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    Monday, July 19, 2004

    Pulse of the People: I usually try to avoid talking politics in my practice, but once in a while it creeps into the exam room conversation. My practice is a diverse one, and the mood of my patients has never failed to mirror the mood of the nation. In the 2000 election, it was clear that people were ambivalent about the two candidates. One was as good as (or as bad as) the other, so it was no surprise that the election was as close as it was. So far, this year looks like it might be a close one, too. (Looks like Kerry thinks so, too.)

    Some of the comments I've been hearing these past few weeks do not bode well for the Republicans. A normally very pleasant, mild-mannered elderly patient apologized for missing her appointment the week before because her return from vacation was delayed by an airline cancellation. She blamed Bush. Air Force One had landed and delayed things at the airport. "I hate that guy," she said. (She also thinks we should be spending tax dollars on drugs for the elderly, not arms for the army.) Another patient, during a mental status exam, answered the question "Who is the President of the United States?" with "That's one I'll never forget. George W. Bush, that idiot who got us into this mess in Iraq."

    I've also been hearing bizarre comments that make me think this will be a particularly nasty election. One patient just recently began collecting social security and was complaining about the meagerness of her payments. She told me it was Bush's fault. Someone from the social security office told her (or at least she understood them to say) that the Administration had changed the rules so that her payments were lower than what they would have been four years ago. As far as I can tell, that's patently false. Social security payments are based on your highest yearly earnings rate. Another patient told me she could no longer get her medications from a discount distributor in Florida because "Bush put a stop to it." She's always paid for her own medications, so she didn't lose an employer-funded drug benefit to the new Medicare drug discount program, so I'm not sure what she's talking about, but she said that someone from the discount pharmacy told her it was the Republicans who were behind the change. She's also paying less at the local pharamcy than she was through the mail order firm, but she's still mad as heck that she had to change.

    When I heard the social security story I thought there must be some partisan hack at the social services office spreading disinformation. But after hearing the pharmacy story I've got to think it's something worse and more widespread - a willingness to believe the worst about Bush, no matter how cock-eyed the story. That shouldn't be surprising, I suppose, given the type of media coverage he gets. They're all too willing to believe the worst, too. It's the Michael Mooring of America.

    And yet, there are also indications that people aren't that happy with the Kerry/Edwards duo, either. When I examine people's eyes, I shine the light of my ophthalmoscope on whatever magazine happens to be in the front of the wall rack and tell them to focus on the celebrity on the cover. This week, in one exam room, it's been Kerry and Edwards on the cover of Time. I say "Focus on that million dollar smile," and invariably the response is a deep disapproving grunt, often accompanied by comments like, "ambulance chaser," or "it's a crime those lawyers can make that much money." (Somehow, it's Edwards they always focus on, not Kerry. Maybe his smile looks more like a million.) And then there's my own mother, a devout Democrat who's never voted for a Republican in her life but who says she doesn't think she can vote for Kerry/Edwards. It's the tort reform thing. She sees it as a threat to the future of her beloved grandchildren.

    It's certainly not as valid or significant as a political poll, but that's the Medpundit office prediction for election 2004 - an extremely close race, a nasty campaign (which it already was even before the primaries ended), and a slight advantage to Kerry.

    UPDATE: A reader who works with Social Security responds:

    There've been no substantive changes in Social Security benefit computation in quite a while. I ought to know, since that's where I work. The current basic formula was adopted in the Carter administration, in fact, with changes in the Clinton administration. It's amusing that the only presidents who can reduce Social Security payments are Democrats. In essence, a worker's benefit is based average earnings, the earnings being indexed for inflation. There's a complicated formula that is based on changes to the consumer price index, but nothing that an adminstration can change from year to year. The big Clinton change was to raise the age of "full retirement" slowly. This means that anyone who starts getting benefits before "full retirement" gets slightly less. Medicare policy is set in Health and Human Services, but I don't think they've done anything dramatic. I suppose there might have been some regulatory changes due to implementing the Medicare prescription benefit, but I wouldn't know.

    posted by Sydney on 7/19/2004 11:00:00 AM 0 comments


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