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.

Labor Day web browsing

While out with the dog for a walk on this last weekend of summer, I glimpsed a spider suspended between the steel supporting cables of a utility pole.  Stooping down for a closer look, I could appreciate the speed at which she worked.  What I couldn’t see clearly was the web she wove, almost invisible in the morning light.  Yet I knew the completed orb would be on display later that afternoon.

When he was perhaps five or six, my son and I paused on our way home from the school playground to watch a similar spider at work in the flower garden at a local church.  As I recall, we reclined on the grass for the better part of an hour observing the miniature master weaver at work.

The spider had already constructed a tetrahedron by running silken threads between several green stems and proceeded to drop lines from these outer boundaries to the center.  Afterwards she moved from radius to radius, deftly spinning parallel threads between the spokes.  Mesmerized, we watched this industrious litttle artist shuttle around her newly formed web, engrossed in her work.

Later that day we stopped back to find the web completed, billowing slightly in the evening breeze.  Its architect hung head down, suspended in the orb’s center, resting from her labors.

And so today, on the morning of this day of rest deemed our day of labor, I sit on my front porch to browse yet another arachnid artist suspended in her silken web, eagerly anticipating the first fruits of her work.

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.

Author to speak at 4th annual Cell2Soul retreat

Author Brian T. Maurer is slated to speak at this fall’s Cell2Soul gathering at Mason Hill in the Berkshire mountains of western Massachusetts on Saturday, October 3, 2009. Maurer will deliver a short presentation on Henry David Thoreau and the significance of his philosophic outlook for contemporary living.

Of the many observations that we could make about the man Thoreau—indeed, we could make many, because, like us, Thoreau was a complex human being with his own inconsistencies, pet peeves and private issues—today I will emphasize two:  the satisfaction he derived from working with his hands, and the cultivation of his spiritual awareness.  The two are not mutually exclusive.

For further information on this weekend retreat click here.