In the Doldrums

Down dropt the breeze, the sails dropt down,
‘Twas sad as sad could be ;
And we did speak only to break
The silence of the sea !

All in a hot and copper sky,
The bloody Sun, at noon,
Right up above the mast did stand,
No bigger than the Moon.

Day after day, day after day,
We stuck, nor breath nor motion ;
As idle as a painted ship
Upon a painted ocean…

Her lips were red, her looks were free,
Her locks were yellow as gold :
Her skin was as white as leprosy,
The Night-mare LIFE-IN-DEATH was she,
Who thicks man’s blood with cold.

The doldrums.

Samuel Taylor Coleridge, in his epic poem Rime of the Ancient Mariner, depicts the dread of all ancient sailors: becalmed, abandoned by nature and fate, powerless to move forward and at the mercy of vast forces and spirits beyond their control.

In some measure, these have been days much like that. The past few months have been some of the most difficult of my professional career. There has been a sense of fatigue, of purposelessness, of weariness with the routine and the rush, the frustrations and failures inevitable in any life pursuit, but perhaps nowhere more so than in the practice of medicine.

It is a high calling, this profession — words which, while true, seem fatuous and hackneyed in an age marked by hard science and even harder cynicism. It is a vocation fraught with paradoxes and contradictions: compassion and cold steel; empathy and enervation; arrogance and humiliation; deep satisfaction and bone-wrenching sadness. Its rewards, while rich, seemingly come at the cost of your very life, as the slow extravasation from countless battle wounds weaken the spirit and shock the soul, sapping your strength, leaving but an empty, fractured vessel, gloriously engraved on the outside but pervious and parched within.

It is no one thing, this weariness, but a score.

It is the two hours spent filling out a mandatory online recredentialing form for an insurance company, insisting on intrusive and irrelevant information (“What is the mailing address and contact phone number of your high school (required)?”) so that their marketing department can claim they only use the “finest” physicians.

It is the three hours spent dictating charts after a 10-hour office, missing no detail that might lead to an insurance denial, a government audit, or a later lawsuit — and knowing you will be back before sunrise to finish those charts you no longer have the mental or physical energy to complete.

It is the mandate to comply with the endless and every-engulfing tsunami of government compliance regulations, demanding coding quality assurance, privacy protection, identity fraud, or pay-for-performance “programs” which would overwhelm entire QA departments at Lockheed-Martin or Raytheon, but which you are expected to implement, by yourself, for free, in your spare time.

It is the countless hats you wear every day: employer; small business owner; conflict resolution manager; IT consultant; accountant; complaint department clerk; therapist; social worker.

It is the garrulous patient who talks endlessly but never answers your questions, while you run ninety minutes behind schedule; the sullen patient who refuses to fill out your history form or answer your questions, demanding you “get that information from my other doctors”; the demented patient from the nursing home with no records, accompanied by an aide who knows nothing about her or why she is here; the angry patient who blames you for their disease, refuses to follow your advice, and who is certain that you are only seeing his sorry ass to make a buck off him; the uninsured patient who needs major surgery or expensive medications but has no way to afford it.

It is the patient in intractable severe pain, incurable by every means modern medicine has to offer, who sits weeping before you, her shriveled life constricted to never leaving her home or getting out of bed, who begs you for answers you do not have. It is the insurance company who refuses her next treatment because it does not meet their “treatment guidelines.” It is the state regulators who harass and threaten you as you manage her severe pain with carefully-managed, medically appropriate chronic opiates while they perceive you as an addict-enabling criminal.

It is the perfectly-performed surgery with a disastrous outcome; the excellent outcome that leaves a bitter patient because it did not meet their wildly-unrealistic expectations — which you told them it would not and could not meet; the out-of-town and out-of-touch daughter who demands everything be done for her dying father’s terminal cancer to assuage her guilt, hating you almost as much as she hated him.

Add to these the seemingly-daily debacles the freakonomics of health care in the new millennium: overhead costs spiraling at multiples of the inflation rate, as income dives inversely; ever larger numbers of legitimate treatments and services denied or criminally underpaid by government and the insurance industry cartel; the ludicrous notion that you can somehow provide the highest quality (or even barely adequate) care while being reimbursed substantially less than the costs to provide it; the horrifying freak show in Washington where corrupt and prevaricating politicians shamelessly conspire to destroy a noble profession and an extraordinary health care system to line their own pockets and acquire perpetual power and control.

And then there are the lawyers — aah, the lawyers.

I spent the better part of twenty years in the practice of medicine avoiding their clutches. I came to believe that careful, conscientiously-practiced professionalism, a willingness to spend substantially more time than my peers teaching and communicating with my patients, constantly striving to treat them with dignity, kindness, and respect, would prove a bulwark against the woes my professional peers suffered at the hands of an out-of-control legal system.

What a fool.

My first two malpractice suits came within a year of one another, now over ten years ago. Both were frivolous, and were tossed out of the courts for lack of evidence — after tens of thousands of dollars were spent on their defense. Both, incidentally, were triggered in large part by inappropriate comments by another physician (anyone who thinks physicians cover up for their peers is badly misguided — we are an arrogant lot, shooting our wounded and eating our children). During this same period, several other suits were threatened but never filed. Small comfort, indeed.

It is difficult to express the personal devastation afforded when accused in a medical malpractice lawsuit. It is an existential crisis, cutting to the heart of who you are as a professional, challenging motive, integrity, and competence. Anger, betrayal, self-doubt, fear, and sleeplessness become your daily bread. Every patient becomes a future litigant. An invisible attorney sits in the examining room on every visit, condemning and second-guessing your every decision and action, as you wildly check off every test and x-ray you can imagine to defend yourself against his future judgment: “Doctor, could you explain to the jury why you did not order this study, which could have diagnosed her disease before it became so advanced?” Check. “Doctor, could you read page 1235 of this medical reference — which you stated you have in your office — which points out how all patients with this disorder should be evaluated thus?” Check. “Doctor, isn’t it true that you dismissed his complaints as nothing to worry about, when in fact his cancer was eating away at him and you ignored its warning signs?” Check.

My current litigation, scheduled to come to trial this June after nearly three years in process, of course cannot be discussed here; perhaps I will discourse on the lessons learned therein — for they are legion – when it is resolved, one way or the other. Suffice it to say for now that it involves a child, and that the damages sought exceed the limits of my malpractice coverage by multiples of seven figures.

Sleep well, Doctor.

In truth, why would anyone choose to go into this profession today? Why would any sane man continue to practice medicine in this environment? Why, indeed, do I continue in this insanity?

As a man of faith, a Christian physician, the answers to these questions are far from simple. They cut to the very heart of free will in the service of God and man; of matters of purpose in life and submission in faith; of trust and obligation, gratitude and motives, prayer and practice. The high-sounding principles of pew and pulpit are now tested in the fiery crucible of life, and you discover that lofty ideals and strong convictions alone are insufficient ground on which to stand. The dark night of the soul strips away your props and annihilates all your pretensions; will there be anything left but ashes when the flames have died out?

Time will tell, I suppose, whether I stand on rock or sand.

May God be with me. May God be with us all.

Medicaid, Anyone?

In my prior post I highlighted some of the problems with Medicaid, the joint state and federal health coverage for the poor. In case you might think that physicians won’t participate simply because the reimbursement is so poor (which would certainly be reason enough), check this out, from my state medical society today:

The WSMA has complained to both the Centers for Medicare and Medicaid Services (CMS) Region X and the Washington Department of Social and Health Services (DSHS) about the egregiously burdensome requests made of physicians’ practices by the Audit Medicaid Integrity Contractor (MICs). CMS has awarded the Medicaid audit contract for Washington to Health Management Services (HMS) of Irvine, Texas.

HMS is making unrealistic requests of practices in preparation of “field audits:” An eight page detailed request for information on each of the practice’s “providers,” with a 15 calendar day deadline; complete medical records on claims selected for audit, in some cases hundreds of records, and for records dating back to January 2004. Even worse, the lengthy list of records requested does not include patients’ names, only identification numbers and dates of birth!

So, let’s see: Medicaid pays far less than the cost of providing care, and often take 6 months to pay that poor pittance. For those dwindling number of physicians foolish enough to remain in this system, they pursue aggressive audits which require enormous amount of practice resources in response, and then, after such an audit, almost certainly will require large “refunds” of money “fraudulently” paid to physicians, who have failed to master the Byzantine and inscrutable regulations which no mere mortal can understand, much less comply with.

Is it any wonder that physicians are are heading for the lifeboats of this sinking vessel?

So, let’s move the uninsured in large numbers into this very same system, shall we?

The Future in Health Care

From the New England Journal of Medicine, a recent physician survey on the effects of the pending health care reform legislation on physician supply:

Key Findings

Physician Support of Health Reform in General

• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income
• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option.
• 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply
• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career
• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

And this from the New York Times today:

With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise [hedge alert!] if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

What the Times neglects to mention is that physicians’ overhead expenses substantially exceed these reimbursements — every Medicaid patient seen will cost the physician more than they will be reimbursed, often substantially more. Malpractice premiums annually for obstetricians? Generally well over $100,000. It takes a lot of $29 office visits to pay for that — and that’s just one part of overhead.

So, for those who believe we have to do “something” to fix health care, so let’s just pass this monstrosity and fix it later, this is what you’re looking at: fewer doctors, already in significant shortage; health “insurance” that pays so poorly no physician will be financially able to see you.

My suggestions, if this health care bill passes? 1) stay healthy, very healthy; 2) start saving a lot of money, since your only access to health care will likely be a shadow system where physicians will see you for cash only.

Welcome to the new millennium in health care.

What’s the alternative? Well, I hope to lay some out in the near future, time permitting.

‘They Need to Be Liberated From Their God’

I’ve been incommunicado for a while, in no small part for reasons shortly forthcoming. But lest you be left completely high and dry, here’s a little nugget for you.

The WSJ has a book review of Son of Hamas which will definitely be on my reading list when it comes out:

Mosab Yousef is the son of Sheikh Hassan Yousef, a founder and leader of the Palestinian terrorist group Hamas. Throughout the last decade, from the second Intifada to the current stalemate, he worked alongside his father in the West Bank. During that time the younger Mr. Yousef also secretly embraced Christianity. And as he reveals in his book “Son of Hamas,” out this week, he became one of the top spies for Israel’s internal security arm, the Shin Bet.

Matt Kaminski describes the book as follows:

The book, a Le Carréesque thriller wrapped in a spiritual coming-of-age story, is an attempt to answer what he says “is impossible to imagine”—”how I ended up working for my enemies who hurt me, who hurt my dad, who hurt my people.”

“There is a logical explanation,” he continues in fairly fluent English. “Simply my enemies of yesterday became my friends. And the friends of yesterday became really my enemies.”

Just to whet your appetite — back soon.

Taking the Blue Pill, Rather than the Hip Replacement

As the Democrats in Congress press forward in blind determination to pass their health care reform legislation come hell or high water, the pernicious effects of the legislation are increasingly becoming evident to anyone who takes the time to dig into its details. Though our Congressional representatives cannot seem to find the time to read these gargantuan, 2000-page bills, busy as they are padding their pockets with filthy lucre from lobbyists and interest groups, those at the state level who are will be responsible for picking up the credit card bills from this monomaniacal spending spree are starting to sweat. Even the Blue states — no strangers to fantasy spending budgets, punitive taxes, and political giveaways — can see the handwriting on the wall.

Out here in scenic Washington — where Patty Murray is considered an astute statesman and Jim McDermott is considered sane — the details of Obamacare are becoming frighteningly clear:

Washington has a 13.2% uninsured rate and one half of these people are in the age range of 18-34. Because of the bill \'s individual mandate that would require every adult to buy health insurance, 432,000 young healthy people in the state would be forced to make this purchase … The bill also requires a community rating price control on all policies which would cause these young Washingtonians to pay a higher price for coverage, while older, sicker individuals would pay less for their insurance.

There is something of a sweet irony here: those who voted overwhelmingly for Obama and who much prefer spending money on grunge music, Hempfests, and gas masks are about to wake up and find themselves paying hefty premiums to greedy insurance corporations, or facing big fines or jail time for refusing to do so — proving there truly is Karma in the world.

The Avatar-blue seasoned citizens will likewise find themselves unpleasantly surprised:

On the other end of the age spectrum, 890,000 seniors have Medicare coverage in Washington. Congress plans to finance the Senate bill in part by cutting Medicare by $471 billion. Physician reimbursement would be reduced by 21%, while Medicare Advantage would essentially be eliminated, forcing 205,000 Washington seniors out of the program and back into traditional Medicare. Access to doctors is already a problem for Washington seniors because of low Medicare payments compared to private insurance. Further cuts in how much Medicare pays doctors will only make this access problem worse for seniors.

In fairness here, the 21% cut in physician reimbursements is by no means certain: Congress has consistently blocked these “budget neutrality” cuts in the past (to prevent a mass exodus of physicians willing to see Medicare patients), even though they use the imaginary $250 billion “savings” as part of the budgetary chicanery to make Obamacare look affordable.

But Medicare Advantage plans are squarely in the sights of the Congressional cost-cutting guns. These plans provide benefits to Medicare patients using private health insurance, typically providing much better benefits than Medicare alone while costing less than expensive supplemental plans which merely cover Medicare’s substantial co-pays and deductibles. MAs are very popular — 30-40% of Medicare-eligible patients use Advantage plans, and the percentage has been growing rapidly. The drastic slash in funding for MA plans will result in benefit cuts and stiff premium hikes, driving many patients back to traditional Medicare, drastically ratcheting up out-of-pocket expenses for the elderly and cutting many of their benefits.

And it should be stressed that physician access problems in Medicare patients (it is extremely difficult in Washington to find primary care physicians who accept new Medicare patients, and the specialists are fast bringing up the rear given Medicare’s drastic cuts in fees to specialists) are not simply about low payments, and greedy doctors wanting more money; it is about reimbursing physicians to provide care at levels substantially lower than their overhead costs.

Quite simply, when you see a Medicare patient, you lose money.

Of course, you don’t have to be young or on Medicare to reap the benefits of health care reform:

Almost 130,000 Washington residents have health savings accounts (HSAs) and high deductible insurance plans. The Senate bill reduces the HSA contribution amount by one half and doubles the penalty for non-medical withdrawals. New government limitations will probably eliminate high deductible policies and consequently eliminate HSAs. All HSA holders would lose their personal coverage and be forced to buy traditional insurance.

The Seattle area has growing industries in biotech and medical device manufacturing. The Senate bill would add a 10% to 20% tax on these businesses. The cost would either be passed on to consumers or, more likely, would cause a reduction in medical research and development.

Almost 2.7 million workers and their family members in Washington receive health insurance through their employers’ self-insured programs. These people would be allowed to keep their insurance for five years. The plans must then comply with strict government benefit plans which would cause many employers to drop their coverage and force many workers to join a government plan. In addition, generous employer-sponsored insurance will be subject to a new 40% tax. In three years, 20% of all workers will be paying this tax and in six years, 20% of all households making more than $50,000 a year will have to pay this tax.

And then there’s Medicaid — coverage for the poor co-funded by federal and state governments. Obamacare extends health insurance to the uninsured poor by greatly expanding Medicaid, which is already well on its way to bankrupting the states:

Under the Senate-passed bill the number of Medicaid recipients in Washington would immediately increase by over 280,000 people. The federal taxpayers would initially pay for these new enrollees, but within five years state taxpayers would be forced to pay at least $6.8 billion more over the following ten years. The total cost of Medicaid to Washington taxpayers would then be nearly $36 billion for that ten year period. Access to doctors for Medicaid patients is even worse than for Medicare patients because of lower doctor reimbursement rates. Adding hundreds of thousands of people to Medicaid, when these patients are already being turned away by doctors, makes no sense for either patients or taxpayers.

This is fiscal insanity, akin to buying a ticket for passage on the Titanic after it has hit the iceberg.

Washington State is hardly alone in its terror about the coming health care regime. California, whose credit rating is shakier than a welfare queen on crack, is looking at financial and medical Armageddon as well. From the New York Times:

The [California Medicaid] program, known as Medi-Cal, currently serves roughly 6.5 million poor Californians. And that number could increase by 2 million under the pending legislation. Congress wants to use the Medicaid program as a way to cover more of the uninsured poor, reasoning that it’s a relatively cheap way to go by relying on existing programs.

But doctors say only a third of the state’s 60,000 practicing physicians are participating in the program because of low reimbursement rates, and they fear that more physicians will opt out.

“Increasing eligibility for Medi-Cal without increasing reimbursement rates would be catastrophic,” said Brennan Cassidy, president of the 35,000-member California Medical Association. “There’s no place for those patients to go for primary care because doctors aren’t accepting them.”

Again, the problem is not merely “low reimbursements” — it is Medicaid payment rates which cover less than half a physician’s costs to see the patient.

It is difficult to overstate how disastrous the pending Congressional legislation will be for health care and our nation’s financial stability. Are we really getting ready to jump off this precipice?

Sadly, it appears so.

I’ll Have the Medicare — & Hold the Mayo

The blogs have been abuzz about the big news from Arizona: The Mayo Clinic in Arizona will no longer be accepting Medicare patients for primary care.

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government \'s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won \'t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo \'s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians…

I’m surprised it took this long.

Mayo Clinic has long had a well-earned reputation for providing high-quality care at lower cost than much of the health care economy, due in large part to their successful formula (closed panel, salaried clinic physicians, and the resulting tight peer review) which is difficult or impossible to reproduce throughout the highly-diversified delivery systems in U.S. healthcare.

But Mayo Clinic is now coming to terms with the hard economic realities of seeing Medicare patients: it costs more to see them than you are paid:

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government \'s health program for the disabled and those 65 and older…

For years, physicians and clinics have simply absorbed this cost, effectively using their cash flow from better-paying private insurers to cover their Medicare losses. And we have reached the point where this calculus is no longer viable — a line crossed some years ago with Medicaid, the federal health program for the poor, whose reimbursements are only 60% or less of what Medicare currently pays.

What we have here is an unsustainable business model.

Typically, the folks at CMS downplay this reality, using the accounting chicanery so prevalent among our government bureaucrats, who love to piss on your leg and tell you it’s raining:

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

Yes, the gap may have remained stable — but Medicare payment rates have declined significantly over the past decade. In 1997 the Medicare conversion factor per relative value unit (RVU) was $40.97; in 2007, it was $37.89 — a nearly 10 percent decline, without factoring in inflation — and not including significant reductions in relative value units themselves (which are purportedly a hard measure of the costs and value of the service provided, but in reality are frequently “recalculated” to reduce Medicare expenditures), and a marked increase in bundling (wrapping several services together and paying for only one). What has happened is that private insurers have followed Medicare’s lead and also significantly reduced their fees, which are commonly calculated based on Medicare’s rules and formulas, but at a slightly higher conversion factor.

So while the ratio may appear stable, the reality is that both Medicare and private carriers have been dropping their fees, while medical expenses (salaries, benefits, supplies, malpractice premiums, etc.) have risen significantly faster than inflation. So the income vs. expense curves are now crossing for many, if not most, medical practices, and Medicare patients are beginning to generate significant losses, while private reimbursements can no long cover the difference. The only economically sane decision to remain solvent is to cut back or eliminate Medicare patients. The result? Reduced access to care. Of course the politicians will take credit for reducing health care costs — caring for fewer patients will certainly cost less.

Who needs death panels?

This is simple economics, really — but far too difficult for our politicians and liberal policy wonks to understand:

Robert Berenson, a fellow at the Urban Institute \'s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don \'t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

No, Medicare doesn’t just look like a poor payer — it is a poor payer, and doesn’t cover the expenses involved in providing the medical care it pays for — even for a highly efficient organization like Mayo Clinic. This idiot’s theory is that simply by increasing the number of primary care providers, competition will be greater, and more MDs will be willing to take less to provide care. Law of supply and demand and all that.

So if you’re selling TVs which cost you $500 to purchase wholesale at a retail price of $350 (and that’s the price the government mandates), opening new dealerships will make this arrangement more economically viable, through competition.

Where do they find these morons?

Not unexpectedly, Mayo Clinic’s jilted Medicare patients are none to happy, as they are being asked to pay cash (gasp!) to keep their physicians:

A Medicare patient who chooses to stay at Mayo \'s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won \'t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic \'s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We \'ve had many patients call us and express their unhappiness,” he said. “It \'s not been a pleasant experience.”

Mayo \'s decision may herald similar moves by other Phoenix-area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We \'ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

So Mayo’s trying to offload their Medicare patients onto other primary care physicians in the community, who no doubt will be more than happy to pick up these new financial albatrosses.

Best of luck with that plan.

The solution to this imminent disaster in access is not merely an increase in Medicare payment rates — Medicare and Medicaid are hell-bound for bankruptcy, and a few band-aids won’t stem the hemorrhage, but only make it worse. The imminent passage of “health care reform” legislation now bubbling in the witches’ cauldron of Congress will not only worsen Medicare’s situation — half a billion dollars are being cut from Medicare under the new legislation — but will instead bring this access disaster to private insurers as well. As their loss ratios are fixed by law at unsustainable levels, and community ratings forces them to accept high-cost patients without financial compensation for their increase risk and cost exposure, they will be forced to raise premiums to untenable levels — or drastically cut reimbursements to hospitals and physicians.

The system is a disastrous maze, and needs to be completely dismantled, and rebuilt from scratch. And the chances of that happening are zilch, zip, zero.

Welcome to the future of health care in America. Better stay healthy.

Merry Christmas!

SantaHere’s wishing you all a very blessed a Merry Christmas!

Enjoy your family, the great food, and the time off.

And be mindful of its meaning:

Now in those days a decree went out from Caesar Augustus, that a census be taken of all the inhabited earth. This was the first census taken while Quirinius was governor of Syria. And everyone was on his way to register for the census, each to his own city. Joseph also went up from Galilee, from the city of Nazareth, to Judea, to the city of David which is called Bethlehem, because he was of the house and family of David, in order to register along with Mary, who was engaged to him, and was with child. While they were there, the days were completed for her to give birth. And she gave birth to her firstborn son; and she wrapped Him in cloths, and laid Him in a manger, because there was no room for them in the inn.

In the same region there were some shepherds staying out in the fields and keeping watch over their flock by night. And an angel of the Lord suddenly stood before them, and the glory of the Lord shone around them; and they were terribly frightened. But the angel said to them, “Do not be afraid; for behold, I bring you good news of great joy which will be for all the people; for today in the city of David there has been born for you a Savior, who is Christ the Lord. “This will be a sign for you: you will find a baby wrapped in cloths and lying in a manger.” And suddenly there appeared with the angel a multitude of the heavenly host praising God and saying, “Glory to God in the highest, And on earth peace among men with whom He is pleased.”

Our Gnostic Masters

The madman is not the man who has lost his reason. The madman is the man who has lost everything but his reason.
 
       — G.K. Chesterton —

We have become a nation of experts.

They are everywhere: on TV, advising us about raising our children or improving our sex life; in magazines and newspapers, lending a measure of weight to opinion pieces disguised as news; in business, promising to improve productivity and bolster profits through higher productivity, or slicker marketing, or yet another reorganization or “team-building” project. They are ubiquitous in government and politics, lending credence to the implausible and certainty to the unpredictable. Armed with statistics, and studies, and the ethereal proclamations of other unnamed experts like unto themselves, they saturate our psyche with innumerable “facts” and figures, that we may live perfect lives in an imperfect world. The chaos which swirls around us need not engender fear and hopelessness — there will always be an expert to hold your hand, lest you become lost and wander from life’s perfect path.

Intimidated by their credentials and self-assured certainty, we slowly relinquish the uneasy feeling that their advice and conclusions invariably run counter to our experience, and common sense, and the simple wisdom of life acquired through parents and parish, logic and lore. Theirs is a relentless battering of our natural defenses, made ever more potent by lives lived without margin, frantically running to and fro, pursuing the very goals our experts have set forth, while quietly dying to the insight gained by simplicity and satisfaction with life’s precious but fragile treasures. Their strident advocacy drowns out the the quiet wisdom whispered to the soul in contemplation and prayer, found only in reflection and the fertile soil of rich relationships.

The fecklessness of our experts is often utterly dispensable, if annoying, as our guilded guides waffle from truth to contradictory truth: “Take estrogen!” “Don’t take estrogen!” “All fats are bad!” “These fats are good!” “Sun causes cancer!” “Sun prevents cancer!” What is true today will be foolishness tomorrow — and nary a hint of humility will be heard from those who hustled us mere months before.

As our increasingly secular and superficial culture abandons the transcendent truths of faith and the tested wisdom of tradition, we search desperately for a lodestone upon which to ground our lives, and so trade trust and belief in transcendent and transformational absolutes for fear and the desperate desire to control the world which has become our enemy. We frantically cling to every proffered proof, no matter how foolish or feckless, seeking something upon which to ground and anchor our lives. As these sands shift dangerously beneath our feet, we lurch and stumble from fragile branch to broken rail, as we stagger along a path which leads ever downward.

Yet the allure of the experts can prove far more destructive than mere personal angst in a turbulent, fast-moving world: how many listened to the professionals who told us we could not lose in real estate? Leverage to the max, it can only go up! The consequences across the economy have been devastating — except for those who sold us this sage advice. These “experts” understood the game far better than the market, and walked away unscathed and wealthy, leaving only our wreckage in their wake.

Our dependence on the guidance of scientists, economists, educators, and technocrats proves especially toxic when their expertise becomes wedded to money and political influence. Under the guise of shielding us from the complexity of their disciplines, they evolve into closed guilds, guardians of a secret knowledge which we, in our harrowed and hectic lives, have no time and little interest in understanding. As our educational system — itself run by a closed guild — produces generations of students tutored in woman’s studies, postmodern deconstructionism, and the evils of the West, yet ignorant of logic, philosophy, and the rigors of the hard sciences, the problem is compounded. We increasingly are left with little recourse but to trust those who guard and disperse the hidden knowledge we no longer comprehend. Our gnostic masters dispense their wisdom; ours is but to nod, and obey.

Nowhere can this process better be seen than the unfolding drama surrounding the East Anglia email scandal. Centered on one of the three major centers for climate research and data in the world, the hacked emails and software code have ripped open the veil to show us the inner sanctum of science utterly corrupted and politicized. At issue is anthropogenic global warming (AGW) — the theory that recent warming trends in global temperatures are caused by rising levels of carbon dioxide from human activity, fostered by industrialization. It has long been a theory which struggled to pass the sniff test, placing undo weight on a trivial component of so-called greenhouse gases, while ignoring the enormous (and obvious) impact of solar activity, water vapor, and cloud cover. Yet for years we have been told — in increasing shrill and strident tones — that this theory is “settled science,” and there is an imminent crisis at hand.

It has been fascinating to watch this ball of yarn unravel. In what may prove to be the greatest hoax mankind has ever witnessed — most certainly the one with almost unimaginable financial impact globally — we are watching the “settled science” of AGW disintegrate. We read how data was manipulated to hide declining global temperatures and make them appear to be rising sharply (“Mikes nature trick“). The peer review process made sure no contrary or skeptical opinions were published, and efforts were made to delegitimize journals which published such articles. Proxy data such as tree-rings were cherry-picked to ensure that the data conformed to the AGW philosophy. FOIA requests for data were met with stonewalling and destruction of raw data. The homogenization of temperature station data — making adjustments to the temperatures to reflect changes in the surrounding environment, such as urbanization — showed shows striking and arbitrary adjustments to demonstrate a sharp rise in temperatures when no such changes existed in the raw data. Other major climate research centers are similarly stonewalling raw data requests. The data problems just scratch the surface; the software used to generate reports and alarmist graphs was incompetently written by amateur programmers — and could not even reproduce the graphs from the original data without massive software hacks and fudge factors — by the programmer’s own admission.

The response of climate scientists to these devastating revelations? Denial and attack. The response of the UN Climate gurus and American and Western policy makers? Denial and attack. The response of the media to this massive global meltdown of AGW “settled science? Silence.

Amazing.

Whatever the role of human activity in global warning, one thing is abundantly evident: the current “science” of AGW is not really science at all, but more closely resembles a pernicious, cultic religion. Its priesthood holds the secret knowledge about “climate change,” and we the fools who question or challenge them engender naught but condemnation, ridicule, hatred and disdain. For the priesthood and the true believers who bow to them, the payoff for guarding their secrets are huge: for our scientist priests, millions in research grants, often at taxpayer expense; for the evangelists (Al Gore comes to mind), the ability to engender hysteria with wild, apocalyptic climate claims while raking in millions on carbon trading and investments in “green” technology; for the politicians, the opportunity to further extend the control and power of government into every aspect of its citizens lives while pocketing huge political contributions from environmental groups and green industries.

We have been lectured endlessly by our postmodern mentors that religion is naught but ignorance and superstition, while scientific “facts” are Truth. But “knowledge is power,” as the saying goes — especially when the knowledge can be hidden behind a veil of secrecy, manipulated at will to conform to unchallengeable presuppositions and philosophies, then relentlessly drilled into our collective consciences through compliant and complicit channels of media, education, and politics.

The climate scientists are hardly alone in such gnostic gambits; evolutionary biology — whose “scientists” seem to spend most of their efforts proving that God doesn’t exist rather than demonstrating that their tattered and threadbare theories of evolution have an actual basis in reproducible science and genetics, and a demonstrable and reliable predictive value (which all solid science must have) beyond the the pure speculation and projection that comprises most evolutionary science. Think I’m being a crazy fundamentalist creationist? Try, as a scientist, to demand that evolutionists satisfactorily answer any host of devastating challenges to their theories: the irreducible complexity of biological subsystems such as the eye, the cellular mitochondria and intracellular protein factories; the entropy problem (complex systems tend naturally to disorder and chaos, not more complexity); the Cambrian explosion; the impossibly long odds that all physical constants stood at precisely the correct values at the instant of the Big Bang; the enormous problem of free will, higher intellect, and purpose in the human animal which has no precursors in lesser beasts. Challenge these — even with understated, respectful, and serious questions — and watch how quickly the ad hominem attacks begin, how quickly you will be excluded from “peer reviewed” literature, ridiculed and ostracized, and labeled as an ignorant creationist fundamentalist, an enemy of science — or worse.

In our repudiation of a world based on absolutes and transcendency, our free fall into secularization has ironically left us clinging to science as our sole absolute, our foundation in a world which no longer makes sense, in which there are no true absolutes. Yet science cannot bear such weight alone, detached as it has become from notions of absolute truth and the true nature of the creation that is man and his universe. It has become instead a tool of power, and manipulation, and deception. The ship of knowledge no longer has an anchor, and drifts aimlessly toward the rocks of self-righteous deception and the shoals of arrogance.

G.K. Chesterton, writing nearly a century ago, mused that “this is the age in which thin and theoretic minorities can cover and conquer unconscious and untheoretic majorities.” What was true then is ever more true today, as we relinquish our own convictions and the truths which come by faith and tradition for the perilous tyranny of rule by experts. True freedom requires absolute truth, with its liberating transparency and the humility of knowing we are not gods. Science detached from absolutes will not bring progress but peril, not truth but tyranny. In our quest for the Utopia which technology enticingly promises, to forget our foundational truths is to invite disaster and slavery.

Sadly, we are already well on our way.