The CADEUSES Serpents

Expressed or implied weakness creates the predator. You see when the unicellular organism, many eons ago, wrapped itself with another unicellular being and created the mitochondrial factory of energy production, a multicellular being was born. Soon the many varied species would emerge as they floated past the waters onto lands and developed pedal motion. The smaller animals evolved into bigger ones and the food fight began for survival. That food fight amongst animals in the wild continues till this day. Man came along and changed the entire paradigm. He developed a little swelling on the left side of his brain called the Broca’s area and soon heralded the “hunter-gatherer” form. His evolving intellect grasped the flint as a mechanism to bring the animals, many times his size, down to their knees that he would need to feed his lot. Soon the flint heads turned into arrows and spears and then into high velocity projectiles. Similarly, as the brain evolved so did the means of transportation. Inventing the wheel created a booming commerce. Soon the beast of burden morphed into a Mack truck capable of carrying a farm load of food and other needed products. Meanwhile man wondered about the wings of the birds and dreamed to fly. The feathered wings turned into wooden slats covered with double layered fabric of the Wright Brothers, turned into aluminum and then into composite material; harder, stronger and more resilient than steel. Today the aircraft are capable of being in the air with hundreds of travelers.

Innovators innovated and everyone else gained from the fruits of their successes, they stood on the shoulders of the giants and built better products. However, today the less intellectually endowed versions of humans have crafted mechanisms for controlling the innovators by placing hurdles, which soon become so large as to quash the flame of innovation. These few middling managers grow in numbers and multiply like rabbits, finding places wherever there is wealth to be made on the shoulders of others. For in the far reaches of the psyche of these people on whom everything is lost, you will find emptiness.

Cadeuses...Notice the Serpents

Medicine in the yesteryears was a simple mechanism of doctor and patient relationship. One called, the Other answered and to the best of his or her abilities fixed the malady that had struck the former. Soon evolutionary products took over and in came the carpetbaggers that had hogged and slowly destroyed the innovator spirit in other fields by feeding their unrestricted desires of gaining wealth in the health care field. These few realized that a whole industry had been created by a stroke of a pen in 1965 with the advent of the Medicare Act. The Government in the United States would be involved in using tax payer funds and placing a safety net for the elderly and the misfortunates. Tax payer funded healthcare was the “Manna” for the Middling Managers. They gobbled it up by creating serpentine paths, as hurdles, between the simple doctor-patient relationship. Their demand was simple, really, to get paid, one must have to do this and that before the check was cut, they said. In 1973 when President Nixon unilaterally eliminated the dollar to gold convertibility, a large number of paper money became available and resulted in the loss of value for the dollar, which now relied on the “full faith of the government of the United States.” The "manna" however, grew exponentially.

While Emerson wanted us to "live amid surfaces, and the true art of life is to skate well on them." He also warned that, "The coarse and frivolous have instinct of superiority." Unfortunately the evil exists below the surface and thrives and grows to ruin those "surfaces." So he went on to suggest, "Let us be poised and wise, and our own, today." Or think for ourselves! For the stem of knowledge to reach the light above, the roots have to drill deep the dark below. 

The cost of healthcare increased exponentially from multimillions of dollars per year and single digit percent of the Gross Domestic Product (GDP) to double digits rapidly. In 2008 the cost was $2.3 Trillion a year at 16.6% of the GDP and not a decade later it is 18.2% of the GDP today circling the $3.5 Trillion mark. A 30% increase!

So one asks a simple question…where does the money go?

To the Patient Care? Answer a little…perhaps 8-10%

To the Doctor Services? Answer about 6% or $180 billion of the $3.5 Trillion. Then, where does the rest go? To answer that, perhaps one should look at the Administration and the Middling Managers that have warmed millions of seats and sit cozy behind desks looking at the screens as their pensions pile up. And some of it never gets past the Insurer enclave.

In 2012 alone that segment garnered around $385 Billion of the $1.2 Trillion of the CMS expenses based on some estimates. One can only wonder what the tally is today, that is, if real GAAP measures of financial practices were used and not some other measures that use “goodwill hunting” in financial sheets. And here is the ultimate rub, everything the experts do is largely based on estimates and probability. Nothing is concrete!

The costs of healthcare increases steadily and the carpetbagger fat fingers of instability keep pointing to the cost of patient care, doctor charges, drug costs etc. But those are false dichotomies mostly. Yes, drug costs have gone up in cancer but only to the tune of $38 Billion and that represents 0.01% of the $3.5 Trillion. You wonder why Amazon, Buffet’s Berkshire Hathaway and J.P. Morgan are running after this train? Think again! They want to be the "intermediaries" between the patients and their physician too.

"In Medicine what has happened is even a worse travesty for all our patients."

The Predators here are like serpents, they continue to raise the bar of how much something costs in isolation but never really look at the whole ensemble. Serpentine paths by these serpents is to delude the easy mind and obfuscate the busy mind. And then to boot, they advocate groupthink, collaboration as the only means of progress. Hmm…Apparently, critical thinking is for the conspiracy creators and that needs to be vilified.

In Medicine what has happened is even a worse travesty for all our patients. They are lead to a primrose path of insurability as equating to care, with high annual premiums ($14,500 per family of four) a CoPay of $50.00 for each “encounter” and one has to reach the threshold of “$6,500.00” deductible (or $21,000.00 spent) before a single insurance cent is paid out. All the while the Health Care Insurance Companies are sitting on Market Caps in the many hundreds of Billions (below). And the CEOs are earning handsomely in the Millions.

Company	2018 in Billion$	2016 CEO Salary    Million$
United Healthcare	$         222.71	$                 17.80
Aetna	$           57.39	$                 18.70
Humana	$           38.74	$                 17.00
Well Point	$           60.40	$                 17.00
CVS	$           69.05	$                 15.07

But that is not where I am going with this. You already know this. There is another path that often eludes the eye. The cost-controlling managers realize that the only way they can make more money is by reducing costs even more. So they take the next step…

"...in some cases, has now been equated to 10 years of education and many more of experience with the stroke of a pen!"

Enter the artificially created “Physician Shortage.” This shortage is accrued as the population of the United States grows. The total number of Medical Students remains the same or even dwindles. Additionally, when two new Medical Schools came online a few years ago, the Residency spots to help the physicians hone their skills under a mentor’s tutelage remained the same so some of the newly minted Medical graduates could not find residency slots and had to waste a year of their lives waiting to be “matched.” Meanwhile most of the graduates were indebted with at least $300,000.00 of school debt. So, the “Market-Makers” of Medicine decided in their supreme intellect, again “for the public good,” to allow a larger portion of Nurse Practitioners, Physician Associates and the like to practice medicine. Initially this was under the supervision of the physicians, now, not so. Under pressure from the media, the States are clamoring for action and their legislators are signing bills upon bills to let these paramedical staff enjoy the “privilege” of independent practice of medicine. 2-year of schooling, in some cases, has now been equated to 10 years of education and many more of experience with the stroke of a pen!

"Remember the artful, fear-mongering media mavens talking about “medical errors were equal to a jumbo jet crash every week?” Well get ready for the metaphorical 2 or 3 Airbus 380s going down a day!"

Yet all actions have consequences, don’t they? In this case it appears that the very costs the Managers were trying to reduce has skyrocketed. The Diagnostics under the paramedical staff has spiraled upwards because decision making is based on knowledge and experience and lacking both, one flails with irrational ideas and keeps the patient locked up in a mind game of being "ill,” with more and more tests. The differential diagnosis goes on and on in perpetuity…

Remember the artful, fear-mongering media mavens talking about “medical errors were equal to a jumbo jet crash every week?” Well get ready for the metaphorical 2 or 3 Airbus 380s going down a day!

Meanwhile pouncing on the costs, their fingers are ossified in place against the physicians. A bevy of acronyms plague the scene such as; PCORI, MIPS, MACRA, EHRs etc. The Physician is practicing today with both his hands tied behind his back, one eye on the computer screen and the other looking over his shoulders at what is coming next and where he might not step into and be fodder for the army of finger-pointers. O’ woe to him or her that does not understand the folly within these actions.

So what of the serpents?

They are everywhere; in pinstripes, flannel, skirts and flowery dresses. These serpents crawl in the halls of power, dismantling a life-long work to the community with the stroke of a pen or press of a computer key, ending a professional life.

Within the medical profession as well there are many serpents feeding and growing in size. These clever ones or so they think, hide behind the façade of sniffing out the “public good.” They create hurdles upon hurdles which can only be surmounted by paying them a grandiose fee of a few thousand dollars periodically to allow the physician to stay within the confines of their medical practice. You see, these corrupt intransigents have created a wall of good will through lobbyists and gained the well wishes of the policy-makers to make physicians subservient to this shell game of “Certification.” The American Board of Medical Specialties and the American Board of Internal Medicine in cahoots with American College of Physicians and the American Medical Association have decided that constant testing has to be done every year of the physician to maintain their medical edge and the certification. To pass these tests, one has to go and spend time and pay monies to learn the answers to the potential questions being posed in the tests. The gig has garnered a mere $134 million in less than 10 years for the ABMS/ABIM and untold revenue for the ACP in their “Exam Preps.” Experts cannot be refuted because they use complex rationalizations to thwart any opposition. They do so in unison, because power lies in their collectivism. As Theodore Darylimple (Anthony Daniels, MD) a retired UK prison psychiatrist states, They (intellectuals) use the “dark art of suggestio falsi and suppressio veri," to advance their agenda.

You see dear reader, tyranny is enacted in many ways, and not only by material force. Any irrational absurdity imposed upon the governed without their consent is still tyranny. This form of tyranny prevents the symphonies being played out in a blank slate of silence in the human mind. The mind is cluttered with nuances of useless thoughts. Innovation and desire become subservient to fatigue and chaos in the mind and physicians leave their vocation and get “burnt-out” from tyrannically imposed untested theoretical regulatory fiats, or they commit suicide. The Angel's feathers are fraying as the serpents grow in size. A reckoning is coming, if it is not already here.

Interestingly, while these self-imposed experts keep talking that physicians should not be paternalistic with patients in their care, they force their own paternalism upon their own peers.

"Innovation and desire become subservient to fatigue and chaos in the mind and physicians leave their vocation and get “burnt-out” from tyrannically imposed untested theoretical regulatory fiats, or they commit suicide."

Medicine has become a place of groupthink and Mediocrity instead of a place of Meritocracy and excellence. The Organizers have command over the Organized. The insurers and their Managers have scrubbed off Adam Smith’s Invisible Hand. They have imposed price controls and created shortages only to allow their own egotism to flourish and gather stream as they pocket wealth in their deep pockets. They forget that for a concept to endure, it must have discrimination value, absent such value, the concept should wither. But they pile on and on their failing concepts, because a lot of future earnings are relying on their deceipt.

A nation of innovators and Risk-takers have turned into a nation of poll-takers bending to the whims of their personal self-serving needs.

Dissecting the anatomy of this terrible cancer reveals a plethora of bleeding blood vessels supplying the wayward cabal of individuals, that grow in size and number and ultimate power to usurp the rights of every patient and their physician in these, The United States of America. To make medicine what it was meant to be, one has to use ligatures and cut off the blood supply to this cancer!