‘Paging Dr. Doctivity’: Medicine Evolves Into a Business Model

By Walter Brasch

      Beneath a three-column headline in my local newspaper was a barely-edited press release.

      That’s not unusual. With the downsizing of newsrooms, there’s more room for wire service soft features and press releases. But this one caught my attention.

      SystemCare Health in New Jersey promoted a graduate of a college in my town to the lofty position of Senior Director of Doctivity.

      I checked the dictionary—“Doctivity” didn’t exist. I checked WebMD, the website for amateurs to learn the meaning of unpronounceable medical terms—and how to recognize their symptoms and treatments. Nothing there.

      That left SystemCare Health’s website, which spewed a barrage of buzzwords and useless gibberish, the kind that people in marketing and business think will impress those who speak fluent English.

      The company says it works with major health systems and medical colleges, giving them insight and “strategic brand platforms, service line business building programs, and breakthrough creative ideas so our clients experience real market-moving results [to] increase physician productivity, streamline operations and strategically acquire new patients.” I assume there is little difference between strategically acquiring new patients and an Army sniper strategically acquiring his target in combat.

      After wading through the mission of the company, I plunged into the swamp of Doctivity, which the company claims is “woven into a health system’s culture to create a repeatable process that provides visibility and accountability for the time it takes a new physician to break even [and] eliminates functional silos.” Since “functional silos” are probably what exist in field of cow manure, I was able to reaffirm my initial impressions about the company, and moved forward.

      Forward led me to learn that the company “delivers a personalized business plan for every new physician so they can reach their financial goals faster,” and that “Physician productivity is at the forefront of most profitability discussions.” Unfortunately, somewhere in those left-over functional silos, “It can take 18-24 months or more for a new physician to reach a break-even point (where they are covering their salaries).” But, with layers of Doctivity, which SystemCare Health says is an “innovative business approach that improves physician productivity,” physicians “are hitting their financial goals faster.”

      The psycho-marketing babble splashes website visitors with explanations— “Internal processes sometimes are burdened with lack of resources as well as market and operational constraints to successfully improve new physician productivity and strengthen retention,” and because of Doctivity, “Physicians reach their financial goals much sooner and better understand their new organization, their business and how the organization intends to market them to build a successful practice. Happy doctor = happy patients.” That last sentence, surgically cut out of a fortune cookie, could mean that SystemCare Health brings clowns and comics into physicians’ offices and operating suites. Physicians who are laughing at uterine cancer, multiple sclerosis, and aortic aneurysms will lead to patients who are so happy about their conditions they are willing to pay their physicians even more so everyone is happy. It could also mean that SystemCare  Health might apply “synergy” with pharmaceutical companies to assure they bring plenty of happy food to meetings with physicians. It could also mean productivity increases with the better use of computers and software, which requires physicians to look at screens more than they look at patients. Possibly, happiness is that SystemCare Health has someone on its staff whose job is to make sure that physicians, who can get depressed at workloads and corporate demands, are able to get the proper mood elevators to improve their happiness quotient.

      Under the Doctrine of Doctivity, health care has evolved from care and compassion to the surgical sterility of a business model, where liquidity, maximizing profits, and return on investment become the fabric and glue of health care practices.

      It’s a model where doctors in corporate health care systems are just like factory workers who help provide their corporate bosses better returns on investment that are contiguous with raising the bottom line. Like some workers who are paid by how many widgets they create every hour, or how many bushels of fruit they pick, these health care workers increase their own productivity by seeing more patients every shift. To increase their own productivity, physicians become more “efficient,” seeing patients every 10 minutes; maybe 30 to 40 a day. It’s not unusual for physicians to have a 5,000 patient case load. Spend too much time with a patient, and you lose that productivity. Take time to research a patient’s symptoms and consult with other physicians and you lose income. But, if you refer your patient to a specialist or order more tests, both you and the system will be happy with additional income. Get those patients into your exam room; move ’em in; move ’em out.

      Physicians in some systems who take too much time with patients get reminders about being focused. They don’t get reminders that spending more time with patients, sometimes just chatting about hobbies, the latest films, or the family, can help a physician better understand a patient’s issues and problems. Trapped by those 10- and 15-minute blocks of time, physicians rely upon templates and superficial questions to determine their diagnoses. They may know, but don't have the time to follow through on the most basic part of research--if you ask enough questions, and if you ask the right question, you'll get the right answer. And since it’s been decades since physicians made house calls—too inefficient—they don’t see or understand how a patient’s home or lifestyle might affect that patient’s illness.

      Most physicians, even those who take lessons from a Doctivity specialist, care about people. Most didn’t go into medicine to be part of the country club set. But when corporations set up Doctivity-induced programs, even the best physicians reluctantly sacrifice the art and science of medicine, possibly forsaking the principles of the Hippocratic Oath, to the business of medicine.

     [Walter Brasch is an award-winning journalist whose undergraduate degree was social work with a minor in health sciences. His current book is Fracking Pennsylvania, which has major sections about business decisions made by the oil and gas industry that may be more important to some companies than the health and environmental effects.]

The Politics behind the Killing of Americans

by Walter Brasch

Gov. Rick Perry (R-Texas) opposes the Patient Protection and Affordable Care Act (ACA), and vows to block the expansion of Medicaid in his state. At a news conference this past week, Perry, flanked by conservative senators Ted Cruz and John Cornyn, declared “Texas will not be held hostage by the Obama administration's attempt to force us into the fool's errand of adding more than a million Texans to a broken system." About one-fourth of all Texans do not have health care coverage.

According to an analysis by the Dallas Morning News, if Texas budgeted $15.6 billion over the next decade, it would receive more than $100 billion in federal Medicaid funds, allowing the state to cover about 1.5 million more residents, including about 400,000 children.

Texas isn’t the only state to politicize health care.

Gov. Rick Scott (R-Fla.) says that expanding Medicaid is the “right thing to do,” but the Republican-dominated state legislature doesn’t agree. Gov. John Kasich (R-Ohio) is having the same problem with his Republican legislature, although participation in Medicaid would save the state about $1.9 billion during the next decade. Gov. Jan Brewer (R-Ariz.), one of the nation’s most vigorous opponents of the ACA, surprisingly has spoken in favor of Medicaid expansion to benefit her state’s residents.

Gov. Bobby Jindal (R-La.) and the Republican legislature oppose implementing the ACA and Medicaid expansion. Jindal says the expansion would cost Louisiana about $1 billion during the next decade. However, data analysis by the state’s Department of Health and Hospitals reveals that if Louisiana accepted the federal program, which would benefit almost 600,000 residents, the state would actually save almost $400 million over the next decade. About one-fifth of all Louisianans lack health insurance.

Pennsylvania, by population, is a blue state, but it has a Republican governor, and both houses of the Legislature are Republican-controlled. Gov. Tom Corbett says he opposes an expansion of Medicaid because it is “financially unsustainable for Pennsylvania taxpayers” and would require a “large tax increase.” This would be the same governor who believes that extending a $1.65 billion corporate welfare check to the Royal Dutch Shell Corp., a foreign-owned company, is acceptable but protecting Pennsylvanians’ health is not.

Fifteen states, dominated by Republican governorships and legislatures, by declaring they won’t allow Medicaid expansion, are on record as placing political interests before the health of their citizens. Another 10 states are “considering” whether or not to implement additional health care coverage for their citizens. The Republican states, pretending they believe in cost containment, claim they oppose Medicaid expansion because of its cost, even though the entire cost for three years is borne by the federal government, the states would pay only 10 percent of the cost after that. The cost to the states would average only about 2.8 percent, according to the non-partisan Congressional Budget office.

If all states agreed to the ACA expansion of Medicaid, 17–21 million low-income individuals would receive better health care. Among those would be about 500,000 veterans who do not have health insurance and whose incomes are low enough to qualify for health care, according to research compiled by the Urban Institute. Veterans don’t automatically qualify for VA benefits. Even those who do qualify for VA assistance may not seek health care because they don’t live close to a VA medical facility, and can’t afford health care coverage closer to home. Spouses of veterans usually don’t qualify for VA benefits.

Under the ACA, Medicaid health care would cover persons whose incomes are no more than 138 percent above the federal poverty line. That would be individuals earning no more than $15,856 a year, only about $800 above minimum wage. Among those covered by Medicaid expansion would be women with breast and cervical cancer, and those with mental or substance abuse problems.

Because they have no health insurance, 6.5 to 40.6 percent of Americans, depending upon the county they live in, delay necessary medical treatment, according to research published in the New England Journal of Medicine. The 6.5 percent rate is for Norfolk, Mass.; the 40.6 percent rate is in Hidalgo, Texas. (Most of Pennsylvania falls in the 6.5–13.4 percent rate.) Texas and Florida have the highest rates of residents who delay getting proper medical care because of a lack of adequate insurance.

Low-income individuals who delay getting medical care because of the cost often develop further complications, some of them catastrophic. The medical bill that might be only a few hundred dollars, which would be covered if the recalcitrant states approved Medicaid expansion, could now become a bill in the thousands of hundreds of thousands of dollars. The hospitals would have to absorb those costs or force the patient into bankruptcy, which could impact dozens of other businesses. The Missouri Hospital Association reported if the state refused to accept Medicaid expansion, the state’s health care industry would be forced to accept more than $11 billion in uncompensated costs.

But, let’s assume that the medical condition isn’t catastrophic, but just serious. Low-wage employees, most of whom have limited sick leave, might be forced to come to work so as not to lose the limited income they already earn. If their illness is a cold or flu, or some other contagious illness, they could infect others, both employees and customers. A waitress, fry cook, or day laborer in the agricultural fields with no health insurance could cause massive problems.

Medical problems, such as rheumatoid arthritis, not treated early would also lead to a severe physical disability, forcing the employee into becoming unable to work even a minimum-wage job. This, of course, reduces both income that could be put into the local business economy and a corresponding decrease in amount of taxes paid. That would trigger disability payments, which could raise taxes for those who are not yet disabled.

Research conducted by the Harvard University School of Public Health, and published in the New England Journal of Medicine, concluded that expanding Medicaid coverage would result in a 6 percent reduction of deaths among adults 20 to 64 years old. According to that study, “Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties.” For Texas, according to the research, expansion of the Medicaid coverage would result in about 2,900 fewer deaths; for Florida, it would be about 2,200 fewer deaths; for Pennsylvania, it would result in about 1,500 fewer deaths.

But, the real reason Republicans may not want Medicaid expansion could be for the same reason they have been pushing oppressive Voter ID laws to correct a problem that doesn’t exist. Those who are most affected are those who generally are the low income wage earners and persons of color, most of whom—at least according to recent elections—don’t vote for Republicans.

[Dr. Brasch’s latest book is Fracking Pennsylvania, which looks at the health, environmental, geological, and economic impact of natural gas horizontal fracturing. He also investigates political collusion between the natural gas industry and politicians.]

Universal Neglect: A Failure to Protect Americans’ Health

by Walter Brasch

I received a letter from a friend this past week.

It was a letter he should never have had to write, yet did so out of desperation.

He is 80 years old, living off occasional writings and Social Security.

He has Medicare, but no dental insurance, and that’s the problem. He needs dental work. A lot of dental work. $10,000 worth of dental work.

Many dental insurance plans for individuals are so expensive, and give relatively few benefits, that many dentists suggest the premiums just aren’t worth it.

Without the dental work, my friend, like many people in the country, will suffer significant additional problems. Infection is one. Poor nutrition is another. There are even links to diabetes and thickening arteries.

American Patriotism in Hyper-Drive

LEE GREENWOOD  

by Walter Brasch

                                                      

It’s midway between Flag Day and Independence Day.

That means several million copies of full-page flags printed on cheap newsprint, June 14, have been burned, shredded, thrown away, or perhaps recycled. It’s an American tradition.

Flag Day was created by President Wilson in 1916 on the eve of the American entry into World War I. It has since been a day to allow Americans to show how patriotic we have become, and give a running start to celebrating the Revolution by buying banners, fireworks, and charcoal briquettes for the upcoming picnic.

 Within American society is a large class of people who fly flags on 30-foot poles in front of their houses and adorn their cars with flag decals and what they believe are patriotic bumper stickers. They are also quick to let everyone know how patriotic they are, and how much less patriotic the rest of us are. But patriotism is far more than flying flags and shouting about liberty in Tea Party rallies.

FRACKING Pennsylvania Gags Physicians (Part 1 of 3)

GRAPHIC BY AL GRANBERG, ProPublica

by Walter Brasch

A new Pennsylvania law endangers public health by forbidding health care professionals from sharing information they learn about certain chemicals and procedures used in high volume horizontal hydraulic fracturing. The procedure is commonly known as fracking.

            Fracking is the controversial method of forcing water, gases, and chemicals at tremendous pressure of up to 15,000 pounds per square inch into a rock formation as much as 10,000 feet below the earth’s surface to open channels and force out natural gas and fossil fuels. After drilling down vertically, the natural gas company will create a lateral borehole that will fracture the shale and rock for up to about 6,000 feet.

            Advocates of fracking argue not only is natural gas “greener” than coal and oil energy, with significantly fewer carbon, nitrogen, and sulfur emissions, the mining of natural gas generates significant jobs in a depressed economy, and will help the U.S. reduce its oil dependence upon foreign nations. Geologists estimate there may be as much as 2,000 trillion cubic feet of natural gas throughout the United States. If all of it is successfully mined, it could not only replace coal and oil but serve as a transition to wind, solar, and water as primary energy sources, releasing the United States from dependency upon fossil fuel energy and allowing it to be more self-sufficient.

The Marcellus Shale—which extends beneath the Allegheny Plateau, through southern New York, much of Pennsylvania, east Ohio, West Virginia, and parts of Maryland and Virginia—is one of the nation’s largest sources for natural gas mining, containing as much as 500 trillion cubic feet of natural gas, and could produce, within a decade, as much as one-fourth of the nation’s natural gas demand.  Each of Pennsylvania’s 5,255 wells, as of the beginning of March 2012, with dozens being added each week, takes up about 8.8 acres, including all access roads and pipe, according to data analysis by Nature Conservancy.

Over the expected lifetime of each well, companies may use as many as nine million gallons of water and 100,000 gallons of chemicals and radioactive isotopes within a four to six week period. The additives “are used to prevent pipe corrosion, kill bacteria, and assist in forcing the water and sand down-hole to fracture the targeted formation,” explains Thomas J. Pyle, president of the Institute for Energy Research. However, about 650 of the 750 chemicals used in fracking operations are known carcinogens, according to a report filed with the U.S. House of Representatives in April 2011. Fluids used in fracking include those that are “potentially hazardous,” including volatile organic compounds, according to Christopher Portier, director of the National Center for Environmental Health, a part of the federal Centers for Disease Control. In an email to the Associated Press in January 2012, Portier noted that waste water, in addition to bring up several elements, may be radioactive. Fracking is also believed to have been the cause of hundreds of small earthquakes in Ohio and other states.

The law, known as Act 13 of 2012, an amendment to Title 58 (Oil and Gas) of the Pennsylvania Consolidated Statutes, requires that companies provide to a state-maintained registry the names of chemicals and gases used in fracking. Physicians and others who work with citizen health issues may request specific information, but the company doesn’t have to provide that information if it claims it is a trade secret or proprietary information, nor does it have to reveal how the chemicals and gases used in fracking interact with natural compounds. If a company does release information about what is used, health care professionals are bound by a non-disclosure agreement that not only forbids them from warning the community of water and air pollution that may be caused by fracking, but which also forbids them from telling their own patients what the physician believes may have led to their health problems. A strict interpretation of the law would also forbid general practitioners and family practice physicians who sign the non-disclosure agreement and learn the contents of the “trade secrets” from notifying a specialist about the chemicals or compounds, thus delaying medical treatment.

            The clauses are buried on pages 98 and 99 of the 174-page bill, which was initiated and passed by the Republican-controlled General Assembly and signed into law in February by Republican Gov. Tom Corbett.

            “I have never seen anything like this in my 37 years of practice,” says Dr. Helen Podgainy, a pediatrician from Coraopolis, Pa. She says it’s common for physicians, epidemiologists, and others in the health care field to discuss and consult with each other about the possible problems that can affect various populations. Her first priority, she says, “is to diagnose and treat, and to be proactive in preventing harm to others.” The new law, she says, not only “hinders preventative measures for our patients, it slows the treatment process by gagging free discussion.”

            Psychologists are also concerned about the effects of fracking and the law’s gag order. “We won’t know the extent of patients becoming anxious or depressed because of a lack of information about the fracking process and the chemicals used,” says Kathryn Vennie of Hawley, Pa., a clinical psychologist for 30 years. She says she is already seeing patients “who are seeking support because of the disruption to their environment.” Anxiety in the absence of information, she says, “can produce both mental and physical problems.”

            The law is not only “unprecedented,” but will “complicate the ability of health department to collect information that would reveal trends that could help us to protect the public health,” says Dr. Jerome Paulson, director of the Mid-Atlantic Center for Children’s Health and the Environment at the Children’s National Medical Center in Washington, D.C.  Dr. Paulson, also professor of pediatrics at George Washington University, calls the law “detrimental to the delivery of personal health care and contradictory to the ethical principles of medicine and public health.” Physicians, he says, “have a moral and ethical responsibility to protect the health of the public, and this law precludes us from doing all we can to protect the public.” He has called for a moratorium on all drilling until the health effects can be analyzed.

            Pennsylvania requires physicians to report to the state instances of 73 specific diseases, most of which are infectious diseases. However, the list also includes cancer, which may have origins not only from chemicals used to create the fissures that yield natural gas, but also in the blow-back of elements, including arsenic, present within the fissures. Thus, physicians are faced by conflicting legal and professional considerations.

            “The confidentiality agreements are worrisome,” says Peter Scheer, a journalist/lawyer who is executive director of the First Amendment Coalition. Physicians who sign the non-disclosure agreements and then disclose the possible risks to protect the community can be sued for breech of contract, and the companies can seek both injunctions and damages, says Scheer.

In pre-trial discovery motions, a company might be required to reveal to the court what it claims are trade secrets and proprietary information, with the court determining if the chemical and gas combinations really are trade secrets or not. The court could also rule that the contract is unenforceable because it is contrary to public policy, which places the health of the public over the rights of an individual company to protect its trade secrets, says Scheer. However, the legal and financial resources of the natural gas corporations are far greater than those of individuals, and they can stall and outspend most legal challenges.

            Although Pennsylvania is determined to protect the natural gas industry, not everyone in the industry agrees with the need for secrecy.  Dave McCurdy, president of the American Gas Association, says he supports disclosing the contents included in fracturing fluids. In an opinion column published in the Denver Post, McCurdy further argued, “We need to do more as an industry to engage in a transparent and fact-based public dialogue on shale gas development.”

            The Natural Gas committee of the U.S. Department of Energy agrees. “Our most important recommendations were for more transparency and dissemination of information about shale gas operations, including full disclosure of chemicals and additives that are being used,” said Dr. Mark Zoback, professor of geophysics at Stanford University and a Board member.

            Both McCurdy’s statement and the Department of Energy’s strong recommendation about full disclosure were known to the Pennsylvania General Assembly when it created the law that restricted health care professionals from disseminating certain information that could help reduce significant health and environmental problems from fracking operations.

[Part 2 looks at the health issues and research studies. Part 3 looks at the truth behind why Pennsylvania has given advantages to the natural gas industry. Assisting on this series, in addition to those quoted within the articles, were Rosemary R. Brasch, Eileen Fay, Dr. Bernard Goldstein, and Dr. Wendy Lynne Lee. Dr. Walter Brasch’s current book is Before the First Snow, a critically-acclaimed novel that looks at what happens when government and energy companies form a symbiotic relationship, using ‘cheaper, cleaner’ fuel and the lure of jobs in a depressed economy but at the expense of significant health and environmental impact. The book is available at amazon.com and through the publisher, Greeley & Stone. 

Outsourcing America’s Health Care

by Walter Brasch

“Ola, Amigo! Pack your bags, we’re going to Mexico!” bubbled Dr. Franklin Peterson Comstock III, faux physician and money-maker.

“Yeah, I could use a decent vacation,” I replied, figuring he’d pay for both of us since he had just set the world record for the most nose jobs in a 24-hour period.

“What vacation?” he said. “I’m setting up practice.”

“And give up catering to rich people with inflated bank accounts and deflated ethics?”

“Don’t have a choice. I’m getting laid off.”

Comstock had been a rainmaker for the Megabucks Happy Health Care Medical Center for the past decade. There was only one reason I could think of why he’d be laid off. “Megabucks tired of paying your malpractice insurance?” I asked.

“Not just me,” he said. “Hospital’s laying off most of the staff, making the rest work overtime, and hiring outside contractors. They said it was hard to survive when the profit was down to only 20 or so million a year.”

“I didn’t realize it was that serious,” I said. “You planning to set up private practice to help the poor in Mexico?” I asked admiringly.

“Not a chance! Gonna get rich working for Megabucks!”

“You just said you were laid off.”

“Been laid off in the U.S.,” said Comstock while putting a frozen burrito into the microwave. “Megabucks/Mexico just hired me. There’s cheaper labor down there.”

“You crazy?” I asked. “You’re the cheaper labor.”

            “Obviously you don’t know American business,” said Comstock haughtily.

“Megabucks/U.S. closes its auxiliary operations, and then contracts with Mexican companies for a fifth of the cost in the U.S. They do the work, ship it back to the U.S., and Megabucks bills Blue Cross the full rate as if it was done locally.”

            “So where do you fit in?” I asked.

            “Just as before. Nose jobs. Breast augmentations. Tummy tucks. All the important medical procedures. But this time, I do it in Cancun.”

            “To rich Mexicans,” I said disgusted.

            “To rich Americans!” said Comstock. “If they want the best care, they’ll take their private jets to Mexico and then deduct the trip as a necessary business expense.”

            “And what about the impoverished and middle-class Americans?”

            “If they can sneak across the border, they can also get medical care.”

            “What about prescriptions?”

            “Megabucks contracted with some of the best drug dealers—I mean pharmacists and chemists—in Mexico. Quality is just as good and it’ll only be four or five times production costs. Unlike the U.S. there’s no TV advertising and six-figure MBAs and lawyers that require drugs to be 30 or 40 times production costs.”

            “With prices that low, how do you know there won’t be mass rushes by Americans to grab everything they can?”

            “Because there’s security! Every hospital and pharmacy has armed guards with the best automatic weapons smuggled through the God-fearing 2nd Amendment patriotic Southern states.”

            “Is Megabucks outsourcing all its operations?”

            “Keeping the ER. After tummy tucks and butt lifts, that’s the hospital’s ‘cash cow.’”

            “So, then, it’ll have to keep some services like X-Ray and the lab,” I said. “Maybe even a doctor or two.”

            “Too expensive,” said Comstock. “Megabucks will hire more residents and foreign-educated doctors, and work them 18 hours a day. More work, less time to complain. Residents will do anything to get experience to pass their boards. May even hire a couple of hospitalists. You know, the ones who graduated at the bottom of their class and can’t even get work in a Free Clinic.”

            “I suppose they’ll also do the lab work?” I asked.

            “Do you know some of those lab techs are making as much as $30,000 a year! Made sense to lay them off, too.”

            “So how will the ER know a victim’s blood chemistry, or if there’s internal injuries?”

            “Technology,” said Comstock. “They scan the blood here, and send digital X-Rays to Mexico. Mexican lab technicians—you know, the ones that don’t know about unions and will work for only a few bucks a day—will analyze everything, then text the results back to the U.S.”

            “This sounds like it’s not only a way to maximize profits, but also a way to avoid dealing with the President’s health care reform program.”

            “Obamacare!” spit out Comstock. “Nothing but socialized medicine.”

            “Most countries have forms of socialized medicine,” I countered, “and they not only have good health care but affordable prices to their citizens.”

            Comstock put his hands to his ears and began chanting, “We’re Number 1, We’re Number 1.”

            “Number 37,” I corrected him. “The World Health Organization ranked the U.S. just below Costa Rico.”

            “They’re all Commies,” replied Comstock. “Besides, that study is a decade old.”

            “Last year, the independent Commonwealth Fund compared the nations of the United Kingdom against the U.S., and the U.S. ranked seventh of the seven.”

            “Yeah, like Americans will go to Canada? It’s covered by snow and run by a queen who can’t even speak English.”

            “You and Megabucks are crazy!”

            “Possibly,” said Marshbaum, “but outsourcing is the American way. By the way, do you put ketchup or mustard on a burrito?”

            [Dr. Walter Brasch isn’t licensed to practice medicine, but he goes to some excellent physicians who are—and they’re just as frustrated with the costs, corporate greed and incompetence, insurance companies and myriad forms as anyone else. His current book is the critically-acclaimed mystery novel, Before the First Snow]

Stories We Will Still Have to Write in 2012

by Walter and Rosemary Brasch

            In January 2009, with a new president about to be inaugurated, we wrote a column about the stories we preferred not having to write, but knew we would. Three years later, we are still writing about those problems; three years from now, we’ll still be writing about them.

We had wanted the U.S. Department of the Interior to stop the government-approved slaughter of wild horses and burros in the southwest, but were disappointed that the cattle industry used its money and influence to shelter politicians from Americans who asked for compassion and understanding of  breeds that roamed freely long before the nation’s “Manifest Destiny.”

We wanted to see the federal government protect wolves, foxes, and coyotes, none of whom attack humans, have no food or commercial value, but are major players in environmental balance. But, we knew that the hunting industry would prevail since they see these canines only as competition.

              We have written against the brutality of clubbing more than 300,000 baby seals each year, of cutting the fins off of more than 50 million sharks a year and letting them die lingering deaths, and of killing whales, even though there is no longer much use for whale oil.

We wrote against the use of inhumane traps, and of trappers who don’t seem to care what torture their traps can do before the animal dies.

We spoke against the killing and skinning of animals for their fur, especially since there are innumerable ways to efficiently and inexpensively clothe humans.

We wrote against current laws that treat pets as chattel, to be bought and sold at will, with values as property not as life. Because of these archaic laws, those who abuse animals usually pay only a small fine and usually serve no prison time.

We wanted to see the Pennsylvania legislature stand up for what is right and courageously end the cruelty of pigeon shoots. But, a pack of legislative cowards left Pennsylvania as the only state where pigeon shoots, with their illegal gambling, are actively held.

For what seems to be decades, we have written against racism and bigotry. But many politicians still believe that gays deserve few, if any, rights; that all Muslims are enemy terrorists; and publicly lie that Voter ID is a way to protect the integrity of the electoral process, while knowing it would disenfranchise thousands of poor and minority citizens.

We will continue to write about the destruction of the environment and of ways people are trying to save it. Environmental concern is greater than a decade ago, but so is the ignorant prattling of those who believe global warming is a hoax, and mistakenly believe that the benefits of natural gas fracking, with well-paying jobs in a depressed economy, far outweigh the environmental, health, and safety problems they cause.

We will continue to write against government corruption, bailouts, tax advantages for the rich and their corporations, governmental waste, and corporate greed. They will continue to exist because millionaire legislators will continue to protect those who contribute to political campaigns. Nevertheless, we will continue to speak out against politicians who have sacrificed the lower- and middle-classes in order to protect the one percent.

We will continue to write about the effects of laying off long-time employees and of outsourcing jobs to “maximize profits.” Until Americans realize that “cheaper” doesn’t necessarily mean “better,” we’ll continue to explain why exploitation knows no geographical boundaries.

The working class successfully launched major counter-attacks against seemingly-entrenched anti-labor politicians in Wisconsin, Ohio, and other states. But these battles will be as long and as bitter as the politicians who deny the rights of workers. We will continue to speak out for worker rights, better working conditions, and benefits at least equal to their managers. We don’t expect anything to change in 2012, but we are still hopeful that a minority of business owners who already respect the worker will influence the rest.

There are still those who believe education is best served by programs manacled by teaching-to-the-test mentality, and are more than willing to sacrifice quality for numbers. We will continue to write about problems in the nation’s educational system, especially the failure to encourage intellectual curiosity and respect for the tenets of academic integrity.

Against great opposition, the President and Congress passed sweeping health care reform. But, certain members of Congress, all of whom have better health care than most Americans, have proclaimed they will dismantle the program they derisively call “Obamacare.”

During this new year, we will still be writing about the unemployed, the homeless, those without adequate health coverage—and against the political lunatics who continue to deny Americans the basics of human life, essentials that most civilized countries already give their citizens.

We had written forcefully against the previous president and vice-president when they strapped on their six-shooters and sent the nation into war in a country that posed no threat to us, while failing to adequately attack a country that housed the core of the al-Qaeda movement. We wrote about the Administration’s failure to provide adequate protection for the soldiers they sent into war or adequate and sustained mental and medical care when they returned home. The War in Iraq is now over, but the war in Afghanistan continues. The reminder of these wars will last as long as there are hospitals and cemeteries.

We had written dozens of stories against the Bush–Cheney Administration’s belief in the use of torture and why it thought it was necessary to shred parts of the Constitution. We had hoped that a new president, a professor of Constitutional law, would stop the attack upon our freedoms and rights. But the PATRIOT Act was extended, and new legislation was enacted that reduces the rights and freedoms of all citizens. At all levels of government, Constitutional violations still exist, and a new year won’t change our determination to bring to light these violations wherever and whenever they occur.

The hope we and this nation had for change we could believe in, and which we still hope will not die, has been minced by the reality of petty politics, with the “Party of No” and its raucous Teabagger mutation blocking social change for America’s improvement. We can hope that the man we elected will realize that compromise works only when the opposition isn’t entrenched in a never-ending priority not of improving the country, but of keeping him from a second term. Perhaps now, three years after his inauguration, President Obama will disregard the disloyal opposition and unleash the fire and truth we saw in the year before his election, and will speak out even more forcefully for the principles we believed when we, as a nation, gave him the largest vote total of any president in history.

We really want to be able to write columns about Americans who take care of each other, about leaders who concentrate upon fixing the social problems. But we know that’s only an ethereal ideal.  So, we’ll just have to hope that the waters of social justice wear down, however slowly, the jagged rocks of haughty resistance.

[Dr. Walter Brasch is an award-winning social issues columnist, former newspaper investigative reporter and editor, and journalism professor. His latest book is Before the First Snow, a social issues mystery novel. Rosemary Brasch is a former secretary, Red Cross national disaster family services specialist, labor activist, and university instructor of labor studies.]