in Kulturkampf

Dear Dr. Starner Jones, MD

Today I got a viral email containing your letter to the editor of the Jackson, MS Clarion Ledger. I was not so much disturbed by its content as by the Comic Sans MS font; that, sir, was a crime against typography.

Dear Sirs:

During my last night’s shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R&B tune for a ringtone. Glancing over the chart, one could not help noticing her payer status: Medicaid. She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer.

Artfully worded, sir. Your patient’s negro features remain unstated, yet perfectly implied through “cultural” observations. Bravo!

And our Congress expects me to pay for this woman’s health care? Our nation’s health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture — a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. A culture that thinks “I can do whatever I want to because someone else will always take care of me”. Life is really not that hard. Most of us reap what we sow.

Don’t you agree?

No, Dr. Jones, I don’t agree. Our country already pays for this woman’s health care — but in the most expensive possible way. Your easy moralisms don’t prevent vices or solve our nation’s actual health care problem, which isn’t “culture” but spiraling costs. We are all going broke in the current system, and indigent care is a big reason. So is prevention, or rather the lack thereof.

As for the culture of poor, black Mississippi smokers living in the land of fried food and vending-machine junk: I’ll assume that, as a professional healer licensed by the state to “first do no harm,” you spoke to this patient about the importance of diet, exercise, and breaking her addiction to nicotine. If not, then I’ll assume (charitably) that you didn’t bother because Medicaid won’t cover those services.

You might be interested to know that Canada and the UK freely provide them, and have produced massive cuts in preventable illness (thus bringing the social costs of medicine down). Only in “free market” American healthcare are these problems still so problematic; only in America is health coverage so damned expensive that poor, black women in Mississippi cannot afford a primary care provider to offer them these services.

Knowing your state’s history of economic and social oppression of slave descendants, I recognize the patient’s “lifestyle” as the product of poverty. Eating right is more expensive than a pack of cigarettes a day; junk food is cheap, while cigarettes and booze kill her pain.  She is only vaguely aware of the deadly crap marketed to her in those shiny plastic wrappers. It’s what she was born to, and unless something changes it is how she will die. Your patient is not unique.

Furthermore, the unstated but clear implication is that she is unemployed or underemployed, which is true for about one in five Americans these days; but I assure you that plenty of your Medicaid patients do work but don’t make enough money to buy health coverage. No state has a higher percentage of working poor than Mississippi, a fact that puts your state at the bottom of the human development index. You might understand these things if you talked to your patients instead of judging them.

Doctor, get to doctoring. Politics are unbecoming of you and the facts are not on your side.

Socialize this!