Doctoring the stats, if we may

We live in noisy, acrimonious times, bombarded by denunciations of the kids these days for being disgraces to their parents. The barbs the Baby Boom caught were more or less for being insolent, i.e., too mature. The ones Millennials catch are even worse. Go read about that recrimination and religitation and general upset somewhere else, say, in any of the hundreds of passages where it’s already been beaten to death like Nigel St. Nigel’s dinner steak in these pages alone.

Occasionally an absolutely standout statistic pops over the transom and brings this bullshit into the stark relief it so desperately needs but so rarely gets, spotlighting the unlikelihood that tens of millions of extra Westerners under forty independently but simultaneously developed the same set of dysfunctional habits, made the same bad choices, and ended up with the same disappointing accomplishments and bleak prospects. From time to time—more like day or few, for those who aren’t numbed by the cultural onslaught—a snapshot pops up to prove, and I mean prove, that what’s happening is not just entire youth cohorts of current, erstwhile, and aspiring hikikomori freely choosing to make ruins of their own lives.

Tonight’s snapshot, for me, was a graph of the annual number of medical graduates in the postwar United States. The line rises steadily through around 1980. Then it falls into an undulating plateau for the next three decades, before rising more steadily again over the past decade, to the present day.

Did the national population do that? Of course not. It didn’t drop some years or decades and rise in others. It kept growing. Say, the turn of the eighties didn’t feature any other pivots from stewardship into schemes to sneak into other people’s houses and gorge on their seed corn at their kitchen tables, did it? Surely that wasn’t a period of constant strikes and lockouts in an effort to hold the line on the worst of the yuppies.

Metric after metric stagnated or reversed in the seventies and early eighties. It’s chart after chart after chart. It turns out they decided to stop training yuppies into doctors, too. It’s odd. It’s surprising. Aren’t the doctors all yuppies?

Yeah. That’s gotta be why. It’s artificial scarcity. When the unions attempt to enforce a third artificially scarce day of each air traffic controller’s work, they’re lazy freeloaders. When the medical schools and professional associations allow the training of new physicians and surgeons to detach from population growth in an aging country on course to start really aging a generation into the future, that’s, uh, markets something. It couldn’t be professional collusion. It’s not like Adam Smith snickered about how it’s impossible to put any two of any type in the same cafe at the same time and not immediately get them to hatch a conspiracy to fix prices.

The civic implications of Adam Smith complaining not just about every possible sort of tradesman being a born price-fixer but also about landlords are important, eternal vigilance as the price of freedom and all that shit. If that priggish gasbag was Mao by way of the Marquis of Queensberry, maybe the business of business really is monkey business and the landlords really are parasites. Smith happily granted that tradesmen are mere cheats. This might be worth keeping in mind when our elected officials and think tank sinecurists open their pieholes to spend time as the economics faculty.

As fellow tradesmen (and women!), certain members of the b College of Esteemed Barber-Surgeons might wish to do likewise for their own financial gain. They might wish to establish themselves as a strictly select fraternity.

Midwives and midwifery enthusiasts have things to say on this topic.

We risk veering into woo. Is natural childbirth any better than natural root canal or natural orthopedics? I don’t have any she-crunchies in my circles to impress at the moment; none of the bitches in that fight are mine. So let’s flip the question. If obstetrics is such a good idea, why have we spent forty years trying to have less of it? Patch my damn cunt right now, Adams! Be of cervix!

This is an entirely serious question. If a stagnating pool of physicians serving a growing population moves out of general or internal medicine and into OB/GYN for the pay (say, due to student debt), there will be a different mix of ill effects on national health, in this case through the neglect of routine checkups and preventative care, and there probably still won’t be enough obstetricians.

Did the raw ability of American medical schools to train new doctors falter for decades in the midst of breathtaking medical and pharmaceutical breakthroughs? I don’t particularly think so. That isn’t a deal where they just dump all the lab instructors into fulltime R&D. These are complementary parts of the system. They have synergies.

That’s a ridiculous answer for why medical school graduations plateaued alongside surges in the yuppie population. It’s more sensible to explain it by pointing out that recruiters for high-frequency trading shops spent years telling undergraduate math whizzes they were too smart for medical school. Don’t waste your career listening to geezers cough; come help us exploit our microsecond advantage over the other bastards by writing algorithms for the direct line we have from the NASDAQ floor to our new server farm in Hoboken.

These are gentlemen’s pastimes. It’s the kind of parasitic legerdemain that would tempt any ruined aristocrat who’s otherwise prone to club his fellow to death because he was budgeting tonight’s winnings for the latest round of last-ditch payments on his ample household debt. Granted, there are workarounds. For example, parliamentary immunity as a refuge from debtor’s prison is an exercise of classic Burkean conservatism.

It helps to know people to get into medical school these days, too. For veterinary school it’s just about a necessity. Mom and Dad are vets, they both know a bunch of other vets, and whaddaya know, precious Madison seizes the opportunity to shadow one of their colleagues and then gush about it on her improbably successful application for veterinary school. Honorably and lucratively, the family tradition endures.

In the Old World, this professional arrangement would generally be called a hereditary guild. Here, in the land of the free and the home of the brave new one, it’s called—well, shucks, it’s called nothing. We’re one of the most obnoxiously, inexhaustably talkative peoples on God’s green earth, and we somehow don’t have the language to describe the hardening tendency of children, in this case the children of the upper middle class, to take up their parents’ lines of work, to the exclusion of young people from other, less fortunate families.

Counterintuitively, it’s because Americans believe so deeply in the power of language. This is why we lack the language to talk about shit the English, the crew of our mothership and the namesake of our common tongue, traditionally classify with a single syllable. Over here, we’re pretending it isn’t odd that the children of veterinarians have such a preternatural inability to regress to the professional mean of not being veterinarians. They get prodded and hazed through the same test hell as any of their class peers, but kum-on, they aren’t all that competitive. They are not all so smart and capable.

Problem is, our Brahmins today get really touchy about what to do with the family dimwits. Maybe it’s their fault if they won’t study hard enough, but that’s beside the point. The dim their families will have with them always. The intense pressure to succeed doesn’t help, either. Some of their cognitive deficiencies—like, where if you talked to them just to talk to them without thinking about their excellence as striver brats you might walk away thinking they aren’t too fucking bright—arise from the pressure to turn them into Scantron idiot-savants. I was transiently dumber for putting up with that shit. You would be, too.

As Dan Quayle supposedly said, not to have a mind is being very wasteful; how true that is. Palo Alto’s teen suicide victims present, or absent, with scholastic aptitude such that they’d have to go to Atlanta to pass their tests. Youth suicide clusters in affluent communities may well in fact skew test scores and college acceptance letters upwards; I don’t care whether they’re crass enough to think of this, because I am, and I consider it a legitimate, relevant consideration.

All they’d do in Atlanta is grab a damn eraser. Encouragingly, it’s the same approach the proctors took on the Operation Varsity Blues show. Hey, champ, I know a guy in Houston. We’re seriously talking about saving people’s lives here.

*****

I’m shitposting, but I am not kidding. Colleges drive teenagers to suicide, and many more to self-harm, by playing around with the admissions dials to goose their cut of the vig. Then they wonder, oh no, our students have mental health problems. How did that happen? This stance conveniently opens up a slot in the trough for every grifting oddball with a PsyD to devise “solutions” that don’t force their employers to solve a goddamn thing. Our colleges retain an awful lot of in-house solicitors and regulatory specialists per capita for institutions that deal with customers they’re destabilizing to the verge of suicide by commending them to the mental health care of psychologists they employ.

Sociopathic multinational corporations that pull this company town shit on their employees in the interest of “wellness” at least pay them a little something for their trouble. The college model is to charge fees for healthcare upfront, along with tuition, and then delay or deny requests to apply the same fees, by this point on deposit at interest and declarable as liquidity on applications for corporate lines of credit, towards bills for the mental healthcare of outside providers who do not have prima facie conflicts of interest.

This shit is just too fucking obvious to give the benefit of the doubt. Rob Ford needed, like, a week of heat from the press to be like, yeah, I guess I can only prove that I smoked crack, but I’m pretty sure I was also drunk to the point of incapacitation, because that seems like the reason why I’d smoke crack. Dude’s Rock.

I am not here to humor anyone who runs a fucking chartered and accredited bachelor’s or graduate program and insists that isn’t a conflict of interest because it’s complicated and I don’t understand. No, asshole, I’m not a moron. I fucking understand. The arrangement for student mental health services at these schools is tangled but easy enough to describe and explain.

The schools are the immediate payors, the patients are their students, and the clinicians are their employees. The patients, usually via their much more solvent parents, have parallel customer relationships with the payor, as tuition-paying students and de facto policyholders enrolled in a group health coverage plan providing routine outpatient care in campus clinics closed to the general public.

Here’s where it gets sick. The clinicians have the specific, exclusive responsibility of treating mental health outpatients who almost always present with specific complaints against the clinicians’ employer, which is also the patients’ insurance carrier and provider network for psychological care whenever classes are in session and they happen to be on campus.

These are distraught teenagers and early twenty-somethings telling psychologists, all but explictly: Your employer is why I’m sick. Your employer is why I’m cutting myself and thinking of suicide. You work for my college. Our college is emotionally ruining me.

This is a mental healthcare system where the patient has an adversarial relationship with the counselor’s employer, EVERY SINGLE TIME. On rare occasions a patient’s difficulties may not have a provable relationship to the school, one of those situations that’s totally unlikely but plausible enough for Coast to Coast. Okay, I’m not saying I was on meth, but I’m not saying the alien didn’t stick a probe up my butt to download my soul, but I’m definitely saying the way I treat my patients is exactly the way I would if they weren’t telling me I’m working for the same organization that makes them want to kill themselves.

*****

At the institutional level, nobody at these schools can do a thing without debasing themselves to some combination of sophistry and carnival barking. That’s an American story if ever there was one. The combination of self-seriousness and power may be the most ruinous thing about this system. It seems not too conducive to peace of mind to bully teenagers already passing through a drawn-out, incoherently justified liminal period that their future wellbeing in everything from earning capacity to professional advancement to marriage and childrearing depends on their successfully walking a gauntlet of power-mad boors, scolds, busybodies, snitches, and lunatics.

Yes, the individual authority figure is allowed to be a mix-and-match; yes, it’s payable upfront; yes, usurers are standing by with installment plans. Call now.

I swear to God, it’s enough of a rite of passage to get the kids into the payroll workforce. The rest of this shit is just fucking insane.

I once had dinner in the same room as John Yoo for a symposium about Lincoln and Taney and why that did or did not make it okay for the intelligence services to subject detainees they’d gotten for bounties to mock executions. You know, the usual. We were treated to the usual high platitudes about robust debate and intellectual diversity and my balls, which were feeling better than they would have in Homan Square. The idea was that we’d be incurious not to give a fair hearing to a scholar of such stature just because we disagreed with his positions.

Whipped little bitch that I still so often am, I fell for this shit. A fair hearing of that asshole’s heinous and yet boring arguments would be to scream at him to shut up and promise to call 911 the next time he comes into sight. That reaction would rise vaguely towards the level of street justice. A pampered asshat like John Yoo would be horrified. People like him flip their shit at the thought of being heckled. They consider it censorship to be denied salaried academic posts and honoraria just because everything they have to say outrages their paying audiences.

This is the usual grievance about cancel culture: some bigshot pissed the wrong people off in exactly the way he knew not to do when he was on one platform, and how he must suffer the humiliation of having to take his large, established audience to a different, comparably prominent platform whenever he feels like it. The same assholes who are so fed up with liberal snowflakes throw a fit whenever one of them is belatedly denied ongoing payment to say absolutely any rotten thing that comes to mind on Fox News. They get outraged at the possibility of a marginal loss in viewership just because one of them barked a vile racist diatribe through a mouth too wine-soaked to form normal consonants.

To make it even more pathetic, they’re all bitter about their relegation to Fox News or some other platform of similar cultural dominance because a fair society would reward their talents with an appointment to Harvard. Yeah, Harvard doesn’t want me, either, doofus. Harvard does not encompass all possible atrocities just because it’s atrocious.

On the other hand, Boalt Hall made space for Philadelphia Eichmann.

This is the point where I start feeling like I’m fucking hallucinating. I’m just some schmuck who does more or less his fair share of the country’s farm work and publishes huge amounts of weird samizdat, some of which a few strangers enjoy reading. I’m over here chronicling the surreal from time to time, and I feel like a huge disappointment for not doing something more worthwhile. Meanwhile, the surreal who give me themselves as posting fodder do circle jerks for a living. They give each other accolades for publishing “legal scholarship” that would get them fired from the average newsroom for incompetence and serious ethical lapses. They get strivers to prove their own genius for a chance to pay for lectures about how it’s constitutional to commit the kinds of war crimes that got all those guys hanged in Nuremberg. It takes excellent grades and stratospheric LSAT scores to get into John Yoo’s lectures, plus a small fortune in tuition and fees.

Academic grades are barely credible without any of these freaks. They have the same problems with fraud, corruption, and chain of custody as subprime mortgages exhibited in the crash of 2008. The very premise of this system is that it can use printouts of some spreadsheet calculations derived from summary reviews of academic performance to classify alumni as anything from heroically hardworking geniuses to lazy retards, often based on coursework whose only copies existed for all of a day or two. To continue the unnerving hallucinatory feeling, the reason grades and grade point averages are taken so seriously is that the assholes relying on them are too lazy to review applicants’ portfolios. The standardized tests serve the same purpose.

The only thing we know about sexual quid pro quo in academia is that it’s underreported. I guarantee it. Sucking or fucking the right person to change some letters and numbers for potentially hundreds of thousands of dollars’ worth of future earnings is exactly what happens when the stakes are as high as they are now.

Most of this perversion and dissolution is only circumstantially provable. There’s conclusive, thoroughly documented evidence of the parallel ideological extortion that pervades academia and institutions associated with it. Freedom means the latitude to treat Alan Dershowitz like any other jerk with vile politics. It tells us what we need to know about the extent of intellectual freedom that it’s beyond the pale for so many professors and reporters to repay the foultempered immorality of such characters with anything but graciousness and patience. It isn’t mercy or magnanimity to put reactionary shithead lawyers on TV. It’s enabling. It’s collusion.

The assholes could always just grab soapboxes and serve as models of pluck and independence for the young people they rue have turned into whiny, easily offended conformists. They hate the idea. It would be an ego hit. I don’t usually look at my site stats these days. None of these emotionally volatile freaks would be able to resist. None of them can bear to be denied Harvard’s imprimatur, or to be quiet on any platform within their reach about the injury they sustain by being so denied.

*****

The simple explanation for their ill cheer is that they’re courtiers. They’re as bitter and resentful as any other chorus of petty little bitches about being barred from the courts of true power, those stuck kissing noble ass in Avignon for a living always pining for Versailles, where they’ll finally show the world that they’ve arrived.

Bruh, they feed you, right? And of course they do. Courtiers and whatever else they are as well—priests, scholars, jesters, counselors—are fed by the sweat of other brows. It’s one of the draws of the gig. They just have to concoct or perpetuate whatever story it takes to convince the peasants that they shouldn’t have to pitch in on the chores.

What makes these already miserable “conservative” crybabies go from the tragically insatiable to the farcical is their confusion of prestige with power. Sure, maybe critical race theory or whatever on earth is the matter with Larry and the Lady Mathematicians is obnoxious. That doesn’t mean it’s relevant. The people who actually run the Ivies and the United States are happy enough to toss some more feed into the vealpen on demand while those with the real wealth, power, and privilege either do their own whining about how marginalized they are or simply ignore the spectacle.

Our dean of humanities Dr. Summers plays both roles, getting rich and powerful and also splashing around in the mudpit of academic feuds. The litmus test of power, however, is simple. Whoever is getting rich is who matters. That’s the finbros and Tommy Tuberville before it’s anyone maxing out at $30k complaining about representation or free shit from the sponsors to fill out the team.

*****

The more or less reasonable assumption about the applicant pools and student bodies of prestigious universities—the Ivies, the Hidden Ivies, the flagship state schools—is they’re drawn from elite families, ones corresponding at least to the aristocracy or the medieval court clergy. This is intuitive, except it isn’t entirely the case. Harvard wouldn’t make its applicants grovel like peasants if it didn’t regard them as peasants. It esteems a few of them as true nobles; the remainder it regards as mere peasants with disposable assets.

Making these losers do a song and dance is entertainment for profit. It confirms the Good Schools as good schools, ones worth slashing throats and paying fortunes to attend. It reinforces the national and transnational class structures.

Once the higher strata of the peasantry matriculate, their mental health becomes important, because if it decides to go on sabbatical again the kids might do something to make their schools look bad, like drop out. The embarrassment of a high dropout rate comes with a significant loss of tuition and fee revenue, which also makes a school look bad.

There’s no fence bounding the prison. It’s still prison psychiatry.

To quote Zachary Karabell’s awfully unfortunate phrasing, what’s college for? It’s for itself. That’s the thing. It isn’t to prepare students for the professional world or cultivate in them the life of the mind or any of that shit. It’s an expensive crowdsourced matchmaking service, after a fashion, although Grove City is the only college to be honest about this pupose, and hence somewhat coherent. At other colleges the matchmaking role is mostly incidental; the same striving assholes might just as easily meet each other in prep school or grad school or even some yuppie bar in the big city, being yuppies.

The faculties do not govern themselves. Professors can be profoundly disturbed, but one thing they are not inclined to do is elevate the most parasitic flimflammers from among themselves to serve as their chiefs. The quality of administrator drops noticeably from department chair to college president. The central administrators are so much more expensive and so much worse. The principle is that it costs more to get more; quality of personnel demands quantity of funds.

Everything about this is happy horseshit. It’d be cheaper to elevate a sitting professor for a year or two instead of mounting national searches for the best of all candidates, and the candidates would be better. But that’s not the point. The point is to semi-randomly reward suckups for their sycophancy and corruption. Our college presidents couldn’t possibly be pulled from a grab bag of obnoxious, arrogant mediocrities for awards of salaries multiples of what any of the professors they govern earn and also free mansions. Surely they’re intellectuals of great distinction.

The true extent of academic self-government is the department. In some universities it may be an internal academic division, a “college” or “school” or whatever. /Most philosophical Jeffrey and the Jailbait Enjoyers salon voice/ Karabell, I don’t care what it’s for. What’s “college?” Yeah, okay, but wood does dat godda do wit pussy?

It has much to do, of course, just not in coherent or scrutable ways. HQ and the assholes who call their shots—the boards of trustees, the boosters, individual alumni who live to throw their money and weight around—tend not to interfere directly in departmental operations for a number of reasons, all of them better than nothing but none of them reputable. They want their precious schools to look good, and a reputation for sleazy bigshots intruding into departmental affairs is bad. They don’t want tenured faculty getting hostile, and if the vulgarians push the envelope the eggheads most assuredly will. These moneyball shysters are in it to make bank and move bank, not to get berated back off the academic quad by professors who are both avowedly and by consensus more educated, making a scene only to defend the ethical and intellectual high ground.

Besides, the departments have nothing of value to seize in the first place. They’re loss leaders for the big grift. It’s the vealpen again. No need to close the gate; just toss some feed in over the rail. They’ll gladly lie down and chew.

This is why the big cheeses keep the humanities departments around. This is why they don’t pare down the 100-level chemistry courses to excuse the morons who enroll for the distribution requirements and to have the TA’s turn on their Bunsen burners and do their math. They need to pretend that everybody who graduates is educated. Chad Kroeger is educated enough to admit he’s uneducated. That’s too educated.

Okay, he’s singing about high school. Is it the same notorious retard factory in Alberta that it is down here? It’s no pride of th’ American side, to judge from the bitter complaints of its being a volume-discounted version of college with marginally worse academic and occupational results. Nobody who comments on this shit has the intellectual curiosity to go after the deeper, real problems when it’s so easy to whine about low returns on investment. The rest of us get the discourse they deserve.

*****

If college’s intellectual mission is the formation of intellectually curious critical thinkers, a critical thinker would think college graduates would stand out for that, not for being insecure social climbers who get upset whenever somebody disses one of their cults at lunch. If the goal is to produce well-rounded physicians–hold up, because if that’s what we’re doing, we need to start by redesigning medical school.

It must feel too much like vo-tech to think about reclassifying medical training as a strictly professional course of study, such as the law still is in the crustier corners of Vermont. Medicine needs to be a profession of the Renaissance Man (and Woman!), not a grubby trade in which the barber-neurosurgeon is expected to know more about where and how to cut the brain than he does about the classics, butt enough about the Castro, or than she does about walking into her ex-boyfriend’s kitchen and yelling at him while he calls 911 from upstairs because she just woke him up from a nap. Understand, we cannot have the general public accusing The Doctors of exactly the obsessive narrow intelligence that’s drilled into them over the course of their medical training. This would decrease the public’s confidence in, as doctors do not call it but those who seek to marry doctors do, the medical field.

The popular understanding of this shit is all wrong. Everything I publish in these pages is the liberal arts. This right here is the real deal. You can say, well now, it’s nothing but gonzo shitposting, and fine. What I’m saying is still this: Whenever I barf forth another 2,500-12,500 words about Kwesi Millington or whatever the hell to polerize a friend, I’m objectively engaging in the liberal arts. There is no strict professional or technical purpose to this stuff.

There are strict professional and technical purposes to medical education. That’s why we’re all made to pretend that our doctors have to be Jonas Salk and also Marcus Aurelius. Look, I can hardly give my dentist a clear field of view when he starts talking to me about how much he loved “those trees with the pretty bark” (eucalyptus, I determined) on the first trip of his life to California because there was a clinical conference in, like, Altadena. I don’t need him to learn additional topics of conversation; that’s for his personal life, not my already full mouth.

Mind you, I’m just being too smart for school again. I’m not entirely joking, either. One of the purposes of the broad education of medical doctors, and Dr. Puliafito has indeed given a broad or two an education, is to encourage the public to think, patiently, as it were, of polymath brilliance as a proxy for the sharp clinical knowledge and acumen the same doctors may or may not possess.

What the fuck does that have to do with anything? I’m not over here telling Dennis Geyer where to cut, or what to cut, other than out the antics on the bridge, because young man I do not like the sound of that. Do we need or want our surgeons writing crap like that? No. We might wish for them to write post-op notes based on actual reviews of systems, but we can’t have a thing that nice, either. The professional standards are surprisingly mythical. Please insert my usual review of systems.

Medicine is a profession in which Dan Crenshaw’s eyes are equally reactive and dilated. The only way to face consequences for writing notes of that quality is to do so in a practice that maintains its own internal standards. The Mayo Clinic will probably shitcan anyone it catches doing that. The average hospital group? Lol wut, sure. Basically, you can do whatever until you get fired or sued, and if you get into either sort of trouble, you can find somewhere else to work. Drylabbing is okay as long as nobody gets maimed or killed, and the med-surg nurses are there to handle the med part.

My usual, please.

There might be less in the way of funds to slush if the normies start wondering what the fuck doctors know. Out in the streets a lot of Americans are bitter about medical mistakes and the incompetents who make them, but the main point is to overwhelm them by bamboozling nine-to-fives who vote. Dr. Oz is a doctor, you see.

Yeah, no shit. I’ll go to a different cardiac surgeon if I need one because he only practices part-time and the rest of them are somebody else. Does that mean he knows anything about probiotics or superfoods that can’t be learned from a list of ingredients? Does he know anything about exercise that any rando who gets out for a walk doesn’t also know? Of course not. He’s some freak on TV who eats an ounce of raw walnuts for lunch. He’ll be telling me what to eat just as soon as I’ll listen to some performatively folksy dipshit from the Farm Bureau tell me the parish hall coffee in his thermos is good enough for a breakfast at daybreak under the old oak out front of the barn when you’ve got twelve hours of silage to cut. Okay, then, you drink it, you twerp.

That’s the other thing: A whole lot of Heartland Leaders are teachers, not farmers. (I’m leaving the lawyers aside because they’re too numerous to be interesting.) Ben’s Ass—now goodness, can somebody teach me how to spell?—was a college president. Both of his parents were high school teachers. Lyndon Johnson and Chuck Grassley went to normal school. Denny taught in one.

Take that one to the mat. We all wrestle with these things, if we’re so unfortunate. The mere instructor goes to Minnesota for being homosexual; the true rancher goes there to BE homosexual.

The folksy wonders strutting around Washington and its many outposts around the world with their obnoxious method acting projects are eggheads. They’re thousands of times more likely than the average American to have Ivy League pedigrees. So much school, so little refinement. What the hell was the point of sending them? Brett Kavanaugh did not need to enroll to learn about beer.

Are we still to imagine college refines its alumni? Are we still to imagine it has a culturing effect? They matriculate as crass boors, and they graduate as crass boors. As Tom Lehrer might say, it’s a sewer like the rest of life, just costlier.

Rich people love having the merely affluent extrapolate and project their own fussy aesthetics and habits to the very top. They want the upper middle class to imagine that the overclass is not crawling with what Michael O. Church called uncultured barbarians. They want the PMC to continue to take Donald Trump for a poor man’s idea of a rich man, not simply a rich asshole. Between their sheer wealth and their forsaking of the noblesse oblige their ancestors learned the slightly hard way in the Depression, a rich person with coarse tastes today faces few obstacles to acting like Donald Trump. The press earnestly celebrates the vile antics of the rich. We love our celebrities, don’t we, folks. The authorities do little to temper their worst impulses. The matriarchs and patriarchs who were around for the lessons of the Depression in real time are too frail, feebleminded, or dead to meaningfully object. Who was that negro? Why, he was Kofi Annan, Mrs. Astor. Well, now, surely his parents were not foolish enough to name him Coffee.

The hardcore rich do whatever the fuck they please whenever the fuck they please. Sometimes they actually, sincerely try to be reputable and modest. We hear very little from or about these cases. The infamous hard workers among the rich work, or hold acting roles showcasing their own work ethics, almost exclusively to gather and hoard more wealth and power.

During the Great Compression they had to restrain themselves or be restrained. They had to negotiate with unions and submit to regulators. They love their current restoration to the powers of gods on earth. They have always consideed these powers their birthright. It smarted to have their worst wants denied for several decades on account of government intrusion into their affairs and the omnipresent threat of swift mob violence for overreach. They’re gratified to again be given tacit blessings to set quotas in ways forcing their employees to wear adult diapers. They approve of the prerogative Donald Trump used on television to ritually humiliate “apprentices” by breathing the words of ruin upon them like Zeus. They consider this a good model for the economy and for their own lives.

Yes, this includes #resist #WithHer #NeverTrump scolds. As always, it’s about substance, not style.

*****

As we mentioned above, medicine is a grubby, tiring way to try to make a fortune, and one requiring high intelligence. Some families are practically medical castes of their own. There are, for example, many Drs. Gupta. Judy Dench once got the sads on As Time Goes By and had to see a Mr. Percival, a Norman French cunt. To judge from the compensation packages, American doctors push their children High French and Original Brahmin children into medicine for the money. Prestige is the other obvious factor.

To be quite blunt, medical doctors and their class peers do not have a 70% or 90% lock or however much of it is they hog on young adult children capable of completing medical training and serving capably as doctors. Come on. Too many of their kids are too dull or soft or, inflammatory though it is to admit this away from the academic vealpen, traumatized to get through medical school and a residency the way these programs are run.

In the USA today (lol), these rounds of hazing are all too clearly a series of forced marches into a crooked, cruel system that doesn’t work. On an alarming number of floors, it’s acceptable for doctoring to fall somewhere between an acting gig and cosplay. The Village People were not in fact a cop and a logger and whatever. A medical license is worth its printstock as evidence of fitness for a physician who drops acid to make rounds “fun” or a surgeon who scrubs in too drunk to maintain normal gross motor function when he gropes his scrubs nurse with a breast pocket full of sharps.

It’s hard to imagine the quality of available medical staff not plummeting as word gets out about incidents of that nature. It’s more than a few assholes; it’s all the enablers among their colleagues turning a blind eye to flagrant unfitness for duty that could get patients killed, plus the openly homicidal executives and shareholders, plus the ethical impunity for consorting with cheerleader bimbos hawking the latest patent medicines on the junket circuit.

The prevailing ethics and standards of care in American medicine today are, if anything, higher than they should be given how notoriously riddled it is with profiteers, quacks, drylabbers, and other trash who have no business anywhere near it. It’s a powerful strange attractor for bad actors that is incidentally also a powerful strange attractor for good actors.

Where’s the tipping point? I think we’re right around it, but I couldn’t say for sure which side. Ask Malcolm Gladwell. Are Nickelback the dumbest Canadians? They sing popular songs about life, death, relationships found and lost and maybe found again, the sociology of small towns, luck good and bad, high school, sex in the shower, and the criminal justice system. Gladwell is famous for writing about how if you play a lot of hockey, there’s a good chance you’ll get good at hockey.

By God my stories about how if you spend 1,000 hours learning about horses at a government sleepaway school you’ll have no idea how to calm down a Pollack are better than that.

*****

The answers are so straightforward and yet so daunting. Train more doctors instead of whatever the hell we’re doing to miseducate our smart people instead. Nationalize the big pharmacorps, which profiteer on government research all the time as it is. Investigate the shit out of anyone trying to trade dinners and swag and a little something-something under my blouse for prescription sales, on both sides of the agreement; that setup is a way for our already quite well-compensated physicians and surgeons to charge their hookers to company expense accounts. Break up the for-profit hospital groups. Yank their nonprofit status on grounds of fraud. Establish more and better government clinics.

Medicare for All or Medicaid for All or Tricare for All would be a good adjunct.

Or an army of bright-eyed, bushy-tailed idealists could try to join it and reform it from the inside. It’s admirable, until it turns into a sellout fiasco like Teach for America or the law for most anybody. It’s the usual shit about systems and their inertia and peer pressure from colleagues and the kids’ classmates and all the rest of it. It’s a fucking mess, rather like the mainstream culture of this decadent, decrepit land.

Besides, you won’t need to call Toni Morrison to babysit your toddler while you become a neurosurgeon. There aren’t any openings. Help is not wanted.

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