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Reflections on a Medical Career Robert S. Dotson, M.D.

By       Message Paul Craig Roberts     Permalink
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The ascension of son Bush and his neoconservative cabal turned the government to the drive toward world hegemony. The serendipitous events of 9/11 opened the door for passage of the neocon's PATRIOT Act and for the still on-going implementation of their Project for the New American Century (PNAC). New alphabet agencies like DHS and TSA were created to augment existing departments and agencies (FDA, DHHS, IRS, FTC, FCC, EPA, FEMA, DEA, BATF, FBI, NSA, CIA, and DOD) charged with dominating the nation and the planet beyond. Orwell's dystopia, 1984, became reality: "War is Peace. Freedom is Slavery, Ignorance is Strength." President Bush modeled Big Brother's third slogan for an admiring populace more concerned with Harry Potter and Janet Jackson's nipple than with the deadly machinations of the psychopath in charge.

It seems likely that steps toward the Third World War were taken during Bush II's reign with "war, war, WAR" being unconstitutionally declared against the nebulous (some might say, non-existent) terrorists lurking under every bed and in every closet, cave, and country on the planet. In spite of a premature proclamation of "Mission Accomplished" from a flag-festooned carrier in 2003 by the Decider-In-Chief, the killings have continued with little pause up to this day. The Great Decider used the opportunity of "victory" abroad, however, to turn his attention to the health-care needs of his subjects.

What could be a better bone to throw to the peasants than the expansion of pharmaceutical coverage for those under Medicare? And, what could be a better pay-off for corporate buddies than massive new government wealth transfers of taxpayers' dollars to Big Pharma via such a plan? It was a perfect "win-win" for the oligarchs at the top of the pyramid and a "lose-lose" for the peons at the bottom. To the great joy of Big Pharma, the Medicare Prescription Drug, Improvement and Modernization Act (Medicare, Part D) was launched in 2003 to insure unimaginable profits for its corporate members and more expense for the common people it was alleged to help. As in any casino, our healthcare croupiers are well trained to leave no dollar on the table.

President Obama, a corporate stooge par excellence, was able to ram through "universal healthcare" with the help of a Howdy Doody smile, his corporate sponsors, and the slavish devotion of an ever-delusional, pseudo-Left. It mattered not that the legislation was written by the insurance companies who had been profiting from the misery of patients for decades.

It is no accident -- and would be comical, if it were not so serious -- that there will be no true, equitable national health care system under the Patient Protection and Affordable Care Act of 2010 (aka, "Romneycare II" or "Obamacare" or, lately, "Robertscare" in homage to a Supreme Court judge) and its accompanying legislation, the Health Care and Education Reconciliation Act. No Single Payer. No mutual insurance system that provides a basic level of healthcare for the proles of this collapsing Security State. Instead, we are witnessing the imposition of a system that will further enslave and impoverish the peasants here in Gulag Amerika. How poetic that a self-identifying "black man" is the front for resurrecting a 21st century version of chattel slavery in the twilight years of Empire.

Obama was positively beaming in his many photo-ops with the sponsoring corporatist representatives of Corporate Medicine, Big Insurance, Big Pharma, and Big Government who enabled the Prince of Change to achieve this milestone deception of America. The very fact that this "wonderful" new system -- lauded by supporters as "revolutionary" -- is to be enforced by a projected army of 16,500 new IRS agents should give us pause.

Notwithstanding passage of the legislation, decades of bad healthcare policy and corporatist plunder are finally taking their toll. The collapse of the ill-conceived US health care system might be near.

Ever more intrusive regulations are driving up the cost of medical care, and the practice of medicine is being criminalized. Even with all of their flaws, Medicare and Medicaid have provided a safety net for the elderly and disadvantaged since their inception. Those systems' days are numbered, however, as they are being gutted to turn health care into profits not for doctors and hospitals but for insurance companies and Big Pharma. For starters, large sums have been ear-marked to be taken from Medicare and Medicaid to help fund PPACA (Patient Protection and Affordable Care Act). Is looting Social Security and Medicare "change one can believe in"?

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If this system is bad for patients, what does it mean for doctors? It means falling reimbursement rates and rising overhead costs for providers, onerous government mandates and regulations, and institutionalized, legalized larceny by Big Pharma, Big Insurance and Corporate Medicine. As an example of how time and circumstance have affected my own profession of ophthalmology, one need only look at Medicare approved reimbursement rates for cataract surgery.

In reflecting back over my many years in the field of ophthalmology (as of this writing, I am 63 years old and feeling pretty shop-worn), I am staggered by the changes that have occurred. When I opened my practice in 1982, Medicare approved surgical fees for cataract and implant surgery were near $1,200. By 2012, that approved charge had dropped to about $570 in Tennessee. (There is some variance within states based on rural versus metro areas and between states where some are declared to have higher costs of doing business.)

Additionally, the US dollar has declined in value an average of almost 2.5% per year over the past 30-year period. Needless to say, overhead operating costs -- salary, rent, insurance, personnel costs, taxes, and normal business expenses -- have exploded during this same 30-year period. My office rent was raised 20% in the Fall of 2011, for instance.

To further illustrate the absurdity of the situation, it is worth recounting an anecdote. Several years ago, a patient excitedly told me of the vision restoring cataract surgery that her poodle had received at the local veterinary college. It "only cost $2,600 for both eyes!" At the time, Medicare was paying about $1,400 for two eyes in a human -- including work up, surgical fee, post-op care for 90 days, and the very real liability associated with being a physician in a litigious society.

I do not begrudge my animal doctor friends their success, but surely the worth of human care should at least approximate that for a poodle. Although I know veterinarians who are struggling in their own practices due to the economic recession, at least they do not have to deal with government fee-setting and the liability and costs associated with treating humans. They are able to price their services sufficiently to keep their practices open and to provide for their own health care and retirement.

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In my own practice, the amount of "write off" on charges for legitimate services rendered began to climb as we entered the 21st Century. For years, the "disallowed" charges by Medicare and private insurers resulted in "discounts" of 20-25%. As the economic upheaval of 2008 rolled around, those fee adjustments (actually theft of labor from providers) began to climb -- 30%, 32%, 35%, and in my last year of practice over 60%! For years, I had been able to subsidize my Medicare (cataract) side of the practice by offering elective refractive surgery procedures (LASIK, PRK, etc.) to my patients. As these were private pay cases, they offset the draconian cuts in Medicare and insurance fee "adjustments." The economic collapse of 2008, however, reduced that income stream for many ophthalmologists and, subsequently, led to the closing of many practices throughout the country.

Most general ophthalmologists are, by definition, primarily cataract surgeons. Many people -- including Medicare recipients -- do not realize that the fees paid to their physician are fixed by the U.S. Government after consultation with its many corporate sponsors within Big Insurance, Big Pharma, and Corporate Medicine. Patients also do not realize that those reimbursement levels are set by central planners at below-cost levels.

Medicare issues cut across all specialties, and ophthalmology has not been alone in experiencing cutbacks. Primary care physicians have increasingly become "piece good workers" -- managed by corporate pencil pushers to see a patient every 6-8 minutes while being forced to carry all the liability and manage all the data and coding previously done by insurers. Who can diagnose, much less treat a patient in 6-8 minutes?

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http://www.paulcraigroberts.org/

Dr. Roberts was Assistant Secretary of the US Treasury for Economic Policy in the Reagan Administration. He was associate editor and columnist with the Wall Street Journal, columnist for Business Week and the Scripps Howard News Service. He is a contributing editor to Gerald Celente's Trends Journal. He has had numerous university appointments. His books, The Failure of Laissez Faire Capitalism and Economic Dissolution of the West is available (more...)
 

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