Humans have a neural substrate of imagined sounds. In music sometime anticipation is used. At times, the musician will withhold a much-anticipated note to increase the desire to hear it by the listener. In fact, our mind predicts such imminent structural pauses as whetting the desires of the potential future. Ringo Starr of the Beatles did that masterfully in his drumbeats. But what happens when that note fails to materialize? It simply jars the mind.
Why I bring that up is simply to explain the nuances in our current state of society that have subverted the naturally occurring structural pauses into dead ends. Permits and licenses and certifications are everywhere! The pedigree of these chaotically semi-predictable meanderings has long been passed down as pedogogical constructs. We expect them. We know them to happen as the laws of Nature and civility.
Imagine if you will, a 9-year old sitting on a bare-bone furniture of chair beside a table with the following set of artifacts. A Pitcher filled with Lemonade, some plastic cups and a sign “50c Lemonade.” People come and go in front some with a glance and a smile and others willing to partake in the offering. Soon the child has accumulated $8.00 as her revenue and starts on the second pitcher when a blaze of blue and red lights filter across the horizon and stop in front of her lawn. By then, the child is in tears and the parents are answering legal questions to protect their child and themselves. Far-fetched imagination, you think? Nope. It happens in most of the “ultra-intellectual” states of the United States today.
In fact, the other day there was woman aptly termed “Permit Patti” who upon seeing a 8-year old selling water called the police. Ah yes, she was the whistleblower against the 8-year old child. Permit Patti was looking to put an end to the child’s entrepreneurial spirit and dashing all hopes of an innovative mind of the future. A shame!
Yes, we as a society of the “developed and civilized” world have become the most developed “permit, license, certification needs” hungry society of all times. The legion of Rent-seekers are burgeoning to fill the void where common sense once prevailed. A pity! You want to cut a tree down, get a permit. you want to put up a fence, get a permit. You want to add plumbing to your house, get a permit. In fact, you want to have a garage sale, get a permit. Our lives revolve around the “Permit Alleys” of the Municipal buildings and other such Regulatory bodies daily. Still, I haven’t yet seen a permit for practicing witchcraft yet. But I have seen one for landscapers, pest catchers, pet groomers and all other sort of occupations. It appears, the authorities are at the threshold of every mode of work one can do, collecting fees.
via Charles P Kroll CPA
Case in point, once again; Medicine. You need a license to practice medicine governed by a small cadre of physicians and others called the Board of Medical Examiners (BME) (Hmm... The others include; lawyers, lay people, nurses, insurance liaisons and others sought fit to deem if the physician is fit to practice medicine). Each State in the United States has one. (Then there is a Federation of the Board of Medical Examiners a quasi-non-governmental organization that seeks to rent-seek at the National level and recently tried to acquire a large multi-million dollar building in Washington DC near the seat of power to exact some for itself, but failed). Well okay then, that is the law of the land. And away we go to the proverbial “paddy-fields.”
Next, we get to some off-the shelf, quasi-self-appointed-governing body that has coopted some of the BME power over the physicians by crafting a net over the entire nation and wishes to exact its authority and the physician's financial resources around the globe as the global authority in physician knowledge testing. It is a not for profit organization. Using their “(esoteric-)knowledge-based examination certifying that the physician had achieved a level of knowledge above the rest of his or her peers, they claimed, was a badge of excellence, . No support for this excellence in patient benefit or physician benefit has EVER been found. Yet the drum beat goes on. That examination, initially, was voluntary and would cost around $2000.00. But as time went on and conflicted Authors from that Board wrote self-serving papers trying to prove the validity of the need for that examination as a corollary to a physician’ s competence in caring for the patients, the cost now seems well in advance of $10,000.00-$15,000.00 (if you factor in all associated costs). Soon ABIM/ABMS were awash with money, enough to lobby and win the governmental seal of approval. The Certification Examination being a very expensively generated and with proprietary set of statistical modelling tools, was held in “prison-like environment to prevent physicians from copying the questions. See Dr. Westby Fisher’s podcast.
Next, we get to some off-the shelf, quasi-self-appointed-governing body that has coopted some of the BME power over the physicians by crafting a net over the entire nation and wishes to exact its authority and the physician's financial resources around the globe as the global authority in physician knowledge testing. It is a not for profit organization. Using their “(esoteric-)knowledge-based examination certifying that the physician had achieved a level of knowledge above the rest of his or her peers, they claimed, was a badge of excellence, . No support for this excellence in patient benefit or physician benefit has EVER been found. Yet the drum beat goes on. That examination, initially, was voluntary and would cost around $2000.00. But as time went on and conflicted Authors from that Board wrote self-serving papers trying to prove the validity of the need for that examination as a corollary to a physician’ s competence in caring for the patients, the cost now seems well in advance of $10,000.00-$15,000.00 (if you factor in all associated costs). Soon ABIM/ABMS were awash with money, enough to lobby and win the governmental seal of approval. The Certification Examination being a very expensively generated and with proprietary set of statistical modelling tools, was held in “prison-like environment to prevent physicians from copying the questions. See Dr. Westby Fisher’s podcast.
via Charles P Kroll CPA
The ABIM/ABMS revenue stream was increasing at a geometric scale but not as fast as the salaries of these “esteemed” board member individuals and their lucrative pension plans. They decided that the initial examination was not enough to sustain their avarice and thus the new dictum came down; “all physicians needed to take the recertification examination every 10 years.” There was another revenue spike to the delight of these few. Soon the Cayman island resorts and associated “free-from the prying jurisdiction of the IRS,” banks were frequented for annual, semi-annual and quarterly “Retreats.” A nice multimillion dollar condo in Philly fully furnished with a Mercedes Limousine and Tax-exempt cash stored offshore for safe-keeping became a “brilliant scheme” away from the prying eyes of physicians and others, didn’t it? Or so they thought, till it was brought to light. They concocted the scheme to have a continuous “Maintenance of Certification” operation inflicted upon the physicians, because, well, physicians, they implied, seem to lose their grasp of medicine pretty quickly and their care could not be trusted, because, well, jumbo jets filled with physician mistakes were crashing and causing a high mortality...see the Susannah Fox piece virtual patient-loaded-jumbo-jets crashing every week.
Meanwhile the MOC as it was named generated oodles of money to the tune of $160+ million for the so called Not for Profit organization, yet the handsome salaries, bonuses and pension liabilities of these few, continue to exceed the revenue streams. “What to do?” they must have thought? More pseudo-scientific papers were written to convince the need for the maintenance of certification (MOC). Those with vested interests and no SITG (Skin in the Game) http://www.medtees.com/content/MedicareBilling.pdf sang praises as they lined their pockets,while, in the meantime the physician force was getting despondent, depressed and with the burdens imposed upon it from this organization and other governmental Regulatory initiatives, there was a rash of physician suicides. “No, don’t look there!” they implied, “Look here, where we are doing so much “public good,” by testing the competency of the physicians constantly.” But the gig seems to be up!
A few physicians have seen the charade and the façade behind the whole scheme. More are learning daily. And, the dollar-lined walls of these organizations are starting to show deep cracks.
“Permits,” it’s all about permits and licenses and certificates Oh My!
A society so constrained from achieving its potential will ultimately die from starved ideas. The bureaucratic hold on innovation and entrepreneurship always destroys the desire of the few lurching towards the “Next Frontier.” Only the few crooked ones make out fortunes for a while until the hammer comes down on them: Theranos and her Holmes face, to name one. Where exactly were the permit-granters, allowing $9 billion investor money and hundreds if not thousands of patient harmed based on inexact diagnostic report generation. Where were these “expert permit granting authorities?” Nowhere close because Elizabeth was smart enough to fill her Board seats with well-known politcos and power-brokers so no one dared, until John Carreyrou, a recalcitrant health-care reporter from The Wall Street Journal did.
So you see dear reader, this charade of “Permits, Licenses and Certifications” is a game for the thrones. Decrees to pay up and shut up. Who thrives is known. Who gripes, who cares?
By the way, I forgot to mention the Medical Organization… It is the American Board of Internal Medicine (ABIM) and American Board of Medical Specialties (ABMS). Other agencies and organizations usurping physician’s abilities to give good care to their patients also include the now famous American Medical Association with 12% membership and most (Almost $200 million) revenues coming from the CPT coding needed for the Electronic Medical Records and Billing… @CharlesPKroll (twitter) a stalwart researcher CPA, adds these miniature bites to inform us:
AMA Membership Dues vs CPT Royalties 2008 - 2016
☐Total Dues: $362.3 million ☐Total Royalties: $673.9 million
☐2016 Dues Down $5.0 million (-11.3%) from 2008
☐2016 Royalties Up $53.5 million (+97.1%) from 2008
☐2017 Dues Down Another $2.5 million
The American College of Physicians and other specialties with the word “American” before it, all appear in cahoots with raising their revenues thru these quasi-ponzi authoritarian schemes without concern about the harm to patients.
The "note" of humaneness and harmony is missing and there is grave dissonance in the society these days. Maybe it will pass and maybe it won’t. But it won’t be for the want of telling the truth.
Because Dear Reader, remember, if you harm the physician, you also harm the patient!
I wonder how they (the rent seekers) can live with that?
https://www.vanityfair.com/news/2016/09/elizabeth-holmes-theranos-exclusive
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