“Notes from a Healer” — Once a Year

Harry was a typical adolescent in the practice. Although I would see him now and again for the occasional minor illness, for the most part he came but once a year for a check up. But Harry was atypical in one respect. more»

My latest installment of Notes from a Healer — Once a Year — is now online, newly published in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine is an online journal fostering discussion about the culture of medicine, medical care, and experiences of illness. Interested readers can access a list of editorial board members and regular contributors here.

A Socratic dialog on health care reform (VII)

Socrates pays Hippocrates another visit to discuss the latest political rumblings concerning the health care reform legislation.

Hippocrates: Good day, Socrates. I see that you walk with the step of a healthy man these days. I trust the former injury to your foot is now well healed.

Socrates: To be sure, my good friend and physician. Once again I find myself healed well, if not well-heeled. (chuckles to himself) But tell me, Hippocrates, what do you make of the recent resurgence of heated political debate in the Senate concerning our newly passed health care law?

Hippo: Ah, my good Socrates, know you not that the opposition has sworn to dismantle the law even before it is enacted? For they have sworn an oath to have it annulled before the legislative session is brought to a close.

Soc: By whose authority?

Hippo: By the mandate of the voters in the mid-term elections of last fall. The opposition is claiming victory on the basis of the mandate for change.

Soc: But I was of the understanding that the law contained many desirable provisions to enhance the coverage of health care for the citizens of Athens—forbidding third-party payers to deny coverage for preexisting conditions, guaranteeing the portability of coverage, removing the provision for lifetime caps on payments for care, and so on.

Hippo: What you say is true, my friend. But those of the opposition argue that the law is unconstitutional because it mandates coverage for all citizens—

Soc: (breaking in) Excuse me, Hippocrates, but is that not a good and desirable thing, to have coverage for all our citizens?

Hippo: To be sure, it is—but in this instance the law mandates that coverage be purchased by individual citizens if they have no provision for coverage from their employer.

Soc: I was under the impression that universal coverage was to be enacted as a right of every Athenian citizen.

Hippo: Alas, the single payer option was defeated in the preliminary debate. The lobbyists for the health insurance industry made certain of that through the influence of much silver coin in the pockets of the politicians. Likewise, the sorcerers bought their influence to insure that the price of pharmaceuticals could not be negotiated in the Agora.

Soc: It seems as though that which began as a good and noble idea has been degraded through bribes, trickery and quiet whisperings behind the scenes.

Hippo: Legislation is crafted much in the same way as sausage, good Socrates. In each instance the process is best left undisclosed to prevent a sudden surge of nausea and queasiness of the stomach.

Soc: Tell me, Hippocrates; is there no way to retain the noble points of the law while discarding the undesirable tenets?

Hippo: Undesirable to whom, Socrates? To those with influence and power? They will see the entire piece of legislation rescinded before compromising on these points. In the end we live in an era where the winner takes all in politics.

Soc: But our Athenian government is based on the premise of democratic rule. Ultimately, the people decide their common weal.

Hippo: Have you not heard that our supreme court has ruled that the multimillion drachmae corporations must be considered as bona fide entities having a political voice? A fist full of drachmae speaks louder than the jingle of pennies in a purse.

Soc: Then our democracy—

Hippo: Is but an oligarchy, my dear Socrates. Or better stated, a plutocracy in which the great wealth of the few controls the destiny of the many.

Soc: And what of the middle class, those of the artesian guilds and such?

Hippo: Alas, Socrates, they continue to disappear from the Athenian social strata. The gap has widened between those who have and those who have not.

Soc: What! Is there no political solution to this dilemma, Hippocrates?

Hippo: Perhaps, Socrates. You should pose that question to your old student and politico, Plato. He might be able to offer a feasible plan. I’m told he spends his days engaged in drafting a treatise that deals with such issues. He calls it The Republic.

Soc: Indeed, he has written “the price of apathy towards public affairs is to be ruled by evil men.”

In and out of medical practice

At the age of 46, disillusioned with modern medical practice, Dr. Margaret Kozel decided to end her 17-year-career in primary care pediatrics. She cites some of her reasons in her blog post, Confessions of a worn-out pediatrician.

“Our system of paying for health care and the stresses on today’s families were pitting my best medical judgment for the child against all the other worries and desires of the parents,” Dr. Kozel writes. “The economics of health care trickled down into my exam room, into the conversation between doctor and patient, distorting the relationship.”

High on her list of complaints are the inequalities inherent in our American healthcare system. Those who need pediatric care the most—poor and underinsured children—are the least likely to access it. And in those cases where health care is available, third-party payers dictate standard of care, sometimes with substandard results.

“Private insurance companies decide who gets paid for what, so pediatricians treat serious mental illness with little psychiatric training, use nebulous tools to diagnose attention deficit disorders, and valiantly tilt at the windmill of childhood obesity not because we can do this most effectively, but because we are the only professionals who can get paid to do so.”

“At the other end of the treatment spectrum, free market forces often urge us to over-intervene with minor illness, where less really would be more.”

“Clinical truth has only grown more obscure since my medical school days,” Dr. Kozel muses in a separate NYT Well blog post. “Today, as we take on the hard work of health care reform, doctors continue to work under an avalanche of pharmaceutical marketing, malpractice threats and shortsighted health insurance strategies.”

“In an age when public health issues like obesity are what pose the greatest threats to our children, pediatricians will need to move out of the confines of the fee-for-service exam room to advocate for effective healthcare policy in the wider community.”

Dr. Kozel has fleshed out her career in and out of medicine in her book, The Color of Atmosphere. Interested readers can glean much of her sentiments from an online video interview here.

Despite her misgivings, Dr. Kozel maintains a positive outlook for the role of pediatric healthcare in the future.

“I believe our society will eventually see the economic sense and moral imperative of universal health care coverage, paving the way for healthcare to be designed by health professionals, and to be viewed as a right and a responsibility, rather than a commodity to be purchased. I believe that pediatrics can evolve, too, in a way that will truly meet our society’s health needs.”

Follow Dr. Kozel’s opinions on these and related issues at Barkingdoc’s Blog.

“Medicine in the time of the EMR” posted in YJHM

The EMR, we are told, will help cut healthcare costs.  When medical records are converted into digital format, data will be instantaneously available to all providers caring for the patient.  Clinicians will have carte blanche access to previous laboratory and radiological studies, thus insuring that such investigations are not performed repeatedly or needlessly.  Data will be collated and scrutinized to insure that standards of care are met and that medical errors are eliminated.  Electronic billing will become the norm.  One day patients might even be able to schedule their own appointments online.  Somehow all this will serve to lower costs and improve the efficiency and quality of healthcare delivery.

Indeed it might.  But in my mind healthcare delivery is something different than the practice of medicine….>>more

My latest essay, Medicine in the time of the EMR, is now posted at the Yale Journal for Humanities in Medicine blog, a companion blog for the Yale Journal for Humanities in Medicine.

“One More Child Left Behind” published in “Pulse”

Making the diagnosis might be straightforward, but sometimes getting adequate medical care poses a more formidable challenge.

Readers can now access One More Child Left Behind, newly published in Pulse, voices from the heart of medicine.

A previous version of this piece appeared in the online journal Dermanities and was subsequently published in Patients Are a Virtue: Clinical Tales in the Art of Medicine.

Pulse is an online magazine that uses stories and poems from patients and health care professionals to talk honestly about giving and receiving medical care.

A Socratic dialog on health care reform (VI)

Toward the evening of a long day of discussions with Aeschylus, Plato, Aesculapius, Apothos, and Litigius, the philosopher Socrates makes his way to the home of Hippocrates, the father of medicine.

Socrates:  Hail, Hippocrates!  Are you at home?

Hippocrates:  Socrates, good fellow, welcome!  Come in, come in.  But I perceive that you walk with a limp.  What ails you, my friend?

Socrates:  An infection on the sole of my foot, Hippocrates.  I consulted Aesculapius, who cleaned and dressed the wound; then purchased an antibiotic potion from Apothos.  The rubor and dolor have already begun to subside.  But enough of my woes.  I came to consult you on a related matter:  that of the state of contemporary medical practice in Athens.  I desire your opinion on our health care system, as there is much discussion in the Agora and the Senate.

Hippo:  Ah, yes; as of late I’ve had my ear attuned to these myriad discussions myself.  Truly, they have become intricate and arduous, a snare to all who dare to enter into the fray.

Soc:  Fair Hippocrates, if you, the father of medicine, find these discussions convoluted, can the rest of us hope to make any meaningful sense of them?

Hippo:  I dare say that it would be difficult.  But I shall endeavor to enlighten you as best I can, Socrates.  Ask away, and I shall mix you a bowl of wine in the meantime.

Soc:  I appreciate your hospitality and willingness to dialog with me, Hippocrates.  Now tell me, what is your opinion of the system of health care delivery in Athens?

Hippo:  In a word, broken; although it pains me to say it.  The system has devolved from what I had originally envisioned it to be into a massive and complex enterprise of business.  All relationships are now contractual, defined by the solicitors and their ilk.  Products and services are bought and sold in the medical marketplace like milk and meat in the Agora.  All participants profit at the expense of the citizenry.  The cost of care escalates, and from what I read, the system will soon be unsustainable.

Soc:  How did all of this happen?

Hippo:  It is the fate of mankind, Socrates.  All men want just one thing:  a little more than they already have.  More silver, more material things, more pleasure—and longer lives to enjoy it all in.  Health care is no exception.  The more we create, the more we consume.

Soc:  But speak to me of the health of our citizens, Hippocrates.  Is it not vastly superior than it had been when you first formulated the tenets of medical practice?

Hippo:  In some aspects, yes.  We have managed to lengthen the average lifespan of our people through improved housing and sanitation services.  Overall, we enjoy a more healthful diet.  And when it comes to intricate technology, we lead the entire Mediterranean world in procedures such as open heart surgery, organ transplantation, and artificial joint replacement.  Yet this has come at an enormous price to our society.  Many of our citizens are still unable to obtain basic health care.  It grieves me deeply to read of the numbers of children who fail to receive their immunizations and in some instances proper nutrition.  At its inception I had envisioned that the system would care for all of our citizens, not just those who were well off.

Soc:  I perceive a certain sadness in your words, Hippocrates.  There is much wrong with the system, and yet much is to be admired as well.  Certainly you have strived to elevate ethical practice in the healing arts.  Why, look at the oath that you and your students have drafted—an example of high ideals and excellence of care.

Hippo:  True, perhaps; but I fear that the system corrupts many of those who elect to practice the art.  And many of those it does not corrupt experience burnout and choose to depart the ranks of the profession.  You see, Socrates, we have amassed a great deal of knowledge that has allowed us to immensely improve the health and longevity of our citizens.  But what we lack, what we truly lack, is the wisdom to guide us in meting out the resources of care.

Soc:  I understand that 4 out of every 10 Athenian healthcare drachmae are spent on caring for the old and the infirm at the end of their lives.  Is that true, and if it is, can you enlighten me as to how this came to be the case?

Hippo:  Indeed, it is true.  Many families desire that every effort be made to prolong the lives of their elders, even though the situation is hopeless in many cases.  A good deal of silver is spent shunting patients back and forth from assisted living facilities to hospitals, where procedures of questionable merit are performed, instead of allowing nature to take its course.

Soc:  But surely we can not stand by and allow our elderly to die when we have the means to restore them to health!

Hippo:  Restore them to health, or merely prolong their existence?  I need not remind you, my dear Socrates, that unlike the gods, we humans are mortal.  At some point our bodies will wear out and pass away.  Death, merely the last stage of life, will eventually hush us along.

Soc:  I perceive now that your title of father of medicine is one well bestowed, Hippocrates.  You are not only a healer, but a philosopher as well.  But, to return to our previous line of thought, where can we procure the wisdom to guide us in formulating a more just and equitable system of health care delivery?

Hippo:  You, the wisest of all men in Athens, ask that of me, Socrates?  It is I who should be asking that of you.

Soc:  But in truth, Hippocrates, I recognize that I know not the answer to this dilemma.

Hippo:  As you well know, Socrates, admission of ignorance is the wisest place to begin a rational dialog.  If we can come to an agreement on the problems, perhaps then we can hope to ameliorate at least some of them.

Soc:  If we should find a remedy to this medical morass, I must remember to ask Crito to sacrifice a cock to Asclepius.

A Socratic dialog on health care reform (V)

After leaving the pharmacy of Apothos, Socrates finds himself pursued by Litigius the solicitor.

Litigius:  Socrates, my dear friend, wait—please wait!

Socrates: (pausing to turn his head)  What’s that?  Who calls me?

Lit:  It is I, Litigius.  If you would be so kind as to allow me to have a word with you, Socrates.

Soc:  By all means, speak then, Litigius; though I can’t remember when we’ve met before.

Lit:  I sat as one of your students in rhetoric at the Academy of Athens years ago.

Soc:  Strive as I might, I can’t recall your face.  I have grown old; and as of late, my memory fails me.  But no matter: what is it you wish?

Lit:  As I lingered outside the door of Apothos’ shop, I couldn’t help but overhear your conversation with him.  I understand that you have suffered a wound on your foot, which has lately suppurated, even though it had been attended to by Aesculapius the physician.

Soc:  How acute your hearing, Litigius!  You have described the matter truly.

Lit:  I imagine that, as I perceive you to ambulate with a limp, you are in some discomfort from the infection.

Soc:  It bothers me but a trifle.  But why do you ask—have you lately taken an interest in the healing arts as well?

Lit:  In a manner of speaking, Socrates.

Soc:  How so?

Lit:  As a solicitor, I am concerned for your welfare; especially in view of the fact that I fear you may have been mistreated.

Soc:  Mistreated?  By whom?  It was merely a stone which I treaded upon that cut the sole of my foot.

Lit:  Good Socrates, I refer not to the stone, but to the person of Aesculapius himself.

Soc:  Aesculapius!  The gods forbid that he should have done me wrong.  Why, Aesculapius is a fine practitioner of medicine.  I trust his judgment and skill completely.

Lit:  I’m certain his intentions have always been honorable, Socrates.  But here I refer not to intentions but rather technique.

Soc:  How so?

Lit:  Had his intervention been appropriate, the wound on your foot would not have suppurated.

Soc:  Any wound can suppurate, Litigius.  Well you know that to be the case, as many more infect than not.  On the contrary, Aesculapius did the best he was able to clean and dress my wound, and I thanked him for his efforts.

Lit:  Sometimes efforts fall short of the mark.  And when that happens, the law provides for redress—

Soc:  Of the wound?

Lit:  Of grievances.  I stand ready to offer you my services to petition the courts for redress of grievances, for the bodily harm that Aesculapius caused you through negligence in the practice of his art.

Soc:  (narrowing his eyes)  Are you saying that you wish me to bring suit against Aesculapius on the grounds of malpractice merely because the wound on the sole of my foot became infected?

Lit:  Precisely.

Soc:  But that borders on inanity, Litigius.  Had it been my soul which had been wounded to the point of festering, should I consider suing the clergy?

Lit:  Should that problem ever arise, I would be happy to be likewise of service.  But here we have a watertight case, one well worth several thousand drachmae, of which I would only require a mere third, should we be able to prove malpractice.  You stand to become a wealthy man, Socrates.

Soc:  And if I choose to sue and we should win, then I would become rich at the expense of Aesculapius, who would then become poor; and, in despair, might even forsake the practice of his profession.

Lit:  Aesculapius would suffer little setback, if any.  His malpractice insurer would pay the restitution, Socrates, not he.

Soc:  If so, then what would happen to his malpractice premiums should he choose to remain in practice?  Would they not ascend exponentially and the payment become prohibitive?

Lit:  But that would not be your concern, Socrates.  In this world we must all think of ourselves first.

Soc:  If that be the case, then who would look out for the weaker citizens, Litigius?

Lit:  Why, we solicitors, of course!  We always put the interest of the downtrodden first.

Soc:  Off with you now, Litigius.  I would rather bear an injustice done to me than provoke an injustice toward another.  Besides, I must be on my way.  I need to speak with Hippocrates on a number of grave matters, not the least of which is end-of-life care.

Lit:  As you wish, Socrates.  But here is my card, should you require my services in the future.  At the very least, please consider what I have said.

A Socratic dialog on health care reform (IV)

The philosopher Socrates seeks advice from Apothos the sorcerer for a potion or pill to dampen the discomfort in the wound on his foot.

Socrates:  Hail, Apothos, purveyor of pharmaceuticals.  I trust that you might be of service to me this day.

Apothos:  Good Socrates, hail.  Tell me your needs, and I will prescribe a pill or potion guaranteed to restore you to homeostatic health.

Socrates:  Lately, I have lacerated the sole of my foot on a stone.  Aesculapius the physician cleaned and dressed the wound; yet even though I have been careful to guard it from further harm, I fear that it has suppurated.  (lifts his foot to show the wound)

Apothos:  Aye, you speak truly, as a philosopher is bound to do.  The purulence reeks of infection.  Let me peruse the bottles on my shelves.  Ah, here we go—just the medicinal substance to cure the vile suppuration.  One pill swallowed twice daily for three days will surely have you back on your feet in no time.

Socrates:  But tell me, Apothos:  what is this substance which you advise me to take?

Apo:  The substance, you say?  Why, nothing more than the most powerful antibiotic yet concocted by one of the most highly respected laboratories in the sorcerers’ guild.  It just appeared on the market last week.

Soc:  How new!  But tell me:  has it been tested properly before its release for public consumption?

Apo:  Of course, Socrates.  All of our medicinal substances undergo extensive field trials before they are released to the market.

Soc:  Then I take it that you vouch for the safety of the product?

Apo:  My dear Socrates, it is not I, a mere man, who vouch, but rather the sorcerers with their collective years of experience and expertise who stand behind the drug.

Soc:  And are there scientific studies published that substantiate its efficacy and safety?

Apo:  (chuckling) Of course, but of course, Socrates.  Here is one I just happen to have in my files vouchsafing the data on this particular drug.

Soc:  Although my eyes are dim with age, I perceive the fine print which states that this particular double-blind study was underwritten by the very laboratory firm that developed the drug and authored by sorcerers employed by the same company.

Apo:  A mere trifle, Socrates.  Science is science, not political opinion.

Soc:  Thank you for enlightening me on that point, Apothos.  Now then:  what would be the cost for this course of treatment?

Apo:  Of the cost you needn’t concern yourself, Socrates.  I will bill your health insurance directly.

Soc:  But I have no health insurance coverage, Apothos.  Alas, we philosophers have lately been forced to pay out of pocket.

Apo:  I sympathize with your plight, Socrates.  If you wish to purchase the medicine, it will cost 100 drachmae.

Soc:  One hundred drachmae!  For six tablets?  That’s 12-1/2 drachmae per pill!  Have you nothing equally efficacious and cheaper for those who must pay from their purse?

Apo:  If you wish, Socrates.  But this latest medication is by far the more modern drug.

Soc:  (shakes his head)  I can not afford to purchase it, Apothos.

Apo:  Then here—this will undoubtedly work as well.

Soc:  What’s this?

Apo:  An ancient generic drug of the penicillium mold.

Soc:  How much?

Apo:  (looks away)  Two drachmae.

Soc:  Two drachmae—compared to 100?  Such a decision is easily made.

Apo:  Suit yourself, Socrates.  You get what you pay for.

Soc:  (laying two coins on the counter)  Tell me, Apothos, what is your opinion of the debates in the Senate on reforming the Athenian health care system?

Apo:  Such proposals, I fear, would ruin the pharmaceutical industry.

Soc:  How so?  Please explain your reasoning to me.

Apo:  From what I understand there is talk of rescinding the ban that forbids the government to negotiate lower prices for drugs with the sorcerers’ guild.  If the ban is rescinded, prices of prescription drugs will drop, and market share will plummet as cheaper medicines are imported from Thrace and Macedonia.

Soc:  But would that not be a good thing for the citizens of Athens?

Apo:  Of course not.  If pharmacologic prices drop, profits will follow suit.  There will be less silver coin available to invest in research to develop newer and more expensive drugs.  Many of those in the sorcerers’ guild would lose their livelihoods.  The unemployment rate would continue to rise.  More and more of our citizens would lose their health insurance and with it, coverage for prescription drugs.  I would be forced to resort to peddling the ancient medicines like foxglove and acetylsalicylic acid, drugs to be had for next to nothing.  Why, I might even lose my apothecary shop!

Soc:  What might you do then?

Apo:  (ponders a moment)  I would consider opting for a career in politics and run for a seat in the Senate—or perhaps become a professional lobbyist for the sorcerers’ guild.

A Socratic dialog on health care reform (III)

The philosopher Socrates pays a visit to Aesculapius, a general practitioner of medicine.

Socrates:  Greetings, fair Aesculapius, practitioner of the healing arts.

Aesculapius:  Socrates, my dear friend.  To what do I owe the honor of a visit from you this fine afternoon?

Soc:  I have come to ask both your opinion and a favor.  I trust I don’t intrude upon your time?

Aesc:  Of course not, Socrates.  It is always a great pleasure to see you.  Ask away:  what opinion and favor do you seek?

Soc:  I desire to know your thoughts on our present system of Athenian health care delivery.  I’m told that lately it has become a matter of contentious debate in the Senate, and indeed, many citizens have become concerned about where proposed reform might lead us.

Aesc:  A timely topic, to be sure.  Gladly will I share my thoughts with you.  But what is the favor you wish?

Soc:  A mere trifle.  I have lacerated the sole of my foot on a stone while speaking with Plato in the Agora.  Might you be able to attend to the wound, or at the very least, advise me as to what should be done about it?

Aesc:  By all means.  Here, sit on this rock and show me your foot.  Ah, the wound is indeed deep into the fatty flesh.  Allow me to clean and dress it for you.

Soc:  Aesculapius, I must warn you before you proceed—I have no health insurance coverage.

Aesc:  No matter, Socrates.  It is I who am in debt to you, not you to me.

Soc:  How so, Aesculapius?  For truly, in as much as I can remember, you owe me nothing.

Aesc:  “Owe no man anything, but the debt of charity.”

Soc:  I perceive that you are a philosopher as well as a practitioner of the healing arts.  But come now—surely you can bill me for your services, and I will pay you what I can.

Aesc:  (dismissing Socrates’ words with a sweep of his hand)  Let me draw a basin of clear water into which you can immerse your foot for a bit while we talk.  Now then, what questions had you about our system of health care?

Soc:  From what I am told, it seems as though opinion falls into two camps.  There are those who wish to reform the current system and those who feel that it should be left as it is.  I ascertain that those of the former persuasion perceive that the system is dysfunctional in its present state, while those in the latter maintain that whatever dysfunction there might be, the profit motive will serve to fix.  What say you, who deal with patients every day?

Aesc:  In my youth I elected to study the healing arts out of a deep seated desire to help my fellow citizens.  After completing my medical studies, I found my educational debt to be so high that I was forced to practice one of the more lucrative subspecialties just to keep my creditors at bay.  I would work long hours and return home in a state of fatigue to find my wife and children already asleep.

Soc:  What happened?

Aesc:  The demands of practice became more than I could bear; I became dysfunctional.  I closed my surgery, returned to the Academy to teach and read the classics, then decided to reenter the profession as a general practitioner.  My earnings have plummeted to half of what they had formerly been, but I make enough to live comfortably.  And my satisfaction in the profession has grown to the point where I have been able to recover a small portion of the idealism of my youth.

Soc:  But I perceive that you, Aesculapius, are something of an anomaly among those who practice the healing arts.

Aesc:  Think you so?  I myself am not convinced of this, for there are many physicians who enter the profession with similar intent.

Soc:  What’s that you’re applying to the wound, Aesculapius?

Aesc:  The orb of an arachnid, Socrates.  Over the years I’ve experimented with various modalities to stay the flow of blood from a fresh wound and to promote its healing.  A common spider web seems to do the trick—it’s cheap, and readily available.  Now then, slip on your sandal.  How does that feel?

Soc:  Much better.  I thank you, Aesculapius, for your time and expertise, as well as for your words.  Would that there were more practitioners of your ilk in Athens.

Aesc:  You are too kind, good Socrates.  And now you must excuse me, for I have other patients to attend to.

A Socratic dialog on health care reform (II)

The philosopher Socrates encounters his former student of political science in the marketplace.

Socrates:  Good day, Plato, if my dim ancient eyes do detect this human form to indeed be Plato, who lately sat at my feet in the Academy of Athens.

Plato:  Socrates, my former mentor and fellow citizen!  How good to see you; how well you look!

Soc:  And you also, my friend, though you seem to have filled in about the midriff more than a mere smidgen.  The life of a politico must agree with your constitution.  I have lately encountered Aeschylus along the Parathenaic Way, who tells me that you have been engaged in extensive dialog in the Senate chambers regarding proposals for the reform of our health care system.

Plato:  Aeschylus speaks the truth, good Socrates, albeit with a lower case “t”.

Soc:  What—how say you now, that Truth is no longer Truth?

Plato:  True enough, Socrates.

Soc:  But how can this be so?

Plato:  In the political realm the fine lines between truth and opinion blur the vision.

Soc:  I perceive that you, like the clever foxes, have spoken wisely.  But tell me, how goes the debate?

Plato:  Formerly, not well.  But our August recess has allowed us to plant seeds of doubt amongst those citizens formerly in favor of democratic proposals for a public option.  We have also been able to mount a media campaign in the Agora against the liberal idea of government run health care, which, if truth be known, would undoubtedly bankrupt the Athenian treasury.

Soc:  And what is the proposal of those of the republic?

Plato:  For the time being, to leave things as they are.  There is plenty of time for discussion and debate.  The last thing we want to do is to rush prematurely into redesigning a system which has become the envy of the Mediterranean world.

Soc:  Aeschylus has spoken to me of its vile corruption, of the unethical behavior of those of the insurers’ guild, the sorcerers, and some of the guild of Aesculapius—that many are motivated by profit at the expense of the citizenry.

Plato:  Aeschylus is a poet, a dramatist, a tragedian.  He knows not of what he speaks—all health care is based on the business model.  In the end profit is good, for what profits me ultimately profits you.

Soc:  How so then?  Please explain this concept to me.

Plato:  If the reward of potential profit motivates me to deliver a better product or service, you benefit from those improvements, in whatever form they happen to take.

Soc:  In this case improved health care delivery means better health for all citizens of Athens?

Plato:  In theory, yes.

Soc:  How so, “in theory”?

Plato:  It depends upon those products or services.  For example, if you need a heart transplant—”

Soc:  A heart transplant!  What next—will they take my soul as well?

Plato:  My sources tell me that they’re working on that too.  But we digress.  As I was saying, if you need a heart transplant, you can get one done in a timely fashion right here in Athens.  In Macedonia, you would have to wait months, perhaps years, and never be guaranteed a heart in the end.

Soc:  So you infer that, meantime, I might die of a broken heart?

Plato:  Exactly!  But you live in Athens, where the health care is the best in the Mediterranean world.  Why would you want to change it?

Soc:  Tell me, Plato, what is the cost of such a procedure?

Plato:  The cost of a heart transplant?  Off the top of my head I can not say—perhaps 100,000 drachmae—

Soc:  One hundred thousand drachmae!  Why, that is outlandish!  With costs of that magnitude, how can we hope to sustain the present system?

Plato:  Those of the insurers’ guild will increase premiums to cover costs.

Soc:  Aeschylus tells me that much of the silver coin remains in the purses of the insurers.  Is this true?

Plato:  Not much—only one drachma in five.

Soc:  One drachma in five!  That’s 20 percent.

Plato:  That’s part of the business of health care.  Remember—profit is the incentive that motivates progress.

Soc:  And what should it profit mankind if we gain the whole world but lose the health of our collective soul?

Plato:  As I said before, good Socrates, we’re working on fixing that one as well.