Substance: Obama names Regina Benjamin, MD, MBA, to Surgeon General Post

President Barack Obama with Surgeon General Nominee Dr. Regina Benjamin in the Rose Garden of the White House July 13, 2009 Official White House Photo by Lawrence Jackson

In a week that has us considering personal experience as it relates to job performance as regards a seat on the Nation’s Highest Bench, I’ve found myself considering the well worn aphorism of Oliver Wendell Holmes: “The life of the law has not been logic: it has been experience….The law embodies the story of a nation’s development through many centuries, and it cannot be dealt with as if it contained only the axioms and corollaries of a book of mathematics.”

And it has occurred to me that perhaps Holmes’ rubric lends something to a consideration of health care reform and President Obama’s pick for Surgeon General, Regina Benjamin, MD, MBA.

Although much in healthcare (and healthcare reform) can be (and perhaps must be) the complex and dismal mathematics of zero sum, gored oxen and have and have not—as Holmes reminds us: the math is not all. Yesterday, in a post by Professor Kathleen M. Boozang, we looked at health reform through the lens of Catholic social doctrine: a proposition leading to the conclusion that

We must pursue a system in which each of us has access to health care, which necessarily requires that, in solidarity for our fellow being, those of greater fortune accept the responsibility for those who do not, giving the gift of an opportunity for the basic good of health.

In a recent post considering Atul Gawande’s article on McAllen, Texas, which lamented Medicine performed as a sheer business proposition (McAllen is “one of the most expensive health-care markets in the country” and suffers from what Gawande sees as an all too prevalent, treat the patient as though they were an ATM mentality), we came face to face with Immanuel Kant’s Categorical Imperative:  “Act in such a way that you treat humanity, whether in your own person or in the person of any other, always at the same time as an end and never merely as a means to an end.”

We noted then that we found it “passing strange to find ourselves, in the midst of such daunting medical, technical, and financial data contained within the  proposed solutions and counter-solutions to arrive at this–a simple (but difficult) age old moral truth.”

And that it had “struck me while reading that what Gawande finds is essentially a medical culture functioning, and incentivized, contrary to Kant’s categorical imperative (see above): the simple moral admonition that one must not merely “use” others.”

And then there’s Dr. Benjamin.

Bayou La Batre, Photo by Dystopos via Flickr

She is the founder and CEO of the Bayou La Batre Rural Health Clinic in Bayou La Batre, Alabama (if the name of the town sounds vaguely familiar, think Forrest Gump, shrimping boat). Emily P. Walker, Washington Correspondent, MedPage Today reports:

A major supplier of charity care, Dr. Benjamin has provided medical care to patients in the Gulf Coast regardless of insurance status.

“I decided I would treat patients regardless of their ability to pay,” she said when she accepted the president’s nomination in the Rose Garden on Monday. “It should not be this hard for doctors and other providers to provide care for their patients.”

Dr. Benjamin’s practice was destroyed several times by hurricanes, and once by a fire, but she always rebuilt, sometimes by refinancing her home and maxing out her personal credit cards, President Obama said Monday.” (emphasis added).

She is also said to have “had to moonlight in an emergency department and nursing homes to keep her practice open.”

It is notable that while Congress argues over where the money will come from to fund health care reform, when faced with the need to rebuild the clinic she herself had started– which offers care regardless of ability to pay–Dr. Benjamin, despite the MBA which follows her name, maxed out her credit cards, mortgaged her house and took a part-time job.

Extraordinary and beyond the call. Perhaps beyond Kant, and certainly beyond the math. According to the NY Times, “Dr. Benjamin is a devout Roman Catholic.”

By no means am I advocating this degree of personal risk and sacrifice as a paradigm for health care reform. It is much too much to ask or expect–as it seems Dr. Benjamin herself well understands: “It should not be this hard for doctors and other providers to provide care for their patients.” Agreed.

As noted in the post,  “Why McAllen Texas Kant be the Answer to Health Reform,”

Pragmatically, as one looks upon the current system of health care and health care finance,  it is well worth quoting Harold Luft from today’s Washington Times: “A redesigned system must create new incentives for those entities so their self-interested behavior leads to a better societal outcome.” Gawande offers examples of systems which provide an infrastructure conducive to Mr. Kant’s imperative.

Dr. Benjamin offers an example of personal commitment despite extraordinary disincentives. The Huffington Post reports

She said she would combat preventable diseases. Her father died with diabetes and high blood pressure, her only brother of HIV. Her mother died of lung cancer because as a girl “she wanted to smoke just like her twin brother,” an uncle now on oxygen.

“I cannot change my family’s past. I can be a voice in the movement to improve our nation’s health care and our nation’s health,” Benjamin said. “I want to be sure that no one falls through the cracks as we improve our health care system.”

Sounds like the voice of experience.