An Open Letter to my “Pro-Life” Friends

To all of my fellow Catholics, Christians and Pro-Life Friends, and anyone who will read, Post March-for-Life day 2,

Admittedly, I used to consider myself Pro-life……and I still do, if I am correct on what that term means.  However after recent Executive Orders by President Trump and the consistent message I saw while following the “March for Life” that really it was solely about unborn babies lives, I just don’t feel comfortable calling myself Pro-Life.  Obviously I am making some generalizations and the media focused on abortion as the primary issue at the march (as it always does) and I realize that.  I’m hoping to clarify how I reached my current impression of the label “Pro-Life” and reach out to my pro-life friends as an olive branch to help me not feel this way.  Because I know all of my friends who attended the March for Life are loving, holy, beautiful people.  While our FB relationship is our main mode of contact these days, I have at some point lived near (or am related to) each of you and gratefully gotten to know you on a personal level and what Grace-filled people you are.  But here is what I don’t understand:

Is the term “Pro-Life” meant to only refer to those lives that are in the womb?  Because I am really confused.  I watched the coverage of the March for Life, and the only mention I saw of other life issues was was a brief clip of someone interviewing people, and a tiny minority of those mentioned the other issues (like helping the lives of the poor, the outcast, the immigrant, the refugees).  All of the signs were just about abortion.  That’s it. I understand the theology, philosophy, and teaching behind life starts at conception.  Since I’m also a physician trained broadly I also understand the physiology and science behind it.  I totally agree.  Human life starts with conception. And ALL human life is equal in dignity, and we should defend the dignity of natural life from womb to tomb until our dying breath.

So here is where I am confused.  If we agree on the above bits, which I think we really do, then why do I get the overwhelming impression that those who ascribe to the “Pro-Life” mantra and attended the March (or would have if they could) only did so for the dignity of lives within the womb?  I realize I am vague here.  Let me explain how I get that impression.  First of all, I recognize Facebook is not the perfect sample, but it happens to be one of my only avenues for connection to my friends and family far away and what they think, feel and prioritize (and to see their joyous moments and rejoice for them).  I’ve also not subscribed to other social media outlets because, well, they can be pretty addicting and I discovered facebook first (although I am rethinking this strategy).  And for a good 90% of my Facebook friends and family that attended this year’s March and have, I know, attended in years past, the sole political and/or life related thing that is ever ever posted on their wall is regarding abortion.  Likewise, the sole thing on my facebook feed that ever gets any likes from them are posts against abortion.  Otherwise it’s fun family and personal photos for both posts and likes.  I know facebook feeds us what we want to see based on our history.  I totally get that not everyone can advocate for everything and so prioritizing and focusing on a cause of utmost importance is necessary.    It’s similar to medicine.  The majority of American Doctors specialize and get a narrow focus because it is really hard to do a bit of everything and know one’s limitations.  We also don’t get paid well to be Generalists, so it’s less fiscally rewarding for more burden.  Within the wide umbrella of pro-life causes, it is good that we have some who make their specialty fighting against abortion and it’s also good that we have generalists for the pro-life cause.  I see some parallels though to those who have made eliminating abortion their pro-life cause at the exclusion of all else to a certain ilk of specialist I have come across in the medical field.  Being a family medicine doc first and then a geriatrician who is a generalist in all things aging, I have found two types of specialists.  The first type are for their patients first, and therefore appreciate and communicate with me for what I add to our mutual goal of caring for patients even if it means our patients don’t need their specialty services for a time.  Then there are the second type of specialists who find me threatening (fear me) because they know, particularly for the Geriatric population, if our mutual patients don’t need a procedure they offer that the patients will consolidate all their medical care with me (because it’s safer and more convenient).  And they will lose patient volume until a procedure is necessary, at which point I will instead refer to one of the first types of specialists who I know communicates with me.  Thus the second type of specialist also looses the lucrative procedure that I otherwise would have referred them.  The second specialist approach is actually self-defeating.  They are unwilling to concede that perhaps anyone other than themselves might benefit the whole of the patient.   They eventually lose business and word gets out that they don’t play well with others. Yes, I’m using the well-being of a patient as a representation of the Pro-life movement as a whole.  To date, I have never seen any of that 90% I referred to ever even acknowledge that there are other issues that greatly threaten the dignity of human life.  I’m not asking to make those issues your specialty within your advocacy for life, but some appreciation of those other issues is indeed helpful and crucial to the whole of the “pro-life” cause.  And without communicating it, I can’t tell at all that you have that appreciation.  Which baffles me, because I know you love and know the gospels and also recognize that there is far more to the defense of the dignity of life than the defense of the unborn.

I saw many posts from Facebook friends from the March for Life and consistently only the unborn were mentioned.  Check that, I saw a friend note first their enthusiasm for ending abortion, and then tagged on that they were in defense of the dignity of natural life from womb to tomb.  I find the “tomb” bit vague.  The “Right to Life” coalition where I currently reside has diabolically miscommunicated to the masses that they feel defending life at the tomb end means using artificial and invasive means to maintain people having a heartbeat for as long as feasible.  Instead of celebrating and dignifying natural life, it has lead to horrifically undignified, artificial and unnatural means of intervening with what is clearly God’s will to bring His creation home to Him.  That’s possibly a pet peeve of mine due to my profession in Geriatrics and witnessing first hand the ramifications of certain types of propaganda at the end of life.  Still, there’s this thing I can’t figure.  If we are Pro All Life, womb to tomb, regardless of ethnicity, culture, religion or creed, then why are none of the Pro-Lifers as the March for Life (that I know, and I know quite a few) speaking up for other life issues, at all.  I mean, again, I get that your specialty and priority within pro-life is ending abortion.  But does that also mean you can’t say anything against the recent Executive Orders that have literally denied refugees, the poor, immigrants just looking for somewhere to have the freedom of dignity of life?  Can you not acknowledge other life issues?  Will you counter President Trump with his other anti-life policies, like restricting refugees (Matthew 25: 35-40) from specific countries that he deems a threat (but interestingly not the countries where the most terrorist have originated that he also has business dealings with)?  Or like suggesting he’d keep a running tally of all the crimes committed by immigrants or Muslims (this is exactly what Hitler did to the Jews to kick off the Holocaust)?  Will you speak out against gutting the Affordable Care Act before an iota of an idea for a replacement plan exists, thus ripping basic LIFE-saving healthcare from millions of Americans?  Will you not speak out against the type of “locker-room-talk” and objectifying language that President Trump has routinely uses that certainly does not bring women (the well being of which predicates a successful pregnancy and birth as women are the vessel of the unborn life) up?  I have been paying attention, and while perhaps you also feel at your heart these other issues are important and maybe even prayed on it, the very clear image you have presented to the world is one that makes pro-life solely about abortion without any communication to suggest you acknowledge the other issues.  And I, frankly, really just want to know if you do?  If it was part of the March for Life, if you discussed things that were important to the dignity of every human life other than only abortion, could you please just say so, make one comment about some other than abortion life related issue in your postings and advertisements about your participation in the March, or even like this when I post it on Facebook?

Pope Francis’ gracious message to President Trump concluded in this way, “Under your leadership, may America’s stature continue to be measured above all by its concern for the poor, the outcast and those in need who, like Lazarus, stand before our door.”  The reference to Lazarus in the Gospel of Luke, I believe, is crucial here.  Luke 16: 19-31 is the parable of the rich man and Lazarus.  All we know about the rich man from the Gospel is that he was rich, dressed fancy and ate quite well……….and also he is the only person in all of the parables of the Gospels who definitively landed himself in hell.  What landed him there?  Nothing other than being rich and not opening his door to Lazarus, the poor man.  I don’t know why, but I do know that the only person the Gospels suggest is undoubtedly permanently separated from God was a man whose only sin was to be rich and get too comfortable (not a murderer, a sexual deviant, or a democrat), and in doing so ignore Lazarus.  I’m not a huge fan of fear tactics as fear of fellow brothers and sisters in Christ (all of humanity) only breads anger and hate.  But fear of God is worthy fear.  So I ask those who marched for life, can you not see the parallels between Lazarus and the poor immigrants and refugees of the world knocking at our door?   Do you acknowledge that there are many other issues just as important as ending abortion to the Pro-Life cause?  If so, please say so.  It doesn’t need to be your main thing, but by ignoring the other issues or refusing to acknowledge them due to your devotion to abortion, it seems as though you are acting like the second type of specialists I referenced.  That type of medicine is detrimental to the well-being of patients.  My fear is that the type of Pro-Life activism which emphasizes ending abortion through legislation and Executive Orders at the exclusion of all other life issues is similarly self-defeating and detrimental to the Pro-Life cause as a whole.  Enlighten me, clarify this for me, and really just acknowledge that there is more to being Pro-Life than the issue of abortion.  And if not, just tell me so I can separate myself from the Pro-only unborn life movement and work to create a Pro-All Life movement based in the truth and love of the Gospels.


An Open Letter to my “Pro-Choice” Friends

To my pro-choice friends, and anyone willing to read, Post-March day 3,

I am one of the women who considers herself a feminist, maybe not in the typical sense, but a feminist nonetheless who was made to feel like I didn’t have a place at the Women’s march.  Admittedly, I am super sensitive to exclusive behavior.  I don’t know if it’s because I was bullied as a kid or what, but nothing irks me more than when a group that I feel connected with (like the group that purports to speak on behalf of my ENTIRE gender) excludes me or anyone really.  Maybe that’s why I’m an Independent and don’t subscribe to labels such as liberal or conservative or parties such as Democrat or Republican (it’s super inconvenient and lonely in our bipartisan system).  I confess, I didn’t actually go to the DC March or the one in my hometown (more due to logistics of my son’s over-packed Saturday schedule than hurt feelings).  But had I felt welcome, I would have prioritized the march over consecutive 7 year old birthday parties on Sat Jan 21, 2017 because I am an ardent supporter of human-rights, better treatment of all women everywhere, immigration, equality for the LGBT community under the law, separation of church and state, basic healthcare (including contraception) for everyone who needs it, Black Lives Matter, opposing dictatorial leaders such as Trump from gaining unbridled power and really all social justice issues.  The Women’s March official website, under their “Unity Principles” tab, states, “We do not accept any federal, state or local rollbacks, cuts or restrictions on our ability to access quality reproductive healthcare services, birth control, HIV/AIDS care and prevention, or medically accurate sexuality education. This means open access to safe, legal, affordable abortion and birth control for all people, regardless of income, location or education.”  Frankly though, I am big enough to let that slide because with the exception of the abortion bit, I am on board with all of it, including access to reproductive healthcare services and prevention such as birth control.  I’m a devout Catholic family physician who has never used contraception personally.  But that’s a personal choice enlightened by my faith and allowable due to my privilege of being white and having an extremely supportive and intact family and high education status (I’m a medical doctor).  What really tipped me over into feeling unwelcome was when a Pro-Life secular group called New Wave Feminists were taken down from the Partner’s page of the website with this message from the organizers: “The Women’s March’s platform is pro-choice and that has been our stance from day one. We want to assure all of our partners, as well as participants, that we are pro-choice as clearly stated in our Unity Principles. We look forward to marching on behalf of individuals who share the view that women deserve the right to make their own reproductive decisions. The anti-choice organization in question is not a partner of the Women’s March on Washington. We apologize for this error.

Here’s the thing.  I have so many amazing friends who are inclusive, amazing people, pro-choice and despite knowing my views on abortion would have made me feel so darn welcome because they know damn well what I stand for and that it’s for them and all women and humanity and essentially relieving suffering wherever I can in my imperfect but genuine way.  On the other side, I am an avid reader who believes in going to primary sources, thinking critically and accepting facts that are indeed facts (and not alternative facts).  The facts are this.  The primary page for the Women’s March and organizers made it VERY clear in the above statement to all of their partners and participants that they are only “marching on behalf of individuals who share the view that women deserve the right to make their own reproductive decisions  [which they clearly define abortion as a reproductive decision]”   There is another kicker in all of this, one that actually hurt me more than the exclusionary statements from the official organizers.  On the Mission Statement page, they say “In the spirit of democracy and honoring the champions of human rights, dignity, and justice who have come before us, we join in diversity to show our presence in numbers too great to ignore.”  It’s beautiful and I thought it was speaking to me.  They also have a quote from Audre Lorde stating “It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.”  Silly me. I thought after reading those beautiful quotes that the March was about all women everywhere who work to bring women up, not just the ones who believe that access to abortion an essential part of that.  And yes, it was far more than the organizers that finally led to this “open letter”.  After the march, I saw some very encouraging Facebook posts from the day that were focused on all the other issues other than abortion that people were about at the March, and I was happy and grateful.  Sadly, it took a turn for the worse.  I saw the few like-minded to me people hint at their frustration with feeling excluded and the barrage of exclusionary comments that essentially reduce all things women down to being for or against access to abortion.  Women stating, “If you aren’t for women having the right to chose what to do with their bodies, then you shouldn’t be at a women’s rights march.”  There was the friend who asked if I was going to the March, and when I confided that I didn’t feel totally comfortable because it seemed more about being pro-access to abortion than all the other social justice issues I fight for, her response was, “If you don’t like abortion, don’t have one.”  I could go on, there were many many more posts and comments clearly making it about abortion.

While I am so grateful to my friends and those who were inclusionary, the overall message from the group’s organizers and the many comments suggesting that if I wasn’t gung-ho for more access to abortion that I really didn’t have a place hurt.  It lacked love, compassion and an open-mindedness to a diversity of thought.  I saw an awesome interview from VP Joe Biden in which he noted a lesson he learned that to not attack motives, but to attack judgement.  Well, I feel like my motives have been attacked.  I’ve been straight up told that if I’m not pro-access to abortion that I am somehow not for women’s rights and even better choices for women.  And it’s just not true.  Moreover, it was even more heart-wrenching because I have already received enough flack from my faith community for voting for Hilary (due to her pro-access to abortion stance).  My old Parish Priest and I thought personal friend replied to an article I posted on Facebook entitled “Thanks to Trump, We Can Better Understand How Hitler was Possible” stating, “…..We are called to be a  faithful Catholic citizen and vote with our church, not against her.”  My response was this, “First and foremost our Church urges me to form my conscience and vote based on what I know is right. There is a separation of Church and Sate in this country (or at least there was) that is in our constitution and equally important as the 2nd Amendment. I didn’t know the Church took sides in American Politics………if it did where is Pope Francis’ comment?”  Needless to say we are suddenly no longer facebook friends (not my doing) and I am lonely and tired of being made to feel like I don’t have a place within my Church, a political party, a social group, my entire Gender’s cause, my profession, etc because my views don’t consistently align with “liberal” or “conservative” labeling and exclusionary rhetoric.

So, now that I’ve expressed why I’m hurt, here’s who I am and what I’m about.  I’ll let you decide if you think I should be made to feel welcome at a Women’s Rights March.  I’m first and foremost a woman.  I am Pro All-Life.  I am imperfect.  I am Catholic because I believe the teachings of my Church to be the best way for me to find God and be the best I can be. I also realize my Catholic faith is made up of many imperfect humans just like me and it takes a lot out of me to not let the hurt that people have caused in the name of the Catholic Church to shadow the actual message of my Faith.  I recognize my privilege in being lucky enough to be born to an amazing supportive white family with a strong emphasis on education and knowing my own self worth.  I also am a Family physician/Geriatrician, and I became a mother at the most inconvenient time relative to my profession in 4th year of medical school while married to another 4th year medical student.   Despite having an awesome family, they didn’t always have money and I had to rely on medicaid to have access to essential prenatal, maternity and childcare.  I can’t imagine what I would have done had I not qualified for medicaid but also couldn’t afford healthcare.  Personally and professionally I know how crucial access to basic healthcare and education are for true freedom and opportunity.  In practicing family medicine, I have listened, felt the pain of, suffered with and felt the injustices of our society of hundreds of women of all socioeconomic backgrounds, races, religions, ages and creeds.  I have felt powerless when I hear my female patients or even friends tell me stories of how they define their worth based on what a man thinks, or they were made to feel objectified or less than, or when they told me they had an abortion because they couldn’t support a child on their own.  It breaks my heart because after what I have done, worked for and been through, I know that in our society women can’t have it all, but we certainly can do it all, and we do so while creating life with our own bodies.  I also know that this is a very threatening prospect to men with big egos and many insecurities.  As a mother, I know the miracle that I created.  I also have been infertile since my one and only and know the pain that comes with not being able to create life as I once did and the frustration with how difficult and costly adoption is.  As a physician, I know the difference between disease processes, natural physiology, and when the two play a dangerous dance.  I know well what it’s like to be stereotyped based on my looks, gender, or religion or to have very un-me things assumed falsely about me.  As a scholar, I know that semantics and definitions matter and should only be narrow if highly specific.  I know that the term “pro-choice” tries to paint a broad stroke where it shouldn’t.  Technically, reproductive health care is a misnomer if it includes abortion.  If one is already pregnant, then they have technically already reproduced, and abortion should not be clumped in with reproductive health care as abortion has nothing to do with reproduction (as it already took place).  It’s reasonable semantically to include both contraception and fertility treatments in the term reproductive health care, and also preventative care.  Also, when a “choice” is made out of fear, or desperation, or any negative unloving constructs that our society has forced upon women than it is not really a choice at all.  Lastly I am a Geriatrician.  I am the most needed and yet most taken for granted type of doctor there is in America.  Despite this, I never stop fighting for my patients, loving them, caring for them, taking the time despite not getting paid for it to do the right thing.  I’m not only a Geriatrician because the type of medicine suits me.  It’s also because I know that every patient that I help through old age is a patient that likely died or will die with dignity towards the inevitable end of their natural life (while simultaneously not costing our tax payers millions that could be otherwise spent on younger future generations in non-curative and futile medical treatments).   I do not fit into a stereotype.  But I thought I fit into the category of a woman fighting for Women’s Rights in the best way I can with the tools and gifts I was born with……until the organizers of the Women’s March told me I didn’t and many women reinforced that.

So, now that you know me, what do you think?  Did I belong at the March for Women, possibly the only gathering of its size ever without any violent incidents (probably because it was organized for and by women)?  If you think its purpose was inclusive of women like me, then please let the organizers know.  I appreciate the apologies for having my feelings hurt by being excluded, but that’s not enough.  If we (women) really want to bring all women up, we need to be open to anyone willing to fight that cause in whatever form and we must make it clear we’re open.  We can’t state our mission as inclusion and diversity but then explicitly exclude anyone who has a diverse thought other than our own as to the means to achieving the shared mission of the cause.  It’s by making women with loving motives and good intentions feel like we aren’t pro-woman that we fragment ourselves.  Every pro-life, anti-abortion woman I have ever met not only takes the stance at the defense of the unborn life (or other body we don’t seem to want to acknowledge) but also because she truly and at her loving core believes that abortion is not good for women and overall hurts women everywhere.  And we have to be honest with ourselves.  It’s an amazing and powerful thing to be able to grow a human life inside you.  When society is constructed in a way that makes women believe their greatest physiologic power (and essential for the future of our human race) is an inconvenience, then it’s a tragedy committed towards women and our future children and the society that must change.  There are many women fighting for those necessary changes while still being pro-life.   When we fragment ourselves, we hurt our unity and we hurt ourselves, and then people like Donald Trump get elected.  Not every pro-life woman with good intentions is as experienced with diversity, as objective in their news and fact sources, and as knowledgeable about our Constitution and politics as I am.  If we are honest with ourselves, this election result was as much about the disenfranchised white rural person as it was about the pro-life religious right feeling the wrath of liberal intolerance and having no other way of getting their voice heard than to vote for an objectively anti most life other than rich white men and persons who can give him power based on the single issue of abortion.  I had this inkling on November 10th, along with an awful sinking in my stomach of the horrific reality of what was to (and now has) come.  I had so desperately hoped the Women’s March would help heal and prove me wrong.  Instead, the Organizer’s went out of their way to exclude pro-life women, and thus proved me right.  I won’t pretend, I like being right, but not always.  It was not even bittersweet.  It just made the hurt more, like my faith in women and people was crushed even further than it already was this year.  It was just a bitter and awful kind of right.

My hope now is that my pro-choice friends, all of them, will be open-minded enough to read this open letter.  After that, I hope and pray that we, women and men for women, will not make this mistake again.  If we are about all women and diversity and inclusion, don’t allow those who speak on behalf and for the entire cause to alienate a not insignificant number of women who are fighting for women’s rights too.  There’s a multitude of issues, for better or worse, that all contribute to equality, dignity, justice, and women’s rights.  Do you really need to constantly talk about your stance on more access to abortion as a means to find common ground with me?  Cuz right now that’s what it feels and sounds like……and it certainly is not building any bridges where we can meet in the middle.

Inspiration for this post came from and I hope they’ll have me despite my pro-life stance.  Also, if you prefer more scholarly and eloquent writing, here’s another “open letter”






A Moderate’s Plea

I had hoped that our nation’s absurd 2016 election result in electing a tweeting, whining, entitled, inarticulate, narcissistic (yes I am a doctor who had dealt with a lot of mental health issues, it’s an appropriate adjective in this case), reality TV show host would pull our polarized egos out of our extremist behinds and bring people together a bit for the common good.  I was wrong.  So this highly educated physician mother is going to beg that we start using reason, compassion and logic in going forward instead of whatever the heck it is we’ve been doing and are doing.

Dear Democrats:  Why are you becoming more extreme?  Answer me honestly; do you really think abortion should be a thing that any woman should be able to get whenever she feels like it?  Or, do you feel it’s a necessary evil due to societal ills?  I hope that your answer is the latter; in which case I think I can help you achieve your goals more efficiently.  Your goal, if I understand you correctly, is absolutely not that women have abortions.  Rather, you would like women to have unfettered and fair access to healthcare, contraception, and prevention without antiquated judgments about how we choose to use our amazing bodies.  Furthermore, you have seen how poorly our society treats and supports unwed women and single women with pregnancy or children and how corporate America and the higher education system treat pregnant woman or mothers like victims of the plague.  So, you feel for women and it’s too big a fight to change society so rather you would just advocate that these women have easy access to abortion.  Does that sound right?  Well, just say that instead of applauding the sadness and tragedy that is aborting a human life. You would have so much more credibility and progress in actually changing society, changing hearts, and gaining necessary access for women if you stopped advocating so intensely for abortion.  Drop it from the vernacular and focus on access to education for women and contraception.  Advocate for better care for all women, those who are mothers and those who are not. Continue to speak out against misogyny, locker room talk aka rape-talk, and the objectification of women.  Stop clumping abortion into the “pro-choice” category.  Having an abortion is not a choice.  Nothing done out of desperation can actually be a free choice.  No woman who valued herself and her awesome life giving power would choose to end the life inside of her unless circumstances were dire, whether due to mental debility, economic hardship, or even complete lack of support and hope for upward opportunity for herself and her unborn child.  Women should 100% have choice and agency over their bodies, including if they’d like to be sexually active without conceiving. However, once another life is in the mix, it’s not just the woman’s body. Let’s fight so women don’t have to be ashamed of the awesome power they have to grow a life inside them.

Dear Republicans: You need to gain back some credibility. Stop believing everything on FOX news. Stop propagating lies and fear. You have access these days to all the information in the world, so use it before spreading untruths. Many of you just elected the most unsuited and unqualified candidate to our highest office because of one-issue voting (like being against abortion) or because your insurance premiums on the ACA (Obamacare) went up. With the exception of Russia and a select few white-nationalists in other countries, our world-wide credibility as a Nation that supports freedom, equality and justice for all has been irrevocably damaged if not lost all together. Stop denying climate change because when you do so you inadvertently seem to not care about the lives that are ravished by it’s effects, usually those in the poorest areas. Most importantly, please recognize that right now the sole reason Planned Parenthood has to exist is not for abortions but because it is the only place women without health insurance or Medicaid can get access to contraception, preventative care (pap smears), STD treatment and education as to how to prevent STD’s and pregnancy. Planned Parenthood is currently a necessary evil exactly because our country does not have a single-payer option as a backup for everyone to ensure basic preventative care and basic healthcare needs. Admittedly, I will not ever support PP due to the abortion issue, however I can recognize why it has to be here. Try being open to a publicly provided option for healthcare for everyone and maybe you’ll find that indeed, once all women have access to all the other care they need through public clinics and centers, the real reason for planned parenthood will only be abortion. Then there would be no argument to fund it other than abortion.

Moreover, stop ignoring the fact that to support life in the womb we must support the vessel of that life (women, I’m talking about women). You can’t dismiss derogatory talk, locker-room talk, sexual assault talk that is specifically meant to put women in “their place” and be pro-life at the same time. It’s that dismissive attitude that leads to further objectification of women, policies that make it impossible for women to both support their families in the working world and cope with an unexpected pregnancy, and insidiously persistent yet oppressive views towards women. It’s super easy to be an advocate for the innocent (the unborn child). It’s not as easy, but so much more necessary, to do as Jesus did and bring people out of their sin while at the same time loving and helping them (the time Jesus prevented the hypocritical Pharisees from stoning a whore by standing in their way and saying “Let him who is without sin among you be the first to throw a stone at her.” is coming to mind). Start advocating for women in general, even the ones who have made lots of mistakes, rather than abandoning them when they need it most.

Finally, Dear fellow moderates: Please speak up. I am lonely, so lonely. I think the USA has proven that the emotional partyism path pushing everyone to extremes is not healthy, not loving, not truly democratic, not unifying and not working. I know there are more people out there like me. People who have consistently had to choose a candidate to vote for that they didn’t always agree with on everything but recognized that in our bipartisan system one’s vote only really matters if it’s for a democrat or republican (and sometimes doesn’t matter either way depending on your state and electoral college).  I know more have taken this road less traveled. We have been silent too long, so please speak up. I’ll leave you with these quotes. “We must learn to regard people less in light of what they do or omit to do, and more in light of what they suffer.” – Dietrich Bonhoeffer.  Finally, “May we think of freedom not as the right to do what we please, but the opportunity to do what is right.” – Peter Marshall.

The Best of Both Worlds – A Capitalistic Case for a Public Single Payer Option and Private Sector for Health Care in America.

I think I’ve bitten off more than I really can chew with my first idea for a post, but I am going to go for it anyway.  As a family doc geriatrician, I have treated people from literally every arena (medicaid, medicare, private insurance in all it’s variety, and uninsured).  I know first hand the risk of a federally provided program that is over-regulated and that does not actually put money into quality relative to the population’s needs (yes I am talking about Medicare).  I also completely recognize that whether it be a “right” or not, healthcare is a business.  Money is involved, whether at the government level or the private insurer level.  Yet if we truly are a country that believes first and foremost in everyone’s inalienable rights of life, liberty, and the pursuit of happiness, than how can we as a nation not provide some minimum standard of healthcare for all it’s citizens?  What one thing does everyone need to live, to have liberty and be truly free to pursue happiness?  Their HEALTH (mental and/or physical)!  I am not advocating for a single payer system publicly funded that pays for EVERYTHING.  However there are a number of basic things that are non-controversial that can easily be agreed upon that yes, our government and our taxes should pay for so that everyone in our society can have their best chance at success.  If you want to bring free-market economics into it, then allow for the private sector.  But when people are desperate and feel their lives depend on something (whether they really do or not) they will pay anything, say yes to anything, and ultimately competition and free-market choice just don’t apply.  The American Healthcare system already rations care.  Insurance, private docs, medicaid and medicare all have rules as to what they deem valuable and will or will not do or pay for.  I’d contend however that despite our highly polarized country, there are very basic healthcare and medical needs that Democrat and Republican alike could agree on to be covered for everyone in a nationally funded and provided healthcare system.  Some of these include basic preventative measures like vaccines, pap smears, contraception for women (note I differentiate contraception from abortion……they are different, very very different), basic health literacy education, screenings for treatable chronic conditions and treatable cancers, etc.  Then there are common ailments that are easily treatable (at a certain age) no one expects to get but also should not financially ravage a person or a family if they do, such as an appendicitis, a pneumonia, a traumatic incident or a heart attack.  If the primary panel that determined the type of care needed was made mostly of PCP’s and General surgeons, I’d wager a million to one they’d come up with a bipartisan agreement on what should be covered.  And no, not everything would be covered under a national healthcare system.  Just like in the public school system, not everyone gets a voucher to go to whatever expensive private school they like.

Ok so say we do this (I am an idealist and a cynic at the same time…..I know we aren’t going to do this)?  Who would work in that system?  Most American Doctors are extremely FED UP with the regulations, oppressive burdens of medical school debt, bad technology at our disposal, administrative burdens, I could go on forever, that distract from our ability to care and form relationships with our patients.  For this kind of thing to work, we’d have to step outside of our bubble and not be constrained by the many issues of our current private and public Health sectors.  We’d need to take the good things from other countries of comparable standing and be willing to use what could work for us.  Meanwhile we could tap into the amazing resources and technologies we do have in brain power in our own country.  So what could this look like?  Let me tell you.

  1. Scrap Medicare and Medicaid, completely, and start over with a United States National Health System (USNHS).  This would be similar to Medicaid in that it would be a Federal and State program.  Certain minimums would be mandated by the Federal government that would be agreed are basics that must be provided and the current Federal social security tax/medicare federal would essentially become the USNHS tax.  This won’t be enough though for coverage of everyone and therefore allow the States to both administer the plan and levy taxes in whatever ways they feel will work best relative to their respective State needs.  We have 50 vastly different states in this country.  To assume that the needs of one are the same as all is just naive.  Therefore in setting this up, allow for some State autonomy.
  2. Will this be something we can afford to fund with taxes? – Heck yes.  Again it should NOT pay for EVERYTHING.  The USNHS should cover acute, chronic, and preventable healthcare needs agreed upon by experts in medicine and public health (I’d contend mostly family physicians from both urban and rural settings) based on age and likelihood of successful prognosis with treatments.  Yes there will be rationing, as there already IS in every single aspect of healthcare.  However when people find their income is much greater because they did not have to elect for the employer covered private insurance benefits that make healthy people pay for very sick people who over-use the system they’ll find that despite a slight increase in taxes, they’re coming out ahead.    The payment for the physicians and other medical providers should be time-based relative to their expertise and degree level, rather than volume and procedural based.  If payments are time based (like an hourly salary) then physicians are more likely to take the time to explain things, to get a proper history so we don’t just order costly tests, to take the time to talk to other health team members, and to re-establish the sacred relationship between a doctor and patient.  If time-based then we don’t need the Electric Health Records that were built based on cumbersome and business minded ICD-9 or 10 codes.  The USNHS could establish a nationwide EMR created with 80% input from medical providers and 20% from computer coders and engineers that would allow easy documentation the way providers need and want it.  Also, because it would be national, if a patient stays within the NHS, it would be visible from any USNHS site.  So if they seek care, there would not be more ordering of unnecessary, costly and sometimes risky tests because providers in the USNHS would be able to see results and notes from other providers, even in other states.
  3. Who would work in this system and will a time-based salary make people lazy? – If set up correctly, it would be very attractive and no, it won’t make medical providers lazy.  First of all, I am not advocating (because it’s far too much of a long shot) for almost free medical school education (like many of the countries with socialized healthcare have).  However, we could very easily incentivize people to work for the USNHS if we offered complete loan repayment for those who dedicated at least 4 years (or maybe however many years their residency/fellowship training was) to the USNHS.  Just for reference, I took out over $150,000 of loans at 7% interest that started accruing immediately after med school and annualized quarterly.  I also had a few loans at higher interest rates.  I did 4 years of training (3 years residency, 1 year of fellowship all working about 80 hours a week getting paid 50,000$ per year).  Now, as a full fledged expert Geriatrician with a job at 80% time (part-time is actually not a thing as a primary care doc) I get paid 120,000$.  Before you tell me to stop whining, do the math of my loan payments and hourly wage based on time worked (and inquire into what other professionals of comparable IQ and education level get paid relative to debt burden).  If I were not married to an Anesthesiologist, I would not get out of debt and be able to cover basic costs for living and my one child for near 30 years.  If it were a true national program, then there wouldn’t be horrible constrictions on where people would be placed, because likely there would be an opening near where they want to be (currently you can get your student loans paid for if you commit to being placed in literally wherever, often Native American Indian Reservations, Alaska, or the most challenging Federally Qualified Clinics, for at least 4 years after residency).  Also, if the USNHS is set up correctly, many quality family doctors and altruistic health providers would be attracted to the concept of getting the time necessary to establish relationships, educate people about their health and healthy living, and less administrative burdens that I would bet a number of people would stay on with the USNHS despite the overall lower salary paid than the private sector.  There would certainly be more Geriatricians.  And the argument that salaries make people lazy……sorry but no.  No medical providers make it through our training system (whether it be nursing, physician, Nurse prac, PA, etc) by being lazy.  If they get burned out by our current awful system and start doing less, yeah it’s the system.  Medical providers are not inherently lazy people and salary paying the altruistic ones who work for the USNHS will likely only improve care.
  4. What about Capitalism and the Free Market and Competition and the Private Sector – Good news!  We’re America.  People are easily swayed that they need fancier things, treatments to make them live longer, look younger, look skinnier, or even that just because it’s more expensive it’s somehow better.  And the people want choices!  Why do you think Dr. Oz is so successful?  There will always be a free market for healthcare if the basic needs are already met (like with a USNHS).  Why do you think plastic surgeons who do boob jobs (clearly not a basic necessity) always make bank and have a steady supply of patients?  That’s maybe an extreme example.  Here are some more.  There will always be cosmetic Dermatologists that people will pay for if they have the means.  There will always be fertility specialists offering IVF if you can pay for it.  There will always be someone willing to do your surgery for the right price even if you are risky and it’s not an emergent medical need.  And there will always be doctors willing to keep you alive on machines, or perform a code on your 85 year old Grandma, or offer you chemo they know will not help because you have a strong Faith in God and miracles.  And they will charge you what the market will bear.  And yeah, they’ll have to be better because they will be competing with the USNHS, which will only control costs, improve care, and make for happier Americans all around.
  5. How would this approach support Capitalism, Free market exchange of goods and ideas, entrepreneurship, etc etc etc? – I’m frankly dumbfounded that this isn’t more obvious to politicians and economists.  But then I recall that many politicians and rich business people respond more to the needs big business and big money than the average American working class, rural or urban.  They also are not physicians……or at least the physicians that are on the front-lines of healthcare.  How many of you reading this (I’m hoping I’m getting other views than just medical professionals) have wanted to start your own business, or have an awesome idea that you really think could work, but also have a family to provide for?  How many of you work for an employer who you don’t love, isn’t particularly fair, does not necessarily inspire you, but does provide for basic healthcare benefits so you and your children can get vaccines and basic care if someone breaks a bone or gets an appendicitis?  How many of you know that if you started your own small business it would be successful enough for just the right amount of profit that you wouldn’t qualify for medicaid?  I bet there are a number of you thinking, “yeah, heck yeah, that’s me.”  But, you stay in your corporate big business job and never bring your awesome ideas to our “free market” because your health and your family comes first and you can not take the risk that their healthcare needs and your benefits wouldn’t be met.  So how is this system of no true basic minimum of healthcare met publicly helping capitalism and the “free market”?  It’s not.  It’s helping the already rich corporations solidify their monopoly on ideas and the market.  It’s helping the already billionaires eliminate competition because we are not allowing our true potential to be met.  By trying to force a basic human need, such as minimum healthcare standards, into a private free market capitalistic system, we are actually harming capitalism, the free market, and fostering monopolies.  Did this system make sense at one point?  Yes, it did.  But that was years ago.  Our medical knowledge, treatments, and possibilities and treatable issues have changed drastically.  So it’s time we get up to speed with the times and change to.
  6. How could this be bipartisan? – First of all take a deep breath and try to use reason, logic, and empathy.  Remember the First Amendment that separates church from state.  For a USNHS to be publicly funded, we would need to come up with a compromise of funding non-controversial things.  I will say, abortion and physician assisted suicide should NEVER be publicly funded with our tax dollars.  They are issues that are controversial, rooted in human life and dignity, and never anyone’s real choice as when women or persons find themselves in those situations it’s because they are desperate.  However, contraception is a thing that should be funded publicly with our taxes, as it gives women autonomy and agency over their bodies.  This is coming from a devout Catholic who has never used contraception.  It should also cover free sex education for everyone starting in 8th or 9th grade as part of the federal mandate, including what it’s for, the risks, respecting others and how to choose responsibly to engage in it.   It’s reasonable to cover it publicly, and if we did, and provided a USNHS that actually gave free preventative healthcare and education to women (but not abortion), we’d essentially eliminate the arguments for funding Planned Parenthood as the only thing they’d provide that women couldn’t get at their USNHS clinic would be abortion.  Think about it!  Likewise, hospice and palliative care for terminal conditions should ALWAYS be covered.  If you are someone that insists the medical field do absolutely everything invasive for yourself or loved one despite a dire prognosis or clearly terminal condition because you think it’s God’s will for a miracle……GREAT!  But don’t expect the state USNHS to fund that with American tax dollars.  Miracles are for God, the Churches and religion, not the publicly funded health system.  Pay yourself or get your church to fund-raise.  It’s your choice, it’s a free country.  I could go on and on about medically rational and reasonable things based on science, evidence, epidemiology and experience to cover publicly and not, but this is already way too long.  The point is, don’t let emotion and blind following cloud your potentially well-educated and informed opinion of this issue.

In conclusion (few she’s almost done……bravo to you if you’re still reading this), don’t let the media, people who know nothing of health and medicine, or those who are medical providers but are also practicing in fields of narrow scopes while making out like bandits cloud your judgement.  We are in dire straights right now in this country and it isn’t sustainable.  We need a real solution and our health is not something that fits into supply and demand economics and free market capitalism.  It just doesn’t work that way.  There is a better way, a compromise of both (Obamacare was doomed from the get-go because to get support from Republicans it had to enmesh the big business health insurance industry as its means to expand coverage……it didn’t work).  I know this probably won’t be read (it’s far too long), that this kind of thing is not in our horizon.  I have good reason to be cynical.  But I can dream.  I refuse, as a woman, mother, Family Physician/Geriatrician, healer, wife, sister, daughter, educator, athlete, granddaughter, Christian, to accept that the status quo is our future.  And I’ve had a long day and my eyes can’t take anymore screen to go back and edit this for grammar and whatnot……Here goes nothin.