Kiev on the Bayou


Leonard Zwelling

         I follow national politics closely and am considered
reasonably knowledgeable on health policy. Foreign policy? Not so much.

         My limited understanding of the recent events in Kiev,
Ukraine are that an elected government pillaged the wealth of the nation. In
turn, the populace wanted to become more aligned with the European Union and
gain the freedoms of a westernized democracy including more control over its
government and the economy. The elected leaders had promised this.

         Russian leader Vladimir “Putie-ride the horse
bare-chested with a gun in your hand” Putin would have none of that and bought
up $15 billion dollars of Ukrainian bonds and other debt to stabilize the country and bring it
more into the sphere of Russia. It is no secret that Vlad the Unshirted
Unveiler thinks the fall of the old Soviet Union was the worst day in all of
history and would like nothing better than to put the pieces back together so,
he too, could pillage the people just peeking out from under years of
oppression and corruption.

Here’s a great link from
today’s NY Times and David M. Herszonhorn that summarizes the making of the crisis
in the Ukraine:

         To us here in the United States, it looks like a colder
version of the Arab Spring and while we are cheering on those protesting for
their freedom, at least this time we know there may really be no good guys and bad guys squaring off across another, icier square, and that we in America are probably
relegated to do not much more than watch. If Vietnam hasn’t taught us to stay
out of internal conflicts in foreign countries Iraq and Afghanistan should

Syria. And Egypt. And…..

         Really, at this point, when it looks like the Ukrainian
government is going to fall and the Parliament will try to put the pieces
together while holding down the death toll, there is one lesson to learn. The
people still hold the power IF they choose to assert it.

         The civil disobedience at the Maidan in Kiev degenerated
into true violence despite what I suspect were some well-meant efforts to
prevent this. On the other hand, from my vantage point, it looked very unlikely
that anything short of violence would get the corrupt administration out, so perhaps
we should be neither too surprised nor too critical that this occurred. Please remember that the Minutemen did not greet the British with protest signs in 1775 Boston. 

         Which brings me to my favorite topic of late, wimpy doctors.
Recently I was speaking to a physician friend of long standing who bemoaned
what had happened to our profession. We were being run by bean counters and
efficiency experts who were unconcerned with the quality of the care we
delivered or appreciative of the nature of what even occurred behind the exam
room door. Patients to them were widgets moving on conveyers with scannable bar
codes on their plastic white wrist bands with billable charges to the private
insurers lining the pockets of the leaders of most health care delivery systems.
A word previously pejorative when describing an academic physician,
entrepreneur, had risen to become a compliment. Entrepreneurial skills were
even being sought among candidates for significant leadership positions as
institutional boards were desperately seeking ways to augment the shrinking per
unit revenue generated by those “encounters” (aka, patients) with bar codes on
their cheap bracelets. And where were the doctors when all this was occurring?
They were either trying to get in on the action while the getting was good and
make money by translating their ideas into stock options, or by doing
unnecessary tests and procedures for which they will be paid more. There was no
one advocating for health care excellence or for that matter, for patients. Oh
lots of people say they were, but most were elbowing their way to the front of
the line on the gravy train or griping about being left behind and desperately
seeking another new color for lapel perched ribbons on their white coats.

         I believe we have come to a fork in the road and as Yogi
might say, we have to take it.

         Only doctors can clean up this profession. We should be on
the political front lines advocating for the creation of a true health care
system where every American (including immigrants if the care system we devise
is cheaper than mandated care provided in emergency rooms) has access to some
minimal form of health care. That the public and private school curricula
include courses in health maintenance (like where babies and HIV come from),
cooking, and buying food. The government should offer tax breaks to grocers
opening fresh food markets in underserved areas. And as long as we are going to
teach our children how to live, it might also be a good idea to teach them that
we all die and that is neither evil nor areligious. In fact, it’s God’s way.
The Buddhist principle of impermanence applies to people too, not just flowers
becoming garbage and garbage becoming flowers.

         Finally, it is only the doctors who can trump the lawyers,
bean counters and green eye shade administrators who are trying to enslave us
by chaining us to examining room tables so that we cannot interfere with their
business. You know, the one that used to be ours.

         Unfortunately, much like the rebels in Kiev, all we have is
one card to play. For them it was civil unrest. For us it is the denial of our
services upon which the bureaucrats of medicine depend to make their millions.

         I am happy to hear alternative viewpoints, but I haven’t
heard one yet that is capable of melting the heart of the Pharaohs of
Physicianship that run the academic centers and hospitals and medicine in

         Without burning tires or getting help from above to slay the
first born, we can just say no. One of these days, with elaborate planning that
precludes any danger to any sentient being, especially another human, we should
play the card. And if need be—double down! We could do this without any
violence or detriment to any patient!

         If the medico-legalo-businesso class wants to play You Bet
Your Life with the patients for whom physicians care, I have a better Groucho
quote from Horsefeathers: “I’m Against It”!

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