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...
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?
...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. http://www.forbes.com/sites/dividendchannel/2014/12/12/walgreen-moves-up-in-market-cap-rank-passing-ebay/ Whereas for the CVS Pharmacy and now CVS
Health the market capitalization is $113.4 Billion. No small change, you would
agree. (NYSE: CVS)
http://www.wikinvest.com/stock/CVS_Caremark_Corporation_%28CVS%29/Data/Market_Capitalization 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. https://www.opensecrets.org/lobby/top.php?showYear=2014indexType=s
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. http://www.telegraph.co.uk/news/health/news/10717566/Aborted-babies-incinerated-to-heat-UK-hospitals.html
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.
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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