ObamaCare Morbity and Mortality Conference

Reading the transcripts of the three days of Supreme Court hearings (Day 3 is here) on Obamacare is enough to make me scream in frustration and pain at the convoluted arguments.  Sometimes it seems to me as though the Court is playing games with our lives and laughing about it as though it’s an inside joke.

Why don’t they just stick to the plain reading of the Constitution and the law? Who cares about Lochner or Brock or Printz, Raich, Wickard?  Why are Ginsburg and Sotomayor leading the Solicitor General?

Part of the problem is that this really is an elite group, immersed in the minutia of Court rulings that most of us have never heard of, much less read. What probably should have been a clear and easy reference by Justice Scalia, made me look up the Eighth Amendment and “cruel and unusual punishment.”

In an attempt to give the Justices and lawyers the benefit of the doubt, I’m trying to think of the hearings as a sort of “Morbidity and Mortality” (“M and M”) conference. (The other analogy had to do with zombies. Decided not to go there.)

I imagine that a layman would feel equally lost and frustrated at a M and M, watching doctors review outcomes from tough cases where something went wrong or someone died. No detail is too small or unimportant for debate and (excuse the pun) dissection, unless the attending or Chief (Justice) declares it so.  Where there are rivalries or competition, the docs try to “one up” each other by the use of jargon and eponyms, correct pronunciation, obscure research and cute little “you had to be there but you weren’t so I’m brilliant/safe/top dog and you’re not” digs.

(Even here, I indulge in jargon: “eponyms” are names given to something based on the person who is given credit for the technique or discovery or some aspect of the disease or technique discussed, a sort of nickname that saves time and breath for the speaker. My theory about jargon – at least since I’ve finished residency and can’t be made to repeat a couple of months of training – is that whoever says the word loudest, is right about the pronunciation. As a Family Physician among sub- and super-sub-specialists, I want the anatomical or pathological name, not some esoteric reference to a paper in a journal or a dead guy’s name. I advise my patients to demand the same.)

Going back to the M and M: families and patients watching the conference, with our obscure references, jargon and eponyms probably would feel that the doctors and doctors-in-training don’t care as much about the patient as we do about shaming our rivals and proving and improving our own superiority and power in the group. While that may be true in some cases, the purpose – and more often than not, the result – of the process of review and debate is to make each of us more knowledgeable and to try to make sure we never make the same mistakes twice.

So when we call patients (or the hearings) “trainwrecks” we don’t really mean disrespect. The analogy is good: just as the cars on the train hit the one in front of them, go off the track, pile up each other, turn upside down and cause damage on top of damage, treatment.of very sick patients involve correcting one problem without creating another, organ failure on top of organ failure and digging through the most urgent crises before we can get to the point where we can fix what went wrong in the first place. It just looks like we don’t know what we’re doing.

Hopefully, we’re watching the Supremes review the autopsy of Obamacare rather than a debate over how much and how long to give life support. The “patient” in this case was a “trainwreck” from the beginning, but maybe Congress will learn something.

HatTip to Sonja Harris’ Conservatives in Action for the “trainwreck” link.