Supporting Reparations

 Reddit Post I wrote with links and don't want to lose.

1. It's not about being 'Black' it's about being a descendent of someone who was held in chattel slavery. There are any number of descendent groups who do this work. Since the people doing the deciding will be Black people, I suspect Rachel Dolezal is SOL. Although apparently Kerry Lake may be invited to the barbeque. It is so hard for non-Black people to understand, its not your business. One of the reasons I recommended that the Swiss or some such manage the Trust is that non-Black USians cannot stop themselves from telling Black people what they ought to do. Black people survived us, and many still thrived despite our destructiveness.

2. If you have read about the recent dis-enrollments in US Native tribes you will understand why I say no disenrollments. I'm thinking 100-200 years from now, not next month.

3. The 14 trillion would come from a one time progressive wealth tax on the 1000 richest USians (number made up, need more data). Making the heirs of Sam Walton, Jeff Bezos, the Koch brothers, Bill Gates, and Rupert Murdoch cough up the cash would give me great joy.

4. College Admissions are corrupt is so many different ways, legacies, elite sports...I've often said the difference between Democrats and Republicans is that Democrats think poor people should be able to steal a little, too. There are fewer Black men in medical school in the US today than there were in 1970. And every person mentioned in this article is Nigerian and a Recent African Immigrant (RAI).

5. 'nothing to do with slavery' go read Color of Law. It didn't end in 1865. I recommend reading it a chapter at a time and doing something else in between. It's a lot.

6. I don't know if reparations works. I suspect that getting us as a country to the place where we think it should happen would be just as much of the benefit as the $$$ to descendents.

Lastly - did you know that the French demanded that the newly independent country of Haiti pay them the modern day equivalent of $560 MILLION for reparations for FREEING THEMSELVES! Yes I totally want France to set up a fund for Haitians under the same model as I have proposed for the US trust.

Our country paid DC slaveholders $300 for forcibly freeing their slaves. The freedmen got...nothing.

It's just an idea, really

0-30,000	0%
30-60000	10%
60001-90000	25%
90001-120000	33%
120001-183000	50%
183001 +	33%

No deductions, none.  I'm not attached to the brackets, I just kind of threw it together, but given that I paid a higher effective rate than Mitt Romney the year he ran for president, I would like to see it be fairer.

Email to Senator Heller, copied to Murkowski and Collins

Sir, having watched your statement on the current proposition I wanted to reach out.  I  live in Virginia, but spent most of my life in Maine.  I voted for a number of Republicans in the past, I voted for Senator Collins in 1996 and again in 2002.

The current republican party seems to be in service to the rich, the Russians and the racists.  To value smaller government does require this.  I have probably become a Roosevelt Democrat and will rarely again vote Republican, but there should be a dynamic tension between those who wish to expand government services and oversight and those who wish to constrain it.

I'm a supervising physician in a public health clinic and I tell the clinicians and the accountants, that if either group gets everything they want, we're doing something wrong.  I feel the same way about government.

If you believe that the goal of government is to serve the people, would you consider reaching out to Collins, Murkowski and a few of the others who seem like reasonable folks and forming a new party?  Caucus with the Republicans, but give yourselves a chance to set a new platform?

Fixing American healthcare requires regulation and price setting, I don't think single payer would suit us as a country, but I suspect that will be where we go if the Senate passes this bill.  After 10-20 years of misery for a lot of folks.  All payer rate setting (including pharma), a public option in rural areas and nation wide medicaid expansion would preserve the majority of the current system intact and probably cost less.  A few very rich people would make a bit less, but everyone would have more.

Respectfully,
W.W. Weaves, MD

Pro-choice and Pro-life

I describe myself as both pro-choice and pro-life. 

Sometimes I have described myself as anti-legislation, but that doesn‘t encompass the fullness of my position.  I am also anti-demonstrations out side of clinics, anti-shaming of women for the choices they make, anti-ignorance, anti-abstinence only education, and anti-forced birth.  I'm also very pro contraception.

Edward Snowden

This is not intended to be in anyway comprehensive, just quick thoughts:

1. As an American I would like to get Snowden out of Russia.  Both for his sake and ours.
2. I think he needs to do some jail time.  Not hardcore, but some.  
3. For absolutely no logical reason I've decide 3 years, low security is about right.
4. I wish he and Obama had worked out a deal before the election.  I'd rather have him back.

Always Relevant

https://imgs.xkcd.com/comics/free_speech.png

Work hours for Interns

There's a lot of uproar about the fact that the maximum shift for first year residents (interns) has been extended to 24 hours again.  I was an intern twice (don't ask) and worked first under no restrictions and then under the 80 hour work week.  I had a variety of chief residents who fiddled the schedule in various ways.

I did a number of 36 hour shifts, they suck.  Unless you are one of those people who is wired that way, they are complete misery.  I found out later that a lot of my fellow residents used adderall to get through.

Twenty-four hours, when you were done at morning sign out, was not that bad.  You had a whole day, often during the workweek, to use as you wanted.  I tended to spend the morning in the hospital finishing up paperwork, left at noon as directed and went home, did laundry and went to bed at 7 or 8  pm and slept through to the next morning.  If the night had been horrible, I would go straight home, shower, put on my jammies, sleep if I could and work on catching up medical records via a Virtual Private network in to the hospital computer system.  (I LOVED that, from my standpoint it was the best invention ever.)

What I hated was having call, and then being assigned the next morning do cover something, a surgery or the floor on patients I didn't know.  It is one thing to be dog tired and delivering a baby after getting to know the woman all night, another to have to hang around for a stranger because there's no one else.  It was being allowed to stay for something you wanted to do, versus being forced.

Hand-offs are their own kind of danger.  Hand-offs create more problems at the lower (less experienced) levels.  There was a study on this in JAMA, I'm not going to go find it.  I read it during my semi-annual CME binge.  For senior residents, sleep may be more important than familiarity.  For juniors, this may not be true.  As someone who does only office work now, my middle of the night phone calls are non-existent.  But for a few years I worked in a general clinic where I took the middle of the night calls from my patients.  These were relatively few, and always on point.  Because I knew the patients well I could triage between "go to the ER" and "Be at the office at 8am," pretty easily.

I found a certain amount of value in the learning I did when bone tired.  I learned that I prefer to do my thinking ahead of time and I develop routines and workflows that keep me from missing things.  This still serves me well, even as I get a full night sleep every night.

I think there is a possibility that period 24 hour shifts are NOT the problem.  That the problem is frequency of them, and the casual disregard of people's health the rest of the time.  I really enjoyed a Q6 call schedule, and still kind of miss it.