There was a science fiction movie which showed people as having multiple portals on their bodies to which were attached hoses, perhaps half a dozen to a person, which swung free and were available to be connected to machines that took or received some fluids. It was very unnerving to see people so dependent on their mechanical devices that made them able to survive though, if you think about it, this was a biological metaphor in that people do have tubes that sustain life. Food goes down your gullet and wastes come out of tubes whose exit points are covered. It was just unsettling to see these processes as mechanical rather than biological. There are, however, another set of portals that, as the expression goes, connect every person to their lives. These are the organizational portals whereby you are connected to your identity and therefore have access to the services which sustain us, both biologically and otherwise. I have become particularly aware of my reconnecting to my new portals when I recently moved from New York to Salt Lake City. I did not have to change my phone number because of the miracle of a cell phone, but I did have to change addresses for my credit cards and my health insurance companies and I still keep my passport handy to identify who I am. All those verifications of my identity enable me to live an ordinary life. I don’t need one for a supermarket, but Utah requires an identification so as to access a liquor store, which was not the case in New York.
The most significant organizational portals, I have found, have to do with health care. I have accessed a cardiologist, an ophthalmologist and a primary care physician at the University of Utah Medical Center. They seem friendly as well as informed, though I cannot really say, not knowing much about medicine, and instead rely on the reputation of the medical center as the way to get a connection, just as I referred to Columbia Presbyterian in New York City as the place to go for some specialist my primary care physician recommended. Today, in Salt Lake City, I just take cold whomever the doctors recommend in their phone referral for a new physician. Getting my Walgreens pharmacist wouldn’t open up the spigots to allow me my medications. It had to wait until there was a new primary care physician to enable me to get my drugs but that didn’t take long because Walgreens has a single computer system throughout the country. Reaching any branch opens up all the branches.
Medicine is fast changing and I have remarked before at how agile is medicine at reorganizing itself. When I was a child, independent practitioners dominated the field. Then came hospital based medicine, it having replaced house calls because having a doctor drive around his own chauffeur was an inefficient use of time and, it dawned on them, if a person was sick enough to need medical care, then it needed hospital care. Headaches just needed an aspirin and heartburn needed Pepto Bismol. Then hospitals realized that their major expense was hotel services, and so tried to eliminate overnight or even shortly extended stays by outpatient one day services. Hemorrhoidectomies were done in and out and the number of nights to recover from delivering birth was decreased, the new insight that keeping people moving around would make people recover their health more quickly while bed rest was a bad thing unless necessary. I don’t know which came first: the economic efficiency or the new discoveries about managing health care. After that, hospitals again revamped in that they created free standing suites of medical practitioners without the full range of services but capable of doing routine procedures and visits for their specialists. The result, in part, was that practitioners became salaried employees where the hospital required rent for the practitioner and gave little advantage to someone who oversubscribed his or her usual case load, and very little danger of falling short of his or her own caseload.
Now we are in the midst of another medical changeover. Medical patients in Salt Lake City and elsewhere around the United States have to enter a medical portal in order to identify and access their services. The computer system requires you to identify yourself and then will unfold your records, those including your medications, your scheduled visits, your various practitioners and their notes to you about what they said to you after a visit, and a place to send inquiries to one or another of your physicians. A doctor is, I think, like a console whereby you push and pull the levers which physician extenders use to accomplish their work,the primary care physician orchestrating the pharmacists and nurses and specialists and technologists who do bloodwork or actually make the appointments that the doctor wants to happen. As is the case with other technologies, such as the early internet or, even before that, early radio, a technology comes on line even before it is not quite ready for prime time because it is such a quickly essential technology, and so the portal I now use has redundant entries I am required to enter and not an easy way to access prior notes with doctors, but it works well enough and there are easy telephone lines to reach people who will be very helpful about helping a patient manage the interaction through the portal. But the truth of the matter is that I have to plug myself into the portal every time to engage with my health providers at least until the time when i am comfortable enough with it so that it does not seem to me to be a new access point for me to notice my plugging into it, just as happened when telephones moved from being switchboards with operators to automatic electronic dialing that no longer needed the initial invocation of “Hello, Central”.
Conservatives can often say that the troubles with medical access are the results of the regulations on medical care that have been imposed by the government, and that we would all be better off if we got the government off the backs of consumers. Conservatives are always critical of unnecessary regulations, though it happens that if you get down to cases, most of those regulations make sense even if they are a burden to corporations. Most people would not want us to get rid of the early twentieth century regulations that allowed for the inspection of meat and other foodstuffs, or the ones that require chicken farms to control the spills of waste into streams and rivers. Moreover, the reason for the introduction of highly organized medical portals doesn’t have to do with the government but with the need for ever increased efficiency in medical practice, all the way back to getting rid of house calls. In most places in the United States, except for places like NYC and LA, where a lot of doctors want to practice, there are too few medical doctors and so it is necessary to save on their time by making other people do as much of their work as possible, even arranging phone calls and only then having an actual phone exchange between doctor and client and, even more rarely, scheduling an in person visit, given that so much of the doctor’s work has to do with checking the results of lab tests and other procedures that do not require the doctor to take part of the interaction with the client, but just deal with the documented result so as to make a decision about what to do about it. The same is the case with regard to Catholic priests, another relatively scarce commodity. Deacons can provide more services and married priests can be accepted so that the vital and legitimate service of offering Mass can take place for members of the communion. Perhaps other shortcuts may become adopted to deal with the bottleneck of insufficient practitioners for the population needing the service. As I say, medical care has been remarkably flexible and creative in reorganizing its work to deal with patient care through technology and physician extenders, and so the process will go on.
There is, however, a different point that Conservatives make that does legitimately rankle about the multiple organizational portals through which consumers enter. An image of what constitutes liberty is a person and his family going across the Alleghenies at the beginning of the Nineteenth Century so as to establish a farmstead where you could not hear the sound of some other homestead wielding his axe or seeing the smoke from his chimney. That made a person free, dependent upon himself rather than other people, much less subject to a government. This sense of independence, I think, is overvalued, a vestigial sense of freedom, which rightly has to do instead with the guarantees of government to secure citizens the right to vote and assemble and have jury trials and to have equal protection of the laws, whatever that means, including the right to be treated women as equal in the ways we have decided men are to be equal while yet different. Freedom from government and other kinds of supervision, as happens in medical portals, intrude on people in that they are always being questioned for their credentials, whether to show their medical insurance or to have kept up your prescription so as to get a drug renewed. These accesses are as if you needed multiple passports to manage your way, no internal passport supposedly required to travel around the United States, but needing any number of certifications to let you know who you are. Everybody has to show his or her papers to get by. As a Liberal, I do not object to the requirements of providing paperwork, perhaps because most of them do not have to do with political freedoms, but they certainly do seem to be intrusive and constraining. These are, indeed, the burdens of managing the modern world and not the lot of life in Nineteenth Century Kentucky.
But think of yet another twist. Part of freedom in the modern world, rather than being a form of subservience, is precisely that there are all those records that a benign Big Brother looks into. Our educational and medical and financial systems keep track of any number of records and people, even Conservatives willingly abetting at doing so as when they get credit cards or use cell phones, not wanting to do without GPS so as to find where they are and where they want to get to even though everyone on the system knows where you are and what have been your travel patterns. These systems are empowering. Jim Bridger got to the mountain West without a map much less a GPS, while a person can’t find a Chinese restaurant without one.
Moreover, truth to tell, I like knowing there is a permanent record card in the My-Chart computer. It shows someone cares and looks out for my health. I rely on that rather than on my being on my own to manage my health. Is there an abandonment of freedom because my health care is monitored, even if it is a spiritual kind of freedom rather than a political kind? Perhaps so, but I am not sorry for the exchange. In fact, I would go so far as to say that I don’t begrudge anyone in the world hearing about what I communicate about politics or public policy in my blog or whatever places I access. I have nothing to hide, though I do agree that there should be privacy restrictions about sexual matters that can indeed be exploited for purposes of profit or revenge. Maybe my cavalier manner about intrusion is because we do not punish people except by disdain for our views, but if there were a large scale intrusion so as to have the government condemn people for their views, that would indeed be political and so have to deal with as what seem to me to be a danger to freedom. That is why I did not like the FBI intruding with David Korash in Waco. Distrust the FBI, whether a Conservative or a Liberal, but let me show my blog and manage my My-Chart.