It's bad and it's going to get worse, YAY!

As a physician, I hear all the intimate details of my patients' lives, whether I want to or not. The hot topic has been their cancelled insurance plans and what other insurance do I take. Also on the agenda-- the doctor "de-selections" from Medicare Advantage by AARP/United Healthcare "products" or plans.

People are seriously angry and scared. They won't go on to the abysmal healthcare.gov website for fear of having all of their data hacked. Click here to read something that has been given 3 minutes of media time, but it is devastating testimony, and the public, smarter than one would think, is aware.

I myself tried to get onto the website to find out, as a physician, what plans are on the Florida exchange. I can't, I keep getting the error message. I am completely unaware and have no way to access the info, because no government agency has communicated with A SINGLE DOCTOR in the USA as to what the nuts and bolts of this mess contains. I don't know, and can't get, info on plans, fee schedules, etc.

You might think the AMerican Medical Association would have some information on this, since they so steadfastly supported PPACA in 2009. Take a quick look at the home page of the
website and there is ZERO info on Obamacare or the doctor deselections from insurance plans. Just some platitude about how great we are and how the Medicare SGR formula needs fixin', the same tired story for the past decade.

Therefore in planning a business strategy for 2014, which is about 45 days away if one considers the Thanksgiving and Christmas closures, I must seriously plan to NOT accept new patients. I cannot enter a world where I have no data, no info, no knowledge of how to navigate. One cannot conduct business blindly. One cannot do as the clowns in DC have done, with zero prepping and zero oversight, and accept a destructive product.

I do see this whole thing imploding in short order.

The only silver lining I see is that the anesthetized horde that believed in hope, change, and that government can decide and orchestrate their lives for them...suddenly they've woken up to the fact that the failed parable of Obamacare has hit them in the wallet, hit them in their ability to even continue to see their doctors, even if they were already insured--and they are unhappy and don't want this at all. I can't see how the president can govern if the people aren't with him, at all.

He can spout what he wants from Mt. Olympus but it makes not one iota of difference. The law stands. And it's crumbling. Inept, incompetent, a horrendous thing. People will suffer medical morbidities from this botched thing--cancelled plans beginning in 2014 and not continuing to see their doctors or get their prescriptions-- and the politicos will have blood on their hands. I hope someone tracks mortality and morbidity from this when it fully kicks in on Jan 1, 2014.

wow they're all flip flopping

I have a chronic huge-ass migraine from all of this Obamacare dreck. What I'm especially fond of, and what I won't forget, is the loud singing and praising that was happening for 4 years. Now that the product is a piece of crap, the public figures are retracting.

Patients are in a tizzy, the country is in a tizzy, the let down is enormous. The president lied--gasp, horror--can you all seriously have such crooked pseudo individuals as your object of idolatry?

Hilarious juxtaposition from the CEO of Starbucks, here is what he praised on Sept 16, 2013, 2 weeks before the catastrophic roll out on Oct 1.

Now let's read what he has to say, one month after the spectacular failure.

The hearings say just you wait, things will improve and get fixed. It's too late. There's a bad collective taste in America's mouth, and left or right, people still abhor blatant liars.

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.