Wednesday, May 13, 2015


There is an interesting play that is playing out in front of our eyes. It is quite provocative and stealthy. It is filled with all sorts of assumptions and the players are well dressed in expensive costumes. The play is being staged in every Main Street America. The players strut their stuff as the Tchaikovsky 1812 Overture plays in the background. You can spot the stagehand peering beneath the curtains looking at the audience reactions. His eyes appear and disappear through the course and simultaneously the players direct their attention to a specific segment of the audience. The undercurrent in that attention is a warning to stay quiet, be attentive and follow the discipline of proper public discourse.

Let us make some substitutions: The patients and doctors for the audience and the Bureaucrats and Authoritarians for the Players. And now imagine the Playwright standing with his bejeweled hands folded at the entrance to the stage. His unscrupulous eyes darting this way and that looking for any displeasure that the audience might register and turning into slits with pleasure as the audience claps its approval.  His Cheshire cat like smile is both radiant and visible to the pleasure of his players. Some of his actions are teasing, some tortuous, some monstrous and some evil. Like mathematics for most, his musings are irrationally caged in obscure symbols and drive his desires with help from the willing. It is in this style and the proofs rendered that the character of this maestro shows, couched in euphemisms, evoking images of empathy yet holding the glare of dogma and detriment.

Okay now to reality…

If you haven’t yet noticed, bet this will get more than a silent response: the current zeitgeist in the U.S. is to vilify the doctors. The daily headlines declare that the healthcare costs are burdening the society and account for 17.9% of the GDP. And you say to yourself, Hmm that is true! The next headline suggests that the Doctors should “Choose Wisely” in their diagnostic and therapeutic endeavors. The implication of course is that doctors don’t. The other new bandwidth that is being stretched to carry their messaging is that Medicare will now pay only for “Quality care.” Again implied therein is that patients do not get quality. And here the real kicker is how does one define quality? There are no hard or soft metrics to determine quality unless one considers ONLY the cost of rendered care. If you have not tuned into the “2012 Data Dump” that clearly showed that the doctors were direct paid $77 Billion that year from CMS expense of nearly $1 Trillion ($1,000,000,000,000.00), take into account that there are 850,000 physicians that were paid for their services, which included their overhead costs. If you have a calculator handy, that, translates to $90,588 per physician. So on the one hand the talking heads are railing over the costs and pointing fingers at the physicians and yet the reality is quite different. Isn’t it? Where is the rest of the expensed money? That’s an easy one to answer… Administrative expenses, “Hospital-facility” care, Pharmaceutical and Device costs of course! "While the AIDS Healthcare Foundation has criticized the price of Solvadi treatment—$84,000 for 12 weeks, $168,000 for 24 weeks—two Leerink Swann analysts said in a note to investors the cost was comparable to the other treatments, citing in part the $66,000, 12-week cost of Olysio, and $100,000 for an eight-week combination of Solvadi and Olysio." Don't forget, there is a price for innovation in there too...

...but none here except...make plans to take money

When some physicians start talking about Fee-For-Service (FFS) as in Concierge Medicine, the pundits descend on them like vultures calling them “greedy doctors.” These pundits continue to trawl the waters, with nuclear device carrying nets, for planktons. But don’t you think, costs can be best contained when the buyer and seller of a service are equally involved in the contract?

Perhaps, only when one sees the human affairs from a distance can one see the convention behind them… For the Rulers, their proof glides smoothly over the water as the turbulence from the webbed feet below the surface creates giant eddies trying mightily to throw the planktons into a vortex of confusion.

Then, there are the horns of this dilemma pointing south to real greed and wealth. On the south side is the new found love of having care provided at the CVS, Walgreens and Walmart retail stores. The difference is that in these locales one has to fork out their cash. No insurance payments required. There is no greed there? I am of the Austrian persuasion; win only through a better product and service, not another's destruction.  By the way In the case of Walgreen Co. (NYSE: WAG) the market cap is now $70.44 billion and is #63 in all time high market capitalized firms in the world.  Whereas for the CVS Pharmacy and now CVS Health the market capitalization is $113.4 Billion. No small change, you would agree. (NYSE: CVS) Walmart market cap should you wish to know is around $261 Billion. Good for them, but...
Most would say, well they are retailers and provide services. Umm, yes they do, but so do physicians who care for their patients and do not engage in retail sales, yet are demonized daily. Apparently these retail riches from healthcare don’t seem to bother the policy makers as they pump the dollars in their direction while heralding the new era of cheaper healthcare and simultaneously vilifying physicians. Oh by the way did I mention that the “providers” at these retail facilities are mostly non-physicians, who man their health centers and are free to write prescriptions, without a medical license that the in-house Pharmacists are glad to fill. Is there a conflict of interest here? No! …Most will say… Really? Guess there are a lot of pin-striped suits, from K street, with pockets filled with lobby money that walk the halls. CVS Health for instance, spent $14,787,646.00 in lobbying Congress in 2104. Hmm.
And if you count, 6 of the top 20 lobbyists in Congress are related to healthcare. The Quid in this is definitely for the Pro to carry to the Quo! Bring this up and their answer will be “We are making a Yeoman’s herculean effort in providing the ‘right’ kind of care that America needs.” Huh? The shades of National Health System in the United Kingdom come crawling to the mind, as the image of burning fetuses to warm the hospitals run through the mind.

Seriously, there is something out of frame. The context of reality is buried deep within Bills, Guidelines, Mandates that no one reads and everyone, lazy as they are in the government, assumes and the talking heads vocalize and the gentry’ signs on. Meanwhile patient care suffers due to denied care. Physician health suffers from early depression and high rates of suicides. Universal morals and morality decline. Substandard values take precedence. The rhetoric continues because the rulers and makers of rules have little care except for control and command. They have little worries for they will be provided with the best staffed hospitals and the most dedicated staff to care for their pinky when it gets scraped.

It is possible that the lost habit of the laity’s concentration will be replaced by the eyes of their spirit and the virtues of their needs, someday. But these are the days of unguessed configurations, unknown unknowns, uncertain futures, unglued tautologies that sneer at all of us. It might be time to hang the image in the frame correctly.

How this play will end, one can only guess. 

Meanwhile, Tchaikovsky’s symphony, with canons blazing, plays on…

Time to Wake up America.

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