Not Bad for a Heart Cripple

A little over a year ago, I was having stents placed in my coronary arteries. Thirty pounds of weight loss and lots of exercises followed, as well as a focus on stress reduction. I purchased my bicycle (a Novara Trionfo) in early September and found that I could only do about 10 miles before becoming exhausted. But, I decided in October to do the STP this year (an annual Seattle to Portland bicycle ride). It was a wonderful feeling to do 203 miles at a reasonable pace and yet never feel really drained. I’m already thinking about doing it again, hopefully in just one day. We’ll start a little bit earlier in the day, before daybreak. My main problem is the mistuning of the bicycle had the chain coming off. My bicycle worked perfectly well until I took it in to be tuned at REI several weeks ago. I have never had such a bad time with chains coming off. Fortunately, we had no flats on the trip, though my tires look rather chewed up, and in need of replacement at the end of the trip. I hope that son Jonathan would be able to do the STP with us next year. He’ll have to get riding a bit. I also hope that Ara could make it out next year. Start riding, dude! I’ve learned to tune my own bike, and feeling comfortable about riding long distances, I don’t anticipate any problems next year.
Today is Bastille Day! Vive la France! J’adore le Français. Our family is relishing the wonderful freedom we have from our revolutionary forefathers. That is why we try to suppress the spirit of revolution because it’s already been done for us. Now, our benevolent and all-caring politicians will supply our every need, big or small. If your name is Freddie or Fannie, and you just somehow squandered 3-4 trillion dollars, hey, no problem, Uncle Sam will bail you out. Freddie and Fannie might get a slap on the wrist, or be given a few additional regulatory orders, but that’s it. The kind and ever gracious benevolence of our dear politicians also wishes to provide for your’s and my healthcare. They will make the rich pay. The rich are anybody that is not buried six feet under.
When I put on my libertarian Ron Paul hat, I demand that the health care system be as far removed from government as humanly possible. There are several problems with that. 1) The feds require that health care be provided for all. Though the emergency room is only for emergencies, eventually every disease will become an emergency, in which you can go to an emergency room and demand care for free. 2) The feds have imposed massive rules on health care that make it nearly economically unstable. These rules are most prevalent in hospitals, governing the most inane items, such as initials that have been used for orders since the development of medicine, and are uninterpretable only to the clueless, like lawyers. 3) The legal profession has defined an ethereal standard of care that forces maximal possible care in all situations and makes you guilty even when right. 4) The feds have defined pricing for all but the most elective procedures, such as plastic surgery and dermatology procedures. This means that we have absolutely no control over overpricing. We take what we can get, and rarely is it comparable to other highly professional services rendered and always without the extreme risks that are assumed by the physician. 5) The feds have removed value from the cost of medicine, forcing costs to sky-rocket. 6) The third-party payor system has removed cost impact on the health care consumer, thus removing any sense of value to any drug or procedure performed. How much is an appendectomy worth? What about a perforated appendectomy in a 500 lb diabetic smoker with heart disease that stays in the hospital for 2 weeks. Under medicare, the surgeon gets about $400 for any case of appendicitis, slightly more if the appendix is ruptured. That is barely enough to cover overhead costs. Medical care no longer has value, and the public expects it for free. 7) Our current system was based on a historically previous better economic arrangement for physicians, which allowed them to often render services for free, such as caring for indigent patients or offering their time as “community service” to the hospital as call. With the loss of any margin to health care, most physicians (especially surgeons) can no longer freely give of their time, creating extreme tension between physicians and hospitals, with physicians now demanding to be paid for their hospital service call and hospitals insisting that such care continue to be rendered for free.
The only difference between the current US health care system and most European health care systems, such as that in Great Britain, is that the socialized system in the US is funded mostly by entrepreneurial private dollars, while the socialized system in Great Britain or Canada funded by public funds. In reality, we are giving the feds a very foolish deal. They can carry on the most asinine regulatory actions, pretend to offer tort reform, offer grandiose promises to the public, and act truly sincere about caring for the health care provider. They reluctantly save the health care system at the last moment after doctors throughout the nation have kissed the derriere of their local politician with begging and pleading not to enact Medicare cuts (which still is a cut, since current inflation is estimated at between 3-16%) thinking that we should be ever grateful for them. As a response to decreased Medicare reimbursement, private enterprise is trying to become increasingly creative about making a profit. Historically, our response to decreasing reimbursement was simply to work harder. Now, we are working as hard as possible in order to maintain financial equity. Several years ago, a colleague announced that he was going to take a week a month off since that would then give him the equivalent of an eighty-hour work week and provide some sanity to his life. Several months later, his revenues plunged to not even supporting his overhead. He is now back to much less time off, and making a modest profit, though his investments are probably more financially rewarding than his profession itself, and he rarely ever seems to be happy or enjoying himself at work.
With all of this under consideration, I have several proposals. 1) Private enterprises quit funding federal health care programs. We should back out of investing in health care, whether it be for our own private offices, or for community-driven ventures. 2) We should encourage medical care to go to a purely socialized venue like Canada. This will force the feds to live by the insane rules that they create since they will be creating them for themselves. This will also not allow for “boutique” practices, which is healthcare that tries to escape from the “system”.  3) We should quit funding the entire bureaucracy through taxes. The state is currently sucking us dry. If you count all the taxes that we are forced to pay, including Medicare, income, property, sales, telephone use, vehicle, and many other taxes, all but the poorest are paying over 50% of our income into taxes. Stop working. Retire. Go on Medicare. Leave the country. Find another profession. Live off the inheritance you were planning on giving to your children. 4) The final solution (Enderlösung!) is to find a system whereby the hospital or state assumes all of your overhead, and truly pays you on a per-hour basis that is commensurate with your skills and level of training. This would also allow you to work as much or as minimally as possible without incurring major debts through massive overhead. Sadly, such a system doesn’t exist. If physicians would uniformly refuse to continue funding the system and allowing to hold us in forced servitude and quit, go on strike, shut down, or terminate virtually every state and third party payment, the system might be forced to correct itself. Until then, the fed is going to be content with letting private enterprises fund their health care follies.
With all of this under consideration, it would be best for me to get out of medicine altogether. Yet, I continue to look for alternatives, with less stress and fewer work hours. I will not be a sacrificial lamb to the state.
Vive la France!

Dennis, if you comment, please keep it short, and mention something about your celebration of Bastille Day.