As a video talk show host, I talk directly and indirectly to hundreds of people every week. Right-wingers troll me ad nauseam. Recently, something strange has begun; I find conservatives trolling my trolls in my defense as I continue to expound our progressive mantra. Many are open for a dialogue.

It is clear to me from my experience in my own community, people who stumble onto my radio show Politics Done Right and from a recently attended Bridge Alliance Conference that the fever is breaking. People yearning for dialogue need a path to spaces.

This needs rethinking

I think one of the biggest mistakes as a society we are making, irrespective of ideologies, is allowing the plutocracy to use these differences to maintain and increase their power. As we are fight one another we essentially give a pass to those who are inflicting the damage. Progressives and conservatives have a manufactured fear of each other. It is irrational and it is by design. Were you to watch Fox News, you would fear progressives as well.

This week a caller to Politics Done Right made several points. She first made it clear she was on the right. But then she explained that she came to the realization that it was less about the parties and more about class. More importantly, she realized that "others" are instigating. If we are fighting each other we cannot fight those truly responsible for our ills.

I remember discussing with a very attentive white conservative woman what a healthcare system could look like if it were humane. I bring race up because in my area there are false preconceived notions that I initially had to break through before she became a very deep listener.

The thing is, I never used the word Medicare for All, I just defined the process and fair method to pay for it. She was loving it so much she began adding to the narrative. I started to feel a bit guilty. I knew this woman was very conservative who likely thought that because I was in that Starbucks I was likely a conservative.

I finally told her I was very progressive at the very left of the spectrum. She turned red, looked me straight in the eye and said, "But you are so nice." Suffice it to say our conversation continued and I encouraged her to have lunch with "Liberal Ladies Who Lunch."

Democrats are going to continue to win the conversation wars in 2020. The right are losing sensible people. I believe Republican polls to simply be a tribal abstraction. That said, Democrats need to add empathetic engagement with the right. I am not talking about asking them to be either progressive or a Democrat. I am talking about creating the narrative that you are tolerant of their Republicanism and conservatism. Speak our values in their language.

Many consider engaging the other side is either a fool's errand or undeserved engagement. This isn't about being nice. It is about being necessary. We need more than fifty plus one for transformational change.

It is important for everyone to understand what is happening in this blogger's opinion. Many of us love to love our politicians. Hell, many of us love that Obama blew the door open and showed how a president must behave.

That said, after his recent statement Obama proved that he is not immune to Wall Street, the corporatocracy, the plutocracy, or the oligarchy. In fact, the plutocracy understands that our society could be at a flex point for a huge progressive takeover. This puts their continued pilfering at risk and they will employ all their puppets to temper wins by using fear and/or force.

The uncertainty supply-side economics is palpable. A credible and personal connection between progressives and conservatives is required. Engagement, not disengagement, is the answer to curing political maladies.

I walked into the hospital for my 7-7 overnight shift through the ER, as was my practice. Always good to know what little surprises they have in store for you. My pediatric colleague, whom I was about to relieve, looked upset. She gave me the thumbnail: " Four month old had been there almost three hours, came in looking toxic. Work-up done; blood, urine, spinal fluid all in the lab, fluid bolus on board.The pharmacy would not mix and send the antibiotics, stating the ER's computerized ordering system was not communicating with theirs."

This seemed a simple enough problem to me. " Haven't you just called the pharmacy and asked for the antibiotic?"

 "Yes, but remember this week, the electronic ordering system is in full operation. Administration has told us that only electronic orders are acceptable."

 Ah, yes, our good friend the EHR. Several years before our hospital had converted to electronic notes. As a hospitalist, it wasn't that bad, except on busy nights, because I didn't have that many patients. I sat with each family, looked them in the eye, jotted down a few notes during the history, examined the patient, then entered my note into the system. And the system was decent. Of course for physicians in practice it was harder: seeing 40+ patients daily, face to face patient encounters would morph into Doctor face to computer screen encounters, with a stylus madly checking off boxes so as to not get caught behind. (Where did the patient go?)

 Then came endless meeting after endless meeting of our hospital's enforced transition to electronic doctors orders. They showed us screen snapshots of how the system looked. It looked awful. Every time I asked the question 'why', I was met with an eye roll and told to just accept this wave of the future. The IT people had to train each physician (it didn't cost us a dime for this fabulous educational activity, but our IT friends were no doubt well paid for their expert time).

We entered a months-long period of trial for the ordering system. Took us three times as long to 'write' orders, and with each set of orders came a dozen pager beeps of questions from the nurses, the pharmacy, the respiratory therapists. In the days following each set of orders came the beeps from IT telling us all the little things we did wrong. 

Worst of all.... the mistakes. Not possible, you say, computers don't make mistakes. A patient got Clonidine instead of Klonopin . A mere autocorrect, but not nearly as funny as when my personal yoga parties get turned into toga parties by Evite's system. Entire therapies weren't administered, because in my haste to run to the delivery room for resuscitation, I neglected to click on the correct drop down menu for pulmonary toilet (can we correct that ridiculous term, anyway?) I saw so many more mistakes under our new system than I have ever seen in medicine. It became a joke whenever I raised my hand at departmental meetings, because I was nearly the only one complaining and did so vociferously. We were told many nuances of our very UN-intrinsic system were beyond repair because they were part of the system the hospital purchased. (How come no one ever talks about the billions made by software companies when EHRs became a mandate? That must've been one doozy of a quid pro quo!)

Okay, so the really worst thing was the complacency of my fellow physicians. When did we become such puppets for our masters and the administrators? I understand that hospitals and doctors need administration, but we surely do not need as much as we've got. Who cared if it bankrupted the system?

But I digress.... Let's get back to what really matters: the patient. The moment I heard about a toxic four month old who had waited nearly three hours without crucial antibiotics, I snapped. I was fortified by the months of EHR snafus I had already experienced. I walked to the nearest phone and dialed the pharmacy, asking for the most senior pharmacist. "This is Dr. Mass. Is there any reason that patient x has waited so long for their meds?" .........(party line reply delivered)...." I see. Here is what you are going to do. You are going to mix up the antibiotics and have them delivered to the ER in ten minutes. If you don't I will have the supervising nurse call the hospital CEO and tell him that I am going in to the patient's room to tell the parents that their child is in danger because of hospital policy. I will not have some (un-publishable word deleted) bureaucrat dictate my patient’s care. What? ...Oh, thank you, we will await the antibiotics." Coming clean to let you know how fun and liberating that moment was, as the ER staff stared at me in shock. 

I don't wonder why more physicians don't complain; it takes time. Physicians all need Continuing Medical Education, which takes time. Now add in MOC, state mandated background checks, fights with insurance companies to get patient tests approved, hospital reappointment applications, hospital meeting requirements, blah, blah, blah.... No wonder the patients complain we don't take enough time with them. We have none! Approximately two thirds of physicians are hospital employed, and to buck the system could cost them their jobs. Jobs necessary to pay off their six figure loans, which they will do just in time to pay full price for their kids' five figure college tuition. And if you aren't hospital employed, you are bogged down working long hours keeping your indie practice alive for the sake of the patients you love.

Oh, yes, back to the patient. Isn't that why we all took the Hippocratic Oath? Being a Classics scholar, I consider it truly sacred. The patient comes before all else, even administrators and insurance company execs. But we have created an unsustainably bloated system that the patients can't understand, and the docs have no time and no power to fix. Shame on us physicians for letting it get so bad. The only scenario in which physicians will regain power is the zombie apocalypse, The 'suits' will no longer be useful when the zombies arrive, as they will be unable to deliver babies, remove appendixes, etc. 

And shame on all physicians who remain complacent and allow our current healthcare death spiral. You who sit back and don't inform your patients of what is really happening are creating a bleak future for our country. For God's sake, find your voice, unleash the power of your training, and speak up for your patients and your children, before it is too late. I know it takes time you do not have. But hit fast forward and ask your future self, amidst the rubble of health care's future if you did the right thing to remain silent. We owe thanks to the brave ones who fight. Sympathy for those physicians who are ill, post partum, fighting a lawsuit, or caring for your aging parents… I know you have little extra time.

There is a beautiful passage in Shakespeare's Henry V. Henry's speech before the battle of Agincourt…. "and we few, we band of brothers...gentlemen in England now a-bed shall.... hold their manhoods cheap while any speaks that fought with us upon St Crispin's Day". Naturally it should be updated for the women! 

Our four-month-old patient did well. Blood culture was negative, but what if the patient was frankly septic, and continued to lack antibiotics? Would you want that to be your child? Your grandchild? So the question remains: ‘When will more doctors stand up for their patients and themselves?’

This year, America turns 245-years old. Despite recent proclamations made to MAGA, America was never that great in the first place.

Growing up in Smalltown, USA in the 1960s can leave an indelible mark on a life. One of my earliest memory of my Mother was in 1960 as I accompanied her to the town’s Fire Department as she cast her vote for John F. Kennedy.

Also at the firehouse were World War 1 veterans, The same whitehaired men who were normally seen at the towns July 4th parade down the village’s main, and only, street.

World War 1 was ancient history to me as Mom pointed out these men had been to Europe and fought for American Democracy — and to deliver Democracy to the rest of the planet. It was either the tone of her voice, or the distant stares of the old men, as they rode in the back seat of open convertibles provided by Criser’s Chevrolet dealership, which told me this was a solemn occasion.

Everyone has their priorities, and mine centered more around getting home to feed my dog and restoring the Alamo. It was an imagined fort I had built among the apple trees, but anything was more important than hanging out at the fire house watching old people do their part to protect democracy at the ballot box.

What is the Limit to My Freedom? — Your Nose

Every person has the right and freedom of thought, belief, possessing a political opinion, the choice to fulfill or not to fulfill the demands of his chosen religion, political party or social group.

However, idiosyncratic freedom cannot be taken to be absolute in a democratic and civilized country. People have forgotten that my freedoms stop where your nose starts.

The Jokes Were Funny, Until the Humor Stopped

What if journalists wrote about American politics the same way they write about other nations? Twitter users laughed about the embattled president of a onetime British colony, huddling in his castle as he refused to concede the election. All of that laughter ended January 6th when a mob encroached upon Congress and caused the lawmakers to flee to safety.

The images coming out of D.C. that cold January day reminded many of Boris Yeltsin on top of a tank, the Arab Spring and even the turmoil in Venezuela.

For those around the world watching us, America had become the very thing American leaders decried: a weak democracy unable to prevent a criminal rabble from staining what has always – until this last President – a peaceful transition of power.

Viewing a literal coup attempt aimed squarely at stopping the certification of a democratic election rational people began to wonder, for the very first time, if America could still champion democracy abroad and engage in power competition with other nations.

America Wobbles

The violence of January 6th has affected both the nation’s image and standing. The events of the November’s election and its aftermath raised concerns abroad that U.S. elections may not even be free and fair.

Other countries have been sensitized. Other countries are seeing America as a risk factor in the international system of diplomacy. Other governments are wary of binding commitments or cooperation with America and countries; Europe and Asia are convinced that U.S. promises and commitments are not worth the paper they are written on.

Doubt this? Think of the Iran nuclear deal. The Trans-Pacific Partnership. The Paris climate accord. These all fell victims of a shift to our seesaw foreign policy.

There is something to this fear. America’s actions in the Middle East have helped to destabilize that territory and contributed to Europe’s refugee crisis. U.S. sanctions have been costly and unpopular abroad and the former administration’s brinkmanship — with Iran, North Korea and China — have hardly been” stabilizing.”

 A country which retains a massively powerful military and whose domestic politics have become suspect is something other nations cannot take lightly.

The Takeaway

From 2006-2010 as I walked across America one and twice rode a bicycle coast-to-coast, it is safe to say that I saw America up close and personal. 

Passing through Gainesville GA one Veteran’s Day, the local chapter of Veterans for Peace honored me (I am a U.S. Navy vet) by asking me to serve as the parade’s grand Marshal. 

Suddenly, I found myself to be one of the old, white-haired men waving from the back seat of a Chevrolet as we rode down Main Street. I waved at all the little kids lining the route, as they watched and returned my wave.

They stood in awe of ‘real’ Vietnam Veterans who had fought in a war which was as ancient to them as WW1 had been to me. 

If we don’t rethink – and renew – America’s democracy, will people even want to show up at future parades? We have a democracy to fight for right here at home. If we win it I will be happy to march in it.