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.
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!
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.
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!
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