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Baseball and Civil Rights

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Last week on Wednesday April 15th was Jackie Robinson day, celebrating the 68th anniversary of the first modern day African-American to play in Major League Baseball (MLB) (there had been a small number of others prior to the current MLB professional system). Like most of us baseball fans, I love seeing all players wearing #42 in his honor, this being the only number retired by MLB as a whole but allowed to be worn on this one day a year. Jimmy Rollins, shortstop for the Los Angeles Dodgers, recently wrote about what a thrill it would be to wear that number while playing for Jackie’s Dodgers, an experience he has for the first time this year (log in likely needed for article).

Jackie Robinson has been my hero since I was in elementary school, either the 4th or 5th grade. I read Stealing Home: The Story of Jackie Robinson, a Scholastic Biography by Barry Denenberg aimed at kids my age. I don’t remember how I came upon it, though being a big baseball fan it wouldn’t have been hard for me to pick it up seeing it at the library or book store. The first thing that really caught my imagination was that thought of stealing home, such a lost art of the game in the early ‘90s (and on through today), having seen that iconic picture of him hook sliding into home against Johnny Pramesa in 1952, his hat flying off and his teammate watching on, filling me with immense excitement.

But as for so many of us, Jackie’s story has inspired me immeasurably. Having to be yelled at, taunted, sworn at, thrown at, spat at, ridiculed, hated, spiked, received multiple death threats to him and his family while being completely alone in this endeavor and not being able to give into his natural instincts of fighting back or responding brings me to tears whenever I think about it. I love him for his courage, for working towards something that was bigger than him (or baseball), for being willing to go through all of that. He was truly amazing.

These experiences were shared by many more than just Jackie, both in baseball and outside. But generations of African-American struggle were personified and epitomized in him. He obviously prepared and foreshadowed the remaining civil rights movement in this country, providing more liberty and opportunity for the descendants of those who were physically enslaved by allowing other courageous men and women to free themselves and all minorities from societal enslavement. It all could have blown up if he had behaved differently.

The thing that really sold this was that Jackie could play; if he couldn’t, none of the other stuff would have mattered. He has also been credited with starting a revolution in how the game is played. Those from the Negro Leagues who came to MLB after him furthered this free-styling, risk-taking, hard-running, slap-and-dash method of play, what would commonly be referred to today as small-ball. Buck O’Neill, the late great spokesman and advocate for greater knowledge about and appreciation for the Negro Leagues, describes it as something close to jazz. Many, myself included, would call this a much funner way to play and watch baseball. “There was a lot wrong with the world, but we weren’t sad, man. We had the time of our lives,” said Buck O’Neill about those days.

I have also had much more interest in the Negro Leagues in recent months. Part of it is because of my love for Jackie, part of it is because I travel to Kansas City a few times a year and get to visit the Negro Leagues Museum, part of it is because if you’ve ever listened to Buck O’Neill how can you NOT love the Negro Leagues! It’s characters, it’s history, it’s BASEBALL is full of wonder and excitement. Its “separate but equal” place in baseball history should not be forgotten nor neglected. “We overcame, see. That’s the lesson of the Negro Leagues,” said Buck O’Neill on another occasion.

Both Jackie and the Negro Leagues led to not only more African-American players, but also many Latino players, who have left their own indelible mark on baseball. Roberto Clemente, who had the 60th anniversary of his first game played on April 17th and a huge pioneer in his own right for the racism he faced and overcame, chose number 21 because he hoped he could be “half the man” that Jackie Robinson (#42) was. Robinson Cano, by far the best 2nd baseman in MLB today, was named after Jackie because that is who his father’s hero was. Many other Latino ballplayers now participate in what we greedily refer to as “our” national pastime, and do so with many similar challenges, though to a far lesser extent, than what Jackie experienced.

But the best way that civil rights and baseball intersect is an experience Joe Posnanski had with Buck O’Neill while writing a book about Buck near the end of his life. Buck had just spoken at a press conference in Washington, D.C. to request national designation to the Negro Leagues Baseball Museum in Kansas City. Buck needed to take a break in a backroom after speaking. Here is an excerpt from The Soul of Baseball (one of my favorite books, and definitely one of the best baseball books ever written):

“’Hold on for a second, hold on,’ Buck said, and he pointed at a television nearby. ‘You know something funny? Look at that television. You know, if the Willie Mays catch was on right now—the one from the World Series—everyone would stop and watch it.’

“Everybody around stopped and listened to Buck. He was talking about the catch Mays made at the Polo Grounds in the 1954 World Series, the one where he turned his back and raced toward the wall on a long ball hit by Vic Wertz. Mays ran full speed to a spot and somehow caught the ball over his head without even looking back. His hat flew off. And then, in one motion, Mays whirled and threw the ball back to the infield. Jack Brickhouse, the announcer, screamed that it must have looked like an optical illusion to a lot of people. More than fifty years later, most people would say it was the greatest catch ever made.

“’How many times have we all seen that catch?’ Buck asked. ‘And yet, if Willie Mays was up there on the television, this whole place would come to a stop.’

“’If Willie was up there, people would stop making laws. They would stop running. They would stop arguing about little things. Or big things. No Democrat or Republican, no black and white, no North or South. Everyone would just stop, watch the TV, watch Willie Mays make that catch. That’s baseball, man.’”

That’s what baseball means to civil rights. Jackie sliding into home against Yogi Berra—the wonder of baseball and nothing else—still represents that to me.

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Health Care the Way it Should Be

I work at the Neurobehavior HOME Program at the University of Utah. It is a unique clinic that cares for individuals with developmental disabilities. In addition to the primary care team, we also have comprehensive mental and behavioral health supports, including psychiatry, therapy, and behaviorists. We also have case managers to help with the integration of the team and address additional patient concerns.

Here is a sample video of how we do things. There are 2 problems with this video, however:

1) it cut out the information of how we made the goals of treatment with the patient, and make it sound as if we came up with everything without her

2) it does not include all of the other team members that assisted in her care, such as another case manager, her psychiatrist, her therapist, etc. For simplicity’s sake it was not included but those who helped her and our other patients should not be neglected!

In my opinion, this is health care as it should be.

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The (seemingly) Annual Update on Physician Income

My main assertion is that if people and society are not going to pay life-savers that which a life saved is worth, or even what they gladly pay for a new hip, pair of breasts or luxury shoes, that at a minimum they hold emergency physicians, nurses, EMTs and other emergency service workers in the highest regard.

–Birdstrike, MD

Let’s focus on other factors that have a much bigger impact on health costs: wasteful spending and administrative overhead, for instance.  Those comprise a much larger slice of the health cost pie, and dwarf the sliver that physician pay represents.

–Kevin Pho, MD

It’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze

 A lot of debate comes up nearly every year over a few different questions regarding physician payment. Do physicians earn too much money? Is there a maldistribution of income among specialties? Does physician income contribute to such high health care costs in the US? Multiple opinions abound, and multiple economic studies have been done to try to answer the question; they give much more insight to the question than I could do (and many are linked to below). But in short, the answer to all of these questions is yes and no.

Lots of people believe that “greedy doctors” are to blame for our exorbitant health care costs. After all, physicians in the US make about double than those in many other Western countries, though the amount of services provided is roughly the same. Some studies suggest that physician income does significantly contribute to our inordinate health care spending, though others refute that.

Ideas of covering malpractice premiums and paying off student loans are some of the most cited reasons for higher pay, though those don’t make up for the gap between us and other countries. Malpractice premiums as a whole declined from 1986 to 2000, but all other practice expenses increased during that time, leading to lower net income. The threat of malpractice definitely takes an emotional toll, and defensive medicine is a real concern, though frankly the financial impact of malpractice on the US system is much less than would be guessed by most physicians.

Doctors are reimbursed at a higher rate than is needed to “merely” pay back student debt, though the notion that physicians can “pay off that debt in five or so years” is preposterous for most. The median cost of 4 years of medical school in the US is $286,806 which certainly eats into any income, but the fact is that malpractice and debt do not make up the difference between pay in the US and elsewhere.

Physicians give up many prime years of income, as many college educated young adults in their late 20s and early 30s are making reasonable amounts of money on which to live, while physicians are essentially paying a similar amount of money during that time. Physicians also work many more hours than the average worker, both during training and after, contributing to a lower amount of earnings per time spent working. This contributes to a significantly lower rate of return of a medical education as compared to a MBA or law degree.

The remaining difference likely comes from a disparity between the take-home pay of physicians and the median income in the US. Interestingly enough, this may be the biggest factor that explains the difference in pay as compared with physicians in other countries. Even though physicians in the US are paid several multiple times of GDP per capita above the average worker, it is the same in other Western countries. Our income looks so much larger than doctors in other countries simply because there is a greater income inequality in the US, and thus those earning over the 95th percentile in the United States will have a much higher income than that same position in another country.

There is also a big issue of varying pay among different specialties, with lots of data showing that underpaying primary care physicians, who provide the best health care value, contributes to higher costs, though in a more indirect way. The exact info on that is a topic for a future blog.

Physicians make a lot more money in the US than elsewhere, and it is not all explained by the common beliefs of student loan debt and/or malpractice insurance. As the whether or not physicians are paid enough, there will never be an appropriate answer. I am always willing to take on a raise, but the cost of that raise coming from elsewhere may not be worth it over the long haul to society. No non-physician is going to allow any whining over not being paid enough. In the end, “Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.”