The American Dilemma and How We Can Fix It

Archive for the ‘medicine’ Category

HYPOCRITICAL HIPPOCRATS

“With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.”

– The original Hippocratic Oath – third paragraph.

Teddy Papadopoulos and I met during Orientation Week at the University of Chicago.  He was one of the few students among us who was a native Chicagoan.  A lifelong resident of the university’s Hyde Park community, he was brilliant and was pursuing a bachelor’s degree in physics.  In any event, we met over what passed for a typical dormitory dinner and both of us had equally unkind comments about the cafeteria’s culinary output.  Naturally, we hit it off and became very good friends – a relationship that exists still today.

Nikos Papadopoulos, Teddy’s father, was an extremely congenial man who was one of the partners in Café Hellas, one of the many restaurants on Halsted Street that comprised Chicago’s Greek Town neighborhood.  He could be seen there six days and nights a week greeting and seating the busy restaurant’s customers, treating regulars and newcomers with the same obvious joy that they had decided to patronize his establishment.

Nikos was an immigrant from Thessalonika who came to the United States when he was eight years old.  He met his wife Diana here.  She was the daughter of a green grocer, one of seven children, six girls and one boy.  They married when he was thirty and she was twenty-six.  Besides Teddy, they had two other boys.  Teddy, by the way, was named for Theodore Roosevelt.  Nikos admired the former president as a person who said what he meant and meant what he said..

Diana was typical of many women in Chicago’s Greek community.  She was, to use an out of date phrase, a homemaker whose enjoyment came from keeping the house neat as a pin and making dinner for her children and on Sunday for her husband when he wasn’t at the restaurant.  She made sure that the kids all looked their best for the lengthy Sunday services at Annunciation Greek Orthodox Cathedral which they attended.  She was a warm and very loving person who enjoyed nothing more than giving everyone a hug and if they were short enough like her, a kiss on the cheek.  Although it was never official, I thought of her as a foster mother.

During my third year in school, Diana was hospitalized.  She was in her late forties.  She was, I think more concerned about being away from her family than she was for her own condition.  But she tried to wear a happy face and joked about getting out of the hospital so that she could cook her family dinner.  “By now I’m sure the house is not fit for pigs to live in,” she said on one of my visits.  That was the visit when she got the news.

Teddy and I were in her room when a specialist whom she had not seen before came in.  He had the results of the tests and the lab work that had been conducted over the previous ten days – and had an analysis.  His name was Dr. M., an oncologist.

Without so much as a, “Hi, how are you,” he introduced himself.  Perhaps you’ve heard of bedside manner.  Well, Dr. M. had obviously cut that class.

“I have reviewed your tests and your lab work and I need to tell you that you have cancer of the pancreas.  It’s inoperable and there’s no treatment.  Based on the progression of the cancer I estimate that you have at most four to five months to live.  I’m sorry.”

And he turned on his heel and left the room.

Diana burst into tears and Teddy rushed to his mother’s bed, sat down and put his arms around her.  I was so shocked, my mouth wide open at the ruthless way in which this physician had delivered his news that I didn’t know what to do.  But in a few second my shock turned into serious anger.  I have only been really angry three times in my life – and this was one of them.  I rushed from the room to find the doctor, half intent on slugging him.

When I caught up with him I grabbed his arm and said, “Excuse me.”   By now my blood pressure was returning to only twice its normal range.  “I can’t believe that you as a trained medical practitioner who is supposed to try to help people could have told that poor woman her prognosis in such a cold and uncaring manner.  You should be ashamed of yourself.”

He replied, “Why?  She’s a dead woman.  If I waste my time on her I might be putting someone at risk whom I could actually help.”  And he walked off.

I remember standing there for a few minutes, totally numb, completely shocked and feeling the tears run down both my cheeks.  And then I returned to Diana’s room.

Well, Dr. M. was fairly correct.  But Diana lived seven months from that date and the outpouring of love and grief from her friends and members of the closely knit Greek community was amazing.  There were well over four hundred people who attended her funeral that September.

“Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.”

– The original Hippocratic Oath – fourth paragraph.

The original Oath has been changed many times.  Obviously, were the above portion of it still in effect there would be no abortions performed by any physicians who swore to it nor would we have things such as the “morning after” pill.

This week a pro life group released an undercover video in which Planned Parenthood’s Dr. Deborah Nucatolo discusses in a very off handed, dismissive and clinical manner the method of performing abortions so as to “extract the most tissue which can then be furnished for research.”  The link to the video and a CNN piece on what has become a very controversial issue can be found below.

http://www.cnn.com/2015/07/15/health/planned-parenthood-undercover-video/

One of the counter attacks by those who are Pro Abortion is that the video was edited.  So is every movie that is released by Hollywood and every news story that appears in print.  Many years ago I had two separate three hour conversations with a Wall Street Journal staff writer and when the piece on which she was working, appeared in the paper she had reduced our conversation to two lines.  Editing is not the issue.  Nor is the motivation of the group that produced it – so long as the facts presented are actually the facts.

What really is the issue, something about which people who are both Pro Abortion and Pro Life should be concerned, is the level of ethics – both in our society generally and by extension among our medical practitioners.  In a self-centered, self-absorbed society that is a serious question.

Presumably, most of us would have no question about returning a guilty verdict in the case of a mother who suffocated her three  year old Downs Syndrome child because she couldn’t handle the stress of dealing with a youngster with this disability.  So why then would we applaud the woman for aborting that child as a fetus if it were clear the child would be born with this genetic defect?  Or for that matter, a child who would be born with Cystic Fibrosis?  Or for that matter, a child who was a female when the parents wanted a boy?  Or a child whose hair color would be red when they wanted a blond?

Today, whatever your philosophy, this is a choice that is purportedly left to the parent.  But those who press most strongly for further government entrenchment in our lives may not fully perceive where their efforts, if successful, may lead.

Because the truth is that government might one day decide that the right to reproduce is not a right but a privilege and it is they, (in the interest of the greater good) who should determine to whom that privilege should be granted and to whom it should be denied.

After all, the right to have children is not specifically enumerated in the Constitution, that venerable document that receives as little attention from those on the left as some members of the medical community pay to the original Hippocratic Oath.

GOOBERS AND GRUBERS

It finally arrived – the long awaited envelope.  It had been well over a week since I had sent away for it – but my letter had to make it from New York to Arizona and then the response had to come all the way back.

I had found an ad in one of my “Fantasy and Science Fiction” magazines and had responded.  Who wouldn’t answer this ad?  It promised to send the person who clipped the ad a “secret” way to accumulate wealth without really having to do much of anything.  It didn’t matter if you were young or old, a PhD or a high school drop out, the system would bring riches to whoever used it.   It was the American dream – and the information would be sent absolutely free of charge.

Some people are motivated by theory and others by practical concerns.  In my case, I wanted to become a fourteen year old success because I was tired of sleeping on the Castro convertible sofa and sharing my “bedroom” with the “dining room.”  If I made a lot of money we could move from our small apartment into one of the new high rises that were being built throughout Manhattan.  My parents had looked at several apartments in these new edifices, but decided that quadrupling the rent for just a small amount of additional space just didn’t make sense or fit our budget.

When Grandma handed me the envelope containing the “secret system” I took it and held it with the reverence due a holy relic.  I went to my desk, placed my school books on the side and laid it gently in the middle of the blotter.  I took the seldom-used letter opener and carefully opened it, making sure that my cut was even and neat.  After I completed that I waited a minute or two before daring to pull out and read its contents.  But I finally summoned up the courage.

Before me I had a pamphlet that explained how a person could make a huge amount of money by getting into mail order.  I read every word of this brochure, replete with “testimonials” from people who were identified only by their first names and an initial for their surnames and the city in which they lived – stories about how they had made a small fortune in mail order thanks to the secret system.

And what was it that they were selling?  They were selling copies of a booklet that explained how to get into mail order – a copy of which was reserved for me – if I merely completed the enclosed order form and returned it with my five dollar remittance.  Once I had received my copy, I would have the opportunity to purchase additional copies which I could sell at a “huge profit” and the booklet would explain the step by step way of doing that.  To say I was disappointed would be an understatement.

Even though I knew that something just didn’t add up, I was reluctant to give up so quickly on this opportunity to get my own bedroom.  So at dinner that evening I asked my parents to read the brochure and give me their opinion.  Needless to say, it did not survive their imprimatur.  Nevertheless, having explained why this was a scam  they still permitted me to purchase the book if I chose to spend my five dollars on it.  My parents allowed me to make my own mistakes – as long as they weren’t likely to be dangerous to my health or well being.  Their theory was that rather than hearing them preach, a little personal experience would be far more enlightening to me.

Even before I had given my folks the brochure I knew that something just didn’t sound right.  But I was hoping that I was wrong and that my parents would agree with my original opinion that I had latched on the key to riches.  After several days of soul searching, I concurred with my parents and tossed the brochure in the wastebasket.  My father summed up the experience with the statement, “When something seems too good to be true – it probably isn’t.”

In 2010 the Congress passed and President Obama signed the PPACA into law.  Now more commonly referred to as Obamacare, the law was touted by Obama and lawmakers who supported it as the best thing that had happened since the invention of sliced bread.  It offered every American the opportunity to get “affordable health insurance”; we would be able either to keep our existing insurance or get a better policy through the healthcare exchanges that were going to be established; despite the fact that these new policies would be better they would be less expensive; every American household would save $2500 per year for this insurance; and on top of all of that, this three thousand page bill would reduce the national debt.  It almost seemed too good to be true – and it wasn’t.

Nobody who took the trouble to read through the law believed that the promises could be delivered for a simple reason.  The numbers just didn’t add up – and they still don’t.  But without going into a detailed analysis of the math, if you think about the law’s purported primary goal – insuring all Americans with affordable, quality medical care – it should be clear that goal is inconsistent with providing quality healthcare.

Let’s assume that magically everyone suddenly signed up and there were no longer Americans who couldn’t see a doctor for lack of insurance.  How would this impact the quality of delivering medical services?  It would cause a lower quality of health care if, for no other reason, than that we have now added forty million potential patients to a system to which no new medical practitioners or hospital facilities have been added.  The overall effect would necessarily be longer wait times to get an appointment which in and of itself constitutes a decrease in the quality of healthcare.

We know that few if any legislators actually read the bill before voting to approve it – per then Speaker Nancy Pelosi.  That in itself is disturbing as that is the reason that we pay these people quite handsomely.  But if they had read the bill I sincerely wonder if they would have been much more elucidated on its contents than before they began that exercise.  Besides its length, the law is convoluted and the language goes beyond what we have come to expect from Washington speak.  For that reason perhaps, we employed an MIT professor, one Jonathan Gruber to advise those who wrote the law on how to craft it.  The Federal government and various state governments apparently paid Professor Gruber the sum of nearly $6 Million over several years for his insight.

Over the last ten days a series of videos have surfaced in which said professor has been recorded delivering a number of talks to various groups, mostly within the hallowed halls of academia, and explained that in order to secure the law’s passage, basically its contents had to be both disguised and lied about because it would never have passed if the public new what it actually contained.  In the course of his explanation he pointed out that, “The American public is stupid.”

While this academic apologized for the statement from the first of these videos which was released as an unfortunate malapropism, on several other occasions he made essentially the same comment.  This is not a faux pas but a reflection of the professor’s world view – and more generally – an example of the world view of most on the liberal left.  People are simply too stupid to do what is in their best interest – so it is up to enlightened do-gooders to enforce what is good for them on them.

These comments brought me back to the time I was able to attend “The Howdy Doody Show.”  It was much earlier than my experience with the magic mail order system.  I think I was about eight – and like all the ther kids who attended, I sat in “The Peanut Gallery.”  Like all the other “peanut attendees” I was wowed by Buffalo Bob, Princess Summerfallwinterspring and Mr. Bluster.  It was a half hour of pure fantasy and delight.  But I graduated from The Peanut Gallery.

I wonder if Professor Gruber ever had that same experience.

“Goober – a peanut.”  {Colloquially – A person of limited intelligence}.

“Gruber – a pompous, cynical ass paid nearly $6 Million by various government agencies to deceive the American goober to buy into Obamacare.”

CALLING A SPADE A SPADE

 

There are those who claim that poker is a game of skill.  Usually, those are people who have just taken down a big pot or won a tournament.  There are those who claim that poker is a game of luck.  Usually, those are people who have just taken what is affectionately known in the poker world as a “bad beat.”  My personal view is that poker is a game of luck combined with an element of skill.  I base that on the fact that if poker were simply a game of skill, each of the sixty-five events at the World Series of Poker would see the same faces at the final table.  That is simply not the case.  Even the greatest marksman is not going to be able to show his stuff if he does not have a supply of bullets.

Back in the days when I played a great deal of live poker I noticed that there were certain days that I could do nothing wrong.  It was as though I were a magnet for the winning hand.  Sadly, those days were few and far between.  More often the rules of random mathematical probability held sway (whether poker is a game of luck, skill or a combination of the two, there is no question that it is a game based on math), and I would receive my share of good, bad and indifferent starting hands.  Then there were the times that I would sit at the table for hours without having a hand that had any high probability of being the best when then final card was dealt.  For some reason, those slumps seemed to last for an inordinately long period of time – once for over a month of daily play.

As I was in my “slump” period, I began wondering why I subjected myself to this sort of abuse.  Anyone who has experienced the phenomenon of consistently bad cards has probably asked the same question.  I was about four hours into the session and nothing had changed when I picked up my cards and saw the six of spades.  I slid the bottom card to the right, keeping my cards sequestered from the player to my left who had a habit of staring over to see if he could make out what I had been dealt when I saw the corner of the top card, a black ace, the ace of spades.  If you don’t play poker you might think this was a good hand – but it isn’t.  In fact, A – 6 is the worst holding with an ace that you can have.  The fact that it was suited only slightly improves the hand.  But as my stack of chips had dwindled through four hours of antes, I decided to play it anyway.  There were four callers so that gave my hand some improvement through what is known as “pot odds.”

The dealer removed the first card from the deck, placing it on the discard pile and turned over the first three cards of the hand, otherwise known as the “flop.”  Much to my delight, three spades came up, the queen, eight and deuce.  I had, at that moment, what is known as “the nuts,” in other words, the best hand that could be held at that particular stage of play.  I kept my poker face and showed no reaction to the cards on the table.  One of the players to my right made a moderate bet and three of us called.  I presumed he held a queen and was betting top pair.

The next card, the “turn” was dealt.  It was the seven of hearts.  Unless you were holding a seven or two of them, this didn’t improve anyone’s hand.  The original bettor made a more aggressive bet, which another player raised.  I figured the raiser either was holding a pair of sevens or a seven and another card that had already appeared on the board.  At that point, I called with all my remaining chips and the original bettor called.  Then the final card, the “river” was dealt.  It was the three of diamonds.  I had survived and my “nut flush” had finally broken my long run of terrible cards.

The first bettor turned over his cards, A – Q for a pair; the second player turned his cards up and, as expected had three sevens; and with glee I turned up my cards, only to discover that what I had taken for the ace of spades was in fact the ace of clubs.  I had mis-read my cards and had nothing.  So I picked myself up from my seat, went home and took a month long sabbatical from playing poker.  That improved my attitude – a great deal – if you’ll pardon the expression.

Was it wish fulfillment that I saw a spade where a club existed?  Was I simply tired and misread the card?  Perhaps it was some combination of the two.  But this episode reminded me of the turmoil in which we in the United States now find ourselves – primarily because we are being fed a line that says that a club is a spade – if it’s more opportune to call it that.  While some call that “political correctness” my name for this form of communication is deceit.

As I’ve gotten older I’ve used the term “senior moment” from time to time to explain why I lost my train of thought or forgot the reason that I went into the cupboard.  Fortunately, those moments are relatively rare and only affect me.  But there is a more pernicious lapse afoot that I have named “an Obama moment.”  Should you wonder what that is, here’s my definition:  Diddling around while a solvable problem festers into a crisis and then, finally, making the wrong decision on how to handle it.

During the past month or so I’ve begun many posts.  But almost as soon as I began, a new issue has arisen which distracted me from my original writing.  This is, clearly, a fast paced world and we no longer have to wait for the evening paper to find out what has been happening here and abroad.  While many hope for their five minutes of fame, that fame has now been reduced to the length of a nanosecond.  It’s almost as though there is a concerted conspiratorial effort to so overwhelm us with “news” that we are being distracted from what is really happening and what events are truly important.  As I am not a fan of “conspiracy theories” I dismiss that – with a modicum of reservation.  So what are the real “crises” that President Obama has allowed to reach their present state?  They are immigration; ISIS and Ebola – although I can’t blame him for inventing Ebola.  More importantly, might these three be potentially interconnected?

The vast majority of Americans support legal immigration and a path to citizenship for those who want to come here.  They also support our having borders that are secure.  While charges of “racism” are lobbed because the vast majority of illegals (or “undocumented people” per Ninny Pepperoni, a/k/a Minority Leader Nancy Pelosi), are of Mexican or Central American origin, there are documented cases of people from Iraq, Iran, Syria and other middle eastern countries where ISIS has grown exponentially, who have also made it across our southern border and were apprehended.  At least some of them were apprehended.

Virtually everyone who has seen the acts of terrorism which ISIS regularly employs would agree that it is an organization based on consummate evil – and something that the rest of us in the world who do not subscribe to its tenets – would be better off without.  Certainly those who have been victims would, if they were still with us, agree with that statement.

Yet while ISIS grows in size and controls a greater amount of territory almost on a daily basis, this administration and its supporters engage us in a debate about whether using the term “Islamic” is a term of racism.  It hardly seems like a worthwhile argument since ISIS or IS (or in the administration’s preferred variant ISIL) uses Islamic as the first word in its acronym.  While we engage in that meaningless discussion, we see the focus of the liberal left applauding the speech that high school dropout Leonardo DiCaprio gave as he waxed eloquently before the UN about the evils of climate change.  Unfortunately, Mr. DiCaprio and his cohorts in Hollywood would have little to fear from climate change as, if ISIS were to prevail in its objective of theocratic domination, they would be among the first to face the executioner’s sword.

Then, of course, we have the West African Ebola outbreak.  We should all feel reassured that the president went on record that no cases would be spawned here – other than the fact that we now hear there may be several people who are  currently under observation for the disease.  Politicians, and the rest of us for that matter, should refrain from using the words none or all, since one exception makes our statements incorrect.  But to the average Joe or Juwanna, making sweeping statements is very reassuring – until the exception manifests itself.

Now what do all three of these issues have in common?

We know that ISIS’ members are so fanatical that they are willing to sacrifice themselves for an assured place with Allah in the afterlife.  I applaud their devotion and wish them all a speedy trip.  One of the ways to make that dream a reality is dying while killing the infidel – namely any or all of the six plus billion people or so who do not subscribe to Islam – and, for that matter, many of their Islamic brethren who do not adhere to their exact interpretation of that faith.

Given the porosity of our borders, the ease of international air travel, what is to prevent these zealots from sending a contingent of their fellow jihadists to West Africa, purposely infecting themselves with Ebola and then travelling to the United States and dispersing among many of our cities?  Purportedly, we have five medical centers nationwide which are equipped to treat patients who are affected by the Ebola virus.  How would we handle hundreds or thousands or tens of thousands of such cases?  The answer is that we couldn’t.  And, sadly, that’s true no matter how much Obama, his cronies and supporters claim otherwise.

The nation has endured nearly six years of an administration that is either ineffectual, indifferent or incompetent.  It’s hard to imagine suffering through another two more years of the same.  Should President Obama decide that the greatest contribution he could make to the country is taking an early retirement and heading for the golf course, I’d be willing to chip in to help pay his greens fees.  And while gaffe stricken VP Biden doesn’t seem much of an improvement, at least he would provide us with a little comic relief.  And just about now, based on the pessimistic view most Americans hold of the future, we could all use a good laugh.

And that’s calling a spade a spade.

CRONY ACCOUNTING

On April Fools Day amid blares, whistles, balloons and dancing buffoons our government announced that they had (due to a last minute surge in enthusiasm and interest) attained their goal of enrolling 7.1 million people in Obamacare.  Naturally, Chief Head Games Player Obama did a lap victory dance in the Rose Garden to make the announcement.

Frankly, I have always been suspect of government accounting.  There is a reason for that.  In my first job after college, I worked for the State of Illinois for two years and was one of the people who helped develop some of those numbers.  And I saw how they were crafted together.

My division of the Illinois Department of Revenue was responsible for determining the valuations for personal and real property which would be the basis for assessing the amount of property taxes that the railroads who ran through the state would pay to the various local taxing districts and to the state itself.  We had a formula for making these assessments which was fair and which had been used for years.  Not only had it been in use for a long time, it had been challenged in court by several of the railroads and upheld as a valid way of assessing their property by the Illinois Supreme Court.

As it happened, the man who was the head of my section was the retired general counsel for one of the smaller Illinois railroads.  In that position, one of his responsibilities was trying to reduce the assessments that the state levied against his employer.  Now he was sitting on the other side of the desk.  Naturally, over the years he worked for the railroad industry, he had many friends and associates at other railroads who had the same responsibility.

One of our largest railroads had a tradition of coming to our office a few days after we had compiled their assessment and taking my boss to lunch to “discuss” it.  Traditionally, they enjoyed this repast at one of Chicago’s nicer businessman’s lunch facilities, The Union League Club.  On his return my boss always seemed quite contented and a bit quiet – perhaps due to the Old Fashioneds which accompanied the meal.

Several days after one of these lunches, I had to go into that railroad’s file to make a minor change in the valuation of their property in one county for which they had filed an amendment.  As I pulled the file, I happened to notice that the total valuation which we had assessed had been reduced by a little over fifteen percent and that new valuation was certified by nothing more than my boss’ initials.

After spending hours trying to compute the assessment correctly and fairly, I was offended that all this work could have been wiped out with the stroke of a pen.  I was a little steamed and asked to see my boss to discuss this with him.  He always made himself available to me and we sat down to chat about the change.

During that conversation he told  me that the same Illinois Supreme Court decision which validated our formula for arriving at assessments also said, “Notwithstanding any formula, it remains within the purview of the Chief Assessor of Common Carrier Assessment to adjust, change or re-compute any assessment based on his knowledge and judgment.  His final determination shall be the final determination of any assessments for those railroads and private car lines who are required to report to his department.”

In other words, two Old Fashioneds and a nice lunch had far more value in determining railroad assessments than the hundreds of hours that my colleagues and I had put into following our formula.  While I followed the formula precisely during my second and final year with the department, I must say that I did so without the enthusiasm that I exhibited the previous year since I realized that the final number was going to be adjusted by my boss.  And I began thinking about starting my own business, which soon followed after my second year of employment by the state.

So what does all that have to do with yesterday’s announcement of Obamacare’s enrollment success?  Just about everything.  Simply put, I have always had some degree of suspicion when I view numbers that are generated by the government, based in part, on my personal experience.  The way in which this administration either throws around or withholds numbers seems more determined by whether they will bring political advantage or disability than providing the facts.  That certainly has been the case for Obamacare.

Since there is no oversight – no independent person or group who oversees the actual enrollment numbers – we will probably only know the truth after the fact.  But even if we were to take the generous position that the administration has accurately reported the number of enrollees, we should view that in light of the primary goal of the law to see how well it is working.

The key focus of Obamacare was to insure all Americans.  The estimates of those who do not currently have insurance range between 30 – 50 million individuals.  We need to take into consideration that many of those being counted in that 7.1 million are people who annually renew their applications for Medicaid.  Then there are the 5.6 million whose plans were cancelled because of Obamacare and might have enrolled because they had to replace their former plans with which they were perfectly happy..

So what is the net effect of this total shakeup of our health care system?  To make any definitive statement would probably be rash because all we have to rely on is anecdotal evidence.  However, based on that evidence, it is reasonable to make the estimate that we now have about two million fewer uninsured people than before the enrollment period began last October.  That number might be generously high.

And what have we spent to achieve this accomplishment that the White House celebrated yesterday?  It has cost the Federal government $677 Million to develop its website.  That states which developed their own websites have probably spent a nearly equivalent amount.  And then we spent another $100 million at the federal level to promote this law and get people to sign up for it.  That’s about $1.5 Billion to enroll perhaps two million people.  In other words, we spent $7,500 per person to get them health insurance.

Now we have to hope they continue to pay the premiums and choose to keep it.  Soon they will be receiving their insurance booklets and, if they read them, will realize that they are subject to high deductibles and will, except in the event of a serious medical event, be self-funding the entire cost of their own insurance.  In other words, with the exception of complying with the law (and even that is now in question with yet another Obama administrative change), they would still be better off if they get a bad cold or strep throat to bypass their insurance plan and get treated at the Emergency Room – as is the case now.

While I do not have a background in medicine, if one of my friends with a brand -spanking new Obamacare plan phoned me, sufferring with a sore throat and asked me what to do for it, my advice would be simple.

Have two Old Fashioneds and call me in the morning.

MODERN MEDICINE

Perhaps too many of us have fallen prey to the syndrome of not being able to see the forest for the trees when it comes to Obamacare.  I believe that I am guilty of that.

Sure, Republicans are hoping that this grand scheme falls on its face because they envision billion dollar increases in taxpayers’ expense to fund subsidies and millions of new patients enrolling in Medicaid costing even more billions; if successful in meeting its enrollment goals, they expect that there will be rationing of services; they wonder who will treat  the American public as more and more medical practitioners voluntarily choose not to accept the new order; and, most frightening, how will this be administered by a regime that cannot develop a website.

The Democrats on the other hand, are praying to any god who will listen that the website will be repaired and that zillions of the uninsured will enroll; that the President didn’t really say what millions heard on dozens of occasions – obviously the result of a mass delusion; that the cause of cancer will ultimately be proven to be the fault of George W. Bush; and that right thinking people don’t really have to get sick if only they sing Kumbaya loudly enough.

Well, if I say so myself, I have come up with a way to solve all these problems.  If Obama could get a Nobel Peace prize, I expect to be awarded with something at least ten times grander.  And the answer is RoboDoc.

Think about all the advantages of having an Artificial Intelligence robot taking care of your medical needs.  I am going to offer a list which I believe sets forth some of the primary benefits but is anything but all-inclusive.

First, RoboDoc will never misdiagnose your condition.  He/She/It will always have the most current medical knowledge automatically downloaded to His/Her/Its  processor.  No longer will a patient have to worry about getting the wrong prescription for a particular illness.

Second, RoboDoc will be available 24/7.  Those of us who remember house calls will certainly look back with fondness at having RoboDoc available whenever we need Him/Her/It.

Third, there will no longer be a need to get an appointment with RoboDoc just so that you can get a referral for another appointment with a specialist.  RoboDoc will be able to do it all, from Internal Medicine to Surgery to Psychiatry.

Fourth, with so many medical practitioners in this country whose origin and accents are foreign, we will no longer mistake the doctor’s telling us “You’re going to die,” with “Have a nice day.”

Fifth, since RoboDoc will always know the right thing to do and do it according to the most recent protocols, there will be no left over sponges or scalpels left in patients who require surgery, nor will anyone who is in to have a mole removed have his right hip replaced.

Sixth, since RoboDoc will always do His/Her/Its job absolutely perfectly, there will be no further need for medical malpractice insurance or plaintiffs’ lawyers – thus saving the taxpayers countless billions.

Seventh, once assembled, RoboDoc will be fully operational.  This will eliminate countless wasted years in medical school and interning in hospitals, not to mention those nasty expensive student loans that hang so cumbersomely around the necks of those who are studying to become doctors.

Eighth, the savings to the healthcare system from not needing to pay the RoboDocs will more than cover the cost of developing this AI miracle of modern medicine.  The only cost associated after the initial outlay will be finding an appropriate green energy power source to recharge His/Her/Its batteries.

Well, as I said, I could go on and on extolling the virtues of RoboDoc.  No doubt you have some excellent ideas of your own.  There are only a few minor drawbacks which come to mind.

The corps of RoboDocs will have thousands of patient records in memory and might be the target for cyber-terrorists who seek to profit from this information.  So we build in a self-destruct protocol should any unauthorized person attempt to access it.  While this will destroy the RoboDoc unit, it will also take out one of the terrorists, thus saving us time and money by avoiding a lengthy trial.  And this would make patient information more secure than on a poorly designed government website.

But the one that gives me goose bumps is the thought of those cold digits, poking and probing during the course of a proctology exam.  That sends shivers up and down my spine.

“THE FOLKS”

In the last post I spoke about the latest new catch phrase, “the law of the land” which those who support the ACA use in reference to justifying Obamacare.  But there is a second term which I find equally annoying and which is frequently employed both by the President and by some on the right, notably Bill O’Reilly of FOX News and literary fame.  That phrase is “The Folks.”

Personally, I find this term rather disparaging – no matter who the speaker.  To me it is condescending, as though the President and Mr. O’Reilly are both sitting on their lofty perches, looking down on those who are, in their perception, beneath them, the “little people.”

Well, “the folks” are getting a little taste of “the law of the land.”  The Heritage Foundation has released their analysis of how health insurance rates, on average, will be affected as a result of Obamacare.  The following link will take you to their study – which shows an increase in 45 of the 50 states and the District of Columbia.

http://www.heritage.org/research/reports/2013/10/enrollment-in-obamacare-exchanges-how-will-your-health-insurance-fare

The Heritage Foundation in this study, which makes certain assumptions which may or not prove to be completely valid, simply examines the cost of currently available insurance versus what will be available on the insurance exchanges.  It is unclear whether this study incorporates the generally higher deductibles which most insurers are building into the new policies.

This, however, is merely the first issue, albeit probably the most surprising one, which “the folks” will deal with come next year.

It is hard to argue that Obamacare is anything but an “ambitious program.”  And it shouldn’t surprise any of us that despite having more than three years to build a website, the one that HHS commissioned is flawed, perhaps fatally so.  We are now into week three of the “rollout” and even supporters of Obamacare are being forced to admit that there are “glitches” which some are even willing to admit are “serious problems.”

Beyond the problems of simply enrolling people in Obamacare, and if you review the increases which the majority of healthy, younger people will face in order to support those who are older and more sickly, it seems unreasonable that the underlying financial assumption that getting the young to enroll and pay more than they actuarially should in order to subsidize those with serious health and pre-existing conditions, will be realized.  That is simply a statement related to the economics of this program.

But that may be the least important reason for a person choosing not to enroll in Obamacare.

One of the much touted benefits which purportedly makes Obamacare “affordable” is the fact that some taxpayers will be eligible for subsidies.  However, the system is currently unable to compute what those subsidies will be.  Therefore, no one who enrolls can be certain what his or her net premium cost actually will be.  That, of course, provides a further dis-incentive for signing on the dotted internet line.

But let us “folks” step back from the problems in getting an effective website up and running, despite the government’s spending hundreds of millions of our taxpayer dollars to implement it, and look at the broader picture.

When I flew frequently, I remember reading an article in one of the In Flight magazines that there were certain things about an airplane which caused consternation among passengers.  One of those was getting on a flight and noticing that the ashtray in your seat’s armrest was filled with cigarette butts.  Passengers tended to ask themselves, “If they can’t clean the ashtrays, how well does the airline maintain the plane itself?”

That same line of thinking can reasonably be applied to Obamacare.  If it is essential for the success of the program that young people sign up but have commissioned a website, the primary vehicle to achieve that end, that is apparently incapable of achieving that goal, then what would a reasonable person expect from the far more important issue of taking care of “the folks’” health – and at what price?

If a person bought into the value of Obamacare as it was sold by the President and his supporters based on how it was originally presented, they must, if they are honest, be greatly disappointed in the product which we are now being required to purchase.  Of the original promises made by Obama, the only one which appears to be accurate is that those with pre-existing conditions will be able to obtain coverage.  And that is a good provision.

But the promise that “the folks” would on average see a decrease of $2,500 per year in the cost of insurance, apparently not the case for most; that people would be able to keep their present insurance if they liked it, apparently not the case for many; that people would be able to keep their health care provider, apparently not the case for many more.

A reasonable person would ask himself or herself, with this sort of a track record at its launch, what can we expect if Obamacare gets fully implemented?  But before you come to a conclusion there is yet more bad news.  Embedded into the source code is a disclaimer that “the government is not responsible for the security of any information which is posted by the user on the site.”  According to interviews I heard with five different IT professionals, the way this site was designed provides an open invitation to hackers to access our most important health and financial information.

Recently, I read that an astounding one out of four of us currently suffers from some form of mental illness, including depression.  I suspect that if Obamacare truly gets fully rolled out, “the folks” are going to be asking for a lot more prescriptions for valium. .

WHAT MY VET TAUGHT ME ABOUT OBAMACARE

While I have read the ACA in its entirety I wished that I were dyslexic while going through that task.  It might have made more sense.  Unless I missed it there is not  yet a provision that those of us who have companion animals are required to provide health insurance for our pets.  That might be coming.

So when Gracie developed a hematoma near her right ear, I realized that I was going to have to pay to have this treated out of pocket.  My regular vet was on vacation and would not return for two weeks.  While this was not a life-threatening condition, I could tell that it bothered her as she shook her head regularly throughout the day and I wanted to get her treated as soon as possible.  And the hematoma was enlarging on a daily basis.

I took her to another animal hospital which is close to my home and which I had used from time to time for routine things such as updating vaccinations.  This facility is only about five minutes from  the house and, unlike my regular vet, is open seven days a week.  But I always get the impression when I go there that I am going to a place that is a business more than a healing practice.  It’s hard to describe the reason for that impression other than to say that perhaps having had the company of dogs all my life, perhaps I’ve picked up on some of their intuitive perceptions.

Gracie and I met with a young female vet who was extremely sweet and very nice.  She got on the floor to examine Gracie and obviously loved animals.  So far so good.  As I lost a dog years ago while under anesthesia I asked if they could treat the hematoma using a local and simply drain it.  She went to confer with the owner of the hospital and returned to tell me that they would indeed need to use a general anesthetic and remove any mass that might have formed at the base.  She also returned with an estimate of the costs.  Reluctantly, I resigned myself to going through the general anesthesia and treating the condition as they had suggested.

As I read through the estimate I noticed that she had included a charge for a teeth cleaning.  I pointed out to her that there was no need for that as I had Gracie’s teeth cleaned five months earlier.  She said, “Well, if you don’t do the cleaning ($65) the cost of the anesthetic ($32) will be “slightly higher.  We give you a break on the anesthesia with a cleaning because we try to encourage people to follow a regular oral regimen for their pets.”  The actual charge for the mass removal was $140.  I thought to myself, that seems like a reasonable fee – $140 plus (I figured for the “slightly higher” anesthesia at $50-$60), not too bad.

So I left Gracie at the vet and asked them to call me when they had finished the procedure.  The doctor called me promptly when the operation was finished to let me know that Gracie was doing fine, the operation was a success and I could pick her up after four o’clock that afternoon.

I arrived to pick up Gracie precisely at four and asked the reception for my bill so that I could settle it while the staff brought Gracie out from the back.  When I looked at the bill I was a little startled.  The mass removal was listed at $140 per the estimate, but the anesthesia had gone from $32 to $150.  My invoice came to $53 more than it would have been had I not only had the mass removed but had her teeth cleaned unnecessarily.  Naturally, I thought this was an error so I asked to speak with the vet who owns the hospital, but he had just left for the day.

So I gave the hospital a check for the balance – less $53 and said, “I’m going to pretend that you actually did Gracie’s teeth cleaning and pay you on the basis of the estimate.  Since you didn’t actually do a cleaning, I think that’s more than fair.  But please ask Doctor K. to call me tomorrow so that we can discuss it.”  Gracie and I then left.

I didn’t hear from the owner the next day or the next so I called to speak with him.  I was connected to the office manager.  I explained my view and asked her to confirm that the bill I paid, as adjusted, was satisfactory to the hospital.  She promised to call me back within a few days.  When I didn’t hear from her I called her back.  At that point she said that she had discussed it with the owner and they were going to give me a $50 credit for the anesthesia and that my balance was $3.

I said that I would like to speak to the owner directly and would do so a few days later when I brought Gracie in to have her stitches removed.

By that time I was feeling exasperated over this three dollar invoice and had decided just to pay it.  In fact, I brought 300 pennies with me in a paper bag to settle the account.  But when I went to reception and Gracie went to the back to have the stitches removed, I was informed by reception that I owed them $53.  I explained that the office manager had indicated that the hospital was going to issue a $50 credit and that my balance was only three dollars.  So they asked the owner to come out and speak with me.

Dr. K. came out and began our conversation with the statement, “I understand you have a problem.”  Given the strident way in which he made that statement, I truly understood how John Boehner must feel in dealing with Harry Reid and President Obama.  I replied, “No, actually I have a question.  And here it is.”

“Why is it that anesthesia and a mass removal costs $290 but anesthesia, a mass removal and a dental cleaning costs $237?  This reminds me a little of Obamacare where you pay more and get less.”  (That did elicit a smile from the vet).

Well, we finally agreed that my balance was only three dollars.  So I left my bag of pennies on the desk and Gracie and I went home.  I’m most grateful that she is doing well and the scar has almost completely healed. 

I am not the sort of person who simply alters invoices because I believe that the product or service provided was worth a lesser amount.  At least, I wouldn’t do that without offering the provider the opportunity to discuss the matter.  So the reason for this post is to solicit some input from my readers.

What are your thoughts on this situation.  Should I have paid the invoice just as rendered?  Should the vet have offered to accept the amount that I tendered as payment in full?  Or should he have made a reduction in the amount he charged since one of the services wasn’t provided?

I look forward to hearing from you.

P. S.  Isn’t this a pleasant change from all the politics that I’ve posted of late?

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