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John McCain, Frank Underwood and Salman Rushdie: Beyond The Hunger Games
Watching the recent Supreme Court nomination process — so reminiscent of the sociopolitical processes of The Hunger Games — I realize how much I miss the presence of Sen. John McCain.
I didn’t vote for him — as I thought he had lost his way for a while when he selected his 2008 presidential campaign running mate — but I do miss him.
I yearn for the United States of yesteryear, a nation that stood for fair play, equal opportunity, common sense and principle.
To me, Sen. McCain seemed to espouse all those basic strengths. He made some errors — who doesn’t? — but at his core, he seemed to want to do the right thing.
Although anyone with a brain would recognize how flawed the Obamacare plan truly is — with the worst aspect being the dreadful definition of who actually should pay for it — Sen. McCain had the wisdom to understand that repealing it without a well-structured replacement plan would be idiocy personified. Although struggling with his own medical issues, he dragged himself to the Beltway and memorably gave the repeal vote his historical thumbs down.
As a physician-administrator responsible for an entire population — not just the wealthy — I recognized the ethical, pragmatic and fiscal importance of that courageous act, which was so unpopular among the fat cats.
Our own ‘House of Cards’
For a completely different set of reasons, I also miss Frank Underwood, a politician and eventually the U.S. president in the Netflix series “House of Cards.”
Who can forget two of his great scripted lines: “What is the face of a coward? The back of his head as he runs from the battle,” and, “The road to power is paved with hypocrisy and casualties. Never regret.”
When the series began, it seemed to be almost a parody of the Beltway, wryly and darkly amusing, extreme but so close to the mark.
Just a few years later, “House of Cards” has become a fearsome reflection of the world of U.S. politics, characterized by so many leaders — on both sides of the House — without conscience, morals or rational strategy that could benefit the nation.
I miss Underwood because he acted as a weekly reminder of the venality of our political system, perhaps stimulating us to move closer to social conscience and consequent action rather than to mere passive acceptance and regret.
Somehow there was wry irony in the real cause of Underwood’s disappearance in a metaphor of political death, caused in the real world by the alleged social misadventures of the actor who portrayed him — particularly odd, as some of our politicians seem to be protected from a similar fate when accused of similar behavior.
Be that as it may, you might be wondering how Salman Rushdie fits into all of this.
More than a decade ago, Rushdie had the temerity to write The Satanic Verses, which was interpreted as critical of the political powers in Iran. As a result, he was forced into hiding for several years, to protect himself from the secret service agents who had purportedly been sent to execute him.
At the time, we marveled at the benefits of our democracy, satisfied that such excesses would never occur in the United States.
How sad it is today to read, so frequently, the hateful rhetoric and death threats emblazoned in the popular press and social media whenever someone of courage expresses concepts of political principle in public. Each time, we move closer to the Rushdie paradigm.
This brings us back to the primary construct of my editorial of Oct. 25, 2016 — titled “Animal Farm, 1984 and The Hunger Games” — in which I wrote a harbinger of life today; namely, I proposed that thoughtless exercise of our electoral mandate could create a sociopolitical morass of unparalleled proportions ... and, thus, here we are.
Principles of wellness
This is a medical newssheet, and I am always quite careful not to espouse either side of Congress. Rather, I strive to encourage physicians to climb down from their lofty world and remember that they have the potential to be opinion leaders and to influence society.
If one believes that oncology is a high exemplar of our profession, with princes of our realm residing in our domain, it is quite reasonable to hope that the thousands of us who are available might act responsibly to support the following — and other — principles of wellness:
- There is global warming, supported by incontrovertible scientific evidence, and it will be medically harmful in due course, if not already so. Our nation needs to be involved in providing solutions to the problem;
- Citizens who are laid off, lose employment because of illness, or who have been lured into health insurance products that leave them functionally underinsured, and who are faced with crippling medical and pharmaceutical costs from chronic illness, should be entitled to life-saving treatment without falling into penury. We should remember that many of these financial challenges are due to inflated health expenses associated with the excesses of the pharmaceutical and health insurance industries, government rules about documentation and enforced use of imperfect electronic medical record systems;
- When life-saving generic medications are no longer available in the United States due to “production problems,” patients should have access to Canadian or other commercial products that are essentially available under similar safety controls but are precluded from sale in the U.S. via the actions of lobbyists. This should be part of cleaning up the swamp!;
- Common sense should be introduced into government management of health care, including an acceptance that the federal budget simply cannot cover everything, that evidence-based medicine should increasingly govern reimbursement, and hype and rhetoric should not influence the corridors of power or health policy; and
- Evidence-based programs that contribute to earlier detection of disease should occupy a greater part of federal health expenditure with a reduction of reimbursement for nonevidence-based activities (let us not forget the wealth of data on PSA screening and its true impact). Again, we cannot pay for everything!
These are just a few points that our national leaders must consider when defining a rational approach to health care.
Although still a work in progress, governments in other purportedly civilized nations have begun to tackle these tough issues. However, this is simply impossible when the extant political philosophy of both sides of government is focused on re-election and political survival rather than on simply trying to create realistic and rational solutions to the challenges of providing and funding optimal health care.
There is no question that we have political leaders of principle and idealism, but the numbers are falling dramatically, and a substantial impact factor was lost when Sen. McCain lost his battle for life. I miss him, and I hope that the midterm elections might yield a bunch of newly elected politicians who are more like him.
It’s not too late for us all to scrutinize the track records of those who present themselves for election, to proselytize for excellence, and to use our mandate to achieve the environment that we should all desire for the future.
We really don’t want to progress from The Hunger Games to a time of apocalypse!
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Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.
Disclosure: Raghavan reports no relevant financial disclosures.