Wednesday, March 25, 2009

Government Healthcare: Let's Review.

Sometimes it's good to take a step back when considering a big decision. There are lots of things I would like. I'd love a bigger house, for instance. I imagine how nice it would be. I can see myself entertaining my family for holidays. I picture standing on a big balcony overlooking an enormous yard, walking around in spacious would be great.

Then I have to get real. Sure, a mansion would be nice in a lot of ways. But they cost a lot of money, generally. And sadly, I don't have a lot of money. They require a lot of upkeep. More rooms to live in means more rooms to clean and fill with clutter. I look at my present, more modest house as a way of measuring my capacity to deal with a bigger one. I barely have time to keep my small yard from swallowing us up with weeds. I have a bad habit of cluttering things - the garage, the spare know. So when I look at my history, I realize that a big glorious house probably wouldn't be glorious for long with me living in it. To paraphrase a much more authoritative source, I haven't been faithful in a little, so I probably shouldn't be trusted with more.

So using that model as a backdrop, let's think for a moment about government health care. Government seems to be so incredibly eager to take on this monumental task, and I think it is wise for us (and them) to take a step back:

Medicare. The "safety net" that was instated to ensure that our elder citizens have access to rudimentary health care has now been expanded to the point that it requires three of us working people just to provide the benefit for one of the covered people. The enormous strain on the system has caused the benefits to become insufficient. Many, if not most elders have to take out additional private policies to cover costs not covered by Medicare. It's still not enough, though. Now doctors are faced with the fact that reimbursements for their services are likely to be cut up to 20% in the next few years. This, along with the endlessly changing and massively irritating logistical paperwork nightmare that dealing with the government entails will likely drive most of us out of the Medicare business. Not exactly a great success story by any measurement.

Medicaid. The joint Federal-State program to cover the medically indigent has forever been plagued by problems. It's not just that you get to multiply the problems of dealing with one government agency by 2. They've traditionally been slow to pay doctors, lousy in quality, and lax on regulations. Once again, not much in the way of inspiring confidence.

The V.A. system. Like socialized medicine? Why? Have you seen it in action? If not, try checking out a VA hospital. Every move is regulated - limited medicine choices, waiting lists...all the things that make it the opposite of what most of us have come to expect from our health care.

So which of these models makes government think that it is equipped to handle care for all of us? I suggest that they try to make even one of these things decent before expanding their failure to the masses. In the same way that I can't afford or even deal with the responsibility of having a bigger house, the government has shown conclusively that it is not ready for more right now.

Thursday, March 5, 2009

Don't Be That Guy

I'm a doctor. That means different things to different people. A few view me with a kind of respect that is almost uncomfortable. Others view me with skepticism, even mistrust. Still others view me with a bit of disdain. Then there are those who are indifferent. The indifferent people form the vast majority of my patients and acquaintances. The indifferent have varying views on what my job and my life is about.

An increasing number of them think of me as a skilled laborer - like a mechanic or a cabinetmaker. This is really fine with me, because this is probably the closest to how I view myself. You see, I didn't grow up with a lot of money or anything. I was a pretty normal kid from a small town who found himself becoming a doctor because he had a talent for it. It wasn't my life's ambition like it is for a lot of people. It's just my job. It's how I pay my bills and how I hope to be able to save for my retirement and send my kid or kids to college someday.

I like my job. I get to meet a lot of people, and help them through difficult times. I take pride in being as good at it as I can possibly be. It's important to me. I try really hard to be timely, courteous, competent, and fair. I take pride in the results of my work. When I sew up a cut, or cast a broken arm, or help someone get their blood pressure down or diabetes under control, I view it with the same sense of satisfaction that a carpenter or brickmason might feel after finishing a demanding job. It's rewarding.

I tell you all this biographical information to get to a point, I promise. I had an interesting conversation with a colleague the other day. He invited me to do a little experiment. He suggested that I ask people what they think I make for performing my job. He promised I'd be surprised. I was. Guess what people think I, a lowly general practitioner, make in a year. One million dollars.

I guess it is that belief that leads people to be so indifferent to the economics of being a professional. I won't waste your time telling you that I don't make one million dollars each year. I don't, of course, but I won't go that route. Let me just put it this way. Imagine what you make in a year. Now divide that in half, because that is what the government takes from me each year - half. Got that new number in mind? Okay, now divide that half in half. That's what is left after I pay for licenses, fees, college and medical school loan payments and malpractice insurance just so I can do my job.

Could you live on 1/4 of your annual salary? Could you send your kid or kids to college? Could you take vacations? I'm just asking. If I actually made $1 million each year, that would leave me with a very respectable $250,000 each year. Sadly, I don't make anywhere near $1 million a year. I don't even make $250,000 a year. No, I am struggling, just like many of you. I live in a nice but modest 3 bedroom house and struggle to pay the mortgage just like you. We are waiting to have more children because we can't afford to right now - maybe just like you. I have too much credit card debt, just like you. I'm more like you than you probably realize.

I understand the way people feel about the fabulously wealthy. Sometimes I feel that way myself. I am sickened, just like you, by the greed of those at the top of big corporations who take bail-out money and go to an exclusive spa. That's why it is almost funny to me that my government puts me in the same category as those people. If Bill Gates is taxed at a 50% or 60% rate, he would be understandably upset. If that happens to us, we'll be devastated.

What upsets me the most, though, is that my own fellow citizens are okay with that. They are fine with taking from the "rich" and giving to others. It's all so anonymous. I'm sure most people would recoil in horror if they had to come and ask me personally for half of my paycheck. They would probably be offended if they were accused of stealing half of my paycheck. But know this. Just because someone in Washington steals it and gives it to you with your approval doesn't make it right. If you are in support of taking half of my paycheck by proxy then you aren't just a thief. You are a coward.

So don't be the person that hates "the rich". The one you are stealing from is me, my wife, and my son. When a politician tells you that you have a right to send your child to college for free, know that you are getting that because I am being deprived of sending my child to college at all. When you get your mortgage paid for, it is because I can no longer pay my mortgage.

Oh, sure. Some of the money paying for your new unearned wealth will be coming from the pockets of the people you hate at the top of those corporations - from people with names like Vanderbilt and Rockefeller. But the vast majority of the people who will be suffering to give you a quality of life you haven't earned are just like me. And surprisingly, just like you.

Thieves and Cowards

Congress has done it again. No, not anything all that earth-shaking. They just passed an Omnibus spending bill. No big deal. Well, except for the timing. This time, we're paying attention.

We in Alabama are paying attention to the fact that the bill contains $20 million for some sort of R&D park at the University of Alabama (Senator Richard Shelby's alma mater), several million more for some kind of silliness at Auburn University, $250,000 for "catfish research" get the idea.

The same government that warns that we're bankrupt - so bankrupt that they may just have to spend us into oblivion - still has money for pork, thankfully.

You know what would make me feel just a little bit better? Better about the fact that my own government is about to seize most of my assets so they can buy votes from lazy, unproductive people? Better about the fact that they are about to make doctors government employees and destroy my means of making a living? What would make me feel just a tiny bit better would be for just one of those lying thieves inside the beltway to just pay lip service to a crazy idea - that maybe, just maybe, we should cut a little bit of the ridiculous crap they are spending money on.

Take notice, Washington. I heard you loud and clear when you told me that my kid won't be able to go to college because you are going to tax the hell out of me to send the kids of inner-city crack mothers to Harvard. I heard you when you promised to "reform health care" (translation - ruin it). But now hear me. I am watching. Lots of us are. And we will not forget, Senator Shelby, how you stewarded our money during this "crisis". You may not believe this, but there really is someone with a brain on this end of the money cycle.

Stand by for hell, boys and girls. They may create it in Washington, but we must stand prepared to give a little of our own. Al Quaeda just moved to #2 on the list of biggest threats to Liberty. Congratulations, Washington. At least you are #1 at something.

Sunday, March 1, 2009

What Did You Expect?

If it weren't so sad, it would be almost humorous. More and more I'm starting to see the voices of disappointment. People who were all to happy to jump on board the Obama bandwagon during the campaign are beginning to wake up with a sort of hangover. Waking up only now to the realization that the guy with socialist friends, socialist ideas, socialist plans is...*gasp*...a Socialist.

His solution to the loss of jobs? Raise taxes on the people that provide those jobs. What are they to do? Lay people off, of course. They'd be idiots not to. His so-called solution to job loss is to cause more job loss.

His solution to the drop in industrial productivity? Institute a "cap-and-trade" policy on carbon emissions so that industry can't compete as well in a global marketplace. Nice. Industry has no choice but to cut productivity even further. This means still more job loss, of course.

His solution to the health care crisis? Cut medicare reimbursements. What will this do? It will force vast numbers of physicians to stop accepting Medicare patients, because it costs more to see them than it is worth. What then? Force doctors to see them? Of course. This will, of course, hit primary care providers the hardest, as we operate on the thinnest margins. Faced with staying in a profession that enslaves them by forcing them to see people at a loss, even more of us will be forced to abandon our practices. When we close our doors, this will mean even more job loss.

Are you poor? Now you have a President who supports the same old tired enslaving welfare state that keeps you poor and destroys your hope of something better.

Are you "middle-class"? Now you have a President who will do everything in his power to make you stay where you are, or worse, whose policies will cause the loss of your job.

Are you a factory worker? Your industry will be hobbled by cap-and-trade. Hours will have to be cut. Jobs will have to be cut.

Are you an entrepeneur? A professional? Hang on. Obama promises to punish you for your hard work and productivity.

So what did you who supported him expect? He told you what he wanted to do. Now we will all have to deal with your decision. If I were you, I would probably think about removing those bumper stickers. More and more people will be looking for someone to blame for where we're going.

Don't say we didn't try to warn you.