.

Working in psychiatry has made me a bit more conservative on some social policies. E.g. after seeing years of welfare & other social assistance patients spend all their money on cocaine & then show up to the ER becuase they want a hospital bed (not so much because they're crashing but because they have no money for food & want free food while living at the hospital), that's made me think these people should not be eligible for social assistance without more checks to make sure they're not abusing their funds. Mind you that it was the same patients, month after month after month......I was thinking this had to cost the system tens of millions of dollars a year--for just 1 state, since about 100 days of hospital stay per month were spent on these types of patient--only at the hospital where I worked.

My wife & I (she worked on an inpatient psychiatric unit) discussed that, and thought perhaps urine drug screens should be given to people on social assistance & a history of drug abuse. We both knew though that this would never pass.

 

[notdeadyet]

Well I was born in Camelot and weaned on the Great Society, but that still only brings me up to 40% of my life under a Democrat. But calling it a "fad"???? Please!

Sorry if I appear jaded. By the time I was 21, there had only been 4 years of a Democrat in office in my life. Being a fiercely political leftist, this was tough to swallow. When Clinton was finally elected, I thought the country was finally coming to its senses. Then we followed him with George W. Bush.

The country may be swinging the Democrat flags right now, but I'm not getting my hopes up. After going from Clinton to Bush, I shudder at the thought of who we might toss up the ladder after Obama.

Assuming we don't have a Palin administration....)

Bite your tongue. Don't even joke.

 

[notdeadyet]

Capitalism is a marxist term that denotes people who believe that wealth and power should go together.

In fairness, Marx didn't coin the term capitalist and I don't think his use of it is the actual meaning. The term can mean either the great God or the great Satan depending on if you're on either end of fringe politics, but it has an actual meaning in economics that isn't so loaded.

Most libertarians make far far less than I will as a an academic psychiatrist.

Most Democrats, Republicans and Americans in general will make far far less. But I have to be careful not to confuse threads.

That said, I'm not even sure what I'm saying anymore, except that I don't think government is the only way to serve the underprivileged, and it gets frustrating when people seem to assume that I must think that way.

I love the libertarian notion that if the government stepped away from the chore, people would naturally just help out their fellow man in a way that was just and impartial. Unfortunately, from having lived in other countries that doesn't have the extent of social programs that our country does, I can tell you emphatically that it doesn't work that way. Left to their own devices, people help others sporadically and with a great deal of prejudice. The result is that people end up dying on the street.

There's a reason that every major industrialized country runs social programs to help out their fellow man. It's necessary.

 

[whopper]

Unfortunately, from having lived in other countries that doesn't have the extent of social programs that our country does, I can tell you emphatically that it doesn't work that way

Having lived in other countries where there have been more social programs than we have here I can tell you that causes problems too.

I lived in the UK where taxes are higher, welfare funds more people & there is more social assistance & as a result, people didn't have as strong an urge to work if they were being nicely supported by the system. With taxes much higher, people weren't as motivated to make a business on their own & try to be a financial success.

There were some benefits, for example, the typical welfare person I worked with in the hospital (whether or not they were psychiatric) often had a substance abuse problem, had some antisocial elements & an anti-intellectual attitude. The welfare people in the UK were polite, often times filled their free time with hobbies we in America would think are respectful (E.g. reading books, gardening, trying to make money having a small gig at a flea market.)

 

[notdeadyet]

Having lived in other countries where there have been more social programs than we have here I can tell you that causes problems too.

I agree. There's a happy medium. Libertarian philosophy and communist philosophy scare me equally.

The welfare people in the UK were polite, often times filled their free time with hobbies we in America would think are respectful (E.g. reading books, gardening, trying to make money having a small gig at a flea market.)

Yeah. I lived in the UK for a bit too. I also found that in addition to cutting checks, they also had a lot of train-to-work programs that we lack. I had friends during the Thatcher years who took all sorts of interesting courses, like film editing, wildlife preservation, photography, etc.

It didn't seem to get the unemployed any more jobs, but it made for an unemployed who were more interesting to talk to at pub.

 

[whopper]

Well the welfare people in the US in Newark NJ, that I typically saw at the hospital--on crack, having their 5th baby while on crack, etc.

In the UK, in Coventry (one of the worst towns there, at least from what the Brits tell me)--"Dr I make some money selling vegetables at the flea market. During my free time I've been reading some Stephen Hawking books".

Which actually brings up another point. Give the person in category #1 $1000 a month in social assistance, it'll probably go to crack. Don't think the situation would be as bad as #2. Some of this really depends on the culture of our country.

 

[strangeglove]

Well the welfare people in the US in Newark NJ, that I typically saw at the hospital--on crack, having their 5th baby while on crack, etc.

In the UK, in Coventry (one of the worst towns there, at least from what the Brits tell me)--"Dr I make some money selling vegetables at the flea market. During my free time I've been reading some Stephen Hawking books".

Which actually brings up another point. Give the person in category #1 $1000 a month in social assistance, it'll probably go to crack. Don't think the situation would be as bad as #2. Some of this really depends on the culture of our country.

Hmm. I think I hear a little cultural commentary here. What else in your mind distinguishes the Hawking reading vegetable gardener from the crack baby mother, apart from their interest in cosmology? There you go. You have just slipped one notch down the slippery slope of conservative politics.

 

[notdeadyet]

Well the welfare people in the US in Newark NJ, that I typically saw at the hospital--on crack, having their 5th baby while on crack, etc.

In the UK, in Coventry (one of the worst towns there, at least from what the Brits tell me)--"Dr I make some money selling vegetables at the flea market. During my free time I've been reading some Stephen Hawking books".

Coventry? It had some tough times in the 80's, but I wouldn't consider it one of the worst towns in the UK by far. I'm not even sure I'd consider it the worst town in the Midlands.

If your impression of the typical person on public support in Newark is a 5th-time-mom-on-crack and the typical person on public support in Coventry is the gardening-Hawking-reader, do you think that perhaps you're stereotyping?

I've neither worked in Coventry nor Newark, but in my experience, folks on public welfare aren't that different from place to place. The biggest difference between those on public support in the UK and the US is that it's much more accessible in the UK with a wider range of support services. You have a fairly wide spectrum of working class folks on the dole there.

Slash public support in the UK to what it is in the U.S. and I have a hunch you'll lose your reading gardener and see more of your drug addict.

Which actually brings up another point. Give the person in category #1 $1000 a month in social assistance, it'll probably go to crack. Don't think the situation would be as bad as #2.

Give $1,000 to a crack addict and $1,000 to a well-read gardener and you think the money is more likely to be spent on crack by the former? I'm pretty liberal, but I can't argue with you there.

Some of this really depends on the culture of our country.

I could take you to some tenements in London and I think you'd be shocked how very much they are like ours here. The people who live in them would probably look familiar to you too.

There are also folks a step up from that you'll find in the UK who are supported by the government. You won't see that here.

 

[whopper]

If your impression of the typical person on public support in Newark is a 5th-time-mom-on-crack and the typical person on public support in Coventry is the gardening-Hawking-reader, do you think that perhaps you're stereotyping?

Of course-simplification for a post. However the amount of drug abusing patients I saw in Newark in the ER vs those in Coventry on welfare were far different. Did I track the exact numbers down? No. I do though see why you may think I was stereotyping which was not my intent and I apologize.

I'm not even sure I'd consider it the worst town in the Midlands.

You may be right, though I was just going by what the Brits I met with were telling me.

What else in your mind distinguishes the Hawking reading vegetable gardener from the crack baby mother, apart from their interest in cosmology?

Hmm, how far in depth would you like on a cultural commentary to convince you that this is not stereotyping? Give me a list. The ERs at a large urban hospital in a crime ridden area in the US will face different problems than the ones in the UK. (Nuts forgot what they call them there. They're not called ERs, I think they were called A&Es).

I guess its not appropriate if you worked in an ER in Salt Lake City Utah or Lake Geneva Wisconsin, & made a comparison to one in Newark NJ, and mentioned the differences in the typical type of patient you saw.

I've neither worked in Coventry nor Newark, but in my experience, folks on public welfare aren't that different from place to place.

Tit for tat--are you stereotyping that all welfare folks are the same? The US and the UK and all the industrialized nations of the world with socialized medicine have different cultures. What may work in one culture may not work for another. For that matter, a lot of socialized medicine in other countries such as the UK are experiencing problems with their systems like we in the the US system in terms of satifsaction & expenses, while other socialized health care nations such as Canada aren't.
The types of patients in general you will see in a Newark NJ ER is far different than the ones you will see at the University Hospital in Princeton NJ, and they're only about 1.5 hrs away from each other. Same country--far different local cultures. Call that a stereotype, I call that acknowledging reality. Cultures are vastly different with less than 100 miles separating them.

I could take you to some tenements in London and I think you'd be shocked how very much they are like ours here.

That actually doesn't surprise me, haivng spent a lot of time in London as well. London is far culturally different from Coventry, or Newark for that matter and is much more of a multicultural hub than Coventry more similar to America, with people from several different backgrounds, more of a cosmopolitan atmosphere, I'd say London is more similar to NYC than several towns & cities in the US.

 

[notdeadyet]

However the amount of drug abusing patients I saw in Newark in the ER vs those in Coventry on welfare were far different.

I'm sure there were. But I wonder how much of this is the fact that the ER here is used as primary care by lots of folks, which you don't see over there due to nationalized healthcare.

The ERs at a large urban hospital in a crime ridden area in the US will face different problems than the ones in the UK. (Nuts forgot what they call them there. They're not called ERs).

I agree. But I think this is much more representative of our very different healthcare systems (especially Emergency Med) than the nobility of the English poor and the depravity of ours.

I believe they're called "Casualty", if I'm not mistaken. But that goes back a ways. I could be wrong.

Tit for tat--are you stereotyping that all welfare folks are the same?

Boy, that's an interesting one. If you argue against a stereotype by making another generalization, are you just creating another stereotype? I'll have to chew on that.

The US and the UK and all the industrialized nations of the world with socialized medicine have different cultures. What may work in one culture may not work for another. For that matter, a lot of socialized medicine in other countries such as the UK are experiencing problems with their systems like we in the the US system in terms of satifsaction & expenses, while other socialized health care nations such as Canada aren't.

Yeah, I agree. I think where we differ is that I think the issues are a more economic than cultural. I'm not saying we're all homogenous and interchangeable, but your original post made it sound as if welfare recipients here were drug-addicted losers and in England they were noble educated folks. That just isn't my experience. I see a lot more similarity in the poor in both countries and the differences I see amongst those on public assistance is the fact that the UK has more of it, so you'll get a wider variety of people. Make sense?

The types of patients in general you will see in a Newark NJ ER is far different than the ones you will see at the University Hospital in Princeton NJ, and they're only about 1.5 hrs away from each other.

Agreed. But again, I think this is a more a matter of economics. The patients you see in a busy Friday night ER in Queens, NY will look a lot more like a busy Friday night Casualty in Brixton, London than it will a Tuesday afternoon ER in a an upscale suburb of Omaha.

The pocketbook makes for a bigger difference in culture than the passport.

 

[whopper]

Very interesting discussion. I'll say this to keep things civil, and I'm not suggesting they aren't civil or there's any ill intention from any of us.

Often times on a forum, when debates get real detailed on non-PC issues (as in this case-politics & culture), things sometimes get histrionic & angry.

So, I will say thank you for not putting it that level, and let's all be nice & calm so this doesn't happen on this thread.

I am though wishing I could be at a bar with you discussing this with a beer. Makes for a much better debate environment.

The pocketbook makes for a bigger difference in culture than the passport.

That too is a big factor.

I'm not saying we're all homogenous and interchangeable, but your original post made it sound as if welfare recipients here were drug-addicted losers and in England they were noble educated folks.

Not trying to say anyone's a loser. I have noticed from my own experience a big difference between the welfare recipients of one sample of 1 country vs another--both countries have different economic & welfare situations on a national level, as well as differing cultures. My intent to bring up Newark vs Coventry was to clarify the cultural differences, not to judge anyone.

I also wouldn't say the Brits are "noble", though I'm trying to say anything bad about them either. Just different. I had to lay low during the World Cup for fear that I would literally get my Asian American butt kicked because there was a possibility Korea or the US would go against the UK & beat them. I was enjoying going to the pub after work, but was keeping a careful watch of how the World Cup was going.

Thankfully for me, that year, the UK ended up going against Germany-which made me safe and made another doctor with the last name of "Baumgartner" have to lay low.

 

[notdeadyet]

I am though wishing I could be at a bar with you discussing this with a beer. Makes for a much better debate environment.

Amen to that. Talking politics without a pint in my hand just feels wrong...

 

[BabyPsychDoc]

You may be right, though I was just going by what the Brits I met with were telling me.

Brits like whining. They made an art out of it. They write books about the art of complaining. Coventry is actually a pretty decent city - Merceyside, Greater Manchester, Nottingham... that is getting worse...


As far as welfare in the UK vs welfare in the US is concerned - the systems are very different, and comparing welfare recipients in the two countries is not easy. However, generalising that Brits on welfare are artsy intellectuals and Americans on welfare are maladjusted drug addicts would be a bit of a stretch. The vast majority of British welfare recipients are, in fact, just as uneducated and maladjusted as their US counterparts - if I am allowed to use that stereotype (there is research to support this, but I am jetlagged & dying to get into bed, so ttfn)...

 

[Doc Samson]

Brits like whining. They made an art out of it. They write books about the art of complaining. Coventry is actually a pretty decent city - Merceyside, Greater Manchester, Nottingham... that is getting worse...


As far as welfare in the UK vs welfare in the US is concerned - the systems are very different, and comparing welfare recipients in the two countries is not easy. However, generalising that Brits on welfare are artsy intellectuals and Americans on welfare are maladjusted drug addicts would be a bit of a stretch. The vast majority of British welfare recipients are, in fact, just as uneducated and maladjusted as their US counterparts - if I am allowed to use that stereotype (there is research to support this, but I am jetlagged & dying to get into bed, so ttfn)...

Another gross generalization: Since socialism isn't a taboo subject in the UK, you're more apt to find welfare recipients who justify their lifestyle using political ideology. The US version of this tends to be more of an anti-intellectual stance. Thus, the British welfare patient SOUNDS more educated than the US counterpart, but is probably similarly uneducated. This is not disimilar to the psychiatrist with the British accent (in the US) sounding smarter than his equally educated American counterpart - a phenomenon I've been trading on for years.

Tangentially, just received this link from my sister. Examples of questions from the 11+ exam that we (as all good british children aspiring for a brighter future did) took when we were 10. Looking at it now, seems like they were setting me up for med school exams at an early age.

http://news.bbc.co.uk/2/hi/uk_news/magazine/7773974.stm

 

[Still Kickin]

Tangentially, just received this link from my sister. Examples of questions from the 11+ exam that we (as all good british children aspiring for a brighter future did) took when we were 10. Looking at it now, seems like they were setting me up for med school exams at an early age.
http://news.bbc.co.uk/2/hi/uk_news/magazine/7773974.stm

DS - I checked out that link. Seemed to be a kind of a disturbing theme running through the word choices in the questions. What's up with that - ?!?! - Kind of freaky. [Don't get all psychoanalytic on me and point out that I might be the freaky one for noticing... ]
(Hmm, maybe the test-writer was having a very bad day - ???)

In these questions, one letter can be moved from the first word to the second word, to make two new words. The letters must not be otherwise arranged and both new words must make sense:
BLIND & SAY --> BIND & SLAY (**This is the one that really caught my attention & probably made me notice all the other "negative" connotations.)
SCARF & RAIL --> SCAR & FRAIL
GUILT & POND --> GILT & POUND

In these questions, the same letter must fit into both sets of brackets, to complete the word in front of the brackets and to start the word after the brackets.
FOR ( ) ILL PAC ( ) ICK --> FORK, KILL, PACK, KICK
THI ( ) ECK STU ( ) OON --> THIN, NECK, STUN, NOON
SHE ( ) ONE COR ( ) INE --> SHED, DONE, CORD, DINE

 

[whopper]

you're more apt to find welfare recipients who justify their lifestyle using political ideology.

Socialism IMHO is far more accepted in the UK. Its more a dirty word in the US.

 

[masterofmonkeys]

I love the libertarian notion that if the government stepped away from the chore, people would naturally just help out their fellow man in a way that was just and impartial. Unfortunately, from having lived in other countries that doesn't have the extent of social programs that our country does, I can tell you emphatically that it doesn't work that way. Left to their own devices, people help others sporadically and with a great deal of prejudice. The result is that people end up dying on the street.

There's a reason that every major industrialized country runs social programs to help out their fellow man. It's necessary.

Actually, I often catch a lot of flak from other libertarians because I can't envision a society without a safety net. I'm a consequentialist libertarian, got there through the work of Garret Hardin, the guy who wrote the landmark conservation paper The Tragedy of The Commons.

Being an evolutionary biologist, the self-interested individual and game theory and all that are old hat to me. And as a consequentialist libertarian I see the role of government to intervene specifically in commons and anti-commons (haven't found a better word for it yet--where some pay the costs but all benefit) situations arise.

But just because a situation (such as the poor that would otherwise go unserved, unclothed, or unprovided for) may fail to be taken care of through pure free associations, does not mean that it requires monolithic government bureaucracy to take care of either.

The average doctor pays 30% plus in income taxes. If the government told me tommorrow that instead of paying income tax, I could see my less well-off patients for free or reduced rates to 'work off' my income taxes, I would crap myself with joy. I would do cartwheels in the middle of the street. That would be the perfect way for me to serve my patients in a way that medicaid wont' let me.

Likewise, if government offered the same deal for wal-mart, now you've made quality food and sundries more readily available to these same people.

Obviously, you couldn't just roll out a scheme like that. It's just a thought experiment. But a pretty compelling one IMO.

And when it comes to healthcare, as a health nut, I know that the costs of health care are significantly affected by how we live our own lives. I don't see anything particularly fair or equitable in a system in which thsoe who live well and clean (regardless of income level--and there are plenty of people making roundabout 20-40k who exercise and eat right at my gym), to shoulder the burden of those who don't. Granted there are genetics, and there are accidents, but all the same, any system in which you are free to destroy your own health and have a 'right' to demand that others help you maintain what's left strikes me as problematic.

And just as whopper found that he tired of his pregnant ladies with their 5th time crack babies, I have a problem with people bringing children into this world when they abuse their own bodies during pregnancy (whether through drugs or poor living) and aren't prepared to offer their children a good home. To me that's the biggest crime there is. It is child abuse, and nothing less. And yet you see G5s doing this all the time.

On a somewhat unrelated note, they have established several free/cheap clinics in this city in recent years, with the help of the major hospitals because it made sound financial sense.

And of course, we couldn't just up and get rid of social welfare, if there were a change it would have to be made gradually.

And before I end this rant, let me just say that I find a system in which 40% of adults pay no taxes (up to 60% under Obama's plan) to be problematic. Not because of a 'oh poor me I'm rich I have to pay taxes why don't they' point of view but because of the game theoretic implications of having such a sizeable proportion of the population who benefits from government without sharing the costs therein. We don't husband what we don't value.

 

[whopper]

I don't see anything particularly fair or equitable in a system in which thsoe who live well and clean (regardless of income level--and there are plenty of people making roundabout 20-40k who exercise and eat right at my gym), to shoulder the burden of those who don't

Agree--we had that debate before on this board. My argument was there should be incentives for people to be healthy. E.g. tax cuts for gym memberships, not being overweight etc, but no penalties for health problems that are not preventable such as genetic disorders.

I do though want to clarify that I wasn't so much "tired" of the mothers delivering babies while on heroine or crack as I was frustrated that it was an issue I felt society was not dealing with because no one had a solution. The hospital couldn't do anything other than what it was doing, the state didn't want to address the issue. I'm sure it happens in several other large poor urban areas, but at least in the state I was in, it was causing problems such as a major drain & low quality services provided by the DYFS in NJ.

There's a case of I know of where a guy hung himself on a state run psyche ward. The state's immediate response was to buy more metal detectors. Papers were able to show the state had spent more money into the mental health sector --> public is appeased. Oh and by the way, sneaking a metal object into the unit was in no way involved in that patient's hanging. Hospital couldn't do more than it was doing, the state had already gave its "solution" and the public is appeased--problem is not solved.

This is the state of what our current healthcare system is in. There's a lot of wasteful practices going on but its not at a level where its going to get anyone making a real solution.

 

[notdeadyet]

Actually, I often catch a lot of flak from other libertarians because I can't envision a society without a safety net. I'm a consequentialist libertarian, got there through the work of Garret Hardin, the guy who wrote the landmark conservation paper The Tragedy of The Commons.

Being an evolutionary biologist, the self-interested individual and game theory and all that are old hat to me. And as a consequentialist libertarian I see the role of government to intervene specifically in commons and anti-commons (haven't found a better word for it yet--where some pay the costs but all benefit) situations arise.

But just because a situation (such as the poor that would otherwise go unserved, unclothed, or unprovided for) may fail to be taken care of through pure free associations, does not mean that it requires monolithic government bureaucracy to take care of either.

The average doctor pays 30% plus in income taxes. If the government told me tommorrow that instead of paying income tax, I could see my less well-off patients for free or reduced rates to 'work off' my income taxes, I would crap myself with joy. I would do cartwheels in the middle of the street. That would be the perfect way for me to serve my patients in a way that medicaid wont' let me.

Likewise, if government offered the same deal for wal-mart, now you've made quality food and sundries more readily available to these same people.

Obviously, you couldn't just roll out a scheme like that. It's just a thought experiment. But a pretty compelling one IMO.

And when it comes to healthcare, as a health nut, I know that the costs of health care are significantly affected by how we live our own lives. I don't see anything particularly fair or equitable in a system in which thsoe who live well and clean (regardless of income level--and there are plenty of people making roundabout 20-40k who exercise and eat right at my gym), to shoulder the burden of those who don't. Granted there are genetics, and there are accidents, but all the same, any system in which you are free to destroy your own health and have a 'right' to demand that others help you maintain what's left strikes me as problematic.

And just as whopper found that he tired of his pregnant ladies with their 5th time crack babies, I have a problem with people bringing children into this world when they abuse their own bodies during pregnancy (whether through drugs or poor living) and aren't prepared to offer their children a good home. To me that's the biggest crime there is. It is child abuse, and nothing less. And yet you see G5s doing this all the time.

On a somewhat unrelated note, they have established several free/cheap clinics in this city in recent years, with the help of the major hospitals because it made sound financial sense.

And of course, we couldn't just up and get rid of social welfare, if there were a change it would have to be made gradually.

And before I end this rant, let me just say that I find a system in which 40% of adults pay no taxes (up to 60% under Obama's plan) to be problematic. Not because of a 'oh poor me I'm rich I have to pay taxes why don't they' point of view but because of the game theoretic implications of having such a sizeable proportion of the population who benefits from government without sharing the costs therein. We don't husband what we don't value.

Too much college theory. I'll abstain from debate. I'm underqualified.

I'll look out for my neighbor in spite of his bad choices. I'll pay taxes and vote through whatever laws are needed so that folks don't go without healthcare, education, food or shelter. Every other industrialized country in the world does this. I lack the ego to think that as Americans we're uniquely qualified to ignore the less fortunate and still hold our heads up high.

 

[notdeadyet]

My argument was there should be incentives for people to be healthy. E.g. tax cuts for gym memberships, not being overweight etc, but no penalties for health problems that are not preventable such as genetic disorders.

I'm find with giving breaks to those who are healthy. Just so long as we penalize those who aren't. There is just too much correlation between health and economics and education.

Besides, if we ever tried to launch a true health tax, there's the possibility that regions with high smoking and obesity (such as the South) would try to secede.

 

[michaelrack]

Most physicians, whether liberal or conservative are compassionate. Liberals tend to believe that government should provide the social safety net, while conservatives tend to favor a wider role for private charities/churches.

In my opinion, government should play a bigger role in mental health care than for "medical" illnesses.

 

[whopper]

There is just too much correlation between health and economics and education.

Yes which is why IMHO more drastic measures need to be taken. Not just because the health care system is broken the way it is, its also because the country is facing a potential social security meltdown that could drive it bankrupt and no one's dealing giving that issue the level of concern it needs--because its a problem that'll blow up in our faces years from now, but not in the immediate future.

 

[masterofmonkeys]

I'll look out for my neighbor in spite of his bad choices.

As will (and do) I. I just choose to do it myself and with like-minded individuals, rather than writing a check to the government and hoping that corrupt politicians and inept bureaucrats who normally can't find their butts with both hands in the dark somehow manage to pull it off.

I'll pay taxes and vote through whatever laws are needed so that folks don't go without healthcare, education, food or shelter.

I'm not a big fan of people dying in the streets and youth squandering their talents for lack of a way to harness them myself. But of course your implication is that since I don't believe that more government is always the answer in these issues, I don't concern myself with these issues. This is exactly the kind of thing that I found so uninviting during my residency interviews.

Every other industrialized country in the world does this.

And in 1776, every major power was an aristocracy.

And not too long before that, almost every major civilization thought that there was nothing morally reprehensible in slavery.

In 1754, no country endorsed a woman's right to vote.

I lack the ego to think that as Americans we're uniquely qualified to ignore the less fortunate and still hold our heads up high.

I personally lack the ego to be so self-centered that I believe I can determine the moral values of someone based on who they vote for. Throughout your little spiel you have implicitly and explicitly made the fallacious argument that if you don't support widespread government intervention, you don't support the poor. Now, if you believe that government intervention is the best way to help the poor, say that. It's a logically defensible statement, and one that doesn't insult and impugn the character of those who you disagree with.

Personally, I have a problem with a government healthcare system that doesn't reward those who live right, and one that doesn't in some way or another oblige its recipients to make healthy choices. I think prudent husbanding of the variables in the health equation that are under one's control are the least one can do in return for the financial support of their fellow citizens.

And I take issue with the rapid increase in educational spending even as the high school diploma has lost so much meaning that we now require college degrees to prove that someone has a high school education.

And how can we say that government is doing its job in taking care of the poor when every day hundreds if not thousands of children are born into less than ideal circumstances, when we aren't doing a single thing to control this proliferation? Even for repeat offenders? Birth control is 99% effective. And covered under medicaid. There is no excuse (well, I guess there is 1% of the time).

I personally don't want to fall into the trap of subsidizing poverty and poor choices. I want to eliminate them. I have yet to see a social welfare plan that even pays lip service to this idea. Worse, some seem to encourage the development of a dependent class.

With any luck I'll have the self-restraint to stay away from this thread, but that's doubtful considering how poorly I deal with those who imply I don't care about the less fortunate, and how active politically I have been in my young life.

 

[notdeadyet]

As will (and do) I. I just choose to do it myself and with like-minded individuals, rather than writing a check to the government and hoping that corrupt politicians and inept bureaucrats who normally can't find their butts with both hands in the dark somehow manage to pull it off.

What worries me about this logic is that it requires the confidence that you and like-minded individuals make up the vast majority of the general public. You might have more confidence in the public than I do. Most folks will step over a homeless person than try to help them.

But of course your implication is that since I don't believe that more government is always the answer in these issues, I don't concern myself with these issues.

Woah, that implication wasn't there at all. Where are you getting that from, out of curiosity? I disagree with your politics, but I never called into question how you feel about the issue or the poor. I think you might be personalizing this a bit.

My concern is that most people do not concern themselves with these issues. I'd be fine with getting rid of social programs and having us take care of each other organically, but it assumes everyone will do so. You might. Most won't. I'm not cynical, but all my experiences from working in the profit and nonprof sector have shown me that you can't depend on the public like that. They'll leave you (and those in need) in the lurch.

This is exactly the kind of thing that I found so uninviting during my residency interviews.

That's a bummer. Politics has no place in interviews, because folks often take them personally. This discussion is probably a pretty good case in point for why politics should probably be avoided at interview situations. Ethics are fair game, yes, but ethics and politics are radically different things. I know plenty of ethical people from all parts of the political spectrum, I just disagree with some of their strategies.

I personally lack the ego to be so self-centered that I believe I can determine the moral values of someone based on who they vote for.

Sure, me too.

Throughout your little spiel you have implicitly and explicitly made the fallacious argument that if you don't support widespread government intervention, you don't support the poor.

Read through my postings again. I tried to be very careful not to express that. In fact, I don't think I said/implied that, as I don't believe it.

Let me be more explicit, to resolve any confusion:

I do not believe that if you don't support government social programs, you do not support the poor.

I do believe that if there is not government social programs, the poor will not be adequately supported.

Make sense? I tried to make that sentiment clear in my above posts. If I failed, I apologize. I didn't mean to hurt anyone's feelings.

Now, if you believe that government intervention is the best way to help the poor, say that. It's a logically defensible statement, and one that doesn't insult and impugn the character of those who you disagree with.

Hmmm. Reading through my posts, I think I did say that. And I don't see where I was insulting or impinging anyone's character. If that's what came across, my apologies.

And how can we say that government is doing its job in taking care of the poor when every day hundreds if not thousands of children are born into less than ideal circumstances, when we aren't doing a single thing to control this proliferation?

This is the rub of the argument. If government programs are doing a faulty job, the options are to stop the programs or do them better. I don't agree with the notion of stopping, I prefer doing it better.

With any luck I'll have the self-restraint to stay away from this thread, but that's doubtful considering how poorly I deal with those who imply I don't care about the less fortunate, and how active politically I have been in my young life.

You seem to be taking this personally. Read through my posts again. I don't think I ever said or implied you don't care. I just disagree with your strategy. No harm, no foul. Being passionate about politics is a wonderful thing, but personalizing things doesn't really help anyone's case, imho.

Regardless, I'll drop off the thread. It's an interesting academic discussion, but not worth anyone getting their feelings hurt over.

 

[Therapist4Chnge]

I lived in the UK for a bit too. I also found that in addition to cutting checks, they also had a lot of train-to-work programs that we lack. I had friends during the Thatcher years who took all sorts of interesting courses, like film editing, wildlife preservation, photography, etc.

One of the best things to come out of this country was Roosevelt's focus on public works projects (through the "New Deal" platform). Unfortunately our society has taught people to be entitled, lazy, and unwilling to give an honest days work for pay. We need to go back to a system that rewards those willing to work (with the "assistance" filling the gap), and cuts off those trying to leech off of the system. There are multiple generations that work the system in an effort not to work.

--
My personal beliefs are that our social services are bloated, inefficient, and should be gutted. "Some" social service support is okay....for those that work and contribute in some way, but I'll be damned if my tax dollars go towards supporting people who are able, but unwilling to work. I'd much rather that money go towards prevention programs.....and not paying for someone to have their 8th kid.
--

Oh, and in academia, it is FIERCELY liberal, with the exception being biz/economics depts (and even then there may still be some liberal hold outs).

 

[whopper]

I'll look out for my neighbor in spite of his bad choices.

Paternalism violates current western medical ethics, with the exception of Parens Patriae which is currently used in commiting psychiatric patients against their will if they wish to harm self or others.

There is a fine line with looking out for someone & enabling them. If you always bail out a substance abuser, several in that situation will exploit your good intentions, and use it to continue to do bad things, to the point where more harm is caused overall vs the good deed you have done.

If the gov had more of a paternalistic approach, it'd cross certain boundaries that the ACLU would have a big problem with--& would result in people fearing the gov as Big Brother.

There's also a lot of people who don't think they should have to pay for other people's mistakes, and believe that in doing so, it will enhance the ethic of personal responsibility.

Not that I am totally for one or the other. I definitely think society & individuals benefit from some social assistance. The GI bill, gov scholarships, federal loans for school.

I draw the line where that social assistance causes enabling of bad behavior to the point where overall, more harm is caused then good. The above examples--e.g. the GI bill, gov scholarships, federal loans for school--they go to people who still want to work for the possible rewards they will reap. E.g. in the case of a federal loan-that person will have to pay it back with interest.

There are many forms of social assistance which are pure & simple enabling.

The "freedom with responsibility" adage from Austin Powers is the one I'd side with. For example--making welfare recipients show proof that they are trying to find work as a criteria to continue to get welfare, instead of just giving out welfare with no conditions, or taking it away from everyone--even people who really need it while they look for another job.

My personal beliefs are that our social services are bloated, inefficient, and should be gutted. "

Totally agree. For example, when I saw the same people again & again & again for years show up in the ER, having spent their social assistance on cocaine, & only being in the hospital to pretend to be suicidal so they could go into psyche inpatient & get free food, all at a taxpayer cost of $1500/day. In this situation their social assistance enabled them. Had those same people have to do a urine drug test to maintain their social assistance, several of them wouldn't have kept using cocaine.

But the way the system is--there was no safety feature in the system to prevent these people from exploiting their situation and no one in the state cares enough to change it because it didn't affect their pay, so no one did anything.

 

[Therapist4Chnge]

Totally agree. For example, when I saw the same people again & again & again for years show up in the ER, having spent their social assistance on cocaine, & only being in the hospital to pretend to be suicidal so they could go into psyche inpatient & get free food, all at a taxpayer cost of $1500/day. In this situation their social assistance enabled them. Had those same people have to do a urine drug test to maintain their social assistance, several of them wouldn't have kept using cocaine.

I've been on the "drug test for welfare" for a long time, and people seem so against it. I believe NOT drug testing everyone on gov't assistance is ignoring a HUGE contributor to their situation, and willfully enabling their behavior.

How many educational and intervention programs could be developed if we found a way to curb the $1500/day babysitting bills. The docs are put in a tough position because they are afraid of liability, but if there was an intermediate step that helped weed out those people, we'd save a TON of tax payer dollars.

 

[whopper]

I believe NOT drug testing everyone on gov't assistance is ignoring a HUGE contributor to their situation, and willfully enabling their behavior.

Agree, and I'm not arguing that everyone on social assistance should be given UDS--just those that are found to chronically abuse the system. E.g. they're on SSI or SSD and end up going to the hospital more than 2x per year for substance abuse reasons.

This however then brings up other problems. The gov is not supposed to look into people's medical records--but then there's a counter argument. Insurance can, then why should the government if the gov is paying for that person's bill?

I worked with a PACT team, and techniques like this worked. If you had a patient using their SSI or SSD to buy cocaine, you got them a payee, or a guardian who was responsible enough to handle the funds. If you gave the person money to buy groceries, and they had a (+) UDS, you stopped giving them cash, and started giving them gift cards for groceries. Some of those patients--it stopped the bad behavior, others, well they just kept upping the ante, e.g. they'd then look for drug dealer after drug dealer until they found the one that swapped gift cards for cocaine. Then you made them buy groceries with you.

But the ante has to stop somewhere, and the patients would up it to the point where they knew where it would stop. They usually never crossed more than that because they didn't want to pay the consequences.

You just can't throw money at a problem. Take a look at New Orleans--guy gets a 0% gov loan to fix his home, he's not going to do it because its 0% so he'll put it into a CD earning 5% and leave his home broken. Billions were thrown at NO, and there were sections of NO that laid in waste for years without any noticeable improvement. Any social assistance IMHO needs to create means where it gives people incentive to want to do the right thing on their own. Besides, society doesn't have the money to throw at it anymore. Even if someone believes the government should take a paternalistic approach, we can't afford it anymore. We're squirming in debt and we're just going to go into much worse debt the next few years. Like I mentioned above, within the next few decades social security will bankrupt the nation unless its fixed. Should that happen there'll be no money for any social services that people want to expand. A big irony I think a lot of people for social services don't realize is that the more services they want, the more it'll tip social security over the edge of no return & break the camel's back--> and there'll be even less services available if any. The big reality check that these people don't realize is this bankruptcy won't happen for years, so they'll continue to push for action that'll appease the here & now but doom our future.

Whatever actions the country takes in the next few years to combat our problems of our reduced dollar, federal & trade deficits, & our dropping status as the world's only super-power--the next administration has to take efforts to make our country more effective as if we're a business. With our current trends, unless they are stopped--> our nation will be bankrupt.
http://seniorliving.about.com/od/retirement/a/ssbenefitsfaq.htm

Q: How big is the future problem?

A: Plain and simple, without a large infusion of additional revenue, Social Security benefits are not sustainable over the long term.

http://www.pbs.org/wgbh/pages/frontline/retirement/

My own suggestion is we have to fix the healthcare system, but in doing so make it cost efficient. Whether people want to hear it or not, that entails people to take responsibility over their own health.

 

[Therapist4Chnge]

^^That was a great post.

 

[wolfvgang22]

Sort of back on the original topic: Yeah, it's odd how politics gets mentioned from time to time during interview day by those who can't seem to see others point of view. So far I've seen a balance of both liberal and conservatives, but only one that ranted for a while.

I attended grand rounds on a recent interview at a program in the bible belt where a respected faculty member made several Rush Limbaugh type statements throughout grand rounds. I like the program overall, but that was really a turn off. I said nothing, but during a break later in the day other applicants mentioned it bothered them also and wondered if they would be subjected to that every week. Haven't seen the liberal equivalent yet, but I'm certain it's out there.

 

[whopper]

Politics can have a way of alienating people who don't agree with your viewpoint.

If you were asked political questions during an interview, I hoped it was asked in a manner where you weren't made to feel uncomfortable.