I told you so

Obamacare--the website, the law, the mandates--is probably the biggest disaster since the movie Ishtar, from 1978 I think with Warren Beatty.
No wait, the biggest since "the new Coke".
I knew it, along with the millions of voices taped shut by ObamStalin thugs, but the schadenfreude is being replaced by fury. I am FURIOUS about so  MUCH--THE GOVT WASTE, the $634 million website that functions like MS_DOS computer screens of 1989, and most of all, the lack of information about anything happening to the thousands of people who in 90 days don't have health insurance, can't buy a replacement, and don't know who to ask for help but yours truly, their doctor who will actually talk to them. I tell them I'm in the same boat, my Blue Cross policy is one of the 300,000 being cancelled Dec 31, 2013. As a doctor and as a patient, this is soooo outrageous. Increasingly, I find myself repeating to them to be strong and independent and to refuse to look to govt for the answers, Washington is so corrupt and tied up in knots that NOTHING will come of anything. More uninsured people means more cash paying patients, simple as that.
The populace is deeply confused and unhappy, I am witnessing an increasing level of anger and impatience. This does not bode well. The antics are affecting all socioeconomic strata, and some of these folks will resort to illegal action to get what they want. I don't know what concretely, but I can see it on their faces when I tell them that I don't have insurance either, I don't have any answers. I have heard the granola/tattooed mamas and papas spouting to me Rush Limbaugh and Grover Norquist-isms and I feel like I'm in the twilight zone. I agree with them, of course, but I do know this: the plebes are not all sheep. Some are very active and knowledgable and are canvassing actively and passively for the implosion of this monstrosity.
Let's take a look at a few little gems, to review the tortured history, of this big fat FAIL.

2009 juicy morsels-- read at the Guardian (UK)  and another here. 

The right Hon. Nancy Pelosi and her Idiocracy-level statement here.

All of these bozos can go eff themselves.

oh yes.....

Obamacare is this: a huge government expansion to make sure everyone "gets into the system" and buys health insurance thru the govt. You are forced to buy and report the receipts on IRS annual tax forms, and if you don't buy enough of their sanctioned plan, it would be deducted from your refund, if any, or levied as a fine. Also, all health habits, whether real or not, will be entered into a computerized database that the govt. will have open access to this. So, if your blood level doesn't show enough iron, the govt will force feed you more iron until you have the correct blood profile.

Think I'm kidding? Just you wait. BMI and overweight could be taxed MORE and weight will be a number that will be used against you. Purchases of fatty foods had a tax surcharge in Denmark for a while but then dropped, read about it here.


I'm feeling schadenfreude and I'm loving it. The govt shutdown is amazing. Nearly 1 million non-essential workers--what do these people do anyway? Push papers around for a grant to study roadkill? Hmmmm, lets see--airports are open, borders are open and letting goods through, military and VA hospitals open, postal service, Medicare and SSI, all open.

If you have an IV given to you from the govt mainline, of course you're whining and in pain, as all drug addicts are in the beginning.

And Harry Reid denied chemo to a little girl at the NIH saying everyone must get funding or nobody gets funding. Why is this asshat still around?

We're too dumb to learn the truths

Another upsetting Monday. This time compounded by yet another mad gunman on the loose, this time it was the D.C. Naval Yard. The Senate boogied out right quick, bunch of spineless cowards. The narrative had been shifting, from PTSD vet to mentally ill/schizophrenic dumped by his girlfriend and distraught. My only question is, how is it that these military installations take so long to shoot down a gunman? Don't they have folks in there all armed? Oh wait, I forgot. We can thank Clinton for barring weapons from military locales (WTF?).

And how come he kept his security clearance after all those police calls, where he shot thru his own apartments' ceiling to quiet down the upstairs noisy neighbor? How come this keeps happening?
What's with all the NSA data just sitting around? Nobody is looking at it with game theorems, nobody is analyzing, nobody is extrapolating. They just want you to think that they are.

AND then we have Putin grandstanding and making the US president looking like a spoiled teenager. He's right, he is. AND Time magazine won't publish the same cover in the US with Putin on it, instead the mealy argument of the bread-and-circuses crowd on how college athletes should be paid.
Read more here. Hey, they're getting a free ride, inflated grades, room and board, and a college degree that they otherwise wouldn't get--let's face it, it would be either lay down some bricks/get a Welfare check/jail if it weren't for college football scholarships and programs. Because this argument is strictly about college football, nobody will pay pro wages to the college lacrosse team.

In other news, I learned the magic of making a roux as a base for home-made mac 'n'cheese. Who knew that 2 tbl melted butter plus 2tbl flour stirring quickly makes this putty-like thing to which milk whisked in will attach and allow more fatty goodness--cheese--to be incorporated into a smooth sauce. I'm hooked and it's a fine thing. :-)

it's come to this

Lots of difficult thorny issues everywhere. I'm totally exhausted and I want to retire. No joke.

Another altercation with an elderly don't-take-away-my-Medicare cohort. This patient actually put white tape over his Medicare Card ID number, photocopied it, and presented this copy to my front desk staff. Sotto voce, he states he will verbally tell us his Medicare ID number because he's been told by the feds to never carry it around because it can be fraudulently used.

***my eyes are rolling into my skull****

Yessirree, BUT YOU NEED TO PRESENT IT WHEN YOU ARE GETTING HEALTH CARE FROM A DOCTOR OR HOSPITAL.

I CAN'T TAKE THE WILES OR THE GAMES FROM THEM ANYMORE!!!!!!

My personal brick wall has gone up. No card, no service. Go home. Go see another doctor. I'm not playing your game.

When the doctor cares TOO much

I've had an interesting scenario develop. A few months ago, a local doctor referred several patients to me for dermatological care, and I was grateful. The patients were happy. Everything was nice. However, a little thing called "snowbird season" happened. In southwest Florida, hordes of retirees from the northern half of the country descend to flee the cold weather from December-May. Often, these patients are in a tizzy to return home in the spring and put off their health issues.
We tried like heck to get a certain lady from Boston with a skin cancer on her nose, referred by this cardiologist. Many faxes and phone calls ensued. She was scheduled. Then she didn't show up. When we called, she said she had to "go back home to Boston".
Today the cardiologists' wife, his office nurse, came in to find out what happened. I told her plainly, you cared more than the patient. The patient didn't care that she had a skin cancer, a colon cancer, a defibrillator, whatever. The patient ultimately is the arbiter of what happens and why. Nobody can force the patient into the medical realm. The nurse looked at me and blinked hard. She is 20 years older than me and she still has a paternalistic view of "we know what's best for the patient". Yes, this is true oftentimes. But people have complicated lives and dramas and if their health isn't their priority, how can it be for us? How can it be for any doctor? We need to step back and accept that people won't do what they need to do. As doctors, we need to accept that maxim, and move on.
Moral of the story, and this is something I stand by 100%: I only want to treat patients who want treatment. Sounds simple, but it's not. I will not treat a husband dragged by his wife who declares there's nothing wrong with him. I will not go to a patient's home and drag them to my office to get a biopsy.

Harsh

These are dark times. Boston terror attacks with innocents killed and maimed, schoolchildren shot up in classrooms in Connecticut, missing and kidnapped women screaming for escape from a run down Cleveland snake pit...it's constant awfulness. I don't have an answer but it makes me want to carry a concealed weapon. I feel scared and vulnerable in crowds and I know law enforcement cannot do what they're supposed to do. Increasingly, ordinary people save the day.

This may sound harsh and brutal but the heinous crimes are demanding this--public bloody executions. Any f***tard thinking about it, doing it, or having done it, will have to take pause.

I cannot imagine the families of these victims, or how the survivors feel, my heart goes out to them.
I'm always astounded when there's invariably an interview with a mother/father/sister and they just seem so grateful and they say,"no, we do not want to wish harm on the criminals". I put myself in their shoes and I'd seriously have a problem being so forgiving. I think I'd volunteer to administer the death penalty myself to these evil criminals if a family member is victimized like this.

stick a fork in me, I'm done

Believe me, I hate having to ask people to fill out 10 forms and get all sorts of data from birthdate to social security number when registering patients in my practice. In particular the social security number is necessary because a) insurance companies identify patients via that number along with other data to make sure the patient is the correct one b) there are people that present fictitious data thus I must protect my business from fraud.
If a patient pays cash then we don't need ID's or anything, of course. But with third party payors, we need a lot of info to file claims and to get paid. I don't make the rules, I follow them.
Here's where it gets sticky and complicated. Patients are urged at every turn to never give out their social security number. But their Medicare is their social security number plus a letter, or if through a private payor then there's that info registered with the home plan. I need that info to get paid. In particular, if people are delinquent in payment and collections have to be retained, a social security number is needed, it's like a loan done by a financial institution. You go anywhere, get a fishing license, get a car or insurance, get labs drawn by a phlebotomist, you must give your SS#. If you don't give it, you may be refused service.

If a patient refuses to give this info then I have the right to refuse service. Period.

I also love it when retired octogenarian FBI agents threaten me for not calling them back within an hour. Yeah, because you're important. Sorry but the cynical side springs to life with these situations.  Don't pull rank. Be nice.