Several months ago in this space, I discussed my concerns about a Trump presidency regarding the Latin phrase “primum non nocere,” which means “first do no harm.” Now, at the end of the 2018 Iowa Legislative session, I revisit this phrase to discuss my concerns about the results that this Republican-dominated Legislature and the Republican governor have created or are creating.
Category Archives: elections
Health Reform and Why Words Should Matter
Ah, words! Especially to writers, they are more precious than jewels, as essential as air, and powerful enough to create entire worlds. We chase them, massage or mince them, we roll them around in our mouths, savoring every delicious subtlety. Mostly, we love them.
~Tammy Letherer
Ms. Letherer wrote these words on a blog entry titled Why Words Matter (In and Out of the Locker Room), on October 16, 2016. In that post, she discussed her unhappiness with Donald Trump’s language regarding women.
In Iowa, former U.S. Representative Bruce Braley lost his Senate race with Joni Ernst in large part to an audiotape of his words to political contributors in Texas disparaging our senior senator, Chuck Grassley, describing him as “a farmer from Iowa who never went to law school.”
This year’s health-care debate, centered on the Republicans’ efforts to repeal the Affordable Care Act (ACA), has led to many statements by Republican leaders in Iowa that should come back to haunt them this Halloween season and for seasons to come, as Bruce Braley’s words haunted him.
Health Reform and Post-Truth Politics
As a physician, I have a hard time understanding post-truth politics. Wikipedia defines the post-truth culture as “a political culture in which debate is framed largely by appeals to emotion disconnected from the details of policy and by the repeated assertion of talking points to which factual rebuttals are ignored… . (It) differs from traditional contesting. … Falsifying of truth … (is viewed as) … of secondary importance.”
I live in a world where the absolute values of lab tests — such as INR levels (the international normalized ratio (INR) is calculated from the result of a prothrombin time (PT) test, which is used to help detect and diagnose a bleeding disorder or excessive clotting disorder; the INR is used to monitor how well a blood-thinning medication is working to prevent blood clots), ejection fractions (which measure the percentage of blood leaving the heart each time it contracts), creatinine levels (used to assess kidney function), and hemoglobin levels (hemoglobin is the substance in red blood cells that carries oxygen) — affect function, quality of life, and the potential life or death for my patients. I live in a world where, for my geriatric patients, the commonly accepted truth of gravity plays a huge role in falls. I spend much of my time as a geriatrician trying to prevent falls and treating the outcome of falls. In my 32 years of practice, I have seen how details of policy and falsifying of truth have tangible consequences.
Health Reform and Uber and Food Trucks
Recent economic trends nationally and in Iowa include the proliferation of Uber contract-driver taxi services and owner-operated food trucks. Both of these services rely on individuals starting a small private business in the competitive world of commerce.
My brother, my father, and my grandfather have all been owners of their own small businesses. The gumption and personal sacrifices needed to take on all the requirements necessary to run a successful small business have always humbled me. From advertising and marketing to hiring and personnel management, to municipal, state and federal regulations, to eventual retirement, a small-business person needs to consider every aspect of their business. Despite this, many individuals crave the freedom and independence that running their own businesses or being independent contractors allows. Given the other options of being someone else’s employee in a large business or a government worker, I sympathize with and support individuals who are willing to risk their time, resources, and self in these challenging endeavors.
Health Reform and “Yuge”
Former Vermont Governor Howard Dean speaking this week at the 2016 Democratic National Convention quoted Donald Trump. According to Governor Dean, Donald Trump said that he’s going to replace the Affordable Care Act (ACA) with “something so much better” — something “‘Yuge,’ no doubt.”
In researching this “something so much better,” I could find only a mismatched set of random ideas such as buying health insurance across state lines, establishing Medicaid block grants for each state to administer, allowing Americans to import medications, eliminating the individual mandate but still preventing insurance companies from excluding patients based on pre-existing conditions, and expanding tax exemptions for corporate health insurance to individuals.
Health Reform and the “Vulnerables”
In the health insurance industry, young adults are known as the “invincibles.” Like the superheroes that inhabit movies and TV now, these young men and women believe they are impervious to illness, disease, and injury. Therefore, they do not acquire health-care coverage, believing they are invincible. It is human nature to create groupings of individuals and name that grouping. We commonly talk about “baby boomers” and “millennials.” Tennessee Williams said that he wrote about the “incomplete.” Studs Terkel, in his book, Working, said he interviewed and wrote about the “uncelebrated.” Today for this blog, I create my own grouping. Here’s why.
Health Reform and Wrapping Up
I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.
Health Reform and Quid Pro Quo
This week, a high-ranking politician left a phone message for me at my clinic. He asked that I call him. The purpose of his call, according to the note from my receptionist, was “politics.” I did return his call and left a message. He called me back while I was out at a movie. Stepping out of the movie to look at my phone, I found that the purpose of his call was direct and to the point: He asked for money for his political campaign fund. Another politician currently running for office has called me at various times during my work hours. He called once just as I prepared to do a knee injection for a patient and again while I was making rounds at the hospital. During each call, this politician asked for campaign money.
Health Reform and the 2014 Iowa Senate Race
I ask the few remaining independent voters — those who have not yet decided for whom they will vote in the U.S. Senate race between Iowa State Senator Joni Ernst and U.S. Congressman Bruce Braley — to give me two minutes of your time.
I am Dave Carlyle, a family physician and hospice medical director from Ames. I grew up in Denison. This is where, during my summers home from college, I learned the value of hard work by sweating 10 hours a day at the Iowa Beef Packers slaughterhouse. After medical school at the University of Iowa and family-medicine residency in Waterloo, I practiced nine and a half years in Kossuth County. I have now practiced 21 years in Ames. My family has been serving Iowans for 160 years. My two daughters, both of whom are physicians, also care for Iowans.
Health Reform and Reminiscences of Hospice Patients
This blog is dedicated to a good friend and patient of mine who died last month in hospice. I had taken care of her for 15 years. We had many remarkable and enjoyable conversations regarding her growing up in a home where her father was a physician. She thought very highly of her father and the profession of medicine. She knew the value of good medical care and how much it means to all of us, even physicians and their families. She had seen the human side of medicine in its effects on her father and her family.