The Doctor Is In

a physician looks at medicine, religion, politics, pets, & passion in life
 

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Our limited minds cannot grasp the mysterious force that moves the constellations.
--Albert Einstein--

Still Breathing…

June 21st, 2011 · 15 Comments  

Word of my demise, widespread and nefarious as it has been, is most assuredly premature. I must put these scurrilous rumors to rest…

But life has been, well, most interesting

The past year or so has been one of the most challenging in many a season, on a number of fronts. Professionally, the passage of Obamacare has made it abundantly clear that the independent private practitioner is a dying breed, and likely will disappear — with the exception of cash-only, concierge-style arrangements — within the next few years. The administrative burden is crushing — unfunded mandates, such as pay-for-performance, compliance programs, HIPAA, mandated “government certified” EMRs (even though existing, non-certified ones are fully functional), and intrusive, abusive audits by the Feds and third party carriers. Such mandates and regulatory excesses place, or will soon place, such an overwhelming burden on the solo physician or small group as to make their continued existence unsustainable, even in the near term — and the full implementation of Obamacare will put roses on their grave. Reimbursements are dropping precipitously (my income dropped about 25% last year), as expenses spiral upward (employee health insurance rates are up 25%; malpractice rates up 15%, etc., etc.). The small business model of solo practice or small medical group is rapidly becoming extinct: its executioner, Big Government and Big Insurance.

The medical-legal environment remains as hostile and capricious as ever — I have endured two lawsuits in the past three years, both resolved with decidedly mixed outcomes while taking an enormous toll both in time wasted and emotional sobriety. I hope to share some insights thus gleaned on this horrendously dysfunctional system in the not-too-distant future.

Personally, although my health remains good, the exhaustion borne of these and other struggles had taken much of the joy and energy from life. The time for renewal was long overdue.

And so, big changes are in store: my practice will be sold in the next few months to a large medical group affiliated with a nearby hospital, and I will have as a primary responsibility inpatient hospital care, with a much diminished office practice focusing primarily on my specialty of male infertility and vasectomy reversal. I have decidedly mixed feelings about this change — I anticipated going to my deathbed as a private, solo practitioner, loving the independence and rich patient relationships which this brings.

But I am weary. After nearly 30 years in private practice, I am not sure which straw broke the camel’s back, but it is most surely broken. It is a weariness born of 14 hour days; of dictating charts and finishing paperwork until 8 or 9 pm each night, after starting the day at 7 am; of endless audits by the insurance industry and Medicare; of the constant threat of litigation; of the crushing burden of one more federal requirement mandated but never recompensed; of a host of ever-expanding administrative burdens having nothing to do with patient care, and everything to do with bureaucratic micromanagement of the profession. And this before we have even begun to see the nightmare which Obamacare will inflict. Camels weren’t designed to carry such a load.

But the change is nevertheless much anticipated in a host of other ways, with its reduced administrative and regulatory burdens, and substantial increase in free time. For me, the war is over: I have fought the good fight, and no longer see it as profitable to battle the inexorable forces which threaten to crush a beloved profession. My spirit is in many ways free now, as though a great burden has been lifted. God is good, and has been gracious and kind to me in so many ways.

I have needed an extended break from blogging to process these many life changes, but in its absence have heard the siren call of the muse quietly whispering to my soul.

So I am back — bitterly clinging to God, guns and guitars — and hope to speak of each in their turn, among others, as the spirit moves. For those who have checked back regularly, only find a petrifying post from the past, you have my great gratitude for your loyalty. I hope to reward that loyalty with something of worth in the coming days.

Tags: Blogging · General Interest · Health care reform · Medicine

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Meditation on Good Friday

April 22nd, 2011 · 2 Comments  

Today is Good Friday. It has been my custom, on this extraordinary day, to post an old meditation on the meaning of the cross, called Three Men on a Friday. Today, however, I feel led to meditate on something rather different, though not unrelated.

Good Friday, of course, is the Church’s remembrance of its most central truths: that God became man, was crucified to pay the price which we could not pay, and was raised victorious on the third day. Good Friday is a somber day, a day to remember that we individually are responsible for the torture and agony which befell Christ — that he hangs on the Cross in our stead.

Yet, in the deep sorrow and humility which we bring to mind on this profound day, there is also an extraordinary hope: that in our greatest disasters, in our biggest failures, in our most agonizing and painful moments, there is a purpose, a plan, a hope which is both utterly irrational, yet absolute and sure.

Good Friday teaches me that failure is not to be avoided at all costs, but instead embraced as a great opportunity. Good Friday teaches me that my lifelong struggle for perfection is doomed to failure, and is chasing after the wind. Good Friday teaches me that I have no idea what is best for me, that pain and suffering have a purpose which I need not, and often should not, understand. Good Friday teaches me that God can make sparkling diamonds out of filthy coal, that my worst attributes, my most painful failures, the most disastrous events which have befallen me beyond my control, are but the building blocks of a new and far better life in hands of God.

I have recently shared some of the struggles in my life, especially my professional trials, and these have indeed taken no small toll on my spirit. Beyond that, like many, I have watched as a country which I love, whose institutions and traditions have blessed and prospered millions, is undermined and corroded by greedy men lusting for power who serve only themselves. Like many, this has been most painful to watch, engendering much anger, frustration, dismay, and discouragement.

Yet I must not forget that I too am greedy, that I too seek to control others and manipulate my world for my own benefit and betterment. We hate most in others what we see in ourselves, and our instincts scream to return evil for evil. Yet by so doing, I enslave myself to those who would enslave and destroy me.

The Cross teaches me another way. It teaches me, quite simply, that God is in control of all things, and that His ways are not my ways. It teaches me that the darkest hour comes before dawn, that God can use evil for good, and that only by bending my will and my knee before Him, no matter what the cost, can my own victory and deliverance, and that of others, be purchased.

We are at war. This is a war, not merely of bombs and guns, nor of words and arguments, nor of politics and power. It is an ancient war, from the very beginning of time: a war between the will of man and the will of God. One way is the way of hatred, anger, revenge, and destruction, whose outcome, no matter how fleeting its seeming victories, will inevitably and invariably lead to defeat and destruction. The other way is that of submission, of self-crucifixion, of “not my will but Thine.” Every fiber of my being strains against this way; every inclination of my will and spirit runs contrary to such surrender. Yet on the Cross, surrender, humiliation, agony, and defeat became the very instruments used of God to reconcile man — stubborn, rebellious, hateful man — to Himself, and to bring new life, and new power, and new hope to those who would follow in the irrational ways of God. And this war must be fought and won, first and foremost, within me.

Yet in this way of submission, brokenness, and humility, we are not called to passivity nor defeat. We are called — each in our own way, using our own gifts — to do battle. For some this will be a way of persuasive words, or prophetic proclamation of the evil which surrounds us. For some it will be writing letters, contributing money, volunteering time and effort, running for office, becoming involved.

But for all, first and foremost, it must begin with prayer, with self-examination, with the submission of every aspect of our lives to the will and wisdom of God, for judgment begins with the house of God. It is time, quite literally, to be on our knees; it is time to fast, to repent, to make amends, and take hold of that joy and purpose which can only come by aligning our wills with that of Him who paid the ultimate price to make us whole.

We do not know — we cannot know — what the outcome will be; the ways of God are vastly higher than our capacity to understanding, and our efforts will come to naught if we try to bend the plans of God to the will of man. We must submit to crucifixion if we are to see the Resurrection.

There are many paths, the broad leading to destruction, the narrow to life. May God give us the will and the wisdom to follow that narrow path.

Tags: Christianity · Cross · Crucifixion · Faith & Religion

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Doin’ da Bird

November 24th, 2010 · 4 Comments  

This post was published first several years ago, just after Turkey Day. But before T-day makes more sense — so here it is.
 
turkey
 
OK, just when you thought it was safe to forget about the overindulgence and caloric excesses of Thanksgiving day, here comes another blog post on Thanksgiving recipes. This one sticks to the basics: roasting the turkey itself and making gravy. It is my traditional holiday task to make the dim-witted bird into a delectable feast (and yes, I know wild turkeys are very smart), so this recipe has matured with age–unlike me. So grab your blunderbuss, put on your Pilgrims hat, and let’s get to it.

Continue reading: Doin’ da Bird  →

Tags: Cooking

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Thoughts on Thanksgiving

November 22nd, 2010 · Comments Off  

Before the joys and trials of family get-togethers, the bacchanalian consumption of endless pounds of poultry, and the weariness of holiday travel tempered only by the thrill of a TSA patdown, it is perhaps fitting to pause and reflect a moment on the reason for the season we celebrate this week: Thanksgiving.

Like most of our holidays, Thanksgiving has become commercialized, sterilized, and neutered, long ago detached from its original significance, its spiritual roots withered and wizened, lost in the ever-longer lead-in to the crass commercialism of Christmas. To be sure, we nod in its direction, with cursory platitudes of gratitude for material blessings and bountiful food. Yet our lives betray the truth behind the truisms: we are a most unhappy, ungrateful, ungracious, and resentful lot. We who reside amidst the greatest wealth ever accumulated, suffer from an acquisitive sickness, a deep and abiding unhappiness which even greater and ever more cannot heal. We live in expectation more than acceptance, revenge rather than reconciliation, greed not gratitude. For all we have, we have not peace, and thanksgiving is the farthest thing from our minds and hearts.

So what then of gratitude, of true thanksgiving? It is not the cheap grace of the smug acknowledgment of all we possess, lest we be seen by others as a selfish boor. Nor is it some warm emotion poured forth like spirits from a crystal decanter, transparently empty after its contents are spilt. It is indeed poorly expressed by words alone, which cost far too little to repay our debts.

It is, rather, a proper sense of perspective, grounded in a larger vision of purpose. It recognizes, first and foremost, that we are limited and flawed, not the pinnacle of evolution but the pride — and the problem — of creation. We are magnificently made but fatally flawed; we aspire to the stars but stumble in the mud. What we have is not what we have earned, but we we have been given — and far too often used not for glory but for gain.

Thanksgiving tells us that we have a higher purpose, a calling which draws us toward the divine, in order that His highest purposes are fully served. It tells us we are hopelessly handicapped in our pursuit of this noble calling, waylaid in wanton selfishness and frivolous foolishness, distracted from our goal by baubles and the banal. Indeed there is little hope of restoring our vision but by grace, by the gracious hand of God to guide, empower, and correct us. It is in this extraordinary reality that true gratitude is found, that we who have hated the good have, in spite of ourselves, been called back home, in forgiveness and with vision restored, to be made useful and purposeful again, to be made new.

This grace empowers gratitude, for it opens all things, both good and bad, to the possibility of redemption. For the good we may be grateful, not merely that it blesses us, but that it enables and empowers us to serve and give to others. Our trials and liabilities, too, become tools by which we may reassess and redirect our lives, growing in empathy for the suffering of others, and in trust in the inscrutable goodness and wisdom of God, who uses evil for good. Our thanksgiving is a celebration of freedom — the freedom to transform all things, whether good or evil, to the higher purposes of God.

A cynical and empty culture knows nothing of this miracle of grace, and thus has no gratitude, no graciousness, no humility or hope. We are called, in this season of Thanksgiving, to be a light shining in a dark and empty world, which by disowning transcendence has destroyed its hope.

Let us, then, be truly grateful this Thanksgiving, for the grace of redemption, the hope of transformation, and the mercy shown to us through Him who is most gracious.

Have a most blessed and fruitful Thanksgiving.

Tags: Christianity · Faith & Religion · Grace

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On Faith I: Faith & Reason

November 8th, 2010 · 3 Comments  

Grand opening, first Tacoma Narrows BridgeIn July 1940, an engineering marvel was completed: the first Tacoma Narrows Bridge. One of the longest suspension bridges in the world at the time, it exemplified the light, graceful architectural trend of suspension bridges built in this era. Called the crowning achievement of his career, designer Leon Moisseiff — the architect of the Golden Gate and Bay bridges in San Francisco — later declared “our plans seemed 100% perfect.”
 
 
Yet 4 months later, on November 7 1940, the Narrows Bridge catastrophically collapsed in a windstorm into Puget Sound.

Gertie collapsesLeon Moisseiff had unshakable faith in the reliability of his newly-completed masterpiece. He would have had no qualms whatsoever trusting its dependability in any weather conditions. Yet had he stood upon his own creation on November 7th, 1940, his faith would have been fatal. The object of his faith was unreliable, and the strength of his faith irrelevant.
 
 

Faith has become the diametric of reason … practiced only by deluded fools who reject the graceful catenary and steel-plate certainty of scientific rationalism.

Faith is an idea frequently voiced, but little understood. It is commonly mentioned in the pejorative sense in today’s secular society, where it has become a proxy for belief in the unbelievable, the unprovable, the superstitious and the mythical. Faith has become the diametric of reason — unreasonably so, as we shall see — practiced only by deluded fools who reject the graceful catenary and steel-plate certainty of scientific rationalism.

Yet faith–not love–makes the world go ’round. You exercise faith when you place the key in the ignition and start your car. You have faith when you flip a switch, expecting light to rush forth from a fixture, or music from stereo speakers. You have faith that your coat will keep you warm and dry; your plane will stay aloft; your surgeon will bring you through a heart bypass. The atheist has utter faith in his reason, that belief in God is beyond logic and therefore must be rejected. Such faith is nothing more than trust: a confidence that the object is reliable, the tool is trustworthy, its behavior predictable, its nature dependable. In the physical realm, such trust may be based in part on knowledge — one can study the flow of electrons and principles of resistance which make a light bulb glow — but such erudition is entirely optional, and rarely grasped by those who rely on its behavior. The object of faith may be entirely reliable yet utterly beyond our comprehension — or, as Leon Moisseiff discovered to his great dismay, deeply understood yet profoundly unreliable.
 

Continue reading: On Faith I: Faith & Reason  →

Tags: Best of: Faith & Religion

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Open Source Politics

September 19th, 2010 · 4 Comments  

If you have not done so, I encourage you to mosey over to the National Journal and read Jonathan Rauch’s in-depth analysis of the Tea Party movement: How Tea Party Organizes Without Leaders.

The Tea Party movement which has arisen over the past two years has proved an enigma to politicos and pundits alike. Unable to grasp its essential nature, caricatures and character assassinations have abounded, and the straw man thus erected — angry, racist, extremist white men, secretly funded by corporate America and puppets of the Republican Party — bears no resemblance to the reality on the ground. In reality, the Tea Party represents open source politics — individuals empowered by connectivity and the internet, functioning in many ways like a living organism.

If you have been reading John Robb’s Global Guerrillas blog (and you should, if you want some deep insight on how society and the nation-state are evolving to something radically different than that to which we have known over the past half-millennium) you will recognize well its form: the empowerment of individuals and small groups by technology and connectivity, undermining and hollowing out centralized command-and-control structures, whether they be military, governmental, or political in nature, utilizing their very size, ossification, and inertia against these institutions in sociopolitical jujitsu.

The Tea Party movement has grown out of the widespread frustration with aristocratic, corrupt government and politicians, of both parties, indifferent and contemptuous of their so-called constituents, running a nation reeling toward bankruptcy as their “experts” increase their control over society with increasingly reckless and destructive policies and plans.

The goals and concerns of the Tea Party movement are laudable and widely held: reign in out-of-control spending and massive expansion of government; address our disastrous spiraling national debt; increase the accountability of politicians and civil servants to the public; foster transparency and rational governance among the elected. The Tea Party has the potential to bring about enormous changes in our political system — which is why those entrenched in power fear it so, while understanding it hardly at all.

But we would be foolish if we were to ignore the downside potential of this 21st century phenomenon. The potency of connectivity and instantaneous communication, unbounded by geography and national borders, resides in the leveraging of the Lilliputians: a small terrorist faction with a few thousand dollars can destroy an oil pipeline carrying billions of dollars of crude; an unknown pastor with a match and a Koran can trigger a global crisis in Islam. A miscreant with a web site can expose tens of thousands of secret military documents, endangering the lives of thousands of informants and forcing changes in strategy in billion-dollar military campaigns. A broker with an incorrect trading order can spark a flash crash in global stock markets, potentially triggering a financial crisis costing trillions.

Our current government has become profoundly dysfunctional. Its massive size creates an enormous inertia rendering it incapable of responding appropriately to even the most straightforward problems; it is a paraparetic pachyderm crushing everything it stumbles toward. Its politicians and civil servants have created an impenetrable fortress, gerrymandering their way to eternal election, indenturing the the taxpayer to support lavish and corrupt lifestyles and unsustainable public salaries and benefits. The Tea Party is a response to the widespread frustration and helplessness engendered by a preening, ignorant, arrogant aristocracy which treats its citizens with utter contempt as it squanders their grandchildren’s future to further entrench themselves in power. Party no longer matters; all are spoiled royal heirs whining and squabbling over who wears the king’s robes.

The Tea Party movement — loosely organized, decentralized, superempowered by modern technology and connectivity — may represent our best, and perhaps last, hope of reversing the disastrous and destructive bent toward an economically bankrupt aristocratic dystopia. It is by no means assured of success; our fate may already be preordained, and we do not know how well those elected by them might govern. But the genius of our young republic resides in the checks and balances of tripartite, representative government. It is not a populist democracy, as was ancient Greece — indeed the Founders saw the dangers of purely populist government, where charismatic despots or a fickle and easily-swayed populace could make drastic changes in governance ultimately destructive to the health and integrity of the nation.

The empowerment of a populist revolt is not without risks: an enraged and empowered populace could sweep into power those supportive of despotism, or religious persecution, or reckless policy-makers who could trigger financial or social meltdown.

But one thing is clear: the rules of the political game have changed, forever. Let us hope and pray they have changed for the better.

Tags: Politics & Culture

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The Doctor Will See You Now – Or Else!

July 25th, 2010 · 16 Comments  

 
It has been clear since the passage of Obamacare, with its ludicrous economic projections and Enron-accurate accounting, that the outcome of this gargantuan medical gewgaw will be enormous shortfalls in funding for healthcare. The long-term consequences of its financial chicanery are legion, from spiraling deficits, to drastic cutbacks in funding to hospitals and health care providers , to the hyperbolically-described “death panels”: restrictions in payment for health care services as determined by faceless bureaucrats, based on cost considerations masquerading under the paper-thin guise of “medical consensus.”

One of the most disastrous aspects of this plan, both economically and practically, has been the decision to provide coverage for the low-income uninsured by rolling them into Medicaid, the joint federal and state health insurance program for the poor. Medicaid in virtually every state has been an economic disaster, leading to massive state budgetary deficits, and reimbursements to physicians and other health providers substantially below the costs of providing services. This has resulted in the inevitable migration of physicians out of Medicaid, and increasingly from Medicare as well, as Medicare treads the same path of massive bureaucratic burdens on providers and sharply declining reimbursements. The end result has been a crisis of access, where covered patients under these federal programs are increasingly unable to find physicians who will see them. The massive expansion of beneficiaries in Medicaid will drastically worsen this access problem, leaving many, if not most, of the newly covered without health care.

In a classic statist response to this inevitable and impending crisis, our aristocratic masters have discovered, anew, the joys of coercion and intimidation in solving another of their self-engendered debacles:

Justice Department declares war on doctors

Today the Antitrust Division, joined by Idaho Attorney General … forced a a group of Boise orthopedists to accept price controls for worker’s compensation and HMO contracts as part of a settlement accusing the doctors of “price fixing.” According to the complaint, the conspiring orthopedists engaged in two antitrust conspiracies, which took place from 2006 to 2008. In the first conspiracy, through a series of meetings and other communications, the orthopedists agreed not to treat most patients covered by workers’ compensation insurance.

They entered into a group boycott in order to force the Idaho Industrial Commission to increase the rates at which orthopedists were paid for treating injured workers. The Idaho Industrial Commission sets the fee schedule that determines the amount that orthopedists and other healthcare providers receive for treating patients covered by workers’ compensation insurance. The boycott resulted in a shortage of orthopedists willing to treat workers’ compensation patients…

In the second conspiracy, all of the defendants … and other conspiring orthopedists agreed to threaten to terminate their contracts with Blue Cross of Idaho. They jointly threatened to terminate their contracts to force Blue Cross of Idaho to offer better contract terms to orthopedists.

The proposed settlement prevents the Idaho Orthopedic Society and the named orthopedists from agreeing with their competitors on fees and contract terms. The settlement also prohibits them from collectively denying medical care to patients, refusing to deal with any payer or threatening to terminate contracts with any payer.

To say this action is chilling is a profound understatement: the implications of this settlement are nothing less than the erosion and ultimate destruction of our current system of providing health care in this country.

At first glance, this appears to be a legitimate attack on a price-fixing scheme by physicians to increase their income. The reality is far more sinister.

The Justice Department, in cooperation with the Idaho State Attorney General, brought suit against the physicians under the Sherman Antitrust Act. Passed in 1890, it was designed to prevent collusion by Standard Oil and other oil companies to raise prices by creating monopolies or cartels. The Act and its application has been controversial since day one, and it has morphed over the years to address real or perceived commercial malfeasance far removed from its original intent.

The case against the physicians in Idaho represents a tectonic shift in the way government deals with the physicians they pay. As the Mises Economics blog points out:

This case is a watershed for two reasons: First, until now the Federal Trade Commission, not the Justice Department, has taken the lead in prosecuting physicians. Since 2000, the FTC has brought about three dozen cases against physicians (all but one of which settled without any trial). But the FTC only has civil and administrative jurisdiction; the Antitrust Division has civil and criminal jurisdiction. The Sherman Act makes no distinction between civil and criminal “price fixing,” so in a case like this, it’s entirely a matter of prosecutorial discretion whether to charge the doctors with a civil or criminal offense. Based on the descriptions in the Antitrust Division’s press release, there’s certainly no reason they couldn’t have prosecuted the doctors criminally and insisted upon prison sentences — and there’s little doubt such threats were made or implied to obtain the physicians’ agreement to the proposed “settlement.”

The second reason this is a landmark case is that the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.” The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices,” in the form of the Idaho Industrial Commission’s fee schedule. The IIC administers the state’s worker compensation system … This isn’t a quasi-private or semi-private entity. It’s a purely government operation.

What’s more, the Antitrust Division has linked a refusal to accept government price controls with a refusal to accept a “private” insurance company’s contract offer. This leaves little doubt that antitrust regulators consider insurance party contracts the equivalent of government price controls — and physicians and patients have no choice but to accept them.

Please read the whole article, in particular the update at the end. This settlement is nothing short of stunning.

Has the nickel dropped yet?

Virtually all health care provided in this country is contractual, whether by the Federal Government or third party private insurers. The consolidation of the insurance industry and the growth of government-funded health care — which Obamacare vastly expands — means that, with the exception of certain cash-based niches such as cosmetic surgery and Lasik procedures, physicians are legally obligated to accept the contractual fee for any covered service. The cartel in health care lies not with the physicians — who remain loosely organized if at all and prohibited (rightly and ethically so, in many ways) from unionization — but with the government and the insurance industry. The insurance industry closely tracks federal actions, both in regulation and fees — and hence both private insurance and the Federal Government collude in very real ways to fix physician fees.

In most areas of the country, a small number of major national insurance carriers insure the vast majority of patients not covered under Federal programs — thus leaving physicians largely powerless to refuse the increasingly austere payments these plans offer, lest they find themselves without patients. Thus the government and private insurance carriers are free to ratchet fees downward to the point where there can no no longer be economic viability for physicians. This is exactly the scenario under which the Idaho orthopedists declined to see patients — very reluctantly — who were covered under workman’s compensation, and threatened to withdraw en mass from their Blue Cross of Idaho contracts. They quite simply had no other leverage against the government/insurance cartel.

Now they have none.

It is important to realize that under antitrust law, there does not need to be a formal agreement or conspiracy to “fix prices” — collusion can be inferred by the behavior of competitors, to wit: if enough physicians in an area decline to see, say, Medicaid patients, because of unsustainably low fees, the Justice Department may infer that they are colluding to fix prices, and move against them with an antitrust action.

Checkmate.

It should not be difficult to see the inevitable outcome of this coercive economic thuggery. Physicians will inevitably be forced into large organizational relationships — primarily hospital-based (toward which there is a virtual stampede from private practice over the past 2 years) for economic security. But this financial haven will prove short-lived, as the endless financial pressures of burgeoning health care costs and spiraling federal and state deficits will drive many physicians from practice altogether as burdensome regulation and plummeting incomes ultimately drive the best and the brightest to find employment elsewhere. There will then be no doctor to see you — coerced or not — and the answer, as always the case in such government-engendered crises — must be a government solution: government-employed physicians. Hello, National Health Service.

Hyperventilatory, catastrophizing rhetoric? Right-wing extremist fear-mongering? Hysterical overreaction to loss of income? No, none of the above. Mark my words, we are witnessing the disassembly of the American system of medicine — a system which, for its many flaws, has provided the best and most advanced health care the world has ever known. For some, its destruction will be a victory, flush with the naive Utopian vision of universal, government-controlled health care.

For you, the patient, the outcome will prove far less sanguine.

Tags: Health care policy · Health care reform · Medicine

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The Coming Cataclysm

June 13th, 2010 · 8 Comments  

It is late in the day, and few are prepared for the darkness coming. The signs, it seems, are everywhere:

U.S. Treasury 2009 Financial Report Shows Dire Course

The Treasury Department recently issued the 2009 financial report of the United States government. … the annual report is untainted by creative accounting but also because its message is too important to ignore.

That message is that the sky is indeed falling…

…simple addition indicates that the total net position of the government is a whopping negative $57.4 trillion… if current policies are left unchecked U.S. government debt held by the public will increase from approximately 80 percent of GDP today to 700 percent in 2080.

The Fiscal Nightmare of the Welfare State

Bloggers post what they claim to be the scariest economic chart or the chart of the century. Indeed, many data sets are frightening, but none more so than the tables found here. This data shows incontrovertibly that modern government has failed. These countries are all insolvent and will eventually default.

All Western democracies are on death row. The unlimited welfare state is the cause. Some governments are delusional, believing they can continue on their present paths. Others cling irrationally to hopes of some miraculous reprieve. All are dead men walking.

Is Greece Just the Tip of the Iceberg?

Virtually every country in the EU spends more than it takes in and has made long-term fiscal promises to an aging work force that it can’t keep … Europe would have to have the equivalent of roughly $60 trillion in the bank today to fund its very general welfare benefits in the future. Of course, it doesn’t.

Today, Greece is only the tip of a very large iceberg.

America in the Red

America is digging itself into a deep fiscal hole. In 2009, the federal government spent $3.5 trillion, but took in only $2.1 trillion in revenue — thus spending $1.67 for every dollar it collected. The resulting $1.4 trillion deficit was equivalent to 10% of the nation’s economic output, the highest percentage since the end of World War II. America’s publicly held debt now totals $7.5 trillion, about 53% of gross domestic product — the highest it has been in more than 50 years.

These figures are alarming, but they pale in comparison to budget projections for the years ahead… By 2020, the United States would owe more than $20 trillion, the equivalent of about 85% of GDP. At that point, interest payments alone would consume about $900 billion a year — almost five times as much as they did in 2009.

The outlook grows even more bleak when we account for the ongoing retirement of the Baby Boomers and further increases in public spending on health care… The twin pressures of increased entitlement spending and slowing revenue growth mean that the debt will skyrocket — to roughly 200% of GDP in 2035, under one CBO scenario — unless there are dramatic cutbacks in all other government activities or an equally dramatic increase in taxes.

The euro crisis is a judgment on the great lie of ‘Europe’

We have still scarcely begun to wake up to the gravity of the crisis now upon us, not just for the eurozone but also for us here in Britain and for the entire global economy. The measures so far taken to prop up the collapsing euro, such as that famous “$1 trillion package”, are no more than gestures.

Greece was just the antipasto: Italy, Spain, Portugal and others are now hanging over an abyss of debt which scarcely all the money in Europe could fill – created by countries living way beyond their means, thanks not least to the euro’s low interest rates. The only possible consequence of the collapse of one of the world’s leading currencies, leaving Europe with no money to trade in, would be utter chaos…

…If the euro does disintegrate … the consequences would be incalculable … Without a currency, trade would collapse – leaving Britain, dependent on Europe for 50 per cent of its trade, just as seriously affected as everyone else. A system failure on this scale would make the 1930s pale into insignificance…

Dow Theorist Richard Russell: Sell Everything, You Won’t Recognize America By The End Of The Year

Do your friends a favor. Tell them to “batten down the hatches” because there’s a HARD RAIN coming. Tell them to get out of debt and sell anything they can sell (and don’t need) in order to get liquid. Tell them that Richard Russell says that by the end of this year they won’t recognize the country. They’ll retort, “How the dickens does Russell know — who told him?” Tell them the stock market told him…

… If the two Averages violate their May 7 lows, I see a major crash as the outcome. Pul – leeze, get out of stocks now, and I don’t give a damn whether you have paper losses or paper profits!

Is Europe heading for a meltdown?

The Bank of England Governor summed it up best: “Dealing with a banking crisis was difficult enough,” he said the other week, “but at least there were public-sector balance sheets on to which the problems could be moved. Once you move into sovereign debt, there is no answer; there’s no backstop.” … Politicians temporarily “solved” the sub-prime crisis of 2007 and 2008 by nationalizing billions of pounds’ worth of bank debt. While this helped reinject a little confidence into markets, the real upshot was merely to transfer that debt on to public-sector balance sheets. This kind of card-shuffle trick … is not so different to the Ponzi scheme carried out by Bernard Madoff, except that unlike his hedge fund fraud, this one is being carried out in full public view.

No worries, mate — sleep well.

Of course, this is merely the opinion of the pessimists, who, if they predict calamity long enough will eventually prove right. The optimists say: no worry, the economy’s getting stronger, and once that bipartisan commission on deficit reduction reaches its conclusions we’ll just spend our way out of this crisis, just like we always have in the past…

Meanwhile, the U.S. Treasury is buying its own T-bills to artificially suppress interest rates; states are going bankrupt, issuing IOUs instead of tax refunds or civil service salaries; and are funding their public pension plans … by borrowing the money from their public pension plans. Sweet! Let’s pay off our credit card debt by putting it on our credit card!

I’m no economist, but it seems blindingly obvious that the current global economic climate is extraordinarily fragile, and seems poised for an cataclysmic meltdown. Even without a black swan — a hot war in the Middle East or Korea; a mass casualty terrorism attack here or abroad; a huge natural disaster or another financial meltdown like September 2008 — the whole house of cards is poised to collapse, catastrophically. The timing is unknown, but the inevitability clear. The players are hard-wired: the Ponzi scheme of being paid today with tomorrows dollars is a powerful drug, intoxicating to both those who deal and those strung out on its increasingly delusional indulgence. And the addicts will not lie down meekly when the dealer runs dry.

Beyond the obviousness of this impending crisis lies our stunning unpreparedness to face the chaos which most surely ensue. As David Warren writes,

Europeans, outside the Nazi-Fascist Axis, and North Americans were as utterly unprepared for the horsemen of the apocalypse riding their way in the 1930s, as we are today. In fact, they were materially less well-prepared, though spiritually perhaps rather sounder. Nevertheless, the spirit of denial, which includes the desire to focus on problems that aren’t real, to avoid staring at the real ones, was so alive in our predecessors that their naiveté has become our cliché.

But I think the tests we face from abroad may, this time around, be matched by the tests we face domestically. And for those I think we are even less prepared… we are living out lives in which the focus of our attention is constantly displaced from the here and now, towards any number of fidgeting external distractions, in a “virtual reality” that disappears in the first moment of a power failure. So that, when something happens in the here and now, transcending the technological order, and muting all sources of external entertainment, we are at a loss.

How or when this cataclysm will play out is pure speculation — a speculation in which I may indulge, time and grace permitting, in coming days. Our leaders have arrogantly boasted: “Never let a crisis go to waste.” While theirs is the opportunism of self-destructive power, we too should not waste the opportunity afforded us by this impending implosion to make the most of that which soon threatens to burst upon us in ways most frightening and unpredictable.

Now is the time to become grounded, to set aside frivolous things and focus on that which is permanent, unshakable, and sure. The time to do so surely is short.

Tags: Politics & Culture · Social Issues

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