300 thoughts on “Mortality and lack of health insurance

  1. parents went through the GD also, along with 8 children on my mother’s side, and 6 on my father’s side…they didn’t have any safety net either. They worked nickel and dime and they all actually pulled themselves out. It wasn’t an exception either. In any case..this is the problem we have today. No one knows when enough is enough. We have social welfare, for those unable to work, for babies, children whose fathers left, or unable to work, we have social security that people paid for..we have a few decent programs. That’s not what I’m referring to in any case. I’m talking about where does it stop? Now we have to pay for those who don’t want to lose their bank accounts if they are sick, or for young people who more than likely don’t want it or need it. When is enough enough? What justifies another Trillion dollar hc program, when we have medicaid already for the poor. We’re tired of it. Enough is enough.

  2. weing says:


    Read about Sisyphus and you’ll see what I mean. Thankfully, not all patients are like that. But there are those that you just discharged 3 days ago, had them set up with outpatient services and now they are in the ER with alcoholic pancreatitis again. Believe it or not, I have seen some residents drop out of medicine altogether after experiences like these. And I think you misunderstood the reason I don’t see patients like that. It is because they don’t come into the office. They are no shows. They show up in ERs where SH has to deal with them.

  3. This is an interesting fact, 80% of the dollars in government ‘programs’ go to administrative cost..20% goes to the people who actually benefit from it. In private charity..80% goes to the people who actually need it, and 20% for administrative cost. Funny huh?

  4. Narad says:

    Believe it or not, I have seen some residents drop out of medicine altogether after experiences like these.

    I know a fellow who ditched a specialty in geriatrics and retrained out of crushing discouragement with the gig. He chose the eminently tractable field of psychiatry.

  5. nybgrus says:

    Well, I am obviously late to the party… and what an interesting party it is! Normally I don’t bother catching up on an article I missed and the ninety-nine! comments within 24 hours that ensued. This, however, is a topic I am interested in and the comments were (for the most part) worth reading.

    I won’t jump in with a huge discussion of the politics (my thoughts are more or less in line with Dr. Halls on the topic of PPACA specifically and BJ’s in general) or the trollery (a sadly good riddance to SH, and rustic is… well, rustic).

    However, many of the comments seemed apropos of a discussion that I had just this afternoon with a couple of colleagues – namely the kind of patients a hospitalist tends to see.

    I spent 8 weeks on a single hospitalist service and by the end was essentially admitting and managing patients entirely on my own with oversight from my superiors (essentially acting as a sub-I). We had a lot of bounce backs. As the only tertiary care center in a 95 mile radius with some very serious backwoods and podunk places in that radius I saw a lot of non-compliance, repeat alcohol/drug admissions, babysitting a gentleman in DT’s because he had no place to go and no money to continue outpatient xanax treatment (and the hospital decided 5 extra days of hospital stay was preferable to pay for instead of a shelter and $20 bucks for some benzos), etc etc etc etc etc.

    So today my colleagues were talking about how much they loved medicine and were interested in an internal med residency, but whinging about just how much they hated all the bounce backs, the non-compliant patients, the babysitting jobs, the waste, and the lack of resources for psychiatric and other social support. Hell, I have a 5 year old kid as a patient who needs a liver transplant within the next 6-12 months, but can’t get listed because his social situation is so poor, his mother so destitute, and absolutely no support net. This child will most likely die because his family – and he – was born into an utterly desolate situation with no means of public support. They asked me, incredulously, didn’t all “those patients” grind on me? Make me wonder if that field was the right choice? Without a second thought I said no. Why would it? These are the people we are spending a very decent chunk of our lives learning how to help.

    Shunning these patients and making everyone pony up or die – as rustic and the repubs in lilady’s link would like – will not solve this problem. It will continue to bleed us dry slowly until we either fix the entire system radically or truly grow that heart of stone and actually create a schism of the haves and have-nots and watch entire swaths of people die before our eyes and marvel at how “those people” have a life expectancy decades less than ours. The sad thing in all of this is that most of the proponents of this selfish system don’t realize what side of that schism they will actually be on, or else they would not be advocating it.

    In Australia, the Aboriginals have a life expectancy 17 years less than the average and vastly higher incidences of basically everything, most notably high blood pressure, cardiovascular disease, kidney disease, diabetes, and trauma. Rather than writing them off, the Aussie government has their med students train specifically on the societal, systemic, and sociocultural issues that lead to these poor outcomes and how to overcome them. They have a single payer public system with a private system on top of that for those that can afford it. Shockingly enough, despite this, they still have just as good (if not better) outcomes than we do, slightly better life expectancy, spend (roughly) half as much adjusted dollars on healthcare, don’t have atrocious waits for medical care, pay their primary care doctors roughly 20% more than their US counterparts make (though admittedly specialists make roughly 20% less, though still quite a bit to live a comfortable life), pay their interns and residents at least 40-50% more than American interns and residents (and they can work overtime for extra money if they want/need), and have a dollar that is stronger than the US with an economy that is vastly more secure than ours. And some have wondered why being licensed to practice medicine in Australia is something I would even remotely like to have as a bonus in my back pocket. Oh yeah, and the domestic med students? The worst case I have ever seen is someone finishing with around $40k in debt for their education. Most only need about $20-30k in loans and they can have that completely erased if they do their intern years in underserved areas. But most pay it down during med school because minimu wage there is $18AUD/hour and part time work actually affords you a decent pay.

    I’ll add that the TGA – which provides all the meds for Aussies for free or cheap – demands evidence that a drug is effective, safe, and that the marginal cost is worth it before approving it. People can still buy whatever they want with private insurance subsidies or out of pocket, but if the peoples’ money is paying for it, they demand it is really worth it. And they use the collective buying power and demand for evidence and cost effectiveness to leverage pharmaceutical companies for good prices on bulk quantities.

    So clearly, and without doubt, the American system is vastly superior.

    No system is quite perfect, but certainly the hobbled on public benefits stuck on to a private for-profit system like Frankenstein’s monster is farthest from it.

    I’ll close by commenting that not all bounce backs are “those people” either. I did have one sweet old lady bounce back a number of times because her condition was simply that hard to manage. She was my patient through changes in the team and I got to know her best. Eventually I was the one that placed a dialysis catheter in her jugular vien for palliative dialysis and had the conversation with the family about end of life and signing a DNR. When we were finally able to get her home for her last few days – literally her only dying wish – her family thanked me for everything I had done and I hugged them and cried a little, feeling good that we had managed to do the best we could and the right thing.

    I want to practice medicine to help everyone. Some patients do grind on you, in the same way your kids grind on you because they don’t listen and think they know better. But we don’t fault them for their lack of knowledge and experience and we shouldn’t our patients who really are like children when it comes to understanding health care. We try and help and educate them. And we live for the moments when we have our greatest successes because it makes weeks of grinding worthwhile in the flash of a smile or the hug of a grateful patient.

  6. nybgrus…” Hell, I have a 5 year old kid as a patient who needs a liver transplant within the next 6-12 months, but can’t get listed because his social situation is so poor, his mother so destitute, and absolutely no support net. This child will most likely die because his family – and he – was born into an utterly desolate situation with no means of public support.”

    In America we have medicaid..for low income unable to afford healthcare for children already, that’s not what we’re talking about in Obamacare..see my post above…..

    (((We have social welfare, for those unable to work, for babies, children whose fathers left, or unable to work, we have social security that people paid for..we have a few decent programs. That’s not what I’m referring to in any case. I’m talking about where does it stop? Now we have to pay for those who don’t want to lose their bank accounts if they are sick, or for young people who more than likely don’t want it or need it. When is enough enough? What justifies another Trillion dollar hc program, when we have medicaid already for the poor. We’re tired of it. Enough is enough.)))


  7. Chris Repetsky says:


    I was having a “meh” day, and your post just brightened it considerably.

    That’s the exact motivations I have for choosing this field, and when I start practice, that’s the kind of doctor I want to be.

    Thanks for such an insightful and thought provoking comment.

  8. and nybgrus..we have a co ed going to D.C. testifying how she needs $3000 of contraceptives to get through law school and for us to pay for them…see how needy people are in America?

  9. tmac57 says:

    DugganSC commented way up thread,speculating on why Americans were so loath to accept universal healthcare by saying,in part, “…or having to wait for hours to get into an emergency ward. ”
    Let me submit my own anecdote here on that specific point:
    About 8 years ago,just after my wife went through extensive treatment for cervical cancer,she developed a cellulitis infection on her upper thigh,extending to her groin and abdomen. She was treated with powerful broad spectrum antibiotics,and told that if the infection appeared to spread,to go to the hospital ER immediately.
    Of course,about 24 hours later,that is exactly what happened,at 9PM on a Saturday night (you docs out there know where this is going,right?).
    I got her quickly to the Baylor Medical Center ER in Dallas,where she was triaged,and we spent the next 6 hours,with her in agony from pain,and exhaustion,waiting to be next in line to be treated,and here is the kicker,we DID have what is considered to be Cadillac heath insurance via my job at AT&T!
    So the bottom line is how is that a superior system,for either a person like her (very well covered),or the poor schmucks that were clogging up the ER that lousy evening with everything from a bad cough to a barroom laceration?
    If people think that just because they have excellent insurance,that they can waltz in to an emergency room,and go to the head of the line…they are fooling themselves.

  10. Harriet Hall says:

    I remember a patient who was brought to the ER because he had a seizure in a public place. He still had the bottle of anti-seizure pills in his pocket, unopened, from his visit to the ER the night before for a seizure. Why do you think he hadn’t taken them? Was he a bad person who was just out to make the doctor’s life difficult? Could his noncompliance be based on something beyond his control? Low intelligence? Education? Misunderstanding? Memory lapse? Psychological disorder? Cultural factors? Alcohol? He wasn’t my patient, and I don’t know the followup, but I wonder if anyone really tried to find out why he hadn’t taken his pills or to understand his thinking processes.

    I remember another patient everyone hated. He was angry and abusive. It turned out he was suffering from organic brain syndrome and his anger was a desperate coping mechanism. He was doing the best he could.

    I remember a child who was brought into the ER for a headache that had already resolved. I thought the parents were abusing the system (just because care was free in the military) until I questioned the mother and found out she was genuinely concerned because the child had recently had a head injury and she thought the headache could be a sign of a brain bleed.

    I remember a newspaper story about a homeless man who was arrested a ridiculous number of times for drunkenness and cost the public a ridiculous amount of money, but who was eventually helped to stop drinking, to find a place to live, and to turn his life around.

    I may be a Pollyanna, but i like to think most people are doing the best they can. Sometimes their best just isn’t good enough. Sure, some people simply can’t be helped no matter how hard we try. But shouldn’t we at least try to understand them and help them?

  11. Quill says:

    But shouldn’t we at least try to understand them and help them?

    Yes. Many times yes!

  12. lilady says:

    Because Passionless Drone has posted brilliantly on “Obamacare”, (and because I swore not to *go there*), I am offering up my experiences as the parent of a multiply-handicapped child.

    My son was a *frequent flyer* at area hospitals for seizure control, FUOs, and for IV hydration. A few of the resident ER docs treated him like a “GOMER” (Get Outta My Emergency Room), hesitant to admit him…and fearful that I would abandon him. I quickly and succinctly disabused those doctors about his condition and my devotion to his care. There would be no miraculous *cure* and he would be back, frequently, for life-sustaining treatment.

    He was, for all of his twenty-eight years of life, a *drain* on the health care system…even though we had private health care insurance. He would never be a *productive member of society*, but he was a human being who fought to stay alive and deserving of good health care. Perhaps that is the reason why I thoroughly enjoyed working as a public health nurse, to care for patients who are dependent on our publicly-supported health care system.

  13. @nybgrus: As a non-doctor, I will agree with Chris Repetsky. It’s heartening to see the dedication of doctors like you.

  14. mousethatroared says:

    Wow, so many really impressive and heartfelt comments. I feel lucky to have had the opportunity to see a little bit into all of your thoughts and lives*. Thanks!

    *Although I’m a bit bummed out that I don’t live in Australia now. ;)

  15. Marco Rosaire Rossi says:

    As colorful as this thread is, I actually have a technical question that I was hoping Dr. Gorski could answer. The Harvard paper supported by Physicians for a National Health Program concluded that 45,000 people a year die of lack of insurance, while the IOM study from 2002 concluded that the number is more like 18,000. However, the Harvard paper also claims that is used many of the same statistically methods as the IOM paper. (It is mentioned in the link). If that is the case, why is their figure more than double the IOM one? What does the Harvard study consider that other report leaves out, and can we say that they used an improved methodology, or one that merely validated their political position? Anyone know -

  16. JayJay says:

    “I have a problem paying for anyone except myself and my family. Everyone else should have a problem paying for me too.”

    I can’t argue that there isn’t an element of fairness in your statement rustic. We have a similar idea of matching input and return in the Australian health system, except instead of ‘I give nothing and expect nothing,’ we opt for ‘we all [well… most of us] give, and we all receive.’ It’s not a perfect system, we may still have to pay for certain things, such as imaging studies for some conditions, and we may have to wait for some procedures (although this can be minimised by paying a little extra for private cover), but it’s nice to know that the contents of my wallet will have little to do with my healthcare if something awful happens. I’m happy to have ~30% of my wage go to tax if a decent part of that is going towards securing the wellbeing of myself, my family and my community.

    Also, I’m starting a medical degree in a couple of months and I’m very relieved that the ‘wallet biopsy’ won’t be featuring in my day-to-day.

    @nybgrus – you’re right, the Aussie government is very kind to university students, they knock the total cost of a four year graduate medical degree from ~$200,000 down to roughly ~$40,000, although the undergraduate course is at least a year longer, so that may result in a higher total. The loan scheme is also quite nice, the interest rate is inflation-only, and the default option is to pay it as a small percentage of our income once we start earning >~$50k/year. It’s not all rosy though – housing is hugely overpriced here, especially in the big cities, which can be a big problem for students.

    My parents still love to rub in the fact that university was entirely free back when they went through, but having compared my debt situation with that of an American law graduate, I can’t bring myself to be upset about how things stand at the moment.

  17. David Gorski says:

    and nybgrus..we have a co ed going to D.C. testifying how she needs $3000 of contraceptives to get through law school and for us to pay for them…see how needy people are in America?

    Sandra Fluke? Seriously? You’re attacking Sandra Fluke on a huge straw man argument that basically implies she’s a slut? Pathetic:

  18. Dr. point is how far does it go?..enough is enough…I don’t have a bank account myself, I’m not wanting to to pay extra in premiums to “save” someone else’s bank account, or someone’s sex, or for 25 year olds who should be supporting themselves by then..sorry..I think that’s beyond…enough is enough.

  19. weing says:


    Australia is nice. I was debating going there about 15 years ago. Too bad my kids didn’t want to. Now, I think, it’s too late. Even with my skills, I may be considered too old for an immigrant visa. I don’t think you have the illegal immigration issue that we have here in the US. Correct me if I’m wrong. Does Australia still bar HIV + immigrants?

  20. ((My friend was not alone. Hart Research Associates found that 55% of young women ages 18-34 report having had difficulty affording the contraception they need to treat medical conditions or to prevent unintended pregnancies. That’s no surprise when you realize that for some women contraception can cost as much as $960 per year ($1,210 with the doctor’s appointment), according to the Center for American Progress)).

    For medicinal purposes, no I’m not familiar with how contraceptives will work for it, and we all pay for doctor visits don’t we…in any case that would be an exception to the rule, and could easily be done through doctor and insurance company I’m sure, not to make it a blanket Demand by all for “unintended pregnancies”… and, going to a catholic university, expecting them to go against their own belief and policy for her (who chose to go there) or anyone else is ‘attacking’ the freedom of one’s religious belief..actually.

  21. mousethatroared says:

    RusticHealthy – (sigh) the Sandra Fluke argument?

  22. lilady says:

    @ rustic health: Haven’t you read the links that Dr. Gorski provided? Sandra Fluke was discussing her friend who lost an ovary because she was denied birth control pills, to treat PCOS (Polycystic Ovary Syndrome)

    For goodness sake, before you post here, why didn’t you “Google” “Polycystic Ovary Syndrome-Treatment”. There are plenty of web pages, that are reader-friendly about treating PCOS with birth control pills.

    The ACOG (American College of Obstetricians and Gynecologists), has “Treatment Guidelines-PCOS”, here:


    Anovulation and Amenorrhea

    Combination oral contraceptives

    Progestin, including medroxyprogesterone acetate

    Insulin-sensitizing agents, including metformin and thiazolidinediones*

  23. lillady..(( Haven’t you read the links that Dr. Gorski provided? Sandra Fluke was discussing her friend who lost an ovary because she was denied birth control pills, to treat PCOS (Polycystic Ovary Syndrome)

    For goodness sake, before you post here, why didn’t you “Google” “Polycystic Ovary Syndrome-Treatment”. There are plenty of web pages, that are reader-friendly about treating PCOS with birth control pills.

    The ACOG (American College of Obstetricians and Gynecologists), has “Treatment Guidelines-PCOS”, here:))

    I said I didn’t know, but there could be ‘exceptions to the rule’…that could or should be worked out with her doctor..that’s not the norm…Fluke also added “unintended pregnancies”..birth control..for all women, not only medicinal purposes..and that’s against catholic belief..forcing them to cover it in all instances is against their religion and that’s against religious freedom of a catholic university.

    Fluke can always go to another could any other coed..or they can buy their own contraceptives…and I suppose the guy should help out with the big expense too :)

  24. nybgrus says:

    @Rustic, you genuinely have no idea what you are talking about. And to insinuate that a 5 year old child might die because myself and his doctors couldn’t figure out to refer the person to Medicaid is downright insulting.

    @weing: I don’t know actually if they bar entry, but they certainly do require a check. I had to demonstrate HIV status prior to getting my student visa. I just don’t know exactly what would have happened if it had come back positive.

    Also, I am American, currently live in America, and (at least for now) plan on practicing in America. Except for one rotation next year I am done with my studies in Australia. But yes, it is indeed much harder to be an illegal immigrant in Australia for myriad reasons.

  25. nybgrus…I misunderstood. I thought you were in Australia…Not sure why a 5 year old is not covered.

    that’s sad..see that should be fixed…but, not all the other my paying for someone to keep their bankbook, or for 25 year olds who should be supporting themselves..or anything else someone comes up with claiming they need for us to pay for…enough is enough is my point.

  26. JayJay says:

    @weing – Immigration health requirements are discussed here:

    According to the website: ‘Only TB is mentioned in migration legislation as precluding the grant of a visa, but the applicant is given the opportunity to undergo treatment in most cases. Other health conditions are assessed on the potential cost and impact on the Australian community resulting from the possible use of health and community services.’

    Illegal immigration is one of the big political issues in Australia. Being an island nation, the only real option for arriving in secret is via sea. It’s a risky method, especially given the safety standards in the people trafficking industry, but unfortunately it’s still popular. It often doesn’t end well.

  27. Quill says:


    Australia is an interesting case regarding long-term stays and HIV. You may find this site useful:

  28. lilady says:

    In the United States, we have tuberculosis protocols in place for legal immigrants. As far as I know very similar TB protocols are in place in every country.

  29. nybgrus says:

    Rustic, as I said, you really don’t have any idea what you are talking about. It is not an issue about getting the money or means for the liver transplant itself. Getting a new liver doesn’t instantly mean you are all hunky dory for the rest of your life. It is an extremely complex illness to manage and this boy will not survive the aftermath of the surgery in his current sociocultural living situation. It was an example of the most basic and fundamental ways in which systems level issues – completely outside the direct control of individuals mired in them – create a very real second class citizen with very, very little recourse for good long term outcomes. The argument you are making would make them third class, people like yourself (and potentially me) as second class, and leave a very small 1st class you can actually afford good longitudinal care.

    Stop embarassing yourself. Please. It is one thing to try and prattle on about how your vitamins and organic foods saved your life. It is quite another to think you can even remotely adequately comment on complex socio-medical topics and studies which you link in your comments (but clearly have nearly zero capacity to read beyond the title and a few sentences of the abstract). I see this boy every day and it pains me to realize that there is literally nothing that can be done for him. I’ll find out tomorrow what the outcome of the ethics committee, family, and child protective services meeting actually was.

    This attitude of “mine and f*ck you” is patently archaic and stupid. You should want to divest yourself in the improvement of others with the social contract that others will do the same. If you at least argued that you don’t want to help others because nobody wants to help you then that would at least be a starter. But to argue that in principle everyone should fend for themselves is just downright stupid. We succeeded as a species because of cooperation and civilization, not because everyone tried to play king of the hill. The intelligent discussion is “how do we get society at large to buy into the social contract in a mutually beneficial way” not “that damned slut is making me pay for her contraception so screw her and everyone else!”

    Jeez. Have some humanity along with your organic vegetables and mega doses of vitamin C.

  30. Narad says:

    forcing them to cover it in all instances is against their religion and that’s against religious freedom of a catholic university.

    As you’ve made this incredibly foolish claim more than once, I’ll give you a hint: No, it’s not. It is the choice of the Church to enter into the secular realm of employment and insurance, and they’re free to leave it.

  31. nybgrus..maybe I’m not making myself clear..I’m really not sure but, I have no problem helping those who can’t help the little boy and his illness, and his socioeconomic situation. I have no problem ..I understand there are things we should and could help in. (I’d question where 4 trillion $ went that didn’t help him went) but, never the less…I can see you’re emotional of course about it..being personally involved, but, once again, I’m not talking about such a situation. I do have to say, after so many brains in d.c. got together for 2 years to put through such a hc bill that doesn’t address it, I think it should indicate to you and everyone else where the problem lies.

    What I’m referring to is the ‘entitlement’ mentality, and over things the people can even pay for saving someone’s bank account paying more for my insurance (5 times more).. myself not having a savings account..nor a possibility in the future to have one as I pay more and more for other’s contraceptives, bankaccounts and 25 year olds that won’t get out and support themselves. I hope I can still afford my Vit. C, and organic food when you all get through.

  32. Translating in a language that hopefully (I have high expectations) RusticHealthy will understand. nybgrus is arguing for basic human dignity, which is what every civilization should strive for. RusticHealthy, on the other hand, is arguing to the Hobbesian natural state, where everyone is a savage beast.

  33. And before you start accusing us of being socialists, RusticHealthy, please note that the first state-sponsored health insurance program was started in Germany in 1891 by … Otto Von Bismarck, who, last time I checked, was far from a leftist. The French Sécurité Sociale (which doesn’t have anything to do with the US Social Security) was founded by Charles De Gaulle in 1945. Again, not a socialist. The NHS … Okay, you can have that one. It was started by a Labour government. But you know where the Canadian health insurance program started? In Saskatchewan. Not really a leftist province either.

  34. lilady says:

    @ Narad: New York Case, where Catholic Charities-Albany tried to get an exemption to Federal and State laws to provide contraceptive coverage enrolled in their group prescription plan…they lost. A similar case was heard in California, the Church lost the case:

  35. @Narad: Don’t forget that Georgetown has also made the (now) secular decision to enter education (with all the federal funding this entails).

  36. I know.. why don’t we all pool everything together, and we all get exactly the same be perfectly fair because I’ll be damned if you’re entitled to more than I I can call you greedy..nybrus..I’m going to guess you probably make 10 times more than I do..and I don’t think that’s fair..and if anyone makes a dollar more, well..they just have to give it up…is that the idea? Let’s see what that produces. Wait..wasn’t that tried before? and then everyone was equal..equally desolate that is. Oh, there were a few, in gov, that ran the system..they somehow were entitled to a little more..of course. It’s easy to call others ‘greedy’ isn’t it..when they don’t want to give you all that you want and demand. That’s a great tactic…that settles everything…you’re a selfish ‘greedy’ bastard nybgrus for making more than I do..I can’t even afford a decent car right now, now I have to tell you my economic situation, just to prove to you how I’m not greedy, just that I like freedom and I’d rather do without with freedom to decide for myself what I do with the little I have. Have you all gone mad? Do you even think of what you think you consider this ‘ideal’ b.s. sharing will entail?

  37. Francois..’accusing’ you..would infer that you’re not, but that I’m falsely ‘accusing’ you..but you I’m not ‘accusing’ you, I would be stating a fact. Why? are you denying it? It’s what you are.

    You haven’t considered the results of it, what will happen more and more, as it grows, but, it’s what you are, (or you think you are), until you one day find yourself in ball and chains owing everyone else ..atleast what those in the government lording it over you say you owe..(for the others good of course) you give whatever you have to them..those in control (you’d be greedy not to) divy out..(pocketing first what their ‘needs’ may be first of course) (you’d be greedy to question it)..but you’ll trust them of course to do what is ‘right’…while in your ball and chains… then tell me if you want to be a socialist or not then. :)

  38. lilady says:

    April, 2012 The faculty of Georgetown University took Paul Ryan to task…

    Representative Paul D. Ryan, the Republican chairman of the House Budget Committee, has been excoriated by some Roman Catholic leaders ever since he claimed this month that his budget plan, which slashes antipoverty programs, was inspired by the moral teachings of his Catholic faith.

    The latest criticism comes in a letter released Tuesday and signed by nearly 90 faculty members and priests at Georgetown, the Jesuit university in Washington, in advance of Mr. Ryan’s visit there on Thursday. Mr. Ryan is to deliver the prestigious Whittington Lecture, named for an associate dean who was killed on the airplane that crashed into the Pentagon on Sept. 11, 2001.

    The letter says, “We would be remiss in our duty to you and our students if we did not challenge your continuing misuse of Catholic teaching to defend a budget plan that decimates food programs for struggling families, radically weakens protections for the elderly and sick, and gives more tax breaks to the wealthiest few.”

    “Your budget appears to reflect the values of your favorite philosopher, Ayn Rand, rather than the Gospel of Jesus Christ,” says the letter, which the faculty members sent to Mr. Ryan along with a copy of the Vatican’s Compendium of the Social Doctrine of the Church — “to help deepen your understanding of Catholic social teaching.”

    Paul Ryan, has also stated he wants to eliminate the Title X Family Planning Program, which has never funded abortions, since the enacting legislation for the program was during Richard Nixon’s administration, 1970. After all, coitus interruptus (The Sin of Onan), is in the bible.

  39. nybgrus says:

    I wish I could dig it up but just don’t have time at the moment. I will try and find it later today at some point if I can.

    However, firstly, any purely sectarian organization is exempt from the mandate. I don’t think they should be, as all the exemptions granted to sectarian organizations are based on the principle that they are completely removed from the secular sphere (i.e. no politicizing) but clearly continually and forcefully inject themselves into it. I think we should also repeal tax exemptions for sectarian organizations that don’t meet 501(c)3 criteria. But I digress. They are exempt.

    Additionally, each individual is exempt from both the mandate and the fine if they express sectarian objections. Once again, I don’t think they should be, unless they also sign a contract stating that they will not consume medical services until after payment has been rendered (i.e. they are still members of society with access to medical care, but opt out of the social contract involved). But, they are exempt.

    And lastly, organizations headed by sectarian groups but whose primary activity and employee constituency are not sectarian are not exempt. In a recent court case (which is what I was trying to find but couldn’t), it was ruled that this lack of exemption stands. The plaintiff (sectarian group) claimed that it was an unfair religious burden that they subsidize something they are morally opposed to (contraception). The judge deemed that such subsidization was not a substantial burden on their religious freedom since they pay their employees money and money can (and is) used to purchase contraception. Thus, they are still subsidizing the individual use of contraception and denying the entirety of a mandated health cover for that one issue becomes an unfair burden on the otherwise secular employees. The point is that we all – directly or not – ultimately subsidize something we don’t particularly like in society because we are a diverse and secular country. Some people may not like cars and driving, but their taxes still subsidize roads. I don’t like war, but my taxes subsidize wars. Jane Doe ay not like animal testing, but her taxes subsidize the NIH. And such is the social contract we have to act in the greater good of the whole of society – not specific subsets of it. If we did that, it would be anarchy.

  40. mousethatroared says:

    lilady – ouch! Gotta love those Jesuits – although I disagree with the Georgetown policy on contraception, that is a damn good set down on social policy.

  41. mousethatroared says:

    nybgrus “The judge deemed that such subsidization was not a substantial burden on their religious freedom since they pay their employees money and money can (and is) used to purchase contraception.”

    This has been so obvious all along, it just kills me how seldom it comes up. Glad a judge figured it out.

    Also – So you’re back in the States now, jetsetter? During one of the recent comments dust-ups I took the liberty of checking out your school (cause I’m a stalker). My dad lived in that region for a number of years. They are sorely in need of medical people. Thanks so much for your service there.

  42. The Georgetown faculty do not know the difference between giving, and taking, apparently. Or what the bible actually means by it. Between one’s true heartfelt voluntary own choosing of giving, and the individual freedom to choose who/what they want to personally give to; to government bureaucrats taking (taxing) $ and handing them out for votes. That’s all this mounts to. Some pols divying $ to the most likely people/place that will get them Votes…and nothing more. And, of course the attitude of You Owe Me helps to have in order to get them in your hands, whether it be for your bank account …or sex life…or failed business (or ‘educational’ grants to university). What this mounts to is a nicely acceptable way of theft and highway robbery, and a total infringement on freedom…it’s not’s Taxing and pandering..I wonder how many of my $$ will go in Georgetown U hands to spend on their nice new desks and big faculty salaries. So, is the catholic ‘doctrine’ governing us now? I wonder.

  43. And, just to clarify..there’s a difference between tax breaks, (what R’s propose) and bail outs (bailouts would be taxing others (like me) to give to a business/corporation/crony so their ‘bottom line’ is not altered)… tax cuts is allowing any and all businesses/ (without bias or prejudice) to keep their own dollars , to decide what they do with what they’ve earned…i.e. Freedom. And, come to think of it..I’d like to see how much those faculty members give of their own to families struggling. Prove to us all how much they’re suffering and giving out of their own pockets, now that they’ve brought it up.

  44. Just an idea nybgrus..why don’t you hit those GU faculty for the $ to help out that little boy?

  45. mousethatroared says:

    The preamble of our constitution gives these tasks to our government. “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

    That is the point, we accept the constrains and responsibilities of being part of the People of the United States so they we may share in Justice, Tranquility, Defense, General Welfare and Liberty.

    The constitutution specifically allows for taxation (WITH representation, which we have) to fulfill those tasks.

    Disagreement in how we go about fulfilling those tasks is credible in my mind. But disagreement with the basic tenants of our constitution does suggest that a move to another country with a different constitution or no constitution may be in order.

  46. mouse..and if we the people so decide to have less we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too.

  47. @rustichealthy: Oh the poor citizens of Norway, Sweden, Finland, Denmark, Japan, Canada, France, Germany, Argentina, Brazil, Switzerland, the United Kingdom, the Netherlands, Belgium, Luxembourg, Iceland, … all under that totalitarian boot of their socialist government. Oh, the evil socialist Angela Merkel, oh the evil socialist Otto Von Bismarck, oh the evil socialist Charles De Gaulle, the evil socialist David Cameron, the evil socialist Stephen Harper, oh evil socialist me, oh the evil socialist François Hollande, oh the evil socialist Julia Gillard. Oh, wait, the last two are actually Socialist and Labor respectively. But quite frankly, you’ve just proven your ignorance here, rustichealthy. Get out of the country a little bit, RH, it will do you some good. And it will also show you how narrow your point of view is.

  48. DugganSC says:


    You’re probably thinking of the Hobby Lobby case. As I understand it, they’re not so much against the contraceptives as the abortifacients that got included in the list. I can kind of see their point. If a law got passed requiring businesses to provide non-lethal self-defense weaponry to women and included handguns on that non-lethal list, I suspect people would complain there too.

  49. lilady says:

    @ rustic health:

    I’m giving you points for the longest run-on sentence, that I seen in a very long time.

    (I’m still the undisputed *queen* of the run-on sentence…nice try, though).

    “And, just to clarify..there’s a difference between tax breaks, (what R’s propose) and bail outs (bailouts would be taxing others (like me) to give to a business/corporation/crony so their ‘bottom line’ is not altered)… tax cuts is allowing any and all businesses/ (without bias or prejudice) to keep their own dollars , to decide what they do with what they’ve earned…i.e. Freedom.”

    Romney also proposes to keep the capital gains tax rate at 15 %…down from the former capital gains tax rate at 35 %, before the Bush Tax Cuts were implemented in 2010. Those tax breaks were due to *sunset* in 2010. Why didn’t they RH? All of Romney’s income is derived from capital gains taxed at 15 %.

    BTW, where are all Romney’s prior years Income Tax Filings? I want to see if he is part of the “47 % of Americans who don’t pay any Income Tax”).

    “mouse..and if we the people so decide to have less we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too.”

    Are you stating RH, that if Romney wins you will move out of the USA? Promise?

  50. mousethatroared says:

    RH – “and if we the people so decide to have less we did 2000..then you should all have been happy with that too..because that’s what we the people decided. I guess we’ll see what we the people decide this election..and yes a move might be necessary, unfortunately..but that goes both ways too”

    That is the whole point. It doesn’t go both ways, because I support and understand Democracy.

    If I am not happy with the decisions made my our democratically elected representatives, I don’t move, I vote and I speak.

    You can do the same, but all these claims that you are making that you only have the responsibility to take care of yourself…that is just not consitent with the responsibilites of living in a democratic nation.

  51. mousethatroared says:

    DugganSC – “I can kind of see their point. If a law got passed requiring businesses to provide non-lethal self-defense weaponry to women and included handguns on that non-lethal list, I suspect people would complain there too.”

    Businesses pay their employees a salary. Should a business be given the power to prevent an employee from purchasing a legal firearm with that salary? If not, why should an employee be prevented from using their company benefits, which are an agreed upon substitute for salary to obtain legal/standard of care medications?

    Why does it matter whether the employee’s salary or benefits are being used to abstain the legal thing you don’t like?

  52. mousethatroared says:

    obtain, not abstain….that’s another contraception argument. :)

  53. nybgrus says:


    Yes, I’ve been stateside all year and except for 2 months next year will continue to be. As for”stalking”me, no worries. It should be reasonably easy for anyone to have figured out what program I am in by now. Hopefully it is a little harderto figure out really who I am, but I have nothing to hide anyways. And thank you for the kind words.

    Also, I was going to say exactly what you just did in response to the hobby lobby case (yes, that was the one). It doesn’t make one whit of a difference if you are opposed to one small part of the mandate or one really small part of the mandate. The underlying principle is exactly the same and it is still not an unjust burden of religious freedoms. I mean, what if the Jehovah’s witnesses wanted to object because they didn’t want to indirectly support blood transfusions?

  54. mousethatroared says:

    nybrgus “Hopefully it is a little harderto figure out really who I am”

    Oh well, I haven’t figured out really who I am. I hardly have time to figure out who someone else is. ;)

  55. mouse..we’re a Republic..”for as long as we can keep it”..I think that was Benjamin Franklin..but, there is a a straight democracy..the majority rules.

    In a Republic, there Are rules of law such as the Constitution, ..despite what the majority says or ‘votes’ for. I always remember this scenario… Democracy is 2 wolves and a lamb voting on what’s for supper, (not good for the lamb)..and a Republic is one well-armed Lamb.

    There are certain inalienable ‘rights’, that can’t be taken away..the right to bear arms, for instance. Or, the right to free speech. Let’s say..the ‘majority’ believes they should ban arms ..well you can’t do that..that’s why we’re a Republic as much as the left tries and keeps trying to do. The Constitution was made for Individual rights..not what the Majority happens to vote for or against.

    I believe our forefathers were geniuses..that or, extremely committed to freedom individuals..knowing the nature of the ‘beast’ i.e. big Federal government, and the hardship they endured and the blood they shed, knowing how important freedom of the Individual was..and not the majority. We’re a Republic.

    Regarding “Congress shall Tax” it was originally a limited Federal government…meant to protect us in defense, and a few other federal duties perhaps… and I believe they used tarriffs then. It wasn’t to micromanage everyone’s income in the whole it’s doing now. It was never meant to take from one and give to another, they may have taxed the rich cover defense , but not to redistribute wealth. In fact, there was no federal taxation until the 20th century I believe..except for wartime which had to do with defense…nothing more from the Federal level. All taxes were decided at the state and local level..where it’s much more manageable and close to the people it affected.

    Anyway..what we have is a huge beyond manageable mess. 4 Trillion dollars..printed out in four years redistribute to cronies and buy votes. None of it helped that little boy though.

  56. Francois..or Stalin, Lennon, or Hitler..let’s not forget them :) And Nazi stood for a National Socialist party..he and Stalin pretended to be friends on the same page until one of them decided to not be. And, one thing..I think it’s’s the size of half of NYC in population #s..half of them are probably related! :) it’s a bit different then a huge micromanaging Fed government over 330 million in America. We have 50 States..that’s what we have states for..Not to be micromanaged by a monster Federal Gov. costing more and more each day..beyond control. Your countries are limited in their spending because they don’t have printing machines our Fed gov has contribed along with the banksters. :)

  57. DugganSC says:

    @mousethatroared / nybgrus:

    I suppose that, in the end, it kind of gets into the question as to whether it matters whether it’s a personal choice or something happening to someone else. As I understand it, the owner of Hobby Lobby isn’t opposed to his employees using contraceptives (which only affects themselves, same as the Jehovah’s Witness example) but was concerned when it included medications that directly affected another person. It’s kind of like the difference between giving money to a person to buy cigarettes and giving it to them so they can shoot their wife. *sheepish smile* Maybe… as I recently commented to a friend, I’m as good at analogies as I am at describing something which is entirely non-bowling-ball shaped. The basic argument is that the law stated that they were doing A, which was approved, and somewhere along the lines, someone added B as well.

    @tmac57 (way up there):
    FWIW, I had a similar situation, albeit in a strangely reverse fashion. Several years back, I developed a severe nosebleed that wouldn’t stop for the space of a few hours. After waking up choking on my own blood one too many times, I drove down to the emergency room (the only thing open at 3 AM) whereupon, after only about a half hour (me obviously being a low-risk case), I got admitted in, ahead of several people who’d just got in and had obviously just gotten out of a traffic accident (one guy still had bits of gravel embedded in his chest). I guess that hospital really took “first come, first served” seriously… Ultimately, though, I was commenting on the perception and belief involved between private and public care. People here have heard horror stories about overseas and most of them have had speedy treatments in the E.R.

  58. lilady…how much did Obama give out of his Own pocket to the poor? :) lol big taxing kind of people don’t do that do they..I remember Clintons claiming $25,000 in deduction to underwear they donated..that was amusing. And, I remember Gore, the change your lightbulbs and cut your electricity guy..had an electric bill upwards of $2000 a month! I love how that goes. Just an fyi..Canada cut their capital gains tax finally to 17%..half of what ours is, and their economy started leaps and bounds. You lower taxes on business and you see how they open up to expanding and hiring..something that just didn’t happen the last 4 years of squandering trillions to cronies did it? Romney has the right idea.

  59. nybgrus says:

    @mouse: lol, fair enough.

    @duggansc: That still does not fundamentally change the calculus of the issue at hand. The choice is legal, the cover is under the jurisdiction of medical expertise, not employer expertise. No matter how many steps or refinements you take the outcome is still the same. If a Hobby Lobby employee used money from his employment to kill his wife, should Hobby Lobby then enact a system wherein they do not pay their employees money but instead have them mail bills to corporate to pay their cost of living?

    Once again, we cannot prevent people from making bad choices (at least not most the time). But when your claim is an undue infringement upon your beliefs – religious or otherwise – the law requires demonstration of substantial burden for that claim to be valid. As long as the cover in the mandate covers legal medical procedures (which obviously it must) then any objection to any part of it will simply not meet that test.

  60. mousethatroared says:

    DugganSC – I don’t understand. What other person does the medication directly affect?

  61. And, the general ‘welfare’ didn’t mean a welfare state, and ‘blessings of Liberty’ doesn’t mean taking anyone’s money or property…even if I decide I need or deserve it..(as I do :)

  62. nybgrus says:

    I believe he is referring to the hypothesized conceptus, but correct me if I am wrong

  63. lilady says:

    rustic healthy:

    “lilady…how much did Obama give out of his Own pocket to the poor?”

    Mormons tithe to the LDS church 10 % of their income. So, why should should I support the Mormon church…when Romney’s 10 % tithes further reduce the income tax he pays?

    Do you need any help packing your belongings for shipment to a foreign country, when Romney gets his butt whupped on November 6th?

  64. lilady..we’ll see..but I have to tell you…not too many people I know see it as you do. They like deciding what to do with their money, and their property, and their businesses, and they have no problem with someone else having the same freedom..whether you approve or not..that’s freedom. Of course, if you’re a taker, and benefit from taking ..maybe in grants, free handouts, union raises more than what the people who work and pay for them now get…then I suppose you’ll vote for more. Unfortunately, not even considering the ramifications of it all. I don’t intend to change your minds…there are givers and there are takers. The confounding part is..the takers in this country are walking around as IF they’re givers..because they believe in taking and accusing others of not being givers! they can have the ‘right’ to take! Kind of something you expect in a mental ward.

  65. @rustichealthy: Funny, I remember talking to Canadians (I work a lot with Canada) and none of them were very happy with the capital gains cut, considering it lead to degradation of infrastructure. And those are people from the mainstream Canadian political spectrum. And this is lamented in the Globe and Mail and other Canadian newspapers. Remember those demonstrations in Québec, Toronto and Vancouver? Yes, all in opposition of Stephen Harper’s policies. Again, you make a completely ignorant statement.

  66. Quill says:

    I wondered how long it would be before rustic healthy added yet another unnecessary proof to Godwin’s Law. The more rh writes the greater becomes my wonder at how much ignorance one can contain without bursting one’s clothes.

  67. Francois..Well some are simply conditioned very well I suppose..or they have political loss, like the whining and grumbling 6 years of an incredible economy in America during Bush years!!..the whining was unstoppable from the left!…Jobs everywhere, UE down to 4%, growth, more revenues went to Feds because of tax was really amazing! Then the Left took control of both houses..and things spiraled from there..increased spending..bailouts…UE…policies destroying American economy..just 2 more years and Americans woke up and got the House back.. what were they protesting btw? exactly? didn’t get the freebees they wanted? you’ll have to explain that..but, not now..I’m going to wrap this up lol it’s neverending the whining of socialists..sorry :) see you all later.

  68. @Quill: I had totally missed her reference to Stalin, Hitler and Lennon. Wait, what? John Lennon? What does John Lennon have anything to do with this? I also like her overt racism toward Norwegians and the fact that she completely ignores the existence of this little thing that just got the Nobel Peace Prize, the European Union (I’m not going to discuss the merits of that Peace Prize). Or that she ignores the fact that Germany, the Netherlands, Canada and Belgium are, like the United States, a federation of states. Or that Japan has 128 million inhabitants and still manages to offer state-sponsored health insurance. As for the Nationalsozialistische Deutsche Arbeiterpartei, thanks, RH! Having lived and studied in Germany, I thought I had a very good grasp on its history, but never ever would I have thought that a name stood for everything an entity stands for. Now, thanks to you, oh dear rustichealthy, I will have to rethink the connection between Ayn Rand and the US Objectivist poets of the 1930s like Oppen, Zukofsky, Niedecker, Bunting and Rakosi. Now, thanks to you, oh dear rustichealthy, I will have to rethink the Republican Party as the true inheritors of the legacy of Plato’s Republic, the Roman res publica, the Republic of Venice, and the French Republic! Gee whiz, the things people learn thanks to you, oh dear rustichealthy.

  69. mousethatroared says:

    Lilady – the funny thing about RH is, she can leave, but as an U. S. citizen, she still has to pay U.S. taxes and it’s illegal to give up your citizenship to avoid taxes. Also you need a passport to enter most countries and often a Visa as well, therefore you need some sort of citizenship. Not really sure what her plan is.

  70. mousethatroared says:

    FL – you are confusing me, but then I still get bemused by the fact that Teddy Roosevelt was a Republican and where does the Banana Republic come in? :)

    I’m pretty sure there’s a Life of Brian bit in there somewhere.

    pretax so suspect that John Lennon would have been happy to have offended RH.

  71. @mouse: Banana Republic, Republicans, Irish Republicans, the Republic of California, même combat !

    (For more context, see RH’s post at 4:20PM. I wonder if that timestamp is indicative of anything)

  72. nybgrus says:

    I would like to comment that I wish I had François Luong’s breadth, let alone depth, of knowledge when it comes to literature and philosophy. In my circles I am often amongst the more well read and while I admit you may turn out to be a poseur, I think it more likely that I would be well out of my depth in a conversation with you on such matters. Which makes me wish all the more to share an appropriate libation* and have said conversation. One of my most fun conversations of recent memory was over multiple Scotch’s whilst learning about the architecture of Le Corbusier from an Irish architect in Australia.

    *I recently discovered a wonderful such libation at a local restaurant. They call it “A Little Indescretion.” I bought what I needed and recreated the drink at home the very next night.

    First you must take caraway seeds and boil them in simple syrup until it reduces by about half. Then you take 2 parts bourbon, 1/2 part each of lemon juice and the caraway syrup (sans seeds), and a splash or two of rose water, with a little lemon zest. Shake thoroughly, strain, and serve up.

  73. lilady says:

    @ Nybgrus: I remember get thoroughly trashed on Kummel Schnaps in Germany ~ 40 years ago:

  74. David Gorski says:

    And Nazi stood for a National Socialist party

    And queue right wing talking point used only by those who are mind-numbingly ignorant of basic history and politics. Fortunately, I am not. I’m actually fairly conversant about WWII history and the rise and fall of the Nazi regime, as it’s one of my interests and I’ve long been involved in combatting online Holocaust denial. In any case, one of the more amusing refutations of the whole “Nazi-ism is socialism” meme was published in, of all places, Cracked, which proclaims, quite correctly, that Nazi-ism is not:

    Socialism: Despite the presence of the word “socialism” in the name, National Socialism is not socialist. National Socialists actually opposed democratic socialism, along with capitalism, communism, liberalism, and The JewsTM. It’s kind of like how a square is a rectangle but a rectangle is not necessarily a square, or whatever. That doesn’t stop anyone from making the association anyway, though, so feel free to fire off accusations with impunity. It’s fun for the whole family!

    Communism: Despite the Nazis’ well-documented campaigns against the Soviet Union, which featured some of the most vicious fighting of the war, National Socialism continues to be equated with communism for no apparent reason. National Socialists envisioned themselves as a “Third Way” outside of capitalism and communism. Sort of like hermaphrodites, only with less social acceptance. So please stop comparing them to communists; they so do not swing that way.

    Marxism: Pop quiz hotshot! The Nazis hated (a certain group of people) more than anyone else on Earth. And Karl Marx was a… (member of a certain group of people). Do we have our answers children? And so does it make any sense that National Socialism would have anything to do with Marxism? Of course it does, everyone knows the Nazis were liberals. Why do you think they hated America so much?

    I know, I know, it’s a sarcastic deconstruction, but the blurb above about what Nazi-ism is not has the advantage of being true. Nazi-ism is much more akin to fascism thansocialism; Nazis fought socialist parties before they took power in Germany and destroyed them after they took power. Ditto Communists, whom Nazis viewed as their mortal enemies, so much so that this enmity drove Hitler to do something as stupid as invading the Soviet Union and opening up a two-front war that Germany couldn’t possibly win in the long run.

    In any case, Nazi-ism rests on the concept that the strong have the right to dominate and exploit the weak, of nationalism such that only members of the “volk” are entitled to the benefits of the state, and encouraged private property and enterprise in the state interest, most famously the arms manufacturers, which became in essence extensions of the Nazi state. Historian Ian Kershaw, whom I’ve read fairly extensively, points out that the Nazis were one of many nationalist and fascist parties vying for the leadership of Germany’s anti-Communist movement in Weimar Germany. The Nazis viewed communism as dangerous to the well-being of nations because of its ideology demanding the dissolving of private property, its support of class conflict, its aggression against the middle class, its hostility to small businessmen, and its atheism. Kershaw points out that Nazi-ism rejected class conflict-based socialism and economic egalitarianism, favoring instead a stratified economy with social classes based on merit and talent, retaining private property, and the creation of national solidarity that transcends class distinction.

    Here’s a nice quote from Hitler from 1930: “Our adopted term ‘Socialist’ has nothing to do with Marxian Socialism. Marxism is anti-property; true Socialism is not.” In 1942, Hitler was quoted as saying: “I absolutely insist on protecting private property … we must encourage private initiative”. Later, Hitler came to regret the party having included the word “socialism” in it.

  75. Narad says:

    I know.. why don’t we all pool everything together, and we all get exactly the same be perfectly fair because I’ll be damned if you’re entitled to more than I have..

    Which is being able to not be able have a bank account and blowing what cash there is on supplements?

  76. Narad says:

    ^ “Which is not being able to have”

  77. @nybgrus: I studied English lit and philosophy at university, then more of the former in grad school, so I guess it should be expected that I have a fairly extensive knowledge of American modernist and postmodernist poetry. But don’t sell yourself short, if we were to have a drink, I’m sure we’d have an interesting conversation on histology, biophysics or anatomy, areas you have an extensive knowledge of.

    And thanks to Dr. Gorski. I’m afraid it will fall on rustichealthy’s deaf ears. She’s already labeled us all socialists, despite our various political affiliations.

  78. Chris says:

    Where I want to sit at a Drinking Skeptically meetup… right next to François Luong and Nybgrus, plus Narad.

  79. mousethatroared says:

    nybrgus – I was partly uncertain if DugganSC was talking about an actual legal person, such as the employer, who feelings are affected or if we were talking about the “conceptus”, which set of cells was being designated a person. I’ve heard people designate eggs or sperm a person, or fertilized eggs before implantation, post implantation, etc. I have heard some people argu against all birth control pills on the grounds that they can act as arbortificient.

  80. Narad…that would be my business..or would I have to spend it on what you tell me to spend it also? maybe the way Fluke spends hers is more appropriate.

  81. nybgrus says:

    Narad reminded me of another quite stupid trope that RH busted out on us – the money aspect. There was a time when some physicians made it out with extremely low debt and went into extremely high paying specialties. That is simply no longer the case. A friend of mine has been an ER attending (i.e. finished residency and started making “the big bucks”) for over 10 years. He still has $75,000 in med school loans to pay off. When I graduate I will have close to $300k in loans to pay back between undergrad and med. Those loans are accumulating interest as we speak. 6 months after I graduate the interest will re-capitalize on the principle and I will be expected to begin paying the new total back. However, since the average intern salary is around $47k per annum, I will have absolutely no way of affording my loan repayment. So, just like every other intern in the country, I will ask for a hardship deferal for the 3 years of my residency. Then, after that I will go on to another 3 years of fellowship, where I still won’t be able to afford my loan. So 6 more years of interest will be recapitalized on the previously recapitalized principle. Then I will get the job that pays me the big bucks and finally be able to start paying off my loan. To the tune of well over $3,000 per month for ten years. But I am making an amazing salary right? Some 30 times more than rustic? Well, not quite. Most doctors will be lvery ucky to make 15 times the national average salary, while the majority will make between 5-10 times. Well, that’s still a lot, isn’t it? Yeah, it is not an insignificant amount. And I have been known to quite crassly remind colleagues that they have pretty much the only degree that effectively guarantees you such a salary. However, we do have vastly more liability, lost out on a minimum of 8 years of any sort of salary, and work copious overtime without more money. Oh yeah, and that loan worth 3 times the average house to pay off.

    So when you figure that other college grads (because my numbers above were based on the average US salary, not the average US college graduate salary) were making more than will for my 6 years of post grad training and have a few hundred thousand less in loans and don’t have the same liability I will…. let’s just say that the “gets paid a lot of money” argument is a pretty darned weak one.

    To some back of the envelope stuff that means that if I had just gone to work using my undergrad degree instead of going to medical school to “make the big bucks” by the time I finish fellowship, I will have made a total of roughly $500k more than I otherwise will and be roughly $350k less in debt. So just at the word go, I start out my attending life $850k worse off for having chosen this path (and those are conservative numbers. It would be very reasonable to round up to $1m). Some people have spouses that can help out, but most don’t, and many even have other med students as spouses further compounding the debt. Thankfully my fiance does not have med school debt, but she does have grad school debt, and as cool as it is rocket science doesn’t actually pay all that much (plus she is applying for he PhD at CalTech).

    This is not to say that physicians, in general, don’t live very comfortable lives and have a lot more security than most people. We certainly do and as I said I rebuke colleagues who lose sight of this. But we most certainly are not all fat cats rolling in the easy money. I knew one hospitalist who couldn’t afford to get the laser eye surgery he wanted so much because between his low salary (that group was on the low end, paying about 20% less than a typical hospitalist group in my area), his student loans, his wife’s student loans, and their desire to have a house and family (how dare he?) he was living month to month, let alone building a savings account.

    Sorry for the rant, but on top of all of it, I hate the rhetoric that doctors tend to be these excessively rich people. Some most certainly are, and still can be today, but the vast majority are far from it.

  82. nybgrus says:

    @ François Luong:

    Indeed, this is why we become experts at different fields. And why I love hanging out with people who have different expertises. Histology and anatomy were my least favorite topics (kind of like saying chips ahoy is my least favorite cookie) but physiology and molecular biology we can certainly talk about :-D

  83. nybgrus says:


    I have high hopes to make it to TAM! next year. Perhaps if you and François Luong are there we can make it happen :-D

  84. nybgrus says:


    I agree, it was indeed obscure. However, based on previous discussion involving DugganSC on the topic (abortion) I do believe that is what (s)he was referring to.

  85. Won’t you all love the watchful eye of socialism when it takes full root, making sure you spend every penny you get on approved items only? let’s see..drugs are good, contraceptives (of course), mercury filled lightbulbs…chemical filled foods,..what a life:)

  86. mousethatroared says:

    FL – Sorry, I did get and genuinely appreciate your previous post on RH, it’s just to hear her “logic” voiced by a rational person is even more confusing than hearing it from her.

    RusticHealthy – Yes, our individual rights are protected by the constitution. That was my point. Every time you proclaim that ‘all this taxation’ is just a slippery slope to some form of communism, you are completely denying how that is prevented by the Constitution. Our slope is not so slippery, it has an elected legislature, president and supreme court (not to mention all the state component who also play a part).

    Come on, do you really not recognize that saying a constitutional democracy that taxes people to expand healthcare coverage is on a road to Stalinism is “Sky is Falling” hyperbole at it’s worst?

    As to your version of recent economic history. Well, I would try to point out some areas where you are mistaken. “But reality has a well-known liberal bias”, So I doubt you would listen. Really, get out of your echo chamber and read some real economic analysis, read the Economist. Be a Republican or an “Independant” or whatever, but be informed(!) try to make your decisions based on reality! Even Pres. Bush or Gov Romney don’t believe your version of history (well, at least I hope Romney doesn’t believe it, because that’d be REALLY scary).

    nybgrus – I’m a big fan of mysterious drink concoctions. I’m bookmarking so I can try your recipe.

    David Gorski teaches me more about Nazism than I learned k-12 in one blog comment incorporating a quote from Cracked. That’s just one of the reasons I love this blog.

  87. you don’t like explaining where all your money goes do you…why not? …No one should have to explain to anyone how they spend their money, because ? it’s Their money ..right? one should be determining how much one makes..or take from those who make more… But, that’s what socialists do,’s not fair someone has more money than someone else…as Mitt Romney ..but’s OK that Obama is a multimillionaire..or the Clintons, or the Gores, funny how that is.

  88. nybgrus..and paying for others ‘welfare’ in free education for life, salaries and benefits, contraceptives and sex change operations will help have so much to look forward to! I’m sure you will be really happy to ‘give’! when you’re out.. :)

  89. and Francois..socialists..You know who you Are! (I think) :)

  90. mouse..yes..and once again, when we elect a majority of Less taxing, Less welfare state representatives, then I hope …well never mind, I gave up ‘hoping’ the left would ever stop whining for more.

  91. ok..I’ll go now, going shopping…what can I there a socialist approved list out? :) because, I don’t want to spend my $ on vitamins and organic I can pay for your chemical drugs and bank accounts. :)

  92. nybgrus says:

    Rustic – I obviously have no issue taking about such things. I wish more people knew the reality of the “affluence” of doctors. And not that it will matter to you, but social MEDICINE is not necessarilypart and parcel with SOCIALISM. Australia is not a socialist country, but they have social medicine. I’d write more but it’s a certain waste of time to do so.

  93. tmac57 says:

    nybgrus,bet that door to door vitamin salesman job is lookin’ pretty sweet to you now ;)

  94. mousethatroared says:

    Wow….RH’s comments should be a road side attraction. “Biggest Strawman Ever Constructed!”

  95. Quill says:

    ^ And out of totally 100% natural, chemical-free organic straw, too!

  96. @nybgrus: What’s TAM!? (My conferences are MLA and AWP) Whatever they are, yes, it’d be nice for this drink to happen. And if your fiance gets that fellowship at CalTech, you’ll only be a couple of hours from me (I’m in SF).

  97. DugganSC says:


    I may have succumbed to my tendency towards bad analogies. My intent was to indicate the difference between a personal belief that only applies to oneself and one which applies to others. The Catholic viewpoint on contraceptives is that it’s bad for the individual, but they only believe that the individual is responsible, so they don’t try to force that belief on others. Think of it as like being vegan. Most vegans do it as a personal choice rather than trying to force the rest of the world to cease to consumer animal flesh (although there’s always a lunatic fringe). Their stance on abortifacients is that it’s no longer a matter of the individual themselves. Compare it to being against animal abuse. For the most part, people don’t just shake their heads and say, “Well, I don’t believe in putting kittens in microwave ovens, but it’s their choice.”

    Ultimately, though, this is a debate for a different forum. My original intent was to clarify that Hobby Lobby was likely the case you were speaking of where someone was protesting the law by refusing to comply with it.

  98. nybgrus says:

    @tmac57: Ha! I’d sell Rhodiola rosea since I actually did research on it and it is showing promise in anti-aging pharmacology (very, very bench science promise but that is like gold in these markets!)

    @Quill: That makes it a very high quality and good for you straw man. Eat up!

    @François Luong: TAM! is The Amazing Meeting every summer in Las Vegas. SBM has had a booth there the past two years (I believe… at least this year for sure). I will (hopefully) be doing my elective in San Diego next year at right around that time which is why I think I can make it. I am currently trying to make a bid for and decide whether to do a second elective in SF or LA. Ultimately I would like to go back to SoCal (as would the fiance), hence her looking into further graduate work in aerospace out there (plus it has been a dream of hers to attend CalTech).

    @DugganSC: I won’t belabor the point since it is indeed a different conversation, but the notion that Catholics don’t care what others think for themselves is absolutely blinkered. They care very much and demand others believe like they do as much as possible. That point aside, your clarification still doesn’t change the issue at heart.

    Whether the dispensation – whatever form – from the Catholic employer is used on the person themselves or someone else (regardless of how you define “someone”) really doesn’t change the argument at all. I can buy a gun and shoot myself or shoot someone else. Either way, the money the employer gave me afforded me the gun. No matter how many degrees of separation it is still a fundamentally flawed argument against a legal choice that the employer has absolutely zero right to weigh in on.

  99. nybgrus says:

    um, poor wording. Shooting someone with a gun is not the legal choice, but the Plan B* and abortions are. So, quite frankly, if we can justify people purchasing guns we should grant even more justification for medical services sucha s these.

    *and on top of that, Plan B is not an abortefacient.

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