Health Care Health Care Reform Reflection

We get what we tolerate…

Richard Fries, a cycling-safety advocate in Boston, uses the phrase we get what we tolerate to describe the dire situation of drivers killing cyclists and pedestrians. Many humans die from these collisions because we tolerate it. An inattentive driver kills a person on a bike; then nothing changes.

The phrase applies well to other dubious policies in the US. Before a gunman slaughtered 60 innocent people with a machine gun in Las Vegas Sunday night, I had planned to use the we get what we tolerate phrase in health care policy.

I was going to argue that US citizens pay too much for medication, navigate a morass of bureaucracy to get to their doctor, and succumb to capricious insurance companies for important medical decisions because we tolerate it. We get an unjust healthcare system because it’s what we tolerate.

Then came another gun massacre.

We also tolerate gun violence. Every damn time a mass slaughter occurs, the “thoughts and prayers” go out, and nothing changes. The comparative graphs of US gun violence to any other country boggle the mind.

During a fishing trip in Alaska this summer, the boat captain told me nearly every Alaskan has a gun. Guns, he said, are necessary if you live in the wilderness. I then asked if they have gun violence in Alaska. “Almost none,” he said.

The thing is: most of the US is not an Alaskan wilderness. Bears do not wander into most of our cities and suburbs. The lack of gun violence in Alaska, therefore, does not argue for arming teachers in suburban schools.

I don’t fancy guns, but I understand some people do. That is fine.

But, similar to the healthcare debate, it seems we could start a civil discourse with new set points. For instance, let’s agree on the notion that citizens need not own assault weapons, which are essentially war machines. Could we at least discuss how to register and regulate gun purchases?

I suspect a majority of citizens–even most gun owners–would favor a ban on assault weapons and some degree of gun registration.

Consider the we get what we tolerate phrase in relation to other public safety issues:

If plane crashes killed a fraction of those killed in gun massacres, there would be an outcry for aviation safety.

When infections threaten the population, people clamor for preventive therapies.

Society gets aviation safety and protection against microbes because we don’t tolerate unsafe planes and the spread of dangerous infections.

When we decide not to tolerate gun violence, dangerous drivers, and an unjust ineffective healthcare system, things might change.


12 replies on “We get what we tolerate…”

Hear, hear! Truer words have never been spoken. Grassroots advocacy has never been more urgent than it is now.

A reasoned discussion would be welcomed. I am always concerned, however, by people who push for solutions before we know what the problem is. In this case (from what I have read), there may be legitimate questions about whether “butt stocks” were used to make some of the guns automatic, and I wonder if there is some screening for people who buy over 40 weapons, if for no other reason than to see if they are dealing the weapons on the side. And yes, the high capacity magazines seem to be an issue here. I would like to see the investigation done, however, before rushing a bill through Congress to see if the bill would actually fix the problem. I doubt you Rx medicine until you know what ails the patient. I do enjoy your posts–as one biker and afibber to another!

Looking in from outside the US, the root cause of the logjam appears to be extreme political polarization.

I assume that the majority of republicans (again, from the outside, it seems that there is a strong correlation of being a republican to not wanting any real gun control) don’t really think its a good idea to have citizens owning their own arsenal of assault weapons.

At the same time, I imagine most democrats are OK with farmers having guns to shoot pests, or law abiding citizens having guns to practice target shooting at a range.

The problem seems to be that any movement in a more sensible direction is bitterly opposed, not because its a a bad idea, but because its seen as something that mighty lead on to something that is a bad idea (i.e. total removal of guns).

This “thin end of the wedge” thinking seems weird to the rest of us. But I guess when things are so utterly polarised as they appear to be in the US right now, maybe it makes sense – we can’t take even baby steps in a sensible direction because that might the thin end of the wedge that leads everything to collapse.

What’s the answer? Maybe its more courtesy, the ability to discuss these challenges without instantly assuming that the person on the other side is an idiot/fascist/evildoer.

Several comments from someone living in a ‘relatively’ gun-free country, with good socialised healthcare and some great cycling options (e.g. NZ Rail trail).
American healthcare is a broken embarrassment. Driven by a largely private-profit based scheme there is no fix. Yes, our healthcare system is paid for by taxes and is essentially a public model but there is a pretty good level of care offered e.g. My son’s septic arthritis with 2 x MRIs and G.Anaes cost nothing to our family. The US is the outlier vs other developed countries.
Congress vetoed funding for the NHI to investigate gun-related deaths quite some time ago and I understand there has been lobbying against this position. To fix a proble you first have to understand it. And this won’t happen in the current climate. Ezra Klein has a good overview (FB) on gun ownership/deaths in the USA (worth a look).
If riding is problematic, trying rowing. The concept 2 rower provides the same misery that time trials and hills reps do!

I look at your health system and I look at your gun violence and I just thank my good fortune to be an Australian. I wish that US public opinion will eventually change enough so that you can experience living in a safer, fairer and healthier society than you currently do. I have no clue how that change will happen. In Australia we had great leadership at a crucial time that made the changes to gun control and some years before that, the health system. The vast majority of Australians, and both major parties, still support our gun laws and our imperfect health system (which has universal coverage, is much cheaper and provides better outcomes than your system). Good luck with your endeavours.

I couldn’t agree more. As a retired healthcare administrator I’ve seen the problems with our healthcare system firsthand. Our system is seriously broken. We need more functional medicine practitioners and holistic dentists, and a way for insurance to cover these provider’s services.

By far, the two big killers in this country are tobacco and uncontrolled chronic hypertension, the later most of which can be controlled with cheap, generic drugs. Of course, I feel for those who are gunshot victims, auto accident victims, but I don’t see much action with nationwide legislation.

Instead focus on implementing WHO’s MPOWER program in Kentucky which has among the highest rate of adult smokers in the country at 29% and one of the lowest cigarette taxes at 60 cents. Nationwide tobacco use is about half the Kentucky rate of about 15%. In NYC, the tax is $5.85 ($4.35 in NYS) with a minimum pack cost of $13 and minimum purchase age of 21. Raising the tobacco tax contributes more than half the effect of getting people to quit or to never start.

Another huge killer nationwide is uncontrolled chronic hypertension which for most individuals can be controlled with cheap generic drugs. Nationwide only about half of the 80 million adults with chronic hypertension have it under control.

Only about 20% of those who die of cardiovascular disease die from tobacco, the remainder die from cardiovascular issues such as uncontrolled hypertension.

By simply focusing on existing plans for tobacco cessation and for increasing those with uncontrolled hypertension in your state of Kentucky you’ll save far more lives.

In the 1960s, I was a cyclist after buying an ITALA from a neighbor and former Olympic hopeful. Last year, I had two (2) RF cardiac ablations after a ten-year-ago mitral valve repair (anuloplasty) that I’d probably needed my whole life. Now I don’t take a baby aspirin. I also spent ~30 years, off and on, carrying a gun professionally and understand that it is primarily governments that kill people and, from Abraham Lincoln to Dr. William Pierce,, disarmament simply isn’t the answer.

If I didn’t enjoy you’re column via MEDCAPE, I’d quit because I’m not interested in your left-liberal politics since your advocacy of Bernie Sanders and suggestion that the Bill of Rights be further infringed.

Interesting that you cited aviation as an example. What about automobile travel (not autos vs. bicycles)? Here in Georgia the death statistics are shown on a daily basis on the overhead traffic alert signs- we’re up to 1200 this year. Far more than gun deaths (most of which are suicides, actually), yet there is no clamor to “ban fast cars”… Who wants to give up their four wheeled freedom because the careless keep crashing into the unfortunate (or each other)? Few, I’d say.

Dr. John I think you are a really smart guy and respect your opinions, but I think you are just plain wrong on both socialized medicine and guns, and I wish you would do more research on both subjects.

Medicine is primarily screwed up because the customer does not pay for the services directly, and free market forces are not in play. This originated as a way to bypass confiscatory tax rates during WW2, by means of allowing employer paid health insurance to be a tax-free benefit, with the expense written off by the employer. All over avoiding high government taxes. More government control is not the answer. Ask the Canadians and British who have to wait months or longer for services we can get here immediately how that’s working for them.

This country has always been heavily armed, and as heavily armed as we still are, statistically violent crime continues to drop. What we have is a crisis of morals. Our Founding Fathers entrusted us with the right to defend ourselves, our loved ones, and our homes from threats, including a tyrannical government, because they understood we had that right because we are human. Evil will always find a way to wreak its destruction when we don’t, or aren’t allowed, to defend our weakest citizens. And the epidemic of self destruction will continue in the spiritual vacuum we are promoting these days.

A mass murderer spent years meticulously planning a horrific act and executed it according to plan, and he took 59 priceless lives. He happened to have used guns. He could have run into the crowd with a truck and killed many more. The murderer in Nice did. It’s not the means, it’s the act, that has to be addressed.

Without discourse there can be no progress. This topic is worthy of civil discourse, no doubt. While the right to bear arms is a right that most are interested in keeping intact, defining the limit of that right is needed. I am unconvinced the writers of the constitution in 1787 foresaw the destructive potential of modern-day weaponry. Some congressional response to this modernization of weapons has already previously been passed evidently without destruction of our state, i.e.the right is already limited by the 1968 crime control act- citizens of the U.S. can’t own grenades. I was not alive at that time so feel unauthorized to discuss how that ‘limit’ was felt by the public. Nonetheless, the point I want to make is that somewhere between knife and nuclear warhead the right to bear arms does and will always have limits. Perhaps a starting point for discussion is to recognize that the right to bear arms is limited, and that commonality must be found as to what is an acceptable limit.


The Founding Fathers absolutely did intend for the citizenry to be equally armed as the government. They probably did not foresee radio, television, or the Internet either, but the First Amendment still applies to those. And an armed populace dedicated to the cause does not have to have the same weaponry to succeed- for example the Viet Cong, or Afganis throughtout their history.

This was the case until the 1930’s and the advent of newsreels publicizing the antics of gangsters and a few high-profile bank robbers with the Thompson submachine gun. But 50 years ago, you could still mail order a rifle- Lee Harvey Oswald did, a bolt-action hunting rifle. The U of Texas shooter used a bolt action also- interestingly, he was subdued (killed by police) after receiving fire from civilians who had retrieved their own rifles from their cars and homes which pinned him down. Rifle racks were common in the back windows of pickup trucks, and often held more than an umbrella placeholder. The 1968 act was in response to several high profile assassinations, and marked the beginning of a crime wave that did not subside until the 90’s.

Weird, but in those days of institutional mistreatment of many types of people, most people as individuals treated each other much better. Nowadays institutional mistreatment is largely gone, at least from a legal perspective, but as individuals we treat each other much worse.

In our time of unprecedented prosperity, true material poverty is rare, at least compared to most of human history. But we suffer from a poverty of kindness and respect to each other.

So which is it – a potentially resisting populace should have the same level of weaponry as any potential oppressor, or doesn’t need to? The second is factually correct simply from a reading of history, as you suggest. The Founding Fathers’ assumptions need not rule us forever, given their inability to envision future circumstances [note the gender, for example]. They couldn’t have envisioned nuclear weapons, but if they could have, then they could also have envisioned Richard Spencer and said, “I really don’t want that guy owning his own nuke.” Then the question becomes where we draw the line. I do not think average shlubs need to have full-auto machine guns, nor any gizmo that can make a semi-automatic into an effective machine gun.

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